I wrote this paper for the ISSTD’s October 2020 virtual conference*, but these words take a newly urgent significance in the aftermath of the January 6th, 2021, attack at the US Capitol. I want to share them here in the ISSTD Newsletter.
Na’im Akbar first coined the term Post Traumatic Slavery Syndrome in his book, Breaking the Chains of Psychological Slavery (1997). Joy DeGruy enhanced the concept further in her 2005 book Post Traumatic Slave Syndrome. In both writings, the syndrome is one that affects the African American decedent of slaves. The syndrome describes the adverse effects of slavery handed down trans-generationally and, therefore, still exists today. It is a form of internalized racism, defined as internalizing racial stereotypes about one’s racial group (Trent et al., 2019: Sosoo et al., 2020).
The online cognitive test known as the Implicit Association Test (IAT) is an indicator of this effect. The test can determine an individual’s affinity for specific faces. The average white and the average black American both indicate an affinity for white faces (Greenwald et al., 1998; Greenwald et al., 2009; Mania et al., 2018). I believe we can expect that one would show an affinity for a face that looks like oneself and one’s family, so the surprising thing is that African Americans do not (Ashburn-Nardo et al., 2003). This phenomenon is understood to be part of the legacy of slavery deeply embedded in the American Psyche.
I believe that the US’s white population has been equally negatively affected by the institution of slavery. The institutionalization of racism, which began very early in our nation’s history, is codified in the US Constitution and has had a profoundly negative effect on all Americans.
My thoughts on this derive from my experience as a psychiatrist treating those suffering the effects of chronic early childhood hood trauma. The malevolence embedded in child abuse perpetration is in evidence whenever the powerful take advantage of the weak. This malevolence is at heart what is known as the “narcissistic defense.”
Perpetrators use this emotional distancing method to hide the truth about a pervasive, ever-present feeling of worthlessness. The need to deny the feeling of worthlessness drives a desire to demonstrate the narcissist’s false sense of superiority over others. In extreme cases, that means hurting others to feel the power of the moment when the interpersonally dominant person completely overpowers the weaker person. At that moment, the perpetrator silences their fear of worthlessness.
There is still the possibility that one might feel guilty about the harm done to the other. This guilt needs silencing as well. To do so, the most malevolent perpetrators insist that the victim admit that they deserve the abuse. In these cases, the victim realizes that the only way to minimize the pain’s intensity is to help the perpetrator assuage the guilt by saying that yes, I did deserve it. That is the final soul-crushing blow to the victim. The scars left by this are profound, long-lasting, and challenging to overcome.
The Narcissistic Defense
Almond (2004) describes those who “use activity to fight off painful effects from past traumas and current conflicts: He defines the narcissistic defense as a behavior pattern that defies rage, grief, and re-traumatization in object relatedness. Interestingly, for our purposes, he defines a treatment strategy for this problem. “…it is important to be able to move between an actively loving engagement with the patient’s unexpressed dependent longings and a firmly confronting challenge to the destructiveness of the defensive stance.”
In his 2004 paper entitled, I Can Do It (All) Myself Clinical Technique with Defensive Narcissistic Self-sufficiency, Arnold describes patients “whose personality structure is sufficiently developed to enable them to establish successful work lives and to get into relationships, yet internally they fight off dependency feelings and many limits posed by reality.” He states, “Such people are often capable of Herculean efforts and maybe highly effective because of their single-minded dedication to their tasks.”
He goes on to say, “Ultimately it becomes clear that a character pattern built around control and self-sufficiency has provided them both a solution to most of the painful experiences of development—both traumatic and normal—and defense against anticipated discomforts in current affective life.”
Table 1 outlines the criteria for a DSM diagnosis of Narcissistic Personality Disorder.
Table 1 outlines the criteria for a DSM diagnosis of Narcissistic Personality Disorder.
DSM 5 Narcissistic Personality Disorder
Five of these nine are required for the diagnosis
- A grandiose sense of self-importance
- A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- A belief that he or she is special and unique and can only be understood by, or should associate with, other special or high-status people or institutions
- A need for excessive admiration
- A sense of entitlement
- Interpersonally exploitive behavior
- A lack of empathy
- Envy of others or a belief that others are envious of him or her
- A demonstration of arrogant and haughty behaviors or attitudes
The Narcissistic defense is, at its core, a stance against a devastating level of shame and self-loathing. Many people are what has been called “shame-based.” Those who use the narcissistic defense develop their perceived superiority over and ability to dominate others and a bulwark against shame. Their ability to tolerate the shame is low and relentlessly drives the need to demonstrate their superiority.
Basal Self Worth
Robin Dillon’s 1997 paper entitled Self-Respect: Moral, Emotional, and Political state the following, “Individuals who are blessed with confident respect for themselves have something vital to living a satisfying, meaningful, flourishing life, while those condemned to live without it or with damaged or fragile self-respect are thereby condemned to live constricted, deformed, frustrating lives, cut off from possibilities for self-realization, self-fulfillment, and happiness. And that sentence is often served through debilitating emotion.”
The debilitating emotion is shame:
“When the abiding flavor of your life is shame or self-contempt; when you have a profound and pervasive sense of yourself as inadequate, pathetic, like dirt; when your life feels meaningless, your activities of little value, your abilities minimal, your character base; when feelings of worth-lessness swamp everything else-when living feels like this, living well is impossible.”
The narcissistic defense is designed to hold all of this at bay. Dillon highlights a particular aspect of self-worth at the core of shame and is difficult to overcome by status or achievement. She calls it “basal self-respect.” It is the core set of worth developed early in life in a good-enough relationship with healthy-enough parents. It is not based on achievement or status. The child comes to believe the following, “My parents love and care for me even though I have little or nothing to offer them. I must be worthy of love and care as I am.”
Dillon outlines two additional types of self-respect, recognition and evaluative. Recognition self-respect based on social status and derived from “such things as one’s essential nature.
as a person (derived from); membership in a certain class, group, or people; social role; or place in a social hierarchy. Evaluative self-respect is based on a sense of one’s merit and is derived from “the measure of the quality of character and conduct, which we earn or lose through what we do and become.” Dillon stresses that it is difficult, if not impossible, to improve one’s level of basal self-respect through pursuits that increase evaluative or recognition self-respect. Dillon focuses on basal self-respect and most primal. “Basal self-respect concerns our primordial interpretation of self and self-worth, the invisible lens through which everything connected with the self is viewed and presumed to be disclosed, that is, experienced as real and true… It is the ground for the other kinds of self-respect since it serves as the interpretive medium for anything one could take as relevant to recognition and evaluative self-respect.”
Dillon sees damaged self-respect to be a phenomenon connected with oppression, particularly gendered oppression. “…women are more likely than men to have damaged self-respect and that the factors that undermine self-respect, as well as the configuration and meaning of the damage, are likely to be different for women and men…that damage is an effect of the subordination of women in a patriarchal society and that the sabotage of women’s self-respect is a principal means by which subordination is affected. Thus, we cannot fully understand damaged self-respect without taking their gender dimensions seriously.” She suggests that the basic principle of a male-dominated society is that women are worthless. This social subordination is a powerful molder of the basal many women’s sense of self-worth,
Dillon describes this beautifully.
“To grow up female in male-dominant society is to be immersed in a sea of discourses, practices, and interactions -including violent and abusive ones, which saturate…with messages of devaluation, only some of which we explicitly recognize. Messages we cannot fully discern, comprehend, examine, and reject intellectually, perhaps because we have not yet developed the requisite intellectual tools, can invade and deform our psyches as we absorb, digest, and assimilate them into our deepest experiential self-understanding. Motifs of female worthlessness that structure and are enacted in social institutions and the contexts of everyday life thus can come to structure and be enacted in basal self-valuation. And since basal self-interpretation inevitably informs self-construction, then where the basal framework codes inferiority due to deep and long-standing forms of social oppression, the result of self-construction is a diminished self: women become the lesser beings the dominant worldview defines us to be.”
The Damage to American Society
This damaged basal self-respect is at the core of the narcissistic defense and is not just a gendered phenomenon. I find that Dillon’s discussion of the way can play out in gender inequality is apt for my broader discussion today. The framers of the United States Constitution decided that black slaves would count as 3/5ths of a person to allocate seats in the House of Representatives. The Constitution also determined it was lawful that only land-owning white men could hold office and vote. This same Constitution also declared proudly that “All men are created equal.” If all men are created equal, then clearly non-whites and women are not equal, but also non-land-owning white men are not equal either. It set up a caste system where land-owning white men are at the top, followed by non-land-owning white men. The relegates women and racial and ethnic minority individuals to the 3rd rung of that caste system. Caste systems can only be maintained if the individuals from the lower castes buy into the notion of their inferiority. This means that when the Constitution was made public, the United States people had already made peace with this caste system. I was already firmly embedded in the American psyche. I am going to repeat Dillon’s argument, placing it in this broader context.
“To grow up poor and white in wealthy white male-dominant society is to be immersed in a sea of discourses, practices, and interactions -including violent and abusive ones, which saturate…with messages of devaluation, only some of which we explicitly recognize. Messages we cannot fully discern, comprehend, examine, and reject intellectually, perhaps because we haven’t yet developed the requisite intellectual tools, can invade and deform our psyches as we absorb, digest, and assimilate them into our deepest experiential self-understanding. Motifs of poor, white people worthlessness that structure and are enacted in social institutions, and the contexts of everyday life thus can come to structure and be enacted in basal self-valuation. And since basal self-interpretation inevitably informs self-construction, then where the basal framework codes inferiority due to deep and long-standing forms of social oppression, the result of self-construction is a diminished self: Those who are poor and white become the lesser beings the dominant worldview defines poor white people to be.”
This country’s Constitution was built on a promise that poor white men would be supported in relegating everyone else to 3rd class citizenship, in exchange for being relegated to second-class citizens. The malevolence in this is that the lower caste individuals must become convinced that their unworthiness is just, by giving tacit approval of the discrimination they face. The narcissistically damaged abuser demands that the victim accept the abuse as just. This dynamic is very familiar to anyone who works with the victims of complex trauma and dissociation. Somewhere along the way, the promise to poor white men that they would be supported in dominating those in the lower caste, was broken. Now those chickens have come home to roost in the potential destruction of American society taking place before our eyes. There is hope that the long-standing wounds that this caste system, perfectly depicted in Isabel Wilkerson’s new book, Caste: The Origins of Our Discontents, can be more fully understood mended. Healing these wounds would go a long way in ensuring that the United States of American can become the real and enduring democracy that long imagined itself to be.
Akbar, N., & Rasheed, T. (1999) Breaking the chains of psychological slavery. Tallahassee, Florida: Mind Productions & Associates.
Almond, R. (2004). I can do it (all) myself: Clinical technique with defensive narcissistic self-sufficiency. Psychoanalytic Psychology, 21(3), 371–384
Ashburn-Nardo, L., Knowles, M. L., & Monteith, M. J. (2003). Black Americans’ implicit racial associations and their implications for intergroup judgment. Social Cognition, 21(1), 61–87.
Degruy, J. (2005) Post Traumatic Slave Syndrome: America’s Legacy of Enduring Injury, Milwaukee Oregon: Uptone Press
Dillon, R. (1997). Self-Respect: Moral, Emotional, Political. Ethics, 107(2), 226-249. Retrieved January 23, 2021, from
Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. (1998). Measuring individual differences in implicit cognition: the implicit association test. Journal of personality and social psychology, 74(6), 1464–1480.
Greenwald, A. G., Poehlman, T. A., Uhlmann, E. L., & Banaji, M. R. (2009). Understanding and using the Implicit Association Test: III. Meta-analysis of predictive validity. Journal of personality and social psychology, 97(1), 17–41.
Maina, I. W., Belton, T. D., Ginzberg, S., Singh, A., & Johnson, T. J. (2018). A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Social science & medicine (1982), 199, 219–229.
Shabad, P., Worland, J., Lander, H., & Dietrich, D. (1979). A retrospective analysis of the TATs of children at risk who subsequently broke down. Child psychiatry and human development, 10(1), 49–59.
Sosoo, E. E., Bernard, D. L., & Neblett, E. W. (2020). The influence of internalized racism on the relationship between discrimination and anxiety. Cultural diversity & ethnic minority psychology, 26(4), 570–580.
Trent, M., Dooley, D. G., Dougé, J., (2019). The Impact of Racism on Child and Adolescent Health. Pediatrics, 144(2), e20191765. https://doi.org/10.1542/peds.2019-1765
Wilkerson, I. (2020). Caste: The origins of our discontents. New York: Random House.
* The presentation referenced here was part of ISSTD’s 2020 Virtual Conference. Free access to this recording will be provided to ISSTD members upon request. Please email email@example.com to request access to the recording. Please note continuing education credits are not available for viewing this presentation.