How and why does a psychoanalyst become involved with work in the community? What is the appropriate role of the psychoanalyst regarding social and community issues? When asked to write this article, I must confess that I hadn't thought much about the fact that my working in the community might be unusual for a psychoanalyst. I saw what I was doing as a continuation of my psychoanalytic background and of my commitment to help and to learn more about infants and families at high psychosocial risk, the goal being prevention of more serious problems that might arise at a later developmental period.
One of the first realizations I came to in doing work in the community is that despite my desire to help, my participation was not consistently welcomed, either by agencies or by community residents. Further, the response of the latter was not always predictable. Academicians, researchers, and clinicians are often viewed with skepticism. Community residents wonder why these professionals have come around and whether their intention is to work with people in the community according to their needs or merely to follow an agenda of their own. Only over time, as residents are able to share their concerns and frustrations, and the professional is able to demonstrate consistency and commitment, does the relationship develop. I feel a strong sense of dedication to working at the community level, using my psychoanalytic knowledge and skills to assist individuals at high psychosocial risk and to facilitate systems changes that will improve conditions for a broad range of people within the society. A lesson that I have learned in my work, however, is the importance of supporting bottom-up or grassroots approaches to developing interventions or projects. Other analysts and I can then offer training, consultation, and backup. However, the design of the activities or programs must come from the community.
Some academicians and clinicians do not believe that working in the “real” world with “real-life problems” is appropriate; they do not recognize such activities as scientific. However, a growing number are coming to recognize the importance of moving out of the laboratory or office to apply their knowledge and skills to the urgent problems confronting our communities. I was asked to write an article, for the 1993 JAPA Supplement, on my research with infants and adolescents at high psychosocial risk, with emphasis on the relevance of the work for psychoanalysis. In preparing that paper, I enumerated many of the ways in which psychoanalysis is relevant to work with high-risk groups and how our understanding of development can be enriched by such studies. I attempted in the discussion to go beyond the individual studies, and their relevance to psychoanalysis, to deal more broadly with the significant role that psychoanalysts can play in developing community programs.
Deeply concerned about the increasing violence to which our children are exposed, I have been studying and writing about the effects of this exposure on young children. Although this is a problem worldwide, the United States is the most violent highly developed country in the world. I must admit that even I was shocked when the latest statistics released by the Children's Defense Fund indicated that homicide has now become the third leading cause of death among elementary school children. Besides doing research and writing in this area, I have been deeply involved in developing an educational, preventive, and intervention program in collaboration with the New Orleans Police Department, concentrating on an area of the city with a very high level of violence, much poverty, and many subsidized housing developments. Our program involves a collaboration between the police, community residents, and the mental health community, including colleagues in the psychiatry department of the LSU School of Medicine and at the Children's Bureau, a community service agency that for several years has run a program counseling children and families who have been exposed to homicide. Using our skills to come together with people in the community to build an equal partnership that respects and builds on our differences and our strengths has been both challenging and gratifying. Through this work and other collaborations, we can better define the issues and work together to find solutions for many of society's most pressing problems. If we remain solely in our offices and laboratories, we will make valid contributions in helping individuals and advancing analytic theory. However, by working together with people in our community, we make other, societally oriented contributions that are conceptually important and that are likely to be effective for a broad base of people for whom we also feel accountable; further, these benefits are likely to last longer because of their impact at a systems level.
As we have worked together with the police in our community to try to decrease the violence and help children who are exposed to it, I have learned a great deal that I would otherwise not have known. From interacting with police officers, listening to them on an almost daily basis at times, and from ongoing discussions about the effects of violence on children and the need for early preventive intervention strategies, we have become even more aware of children as “invisible victims” exposed to a great deal of violence in their homes every day. In most communities, little attention is paid to this exposure, except when a child is abused or something of an equally dramatic nature happens. I would emphasize that in our work we have found most police officers to be dedicated individuals, underpaid and working in highly stressful situations. Not only are they moved by the difficult situations they encounter, but the almost daily traumas they experience cannot help but resonate with emotions in their own lives. At the same time, police officers are hesitant to ask for help or express their pain—it is part of the culture to be tough and take it. Our work together contributes to their being more helpful to the children when responding to domestic and urban violence calls and leads to their referring children and families earlier for prevention and intervention services.
As a trusted professional and mental health colleague, I am able to offer support and advice regarding many of these cases; we have also established a 24-hour mental health hotline to answer questions, provide crisis intervention, and accept referrals for treatment. In the process, we have gained increased sensitivity to the immense issues and stresses that police officers face every day in their work. We have also learned from officers, and from our involvement in community and individual problems, the crucial nature of systems intervention. A frequent problem reported by the police is the number of children and families at the scenes of homicides. Not only does the crowd make it more difficult for the police to do their work, but, as a result of our collaboration, they have themselves raised concerns about the effects of such exposure on the children. The police
worry, as do we, about the long-term effects of witnessing murders or viewing dead bodies at a young age.
In our work with police and parents, we have provided education about the symptoms of posttraumatic stress disorder in very young children. Some who initially were not attuned to the effects of violence exposure on children have described their increased knowledge and their ability to be of help, as well as to make appropriate referrals. Through our educational and supportive efforts, we have been able to help parents understand and deal with their children's symptoms. These include nightmares, clingy behavior, and fear of sleeping alone, long after having grown beyond these behaviors, as well as other behavioral or relationship problems. We have also been able to help parents deal with their own trauma and grief so that they can help their children talk about and come to grips with the traumas they have experienced. Without the program, many of these parents, who have appreciatively described their own increased strength and ability to be of help, would not have been able to reach out for services.
Working with the police has helped us identify others in the community in need of mental health services. We are currently working with the Housing Authority of New Orleans to train and provide support for a group of mothers whose children have been victims of urban violence. These mothers will in turn work within the public housing developments to support other grieving mothers, as well as helping in the prevention of violence exposure. The skills and techniques that we use to train parents, teachers, and police, and to counsel children and parents, are based on psychoanalytic knowledge and the approaches we all use in our clinical work. The development of trust and empathic listening are also crucial—sensitivities that are very much a part of our clinical psychoanalytic perspective.
One set of findings from our research that is worthy of mention illustrates our efforts to draw on basic psychoanalytic principles in deepening our understanding and developing effective intervention strategies. In Childhood and Society Erik Erikson discussed the development of trust as an initial step in forming healthy relationships. Trust typically develops, according to Erikson, from birth to eighteen months of age and is primarily contingent on the infant's relationship with the caregiver. If the first psychosocial stage of trust versus mistrust is successfully resolved, the infant will learn to survive and to trust others even in a state of total vulnerability. The inadequate or faulty development of trust may be based on a single trauma or on chronic environmental conditions. If parents are emotionally unavailable, inconsistent, or abusive, the infant or child may not develop basic trust. Negative reactions that continually disappoint the child can also lead to mistrust.
Based on this theoretical understanding, we were concerned about possible interference in the development of trust for children growing up in neighborhoods impacted by poverty, drugs, and violence, and often in homes marked by elements of instability. The very components on which the development of trust and trusting relationships are built (including consistency and availability) may be limited or inconsistently
present. In our study, we gathered data on how much children trusted adult authority figures in their lives, including police officers, from 250 African-American elementary school children ages eight to twelve, 60 parents, and 335 police officers. The children and families lived in an area of the city with one of the highest levels of reported violence, and the police officers worked in these violent neighborhoods. Because we already knew that adolescents from such locations frequently are quite explicit in stating and showing their mistrust of the police, the findings of the study were somewhat unexpected. The majority of the children reported trusting the police and feeling safer when police officers were available when the children were lost or felt scared. They were more positive in their feelings about the police than either their parents or the police expected. The findings from this psychoanalytically grounded study have been very useful in our intervention work with the police and the community. Parents and police have been able to discuss and deal with issues concerning trust and mistrust—both how to improve relationships and how to strengthen children's positive views. We are continuing to gather information from older children and adolescents to understand better how developmental, environmental, and interactional components, including poverty, physical and sexual maturity, drug availability, personal relationships, and gang membership, may contribute to an increase in distrust of the police and how to lessen this distrust.
In our community efforts we are broadening the role of the psychoanalyst to include education, consultation, and counseling for individuals dealing with children who may be at high risk to develop problems or to experience at least a derailment of their usual developmental trajectory. We are also developing crisis services for children and families in need of them, as well as services for the longer term. Prevention and early intervention benefit from psychoanalytic knowledge and grounding. This background is very helpful in building supportive networks within communities. From my perspective, community involvement is an important extension of psychoanalytic work and is consistent with the goals of facilitating development and promoting positive mental health.