POST TRAUMATIC SLAVE SYNDROME AND MENTAL HEALTH SERVICE USE
OF AFRICAN AMERICANS: A SYSTEMIC INTERPRETATION
A Dissertation
Presented to
The Graduate Faculty of The University of Akron
In Partial Fulfillment
of the Requirements of the Degree of
Doctor of Philosophy
Symphonie D. Smith
April 27, 2018 POST TRAUMATIC SLAVE SYNDROME AND MENTAL HEALTH SERVICE USE
OF AFRICAN AMERICANS: A SYSTEMIC INTERPRETATION
Symphonie D. Smith
Dissertation Proposal
Approved: Accepted:
Committee Chair Interim School of Counseling Director Karin Jordan, Ph.D. Faii Sangganjanavanich, Ph.D.
Committee Member Interim Dean College of Health Professions Rebecca Boyle, Ph.D. Elizabeth Kennedy, Ph.D.
Committee Member Executive Dean of the Graduate School Heather Katafiasz, Ph.D. Chand Midha, Ph.D.
Committee Member Date Ingrid Weigold, Ph.D.
Committee Member Zachery Williams, Ph.D.
ii
ABSTRACT
This interpretive qualitative study used Post Traumatic Slave Syndrome (PTSS) and Bowen Family Systems (BFST) theories to explore mental health service use by
African Americans. The goal of the study was two-fold. First, to increase understanding of the lived experiences of African Americans, with consideration of the impact of historical and ongoing race and oppression, across generations. Second, to explore mental health service use via the lens of the African American experience. Data collection included the use of two semi-structured interviews, a focused genogram and a demographic questionnaire. All participants self-identified as African American and were comprised of seven females and two males. The data analysis revealed themes in two main categories: The African American Experience and Conversations about Mental
Health. The resulting themes as follows, with four in the first category and three in the second, respectively: ongoing racism and oppression, symptoms of PTSS, strength and character, The Talk, types of sharing, perception and the service use advocate. The findings provide the context through which the African American experience influences mental health service use.
iii
ACKNOWLEDGEMENTS
“It takes a village” are words that have come a long way from a cheesy saying recited by my African American principal in elementary school. It indeed took a village to help me move from that elementary school to this moment. As happy as I am to be here and as proud of myself as I am for doing the work, I have been beyond blessed to have such a vast and loving village to help me along the way. Because there are too many individuals to name, from family, friends, my dear sisters, mentors, my wonderful cohort,
Trio and even old classmates randomly congratulating me on my accomplishments at a local fast food spot, I will like to generally acknowledge all of them in bulk here. Thank you! However, below I must name some of the chief members of my village.
Olin Smith Jr.: My amazing father and number one cheerleader from the beginning!
Lemonard Anderson: My loving mother who never failed to provide love and nourishment, right on time, every time!
Tina Reynolds Smith: My stepmother, who chose voluntarily to join my village and never once missed an opportunity to participate with full support!
Zenobia Johnson: My dear “Aunty Snoop” who found a way to provide the perfect balance of nourishment and motivation to get me to “keep it simple” and progress!
Dr. Margaret Manoogian: My more-than-a-mentor who saw the researcher in this
“kiddo” when I was far from willing or able to.
iv
Stefanie Ankle & Shawntaya Singfield: Best support squad ever!
Dr. Karin Jordan: A committee chair, cheerleader, motivational speaker and nurturer all in one!
Committee Members: Dr. Rebecca Boyle, Dr. Ingrid Weigold, *Dr. Zachery Williams and Dr. Heather Katafiasz, your support is appreciated. *Thank you for introducing me to
PTSS, it has changed my life!
Amari Gay: My sweet baby girl who has waited as patiently as possible for the day she no longer has to share her mother with this process. *She is literally facetiming me as I write this, begging me to hurry and come home (I escaped to a place with less distractions).
Kevin Gay: Last but absolutely not least, my loving husband who has also waited patiently to stop sharing his friend, girlfriend, fiancé and now wife with this process.
With zero complaints, you have been a supporter and powerful example and encourager for me to “do the hard work”! It is done. Thank you!
Special thanks:
God my creator and Jesus my Savior: The purpose, you gave me, fuels me and You sustain me.
Dr. Joy DeGruy Leary: Post Traumatic Slave Syndrome, helped to open my eyes and gave me another tool to help others do the same. Your work also helped me to connect with my final acknowledgment recipient; what an unexpected and priceless gift from this journey. Thank you.
The Ancestors: Thank you for enduring, surviving, adapting, protecting, praying and fighting for me! I know I am your wildest dream!
v
TABLE OF CONTENTS
PAGE
CHAPTER
LIST OF TABLES ...... xii
I. INTRODUCTION ...... 1
Background ...... 2
Risks to Mental Health ...... 2
Mental Health Service Use ...... 3
Barriers to Mental Health Service Use ...... 5
African American Experience ...... 6
Author Statement ...... 8
Theoretical Framework ...... 9
Post Traumatic Slave Syndrome ...... 10
Bowen Family Systems Theory ...... 11
Statement of the Problem ...... 13
Significance of the Study...... 14
Research Questions ...... 14
vi Operationalized Terms ...... 14
Summary ...... 19
II. REVIEW OF THE LITERATURE ...... 21
Post Traumatic Slave Syndrome ...... 21
Vacant Esteem...... 23
Ever Present Anger ...... 24
Racist Socialization ...... 26
Bowen Family Systems Theory ...... 32
Foundational Principles ...... 33
Core Concepts ...... 34
Family Diagram and Genograms ...... 39
PTSS and BFST ...... 41
Mental Health Service Use ...... 42
Low Mental Health Service Use ...... 42
Exceptions...... 47
Barriers to Mental Health Service Use ...... 51
Cultural Mistrust ...... 52
Stigma ...... 56
Inaccessibility ...... 59
John Henryism ...... 61
vii Systemic Nature of Barriers ...... 64
Attempts to Overcome Barriers ...... 68
Attempts by African Americans ...... 69
Attempts by Professionals ...... 71
Summary ...... 74
Restatement of the Research Questions ...... 77
III. METHODS AND PROCEDURES ...... 78
Methodological Framework ...... 78
Sample ...... 79
Sample Criteria ...... 80
Sample Size ...... 80
Participants ...... 82
Recruitment ...... 83
Confidentiality of Records ...... 85
Data Collection ...... 85
Data Analysis ...... 88
Recording and Transcribing...... 88
Managing Bias ...... 90
Research Questions ...... 91
Risks and Benefits ...... 91
viii Summary ...... 92
V. RESULTS ...... 93
Review of Research Questions ...... 93
Systemic Lens...... 94
The Participants ...... 94
Participant One: Maybelline ...... 96
Participant Four: Angelica ...... 97
Participant Five: Leroy ...... 97
Participant Six: Steph ...... 97
Participant Seven: Tasha ...... 98
Participant Eight: Kesha...... 98
Participant Nine: Stacey ...... 98
Themes...... 99
African American Experience ...... 99
Conversations About Mental Health ...... 112
Summary ...... 119
V. DISCUSSION ...... 121
Discussion of Findings ...... 122
Ongoing Racism and Oppression ...... 122
Symptoms of PTSS ...... 124
ix Strength and Character ...... 125
The Talk...... 126
Perception ...... 129
Service Use Advocate ...... 130
BFST ...... 131
Implications...... 132
Mental Health Professionals ...... 133
Marriage and Family Therapists ...... 134
Strengths ...... 138
Limitations ...... 140
Recommendations and Future Directions...... 142
Future Research ...... 142
Researcher ...... 143
Summary ...... 144
REFERENCES ...... 145
APPENDICES ...... 160
APPENDIX A ...... 161
APPENDIX B...... 163
APPENDIX C ...... 165
APPENDIX D ...... 166
x APPENDIX E...... 168
xi LIST OF TABLES
Figure 1: Demographic Summary of Participants ...... 83
Figure 2: Level of Openness or Skepticism for Mental Health Services ...... 95
Figure 3: Second Category of Themes...... 112
xii CHAPTER I
INTRODUCTION
According to the Substance Abuse and Mental Health Services Administration
(Substance Abuse and Mental Health Service Administration [SAMHSA], 2016) approximately 1 in 5 adults experience mental illness, and 1 in 25 suffer from serious mental illness in a given year in the United States. Mental Health America (Mental
Health America, 2017) estimates that more than half of adults with mental illness did not receive treatment, and 80% of youth, despite severe depression, did not receive services in 2014. Furthermore, it is estimated that over 50% of adults with substance abuse disorders also suffer from co-occurring mental illness (Mental Health America, 2017).
According to the National Alliance on Mental Illness (NAMI), percentages of adults living with any mental health condition are as follows: 16.3% (Hispanic), 19.3%
(White), 18.6% (Black), 13.9% (Asian,) and 28.3% (American Indian/Alaska Native)
(NAMI, 2015). Amid the prevalence of mental illness in the U.S., multicultural communities face varying degrees of problems with mental health treatment such as; less access to treatment, less likelihood to receive treatment, low quality care if treatment is received, increased stigma, an overall culturally insensitive health care system, discrimination in treatment settings and language barriers (NAMI, 2015). The burden of mental health conditions is, therefore, greater for racial and
1 ethnic minorities, even when prevalence rates are comparable with White Americans
(SAMHSA, 2016). Subsequently, there are approximately 18.6% of African Americans living with a mental health condition (NAMI, 2015,) yet they seek mental health services at less than half the rate of White Americans.
Background
Historically, African Americans are less likely than White Americans, and sometimes other minority groups, to use mental health services (SAMHSA, 2015).
Mental health services include any form of psychotherapy or psychiatry provided by a licensed clinician, regardless of mode of delivery (i.e., individual, family, couple, or group).
Nonetheless, lack of mental health service use does not imply that African
Americans are in less need of attention or treatment for mental health problems; an overview of demographic variables (i.e., socioeconomic status) would suffice for identifying substantial risk to mental health for African Americans and therefore demonstrating need for mental health services (Mental Health America, 2017; Health and
Human Services, 2015). However, because the focus of this study is not to explore need, the effects of a single demographic variable, poverty, will be highlighted. Due to the disproportionate rate of poverty in the African American community (DeNavas-Walt &
Proctor, 2015), this variable is used below to demonstrate potential need for mental health services.
Risks to Mental Health
Poverty is a known risk to mental health, and therefore, to the disproportionate number of African Americans who suffer from it (Snowden, & Bruckner, 2014).
2 According to the literature, on average, African Americans earn $35,398 annually, compared to the national average of $53,657 (DeNavas-Walt & Proctor, 2015). This gap reflects the 26.2% poverty rate experienced by African Americans, compared to the national average of 14.8% (DeNavas-Walt & Proctor, 2015). Common risk factors associated with poverty include but are not limited to: a lack of resources in general (i.e., healthcare access, food, transportation), greater potential to experience or witness violence and therefore increased susceptibility to post-traumatic stress disorder (PTSD), lack of education, increased rates and severity of health issues and higher rates of substance abuse (Mental Health America, 2017; DeNavas-Walt & Proctor, 2015).
Consequently, African Americans are three times more likely to report psychological distress when they live below the poverty line, due to the compounding affects that poverty has on mental health. It is important to note that African American adults are still
20% more likely to report experiencing serious psychological distress than White adults, regardless of socioeconomic status (Mental Health America, 2017); this level of distress can be attributed to the differences in sociocultural experiences (i.e. race-based trauma)
(Hemmings & Evans, 2017). Given these and other unique risk factors to mental health for this population, researchers have explored mental health service use of African
Americans for decades (Gibbs, 1975; Hines-Martin, Brown-Piper, Kim, & Malone, 2003;
Neighbors, 1985; Williams & Cabrera-Nguyen, 2016).
Mental Health Service Use
Mental health service use patterns are complex, as they encompass an array of components such as: the rate at which one uses mental health services (Chun-Chung,
Jaffee, & Snowden, 2003; Doyle, Joe, & Caldwell, 2012; Garcia, & Courtney, 2011),
3 beliefs held regarding seeking help for mental health and related behavior (Bains, 2014;
Barksdale, Azur, & Leaf, 2009; Cole, Stevenson, & Rodgers, 2009), the likelihood and or the rate at which one cooperates in mental health treatment and/or follows directives from mental health professionals (Cooper et al., 2013; Leis, Mendelson, Perry, &
Tandon, 2011) and barriers to successful completion of any mental health treatment program (De Figueiredo, Boerstler, & Doros, 2009; Fortuna, Alegria, & Gao, 2010).
Each of these components help professionals to gain a more comprehensive picture of service use patterns for African Americans and the contributing factors. To simplify for the purpose of this study, mental health service use will refer to any pre-contemplative or direct interaction with mental health services and related sectors; the current author proposes this definition to encompass any combination of the above components.
In general, the literature supports the telling results from a study focusing on racial differences in help seeking after exposure to the traumatic World Trade Center
Disaster (WTCD) (Boscarino, Adams, Stuber, & Galea, 2005); despite the specific shared trauma (WTCD), African Americans were less likely than White Americans to seek support for mental health. With the exceptions of accessing medical service sectors (i.e., emergency room, primary care physicians) for mental health issues (Chun-Chung, Jaffee,
& Snowden, 2003; Fortuna, Alegria, & Gao, 2010; Nguyen-Feng, Beydoun, McShane, &
Blando, 2011; Paranjape, Heron, & Kaslow, 2006) and using mental health services by way of legal force (Greif et al., 2011; Murry, Heflinger, Suiter, & Brody, 2011), African
Americans, use mental health services at lower rates than non-Hispanic White samples
(Barksdale, Azur, & Leaf, 2009; Lennon-Horvitz, McGuire, Alegria, & Frank, 2009) and, often, other minority groups (Fortuna, Alegria, & Gao, 2010; Garcia, & Courtney, 2011).
4 Due to persistent low likelihood of using mental health services, African
Americans are at a greater risk of going untreated for mental health problems. Going untreated for mental health problems increases risk for experiencing exacerbated symptoms of mental health disorders (NAMI, 2016), suffering from co-occurring disorders (simultaneous substance use and mental health disorders) (SAMHSA, 2016) and developing related medical complications such as heart disease and high blood pressure (SAMHSA, 2016). Generally, African Americans are not using mental health services at rates proportionate to potential need, given the common risk factors they experience. Therefore, barriers to mental health service use for African Americans are also explored in the literature.
Barriers to Mental Health Service Use
Several systemic barriers to mental health service use for African Americans are apparent in the literature. Two examples of systemic barriers are cultural mistrust (Bains,
2014; Conner et al., 2010; Greif et al., 2011; Murry, Heflinger, Suiter, & Brody, 2011;
Scott, & Davis, 2006) and lack of economic resources for obtaining access to services
(Ayalon, & Alvidrez, 2007; Conner et al., 2010; Hall, & Sandberg, 2012; Lindsey et al.,
2013; Ojeda, & McGuire, 2006). Consequently, some researchers have attempted to reduce the impact barriers have on use patterns of African Americans, in a linear (cause and effect) fashion. For example, collaboration with community members and staples of the African American community has been suggested to combat cultural mistrust (Frazier et al., 2007) and finding creative ways to provide affordable services (i.e., free services, sliding fee scales, increased insurance availability) for counteracting the impact of limited resources (De Figueiredo et al., 2009).
5 Nonetheless, because overall low mental health service use persists (NAMI, 2016;
SAMHSA, 2016, Census, 2014), the purpose of this study is to add to the literature by shifting the focus away from use patterns, barriers and attempts to overcome individual barriers. This study will focus on gaining more understanding of mental health service use through a systemic lens that treats barriers, not as individual problems to be solved, but as components of the larger African American experience in the United States.
African American Experience
Differences in experiences between groups, regardless of the dividing demographic factor (i.e., race, age, gender, culture, language, etc.), are best understood within an ecological perspective; Ecological theory suggests that human development is inseparable from environment and context (Kail & Cavanaugh, 2010). More specifically, focusing on a historical and systemic (community and family) context enhances depth of understanding lived experiences, through which people understand and navigate the world across generations. The lived experiences of African Americans are identical to no other groups’ in regards to racism, oppression, discrimination and overall marginalization in the United States (DeGruy, 2005). Race-based trauma, cultural trauma and collective memory are some additional areas of study that help to illuminate the differences in
African American lived experiences (e.g. psychological distress, collective identity) due to their unique history in the United States (Eyerman, 2001; Hemmings & Evans, 2018;
Lemberger & Lemberger-Truelove, 2016).
Marginalize. “To relegate to an unimportant or powerless position within a society or group” (Dictionary.com, 2018). Historic and ongoing racism in the United
States sufficiently corroborates marginalized status for African Americans. The lack of
6 importance is made obvious in numerous ways, all of which arguably affect mental health. For the sake of example, the legal system alone provides several illustrations including but not limited to the following: (a) disproportionate rates of capital punishment (Schweizer, 2013); (b) grossly disproportionate rates (37.8%) of African
Americans in prisons (Federal Bureau of Prisons, 2017; Alexander, 2012); (c) higher arrest rates for drug use despite lower rates of actual use (Alexander, 2012); (d) disproportionate rates of racial profiling with Stop-and-Frisk (Owen, 2013); and (e) longer sentences for the same crimes (Alexander, 2012). Noteworthy is the compounded impact of gender on experiences with the legal system. African American women have been historically overrepresented in prison systems, at times more so than African
American men, and severely under protected under the law (Gross, 2015).
Marginalization is a problem despite the size of the group; nonetheless, the following figures provide an idea of how many people are impacted by the figures above.
In 2014, there were at least 45.7 million people or about 13.2% of the population who identified as Black or African American in the United States; of those, at least 2.2 million of which were military veterans and at least 9.9 million Black family households were represented in these numbers (Black History Month, 2016). In less than 50 years, it is projected that the African American population will increase to 74.5 million (from
13.2% to 17.9%) (Black History Month, 2016). Because marginalized status implies unimportant and powerless (Dictionary.com, 2018), the above numbers have no expected universal significance. These numbers (that represent people) have subjective value, recognized only by individuals, organizations, or agendas that are directly impacted and or convicted by them in some way.
7 Overall, African Americans are one of several marginalized groups in the U.S.; however, their experiences are unique due to their unique history in the U.S. Therefore, so are the risk factors for mental health and the patterns of mental health service use.
Author Statement
“No expected universal significance.” These words are the best I can come up with to describe the frank reality of marginalization, within mainstream American ideals, values and national priorities. To expound, as an African American woman in graduate school, I quickly learned that I was not represented in the majority of the material being used to make a clinician out of me. Moreover, I am unsure if it was more unnerving to see myself erroneously represented than to not be represented at all; for example, while reading a section in a textbook that starts with “African Americans are/do/like/believe etc.” I often felt confused about the source of the information. Nonetheless, over and over, I read chapters in textbooks that would end with what seemed to be an acceptable cop-out for neglecting minority groups, “…and more research needs to be done to understand the relevance of this theory/technique/intervention for African Americans
(and other minority groups).” After seeing this so many times, I wondered, what are we waiting on? Who is going to do it?
I soon realized that it was easy to identify potential candidates; the passion and empathy was often obvious, as was the lack thereof. For many professionals, peers, authors, etc., minorities were simply not their focus, research area, passion etc. I have learned that this is true for any population; not everyone is going to care. “No expected universal significance.” Consequently, I often find myself trying to encourage my people to try mental health services, while simultaneously attempting to shield them from people
8 who do not care; those who choose to remain culturally unaware, do not believe in White privilege (among many other levels of power and oppression), endorse ethnocentric standpoints to practice, and so on.
So, candidly, I write from the standpoint of knowing that a code of ethics or a trend for multicultural awareness is not sufficient for creating “expected universal significance” for African Americans’ collective mental health, because it frankly never has; underrepresentation persists despite the duty of inclusion being included in professional and ethical codes. I also understand how this reality creates and reinforces barriers to mental health treatment. Therefore, this study is the beginning of what will probably be my life’s work: helping African Americans to achieve mental health. By working alongside others who do care, I hope to help create research, produce resources and provide the support and training necessary to enable clinicians to create safe spaces for healing from the collective experience of African Americans in the United States. As of right now, this safe space is not the norm and African Americans themselves, are the richest source of data for making change on our behalf. It is from this stance that I choose to be a co-contributor, with participants, to address the issue of low mental health service use amongst African Americans. As a co-contributor, I will allow my passion and shared experiences, as an African American woman, to complement participant experiences and aid in interpretation.
Theoretical Framework
Post Traumatic Slave Syndrome (PTSS) and Bowen Family Systems Theory
(BFST) are used to explore mental health service use by African Americans. Both theories emphasize the impact of transgenerational experiences on individual and family
9 functioning; PTSS on the impact of historical and ongoing racism and oppression on mental health behavior (DeGruy, 2005) and BFST focusses on the intergenerational transmissions of emotional experiences (Bowen, 1976). Following is a brief overview of the core components of each theory.
Post Traumatic Slave Syndrome
PTSS was developed by DeGruy in 2005. PTSS is based on the belief that there is a cluster of distinct behaviors, seen in African Americans, which are the results of “trans- generational adaptations of behavior … associated with past traumas of slavery and on- going oppression” (DeGruy, 2005, p. 13). PTSS describes particular adapted behaviors that today create more risk than protection for African Americans and should not be considered a testament to an overall collective deficit amongst African Americans. Three main symptoms characterize PTSS: (1) Vacant Esteem, (2) Ever Present Anger, and (3)
Racist Socialization.
Vacant esteem is “the state of believing oneself to have little or no worth, exacerbated by the group and societal pronouncement of inferiority (DeGruy, 2005, p.
125). Vacant esteem is derived from ecological influences, unique to African Americans, resulting from their shared history of trauma and oppression. The unique etiology of this symptom distinguishes it from other concepts such as low self-esteem, self-confidence, or self-efficacy as its impact is experienced in a relatively collective context (e.g. difficulty valuing others who look like oneself) as opposed to an individualistic experience (e.g. inability to believe oneself capable).
Ever present anger describes the emotional experience (and or demonstration) of a chronic level of anger (DeGruy, 2005). Ever present anger is evident when the expression
10 of one’s anger reflects an intensity that is disproportionate to individual stressors but more reflective of the collective experience of transgenerational trauma amongst African
Americans, which is ever present as well. For instance, similar to vacant esteem, ever present anger has a collectivistic component; its manifestation is a testament to one’s experiencing individual acts of aggression (e.g. disrespect from one’s boss), while also enduring systemic and ongoing acts of aggression as a member of a targeted collective group (e.g. racial glass ceiling).
The final symptom of PTSS, racist socialization, is the adoption of the historical and persistent racist beliefs of dominant White culture, by African Americans. DeGruy
(2005) expressed, “One of the most insidious and pervasive symptoms of PTSS is our
[African Americans] adoption of the slave master’s value system” (p. 134). The impact of internalizing such values manifest in the lived experiences of African Americans in many forms; one of which is complexion and hair texture insecurity. This insecurity persists due to adopting a value for a European standard of beauty that is not inclusive of natural
African and African American features (i.e., kinky hair texture, darker skin tones, etc.).
To summarize, PTSS is a syndrome that affects African Americans. The mental and behavioral adaptations of enslaved Africans and their descendants, that were and are necessary for survival within captivity and ongoing oppression, have resulted in generational manifestations of the core components of PTSS: ever present anger, vacant esteem and racist socialization.
Bowen Family Systems Theory
Bowen (1976) understood the family system as simply one of many natural
(living) systems in existence, which share universal experiences; universal experiences
11 are driven by forces deeper than consciousness and therefore unbound by species or in the case of humans, demographic factors (i.e. race). The carrying of life energy or chronic anxiety is one universal experience identified in BFST. Chronic anxiety is a persistent and pervasive level of emotional energy that drives interaction and behavior; it is not to be confused with acute anxiety, which is a transitory reaction to stress. Understanding how chronic anxiety moves throughout the family system, is the essence of BFST. Eight core concepts describe the transferring of chronic anxiety and its impact on the family system. Each concept is briefly introduced below.
The nuclear family emotional process is the pattern of emotional functioning in families, that is influenced by and affects the emotional processes of each individual member. This concept describes the emotional interdependence of families as a single emotional unit or system (Kerr & Bowen, 1988). The differentiation of self-scale was created to classify individuals’ level of differentiation, the ability to balance individuality and togetherness, within the nuclear family emotional process (Bowen, 1976). The triangle is the smallest stable relationship unit (Bowen 1976); this concept describes the use of a third person (or entity) to balance anxiety between two others (Kerr & Bowen,
1988). Emotional cutoff is “a process of separation, isolation, withdrawal, running away or denying the importance of the parental family” (Gilbert, 2013, p. 57). Emotional cutoff occurs because of low differentiation. The family projection process describes the phenomenon of differentiation levels projecting across generations in the family (Kerr &
Bowen, 1988). Fixed personality traits due to sibling position contribute to a child’s ultimate role in the emotional process of the family. Bowen did not introduce the idea of sibling position, but he includes it in his theory as a relevant component for fully
12 conceptualizing the family unit and the family projection process (Titelman, 2014). The multigenerational transmission process describes the extension of the family projection process, into new nuclear families (Bowen 1976). The final concept, sometimes referred to as “societal regression” (Gilbert, 2013), refers to the influence that the societal system has on each emotional family system (Bowen, 1976).
Bowen used the family diagram to create a visual representation of relationships and emotional experiences in families (Kerr & Bowen, 1988). Proponents of Bowen’s family diagram, and similar tools, worked together to create a more standardized version of this tool which was later called the genogram (McGoldrick, Gerson, & Petry, 2008).
Although Bowen alone did not create the genogram, it is often associated with BFST in place of the family diagram (Butler, 2008). DeMaria, Weeks, and Hof (1999) expanded the traditional genogram, by developing the focused genogram for the sake of extracting information that is more specific.
To summarize, Bowen created a theory that accounts for the interaction within families, based on cohesion of each member’s emotional system, within the entire emotional family unit. The eight core concepts build upon one another and describe the underlying and driving forces behind human interaction, which are alike to all systems in nature.
Statement of the Problem
Several studies have been conducted to explore mental health service use of
African Americans. In a linear fashion (cause and effect), barriers to service use have been identified and challenged, across decades, in the literature. No studies however, have been identified that explore mental health service use, from a systemic perspective,
13 via the collective experience of African Americans, utilizing the two theories described above, PTSS and BFST.
Significance of the Study
The purpose of this interpretive qualitative study was to better understand mental health service use of African Americans, by applying a systemic lens to increase understanding in three areas: (a) meaning made of the collective, historical experience of
African Americans in the United States (b) how said meaning impacts African Americans across generations (c) how said impact influences mental health service use. No studies have been identified that use Post Traumatic Slave Syndrome or Bowen Family Systems
Theory (individually or in conjunction) to explore mental health service use.
Research Questions
1. What impact does historical and ongoing racism and oppression have on the
lived experiences of African Americans?
2. How do African Americans share knowledge about racism and ongoing
oppression across generations?
3. How do African Americans share knowledge about mental health across
generations?
4. How does the experience of historical and ongoing racism and oppression
influence perception and use of mental health services?
Operationalized Terms
African American. Black Americans whose ancestors were enslaved in the
United States, or Black immigrants, who are at least third generation and identify more
14 closely to the lived experiences of African Americans than those from their [immigrating generation’s] country of origin.
American chattel slavery. Enslavement of Africans as chattel in America.
Characterized by some of the most gruesome forms of punishment, scientific experimentation, fragmentation of the family system, rape, extensive legal regulation, and span of time (DeGruy, 2005).
Barriers to mental health service use. Any biopsychosocial factor or experience that discourages or prohibits use of mental health services.
Bowen Family Systems Theory. A family systems theory, developed by Murray
Bowen, “based on the assumption that the human is a product of evolution” and therefore its behavior is regulated by the same “natural processes” that are common to all other living things (Kerr & Bowen, 1988, p. 3).
Chattel slavery. A European introduced form of slavery in which enslaved persons are owned forever and whose children and children's children are automatically enslaved.
Chattel slaves. Individuals treated as complete property, to be bought and sold.
Chronic anxiety. A persistent and pervasive level of emotional energy that drives interaction and behavior; not to be confused with acute anxiety, which is a transitory reaction to stress (Bowen, 1976).
Collective memory. Recollections of a shared past that are retained and passed down, by members of the group present for the experience, via commemoration or discourse (Eyerman, 2001).
15 Cultural mistrust. The general lack of trust among Blacks towards Whites and other predominantly White mainstream systems given the long history of racism and oppression (Terrell & Terrell, 1981).
Cultural trauma. “A dramatic loss of identity and meaning, a tear in social fabric, affecting a group of people that has achieved some degree of cohesion” (e.g. slavery experience) (Eyerman, 2001, p. 13).
Differentiation of self-scale. A continuum that classifies individuals’ level of differentiation between polar positions of differentiation and undifferentiation (Bowen,
1976); the scale has not been validated (Gilbert, 2013).
Differentiation. The ability to balance individuality (self) and togetherness
(relationship) within the nuclear family emotional process (Bowen, 1976).
Emotional cutoff. “A process of separation, isolation, withdrawal, running away or denying the importance of the parental family” (Gilbert, 2013, p. 57).
Ever present anger. Ever present anger describes the emotional experience of a chronic level of anger, which is a symptom of PTSS (DeGruy, 2005, p. 128).
Family diagram. A visual representation of relationships and emotional experiences in families (Kerr & Bowen, 1988).
Family projection process. The phenomenon of differentiation levels being projected across generations in the family (Kerr & Bowen, 1988).
Focused genogram. A modified form of the genogram, designed for the sake of extracting information that is more specific and avoiding cumbersome information
(DeMaria, Weeks, & Hof, 1999).
16 Genogram. A visual tool that uses symbols to record information about family members and their relationships (McGoldrick, Shellenberger, & Petry, 2008).
Inaccessibility. An experience of finding mental health services to be unreasonably difficult to access.
Individuality and togetherness. Natural drives, common for all life forms, to be separate and have an individual identity and to be together and interpersonally connected
(Kerr & Bowen, 1988).
John Henry “The Steel Driving Man”. An African American folk hero who died instantly after accepting and successfully winning a challenge to drill through a mountain with a hammer, faster than a machine.
John Henryism. The tendency for African Americans to endorse unrelenting self-reliance as a sole coping skill, despite extremes of distress (James, 1994).
Linear. A cause-and-effect style of reasoning (i.e., A causes B) (Nichols, 2017).
Marginalize. “To relegate to an unimportant or powerless position within a society or group” (Dictionary.com, 2018).
Mental health. A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to her or his community.
Mental health service use. Any pre-contemplative or direct interaction with mental health services and professionals.
Mental health services. Any form of psychotherapy or psychiatry, provided by a licensed clinician, regardless of mode of delivery (i.e., individual, family, couple, or group).
17 Multigenerational transmission process. The extension of the family projection process, into new families of origin (Bowen, 1976).
Nuclear family emotional. The pattern of emotional functioning in families that is influenced by and affects the emotional processes, of each individual member (Bowen,
1976).
Post Traumatic Slave Syndrome. 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 (DeGruy, 2005).
Racist socialization. The adoption of the historical and persistent racist beliefs of dominant culture, by African Americans; a symptom of PTSS (DeGruy, 2005).
Sibling position. The idea that fixed personality traits, due to sibling position
(birth order), contribute to a child’s ultimate role in the emotional process of the family
(Titelman, 2014).
Slavery. The condition in which individuals are owned by others under varying conditions (many temporary) such as working off debt, enduring punishment for a crime or suffering as a war prisoner.
Societal emotional process. The influence that the societal system has on each emotional family unit (Bowen, 1976), also known as Societal Regression (Gilbert, 2013).
Stigma. An internal or external experience of disgrace or shame associated with an actual or perceived need for mental health services.
Syndrome. A pattern of behaviors that is brought about by specific circumstances
(DeGruy, 2005, p. 121).
18 Systemic. A circular style of reasoning that recognizes all parts (i.e., people, organisms, societies, etc.) as components of a complex whole (Nichols, 2010). Focus is not on simple causality (i.e. A+B=C) but on ongoing transactions that sustain cycles of interaction (Nichols, 2017).
Triangle. The smallest stable relationship unit, which includes the use of a third person or entity to balance anxiety between two others (Bowen, 1976; Kerr & Bowen,
1988).
Vacant esteem. “…the state of believing oneself to have little or no worth, exacerbated by the group and societal pronouncement of inferiority” (DeGruy, 2005, p.
125).
Summary
This chapter provided an introductory overview of the literature, regarding mental health service use of African Americans and related components: Risks to mental health, barriers to mental health service use, and the African American experience. It was shown that despite comparable or disproportionate rates of psychological distress, African
Americans traditionally perceive mental health services as a last resort, if not an unacceptable option. Going without mental health treatment, puts African Americans at risk for suffering from disorders that may be common in other groups, yet at disparate levels and compounding health disparities.
Although many studies acknowledge and highlight the impact of historical experiences on mental health service use, a linear (cause and effect) perspective is generally applied. Similar to an ecological view, this study focused on both the historical and systemic (community and family) perspective, to increase understanding of mental
19 health service use of African Americans (Kail & Cavanaugh, 2010). According to
Bronfenbrenner (1979), a major proponent of ecological theory, suggests that each person exists in the midst of multiple interactive systems (Kail & Cavanaugh, 2010). Therefore, this author utilized two intergenerational theories, Post Traumatic Slave Syndrome and
Bowen Family Systems Theory, to deepen current knowledge and understanding of mental health service use of African Americans.
20 CHAPTER II
REVIEW OF THE LITERATURE
In this chapter, a thorough literature review is presented, regarding mental health service use of African Americans; the Boolean method was used to find research related to the multiple versions and combinations of the following terms: African American,
Black, mental health service use, barriers to mental health service use, mental health services, race and genogram (Burns, 2018). Post Traumatic Slave Syndrome (PTSS) and
Bowen Family Systems Theory (BFST) were explored in respect to their relevance regarding mental health service use within this population. More specifically, this chapter was organized in the following fashion. First, there is an overview of PTSS, including etiology, symptoms, and examples of presenting problems. Next, an overview of BFST follows, that includes foundational information and core concepts of the theory. PTSS and BFST were then explored as complementary theories. Next, the literature on mental health service use of African Americans was reviewed, focusing on three areas: (a) mental health service use patterns, (b) barriers to mental health service use and (c) attempts to overcome barriers to mental health service use. This chapter concluded with a summary of the main themes.
Post Traumatic Slave Syndrome
Joy DeGruy, professor, researcher and the author of Post Traumatic Slave
Syndrome: America’s Legacy of Enduring Injury and Healing, proposed a theory that
21 describes a syndrome that is unique to African Americans. Syndrome, “a pattern of behaviors that is brought about by specific circumstances” (DeGruy, 2005, p. 121). Post
Traumatic Slave Syndrome (PTSS) is a cluster of distinct behaviors, seen in African
Americans that are the result of “trans-generational adaptations of behavior … associated with past traumas of slavery and on-going oppression” (DeGruy, 2005, p. 13). Today’s
African Americans experience ongoing racism and oppression that stem from America’s past in addition to trauma impact of all past experiences; it is not necessary for one to directly experience a particular trauma, to suffer or inherit the effects of the traumatic experience. For instance, current literature demonstrates that collective memories
(Eyerman, 2001), shared narratives or “hidden transcripts” (Scott, 1990) and cultural trauma and identity (Alexander, Eyerman, Geisen, Smelzer & Sztompka, 2004) all attest to the ability of trauma to impact future generations.
Nonetheless, it is important to note that many adapted behaviors of enslaved
Africans, and their descendants, were protective, evidenced by the sheer ability to survive what is formally known as American chattel slavery, “a case of human trauma incomparable in scope, duration and consequence to any other incidence of human enslavement” (DeGruy, 2005, p. 73). For example, not only did enslaved Africans survive but they also made it to the dissolution of slavery with high achievement motivation (i.e., value of education), strong family units (i.e., marriage and close-knit kinship ties), strong spiritual faith and hope, portrayed by the civil rights movement
(Cross, 1998). Such protective behaviors or effective coping should be acknowledged yet distinguished from PTSS (Cross, 1998). PTSS refers to adapted behaviors that now create more risk than protection for African Americans and should not be considered an
22 automatic collective deficit. African Americans exited slavery with varying degrees of adjustment, agency, coping ability, psychological resources, assimilation, acculturation, identity, self-image, etc. (Cross, 1998).
The specific circumstances to which enslaved Africans and their descendants did and currently strive to adapt, include a combination of “multigenerational trauma with continued oppression and absence of opportunity to access the benefits available in the society” (DeGruy, 2005, p. 121). The resulting syndrome, PTSS, is characterized by three main symptoms: Vacant Esteem, Ever Present Anger and Racist Socialization. Each symptom was described in the following sections, including definitions rephrased by the current author, brief etiological background, and examples of presenting problems related to each symptom. Thus far, no empirical studies have been conducted to assess for or measure PTSS, however support for its components are provided below.
Vacant Esteem
The first symptom of PTSS, vacant esteem, is “the state of believing oneself to have little or no worth, exacerbated by the group and societal pronouncement of inferiority
(DeGruy, 2005, p. 125). “Healthy self-esteem is the result of an accurate and honest assessment of one’s worth, worth being the degree to which one contributes” (DeGruy,
2005, p. 123). Individuals develop their level of self-esteem in the following ways:
• receiving appraisals of significant others in early life;
• making contributions and having them appropriately recognized later in life;
• possessing actual meaningfulness in one’s own life (DeGruy, 2005, p. 124).
Self-esteem is determined by the ecological influences of family, community, and society. Vacant esteem is derived from ecological influences, unique to African
23
Americans, resulting from their shared history of trauma and oppression; the unique etiology of this symptom distinguishes it from other concepts such as low self-esteem, self-confidence, or self-efficacy. In addition to the unique development of vacant esteem, its manifestations are also distinct in that they often present within collective experiences
(e.g. difficulty valuing others who look like oneself) as opposed to individualistic ideas of self (e.g. efficacy-beliefs of one’s abilities). Examples of behaviors associated with vacant esteem include a low value or expectation of life (i.e. risky behavior, violence, lack of planning for future), efforts to undermine achievements of other African
Americans, materialism for perceived status and a tendency to take emotional responsibility for the behavior of the entire race (DeGruy, 2005). Some of today’s rap and hip-hop subcultures provide lyrical and visual testament to the elements of vacant esteem.
Podoshen, Andrzejewski and Hunt (2014) found higher levels of materialism and conspicuous consumption in individuals who prefer hip-hop music. In short, the first symptom of PTSS, vacant esteem, is the belief of worthlessness engendered and reinforced by the collective experience of African Americans in the United States. The second symptom is ever present anger.
Ever Present Anger
The second symptom of PTSS is ever present anger (DeGruy, 2005, p. 128). Ever present anger describes the emotional experience of a chronic level of anger. This symptom is evident when the expression of one’s anger reflects an intensity that is proportionate to the collective experience of transgenerational trauma amongst African
Americans, as opposed to the individual stressor at hand. DeGruy (2005) describes fundamental concepts related to anger in order to conceptualize the development of this
24 particular symptom. A definition of anger is used from the International Handbook of
Multigenerational Legacies of Trauma (Danieli, 1998):
In its simplest form, anger is the normal emotional response to a blocked goal.
Often, if a person’s goal remains blocked over time, they will begin to consider the possibility of failure and so experience fear and when we are fearful we also lash out in anger (as cited in DeGruy, 2005).
In other words, anger is the natural reaction to blocked goals and fear of failure.
Due to the racism that is embedded in the historical context of the United States, African
Americans have and continue to endure disproportionate experiences with blocked goals and failure. Currently, African Americans are still being blocked from complete
“integration into greater society with all the rights, responsibilities, and privileges concomitant with membership” (DeGruy, 2005, p. 132). Consider the following examples of blocked goals and associated failures at the most basic levels of human need and existence. Disproportionate rates of poverty (Institute for Research on Poverty, 2016), access to health care (Department of Health and Human Services, 2012), unemployment
(Bureau of Labor Statistics, 2016), the “stained glass ceiling” within employment
(Barnes, 2017), education (U.S. Census Bureau, 2016), incarceration (Alexander, 2012) infant mortality (Center for Disease Control & Prevention (CDC), 2016) and low-risk cesarean section (CDC, 2016).
Therefore, each individual angering occurrence, experienced by African
Americans, may provoke anger with an intensity proportionate to the recent incident and the culmination of a history of prior incidences (experienced directly or indirectly).
Examples of behaviors associated with ever present anger may include a generalized
25 strong reaction to being disrespected, by anyone, and especially apparent in the current racial climate, a reaction of intense fear and or obstinacy when approached by police officers perceived to be disrespectful or profiling. In short, “it’s as if there is a wellspring of anger that lies just below the surface of many African Americans, and it doesn’t take much for it to emerge and be expressed” (DeGruy, 2005, p. 130). The final symptom of
PTSS is racist socialization and is discussed below.
Racist Socialization
The final symptom of PTSS, racist socialization, is the adoption of the historical and persistent racist beliefs of White dominant culture, by African Americans. Beginning with the idea that individuals who are held in captivity, often take on the views of their captors, DeGruy (2005) expresses, “One of the most insidious and pervasive symptoms of PTSS is our [African Americans] adoption of the slave master’s value system” (p.134).
The values of the slave masters and the racist society that supported their dominance over
African and African American people for centuries, are evident in science, policy and societal norms until now. Due to the depth and intensity of this symptom, the etiological section is discussed at greater length than the previous two symptoms; key examples, with particularly damaging consequences, are explored in all three areas (science, policy and societal norms) before examples of presenting problems are shared for this symptom.
“Science.” Racism has been justified in the name of “science” for centuries, complete with an actual diagnosis for the behavior of enslaved Africans who insisted on trying to escape, Drapetomania (Cartwright, 1851). Some examples are explored. First, there is the father of taxonomy of living organisms, Carl Von Linnaeus, who used his classification ideals (originally for animal species) to create distinguishing factors
26 amongst human beings. He labeled and provided a description for the following classes of people: Homo Americanas, Homo Europaeus, Homo Asiaticus and Homo Afer (Linné,
1964). In his book Systema Naturae, he described the Homo Afer as “black, phlegmatic, cunning, lazy, lustful, careless, and governed by caprice” (as quoted in DeGruy, 2005, p.57). Despite lack of scientific evidence, Linnaeus’ classifications eventually contributed to the social construct we now know as race (Haller, 1971). Also lacking all scientific rigor, inferiority of intelligence of the African people, was posited by Fowler and Fowler
(1859) in their book, The Self-Instructor in Phrenology and Physiology. The authors described Africans as “deficient in reasoning capacity,” (Fowler & Fowler, 1859, p. 64).
The overarching racist values and beliefs, being written as facts, were so widely accepted amongst dominant White culture, that even superior attributes ascribed to people of
African descent, were used to justify a position of inferiority. In An Inquiry into the Law of Negro Slavery in the United States of America (Cobb, 1858), superior physical and moral characteristics were used to justify enslavement:
… the Negro race … as peculiarly fitted for a laborious class. Their physical frame is capable of great and long exertion … Their moral character renders them happy, peaceful, contented and cheerful in a status that would break the spirit and destroy the energies of the Caucasian or the Native American. (Cobb, 1858, pp. 46-47)
Overall, science has been used to profess African inferiority for centuries but an exhaustive review of this topic is outside of the scope of this literature review. It is important however, to understand the role that the intellectuals of society have contributed to racist socialization throughout history.
Policy. The previous examples are just three from myriad instances of racism in science. The latter example, regarding the justification of slaves and related governing
27 laws based on science, demonstrates how racist beliefs and pseudo-science, influenced policy and law throughout the history of the United States. The following are more examples, to testify to the commonality of this occurrence. The Three-Fifths Compromise
(United States Constitution, 1787), under which enslaved Africans were determined to count as three-fifths of a person in order to settle conflict regarding taxes (between southern and northern states), also exhibits the racist views held by White dominant culture. The Virginia Slave Codes are another example of dominant culture’s lack of value and regard for African and African American people (Vaughn, 2016). The Virginia
Slave Codes were a group of laws, created to help govern the existence of enslaved
Africans and their descendants, amongst the white population. One act amongst the codes, eventually known as the Casual Killing Act of 1669, legally deemed murdering a slave an unpunishable “accident” to be regarded in the same fashion of something that
“never happened” (as quoted in DeGruy, 2005, p. 61).
Thomas Jefferson, founding father and slaveholder, explained the ideas he felt justified racists policies, such as those mentioned above. He described African and
African American people accordingly, “They smelled bad and were physically unattractive, required less sleep, were dumb, cowardly and incapable of feeling grief” (as quoted by DeGruy, 2005, p. 60). He then went on to explain the nuances among species, which enables different varieties to possess different qualifications. He proposed that the differences between White and African varieties create a “powerful obstacle to the emancipation of these people” (Peterson, 1975, p. 193). Finally, concluding that it is best, upon emancipation, that the slave be “removed beyond the reach of mixture” to avoid
“staining” the blood of the White race (Peterson, 1975, p. 193).
28 Societal norms. Thus far, dated examples were provided to show the depth to which racist values were engrained into the history and culture of the United States.
Nonetheless, there are many recent examples that demonstrate the unchangeable nature of such racist values. DeGruy (2005) highlights the resistance to acknowledge the depth of the inhumanity displayed by White Americans and chattel slavery. As an example, she shares the message given when the United States delegates “walked out” of the United
Nations World Conference Against Racism in 2001; which was a conference that declared chattel slavery as “a crime against humanity” (DeGruy, 2005, p. 73). Even more recent, police brutality against African Americans and the failure of the legal system to demand justice, have resulted in new organizations emerging to speak out against messages of inferiority in current society. An example that has gained particular recognition and backlash is the Black Lives Matter movement and the associated hashtag
#BlackLivesMatter: “a chapter-based national organization working for the validity of
Black life” (Cullors, Tometi, & Garza, 2016).
Black Lives Matter was created in 2012 after Trayvon Martin’s murderer, George Zimmerman, was acquitted for his crime, and dead 17-year old Trayvon was posthumously placed on trial for his own murder. Rooted in the experiences of Black people in this country who actively resist our dehumanization, Black Lives Matter is a call to action and a response to the virulent anti-Black racism that permeates our society. (Cullors, Tometi, & Garza, 2016)
Presenting problems. Racist Socialization, the third symptom of PTSS, evokes many presenting problems. Evidence is present in pop culture and scholarly literature that demonstrate the effects of adapted perspectives, aligned with superiority ideals of whiteness, on the self-concept of African Americans. A famous example is what is colloquially known as The Clark Doll Tests (1939), which were used in the famous
Brown vs. Board of Education (1954) case to demonstrate the injury caused to the self-
29 esteem of African American children, in segregated school systems (NAACP, 2016;
“Brown at 60: The Doll Test”). These tests produced results that exposed ideals of inferiority amongst African American children between the ages of six and nine, who showed a disturbingly stark preference for white dolls over black dolls. The children were asked questions that allowed them to identify which doll was nice, good, pretty, etc.
African American children frequently attributed the positive attributes to the white doll and attributes like ugly and bad to the Black doll. The final question in the study, “Which doll is most like you?” caused many children to refuse to answer, cry or run away due to all the negativity attributed to the dolls that looked most like them. One child’s comfortable identification with the Black doll, given all the negative attributes ascribed to it prior, was seen as even more disturbing to the researcher Dr. Kenneth Clark, according to his 1985 interview for Eyes on the Prize: America's Civil Rights Years (1954-1965), a
Public Broadcasting Service (PBS) documentary (Blackside Inc., 1985). When asked which doll was most like this particular child, the child expressed while smiling and pointing, “That’s a nigger. I’m a nigger.” Kiri Davis, an African American, adolescent filmmaker, repeated the Doll Test in her short documentary, A Girl Like Me and found similar results; African American girls still choose the white doll as the “prettier” doll, more than 60 years later (Davis, Williams, Williams, & Rudolph, 2005).
Perceiving appearance as inferior is not a problem experienced only by young
African American girls. A generalized experience of African and African American people adopting a European standard of beauty, which creates shame over hair texture and length and skin complexion, was explored from a historical perspective in Hair
Story: Untangling the Roots of Black Hair in America (Byrd & Tharps, 2014). Byrd and
30
Tharps (2014) traced the traditions and values of African American hair, from Africa
(e.g., a symbol of pride, status, beauty), and through the assault it suffered once enslaved
Africans were brought to the Americas (e.g. ugly, unkempt), and to the adaptations that continue until today. One example is the ongoing debate of “good” versus “bad” hair, which inspired the making of the documentary Good Hair (Chris Rock Productions,
HBO films, & Stilson, 2009). Good Hair explores the great lengths to which some
African American women go, in order to present their hair in a way that is aligned with
White culture. The documentary highlights how the Europeanized preferences have been internalized by many African American women, evidenced by a belief that “good” hair is straighter, more loosely coiled, curly, etc. (textures more common in Europeans) and bad hair is more tightly coiled, afro or kinky textured hair (textures unique to people of
African descent).
Deeper than outward appearance, the infamous misnomer, acting white, is possibly one of the most obvious and damaging presenting problems connected to racist socialization, especially amongst youth and adolescents (Durkee & Williams, 2005;
Grantham & Biddle, 2014; Thompson, Lightfoot, Castillo, & Hurst, 2010; Webb & Linn,
2016). “Acting white” is the accusation expressed that discredits or discourages achievement among African Americans, exposing generally low expectations for African
Americans (i.e., beauty, behavior, intelligence, moral, civilization, etc.) engendered by the pervasive message of collective inferiority. Webb and Linn (2016) summarized some examples of behaviors that may warrant the backlash of the acting white accusation:
“…spending a considerable amount of time studying, reading or completing homework, speaking standard English and associating with individuals from different racial/ethnic
31 backgrounds” (p. 135). Critiques to the ‘acting white accusation’ counter the persistent inferiority message that associates positive attributes to whiteness and negative attributes to blackness (Wildhagen, 2011); an erosive belief that proves racist socialization, the final symptom of PTSS.
To summarize, PTSS is a syndrome that affects descendants of enslaved Africans, resulting from experiences with historical and current trauma, induced by slavery and ongoing racism experienced across generations. The mental and behavioral adaptations of enslaved Africans and their descendants, that were and are necessary for survival within captivity and ongoing oppression, have resulted in generational manifestations of the core components of PTSS: ever present anger, vacant esteem and racist socialization. Due to the transgenerational etiology of the proposed syndrome (PTSS), Bowen Family Systems
Theory (BFST), which focuses on intergenerational transmissions, was chosen to further conceptualize PTSS and demonstrate clinical relevance of the syndrome. The following section, included and an overview of Bowen Family Systems Theory.
Bowen Family Systems Theory
Murray Bowen, originally trained in psychoanalysis and psychiatry, developed
Family Systems Theory, later called Bowen Family Systems Theory (BFST), after observing family patterns amongst patients with schizophrenia and members of their family of origin (FOO) (Kerr & Bowen, 1988; Nichols, 2010). BFST focuses on the impact of family dynamics, from the client’s FOO, on the client’s current and future interpersonal interaction. BFST was developed to capture the understanding of human interaction, as one of the many natural systems in the universe, which are all regulated by natural processes common to all living things (Kerr & Bowen, 1988).
32
Foundational Principles
The foundation of Bowen’s perspective stems from an understanding of natural sciences. Two quotes illuminate the vantage point from which he analyzed the human family: “Scientific theories are only as valid as they are consistent with what is written in nature,” (Kerr & Bowen, 1988, p. 26) and “There are some universal characteristics of relationship systems” (Kerr & Bowen, 1988, p. 48). These quotes imply that families like other natural systems (i.e., animal, plant, solar), have underlying forces, which drive their interaction, that are closer to instinct and reactivity than purposeful action. Therefore, his goal was to contribute to science by creating a theory that accounts for human behavior as opposed to describing it; the latter being the perceived goal of traditional psychology
(Kerr & Bowen, 1988). In other words, he wanted to understand the driving forces behind the patterns that were already written in nature (Kerr & Bowen, 1988).
One phenomenon Bowen identified as universal in all life is what he calls life energy; shared energy within living systems that requires dynamic interaction to hold the system in equilibrium (Kerr & Bowen, 1988). The dynamic interaction is one between closeness and separateness, referred to as individuality and togetherness in human families. Reciprocal functioning positions are automatically assumed, between members of any living unit, in order to keep life energy balanced (Kerr & Bowen, 1988). An example of this would be the occurrence of one family member reducing stress and worry, only for another to become more stressed and worried; life energy does not dissolve but is managed. This core idea, applied to the emotional functioning of the family, is used to describe what Bowen calls anxiety; a level of persistent emotional energy (neither good nor bad) that each person carries indefinitely, inherited trans-
33 generationally from their FOO (Kerr & Bowen, 1988). Not to be confused with acute anxiety, which results from life stressors, anxiety within the context of BFST, is chronic and fluid within the family system. Eight interlocking concepts of BFST help to describe the reciprocal functioning roles of family members, as the overall system manages the anxiety that moves about (Bowen