Mental illness and economic inequality: A compassionate case for an egalitarian society.

There are many contributing factors leading to a deterioration of one’s mental health; environmental, genetic components, ethnicity and of course abuse in all its varying forms. Each of these elements can have a profound effect on someone’s psychological wellbeing. However, there is one particular aspect that is linked to practically all mental health conditions and that is poverty. More specifically we are talking about economic inequality or what can otherwise be termed as relative poverty.

In a paper published by the Lancet Psychiatry, Dr Wagner Ribiero investigated the correlation between income inequality, mental health problems, the use of services and resilience. This inquiry was conducted via a systematic review and meta analysis. What Ribeiro found was that widening economic inequality is associated with higher rates of mental health incidents, particularly with regards to depression and anxiety. However, additional studies suggest that schizophrenia, narcissism and psychotic symptoms are also more common in unequal societies.

Furthermore, this proposed link appears to be much more prevalent in English speaking countries, particularly in the US and the UK. Which incidentally are two of the most unequal countries in the developed world. As an example, Sweden is also considered a rich country, but with markedly less economic inequality than the UK. Similarly to the UK it boasts a comprehensive health system, but in contrast Sweden has substantially lower levels of social and mental health problems. Findings by Wilkinson and Pickett which were published in their book ‘The Spirit Level’ similarly highlighted a disparity between the ‘anglosphere’ and mainland Europe with regards to mental health issues and economic inequality.

mental health and inequality

With all this in mind, if we truly care about society as a whole and how our species can flourish, it makes sense to investigate this pathway in a little more detail. As previously mentioned, a key driver that is persistent throughout the research is one of economic inequality as opposed to absolute poverty. In a nutshell, impaired health and in this case mental health is less about being poor and more about but feeling poor. It is proposed that relative poverty is related to feelings of social failure and inferiority, in addition to social isolation, alienation and loneliness.

Perceptions such as these are exacerbated when we live in societies that encourage us to incessantly compare ourselves to much richer individuals. A practice which by no means is healthy, possessing all the qualities of a sadistic form of motivation and self-punishment. Without doubt we have all been on the receiving end of this regularly in the form of advertisements, TV, magazines and social media.

One theory used to explain the correlation between mental illness and relative poverty centres around the brain’s dominance behavioural system. This processes information around subordination and social dominance, a system which is likely connected to a broad range of mental illnesses and personality disorders. It is purported that externalising disorders, mania proneness and narcissistic traits are related to heightened dominance motivation. On the flip side, anxiety and depression are linked to subordination and submissiveness. However, as we will see this isn’t the only suggestion on offer.

Dr Robert Sapolsky neuroendocrinologist and Professor at Stanford University proposes a further explanation. Dr Sapolsky suggests that relative poverty generates stress, which in turn produces an overactivity of hormones and neural responses, including the secretion of cortisol. Surviving at the lower end of the socio-economic scale is associated with raised levels of stress. It is also well documented that elevated cortisol levels is a risk factor for depression, with relatively poor kids displaying higher levels than richer kids. While it is surmised that this constant battle to return the body to a normal non-stressed state predisposes people to premature ageing.

High levels of glucocorticoids (of which cortisol is one) affects a part of the brain called the hippocampus, which is critical for memory and learning. Regular exposure to excessive glucocorticoids via stress impairs memory and learning by reducing the excitability in this area. In a part of the brain called the amygdala, which is central to fear and anxiety, glucocorticoids increase the excitability and expands neuronal connections contributing to a heightened response.

Together this can offer one explanation as to why a condition such as Post Traumatic Stress Disorder shrinks the size of the hippocampus, while expanding the amygdala. Glucocorticoids can also impact the mesolimbic dopamine system, responsible for reward, anticipation and motivation. This disruption predisposes individuals to the anhedonia component of depression and a vulnerability to addiction. Anhedonia is described as a reduced ability to experience pleasure.

Brain, skull and meninges

The pre-frontal cortex (PFC) is a region of the brain pivotal for long term planning, executive function and impulse control. An excess of glucocorticoids in the PFC results in poor decision making, primarily focusing on short-term gains. As mentioned, stress leads to raised levels of glucocorticoids, making it more difficult to choose long-term health over instant gratification. This is one explanation as to why people with substantial stress increase in weight, smoke and drink more than people with less stressors. Unsurprisingly, this is also a reason why a lower socio-economic standing can effect long-term decision making. When day to day living is proving difficult and life seemingly so precarious, the future can appear to be a place of much less importance.

Lower socio-economic status creates chronic financial concerns, that exhausts and distracts the individual. Although people may on the whole have more money than individuals from developing countries, being poor in relation to the rest of society contributes to being despised, shamed and humiliated. Economic inequality automatically emphasises the importance placed on social status. In unequal societies, the dramatic disparities in income can make the rich appear as superior beings. There is also a tendency among capitalist countries to equate an individual’s wealth with their internal worth, thus compounding any negative self-perceptions for the people who find themselves battling to make ends meet.


Status anxiety increases in relation to the inequality of a nation. We live in a world where many people worry about how others view us and how we are judged. Whether we are seen as capable and successful or as a failure, all adds to our stress levels and has a profound influence on our mental health. More unequal societies are also likely to feel less trust towards one another, falling from 60-65% in the most egalitarian of nations to about 20% in the most unequal. All this can contribute to a reduction in participation within society, for instance being less likely to volunteer and partake in local activities. This is often displayed through an increase of violence, combined with a lack of willingness to help one another out.

All of the above contributes to more stressful social lives and social anxiety, as we worry about how we appear and perform in the world. Responses to this threat can be exhibited as defensive narcissism or alternatively through low self esteem and a lack of confidence. There is a strong implication that mental health and neoliberalism are interconnected, even exploited. Raised social anxiety and narcissism feeds consumerism, using purchases and possessions as a method to give off a good impression, while attempting to create a sense of self worth. In sum money becomes essential as a means for many of us to communicate our self-worth.

People in unequal societies not only work longer hours, but save less and borrow more. In these nations debt rises in a desperate attempt to maintain appearances. Our collective emotional vulnerabilities are seized upon by corporations and advertisers callously using our fears for profit, confirming that status anxiety sells. Meanwhile, economic inequality negatively impacts our mental health, friendships, societal bonds and community life, all of which is integral for our general wellbeing. If somebody does not possess a sufficient income, full participation in society becomes virtually impossible. Particularly in a world that prioritises GDP, while celebrating personal wealth and corporate gains over the wellbeing of our fellow human beings.

There are a variety of compelling arguments suggesting why we should reject neoliberalism, of which mental health is just one element when considering if our current system is really the best we can do. We have well and truly reached a fork in the political and moral road. Simply put, we could persist with our current dominant political ideology, whereby, a tiny group of people will continue to accrue the bulk of money and power, forever loading the dice in their favour. Or we can challenge the status quo, constructing a society that works for most people. Furthermore, neoliberalism does not work in harmony with our beleaguered planet or the vast majority of people who inhabit it.

Effective change must involve questioning all that is used to support the present doctrine; politics, media, education, the law and in particular how we do business. No area of society should be off limits when trying to imagine and construct a better world for us all and future generations. I wrote this article predominantly to highlight the extent to which economic inequality can contribute to mental distress and to ensure this too is added to the list of reasons why we should fight for a serious paradigm shift towards a more compassionate and fairer world.

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