Cupids Health

Heartland: Poverty and Belonging in Rural America


Having spent the past two and a half years writing a book with psychologist Ed Tronick, who developed the still-face paradigm, I’ve been immersed in contemplation of the sources of meaning in our lives. My experience as a pediatrician, as a mother, and as a daughter is added to the mix of insight that comes from Dr. Tronick’s decades of research observing intimate moments between mothers and infants to address basic questions as our introduction asks: “How is our ability to feel a sense of belonging and attachment to other people linked with the way we develop our individual sense of self?”

Just as we were finishing the book, the owner of a local bookstore recommended I read Heartland: A Memoir of Working Hard and Being Broke in the Richest Country on Earth. As the political scene heats up with the approaching new year, I was interested to learn more about economic inequality, an issue central to the upcoming election.

Thus, I was surprised to find that while certainly author Sarah Smarsh gives a compelling analysis of poverty and social class in rural America, the most powerful aspect of the book for me was the insights she gives into the intertwining of poverty and parent-child relationships.

In our book, we offer evidence that moment-to-moment interactions in our earliest relationships shape our core sense of self and our ability to be close with others. Drawing on Dr. Tronick’s buffer-transducer model, we describe poverty as a state that stresses our primary caregiving relationships. We write: “Poverty, for example, is an environmental risk factor. The experience of poverty draws energy from caregivers, making them less available to buffer a child from stress.”

It wasn’t until I read Smarsh’s book that I really understood what we were saying. She writes this striking line early in the book: “The poverty I felt most, then, was a scarcity of the heart, a near constant state of longing for the mother right in front of me yet out of reach”.

So while there is much to say about the lessons from her brilliant book, I am writing this post to highlight the insights she offers into the complex intertwining of poverty and parent-child relationships.

By narrating the book to her imagined unborn child, she addresses the issue of teen pregnancy in a powerful and deeply personal way. She tells the story of three generations of women conceived of teen pregnancies; her grandmother Betty, her mother Jeannie, and herself, beginning with the matriarch her great-grandmother Dorothy, who suffered from schizophrenia. She writes “When I was a little older I’d come to wonder whether my mom and grandma’s vagabond ways amounted to behavioral training from a mentally ill matriarch.”

Smarsh brings us inside her own experience to tackle the interplay of poverty with domestic violence, substance abuse, and mental illness. She takes care to describe the rarity of her own father’s peaceful nature, and her grandfather Arnie, another man unlike most of the men in the book who behave abusively towards the women in their lives. While she balks at the question of how she “got out” and became the first in her family to go to college and move away, I found myself wondering about the significant role played by these two men.

In this review, however, I wish to call attention to her extraordinary capturing of the exquisite pain and longing in the generations of mothers and daughters. She shows a steadfast determination to avoid becoming a teen mother against what feels like an overwhelming pull, writing: “I knew deep in my cells what it felt like to grow inside a girl who couldn’t afford or even love me because of some mix of financial and emotional poverties that I had no choice but to inherit.”

Smarsh communicates empathy for the mothers of these unwanted children, including her own. Of her mother’s childhood and her grandmother’s motherhood she writes:

“Jeannie had a pet monkey, a little stuffed toy. She hung on to that, ya, know, like some babies carry blankets and stuff,” Betty told me, holding back tears. “This was her security, this stuffed monkey. And it got lost. I guess we left it on the train.”

It wasn’t the lost stuffed animal that made Betty cry, of course, but knowing how miserable her daughter’s childhood had been-even her security blanket, of sorts, got lost in the chaos- and interpreting this as her having been a bad mother.”

Smarsh has a remarkable clarity of vision of what the next generation’s experience might have been had she followed the same path:

“The mother I would have been then was doing well on the outside but was in deep pain alone at night. Like it did for my own mother, I think, that pain would have taken over when you cried or tried my patience. I would have slapped you or screamed at you or shut up, or worst of all, beamed that same quiet hatred in your direction that I once felt.”

Smarsh tells us early on that she has named her unborn child “August.” While the name has a number of sources, towards the end of the book she writes, “An august thing is impressive and dignified, and beneath my mother’s pain she saw me and perhaps herself just that way.”

Smarsh addresses the subject of belonging, an experience known to be central to our core sense of emotional wellbeing. When describing the itinerant nature of her childhood and the impact of frequently changing schools she writes: “Belonging is, on a psychological level, a primal need, too. It is often denied to the poor.” Later she raises the issue of belonging in the painful choice she faced in taking a different path from that of her family: “We both knew I was leaving soon, not just from the farm but from the only way of life Grandpa had ever known. It was a separation born of class, that a child might lose a sense of belonging within her own family for going to college.”

I sense from Smarsh, and of course, I do not know for certain, that by holding on to deep love and empathy for a family that was frequently the source of pain, she succeeded in belonging to both worlds. I hope for her sake that she has.

Of her decision to follow a different path she writes: “My life’s work was to be heard, and the poor young mother will have a hard row at that.” I am thankful that her voice has been heard. She has much of importance to say.



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