Another wave of police killings of black Americans — George Floyd, Breonna Taylor, David McAtee — has stunned the nation and led to protests across the country. For African American people, repeated instances of discrimination and racism inflict distress and can lead to post-traumatic stress disorder, or PTSD, says Monnica Williams, PhD, an associate professor of Psychology at the University of Ottawa, in Canada. Williams, an expert in racial trauma, talked with WebMD about how to recognize the signs that you may be experiencing racial trauma, and how people who are not African American can help black friends, family members and colleagues.
WebMD: Videos have surfaced of the killings of George Floyd and Ahmaud Arbery and so many others. What is it like to see those videos and have them repeatedly play in the news and on social media?
Williams: Most black people in America already have some level of racial stress, if not racial trauma. Seeing these things happen on television adds to the traumatization that’s already there. It can be a trigger for feeling traumatized. It can be a tipping point for people who’ve felt very oppressed for a long time.
WebMD: You developed a test that can help psychologists identify racism as a source of trauma, called the UConn Racial/Ethnic Stress & Trauma Survey. Why was that needed?
Williams: I started writing down the questions that I ask to assess for racial trauma, as a tool for my students. Then I realized that it could be useful for anybody doing this kind of work because so many therapists don’t even know how to ask these questions and how to uncover racial trauma in patients. Most of the validated measures we use to assess PTSD, they don’t ask any questions about experiences of racism or discrimination or oppression. That sort of gives clinicians the idea that this isn’t important, or that this isn’t connected to trauma, or this isn’t something we need to talk about.
There’s a knowledge gap and a training gap. I created this interview to fill this gap.
WebMD: What are some of the questions in that interview?
Williams: They’re not hard or tricky things to ask, but it does help, I find, to see it in print. A lot of people, a lot of therapists don’t have practice talking about racial issues at all. Racial socialization in white families is often not to talk about it. Just having the questions written down for people can be super helpful. They are kind of basic questions: Can you share with me a time you were impacted by racism, including any instances where you were concerned about your safety or the event was very upsetting?
WebMD: Is this kind of trauma something that people of color would necessarily recognize that they’re experiencing?
Williams: I think a lot of times we’re not necessarily calling it being traumatized. But I give a lot of talks and trainings on racial trauma. Whenever I say ‘racism is traumatizing,’ I can see all the black people in the room nodding. I never have to explain this to a black person. I never have to convince them that racial trauma is real, as opposed to many of my white colleagues who seem very confused.
WebMD: Is there a line that’s crossed with racial discrimination, where the damage starts causing PTSD?
Williams: Most people, after a trauma, don’t get PTSD. Their minds know how to heal from it. But most people with PTSD have experienced multiple traumas. People accumulate trauma until they reach a breaking point, and it’s the same with racism. One experience of racism is not usually going to traumatize a person, but when it’s happening over and over again, with no resolution, that’s when people end up traumatized.
You can think of it the same way you think of sexual harassment or bullying. If your boss makes a sexist remark to you, one instance probably isn’t going to harm you, but if you imagine that happening every day, and nobody paying any attention, or even believing you when you bring it up, and you’re powerless to make it stop, eventually you’re going to start to feel traumatized.
WebMD: Does trauma from racism have the same features as PTSD?
Williams: This is being researched and studied. To me, it looks just like PTSD. There are some scholars who feel that racial trauma is different, but by and large, you still have the same types of symptoms. People are emotionally upset by reminders of the trauma, they are trying, sometimes unsuccessfully, not to think about it, and it’s making it difficult to focus. They’re feeling a lot of distress—it could be depression, anxiety, anger, or fear. People experiencing a lot of painful emotions around it. They may also develop unhelpful patterns of thinking. They may start to feel like the world is dangerous. I can’t ever be safe. I can’t trust anybody. Sometimes it will start to look a bit like paranoia. They often have difficulty sleeping.
I talked to a woman of color who’s on the police force. They shared that they were feeling stress, were crying, couldn’t sleep, their hair was falling out. They had dealt with racism for a long time and had finally reached a breaking point. I have spoken to many black women in law enforcement, and they’re all struggling with racial trauma.
WebMD: How do you know when you’ve been so traumatized that you need help?
Williams: If you can’t get a good night’s sleep, and you can’t stop thinking about it, or you are crying all the time. Or if you’ve had to turn your emotions off — you feel numb all the time, those are signs that it’s time to get help. The sad fact is that I think most black Americans have some level of this already, just from living in America. That’s traumatic.
WebMD: Can you talk about some of the health effects of this?
Williams: Just about everything we’ve tried to measure, discrimination either makes it worse or causes it. There’s a whole slew of mental health problems that we know are caused or exacerbated by discrimination including major depression, psychosis, obsessive-compulsive disorder, anxiety, addictions, eating disorders, suicide, and then in terms of physical health problems, cardiovascular disease, high blood pressure, stroke, cancer, diabetes, the list goes on. Infant mortality, maternal mortality, low birthweight… all linked to racism.
WebMD: How can people help their black friends, colleagues and family members who are feeling traumatized right now? Do you have suggestions?
Williams: Yes. For one, it’s just really important to recognize that something stressful and awful is happening right now in America. I’ve talked to so many black people who will say, ‘I went into work today and this guy just started talking to me like nothing had happened.’ Completely oblivious to the fact that we’re essentially having race riots. Our country is on fire. An innocent man was killed by the police in front of the world to see.
They’re just stunned that white people in their lives are not acknowledging this. Like ‘Wow, this has been a hard week.’ ‘Are you OK?’ ‘How are you managing right now?’ ‘How are you taking care of yourself right now? Is there anything I can do?’ These are normal things you would say to somebody if you went through a difficult experience, but the fact that our difficult experience now is often unacknowledged by people in our lives, that’s tough. This is something easy that I think all white people can do. Just acknowledge that something difficult is happening right now and ask how they are.
If they aren’t ready to talk or don’t want to talk. That’s OK. There are going to be a lot of people who don’t feel like they can talk about this right now, but it doesn’t mean they don’t appreciate you asking.