The Politics of Psychologisation
Much research has found a positive association between markers of poverty and children’s poor mental health. Children from poor households in the UK are three times more likely to have a mental health diagnosis than children in richer households (Green, McGinnity, Meltzer, Ford, & Goodman, 2005) and certain diagnoses, such as conduct disorder and ADHD, tend to show links to family poverty, particularly for those facing persistent economic stress (Murali & Oyebode, 2004). Higher social disadvantage increases likelihood of diagnosis of childhood behavioural and emotional issues, with poorer children experiencing higher rates of diagnosis of depression and with antisocial behaviour linked to poverty histories (McLeod & Shanahan, 1996). Crystal, Olfson, Huang, Pincus, and Gerhard (2009) in a comparative study of a number of US states found that children from low-income backgrounds in the USA are significantly more likely to be psychiatrically diagnosed and to be prescribed anti-psychotics than youth from high-income homes.
This empirical research is important, yet it leaves questions unanswered. For example, the majority of research into associations between poverty and poor mental health draws upon diagnostic categories. Thus, the research only shows a link between poverty and increased likelihood of receiving a diagnosis. While living in poverty may indeed lead to levels of distress that may appear to meet diagnostic criteria for mental health conditions, it remains questionable how helpful it is to frame this distress as symptoms of an individual disorder. Furthermore, diagnostic categories have been widely critiqued for individualising and depoliticising distress.
The explanatory frameworks employed when conceptualising the relationship between children’s mental health and poverty tend to emphasise ‘increased rates of parental and family characteristics associated with child psychiatric disorder, rather than the economic disadvantage itself’ (Murali & Oyebode, 2004, p. 220). Here poverty is not understood as directly related to mental ill health, but as mediated by other mechanisms, such as level of education and child-parent interactions and attachments (Murali and Oyebode). In much of this work, conditions of poverty remain a ‘trigger’ for what are assumed to be underlying predispositions to mental illness. Much of the literature on poverty and child mental health focuses on the individual psyches and behaviour children and families living in poverty, rather than the politico- economic conditions that sustain poverty.
Here there is a shift in the labelling of poor people from culture of poverty to psychological disorder and medical pathology—where a mental health diagnosis and sometimes compliance with psychotropic drugs (despite sometimes harmful side-effects), as well as mental health screening, are requirements for eligibility to receive welfare provisions (Schram, 2000). For example, Hansen, Bourgois, and Drucker (2014) discuss how the retraction of welfare provisions for low-income groups in the USA has led to a dramatic increase in medi- calised support in the form of disability benefits justified by a psychiatric diagnosis (now the largest diagnostic category qualifying people for payments).
This is one instance of the ‘pathologization of poverty’ (and arguably also its psychologisation), whereby seeking psychological and pharmaceutical intervention has come to be one of the remaining survival strategies for poor people in the USA (Angell, 2011; Wen, 2002) in an ‘era of medicalized poverty’ (Hansen et al., 2014, p. 81). With increased rates of anti-depressant prescriptions written since the recession, this would also seem to be an issue for the UK (Barr et al., 2015). This could be read as an example of the psychologisation of poverty at work within educational psychology practice (Gordo Lopez & De Vos, 2010; Mills, 2015), where psy-expertise and classifications may serve to obfuscate the social relations and conditions in which both poverty and psychology’s classificatory systems are embedded.
This raises the question of whether we are witnessing the reconfiguration of poverty from ‘an economic problem to a medicalized [or psychological] one’ (Schram, 2000, p. 92), paving the way for increasingly clinical and therapeutic approaches to poverty, and resulting in psy interventions being positioned as ‘(technical and medical) solutions to (political) “problems”’ (Howell, 2011, p. 20). There may be huge socio-political ‘side-effects’ in promoting psychiatric and pharmaceutical understandings of and interventions into poverty: ‘Allopathic, individualized, medicalized, approaches to poverty reinforce the isolation, marginalization, and pacification of low-income persons and communities’ and subordinate people to expert discourse (Schram, 2000, p. 98). This is of particular concern as psychological discourse is proliferated through schools, where both nationally and internationally schools as seen as key sites to mainstream particular approaches to mental health (WHO, 2010). Taking seriously the politics of psychologisation in relation to poverty raises the question of whether there is a way for EPs to recognise and act on distress while conceptualising it as a symptom of austerity and poverty.