Commentary: Assessing Impact of Poverty on Mental Health

By Cohen, Ruth | Clinical Psychiatry News, February 2013 | Go to article overview
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Commentary: Assessing Impact of Poverty on Mental Health

Cohen, Ruth, Clinical Psychiatry News

The greatest of evils and the worst of crimes is poverty.

-- George Bernard Shaw, 1856-1950

"I don't care" was the response 1 from Gerardo when I asked, "Of the people you know, is there anyone who loves you?"

Gerardo was a 17-year-old high school senior who had grown up in poverty. He was planning to attend Stony Brook University on scholarship. Gerardo had been referred for psychiatric evaluation because he slapped his mother, slammed a refrigerator door against her back, and cursed at her.

He was eager to leave his family, including his Ecuadoran mother, who sold burritos from a street stand; his 19-year-old sister, Lola, who lived primarily with her 21-year-old boyfriend; and his 9-year-old half-sister, the daughter of the man who beat him repeatedly.

His biological father, an alcoholic and drug addict, had left when he was 3; his stepfather, Manuel, subsequently became violent toward him, and his mother at times held him down during beatings.

After Manuel left the home, his mother took another man into the house. Fred, a cook in a Chinese restaurant, helped with rent and kept to his room.

Gerardo blamed his mother. "She was never around" and was out selling food. His mother overlooked Manuel's molestation of Gerardo 's older sister Lola and enabled her son's abuse. Why? It was only when Lola took an overdose that New York City's Administration for Children's Services learned of the distressed family and intervened.

Gerardo talked about his commitment to school as an entree into a good position. Still, he was cynical. In a provocative manner, he called school, "boring." He added, "The other option is to find a minimum wage job." With anger, he said, "I am preparing to live in corporate America." His disdain encompassed personal, academic, and family areas.

Is the diagnosis of Gerardo depression or a nascent personality disorder? Does he have posttraumatic stress disorder? One thing was clear: Gerardo, an intelligent adolescent, was emerging from childhood scarred by his experience.

The toll of poverty

Poverty is common in the United States. Peter Edelman in his book "So Rich, So Poor: Why It's So Hard to End Poverty in America" (New York: The New Press, 2012) details that 46 million Americans live in poverty, defined as earning no more than $23,050 yearly for a family of four. Food stamps and housing assistance programs are helpful, but with cutbacks in welfare, there are 6 million people living solely on food stamps.

Edelman, a professor at Georgetown University Law Center, Washington, says that good-paying jobs have gone overseas; the number of single-parent households is on the rise; and the wealthiest have created disadvantages for the poor, resulting in economic crises such as the housing bubble. At present, children rather than the elderly are more likely in poverty. More than 40% of families headed by single mothers are poor.

We view poverty as an economic dilemma, but its psychological consequences are profound. Do poor people develop mental illness or does mental illness cause a slide into poverty? Much controversy exists on this question, but both probably are true. Poverty has far-reaching consequences and creates vulnerabilities. It negatively affects mental health.

Many of the social ills associated with poverty confound with mental illness. Poverty is depressing.

A 63-year-old Hispanic patient described her struggle. Glenda suffers from rheumatoid arthritis, depression, diabetes, and osteoporosis. From supplemental security income, she receives $716 a month. She receives food stamps amounting to $200 monthly. Were it not for her daughter, a school crossing guard, sharing the apartment, Glenda could not afford the rent of $604 a month. "Even clothes, buying a pair of jeans for $35, would stop me from getting things for the house," she said. "I'm angry; it gets me irritated.

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