In certain circumstances and amongst certain communities, verbal communication may be eschewed in favour of physical expressions of emotions (Allaz & Cedraschi, 2015; Howard, 2013; Kirmayer & Young, 1998). This was an aspect of consideration in the community in which I conducted my research. While we need to examine the Western propensity to promote “increasing medicalization of misery” (Liebert, 2010; Ussher, 2013, p. 24), we must acknowledge that alternative possibilities of help- seeking are being enacted within the medical model. Included in this consideration is the possibility that in certain populations the mechanisms of help-seeking is expressed almost exclusively through the body (Cosgrove, 2003; Howard, 2013; Nettleton, 2006; Nettleton, Watt, O‟Malley, & Duffey, 2005). In their chapter on women and their bodies, Chrisler, Rossini, and Newton (2015) explore the ways in which the use of the body has been a mechanism of help seeking and empowerment amongst women. Understanding physical modes of expressing distress may contribute to successful collaboration between the patient and the psychologist in the service of recovery (Brown, 2004; Kornelsen et al., 2015; Nettleton, 2006).
Outside of considerations of gender, it would appear self-evident that physical health and wellbeing is impacted negatively by poverty (Burns, 2015; Murray, 2006; L. Smith, 2010). However, in a more subtle way, the lack of such basic amenities as food, shelter, safety and education has the undeniable potential to create a climate which limits the possibility of mental equilibrium and mental health (Burns, 2015; Havenaar, Geerlings, Vivian, Collinson, & Robertson, 2008; Petersen, Bhana, & Swartz, 2015). If one looks at the basics of Maslow‟s hierarchy of needs, however controversial, this becomes clear and unequivocal (Acton & Malathum, 2000;
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Henwood, Derejko, Couture, & Padgett, 2014; Oleson, 2004; Richter, 2003). The literature abounds with findings relating to the existence of mental illness in sub- optimal socio-economic conditions. (Burns, 2015; De Silva, 2015; Patel & Kleinman, 2003). Ironically there is a tendency in resource poor countries to limit the budget for mental health services (Herrman & Swartz, 2007; Saxena, Thornicroft, Knapp, & Whiteford, 2007). In South Africa mental health facilities are severely under resourced as described by Lund, Kleintjies, Kakuma, and Flisher (2010). Reports have indicated that as many as one in three South Africans suffer from some kind of mental illness, yet the chances of receiving treatment are minimal (Tromp, Dolley, Laganparsad, & Goveneder, 2014). However, not only does poverty, and its sequelae, predispose individuals towards such psychopathology as depression and anxiety which are not unrelated to issues of exclusion and isolation (Baer, Kim, & Wilkenfeld, 2012; Belle, 1990; Belle & Doucet, 2003; L. Smith, 2010; L. Smith, Appio, & Cho, 2012; L. Smith & Chambers, 2014). In a tautological process, mental illness also increases the likelihood of socio-economic deterioration.
In the most basic and pragmatic terms: if you are poor you have an increased likelihood of developing a mental illness and, if you have a mental illness, your chances of being drawn into the downward spiral of economic vulnerability becomes exponentially more likely (Haushofer and Fehr, 2014; L. Smith, 2010). Haushofer and Fehr (2014), like L. Smith (2010), suggest that a negative feed-back loop occurs in situations of entrenched poverty. The negative socio-economic situation becomes a self-perpetuating system where goal-directed, problem-solving behaviour is replaced by less helpful risk-aversion attitudes and enactments. Basically poor people may lose the will or direction to make the kind of choices to help them escape the shackles of poverty. This intersect between mental and physical health is a consideration which Prince et al. (2007) suggest are linked with economy and not given sufficient attention.
While poverty as a socio-economic consideration has been shown to have a negative impact on both the physical and mental health of a population, literature indicates that it is in conditions of significant disparity that this impact is most severe and destructive (Kehler, 2001; Lund et al., 2010; Lund et al., 2011; May, 1998; May et al., 2000; Stavrou, 2000; L. Swartz & Bantjes, in press). Based on 2010 figures (Cobham
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& Sumner, 2013) South Africa is found in the unenviable and shaming position as the country with the greatest disparity in wealth distribution. Within the focus of this study, unemployed and poor women, often living in informal developments on the Cape Flats, and within sight of Table Mountain and the affluent, mainly White suburbs, provide a graphic illustration of this disparity. To be poor and lack such basic necessities as adequate shelter, electricity, running water and sufficient food is challenging. To have in sight the unobtainable alternative must be difficult to endure. Lack alone is not necessarily responsible for psychosocial sequelae in the form of violence, crime and mental illness. The real insult comes in the constant exposure to wealth and privilege in immediate geographic proximity – physically close and visible but realistically unobtainable – which creates the potential for enormous emotional and psychological as well as physical difficulties. These challenges of poverty and disparity are possibly accommodated and expressed by the manifestation of both mental and physical symptoms in the particular conjunction found in somatic disorders.
Research shows a correlation between the physical impact of poor diet and lifestyle and mental health. In several studies (Patel & Kleinman, 2003; Lund, 2015; Tampubolon & Hanandita, 2014) results appear to indicate a clear connection between food insecurity, poor dietary and lifestyle choices and mental health problems. The negative effects include feelings of sadness, shame, impaired concentration and fatigue. L. Smith (2010) describes with great eloquence the negative tautological spiral which entrenches both poverty and mental illness.
2.4. PSYCHOLOGY AND PSYCHIATRY WITHIN THE BIOMEDICAL