The Enemy Between Us: How Inequality Erodes Our Mental Health

By Kate Pickett and Richard Wilkinson, who are professors of epidemiology, co-founders of The Equality Trust, and authors of The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Wellbeing, which is published by Allen Lane. Originally published at openDemocracy

Credit: Flickr/mSeattle.CC BY 2.0.

When people are asked what matters most for their happiness and wellbeing, they tend to talk about the importance of their relationships with family, friends and colleagues. It is their intimate world, their personal networks that mean the most to them, rather than material goods, income or wealth.

Most people probably don’t think that broader, structural issues to do with politics and the economy have anything to do with their emotional health and wellbeing, but they do. We’ve known for a long time that inequality causes a wide range of health and social problems, including everything from reduced life expectancy and higher infant mortality to poor educational attainment, lower social mobility and increased levels of violence. Differences in these areas between more and less equal societies are large, and everyone is affected by them.

In our 2009 book The Spirit Level, we hypothesised that this happens because inequality increases the grip of class and social status on us, making social comparisons more insidious and increasing the social and psychological distances between people. 

In our new book, The Inner Level, we bring together a robust body of evidence that shows we were on the right track: inequality eats into the heart of our immediate, personal world, and the vast majority of the population are affected by the ways in which inequality becomes the enemy between us. What gets between us and other people are all the things that make us feel ill at ease with one another, worried about how others see us, and shy and awkward in company—in short, all our social anxieties.

For some people, these anxieties become so severe that social contact becomes an ordeal and they withdraw from social life. Others continue to participate in social life but are beset by the constant worry that they have no small talk or come across as boring, stupid or unattractive. Sadly, we all tend to feel that these anxieties are our own personal psychological weaknesses and that we need to hide them from others or seek therapy or treatment to try to overcome them by ourselves.

But a recent Mental Health Foundation Survey found that 74 percent of adults in the UK were so stressed at times in the past year that they felt overwhelmed and unable to cope. One-third had suicidal thoughts and 16 percent had self-harmed sometime in their lives. The figures were much higher for young people. In the USA, mortality rates are rising, particularly for white middle-aged men and women, due to ‘despair’, meaning deaths due to drug and alcohol addictions, suicide, and vehicle accidents.  An epidemic of distress seems to be gripping some of the richest nations in the world.

Socioeconomic inequality matters because it strengthens the belief that some people are worth much more than others. Those at the top seem hugely important and those at the bottom are seen as almost worthless. In more unequal societies we come to judge each other more by status and worry more about how others judge us. Research on 28 European countries shows that inequality increases status anxiety in all income groups, from the poorest ten percent to the richest tenth. The poor are affected most but even the richest ten percent of the population are more worried about status in unequal societies.

Another study of how people experience low social status in both rich and poor countries found that, despite huge differences in their material living standards, across the world people living in relative poverty had a strong sense of shame and self-loathing and felt that they were failures: being at the bottom of the social ladder feels the same whether you live in the UK, Norway, Uganda or Pakistan. Therefore, simply raising material living standards is not enough to produce genuine wellbeing or quality of life in the face of inequality.

Although it appears that the vast majority of the population are affected by inequality, we respond in different ways to the worries it creates about how others see and judge us. As we show in The Inner Level, one way is to feel burdened and oppressed by lack of confidence, feelings of inferiority and low self-esteem, and that leads to high levels of depression and anxiety in more unequal societies.

A second is to try to flaunt your own worth and achievements, to ‘self enhance’ and become narcissistic.Psychotic symptoms such as delusions of grandeur are more common in more unequal countries, as is schizophrenia. As the graph below shows, narcissism increases as income inequality rises, as measured by ‘Narcissistic Personality Inventory’ (NPI) scores from successive samples of the US population.

Sources: The Inner Level and Twenge et al 2008.

A third response is to find other ways to overcome what psychologists call the ‘social evaluative threat’ through drugs, alcohol or gambling, through comfort eating, or through status consumption and conspicuous consumerism. Those who live in more unequal places are more likely to spend money on expensive cars and shop for status goods; and they are more likely to have high levels of personal debt because they try to show that they are not ‘second-class people’ by owning ‘first-class things.’

In The Inner Level, the evidence we show of the impact of inequality on mental wellbeing is only part of the new picture. We also discuss two of the key myths that some commentators use to justify the perpetuation and tolerance of inequality.

First, by examining our evolutionary past and our history as egalitarian, cooperative, sharing hunter-gatherers, we dispel the false idea that humans are, in their very nature, competitive, aggressive and individualistic. Inequality is not inevitable and we humans have all the psychological and social aptitudes to live differently.

Second, we also tackle the idea that current levels of inequality reflect a justifiable ‘meritocracy’ where those of natural ability move up and the incapable languish at the bottom. In fact the reverse is true: inequalities of outcome limit equality of opportunity; differences in achievement and attainment are driven by inequality, rather than being a consequence of it.

Finally, we argue that inequality is a major roadblock to creating sustainable economies that serve to optimise the health and wellbeing of both people and planet.  Because consumerism is about self-enhancement and status competition, it is intensified by inequality. And as inequality leads to a societal breakdown in trust, solidarity and social cohesion, it reduces people’s willingness to act for the common good. This is shown in everything from the tendency for more unequal societies to do less recycling to surveys which show that business leaders in more unequal societies are less supportive of international environmental protection agreements.  By acting as an enemy between us, inequality prevents us from acting together to create the world that we want.

So what can we do? The first step is to recognise the problem and spread the word.  Empowering people to see the roots of their distress and unease not in their personal weaknesses but in the divisiveness of inequality and its emphasis on superiority and inferiority is a necessary step in releasing our collective capacity to fight for change.

The UK charity we founded, The Equality Trust, has resources for activists and a network of local groups. In the USA, check out Worldwide, the Fight Inequality Alliance works with more than 100 partners to work for a more equal world. And look out for the new global Wellbeing Economy Alliance this autumn.

Our own focus for change is to work for the increase of all kinds of economic democracy—everything from more cooperatives and employee-owned companies to stronger trade unions, more workers on company boards and the publication of pay-ratios. We believe that extending democratic rights to workers embeds greater equality more firmly into any culture.

Of course, we would also like to see more progressive taxation and action on tax evasion and tax havens. We’d like to see more citizens paid a Living Wage, and action taken on universal provision of high-quality lifelong education, universal health and social services. There are lots of ways to tackle inequality at the international, national and local levels, so we all need to work in ways that suit our capabilities and values.

Inequality creates the social and political divisions that isolate us from each other, so it’s time for us all to reach out, connect, communicate and act collectively. We really are all in this together.

Kate Pickett and Richard Wilkinson’s new book is The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Wellbeing.

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  1. UserFriendly

    It took a study to realize this? Quite literally the only people I can stand being around are drug addicts because they are some of the only people who have had lives as bad or worse than mine. They find it refreshing when I don’t have the slightest bit of condescension when they ask me what a word means or don’t bat an eye when they explain what they’ve been through. I find it refreshing that they don’t constantly ask how the job search is going. Because the answer is what job search. 2 years of nothing and I just don’t care anymore, I’m looking forward to being found dead in a ditch. This country is utterly useless.

    1. ChiGal in Carolina

      A society that cannot put the assets of someone with your heart and soul (and mind) to use is indeed a pitiful one. I am ashamed of us.

    2. jrs

      I find real countercultural types easy to be around as well as they reject mainstream values.

      But yea the article does start with some pretty almost strawman statements to begin with:

      “Most people probably don’t think that broader, structural issues to do with politics and the economy have anything to do with their emotional health and wellbeing, but they do.”

      Oh really ask anyone who has ever struggled to make basic bills, or yea to find work for too long, or is stuck in a horrible job and can’t get another. I know they are good to bring up more subtle things but …

    3. Corky

      I hear you. Those of us on the margins are desperately trying to warn everybody else about what is coming their way but they are so clueless just don’t get it. “Did you get a new job yet blah, blah, blah…”. How the f— am I supposed to do that when nobody will hire me because of my chronic health condition and my bad credit rating (caused by my chronic health condition and my student loan default). Its maddening. I like that you are angry but I don’t like you looking forward to being found dead in a ditch. Although I must admit I would almost certainly be dead by now if not for the help of my parents I aspire to remain alive. I want to fight this. This society is predatory and parasitic and its spreading. The clueless will need our help when it comes for them because they are less equipped to withstand it. Ignorance is not bliss. Just hang on. The bastards in charge want you to feel hopeless and they want you to die. Survive another day just to spite them.

      1. animalogic

        Good on you,
        Corky !
        “The bastards in charge want you to feel hopeless and they want you to die. Survive another day just to spite them.” And yes, when the time comes we will need people like you & Userfriendly (to name but two)

      2. RonK

        Being over 40 is viewed as a chronic health condition by employers, and if you’re over 50, their attitude is, “Why haven’t you died yet?”

    4. SpringTexan

      Job searching is hell. I recovered after a few years of unemployment in my mid-50s but I was damn lucky and I know it. Eleven years down the road (and still working for the place that finally hired me) I’m still so relieved and when I find old cover letters or resumes (endlessly reworked) and stuff I cringe in horror with the bad memories. My sympathy.

      People don’t grasp how hard it is to get even a crap job but you can spend infinite hours trying and hardly ever even talking to a person . . . also interviewers seem to think your every skill has totally decayed and you are a pathetic has-been if you’ve been out of work even a year.

      Very best wishes for a lucky break for you too . . . and for a happier time . . .

      While I was out of work it helped me to go chant (kirtan) even though I did not share the religious beliefs that prompted that. Put me in an altered frame of mind. YMMV.

      1. jrs

        the standard for getting a job often seems to be perfection. We all know there are plenty of non-perfect people employed though. Oh boy are there! But being allowed in without having insider connections … seems at times the standard to pass muster there is absolute perfection.

    5. Richard Kline

      I’m far from sure that inequality ’causes’ mental health issues as much as co-occurs with them. There may be psychological impacts, sure, but let’s not sweep over the massive material impacts involved. Inequality means that a few have a lot and a lot have very little. This means than many people, even in the middle, are under constant financial stress. Even if worrying constantly about making ends meet, not the worse condition of actual debt and doing without essentials, that can erode the situation of many, or exacerbate other issues because money isn’t there to paper them over or resolve them. Then there is the fact that, in conditions of equality, there are likely to be upward cost pressures for the many because the affluent few bid up the best and are insensitive to rises in everyday costs which they can easily afford.

      What I’m saying is that is isn’t ‘envy’ or ‘anxiety’ which leads to mental health stress in conditions of inequality, it is endemic background stress due to constant cash flow and debt pressure on the many to which the political system is completely indifferent. Furthermore, if the message is “Go die,” that gets into your head after awhile, especially if there seems nothing you can do about it.

      The study didn’t choose to see the real stressors, to me . . . .

      1. WendyS

        My son is having some luck so far anyway, he is trying to become an apprentice electrician it is taking some time but I understand that they are needing people to go into the field. Lots of people are retiring and for some reason the trades are not seen as a good opportunity.

  2. SeptuagenarianBrent

    Can we call a nasty thing by its name? It’s all sociopolitical. Neoliberalism insists that humans are objects.

  3. The Rev Kev

    Same feeling here, Userfriendly, as Chaucers. I too value your comments and pay attention to what you write in your posted comments. I hope that things do work out for you but just remember this. To quote our British cousins: “Never let the bastards get you down!”

  4. Al Smith

    If this is the case then why do South Korea, Japan, Singapore and Hong Kong outperform the Scandinavian countries on objective health metrics, since they have much higher inequality and much lower spending on public social services.

    Inequality isn’t the problem, culture is.

    1. Corky

      Last time I checked South Korea and Japan had a very high suicide rate. Maybe that is the key to achieving acceptable “objective health metrics”? “Inequality isn’t the problem , culture is” – I was going to dismiss this outright but when your “culture” is all about greed and selfishness then inequality, sickness and death is the inevitable result.

    2. jrs

      well culture and inequality are mutually reinforcing, I mean the culture of Scandinavian countries is also different of course, more pro-social, more social obligation, less individualistic in some ways (I mean U.S. culture does venerate individualism, but it’s tightly constrained to certain roles in reality).

  5. nonsense factory

    Great article and comments. One little issue on this:
    “First, by examining our evolutionary past and our history as egalitarian, cooperative, sharing hunter-gatherers, we dispel the false idea that humans are, in their very nature, competitive, aggressive and individualistic. Inequality is not inevitable and we humans have all the psychological and social aptitudes to live differently.”

    It might be better to say that human nature is not genetically predetermined; we can learn to be cooperative and egalitarian, but there are many records of hunter-gather societies that were heirarchical and competitive, and warfare between tribal groups over control of land is, according to the archaeological record, as old as humanity, and is even seen in our closest genetic relatives, the chimpanzees, as documented by Jane Goodall. So it really is a choice: we can teach children to be aggressive and pro-war, or we can teach children to be cooperative and have a sense of fair play.

    Unfortunately, the dominant economic system in the world today, i.e. unregulated neoliberal investment capitalism, is a war of all against all; it is hypercompetitive, based on the accumulation of wealth by any means available, with no concern for ‘externalities’ (global warming, opiate addiction, widespread poverty, environmental destruction) that the system creates as it steamrolls along.

    At this point, defenders of this economic system chime in and say, no, it’s overpopuation that is doing the damage – but if there were only 2 billion people on the planet, and they all consumed resources at the same rate as the average citizen of the US or Britain does, we’d actually be seeing an increase in fossil fuel emissions and resource consumption. This is because neoliberal capitalism promotes mass consumption as a means of increasing profits for the uber-wealthy – which is said to create jobs, which give people money to buy more stuff, and then they display their stuff to others to enhance their social status and sense of self-worth. . .

    This is an insane, self-destructive economic system, and it is not going to end well. The increasing wreckage on the side of the highway is a sign of that. . . And I’d guess the spread of opiate addiction and alcohol abuse, that’s just the system’s way of extracting that last drop of wealth from humans before death. Like grinding up the bodies of slaves and using them for fertilizer, there’s profit to be made in that.

    Then there’s the fact that if those left behind by this system weren’t addicted to drugs and alcohol, they might turn into something the system really doesn’t want – revolutionary opposition to its ideological foundation.

  6. UserFriendly

    Thanks for the sentiment guys but unless someone has an in with someone hiring Chemical Engineers with 4 years of experience in medical devices (not that I care about sticking with that) to go along with 6 years of not using my degree, or someone willing to pay for a masters fellowship at UMKC for econ I’ve hit the end of the line. It’s not even depression, I just don’t see the point anymore. I’ve run a million simulations in my head and the chance of me ever getting a job that pays enough for me to dig out of debt and afford food and shelter at the same time are vanishingly small. And I absolutely can not stand talking to friends and family now because they might as well have a ticker tape on their forehead reading ‘when’s he going to get a job’

    1. anon y'mouse

      not to be flip, but how’s that shortage of STEM recruits going? yeahright!

      my sympathies. do you think you are too old for the trades? i know someone in similar position to you, who ended up working seasonally in the napa wineries for $11hr while delivering pizza on the side. eventually, he packed away his degree and took up with the electrician’s union.

      1. Glen

        As an engineer with 35 years experience, this is very disheartening. There is no shortage of real problems that need to be fixed. We are truly stupid.

    2. Burritonomics

      If it’s any comfort, you’re not alone. I’m in the same boat of long term unemployment. 5 years here, newly minted degree is useless so far. I have similarly withdrawn from friends and family; the scarlet letter of involuntary joblessness is brutal. It seems long term unemployment is roughly equivalent to convicted felon.

    3. Inode_buddha

      Can you relocate to the northeast? I work for a chemical (powdered metals) manufacturer and they have been looking mostly for production

      1. UserFriendly

        At this point I’d relocate to timbuktu. But moving back out east, where almost all of my family lives, would not be difficult. I have places I could stay all over Connecticut and a sister in Boston. You can email me at this temp email address I set up (to duck the inevitable spam from posting it online) and I’ll reply with my real email. And thanks, even if it doesn’t pan out at least it’s something.

    4. lyman alpha blob

      I once had a large amount of debt and I couldn’t see at the time how I’d ever be able to pay it back. So I didn’t pay it back. And I cancelled my credit card and made sure not to incur any new debts, which I do understand is easier said than done depending on one’s situation.

      Fast forward about 15 years, and I applied for a mortgage and came out with a credit score over 800. This stuff can and does go away with time. And every so often you can actually beat the system.

      1. John Rose

        Student loan debt never goes away till paid, including the many pounds of flesh (interest.)

    5. CogitoErgoSum


      Thank you for sharing. Your experiences are much like mine. There’s nothing like being out of work to realize how rotten the entire system really is, especially if you are an intelligent, educated, sensible person trying to find a reasonable, respectable (basic human dignity), non-toxic job.

      I really don’t see the point anymore either in participating in a society where dysfunction is the default norm, for example, the propaganda about how great the economy is doing. No one bothers to ask questions about the indexes, metrics, etc. (sorry, Lambert, I literally had to cringe when you mentioned the report about job openings in a recent Water Cooler). Anyone who’s looking for work can testify to how many of those “job listings” are deceptive if not fraudulent attempts to prey upon the hopes of others. Add to that, the temp, at-will, contract BS, you have nothing more than further evidence of the decrepitude of a hollowed-out nation and the long past tortuous, painful death of what was once social mobility (feel free to replace and use the ill-defined term “middle class” if you require processed thought that is more easily consumable).

      I also would like to mention my appreciation for your comments. Your comments are the type I often hope to find on a website such as this.

      Lastly, a word to the commentariate. Seriously, folks, enough with the obligatory psycho-babble and word of encouragement. I realize they are well intentioned but if you’re going to do it at least make the effort to reciprocate the thought, honesty and insight of the commenter in your replies. I can only speak for myself but the last thing a person out of work wants to hear is how wonderful life can be and how persistence pays off when they have to deal with the mind-numbing, insulting, degrading, inhuman process of securing employment day in and day out.

    6. Spring Texan

      One of my co-workers who also got the same job I got (programming) was a trained engineer who couldn’t get an engineering job and when he went to a class reunion he found that NOBODY in his class but him (these would have been people in their late 50s or early 60s) was any longer employed in anything remotely technical. It’s very difficult apparently to have a lifelong career in engineering. And then yes they blather about STEM jobs.

      Don’t forget on debt that unless it’s student debt (which it might be, sigh) it’s dischargeable in bankruptcy. And even on student debt laws may conceivably change in future which I think everyone on this site would support.

  7. Jeremy Grimm

    This post talks about rising levels of inequality and its impacts of our society. I think that is something of a red herring. In today’s world money is power. Inequality is one thing but wealth and status disparities pale in comparison with the power disparities between the 99.99% and the 0.01% who own our government, courts, media, industry, land, even our very lives. We live thrall to their whims and fantasies, and their madness.

    I believe most people prefer some inequality, if only to assure that the voices of idiots and fools carry less weight than the voice of someone with wisdom — a rare creature indeed at even the lowest levels of authority in our present society. All the megaphones of the wholly owned media cannot convince me that wisdom can be measured by how much gold the ‘wise’ can put on the scales. I believe I am not alone in rejecting the equation of wealth with intelligence and wisdom, and whatever other good qualities might be serviceable to the holders of great wealth.

    The degree of privation forced on the many by the very few — the level of control and its brutal expressions on the many by the very few — far exceed my concepts of a bland term like ‘inequality’.

    1. Corky

      “The degree of privation forced on the many by the very few — the level of control and its brutal expressions on the many by the very few — far exceed my concepts of a bland term like ‘inequality’.” Yeah I use the term “inequality” too but what I see out there is beyond description without the use of profanity. I think terms like robbery, slavery, oppression, exploitation, etc. are far more appropriate. “Inequality” seems like a word used most often by those who do not experience it first hand. Don’t get me wrong I am not jealous or bitter towards those who are obviously concerned and warmhearted enough to offer solutions but these bland descriptions may do more harm than good when they obscure the true nature of the system in place. If I were getting by okay why would I risk upending the system that so far is allowing me to live comfortably? Bland isn’t going to cut it when the whole thing needs to be torn down and rebuilt. To offer up anything short of that is insane and these bland civilized responses to an evil and bloodthirsty construct is only adding to our hopelessness and despair. I don’t know if its entirely relevant but I heard a dialogue on Game of Thrones: Advisor to the Queen: “Many have dreamed of stopping the wheel…” Queen: “I don’t want to to stop the wheel, I want to break the wheel.”.

  8. Scott1

    Piketty said it in his Capitalism in the 21st Century, or however that title is arranged. More of feudalism not less as aims of Democracy are forgotten.
    The people who inherit wealth are the people that get more and more of it. “Can’t beat compound interest.”

    Taxation is what makes the currency desired. FIRE is a siphoning tool for Goldman Sachs. Beat down taxes because you have the wealth and status and become another taxman. Democratic society would limit pirate powers of the parasitical.

    You cannot help but see the priorities of those in Congress when you see the accountings of their wealth. US was founded for the people by the people but then the rich become the majority voting on the bills written by lobbyists.

    It is an international situation.

    This is just a comment in a conversation amongst friends. We have our models and our books. We have history. “Great life if you don’t weaken.” John Dos Passos “The Big Money”.


    1. MichaelSF

      US was founded for the people by the people

      I’ve been reading Zinn’s “People’s history” (when I can face the next installment of despair that reading it brings) and from what he puts forth the US was founded by and for the wealthy/powerful with the intention of ensuring they stayed that way.

  9. JerryDenim

    Great post. I really do think most Americans are unaware of the extent that toxic inequality affects their lives. Besides the feelings of shame and worthlessness for those towards the bottom and extreme guilt for those towards the top that actually have a conscience, it divides Americans into lonely little class silos and creates incredible stress when attempting to find a partner. My wife and I had a very enlightening conversation once with a young married Belgium couple who had been living and working in Chile for a number of years. The biggest difference they observed between Belgium’s progressive tax system and generous welfare state vs. the Milton Friedman Neoliberal Chilean model was you had to worry less in Belgium, especially if you had kids. In Belgium it’s ok if your kid is spacey and artistic. He/she can pursue a career in sculpture or marry a sanitation worker and *gasp* It’s OK! (In Belgium that is) Unlike the US and Chile, where allowing your child to marry down or not attend the right schools results in utter misery, no healthcare, no retirement, no paid vacation, crappy schools, etc; In Belgium, the basic necessities of a happy life are guaranteed to everyone, so education, marriage, career choices, etc. aren’t all turned into cutthroat competitions with literal life or death consequences. As a result people can relax, enjoy their lives and pursue a career in social work or marry that struggling artist they fell in love with without fear of eternal damnation. Their kids will still be able to get dental care and attend college if they wish.

  10. Luke

    Jerry, you are describing a society (Belgium) where productive people are forced (at the point of government guns in their faces) to pay to support able-bodied strangers while they pursue hobbies, when they could (and IMO morally should) be providing for themselves. How could you possibly think that is remotely moral?

    Further, Belgium is a country whose native stock has not reproduced at replacement rate (or even close) for many decades, effectively having lost the will to live.

    Why in the world would you think that current-day Belgium would be a country to emulate?

  11. Luke

    Jerry, you are describing a place where productive people are forced at the point of government guns to support able-bodied strangers who would rather pursue hobbies than (as they are perfectly capable) supporting themselves. How can you possibly think this is moral, let alone admirable?

    Further, Belgium is a country where the native stock has chosen to not reproduce anywhere near replacement for many decades. A primary rule in biology is that when a population is longterm declining in numbers, it is fundamentally failing, however adaptive it may be in some other respects. Belgium is a country where the people have lost the will to live. I cannot see that as anything to hope my own country would emulate.

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