The statistics in question occur in an article in the December issue of Scientific American (not yet available online), which arrived in my mail box this weekend. Among some fascinating articles on a new approach to modeling the event horizon of a black hole, and a seemingly revolutionary approach to reducing nuclear waste (by extracting the residual energy from nuclear fuel the problem of what to do with the waste practically solves itself) is an article by Robert Sapolsky, Sick of Poverty, which asserts that "new studies suggest that the stress of being poor has a staggeringly harmful influence on health."
The first clue that the article would require close reading was the lack of any identifying data for the author; usually Scientific American has a box labeled "The Author(s)" and describes who they are; this article had no such box. A google search revealed this, about author Robert Sapolsky:
Sapolsky, a neuroendocrinologist, has focused his research on issues of stress and neuron degeneration, as well as on the possibilities of gene therapy strategies for help in protecting susceptible neurons from disease.
I would suggest that this is a rather curious person to do a review of the literature on Socioeconomic status (SES) but I didn't really notice until I read through the article and discovered it is anything but a scientific paper; it is a political tract disguised as a social scientific review.
Sapolsky starts out by saying:
Physicians (and biomedical scientists) are advocates of the underprivileged because poverty and poor health tend to go hand in hand. Poverty means bad or insufficient food, unhealthy living conditions and endless other factors that lead to illness. Yet it is not merely that poor people tend to be unhealthy while everyone else is well. When you examine socioeconomic status (SES), a composite measure that includes income, occupation, education and housing conditions, it becomes clear that, starting with the wealthiest stratum of society, every step downward in SES correlates with poorer health.
The fact that I know a fair amount about these statistics doesn't make them less disturbing. As a physician I recognize that most maladies, from Schizophrenia and Depression to AIDS, are more prevalent in the lowest socioeconomic groups in America, and indeed in the world. So far, I am in agreement with Sapolsky, though, typically, those who talk about being "advocates of the underprivileged" often overlap with those who are enablers of the underprivileged. But let us see what the rest of the article proposes; he next talks about the gradient of SES, from wealthiest to poorest.
Of the Western nations, the U.S. has the steepest gradient; for example, one study showed that the poorest white males in America die about a decade earlier than the richest.
It is always better to be rich than poor, one supposes, but what should we make of this observation? Sapolsky does throw in a bit of evidence which seems to confound some of his later arguments, and he never really addresses it, so I am going to mention it now and return to its consideration later.
(There) is a remarkable study of elderly American nuns. All had taken their vows as young adults and had spent many years thereafter sharing diet, health care and housing, thereby controlling for those lifestyle factors. Yet in their old age, patterns of disease, incidence of dementia and longevity were still significantly predicted by their SES status form when they became nuns, at least half a century before.
He briefly reviews some of the evidence relating to access to and utilization of health care, exposure to risk and protective factors and other "obvious" explanations (his words) and concludes that much of the differential between health on the SES gradient results from "the psychosocial consequences of SES." Bear in mind that most of the illnesses which produce the major part of the differential between the healthy wealthy and the sick poor are illnesses caused by, or exacerbated by, chronic stress reactions.
Now we are getting somewhere. Here is a key excerpt:
An extensive biomedical literature has established that individuals are more likely to activate a stress response and are at risk for a stress-sensitive disease if they (a) feel as if they have minimal control over stressors, (b) feel as if they have no predictive information about the duration and intensity of the stressor, (c) have few outlets for the frustration caused by the stressor, (d) interpret the stressor as evidence of circumstances worsening, and (e) lack social support for the duress caused by the stressors. [Words in italics are Sapolsky's in the original article, bold face words are my emphasis.-SW]
My favorite part of the article comes next. Sapolsky describes the research of Nancy E. Adler of UCSF who has explored the difference between objective and subjective SES and the relation of each to health. He even includes a helpful graph to illustrate her point which he also helpfully summarizes:
Adler's provocative finding is that subjective SES is at least as good as objective SES at predicting patterns of cardiovascular function, measures of metabolism, incidences of obesity and levels of stress hormones-suggesting that the subjective feelings may explain the objective results.
The next section of the report gives itself away by its title, "Being Made to Feel Poor". Anyone want to guess where this is going?
... Wilkinson's income inequality work suggests that the surest way to feel poor is to be made to feel poor-to be needlessly made aware of the haves when you are a have-not. And in our global village, we are constantly made aware of the moguls and celebrities whose resources dwarf ours.
He next presents a fairly incoherent section that treats people as if they are simple machines who are only motivated by their most narrow, short term self interest. The Democrats are almost certainly going to grab this fellow's (pseudo-scientific) research because it supports the idea that the wealthy are interested in denying goods and services to the poor because the poor are benefited by public expenditures and the wealthy by private expenditures; this "secession of the wealthy" leads to "private affluence and public squalor."
If social and psychological stressors are entwined with feeling poor, and even more so with feeling poor while being confronted with the wealthy, they will be even more stressful when the wealthy are striving to decrease the goods and services available to the poor.
Before I address this let me allow Dr. Sapolsky his closing argument, starting with his thesis statement:
As a culture, America has neglected its social safety nets while making it easier for the most successful to sit atop the pyramids of inequality.
And ending with his conclusion:
...when it comes to health, there is far more to poverty than simply not having enough money. (As Evans once stated, "Most graduate students have had the experience of having very little money, but not of poverty. They are very different things.") The psychosocial school has occasionally been accused of promulgating an anti-progressive message: don't bother with universal health care, affordable medicines and other salutary measures because there will still be a robust SES/health gradient after all the reforms. But the lesson of this research is not to abandon such societal change. It is that so much more is needed.
This is why some researchers shouldn't be allowed to talk about anything outside of their field of expertise. After everything Sapolsky writes about, he thinks we need to do more of the same? Folks, this is going to be in the Democratic platform in 2006 and 2008, a pseudo-scientific effort to support scientific socialism-lite here in the United States (I didn't even talk about his description of the differences between here and Europe, which is obviously doing so well with its social model.)
The most obvious flaw in the pseudo-analysis I described is that the author reports on a real finding, that much of the health costs of poverty arise from the way the impoverished person feels and the ways in which he handles the stress thus generated, and then proposes society do the same thing that hasn't worked for 40 years presumably because it might make them feel better! If the problem is in their feelings, then giving them more entitlements will not change this. The impoverished mentality is based on feeling powerless and is compounded by feeling envious; getting more medicaid benefits or other entitlements will not make anyone feel more in control of their life. PC and multi-culturism have been attempts to mitigate envy, among other things, so perhaps the hidden agenda of the left is to make everyone equally impoverished, then no one will be envious. The most remarkable thing is that Sapolsky notes the nun studies, which suggest that the patterns of thought and behavior responsible for the poor outcome is a stable construct in the minds of the once poor and is independent of their true circumstances; as well, he includes the quote about the graduate students which supports the same point from the opposite direction, ie that those who do not feel poor, do not feel poor, independently of their actual circumstances. Here is an easy idea that Dr. Sapolsky should be able to grasp: No one can make you feel poor; only you can do that.
MaxedOutMama offered an excellent example of this last week. She wondered why she is happy and Maureen Dowd is miserable:
I have been wondering why I'm happy and MoDo is not.
After all, we're almost exactly the same, right?
Except, of course, that I have this little neurological problem and my entire life is pretty precarious. Except that I don't make nearly as much as she does. Except that no one reads me, while everyone reads her. Except that I'm not nearly as good looking as she is.
Except that I have a man and she doesn't....
MaxedOutMama is only partly right and short changes herself. I would amend her last comment and take it a step further. The reason MaxedOutMama has a man is because she has the ability to enter such a relationship, which requires a transition, from I-focused to other-focused, that is notoriously difficult for a narcissist to make. The capacity to be in a relationship which is mutually beneficial and loving, which the psychosocial scientists would consider part of a healthy social network, is a part of psychological health that is independent of income. Someone who is healthy enough psychologically to have a loving, long term relationship, is also likely to have the psychological attributes to find a meaningful job, have meaningful friendships, be involved in meaningful activities (is there a pattern here?) MaxedOutMama may have a neurological problem, and not a lot of money, but she is not a victim. No amount of money will cause Maureen Dowd to stop being a victim; her identity depends on it. Sapolsky is describing, using social scientist language, how victimhood has health implications. People on the dole are by definition, victims (which is why they need "advocates"); they can never get enough from the system and are always feeling short changed. Those who financially support the system, again by definition, will always have more than those who live off the system (with the exception of those who run it, like politicians) and will therefore, never be freed from their envy. Until the day when no one has more than anyone else, there will be envy and disparity.
One last item for your perusal. There are two persistent findings that emerge in comparisons between Psychiatrists who describe themselves as having had a successful personal psychoanalysis within the context of Psychoanalytic training and Psychiatrists who do not have Psychoanalytic training. (Psychiatrists are not required to have personal psychotherapy or psychoanalysis, which is the most intense form of psychotherapy, 3-5 times a week, often lasting for many years.) According to the actuarial tables, the Psychiatrists who have had successful analytic treatments live longer and make more money than those who do not attempt the arduous efforts of a personal analysis. I would suggest that this has implications for the research that the article cites. Psychoanalysis, when it works, allows us to understand the myriad ways in which we unconsciously do things that are harmful to ourselves. Once we recognize these formerly unconscious parts of ourselves, we no longer allow others to victimize us, nor do we do it to ourselves.
Maybe it is the refusal to be a victim that is protective. Perhaps what makes out society so resilient is that the first Americans came here to escape being made victims and that ethos has been a part of the American ethic ever since. We should think long and hard as a society if we want to give up that source of our resiliency.
The Political Teen is has a site worth perusal; I have linked this post there.
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