The results of a new study published in the Journal for Social Action in Counseling and Psychology (JSACP) add to the growing body of evidence about the mental health consequences of racism and structural inequalities. The results suggest that racial microaggressions are associated with greater traumatic stress symptoms.
The researchers, Kevin Nadal, Tanya Erazo, and Rukiya King, from the City University of New York, highlight the relevance of their findings for mental health professionals. They argue that counselors and therapists should consider the traumatic effects of racism and utilize culturally-informed trauma-focused approaches.
“When individuals are diagnosed with PTSD, trauma specialists traditionally attribute the negative symptoms that an individual is facing to an external source or force, instead of some weakness or fault of the individual,” the researchers write.
“By not naming racism or other forms of oppression as a legitimate type of trauma, people of color (and others) continue to internalize that they are not coping with discrimination effectively, instead of externalizing the role of historical and systemic oppression in their lives.”
Critical psychologists have argued that the mental health field can perpetuate institutionalized racism when practitioners focus on their patients’ individual factors in therapy and do not address structural issues. However, this neglect of issues of racism, classism, and heterosexism goes beyond clinical practice. Psychological research also focuses on individual perceptions, which often neglects the real material effects of systemic discrimination. Yet, research has found that it is systemic racism, and not only one’s perception of it, that affects mental health. In response, social and community psychologists have argued that mental health interventions should also take place at the structural level.
Overt or intentional racism is experienced through interpersonal encounters with discrimination. However, racism also manifests in covert, subtle forms, at times unconsciously or unintentionally. The term microaggressions, coined by Chester Pierce and colleagues in 1978, is defined as “subtle, stunning, often automatic, and non-verbal exchanges which are ‘put downs.'”
The combined impact of these different forms of racism results in trauma, which can be conceptualized as racial trauma. The researchers argue that people of color have experiences that have long-term effects on their mental and behavioral health that may resemble the symptoms associated with Post-Traumatic Stress Disorder (PTSD). However, the way PTSD has been defined leaves out the experience of racial trauma, which can lead to ineffective or inapplicable mental health treatment. The authors explain:
“People who struggle with pervasive and painful experiences with racism are encouraged to reframe their perspectives or to ‘get over it,’ instead of being validated that they are experiencing ‘normal’ and ‘expected’ responses to trauma.
Further, unlike other more traditionally accepted forms of traumas, people of color who are impaired by racism are unable to entirely remove themselves from the trauma source (i.e., they may encounter racism at work, in public spaces, through racist laws and policies, etc.), increasing the likelihood of being retraumatized continually over time.”
The purpose of this latest study was to understand how excessive and continuous exposure to microaggressions relates to traumatic symptoms. Researchers had already found how frequent exposure to microaggressions predicts depressive and anxiety symptoms, alcohol use, sleep disturbances, and suicidal ideation. They also disrupt functioning and are related to physical health issues, reduced self-efficacy, PTSD symptoms, and other forms of psychological distress.
The results of the study showed that about 33% of the participants met the minimum requirements for a PTSD diagnosis, and half of the participants reported experiencing an actual or threatened death, a serious injury, or sexual violence. When assessing trauma not encapsulated by the DSM, 62% of participants reported experiencing trauma directly, 33% reported learning about a friend or family member experiencing it, and 7.9% reported witnessing it. Others experienced recurring microaggressions at work or in other contexts. Many participants reported race and ethnicity as a factor related to their traumatic experiences.
The researchers also found a significant relationship between racial and ethnic microaggressions and trauma symptomatology, mainly in the contexts of school and the workplace. The relationship between racial and ethnic microaggressions was mediated by sexual orientation, gender, social class, and educational level.
In other words, those who identified as transgender and gender non-conforming had higher levels and severity of traumatic symptoms than cisgender men and women. Similar relationships were found when comparing non-heterosexual with heterosexual participants, those living in poverty vs. those who were not, and those who graduated from higher education and vs. those who did not.
The results of this study provide additional evidence for the adverse effects of microaggressions on mental health, and more specifically, to the development of trauma symptoms. The study also highlights how people of color who are part of other underprivileged groups, such as sexual and gender minorities, those who live in poverty, and those with lower levels of academic education, are more likely to be exposed to microaggressions and their traumatic effects.
The study authors suggest that therapists and counselors should be attuned to the ways in which microaggressions and racism affect their patients’ psychological wellbeing and focus on connecting external factors to personal or individual symptoms. Mental health professionals can validate patients’ experiences and address feelings of guilt and shame. Psychologists should also work to address systemic issues outside the therapy or consulting rooms to confront some of the systemic causes of distress.
Nadal, K.L., Erazo, T. & King, R. (2019) Challenging Definitions of Psychological Trauma: Connecting Racial Microaggressions and Traumatic Stress. Journal of Social Action in Counseling and Psychotherapy, 11(2), p.2-16 (Link)