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Thepsychopathologyofindigentlife
byElioJahaj

Psychiatricwisdomholdsthatyoucanhelponlythosewhowanttobehelpedandwillkeep
theirappointmentsthemselves,butthisisostentatiouslyuntrueinthesepopulations.
AndrewSolomon,TheNoondayDemonpage341

1. Psychopathologyandpoverty

ThereisadegreeofconsensusinthefieldofPsychologythatpsychopathological
conditionsandsocialclassarecloselylinked.Thisstatementhowever,isdifficultto
measureduetoavarietyofreasons,themostevidentbeingthelimitationswithwhich
statisticsinherentlycome.AsAndrewSolomondescribesin
TheNoondayDemon,
itis
particularlychallengingtoacquireaholisticviewofthelevelsofpsychopathological
disturbancesduetothestigmaassociatedwithmentaldisturbances.ToSolomon,this
assertionextendstosocietyasawholehoweveritismostdangerousandmostpresentin
thelowestlevelofsocialclass,theindigentpopulation.Peopleatthebottomofsocial
class,notonlyconformtothestigma,butoftenlacktheproperresourcestoseek
professionalhelp.Thiscanleadtocyclicalmanifestationsofpsychopathological
conditionsthatcanleadpoverty,resultinadownwardmovementinsocialclass,orthat
donotallowtheaffectedtobettertheirsocioeconomicsituation.

ThetakeawaylessonfromAndrewSolomonsmultiplestoriesinChapter9of
The
NoondayDemon
ishowthiscyclecanbeinterruptedthroughactiveintervention,i.e.
helpingthelessablebyprovidingthemwithresourcesthatwillbettertheirmentalhealth
conditions.Thisargumentperhapshasmorepoliticalpullwhenthelongterm
implicationsareweighedmorecarefully.Whenanalyzingthelongtermimplications,
Solomonsstoriesaregoodsourcesofinsight.RetrospectivelythinkingaboutChapter9

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of
TheNoondayDemon,
itisclear

thatacommondenominatorofthesuccessstories
presentedistheimprovementofthechildrensconditionsalongsidewiththeirparents.
ThisisalsoechoedintheNYTimesarticlewrittenbyDavidBornstein,whichstresses
thedecisiveroleofahealthyparentchildrelationshipintryingtolessentheeffectsof
adversechildhoodexperiences.Bornsteinthuscreatesamodelofsocialinterventionby
introducingtheadvancesinthescientificunderstandingoftoxicstressandsubsequently
explainingtheworkofanorganizationnamedChildFirst,whichusesahomebased
interventionapproachtargetingchildrenundertheageof6livinginhighrisk
environments.

2. Povertyandpsychopathology

AlongsideAndrewSolomonsmodelliesthemodelbroughtforthbysociologistsMelvin
L.KohnandCarmiSchooler,whichlinkssocioeconomichardshipwith
psychopathologyinamannerthatdescribestheeffectsofpovertyasamplifiersofmental
healthconditions.Suchaconclusionisalsobackedbytemporarypublications,studies
andpolls,whichdemonstratethepejorativeeffectthateconomichardshipcanhaveon
mentalhealth.ThegraphbelowreferstoapollconductedbyGALLUPthatshowsthe
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significantlyhigherlevelsofdiagnosed
depressionamongthepoorest25%
.Kohnand

Schoolersmodeloffersanarrative,whichassertsthattherateofmentalhealthissues
willdiminishalongsidewiththereductionofpoverty,thusthemodeldoeslittleto
advocateforamorehandsonapproachthroughinstitutionalizedactionfocusedon
mentalhealth.Onthecontrary,itarguesformoreactiontowardsthealleviationof

Itisimportanttonotethatthepollanalyzesthelevelsofdiagnoseddepressionamongthesocialclasstiers.Although
thesefiguresdemonstratealink,theaccuracycanbequestionedduetothelevelsofundiagnoseddepression.The
dangerinthisrepresentationliesinthefactthatifthelevelsofpsychopathologicalconditionsamongthepoorare
considerablyhigher,asAndrewSolomonpredicts,thesestatisticsdolittleinencouragingpolicymakerstoadoptan
activeapproachinordertohelpthepooranddepressed.
Thepollhasalsodeliberatelynotincludeddiagnosedandundiagnosedindividualsundertheageof18.Referringtoour
currentunderstandingoftoxicstress,thesefigureshavesignificantimplicationswhenappliedtothecontextoffamily
relations.

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poverty,whichmakesthemodeloneofthemanyinterdisciplinarymodelsthatidentifies
theadversitiesthatpovertycauses.

[Imagefrom:gallup.com]

3. Bornsteinsmodelanditsbroaderconnections

Inanattempttodirectlyaddresspsychopathologicalconditionsinhighriskfamilies,
Bornsteinsmodel,inthecenterofwhichliestheworkofChildFirst,attemptstoaddress
theissueoftoxicstressbyadoptinganactiveapproachheavilybasedonoutreach.
OrganizationssuchasChildFirstfunctiononthebasisthatasmallchangeinthesystem
willcauseagreaterrippleeffectandsuchaneffectseemstobehappeningasChildFirst
hasbeeninvitedtobringitsmodelto24states.However,thereneedstobeacontinued
emphasisontheimportanceofdealingwithpsychopathologicalconditionsamongthe
indigent,whilemakingcontinuouseffortstoalleviatepoverty.

ThesuccessofBornsteinsmodelishighlydependentonthesuccessofestablishingand
reinforcingacloseandlovingrelationshipbetweenparentsandtheirchildren.Forsome
researchers,thefocusseemstobeparticularlyinaddressingmaternaldepressionamong
lowincomefamilies.SuchacasewasmadeinapublicationbytheNationalCenterfor
ChildreninPovertyinJanuary2008,wheretheauthorsappealtopolicymakersto

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addresstheissueofmaternaldepressioninordertoensureandpromoteahealthyearly
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developmentforyoungchildren
.ChildFirstfollowsasimilarmodelasadvocatedbythe
NCCP,astheyhaveadoptedapsychotherapeuticapproachwhichhelpsboththemother
andthechild.However,asstatedbyBornsteinintheopeningparagraphsofthearticle,
ourcurrentunderstandingoftoxicstresstellsusthatitisnevertoolatetomitigateits
effects.Consequently,thereneedtobeotherchanneledeffortsthataddressthisissuein
adultpopulationsthathavesufferedfromadversechildhoodexperiences,anargument
whichAndrewSolomonhasthoroughlystressedin
TheNoondayDemon.

Infact,manyofSolomonsassertionshavecommongroundwiththeexperiencesof
ChildFirstsince2001.ThefounderofChildFirst,DarcyLowellrecallsanimportant
momentinthearticlethataffectedherviewsonthechallengesthattheindigentface.

Thefamilydidntcometoaspeechtherapyappointment,sherecalled.Whenwe
investigated,wefoundoutMomdidntbringheroutinthewinterbecauseshehadno
shoesforthechild.
This

statementreflectstheconclusionsalsodrawnbyAndrew
Solomonregardingthedeterminationoftheindigenttoimprovetheircondition,butwho
areconstrainedindoingsobytheircircumstances,onceagainreflectingthecyclical
natureofpovertyandpsychopathologicalconditions.Inordertodiminishtheadded
effectsofpovertyandpsychopathology,Bornsteinsmodelurgesintensiveoutreachin
highriskfamilies,whichisthenfollowedbyaninnovativeapproachthatprovidesnot
onlypsychotherapy,butalsothehelpofacarecoordinatorthathelpsthefamilygain
accesstobasicneeds.ThisapproachisdescribedasinnovativebyChildFirstitself,since
itisatakechargeapproachthatfocusesonthehealthydevelopmentofchildren,adirect
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attemptatbreakingthecycleorlesseningitseffects
.

4. TheimplicationsofKohnSchoolermodelandSolomonmodel

Knitzer,Jane,SuzanTheberge,andKayJohnson."ReducingMaternalDepressionandItsImpacton
YoungChildren."
RelationshipsBetweenPovertyandPsychopathology
(January2008):n.pag.Web.22
Nov.2014.<http://www.nccp.org/publications/pub_791.html>.
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"ModelDescription|ChildFirst."
ModelDescription|ChildFirst.
N.p.,n.d.Web.24Nov.2014.

TheempiricalobservationsofAndrewSolomonandthestudiesthathavefoundevidence
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ofadecreaseinchildpsychopathologyasthefamilymovesuptheincomeladder
donot
producemutuallyexclusivemodelsthatdescribetherelationshipbetweenpovertyand
psychopathology.Thisrelationshipispartofalargersocialsystem,whichasanyother
systemisinfluencedbyfeedbackloops.Povertyandpsychopathologicalconditionsform
apositivefeedbackloopinwhichthecauseandeffectamplifyandreinforceeachother,
thusregardlessofwhichisthepresetconditiontheoutcomeismorepovertyandmore
psychopathologicalconditions,bothofwhich,inturn,affecttheyoungergenerations.

KohnandSchoolersmodelreinforcesaviewthatthealleviationofpovertyleadsto
decreaseinpsychopathologicalconditionsamongsttheindigent.Thisclaimdoesfind
supportindataandscientificstudies,asdoestheclaimthattheseconditionscancausea
downwarddriftinsocialclass.Duetothealreadyestablishedefforttoalleviatepoverty
oratleasttolessenitseffects,describingpsychopathologicalconditionsasaneffectof
poverty,onlyaddstothelonglistofundesirableconditionsthatassociatedwith
indigence.Incontrast,Solomonsmodelismoredirectandspecificinadvocatingfor
certainmeasuresthataccordingtohimbenefitnotonlyindividualandtheirfamilies,but
societyasawhole.Hismodelconcretelyasksforprovidingtheindigentpopulationwith
accesstotreatmentandmedication,whichwouldeventuallyprovetobelessexpensive
thanignoringthepsychologicalneedsofthispopulation.

5. TheBornsteinmodelandculturalcontext

DavidBornstein,however,hasanapproachthatimplicitlytouchesupontheconclusions
ofthetwopreviousmodels,butultimatelyprovidesamorepracticalframeworkthathas
alreadybeentested.Howeverthismodelneedstoexpandinordertoincludeprograms
4

CostelloE,ComptonSN,KeelerG,AngoldA.RelationshipsBetweenPovertyandPsychopathology:A
NaturalExperiment.
JAMA.
2003290(15):20232029.doi:10.1001/jama.290.15.2023.

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thatareculturallyspecifictosocialclass.In
ChoiceasanActofMeaning,
theauthors
havefoundresults,whichdemonstratethehighlikelihoodthatindividualsfromthe
workingclassmakechoicesanddecisionsthatconformtothemajority.Incomparison,
middleclassindividualsaremorelikelytomakechoicesthatdistinguishthemfromthe
majorityandtheenvironmentaroundthem.Astheauthorsemphasizewhileanalyzing
theirresults,therearetheoreticalandpracticallessonsthatneedtobescaledwhen
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dealingwithworkingclassindividualsinamentalhealthcontext
.

MainstreamAmericansocialnarrativesemphasizetheimportanceofindividualityand
independencehoweverthisisnottrueinallsocialcontexts.Psychologicalliteratureand
popularculturehavedonelittletonothingtowidelycommunicatetheimplicationsthat
comealongwithinterdependence.First,itisimportantfororganizationssuchas
ChildFirst,tohaveanunderstandingofwhatconstitutesasanormativelygoodactionina
workingclasscontext.Theimportanceofthisimplicationisespeciallyhighlightedwhen
dealingwithchildrenandparentsatthesametime.Duetothefactthatchildrenuse
parentsastheirdevelopmentalmodels,theeffectsofinterdependentmentalityofferthe
careprovidershelpfulinsightsthatbenefitboththetherapistandthefamilybeingtreated
sincethetherapisthasabettergraspofthesubconsciousbiasbehindthechoicesbeing
madebyworkingclassindividuals.

Perhapsthemostinterestingimplicationthatthestudyaddressesisthatofconformity.
Theauthorsdealwithconformityas
anintentionaladjustmenttoothersdesiresin
ordertofitin,belong,ormaintaingoodrelationswithothers.
This,inturn,canalsobe
seenasacauseandeffectsysteminneedofcloseattention.Whenlivinginan
environmentwherethechoicesbeingmadebyothersaroundyouareinherentlynegative
(suchasdroppingoutofschool,unprotectedsexatayoungage,substanceabuse,
domesticabuseetc.),itisofconcernifyoursocialstatusrendersyoumorelikelyto
mirrorthosedecisionsinyourownlife.Itisbafflingthattheinherentculturaldifferences
5

Stephens,NicoleM.,HazelRoseMarkus,andSarahS.M.Townsend."ChoiceasanActofMeaning:The
CaseofSocialClass."
JournalofPersonalityandSocialPsychology
93.5(2007):81430.Web.

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inthisnationarenotincludedintomoremodelsofdealingwithpovertyand
psychopathologicalconditions.Theproblembecomesyetmoretroublesomewhenyour
accountforindividualsthatduetothegrowinginaccessibilitytohighereducationare
deprivedofacrucialexperiencethatintroducesthemtoacultureofindependenceand
autonomy.

Conclusion

Thedebatearoundthesemodelsbestpersonifiestheevolvingpsychological,socialand
biologicalinsightsofpsychopathologicalconditionsaswellaspoverty.Placedina
chronologicaltimeline,themodelscaptureandreflecthowtheyhavegrownand
developedtocomplementeachother.Thelessonwecandrawfromallthemodels
discussedisthatthereisnoonesizefitsallmodelorideology,whichaccountsforthe
mentalhealthdisparitiesbetweensocialtiersandprovidessolutionsthatconformtoour
currentpsychological,socialandpoliticalenvironment.

AndrewSolomonandsociologistsKohnandSchoolerdifferintheiridentificationofthe
povertyaseitherthecauseoraneffectofpsychopathologicalconditions.Whatthispaper
hasarguedforisthat,followingonDavidBursteinsmodelthereisanecessityfor
devolvingprograms(orexpandingcurrentones)thatdealbothwithpsychopathologyand
poverty.Inherently,thismodelbasedinthefactthattheadversitiesofindigentlifeare
suchthattheirsocioeconomicconditionsimpedethemfromgainingaccesstotreatment.
Reasonwhy,concurrenteffortstoalleviatepovertyanddecreaseinequalityneedto
continue,aswegraduallyshiftourattentiontotreatingthepsychopathologyofindigent
life.

Bibliography

Solomon,Andrew."Chapter9and10."
TheNoondayDemon:AnAtlasofDepression
.
NewYork:Scribner,2001.N.pag.Print.

Mirowsky,John,andCatherineE.Ross."SocioeconomicStatus:Economic
Resources."
SocialCausesofPsychologicalDistress
.NewYork:DeGruyter,1989.
8083.Print.

"ModelDescription|ChildFirst."
ModelDescription|ChildFirst
.N.p.,n.d.Web.24
Nov.2014.

Stephens,NicoleM.,HazelRoseMarkus,andSarahS.M.Townsend."ChoiceasanAct
ofMeaning:TheCaseofSocialClass."
JournalofPersonalityandSocial
Psychology
93.5(2007):81430.Web.

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Knitzer,Jane,SuzanTheberge,andKayJohnson."ReducingMaternalDepressionandIts
ImpactonYoungChildren."
RelationshipsBetweenPovertyand
Psychopathology
(January2008):n.pag.Web.22Nov.2014.
<http://www.nccp.org/publications/pub_791.html>.

CostelloE,ComptonSN,KeelerG,AngoldA.RelationshipsBetweenPovertyand
Psychopathology:ANaturalExperiment.
JAMA.
2003290(15):20232029.
doi:10.1001/jama.290.15.2023.