The Other Pandemic: Unpacking the Mental and Physical Health Consequences of Racism

Sept 19, 2020 By Brittney Evans, PhD, Ellen Bee, LCPC, Caroline Adelman, PhD, Oluwaferanmi Okanlami, MD

The killings of George Floyd, Breonna Taylor, Ahmaud Arbery, and the recent shooting of Jacob Blake, along with so many other Black individuals living in America, have led to a period of racial reckoning in our country. The protests that have been taking place across the United States, and across the globe, represent widespread grief and outrage at the stark racial inequity that still permeates daily life for so many individuals and communities. While not at all new, systematic racism and racial inequity are at the forefront of the national conversation today in a way that they have not been since the Civil Rights Movement in the 1960s. In discussing these topics, it has commonly been asserted that racism is a public health crisis, and in the field of health care specifically, it is acknowledged that racism is also a mental health crisis. Maybe you have heard these statements but wondered what exactly they mean, or maybe you are living with the profound negative effects of racism on your everyday life and are trying to navigate and make sense of these experiences. This post dives deeper into the insidious effects of racism on both physical and mental health by providing a framework to understand its negative health consequences. We will end by discussing the roles of self-care and community support in coping with race-related stress; offering strategies for being more effective allies; and linking to a number of valuable resources for collectively continuing the work of anti-racism.

Over the past decade, research has examined the impact of race-related stress as a unique and particularly damaging form of stress that includes personal experiences of racial discrimination, vicarious experiences of racism (i.e., witnessing or hearing stories of racism experienced by others), micro-aggressions, experiences of systemic and structural racism, and experiences of direct or vicarious racial trauma. Of these, direct personal experiences of racism or racial trauma appear to be most strongly predictive of negative mental health impacts. While research on race-related stress has included racial minority groups across the world, most research in this area has focused on experiences of racism among Black individuals living in the United States. Because this article summarizes findings from a range of studies examining the health consequences of race-related stress, we will be using the term BIPOC to refer to findings that apply across Black, Indigenous and People of Color (BIPOC) communities, and will be using the term Black Americans to refer to the findings of research that specifically examined race-related stress among Black individuals living in the United States.

The negative effects of stress on health are well established in the research. Stress arises in situations that pose novelty, uncertainty, uncontrollability, and/or a sense of threat. Isolated instances of stress (e.g., failing a test or going through a break-up), known as acute stressors, are not necessarily harmful and are a normal part of the human experience. However, when factors causing stress are present for a prolonged period, humans experience chronic stress (e.g., repeated exposure to high levels of violent neighborhood crime or experiencing a serious chronic medical problem). Traumatic stress exposure refers to events in which a person either experiences or witnesses the threat of death, serious injury, or other forms of significant harm. The impact of stress on mental and physical health varies depending on the impact, intensity and intervention associated with the particular stressor.

A single act of racial discrimination can be seen as an instance of acute stress; however, when a pattern of systemic racial discrimination is ingrained in the larger societal structure, racism and acts of racial discrimination become chronic stressors, often punctuated by acute episodes of race-related stress and racial trauma. In addition to experiencing acts of racial discrimination, research suggests that BIPOC individuals may be more likely to experience heightened levels of vigilance for racial discrimination, due to past instances of discrimination; in other words, an individual who has experienced past discrimination learns from past experiences to be on alert for future acts of discrimination, even if not actively experiencing discrimination in that moment. Ongoing vigilance in anticipation of the threat of future discriminatory acts, validated by periodic or chronic episodes of discrimination, further adds to the experience of chronic stress. Thus, BIPOC individuals in a systemically racist society are often continuously experiencing a heightened stress response—consciously or unconsciously—which has direct effects on both physical and psychological well-being over time.

As discussed in our previous blog post, the term allostatic load refers to the toll of prolonged stress exposure on the brain and body. Prolonged stress exposure is associated with a host of negative mental and physical health outcomes, from high blood pressure to stroke to depression. Research has shown that Black Americans have higher average scores of allostatic load than White Americans, regardless of age or sex. The difference in allostatic load increases with age, implying that the negative effects of racial discrimination accumulate and are compounded over time. In calculating allostatic load scores, researchers have used a collection of biomarkers (e.g., body mass index, cholesterol levels, blood pressure) to calculate an average health “risk score.” Comparing the “risk scores” for Black and White Americans indicated that the average risk score for Black individuals was roughly equivalent to the risk score for White individuals who were 10 years older. That means that on average, a 50-year-old Black individual is more likely to experience heightened risk for negative health outcomes 10 years earlier than a White individual—a striking difference.

We see similar health disparities in specific illnesses as well. Black individuals facing racial discrimination are more likely to live with obesity, high blood pressure, stroke, cardiovascular disease, inflammatory risk factors, and chronic pain, all of which are associated with chronically elevated allostatic load. The link between these health outcomes and experiences of racial discrimination has been shown in the research time and time again. In fact, a recent long-term study looking at health risk factors for Black Americans showed that exposure to discrimination and segregation had health effects that “were considerably more robust than that of traditional health risk factors such as diet, exercise, smoking, and low [socio-economic status] SES.” Research shows that other racial minority populations facing systemic discrimination face similar health disparities. These vulnerabilities can be understood as the body’s response to the chronic stress associated with structural barriers, microaggressions, stereotypes, and threats to an individual’s identity often experienced by BIPOC individuals.

As a current example of the impact of race on health outcomes, it has been widely reported that COVID-19 is disproportionately affecting and killing BIPOC individuals compared to White individuals. On top of this, studies have shown that once a health problem is developed, BIPOC individuals are routinely provided lower quality health care than White individuals and their pain taken less seriously by healthcare providers than the pain of White individuals, thus deepening already existing health disparities. Taken together, the systematic effects of racial discrimination contribute to many BIPOC individuals being sicker, dying earlier, and receiving poorer health care, creating a very real public health crisis for millions of BIPOC individuals in our country and across the globe.

According to a recent meta-analysis (i.e., a study that statistically combines the findings of many other studies), racial discrimination has even stronger negative effects on psychological functioning than on physiological functioning. Chronic stress fundamentally alters our normal stress response in a way that contributes to negative mental health outcomes. Any person experiencing high levels of chronic stress also experiences prolonged impacts of the body’s stress response system, which includes a range of cognitive and physiological changes, including increased blood pressure and heart rate, muscle tension, hyper-vigilance for threat, heightened reactivity, and a surge of various stress-related hormones coursing through the body. Chronically elevated levels of stress hormones can cause serious problems, including weakening of the immune system, changes to metabolism, and negative impacts on both mood and cognitive functioning. Chronic exposure to race-related stressors may also heighten vigilance for race-related stressors, as well as negative thought cycles surrounding race-related stressors, both of which may exacerbate mental health impacts of racism and discrimination for BIPOC individuals. Severe traumatic stress can also damage a critical part of the brain that aids in recovery from stress, creating a cycle in which exposure to severe traumatic stress can impair one’s ability to recover from future episodes of traumatic and non-traumatic stress. In addition, the elevated allostatic load associated with racism-related stress (RRS) increases risk for a range of psychiatric illnesses, including depression, anxiety, post-traumatic stress disorder (PTSD), and psychotic disorders. While the neural mechanisms are not yet perfectly understood, the effects of racial discrimination on the stress response are thought to largely explain why BIPOC individuals experience disproportionately high rates of negative mental health outcomes.

In light of all we know about the physical and mental health impacts of racism and discrimination, there is no question that the current reckoning with racism in America is both critical for supporting the long-term health of BIPOC communities AND exhausting for many individuals in these communities. If you find yourself saying “I am just so tired” each time you are faced with yet another race-related stressor (including those associated with turning on the news), please consider that this may be a sign that high allostatic load is taking a real toll on your physical and mental health. American Civil Rights activist and Poet Laureate Audre Lorde once famously said, “I have come to believe that caring for myself is not self-indulgent. Caring for myself is an act of survival.” Indeed, if you are part of a marginalized racial group, self-care is especially critical to sustained well-being. We recently published a summary of evidence-based coping strategies and strongly encourage anyone who is hitting the point of exhaustion to take a step back and find a way to care for yourself (or let others care for you), using some of the strategies that we know can meaningfully reduce allostatic load. Furthermore, research-based strategies have been identified for adaptively coping with race-related stress specifically. Below are some strategies identified in the research literature for reducing and coping with race-related stress in particular.

Helping Children and Adolescents to Cope with Race-Related Stress

• Encourage children and teens to seek social support from peers, family members, and community leaders. These actions can promote emotional well-being and help to reduce the negative health impacts of race-related stress (S. P. Harrell, 2000).
• Encourage joining with others to engage in acts of collectivism, including participating in boycotts and protests, civic engagement, demonstrations, and active membership in racial affinity organizations with peers (Cooper et al., 2014; S. P. Harrell, 2000). Group participation and social connection aids in collective coping and promotes factors that aid in resiliency, such as building a sense of community and action. Engagement in one’s racial community also provides valuable opportunities for modeling, mentoring, and feeling connected and understood.
• Talk to teens about the potential of racial barriers and discrimination, and help them develop ideas for how to respond. Communicating about strategies for handling the situation in advance can help teens feel a greater sense of self-efficacy in a challenging situation and can result in greater resiliency and effective coping.
• If you are a BIPOC parent, promote and express messages of pride (e.g., #blackisbeautiful) about your race and cultural background to children, which can lead to stronger racial identity and greater sense of pride associated with their racial identity.

Coping with Race-Related Stress in Adulthood

• Practice healthy coping strategies for managing stress, such as exercise, seeking social support, and engaging in practices that promote a sense of spiritual meaning (e.g., prayer or connection with a meaningful cause). Collective coping strategies involving outreach and conversation in the community can provide a supportive environment to collectively process experiences of racism and to share empowering narratives related to ancestry.
• Engage in values-driven behaviors. Values in the field of psychology are the beliefs or ideals that an individual holds most dear and that help to guide behavior. For example, an individual may hold a value of being a supportive and caring parent, or being an engaged member of a religious community. Identifying personal values and acting in a way that promotes those values (such as providing comfort for your child when they are upset, or attending weekly virtual church services) help build a life that is fulfilling and meaningful, and is associated with improved mental health outcomes.
• The mental health field still has a long way to go in its representation of BIPOC individuals. As of 2015, Black psychologists made up only 5.3% of the mental health workforce. Increasing diversity of mental health providers is a critical goal in the field. It is also important for non-BIPOC providers to practice cultural humility and anti-racism, which is an active process of identifying and eliminating racism by challenging systems, attitudes, policies, and practices in our society (and within ourselves) that contribute to and maintain racism. Providers should aim to practice anti-racism as opposed to non-racism, which is simply a lack of overt racist speech or behavior, but still serves to maintain an inequitable status quo. If BIPOC individuals are seeking therapy or looking for a new healthcare provider, look for providers who make space for the discussion of race and culture, and who are committed to the work of anti-racism in their practice.

Suggestions for Finding a Culturally Competent Mental Health Provider

• Don’t be afraid to ask questions about your therapist’s background or training, or bring up the topics of race or cultural identity to your therapist.
• Check out the website of the clinic or practice before scheduling an appointment; look for language about valuing and supporting individuals from diverse backgrounds and feel free to ask therapy clinics/group practices what work they are doing to create anti-racist cultures in their clinic settings.
• Know that seeing a therapist with a similar racial or cultural background as yourself may be desirable and helpful, and there is nothing wrong with specifically asking to work with a BIPOC clinician. That said, given the relative shortage of BIPOC mental health providers in many areas, working with a provider who is committed to practices of cultural humility and anti-racism may also be a good option.
• Open Path Collective is a great resource for low-fee therapy for individuals without insurance or without access to local providers in-network for their insurance.
• Get therapy referrals from trusted individuals in your life, including other providers that you like and respect. A good fit, a trusting supportive relationship, and training in effective evidence-based treatment approaches are some of the most important factors in getting the most out of therapy, regardless of racial or cultural identity.
• Finally, with any therapist, allow yourself some time (if you can) to develop the therapeutic relationship. You should feel safe and supported in bringing up concerns about race or discrimination in session. If you don’t feel safe or supported by your therapist, it may be time to look for a new provider.

Engaging in Allyship

If you have the privilege of not personally experiencing the harmful effects or race-related stress, there are many things you can do to act as an ally for BIPOC communities:

• Commit to the ongoing work of anti-racism in your personal and professional life.
• Practice cultural humility in your interactions with BIPOC individuals, rather than centering your own comfort, experience, and/or belief system in your interactions.
• When operating in systems in which you do not have the power to shift the culture or practices of the entire system, commit to continuing to do what is within your power to interrupt racism and discrimination, and to create safe spaces (physically and relationally) for BIPOC individuals in your life.
• Learn and talk about White privilege. If you are White, work to recognize the daily privileges you may experience due to your skin color (and if you want to better understand what is meant by the term “white privilege,” see Peggy McIntosh’s essay White Privilege: Unpacking the Invisible Knapsack for some great examples). Discussing White privilege with your family is important for beginning to recognize the many ways that race influences our day to day lives, and the benefits that the social construct of White race affords some people. Recognizing these factors is an important step in being a better ally for BIPOC individuals.
• Believe BIPOC individuals when they share their experiences of oppression and marginalization with you, and validate the pain and injustice associated with these experiences.
• If you are a provider in the mental health field, continually seek out resources and training in anti-racism, bring race “into the room” with your clients, and engage in ongoing dialogue with other colleagues engaging in this work.

Expand your knowledge: Anti-Racism Resources

• Use literature to expand your understanding of the cultural notions and practices that contribute to racism and challenge your worldview starting with this anti-racist reading list compiled by Ibram X. Kendi, a professor and director of the Antiracist Research & Policy Center at American University.
• This excellent and comprehensive list by Dr. Robin DiAngelo, PhD has a huge number of resources related to better understanding and confronting racism, as well as resources for white parents, helpful handouts, and concrete how-to guides for how to engage in the active work of practicing anti-racism.
• Katie Couric published a Detailed List of Anti-Racism Resources including books, movies, television series, articles, and podcasts related to practicing anti-racism for both adults and youths.
• Rachel E. Cargle, writer and activist, has created an online learning platform called The Great Unlearn, a critical discourse that invites White individuals to reexamine their existence in the world by learning the differences between impact and intention.
• Layla F. Saad, author and speaker, has created an interactive book examining White privilege and participation in White supremacy called Me and White Supremacy: A 28-Day Challenge to Combat Racism, Change the World, and Become a Good Ancestor.
• The National Museum of African American History & Culture has developed a detailed resource list, Talking About Race, that provides content for educators, parents and caregivers, and individuals committed to racial equity.

References

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