January: “National Poverty in America Awareness Month”

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

As I started to think about what the focus of my last column for January 2024 might be, I received an email notice from Save the Children on January 27th that it is Poverty Awareness Month. What? I am embarrassed to think and wonder, that for someone who pays so much attention to the psychology of special holidays and times, how did I not notice this? It should have been one of the topics for the resolutions I had for psychiatry in the columns I wrote earlier in this month.

The bulk of my career has been in community mental health, a field developed in the 1960s, and devoted to redressing the adverse influence of poverty on mental health and mental health care. Has poverty in America become so normalized that we barely notice it anymore in medicine and psychiatry?

The formal study of poverty and psychiatry goes back even further, at least to the 1950s. Coauthoring the groundbreaking study and classic book on Social Class and Mental Illness,¹ the psychiatrist Frederick (“Fritz”) Redlich was dean of Yale Medical School when I was a medical student there from 1967-1971. That book and his presence became an early inspiration for the focus of my career. Their main conclusion was that social class played a significant role in psychiatry, with the lower classes receiving more severe diagnoses and less talking psychotherapy treatments.

Later, poverty came to be recognized as one of what has come to be called “the social determinants of mental health.”² In a distressing cycle, poverty leads to more psychiatric disorders such as clinical depression, which in turn leads to further poverty. In addition, minority groups are overrepresented in the lower social classes.

A later review in Psychiatric Times presented these clinical conclusions³:

• Throughout life, poverty tends to have many negative mental health effects
• Assess poverty during a clinical evaluation
• Advocate for a reduction of poverty in society

As a medical director of large community mental health centers, I consciously tried to provide as much equitable treatments as was available in private settings, but limited resources were an obstacle.

Government data for 2022 indicated that our country’s official poverty rate remained around 11%. Over 11 million children live in poverty, and the rates are higher in rural areas.

So far, it seems like the topic has not come up in our national election process public discussions. In psychiatry, there has been a robust focus on racism, but not on poverty per se. I hope to make up for my own unawareness of Poverty Awareness Month the rest of the year.

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

References

1. Hollingshead AB, Redlich FC. Social Class and Mental Illness: A Community Study. Wiley; 1958.

2. Compton M, Shim R, eds. The Social Determinants of Mental Health. American Psychiatric Association Publishing; 2015.

3. Simon K, Beder M. Addressing poverty and mental illness. Psychiatric Times. 2018;35(6).