_______________________________________________ Racial Trauma: The African American Experience
In any client who has experienced trauma, acute stress reactions and/or PTSD should be considered. The actual incidence of race-related PTSD is unclear. Of course, an isolated violent event can be a triggering event for PTSD, but vicarious experiences and racial microaggressions are also contributing factors. This extended and persistent trauma is often referred to as complex trauma. Research indicates that minorities have higher rates of PTSD and experience more severe symptoms than Caucasian Americans [17]. Discrimination contributes to these disparities. The multifaceted trauma experienced by African Americans impacts extended families, with many generations impacted by impoverishment, physical and sexual abuse, domestic and community violence, separation from family and re-victimization by others, mental health disorders, substance use disorders, and adverse interactions with government entities. This type of collective trauma, experienced over time and across generations, has been termed historical trauma. Typically, complex traumas start in early childhood and can disturb numerous facets of development and sense of self. As discussed, individual trauma emerges from an incident, series of incidents, or set of situations experienced by the person as physically and psychologically damaging or threatening and having long-term negative consequences on one’s holistic health [3]. Providers are increasingly aware of the devastating effects of pervasive trauma beginning in childhood. In theory, a significant proportion of the population has experienced a traumatic event. For example, among women of any race seeking substance abuse treatment and community mental health services, 80% to 90% have experienced intimate partner and/or family violence and trauma, usually throughout their lifetime [3]. More than an estimated 90% of all individuals involved in the legal system requiring treatment for mental health disorders (including anxiety disorder, depressive disorders, personality disorders, substance abuse, and eating disorders) have experienced childhood emotional, physical, or sexual abuse. Taken in aggregate, it becomes clear that trauma is a public health crisis. Research beginning in the 1990s supports the fact that traumatic events in childhood, including abuse, neglect, racism, and family dysfunction, are directly related to acute physical, mental, and behavioral health outcomes, including depression and suicide [18]. Abuse and neglect during childhood are clear adverse childhood experiences (ACEs), but other examples include witnessing family or community violence; experiencing a family member attempting or completing suicide; parental divorce; parental or guardian substance abuse; and parental incarceration [19]. When experienced in childhood, exposure to racism (e.g., discrimination, stigma, minority stress, historical trauma) is also considered an ACE. However, structural racism is also a factor in many other traditional ACEs, including birth trauma, community violence, housing
instability, and poverty. As such, African American adults are more likely than the White population to have experienced ACEs [20]. Adults who experienced ACEs are at increased risk for chronic illness, impaired health, violence, arrest, and substance use disorder [21; 22]. An extensive history of injustice and hostile societal treatment has resulted in complex and collective traumas in African American communities. These trauma histories include mutual, historical encounters across generations (e.g., lynchings, slavery, police brutality, mass incarceration). Historical and modern- day encounters with racial discrimination are persistent reminders of the constant dehumanization and devaluation of African Americans. Historical trauma narratives include public reminders of chronic mass traumas, structural inequalities, dominant cultural narratives, and public symbols, as well as family or personal stories, which may include perceived historical loss and discrimination, microaggressions, and personal trauma [16]. Of course, historical trauma is not limited to the African American community; it applies to numerous populations that have historically been ostracized and oppressed, including Asian Americans, Hispanics, Indigenous peoples, gender and sexual minorities (also referred to as lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual/ally or LGBTQIA+), religious minorities, undocumented immigrants, women, and disabled persons. If an individual’s cultural identity interconnects with multiple marginalized groups, then he or she may encounter many forms of historical trauma. Key terms when treating historically marginalized populations include [16]: • Historical trauma narratives: Stories of historical trauma, including oppression, injustices, or disasters, experienced by a population. • Contemporary reminders of historical trauma: Ongoing reminders of past trauma in the form of publicly displayed photographs and symbols as well as contexts,
systems, and societal structures and individually experienced discrimination, personal traumatic experiences, and microaggressions.
• Narrative salience: The current relevance or impact of the historical trauma narrative on the individual and/ or community. • Health impacts: Historical traumas may lead to a range of adverse health outcomes, including risks for PTSD and symptoms of anxiety and depression. • Microaggression: Historically, an everyday, subtle, and nonverbal form of discrimination. Today, the term is used to describe both verbal and nonverbal subtle forms of discrimination that can be experienced by any marginalized population.
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