goal, if not in theory than in practice. In my own graduate program of social work, I reached a point where I had to choose between a clinical (that is, mental health-focused) or social administration (primarily policy-based) approach. The longer I work at my job, the harder it is to tell the two apart. This book is my attempt to bring both sides together.
In the pages to come, I will introduce five of my patients and demonstrate how their lives have been impacted by policies and practices outside their control. We will revisit Jacqueline, a transgender woman of color trying to survive and complete her journey to become herself. You’ll also meet Frida, a deeply traumatized child who grew into a traumatized parent whose children were removed from her care by the Department of Children and Family Services; Robert, who endured trauma in the Cabrini-Green projects and refashioned a self-narrative that made him an African prince in exile; David, who failed out of a selective enrollment high school and lived amongst rats and the books he couldn’t stop hoarding; and Anthony, who lost his son to a random act of gun violence and was still trying to pick up the pieces of his life years later.
I do not want you to feel sorry for my clients. I don’t feel sorry for them, and I don’t think they would want anyone else’s sympathy either. Sympathy does nothing to change their situation in life. Rather, I want you to see them, to be forced to confront the impact that policy decisions have upon the lives of our cities’ poorest residents. Their stories give me hope, yes, but even more than that they challenge me. They challenge the advantages conferred to me because of my white skin, who my parents were, where I grew up, and who I love. I chose none of those facets of my identity, and neither did they.
As is standard practice within my field, all names and identifying details have been changed. I have preserved enough of my patient’s stories to illuminate my thesis but have left out or modified those details that are not relevant. Out of respect for their lives and experiences, the rest has been told exactly as it occurred.
I’m aware that by sharing these stories I risk fashioning myself into the “white savior,” an outsider who comes parachuting into urban communities of color to save them from their woes. That is not my intention in writing this book, but I realize the tension inherent in the project. I will do my best within these pages to let their stories speak for themselves. I may have captured their attention for an hour every week or two as we worked together, but real lasting change can never occur in my office alone. Any progress my patients have made is due to their dedication and hard work; I am privileged to help guide them along the way and be their cheerleader. I strive to always listen to my patients without interjecting my own construct of what I think is going on, and what you will see in this book is largely a reflection of what I have learned by listening to them.
CHAPTER 1
JACQUELINE
When I first met Jacqueline, she was trying very hard to hide in our waiting room. She was wearing large Jackie Kennedy-style sunglasses, and the frayed hood of her hoodie was cinched tightly around her face despite the summer heat. She was wearing gray sweatpants, the cuffs of which were ragged and dingy from dragging on the ground behind her flip flops. Her head was tilted downward, her gaze focused tightly on a spot about six inches in front of her toes. Her mental health assessment noted that she was a transgender woman, but the intake worker did not ask her for her real name. I called out her last name like a drill sergeant and asked her to follow me back to my office.
I was excited but nervous to begin treating Jacqueline. She was the first patient I had seen with borderline personality disorder, and I had heard horror stories from other professionals about working with that population. She was also the first trans patient I treated. I had no special training in trans health or treating LGBTQ populations, but I was trans-affirming and thought I could help her. Looking back, I think I was also trying to atone for the homophobia and transphobia that had shaded my conservative Midwestern upbringing.
In my office, I try to create a safe space that comforts the patient. Plants line my shelves, and I have various art prints hanging on the wall, all in muted colors. I keep my lights low. I noticed that Jacqueline continued to keep her sunglasses on her face even though I felt certain she could barely see a thing. She had come ready to begin treatment; she had already called my supervisor several times asking to be connected with an individual therapist. She wasted no time in telling me about her traumatic past. About twenty years ago she was on vacation in her native Brazil visiting her family. At that time she was living as a gay man. She went to a local bar and had a little too much to drink. She met someone and decided to go home with him. He offered to drive her back to his place, and since she had walked to the club she accepted. Due to the lingering effects of the alcohol, the blindness of lust, or both, she didn’t pay attention to where he was going. She noticed when he stopped in the middle of the field, reached behind him, and pulled out a machete. Her senses sharpened, she wrenched open the door and began running for her life. She ran through unfamiliar terrain for an hour and a half until dawn when a stranger let her use their phone.
I often ask patients when they thought their problems started. I do this not because their answer is necessarily correct, but it gives me a sense of how they think of their symptoms. Jacqueline traced the source of her mental suffering back to that day. It wasn’t hard for me to see why Jacqueline felt that this marked the commencement of her downward spiral. Before then she had lived a decently fulfilling life as a gay man. She had friends, she spent most of her time in Boystown, the historically LGBTQ neighborhood in Chicago, and she was active in the dating scene. Inside she knew that she felt like a woman, and she only really felt comfortable in her own skin when she was performing her drag routine, but she didn’t yet know what it was to be transgender.
As I grew to know Jacqueline better I found out that things before the attempted murder weren’t quite so sunny as she remembered. She felt immense pressure during high school to act hypermasculine. This grew to be exhausting, and she finally came out as gay to her parents when she was sixteen. According to her they were shocked, but she later told me that one of the first English words her immigrant father learned (and then deployed liberally) was “faggot,” so I assume they suspected something. Regardless, they kicked her out that night. Jacqueline rarely had to sleep on the streets, but sleeping on couches and floors is still no way to live. She worked to make something of herself. She completed a year of college. Later her relationship with her parents healed somewhat, and she was invited back into their circle. She tended to gloss over all of this in session; she lived with her mother and saw her father regularly and reported all was well. I wanted to believe this for her sake, but the wounds of our past often don’t heal as quickly as we would like.
Jacqueline’s pain didn’t end with her parents. During her twenties she was reasonably well-integrated in Chicago’s LGBTQ scene, and from what she told me it sounded like she had strong friendships. Her romantic relationships were a different story. Nearly every previous boyfriend she recounted to me had abused her in some way—physically, sexually, emotionally, or all of the above. Jacqueline was vulnerable: She had little contact with her family at that time, she worked but still struggled to make ends meet, and she was Latinx in a predominantly white community. I don’t know exactly how this combined to make love so difficult for her. Like many of my other patients, Jacqueline believed that she was just unlucky. Perhaps, but I find it far more likely that her vulnerability, not to mention her growing recognition that she did not belong in a man’s body, made her susceptible to falling for anyone that showed interest in her. Freud believed that we have a repetition compulsion, an inner drive to keep reaching out for the flame even though we know we’ll be burned. I don’t believe in anything that fatalistic, but I do think the past scratches its grooves upon us, and the record keeps skipping unless we move the needle.
Jacqueline’s first breakdowns began to occur around this point. Nearly every relationship ended with her either calling the police or having her now-ex-boyfriend drop her off at the emergency room doors. None of them accompanied her inside. She turned her pain inward, cutting herself
