Mental health, the economy, & the false dichotomy between individual vs. structural solutions
Money, parental mental health, climate change, & the American dream
Note: Apologies for my inconsistent presence in your inbox. Life has been chaotic (though when is it not?!) I’m hoping to return to regularly scheduled programming in the next few months. Thanks for your patience!
Money matters for our mental health. Recently, there has been a lot of news coverage on the apparent influence of economic policies on infant brain development, with headlines like, “Cash Aid to Poor Mothers Increases Brain Activity in Babies, Study Finds” (NY Times)1 or “Infant Brain Study Helps Make Case for a Universal US Paid Leave Policy” (Neuroscience News).
The same is true for adults, too. Earlier this month, I attended a fascinating talk by MIT economist Frank Schilbach at the Society for Affective Science (virtual) conference on the relationship between poverty and mental health. He presented evidence that when people get the financial resources they may desperately need, their mental health improves. In a study by Christian and colleagues (2019) from The Review of Economics and Statistics, the suicide rate in Indonesia fell by 18% after the government implemented a national cash transfer program to households (providing families with approximately 10% of what they spend every year). Similarly, American economists have argued that increasing the minimum wage would significantly decrease suicide rates in the United States.
Additionally, improving mental health can directly impact the economy. Relevant to this newsletter, Schilbach mentioned a study by Baranov and colleagues (2020) (published in American Economic Review) that examined the long-term effects on families after mothers received treatment for depression. Hundreds of depressed pregnant women in rural Pakistan received home visits from community health workers who delivered either 1) cognitive behavioral therapy to treat depression (treatment condition), or 2) only routine physical health care (control condition). Visits started when women were in their third trimester and continued through ten months after delivery.
The researchers kept track of 585 women for seven years after the study ended. After six months, only 25% of the women in the treatment condition still met criteria for depression, compared to 58% in the control condition. Significant differences between the groups persisted seven years (!) after treatment ended, though to a lesser extent (24% of women in the treatment group met criteria for depression, compared to 30% in the control group). These findings are pretty cool all by themselves: cognitive behavioral therapy (an evidence-based talk therapy) delivered by non-specialists (health care workers without graduate degrees) had a major impact on improving women’s mental health.
Interestingly, they also found that women (and their families) benefited economically from being in the treatment group. Women in the treatment group were more likely to be employed and have control over their spending, among other aspects of what the researchers defined as having “financial empowerment,” compared to women in the control group. This suggests that improving maternal mental health may be important in contributing to gender parity related to responsibilities traditionally associated with men in this culture. Parents from the treatment group were also more likely to invest financially in their child’s education and spend more time with their child, including playing with them and helping them study. Maternal mental health may be especially crucial for parental investment in girls, as the researchers noted that their findings were particularly pronounced for mothers of girls. Addressing a mother’s mental health appears to not only help her feel better, but promote her ability to contribute economically and improve her family’s financial (and emotional) investment in their children.
Economic forces shape mental health, and, in turn, mental health influences the economy.
We often don’t think of mental health as being a structural or sociological problem akin to poverty or climate change, but it is. Depression is one of the leading causes of disability worldwide. The quality of mental health treatment, just like physical health treatment, varies widely depending on many societal factors, such as one’s socioeconomic status, race, or whether one lives in a rural or urban environment. I found Schilbach’s talk invigorating for many reasons, not least of which was its treatment of mental health as both an individual and a structural problem, thus requiring both individual and structural solutions. Of course, such solutions are necessary to address so many of our most intractable issues.
So what’s stopping us?
Let’s talk about a study on climate change that lives rent-free in my mind (bear with me). Werfel (2017) published a study in Nature Climate Change where he surveyed over 14,000 people in Japan after the Fukushima power plant shutdown. He found that when people were asked to list their individual actions to address their energy use (e.g., recycling), they were less likely to support a tax increase on carbon emissions, compared to people who didn’t list these actions. He also found that the more energy-saving actions people reported, the stronger the effect. He argued that individual actions may “crowd out” public support for structural solutions because of the “perception of sufficient progress.”
In other words, when we think we are doing a lot individually to address something big like climate change, we can end up not supporting structural solutions that would have a more significant impact.
It’s like when a suburban white family puts a “Black Lives Matter” sign in their front yard while simultaneously voting against measures that would add more affordable housing in their neighborhood. Or how some people may have no problem offering to babysit a friend’s child so she can attend a therapy session, but have an issue with universal paid family leave policies. In these examples, an individual action is thought to be sufficient over a structural solution that would actually do more for improving racial equality and parental mental health (respectively).
We do this in part because focusing on our individual actions makes us feel good about our choices and more in control (“I’m doing my part by recycling!”). On the other hand, focusing on structural forces is complicated, inconvenient, and usually makes us feel bad and like we have no control (“Umm how do I even contact my representative? What’s a carbon tax?”)
It’s dangerous to believe that one’s individual actions are enough to fix problems like climate change, racism, a pandemic, student debt, or mental health. This focus on individualism is the dark side of the “pull yourself up by your bootstraps” American fantasy, the false notion that our achievements are based on our hard work and being “deserving” rather than luck and privilege. If our grit and determination are not enough to fix a problem, well, hmm, maybe we should just not focus on that problem. Or, worse, we start believing that people different from us, people we perceive to be weaker and lesser than us, are really to blame for these issues.
Becoming a parent is an important crossroads for this type of thinking. It’s easy to become myopically focused on improving the life of your child, at times to the detriment of thinking about the well-being of all children (something I’ve written a bit about before). However, it can also be a time to reflect on and start addressing previously unseen structural inequities (hello, becoming a parent during a global pandemic!)
The talk on poverty and mental health dovetailed nicely with another great talk I attended by Neil Lewis, Jr., social psychologist at Cornell (and all-around great Twitter follow). In his talk, he discussed his research on addressing racial and socioeconomic disparities in higher education, including the importance of both individual and structural solutions to those issues, too. On Twitter, he quoted from one of his papers:
There has been an unhelpful...divide...about whether structural level or individual-level approaches are the 'right' way to move forward, as if those factors operate independently in the world...between the two extremes of individual-level interventions and structural-level interventions, are mixed approaches that capitalize on the affordances of each strategy and assess the effectiveness by examining the outcomes that one should reasonably expect at different timescales of change.
Mental health, just like other structural problems, requires both individual and collective action.
We can reduce our family’s energy consumption AND support policies on curbing carbon emissions from giant corporations to address climate change. We can seek therapy when we feel depressed AND support economic policies, including affordable and accessible health care, that would improve mental health for everyone. Let’s not pat ourselves on the back for doing the bare minimum without committing to the hard, necessary work of addressing the structural forces that maintain the vast inequalities in so many sectors of our lives. When I was pregnant, earning a few extra dollars an hour would have been nice, but it was not the difference between life and death for me. I refuse to settle for a world where we are complacent about this being true for any parent.