Voting's Relationship to Mental Health

Voting is a social determinant of health and possibly of mental health as well.

Reviewed by Margaret Foley

Whether eating a poppyseed bagel with lox, a Gazan braised lamb shank, a dumpling, a dosa, a burger, or a tuna sandwich, I always try to practice gastric diplomacy, remembering that all living beings need food, sustenance, and nurturing. As human beings, we all need the “4 A’s of love”—acceptance, affection, appreciation, and attention—as well as “PPUGS”—presence, patience, understanding, guídance, safety, and support. As Americans, we also need a government, communities, and institutions, such as a functioning democracy fueled by free and fair elections, to support our well-being.

I’m privileged to have enjoyed enough of these essentials to be in a position to support them for others. I am also deeply aware that they are threatened for us all by the conflicts in the Middle East and elsewhere, and by partisan politics here in the United States.

Society depends on its willingness, willpower, and agency to support the basic needs of its entire population, and this has been an uphill battle in many ways. America has a superficial bias towards individualism and the resulting false assumption that individuals can totally provide for themselves. This neglects the reality that we are all dependent in some way on others, and dependent on laws, institutional supports, and the labor and goodwill of countless others that form an invisible scaffolding that gives us freedom, but also asks for our responsibility.

That latter part seems a hard pill for some to swallow. Self-reflection, accountability, apology, and repair are perhaps the hardest for an individual ego, and exponentially harder for institutions and collectives.

With self-reflection, we realize how much we are connected to each other. Our connection is a prompt for fear or care. Because of the bias towards individualism (really factionalism), we have a harder time, culturally, acknowledging our impact on each other and the impact of the social environment on our individual and group prospects. As I wrote in a prior post for Psychology Today, “Society Keeps the Score” of our individual, familial, and cultural distresses and collective wisdom and compassion.

My mental health and well-being depend in myriad ways on the mental health and well-being of others, and when others’ well-being is threatened, I know that the well-being of American and global society is threatened. As Chief Sealth, also known as Seattle, said, “Humankind has not woven the web of life. We are but one thread within it. Whatever we do to the web, we do to ourselves. All things are bound together. All things connect.” I would argue that Chief Sealth’s words are as much a part of the founding consciousness of the nation as Abraham Lincoln’s or the Constitution’s.

Voting is one of the main pathways to register our connection with others, in our dissatisfactions, pragmatic goals, and vision for a better future.

Voting as a Social Determinant of Health and Mental Health

Voting has been named a social determinant of health by the American Medical Association and other medical organizations. In a paper published in Psychiatric Services, psychiatrists Graziane et al. argue that voting is also a social determinant of mental health. They write:

“Recent longitudinal evidence shows that civic engagement, including voting, volunteering, and social activism, is associated with decreased depressive symptoms and risky health-related behaviors. Focus group data indicate that political participation is an important element of psychiatric recovery. Civically strong communities have lower suicide rates, suggesting that civic engagement may insulate against structural drivers of suicide risk. Election outcomes affect access to housing, health care, transportation, neighborhood safety, and other public resources. Lack of access to these social determinants of health is associated with poor mental health outcomes. Civic engagement, including voting, has implications for policies that address these and other social determinants of health. This emerging evidence, although limited, points to an important relationship between civic engagement and improved mental health, suggesting that voting as a form of civic engagement is a social determinant of mental health.”

Voting and civic engagement activate a sense of agency and can help provide greater sense of belonging. Moreover, when we vote, we are deciding how we relate to our goals and distresses, on personal, communal, and national levels. We can vote for greater or lesser capacity to deal with disagreements and dissatisfactions.

Voting and the Reduction of Unconscious and Collective Bias

In his influential intergroup contact hypothesis, psychologist Gordon Allport suggested that four conditions are required to reduce and eliminate racial and ethnic bias and prejudice: equal status, common goals, cooperation, and institutional support.

In other words, cooperating as equals towards shared goals, with institutional support, can go a long way towards eliminating hate and even more unconscious biases.

This year, we can vote to harm or help those similar to or different from us, especially the most vulnerable groups, such as immigrants, the poor, BIPOC, women, the LGBTQ+ population, the disabled, and anyone suffering physical, mental, or relational health challenges.

It is my hope as a psychiatrist and an American that we don’t vote in a spirit of fear, spite, or blame, especially of these groups, or of people who have felt deprived economically or culturally, but in a spirit of reconciliation, growth, and shared understanding that we are all in this together.

But vulnerable populations have been impacted, consciously or unconsciously, by the way America has operated thus far. In broad-brush strokes, the rich have gotten richer while the poor have been left further behind. There is a growing gap economically and culturally between the college-educated and those who are not. There is bias between the haves and have-nots, and as a result, significant levels of resentment, fear, alienation, futility, and hopelessness. Low- and middle-income people of all ethnicities struggle for housing, health care, education and retraining, child care, and even the basics like food, clean air, and water. All of this impacts mental health and social well-being.

If we vote for inclusion and thoughtful attempts to remediate these imbalances, we will make progress towards deeper belonging.

A recent Atlantic article points out that the main goal of both parties is getting infrequent or “low-propensity” voters to the polls. That requires both a vote “for” and a vote “against.” We all need to feel enough positive investment in our candidate’s goals and a significant wish to see the other candidate defeated. Moreover, we need to feel like the system will take us, and even those with differing views, into account.

I’m most worried that false fears and paranoia about immigrants is being used to motivate some swing state voters. Immigration is a substantial policy discussion that is being scuttled by xenophobic and racist claims, and distracting us from actual bread-and-butter issues. Literally.

Isn’t it true that best mental health plan is a meal and a roof over one’s head? Throw in a hug and some love, and we might start to feel happiness and even joy.

I think if we vote for the fundamentals, not for our fears or against each other, we will be in a safer position after the election. There’s always more to be done, but we have to start where we are. We have to face the reality that we are neighbors in this complicated, diverse nation.

In the words of one of Pennsylvania's most treasured sons, Fred Rogers: "Won't you be my neighbor?"

© 2024 Ravi Chandra, M.D., D.F.A.P.A.