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Public policy and toxic stress

A conversation with Professor Ruby Mendenhall

In conversations with Dr. Andrew Garner and Charles Cox, we discussed the biological impact of toxic stress, the ways toxic stress threatens children’s adult outcomes, and the influence of toxic stress as high school students are working their way toward adulthood. What seems clear is that much of what students experience depends on the systems they have access to. These include school systems, job referral and mentoring networks, social services, and systems of family support.

To get a clearer sense of how these systems operate and respond to public policy, I spoke with Professor Ruby Mendenhall, an associate professor in sociology, African American studies, urban and regional planning, and social work at the University of Illinois at Urbana-Champaign. Her first experiences confronting toxic stress in struggling families and neighborhoods got her thinking about how to elevate those families’ ideas about public policies addressing their challenges. She worked with families on the south side of Chicago in the Robert Taylor Homes, a large public housing project that was notoriously plagued with gang violence, crime, and concentrated poverty. She also learned about the effects of residential segregation while working with participants of the Gautreaux housing mobility program, many of which moved from neighborhoods of concentrated poverty to suburbs with greater economic opportunity.

Much of what Professor Mendenhall knows about social policy she says she has learned from working directly with those who are most negatively impacted by racial inequality. She explained to me how adults and children she met dealt with living in an environment with endemic gun violence. She sees the toxic stress generated by exposure to violence as a root cause of many problems, so that asking about individuals’ adverse childhood experiences is a constructive way to start searching for policy solutions.

The following conversation has been edited and condensed. Listen to an extended version of this conversation.

A research career born out of caretaking

Dionissi Aliprantis

Can you tell us a little bit about your background and what kind of influences have shaped you personally and professionally to get to where you are today?

Ruby Mendenhall

Sure. I'd love to. I guess I'll start with my family. Both of my parents are from the South. My mother's from Mississippi. My father is from Alabama and they migrated to Chicago. The stories that we hear from my father's side is that my grandmother's grandmother was enslaved. Then my grandmother's sister used to take care of her as a young person, and so she told me some of the stories that she told her. When I do presentations, I have a picture of my grandmother and my great-aunt and I talk about how recent slavery is in US history. That it was only one person between my enslaved great-great-grandmother and myself to tell the story. I really point to that because a lot of the inequality that we see, a lot of the health disparities are rooted in that foundation of deep structural inequality.

In terms of my professional life, I started out as an occupational therapist. I loved it. I worked at Cook County Hospital. I was also on the protective service team and so I worked with children who were failing to thrive. That was really transformative and what I do today, is that when the mothers came in, usually mothers, usually Black and Latinx mothers, we would ask, as the protective team, like, "What's wrong? Do we need to take the child?" The baby isn't growing like it should. The mothers said over and over again that they couldn't afford to feed the babies, and so they were watering the formula down. After I heard the story over and over, I remember saying like, "Wow, so this isn't an issue with the mothers or if they're able to take care of the kids, if they love their children. It's an issue of: As a country, will we provide enough resources for mothers to take care of their children?”

Then I became interested in public policy, went to the University of Chicago Harris School. Then when I was there, just kind of looking at kind of the structural issues and the role of race and how sometimes race wasn't mentioned but it was clearly in the center of it. Then after that I went to work for the Ounce of Prevention Fund, which is a public private organization. That's what it was called then. We worked on the early Head Start grant and then I remember we received the grant, and it was to work in Robert Taylor Homes. I told everyone, I was like, "I would love to go and work in Robert Taylor Homes and work with the grant." Many of the people was like, "Well, why would you do that? Who leaves downtown to go to Robert Taylor?"

I wanted to do that because I wanted to understand those mothers and what they needed in terms of their children. During that time, I was also in the policy world. I remember sitting around the policy table. It was mostly white males. Often I was the only Black person or the only woman and they were committed, they were really thinking hard about equality. But I remember thinking like, "Where are the mothers who are struggling? Where are the individuals who are deeply in the problems? Why aren't they around the table kind of coming up with some of the solutions?" That was why I was interested in going to Robert Taylor Homes. I went there, saw a lot from gun violence, to poverty, to a lot of things. We worked with young teen moms and we let them know, you can influence public policy, you can put forth your ideas.

Some of them would be like, "Okay, thank you. Thank you. But I need to meet Mr. so-and-so at the end of this to get some money to feed my children." I remember thinking, "Man, here we go again." Lack of money, not able to take care of children. Part of that was why I then went to Northwestern University and kind of merged the two. I studied human development and social policy. Then that led to my work with the Gautreaux Program. That's kind of my story as I put it together over many years and kind of telling it to people.

The toxic stress of violent neighborhoods

Dionissi Aliprantis

One topic that I am very interested in talking about with you was this issue of trauma, mental health, and exposure to violence. You've done some really important work on this, some of your older work, some of your newer work, and I would be curious if you could expand on your motivation for studying these topics and questions.

Ruby Mendenhall

Yeah. Actually, it really does go back to the Gautreaux. Again, when I had the wonderful pleasure of talking with the women in the Gautreaux, a lot of them were sick. A lot of them had diseases. I remember there was one woman, I think she had cancer. She was in her 20s. And others – I was also amazed that they were sick, but then they were also going to work, taking care of their children and doing things. I remember listening to those women and thinking like, "Wow, why are they so sick?"  Not all of them, but again, some of them.

Like I said, my original research was looking at how segregated neighborhoods affected economic outcomes. But it turned to looking at health and gun violence when ... I was here in Champaign, but I'm from Chicago. I love Chicago and was hearing family and friends talk about the violence young people were being involved, young people were affected by it. I was like, "Wow. It seemed different." With Robert Taylor, it almost was an order. The gangs, they had their wars, they had their kind of shootings, but one thing they would say as a community, "Look at 3:30, it's about to be on, so get your kids in the house. Get them off the streets because it's about to go down."

It was kind of, word was passed around, everybody, for the most part, had a sense. Not to say it played out like that all the time, but in general there was conversation about making sure that the children are safe. As I started to listen and to feel, because I had two kids too, and I turned my research agenda to looking at gun violence. We initially did focus groups. We talked to mothers, children, fathers, and wanted to make sure this was an issue, this was something that they were having struggles with. I mean the stories were just something. After that, we received funding to do a really innovative study where we talked to close to 100 Black mothers in low-income segregated neighborhoods. But we also did some genomic analysis because we wanted to see how the stress of living in neighborhoods with high levels of violence affected their health and wellbeing.

I remember when we did the focus groups, we were like, "Okay, now we want to do interviews in the future. How do you think we should talk to the women asking them for their blood to do the analysis?" They kind of gave us some language because even in our research team we were like, "Can we get Black women to give blood because of the racism, because of the exploitation, because of the abuse?"

Dionissi Aliprantis

The history.

Ruby Mendenhall

Yes. "Would they do it?" We put together a script and part of that script was to talk about Tuskegee and other things, and to just kind of say, "We recognize the abuses. This is now what we are trying to do. We are trying to understand how living in neighborhoods with high levels of violence affect your health and wellness." I'll say that the women were really interested in learning about that because they were having experiences in their bodies. Sometimes they connected it to stress and sometimes they didn't. They talked about having headaches, backaches, stomach aches, hair falling out, a loss of sexual desire. I mean, just a whole range of things.

We did the study and it was just ... You know how you have certain experiences in your life that changed you? One was working on the protective service team and hearing the stories. When I talked to the women, that was another life-changing event and in ways that I didn't even recognize myself. Family members were like, "Are you okay?" I was like, "What do you mean?" "You're kind of different. Something's going on." It was hearing all of the trauma. Even sometimes, it was mostly Black women, it was one Latinx graduate student, and we would kind of talk about the study at the end of the day and sometimes just crying. Just kind in tears from what we've heard. I kind of took on that and I didn't recognize how much, but there was a voice in my head that was like, "You need to get some more coping mechanisms." I say all that to say that I'm African American, I'm a Black woman, so I share their experiences on some level. But on the level of the fear, the stress, the anxiety, the panic of not knowing if your child will be okay.

For some of the women, their children were not okay. They were killed. It's really hard think about. I really appreciated them telling their stories, being very open. One woman, again, told me something that was really life changing. I went in thinking about social structures, like oppression, like, "Let's talk about some of the issues, how you're working with them. Let's work together." One of the mothers said, "Thank you for coming to see how we're doing. The little things matter and people don't understand that." I was like, "Hmm." as I thought about it, I was like, "Okay, I think she was saying by us coming and saying, how are you? How you doing? How are your children? What do you need to be well? Let's try to work together to put some of those things in place." That that's really powerful, looking at her humanity, recognizing her dignity. That was transformative.

What happened to you?

Dionissi Aliprantis

Do you have any thoughts or comments about how this actually affects kids growing up in these kinds of conditions?

Ruby Mendenhall

Yeah. We did ask the mothers about how their children were doing it. I will say, the mothers really tried to shield their children from what was happening. But one of the mothers was like, "Kids ask questions. Kids, they see it." One of the mothers, after the kids repeatedly had to kind of get in the bathroom, get in the bathtub. I said, "Well, how do they cope?" She's like, "They're afraid. They don't want to go to school." She talked about how she tells them that they'll be okay. Then I said, "Do you feel that way?" She's like, "No, but I tell them that, so that they'll feel okay, that they'll feel safer." She has panic attacks.

Again, it's just a toll. The kids again, they see it. Some of them, one child, he was somewhere with his friends. He stepped away, the friend was shot and killed by a bullet. The same child was somewhere else, stepped away and the friend was killed by a bullet. So just so much trauma. Then the parents talked about ... I said, "Did the school get services like Sandy Hook?" Because that happened near that time. She put in quotes, like, "We were supposed to have services, but we don't. I called the school once. They told me to call back. I called back again. They said they were busy." I think she may have tried to a third time and then she stopped. Then a lot of times you have these children who are traumatized and they don't get the care that they need. Sometimes kids are traumatized and the parents don't even know. The mothers, they talked about some of the stuff that they witnessed and that they didn't even tell their parents.

Now I always say I, and not just me, others, "When you see kids flipping over tables, yelling, cursing, even shooting ..." And Bruce Perry and others are saying, "the question isn't, what's wrong with you? The question is, what happened to you?" I think as a society, that's the question that we have to unpack and we have to look at our role as adults, as policymakers, as universities, as healthcare systems, other things like how are the lack of opportunities? How is systemic racism over 400 years and for other groups? How does that affect how children are developing, how they're growing? And we can change it.

The opinions expressed in this article are those of the participants and do not necessarily represent the views of the Federal Reserve Bank of Cleveland or the Board of Governors of the Federal Reserve System.

Ruby Mendenhall

Professor, Sociology, African American Studies, Urban and Regional Planning, and Social Work
University of Illinois at Urbana-Champaign

Professor Ruby Mendenhall is the Kathryn Lee Baynes Dallenbauch Professor in Sociology, African American Studies, Urban and Regional Planning, and Social Work at the University of Illinois at Urbana-Champaign. She is also the Associate Dean for Democratization of Health Innovation at the Carle Illinois College of Medicine and an affiliate of the Institute for Genomic Biology and the Institute for Computing in Humanities, Arts and Social Sciences. Dr. Mendenhall has conducted foundational research on the links between neighborhoods, segregation, violence, and economic outcomes, and is currently engaged in community/participatory research with citizen/community scientists, training community health workers, and developing pathway program that provide marginalized youth with unprecedented access to STEAM careers. Her recent awards include a $500,000 grant from the MacArthur Foundation and the 2021 Pearl Birnbaum Hurwitz Humanism in Healthcare Award. Dr. Mendenhall received her PhD in Human Development and Social Policy from Northwestern University in 2004.

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