The end may justify the means, as long as there is something that justifies the end. — Leon Trotsky
In the United States, with its Procrustean treatment of the impecunious by factions of an increasingly inaccessible plutocracy, economic inequality and wage stagnation continue to plague society as unreasonable compromise has steadily morphed into embittered desperation. Social mobility appears to be an antiquated term of a bygone era, and the desire for survival is swiftly replacing concepts like employee satisfaction and work/life balance. In addition, possibilities for self-actualization through fulfilling occupational pursuits are confronted by the realities of relentless exploitation and commodification in an increasingly dehumanized workforce. However, for those who are far below the baseline, mentally ill, or chronically unemployed, the prognosis is even worse.
The psychologist Abraham Maslow is best known for introducing the hierarchy of human needs scale (represented as a pyramid). The scale logically illustrates that well-being must be established by addressing fundamental physiological needs before optimum flourishing at higher levels can be achieved. Incidentally, Maslow didn’t recommend a hierarchy-based oligarchy to accomplish what should be obvious prerequisites for augmenting individual and social prosperity.
In the former DSM-IV-TR (APA manual for clinical diagnosis), psychosocial stressors (e.g., occupational, economic, legal, housing, and interpersonal) were classified in a category known descriptively as Axis IV. The updated DSM-5 simply refers to such situational quagmires as “significant psychosocial and contextual features.” As a therapist who has worked with a significant community mental health population, I’ve noticed the overwhelming extent to which psychosocial predicaments either create a mental health crisis or exacerbate existing mental health problems. In fact, I would submit that a majority of diagnostic assessments in community mental health environments unnecessarily pathologize long-term dispossession. It’s not that these clients don’t need therapy for mental health issues, it’s just that more substantial needs (i.e., food, shelter, transportation, and employment) are understandably predominant. Even an accessible therapeutic modality like Motivational Interviewing can appear abstractly inscrutable when working with a client who is homeless and hasn’t eaten in three days. Psychotherapy might be viewed as a non-essential luxury for those who encounter extreme adversity. A baseline of stability must precede therapeutic processing ability, and access to resources is critically necessary—even though it’s not sufficient—when confronting mental health concerns. Nevertheless, there are clients who do require immediate symptom reduction and behavior management before pursuing the path of resource acquisition—especially if mental health problems are determined to be the initial cause of destitution. Overall, restoration through a synchronicity of therapeutic support and resource allocation will be possible only if public sector efficiency and sustainable mental healthcare become a national priority. Regarding the current state of social services, both employees and clients are being asked to do more with less.
Learned helplessness naturally follows from years of enduring social and economic inequality, and systems of injustice teach us to be complicit with economies of scarcity through internalizing imbalances of power. Platitudes of self-efficacy, such as “pull yourself up by your bootstraps,” only make sense if you have access to boots. Despite stereotypes aimed at the impoverished, most people desire a sense of meaning, value, connectivity, and purpose in their daily lives.
When pyramid schemes hijack a society’s pyramid of needs, we abjectly witness how most pyramids are built on the backs of slaves.