I am a social psychiatrist. This field of psychiatry is interested in understanding the ways in which the organization of society affects mental health and mental illness. My own work focuses on cities. I got to this work by a somewhat circuitous route, beginning in 1986 with studies of the AIDS epidemic. 1 Although the Human Immunodeficiency Virus, the virus that causes AIDS, actually travels from one person to another, its voyage is determined by social policies that affect where and how people live and how prevention and treatment are managed in those places. I would like to bring my reflections on the AIDS epidemic to bear on the recovery of the Gulf Coast after Hurricanes Katrina and Rita.
The spread of AIDS in the United States, as it turns out, is closely tied to displacement. 2 Among gay men, this displacement was from hometowns all over America to the gay ghettos in major cities that offered both relief from homophobia and freedom of self-expression. Among African Americans and Hispanics the crucial displacement was related to the destruction of ghetto neighborhoods as a result of federal, state, and local policies.
The spread of AIDS is also affected by secondary policies of neglect, which are themselves tied to the forces that created displacement. Gay men and people of color—especially if poor—are easily shunted aside and marginalized in U.S. society. Unfortunately, public health interventions are distributed by wealth and power, not need, so the neediest people are the least likely to get the disease prevention help they require. Three case studies of organizational response to AIDS helped me understand this in more detail. Organizations were slow to respond to the epidemic, and interventions were often disorganized and always underfunded. Stigma directed at gay men and drug users interfered with the delivery of health care, prevention information, and prevention tools. Many marginalized people were left to suffer. Time and time again, cultural rules trumped public health advice.3 As a psychiatrist, I was fascinated to observe the ways in which society created policies that put people at risk, and then blamed people for being at risk.
In many ways, the story ofAIDS is a story of “what not to do when faced with a big problem.”
But what should be done?
How Places Should
Work In order to answer that question, I have studied how places work.4 Places are like nested dolls, with home as the smallest and most central, nested in the neighborhood, nested in the city, nested in the state, nation, globe, and universe. In the best of circumstances, places would interact in a manner that supports the wellbeing of all people and other living creatures around the globe. In good places, people look out for each other, government tries to share resources equitably, and the vulnerable are protected from predators. Good places are “wired”; that is to say, people are densely interconnected and it is easy for them to follow what is going on with one another. This helps them to solve problems, supervise children, take care of the weak, and support the ambitions and creativity of all. I drew a “wiring diagram” in Figure 1 which captures the idea of this complex interconnectedness people describe in good places.
David Jenkins, a man who lost his boyhood home to urban renewal, has spent many hours exploring this idea of place with me. On one occasion, he drew a map of the special places in his childhood neighborhood: the resources of people, animals, food, and learning that made the neighborhood work for him. In Figure 2, I have indicated some of these special resources he marked on his map.
Mr. Jenkins lived in a “wired” neighborhood that took care of him in many ways. The loss of that neighborhood was devastating. Listening to him describe the uprooting and dispersal of his neighborhoods and his terrible, lingering sorrow about the loss of his home, I came to think of this kind of violent uprooting as causing “root shock”—the traumatic stress reaction to the loss of all or part of one’s emotional ecosystem.
I learned that upheaval can be repaired. But, as with the AIDS epidemic, the policies and social processes that led to destruction of a neighborhood are not likely to support its repair afterwards. In studies of urban renewal in five American cities—Newark, N.J.; Pittsburgh, Pa.; Roanoke, Va.; St. Louis, Mo.; San Francisco, Calif.—I found that functional poor neighborhoods were destroyed in the name of “progress.”5 The poor did not have a voice in deciding on the “progress.” The serious losses they endured were written off as the “costs of progress,” often summed up in the quip, “You have to break a few eggs to make an omelet.” Over time, the blame for the degradation of collective life devolved from the policy-makers who instituted urban renewal and landed on the “criminals,” “drug addicts,” and other people who were “bringing down” the neighborhood. This is a shift of the collective gaze toward criminals and away from the marginalizing processes that structure American society. Neighborhood recovery is nearly impossible from the position that says, “The criminals did it.”
“Recovery” in the Gulf
The parallels between the AIDS epidemic and urban renewal are these: Marginalized people were most vulnerable; they were blamed for causing the troubles; and help was inadequate and disorganized, adding insult to injury. We can identify this process in the post-hurricane disaster response in the Gulf. Hurricanes Katrina and Rita, and the flooding of New Orleans, caused massive damage to an enormous area. In the immediate aftermath of the catastrophe, disaster relief was slow, inadequate, and disorganized. But what emerged immediately was a counter proposal to full emergency intervention. What emerged was the idea that the poor would make better “progress” if they never went back home. They could be “mixed in” in cities like Houston and Atlanta, their children could go to better schools, and the adults could benefit from being near wealthier people. In the meantime, the land they had vacated would be redeveloped for the benefit of wealthier people.
This false “win-win” effectively stopped the recovery from the emergency and set in motion a displacement scenario that is still playing out. By the August 2007 second anniversary, the outlines of recovery were quite clear. The French Quarter was doing well, wealthier neighborhoods were working, and landlords were benefiting from major increases in rent. Meanwhile, poor and working people were stranded in other cities or trailer camps or, if they had managed to get home, were suffering because schools had been slow to reopen, few bus lines were running, and rents had gone through the roof. Though media continue to talk about the “progress” being made in the Gulf, the real progress stopped when the real estate scam started.
Preservation Can Promote a Better Way
Preservationists can point to a just and beautiful alternative, the Manchester neighborhood in Pittsburgh. Arthur Ziegler and James D. Van Trump, cofounders of Pittsburgh History and Landmarks Foundation, began their work in historic preservation in 19646 While working through the historic Manchester neighborhood, they realized that a beautiful and historic community was threatened with destruction. They worked with community residents to preserve the neighborhood, first defeating the city plans to demolish the area and then developing tools for invigorating the neighborhood without displacement.
The tools that they developed were quite remarkable. One of the most important is that Ziegler and Van Trump have always worked in partnership with the Manchester neighborhood. Many community groups are engaged in the work. The local people are part of what is happening there. It makes Manchester feel like a safe and welcoming home for those who settle there.
A second important tool is the inventory of neighborhood structures, which resulted in a series of maps that document everything in the neighborhood. These maps are not hidden in a vault. They are living documents, used by community leaders in their every day of restoring the neighborhood. I vividly remember the maps from a 1998 visit. What struck me then was that the maps created a shared understanding of the neighborhood and gave transparency to the redevelopment efforts.
A third element is that they were able to develop a revolving loan fund which helps to provide money for building and renovating. This fund was started in 1966 with $100,000 from the Sarah Scaife Foundation. Manchester has benefited from the fund, as have other neighborhoods. Other the years the fund has grown. Now it is a major funding source, providing loans to more than 30 Pittsburgh neighborhood organizations.
On its website, Pittsburgh History and Landmarks Foundation describes its achievement as demonstrating that “grassroots, nonprofit historic preservation…can be a catalyst for urban renewal” ( www.phlf.org/global/mission.html). I would say that its work demonstrates that honesty is the best policy. Rather than using doublespeak to displace and impoverish the poor, PHLF has used participation, transparency, and commitment to create new vitality in abandoned urban areas. A brief glimpse of this powerful work can be obtained on YouTube ( www.youtube.com/watch?v=VI2mJz7KGOM).
Arthur Ziegler and James Van Trump demonstrate the kind of savvy that preservationists bring to American cities. I have noticed that preservationists tend to appreciate place. They understand what a historic site adds to the workings of the modern world. Preservationists have skills in working for stabilization of place, rather than its destruction. They understand how to reach the general public and they are willing to stick to the task until it is done. Most American cities are in desperate need of such leadership. As was the case in Pittsburgh, enlightened leadership from preservationists can have a major effect on the substance of urban life.
Acknowledging and Addressing Root Shock
Root shock, like other kinds of traumatic stress, is a very painful experience. The pain is not resolved in a day or a week. In fact, it can endure for decades. Once a neighborhood has been destroyed—its wires cut and residents dispersed— the synergies of that settlement are lost to all of us forever. The shock reverberates far beyond the local area to touch caring people everywhere. It is not a coincidence that many preservation organizations came into being in the aftermath of the massive urban renewal projects of the 1950s. Reasonable people saw the destruction and decided to stop it.
At the same time, my observations suggest that most of the injury gets swept under the rug, hidden out of sight, and covered over as “progress.” The residents pushed out of the way are stranded—like the poor from New Orleans who are suffering in trailer parks. At that moment, recovery stops, as it did when land speculation trumped rescue in the Gulf. A society that sits in limbo, pushing the vulnerable out of the way and then leaving them in pain, is a society that has created a substantial weakness in its internal connections.
This affects all organizations, whether they are bowling leagues or preservation societies, because all organizations are forced to work from incorrect assumptions about the nature of our problems and the possible solutions. Misinformation poses enormous hazards.
In light of that, I recommend a task be added to the work of preservation societies, and that is the preservation of the whole story and the big picture. This implies learning to look at landscapes in a new way. The wanton destruction of historic neighborhoods has cleared out what was there and it has created new uses of other spaces. The new set of concerns should be about both the injured “here” and the displaced “there.” Furthermore, it should be understood that, without a resolution of both “here” and “there,” no recovery is possible.
Many may think this is an extreme statement. After all, if the French Quarter is functioning, isn’t that some progress in the Gulf? I am arguing that the apparent recovery signified by the reopened hotels and restaurants in the French Quarter is an illusion. The history and culture of the city remains in diaspora. That it will be irrevocably lost seems highly likely, given the deep commitment of many levels of government to a vision of “progress” that simply tries to eliminate the poor. If preservation of the Gulf is an important task, then it must confront the complex reality that the Gulf is spread all over America. Visionaries, like Ziegler and Van Trump, can find solutions even to problems as complex as this. Let us give them our utmost support.
1Levenson J. The Secret Epidemic: The Story of AIDS in Black America. New York: Pantheon;2004.
2Wallace R. “A Synergism of Plagues: ‘Planned Shrinkage,’ Contagious Housing Destruction, and AIDS in the Bronx.” Environmental Research 1988;47:1-33.
3Fullilove MT. “AIDS and Social Context.” In Ellen G. Feigal Alexandra M. Levine, and Robert J. Biggar, editors. AIDS-Related Cancers and Their Treatment. New York: Marcel Dekker; 2000. p. 371-385.
4Fullilove MT. “Psychiatric Implications of Displacement: Contributions from the Psychology of Place.” American Journal of Psychiatry 1996;153(12):1516-1523.
5Fullilove MT. Root Shock: HowTearing Up City Neighborhoods Hurts America and What We Can Do About It .New York: Ballantine/OneWorld; 2004.
6 Moe R,Wilkie C. Changing Places: Rebuilding Community in the Age of Sprawl .New York: Owl Books; 1999.41
Publication Date: Winter 2008