PROZAC AND PRIVILEGE

Diagnosing the treatment gap.

Words by Isa Naro

Art by Katie Cefalo

It doesn’t take much research to learn that we live in a world riddled with depression and anxiety. As students, pressure for good grades, internships, and relationships alone is enough to send us into a downward spiral. When I was 15 years old, I started speaking to a therapist. My anxiety became too much for me to handle on my own, so my parents brought me to a mental health center for adolescents. The center was 9 minutes away from our house in the city and the income of my parents allowed me to see this therapist weekly for two years. If I had an anxiety attack in school, my dad could pull me out. If I became overwhelmed with my responsibilities, I had the ability to take a step back. This is how my privilege affected my experience of depression. The ability to step back when you need to. The ability to seek and receive treatment when it’s needed. The ability to put your life on pause when you need help. This is a luxury that is too often taken for granted by people with privilege.

No matter how rich you are, how pretty you are, or how amazing your life is, anyone can experience clinical depression. For decades, psychiatrists believed depression to be a strictly Western phenomenon that’s only experienced by the wealthy. Numerous studies have shown that those with more money and more success are at a higher risk of being depressed. It could be from pressure, competition, or a never-ending need for material things, but according to a psychologist at Compass Health Group, privilege makes people less resilient. When you haven’t experienced any significant adversity in your life due to your identity or economic status, you’re more likely to accept defeat when faced with mental health issues.

Money is power. Those with financial security are a lot more flexible in allowing the effects of depression to navigate their life. This could mean calling off from work, not showing up to school, or ignoring necessary responsibilities. When the consequences of disregarding these responsibilities don’t make or break your living conditions, resilience seems less essential. However, when your basic needs aren’t being met, the problems that we face as American college students appear to be completely futile. This doesn’t mean that wealthier people don’t experience adversity or haven’t had to overcome any obstacles, what it does mean is that financial stability offers the luxury of letting obstacles overcome your life and routine.

Those who are struggling to make ends meet may not be able to include mental health in their list of priorities because they are more concerned with other things. These people might experience the same symptoms of hopelessness, sadness, and exhaustion as their wealthy counterparts, but can’t afford to put their life on pause to do something about it. Some critics argue that depression medicalizes experiences that could be easily dealt with by stronger family ties, with the implication that people in poverty don’t need the kind of counseling that people in wealthier people receive. Views like these diminish the very real experiences that these people are going through, and create a narrative that only wealthy people in Western countries struggle with depression and anxiety. Dr. Pamela Ryan, an SU philosophy professor, and licensed therapist has worked in shelters with assault and trauma survivors.

“When you’re talking to people living in these shelters, there’s just no way for them to be happy in a housing situation like that. There are fleas, there are bedbugs. People are using drugs and abusing each other. It’s a whole different reality than the reality of this middle class.”

A large factor that contributes to this is accessibility. Access and coverage for mental healthcare and treatment are incredibly limited. Mental health clinics are concentrated in urban areas and psychiatric treatment costs hundreds of dollars per session, as most providers operate outside of health insurance systems. Most health insurance plans don’t cover psychotherapy treatment after the age of 65.

“It’s just so mean,” Dr. Ryan said. “If I’m seeing a patient in their early 60s, I have to stop seeing them when they turn 65 because, in the end, they’re left without money or without good health insurance.”

This leaves a staggering number of outliers in need of mental healthcare that can’t afford the treatment or even the journey to the nearest facility. While the progression of teletherapy and virtual appointments might be intended to mend the accessibility gap in mental health care, it actually deepens the divide. Dr. Ryan says that access to a computer, strong wifi, and a quiet place to talk can be just as inaccessible as actually driving to a mental health clinic.

According to the National Institute on Minority Health and Health Disparities (NIMHD), less than half of Americans who have a mental health disorder receive treatment and less than 10% receive effective treatment. The numbers only get lower when you look at low-income communities.

“It’s a very eye-opening experience to see how the system works aggressively, at every turn, to make it more difficult to get out,” says Dr. Ryan, “When the system doesn’t care about you, you know it.”

Privilege can present itself in many ways. Depression and anxiety are not to be taken lightly by anyone, regardless of socioeconomic status, but mental health treatment should not be an unattainable luxury that only serves the rich. This is a systemic issue. Making mental health treatment available and accessible is not something that can be changed overnight. However, it is important to acknowledge the ways in which financial stability and routine flexibility are privileges that should not be taken for granted.