Bill is a picture of success: A Yale graduate, the 47-year-old African American worked his way up to a management position at a large corporation. But he was reminded one night of how society often views him when he took a white business client to an expensive New York City restaurant to close a business deal: The maĆ­tre d' ignored Bill and instead asked his guest whether they had reservations; the waiter returned Bill's credit card to the client; and then, after the client immediately grabbed a cab with ease following dinner, Bill tried unsuccessfully for 15 minutes to hail one himself. After another cab ignored Bill but stopped for a white couple instead, Bill exploded with rage, cursing at the driver.

This story is one of many real-life examples of subtle but insidious racism that Anderson J. Franklin, PhD, a professor at the City College and Graduate Center of the City University of New York, describes in his new book, "From Brotherhood to Manhood: How Black Men Rescue their Relationships and Dreams from the Invisibility Syndrome" (Wiley, 2004).

Despite making strides in stamping out more obvious forms of discrimination since the civil rights movement of the 1950s and 1960s, the United States still has a long way to go to combat more subversive forms that happen on a more individual level, claims Franklin, a former president of APA's Div. 45 (Society for the Psychological Study of Ethnic Minority Issues).

Bill's experience of taking his client out to dinner is a perfect example of what Franklin calls the "invisibility syndrome"--the feeling people get when their abilities, personality and worth are disregarded because of others' prejudice.

Research by him and other psychologists is painting a stark picture of these subtle slights and how they affect not only people's self-worth, but also their mental and physical health. This work, say psychologists, can help expose the problem as well as point out solutions--just as work by psychologists helped support the Supreme Court's landmark Brown v. Board of Education decision (see pages 56-68) 50 years ago.

"Nobody in traditional Euro-American psychology has ever addressed racism as a process of taking away from the energy, life force or true spirituality of a person and what it means to be dehumanized--I think Franklin does a great job of capturing that phenomenon and its consequences," says Thomas A. Parham, PhD, assistant vice chancellor of counseling and health services at the University of California, Irvine. "We've now given voice and visibility to this syndrome with the hope that psychologists will make considerable efforts to address it."

Causes of invisibility

In a field that has been discussed for more than a century and has included such preeminent thinkers as W.E.B. DuBois and Ralph Ellison, the latest visibility comes from Franklin's in-depth book, compiled from research, writing and notes from a clinical practice spanning nearly three decades.

In it, Franklin explains how the invisibility syndrome concept refers to Ellison's 1952 book "Invisible Man." He quotes from the opening of Ellison's book, in which the African-American narrator describes the concept of being invisible: "I am a man of substance, of flesh and bone...I am invisible, understand, simply because people refuse to see me...They see only my surroundings, themselves, or figments of their imagination--indeed, everything and anything except me."

When people feel invisible, they can interpret seemingly innocent actions--such as the waiter putting the charge slip in front of Bill's client--as racist slights, which can create a palpable feeling that their integrity is under assault. These slights, or "microaggressions," as Franklin calls them, can build over time and ultimately explode, as it did for Bill when trying to hail a taxi.

"People's presumptions are filled with all types of stereotypes, leaving the real person invisible from those holding prejudiced attitudes," Franklin explains. "Bill went to the restaurant with a set of presumptions about his own status, and it came under assault when his status was not recognized. He had a series of encounters that frustrated him and boiled over. That is a common experience and a common process."

And they occur in the most unlikely places. Parham tells of the time several years ago when he was at New York City's renowned Waldorf-Astoria hotel attending an Association for Black Psychologists convention. He and psychologist Horace Mitchell, PhD, now president of California State University, Bakersfield, were waiting for an elevator for several minutes with two white women during a period of heavy ridership. He says the women sighed impatiently for the elevator to arrive; yet when it did, and even though the two men held the elevator doors open for the women to enter first, the women said they would wait for the next ride.

"The only thing they could see is not professional gentlemen in coats and ties holding the elevator, but black men with criminal intent," Parham says. "That's the kind of stuff that happens every day in America."

Enduring such microaggressions can damage one's mental health, Franklin says. In his clinical practice, he has seen clients who say feeling invisible causes them a range of ills, including disillusionment, chronic indignation, pervasive discontent, anger, depression, substance abuse and hopelessness. It can also interfere with achieving professional goals or creating loving personal relationships, he adds.

Invisibility's impact on health

Indeed, the invisibility syndrome may be as damaging to people's physical health as their mental health. Some research suggests that racism can be a potential stressor that can contribute to hypertension. For example, while conducting research with colleagues at the Duke University Medical Center, APA Chief Executive Officer Norman B. Anderson, PhD, found that stress caused by perceived racism is positively correlated with higher levels of blood pressure.

And while Franklin's new book focuses on African-American men, invisibility's problems also affect women.

Recent work by Angela Neal-Barnett, PhD, an associate professor of psychology at Kent State University, shows how such microaggressions often produce anxiety in African-American women. In her latest book, "Soothe Your Nerves: The Black Women's Guide to Understanding and Overcoming Anxiety, Panic and Fear" (Simon & Schuster, 2003), Neal-Barnett explains that many African-American women feel they can't seek help for that anxiety because of stereotypes that say they should be strong.

"To be weak and a black woman is an oxymoron in this country," Neal-Barnett says. "If you have anxiety, the implication is you just have to deal with it."

What's more, negative self-images and feelings of invisibility among African-American women can put them at risk for unhealthy relationships, says Gail Wyatt, PhD, a professor of psychiatry and biobehavioral science at the University of California, Los Angeles, and author of "Stolen Women: Reclaiming Our Sexuality, Taking Back Our Lives" (Wiley, 1997). The book discusses how long-standing cultural stereotypes form negative body images in black women and how women must see themselves as they want to, not as other see them. "Racism and people's reactions to it really work against people being perceived as real human beings," explains Wyatt, the first African-American woman to be licensed as a psychologist in California.

Ending invisibility

Although the racism associated with the invisibility syndrome is not as clear cut as the institutional racism ended by the decision reached in Brown, it's just as painful because social and cultural--if not institutional--divisions still exist in our society, Parham says. Because of this, researchers working in the field of racial equality say psychologists have the same obligation today that they did 50 years ago to educate the public and promote healthier attitudes and behaviors about racial issues.

Since racial slights occur less on an institutional level than on an interpersonal one, face-to-face interactions between people of all different ethnic backgrounds--such as through company-sponsored diversity awareness training programs--help break down misconceptions, says Neal-Barnett.

And psychologists have the background, knowledge and credibility to help facilitate such interaction through discussions, training programs and diversity workshops.

"Having a PhD opens the world to you to get your message across that racism has real and detrimental health effects," says Neal-Barnett. "We as psychologists can use our grant-writing skills not only to fund research that disproves racist stereotypes and demonstrates their impact on our health, but also to then disseminate that research to the public. I think we don't take full advantage of that."

For example, she uses funds to hold workshops on combating anxiety at conferences promoting African-American women's health. She encourages other psychologists to look beyond academic journal publishing to bring their findings to the communities in which they conduct research.

Franklin, for example, has led racism workshops for people to discuss the social tension, conflict and indignation that result from microagressions and share ways to handle those responses.

Yet another way psychologists can combat invisibility and racism is to start teaching children about the positives of diversity and negatives of prejudice early, in elementary, middle and high schools, says Parham, who wants to start a campaign to do so. After all, he points out, a national campaign of psychological research, education and activism radically helped to change people's attitudes about smoking in a little more than a decade.

"If we can do that for smoking, can't we do that for racism?"