Poverty and mental illnesses often go together. Depending on the studies you follow, poor people are between two to nine times as likely as wealthy people to suffer from mental illness, whether depression, schizophrenia, or substance abuse.

So does poverty cause mental illness? Most researchers today acknowledge that an intersection of social, environmental, psychological, and genetic causes lead to mental disorders, though research into causes and cures have tended to focus disproportionately on genetics and drugs in recent years.

But public health experts acknowledge that the conditions of poverty – poorer medical care, fewer resources, higher levels of mortality and substance abuse – seem to themselves lead to mental disorders. Poorer people also recover at lower rates from mental illness and they are more often admitted to institutions, less likely to have jobs, and are more alone and stigmatized.

But there is one surprise: mentally ill people from developing countries are more likely to recover than those from developed countries, with double the rates of remission. This goes against experience in every other medical field, where fewer hospitals and less availability of drugs, for example, produce worse outcomes in public health.

Why? We don’t really know. The WHO in its World Mental Health Report of 2001 speculated that the greater familial support, lesser stigma, and the fact that it is easier to go back to earning your livelihood in developing countries, for example with domestic or other kinds of physical labor, help mentally ill people in countries like India do better than mentally ill people in wealthier countries.

Which is something that reinforces what I believe in: where mental illnesses and disorders are concerned, drugs alone are simply not enough. You also need to provide shelter, food - and sympathy and respect for the person who is suffering.

Susan Vinodh Pandian

Read more about it:

1. Poverty and health

2. Financial crises affect the mental health of children

3. War makes Afghan children more vulnerable to Post Traumatic Stress Disorder

4.  Global recession can cause rise in mental health problems

5. Poverty forces couple into depression and suicide

The bladder shows one example of the mind-body connection: many children lose bladder control when they are afraid, or in periods of stress like when a new brother or sister is born.

Perfectly healthy adults, with no previous incontinence problems, have been known to urinate when in extreme fear. There is also a connection between incontinence and depression - depressed women are more likely to be incontinent, and incontinent women are more likely to be depressed, though the causal link is not clear.

We don’t know yet how this happens: the walls of the bladder are normally relaxed and the sphincter (the ring-shaped muscle leading out of the bladder which dilates to allow urine to flow out) closed in the ‘fight or flight’ response to stress or fear. In extreme cases, though, it seems the digestive system in effect ’shuts down’, and a person will have an urge to urinate, or feel as if he has an attack of diarrhea.

The mind-body connection works the opposite way too. So if you suffer from incontinence, some mental training can help. A study by the Loyola University Health System, reported in the April issue of the Journal of Urology, showed that cognitive behavior therapy (CBT) and meditation helped ten patients (mean age: 62) reduce their episodes of incontinence to almost one-fourth of what it was before the therapy.

So should those who suffer from incontinence choose meditation and CBT over the many other surgical treatments, exercises, and drugs available for urinary incontinence? Is it a sign of mental strength? Not necessarily - some people try CBT and meditation and if they are not successful look for other options.  Others find surgery and drugs have not helped so much, and try out meditation and CBT as their final desparate resort.

It’s a cliche, but it’s true: combining positive mental imaging, CBT, bladder retraining (learning how to predict and control urination, for example, through keeping a bladder diary), pelvic-floor exercises, and if necessary drugs and surgery, will help you most.

Susan Vinodh Pandian

Read more about it:

1. Urinary incontinence calculator for women

2. For women with incontinence: keeping a bladder diary

3. Stress incontinence

4. Scientists try to identify mechanism of mind-body connection