And One Day, They Will Come For You

My Dear Readers,

Fear can be powerful and overwhelming.  Many of us grapple with it every day.  The foolish will try to convince themselves that they fear no one, but most of us struggle to overcome our fear.

The wise, however, will realize and accept that fear is simply an emotion that we actually want in our lives.  Fear, in and of itself, is here and it’s here to stay.  The individual must stand at the crossroads and choose whether to live their life IN fear, or WITH fear.

Below is such a story…

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“They are coming for me.”

“What do you mean?”  I ask. “They are coming for you?”

“It’s just a matter of time,” he says. “They’re coming for me.  And one day, they will come for you, too.”

These are the words coming from one of my patients. He’s not delusional. He’s not seeing others in the room—he’s not having hallucinations. He’s not hearing voices either. Paranoia is a possibility, but I need to find out more about him.

Let’s call him Daniel.  He is African-American and 64 years old. He recently retired as a family support worker in one of the local school districts in the Puget Sound area of Washington State.

He is a veteran of the US Marines, having been honorably discharged after serving two tours in the Vietnam War. He has been married for 27 years, has four adult children, and three grandchildren.  He owns his home, and his mortgage is just about paid in full.  This is a man who has never been in trouble with the law.

Then out of the blue, I received a call from his wife saying that he had locked himself in the home, refusing to come outside, and had been wearing the same clothes for a week.

In my session with Daniel, the one sentence he keeps repeating is “they’re coming for me, they’re coming for me.”  Understanding that sharing internal secrets with a stranger is extremely difficult for many African-Americans of his generation, my goal was to provide Daniel with an avenue to speak, and to release himself from this dark place. I was happy that he agreed to sit down with me once again and process the anguish he was going through.

In the war, Daniel was a member of a group of Marines who had been overrun by a larger North Vietnamese unit.  Out of supplies and ammunition, they fought to the last man.  Daniel was one of the few to survive.  Daniel had spent many years dealing with traumatic memories and was now just beginning to normalize his life.

So, what happened?  Was it memories of the Vietnam War?  Had Daniel relapsed into old emotional wounds of his post-traumatic stress? Perhaps.  His relapse didn’t appear to be specifically related to the war in Vietnam; it seemed to result more from the war he’d been fighting here at home since being discharged from the military.

Daniel had kept it together for many years following the war.  He had been successful in his work, marriage and family, and he’d never been in trouble with the law.

Although Daniel felt safe in his self-imposed exile at home, he could not release his demons.  He could not talk to his wife or pastor.  He wanted to, but couldn’t free his psychological self from pain and suffering.

I initially considered a diagnosis of paranoia, but as we spoke, I realized that Daniel didn’t meet any of the indicators.  I was able to understand that essentially, Daniel had been traumatized during his experiences in the war, and due to a recent direct observation of an impactful event, his trauma had been triggered.

In the sub-field of traumatology, there are eight specific types of trauma that a person can be exposed to at any given time.  It is possible that an individual as in the situation of Daniel can be simultaneously exposed to a variety of different traumas.

The types of traumas, which Daniel was responding to, are race-related stress, racial profiling, historical trauma/inter-generational transmission and the invisibility syndrome.  The cause of his exposure was vicarious trauma via repeated viewing of scenes that are the basis of the distress.

In more detail:

  • Race-Related Stress– a single race-related adverse event such as being threatened with death or injury because of one’s racial appearance.
  • Racial Profiling– suspicious behavior being attributed to an individual due to membership in a specific racial group.
  • Historical Trauma/ Inter-generational Transmission-cumulative massive traumas associated with historical events that affect a given culture, group, country, religion or ethnicity, and are passed down from generation to generation.
  • Invisibility Syndrome-the internal struggle with the feelings that one’s talents, abilities, personality, and worth are not valued or recognized because of prejudice and racism.

In January 2015, while walking in downtown Seattle, Daniel observed and nodded to another African-American of similar age who had been walking using a golf club in the method of a cane to support his walking stride.

Daniel witnessed this person being stopped by a police cruiser, wrestling with a white female police officer over his golf club.  He watched in horror as the police officer violently threw the elderly man on top of the police cruiser, handcuffed him, and tossed him aggressively into the cruiser.

Daniel was terrified. He quickly turned away and went home, later seeing repeated media coverage of the incident.

So, to be clear, what happened to Daniel was the triggering of his vicarious trauma by repeated viewing of the initial incident that resulted in the feelings of panic.  This alarmed Daniel’s wife Betty, and she took him to the emergency room at the local hospital.

The emergency room physician told her that Daniel was showing symptoms of psychosis, paranoia and delusions and that he should be hospitalized immediately.  The basis of his diagnosis was Daniel’s suspicion and distrust that the physician considered baseless. However, since Daniel was not a danger to himself or others and did not require hospitalization, the physician indicated that this was not a bad paranoia, and instead was a good, acceptable type of paranoia.

Poor Betty was so confused.  Her spouse is paranoid and delusional, which is bad, but it was a good type of paranoia? If paranoia in general is an indication of mental instability, how can it possibly be good?

So the physician providing the psych consult explains that in some cases, healthy cultural paranoia is a “defense mechanism” for African-Americans and other races and cultures who have had to respond to the repercussions of racism, oppression and discriminatory treatment.

After hearing all of this, Betty contacted me.

I believe that Daniel is healthy.  He has a good understanding of his culture.  He isn’t just “paranoid” in the classic clinical sense.  Following a full psycho-social work up and history, it is clear that Daniel’s “radar” or “vigilance” had been triggered by the incident he witnessed and the repetitive viewing through the media had forced his vigilance into overdrive, thus becoming “hyper-vigilant.

In our therapeutic process, Daniel was able share with me his story of growing up in Alabama during the Civil Rights Movement, witnessing repeated acts of police brutality, which triggered race-related stress, and the fact that he recently saw the film Selma, which returned him to those memories he sought to escape in coming to Seattle, which was responsible for historical trauma and inter-generational transmission.

Regarding Daniel’s experience in witnessing the arrest in downtown Seattle, he noted in his discussion with me that the elderly black man arrested had done nothing wrong, and that the police officer did not have a cause to stop, detain and arrest him—that she simply racially profiled him. Consequently, Daniel, felt that for the grace of God, that could have been him, and that brought him feelings of helplessness, powerlessness, and made him feel less of a man, which is the invisibility syndrome.

In session, Daniel shared that he had been living his life with the hope that if he simply followed the rules, kept low, minded his business, and paid his taxes that “they,” meaning the police, would leave him alone. After this incident, knowing that the elderly black man was no different from him, he lost that sense of security.

Daniel cried hard and long that day.  It was a good thing, because now the healing could begin.  Using the Advocacy, Balance and Empowerment (ABC) Model, our work then centered on helping Daniel to gain personal empowerment. Utilizing this model, Daniel was able to learn to advocate for the psychological self, attain balance within and display calmness with the external world.  Daniel is doing well today.

Concluding Words

“Healthy Cultural Paranoia” is a clinical descriptor that seeks to justify vigilance utilized as a defense against being psychologically overwhelmed by racism, oppression and discriminatory treatment.

As healthcare professionals, we must be cautious about using terms like healthy cultural paranoia where its basis, paranoia, is the foundation of the mental illness.  We must police ourselves against the possible confusion and damaging impact upon others should they start to see normal and natural responses to traumatic events as being “paranoid.”

When it comes to physician diagnosis, there is always the possibility of overuse or hyper-extension.  When this occurs, it is up to the individual to seek secondary assistance to return to a normal level of functioning.   This can be achieved by checking in with someone sharing the same background or experience or in extreme situations such as Daniel’s working with a trained mental health professional to obtain access to the root of the issue.

Daniel’s regression was reinforced in that after this experience, he now lived his life in fear of that one day “they would come for him.” Prior to this, he thought that since he was now elderly and retired, he was no longer at risk.  In observing the harsh treatment of a black man who is similar to him, he realized how wrong he was.  Now, Daniel is empowered.  He has advocacy, balance and calmness and can now live with fear instead of living in fear.

Until the next crossroad…the journey continues.

Dr. Kane

 

 

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