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One helpful conceptualization of racial trauma comes from Dr Shelly Harrell (2000). She offers a six-level framework that examines the ways in which we are harmed by racism, through:
1. Racism-related life events - these are racial events such as assaults and other acts of race discrimination that target us directly and unequivocally. For example: When we are called a racist term or assaulted. I don’t wish to provide examples of this; I’ll offer some writing instead: "Certain moments send adrenaline to the heart, dry out the tongue, and clog the lungs. Like thunder they drown you in sound, no, like lightning they strike you across the larynx." (Rankine, 2014) 2. Vicarious racism - when the exposure to racism is indirect, for example when we hear stories of or witness racism occurring to those around us. This is painfully evident if you pay just a little attention to the news cycle, with the endless repetitions of deaths of racialized folks, and Black and Indigenous folks in particular, at the hands of the police. This is also the reason why you should never, ever share videos of such killings on social media. 3. Daily racist micro-stressors - these are subtle, normalised and ambiguous acts of racist denigration, the kinds of things we today call microaggressions, for example being asked: 'Where are you really from?'. The cumulative, pervasive nature of microaggressions is harmful to a person’s physical, intellectual, emotional, and social health. They can limit access to resources, contributing to employment barriers, unequal representation, and pay inequity. The resultant chronic stress can contribute to a range of physical health complications. They can also lead to feelings of isolation and an invalidation of experience. Microaggressions can sometimes result in greater overall harm than more overt forms of oppression. “…one did not have to be abnormally sensitive to be worn down to a cutting edge by the incessant and gratuitous humiliation and danger one encountered every working day, all day long.” (Baldwin, 1963) 4. Chronic contextual stressors - the mere awareness of structural race inequality and unequal distribution of resources. For example: simply being exposed to race inequality statistics via the media or popular culture. Or the chronic contextual stressor of the gaslighting involved in the reporting of police violence against racialized folks, where the passive voice tends to be used to subtly absolve the perpetrators of any responsibility. “You were born into a society which spelled out with brutal clarity, and in as many ways as possible, that you were a worthless human being.” (Baldwin, 1963) 5. Collective experiences of racism - which involves witnessing the racism inflicted on one's racial group. 6. Transgenerational transmission of group trauma - when aspects of oppression related to historical events are passed on. An example of this from my own family: India was colonized by the British in the 1800s and they remained there until 1947, meaning both sets of my grandparents were born under British rule and were colonized subjects. In 1947, in order to enable a self-serving withdrawal and leave behind two separate states, an arbitrary, last minute line was drawn from the Himalayas down to the sea by Sir Cyril Radcliffe, with the western side labelled Pakistan, and the eastern side labelled India. This led to the mass displacement of between 10 to 20 million people, as Muslims on the Indian side and Hindus and Sikhs on the Pakistani side abandoned their homes and tried to get to the other side of the border. There was mass bloodshed as those escaping were set upon as they tried to leave, with up to 2 million people believed to have been killed. This randomly assigned border split the native land of my people - the Punjab – in two, making it the scene for the worst of the violence. This theme - of division, of dislocation and of otherness - runs through my story. My experience was of splits and lines everywhere that harked back to the original Radcliffe line – the split between Indian and English culture, and the split between my maternal and paternal families, for example. Dr. Harrell’s framework highlights the chronic nature of racial trauma, which sets it apart from most other forms of trauma. Secondly, the last three levels stress the collective impact of racism, something that tends to be missed in most conversations on racial trauma. Baldwin, J. (1963). The Fire Next Time. The Dial Press, New York. Harrell, S (2000). A Multidimensional Conceptualization of Racism-Related Stress: Implications for the Well-Being of People of Color. American Journal of Orthopsychiatry, 70 (1), pp. 42-57. doi:10.1037/h0087722 Rankine, C. (2014). Citizen: An American Lyric. Graywolf Press, Minnesota. It's exhausting to be a guest
In somebody else's house Forever. Even though the host invites The guest to say Whatever it is they want to say, The guest knows that host logic Is variable. Prick me. And I will cut off the energy To your life. Kapil, B. (2020). How to Wash a Heart. Pavillion Poetry, Liverpool University Press. When thinking about the effects of racism, a key variable to consider is that of stress. Stress usually refers to things that threaten or are perceived to threaten our well-being and therefore tax our coping abilities. This creates what is called an allostatic load – an overall “wear and tear” on the body that has very real physiological consequences (McEwan & Stellar, 1993). Because racism is a unique and often daily stressor, it leads to very real consequences on the bodies and souls of racialized folks everywhere.
Theorists have suggested two kinds of stressors: acute stressors, which are threatening events that have a relatively short duration and a clear endpoint, and chronic stressors, which are threatening events that have a relatively long duration and no apparent time limit. Both acute and chronic stressors can result in internal conflict, which is when two or more incompatible motivations or impulses compete for expression. Conflicts have been described as coming in three types (Lewin, 1935): approach–approach conflict, which involves a choice between two attractive goals, and is least stressful; approach–avoidance conflict, which involves a choice about whether to pursue a single goal with both attractive and unattractive aspects , and can be quite stressful; and finally avoidance–avoidance conflict, which involves a choice between two unattractive goals, and is highly stressful. Let’s think about the internal experience of racial trauma: because of the minority status of the person on the receiving end, when you are in that position you are forced to ask yourself - do I accept this discrimination and othering, or do I push back, when pushing back means not just against an individual, but against an entire structural edifice? Neither option is much fun, and if you have to face this every day, you will soon be exhausted. Which is, by the way, the whole point: to keep you exhausted. Hans Selye (1956) proposed a theory of stress reactions described as the “General Adaptation Syndrome”. It involves three stages: alarm, whereby physiological arousal occurs and the body musters its resources to combat the challenge, then resistance, where physiological arousal remains higher than normal but may stabilize somewhat as coping efforts kick in, and finally, after some time, exhaustion, which occurs because the body’s resources for fighting stress are limited, and will become depleted. Now apply this to the life-long experience of racialized people, and you begin to understand the challenge we face. Lewin, K. (1935). A Dynamic Theory of Personality. New York: McGraw-Hill. McEwen, B. S. & Stellar, E. (1993). Stress and the individual. Mechanisms leading to disease. Archives of Internal Medicine. 153 (18): pp. 2093-101. doi:10.1001/archinte.153.18.2093 Selye H. (1956). The Stress of Life. New York: McGraw-Hill Book Company. Immigrants typically face a broad range of stressors upon arrival in a new country, such as a lack of environmental mastery, social support, language proficiency and socioeconomic status, as well as a painful loss of familial connections, all of which tend to yield a higher rate of mental disorders in the population (Khawaja, Gomez & Turner, 2009). Racialized immigrants also face the challenge of racism at the institutional, cultural, and individual levels, potentially resulting in experiences of prejudice, discrimination, and violence (Chen & Chen, 2020). The subsequent effect of all this on second generation children of immigrants may involve developmental issues around forming an identity associated with ethnicity and subsequent related adverse mental health symptoms (Lee & Neese, 2020).
It’s no easy task to leave your homeland and all that you know for a new life in another country, nor is it easy to be descended from immigrants and find yourself neither one thing or another, but a separate, third thing – one that belongs nowhere. I am gratefully able to personally attest to the fact that therapy can be a key tool to unlocking a more resilient and adaptable sense of your own self in the face of such overwhelming challenges. Chen, H. & Chen, E. C. (2020) Working with Interpreters in Therapy Groups for Forced Migrants: Challenges and Opportunities. International Journal of Group Psychotherapy, 70:2, 244-269, doi: 10.1080/00207284.2019.1685885 Khawaja, N. G., Gomez, I. & Turner, G. (2009). Development of the Multicultural Mental Health Awareness Scale. Australian Psychologist, 44(2), pp. 67–77. DOI: 10.1080/00050060802417801 Lee, H. Y. & Neese, J. A. (2020). Mental and Behavioral Health of Immigrants in the United States. Published by Elsevier Inc. https://doi.org/10.1016/B978-0-12-816117-3.00008-7. Racialized women can experience discrimination based on both gender and race, and as such be doubly at risk of psychological effects (Hall & Sandberg, 2012; Jones & Pritchett-Johnson, 2018). However, the heterogeneity of racialized women prevents a one-size-fits-all approach (Henderson-Daniel et al., 2004). For example, Black women may experience pressure to embody strength and resilience rather than seek support or express emotional needs (Jones & Pritchett-Johnson, 2018), while for Indigenous women an awareness of the legacy of colonization and current social practices which wreak devastation upon Indigenous peoples’ mental and physical health may be the minimum understanding required of a therapist (Lavallee & Poole, 2010). Asian women may require consideration of other factors, such as the greater somatization seen in this broad category (Presley & Day, 2019). For Latinx women the scapegoating of Latinx people in North America may have exposed them to higher risk for mental health issues (Elias-Juarez & Knudson-Martin, 2016).
The intersecting oppression experienced by these populations is linked to various mental and physical health issues (Rojas-Vilches et al., 2011; Nygaard, 2012; Abrams et al., 2019) as well as an underutilization of services (Yeh et al., 2004; Interian & Díaz-Martínez, 2007; Chen et al., 2008; Awosan et al., 2011). Each client’s meaning-making around race in the therapeutic relationship may impact their presentation and disclosure (Chang & Yoon, 2011), while issues of transference and countertransference may arise (Nagai, 2009), with practitioners needing to be particularly attuned to potentially traumatizing responses (Stevens & Abernethy, 2018). Conversations about race may be critical to treatment (Kivlighan et al., 2019) - but even if not related to the client’s presenting problem, an understanding of the unique stressors that result from multiple marginalized identities is key for any therapist aiming to create safety and develop and maintain a functioning therapeutic alliance (Jones & Pritchett-Johnson, 2018). Abrams, J. A., Hill, A. & Maxwell, M. (2019). Underneath the Mask of the Strong Black Woman Schema: Disentangling Influences of Strength and Self-Silencing on Depressive Symptoms among U.S. Black Women. Sex Roles, 80, pp. 517–526. https://doi.org/10.1007/s11199-018-0956-y Awosan, C. I., Sandberg, J. G. & Hall, C. A. (2011). Understanding the experience of black clients in marriage and family therapy. Journal of Marital and Family Therapy, 37 (2), pp. 153-168. doi: 10.1111/j.1752-0606.2009.00166.x Chang, D. F. & Yoon, P. (2011). Ethnic minority clients’ perceptions of the significance of race in cross-racial therapy relationships. Psychotherapy Research, 21 (5), pp. 567-582. doi:10.1080/10503307.2011.592549 Chen, E. C., Kakkad, D. & Balzan, J. (2008). Multicultural Competence and Evidence-Based Practice in Group Therapy. Journal of Clinical Psychology: In Session, 64 (11), pp. 1261-1278. doi:10.1002/jclp.20533 Elias-Juarez, M. A. & Knudson-Martin, C. (2016). Cultural attunement in therapy with Mexican-heritage couples: a grounded theory analysis of client and therapist experience. Journal of Marital and Family Therapy, 43 (1), pp. 100–114. doi: 10.1111/jmft.12183 Hall, C. A. & Sandberg, J. G. (2012). “We Shall Overcome”: A Qualitative Exploratory Study of the Experiences of African Americans Who Overcame Barriers to Engage in Family Therapy. The American Journal of Family Therapy, 40, pp. 445–458. doi: 10.1080/01926187.2011.637486 Henderson-Daniel, J., Roysircar, G., Abeles, N. & Boyd, C. (2004). Individual and Cultural-Diversity Competency: Focus on the Therapist. Journal of Clinical Psychology, 60 (7), pp. 755-770. doi:10.1002/jclp.20014 Interian, A. & Díaz-Martínez, A. M. (2007). Considerations for Culturally Competent Cognitive-Behavioral Therapy for Depression with Hispanic Patients. Cognitive and Behavioral Practice, 14, pp. 84—97. https://doi.org/10.1016/j.cbpra.2006.01.006 Jones, M. K. & Pritchett-Johnson, B. (2018). “Invincible Black Women”: Group Therapy for Black College Women. The Journal for Specialists in Group Work, 43 (4), pp. 348-375. doi:https://doi.org/10.1080/01933922.2018.1484536 Kivlighan, D. M., Drinane, J. M., Tao, K. W., Owen, J. & Liu, W. M. (2019). Detrimental Effect of Fragile Groups: Examining the Role of Cultural Comfort for Group Therapy Members of Color. Journal of Counseling Psychology, 66 (6), pp. 763–770. http://dx.doi.org/10.1037/cou0000352 Lavallee, L. F. & Poole, J. M. (2010). Beyond Recovery: Colonization, Health and Healing for Indigenous People in Canada. International Journal of Mental Health and Addiction, 8, pp. 271–281. doi:10.1007/s11469-009-9239-8 Nagai, C. (2009). Ethno-cultural and linguistic transference and countertransference: from Asian perspectives. American Journal of Psychotherapy, 63 (1), pp. 13-23. doi: 10.1176/appi.psychotherapy.2009.63.1.13 Nygaard, A. (2012). Cultural Authenticity and Recovery Maintenance in a Rural First Nation Community. International Journal of Mental Health and Addiction, 10, pp. 162–173. doi:10.1007/s11469-011-9317-6 Presley, S. & Day, S. X. (2019). Counseling Dropout, Retention, and Ethnic/Language Match for Asian Americans. Psychological Services, 16 (3), pp. 491–497. http://dx.doi.org/10.1037/ser0000223 Rojas-Vilches, A. P., Negy, C. & Reig-Ferrer, A. (2011). Attitudes toward seeking therapy among Puerto Rican and Cuban American young adults and their parents. International Journal of Clinical and Health Psychology, 2 (2), pp. 313-341. Stevens, F. L. & Abernethy, A. D. (2018). Neuroscience and Racism: The Power of Groups for Overcoming Implicit Bias. International Journal of Group Psychotherapy, 68: 4, pp. 561-584. doi:10.1080/00207284.2017.1315583 Yeh, C. J., Hunter, C. D., Madan-Bahel, A., Chiang, L. & Arora, A. K. (2004). Indigenous and Interdependent Perspectives of Healing: Implications for Counseling and Research. Journal of Counseling & Development, 82, pp. 410-419. https://doi.org/10.1002/j.1556-6678.2004.tb00328.x Not only do women have to contend with overt forms of violence and control at the hands of men, they also have to contend with gender microaggressions on a daily basis - such as sexual objectification, assumptions of inferiority, assumptions of traditional gender roles, use of sexist language, denial of individual sexism, invisibility, denial of the reality of sexism, and environmental gender microaggressions (McSorley, 2020).
Women in general - and racialized women in particular - experience more social disadvantage than men, which is a mental health risk factor and which also impacts access to care (Straiton et al., 2016). Trans women may likely have experienced quotidian microaggressions and possibly violent discrimination as a result, both linked to depression, anxiety, and suicidality (Hughto et al., 2017; McSorley, 2020), while any female-coded client’s sexual orientation, and the world’s response to it, may play a big part in their well-being; 2LGBTQ+ people face heterosexism, violence, and discrimination again associated with mental and physical health problems (American Psychological Association, 2012) - lesbians and bisexual women face this in relation to both sexuality and gender, while the cumulative effects of heterosexism, sexism, and racism puts racialized 2LGTBTQ+ people at unique risk (American Psychological Association, 2012). The literature suggests that all of these experiences have a profoundly negative impact on mental health outcomes, with women being 60% more likely to have anxiety and 80% more likely to have major depressive disorder as compared to men (McSorley, 2020), while the lifetime prevalence rate of Social Anxiety Disorder has been found to be 5.7% in women compared to 4.2% in men (Straiton et al., 2016; Graham-LoPresti et al., 2017). And yet, despite this, therapy itself continues to be contextualized within the dominant patriarchal culture that upholds narratives situating cis men as superior to cis women (McSorley, 2020). As a male practitioner, the absolute minimum I require of myself in order to be culturally competent while working with this demographic is to divest from such conceptualizations. A list of gender microaggressions that women might experience during therapy includes: objectification, stereotypes about their psychological distress, assumptions about diagnoses, insensitive treatment suggestions, and neglect of gender issues (McSorley, 2020). Furthermore, interventions in which the practitioner uses manipulation, persuasion, and assimilation into the male-dominant society also shows a lack of knowledge of a female-coded client’s worldview and are thus flawed (Henderson-Daniel et al., 2004). Holding all of this in mind is critical in my attempts to embody an anti-oppressive practice. How my identity as a male-coded individual affects others continues to be a priority for my inward gaze, and involves attentiveness to both my client’s and my own reactions, facilitated by an awareness of my own values, assumptions, and biases. American Psychological Association (2012). Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual Clients. American Psychologist, 67 (1), pp. 10–42. doi: 10.1037/a0024659 Graham-LoPresti, J. R., Gautier, S. W., Sorenson, S. & Hayes-Skelton, S. A. (2017). Culturally Sensitive Adaptations to Evidence-Based Cognitive Behavioral Treatment for Social Anxiety Disorder: A Case Paper. Cognitive and Behavioral Practice, 24, pp. 459-471 Henderson-Daniel, J., Roysircar, G., Abeles, N. & Boyd, C. (2004). Individual and Cultural-Diversity Competency: Focus on the Therapist. Journal of Clinical Psychology, 60 (7), pp. 755-770. DOI: 10.1002/jclp.20014 Hughto, J. M. W., Clark, K. A., Altice, F. L., Reisner, S. L., Kershaw, T. S. & Pachankis, J. E. (2017). Improving correctional healthcare providers' ability to care for transgender patients: Development and evaluation of a theory-driven cultural and clinical competence intervention. Social Science & Medicine, 195, pp. 159–169. http://dx.doi.org/10.1016/j.socscimed.2017.10.004 McSorley, K. (2020). Sexism and cisgenderism in music therapy spaces: An exploration of gender microaggressions experienced by music therapists. The Arts in Psychotherapy, 71, pp. 1-9. https://doi.org/10.1016/j.aip.2020.101707 Straiton, M., Powell, K., Reneflot, A. & Díaz, E. (2015). Managing Mental Health Problems Among Immigrant Women Attending Primary Health Care Services. Health Care For Women International, Vol. 36. 10.doi: 1080/07399332.2015.1077844. Families are where we first learn “what feelings are acceptable and family authorized and what feelings are prohibited” (Bradshaw, 1988b). Many young boys experience a “shaming of all emotions” (Bradshaw, 1988a), in particular that of any expression of pain, of grief, as being unmanly and a sign of weakness. It is in this way that men “are socialized to mistrust feelings, particularly difficult feelings, to experience them as threatening, overwhelming, and of little value” (Real, 2002). As bell hooks (2004a) states, “Soul murder is the psychological term that best describes this crushing of the male spirit in boyhood”.
The effect of this ‘soul murder’ is greater than only inhibiting certain emotional experiencing, however. It can also lead to a privileging of acting out in anger, something that is socially rewarded – the lesson being that anger is the “only emotion that patriarchy values when expressed by men” (hooks, 2004b), with the bottom line being that “manhood is synonymous with the domination and control over others” and the use of “coercion and/or violence to gain and maintain power” (hooks, 2004a). Indeed, it can be argued that “...violence is boyhood socialization” (Real, 2002). In psychodynamic terms, acting out in anger can thus became men’s primary defense against feeling our grief. “When we are raging, we feel unified within—no longer split. We feel powerful. Everyone cowers in our presence. We no longer feel inadequate and defective. As long as we can get away with it, our rage becomes our mood altered of choice. We become rage addicts” (Bradshaw, 1988a). Acting out our rage “is the perfect cover-up for … unreconciled grief” (hooks, 2004a) - while healing “begins with acknowledging and feeling the pain” (hooks, 2004a). This can be quite challenging, however, given that most men refuse to acknowledge their deep childhood losses, “seem incapable of grieving and mourning on an individual basis” (Dutton, 1995) and are unsupported in this attempt because “male models for grieving are few” (Dutton, 1995). Therapy can be a space in which to challenge this damaging status quo, a space for masculinity to be given the freedom - to just be. Bradshaw, J. (1988a). Healing the Shame That Binds You. Deerfield Beach, Fla: Health Communications. Bradshaw, J. (1988b). Bradshaw on: the family: A revolutionary way of self-discovery. Pompano Beach, Fla: Health Communications. Dutton, D. (1995). The Batterer: a Psychological Profile. Basic Books, New York. hooks, b. (2004a). We Real Cool: Black Men and Masculinity. Routledge, New York. hooks, b. (2004b). The Will to Change: Men, Masculinity, and Love. Atria Books, New York. Real, T. (2002). How Can I Get Through to You? Closing the Intimacy Gap Between Men and Women. Simon and Schuster, New York Every boy is inducted into the code of patriarchal masculinity, and thereafter becomes both primary benefactor but also unwitting victim of the patriarchal system of thought – of the hierarchical, one-up/one-down way of relating to others, and to one’s own self. As Terence Real states: “Both the roots of [man’s] pain and also his entitlement to run from it, inflicting it, instead, on those he most cares for, lie at the heart of patriarchy.” Or, as the late Black radical feminist scholar bell hooks (2004a) put it, boys learn “that the patriarchal man is a predator, that only the strong and the violent survive.”
The understanding here is that “Patriarchy is the single most life-threatening social disease assaulting the male body and spirit” (hooks, 2004b) - that men are ourselves oppressed by the unspoken patriarchal code. We are “taught that a boy should not express feelings” (hooks, 2004b), and it is this learning that seems to underpin many of men’s presenting problems in therapy, for not only do we often not know how to express our feelings beyond acting out upon them, we also often appear not to know how to even feel them. hooks, b. (2004a). We Real Cool: Black Men and Masculinity. Routledge, New York. hooks, b. (2004b). The Will to Change: Men, Masculinity, and Love. Atria Books, New York. Real, T. (2002). How Can I Get Through to You? Closing the Intimacy Gap Between Men and Women. Simon and Schuster, New York Many neurodivergent people, with or without a diagnosis, can see “difference” as a lonely experience of not belonging (Humphrey & Lewis, 2008; Huws & Jones, 2008). Internalized oppression can lead some who have received a diagnosis to wish for a cure (Bagatell, 2010; Punshon et al., 2009). These are just some indicators of the pressures placed upon this demographic to adopt a “less than” stance toward themselves. A “less than” internalization can lead to all manner of difficulties for people, neurodivergent or not. While it’s likely that most therapy is generally geared towards addressing such internalizations, I believe ISTDP is a particularly effective modality with regard to interrogating the relationship you have with yourself and how that plays out in your relationships with others. But for neurodivergent folks, as with folks who feel similar pressures as a result of other aspects of their identity, finding safety and understanding with a practitioner is the important thing. When the risk of being harmed by someone you are going to for help and support is high, it takes genuine courage to reach out for help in the first place.
Bagatell, N. (2010). From cure to community: Transforming notions of autism. Ethos, 38, 34 –58. doi:10.1111/j.1548-1352.2009.01080.x Humphrey, N., & Lewis, S. (2008). “Make me normal”: The views and experiences of pupils on the autistic spectrum in mainstream secondary schools. Autism, 12, 23– 46. doi:10.1177/1362361307085267 Huws, J. C., & Jones, R. S. P. (2008). Diagnosis, disclosure, and having autism: An interpretative phenomenological analysis of the perceptions of young people with autism. Journal of Intellectual and Developmental Disability, 33, 99 –107. doi:10.1080/13668250802010394 Punshon, C., Skirrow, P., & Murphy, G. (2009). The “not guilty verdict”: Psychological reactions to a diagnosis of autism in adulthood. Autism, 13, 265–283. doi:10.1177/1362361309103795 |
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