By Sarah Beck
What does mental health have to do with poverty, and why does it disproportionately affect minority groups?
I remember the day my friend, a grad student working to help revitalize the educational programming at an underfunded school in a poor neighborhood, told me that the young school kids he taught had already written off any disposition for success. The students had never felt prosperity or experienced the effects of it firsthand, so it was beyond their imagined realm of accessibility. Before reaching the age of ten, many had already exhibited “bad” behaviors of inattentiveness, bullying, and crudeness. They’d also resigned themselves and voiced acceptance that their futures involved low-paying jobs, alcoholism, and unstable housing. My heart sank.
I’d like to imagine that as the strong-willed and tenacious person I am, even in the worst possible circumstances, I’d never end up impoverished. But how true is that?
Members of our society with lower economic status are externally affected in numerous physical ways, most plainly financially. Other physical examples include a meager quality of education because of lack of funding, increased exposure to environmental toxins (including air pollutants and lead due to gentrification), decreased accessibility to fresh healthy foods, and an oversaturation of unhealthy resources, such as fast food and alcohol (Shack 2016).
When we start analyzing the physical limitations that finances have on other resources, it starts to add up and can have serious health effects over time.
This is important, not only for daily quality of life, but also because a lack of resources reduces an individual’s capacity to perform labor in a capitalist society. As access to physical resources suppresses, so do opportunities to thrive and contribute.
More insidious, and less often discussed, are the internal physical effects that result from lower socioeconomic status. The stress and natural bodily response to adverse living circumstances have literal physical effects on the body, some that will be permanently carried for the entirety of a person’s lifespan and potentially passed down to future generations through trauma and other illnesses.
I’d like to raise awareness of mental health for three primary reasons:
Our physical and social environments staunchly influence our mental health and are critical to our overall well-being.
Intense and long-term stressors can both result in mental and physical impairments.
Prioritizing mental health drastically improves overall quality of life.
What is mental health?
Mental health is the holistic status of someone’s emotional, psychological, and social well-being. It has both subtle and overt effects on our thoughts and behaviors, influencing our ability to function in day-to-day activities and to connect with ourselves and others.
How is mental health impacted?
Mental health is strongly influenced by our physical and social environments. It is impacted differently in various stages of our lives, most prominently while our brain is developing in childhood.
Our body is hardwired for survival through whatever means necessary. In healthy environments, this generally results in molding to social norms. In unhealthy environments, the brain develops coping mechanisms for the sake of survival.
Let’s look at stress hormones as an example. When the body experiences stress, there is “activation of the hypothalamic-pituitary-adrenal (HPA) axis, culminating in the production of glucocorticoids.” These glucocorticoids “can easily access the brain, where they bind to receptors and influence the brain and behaviour” (Lupien, McEwen, Gunnar, & Heim 2009).
In an adult with a healthy brain, most stressors are tolerable and can be managed, especially once the stressor is removed. As an example, imagine you are rushing in the morning and later realize you forgot your lunch at home. You have a brief moment of panic before you rearrange your schedule and make plans to pick something up. Problem solved.
In the developing brain of children, however, “early-life stress permanently blunts the ability of the brain to rein in glucocorticoid secretion,” thus exposing the brain to excess glucocorticoids and eventually “adversely [affecting] cognition, impulse control, empathy, and so on.” (Sapolsky 2017) This could be like a child that consistently does not have lunch provided for them and begins to stress. The child doesn’t have the means to acquire lunch elsewhere or it comes at the expense of additional stresses such as shame when informing a teacher, being bullied by privileged peers, confusion at the need for a counselor, retaliation from the parent, etc.
Context is extremely important to understanding the effects of stress. Specifically, the quantity, length of exposure, and whether the person has the means to manage and address the situation are key differentiators to the severity of the effects and whether they will be long-term. As an example of such effects, “childhood adversity impairs learning and memory. Crucially, it also impairs maturation and function of the frontal cortex.” (Sapolsky 2017)
A child in poverty has no real means to ease the stressors that come with lack of access to basic needs. A child’s brain needs exploration and stimulation, not the stress of wondering where their next meal will come from, where they will sleep, how to escape physical and emotional abuse from their stressed parents, etc.
What makes mental health decline?
Movies often portray a car accident, brutal betrayal, or death of a loved one as triggers for mental health decline. These are absolutely valid in addition to a whole breadth of other experiences that can lead to trauma or poor mental health; and they are all dependent on context.
Whether we have the tools and opportunities to react to circumstances profoundly impacts the severity of its effects. Because of this, poor Americans are set up for failure. The odds stack strongly against them because of inhibited resources and support. Lack of nutrition, lack of accessibility to quality housing, poor education, deprived access to physical and mental healthcare, undervalued jobs and labor, over policing, and biased governmental policies compound to create this almost insurmountable barrier that generates trauma.
Unresolved trauma has physical and mental expressions in the body. We witness the outward effects as unhealthy coping mechanisms that parents unintentionally pass down to their children. Their mental health suffers and so does that of the generations after them.
Children that are born into and develop in unhealthy circumstances can be permanently stunted. Adults that are subject to continuous stressors, such as affording their basic necessities, can have their mental capacities altered.
It’s a cruel, inhumane cycle of physical and mental needs going unmet.
I thought adversity was good? “What doesn’t kill you makes you stronger, right?”
To an extent, yes, but there is a tolerance. In the United States, this tolerance is often exceeded in extreme ways amongst the lower and working-classes.
Tolerance is context specific and varies person to person, though generally refers to the ability to take an action to resolve an issue without being overextended. Trauma originates when a person has no guaranteed means to move forward or feels stuck.
The science behind childhood adversity is disheartening. There is a strong connection between childhood poverty and maturation of the frontal cortex (responsible for memory, emotions, impulse control, problem solving, social interaction, and motor function) and the hippocampus (which plays a major role in learning and memory).
Children even as young as five begin to show declined mental capacities as a result of lower socioeconomic status. They found more reactive glucocorticoid stress responses, thinner frontal cortexes, and “poorer frontal function concerning working memory, emotion regulation, impulse control, and executive decision making” (Sapolsky 2017). This means it takes more mental effort for children raised in adversity to achieve equivalent frontal regulation than for children raised in healthy environments.
Additionally, childhood adversity results in a larger and hyperreactive amygdala, increasing the risk for future anxiety disorders. Childhood adversity damages the body’s dopamine system and increases the risk for depression later in life. Given all this information, “little in childhood determines an adult behavior,” but “virtually everything in childhood changes propensities toward some adult behavior (Sapolsky 2017). Meaning that economic success is not completely unattainable but likely much more difficult.
Why is mental health important?
Mental health is potentially the strongest determining factor in general quality of life. Mental well-being is also necessary for performing some of the most basic tasks, including meeting our own dietary and hygienic needs. Mental illness increases the risk for various health problems, including heart disease (notably the leading cause of death in the US) and diabetes (the seventh leading cause of death in the US) (FastStats 2021).
It's a cruel cycle that self-perpetuates. A person’s needs go unmet; their health declines; then the disparity between their unmet needs increases, and so on.
It's also important because it is widely misunderstood and mischaracterized. Mental health is a basic need, not a luxury, as often glamorized by influencers and public speakers.
“Bad behaviors” are usually just unhealthy coping mechanisms. Our criminal justice system penalizes people for not having the resources they need by further withholding access. Many criminal behaviors are the result of someone whose needs went unmet for too long. They need rehabilitation and care, not punishment.
Our current societal and criminal justice systems perpetuate a cruel system where it often takes an anomaly to escape.
What is the status of mental health in America?
Although mental health is a global issue, in 2016, the US ranked third for the most depressed and anxious country in the world and second for use of alcohol and drugs according to the WHO. Every year, one in five adults experience mental illness, but only 41 percent of those receive care (McPhillips 2016).
Even an appointment with a therapist can require hefty copays for $100 or more for a single session. Therapy treatment takes months, years, or even the remainder of a lifetime.
Seeking more thorough treatments than basic talk therapy (which alone has not proven effective for treating trauma in many instances) quickly becomes less accessible, even with insurance.
Mental health education is widely unavailable and is not taught in public school. People within the lower class who are struggling are often written off as lazy, stupid, or crazy and never receive the care they so desperately need.
Why are there disparities?
Access is one of the biggest reasons for the disparities. Working and lower-class persons financially cannot afford therapy treatments, but by some circumstance (such as insurance) even if they could, many times their schedules will not allow it (no flex-time). Or they don’t have transportation or technology to get themselves the care. Sometimes they don’t even know that treatments exist or believe that it will actually help.
Additionally, there is no single textbook answer to resolve mental health concerns because they are so complex. Our current research studies predominantly include white, male participants, which is a bias in information that can lead to patients being mistreated or dismissed (Konkel 2016). There is a huge need for understanding and mental health is not getting the attention it deserves.
What can we do about it?
Get uncomfortable and educate yourself about it. Work on your own healing and understanding. Here is some recommended reading:
Behave: The Biology of Humans at Our Best and Worst by Robert M. Sapolsky https://bookshop.org/books/behave-the-biology-of-humans-at-our-best-and-worst/9780143110910
The Body Keeps Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk, M.D. https://bookshop.org/books/the-body-keeps-the-score-brain-mind-and-body-in-the-healing-of-trauma/9780143127741
It Didn’t Start with You: How Inherited Family Trauma Shapes Who We Are and How to End the Cycle by Mark Wolynn https://bookshop.org/books/it-didn-t-start-with-you-how-inherited-family-trauma-shapes-who-we-are-and-how-to-end-the-cycle/9781101980385
The New Jim Crow: Mass Incarceration in the Age of Colorblindness by Michelle Alexander https://bookshop.org/books/the-new-jim-crow-mass-incarceration-in-the-age-of-colorblindness-anniversary/9781620971932
Women, Race, & Class by Angela Davis https://bookshop.org/books/women-race-class/9780394713519
We Need to Talk: How to Have Conversations that Matter by Celeste Headlee https://bookshop.org/books/we-need-to-talk-how-to-have-conversations-that-matter/9780062669018
Check your bias. If you are reading this as a non-minority, do not let the fear of being a “bad person” prevent you from learning of your own unhealthy behaviors and taking action to change.
Seek treatment (yes, you). Participating in therapy does not mean you are broken and there are more options than simply talk therapy if that doesn’t feel right for you! Public education does not teach us how our brains work, so it is important to invest in that level of understanding on your own time.
Connect with a community. Change, inherent to our own physiology as social creatures, requires that we fully engage in a community.
Bring mental health up in conversation and break the taboo.
Vote for programs that increase access to healthcare for all. Prioritize rehabilitation over incarceration.
Vocalize support for equity programs.
Summary
I think back to those kids already resigned to a lifetime of poverty and abuse. No person deserves that. The cycle will not end without acknowledgement and resources. Mental health is essential, just like the health of every other bodily system. Our brain and bodies are interconnected and it is impossible to fully serve one while neglecting the other.
A lot of the issues within our society would naturally begin to resolve if resources were more accessible to everyone. The best way to universally improve mental health is with convenient, judgment-free access to essential resources, such as quality food, affordable shelter, clean water, social connection, and unbiased mental and physical healthcare services.
The views expressed in this guest article do not necessarily reflect the views of the staff of The Civility Initiative. The purpose of guest articles is to to help our readers more fully understand and see current issues from as many different vantage points as possible.
References
FastStats - leading causes of death. (2021, March 01). Retrieved April 19, 2021, from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
Konkel, L. (2015, December). Racial and Ethnic Disparities in Research Studies: The Challenge of Creating More Diverse Cohorts. Environmental health perspectives. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670264/.
Lupien, S. J., McEwen, B. S., Gunnar, M. R., & Heim, C. (2009, April 29). Effects of stress throughout the lifespan on the brain, behaviour and cognition. Retrieved April 11, 2021, from https://www.nature.com/articles/nrn2639#citeas
McPhillips, D. (2016, September 14). U.S. among most depressed countries in the world. Retrieved April 19, 2021, from https://www.usnews.com/news/best-countries/articles/2016-09-14/the-10-most-depressed-countries
Sapolsky, R. M. (2017). Behave: The Biology of Humans at Our Best and Worst. New York, NY: Penguin Books.
Shack, E. (2016, October 07). Low-income neighborhoods home to higher number of liquor stores. Retrieved April 19, 2021, from https://cnsmaryland.org/2003/04/18/low-income-neighborhoods-home-to-higher-number-of-liquor-stores/