Long before 1968, the officially recognized end of the civil rights movement, Black Americans have been urged to forget – forget Jim Crow, forget slavery, forget any connection to Africa before the transatlantic slave trade.
But while they may try to forget, the legacy of slavery lives on in the actions, beliefs and behaviors of Black people today, according to some psychologists and educators. Post-traumatic slave syndrome was first examined in 1997 by Na’im Akbar, a pioneer of Black psychology. The theory was further explored in the 2005 book “Post Traumatic Slave Syndrome” by Joy DeGruy. DeGruy defines PTSS as “a condition that exists when a population has experienced multigenerational trauma resulting from centuries of slavery and conditions to experience oppression and institutionalized racism today.”Add to that the belief – real or imagined –that the benefits of the society in which they live are not accessible to them, and the stage is set for people to experience a syndrome that manifests in symp-toms similar to those of post-traumatic stress disorder. Imagine the young enslaved girl ripped from her mother’s arms who then has her own children ripped from her arms. Generations later, that same attachment experience may surface in a mother with insecure attachment who struggles to raise her child through secure attachment, say mental health experts. Another example is enslaved people who were not allowed to partner, yet were expected to create stable families and model that stability for future generations. A lack of resources and info Though the theory of PTSS has been circulating in mental health circles for 25 years, there are limited resources available to mental health professionals who might benefit most from a deeper understanding of the syndrome, says Dr. Heather Hall, a psychiatrist in Sacramento, California, and a board member of the International Society for the Study of Trauma and Dissociation. “Many of us have caseloads that are overrepresented with racial minorities because those are the people who seek us out and those are the people who we are interested in working with,” Hall says. “But PTSS is not something there is much supervision or literature about.”That needs to change, says Akinlana Burrowes, a licensed counselor located near Charlotte, North Carolina, who works with traumatized populations throughout the world. “There are many people of African descent showing up in therapy being ineffectively treated for conditions which stem from PTSS,” Burrowes says. “We as clinicians need to first know and name the condition. Once it’s named, an appropriate treatment plan and implementation can take place toward a healthier prognosis.”DeGruy identified three patterns of behavior that emerge from PTSS: vacant esteem, ever-present anger and racist socialization. Vacant esteem – in society, community and family – is Black people believing they have little or no worth, DeGruy writes.
When Black people lack that basal self-worth – the ability to see themselves as fully human and deserving basic human rights – they are susceptible to feelings of shame, says Hall. “A lot of times we compensate for that and we tell ourselves we haven’t been affected by it and that somehow we have risen above it … but I think we do that at our own peril.” For many Black people, anger always simmers just below the surface and can erupt at any moment, according to DeGruy. And finally, Black people are socialized to believe the value system of white people is superior, resulting in racist socialization.PTSS can bring feelings of social defeat, something Hall says can have far-reaching impacts on mental health. “People who feel discriminated against are more likely to get a diagnosis of schizophrenia than people who don’t,” Hall says. There are detractors of PTSS. In 2016, antiracist author Ibram X. Kendi said PTSS is a racist idea. “Only Americans suffering from racist ideas see negative Black behaviors,” he wrote in Black Perspectives. “For antiracists, negative behaviors are what makes Black people a human group – imperfectly equal to all other imperfect human racial groups.”How to identify PTSS Burrowes says identifying PTSS in patients is tricky because there is no single presentation. “To some, it may look like anxiety or depression. To others, it may look like substance abuse,” she says. The key is in the context. “It starts with a comprehensive history-taking process. I like to employ history-taking annually with my clients, as more of a client’s background can be revealed as the therapeutic relationship and trust grows. Utilizing biopsychosocials with questions that specifically address systemic oppression are vital to this process. Using a family genogram and narrative interventions can also help to identify intergenerational implications of PTSS.”Healing from PTSS can take many forms, says DeGruy, including knowing ourselves, building our self-esteem, managing rage and stress caused by racism, and continually learning to combat racist socialization of American society. Black people must tell their own stories and find strength in faith, community and relationships, she says. Some mental health practitioners have explored liberation psychology to help empower patients with marginalized identities. The practice helps patients analyze the history that led to their current life circumstances and concerns. They are then able to gain a sense of agency and find new pathways of action, according to a learning session last year conducted by Marissa Coleman, a psychologist at University of Vermont Medical Center and vice president of diversity, equity and inclusion. In the session, Coleman provided medical students with some questions that clinicians can ask patients to help build trust around conversations about PTSS. Providers can ask clients to share stories passed down through generations of the family and if those stories align with what patients learned in school. They can also ask how the patient’s family history has impacted their experience today and how it is impacting their mental or physical health. Asking with genuine curiosity can help build a strong therapeutic relationships, Coleman says. But the mental health community must also consider an update to the Diagnostic and Statistical Manual of Mental Disorders, one that includes PTSS, Burrowes says. “Currently there is no condition of record that covers systemic or institutionalized racism,” she says. “This initial validation of the African American experience could then give way to more training on the topic and thus more culturally sensitive treatment for peoples of African descent.”
First published in Black Mental Health Today, Fall 2022 (Vol. 5).
