Lillian Comas-Díaz is a pioneer in the field of ethnocultural approaches to mental health. She is both a clinical practitioner and multicultural feminist psychologist, writing numerous journal articles and books pushing the field toward more inclusive and less ethnocentric theories and practices.

She was recently awarded the 2019 American Psychological Association gold medal award for lifetime achievement and the practice of psychology, the first time a person of color has been recognized with the award. She credits the long-term, collective effort of professionals of color working on expanding psychology’s lens to include the perspectives of marginalized peoples’ experiences.

Comas-Díaz, along with her colleagues, recently introduced a special issue on the concept they call racial trauma (see MIA report). She describes racial trauma as “an insidious type of distress that many people of color and other marginalized individuals experience, where they are living in a society where racism, heterosexism, classism, and all those kinds of ‘isms’ are making the society oppressive towards those targeted groups.”

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

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Hannah Emerson: Could you connect us to how you’ve grown to research ethnocultural approaches to mental health, maybe it was a response from your personal story or your psychological training?

Lillian Comas-Díaz: Yes, absolutely, being a mixed-race woman and woman of color and having a transnational background, all of those experiences informed my personal and my professional development as a clinical psychologist, as a multicultural psychologist, and as a feminist psychologist.

I was born in Chicago to Puerto Rican parents, we moved back to Puerto Rico, and then I came back and forth to the United States. Having to deal with different cultures, culture shock, and culture adaptations from moving back and forth sensitized me to the importance of having a broader lens to look at culture. Those experiences revealed how important it is to be a culturally committed, culturally competent psychologist but also person.

Given what we’ve been dealing with right now in the United States, it’s very important to have a vision that is not limited by an ethnocentric perspective. We have to be more global in our perspective, particularly knowing that the United States is a nation of immigrants. So it’s important to address the richness that diversity brings into our culture.

Emerson: Could you describe the ways that it can be psychologically challenging to be a person of color or an indigenous individual in the United States today?

Comas-Díaz: Race is a major issue in the United States. Even though we see it talked about more prominently right now, it has always been a major issue. The history of people of color in the United States has been quite difficult and traumatic. There have been a lot of gains, but still, right now we’re seeing a resurgence of xenophobia — hatred of the strange, the different person.

The kinds of racism that we see right now are quite obvious, and we can operationally define what are the results of racism just by looking. There’s an increase in hate crimes. The relationships between people of color and communities of color and the police, for example, is extremely conflictive. The prison systems — we have more people of color incarcerated when compared to white individuals who have committed similar kinds of crimes. Even the current political climate right now, where race is becoming a political issue for those people running for office and to some extent race is being weaponized politically.

The whole situation of race is quite relevant to our situation here. Unfortunately, research shows that for people of color, racism is not healthy. It creates a lot of mental health problems and physical problems. Even more than that, unfortunately, there’s research that also shows that people of color who are exposed to racism, when they have children, there is an intergenerational effect. In other words, the children of people of color tend to have more susceptibility to physiological trauma triggered by racism. So that’s where we talk about the concept of racial trauma.

Racial trauma, even though it shares some similarities with post-traumatic stress disorder (PTSD), it is an entirely different phenomenon from PTSD. Racial trauma is unique because racial trauma is the result of sociopolitical trauma. In other words, there is an insidious type of distress that many people of color and other marginalized individuals experience. And it is a result of living in a society where racism, heterosexism, classism, and all those kinds of “isms” are making the society oppressive towards those targeted groups.

The other reason racial trauma is unique is that it relates to the community attacks that minority people (particularly people of color) receive, even though the perpetrators may not intend to attack people. They can be intended or not intended, but they are in the form of microaggressions. These experiences include attacks, but also any threats of harm or injury. Also, when people are witnessing attacks when the attacks are being perpetrated on other people of color, we call that vicarious racial trauma.

We cannot medicalize racial trauma because, again, it is different from a medical situation like PTSD. Because the origins, or the roots, of racial trauma, have to do with history, with oppression, and with sociopolitical issues. Those are the areas that we need to address on a more collective level. They are being transmitted individually, but also in communities.

Emerson: Do you have any direct examples of microaggressions? Could explain them to our listeners so they might understand what this looks like?

Comas-Díaz: The person who first coined the term microaggression was an African American psychiatrist, Chester Pierce, and we psychologists have popularized the term. There’s a lot of literature on microaggressions. The person who is the victim of a microaggression receives a negative and hostile message, sometimes derogatory, toward a marginalized group, in this case, people of color. The issue is often that the perpetrators may not be aware that they’re engaging in negative, racist behavior.

For instance, asking Asian Americans or Latinx Americans, which country they came from, even though they’ve been born and raised here. Another microaggression that is more common nowadays is, “Go back to your country,” when these are people who have been born and raised here. Other examples would be, “You don’t look Asian American,” “You don’t look Latino,” being ignored by clerks if you’re in a store with white customers, and the incidents that come when driving while black or driving while Brown.

Many microaggressions happen on an ongoing basis. If it’s happening only once or twice, most people can cope with it. It is the insidious and persistent microaggressions that people of color are subjected to that result in racial trauma — or when it is toward their loved ones, or to anybody else, that results in vicarious racial trauma.

Trying to deal with that while trying to negotiate with the person who commits a microaggression, at times, can backfire. There’s a tendency of the person that engages in a microaggression to justify their behavior because they don’t get why their behavior is offensive or how it is attacking the person.

Because of that, in 2000, the US general surgeon indicated that the leading cause of the health disparities between communities of color and white Americans has to do with the effect of racism. It is apparent that it is happening via microaggressions or systemic issues or historical issues and that many people of color are being exposed to racism and particularly to microaggressions.

Emerson: How would you respond to those who say microaggressions show just how fragile young people are today? Perhaps you would say it’s a justification, but I wonder how people can understand that it may be more, that it impacts mental health if it’s persistent and it’s insidious as you described.

Comas-Díaz: Let me mention that the concept of microaggression has been criticized from psychologists saying that there is no specific scientific data — but we do have a lot of research. In terms of being susceptible or talking about microaggressions, whether that affects people or not, what the research has shown is that even kids of color, when they are subjected to a microaggression, or they experience a vicarious microaggression, that tends to affect the development of their cultural and racial identity.

In other words, it makes them feel negative about being black because if being a person of color means that people can engage in microaggressions and nothing happens, then there could be an internalization of that, “Well maybe we’re treated like this because we deserve it,” that kind of stuff. So the internalization of when you’re being attacked, not for anything that you have done but just because of your identity, really affects not only the development of your identity, but it affects your mental and your physical health, and there’s a lot of data on that.

Emerson: It has me connecting back to what you said, that you cannot medicalize racial trauma, that it feels like a completely different phenomenon from PTSD. If you talk about racial trauma within the psychiatric context that we’re in, don’t you risk pathologizing people of color as though the problem is inside of them instead of within our society?

Comas-Díaz: No, you’re absolutely right, and that’s why we’ve always been saying that racial trauma is unique and that we cannot medicalize it because the roots and the enforcement of the condition have to do with histories and historical trauma. This means, Native Americans, and African Americans, and Latinx, they have been historically attacked, and that continues to be transmitted to people now.

There is an issue with medicalizing a condition that, even though it has physical and mental symptoms like anxiety, hypervigilance, some symptoms from PTSD, of course, it is unique in the sense that it is ongoing. There is not a response to a systemic issue on how to curtail or how to cope with racism. So people who suffer from racial trauma don’t see any relief in terms of what the system is going to do to ameliorate this situation. If anything, what’s happening at this moment, hopefully, that will change, is that there’s a polarization right now in our country due to race.

So using a medical perspective is actually limited because if the person is seen as suffering from just trauma, the provider, whether it’s a psychiatrist, mental health provider, or a physician, will not incorporate a sociopolitical and historical perspective in the treatment, leaving out the roots of the problem.

We also have to remember that in the concept of trauma right now, it is centered on Western and Eastern European values. As a result, the concept of trauma is more responsive to an individualistic society where values such as self-agency, internal locus of control, the words, “I can do it, I can be the center of my universe,” the meritocracy, are quite normative. Yes, merit is important, but this is not usually applicable to most people of color because they either get excluded from a meritocratic society and/or they tend to have more collectivistic values like connectedness, solidarity and being affiliated with others.

The medicalized concept of trauma is not addressing those things. So that’s what we need. We need systems of treatment that are rooted in history, in the context, and this sociopolitical situation. Many of these medicalized approaches tend to be ahistorical, and they are decontextualized. They ask, “Tell me what your symptoms are,” and that is it. They try to deal with trauma without understanding the broader sociopolitical and even geopolitical context.

Emerson: How do you identify racial trauma in a person or a community if symptoms might not be the marker? How would you know it’s there?

Comas-Díaz: You do a clinical assessment, as you would with anyone who’s presenting with trauma symptoms, but then you also explore with the person their history and how they identify (because some people may identify as a person of color and some may not).

Many people who do not have the sociopolitical perspective will not even ask, “Have you had any experiences with racism?” Sometimes the client may not bring it up because the client, the person of color, may not feel that the provider is going to pay attention to what he or she has to say about being a victim of trauma, of racial trauma. It takes a particular lens to identify that and give the person permission — yes, we can talk about racism here if this is something that happened to you, or your loved ones, or your community.

The first thing is that the therapist needs to be more aware of the social and political situation they’re in and have some racial consciousness; to understand that yes, race can be a reason for people becoming sick, having racial trauma. That is a difference from the mainstream psychotherapy approach.

The other thing is to engage in a process that can help the person to develop “critical consciousness.” This means applying critical thinking if the person has internalized that he or she is the cause of the trauma, in this case, the racial trauma, and that is not helping, and that is making the situation worse. Helping that person to sort out what are the causes of this racial trauma, versus the individual behavior, helps a lot to not promote the client’s internalization of “it was my fault.” That is something that happens in other kinds of trauma victims. The victim many times feels like he or she caused the trauma.

Critical consciousness means developing an awareness of why this is happening, who benefits, against whom this is being done, and what is the effect on society of this micro-aggression, racism. One effect is the preservation of the status quo. We talk about using what is called liberation psychotherapy approaches, which is basically to help the person develop a sense of awareness, a clinical awareness, of his or her circumstances and how they contribute to their trauma, in this case, racial trauma. Once that awareness is there, they become more liberated in terms of, well, maybe there are some things that I can do about this to cope with this situation.

Decolonial approaches involve helping the person to acknowledge the reality that they have as a person of color. For instance, we talk about racial trauma, but there’s a lot of resilience among people of color and minority communities. Because otherwise if you look at history, a lot of people of color would not have made it. So the resilience is there, it’s inherent, and sometimes when people are suffering from racial trauma, they cannot connect with that resilience.

In a therapeutic approach with a liberatory decolonial perspective, the provider helps the client to connect with that resilience, and that can be through art, that could be through community involvement, and that could be through social justice action.

There’s research that shows that when people are victims of trauma, particularly when it’s a sociopolitical or racial trauma, they become aware that is not because of who they are, but because they happen to be a member of a marginalized group, and that initiates a healing process. Then the person does not internalize and does not victimize himself or herself.

The other thing is the social justice action. We do not tell people what to do. We tell people to say, “How do you think you can engage? What would it be for you, a social justice action?” For some people, they say raising my kids and teaching them what it is like to be, for example, a black male in this country is important. Some people may say contributing to something, helping, or volunteering in a school. Other people may say they go to church or something like that. What I hear people saying is either supporting someone or running for public office to make sure that on a systemic level, things start to change. I think we are witnessing some of that right now.

Therapists who are working with people who have racial trauma need to be connected to what’s going on — the social, political, economic, and systemic issues in society — because right now doing therapy is not just about the person coming to the office and what’s happening in between the four walls. Doing therapy is also to help the clients to live a healthier life outside of the therapy room. That’s why the provider needs to know what’s going on outside of those four walls.

Another thing I want to share with you that I think is very, very important is that racism not only affects people of color or marginalized people. It affects all of us. It affects white people; it affects everyone. When there is an insidious situation like racism, it divides our country. That’s why it’s important that all of us, whether we’re people of color or white, do an ongoing self-examination, self-evaluation, questioning yourself.

Emerson: What do you think would encourage people to say, “I’m committed to becoming culturally competent” and engage in this ongoing self-examination?

Comas-Díaz: What the research shows is that people, let’s say white people, who are either in school or college rooming with a person of a different race, they tend to be more amenable to becoming culturally competent. This translates in plain English to if you have a relationship with someone different from your culture or your environment, and that relationship is not mired by racism, then that relationship motivates you to become, if you’re white, what we call an ally.

When you become more and more conscious about racial microaggressions, then when you witness one happening, and you ignore it or turn around, that really affects you. When you are an ally, and you witness a situation with racial microaggressions being committed, you might say, “Oh, you know what this is, I can understand why you don’t think this is, but this is racism from my perspective.”

Standing with the person who is saying, “This hurts me, your words or your actions hurt me,” is very important. Not only is the ally going to feel better about him or herself, but it also may be helping to translate the message from the person of color who is suffering the racial trauma to the perpetrator, assuming that he or she is not aware that they are engaging in racism or the microaggression.

I think an important message, the take-home message, is that racism affects all of us. Many times we think it is only that person who is the victim of racial trauma, but it is endemic, and it affects all of us. I think it is important that we see that, because many people who engage in microaggressions as the perpetrators may not be aware they are doing that. Without developing critical consciousness, they may continue to do that, and that means that they will be isolating themselves from people who are different from themselves.

Emerson: So what would you say to these people? What would you say to people, perhaps globally or people in the US right now, that could be experiencing what you’re calling racial trauma?

Comas-Díaz: To get critically aware that this is something that is not happening to them alone. Part of the problem with trauma is that it is very isolating. The victims usually feel not only that it is their fault, but also that this is something that they have to do by themselves. So start by collectively addressing this, asking, “Who else has been affected by this?”

What would I say to the people globally is: this is a concept that may or may not apply to you. If you think it applies to you, it will be important to identify what parts of your identity are being targeted with the oppression that causes you to develop trauma. This shares some components with PTSD, but is unique because if you did not belong to that marginalized group, you would not be experiencing this kind of trauma.

Emerson: Lastly, would you suggest therapy as a forum to provide healing for people who experience racial trauma, or would you recommend exploring other healing modalities?

Comas-Díaz: If it’s therapy, it has to be a particular kind of therapy. It has to be a therapist that has a sociopolitical perspective, that knows the effects of history, systems, politics, and social differences on the health of the person. It has to have a decolonial approach, making sure that the client is not rejecting parts of him or herself because society is rejecting that in him or her. It has to be addressed through critical consciousness. It has to include a perspective where the person is invited to engage in a social justice action defined by the client, not defined by the therapist — a perspective where there is creativity, where art can help a lot.

I also mentioned the nurturing of the resilience inherent in most people of color who have survived generations of dealing with racism — also, coalitions where solidarity with other members of the marginalized group can be helpful. I think part of the problem that we want to avoid is the divide and conquer the situation. That kind of solidarity helps to heal and helps to develop strategies to change not only themselves but the system as well.

I want to wrap up with what I have mentioned several times, that racism and many types of oppressions affect all of us. It is so important for all of us, whether we are perpetrator or victim, to become critically aware of our role and to commit to change so we can co-create a society that is more peaceful, more respectful, and celebrates our differences.

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MIA Reports are supported, in part, by a grant from the Open Society Foundations