Kaari Aubrey was in preschool when she tried to rub off her brown skin.

Her classmates at her school in Athens, Ohio, were passing a ball back and forth in the school’s playroom when Kaari noticed they weren’t including her. For a while, she pled with them to let her play, but when that didn’t work, she burst into tears. Moments later, a white girl who was playing announced that the others shouldn’t include Kaari because she was “dirty.”

“My hands were clean,” Kaari says, remembering that afternoon. “I didn’t think I was dirty.”

When her white classmate clarified, laughing, that it was Kaari’s brown complexion she considered dirty, Kaari escaped to her cubby, furiously rubbing her arm in an attempt to get the color off.

“It smelled like burnt clay,” Kaari recalls matter-of-factly. At 24, she’s now a teacher living far away from Athens in her Brooklyn apartment, but she still remembers the smell of the rug burn vividly. She also recalls being unaware of the gravity of the situation until she got home and her mother, Lisa Aubrey, began to ask questions.

Lisa is an Arizona State University professor who teaches African and African American studies and political science and splits her time between Arizona and Cameroon. “I saw her rubbing her skin, desperately, almost violently,” Lisa says. “I asked her what was going on. She told me she wanted to rub off her skin and that she wanted to look like the other girls.”

Lisa and Kaari both recall facing discrimination frequently when they lived in Ohio. Kaari remembers being called “a n*gger” on occasions and being asked if she “spoke African.”

Soon after the incident on the playground, two things in the Aubreys’ lives changed.

First, the mild eczema Kaari suffered from as a baby returned. Eczema is a skin condition that behaves like an allergy and can worsen with stress, so the condition came back more intensely and incessantly after being bullied by her classmate in the playroom.

Second, people in their community became intolerable. “They became patronizing and presumptuous and even started dropping by my house to ‘check’ on my parenting,” Lisa says. “As I reflect, some of the parents of Kaari’s schoolmates became more overtly racist as well and often didn’t even recognize their racism, I think.”

As a result, Lisa moved the pair out of Ohio to Arizona, and eventually to Ghana, where they lived for a six years.

In November 2017, NPR published an article about how racism can have physical implications for those subjected to it. “In studying black women, for example,” they reported, “[social epidemiologist Amani Nuru-Jeter] found that chronic stress from frequent racist encounters is associated with chronic low-grade inflammation — a little like having a low fever all the time.”

Nuru-Jeter and others found that the body’s natural reaction to stress can wear down those who experience that stress long-term. That same chronic stress actually changes the genes of the victims of racism, a fact that fits in with previous research finding that trauma can be passed down through generations.

Another study cited in the article by behavioral scientist Arline T. Geronimus found that after a 2008 Immigration and Customs Enforcement (ICE) raid in Postville, Iowa — which “saw more than a tenth of the town detained” and focused on people who “looked Latino” — some local Latina women started giving birth to smaller babies. A follow-up NPR piece also found that black mothers are more likely to lose their babies or deliver prematurely because of the stresses of racism.

When I interviewed Kaari about her experience on the playground in Athens, Lisa told me she had read somewhere that “being black is bad for your health.” After so many years of research on the topic, we now know that statement is true, at least in the U.S. The question that remains is how to solve this problem. What can be done to fix these disparities in wellness when the causes are so institutionalized? And why, after so many years of study, hasn’t more been done to change the way people of color are treated for illnesses?

Susanne Babbel is a San Francisco psychotherapist who specializes in trauma and is the author of the upcoming book Heal the Body, Heal the Mind: A Somatic Approach to Moving Beyond Trauma. She says that when a body experiences trauma — whether physical, emotional or verbal — it prepares to fight, flee or freeze. This means that when Kaari was in the playroom that day, not only was she emotionally traumatized, her body was also completing complex physical processes to solve the problem of her “otherness.”

Her heart rate may have sped up or slowed, blood may have moved to her limbs as she prepared to flee and hormones like adrenaline were fluctuating. Kaari’s body was preparing her for an act of survival. The problem for her and other people of color who experience racism is that there is no “solution” for blackness or brownness. Their bodies are preparing for a threat that will persist until the day racism ceases to exist.

Dr. Babbel says there are major health impacts when individuals face long-lasting, pervasive abuse like the name-calling and bullying that often dovetail everyday forms of racism, explaining that “we get stuck in a state of fight, flight or freeze. When we always have stress hormones, what does that do? It attacks the body. It hijacks the logical brain. The nervous system has to be addressed.”

Dr. Babble explains that when our nervous systems — the network of nerves that web throughout each of our bodies from our spines to our limbs to our brains and our skin, brown or otherwise — are worn down by chronic stress, we begin to think and feel differently. We experience symptoms like chronic pain, thyroid dysfunction and immune disorders. We can become depressed or hypervigilant.

“When people experience racism [or] when they are put down and humiliated [in general] … ,” she adds, “they disconnect from their bodies and themselves. There is a general disconnect.”

Christ-Shamma Matalbert, a 20-year-old student at the University of Arkansas at Pine Bluff, remembers being teased mercilessly after she emigrated to the U.S. from Haiti due to the devastating effects of the 2010 earthquake on her home country. Learning English and adjusting to her new surroundings while being bullied sent Christ-Shamma (who goes by Shamma) reeling into anxiety, depression and what she calls “a lack of hopefulness.”

“I didn’t like going into the cafeteria because of all of the eyes that would be staring like I was an object,” Shamma says. “I felt like I was the only one and the world was against me. Even now, I feel like this in different circumstances.”

As a seventh grader, Shamma’s reaction was to distance herself — to write, to try to ignore how her classmates were treating her, and to freeze, as trauma victims sometimes do. But this year, when Shamma heard President Trump’s remarks about Haiti, she decided to fight. She took to Twitter to write about her accomplishments and her pride in her country. Mixed among the comments of support below the post are insults like “lowlife” and “human garbage,” but Shamma appears to be unbothered. “All of the foreign students were standing up and representing, so I made it my issue to do the same.”

In her 2003 book, Soothe Your Nerves: The Black Woman’s Guide to Understanding and Overcoming Anxiety, Panic and Fear, psychologist Angela Neal-Barnett points out that black women respond to stress in a way that is distinct from others. After finding common ground with other women and nurturing those around us (which is common among women of all races), black women eventually stuff down our pain and commit ourselves to rising above bias. Such is the making of what Neal-Barnett refers to as the “Strong Black Woman”:

“Rather than being seen as less than she [what] is supposed to be, a Strong Black Woman refuses to admit she is stressed and keeps her feelings and emotions bottled up inside while she helps everyone else. This strategy makes the Strong Black Woman an excellent candidate for the development of anxiety.”

In fact, when Dr. Neal-Barnett studied women who identified themselves as “strong black women,” the results of heart rate monitoring showed they experience as much stress as anyone else. The difference was that most of these women described themselves as some version of calm, even when their heart rates were spiking.

“Several said to me, ‘Baby, I don’t have time to think about that mess. If I did, I’d be stressed out about everything,’” says Dr. Neal-Barnett. “Yet taking the time out to acknowledge the stress and do something about it would go a long way toward preventing the development of serious anxiety and the health problems associated with it — chronic upper respiratory infections, hypertension, heart disease and obesity.”

Shamma, the Arkansas student who froze and later fought when faced with discrimination, admits to feeling depressed and anxious when she was bullied as a child, and talks of later dismissing the pain to speak up for other immigrants in a way that affirmed her strength. After exposing her feelings, though, Matalbert neatly packed them back up.

I can’t blame her. I do the same thing. I’ve found the narrative of strength far easier to share than the narrative of ongoing pain. We all want a happy ending.

Last month, while standing around my aunt’s kitchen table, my father recalled a hernia operation he’d had when I was a little girl. My father is now a full-time artist and part-time teacher at the Art Students League of New York, but back then, he worked full-time as a backstage carpenter at Lincoln Center in New York City and only part-time on his art.

Working as a stagehand was a physically demanding job that put him at constant risk of injury, so when he was diagnosed with a hernia, it shouldn’t have been a surprise. I cannot deny, though, that I was shocked when he returned home from the hospital, stumbling into the lobby of our apartment building and retching into one of the trash cans.

During our conversation in my aunt’s kitchen, I found out that my father had been refused pain medication when he’d requested it that day. He’d laid there in his hospital bed in excruciating pain, begging for the painkillers he wouldn’t receive until he threatened the supervising doctor with a lawsuit.

How can a patient trust a doctor whose racism may be contributing to their own illness?

In 2016, The Washington Post published a story revealing that black people are less likely to be treated for their pain because of the implicit biases held by medical students and doctors about their physical makeup. More than half of medical students and residents who were surveyed believed that “blacks’ skin is thicker than whites.” Others believed that black people have less sensitive nerve endings. “Doctors Don’t Always Believe You When You’re a Black Woman,” an article published in Vice in February of this year, recounts black women’s experiences with doctors who failed to trust them.

If black people like my father or the women cited in Vice’s piece are not believed when they describe symptoms as straightforward as post-op pain or headaches, what hope do they have of being treated for more complicated problems caused by pervasive racism? How can a patient trust a doctor whose racism may be contributing to their own illness?

Kaari, the teacher in Brooklyn who was viciously bullied in Ohio, tries to treat herself. “I tell myself, ‘You’re beautiful. Your skin is beautiful,’ [but] even now, to this day, I’m still self-conscious. I get eczema associated with that shame. [It] is amplified by stress that I’m causing myself. The more I get it, the more I’m frustrated with myself.” She asks herself, “’Why can’t you just deal with it? Why can’t you just get over it?’”

While Dr. Babbel says that talk therapy is a solution for individuals’ chronic stress, healing battered nervous systems is equally important. She tells me about the vagus nerve, located in the face, which is calmed by activities like humming. “That’s why people in church sing,” she says, “to have courage and to calm themselves down.”

For a second, I feel relieved. It’s inspiring that we’ve been working to heal ourselves all along. But then, the thought is sobering. I don’t think I’ll ever hear those psalms in church the same way again, knowing now, for certain, that these are the voices of people literally crying out for healing.

Collages by Louisiana Mei Gelpi; Art Direction by Emily Zirimis.

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  • Suze

    Woah, what an interesting and heartbreaking topic!
    “How can a patient trust a doctor whose racism may be contributing to their own illness?”
    This is so horrible.

    Thank you Celeste and MR for educating me.

  • Rosemary

    Thank you so much for writing this. Your pain does not go unnoticed and this will help educate so many people. “I don’t think I’ll ever hear those psalms in church the same way again, knowing now, for certain, that these are the voices of people literally crying out for healing.” -Me neither. This is absolutely heartbreaking and awareness is so necessary.

  • UranianAquarian

    Thank you so much for writing this article! As more and more people begin to uncover how deeply entrenched racism, and specifically anti-blackness, is in this country and world we begin to reimagine not only how we heal from our various traumas, but how we can thrive mentally, physically, and so forth. It often feels like an impossible task( to eradicate white supremacy and racism), but I have hope that through narratives such as yours and others that we can continue to illuminate the continuous inhumanity that people of color have to contend with on a daily basis.

  • ValiantlyVarnished

    Thank you for writing this. This really rings true for me. I have battled depression and anxiety for most of my life. And at no other time were they as bad as they were in 2016 after the election. My mental and emotional health plummeted during that time and my already bad migraine headaches became worse. The narrative of the strong black woman is nice- but just like other narratives and stereotypes it doesn’t allow us to be full human beings with all of the complexities- and pain – that everyone else is allowed to feel and experience without judgment.

  • Archana

    Dear ManRepeller,

    Thank you for this article. Thank you for speaking up on the important issues.

    If I may make a request : Could you do an article on Fashion Revolution Week please ?

  • Barbara Robinson-Kenner

    As a black woman reading this article, I shout great, someone is addressing the crap that black people deal with on a daily basis, but on the other hand, I would love to see an article about sons of slave owners (white folks) and what is happening in their bodies and minds that relate to how they treat black people today.

  • Astounding piece. Thank you.

  • Emily M

    I can honestly say that I have never thought about this. And why would I have? I’m not personally affected. But what an interesting and sad thing to learn about. Another layer of perspective, thank you.

    • CM

      “I can honestly say that I have never thought about this. And why would I have? I’m not personally affected.” In these three short sentences, you’ve incidentally summed up the basis of sooo much ignorance and narrow-mindedness.

      • Emily M

        That was my point. I consider myself pretty knowledgable about a lot of systemic issues in this country and actively work to challenge my biases, help others challenge theirs, and grow in my knowledge of what affects others and how I can help, but I’m acknowledging that there are still blind spots and am grateful that the author helped me identify one of mine.

  • Yoly

    Celeste, thank you so much for this amazing article. Education is power and the information era will help the world heal. Your contribution makes me have hope for the future. :))

  • Bee

    Man, this article breaks my heart.

  • Caroline Christianson

    I’m in medical school now, and can comment that this example and concept is so important when discussing the epidemiology of disease. “High blood pressure is more common in the African American US population” <— this is a fact, but one largely due to socioeconomic and access to care inequalities (this doesn’t even touch the effects of past mistreatment of the patient, his/her/their family or community by medical professionals). Ethnic minorities are also silent sufferers of chronic fatigue syndrome, constantly on guard against stereotype threat. (As this article depicts. I highly recommend the book Whistling Vivaldi on this topic!!) Thus, more black Americans have high BP when compared to white Americans. IT IS SO IMPORTANT TO KNOW WHY THAT IS. Diagnosing and treating patients based on race validates that the human body is different between races when in fact, genomic studies including the Human Genome Project (the motherload) show that there are more genetic variations within races than between them. (There is no greater failing in this realm than in the treatment of blood pressure.) Race is a social construct that works in service of racism in its creation of tangible differences between black and white Americans. The nuanced differences between correlative and causative facts in medicine is yet another (and perhaps the most urgent) example of education as a tool for civil and social rights of marginalized Americans.

    • Kristin

      The amount of racism in medicine is insane—even aside from personal biases, even testing can be biased—testing for kidney function calculates GFR for African Americans differently than all other races based on the assumption that black people have more muscle mass; this can lead to the underestimation of the extent of kidney damage.

      • Caroline Christianson

        You are right. Hopefully the patriarchy of medicine falls with the rest of it as we challenge these false reasonings

    • jinap

      Thanks for this comment. I know my reply is late, but to further support this, research shows that this difference in blood pressure disappears for black people in Africa, where they are not a minority and are much less likely to deal with the daily effects of racism. (Not to say that there isn’t any racism at all.)

  • ginnfred

    Thank you for this article!

  • torioes

    This was such a great piece. Thank you.

  • Daniela Fernandes

    People can be so fucking idiot. This article really hurts! And instead of having an amazing Barack Obama, now the US has a president who is, among many other terrible things, a fucking racist who gives no good example for society to follow. I live in Portugal and have always had many black friends. I just hope none of them feels this way. In years, this – and being gay, etc – won’t be an issue anymore. I am so sorry for all of you who suffered and/or suffer because of these kind of non-human ignorant people. Many of them criticise the nazis and hitler but, guess what?? They are just the same!

  • Permanent Bishface

    I’d been ignoring articles about this for awhile there because I knew they’d hurt. Thank you so much for writing about this extremely important topic in such a compelling way.

  • Katja N

    Thank you for this article.

  • Allegra

    Great article – thank you for writing about this eloquently and bringing attention and care to this topic.