Poverty, violence, and trauma

By Jeanne Felter

On Dec. 14, the nation observed a somber anniversary. It had been a year since a troubled young man stormed into Sandy Hook Elementary School in Newtown, Conn., and opened fire on innocent children and adults. By the time the shooting ended, 20 first graders and six adults had been killed in this violent tragedy.

It's difficult to imagine the grief and emotional toll borne by the families who lost loved ones on that sunny December day, shortly before Christmas. And what about the hundreds of schoolchildren, teachers, and others who were witness to the carnage?

The unfortunate truth is that trauma is all around us. The state of our world is such that violent acts are increasing and people are faced with unimaginable hardships more frequently. In the last 15 months, the United States has suffered through the devastation of Hurricane Sandy, the Boston Marathon bombings, and devastating tornadoes and wildfires, in addition to the massacre at Sandy Hook.

These are the "Big T" traumas - war, terrorist attacks, school and workplace shootings, plane crashes, and natural disasters - that capture media attention and elicit grief, anger, and fear from millions of people.

As a clinical therapist, I understand too well the impact of this type of large-scale traumatic event. But it's also important to recognize that tragedy exists pervasively in the everyday human experience.

In Philadelphia, we see this type of day-to-day trauma in the lives of children and adults who are living in poverty - struggling to survive, to feed themselves and their children, to have a roof over their heads, and to stay safe in some of the most violence-prone areas of the city. The impact of pervasive poverty on the citizens of Philadelphia is enormous.

Just recently, The Inquirer had a front-page story with the headline "Poverty Rising." Based on just-released U.S. Census Bureau data, the story reported that the overall poverty rate in Philadelphia this year is 26.9 percent - the highest rate of any U.S. city with a population of more than one million. In the Lower Northeast section of the city, there has been a startling 62 percent increase in poverty since 1999.

What does this mean for our city and for the children being raised in impoverished neighborhoods?

The adverse effects of poverty on child development have been well-established in research. Poverty has been identified as one of the most powerful risk factors leading to poor developmental, cognitive, and academic outcomes. Children living in poverty are at higher risk for antisocial behaviors and mental disorders, according to a 2013 study published in JAMA Pediatrics, a journal of the American Medical Association. Research also shows that people with lesser social status are more likely than others to be victimized. This is what we see daily in Philadelphia - children growing up in extreme adversity being repeatedly traumatized by their circumstances.

As a clinical consultant to a child-violence prevention program, I often hear such grim cases as that of an adolescent who was shot and later assaulted in his neighborhood, and who is now expressing suicidal thoughts. Another teen dropped out of school and relocated after a sibling was shot and killed.

These may seem like extreme cases, but, unfortunately, many of us in this field do see clients similar to these in our caseloads. Most of my clients, however, are children - they may have parents who are incarcerated or are victims of neglect and abuse. Because of the high rate of poverty and its deleterious effects, cases such as these are far too common in Philadelphia - and other cities with similar demographics.

Acknowledging these problems, of course, is far easier than solving them. Certainly there are some positive efforts underway in Philadelphia, which is serving as a model for other cities in recognizing the need for trauma services. And programs such as Philadelphia University's program in community and trauma counseling, where I work, are helping to address the significant shortage of trauma-informed mental health professionals in the field.

As we reflect and grieve anew about the children and teachers who were killed at Sandy Hook, let's also recognize the everyday trauma in the lives of children and families who face the extreme adversity associated with living in poverty. Let's resolve to do a better job of meeting their needs, even if they do not make the evening news.