Anthropology
De'Sean Weber

Trauma-Informed Care

Re-contextualizing, Depoliticizing and De-pathologizing the Black Experience

  • Faculty Advisor

    Peter Locke

Published On

July 2018

Originally Published

NURJ 2017-18
Honors Thesis

Introduction

Black Americans are a politically oppressed people, burdened by the cumulative, everyday traumas associated with living in a racist society, ruled by ideologies of white supremacy. [1] [2] [3] Black Americans often face housing segregation, healthcare disparities, unequal treatment under the law and discrimination in the job market and in education, each of which is a traumatic experience independent of the other. But Black Americans often do not face just one type of discriminatory act. They must navigate the racist society that compounds and perpetuates interconnected traumas. Historical trauma must also be considered — by virtue of history and their identification as black, scholars of topics ranging from epigenetics to critical race studies argue that Black Americans are subject to intergenerational trauma through complex mechanisms of biosocial inheritance. [4] [5] [6]

1. See Davis, Freedom is a Constant Struggle.

2. See Bonilla-Silva, White Supremacy and Racism in the Post-Civil Rights Era.

3. See Alexander, The New Jim Crow: Mass Incarceration in the Age of Colorblindness.

4. See Kuzawa and Sweet, “Epigenetics and the embodiments of race: Developmental origins of US racial disparities in cardiovascular health.”

5. See Myers, “’No One Ever Even Asked Me that Before:’ Autobiographical Power, Social Defeat, and Recovery among African Americans with Lived Experiences of Psychosis.”

6. See Cheng,“The Melancholy of Race.”

To truly begin to understand the present trauma in the lives of Black Americans in Chicago, one must begin to examine the past that has shaped the present. Some of this past has been forgotten or repressed, but its effects are still palpable today. Governmental programs that created Chicago’s historic housing projects and the Black Belt have led to racially concentrated areas of poverty. Past modes of housing segregation have taken new forms through, for example, a transportation system that favors wealthy northern Chicagoans over predominately Black and Brown western and southern neighborhoods.

The Chicago Police Department’s (CPD) racial biases are also nothing new, as I show in exploring its collaboration with J. Edgar Hoover’s FBI. The CPD was involved in the FBI’s efforts to quash civil rights leaders, such as Fred Hampton and Martin Luther King Jr., but more recently the Department of Justice report on the CPD proves that these discriminatory practices are still in place today. [7] The city of Chicago continues to close schools that primarily serve communities of color, while it pays settlements for the wrongful police killings of many people of color. These new forms of white supremacy mostly have the same effects as in the past. Donald Trump has endeavored to make sure that authorities continue to over-police communities of color, while his Attorney General hopes to re-energize the “War on Drugs” — which is coded language for “War on People of Color.” [8]

7. Department of Justice. “2017 Report on Chicago”

8. Horwitz, “How Jeff Sessions wants to bring back the war on drugs.”

The United States was founded on institutionalized racism, genocide and colonialism. Remnants of the past permeate the lived experiences of many in society today. The consequences of past institutionalized racism have led to present lived traumas within the Black community. The past haunts and influences the present across all levels of power –– from the municipal to the executive branch of the federal government.

What I endeavor to do is explore the stakes, politics, and potentialities of what I call — loosely inspired by the late philosopher Gilles Deleuze — “major” and “minor” narratives around trauma, inequality and care in the US today. [9] [10] The major narrative, as developed by mental health and biomedical disciplines, is apolitical and decontextualizing. From this perspective, trauma and post-traumatic stress are induced by a discrete, exceptional experience that has already passed. The minor narrative of trauma, by contrast, is a narrative that is political, contextualized, oriented toward social justice, and potentially liberating in nature.

9. See Deleuze, G and Guattari, F, Anti-Oedipus.

10. See Deleuze, Gilles; Guattari, Félix and Brinkley, “What Is a Minor Literature?”

Background

Traumatic events involve a threat to one’s physical or mental well-being through violence or threat of violence, which can become overwhelming to the extent that it interrupts daily function and personal interactions. [11] The concept of trauma has a long and tumultuous history, entangled with the politics of war, racism and sexism. [12] These historical perspectives on trauma lack almost any consideration of race and race-based oppression. Therefore, I argue that a new framework must be posed to understand the suffering of individuals subjected to institutional racism. For the purposes of this paper, I understand traumatic events to involve a threat to one’s physical or mental well-being. While each experience of trauma is subjective, the mere definition and categorization of trauma as a label can become limiting and fraught with controversy.

11. See Herman, Trauma and Recovery: The Aftermath of Violence, from Domestic Abuse to Political Terror

12. See Fassin, D and Rechtman, R. The Empire of Trauma: An Inquiry into the Condition of Victimhood.

In my analysis, I separate the concept of trauma from some of its most problematic historical forms and usages to link it more productively with the traumatic experiences of Black Americans both in the past and present. How can the concept of trauma avoid the dangers of medicalizing social conditions to become liberating, contextualized and political? Critical social scientists have worked to contextualize and politicize the experiences of women who are traumatized, simply by having to live within sexist and patriarchal societies, and those of soldiers traumatized by fighting within the violent context of war. [13] The three main historical perspectives on trauma are hysteria, shell shock, and sexual and domestic violence, all of which center on gender-based or combat-based forms of psychic injury.

13. See Burstow, “Toward a Radical Understanding of Trauma and Trauma Work.”

In this paper, I attempt a critical re-appropriation of the trauma concept as a way of highlighting the cumulative injustices and forms of violence to which Black Americans have been subjected for generations, and the psychosocial consequences of these realities. Being Black in America is inherently traumatic in a way that challenges medicalized approaches to trauma. The claim that to be Black is to be, to some degree, “traumatized” is a call not simply for mental health care, but for restorative justice on behalf of Black communities, both past and present.

Psychological and social services that do not acknowledge this history of trauma in Black communities, some have argued, can inadvertently reinforce harm if the proper accommodations are not made. Such accommodations include recognizing the historical and lived traumas of being Black, and admitting to how biomedicine and psychiatry have played a part in the continuation of institutionalized racism. [14] [15] [16] Furthermore, psychiatric practice often fails to help individuals conceptualize the meaning of their experience in social context — a failure that contributes directly to trajectories of confinement, overmedication and reinforced stigma. [17] What then does this mean for the treatment of trauma — particularly considering the fraught history of Black Americans in the biomedical sphere? [18] I argue that the emerging paradigm of “trauma-informed care” offers a promising first step toward modes of support for struggling Black Americans that are sensitive to the weight of history, context and systemic racism. [19] [20]

14. Burstow, “Toward a Radical Understanding of Trauma and Trauma Work:” 1307

15. See Myers, “’No One Ever Even Asked Me that Before:’ Autobiographical Power, Social Defeat, and Recovery among African Americans with Lived Experiences of Psychosis.”

16. See Hopper, E; Bassuk, E; Olivet, J. “Shelter from the Storm: Trauma-Informed Care in Homelessness Services Settings.”

17. Ibid 1308

18. See Brandt, “Racism and research: the case of the Tuskegee Syphilis Study. Hastings Center Report.”

19. See Myers, “’No One Ever Even Asked Me that Before:’ Autobiographical Power, Social Defeat, and Recovery among African Americans with Lived Experiences of Psychosis.”

20. See Myers, “Recovery stories: An anthropological exploration of moral agency in stories of mental health recovery.”

Trauma-informed care requires an organized and interdisciplinary approach that often involves mental healthcare, substance abuse, primary care, criminal justice, homelessness and domestic violence agencies. [21] Through an understanding of the multidimensional impact of trauma, trauma-informed care has four key components per recent research: trauma awareness, emphasis on safety, opportunities to rebuild autobiographical renderings and use of a strengths-based approach. [22] This approach creates a different narrative surrounding trauma and mental illness that may allow for greater empowerment of the individual and communities vis-à-vis those promising to help them.

21. Ibid

22. Hopper; Bassuk; Olivet, “Shelter from the Storm: Trauma-Informed Care in Homelessness Services Settings.”

Methods

To examine this new paradigm of care, I focused on the Pathways Program at Heartland Alliance, a permanent housing program for individuals with a history of homelessness, serious mental illness and addiction. During my 12 weeks at Pathways, I conducted approximately 120 hours of conversational participant observation and various training sessions with staff members at Heartland Alliance. I also conducted three semi-structured interviews with one staff member and two participants of the Pathways Program which lasted around eight hours.

Ethnographic Data

Tasha, the first participant, looks up at me and says slowly and deliberately, “Tragedy. If there is a tragedy, like if someone get shot in the head –– like my cousin got shot in the head last week. That really messed me up. There is always something.”

Tasha is in her early 50s and comes from a large middle-class family on the South side of Chicago. Despite her upbringing, Tasha’s life was full of tragedies. “I had more than most of my friends. I didn’t know what a bad childhood was. I found out people dying and stuff. I just shut down. My kid’s father got car-jacked. He got shot in the head and died. He got shot in ‘98 and died in ‘04. The bullet traveled in his head. And, this is the same person who broke my heart but I stayed there for months. Changing him and teaching him how to talk right. Everything. He didn’t recognize nobody but me. I mean not even our kids. So that’s about it. Then my kid, my son got kidnapped. They put him in a truck, drugged him, beat him, raped him all that. He was 13. And, he never got over that. I never got over that. It has affected me tremendously.”

“My history with drugs has never been about money. I found out I had money all the time. But if there is a tragedy, like if someone get shot in the head. Like my cousin got shot in the head last week. That really messed me up. There is always something. This will be the fifth or sixth funeral in the last six months. One cousin hanged hisself and the other got shot in the head. And her son had just gotten killed by the Amtrak police. He got shot in the back for weed in his pocket, they shot him in the back while running. The family is suing and now his mother will be getting a settlement.” She ends the brief interview gloomily saying “my sobriety goes up and down. As long as nothing happen, I’ll be alright.” She tells me she has to go run and grab dinner with her daughter in the city and abruptly leaves the interview with the recorder still going.

At our first meeting, Tasha is lively and jokes around with many of the other residents, but when she recalls the stories of how she ended up here, she becomes somber and laconic.

The second participant that I interview at Pathways is James, a man in his early 50s who also grew up in a small middle-class family on the west side of Chicago. He reflects on this and says, “I took a wrong turn somewhere. I left and came up North. I came up here in ‘85. I came up on this side of town in ‘85 and I came out here and made myself homeless. Started hanging out with the wrong crowd. Started drinking, started using drugs. From that point on it just spiraled out of control.”

James tells me about his journey to Heartland Alliance. Because of a perceived lack of economic opportunity and his desire for a community, he joined the Vice Lords, a Chicago gang, to support himself. He went to prison after a robbery. He reflects fondly on his experience in prison, but speaks of his abandonment by the gang, of whom he thought as family. After his release, he went to the north side of Chicago, but was unable to support himself and was homeless for over seven years. He speaks of the harassment suffered by police while on the streets. The police were “chasing the alcoholics and the people who are hooked on the crack? Chase the dope boys not the people who are doing it. They aren’t fucking with the dope boys up here. They are fucking with the people who are using. The judge throws those cases out, those aren’t the kinds of cases they want to see. So, every time something goes wrong, it’s our fault. It ain’t our fault. Go check the gang members.”  After numerous encounters with the police, James finally got in contact with a caseworker who encouraged him to find housing with the Pathways Program.

James has been at Heartland for six years and his intention is not to remain for the rest of his life. “I’m trying to move onto something different,” he says. “And from time to time, being in here, ya know, I’m going to stay here until I get my stuff together.” When explaining his experience at Pathways, James says that “staff can only do so much. The participant has to do some of the footwork themselves. They have to do the footwork. You know. And I’m to the point, staff can do something for me, but I have to put the footwork into the rest of it. If it’s something that I have to do, I have to go out there and get it myself. It makes me feel better about myself.” James ended the conversation in almost the same way he started. “I had a pretty good life coming up, ya know?” He pauses and looks up at me. “It all just came to a halt. I think I have a pretty good life now, but it’s just not going the way I want it to go now. But it will get better, I’m doing a little bit better as far as I’m concerned. I’m not too angry anymore. I’m trying to control my anger.”

Discussion

The stories of James and Tasha illustrate the traumas associated with being Black in the United States. Historical and social forms of institutionalized racism led to a compounding of these traumas. Institutionalized racism contributed to limited access to good housing, education, and employment for James and Tasha. James spoke about his inability to find economic and social opportunities outside of gangs, leading to his incarceration and a gunshot wound. Upon his release from prison, James found it challenging to find consistent housing and a full-time job because of his felony charge. His experience with homelessness led to traumas associated with his diabetes. The dearth of employment opportunities, an inability to attain social capital, brushes with gun violence, frequent interactions with the police and penal system, and homelessness are all higher in Black communities than in white. [23] [24]

23. Alexander, New Jim Crow.

24. Glaude, Democracy in Black: How Race Still Enslaves the American Soul

Tasha, also from a middle-class background, explicitly described the lived traumas she and her family experienced. After her grandmother died, she broke down and turned to drugs for comfort, a common path for many of the participants with whom I spoke. Each time a traumatic instance occurred –– from the shooting of a former boyfriend, the police shooting her cousin, or her own son being brutally assaulted and raped — she used drugs to cope. These instances of trauma often occur within Black communities due to structural violence and institutionalized racism. She struggles to find a job and housing, which she attributes to her felony status.

Their middle-class origins suggest that trauma is not just about poverty. The commonality underscores that racial inequalities, and the intersection of race and gender, are what made James and Tasha vulnerable. Both stories index the cumulative and repetitive traumas of being Black. This trauma is not abnormal. It is the unfortunate norm of Black lives that are shaped by a near-constant vulnerability to violence perpetrated by institutionalized racism, structural violence and white supremacy.

It is important to note that my research has been limited in time frame and scope, with two in-depth interviews conducted with participants, and one with a staff member. During my 12 weeks at Pathways, I also conducted approximately 120 hours of conversational participant observation. I argue that this research can nevertheless elucidate core truths about the collective trauma associated with being Black in America. Even with its narrow scope, the research clearly shows how experiences of racism impact livelihoods and care.

What, then, do these two experiences mean for the care administered by Heartland? Trauma-informed care requires varied and unique forms of contextualized treatment for each participant. James attends every meeting he can, while Tasha avoids all meetings and most interactions with staff and participants. However, the underlying treatment attempts to empower participants to take control of their health and life, with varying amounts of support. James has been successful at Heartland, as the staff encourage him to attend sessions and to form a community. Tasha does not require as much support, and primarily relies on staff to encourage her efforts to find classes and new housing. Based on my research and conversations with participants, I suggest that caregivers continue to better understand and address the effects of institutionalized racism. This race-sensitive lens could be used to develop context-specific, individualized care that acknowledges structural violence. In this way, a contextualized and politicized perspective that understands the Black experience as inherently traumatic can contribute to radically changing the structures that perpetuate trauma.

Conclusion

History is never quite past, just as trauma persists. Trauma is a deeply disturbing experience. However, it should not be thought of only in terms of discrete and exceptional events when examining the Black experience. Rather, it should be understood as compound, cumulative, and transgenerational trauma, with its roots in colonialism, racism, slavery, Jim Crow, housing discrimination and mass incarceration, among other techniques of exerting power. There is a cyclical nature to the experiences of Black Americans, as the same traumas and touchstone historical moments recur, from Emmett Till to Trayvon Martin. Black communities feel each historical and contemporary instance of trauma with profound ramifications for their lived experience, aspirations and senses of belonging. By connecting trauma to the sociopolitical context of being Black in the United States, the trauma concept can become liberating, highlighting systemic social injustice as its etiology, while illuminating paths toward effective care for traumatized Blacks, including the promising new approaches captured by the term “trauma-informed care.”

Trauma-informed care is based on an appreciation of the ways historical injustices affect present communities and produce new forms of violence and traumatization. But the institution providing care must be reflexive in understanding the role that healthcare has often played in perpetuating historical injustices for Black communities, and actively work to make amends through context-sensitive forms of treatment. The trauma-informed care provided at Heartland Alliance attempts to create justice and foster resilience through a multidisciplinary effort linking housing, care, economic opportunities and legal services. Ultimately, healthcare must endeavor to contribute to justice for those who are marginalized, and those affected by institutionalized racism. However, healthcare is only part of the equation for justice. But without consistently acknowledging its complicity with past and present evils, and seeking appropriate transformations in theory and practice, healthcare is unlikely to significantly contribute to meaningful forms of justice, care and knowledge-production.

Trauma-informed care within healthcare cannot radically change the structures in society that perpetuate Black trauma. The approach must be a interdisciplinary effort, utilizing the trauma-informed approach. Politicians, educators, policy-makers and advocates must understand the link between institutionalized, interpersonal, and internalized racism and trauma. This understanding begins with contextualized experiences. The statistics overwhelming show that Black American live with fewer opportunities for social and economic advancement. [25] [26] The United States grew on principles of slavery, colonialism and genocide. We often view slavery in the past tense, disregarding the many effects that past crimes and abuses have on society today, such as slavery through mass incarceration. [27] Unless society moves toward changing its practices at various levels of power, being Black will continue to be traumatic.

25. Ibid

26. Street, Racial oppression in the global metropolis: a living black Chicago history.

27. DuVernay, 13th.

ABOUT THE AUTHOR

Born and raised in Cincinnati, OH, De’Sean Weber is a senior studying anthropology and global health studies in Weinberg College. He wrote an honors thesis examining how new paradigms of trauma-informed care can improve health care delivery and social services for marginalized urban Black communities. At Northwestern, De’Sean was president of Phi Delta Epsilon Pre-Medical Fraternity and Mixed Race Coalition and a general member of NU Community Health Corps. He was recently selected to be a fellow in the 24th class of Bill Emerson National Hunger Fellowship at the Congressional Hunger Center. He is currently placed at the Jersey City Department of Health and Human Services expanding the healthy corner store initiative to increase healthy food access in the city. During his fellowship year, De'Sean aims to draw from his own experience and looks forward to researching poverty and hunger on the ground to better inform national policy.

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