The Great Divide: Trauma and Social Class

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10THE GREAT DIVIDE:TRAUMA AND SOCIAL CLASS

In this cha pter, I discuss the various definitions and expressions of so-cial class status, exam ining both socioeconomic status and the possession ofsocial capital as aspects of social class. Passing and assimilation as response toclassism and shame are explored. The role of poverty in greatly increasingrisk of trauma exposure is examined.

Social class is the great hidden aspect of social location in the UnitedStates, one that is hidden in psychology's discourse as well (Lott & Bullock,200 6). Many people living in the Un ited States today were raised to see it asan exp licitly classless society, held up in adm iring contrast to the highly so -cially stratified worlds of Europe from whence the original European invad-ers of this continent cam e. A discourse of classlessness has had several func-tions. First, it has operated to obscure the realities of income disparities inthe United States, particularly disparities within the broad swath of the p opu-lation that self-identifies as middle class. Second, it has functioned to castshame and stigma on the poor, especially those who are chronically caughtin poverty, with all of the social and emotional distancing associated withstigma (Lott, 2002). Third, it has upheld the American narrative of ruggedindividualism, the notion that any one person by her- or himself can "pull

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oneself up by the bootstraps" and obtain a higher social status and income.This narrative implies th e converse as well, that those not successful finan-cially have failed to exercise initiative, work hard, or seek success and arethus solely at fault for their poverty or financial struggles. Finally, the dis-course of a class-free society obscures th e power resting in the hands of thevery rich by making them invisible except as objects of prurient interest ingossip media and thus obscures th e ext reme difference in resources availableto rich people and poor people.

In the past decade this discourse of the classless society has begun tocrumble. Some of this reflects social forces at work since the early 1980s.Much of the classlessness na rrativ e of the middle 20th century was derivedfrom th e post-World W ar II successes of union s and the c ontin uing effects ofth e policies of the New Deal and then th e Great Society. Each of these socialphenomena had the temporary effect of smoothing out economic differencesamong social classes by creating more equitable distribution of income andby ensuring good w ages fo r blue-collar unionized workers. Generous veteran'seducational and housing b enefits available to returned troops of World W arII and the Korean War had sim ilar imp acts on the landscape of Americanlife.

But with th e election of Ronald Reagan and the ascendancy in Ameri -can politics of social forces whose credo has been the reduction of spendingon social programs, education, and health care, th e gains made in incomeequalization have become slowly but surely unraveled, to the extent thatdiscussion of social class advantage and disadvantage are now part of thepublic dom ain, with med ia pun dits opining abou t a "war on the middle class."During th e past almost 3 decades man y of the social program s that allowedmovement within levels of income and education have been undercut ordestroyed, leaving poor and work ing-class people with decreasingly few op-tions fo r changing their economic circumstances. Unions have shrunk, andth e percentage of the workforce represented by unions has diminished intandem . Because of free trade agreements, formerly well-paying w orking-classfactory jobs have disappeared, with work shipped to developing countrieswhere labor can still be cheaply exploited. Classism also directly affects ac-cess to educational resources in the classroom (Lott & Bullock, 2006); be-cause school districts in the United States are tax supported at the locallevel, poor communities have less money to spend on education than dowealthy ones. As the costs of postsecondary education have risen, fundingfor students to obtain such education has fallen; more students start collegetoday, but a sm aller percentage com plete it, and most of those who do suc-ceed in obtaining a bachelor's degree emerge laden with debt. In tandemwith th e increased frequency of discourse about class in the general media,psychologists are also attending more to the issue of social class, exploringboth why it has been neglected and how it affects people's well-being (Lott& Bullock, 2006).198 CULTURAL COMPETENCE IN TRAUMA THERAPY


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Historically, psychology has been most concerned with mental healthissues as they pertain to very poor people and has had some impact as a disci-pline in reducing stigma associated with poverty (Bullock, Wyche, &. Will-iams, 2001) . But classism, defined by Bullock (1995) as "the oppression ofpoor people through a network of everyd ay practice, attitude , assum ptions,behaviors, and institutional rules" (p. 1 19 ), as w ell as internalized ckssism, thepresence of bias against oneself for being poor, persists among psychothera-pists. C lassism is not reserved only for the poor; it also affects people who areworking class. This is in part because working-class people frequently live onthe slippery slope that can lead to poverty. Because trauma exposure is oftenimplicated in a person's economic difficulties, attitudes toward people of otherthan middle-class status can infiltrate and negatively affect psychotherapy w ithtrauma survivors. Traum a exposure can undermine a person's shaky status inthe middle class, leading internalized classism and classist oppression to be-come contributing factors in the posttrauma experiences of a survivor.Social class in the United States does not exist separately from othersocial locations. Because of racism , sexism, heterosexism, ageism, and ableismand their individual and collective impacts on access to economic resources,education, and high-paying wo rk, social class is not evenly distributed acrossall groups in American society, nor is absence of social d esirability ascribedto working or poverty-class status evenly distributed either. Larger percent-ages of communities of color in the United States live in the working orpoverty classes, although th e bulk of working- and poverty-class people areEuro-American. Classist bias thus is frequently tinged by racism, becauseracist bias often contains classist assumptions. Women are more likely to bepoor than are men with similar levels of education because jobs at all levelstend to pay women less than men. Poor women are also more likely thanpoor men to be parents, which means that poor women's challenges in ob-taining material resources affect not only themselves but their children. Re-search on lesbian, gay, and bisexual (LGB ) people shows that holding steadysuch factors as years of education an d other demographic variables, LGBpeople earn significantly less annual income than their heterosexual coun-terparts. People with disabilities are disenfranchised from the wo rkforce; ifpeople access governm ent disability benefits, they are constrained from makingmore than a small amount of additional m oney, often forcing people w ithdisabilities into the choice between medical coverage linked to disabilitybenefits or entering a workforce in which their medical care needs are un-likely to be met. Age discrimination in employment affects many peopleunder 18 and over 55; children are more likely to be in poverty than anyother dem ographic age group. Thus a range of other forms of oppression op-erate to conflate poverty and near-poverty status with other target sociallocations. The stigma and negative biases associated with membership inthese other target groups accrue to the stigma associated with poverty orbeing w orking class.

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Social class has a circular relationship with trauma. People who arepoor or working class are more likely to have exposures to some kinds oftrauma and also less likely to have the resources with which to respond to at rauma when it does occur. In fact, extreme poverty in the United Statesmeans almost certain exposure to endemic forms of trauma such as violenceand dangerous housing conditions; if one is poor in this country, trauma ofsome sort m ay well be inescapable. Middle- and upper-middle-class people,whose class status is largely dependent on continued participation in thepaid workforce, are vulnerable to economic disruptions catalyzed by the af-termath of trauma exposure in ways that very wealthy people, whose finan-cial well-being is not related to their ability to appear at work regularly,arenot. Disruption in earning capacity can lead to a fall in class status, whichcan be experienced by and of itself as traumatic depending on what that classstatus represents emotionally to individuals and their culture.

Although the film House of Sand and Fog (Perelman, Dubus, & Otto,2003) is also a commentary on immigration an d social dislocation, it is largelyabout how social class and trauma are interrelated. One of the main charac-ters is an Iranian man who has lost his social class status and been forced toflee to America after th e 1979 Islamic Revolution; although he works as aday laborer and as a clerk at an all-night gas station, he finds th e notion ofhaving his actual poverty exposed sopainful that he eventually commits ter-rible crimes and then kills himself, rather than have the reality of his povertyexposed. The other main character, impoverished because she is apracticingalcoholic an d exposed to homelessness an d violence as a result, is so under-mined in her functioning by the loss of resources and home that she toodescends into violence.

Ironically, wealthy people are at some risk of having their trauma expo-sures ignored or perceived as inconsequential given th e apparently shieldingeffects of financial privilege; th e trauma of wealthy individuals can betrivialized or minimized with sometimes deadly consequences (Wolfe & Fodor,1996). Grethe exemplified that conundrum. She was raised in an upper-classSwedish family, married an older and also wealthy man, and came with himto the United States as a young woman pregnant with her first child when heaccepted a job as a manufacturer's representative. Not long after her daugh-ter wasborn her husband began to beat her. The physical abuse, and accom-panying verbal and emotional abuse, continued for the entire 30 years oftheir marriage. One time she called the police, who came through the guard-house of her gated community to find her urbane, smiling husband tellingthem that there had been a misunderstanding. The terrible beating Grethereceived after that episode convinced her never to call them again. Her phy-sicians never asked her about her bruises; although all of them worked in amedical community with a high degree of awareness of domestic violence(DV) , her wealth and European background seemed to make the violenceshe was experiencing invisible. She was treated for 15 years by a psychiatrist200 CULTURAL COMPETENCE IN TRAUMATHERAPY


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wh o tried a var iety of antidepressant m edications w ith little success. Finally,after seeing a popular television show on which a famous woman spoke of herown DV history, Grethe felt emboldened to reveal her experience to herpsychiatrist. He imm ediately transferred her care, commenting that he knewnothing about DV. In her work w ith her subsequent therapist, she processedhow abandon ed and invisible she had felt. "I am the b ird in the golden cage,"sh e said one day. "Lovely designer cage, carpeted w ith thorns. But all anyonecould see were the golden bars."Culturally competent psychotherapy is conscious of and attends to is-sues of social class and interrogates it in a com plex and sophisticated m ann erthat includes an understanding of both the monetary and nonmonetary as-pects of social class status. It is important to note that when working withsurvivors of any sort of t rauma the contribution of class an d classism to theexperience is used as one means of deepening understanding of the experi-ence of trauma exposure.

WHAT CLASS?Current critical thinking about class suggests that social class status

derives from a person's location on two non parallel co ntinua and is not sim-ply a matter of income or financial resources. The first is the continuum ofactual income or access to real cap ital resources such as current income, sav-ings, inherited wealth, and other aspects of net financial worth. The second,which can be equally meaningful and is quite powerful psychologically, is thecontinuum of what has been referred to by some authors as symbolic or cul-tural capital. Symbolic capital refers to a person having attitudes, behaviors,values, and knowledge that are associated with education and higher classstatus or a family history of these. Thus, fo r instance, a person who is cur-rently living in poverty as a result of a posttraumatic inability to work butwho attended an Ivy Leag ue college and has an advanced degree is not sim-ply a poor person; she or he is a person with mixed-class status, which cancreate attendant confusion and shame or attendant resilience and feelings ofentitlem ent. She or he is also a poor person who kno ws how to work systems,how to dress for job interviews, and how to write a resume and a poor personlikely to have con tacts w ith college friends who can help network her or himto a job when she or he is ready.Conversely, the person who grew up very poor, never attended college,did very well in his work , and is now well-off financially and who, becauseof an absence of education, lacks sophistication about art and music orwhich fork to use at a formal dinner, is not simply a wealthy person, she orhe is also som eone of m ixed-class status, which may also lead to confusionand shame. Coffey (200 5) noted that "it is unlikely that upward m obility ofpersons from a lower class to an uppe r class will be comfortable, or the actual

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change in financial status will result in a fully realized transform ation of classstatus" (p. 12).The many psychotherapists who are themselves the beneficiaries of

cultural capital have little awareness of the advantage it gives them in theirprofessional education and practice until they encounter colleagues, all ca-pable and intelligent people, who seem confound ed by the things that middle-class and up per-m iddle-class people take for granted . I 'm one of those for-merly obtuse psycho therapists. Because of my own family's mixed -class status(m y parents grew up poor as children of imm igrants, went to college andbecame middle class, and raised their family in an upper-middle- to upper-class neighborhood), I never saw myself as having advantage. The fact thatin my public school I could choose to study any one of six languages, takeadvanced placem ent courses, and be coached continuously from fourth gradeonward about what I needed to do to apply to college and graduate or profes-sional school was simply the reality of life as I knew it. I felt shame becausemy mother did not know how to dress correctly, understanding only as anadult that she dressed like the working-class wom an she had been raised tobe and not like the upper-class mothers of many of my schoolmates. So Iaspired to look and sound like the teachers and scout leaders who, in retro-spect, we re those who demonstrated th e most markers of upper-middle-classstatus; their accents, their ways of dressing, their styles of affect expressionwere all what I emulated.

After attending a small private unde rgraduate school where m ost of mypeers were from the parallel universe of the Jewish-majority suburbs of citieseast of St. Louis, I was accepted into a doctoral program where I met , for thefirst time, people who lived in trailers. One of my classmates had grown up ina trailer and was pleased and thrilled that the one she was able to rent inCarbondale was larger and more modern than the ones she had inhabited asa girl. I can look back now with embarrassment and compassion on my re-sponse to this; why, I won dered, would anyone live in a trailer? When thissame classmate struggled with what seemed obvious to me about writing apaper or giving a talk in front of the class, I had no framework for compre-hending that she was struggling with class issues. I noticed that her styles ofdress and m akeup reminded me of my mother 's and told m yself that my dis-comfort with m y classmate was just a transference-like phenomenon. I didnot know then that I was being classist.

Because of this complexity of the meanings of social class, cultu rallycompetent practitioners engage the topic best by askin g their clients ab outthe economic and educational realities of their lives, both in childhood andadulthood in a descriptive way that will invite inform ation and decrease as-sociated shame. Bullock (Lott & Bullock, 2006) noted the surprise of hercollege students when she, a Euro-A m erican college professor, revealed tothem that although she grew up mostly in the middle class she also spentsome time growing up in pove rty, interm ittently hom eless and dependent on202 CULTURAL COMPETENCE IN TRAUMA THERAPY


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welfare paym ents to survive . Her story exposed the realities of class in Am erica;people do not always spend their lives entirely in one social class location,and middle-class status is a fragile phenomenon for man y, even those peoplewho are highly educated as were Bullock's attorney father and social workermother. Asking clients about whether family income was just enough, lessthan enough, more than enough, or changed at times, can be a useful strategyfor eliciting information about class status in a nonstigmatizing manner.Gathering information about the educational levels and occupations of pri-mary caregivers is also a useful source of data; asking about both formal andpractical education will make the picture of social class origins for clientsmore complete (Wyche, 1996).The apparent mutability of social class status, especially in the UnitedStates, sometimes leads to a discourse abou t the undeserving nature of pooror working-class people. America's radical individualism preaches that ifpeople are poor it is because they have not worked hard enough or beenwilling to try hard enough and are lazy or quitters. As Baker (1996) noted,class status, dissimilar to phenotype or sex, superficially appears to be easilychangeable through h ard work , education, or some combination of both.When trauma enters into this equation and affects a person's ability to work,learn, or participate either in upward mobility strivings or maintain currentlevels of income, the stigma associated wi th lower social status becomes wo-ven into the experience of trauma.Because so many psychologists an d other psychotherapists are them-selves middle-class persons, they often fail to appreciate the degree of privi-lege attendant on their class status, simila r to the way in which psychothera-pists and other persons of European descent often do not see the White-skinprivilege that makes life easier. Middle- and upper-middle-class people donot only have financial means. They also are possessed of cultural an d sym-bolic capital that allows for certain assumptions about safety, control, andaccess to medical, psychological, an d educational resources that are not readilyavailable, or available at all, to working class or poor people. Those psy-chologists who grew up poor an d working class an d have, through education,moved financially and professionally into a different class statu s than that oftheir raising may experience themselve s as imposters or frauds not deservingof being taken seriously (Coffey, 2005) .

CLASSISM AND THE HIDDEN WOUNDS OF CLASSClassism, the stigma associated with poverty and working-class statusand the overvaluation of wealth and middle-class status, is the form of op-pression powering insidious trauma for people who are poor and working

class. Like other forms of hierarchical devaluation, classism is ubiquitous an dconveyed in a myriad of ways. There are almost as many ways for it to w oundpeople and func tion as a trauma.

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An excellent example of classism at work has to do with the differentialvalue assigned to different sorts of governmental benefits. Money given topoor parents and their children to ensure basic needs for those children suchas housing, food, an d medical care is generally stigmatized;welfare, the um-brella term under which this sort of funding is discussed, is part of a socialnarrat ive of laziness, absence of initiative, and unearned entitlement. Whenin 1996 the Congress passed so-called welfare reform, the ironically namedPersonal Responsibility and Work Opportunity Reconciliation Act (1996),the emphasis of this reform was to require the poorest mothers to work out-side th e home for low pay and place their children in the care of strangers.The message conveyed was if one is responsible an d works hard then one willnot be poor.

Classism denies the presence of institutionalized obstacles to economicwell-being and justice; these obstacles can be sources of insidious traumawhile the poor person is blamed as the cause of her or his own problems.Caroline is a Euro-American woman in her late 30s. Her parents were col-lege educated; her father, an aeronautical engineer, lost his job in thedownsizing of the aerospace industry, and her mother had worked at home asa parent and homemaker for no pay.Her father w as never able to find profes-sional employment after being laid off in his mid-40s and had a series oftemporary jobs; her mother found work as a retail salesperson. Savings fo rCaroline's college education were depleted to keep up mortgage payments.She finished high school and went to work as a waitress.There she met andbecame pregnant by one of the cooks; the pair did not marry, and when theirson was 1-year-old they separated. Unable to find adequate childcare, sheapplied fo r welfare so that sh e could support her son.

Over the intervening 12 years Caroline was on and off welfare. Whenshe was on welfare she made money under the table by babysitting to makeends meet. She returned to waitress work when her son entered kindergar-ten, working less well-paying day shifts where the tips were smaller so thatshe could be home when he returned from school. During those times whenshe was off welfare she had no medical coverage fo r herself, and she wouldoften go to work ill or hurting.One day at work sh e slipped and fell on a floor where someone hadspilled cooking grease; she injured her back so badly that she could not keepworking. Worker's compensation payments covered only tw o thirds of heractual wage and did not take into account the considerable contribution oftips to her income; thus her actual cash flow was cut by two thirds, not onethird. The compensation system paid for some of the medical care requiredto treat her injuries, but as her pain and disability persisted over severalmonths she wassent to an independent medical examiner who pronouncedher malingering and told the state that she was fit to return to work. Worker'scompensation cut off her payments. While she had been on worker's com-pensation sh e became il l with flu, which deteriorated into pneumonia be-204 CULTURAL COMPETENCE IN TRAUMATHERAPY


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cause the steroidal antiinflammatory medications that she was on had, un-beknownst to her, severely depressed her immune response system. Whenshe finally went to an emergency room for care the physician wished tohospitalize her for intravenous antibiotics, but knowing that she had nohealth insurance and no one to care for her son she refused and went homewith oral medications.

When required to return to work Caroline was still coughing from herbout with pneumonia and in pain from her back injury. She lasted 1 day atthe job, quit, and went back on welfare.At that point she wasalso 3 monthsbehind on her rent, in debt to the hospital for her care and medications, anddispirited about ever being able to get ahead. She became depressed. Credi-tors called multiple times a day about her past due bills, and she was threat-ened with eviction from her apartment. Eventually she and her son moved inwith a friend of hers from work who allowed them to sleep on her couchwhile Caroline was applying fo r low-income housing.When Congress passed welfare reform, Caroline was informed that sh ehad a time frame during which she had to become employed; she had todemonstrate that she wasattempting to get work or have her current benefitsreduced by a certain amount each month. By that time Caroline had beenliving with chronic pain and depression fo r several years; she had receivedtreatment for neither. Although she had medical coupons since returning towelfare, her requests fo r pain medication had been viewed with suspicion as"drug-seeking behavior," and the only treatment available fo r depressed peoplewho used coupons wascase management and antidepressants. She found theformer demeaning, describing some of the case managers as being "kids like Iused to be, middle-class brats who don't know any better. I think I wouldhave been just as cruel if I hadn't had my life experiences." The latter hadside effects that were difficult for her to tolerate. It was ironically because ofher difficulties complying with th e demands of the welfare-to-work programin which she had been enrolled that she finally received access to psycho-therapy, which was being mandated for the noncompliant participants inthat program.

Caroline's story illustrates th e hidden but daily insidious wounds of pov-erty. Because health care in the United States is not universal, poor peopleare caught in no-win sets of bad choices; go without, as a member of theworking poor, or have access to medical care that often comes with a rationof stigma including restricted access to mental health care an d some kindsofmedical care (recall George's story in chap. 9 , this volume, of losing access tohis antispasmodic medication because it was not on the list of those forwhichhe could be reimbursed). Ill health can lead to financial reverses, financialreverses to loss of housing, loss of housing to risk of exposure to unsafe situa-tions, and all of the these factors to trauma exposure. The concatenation ofexperiences that is systemically present fo r poor people in the United Statesresists th e efforts of all but the most hard-working, personally responsible,

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and optim istic poor people. A ll the while, the stigm a associated w ith povertyplays in the psychological and psychosocial background.

INTERNALIZED CLASSISMInternalized classism also leaves it m arks on the psyche (R ussell, 1996).As Coffey (200 5) noted, th e experience of being fake shared by man y peoplewho grew up work ing class or poor and who have achieved professional statusthrough education is accompanied by a range of psychological distress in -cluding high levels of anxiety an d self-doubt and fears of becoming exposedto professional peers as not being really middle class. Additionally, because

of the inequitable distribution of educational resources across the social classspectrum, the achievement of higher education is itself more difficult formany poor and working-class persons. These difficulties are often codedthrough internalized classism as evidence of being stupid or intellectuallyinferior to classmates raised by college-educated parents in school and homesettings that were rich in education resources.

Helen's story illuminates this phenomenon. H er parents, SlovakianAmerican children of immigrants had less than high school educations an dhad divorced when she was young. She lived with her mother, who worked asa housekeeper at a local hotel; th e family struggled fina ncially. H er motherhad 4 young children with 2 different fathers. She did well in her publicschools in a lower income urban neighborhood, but her classes left much tobe desired, and her teachers freq uen tly com mu nicated to her and other stu-dents that they w ould be unlike ly to attend college. She left high school after10th grade and worked in fast food restaurants to help support her motherand 4 younger siblings, none of whose fathers contributed to the family'sfinances fo r long.In her 20s, after her youngest sister had started high school, Helen,with the support and at the urging of her parish priest, started to take classesat the local community college and got her general equivalency diploma.She continued on to earn an associate's degree, experiencing m ounting anx i-ety as each term passed and she continued to do well academically; she was"waiting for the other shoe to drop," as she commented later, certain that shewas insufficiently intelligent to succeed in the n ursing program she had en -tered. She struggled with writing, gramm ar, and punctuation, subjects thather school had given short shrift; her study skills were absent as well, all ofwhich appeared to validate her view (and those of her high school teachers)of herself as academically incapable. Her mother was critical of her efforts,complaining that Helen was going to thin k that she was too good for thefamily now that she had exceeded everyone else's educational accomplish-m ents an d expressing irritation that Helen was preoccupied with he r studiesinstead of working more hours.206 CULTUR AL COMPETENCE IN TRAUMA THERAPY


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At a meeting with her mentor the priest Helen broke into tears. "I'm abad daughter," she said to him, "and who do I think I am anyhow? I'm justfaking it. I'm going to fail m y nursing exam and disappoint all of you. I shouldjust quit now." Her priest comforted her, telling her that she was indeedhonoring her mother by staying in school "even if your mom can't see it thatway just yet." He also connected her with another mentor in the form of afr iend, a woman who had formerly belonged to a religious order, who hadherself struggled with internalized classism on her path from poverty. Muchlike Helen, she too had made great efforts to attain her position as the assis-tant dean of a local private Catholic college. That woman also recognizedHelen's intelligence and interpersonal talents and challenged her to go be-yond her associate's degree. She held Helen's hand, literally and symboli-cally, through the last 2 years of college and onward to Helen's doctorate inpsychosocial nursing, coaching her about how to write, do research, speak,and dress, and spending time with Helen and her family helping to assuageher mother's concerns.

As Helen told me, her friend, many years later,I f Father Jim had responded any other way at all I would have droppedou t that moment an d gone back to supervising the late shift. It was soincredibly painful, the voice inside m e that said that I was a fraud and aphony. My mom didn't really know better;she was afraid that she wouldlose me, and she was doing what she knew to do to keep me close. Andshe was afraid I'd get hurt, that I didn't have what it took an d would justbe bashing my head against the wall. Rosemarie was just as essential; shetaught me not to be ashamed of what I didn't get and helped me learnhow to get it. But it still scares me to death when I have to present at aconference; the ghost of my inne r imposter shows up every time. So I'vestarted doing eye-movemen t desensitization and reprocessing to deal withthat, because I'm tired of being that anxious about my accomplishments.Helen had luck; she had rich human resources in the form of her priest

and her mentor who helped her to fill in the pieces that were missing fromher secondary education and who gave her the emotional support that sheneeded to navigate the complexities of becoming the only doctoral profes-sional in her family. Even with that remarkable assistance she continued toexperience anxiety; although no one, including Helen, would call that dis-tress posttraumatic stress disorder (PTSD), in it were the echoes of how in-ternalized classism and the institutional wounds of class served as forms ofinsidious trauma for her earlier in life.

CLASS: THE NOT-SO-HIDDEN WOUNDSPoor people also experience the real traumas of risk to basic needs. Pov-

erty can mean going without dependable food, shelter, medical care, or ad-equate clothing. The numbers of poor people who chronically are in a state

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of food-related risk has grown in the past decade, with the federal govern-ment reporting that in 2002 meals were skipped as a result of lack of moneyfor food in 12 million American families (Lott & Bullock, 2006). In a me-dian cost American city a wage earner must take in more than double th eminimum wage to afford ma rket-rate housing, and in hot urban markets af-fordable housing is being razed and replaced w ith expensive housing at ratesthat endanger the viability of those other than middle class (Lott & Bullock,2006). Housing fo r poor people is additionally often situated in locationsthat are physically unsafe because of the presence of toxins in the soil andwater, current dumpsites or incinerators, and other forms of environmentalhazard (Allen, 2001). According to the Diagnostic and Statistical M anua l ofMental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric As-sociation, 2000) definition of t rauma as a threat to life or personal safety,then fo r many poor people life is a continuous series of potential exposures totrauma related to basic needs.Poverty increases th e risk of exposure to violence in one's immediatesurroundings. Poverty is associated with homelessness, which increases thelikelihood of exposure to random violent acts by strangers b ecause of the lossof control over one's physical environm ent. Pov erty mak es natural disastersmore disastrous; having savings and credit cards means that one can find ahotel room to stay in and rent a place to live while one's storm-damagedhome is repaired. Having little or no financial margin in the same circum-stances m eans living six to a m otel room or in a Federal Em ergency M anage-m ent Agency trailer, with little hope of being able to afford the restorationof one's home.Poverty is not per se a traum atic stressor; people can live in the pov ertyand working classes and be joyful and completely emotionally functional.How ever, the potential fo r poverty to be a powerful and pervasive risk factorfor the range of traum atic stressors is something that needs to be taken intoaccount in a psyc hotherap ist's process of assessing a client's total trauma ex-posure. The fragility of the social m atrix that supports good func tioning fo rpoor people can be exposed when trauma of the DSM-IV-TR Criterion Atype appears and sweeps that social m atrix away. If , like racism , psychothera-pists consider p overty and the threat of poverty to serve as insidious traum atathat can effectively widen a person's v ulne rability to other traum atic stres-sors at any time then their assessment of their clients' suffering and of theresources available to their clients for the amelioration of that suffering willbecome more culturally competent.

CLASS PLUS TRAUM A EQUALS DIFFERENTIAL IMPACTThe experience of being poor or working class intersects with each andevery other aspect of a person's multiple identities to affect how an indi-

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vidual will be affected by trauma exposure. Differential access to resourcesmeans differential capacities to respond when trauma happens. Even ifsome-one has changed economic status over her or his lifetime, the memory ofpoverty may give different meaning to the occurrence of trauma. To under-stand the impacts of class on the experience of trauma the culturally compe-tent psychotherapist considers both of these variables.

An individual who grew up with not enough or barely enough financialresources is likely to retain a consciousness of scarcity that trumps anycurrent-day realities of apparent economic plenty. For this person, threats toincome as a result of trauma exposure will be potentially experienced as morethreatening than for a similar person raised in economic safety. Class privi-lege leaves people with a perception that no matter what the nature ofcur-rent economic circumstances there is likely to be enough to meet their needsat the end of the day: This belief structure often reflects the fact that theywill have access to family sources of capital or have economic resources thatare not dependent on their earning a living.

Erin, a fourth-generation Japanese American woman, w as raised in awealthy suburbbyparents who were both practicing physicians. She attendedprivate schools and graduated from college with no debt because her parentspaid her way. They had also invested money in stocks for her every yearwhile she was growing up so that at the age of 25 she had a considerableportfolio. She joined Volunteers in Service to America (VISTA), lived in ashared household with 5 other people, and drove her parents' old car, a 12-year-old luxury vehicle. While attending a party one night she met a manw ho apparently druggedher drink; sh e woke to find herself naked, strugglingunderneath him to free herself from being sexually assaulted.

In the aftermath of this rape Erin became depressed and developedPTSD; she dropped out of her VISTA job. Because one of her housematesknew the man who had assaulted her she began to feel unsafe in the house,not trusting where his loyalties lay. She turned to her parents, who assistedher by paying first and last month's rent on an apartment close to where theylived. They suggested that she consider drawing on the dividends ofher stockfund, th e presence of which had been background noise to her life previ-ously. As she told her psychotherapist,

It's such a relief to know that I don't have to go back to work until I'mready! M y parents did a great job of investing for me, and they're sowilling to help me out financially. I don't know what I'd do if I had to tryto work feeling the way I do now.Erin's experiences are those of a person with privilege. Familieswho arepoor and working class care no less about their children than do those of

privilege, but the reality of scarcer resourcesor class-baseddifferences in deal-in g with finances may be interpreted by a psychotherapist who lacks con-sciousness of class issues as evidence of less care or poorer quality parenting.

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Contrast Erin's experience with that ofJoan, Erin's Euro-American age peer.On the surface she appeared solidly middle class, but her consciousness wasworking class. The first in her family to attend college, Joan graduated with adegree in business and was tens of thousands of dollars in debt. Debt was nostranger to Joan; she had grown up watching her parents, a father who drovea cement truck for the county and a mother who worked in a plant nursery,struggling each month to pay bills and make ends meet. Joan described herfamily as having "just enough to get bybut my folks were always willing toput something on plastic when it was something we really wanted. We al-ways had a new car, and we took trips every summer." Joan lived with aroommate in an apartment and drove a newish car; her job as a mortgagespecialist at a bank paid her very well, but she joked that "I'm a normalAmerican. I live on my credit cards."

When Joan was mugged in a parking garage one evening when she gotoff work and subsequently developed PTSD, she forced herself to go to workdespite her debilitating symptoms. "I wasn't sleeping, so I started drinkingbefore I went to bed. Then I couldn't get up." Her work suffered from hertardiness and her inability to concentrate. "But I had to go to work; I wasalways one paycheck away from being a bag lady." Her first psychotherapist,to whom she was referred by the company's employee assistance plan, sug-gested that she quit her job and get crime victim's compensation, not think-in g about th e fact that this fund offered only about one half of what a indi-vidual made and that without her jobJoan would have no health care coveragefor anything except the direct effects of the mugging. "Your family couldalways help you out," she offered to Joan who, feeling invisible but not know-in g why, quit therapy and decided to try to make it on her own.

Approximately 6 months later, with her nightmares worsening and herjo b on probation she found her way to a psychotherapist who had himselfgrown up working poor. H is cultural competence about class immediatelyinformed the therapy process; when she recounted her previous experience,commenting that she was not sure why her prior psychotherapist had notseemed very helpful, he was able to validate the realities of social class thatinformed her understanding of what her options were. "You're feeling trapped,aren't you?" he asked her. Indeed, the trauma of the mugging had becomemagnified by the anticipated trauma of becoming bankrupt and having no-where to turn. Joan's ability to solve the problems of her financial situationhad become impaired by the terror occasioned by her knowledge that theveneer of middle-class status with which she was viewed by the world wasthin indeed. She had learned that financial life waslived on the thin marginof debt but had not learned that trauma could push her over that margin orhow not to see herself as a failure when she teetered on the edge.A psychotherapist's awareness of social class issues can assist clientsand psychotherapists alike in making sense of what appears to be added per-ceptions of threat emerging from trauma exposures. Experiences of poverty,21 0 CULTURAL COMPETENCE IN TRAUMA THERAPY


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and to an even greater extent of living just on poverty's edge, can leave long-lasting impressions that in turn define an experience of trauma as more orless dangerous. The person who now has money but who grew up without itmay, in the absence of class c onsciousness, not understand her or his panicabout the possible financial impacts of a trauma; a psychotherapist withoutan awareness of class may look for some other form of underlying anxietydisorder, pathologizing the response rather than seeing it as a class-informedunderstanding occurring in the absence of a consciousness of class. B ecausethe American silence on class issues is an obstacle to the development ofclass consciousness in working- an d poverty-class A mericans, it can frequentlybe the job of the culturally compe tent psychotherapist to raise the issue ofsocial class and to interpret what is troubling the client through the lens ofclass, assisting the client in developing class consciousness in the process oftrauma recovery work.

SOCIAL CLASS AND PSYCHOTHERAPYMany persons in poverty- and work ing-class settings will have culturalnorms that make it more difficult to seek psychotherapy, even when and if

affordable high-quality resources are available. This is not because, as someauthors have posited, poor people are less psychologically minded than thosein the middle and upper classes. Rath er, av oidance of psychotherapy may bedue to continuing shame and stigm a associated in those social contexts withmental health care. Because those among the poor who receive such servicestend to be only the most psychologically impaired and disabled, th e prob-lematic synergy of internalized ableism, especially mental health relatedableism, with social class barriers can mean that by identifying oneself assuffering emotionally on e will run the risk of being perceived as weak or crazy(McNair& Nevi l le , 1996) .Poverty as it intersects with othe r compo nents of identity also conveysdifferential social and emotional meanings that can infuse trauma with emo-tional valence that is not apparent from the details of the traum atic stressor.Among African Americans even highly educated professionals were oftenmaterially poor until the gains of the civil rights movem ent of the last halfcentury . M aterial pov erty was not per se associated w ith poverty-class status,and material wealth was not necessarily associated with middle- or upper-middle-class status because the effects of systemic racism often separated thosetw o continua. However, th e inability to perform one's job, a job that was thesymbol of having achieved middle-class status, was especially threatening.Thus a trauma that interferes with vocational capacities, even though actualthreat to life or well-being appears relatively low, may be experienced asmore severe by a person to whom doing the job well is core an d central to asense of self and safety.

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Sherry was an African American woman in her late 30s, divorced andthe single parent of an adolescent daughter. Her father had been a mail car-rier and her mother an elementary school teacher; Sherry, with a master'sdegree in social w ork, was employed as a supervisor for a Head Start programfor high-risk children, which required her to travel from one site to anotherdoing evaluations on children and consulting with staff and parents. Sheloved her work and wasproud of her excellent evaluations and feedback fromall of the divergent groups that she served. One winter day she slipped andfell on an icy sidew alk, striking her head on the concrete and suffering a briefloss of consciousness.

In the weeks and mon ths following this apparently inconsequential in-jury Sherry struggled w ith cogn itive problems; she was fatigued, her memorywas spotty, and her vocabulary suffered from holes that she could not ex-plain. Her prim ary care physician told her that she wasdepressed and put heron a selective serotonin reuptake inhibitor; this made her feel n u m b but didnothing to improve her difficulties. She began to receive poor performan ceratings at work and after 9 m onths was placed on adm inistrative leave forfailing to remediate. H er physician then referred her to a psychologist fo rpsychotherapy; th e psychologist, suspecting minor traumatic brain injury,referred her for neuropsychological evaluation. Although th e results of theassessment were in the normal range, the evaluator commented that he couldsee that Sherry was struggling to do as well as she did and that her results,even though n ormal, were inconsistent w ith the scores she had made on theGraduate Record Examination a decade earlier. He suggested that Sherry getvocational counseling to retrain into work that required less cognitive ca-pacities than her job had had.

This news appeared to trigger PTSD-like sym ptoms fo r Sherry; learningthat her slip and fall had led to possibly long-lasting changes that wouldaffect her ability to function as a high-level professional led to a cognitivereappraisal of the event as a life-threatening one. "My work is my life," shetold her psychotherapist. "Without it I don't know who I am anymore. Iknow that Dr. Prakash thinks that there are plenty of jobs that I can do, butI was proud of my w ork and my contributions." What emerged in her psycho-therapy was the degree to which Sherry's job had satisfied elements of cul-tural identity about giving back to communi ty and sharing her middle-classprivilege with less fortunate and more troubled A frican Am erican families.The issue of income loss was troubling to her; Sherry's job, although middleclass in status, paid as poorly as did ma ny o ther social services job s. But thetheme of how the accident had come to feel t raumatic to her was less abou tmoney, "M y parents will help m e out, and I've been thrifty, so I don't havem any bills to wo rry about," an d far more abo ut the loss of middle-class iden-tity that involved being a professional and a contributor.

Poverty, which represents the ult ima te trajectory of generations of so-cial injustice , can itself feel traum atizing , and po verty can also come to be a212 CULTURAL COMPETENCE IN TRA U M A THERAPY


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component of cultural identity, making it s treatment feel like a threat tocultural connection. This complication can most easily be seen in communi-ties with what Duran, Duran, Brave Heart, and Yellow Horse-Davis (1998)have described as "post-colonial syndrome," In indigenous communities, wherepoverty is endemic, that phenomenon iswell-known to be associated with 3centuries of genocidal violence aimed at indigenous people by European andEuro-American invaders. The tightness with which genocide and povertyare woven together in these communities is such that internalized coloniza-tion and poverty have themselves become intertwined and thus a compo-nent of ethnic identification fo r some. In these communities any individualeffort to break free of the effects of multigenerational trauma may be experi-enced as a threat to the community because of a perception that such indi-vidual change can bring unwanted and potentially dangerous attention fromthe dominant culture. Healing and recovery from trauma by one person canironically be experienced by the extended social network as betrayals of fam-ily and culture. When resources are made available in the form of individualpsychotherapy they may go unused or be ineffective in the absence of familyor culture-wide interventions that address poverty and trauma as end pointsof genocidal violence against a group. Healing from trauma in these indig-enous communities is best conceived of as a systemwide effort. An exampleof this phenomenon is the community-healing process engaged in by theAlkali Lake band of indigenous people in Canada in which a communitywhere substance abuse and violence were endemic made a collective deci-sion that these results of genocide would no longer be the identity of theircommunity (The Honour of All: The Story of Alkali Lake, 1992).

A s these examples illustrate, the issue of class is neither simple noreasily seen when it comes to its effects on trauma. Cultural competence aroundissues of class in psychotherapy means confronting psychotherapists' ownclassism and internalized classismand being willing to deconstruct the mythsabout poverty and wealth that pervade American culture. A psychotherapist'sow n class consciousness or lack thereof ca n deeply affect cultural compe-tence by making visible or obscuring the contributions of social class experi-ences to identity. Understanding how realities of resource scarcity and abun-dance become experienced through the lenses of multiple social locationsand acknowledging that current resources may be inconsistent with self-perceptions about what is available will aide both psychotherapists and cli-ents in seeing a client's distress more clearly.

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The Great Divide: Trauma and Social Class