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Joe R. Feagin, Kevin E. Early
and Karyn D.
McKinney
excerpted from: Joe R. Feagin, Kevin E. Early and
Karyn D. McKinney, The Many Costs of Discrimination: the Case of
Middle-class African Americans , 34 Indiana Law Review 1313-1360,
1346-1354 (2001)(186 Footnotes)
As seen by all our respondents, blocked opportunities and
discrimination not only generate psychological pain and suffering, but
also link to many different bodily conditions such as chest pains,
stomach problems, headaches, and insomnia. Other research supports this
observation. The economic status of African Americans has stagnated and
even declined in regard to some indicators in recent years, and this
decline in economic well-being is associated with worsening health
status for African Americans. Some research has shown that the
realization that negative treatment in the workplace is based on one's
race or ethnicity causes more extreme stress than usual workplace
problems that are not based on racial discrimination. Other research has
found that not only are physical health problems associated with
workplace discrimination but other health problems are also experienced
by persons of under-represented groups.
The overall life expectancy of African Americans is lower than that
of whites, and this gap increased between 1980 and 1991. African
American infant mortality is twice the rate of that of whites. For
African Americans under seventy years of age, fifty percent of excess
deaths of males and sixty-three percent of female excess deaths can be
accounted for by cardiovascular disease, cancers, and problems resulting
in infant mortality. Despite popular conceptions, only nineteen percent
of excess male deaths and six percent of female excess deaths can be
accounted for by homicide. Additionally, excess deaths related to
genetic problems make up a tiny percentage. For example, excess deaths
from sickle cell anemia make up only three-tenths of one percent of all
African American excess deaths. African Americans are disproportionately
represented among people with coronary heart disease, myocardial
infraction, strokes, and renal disease, and are more likely to have risk
factors such as hypertension, high cholesterol, smoking, and diabetes.
African Americans, regardless of socio-economic status, also have the
highest age-adjusted rates of cancer incidence and mortality of any
racial group in the United States. Not only do African Americans have
higher rates of several illnesses, they also have poorer outcomes and
survival rates for most illnesses, evidence that the health care they
receive may not be adequate. For example, the cancer survival rate for
African Americans is twelve percent lower than that of whites. In
addition to the discrimination that increases the health problems of
African Americans, racism in the health care system may cause African
Americans to receive less adequate care than do whites.
African Americans tend to report more health complaints than do
persons of other racial or ethnic groups. In a national study of two
thousand African Americans, when asked if they have had any health
complaints in the last month, only thirty-five percent of African
Americans said that they had no health problems at all. The most common
health complaints reported were high blood pressure (31.6%), arthritis
(24%), and "nervous conditions" (21.9%). Twenty percent of the
African Americans studied had never gone to see a doctor in an
independent office setting, and twenty-one percent were uninsured.
However, as in the case of psychological complaints, most (sixty-eight
percent) of the respondents said that they have three or more people
from whom they can seek informal health care.
As in the case of psychological health disparities, racial
disparities in physical health can also not be totally accounted for by
racial differences in socioeconomic status. In fact, some studies have
found higher mortality rates for African Americans with higher
socioeconomic status than whites with the same status. Neither can
racial disparities in health be accounted for by oft-repeated notions of
"genetics." In her research, Dr. Camara Jones, a Harvard
epidemiologist, has found that African Americans have the most genetic
diversity of any racially defined group. Nor do African Americans as a
group have weaker immune systems than whites. In fact, African American
transplant patients run the highest risk of complications because their
immune systems are so strong that their bodies are more likely to reject
donated organs. Moreover, excess hypertension cannot be attributed to
genetics. Black blood pressure levels are similar to whites until
adulthood, at which time they increase faster with age than those of
whites. This suggests strongly that the racial differential is not a
matter of genetics or lifestyle; it suggests that being a victim of
racism has a detrimental effect on blood pressure. In a study of African
American and white nurses, Jones found that the majority of African
American nurses think about race at least daily, and many of them are
constantly aware of their racial classification. This constant awareness
contributes to undue stress.
Others have highlighted the need to take into account not only
African Americans' personal context, but also the larger historical
context when looking at racial disparities in health. For example, the
civil rights movement seems to have had a positive effect on African
American health. Other research has found that African American physical
and mental well-being is highest when the discrimination reported by
African Americans is lowest. Research suggests that racism can affect
African American health in three major ways. First, racism can transform
socioeconomic status such that its effects are not equal across race.
For example, African Americans cannot expect the same returns on their
educational investments, in terms of wages, as those of whites. Second,
racism may restrict access of African Americans to health services and
to recreational facilities that could benefit their health. Finally,
racism causes psychological distress that may create severe health
problems for African Americans.
Our respondents noted the impact of racism on their health. One focus
group participant, a dental assistant, made the connection between the
discrimination and physical ailments eloquently:
I don't think a lot of [people] realize that, when you're talking
about ailments, you're talking about more colds, higher blood
pressure, things like that. People don't relate that to your job. Like
when you come down with more colds, a lot of times, it's [racial]
stress on your job . . . . [I was] in another job, and it seemed like
the more stress I was under, it would make me feel worse. I would be
sick, I would have more colds, I would want to sleep more, and
basically it was related to my job, the pressure on my job. But I
didn't put it that way, you know, a lot of times I would think if I
was under stress, I wouldn't relate it to a cold.
Similarly, a nurse in a southeastern state noted that the bottling up
of stress from discrimination leads to a variety of health problems, as
well as to excessive smoking and drinking:
But you stuff that stuff inside, and it comes out in these kinds of
ways. And we can sit down and talk to each other, and that pain . . .
they said that it can cause fibroids in women, that's why black women
have a lot of fibroids. Because all of that pain gets stuffed inside.
. . . That's why black men . . . die so early. You know, if you take
out the factors of drinking, and smoking, and why is it that black men
die from heart disease or from-it's that stuffing inside of those
subtle things that we, that we just, that we can't say anything . . .
.
From this perspective, it seems discrimination has many consequences,
ranging from fibroids to heart disease. To ease their pain stemming from
racial harassment, some African Americans smoke and use alcohol
excessively. Benjamin suggests that racial barriers are likely to be
associated with stress patterns, alcohol abuse and other health
problems. Gibbs similarly contends that anger created in black men by
racial discrimination is likely to manifest itself in chronic fatigue,
depression, anxiety, and psychosomatic complaints such as headaches.
A. Headaches
A number of male and female respondents spoke of severe headaches
that they attributed to workplace stress, such as a nurse in the
Midwest: "I would have this headache and it would be for eight
hours until I walked out the door and then it was like . . . a weight
was lifted off." A social services coordinator described headaches
and other consequences in a discussion of discriminatory work
conditions:
I was having severe headaches and chest pains. . . . It would be
times when I would almost be in the office hyperventilating. And . . .
it was just a lot of physical things happening to me. I would pull
hair more, because, just the stress, you know? You just, you're trying
to do so much, and collect your thoughts and do what needs to be done.
And my hair had fallen out in the back of, the back of my hair, it
just had fallen out! . . . And the headaches were just, just terrible,
just unbearable. And it's also a psychological kind of ill, in that,
well you know if [white] people are constantly watching you. . . . But
it, it's just amazing the psychological ill that it does to you. And
even though you know you're competent? People can do that so much to
you . . . they can get in meetings and try to show you up and make you
look like you just don't know anything. And it is so many of them, you
are outnumbered! Sometimes, you come out, and lash out, and you almost
validate what they're trying to say about you, because you feel
outnumbered! . . . So, you, you begin to doubt yourself, you begin to
psychologically feel somewhat incompetent. . . . So, it, it can take a
toll on you, and I think it takes more of a psychological toll on us
than we even care to admit.
Headaches are only one part of an often complex set of consequences
that come from coping with hostile or unsupportive whites in a workplace
with fewAfrican Americans. Chest pains, hyperventilating, and serious
psychological doubts also accompany headaches that stem from whites
questioning African Americans' competence and abilities.
B. High Blood Pressure
Recent research reports have indicated that high blood pressure is a
serious problem among black Americans. A few studies have shown that
stressful life events, such as racial inequalities, are linked to high
blood pressure. For African Americans, socioeconomic status has been
shown to be associated with blood pressure and hypertension; as
socioeconomic status decreases, blood pressure increases. A recent
research study of 1784 African Americans found that this relationship
may be in part due to poorer nutrition of those with lower socioeconomic
status. Yet, racism also has an effect. Research by Krieger and Sidney
examined stress and blood pressure in over 2000 African Americans. Those
who gave accounts of facing discrimination on three or more of seven
situational questions tended to have higher blood pressure than those
who reported facing discrimination on one or two questions. In a
previous study, Krieger found that black Americans who usually keep
quiet about or accept unfair treatment are more likely to report
hypertension problems than those who talk to others and take action
against unfair treatment. Another study, which controlled for age and
weight, found that higher levels of discrimination were positively
related to higher blood pressure for African Americans. Still other
studies have found that for hypertension, as well as for certain forms
of cancer, socioeconomic status alone did not account for differences in
illness rates between whites and African Americans.
Recent research has associated a cultural pattern known as "John
Henryism" with higher blood pressure. "John Henryism"
refers to the attempts made by African Americans to control their
environment through hard work. These attempts amount to long-term,
intensive contending with the psychosocial stressors associated with
dealing with racism. Sherman James and his colleagues have found that
African Americans with higher "John Henryism" are more likely
to have high blood pressure. Several focus group participants gave
details on how hypertension is linked to racial stress, including that
encountered at work. One nurse in the Midwest commented on her reactions
as she enters the driveway of the place where she is employed:
That's when I got high blood pressure. And my doctor . . . I told
him what my reaction, my body's reaction would be when I would go to
this place of employment . . . . which was a nursing home. When I
turned into the driveway I got a major headache. I had this headache
eight hours until I walked out that door leaving there. . . . I went
to the doctor because the headaches had been so continuously. And he
said, "[Her name], you need to find a job because you do not like
where you work." And within myself I knew that was true. But also
within myself I knew I had to have a job because I had children to
take care of. But going through what I was going through wasn't really
worth it because I was breaking my own self down. . . . It was
constant intimidation. Constant racism, but in a subtle way. You know,
but enough whereas you were never comfortable. . . . And then I
finally ended up on high blood pressure pills because for the longest,
I tried to keep low. I tried not to make waves. It didn't work. I hurt
me.
Again the workplace is filled with the headaches and other pains of
"constant racism."
In one focus group, a secretary working in the South believed that
being repeatedly passed over for promotions caused her hypertension:
And to me, it hurt me deeply. . . . So I had, you know, I had stood
in prayer lines for prayer, to help me ease my mind and everything. To
help me say the right thing, or go to the right, appropriate
department, to get, you know, get it started. And it was just hard,
because I was real hurt, and sometimes I would just down and cry about
it. . . . So, well, to make the story short, I had applied for a
promotion, and I had applied for this promotion twice. . . . I was
tired, I was getting stressed out, and everything, and plus this-so I
was in a lot of pain, so I think I built up my blood pressure, really.
Later, this woman required a doctor's care for her high blood
pressure:
I had to see several doctors, because of the discrimination, and I
went through a lot of stress. And then, my blood pressure, I had never
had high blood pressure, and all of the sudden, it just went on the
rise, and I couldn't control it. And . . . [her supervisor] wanted me
to perform the duties, you know, totally by myself, which it took like
three, two or three people to do.
This account underscores the levels of pain and the loss of energy
involved in contending with mistreatment seen as racially motivated.
Using religion for solace, as well as speaking out, are strategies for
the daily struggle. Although this woman noted in the interview that she
finally received the help needed at work, the damage to her health had
already been done.
As we have noted previously, in the focus groups, the suffering of
other African Americans was sometimes cited as a cause of personal
stress for the commentator. In one focus group an engineer explained how
he empathized with a fellow employee who developed hypertension:
I have a prime example of this, this has actually happened in our
job. A particular [black] person in our, in the branch. . . . was
being discriminated against. The supervisor knew of it, and-what was
happening, all our branch chiefs, they knew of it. And knew that the
[white] supervisor was discriminating against this young lady. And,
matter of fact, it drove this young lady to where now she's on high
blood pressure medicine, and it really affected her. She wasn't
getting promoted and all that. And the branch chief knew what was
going on. . . . But the thing is, is that this person went through all
that, and now the person is on high blood [pressure medicine]-it
affected her mentally and physically.
Being hired is only the first hurdle for black employees. For
recurring promotion problems are also reported by African American
employees in a variety of businesses. Not surprisingly, they create
great stress. In late 1996, some unexpected evidence of this problem
surfaced on an audiotape made of top Texaco executives discussing a
lawsuit brought by black employees, some of whom asserted they had been
passed over for promotions because they were black. In the taped meeting
the white executives did not take the reports of the black employees
about the pain and frustrations of a "hostile racial
environment" seriously.
C. Stomach Problems and Emotional Distress
According to several of the focus group participants, stress in the
workplace creates or contributes significantly to stomach and other
intestinal problems. A telephone technician explained the intertwined
nature of psychological and physical problems resulting from overt
racial animosity:
Well, psychologically, the psychological part and the physical part
kind of go hand and hand. . . . And I have never been a sickly type
person, and I had never had any problems with my stomach, but I
actually did have to go to the doctor, and the doctor said I was
having-they ran a test and he diagnosed it as gastrointestinal
problems. And . . . depending on the amount of stress work would be
in, I would actually have serious attacks, where I would really get,
really feverish, high fever, and I would just get real, real sick. And
they prescribed Tagamet . . . for me to take, but after taking that a
couple of times, it made me really sick, and so, when I would have
these gastrointestinal, these attacks, I would just kind of really
have to go through it. And a lot of times my job would just be so
stressful, because I work for people that . . . they were overt . . .
not covert . . . they'd just flat out let you know that they just
didn't like black folks . . . . I worked with those kind of people.
And even though I kind of enjoyed my work, I didn't enjoy those
people, because they could make the situation really hard for me. . .
. And they would actually try to find . . . something wrong with [your
work] . . . and that would just bug me, because, you know, I know that
I meticulously try to do it, but even in that they could come right
behind me and try to pinpoint little, little small things, and find
something wrong with it.
Then she added how she copes in advance: "It was very, very
stressful, because every day you're constantly mentally trying to
prepare yourself when you get out of the car in the morning and you go
in, go into work, you're trying to prepare yourself, 'Well what do I
have to face today?"' One factor in the personal cost of
discrimination is that which comes from having to be constantly
prepared. One strategy used by African Americans to counter mistreatment
from whites is to put on a defensive "shield," the term used
in a conversation with a retired teacher recorded by Feagin and Sikes.
In that account an older black woman contrasted her life with that of a
white woman, who, like her, bathes and dresses before leaving the house.
Unlike the white woman, however, she must put on her "shield"
just before she leaves. She noted that for six decades, she has had to
prepare herself in advance for the often unpredictable racist actions in
the white worlds she often traverses.
Another woman, a supervisor in the Southeast, reported stomach
problems that she believed stemmed from actions of a fellow white
employee:
But I was just so frustrated because she was . . . prejudiced, and
she let it be known. And even though I confronted her on it, and any
time she would say something to me, and I would tell her, I said
"Look, if you can't deal with me on a professional level, then
don't deal with me at all." And she was the type that, she would
just do little things. And that just would annoy me . . . and I never
knew it then, and then I was reading a book one day, and it said don't
let things bother you, because, you know, physical breakdown. . . . I
can't really say it's an ulcer, but I had stomach problems. I'm gonna
tell you what, what I did come to find out about her, though, was that
sometimes when people are like that . . . she was raised in [names a
southern state], this is backwoods. So she was brought up that black
people-you know to treat us like that. And I told her, I said,
"Well, you can't treat-everybody's not the same, what if I treat
all white people bad? You know, call you all kind of names and
everything like that? That's not fair!" I said, "Because I
could miss out on a good friend, or a good person." And it took
some convincing, but what I did, I didn't step to her level. Because
she would [say] little things-I would never get upset with her, but I
always remained myself, because I didn't want her to think that she
was getting next to me, because once they figure that out, then they
really start to pour it on. . . . . But see, sometimes people do you
like that, it was a girl at work . . . she called me and another girl
. . . a "nigger" one day. And the other girl got mad, was
very, was ready to fight.
Physical ailments are only one aspect of such complex situations.
Again one sees the energy lost in making and implementing one's decision
about interpersonal confrontations over racial matters. This black woman
shows much understanding and even forgiveness for a white employee. In a
later account, not quoted here, she relates how the woman became sick
and how the respondent was the one who accompanied the woman to the
hospital and stayed with her. In the end, the white woman eventually
told the respondent that "all black people aren't bad." This
black woman was able to treat the prejudiced white woman with compassion
despite how the white woman had treated her. |
