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Trauma is considered a physically or emotionally harmful event or set of circumstances that results in lasting mental, spiritual, or emotional anguish. Not all traumatic experiences lead to the condition known as PTSD. That can develop when a person is terrified, perhaps afraid for his or her life or that of a loved one. In adults, common symptoms include nightmares, flashbacks, emotional numbness, and avoidance of people or places that evoke the original trauma. Younger children affected by PTSD might wet the bed, forget how to talk, or act out the scary event during playtime.
No one in Oakland knows how widespread PTSD or related conditions have become. This is partly because psychologists are guardians of this information, and most of the local agencies that treat children don't track diagnoses. For a low-income child who lacks private insurance and qualifies for public assistance, Medi-Cal will cover the cost of therapy. In Alameda County, it did that for 1,100 children diagnosed with PTSD in fiscal year 2011-2012. At less than 1 percent of the population under age eighteen in the county, that's clearly not representative of the problem; the nationwide rate of adolescent PTSD is estimated at nearly 5 percent, according to a study published this summer in the Journal of the American Academy of Child and Adolescent Psychiatry.
There's another reason the Medi-Cal data might obscure what's happening locally: An additional 4,300 low-income children in the county received subsidized counseling for anxiety, depression, mood disorders, and attention deficit hyperactivity disorders, all of which are tied to symptoms that can be traced back to traumatic experiences. These figures also omit privately insured kids, those who can't get government coverage, and those who remain undiagnosed. (However, the expansion of Medi-Cal through Obamacare will make it easier for uninsured children to qualify for coverage.)
Psychologists working in Oakland say they are often frustrated by the current requirements of the PTSD diagnosis, which center on a single life-threatening incident. This definition can't capture the breadth of a child's trauma in Oakland, so therapists may instead give a fitting alternative diagnosis, like attention deficit disorder or depression. A broadened definition of PTSD will take effect next year and should allow therapists to more precisely diagnose traumatized children.
Some counselors, including Hill-Ford, don't even like the term PTSD. "In urban settings like Oakland, there's nothing 'post' about it," she said of the constant trauma children face. "So the diagnosis isn't correct." Another way to describe it is complex trauma, or relentless suffering that takes numerous forms over time, she said.
In 2008, the Department of Justice surveyed thousands of adolescents and teenagers about how often they'd been exposed to violence in their short lifetimes, and more than 60 percent reported at least one incident in the previous year. Forty percent of these children were victims of two or more violent acts, while 10 percent were victimized five or more times. The categories included sexual assault, domestic battery, child abuse, and community violence.
Children may be resilient, but these malevolent forces can wear them down. Those exposed to violence are more likely to fail or struggle in school, exhibit criminal behavior, and develop depression, anxiety, and PTSD, according to the Justice Department. The agency doesn't yet know how violence affects children across racial, ethnic, income, and geographic lines, but US Assistant Attorney General Karol V. Mason said in an interview that the problem knows no bounds.
African-Americans and Latinos comprise more than half of Oakland's population. Though the city's poverty rate is 20 percent, nearly a quarter of African Americans and a third of Latinos earn less than that. The city's robbery rate is the highest in the nation, and in 2012, about 2,000 violent crimes were committed per 100,000 people, according to data from the Federal Bureau of Investigation. By contrast, nationwide there were 387 violent crimes per 100,000 people.
Reverend Michael McBride, who is based in Oakland, directs the Lifelines to Healing Campaign, an anti-violence initiative run by the faith-based PICO National Network. The countrywide campaign, he said, encourages congregations and clergy to talk about violence and poverty in a way "that includes trauma as a very central part of how we humanize our communities in the national consciousness."
McBride served on the gun violence panel convened by Vice President Joe Biden following the Sandy Hook shooting last year, and he has been disheartened to see that routine shooting deaths in cities like Oakland, Chicago, and Detroit don't elicit the same outrage as the mass casualties in Newtown, Connecticut. "Part of what we have to do," he said, "is make sure that someone on the corner is considered as valuable and worthy of life as the precious kids in the Newtown classroom."
This requires a new way of thinking about impoverished neighborhoods. "There's a pervasive thought that if you just give someone a job, all of their problems will be solved," McBride said. But, he added, it goes beyond money to healing a wounded mind and heart.
Like veterans who are considered fully incapacitated by PTSD, and receive disability payments as a result, children and adults are also scarred by homegrown violence and trauma. In a community like Oakland, where violence is concentrated, so much misfortune can "break the human psychological threshold," McBride said.