Between the World and Me

African-American males are disproportionately incarcerated,¹ leaving the population in fear. Between the World and Me allows us to see, through the author's perceptions and experiences, aspects of American life as a black male. A predominant theme is how black males must adapt to a culture and criminal justice system intent on controlling their bodies. His recurrent use of the words “black body” provides a chilling sense of the tenuous ownership of oneself. The metaphor is reminiscent of the parallel with concerns of African-American females' reproductive rights in the work of Dorothy Roberts.² She documented interference with ownership of the female black body and the struggle for self-determination, from the time of slavery through the 20th century.

The book, a 152-page series of essays that attempt to explore difficult questions about race in America through the recollection of personal and historical accounts, is framed as a letter to Coates's adolescent son. It echoes James Baldwin's “Letter to My Nephew on the One Hundredth Anniversary of the Emancipation” in content and literary style.³ Coates describes his development as a black male. Fear, he observes, is an entrenched part of black people's lives: fear of American society, of law enforcement, and of each other. It perpetuates “a catalog of behaviors and garments” (p 14), placing black youth at risk of the racial victimization that created the fear. Fear also creeps into how black families discipline their children. Coates recalls, “My father was so very afraid. I felt it in the sting of his black leather belt … my father who beat me as if someone might steal me away, because that is exactly what was happening all around us. Everyone had lost a child, somehow, to the streets, to jail, to drugs, to guns” (pp 15–16).

Coates's accounts resonate strongly with those of us working in the juvenile justice system. The long-standing belief that harsh punishment is part of African-American culture is now better understood as transgenerational trauma. The racial disparities among arrests, adjudications, and placements in the juvenile justice system have been well documented.⁴ The concept of the absent black father and the ever-growing number of missing black youth, as powerfully described by Coates, exist in parallel to American mass incarceration and failed public education.

Dynamics of systemic difficulties, racial disparities, and cultural differences are within the purview of what forensic psychiatrists should bring into their clinical practice. With increased understanding of how cultural and social factors affect mental health, forensic mental health professionals are equipped to assess and comment on how these affect an individual's mental health. To ignore these concerns is to carry on the injustices faced by black youth in our country. When forensic clinicians take a history, we must consider early trauma and experiences that may be alien to our own.

While speaking as a father to a son, Coates also provides us with a roadmap to conveying a criminal defendant's narrative. Addressing historical trauma, Coates discusses how African Americans have been slaughtered at the hands of their oppressors, who seem to bear no accountability. This unchecked oppression has played a major part in the psychological development of minorities. What began as fear during the time of slavery, fear of being sold and separated from one's family, fear of seeing a loved one lynched, and fear of seeing a family member raped, has resulted in the harsh reality of transgenerational trauma transformed into anger, misguidance, loss of identity, hopelessness, and a disregard for the future.

Recounting how these cultural and systemic factors affected his well-being, Coates describes a vague awareness that his brain was too preoccupied with fear and survival when it “should have been concerned with more beautiful things” (p 24) and how hypervigilance in protecting his body was an “unmeasured expenditure of energy, the slow siphoning of the essence” (p 90). Coates argues that “the dream,” which he describes as “their need to be white, to talk like they are white, to think that they are white, which is to think that they are beyond the design flaws of humanity,” (p 146) is the reason for the perpetual view of the black community as less than human and has given permission for seeing black “bodies stowed away in prisons and ghettos” (p 151). He emphasizes the need to move away from single-population blaming, such as the well-known phenomenon of blaming law enforcement for police brutality.

Many of Coates's observations can be incorporated into forensic reports about juvenile dispositions, but not if we are blind to them. Treatment recommendations may go further than medication and unspecified therapy needs. For example, a clinician who has a basic understanding of the cultural stressors and historical trauma that Coates describes could comment on factors such as family dynamics and attachment to caregivers, and advocate for social services and referrals to trauma-based and family therapy, especially in youth. As responsible clinicians striving for objectivity, we are all responsible for noticing and acknowledging the unconscious biases reducing our ability and willingness to discuss these matters in clinical reports. The notion that police reflect most Americans' views suggests the need for general increased awareness of one's own personal biases. As previously described in this journal, we as mental health providers are not immune to our own personal biases.⁵ As a generally privileged group, we have a duty to ensure that our clinical practices reflect an appropriate cultural awareness and understanding of the systems and the restrictions that our clients are facing. Between the World and Me offers an emotional and intellectual journey highlighting the need for mental health clinicians to strive for a higher understanding and appreciation of basic psychological and cultural concepts that affect black youths' lives.

• © 2018 American Academy of Psychiatry and the Law