Racial Trauma and BIPOC Mental Health | Affirmative Heart Counseling

Racial discrimination and systemic oppression inflict deep psychological wounds on Black, Indigenous, and People of Color (BIPOC). The relentless trauma of racism can profoundly impact mental health, causing trauma, anxiety, depression and more. However, mainstream society and healthcare systems often fail to recognize or adequately address this crisis.

This article explores the concept of Racial Trauma, its impacts on BIPOC individuals, and culturally responsive treatment approaches. Treatment must empower and restore cultural identity, not just manage symptoms. Liberation from racism’s toll involves both clinical interventions and collective action.

Defining Racial Trauma

Racial trauma refers to the mental and emotional distress caused by encounters (either direct or indirect by witnessing, hearing about, or being exposed to the traumas of others via news media) with racial bias, discrimination, overt acts of racism, and hate crimes. Racial trauma can occur from a single distressing racist event or from repeated exposure to prejudice and discrimination over time. This ongoing trauma is sometimes called Race-Based Traumatic Stress.

Race-based Traumatic Stress (RBTS) is a mental and emotional injury caused by encounters with racial bias, ethnic discrimination, racism, and hate crimes. It’s a concept that seeks to encapsulate the unique experiences and challenges that individuals face in relation to Racial Trauma. I think of it as the racial justice form of complex post traumatic stress disorder (C-PTSD).

It is important to remember that Racial Trauma does not happen in isolation and is not a “disorder” in the person experiencing it. It stems from systemic racism – entrenched societal systems and institutions that perpetuate racial inequity and disadvantage BIPOC individuals. Systemic racism manifests in disparities across education, healthcare, housing, employment, and other domains. Exposure to these inequities over time contributes to Racial Trauma and the formation of RBTS in BIPOC individuals.

For example, in education, BIPOC students face issues like stereotype threat, Eurocentric curricula, harsher discipline, and underfunded schools. In healthcare, BIPOC individuals often receive lower quality care, inadequate pain management, and improper diagnosis. Discriminatory housing policies have led to segregated neighborhoods and generational poverty. Racial wage gaps, hiring discrimination, and glass ceilings limit economic opportunities.

The repeated exposure to these inequities and stressors can lead to traumatic responses like hypervigilance, fear, and feelings of powerlessness. Lack of access to mental health resources also prevents healing, continuing the cycle. Ending this cycle requires examining and reforming systems that enable racism.

Impacts of Racial Trauma

C-PTSD and RBTS

Complex Post-Traumatic Stress Disorder (C-PTSD) is a psychological condition that arises from prolonged exposure to traumatic situations, often in situations where the individual feels they have little or no control and is trapped, such as cases of ongoing abuse, oppression, discrimination, domestic violence, or captivity. Unlike PTSD, which typically stems from a singular traumatic event, C-PTSD is characterized by continuous exposure over time. Symptoms of C-PTSD can include emotional dysregulation, difficulties with interpersonal relationships, a negative self-concept, and a distorted perception of the perpetrator.

Race-Based Traumatic Stress can be seen as a specific expression of C-PTSD, with a focus on the unique characteristics of Racial Trauma. While it shares many features with C-PTSD, RBTS emphasizes the racial dimension, taking into account the complex interplay of personal, systemic, cultural, and historical factors. It offers a framework for understanding and treating Racial Trauma that recognizes its distinct nature and the specialized approach required for effective support and healing. By framing it within the context of C-PTSD but also differentiating it, mental health professionals can better tailor their approaches to meet the specific needs of those experiencing race-based traumatic stress. I also prefer it because it does not include the word “disorder” in the label, although sometimes, for insurance purposes, accommodation letters, medical treatment like medications, or medical leave and disability benefits, a diagnosis of PTSD with the concept of “disorder” attached, is necessary.

For BIPOC individuals facing Racial Trauma, the symptoms of RBTS permeate daily life and relationships. Effects extend beyond mental health into chronic pain, fatigue, and other physical symptoms.

Symptoms of C-PTSD and RBTS

Both C-PTSD and RBTS emerge from exposure to chronic, repeated trauma, often taking place over a long period. In the context of Racial Trauma, these symptoms can be accentuated or uniquely manifested:

Emotional Regulation Difficulties: Individuals may experience frequent mood swings, intense anger, or persistent sadness, all of which can be exacerbated by racial microaggressions or overt racism.
Negative Self-Perception: Persistent exposure to Racial Trauma can lead to feelings of worthlessness or shame. Individuals may internalize racist stereotypes, leading to a distorted sense of self.
Interpersonal Challenges: Trusting others and forming close relationships may be difficult due to consistent experiences of betrayal, discrimination, or exclusion based on race.
Dissociation: This involves a disconnect from one’s thoughts, emotions, or body, often acting as a defense mechanism against relentless trauma. It might manifest more intensely in Racial Trauma contexts due to the continuous and pervasive nature of racism.
Avoidance and Hypervigilance: BIPOC individuals might avoid situations that remind them of Racial Trauma, or they may be constantly on alert for potential racial threats.
Increased Vulnerability: Chronic exposure to Racial Trauma can increase vulnerability to mental health disorders, including anxiety, depression, and substance abuse.
Distorted Perception of the Perpetrator: This includes idealizing the perpetrator, internalizing their beliefs, or becoming preoccupied with understanding their actions. In Racial Trauma contexts, it may manifest as acceptance of systemic racism or focus on those upholding it. Fear, loyalty, or dependency on the perpetrator may also be present, reflecting complex coping mechanisms.

Symptom in Focus: Distorted Perception of the Perpetrator

This symptom can manifest in several ways, including, but not limited to:

Idealization: Sometimes, a person who has experienced prolonged trauma might idealize the perpetrator, especially if the trauma involves an authority figure or someone close to the victim. This idealization can be a coping mechanism, allowing the victim to reconcile the cognitive dissonance created by the harmful actions of someone they otherwise respect or depend on.
Internalization of the Perpetrator’s Perspective: Victims may internalize the beliefs or values of the perpetrator, adopting their views, especially if the trauma is repetitive and there is a power imbalance. This internalization can be seen as a survival strategy, aligning oneself with the perpetrator’s worldview to minimize conflict and additional harm.
Fear and Dependency: Even if the victim recognizes the harm done by the perpetrator, they may still feel a sense of fear, loyalty, or dependency. This is particularly common in cases where the perpetrator has significant control over the victim’s life, such as in domestic abuse or in systemic racism where institutions wield power.

All of these experiences may manifest in behaviors within a BIPOC individual such as assimilation and disowning one’s own culture or heritage as a coping strategy.

Why does this happen? As a therapist, I have seen that a common response to trauma includes internalizing and blaming oneself for being inferior in some way, believing that one brought on the abuse by being deserving of it or having provoked it. This way of conceptualizing one’s own trauma is sometimes easier than externalizing the blame onto the perpetrator (where it truly belongs) because it gives the victim a greater sense of control.

We are beings who are wired to need a sense of control and choice at least in some small ways in order to retain a sense of self and hope. Therefore, to maintain that sense of control, for example, I may decide that I am to blame for my own trauma because I was weak, or failed to fit in, or said or did the wrong things. Those are all things about myself that I can try to alter in order to avoid further trauma and pain from the perpetrator.

However, if I conceive of my perpetrator as just an unreasonable torturer and that I did nothing to warrant the mistreatment, then I may feel that I lose control over the ability to save myself from further pain. The idea of that can be truly frightening and overwhelming to the point that it might drive me to complete and intolerable hopelessness and helplessness. Understanding the nuances and complexity of this particular symptom is essential for therapists hoping to help their clients suffering from RBTS.

Other Conditions Associated with Racial Trauma

Racial discrimination also contributes to mental health conditions like:

Depression – Hopelessness, low self-esteem, loss of interest
Anxiety disorders – Chronic worry, restlessness, panic attacks
Substance abuse – Using alcohol/drugs to cope with trauma
Psychosis – Discrimination may increase psychotic symptoms
Somatization – Manifesting psychological distress as physical symptoms
Suicidal thoughts – Trauma can lead to suicidal ideation

Concrete Impacts on Physical Health

Racial trauma can seriously impact physical health, especially in communities facing health disparities. Discrimination and chronic stress cause allostatic load – strain on the body from repeated neural and hormonal responses. This can lead to illness like hypertension, heart disease, diabetes, and weakened immunity.

Studies reveal higher rates of stress-related illnesses in BIPOC communities. Racism likely contributes to health disparities even when controlling for socioeconomic status. Disparities in healthcare access and treatment also exacerbate the trauma’s health effects.

Addressing health disparities requires considering Racial Trauma and making systemic reforms to eliminate bias in healthcare and society. The trauma of racism has clear physiological effects that must also be addressed. The body is a system, and mental health is not something we can treat in isolation.

Treating Racial Trauma

Culturally Sensitive Treatment Modalities

Supporting individuals with Racial Trauma requires cultural sensitivity and addressing systemic factors, not just individual symptoms. Mainstream treatments like CBT, EMDR, and group therapy can help but are most effective when applied in a culturally responsive way. Culturally responsive therapies are approaches to mental health treatment that are attuned to the specific cultural context of the individual seeking care. These therapies respect and incorporate the client’s cultural values, beliefs, and practices into the therapeutic process to better address their unique needs and enhance treatment outcomes.

Here is a handful of therapy approaches that can be adapted to become culturally responsive (though almost any approach can be modified to be culturally responsive with proper attention and care):

Culturally Adapted Cognitive-Behavioral Therapy (CA-CBT): Cognitive-Behavioral Therapy (CBT) is a widely-used therapeutic approach that focuses on changing maladaptive thoughts and behaviors to improve emotional regulation and develop personal coping strategies. CA-CBT modifies traditional CBT to better fit a patient’s cultural context, such as including culturally relevant metaphors and examples, or integrating cultural traditions and beliefs into the therapy process.
Narrative Therapy: This approach values the client’s lived experiences and personal stories. Therapists using this approach believe that people are the experts in their own lives and encourage them to tell their stories in a way that strengthens their sense of identity and resilience. This therapy can be highly culturally responsive when it acknowledges and respects the unique cultural narratives and experiences of BIPOC individuals.
Intersectional Therapy: Intersectional therapy takes into account the multiple, intersecting identities that a person may have, such as race, ethnicity, gender, sexual orientation, socioeconomic status, and more. This therapy approach considers how these identities interact with societal structures and acknowledges the specific challenges, biases, and power dynamics an individual might experience due to these intersecting identities. (This is the backbone of my own approach.)
Traditional Healing Practices: Some therapists may incorporate traditional healing practices from the client’s culture into the therapeutic process. These could include practices like indigenous healing rituals, spiritual or religious practices, or traditional medicine. It’s important to note that these practices should be used ethically and respectfully, with a clear understanding of their cultural significance–and typically should be performed by therapists of the same culture as the healing practice they are engaging in to avoid appropriation.
Multicultural Counseling: Multicultural counseling focuses on the counselor’s competency in understanding and respecting cultural differences. It involves tailoring the therapy process to accommodate the cultural values, beliefs, and practices of the client. This can range from recognizing the impact of microaggressions to understanding the cultural significance of certain behaviors.

Therapeutic Directions and Goals: Decolonization of the Self

The following is strictly my take on some important directions and goals for treating and supporting those with Racial Trauma, whatever modalities are chosen. In my opinion, therapeutic interventions should be carefully tailored to help the person unravel the intense emotions and perceptions associated with Racial Trauma and its other associated impacts. This is especially if the individual’s coping strategy has been to internalize the trauma and assimilate or otherwise join with the oppressor. Helping someone decolonize themselves is a delicate, but necessary process if liberation is to be achieved.

Furthermore, because of the unlikelihood of solving all the systemic issues that create the conditions for Racial Trauma within our lifetime, the idea of “healing” (in the sense of finding a “cure”) from it is for a BIPOC individual is complex and difficult. A more nuanced definition of “healing” that includes concepts like “thriving despite of” and incorporating goals of decolonization of self by moving away from harmful coping strategies to positive coping strategies is more accurate.

During treatment, it is important to acknowledge the adaptive functions that internalized beliefs have served, even if they are now considered unwanted. Adaptive functions are not “bad” or “wrong” per se. Although they may have harmed the client in the long run, they have also allowed the individual to survive hostile situations. It is important to remember that the person is a victim and that criticizing their coping strategy may blur the line toward victim blaming. Accountability for harms toward others, however, is still appropriate and important to re-establishing self integrity and trust in self.

Creating space for all of this will involve assisting individuals in understanding the systemic nature of their trauma while finding other ways to feel a sense of control and choice. It will require processing significant amounts of grief over a lost understanding of self, missed opportunities for a sense of belonging, and broken connections with their cultural heritage and birthrights within said culture. Further, time must be set aside for processing and discouraging further self-blame that may take the form of self-flagellation for their use of assimilation as a coping strategy, as well as coming to terms with harms they may have perpetuated by upholding ideals and using the tools of the oppressors for their own survival.

Overall, therapy must combat the cognitive distortions, self-abandonment, and self-hate that may have arisen, while working to rebuild a sense of empowerment and agency, grounded in the client’s deepest core values and their emerging authentic identity as they become reconnected to their cultural heritage.

The Role of Empowerment

Perhaps most imperative to treatment strategizing is recognizing that the need for a sense of control is a fundamental aspect of psychological well-being, especially when working with trauma. The need for a sense of control is rooted in our evolutionary biology and plays a crucial role in how we navigate our environment, relationships, and self-concept. Having a sense of having some control, autonomy, choice, and influence can be collectively grouped under the umbrella of “empowerment”.

When our sense of control is taken away and our ability to cope with the loss of it is overwhelmed, as is the case with trauma, it disrupts our sense of safety, predictability, autonomy, and purpose. This experience can lead to a cascade of negative psychological effects, ranging from stress and anxiety to depression and existential despair.

The Necessity of Empowerment

Cognitive Framework: Control serves as a cognitive framework that helps individuals predict and understand their environment. A sense of control enables us to navigate complex social systems, make decisions, and engage in goal-directed behavior.
Autonomy and Agency: Control is linked to autonomy, the ability to govern oneself, and agency, the sense of efficacy in one’s actions. These are central to identity formation and self-esteem.
Stress Reduction: Having control often reduces feelings of stress and anxiety. When we believe we can influence outcomes, we tend to feel more secure and optimistic.
Motivation and Goal Pursuit: Control fosters motivation by allowing individuals to set and pursue goals. It enhances our belief in our ability to achieve what we desire.
Social and Evolutionary Aspects: From an evolutionary perspective, control over one’s environment was vital for survival. Those who could adapt and influence their surroundings were more likely to thrive.

The Devastating Effects of Losing Empowerment

Depression and Anxiety: Chronic loss of control is strongly associated with depression and anxiety disorders. It undermines self-efficacy and can lead to a negative spiral where lack of control leads to further mental health deterioration.
Physical Health Impact: Loss of control has been linked to negative physical health outcomes, including cardiovascular problems and weakened immune response, likely due to chronic stress.
Social and Relationship Challenges: Lack of control in interpersonal relationships can lead to conflict, dissatisfaction, and disconnection. It may impair one’s ability to form and maintain healthy relationships.
Existential Crisis: Profound loss of control, such as in the face of a terminal illness or immense societal injustice, can lead to existential crises, where fundamental beliefs and values are challenged.
Learned Helplessness: This state develops when an individual repeatedly encounters racially charged situations that seem uncontrollable or inescapable, leading to a generalized belief that their actions have no effect on their circumstances. Consequently, they may disengage from social, political, or personal endeavors that could improve their situation, as they perceive these efforts as futile. This withdrawal can further entrench feelings of despair and disconnection, thereby exacerbating the impact of Racial Trauma.

As seen here, the negative effects of losing empowerment are similar and even the same as the symptoms of C-PTSD and RBTS. Therefore, creating a therapeutic environment that restores a sense of control, fosters empowerment, reinstates hope, and supports resilience is vital to the process of creating positive coping strategies.

Empowerment Strategies

Cultivating Personal Agency: Encouraging autonomy, self-awareness, and the recognition of personal strengths can help BIPOC individuals reclaim control and resilience in the face of RBTS.
Cultural Connection and Pride: Building connections within racial and ethnic communities fosters a sense of belonging and validation. Reconnecting with cultural heritage and traditions can be a source of strength and pride.
Education, Self-Advocacy, and Social Justice Movements: Understanding the structural and systemic origins of Racial Trauma empowers individuals to advocate for themselves and others within their community. It moves the blame from the individual to the broader society, where it belongs.

Strategy in Focus: Enhancing or Instilling Cultural Pride

Cultural pride enables individuals to reconnect with their heritage, traditions, and values. This connection fosters a sense of belonging and continuity, often restoring a sense of self that may have been eroded by Racial Trauma. Cultural pride can be a source of strength and empowerment, allowing individuals to reclaim narratives that have been suppressed or distorted by systemic racism. Embracing cultural pride builds community connections, solidarity, and mutual support, essential elements in the collective healing process. Fostering cultural pride helps counteract internalized racism, where the negative stereotypes and prejudices of the dominant culture are absorbed by the marginalized group. By celebrating and valuing their culture, individuals can resist or heal these harmful internalizations.

Strategy in Focus: Involvement in Social Justice Movements

Encouraging clients suffering from Racial Trauma to become involved in advocacy for themselves and others is a potent way to re-establish feelings of empowerment. Engaging in social justice movements that align with personal values and community goals can foster a sense of collective empowerment. This collective action provides a sense of purpose and helps individuals realize they are not alone in their struggle.

Involvement in liberation movements actively challenges the systemic oppression that underlies Racial Trauma. This action helps transform feelings of helplessness into active resistance, rekindling a sense of control and influence. Furthermore, finding camaraderie and understanding among others who share similar experiences can promote emotional healing. The sense of solidarity often found in social justice movements can be deeply affirming. By contributing to a larger movement for change, individuals can connect their personal healing journey to a broader vision for a more equitable and inclusive future.

Engagement in social justice movements serves as a bridge between personal healing and systemic change. It provides avenues for collective empowerment, emotional connection, and active resistance against oppression. The very act of joining in the fight for liberation can be a profound positive experience, weaving personal resilience into a larger goal of social transformation.

In the struggle for liberation and justice, BIPOC individuals not only contribute to positive societal change but also engage in a personal journey of empowerment, healing, and self-realization. By intertwining the personal with the political, they forge a path that transcends trauma and builds a legacy of resilience, compassion, and hope for future generations.

Conclusion

Trauma-informed care in this context involves recognizing Racial Trauma as requiring systemic change, including improved mental healthcare access and reducing inequities. Racial trauma is a complex issue needing both individual treatment and societal reforms for true wellbeing. Widespread education, policy changes, and societal attitude shifts are needed to address Racial Trauma as a public health crisis. Both clinical treatment and systemic reforms are vital for reducing Racial Trauma and disparities for BIPOC individuals.

All therapists, but especially white therapists, should aim to become deeply knowledgeable about Racial Trauma, because finding a culturally sensitive provider is crucial for BIPOC individuals seeking therapy and there are simply not enough BIPOC therapists who have overcome the systemic barriers in place to enter the profession.

On a personal note as a BIPOC individual and as a therapist, I encourage other BIPOC individuals to reconnect with their cultural heritage and immerse themselves in the elements of their culture that have resisted colonial influences. Join grassroots movements that fight for our rights and for better treatment for us all. Find solidarity with other like-minded BIPOC individuals. This reconnection serves as an act of resistance, helping individuals reclaim their identities in a society that marginalizes them. This connection to our community and our pre-colonial heritage helps us survive and thrive despite the daily traumas we face in a society that has been built to exclude and eradicate us.