What path are you going to take?
How do you walk around and not look depressed?
How do you walk around and not look angry?
And be able to hold your head up?
And you have to realize that your child is growing.
They’re going to have to do the same thing.
You got to break the chain somewhere.
You got to break it.
—JEWELL, WITNESSES TO HUNGER
Jewell described her mental health as poor because she had been raped many times. The first time at age five. With conviction, she said, “Just because that happened to me doesn’t mean I have to let that define me.” The “chain” of the intergenerational transfer of violence, she insisted, can be broken.
Many mothers we spoke to are fierce advocates for themselves and their children. No one wants to be defined by poverty, adversity, violence, or trauma. A person and a people are far greater than their traumas and oppression. They can resist societal forces, break the chain, choose life, plan, generate joy, and imagine a future.
Though some get lucky and have superhuman powers to overcome trauma and systems of oppression against all odds, it is wrong to think that people should be expected to break the chain by themselves. Millions of others are left behind, dragged down, mowed over, kidnapped, or pushed down by US government systems, white terrorists, and everyday people who harness racism in big and small ways, such as calling police for some imagined slight by a Black person, or excluding Black people from particular jobs, neighborhoods, and other public spaces. Instead, we must set the conditions to break the chains so that all people can flourish.
To do this, one must be willing to see what has always been there, but that most people ignore or shove away. This means that as a society, we must deal with our “dissociation” at an individual, family, organizational, community, and systems level that is due to physical, social, political, and economic violence.
Faith and Carla are long-standing members of Witnesses. I met them both when they were in their late twenties. Faith is currently a mother of three children, though when we met, she had two young boys. Carla is the mother of four children, although when we first met, she had three. Both are kind and soulful Black women who have experienced a lot of hardship. Faith has an occasional edge of hostility while Carla is always kind and full of humor. Both suffer no fools.
It was morning, and I had met up with a few staff members of a US legislator to visit Carla at her house in North Philadelphia in spring 2010. On the same afternoon, the staff of Witnesses were going to host a meeting with these staff members and many members of Witnesses and prepare themes and photos for a traveling exhibit across the state. It was a big moment for Witnesses and signified a new chapter in our collective work.
My cell phone buzzed with a text. It was Faith.
“Mariana, I’m getting ready to kill myself.”
I immediately stepped away from the conversation and called her.
“What’s wrong, Faith?”
“I just can’t do this anymore. I just can’t.”
“Please don’t, Faith!” I said, heart pounding. “You are wonderful and beautiful and I love you. Also, we are counting on you to come to our meeting this afternoon. We’re all looking forward to seeing you.”
“I can’t, Mariana. I just want it to end.”
My professional training kicked in. I asked tentatively, “Do you have a plan?”
“Yes, I got the gun right here, and I’m going do it here in the basement laundry room because it has a drain, so the mess won’t be too bad.”
“Oh my god, Faith. Please don’t.
“No, Mariana. I don’t fucking matter. No one gives a fuck. I don’t give a fuck.”
I saw the conversation between the visitors and Carla was in a pause. Knowing I was out of my depth, I asked Carla to talk to Faith. Carla took the phone from me, manifesting her warm, kind spirit, and said, “Come on to the meeting, honey, and let’s talk about it.”
During their conversation, I texted other members of Witnesses asking them to reach out to Faith to encourage her to come to the afternoon meeting. They texted to encourage her too, expressing their care and support.
None of us were sure if she would show up to the afternoon meeting.
When she did, the whole group stood up to embrace her.
But she did not really feel like being in the meeting. Things were dire. She agreed she ought to be hospitalized.
While Carla sat with Faith in my office and held her hand, I worked the phones with the emergency room across the street. After a time, she willingly walked across the street with Witnesses staff.
After being hospitalized for a week and taking medications to stabilize, Faith said she felt better. Years later, Faith still has her ups and downs. But she is generally well. She had another baby who is full of laughter and growing up loving the world.
What saved Faith was her ability to reach out for help. Second, the group reached out to her to express their care and remind Faith of her belonging. Several members of Witnesses had started to form strong social bonds they referred to as a sisterhood. When people came to meetings to talk about their photos or plan an exhibit, they would talk about how they felt seen, heard, and recognized.
When members of Witnesses spoke in public about why they joined the program, they explained it was mostly because they wanted the camera. They also wanted the money for doing the interviews.1 Once they started coming together in the groups to design the exhibit, they noted, everything deepened, and the social bonds kept them together and provided each other support for many years.
When Audrey and I met, she was the mother of six children. She was one of the few white non-Latina women who joined Witnesses. Her intermittent partner and father of several of her kids was an undocumented immigrant from Mexico. Her life was difficult and complicated. She was a loving mother when she could be and stayed in touch with one family that was fostering several of her children. Due to her hardscrabble life, the Department of Human Services later removed all of her children.
She contributed several photos, and joined our meetings when she could. Audrey explained what Witnesses meant to her:
I needed food.
I needed money to take care of my children.
But in the process of it, I became more involved,
and I felt like I was fighting for something
that could help not just myself and my kids
but a lot of other people as well.
Becoming a part of something helps people grow.
It helps them change their outlook on life
and helps people find different things that make them happy in life.
And it helped me grow.
Before, I was not thinking of anybody but myself and my family.
But now I have an acquired thought for others,
and how I can be a voice for them in any way I can.
Other members explained, “It felt good to get my story out.” As they did that, they felt connected with others, or simply felt relieved and more at ease.
Witnesses meetings always had ebullient energy as we collaborated to prepare for conferences, hearings, and exhibits in both the US House of Representatives and US Senate, ran our own events, hosted a national conference, and grew the program to other cities and invited in new members. We hosted panel discussions on housing, child development, and violence to accompany the exhibits in city halls and state households in Boston, New Haven (CT), Camden (NJ), Harrisburg (PA), Scranton (PA), Johnstown (PA), Philadelphia, Washington (DC), and Providence. While we celebrated these public appearances, the most joyful experiences were in our social gatherings.
Jack Saul, founder of the International Trauma Studies Program, explains that trauma is more than one person can bear. We need others to acknowledge and provide support for us to bear the trauma. According to Saul, the most important work of addressing trauma is to do it with other people. You need the support of a peer group so you are not “confined in your own story.” Peer group support is known to help reduce anxiety. It helps heal loneliness and improves mental health.2
Some have declared social isolation and loneliness to be America’s number one public health problem.3 Those who experience social isolation are more likely to report household food insecurity.4 Lonely people are also more likely to report depression, have complications from heart disease, diabetes, and being overweight, and die an early death. According to a 2020 study, among all generations from baby boomers to Gen Z, 47 percent of people in the United States feel alone, left out, and lacking in meaningful connection with others.5 Some scientists declare that this isolation is causing “deaths of despair” such as suicide and opioid overdose.6 Even the surgeon general has released a report on the public health crisis of loneliness and the need to establish social connection and community.7
How can we start to heal?
Express solidarity. Join a group. Love one another across racialized and class lines, ethnicities, and nationalities.8
Knowing the group was eager to see her, Faith remembered she belonged. Being part of the group helped save her life. This gave her purpose and interrupted her intended suicide. But the group experience alone was not enough to help her heal. In her crisis state, she needed professional and intensive clinical care. There are multiple forms of care that help to prevent people in Faith’s situation from escalating. This includes peer group experiences integrated with trauma-informed practice.
Trauma-informed care used in clinical settings or trauma-informed practice used in other organizational settings are umbrella terms encompassing practices and values that recognize how interpersonal violence and victimization impact health, well-being, and social relationships. They are organizational and treatment practices rooted in establishing safety, recovery, and resilience. Healing and recovery are primary trauma-informed care and practice goals. Such approaches are meant to build individual agency and collective efficacy. Collective efficacy is a group’s shared belief in its joint capability to organize and execute a course of action for group achievement. Individual agency is a person’s ability to take charge of their life; specifically, to have conscious choice and control over their own actions.9 Since fear and helplessness are legacies of victimization, empowerment in safe environments with healthy relationships can go a long way to help people find and harness their dignity, purpose, and power. Trauma-informed practices focus on healing, empowerment, self-control, and resilience, rather than mandating specific behaviors, demanding compliance, or implementing outright punishment (such as kicking a person out of the program or isolating them from the group).
When organizations are set up to serve or help people, they are also implicated in how interpersonal relationships play out between professional and client as well as among staff themselves. So how an organization is set up and structured in the day-to-day becomes important. An example of an organization’s ability to potentially retraumatize someone is when a welfare office (where people apply for public assistance) is set up in such a way as to resemble the waiting room of a prison.
Put yourself in the winter boots of a woman who needs to apply for SNAP. When you enter the Philadelphia county assistance office, there is a security officer with a gun waiting for you to sign in at the door. Though most assistance programs serve families with young children, there are no child-size chairs and toys, nor decorations on the wall or plants. There are, however, pitiful black-and-white photocopied flyers taped to the walls with signs that shout
NO FOOD
NO TALKING
NO CELL PHONE USE
The guard could trigger emotions or sensations of previous encounters with police. In West Philadelphia, one office has all the chairs facing the back wall of the waiting room, away from the cubicles where the social workers and frontline staff sit with their computers. A person sits there for hours at a time, facing backward, and waits for their number to be called—like they are a criminal to be controlled and called to account.
A more severe example of traumatizing organizational practices is what happens in residential treatment facilities where they may use restraints on a child who might be having a mental health crisis. This can push a child into reexperiencing the same symptoms and signs of duress as a traumatic episode that caused them to be placed in the residential treatment facility in the first place.
Sandy Bloom, an internationally renowned psychiatrist based in Philadelphia, created the Sanctuary Model, a trauma-informed approach that extends beyond the boundaries of interpersonal relationships to create patterns of working that organizations can adopt to ensure that people and processes within organizations themselves do not retraumatize clients and their staff.10 Based on years of research and experience with colleagues in mental health care services, Bloom and her team developed everyday practices to ensure that people who struggle with exposure to violence and adversity (including staff) have opportunities for healing. Organizations can transform their processes and spaces into healing environments, and adopt organizational practices that support growth, care, and community. The model and ethos of trauma-informed practice helps clinicians, social workers, and frontline staff to redirect their thinking from concepts such as What’s wrong with you? and change it to What happened to you?
But this is not enough. Shawn Ginwright, a professor of education at San Francisco State University who works with African American youths, implores us to look beyond the pain. Let’s move, he says, from What happened to you? to What’s right with you?11 This places healing at the center. Echoing these sentiments of the people in Ginwright’s youth programs, members of Witnesses insist, “I cannot let what happened to me define me.” Ginwright adds that sometimes, trauma-informed work stays at the individual or group level while ignoring the historical, social, and political context. Ongoing political consciousness-raising and community engagement are fundamental to the healing. It opens space for people to explore and stake a claim to their desired place in the world.
In the early years of Witnesses, I was experiencing trauma-related symptoms such as hypervigilance, lack of sleep, depression, and misplaced anger. I became more demanding of people’s time as well as more impatient with staff, students, and colleagues. I was trying to urgently implement processes that could not tolerate flexibility. The staff, too, were starting to feel the strain on our ability to communicate well and support each other to stay healthy.
As I became more familiar with trauma theory, I could see that not only was I experiencing secondary trauma but our organizational practices such as intolerance for ambiguity, lack of flexibility, misplaced urgency, and hyperarousal over the slightest organizational hiccup were also starting to mirror the same trauma-related behaviors I was learning about from members of Witnesses. We needed a reset and deeper training to help us stay healthy. We sought training in the Sanctuary Model, which consisted of a five-day residential experience along with ongoing coaching and group assessment.
Since we received our original trainings in 2010, the center’s staff, members of Witnesses, and members of our new Building Wealth and Health Network program have been using healing-centered techniques and strategies to create opportunities for healing and resilience. Any new staff member who joins the center also participates in healing-centered trainings. The practice tools have become so much a part of our everyday grounding that I couldn’t help but use “community meeting,” one of the Sanctuary Model tools, to start this book. This tool supports opportunities for all to be seen, recognized, heard, and valued, to acknowledge our emotions, ground ourselves in a goal, and ensure we can ask for and provide support for each other.
Continuing the work with Witnesses, and building on the immense power of solidarity with a group and utilizing the sanctuary ethos, our team launched a new program in 2014. Tired of the same old dominant stories about scarcity and poverty, we wanted to focus energy on the positives of human potential. We concentrated on creating abundance and well-being. This is why we called it the Building Wealth and Health Network (or for short, the Network).
We developed the Network as a program to treat and prevent isolation, depression, and food insecurity for people with high ACEs. The Network is a healing-centered peer support program that integrates financial education and matched savings accounts. Inspired by the resilience of Faith, Audrey, Carla, and so many others, the goal is to support parents of young children who are participating in Temporary Assistance for Needy Families (TANF) to get help from peers to improve their health and build wealth. This would, of course, aid the participants in being able to pay for food and heal from trauma by helping them develop social relationships and build collective efficacy that could mitigate depression while building financial security.
Members of the Network help each other face their experiences with trauma and deep poverty, and learn financial strategies to save money and build wealth. The Network members share their needs and struggles with their peers, who are eager to help and offer understanding. Members of the group almost always offer up resources and assist with problem-solving; consequently, the role of the coaches recedes to the background. The coaches merely hold the space, and on occasion, provide one-on-one support after class. In addition to basic and creative financial strategies and emotional wellness, the curriculum includes political education, which is a way of deepening everyone’s understanding of how structural racism and capitalism work and influence our lives. Everyone gets an opportunity to open a savings account, and we match their savings.
We started out the program as a randomized controlled trial, a type of research study set up to compare health and well-being among different groups of people randomly assigned to each group. Random assignment ensures there is no obvious “selection bias” that facilitates people’s self-selection into a particular group. This way you know you are comparing groups that are relatively equal or have the same variability of people within each group. When people signed up for the Network, they agreed to be randomly selected to one of the three groups. Two were “intervention groups,” and one was the “control group.” A control group receives nothing extra, just the currently accepted standard of care, which in this case was TANF programming as supplied by the state. In doing so, one can find out if the proposed program or “treatment” works—that is, if one sees a positive difference in the intervention groups in comparison to the control.
Peer support healing circles coupled with financial empowerment education and matched savings was the full intervention. We compared it with the partial intervention, which consisted of financial education and matched savings but lacked the trauma-informed approach to building community and healing. Finally, we compared these two groups to the control group, which received regular TANF assistance with no peer support healing circle, no financial education programming, and no matches for savings.
We followed each group over fifteen months, and each person anonymously filled out surveys every three months on the computer with audio prompts. Each participant answered a series of questions related to health, well-being, financial skills, and practices. We added our old standards: ACEs, depression, and household food insecurity. The results showed that the group that had the greatest reductions in depression, food insecurity, and housing insecurity was the group that had both financial empowerment training and the trauma-informed group approach. Not only did it help in terms of caregivers’ health and financial well-being, but the trauma-informed financial empowerment approach helped protect their children from developmental risk. So the Network had a two-generation impact.12 After the original research study was completed and showed positive results, we were able to expand, adapt, and continue the program, which is still ongoing. We have worked with over three thousand people, and the program has extended outside Philadelphia to Atlantic City, NJ, and rural areas in central Pennsylvania.
Here are the results: participation in the Network reduced depression, improved rates of employment, and increased family savings.13 We offered no medication, no direct therapy, and no job search support.
Here’s the clincher: the Network reduced the odds of household food insecurity by 65 percent. There was no food involved.14
How did we improve mental health without pills? How did we reduce food insecurity without food?
At the outset of this book, I explained that solving hunger is not achieved through food alone. It has much to do with power and control. Through the Network, we sought to ensure that people built power and control over their own futures, had a sense of emotional sovereignty, and could make choices and take advantage of opportunities to heal from trauma. We also nurtured strong social connections where people were committed to helping each other. This is what the members of the Building Wealth and Health Network were able and eager to do. When they started our program, most members had no bank accounts, and many reported low to moderate social isolation as well as high rates of household food insecurity. By the end, the majority of people without bank accounts had opened one and started saving. Thanks to being in a community of support and solidarity, they felt happier, more capable, and healthier. Food security was significantly reduced, especially for those who had high ACEs.15
Currently, the Network curriculum adapts to each group that comes through the program. As an outcome of these adaptations after the original randomized controlled trial, the program has become more attuned with issues of structural racism, antiracism, and political education coupled with community advocacy. But the core of the Network has always remained. That is, we sustain the common language from the Sanctuary Model called “SELF,” which stands for safety, emotions, loss, and future (or freedom).16 This SELF-based language convention helps people take the space they need to work through their challenges. Here are questions that can help people do so:
There is so much more to the program, but this simple framework indicates how the complexity of trauma across the life course is held in a space of wonderment, care, and solidarity.
The Network helps people deal with trauma symptoms at the individual and small-group level. It also promotes resilience against community trauma. For instance, we help people learn about and resist predatory lending, heal from toxic family relations, handle conflict on the job, and testify when called on to improve policies and social services. We help people face their emotional challenges head-on and learn about ways to improve their relationships, have a greater sense of self-worth, and find tools for self and community care. We help people strategize about saving and spending that promotes household food security along with greater access to safe, affordable housing.
The Network is a success as well as inspiration.
It does little, however, to address the epic proportions of collective and historical trauma in the United States. Even if a person can work through their personal traumas, the systems in place around them—schools, health care systems, social services, and employers—can still exacerbate trauma while regenerating inequality, racism, and sexism.
To take action at collective and historical levels, we need to reconsider everything.
1. The ethics of carrying out research always inform how research is carried out. All the studies mentioned in this book were approved by the Drexel University Institutional Review Board, which considers the study setup, vulnerability of research participants, amount of money involved to ensure that the amount is not coercive, types of questions asked, management of the data to ensure it is secure, types of outcomes measured, and more.
2. Cecilie Høgh Egmose et al., “The Effectiveness of Peer Support in Personal and Clinical Recovery-Systematic Review and Meta-Analysis,” Psychiatric Services 74, no. 8 (February 8, 2023), 847–858, https://
3. Jack Saul, Collective Trauma, Collective Healing: Promoting Community Resilience in the Aftermath of Disaster (New York: Routledge, 2013).
4. Michael S. Martin et al., “Food Insecurity and Mental Illness: Disproportionate Impacts in the Context of Perceived Stress and Social Isolation,” Public Health 132 (March 2016): 86–91, https://
5. “Loneliness in America,” Cigna, accessed February 17, 2022, https://
6. Mark S. Gold, “The Role of Alcohol, Drugs, and Deaths of Despair in the U.S.’s Falling Life Expectancy,” Missouri Medicine 117, no. 2 (2020): 99–101.
7. Vivek Murthy, Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community (Washington, DC: US Dept. of Health and Human Services, Office of the Surgeon General, 2023), https://
8. Reverend angel Kyodo williams says this phrase often. I heard her encourage this in an antiracism training I participated in during summer 2019.
9. Jerome Dugan et al., “Effects of a Trauma-Informed Curriculum on Depression, Self-Efficacy, Economic Security, and Substance Use among TANF Participants: Evidence from the Building Health and Wealth Network Phase II,” Social Science and Medicine 258 (August 1, 2020): 113136, https://
10. Sandra L. Bloom and Brian J. Farragher, Restoring Sanctuary: A New Operating System for Trauma-Informed Systems of Care (Oxford: Oxford University Press, 2013).
11. Shawn Ginwright, “The Future of Healing: Shifting from Trauma-Informed Care to Healing-Centered Engagement,” Medium (blog), May 31, 2018, https://
12. Booshehri et al., “Trauma-Informed Temporary Assistance for Needy Families (TANF).”
13. Booshehri et al., “Trauma-Informed Temporary Assistance for Needy Families (TANF).”
14. Pam Phojanakong et al., “Trauma-Informed Financial Empowerment Programming Improves Food Security among Families with Young Children,” Journal of Nutrition Education and Behavior 52, no. 5 (May 1, 2020): 465–473, https://
15. Phojanakong et al., “Trauma-Informed Financial Empowerment Programming Improves Food Security among Families with Young Children.”
16. Bloom and Farragher, Restoring Sanctuary.