Child Study Center Grand Rounds 04.20.21

June 08, 2021

Annual Samuel and Lucille Ritvo Lecture: "The Neurobiological Underpinnings of Core Psychoanalytic Constructs"

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00:02So I want to welcome everyone and
00:05it's just very, very good to have
00:08everyone here for the 13th annual
00:10Samuel an Lucille Ripoll lecture and
00:13child and adolescent psychoanalysis.
00:16And before I tell you a little bit about
00:18the lectureship and Salmon Lucille,
00:21I just want to note that we're doing
00:23this virtually because of the pandemic.
00:26I know everyone knows that,
00:27but that actually it is very nice to have
00:31people from all over the country and be
00:33able to join us by this virtual modality.
00:36So we'll need to think as we look ahead
00:39to the future how we can have both worlds.
00:43But it is remarkable that this is the
00:4613th lectureship established in 2007.
00:48By the rightful family to honor Samrit fo.
00:51A psychoanalyst and professor
00:53at the Child Study Center.
00:55From 1950 to 2008 and his wife Lucille Ritvo,
00:59who was a historian of medicine,
01:01specializing in the history
01:04of psychoanalysis.
01:05Look very special about us.
01:07For all of us about this lectureship is
01:09it is a collaboration between the CHILD
01:11Study Center in the Western New England.
01:14The two places that Sam and Lucille
01:16were so devoted to and gave so
01:19much of their life too.
01:20And the lectureships goal is to offer
01:23a psychoanalytic understanding of the
01:25inner life of children as a compliment
01:26to the many other perspectives
01:28that are in the child Study Center.
01:30From neuroscience,
01:31the neurogenetics and child development.
01:33It's also an opportunity for all of us
01:36to come together with our memories and
01:38our gratitude to both Sam and Lucille
01:40is our teachers for so many years.
01:42I wish for all of you who didn't
01:44get to know Sam and Lucille is that
01:47you get a sense of them through the
01:49generous spirit of these lectures and
01:51on the time to be with their family.
01:54I mean,
01:55this is most importantly what we would
01:57like to have come through in these lectures.
02:00And today we're especially honored to
02:02have our 13th annual Extra and Donna
02:05Harris an very pleased that Miss Harris
02:07has returned to the Child Study Center today,
02:10and I'm especially grateful to our
02:12social work fellows who introduced us
02:14to Donna and our choice to our Child
02:17Study Center community in December.
02:19For Sessions on working cross culturally,
02:21both among ourselves and in our
02:24clinical setting.
02:25Her workshops with us.
02:27We're so thankful that
02:28we wanted more and Donna.
02:30We're just so grateful that you can
02:32join us again and that you can join
02:35us again without having to travel and
02:37be with us through the week is one
02:40of the advantages of our otherwise
02:43way too prolonged virtual world.
02:45To tell you just a little bit
02:48about Miss Harris,
02:49she received her undergraduate education
02:51at Bennington College in Vermont and
02:54her Masters degree in psychology at
02:56the new school and then a Masters
02:58degree in social work at a Delphi
03:00Gator psychoanalytic training at the
03:01Manhattan Institute for Psychoanalysis,
03:03and she's been in private practice
03:05since completing her training
03:07in both New York and in Pennsylvania,
03:09and is also on the clinical faculty
03:12of Brenmar Graduate School of
03:14Social Work and Social Research.
03:16She teaches at her psychoanalytic
03:18institute and also in Division 39. In 2016,
03:22she founded the Intercultural Counseling,
03:25an organization to provide services
03:27to individuals, couples, and groups.
03:30Around issues of oppression.
03:33Social identity development.
03:34An concerns, especially that
03:37impact marginalized populations.
03:39But then two years later,
03:41Commissaris expanded her work in this area
03:43and founded the intercultural network.
03:45To address these,
03:46these same issues in the needs
03:48of organizations,
03:49which is how she came to us at
03:53the Charleston Center.
03:54Our intercultural network specializes
03:56in helping groups such as ours
03:59determine how they can become
04:00much more inclusive and diverse,
04:02as well as teaching skills to help people
04:05work much more effectively among each other,
04:08as well as with clinical populations.
04:10I know from our experience in
04:12December that she is a compassionate,
04:15patient, and accepting teacher.
04:16And then I can actually imagine.
04:19I know you didn't get a chance.
04:21I don't think to meet Doctor Info,
04:23but I can imagine some very warm
04:25and deep conversations between you
04:27and Sam that would have extended
04:28over many months to years.
04:30And on a day like today he would have
04:33wanted to walk with you and talk with you.
04:36So thank you for coming back
04:38virtually over these virtual waves,
04:40and once again I hope you'll feel
04:42very welcome to continue returning
04:44to our Child Study Center,
04:46an Western New England community,
04:48and let me turn it over to you.
04:50Thank you.
04:59Thank you so much for having me again.
05:01I just realized I was completely muted,
05:03which you know we were just talking
05:06about your muted being a thing.
05:09I'm very pleased to be here again and to
05:12continue to feel very welcome here at Yale.
05:14I wish actually that we weren't in
05:16the midst of a pandemic and that I
05:19could be there all week long because
05:21the problem with being virtual is
05:23that it lends itself to working
05:25constantly and putting clients and
05:27patients in the middle of your day.
05:29So it would be nice.
05:30It would have been nice to have a
05:33break in and be there in person,
05:35but I'm very glad that so many
05:37people can join us today.
05:40An just a technical issue,
05:42if you would all please mute,
05:44it would be very helpful for me and
05:47help me to cut down on echoes a bit.
05:51So today I'm going to be presenting a
05:54paper on healing from racial trauma
05:56and just by way of background, it is.
06:00Grounded in many different areas of thinking,
06:05social work, psychology,
06:06psychoanalysis and so forth,
06:08and in particular other people
06:12who have contributed.
06:14But who may be outside of
06:16the world of psychoanalysis?
06:17But as I was just saying in
06:20my previous meeting,
06:21the world of social analysis is broadening.
06:24And welcoming.
06:27More
06:28and more ideas. So I am
06:32going to share my screen so that
06:35we can get my PowerPoint up here.
06:48Alright.
06:51So over the past decade or so,
06:55researchers and clinicians have
06:56expanded the scope of trauma to
06:59include generational and historical
07:01traumas as vital to consider
07:04when working with patients.
07:11Having difficulty with my PowerPoint here,
07:13so bear with me for one second because what
07:17I didn't try to do was change slides haha.
07:23Apologize for that.
07:29Stop sharing and start over.
07:35The joys of technology.
07:48One second, unfortunately I haven't learned
07:50to talk and do this at the same time.
07:56OK, here we go alright.
07:58Apologies for that groups who have
08:01been fortunate enough to survive
08:03the atrocities of war and genocide,
08:06slavery and colonization are
08:09historically vulnerable.
08:10To experiencing prolonged grief,
08:13loss of spirituality. Paranoia,
08:15low self esteem low self worth self hatred.
08:20Anger and aggression.
08:22In addition, they are at elevated risk
08:26for substance abuse or dependence.
08:28Physical abuse, domestic violence.
08:31Sexual abuse and suicide.
08:34According to Braveheart and others.
08:37Children and grandchildren of historically
08:40traumatized populations continue to
08:43manifest symptoms an risk factors
08:45even when they have not themselves
08:48been directly exposed to trauma.
08:59Historically traumatized groups that
09:02I'm referencing include endangered
09:05indigenous Native Americans.
09:07Holocaust survivors people who survived.
09:13Domestic who survived domestic
09:16genocide and African Americans.
09:19And apologies again,
09:20I continue to have for some reason
09:23difficulties with this PowerPoint there
09:24we that's not where I want to be.
09:31There we go.
09:38African Americans are at risk due to
09:41their history of enslavement and the
09:44subsequent effects of white racism.
09:46Jim Crow laws.
09:47And other post civil war injustices.
09:50And as clinicians,
09:51it is our job to recognize and help
09:55them heal from the impact of racial trauma.
09:59Doctor Kenneth Hardy notes that
10:01the failure to consider powerful
10:03relationships between sociocultural,
10:06oppression and trauma has made it
10:09difficult at best for practitioners.
10:12To respond effectively to the complex,
10:15multifaceted needs of many clients
10:18from oppressed backgrounds.
10:20In fact, as many of you know,
10:23these clients are often misunderstood.
10:25Misdiagnosed and as a result,
10:29underserved.
10:31So I would like for you to do
10:33something now I'd like to do just
10:36a little brief exercise with you.
10:38I would like for you to mute your volume.
10:43Take a deep breath.
10:46And reflect on a small
10:48traumatic event in your life.
10:50We used to call these Maltese.
10:54This should be an event that you've
10:56already processed have no difficulty
10:57talking about and so forth.
10:59We're not looking to bring
11:01up major trauma here today.
11:04So for me, one of those events
11:06was an automobile accident many,
11:08many years ago on the entrance
11:10to the George Washington
11:11Bridge where it was rush hour.
11:13And instead of hitting the brake,
11:15I hit the gas and smacked right into a van.
11:19Nobody was hurt,
11:21but my car was totaled.
11:24So go ahead and think about something
11:27that impacted you in your life that
11:29you can bring up fairly easily.
11:31And I want you just to notice,
11:33as you think about this.
11:36What you feel in your body?
11:40Do you notice any tension,
11:41and if so, where do you notice it?
11:45Does it impact your life at all today?
11:49And if so,
11:50how does it impact you?
11:57And what is the residue?
12:01And what is the residue from that experience?
12:05Do you still experience any fears
12:08or irrational worries or thoughts?
12:11That you can trace back to that event.
12:16So for me this car accident
12:19occurred about 25 years ago.
12:22But it's only in the past.
12:24I'd say five or six years that I
12:26can actually comfortably ride in
12:28the passenger seat without wincing.
12:30When cars come too close
12:31or holding on to my seat.
12:33Or, you know, we used to
12:35have the strap by the window.
12:42And that was 25 years ago. Bless you.
12:49So let's return to the issue of
12:52racial trauma. And how this began?
12:56Researchers estimate that between 3
12:59to 4,000,000 people died aboard ships
13:02during the triangular slave trade.
13:09During that Tresch Treacherous Three
13:12week journey from Europe to the
13:15Americas known as the Middle Passage.
13:18Africans died due to overcrowding
13:21and starvation. Which led to common
13:24diseases such as dysentery, scurvy,
13:27smallpox, syphilis and measles.
13:30Enslaved Africans who survived
13:32the passage experience rape. This.
13:35Psychological and physical abuse.
13:39As well as the selling of
13:42mothers from children.
13:43And ripping fathers from families,
13:46dividing siblings and
13:47selling them all separately.
13:54Enslaved people routinely dealt
13:56with the assault on their bodies.
13:59As well as daily assault on their psyches.
14:05There were daily attempts to break
14:08slaves as at to break slaves will.
14:12In her book on Post Traumatic Slave syndrome,
14:16Doctor Joy de Grue asks us to imagine.
14:20What it was like to be told that
14:23you're no different than livestock?
14:27What it would be like if
14:30you were severely beaten?
14:32If you try to protect your loved ones
14:35or even dare to try to learn to read,
14:37or if you are just too tired to work.
14:41Fast enough. On the plantation.
14:46The belief that blacks were inferior
14:48to whites preceded slavery,
14:50so that by the time European
14:53colonizers were in slaving,
14:55Africans, it somehow made sense.
14:57That they be sold as property.
15:01The fundamental principle of
15:04slavery according to Gump.
15:06Was that blacks are inferior to whites.
15:09Inadequate and effective.
15:12In other words, not quite human.
15:20And so the state of slavery in
15:22and of itself was traumatic.
15:27Atwood and Solar Rd described the
15:30notion of breaking a slave as referring
15:33to the success of subjugation.
15:36They further state that what was done to
15:39slaves impair their ability to function.
15:44They were demeaned and punished
15:47for their deficiencies.
15:49And so they ask, how could someone
15:52being held captive being forced
15:54to perform according to another's
15:57demands and controlled and almost
15:59every aspect of their existence
16:02possessed a sense of agency?
16:07In other words, slavery demanded the
16:09enslaved surrender. Their sense of self.
16:14And to give up wanting to give up hope.
16:19To me, slavery seems to have been
16:22pervasively traumatic in many ways.
16:28There are individual differences in
16:30terms of how people respond to trauma.
16:33Earlier I asked you to imagine a
16:36little trauma and its effects.
16:38And to think of how it impacted your body.
16:44Think of the different ways people were
16:47impacted by the events which occur.
16:49Did, for instance on 9/11 in 2001.
17:06Donna, you're muted you become muted.
17:13Where did I leave off?
17:16After 2001, OK, that's not
17:18too much. Alright sorry,
17:19I have no idea how that happened.
17:21OK, some people were directly exposed
17:23to the events of 911 such as myself.
17:26I was just a mile away.
17:29Others saw repeated images of
17:32buildings collapsing on the news.
17:34Some people who were there?
17:37Experienced severe traumatic stress while
17:39whereas others who had secondhand experience,
17:43such as from the news.
17:46Develop PTSD.
17:49And then some others from both
17:52categories of experience were fine.
17:55There was no residual impact at all.
18:01The impact of generations of slavery
18:03and systemic oppression also varies.
18:06However, I feel pretty confident in
18:08suggesting that a significant number
18:10of African slaves experienced enough
18:12trauma to warrant the diagnosis of
18:15post traumatic stress disorder.
18:19Why then I ask myself, is racial
18:22trauma not included in any addition?
18:26And certainly not in the 5th edition of
18:28our Diagnostic and Statistical manual.
18:39Most people can identify some of the
18:43things involved in what we call trauma.
18:46This includes laypeople and so forth.
18:54Experiencing difficulties one
18:55more time with this, in case
18:58you're wondering what's going on.
19:00My slideshow here, so I'm going
19:03to keep trying to get back to it.
19:09This is never happened to me before,
19:11but of course it would happen today.
19:20Mika.
19:35Alright, so here we have a slide of.
19:39The criteria for PTSD.
19:41And most of you are familiar with this,
19:46and as you look at these
19:48these different aspects,
19:50these different criteria
19:51for the diagnosis of PTSD.
19:53I'm sure that you would probably
19:57agree with me that enslaved people.
20:00No doubt experience all or
20:03most of these symptoms.
20:06It's interesting to note that
20:08the DSM is careful to include
20:10people whose vocation exposes
20:12them to violence or to death,
20:15such as first responders,
20:17police officers, etc.
20:18They also include a section on
20:21culture related diagnostic issues,
20:23which attempts to address different
20:25types of traumatic exposures,
20:27such as genocide.
20:28And the inability to perform
20:31funerary rites after mass killings.
20:36But where do they discuss the impact
20:39of slavery, racism and oppression?
20:46I'll just let you think about that one.
20:52Alright, so here's what we know
20:54about the impact of racial trauma.
20:57Reacher research has shown that trauma
21:00can be transmitted over generations.
21:03Animal studies suggest that
21:05there is genetic memory.
21:06In other words, your DNA may
21:09contain biological memory of the
21:11stress your grandparents endured.
21:16In fact, scientists believe
21:17that Trump trim trauma,
21:19stress and even nightmares can be passed
21:22down from generation to generation.
21:25It doesn't matter that none of us,
21:28black or white have experienced
21:30slavery or currently slave owners.
21:32What does matter is that African
21:34Americans who we see as clients have
21:37experienced the legacy of trauma.
21:39Which must be considered in
21:42efforts to provide support.
21:45Doctor Joy degree.
21:47Gives a poignant example of the
21:50legacy of trauma on with regards to
21:52how we learn to raise our children.
21:57She asks us to ponder.
22:00What gets passed down to us and
22:03she notes that it was experience.
22:05What I'm sorry and she notes.
22:08That if it was.
22:12Abuse at the hands of slave masters,
22:14if that's what we experienced or fathers
22:17not being allowed the power and the
22:20authority to parent their own children.
22:22She wonders what might be the consequences.
22:26What would it be like if the
22:29primary skills mothers taught their
22:32children or associated with having
22:34to adapt to a life of torture?
22:37What training did children
22:40receive in *******?
22:44Certainly the messages were.
22:46That they exist to serve the master.
22:50They must accept exploitation
22:52and abuse and ignore the
22:55absence of dignity and respect.
22:58Just think of the not so implicit messages.
23:02Enslaved males internalised.
23:06They would have internalised that the
23:09dominant male in their lives was the master.
23:12And that he became the imprint
23:15for male behavior, right?
23:17And this imprint was considered.
23:21This imprint consisted of the
23:23need to control others through
23:25violence and aggression.
23:29We carry that legacy.
23:34Today's black community is made
23:36up of families who collectively
23:39share anxiety as well as adaptive
23:41survival behaviors which have been
23:44passed down from prior generations,
23:46many of whom most likely suffered from PTSD.
23:51The black community serves to reinforce
23:54both positive and negative behaviors
23:57through the process of socialization.
24:00For example, in the 1940s,
24:02African Americans had to suppress any sign
24:05of anger or aggression in their children,
24:08especially their male children.
24:10They taught their children to be docile
24:12to the extent of severely beating boys
24:15so that they would never make the
24:17mistake of trying to stand their ground.
24:22Doctor Decroo gives a vivid example
24:25of what this lesson looks like today.
24:32So in her book post Traumatic Slave syndrome,
24:36Doctor Degroote has a wonderful
24:38example and I think this is the very
24:41beginning of the book where she talks
24:44about parenting and how children
24:46are parented different by African
24:49American parents than by white parents,
24:51and she gives an example of standing
24:54in the bank and watching children play
24:57and she notices white children that
25:00are being very playful and there.
25:02Going around the bank and there kind of.
25:05Playing with different things and the
25:07mother says a couple of things to them,
25:10but by and large they're allowed
25:12to roam around and explore the room
25:14without getting into too much trouble.
25:17And then she notices two African American
25:20children watching the white children.
25:23And they too want to engage in this play,
25:26but their mother pulls them back
25:28very quickly, giving them a look.
25:31To communicate, stay, put,
25:34don't move, behave.
25:37Eventually, as the African American woman
25:39approaches the teller with her children,
25:41the children are kind of sliding underneath
25:44that that bar that you have there and another
25:47African American looks at the children,
25:50as if to say,
25:51stay, put,
25:52stay in place.
25:54And so there's a lot of discussion
25:57you know amongst African Americans
25:59about the differences in child
26:01rearing and theories and so forth.
26:03But Doctor Digroup basically states
26:05that it's her belief that we,
26:08that African Americans,
26:09and myself we've learned to teach
26:12our children to behave to stay
26:15put so as not to get into danger.
26:18Because it could be deadly.
26:22African American parents at times may
26:25seem hypervigilant and may be labeled
26:27as such in their efforts to prepare
26:29their children for what they perceive.
26:31An experience as a dangerous hostile world.
26:33This is illustrated by the talk right,
26:36which is something that some
26:38of you may have heard about.
26:40I, for instance, had the talk
26:42when I was about 8 years old.
26:45An 8 years old is a little too young to be
26:48worried about being stopped by the police,
26:51but nonetheless my father sat me down
26:54and carefully gave me instructions
26:56about how to behave should I
26:58ever be stopped by the police.
27:01I listened to him very carefully.
27:03And he gave me very specific,
27:06very clear instructions.
27:09Now, not long after that experience,
27:11which as a child I kind of dismissed.
27:15My father and I were driving
27:18and we were pulled over by the
27:21police for some minor infraction.
27:23And what I noticed was my father,
27:26who was a very large,
27:28proud black man who spoke in a deep, vibrant.
27:33Voice most of the time.
27:35Transform before my very eyes.
27:39He became meek.
27:42Docile,
27:43obedient,
27:44impassive.
27:48And basically was at the
27:50mercy of the police officer.
27:54And that's what I mean
27:55when I refer to the talk.
28:00Numerous scholars drawing on
28:02research and clinical evidence have
28:05have called for the inclusion.
28:07Of racial trauma as an equal
28:10as an etiological factor in
28:13post traumatic stress disorder.
28:16And in complex PTSD,
28:18but it continues to be excluded
28:20from our diagnostic system.
28:30So there are some people who have been
28:34acknowledging the history of oppression and.
28:37Here are a few of them friends final.
28:40For instance, who was an African.
28:43An Afro Caribbean psychiatrist raised
28:45in the MARTYNEC during colonization.
28:48Recognized that oppressed people are
28:51made to feel inferior systematically,
28:53and that thus they internalize
28:57negative images of themselves
28:59and their cultural group.
29:02Judith Herman.
29:03Noted that the diagnosis of PTSD did not
29:08capture racial trauma experienced by many
29:12marginal marginalized people she worked with.
29:17In the year 2000, Lillian Comas.
29:20Diaz identified post
29:22colonization stress disorder.
29:24Which locates pathology in the
29:26social structures as opposed to the
29:30individual or rather novel idea.
29:32And in 2004,
29:34Anderson Franklin used the
29:37term invisibility syndrome.
29:39To describe the reactions of African
29:42American men to pass an ongoing
29:46racial insults and microaggressions
29:51these reactions.
29:52To insult an ongoing microaggressions
29:55generally consist of feelings,
29:57thoughts, and behaviors that impede
30:00one's ability to achieve goals.
30:03To engage in fulfilling and
30:06fulfilling relationships and
30:08involve deep internal conflict.
30:11And stress as identity development emerges.
30:15In the context of racism,
30:16and we see this with our youth.
30:24Doctor Joy Degruy, who coined
30:26the term post traumatic slave
30:29syndrome or PTS S in her book,
30:32which was originally published in 2005.
30:35Ann revived in 2017.
30:41So PTS S is a theory that explains
30:44the etiology of many of the
30:47adaptive survival behaviors.
30:49Again, adaptive survival behaviors
30:51in African American communities
30:54throughout the United States
30:56and the and the diaspora.
30:58It's considered to be a condition.
31:01That exists as a consequense of
31:04multi generational oppression of
31:06Africans and their descendants
31:09resulting from centuries of slavery.
31:14This was then followed by
31:17institutionalized racism,
31:18which continues to perpetuate
31:20injury and is alive and well
31:23in our institutions today.
31:29Post traumatic slave syndrome.
31:36Is. Consists of what she
31:40refers to as map OMAP,
31:42right so it is multi generational trauma.
31:46Combined with continued oppression,
31:49so continued ongoing oppression,
31:51microaggressions, etc.
31:52The A stands for an absence of
31:56opportunity to heal or access the
31:59benefits available to society.
32:01Which then leads to post
32:03traumatic slave syndrome.
32:04So that's just how she breaks it down.
32:07Under such circumstances,
32:09these are some of the
32:12predictable patterns of behavior.
32:14So what we see are vacant listing.
32:19A marked propensity for
32:22anger and violence. Alright.
32:27Racist socialization or internalised racism?
32:32So let's take these one by one.
32:34So in terms of Vacantes scheme,
32:36what we're talking about is.
32:39Insufficient development of what doctor
32:41Degrood refers to as primary esteem.
32:45So she differentiates that,
32:47along with feelings of hopelessness,
32:49depression, and a general
32:52self destructive outlook.
32:53In other words,
32:54the belief that no at that
32:56one has little or no value.
33:02The mark propensity for anger and
33:05violence involves extreme feelings
33:06of suspicion and perceived negative
33:08motivations of others. Right?
33:10Again, this is not pathological.
33:12This is based on the reality that
33:16some people experience and live in.
33:19Violence against self property an others,
33:22including members of 1 on one's own group,
33:26relatives, friends and acquaintances.
33:28So this is where we see and
33:31we wonder you know, well,
33:33why is it that people are committing
33:35violence in their own communities?
33:41She also talks about in this might
33:44answer that question racial racist
33:47socialization and internalised racism.
33:50So this sense of learned helplessness.
33:55Living without hope.
33:57Also, literacy deprivation and
33:59distorted self concept or antipathy,
34:01which manifests in negative feelings.
34:04These negative feelings can
34:06be towards members of 1's own
34:08identified cultural or ethnic group.
34:11They could also be towards customs
34:14associated with only one's own
34:17identified cultural and ethnic heritage.
34:19Or towards the physical characteristics of
34:221's own identified cultural or ethnic group.
34:25Because so we see this in terms of
34:27standards of beauty etc that that people
34:29aspire to have and they don't because
34:32they're different backgrounds or different
34:35ethnicities and different body types.
34:39But when people have internalized
34:41the values of the dominant culture,
34:43than these are the consequences.
34:47Today's African American family has
34:50continued to rear their offspring to
34:53survive a multitude of indignities,
34:55disrespectful behaviors and blocked goals.
35:02All right, so we have this myth out there
35:05that African Americans don't do therapy.
35:08Anne. All too frequently you know
35:12people say this that they that African
35:14Americans don't go to therapy and that
35:17they remain an underserved population
35:19and there are a lot of reasons for
35:22this for the reason that African
35:24Americans might not take advantage of
35:28psychotherapeutic services services.
35:30Sometimes it's attributed to cultural norms
35:32and you know there is some truth to that.
35:36And these norms might be rooted in beliefs
35:39that one should solve one's own problems.
35:41In other words,
35:42we don't air our dirty laundry.
35:47And that one must solve one's own
35:49problems either with family or
35:51friends or within the context of
35:53the church community, and so forth.
35:55So seeking help can be seen
35:58as a sign of weakness.
36:00And there's often mistrust for
36:02health care systems as well as
36:04providers of mental health services.
36:06So consequently,
36:07people of color are unlikely at times
36:09to seek professional help except
36:11for when they can no longer tolerate
36:13distress from overwhelming symptoms.
36:18We're seeing this now with a large number
36:21of people of African Americans not wanting
36:25to be vaccinated against COVID-19 and
36:28an awful lot of my clients who come to
36:30see me wait until the very last minute.
36:32At least my African American clients
36:34are where they're so overwhelmed.
36:36With stress and problems of living that
36:39I have to start in, crisis intervention,
36:42movie, a crisis management,
36:43I can't just you know they're not
36:46coming in to self actualize or explore
36:49things like some other clients might.
36:52In her New York Times bestselling
36:56book cast Isabel Wilkerson reminds
36:58us that African Americans were indeed
37:02used for medical experiments from
37:05slavery into the 20th century.
37:08So during this time they were
37:10injected with plutonium.
37:15Diseases like syphilis were
37:17allowed were gone were allowed to
37:20go untreated for the purpose of
37:23observing the effects of the disease.
37:26And vaccines were perfected.
37:30The vaccine for typhoid.
37:33Was developed based on observations.
37:36An experiments with black bodies.
37:40In addition, gynecological and other
37:43exploratory surgical procedures
37:44were performed without anesthesia.
37:47So given the atrocities and this
37:50country's history of systemic
37:52oppression and healthcare disparities.
37:54The lack of information,
37:56an inclusion as well as the
37:58impact of racial trauma,
38:00is it any wonder that black
38:02people often don't seek treatment?
38:05Would you?
38:08These factors, coupled with the fact
38:10that mental health professionals
38:12are not trained to deal with
38:14historical and racial trauma,
38:15suggests that African Americans are left
38:18to cope with the effects of untreated.
38:21Physical and psychological issues.
38:25Now we get to the reason that I'm here
38:29today healing from the legacy of historical.
38:32First, I really need to point
38:35out the UN obvious fact,
38:37or maybe not so obvious that people of
38:40African ancestry are extremely resilient
38:42despite historical trauma and ongoing
38:45personal and institutional racism.
38:48They are resilient.
38:51Therefore, engaging people of
38:53color must must absolutely,
38:55positively include an orientation to their
38:58strength as individuals and as community.
39:01Trauma is not the only thing that has
39:04been passed down through generations.
39:07The tradition of family and Clanship
39:10has helped African Americans survive.
39:13In today's world,
39:15the strengths of extended families and
39:18spirituality can constitute cultural
39:21resources which have been compensated.
39:24Which have often compensated
39:25for the lack of other resources.
39:30Who shot to molinara?
39:33Emphasizes that when mental
39:35health providers are unable to
39:37recognize and validate the clients
39:40history of social oppression,
39:42they create a therapeutic
39:45space that is potentially.
39:48That potentially can
39:50reproduce traumatic events.
39:52Somehow disavowing the oppression
39:54experienced by the client
39:56and perpetuating the status,
39:58the status quo of our
40:01socio political systems.
40:03In other words,
40:04we engage in a reenactment of
40:06black peoples experiences of
40:08oppression in our consultation room.
40:13Braveheart calls on clinicians to
40:15take responsibility in conversations
40:18about injustice by recognizing and
40:21acknowledging the clients experience
40:23of oppression and suffering.
40:25Boulanger suggests that we are
40:28morally obligated to bear witness
40:30to oppressive events that disrupt
40:33the client's sense of self and
40:36their relationships with others.
40:38As clinicians, we must be willing to
40:41engage with difference and similarities
40:44in privilege and marginalization with our
40:47patients across the intersection of race,
40:50ethnicity, gender identity,
40:52sexual orientation, social class,
40:54religion, ability, status,
40:56language, an immigration status.
41:01Doctor Megan Corredo,
41:02who's the founder of the narrative approach,
41:05called Stories that stories with
41:08spelled with a Z as to your eye easy.
41:12She stresses a collaborative
41:14approach to working with clients
41:16with an emphasis on the ability to
41:18work with the clients narrative.
41:21The stories approach helps
41:23people work through unresolved
41:25grief related to oppression,
41:28morning and losses and focuses on
41:31deconstructing experiences of social
41:33oppression related to traumatic stress.
41:42Black Rage is another piece
41:45that's really important here.
41:48It is considered to be a complex
41:52multi dimensional response.
41:55It's psychological displacement of grief
41:58and pain that masks emotional wounds.
42:01Doctor Kenneth Hardy discusses ways in
42:04which we can help clients deal heal from.
42:08The hidden wounds of racial trauma.
42:11Like others, he supports a narrative approach
42:15and recommends 8 interrelated steps.
42:21And I'm going to go through each one of
42:24these affirmation, an acknowledgement.
42:29By this he means a helper must convey
42:31a general understanding and acceptance.
42:34That race is indeed a critical
42:38organizing principle in our society.
42:41Matter what color you are,
42:42that is what is going on in
42:45the United States of America.
42:47And that creating a space
42:49for race is necessary.
42:51We must convey a sense of
42:54openness and curiosity.
42:55And take a proactive role in
42:57encouraging conversations about race.
42:59So that means that those of
43:01us who are clinicians must,
43:03because we hold the power in the room.
43:06We need to initiate these conversations
43:09and not just wait for the client
43:11or patients to bring them up.
43:16We must engage in racial storytelling
43:18by inviting clients to share their
43:20stories of racial experiences.
43:22This helps them develop their voice
43:25and critical thinking about the self.
43:30Validation is seen as a tool for
43:34counteracting the devaluation.
43:35An assaulted sense of self.
43:38Validation confirms the racialized
43:41experiences of people of color
43:43and validates resilience.
43:50Naming. One of the most debilitating
43:54aspects of racial oppression is
43:56that it is a nameless condition.
43:58It's difficult to describe and to quantify.
44:02A life of ongoing microaggressions
44:05leads to self doubt.
44:08And self denigration.
44:09This step is a process to connect words
44:13with reality based traumatic experience.
44:16Naming allows us to make the
44:19hidden wounds of racism visible.
44:23Externalising devaluation this helps heal
44:28the wounds of internalized evaluation.
44:32Clients learn to recognize that
44:34devaluation and disrespect are
44:36connected to race and racial oppression.
44:43Counteract evaluation.
44:46After Externalising d'evaluation,
44:48this step endeavors to provide the
44:51client with an array of resources.
44:54Emotional, psychological,
44:55and behavioral to help them build
44:58strengths and healthy ways of coping.
45:01Ana buffer against future assault.
45:04And finally re channeling rage.
45:09The pain of rage is seen as normal
45:11and a predictable response to
45:14perpetual experiences of degradation,
45:17devaluation and domination.
45:19It is a combination of emotions
45:22which have been blocked.
45:24There's a strong relationship
45:25between Voicelessness,
45:26an rage which needs to be
45:29properly channeled so that it
45:31does not become all consuming.
45:34The goal of treatment is not
45:36to rid people of their rage.
45:38But rather to help them be aware of it.
45:41Express it gain control over
45:44it and ultimately redirect or
45:46channel it in productive ways.
45:49These represent some of the
45:51positive ways which we can
45:53support our patients process of
45:56working through racial traumas.
45:57For clinicians,
45:59it's imperative to develop a support
46:02network for the work we do and
46:05identify ongoing self care practices
46:07to help sustain the emotional
46:10toll of working with trauma.
46:12This is especially true for clinicians
46:15who themselves have marginalized identities.
46:17We need to be fully present in
46:20order to help our clients deal.
46:23In order to help our clients heal
46:26in multiple ways at multiple levels.
46:29This work necessitates that
46:31practitioners and their patients
46:33begin by telling their story.
46:36We must return and claim our past
46:39in order to move forward and heal.
46:43This is the message of Sankofa.
46:47Which in that we language of Ghana means.
46:51Go back and seek.
46:54I'll go back and take it.
46:56And with that,
46:57I thank you for listening to this
46:59presentation today and putting
47:01up with the numerous technology
47:04technological difficulties iPad.
47:11Thank you very
47:12much, Donna. Would you be willing
47:13to have questions for me? I most
47:15certainly am. I was watching
47:17the time to at least allow for
47:18a few minutes for questions.
47:20I think we've got about 10 minutes. So
47:23as as we always do, please if you want
47:25to put your questions in the chat,
47:28I can moderate the chat or just
47:30shout them out either way.
47:43Hear someone starting to speak.
47:46They might be muted.
47:48OK up I have a hand here in a
47:51person who's move Andreas? Hi
47:53Donna, thank you
47:54so much and I'm sorry that I joined
47:57a little bit late, but I'm so
48:00glad that you're
48:01reminding us about independent and
48:03so costly thanks. Of
48:05racism is an independent
48:06traumas and ongoing trauma,
48:07and I think that we need to
48:09think about it and we need to
48:11talk about it and in that way I
48:13think that we often elide those
48:15conversations and I think you
48:16made a very compelling case for
48:18that, so I really thank you. Thank
48:20you for a wonderful talk.
48:22You're welcome. Thank you, I also see
48:25there's a question from
48:26Deborah Stevens in the chat.
48:28Does healing from racial from
48:29a help decrease the amount that
48:31is passed down to offspring?
48:32That's a wonderful question.
48:34I wish I knew the answer to that.
48:37I would suspect that if one is
48:38able as as with domestic violence
48:41and other forms of trauma,
48:43that we know that if we are
48:45able to interrupt the cycle,
48:47the cycle of trauma or the cycle
48:49of violence that that certainly
48:50does help with offspring because
48:52it's going to impact the way
48:54you raise your children, right?
48:56It's going to impact that that
48:58level of hyper vigilance and also
49:00what you what you communicate.
49:02I don't know, for instance,
49:03how long it takes to.
49:07To diminish the impact in one's DNA, that is.
49:10That's a really interesting question
49:12that I think we need to study more.
49:18Then there's another question in the chat.
49:20Can you see it or do you
49:22want me to read it out?
49:24I can see it for those of us who are
49:26not clinician basic researcher here.
49:28How can we best support our clinician
49:30colleagues in this important work, huh?
49:33Maybe by answering the question
49:35that was just asked, but no,
49:37I think really doing research in this area.
49:40You know really considering trauma,
49:41the effects of trauma an and
49:43doing more research around
49:44racial and historical trauma.
49:46We've done some research on it
49:48as it pertains to survivors of
49:50Holocaust and so forth,
49:51and I just think that that
49:53work needs to continue.
49:58Jose
50:00hello, thank you first of
50:02all for a wonderful talk.
50:03I had a question specifically to the
50:06comment or the the point you made to
50:08let us know that it was up to us to
50:11bring up race in a therapeutic setting.
50:13I couldn't agree with you more.
50:16But from the from my viewpoint,
50:18my question is particularly about what age
50:21when it comes to children, adolescents,
50:23we start asking them 'cause we,
50:25you know I'm a child and
50:27adolescent psychiatry trainee,
50:28so that's that's specifically
50:29the question that I have.
50:31Is what age would you say
50:33is too young or too old?
50:35Or you know what's the best
50:37way to lay that groundwork?
50:39Or in that foundation for that.
50:41So you may not know the answer to
50:44this, but I'm putting this out to the room.
50:47At what age do you believe
50:49children begin to notice?
50:50Racial differences if put in the room
50:52with someone who is different from them.
50:54What age is that? Anyone?
50:59I'm going to say in the first year of life.
51:03Someone says under under first preschool
51:05Yeah's youngest for before four,
51:06I would say definitely by three to a
51:09certain extent, it's going to depend
51:11on what they're exposed to, right?
51:13If they are in an environment where there
51:15is difference in their racial differences,
51:18they are going to notice them.
51:20The wonderful thing about children
51:21is that they don't trip all
51:23over themselves like adults.
51:24Do you know they haven't internalised
51:26all the nonsense that we have
51:28internalised with regards to race?
51:30An impression, so they're very direct.
51:32They're very love kids.
51:33They're very straightforward. Who are you?
51:35What are you? They wanna know?
51:37Why are you different than me?
51:38Are you different from me?
51:40So that's perfect.
51:41It's such a perfect opportunity to
51:43introduce that to kids and you don't
51:45really have to push them very far.
51:46With adults they'll have.
51:47And you know those, oh,
51:49I don't notice color.
51:50You know they'll go through all that
51:52children will be right there with you and
51:54they'll jump right in and they will say,
51:56yeah, yeah you are different than me.
51:58You know, let's talk about that.
52:00Or let's not let's play instead.
52:03So.
52:06As early as possible is the answer to
52:08that question. Thank you, thank you.
52:13Let's see question from Amanda
52:14Calhoun. Can you see that one? I
52:18can if I bring it up here we go.
52:21How can I, as an African American
52:24or black psychiatry residents,
52:25get training and navigating
52:27racial trauma from my patients?
52:29Racial trauma is largely unmentioned
52:31in our medical education and I
52:33would love training and guidance.
52:34Yes, yes yes. Well you're here.
52:37So that's the first step you came today.
52:40And the other thing is we have to
52:42reach out to other disciplines.
52:44I think I mentioned earlier that.
52:46I wasn't trained in this in school, you know?
52:50So I did anti racism training and cross
52:52cultural dialogue in training in order to
52:55actually process whatever I had internalized.
52:58As a black person and then begin
53:00to use that in my practice,
53:02my whole track practice transformed
53:04about 10 years ago because,
53:06you know of my own awareness,
53:08an willingness,
53:09willingness to delve into these
53:11topics because just because you're
53:13a person of color doesn't mean
53:15that you just jump in and go.
53:17And you're you know.
53:20Do you speak to these things with ease
53:23so someone's putting in the chat?
53:26Thoughts about the Kellogg Foundation.
53:28Yet there are a lot of really,
53:30really good resources out there
53:32now and and what I will say that
53:35brings me a lot of joy is that all
53:38of my professional organizations
53:40and I belong to so many of them.
53:43But whether it's the the
53:44group psychotherapy folks,
53:46the cycle analytic folks that
53:48Division 39 at the Appa?
53:50My own institute and so forth.
53:53They are all trying very hard
53:55to delve into the topic of race,
53:58racism and systemic oppression.
54:00Right now they're struggling.
54:01I will say that they are struggling a lot,
54:05but they're having the conversation.
54:07So these are good places to join
54:10my colleagues in terms of trying
54:12to explore this work, Terra.
54:16Thank you Donna, and thank you for
54:19your talk. I really enjoyed
54:21listening to what you
54:22had to say and you spoke about sort
54:25of implications for treatment and I
54:27wondered if you had thoughts and ideas
54:30about sort of structural changes and
54:32differences to settings that my ANAN
54:34policies and practices that would make
54:37even engaging in treatment or or just
54:39make a sort of more aware and welcoming.
54:42Consider it from the beginning. Yes
54:45yes yes no. I have many thoughts about that.
54:50I think we really need to look
54:52at our space is first of all the
54:55spaces that we do treatment in and
54:57re examine some of the limitations.
54:59The boundaries that we place on treatment
55:01because it may not be conducive for everyone.
55:04So for instance, there is a lot of
55:06work that's been done with children and
55:09adolescents around being organizations
55:10such as outward bound and just doing,
55:13you know, either equine therapy or therapy.
55:15And in the woods and things like that.
55:18And the reason for that.
55:20Is because people have found
55:21it to be more effective.
55:23Kids talk not so much in an office.
55:25I know my kids when they were
55:28adolescents that was, you know,
55:29having the conversation with them in the
55:32living room was never going to happen.
55:34Put them in the car and maybe
55:36go for a drive absolutely.
55:38So I think we we have to think about
55:40ways in which we can bring the
55:42expertise that we have to a broader
55:45population that may not be willing to be
55:48confined in the spaces of our offices.
55:50Which can be quite limiting.
55:52I can do therapy in the lunch room,
55:54you know,
55:55and I say that because having
55:56worked in a day treatment program
55:58day treatment program,
55:59that's where I did an awful lot
56:01of my work in the lunch room.
56:04So we have to,
56:05you know,
56:06we have to be more open and flexible as to
56:09where treatment happens and how it happens.
56:13That's a very short answer to
56:14a very complicated question,
56:15'cause there are a lot of things
56:17related to what you're asking,
56:19but we do have to be examining our policies.
56:22And our training and and all of that.
56:28So I think we have time
56:29Donna for one more question.
56:32Hi.
56:34Please doctor birds.
56:39You're on mute.
56:41You can stay you go.
56:49I think you're still muted, yeah?
56:54You look down on the bottom of your screen.
56:56You should see a microphone with a mute,
56:58and if you click on that it should unmute.
57:02And sometimes I think the
57:04space bar does the same
57:05thing. Sometimes I think it does.
57:10You almost had it.
57:12Who are we asking to unmute?
57:15Not to burst.
57:18Can you do it? Roast me
57:19for him? I'm not let me
57:20see if I can hang on just a second.
57:23May go into participants and see if I
57:25can do it while you work on it too.
57:28One second, let me see I
57:29might be able to unmute him.
57:33There you go. This unmuted.
57:36I had some experience in retaining
57:38the term neurosis in DSM three years
57:42ago. I wonder? If
57:45you would tell me what your thoughts
57:48are about the prospects of getting
57:51the post traumatic slavery disorder
57:53into the official nomenclature.
57:56Uh-huh I would
57:58be happy actually if we just consider
58:02you know racial trauma as part of.
58:05Post Traumatic stress syndrome that
58:07that would make me extremely happy
58:10considering the fact that the DSM
58:12does reach out to professionals,
58:14physicians, psychologists,
58:15an even social workers when
58:17a new addition comes out,
58:18it's an opportunity for us to present
58:21these findings and to question
58:23the fact that that is not there.
58:26So I do have high hopes.
58:29I'm a little optimistic that
58:31because there is more focus on the
58:34impact of culture and the idea that
58:37experiences of slavery and genocide
58:40and so forth have been traumatic
58:43at that will also be included.
58:45But I think that anyone in this room
58:48who has the power and the privilege
58:52to be asked to contribute in some way
58:55to the DSM ought to think about that.
58:59But thank you very much for your
59:02presentation. I found it extremely.
59:06Broadening and lightning,
59:07anyone in the field should be have
59:10an opportunity of hearing him speak
59:12that thank you very much. Thank
59:15you so much.