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Adversity, Ambivalence, and Mental Health: the Emotional Costs of Severe Deprivation

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Adversity, Ambivalence, and Mental Health: the Emotional Costs of Severe Deprivation Adversity, Ambivalence, and Mental Health: The Emotional Costs of Severe Deprivation The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Mpondo-Dika, Ekedi. 2019. Adversity, Ambivalence, and Mental Health: The Emotional Costs of Severe Deprivation. Doctoral dissertation, Harvard University, Graduate School of Arts & Sciences. Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:41121358 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA Adversity, Ambivalence, and Mental Health: The Emotional Costs of Severe Deprivation A dissertation presented by Ekédi Mpondo-Dika to The Department of Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the subject of Sociology Harvard University Cambridge, Massachusetts January 2019 © 2019 Ekédi Mpondo-Dika All rights reserved. Dissertation Advisor: Professor Christopher Winship Ekédi Mpondo-Dika Adversity, Ambivalence, and Mental Health: The Emotional Costs of Severe Deprivation Abstract This dissertation uses small-scale ethnographic fieldwork to examine the affective underside of severe deprivation and its institutional management. Chapters 1-3 draw on three years of participant observation in a low-income network. Chapter 1 outlines the key research participants’ trajectories and illustrates the proliferating nature of poverty’s trials. Chapter 2 traces some consequences of cumulative adversity by focusing on the on-again, off-again quality of several relationships in my participants’ network. Dispossession increased participants’ reliance on each other, not only materially, but for emotional nurturance. However, poverty also made it more difficult to meet each other’s needs. Disappointment and sometimes violence ensued, breaking up social ties. Nevertheless, at the next crisis, people found themselves rekindling their relationships for lack of a better alternative. The travails of chronic scarcity thus worked both as strains on relationships and sometimes as traps that brought people back together under the pressure of necessity. This resulted in relationships marked by deep ambivalence. A stronger institutional safety net would free poor people from having to negotiate emotional fulfillment under the pressures of economic survival. Given the distress documented in chapters 1 and 2, however, it is also reasonable to consider psychological and therapeutic interventions. Chapters 3 and 4 examine uses of mental health services as institutional responses to suffering. I argue that treatment and counseling, when nested within structures of poverty governance, present a troubling fusion of care with control and mistrust. Chapter 3 focuses on a mother and her five-year old son’s experiences with counseling services and psychiatric treatment. Chapter 4 iii investigates an incipient development in social service delivery: the rise of “trauma- informed care”. This chapter introduces a new set of data, collected during eight months of visits to a social service agency. In both case studies, being labeled as mentally disordered brought benefits, e.g. disability income or the chance to escape incarceration. The wages of mental illness, however, were problematic in two ways: Offered against the backdrop of punishing alternatives, they could be considered coercive. Second, they came at significant costs: increased distrust of healthcare providers, exposure to potentially serious side-effects, and a loss of credibility. iv TABLE OF CONTENTS ABSTRACT ............................................................................................................................ III TABLE OF CONTENTS ..........................................................................................................V DEDICATION .......................................................................................................................VII ACKNOWLEDGMENTS.................................................................................................... VIII LIST OF TABLES .................................................................................................................XII INTRODUCTION: THE EMOTIONAL EXPERIENCE OF POVERTY .............................. 1 THEORETICAL FRAMEWORK .................................................................................................... 4 THE STUDY: AN INTIMATE ETHNOGRAPHY IN GEOGRAPHIC AND INSTITUTIONAL CONTEXT..... 16 OUTLINE OF THE DISSERTATION ............................................................................................ 26 CHAPTER 1: THE STORY ................................................................................................... 30 VICTORIA RUIZ’S PAST ......................................................................................................... 30 THREE YEARS IN A LIFE ........................................................................................................ 46 APPENDIX TO CHAPTER 1: SUMMARY OF VICTORIA’S NETWORK AND TIMELINE OF MAIN EVENTS .............................................................................................................................................. 76 CHAPTER 2: PAINFUL YET ESSENTIAL: AMBIVALENT BONDS AND THE ‘FAMILY SAFETY NET’ ..................................................................................................................................... 80 INTRODUCTION ..................................................................................................................... 80 LITERATURE REVIEW ............................................................................................................ 82 OVERVIEW OF THE ARGUMENT .............................................................................................. 90 THE IDEAL: LOVE AND FAMILY IN THE TIME OF SOCIAL ABANDONMENT ................................ 91 TRAPPED IN CIRCLES ........................................................................................................... 100 CONCLUSION: THE FRUITS OF AMBIVALENCE ....................................................................... 127 CHAPTER 3 - MENTAL HEALTH BETWEEN CARE AND VIOLENCE: A PRELIMINARY ANALYSIS .............................................................................................................. 135 v THE CARING HAND OF THE STATE: BOTH TOO LIGHT AND TOO HEAVY ................................. 136 WHEN CARE AND VIOLENCE MERGE: THE NEUROCHEMICAL TAMING OF BENJAMIN “SWING” QUINTANA ........................................................................................................................................ 147 CHAPTER 4: THE DOUBLE-EDGED SWORD OF TRAUMA-INFORMED SERVICES FOR THE POOR ................................................................................................................................ 170 FRAMEWORK: TRAUMA-INFORMED SERVICES AS PROGRESSIVE NARRATIVE .......................... 172 FIELDWORK IN A STATE SATELLITE ...................................................................................... 175 FINDINGS: A DOUBLE-EDGED SWORD .................................................................................... 177 CONCLUSION ....................................................................................................................... 191 CONCLUSION ...................................................................................................................... 197 BIBLIOGRAPHY .................................................................................................................. 199 vi DEDICATION For my mother, who taught me about unconditional support, strength and vulnerability, self-reflection and empathy, and most of all, the importance of fighting the good fight; For my father, who taught me that past suffering doesn't preclude trying anew, and that thinking can be pure joy; For my siblings, who first taught me about love and companionship among equals, and keep teaching me about resilience, from up close and from afar; For my grandparents and uncles, who taught me that sharing is caring, and that actions can speak as loud as words; For my in-laws, who showed me how to become family; For Joan, who taught me that love isn't easy and that care and forgiveness carry the day; For all those who taught me that a good life is made of good friends; And for Johann, who taught me about acceptance and commitment, and who reminds me of everything else every day. vii ACKNOWLEDGMENTS As I complete a dissertation on the limited institutional and interpersonal resources available to people living in poverty, I must acknowledge my own good fortune, and I am humbled by the many kinds of support I have received over the years. My first thanks go to the research participants who have let me into their lives over months and years. Nothing would have been possible without your openness and generosity. Nothing would have been possible either without the mentorship I have been lucky to receive. My advisor, Christopher Winship, is a well of intellectual generosity, understanding, and kindness. His curiosity is without parallel and each of our many conversations has enlarged my horizons, as well as made me more confident in the interest that someone could find in my own ideas. Much thinking happens in conversation, and I couldn’t
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