DR. RICHARD M. CARPIANO

Medical Sociologist and Professor at UBC's Department of Sociology, Dr. Richard Carpiano discusses the significant impact our social relationships have on our overall health: why others are necessary to meet our material, informational, and emotional needs for long-term wellbeing. As he reminds us, "No man is an island".


Tracy: As a medical sociologist, professor, and researcher at UBC's Department of Sociology, you look at the social determinants of health. How do our social networks affect both our physical and mental health? Particularly, you've noted before that isolation can be quite harmful?

 

Dr. Carpiano: To understand how social isolation impacts our health, we can start by thinking back to the famous poem by John Donne, 'No Man is an Island'. We're social animals: we're dependent on each other for survival. We can think about this from a classic evolutionary perspective in regards to protection, but this also concerns how relationships with other people matter not just for our material needs, but also in a very heavy psychological way as well. So talking about isolation, it's best to start with why exactly others matter for us, and how that translates to our health.

We can break this down into three components. First, needing people for material resources: we can think of spouses, parents, children, and friends in terms of providing different types of support--say, when we need money, a car ride, a place to sleep. That type of social support is critical.

Then we can think of informational resources that we get: our networks inform us of jobs, a helpful book, accounting advice, etc. Mind you, by 'networks' I mean in terms of not just family and friends, but acquaintances too. There are other individuals and organizations that we might draw assistance from, where we can effectively tie into that human relationship. It's not just thinking about online information, but the actual mode of human communication in face-to-face conversation or by phone. Knowledge is power, and the information we rely on will either achieve some sort of direct goal, or will be from things that we pick up in our day-to-day lives that we might draw upon later on.

We also need people emotionally: having people that we know we matter to, or to know that people are there for us, is very important for our overall wellbeing. We definitively know that this plays out for mental health, and to the extent that mental health is known to be important for our physical health as well, is very important.

Those three components provide a nice framework for thinking about why others matter, as well as what types of resources we get from others. The extent to which we can get those resources is very heavily dependent upon the types of networks that we have. Unfortunately this varies for each of us. Some people might have more intimate types of relationships; closer friends and a very cliquey type of network. Others might have a more diffuse network. The shapes of those networks and the structures of them have important consequences for the type of information we are able to access, and even protect us from different stressors in our lives and different challenges.

 

What do you think in terms of diversity of networks? For example, speaking to the elderly (say, a great grandmother) about how to make traditional foods that are gut-healthy as opposed to just microwaving a frozen pizza because that's what your roommates do.

 

Yes, this is important too: that intergenerational knowledge. As well, if you're an older adult and you have certain health needs or physical limitations, having more younger people to draw upon to help you meet those needs is another good example of that. When I brought up having a more cliquey type of network versus a diffuse one, that can have consequences too when thinking about information: the type of information that we receive and how valuable that might be. Diverse information is going to circulate less within a tight network, or not be as fresh, whereas ties outward and more acquaintances can bridge people to other types of networks, so you can have wider information available to you.

For things like health information; say you're looking for a new doctor, or find out you have a particular type of condition. A more broad network in this case, would be more likely for others to say, "You know, I had that." or, "I knew somebody who had that, and they told me they did this.", or "I went to this particular doctor and had a good experience."

 

In terms of the cognitive, I've read that the more isolated you are, or the more time you choose to spend alone, the more negatively you may begin to think about other people. So for whichever reason, if you are excluded from the community, clique, or family, is it true that you might begin to assume that people are out to get you? Or are more malicious than they really are?

 

Yes, we do know that. For instance, in places where there is higher income inequality, this correlates with levels of trust within that [community]. So it definitely does have implications for isolation. Crime rates within a neighbourhood can undermine a community and certainly promote isolation. There's evidence to support that a fear of such crime can put people at risk too: as just one result, they're unable to get outside to access the social support and services that they need.

There's a bit of the chicken or the egg argument tied to this question though. People who are suffering from different types of mental health crises might also be less likely to engage with others. In terms of anxiety or other types of compounding problems, this makes reaching out much harder.

 

So being cast-out from a community can impact mental and physical health in addition to lack of access to resources. It can't be good on the nervous system, or make it easy to jump right back into a new network after you've been stigmatized.

 

There is a lot of research being done on stigma. Someone who's been labeled as different and then cast-out from a group, or who may have been identified as having an undesirable characteristic can certainly have many different impacts. Stigma complicates things a lot because there are multiple components to it. Being identified as different--having certain characteristics linked to something that is perceived as undesirable--is highly [detrimental] to the individual. We are all different, but there are certain things that are more often stigmatized. Some people have long hair or short hair, and that hasn't necessarily been grounds for mass discrimination (depending on what group you're hanging out with of course). But when we get to issues surrounding skin colour for instance, or certain types of behaviour like those we tie to mental illness, or when someone does something that violates certain norms within a group, these characteristics get linked to something more broad: maybe they are feared as unstable or dangerous. We can also add the stigma of substance [abuse] issues, or maybe they hang out with a bad group. You start to get this bundling that's assumed with the behaviour, or inferences that can come from it.

From there, you've got the next component of the social distance: either discrimination, or at least some distancing of an individual, which we do know is tied to furthering problems that people have. A lot of work has been done as it relates to mental illness because of the stigma that comes from identifying that you have a mental illness. Think about it this way: we're socialized in a culture where certain things are considered normal and certain things are considered not normal, and mental illness is certainly one of them [considered not normal].

 

Yet research shows on a mass and historically long scale that community or secure social connection is extremely beneficial to deflecting, improving and repairing mental health disorders. 

 

Yes, but the research has yet to defeat the age-old stigma of mental illness. We see this when suddenly an individual is experiencing problems; they go to see their doctor, then receive the diagnosis of some mental illness. Let’s say, it's major depressive disorder as a good example. Now they are confronted with essentially a societal ideal about healthy and unhealthy, or normal versus not normal, which has a personal salience to it. The idea that they've received a label of mental illness has implications for self identity. Existing norms about stigma impact an individual's behaviour as a result of their own self definition: "I either have to hide this" or, "I have to hide certain behaviours" or, "I don't want people to know that I'm taking medication" or "People might view me differently and may not want to hire me." Etcetera. There's a concealment aspect which comes along with a certain performance that might now have to be there in order to avoid the rejection or out-casting from a society. We know that stigma certainly has consequences for people, and impacts things external to the individual. The person gets identified, and there are social consequences that tie to that. So we see how society works on these two angles here; there are social pressures that exist.

 

Just as how our physical environments affect our physical health, I'm interested in how our social environments affect our mental health. Things like anger or crying get stigmatized as 'over-emotional', but they're really just biological responses coming from the body in reaction to an external stressor. If I dropped a jar on your foot, and your toe started to swell, that doesn't get judged but the others do. Yet, they're both just biological responses to external harm.

 

There's a lot of variation in terms of how people in the public think about mental illness, and there's a long history with it. For a lot of physical injury instances, we've put our faith in medicine to be able to identify what something is from a symptom standpoint: to spot an illness or condition, and to deal with it. We've made some really great grounds in dealing with physical ailments of the body. Mental illness has a longer history of being associated with other things, whether that's something like personal choice of behaviours or moral failings. [People] don't definitively know the cause so they can easily assume it's a choice. In terms of us understanding causes, there have been much slower gains in understanding that mental illness, versus, say, heart disease, or how to mend fractures or deal with infectious diseases. There's a complicated history as well as lots of variation across different cultures over an understanding of it too.

We tend to see health as something personal, and we see decisions and behaviours as something very personal--very purposefully driven or that there is volition in what we do. With mental illness there is a lot that is tied to a person’s behaviours and perceptions of the world, and so it lends itself unfortunately quite well, to blame; if a person is experiencing a certain condition or certain type of impairment as a result of some sort of mental distress or clinical psychiatric condition, there's long been the belief that a person can just snap out of it: we've been socialized to think that we can just change and 'behave'.

I coauthored a study a number of years ago where we looked at some US data on this. It was an experiment that was given to a national sample of respondents; they received vignettes—short stories detailing a person who had a particular clinical mental illness. Individuals were randomized to a vignette, and you could be randomized to a troubled person with a condition--not necessarily something clinical. There were a lot of other characteristics about the person in the story that got randomized, so it wasn't just about evaluating a person who was well-educated or not, male or female; things like that. We found that, how people attributed the cause of the person's condition [in the vignette] had created different patterns of what people thought were appropriate treatments that the person should undertake.

The underlying causal attributes people tend to make about mental illness really did [matter]. They were given options like genes & biology, to stress, to a result of having bad character, to being God's will. Generally, many people certainly viewed stress as being a major pre-disposing factor for mental illness, but if you saw things in terms of a personal moral failing, you did see the appropriate ways of handling it very differently than if you thought it was genetic or biological. So in terms of either seeing formal care, or going to see a priest or religious person, or just seeing a self-help group, for instance, varied dependant on what people thought was the cause. I think it's fair to say that there's far more variation on how we [the general public] view mental illness, and how we see the options for dealing with it, than we would for something like heart disease or cancer.

 

Blame is often placed when we don't know how to deal with a situation; it's easier to deflect it as someone else's problem, not as a result of your or a peer's actions. In terms of public policy, it's easier to blame things like mental health and crime on a "moral failing" and toss someone in jail, rather than to look at what caused the behaviour.  Abuse in your upbringing (known to increase the stress response across their lifetime), or having suffered rejection from your community, or systemic racism, all have negative effects on behaviour.

 

Again, going back to being exposed to a larger network of people, or having an individual in such a circumstance in your life, it's fair to say you are going to have a very different view of these things situations than someone who has never encountered these [setbacks].

The other thing is that blame is going to vary by condition. There's a full range of mental illnesses. It's quite a spectrum. You might have something like schizophrenia affecting a family member or a loved one being attributed to biological factors, and then you could have something like substance issues, addiction disorders, which we do think about as having very heavy moral baggage; that this is some sort of personal failing of good choice.

There are also conditions that are in some ways, even more of a debate, or more of a grey area. You think of things that appear in the news like sex addiction. People may think, “So what is that, really?” Does this person have a legitimate condition or is this just an excuse? Is this a get-out-of-jail-free card for being unfaithful to partners? Or is it them just being self-centred? Many will point to this as a convenient outlet for people who are just making bad decisions in their life. You see celebrities in the news with these stories all the time. In this case, here you have a condition that is even more in flux in terms of its classification, and even more prone to different interpretations by the public about behaviors.

I think it's important to tie into this that stigma doesn't always just land on the individual to carry around the proverbial scarlet letter through their lives; there's good evidence to show that it extends to family or close relationships as well, particularly if people think that a condition is genetic. That [relationship] can carry the consequences of blame by association. 

In terms of forming romantic relationships, stigma can have implications for future planning as well if you're viewing someone as, not just potentially dangerous, but also that they're carrying some sort of genetic mutation, or that these things "run in the person’s family". In some stigma research, people will get asked questions like, "Would you want your child to marry this person?" We definitely see variation in that too [some people indicating concern].

 

Millenials en masse have rejected organized religion as something that's sort of backwards, or, unscientific. Lately I've been reflecting on that opting-out of religious communities as a missed opportunity for belonging and consistent social connectivity that is so important to our health. 

 

Almost certainly, in terms of being a center of community life, or even a place to receive those who have been rejected elsewhere, yeah, absolutely these benefits [of religious communities] to our health can]exist, and I think organized religion still does offer those opportunities for belonging and connectivity. Obviously, the membership has changed as times have changed. I'll point out that I think a lot of people, scholars and social critics, tend to focus on the demise of things. There's some lament of the way things were. I think we all do it.

 

That's so funny. I'm certainly guilty of being nostalgic for another era.

 

It's important to see why something is perhaps on the demise or on the decline, but it's also important too, to think what might be replacing that. You could pick opportunities to socialize: A, B, and C, and follow them over time, and see that they start to decline, and then draw concern that we are becoming too individualistic, or that we're a society of non-joiners, or the metaphor [Robert] Putnam uses that we are bowling alone and not bowling in a bowling league. At the same time, are there new forms of joining? Are there new forms of community that are emerging? What might those be?

 

Well thank you very much for this discussion Dr. Carpiano, your research and observations are all great motivation to reach out and get more involved in a community!

 

Anytime Tracy, thanks for coming out here to chat!


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