33% people in India live below the international poverty line of a daily wage of $1.25. Indian governments have conveniently manipulated the poverty line as per their wish to show fudged numbers of poverty in India. In recent years, rural electrification is seen as a major driver of poverty rates down. Electricity has increased the opportunities for rural people, empowered women and even encouraged girl child education in many places. The electric spark is driving India into the modern age.
Stigma, Poverty and Mental Health
It is a common belief that people who are poor are more likely to suffer from a mental illness. Something that hasn’t been investigated or reported on often enough is how severe mental illnesses can lead to poverty. Also, how stigma plays such a destructive role in the lives of people with severe mental illnesses.
When we talk about stigma, there are two broad types of it. One is social stigma and the other is self stigma. For people with severe mental illnesses, self stigma and social exclusion play the major roles in them having poor social standing and a low self esteem. People with mental illnesses are often demonised to the point that even they start hating themselves. This is known as self stigma. It is something that is present in a huge chunk of the global population of people with severe mental illness.
The unfair or discriminatory treatment meted out to mentally ill people can result in creating a barrier as the patients struggle or are even pushed away from seeking a medical intervention.
Women, Reserved Classes and Poverty
The same study that came to the conclusions listed above also highlighted the disproportionate deprivation of resources for women and people from lower castes who suffer from a mental illness. Stigma linked to various marginalised groups has the power to accelerate and intensify exclusion and related discrimination.
Women have to face this stigma in two ways. First, since they are unable to fulfil family roles, they are considered a burden on the family and hence treated poorly by other family members. Second, the prevalence of superstitions in the Indian society makes people believe that women who are mentally ill are under the evil influence of demons or spirits and must be treated through faith rather than through counselling and medicines.
The reserved classes (SC/ST/OBC) have to face further stigma when it comes to accessing education centres or job opportunities. Even though reservations and various governmental policies have been put into place to reduce the stigma, they have largely been ineffective or disproportionate. This perpetuates a cycle of powerlessness and dominance over the people from lower castes. This is then further intensified for people with mental illness.
It is hence clear that negative feedback loop exists. Stigma reinforces mental illnesses which then lead to more stigmatisation. This is particularly more evident in people from lower castes and women. Another aspect is the shame and stigma felt by the primary care givers of the sufferers. This includes things like feeling embarrassed or ashamed of being associated with people who are mentally ill. Mentally ill people are sometimes even shunned by their own families and this leads to homelessness poverty for them. Even if they belong to highly educated and resourceful families, the threat of social exclusion and being pushed to the sidelines of the family remain major threats for the sufferers.
Hence this brings me to a question I ask myself often, must a lack of financial resources also mean that we are empathetically bankrupt as well?
Trani J, Bakhshi P, Kuhlberg J, et al, Mental illness, poverty and stigma in India: a case–control study, BMJ Open 2015;5:e006355. doi: 10.1136/bmjopen-2014-006355