What is intergenerational trauma?
In its most basic form, intergenerational trauma refers to the transmission of trauma across generations. It is considered to occur through two main mechanisms: maladaptive coping mechanisms that have impacted parenting behaviours, or through harmful belief systems perpetrated by parents, families, or cultures.1,2,3 While the term intergenerational trauma focuses on how trauma is transmitted, the source of the trauma can arise from a variety of different experiences, such as historical trauma, referring to trauma stemming from colonialism, or cultural/racial trauma, referring to traumatic lived experiences of specific ethnic or racial groups.1,3,4 Each form of trauma may or may not co-exist, but both have the potential to be exacerbated by systemic factors such as public policies, which may limit the ability of those impacted by the trauma from being able to deal with it effectively.3,5
For Black women, intergenerational trauma is especially intense due to its convergence of “racialized, gendered, and classed dis-privilege”.6 One large source of intergenerational trauma for Black women may stem from a combination of their current systematic disenfranchisement in society, which subjects them to experiences of gendered racial micro- and macro aggressions and racial battle fatigue, whether they occur within the healthcare system or outside of it.7,8,9,10 The intersection between race and gender for Black women also contributes to their increased susceptibility to further traumatic experiences related to childhood sexual abuse, dating violence, intimate partner violence, sexual assault, and sexual harassment.8,9,10 For some Canadian Black women, these everyday experiences of racial trauma may be coupled with historical trauma related to Canada’s past colonial history with their involvement in the exploitation of African slaves if descendents from slavery11, or histories related to experiences as refugees.
While the particular combination of trauma in Black women varies due to the diverse experiences and profiles of Black women themselves, the resulting impact of these experiences have the potential to lead to a number of psychological and neurophysiological outcomes that may be transmitted across generations. For instance, these experiences may lead Black women to feel a sense of isolation and alienation, which may account for higher rates of depression, posttraumatic stress disorder (PTSD), substance abuse, suicidal ideation, and physical health issues in this population.9,10 And as discussed earlier, the transmission of these forms of trauma may take many forms, ranging from cultural beliefs/ideas to maladaptive coping behaviours, sometimes involving post-traumatic stress symptoms of hyperarousal and avoidance.1,11,12,13,14
In addition to psychosocial outcomes, historical, cultural and social disparities experienced by Black women can leave an intergenerational neurophysiological mark. The biological responses to trauma caused by chronic stress are found to be transmitted and persist intergenerationally through adverse epigenetic states.15,16 For example, studies assessing young African American women who experienced violence found that an elevated level of IgE (an antibody associated with allergy and asthma) in mothers was transmitted perinatally to their children.17,18 Thus, experiences of trauma may result in the transmission of poor physical health, in addition to the psychosocial.
Adopting a Trauma-Informed Care Approach
As engaging in culturally competent therapy is an important responsibility for medical professionals when working with Black patients, medical professionals must further understand the role intergenerational trauma may play on the physiological and psychosocial health of Black women in Canada. Thus, incorporating skills related to Trauma-informed care (TIC) when working with this population may be a worthwhile avenue to explore. TIC is a care provider strategy that seeks to not only understand the impact of traumatic events on an individual’s life, but also modify different parts of the service to better serve these individuals.19 This is done by adopting a care approach that centers principles related to empowerment, choice, collaboration, trustworthiness, safety, and a person-centered care approach, all with the goal of reducing long-lasting burdens of trauma.19 TIC primarily comprises two major domains within healthcare: universal trauma precautions and trauma-specific care.7 Universal trauma precautions involve small changes that can be implemented for all patients, regardless of past trauma history. Such techniques are helpful for building trust and rapport with trauma survivors and involve strong patient-centered communication and care and an understanding of the health effects of trauma. Trauma-specific care techniques are employed when healthcare providers are aware of an individual’s trauma. These strategies require healthcare providers to collaborate across disciplines and be cognizant of their own trauma history and stress level. Additionally, a holistic model that accounts for social and cultural factors is needed to improve interactions of trauma survivors in healthcare settings.19
While Black women in Canada throughout this discussion have been discussed as a single population, it is important to note that this is a culturally heterogeneous group within which exists a multitude of experiences. This leads to a diversity in the levels and experiences of trauma across the population and journeys when it comes to dealing with such trauma. Thus, the adoption of a universal trauma precaution may be best suited when working with this population. Adopting such an approach may be beneficial in targeting the prevalent perception of the healthcare system as a “white, racist institution”20, stemming from personal experiences, family memories, or learning about the history of racism within healthcare. This perception of the healthcare system might lead Black women to avoid seeking care for medical issues due to mistrust, thus preventing a more targeted trauma-focused approach. Thus, providers should also work with the community to rebuild trust and rapport, in order to allow for a more culturally specific TIC approach to further support the health of Black women with experiences of intergenerational trauma.
Authors | Whitney Ereyi-Osas, Mia Song, Ayesha Kalim, Dilini Kekulawala (Culturally Competent Resources Portfolio)
- Stamm, B. H., Stamm, H. E., Hudnall, A. C., & Higson-Smith, C. (2004). Considering a theory of cultural trauma and loss. Journal of Loss and Trauma, 9(1), 89-111.
- Coyle, S. (2014). Intergenerational trauma: Legacies of loss. Social Work Today, 14(3), 18.
- Alexander, A. E. (2018). Examining the Legacy of Transgenerational Trauma and its Effects on Contemporary African American Adults in Parenting and Caregiver Roles to African American Adolescents (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/1487
- Carter, R. T. (2007). Racism and psychological and emotional injury: Recognizing and assessing race-based traumatic stress. The Counseling Psychologist, 35(1), 13-105.
- Menzies, P. (2010). Intergenerational trauma from a mental health perspective. Native Social Work Journal, 7, 63-85.
- Jacobs, S. & Davis, C. (2017). Challenging the Myths of Black Women—A Short-Term, Structured, Art Experience Group: Exploring the Intersections of Race, Gender, and Intergenerational Trauma, Smith College Studies in Social Work, 87:2-3, 200-219, DOI: 10.1080/00377317.2017.1324091
- Raja, S., Hasnain, M., Hoersch, M., Gove-Yin, S., & Rajagopalan, C. (2015). Trauma informed care in medicine: current knowledge and future research directions. Family & community health, 38(3), 216–226. https://doi.org/10.1097/FCH.0000000000000071
- Brown, D. L., White-Johnson, R. L., & Griffin-Fennel, F. D. (2013). Breaking the chains: Examining the endorsement of modern Jezebel images and racial-ethnic esteem among African American women. Culture, Health, & Sexuality, 15(5), 525–539. doi:10.1080/13691058.2013.772240
- Bryant-Davis, T., Ullman, S., Tsong, Y., Tillman, S., & Smith, K. (2010). Struggling to survive: Sexual assault, poverty, and mental health outcomes of African American women. American Journal of Orthopsychiatry, 80(1), 61–70. doi:10.1111/j.1939-0025.2010.01007.x
- West, C. (2002). Battered, black, and blue. Women & Therapy, 25(3–4), 5–27. doi:10.1300/J015v25n0302
- Cuffy, P.L. (2019) Multigenerational Trauma and the Canadian Black Woman:A Subjective Inquiry into the Enduring Black Slave Experience [Master’s thesis, York University. Interdisciplinary Studies
- Elliott, D. E., Bjelajac P., Fallot R. D., Markoff L. S., & Reed B. G. (2005). Trauma-informed or trauma-denied: Principles and implementation of trauma-informed services for women. Journal of Community Psychology, 33(4), 461-477. https://doi.org/10.1002/jcop.20063
- Goosby, B. J., & Heidbrink, C. (2013). Transgenerational Consequences of Racial Discrimination for African American Health. Sociology compass, 7(8), 630–643. https://doi.org/10.1111/soc4.12054
- Leary, DeGruy, Joy (2005). Post Traumatic Slave Syndrome: America’s Legacy of EnduringInjury and Healing, Uptone Press.
- Mann DL, Hamlin-Green G, Willoughby A, Landesman SH, Goedert JJ (1994) Immunoglobulin class and subclass antibodies to HIV proteins in maternal serum: association with perinatal transmission. J Acquir Immune Defic Syndr 7: 617-622.
- Musazzi L, Marrocco J (2016) Stress Response and Perinatal Reprogramming: Unraveling (Mal)adaptive Strategies. Neural Plast Article ID 6752193.
- Hicks WB, Nageotte CG, Wegienka G, Haystad S, Johnson CC et al. (2011) The association of maternal prenatal IgE and eczema in offspring is restricted to nonatopic mothers. Pediatr Allergy Immunol 2011 Nov; 22: 684-687.
- Vergara C, Murray T, Rafaels N, Lewis R, Campbell M et al. (2013) African Ancestry is a Risk Factor for Asthma and High Total IgE Levels in African Admixed Populations. Genet Epidemiol. 37: 393-401.
- Ranjbar, N., Erb, M., Mohammad, O., & Moreno, F. A. (2020). Trauma-Informed Care and Cultural Humility in the Mental Health Care of People From Minoritized Communities. Focus (American Psychiatric Publishing), 18(1), 8–15. https://doi.org/10.1176/appi.focus.20190027
- Nicolaidis, C., Timmons, V., Thomas, M. J., Waters, A. S., Wahab, S., Mejia, A., & Mitchell, S. R. (2010). “You don’t go tell White people nothing”: African American women’s perspectives on the influence of violence and race on depression and depression care. American journal of public health, 100(8), 1470–1476. https://doi.org/10.2105/AJPH.2009.161950