Racism as Trauma: Clinical Perspectives from Social Work and Psychology

 

Last Friday, February 26, 800 people filled the Laguna Honda Hospital & Rehabilitation Center in the beautiful Twin Peaks area of San Francisco. They were there for a Black History Month event coordinated by the San Francisco Health Network. The event featured presentations from two outstanding clinicians: Dr. Joy DeGruy, researcher, educator, and author of Post Traumatic Slave Syndrome: America’s Legacy of Enduring Injury and Healing; and Dr. Ken Hardy, professor at Drexel University College of Nursing and Health Professions, and director of the Eikenberg Institute for Relationships in New York City.

The full conference title was: 

Racial Trauma: Healing Ourselves, Our Clients, & Our Communities: Addressing the aftermath of historical trauma and today’s societal need for racial humility

Dr. DeGruy framed the day’s conversation when she drew a compelling correlation between the DSM V (Diagnostic and Statistical Manual of Mental Disorders) criteria for Post-Traumatic Stress Disorder, and the experiences that have defined life for African Americans in the US for 400 years, from enslavement through today’s epidemic of disproportionate state violence and incarceration plaguing the African American community.

With this correlation, Dr. DeGruy made a strong, clear argument for why race and racism need careful consideration by ACEs communities as we attempt to address and remediate trauma. Effective strategies for screening for adverse childhood experiences, as well as strategies for building resilience, will need to account for how racism traumatizes communities. And these strategies will necessarily need to adapt to the unique ways different communities experience racism.

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ACEs Connection member, Daisy Ozim (right) with Dr. Joy DeGruy (left)



“Truthfulness is the foundation of health. It is secrets that make us ill"

Dr. DeGruy’s presentation turned on a central theme: that part of the reason people struggle to heal from racial trauma, why generations continue to have trauma inflicted upon them, is that American society has been unwilling to truthfully address its history of racism. Her book, Post Traumatic Slave Syndrome, as well as her body of work and presentations to wide-ranging, global audiences, attempt to fill this gap by providing historical details which most Americans have never learned. Dr. DeGruy discussed how the silence around racism, and the work it takes to maintain that silence, impacts both victims and beneficiaries of racism alike. In the context of anti-black racism in American society, Dr. DeGruy notes that white Americans have had their ability to feel and to empathize, impaired. This impairment needs to be acknowledged, addressed, and healed. The pathway to this healing is to embrace historically accurate knowledge. When there are secrets, no one escapes unwounded.

The implications for those who serve as providers to society’s most vulnerable communities -- those struggling with a variety of forms of trauma -- is that providers must work to break down that clinical distance, for the sake of their clients’, as well as their own, health. Dr. DeGruy advised, To systemically traumatized communities, relationship is more important than traditional, distancing clinical "rapport". And that stance of distance is equally harmful to providers who have not reckoned with the historical trauma of racism.

"Invisible Wounds of Trauma"

Dr. Hardy’s message was just as powerful. He focused on the “invisible wounds of trauma” that science shows send many African Americans to an early death. He believes that learning to talk about the pain of racism could literally save lives. His message of the day was to help African American communities find their voice. 

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RYSE Youth Center Staff represent!



Dr. Hardy issued a strong public health argument for addressing the trauma of racism at the individual level. He has observed in his clients over the years, that the constant wounds of racism, the assaults on dignity, the continuous energy expended to find ways to circumvent the effects of racism on one’s life, create wounds that manifest as mental health diagnoses. He has also found that when people are en/abled to talk about these experiences of racism, they find relief from their distress.

This was a phenomenal insight, one that links right to the root of the original ACEs work. Dr. Vincent Felitti found that having people fill out an extended bio-psycho-social questionnaire and then having a nurse-practitioner talk with them about their ACEs at their first visit, was enough to reduce ER and physician visits. Just the acknowledgement of their trauma, as well as the ability to have another person listen without judging, was healing. Later research found that this effect persisted over years. If we are to accept that racism traumatizes, then we must find ways to provide the interventions necessary to reduce and heal that trauma.

Both Dr. DeGruy and Dr. Hardy observed that this traumatization of African American communities -- unbroken since Africans were first brought to these colonies, until today -- has gone without therapy to address and remediate the trauma. Dr. Hardy stated, “When you’re dehumanized, there is no expectation that you even need healing”.

This painful truth becomes a powerful starting point for ACEs work: to teach the clinical, policy, and practice worlds that there is, indeed, a need for healing.

Click here for the storified live-tweets from the conference.

For more on this event, go to ACEs Connection member Alicia St. Andrews post at: http://www.acesconnection.com/...ble-wounds-of-trauma

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Hi Paul, 

That's exciting to read about your ongoing work as well as your upcoming work with Dr. Felitti!  Re-entry is definitely an issue that needs trauma-informed staff for every aspect of the process. I hope you will continue to post your work here on this website; it will be a great resource for those who are also interested in improving service to this population. 

Good Morning, Dr. Donielle Prince,

It has been a refreshing morning, having read the article you published in the ACES Connections for California about the gathering last week at Laguna Honda.  I have been looking for a body of work that reflects the impact of Adverse Childhood Experiences on communities of color. I knew it must have been done because of the sadness and depression that bounces around on the minds of shackled souls. We field tested the ACES questionnaire in African American churches - because a Kaiser Permanente population does not reflect the biases suffered by Black people.  It was the weight of Jim Crow that made Black men bend over. It has been over a dozen years since this work was originally published.  Others must have seen what we saw. 

On September 12, 2015,  San Diego Black Health Associates, Inc.  brought Dr. Vince Felitti, Principal Investigator for the ACES Study and Dr. Cheryl Grills, Ph.D., Immediate Past President of the Association of Black Psychologists for a community forum on ACEs and Their Impact on Health Disparities . Rather than on a university campus, the event was held in Southeast San Diego - at no charge - in the community with the highest concentration of African Americans and Hispanic Americans and a cluster of advocates working hard to improve health and welfare. Over 100 residents spent the morning working through the insights, viewing cartoons and cascading forward from one adversity to another, we learned about  ACES and the importance of trust on the pathway to survival.  Here is a summary of the event, published in the Voice and Viewpoint Newspaper((http://sdvoice.info/ace-impact...ve-their-own-health/). 

David Chadwick, MD, Medical Director for Children's Hospital in San Diego saw it when the research was first published last decade.   Dr. Chadwick launched a training effort in Juvenile Hall to get parents, counselors and correctional officers working with foster kids on acts of hostility. In our conversation in 2013, Dr. Chadwick made clear the importance of this work to reach young people, who were otherwise in isolation and confined in an exit-less correctional system.  Samir Chatterjee, PhD and I pursued the development (at Claremont Graduate University) of devices (hand-held games) with PTSD (Post Traumatic Stress Reduction) grant funds which could help release hostilities among veterans who had returned from Iraq. We argued then that PTSD-type approaches would also be relevant on African American and Hispanic youth, who had witnessed violence and acts of murder.  We presented Dr. Felitti as a keynote speaker at "Patient Empowerment through Innovations Conference" held in Pasadena (November 2012). 

How this all becomes so very important is that SDBHA has been working to design a RE-ENTRY Program in San Diego, that is built around a higher consciousness focused on prevention, public health and mental health integrated with career training, substance abuse management  and soft-skills development.  We believe that a "Rites of Passage" is important in working with men and women who have been targeted as "teaching material" and who have been depressed/suppressed and made helpless by not being asked the right question.  Helping a man or woman become more fully established as a positive asset to the community and society means that they trust the advocates to not sell them out. This means having been mindful of the consciousness of a victim, and how not to judge a person because of poverty.   Dr. Felitti is prepared to work with us to help build a mental health - physical health screening tool - so we can identify who has which needs and how many of those needs existed upon incarceration still exist. We also need to develop a model to ensure that the rising force of good choices displaces the falling force of depressed, futureless lives. Support from social workers, psychologists, psychiatric nurses and physicians who are known and trusted by men and women on both sides of the correctional bars is needed.(simmstech@cox.net)

I had grown discouraged, not being able to identify and obtain funding for the elements of OASIS that need building. At first, we were promised funds from a 1% tax on the income of millionaires.  Today, over $15 million is being held in reserve and only generalizations as it funding intent.  Our planning effort has been two years in the making.  Until this morning, I was unclear what to do next, in the way of promoting system change and connecting Re-Entry to some of the forces which result in a different from of enslavement. Being denied a right to become fully integrated into a community, because of a felonious conviction, might be just the right place for ACES.  It would definitively be a platform  that would help restore balance in our communities and connect resources and families.  I know what to do now.  Thank you very much.

Paul B. Simms, Visiting Scholar

Claremont Graduate University

 

 

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