by Brook Damour, MSW, LICSW

Hidden Trauma

Using Therapy to Help Integrate Childhood Poverty

Originally published in Washington State Society for Clinical Social Work Newsletter, Spring 2013 Issue.

Most trauma is associated with shame and secret keeping in one form or another. The comedian Darryl Hammond, of Saturday Night Live fame, wrote a book about his on-going abuse by his mother as a child. He said that one of the reasons he wrote the book was to address "the agreement between perpetrator and victim in which the victim agrees to remain silent because he’s in fear.^[1]"

Victims of assault, war, domestic violence, and other forms of abuse often describe feeling deeply shamed by what has occurred to them. They often feel that to move on in their lives they must try to forget what has happened to them, or at the very least, hide it carefully from others so that they will not face stigma. Victims of trauma are often silent.

One area of trauma that is not always recognized as trauma is the experience of growing up in poverty and economic hardship. I make a case that this is a form of trauma to one extent or another, because of the amount it can distort and limit a person’s self-esteem, opportunities, and sometimes, their ability to develop at a pace with their peers. It is particularly haunting because poverty is generally not something that has a single perpetrator, like physical abuse might, but is the result of a great many factors that are difficult to tease apart and understand. As such, the trauma from poverty can take on a particularly mysterious, phantom-like quality for those who experience it. To use Hammond’s words, when the trauma you deal with is poverty, it’s hard to say who the perpetrator is that keeps you silent and fearful. And when your whole family has been in poverty, it is often confusing to try to understand who was victimized and how that victimization was passed on intergenerationally.

While certainly some of these issues can be mitigated (a few possible mitigating factors might be a healthy, supportive family environment, high quality social services, educational enrichment programs, mentorship and connecting with people who model successful behavior), the reality is that many people who struggle with poverty in the U.S. do not have enough protective factors to allow them to feel safe and whole. This can also be true for people who have grown up poor and have been resourceful enough to escape the poverty. Because poverty is often stigmatized and pathologized, there can be a tendency to hide experiences with poverty from others, much like hiding other forms of trauma. People often feel ashamed, marked, and somehow bound to their history of poverty in silence because of what they fear it might say about them. Poor and working class people are commonly stereotyped as being lazy, not intelligent enough to do “higher class” jobs, courser, and even damaged. Who would want to openly carry around those labels?

I propose that for people who have grown up poor and found ways to move out of poverty, there are other special considerations. Many people with a poor background describe feeling “survivor’s guilt,” a sense of not deserving to have prospered, a feeling of responsibility for people they care about who still struggle. This feeling of responsibility can be particularly difficult because it can lead to challenges with maintaining boundaries with others. It can be likened to people of multiple cultural backgrounds who describe feeling like they are from two worlds. People who have grown up poor and then earned their way out of poverty live both in a world of poverty and a world of more privilege. Where do they fit when they have experiences in both worlds? How do they bridge those experiences to feel whole? If you have had these experiences, you may have survival skills and strengths that have allowed you to succeed to some extent but still feel held back internally, fearful, ashamed, and confused about who you are.

In my study of social class as it impacts therapy and people’s growth toward wellness, a common concern is the fear that even though a client has accomplished things in the world and earned what they have, they still feel false or unworthy. To some extent, poverty seems linked to feelings of unworthiness, and often, inferiority and uselessness. Poverty and disenfranchisement are not such different words. Growing up poor means there may be limited role models to learn from about how to be assertive and navigate the cultural complexities of earning money. To be able to succeed in American society, where assertiveness is valued, you often have to find ways to “fake it” when you feel unworthy, if you want to “make it.” For some this takes the guise of observing others who look successful and trying to imitate them. This is a double edged sword because it can help a person succeed but it can also feel unnatural and strange, which can lead to a profound feeling of falseness and feeling like an imposter. It all circles back to secret keeping about trauma, and trying to integrate the pain from the past with current circumstances. A person can try to mimic what they think they should be, but keeping part of their identity secret can lead to profound pain.

Therapy can help begin to make peace with these two worlds - the world in which you grew up without enough money, and the world in which you may actually have enough. Much like our work in other areas, careful attention to trauma and pain surrounding childhood social class can help people integrate different parts of their identity that may cause them pain, so that they do not have to keep secrets, feel shame, or dismiss their own experiences and worth.

These are some areas I now include in assessments to better understand if childhood poverty may be an important issue to consider in therapy:

• do clients feel tremendous guilt about the good things they have?
• do they feel responsible for and often struggle to maintain boundaries with friends and family members who are struggling?
• do they express feeling phony (what Donald Winnicott described as a “false self,” someone who pretends to be “as if” they are the person they think they need to be, but the false self doesn’t match how they feel on the inside, which may be empty, shameful)? Do they look good on the outside but feel terrible inside? In this case, the role of attachment takes on more layers than being solely shaped by a primary caregiver. When social class is a source of feeling false, both the family and society at large begin to impact early development of self.
• do they experience anxiety about scarcity, even with a relatively stable financial state? This may manifest as nightmares about losing everything, or hoarding things that were sources of scarcity in childhood, such as food. Do they feel unsafe most of the time, unable to protect themselves, or as if everything good might get taken away? Here, manifestations of past deprivation can dovetail with PTSD symptoms.
• do parents with a history of poverty find they are puzzled about how to instill the value of material things provided a work ethic in their children? Are they anxious because of memories of when their own family could not provide enough for them?
• do fears about and memories of scarcity while growing up impact present functioning, and hold the client back?

I have found the way childhood poverty impacts people as they grow up, even if they are no longer poor, to be an important part of recovery and growth for clients. As we all know, creating safety is usually about more than money and our current situations; it is also often about integrating the past, and social class in childhood is an often ignored, but vitally important part of this. If you do not already, I invite you to consider the importance of your clients’ social class history, particularly the parts of that history that still sting, as you help them to grow.

[1]:Gross, T. (Producer). (2011, November 7) Fresh Air [Radio Show] Philadelphia: National Public Radio, WHYY-FM.