When we talk about helping people overcome depression the solutions we offer involve them finding confidence and improving their self-esteem so they can deal with the challenges they face and ‘live normal lives’, whatever that means. This puts the emphasis is on the individual to change and carries the connotation that the problem is internal. Speaking from experience, I know that the causes are not always from within. In the past few years many researchers and commentators have pointed out that the high instances of depression we see today are likely caused by social influences such as income inequality, consumerism and competitive lifestyles, ideas which have not been talked about enough.
Of course, bar media coverage of a few exceptional speakers and the occasional feel-good stories, we have done a dismal job of talking about mental health in the media, in schools and in the public in general. If we are serious about addressing this epidemic, we should be looking at all the information, something we have not always done well. For example, the common belief for years was that depression is simply a chemical imbalance where low levels of serotonin would cause people to exhibit depressive symptoms that medication (antidepressants) could alleviate. This idea was perpetuated despite a lack of evidence to support it and many doctors reluctantly prescribed antidepressants despite knowing they weren’t necessarily going to make a difference, at least not in many cases.
Thankfully, things have changed somewhat, and now we acknowledge that the causes of depression are unique to the experiences and lifestyles of the individual, and therefore the help a person needs is also unique. But there has still been little discussion of the social causes of depression despite researchers and organisations including the World Health Organisation have been saying for years that the causes of the widespread instances of depression in part result from the way society is structured.
“It is No Measure of Health to Be Well Adjusted to a Profoundly Sick Society” – Jiddu Krishnamurti
To paraphrase Johann Hari who has written on this very topic, rather than viewing depression as the problem that needs to be fixed, perhaps we need to look at it as a symptom of much bigger problems we face. After all, if one in six people in this country suffer from depression and many of them because they are struggling with daily challenges like unemployment, economic uncertainty and material hardship, perhaps the system isn’t working as well as we like to think. Indeed, there are some pretty clear ways this is happening.
The Influence of Social Hierarchy
A popular theory is that top-down hierarchies adversely impacts an individual’s mental health, particularly that of those in the middle and lower end of the pecking order. Hierarchies cause those with less power to avoid conflict with those that control resources and wield economic and political power because they live in a state of perpetual fear; their position and access to resources that sustain their lifestyles are not guaranteed as they are dependent on those with more power. They must tread carefully, for to upset the powers that be too greatly is to risk losing much. Thus, they suppress their emotions, often choosing to keep a low profile and accept the status quo rather than expressing how they really feel, just as the middle and lower classes do in Western societies in the face of injustice. As we know, the worst thing people suffering mental health problems can do is keep things bottled up.
Surprisingly, it is often those in the middle who exhibit higher rates of anxiety and depression than those in the lower section, possibly because their position in the social hierarchy is so precarious. They are not at the top of the order but believe they are almost there, but they are also aware that they are not far from the bottom and only a few missteps could land them there. This fear of being inferior or becoming even more inferior adds to the likelihood of anxious or depressive symptoms.
“…social pressure to be polite and deferential to people with greater status and power results in more emotion suppression among those who occupy low positions within a social hierarchy” (Langner et al., 2012, p4)
The modern workplace is a great example of such a hierarchy. The more responsibility a person holds within an organisation, the more pressure they are subjected to. Those in supervisor and manager roles are subjected to pressure from above, the executive level, and are also the ones that have to deal with the workers and pressure from them. As they embody that precarious middle space, they are often striving for higher office (and therefore pay) while being aware that several mistakes could see them demoted, which would undoubtedly be embarrassing. The workers on the ground floor are equally miserable because they have little control over the allocation of resources and wealth, in particular receiving a relatively small share of the latter. The executives on top of the pile have all the power, significantly more money and less reasons to be stressed, anxious or depressed.
Income Inequality and Depression
Because of the obvious class divide in this country and similar developed countries, it goes without saying that the distasteful levels of inequality are having an impact on our mental health. Numerous studies have demonstrated a positive relationship between economic inequality and depression in countries all around the world which cite a range of reasons for this relationship. One reason is that people compare themselves to others who are better off and feel a sense of defeat at the structural unfairness. Other reasons include associated developmental disorders in adolescents and a sense of withdrawal or shame by worse-off people in a community.
Whatever the reasons, the fact remains it is a serious problem. The graph below shows how in the United States, states that have higher levels of income inequality according to the Gini Coefficient tend to have higher instances of depression.
This phenomena is not unique to the United States, and nor is it limited to mental health. As the graph below demonstrates, more unequal countries experience a range of health and social problems which combine to create a perfect storm for those less fortunate.
In unequal societies, competition for resources and wealth creates a host of problems.
Competition breeds misery
The defenders of the capitalist status quo love the idea of competition because apparently financial incentives foster innovation. To be fair, they are correct. It is amazing how much money and effort companies will invest to extract as much value from workers without paying them their fair share, or how to extract as much capital from the natural environment without having to pay to fix the problems they create. From that point of view, competition certainly does lead to innovative thinking, but not necessarily thinking that will benefit the majority of people.
Elsewhere, competition leads to misery in other ways. Financial wealth is often a determinant of social status, as it allows individuals to afford the symbols of wealth. In our consumerist society, clothing brands, expensive cars and the price of one’s house are common symbols of wealth, and targeted advertising convinces us either subconsciously or consciously to pursue these things. When societies are as unequal as New Zealand is, the class divide is noticeable. Because people want to climb higher up the social ladder, they pursue as much as possible the appearance of high social status, often by purchasing material goods like those mentioned above and often to the detriment of their health and well-being.
What should we be doing about it?
We should be working together
The strength and quality of relationships between people within communities plays a significant role on mental health. Alienation, isolation and loneliness are causes of depression that are themselves caused by inequality. Neoliberalism favours individualism and places emphasis on ‘individual responsibility’, even for socially-created problems, which only further isolates and alienates people. Therefore, we can live healthy lifestyles in which we accomplish things by working together.
In a clip discussing this very topic, Johann Hari presents an anecdote of a woman suffering from crippling anxiety and depression who finds purpose by working with others to create a garden. The best thing about this story is that it isn’t some unsubstantiated ‘hippy cure’ or anything; there are plenty of studies that link improved mental health to exposure to green space and working on collaborative projects like community gardens. We should be thinking how our communities can be restructured to encourage neighbourhoods the care for and empower each other.
We need a society that works for everyone
Perhaps the best way that we can care for each other is by creating a society that is fair and just. Currently, our neoliberal capitalist system is designed to continually advantage a select few while an increasing majority are left with less. This is making the mental health problems so many people face even worse and there is no legitimate reason why such an unfair regime should continue. Not that long ago, the distribution of wealth was more fair and those who earned more than enough would pay higher taxes that would ensure they are making positive contributions to society. Now, with essential services like healthcare and education so underfunded, it is beyond time for them to give back and use their wealth for good.
Currently there are a range of wonderful and aspirational organisations working on initiatives to combat mental health by empowering people, and while it is great they are making a difference in communities, imagine how much more they could accomplish if they didn’t have to rely on charity and volunteers. Imagine how much happier and productive people would be if they weren’t living with the constant anxiety of worrying whether they will be able to make rent or put food on the table. If people were taxed appropriate to their means and needs then those struggling to get by wouldn’t have to endure tax hikes for necessary infrastructure upgrades and others could have access to suitable, equitable education, housing and health services that are needed to improve mental health. Finally, imagine the things we could accomplish if society didn’t pit people against each other and valued cooperation and working for the collective good.
Understand That It’s Not You
Perhaps the most important thing to take away from this is that depression and anxiety are not always caused by chemical imbalances or traumatic experience, but can actually be a response to a world that isn’t right. The problem, certainly in my case, is with the society we have created, a society that compels us to compete with each other and to be critical of ourselves. As we work to combat mental health in New Zealand and abroad, while our efforts should certainly empower people to find joy and purpose in each day and encourage openness about our feelings, we should also be talking about how our values as a society need to change. A happier society will be found when things are more fair and equal.
- Gilbert, P., McEwan, K., Bellew, R., Mills, A. & Gale, C. (2009) The Dark Side of Competition: How Competitive Behaviour and Striving to Avoid Inferiority are Linked to Depression, Anxiety and Self-Harm. Psychology and Psychotherapy, 82(2), 123-36.
- Lacasse, J. & Leo, J. (2015) Antidepressants and the Chemical Imbalance Theory of Depression: A Reflection and Update on the Discourse. Florida State University Libraries.
- Langner, C., Epel, E., Matthews, K., Moskowitz, J. & Adler, N. (2012) Social Hierarchy and Depression: The Role of Emotion Suppression. Journal of Psychology, 146(4), 417-436.
- Macintyre, A., Ferris, D., Goncalves, B. & Quinn, N. (2018) What Has Economics Got To Do With It? The Impact of Socioeconomic Factors on Mental Health and the Case for Collective Action. Nature.com, <https://www.nature.com/articles/s41599-018-0063-2>
- Patel, V., Burns, K., Dhingra, M., Tarver, L., Kohrt, B. & Lund, C. (2018) Income inequality and depression: a systematic review and meta‐analysis of the association and a scoping review of mechanisms. World Psychiatry, 17(1), 76-89.
- Schultz, W. (2015) The Chemical Imbalance Hypothesis: An Evaluation of the Evidence. Ethical Human Psychology and Psychiatry, 17(1), 60-75