This story was supported by the journalism nonprofit the Economic Hardship Reporting Project.
The first time I met a rich person, I was 15. I’d just arrived at boarding school on scholarship after time in foster care. My new roommate—let’s call her Jane—had transferred from a top-ranked public high school that educated Silicon Valley’s heirs. I grew up with an anguish that came from low expectations, while Jane suffered from the stress of never being good enough. In our tiny, cell-like dorm room, I learned that despite our opposite upbringings, we had a lot in common. We both loved calculus and hated our nosy RA, and we were both miserable. And we both coped in ways that have now become ubiquitous among America’s youth. I cut myself, abused Adderall, and made myself throw up in our dorm’s bathroom. Jane grappled with overwhelming anxiety, distorted body image, and social media addiction. Even our emotional torment seemed to have a common origin: economic inequality.
In America, the gap between haves and have-nots is enormous, and has been widening for years. What’s less well-known is the growing body of evidence, summarized this month in a Lancet report, suggesting that inequality harms us psychologically and physically, no matter our tax bracket or the size of our house. It makes status hypersalient, weakens social ties, and encourages us to choose prestige over purpose. As inequality rises in lockstep with measures of psychic distress among teens, we need to consider its role if we want to keep kids from suffering needlessly, falling short of their potential, and, increasingly, dying before they reach adulthood.
This problem, which defined my teenage experience, has become particularly urgent to me as a new parent. I don’t want to raise my daughter in a culture where well-meaning parents push their progeny to the brink, where it increasingly feels like the only two options are amassing enormous wealth at all costs or suffering through a life of penury.
Sociologists and demographers have long recognized a relationship between poverty and illness, but inequality itself seems to contribute to negative outcomes—for rich and poor alike. In her book The Spirit Level, epidemiologist Kate Pickett found that less egalitarian nations had three times the rate of mental illness of more egalitarian countries, and that even wealthier citizens in those unequal places were vulnerable. Inequality, Pickett told me, “affects everyone in a society. We’re all exposed to it.” By making social status increasingly important, inequality spurs people to incessantly compare themselves to others, a source of constant stress that wears us down and, in turn, makes it hard to trust, eroding the social bonds that protect against despair.
Many researchers who track health trends see the 1980s as a turning point in American mental health. During the Reagan years, the rich began getting much richer while average wages flatlined. Soon, rates of emotional disturbance ticked upward rapidly, while trust in other people began to fall. U.S. life expectancy began trailing that of peer countries.
Today, the situation is even more dismal: American life expectancy has fallen for five straight years, and is at its lowest rate in almost 20 years. More children and teenagers are dying, too, many by gun violence, overdose, and suicide: 1 in 25 American kindergarteners won’t live to age 40. This is unprecedented for a rich country in the modern era. The Lancet report, crafted by more than 50 people over five years, points to inequality-increasing economic policies as a key reason why people’s mental health is suffering.
To me, this is personal: As a working-class teen from the Midwest coming of age during the Great Recession, hopelessness consumed me. Financial instability weakened my parents’ marriage; the ensuing divorce buried my mom in debt and left her on the hook for raising me alone. Union jobs, like my mom’s, were disappearing. She lived in fear of getting laid off, which fueled her compulsive shopping and hoarding until we lived in squalor. I grew depressed and eventually spent time in a locked residential psychiatric treatment center and foster care. When I tried to kill myself at 13, it was because I saw no future.
My family wasn’t even the worst off. We never fell into dire poverty, and we were white, so we never faced racism. But I was tormented by the sense that a shimmering paradise existed somewhere, just out of reach. The internet taught me that in other, fancier places, people ate salads instead of McDonald’s, practiced Pilates instead of clearance-shopped, and pronounced bagel “bay-gull.” Those sophisticates had easier problems and brighter futures. Whether or not I could enter their idyll depended on navigating an obstacle course where one wrong move would consign me to flyover land forever.
It turns out that my high school roommate Jane was as terrified of downward mobility as I was. For her, staying in the one percent required earning straight As, getting into an elite university to study math or computer science, and then landing a job at one of a handful of blue-chip companies. Yes, her parents could help, but that prospect brought shame. Money hadn’t been enough to save a close family member from psychiatric crisis— nor to protect Jane from the fallout. While only catastrophe would plunge Jane into privation, she’d have to fight to maintain the comfort of her youth and, like me, doubted she would succeed. In a country with a meager welfare system, where net worth often translates into self-worth, anything less than affluence felt like a terrifying drop into the abyss.
Jane’s parents felt this fear, too, leading them to parent in ways that may have worsened their daughter’s anxiety. Even in one of America’s safest towns, 18-year-old Jane was rarely allowed outside alone when she was home from school. Of course, in a highly unequal society, hypervigilance makes economic sense as a way to prevent kids from falling behind. “Across countries, the intensity of parenting lines up very closely with economic inequality,” economist Matthias Doepke, co-author of Love, Money, and Parenting, has said. In egalitarian Denmark, kindergarteners routinely play with axes; Swedish elementary schoolers are encouraged to build fires. In stark contrast, Illinois parents can’t leave 13-year-olds home alone without risking neglect charges. As America has become more unequal, parents of all incomes helicopter more. This increased parental guidance may help youngsters academically, but the lack of autonomy takes a psychological toll: Many experts believe intensive parenting is one of the most important causes of adolescent distress.
But even those on the top rung of the economic ladder suffer from inequality. Clay Cockrell, a therapist to ultra-high-net-worth individuals in Manhattan, told me, “Money at this level is toxic and dangerous. People die of this.” When you have so much more than others, it’s hard to tell whom you can trust, leading to loneliness and paranoia. Studies suggest that upper-middle-class Americans exhibit less compassion and empathy compared to those with fewer means—emotions that are crucial for creating the bonds that sustain us. Enormous wealth engenders a sense of competition between the generations, Cockrell said, intimidating children who fear they will never emulate their parents’ success.
Given all the evidence that inequality harms our well-being, why have discussions about mental health ignored this scourge? One reason: The every-man-for-himself principles that fuel inequality also frame health as a purely personal issue—a problem that should be addressed with individual interventions like medication and therapy, rather than policy change.
Now that I’m in my early 30s and a new parent, my circumstances are closer to Jane’s than those of my family of origin. Jane got into music school but decided to major in math; after a few years of finding herself, she became a data scientist in San Francisco. Meanwhile, aware that any old Ivy League degree wasn’t enough to ensure my stability, I studied computer science. I worked as a software engineer at Google and Meta, married a fellow Harvard-trained engineer with generational wealth, and bought an apartment in Manhattan.
But I’m still terrified for myself and for my child. There’s only so much I can do to shield my daughter from capitalism’s vicious reality. My child will face pressure to excel at all costs—if not from me, then from the winner-take-all economy. She will grapple with what it means to live in comfort while many more go without. They will wonder if they’re next on the chopping block, fated to fall through a nonexistent safety net.
Mental illness isn’t just an emotional problem—it’s an economic one. As the population ages, America relies on an ever-smaller pool of young workers to support the elderly. Debilitating psychiatric disorders make it hard to get an education or hold down a job, creating a dire threat to society as diagnoses rise.
Individual solutions like therapy and medication alone will never solve the mental health crisis. We also need to target inequality and the policies that foster it. While few people think about tax codes as public health measures, removing loopholes to increase tax revenue and expanding Child Tax Credits—a move supported by both presidential candidates in the 2024 election—can and do address rates of mental illness.
And these changes are popular. In a 2021 poll, two-thirds of Americans said the government should pursue policies to reduce the wealth gap; even a majority of young Republicans concurred. Instead of bemoaning modern parenting trends, we need to look at the factors that push caregivers to helicopter—and that make kids status-obsessed, materialistic, and sick with worry. Therapists can play a role by talking frankly about class and money, long taboo topics in the treatment room.
In our dorm room late at night, Jane and I agonized about our futures. Lying below me in our bunk, she grappled with the petrifying freedom that her family’s money gave her. I feared what would happen if I couldn’t pay for college or find a job that offered health insurance.
At 17 and 18 years old, we didn’t have the answers. We were stuck in a world we had not created: Like any other inheritance, it was ours.
