The Inner Level

by Richard Wilkinson

  EQUALITY RE-ENVISIONED

  Perhaps because people tend to imagine that human beings have always lived in hierarchical societies, we rarely, if ever, stop to imagine what it would be like to belong to a community of near equals, free of the insecurities caused by class and status divisions. We assume that the only way to regain the confidence and social ease which we lack would be to increase our own status, to be better educated, more affluent or successful, or to live a more interesting and enviable life.

  There are, however, some intriguing indicators that living in much more egalitarian communities may make rather fundamental differences to human relationships and stress levels. A few recent studies show the physiological effects of ‘modernization’ – the shift from traditional rural cultures to developed urban societies. For example, it is well known that blood pressure tends to rise among people frequently exposed to stress.51, 52 Partly as a consequence of that, it is taken as entirely normal in developed countries for blood pressure to rise as people get older. However, in tribal societies without settled agriculture, in which people live in non-hierarchical communities, several studies have found that blood pressure shows no tendency to rise with age.53-55 In the Intersalt study, which measured blood pressure in 10,000 people across 32 countries, average blood pressure from the samples in developed countries was almost always between 12 and 25 points (systolic blood pressure, in mm Hg) higher among 60-year-olds than among 20-year-olds. The only two examples to show no age rise in blood pressure were the Xingu and the Yanomami foraging tribes in the Amazon rain forest.54 That was true even when comparisons were adjusted for the effects on blood pressure of things like diet, salt intake and obesity.

  That members of these tribes live together almost naked, without private areas in their huts, indicates levels of exposure to, and familiarity with, each other which would feel very uncomfortable to modern populations. Presumably if most people had felt a strong need to keep substantial areas of personal life hidden from each other, the custom would have been to erect internal walls or screens to provide privacy, rather as the owners of Haddon Hall did to separate themselves from the communal sleeping area. Just how appalling this way of living seems to those in developed societies is a measure of the fundamental changes which have taken place in the nature of human relationships even at the most personal level.

  Another angle is provided by a study that recorded changes in blood pressure among nuns living in a closed order in Italy. Though they were eating much the same diet as the rest of the local population, the study found they had no rise in blood pressure as they aged during a twenty-year follow-up period. The study’s authors attributed this to living in a stress-free, closed, monastic environment ‘characterized by silence, meditation, and isolation from [outside] society’.56

  It is difficult to guess what human psychology might be like in such different contexts and societies. Perhaps our hunter-gatherer ancestors did not feel that they would only be valued and accepted by others if their less attractive characteristics remained hidden. What is clear is that our modern belief that privacy is a legal right would have been alien to them. But the point of raising these issues here is not simply to glimpse what might once have been. It is instead to understand the debilitating strength of the heightened social evaluative threat we all face, how it contributes to our present social and psychological problems, and how it can be reduced. Not only does a larger area of privacy increase the potential for anxieties about what others would think if they knew what was hidden, but, as honesty has always been associated with what is done ‘above board’, ‘out in the open’ and ‘for all to see’, it also gives more scope for mistrust and paranoia.

  The chapters ahead progress from an analysis of the problem towards ways in which it might be solved. In Chapter 2 we show that people living in countries with bigger income differences between rich and poor are more prone to status anxiety. Regardless of individual income levels, people in more unequal societies become more worried about how they are seen and judged. We also outline research which shows that those kinds of anxieties have particularly strong effects on people’s levels of stress hormones. Greater inequality almost inevitably increases the tendency to regard people at the top of society as hugely important and those near the bottom as almost worthless. The result is that we judge each other more by status and become more anxious about where other people think we fit in.

  There seem to be two contrasting responses to the way inequality increases the ‘social evaluative threat’. High levels of social anxiety make some people feel that social life is a constant battle with low self-esteem. Lacking in confidence and overcome by extreme shyness, they tend to withdraw from social life and often become depressed. Chapter 2 also shows evidence that this kind of response is more prevalent in more unequal societies. It also provides evidence that some other common categories of mental illness involving feelings of superiority or inferiority also become more common in societies with bigger income differences.

  The other common response is almost the opposite. Instead of withdrawing from social life, we show in Chapter 3 that many people respond to the status anxieties and increased worries about how others see them by projecting an exaggeratedly positive view of themselves, apparently to conceal their self-doubt. Modesty about personal abilities and achievements tends to be replaced by narcissism and a kind of self-enhancement or self-promotion. For most people this second strategy is a matter of putting on a brave face, putting their best foot forward and trying to hide their insecurities. But there are probably also people with thick skins and apparently impervious egos who feel secure in a belief in their inherent superiority. Chapter 3 provides evidence that narcissism and self-aggrandizement increase with inequality.

  Working in the early twentieth century, without the benefit of statistical evidence, Alfred Adler had, as mentioned earlier, made important progress in understanding these responses to social anxieties. Whether people are overcome by a low sense of self-worth or hide it under a narcissistic cover, higher levels of social anxiety mean that they feel the need for various props to put themselves at ease, to bolster confidence or to reduce self-conscious inhibitions. The result is that people resort to drink, drugs and large numbers of prescribed psychoactive drugs to help themselves deal with high levels of anxiety. Consumerism often provides another prop to keep social anxieties and status insecurities at bay. Because a heightened social evaluative threat means that appearances matter more, people become more consumerist in an attempt to create a positive image of themselves. These responses, along with other props to boost self-confidence, are discussed in Chapter 4.

  We explore the evolutionary origins of social anxiety and the powerful place it has in the human psyche in Chapter 5. The discussion there focuses on our vulnerability to each other and the extent to which good social relations have always been determinants of human well-being. Likewise, we show that ignoring how others see and react to us has also always been a serious mistake. Monitoring how people respond to us has been essential to well-being because other people have the potential to be either the greatest source of help, co-operation and assistance of every kind, or our most formidable adversaries and rivals for all the necessities of life.

  In Chapter 6 we show why it is mistaken to think that the hierarchy in the societies we analyse is meritocratic, ordering people by inherent ability from the most able at the top to the least able at the bottom. The belief that people are genetically endowed with substantial differences in intelligence and ability, which determine where they end up in the social hierarchy, is almost the opposite of the truth. Brain-imaging techniques, and our growing knowledge of the malleability of the human brain, have made it clear that the most important differences in ability result from an individual’s position in the social hierarchy, rather than being determinants of it.

  We discuss in Chapter 7 how the cultural markers of status, which flesh out – or clothe – the crude differences in income and wealth, have dev
eloped to maintain visible class distinctions. Aspects of the cultural differences between classes seem to exist primarily to provide tests of status, almost for the purpose of identifying those who can be devalued and excluded.

  The point of trying to understand these issues is to see what can be done to change them. In the last two chapters we suggest how we can move towards a society which will cease to generate such intense and counterproductive feelings of insecurity and self-doubt by fostering a radical egalitarianism in terms of income, class and power. However, as we show in Chapter 8, it is no longer possible to make suggestions for radical reform of the way our societies work without also taking account of the urgent need for them to become environmentally sustainable. The challenge is to combine a transformative reduction of inequality with progress towards an environmentally sustainable way of life. Fortunately, just as inequality is inimical to sustainability, we shall see that greater equality is a pre-condition for living within our planetary boundaries. But rather than having to tighten our belts and accept a deterioration in our real quality of life, we show that the key is to replace materialism – as a false source of well-being – with a way of life more fundamentally consistent with our human sociality. We believe that it is possible to achieve a more equal and sustainable society that will improve the quality of life for all. In Chapter 9, we show that this objective can be achieved not simply by some marginal redistribution of income, but by embedding greater equality more deeply into the structure of social relations to produce a better quality of life for all of us.

  Part One

  * * *

  INEQUALITY IN THE MIND

  ‘Like to sample an antidepressant, sir? Brighten your day a bit? … Free antidepressant, ma’am? …’

  2

  Self-doubt

  ‘Do other people feel like this? Or is there something really wrong with me? … I do feel I hide the real me from people.’

  Posted online, 2012, on internet chat site I Just Want To Be Left Alone

  THE ANXIETY EPIDEMIC

  To test whether, as we had hypothesized, income inequality really does make us all more anxious about status and how others see us, sociologists Richard Layte and Christopher Whelan looked at levels of status anxiety in more and less unequal societies. They used data on the 35,634 adults in 31 countries (27 European Union member states, plus Norway, Croatia, Macedonia and Turkey) that took part in the European Quality of Life Survey in 2007.57

  Respondents were asked to what extent they agreed or disagreed with the statement: Some people look down on me because of my job situation or income, which seems a reasonable measure of whether or not people are more or less concerned with social status and status competition in different societies. The researchers found big differences between countries in the proportion of the population who either agreed or strongly agreed with the statement. In all countries, status anxiety increased as people’s income rank decreased and, as you would expect, those at the top of the income hierarchy were consistently less worried about their status than those at the bottom. But status anxiety was higher at all income levels in more unequal countries. Bigger income differences do, as we had predicted, increase everyone’s social evaluation anxieties. Inequality makes everyone more worried about status and how they are judged by others.

  In Figure 2.1, the top solid line shows the level of status anxiety in the more unequal countries, running from the poorest tenth of people living in those countries on the left, to the richest tenth of people on the right. The middle line shows the same thing for medium inequality countries, and the bottom dashed line shows the same thing for the most equal countries. Whether you are in the highest or the lowest income group, you are more likely to suffer status anxiety if you live in a more unequal country. Among the countries in this study, status anxiety was highest in more unequal countries such as Romania, Poland, Lithuania, Latvia, Portugal and Macedonia, and lowest in more equal countries such as the Czech Republic, Denmark, Norway, Sweden, Slovenia and Malta. Most of the other Western European countries came within the medium inequality group. Perhaps the most likely explanation of why inequality increases status anxiety across entire societies is because it increases the sense that people at the top of the social ladder are extremely important and those at the bottom almost worthless, and, as money becomes more entrenched as a measure of people’s worth, it makes us all more worried about where we come in the hierarchy.

  Figure 2.1: Status anxiety is higher at all levels of income in more unequal countries.57

  Differences in status anxiety are important. Social evaluation anxieties have been found to be a particularly powerful source of stress. There have been many studies of how levels of stress hormones respond when you have to do something stressful. Typically they measure levels of cortisol (a central stress hormone) in the blood or saliva of volunteers before, during and after a stressful task. Different studies have used different activities to make people feel stressed. Some asked volunteers to solve mathematical problems – sometimes with the additional embarrassment of having to announce their mark publicly. Others were asked to write about an unpleasant experience they had had, or were given tasks which involved verbal interaction, or being videoed, or having to put up with a loud noise. Because so many different kinds of tasks were used as stressors, Sally Dickerson and Margaret Kemeny, psychologists at the University of California, were able to go through the data to see what kind of task most reliably raised levels of cortisol.58 They analysed results from 208 such studies and found that what pushed up stress hormones most dramatically were ‘Tasks that included social-evaluative threat (such as threats to self-esteem or social status), in which others could negatively judge your performance.’ Rises in cortisol were over three times as high for tasks which involved some threat of social evaluation compared to tasks which did not. Dickerson and Kemeny suggest that what is at stake is your social (as distinct from physical) self-preservation, which they say is a matter of your social value, esteem and status, based largely on other people’s perception of your worth.

  These findings mean that the higher levels of status anxiety across all income groups shown in Figure 2.1 are almost certainly an indication of an important increase in stress throughout the populations of more unequal countries.

  ARE WE ALL GOING UNDER?

  In 2010, we published an article in the British Journal of Psychiatry, showing that – at least in rich countries for which data was available – greater income inequality is associated with higher rates of mental illness.59 We showed that the more unequal countries had three times as much mental illness as the more equal ones: in Japan and Germany, for example, fewer than 1 in 10 people had experienced any kind of mental illness in the past year; in Australia and the UK it was more than 1 in 5; and in the USA more than 1 in 4. The data are illustrated in Figure 2.2.

  A more recent study published in 2017, which combined the data for twenty-seven separate studies, concluded that rates of mental illness are indeed higher in societies with bigger income differences.60 But when our article came out, it received an irate response from a consultant psychiatrist.61 His quarrel was not with us – he didn’t question the link between inequality and mental health – but with the high rates of mental illness shown in the data we had used. How, he asked, could we take at face value such outrageous figures? One million British school children mentally ill? More than a quarter of the American adult population? He said that such figures seemed ‘preposterous’ to him, as a doctor and as a citizen, and represented the increasing medicalization of everyday life, a tendency to label distress, discomfort and difficult emotions as illness.

  Figure 2.2: The prevalence of mental illness is higher in more unequal rich countries.59

  The data we had used came from the World Health Organization’s World Mental Health Survey Consortium and similar epidemiological surveys of mental illness.62-65 In all such surveys, the most commonly reported mental illnesses are depression and anxiety; the World Health
Organization now estimates that depression alone affects 350 million people worldwide. Depression is the leading cause of disability in the world, as it can affect people’s ability to take care of themselves and carry out their day-to-day responsibilities. Women are particularly affected, and in rich and poor countries alike depression is the number one cause of women’s burden of disease, far more prevalent than the next leading causes, HIV/AIDS and tuberculosis. Unlike most physical illnesses, depression often strikes at a young age. At its most severe, depression can lead to suicide; 1 million people take their own lives every year. Suicide is a leading cause of death among people aged between eighteen and thirty years old, and contributes to rising mortality rates among middle-aged Americans.66, 67

  So, who is right? The surveys, which suggest a heavy burden of mental illness? Or our irate psychiatrist, who deplores the modern tendency to give pathological labels to normal human emotions? Is the world suffering from an intolerable burden of disease, or are we simply mislabelling valuable human emotions and responses as illness, pathologizing sadness and anxiety, and turning everyday experiences into medical problems?

  The psychiatrist’s reason for not believing the evidence from carefully constructed scientific surveys stemmed from his surprise at the high rates of mental illness they suggest. The numbers are shocking. But casting our minds over family, friends and acquaintances, we can easily count episodes of depression, anxiety, self-harm, eating disorders, addictions, bipolar disorder and more which are broadly compatible with the data. As we shall see, the ways in which inequality affects mental illness rates are tied up with incentives for people to conceal their suffering and blame themselves for it – perhaps this is why we seem to regard mental illness as less common than it actually is.