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The System Has Never Worked

In his new book, social worker Jonathan Foiles argues that policy change and clinical practice go hand-in-hand.

(Jacket) Courtesy of Belt Publishing; (Headshot) Anna Zajac

In case it wasn’t clear from the title of his new book, West Side social worker Jonathan Foiles doesn’t mince words. In This City is Killing Me: Community Trauma and Toxic Stress in Urban America, out today from Belt Publishing, Foiles follows five current and former patients at Mount Sinai Hospital in Douglas Park as they deal with the demons of urban life. Their stories are engaging — one, whom Foiles calls Robert (names and identifying details have been changed), believes he was an African prince stolen from his family at birth — but never voyeuristic. Rather, each case exemplifies how systems like Illinois’s Department of Children and Family Services, Chicago Public Schools, and, in Robert’s case, the Chicago Housing Authority affect patients. 

Ahead of the book’s publication, Foiles discussed why he decided to write about policy from a first-person perspective and how writing assuaged his own helplessness. 

When did you know that you wanted to write this book?

I did a piece for BELT magazine in January 2018 on the state of mental health in Chicago. What struck me was how a lot of people seemed surprised by the state of things here, even people who are well-meaning and sort of “with it.” With that piece in particular, I had multiple family members be like, “Oh, I didn’t realize all that is going on." I realized I was missing that piece — the idea of how outside forces and policies really impact the lives of people.

One of the epigraphs at the start of the book is by Gustavo Gutierrez, a Dominican priest. It reads, in part: “The poor person does not exist as an inescapable fact of destiny. His or her existence is not politically neutral, and it is not ethically innocent.” Why did you choose this quote?

Before I got my master’s in social work, I did a master’s in divinity. Seminary is where I discovered liberation theology, which Gutierrez is associated with, and that’s the sort of work that continues to resonate with me. It was a way of nodding to my formative influences without making the book too much about myself.

Each chapter follows a different patient’s journey. How did you decide on Jacqueline, Frida, Robert, Luis, and Anthony?

I had already been writing about them for a little bit because they’re the cases that stuck with me. There were a few, especially Jacqueline and the person I call Anthony, that I’ve written about before — how their lives intersect with some of these larger themes and influences — which helped me get a sense of how I wanted to write the book. I approached it from both angles: patients I felt like I could write about well and problems that I wanted to address.

How do you run a therapeutic practice that keeps an eye on social causes rather than just individualized causes? 

When it comes to working with patients on a one-on-one level, just being aware of these issues and being able to name them has some power in and of itself. Most social workers and other mental health professionals are white and usually from middle-class or upper-middle-class backgrounds; in most settings, our patients don’t look like us. It’s important to acknowledge that, because a lot of the things I write about probably wouldn’t be news to my patients.

How do patients alert you to flaws in the system? 

Most of them wouldn’t be like, “Oh, the state budget crisis is impacting things in this way.” But they’re telling me, “When I go to the aid office to check on something, I have to wait three or four hours.”

A thing that has struck me is how patients have been since the presidential election. Certainly they have been upset about it, but a good chunk of them have this feeling that the system has never worked for them anyway. Some of them have told me, “My life hasn’t really improved under presidents who are Democrats or Republicans, so I’m not really all that invested in it.” That is understandable, but also deeply sad and troubling.

If you could have one person or group read this book, who would it be?

One of the groups that comes to mind is people who are starting out in the field. Social justice is one of the core values of social work. But I do think there’s a tendency to separate clinical practice from these big policy questions. It’s a lot to try to help someone going through these things, but also ask, “Why are they suffering in the first place and what can we do to address the contributing factors?”

What’s the most striking change you’ve noticed about the state of mental health in Chicago over the past 11 years that you’ve been living here?

The obvious thing is the closing of many city run clinics and the privatizing of one more. But something that gives me hope is things like the Kedzie Center on the North Side, which formed after a state law was passed that [allows] communities [to] agree to a voluntary bump on their property taxes to fund a mental health center, which will service the area for people who have insurance or who don’t. 

There’s one in Lawndale that is pretty close to starting up, and then a resolution passed not too long ago in Logan Square–Avondale to fund the same sort of thing. People who live here know that these are services that people need, and they’re willing to give up a little bit more money to help out their neighbor.

How does activism dovetail with your daily work?

Frankly, writing started out as a way for me to feel less helpless. I’m coming from a place of, “If people knew more they’d do more.” For me, writing is advocating for patients on a grander level. It’s the way I feel the most engaged in fighting for them. 

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