An Introduction to Class in Mental Health and TherapyOn November 13, 2023 by sarmientoverano
Featured photo credit: Mathieu Stern
By: Lucia Sarmiento Verano
Something to be noted about class is that, like other axes of privilege and oppression, it has a deep impact on people’s material and emotional wellbeing. Unlike other axes of privilege and oppression, it is not recognised as a protected characteristic. Now obviously, different types of oppression are not comparable nor should they be compared. It’s not about creating an oppression Olympics.
Each axe of oppression is linked to material conditions and historical realities reproduced today that are indeed different and it is important to keep those specificities in mind. Class however, is one axe of oppression that is so pervasive in our capitalistic society and it intersects with all other axes in a way that often potentiates their negative impact.
What do we mean by that? Remember the phrase “Race is the modality in which class is lived” (Hall et al., 1978, p. 394)? This is one example. It just means that race and class are inextricably linked. The historical construct of race superiority or inferiority, practically places people of colour around the globe in a position of being the global working class, living and working for very small wages and in conditions of near-slavery in order to build the wealth of white groups of the Global North. In this way, racism and white supremacy are expressed in our capitalistic society by the creation of socio-economic hierarchies not only based in wealth but also on colour lines.
If we look at gender for example, we see how women have been excluded from the workforce and the accumulation of property and wealth until recently. Often when we work with cases of gender or domestic violence, it is the victim who will be excluded from the family’s resources and end up in situations of poverty along with the children. In the case of trans women, exclusion from opportunities to make a living are often total which forces them into sex work, often precarious and dangerous situations.
These are just examples on how class and other axes of oppression intersect. It is the pervasiveness of class injustice linked with all other kinds of injustice is what brings me to be interested in how class hierarchies work more in detail.
The psychological components of class
Our class background positions us in a social hierarchy and has impact on how we can (and how we are expected to) navigate society and its different circles. It also affects what we have access to in life whether is education, opportunities, resources (material, cultural and social resources) etc.
It has a profound impact on so many aspects of our life from childhood to later years that is it bound to also have a direct impact on how we see ourselves, how we feel about ourselves and our place in the world.
Class identity is a controversial and debated concept. Especially how it has changed over the last decades and if it creates a sense of belonging at all anymore. There is also a notable difference in the way people might experience their social position in regards to class and their actual material reality in relation to national averages and medians (Savage, 2000).
What is true is that there is a social hierarchy that exists and is reproduced in relation to material conditions, financial wealth and socio-economic status that is expressed by professional status, geographical location, access to consumer goods or cultural capital and social capital.
Sociologists have done extensive work trying to understand how these hierarchies get reproduced at the group & social level and at the individual level (Bourdieu, 2010; Elias, 1978).
This work has much to do with emotions and psychological processes of internalisation and tensions expressed socially by individuals and groups. The scope of Bourdieu, Elias and subsequent sociologists’ work is far too broad for this piece but I will touch on two quick points that can impact on our work directly.
Moralised sense of class
To understand the emotional impact of class we need to learn about the different implicit and explicit messages surrounding social hierarchies. Historically, the fact of accumulating wealth through owning the means of production and exploiting people who actually produce goods (the working class) by paying them less than living wages had to be cognitively justified in some way. This, to alleviate the conscience of the wealthier classes and morally justify their position as one they earned and/or have a right to.
This was done by appealing to a moralised view of class and ascribing moral values to people and groups belonging to different socio-economic statuses. One example is viewing working-class people as dirty, uneducated, alcoholic, violent or lazy to “explain” their lot in life and convey that they wouldn’t be able to fulfil other roles in society. I am sure we can, to this day, identify these messages in what we hear around us.
Internalisation of these messages may lead people to feel shame, low self-esteem and a sense of being undeserving and unconsciously self-sabotaging. This is only one example but these harmful messages can create different ways of coping in people that may be harmful in the long run, whether it is introjecting these images or responding to them by assimilating into the dominant culture.
Superiority & exclusionary behaviour
The process of distinction and class reproduction can also be understood by looking at the other side of the coin: the inherent sense of superiority of upper and middle classes, and the creation of exclusionary behaviour as a result.
Much like with racism, explicitly expressing a sense of superiority is now frowned upon. And much like with racism, we know it persists unconsciously and it influences how we move in society and how we relate to others and the world. This is where I call on therapists, belonging to a profession dominated by the middle class mostly due to the financial burden of training, to examine their own internalised sense of class, and superiority.
This, in ourselves but also in our theories and practices. Therapy comes from psychoanalysis, and has always been a middle-class endeavour. Most of our theories have been crafted by and for people belonging to this social group, working with other people belonging to this social group. This creates distinct assumptions on what is (or should be) mental health, or what do healthy behaviour and relationships look like, that come from this middle-class perspective. As a result, there is a tendency to problematise (much like the moralised view of class does) other ways of being.
I will now briefly reflect on how this can affect our therapeutic work more directly.
Ethics of working across class divide
Have you ever felt uneasy about the tendency for therapy trainings to send trainees into placement in low-cost services where they encounter mostly complex cases of people dealing with mental health issues and financial difficulties? In fact, these are places where many of those mental health issues might actually stem from or might be exacerbated by those financial difficulties.
Trainees are sent to work with this complexity without any detailed knowledge on how these social circumstances have an ongoing impact on client’s emotional wellbeing. What’s more, trainees are often middle class (or at least have the capacity to invest in therapy training). Is it unsettling to see that they are working across class divides without support or knowledge on class and power dynamics, their own internalised oppressiveness and the unconscious baggage that may be present.
Much like the middle-class Victorian lady going to teach hygiene lessons to working class women, middle-class therapists will “guide” struggling clients to a “better way of life” from an individualistic perspective, without necessarily considering the impact of the social system on their wellbeing.
In order to develop an anti-oppressive approach, we need to reflect on this like on other axes of oppression. Profound self-reflection on our positionality, in relation so social hierarchy and in relation to others is needed. Examining our internalised messages and how we express them in turn, effectively reproducing these hierarchies in our lives is a good way to start.
How do we strive for distinction for ourselves and our families? How do we enact class oppression in our attitude, our speech, our decisions? How might our saviourism influence our therapeutic relationships? Being candid and willing to connect with feelings of shame and guilt is necessary.
Bourdieu, Pierre. (2010) Distinction: A Social Critique of the Judgement of Taste. London: Routledge.
Hall S, Critcher C, Jefferson T, Clarke J, Roberts, B. (1978) Policing the Crisis: Mugging, the State, and Law and Order. London: Macmillan.
Elias, N. (1978) The Civilizing Process, Vol. 1: The History of Manners. New York: Urizen Books
Savage, M. (2000). Class analysis and social transformation. Milton Keynes: Open University.
Featured photo credit: Dima Pechurin