Poverty's Effect on Mental Health

The greatest of evils and the worst of crimes is poverty.

– George Bernard Shaw, 1856-1950

"I don’t care" was the response from Gerardo when I asked, "Of the people you know, is there anyone who loves you?"

Gerardo was a 17-year-old high school senior who had grown up in poverty. He was planning to attend Stony Brook University on scholarship. Gerardo had been referred for psychiatric evaluation because he slapped his mother, slammed a refrigerator door against her back, and cursed at her.

He was eager to leave his family, including his Ecuadorian mother, who sold burritos from a street stand; his 19-year-old sister, Lola, who lived primarily with her 21-year-old boyfriend; and his 9-year-old half-sister, the daughter of the man who beat him repeatedly.

His biological father, an alcoholic and drug addict, had left when he was 3; his stepfather, Manuel, subsequently became violent toward him, and his mother at times held him down during beatings.

After Manuel left the home, his mother took another man into the house. Fred, a cook in a Chinese restaurant, helped with rent and kept to his room.

Gerardo blamed his mother. "She was never around" and was out selling food. His mother overlooked Manuel’s molestation of Gerardo’s older sister Lola and enabled her son’s abuse. Why?

It was only when Lola took an overdose that New York City’s Administration for Children’s Services learned of the distressed family and intervened.

Gerardo talked about his commitment to school as an entrée into a good position. Still, he was cynical. In a provocative manner, he called school, "boring." He added, "The other option is to find a minimum wage job." With anger, he said, "I am preparing to live in corporate America." His disdain encompassed personal, academic, and family areas.

Is the diagnosis of Gerardo depression or a nascent personality disorder? Does he have posttraumatic stress disorder? One thing was clear: Gerardo, an intelligent adolescent, was emerging from childhood scarred by his experience.

The Toll of Poverty

Poverty is common in the United States. Peter Edelman in his book "So Rich, So Poor: Why It’s So Hard to End Poverty in America" (New York: The New Press, 2012) details that 46 million Americans live in poverty, defined as earning no more than $23,050 yearly for a family of four. Food stamps and housing assistance programs are helpful, but with cutbacks in welfare, there are 6 million people living solely on food stamps.

Edelman, a professor at Georgetown University Law Center, Washington, says that good-paying jobs have gone overseas; the number of single-parent households is on the rise; and the wealthiest have created disadvantages for the poor, resulting in economic crises such as the housing bubble. At present, children rather than the elderly are more likely in poverty. More than 40% of families headed by single mothers are poor.

We view poverty as an economic dilemma, but its psychological consequences are profound. Do poor people develop mental illness or does mental illness cause a slide into poverty? Much controversy exists on this question, but both probably are true. Poverty has far-reaching consequences and creates vulnerabilities. It negatively affects mental health.

Many of the social ills associated with poverty confound with mental illness. Poverty is depressing.

A 63-year-old Hispanic patient described her struggle. Glenda suffers from rheumatoid arthritis, depression, diabetes, and osteoporosis. From supplemental security income, she receives $716 a month. She receives food stamps amounting to $200 monthly. Were it not for her daughter, a school crossing guard, sharing the apartment, Glenda could not afford the rent of $604 a month. "Even clothes, buying a pair of jeans for $35, would stop me from getting things for the house," she said. "I’m angry; it gets me irritated. I like to listen to music, go to concerts, Central Park, but I have no financial means."

She planned to go to a local food pantry in Long Island City because grocery prices are rising.

According to Susan Grange, a social worker and assistant director at a family services agency in Queens: "Poverty leads to depression and hopelessness – no expectations in clients. They are burnt out before they can grow up. Most don’t make it through high school."

The inner-city youth she sees abuse drugs and become sexually active by age 12 or 13 years. If the children succeed, it is because "someone is there emotionally for them." Some recognize the importance of school; others have the financial resources to get mental health assistance.

Apathy among the young is significant as illustrated by Gerardo’s outlook. Domestic violence and sexual abuse wreak havoc in these families.

Education for All

Many focus on formal education of youth as a means of curbing poverty, but the picture is complex. Chaotic family life erodes early brain development.

Neurobiologists find that stress and trauma impinge on development of executive function and impulse control. With these deficits, children fail at school, and a cycle of failure ensues. Evidence suggests that the poorest children do worse as students.

Journalist Paul Tough, the author of "How Children Succeed: Grit, Curiosity, and the Hidden Power of Character" (New York: Houghton Mifflin Harcourt, 2012), studied poor families in Chicago and the ways in which children grow up in poverty.

He emphasizes that youngsters in stressful homes are not able to develop normally. Character traits such as perseverance, grit, self-discipline, and the ability to conquer adversity are survival skills. They get fostered in mentoring programs geared for inner-city youth.

There already are isolated community-based projects such as the Harlem Children’s Zone, which have raised awareness of education’s value and the need for family involvement. Unfortunately, funding for such projects remains scarce.

Young people such as Gerardo are channeling their grit – despite cynicism – into an education. Others in similar circumstances commit crimes and cause us to wonder whether they lack humanity. They live on "the edge of the law, the edge of the economy, the edge of family structure and communities," according to then Sen. Barack Obama in his speech at Hampton University in 2007. Depression, posttraumatic stress disorder, and character disorders abound in this population.

Remedies Through Education

Education is cited as the first step in curbing poverty. Learning leads to awareness and the acquisition of marketable skills. But education is a family matter. It should extend to the parents of children at risk. Adults need to know that their children require peace and safety to get homework done and to thrive. Working, devoted parents are role models. The way in which parents eat determines what children consume.

I see in my practice parents whose misconceptions prevent their children from benefiting from learning opportunities. Tutoring is available in public schools but overwhelm parents who say their child’s teacher never advised it. The same reasoning applies to summer school and sponsored summer camps such as the Fresh Air Fund. Sometimes parents fear after-school activities or church groups because they hear of incidents of child abuse on the news. Instead, children languish in front of a TV or play video games; they fall behind academically after inactive summers.

Parent education can make the adults advocates. It should be broadly available in schools and social service agencies. If adults become knowledgeable and improve their judgment, the needs of youngsters will be met.

This is where we psychiatrists have a role. As mental health professionals, we can help parents change their behaviors. We also can work with young people such as Gerardo so that they are able to come to terms with their circumstances and go on to lead prosperous and fulfilling lives. Education and mental health services can help patients overcome poverty.

Dr. Cohen is in private practice in New York. She consults at New York Presbyterian Hospital-Cornell and at the Hospital for Special Surgery.

The greatest of evils and the worst of crimes is poverty.

– George Bernard Shaw, 1856-1950

"I don’t care" was the response from Gerardo when I asked, "Of the people you know, is there anyone who loves you?"

Gerardo was a 17-year-old high school senior who had grown up in poverty. He was planning to attend Stony Brook University on scholarship. Gerardo had been referred for psychiatric evaluation because he slapped his mother, slammed a refrigerator door against her back, and cursed at her.

He was eager to leave his family, including his Ecuadorian mother, who sold burritos from a street stand; his 19-year-old sister, Lola, who lived primarily with her 21-year-old boyfriend; and his 9-year-old half-sister, the daughter of the man who beat him repeatedly.

His biological father, an alcoholic and drug addict, had left when he was 3; his stepfather, Manuel, subsequently became violent toward him, and his mother at times held him down during beatings.

After Manuel left the home, his mother took another man into the house. Fred, a cook in a Chinese restaurant, helped with rent and kept to his room.

Gerardo blamed his mother. "She was never around" and was out selling food. His mother overlooked Manuel’s molestation of Gerardo’s older sister Lola and enabled her son’s abuse. Why?

It was only when Lola took an overdose that New York City’s Administration for Children’s Services learned of the distressed family and intervened.

Gerardo talked about his commitment to school as an entrée into a good position. Still, he was cynical. In a provocative manner, he called school, "boring." He added, "The other option is to find a minimum wage job." With anger, he said, "I am preparing to live in corporate America." His disdain encompassed personal, academic, and family areas.

Is the diagnosis of Gerardo depression or a nascent personality disorder? Does he have posttraumatic stress disorder? One thing was clear: Gerardo, an intelligent adolescent, was emerging from childhood scarred by his experience.

The Toll of Poverty

Poverty is common in the United States. Peter Edelman in his book "So Rich, So Poor: Why It’s So Hard to End Poverty in America" (New York: The New Press, 2012) details that 46 million Americans live in poverty, defined as earning no more than $23,050 yearly for a family of four. Food stamps and housing assistance programs are helpful, but with cutbacks in welfare, there are 6 million people living solely on food stamps.

Edelman, a professor at Georgetown University Law Center, Washington, says that good-paying jobs have gone overseas; the number of single-parent households is on the rise; and the wealthiest have created disadvantages for the poor, resulting in economic crises such as the housing bubble. At present, children rather than the elderly are more likely in poverty. More than 40% of families headed by single mothers are poor.

We view poverty as an economic dilemma, but its psychological consequences are profound. Do poor people develop mental illness or does mental illness cause a slide into poverty? Much controversy exists on this question, but both probably are true. Poverty has far-reaching consequences and creates vulnerabilities. It negatively affects mental health.

Many of the social ills associated with poverty confound with mental illness. Poverty is depressing.

A 63-year-old Hispanic patient described her struggle. Glenda suffers from rheumatoid arthritis, depression, diabetes, and osteoporosis. From supplemental security income, she receives $716 a month. She receives food stamps amounting to $200 monthly. Were it not for her daughter, a school crossing guard, sharing the apartment, Glenda could not afford the rent of $604 a month. "Even clothes, buying a pair of jeans for $35, would stop me from getting things for the house," she said. "I’m angry; it gets me irritated. I like to listen to music, go to concerts, Central Park, but I have no financial means."

She planned to go to a local food pantry in Long Island City because grocery prices are rising.

According to Susan Grange, a social worker and assistant director at a family services agency in Queens: "Poverty leads to depression and hopelessness – no expectations in clients. They are burnt out before they can grow up. Most don’t make it through high school."

The inner-city youth she sees abuse drugs and become sexually active by age 12 or 13 years. If the children succeed, it is because "someone is there emotionally for them." Some recognize the importance of school; others have the financial resources to get mental health assistance.

Apathy among the young is significant as illustrated by Gerardo’s outlook. Domestic violence and sexual abuse wreak havoc in these families.

Education for All

Many focus on formal education of youth as a means of curbing poverty, but the picture is complex. Chaotic family life erodes early brain development.

Neurobiologists find that stress and trauma impinge on development of executive function and impulse control. With these deficits, children fail at school, and a cycle of failure ensues. Evidence suggests that the poorest children do worse as students.

Journalist Paul Tough, the author of "How Children Succeed: Grit, Curiosity, and the Hidden Power of Character" (New York: Houghton Mifflin Harcourt, 2012), studied poor families in Chicago and the ways in which children grow up in poverty.

He emphasizes that youngsters in stressful homes are not able to develop normally. Character traits such as perseverance, grit, self-discipline, and the ability to conquer adversity are survival skills. They get fostered in mentoring programs geared for inner-city youth.

There already are isolated community-based projects such as the Harlem Children’s Zone, which have raised awareness of education’s value and the need for family involvement. Unfortunately, funding for such projects remains scarce.

Young people such as Gerardo are channeling their grit – despite cynicism – into an education. Others in similar circumstances commit crimes and cause us to wonder whether they lack humanity. They live on "the edge of the law, the edge of the economy, the edge of family structure and communities," according to then Sen. Barack Obama in his speech at Hampton University in 2007. Depression, posttraumatic stress disorder, and character disorders abound in this population.

Remedies Through Education

Education is cited as the first step in curbing poverty. Learning leads to awareness and the acquisition of marketable skills. But education is a family matter. It should extend to the parents of children at risk. Adults need to know that their children require peace and safety to get homework done and to thrive. Working, devoted parents are role models. The way in which parents eat determines what children consume.

I see in my practice parents whose misconceptions prevent their children from benefiting from learning opportunities. Tutoring is available in public schools but overwhelm parents who say their child’s teacher never advised it. The same reasoning applies to summer school and sponsored summer camps such as the Fresh Air Fund. Sometimes parents fear after-school activities or church groups because they hear of incidents of child abuse on the news. Instead, children languish in front of a TV or play video games; they fall behind academically after inactive summers.

Parent education can make the adults advocates. It should be broadly available in schools and social service agencies. If adults become knowledgeable and improve their judgment, the needs of youngsters will be met.

This is where we psychiatrists have a role. As mental health professionals, we can help parents change their behaviors. We also can work with young people such as Gerardo so that they are able to come to terms with their circumstances and go on to lead prosperous and fulfilling lives. Education and mental health services can help patients overcome poverty.

Dr. Cohen is in private practice in New York. She consults at New York Presbyterian Hospital-Cornell and at the Hospital for Special Surgery.

The greatest of evils and the worst of crimes is poverty.

– George Bernard Shaw, 1856-1950

"I don’t care" was the response from Gerardo when I asked, "Of the people you know, is there anyone who loves you?"

Gerardo was a 17-year-old high school senior who had grown up in poverty. He was planning to attend Stony Brook University on scholarship. Gerardo had been referred for psychiatric evaluation because he slapped his mother, slammed a refrigerator door against her back, and cursed at her.

He was eager to leave his family, including his Ecuadorian mother, who sold burritos from a street stand; his 19-year-old sister, Lola, who lived primarily with her 21-year-old boyfriend; and his 9-year-old half-sister, the daughter of the man who beat him repeatedly.

His biological father, an alcoholic and drug addict, had left when he was 3; his stepfather, Manuel, subsequently became violent toward him, and his mother at times held him down during beatings.

After Manuel left the home, his mother took another man into the house. Fred, a cook in a Chinese restaurant, helped with rent and kept to his room.

Gerardo blamed his mother. "She was never around" and was out selling food. His mother overlooked Manuel’s molestation of Gerardo’s older sister Lola and enabled her son’s abuse. Why?

It was only when Lola took an overdose that New York City’s Administration for Children’s Services learned of the distressed family and intervened.

Gerardo talked about his commitment to school as an entrée into a good position. Still, he was cynical. In a provocative manner, he called school, "boring." He added, "The other option is to find a minimum wage job." With anger, he said, "I am preparing to live in corporate America." His disdain encompassed personal, academic, and family areas.

Is the diagnosis of Gerardo depression or a nascent personality disorder? Does he have posttraumatic stress disorder? One thing was clear: Gerardo, an intelligent adolescent, was emerging from childhood scarred by his experience.

The Toll of Poverty

Poverty is common in the United States. Peter Edelman in his book "So Rich, So Poor: Why It’s So Hard to End Poverty in America" (New York: The New Press, 2012) details that 46 million Americans live in poverty, defined as earning no more than $23,050 yearly for a family of four. Food stamps and housing assistance programs are helpful, but with cutbacks in welfare, there are 6 million people living solely on food stamps.

Edelman, a professor at Georgetown University Law Center, Washington, says that good-paying jobs have gone overseas; the number of single-parent households is on the rise; and the wealthiest have created disadvantages for the poor, resulting in economic crises such as the housing bubble. At present, children rather than the elderly are more likely in poverty. More than 40% of families headed by single mothers are poor.

We view poverty as an economic dilemma, but its psychological consequences are profound. Do poor people develop mental illness or does mental illness cause a slide into poverty? Much controversy exists on this question, but both probably are true. Poverty has far-reaching consequences and creates vulnerabilities. It negatively affects mental health.

Many of the social ills associated with poverty confound with mental illness. Poverty is depressing.

A 63-year-old Hispanic patient described her struggle. Glenda suffers from rheumatoid arthritis, depression, diabetes, and osteoporosis. From supplemental security income, she receives $716 a month. She receives food stamps amounting to $200 monthly. Were it not for her daughter, a school crossing guard, sharing the apartment, Glenda could not afford the rent of $604 a month. "Even clothes, buying a pair of jeans for $35, would stop me from getting things for the house," she said. "I’m angry; it gets me irritated. I like to listen to music, go to concerts, Central Park, but I have no financial means."

She planned to go to a local food pantry in Long Island City because grocery prices are rising.

According to Susan Grange, a social worker and assistant director at a family services agency in Queens: "Poverty leads to depression and hopelessness – no expectations in clients. They are burnt out before they can grow up. Most don’t make it through high school."

The inner-city youth she sees abuse drugs and become sexually active by age 12 or 13 years. If the children succeed, it is because "someone is there emotionally for them." Some recognize the importance of school; others have the financial resources to get mental health assistance.

Apathy among the young is significant as illustrated by Gerardo’s outlook. Domestic violence and sexual abuse wreak havoc in these families.

Education for All

Many focus on formal education of youth as a means of curbing poverty, but the picture is complex. Chaotic family life erodes early brain development.

Neurobiologists find that stress and trauma impinge on development of executive function and impulse control. With these deficits, children fail at school, and a cycle of failure ensues. Evidence suggests that the poorest children do worse as students.

Journalist Paul Tough, the author of "How Children Succeed: Grit, Curiosity, and the Hidden Power of Character" (New York: Houghton Mifflin Harcourt, 2012), studied poor families in Chicago and the ways in which children grow up in poverty.

He emphasizes that youngsters in stressful homes are not able to develop normally. Character traits such as perseverance, grit, self-discipline, and the ability to conquer adversity are survival skills. They get fostered in mentoring programs geared for inner-city youth.

There already are isolated community-based projects such as the Harlem Children’s Zone, which have raised awareness of education’s value and the need for family involvement. Unfortunately, funding for such projects remains scarce.

Young people such as Gerardo are channeling their grit – despite cynicism – into an education. Others in similar circumstances commit crimes and cause us to wonder whether they lack humanity. They live on "the edge of the law, the edge of the economy, the edge of family structure and communities," according to then Sen. Barack Obama in his speech at Hampton University in 2007. Depression, posttraumatic stress disorder, and character disorders abound in this population.

Remedies Through Education

Education is cited as the first step in curbing poverty. Learning leads to awareness and the acquisition of marketable skills. But education is a family matter. It should extend to the parents of children at risk. Adults need to know that their children require peace and safety to get homework done and to thrive. Working, devoted parents are role models. The way in which parents eat determines what children consume.

I see in my practice parents whose misconceptions prevent their children from benefiting from learning opportunities. Tutoring is available in public schools but overwhelm parents who say their child’s teacher never advised it. The same reasoning applies to summer school and sponsored summer camps such as the Fresh Air Fund. Sometimes parents fear after-school activities or church groups because they hear of incidents of child abuse on the news. Instead, children languish in front of a TV or play video games; they fall behind academically after inactive summers.

Parent education can make the adults advocates. It should be broadly available in schools and social service agencies. If adults become knowledgeable and improve their judgment, the needs of youngsters will be met.

This is where we psychiatrists have a role. As mental health professionals, we can help parents change their behaviors. We also can work with young people such as Gerardo so that they are able to come to terms with their circumstances and go on to lead prosperous and fulfilling lives. Education and mental health services can help patients overcome poverty.

Dr. Cohen is in private practice in New York. She consults at New York Presbyterian Hospital-Cornell and at the Hospital for Special Surgery.