Watching the unsettling video of George Floyd crying out for his mother while gasping for air made Gwen Carr, the mother of Eric Garner, "relive her son's death."
Put in a choke hold by a New York City police officer in 2014, Garner's cry of "I can't breathe," became a symbol of the Black Lives Matter protest movement.
Six years later, flame and smoke fill the night skies in cities across America as protestors demand justice for Floyd, the unarmed and handcuffed black man in Minneapolis who died after gasping "I can't breathe" as a white police officer pressed a knee into his neck.
More recent video shows as many as three officers may have held him down.
"No matter what he did, he wasn't doing anything to threaten them, so why would they kill that young man? Just like they killed my son," Carr told CNN on Wednesday.
"I don't condone violence, but I understand it," said Carr days later, speaking out about the fires, looting and destruction happening in cities like Atlanta, Denver, Milwaukee and Minneapolis. Protests, some peaceful, others violent, have spread to at least 30 cities nationwide.
"When something like this happens you just combust, everything just comes out," Carr said.
We all suffer racism vicariously
Angry demonstrators point to Floyd's death as yet another example of brutal, systemic racism that has led to the recent deaths of Breonna Taylor, an EMT who was killed in March after officers forced their way inside her home, and Ahmaud Arbery, the 25-year-old unarmed black man shot while taking a jog in rural Georgia in February.
Witnessing acts of racism via video, radio or social media can produce fear, anger and outrage, but even those who don't take to the streets can experience significant emotional distress.
Experts call it "vicarious racism." You don't have to be the victim to be harmed.
"I think of it as like a secondhand racism, similar to secondhand smoke," said Chicago pediatrician Dr. Nia Heard-Garris, who chairs the minority health, equity and inclusion committee of the American Academy of Pediatrics.
"Even though you're not the one to smoke or in this case to directly experience racism, you still might experience the negative health impacts," she said.
Studies show that race-related stress is a significantly more powerful risk factor for poor mental health than stressful life events. It can contribute to anxiety disorders and depression. It can also impact heart rate, raise blood pressure and create chronically elevated levels of the stress hormone, cortisol, which can in turn lead to cardiovascular disorders and diseases.
"Some people think only black and brown folks who see themselves as potential victims will identify and experience health impacts," Heard-Garris said.
"But we have data that shows despite color, if a person is exposed to racism, it hurts them too. It really actually hurts all of us."
A bigger burden
There's no doubt that African American and Latino families carry the biggest burden from systemic racism and police brutality.
Black Americans are nearly three times more likely than are white Americans to be killed by police and five times more likely than white Americans to be killed unarmed, according to the Mapping Police Violence database, which has tracked police killings in the USA since 2013.
A study last year found nearly 40,000 of 103,710 black Americans -- more than one-third -- had been exposed to one or more police killings of unarmed black Americans in their state of residence in a three-month period prior to the survey. Feelings of stress, depression and problems with emotions increased with each additional killing.
A 2018 Pew Research Center report found nearly four in 10 Latinos say they have been called offensive names or experienced discrimination or unfair treatment because they are Hispanic. Feelings of racial discrimination can lead to higher levels of psychological distress, suicidal thoughts, anxiety and depression, according to the American Psychological Association.
Children are hit the hardest
Heard-Garris studies the impact of vicarious racism on health, especially children's health. She says observing racism in the media or hearing about it from friends may transmit trauma to children as they imagine their parents, siblings or even themselves in place of the target.
She published a systematic analysis of some 1,300 studies and found kids that experienced vicarious racism were more likely to have low self-esteem, use illicit substances, and suffer with anxiety and depressive symptoms.
"The biggest kind of health impacts are the behavioral health issues," Heard-Garris said. "Some kids will show aggression and other negative behaviors. Others will go within and be socially withdrawn, be distant from others and not seek help when they really need it."
Dr. Jacqueline Dougé, who co-authored the AAP's statement on the impact of racism on child and adolescent health, points to images on social media that show young children at the protests happening around the country holding up signs "fearing they may be next."
"It's going to have an impact on any child's physical and emotion health," Dougé said. "So we need to turn it off and really engage with our kids and make sure that they're okay."
Vicarious racism hurts adults
The same applies to adults who've seen agonizing images such as George Floyd's arrest and death, and now feel fear, frustration or rage.
"We also need to tune in to our own emotions as adults and check that we're OK," Dougé said. "And if we're not OK, then we got to ask for help. We've got to get help to deal with the trauma and emotional impact of these images."
But adults also have a responsibility to stop the cycle of racism and violence, said Kira Banks, a clinical psychologist whose website "Raising Equity" provides videos and resources on how people can cultivate an open mind in themselves and their kids.
"Is this a teachable moment? Absolutely. It must be, it has to be," Banks said. "And if a person hasn't done the work to understand the history of racism and discrimination in America they should do so, and then join us in raising our children to see and disrupt racism, and be the change we want to see."
It's time to speak up and call racism what it is, Dougé said.
"If as a human being, you understand that another human being debased, dehumanized and not treated like you are just because of the color of their skin, I think it's important to feel something. I think is important to acknowledge privilege," Dougé said.
"I think it's important to ask what am I not doing by being silent that perpetuates this? How do we open the door so that everyone sits at the table? That's only done when each of us understands that we have the power to do that."