I hope this doesn't sound condescending but psychosocial health impairments are a pretty big factor in downward mobility. This is my mother, a reservation school principal, talking.
But isn't that just a convenient 'medicalization' of rejection of a lifestyle and system that is in fact of dubious desirability? In other words: if you don't accept the validity of the servile work ethic, you are 'mad'.
Well, it isn't really about that as it is that you live a lot worse than the rest of your family does. There's tons of weirdos that live far better than their folks...but what works? What doesn't work?...regardless of what others think.