HJNO Nov/Dec 2020

HEALTHCARE JOURNAL OF NEW ORLEANS  I  NOV / DEC 2020 49 Jan Kasofsky, PhD Vice President of Behavioral Health & Human Services Access Health Louisiana unfair and problematic practice known as “redlining” of neighborhoods, whereby institutions, such as banking, selective- ly raise prices or deny services; poorly maintained/serviced communities of low income, largely black residents; insuffi- ciently resourced public schools; and until the recent expansion of Medicaid, lack of access to health insurance by many low income People of Color nationally. It is widely acknowledged that the practice of redlining of neighborhoods reduces access to home ownership, depreciates property value, leads to financial loss and is a major factor creating intergenerational poverty. The impact of unfair access to the al- ready limited services and opportunities listed above takes a toll on one’s physical and mental health. The Surgeon General’s Report in 2001, highlighted the negative impact of racism and racial discrimination on the mental and physical health of Peo- ple of Color. Two years later, the Institute of Medicine echoed these findings in their “Unequal Treatment” report. Both reports documented a higher rate of anxiety, de- pression and hypertension as a result of psychological distress due to perceived racism. More health-risk-taking behaviors such as smoking and drug misuse are also documented consequences of perceived institutional bias. The negative effects of perceived racism can be experienced on individual, insti- tutional and cultural levels. These effects can be experienced simply as occurrences or as stressful events. Within the past few years several researchers have studied race-based traumatic stress and note that depression and anxiety that result from experiencing bias and prejudice is an “in- jury” and not a disorder, as it is something “done” to you versus something that is wrong with you. Traumatic stress is defined by three cri- teria and includes the perception that an event is negative, that it is sudden in terms of its predictability and that the individ- ual has no control over it. This traumatic stress work by E. B. Carlson in 1997 also noted that a person’s response to traumat- ic stress can be influenced by their biology, developmental levels at the time of trau- ma, the severity of the trauma and their social context and life events both before and after the trauma. Understanding these five modulating factors can assist individ- uals and therapists to develop an individ- ualized (therapeutic) approach supporting resilience. In a recent conversation with Cirecie West-Olatunji, PhD, Director of the Center for Traumatic Stress Research at Xavier University of Louisiana, who has spent decades studying the impact of structur- al racism and traumatic stress, she noted the importance of truly understanding the context and culture of Black People and People of Color. She stresses that “unlike Post Traumatic Stress Disorder, traumat- ic stress is continuous.” She further com- mented that “Racism impacts all of us.”The sporadic yet continuous, negative impact of racism faced by People of Color creates an emotional drain. Therapeutic approaches to race-based traumatic stress requires the impacted individual or group to define their own stressors and then to identify what gives them strength or what feels protective. Protective factors will be defined by the individual or group as supportive or com- forting andmay include connecting to oth- er individuals, spiritual or religious groups or to community groups experiencing the same trauma. Therapy must be developed within their cultural context to assist the individual or group to successfully cope or initiate successful strategies that support resilience. Collective problem-solving is when a group or community gets together to solve an issue experienced more broadly by the group. It not only gives voice to the indi- viduals experiencing the trauma, it also establishes needed connections for resil- ience. The Community Healing Network and the Association of Black Psychologists support a group experience where partic- ipants share their stories and discuss the constructs of labelled superiority or infe- riority. In these “Emotional Emancipation Circles,” participants help each other to heal, to be emotionally protected through offering support and connectedness, and by assisting one another to find purpose and peace. Helping individuals to cope and to be resilient requires a full appreciation of one’s culture, what they identify as hurt- ful, helpful or offering growth opportuni- ties. Self-advocacy, learning more about one’s history and culture, using meditation and mindfulness and reflecting on where one finds peace, strength and purpose all help to build resiliency. Clinicians need to understand that to help an individual successfully cope and grow through the trauma, insults and challenges of racial prejudice and discrimination and institu- tional racism, they must understand the history, context and culture of the individ- ual or group. They must understand, too, that real change requires their role, beyond their office door, to see and understand the harm of traumatic stress and to dismantle institutional racism. n