Race, Ethnic Identity & Mental Health: The Psychology of Racism

Reviewed by therapist.com Team

Race, in and of itself, is not a determining factor that predisposes you to certain mental health disorders. This means that the color of your skin does not inherently put you at a greater or lesser risk for mental illness. However, race is a societal factor that may affect your mental health in a number of ways.

What Is Race?

Race is one way to categorize different groups of people based on shared physical attributes. Definitions of racial groups have changed over time and will likely continue to change in the future. This is because our understanding of race is largely defined socially, not biologically, genetically, or anthropologically.

Although this method of categorization views race as a social construct, that doesn’t make race any less “real.” The history of how humans have used and abused the category of race, especially in the United States, makes it a lived reality for our culture and society.

The United States Census Bureau recognizes five racial categories, although people are welcome to self-identify as more than one race:

  • White
  • Black or African American
  • American Indian or Alaska Native
  • Asian
  • Native Hawaiian or Other Pacific Islander

What Is Ethnicity?

Ethnicity is another way to categorize different groups of people. Instead of being based on physical attributes, ethnicity is based on shared cultures, traditions, and/or place of origin. While your race is largely based on physical attributes that you inherited from your family, your ethnicity is based on the cultural identity you learned as a child.

The United States Census Bureau only collects information on Hispanic and Latino ethnicity. Other common ethnicities in the United States include:

  • Jewish
  • Italian
  • Irish
  • Hmong
  • Indian
  • North African
  • Arab
  • Persian

What Is Racism?

Racism is the systemic oppression and marginalization of people of color and the prejudice of those in power based on race. In the western world, those in power historically have been White people, and racism has been fueled by a belief in White supremacy over other races.

Personal prejudice and bias are different from racism, although they do contribute to racism. You can be personally prejudiced or biased against people for a number of reasons: their politics, faith, place of origin, class, etc.

According to the Center for the Study of Social Policy, prejudice is “rooted in stereotypes, rather than reason or fact, leading to unfavorable bias or hostility toward another person or group of people; literally a ‘pre-judgment.’” Racism codifies these stereotypes, biases, hostilities, and judgments into an entire belief system.

When racism is embedded into a nation’s politics, schools, social sphere, justice system, and overall culture, it is called systemic racism. Under systemic racism, institutions intentionally privilege and empower White people while continuously disadvantaging and harming people of color. Examples of systemic racism include mandatory sentencing laws, racial profiling, inequitable access to health care, housing discrimination, and property taxes that put low-income school districts at a disadvantage.

Glossary of Terms Regarding Race and Racism

  • Racism: the systemic oppression and marginalization of people of color, perpetuated by White people
  • Prejudice: irrational or unjustifiable negative emotions or evaluations of people from other social groups
  • Systemic racism: when systems and institutions intentionally privilege and empower White people and disadvantage and harm people of color
  • White supremacy: the racist belief that White people are inherently superior to other races and deserve to subjugate and rule over them; also, the pervasive societal belief that undergirds systemic racism by privileging White people over others
  • White privilege: the advantage White people have of not being defined by, discriminated against, or harmed due to their race
  • POC: people of color; a term to encompass all non-White persons
  • BIPOC: Black, Indigenous, and people of color; a term to encompass people of color while also acknowledging the different levels of racism faced by Black and Indigenous people in America due to the country’s history of slavery and genocide
  • Microaggression: an interpersonal interaction that intentionally or unintentionally communicates racist attitudes toward a person of color

A Brief History of Racism in the United States

Racism has been a part of the United States since before its founding. The first African slaves arrived in Virginia in 1619, a full 170 years before the adoption of the United States Constitution.

Racist policies have affected multiple non-White racial and ethnic groups. The legacy of these policies creates a country in which racial and ethnic identity continue to affect people’s mental health.

Below is a brief list of some of the racist events, policies, and tragedies in U.S. history that continue to affect different racial and ethnic groups today. Please click the links to learn more:

Race, Ethnic Identity, and Mental Health

The most recent version of the Diagnostic and Statistical Manual of Mental Disorders—the DSM-5—has taken a greater role in acknowledging the role of cultural factors on mental health. When it comes to issues of race in particular, it is important to know that race intersects with mental health in a number of ways, including:

  • The psychological effects of discrimination
  • Mental health disparities in health care
  • Intergenerational trauma
  • Your sense of racial and ethnic identity

1. The Psychological Effects of Racial Discrimination

Racial Trauma

Living in a culture of racial discrimination negatively affects your mental health. Whether you experience racism personally, witness an act of discrimination, or see racism portrayed in the media, you can develop what is known as racial trauma. The symptoms of racial trauma are similar to those of posttraumatic stress disorder (PTSD) and can include depression, anxiety, chronic stress, and fatigue.

Racism and Depression

The goal of racist behavior is to make a person of color feel isolated, powerless, and worthless. These are the same feelings that often accompany depressive episodes. Experiencing racism may increase your likelihood for developing depression, or it may worsen the symptoms of an existing diagnosis.

Racial Stress

Even if you don’t experience an explicit act of racism, you may still experience racial stress from having to navigate a racialized world. Black people in the United States often experience additional stress because they know how racism affects their health and safety. For example, they are at a greater risk of dying from COVID-19, dying in childbirth, and being brutalized or killed at the hands of the police. All of these potential threats stem from racist systems, policies, and institutions that people of color have to navigate on a daily basis.

Racial Trauma in the Workplace

Racism can occur in the workplace, covering everything from microaggressions and institutional barriers to blatant, illegal discrimination. Various studies have shown that:

  • The average hourly wage of Black workers in 2015 was nearly 27% less than the average wage of White workers.
  • Job applicants with names that sound “less White” are less likely to get called back for an interview.
  • Employers offer Black job seekers less compensation than White job seekers.
  • Race discrimination can also be compounded by gender discrimination. For example, American Indian/Alaska Native women earn just $0.69 for every $1 a White man makes.

Poverty is another societal factor that can affect your mental health. When racism enters the workplace, it can affect you both economically and psychologically.

2. Mental Health Disparities in Health Care

Perhaps the greatest legacy of racism on mental health is that it prevents BIPOC from accessing mental health treatment. According to the American Psychiatric Association, 48% of White people with a mental illness received treatment in 2015, compared with just 31% of Black and Hispanic people and 22% of Asian people.

Misdiagnosis

Racism is pervasive in how the healthcare system treats patients of color. For example, many clinical drug trials lack diverse participants, even when the drugs being tested are intended to treat diseases most commonly suffered by diverse populations.

When it comes to mental health, there is also the risk for misdiagnosis or lack of diagnosis altogether. There are many factors that contribute to these errors in care, including:

  • Lack of representation: Fewer than 2% of members of the American Psychological Association are African American.
  • Language/cultural barriers: Language barriers and cultural differences can result in misdiagnosis if not navigated with patience, understanding, and respect by the therapist.
  • Treatment biases: Health professionals can also discriminate in terms of diagnosis and treatment. In the U.K., Black people are more likely to be prescribed medication instead of talk therapy. In the U.S., Black people are more likely to be diagnosed with schizophrenia than White people who exhibit the same symptoms.

Criminalization vs. Treatment

Both people of color and people with mental illness are overrepresented in the United States criminal justice system.

Black people represent an estimated 13.4% of the population of the United States, yet they are more than twice as likely as White people to be arrested. Nearly one in five adults in the U.S. has a mental illness, but one study found that 37% of people in prison had been diagnosed with a mental health disorder.

In the juvenile justice system, the numbers are even higher. An estimated 50–75% of youth in the juvenile justice system meet the necessary criteria to be diagnosed with a mental health disorder.

Addiction in particular has been criminalized for people of color in the past. For example, according to the ACLU, 66% of crack cocaine users in the United States are White or Hispanic, yet more than 80% of defendants sentenced under federal crack cocaine laws are Black. Blacks and Latinos make up only 30% of the U.S. population, but they make up approximately 57% of people in state prisons and 77% in federal prisons for drug offenses, according to the UN Office on Drugs and Crime.

Lack of Access to Care

People of color also struggle with lack of access to care at every level of the healthcare system. Barriers to care come in many forms, including:

  • Being uninsured or underinsured
  • Not having access to transportation to a mental health care provider
  • Having to focus on other needs (housing, food insecurity, etc.) at the expense of mental health
  • Lack of reliable internet access for telehealth therapy 
  • Inability to see a primary care doctor to secure a referral
  • Having to work unpredictable or excessive hours, preventing regular therapy appointments
  • Lack of adequate PTO policies to take time off for mental health

3. Intergenerational Trauma

Intergenerational trauma refers to the ways in which trauma is passed down between family members across generations. This type of trauma can be transferred in a number of ways:

  • Stories: Family stories of trauma can affect us just as deeply as our own experiences. You may have heard harrowing stories of your parents’ immigration to America or a beloved uncle who was lynched before you were born. Although these stories didn’t happen to you personally, you may process them in ways that affect your mental health.
  • Cycles: For many families, trauma can become cyclical in nature such that the same trauma reverberates across generations (e.g., a legacy of addiction in a family). Families may also get caught in a cycle involving different traumas. For example, a father may develop an alcohol addiction to cope with the racism he encounters in society, while his daughter may develop OCD to cope with her father’s alcoholism.
  • Epigenetics: Trauma can change the way certain genes are expressed by causing them to turn “on” or “off.” These altered gene expressions (known as “epigenetic” changes) are then passed down across generations to children and grandchildren who never experienced the trauma but still carry its genetic legacy.

4. Your Sense of Racial and Ethnic Identity

Your sense of attachment to your racial and ethnic identity can also affect your mental health. For some people, identifying more strongly with their race and ethnicity can act as a buffer against the negative experiences of racism and discrimination. For others, this strong attachment can actually exacerbate the negative experiences of racism.

Whether or not your identity brings you comfort or crisis may depend on your age or birthplace. It may also depend on your sense of belonging to your own racial and ethnic identity. For example, people who identify with two or more races are more likely to report mental illness than other racial or ethnic groups.

Does Racism Affect the Mental Health of White People?

Although racism principally harms people of color, it can indirectly affect the mental health of White people as well. This does not mean that White people are victims of “reverse racism.” Instead, White people suffer the psychological costs of racism (PCRW) because they actively perpetuate an unjust system.

Essentially, the privileges and powers White people enjoy as the dominant group in a racist society come at a psychological cost that involves guilt, fear, shame, inauthenticity, lack of empathy, and insensitivity. As one study puts it, “These costs are in no way comparable to the substantial economic, political, and social costs that racial and ethnic minorities face as a result of White racism. Nevertheless, even as Whites benefit from White racism, it is noteworthy that racism affects everyone in negative ways.”

Racism is not a mental illness, but living in a racialized society may affect your mental health, even if you are White. Witnessing racist violence can also affect your mental health regardless of your race. If you’ve witnessed a racial trauma or if you need help understanding the relationship between racism and your mental health, click here to find a therapist near you.

Seeking Therapy

Should I See a Therapist Who Is the Same Race as Me?

Whether or not you seek a therapist who has the same racial or ethnic background as you is entirely up to you. It’s important to be honest about whatever preferences you may have for your therapist’s race, gender, sexuality, faith background, or other characteristics. Choose a therapist you feel comfortable trusting with difficult emotions and experiences.

Although your therapist doesn’t need to have the same racial or ethnic background as you, it’s important to choose someone who is multiculturally competent, meaning that they can effectively treat patients of varying beliefs, perspectives, and backgrounds, regardless of their own personal characteristics or experiences. It’s also important to choose a therapist with experience in addressing your specific area of concern so they can help you discover new insights and perspectives.

People of every race and ethnicity deserve access to quality treatment for their mental health. In the United States, people of color may face barriers when trying to find a therapist. However, that doesn’t mean getting help is impossible.

Help is available now. Click here to find a therapist near you.


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