Racial Trauma and Avoidance
By: Foluso Solarin, PhD
A Picture of Racial Trauma
*Monet’s heart raced as she stared into the screen. The doctor’s words echoed in her head. “Just follow up with me in a few weeks in my office….I know you prefer telehealth, but I need to see you guys in person soon,” “I’ll be in touch,” Monet said shakily. Ever since the incident with her toddler son Jaden, she avoided in-person doctor visits as much as possible. Weird things, like the smell of rubbing alcohol, made her panicky and nauseated. Her mind went back to when her son was only a few weeks old, during a newborn medical checkup. She clearly remembered the eyes of the nurse, seeming to look right through her, as she called Child Protective Services. “I didn’t hit my son, I never hit him,” Monet pleaded. “It’s a birthmark.” Jaden had Congenital dermal melanocytosis, commonly known as Mongolian spot near his bottom, a large, dark colored birthmark not uncommon in children of color. He was especially fussy that day, and upon examination, a nurse saw the birthmark, claimed it was a bruise, and determined that Monet was responsible. It wasn’t until several hours of questioning that she was cleared, and Jaden was returned. She felt powerless when security guards appeared. She was accused of being aggressive and angry when she repeatedly asked that the nurse let her see and hold her son. Even after the incident, she terrified to that Jaden would be taken away from her if she took him to any medical setting. Her heart would race anytime she drove by a medical setting and when he cried, she would have intrusive flashbacks of his legs flailing as the nurse carried him away.
OCD Symptoms and Racial Trauma
Research has not yet defined a specific and exact cause of OCD. However, there is a significant relationship between trauma and OCD, that is people with OCD are more likely to have experienced past trauma. 1 Monet experienced racial trauma in the doctor’s office when she was assumed to be abusive, and her child was taken away from her without a proper investigation. Racial trauma is not always direct and overt, (i.e. being called a racial slur) nor is it always confined to a single traumatic event. Racial trauma is the result of ongoing stressors related to racism that add up over time. For people of color and minoritized populations, repeated incidents of being stereotyped or discriminated can add up over time, as they did for Monet. The tipping point was the incident with Jaden, and the sum of all the discriminatory incidents that she experienced can be defined as racial trauma.
Monet often obsessed about being viewed as a bad mother when she went to the doctor’s office. Her mind raced anxiously, thinking of all the reasons someone could find to take Jaden away. What if they thought she was not feeding him enough? What if they thought he was sick because she did not take good enough care of him? What if he was taken away from her permanently? To get rid of these anxiety-fueled thoughts she would engage in mental rituals, such as remembering what she fed him or picturing the number that flashed on the scale when she weighed him, which was multiple times per week. She had a particular ritual for holding him and examining his body to make sure he looked “ok” and repeatedly asked those around her reassurance that he appeared fine and healthy. She frequently checked Jaden to make sure he did not have any scratches, cuts, or bruises. She became anxious if she saw a small cut or scratch and did not know where it came from and imagined the worst possible outcomes in her mind.
Avoidance and OCD
Monet was too anxious to bring Jaden to a medical setting by herself, so she scheduled most of her visits via telehealth. When she had to go with Jaden for an in-person visit, she had to schedule visits in such a way where her husband or family friend could go with her. One time, her husband had an emergency work meeting and had to cancel unexpectedly. With shaking hands, she drove to the office with Jaden but was so anxious she stayed in the car and missed her appointment.
ERP for OCD
Have you ever experienced anything like Monet? For people of color, experiencing racial trauma can be draining, leaving you feeling hopeless and without a voice. Racial trauma can occur in indirect ways; her competence as a mother was immediately questioned without a proper investigation. She was viewed as aggressive when she wanted to see her child; however, any parent separated from their child and falsely accused of abuse would likely react in the same manner. Because of the racial trauma she experienced, Monet understandably avoids medical settings with her son. While Monet’s reasons for doing this are understandable, her response to the trauma she experienced is worsening her OCD symptoms. By her avoiding medical settings by doing telehealth visits, or by having someone accompany her, Monet prevents herself from experiencing full-blown anxiety and letting it resolve on its own, without interference from compulsions and other OCD rituals. Once again, she is stripped of all her power and agency, though she is doing everything in her power to keep herself and her family safe.
Monet will benefit from getting ERP (Exposure and Response Prevention) Therapy from a culturally competent ERP therapist. ERP is the gold-standard, non-medical treatment for OCD. A competent will fully explore Monet’s racial trauma and not dismiss it. Research shows that racial discrimination worsens OCD symptoms, so it is important that an ERP therapist understands subtle ways that discrimination can be manifested as well as meaningfully engage with their client about their racial experience.2 A culturally competent therapist will always collaborate with Monet in creating ERP exercises that will address her core fears, while being sensitive to the racial concerns she faces as a woman of color.
Some ERP exercises can include
- Spending time in the parking lot of a doctor’s office
- Smelling rubbing alcohol
- Reviewing a scene from a movie in which a child is separated from their mother
With the help of a skilled ERP therapist, Monet can learn to engage in such exercises without doing OCD rituals, such as mental rehearsals or other reassurance.
A culturally competent ERP therapist will understand that self-care and advocacy are an important part of Monet’s recovery journey. A therapist can suggest things to Monet such as
- Making plans to address any racial injustice she may face in a medical setting, such as documenting incidents and finding a patient advocate
- Identifying and committing to a specific self-care practice
- Seeking support from others without looking for reassurance or engaging in compulsions
*Disclaimer: This article is educational in nature and is not intended to be a substitute for professional treatment. This story in this article is fictional and does not represent any former or current clients or patients of the author.
REFERENCES
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346088/
- Williams, M. T., Taylor, R. J., Mouzon, D. M., Oshin, L., Himle, J. A., & Chatters, L. M. (2017) Discrimination and symptoms of obsessive-compulsive disorder among African Americans. American Journal of Orthopsychiatry.87 (6) 636-645
Here at ERP Kaleidoscope, we have a client directory of culturally competent clinicians who “get” your experience as a person of color. Our therapists provide a safe space for you to process racial trauma as well as provide targeted ERP services.
Foluso Solarin, PhD is a licensed psychologist and owner of Skillset Counseling, LLC a private practice that focuses on the treatment of OCD, Spiritual Abuse, and Cultural Abuse. The website for the practice is https://skillsetcounseling.com