I have treatment resistant depression. I’m aware of all the problems with labels and the flaws in the diagnostic system, but for my purposes today I’m using this designation as a place holder, a short hand of sorts. It holds a place for all the days I’ve spent in bed and all the hopelessness I’ve felt, wide as the sky, deep as the ocean. Whatever this thing I have is, I’ve come by it honestly. Major depressive disorder and debilitating anxiety are smeared in an unbroken line from my generation backwards in time to my great-grandparent’s generation. You need only go back one generation to find family members institutionalized for ‘nervous breakdowns’ and suicide attempts, repeated rounds of electroconvulsive therapy, lobotomies. I have lobotomies in my family for God’s sake.
Needless to say, my psychiatrist has advised me to stay on my medications indefinitely. My reproductive psychiatrist concurred, saying that even in pregnancy I am likely to pose less risk to a fetus drugged up than sad. But listen, depression is cyclical, and when money is hard to come by and my mood is bright, it’s hard to imagine these doctors have any idea what they are talking about. It’s easy to start wondering if you ever really even had depression in the first place? Maybe I was just very very bored, like a smart kid misbehaving at their desk? Maybe I was under-stimulated, but not depressed at all? Maybe I had walking pneumonia? Maybe I wanted an excuse to be lazy, to hide, to do nothing at all, to be taken care of? Maybe this is just the human condition? Perhaps everyone feels this way? Maybe I’m remembering it so much worse than it ever was? A million good reasons to ditch the drugs float through my mind, all undergirded by the naive optimism of “I’ll probably be fine”.
Also, my medication costs $400+ a month. I once had a psychiatrist who helped me get this fee reduced to almost nothing, but she was like a magician and thus far nobody has been able to help me replicate this trick. As a student, my university covered exactly zero of this fee, and I have no health coverage at my current job. Sometimes all my credit cards are maxed out and I quite literally cannot afford the medications at the end of the month, and sometimes my more reckless side simply begins dreaming of everything fun I could do with an extra $400 a month.
In any case, in my experience, going off my medication has generally been a disaster. It jeopardizes my stability at school and at work, which in turn stands to put me in even more dire financial straits. And all this without even mentioning the cost of therapy, which is a luxury that someone in my position cannot even contemplate. Counselling generally costs anywhere from $120-$200/h and this is either a weekly or biweekly cost. Depending on who you see, it may or may not be covered by extended healthcare, but those without extended healthcare are shit out of luck.
This is just one very obvious and direct way that poverty leads to mental illness or decreased mental health. This is a direct line. I’m not the only one with this problem. Mental health care is expensive, and I suspect that even those who are not living beneath the poverty line often have trouble covering its costs. It’s a systemic problem, which at heart is an empathy problem, a failure of the imagination. Those who are mentally well, either by chance of easeful genetics or because they are able to engage in appropriate self-care and treatment, may have difficulty imagining those who are neither well, nor well-resourced. This failure of the imagination is reflected in public policy. I am just the tip of this iceberg.