This City Is Killing Me: Community Trauma and Toxic Stress in Urban America (pre-order)
By Jonathan Foiles
August 6, 2019
When Jonathan Foiles was a graduate student in social work, he had to choose between a mental health or policy track. But once he began working, he found it impossible to tell the two apart. While helping poor patients from the South and West sides of Chicago, he realized individual therapy could not take into account the importance unemployment, poverty, lack of affordable housing and other policy decisions that impact both individual and community well-being. It is easy to be depressed if you live in a neighborhood that has few supportive resources available, or is marred by gun violence. We are able to diagnose people with depression, but how does one heal a neighborhood?
This City Is Killing Me: Community Trauma and Toxic Stress in Urban America, brings policy and psychology together. Through a remarkable set of case studies, Foiles opens up his therapy door to allow us to overhear the stories of Jacqueline, Frida, Robert, Luis, Anthony, and other poor Chicagoans. As we listen, Foiles teaches us how he diagnoses, explains how therapists before him would analyze these patients, and, through statistics and the example of Chicago, teaches us how policy decisions have contributed to these individuals’ suffering. The result is a remarkable, unique work with an urgent political call to action at its core.
Praise for This City is Killing Me:
"Chicago-based mental health clinician Foiles looks at the many ways in which urban poverty, crime, violence, and other socio-economic factors can destroy a life.'We diagnose people, not cultures or neighborhoods,' writes the author. If neighborhoods were to be diagnosed, some might be sociopathic—but seldom through any fault of their own. For example, he writes of the Cabrini-Green housing project that sprang up in the 1950s and '60s, providing poor African Americans with public housing in neighborhoods in which they were then not the majority. "To live in Cabrini-Green or any of the other housing projects was to be constantly reminded that you didn't matter," writes Foiles: You were surrounded by rats, barbed wire, garbage, warring gangs, and indifferent police and public agencies whose attitude was that the people who lived there were on their own. Small wonder that those in such environs experience trauma, manifested in many ways. The author offers five such case studies. In the case of 'Robert,' who grew up in Cabrini-Green, the trauma manifests in PTSD accompanied by literal delusions of grandeur, all of which "read like a novel." Another patient is categorized as a "frequent flyer," someone without regular access to medical services so that she must resort to emergency services for every medical encounter, at tremendous cost. The whole enterprise, Foiles writes, is wrapped up in white privilege. The white power structure of Chicago has steadily whittled away services in poor, minority neighborhoods, from public schools to hospitals and mental health clinics. There is seldom any opportunity to intervene at early signs of trauma and illness and seldom much official interest shown in doing so. The author closes with the exhortation that what is needed is 'a modern-day Poor People's Movement to aid those who by circumstance of their birth are at a higher likelihood of experiencing suffering in all its forms.' An urgent call for reform worthy of serious consideration." -- Kirkus Reviews
"We rediscover the trauma of everyday life in urban America as Jonathan Foiles documents the course of his practice as a psychotherapist in the most hard-pressed surrounds of Chicago. He explores the conditions that perpetuate the experience of oppression, demoralization, and suffering, challenging us to rethink what it means to speak of help and care. He brings a moral energy and a muscular pragmatism to his conceptions of therapeutic action and hope." —William Borden, PhD, Lecturer, School of Social Service Administration and Department of Psychiatry, University of Chicago
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