Black, Indigenous and People of Color (BIPOC) experience excessive worry about their family’s safety, feelings of hopelessness, worthlessness, and emotional distress because of something completely out of their control: Their race. Racism adversely and critically impacts the mental health of BIPOC and is associated with increased symptoms of depression, high stress levels, low self-esteem, anxiety, and trauma.
What Is Racism?
Racism is a complex, pervasive, and damaging system with interpersonal, internalized, institutional, and structural factors. These factors maintain inequality, inequity, oppression and discrimination against people of a particular ethnic or racial group.1 Racism is experienced as overt and explicit actions, as well as more subtle and covert interactions. All levels of racism coexist with one another and cause significant negative mental health outcomes for those on the receiving end.
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Racism Is Widely Reported & Impacts on Mental Health Are Increasing
According to a recent study, an overwhelming majority of BIPOC say American society is racist and that they experienced discrimination, confirming the idea that racism is embedded within the lived experiences of BIPOC in this country.2 According to Mental Health America screenings, the impacts of racism and discrimination are having more and more severe impacts on BIPOC folks’ mental health.
Since January of 2020, the highest increase of anxiety and depression symptoms were reported by Black or African American screeners, and the largest increase of thoughts of self-harm or suicide were felt by Native American or American Indian screeners.3,4,5 Mental Health America also found that Black or African American participants who screened positive or moderate to severe for a mental health condition reported that racism was one of their top three concerns.
Types of Racism
Racism can take on many forms, including more overt acts like violence or slurs, covert iterations like microaggressions, and systemic problems. Someone can also be racially gaslit with phrases such as, “I don’t see color,” ignoring how race and racism impact someone’s day-to-day existence.
Types of racism include:
Overt Racism
Overt racism consists of blatant oppressive views, statements, policies, laws, unfair treatment and intentional prejudice targeting BIPOC people; this includes racial slurs and insults, bigotry, violent attacks, and any other discriminatory practices designed to maintain the oppression of a minoritized person or group.
Covert Racism & Microaggressions
Covert racism involves more subtle actions typically described as racial microaggressions. Microaggressions are comments, actions, or exchanges that are often automatic and invisible manifestations of racism that send derogatory messages to individuals of a particular race or ethnic group. Microaggressions can occur within three categories: microassaults, microinsults, and microinvalidations.6 All levels of microaggressions communicate an offensive message towards its target.
Because covert racism and microaggressions are nuanced frequent occurrences, they can exacerbate daily stressors contributing to adverse mental health functioning. One study found that 96% of Black women reported experiencing microaggressions at least a few times per year, which significantly predicted depressive symptoms in participants.7
Systemic/Structural Racism
Systemic or structural racism refers to prevalent, unfair, discriminatory treatment. For example, residential segregation or biased jail sentences of men and boys of color are strong examples of this kind of racism. Such racism bleeds into all areas of society and perpetuates ongoing oppression.8
Institutional Racism
Institutional racism refers to the explicit racial biases toward POC. This type of racism exists in educational systems (such as children attending schools from lower-income neighborhoods have fewer access to resources), healthcare settings (i.e. discrimination against people in the BIPOC community), and within the workforce.8
Internalized Racism
Internalized racism is a type of internalized self-oppression. This can manifest in several ways, including isolating or withdrawing from one’s family, excessive self-doubt or self-loathing, ethnocentrism, and feeling angry toward their race in general.8
Racial Trauma
Racial trauma refers to the compounding impact of racism on someone’s physical and emotional well-being. This particular type of trauma affects people of all BIPOC communities, and it can impact children and adults alike. The effects can include low self-esteem, anger, relationship problems, substance use, hypervigilance, and depression.8
Racial Gaslighting
Racial gaslighting happens when people deny or minimize the impact of racism. For example, the “All Lives Matter” slogan is a form of gaslighting that discredits the racism experienced by black people. Gaslighting can also sound like, “I don’t see color,” “Nobody is racist anymore,” or, “Not everything has to be about race.”8
Racism & Mental Health Impacts
Navigating a world in which your racial group is systematically and perpetually treated unfairly, threatened, harassed, and ostracized is exhausting. BIPOC people have to maintain an acute awareness that the perceptions, biases, and beliefs of others can lead to assumptions of inferiority, guilt, unintelligence, or incompetence, and can result in many negative effects, even including fatal interactions.
All of this affects how you view yourself, how you view others and how you maneuver through the world. But the effects of racism are overlooked, as they are disguised within typical presentations of mental health disorders such as anxiety disorders, depressive disorders and posttraumatic stress disorder (PTSD).
Symptoms of the effects of racism could include:
- Isolation
- Sadness
- Helplessness
- Hopelessness
- Negative thinking
- Irritability
- Overthinking
- Hypervigilance
- Paranoia
- Anxiety
- Avoidance
Oftentimes, these symptoms are not immediately acknowledged as results from chronic exposure and retraumatization of racism. Finding a therapist who can spot the effect of racism on your mental health can be paramount to getting the help you need.
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Racism & Anxiety
Racial anxiety cannot be dismissed or minimized, as there is an undeniable history in this country in which racism and bigotry result in ongoing harassment, assaults, and threats of danger and death. It is very hard not to worry when seeing plenty of threats towards the lives and safety of Black men, women, and children being policed for engaging in everyday behaviors.9,10 The zealous anti-immigration policies post-2016 have caused an increase in ruminating thoughts, social isolation, fear of family deportation, and separation anxiety for US-born Latino adolescents and Mexican American individuals.11,12
Madeline Maldonado, LCSW explains, “Racism provokes feelings of paranoia and confusion—‘Am I being overly sensitive or was that person or situation racist?’ It depletes your emotional energy and contributes to chronic stress, anxiety and depression.” – Madeline Maldonado, LCSW
Anxiety Related to Social Isolation & Marginalization
Racism can cause individuals to isolate, become socially anxious, shy, and avoidant. One 2014 study in the Journal of Counseling & Development reported, “Shyness involves an internal experience of emotional isolation, whereas perceived racism creates an even deeper sense of social marginalization and relational disconnection. Moreover, when African Americans are disturbed by racism, they may become lonely and frustrated and may be unable to manage their shyness, which in turn leads to greater psychological distress.”13
Anxiety Regarding Explaining Racial Stressors
In addition to experiencing racial stressors, the process of explaining them can exacerbate levels of anxiety. You may have recurring thoughts about the racist incident(s) and question the seriousness of your experience. Unique to microaggressions and covert racism, because of the subtle and innocuous presentation, oftentimes you may be invalidated with racial gaslighting statements like “you are just playing the race card,” “you are just being dramatic,” or, “that happens to me too and I’m White.”
Racism & Depression
Racism sends internalized messages to individuals or groups that they are unwanted, inferior, and do not matter, which affects a person’s sense of self-worth and belonging. These constant internalized messages can lead to sadness, depression, isolation, anger, irritability, loneliness, and worthlessness.
A 2015 longitudinal study found that adolescents reporting a combination of ethnic/racial discrimination and poor sleep also reported a corresponding increase in depressive symptoms and lower levels of self-esteem.14
Depression Related to Racial Stereotyping
In 2012, researchers described the dynamic of racism and stereotyping between the Source (the person or people who hold the stereotype) and the Target (the person or people the stereotype is about).15 It was explained that the Sources display hate, disdain, and aggression towards the Targets, leading Targets, in response, to feel despair, depletion, sadness and hopelessness.
Depression as a Byproduct of Hopelessness
Being a member of a historically targeted group is quite literally like having a bull’s-eye on your back that—regardless of perceived societal progress—remains. This creates a communal sense of hopelessness from confronting centuries of racism, oppression and discrimination to no avail.
Racial Trauma & PTSD
The effects of racism can mirror common trauma reactions found in people with PTSD. Individuals who experience racism are found to display higher stress levels, acute alertness and paranoia regarding their safety.16 Racism has a way of profoundly affecting someone’s perception and assessment of safety, security and control.
A 2009 study found that 97% of Arab and Muslim Americans reported moderate to extreme discrimination in the form of hate crimes, racial harassment and assaults post-9/11.17 This same study found that 94% of participants experienced PTSD symptoms, including increased arousal (94.1%), anger (68.6%), difficulty falling or staying asleep (79.4%), feelings of emotional numbness (52%), anxiety or fear (73.5%), and feeling despair or hopelessness (59.8%). Results found that feeling less safe after 9/11 was the most significant predictor of PTSD.
Thoughts like “Am I next?” “What will happen to me?” and “Will I be safe?” as a result of racial stressors creates exhausting cycles of fear, paranoia, hypervigilance, and heightened startle responses. Even the ways in which our brains respond to chronic hyperarousal due to our trauma perceptions and triggers of fear make it difficult to self-soothe and regulate our nervous system.
“Racism, racist policies, and racist behaviors towards Black and Indigenous and People of Color (BIPOC) leads to stressors, traumas which then impacts our complex identities. Racism in the workplace, and in the classroom can feel like a lack of transparency and add pressure to assimilation. Racism carries a burden for BIPOC mentally and emotionally based on being underrepresented and marginalized and taking up that risk and responsibility to show up in this environment every single day.” -Fatima Mabrouk, MSW
The incessant exposure to racism and racial trauma not only permeates the lives of those directly affected, but the lives of their families and generations to follow, causing intergenerational trauma.
Post Traumatic Slave Syndrome
Dr. Joy Degruy coined a phrase called Post Traumatic Slave Syndrome in which she describes the inherited legacy of trauma and suffering on present-day African Americans: “Post Traumatic Slave Syndrome is a condition that exists when a population has experienced multigenerational trauma resulting from centuries of slavery and continues to experience oppression and institutionalized racism today. Added to this condition is a belief (real or imagined) that the benefits of the society in which they live are not accessible to them.”18
Racism Can Also Have Medical & Physical Impacts
Research shows that racism adversely impacts the physical health of millions of people. Many people in the BIPOC community indicate negative experiences with healthcare. On average, people in racial or ethnic minority groups also experience higher rates of illness and premature death. The life expectancy of Black Americans is four years lower than White Americans.19 Racism also affects equal opportunity for healthcare. Medical racism exists, and it refers to the biases healthcare professionals have toward various patients. At times, this can look like racism affecting how providers assess, diagnose, and treat their patients. In addition, quality healthcare is not always feasible, particularly for people with low income.19
Does Racial Bias Affect Mental Health Treatment?
Racism, discrimination, and prejudice are not confined to specific sectors of our world. Mental health professionals, like all people, are not immune from engaging in racially biased practices and policies. Research has shown that racial bias has significant impacts on the quality of care and attentiveness BIPOC patients receive from service providers.20,21
Risk of Poorer Therapeutic Bonds
One study found that poorer therapeutic bonds were anticipated with Black versus White patients among counselors and counseling trainees.22 Other studies have shown that, in comparison to White patients, Black and Hispanic patients were shown less empathy and emotionally responsive communication.23,24 Provider bias and cultural incompetence is one of the main reasons why it is important for Black patients to consider finding a black therapist.
What Are Therapists Doing to Confront Their Biases?
There’s not any single proven strategy to ensure that mental health professionals are bias-free. Many mental health professionals turn to the DSM-5’s Cultural Formulation Interview (CFI) to help them, which is a tool to assess the impact of a client’s culture on all aspects of their clinical presentation, functioning and treatment.
Beyond that, more and more mental health professionals recognize they must acknowledge their biases, assess the impacts of racial and cultural experiences of their clients and engage in anti-racist practices in order to not contribute to further oppression and marginalization of the populations that they serve.
Erica Sandoval, LCSW and President of the National Association of Social Workers NYC Chapter, stressed the importance of mental health professionals acknowledging personal biases: “Due to the power-dynamic between client and clinician, our clients may not be able to express their frustration, so we must recognize this. As clinicians we must do the work ourselves to help our clients. As our BIPOC community is constantly re exposed to assault, violence, and death it increases mood dysregulation which then increases the need for mental health support. When there is not enough support for our Brown and Black communities it creates an ongoing, horrific cycle.”
How to Find a Therapist Who Is Trained in Anti-Racism Work
Unfortunately, typical databases for finding a therapist do not have options to filter selections based on anti-racism training. You can pay attention to language in a therapist’s profile such as “multicultural” or “inclusive” that suggest racial and cultural competence. The best way to know if a therapist is anti-racist is to determine if they are a good fit for you. This can be most helpful at the start of treatment, however assessing your therapist can occur at any point during your therapeutic relationship.
Some questions you can ask are:
- Have you worked with clients of my race/ethnicity before?
- What training have you received in anti-racism?
- How would you describe your role as an anti-racist?
- What work have you done to address your privilege?
“Some social workers and therapists will try to ‘put themselves in your shoes.’ They will try to use classic social work skills like empathy or ‘tuning in’ to connect with their client. The problem is that unless someone is making antiracist practices core to their work, it’s very easy to unintentionally trigger racist and xenophobic ‘buttons.’ Unintentional or not, it’s not your responsibility as a client to continue seeing that therapist. Your responsibility is to yourself and your mental health and to continue to seek out that therapist that can best support you.” -Elisheva Lock, MPA, LCSW
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Signs That Your Current Therapist Is Not Culturally Competent
It is critical to the success of therapy that you are able to freely share and process in a non-judgmental and supportive environment. It is imperative that the totality of who you are and all of your stressors (which includes the impact of your experiences within your racial and ethnic identity) are explored within therapy. Your therapist should actively empower and validate your experiences.
Some warning signs of cultural incompetence include if a therapist:
- Claims that they “do not see race”
- Minimizes or dismisses your experiences
- Does not allow you to discuss your race and ethnicity freely
- Justifies the reason why you experienced racism, prejudice, or discrimination
- Makes generalizations and stereotypes about your race, ethnicity, and culture
- Does not express empathy and compassion while discussing your experiences
Madeline Maldonado, LCSW-R, notes a sign that your therapist is not a good fit is, “If the professional tells you that you are being too sensitive in response to your experiences of racism or racial microaggressions and thus invalidates your experiences.”
If you feel uncomfortable discussing how your racial experiences have impacted you, you should try and find a better fit. There are resources and websites designed to help you find Black therapists, Latinx therapists, etc, and they can be a good place to start. You deserve a mental health professional who sees you in all of your being; including but not limited to your race, ethnicity, sexuality, and religion, and acknowledges you fully.
10 Strategies for Coping With Racism & Prioritizing Your Mental Health
Racism is a pervasive issue that deteriorates the mental health of BIPOC. Therefore, it is of utmost importance that BIPOC employ radical self-care and develop an arsenal of coping skills to protect their psychological fortitude.
Some strategies to cope with racism and prioritize your mental health include:
1. Conducting a Mindful Self-Assessment
Dr. Howard C. Stevenson, the executive director of Racial Empowerment Collaborative (REC), describes how to self-regulate when you are impacted by racial stress.2 Stevenson explains during his TED talk that using this mindfulness strategy can reduce the threat of racially stressful situations:
- Calculate: Identify and rate the feeling you are having in the moment.
- Locate: Where in my body do I feel it?
- Communicate: What self-talk and images are coming in my mind?
- Breathe and Exhale: Breathe in and exhale slowly.
2. Allowing Yourself to Feel Without Judgment
Process the effects of racism within a safe place and acknowledge the full spectrum of your feelings. Research has found that problem-focused coping strategies such as focusing on and venting negative emotions freely moderates the relationship between lifetime racial discrimination and depressive symptoms.25
3. Channeling Your Reactions
Anger and frustration are valid emotions to feel as a result of racism. It is most effective to direct those feelings in adaptive ways such as journaling, community organizing, and advocacy work.
4. Prioritizing Face-to-Face Contact With Close Community
It’s important to feel connected to the people in your community. Although virtual friendships absolutely have their merit, real-life conversations matter. It’s so valuable to feel like you’re a part of something greater than yourself, and a strong community can offer that safety and reassurance that you’re not alone and that your experiences matter.
5. Accessing Your Support System
Community pain can lead to community healing. Utilize your social supports (friends, family, neighborhood, mental health services, religious congregations, etc.) to engage in processing and solution-focused conversations with people who understand, validate, and empathize with your experiences. You also may consider joining advocacy groups aimed at ending white supremacy, racism, and oppression for additional support.
Madeline Maldonado, LCSW-R, notes, “Ensure that people in your support system validate your experiences—you are not being too sensitive! Seek role models (both professional and personal) who motivate & inspire you.”
6. Managing & Monitoring the Content You Are Consuming
Watching incidents of racism and racial violence contributes to vicarious trauma and is shown to have negative impacts on your mental health.26 Consider limiting your social media engagement and news content that you are consuming to reduce retraumatization by way of flooding yourself with viral images and videos of racism and dehumanization.
7. Engaging With Your Culture & Ethnicity
Spending time engaging with your culture doesn’t fix racism, but it can help you feel more grounded in who you are and who’s with you in this journey. You have a right to feel proud of who you are, and if racism is affecting that, it may be valuable to dig into your heritage to restore a sense of joy and purpose.
8. Research Your Family History
It can be both interesting and rewarding to spend time researching your family history. This activity is also a great way for family members to bond and share stories about the past. Your research might also help you learn more about your background or even connect with long-lost relatives.
9. Join an Anti-Racism or Other Activist Group
Societies change when people get highly engaged in activism. Getting involved at any level (whether it’s more micro or macro) can be fulfilling, and it can connect you with like-minded individuals who can become a valuable part of your support system.
10. Indulging in Guilt-Free Joy
It is incredibly painful to experience racial trauma. It is necessary to counter your experiences of hate, despair, loneliness and depression as often as you can. Accessing joy in the face of racial trauma is self-preservation.
Mental Health and Anti-Racism Resources for Those Affected By Racism:
If you or a loved one is experiencing mental health challenges as a result of racism, consider outreaching support from the resources below:
- Sukhi Culturally Aware Therapist Directory
- Inclusive Therapists
- Therapy For Black Girls
- Therapy For Black Men
- Melanin & Mental Health
- BEAM-Black Virtual Wellness Directory
- Latinx Therapy
- Therapy for Latinx
- Society of Indian Psychologists
- Indigenous Circle of Wellness
- Asian Mental Health Collective
- South Asian Mental Health Initiative & Network
- Bay Area Muslim Therapists
- Institute For Muslim Mental Health
- National Queer and Trans Therapists of Color Network
To learn more about anti-racism, refer to the following organizations:
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Racism & Mental Health Infographics
