Photos by Brian Follmer unless otherwise noted.
Hordes of priced out San Franciscans keep repeating about how Oakland is the new Brooklyn, that it’s cheap and artsy, and that it really isn’t that much more dangerous than the Tenderloin. Despite that, the city on the other side of the Bay is actually a hotbed of gang violence, poverty, drug abuse, and mental illness. Violent crimes, like assaults, rapes, and murders occur at three times the national average, with an average of 11 firearm crimes per day. This makes Oakland the fifth most violent city in the country based on data from 2012. Additionally, since 2004, the city has cut the police force down to about one officer per 555 people, which is less than half the number of officers Detroit residents get per capita.
While the city scrambles to maintain control of an endemic crime problem, the greatest casualty seems to be the mental health of Oakland’s children. Bay Area CBS affiliate, KPIX 5 reported according to the Center for Disease Control, roughly one-third of inner city children suffer from a form of post-traumatic stress disorder, colloquially called “Hood Disease," although since I can find literally no evidence for this term prior to the CBS article, I’m pretty sure they invented it.
The well-known “thousand yard stare,” a classic PTSD symptom usually reported in veterans, is a familiar sight in Oakland. To learn more about what these kids are going through, I got in touch with licensed child psychologist, Dr. Sam Himelstein. Sam has worked with high-risk, with incarcerated youths in juvenile detention, and with students in an East Oakland high school. He specializes in youth addiction and trauma.
Oakland Interactive Crime Map from KQED
VICE: Have you personally seen symptoms of PTSD in the kids you work with?
Dr. Sam Himelstein: Absolutely. Well, actually a lot of inner city kids deal with something called “complex trauma” [or C-PTSD] which is similar but a little bit different from PTSD. PTSD is characterized by a violent event or a catastrophic event; something where the individual feels threatened, and they can develop PTSD symptoms. Now, complex trauma basically means that these kids are constantly in a state of hyper arousal due to their environment. For example, an event based trauma for PTSD is something like being robbed or shot or physically threatened. On the other hand, complex trauma is living in a neighborhood where you’re always hearing gunshots and seeing violence. A lot of the youth who experience complex trauma also experience PTSD—there’s comorbidity.
So how do you get through and help these kids?
Well, the first thing is developing effective relationships. You gotta have a real relationship to work with somebody who has experienced trauma. It’s very important for them to be able to trust you or for them to feel comfortable enough to talk to you. A lot of kids aren't used to doing any type of therapy. It's a foreign thing for some of them. But it’s a big deal for these children being able to create real authentic relationships.
So do you teach coping strategies or do you try to work through the trauma? What’s more effective?
You never want to talk to somebody about an event that happened if they are too hyper-aroused, actually. The best thing to do is to just work with the symptoms that are there. For example, if they’re wound up and hyper-aroused, and their central nervous system is really activated, then we can do some breathing techniques to bring that down to a place that’s tolerable. Then, maybe in the future after they’ve come back into a place of being able to tolerate the memory, you can try to talk about it, and derive meaning from it. That's the basic path, but it’s different for each individual.
Photo via Flickr user Kai Schreiber
Is therapy stigmatized in the inner city? I could see it being considered “soft."
It depends. I work in a juvenile hall, and I work in a high school in Oakland, and everybody knows who I am. When I’m up there on the campus nobody tries to hide it or anything like that. Sometimes it can be stigmatized, but people oftentimes are happy to just get somebody to listen to what they have to say for once, especially young people.
What kind of outreach do young people have in the community?
Some schools do a really good job of making sure all the necessary kids are on the therapeutic caseload, and some communities have great community outreach centers that do that themselves, but honestly that’s just one of the routes. If the kids are not in school, or they’re locked up, there are counselors who’ll try to find them. The sad part is that, of course, they can’t get to everyone, and there are people who slip through the cracks.
In what kind of situation do you see victims of PTSD or complex trauma the most?
You see it a lot more in communities like Oakland and Hunter’s Point, in communities that are dealing with poverty, violence, and drug abuse—basically systemic oppression. Those are the things that sort of plant the seed for stress disorders. A lot of those communities are screwed over for multiple generations by the government and by, you know, elitists who are in power. It’s not like if somebody’s from “the ghetto” then they’re automatically going to have complex trauma or PTSD, but there is a correlation, and it’s not the lifestyle. I don’t like the word lifestyle because I don’t think it’s as though it’s primarily their fault; it’s that they grew up in a situation where they didn’t get the greatest deck of cards based on the neighborhood they grew up in, and that’s a systemic issue.
Do you see a lot of change after kids go through therapy, or is the source; the poverty, drugs, violence, too overpowering?
It’s kind of both. There’s still stuff that’s rooted, that causes people to be in poverty and then to go commit acts of violence to put food on the table. Those types of things breed PTSD, and that’s difficult to fight. But the person on the individual level is the one who experiences the trauma and that’s something that can be worked with and that can be healed, even though they might live in a situation where there’s a lot of oppression and so forth. So, yes, it’s hard to fight the system but you can definitely work with an individual with their individual trauma.
What’s the most important part of youth stress therapy?
Young people in this society are not listened to, they’ve been kind of marginalized by their communities, and nobody takes them seriously. But if you go towards them with an open heart and compassion, treat them like a human being, and build an authentic relationship and actually listen to them, then that may be the first time they’ve ever had an adult listening to them, and that’s the beginning of the therapy and the beginning of the healing. Over time you teach them a bunch of techniques, but really the relationship that’s the most important thing.
Is it reasonable to expect these kids to grow up well-adjusted?
They absolutely can heal from their trauma, sometimes. I mean it’s rare that you’re going to get somebody who in six months is fully healed. It’s more like you learn lifelong things to make some significant progress, and get them to incorporate some real tools into their lives so they can live a healthier lifestyle and deal with their trauma. One of the biggest things for the youths that I work with, especially since many have been incarcerated, is that when they get out, they are put into programs that help them get jobs, and I think that’s great.
But then at the same time, for some of these kids with intense trauma, a job isn’t going to solve all their problems. If their employer yells at them the wrong way one day and triggers an autosomatic reaction, it could lead to a violent episode. Then the job doesn’t matter because they’re going to get fired and go back on the street and repeat the cycle. So really, it’s them being able to regulate the strong emotions that arise when their trauma is triggered, so they can maintain that self-regulation when dealing with someone who is untrained or unaware. The ability to self-regulate is an important tool that comes out of successful therapy, they still may be battling with their trauma, and aren’t fully healed, but it’s one step into the treatment.
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