Lee revisits his father Leroy’s final moments in the hospital, and tries to parse out what really led up to his father’s death. Later in the episode, Lee talks with Natalie Slopen, an assistant professor at Harvard University, about ACES (Adverse Childhood Experiences) and how they can contribute to shortened life expectancy. Lee also speaks with Dr. Nathaniel Harnett, a neuroscientist and the director of Neurobiology of Affective and Traumatic Experiences Laboratory at McClean Hospital, about childhood trauma and how it disproportionately affects Black children.

TRANSCRIPT

My name is Lee Hawkins and this is What Happened in Alabama.

This episode is very emotional for me because we’ll be revisiting the details of my dad’s death. My sister, Tiffany, recorded some of our exchanges with the intensive care doctor and nurse in our father’s final hours. It’s difficult to listen to some of it, so sensitive listeners, please take care. I want to understand how the stressful experiences my father had growing up as a child under Jim Crow apartheid affected his health as an adult, and the role I believe racism-related stress played in his death, first in Alabama, but later in Minnesota. The conversations in this episode connect the dots between the Adverse Childhood Experiences of three groups: the twelve generations of enslaved Black people in the US, the five generations of Black people who, like my father, lived through Jim Crow, and the millions of Black American descendants of both who are alive today.

But, if you’re joining us for the first time, you’ll get a whole lot more out of this episode if you go back and listen to the prologue first - that’ll give you some context for putting the whole series in perspective. Do that, and then join us back here. Thank you so much.

Lee: Don't put our father through any pain with restarting his heart. We know you wanted that and we agreed to that. So now this is where we are…

Roberta: We just want our time with him

It’s 3:30 in the morning on February 28th 2019. My entire family - my mom, two sisters and me, are in my dad’s hospital room. I had been sleeping in my hotel room down the street when my sister Tiffany woke me up to tell me that the night shift doctor wanted to meet with all of us. Four days earlier, he was rushed to the hospital by helicopter after his heart had stopped at the Buddy Guy concert he’d gone to with my mom. It was a date night. They were celebrating their 50th anniversary. Though they were able to restart his heart a few times, his condition wasn’t improving.

The ICU room was slightly smaller than a college dorm room. It had a curtain instead of a door and a window that faced the hospital entrance. Every day, I could see Dad as I approached the room, with a bunch of tubes connected to his upper body. An intubation tube protruded from his mouth, and a breathing tube came out of his nose. An electronic panel behind his head monitored every sign of progress and every setback. Those four days were an emotional whirlwind. My dad still looked youthful with his hair parted on the side as always, and that gave me a little hope. But his kidneys were another story. A dialysis machine had been moved into his room. He wasn’t talking, but there was a good chance that he could hear all the conversations happening in the room.

Eventually, the doctor walked in to give an update. “Your father is a very sick man,” he began. “We see cases like this, and the survival rate is very low. There are so many possibilities with this. His lungs aren’t clearing up, and we’re worried he could develop sepsis at some point. He’s on dialysis now, but if we take him off, he’ll stop functioning within two hours. His organs are shutting down.”

I thanked him for the information and then gave him our position. Knowing that our father was a God-fearing man who would want us to exhaust every option before pulling the plug, we were standing by our consistent position that we were going to keep praying for a miracle and that we wouldn’t be stopping dialysis at any point. I told him that we appreciated the work they were doing to keep him as comfortable as possible and that we wanted to continue until his situation improved or his heart or organs shut down naturally. We made it clear, once again, that the only way we would allow them to discontinue treatment was if my father’s heart was to stop again. Using a defibrillator at that point would have been brutal.

The doctor’s position was that we should just trust him and the medical staff and that every person–including my father–would want his or her family to stop dialysis at this stage. I felt resentment towards them. They were culturally clueless, just blindly assuming that Black patients and their families trust medical institutions. Our decisions to embrace our faith and our father’s faith, and exercise our father’s wishes and our legal rights were paramount.

We felt that the doctors weren’t listening to us.

Our mother, who had been a nurse herself for decades of her career, knew my dad was likely in his final hours. But as we sat there, we knew she needed a little time and that she’d probably never forgive herself if she stopped dialysis at this stage. She was grieving the likely loss of that handsome boy she met at the beach when they were just fourteen. She’d known and loved this man for nearly sixty years, had children and grandchildren with him, and was squeezing his hand as they loaded him on the helicopter. She just needed to sit with her family, and pray, and think.

Lee Hawkins: I know that in the industry there's a lot of concern about that and how families, particularly in our community, you know, are treated. And we appreciate your concern. You know, our position as a religious family and you've dealt with religious families before here. So that's the situation and we really appreciate you.

Tiffany: Know it's human nature. It's my heart. My father. I didn't expect to wake up today and get this pain. And so this is why.

Lee: And if my father didn't explicitly say.

crosstalk: Anything, he wanted to go. He didn't.

Lee: Measure that. He didn't if he didn't explicitly say that he didn't want you to do anything, you know, he said he wants.

Roberta: And he told us.

A doctor ran up to us and told us that, as a last attempt at saving our father, he was going to do something he’d never done in his career before: Put my father on two kidney dialysis machines and run them, simultaneously. He ordered everyone out of the room and commanded his staff to hook the other machine up.

Only minutes after they did that, the code blue rang out, and my father was gone.

If you check the records, my father’s cause of death was cardiac arrest. He was 70 years old and had survived prostate cancer and Type-2 diabetes for years. But in the end, his heart wasn’t strong enough to withstand his weight, his stress level, and his three decade battle with obesity.

In the years since he passed, I’ve realized that it’s much deeper than what was written on his death certificate. This podcast was inspired by my research for a forthcoming book -– I Am Nobody’s Slave: How Uncovering My Family’s History Set Me Free, which set the stage for me to interview my dad for four years about his time in Jim Crow Alabama, and to do extensive research about everything that’s been covered in this podcast. Through all of that work, especially the books I read, the related journalism fellowships I completed, and the discussions I had with experts in psychology and neurobiology, I realized that my father’s fate might’ve been determined much earlier than that one day in 2019.

As part of my research, I came across a 2014 study from Harvard, published in the journal Epidemiology, that examined the health effects of Jim Crow laws on Black and white populations in the U.S. from 1960 to 2009. Researchers looked at data from all U.S. counties, focusing on people born between 1901 and 2009, and assessed the racial differences in premature mortality, defined as death before age 65. The study found that in 1960 36% of the U.S. population lived under Jim Crow laws, with 63% of Black Americans affected.

1960 was just one year before my father’s mother, my grandmother Opie, died of kidney failure at 56. Her death is why my father moved from Alabama to Minnesota, to live with his older sisters up north.

Black folks born between 1921 and 1945 in Jim Crow areas were 20% more likely to die prematurely compared to those outside these areas. Throughout the study period, Black people were about twice as likely to experience premature death compared to whites, regardless of Jim Crow laws. The highest risks were for Black people born between 1901 and 1945, while there was no clear pattern for whites. The study concludes that Jim Crow laws have had a lasting impact on premature mortality among Black Americans, and their abolition has not eliminated the racial disparities in premature death rates over the past 50 years.

Born in 1948, my father lived five years longer than age 65, so compared to many other Jim Crow survivors, he was fortunate. But compared to Black men as a whole, my father’s death at 70 fell short of the average life expectancy for a Black man, which, according to the CDC, was 71 1/2 years. In comparison, the life expectancy for a white man was about 76 years. I would have given my life savings for my father to have been given that extra year and a half , and my right arm for an extra 6 years. I believe Jim Crow – for all the chronic stress it caused my father from the moment he opened his eyes in Alabama– took that from me. I can’t prove definitively that Jim Crow killed him, but all of the research, all the science, and the studies I’ve seen– combined with my understanding of the toll racism took and how hyper cautious it made him, I would never rule it out. It would be easy to dismiss the dozens of cities and counties across America that have declared racism a public health crisis as some sort of “woke” agenda, but my knowledge says otherwise.

To deal with life’s calamities, secrets, and stresses, my dad didn’t turn to alcohol, cigarettes or drugs. Instead, food was where we found our joy. In fact, the last time I saw my father in-person was at the Old Country Buffet, a place where our family and tons of other Black families would often go after church– dressed in our Sunday best– for food and fellowship. On any and every given Sunday, I made sure to load up on three or four plates of fudge covered ice creams. I was never scolded for that, because my dad was doing it right along with me.

And it wasn’t until I became a journalist that I learned chronic stress from childhood trauma and racism can lead to food addiction as a coping mechanism. These stressors trigger the body's fight-or-flight response, releasing stress hormones. Elevated cortisol levels increase cravings for high-fat, high-sugar foods, providing temporary comfort and relief. Food becomes a way to self-soothe, creating a cycle of emotional eating. Additionally, repeated exposure to trauma and discrimination can disrupt the brain's reward system, making people more susceptible to addictive behaviors. In my father’s, my sister Tiffany’s, and my case, this sometimes resulted in compulsive eating.

We may not look like it, but just like my father, Tiffany and I have struggled with food addiction too.

Tiffany Hawkins: I feel like in some ways, you know, my weight has always fluctuated through my adult life, but it's because of an unhealthy relationship with food.

As kids, eating was one of the few escapes we could indulge in and not get scolded for.

Tiffany Hawkins: If there is a celebration or getting together with family, there was going to be a lot of food. And that you had to eat. If you didn't eat, they'd say, ‘Oh, you acting funny.’ And it's like, No, I'm just not hungry, but. You're still going to eat anyway.

Since our mom was a nurse while we were growing up, she was very conscious of the dangers of processed foods and sugars, and she tried her best to limit them. But this was the 80s, and many families kept soda, potato chips, and hot dogs in the fridge. Our mom refused to buy us the sugary cereals other kids had, but I’d still wait until she wasn’t looking and sprinkle a whole tablespoon of sugar over my Cheerios. If she caught me, she was surprisingly chill about it. Sometimes she’d even give me a rare laugh, and just say, “Put the spoon down, Lee Lee.” Food– even if it wasn’t always healthy– was one of the few things my parents were relaxed about, like a lot of parents and grandparents of that era.

Lee Hawkins: We could go in the refrigerator and just stuff our mouths with…

Tiffany Hawkins:...as much. As we wanted….

Lee Hawkins: Do you remember the eight packs of Coca-Cola in those bottles that we would tell.

Tiffany Hawkins: The bottles that were returnable.

Lee Hawkins: Yeah.

Tiffany Hawkins: Yeah, they're recycled. Yeah, absolutely.

Tiffany Hawkins: And we'd have the crush in that Coca-Cola and yeah, we could pick them. You can mix and match Mountain Dew. Yeah. We always had that in the house

In the days after my father died, family and friends started coming to the house from everywhere. Bless their hearts, they were determined to feed us. In the classic spirit of church and the community, they began showing up with piles and piles of food.

Tiffany Hawkins: I'm grateful for them reaching out. And people are bringing food to the house and whatnot. But we had so much food, Lee, when dad passed away. Pies, chips. These were from great places, fried chicken, corn man, ribs. And like.

Everything, food, food, food, food, food. But I was in. There eating, eating, eating, eating, eating. And probably during that time, I mean, not only from just eating them, but the grief of losing Dad and whatnot, I gained a considerable amount of weight and I had to get off.

I was so touched by it, so appreciative. But I couldn’t bring myself to eat it. I just couldn’t. Seeing my dad succumb in the way he did made me research and think more intentionally about the dangers of clogged arteries, and as far as I was concerned, the day he died was the first day of the rest of my life, when it came to my health. I vowed to be even more health-conscious.

Tiffany: You were smart. You would bring your own salad over or something. You would stop and go and get something.

Lee Hawkins: Sis, I wasn't smart. I was scared.

Lee Hawkins: We hadn't buried Dad yet. And then that was when I learned that diabetes makes your arteries weak and you know, and that that led to his cardiac arrest. So I was actually scared. And, mad, like, I agree with what you're saying, I mean I was angry.

Lee Hawkins: I said it's like bringing heroin to someone's house who just died of a drug overdose and just bringing heroin and crack and all of the high sugar. That's what was brought to our house.

As I stood over the kitchen counter, looking at all the pies, casseroles, and other delicious food, I couldn’t stay angry at our loved ones for long. I was more mad at myself than anything. The only reality separating me from my dad was that I still went to the gym. Inadequate rehab after a knee replacement made even walking painful for Dad. I closed my eyes and thought of all the times he told me later in life, “Boy, stay in that gym. Don’t turn out like me, son.” He kept playing basketball into his fifties, while I gave it up in my thirties in favor of weightlifting, swimming, and running. But I got all of that from my dad. For decades, he was in that gym. He just couldn’t stop eating. And eventually, the food won.

If I had stopped working out, I would have been overweight too, because I’ve been addicted to candy and ice cream for most of my life. It all goes back to being that kid.

Whenever I’d get a belt whipping from my parents, they’d beat me for five minutes, then walk down the hallway to their bedroom and slam the door. I’d lay there, often not wanting to get up, and the only motivation I had was knowing I had some money in my room and my bike in the garage. I’d get up, grab that money, and tear off on my bike to McDonald’s, ordering a soft serve vanilla ice cream cone or a chocolate fudge sundae. Sometimes I’d have both, or two large chocolate malts. The ice cream was like a memory eraser. I escaped to that feeling of joy, which was just what I needed to ride back home and act like nothing happened. Because if I went home and acted sad, my parents would get mad and accuse me of having an attitude. They called it “acting smart.” Ice cream made the pain fade away. It helped me turn the ache of my heart into a smile.

And on some of those nights, as I massaged the raised welts on my arms and legs in my room, I’d walk out and see my dad in the living room, sitting by the record player all alone – quiet – with his eyes closed.

He was always playing this one song.

Tiffany Hawkins: Yeah, the Sadie song he would listen to and he would listen to it on repeat and it was a song about their mother. Her name was Sadie. And, you know, don't you know we love you, Sweet Sadie. But it's really a sad song. And yeah.

Lee Hawkins: Sweet sadie. Don’t you know we love you sweet sadie. [singing] Yeah, of course.

And we knew that he had to be reminiscing about our Grandma Opie, his mother – the grandmother we never got to meet.

Tiffany Hawkins:I'm sure that it had a lot of significance to Dad absolutely it did. How could it not? And I think just how as a child, like dad was dealing with a lot, Have you thought about like when we would celebrate like Mother's Day or Father's day? Like how he must have felt?

And now, when I think about the pain– not just the emotional but the physical pain — that I felt when we lost our father, I can’t imagine how he went through the loss of his mom at 12 years old. My dad was the baby of the family – and a very sensitive man – who was coddled a lot more than I was, and he was much closer to his mother than I was to mine. When he was alive, those memories and death dates of his parents and even the siblings who had died before him would pass by, without him ever saying anything to us about it. I guess he’d mourn in silence, and we were clueless– and now I see that we were insensitive, because we rarely if ever asked about them– and he just kept quiet about it.

I think about those days all the time, especially now that our dad has passed away. In the US, we celebrated Mother’s Day and Father’s Day last month and the month before. When Dad was alive and we celebrated those holidays, the loss of his parents was never acknowledged. We never talked about what he went through.

Tiffany Hawkins:I wonder how many of those days he did take his aggression out in that way or he ate something that he shouldn't have been eating.

It made even more sense years later, when I did a national fellowship for Reporting on Child Well-Being and we studied and heard from experts on the short and long-term effects of Adverse Childhood Experiences, or ACES. And it was there that I learned about the ACES test. Anyone can take it and it’s pretty straightforward, like a checklist, a yes or no test.

The study measures ten types of childhood adversity, including five types of family dysfunction: witnessing violence, experiencing violence, having a household member who suffers from alcohol addiction, having a household member who has been incarcerated, and experiencing poverty. Later studies expanded the list of potential stressors to include experiences such as social injustice and racial and economic disparities.

Each type of trauma, including physical and sexual abuse, was assigned an ACE score of one. For example, a child who experienced racism, lost a parent, and witnessed violence, would have an ACE score of three.

The study showed that with each additional childhood adversity, children became more susceptible to obesity, cancer, diabetes, heart disease, marital discord, suicide, and other challenges in adulthood. The more stressors a person experienced, the higher their risk of medical, mental, social problems, chronic illnesses, and early death as an adult. Compared to those with zero ACEs, the study said “Individuals with an ACE score of four are twice as likely to be smokers, twelve times more likely to attempt suicide, seven times more likely to be an alcoholic, and ten times more likely to inject street drugs.” Those with an ACE score of six have a lifespan that is 20 years shorter on average.

This research highlights the profound impact of childhood adversity on long-term health and well-being​.

These are all challenges that Natalie Slopen, an assistant professor at Harvard University, considers critical in shaping the mental and emotional capacities of a child into adulthood. I met Professor Slopen as part of the Fellowship training, since she specializes in research around adverse childhood experiences, or childhood trauma.

Natalie Slopen:And this is a phrase that's used to reflect a variety of early childhood experiences that are known to have a harmful impact on child development at the population level.

In recent years, researchers and public health advocates have discussed how exposure to racism and discrimination can increase the risk of developing toxic stress and ACE-associated health conditions. Studies indicate that experiences of racism are significantly associated with other ACEs and can exacerbate or compound their effects, leading to negative health outcomes, like the ones I mentioned earlier.

At the population level, ACEs are used to understand the prevalence of various health outcomes across different groups of people, like why there are higher rates of heart disease in the Black community. But the implications are what drew me in.That data gave me extremely important context because, for all my life, I’d wondered about my father's siblings and other adults I knew who died in their forties and fifties. Anecdotally, I had many examples of people who’d dealt with heart disease, cancer, and/or Type-2 diabetes at young ages, but I never knew about the role that stress—especially during childhood—could play in raising a person’s chances of developing these chronic diseases so young.

I asked Dr. Slopen about the effect that growing up during Jim Crow, or facing racism in a predominantly white environment could have on a person’s long-term health and well-being.

Natalie Slopen Experiences of interpersonal or structural racism absolutely fit within the definition of adverse childhood experiences for those types of life experiences that we can imagine, lead to negative health outcomes. What was unique about the ACEs study is that it was able to document this, dose response relationship across a very broad range of health outcomes, mental health outcomes, behavioral health outcomes such as smoking or high risk sexual behavior or alcohol consumption, in addition to chronic disease outcomes that, had not been broadly recognized to be associated with early life experiences, such as cardiovascular diseases or cancers or, inflammatory, conditions associated with aging.

After I did the reporting fellowship, I asked my dad if a doctor had ever sat him down and asked him about his childhood or any of the adversity he’d faced. I remember it vividly because, before learning about this, it hadn’t occurred to either of us—or his doctor, apparently—that the stress building up in a child’s system could be inextricably tied to disease later in life. In my father’s case, no doctor knew his background well enough to develop an intervention strategy to help prevent diseases like his diabetes, prostate cancer, and the heart disease that ultimately ended his life.

When my grandparents were five and nine years old, both of their fathers were murdered by white men who were never brought to justice. They faced trauma before they even had a chance to live any life. I wonder if that played any role in my grandma dying of kidney complications at only 56 years old.

Lee Hawkins Can ACEs kill a person in terms of looking at life expectancy numbers and what we've seen?

Natalie Slopen There is data to show that adverse childhood experiences shorten one's lifespan at the population level. All of our work that is typically referenced is talking about populations, and not individuals. But on average, we know that adverse childhood experiences are associated with poorer health and premature mortality.

While Dr Slopen’s data focuses on population-level trends rather than individual cases, I recognize that individual stories can illustrate how specific trauma events can negatively affect someone's health.

Hearing this helps me understand my father’s situation as a child, so much more.

It makes me think about when my dad told me that he slept through his mother’s funeral. As that twelve year old kid, he didn’t know how to process all that grief, so his body just kicked in and took him out of the situation temporarily. But when he woke up, his mother was still gone. And I don’t think he was ever able to find a proper or healthy way to grieve– if that even exists– he just carried it around in his body– everywhere he went, for another 58 years.

Lee Hawkins: And what are the symptoms that people can see both as children and as adults? How does it present?

Natalie Slopen: When people begin to study this among young children, they often look at social and emotional developmental outcomes, such as ability to learn, ability to self-regulate within, you know, in peer to peer settings, in schools or at home. As children become adolescents, often, we can observe associations between adverse childhood experiences and mental health outcomes, as well as physical health outcomes such as sleep, weight gain, as well as, there can be changes, to the expression of certain genes potentially that could alter trajectories of health with implications for later chronic disease outcomes. You know, I think there's a lot of questions in the scientific literature about how it's the case that some people experience tremendous hardships and still manage to be excelling and highly functional in ways that others who have experienced similar hardships are not. You know, we don't fully understand how some individuals are more resilient than others yet, but that's an area that people are really trying to learn a lot more about, because it could give us insights and strategies to be able to help individuals, experiencing early life trauma to, to go on and have healthier futures.

Even as a kid, I never thought complaining or expecting anybody to ever come and save me from anything would serve me well. And while I did have to endure challenges like constant belt whipping, hate speech, and needing to have a police escort to school because of those white supremacist letters, my family was economically stable, I had two parents, and was also rooted in a strong, Black community.

Yet, I was still considered "at-risk" by some standards. I didn't fit the usual idea of an "at-risk" kid since I grew up in the suburbs with both parents. What set me apart and kept me from becoming just another statistic were the people who supported me. Unlike many kids who suffer long-term effects from childhood trauma, I had a dedicated support system, mostly from my Black community and a few white teachers who genuinely believed in me. That support made all the difference. Without that support, I probably would have had a much harder time as a child navigating through all that, because disparities in race and income often play a role when it comes to ACEs.

Natalie Slopen: So we know that exposure to adverse childhood experiences is not distributed equally across the population. So, individuals from poorer socioeconomic backgrounds and marginalized racial and ethnic groups, tend to display higher ACE scores in our epidemiologic literature, even using the traditional ACE measure that we've talked about that may even miss types of childhood adversities that may be more common among certain subgroups of the population.

Lee Hawkins: What do you think our listeners need to know about ACEs to understand why it is important?

Natalie Slopen: It's really important to understand that early life experiences affect health and development across the entire life course, so childhood provides this foundation for everything that follows. Our entire life course is rooted in our early experiences and these experiences shape our opportunities to learn and to develop physiological systems to maintain health over time. I also think it's really important to emphasize that there's strong literature to suggest that supportive, healthy relationships can be protective in the face of experiencing adverse childhood experiences. And so we don't want to create a fatalistic story around adverse childhood experiences. On average, children who experience adversity are at risk for worse outcomes. But this does not have to be the way things unfold. And there are things within social environments that can be done to protect individuals and to help promote positive health even in the face of adversity.

I believe my grandmother’s insistence that her youngest children be moved out of Alabama made all the difference for my dad. None of his older brothers who stayed back in Alabama made it to age 70.

The question now is, how much of the trauma we experience comes from environmental factors? There’s a growing camp of researchers investigating the extent to which trauma can be transmitted epigenetically. That means that trauma can cause changes in how our genes work without changing the genes themselves, often due to environmental influences. This raises the possibility that the effects of trauma could be passed down to future generations, impacting their health and wellbeing even if they haven't experienced the trauma directly.

While I hope it is not the case that we can inherit the trauma of previous generations, I am curious about it. I consider it an extremely worthy area of study that could significantly impact our understanding of trauma and its intergenerational effects, and how it can be addressed in the future.

I asked Dr Slopen about this too.

Natalie Slopen: There is a lot of research, actively being pursued in both unique samples of adults as well as animal studies to understand the intergenerational transmission of trauma experiences and how epigenetics may be one pathway by which trauma may have consequences across generations. So people have been doing this work, looking at epigenetic changes in samples related to with Holocaust survivors. So it may be the case that trauma leads to changes in gene expression.

If we find that there are epigenetic intergenerational effects, families who might be impacted include those who survived atrocities such as slavery, Jim Crow, the Holocaust, internment camps, genocides, and personal traumas like having family members murdered. These families could benefit from comprehensive support systems including mental health services tailored to address inherited trauma, educational programs that acknowledge and teach about these historical events, and community resources to build resilience. Early intervention programs focusing on childhood development and family support could help break the cycle of trauma. Promoting healthy lifestyles, including proper nutrition and regular exercise, can also counteract negative epigenetic influences. Additionally, policies aimed at reducing socioeconomic disparities and ensuring access to quality healthcare can further support these families in overcoming the lasting effects of their ancestral traumas.

Lee Hawkins: Thank you - I really appreciate you so much.

Natalie Slopen: My pleasure.

As a child, my father would have scored high on the ACEs study.

While the ACEs study looks at populations, not individuals, it’s clear that the traumatic events my father and grandparents endured reflect the kinds of experiences the study examines.

The grief from those losses devastated them and influenced the hyper-cautious way they raised my father and his siblings in the South. The reality of never feeling safe in Alabama shaped my father’s view of America and its racist laws and practices. These experiences led my father to traumatize me at times, believing that his harsh methods were necessary to prepare me for life. That’s the intergenerational aspect of this.

Reflecting on my grandparents and my father’s experiences in Alabama, and the impact on me, I wonder about the mental health implications. I wasn’t the only Black kid with Jim Crow survivor parents who thought as my dad did. I’m not naive enough to believe that the parents of today, many raised by Jim Crow survivors, wouldn’t take a similar approach with their own children. Even though times have changed, the problems and inequities facing our community often haven’t. That’s why, in thinking about mental health, I wanted to know if and how these experiences impact Black children disproportionately. I was pleased to find that one researcher has studied today’s Black children to measure the effects.

Dr. Nathaniel Harnett is a neuroscientist and the director of Neurobiology of Affective and Traumatic Experiences Laboratory at McClean Hospital at Harvard. His work focuses on how a traumatic and stressful event impacts the childhood brain.

Nathaniel Harnett: How does it affect the structure of the brain? How does it affect the way that we respond to other events in our lives? And part of the goal of my work really is to understand or figure out if we can figure out how trauma impacts the brain. Can we then use that information to figure out who's likely to develop PTSD after they get another traumatic event or experience something that's highly stressful.

His latest research looks at how these kinds of experiences in childhood are tied to racial disparities.

Nathaniel Harnett: So the study that we're talking about looked at about 12,000 kids, from across the country who are white or black. And we looked at a number of measures related to structural inequities that might be tied to structural racism, things like the relative advantage of environments that kids were growing up in and how much conflict there was in the home. What were the incomes like of their caregivers? And so part of the work that we've been doing over the last three, four, five years now is really trying to get at how do these sort of adverse childhood experiences that we might have had when we were younger shape how we respond to another traumatic event? And does that affect our likelihood of developing PTSD? And what is it really doing to the brain at a fundamental level?

The data showed that Black children were subject to more material hardship and had less access to resources as a result of structural and institutional racism.

Harnett: And what we're finding really is that that disparity, those discrepancies in experience, directly impact brain regions that we know are important for regulating how we respond to stress and for determining sort of our outcomes after a traumatic experience. For the kids that we looked at they're still so young that the differences we're seeing don't exactly look just like PTSD. But they're also, again, they're really young. We looked at the number of PTSD symptoms they had. And there was a difference between white and black kids, where black kids endorsed more PTSD symptoms. But we're talking about like 1 or 2 symptoms, not like the whole cacophony needed for a diagnosis of PTSD, but the patterns that we're seeing in childhood part of the worry is that if we're able to see these differences at this age, at really only nine, ten years old, and they stay in these environments, they stay in these deprived neighborhoods, they stay in areas where they're going to experience more racism, they're gonna experience more hardship that those differences might accelerate as they get older. And then it really is going to look a lot like what you see in individuals with PTSD.

It's important to understand that racism-inspired trauma can transcend class boundaries. Throughout my life and career as a journalist, I have come across many Black children who weren't struggling financially but still dealt with significant trauma. These children often faced abuse at home or as the result of being physically beaten by educators at school, racism in their communities, and were frequently punished more severely in school settings. I don't use the word "microaggressions" when talking about Black kids in suburbs because there is often nothing "micro" about the aggression they face when they are one of the few students of color, and this impact often goes unnoticed and unprotected. I've met children in suburban areas who endured outright hostility and others who experienced racial profiling by law enforcement despite their family's affluence. I've also known Black kids who were murdered by other Black people from our own community, who came from families with solid financial footing. The reality is that systemic racism, violence, and intraracial discrimination can affect Black children from any socioeconomic background, leading to significant psychological stress and trauma.

Lee Hawkins: You know, obviously racism transcends the economic experience. Is there any room for you to study kids who are Black who are, you know, even in boarding schools or or in prep schools. I mean, because the black we see it in corporate America with black people being the only person in the room a lot of the time. Is it possible that some of these experiences also affect the minds of black children, like being the only black kid in a school?

Nathaniel Harnett: Yeah, I think the racialization of an individual and the then associated racism really does transcend economic class. It interacts with class and poverty and money and things like that. But it's unique in those different situations. And I agree with you that we can study the impacts of poverty, of outcomes of structural racism, but we're going to need to start to think more intersectionally as to, you know, how do black individuals at different socioeconomic classes deal with the racism that they're experiencing or the different impacts. And how might that be different between black men and black women who have to shoulder different burdens? I think as our research matures, as we move forward, we really do want to get more granular, more in-depth, more intersectional, and really start to tease apart what's happening so that we can best represent all individuals.

Lee Hawkins: Yes. And I thought it was interesting and critical that high up in your announcement, when you announced the research, you said physicians and scientists tried to demonstrate that African-Americans were inferior to justify discrimination and systemic racism. Challenging that narrative with data is incredibly important. We need to rewrite that unfair history, right? And that's often what people miss when they talk about, you know, black people in America as the inequalities amd the foundational aspects of the way that, you know, social and economic stratification, white supremacy and all of that being inextricably tied. Why was that important to make sure that you said that so high up in your release?

Nathaniel Harnett: I think that as you sort of mentioned, one thing that we like to do in psychiatry and medicine, in dealing with mental health disorders is we like to treat everything as if it's an individual problem. Right? Like if someone has PTSD, it's because they were exposed to a traumatic event. And what we have to do is we have to give them yoga or medicine or cognitive behavioral therapy or something to treat them in particular. The reality of the situation is that the neighborhoods that people are growing up in, the experience that they're having, they're not random. You know, these are a result of historical. They have strong historical roots. There are policies set in place to segregate people so that they would have different experiences. And that has long standing effects even now. But we have such a tendency in our field in medicine to be like, well, these are just different groups at base level, right? There's white and there's black. There's nothing else to think about there. But really, I think it's not that people's skin color determines how their brain is going to function. It really is the case that it's the experiences they've had that are driving that brain function. And if we can accept that, if we can understand and really come to terms with the fact that the experiences that people are having are not random, it means that in order to fix these disparities, to fix these discrepancies, to fix these effects on the brain, we have to take much more of a structural approach. We have to actually change systems to bring about better brain health.

Lee Hawkins: Have you been able to when you talk about kids being exposed to violence and family conflict, was corporal punishment any part of your research?

Nathaniel Harnett: That’s such a good question. Corporal punishment was not something that we looked at in particular in this study. We know that things like corporal punishment can lead to or contribute to the development of other psychiatric disorders, and poor emotional regulation habits. And so is it the case that what parents end up doing to try to help their kids in some way hurts them, too? I think that's a really important research question as we think about how do we really understand all the impacts of early life adversity on the brain.

Corporal punishment is legal and prevalent in many homes across the nation and seventeen states still allow educators to hit students in public schools.

I wonder if the fact that Black children experience higher rates of corporal punishment contributes to higher rates of PTSD among Black children. And frankly, it bothers me that this possibility isn’t being extensively researched. But I also wonder, how would this research be perceived, especially since because of racism, so many people believe physical punishment is a necessity for Black children. Would this research be controversial and criticized? And, if so, would any institutions still support it?

In 2019, the American Academy of Pediatrics' took a stance against spanking. That same year, the New York Times published an article from author and journalist Stacey Patton, about Black pediatricians opposing the stance. The doctors felt the policy didn't separate spanking from abuse and could unfairly target Black communities, increasing fears of law enforcement and child protective services. The fact that even some Black pediatricians fought to defend corporal punishment against Black children, despite all the science proving the harm it causes, underscores how deeply rooted this practice is.

Nathaniel Harnett: I think that the reaction to the research has been mostly positive, but a little bit mixed. On the one hand, there are a number of people who I think are reacting to this and saying, yeah, we knew this. We didn't really, did we really need a study to tell us something that we already knew? We knew that racism and structural inequities were harming us. So why do we need this? We need to focus on doing something. And I'm not going to say I entirely disagree with that, I understand. Differences in prioritization.

Lee Hawkins: I disagree with it though. I'll say I disagree with it. Why do we need studies about cancer? Why do we need studies about diabetes? Why do we need … so we can solve the issue. And if there's no real empirical data to back up.

Nathaniel Harnett: Right.

Lee Hawkins: Then how do we solve it? Right? I mean, can you explain, I mean, can you explain why you did this research right?

Nathaniel Harnett: No. And I think you're you're absolutely right. We really just need data. But I think that having a body of work that just show people, look, when we have unchecked structural racism, when we have unchecked individual racism, we have all these inequities in the country. They're having a real impact on our kids' health. And if we want to fix that, we have to do something about it.

Lee Hawkins: So does some of this coincide with the Adverse Childhood Experiences data that shows that if you have 4 or 5 adverse experiences, you're likely to have shortened life expectancy, cancer, diabetes or heart disease. I mean, it seems like this is all part of, all part of that, like understanding how all of this is inextricably tied.

Nathaniel Harnett: Yeah. No, I think you're right. I think this is all connected. I think the discrepancies we see across medical outcomes, across mortality, across psychiatric disorders, it's all tying back to these experiences that we're having as we're kids and younger. And of course, the unequal distribution of those childhood burdens that disproportionately affect black and brown individuals.

Lee Hawkins: And what will this arm us with now? What are the solutions?

Nathaniel Harnett: I think that's always the hard question of what can the brain actually tell us about what we should do next? I think if anything, the most … the most immediate thing that I would hope for is that this data serves as a call to action for people that want to address childhood adversity, structural racism, other aspects of systemic inequities that affect black and brown individuals and really affect all kids. Because I think that, as I mentioned before, just having individual solutions to these problems like therapy or medication, that's not really going to help the structural issues. Getting medication isn't going to help the fact that you're growing up in an area that has been historically redlined, and therefore you don't have access to quality education or other things that are going to set you up well for life because of things that were set in place in this country that are now outside of your control. Doing yoga doesn't stop the fact that there's police brutality. I think part of what I'd like people to do with this work is recognize there is a real whole body brain impact from these effects, and that we really need to start stepping up to move towards actual structural change.

Lee Hawkins: Nate! Keep it up, brother. We just need you more than ever. So thank you.

Nathaniel Harnett: Thank you so much.

Lee Hawkins: Seriously, man

Nathaniel Harnett: Thank you so much again for having me. I appreciate it.

Understanding Adverse Childhood Experiences helped me better understand the trauma of my grandparents, my father, and my own. Jim Crow's racial violence took my grandparents' fathers and health inequities led to my grandmother’s early death, causing my father to lose his mother as his parents did. This trauma, from an early age, made them aware of the caste system’s injustice, causing my grandparents to fear for their children and my father to fear for me.

This fear led to me receiving over 100 beatings as a child.

That fear is why it took me years to stop having nightmares about them, as a grown adult. These beatings made me a jumpy, nervous child and haunted me into adulthood, despite having more basic rights and privileges and economic stability and opportunities than my father and grandparents.

Still, some form of post-traumatic stress haunted each generation, dating back to my enslaved ancestors. In modern times, if beatings at home and school could be contributing to trauma in Black children today, it's tragic. But there's hope. If research were to show it to be true, our community would be able to consciously reduce this disparity by rejecting this as part of our identity and by fighting to give our children a reprieve from violence, at home and at school.

I hope for a future where the impact of ACEs, especially those related to systemic racism, is fully acknowledged and addressed to an even greater extent. This means more research focused on Black communities and creating culturally sensitive support systems. By doing so, despite the factors beyond our control, we strive to help reduce the cycle of trauma and to provide healthier environments for all children.