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.