Poverty as a consequence of and determinant of Poor Mental Health

In his article, “Water Flowing North of the Border: Export Agriculture and Water Policies in a Rural Community in Baja California” Christian Zlolniski uses an ethnographic analysis of how the production of fresh water in the San Quintin Valley in Baja California for consumer markets in the United States affects access and distribution of scarce water resources among different social groups in this region. In addition, he explores the connections between the neoliberal economic policies that drive the growth of the global fresh produce industry and the ways in which they shape regional power and differential access to water along class and ethnic lines. Access to clean water is one of the most basic human needs. Unfortunately, according to the International Medical Corps, one in eight people do not have access to safe drinking water. Without clean water and sanitation, public health cannot be achieved.  The majority of people who do not have access to clean water are poor. Thus, unsafe drinking water, and unequal access to clean water is one of the consequences of poverty. In addition, malnutrition from unsafe drinking water or no water stunts physical and mental health. The relationship between water and poor mental health is not direct, rather it is correlated through low socioeconomic status. For example,  Psychiatric conditions, which not only occur at higher rates in the poorest areas, but also cluster together, usually in disintegrating inner-city communities or agricultural communities like San Quintin Valley. While money is not a guarantor of mental health, nor does its absence necessarily lead to mental illness. However, it is generally conceded that poverty can be both a determinant and a consequence of poor mental health. Relationships between social status and various aspects of mental disorder have long been of interest to both clinicians and researchers, and a large body of research exists showing the importance of social status in understanding psychiatric illness and disability. Epidemiological studies throughout the world have demonstrated an relationship between mental illness and socioeconomic status. Further, these studies have shown that mental disorders have been consistently shown to be more common among people in lower social classes. Addressing poverty in such communities can not only give them access to clean water but can also alleviate poor mental health symptoms as well as prevent them.

The Role of Epigenetics in Mental Health

This weeks readings discuss the emerging field of Epigenetics, the study of how people’s experience and environment affect the function of their genes. Specifically, these readings talk about nutritional epigenetics such as the article by Hannah Landecker, “Food as Exposure.” In this article she uses nutritional epigenetics to understand the relationship between food and health by using nutritional epigenetics to seek to understand how the molecules in food affect long-term health through their interaction with the molecules that mediate gene expression in the body. In addition to food, epigenetics also plays a role in mental health. For decades, researchers have been trying to search for a gene or a common variation in genes that combine to cause debilitating mental illnesses such as schizophrenia and bipolar disorder. Their efforts have been stalled however as while there is genetic disruptions, no single gene or genes has been found to account for even a fraction of cases. Researchers have now turned to the field of epigenetics to understand the missing link between behavior and genetics. Numerous studies on animals have shown that epigenetic markers develop as they adapt to their environment and thus can profoundly affect behavior. Epigenetic markers refer to the chemical attachments in genes that regulate where or how much protein is made. As a result of these studies, it is hypothesized that genetic markers likely hinder normal development in persons diagnosed with a mental illness. For example, the offspring of parents who experience famine are at heightened risk for schizophrenia, some of the research suggests because of the chemical signatures on the genes that the parents passed on. The role of Epigenetics in mental health is profound: Until recently, heritable illnesses such as schizophrenia and bipolar disorder (many of whom end up in the corrections system) were presumed to be genetic in nature. Now, these disorders are thought to be epigenetic. The role of epigenetics in mental health can help mental health care workers better understand how to treat these individuals so their behavior does not cause them to get in trouble, harm themselves or harm others.

Homelessness amongst the Mentally Ill

In chapter 6 of “Awakening Hippocrates,” Edward O’Neil discusses the forces of inequality that continue to keep the lives of the poor unchanged. In this chapter he discusses how financial forces foster unequal and unsustainable world economic order. The homeless mentally ill is one of the United States’s biggest issues. According to the National Coalition for the Homeless, approximately 20 – 25% of the single adult homeless population suffers from some form of severe and persistent mental illness. While 22% of the American population suffers from a mental illness, a small percentage of the 44 million people who have a serious mental illness are at increased risk for homelessness at any given point in time. Specifically, low-income people with mental disorders are at increased risk for homelessness. Thus, poverty and homelessness can both be caused by mental illness and drive persons to become mentally ill. As I discussed in my first paper, the history of deinstitutionalization and the denial of services or premature and unplanned discharge brought about by managed care arrangements in the United States that may be contributing to the continued presence of seriously mentally ill persons within the homeless population. Unfortunately, mental health services is one of the first to but cut during a time of economic crisis. For example, my uncle who is diagnosed with paranoid schizophrenia and bipolar disorder was denied access to his psychiatrist and to his medications because of state budget cuts in California. As a result, his mental health greatly deteriorated and he was at great risk for becoming homeless. Community mental health services need to be expanded and social security benefits need to be increased greatly in the United States if we are ever going to make a dent in this growing issue.

 

The Death Penalty and Mental Illness

He did a terrible thing, but he was sick. Where is the compassion?
Is this the best our society can do?” – Yvonne Panetti, mother of Scott Panetti, mentally ill man on death row in Texas (Milwaukee Journal Sentinel, December 6, 2003)

Michel Faucalt introduces his concept of biopower in Part 5 (Right of Death and Power over Life) of his book The History of Sexuality. In earlier times, the sovereign had the right of life and death over his subjects. The power exercised by the sovereign was simply a matter of deciding whether or not someone would be killed. Faucalt suggests that today this power has shifted because the interest of power is now in life, and how to secure, extend and improve it. The Death Penalty, Faucalt suggests is one example of how biopower ia practiced by modern states. The Death Penalty, once a vengeful act of destruction, is now  seen as as a way of eliminating a menace to society and therefore protecting it. Faucalt’s analysis of the death penalty is correct in its assumption that we control the life (or as he would say, body) of one person in order to protect society. However, how we decide who gets the death penalty and why, is not so clear. The execution of the mentally ill is prohibited under international law. In the United States, the execution of the “insane”, defined as someone who does not understand the reason for, or the reality of, his or her punishment is a violation of the U.S. Constitution. However, it still happens According to the The National Association of Mental Health, about five to ten percent of those on death row have serious mental illness. One well known example is Scott Panetti, a man on death row who is convicted of killing his parents in law and a long history of schizophrenia, manic depression, auditory hallucinations and paranoia. In my paper, I will argue that this type of biopower is inappropriate for persons who are mentally ill. Punishment, especially punishment by death is not the appropriate way to protect society from a person who has a mental disease. Rather, persons with mental illness who have committed murder and other violent crimes (which is very rare) should be subjected to treatment. It is the gaps in our health care system that cause the mentally ill to go untreated and thus their symptoms lead to erratic behavior. We need to protect these bodies, protect their lives; not take them away.

Exclusion of the Mentally Ill through Solitary Confinement

In chapter three of his book, Discipline and Punish, Michel Foucault argues that modern society increasingly controls and administers the docile subject through individualization. He uses the metaphor of the Panopticon, a circular prison designed by the 19th century English reformer Jeremy Bentha. Foucault’s central thesis is that asylums, hospital and prisons are devices used by society to exclude certain groups and that these social attitudes represent the deployment and use of power. This argument is at the heart of what I am trying to unveil in my paper: how and why the mentally ill are being put in prisons. In the U.S, the use of segregation to confine the mentally ill is widespread and growing. Even though they are designed and operated as a place of punishment, prisons have become a de facto psychiatric facility despite a serious lack of mental health facilities. In essence, the mentally are put under solitary watch. Isolation is difficult for anyone to withstand, but it is especially detrimental for a person with mental illness. The stress, lack of  social contact, and unstructured days can exacerbate symptoms of illness or provoke recurrence of them.  In consequence many mentally ill prisoners end up requiring crisis care or psychiatric hospitalization due to their isolation. Even if they get this care, they will most likely not get better because they will continue to be isolated.
Isolation is a key concept in my paper. It will better help my reader to not only understand the history of the how’s and whys behind this national issue, but also why it’s important that we address it.

Ontology of Madness

Franz Fanon refers to ontological blackness, the social-psychological notion of ‘self-identity’ in relation to the “fact of being a black person,” in chapter 5 of his book, Black Skin, White Masks. As a part of my quest to answer how and why the mentally ill have become criminalized, I have come to realize the importance of identity, self-identity and labeling. The classification of the mentally ill as a “mental disorder,” “disease,” and “illness” has existed in U.S. history for over 100 hundred years. However, it is still unclear what these classifications actually denote. Thus, we are labeling people with a cluster of symptoms with out actually understanding what these labels mean. As we can see from Fanon’s example, this kind of identification has negative consequences for the person(s) labeled. The mentally ill person, just like “the black man” faces the burden of being such while struggling with their own self-identity and self determination. Once someone is labeled as mentally ill, they are “it” and everything else about them is suspect as well. These are human beings who happen to struggle with emotional experiences that are uncomfortable and distressful. It does not define them. We have to examine the full depths of a person rather than subject them to a single word or label. Further, these persons can come to self identify themselves as only “mentally ill,” rather than say, a musically talented woman with a passion for animals. Thus, mental illness can also be a self fullfilling prophecy.

However, in our society this labeling of a mentally ill person is evident in society’s history; the media, the police, the corrections system and even the health system. I will argue that the criminalization of the mentally ill is in part due to what I will call ontology of madness- the notion of self identity in relation to being a mentally ill person.

What Mental Illness Looks Like: Brain Matter Loss in Schizophrenia

Joseph Dumit, in his paper “Objective Brains, Prejudicial images,” argues that although there are no necessary connections between an abnormal brain and an insane person, “popular portrayals of the brain continuously reiterate the chain of associations than an abnormal brain implies mental illness which implies insanity.” In todays U.S. courtrooms, PET scans, CT scans and x-rays are being used to determine whether a defendant is legally insane at the time of the crime and is competent to stand trial. He argues that these images are not seen as prejudiced representations of correlation between abnormal brain and mental illness, but as a “straightforward, objective photographs of…madness.” This perception implicates that mentally ill persons have defective brains compared to the brains of non mentally ill persons. By claiming that these images are evidence of what mental illness looks like, scientists are creating an”us” and “them” mentality that may rob mentally ill persons of accurate treatment. Inaccurate treatment further progresses the behavioral symptoms of mentally ill persons which can lead them to act out, and become imprisoned. Further, this perspective does not take into account the social, environmental and economic forces shaping the causes of Schizophrenia A primary example of this is the claim that Schizophrenia is a brain disease that is caused be a physically defective brain. In support of this theory are brain scans of schizophrenic persons who have shown to have significantly less brain matter than non schizophrenic persons. However, the correlation between brain matter loss and schizophrenia may actually be due harmful effects of antipsychotics, the most common treatment for Schizophrenia. Thus, psychiatrists are claiming these images prove schizophrenia directly effects the brain, when in fact, a medication with harmful effects may be to blame. Perhaps brain images of the schizophrenia persons can be used in my paper as a case study of how discrimination of the mentally ill is due to inaccurate portrayals, prejudice and stigma.

Stigma, Prejudice and Discrimination of the Mentally Ill

– WordPress finally let me upload this! Did any one else have issues?

In Yanqiu Rachel Zhou paper “If you get AIDS…You have to endure it alone”: Understanding the social constructions of HIV/AIDS in China,” she explores how HIV/AIDS, as a social construct in the Chinese context, are understood by the individuals in their daily encounters with family, friends and health works. In China, there has been widespread discrimination toward people living with HIV/AIDS due to general ignorance and misconceptions about the disease. HIV/AIDS is one of many diseases that have been socially constructed in this way. For instance, the stigma of mental Illness -the negative attitudes toward and rejection of the mentally ill still exists in the United States despite numerous efforts to combat it.  This stigma discourages mentally ill persons from getting help because they do not want to be labeled as “crazy,” or “insane.” It leads to employers reluctant to hire mentally ill persons despite the American Disabilities Act. The media’s portrayal of mentally ill persons as “violent,” leads to fear, mistrust and even violence towards them. Most importantly, this social stigma results in inadequate treatment and medication and also limits access to community health centers. Finding out why this stigma exists is crucial to understanding how mentally ill persons end up homeless or in prison with inadequate treatment, the topic of my paper. In her paper, Zhou applied Goffman’s Social Stigma to explain the prejudice toward HIV/AIDS infected people in China Erving Goffman’s theory of social stigma states that “a stigma is an attribute, behavior, or reputation which is socially discrediting in a particular way: it causes an individual to be mentally classified by others in an undesirable, rejected stereotype rather than in an accepted, normal one.” I will apply Goffman’s theory in my paper in order to explain the stigma of the mentally ill and how it leads to prejudice and discrimination.

Impact of Deinstitutionalization in the United States

In his article, Modernity, Cultural Reasoning, and the Institutionalization of Social Inequality: Racializing Death in a Venezuelean Cholera Epidemic,” Charles L. Briggs explains the long term impact of institutional responses to the cholera epidemic as a significant worsening of social, economic and health conditions in the country. Another example of institutional responses lead to long term negative impacts is the deinstitutionalization of mentally ill persons in the United States. In the 1960’s, a social-political movement, known as deinstitutionalization, occurred as a process of replacing long-stay psychiatric hospitals with less isolated community mental health centers for those diagnosed with a mental disorder or a developmental disability. This movement was based in part as a alternative to he asylums which were notorious for poor living conditions, lack of hygiene, ill-treatment, overcrowding, starvation and abuse of patients. Although deinstitutionalization as been relatively positive for some of the patients, it has severe consequences and adverse outcomes for many. For example, the new community services are uncoordinated, unable to meet complex needs and are socially isolated from the public. Further, patients in the community services are often discharged without sufficient preparation or support. As a result, a greater proportion of mentally ill persons become homeless or go to prison. The impact of deinstitutionalization gives an explanation for the topic of my paper, the inadequate treatment of mentally ill persons in U.S. prisons. Without access to adequate support and treatment, mentally ill persons are often brought into the justice system when their behavior leads them to commit criminal, often petty, offenses. Research has shown that not only is the prison environment an inadequate form of treatment for mentally ill persons, it is also dangerous and debilitating.

      

Racial Bias in the Diagnosis and Treatment of Minority Mentally Ill Prisoners

In their article on Race, Ethnicity, and Health: An Intersectional Approach, Lynn Weber and M. Elizabeth Fore examine the relationship between health and race, ethnicity and other intersecting systems of inequality. They define health disparities as “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the U.S.” In the United States, one such  health disparity exists in the diagnosis and treatment of mentally ill minorities in prisons. This trend is related to the inadequacies of community and mental health systems and services. Racial bias exists when racial and ethnic minority patients, without adequate mental heath services, are frequently mislabeled as criminals rather than as individuals suffering from a mental disorder. As a result, they end up in prison where they are often misdiagnosed and rejected from appropriate treatment and medication. This is one of the many issues related to my paper topic on inadequate treatment of mentally ill prisoners in the United States. Our correctional system has become the greatest provider of treatment for the mentally ill in the country. In 1999, the U.S. Department of Justice reported that 16 percent of all inmates in state and federal jails had severe mental illness. In my paper I will argue that our correctional system is inadequate in providing treatment for mentally ill persons. I will discuss the issue that minorities with mental disorders are more likely to end up in prison and receive this inadequate treatment.