Addressing Poverty and “Mental Illness”


From Psychiatric Times: “In working with people experiencing poverty, clinicians need to be mindful of the privilege that comes with the role of health care professional. There is a long history of professionals telling people in poverty what they need, without carefully listening to the creative ideas and strengths present in poor communities. Whether in the clinic, at the community-level, or when advocating for policy change, the voices of those directly impacted need to be at the front and center. For psychiatrists, this can mean listening closely in clinical encounters, asking for community input and partnership for any new local programs, and ensuring that all advocacy efforts involve the leadership of people with lived experience, with clinicians as allies.”

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  1. Doesn’t seem at all critical to me. The authors are promoting drugging, assertive community treatment or whatever it is called, etc. It is almost as if they are turning poverty into a symptom, with a screening tool, which incidentally seems to be at least partly about budgeting.

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  2. I am genuinely curious to know how articles are selected for this section, given that every day there must be a lot of articles published about psychiatry and mental health. This article was published in a psychiatric journal edited by Robert Pies and the first paragraph reveals the authors’ belief in mainstream psychiatry “she stopped taking her prescribed psychotropic medications…” There is then a lot of vague stuff about poverty before we get to the well, what can they do about it, having admitted that screening for poverty isn’t much use unless you can do something about it. On an individual level it doesn’t seem to go beyond signposting for housing and benefits help. Finally they call for psychiatrists to come out onto the streets to demonstrate for higher taxes. How many are going to answer that call? One of the authors has actually spoken at some parliamentary committee so perhaps it is not just rhetoric. Okay I like the bit about higher taxes even if it is a bit unrealistic but for me the good bits are outweighed by the vignette and screening tools and biological psychiatry stuff.

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    • Well, it is from Psychiatric Times, so we should expect a fairly mainstream rhetoric. I think the reason this one appears is that it promotes the radical concept that doctors should actually try LISTENING to their “patients” before telling them what to do. If this really happened, if the doctors actually dropped their arrogant attitude and started really hearing those they are purporting to help, a revolution would follow soon afterwards, I think, if only because most of them would realize that they have their heads up their butts.

      I am sure that MIA editors can’t pre-select only such articles as meet some “radical sufficiency” standard, or it would be a very thin read. I don’t think they intend approval of everything they publish – it’s an attempt to keep us all informed of what’s going on in the “MH” world, and in particular, any efforts to diverge from the standard paradigm of what passes for “care,” even if it’s still mostly mainstream. Makes for more interesting discussions, don’t you think?

      — Steve

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  3. at least they’re talking about poverty in health care…especially in the world of mental health, inc., social class is a -huge- issue. In American culture, of course, social class is not discussed as openly or as frequently as in many other societies, so that (to me…) gives the mental health, inc. people more power, because its an issue but no one talks about it, which leads to more obfuscation and such in the mental health realm.

    when I was -poor-, i had -1- shrink discuss resources, social class, etc. with me, and that was in the context of making sure i wasn’t going to flip out. to be fair…at least that shrink brought it up. its worth noting that particular shrink was trained in Europe, so that might have been part of it. Now, I’m no longer living in poverty, etc., so…social class is once again -off the table- , in terms of talking points w/ the shrinks.

    Szasz sharpens my mind and thinking, but I agree that he wasn’t the best human being. Maybe its because I”m a Christian that I don’t find Szasz worth emulating or idolizing? I do, however, find his analysis of psychiatry helpful, as I try to exit Mental Health, Inc. (if possible…).

    I think the drugs can take the edge off distress and madness, for a season, for some people. I don’t think psychiatrists or psychiatry are necessary, though. A family doctor could provide benzodiazepines, low dose neuroleptics, etc., and they’re usually better about monitoring overall health and dealing with low-income people than the shrinks.

    I get the sense that some shrinks do have a sense of human decency, compassion, etc., which kind of makes me wonder…why didn’t they become real doctors?

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