In the course of interviewing and treating inner-city youths in the District of Columbia for over thirty years, I was struck by the fact that almost all had lost their fathers and were unable to mourn their losses. In the past five to ten years, I've noticed that what we had been hearing about the fathers, we are now also hearing, at an accelerating rate, about the mothers: they are in St. Elizabeth's Hospital, they are prostitutes or in prison; they have addictions, are homeless, or depressed; they are dying of AIDS. I also observed that the families no longer seem to have relatives in the rural South — the aunts and grandmothers in North Carolina, South Carolina, and Georgia — who the children would visit in the summer or in times of crisis. Many of the older generation who remained in the South have died. In addition, many of the youths are also losing their siblings and peers in shootings.
A traumatic loss is more difficult to mourn than a natural death. Robert Pynoos speaks of a three-part process of mourning such deaths: Revisiting the traumatic moment in all its complexity; dealing with the loss itself; and confronting the change in living circumstances such as decreased income and changes in housing. But in the clinic population, a sad reality too often undermines this ideal process of mourning; caretakers who should console, facilitate, or act as models for mourning are themselves terribly burdened by their own unmourned losses. Hobbled by their own depression, they are unavailable to help their children cope with loss.
Having had little clinic contact with lower-class white families, I wondered how race and social class interacted to influence the ability to mourn effectively. Some years ago I had the opportunity to talk with Charles Pinderhughes of Boston, one of the first African American psychoanalysts. I spoke of mourning in “the” black church. He looked at me and said,“ The black church?” I felt like Spiro Agnew when he said, “Seen one, seen them all.” Pinderhughes continued that some cultures that have developed continuous rituals around mourning and loss over thousands of years. (At that point, already sensitized, I thought he was looking at my Jewish profile.) He reminded me that less than 150 years ago, during slavery, there was an effort to annihilate traditions that had gone on for millennia and that African Americans had to start anew.
A few years ago, I was supervising three psychology interns who were evaluating very recalcitrant, acting-out adolescents. To our great surprise, spontaneously and with poignant affect, three of these adolescents began talking about the fatal shootings of peers. One had been a good friend, but he was killed a year before; two were acquaintances who died more recently. We realized that some of the intensity of the affect may have been displaced from earlier losses of parents and caretakers, traumatic events that were more difficult to talk about. This observation led to our organizing mourning groups where the adolescents might experience safety in the company of their peers, containment, and empathy from others. Talking about their recent losses might allow them to begin mourning their earlier parental or caretaker losses. Later we decided to focus on pre-adolescents, for many reasons, including: 1) to counter the developmental arrest that results from traumas and unmourned losses at an earlier age; 2) to ameliorate the regressive pull at pubescence, particularly intense with developmental disturbances. Adolescents fight against it by defensive acting-out. Mourning work will address the developmental arrests resulting from unresolved loss and trauma and thereby lessen this regressive potential; and 3) to provide an opportunity, through mourning work, to lessen the underlying depression produced by unmourned losses.
“…in the clinic population, a sad reality too often undermines this ideal process of mourning; caretakers who should console, facilitate, or act as models for mourning are themselves terribly burdened by their own unmourned losses. Hobbled by their own depression, they are unavailable to help their children cope with loss.”
Once children reach adolescence they are more likely to deal with the threat of the abyss of mourning and depression by acting out sexually, aggressively, and with drugs. To illustrate this hypothesis, one boy had a friend whose older brother was shot at the edge of the school grounds. In recounting this, the boy said, “I feel so sad that I am about to cry, and then I get mad and beat people up and start messing stuff up. I want to kill the person who did it.” Another boy said, “The sadness tries to get out but it can't.” Underlying much violence is shame, humiliation, feelings of helplessness and hopelessness, and finally, various forms of “dissing.” The victim of physical, mental, or sexual abuse turns from the passive vulnerable position, and by identifying with the aggressor, becomes the active perpetrator, often enjoying some of the destructiveness of the hatred.
There are certainly many other causes for the violence we see in the inner city. Set against a background of slavery and segregation that had already initiated a sense of degradation and humiliation, these include the availability of guns, drugs, the gap between the rich and the poor, the intensity of racial discrimination, and the lack of opportunity. Could the United States' murder rate, which is ten times that of Western Europe, relate to the history of slavery? Noshpitz sees slavery and the ensuing traumatic history as building up an “inner hater, inner enemy, inner destroyer. This is portable, they carry it with them everywhere.” Few youths escape its effects. Someone like Tre in Boys 'N the Hood, who was given great positive input, can overcome the pressure of the self-destructive moiety, but this is exceptional. “Most simply hate themselves (albeit largely unconsciously); when they are dissed or insulted, they have extreme reactions not only to the external threat but to the even more painful inner gout of derisive self-devaluation.”
Children's experiences in school, foster care, and the criminal justice system reinforce these underlying factors. Too many children who have been traumatized by growing up in this emotional and environmental setting have an internal preoccupation with issues of aggression, retaliation, and revenge. A paranoid stance can develop: The world is a dangerous place and no one is to be trusted. The behavior resulting from this paranoid stance can then provoke others to act in kind. In addition; the absorption of self-hatred, the self-destructiveness, can be
further projected onto others, leading to more attacks. Noshpitz describes an incident in an inpatient drug rehabilitation center. A nineteen-year-old drug addict bolted away while he was being interviewed and tried to choke a newly arrived female patient. When the scene quieted down, Noshpitz learned that years before the woman had announced that she had AIDS and had entreated, “Are any of you guys man enough to fuck me?” This man took the dare and contracted AIDS. He believed that she had given him the virus and attacked her as though she were responsible for his AIDS, not acknowledging his own self-destructiveness.
The inner city has been described as a war zone, as a cycle of violence going on and on. In a cartoon, amid flying bullets and drug dealing, a five-year-old boy asks another, “What do you want to be when you grow up?” and the answer is “Alive.” UNICEF posters pose the same question and answer. Numerous newspaper articles in the Washington Post and the Los Angeles Times refer to adolescents planning their own funerals in exquisite detail. Sixty percent of inner-city children say they do not expect to make it to old age. One in twenty-one African American men will be murdered. This inner-city “war” is most insidious. During “normal” warfare, the community coheres and acts as a group to fight the “other.” In the inner-city wars, the fighting is carried on within the community itself. While all wars are terrible and people are victimized, there is the expectation that some day it will be over. This is in striking contrast to the hopelessness in the inner city, where the war continues generation after generation.
This dark picture of the inner city is the backdrop for the School-Based Mourning Project, which began in the Northwest Family Center of the D.C. Commission on Mental Health. Two years ago we were fortunate to receive two small grants, primarily for the research and training aspects of the project, from the Kentworthy-Swift Foundation and a small private foundation. Eventually we obtained the cooperation of the principals, counselors, and teachers. We found that many of the school staff were themselves depressed and overburdened, and just did not have the resources to do the extra work of helping to find the children and select the control groups. After traversing these issues, we needed parental/guardian permission for children to participate in this clinical/research project. Our first unsuccessful approach was to send home with the children letters explaining the project along with permission slips for the parents to return by mail. Then, by good fortune, a University of the District of Columbia master's student volunteered to obtain developmental histories and permissions as part of a practicum. She went into the most unstable sections of D.C., in Anocostia, usually accompanied. As a female, African American, Muslim wearing a white headress, she was least threatening and received cooperation in most cases.
The children became very involved and were very connected to the co-therapists. Working during school hours, we had practically no attrition. Some groups were short-term, others lasted most of the school year, depending on practicalities. Most of the children did significant mourning work and began to deal with their multiple traumas and deprivations. One group initiated unusual funeral rituals as a form of mourning. We were challenged by some significant discipline problems with children who were acting out in this less-structured situation.
Because of our late start the first year, most of the groups had only ten weekly sessions. In comparing the treatment group and control group on outcome measures, we found that these two groups differed in the hypothesized direction at a p < .03 level of significance on the Interpersonal Problems subscale of the Childhood Depression Inventory. In addition, the difference between the two groups of children post-treatment approached significance on a teacher-rating scale of peer social skills. The combination of these two measures reinforces the evidence that the groups enhanced relatedness with others.
On the basis of this pilot project, we obtained a significant grant from George Soros's Project For Death in America, administered through the St. Francis Center of the District of Columbia, a nationally acclaimed agency for working with the bereaved. In this ongoing study the primary therapists, Dottie Ward-Wimmer and Martha Gibbons, are most experienced and accomplished. Selecting two particularly cooperative inner-city schools, we are offering additional groups for caretakers and school staff in one school to study the effectiveness of this additional program. After learning of these projects, Dianne Powell of the D.C. school system organized training workshops conducted by Ward-Wimmer for a large number of school social workers and psychologists, and I have been asked to be the supervisor of ongoing groups.
With the enormity of problems in the inner city, the question arises, “What can we do about it?” There are many oft-cited forms of possible intervention: better housing, educational opportunities, jobs, mental-health services, and ways to prevent unplanned pregnancies. Some are developing more specific intervention programs. Pynoos's program in South Central Los Angeles elementary schools begins with individual therapy, then group therapy, followed by long-term mentoring.
Other approaches include the Comer Community School Programs and a project in Washington, D.C. on teacher well-being, in which teachers are nurtured in many ways, including stress reduction techniques and even massages. This innovative program enables the teachers to more effectively cope with the slings and arrows launched by the kids, to experience less burnout and depression, and to engage in less retaliation against their would-be tormentors. Long-term mentoring is obviously needed, as are consultation and training in mental health principles for the school staff.
Another exemplary and successful program led by Steven Marans at the Child Study Center at Yale is being replicated by the Justice Department in four other cities. The program trains most of the police force in child development and psychopathology and brings them to the Yale Child Study Center for case conferences. A team from the Child Study Center is on twenty-four-hour beeper call to go to the site when a child is either a witness, victim, or perpetrator of violence. New Haven has a most enlightened police chief who says that he does not want more cops, he wants more mental-health people. He talks about police doing house calls for many generations and having a community where all murders are solved as a result of community policing and mental-health efforts. These are just a few projects I know about. We hope that the School-Based Mourning Groups will evolve into efficient and effective programs so that more children can start working from the inside — hopefully to give them time to plan for their futures, instead of their funerals.
References can be obtained by contacting the author.