Research has consistently documented black-white differences in rates of voluntary psychiatric treatment that cannot be reduced entirely to differences in either need or access. A variety of explanations have been offered for the gap that remains, but the empirical testing of alternative propositions has thus far been minimal. Using the 1998 General Social Survey's Pressing Issues in Health and Medical Care module (n = 1,387), I find consistent and substantial black-white differences in a variety of beliefs about psychiatric medications, one of the most common treatments for mental illness, and the predisposition to use them. Specifically, blacks express less willingness to use psychiatric medications themselves or to administer them to a child for whom they are responsible. Neither socioeconomic status, knowledge, religious involvement, nor trust in medicine appears to explain this reluctance. Rather, it stems almost entirely from blacks' beliefs about psychiatric medications' efficacy and side-effects. The results indicate, first, that researchers should not assume that African Americans will use psychiatric medications at rates similar to whites if offered equal access. Second, the results indicate that blacks' skepticism of psychiatric medications may be rooted in specific beliefs about psychiatric medications, rather than general ideologies about medical practice. Health beliefs about psychiatric treatment, therefore, will continue to play an important role in understanding race differences in the use of psychiatric medications.