Impact of Racism and Trauma on Black Mental Health

Michelle Wagner

Thank you for joining us this afternoon.

 

Michelle Wagner

We’ll give it just a few seconds for people to hop on takes a while for people to get into the zoom room. We’re very happy to have everyone with us this afternoon. And I am Michelle Wagner with Naomi, New Hampshire. I work on the first episode, psychosis early serious Mental Illness initiative. Thank you for joining us for today’s webinar, which is impact of racism and trauma on black mental health. Today’s presentation is being recorded and you’ll be able to find it on the education page of onward and h.org. There’s also a short survey. We’re asking folks to complete after today’s presentation. You’ll receive a follow up e-mail with links to both the survey and the recording. This is a zoom webinar. Your camera and microphone are off the Q1. The pardon me, the Q&A feature is working, however, so please enter any questions you have there. My colleague Michelle Watson and I will work together to get those questions answered. And now I’m going to turn it over to the Executive director of NAMI New Hampshire, Susan Stearns, who will introduce our guest, Susan.

 

Susan Stearns

Thank you, Michelle. Before I introduce Doctor Crawford, I do want to remind you that this Thursday at and I’m going to blank on it at noon. NAMI, New Hampshire is really pleased to be offering a diversity Inclusion project showcase in partnership with NAMI Connecticut, Samsa, the Substance Abuse Mental Health Services Administration. And the New England mental health Technology Transfer center. So please head on over to our website. Check that out and register. We really look forward to seeing you there on. Now it is my true pleasure to introduce Doctor Christine M Crawford, Associate medical director of NAMI. Doctor Crawford is an adult and child psychiatrist based in Boston and is an assistant professor of psychiatry at Boston University School of Medicine. She completed her adult psychiatry residency as well as child and Adolescent Psychiatry fellowship training at Massachusetts General Hospital, McLean Hospital. She received her MD from the University of Connecticut and her Masters in Public Health. At BU School of Public Health, where she concentrated in social and behavioral science. During residency, she was the recipient of the MGH Laughlin Award and was selected by the American Psychiatric Association as an APA, Samsa Minority Fellow, which provided her with funding to develop community based interventions to reduce mental health stigma within the black community. Doctor Crawford has worked in various outpatient community settings where she has provided psychiatric care to individuals from diverse backgrounds. She has a strong passion for using education. As a tool. For community outreach and engagement, she has been engaged in numerous community outreach initiatives through the boys and Girls Club of Boston, N Double ACP and Naomi. She has authored multiple book chapters on mental health disparities and sociocultural issues. Within psychiatry, as well as made appearances on a number of media outlets where she has discussed various topics within mental health and racism, it is truly our pleasure to welcome Doctor Crawford from just over the border. Welcome to Nami, New Hampshire, doctor Crawford.

 

Dr. Christine M. Crawford

Thank you so much for having me, and thank you so much for that warm introduction. New Hampshire has a very warm place in my heart, given that I’m from New England and would always love to spend summers and also visit during the. Autumn months, so I absolutely love. Of New Hampshire. And so when the invitation to speak with you all came up, I automatically said yes. But of course I love New Hampshire. So thank you so much for for having me, so I’m really happy to be able to talk to you about a topic that’s near and dear to my heart. And I know that. Over the last. Couple of years, especially starting in 2020, there were a lot of conversations and discussion around racism around its impact on mental health of people who are from communities of color. And I’ve been really encouraged by the fact that. A group such as NAMI, such as Nami New Hampshire, is still motivated and interested in having these conversations. Patients about communities of color, about the role that trauma and racism has. And so I’m really encouraged by the fact that there are spaces that remain open for learning and for growth on the subject matter, because when we all lean into this difficult material. Better understand how it is that other people lives their lives. That’s only going to make us good people. That’s only going to allow. For our communities. To be stronger as our communities continue to diversify. And so again, I’m really privileged to have the honor to speak to you all about the impact of racism and trauma on black mental. What I’m going to do is I’m going to define the various forms of racism. I know it’s a term that’s. Been widely used. But I think it’s important for us to all be on the same page. As to what? It really means I’m going to describe racially based trauma and its associated symptoms. Hopefully we’ll be able to illustrate the impact of various forms of racial trauma on black people, and I really am looking forward to a Q&A session towards the end. I’ll make sure to allow some time for that. So let’s get into the definitions. When we’re talking about racism, it’s really important to know that it is a system and it’s a system of oppression that disadvantages certain racial groups that are designated to be inferior compared to those who are designated as superior. And it’s a system that has been present for quite some time. And it’s a system that is really based on assigning these sort of categories to people such that one group is advantage, the other is disadvantaged and is the oppression that allows it for those power differentials to remain in place. And the other thing that’s important to know is that it can occur on multiple levels. We see it. Individually and so thinking about that one person who may have negative views towards an entire race of people, but also was important to think about the role that racism plays on our culture as well as various institutions and systems. So let me go into a little bit more detail about that. As you can see here in this figure. This really just goes to describe and illustrate how all of the different forms of racism interact with each other. So let’s start in the middle with the individual acts, right. And you could see on the outside how that is being influenced by the culture and systems that. The individual lives them right. And So what we’re thinking about when it comes to racism on the individual level, so easily, we so often we think about that one bad apple who said this thing, who did this bad thing towards a person of another racial group. But we also need to reflect on how it is that. We as individuals interact with that one individual who’s in, who’s engaged in some. Racist behavior, are we? Holding them accountable. And so we need to think about folks from an individual perspective both. From the level of who is engaging in racist activities, but also how, as an individual, are you holding other people accountable now thinking about it from a cultural perspective, what are things that really signal to people who are part of the American culture? That there are certain beliefs and values and norms that validate whiteness and may and validate the experience. Of people of color. An example that I often like to share to illustrate this point is thinking about back in the day when you used to go to a toy store and you were. Looking for a doll? And let’s think back to the 80s when cabbage. Patch dolls were huge. You know, for a lot of families, when they were trying to look for a doll. Who was brown skin? It was really hard for a lot of parents to find brown skin dolls and thinking even about baby uh Barbie. You know, as a child going to the store and seeing on the shelf that there are dolls that are blonde hair and blue eyes with their skin, maybe they have brown straight hair and that’s sending a message very early on to that child who maybe from a different group, different racial group. That that’s what the culture values as beautiful because you don’t see dolls who look like you or look like your family members being, uh, represented on the. And so we really need to think about what are some of the things that we have that are. Part of our. Culture that is sending a message to our young people, that their experience as a black person is not being uplifted or validated and the experiences of other groups are now let’s think about it. Even from a more institutional or structural level too. And that’s thinking about what are some of the policies and practices that are in place that allows for it such that there are certain people, certain groups, that continue to be uplifted and validated, included and served, but yet at the same time these policies and practices. Make it such that there is a whole nother group that’s in an inferior position, because these policies and practices are oppressing them and validating their experience. Says they are excluding them, so that’s what allows for this. Organized system of oppression to remain in place. Because of these. Policies and practices that remain in place that keeps that difference ongoing. Some other definitions that I want to provide you all as prejudice. And so predators is thinking about the negative attitudes towards an entire group of people. So that’s having anger or fear towards black people. And when you’re around. Black people just it elicits a certain attitude in you. Discrimination now is the behavioral response to predators, so those are the negative actions that’s associated with having these negative attitudes towards an entire group of people. And then stereotypes are the negative expectations or beliefs of an entire group of people. So having the expectation that black people aren’t as smart as other groups of people, or that they’re inherently dangerous, or that they’re incompetent, or that they have some kind of character. And so we need to kind of reflect on some of our prejudice or, UM, stereotypes that we have in our minds about certain racial groups, because it’s just been so normalized and ingrained in us just based on the way in which we. Were brought up where? We live, and so sometimes it’s hard to. Be aware of some of these attitudes, beliefs and actions that may negatively impact other groups of people. One way to also kind of tie all of this together is to think about racism as prejudice. So having the negative attitudes towards the entire group of people, but also being in a position of power and having that privilege of being in that position of power to allow it such that you could. Remain in that position, but continuing to have these negative attitudes towards an entire racial group, and that’s that’s racism. And we need to think beyond, just as I mentioned before, racism on the individual level in which you observe someone who is treating a person of color poorly or hearing on the news about hate crime. We could all agree. That those are examples of racism, and it’s readily observable and we know what it is. But I argue what is far more dangerous than what has really had a tremendous negative impact on us as a society is what’s below the water line. What we’re seeing is really just the tip of the iceberg. But we need to be curious about where all of that is coming from and what is below the water line. Are the things that are difficult to observe. So that’s thinking about things such as implicit attitudes or unconscious biases. Thinking about some of the institutional policies and other structural factors, so we really need to be curious about why is it that things are the way that they are such that a certain group remains disadvantaged. Those are the things that are difficult for us to observe, while at the same time I’m hopeful that. With ongoing discussions about this and people’s openness and willingness that people will be more aware of, UM, all of these additional factors. So just tying.

Speaker

It all together.

 

Dr. Christine M. Crawford

And how it really is important for us to take a step back and ask ourselves, why is it such that we hear about all of these disparities when it comes to education and people of color dropping out of high school at higher rates? Why is it that they’re experiencing? Far worse outcomes with regards to their health and their medical status. Why are they incarcerated at much higher rates than other? Groups we need to understand what is driving them and a lot of it has to do with history and and the policies and practices that have taken place over time. So thinking about things that have had an impact on some of these outcomes such as residential segregation and history not too long ago really and. People had significant difficulty being able to obtain mortgage loans in certain areas and that resulted in redlining, and that has contributed to the ongoing racial, racially motivated residential segregation. That we continue to see and also thinking about the resources that are available in certain communities and how the lack of resources can have an impact on the educational system within a given. Place and and so that’s why we see some of these inequitable outcomes and these disparities that I described earlier. But when we hear about these disparities and we then kind of are primed by the media by. The environment that we see to make these associations and these assumptions about. People of color. You know, to think, oh, well, they don’t know how to take care of themselves and that’s why they always have poor health outcomes or, UM, yeah, they always are living in communities with lots of violence. And you know, they’re always involved in shootings and whatnot. And all of those messages are being reinforced by the structural environment. What is shared in the media and all of that has an influence on our. On our consciousness and we make decisions, especially people who are in a position of power that is being fueled by all of these things that have led to these unconscious biases. These implicit biases that allows for structural racism to continue because all of these things when you’re. Person in a position of power and you have these attitudes and beliefs. It will influence the type of policies and practices that you’ll put in place. So that was a lot of information, but I do think it’s important to have that foundational knowledge to understand how it is that all of these different factors can have an impact on on someone and to know that racism and its. Many different forms can be traumatic for people of color, and it can be experienced as a trauma, even though it’s not listed in the DSM 5 in terms of it being part of the definition of trauma. What I will share with you today is that racism, racism, in fact, is a form of trauma and can present with the same symptoms that we can see in people who’ve experienced PTSD. So let’s go into it a little bit, but first, another definition. And the definition here, and this is another really important one. It’s the definition of trauma. And simple plain terms. Trauma is an extreme and sudden violent event that is perceived and experienced by individual. As shocking is intrusive in nature, it can be emotionally numbing and it can result in altered arousal state. So what I mean by that is being. On Edge, being jumpy, having problems with your sleep and it. What is key to know is that violence, it can be psychological, and it could be physical. And we need to understand and realize. That for the. Person who experienced trauma for that individual, that event poses a threat to that individual sense of self. And so if a person. Experienced an event. And perceived it to be negative, sudden and uncontrollable, and felt as though their sense of self was being threatened. That is a traumatic event and it’s important for us to know that the subjective experience of that individual. Is completely valid. And the way in which that person perceives an event, the particular incident, if it was perceived to be as dramatic, that is valid because we need to keep in mind that the way in which that individual perceived it has been influenced by many, many years of various. Experiences that date all the way back to childhood and that have been reinforced by a number of different interactions with a variety of different individuals and systems. That have made it such that the trauma continues to repeat itself and that’s why the experience of an event may be perceived differently given everything they’ve been through compared to someone else who may not have that same life experience. But we need to make sure to validate it. And not invalidate it or minimize it because that can result in further trauma. So let’s go into some details about what is referred to as the race related stress models. So thinking about what are all the factors that have contributed to a black persons experiences and the way in which they perceive certain events as they move forward throughout their life. And because I’m a child psychiatrist, we have to talk about kids. A lot of this starts in childhood and we see it being played out in the educational system, which is an institution which is a system that everyone has an interface with at some point in time. What is deeply concerning is that. Looking at preschool age kids, so that’s ages 3 or 4 blacks. Preschoolers make up about 18% of all preschoolers, but for some reason they account for over for almost 50% of all preschool suspension. Now #1. Everyone should be shocked to hear that preschools. Are getting suspended. But why is it that nearly half? Of the preschoolers who? Are getting suspended happen to be? Of color who are most. Likely engaging in the same behaviors. As their non black peers who are in the same class. And so, to know as young as three that you generate more attention from your teachers, that you’re more harshly disciplined. When compared to. Other kids really sets up this message very early on that you stand out and. You’ll see a pattern that perhaps maybe you stand out because of the color of your skin, and perhaps that is something that is being being reinforced by all of the messages that you’re hearing on the radio or on the news. And we see this play out over the course of a black students educational career. As they go through elementary school, middle school and high school, we know that black students are suspended and expelled at a rate that’s three times greater than white. As you can see here on the right, this is data from the US Department of Education and which you could see in the yellow that black boys and black girls are receiving out of school suspension rates out of school suspensions. UM at higher rates than other ethnic groups, and this is important because we already know that there are disparities that exist with regards to high school dropout rates and if you are receiving the message throughout your educational career that you’re perceived to be dangerous, that you are being. Punish harsher that you are attending schools that are staffed by police officers is sending the message that perhaps they don’t belong in this system. My teachers see me as more of a threat. They’re not interested in supporting my learning, so why do I want to remain in the system? Just going to drop out. And and a lot of that is influenced by this experiences that they’ve had from a very young. Also in in terms of school and and this is going beyond kind of the experiences of children in the school environment, but even thinking about our adults, another significant stressor that can be perceived as traumatic is experiencing something that’s referred to as a microaggression. Even though micro is part of. Of the the the word here to the person who experienced that microaggression, it may not be small in scale, but to the person who might have said something or acted in a certain way, and did so unintentionally, that might have. Uh put down that person of color, uh or might have invalidated that person’s. Variants. When these things happen repeatedly, it can really have a significant impact on one’s overall well-being, and So what are some examples of microaggressions, especially in school? So setting lower expectations for students of color with regards to their academic performance? A story that I often like to share is when I was in school, you know, I had dreams of going to to medical. School and I was a pretty good student, but the. Guidance counselors at my school really encourage people to go to a Community College or state school, and so it was rare for people to want to apply for a private school. But the message is that we were receiving was ohh keep going to you know certainly apply to the community colleges and state schools and there’s nothing wrong with that. But there wasn’t really a lot of support or expectation that we would get into private schools, and I went to a school that had a lot of students of color. And then when I finally got into college, I was excited about being pre. Med was in a private institution and I had some difficulty. Then my general chemistry. Class because here I am attending this school in which kids who attended high school previously went to boarding school and paid to go to school, which was a whole new concept to me and and I was really struggling academically just in one class, met with the pre Med advisor and I said, you know. And having difficulty in my general chemistry class. I was wondering if you have any words of wisdom or any advice for how I can navigate this. And he said to me, well, I wonder, you know, if another profession would be better suited for you, maybe another profession, another career in a health related area. And I’m I’m not sure about you being. A doctor. This was the. First time that I met him, I. Me had one low grade and I was 17 at the time and so I read between the lines and the way in which I perceived that interaction was that someone like me, who looked like me, who was where, who came from, where I came from, wasn’t capable of remaining on this journey. Of being pre Med and ultimately getting it to medical school. And that interaction literally set me back about four to five years because I wasn’t pre Med. And then finally I had to after I graduated. I took some time off. I had to take all the classes again, but it took me a long time to get over that comment and to finally believe that. I was able to pursue a career in medicine, so for that one pre Med advisor he probably didn’t think much of it. He probably thought he was being really supportive. And at the same time really did have it impact on how I thought about my academic career and the speed at which I got into medical school, other things that could be considered as a microaggression is failing to learn to pronounce or continuing to mispronounce the names of students after they’ve corrected. You, and even people that you may interact with, you know there are a number of last names that are complicated to pronounce, but yet there’s an expectation that people. Pronounce them correctly, and there are people from other cultures in which maybe there seems to be less of a appreciation for this special for the pronunciation of their name. So a great example is Kamala Harris. This was a woman who was running. For president of the United States. And it was amazing how many people continue to mispronounce her name. When she was all. Over the TV it was, it was really. It was really something. So those were microaggressions. The other thing that’s part of the race related stress model is thinking more about the collective experience of racism. So belonging to. So a a community of color belonging to a particular racial group. And even if you haven’t directly experienced racism yourself, everything, all the messages that you’re receiving in the media messages that you’re receiving throughout the culture. It gives you the perception that your racial group is being treated negatively or is being portrayed in a negative way and a great example of that is just thinking about the stereotypical portrayals of black people in the media. When, while watching the news. It can oftentimes feel like some of the negative stories or the stories about crime, or just the negative stories in general seem to feature black and brown people. But the uplifting, positive fun, bubbly stories primarily like predominantly featured white people. And so it makes you curious about what’s influencing some of those decisions in the news stations about what’s the what stories to feature, what populations to include in these stories. And you know that in back in 2019, only 12% of TV news employees were black. And so thinking about who’s sitting at the table and making these decisions and who is able to influence what is being actually represented. In the news. And another important term is vicarious racism, and especially when we’re talking about vicarious racism on children. But this is something that everyone certainly can experience, regardless of their age. Now, what is vicarious racism? So that’s exposure Teresa’s incidents that occur to other people. Well, so yes, it could be about hearing someone experiencing racism, who happens to be a friend of yours, who was part of your family, but also could be due to hearing about a stranger who might have experienced racism. And the way that we see it played out in children. It’s that it’s developmentally appropriate for kids to cook themselves in the shoes of. A family member, a loved one and think to themselves, well, if if Auntie Susan went through this, then that means that could happen to me too. Is there something wrong with me being brown? And people are. Gonna treat me like that because I’m brown. And so we oftentimes see that in our young kids, they. Naturally imagine themselves in the place of that target, that individual who might have experienced the racist incident, and we’ve seen this be associated with lower psychological well-being. As well as some social emotional difficulties, and this is just by hearing about someone that they know and don’t know or don’t know experiencing racism. We see kids experiencing increasing anxiety, heightened sense of danger and vulnerability as. Well, as could have an impact on. Their mood state, and they could feel more sad. And there have been some studies that have found. Caregivers who’ve experienced racial discrimination are known to there’s an association between those experiences and seeing depressive symptoms in their kids. Has Ripple and downstream effects hearing about racism? Hearing about the trauma of racism towards black people doesn’t just impact that one individual who experienced it, but many generations and including kids. So yes, thinking about the kids and thinking about the trauma that they’ve experienced over these last several years and even the trauma prior to 2020. But let’s just focus on 20/20. And since that time you can imagine. As a child. Who’s hearing about? People being killed because of the color of their skin or being treated in a poor way because of the way that they look can be very confusing to a kid. They’re seeing this on the news, and then they’re also hearing about the protests. The Black Lives Matters protests back in 2020 and wondering why is it? That people who look like them are dying and people were against the phrase Black lives matter. Now a kid of this age in this picture is not going on the Black Lives Matters website to read the organizations mission statement. All they know are the words, and they see that these words have generated a lot of anger in people who aren’t black and to. Kind of experience and witness that trauma on top of the trauma of losing your sense of normalcy, your ability to go to school, the ability to hang out with your friends and participate in your usual activities because of Cove. And and the trauma related to the virus in which you might have lost loved ones to COVID. So a tremendously impactful and challenging time for everyone, but especially for our young children of color. And as a child psychiatrist, when I was seeing in the clinic was truly heartbreaking and UM, just unbelievable in terms of. The the way in which kids were presenting and the type of symptoms they were experiencing, even though they might not have experienced the trauma themselves just by hearing about all of this and kind of experiencing it, was challenging. So what are some of the symptoms that people can present with if they’ve been? Impacted and traumatized by racism. So they can. Have what is referred to as intrusive thoughts, so these are unwanted and recurrent thoughts or images of a traumatic event. And so these are things that just pop into your head in the middle of nowhere that can be incredibly distressing and can be a challenge to stop thinking about. I had previously mentioned in the definition of trauma that it can result in altered arousal state, so folks can have problems with sleep. It’s hard for them to be able to focus. They have variable energy. They may feel on it or just. Be and then also people can engage in some avoidance behavior, such as avoiding certain people, certain places, certain environments out of concern and fear that it’s going to trigger some of these unwanted thoughts or negative emotional response. And also, sometimes people can have memory gaps in their ability to recall all of the details of the traumatic incident, and we see this even too with racism. So when people who might have experienced the racial trauma, it could be challenging for them to articulate all the different details, and the person who is hearing the story may think ohh well, they’re being so vague about everything and therefore it wasn’t. A big deal, but. We need to be mindful of the fact that. Because that that might have been traumatic. It could have had an impact on their ability to recall the details and it’s not to us up to us to invalidate that person’s experience. And then some mood symptoms. So experiencing anxiety and depression and anger, as well as some physical symptoms that we see because experiencing A trauma of any kind is very stressful for the body and results in the release of a number of stress hormones that. Uhm, leads to a cascade of different events that just alters your Physiology and can lead to increasing your blood pressure and increasing your heart rate. As well as an increase in other things in increase in cortisol and all of this has been associated with a greater likelihood of developing chronic medical conditions. That’s going to also make you more susceptible to various infectious diseases because it will. Have the negative impact on your overall immune system and can weaken immunity. Which is part of the reason, among many other reasons that include structural racism, in which communities of color were significantly impacted by the COVID-19 pandemic in terms of the severity of symptoms and which we we saw. The ability to access medical care among many other. And So what I tell people is that being black in America for for many is similar to walking around with. A sticky soup. In which all of these different life events, these stressful race related life events, they stick with you. And so someone mispronouncing your name. Sex with you or having someone follow you around in the classroom, being suspended from school early on, being pulled over by police for no good reason at all these events. They stick with you. And it’s hard to just shake them off. And carrying all of that on your two shoulders can really weigh you down physically and mentally. I mean, know that it can have a a significant toll on one’s overall physical and emotional well-being. What we also know is that racism is a form of adverse. And we know that kids who have been exposed to prolong adversity are known to have significantly negative health outcomes when they enter into adulthood. And so being exposed to this type of stress. This type of adversity can not only have an impact on that child in the here and now, but also have. Would impact on their future. And so we call these adverse childhood experiences and there was a study that was done back in the 90s that was able to discover that being exposed to physical and emotional abuse or neglect or household. Function was associated with poor mental and physical outcomes later on in life, but in recent years there’s been appreciation for how community violence as well as racism can have a significant toll, and that can result in toxic stress. And imagine living under these conditions in which you are chronically exposed to adversity. You are chronically exposed to an over activated stress response system. As I mentioned earlier, racism that trauma can result in a cascade of stress hormones being released that are part of the fight or flight response system, but chronically being in that. Fight or flight state can disrupt healthy brain development. So all of the things that I just articulated can actually alter can actually alter the architecture of a child’s brain and can remain disrupted throughout childhood, into adulthood. And we know that this can have an impact. On their ability to learn can have significant impact in terms of their cognitive abilities, as well as increase their likelihood for some diseases. As I had mentioned before and so this figure on the left really just shows how an adverse childhood experience such as racism. Can result in disrupted neurodevelopment that can lead to cognitive impairment. As well as. Difficulty with emotion regulation and being able to tolerate stress and be able to self regulate to cope as well as interfere with one’s ability to. Learn a variety of different social skills, and if all of this is disruptive and impaired your social, your emotional learning. Your cognitive function, it can lead to the adoption of various health risk behaviors that can lead to a variety of different problematic behaviors that can increase your likelihood for disability and disease. And unfortunately, early death. So all of this matters, and I really just want to emphasize the point. That we are altering the brain structure of young children when they are experiencing racism, when they’re hearing about racist incidents. This is the toll. That it takes on them and so. What I would. See in the clinic or hear about from teachers or from parents is that kids would present with symptoms such as increased bed wetting or they’re more irritable. They could be more clinging, clinging. They could have some learning difficulties. They can present as though they have 80 HD in some situations. And have a number of physical complaints such as headaches and stomach aches, and it’s hard for teachers to see their kids present in this way, and to know exactly what is contributing to some of these presentations. And I think it’s important for all of us as adults, to come from a place of. Curiosity about what’s driving some of these behaviors rather than looking at the kid and saying what’s wrong with you, why are you acting this way? The phrase that is out there, kind of the question that often is suggested, is to kind of think about the question of, well, what happened to you. And it’s really important for us to think about what has happened to our children that have made it such that they present in this way and to. Address some of those root causes. Now kind of going towards the conclusion of my talk, I just wanted to again and talk about Vicarious trauma and talk about again about the summer of 2020 and just share, you know, personally during that period of time, as I was watching the news. I was deeply troubled to hear about all of these stories about people who look like family members who look like adult versions of my kids, who who died. Really was upsetting and the constant reminder of that, the constant reminder of how black skin is associated with a heightened level of dangerousness and vulnerability, was truly overwhelming for me, and I was experiencing. Difficulty sleeping and I couldn’t concentrate and it’s hard for me to see people in clinic and to be as responsive to their needs and that’s because I also was experiencing some of the symptoms I described earlier. That was related to racism and in particular vicarious racism, and it doesn’t go away right. And so this isn’t a new thing. This is part of the. Black experience, you know, hearing about these stories on TV from our family, from our friends. It’s just a repeated. Of how being black in this country is associated with a number of stressors that can really take a toll on one’s body. And there’s been studies that have found that, you know, repeated exposure to the media as stressful and violent events such as such as what Ed shared in the. Earlier slides with some of the pictures of uh, you know, like George Floyd, uh, Brianna Taylor, we know that repeated exposure to these. Events through social media on websites it’s associated with PTSD symptoms, depression, anxiety, physical complaints, as well as increased alcohol consumption. And the thing about that is we know when it comes to interactions with the police. There have been lots of studies that have documented. That black people are three times more likely to be killed by by police, compared to to whites. And so if that’s the statistic that you’re reading as a black person or as a is a statistic that has been reinforced by what it is that you’ve heard. In the news, you can imagine how people would feel on the edge naturally when they interact with the police. But going back to this topic of vicarious racism and the trauma related to that, there was a study that was published. Back in 2018, in which they found that police killings of unarmed blacks contributed to 55 million more poor mental health days every year for black Americans. Now a lot of people are like, what does that even mean? 55 million more poor mental health days. What? Does that mean? That’s nearly as many poor mental health days that’s associated with a chronic medical. Conditions such as diabetes, so we know that it’s having an impact. Vicarious racism is having an impact on one. ‘S mental health. And the frequency at which that occurs is so high and a lot of that has to do with the structural racism that may be embedded within the criminal justice system. And So what I know is that. Oftentimes when it comes to talking about racism, it can feel really uncomfortable. One can think to themselves 1:00 AM. I supposed to do. Just one person, right? But I think what we can all do is to keep in mind that there is a shared sense of responsibility to, UM, addressing racism and to dismantle systemic racism. And we can all do our part and what we can do as human beings is to. Talk about this. By ignoring it, we’re just contributing to the problem by having open conversations and dialogue about it is important, and it’s also important for our kids. When we’re talking. About racism, because that can provide good modeling for them, and that can teach them to also not avoid these difficult conversations. To not adopt A colorblind mentality, and for you to share what your emotional responses were to some of. These moments that could be perceived as racially motivated, if you’re hearing about in the news or if your child is talking about a peer in school who might have been treated differently to talk about how it felt emotionally to to hear about that. And to discuss strategies, effective coping strategies for navigating. And we really need to start talking about this and to provide concrete strategies and tools for our kids to navigate these conversations, to be able to recognize and identify. It and to feel comfortable actually talking about it and addressing it if they happen to see it play out in real time. And then also to consider the possibility of limiting exposure to media for both parents and children, especially as a parent as a caregiver. If you are negatively impacted by everything that you’re hearing about on the news to appropriately expose yourself to it, especially if it’s having a negative. Impact on your mood and your ability to connect with with your kid. So I wanted to make sure that we had some time for questions, but I’m really happy that we were able to to talk about this. Again, it’s all about just being open and willing to understand all of our roles and and what is happening. In our society, and to not feel bad about. It but to. Lean into it and continue to educate ourselves and to reflect on how it is we may be reinforcing some of this. So thank you. Thank you all.

 

Michelle Wagner

Thank you, Doctor Crawford. You are such a powerful speaker and you’ve educated and enlightened. Many of us today we have some comments coming in to the Q&A. Steve says thank you for this very informative presentation you describe well how racism leads to poor health outcomes. For black people, my area focuses suicide prevention. For many years, black people died by suicide at a lower rate than white people. I’ve never seen research on why that is, but I always assumed it was because the support of the support system provided by the black community. Do you have an opinion on that? And he goes on also, in recent years, the rate of suicide of black people is increasing. Do you have thoughts on why that might be and what can we do to address it?

 

Dr. Christine M. Crawford

So I I. Really appreciate the question because there’s been lots of discussion in the media about the increased rates of suicide among black people. But I think in terms of the earlier data, why it is it seemed as though black people were dying by suicide or engaging in suicidal behavior at lower rates. Because I think that there was under recognition of what was actually suicidal behavior or suicidal thoughts. And so being. Curious about the cause of death? The extent to which A cause of death was investing. Stated the openness and willingness of the family to disclose whether or not that individual experienced any mental health related challenges and also we know that black people underutilize mental health services, especially when it comes to outpatient therapy. As well as medication management. So I think that there was under recognition and under appreciation for how it is that black people can also have thoughts of suicide. And I do think that stigma also played a significant role within the black community to be open and willing to talk about how mental health was impacting them. I think what we’re seeing now is this trend. And kids, it’s scary because we’re talking about kids between the ages of 5 to 12, and they are two times more likely to die by suicide. Imagine that they had five year olds in the study. And So what we know is that there’s more awareness among everyone, including our pediatrician and colleagues, to screen for depression, to screen, for suicidal ideation, as well as other mental health concerns. And so I think there’s more screening. I think there’s more discussion and I think there’s a greater appreciation for how this can impact all communities. And what we’re seeing is that the rates of suicide are also going up among black young girls, black young women. So like 15 to 24. That’s like another demographic in in which things are going up. But I think that has to do with the fact that the traumas that I just described in this talk. Here we see that’s impacting them, right. And when you feel as though your experience is being minimized or invalidated and you’re not getting the supports and you don’t feel comfortable talking to your parents about it, talk to your church community about it. It can really. Be isolating and unfortunately lead to some negative consequences. So thank you for that question.

 

Michelle Wagner

Thank you for answering from Rebecca. My biracial foster son was told by a classmate that he was bad because he was Brown. Since then, he has frequently mentioned that he wishes he was white. And made very belittling comments about us being. He had extreme trauma prior to coming to us as well, and has really internalized her comments despite our reassurances and living with our family. Both our home and our extended family is very diverse in regards to race. How would you address this with him?

 

Dr. Christine M. Crawford

Yeah. So what? He’s experiencing is what we refer to as internalized. Seeing especially as a young person that people who look like you are doing bad things or their experiences are being invalidated, they’re having bad outcomes. They’re being viewed as dangerous and people are saying this all out loud and seeing this happen around you. And to live at first hand that what you think about as a a child especially is that OK people who look like me aren’t good. I’ve been told that being Brown isn’t good. Therefore I’m not good. I’m less than I’m not worthy. And that’s what happens. They internalize it and they begin to believe everything that’s been said about their racial group, but they believe that’s also true about who they are as an individual. And we see that being associated with lower psychological well-being behavioral dysregulation because especially as a child not being able to articulate that. You know, I’m an assistant professor of psychiatry, and I could say it, but imagine. Being a 8 year old. For a nine year old, you’re you don’t understand what that’s about. So we see some of these acting out behaviors where they’re getting into fights with kids. They may be talking back to teachers, but a lot of that has to deal with the trauma of the internalized racism. Now, what to do about that? What you can do is to start to introduce the possibility or the idea that you’re willing and open to talk about how being Brown has an impact on the way in which they navigate the world and the way in which they experience that world. And to validate that. And to say I am. I wonder how you fell when you were told that being brown is bad, right? And to start. Talking about the feelings and talk about strategies that you all. Can do together. To combat or counteract that thought, right? And so if this is a. Really young kid, you could say well. How did that make you feel about being told that being Brown isn’t? It made me feel. Angry because I I I I don’t like this color I wanted. I want to get it off right. Well, I wonder instead of trying to change your outward appearance, let’s talk about ways in which we can kind of deal with when you feel angry inside, what are things that you could do when you’re angry and kind of doing that at a very young age and then kind of expanding upon that as they get older. With all the different nuances having to do with racism, that’s that’s one approach.

 

Michelle Wagner

We are at time, but there’s one other question.

Speaker

OK.

 

Michelle Wagner

I love that you talked about not avoiding the topic that children and I wonder not just black children, but also white kids with black friends.

 

Dr. Christine M. Crawford

White kids with white friends, too. All kids, because these kids are going to grow up to be adults who are working with black coworkers. We’re rooming with a black roommate in college, right? So we need. To have these conversations all the time it. Shouldn’t only be in the context of let’s? Get you prepared to hang out with Johnny, who’s the only black kid in class? We gotta normalize these conversations across the board.

 

Michelle Wagner

Right. Because racism affects everyone.

 

Dr. Christine M. Crawford

Yeah, that’s why it keeps going.

 

Michelle Wagner

Right. Thank you so very much for being with us today, Doctor Crawford joining. And just a reminder to folks, a recording of today’s presentation will be posted on the education page of onward nh.org. You will receive an e-mail after today which includes links for the survey. Because we’d love to have you fill out the survey. When you do that, you’ll get a certificate of attendance. If you’re looking for that and we’ll have the website. Link for questions or comments, please reach out to me and Wagner at naminh.org. We look forward to seeing you next month, Thursday, August 18th at noon when we’re going to cover the differences between 988 rapid response and 911. Until then, take care. Thank you so much.