There is a difference between being a racial or ethnic minority in this country and simply being unique. For Americans of color, the othering experience is far starker, and often more dangerous, than it is for even the quirkiest white people. As I described in a 2018 Atlantic article, several studies191 have now shown that racism might help explain why black women like Joi are about 50 percent more likely than white women to give birth prematurely. There might be several possible mechanisms at play, including racism-induced stress sending the body into labor too soon.

What’s more, income doesn’t appear to inoculate minorities from the stress of discrimination. Even when compared to the same class of white medical-school graduates, African American doctors were more likely to suffer from cardiovascular disease and diabetes twenty-five years later.192 Perhaps what ate away at them was what W.E.B. Du Bois called “double consciousness,” or the fact that even successful African Americans are forced to constantly be “measuring one’s soul by the tape of a world that looks on in amused contempt and pity.”193

Joi’s son, Alexander, stopped breathing at least four times a day, and it became harder and harder to revive him each time. He also had pneumonia and a problem with his heart, and he had to be intubated. He was too small for the tube, so the doctors had to push it down his throat, scarring it on the inside. In all, Alexander was in the hospital for six months before being released to a regimen of oxygen tanks and specialists. During his first winter, Joi had to keep Alexander quarantined inside the house.

Joi, who now does web development and works in academia, tries not to dwell on racial grievances. But there were incidents that made her wonder. There was a time in a bar when she felt her hair moving, and turned to find a man groping it. There was another time in a restaurant in a gentrified hipster neighborhood when a waitress threatened to call the police because Joi’s boyfriend had knocked over a bowl. Thinking of the woman’s eagerness to call the cops on a black man, Joi worries about her son.

Joi loved engineering school, but work was another story. The place where she worked—she asked me not to say where—was dominated by white men. They would “mansplain” to her, take credit for her ideas, and express surprise when she finished projects quickly, she said.

You “push your feelings down,” she told me, “so you won’t be the angry black woman.” But your feelings can affect you, even from deep down.

People often feel injured when they’re lonely or socially excluded, and inside their bodies, it’s almost as though they are. But some of the worst consequences of social exclusion might be the ones that occur in the mind.