ABSTRACT
It has become increasingly apparent throughout this book that we must go far beyond psychiatry itself to understand both the problems inherent in the discipline and their possible solutions. Indeed, as we saw in the section on classism, it is to some extent artificial to separate out the social and political causes of mental from physical ill health. Recent analyses have pulled together a powerful range of evidence that the most pernicious effects of poverty, unemployment and poor housing are mediated, even in the case of physical disease, mainly through psychosocial processes. The crucial factor is not absolute material deprivation, harmful though that obviously is, but relative inequality within societies, which has increased dramatically in Britain over the last fifteen years, and which ultimately affects the security, social cohesion and life expectancy of the whole population:
To feel depressed, cheated, bitter, desperate, vulnerable, frightened, angry, worried about debts or job and housing insecurity; to feel devalued, useless, helpless, uncared for, hopeless, isolated, anxious and a failure: these feelings can dominate people’s whole experience of life, colouring their experience of everything else. It is the chronic stress arising from feelings like these which does the damage . . . The material environment is merely the indelible mark and constant reminder of the oppressive fact of one’s failure, of the atrophy of any sense of having a place in a community, and of one’s social exclusion and devaluation as a human being . . . The psychosocial processes round inequality, social cohesion and its effects on health, are overwhelmingly important . . . The deterioration of public life, the loss of a sense of community, and particuarly the increase in crime and violence, are fundamentally important to the quality of life for everyone.1
