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Healing Requires Recognition: The Case for Race-Based Traumatic Stress



Race-based traumatic stress has been studied in the literature under various names including but not limited to insidious trauma, intergenerational trauma, racist incident-based trauma, psychological trauma, and racism. This article reviews and analyzes R. T. Carter’s article in this issue. The author underscores and reacts to the trauma of racism as discussed in Carter’s article, and also highlights efforts that should be directed to racist incident-based trauma counseling. Counselors have to be trained to effectively conduct assessment and interventions with clients who have been victimized by race-based traumas. In addition, counselors should be aware that intersecting identities can result in multiple traumas or forms of oppression, such as 1 client experiencing racism, sexism, poverty, and heterosexism. While it is important to study the dynamics of race-based traumatic stress within the United States, as Carter comprehensively does, it is also essential for counselors to examine and respond to race-based traumatic stress internationally.
Healing Requires Recognition:
The Case for Race-Based Traumatic Stress
Thema Bryant-Davis
California State University, Long Beach
Race-based traumatic stress has been studied in the literature under various names
including but not limited to insidious trauma, intergenerational trauma, racist incident–
based trauma, psychological trauma, and racism. This article reviews and analyzes R.
T. Carter’s article in this issue. The author underscores and reacts to the trauma of
racism as discussed in Carter’s article, and also highlights efforts that should be
directed to racist incident–based trauma counseling. Counselors have to be trained to
effectively conduct assessment and interventions with clients who have been victimized
by race-based traumas. In addition, counselors should be aware that intersecting iden-
tities can result in multiple traumas or forms of oppression, such as 1 client experi-
encing racism, sexism, poverty, and heterosexism. While it is important to study the
dynamics of race-based traumatic stress within the United States, as Carter compre-
hensively does, it is also essential for counselors to examine and respond to race-based
traumatic stress internationally.
In his in-depth Major Contribution, Carter (2007 [this issue]) explains
the ways in which racism can be a source of stress, trauma, and emotional
injury. For counselors to effectively address race-based traumatic stress,
they must first be educated and trained to recognize and acknowledge it
(Bryant-Davis & Ocampo, in press; Carter, 2007; Sue & Sue, 2003). Race-
based traumatic stress has been called by various names including, but not
limited to, societal trauma, intergenerational trauma, racist incident–based
trauma, insidious trauma, psychological trauma, emotional abusiveness,
and racism (Bryant-Davis & Ocampo, 2005; Carter, 2007; Carter & Helms,
2002; Daniel, 2000; Loo et al., 2001; Root, 1992; Sanchez-Hucles, 1998;
Wyatt, 1990). Race-based traumatic stress can be defined as (a) an emo-
tional injury that is motivated by hate or fear of a person or group of people
as a result of their race; (b) a racially motivated stressor that overwhelms a
person’s capacity to cope; (c) a racially motivated, interpersonal severe
stressor that causes bodily harm or threatens one’s life integrity; or (d) a
severe interpersonal or institutional stressor motivated by racism that
Correspondence concerning this article should addressed to Thema Bryant-Davis, California
State University, Counseling Psychology, 1250 Bellflower Boulevard, Long Beach, CA
THE COUNSELING PSYCHOLOGIST, Vol. 35 No. 1, January 2007 135-143
DOI: 10.1177/0011000006295152
© 2007 by the Division of Counseling Psychology.
causes fear, helplessness, or horror (Bryant-Davis & Ocampo, 2005; Carter,
2007; Loo et al., 2001). To build on the arguments raised by Carter, this
reaction article will examine the need for (a) counselor training on race-
based trauma, (b) recognition of the parallels between posttraumatic stress
disorder (PTSD) and race-based trauma, (c) validation of a separate cate-
gory for race-based trauma, (d) examination of racism as an additional
trauma for survivors of other forms of trauma, (e) cultural competent
assessment and intervention for race-based traumatic stress, (f) acknowl-
edgement of the intersection between race-based trauma and other forms of
societal traumas, and (g) the need to extend psychologists’ lens to include
international cases of race-based trauma.
Carter (2007) notes that all counselors, including counselors in training
and those who entered the field prior to cultural competence training
requirements, need to receive education on race-based traumatic stress.
This education needs to include definitions of race, racism, and race-based
traumatic stress, as well as assessment needs, effects, and intervention
strategies for race-based traumatic stress (Bryant-Davis & Ocampo, in
press). Education on cultural competence needs to include not only self-
awareness, knowledge of cultural traditions, and skills for culturally appro-
priate interventions, but also an understanding of power, privilege, and
racial oppression (Sue & Sue, 2003). A grasp of these concepts is critical to
a counselor’s ability to recognize, acknowledge, and address race-based
traumatic stress.
In his Major Contribution, Carter (2007) and other scholars (Bryant-
Davis & Ocampo, 2005) have noted some resistance to an association
between racist incident–based trauma and PTSD for multiple reasons. One
of the concerns is that a PTSD diagnosis will lead to victim blaming and
pathologizing (Carter, 2007). It is important to note the following: (a) PTSD
is one of only a few diagnoses that by definition is precipitated by an event (a
traumatic experience) versus other diagnoses such as depression and anxiety;
(b) no one who experiences a trauma should be pathologized—postracism
distress is a normal response to an abnormal experience or a sane response to
an insane stressor (Greene, 2004); and (c) calling a trauma by another word
such as injury will not prevent those who seek to blame victims from blaming
victims; therefore, avoiding an association with the concept of PTSD does
not truly address the problem. Only education, prevention, intervention, and
justice can work against the insidious and tenacious nature of racial oppres-
sion, victim blaming, and pathologizing. As scholars and researchers, psy-
chologists can become distracted by debates over labels and linguistics
while the traumatic experiences of racism are themselves sorely neglected.
It is important for counselors and researchers to find a necessary balance for
all psychologists working in the trauma field; this balance is the cognitive
space between understanding individual factors that moderate the relations
between traumatic experiences and their effects while avoiding the pitfalls of
victim blaming.
While trauma and PTSD are not synonyms, researchers and counselors
often merge the two, assuming that a person has only experienced a trauma
if, as is noted in the diagnostic criteria for PTSD, he or she has experienced
a physical violation. This view of trauma is unnecessarily narrow and dis-
regards the severity of such stressors as nonphysical violation experiences
of sexual harassment, partner/spousal abuse, and racist incidents.
Although it is important to recognize the parallels between racism and
other forms of trauma (Bryant-Davis & Ocampo, 2005), one can also make
a convincing argument for a specific conceptualization of race-based trau-
matic stress (Carter, 2007). I would like to agree with and extend the case
built by Carter for race-based trauma, although I do diverge from the
premise that nonphysical stressors cannot be traumatic. A stressor does not
require physical contact for it to be severe or traumatizing. Instead, the case
for the concept of race-based trauma is that it provides a more precise
description of the psychological consequences of interpersonal or institu-
tional traumas motivated by the devaluing of one’s race. There is actual
precedent for giving a specific trauma that may result in PTSD a more spe-
cific classification. An example of this is rape trauma syndrome, which
describes specific psychological manifestations of sexual assault. In this
same vein, race-based traumatic stress conceptually gives greater depth of
understanding to a trauma that, while sharing some commonalities with
other traumas, is also quite unique (Bryant-Davis & Ocampo, 2005).
As Carter (2007) significantly observes, it is important to recognize the
multiplicative effect race-based traumatic stress can have on survivors of
other forms of trauma. Examples of this multiplicative effect include the trau-
matic race-based and class-based neglect experienced by Hurricane Katrina
victims as well as race-based trauma experienced by ethnic minority rape vic-
tims in their encounters with the judicial system. It is, therefore, imperative
for counselors to be cognizant of the potential for additional race-based trau-
mas facing racially marginalized survivors of other severe stressors such as
war, domestic violence, and assault. Given the vulnerability and violation
already affecting these survivors, it is particularly vital for trauma counselors
such as those working with rape crisis centers, veterans’ hospitals, domestic
violence shelters, and emergency response workers to be trained in race-
based trauma assessment and intervention. In other words, counselors and
researchers must consider the impact of being raped physically, and then
being emotionally “raped” by systems and institutions that devalue members
of one’s race, or of being shot, but the impact of this violation being mini-
mized or ignored because of one’s race. These race-based violations can add
and in some cases multiply the traumatic stress of survivors.
As argued in Carter’s (2007) Major Contribution, attending to issues of
assessment and intervention with persons who have been targeted by racism
is essential. Societal traumas such as racism receive insufficient attention in
assessment and treatment (Scurfield & Mackey, 2001). Counselors need to
address race-related traumas and race-related positive experiences, particu-
larly when the client is a member of a racial or ethnic minority group
(Scurfield & Mackey, 2001). Culturally competent and ethically responsi-
ble counselors respond to reports of racist incident–based trauma with val-
idation, competence, and compassion, as they should to any other trauma
(Bryant-Davis, 2005). To conduct effective assessment and intervention,
counselors need to create a therapeutic environment that is safe for clients
to disclose racist experiences (Goodman et al., 2004). Clients are disserved
by counselors who minimize or avoid attending to experiences of racism.
Scurfield and Mackey (2001) attributed the minimal attention given to
racist incident–based trauma to both confusion about and discomfort with
dialogue centered on traumatic experiences of racism. Resisting silence and
risking discomfort, counselors should assess for and explore race-based
traumas as well as any of their lasting psychological effects (Wyatt, 1990).
Assessment for race-based traumatic stress, according to Bryant-Davis and
Ocampo (in press), can be accomplished by (a) creating a trusting and safe
therapeutic relationship; (b) establishing counseling as a safe place to
process difficult experiences such as race-based traumas; and (c) inquiring
directly about the client’s full trauma history, including race-based traumas,
through the use of either a standard structured interview or standardized
assessment tools or surveys. During assessment, the counselor should
attend not only to the trauma history, but also to the impact of the trauma(s)
on the client’s current functioning; particular attention should be paid to
reports of intrusive thoughts, hyperarousal, numbing, intense emotional
reactions, difficulty concentrating, difficulty with memory, feelings of
destructiveness toward self or others, as well as psychosomatic reactions
(van der Kolk, McFarlane, & van der Hart, 1996).
Regarding counseling interventions themselves, Comas-Diaz (2000)
called for psychologists to adopt an ethnopolitical approach when working
with ethnically marginalized clients; such an approach recognizes the impact
of oppression and racism. Comas-Diaz argued that counselors must take an
antiracist stance in their therapeutic work, which is to say the counselor
should never minimize, ignore, or intellectualize racism. Bryant-Davis and
Ocampo (in press) recognized that a number of therapeutic modalities have
been found effective when working with trauma survivors. These evidence-
based treatments include, but are not limited to exposure therapy, eye move-
ment desensitization and reprocessing, supportive group psychotherapy,
psychopharmacology, and cognitive therapy. Regardless of the theoretical ori-
entation or therapeutic approach, Bryant-Davis and Ocampo suggested that
counselors working with victims of race-based traumas explore and address
the following themes: acknowledgement of the trauma, sharing the trauma,
safety and self-care, grieving the losses, shame and self-blame/internalized
racism, anger, coping strategies, and resistance strategies.
Carter (2007) outlines the major effects that a racist incident may poten-
tially inflict on its targets. To delve into further detail, as with other trau-
mas, it is theorized that race-based traumatic stressors have the potential to
affect victims cognitively, affectively, somatically, relationally, behav-
iorally, and spiritually (Bryant-Davis & Ocampo, 2005). Cognitive effects
may include difficulty concentrating, remembering, and focusing. Affective
effects may include numbness, depression, anxiety, grief, and anger. Somatic
complaints may include migraines, nausea, and body aches. Relationally, vic-
tims may demonstrate distrust of members of the dominant group or, in cases
of internalized racism, distrust of members of their racial group. Behaviorally,
victims may begin to self-medicate through substance misuse or other
self-harming activities. Spiritually, victims may question their faith in God,
humanity, or both. There has been evidence of race-based traumatic stress
resulting in intrusive thoughts, hypervigiliance, and avoidance (Loo, Singh,
Scurfield, & Kilauano, 1998). Other effects may include external locus of con-
trol, dissociation, and a sense of foreshortened future or hopelessness.
In addressing an issue that is often overlooked, Carter (2007) acknowl-
edges the importance of examining race-based trauma within the context of
people’s lives, given their multiple identities. In taking a more complex
view of culture and cultural oppression, scholars have begun to examine the
realities of those individuals who live at the margins of society as a result
of more than one aspect of their demographic background (Suyemoto &
Kim, 2005). This has been referred to as multiple identities, intersecting
identities, intersectionality, and the multiplicative effects of oppression
(Crenshaw, 1994; Suyemoto & Kim, 2005). Carter (2007) acknowledges
this important concept in his review of Essed’s (1991) work on gender and
class oppression. In addition, Daniel (2000) has examined race-based
trauma specific to African American women, and Greene (2003) has exam-
ined the intersection of racism and heterosexism. Societal traumas include
not only racism but also sexism, poverty, heterosexism, and religious intol-
erance. While in-depth, separate examinations of each of these issues is
necessary, it is also important for scholars and counselors to recognize that
many clients are confronted with multiple traumas based on their multiple
identity markers. Counselors need to be sensitive to the potentially trauma-
tizing impact of all forms of societal oppression.
As Carter (2007) extensively explains, it is imperative for counselors
to acknowledge, assess, and respond to domestic instances of race-based
trauma. It is also critical for psychologists to study and intervene in cases
of international race-based trauma. The United Nations hosted a World
Conference to address racism, discrimination, xenophobia, and related
intolerances (Bryant-Davis, Okorodudu, & Holliday, 2004). These traumas
include, but are not limited to, the treatment of the Dalit in India, the Aborigine
in Australia, the Indigenous Peoples of the United States, women and children
trafficked globally, and Blacks in South Africa, as well as Islamaphobia and
anti-Semitism. Healing the wounds of race-based trauma requires acknowl-
edging them nationally and globally. An issue that calls for immediate study
and intervention by culturally competent counselors is the genocide and mass
rape of Black Africans in the Darfur region of the Sudan by the Arab militia.
Researchers and intervention developers must examine the psychological con-
sequences of racially motivated mass violence in the context of consistent
global racial devaluation that results in silence and disregard for the well-being
of people of color. What does it mean for one’s safety to not be in the interest
of those with the power and resources to intervene? How does one heal the
scars of a global racial hierarchy that places you and your children at the
bottom? These questions and issues appeal to the consciousness of counselors
committed to resisting racism. They require individual and institutional inter-
vention, as well as just practice and policy.
As Carter (2007) notes, although there is much literature written about
the social, economic, and political effects of racism, much more is needed
in understanding and acknowledging the psychological effects of racism.
The need for this awareness is seen not only in the United Sates but also on
a global level, particularly when one considers the role of psychologists at
the United Nations. The American Psychological Association, among other
psychological nongovernmental organizations (NGOs), has representation
at the United Nations. The role of the psychology representatives at the
United Nations includes educating governments and other NGOs about the
mental health consequences of issues such as racism that are usually pri-
marily examined economically, legally, and medically (Bryant-Davis et al.,
2004). There is a need for psychologists working in various capacities, edu-
cators, counselors, researchers, and advocates to come to a greater under-
standing of the potentially traumatizing nature of racist incidents; this
knowledge must then be disseminated globally to protect and improve
public mental health.
Carter (2007) provides an in-depth exploration of the impact of racism.
Building on this important issue in the context of counseling, research, and
advocacy, he outlines ways in which the trauma of racism can be extended.
Comas-Diaz (2000) called for an ethnopolitical approach to counseling; in
that vein, it is important for culturally competent counselors to adopt a
framework of liberation psychology. Liberation psychology requires the
counselor to attend to issues of social justice, cultural context, action
research, and resistance (Watts & Serrano-Garcia, 2003). With this frame-
work, which is evidenced in feminist psychology, Black psychology, and
Latin American psychology, counselors prioritize transformation of indi-
viduals and institutions. The healing of psyches necessitates the disman-
tling and healing of the source of societal wounds of oppression; active
perpetrators and passive privilege recipients of racial hierarchy require redress.
As with all interpersonal traumas, individual recovery is not sufficient; collec-
tive acknowledgment, justice, and prevention are critical.
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Women from racially/ethnically minoritized communities remain significantly underrepresented at all levels of education in STEM. The pervasive white and heteronormative culture of the STEM environment has contributed to Women of Color feeling isolated, hyper‐visible, and invisible as they contend with racism, sexism, and gendered racial microaggressions. Scholars have found that counterspaces are key sites to support the persistence of Women of Color in STEM and ameliorate the negative psychological effects of navigating oppressive STEM milieus. Missing from the current literature is research on how counterspaces contribute to Women of Color's STEM persistence. This study sought to fill this gap in the literature by understanding the experiences of undergraduate Women of Color in the I CAN PERSIST STEM initiative, a multigenerational counterspace designed to support the holistic persistence of Women of Color in STEM. Steeped in the theoretical conceptualization of counterspaces, and using a case study methodological approach, we found that the multigenerational counter‐storytelling and support from Women of Color in STEM, as well as the embodiment of holistic wellness, and justice‐focused mentor‐teaching supported STEM persistence intentions among undergraduate Women of Color in the sample. Furthermore, participants described being able to reconcile their STEM identities with their need to be active in addressing and mitigating the inequities in their communities, while also prioritizing their well‐being and rejecting the STEM culture of overwork and burnout.
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Racism is a chronic stressor fueled by stigma that can result in significant distress and dysfunction as well as negatively affect emotions, behavior, quality of life, and brain health. The effects of stigma and discrimination emerge early in life, with long-term consequences. The present review sought to use neuroscience research to describe how stigma, racism, and discrimination can impact the brain and mental health. Societal stigmas may be ‘encoded’ by associative fear learning and pattern completion networks, and experiences of racial discrimination may similarly affect threat-responsive regions and circuits. Race-related differences in brain function and structure supporting threat circuitry are largely attenuated when negative life experiences and discrimination are taken into account. Downstream, chronic activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic-adrenal medullary (SAM) axis in the context of discrimination and stigma can contribute to physical health disparities in minoritized and marginalized groups. Finally, we discuss models that provide a framework for interventions and societal-level strategies across ecological systems to build resilience and foster posttraumatic growth.
This article introduces a Social Work Model of Historical Trauma. The model draws from social work perspectives (ecosystems theory and the life model, human rights philosophy, race-based traumatic stress injury theory and attachment theory), disparities research, social work issues and policy statements, social work ethics and epigenetics. Assessment and intervention in micro, mezzo and macro domains are discussed. The article concludes with a case vignette and model application.
Objective: To understand providers' perceptions of how patient's experience of racism may impact successful implementation of a brief PTSD treatment in the safety net integrated primary care setting. To conduct a developmental formative evaluation prior to a hybrid type I effectiveness-implementation trial. Data sources and study setting: From October 2020 - January 2021, in-depth qualitative interviews were conducted with integrated primary care stakeholders (N=27) at the largest safety net hospital in New England, where 82% of patients identify as racial or ethnic minorities. Study design: Interviews with clinical stakeholders were used to (a) contextualize current patient and provider experiences and responses to racism, (b) consider how racism may impact PTSD treatment implementation, (c) gather recommendations for potential augmentation to the proposed PTSD treatment (e.g. culturally responsive delivery, cultural adaptation) and (d) gather recommendations for how to shift the integrated primary care practice to an anti-racist framework. Data collection/extraction methods: Interview data were gathered using remote data collection methods (video conferencing). Participants were hospital employees including psychologists, social workers, primary care physicians, community health workers, administrators, and operations managers. We used conventional content analysis. Principal findings: Clinical stakeholders acknowledged the impact of racism, including racial stress and trauma, on patient engagement, and noted the potential need to adapt PTSD treatments to enhance engagement. Clinical stakeholders also characterized the harms of racism on patients and providers and provided recommendations such as changes to staff training and hiring practices, examination of racist policies, and increases in support for providers of color. Conclusions: This study contextualizes providers' perceptions of racism in the integrated primary care practice and provides some suggestions for shifting to an anti-racist framework. Our findings also highlight how experiences of racism may be a PTSD treatment implementation barrier. This article is protected by copyright. All rights reserved.
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This article describes the development and validation of the Race-Related Stressor Scale (RRSS), a questionnaire that assesses exposure to race-related stressors in the military and war zone. Validated on a sample of 300 Asian American Vietnam veterans, the RRSS has high internal consistency and adequate temporal stability. Hierarchical regression analyses revealed that exposure to race-related stressors accounted for a significant proportion of the variance in posttraumatic stress disorder (PTSD) symptoms and general psychiatric symptoms, over and above (by 20% and 19%, respectively) that accounted for by combat exposure and military rank. The RRSS appears to be a psychometrically sound measure of exposure to race-related stressors for this population. Race-related stressors as measured by the RRSS appear to contribute uniquely and substantially to PTSD symptoms and generalized psychiatric distress.
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The purpose of this paper is to outline a thematic approach to the clinical treatment of clients who have experienced racial trauma. Using the literature on trauma and racist incidents, the authors explore the following counseling themes for trauma treatment: acknowledge, share, safety and self-care, grieve, shame and self-blame/internalized racism, anger, coping strategies, and resistance strategies. The authors then provide a case study of a Native American client. In addition, potential buffers to the traumatizing impact of racist incidents are provided. In conclusion, the importance of counselor competence is explored. Limitations of the proposed themes are described and a call for further examination of counseling responses to racist-incident-based trauma is made.
There are an infinite number of pathways to the central goal of understanding and helping. Therapeutic orientation as well as general values will have a great impact on which pathway is chosen. Some may be narrow pathways, paved and constrained by walls and relatively disconnected from the environmental contexts through which they pass. Others may travel across uncharted open fields or wind through forests, with guidance only visible to those trained to see. Many of these paths will stay within one terrain at a given time or explore each in sequence (moving from forest to savanna to desert to ocean). We believe that the challenge for multicultural feminist therapists committed to social justice is not only to understand how these environments affect the individual (and vice versa), but also to understand how these environments interact within, and depend upon, each other to create meaning and sustain health. In this chapter we have two primary aims: (1) to provide basic understandings of definitions, contexts, and the complexity of interactions and thereby create a foundation for the later chapters; and (2) to share our attempts to create a map that connects the multiple pathways and assists us as therapists to see their interdependence. In less metaphorical language, we will share our attempts to conceptualize the multiple contributions of individual, group, and systemic contexts and meanings as they are integrated and enacted in individuals, so that we as therapists can provide a therapy that embraces the holistic person within her multiple contexts. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Racist incidents are potentially traumatizing forms of victimization that may lead to increased psychiatric and psychophysiological symptoms in targets. The magnitude of the problem of racist incidents in the United States is difficult to estimate; however, data from several sources permit the inference that the prevalence of racist incidents, particularly among people of color, is high. This article (a) distinguishes traumatic stress from nontraumatic stress and (b) draws parallels between experiences of racist incidents and experiences that are acknowledged to be traumatic, such as rape or domestic violence. Conceptualizing the symptoms of some survivors of racist incidents as trauma responses may help inform treatment when these individuals are clients in psychotherapy.
The purpose of this article is to discuss the psychological and emotional effects of racism on people of Color. Psychological models and research on racism, discrimination, stress, and trauma will be integrated to promote a model to be used to understand, recognize, and assess race-based traumatic stress to aid counseling and psychological assessment, research, and training.