Medicalizing Poverty

Wayne Munchel
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In his Alternatives Conference 2012 Address, Will Hall called attention to the ongoing phenomena of “medicalizing poverty and calling it mental illness.”  Mental health systems and practitioners often tend to perceive and identify the myriad ways that impoverished people cope and adapt to adverse environments (such as food and housing insecurity) as pathological indicators of mental illness.  A poor child who does not pay attention to the day’s lessons at school may be diagnosed with ADHD, yet focuses intense attention on how he will return home safely, take care of his siblings and get a meal.  A young woman may be labeled as Oppositional/Defiant who bravely copes with an erratic mother and her abusive boyfriend.  Behaviors that can make sense in one context (home, neighborhood), are flagged as dysfunctional and impaired in another (school & work).

This approach of decontextualizing behaviors often results in referrals to mental health clinics.  Poor children’s seemingly impulsive, “emotionally dysregulated”, hyper-activities are seen as symptoms to be targeted with medications and other psychological interventions.  The medical model myopia of focusing on “what’s wrong?” rather than “what’s happening?” is applied all too often.  Schools frequently identify poor children as “Severely Emotionally Disturbed” (SED), at-risk and in need of treatment, but pay scant attention to the social conditions that are causing the disturbances.

Another troubling aspect of this intersection between poverty and public mental health is the dramatic rise in SSI/disability rates.  Robert Whitaker cites this alarming increase in Anatomy; “”Mental illness is now the leading cause of disability in children, with the mentally ill group comprising 50 percent of the total number of children on the SSI rolls in 2007.”  But what is contributing the most to this upsurge; more illness, more exposure to biological psychiatry or more poverty? In 2010, Patricia Wen (Boston Globe) wrote a series of articles about how many impoverished families have turned to SSI as the “new welfare.”  (SSI Program: A Legacy of Unintended Side Effects).  In her articles, Wen describes how several families sought SSI benefits by taking their children to psychiatrists to assess for disabilities.  (ADHD and bipolar were the most common diagnoses.)  One parent was quoted as saying “to get SSI, the child must be on meds.”  It’s a truly disturbing scenario; low income families seeking to establish a reliable income by getting their child diagnosed and “treated” with powerful, brain altering neuroleptics.  Means-tested entitlements would seem far less toxic and present far less risk to poor children than this potential exposure to psychotropics.

In a broader view, pathologizing poverty may conveniently serve purveyors of the American Dream.  The American Dream narrative instructs us that everyone can succeed in the U.S. through hard work and righteous behaviors.  The darker corollary to this ingrained attitude is that anyone who is poor must be sick, deficient or criminal.  When confronted with the uncomfortable facts of income inequality, many Americans can feel assuaged by believing that it is solely poor people’s fault that they are poor.  However well intentioned, the mental health system can serve to confirm this sanctimonious perception.

However, not all mental health programs participate in this insidious form of victim-blaming.  Many recovery-oriented programs and trauma informed services attempt to understand “what’s happened” to help seekers and recognize their adaptive coping and resilience in the face of many hardships. These strength-based programs concentrate on trying to connect their members to jobs, housing and social capital, and to support creating their story – rather than a diagnosis.  The more trauma-informed, mental health programs can incorporate principles of social justice and community development – the more they can truly help stressed-out, poor people.

 

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Wayne Munchel
Trauma-informed Care Meets Pharma-informed Care: Social worker Wayne Munchel will focus on the intersection between trauma informed care/recovery models and biological psychiatry. Early intervention programs for psychosis will also be discussed.

20 COMMENTS

  1. This article brought tears to my eyes. I believe that the issue of class is one of the least discussed, most culturally taboo issues today. At the same time, I believe that the issue of class, and attitudes towards poverty are one primary factor in the corruption and abuses of the mental health system today.

    I wrote in a past article that I imagined the experience of a rich, white, heterosexual man experiencing emotional distress would be vastly different than the experiences of a poor, black, bisexual woman. The former, I argued would be likely to have access to the best supports and the most designer programs, along with the power to pick and choose what he wanted to participate in, fire people he did not believe were serving him well, and remain hospital-free no matter how “eccentric” his behaviors became. The latter, I argued would most likely be picked up by police and brought to the hospital emergency room, given a diagnostic label of “mental illness” after 30 minutes of assessment, possibly involuntarily hospitalized, possibly forcibly drugged, and so on.

    Attitudes towards poor people that we also label as “mentally ill” are heavily focused on “stability.” How do “we” keep “them” stable, meaning out of expensive hospitals and emergency rooms, out of doctors offices and not inconveniencing or irritating the rest of us non-poor people. In contrast, if a person is rich and powerful, the questions of professionals become “how do I work for YOU and what you want for yourself?”

    Thank you for drawing further attention to these issues. I believe we need much, much, much more conversation about the issue of class in its intersection with the mental health system in the United States.

    • “Qu’ils mangent de la Prozac.” Couldn’t let that pass…perfect.

      Yes great post Wayne. In a hospital setting a substantial amount of people come in who are homeless and are hoping for a social work referral to better housing. But they get a prescription for psych drugs instead…that many stop taking once they are out the door within a few days.

      Let them eat Prozac indeed.

      • Jonathan: My experience is 15 years with at-risk youth. As an instructor I am supposed to treat sleeping in class as a disciplinary issue. Some students are bouncing back and forth on ADHD medicine, and who knows what other types of psychotropics, so I have mostly resisted following this directive. Teachers are threatened in staff meetings for not following this directive. Neither the Human Resources, the AFT, nor the Department of Labor can provide me a policy on psychotropics. It’s like they dropped down out of the sky. Everyone goes along, without integrating the rational for their existence..

        • chrisreed,

          As a person who has sleep apnea, I find that policy horrifying. And I have read that about 30% of kids diagnosed with ADHD turn out to have the condition.

          Is there anyway to educate the powers to be that students following asleep in class might need to be evaluated to find out why this is occurring?

          • AA: it is my duty this week to right a letter to the union signally my displeasure with this particular situation as well as the various other problems I have encountered. I have since found other employment, but I feel that it is my duty to follow up on this. It is good to know that this policy strikes other people as wrong-headed.

          • chrisreed,

            I decided to reply above you because the only other option was to go to the bottom. I sure wish this site would add more “reply” buttons. But meanwhile-

            I am glad you found another job but still intend to protest about this situation. Punishing kids for falling asleep would be like punishing someone for having a diabetic coma or epilepsy.

  2. Where are these strenght based programs? I would love to find a community of mutual support where I could find access to jobs, housing and social capital…I just read about and saw the short video mentioned in the forum section about the formation of the Mental Patients Association in Vancouver, BC back in the ’70s…

    It doesn’t seem possible nowdays; money is so scarce for social programs…people are so atomized and hurried trying to keep the rent paid and food on the table…I would love to have a center like the one mentioned available to me. I would love to have a space to do creative projects and JUST HANG OUT. But this seems like idealistic dreams of a past time…how can anything like this be possible now?

    Thanks for calling ’em as you see ’em…Will Hall is one of my favorites.

    If I had money when I went thru my personal trauma, I would not be in the position I am now. Fact.

  3. As someone who lived all of my adolescence dirt poor but managed to dodge the system, everything you said is correct.

    The powers-that-be choose to focus on the individual in order to deny the societal problems that were supposed to all magically disappear with the War on Poverty or the trickle down of wealth.

    Btw, I didn’t know “decontextualizing” was a word, but that is what is happening, and I think I will use this word from now on.

  4. I hope one day the “mentally ill will realize the system that is keeping them down, perpetuating and reinforcing illness and stigma. What we really need is strength. We need to realize that trauma is the source of our differences. Our dissociation from ourself and our suppressed memories keep us afraid. Society keeps us afraid and ashamed of our trauma, of our anxiety. This fear of being different can escalate symptoms of mental illness. “Mental illness”

    It is designed to oppress us, take away out power, our voice. There is a cure. It is realizing there are suppressed memories. We have hidden these memories to protect ourselves, but once we realize how past traumas have influenced “symptoms” we can become whole.
    My mission is to find the cure to the Illness that does not exist.

    -Tru Harlow

    http://Www.curementalillness.wordpress.com