Extreme Inequality Is Driving Anxiety and Depression in the US

It starts at the gate. You’re huddled in a mass of people waiting to board the flight as you hear your gate agent make an announcement inviting first-class passengers onto the plane. You’re in economy class, so you wait. After the first-class passengers have all made their way onto the plane, you’re finally allowed to board. As you drag yourself slowly down the jet bridge and onto the flight deck, you hit a wall of passengers. In order to get to your seat in economy, you have to pass through first class. But the aisle is congested, so as you shuffle slowly along you have plenty of time to notice the first-class passengers reclining in their oversized seats. You notice their fruit bowls. Their champagne. Their cheese plates.

As you mentally prepare yourself for the armrest battles and lower back pain that await you, you become aware that the first-class passengers are avoiding eye contact. Maybe they feel superior? Entitled? Or perhaps guilty? Whatever it is, it just might leave you feeling like shit.

Although the ability to board an airplane at all is already a sign of some modicum of class privilege, even for “economy class” passengers, the internal class segregation within modern air travel also functions as a microcosm of class society. As a result, the aforementioned feelings of stress, resentment, and guilt don’t begin and end on the flight — they’re just a particularly recognizable instance of what psychologists refer to as status anxiety, a phenomenon that is prevalent in societies with high levels of inequality.

“Air travel replicates, on the micro scale, almost exactly what we find are the effects of inequality at the societal level,” social epidemiologist Richard Wilkinson explained to Truthout. “More unequal societies make us more aware of class and status — people become more concerned with issues of superiority and inferiority and worry more about how others judge them. Social life becomes more stressful and people start to withdraw from it. As inequality undermines confidence and feelings of self-worth, mental health inevitably deteriorates.”

There’s a whole body of research to back this up. Wilkinson, along with social epidemiologist Kate Pickett, have been writing on the harmful effects of societal inequality for quite some time. In their widely acclaimed book, The Spirit Level, published in 2009, the two authors documented how individuals in societies with larger income gaps are more likely to experience a very wide range of health and social problems.

Of course, the point is not to discount the impact of biological, genetic, or personal factors affecting mental health, but rather, to acknowledge the social, political, and economic factors as well.

Some level of economic inequality has always existed within our economic system — it’s stitched into the very fabric of capitalism. But since the Occupy movement brought economic inequality to the forefront of the national conversation in 2011, awareness of this glaring phenomenon has grown. In 2017, when Oxfam presented the stunning finding that just eight men owned as much wealth as the bottom half of the population — 3.5 billion people — the topic began to really grab headlines. The focus on inequality has largely rested on the economic and political implications: As wealth concentrates at the top, so does power, and this has all sorts of harmful consequences for democracy. But researchers like Wilkinson and Pickett have demonstrated that the effects of income inequality go far beyond the economic or political realm.

“In The Spirit Level, we presented evidence showing that less equal countries, like Britain and the United States, have higher levels of homicide … lower levels of child wellbeing, weaker community life,” Wilkinson told Truthout. “There are more drug problems, there is mental illness, there’s worse physical health — a whole range of apparently unrelated outcomes are worse in less equal societies.”

And it’s not just those who are on the lower rungs of the economic ladder — income inequality affects everybody in society. So that means that in highly unequal societies, it’s not just that the gradient of problems within that society are more dramatic, but that the average level of problems in those societies is higher than in a less unequal society. Everyone does worse when inequality is higher. So even rich, well-educated and affluent people in countries like the United States do worse than their counterparts in more equal societies like Japan or the Scandinavian countries.

Whereas The Spirit Level explored the many problems that inequality produces on a societal level, Wilkinson and Pickett’s latest book, The Inner Level, published in 2018, dives specifically into the psychological effects of inequality on the personal level.

“In less equal societies we see more [diagnoses of] depression … narcissistic personality disorder, schizophrenia — a wide range of worse mental health outcomes,” Wilkinson told Truthout. “Mental illness is [often] triggered or exacerbated by issues to do with dominance and subordination.” He added that when people feel subordinated or at constant risk of subordination, they are more likely to experience emotional distress and pain, and may be more likely to behave in ways that are considered “anti-social.”

Let’s go back to the air travel example. When the class veil is lifted and the bifurcation between first class and economy is visible, this not only creates a yawning chasm between the aviatorial haves and have-nots — prompting feelings of resentment or guilt — but research has shown that it also increases incidents of air rage within economy class itself. If this kind of limited and situational inequality can foster this kind of antisocial behavior, it’s no wonder that pervasive inequality in all aspects of life will have a detrimental effect on society as a whole.

“Material differences between us are damaging to the whole social fabric of society,” Wilkinson explained to Truthout. “For example, we’ve found that in more unequal American states or European countries that only 15 or 20 percent of the population feel they can trust others. But in the more equal ones, it rises to 60 or 65 percent.”

As the social fabric of society frays and social relationships become more fraught with status concerns, many individuals experience chronic status anxiety: the constant fear of or tension associated with being judged by society according to your material success. And research by sociologists Richard Layte and Christopher T. Whelan has shown that status anxiety not only increases as you go down the socioeconomic ladder, but that status anxiety is also higher at all income levels in less equal countries.

This chronic stress is linked to a wide range of mental health problems. A 2017 paper in Lancet Psychiatry that combined 27 different studies revealed that less equal countries had three times as many conditions classified as mental illness as more equal ones.

In his most recent book, Lost Connections: Uncovering the Real Causes of Depression — and the Unexpected Solutions, author and journalist Johann Hari takes a deep dive into the social causes of mental illness — specifically depression.

“In a highly unequal society, everyone has to think about their status a lot. Am I maintaining my position? Who’s threatening me? How far can I fall? Just asking these questions — as you have to when inequality grows — loads more and more stress into our lives,” Hari writes in Lost Connections. “This means that more people will unconsciously respond to this stress by offering a response from deep in our evolutionary history — we put our head down. We feel defeated.”

The relationship between inequality and depression has been well documented — particularly through a 2011 study conducted across 45 U.S. states that revealed that people in less equal states experienced higher rates of depression. Similar relationships are seen in international studies as well.

The social factors that contribute to mental illness go beyond the basic fact of inequality — in Lost Connections, Hari explores how depression is linked to the wide range of junk values underpinning modern neoliberal society. These values are rooted in the belief that we are all atomized individuals out to seek our own self-interest — and that this is somehow natural and in fact good.

In this neoliberal world, human beings have been reduced to consumers. Our beliefs, desires, relationships — almost every aspect of our lives is subsumed within the capitalist marketplace. As our relationships become increasingly transactional and as departments of large multinational corporations gain inroads in dictating our sense of self-worth, we grow more and more disconnected — from ourselves, from each other and from society in general. It’s this disconnection, Hari believes, that helps to explain why people in a country like the United States, where the neoliberal project is in hyperdrive, experience very high rates of depression.

“Income inequality is a major determinant of disparities in mental health in the United States, but it’s also critical to consider other forms of inequality such as gender, racial, or sexual minority inequality and the experiences associated with those,” Brea Perry, a professor of sociology at Indiana University, told Truthout.

Perry’s research focuses on relationships between social networks, social inequality and mental health. She believes it’s critical to understand the multifaceted links between inequality and mental illness because many different forms of inequality — not just income inequality — can overlap with one another to create unique outcomes for different groups.

“So for example, although we know that there is a clear social gradient in mental health at each increasing level of education, Blacks get a lower return on their educational investment,” Perry explained to Truthout. “Put differently, social class is not nearly as protective of physical and mental health for Black Americans as it is for white Americans in terms of their physical and mental health. And that’s true across all kinds of outcomes. Marginalized groups tend not to see the health benefits of class advantage to the degree that white, cisgender, straight men do.”

Research has also shown that discrimination can also lead to adverse health outcomes. This happens in two primary ways: one is biopsychosocial, the other is social-psychological. In the first case, it has been shown that racism and discrimination can lead to increases in stress hormones like cortisol that activate the body’s hypothalamic pituitary adrenal (HPA) axis.

“This is particularly insidious because these elevated stress levels have adverse effects on mental health but also on physical health. This can lead to a phenomenon called ‘weathering,’” Perry told Truthout. “When you’ve experienced persistent inequality, persistent racism or discrimination, then your HPA axis is consistently turned on. Over time, this leads to a degradation of different biological systems, which is why we see higher rates of physical illness and chronic diseases like hypertension in Black Americans.”

For example, Black adults are up to two times more likely to develop high blood pressure by age 55 than white adults. And the differences can actually start before birth. According to the U.S. Department of Health and Human Services Office of Minority Health, Black people who categorized their identity as “not Hispanic” have an infant mortality rate more than two times that of white people who categorized their identity as “not Hispanic.”

The second pathway through which racism and discrimination can affect stress and depression is through social-psychological processes — how a person’s thoughts, feelings and behaviors are influenced by the actual, imagined or implied presence of others.

“When you experience discrimination, it leads you to have lower self-esteem, it leads you to question your sense of purpose in life, your sense of belonging — it changes the way that you feel about yourself. These things then in turn lead to depression,” Perry explained.

And this pattern holds true for almost every form of oppression for which research is available.

“There’s less research on things like transphobia because there are not many datasets out there,” Perry told Truthout. “But we see it with respect to race, gender, sexual minorities — really any group that has a marginalized status in society. If they’re experiencing adverse treatment or if they even just have knowledge of stereotypes associated with their group, for example, that can affect their physical and mental health.”

As income inequality continues to increase and a slurry of discriminatory divide-and conquer-rhetoric spews out of the highest levels of government, it’s important to emphasize that systemic inequality is not inevitable. Racial inequality, gender inequality and economic divides are all forms of inequality that are inherent to the very structure of class society — and have been since its inception. But for the vast majority of human existence, humans have not structured our societies in this way.

“There’s widespread agreement amongst anthropologists that hunting and gathering societies … were remarkably egalitarian,” Richard Wilkinson told Truthout. “Inequality came in after probably a couple of thousand years of agriculture — when you start getting cities and slavery and class societies. But if you look at the greatest period of human history and prehistory, you would probably see an extraordinarily egalitarian species.”

To begin adequately addressing the many mental health crises that our society is experiencing today, we must begin looking at depression, anxiety and stress — as well as the many harmful physical health outcomes that they lead to — as not simply genetically predetermined chemical imbalances in the brain, but also as social, economic and political issues.

It’s time to discard the myth of Homo economicus, which has taught us that selfishness, greed, and competition are good and natural. We now know that the opposite is true: selfishness and greed have been taught to us, and as we’ve learned, competition — at least the status and survival kind — makes us miserable.

Instead, if we could focus on reducing income inequality, strengthening community life, and building a society and economic system that increases connection and brings people together, perhaps we could start to lower the high rates of anxiety and depression in our society.