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With regards the issue of race and therapy, the overwhelming focus within the industry remains on how to mitigate the issues that arise in the context of racialized clients and White therapists. Here the multicultural competence literature indicates that matching the cultural characteristics of the treatment with those of the client increases treatment effectiveness (Interian & Díaz-Martínez, 2007; La Roche & Lustig, 2013). But this remains a foggy and under researched task, and it is increasingly being shown that matching the cultural characteristics of the therapist themselves to the client also increases treatment effectiveness – due in large part to a greater consequent understanding of the intersections of the client’s complex individual identity (Collins et al., 2010; Ecklund, 2012). There is significant evidence to support this, with clients whose therapists were ethnically similar and/or spoke their native language dropping out of treatment less, staying in treatment longer, and experiencing better treatment outcomes (Wilson & Stith, 1991; Interian & Díaz-Martínez, 2007; Awosan et al., 2011; Hall & Sandberg, 2012; Presely & Day, 2019), highlighting the value of cultural knowledge exercised by ethnically similar therapists. Furthermore, there is strong evidence indicating that this is also the clear preference of racialized clients themselves (Chang & Yoon, 2011; Mofrad & Webster, 2012).
The message here is that racialized therapists are uniquely positioned to serve racialized populations by helping them to recognize their individual and collective strengths; by helping them to define themselves as individuals with unique qualities that can help them overcome individual difficulties; and by being comfortable with and empathic about the impact of skin color differences and associated projections on our lives. (Chen et al., 2008; Chang & Yoon, 2011; Zaharopoulos & Chen, 2018; Sawrik, 2020). A racialized therapist can provide a unique opportunity for racially marginalized folks to better understand their own selves – an opportunity to better learn how to manage the stressors unique to their marginalized status alongside someone who shares the experience of otherness and who can work together with them to understand and shape their experience while highlighting their own agency in doing so (Jones & Pritchett-Johnson, 2018). This opportunity comes at less risk of further traumatization – not at zero risk, as aforementioned, because intersecting and often invisible aspects of identity can still collide – but one that can provide a worthwhile mitigation of a pressure racialized folks otherwise experience every day of their lives. 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), 1261-1278. DOI: 10.1002/jclp.20533 Collins, S., Arthur, N. & Wong-Wylie, G. (2010). Enhancing Reflective Practice in Multicultural Counseling Through Cultural Auditing. Journal of Counseling & Development, 88, pp. 340-347. Ecklund, K. (2012). Intersectionality of Identity in Children: A Case Study. Professional Psychology: Research and Practice, 43 (3), 256–264. DOI: 10.1037/a0028654 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, 40:445–458. DOI: 10.1080/01926187.2011.637486 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 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), 348-375. DOI: https://doi.org/10.1080/01933922.2018.1484536 La Roche, M. & Lustig, K. (2013). Being Mindful About the Assessment of Culture: A Cultural Analysis of Culturally Adapted Acceptance-Based Behavior Therapy Approaches. Cognitive and Behavioral Practice, 20, pp. 60-63 Mofrad, L. & Webster, L. A. D. (2012). The treatment of depression and simple phobia through an interpreter in the North East of England: a case study. The Cognitive Behaviour Therapist, 5, pp. 102–111. doi:10.1017/S1754470X13000044 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 Sawrik, P. (2020). Service providers’ cultural self-awareness and responsible use of racial power when working with ethnic minority victims/survivors of child sexual abuse: Results from a program evaluation study in Australia. Children and Youth Services Review, 119 (10). https://doi.org/10.1016/j.childyouth.2020.105641 Wilson, L. L. & Stith, S. M. (1991). Culturally Sensitive Therapy With Black Clients. Journal of Multicultural Counseling & Development, Vol. 19, Issue 1, p32-43. DOI: 10.1002/j.2161-1912.1991.tb00455.x. Zaharopoulos, M. & Chen, E. C. (2018). Racial-Cultural Events in Group Therapy as Perceived by Group Therapists. International Journal of Group Psychotherapy, 68:4, 629-653, DOI: 10.1080/00207284.2018.1470899. Research has shown high prevalence rates of microaggressions in individual therapy, and conversely demonstrated the importance of addressing such microaggressions in therapy (Kivlighan & Chapman, 2018). Shockingly, most clients experience at least one microaggression within any given counselling relationship (Kivlighan et al., 2020), while a large number of therapists remain unable to accurately identify the presence of a microaggression (McSorley, 2020). Such microaggressions might involve stereotyping, misgendering, or denying experiences of oppression (McSorley, 2020).
One problem here is that the industry remains overwhelmingly White. Back in 2012 only 3% of marriage and family therapists and only 6% of all psychologists in North America were racialized practitioners. Even if we account for potential increases in these numbers over the previous decade it still means that the likelihood of a racialized individual receiving services from a White practitioner is very high – even if their presenting issue is related to racism (Henderson-Daniel et al., 2004; Hall & Sandberg, 2012). The issue here is that studies have shown that if the therapist is at all uncomfortable with the issue of race, it is highly unlikely that they will be able to help their clients work through these difficulties (Stevens & Abernethy, 2018). Studies have also shown that most White therapists do report discomfort with broaching the topic of race in therapy, whether directly or indirectly, due to their own cultural and racial socialization (Knox et al., 2003; Chang & Yoon, 2011). Some even report allowing clients to focus on universalities rather than cross-racial differences because of this discomfort (Zaharopoulos & Chen, 2018), while others can resort to strategies such as color blindness and assumed racial superiority to avoid engaging in explicit conversations about race (Kivlighan et al., 2019). Such defensive reactions have been shown to adversely impact communication and the ability to collaborate effectively across racial lines (Chang & Yoon, 2011) and may also result in racialized clients feeling burdened to take care of their therapists by monitoring their disclosures in order to protect the therapist's feelings (Henderson-Daniel et al., 2004). Experiences of racism can often be traumatic, and as clients share their personal experiences with such they may experience in session all the feelings these bring up, such as grief, and anger. These feelings and experiences may well in turn activate varied and challenging feelings within a White therapist, who in an effort to cope may react in any number of defensive ways, such as by withdrawing, asserting their lack of racial bias, or dismissing their clients' experiences as anecdotal or as ‘reading too much into things’. These defensive responses can be potentially traumatizing for the client (Nagai, 2009; Stevens & Abernethy, 2018). It is therefore critically important that racialized folks not encounter such responses when in need and actively seeking care and support. 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 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, 40:445–458. 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 Kivlighan, D. M. & Chapman, N. A. (2018). Extending the Multicultural Orientation (MCO) Framework to Group Psychotherapy: A Clinical Illustration. Psychotherapy, 55 (1), 39–44. http://dx.doi.org/10.1037/pst0000142 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), 763–770. http://dx.doi.org/10.1037/cou0000352 Kivlighan, D. M., Swancy, A. G., Smith, E., & Brennaman, C. (2020). Examining Racial Microaggressions in Group Therapy and the Buffering Role of Members’ Perceptions of Their Group’s Multicultural Orientation. Journal of Counseling Psychology. Advance online publication. http://dx.doi.org/10.1037/cou0000531 Knox, S. Burkard, A. W., Johnson, A. J., Suzuki, L. A. & Ponterotto, J. G. (2003). African American and European American Therapists’ Experiences of Addressing Race in Cross-Racial Psychotherapy Dyads. Journal of Counseling Psychology, Vol. 50, No. 4, 466–481. DOI: 10.1037/0022-0167.50.4.466 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 Nagai, C. (2009). Ethno-cultural and linguistic transference and countertransference: from Asian perspectives. American Journal of Psychotherapy, 63 (1), pp. 13 – 23. 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, 561-584, DOI: 10.1080/00207284.2017.1315583 Zaharopoulos, M. & Chen, E. C. (2018). Racial-Cultural Events in Group Therapy as Perceived by Group Therapists. International Journal of Group Psychotherapy, 68:4, 629-653, DOI: 10.1080/00207284.2018.1470899. For many racialized folks, racial socialization occurs in stark contrast to that of White folks (Kivlighan et al., 2019). Engagement in explicit conversations about race is critical not just for the development of a positive racial identity, but also for successful navigation of the hostile world around us (Kivlighan et al., 2019). An example of this is the tragic necessity of early conversations between Black parents and their children about how to respond to law enforcement, how to exist in public spaces, and how to make sense of the messages they receive about themselves from the world around them – conversations which facilitate protective factors such as healthy skepticism and self-esteem (Kivlighan et al., 2019). A therapeutic relationship between a client and a racialized therapist can provide an extension of this dynamic - indeed, many studies have indicated engagement with culturally similar peers to be more advantageous for racialized folks (Jones & Pritchett-Johnson, 2018).
However, even in racialized therapeutic pairs it is impossible to fully match client and practitioner, since many aspects of identity - such as sexuality and disability - can remain invisible (Chen et al., 2008). It is dangerous to assume that all racial minorities share the same experience and awareness of racism. I can't remember who I am paraphrasing here, but it is often the ones who look most like you that can hurt you the most - by which is meant that when faced with an oppressor you can at least prepare for impact, but when the slap comes from an unexpected, closer to home source, you can be caught dangerously off-guard. Internalized racism is a powerful mechanism in the maintenance of that oppressive structure. It becomes even more important to be aware of when considered in the context of the therapeutic relationship - I know I cannot ever make the assumption that any individual shares my own understanding of what it means to exist on the margins. Poor cultural competency in counselling can result in inappropriate and harmful case conceptualizations and interventions, an inability to recognize when microaggressions occur, poor counselling outcomes, poor adherence to treatment, poor health outcomes, increased prevalence of adverse events, and ultimately, premature termination of counselling services (Henderson-Daniel et al., 2004; Chang & Yoon, 2011; Brooks et al., 2019). Further, discrimination and prejudice in the lives of marginalized populations impacts access to health care resources in the first place (Henderson-Daniel et al., 2004; Collado et al., 2017), with marginalized folks more likely to receive poorer quality mental health care and more likely to drop out from treatment than White populations (Yeh et al., 2004; Chang & Yoon, 2011; Collado et al., 2017; Graham-LoPresti et al., 2017; Pinedo et al., 2018; Horwitza et al., 2020). One issue here is that the mental health field continues to be understood and situated in a predominantly Eurocentric western paradigm and is often managed through programs and interventions that ignore cultural, historical, and socio-political contexts (Henderson-Daniel et al., 2004; Lavallee & Poole, 2010; Daniels & Fitzpatrick, 2013; Vukic et al., 2011) What literature there is on this issue indicates that due to the mistrust of service providers racialized folks tend make particular decisions about how they present and may tend to be reluctant to disclose in the therapeutic environment, because of the fear of being misinterpreted, misunderstood, stereotyped, overpathologized, even incarcerated, as a result (Moodley et al., 2008; Awosan et al., 2011; Chang & Yoon, 2011; Phiri et al., 2019). In this context, how exactly is healing meant to occur for racialized populations? 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 Brooks, L. A., Manias, E. & Bloomer, M. J. (2019). Culturally sensitive communication in healthcare: A concept analysis. Collegian, 26, pp. 383–391. https://doi.org/10.1016/j.colegn.2018.09.007 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), 1261-1278. DOI: 10.1002/jclp.20533 Collado, A., Lim, A. C., & MacPherson, L. (2017). A systematic review of depression psychotherapies among Latinos. Clinical Psychology Review, 45, 193-209. doi: 10.1016/j.cpr.2016.04.001 Daniels, C. & Fitzpatrick, M. (2013). Integrating Spirituality into Counselling and Psychotherapy: Theoretical and Clinical Perspectives. Canadian Journal of Counselling and Psychotherapy, 47 (3), pp. 315–341. 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 Horwitza, A. G., McGuire, T., Busby, D. R., Eisenberg, D., Zheng, K., Pistorello, J., Albucher, R., Coryell, W. & King, C. A. (2020). Sociodemographic differences in barriers to mental health care among college students at elevated suicide risk. Journal of Affective Disorders, 271, pp. 123–130. https://doi.org/10.1016/j.jad.2020.03.115 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), 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), 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 Moodley, R., Sutherland, P. & Oulanova, O. (2008) Traditional healing, the body and mind in psychotherapy. Counselling Psychology Quarterly, 21:2, 153-165, DOI: 10.1080/09515070802066870 Phiri, P., Rathod, S., Gobbi, M., Carr, H. & Kingdon, D. (2019). Culture and therapist self-disclosure. The Cognitive Behaviour Therapist , 12 (e25), pp. 1-20. doi:10.1017/S1754470X19000102 Pinedo, M., Zemore, S. & Rogers, S. (2018). Understanding barriers to specialty substance abuse treatment among Latinos. Journal of Substance Abuse Treatment, 94, 1–8. https://doi.org/10.1016/j.jsat.2018.08.004 Vukic, A., Gregory, D., Martin-Misener, R. & Etowa, J. (2011). Aboriginal and Western Conceptions of Mental Health and Illness. Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health, 9 (1), pp. 65-86. 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 “…numbness is a quality of transgression.” (Kapil, 2001)
“Addiction is often seen as a way to find sanctuary, a way out of the feelings of powerlessness.” (hooks, 2004) Some folks respond to the stressor of racism with fatalism and resignation, passively accepting their racialized reality. This is referred to as learned helplessness (Seligman, 1974, 1992; Carver et al., 1989; Carver et al., 1993). Others exhibit depression (Isaacowitz & Seligman, 2007), while others still respond by striking out at those around them with aggressive behaviour (Hoobler & Brass, 2006; Marcus-Newhall et al., 2000). Another response is a lack of impulse control, leading to excessive patterns of eating, smoking, gambling, and alcohol and drug use (Tice et al., 2001; O’Connor & Conner, 2011; McClernon & Gilbert, 2007; Wood & Griffiths, 2007; Grunberg et al., 2011), while many people develop other, varied defense mechanisms - a term for internal methods of distorting a threatening reality so that it doesn’t seem so threatening - in response (Vaillant, 1994; Aldwin, 2007). Blaming oneself is a common response – the tendency to become highly self-critical (Ellis, 1973, 1987). The racial stressor also takes its toll on the ability to perform effectively on a task at hand (Baumeister, 1984). Being surrounded by faces that don’t look like yours and knowing that you are being seen and judged differently leads to a level of self-consciousness that disrupts attention. This and the stress response can lead to burnout (Maslach & Leiter, 1997) - a physical and emotional exhaustion, cynicism, and lowered sense of self-efficacy that can be brought on gradually by chronic stress. Racism can therefore be understood as a self-perpetuating wheel of oppression, designed to keep a racialized person forever one-down, both out in the world and - perhaps most perniciously - within our own bodies. Aldwin, C. M. (2007). Stress, coping, and development: An integrative perspective (2nd ed.). New York, NY: Guilford Press. Baumeister, R. F. (1984). Choking under pressure: Self-consciousness and paradoxical effects of incentives on skillful performance. Journal of Personality and Social Psychology, 46, 610–620. Carver, C. S., Pozo, C., Harris, S. D., Noriega, V., Scheier, M. F., Robinson, D. S., et al. (1993). How coping mediates the effect of optimism on distress: A study of women with early stage breast cancer. Journal of Personality and Social Psychology, 65, 375–390. Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267–283. Ellis, A. (1973). Humanistic psychotherapy: The rational-emotive approach. New York: Julian Press. Ellis, A. (1987). The evolution of rational-emotive therapy (RET) and cognitive behavior therapy (CBT). In J. K. Zeig (Ed.), The evolution of psychotherapy. New York: Brunner/Mazel Grunberg, N. E., Berger, S. S., & Hamilton, K. R. (2011). Stress and drug use. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 111–121). New York, NY: Springer Publishing. Hoobler, J. M., & Brass, D. J. (2006). Abusive supervision and family undermining as displaced aggression. Journal of Applied Psychology, 91(5), 1125–1133. hooks, b. (2004). We Real Cool: Black Men and Masculinity. Routledge, New York. Isaacowitz, D. M., & Seligman, M. E. P. (2007). Learned helplessness. In G. Fink (Ed.), Encyclopedia of stress. San Diego: Elsevier. Kapil, B. (2001). The Vertical Interrogation of Strangers. Kelsey Street Press, CA. Marcus-Newhall, A., Pedersen, W. C., Carlson, M., & Miller, N. (2000). Displaced aggression is alive and well: A meta-analytic review. Journal of Personality and Social Psychology, 78, 670–689. Maslach, C., & Leiter, M. P. (1997). The Truth about Burnout. San Francisco: Jossey-Bass. McClernon, F. J., & Gilbert, D. G. (2007). Smoking and stress. In G. Fink (Ed.), Encyclopedia of stress (2nd ed.). San Diego, CA: Academic Press. O’Connor, D. B., & Conner, M. (2011). Effects of stress on eating behavior. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 111–121). New York, NY: Springer. Seligman, M. E. P. (1974). Depression and learned helplessness. In R. J. Friedman & M. M. Katz (Eds.), The psychology of depression: Contemporary theory and research. New York: Wiley. Seligman, M. E. P. (1992). Helplessness: On depression, development, and death. New York: Freeman. Tice, D. M., Bratslavsky, E., & Baumeister, R. F. (2001). Emotional distress regulation takes precedence over impulse control: If you feel bad, do it! Journal of Personality and Social Psychology, 80, 53–67. Vaillant, G. E. (1994). Ego mechanisms of defense and personality psychopathology. Journal of Abnormal Psychology, 103, 44 Wood, R. A. & Griffiths, M. D. (2007). A qualitative investigation of problem gambling as an escape- based coping strategy. Psychology & Psychotherapy: Theory, Research & Practice, 80(1), 107–125. I know the consequences of the internalizations that may arise for racialized and marginalized folks. Both sets of my grandparents were born in India under British rule and as such were colonized subjects. My people entered the United Kingdom as immigrants and I was born into an England in which the politician Enoch Powell, echoing the majority feeling of the population, made his famous “Rivers of Blood” speech in the House of Commons calling for violence against those arriving from colonized lands. At the time of my birth London was host to numerous race riots, and the National Front, a far-right organization characterized by its violent skinhead youth, was extremely active. There was a deafening silence about this fact in my family, however, perhaps an internalized manifestation of the constant efforts (still) made in the dominant discourse to deny the effects of colonial practices, and that systemic racism even exists (Turner, 2020).
There is a growing literature about the profoundly negative impact of racism on mental health outcomes, the way in which oppression is internalized, and the various consequences of this. The experience of racism has been linked to higher levels of issues such as depression, psychosis, anxiety and posttraumatic stress (Henderson-Daniel et al., 2004; Karlsen et al., 2005; La Roche & Lustig, 2013; Graham-LoPresti et al., 2017). Research suggests that anxiety, including Social Anxiety Disorder, is more persistent and chronic in racialized populations than White populations. Women are already 60% more likely to have anxiety and 80 % more likely to have major depressive disorder compared to men, but racialized women often experience discrimination based on both gender and race. Psychoses are also reported to be more common in racialized groups, with a significant increased risk of schizophrenia in migrant groups from the Global South. This is just an example of what the pernicious, quotidian experience of racism can lead to in terms of mental health outcomes. “I am talking of millions […] who have been skillfully injected with fear, inferiority complexes, trepidation, servility, despair, abasement.” (Césaire, A., 1955) Césaire, A. (1955). Discours sur le Coloniali. Editions Présence Africaine. 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 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 Karlsen S., Nazroo J.Y., McKenzie K., Bhui K. & Weich, S. (2005). Racism, psychosis and common mental disorder among ethnic minority groups in England. Psychological Medicine. 35 (12), pp. 1795-803. doi: 10.1017/S0033291705005830 La Roche, M. & Lustig, K. (2013). Being Mindful About the Assessment of Culture: A Cultural Analysis of Culturally Adapted Acceptance-Based Behavior Therapy Approaches. Cognitive and Behavioral Practice, 20, pp. 60-63 Turner, D. (2020). Fight the power: A heuristic exploration of systemic racism through dreams. Counselling and Psychotherapy Research, 00:1–6. DOI: 10.1002/capr.12329 Chronic overactivation of the stress response (such as is a result of racism) can have damaging effects on many organ systems, undermining and disrupting the immune, hormonal and metabolic systems, for example (Kiecolt-Glaser & Glaser, 1995; Segerstrom & Miller, 2004; Mikkonen & Raphael, 2010). It is implicated in acute cardiac symptoms, increases in inflammation (contributing to cardiovascular risk), rheumatoid arthritis, back pain, diabetes, herpes, and irritable bowel syndrome to name but a few issues (Baker, Suchday, & Krantz, 2007; Blanchard & Keefer, 2003; Kop et al., 2008; Davis et al., 2008; Lampe et al., 1998; Landel-Graham, Yount, & Rudnicki, 2003; Padgett & Sheridan, 2000).
There are also effects on the brain: Van der Kolk (2015) argues that there are three major ways that the brain changes as a response to trauma, with the fear centre becoming oversensitive, our ability to filter out what is relevant from what isn’t becoming compromised, and the part of the brain responsible for how we experience the world changing, too. Stress can also interfere with neurogenesis, which is the formation of new neurons, primarily in key areas in the hypothalamus, which enhances learning and memory. In fact, suppressed neurogenesis may be a key component of depression. People with histories of trauma often have abnormalities in the hippocampus, the amygdala, the prefrontal cortex and changes to the autonomic nervous system (Dranovsky & Hen, 2006; McEwan, 2009; Pal & Elbers, 2018). Trauma can also effect epigenetics; it changes the way DNA is expressed, and these changes can be passed on to the next generations, which can affect how the children and grandchildren of trauma survivors react to stress, adapt to various environments, their vulnerability to certain illnesses and even their mortality (Avramova, 2015; Mangassarian, 2016). Apply this to the multi-generational experience of racism, and you get a heart-breaking picture of what happens to our communities. Avramova, Z. (2015). Transcriptional 'memory' of a stress: Transient chromatin and memory (epigenetic) marks at stress-response genes. Plant Journal, 83(1), 149-159. https://doi.org/10.1111/tpj.12832 Baker, G. J., Suchday, S., & Krantz, D. S. (2007). Heart disease/attack. In G. Fink (Ed.), Encyclopedia of stress. San Diego: Elsevier. Blanchard, E. B., & Keefer, L. (2003). Irritable bowel syndrome. In A. M. Nezu, C. M. Nezu, & P. A. Geller (Eds.), Handbook of psychology (Vol. 9): Health psychology. New York: Wiley. Davis, M. C., Zautra, A. J., Younger, J., Motivala, S. J., Attrep, J., & Irwin, M. R. (2008). Chronic stress and regulation of cellular markers of inflammation in rheumatoid arthritis: Implications for fatigue. Brain, Behavior, and Immunity, 22(1), 24–32. Dranovsky, A., & Hen, R. (2006). Hippocampal neurogenesis: Regulation by stress and antidepressants. Biological Psychiatry, 59, 1136–1143. Kiecolt-Glaser, J. K., & Glaser, R. (1995). Measurement of immune response. In S. Cohen, R. C. Kessler, & L. U. Gordon (Eds.), Measuring stress: A guide for health and social scientists. New York: Oxford University Press. Kop, W. J., Weissman, N. J., Zhu, J., Bonsall, R. W., Doyle, M., Stretch, M. R., et al. (2008). Effect of acute mental stress and exercise on inflammatory markers in patients with coronary artery disease and healthy controls. American Journal of Cardiology, 101, 767–773. Lampe, A., Soellner, W., Krismer, M., Rumpold, G., Kantner-Rumplmair, W., Ogon, M., & Rathner, G. (1998). The impact of stressful life events on exacerbation of chronic low-back pain. Journal of Psychosomatic Research, 44, 555–563. Landel-Graham, J., Yount, S. E., & Rudnicki, S. R. (2003). Diabetes mellitus. In A. M. Nezu, C. M. Nezu, & P. A. Geller (Eds.). Handbook of psychology (Vol. 9): Health psychology. New York: Wiley. Mangassarian, S. (2016). 100 Years of Trauma: the Armenian Genocide and Intergenerational Cultural Trauma. Journal of Aggression Maltreatment & Trauma, 25 (4), pp. 1-11. doi:10.1080/10926771.2015.1121191 McEwen, B. S. (2009). Stress and coping. In G. G. Berntson & J. T. Cacioppo (Eds.), Handbook of neuroscience for the behavioral sciences (Vol. 2, pp. 1220–1235). Hoboken, NJ: Wiley. Mikkonen, J., & Raphael, D. (2010). Social determinants of health: The Canadian facts. Toronto: York University School of Health Policy and Management. Padgett, D. A., & Sheridan, J. F. (2000). Herpes viruses. In G. Fink (Ed.), Encyclopedia of stress (pp. 357–363). San Diego: Academic Press. Pal, R., & Elbers, J. (2018). Neuroplasticity: The Other Side of the Coin. Pediatric Neurology, 84, 3–4. https://doi.org/10.1016/j.pediatrneurol.2018.03.009 Segerstrom, S. C., & Miller, G. E. (2004). Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychological Bulletin, 130, 601–630. Van der Kolk, B. A. (2015). The body keeps the score: brain, mind, and body in the healing of trauma. New York, New York: Penguin Books. 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. |
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