Healing When You Are Poor
My family has always had an unstable relationship with money and its older cousin, wealth. My maternal grandfather was an intellectual — a career economist with a stellar grasp on the intricacies of the subject on the one hand, a spirited and aggressive social activist on the other. His term as a bureaucrat working in a particularly unsafe space dedicated to agricultural reforms in rural India was not necessarily the most moneymaking of tenures. This was mostly because of his own iron-stomached dedication to an ethical compassion that guided almost all his decision-making. My mother and her 4 siblings grew up with alternating currents of austerity and abundance with the former being more prominent and long-lasting. There was also the interwoven aspect of caste apartheid that often enacted its collusion with hierarchal powers to stall my grandfather’s promotions, keeping the family barely afloat during most of my uncles and aunts’ young adult lives. A generous peppering of hardships drove the children of the house to seeking comfort in education for better future prospects. This is generally the storyline for a lot of lower middle class families in India. However, the strain of financial struggle coupled with socio-cultural variances in how self-worth is measured in our society had evident effects on my mother and her family. My mother’s favourite story from the time she started earning as a teacher/counselor was how she could afford 2 birthday dresses for me when I turned 7. This is a matter of pride and often summoned as a measure of tangible affection in saying that because she could provide beyond her means on these few occasions, her love for me was validated.
When you grow up in an environment where the patterns of deprivation are blatant and continuous, your sense of certainty about your place in the world is inadvertently tied to the gravity of your bank account. I saw my mother deal with bipolar episodes triggered by financial uncertainties that are faced by many single mothers on a wafer-thin school salary. I experienced their repercussions because my presence was the chief reason for her to want an elevated sense of economic security. She still remembers the time when she was finishing up on her dissertation after I was born and as a student living on a meagre stipend, she would have to barter with her only guilty pleasure — twice-a-day-cardamom-tea — just so she’d have enough spare change for diapers. I have never been put in this position myself but I can imagine the slow cratering of self-reliance one must experience when faced with choices as desperate as these. Even though my mother now has a comfortable life, I still see her panic wildly if she can’t remember where she placed a 50 rupee note as if her life depends on it.
When people think of mental health, the brief net of perception is still generally only cast wide enough to sieve conflicts and dissonance that are more singular and personalized in nature as opposed to accounting for the inseparable Gordian knots tied at intersections of class, caste, gender, race, inter-generational trauma, social imagination, financial location among others.
The English psychiatrist, Dr. David Smail, wrote the following in his book “Power, Interest and Psychology: Elements of a Social Materialist Understanding of Distress” —
“There is, I suggest, a strong positive correlation between a) the height of the rung occupied on the ladder of power, b) the strength of a sense of personal virtue, and c) the firmness of the conviction that those lower down could and certainly should act more responsibly.”
Further, in “Fundamentals of an Environmental Approach to Distress”, he expressed this series of algorithmic connections about individual, environment and shifts in the loci of power.
1. A person is the interaction of a body with a world (environment).
2. By ‘environment’ is meant, most importantly, social space-time.
3. The environment is structured by material power.
4. Power may be coercive, economic or ideological. These may be, but are not necessarily, positively correlated. (My note : The positive value is for correlation not the value determinant of individual entities in the triad.)
5. Ideological power is viable only to the extent that it can be rendered material through solidarity.
More and more as I expand my work as a therapist and a community catalyst of sorts, I hold in suspicion the performative nature of prevalent psychotherapeutic modes which fail to calculate the staggering impact of money and power in destabilizing mental health. Yes, we can all agree that there are innate biological and neurochemical markers which can essay pivotal roles in how mental illness/wellness is realised for different individuals. However, very often the distance between cognition (how/what we think) and behaviour (how we act on what we think) is measured in the interactions of environmental variables enabling or disabling our sense of self/selves and the relationships we extend towards others around us. Even the feasibility of being able to access help for mental illness has a deeply lopsided dependence on your financial status. In countries where health insurance is the norm, mental health is a high-rung condition and affording suitable, condition-matched treatment is a grueling task. In places like India, where I live and practice currently, the depth of your pockets determine if you can or can not receive necessary help for your mental health condition and disabilities.
Poverty is as much a factor for continued disturbances in emotional and mental health as any physical or psychological predisposition. In a recent counseling session, a new father mentioned how his inability to afford necessary care for his baby had spiraled his depression. A young engineering student who comes from a family of farmers in rural India has expressed how her anxiety is repeatedly locked in those moments of lack when her hostel roommates want to go to an expensive cafe and she has to refuse. She lives on a tight budget and even the smallest of increases in expenditure can dip her finances. In therapy I can certainly use the necessary tools and techniques for addressing their individual conditions but I can’t ignore the critical power of monetary cachet in how their self-image is developed or abbreviated in these circumstances.
There is a greater likelihood of mental illness being unaddressed in lower income groups in any population. As per research conducted by WHO, people with the lowest Socio-Economic Status (SES) have 8 times more relative risk for schizophrenia than those of the highest SES. It is impossible to debate against the fact that alleviating poverty will, by default, lead to marked improvement in life satisfaction. In a study conducted in 2010, clinical researchers established a clear and categorical linkage between Common Mental Disorders (CMD) and a variety of poverty dimensions in Low or Median Income Countries. The Indian subcontinent has slowly started recognizing the importance of effective mental health care systems even though we have a long way to go before we can truly universalize access and account for the most marginalized and vulnerable populations. Yet, the popular “face” of mental illness is almost always someone urban, educated and conveniently obvious. Our discourse very rarely diverts its attention towards, for example, homeless queer folks or senior citizens(women, in particular) in rural demographics. The reverse is also true — acute mental illness will keep marginalized populations poorer without enough interventions from the mental health community. This case study about correlations between severe mental illness (SMI) and poverty in India states that “public stigma and multidimensional poverty linked to SMI are pervasive and intertwined”. It is an iniquitous tussle where an already oppressed person is further caught between between Scylla of resource deficiency and Charybdis of co-morbid psychological and emotional disabilities. I remember an affluent friend of mine expressing “surprise” about her driver seeking counseling. It was a leery euphemism for but-what-do-they-need-counseling-for? mentality that I have encountered far too frequently in uberpolitan circles which simultaneously champion a ton of social media campaigns hashtagging *mentalhealthmatters*. The dichotomy is a somber reminder for how much further we need to walk in order to equalize the struggles for mental health reform and rights.
At 18 I was forced to step away from school and take up a full-time job in order to escape an abusive step-parent. I worked graveyard shifts for an American mortgage company and the working condition was psychologically cannibalistic; neatly modeled after prison labour like routine. The job was simple on the surface—fielding angry banking customers 9–10 hours straight. You were timed for bathroom breaks and had a half hour to eat a tepid dinner on days where the call traffic was less than lethal. When you got back on the call, someone would racially insult you and demand you “go back to your country” even though you already were! On a few sparse occasions when the capitalist overlords felt generous, they’d offer us burgers for the 6 or sometimes 7 days work weeks (unpaid overtime, of course). On one occasion, I was given some extra burgers and a few packets of fries to take back home as a “reward” for good performance. This is the beginning of internalized oppression and its drastic conditioning — to equate an act of covert oppression with care. Instead of giving me my rightful monetary compensation for extracting more than their pound of flesh, the Powers That Be flung a few pieces of food in my direction and in turn, I felt indebted with gratitutde. This act of pretend benevolence on their part had a psychic hold on me so much so that even though I had worked up the courage of asking for a different shift— the 12 am to 9 am rigmarole was affecting my health very badly and they had flouted internal rules by keeping me on the shift for more than 6 months because I did well on the job — I stayed quiet for another 3 months, slogging my way through severe depression and eating disorders. My weight dropped to 48 kilos. I am 5'8" in height. My bones stretched against my skin like eager relics waiting to knife their way out into the sunlight.That period of my life caused irreversible damage to my mental and physical health.
Money denotes unchallenged privilege to social power in a purely capital driven society. If you add matrices of gender, race, caste and class, the aftereffects are protracted and often interminable. When we look at addressing the challenges that arise due to mental illnesses and disabilities, we have to factor the function and register of financial immunity for those who have an ease of wealth that can enable oppressive structures to segregate who is humanized and who isn’t. This results in further separating those whose mental health matters and whose doesn’t. Of course, money can’t protect us from everything but it does afford the key to certain locks which we can’t manage to pick on our own no matter how hard we try. Economic oppression is coded into inter-generational trauma. As a person of Roma descent, I know that a major contributor to Roma displacement and thereby mental health/developmental gaps is the inability to mobilize resources for education, community-building and even basic safety in living quarters. We can’t solve this just by running CBT worksheets, playing audio for guided meditation and recommending breathing exercises.
I return to Dr Smail and his piercing words where he called for people to direct their struggle towards “other targets than our selves”. This has been my most fruitful revelation/acceptance — unmasking the habit of targeting myself with what I translated as my personal lack. I think our goal now should be to recognize, question, understand and continually disturb implicit as well as overt power structures invested in those socio-economic systems that benefit from keeping us hidden and “unwell” for financial benefits.
Scherezade Siobhan is a psychologist, writer and a community catalyst who founded and runs The Talking Compass — a therapeutic space dedicated to providing mental counseling services and decolonizing mental health care. She is an award-winning author and poet whose work is published or forthocming in Medium, Berfrois, Feministing, SPR, Jubilat, DATABLEED, Nat Brut, Winter Tangerine, Cordite among others. She is the author of “Bone Tongue” (Thought Catalog Books, 2015), “Father, Husband” (Salopress, 2016) and “The Blues Kali” (Forthcoming, Lithic Press). Send her chocolate and puppies — nihilistwaffles@gmail.com
