SURVIVING POVERTY AND LOW SOCIO-ECONOMIC STATUS

Related PTMF Provisional General Patterns: ‘Identities’, and

‘Surviving defeat, entrapment, disconnection and loss’ and
Pattern: ‘Surviving a highly unequal society’.

Narrative summary
Poverty is usually described as absolute (where people can’t afford basic necessities such as
adequate shelter, food, clothing or health care) and relative (where people’s income is a certain
amount below a measure of national income). But the boundaries between these are porous as are
the boundaries between living and not living in poverty. People in relative poverty may sometimes
have to choose between adequate clothing or heating or food, or between food for themselves or
their children; people also move between poverty and non-poverty at different times in their lives.
Poverty of any kind confers low social status, with often extremely negative social judgements.
Even where basic necessities are affordable, the impact of poverty is greater in countries with large
income inequalities, such as the UK and US. This is because people’s positions in social hierarchies
seem to matter more in those countries so that people are more anxious about their status and
about how they are seen by others. There is also more pressure to achieve status by purchasing
valued goods and services, and to do this by getting into debt. All of this is made worse by cultural
narratives of individual responsibility and success due to individual merit.

Research on adverse childhood experiences (ACEs) suggests that poverty is associated with a wide
range of other adversities such as child abuse and neglect, family conflict, witnessing domestic
violence and being taken into care. Partly for this reason, poverty has been called ‘the cause of the
causes’ of ‘mental health problems’ and it is linked to almost every common psychiatric diagnosis,
including depressive and anxiety ‘disorders’, ‘post-traumatic stress disorder’, ‘personality disorder’
and ‘substance use disorder’. The links between poverty, low socio-economic status and
‘schizophrenia’ are amongst the strongest. These links hold across many different measures of
poverty and low SES and show that these are both major causes, and consequences, of a wide range
of emotional and behavioural difficulties.

In PTM terms, people living in poverty experience the negative operation of many forms of power
which creates multiple threats across most areas of their lives and limits opportunities for
constructive threat responses. In other words, poverty makes it much more difficult for people to
meet their core needs in positive ways – needs such as for safety and security, social esteem and
connections, control over important areas of their lives and a sense of meaning and purpose.
Poverty is especially likely to create a sense, and reality, of entrapment. This is partly because money
is such an important element in avoiding, lessening, or escaping not just major adversities but also
‘normal’ day-to-day stress, while lack of money can turn what seem like minor difficulties into major
crises. Entrapment can also be psychological. Feelings of powerlessness, shame and defeat can lead
people to downgrade social or economic goals such as successful relationships, exam results or job
searches because they can feel unachievable. Living in disadvantaged communities can reduce
expectations of social support needed to make changes. Poverty also means that much of people’s
material, relational, emotional and cognitive resources are needed simply for day-to-day survival,
including interacting with welfare systems, rather than more positive action and planning. Short-
term goals (paying essential bills; producing cheap, filling meals; repairing a car needed for work)
may have to take precedence over longer term outcomes such as avoiding high-interest debt, having
a nutritious diet, helping children with schoolwork or planning for training or education.

1
Poverty has a strong impact on physical health, for example through low quality housing; living in
areas of high pollution; poor diet; physically demanding work, possibly with inadequate safety
procedures; unaffordable health and dental care and/or not being able to take time off work to
access healthcare or recover from illness; and the bodily effects of chronic adversity. Having to focus
on short-term goals as well as pessimism about the future can make it difficult to invest in ‘self-care’,
to complete prescribed treatments and so on. All of this in turn increases psychological and social
challenges creating complex links between physical and emotional problems.

Poverty interacts strongly with other devalued identities and inequalities, amplifying its impacts
through systematic discrimination in access to education, jobs, housing and so on. In white
dominated societies, people from black, Asian and some other minority ethnic groups are more
likely to be poor, as are women, older people and people with disabilities. Everyone who is poor
faces judgements about being ‘deserving’ or ‘undeserving’ and these judgements can be especially
harsh in individualistic societies which focus on the role of individual attributes in people’s ‘success’.
However, the meanings attached to poverty will play out differently for different groups. For
example, in white dominated societies, black people may be assumed to bear greater responsibility
for being poor, especially if systemic racism is denied; women may be held especially responsible for
their children’s behaviour, well-being and educational progress while men feel especially shamed by
being unable to ‘provide for’ their families.

Many if not most people living in poverty will rely on state benefits but claiming these benefits can
itself be a source of considerable stress. There may be a constant sense of uncertainty and
insecurity, for example about whether complex application systems have been correctly completed,
how best to present for assessments and meet any requirements, or about whether benefits will be
withdrawn. The process can create a pervasive sense of powerlessness, shame and fear of
challenging the system in case payments are reduced or removed. Claiming benefits can also lead to
‘self stigmatisation’ drawing directly on public narratives, for example seeing yourself as a potential
‘sponger’ ‘fraudster’ or ‘scrounger’.

Children living in poverty can be disadvantaged from birth physically, cognitively and socially,
including through poor maternal health; low quality housing; exposure to family tensions and
conflict; caregivers who lack time and resources to provide high-quality care; rejection and bullying
by peers and low expectations from teachers. Although parents may try to hide it, children are often
acutely aware of their family’s struggles and the negative social narratives surrounding poverty. They
may exclude themselves from learning opportunities if schools charge extra or conceal from
teachers why they are distracted or inattentive in class or haven’t done their homework.

Seeking help for the anxiety, despair or other outcomes of poverty is not straightforward and can
itself create many threats. Individualistic narratives suggest people need to be seen to be taking
responsibility to help themselves but at the same time, talking about difficulties risks negative
judgements and, for parents and especially single parents, raises fears of their children being ‘taken
away’. Seeking help from health services will often result in a psychiatric diagnosis (something else
‘wrong with you’) and a prescription for drugs such as ‘anti-depressants’. Even if these are unhelpful,
people may still feel that they need to keep taking them to avoid negative judgements that they are
rejecting help or not taking control. Talking therapies services will often present problems of getting
to appointments and have a standard approach not tailored to individual needs. Like psychiatric
drugs, they also risk leaving people feeling ‘fobbed off’ or blamed as they cannot address the real
causes of distress. And other forms of help such as parenting skills training or nutritional advice can
carry similar messages of deficit and responsibility for helping yourself while leaving basic life
circumstances unchanged.

2
Overall, poverty and low socio-economic status can set up an accumulation of multiple, chronic
threats and adversities which makes it difficult to deal effectively with any of them and whose
impacts can be passed from one generation to the next.

Power, threat, meaning and threat responses within the sub

pattern
Power
Economic/material: Living in poverty obviously involves lack of economic power. This in itself has
profound effects because money is so important in reducing the number and intensity of threats and
in accessing all kinds of goods and services, including housing, transport, heating, food and clothing,
holidays, cultural and leisure opportunities and medical care. Poverty also means potential exposure
to the negative operation of almost every other form of power:
Biological/Embodied, through e.g. poor nutrition, sub-standard housing; work injuries, ill-health and
other visible bodily markers such as dental problems and inexpensive clothing; through ‘self-
medication’ for example with smoking or alcohol; and through high levels of prescribing of
psychiatric and other drugs.
Legal, through e.g. laws surrounding the welfare or mental health system; police surveillance; and
links between poverty and contact with the justice system, including as victims.
Coercive, through e.g some contacts with legal, welfare and mental health systems; street violence
and aggression; domestic violence; child abuse and increased relationship conflict. In general,
coercion and intimidation are more likely in any context where people feel threatened – especially if
access to constructive threat responses is limited – and in contexts where others routinely control
access to someone’s basic resources such as shelter, food, paid working hours and so on.
Relational/interpersonal, through e.g. relationship conflict; dependence on others for loans or for
unpaid help in looking after children, doing repairs and so on.
Social Capital, through e.g. lack of access to high status education, qualifications and employment;
lack of knowledgeable and influential contacts and information; lack of confidence in negotiating
difficult situations with officials and institutions; having an address which suggests a low status
neighbourhood.
Ideological – through e.g. exposure to very negative representations of people who are poor or
working class from politicians and the media. This is reinforced by individualistic discources
suggesting that personal characteristics such as aspiration, self-esteem, self-efficacy and resilience
are key to success. People from lower socio-economic backgrounds are overrepresented in mental
health systems where their understandable responses to adversity can be stripped of meaning and
transformed to 'illnesses'. These groups have few public opportunities to create alternative
influential meanings of their situations and responses.

Overall, people living in poverty and especially those receiving welfare payments are subjected to
intense State and public scrutiny, surveillance and judgement for their ‘lifestyles’, food choices,
relationship and parenting practices, spending patterns, employment/job-seeking and so on. This is
often linked to policies designed to change their behaviour, even when similar behaviours are
widespread across society.

Threat

3
These power processes create multiple, often chronic, threats which make it difficult for people to
meet their core needs in positive ways. Some of the major threats are:

Economic/material – not being reliably able to meet basic physical or material needs or access basic
services for yourself and/or dependents; struggling with debt.
Bodily – e.g. ill-health; work injuries; exhaustion; physical danger.
Relational – e.g. not having material or emotional resources to provide an optimal environment for
children’s development or to maintain positive adult relationships.
Low safety and security – e.g. living in a high crime area; domestic violence; insecure employment or
housing; dealing with creditors or bailiffs; high uncertainty about and low control over important
aspects of many areas of life.
Identity – e.g. loss or restriction of identity through unemployment or insecure work; being unable
to meet expectations as a ‘real man’ or ‘good mother’; being seen as ‘undeserving’, ‘scrounging’ or
‘malingering’; often having to provide negative information about oneself to welfare officials,
potential employers etc.
Social/community – e.g. isolation from others because of lack of money or fear of being judged; loss
of employment; social stigma and exclusion; ‘stress contagion’ where others in the community are
experiencing similar threats and the community lacks access to positive resources.
Value and meaning – e.g. lack of meaningful work or work that allows expression of personal values;
lack of resources to undertake meaningful and valued activities; spending large amounts of time in
activities controlled by others such as navigating welfare systems or fulfilling job search
requirements.

These threats often involve factors which reinforce their impact and make them even more difficult
to deal with, e.g. there are many threats; they are often long lasting, repeated and/or severe; it is
not easy to escape or avoid them; they can be unpredictable e.g. unexpected financial demands;
changes of welfare policy; they often involve your identity and self-worth as a person.

Meaning
Meanings commonly associated with these threats include: overwhelmed; shamed, humiliated;
helpless, powerless; controlled; defeated, trapped; unsafe, afraid; failed, inferior; unproductive;
excluded; sense of injustice/unfairness.

Threat responses
The threats and associated meanings give rise to threat responses that are mediated by the body.
Threat responses are conceived of as fundamentally protective, as attempts to meet core needs
under challenging circumstances. Disabling aspects of threat responses can be reduced and
counteracted by other responses which draw on skills, strengths, material, relational and social
support, alternative narratives and other power resources. However, the presence of multiple
exacerbating factors, lack of money and social capital, and the scale of negative and shaming
narratives about being poor or low SES, can deprive people of these power resources, or make them
only narrowly available, for example through alternative narratives of support, strength and survival
within disadvantaged communities but which are not part of wider society. All of this makes it more
likely that threat responses that are more damaging in the longer term, and more socially
unacceptable, will be used. This is linked to higher risk of psychiatric diagnosis, psychotropic drug
interventions and/or contact with the criminal justice system.
In this context, threat responses are often used to serve the following functions:

Regulating overwhelming feelings – e.g. through use of alcohol and drugs, smoking, ‘comfort’
eating, compulsive rituals, rumination, giving up, low mood.

4
Protection from danger – e.g. through hypervigilance, insomnia, anxiety, attention and
concentration disruption, distrust, suspicious thoughts or voices, carrying weapons, aggression,
restricting activities, isolation.
Protecting identity, self-image and self-esteem – e.g. through avoiding social contact; concealing
markers of poverty, such as where you live; avoiding or under claiming benefits you are entitled to;
hostility and aggression, dominance in relationships; hostility to others living in poverty and
projection of negative cultural stereotypes onto them.
Preserving a place in a social group(s) – e.g. through concealing markers of poverty in social
interactions, self-silencing, getting into debt to buy consumer goods, bullying, appeasement.
Communicating distress/eliciting care e.g. through low mood, giving up, self-harm, somatic
symptoms.
Creating a sense of meaning and purpose/ Protecting self-image and self-esteem/ Preserving a
place in a social group – e.g. through setting up or engaging with community support systems and
through social and political activism.

Strengths
Surviving poverty and low SES also fosters many strengths. These include financial skills in managing
very small budgets; time management in holding down several low-paying jobs; negotiating
complex welfare systems; self-presentation skills; achieving in education and work in spite of
multiple challenges; creative problem-solving, rather than simply ‘throwing money’ at a problem,
including creative parenting in organising low cost or free activities for children; and sensitivity to
and skill in supporting others in similar difficult situations. However, and especially when shown by
disadvantaged groups, these skills tend to be unnoticed or devalued by wider society.

REFERENCES AND SOURCES

Johnstone L & Boyle M With Cromby J, Dillon J, Harper D, Kinderman P, Longden E, Pilgrim D and
Read J (2018) The Power Threat Meaning Framework. Towards the identification of patterns in
emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to
functional psychiatric diagnosis. Leicester: British Psychological Society. (Chapter 4, Section 4:
Poverty and low socio-economic status.)
[Link]/power-threat-meaning-framework
This provides a detailed review of theory and evidence related to the social, psychological and
biological impact of poverty and low SES and their relationship to distress.

British Psychological Society (2020) Briefing paper: Foundations for the best start in life – How a
psychological approach to policy can help tackle poverty. Leicester: Author.
Outlines a systemic approach to understanding how poverty affects people’s experience and well-
being.

Cantrell, E. (2021) Exploring the interface between clinical psychology and the benefits system.
[Link]
This clinical psychology doctoral thesis includes a review of the literature on the psychological impact
of claiming benefits, drawing on the Power Threat Meaning Framework. The thesis also includes a
study of clinical psychologists’ experience of working with people who are claiming benefits which
provides further insight into the psychological impact.

5
Holloway, E., Mahony, S. and Royston, S. et al. (2014). At What Cost? Exposing the Impact of Poverty
on School Life. London:The Children's Society
[Link]
Reports on a qualitative study of the impacts of poverty on children’s school experiences, particularly
in relation to school costs that parents find difficult to meet. It shows how children are acutely aware
of this and often conceal the difficulties it causes them

Jones, O (2020) Chavs: The demonisation of the working class. (3rd edition) London: Verso.
Although not couched explicitly in the language of power, this book offers a very detailed account of
the operation of ideological and other forms of power in controlling meanings of poverty and low
SES, and of the personal and social impact of these processes.

Joseph Rowntree Foundation (2011). Poverty and ethnicity: A review of evidence.

[Link]
[Link]
Summarises evidence on links between poverty and ethnicity in six areas: education, work, caring,
social networks, the role of places and inequality within ethnic groups. It emphasises the importance
of intersectionality in understanding how ethnicity affects people’s experiences of poverty and its
outcomes.

Marmot M, Allen J, Goldblatt P, Herd E, and Morrison J (2020). Building back fairer: The Covid-19
Marmot Review. The pandemic, socio-economic inequalities and health in England. London: Institute
of Health Equity.
Reviews links between inequalities, ethnicity, poverty and health in the context of the Covid
pandemic and suggests remedial policies.

Roberts, H, Stuart, S, Allan, S, & Gumley, A (2022). ‘It’s Like the Sword of Damocles’ – A Trauma-
Informed Framework Analysis of Individuals’ Experiences of Assessment for the Personal
Independence Payment Benefit in the UK. Journal of Social Policy, online 1-16.
doi:10.1017/S0047279422000800

[Link]
damocles-a-traumainformed-framework-analysis-of-individuals-experiences-of-assessment-for-the-
personal-independence-payment-benefit-in-the-uk/95AA91106CE11CB492CFF7563ADF0C81

Thomas, F. [Link]. (2019) Poverty, pathology and pills: De-stress Project final report.
[Link]
Focuses on the experiences of people living in poverty in relation to ‘mental health’ and help seeking
particularly in the context of very high prescribing rates of ‘anti-depressants’. It reports on GPs’
experience of trying to help people suffering the psychological impacts of poverty and on
consultations between them and their patients.

Treanor, M. C. (2020). Child Poverty: Aspiring to Survive. Bristol: Policy Press

An analysis of the material, social and psychological impacts of poverty on children in affluent
societies, highlighting their lack of power and resources; awareness of their families’ struggles and
attempts to mitigate them; and the impact of social discourses and narratives about the nature and
causes of poverty.

Wilkinson R. and Pickett K. (2018) The Inner Level. How more equal societies reduce stress, restore
sanity and improve everyone’s well-being. London: Allen Lane.

6
Reviews global research on the psychological impact of large income inequalities particularly in
terms of increased concerns about status and social evaluative anxiety. The research highlights how
large income inequalities negatively affect all social groups but that the effect is much greater
amongst those in lower socio-economic groups.

Lead Author: Mary Boyle