The psychiatrization of poverty: Rethinking the mental health-poverty nexus

The positive association between 'mental illness' and poverty is one of the most well established in psychiatric epidemiology. Yet, there is little conclusive evidence about the nature of this relationship. Generally, explanations revolve around the idea of a vicious cycle, where poverty may cause mental ill health, and mental ill health may lead to poverty. Problematically, much of the literature overlooks the historical, social, political, and cultural trajectories of constructions of both poverty and 'mental illness'. Laudable attempts to explore the social determinants of mental health sometimes take recourse to using and reifying psychiatric diagnostic categories that individualize distress and work to psychiatrically reconfigure 'symptoms' of oppression, poverty, and inequality as 'symptoms' of 'mental illness'. This raises the paradoxical issue that the very tools that are used to research the relationship between poverty and mental health may prevent recognition of the complexity of that relationship. Looking at the mental health-poverty nexus through a lens of psychiatrization (intersecting with medicalization, pathologization, and psychologization), this paper recognizes the need for radically different tools to trace the messiness of the multiple relationships between poverty and distress. It also implies radically different interventions into mental health and poverty that recognize the landscapes in which lived realities of poverty are embedded, the political economy of psychiatric diagnostic and prescribing practices, and ultimately to address the systemic causes of poverty and inequality.