Socioeconomic Status and the Crisis of Mental Health
How the Health Care System Makes Us Sick
In today’s world, if you’re not mentally ill… there’s something wrong with you.
The Public-Private Nexus of the Mental Health Crisis
The mental health care system gave me depression, among many other things. I don’t just mean they gave me a diagnosis; I mean they infected me with the illness through their professional gaze, and made me even more depressed and mentally ill. Doctors made me sick(er). Let that sink in. There is a term for when a doctor or medical (mal-)practice causes illness: iatrogenic. It happens to lots of people. And most likely the first thing you need is the last they’ll give you: money to survive when you can’t work, or can’t get work.
In my case, I had developed a series of mental and psychosomatic afflictions due to poor “socioeconomic status” (“SES” in some literature), and then the health care system simply made it worse. After grad school I wasn’t even eligible for EI for technicality reasons (you have to have lost a job, not just not have one), and was unemployed for an entire year without any kind of support. When I finally started working I was able to seek help, but then things only got more difficult for a few years. All the while the system made sure that those apparently servicing me patted themselves on the back and collected their pay cheques too. How depressing. (And this is in Canada mind you; it’s much worse in the US.)
This is a common refrain. I know many people with similar stories of trauma and frustration at the poor quality of mental health care, not to mention the poor definition of it. Seeking concrete help for something as abstract as mental health care is a wild goose chase, even though you’re encouraged to “get help” by friends, family, professionals, and the marketing of such services. The endless referrals/deferrals, the medicalization of behavior, the pharmaceutical lobby, the poor policies, the red tape, the shadow work (unpaid labour of the patient, such as redundant forms, pointless appointments), the dystopian waiting rooms, the fear of not being helped, etc... It’s enough to make a person go crazy. None of it helped me get better; it made me worse, until I broke down and couldn’t even work. All in all it took me about 5 years to even begin to receive appropriate financial support for my needs.
It’s enough to make a person go crazy. None of it helped me get better; it made me worse.
But the fault and responsibility isn’t completely on doctors and the heath care establishment alone. They do a lot of great work, and are absolutely needed. In fact, it wouldn’t hurt to simply add more jobs for doctors and health care workers. They are always understaffed anyway. So why don’t they expand? Because its part of the systemic-conspiracy, like everything these days. The insurance lobby wants to keep healthcare privatized, and the pharmaceutical lobby wants to keep people medicalized, so changing the system becomes part of a wider meta-problem of tweaking a status-quo that is broken. The problem is systemic, and the meta-problem is denial and ignorance about these fixable problems.
All aspects of healthcare are underfunded, laws and economic policies require fundamental reforms, and money is wasted on war. The government and private industry invest more in the medical system than they do in people in the first place, so it becomes a less and less efficient system. Doctors and admin are just doing their job, but in cases like mine, if they aren’t also trying to help you change the system, they’re falling short of their Hippocratic oath of “do no harm.” They would be wise to follow some principles of ‘metamodern counselling’ that do just that; help you and them change the systems that are doing harm.
So, if you have mental health issues, you may be better off staying home getting your advice from webmd.com, meditating, or watching countless hours of Jordan Peterson’s self-help videos or bible lectures… so long as you don’t buy into his paranoid ravings about leftists and other things. Each person’s problems are unique, but if your issues are rooted in poverty, you may well be getting your time wasted seeking medical or psychiatric care, unless it is leading to financial support. Sometimes the right prescription is just money, or psychedelics, or a supportive community, and the system is set up to block access to those things if you find yourself poor and/or unemployed and suffering from SES mental health issues.
There are exceptions, as many people do find that getting professional ‘help’ works; I suppose each person has to take on the burden of finding out for themself if it was worth it or not, but they shouldn’t have to. Everyone deserves not only proper health care, but basic income. For me, it’s hard to say if it was worth it, or know where other paths may have led. Eventually, I did get lucky enough to avoid ending up on the street, but I didn’t feel like I had much of a choice, in that I became extremely unwell. I could not work any more, and after walking off the job it took a year until support stabilized. In that year, things got harder before they got better. I now have severe limitations and abilities — seemingly permanent — in some regards. With the therapy I receive and practice, I’m able to get some thinking and writing done, which is not considered as remunerable work by any capitalist standard. So I write this unpaid and do the occassional research contract to supplement my income.
Regardless of exceptions, the general critique of the health care system is true. The system is deeply flawed in obvious ways that need to be fixed. The disability income supplement should have already been there in the form of Universal Basic Income, for it literally would have saved the health care system all the expenses incurred on tax payers to waste my time, and it would have saved me. Furthermore, were the economy to provide more jobs for sociological entrepreneurs (which are sorely needed) in the first place, I probably wouldn’t have become sick. Thus, most attempts at seeking help only deepened my crisis because I couldn’t work my way out of my hole, no matter how hard I tried. Also, the health insurance provider Sun Life Financial was negligent in their obligations and exploited my situation to deny me benefits for two years. Pretty shallow for a company that profitted CA$ 2.581 billion in 2016.
Maybe I’m just different. Maybe I’m not like other people that can just have a chat with a doctor, or pop some pills, and let their neuroses fade away; it’s more complex. Or maybe many people actually suffer like me, are impoverished and oppressed by a hyper-competitive artificial-scarcity-based economy, just coping, being coached and drugged to better adapt to a depraved [Brave New] World rather than to fix it, not really beginning to heal until the basic support is there. I prefer to act in solidarity with the global precariat class toiling to produce the world’s wealth, only to have the lion’s share expropriated by corporations. Economic justice will come for the dispossessed of the world.
But I also believe my problems were/are deeper than could be patched with some cognitive-behavioural-therapy or medication alone, because my problems were society’s problems. I internalized the injustice of the world and it became my mental illness in very complex and nuanced ways. Just after graduate school in 2011, before I began to struggle severly and seek help in 2012, I (half-jokingly) self-diagnosed with a serious case of Weltschmerz, the German word for world-pain, described as “a mood of weariness or sadness about life arising from the acute awareness of evil and suffering.” There is no salve for this, except to commit oneself to resolving it by any (peaceful) means necessary; such as through progressivism, art, music, dance, moral absolutism, satire, metamodernism, etc…
As a sociologist, I was “going native,” as the expression goes, which means “becoming so involved with and sympathetic to the group, the researcher loses objectivity” (or adopting their dress and customs). Except I was going native in the most abstract way possible, not identifying with one particular cause or culture, but with all of them, and with a new metaphysics of social reality itself. I was perpetually seeing the matrix through critique-colored glasses. I could see everything wrong with the world (a consequent of postmodernism), and how to diagnose, treat, and cure it (a product of metamodern thinking), but at the same time I was paralyzed by the system, by it’s resistance to change. As such, in this case I insist that my research into global problems and my direct experience with the effects of poverty improved my objectivity, rather than created a bias. On it’s path of self-destruction, the world is categorically crazy, clinically insane even at times. Hence, in today’s world, if you’re not mentally ill… there’s something wrong with you.
“the pandemic of mental anguish that afflicts our time cannot be properly understood, or healed, if viewed as a private problem suffered by damaged individuals.” — Mark Fisher, Capitalist Realism
The Material Conditions of the Social Fabric
Which brings us to the root of the problem: poverty. The poverty problem is twofold: the poverty (or financial insecurity) of the patient, and the intellectual poverty of the medicalization (diagnostics) process by doctors and administrators. The health care system is simply not equipped to treat late-capitalist anxiety, and that shouldn’t be it’s job anyway. In fact, you can’t treat deep complex economic problems with pharmacological solutions. The appropriate treatment for financial poverty is money, not medicine. We need bills not pills. It is the responsibility of health care professionals is to realize that, and to recognize where the world’s wealth has actually gone (hoarded by financial elites). (See my post on metamodern philathropy for new critiques and solutions to this problem.)
My story is that despite having a world-class education and a broad skill set, the world has not been receptive to my critical ideas, or even my self-compromising pursuit of jobs I was matched or over-qualified for, and I began to fall through the cracks of society. In virtually all of the jobs I applied for after graduating, in which I was actually a good fit, I didn’t even receive a response, let alone an interview. This is a common experience among millions of millennials in the over-saturated and underpaid labour market — I’m not that special in this regard. I remember I went for an information interview at Demos (think tank) in London in 2011 and was told they had a stack of 100 resumes of people waiting to intern for free. Unable to acquire a decent job, and unable to perform in a poor quality low-paying job, my stress was so chronic, severe, and untreatable that it thrust me back into unemployment, on to sick leave, social assistance (welfare), and then permanent disability. Ironically, my alma mater gets it, but offers no help;
And all the while I’ve been somehow managing to mingle online and meet with world-class intellectuals who are partial to the emerging discourse of metamodernism. For the first 3 years of seeking help, I never once felt truly heard, and thus it is no surprise that Hanzi Freinacht’s metamodern “Listening Society” is music to my ears. This work has been an incredibly rewarding and validating experience, but not a particularly lucrative one, inhibited to a degree by my own mental illness and limitations, and also by the austere and exploitative state of the labour economy.
We simply need to give people their due — a universal basic income (UBI), or some form of foundation — to take care of themselves, and it will instantly alleviate a large burden on the health care system. People will still work, and the economy will still march along (as 100% of UBI gets spent back into the economy). Not only this, but some foolproof form of UBI needs to bundled with a whole host of other system changes that need to happen (funding and fixing the health care, education, the environment, the justice system, etc...). Encouraging and enabling people to simply compete better in an economy rigged like a game of musical chairs does a disservice to us all.
Johann Hari explains how ‘universal basic income is an anti-depressent.’ — Lost Connections: Uncovering the Real Causes of Depression w/ Johann Hari — MR Live — 3/19/19, 20–55m. Also, see Rutger Bregman’s excellent TED talk on the reality of poverty and the simple affordable systemic fix:
Rich people and poor people experience mental health in very different ways, and they are also treated differently and unequally. This is not typically taken into account when diagnosing and conducting mental health treatment. The DSM does not have a section on class or social justice, at least not yet. We are told that psyschological and pharmacological studies control for differences, so that the measure is objective, but a reality check is in order.
Conditions like depression, anxiety, psychosis are measured across populations for quantity, not across classes for quality. The data is equalized to show that all humans experience depression and mental illness in some fundamentally consistent way, which does not ring true to me. It’s a shortcut, because if they didn’t equalize it, there would be a lot more explaining to do and they couldn’t “treat” it from a textbook and prescription. Similarly, measurements of happiness are operationalized and adjusted to show that people in poverty or poor countries can be just as happy, if not happier! As if that is some kind of serious and meaningful scientific discovery; it simply papers over global inequality rooted in corporate hegemony.
What is my basic thesis here? It is two fold. First, that the current mental health paradigm, the DSM-5 and the institutions that follow it, are analogous to very expensive band-aid solutions. It is completely sociologically blind, prescribing patients to conform to some standard of ‘wellness’ in a society that is perfectly sick and delusional (in a constant state of war one way or another).
Second, I would venture to claim that much of mental illness is socially constructed and predicated on wealth and inequality. That is to say, at worst the depression or neurosis of rich folks is pretentious and naive (think American Psycho), at best it is still a real epistemic problem and they need the Cognitive Behavioural Therapy (or whatever) to be healthy. On the other hand, the depression or neurosis of poor folk is rooted in, or at least related to, their oppression and their adaptive coping mechanisms. At best, the illnesses that respective classes experience are very real but of a different quality, so certainly the priority and quality of treatment should be directed to those most in need, whereas in reality affluent folks will always receive the best treatment, and much sooner.
Let’s Talk About It Right
If we’re going to talk about it, let’s do it justice. There is this facetious attempt to dignify mental distress by getting people to ‘talk about it.’ Rather than hide it in shame, we are encouraged to express our struggle and challenge the stigma. This is exemplified best in Bell Mobility’s #BellLetsTalk hashtag campaign. This is the poverty of PR/advertising these days: to co-opt social issues to increase their bottom line, and maybe do a little good along the way. All corporations whitewash, greenwash, and pinkwash their image to be more fit for public consumption — they spin their messaging to hide their negative externalities and appear progressive — but at what greater cost? If they were to put their money where their mouth is, they’d make their services completely free for people with mental illness, for starters.
In principle, challenging mental illness stigma and promoting empathy is a good idea, but who do these campaigns really help when it offers no change to the structural/societal conditions that create mental illness? Talk is cheap, and nobody’s listening. If I’m hungry and can’t afford food, what good does it to do talk about how hungry I am? And this is why we should be striving to build what Hanzi’s The Listening Society, which includes deep listening but also goes a lot further. Chris Hedges is also a person who knows how to correctly frame these issues:
“A loss of income causes more than financial distress. It severs, as the sociologist Émile Durkheim pointed out, the vital social bonds that give us meaning. A decline in status and power, an inability to advance, a lack of education and health care and a loss of hope are crippling forms of humiliation. This humiliation fuels loneliness, frustration, anger and feelings of worthlessness. In short, when you are marginalized and rejected by society, life often has little meaning.” — Chris Hedges, Diseases of Despair, Truth Dig
So, first, let’s look at the problem at the inbox, they way we are approached as citizens. I recieved an email from the Liberals (Canada) asking me for money to fight mental illness. Why should we pay out of pocket for something that Conservatives gouged out of the budget? Why should we pay for a defective mental health care system, when many of us are suffering mentally because of economic deprivation? And why should I pay for it when I’m already advocating for the right improvements. It’s ironic, stupid, and offensive. Needless to say, as a metamodernist, I support neither the Liberals or Conservatives unconditionally (or Democrats or Republicans), because something much better is needed.
Second, what is mental illness anyway? It’s not what you think. We’ve been pushed down slippery slope of delusional diagnoses and pathological prescriptions. You can start your homework back in the ‘60s, and ask yourself why you might have never heard of The Myth of Mental Illness before. The ‘myth’ is that mental illnesses can be categorized and pathologized in the same way as diseases, when in reality this is untenable, because mental issues are psychosomatic, subjective, and contextual, although they often have a foundation or correlate in material existence and biology. Thus, they are rooted in the body, but only if the body is not properly taken care of in the first place.
Not to mention, we live in an insane world, so who should really be the authority on mental health? Perhaps sociologists, not medical doctors, should be the primary consultants on public health. There is a pandemic of ideology in the post-truth crisis. Health Canada very recently used to think that cannabis is dangerous and addictive — a scientific claim that is morally and intellectually equivalent to saying coffee is lethal. In fact, this scientific article argues that cannabis has harm-reduction and homeostatic functions: cannabis is more good for you than bad.
Money Talks, Patients Listen
In this often neglected category of sickness based on socioeconomic status, a whole host of psychosomatic issues foment and lurk, and threaten our basic physiological and existential security. The mental health literature confirms it, but when you get to the clinic there is no conclusive treatment for it, only bandaids. This is the personal hell I lived in. By analogy, doctors put a bandaid of your gaping stab wound and give you a sucker on the way out. But do you think there is a doctor that prescribes the one thing we need — money?
Does it occur to anyone that their bandaid solutions may do more harm than good? Does it occur to anyone that I (or others) might contribute more to society (and sociology) than your average doctor and deserve the same material basis for my own work and my mental health? No. Instead, we are invited into a moronic debates about the health care system that multiplies patients’ burdens, amplifies anxiety, and further cripples our ability to take care of ourselves effectively. I’m thinking (sarcastically), “Yes, please, choke me to death with your red tape.”
But of course its not all about money. Rich people get mentally ill too, poor people mismanage money. I argue that poverty is a mental illness in its own category. It is largely at the root of persistent mental illness, because one gets stuck in a trap. While Jordan Peterson fundamentally ignores and rejects sociological approaches to improving systems, he hits the nail on the head here regarding money:
“If you don’t have any money, it’s really hard to get some. Like once you have some, it’s not so hard to get some more. But if you’re at zero? Jesus man. You’re in the reverse situation. You’re poor, you don’t have anything, no one wants to talk to you. You can’t get out of it, because you’re too poor to get out of it. You’re penalized by the economic system because you can’t even afford to play the game. You’re stuck at zero.” — Jordan Peterson
See, unless the likes of Bell and the Liberals are willing to talk about the deeper reality of mental illness (the social-structural component), why talk about it at all? Why invite discussion about it? Why clutter social media with more people’s neuroses, trite opinions, and confessions of diagnostic labels, masking the cancerous medicalization of society and the psychotic conception of mental illness? And so many people go along with, even being profiled on Bell’s website. I’m glad it’s working for some people. Time to make it work for everyone. If it’s not going in that direction it’s all for nothing.
We cannot talk about mental illness without talking about socioeconomic justice. So, #LetsTalk about breaking up the telecommunications oligopoly, among other things. #LetsTalk about getting those cellphone rates down. #LetsTalk about how mental health has to go hand in hand with Universal Basic Income (UBI), socialization of health care, and thus better cost efficiency and less burden for all.
We cannot talk about mental illness without talking about socioeconomic justice.
Let’s talk about the material conditions of the social fabric. Each individual is a thread in a larger tapestry, interacting, working together in harmony. We need to make the social fabric out of quality material, lest it tear and unravel. Each person is a cell in the superorganism of society. Society emerges from the material conditions of existence — wealth — and if you impoverish people, and deny them that lifeblood, you will have a very sick society, and a very expensive health care system.
Let’s talk about the material conditions of the social fabric.
Time is money, goes the well known Marxist adage. So what happens when you run out of money? You run out of time. Everything becomes a burden, and then a crisis. All of the sudden bus fare is unaffordable, and being in public is stressful. The time it takes to go for a walk or relax is also time wasted, so you can’t relax. You have to buy cheaper groceries, and cook more at home, which eats up more of your time. You feel like you’re dying and literally running out of time. Andrew Niccol’s film In Time — not quite as profound as Gattaca, but still poignant — is the extremely dystopic incarnation of this temporal devaluation of humanity. And when you’re out of time, you lose patience faster.
You can’t spend time with your employed friends because they want to go out and spend money. Some may make six figures but are still too cheap to buy you dinner, even when you work just as hard or harder for $20k a year. Some may take sympathy and help you out occasionally, but it just makes you feel worse anyway because you want to be self-sufficient, and you believe welfare should be depersonalized — you (I) don’t give money to homeless people for the same reason, and because your too poor anyway. Your mental state deteriorates rapidly and you develop mental and verbal tics, neuroses, stress disorders, sleep disorders, eating disorders. You get cynical and jaded and start to see everyone around as idiots and obstructions, how they perambulate through the world, so pedestrian and carefree. You may even be jealous of how they mask their symptoms of suffering from late capitalism, which you probably have in common.
You start to see your doctor visits as serving only them and not yourself. You see how they get paid $100/hr to sit there and listen to you complain, only to send you off with a palliative scrip or refer you to another doctor. You try to apply for disability and are denied. You try to apply for welfare and the website fails, and when it works you are denied. And then your old printer breaks or your computer crashes and you can’t process the documents they want. You want to kill yourself, but don’t because fortunately you know that it’s not right, will hurt others, and will not spread your message.
As they astutely put it in their defense of UBI, Srnicek and Williams explain the high cost of ‘free time’;
“Yet this free time will be of little value if people continue struggling to make ends meet. As Paul Mattick puts it, ‘the leisure of the starving, or the needy, is no leisure at all but a relentless acitivty aimed at staying alive or improving their situation. The underemployed, for instance, have plenty of free time but lack the means to enjoy it.”
“Low-waged work is often crass and disempowering, and under a programme of UBI it is unlikely that many would want to undertake it… UBI therefore forms a positive-feedback loop with the demand for full automation.”
— Inventing the Future, 2015
We need to get back to basics. There are simple solutions to complex problems. Generally things like art therapy or physiotherapy need to be 100% free and accessible. But more specifically, the whole paradigm of medicine has to evolve. For example, cannabis is not a panacea but it’s the closest thing to it, and it’s a windfall for the healthcare system and the economy. That Health Canada had been against it in recent history is the transparent politicization of science; a vestige of the Conservative government policy. One thing to keep in mind: Health Canada, what is supposed to be an informed authoritative scientific organization, has produced anti-cannabis propaganda in the recent past, and too many people in government positions still believe this. With respect to mental health, cannabis can have some adverse consequences, but it can also be very beneficial when used correctly.
While it can have some side-effects, it also has ride-effects. It all depends on how you use it. I’ve detailed exactly how this works in the post Cultivate Yourself with AvantGardening. To be sure, set and setting are everything, so if you are a vulnerable or addictive person and don’t have access to a nice environment and guidance, it may not be the right treatment or the right time.
While it can have some side-effects, it also has ride-effects. It all depends on how you use it.
Personally, I can say that cannabis saved my life because I was starting to get deeply depressed and suicidal and it gave me new hope, insights, physicality, and creativity, so I am right to call it malpractice when a doctor ignorantly denies the general merits of cannabis for a specific patient’s subjectivity, physiological, psychological, and spiritual needs. Though it can also be habit-forming and create a dependancy, it is not technically addictive and should never have been criminalized. And it is well established fact that it was criminalized in part for racist reasons.
Similarly, if cannabis is the only thing that cures violent seizures in some children, and other previously unsolved medical mysterious (Parkinson’s, for example), then it should certainly be legal and accessible already. At any rate, for most people it is simply a life style choice that should be outside the purview of doctors. This has always been true, and prohibition has always been ignorant, dysfunctional, classist, racist, and evil, despite claiming to provide some social order.
At the time when I first sought psychiatric care and legal access to cannabis (2012), medicinal cannabis was still a few doctor’s notes out of reach. I was denied medical access, so by definition I had to go through ‘black markets,’ which generally, if you’re not careful, in part funds organized crime. You’d think that in progressive Vancouver (Canada) doctors would be more open minded, but I was met with oppositional ignorance about cannabis, and treated like a drug addict (that is to say I was pathologized), adding insult to injury.
And I never did get access through a normal doctor. I first got access through a dispensary doctor (which hinged on a 2 minute phone call). It is now (circa 2015-) available by just walking into one of the many swanky dispensaries, no medical need necessary, as industry pushes ahead of the coming legalization in Canada, which is actually set to once again temporarily restrict access. And of course more recently, as of October 2018, it is fully legal in Canada. But we still have a long way to grow, pun intended.
To be sure, any drug also has diminishing returns, so for certain things (like depression) it may not be a long-term solution. For mental illness the only long-term solution is to give (all) people a baseline (income) so that you can correctly diagnose and treat problems in the first place.
All in all, my contention is that for those living below the poverty line, as I am, the DSM does not apply strictly, because it does not take into account socio-economic status and unemployability. It does not take into account ‘the world’ in which its psychiatric subjects live and move, hurt and heal; it does not take into account the psychopathy of said world. The DSM may very well be inaccurate on the whole, while also functionally true in the context of a crazy world. But at least we can say that it is definitely blind with regard to socio-economic illness. I, a mentally-ill non-medically trained individual, with the aid of much sociological research on these subjects, can correctly diagnose the pathology of the mental health care system. What does that tell you about it?
I have been struggling with mental illness, poverty, and ‘the system’ for over 7 years now. Prospects on the horizon are always tenuous. It’s the 99% of the world against the 1%, the precariat against the superclass. Like Mark Fisher and many other people in the precariat around the world, I feel “good for nothing,” and yet I am stand for what’s best in and for everyone.
Yet, I am — and probably many people are — extremely high-functioning but happens to suffer from an array of mental illnesses, and if I had to go through that much crap, I can only imagine what it is like for less capable or maginalized people. For the love of God (figuratively speaking), pay us our due.
Call to Action. Here’s what you can actually do:
First, follow, support, and donate to The Abs-Tract Organization. Second, advocate for Universal Basic Income and universal health care. When you see it, vote for it. When you hear people talking about, defend it. Debunk partial and piecemeal solutions. Call out corporate advertising like Bell’s #BellLetsTalk campaign. Criticize articles about mental health that don’t address the root causes. Reject the medicalization of metaphysical things like thoughts and behaviour.
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