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Race-Based Traumatic Stress: Page 2 of 2

Race-Based Traumatic Stress: Page 2 of 2

Connecting racism to mental health
Generic definitions of racism do not provide concrete and specific terms that describe the types of events that may lead to emotional reactions or psychiatric symptoms. With the use of more specific types of racism, it is easier for targets, mental health professionals, and lawyers to make direct links to emotional and psychological reactions.

Anna's encounter with racism is better understood as racial harassment designed to demean and denigrate her as an employee and as a person. Thus, a mental health professional can link the racial encounter to her emotional and psychological reactions. It therefore becomes possible to assess and document race-based psychological and emotional injury and treat it, as well as assist
the legal process when complaints are lodged in courts or within organizations. This begins to address the complicating factor that difficulty in obtaining legal redress for racism may itself be an additional source of psychological harm to those who are targets of racism.

The law: a source of
psychological harm

The erosion of legal remedies makes the need for ways to think differently about racism and its mental health effects more imperative.9 It is extremely difficult, and perhaps psychologically damaging, for a person to establish a claim of racial discrimination (disparate treatment or disparate impact). Historically in the United States, many laws and legislative acts have been directed at racism, and these predate laws for other protected groups; yet, more progress has been made with respect to sexual discrimination and harassment than with racial discrimination.10 Sexual discrimination and sexual harassment are treated as distinct events; furthermore, sexual harassment claims can be established without evidence that the defendant intended to harass or discriminate.

In contrast, racial harassment is not treated as a distinct event. When a complaint is filed, the plaintiff must show that the defendant acted with intentional racial animus. It is more difficult to establish that one was psychologically harmed or experienced emotional distress in racial discrimination cases. Complicating the effort to establish claims for emotional distress is the fact that assessment criteria used by mental health professionals are not specific to the racial aspect of the experience. These difficulties are exemplified by the fact that in 2005, of the 26,740 claims of discrimination filed, 68% were dismissed by the Equal Employment Opportunity Commission because investigations found that they did not meet the requirements necessary to seek legal remedy.11

The approach I advocate distinguishes racial acts so that it is possible to connect the type of act of racism to specific psychological and emotional reactions. The specific types of racism will make it easier to label race-based encounters as avoidance (racial discrimination), such as when persons are falsely told there are no job openings; as hostility (racial harassment), for example, when they are followed in a store; or aversion/hostility (discriminatory harassment), such as being suspended from school.

Anna's experience illustrates the utility of the approach I advocate for differentiating the types of racism. She was not being avoided nor was she subjected to aversion/hostility; rather she was the target of hostility or racial harassment designed to communicate her inferior status at work. Her experience was, in part, a matter of perception, and there is considerable dispositional variation in how persons perceive their experiences in general and with race and racism in particular. One aspect of dispositional or individual differences regarding how one processes racial information is one's racial identity ego status (ie, psychological orientation to one's demographic racial group), which is distinct from one's demographic group or "race identity." Racial identity applies to members of all races in North America. Racial identity ego status is associated with a constellation of different thoughts, behaviors, attitudes, values, and emotions.

A matter of perception
Regarding perceptions, several important empiric research findings taken from the evidence I have presented are noteworthy. Researchers have shown that stress—whether objective (eg, sudden death of a loved one) or subjective (perception of harm)—affects both physical and mental health.3 Thus, when the effect of stress or trauma is a consideration, perceptions are as valid as verifiable events. The practice of relegating the experiences with racism of blacks and others of color to subjective forms of perception actually reflects subtle racism.

Mental health professionals and psychiatrists should work to affirm the person's possible harm or injury, and racism should be treated as a potentially harmful experience that warrants treatment and redress. Clark and colleagues12 have stated that "to discount perceptions of racism as stressful is inconsistent with the stress literature, which highlights the importance of the appraisal process. . . . The perception of demands as stressful is more important in initiating stress responses. . . . With this in mind, the initiation of psychological stress responses as a result of perceiving . . . racism would qualify [such] stimuli as stressors (p 810)."

In order for a person (either patient or psychiatrist) to recognize racism, he must have a developed and mature racial identity ego status. Thus, as part of the assessment process, it should be determined that the person is able to recognize racism and understand its meaning. However, to be able to appreciate racial experiences in others, clinicians must have an evolved personal understanding of their own demographic racial group, in which their race and culture are valued.

In the interview with Anna, I specifically asked about prior experiences with race and how she perceived race relations, and I questioned her about how she had coped with the situation at work. I learned that she had a mature and developed racial identity ego status and could accurately recognize her experiences as racial discrimination.

Concluding thoughts
The models and concepts that I have presented regarding how to think and use race and culture in a more complex, psychologically grounded way are consistent with people's experiences. Most people recognize that skin color or socially constructed racial categories do not accurately indicate how a person thinks and behaves. Racial identity ego status treats all people as members of distinct racial and cultural groups and recognizes that there is considerable individual variation. What matters is not skin color but how individuals think and feel about their racial group.

The combination of racial identity ego status and the race-based traumatic stress approach offers mental health professionals a way to assess patients and develop treatment strategies and interventions that address the complexity of race and culture. The use of race-specific and psychologically based models will aid in the efforts to reduce mental health disparities.

Dr Carter is professor of psychology and education in the department of counseling and clinical psychology at Teachers College, Columbia University in New York. He reports that he has no conflicts of interest concerning the subject matter of this article.

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References

References
1. US Public Health Service. Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Available at: http://www.surgeongeneral.gov/library/mentalhealth/cre/. Accessed October 23, 2006.
2. Williams DR, Williams-Morris R. Racism and mental health: the African American experience. Ethn Health. 2000;5:243-268.
3. Carter RT. Racism and psychological and emotional injury: recognizing and assessing race-based traumatic stress. Counsel Psychol. 2007;35:1-93.
4. Carter RT, Forsyth J. Mazzula S, Williams B. Racial discrimination and race-based traumatic stress. In: Carter RT, ed. Handbook of Racial-Cultural Psychology and Counseling: Training and Practice. New York: Wiley; 2005;447-476.
5. Hicks JW. Ethnicity, race, and forensic psychiatry: are we color-blind? J Am Acad Psychiatry Law. 2004;32: 21-33.
6. Butts HF. The black mask of humanity: racial/ethnic discrimination and post-traumatic stress disorder. J Am Acad Psychiatry Law. 2002;30:336-339.
7. Bell C. Racism: a mental illness? Psychiatr Serv. 2004;55:1343.
8. Breland-Noble AM, Bell C, Nicolas G. Family first: the development of an evidence-based family intervention for increasing participation in psychiatric clinical care and research in depressed African American adolescents. Fam Process. 2006;45:153-169.
9. Green TK. Discrimination in workplace dynamics: toward a structural account of disparate treatment theory. Harvard Civil Rights-Civil Liberties Law Rev. 2003;38:91-157.
10. Buff DM. Beyond the courts standard response: creating and effective test for determining hostile work environment harassment under title VII. Stetson Law Rev. 1995;24:719-764.
11. US Equal Employment Opportunity Commission. Race-based charges FY 1992-FY 2006. Available at: http://www.eeoc.gov/stats/race.html. Accessed October 25, 2006.
12. Clark R, Anderson NB, Clark VR, Williams DR. Racism as a stressor for African Americans: a biopsychosocial model. Am Psychol. 1999;54:805-816.

 
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