The Inner Level

by Richard Wilkinson

  MOVING ON

  That, at its briefest, is where the evidence had led us almost a decade ago. We wrote The Spirit Level in 2007, sent it to our publisher in 2008, just as the global financial crisis was unfolding, and it was published early in 2009, with an additional chapter inserted in 2010 that responded to critics and gave a partial update. Since then the world has changed, rocked by economic crises, political polarization and populism, ideological conflicts, and the mass movement of refugees and economic migrants worldwide. Inequality has made no small contribution to all of these; and the need to combat climate change has become ever more urgent. At the same time, researchers from many different disciplines, including psychology, economics and environmental science, have added a rich body of new evidence on the impact of inequality. The result is that we can now see more clearly how inequality affects our values, our sense of self-worth, the way people feel towards each other and our mental health. In laying out in this book how inequality gets into our heads and our spirits, we also shed light on the causal processes that lead to a greater burden of health and social problems. This book brings together that new body of work and evidence to develop a vision of how we can create societies, economies and communities that focus on the sustainable well-being of people and the planet. Inequality may be entrenched in many of the societies we examine, but its current levels are neither inevitable nor irreversible. And despite the many challenges the last decade has brought, a better world is possible.

  1

  This is Not a Self-help Book

  ‘Many people of balanced mind and congenial activity scarcely know that they care what others think of them, and will deny, perhaps with indignation, that such care is an important factor in what they are and do. But this is an illusion. If failure or disgrace arrives, if one suddenly finds that the faces of men show coldness or contempt instead of the kindliness and deference that he is used to, he will perceive from the shock, the fear, the sense of being outcast and helpless, that he was living in the minds of others without knowing it, just as we daily walk the solid ground without thinking how it bears us up.’

  Charles Cooley, Human Nature and the Social Order, 1902, p. 2075

  In an article in Oprah Winfrey’s O Magazine, her ‘style coach’, Martha Beck, discusses her experience of what she calls ‘party anxiety’.6 When exposed to other people, she says the ‘real enemies are shame, fear, and cruel judgment’. Beck says she is ‘one of the millions of party-impaired people … social-phobes [who] dread party talk’, who are ‘petrified of saying something stupid, something that will reveal us as the jackasses we are, rather than the social maestros we wish we were’. She says that she felt she ‘needed a whole armoury full of impressive weapons to survive a party – things like cleverness, thin thighs, social connections, and wealth … Every act, from choosing clothes to making small talk, is a fear-based defense against criticism.’

  We treat our shyness, self-doubt and frequent inability to feel at ease with others as if they were purely personal psychological weaknesses, as if they were flaws built into our emotional make-up that we must cope with on our own as best we can. Because we tend to hide these insecurities from each other, we fail to see them in others. But, as we shall see, surveys suggest they are so widespread that few but the most confident escape them. Indeed, Alfred Adler, the Austrian psychoanalyst who broke away from Freud’s circle early in the twentieth century, saw them as so fundamental to our human make-up that he developed the concept of the ‘inferiority complex’, and maintained that: ‘To be human means to feel inferior.’ Adler also saw what the statistics now demonstrate, that people respond to these feelings in two different ways – with shyness, low self-esteem and sometimes social phobia, or, alternatively, by hiding their insecurity under a show of self-importance, pomposity, narcissism and snobbery. He interpreted people’s attitudes of superiority as a defence against underlying feelings of inferiority. The stronger the underlying sense of inferiority, the stronger Adler thought that defence was likely to be. ‘Behind everyone who behaves as if he were superior to others, we can suspect a feeling of inferiority which calls for very special efforts of concealment.’ ‘The greater the feeling of inferiority … the more powerful is the urge to conquest and the more violent the emotional agitation.’7 It is of course because these ‘efforts of concealment’ are effective that we underestimate how widespread these insecurities are, and imagine our own are a personal affliction.

  What Adler could not see simply in his patients’ psychologies, but which we can see with the help of modern statistics, is that these difficulties – and with them the different forms of concealment – are in fact much more common in some societies than others. This suggests that there are powerful external factors, which we may be able to identify, that make them better or worse for all of us.

  Epidemiologists are trained to study the distribution and determinants of disease. They might, for example, try to identify the extent to which diseases like asthma and bronchitis are made worse by air pollution. Approaching the frequency of shyness, social anxiety and self-doubt in this way, as if they were caused – or at least made worse – by something in the emotional or social atmosphere, may enable us to identify those causes. Though we are all used to the idea that there are pollutants and carcinogens in the environment that have to be reduced in order to diminish the burden of physical disease, we are less used to the idea of tackling harmful emotional or psychological environments. Yet if the causes of heightened levels of social anxiety are the source of serious damage to social life and well-being, they surely warrant as much political and public attention as the air we breathe.

  We are a social species, and our sensitivity to each other and our ability to avoid behaviour which might offend others are necessary skills. But a normal and beneficial sensitivity to people around us is being triggered so frequently and so strongly in everyday life today that for many it has become an intensely counterproductive reaction. Feelings of insecurity are often so great that people react defensively to even minor criticism; others are seemingly so nervous of social interaction that they isolate themselves. We also see endless signs of the desire for the trappings of status behind which people try to hide their insecurity. The widespread lack of confidence and sense of insecurity have reached a level of intensity that makes them perhaps the most important limitation on levels of happiness and the quality of life throughout many rich societies. The answer, as we will show, is not for us all to learn to become more like the most thick-skinned; it is instead to identify and deal with the factors in society that do the damage.

  To understand the distinction between the components of shyness and self-consciousness which come from within and those which come from outside, imagine people running a hurdles race. If you wanted to know why some runners knock down more hurdles than others, you would look at individual differences between the runners – their ages, fitness, height, etc. But if you wanted to know why more hurdles were knocked down in some athletics meetings than others, you’d start by looking at whether the hurdles were higher in some than others. Similarly, if you wanted to know why some people could or couldn’t do a bit of mental arithmetic, you would look at individual differences in their capacity and familiarity with arithmetic, but if you wanted to know why more people could solve one problem than another, you’d look at differences in how hard the problems were.

  This is not a self-help book, and we will devote very little time to discussing the personal sources of individual differences in confidence and shyness. Our hope is that, by identifying why our social inhibitions are so easily triggered, we will have contributed to an improvement in the well-being of whole populations. Our primary focus is on the ‘vertical inequalities’ in society, on the effect of material differences from top to bottom of society, their implications for social hierarchy and status that lead us to value people differently and which feed into personal feelings of confidence or self-doubt. The so-called ‘horizontal inequalities’ betw
een whole groups of people, whether defined by gender, ethnicity, class, disability, religion, language or culture, are experienced as major injustices because they involve the same issues of superiority and inferiority. Rather than concentrating on any of these particular group distinctions, our aim is to unravel the processes of dominance and subordination that are central to all such experiences of inequality. We begin by discussing our common vulnerability to them. In effect, we need to understand the receptors of social pain before we can recognize the structural causes of that pain.

  Today we live in societies in which worries about how we are seen and judged by others – what psychologists call ‘the social evaluative threat’ – are one of the most serious burdens on the quality and experience of life in rich developed countries. The costs are measured not only in terms of additional stress, anxiety and depression, but also in poorer physical health, in the frequent resort to drink and drugs we use to keep our anxieties at bay, and in the loss of friendly community life which leaves so many people feeling isolated and alone. These insecurities are a cancer in the midst of our social life. Yet, despite this, they rarely if ever feature in measures of the quality of life.

  Rather than discussing individual differences in genetics, early childhood experiences, or how people were treated at school, which might underlie differences in individual vulnerability, we instead treat this as a public health problem. Public health has always been highly political, from the provision of sewers and the Clean Air Acts to more recent battles over vehicle exhaust emissions. As the nineteenth-century German pathologist Rudolf Virchow said, ‘Medicine is a social science and politics is nothing else than medicine on a large scale.’ This book follows in that tradition.

  SOCIAL ANXIETIES

  Shyness is a very common sign of our feelings of vulnerability to how others see us. The most widely referenced survey of shyness is the Stanford Shyness Survey. It found that over 80 per cent of Americans surveyed said they were shy during some period of their lives, whether now, in the past, or always. One-third said they felt shy at least half the time and in more situations than not.8 About a quarter regarded themselves as chronically shy. Although fewer than 20 per cent of respondents did not regard themselves as shy, most people even in this group reported that they sometimes experienced what are usually regarded as symptoms of shyness – blushing, a pounding heart or ‘butterflies in the stomach’. These people appeared not to regard themselves as shy because they experienced shyness only in occasional situations. Only 7 per cent of those surveyed said they never felt shy.

  Between 2001 and 2004, the US National Comorbidity Survey – Adolescent Supplement, surveyed over 10,000 American teenagers (13–18 years old). Asked to ‘rate their shyness around people their own age who they didn’t know very well’, almost half regarded themselves as shy, but their parents reported that over 60 per cent of them were shy.9

  Feeling shy means feeling increased self-consciousness, a sense of awkwardness and anxiety in relation to others, a lack of confidence in your social competence, which produce levels of stress which interfere with and interrupt thought processes. It makes it harder to interact with other people and enjoy their company, and harder to think and express yourself clearly – often to the detriment of careers and social life. Those who suffer high levels of shyness may be classified as suffering from social phobia, social anxiety or social anxiety disorder, but the clinical criteria for these conditions are designed to catch only the most severe end of the spectrum. People are only classified as having ‘social anxiety disorder’ when their fears and anxieties are ‘grossly disproportionate to the actual situation’ – and that is, of course, largely a reflection of what is regarded as normal.

  A small minority of people find their lack of confidence so inhibiting, and social life such an ordeal, that they avoid contact with other people as much as possible. Many are so racked by social anxieties that the pleasure of meeting others is far outweighed by the stress. The following examples, from four different people, are all taken from the Experience Project website, set up to allow people to share their emotional problems.

  In social situations I shut down and I tend to be awkward because I’m scared of people judging me and not liking me so much that I just distance myself. I hear people laughing and I immediately think they’re laughing at me (which is stupid) but I can’t help it. Over the years I have learned to embrace the loner life style …

  Sometimes I avoid anyone and everyone because I can’t stand the thought of them judging me.

  I’ll have panic attacks over something as simple as going to the checkout at Walmart. I do self-checkouts so I don’t have to talk to anyone.

  I am extremely shy around both people I know and don’t know. It hinders my everyday life so much that people think I am making it up. I have no friends. It is hard for me to go anywhere. I always make sure I go shopping in the day – that way I can wear sunglasses or a hat. It is my security blanket from Social Anxiety Disorder. I get tongue-tied and sweaty, then I feel like they’re looking at me like I am some sort of freak! It is a living hell I struggle with on a daily basis.

  Accounts like these of self-imposed isolation leave no doubt as to the amount of pain felt by those afflicted or why normal life can become impossible for them. Many of those experiencing high levels of anxiety regard themselves as suffering from a mental illness; they seek medical help from professionals and are often prescribed anxiolytics (anti-anxiety medications) and other psychoactive drugs. Since 1980, social anxiety has been included in the American Psychiatric Association’s classification of mental disorders – the Diagnostic and Statistical Manual (DSM). Unlike common levels of shyness, the prevalence of social anxiety has been carefully measured over time. In the USA the number of those suffering from social anxiety disorder has increased over the last three decades from 2 per cent to 12 per cent of the population.10-12

  RISING MENTAL ILLNESS AND STRESS

  The rich developed countries have for some time been suffering from high and rising rates of mental illness. The better surveys take great care to make sure that they count only severe and disabling conditions and are not simply a reflection of changes in the awareness of mental illness among either the medical profession or the public. There are strict criteria for assessing the seriousness of conditions, designed to exclude minor mental and emotional upsets. One of the most respected and frequently cited studies, which measured the frequency of mental illness in the USA during the years 2001–2003, was the National Comorbidity Survey Replication. Using questionnaires designed and tested for their ability to identify people with mental disorders, trained research workers interviewed almost 10,000 people for an hour in their homes.13 Among people aged 18–75, 46 per cent reported that sometime in their lives they had had symptoms which met the criteria for one or other mental disorder, not only in terms of symptoms but also in duration and the disabling effect of the disorder in question.

  The biggest weakness in the way these statistics are compiled is that they mostly depend on memory. Studies that have compared retrospective surveys, which depend on recall, with ones that interview the same people repeatedly over time, find that people either forget some earlier episodes of mental illness or are reluctant to mention them. This means that the figures most commonly quoted – including that 46 per cent – are almost certainly substantial underestimates of the scale of the problem.

  The evidence that rates of mental illness have been rising comes partly from comparing the experience of different age groups. Looking back over their lives, younger people seem to suffer higher rates of illness per year than are reported by older people. This is not just a reflection of poorer memory among the older age groups. That explanation is decisively ruled out by studies which have compared anxiety rates in successive samples of students and children over the years. One such study compared samples from all over the USA, spanning the years 1952 to 1993. It found dramatic increases in levels of anxiety among both the student and
adult populations over that forty-year period, so much so that the report’s author said that ‘The average American child in the 1980s reported more anxiety than child psychiatric patients in the 1950s.’14 In the UK, researchers from King’s College London found that teenagers in 2006 had much higher levels of problems, particularly serious emotional difficulties, than teenagers just twenty years earlier.15 The rising trend was true for boys and girls, and was found whether they lived in families with both parents or with single or step-parents, and whether or not they lived in poverty. An American Psychological Association survey in 2017 found that 80 per cent of Americans reported one or more symptoms of stress, such as feeling overwhelmed, depressed, nervous or anxious. When asked to rate how stressed they felt, on a scale from 1 (little or no stress) to 10 (a great deal of stress), 20 per cent rated themselves an 8, 9 or 10.16

  Although anxiety and depression disorders are the most common afflictions, there have also been rises in the other main categories of mental health problems, including other mood disorders, impulse-control disorders and substance abuse disorders. That they have all been rising together might lead us to expect some underlying common causes. It would be surprising if anxiety was not one of them.

  It is difficult to assess how rates of shyness and social anxiety contribute to mental illness. The system for classifying mental illness, with few exceptions, categorizes by symptom rather than by cause. People can react to the same underlying anxieties in very different ways: if your social anxiety means you panic when you go out, you might be classified as suffering from agoraphobia; if it makes you depressed, then as depression; if over the years your attempts to steady your nerves develops into alcohol dependence, then alcoholism is itself classified as a mental disorder. If your worries about how you are regarded mean you are always trying to impress or are too concerned with what you look like, then, perhaps (with a few other contributing factors), you might be thought to be suffering from narcissistic personality disorder.