The role of the social environment in the creation of mental distress is still not given sufficient attention. Why is this important?

For most of us, adversity is bound to be a part of human experience. We are all created equal and have the same opportunities—or at least, that is what system within which we live today says. In theory. In practice, we don’t all have the possibilities to get there. We have diverse education, social contacts, or psychological resources to begin with. Maybe some of us are members of groups which were historically underprivileged and have to start by fighting with the remnants of that marginalization.

Every woman whose female ancestors had to stay at home instead of following their dreams based solely on their gender knows how this feels in her bones, even long after her loving ancestors are gone. Every racial or ethnic minority who has been looked at as different within the local community knows how it feels within their body. Having to endure hardships within everyday encounters, or systemic injustice, makes a great difference to one’s ability to thrive in life and may sooner or later cause mental distress.

Then there are economic insecurities. Less economic possibilities means survival mode. If one’s basic existential needs are unmet, one’s whole focus and energy will go to that area. Since there will be no energy left for emotions, they will be left buried, denied, not felt. This will all leave its mark on mental health.  If you ever had to worry if you will be able to pay your heating bills, you probably know how this existential insecurity comes down to anxiety that does not subside long after this danger is gone. All of this is also linked to mental distress.

Human beings need a certain level of security to thrive in life, and not all of us have this. We do not all have the same resources to live a good life. All of this is not unrelated to mental health. One’s mental health is greatly determined by the level of adversity one has to face in one’s life, from starting positions onwards. This is recognized even by the World Health Organization.

For example, a meta-analysis of the global research by Vikram Patel and colleagues reported evidence that low socioeconomic position is associated with increased rates of depression. Also, studies show that children growing up in less privileged socioeconomic context have higher risk of developing mental distress. An analysis of population surveys in European countries found that higher frequencies of mental distress are associated with low educational attainment, material disadvantage, and unemployment.

One wonders then—why isn’t the role of social context sufficiently recognized in the prevention and tackling of mental health distress? There is room for improvement here. I am not saying that psychotherapy cannot help here, because it sure can. However, in this sense, the field of psychotherapy is often in a bit of a difficult position today. Namely, it is bound to work with problems created in a certain social context, but it often has to solve them without being able to tackle the systemic characteristics of that exact context. Yet, how is that possible—to transfer certain psychological resources from the healing setting to a wider social setting where the power processes are at odds with this? What if the situation outside of the healing setting is stronger than the individual agency allows?

What if a person’s mental distress is related to oppressive power relations, where inequality is experienced on a daily level and is based on social relationships beyond their individual scope of possible action? Maybe the situation of living in poverty and not being able to afford basic living expenses results in a depression? Maybe the wider social life is robbing a person of her dignity, as in the cases of the daily encounters with racism, sexism, or homophobia. Rollo May, one of the leading existential psychologists of all time, located the feelings of apathy and anxiety felt in contemporary times precisely within the powerlessness and helplessness which modern individuals feel when faced with a wider social context in which their ability to influence things is not sufficient for change.

Maybe it can be worth revisiting some existing methods that have not garnered enough recognition, despite their usefulness in dealing with social adversity. For example, Augusto Boal’s theatre of the oppressed, influenced by Paulo Freire’s pedagogy of the oppressed, is a method worth trying out. It provides concrete enactment of oppressive life-situations in which a person finds themselves, and focuses on the communal seeking of very concrete solutions.

The most famous type of theatre of the oppressed is called forum theatre. It is an interactive form of theatre where some kind of oppressive situation is enacted. The actors can be a part of the forum theatre group or they can be people gathered together who share their experiences with challenging social situations and who create a forum theatre play from them. The audience, people who come to see the theatre-performance, or perhaps the local community which experiences some kind of adversity, is invited to seek solutions to the oppressive situation by replacing the oppressed character and finding a new course of action he or she can take in that particular situation.

The audience can bring in their strategies, ideas, and ways of taking empowered action. In this way, everyone participating gets the chance to contribute to the finding of different courses of action. After each enactment, the audience gives feedback on how satisfied they are with the proposed solution. The idea is for the audience not to be an outside observer but to instead jointly transform the experienced oppressive reality. As Freire’s pedagogy of the oppressed suggests, no one can transform the situation alone or do it for the other.

Even though both psychotherapy and the theatre of the oppressed are done within a protective environment, there is still a big difference between them.

The theatre of the oppressed directly challenges societal problems of oppression. Here the involved learn much from the enactment—concrete possible solutions and possible practices of resistance. This can empower participants to find actions to take in real-life oppressive situations. Further, the audience seeking the solution gets to experience the position of the oppressed person directly, which can be really informative as a lived experience.

This experience can foster empathy, solidarity, dialogue, or wider social recognition of a certain problem. By using this method, participants literally get resources to use when faced with an oppressive situation.  This method could greatly increase one’s ability to deal with an oppressive system. It can teach people to recognize power play implicit in everyday situations, which is the first step in dealing with them. Breaking situations down into tackle-able problems solved jointly can also help ease one’s feeling of powerlessness. This can be something worth exploring.

No less important, this method does not need a lot of funding to function. This makes it scalable, which is important for its delivery to a wider population, both when it comes to prevention of mental distress and as a tool for resistance when faced with an oppressive situation. So that maybe, that person who has problems scraping up the money for heating bills finally learns how to be respected by her boss. Or that that woman who feels the unfairness of how her ancestors were treated learns how to never let anyone tell her what she should or shouldn’t do due to her gender. Or that the person who experiences different treatment due to her or his race learns what else he or she can do as a response to an unfair situation. And that everyone else involved starts seeing these as problems. How to handle adversity in an oppressive system can be viewed as a way of preventing mental distress from happening in the first place. How come these things are not taught at schools even though they are of such a great importance for one’s life?

Of course, this is not to say that theatre of the oppressed can on its own solve the systemic problems that have accumulated for centuries. It is just one example of a method that can be used to develop individual agency. These are huge issues—first and foremost, public mental health ones. They need to be tackled on the social level—on the level of public policies and social programs. Programs that deal with socially marginalized communities and mental distress, such as this one, are of the essence.

General programs that tackle recognition of oppression and resilience-building as a form of prevention of mental distress are needed. Community services that tackle the link between social inequality and mental distress are important. And all of this needs funding. For this, the awareness of governments has to be raised on how mental distress is fundamentally linked to social inequality. Because it is.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.





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