Cash can cure you

Explanations of depression are varied and complex. They take in
genetic, psychological, emotional and environmental factors.
Treatments include drugs, psychotherapy, group therapy, and
residential care. Less attention is given to the association
between poverty and depression, especially in regard to children
and young people. This is not to imply that all poor people become
depressed and that the wealthy do not. Far from it. It is to say
that poverty and the effects of poverty can make some victims more
vulnerable to depression.

Living in deprived areas, I have often met families whose emotional
and mental states have been impaired by poverty. Anita Pace* was a
widow with debts and a large family. Full of guilt about the death
of her husband and highly anxious about coping with her children,
she withdrew from outside contacts and would not leave her flat.
Tired, weepy, depressed, she often said: “I can’t cope, I can’t go
on”. For the sake of her kids, she did go on but her depression
then contributed to her children’s problems. One became a heroin
addict. Another resented what had happened to his family and his
aggression led to prison sentences.

I have known Arnold MacDonald* since he was eight. He never knew
his dad who deserted him at birth. His childhood was one of extreme
poverty as his mum went from flats to hostels to bed and breakfast
lodgings. Today, as a young man, he possesses a deep anger about
the dad who let him down and he has experienced depression and
attempted suicide. Stays in psychiatric units and drug treatments
do not seem to have helped and I am about to visit him in
prison.

Sometimes I chat with what I call socially disengaged young people,
mostly men. In Scotland, thousands of young people have disappeared
from the official system. They are not in education, training or
registered for work. The think-tank Demos estimates the UK number
at 500,000. In addition are those on the fringes who work in
temporary, badly paid, grotty jobs. Among these young people are
those who appear depressed, apathetic, withdrawn. Drug abuse can
seem almost a rational step for, apart from the kicks, it often
means entry into a group who seem united against the outside world.
Of course, it is dangerous but their response to warnings is often
a shrug of the shoulders and “So what if I do die?” Perhaps it is
not surprising that it is young people who are the group with the
highest rise in suicide rates.

I don’t pretend to have the answers but I believe there are
approaches that could be of help. First, skilled counselling. As a
student I was taught by Clare Winnicott. After working in youth
clubs in poor areas in the 1930s, she qualified as a psychiatric
social worker and during the war did casework with evacuees who
displayed disturbed behaviour as a result of leaving their parents.
After the war, she tutored on child care courses before moving to
the Home Office as director of child care studies. Although her
husband was the well known psychiatrist Donald Winnicott, she did
not regard social workers as mini-psychiatrists who delved into the
unconscious. Instead she believed they should be skilled at
communicating with children about traumatic experiences.

She wrote: “Having reached the child we try to look at his world
with him and to help him sort out his feelings about it; to face
the painful things and to discover the good things.” Today we need
social workers who can communicate with young people about their
depression and pain.

Second, poverty and inequality must be addressed. As long ago as
1964, the US researcher, William Haggstrom, reviewed empirical
studies that demonstrated how long-term poverty undermined the
emotional and mental well-being of its victims. So it is not enough
to provide personal counselling. The key objective must be to
drastically reduce poverty and inequality. It must be for a society
where all young people can have jobs which bring dignity, meaning
and decent income. It must be a society in which the gaps between
the top and bottom are so small that the former are not arrogantly
superior while the latter are not pushed into a sense of
inferiority, which can lead to depression. Individual relationships
and structural change, the micro and the macro, must go together to
build the good society.

* Not their real name

Bob Holman has a chapter on Clare Winnicott in his book,
Champions for Children. The Lives of Modern Child Care
Pioneers, Policy Press, 2001.