A. Racist Acts and Invectives Cause Harm to Physical and Mental Health.

The physical, mental, and psychological harms linked to overt racism and other forms of racial bias are well established. Robert T. Carter et al., A Meta-Analytic Review of Racial Discrimination: Relationships to Health and Culture, 11 Race & Soc. Probs. 15, 23 (2019) (metaanalyses of 242 studies found racial discrimination was related to mental health effects of obsessive-compulsive behavior, stress, and hostility and anger and physical effects of high blood pressure and negative health).

Research analyzing a broad sample of studies on racism's physiological impact found that “direct encounters with discriminatory events contribute to negative health outcomes.” Jules P. Harrell et al., Physiological Responses to Racism and Discrimination: An Assessment of the Evidence, 93 Am. J. Pub. Health 243, 243 (2003). One such study examined the relationship between cardiovascular reactivity and interpersonal mistreatment and discrimination in middle-aged Black and white American women. Max Guyll et al., Discrimination and Unfair Treatment: Relationship to Cardiovascular Reactivity Among African American and European American Women, 20 Health Psych. 315 (2001), https://doi.org/10.1037/0278-6133. 20.5.315. The Black women, who attributed mistreatment to racial discrimination, exhibited greater average diastolic blood pressure reactivity. Id. These findings support the hypothesis that discrimination is a chronic stressor that can negatively impact the cardiovascular health of African Americans.

In another study, Black college students viewed three scenarios: racist situations involving Black people; anger-provoking, nonracist situations; and neutral situations. Cheryl A. Armstead et al., Relationship of Racial Stressors to Blood Pressure Responses and Anger Expression in Black College Students, 8 Health Psych. 541, 541 (1989), https://doi.org/10.1037/0278-6133.8.5.541. Analysis done after each viewing revealed significantly increased blood pressure in response to racist stimuli, but not to anger-provoking or neutral stimuli. Id. at 552. The study concluded that racism was associated with increased blood pressure in Black people and posited, “[t]here may be a heightened sensitization and vigilance for racism,” because “[r]acism is an aversive stimulus that threatens ‘selfhood,’ whereas mere anger does not have such deleterious effects.” Id. at 553. High blood pressure or hypertension correlates with cardiovascular disease for which the mortality rate of African Americans is twice that of their Caucasian peers. Mary Dunklin, High Blood Pressure Increasingly Deadly for Black People, Am. Heart Ass'n (July 13, 2020), https://www. heart.org/en/news/2020/07/13/high-blood-pressure-increasingly-deadly-for-black-people.

Abusive and discriminatory speech in the workplace also harms mental health. Kerri Lynn Stone, Decoding Civility, 28 Berkeley J. Gender L. & Just. 185, 213-14 (2013). One study of hospital employees found that Black employees were more likely to report frequent discrimination correlated with depressive symptoms “above and well beyond that of simple job strain or general social stress.” Id. (citing Wizdom Powell Hammond et al., Workplace Discrimination and Depressive Symptoms: A Study of Multi-Ethnic Hospital Employees, 2 Race & Soc. Probs. 19 (2010)); see also Robert T. Carter, Racism and Psychological and Emotional Injury: Recognizing and Assessing Race-Based Traumatic Stress, 35 Counseling Psych. 85 (2007) (noting the psychological and emotional harm from language such as “Nigger” and “Boy”).

Further, the negative mental health impacts of racist incidents can compound racism's physiological harm. A study based on in-depth interviews of African Americans concluded that incidents of race discrimination affect mental health “so profoundly” because “they are experiences of exclusion that trigger feelings of a ‘defilement of self... includ[ing] feelings of being over-scrutinized, overlooked, underappreciated, misunderstood, and disrespected.” David R. Williams, Stress and the Mental Health of Populations of Color: Advancing Our Understanding of Race-related Stressors, 59 J. Health & Soc. Behav. 466, 469 (2018), https://www.ncbi.nlm.nih.gov/. This often triggers a state of heightened vigilance in the affected employee, further compounding the stress response. “Heightened vigilance” refers to a specific type of stress, namely “living in a state of psychological arousal in order to monitor, respond to, and attempt to protect oneself from threats linked to potential experiences of discrimination and other dangers in one's immediate environment.” Id. at 470. Research links this race-related heightened vigilance to hypertension, negative cardiovascular function, sleep difficulties, obesity, and depressive symptoms. Id. The cascade of harms is so severe that the American Psychological Association (APA) has concluded: “Quite literally, racism can kill.” Naomi Torres-Mackie, How Racist Messages Harm Physical and Mental Health, Psych. Today (Aug. 9, 2019), www.psychologytoday.com/us/blog/underdog-psychology/201908/how-racist-messages-harm-physical-and-mental-health.

The word “Nigger” at work is particularly deleterious and triggering of hyper-vigilance syndrome. Historian Elizabeth Strouder-Prior describes her encounter with the N-word at work (in the classroom) as annihilating and immobilizing. Why It's So Hard to Talk About the N-Word, TEDx (Dec. 2019), https://www.ted. he_n_word. Strouder-Prior's immobilization is a bio-physical response on the spectrum of somatic responses to the N-word consistent with hyper-vigilance. “[W]hen a white person uses the term ‘Nigger,’ regardless of his conscious intentions, he is making a fundamental statement about his place in the world and... the place of African Americans... akin to ... saying explicitly: I reject the concept of equality, I reject your humanity, I am more powerful than you, and because of that power, I can say anything I want, and you have no recourse.”' Leora F. Eisenstadt, The N-Word at Work: Contextualizing Language in the Workplace, 33 Berkeley J. Emp. & Lab. L. 299, 319 (2012). Social science demonstrates that the word “typically renders the targeted listeners speechless and demoralized, and creates in them a feeling of helplessness that is met with anger, fear, or sadness.” Id. at 319-20. The hyper-vigilance response leads to a constellation of dangerous health conditions for African American employees. See supra Section I.A.

The N-word is also uniquely harmful because it undermines dignity and self-esteem, moral characteristics that modern psychology embraces as fundamental human needs. When used in the workplace, the N-word can trigger a self-demotion dynamic that manifests in the form of stereotype threat - a phenomenon that occurs when people placed in situations where negative stereotypes about groups to which they belong are at risk of being confirmed and experience apprehension, severe anxiety, poor recall, and poor performance. Chad E. Forbes & Jordan B. Leitner, Stereotype Threat Engenders Neutral Attentional Bias Toward Negative Feedback to Undermine Performance, 102 Biological Psych. 98 (2014), https://www. sciencedirect.com/science/article/abs/pii/S030105111 4001525. Studies show that the N-word at work triggers stereotype threat that impairs Black workers' performance in the workplace and other evaluative settings. Williams, supra, 470-71.

The deleterious physical and psychological impacts on Plaintiff-Appellant Brian Collier and other Black people targeted by the word “Nigger” at work track these research findings:

• Mr. Collier testified that the word “Nigger” carved into the elevator he took every day at work and other “very upsetting” incidents never “went away or out of [his] mind,” ROA 241, 251, 256, indicating his daily anxiety and hypervigilance.

Tyshanna Nuness testified that she “couldn't go to sleep” after being called a “Nigglet,” “like a Pig Nigger,” by her co-worker. Nuness v. Simon & Schuster, Inc., 325 F. Supp. 3d 535, 541 (D.N.J. 2018).

• Contonius Gill testified of being called “Coon” and hearing “Nigger” and other racial slurs at his job as a tanker/truck driver: “This treatment at work left me depressed. I felt isolated, demeaned and dehumanized. I began having difficulty sleeping and I was filled with anxiety.” Meeting of June 20, 2016 Rebooting Workplace Harassment Prevention, EEOC v. A.C. Widenhouse, Inc. (2016) (written testimony of Contonius Gill, Charging Party), https://www.eeoc.gov/ meetings/meeting-june-20-2016-rebooting-workplace-harassment-prevention/gill.

• Fred Gates, a school building engineer, took one month of sick leave for psychological distress, including violence-provoked thoughts about his supervisor and other higher-ups, after his supervisor racially harassed him and called him “Nigger” twice. Gates v. Bd. of Educ. of the City of Chicago, 916 F.3d 631, 634 (7th Cir. 2019).

. Brenda Smelter, a homecare worker, testified that enduring racist remarks culminating in being assailed with “Dumb Black Nigger” by her co-worker was “stressful and hurtful.” Smelter v. S. Home Care Servs. Inc., 904 F.3d 1276, 1285 (11th Cir. 2008).

. Edward Blackwell was one among a group of Black construction workers who testified that they felt “fear,” “stress,” “hurt,” “saddened,” upset,” and “humiliation” when co-workers used the slur “Nigger,” hung nooses and displayed the confederate flag on the worksite. Equal Emp. Opportunity Comm'n v. L.A. Pipeline Constr. Inc., No. 2:08-cv-840, 2010 WL 2301292, at(S.D. Ohio June 8, 2010).

These accounts accord with the substantial social science showing that the word “Nigger,” when inflicted in the workplace, has great power to cause physical, moral, and psychological injury.