Post-Traumatic Stress Across Color Lines: A History of Anti-Black Exclusion & PTSD

Black Americans with Posttraumatic Stress Disorder have less access to mental healthcare compared to White Americans. Many factors contribute to this inequity, including broader disparities within the healthcare system driven by systemic racism, and an underutilization of mental health services by Black Americans due to provider bias and stigma around mental health care. These disparities are rooted in a racist historical context of exclusion and abuse of the Black community by the White psychiatric establishment, and a perpetration of further trauma on Black clients, a context that is largely missing from traditional mental health education and literature on Black mental health today. This article aims to provide a necessary historical context of how the U.S. mental health care system has excluded Black Americans from trauma treatment. We use a contemporary trauma lens to demonstrate the ways in which Black trauma has existed throughout U.S. history, but how White psychiatry has cast trauma symptoms as evidence of racial inferiority, has excluded Black individuals from treatment, and has abused Black patients, thereby increasing Black trauma. The purpose of this review is to inform and educate mental health providers about our collective history, to counter a narrative of amnesia which identifies Black underutilization of services but forgets the exclusion from and abuse of Black people within the mental health system. We conclude with recommendations that providers can utilize to engage in antiracist practice and create an affirmative space for Black Americans to utilize trauma treatment and mental health care freely.