Monday, October 17, 2011

The Black Mask of Humanity:
Racial/Ethnic Discrimination and
Post-Traumatic Stress Disorder

Hugh F. Butts, MD
J Am Acad Psychiatry Law 30:336–9, 2002

Knowledge of the impact of racism on the psyches of
African-Americans is limited by the following considerations:
the tendency among European-Americans
to deny, minimize, and rationalize the existence
of racism; the tendency among European-Americans
to ascribe inferior status to African-Americans; the
application of many stereotypes and myths to African-
Americans that serve to have them viewed as
nonresponsive to human influences; and finally, an
African-American tradition “which teaches one to
deflect racial provocation and to master and contain
pain” (Ref. 1, p 25).
It is not surprising that, given this disregard of
African-Americans, responses to racial discrimination
by African-Americans are often not viewed as
severe enough to indicate that these blacks may have
post-traumatic stress disorder (PTSD). Even in those
instances in which African-Americans are objects of
discrimination and describe symptoms consistent
with PTSD, their symptoms may be dismissed or
trivialized because of the view that the stressors are
not catastrophic enough, according to the Diagnostic
and Statistical Manual of Mental Disorders
(DSM), to warrant a diagnosis of PTSD.
The tendency on the part of some European-
Americans to define casually the reality of African-
Americans’ experience may be problematic in view of
the lack of knowledge about the “Black Experience”
displayed by so many European-Americans. This
tendency led Ralph Ellison to write: “Thus when the
white American says, ‘This is American reality’, the
Negro tends to answer . . . ‘perhaps, but you’ve left
out this and this, and this. And most of all what you’d
have the world accept as me isn’t even human’ ” (Ref.
2, p 111).
There are intriguing psychodynamics implicit in
the refusal by European-Americans to acknowledge
and accept that the African-American response to
racial discrimination should be viewed as potentially
clinically symptomatic. First, there is a lack of sophistication
regarding the adaptive nature of the formation
of symptoms and that a symptom simultaneously
represents a mechanism of constructive
adaptation to the effects of stressors as well as (in the
extreme) a maladaptive response to the effect of stressors.
Thus, there is a great deal to be learned about
formation of symptoms as African-Americans react
to traumatic acts of discrimination and then define
and expand their self-definition in response to these
traumatic acts. Second, failure to characterize as serious
trauma the symptoms that African-Americans
report as responses to discrimination tends to further
the emotional gulf between African-Americans and
During four decades of psychiatric and psychoanalytic
practice, the author has treated thousands of
African-American individuals, many of whom have
described various types of racial trauma. Most of the
African-American patients evaluated and treated by
the author have described multiple personal experiences
of racial and ethnic discrimination. Considering
the ubiquity of racism, it is not surprising that

instances of discrimination are as frequent as reported;
but the devastating emotional responses to
the racist acts are unsettling. The range and intensity
of emotional responses varies from mild to overwhelming,
and the duration of such responses varies
from days to months or years. With a fair degree of
frequency, black individuals who experience racial
discrimination report symptoms consistent with a
diagnosis of PTSD, even though the DSM-IV requires,
for the diagnosis, that the symptoms follow
exposure to extreme traumatic stress.
The essential feature of Posttraumatic Stress Disorder is the
development of characteristic symptoms following exposure
to an extreme traumatic stressor involving direct personal
experiences of an event that involves actual or threatened
death or serious injury, or other threat to one’s physical
integrity; or witnessing an event that involves death, injury,
or a threat to the physical integrity of another person; or
learning about unexpected or violent death, serious harm, or
threat of death or injury experienced by a family member or
other close associate. . . . Traumatic events that are experienced
directly include, but are not limited to, military combat,
violent personal assault (sexual assault, physical attack,
robbery, mugging), being kidnapped, being taken hostage,
terrorist attack, torture, incarceration as a prisoner of war or
in a concentration camp, natural or manmade disasters, severe
automobile accidents, or being diagnosed with a lifethreatening
illness [Ref. 3, p 463– 4].
It is my premise that the clinicians who formulated
the DSM have used an extremely narrow focus
in citing the traumas that may be causative of PTSD.
It is my view that racial/ethnic discrimination experienced
by African-Americans frequently results in
symptomatology consistent with a diagnosis of
PTSD. Further, it will be argued herein that the subjective
experiences and symptoms experienced by
those African-Americans are often extreme and catastrophic,
requiring active psychotherapeutic and psychopharmacologic
care. Recognition of this notion
should make it easier for blacks who have experienced
intentional discrimination to bring claims that
they have suffered psychological harm.
A Review of Selected Literature
Several behavioral scientists have sought to expand
the view held by the DSM’s authors as to the nature
of trauma. Charles Brenner states:
What is traumatic is the subjective experience of the traumatized
individual. It is what the event meant to the individual. It
is the impact of the external stimuli, how they heightened fears,
intensified sexual and aggressive wishes, resonated with feelings
of guilt and remorse [Ref. 4, p 196].
Jacob Arlow in a 1984 article notes:
What constitutes trauma is not inherent in the actual event, but
rather in the individual’s response to a disorganizing disruptive
combination of impulse and fears integrated into a set of unconscious
fantasies. The traumatic event itself has not been at
issue, only the reaction that it evokes in the survivor [Ref. 5,
p 521].
Pitman and Orr, in describing the illusory objectivity
of the stressor, write:
The assumption that there exists a “range of usual human experience”
is dubious from a cross-cultural perspective. For example,
gang related shootings may be rare in rural Minnesota but
all too common in urban Los Angeles. A recent study found that
at some time in their lives, 39 percent of the middle-class Detroit
population was exposed to traumatic events potentially
capable of causing PTSD, and 25 percent of exposed persons
went on to develop the disorder. Another study reported that
stressors falling within the range of usual human experience are
sometimes capable of resulting in the PTSD syndrome [Ref. 6,
p 37].
Pitman and Orr add:
The examples presented in DSM III-R of stressors that may
cause PTSD raise as many questions as they settle. Does the
“sudden destruction of one’s home” include losing one’s summer
house in a fire? Of all the examples provided in DSM III-R
“serious threat to one’s life or physical integrity” appears the
most straightforward. However, not all experts would accept the
sudden denuding of a litigant’s scalp by a faulty hair rinse as a
stressor sufficient to cause PTSD. The illusion of an “objective”
stressor is further evidenced by the consideration that the victim’s
appraisal constitutes a necessary link in the causal chain
from event to stress response. An identical event may not be
experienced the same way by two people. Pilowsky has coined
the term “cryptotrauma” for a situation in which a stressor that
appears innocuous to an observer may be perceived by the victim
as life-threatening. Retrospective discovery that the appraisal
was incorrect doesn’t erase the distress associated with
the original experience [Ref. 6, p 38].
Butts7–10 and Butts and Butts,11 offer cases documenting
the appearance of PTSD symptoms in a
series of African-Americans who experienced racial
and housing discrimination. Each of the patients described
symptoms consistent with a diagnosis of
PTSD. Each was given the diagnosis and in several
cases, expert testimony at the time of civil trial resulted
in findings for the plaintiffs and awards for
damages or settlements out of court.

Dr. Butts is in private practice in psychiatry and psychoanalysis in New
York, NY. Address correspondence to: Hugh F. Butts, MD, 350 Central
Park West, Suite 13-I, New York, NY 10025. E-mail:
336 The Journal of the American Academy of Psychiatry and the Law

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