African Americans who endure life-altering instances of racism and discrimination are more likely to develop high blood pressure than those who have not been traumatized. High blood pressure, also known as hypertension, is one of the major health outcomes that affect African Americans in the United States. There is a higher prevalence of hypertension in Blacks living in the United States rather than Africa, due to environmental and behavioral characteristics of Black Americans in the United States.

Black Americans develop high blood pressure at younger ages than any other age group in the United States. African Americans have a much higher rate of hypertension by the age of 50 than any other racial group. Black Americans are more likely to develop complications associated with high blood pressure, including stroke, kidney disease, blindness, dementia, and heart disease.

Researchers have not discovered exactly why hypertension is so common in Black individuals and communities, however, there is a belief that hypertension may be triggered by the following:

Genetic factors, such as Black Americans responding differently to high blood pressure medication than other racial/ethnic groups. Black Americans seem to be more sensitive to salt, which increases the risk of developing high blood pressure.

Environmental factors, in that scientists believe that high blood pressure in Black Americans is due to the factors unique to the African-American experience in the United States.  In the United States, 41 percent of Black Americans have high blood pressure, compared to 27% of White Americans. Social and economic factors, including racism, discrimination, and economic inequity, are responsible for these differences.

In a majority of the cases that involve hypertension, there are multiple causes that may be involved. There are no clear instances where the cause of hypertension can be determined. While there are factors such as high blood pressure or a stressful lifestyle that may contribute to hypertension, it also may be helpful to address unresolved repressed emotional pain and tension from the past.

John Henryism as a Coping Mechanism

John Henryism, a term coined by an African-American epidemiologist and public health researcher, Sherman James, investigated racial health disparities between African Americans and other racial groups in North Carolina, particularly working class African American men between 17 and 60 years of age.  James theorized that in some cases, African American men attempt to control their environment through similar attempts at superhuman performance, which may involve working harder and longer to prove one’s sense of worth. 

The term, John Henryism, originated out of a fable folk hero, John Henry, who was an African American man who worked vigorously to compete successfully with a steam powered machine, but died as a result of his effort.  The story of John Henry was a metaphor for the literature that links active coping with psycho-social stress to dysregulation of the sympathetic nervous system, which heightens blood pressure and risk for hypertension. 

African Americans have been going against the machine in a racist environment where there is a need to prove that they are better than what is perceived about African Americans in society and culture. This is a condition stemming from the inferiority complex developed since the institution of slavery from the past.

Some of the internalized messages that lead African Americans to participate in John Henryism are statements such as “When you are Black, you have to work twice as hard” or “Never let them see you sweat”.  These are the internalized messages that we must transform one's natural capacities and abilities to a hyper, supernatural level to accomplish normal objectives and goals.  These beliefs and perceptions can be dangerous and harmful to the physical, emotional, and mental health of African Americans.

Many African Americans may have grown up in emotionally and psychologically stressful living environments where the expectations for performance was unreasonably high. Children may have had parents who were not able to be present with their anger and frustrations, so they grow up without learning how to cope and manage their anger. Some came from family systems with strict and rigid political and religious views and perspectives, so they learned to hold on firmly to these perspectives. They also were conditioned to eat foods that put the body and mind under more stress, which breeds bacteria, yeast, molds, heavy metals, parasites, and viruses. Children may have learned very little on how to keep oneself physically and emotionally fit.

African American children grow up and go to work in stressful and toxic work environments, where the same habits from their families are being repeated. Avoiding one's feelings and emotions about the past rather than addressing them may contribute to high blood pressure which leads to hypertension. There is old, unhealed, repressed trauma that can play significant factor in high blood pressure. It is the hidden emotions, the ones that often are not felt or experienced, that could lead to hypertension, and many other health-related disorders.

Energetically, high blood pressure is about the stressful, unrealistic pressure that has been internalized and placed upon ourselves. This pressure leads to a sense of overwhelm, helplessness, frustration, and exhaustion. Being rigid in one's expectations, it can leave a person  unwilling to trust themselves and others.

What can African Americans do emotionally to address hypertension?
We are living in a time where the light is getting much brighter. It is become more difficult to hold onto our inner darkness -- our old, unhealed, unprocessed pain and fear. The failure to release those dark old emotions, and releasing them fully, increases our chances of becoming ill, whether it is high blood pressure or some other health condition. We have been socially programmed and conditioned to be afraid of our tears, rage, and our grief. It is not the feelings that are the issue. It is bottling up the feelings and emotions that is the presenting problem.

Self-care is important in addressing John Henryism and effects. For some, reading this may bring up feelings and emotions that require a release. Others may need the assistance of a skilled psychotherapist, bodyworker, or medical practitioner. If you have high blood pressure or hypertension, consult with your health care provider to find out which combination of treatments would work best for you, given your individual health and lifestyle.

Becoming knowledgeable about John Henryism and its harmful effects may prompt one to make changes in their lifestyle habits such as stress management, exercise and diet. Giving oneself the permission and opportunities to get comfortable with the discomfort, chaos, lower standards, and no control.

Spending time in nature is a great place to learn about the wonders of chaos and imperfection because it is all around, and we can find peace in its crooked edges, unpredictable growth patterns, and erratic sounds.

Holding enough space for anger, frustration, and rage to be felt and experienced with compassion can serve as a meditative experience for those who have hypertension in their body. Compassion naturally dissolves the charge and invites an experience of emotional clarity and understanding.

Laughing at life, as much as possible, can serve as an emotional release to reduce high blood pressure. Finding opportunities to laugh and find humor in the imperfections of life, and shifting our perspective makes life much more interesting than it is.

Here is one affirmation that can assist with the pulling and releasing of any of the repressed emotions and feelings that may need to come up:

Change me into someone who can easily release anything that is hidden in my mind and heart, anything that I may be holding -- even if I do not even know about it or what it is. I need some help with recognizing and naming whatever it is that I am feeling, and then releasing everything that needs to come up and out of me. I know that I am safe and I know that all is well with me. 

References:
High Blood Pressure and Blacks - https://www.webmd.com/hypertension-high-blood-pressure/guide/hypertension-in-african-americans#091e9c5e800919ec-3-6

The Downside of "John Henryism" - https://www.hsph.harvard.edu/news/features/the-downside-of-john-henryism/​
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Anti-racist activist and librarian Juliette Hampton Morgan observed in a letter in 1952 about how the most polite and nicest individuals identifying as White were the biggest problems in addressing systemic racism. She wrote letters to local newspapers with critiques about segregation.  Outside of the mistreatment of Black people during that time in history, what horrified her the most was the way in which White decency obstructed social change. Seven decades later, anti-racist educator Robin D'Angelo wrote a book, Nice Racism, to bring attention to the enduring facets of this activity. 

DiAngelo analyses how individuals who identify as White deem themselves exempt from and inoculated against systemic racism, however, uniquely embody racist practices and interventions, including herself.  She defines racism as a" collective racial bias that is backed by legal authority and institutional control", in which individuals and communities participate. DiAngelo distinguishes anti-racist strategies from the valued currency of White friendliness, stating that "niceness does not indicate a lack of racism nor is it a solution to racism.  She added that a culture of niceness does not mean that racism is absent in the environment.

​Robin DiAngelo wrote in her book about the racial illiteracy from proud liberal attendees who insinuate that they are beyond workshops on race, demonstrating how gradations in systemic racism is systemic racism itself.  Janine Jones, an African-American philosopher, has also written about the efforts of White people to empathize with the difficulties of non-White people. She describes these individuals as praiseworthy for the concern they have for others, but asserts that they usually do not realize that their efforts are about helping others become more like themselves. Jones writes that unconscious level, they believe that their customs and beliefs are the best customs and beliefs for all. According to Jones, they offer their assistance from a position of condescension, because they do not see themselves as White, and do not understand how their Whiteness has come to deeply inform who and what they are. 

These are all writers who have challenged and confronted the machinery of White progressiveness, how it works, and how effective and functional it can be, and impact those who are non-White.  There are many liberal-sanctioned tactics and mechanisms that prioritize the insecurity, performance, and superiority of Whiteness over the needs and interests of those racially marginalized and oppressed groups and communities. 

Defensive tropes are used against the critique of racial illiteracy -- such as adopting BIPOC children, interracial relationships, cross-racial friendships, or developing programs for children and adolescents in undeserved neighborhoods and communities.  D'Angelo explores the ideology of White feminism as a product of racism, where there are dynamics employed by White women to the detriment, denigration, devaluation, and decentralization of BIPOC women in White-dominated spaces. Jones describes in her work that those who identify themselves as "goodwill Whites, administer programs, tools, resources, and interventions that confidently express to the world that what they offer is inherently "better", and individuals who receive their offerings are much more "better off" than those who are in racially-oppressed, poverty-stricken, under-funded environments and communities. 

In these critiques of Whiteness, there was a sense of urgency and call to action to get the readers to consider how Whiteness shows up in areas of human activity: its illusions, promises, assumptions, and casual narratives of self-importance. It is in this space where we can collectively begin to remove the veil of Whiteness and see it what it truely is:  an overinflation of the self based upon a mythology and lie that systemic racism has afforded itself. When individuals who identify as White interrogate, scrutinize, and deconstruct racial superiority they have inherited from their ancestors, they cannot do it. The perception is that being White is "neutral" in an otherwise racial world that they do not feel equipped with a voice. 

DiAngelo challenges her White readers to ask why they think and believe that being nice is the best response to addressing racial inequity. This is a question that would lead one down this path towards knowledge and understanding of the self.  

Having a shared identity is one of the most commonly requested factors for individuals who identify as Black, Indigenous, and People of Color (BIPOC). Therapists who identify as BIPOC add value to our field. However, according to the American Psychological Association, only 12 percent of United States therapists identify with a racial/ethnic group. Everyone deserves a space where they are fully seen, heard, and able to achieve their personal and professional goals, so it’s critical that non-BIPOC therapists are knowledgeable, empathetic, and compassionate when addressing racism in therapy.

But what does this look like in practice? Non-BIPOC therapists must strengthen their cultural competency about racist and anti-racist practices, interventions, and methods to create safer and more informed spaces for BIPOC clients to discuss their lived experiences. As a Black therapist in private practice, I created a peer cohort where therapists like myself have accessible tools, resources, consultations, and training to address racism, race-based trauma, racial identity, and identity-based trauma and violence in a safe, supportive environment with both BIPOC and non-BIPOC therapists. In an ongoing process, we’re developing a culturally sensitive framework to help clinicians become more mindful of race, racism, and identity in the consulting room. Here are the ten points distilled from our conversations.

1) Commit to Ongoing Practice and Research

The first step is to address your own unconscious racial biases. Addressing racism goes beyond the belief that you’re not racist. It requires the humility, time, and commitment of energy and resources to pursue training, actively identify personal unconscious racial biases, and understand how your own social positioning may impact your relationship with clients. Consider listening to and reading books, articles, and podcasts. Attend in-person and online training, workshops, and consider consulting with and speaking with colleagues who identify as BIPOC or are racially-informed.

2) Learn Outside Therapy, Not During It

Self-education is important so that therapy can focus on the client's healing, rather than countertransference from your own racial identity development. Develop a personalized continuing education plan involving multiple methods to learn about systems of oppression and cultural norms, both inside and outside of your individual experiences. Educate yourself on the common misconceptions about police brutality, protests, and looting. Prioritize conversations with other white clinicians about anti-racism and anti-racist therapy, and learn about the differences between individual and systemic racism.

3) Get Curious about Your Client’s Unique Experiences

Making assumptions based on a client’s race or ethnicity can undermine their trust in the therapeutic process or cause them to feel stereotyped. In addition, asking a client to educate you about their culture centers you in the counseling process, when your focus should be on your client’s healing. Instead, it’s important to focus on your client as a unique human being with unique experiences. Questions like “How did that feel?” or “What were you thinking?” are ways of generating curiosity with your clients and understanding their unique experiences.

4) Be Aware of Microaggressions

Common mistakes that non-BIPOC therapists make include gaslighting, microaggressions, or lacking curiosity. Gaslighting is the act of questioning and dismissing clients’ unique experiences. Microaggressions are subtle intentional or unintentional actions and behaviors that denigrate or degrade clients, causing them to feel unsafe, attacked, or re-traumatized. Examples of gaslighting include questioning whether your client’s experiences related to their racial identities were actually racially driven. Microaggressions can include adopting or asking clients to adopt a colorblind or color-denial approach. It’s important that you gain self-awareness to know when you might be committing microaggressions, and learn how to counteract them. Look for workshops in this area or seek professional supervision to help. 

5) Validate the Impact of Race and Racial Trauma

Racial colorblindness or racial color denial as it applies to therapy is the idea and belief that you see all clients equally, regardless of race. A colorblind approach prevents therapists from noticing how race impacts a client’s lived experiences and allows therapists to dismiss and minimize racial trauma, along with the client’s reality. It’s important to validate the client’s interpretation of their situation and recognize and consider the degree to which racism is embedded in our society. A few ways to address racism with clients include recognizing and validating the gravity of these experiences, identifying racism that clients experience as a form of racial trauma, and acknowledging that working through the pain of these experiences is a critical part of healing.

6) Acknowledge Differences and Express Your Commitment to Inclusivity

If you don’t understand the lived experiences and reality of someone who identifies as BIPOC, be transparent and open about your lack of understanding and cultural competence. Acknowledging cultural differences lets clients know about your openness to discussing race or racism. It’s an invitation to collaborate. Acknowledge and validate your client’s reactions to racism with statements such as, “Of course, your reaction and response to racism is completely understandable.” Acknowledge and validate that working through and processing these experiences is a critical part of healing and recovery. White therapists should tell their BIPOC clients something along the lines of, “While I may be a white person, I’m actively committed to creating an inclusive practice and a therapeutic space.” Acknowledge that every topic can be brought into the therapeutic process, which creates a safe and welcoming space for the reality and lived experiences that BIPOC people face on a daily basis. Topics related to race and racism are challenging to discuss, so it’s important to develop a sense of comfort in the discomfort.

7) Use Self-Disclosure to Bridge Social Distances

Multiple studies demonstrate the profound influence that white therapists’ self-disclosure can have in creating equal spaces for clients of color. This might include judicious sharing of personal information, such as your family life, which can make clients feel more trust and openness. Or, more generally, you can share your genuine reactions to your client's experiences of racism and oppression. However, there are instances where self-disclosure is not beneficial and may even worsen the cultural and social distance between you and your client. For example, non-BIPOC therapists may use the opportunity to self-disclose to placate themselves, putting their needs of ahead of their client’s. Self-disclosure should always be done in the interest of your client, not for any self-serving purposes. Carefully consider whether self-disclosure is an appropriate tool, and if relevant, introduce it to build a stronger bond and trust with your clients.

8) Respect Your Client’s Desire to See a Therapist with a Shared Identity

If your BIPOC client feels the therapeutic relationship with you isn’t a good fit or they want your help finding a therapist with a shared identity, make sure to respect their choice. Too often, therapists brush off or question a client’s desire to see a therapist with a shared identity. But if seeing a therapist of the same race will help your client in their healing journey, it’s important not to dismiss this.

9) Seek out Consultation and Supervision

Supervision, peer consultation, and personal therapy can be particularly helpful in identifying your biases, bringing awareness to countertransference, and helping you develop comfort discussing race. Many therapists who specialize in diversity and inclusion also offer formal supervision. Even if you’ve been practicing for years, supervision can be a useful tool to bring greater awareness to countertransference and ensure you’re growing as a therapist. If formal supervision is difficult to obtain or doesn’t feel like the right path for you right now, you can still do a lot of this work in peer consultation with non-BIPOC colleagues, by regularly discussing articles or books on the subject, for example.

10) Keep Doing the Work!
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It’s important to recognize that this is challenging and ongoing work—but don’t give up! While it can be hard to hear a client say, “you don’t understand me,” keep investing your time and energy in understanding your own privileges and biases in order to assist BIPOC clients. Margaret Clausen, a clinical psychologist in Berkeley, California says, “Our privilege as white folks is that we can dip in and out of this work. I think of white therapists’ professional development regarding talking about race as an ongoing practice, one that involves further dialogue with other white therapists, and ongoing education."

​This is hard work, and it can bring up feelings of guilt, shame, or defensiveness, so you’ll want to practice self-compassion and lean into the discomfort. After all, the only way through is through.
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As issues of race and racism are being publicly explored, along with a more open dialogue around the experiences of BIPOC individuals, we therapists have a great opportunity to dig deeper into this work. This requires ongoing commitment and practice, but with the right tools and resources in place, we can begin creating more healing, inclusive spaces for all of our clients.