Culturally Competent Psychotherapy for African-American Individuals, Couples, and Families
Impact of Racism on African-American Mental Health
Impact of Racism on African-American Mental Health
Although the Civil Rights Act of 1964 outlawed discrimination in employment and banned race-based segregation, racism still looms large in 21st-century America. Moreover,
within the African-American community, we generally acknowledge and discuss experiences of racism and the detrimental impact of racism on equitable access to resources (including education, housing, health care, etc.). However, we less frequently discuss the detrimental impact racism often has on our mental health.
Racism is a serious, prevalent issue in the US, and there is a link between racism and anxiety, stress, and other mental and physical health problems. Nationally representative polls and surveys have indicated that the overwhelming majority of Black Americans:
- Believe that Blacks experience racism in the United States (88%)1
- Characterize racism as a "very serious" or "serious" problem (87%)2
- See racism as being "widespread" in the United States (78%)3
Racism can take on many forms including racial macroaggreesions, which are described as more overt racist experiences including being called a racial or ethnic slur, being physically assaulted due to race, or being denied fair wages due to race.
Racial microaggressions are described as subtle, intentional or unintentional slights that denigrate or degrade individuals of color due to race. Examples of microaggressions include assumptions of inferiority or criminality due to race, not having people who look like us represented in work, educational, or governmental contexts, being told that we "talk about race/racism too much," and assumptions of sameness due to race. In addition, racism can be experienced on the structural/institutional level (e.g., voter disenfranchisement) and on the individual level (e.g., a boss being surprised that you are intelligent or articulate).
About one in four Black Americans will experience an anxiety disorder at some point. Social anxiety disorder is the most common anxiety disorder, with a lifetime prevalence of 10.8% among Blacks, followed by generalized anxiety disorder (5.1%), panic disorder (3.1%), and obsessive-compulsive disorder (3%)4 In addition, anxiety is more persistent (i.e, symptoms last longer) in Black Americans as compared to the general population. However, Black Americans seek mental health treatment considerably less often and/or dropout of mental health treatment before the recommended dose of therapy more often compared to the general population.
Understanding the Link Between Racism and Anxiety
In addition to experiencing racism at all levels frequently, we know that these experiences have significant negative effects on both physical and mental health outcomes for Black Americans. Some researchers have suggested that chronic experiences of racism and microaggressions result in "racial battle fatigue," which includes anxiety and worry, hyper-vigilance, headaches, increased heart rate and blood pressure, and other physical and psychological symptoms.
While the negative impact of racism on mental health is pervasive and far-reaching, these studies suggest a link between racism and symptoms associated with anxiety.
There are three specific ways we think experiences of racism negatively impact stress and anxiety for Black Americans:
- Perceptions of lack of control
- Avoidance of valued action
Perceptions of Control
An individual's perception of control over life contexts, safety, and environment is directly linked to stress and anxiety. We are not responsible for our experiences of racism, and we have very little, if any, control over whether or not we experience racism. So, in the context of racism, racist experiences can elicit an understandable perception of lack of control of one's environment, therefore contributing to the development and maintenance of stress and anxiety.
Specifically, as Black Americans we might work hard to provide for ourselves, our families, live in accordance with our own values and societal expectations and expect to receive equitable treatment, dignity, and respect in response to this hard work. This attempt at controlling one's environment through hard work and acting in line with society's expectations has been described as "John Henryism". Theorists have described John Henryism as the value of hard work and determination in the face of extreme and overwhelming odds (i.e., racism and oppression; James et al., 1983).
Despite hard work, determination, and perseverance, the perception that we cannot control our own safety and environmental contexts is initiated and maintained by the frequency of racist experiences. Specifically, the expectation that hard work, determination and living according to society's rules will lead to fair treatment is continually shattered by experiences of racism.
Encountering frequent experiences of racial discrimination can create a feeling of not being valued or being viewed as a person of little or no worth for both Black men and women. This sense of invisibility can contribute to our feelings and beliefs, as Black Americans, that we cannot control whether our talents, abilities, character, and right to safety are acknowledged by others in society. This experience is conceptualized as the invisibility syndrome.
Experiences of racism have also been associated with internalized racism and negative self-evaluations, which may also contribute to the development and maintenance of stress and anxiety for Black Americans. While not all Black Americans experience internalized racism, Williams and Williams-Morris (2000) assert that Black individuals may internalize beliefs of racial inferiority communicated by the majority about us, otherwise known as internalized racism. Internalized racism is defined as the conscious or unconscious acceptance, by the marginalized group, of negative and critical beliefs about one's worth.
This can manifest in different ways, but one example is the belief that having lighter skin or softer hair is more beautiful and has more value than darker skin complexions and coarser hair textures. Many studies have found internalized racism to be linked to poor self-esteem and higher levels of psychological distress. In addition, we know through research and clinical presentations that critical beliefs about oneself and negative self-focused thoughts are associated with the development and maintenance of anxiety symptoms. This points to the significant impact of the negative and pervasive messages about the worth of Black Americans in our society that we see from the media, see reflected in political figures, and see in the low indictment and conviction rates for police violence against Black Americans. Furthermore, the internalization of these negative beliefs can create feelings of helplessness, worthlessness, sadness, fear, and shame.
Avoidance of Valued Action
Finally, experiences of racism might contribute to stress and anxiety for Black Americans through avoidance of the things that are most meaningful in our lives. Wilson and Murrell (2004) describe the ways that both avoidance of our emotions and avoidance of meaningful contexts contribute to the maintenance of stress and anxiety. Specifically, we are taught that positive emotions are good and that negative emotions are bad. For instance, a little boy who cries because he gets knocked over at football practice is called a baby. An adult who is passed up for a job opportunity is told to not take it personally or to get over it.
The underlying assumption is that we must suppress, get rid of, or replace negative emotions with confidence, self-esteem, or optimism in order to move through our lives and do the things that are personally meaningful. However, an abundance of literature documents the paradoxical effects of attempts to control our emotional experiences, highlighting that avoidant coping such as pushing our feelings aside or pretending that experiences of racism do not hurt or negatively affect us, predicts poorer long-term mental health outcomes.
The things that matter to us, our values, become limited when the focus is solely on attempts to avoid distressing emotions. Moreover, negative life events (e.g., racism) can create rigid and inflexible ways of responding that limit our ability to engage in the things that are meaningful to us. For instance, an individual who experiences social anxiety may begin to avoid places where she will interact with others because she does not want to experience anxiety. However, her avoidance of places where she might interact with others is in direct contrast to her value of making social connections with others and finding a life partner.
In the context of racism, frequent experiences of discrimination have been associated with symptoms of anxiety including elevated heart rate and blood pressure, critical and negative self-focused thoughts, and worry. The overwhelming nature of these symptoms can lead to an over-identification or entanglement with these painful emotions, thoughts, and feelings. In order to manage the overwhelming emotional responses that arise in the face of racism, we may attempt to suppress these negative emotions and avoid people and places where racism related events may occur (e.g., certain stores or parts of town).
At face level, avoidance of situations where racism may occur seems adaptive (and safe); however, experiences of racism can occur at any time or place and this type of avoidance can contribute to avoidance of the things that are most meaningful to us or engaging in meaningful actions consistent with our values (e.g., deserving of equal respect at stores and in all parts of town or our rights to equal access to education, healthcare, and employment). For instance, experiencing racism at school, work, or in social environments may be barriers to engaging in meaningful or valued action including education, career goals, and making social connections. Furthermore, research suggests that lack of engagement in valued actions is associated with stress and contributes to the maintenance of anxiety symptomology.
As Black Americans there are a number of barriers to engaging in the things that are meaningful to us including experiencing racism in many contexts within our daily experiences. It is understandable and important to acknowledge that it is natural for us to want to avoid this pain. And, the avoidance of this pain can sometimes lead us down a path of avoiding things that are important and meaningful to us, which leads to more distress.
How to Cope
One potentially effective strategy for responding to experiences of racism and for combating racism's effects on anxiety symptoms is the role of attending to and making choices based on our values (i.e., the things that are meaningful and matter to an individual;. When individuals are able to identify and understand their values, they can be more aware of what matters to them during stressful moments, make choices consistent with their values, and act upon these choices.
For example, during a stressful encounter, it is extremely difficult for individuals to remember that they have choices in their lives and that they can experience empowerment in the face of restricted, judgmental thoughts such as, "I have no choice but to just allow my boss to say racist things to me because I will lose my job" or "I should be able to handle myself and not feel upset when my advisor doubts my abilities." For Black Americans, in particular, reconnecting to values can be empowering such that making choices can feel natural, even in the face of racism.
For example, the individual who experiences distress from his boss' racist jokes, may choose to reconnect to his value of respect and may decide to approach his boss about the racist comments because simply accepting these comments would be living a life inconsistent with who he is and what he stands for. A Black woman who perceives that she is being treated unfairly in school by her advisor because she is Black may be able to reconnect with what is meaningful to her about being a student and make a decision to continue to engage in her value of pursuing her education in the face of this discrimination. She may decide to report this to the dean and/or seek out a more helpful advisor, which is consistent with her value of pursuing education. She may also decide that social connectedness in the midst of discrimination is an important value and begin to develop safe spaces with colleagues or other students to garner social support and process these experiences. Her decision of acting in line with her values despite these painful and unjust experiences may buffer some of the stress associated with racism.
Attending to our emotions
Attending to our emotions, as opposed to avoiding or attempting to push these emotions away, can be described as acceptance. For us, acceptance denotes an accepting relationship with our emotional reactions to experiences of racism and does not at all suggest an acceptance of the existence of racism or racist experiences. The cultivation of an accepting relationship to, and a present moment awareness of, the overwhelming and distressing emotional responses that arise in the face of racism, may lessen the intensity of our anxiety.
For instance, we know that consistently attempting to control or suppress emotions paradoxically heightens the intensity of our emotional experiences. We might begin to think about more flexibility in our coping strategies and, at times, be willing to acknowledge and discuss the deep, emotional intensity that we may experience in the face of racism. For example, as Black Americans, we may wonder how one can be strong and resilient, while acknowledging our emotions and turning towards these emotional experiences. It is important to acknowledge that controlling our emotional responses to racism can be effective and has been one of the very strategies that has contributed to our strength in many contexts.
We are suggesting that it is also important to acknowledge that emotions provide important information and are crucial to helping us navigate the world, especially a world in which we have frequent experiences of racism. Emotions can tell us several things about our experiences, in particular, they communicate to us when we are in a threatening or dangerous situation (e.g., signaling fear or anxiety), when our needs are not being met (e.g., through feelings and expressions of anger), or through sadness, which indicates that we are losing something that is important or valuable to us.
Experiences of racism can elicit any and all of these emotional experiences, sometimes at the same time. There is a way that experiences of racism can threaten an individual's safety, can be barriers to accessing resources (e.g., employment, healthcare, education, respect/validation), and can deplete an individual's sense of self-worth and value. While it is natural to want to turn away from these emotional experiences, emotions provide us with important information that, when clear, can help us respond in a meaningful way to these experiences of racism. One specific example can be found in the Black Lives Matter movement. In part, this movement arose as a meaningful response to the fear, anxiety, sadness, and anger felt by many Black Americans in the wake of the multitude of unarmed Black men killed by law enforcement officers.
As previously discussed, emotions provide us with important information and help us adapt to the life challenges that racism may elicit. However, cultural and societal norms often tell us that feeling anxiety, sadness, or anger are signs of weakness or evidence of having lack of self-control. In fact, as Black individuals who experience racism and emotional reactions to racism, we are often told that we are "overreacting" or "hypersensitive" which perpetuates the self-perception of emotion as weakness or as being out of control.
Specifically, when we experience emotional reactions in the face of racism, we can deliberately practice being compassionate with ourselves and recognizing that the anxiety, anger, sadness, etc. that arises is an understandable reaction during and in the wake of these painful experiences. Self-compassion is described as the appreciation of our emotional responses to racism as being understandable, natural, and part of our human experience. The work here is cultivating awareness of our tendency to judge our emotional reactions in response to racism and bringing self-compassion to both the emotional experiences and the judgment or self- criticism that may also arise.
For example, in the face of a racist experience, a Black woman can acknowledge that she is angry and appreciate that this anger is a natural and understandable response to an unjust situation rather than viewing her emotional response as being unreasonable or something to "get over".