Welcome to the City of Post-Traumatic Stress Disorder

For a long time, Joseph Garcia stayed out of trouble. At 11, he was a gorgeous kid, with the thin physique of a boy built to bloom and the doe eyes of a child. He earned good grades in school. He did what he was told. And his mother, Diana, was less concerned with the dangerous streets than with getting him out of their small rowhome near 5th and York, where he played video games for hours on end.

“Are you sure you don’t want to go out?” his mom would ask. “Why don’t you go play?”

“Nah,” he’d say. “I’m good.”

All the while, his eyes remained focused on the screen, his fingers steadily working the game controller in his hand.

Diana’s days began early in the morning, doing quality control at Hatfield Quality Meats. Evenings, she arrived home and cooked dinner for Joseph and his sister while he filled the house with electronic booms and blurps. Sometimes, she filled his head with visions of the future—“You’re going to go to college,” she told him, “you can be a lawyer”—and he seemed to believe her.

Late at night, when she would awaken to go to the bathroom, she took the opportunity to peek into the separate bedrooms of her daughter and son. She loved seeing them at peace, their chests rising and falling under layers of blankets.

The family wasn’t unaware of the violence outside. They heard gunshots, like everyone else. And they knew what the ambulance sirens that followed meant. It was just that these facets of life in their neighborhood seemed separate, somehow, from what they had built. Then one night about 18 months ago, when Joseph was 12, Diana woke up, used the bathroom, and crept to her son’s door. On this night, when she peeked into his doorway, his bed was empty—his bedclothes lay frighteningly flat, as if he had been sucked out from under them.

In many respects, Diana was alone—had been alone for a long time. There was a period when the biological father to her children had been deeply involved in raising them. But he got arrested when Joseph was just four, on a drug-dealing charge. After his arrest and jail time, he was deported to his native Dominican Republic. Diana moved on, seeing another man, who even moved in. But Joseph never took to him as a father, sometimes even calling him “Bro.” So it was only her blood that was really missing now—that had disappeared from the house.

That night, she dressed, her heart filled with the worst possible fears, and swept into the streets, looking for her son—the little boy she’d once begged to go outside and play, now loose in the wind.

In 2010, around the same time Joseph was still content with video games, seven blocks away, a young man seven years older than him, named Antwan Pack, seemed ready for big things, a special kid rising up out of a bad neighborhood.

Pack was five-foot-four, lean and good-looking, with high cheeks that caught the light when he smiled and enough little boy in him to go right on kissing his mom, even at 18.

Melva Pack was a big woman. She bequeathed Antwan that smile and felt grateful for how her boy had turned out. Living around 4th and Berks, Antwan grew up hearing gunshots squeezed off regularly. But he lived a life that suggested the echoes hadn’t touched him.

He graduated from high school, at Benjamin Franklin, in 2010. He took his sister to the prom. He started attending community college, hoping to major in architecture. The only thing he did that worried his mother was keep bad company.

Melva Pack often told Antwan he was running with the wrong people. His clean legal record, high-school diploma and year in college, she told him, should be all the proof he needed. But he took them on as his set all the same, men on the same path as his father, who bounced in and out of jail on drug charges.

Then something happened to alter his course.

One night in 2010, Antwan, then 18, met up with his friends in Fairmount, near 17th and Francis. They were just sitting on some stoop, talking, when bullets started whizzing past, ripping up the pavement.

Antwan ran so fast, his adrenaline pumped so hard, that he never even felt the stern punch of those bullets—to his hand, to his chest.

Then someone else saw the blood.

There was no official breakup ceremony with him and those boys. But he started keeping his distance. Shot in the chest with no major organs damaged, Melva Pack’s son seemed to understand his luck.

“Cortisol and adrenaline are important and healthy when delivered into the bloodstream in the right amount and under the proper circumstances,” says Drexel’s John Rich. “Like, say, if you’re chased by a dog.”

Cortisol and adrenaline are what fuel the fight-or-flight response. In evolutionary terms, they’re a big reason we’re here—they narrow our focus to the source of a perceived threat and produce our sudden burst of energy to fight or run. The problem is that when they’re released in large amounts, these chemicals actually cause damage to the brain.

What our soldiers and the citizens of our poorer neighborhoods have in common is the regular, repeated experience of undergoing this fight-or-flight response. In many city neighborhoods, residents hear gunfire frequently—at least once every two or three weeks, sometimes far more often. Parents speak of training their kids to get low at the sound of a gunshot, to crawl toward interior rooms, away from windows. “People in impoverished neighborhoods can have brains that are essentially bathed in cortisol,” says Rich.

And that can damage crucial areas of the brain—the prefrontal cortex, the hippocampus, the amygdala—central to long-term thinking and reflection, learning and memory, and emotions like fear and anger. In fact, imaging scans of a PTSD sufferer’s brain show the winnowing of gray matter responsible for adult reasoning and thinking. They also show hyperactivity in the more primitive, emotional parts of the brain.

No one knows precisely why some people can recover from a traumatic event while others require treatment for PTSD. But we do know the urban poor may be even worse off than our country’s soldiers. Among the clearest risk factors for developing PTSD is undergoing trauma as a child—something inner-city kids are particularly prone to. Further, a traumatized soldier home from war might well return to a safe community and stable family structure. In comparison, poor urban neighborhoods comprise test labs where vast numbers of people with PTSD—tens of thousands, if not more—live in close proximity to one another, undiagnosed and untreated. This dynamic, in which poverty, violence and a large traumatized population co-exist, points toward a second condition that Drexel’s doctors call “toxic stress,” wherein people enduring persistent threats and trauma may suffer from many of the symptoms of PTSD without qualifying for that diagnosis.

In this environment, comparatively healthy neighbors can only adapt to the dysfunction in their midst. The result is that the effects of trauma become all-pervasive, embedded in the culture of the urban poor, and difficult to divine. Trauma, as it substantiates in a human being, can take so many forms. It can drive people to drink and take drugs. It turns the good men in this city’s bad neighborhoods into living ghosts—men who drift off to work and back inside their houses, heads down, afraid to tell skinny 15- and 16-year-old boys how to behave for fear of being shot. Trauma and this poisonous, persistent tension make it difficult, if not impossible, for people to maintain healthy intimate relationships—splintering the two-parent family. And trauma produces extreme reactions to real threats, like an argument, and smaller trials, like peer pressure.

In fact, under the constant threat of violence, inner-city kids tend to bond in extreme ways—hanging onto friendships even if it means putting themselves at risk, a phenomenon that helps explain everything from flash mobs to Allen Iverson’s sketchy entourage to our city’s ludicrous murder rate. “People will ask, ‘Where’s their common sense?’” says Drexel researcher Sandra Bloom. “And that’s a good question. People should ask it. And they should listen to the answer. Because what you and I consider common sense, the ability to plan for the future, to put problems in perspective and respond accordingly—these are some of the functions trauma destroys. And what you get from this is a breakdown of civil society and all its institutions: families, schools, children, everything.”