The Agenda

NRO’s domestic-policy blog, by Reihan Salam.

Mental Illness and Social Mobility


Earlier today, I appeared on an hour-long radio program. One of my fellow guests was Scott Winship of Brookings, an expert on social mobility and social policy, and Jared Bernstein, a fellow at CBPP who also served as Vice President Joe Biden’s chief economic advisor.

At the end of the discussion, I strayed from the script to raise an issue that I consider salient to social mobility yet that rarely comes up in discussions of the issue. The host of the program seemed confused, and the topic was basically dropped, which is perhaps understandable given the time constraint. Bernstein, closing out the discussion, then suggested that people are uncomfortable talking about rising inequality. In my limited experience, academics and journalists are favorably disposed towards talking about income inequality, though of course this could reflect the media that I happen to consume and the social circles that I happen to travel in. 

As Robert Whitaker reports in a recent book (which we’ve discussed in the recent past), the number of Americans disabled by mental illness has increased considerably in recent decades. A review essay by Marcia Angell recounts the alarming facts:

The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007—from one in 184 Americans to one in seventy-six. For children, the rise is even more startling—a thirty-five-fold increase in the same two decades. Mental illness is now the leading cause of disability in children, well ahead of physical disabilities like cerebral palsy or Down syndrome, for which the federal programs were created.

After citing this increase in the context of social mobility, my interlocutor asked me if I were suggesting that stagnant mobility was caused by people going mad, a suggestion I found surprising and somewhat strange. Unfortunately, I didn’t have much time to correct this misapprehension.

So let me draw out the implications of the dramatic increase in the number of Americans disabled by mental illness. Part of social mobility is the accumulation of assets over time, the attainment of education but also work experience, and the development of strong emotional attachments early in life. Disabling mental illness tends to reduce income, as paid labor tends to pay more than SSI or SSDI. This, in turn, tends to reduce asset accumulation. Having a child with severe mental illness might depress income for parents, as it introduces the need for close monitoring and supervision, not to mention anxiety that can undermine performance at work. That is, mental illness doesn’t just impact individuals suffering from mental illness. It has knock-on consequences for the broader social network of that individual, and particularly for other members of the same family.

Is it possible that mental illness is actually a somewhat important part of this picture? Much like incarceration, a subject to which I’ve tried to draw attention in the past, it seems that the astonishing rise in disabling mental illness is indeed a neglected part of the social mobility story.

To be sure, there are some who argue that income inequality exacerbates mental illness. This view is not entirely consistent with the fact that countries in the developing world with high levels of inequality and material deprivation tend to outperform the U.S. and other rich democracies in preventing mental illness from becoming a disabling condition. And if Whitaker is correct, it isn’t the driving force. Moreover, the incarceration boom has been far greater in the U.S. than in other countries where income inequality has increased.

I would suggest that people who want to raise taxes will want to raise taxes regardless of the evolving social mobility picture. The more interesting questions, to my mind, relate to what we might do to reduce stickiness at the bottom through channels other than hiring additional public workers. We might, for example, encourage trial-and-error exploratory innovation in early childhood education, reduce crime through an emphasis on effective deterrence that reduces the social costs of incarceration, and reform how we diagnose and treat mental illness. This approach is compatible with raising taxes, but it is also compatible with shifting public dollars to their most efficient uses. 


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