Tag Archives: racism and mental health

The Psychological Importance of Juneteenth

Juneteenth not only celebrates the freedom of Black Americans from slavery, but it also is a time when achievements are noted and continuous self-development is encouraged.

People dress with pride to show spirit, sometimes in African garments. This day of national pride is celebrated with food, music, games, and other activities to promote cultural awareness and community cohesiveness. Memories are shared for passing down to generations.

Black Mental Health and Juneteenth
From the clinical psychology research on Black mental health: (1) messages focused on instilling a sense of pride and learning about the history of one’s racial group (i.e., cultural socialization); and (2) messages focused on increasing youth’s awareness of racial discrimination and skills to manage it (i.e., preparation for bias) are BOTH powerful psychologically.

Overall, cultural socialization messages are associated with positive psychological and academic outcomes for youth. Preparation for bias messages are sometimes linked with positive outcomes, but there are mixed findings indicating these messages in isolation may not be consistently helpful for youth. One reason for these mixed findings may be because youth need a combination of messages that prepare them for racial discrimination along with messages that instill racial self esteem and pride. For example, if parents only provide messages about racial bias without messages focused on pride, it may lead youth to feel worried or hopeless. A combination of racial pride and knowledge and conversations about racial bias led to stronger mental health outcomes.
(For a great review on the research, see  Umaña-Taylor & Hill, Journal of Marriage and Family, 2020).

Additional ways to celebrate Juneteenth:
Vote.
Every time, every election.

Buy Black.
By buying black, people are also assisting in strengthening local economies and positive effects like the creation of more jobs.

Representation.
Promote Black images and experiences in advertising, social media, movies and shows, podcasts, and webinars.

Share resources.
Share information about housing, job opportunities, banking and loans, medical resources and clinics, agencies, and educational opportunities.

Intergenerational conversations.
Build relationships and communication between younger and older adults.

Destigmatize mental health.
Black people are far less likely to seek mental health care. Statistics show that about 25% of Black Americans seek mental health care, compared to 40% of white Americans. Unequal access to health care is one major contributor to this disparity. The lack of cultural sensitivity by health care professionals, feeling marginalized, a history of exploitation by the medical field, the reliance on family, community, and spiritual support instead of medical or psychiatric treatment are others.

Culturally responsive mental health treatment is one way of addressing the disparities in psychological wellbeing in the Black community. Finding and sharing information about culturally informed and responsive mental health professionals and agencies is vital. Also see Racial Trauma and Mental Health.

Strengthen Community.
Conversation around what people can do together that they cannot do apart should be mindful, intentional and strategic.

Racial Trauma and Mental Health

Meta-analysis reviews of racial trauma research unequivocally demonstrate symptoms that mirror post-traumatic stress disorder (PTSD):

  • Mental Health.
  • Psychologically, racial trauma can cause symptoms of post-traumatic stress disorder (PTSD).
  • Arousal: higher reports of somatization when distressed (e.g., stomach aches, headaches, rapid heartbeat).
  • Anger and disruptive behavior: more behavioral problems in children and teens
  • Chronic Stress: depression, anxiety, low motivation.
  • Hypervigilance: reduced ability to trust or form social connections.
  • Avoidance: less willingness to take academic risks, higher school drop-out rates after racial discrimination is perceived.

These negative psychological outcomes are not only present in adults, but have been found to appear as in children as early as 12 years of age. However, the toll of racial trauma and stress is not limited to psychological outcomes. The negative effects of racial trauma also affects physical health outcomes. These symptoms are often exacerbated by lack of access to adequate medical services.

Physical symptoms can include:

  • Physical pain
  • Cardiovascular Disease
  • Hypertension, with spikes in blood pressure following exposure to racist stimuli; blood pressure remains elevated after.
  • Respiratory Complications
  • Higher Allostatic Load (the wear and tear of the body caused by chronic stress) When the body is in a state of distress, it activates the stress response system, which helps us fight or get out of the stressful situations (a.k.a. fight, flight, or freeze). However, when experiences of stress are consistent and chronic, the stress response system becomes taxed and hormones can be unbalanced, exacerbating the physical illnesses and conditions listed above.
  • Digestive issues

See:
APA (American Psychological Association) Guide on the Effects of Stress on the Body
Racism, racial discrimination, and trauma: a systematic review of the social science literature, K.Kirkinis, August 2018. 
Mental Health and Black Patients: Survival and Stigma

On Vicarious Trauma

What is Trauma?
Trauma is an experience where death, abuse, or serious injury is a very real threat. This can include your own direct experiences, witnessed events, or situations faced by someone you care about.

Vicarious Trauma
Vicarious trauma is a process of change over time that results from witnessing, identifying with, or hearing about other people’s suffering and loss. If you are regularly hearing about another person’s trauma, then you are at risk of developing vicarious trauma symptoms. When you identify with the pain of people who have endured terrible things, you bring their grief, fear, anger, and despair into your own awareness and experience. Your commitment, care, and sense of responsibility can contribute to feeling burdened, overwhelmed, depressed, anxious, and perhaps hopeless. Vicarious trauma, like experiencing trauma directly, can deeply impact the way you see the world and your deepest sense of meaning and hope.

Trauma in the Black Community
This familiar pain is a symptom of Black people’s shared post-traumatic stress disorder—a uniquely American epidemic, 400 years in the making. And as viral police killings, trials, and social media force Black Americans to repeatedly endure secondary trauma—or the emotional stress that results from witnessing the trauma of others—and also the hidden cost: the spread of a Black American stress disorder that is often undiagnosed, untreated, and, in the age of social media, ubiquitously spread. Listening to traumatic material can also trigger memories of personal previous traumas. Vicarious or secondary trauma is similar to direct trauma. It carries many of the same symptoms.

Common Reactions to Vicarious Trauma:

  • PHYSICAL: Feeling on edge, difficulty sleeping, feeling tired, getting sick
  • EMOTIONAL: Feeling sad or anxious, angry, irritable, lonely or unsupported, unsafe, hypervigilant
  • COGNITIVE: Difficulty concentrating or making decisions, repetitive thoughts, memory problems, disturbing imagery, nightmares, “zoning out”
  • BEHAVIORAL: Social withdrawal, substance abuse, changes in eating patterns, disturbed sleep, overprotectiveness, spending too much time scrolling through social media, canceling and avoiding activities
  • RELATIONAL: Expecting the worst of others, becoming judgmental, relationship problems, loss of friends, feelings of isolation
  • SPIRITUAL: Cynicism, discouragement, loss of faith, low motivation

How to Help Address Vicarious Trauma:

  • PHYSICAL & BEHAVIORAL: Exercise, sleep 8 hours, eat regular healthy snacks and meals, take necessary medications, limit alcohol, drugs, and smoking, drink water, get fresh air and spend time outdoors, shower to “wash the day away,” follow a routine, balance priorities
  • EMOTIONAL & RELATIONAL: Seek support, journal, paint, laugh, watch movies, avoid news/violent TV shows, read books, listen to music
  • COGNITIVE: Focus on positive experiences, affirm your strengths through self statements, do breathing and visualization exercises, remind yourself that this is temporary, stay in the present moment
  • SPIRITUAL: Participate in a community that you value, pray/meditate/do readings, connect to the outdoors, sing, listen to music, personal prayer

Systemic Racism and Mental Health

Currently participating in the Maryland Psychological Association(MPA) annual Ethics Conference. I was able to speak about systemic racism and mental health. With clients: nurturing diversity awareness gently, but also insisting on it.

Takeaways from Dr. Siddique:

  • It is our obligation as mental health professionals to speak about systemic oppression, environmental context, and racism as an integral part of our intake process and treatment planning. This is a required need of our ethical guidelines, as recently endorsed by the American Psychological Association.
  • Microaggressions by clinicians can be a negative part of the psychotherapy process, without training and awareness. The research shows that BIPOC patients who experience their therapist as invalidating generally do not return to treatment. Ever.
  • We must get supervision from peers, consultants, and our own therapy in order to help others and to get a true understanding. Don’t assume that you know.
  • Developing psychological rapport and alliance is the most important way for us to work with our clients, as shown by psychotherapy research.

Resources
Coping with Racial Trauma
BlackLine provides a space for peer support and counseling, reporting of mistreatment, and affirming the lived experiences to folxs who are most impacted by systematic oppression with an LGBTQ+ Black Femme Lens.

My Personal Readings to Challenge Oppression.
DiAngelo, Robin (2018). White Fragility: Why It’s So Hard for White People to Talk About Racism Beacon Press: Reprint Edition.
Helms, Janet E. (2019). A Race is A Nice Thing to Have: A Guide to Being a White Person or Understanding the White Persons in Your Life. Cognella Academic Publishing.
Kendi, Ibram X. (2019.) How to Be an Antiracist. One World Publications.
Nadal, Kevin L. (2018). Microaggressions and Traumatic Stress: Theory, Research, and Clinical Treatment. American Psychological Association.

Is extreme racism a form of mental disorder?

This question was recently sent to me via one of my psychology blogs:

Is extreme racism a form of mental disorder? 

My answer:
The American Psychological Association has never officially recognized extreme racism as a mental health problem, although the issue was raised more than 30 years ago. After several racist killings in the civil rights era, a group of black psychiatrists sought to have extreme bigotry classified as a mental disorder. At that time, the question was posed to the American Psychiatric Association, a related medical association that is separate from mental health counseling/psychology.

This professional association rejected the recommendation, arguing ‘that because so many Americans are racist, even extreme racism in this country is normative; a cultural problem rather than an indication of psychopathology’.

The psychiatric profession’s primary index for diagnosing psychiatric symptoms, the Diagnostic and Statistical Manual of Mental Disorders (DSM), does not include racism, prejudice, or bigotry in its text or index.

Therefore, there is currently no statistical support for including extreme racism under any diagnostic category. This leads psychiatrists to think that it cannot and should not be treated in their patients.

Others in the profession have argued that to continue perceiving extreme racism as normative and not pathologic is to lend it legitimacy. Clearly, anyone who scapegoats whole groups of people and seeks to eliminate them to potentially resolve internal conflicts meets criteria for a delusional disorder, a major psychiatric symptom of illness.

Extreme racists’ violence could be examined in the context of behavior described by clinical psychologist Gordon Allport in the classic text, The Nature of Prejudice.

Allport’s 5-point scale categorizes increasingly dangerous acts: It begins with verbal expression of antagonism, progresses to avoidance of members of disliked groups, then to active discrimination including segregation, financial, and, social; to physical attack, and finally to extermination (lynchings, massacres, genocide).

Based on these theories, using the DSM’s structure of diagnostic criteria for a diagnosis of delusional disorder, the following subtype of delusional disorder has been suggested:

Delusional Disorder, Prejudice type: A delusion whose theme is that a group of individuals, who share a defining characteristic have a particular and unusual significance to the (psychiatric) patient. These delusions are usually of a negative or pejorative nature, but also may be grandiose in content. When these delusions are extreme, the person may act out by attempting to harm, and even murder, members of the despised group(s). Based on our Allport’s work, individuals suffering delusions usually also have overall serious social dysfunction that impairs their ability to work with others, have healthy interpersonal relationships, and maintain employment.

While psychiatric classification may be a useful tool, other researchers believe behaviors stemming from prejudice/hatred may not necessarily be pathological, and these acts are certainly not generic. Where is the line between societal ‘normal,’ and not? If racism has normative foundations, is it a disease, or an internalization of expectations? Is racism part of intergenerational trauma, as suggested by James Baldwin?

In my forensic work, intent, perceived goals, ability to understand right and wrong, cognitive ability, overall comprehension, and consequences, are all considered when somebody is deemed mentally incompetent. If somebody is aware of all of these factors and fully cognizant of their behavior, is it a mental illness?

We have a lot to study. And we must.

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.

Embolden Psychology
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Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

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