Racism and Mental Health

I was recently interviewed for a mental health blog by a psychiatrist/professor/writer from Georgetown
on the topic of Racism and Mental Health.

Here’s our conversation:
How did you get interested in racism and mental health?

When I was growing up, my father was head of the English department at a historically black college. One of the classes he taught was Race Relations. These conversations were part of my childhood even though my family was not black. Other children would hang posters of musicians and actors in their rooms, and for my birthday I would get Martin Luther King and Malcolm X.

I went on to study genetics, microbiology, and clinical psychology. In addition to practices in Northern Virginia and Montgomery County, I have been Clinical Director at a community health clinic in DC for 18 years, where half my patients have been from communities of color. I have listened and learned a lot from my patients.

What is an example of a case you have seen in your practice that involves racism affecting mental health?
A case that comes to mind I think illustrates what can happen. I was treating a woman who was high functioning with a good job. Her supervisor held her back from promotions and would cut her off in meetings when she tried to express herself. This can happen to all women but especially to minority women. Under this supervision, she deteriorated to the point that this high functioning individual was not able to function. These microaggressions can have a cumulative effect. When this occurs in an area such as your job, these repetitive traumas can accumulate and affect your livelihood.

What are some important findings on racism and mental health?
Some research has found that in patients with a history of discrimination and racism, there can be an overactive amygdala, a similar finding to that in brains of individuals with Post-Traumatic Disorder (PTSD). Also, Dr. Monnica Williams at Louisville discusses race-based PTSD or racial trauma which she describes as PTSD symptoms as a result of racism. The diagnosis of PTSD is a group of symptoms that occur after a single traumatic event. But complex PTSD occurs after repeated trauma in which a number of traumas pile on to one another. Race based stress can be a lifetime of psychological effects and not necessarily something you can leave or get away from. In a recent study, when children were exposed to racism through their lifetime, by the age of 12, there were higher rates of substance abuse and decreased self esteem.

What are your thoughts about the recent events in our country?
One of the hard things about the current events from the wrongful deaths of civilians to the pepper spray of peaceful protesters is the vicarious trauma it is producing for individuals miles away. People see these things and it can feel like it is happening to them. There is intense grief and anger it produces on top of a history of discrimination for many.

The inequities in housing, education, health care, and rental approvals have been longstanding. We all need to listen with an open ear so that people feel seen and heard. As clinicians we need to be careful to not overdiagnose. Someone feeling like the world is out to get them or that they can’t walk down the street might not be simply exhibiting paranoid ideation, but this may be their sense of reality.

How can the medical profession help?
In a number of instances, the medical profession experimented on black women as their scientific subjects. J. Marion Sims, The Father of Gynecology, believed their sensory nerves to be different so they would not feel pain. There is sometimes still a lack of trust in scientists and doctors. As clinicians, we need to be careful in how we interpret and how we understand these complex situations. Psychotherapy research shows that Black Americans begin therapy with optimism, but within a few sessions, they become less optimistic and drop out at higher rates and are unlikely to return. Patients can sometimes feel misheard, misinterpreted, blamed. Race and the experience around this should be part of clinical intakes routinely. Listening with an open ear is crucial to the doctor-patient relationship.

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