You don't have to ‘be strong' and silent, when what you really need is support, says local therapist.

Her fierce love for her grandmother - and her extended community - has long animated Ashley McGirt-Adair‘s work to help people talk about their pain, advocate for their care, and improve a health care system that has historically been a source of racial trauma.

"This book was born at the intersection of my personal grief and my professional calling. The inspiration was my grandmother's life and death, as she died way too early as a result of racial trauma," said McGirt-Adair, author of "The Cost of Healing in Silence: Navigating Racial Trauma and the Call for Culturally Responsive Care." "As a therapist, I began to see those same patterns repeated in the lives of my clients, particularly within Black communities. People navigating not only their own mental health needs, but also the chronic stress of racism, while engaging with systems that often fail to see them fully."

In her book, she details how her grandmother spent years living in a neighborhood that experienced disinvestment, leading to insufficient resources and care, and creating the kind of chronic stress that would lead to a medical emergency. And, while that emergency revealed an area in her brain that was leaking blood, her grandmother was sent home alone, where she suffered a stroke.

"I have held immense anger, rage, and wonder about what could have been if she was able to recover and still be here today. The wonder of how her life would have differed if she had sound culturally responsive mental health support and resources available to her," she writes in the book. "Bridging the gap between low- and high-income families is essential to creating a health care system that values life equally, regardless of socioeconomic status."

McGirt-Adair, 37, is a therapist and the CEO and founder of the Therapy Fund Foundation, providing free mental health services to the Black community in Washington state, with a pilot program underway in San Diego. She is also the author of "I Tried to Travel it Away: Mental Health Tips for Travelers," and lives in Spring Valley with her husband, Huston, and his children. Her work is centered around creating greater access to mental health care for Black people and other underserved communities, a more inclusive health care system and healing racial trauma. She will discuss and sign copies of “The Cost of Healing in Silence" at the San Diego stop on her book tour at 6 p.m. Tuesday in the Shiley Special Events Suite of the San Diego Central Library.

Q: What is racial trauma, particularly as you address it in your book?

A: Racial trauma is the cumulative emotional, psychological and physiological impact of experiencing racism, whether that's direct discrimination, witnessing harm toward others or navigating systems that consistently devalue your humanity. It's not a single event; it's chronic, layered and often carried across generations.

In my book, I talk about racial trauma as something that lives both in the body and in our daily lived experience. It shows up in hypervigilance, anxiety, grief, exhaustion and even in how people move through health care systems, from questioning whether they will be believed, respected or properly cared for. For many Black and other historically excluded individuals, it's the stress of having to constantly assess safety, code-switch or prepare for bias before even entering a room.

I also center how racial trauma is not just interpersonal, it is systemic. It's embedded in policies, practices and institutions, including health care, where disparities in diagnosis, treatment and access persist. So, when we talk about healing, we can't place the responsibility solely on the individual. We have to address the systems that continue to produce harm. In the book, I name racial trauma not to pathologize our responses, but to validate them.

What I love about Spring Valley…

My neighbors. This is the first place I have ever lived where my neighbors brought me a food basket and gifts, like you see happening in the movies. I also love the diversity of my neighborhood.

Q: You talk about how your grandmother's life is the lens you chose to use in telling this story. Can you tell us about your grandmother? Who she was, and why you wanted to share her experience in this way?

A: My grandmother, Dolores McDowell, was a remarkable woman - an educator at her core and a servant in every sense of the word. She was a schoolteacher who believed deeply in the power of knowledge, but also in the responsibility to pour back into community. She raised us with the belief that education was our way to freedom and liberation. Her faith guided her life; she loved God, she loved her family and she lived those values out loud. She also loved watching her stories.

My grandmother was well-traveled, creative and ahead of her time; she actually hosted the first integrated fashion show in her community, designing clothes and expressing herself through both style and service. She loved to cook, to gather people, and to create spaces where others felt seen and cared for. At the same time, she was a social justice advocate and someone who didn't shy away from naming inequities and working toward change. I chose to tell this story through her lens because she represents so much of what this book is about. She embodies both the brilliance and the burden that so many Black women carry - the strength, the giving, the leadership and also the unseen toll of navigating systems that were never designed with her in mind. Her life allows me to ground these broader conversations about racial trauma and health care in something deeply human and relatable.

By sharing her story, I'm honoring her legacy, but I'm also creating space for others to see themselves and their loved ones in these experiences. This isn't just about one woman, or one person, it's about generations of people whose lives and health have been shaped by systemic inequities, and whose stories deserve to be told with care, truth and dignity.

Q: You mention how the silencing of pain has a specific history for Black folks (and for other historically excluded communities). What is an example of what this history has looked like for Black people, particularly as a means of survival during slavery?

A: One of the clearest historical examples of this silencing is rooted in chattel slavery, where expression of pain was not only discouraged, it was dangerous. Enslaved people were often punished, beaten, or further brutalized for showing emotion, grieving openly or resisting in visible ways. In many cases, survival required suppressing fear, sadness and even physical pain. Showing emotion could make someone a target. So, people learned to endure in silence, not because they didn’t feel, but because feeling out loud came with consequences. That suppression became a form of protection. Fast forward, slavery is over, and many still tell their children to “shut up, or I will give you something to cry about”; that is passed down from slavery. I name how this became a pattern that carried forward. The expectation to “be strong,” to push through, to not show vulnerability, didn’t emerge in a vacuum. It was shaped by generations of needing to survive under conditions where expressing pain could cost you your safety, your family or your life.

Today, we still see echoes of that in health care settings, in workplaces, even within families, as there can be an unspoken pressure to minimize pain or keep going despite it.

Q: What happens when that strategy is continually practiced by subsequent generations, even after the need for it has been greatly diminished, or altogether eliminated?

A: When a survival strategy like silence is practiced across generations, it can begin to feel like identity rather than adaptation. What once protected people can start to constrain them. Even if the original conditions have shifted, the body and mind may still respond as if the threat is present. That can show up as emotional suppression, difficulty naming or expressing needs, chronic stress or a sense that vulnerability is unsafe. People may carry pain privately for long periods of time, delay seeking care or minimize their own experiences, even in spaces that are meant to support them.

Over time, that has real consequences. It can impact mental health, relationships and physical well-being. It can also reinforce systemic gaps because when pain is unspoken or dismissed, it becomes easier for institutions to overlook it.

Q: Your grandmother’s silence, and that of so many other people, was the result of “a system that was never built for us.” Can you talk a bit about how the system was built in a way that has excluded Black people and other communities?

A: From the beginning, we were considered three-fifths human, and there were policies and practices that limited access to quality care, segregated hospitals and excluded Black professionals from training and leadership. Even beyond that history, the systems we still rely on today were built on research, standards and norms that often centered White populations, while overlooking cultural context, lived experience and the impact of racism on health.

Q: In your work, have you seen ways that this exclusion has been successfully reversed? That the system is repairing this longstanding exclusion?

A: I’ve seen meaningful steps, but I would describe them as progress and not full repair. There are more conversations happening now about equity and culturally responsive care. Those same conversations are also being banned and penalized today. We were seeing increased investment in community-based organizations, more diverse providers entering the field, and models of care that center lived experience, like peer support, culturally specific therapy and community-rooted healing spaces. Sadly, within the last year, those things that were increasing are now decreasing and being banned in many places.

I was seeing the collecting of better data, acknowledging bias, and in some cases redesigning services to meet people where they are, rather than expecting people to adapt to the system. We just saw how (Secretary of Department of Health and Human Services Robert F. Kennedy Jr.) painted “Black” as a bad word and did not want certain race-based data being collected, or specific race-based treatments that would improve disparities (in a lawsuit filed by a group of parents and Head Start providers last year, against Kennedy in his official capacity as head of the department, are a list of nearly 200 words that some Head Start programs were instructed to remove from their funding applications. Those words included “racism,” “equity,” “disability” and “Black,” among others). The reality is that the foundation of many systems hasn’t fundamentally changed, and in some ways, are getting worse.

Q: Are you comfortable talking about your own experience with quietly carrying your pain/trauma? What did you find you were keeping silent, and why?

A: Yes, I am. In the book, I share my own experience with depression, suicidality and what it looked like to be struggling deeply while still showing up to the world with a smile. From the outside, I appeared OK. I was functioning, achieving and holding space for others. But internally, I was carrying a level of pain that I wasn't naming out loud. Part of that silence was shaped by what I had learned about being strong, about not burdening others, about keeping it together, and much of it was generational.

There's also the reality that, as a therapist and as a Black woman, there can be an added pressure to be the one who is helping, not the one who is struggling. For a long time, I kept parts of my experience to myself, even when I needed support. What I've come to understand, and what I name in the book, is that silence can be a form of survival, but it can also deepen isolation. Healing, for me, began when I allowed myself to be honest about what I was carrying and to receive support without shame. Sharing that part of my story was intentional and about disrupting the idea that you have to look like you're falling apart to be struggling, and creating space for others to recognize themselves and know they don't have to carry it alone.

Q: As you began your work to heal from your own silence, what did you do? What worked for you, and what have the results of that looked like?

A: As I began to heal from my own silence, I started writing and then with therapy. Therapy wasn't always helpful at first. In fact, for me, it was harmful in many ways. It took time to find a therapist who truly saw me and could hold space in a way that felt culturally responsive and aligned. Once I did, it became a critical part of my healing. Writing gave me my first place to be honest without filtering and for me to process what I was carrying. What worked was allowing myself to stay in the process, even when it wasn't easy or immediate.

Q: Can you talk about culturally responsive care? What does this mean, and what is an example of what this looks like in practice?

A: Culturally responsive care means providing support that recognizes and respects a person’s cultural background, lived experiences, and the impact of systems like racism on their health and well-being. It goes beyond awareness. Essentially, it’s about actively adapting care so people feel seen, understood and safe. In practice, this looks like a provider not only asking about symptoms, but understanding context. For example, instead of dismissing a Black client’s anxiety as purely individual, a culturally responsive therapist might explore how experiences with racism, workplace bias or generational stress are contributing to what they’re feeling. They create space for those conversations without minimizing or pathologizing them.

Culturally responsive care shows up in communication by using language that resonates, honoring cultural values, and not making assumptions. Now, this does not mean using Ebonics, or cultural language you never would use just because you have someone in front of you who you think uses that language. It can mean connecting clients with providers who share or deeply understand their background, or integrating community, spirituality and family into the healing process when that’s important to the client.

At its core, culturally responsive care is about shifting from “What’s wrong with you?” to “What have you experienced, and how can I support you in a way that honors all of who you are?”

Q: What is the best advice you've ever received?

A: The four agreements: be impeccable with your word, don't take anything personally, don't make assumptions and always do your best.

Q: What is one thing people would be surprised to find out about you?

A: I have been to over 60 countries and swam with three different types of sharks across the globe.

Q: Please describe your ideal San Diego weekend.

A: I love the beach; it was one of the major selling points getting me here. I tend to walk back and forth from Mission Beach to Pacific Beach.

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This story was originally published May 2, 2026 at 6:16 AM.