How can we prevent retraumatization of vulnerable individuals and enable them to seek redress?
Individuals who are denied agency have all the more need to exercise it. Psychiatric clinicians can help empower patients to exercise their agency, including by resorting to legal remedies. Moreover, clinicians who advise public and private institutions on risk management can provide guidance for preventing retraumatization of vulnerable individuals, as well as enabling such individuals to seek redress.
Restorative justice offers those who have been disenfranchised, marginalized, and disempowered a means of recovering agency. The need to respond to the harms that hate speech creates in vulnerable populations is imperative as humanity increasingly spreads messages via social media. New research on survivors of traumatic incidents and those who live with the day-to-day trauma of ambient prejudice demonstrates a need to empower victims of hate speech against its perpetrators.
Some foreseeably vulnerable individuals are those who have previously been traumatized by hate acts based on their racial, ethnic, or religious identity.1 Such crimes can range from a legacy of insidious discrimination to slavery and genocide.2 There is now an urgent need to provide effective support for such individuals in the wake of the murders, rapes, babies in ovens, kidnappings, and torture committed by Hamas against Israelis and the further atrocity of Hamas using Palestinians as human shields.
Hamas has placed both Israelis and Palestinians in a situation of choiceless choices.3 Israelis are confronted with the prospect of endless terror, and Palestinians are confronted with continuing to be held hostage by Hamas. This tragic conflict has occasioned a worldwide recurrence of virulent, threatening hate speech against Jews who may have been traumatized directly or indirectly by the Holocaust, as well as against Palestinians and other Muslims who may have been traumatized by hate speech and threats after the terrorist attacks on September 11, 2001, or October 7, 2023.
To focus on a timely and horrific example, Jewish students at Cornell University were subjected to online shooting threats, posts encouraging the rape and murder of Jewish students and calling for Cornell’s Center for Jewish Living to be torn down, and a professor’s off-campus speech calling the attack on Israeli civilians by Hamas “exhilarating.”4
Initial trauma can be compounded when it occurs under the veneer of rationalizations in which hate acts are normalized and the victim feels helpless to seek protection or redress. Such helplessness in the face of injustice is a predisposing factor to compounding the harms of complex posttraumatic stress disorder (CPTSD) and its close cousin, extreme personality change after a catastrophic experience (EPCACE).5
CPTSD is a constellation of symptoms thought to represent demoralizing personality changes and an increased propensity for distrust, fearfulness, frustration, and self-hatred resulting from repeated exposure to traumatic experiences and victimization.1 When one feels helpless to respond, helplessness also predisposes to the transgenerational transmission of traumatic vulnerability.
Even the perception of rising vitriol is as much a health risk as direct threats. In recent years, a number of antisemitic hotspots have ignited public displays of antisemitism in the United States, including the Unite the Right rally in Charlottesville and the January 6 insurrection.6 Even if actual rates of violence do not rise to match the hateful rhetoric, fear and stress do, and with them the risk of posttraumatic stress symptomatology.
Survivors of the Shoah, including Joseph Alexander, have spoken publicly about their fears of seeing the old patterns repeat. “These words… this is how it started with Germany,” Alexander said. “These words, where millions of people can hear.”7 Ye West’s misuse of social media and other public forums to spout antisemitic conspiracy falsehoods and violent rhetoric is similarly inflammatory, with fliers and demonstrations in support of him popping up after his public remarks.8,9
The broad cultural reach makes those comments particularly dangerous, bringing out supporters and empowering hate through normalization, which then holds a risk of retraumatizing Shoah survivors.
Equally concerning is that it is not only direct survivors who are at risk of retraumatization. Their children and grandchildren, who may not have experienced the trauma of enslavement, torture, and genocide, are nonetheless at risk for a web of symptoms similar to CPTSD, with foreseeably heightened stress when confronted with a rise in hateful rhetoric.10 Although this research has not been replicated for other survivor groups, the web of symptoms for survivors of the Shoah and other anti-ethnic campaigns overlaps.
One of us who regularly treats elderly survivors of the Shoah, the so-called “hidden children,” has observed patients such as an 80-year-old widow with CPTSD and a complex grief reaction who, after West’s pronouncements, was on the verge of feeling driven out of her home. She had lived alone there for several years following her husband’s death and successfully grieved his departure until she was overwhelmed by memories triggered by West’s hateful statements.
She began to lock her door (which previously she had not been doing), became absent-minded, and eventually began to isolate herself. She no longer felt safe to be in her home and neighborhood, and seriously considered moving from a home of 50 years.
After the recent Hamas attack on Israel, this patient, who suffered from mild spinal stenosis, developed rapid-onset, intractable pain in the absence of any structural changes. Hence, a vulnerable segment of our population—one that may even grow given the legacy of extreme trauma—is put at risk of helplessness compounded by retraumatization in addition to the general fear of violence, regardless of their objective level of personal safety.
Strikingly, West’s public antisemitism is not isolated. The Anti-Defamation League (ADL) reports that 2022 was consistent with 2020’s spike in antisemitic incidents, with 40% of respondents reporting some form of harassment online.11 Severe harassment has not declined significantly, and 37% of Jewish respondents reported religious harassment, as opposed to 14% of non-Jewish respondents. Particularly troubling was the doubling of references to Zionism or Israel, and a 52% increase of incidents connected to right-wing extremist groups.12
This groundswell for antisemitism seems to be bolstered by like-minded hate groups and by political and celebrity influencers such as West. It also appears intertwined with intolerance aimed at other minority populations, with the ADL report identifying that marginalized groups overall were 1.5 times more likely to be harassed based on their identity and were more likely to be severely harassed.
Although this trend was a concern even before former President Donald Trump took office, the pandemic added new fuel to the fire, with conspiracies pointing to a “Jewish-Chinese collaboration to spread the virus” and epithets such as the “China Virus.”13 It should therefore be no surprise that anti-Chinese and general anti-Asian hate have also spiked in recent years. Since 2020, reports show that 1 in 5 Asian Americans and Pacific Islanders have experienced some form of hate crime or harassment.14
Unfortunately, it seems that curbing the spread of hate speech—which, by definition, is not protected as free speech, despite false claims to the contrary—is not a high priority for many social media companies, nor is restoring agency to retraumatized victims.
Elon Musk’s acquisition of Twitter has highlighted the skewed priorities of social media leadership, as a wave of reinstated far-right accounts and a shift in internal policy indicate a concern about misconstrued “free-speech rights” for those who make racist or antisemitic comments.15 This shows not only a misunderstanding of the difference between free and protected speech, but also greater concern for antisemites and racists than for those whom their hateful comments harm.12
The ADL even notes that certain forms of “severe online misconduct” are not currently properly covered by cybercrime or hate-crime laws. If controversy and hate speech make money, all too many companies will not actively curb such communications. To hold them accountable, the full cost and danger of hate speech must be made clear and measurable.
One potential legal remedy for hate speech harm and retraumatization is demonstrated by the resolution of the years-long legal battle by families of the victims of the Sandy Hook Elementary School shooting against Alex Jones.16 Internal documents from Jones’ company, Free Speech Systems, demonstrated that website traffic and revenue spiked when Jones made false claims that the Sandy Hook shooting never took place or that the families were “crisis actors.”17
Claiming hateful conspiracy produced higher profits, so Jones continued to lie and draw suspicion toward the families to make even more money. As of this writing, Jones has been successfully sued for $1.5 billion, has declared bankruptcy, and may face further legal action.
Such a legal remedy can also be helpful for restoring agency to traumatized and retraumatized victims of hate speech precipitated by celebrities such as West. Positively, West’s public platforming of antisemitic conspiracy falsehoods aroused protests and acts of public outcry and cost him lucrative sponsors.18 Negatively, his horrific canards instigated 30 documented antisemitic incidents, contributing to the continuing rising tide of antisemitism in the United States.
West’s comments, although more generally bigoted, are sharply dangerous for American Jews and their descendants who have survived the horrors of the Shoah or other Jewish-specific trauma.8 Given free reign, West may recover his social media reach through an audience that is receptive to his invented conspiracies and willing to create fear or enact violence.
In these circumstances, it would behoove victims to seek legal recourse not only to discourage hatemongers like West from continuing to traffic in and profit from vile falsehoods and conspiracies, but also to detoxify a legacy of vitiated agency in the face of extreme injustice. Moreover, it would benefit society to make the tools for seeking legal recourse readily available to victims. Individuals who have been made helpless find it foreseeably difficult to act. Therefore, the road to restorative justice must be open and accessible.
Where prevention is difficult, postvention is vital. Like anyone else, celebrities must be held accountable. Restricting the profits to be made at the cost of human life is one place where the law can step in. This can be done in conjunction with restoring agency to victims of hate speech. Empowering foreseeably traumatized and retraumatized victims to seek restorative justice versus the purveyors of hate speech is fundamental both legally and clinically for detoxifying a legacy of legalized helplessness compounding extreme trauma.
In addition to our work with patients individually, psychiatric clinicians can guide institutional responses for prevention, intervention, and postvention, as the authors have done through the American Bioethics and Culture Institute. Bioethical principles that can inform such consultation include:
Any educational or other organization is responsible for empowering all those who participate in it—not for leaving them helpless against traumatic assaults.
Dr Bursztajn is in clinical and forensic neuropsychiatric practice in Cambridge, Massachusetts. He contributes as a senior faculty member of the Harvard Medical School (HMS) Department of Psychiatry and as founding director of the HMS Program in Psychiatry and the Law and of the American Bioethics & Culture Institute. Dr Stein is the co-founder and executive director of the Harvard Law School Project on Disability and has been a visiting professor at Harvard Law School since 2005.
Both authors thank Samuel Appleman and Bryce Hollander for superlative research assistance.
Note: The views expressed in this article are those of the authors and not necessarily of any organizations with which they are affiliated. They write both as experts on bioethics and as second-generation Shoah survivors.
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