Stories about life in Liddonfield housing project and its impact on the Northeast Philadelphia neighborhood of Upper Holmesburg. These true stories reveal how government policy affected the lives of real people, from the project residents to area homeowners during the 5 decades of Liddonfield’s existence. Stories and articles are written by a former resident of the project.


Rosemary Reeves, Blogger, standing on Philadelphia Skyline

Nov 8, 2010

The Psychiatry of Public Housing

Under the US government’s HOPE VI Program, only a fraction of public housing residents forced from housing projects slated for demolition will live in mixed-income neighborhood developments.  Most will receive housing vouchers which pay a portion of their rent.  The idea is that poor people will have the opportunity to live in better neighborhoods.  In theory, this will afford them a better quality of life.  But being poor in a neighborhood where everyone else has a higher income can be bad for your health, Stanford University School of Medicine researchers have found after doing a study on the subject. 
In an article in Science Daily entitled, Poor People In Well-to-Do Neighborhoods Face Higher Death Rate, Marilyn Winkleby, PhD, associate professor of medicine at the Stanford Prevention Research Center and lead author of the study, says results indicate that the higher cost of living in a more affluent neighborhood leaves less money for doctor’s visits and healthy food.
But there was another twist - being poor in an affluent neighborhood can be psychologically damaging.  “A discrepancy in a person's social position relative to others may have an effect on a person's health, said Winkleby. "You look out every day and you're at the bottom of the social ladder," she added.
Will the people who use HOPE VI housing vouchers develop psychological problems from being poor in an affluent neighborhood?  Will it affect their self-esteem to be around more affluent people?  Will they find themselves clearly unwanted in their new neighborhood?  Will they be judged unfairly by the people around them?  How will their children be treated by the more affluent children of the neighborhood?  What if it does create psychological problems? 
And if they should want to seek psychiatric advice, will it help or hurt them?  Dr. Laura Schlessinger proved that psychiatrists are capable of doing irreparable harm to their patients when she used the “N” word repeatedly on her radio show after a black caller complained that her white husband’s friends used racial slurs in front of her.  Dr. Laura did us all a favor by revealing her own incompetence.  Furthermore, her actions proved that psychiatrists can be narrow-minded, prejudiced or insensitive despite their claims to be otherwise.  The danger is that psychiatrists hold tremendous power over their patients, many of whom have the false assumption that because the doctors of psychiatry have impressive degrees from prestigious universities, they must know it all. 
People who seek psychiatric help often feel powerless and they’re supposed to.  Traditionally, the psychiatrist-patient relationship is meant to be an unequal one.  Questioning the psychiatrist’s advice or method of treatment throws the whole psychiatric session out of whack.  It’s practically a script and the patient has to play along.  If the patient admits needing help, yet wants to be his own advocate, the psychiatrist may well become offended.  Yes, offended that you dare question their authority.  They are quite proud of their university degrees and because of this, some psychiatrists have a sense of superiority over their patients.  The best kind of patients are the obedient ones who unquestionably follow the psychiatrist’s advice and take the nice little pills they’re prescribed.  Dr. Laura is case in point.  When the caller questioned her advice, Dr. Laura became livid and attacked the caller with racial slurs. 
The poor are especially vulnerable to bad psychiatrists because they can’t afford to shop for a good one.  And if you’re poor or black, you’d better hope you don’t run into an inept and dangerous psychiatrist like Dr. Laura Schlessinger.  Unfortunately, there are a lot of bad psychiatrists out there.  People shouldn’t just assume that all of them know what they’re doing.  
Even if you find one that is genuinely interested in your welfare and has the necessary skills to help you, the fact is that most psychiatrists come from privileged backgrounds.  All they know about the poor is what they have read in textbooks.  While some may have treated the poor for a limited amount of time as part of their psychiatric training, the traditional methods utilized enforce the unequal psychiatrist-patient relationship.  If the only interaction a psychiatrist has ever had with poor people is to treat them as patients, they will develop a warped view of low-income people in general.
Psychiatrists tend to treat low-income patients like children and the poor often go along with it.  Sadly, many low-income people are resigned to being treated like children their entire lives by authority figures.  Their lack of education (not to be confused with lack of intelligence) leaves them uninformed about their rights, long-term side effects of psychiatric medicine and potentially harmful psychiatric methods.  Also, people who were born into poverty lack the sense of entitlement that middle-class and upper-middle-class people are raised with.  Many feel they don’t deserve any better than a random psychiatrist at some urban clinic that offers psychiatric services for free.
Unfortunately, the poor are used to feeling powerless because they often are.  This leaves them vulnerable when being treated by bad psychiatrists and even more so when they are troubled, in despair or don’t know where else to turn.  Even a psychiatrist with excellent skills and a heart of gold is greatly handicapped when treating them as patients, unless the psychiatrist has experienced poverty first-hand. 
Psychiatrists will never admit it, but their privileged upper-middle-class backgrounds can render them clueless when treating someone with poverty-related issues.  For example, in my twenties I decided to make an appointment with a psychiatrist for advice about something that had been bothering me since childhood.  At eight years old, I went through a very abrupt and painful transition from Liddonfield Housing Project to a lower-middle-class neighborhood.  Some of the new neighbors forbade their children from playing with me simply because I was from the projects.  I suffered years of harassment by neighborhood children who teased me relentlessly about being from Liddonfield.  They followed behind me in groups, laughing because my shoes had holes in them and made fun of my second-hand clothes.  One day, they chased me for blocks and I had to climb a padlocked fence to get away. 
In my adulthood, it took everything I had to get over the sense of worthlessness their mistreatment caused.  I eventually lived a comfortable life and my self-esteem recovered.  But as I began to feel better about myself, feelings of resentment set in over the injustice that had been done to me.  At the time I decided to see a psychiatrist, I was not having any serious problems in my life.  On the contrary, everything was going well.  I felt ready to put the traumatic experience of changing social class behind me and make my peace with it.  I just needed a little guidance in how to do that.  I thought this was the place where I could have a down to earth talk with someone knowledgeable regarding the psychology of changing social class.
I had excellent insurance through my job, so this was a beautiful office and I assumed I would be getting the best help available.  Before I was assigned to a psychiatrist, I had to undergo an evaluation.  This consisted of answering some probing questions.  When the evaluation was finished, I asked to be assigned to a black psychiatrist, if they had one on staff.  The woman evaluating me was taken aback.  “That’s an unusual request,” she said, “May I ask why? I mean, you’re not African American.” I thought a black psychiatrist would know what it’s like to have been poor (if he or she came from a low-income family), I explained.  Even if the black psychiatrist had a privileged background, surely he or she would at least know what it’s like to have experienced prejudice.
Sadly, there was no African American psychiatrist on staff.  I wondered what black patients must think when they hear that.  If there were black patients here, that is.  I looked around the room and all I saw were white people.  Then I wondered how many black psychiatrists there are in the U.S. and where I might find one. 
I was led into an empty office and examined the impressive degrees hanging on the wall while I waited.  They were from a few universities, all of them Ivy League.  This psychiatrist obviously had an upper-middle-class background, if not a wealthy one.  I felt a twinge of admiration mixed with jealousy.  How I would have loved to attend Harvard.
The door opened.  A white, middle-aged, cookie-cutter psychiatrist entered.  He caught me looking at his degrees.  I asked him a few questions about Harvard and let him know it had always been my dream to go there.  Although attending Penn State was nothing to sneeze at.  Still, I would have jumped at the chance to be a Harvard girl, I told him.  He glowed with pride when discussing his Harvard education.  We seemed to establish a rapport almost immediately.  The truth is I was secretly using psychology on him.  Before discussing the fact that I used to live in a housing project, I wanted to him to know that I was intelligent and educated.
He sat down at his mahogany desk and I into the black leather patient’s chair.  “What brought you here?” he asked.  Whether the woman who evaluated me didn’t tell him or that question was just par for the course, I don’t know. 
I glanced at his degrees once more.  “Let me ask you something.  Are you from a wealthy family?” I inquired. 
He raised his eyebrows in surprise and fidgeted.  “I wouldn’t say my family was wealthy,” he remarked, “but we were quite comfortable.”
I nodded.  “Upper-middle-class?”
“Yes,” he answered, “I would say we were upper-middle-class.”  I had expected him to dodge the question.  This was perfect.  Now, we were getting somewhere.  I brought up my traumatic experience of changing social class.  I then admitted to having feelings of resentment toward middle-class and upper-middle-class people, because of the mistreatment I suffered.  However, I also pointed out that I did not wish to feel that way.  I hoped to eventually make peace with what happened so I didn’t have to be resentful anymore. 
“But now I’m wondering how someone from an upper-middle-class background can even begin to understand what I’ve been through,” I blurted out.  He fidgeted some more in his chair.  Clearly, our discussion was making him uncomfortable and even worse, now I was questioning his expertise.  Deviating from the submissive patient role was throwing his game out of whack.  He reassured me that he had read a lot of books about poverty and there were classes on it at Harvard.  Studying poor people was part of his intense training, he said.
“That’s just typical of you rich people, isn’t it? That you think you can know all about us from reading books,” I said.  Now, I was the one with the superior attitude.  It was a way of getting my come-uppance against all the people who thought they were better than me.  My emotions were coming to the fore.  Learning about his wealthier background triggered old feelings of rejection.   In a sense, I was re-living the trauma I suffered at the hands of my middle-class neighbors, only this time I was standing up to them.  It felt good putting someone richer in his place.  It was unexpected, too, because I came there for help, not vengeance.  But something happened to me when I dwelled on the past.  Instinctively, I used a combination of book smarts and street smarts to disarm and confuse him.  Vengeance came with a sense of power.  It was power I wanted and so I went on the attack like a street thug with stealth.  As a psychiatrist, I suppose he should have known this and attempted to analyze my behavior.  But he became offended instead. 
“What do you mean by, you rich people?” he asked in an accusatory manner.
I stood up.  “You can’t help me,” I replied, “I know that now.  Sorry.  This session is over.”
Looking back, I suppose I was a psychiatrist’s nightmare.  I walked into his office assuming ours would be an equal relationship.  I charmed him only to catch him off guard minutes later.  I asked him probing questions about his own family background then put his skills as a psychiatrist into doubt, victimizing him when my latent resentment surfaced.  I may have been victorious in the moment, but I was still handicapped by unresolved trauma.  I later regretted my behavior in the psychiatrist’s office.  My own prejudice got in the way.  He could not help being born into an upper-middle-class family any more than I could help being born in the projects.  That psychiatrist may not have been able to completely understand me, but he may have been able to provide some morsel of information that could change my life.  Now, I would never know.  In the next decade, psychiatrists may encounter more patients like me as HOPE VI children grow up.  Ideally, they will be prepared to deal with educated but traumatized poor people with a bone to pick with their more affluent, judgmental neighbors.

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