Culturally Competent Psychotherapy for African-American Individuals, Couples, and Families
WHAT IS RACIAL TRAUMA?
People of color experience higher rates of PTSD compared to White Americans, and one explanation for this difference is the experience of racism, which can itself be traumatic. When traumatization is due to experiences of racism it is sometimes called racial trauma. Racial trauma can result from major experiences of racism such as workplace discrimination or hate crimes, or it can be the result of an accumulation of many small occurrences, such as everyday discrimination and microaggressions. Due to the current political climate, there has been a recent rise in overt racism and hate crimes.
When black death goes viral, it can trigger PTSD-like trauma
When video of the Baton Rouge shooting death of Alton Sterling first surfaced on July 5, social media networks became immediately populated with Sterling’s final moments. The following day, the shooting death of Philando Castile was streamed live by his girlfriend on Facebook. The video, which shows Castile gasping for air after being shot four times by a Minnesota police officer, has since been shared on Facebook more than 5 million times.
Escaping the imagery can be nearly impossible, especially as online users post commentary and news updates. For some, it can merely be a nuisance. But research suggests that for people of color, frequent exposure to the shootings of black people can have long-term mental health effects. According to Monnica Williams, clinical psychologist and director of the Center for Mental Health Disparities at the University of Louisville, graphic videos (which she calls vicarious trauma) combined with lived experiences of racism, can create severe psychological problems reminiscent of post-traumatic stress syndrome.
“There’s a heightened sense of fear and anxiety when you feel like you can’t trust the people who’ve been put in charge to keep you safe. Instead, you see them killing people who look like you,” she says. “Combined with the everyday instances of racism, like microaggressions and discrimination, that contributes to a sense of alienation and isolation. It’s race-based trauma.”
While research on the psychological impact of racism has only emerged within the last 15 years, Williams says it’s “now starting to get the attention that it deserves” and experts are “seeing very strong, robust and repeated negative impacts of discrimination.”
A 2012 study found that black Americans reported experiencing discrimination at significantly higher rates than any other ethnic minority. The study, which surveyed thousands of African-Americans, Hispanics and Asian-Americans, also found that blacks who perceived discrimination the most, were more likely to report symptoms of PTSD. Although African-Americans have a lower risk for many anxiety disorders, the study reported a PTSD prevalence rate of 9.1 percent in blacks, compared to 6.8 percent in whites, 5.9 percent in Hispanics, and 1.8 percent in Asians.
Social media and viral videos can worsen the effects. During the week of Sterling’s and Castile’s deaths, a scroll through timelines of black social media users could uncover subtle expressions of mental and psychological anguish, from pleas for others not the share these videos, to declarations of a social media hiatus. Williams says that’s not unusual. These expressions of anger, sadness and grief can hint at something much more serious.
“It’s upsetting and stressful for people of color to see these events unfolding,” she says. “It can lead to depression, substance abuse and, in some cases, psychosis. Very often, it can contribute to health problems that are already common among African-Americans such as high blood pressure.”
According to April Reign, “it is a dehumanization of black people, and we don’t see that with any other race. It’s ingrained in us from our history,” she says. “White people used to have picnics at hangings and at lynchings, bringing their children to watch black bodies suffer and die. We are not far removed from that, it’s just being played out through technology now. And it hurts.”
Dr. Williams says that history of racism, passed down through generations of storytelling, can become crippling when combined with personal experiences, including daily microaggressions — subtle, racially-insensitive comments or acts such as a person of color being followed in a store, or having their name mocked or mispronounced by peers.
Research Shows Entire African-American Communities Suffer Trauma After Police Shootings
Research results indicate that police killings of unarmed Black Americans are having a population-level impact on the mental health of Black Americans.
According to researchers, these incidents may contribute to 1.7 additional poor mental health days per person every year, or 55 million more poor mental health days every year among Black Americans across the United States. That means the mental health burden for African Americans caused by police killings of unarmed Black victims is nearly as great as the mental health burden associated with diabetes. African Americans have some of the highest rates of the disease, which contributes annually to 75 million days of poor mental health among them.
African Americans make up 13 percent of the U.S. population but they accounted for 26 percent of people fatally shot by police in 2015 and 2016. While the death of a loved one can be tragic for the family and community of any police-shooting victim regardless of race, the study reveals that there is a deeper trauma for African Americans, related to the victim or not.
“#IfIDieInPoliceCustody Know that the color of my skin was the only crime committed,” a woman tweeted in 2015, three days after Sandra Bland was found dead in her Texas jail cell.
“Nothing will happen to the Police in the Freddie Gray case . . . ” a man tweeted three days after the death of a 25-year-old Baltimore man whose fatal spinal injury while in police custody in 2015 triggered protests throughout the nation.
These sentiments — perception of a systemic unfairness and a loss of faith in institutions — are common among black people in the days and months following police killings of unarmed African Americans, according to a study published last month in the medical journal the Lancet.
The paper said the decline in black mental health was seen in all black Americans, regardless of whether there was a relationship with the victim, and can manifest itself in a variety of ways, including “reactions of anger, activation of prior traumas and communal bereavement.”
“Structural racism experienced vicariously can be very consequential for [black] mental health,” said Venkataramani, who is a professor at the University of Pennsylvania’s Perelman School of Medicine. “We are not telling people in the black American community something they do not already know.”
A Clinicial Perspective of Racial Trauma for therapists...
Racial trauma may merit a DSM-5 diagnosis of PTSD when there is an identifiable index trauma (Criterion A), re-experiencing of the trauma (Criterion B), avoiding trauma reminders (Criterion C), negative mood and thoughts (Criterion D), and hyperarousal (Criterion E). However, all symptoms of PTSD may be present due to racial trauma, even if a Criterion A event cannot be identified. The DSM-5 limits what is defined as a traumatic experience to direct exposure to physical and sexual violence, repeated exposure to traumatic information in a work setting, and indirect exposure by way of receiving news of a traumatic event involving a close friend or loved one. This may preclude a PTSD diagnosis, even if all symptoms are present. However, if the nature of the trauma does not meet DSM-5 criteria, PTSD may still be diagnosed based the ICD-10 criteria (International Classification of Diseases), because it does not explicitly restrict the types of traumas that may result in a diagnosis of PTSD.
Sometimes bona fide Criterion A events are missed by mental health service providers because they are unaware of the impact of discrimination, fail to recognize experiences of racism as traumatic, or fail to inquire about experiences of racism at all. For example, being bullied at school for “looking different,” racial profiling by police, and workplace racial harassment can all be DSM-5 Criterion A events, but are these rarely included in conventional checklists and batteries for trauma (Malcoun, Williams, & Bahojb-Nouri, 2015).
Examples of Race-Related Traumas That May Meet DSM-5 Criteria for PTSD
Below are some common racial trauma, followed by examples of Criterion A events that could merit A DSM-5 Diagnosis of PTSD (Williams, Printz, Ching, & Wetterneck, 2018):
- Overt racial slurs and threats made by anyone: Perpetrator threatens the victim with assault or death using a racial/ethnic epithet.
- Police harassment, body searches, and assaults: Law enforcement officers assault the victim of color physically, issue threats, or search the victim’s body for evidence of a crime (e.g., weapons, drugs).
- Workplace discrimination: Coworkers express racially motivated threats or carry out physical assaults against the targeted individual in the workplace.
- Community violence: Victim witnessed gang violence or was afraid for his/her life/personal safety or that of family members.
- Distressing medical experiences: Victim of color has persistent fear for life of self/loved ones due to medical mistreatment.
- Incarceration: Victim of color was physically or sexually assaulted while in prison.
- Immigration difficulties: Victim of color experienced physical/sexual assault or robbery or feared for life of self/loved ones during the immigration process.
- Deportation: Children of undocumented immigrants witness violent confrontation, abduction of, and separation from parents by law enforcement.
Source: Monnica T Williams Ph.D. Psychology Today: Uncovering the Trauma of Racism: New Tools for Clinicians Posted Jan 19, 2019