My Nerves Are Bad: Puerto Rican Women Managing Mental Illness and HIV Risk

9. Power, Processes, and Agency

155 9 Power,Processes,andAgency I know there’s a God. —Katia, explaining how she survives Blame is often camouflaged in the language of responsibility. Individuals are responsible for their own poverty; it results from a lack of motivation and industry. Their ill health results from a refusal to take responsibility for their own unhealthy behaviors: smoking, drinking, drug use, overeating. Infection with a sexually transmitted disease results from their own poor judgment, perhaps associated with drinking or illicit drug use but certainly with their unwillingness to use condoms or their unbridled promiscuity. Homeless individuals have brought about their own fate, preferring to spend their time drinking alcohol or using drugs, or maybe refusing to adhere to the medication regimen prescribed for the symptoms of their mental illness. This inclination to blame the victim is founded on a differentiation between “Us” and “the Other”: Blaming the victim depends on a very similar process of identification (carried out to be sure, in the most kindly, philanthropic, and intellectual manner) whereby the victim of social problems is identified as strange, different—in other words, a barbarian, a savage. Discovering savages, then, is a component to, and prerequisite to, Blaming the Victim, and the art of Savage Discovery is a core skill that must be acquired by all aspiring Victim Blamers. They must learn how to demonstrate that the poor, the black, the ill, the jobless, the slum tenants, are different and strange. They must learn to conduct or interpret research that shows how “these people” think in different 156 “My Nerves Are Bad” forms, act in different patterns, cling to different values, seek different goals, and learn different truths.1 Indeed, we have known for some time that the generic process of Blaming the Victim is applied to almost every American problem. The miserable health care of the poor is explained away on the grounds that the victim has poor motivation and lacks health information. The problems of slum housing are traced to the characteristics of tenants who are labeled as “Southern rural migrants” not yet “acculturated” to life in the big city. The “multiproblem” poor, it is claimed, suffer the psychological effects of impoverishment, the “culture of poverty,” and the deviant value system of the lower classes; consequently, though unwittingly, they cause their own troubles. From such a viewpoint, the obvious fact that poverty is primarily an absence of money is easily overlooked or set aside.2 However, life trajectories are rarely within the control of any individual . Rather, they reflect a series of choices and actions, some producing favorable results and others not, that are made and carried out in the context of, and in interaction with, our larger society. Nevertheless, despite numerous indications from a multiplicity of data sources, we continue to ascribe to the illusion that individuals are solely responsible for their own fates. As a society, we have chosen to ignore the structural violence and oppression—poverty, racism, segregation, marginalization—that characterize the environments in which the women in this study live their lives and in which they struggle to survive. These forms of social inequality are “structural because they are embedded in the political and economic organization of the social world; they are violent because they cause injury to people.”3 These forms of violence are ubiquitous and, as such, have become largely ignored as a focus in our efforts to ameliorate disease and improve health.4 Researchers have long debated whether the apparent relationship between poverty and the onset of mental illness reflects the movement of mentally ill people toward low-income communities because of their illness symptoms (the geographic drift hypothesis, a variant of the social selection hypothesis) and their loss of employment resulting from their illness symptoms (the socioeconomic drift hypothesis, a second variant of the social selection hypothesis), or whether an individual’s risk of mental Power, Processes, and Agency 157 illness is heightened as a result of poorer economic conditions (the social causation hypothesis). Increasing evidence suggests that, even in the case of mental illnesses for which there exists a strong biological component, such as schizophrenia, the illness is attributable, at least in part, to the direct and indirect effects of lower socioeconomic status.5 Indeed, one’s socioeconomic status has the potential to affect, directly and indirectly, an individual’s mental health. There is a continuous feedback between socioeconomic status, environmental-level factors, individual-level responses, and the...