Politics

Trauma Informed Care & people of colour

“If you are silent about your pain, they’ll kill you and say you enjoyed it”                

                                         Zora Neale Hurston

There are different kinds of wounds. Not all pain is deemed legitimate. Oppression causes trauma. Amidst the (fairly) obvious, debates around what really constitutes trauma as laid out in criterion A of the Diagnostic Statistical Manual (DSM)’s diagnosis for Post Traumatic Stress Disorder (PTSD); are alive and well. Criterion A now requires that an individual has been ‘confronted with: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence’ in order to qualify as having experienced trauma. In contrast with the DSM-IV and previous versions, the DSM-V notably includes sexual violence but not racial violence…troublingly evoking the fight for racial justice.

Looking back in history, (white) women’s rights have always taken precedence over the rights of people of colour. For example, in the US white women were afforded the right to vote in both state and federal elections in 1920 but, it was only in 1954 that people of Asian heritage could vote and; well into the 60s that measures specifically designed to bar African Americans from voting (e.g. voting taxes, literacy tests or intimidation) were rendered unlawful. The recognition of racial violence and injustice historically takes much longer than the recognition of sexual violence. It is important to bear that in mind. With some luck, we may get some intersectional thinking within mainstream mental health systems within 50 years.

Still…many of us continue to exist under the weight of racial (and intersectional) violence and more critically; continue to be affected by smaller, less extreme but repeated traumatic experiences. They rarely involve threat to life or to the integrity of our body but, they nonetheless create threat to livelihood, affect life course and limit life chances. They may not cause us to be confronted with overt violence, all the same, they create unsafeness and insecurity, pain and, a sense of futility and resignation or helplessness. Often too, they lead to internalised silencing or self-censorship due to repeated experiences of denial, invalidation or minimisation.

I am amongst those who believe in speaking of our pain.  As marginalised people when we are silent when violence is done to us, we offer a hiding place to perpetrators and to oppressive systems. Oppression and abuse often create a felt sense of shame. And, shame thrives in silence. This is also how oppressive systems reproduce themselves, they locate the pathology, dysfunction or anomaly within those they harm. We do the master’s work when we internalise these (projective) beliefs. Moreover, when one cannot speak of the violence they experience or have experienced, they are done violence all over again. Silence is violence. Often.

Insidious trauma

There is nothing new in considering oppression as a traumatic agent, nothing new at all. Feminist scholars have long critiqued DSM conceptualisations of trauma. Many have advocated for a theoritical expansion so as to locate the experience of trauma within socio-political contexts. The concept of insiduous trauma is born out of this scholarship. Insidious traumatisation (Root, 1992) is centred on the daily ‘subthreshold’ traumatic stressors marginalised people experience which, when taken cumulatively, amounts to trauma because they are constant reminders of one’s precariousness and unsafeness in the world. Some feminists have sought to include insidious trauma within PTSD criteria or put forward conceptualisations of oppression-related psychiatric disorders.

Understanding insidious traumatisation is vital. Nevertheless, I am not sure that some sort of pathologisation parity is required or would be helpful. Nor that pathologising responses to trauma more generally is desirable. This is not because I uphold a hierarchy of suffering or injustice or, because I think, insidious trauma necessarily produces dissimilar physical or psychological reactions to more ‘classic’ traumatic events or experiences. I am simply not convinced that the legitimisation of the psychological harm of racial violence should be via an extension of the DSM/psychiatric classification systems; systems that are based on alleged ‘deviation’ from unpacked and unproblematised norms (and let’s be real which themselves have a long history of doing violence to marginalised groups and indeed may easily be charged with actively living up to that legacy) when being deemed ‘abnormal’ and treated as such in the world is, by definition, the root cause of insidious trauma.

Trauma Informed Care?

When a traumatic event is extreme or when we are able to identify a specific event, it is easier to see and recognise the need for support and care. When the damage is done covertly or more subtly over months, years or decades or; when it is part of the fabric of society culturally or ideologically, it can be much more difficult to attend to our suffering or to legitimise the need for support; even to ourselves. Such violence becomes the norm and our responses the pathology, our inability to cope. Smaller but repeated acts of denigration, of discrimination, of othering; constant reminders of structural inequalities and injustices do culminate into significant psychological distress. The evidence is there. There is nothing abnormal or deviant in survivors. The deviance lays in the violence.

There has been a global push towards what is often referred to as Trauma Informed Care (TIC). Various definitions of Trauma Informed Approaches (TIA) exist; all have at their core, a will to configure services and/or care around the developmental impact of trauma on all level of human functioning including on the psychological, neurological and on social development. TIA, further; seeks to ensure all social systems understand the impact of trauma on families, groups, communities and other social systems. TIC may be less stigmatising and, there are many benefits to understanding how trauma can affect attachment, worldviews and more generally people’s experience of the world and thus how structures can retraumatise.

I remain cautious though, when it comes to uncritically embracing the approach. I am not sure there is a huge conceptual difference between envisaging people as traumatised rather than as ‘mentally ill’.  For starters, most proponents of the medical model would probably argue that both propositions are not mutually exclusive. Indeed, it is precisely what has been proposed of late ‘there is something wrong with you… (in your brain, your emotional responses, your personality, your perceptions, your cognitive or relational processes etc…) because of what you have been through’. Thus, saying or implying, you are damaged because of trauma is no more humanising as a narrative, to me, than saying or implying you are damaged because of faulty brain structures.

Both explanatory models locate the disturbance or pathology within the individual.  In other words, you are still saying to me that there is something wrong with me as opposed to, there is something wrong with the way that I have been treated and everything ‘right’ in the way I have responded to try to survive. Further, and more importantly, the main focus remains on ‘treatment’ rather than on prevention, at least not on holding structures of power to account.  I have seen very little of this within TIA. ‘What has happened to you’ is infinitely more compassionate than ‘what is wrong with you’ no doubt, better still is asking ‘what has happened to you’ then, turning to oppressive systems and those with more social power; to ask ‘what are you doing to stop harming people’ or ‘how are you abusing your power’. Much more difficult questions of course but, necessary ones to balance the focus here and not lay our gaze exclusively or even primarily, onto individuals who survived violence or try to survive the harm done onto them but onto those who abuse their power, individuals and systems.

Trauma Informed Care and oppression

Psychiatry and mental health systems do not own distress or trauma. Or how it is defined. Or how it is or should be experienced. Trauma is not patented by the American Psychiatric Association (APA). Our experience of the world does not cease to exist simply because a group of white American men at the APA, or dominant systems more generally have decided, the daily violence we suffer is not that traumatic or worthy of a name or of a mention in their (conceptually and empirically flawed) book. Or because mental health systems, by and large, continue to struggle to make themselves relevant to so many of us.

I note that despite the recognition that racism constitutes trauma within most TIA I have come across and, the expressed link between trauma and historical and cultural contexts as one the principles of TIC,  I am still to see a single intervention within the framework specifically addressing the damage of whiteness within any mainstream mental health system in the UK. This, I find quite ironic. Racism reproduced at cultural-symbolic level is a source of trauma too. This invisibilisation or disinterest is consequently quite rich.  There is thus no evidence that TIC would be more relevant and/or more centred on people of colour’s needs or experience. Although the potential that it could is certainly there.

Although I am still ambivalent but open about TIC in relation to people of colour and their experience of oppression particularly, I do believe that we could benefit from using insidious trauma to make sense of our lived experience and to render visible and legitimate, the psychological effects of racial oppression. Although here too, the danger of individualising social trauma by narrowing analytical lenses looms very near indeed, constant efforts are required to avoid this process. Sill, by claiming the term, irrespective of dominant groups or systems’ approval, we are choosing self-definition. We are too, asserting our right and power to define reality. We are choosing to centre our experience of the world and hopefully to orientate ourselves towards self-care. And, to be clear, self-care in my book absolutely entails organising and resisting. History, teaches us that it makes little sense, to seek social approval for our struggles before taking action. Eventually, we tend to be proved right.  TIC and particularly, oppression-focused TIA may well prevent more debilitating manifestations of oppression-related or insidious trauma in people of colour, but the evidence base is simply not there and, I cannot say I have seen a rush for it.

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.)

Root M. P. (1992). Reconstructing the impact of trauma on personality. In Brown L. S., Ballou M. (Eds.), Personality and psychopathology: Feminist reappraisals (pp. 229-265). New York: Guilford.

Thank you for reading.

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The intergenerational trauma of the oppressor: A few thoughts

 

A few months ago, I met with a very good friend of mine: a community activist, race equality campaigner and artist. She and I go some way back. Our passion for equality and community work together with our shared experience of immigration (she’s white and of Latin American origins) meant we have built a strong bond over the years. I was invited to her art studio where I met a friend of hers for the first time, a white English man of a certain age who despite his humble social origins, had successfully established his own business. I felt his warmth and openness and, he and I clicked instantly. We quickly bantered and took turn critiquing the artwork on display by proposing outrageously random interpretations. The atmosphere was relaxed and friendly. The three of us eventually settled at a table for a glass of wine. I cannot remember what brought the subject on but the conversation turned to immigration.

Resisting disconnection

Before I knew it, I was listening to some of the most disturbing views I had seen expressed openly in a long while. The gentleman started by recounting an event at work within his previous role as bank manager when he had been accused of racism by an Asian client for whom he had declined a mortgage. He became somewhat agitated as he described what he thought was an attempt by the client at using the ‘race card’. He put to me that people of colour tended to use the race card when things did not go ‘their way’ and subsequently spoke about an incident during which he had got into a dispute with a Jewish man who he said had taken offense at the Christmas decorations inside the bank. Ironically, he lamented what he felt was intolerance on the part of the Jewish man particularly as he, an English man in his ‘own’ country, had to tolerate Jewish decorations on the streets of London.

The talk ended with him discussing the threat of a foreign invasion through immigration, England’s unrecognizable face and the fight the country was required to lead in order to preserve its culture and identity. I was so troubled by this plainly prejudiced tabloid-like rant; which emerged with no prior warning; that my heart started to palpitate. Nevertheless, I felt the strong impulse to stop the conversation had to be resisted.  As he went on (and on); I painfully managed to stay with the anxiety and outrage the tirade had triggered in me. I shifted my focus outward by attending to the emotions and feelings he was displaying which to some degree paralleled what I was experiencing. This slowed my heartbeat down. Helplessness and anger became apparent, but in the main, it was fear and anxiety which dominated. These feelings were palpable and appeared authentic to me. It struck me that it seemed they had been bottled up for some time and; for whatever reason; our very brief relationship had provided an outlet for them.

Empathy and compassion

Why he had felt the need for this cathartic release still evades me. One thing is for sure though, he was addressing me rather than my friend and I almost intuitively refrained from intervening, elucidating and/or challenging him. By not doing so, I bore witness to an experience that is often dismissed. When I shared with him some of my experiences of our conversation, he appeared genuinely taken aback. I noted glimpses of shame as he withdrew into a more socially acceptable and politically correct stance. He apologized profusely and more importantly, became reflective rather than defensive. He said he had not wanted to cause any offense to me; which incidentally I believed; and that he had felt it was ‘okay’ to discuss these things with me. I was surprised by the relatively high level of empathy and compassion I was able feel toward this man.

Although I despised his attitude toward foreigners and immigration and could hardly tolerate his apparent bigotry physically or psychologically, I could not but be touched by his display of emotions regardless of how misguided and irrational he came across. This interaction provided me with an invaluable learning opportunity which I would probably have missed had I taken the moral or intellectual high ground. I have (typically) dissected this exchange in my head and theorized over it hundreds of times using different frames of reference. My aim here is not to offer a commentary on his overflowing raw (male and white) privilege, to condemn his views or to expose the fallacy of his points but rather to try and propose a theoretical interpretation.

Neuroticism and paranoia?

Many may see neuroticism and paranoia in the seemingly disproportionate concerns over identity/cultural losses and the reported fear of being overpowered by some alien enemy. Rationally of course such fears cannot be sustained. Some may argue that the media coverage and political attention immigration receives, would invariably create such unfounded anxieties. It would in my opinion, be difficult to generate such anxieties if something of a nucleus of a pre-existing fear was inexistent. There needs to be something to be tapped into, something onto which political and media agendas and rethoric may be hooked onto.

Fears of invasion precede the invention of the mass media and have been widely documented across centuries and ‘western’ cultures. Undeniably then, such fears have existed for some time independently of media and political influences. Several theories may be advanced to frame such anxieties which may have multiple origins. Here, they will be considered in relation to our imperialist past. Indeed, when one considers processes of imperialism such as colonisation and slavery, fears related to loss of identity, invasion, and imposed enculturation lose their neurotic/paranoid aspects and instead seem to acquire a ‘déjà vu’ quality. Intergenerational trauma may thus offer an interesting framework to consider this resonance.

The Intergenerational Trauma of the oppressor

Intergenerational trauma may be defined as the cumulative and collective transmission of historical oppression and of its negative consequences across generations. It is believed to manifest itself emotionally and psychologically in members of different cultural groups who have not directly been exposed to the traumatic stressor in question. Most of the studies on the phenomenon have concentrated on the offspring of survivors of the Holocaust. Nevertheless, the concept has been used to illuminate the experiences of various racialized and indigenous groups. Here naturally, I am not concerned with the intergenerational trauma of the oppressed but with that of the oppressor.

The trauma the latter suffered as a result of active and passive participation in oppression is less documented and less theorized upon, all the same, there is evidence that terror existed on both sides of the power divide. In view of the abuse oppressed groups endured, rebellion and the possibility of “payback” are bound to have instilled great fears. Many oppressors were indeed hunted by the belief that they would suffer the very fate they had imposed upon oppressed groups, if overthrown. This belief terrorized the hearts of generations and of course led to unspeakably brutal repressions throughout history. As an example, when the collapse of the apartheid system became imminent, many Whites in South Africa violently fought for its maintenance fearing its end would lead to retaliatory genocide by Black South Africans on White populations.

The extreme defensiveness and hostility many feel towards foreigners have been postulated to be manifestations of the guilt evoked by the crimes committed against indigenous and racialized groups. If intergenerational trauma as a conceptual tool can be useful to cast light upon the experiences of those who have historically been at the receiving end of oppression, may it also help make sense of the apparent paranoia and neuroticism evoked by immigration in those who have tended to fulfil the oppressor role? I am not aware that the concept has previously been considered for this purpose. Nonetheless, the hypothesized residual trauma could help account for the appeal of political parties which play on such angst.

On Nigel Farage…

There is really nothing new about the rise in popularity of Nigel Farage. There have been plenty of Farages throughout history particularly during times of economic crises.  The knee jerk muting of the experiences of those we have come to characterize as bigots, with the whip of political correctness, seems unprecedented. However well intentioned, such silencing may lead to feelings of victimisation and alienation and thus result in the entrenchment of prejudice in addition to distracting from more silent forms of racism. If we can truly engage with all experiences then perhaps meaningful dialogues on race, racism and immigration can start to take place both politically and therapeutically (I have previously written on some of the difficulties of creating such exchanges, here). Learning to attend to the suffering of the ‘oppressor’ may consequently provide tools to combat bigotry and prejudice.

Thank you for reading, If you have found this article useful or interesting, please spread the word.

All work published on Race Reflections is the intellectual property of its writers. Please do not reproduce, republish or repost any content from this site without express written permission from Race Reflections.  If you wish to repost this article, please see the contact section for further details.

Want to learn more?

Please see…

Connolly, A. (2011). Healing the wounds of our fathers: intergenerational trauma, memory, symbolization and narrative. The Society of Analytical Psychology, 56, 607-226.

Portney, C. (2003). Intergenerational trauma for the clinician. Retrieved from http://www.psychiatrictimes.com/articles/intergenerational-transmission-trauma-introduction-clinician.