Racism and Trauma

In Searching for Normal in the Wake of the Liberian War, Abramowitz emphasizes the presence of trauma as it exists in the larger context of war conflict.  Her exploration of trauma is unique because, by focusing on war conflict, she talks of a disturbance that is inherently discrete in its timeframe–in the case of the Liberian Civil war, approximately a decade.  But, what happens when that phenomenon of rupture is spread over a longer breadth of time, perhaps centuries?  Is trauma as Abramowitz defined it applicable to long internalized conflicts, such as racial conflict?

Abramowitz defines trauma as “what happens when pervasive violence and vulnerability lead to profound experiences of rupture.”  This indicates that trauma can be triggered by physical and nonphysical impetus and by first hand or indirect manners.  Monica Williams in the NPR article argues that it is this vicarious nature of trauma that allows us to understand racial conflict as a harbinger of trauma.  Speaking as an expert in mental health disparities, Williams says, “We hear in the news about African-Americans being shot in a church, and this brings up all sorts of other things and experiences.  Maybe that specific thing has never happened to us. But…we know people in our community, and their stories have been passed down. So we have this whole cultural knowledge…[that] sort of primes us for this type of traumatization.”  From William’s work, we can extrapolate that the recent media focus on black brutality must be having significant, collective effects on the mental health of the African American populace.  Moreover, second-hand traumatization, such as the overwhelming presence of police officers in the predominately black community of Ferguson after the Michael Brown shooting, can only exacerbate vulnerabilities felt by African Americans.

Nevertheless, second-hand trauma is not a recent experience for African Americans.  Despite contemporary media attention to the phenomenon of black inequality, social disparity has long been the narrative of Africans in America ever since the establishment of the slavery enterprise in the late 17th century.  Over centuries, social hierarchy based on race has been so ingrained in the U.S. that it has become the exemplar of social reality (see Smedley and Smedley).  Therefore, not only is society trained to exhibit certain behaviors to African Americans, but also African Americans naturally internalize and reflect such socially-engineered prejudices. Carl Bell, the former CEO of the Community Mental Health Council in Chicago, suggests that as a result of this institutionalized racism, African Americans must endure speckles of microaggression during their day to day lives.  Overtime, these microaggressions build and build and essentially pull away the individual from his place in society.  As the social fabric ruptures, racism as a whole has an individual & very personal traumatic effect on the African American.

The difficulty with attributing the racism experience to traumatization (as proposed in the NY Times article and the NPR article) ) is that the event of “violence and vulnerability” is not always immediate or readily apparent.  For instance, in chapter 3 of her book, Abramowitz cites Suah, the Liberian director of an international NGO.  Suah claims that the Liberians present in the country during the war were physically marked by trauma.  On the other hand, those who were removed from the incident, such as refugees and Liberians living outside the country during the war, looked significantly “younger, healthier, happier, and fatter.”  This essentially begs the question: where is the empirical proof that racial conflict can cause trauma, especially when experienced second-hand?  Moreover, how can racism, which is often exhibited in contemporary society as underlying rather than overt, be linked to mental health of African Americans with certainty?  The fact is that connecting racism to trauma is difficult especially with the dearth of research.  Perhaps the even bigger worry is whether we need to understand the trauma in its larger context to treat the trauma.

Outside Sources

Corley, Cheryl. “Coping While Black: A Season Of Traumatic News Takes A Psychological Toll.” NPR. NPR, 02 July 2015. Web. <http://www.npr.org/sections/codeswitch/2015/07/02/419462959/coping-while-black-a-season-of-traumatic-news-takes-a-psychological-toll>.

Hu, Elise. “The Psychological Effects of Seeing Police Everywhere In Ferguson.” NPR. NPR, 25 Nov. 2014. Web. <http://www.npr.org/sections/thetwo-way/2014/11/25/366611989/the-psychic-effects-of-seeing-police-everywhere-in-ferguson>.

Wortham, Interview Jenna. “Racism’s Psychological Toll.” The New York Times. The New York Times, 23 June 2015. Web. <http://www.nytimes.com/2015/06/24/magazine/racisms-psychological-toll.html>.

Class Readings

Abramowitz, Sharon. 2014. Searching for Normal in the Wake of the Liberian War. Philadelphia: University of Pennsylvania Press. (Ch. 3)

Smedley A. and Smedley, B. 2005. Race as Biology is Fiction, Racism as a Social Problem is Real: Anthropological and Historical Perspectives on the Social Construction of Race. American Psychologist 60(1): 16-26.

Discussion Questions

1.  Does trauma exist within a well-defined “time frame of injury”?

2.  Should/can race-based trauma be recognized by the DSM(Diagnostic and Statistical Manual of Mental Disorders)?

3.  Perhaps for a second we conclude that race-based trauma should be recognized. According to Williams, race-based trauma should be treated pathologically with clinical interventions. Do you agree?  Or is this just analogous to the case of infectious disease in which intervention (i.e. vaccination) does not really change the course of the culprit at hand?

4. Considering the lack of sufficient research on trauma and racial conflict, in what ways can the evidence behind race-based trauma be strengthened?

25 thoughts on “Racism and Trauma”

  1. Yes, I believe that race-based trauma should be treated with clinical interventions. Although we saw in the graphs of infectious disease deaths over time that the vaccinations and other medical interventions did not change their downward trajectory significantly, the vaccinations still saved some lives. Even though the analogy is appropriate with the case of race based trauma (that the way to fix this is to changer the larger problems of racism and medical inequalities related to race), in my opinion it is undeniable that individually-geared race-based trauma therapy can help the individuals participating. This also reminds me of the lecture where we discussed suicide rates remaining constant in Finland. While individual interventions may not change the larger rate of suicide, the individual interventions will make a difference to that single live saved – and I think this is the same manner in which we should look at race-based trauma interventions.
    The first step to having these race-based trauma interventions may be recognizing it by the DSM or somehow having this type of trauma recognized by the general medical community in another way. If we can first diagnose this type of trauma, then we must be able to work towards treating it.

    1. – I believe that there is an extent to how long this time frame exists, but I do not think this time frame can be measured. In class we discussed an appropriate length of time for a person to grieve over a death of a lost child, and the DSM originally stated that a person could feel “normally depressed” for two months after the loss, (which is really still an abnormal feeling if things that once made you happy do not make you happy anymore). So in the more recent years, the DSM concluded that a person is experiencing PTSD immediately after the horrific event takes place. I think the fact that this can be changed demonstrates that there really isn’t one answer to this question, and it truly depends on the individual.
      *I think that race-based trauma should be recognized by the DSM because it is still a psychological anxiety that people face. If people are seeking help because they feel that they need support, then I think an individual has the right to ask for professional assistance. Based on a psychiatrist’s recommendation they can address what further steps need to be taken to treat the patient. There are just so many different types of mental illnesses, and I think that as long as you are experiencing the symptoms of a traumatized victim then you should be recognized by the DSM.
      * I think that race-based trauma should be treated with clinical interventions. I do agree that this is sort of a “chicken-and-the-egg” problem, like in Monique and the Mango Rains and Improvising Medicine, but in this case, I think it is a little different because horrific events are somewhat external conflicts that we cannot control. Unlike medications and vaccines where we can purchase these items, war and vivid memories are much harder to control.
      * This is a good question. I don’t really think there is a way to prevent it unless racial conflicts cease. But maybe there can be a designated psychiatric center where people can go if they need help?

      I thought you brought up some really interesting questions that really made me think! I would not have thought of the approach you took to these readings, but I think it was cool.

      1. Hi Samantha!
        I appreciated your thoughtful response. I agree that determining trauma and its manifestation by a time frame can be difficult to define. Like in the case of depression we discussed in class, DSM is tricky because it requires a defined normality. Especially in highly stigmatized health problems like mental health, I think defining a “normal state of being” runs the risk of defining the individual by the disease and may even divert attention from larger inequalities. In this sense, there are a lot of unanticipated consequences of defining normal. On the other hand, recognition of a disease is tremendous because it can reduce stigma surrounding mental health. People may find it easier to ask for help and more resources (such as the psychiatric centers that you mentioned) can open up. Personally, I find myself torn on this issue, and I think perhaps this one of the reasons why mental health is so hard to treat. I completely agree that, as you said, mental suffering is much harder to control.

    2. Hi Methma,
      Thanks so much for your insight! I agree that recognition of race-based trauma is the first step to making intervention possible. But I wonder how such a deeply institutionalized trauma can be generalized by a diagnosis or by the DSM. Do we risk “medicalizing” a social injustice? I wonder what your thoughts are about how best to get the medical community to recognize race-based trauma.

      1. Hi Nikisha,

        That is an interesting and valid point. Medicalizing this issue runs the risk of ignoring its deeper rooted sources. It also seems like any of the clinical interventions would only be a band-aid to the larger problem, or a magic bullet kind of solution. However, I still believe it is useful to think of this kind of trauma in a medical setting. Perhaps this could be part of the cultural competency training we have discussed. In general, I believe it would take a movement of advocates and health care professionals in order to get this kind of recognition in the DSM.

  2. Today, Professor Mason brought up an interesting and important point regarding the difference between suffering and illness. I think this question relates to your consideration about whether DSM should recognize race-based trauma as a disorder. While acknowledging the validity and the social/biological consequences of race-based trauma/violence is immensely important, I worry that the clinical acknowledgement of race-based trauma by the DSM would, in a way, assume that people of color who experience race-based trauma have a type of agency that they do not necessarily have. As discussed in class, the organizers of the DSM hope to diagnose with the intent of treating those suffering with those disorders. By diagnosing someone with a disorder — by giving this person “knowledge” about what is “abnormal” about him/her — we indicate that the person now has an ability to seek care and fix his/her “problem.” What type of medical care, however, can relieve a struggle that has been in place for centuries?

    By categorizing race-based trauma as a disease/disorder/illness, the DSM might provide an opportunity for society to tokenize people’s identities without being accountable for the experiences and the experiences they bring from our communities. Thus, I wonder how the DSM can reach out to a marginalized group of people whose pain has been largely ignored (by the media) until recently without exploiting them — without imposing what they think would help the situation and without furthering this structural violence.

  3. Nikisha,

    I’d like to respond to your second discussion question (Should/can race-based trauma be recognized by the DSM (Diagnostic and Statistical Manual of Mental Disorders)?). I think it is a great question, and one the prompts questioning into the advantages and disadvantages of mental illness categorization as determined by Western ideology. Firstly, I think that having a designation for race-based trauma in our society would undoubtedly be beneficial for the many marginalized groups who face daily discrimination and incessant microaggressions in our race-based society. Having a designated category in the DSM would allow for clinical interventions of race-based trauma to be covered by insurance, opening the door for many to seek help who would otherwise be unable to pay out of pocket for therapy or counseling (nonetheless, I do agree with the argument that clinical interventions would merely serve to alleviate individual suffering and would not remedy the underlying cause of problem).
    However, with this is mind I think it is also important to recognize that having this designation in the DSM could have consequences due to the global dissemination of the manual. Would this designation be applicable in other contexts around the globe? What possible implications (good or bad) could creating a designation for “race-based trauma” have in other areas of the world? I don’t have answers to these questions, but due to the increasingly global adoption of a Western diagnostic manual I think they are important considerations to take into account.

    1. Hey Sabrina,
      You brought up a really interesting about the globalization of treatment in mental health. I think it ties back to this larger concern of paternalism of global health and the fear that global interventions risk imposing Western values on other countries. Perhaps an alternative to bringing DSM to other countries would be to build up mental health infrastructure within countries. This may include training MHPs and community health workers or building community psychiatric clinics. It would also be pertinent to train foreign health workers in local culture in the form of a cultural exchange between community workers and foreign workers.
      I recently came upon this video about the mental health crisis in India. https://news.vice.com/video/indias-mental-health-crisis It really highlights that global work in mental health is difficult because each international community has social, economic and political factors that constrain and limit treatment of mental health. In India, there is cultural taboo, colonial histories, poor infrastructure, misinformation about mental health, gender norms, etc. that collectively curb progress in mental health interventions. A biosocial approach to this crisis is essential, but how do we prioritize interventions in a culturally sensitive way?

  4. Hello Nikisha,

    I think in regards to the questions about whether race-based trauma should be recognized and the implications it would have if it was, is that if it was treated pathologically with clinical interventions I believe it would make a difference in the life of that individual and maybe extend to hopefully benefit his/her immediate circle of relations. However if this clinical intervention was covered by insurance companies public and private then we would once again be missing a good portion of the individuals who are disenfranchised because of the way the U.S. system works to offer coverage for some but not all. More to the point , I see this being analogous as you pointed out to the vaccines intervention.

    1. Hey Florisel,
      Great point about addressing health systems as whole. It is definitely crucial to provide insurance for mental health interventions. After all, these traumatized individuals are likely dealing with more than one structural violence (such as poverty and reduced employment opportunities) than just racism. Do you think it would more crucial than to address social welfare instead of just health insurance since financial struggles can affect rates of other health ailments too (such as heart disease, infectious disease, etc.)? Is insurance bandaging an injury that already exists?

  5. I agree that race-based trauma exists. I think that you made a good point about the generational effects racial conflict in America has had on African Americans. As we discussed in lecture, the attitude towards Africans in general have led to a lasting “knowledge” that a black person inferior and less human than a white person. This is still rooted in our society and I agree has presented itself in the traumatic events of Ferguson. I think that it is fair to promote clinical intervention among individuals, even though that steps are going to need be taken on a population level to produce effective results at treating trauma beyond the scope of the individual.
    It is important to reduce suffering in any form even if it is only at the individual level. Like in Liberia it is important to implement programs centered on helping people like Valentine who are products of their environment. Societal chaos because of the Liberian War promoted structural violence, and I think implementing clinical interventions is a worthwhile first step in treating trauma. Any moves taken to alleviate pain is valuable.

  6. Hi Nikisha,

    Thank you for your post. I would like to focus on your third question because I believe it brings up very important points. I agree that those suffering from race-based trauma should be able to seek treatment for it. Anyone suffering should be able to receive help. However, I like the point you next bring up about how treating for race-based trauma is analagous with intervention by vaccine. I believe that while this treatment is very important on the individual level, there needs to be much larger intervention on the population level. To truly rid the population of race-based trauma, drastic measures must be taken to rid the population of race-based trauma. So, like the case with vaccines where a real impact was made on the personal level, little to no impact will be made on the population level with this intervention.
    In order to increase knowledge and awareness of this trauma I believe that an anthropological approach would be the most appropriate. By conducting ethnography, individual experiences would be recorded and provide a first hand account of the trauma this population has experienced.

    1. Hey Steven,
      I appreciated your recognition of this interdisciplinary approach to mental health. It is important that not only public health officials join the mental health movement, but also anthropologists. This way the underlying determinants of health can be better addressed by interventionists. I would add to this team of professionals policy makers because they can make foundational changes in the health care system through their bureaucratic power. However, this is more easily said than done. It is difficult to make governmental change in one’s home country let alone in a foreign country. Is there a way global health efforts can change foreign mental health bureaucracies?

  7. Hi everyone,
    I wanted to post an update on my blog post concerning trauma and health. Over the course of the semester, I have been thinking a lot about why mental health is not immediately thought of as a health problem when we discuss the global burden of disease. Most often, we associate disease with a condition with a biological vector of transmission—for example bacteria or virus. Even when we acknowledge that certain social circumstances (e.g. poverty, gender inequalities, unemployment, etc.) and political circumstances (e.g. health systems, federal funding, civil unrest, etc.) cultivate and hasten disease, global health tends to spotlight the embodiment of infectious disease. Is this because we value infectious as a greater burden in the global health? If so, why is it valued more?
    Given the social theories that we discussed since I posted this blog, I have been attempting to dissect this preferential treatment of infectious disease on both a moral and effectiveness-based analysis. I think it largely comes down to how we define suffering. Social violence must not only be recognized as effecting physiological suffering but also mental health. I think that if global health is true to its understanding that health is an ultimate pathway towards higher living and humanity, mental health—though not as easily defined and treated—must receive equal attention.

    1. Hi Niki,
      I completely agree with your insight on treating mental health with the same importance as physiological suffering.

      As to your question of why infections may be ‘valued’ more in global health, I think this has a lot to do with what’s visibly “easier” to treat and what’s more measurable (in terms of outcome). For example, we learned in class about imagery and portrayals of ‘miracle cures’/’transformative power of medicine’; when treatment is provided for something visible — perhaps smallpox or guinea worm, people get to see the physical results of health interventions/foreign aid. However, I would think that the transformative power of antidepressants/counseling — while extremely important and effective (as seen in the case of Santiago, Childe) — is more subtle in terms of its visibility. Because of this, in terms of trying to get funding, I think it’s easier for groups to focus more on treating for infectious diseases (they also can use the fear tactic of “this is an infectious disease, and it could come to your community very easily”).

      1. Hey Diem,
        You mentioned perhaps the reason for attention to infectious disease is that medical interventions can led to more visible impact. I wonder, however, what the unanticipated consequences of the “transformative power of medicine” approach might be. By not addressing, the mental health burden of disease perhaps we are not truly creating a sustainably healthy population. A solution to this would be a diagonal approach to the infectious disease and mental health. Direct attention to infectious disease can be used to funnel resources into a health sector, and in a manner much like the “nail soup” methodology, resources can be disseminated to create infrastructure and build up mental health care via the process of building up the health care system in general.

        1. Hi Niki,
          I completely agree. I see the same problem with relying on the transformative power of medicine to gather resources and support for health interventions.
          I do wonder if the nail soup methodology could be used to improve healthcare towards mental health; it seems like a good idea, but do you think it needs to be tackled on its own?

          1. Trauma should definitely be tackled as it is an under addressed burden in the health world. I think the misconception here is two-fold: (1) that there is a dichotomy between mental health and biological health, and (2) that mental health is not a significant burden. To highlight the first misconception, I recently read an interesting study correlating psychological stress and MS symptoms. In African Americans who had experienced colonial oppression, there is long and perpetuating history of higher MS incidence. It turns out stress decreases mylenation of the nervous system and leads to mental health disease. Moreover, they found the Africans who had not experienced this oppression and who had migrated to the U.S. did not present this dysfunctional mylenation. However, their children, did present higher MS incidence rates. Experts attribute this to the microagressions and the internalization of racism that is endemically present in the U.S. The study underlines that mental health is part of larger oppressive social structures–perhaps the same social forces that foster higher infectious disease. Additionally, it shows that trauma can effect the body physiologically too.

  8. Hi Nikisha, thanks for your post! I agree that there is something problematic with the way we define the cause of PTSD as necessarily something discrete and isolated. The effects of longer-term trauma such as continuous war or micro-agressions should likewise be acknowledged and validated by the mental health and medical establishments. I think it’s particularly problematic to think about how the inability of the DSM to incorporate that type of psychological suffering reflects deeper issues about the types of mental illnesses and patients in general that are valued, studied, and used for diagnostics.

    What I worry about with this, however, is many of the things we’ve discussed in this class about causality – namely, that defining responses to race-based trauma as an illness brings us closer towards solving the problem with medication on an individual level and farther from more substantial social change. I don’t think this is a reason not to conduct more research on race-based trauma and to include it in psychological and clinical literature and practice, but I just want it to be very upfront in our discussions.

    Finally, I just wanted to comment that I too paused when I read about those who left Liberia being significantly happier and healthier, assuming that their treatment by host countries was
    I think that in other ways, refugees and ex-patriates of conflict zones experience other forms of suffering as a result, and also that the developing countries that often shelter these refugees could certainly be providing better for them.

  9. Oops. *assuming that their treatment by host countries was uneventful and happiness-inducing, not plagued by unemployment and discrimination, for example.

    1. Hey Allison,

      I completely agree. Your fear of medicalization of trauma is valid, and I think it is an important issue to consider, yet a difficult one to address, when we talk about mental illness in general. It is easy to medicate a traumatized patient but that doesn’t change the ultimate fundamental cause behind the disease. In particular, it hard to address trauma induced by migroaggressions and second-hand experiences because the origins are decentralized, and it is difficult to inculpate one perpetrator. The next best thing that mental health sector can do is bring awareness of institutionalized traumas to the public and open-up resources such as psychiatric counseling centers, along with said medical interventions. At least then, the perpetuation of the legacy of traumatic events is being slowed down.

      Your point about treatment of refugees is quite poignant, and I think particularly relevant to the Syrian refugee crisis we are having contemporarily. I wonder what your thoughts would be on foreign mental health efforts. Should we bring refugees in and then provide them specialized treatment for their traumas, or should foreign aid be resourced to helping the mental health sector in Syria itself?

  10. Hi Nikisha
    Thanks for your post!
    In regards to your first question I think while there might be a “time-frame of injury” it is extraordinarily difficult to measure.
    I think that race-based trauma should be recognized by the DSM. It is important to give those seeking help for mental illness the help they deserve to get better and be able to fully participate in society. But in order to make a population shift in race-based trauma we need to address the problem more upstream. Along with programs that change access to care for people once they have already suffered from years of trauma, it might be beneficial to also address the underlying causes of this trauma in a way that changes the population curve. It is by no means an easy task but I don’t think it should be left behind because I believe it to be the only way of really obtaining sustainable societal change in race-based trauma.

    1. Hey Yilena,
      I am in complete agreement that a broad approach that addresses both the immediate injuries of trauma at hand and underlying “weapons” of trauma is the best way to address race-based trauma. On whom do you think the largest weight of implementing such change lies on? Federal government, private entities (such as insurance companies), local/regional bureaucracies, individual movements, corporate groups (such as the American Psychiatric Association?

      I find it interesting that concerning the race-based violence occurring right now, change has been ignited by public outrage and protests by the general population. In a bottom-up manner, these protests have caught the attention of the media, public representatives, etc. It reminds me of our last lecture in which Prof. Mason emphasized the importance of student/youth-led protest in larger societal movements. I would love to hear your thoughts on this!

  11. Hi Nikisha,

    I really enjoyed your post and the connections you made to modern day issues. I’ll try and address the first question right now: “Does trauma exist within a well-defined “time frame of injury”?” Short answer: No, absolutely not. Longer answer: I believe trauma exists where it exists, independent of when the event that catalyzed the trauma had actually occurred. If it was well-defined, we’d be able to treat trauma more efficiently.
    Regarding your third question, yes, I do believe race-based trauma should be recognized by the DSM. But perhaps more specifically, I believe individual-based DSM should be more prioritized. I don’t think any one race should be subject to the same manual. If it really is one’s environment that contextualizes one’s trauma, then shouldn’t it stand to reason that two people of the same race but living in entirely disparate circumstances would be best served by different, more individualized manuals?
    I’ll skip the third question because I don’t think I need to answer all of them and also it’s hard.
    So with regard to the last question, the evidence behind race-based trauma can be strengthened by categorizing not only racial contexts, but historical and present day narratives unique to the individual communities within an entire race rather than of the one race entirely.

    1. Hi Chad,

      Yes, addressing some of these questions surrounding mental health can definitely be tricky, but I think they are important to contemplate and work out if we want to change the scene of the global burden of disease.

      By race-based trauma, I don’t mean to generalize a population and say that all Africans experience migroaggressions. The Ferguson case and the uproar surrounding police brutality is situational to black Americans. Certainly, not all African Americans hold race-based trauma as a personal struggle of theirs. However, I don’t think it’s a far stretch to say that racism can be decentralized, diffused and internalized by individuals who would have previously found themselves removed from the histories of racism in America. An African from Liberia can move to the United States to build a family, and his children will be impacted by the situation that they grow up in. Biological markers of stress have even been measured (if your interested its presented in the book Neuropsychological Assessment).

      However, I agree that trauma is a very personal experience. Perhaps our health care system should insure regular psychiatric care so that individuals can receive specified care. Gathering personal stories is important as you said not only for treatment but also for contextualizing trauma–especially when trauma has such a large, unclear time-frame of injury.

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