Damage control for the system’s victims

I WORK as a psychologist in a large HIV medical clinic in upper Manhattan. Yesterday did not particularly stand out from others; at best, I feel like I'm doing damage control for people who have been screwed over at every turn by "the system."

First, Shondra, a woman with post-traumatic stress disorder resulting from severe childhood abuse, as well as multiple HIV-related medical problems. Her only son, 19 years old, is in prison for a nonviolent drug-related offense and is being tormented there because he is "feminine." She misses him terribly and wishes she was there to protect him.

She comes into my office breathing a sigh of relief after the 90 degree-plus heat outside. She has air conditioning, but has resisted "cutting it on" in the current hot-soupy heat wave because if she has to pay the extra electric, she won't have enough for food.

"It's getting worse and worse," she tells me. "Nobody can make their food stamps stretch to the end of the month. But who I really feel for is my sister."

She relates that her younger sister, whose 5-year-old son is developmentally disabled and in need of extra care, took a part-time summer job at the library (minimum wage, no benefits) to help make ends meet; her Medicaid and public assistance benefits were promptly terminated.

"Now, all she has is the SSI for her son," Shondra says. "It's not enough to pay the rent and buy food. Now they're telling her that she can't get the benefits back unless she hasn't been working for 12 months, but if she quits the job now, how can she live for the next 12 months?"

Shondra's plan: since she has HIV, she can apply for food pantry services of a bit better quality than the usual ones (which hand out substandard food after sometimes hours of waiting in the hot sun). "I'll just apply for all the ones I can and go around and get all the food, and give it to my sister," she says. "And my cousin, too, he's having a bad time." I ask if this will interfere with her GED prep classes this summer. "Yes," she says, "but they have to eat."

And the day goes on, with story after story. This is not what I was taught to think of as psychotherapy; it's damage control--shoring up the ruins of what was once a semi-functional system. We go online to figure out hours, locations and enrollment requirements for food pantries; I let her know what I've heard from other patients about food quality and wait time.

I have heard many people, including my own colleagues, accuse those like Shondra of "working the system." Frankly, I want to strangle them, but I try to remember Eugene Debs' exemplary acceptance that we are all prisoners, to some degree, of false consciousness.

As our patients have their benefits cut, have higher co-payments for needed medication, the staff feel increasingly helpless--and then angry and burnt out--at their inability to meet patient needs, so they fall into the age-old "blame the victim" trap.

Resisting the temptation to give her a copy of the current Socialist Worker with its current "How Bad Will It Get" and "While the World Goes Hungry" cover stories (I do need to keep my job, I remind myself; without it, my own family would have no medical care or steady income), I ask her, "So what do you think it would take to change this system? To make it better for everyone?" She replies: "I have no idea. I'm too busy just trying to survive."

I wish I could tell you that we went on to talk about the power of mass organization, of fightback, but we did not. I ended the day, as I do most, feeling frustrated and beaten down by how very little help I can offer as a therapist--and even more convinced of the dire necessity of struggling to overthrow this barbaric system and fighting for a socialist world.
Hannah Wolfe, New York City