Theory Into Practice: Four Social Work Case Studies In this course, you select one of the following four case studies and use it throughout the entire course. By doing this, you will have the opportunity to see how different theories guide your view of a client and that client’s presenting problem. Each time you return to the same case, you use a different theory, and your perspective of the problem changes—which then changes how you ask assessment questions and how you intervene. These case studies are based on the video- and web-based case studies you encounter in the MSW program. Table of Contents Tiffani Bradley ................................................................................................................. 2 Paula Cortez ................................................................................................................... 9 Jake Levey .................................................................................................................... 10 Helen Petrakis ............................................................................................................... 13 1 Tiffani Bradley Identifying Data: Tiffani Bradley is a 16-year-old Caucasian female. She was raised in a Christian family in Philadelphia, PA. She is of German descent. Tiffani’s family consists of her father, Robert, 38 years old; her mother, Shondra, 33 years old, and her sister, Diana, 13 years old. Tiffani currently resides in a group home, Teens First, a brand new, court-mandated teen counseling program for adolescent victims of sexual exploitation and human trafficking. Tiffani has been provided room and board in the residential treatment facility for the past 3 months. Tiffani describes herself as heterosexual. Presenting Problem: Tiffani has a history of running away. She has been arrested on three occasions for prostitution in the last 2 years. Tiffani has recently been court ordered to reside in a group home with counseling. She has a continued desire to be reunited with her pimp, Donald. After 3 months at Teens First, Tiffani said that she had a strong desire to see her sister and her mother. She had not seen either of them in over 2 years and missed them very much. Tiffani is confused about the path to follow. She is not sure if she wants to return to her family and sibling or go back to Donald. Family Dynamics: Tiffani indicates that her family worked well together until 8 years ago. She reports that around the age of 8, she remembered being awakened by music and laughter in the early hours of the morning. When she went downstairs to investigate, she saw her parents and her Uncle Nate passing a pipe back and forth between them. She remembered asking them what they were doing and her mother saying, “adult things” and putting her back in bed. Tiffani remembers this happening on several occasions. Tiffani also recalls significant changes in the home's appearance. The home, which was never fancy, was always neat and tidy. During this time, however, dust would gather around the house, dishes would pile up in the sink, dirt would remain on the floor, and clothes would go for long periods of time without being washed. Tiffani began cleaning her own clothes and making meals for herself and her sister. Often there was not enough food to feed everyone, and Tiffani and her sister would go to bed hungry. Tiffani believed she was responsible for helping her mom so that her mom did not get so overwhelmed. She thought that if she took care of the home and her sister, maybe that would help mom return to the person she was before. Sometimes Tiffani and her sister would come downstairs in the morning to find empty beer cans and liquor bottles on the kitchen table along with a crack pipe. Her parents would be in the bedroom, and Tiffani and her sister would leave the house and go to school by themselves. The music and noise downstairs continued for the next 6 years, which escalated to screams and shouting and sounds of people fighting. Tiffani remembers her mom one morning yelling at her dad to “get up and go to work.” Tiffani and Diana saw their dad come out of the bedroom and slap their mom so hard she was knocked down. Dad then went back into the bedroom. Tiffani 2 remembers thinking that her mom was not doing what she was supposed to do in the house, which is what probably angered her dad. Shondra and Robert have been separated for a little over a year and have started dating other people. Diana currently resides with her mother and Anthony, 31 years old, who is her mother’s new boyfriend. Educational History: Tiffani attends school at the group home, taking general education classes for her general education development (GED) credential. Diana attends Town Middle School and is in the 8th grade. Employment History: Tiffani reports that her father was employed as a welding apprentice and was waiting for the opportunity to join the union. Eight years ago, he was laid off due to financial constraints at the company. He would pick up odd jobs for the next 8 years but never had steady work after that. Her mother works as a home health aide. Her work is part-time, and she has been unable to secure full-time work. Social History: Over the past 2 years, Tiffani has had limited contact with her family members and has not been attending school. Tiffani did contact her sister Diana a few times over the 2-year period and stated that she missed her very much. Tiffani views Donald as her “husband” (although they were never married) and her only friend. Previously, Donald sold Tiffani to a pimp, “John T.” Tiffani reports that she was very upset Donald did this and that she wants to be reunited with him, missing him very much. Tiffani indicates that she knows she can be a better “wife” to him. She has tried to make contact with him by sending messages through other people, as John T. did not allow her access to a phone. It appears that over the last 2 years, Tiffani has had neither outside support nor interactions with anyone beyond Donald, John T., and some other young women who were prostituting. Mental Health History: On many occasions Tiffani recalls that when her mother was not around, Uncle Nate would ask her to sit on his lap. Her father would sometimes ask her to show them the dance that she had learned at school. When she danced, her father and Nate would laugh and offer her pocket change. Sometimes, their friend Jimmy joined them. One night, Tiffani was awakened by her uncle Nate and his friend Jimmy. Her parents were apparently out, and they were the only adults in the home. They asked her if she wanted to come downstairs and show them the new dances she learned at school. Once downstairs Nate and Jimmy put some music on and started to dance. They asked Tiffani to start dancing with them, which she did. While they were dancing, Jimmy spilled some beer on her. Nate said she had to go to the bathroom to clean up. Nate, Jimmy, and Tiffani all went to the bathroom. Nate asked Tiffani to take her clothes off and get in the bath. Tiffani hesitated to do this, but Nate insisted it was OK since he and Jimmy were family. Tiffani eventually relented and began to wash up. Nate would tell her that she missed a spot and would scrub the area with his hands. Incidents like this continued to occur with increasing levels of molestation each time. 3 The last time it happened, when Tiffani was 14, she pretended to be willing to dance for them, but when she got downstairs, she ran out the front door of the house. Tiffani vividly remembers the fear she felt the nights Nate and Jimmy touched her, and she was convinced they would have raped her if she stayed in the house. About halfway down the block, a car stopped. The man introduced himself as Donald, and he indicated that he would take care of her and keep her safe when these things happened. He then offered to be her boyfriend and took Tiffani to his apartment. Donald insisted Tiffani drink beer. When Tiffani was drunk, Donald began kissing her, and they had sex. Tiffani was also afraid that if she did not have sex, Donald would not let her stay— she had nowhere else to go. For the next 3 days, Donald brought her food and beer and had sex with her several more times. Donald told Tiffani that she was not allowed to do anything without his permission. This included watching TV, going to the bathroom, taking a shower, and eating and drinking. A few weeks later, Donald bought Tiffani a dress, explaining to her that she was going to “find a date” and get men to pay her to have sex. When Tiffani said she did not want to do that, Donald hit her several times. Donald explained that if she didn’t do it, he would get her sister Diana and make her do it instead. Out of fear for her sister, Tiffani relented and did what Donald told her to do. She thought at this point her only purpose in life was to be a sex object, listen, and obey—and then she would be able to keep the relationships and love she so desired. Legal History: Tiffani has been arrested three times for prostitution. Right before the most recent charge, a new state policy was enacted to protect youth 16 years and younger from prosecution and jail time for prostitution. The Safe Harbor for Exploited Children Act allows the state to define Tiffani as a sexually exploited youth, and therefore the state will not imprison her for prostitution. She was mandated to services at the Teens First agency, unlike her prior arrests when she had been sent to detention. Alcohol and Drug Use History: Tiffani’s parents were social drinkers until about 8 years ago. At that time Uncle Nate introduced them to crack cocaine. Tiffani reports using alcohol when Donald wanted her to since she wanted to please him, and she thought this was the way she would be a good “wife.” She denies any other drug use. Medical History: During intake, it was noted that Tiffani had multiple bruises and burn marks on her legs and arms. She reported that Donald had slapped her when he felt she did not behave and that John T. burned her with cigarettes. She had realized that she did some things that would make them mad, and she tried her hardest to keep them pleased even though she did not want to be with John T. Tiffani has been treated for several sexually transmitted infections (STIs) at local clinics and is currently on an antibiotic for a kidney infection. Although she was given condoms by Donald and John T. for her “dates,” there were several “Johns” who refused to use them. 4 Strengths: Tiffani is resilient in learning how to survive the negative relationships she has been involved with. She has as sense of protection for her sister and will sacrifice herself to keep her sister safe. Robert Bradley: father, 38 years old Shondra Bradley: mother, 33 years old Nate Bradley: uncle, 36 years old Tiffani Bradley: daughter, 16 years old Diana Bradley: daughter, 13 years old Donald: Tiffani’s self-described husband and her former pimp Anthony: Shondra’s live-in partner, 31 years old John T.: Tiffani’s most recent pimp 5 Paula Cortez Identifying Data: Paula Cortez is a 43-year-old Catholic Hispanic female residing in New York City, NY. Paula was born in Colombia. When she was 17 years old, Paula left Colombia and moved to New York where she met David, who later became her husband. Paula and David have one son, Miguel, 20 years old. They divorced after 5 years of marriage. Paula has a five-year-old daughter, Maria, from a different relationship. Presenting Problem: Paula has multiple medical issues, and there is concern about whether she will be able to continue to care for her youngest child, Maria. Paula has been overwhelmed, especially since she again stopped taking her medication. Paula is also concerned about the wellness of Maria. Family Dynamics: Paula comes from a moderately well-to-do family. Paula reports suffering physical and emotional abuse at the hands of both her parents, eventually fleeing to New York to get away from the abuse. Paula comes from an authoritarian family where her role was to be “seen and not heard.” Paula states that she did not feel valued by any of her family members and reports never receiving the attention she needed. As a teenager, she realized she felt “not good enough” in her family system, which led to her leaving for New York and looking for “someone to love me.” Her parents still reside in Colombia with Paula’s two siblings. Paula met David when she sought to purchase drugs. They married when Paula was 18 years old. The couple divorced after 5 years of marriage. Paula raised Miguel, mostly by herself, until he was 8 years old, at which time she was forced to relinquish custody due to her medical condition. Paula maintains a relationship with her son, Miguel, and her ex-husband, David. Miguel takes part in caring for his half-sister, Maria. Paula does believe her job as a mother is to take care of Maria but is finding that more and more challenging with her physical illnesses. Employment History: Paula worked for a clothing designer, but she realized that her true passion was painting. She has a collection of more than 100 drawings and paintings, many of which track the course of her personal and emotional journey. Paula held a fulltime job for a number of years before her health prevented her from working. She is now unemployed and receives Supplemental Security Disability Insurance (SSD) and Medicaid. Miguel does his best to help his mom but only works part time at a local supermarket delivering groceries. Paula currently uses federal and state services. Paula successfully applied for WIC, the federal Supplemental Nutrition Program for Women, Infants, and Children. Given Paula’s low income, health, and Medicaid status, Paula is able to receive in-home childcare assistance through New York’s public assistance program. 6 Social History: Paula is bilingual, fluent in both Spanish and English. Although Paula identifies as Catholic, she does not consider religion to be a big part of her life. Paula lives with her daughter in an apartment in Queens, NY. Paula is socially isolated as she has limited contact with her family in Colombia and lacks a peer network of any kind in her neighborhood. Five (5) years ago Paula met a man (Jesus) at a flower shop. They spoke several times. He would visit her at her apartment to have sex. Since they had an active sex life, Paula thought he was a “stand-up guy” and really liked him. She believed he would take care of her. Soon everything changed. Paula began to suspect that he was using drugs, because he had started to become controlling and demanding. He showed up at her apartment at all times of the night demanding to be let in. He called her relentlessly, and when she did not pick up the phone, he left her mean and threatening messages. Paula was fearful for her safety and thought her past behavior with drugs and sex brought on bad relationships with men and that she did not deserve better. After a couple of months, Paula realized she was pregnant. Jesus stated he did not want anything to do with the “kid” and stopped coming over, but he continued to contact and threaten Paula by phone. Paula has no contact with Jesus at this point in time due to a restraining order. Mental Health History: Paula was diagnosed with bipolar disorder. She experiences periods of mania lasting for a couple of weeks then goes into a depressive state for months when not properly medicated. Paula has a tendency toward paranoia. Paula has a history of not complying with her psychiatric medication treatment because she does not like the way it makes her feel. She often discontinues it without telling her psychiatrist. Paula has had multiple psychiatric hospitalizations but has remained out of the hospital for the past 5 years. Paula accepts her bipolar diagnosis but demonstrates limited insight into the relationship between her symptoms and her medication. Paula reports that when she was pregnant, she was fearful for her safety due to the baby’s father’s anger about the pregnancy. Jesus’ relentless phone calls and voicemails rattled Paula. She believed she had nowhere to turn. At that time, she became scared, slept poorly, and her paranoia increased significantly. After completing a suicide assessment 5 years ago, it was noted that Paula was decompensating quickly and was at risk of harming herself and/or her baby. Paula was involuntarily admitted to the psychiatric unit of the hospital. Paula remained on the unit for 2 weeks. Educational History: Paula completed high school in Colombia. Paula had hoped to attend the Fashion Institute of Technology (FIT) in New York City, but getting divorced, then raising Miguel on her own interfered with her plans. Miguel attends college full time in New York City. Medical History: Paula was diagnosed as HIV positive 15 years ago. Paula acquired AIDS three years later when she was diagnosed with a severe brain infection and a Tcell count of less than 200. Paula’s brain infection left her completely paralyzed on the right side. She lost function in her right arm and hand as well as the ability to walk. After 7 a long stay in an acute care hospital in New York City, Paula was transferred to a skilled nursing facility (SNF) where she thought she would die. After being in the skilled nursing facility for more than a year, Paula regained the ability to walk, although she does so with a severe limp. She also regained some function in her right arm. Her right hand (her dominant hand) remains semi-paralyzed and limp. Over the course of several years, Paula taught herself to paint with her left hand and was able to return to her beloved art. Paula began treatment for her HIV/AIDS with highly active antiretroviral therapy (HAART). Since she ran away from the family home, married and divorced a drug user, then was in an abusive relationship, Paula thought she deserved what she got in life. She responded well to HAART and her HIV/AIDS was well controlled. In addition to her HIV/AIDS disease, Paula is diagnosed with Hepatitis C (Hep C). While this condition was controlled, it has reached a point where Paula’s doctor is recommending she begin a new treatment. Paula also has significant circulatory problems, which cause her severe pain in her lower extremities. She uses prescribed narcotic pain medication to control her symptoms. Paula’s circulatory problems have also led to chronic ulcers on her feet that will not heal. Treatment for her foot ulcers demands frequent visits to a wound care clinic. Paula’s pain paired with the foot ulcers make it difficult for her to ambulate and leave her home. Paula has a tendency not to comply with her medical treatment. She often disregards instructions from her doctors and resorts to holistic treatments like treating her ulcers with chamomile tea. When she stops her treatment, she deteriorates quickly. Maria was born HIV negative and received the appropriate HAART treatment after birth. She spent a week in the neonatal intensive care unit as she had to detox from the effects of the pain medication Paula took throughout her pregnancy. Legal History: Previously, Paula used the AIDS Law Project, a not-for-profit organization that helps individuals with HIV address legal issues, such as those related to the child’s father . At that time, Paula filed a police report in response to Jesus' escalating threats and successfully got a restraining order. Once the order was served, the phone calls and visits stopped, and Paula regained a temporary sense of control over her life. Paula completed the appropriate permanency planning paperwork with the assistance of the organization The Family Center. She named Miguel as her daughter’s guardian should something happen to her. Alcohol and Drug Use History: Paula became an intravenous drug user (IVDU), using cocaine and heroin, at age 17. David was one of Paula’s “drug buddies” and suppliers. Paula continued to use drugs in the United States for several years; however, she stopped when she got pregnant with Miguel. David continued to use drugs, which led to the failure of their marriage. Strengths: Paula has shown her resilience over the years. She has artistic skills and has found a way to utilize them. Paula has the foresight to seek social services to help her 8 and her children survive. Paula has no legal involvement. She has the ability to bounce back from her many physical and health challenges to continue to care for her child and maintain her household. David Cortez: father, 46 years old Paula Cortez: mother, 43 years old Miguel Cortez: son, 20 years old Jesus (unknown): Maria’s father, 44 years old Maria Cortez: daughter, 5 years old 9 Jake Levy Identifying Data: Jake Levy is a 31-year-old, married, Jewish Caucasian male. Jake’s wife, Sheri, is 28 years old. They have two sons, Myles (10) and Levi (8). The family resides in a two-bedroom condominium in a middle-class neighborhood in Rockville, MD. They have been married for 10 years. Presenting Problem: Jake, an Iraq War veteran, came to the Veterans Affairs Health Care Center (VA) for services because his wife has threatened to leave him if he does not get help. She is particularly concerned about his drinking and lack of involvement in their sons’ lives. She told him his drinking has gotten out of control and is making him mean and distant. Jake reports that he and his wife have been fighting a lot and that he drinks to take the edge off and to help him sleep. Jake expresses fear of losing his job and his family if he does not get help. Jake identifies as the primary provider for his family and believes that this is his responsibility as a husband and father. Jake realizes he may be putting that in jeopardy because of his drinking. He says he has never seen Sheri so angry before, and he saw she was at her limit with him and his behaviors. Family Dynamics: Jake was born in Alabama to a Caucasian, Eurocentric family system. He reports his time growing up to have been within a “normal” family system. However, he states that he was never emotionally close to either parent and viewed himself as fairly independent from a young age. His dad had previously been in the military and was raised with the understanding that his duty is to support his country. His family displayed traditional roles, with his dad supporting the family after he was discharged from military service. Jake was raised to believe that real men do not show weakness and must be the head of the household. Jake’s parents are deceased, and he has a sister who lives outside London. He and his sister are not very close but do talk twice a year. Sheri is an only child, and although her mother lives in the area, she offers little support. Her mother never approved of Sheri marrying Jake and thinks Sheri needs to deal with their problems on her own. Jake reports that he has not been engaged with his sons at all since his return from Iraq, and he keeps to himself when he is at home. Employment History: Jake is employed as a human resources assistant for the military. Jake works in an office with civilians and military personnel and mostly gets along with people in the office. Jake is having difficulty getting up in the morning to go to work, which increases the stress between Sheri and himself. Shari is a special education teacher in a local elementary school. Jake thinks it is his responsibility to provide for his family and is having stress over what is happening to him at home and work. He thinks he is failing as a provider. Social History: Jake and Sheri identify as Jewish and attend a local synagogue on major holidays. Jake tends to keep to himself and says he sometimes feels pressured to be more communicative and social. Jake believes he is socially inept 10 and not able to develop friendships. The couple has some friends, since Shari gets involved with the parents in their sons’ school. However, because of Jake’s recent behaviors, they have become socially isolated. He is very worried that Sheri will leave him due to the isolation. Mental Health History: Jake reports that since his return to civilian life 10 months ago, he has difficulty sleeping, frequent heart palpitations, and moodiness. Jake had seen Dr. Zoe, a psychiatrist at the VA, who diagnosed him with post-traumatic stress disorder (PTSD). Dr. Zoe prescribed Paxil to help reduce his symptoms of anxiety and depression and suggested that he also begin counseling. Jake says that he does not really understand what PTSD is but thought it meant that a person who had it was “going crazy,” which at times he thought was happening to him. He expresses concern that he will never feel “normal” again and says that when he drinks alcohol, his symptoms and the intensity of his emotions ease. Jake describes that he sometimes thinks he is back in Iraq, which makes him feel uneasy and watchful. He hates the experience and tries to numb it. He has difficulty sleeping and is irritable, so he isolates himself and soothes this with drinking. He talks about always feeling “ready to go.” He says he is exhausted from being always alert and looking for potential problems around him. Every sound seems to startle him. He shares that he often thinks about what happened “over there” but tries to push it out of his mind. Nighttime is the worst, as he has terrible recurring nightmares of one particular event. He says he wakes up shaking and sweating most nights. He adds that drinking is the one thing that seems to give him a little relief. Educational History: Sheri has a bachelor’s degree in special education from a local college. Jake has a high school diploma but wanted to attend college upon his return from the military. Military History: Jake is an Iraqi War veteran. He enlisted in the Marines at 21 years old when he and Shari got married due to Sheri being pregnant. The family was stationed in several states prior to Jake being deployed to Iraq. Jake left the service 10 months ago. Sheri and Jake had used military housing since his marriage, making it easier to support the family. On military bases, there was a lot of social support and both Jake and Sheri took full advantage of the social systems available to them during that time. Medical History: Jake is physically fit, but an injury he sustained in combat sometimes limits his ability to use his left hand. Jake reports sometimes feeling inadequate because of the reduction in the use of his hand and tries to push through because he worries how the injury will impact his responsibilities as a provider, husband, and father. Jake considers himself resilient enough to overcome this disadvantage and “be able to do the things I need to do.” Sheri is in good physical condition and has recently found out that she is pregnant with their third child. Legal History: Jake and Sheri deny having criminal histories. 11 Alcohol and Drug Use History: As teenagers, Jake and Sheri used marijuana and drank. Both deny current use of marijuana but report they still drink. Sheri drinks socially and has one or two drinks over the weekend. Jake reports that he has four to five drinks in the evenings during the week and eight to ten drinks on Saturdays and Sundays. Jake spends his evenings on the couch drinking beer and watching TV or playing video games. Shari reports that Jake drinks more than he realizes, doubling what Jake has reported. Strengths: Jake is cognizant of his limitations and has worked on overcoming his physical challenges. Jake is resilient. Jake did not have any disciplinary actions taken against him in the military. He is dedicated to his wife and family. Jake Levy: father, 31 years old Sheri Levy: mother, 28 years old Myles Levy: son, 10 years old Levi Levy: son, 8 years old 12 Helen Petrakis Identifying Data: Helen Petrakis is a 52-year-old, Caucasian female of Greek descent living in a four-bedroom house in Tarpon Springs, FL. Her family consists of her husband, John (60), son, Alec (27), daughter, Dmitra (23), and daughter Althima (18). John and Helen have been married for 30 years. They married in the Greek Orthodox Church and attend services weekly. Presenting Problem: Helen reports feeling overwhelmed and “blue.” She was referred by a close friend who thought Helen would benefit from having a person who would listen. Although she is uncomfortable talking about her life with a stranger, Helen says that she decided to come for therapy because she worries about burdening friends with her troubles. John has been expressing his displeasure with meals at home, as Helen has been cooking less often and brings home takeout. Helen thinks she is inadequate as a wife. She states that she feels defeated; she describes an incident in which her son, Alec, expressed disappointment in her because she could not provide him with clean laundry. Helen reports feeling overwhelmed by her responsibilities and believes she can’t handle being a wife, mother, and caretaker any longer. Family Dynamics: Helen describes her marriage as typical of a traditional Greek family. John, the breadwinner in the family, is successful in the souvenir shop in town. Helen voices a great deal of pride in her children. Dmitra is described as smart, beautiful, and hardworking. Althima is described as adorable and reliable. Helen shops, cooks, and cleans for the family, and John sees to yard care and maintaining the family’s cars. Helen believes the children are too busy to be expected to help around the house, knowing that is her role as wife and mother. John and Helen choose not to take money from their children for any room or board. The Petrakis family holds strong family bonds within a large and supportive Greek community. Helen is the primary caretaker for Magda (John’s 81-year-old widowed mother), who lives in an apartment 30 minutes away. Until recently, Magda was self-sufficient, coming for weekly family dinners and driving herself shopping and to church. Six months ago, she fell and broke her hip and was also recently diagnosed with early signs of dementia. Helen and John hired a reliable and trusted woman temporarily to check in on Magda a couple of days each week. Helen would go and see Magda on the other days, sometimes twice in one day, depending on Magda’s needs. Helen would go food shopping for Magda, clean her home, pay her bills, and keep track of Magda’s medications. Since Helen thought she was unable to continue caretaking for both Magda and her husband and kids, she wanted the helper to come in more often, but John said they could not afford it. The money they now pay to the helper is coming out of the couple’s vacation savings. Caring for Magda makes Helen think she is failing as a wife and mother because she no longer has time to spend with her husband and children. 13 Helen spoke to her husband, John (the family decision maker), and they agreed to have Alec (their son) move in with Magda (his grandmother) to help relieve Helen’s burden and stress. John decided to pay Alec the money typically given to Magda’s helper. This has not decreased the burden on Helen since she had to be at the apartment at least once daily to intervene with emergencies that Alec is unable to manage independently. Helen’s anxiety has increased since she noted some of Magda’s medications were missing, the cash box was empty, Magda’s checkbook had missing checks, and jewelry from Greece, which had been in the family for generations, was also gone. Helen comes from a close-knit Greek Orthodox family where women are responsible for maintaining the family system and making life easier for their husbands and children. She was raised in the community where she currently resides. Both her parents were born in Greece and came to the United States after their marriage to start a family and give them a better life. Helen has a younger brother and a younger sister. She was responsible for raising her siblings since both her parents worked in a fishery they owned. Helen feared her parents’ disappointment if she did not help raise her siblings. Helen was very attached to her parents and still mourns their loss. She idolized her mother and empathized with the struggles her mother endured raising her own family. Helen reports having that same fear of disappointment with her husband and children. Employment History: Helen has worked part time at a hospital in the billing department since graduating from high school. John Petrakis owns a Greek souvenir shop in town and earns the larger portion of the family income. Alec is currently unemployed, which Helen attributes to the poor economy. Dmitra works as a sales consultant for a major department store in the mall. Althima is an honors student at a local college and earns spending money as a hostess in a family friend’s restaurant. During town events, Dmitra and Althima help in the souvenir shop when they can. Social History: The Petrakis family live in a community centered on the activities of the Greek Orthodox Church. Helen has used her faith to help her through the more difficult challenges of not believing she is performing her “job” as a wife and mother. Helen reports that her children are religious but do not regularly go to church because they are very busy. Helen has stopped going shopping and out to eat with friends because she can no longer find the time since she became a caretaker for Magda. Mental Health History: Helen consistently appears well groomed. She speaks clearly and in moderate tones and seems to have linear thought progression—her memory seems intact. She claims no history of drug or alcohol abuse, and she does not identify a history of trauma. More recently, Helen is overwhelmed by thinking she is inadequate. She stopped socializing and finds no activity enjoyable. In some situations in her life, she is feeling powerless. 14 Educational History: Helen and John both have high school diplomas. Helen is proud of her children knowing she was the one responsible in helping them with their homework. Alec graduated high school and chose not to attend college. Dmitra attempted college but decided that was not the direction she wanted. Althima is an honors student at a local college. Medical History: Helen has chronic back pain from an old injury, which she manages with acetaminophen as needed. Helen reports having periods of tightness in her chest and a feeling that her heart was racing along with trouble breathing and thinking that she might pass out. One time, John brought her to the emergency room. The hospital ran tests but found no conclusive organic reason to explain Helen’s symptoms. She continues to experience shortness of breath, usually in the morning when she is getting ready to begin her day. She says she has trouble staying asleep, waking two to four times each night, and she feels tired during the day. Working is hard because she is more forgetful than she has ever been. Helen says that she feels like her body is one big tired knot. Legal History: The only member of the Petrakis family that has legal involvement is Alec. He was arrested about 2 years ago for possession of marijuana. He was required to attend an inpatient rehabilitation program (which he completed) and was sentenced to 2 years’ probation. Helen was devastated, believing John would be disappointed in her for not raising Alec properly. Alcohol and Drug Use History: Helen has no history of drug use and only drinks at community celebrations. Alec has struggled with drugs and alcohol since he was a teen. Helen wants to believe Alec is maintaining his sobriety and gives him the benefit of the doubt. Alec is currently on 2 years’ probation for possession and has recently completed an inpatient rehabilitation program. Helen feels responsible for his addiction and wonders what she did wrong as a mother. Strengths: Helen has a high school diploma and has been successful at raising her family. She has developed a social support system, not only in the community but also within her faith at the Greek Orthodox Church. Helen is committed to her family system and their success. Helen does have the ability to multitask, taking care of her immediate family as well as fulfilling her obligation to her mother-in-law. Even under the current stressful circumstances, Helen is assuming and carrying out her responsibilities. John Petrakis: father, 60 years old Helen Petrakis: mother, 52 years old Alec Petrakis: son, 27 years old Dmitra Petrakis: daughter, 23 years old Althima Petrakis: daughter, 18 years old Magda Petrakis: John’s mother, 81 years old 15 Worksheet: Dissecting a Theory and Its Application to a Case Study Most theories can be dissected and analyzed. All theories will tell you something about their focus or unit of analysis. A theory will identify its major or key concepts. It will also point to the definition of the problem and its cause. This then guides how the social worker assesses and intervenes, because the theory will also articulate the role of the social worker and how change occurs. Basic Assumptions of the Theory Directions: For each section, respond in 2 to 3 sentences to the following prompts. Where relevant, provide citations to support your claims. Name of theory Name of theorist What are the major assumptions of the theory? What are the theory’s key concepts? What is the theory’s focus or unit of analysis? What is the theory’s overall explanation for the cause of problems? Application to a Case Study Directions: For each section, respond to the following prompts. Where relevant, provide citations to support your claims. In 1 to 2 sentences, how does the theory define the client’s presenting problem? In 1 to 2 sentences, how does the theory explain the cause of the client’s presenting problem? In 1 to 2 sentences, how does the theory explain the role of the social worker for this client? In 1 to 2 sentences, what does the theory say about how this client will improve or how change will occur? Using the theory, list 2 to 3 assessment questions to ask this client to explore the client’s goals and how they will get there. According to the theory, identify 2 to 3 specific practice intervention strategies for the client relative to the presenting problem. For each, explain in 1 sentence how it will help meet the client’s goals. Based on the theory, list 2 to 3 outcomes when evaluating whether an intervention is effective. What is one strength and one limitation in using this theory for this client? Questions to Consider When Evaluating the Theory You are not required to answer these questions for this assignment. However, these questions could help stimulate thinking whenever you are asked to evaluate a theory. To what extent does the theory apply widely to diverse situations? Or does it apply narrowly to particular situations? Is the theory ethical? Is it consistent with the NASW Code of Ethics? Is the theory congruent with the professional value base of the social work field? How cost effective would it be to implement interventions based on the theory? To what extent does the theory fit within the organization’s or agency’s philosophy? What do research studies say about how effective the interventions are? Psychological Theories of Poverty Kelly Turner Amanda J. Lehning ABSTRACT. Social work education, practice, and research are heavily influenced by theories developed by psychologists. A review of the literature was conducted to identify theories of poverty emerging from the field of psychology. In general, until 1980, psychological theories of poverty emphasized the role of the individual or group to explain the causes and impact of poverty. Between 1980 and 2000, psychologists began to consider the structural and societal factors that contribute to poverty and moved beyond the explanations of individual pathology. At the beginning of the twenty-first century, an increasing number of psychological theorists acknowledge the role of social, political, and economic factors in the creation and maintenance of poverty. Implications for social work education, practice, and future research are discussed. doi:10.1300/J137v16n01_05 [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website: © 2007 by The Haworth Press. All rights reserved.] KEYWORDS. Poverty, psychological theory INTRODUCTION According to the U.S. Census Bureau, the number of individuals living in poverty in 2004 rose to 37 million, an increase of 1.1 million from 2003 (DeNavas-Walt et al., 2005). Such an alarming statistic is of parKelly Turner and Amanda J. Lehning are doctoral students at the School of Social Welfare, 120 Haviland Hall, University of California, Berkeley, CA 94720-7400. Address correspondence to: Amanda Lehning (E-mail: AJLehning@berkeley.edu). Journal of Human Behavior in the Social Environment, Vol. 16(1/2) 2007 Available online at http://jhbse.haworthpress.com © 2007 by The Haworth Press. All rights reserved. doi:10.1300/J137v16n01_05 57 58 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT ticular concern to the social work profession, whose primary mission has always included enhancing the well-being of those who are vulnerable, oppressed, and living in poverty (NASW, 1999). The applied field of social work incorporates the theories of a wide array of social science disciplines, including psychology. It is important, therefore, to identify and assess the various psychological theories used to explain poverty. How do these theories inform social work practice with individuals and communities struggling with poverty? This literature review examines the theories of both the causes and impacts of poverty emerging from the field of psychology. The first section includes a historical look at theories concerned with the study of the mind and behavior of an individual or group. The next section presents a brief overview of the debates and changes within psychology from 1980 to 2000, as the field of psychology sought to create more of a balance between the understanding of human behavior and the impact of the social environment of poverty. The third and final section examines psychological theories of poverty that have emerged from this more balanced point of view. The conclusion addresses some of the implications of these theories for the social work curriculum, especially regarding human behavior and social environment. METHODOLOGY This literature review included keyword searches in the most popular social science databases, including PsycINFO, PsycARTICLES, PubMed, Social Service Abstracts, Social Work Abstracts, and Sociological Abstracts. Each database was searched using the keywords “poverty,” “poor,” “socioeconomic,” “economic,” or “class” in combination with the terms “theory” or “analysis” and “psychology.” Once an article or chapter was selected, the reference section was searched to identify additional sources. The limitations of this literature review include the small number of articles devoted to theories of poverty within the psychology literature, the authors’ limited experience with psychological theories related to poverty, and a reliance upon published reviews of theories in psychology. A more comprehensive review of psychological theories of poverty is yet to be found in the literature. Kelly Turner and Amanda J. Lehning 59 PATHOLOGIZING THE POOR Theories on the Causes of Poverty Over the course of the second half of the twentieth century, psychologists developed a number of theories that reflected either the field’s biases about poor people (Carr, 2003; Allen, 1970) or its tendencies to view them in terms of their pathologies (Carr, 2003). These theories tend to locate the source of poverty within the individual (e.g., Pearl, 1970; Goldstein, 1973) or within an impoverished culture (e.g., Pearl, 1970; Rainwater, 1970), and do not address the larger societal or structural forces affecting the poor. One theory, known variously as the naturalizing perspective, constitutionally inferior perspective, or nativist perspective, holds that intrinsic biological factors lead directly to poverty, an argument often supported by psychologist-designed intelligence tests (Rainwater, 1970; Pearl, 1970; Ginsburg, 1978). While this perspective has historically reflected public attitudes (Rainwater, 1970), it appears that this perspective was held by some psychologists as recently as the 1970s (Rainwater, 1970; Pearl, 1970; Ginsburg, 1978). Although IQ tests produce quantifiable evidence that has been used to support this theory, many argue that intelligence is not a measurable construct (Pearl, 1970) and even researchers disagree about the exact definition of the word (see Ginsburg, 1978), therefore calling into question the validity of these intelligence test results. A related theory involves the role of language development and the accumulated environmental deficits that can lead to poor academic achievement and the continuation of the cycle of poverty (Pearl, 1970; Ginsburg, 1978). Based on the inadequate development of the language skills poor children in comparison with their middle-class counterparts, researchers claim, have cognitive deficiencies (Pearl, 1970; Ginsburg, 1978). There is very little research, however, that substantiate any significant class-based differences in language abilities (Ginsburg, 1978) and this perspective has been denounced as based on middle-class arrogance, rather than science (Pearl, 1970; Ginsburg, 1978). As an alternative theory, Ginsburg (1978) proposed a developmental view that acknowledges that there may be class differences in cognition but that children share cognitive potentials and similar modes of language. Intelligence-based psychological theories of are not the only theories that suggest that individual deficiencies contribute to an individual’s inferior social and economic status. For example, Carr (2003) describes 60 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT the McClelland approach, which gained popularity in the 1960s and the 1970s. This approach suggests that the poor have not developed a particular trait, called Need for Achievement (NAch), which therefore prevents them from improving their situation. This approach was embraced as a way to help the poor escape poverty, and researchers sought to test this theory on populations in third world countries (Carr, 2003). Similarly, in the 1980s psychologists viewed attribution theory as a promising explanation of poverty (Carr, 2003); namely, the poor tend to attribute their failures to internal factors, while attributing successes to external, uncontrollable factors. On the other hand, the rich take the opposite view. Both of these theories drew criticism for maintaining the status quo and failing to produce real results (Carr, 2003). Other psychological theorists identified poverty as a manifestation of moral deficiencies (Rainwater, 1970) or psychological sickness (Rainwater, 1970; Goldstein, 1973). While a rare view among professional psychologists, the moralizing perspective, labels the poor as sinners who need to be saved (Rainwater, 1970), and the medicalizing perspective views the behavior of poor people in terms of psychological disturbance (Rainwater, 1970). A number of studies reveal a high concentration of schizophrenia and other psychopathologies among the poor. The social selection hypothesis posits that these mental illnesses actually determine one’s economic position (Goldstein, 1973; Murali & Oyebode, 2004). The social drift variant of this hypothesis suggests that most schizophrenics are born into middle- or upper-class families, but their illness prevents them from earning enough money to maintain this social status and they eventually drift into poverty (Goldstein, 1973). There is considerable debate surrounding this hypothesis, however, and the author of one theoretical piece concludes that social selection is one of many different factors explaining the concentration of schizophrenics in the lower class (Goldstein, 1973). Many social service workers employed by public welfare agencies in the 1950s also relied on psychological theories to explain the economic dependence of the poor on the state (Curran, 2002). They subscribed to Freud’s theories regarding the ego and psychosexual development by perceiving welfare recipients as victims of psychologically abusive histories resulting in character disorders that kept them in poverty. In essence, inadequate socialization and broken homes led to a poorly developed ego and low levels of self-sufficiency (Pearl, 1970). Feeling overwhelmed by sexual and aggressive drives, this theory suggests that the poor acted out this psychic conflict, much like a child (Curran, 2002). The appropriate role of the caseworker was to act as a parent Kelly Turner and Amanda J. Lehning 61 substitute, setting limits and assimilating welfare recipients into the dominant culture (Curran, 2002). This theory was embraced by a prosperous postwar America concerned with the rising numbers of African Americans on the welfare rolls, and disinclined to entertain the idea that the same society that led to their own financial success could also contribute to poverty (Curran, 2002). Looking back almost 50 years later, Fraser commented that this approach reflected “the tendency of especially feminine social welfare programs to construct gender-political and political-economic problems as individual, psychological problems” (1989, p. 155, as quoted in Curran, 2002, p. 382). Social work’s earlier characterization of the poor as children seeking to satisfy their aggressive and sexual urges (Curran, 2002) supports the once-popular culture of poverty thesis. Although the culture of poverty theory developed by Lewis (1975) emphasizes the role of the social environment in “creating” a culture of poverty, he still “describes” that culture in pathological terms, claiming that the poor suffer from flat affect, family tension, a brutal nature, and a lack of refined emotions (Carr, 2003). The cultural-relativistic perspective suggests that while the poor have a different culture from the rest of society, it is not necessarily inferior or superior (Rainwater, 1970). Similarly, the normalizing perspective includes middle-class stereotypes that lead to pity or concern for the poor. For example, the poor were perceived as having their own culture that serves them quite well, and it would be best to insulate them from the outside world, rather than force them to integrate with the larger society (Rainwater, 1970). As noted in the next section, the tendency to emphasize the individual’s culpability for being poor occurs not only in theories of causation, but also in theories on the impacts of poverty. Theories on the Impacts of Poverty Historically, psychologists tended to neglect larger structural forces when exploring the impacts of poverty, especially when treating psychological distress (Goldstein, 1973; Javier & Herron, 2002; Luthar, 1999). Some critics attribute this to the profession’s middle-class bias (Pearl, 1970; Javier & Herron, 2002). One of the potential impacts of poverty is the prevalence and incidence of psychiatric disorders. Many studies have shown that psychiatric disorders, such as depression, alcoholism, anti-social personality disorder, and schizophrenia, are more common in urban, poverty-stricken neighborhoods than in more affluent communities (Murali & Oyebode, 2004). 62 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT A counter-argument to this social selection hypothesis is the social causation hypothesis, which holds that a patient’s economic situation actually causes psychopathologies, rather than the other way around (Goldstein, 1973; Murali & Oyebode, 2004). The conditions of poverty produce intolerable amounts of stress, which can lead to mental illness. For example, stress can occur when there is a wide gap between an individual’s achievements and their ambitions, a situation that is familiar to those living in poverty (Goldstein, 1973). While this hypothesis places part of the blame for the plight of the poor on society (i.e., not providing sufficient opportunities for achievement), Goldstein also suggests that individuals play a role in their own psychopathology by noting that: All of these dimensions of rearing, socialization, and personality development, which seem quite appropriate for adequate adjustment to a lower-class environment, also ill-prepares the individual for adequate coping and development in an essentially middleclass society–and especially for adequate coping with the stresses of this society. (Goldstein, 1973, p. 66) In other words, lower-class individuals are perceived to have fewer coping skills compared to their middle-class counterparts. While the author also calls for social legislation to improve the conditions of poverty, his primary recommendation for psychologists is to improve the social and personal skills of poor clients (Goldstein, 1973). Psychoanalysts also view the poor through a middle-class lens, which could disrupt the therapeutic process (Javier & Herron, 2002). Psychoanalysis has historically been identified with white, middle class, AngloSaxon, male values, focusing on the nuclear family and intra-psychic conflict (Javier & Herron, 2002). Some therapists also believe that poor people do not have the proper skills to make use of insight and other therapeutic processes. This lack of understanding, often based on limited contact with those living in poverty and a belief that certain behaviors (e.g., discipline, hard work, and the ability to delay gratification) will necessarily lead to success, results in countertransference, in which the psychoanalyst’s personal feelings about the patient interfere with therapy and often discourage the patient from continuing with treatment (Javier & Herron, 2002). Some critics believe there are more sinister impulses at work, such as a fear that curing the poor of their psychological distress will hand them the tools to revolt against the middle and upper classes (Javier & Herron, 2002). There is, however, an effort among psychoanalysts to provide better treatment of the poor, and the first step Kelly Turner and Amanda J. Lehning 63 might be to acknowledge this countertransference before it becomes counterproductive in therapy (Javier & Herron, 2002). Moreira (2003) expresses concern about what she calls the “medicalization of poverty,” a process involving psychologists and psychiatrists prescribing psychotropic drugs to treat the impacts of poverty, while ignoring other socio-political factors in the process. She accuses the psychology profession of maintaining the status quo by keeping the poor drugged and therefore docile (Moreira, 2003). Without a comprehensive view of the impacts of poverty that acknowledges external, structural factors, the poor will continue to suffer (Moreira, 2003). Psychologists in the 1980s began to embrace this view, recognizing the integral role that social, economic, and political forces play in the causes and impacts of poverty. UNREST IN THE PROFESSION: 1980-2000 In the 1980s, psychologists began to criticize the overly pathological view of poverty held by their profession (Carr, 2003). They argued that applying McClelland’s NAch theory to poor people (i.e., they remain in poverty because they lack motivation) completely disregarded the external, societal factors that contribute to the epidemic of poverty (Carr, 2003). Similarly, various prominent psychologists also disagreed with the widespread application of Feagin’s popular attribution theory as a way to explain poverty, believing that it inappropriately blamed a poor person’s lack of self-esteem for his/her plight, without taking external factors into account (Carr, 2003). Mehryar, another prominent psychologist of the 1980s, noted that psychological theories had no effect on reducing poverty and possibly had the opposite impact, namely that “psychologizing poverty was liable to pathologize the poor rather than the system that constrained them” (Carr, 2003, p. 5). Mehryar went a step further by blaming the individualistic view of psychology towards poverty as contributing to keeping the wealthy in power and the poor in poverty (Carr, 2003). The psychologists of the 1980s, therefore, proposed a return to the culture of poverty theory (Lewis, 1975) that suggests that civilization itself (compared with pre-literate, tribal cultures) inevitably creates two cultures: one of wealth and one of poverty (Carr, 2003). While some psychologists in the 1980s rejected purely psychology-based theories in favor of society-based ones, they did not discount psychology entirely (Carr, 2003). Rather, they believed that psychology could make a positive 64 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT contribution toward a new understanding of poverty “if” it was used to describe the psychological processes of the “wealthy” (i.e., not the poor) and how the biases of the wealthy helped to maintain the conditions of poverty (Carr, 2003). IMPACT OF SOCIAL FORCES Theories of the Causes of Poverty Taking a broader perspective on the impact of the social environment on human behavior, Moreira (2003) sees globalization (including the spread of capitalism) as the major cause of both wealth and poverty. Specifically, she explains that, “globalization works in a selective fashion, including and excluding segments of economies and societies from information networks, giving us pockets of rich and poor” (Moreira, 2003, p. 70). Moreira particularly condemns globalization for disseminating Western culture’s greed for material goods, which she considers to be responsible for a particular kind of poverty called “Consumerist Poverty” or “Consumerist Syndrome.” Drawing upon theories from other social science disciplines, some psychologists have adopted the Empowerment Theory of an economist (Sen, 1999) to explain the existence of poverty (Moreira, 2003; Carr, 2003). Whereas traditional definitions of poverty use “extremely low or no income” as the sole criterion for the term, Sen proposes that poverty is more than just low income: It is a lack of political and psychological power (Sen, 1999). More specifically, Sen suggests that modern society deprives “certain” citizens of power and control, which then results in poverty for those citizens. In order to escape from such poverty, Sen believes that a society must provide all of its citizens with three things: (1) political, economic, and social freedom; (2) security and protection; and (3) transparent governmental activities (Sen, 1999). The World Bank Development Report for 2000-2001 expanded upon Sen’s Empowerment Theory to develop a three-pillar theory of poverty related to the absence of security, empowerment, and opportunity (World Bank, 2001; Carr, 2003). Carr (2003) and other psychologists view this as an extremely solid theoretical foundation from which the profession of psychology can proceed to investigate poverty. As Carr (2003) explains, “Without all three pillars together, there is no real foundation for concerted development out of poverty. One pillar does not carry the roof” (p. 8). Kelly Turner and Amanda J. Lehning 65 The World Bank’s concept of “security” includes factors such as clean water, adequate food and housing, and the reduction of vulnerability to natural disasters (World Bank, 2001). The concept of “empowerment,” similar to Sen’s definition, entails providing the poor with the means to acquire a greater voice to help them fight for justice within their society (World Bank, 2001). When applied to psychological treatment, “empowerment” encourages psychologists to work “with” the poor, not “for” them (World Bank, 2001; Carr, 2003). Of course, a society in which only a portion of its citizens (i.e., poor persons) lacks empowerment implies that discrimination and prejudice is at the root of the problem (Carr, 2003). Finally, the World Bank’s third concept is “opportunity.” Poverty exists, in part, because the poor are deprived of opportunities to participate independently in the global economy (World Bank, 2001). Such opportunities range from a lack of an affordable education to a dearth of living-wage, entry-level jobs (World Bank, 2001). The World Bank’s three-pillar view of poverty seems to be a comprehensive theory from which psychologists can proceed with both research and interventions. Instead of focusing on empowerment, psychologist Lott (2002) approaches poverty by focusing on discrimination linked to a theory of classism that explains the preservation of poverty in our society. As she defines it, classism is what results from the combination of three negative sentiments: stereotypes, prejudice, and distancing. Similar to discrimination, “distancing” describes how the wealthy distance themselves emotionally and physically from poor people. Although classism is considered to be an impact of poverty, Lott also states that, “Barriers erected by classist bias maintain inequities and impede access to the resources necessary for optimal health and welfare” (Lott, 2002, p. 100). In other words, Lott sees class-based discrimination as both a cause and effect of poverty. Lott (2002) bases her views on Williams’ 1993 theory that the upper class purposefully categorizes people into lower, middle, and upper classes “in order to maintain its power” and to prevent the lower classes from receiving an equal share of resources (Lott, 2002). This approach has been described as “social poverty” (Lummis, 1991), which occurs when the upper class purposefully keeps the lower class in poverty via economic control, thereby keeping themselves in power (Moreira, 2003). Lott (2002) describes two theories that examine the mechanisms behind such unfair discrimination: Moral Exclusion Theory and Dehumanizing Theory. Moral exclusion theory, developed by Opotow, suggests that upper-class citizens incorrectly assume that lower-class citizens are less moral than those in the upper classes, thereby causing or passively 66 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT allowing poverty to become more acceptable in the minds of upperclass citizens (Lott, 2002). Similarly, Bar-Tal, and Schwartz and Struch both propose that the upper classes dehumanize poor people, believing that lower-class citizens have different (i.e., unacceptable) values and emotional tendencies (Lott, 2002). This dehumanizing process makes it easier for upper-class citizens to reduce their empathy as well as discriminate against poor people (Lott, 2002). The most recent comprehensive discussion of poverty within the field of psychology is found in the Resolution on Poverty and Socioeconomic Status by the American Psychological Association (APA, 2000). Intended to represent the collective opinion of psychologists nationwide, it clearly states, “perceptions of the poor and of welfare–by those not in those circumstances–tend to reflect attitudes and stereotypes that attribute poverty to personal failings rather than socioeconomic structures and systems” (APA, 2000, p. 2). Thus, the APA acknowledges that both structural forces in society as well as discriminatory practices contribute to the perpetuation of poverty. Theories on the Impacts of Poverty In 1979, Urie Bronfenbrenner, one of the field’s most influential developmental psychologists, proposed his now-famous ecological theory about how an individual is influenced by “systems” of interaction that include family and friends, community, and society, and constantly change and influence each other over a lifetime (Bronfenbrenner, 1979). This was one of the first developmental theories that took into account the effects that the social environment can have on human behavior and life course development. This theory of interacting systems was used to explain the experiences of children and adults living in poverty, especially the causes and impacts of poverty (Fraser, 1997). For example, whereas psychologists of the 1960s and the 1970s tended to attribute the relatively low IQ score or sub-standard scholastic achievement of the poor to inherent moral or genetic deficiencies, most psychologists today recognize that the multiple systems of a person’s life can have an impact on such scores or performance (Fraser, 1997). As a result, psychologists have moved from blaming the individual victims of poverty to incorporating the social environment into their understanding of people in poverty. Lott (2002) views discrimination directed toward poor people by the upper classes as yet another negative product of a poor person’s Kelly Turner and Amanda J. Lehning 67 circumstances. Lott (2002) calls this particular type of discrimination “Distancing,” which she divides into the following three subcategories: 1. Cognitive Distancing. Herein the upper classes hold onto negative, unjustified stereotypes about poor people’s characteristics and behavior by blaming the condition of poverty on a person’s individual failings, 2. Institutional Distancing. This involves “punishing members of low-status groups by erecting barriers to full societal participation” (p. 104), such as the disparity between suburban and inner city public schools. 3. Interpersonal Distancing. Herein the middle or upper class individuals directly ignore, insult, or discriminate against lower-class individuals to their face (e.g., a shop owner forcing poor children to wait outside the store while their mothers shopped because they might steal if allowed to enter the store). In summary, Lott (2002) views all these forms of distancing as significant in their negative impact on people living in poverty. Moreira (2003) has identified other negative impacts such as the loss of culture, whereby dominant Western culture obliterates regional cultures. For example, cultural rituals are disappearing from povertystricken areas, such as a community ceremony to grieve the death of an infant (often related to poverty and malnutrition). The loss of such cultural rituals that serve to ease the grief of the surviving mother are related to increasing rates of depression among poor women who have lost children (Moreira, 2003). In a similar vein, Moreira blames the invasion of Western society’s consumerist ideology (i.e., assigning great value to the accumulation of material goods) for causing consumerism syndrome in poor people; namely, an unrelenting desire to own more and more material goods. Since poor people do not have the financial resources to satisfy such a desire, she believes it unnecessarily exacerbates a self-perception of being poor and can lead to mental health problems (such as depression). As Moreira (2003) explains, “it is more probable to find someone who thinks he is poor without really being poor, and who is, in fact, just the opposite” (p. 73, emphasis added). Lummis (1991) expands upon this view and notes that when consumerist ideologies dominate a society, people perceive that the only things of value are those that are purchased with money. For example, poor people from regional cultures no longer 68 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT want to plant vegetables because they prefer to buy them in grocery stores (Moreira, 2003). Depression and misplaced low self-esteem resulting from a consumerism syndrome are not the only psychological problems that poor people face (Moreira, 2003). Moreira (2003) notes that globalization and consumerist ideology can cause multiple psychopathologies, ranging from anhedonia (i.e., no longer taking pleasure in activities that were previously pleasurable) to nihilism and suicidal ideation. The invasion of Western culture is particularly damaging to a poor person’s selfesteem, since it imposes the belief that Western culture is superior to the cultures it is supplanting (Moreira, 2003). The APA supports Moreira’s view that the condition of poverty increases one’s chances of experiencing mental illness. As reported in the Resolution on Poverty that “poverty is detrimental to psychological well-being, with [National Institute of Mental Health] data indicating that low-income individuals are 2-5 times more likely to suffer from a diagnosable mental disorder than those of the highest socio-economic-status group” (APA, 2000, p. 1). While psychologists have recognized that poverty can increase one’s chances of developing mental disorders, today they attribute such illnesses to broader societal forces as well as intrinsic, personal characteristics. While societal forces can overwhelm the poor, there are also povertystricken individuals who have overcome the negative impacts to succeed in school or the workplace. Explanations for this form of success emerged from the study of risks, which Fraser (1997) defines as any factor that: (1) increases the probability of a problem, (2) makes a problem more serious, or (3) helps maintain a problem. Not surprisingly, poverty is a risk factor for child abuse, illness, family stress, inadequate social support, depression, and delinquency (Fraser, 1997). Furthermore, because poverty is typically long lasting, it accumulates and magnifies such risks, whereby problems like mental illness are magnified (Fraser, 1997). Despite all of the risks and negative consequences associated with poverty, some individuals succeed despite living amidst such risks (Garmezy, 1985). According to Fraser (1997), one of the first theorists to tackle that question was E. J. Anthony, who called such individuals “psychologically invulnerable” (p. 14). Subsequent theorists criticized this label, saying it gave the false impression that the successful individuals were completely unaffected by risk factors. As an alternative, theorists such as Garmezy (1985) suggested the term “resilience,” which he defined as “risk factors in combination with positive forces that contribute to adaptive outcomes” (Fraser, 1997, p. 14). Garmezy and others Kelly Turner and Amanda J. Lehning 69 went on to propose three different types of resilience: (1) success despite numerous risk factors, (2) sustained coping despite chronic stressors, and (3) recovery from a trauma (Fraser, 1997). According to Garmezy (1985), a person achieves such resilience with the help of positive forces or “protective factors” which can be any internal or external force in a person’s life that helps him/her avoid risk. Garmezy (1985) divides these protective factors into three categories: (1) dispositional attributes (e.g., positive temperament), (2) family milieu (e.g., solid family cohesion), and (3) extra-familial social environment (e.g., extended social supports). According to the theory of resilience, a protective factor can function in one of four ways: by reducing the impact of a risk, by reducing a negative chain reaction that might have actualized a risk, by developing a person’s self-esteem, or by creating opportunities through social reform (Fraser, 1997). It is not surprising that resilience theory is the most recent psychological theory to emerge, given psychology’s own self-criticism for having been previously too disparaging of the inherent abilities of the poor. CONCLUSION From this literature review on psychological theories of poverty, two themes emerged: those that emphasize the role of the individual, and those that emphasize the role of society. Theories that emphasize the role of the individual attribute poverty to one’s intrinsic deficiencies, while theories that focus on society find fault in its broader, structural forces. Based on this brief literature review, it appears that the field of psychology now favors the more ecologically-based theories as reflected in the APA’s Resolution on Poverty (2000) calling for more attention to the social environment and the nature of resilient human behavior. For example, the APA (2001) calls for the support of any public policies that will help eradicate poverty, such as those that provide equal public education, living-wage jobs, and affordable housing. The APA (2000) also calls for further psychological research into the causes and impacts of poverty, especially economic disparity, classism, and prejudicial stereotypes. The conceptual map found in Figure 1 illustrates the major concepts covered by this literature review. The map is divided into two components: The top half represents psychological theories of poverty that focus solely on human behavior and the bottom half contains theories 70 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT FIGURE 1. Psychological Theories of Poverty of poverty that address the social environment. The theories on the “causes” of poverty that focus on the individual include such personal failings as: inferior genes, the absence of a NAch, inherent mental illness, sinister morals, and/or internal ego/superego conflict stemming from an unhealthy childhood. These theories focused primarily on internal deficiencies, whereby individuals bring poverty upon themselves and contribute to their own mental illness. The bottom half of the conceptual map illustrates an entirely different picture, where causes of poverty are attributed to aspects of the social Kelly Turner and Amanda J. Lehning 71 environment: Civilization itself, the spread of a consumerist ideology, structural forces of society (e.g., lack of living-wage jobs), lack of power, security, and opportunity for certain groups, and/or discrimination by the upper classes toward the lower classes. Such theories focus on both the behavioral impacts of poverty (mental illness, consumerism syndrome, or resilience) as well as the environmental impacts (a loss of culture, low-paying jobs, a risk-filled environment, and discrimination). One of the implications for understanding human behavior and the social environment is to recognize the historical trajectory of the development of psychological theories and the recent efforts to balance the impact of societal forces with the resilient behaviors of poor people. Further research is needed in order to understand the interaction between individuals and their social environment, and how this interaction is exacerbated by the condition of poverty. It is equally important to gain a more in-depth understanding of how psychological theories were used to explain poverty and thereby “blame the victim” while ignoring the impact of the social environment, which has been and will be the primary arena for eliminating poverty. REFERENCES American Psychological Association (APA). (2000). Resolution on poverty and socioeconomic status. Retrieved on November 21, 2005 from www.apa.org/pi/urban/ povres.html Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press. Carr, S. (2003). Poverty and psychology: An introduction. In S. Carr & T. Sloan (Eds.), Poverty and psychology: From global perspective to local practice (pp. 1-15). New York: Kluwer Academic/Plenum Publishers. Curran, L. (2002). The psychology of poverty: Professional social work and aid to dependent children in postwar America: 1946-1963. Social Service Review, September, 365-386. 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Lewis, O. (1975). Five families: Mexican case studies in the culture of poverty. New York: HarperCollins Publishers. Lott, B. (2002). Cognitive and behavioral distancing from the poor. American Psychologist, 57, 100-110. Lummis, C. (1991). Development against democracy. Alternatives, 16, 31-66. Luthar, S. (1999). Poverty and child adjustment. Thousand Oaks, CA: Sage. Moreira, V. (2003). Poverty and psychopathology. In S. Carr & T. Sloan (Eds.), Poverty and psychology: From global perspective to local practice (pp. 69-86). New York: Kluwer Academic/Plenum Publishers. Murali, V. & Oyebode, O.A. (2004). Poverty, social inequality and mental health. Advances in Psychiatric Treatment, 10, 216-224. National Association of Social Workers (1999). Code of ethics. Retrieved on November 17, 2005 from http://www.naswdc.org/pubs/code/default.aso Pearl, A. (1970). The poverty of psychology: An indictment. In V. Allen (Ed.), Psychological factors in poverty (pp. 348-364). Chicago: Markham Publishing Company. Rainwater, L. (1970). Neutralizing the disinherited: Some psychological aspects of understanding the poor. In V. Allen (Ed.), Psychological factors in poverty (pp. 9-28). Chicago: Markham Publishing Company. Sen, A. (1999). Development as freedom. Oxford: Oxford University Press. World Bank (2001). Attacking poverty: Opportunity, empowerment, and security (World Development Report, 2000/2001). Retrieved on November 21, 2005 from http://econ.worldbank.org/wdr/ doi:10.1300/J137v16n01_05 
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