The Brain & Poverty

Poverty is a risk factor for mental health problems

From reading the chapter, we understand the different ways poverty is a risk factor for mental health problems. 

• precarious living situations, difficulty meeting material needs, exposure to violence, marginalization and stigma, racial discrimination

• Challenges internalized in feelings of stress and powerlessness

• Difficult to access healthcare

• Practical barriers even when healthcare is available (long waiting times, lack of childcare) and psychological barriers (stigma, mistrust of bureaucratic systems) 

• Traditional talk therapy may not be as effective 

Depression is just as much an illness as Diabetes. 

The bodies of people with major depressive disorder work differently.

• Disrupted sleep, especially waking up early. 

• Loss of appetite

• Loss of sexual activity

• Fatigue and tiredness during the day

• Highly overactive stress response

• Inability to feel pleasure

Connecting the Brain to the Rest of the Body

https://www.youtube.com/watch?v=IipVaPKnjRk&t=239s

The importance of the stress response

Anxiety disorders and major depressive disorder (MDD) have been associated with increased and blunted HPA axis reactivity to social stress. 

Robust evidence has linked the experience of chronic stress to onset of major depressive disorder (MDD), which is the leading cause of disability worldwide.1,6,7 Likewise, onset of bipolar (BD) and posttraumatic stress (PTSD) disorders, both of which are associated with substantial emotional, physical, and financial burden,8,9 has been linked to chronic stress.

The role of stress in the origin and development of depression may be conceived as the result of multiple converging factors, including the chronic effect of environmental stressors and the long-lasting effects of stressful experiences during childhood, all of which may induce persistent hyperactivity of the hypothalamic-pituitary-adrenal axis. 

Your prior experiences shape how your brain biologically functions. 

Living in poverty increases the likelihood of experiencing extreme stressors, with fewer buffers, in early development when the brain is most malleable.

“The brain can be divided into four interconnected areas: brainstem, diencephalon, limbic, and cortex. The structural and functional complexity increases from the lower, simpler areas of the brainstem up to the cortex. The cortex mediates the most uniquely “human” functions such as speech and language, abstract cognition, and the capacity to reflect on the past and envision the future.”

What is trauma?

The 3 “Es” - the Substance Abuse and Mental Health Services Administration (SAMHSA)

• The event itself

• The experience

• The effect

Any pattern of activating your stress response system that leads to an alteration in how that system is functioning. 

Trauma can also arise from quieter less obvious experiences over a prolonged period.

The ACE questionnaire is a tool to measure traumatic experiences. 

•Physical abuse

•Emotional abuse

•Sexual abuse

•An alcohol and/or drug abuser in the

household

•An incarcerated household member

•Someone who is chronically depressed,

mentally ill, institutionalized or suicidal

•Mother is treated violently

•One or no parents

•Emotional or physical neglect

Having more ACEs while you are developing means that you are more vulnerable to a entire host of comorbidities across the lifespan. Not just in mental health, physical health in all areas.

“Research demonstrates the correlation between childhood adversities linked to poverty and negative outcomes in adulthood, indicating that poverty may itself be considered an adverse childhood experience.” North Carolina Medical Journal

• Poverty affects 1 in 5 children

• Poverty is highly comorbid with ACE exposure

• Children living in poverty are more likely than their peers to experience frequent and intense adversities 

• A variety of childhood adversities have a root cause in family economic insufficiency, indicating that poverty may likely be the first adversity that many children experience

• “We find that above and beyond the impact of individual-level economic hardship, neighborhoods with high levels of poverty (between 20 and 39.9% residents living under the federal poverty level) and concentrated poverty (greater than 40% of residents living under the federal poverty level) at the time of birth are associated with an increased number of ACEs reported by age 15. Further, living in a neighborhood with concentrated poverty at the time of birth is associated with an increased likelihood of experiencing 4 or more ACEs.”

“Even in the absence of major traumatic events, unpredictable stress and the lack of control that goes with it are enough to make our stress-response systems sensitized—overactive and overly reactive—creating the internal storm.”

“The hypervigilance of the Alert state is mistaken for ADHD; the resistance and defiance of Alarm and Fear get labeled as oppositional defiant disorder; flight behavior gets them suspended from school; fight behavior gets them charged with assault. The pervasive misunderstanding of trauma-related behavior has a profound effect on our educational, mental health, and juvenile justice systems.”

Resilience and Healing

“Our major finding is that your history of relational health—your connectedness to family, community, and culture—is more predictive of your mental health than your history of adversity”

Healing starts when you stop asking “what is wrong with you?” and instead ask “what happened to you?” 

Related Questions: 

• Can you connect the idea of poverty as an Adverse Childhood Experience (ACE) to the other topics we have discussed in class? How do you see the idea of poverty as a mental stressor intertwin with meritocracy, gender, racism, etc. 

• How does inequality play into all of this? (ex: inequality creating more isolation) 

• Do you have any thoughts on the medicalization (the process by which ever increasing life experiences come to be defined and treated within medical terms) of distress & poverty? 

• Should we be thinking more about “politico-economic context of diagnosis, shifting the question from why higher numbers of people living in poverty may have mental health problems, to the question of whether poor people are more likely than people from higher socioeconomic groups to be diagnosed with ‘mental disorder’, and why?”

  • “there are real dangers in characterizing the poverty population as primarily a population of people who are psychologically disabled”