The “Family History” Physicians Forget to Ask About: Post Traumatic Slave Syndrome & Liberation Psychology

Race Dialogue Series: Part 2

In the summer of 2020, Larner College of Medicine Class of 2023 medical students Grace Eisenbiegler, Lud Eyasu, Akua Frimpong, Charlotte Gemes, Krisandra Kneer, Liana Mathias, and Alexa Rosenthall worked with then Interim Assistant Dean for Students Prema Menon, M.D., Ph.D., to create the Race Dialogue Series – “an elective summer discussion series to allow medical students to engage in peer-to-peer dialogue on the intersection of race and medicine.”

In 2021, Class of 2024 medical students Ankrish Milne, Elise Prehoda, Hannah Cook, Izabella Ostrowski, and Mahima Poreddy became the new leaders of the series.

On July 20, 2021, the group was joined by Marissa Coleman, Psy.D, a medical student wellness advisor at Larner and clinical psychologist at the UVM Medical Center for a session entitled, “Post-traumatic Slave Syndrome and Liberation Psychology.”

Below, Milne and Prehoda reflect on lessons learned during this session – the second in a four-part series.

Left: Ankrish Milne. Right: Elise Prehoda.
Left: Ankrish Milne. Right: Elise Prehoda.

Is it possible that traumas endured centuries ago could impact both the mental and physical health of descendants today?

And if so, why are we as medical students and healthcare professionals not talking about it?

If this is the first time you are hearing about “Post Traumatic Slave Syndrome (PTSS),” the term likely elicits some discomfort; I certainly felt that way the first time I saw the term. Sitting with this discomfort, asking difficult questions, and learning about issues that impact the health of marginalized groups are central themes of the Race Dialogues Summer Series1.

On July 20th, Dr. Marissa Coleman2 generously offered her time and wisdom to facilitate a session about PTSS and Liberation Psychology, theories that can help clinicians better understand, build trust with, and more effectively treat patients with marginalized identities.

According to Dr. Joy DeGruy, the sociologist who coined the term, Post Traumatic Slave Syndrome is “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.”

Dr. DeGruy begins explaining PTSS with the assertion that enslaved African-Americans suffered from post-traumatic stress disorder (PTSD), the symptoms of which include emotional numbness, avoidance, heightened reactions, and unwanted flashbacks. Even after enslaved people were “freed,” their PTSD persisted. The children of these formerly enslaved people, in some sense, inherited their parents’ traumas: they grew up facing their parents’ slavery-induced PTSD, while also experiencing various traumas of their own as Black people living in a racist country. Dr. DeGruy concludes that this cycle of trauma was perpetuated through generations, ultimately leading to PTSS, whose symptoms are similar to those of PTSD.

After a discussion of PTSS, Dr. Coleman went on to discuss Liberation Psychology, a framework founded in the works of Ignacio Martín-Baró3, who referred to the term as a psychology “for the oppressed.” In Western medicine and psychology today, the examination and treatment of patients tends to be ahistorical, acontextual, and individualistic.

In most clinical encounters, we take the patient’s history as an individual, focus on current symptoms and past conditions, and maybe briefly discuss the patient’s social history and family history of disease. However, we rarely ask patients about the stories of struggle in the generations that came before them or the communities that surround them. As we have learned with PTSS, these stories inextricably impact current patient health and health outcomes, especially in those with marginalized identities.

Further, U.S. history has largely been whitewashed, with our education systems perpetuating skewed narratives. Many textbooks, for example, depict the Emancipation Proclamation as a “happy ending” – the moment when all enslaved people were finally freed and treated equitably in this country. Unfortunately, this is far from true.

Liberation Psychology aims for clinicians to empower patients with marginalized identities by helping themreclaim and critically analyze the history (e.g. slavery, colonization) that led to their current life circumstances and ailments. The ultimate goal is to allow patients to not only examine their histories and look at the causes of their oppression, but also gain a sense of agency and discover new paths of action.

Liberation Psychology asserts the role of a physician as an activist as well as a healer. One of the central tenets of Liberation Psychology arises from the concept of praxis, or the idea that theory and action are not mutually exclusive, but rather they must exist in concert. As (future) clinicians, we must go beyond simply understanding theories. To bring Liberation Psychology into practice, Dr. Coleman provided some examples of questions we can ask all patients at an appropriate time in the patient interview:

1. “Can you tell me about the stories that were passed down in your family through the generations?”
2. “Do those stories align with the history that you were taught in school? Does it feel that the history that’s true to you and your family was ignored in school?”
3. “How might your family’s history or the history of your people affect your experience today? Could this be affecting your mental or physical health?”

Asking a patient these types of questions and approaching conversations with genuine curiosity supports the creation of a trusting and effective therapeutic relationship. Though issues of oppression and racism must be addressed at systemic and institutional levels for lasting change, we can make a difference with every patient interaction by promoting practices like this within our own institutions.

Through an understanding of PTSS and Liberation Psychology, we can begin to contextualize and learn about the multigenerational suffering of our BIPOC patients and those with marginalized identities, subsequently transforming the way we connect with, diagnose, and treat these patients.

*Although no dates have yet been set for the next Race Dialogue Series, the goal is to begin recruiting first-year medical students in the coming months to keep the event going into the future.

  1. A weekly series of faculty and student-led conversations and presentations that was started last summer by a group of students from LCOM’s class of 2023.
  2. Dr. Coleman is a clinical psychologist, diversity, equity, & inclusion advisor at UVM Medical Center, and a wellbeing advisor at LCOM
  3. Ignacio Martín-Baró was murdered by a US trained death squad in 1989, around a decade after coining the term Liberation Psychology, by the Salvadoran Army at the University of Central America

What are your thoughts about this topic?