Can racism cause post-traumatic stress? That's one big question psychologists are trying to answer, particularly in the aftermath of the shooting at the historically black Emanuel AME Church in Charleston, S.C., and the recent incidents involving police where race was a factor.

What's clear is that many black Americans experience what psychologists call "race-based trauma," says Monnica Williams, director of the Center for Mental Health Disparities at the University of Louisville.

While researchers are still trying to understand exactly how this phenomenon operates, Williams says it's clear that African-Americans are hit hard by incidents that recall the country's ugly history of institutionalized racism.

And such trauma can occur, even vicariously, after events like the recent church attack in Charleston.

"We hear in the news about African-Americans being shot in a church, and this brings up all sorts of other things and experiences," Williams says. "Maybe that specific thing has never happened to us. But maybe we've had uncles or aunts who have experienced things like this, or we know people in our community [who have], and their stories have been passed down. So we have this whole cultural knowledge of these sorts of events happening, which then sort of primes us for this type of traumatization."

Microaggressions, or routine slights, can trigger psychological stress as well, says Carl Bell, a psychiatrist and former CEO of the Community Mental Health Council in Chicago. Black people experience everyday racism, Bell says. "That's the root behind the white woman on the elevator clutching her purse when the black man gets on." That woman might assume, " 'Oh, he's a killer. He's a rapist,' " Bell adds.

And it's not uncommon for black people to be followed around in stores or outright harassed, says Amani Nuru-Jeter, a public health professor and epidemiologist at the University of California, Berkeley.

Smoke billows from a CVS Pharmacy store in Baltimore on April 27. Demonstrators clashed with police after the funeral of Freddie Gray, who died from spinal injuries about a week after he was arrested and transported in a Baltimore Police Department van.

Smoke billows from a CVS Pharmacy store in Baltimore on April 27. Demonstrators clashed with police after the funeral of Freddie Gray, who died from spinal injuries about a week after he was arrested and transported in a Baltimore Police Department van.

Juliet Linderman/AP

This subtle type of discrimination can be traumatic, Nuru-Jeter says, when the victims of these slights believe that it is persistent. She points to last year's fatal encounter between New York police and Eric Garner as an example. Garner died after an officer put him in a chokehold.

"You'll recall that Eric Garner, before he passed, he said, 'I'm tired of you all. I'm tired of you harassing me. I'm tired of you messing with me every day,' " she says. "He was really acknowledging that what he experienced on that one particular day was what he had experienced on many, many other days."

For some, Bell adds, "It's not the incident that causes stress, distress or trauma; it's the helplessness in the face of the incident." This can result in a variety of anxietylike symptoms such as distress, tenseness or loss of appetite. Some people become preoccupied with things that are not typically worrisome.

One of the most common coping mechanisms, says Williams, is anger. And that can feed into riots and vandalism.

"That's a totally normal response to ... persistent oppression and racism," she says. "Other more adaptive coping methods would be things like peaceful protests, prayer, taking actions to bring the community together and improving awareness and understanding."

Currently, the American Psychiatric Association's manual of mental health disorders recognizes racism as trauma, but only in certain cases. But some researchers want to expand the definition of trauma that's fueled by the experience of racism.

"If we're rolling our eyes at African-Americans, then we should be rolling our eyes at everyone else," says Nuru-Jeter. "What about gender discrimination or discrimination by age? There are lots of forms of mistreatment or unfair treatment that people report experiencing, so there is no reason why racial discrimination should be singled out as one form of discrimination that we belittle."

Nuru-Jeter says the data are clear that experiencing racism can affect people's health. What's important now, she says, is trying to figure out ways to reduce discrimination so that it doesn't hurt African-Americans' lives and mental well-being.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.

Transcript

RACHEL MARTIN, HOST:

We begin with this hour exploring the idea of race-based trauma. That's how some researchers describe what many African-Americans may be experiencing right now in the aftermath of the Charleston murders from news of fires at black churches and recent incidents involving black men killed by police. Past studies have linked racial discrimination to health disparities, and there's ongoing research about racism's psychological toll that scholars say should not be ignored. NPR's Cheryl Corley has our report.

CHERYL CORLEY, BYLINE: Can racism cause posttraumatic stress? That's a question professor Monnica Williams is trying to answer. Williams, the head of the Center for Mental Health Disparities at the University of Louisville, says while there's still more research to do, black Americans do experience what she calls race-based trauma. She says African-Americans are hard-hit by incidents that recall the country's ugly history of institutionalized racism. She says such trauma can occur even vicariously after events like the recent church attack in South Carolina.

MONNICA WILLIAMS: Maybe that specific thing has never happened to us, but maybe we've had uncles or aunts who have experienced things like this. Or we know people in our community, and there have been stories that have been passed down. And so we have this whole cultural knowledge of these sorts of events happening which then sort of primes us for this type of traumatization.

CORLEY: Psychiatrist Carl Bell, the former CEO of the Community Mental Health Council, says it's trauma that also occurs in the aftermath of so-called micro aggression or daily slights.

CARL BELL: Where white people make assumptions about who black people are 'cause they're black. That's the root behind the white woman on the elevator clutching her purse when a black man gets on. Oh, he's a killer. He's a rapist.

CORLEY: Or where blacks are followed around in stores or outright harassed, says Amani Nuru-Jeter, a public health professor and epidemiologist at the University of California, Berkeley. Nuru-Jeter says what makes that more subtle type of discrimination trauma is when the victim believes it's persistent. She points to last year's fatal encounter between police and New Yorker Eric Garner as an example. Garner died after an officer put him in a choke hold.

AMANI NURU-JETER: Before he passed, he said, I'm tired of you all. I'm tired of you harassing me. I'm tired of you messing with me every day, right? So he was really acknowledging that what he experienced on that one particular day was very similar to what he had experienced on many, many other days.

CORLEY: But for some...

BELL: It's not the incident that causes stress, distress or trauma.

CORLEY: Again, psychiatrist Carl Bell.

BELL: It's the helplessness in the face of the incident that causes stress, distress or trauma.

CORLEY: And the result, says Bell and the others, can be a variety of anxiety-like symptoms such as distress, tenseness or a loss of appetite. Some blacks, they say, can become preoccupied about things that are not typically worrisome or weighed down by an accumulation of incidents. One of the most common coping responses, says professor Williams, is anger, including riots and vandalism.

WILLIAMS: That's a totally normal response to an ongoing abnormal situation of persistent oppression and racism. Other more adaptive coping methods would be things like peaceful protests, prayer, taking actions to bring the community together and improve awareness and understanding.

CORLEY: Currently, the American Psychiatric Association's manual of mental health disorders recognizes racism as trauma only when an individual meets certain criteria. University of California professor Nuru-Jeter says people should not be dismissive of efforts to expand the definition of trauma that is a result of racism.

NURU-JETER: If we're rolling our eyes at African-Americans, we should be rolling our eyes at everyone else. What about gender discrimination or discrimination by age? You know, there are lots of forms of mistreatment or unfair treatment that people report experiencing, so there's no reason why racial discrimination should be singled out as one form of discrimination that we belittle.

CORLEY: Nuru-Jeter says the data is clear that adverse health outcomes are a part of racism's equation. She says what's important now is trying to figure out ways to intervene and reduce discrimination so that health disparities caused by race-based trauma are less of a factor in the lives of African-Americans. Cheryl Corley, NPR News, Chicago. Transcript provided by NPR, Copyright NPR.

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