Photo: "I met my love" - Liverpool St Gasworks, Salford by Iain Peacock (used with permission)

Connecting toxic discourses to the health inequalities debate

One of the many toxic features of neoliberalism is the way in which it divides the population into those considered deserving or undeserving. This was recently seen through the ‘strivers’ and ‘shirkers’ debate which occurred as the UK Coalition government sought to legitimise removing benefits from the poor, sick and disabled. Of course, concentrating political attention on those in receipt of benefits also serves to distract from the activities of the 1% who take an ever greater proportion of national income, as Danny Dorling makes clear. Our point here is that neoliberalism makes inequality seem “natural”, drawing the eye away from disparities in income and wealth between those at the top and bottom of society, drawing the eye down and sideways, and then re-defining ‘fairness’ as what you deserve in relation to those in a similar position. But in dividing the population, neoliberalism also shames those who are seen to have ‘failed’ and makes the individual person feel responsible for their circumstances.

The ways in which neoliberalism provides more spaces for shaming is one of the things we want to focus on here. In their well-known book The Spirit Level, Wilkinson & Pickett connect shame and social comparisons, via widening inequalities in income, through to inequalities in health. They show how social stressors such as lack of friends and connections, stress in early life and shaming or invidious social comparisons with those further up the income divide, translate into bodily harm (direct consequences for health) and into more damaging social relations that then add to the burden of ill health. We agree with them that widening income inequality and shame are hugely important; but as we argue here, income and wealth inequalities have to be justified by a range of toxic discourses associated with the spread of neoliberalism, and it is these that may be most damaging.

Wilkinson and Pickett draw on a wide range of studies to support their argument, but their framework doesn’t draw on the sociological literature on shame and because of this, we argue here that there are ways of extending their argument. Numerous studies highlight that the disadvantaged are more likely to experience what Andrew Sayer describes as ‘low level shame’ – repeated exposure to numerous small, instances of disrespect, mis-recognition or symbolic violence running throughout the life-course, and which may form part of the habitus. Or the ‘structural humiliation’ that means expecting those in poverty to compete on the same terms as the rich, but without the same resources – and thus they ‘fail’. In other words, shame both consciously and unconsciously shapes the inner world and our ‘internal conversations’, and not just through making ‘external’comparisons with those further up the income divide.

An example of this can be found in Shildrick and Macdonald’s heart-breaking work conducted in NE England, where those on the lowest incomes routinely blamed themselves, and those in their immediate environment, or talked about an imagined ‘other’ in ways that were demeaning, disrespectful and shaming. But in addition to blaming the self, there are also discourses, resources and strategies – such as the idea of solidarity, political resistance or identification with a place or area – that can be drawn upon to at least partially protect the self. For example, Lamont interviewed American and French workers, and explored how men positioned themselves in different ways to protect themselves from shaming comparisons. She argues that the French workers were able to protect themselves better because they could draw on a more politically sophisticated analysis of class and exploitation, and thus shamed themselves less. So, the point is, that ideas and politics can be protective. But we know that neoliberalism has undermined these resources as well.

Shame may not be the only discourse from neoliberalism that has been internalised. Our qualitative study exploring women’s understandings of shame and social comparison, conducted in Salford, suggests that an equally toxic discourse, what we called no legitimate dependency, is important in understanding the ways people make sense of a changed world. We interviewed women from a range of backgrounds, using a biographical narrative approach, to understand their experiences of inequality. What we found was that shame and social comparison were present in women’s narratives about living in an unequal society, but not quite in the ways that Wilkinson and Pickett proposed. Women didn’t position themselves in a hierarchy and make comparisons around income, rather, they made comparisons with others similar to themselves and focused on their bodies, houses and children as potential sites for shame. Most painfully seen with children, their aim was to protect children from shaming comparisons (often by buying consumer goods and clothes).

But what came as a surprise to us was the no legitimate dependency discourse, which meant that there was no legitimate way to be dependent on another. Dependency meant not just weakness but something more negative than that – as a symptom of a desire to shirk responsibility for one’s own failings. The no legitimate dependency discourse was constituted of a mix of self-blame and ‘othering’ (blaming others) and our suggestion is that this reflects discursive aspects of neoliberalism which are internalised as though they were individual characteristics or points of view.

So, what does this mean? Coming back to The Spirit Level, women didn’t compare themselves necessarily to those who had more, but rather, in thinking about their world, they compared to others in the same position, and it was in this imagined space that no legitimate dependency flourished. The painful business of comparison was infused with individualising discourses about personal responsibility, alongside a need to disavow forms of dependence. So, it seems that neoliberalism and its toxic discourses, plays a much greater role than social comparison in explaining the damages consequent on growing income inequality. Some of the core facets of neoliberalism – the need for the individual to face the market alone, the stripping away of benefits and the erosion of the welfare state – are legitimised by processes which blame, ‘other’, and blame and ‘responsibilize’ the disadvantaged most. Health inequalities need to be seen in this context.

Shame and the no legitimate dependency discourse are used to divide, to render us passive and also serve to legitimate inequality. But sharing shame and other difficult experiences can be both liberating and protecting and may foster pride, solidarity and resistance. Reporting on a study commissioned by Shelter, the journalist Zoe Williams describes the impacts for those living in rented accommodation and how this might produce feelings of inferiority and shame. She goes on to describe how coming together to talk about social housing, the bedroom tax, an absence of affordable housing – as the Focus E15 mothers in Newham have done – involved sharing the problem which ultimately lead to shaking off the murky bonds of shame. One of our tasks as researchers, might be to understand how shame shapes us all, but to find ways of sharing shame such that it produces resistance and protection for those who have been most profoundly hurt under neoliberalism.

 About the authors: Paul Bissell is a professor of public health at the University of Sheffield, and is a medical sociologist by background. He is interested in the ways in which neoliberalism shapes inequality, practices and the inner world of experience. Marian Peacock is a Lecturer in Public Health at the University of Salford and a Senior Research Associate at Lancaster University. Her background is in mental health and her research interests are around the area of health inequalities and in particular how neoliberalism shapes health and identity.