Understanding racial trauma, the mental and emotional injury of racism
When CNN Chief Medical Correspondent Dr. Sanjay Gupta was growing up in a small rural town in Michigan, he wanted to change his name to Steve — hoping that would put an end to the anti-Asian taunts he faced at school from the time he was 6 or 7 years old, he said in a summer episode of his podcast, “Chasing Life.”
“There was nobody that looked like me, that had a name that was like mine, that ate the foods we ate,” Gupta said. “If I changed my name to Steve, it was going to solve all my problems. … I would be just totally assimilated.”
Psychology professor Monnica Williams said she also weighed a big change when she experienced racism as an adult in a past academic position, through a colleague who would block Williams’ students from opportunities and discourage them from working with Williams.
“It was very frustrating to not be able to get anyone to do anything about it,” said Williams, who is now Canada research chair in mental health disparities at the University of Ottawa’s school of psychology. Williams is African American. “Part of what contributes to the problem is because you’re just kind of constantly gaslit, you’re not listened to, and the problems are getting worse.”
Williams ultimately had to leave her job “because I was unsuccessful in getting the help or resources that I needed to get this person to stop harassing my students and making my work environment inhospitable,” she said.
What Gupta and Williams went through could be described as racial trauma, the “emotional and possibly mental injury that comes from folks encountering racial bias and discrimination and, ultimately, forms of racism, which can include hate crimes,” said Nevin Heard, director of intercultural relations at Lake Forest College in Illinois.
The experience of racial trauma can be the result of specific people’s actions or a byproduct of a wider system. It can affect someone vicariously — perhaps by seeing videos of hate crimes — or intergenerationally, as with the lasting emotional scars of the Holocaust or the enslavement of African Americans, according to Mental Health America.
“People do not have to experience an incident of racial discrimination or harm directly to have adverse emotional consequences,” Heard said.
Racial trauma usually isn’t induced by “just one incident,” Williams said. “Usually, it’s a lot of incidents that have accumulated to the point where the person becomes traumatized.” Many ethnic and racial groups in the in the United States experience higher rates of post-traumatic stress disorder than White Americans, and one explanation for this is the experience of racism, according to the American Psychological Association.
However, diagnosing and treating racial trauma, specifically, can be challenging, in part because of the way it’s understood in the health care community.
Unlike post-traumatic stress disorder, racial trauma — also known as race-based traumatic stress — isn’t considered an official mental health disorder or diagnosis in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the authoritative guide used by health care professionals to diagnose mental disorders.
“It’s not a separate category because, for one, it’s not clear if it’s just PTSD that’s caused by something else. And so we don’t necessarily have different types of PTSD based on what caused it,” Williams said. “Also, we don’t have enough research yet to really say exactly what the differences would be between PTSD and racial trauma.”
That the PTSD listing in the DSM-V doesn’t include racism as one of the causes is problematic, she said. “When clinicians see people with distress over racism, they’re not necessarily thinking, ‘Oh, this could be PTSD.’ So, it needs to be in there either listed as a potential cause of PTSD or as a different but related diagnosis.”
There’s “a lot of conversation” about this among experts, but the DSM is based on existing research, which there has been a lack of when it comes to racial trauma — though work on the subject “has been picking up very rapidly,” Williams said.
“The DSM revision process is open to proposals from interested parties for revisions to the DSM, so long as appropriate data can be provided in support of the proposal,” said Dr. Paul S. Appelbaum, chair of the DSM Steering Committee and Dollard Professor of Psychiatry, Medicine & Law at Columbia University, via email.
“To date, we have not received a proposal either to alter the criteria for PTSD to include racial trauma as a precipitant or to establish it as an independent diagnosis,” he added. “However, in the recent text revision of the DSM (DSM-5-TR), which appeared last year, a systematic effort was made to highlight in the text conditions for which there is evidence that racial discrimination, whether overt or structural, might contribute to the disorder.”
Regardless of its classification status, racial trauma affects the well-being of both individuals and communities, Williams said.
People affected by racial trauma might take on some of the physical symptoms of stress, which is called somatization, Heard said. “This could be stomach aches, faster heartbeats, feelings of hypervigilance and chronic stress. They might also experience avoidance, which happens with PTSD, but there’s also re-experiencing of distressing events.”
Other symptoms include difficulty sleeping, fatigue, depression, anxiety, impaired gut health, anger, recurring thoughts of the event, nightmares, sweating, shaking, distrust, self-blame, low self-esteem, headaches and chest pains, according to Heard, Williams and Mental Health America.
Racial trauma doesn’t just affect the individual. “Just like PTSD, racial trauma results in disability, temporary or long term, like lost days from work and lost productivity, increased medical expenses and more suffering in general,” Williams said. “The more people have these problems, the larger the cost is going to be to society and those communities and their families.”
Her experience with racism at a previous job affected Williams’ psyche as she sought new work opportunities. “It was hard because I had to move, and I didn’t want to relocate my family. And that’s difficult to explain to your kids why you’re moving again and starting all over again and having to say goodbye to my graduate students and not being able to finish their training,” she said.
“Of course, professionally, it could be a setback,” Williams added. “And then if you go someplace else and then you start to see some of those same things again, that can certainly be very alarming, because you feel like you’re having a flashback.”
To be diagnosed with PTSD, there has to be an identifiable traumatic event, Williams said — so, having directly or indirectly experienced racial violence would easily fit into PTSD criteria. But if someone’s dealing with trauma from being repeatedly invalidated at work because of their race, that wouldn’t meet the criteria. However, mental health professionals would still be able to diagnose and treat any effects of the racial trauma — such as depression or anxiety — even if they can’t diagnose race-based PTSD itself.
Finding out whether your symptoms are due to racial trauma, mental health disorders or general mood issues is good to do. That’s where it’s helpful to have an assessment by a psychologist or other clinician who understands racial trauma, Williams said. You can find out about an expert’s knowledge on the subject by researching them online before you meet, or asking them directly during an appointment, she added.
If your mental health professional doesn’t know much about racial trauma, getting help could be challenging since they wouldn’t know where to begin, Williams said.
To cope, getting out of the triggering situation is important but not always possible, Williams said. Try to build a good support system of people you can talk with about your struggles, and stay engaged in your everyday life, she said.
While taking a break to give your mind a chance to rest and recover is OK, the more you avoid, the smaller your world gets, Williams said.
“Ultimately, it also involves learning new ways to manage racism when it does come up,” such as how to respond to microaggressions, she added. “People will often deal with racism for a lot longer than they should, because they don’t know what else to do, or maybe they have low self-esteem and they think they deserve to be mistreated.
“It’s really important that people understand their own value and also believe their experiences and not be gaslit by when people say it’s not there — but to trust their instincts and what they’re seeing,” Williams said.
Learning new ways to cope with these experiences is a process, she added, but important for developing a sense of autonomy and empowerment.