As we welcome 2021 with hesitation and expectations, it has become more evident than ever that countries worldwide have failed—on different degrees—to manage the COVID-19 pandemic. The United States, in particular, seems to have a specific struggle to manage the crises within its society.
However, there is nothing equal within American society, and morbid aspects such as COVID-19 statistics do not escape the clear divisive lines.
According to the Center for Disease Control and Prevention (CDC), by November 30, people of color of all ethnic groups within the United States displayed the worst ratios of cases, hospitalization, and death from COVID-19 in comparison to their white counterparts, despite being the minority. Black and African-American citizens are reported to surpass white people in number of deaths by a rate of 2.8 and are nearly four times as likely to be hospitalized.
Although alarming, these numbers fail to grasp the range of devastation left behind by the pandemic.
Mortality rates, sequels, and disabilities caused by the illness, and the implementation of preventive and restrictive measures against COVID-19—such as quarantine—leave tangible and intangible marks within the Black and African-American population in fields that go beyond medical.
Undoubtedly, the psychosocial impact is widespread and hard to measure, and the mental health consequences are near-impossible to determine. The COVID-19 pandemic induces a brand of phantom suffering of the Black community within America that requires careful study yet doesn’t feel entirely new.
Race-Based Traumatic Stress.
The disproportionate numbers of cases, hospitalizations, and deaths are yet another symptom of the multi-headed hydra that is institutional racism. Therefore, it becomes evident that the impact of COVID-19 upon Black, African-American, and other minority communities within the United States is unequal from the get-go.
Institutional, systemic racism is detrimental to the quality of life in multiple ways, both tangible and intangible. However, an unspoken reflection of this monster is within the realm of mental health.
Reputable sources such as Mental Health America and the University of Georgia, as well as dozens of individual research, have repeatedly confirmed the existence of something called racial trauma, also called race-based traumatic stress (RBTS). According to Mental Health America, it refers to mental and emotional injuries caused by the prolonged and continued exposure to the consequences of racism and discrimination. Unfortunately, it can develop symptoms virtually identical to those of Post-Traumatic Stress Disorder (PTSD). However, unlike PTSD, RBTS is not considered a mental disorder and is, instead, a mental injury caused by systematic racism.
Much like PTSD symptoms get triggered by exposure to any reminder of the traumatic event, RBTS reopens the mental wounds caused by trauma each time the individual is exposed, directly or indirectly, to acts of racism and inequality.
Regarding this, Mental Health America recognizes three (3) types of traumatic stressors for RBTS.
First, there are direct traumatic stressors. MHA defines them as the personal and individual events and circumstances a Black or other underserved, unserved, and marginalized men or women can experience while living under systemic racism or through racist attacks. Direct traumatic stressors range from violent or verbal race-based attacks to microaggressions of any type.
Next, MHA recognizes vicarious traumatic stressors, which are defined by delivering an indirect impact to the individual. They often involve the general circumstances of living within systemic racism and other Black individuals’ direct traumatic stressors. Despite their indirect nature, they have an equally detrimental effect on mental health.
Finally, there are transmitted stressors, which involve a generational leap. These are the stressors inherited from grandparents to parents and children, becoming transgenerational and transcending time. Direct and vicarious traumatic stressors have the potential to eventually become transmitted stressors, either within a family or a community as a whole.
Although impossible to determine, it is not an exaggeration to assume most Black Americans have experienced—at the very least—two of these traumatic stressors.
Unfortunately enough, the peak of the COVID-19 pandemic during mid-2020 also coincided with widespread protests across the country, following the violent and unjustified murders of George Floyd, Breonna Taylor, and many more—clear vicarious traumatic stressors for the population. It is not a surprise, then, that the events caused mental health distress across Black Americans, with at least four apparent suicides following Floyd’s murder within days.
These events undoubtedly overlapped with the pandemic, doubling up the emotional and psychological distress of Black Americans. However, it is worth mentioning that police violence is not the only face of RBTS that appeared during 2020.
Race-based Traumatic Stress and the Medical System.
One of the ramifications of RBTS involves medical trauma and Black American’s inherent distrust towards the healthcare system.
Historical betrayals of medical professionals against Black populations due to structural racism are nothing new. It is imperative to mention the Tuskegee syphilis study—a human experimentation study that unethically attempted to study the consequences of untreated syphilis with the African-American population by infecting them with the disease without their knowledge and disguising it as vaccines and free healthcare.
Independent individuals did not perform or execute the Tuskegee syphilis experiment on their own—it was sponsored by the United States Public Health Service and the Center for Disease Control and Prevention and ran from 1932 and 1972. Finishing nearly 50 years ago, the event is recent enough to remain prominent in Black American’s collective memory. It remains one of the most famous examples of transmitted stressors within the population.
This particular case is only one of the vivid examples that trigger collective trauma to this day. During many previous public health crises, Black Americans have been continuously mistreated, misdiagnosed, and have enjoyed less medical benefits than their white counterparts. Examples like Hurricane Katrina and the HIV/AIDS pandemic are only some of the many precedents for the current COVID-19 numbers.
The prevalence of current racial bias within the medical field keeps feeding this particular brand of racial trauma, therefore inducing a justified yet often misguided skepticism towards healthcare institutions that can exacerbate Black communities’ vulnerabilities within pandemics, such as the current COVID-19 crisis.
It is then apparent how it is impossible to separate the grim COVID-19 statistics within Black and African-American communities from mental health variables. Institutional racism hasn’t just created a socioeconomic gap that exposes vulnerable Black communities to closer contact with COVID-19, but it also induced a generational trauma that makes Black individuals skeptical towards receiving healthcare from institutions within the country—even when they have access to it.
Subsequently, racial medical trauma also makes Black individuals more prone to the psychological consequences of the pandemic, while at the same time rendering them less likely to seek help for it. It’s a vicious cycle, festering within the open wound that is racial inequality.
But an already bleak situation can always get worse. Mental health and mental health institutions do not exist in a vacuum—they actively take part in establishing, feeding, or perpetuating the systematic discrimination and racism against Black individuals and other minorities within the medical field.
Prejudice against Black people and communities as well as race-based misconceptions and assumptions regarding the mental health of Black people, have left an overwhelming gap when it comes to addressing the struggles of the entire community. The recognition of RBTS comes a few decades too late, and the managing of the psychological aspects of COVID-19 is the perfect example of this.
Unemployment and the collapse of small businesses as stressors.
Assistant Professor Dr. Paul Sasha Nestadt from the Johns Hopkins School of Medicine in Baltimore has the perfect analogy to describe Black communities’ circumstances amidst COVID-19.
“We are all in the same storm, but we are in different boats,” he explains. “Many people were able to hunker down and be with their family and could afford child care, but some people were just getting by to start with and did not have the reserve or cushion to do this.”
Statistics explain the racial angle of his statement.
Data from the 2019 Survey of Consumer Finances showcased that, by the time of the study, the average wealth of a white family would be eight times more than that of a typical Black family—less than 15%, with a median wealth sitting at around $24,100 compared to the $188,200 of white families. At the same time, Black workers found themselves more laid-off than their white counterparts during the peak of the COVID-19 pandemic but also were hired less during the last months of 2020—particularly Black women.
The grim outcome kept getting worse. Research at the University of California and the National Bureau of Economic Research discovered that nearly 41% of Black-owned small businesses were facing the worst consequences of the pandemic and quarantine, compared to the 17% of white companies.
No savings, no jobs, devastated businesses. The Black boat could barely sail through the storm.
A study by Boston University’s School of Public Health published with data the already evident information: depression symptoms within the United States increased three times more after the start of the COVID-19 pandemic. What’s more, those at greater risk were those experiencing financial stressors such as low incomes, low savings, and unemployment.
As seen above, all the risk factors are led statistically by Black people. Subsequently, we see that a population already at-risk of increased trauma due to racism is also the most exposed to financial stress—all significant factors behind depression, anxiety, and other mental illnesses that keep spiking during the pandemic.
But the adversity does not evade the Black Americans who got to keep their jobs.
Front-line workers and mental health.
Although unemployment remains one of the top risk factors for mental health afflictions on Black individuals during the pandemic, the other side of the coin isn’t exempt from its particular shortcomings.
It turns out, employment is also one of the most widespread triggers against mental wellbeing for Black and African-American communities.
Black employees make up a disproportionately large part of the front-line workers that kept American society functioning during the harsh quarantine. Although they make up 11.9% of the employed workers within the United States, 26% of public transit workers, 19.3% of all social services employees, 18.2% of all warehouse & postal service delivery workers, and 17.5% of healthcare personnel.
Although they kept their positions due to being deemed essential, they were also increasingly exposed to the illness.
To make a bad matter worse, at the start of the pandemic, many employers of front-line workers refused to establish the appropriate safety measures to protect the health of their workers. Likewise, Black individuals in front-line jobs are less likely to take time off from work and enjoy fewer benefits.
Although they still were able to keep their income, it was at the cost of exposing themselves and their loved ones to COVID-19—a choice many of them were forced to make due to the aforementioned diminished wealth and fear of losing their jobs. It is less of an option and more of a mandatory course of action for survival.
The combination of fear, anxiety, stress, mental fatigue, and prolonged exposure to the pandemic has created a cocktail of disaster for front-line workers. A poll conducted by Mental Health America between June and September determined that 93% of healthcare workers reported stress, 86% manifested anxiety, and 76% affirmed they were overwhelmed, tired, and burned out.
Although this study focused only on medical workers, it paints a rather grim picture of first-line employees’ reality—most of whom are Black Americans. A study published in May determined that Black individuals were three times more likely to know someone infected with COVID-19 during the height of the pandemic, something that directly ties to their direct exposure to the illness and which enhances the fears and anxieties of contracting the disease.
It seems inescapable. With a higher unemployment rate and disproportionate representation within front-line workers, Black Americans were undoubtedly the most affected by the job marketplace’s vicissitudes during the pandemic.
However, the true extent of the pandemic’s mental toll upon Black Americans will never be known—it remains underreported and underexplored. The communities do not trust the established medical system, and mental health, in particular, is nearly a taboo topic.
Instead, Black Americans tend to rely on religion and their community for support.
Quarantine, isolation, community, and religion.
Although the quarantine measures were imperative and necessary to slow down the spread of COVID-19, it also involved a radical change in individuals’ lifestyles across the country, disrupting routine and exacerbating mental health triggers.
Particularly, quarantine measures have been extensively proven to contribute to exacerbating isolation, hopelessness, confusion, loneliness, and anxiety—specifically within Black communities.
Culturally, Black communities stand out due to their intense collectivism. According to Carson (2009), collectivism is defined as “an individual’s concern with the advancement of the group to which he or she belongs.” As the author explains, this can be summarized in a simple phrase—“I am because we are, and therefore, we are because I am.” Within systemic racism, supporting one another became the only way to guarantee survival.
This collectivistic worldview establishes a unique connection between the Black individuals and the community they belong to, inducing a sense of mutual dependence and responsibility between the groups. One of the quintessential links connecting the community and individual is religion and church, becoming a staple of socialization within Black communities, an indispensable way to receive social support, and an informal provider of social services and benefits.
Particularly when it comes to mental health, the role of Black communities and churches becomes indispensable.
Lisa Powell, program coordinator for African American Community Together NOW (AACT-NOW), explains the relationship between both succinctly.
“In the African American community, family, community, and spiritual beliefs tend to be great sources of strength and support.” She affirms to Central Jersey. “Most African Americans rely on faith, family, and social communities for emotional support rather than turning to health care professionals, even though medical or therapeutic treatment may be necessary.”
Of course, this is not an arbitrary event. Racial trauma and distrust in the healthcare structure eventually evolve into a reluctance to explore mental health and receive the necessary support. Thus, Black American’s long history of role sharing and communalism makes them seek the mental health support they need amongst each other.
But during the COVID-19 pandemic, quarantine measures, social distancing, and self-isolation stood between Black individuals and their steady, regular support system. Vastly unable or unwilling to recur to medical experts, Black individuals are left to face the overwhelming and disproportionately uneven consequences of the pandemic without recurring to communalism as a support system, creating an unfavorable environment for mental health.
During the pandemic, the odds are against Black people’s mental health across America. But this particular brand of ghost wound is one that lurks beneath the surface, and hardly anyone notices until it is too late.
Conclusions.
It is both deeply tragic and profoundly unsurprising that a study focused on Maryland suicide statistics—one of the only ones approaching the topic—determined that racial inequality permeates through it all.
During the state’s lockdown period—from March 5 to May 7—the overall number of suicides didn’t increase exponentially. However, when the results were analyzed through the racial lens, it became evident what happened: suicides amongst Blacks doubled, while they dropped by half for white individuals. Post-quarantine, the numbers returned to pre-pandemic status.
Socioeconomic distress, isolation, lack of support, impactful vicarious traumatic stressors, and higher rates of infection and deaths amongst the community leave an imprint, which can in extreme circumstances lead to such tragic results.
Naturally, the study only covered events within Maryland, but it reflects a worrisome trend nationwide—mental health within the Black community is an under-discussed and understudied area. The suicide rates during the lockdown were the tragic conclusion of a plethora of triggers scattered all across fields and areas; every one of them related to racism, discrimination, and systemic inequality.
Structural change is a generational change. Therefore this problem is far from over, and the solution requires decades of hard work. However, it’s quintessential to remain aware of mental health struggles as most are about socioeconomic disparities. Identifying Black communities as high-risk areas for mental afflictions and providing the necessary support is merely the first step to take.
The COVID-19 pandemic seems to be far from over, and the possibility of another lockdown is not wholly implausible. As such, the clock is ticking—the mistakes from last March cannot happen again.
As Maryland testifies, the ghost wound bleeds.
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