How’s your social gradient treating you? This past summer I traded the stress of a full-time job as an academic psychiatrist for the stress of a half-time job as an academic psychiatrist, which allows me to spend my mornings stressing over a book I want to write about stress and illness. By choosing to make this move now I may have dropped a few notches on my social gradient, but maybe not. Maybe this book will save me, someday. I’ve waited most of my working life for the privilege to write each morning, and, so far, most days it’s been fun, the good kind of stress.
My current challenge this month is to figure out how to pack into one chapter the most compelling evidence on how some kinds of chronic stress turn into some of our most common illnesses, such as diabetes, heart disease, obesity, and depression. The timeliness of this issue—and its timelessness—came to me through an NPR piece this month on a recent survey about the effects of racial discrimination on poor health outcomes—not only through big unjust events, such as being passed over for a job or a mortgage, but also through the “little indignities” of disrespect in daily life.
Top on my list for this chapter is a story about two scientists, Robert Sapolsky and Michael Marmot, who have separately and around the same time during the 1990’s captured the same key point about stress and illness: the most powerful determinant of your health and the length of your life is your social rank. It’s true if you’re a human and true if you’re a baboon. (It’s also true if you’re a pig, a rat, or a rhesus monkey.) For you humans, Sapolsky and Marmot tell us, your social rank may be a more powerful determinant of your health than the other common culprits, such as your genes, your income, your education, your family history, or your zip code. And they tell us why. But of course there’s also a catch, which will help you sleep tonight.
Robert Sapolsky is a primate biologist at Stanford University, a short, thickly bearded, long haired professor and self-proclaimed nerd—as a boy he was often chosen last in neighborhood pick-up whiffle ball games because he was uncoordinated and usually had a book in his hand. Sapolsky spent 12 summers in Kenya studying the behavior and biology of baboon troops. He has taught and written extensively about stress and illness, most notably in his entertaining and enlightening book Why Zebras Don’t Get Ulcers (1994, 2004). National Geographic featured Sapolsky and his work in a documentary Stress: A Killer (2008).
Also featured in that documentary is Sir Michael Marmot , a professor of epidemiology and public health at University College London. He is the author of the Whitehall Studies and most recently The Health Gap: The Challenge of an Unequal World (2015). I saw Marmot give a rousing call to action last spring at the annual meeting of the American Psychosomatic Society. He’s a trim, well dressed, eloquent speaker with a refined sense of humor and a hard-earned sense of indignation about social injustices.
In the 1990’s while Sapolsky was collecting blood samples on a baboon troop in the bush and analyzing stress measures in relationship to each animal’s rank in the troop, Marmot was analyzing data on illness and mortality in the Whitehall II Study, a prospective study of British Civil Service workers, each of whom had a well-defined rank within the Civil Service. To their surprise they both found that how long baboons and civil servants live is directly related to where they stand on their social gradients. Lower ranks die younger. And their risk for chronic illness was also related to their social standing. This is more than poverty making the poor sick. This relationship holds true even at the higher ends of the social gradient. The higher your rank, the better your chances of being healthier, even among the top tier. It’s not fair, but it’s true.
I was surprised too. Haven’t we always heard it’s tough at the top? Down lower where fewer people can see you, hold your responsible, or shoot at you, it ought to be safer and healthier, right? Not true, said these two sets of data. Both investigators concluded that the stressful aspect of the lower end of the social gradient is the relative loss of control, resources, and rewards. We’re less in charge of our jobs and our lives. Subservience exposes us to the power plays of those above us in the social gradient. Alpha males, older siblings, clique leaders, bosses, bullies, captains—their influence on our stress response systems can be profound and lasting and sometimes toxic.
If you’re a baboon and you lose your stature to the new alpha male, you’re sunk. You don’t have an out, other than leaving the troop, usually a dangerous move. But if you’re a human, you’re probably thinking right now, I don’t have a “social rank,” or nobody could tell me what it is, not like in the British Civil Service where everyone knows whether your rank is a 13, 5 or 2. The closest thing we have in the US may be our military or the Veterans Administration.
But here’s the catch for most of us humans. Unlike the average baboon, we can choose to belong to several social orders. Most of us don’t have just one rank, and ranks change. In 1994 my boss at the University of Cincinnati demoted me from my role as Vice-Chair for Education in our department. It was a searing humiliation at the time, wrapped in what he later admitted was a form of academic bullying. Though it took a few years, and it made me mighty uncomfortable, that demotion did not quite make me sick. I was lucky and I had resources. I could recover because, though I lost a title and a role, I retained my academic rank and salary and other roles in the department. It was a loose system, not a tight one like the British Civil Service or the VA. And I retained my rank in my family and on my soccer team and in other groups that still thought I was okay, which buffered me against the power plays of my boss. I started writing in earnest. I lost an institutional voice and started working on gaining a written voice, a rank in a separate social order. Baboons should be so lucky.
What does the social gradient have to do with attachments and making contact, the theme of these blogs? One of the most powerful ways we’re attached to others is through our social hierarchies. Think about how much time and emotional energy we spend thinking about the person just above us at work, or the person we answer to, or the person who currently has the most influence on our daily lives. If that’s a nourishing relationship, we thrive, but if that’s a troubling relationship, it’s hard to turn off that kind of worry. It leaks into our sleep, it haunts our daydreams, and it can sap our energy at work and at home. You may feel an intense attachment to and lose a lot of sleep over someone you don’t know very well (where does she live, how many kids, where’d she grow up, why does she wear her hair like that?), just because she currently holds a threatening kind of power over you.
Sapolsky and Marmot remind us that evolution has made most of us acutely sensitive to where we stand in our social gradients. It’s a matter of survival. No wonder it’s stressful when the gradient shifts. No wonder we do better when we have more than one gradient to stand on. No wonder the little indignities of racism or bullying are hard on the heart as well as the soul. Even baboons know that.