Last weekend, I had the pleasure of attending the Academy on Violence and Abuse Regional Summit in St. Louis. It was enjoyable listening to local health care providers use a trauma-informed lens to discuss medical care. As well as listening to internationally known experts on the seminal Adverse Childhood Experiences (ACEs) Study. I also had the honor of sitting on a panel that showcased St. Louis based health care practices that are adapting ACEs Science into patient/consumer interactions and business practices. Needless to say, it was a rich experience overall!
The venue for the Summit, St. Louis Missouri, has been a case study of toxic stress, racism, and the propensity for ill-supervised institutions to propagate intergenerational trauma and exploitation. This is not unique to St. Louis. The spotlight has been shone on multiple cities across the US (Baltimore, NOLA, Detroit, LA, etc) and other parts of the world (Brazil and the UK) in light of the killings of unarmed Black children, women, and men and public health catastrophies (Flint Michigan). Still, the backstory of St. Louis being a stage for discussing the infusion of ACEs Science into local practices, the biopsychosocial impact of toxic stress, and the mechanisms of transmitting intergenerational trauma was meaningful. These are difficult, important, and necessary conversations. Emphasis on necessary.
A common theme throughout the Summit was the developmental reality of the transactional nature between people and their multiple ecologies and relational interactions. That is to say, families, community members, and social institutions (organizational, political, and cultural) act upon the stress levels and resilience of children, youth, and adults. It is all of us. Institutions are not separate from us. We are the institution builders and conservators.
As before, an unsettling realization occurred to me, again, during the response to someone else’s question about race and ACEs and my query about if we can comprehensively serve the health needs of African American patients without being fluent in the various sources of toxic stress that affect them; racism being one. I realized that despite all of our ability to detail the ACEs pyramid, our pronouncements about vicarious trauma/secondary trauma, and our skill at expounding upon the social, emotional and cognitive complications from trauma--we in the ACEs community do not have the language to express nor, perhaps, have the conviction to understand racism as an initial or compounding source of toxic stress for Black people. Racism can be an initial and/or compounding source of toxic stress for Black people. (And others. I consciously add “and others” here because I understand it is true and also, notably, because I am well aware, from experience, that centering Blackness in questions of this sort inevitably causes others to wrestle to center their identities within my advocacy efforts to compel action on behalf of Black folk specifically. Stop doing that. It is abusive and is not helpful. It is certainly not trauma responsive.)
As I write this, I question if, more foundationally, we in the ACEs community are able to see how the Black experience in America (of the last 400 years) is steeped and rooted in multigenerational adversity. That is to say, do we--the people who are best positioned to shape practices, policy, and inform institutions about how prolonged adversity undermines health, somehow think that Black folk are or should be the exception to adversity science. That somehow, through it all, Black folk as a group should have been able to spontaneously recover and thrive from generations of trauma.
Thrive not just through tough financial times and occasional social rejection, but through existential invalidation of Black humanity, deprivation of essential needs, and denial of lived experience. I challenge you to name a single evidence-based health intervention that recommends any of those three approaches, much less suggests we should combine them and expect health-affirming results.
Moreover, I am puzzled by how the connection between social-political issues of present day Black America and the hundreds of years of “racial adversity,” which has changed form and social acceptability (openness) in the present day, is not readily translated into the language and construct of adversity science. That is not to say that every conversation about Black folk needs to include racism. At the same time, given what we know about toxic stress and neurobiological impacts of ongoing adversity--in serious conversations about Black health--race related adversity, racism as toxic stress, and race-related intergenerational trauma MUST become a factor in both the analysis and solution.
Black folks don’t need or want a paternalistic savior, yet/and, if you provide care to Black patients, students, or are operating in the field of trauma-informed care, you should be fluent in and articulate about at least the fact that racism is currently, and has been, a factor in the health and development of Black people in contemporary and intergenerational terms in the US. It is a textbook example, I find, of intergenerational trauma and toxic stress. To contradict this proposition, suggests that one believes that the Black experience is the exception to adversity science and traumatology and/or that Black folk have always been poor, disregarded, and underprivileged and/or that the “Black condition” is a result of their own lacking.
I write this article, not to invite input about how non-racist any particular reader is (stop centering your story), nor solicit commentary on the exceptions (stop doing that. It is invalidating; there can simultaneously be exceptions and institutional concerns--that’s why they are called exceptions) nor is it designed to encourage comments about how painful it is to hear (stop doing that; I have my own burdens to bear). I write this as a backdrop to a couple of queries/suggestions (in addition to those already provided parenthetically).
Advancing the Action on Adversity Science and Race
1. As we move forward in strategic planning and corrective actions about toxic stress, intergenerational trauma, and its impact on people's functional performance, can we advance from the explanatory theoretical historical narrative into pragmatic and courageous steps toward accountability (i.e. toward best possible developmental outcomes) that pairs a public health approach, anti-racism, and adversity science?
2. Number 1 will require that those who don’t currently possess the tools actually go out and find the knowledge and language they need to contribute constructively to the conversation, rather than asking survivors to explain it to you.
3. Coping and resilience are necessary for short-term and intermittent stressors. Where adversity is institutional (institutional racism, sexism, for example), shall we in the ACEs community commit to advocating for and incentivizing the dismantling of such institutions and building integrated systems that focus on restoration (politically, socially, relationally, culturally) so we and the Black people we serve can move beyond coping to thriving, post haste?
4. As I shared with the organizers of the Summit (Academy on Violence and Abuse and Alive and Well STL), thanks for allowing me to share. I’m just a woman and health care provider who has experienced my fair share of tough times--adversities and traumas that were compounded by the racism I experienced when it was the last thing I needed. Which encourages me to tailor my health care practice to be more trauma responsive. Perhaps our sharing and thoughtfulness will be generative and advance us further down the road to creating spaces where thriving replaces coping as the norm.
Lastly, if you operate in the space of toxic stress, community development, equity in education/health, and organizational development, I would like to connect with you to do this work. Share this article with others and post your comments below.
P. Denise Long, MS, BHS, OT is a 20-year veteran of Occupational Therapy in private practice with Youthcentrix®Therapy Services, a Psychiatric Occupational Therapy provider, headquartered in the St. Louis area, with a focus on improving functional performance and fuller daily living for those with mental health needs that interrupt successful completion of chosen roles and responsibilities at school, home, and in the community. Denise holds a bachelors of science in Occupational Therapy, master of science in Educational Psychology (learning and cognition) and is earning a Doctor of Education in organizational leadership with research emphasis on trauma-informed organizational development.
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