EMILY KWONG, BYLINE: You're listening to SHORT WAVE...
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KWONG: ...From NPR.
JON HAMILTON, HOST:
Hey, SHORT WAVErs. Jon Hamilton here in the host chair for one day only. I generally cover the brain, so today we've got an episode about the brain and racism. Scientists know that Black people are at a greater risk than white people for health problems like heart disease, diabetes and Alzheimer's. Some other minorities also face greater health risks. And researchers are asking whether part of the explanation involves the brain, specifically the brain's response to racism. Nate Harnett is an assistant professor of psychiatry at Harvard Medical School. He studies how the brain responds to traumatic events and extreme stress, including the events and stress related to racism.
NATE HARNETT: A lot of us experience trauma, and so I think in some ways, a lot of us end up doing me-search (ph) when we go into this field in trying to figure out, you know, why are we sort of resilient or why do we have the reactions that we do? And are there ways that we can help better understand that so that we can help other people, you know, not have to suffer the things that we went through?
HAMILTON: One of Nate's current projects is a collaboration with Negar Fani, a clinical neuroscientist at Emory University.
NEGAR FANI: So I do see racism to be a type of trauma. And racism is kind of an umbrella term that describes multiple things. It's really a system of oppression to a group of people that are treated as inferior based off of their race, ethnicity or skin color.
HAMILTON: Negar and Nate bring two different perspectives. Nate focuses on systems and institutions.
HARNETT: We might think about things in terms of structural racism, the overarching policies or cultural practices or norms that we've adopted that lead to the sort of subjugation of peoples.
HAMILTON: Negar emphasizes how individuals are affected by certain behaviors.
FANI: That could be like, let's say, a woman clutching her purse as a Black man is walking next to her, or they could be verbal, like someone saying, like, wow, I didn't expect you to be so articulate.
HAMILTON: But measuring how racism affects someone's brain is tricky. For example, Nate has used inequities in neighborhood resources as a way of tracking structural racism, you know, things like redlining or...
HARNETT: Biased mortgage practices that led to sort of implicit residential segregation and economic segregation between different racial and ethnic groups. It's very difficult for neuroimaging to look specifically at redlining, but we're able to look at these sort of proxy measures and these outcomes of structural racism, and then correlate those with both brain and behavioral responses to stress or trauma and see how they tie with different psychiatric disorders like PTSD.
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HAMILTON: Today on the show, how experiencing racism can alter the brain and how these changes in turn may contribute to health disparities. You're listening to SHORT WAVE from NPR.
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HAMILTON: OK, Nate and Negar, you're working together on research that looks at health disparities and how they may be linked to what's going on in a person's brain. So Negar, let's start with you, since you have a background in PTSD, and the effect of racial discrimination on a person can be traumatic. Have you seen differences in the brains of PTSD patients versus patients who've experienced the trauma of racial discrimination?
FANI: Yes. One thing that we've been able to see historically is that people who have more of these fear-related symptoms of PTSD, meaning they may be more vigilant or have a lot more hyperarousal - their body's kind of in a constant fight-or-flight state - they have lesser activation in an area of the brain called the ventromedial prefrontal cortex. This is an area of the brain that really puts the brakes on the amygdala, which is the main center for threat detection. And so this is something that we've historically thought of as, like, the problem with PTSD - is the ventromedial prefrontal cortex not putting the brakes on the amygdala when people are in a safe situation.
HAMILTON: OK.
FANI: But what we are able to see with racial discrimination and people who've experienced more of it is kind of an opposite effect. They show an increased activation in the ventromedial prefrontal cortex, that area of the brain that's involved with regulating emotions and regulating the amygdala. And we think that this is related to the fact that they're constantly regulating their emotions in the context of racist stressors.
HAMILTON: And in some contexts, regulating your emotions is considered a good thing.
FANI: Most definitely.
HAMILTON: But maybe not always - not here?
FANI: Well, no, it's pretty adaptive in the short term, let's say when your boss is saying something that was, you know, a microaggression or offensive to you. You're turning that area on in the brain so that you can get through the situation without saying something that might offend them or, you know, mess up your job situation. But when you have to deal with this on an ongoing basis - constantly - or if you're going back and thinking about the situation over and over again and feeling sort of disturbed by it, it's like that area stays on a lot more than our bodies are designed to really deal with, without it breaking down. And it's this overactivation over a prolonged period of time that we think could be contributing to this erosion or structural degradation in particularly those regulatory areas of the brain.
HARNETT: Just to sort of expand a little bit more onto that, you know, there's no such thing as a free lunch when it comes to the brain. Energy has to come from somewhere. And what we think ends up happening is, you know, energy that's reserved for other processes then gets taken away. And we have this process where - some people have called it weathering, where aspects of the brain or the body start to break down so that you can get the energy to keep regulating. And over time, that might contribute to other downstream health problems like cardiovascular disease or diabetes, which is research that, you know, Negar has done really showcasing that the sort of constant exposure to discrimination, constant exposure to these inequities seems to be related to the development of these other downstream problems.
HAMILTON: Since you mentioned Negar's research, Negar, I'd be interested if you could talk about - how do you get from these changes you see in the brain - everything changes the brain - how do you get from that to these diseases that we don't necessarily think of as being directly related to our brains?
FANI: Sure. So, I mean, there are myriad diseases that, you know, I think racial trauma and racial discrimination, racism has been linked to. And so I think there are many paths. I think one way is through the fact that, you know, as Nate was saying, you know, this increased effort expenditure with self-regulation, and when our brains are sort of bathed in stress hormones for a long period of time, there is going to be some structural degradation.
And one way we have been thinking about this is that if there's a greater erosion in regulatory areas of the brain, then we're going to be a lot more likely to choose or reflexively move towards coping behaviors that aren't really health oriented. So we might be more likely to pick up, you know, a piece of candy when we're feeling really upset, or we, you know, may grab a drink. These are things that we do to regulate our emotions, and they - when they're reflexive like this and it happens for a longer period of time, then we're going to become more vulnerable to different types of problems down the line, whether they be metabolic problems like something like diabetes or cardiovascular problems. But it also increases risk for brain health problems like Alzheimer's disease, which we know is twice as prevalent in Black people as compared to white.
HAMILTON: Nate, I'm curious about whether this sort of structural inequities or institutional inequities - are they producing the same kinds of brain changes or different kinds?
HARNETT: Some of the results that we see are a little bit different from Negar's in that we'll see sort of lowered volume or lower integrity of different brain regions involved in emotional regulation, whereas in some of the functional data we see in individuals that are older, we might see sort of greater activity, suggesting better ability to regulate themselves. And if we look sort of at young kids or young adults, we see different strengths of the effects in terms of structural inequities. We see a little bit smaller effects. But then as they get older, in some of our research, we actually see effects that are a lot larger.
HAMILTON: Nate, if I could just follow that a little bit, I'm curious whether you've seen differences among races. Are there different ways that it plays out?
HARNETT: Yeah, we have done work looking at recent trauma survivors who are either white or Black or Hispanic and really see that these sort of brain connections or connections among different brain regions that are associated with PTSD, those associations are actually different between different racial and ethnic groups. And that seems to be driven by the structural inequities between these groups, whether that be in terms of income or neighborhood disadvantage. And so in actuality, these sort of long-term impacts of inequities affect just how well we're able to use brain-imaging data to predict who's going to go on to develop PTSD.
HAMILTON: Negar, I'm curious, how has your research been received? What sort of reactions have you gotten to it?
FANI: (Laughter) I'm glad you asked that question. It has changed over time. So many years ago, when I was just starting out my research as a graduate student, it was not a thing that was really tolerated. And the - you know, in the scientific community and the PTSD community, it was incredibly difficult to get my results published. And many things got kicked down the road, and the focus was taken away from race and more on PTSD because people didn't want to hear it.
And I think that when it comes to racism research, it's often held to a different standard than trauma research. You know, I've been giving trauma inventories to people for, you know, like, decades. And those inventories that ask people about, you know, instances of sexual assault, physical assault or being in a car accident, those kinds of things, those questionnaires were never - they were never criticized for what they were. No one asked for police reports, you know, in my articles. But somehow, you know, with racial discrimination or racism or generally, there is a different standard that we're held to. Like, how do you know that people really experienced racism?
HAMILTON: Do you think, by the way, putting data, fMRI images, things like this, behind these sort of abstract concepts - do you think that's going to change the way people see what racism is and what it does?
HARNETT: It's a tightrope to walk, isn't it? Like, on the one hand, having the brain data makes it almost undeniable. You can visually see the impacts on kids and adults and older individuals, you know, the cumulative stress of racism and its toll in the brain. On the other hand, there's always a concern about biological essentialism when we're talking about racism, this sort of desire for some people to, you know, see race in the brain, when I think it's important to realize that we're still talking about a social construction. It's not race in terms of skin color. It's the cumulative and disproportionate impact of many different types of stressors with rich, complex and dynamic histories and social constructions that impact the brain.
FANI: You know, I think when it comes to marginalized people, not necessarily - many times the messages that I'm discussing with marginalized communities is like, well, yeah, we knew that. Like, that makes sense, and it's a no-brainer. But many times in the medical community, you know, racism hasn't been recognized as the kind of insidiously damaging stressor that it is. And the hope is that this kind of brain research can lend a kind of legitimacy to racism as a potent social stressor that has a very clear and pronounced effect on the brain.
HAMILTON: Nate, when you look at structures and institutions, are there changes you see that you consider hopeful?
HARNETT: I remain hopeful about the ever-changing nature of society and the structures within them. I think from my own perspective, we've seen a lot more interest in terms of different judicial activist groups in trying to change the actual legal way in which people approach racism. I think that we've also had just more conversations among places of power, places like, you know, the conversations we're having now where we're just being willing to acknowledge the fact that these disparities and these inequities exist and even just think about how we're going to go about changing them.
HAMILTON: Well, Nate and Negar, thank you so much for talking today. It's been a pleasure.
FANI: Oh, likewise. Thank you for inviting us.
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HAMILTON: This episode was produced by Rachel Carlson and edited by managing producer Rebecca Ramirez. Rachel and Rebecca checked the facts. Maggie Luthar was the audio engineer. Beth Donovan is our senior director, and Colin Campbell is our senior vice president of programming. I'm Jon Hamilton. Thanks, as always, for listening to SHORT WAVE from NPR.
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