The black mask of humanity: racial/ethnic discrimination and post-traumatic stress disorder.

Knowledge of the impact of racism on the psyches of African-Americans is limited by the following considerations: the tendency among European-Americans to deny, minimize, and rationalize the existence of racism; the tendency among European-Americans to ascribe inferior status to African-Americans; the application of many stereotypes and myths to African-Americans that serve to have them viewed as nonresponsive to human influences; and finally, an African-American tradition “which teaches one to deflect racial provocation and to master and contain pain” (Ref. 1, p 25). It is not surprising that, given this disregard of African-Americans, responses to racial discrimination by African-Americans are often not viewed as severe enough to indicate that these blacks may have post-traumatic stress disorder (PTSD). Even in those instances in which African-Americans are objects of discrimination and describe symptoms consistent with PTSD, their symptoms may be dismissed or trivialized because of the view that the stressors are not catastrophic enough, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM), to warrant a diagnosis of PTSD. The tendency on the part of some EuropeanAmericans to define casually the reality of AfricanAmericans’ experience may be problematic in view of the lack of knowledge about the “Black Experience” displayed by so many European-Americans. This tendency led Ralph Ellison to write: “Thus when the white American says, ‘This is American reality’, the Negro tends to answer . . . ‘perhaps, but you’ve left out this and this, and this. And most of all what you’d have the world accept as me isn’t even human’ ” (Ref. 2, p 111). There are intriguing psychodynamics implicit in the refusal by European-Americans to acknowledge and accept that the African-American response to racial discrimination should be viewed as potentially clinically symptomatic. First, there is a lack of sophistication regarding the adaptive nature of the formation of symptoms and that a symptom simultaneously represents a mechanism of constructive adaptation to the effects of stressors as well as (in the extreme) a maladaptive response to the effect of stressors. Thus, there is a great deal to be learned about formation of symptoms as African-Americans react to traumatic acts of discrimination and then define and expand their self-definition in response to these traumatic acts. Second, failure to characterize as serious trauma the symptoms that African-Americans report as responses to discrimination tends to further the emotional gulf between African-Americans and European-Americans. During four decades of psychiatric and psychoanalytic practice, the author has treated thousands of African-American individuals, many of whom have described various types of racial trauma. Most of the African-American patients evaluated and treated by the author have described multiple personal experiences of racial and ethnic discrimination. Considering the ubiquity of racism, it is not surprising that Dr. Butts is in private practice in psychiatry and psychoanalysis in New York, NY. Address correspondence to: Hugh F. Butts, MD, 350 Central Park West, Suite 13-I, New York, NY 10025. E-mail: [email protected]