LIT
Community Policy, Community Health
Jonathan Foiles’s This City Is Killing Me highlights the role of policy and social context in mental illness through Chicago case studies BY MICHELLE ANDERSON
I
first started writing this review of This City Is Killing Me: Community Trauma and Toxic Stress in Urban America prior to the current global pandemic. While nothing about the book changed, the starkness of its perspective—looking at issues of housing segregation, poverty, racism, and gendered violence as part of the larger landscape contributing to individuals’ experience with mental illness—seems particularly critical. COVID-19 operates as the deadliest killer of vulnerable persons like those discussed in This City Is Killing Me because of that same larger landscape, and the mental health effects of living under its shadow are likely to do the same. The book is a series of five case studies or narratives about therapeutic work done in collaboration between its author Jonathan Foiles, then a clinical social worker at Mt. Sinai Hospital in North Lawndale, and his clients. The narratives are presented as lengthier vignettes that are specific about policy and clinical details but accessible to lay people. Each person’s story simultaneously speaks to that person’s life struggles (the book’s subtitle is, after all, “community trauma and toxic stress in urban America”) and the social-historical context that makes the story seem almost inevitable. In an interview with the Weekly, Foiles said, “My writing bums people out. We should be bummed out.” Instead of succumbing to the pain of trauma and stress, Foiles encourages us to “confront the impact policy decisions have upon the city’s poorest residents.” Through Jacqueline, a patient diagnosed with borderline personality disorder, readers explore the intersection of mental illness and urbanization in the context of gentrification,
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safe spaces, and the closing of Chicago and Cook County’s public mental health clinics. In the mental health field, a diagnosis of borderline personality disorder expresses someone’s experience of extreme instability in all relationships even with themselves. The stigma of this diagnosis places a person at risk of being dismissed and judged harshly by peers and professionals. In the book, you are drawn (briefly) into Jacqueline’s family experience, her own struggles with gender identity, her eventual “pricing out” of the Boystown neighborhood where she once found some refuge, and her difficulty with a fixed income that doesn’t allow even the medical system in her life to be stable. The most consistent service Jacqueline received was publicly funded healthcare near her home. But when six of the city’s then-twelve public mental health clinics were closed in 2012, accessibility and continuity of care became simultaneously more challenging almost overnight. I would like to think that if someone reads this type of story, they can make a leap to appreciate that a context that feels unstable can work as both a catalyst and a continued reinforcement of an individual's pattern of instability. Frida reminds us of the burden we place on parenting and the limited resources our child welfare system has to actually assist people in being the best caregiver they can. When we are introduced to Frida, she’s involved in services required by the state Department of Children and Family Services (DCFS) to be reunited with her children (after one walked outside with no coat in a snowstorm), and is a few months past suicidal behavior that occurred while she was dealing with grief after her father’s death and her separation from her
