The first question. What does it mean to be poor? The government defines poverty with a number and this number comes from the norms of a given society. Here in British Columbia, the LICO (low-income cut-off) is $24,600, such that a single person making less than this amount is thought to be living in poverty, or poor, or impoverished, or low-income. But the reality of what is means to live in poverty extends beyond the idea of low income. Being poor means being isolated from social services and resources, being restricted from participation in many aspects of cultural life, being stigmatized and discriminated against, living in a perpetual state of hopelessness, experiencing unmediated physical and psychological pain, being exposed to dangerous and/or dehumanizing conditions.
Let’s unpack some of the ways poverty can aversely affect mental health.
In an economy where 2/3’s of jobs require a university degree, and attending university carries exorbitantly high costs, living below the poverty line often means accepting dangerous and dehumanizing occupations such as factory work, various jobs in the service industry, construction work, sex work. It can mean working in jobs that are temporary, offer no job security, no healthcare benefits, and less than a living wage. Remember, a minimum wage DOES NOT equal a living wage. In British Columbia minimum wage is $11.35/h, whereas here in Vancouver a living wage is nearly $21/h. Let me be clear: I do not mean to imply that all construction workers or all factory workers or all sex workers find their jobs dehumanizing. Construction work for example, is not inherently dehumanizing. What is dehumanizing is a person’s lack of agency, their lack of options, their inability to choose, the lack of dignity and security afforded to them as employees.
Adderall is a drug that is often abused by factory workers, and anyone who has ever taken it can understand why. Adderall is a methamphetamine that works by increasing the amount of dopamine and norepinephrine in the brain. The net effect of this increase is hyper-focus and a limb-tingling euphoria. One can imagine why this euphoria would be necessary if one was processing dead livestock and euthanized pets at a rendering plant 12 hours a day. Can you imagine what it’s like to work 60 hours a week for 10$ an hour, inspecting and stuffing exactly 10 pieces of tuna into aluminum cans wearing rubber gloves and a rubber hair net?
In sum, poverty leads to shitty repetitive and dangerous jobs without benefits or security. To top it off, being exposed to dangerous and depersonalizing stressors rarely results in making enough money to provide for oneself and one’s family.
On the subject of unmediated pain. Two and a half years ago I needed an emergency root canal. The bad news was in: the cost would be over $3000 dollars and none of it would be covered by healthcare. The Canadian healthcare system posits through policy that the eyes and the teeth and the mind do not belong to the body and are thus not deserving of coverage. I imagine this person, with dark hollow sockets for eyes, like veined rotten peach pits on either side of the nose; a toothless grin like a baby ingesting pablum or broth through a straw. And how to even imagine a person without a mind? The body and the mind are intertwined, it goes without saying.
The pain of my rotten molar was so bad it made the bones in my face hurt. It made my ears whirl. Whenever this tooth came into contact with anything apart from lukewarm water, it literally flattened me. Sometimes pain sends you into the fetal position, but this pain was so bad I would end up prone on the ground, as if in an exaggerated form of prayer. Terrible pain obliterates everything and refines the mind. Everything extraneous, even the urgency of fear, is pushed off the cliff of consciousness. In this way, pain is some sort of terrible mindfulness. My teeth had been hurting for a long time. So had my husband’s. At the time my husband and I had not seen a dentist in over and almost a decade, respectively. He needed his wisdom teeth removed and many fillings, I needed many fillings and major reconstructive work to repair the damage caused by many years of eating lemons. These problems caused minor discomfort on a regular basis, but it was something we tolerated, absent better options. It wasn’t until the thought-obliterating pain made its appearance that I turned to my Dad for help. My Dad paid for my root canal. He called the dentist and gave them his credit card number. It was so simple, so clean. But I have a Dad with a credit card that isn’t maxed out, who is willing to help pay for my rotten teeth, and I know most people don’t have that.
So what happens to people who cannot pay to make the pain go away? And when you are living in constant pain, what does that do to the psyche? I remember reading somewhere that teeth are one of the most obvious indicators of socioeconomic status. To wit, people of lower economic status die with eight fewer teeth than their affluent counterparts (Journal of Dental Research).
I’m not equating myself with those most economically marginalized people in our society. As I have said, and it bears repeating, I am a caucasian cisgender female who grew up with an affluent immediate and extended family. A family whose support I continue to benefit from on a daily basis. In fact, I think of my life as one of those bubbles you blow that contain another smaller bubble. I live in the smaller bubble, and in that smaller bubbles I have always had trouble making ends meet; in that smaller bubble is where I have sore teeth that need root canals and fillings. In this smaller bubble, I can link my struggles with money with my struggles with mental health. But the smaller bubble is contained within a larger bubble that is full of people I can go to when things get bad. And this is a luxury very few people have.
I read this post aloud to my husband and asked for his feedback. He said that in addition to living in a small bubble contained within a larger bubble, that I needed to clarify–having a glimpse of what it feels like to not have basic needs met is NOT tantamount to living in poverty. When you have a social safety net and theoretical access to funds like I do, you do not know what it is like to live in poverty. I agree with him.
Poverty is a spectrum, and it extends from the people with the very least to those who live in excess. In between are those who live pay check to pay check or perhaps off the generosity and support of the family they did nothing to deserve. Those truly living in poverty may be exposed on a daily basis to danger, boredom, pain, desperation–life is full of chronic stressors which inevitably pave the way for depression, anxiety, ptsd, substance abuse and misuse, and all the riches the DSM has to offer.