Social Determinants of Health and the Continued Individualization of Suffering

Kevin Gallagher
20
1716

There’s always a new fad in healthcare—especially in mental health care. Sometimes it’s a new nomenclature or a new technique, somewhat different than the thing it’s replacing, yet never too far from the norm. For example, “intellectual disabilities” replaced “mental retardation” after the latter term became twisted into a slur. We’ve also seen the creation of Trauma-Focused CBT, as well as other core therapy techniques becoming “trauma-informed.” These always help to initially alleviate an additional layer of suffering occurring within members of our society. Yet, many terms eventually become overtaken when faced with our victim-blaming society.

This is currently happening with one of the newer idioms: “Social determinants of health” (SDoH). The term is intended to help healthcare providers and administrators understand that certain health-traits are connected to social and environmental factors outside of an individual’s control. In care management circles, it’s becoming both an administrative requirement and institutional best practice to review and screen for negative SDoH when meeting with a person.

Currently, I am a project manager for a Clinical Quality Team for a Medicaid MCO (Managed Care Organization). One day, while discussing the creation of a Clinical Quality program, I heard the following statement:

“We need to screen our members [of the Medicaid MCO] to see if they have SDoH. Social determinants of health.”

Something clicked. I realized that this term had already taken its negative turn. You see, the idea of discussing SDoH was to describe how everyone’s health is somewhat determined by the environment we are living within. We are all “at the mercy” of SDoH regardless of whether we are suffering from poor health, or not. SDoH can determine both helpful and harmful health traits. Someone raised in cleaner air will have less chance of developing asthma than a child raised in Clairton, PA, next to US Steel’s coke works plant.

But we’ve already turned discussing someone’s SDoH into a stigmatizing situation. Someone who is healthy isn’t concerned about their SDoH, or even aware of how SDoH has benefited their existence. In our culture, they are in charge of their health and living their best life. The person suffering from a condition caused by their environment are victims of SDoH, and become the only members in our society who carry the burden of needing their SDoH “addressed.”

When we start considering mental health and substance use, we can see a familiar pattern emerging.  The person who was a victim of a traumatic and unstable environment may develop mental health and substance use concerns. They start to carry the mark of society’s ills as an embodied and individualized display of social breakdown that we can “cure,” without ever having to change society. By “fixing” the individual (which happens many times without the individuals’ consent) we don’t have to concern ourselves with the inequitable structures that determine the positive health traits within some members of our society, while leaving others suffering.

We have taken the social and made it individual.

This piece is currently being written during day 14 of the writer’s COVID-19 quarantine. For decades, public health officials have worried about a pandemic within the U.S., as our social infrastructure, those things are were supposed to limit inequities around SDoH, were removed, privatized, and individualized. “Why should I pay for their healthcare?!” has been the battle cry of the libertarian army. Well, now we all (almost) see why.

However, many communities, mental health practitioners, public health pioneers, and so many others already know we’ve been dealing with a pandemic. Experiential conditions such as depression, anxiety, suicidality, trauma-based suffering, addiction, and other non-physiological dis-eases have been spreading through our communities for decades. The truth has always been that physiological changes connected to mental suffering are symptoms and not causes, yet they have been reduced to bio-etiological maladies curable by medication. We have ignored the fact that socially determined disparities have been at the root of this suffering and the suffering has grown as social safety nets have disappeared.

We need to stop believing that suffering people are genetically inferior or “diseased.” You, as sufferer, are not alone in having social determinants of health. They are universal. They are systemic. And they are not solvable or “addressable” at the individual level. The only way to alleviate negative social determinants of health is to create a more equitable, inclusive, and just society.

20 COMMENTS

  1. Well done Kevin.
    Enjoyed this blog.
    We know the issue, how we as humans create systems where it is rarely about helping us move
    forwards. It has always been about casting aside, othering, always been a matter of might, and abuses, misuses of power. But surprisingly, the powers never win, even though it has been tried since the dawn of time, and it always bites them in the azz in one form or another.
    This obsession, and focus on “mental illness”, is already biting all of us. It does not even have benefits for the powers. All the “studies”, and “research”, “programs” end up being money wasted.
    Politicians see it, the medical people hide behind it, no one wants to be found out. No one wants to have their pretenses exposed.

    Honestly no clue where it’s going, but it’s a shame that we still cause even one individual to pay the price.
    We have a system in place where I employ a charlatan by letting him dirty my name, my character.
    I pay him, to do so. He takes my money and takes my humanity.
    And this comes in all forms, but especially the exploit called Psychiatry.
    And not only does he mock me, he mocks society.
    It is NOT new. We just have not changed.

    A thin veil between security and chaos.

  2. Author writes taken social and made it individual. This seems to thus say taken the individual and made it political.

    Give I the account that I worked Illinois dept mental health nine years because my commentary is unique.

    These policies emphasize giving care to those need it most. Whether helpful or isn’t I don’t judge. Often it is and sometimes even the policies abuse peoples. I noticed now the correlation with incarcerations and also the high revenue in alcohol substance use field opposed to mental health. Pesky the authors this website writing about mental health and profits when alcohol and substance use brings in a lot business income.

    I don’t judge because I left public work and went to Florida. Then moved to new city doing direct care part time and a another job part time.

    I don’t judge. I discuss these issues and about all topics with the Faith I choose to be.

  3. Suffering is part of life, not a pathological manifestation (in most cases). Suffering is what shapes our personalities, makes us more empathetic, have a broader view, being adapted to more diverse types of situations etc. In fact, in some spiritual cultures, like Christian ascetic one, suffering is seen as the purpose of present existence, as a “temporary evil” necessary for attaining a superior understanding on things useful in a next existence.

    On other hand, intervening in others lives against their consent on the ground of a supposed lack of discernment, is a violation of individual liberties. I can see it only as an expression of the insanity that rules in society and which sees individuals in a simplifiying way, missing the complex nature of rational beings.

    • I agree Andrei.
      Besides, if people experience distress, there are a multitude of help, other than psychiatry and one of the biggest “help” is time. During that process, people can learn that they did not need “help” in the sense of getting rid of something.
      Psychiatry would have fared much better if they had stopped the pathologizing long ago. Now they are in such a fix, trying to justify this huge industry.

  4. “We have taken the social and made it individual.” Yes. All my “mental health” workers believed that distress caused by 9/11/2001 was distress caused by a “chemical imbalance in my brain” alone. Can you say political abuse of psychiatry? And the “mental health” workers are insane?

    “The truth has always been that physiological changes connected to mental suffering are symptoms and not causes, yet they have been reduced to bio-etiological maladies curable by medication.” Isn’t that a dumber than dirt idea? An FYI, the psych drugs are neurotoxins, not “medication,” and none of the DSM disorders have medically proven “bio-etiological” causes. But your two “most serious” DSM disorders do have medically provable iatrogenic etiologies.

    “We have ignored the fact that socially determined disparities have been at the root of this suffering and the suffering has grown as social safety nets have disappeared.” Yes, the “mental health” workers, and their insane, scientifically ‘invalid,’ ‘blame the victim’ belief system, have systemically been destroying America from within for decades.

    “You, as sufferer, are not alone in having social determinants of health. They are universal. They are systemic. And they are not solvable or ‘addressable’ at the individual level.”

    Wow, it only took you two decades to start to garner some insight into reality. But is it wise to have those who it took two decades to start to garner some insight into reality in charge? I’m quite certain it is not.

    And I’m quite certain those of you who took “the social and made it individual,” and have systemically been slandering and neurotoxic poisoning the younger generations for decades should repent, and change your insane and evil ways. Not to mention utilize your malpractice insurance for what it is intended.

    “The only way to alleviate negative social determinants of health is to create a more equitable, inclusive, and just society.” That, of course, would require the “mental health” workers to stop stigmatizing, neurotoxic poisoning people, repent, and make proper amends to those you’ve been systemically harming for decades.

    Our society would also need real systemic change in all the so called “professional” fields as well. Since all the so called “professionals” have been systemically destroying America from within, with your greed, for decades.

    • “The only way to alleviate negative social determinants of health is to create a more equitable, inclusive, and just society.”

      “That, of course, would require the “mental health” workers to stop stigmatizing, neurotoxic poisoning people, repent, and make proper amends to those you’ve been systemically harming for decades.”(S.E.)

      Very true, SomeoneElse.
      It really boils down to jobs for many. To practice their underlying natures in a legal manner.
      It would be a lot less stressful for them too if they quit their lying garbage and found a job to take pride in. One that strives to see people succeed. They themselves could finally be released from their self imposed prisons.
      But in psych, they rely on a premise that people are hopeless or should achieve their measure of what “better” means.
      Though no one ever does get good enough. Imagine reducing their equals, their clients, to degrading positions and holding lordship over them. Disgusting.
      There is no good enough, not that I would EVER want to qualify as normal to a shrink, that is outright frightening and a HUGE insult to me.

  5. Thank you so much for this article. I work in public health, and it is MADDENING (in the metaphorical sense) to see SDOH individualized in this way. It results in “educational” programs that only provide support on an individual level and, as you said, implicitly blame the suffering person for their situation.

    There is so much blame in the way health professionals call people “high-risk”, “high-needs”, “medically complex” and other terms that serve as euphemisms for “undesirables.” Public health professionals need to STOP their hyperfocus on individual risk factors and broaden their approach to address community-level root causes of suffering and preventable illness.

    I read this article recently and I think the points made complement this article nicely: https://medium.com/@HumanImpact_HIP/when-upstream-public-health-efforts-fall-short-3297dca3c47

    • I know a lot of people that think psychiatry goes to far, yet think that psychiatry simply needs to change a few things.
      That is exactly how psychiatry keeps itself alive.
      Stopping “hyperfocus” will not happen, but perhaps research papers will talk about it. Perhaps even the odd shrink will chat about tweaking psychiatry.

      Psychiatry can tweak nor change. They can only change their approach of propaganda

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