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Social status and the neurobiology of stress: Clincally understanding the development of suffering

Introduction

Popularity, high social status and subordinate status can affect person’s sense of well being in lots of different ways.Interpersonal experiences between human relationships can determine how the human brain shapes our personal experiences whether they are positive or negative. Within the Mental Health field, subordinate status can be reduced with strategies put into place to make a person feel more equal within our society.

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Marmot (2010) said that wealth and social rank plays a very important part in how people’s lives develop. This essay will include a client from clinical practice and will follow best practice guidelines on confidentiality from the Nursing and Midwifery Code of Conduct (NMC 2008). It will explain how social status and stress affects individuals within today’s society. To protect the anonymity of my client in this essay her name will be changed to Mrs X.

Mrs X had a troubled childhood; she was born into a working class family where money was tight and she had six siblings to which she was the youngest. She became pregnant at the age of sixteen and was asked to leave the family home where she lived with her parents and siblings. This left her feeling isolated and scared. After the birth of her child she became dependant on alcohol which she used as a coping mechanism for her anxiety. Anxiety is the feeling of fear we all experience when we are faced with threatening or perilous situations (Martin 1997a). It also helps us to avoid dangerous situations, makes us alert and motivates us to deal with our problems. Coping strategies can include the way our minds deal with stress and anxiety. In this case Mrs X used alcohol to deal with stress and anxiety. People who work in the Mental Health field suggest that mental illnesses tend to be coping mechanisms that are derived from certain stressors. For example, panic or anxiety attacks may be the body’s coping mechanisms for inappropriate fight/flight reactions to minor stressful situations (Martin 1997b). Symptoms of anxiety or panic attacks include an overwhelming fear and sense of loss of control, increased breathing rate, increased pounding heartbeat, profuse sweating and in some cases a bad panic attack may make you feel that you are going to die (Levin 2009).

Cortisol, an important hormone in the body is more commonly known as ‘the stress hormone’ as it prepares the body for fight or flight responses during stressful situations. It is secreted into the bloodstream by the adrenal glands which are located on the top of the kidneys. This response to stress is known as the HPA-Axis or the Hypothalamic Pituitary Adrenal Axis. When the body perceives a situation to be threatening or stressful; the Hypothalamus sends a signal to the pituitary gland which then releases the Cortisol into our bloodstream (Waugh and Grant 2006). Within today’s highly stressful society it may be difficult for our body to return to normal after such an event as our stress response is activated so often through everyday life events such as coping with our profession or job, having children and juggling a home life. This can result inchronic stress which is detrimental to both physical and mental health (Martin 1997, c). Mrs X suffered chronic stress which increased her chances of developing physical health problems due to her stressful life and lack of support.

Salpolsky, (1990) researched that even in animals when in astressful situation the higher ranking males showed a faster

increase in Cortisol than a subordinate male, and when there werenot in a stressful situation the basal rate of the higher rank males returned more rapidly than those of a lower rank. This was due to the fact that they had better choice of foods, friends and living conditions.

Mrs X stated that alcohol helped her cope with everyday life as a single mother. She was isolated from her family and didn’t see

much of her friends. She had no job which meant she had little money to socialise and struggled to live what is deemed a ‘normal’ life; as a result of this she became very depressed. Mrs X’s physical health also suffered due to her dependence on alcohol. Mental health and physical health are bound together and depend on each other. They are both affected by the combined influences of biological, physiological and social factors (WHO 2011). Excessive consumption of alcohol can cause significant problems in physical health. It can cause damage to major organs such as the liver and the heart muscle. Damage to the heart can increase the risk of a stroke or a heart attack and increase blood pressure. Alternatively, regular exercise will help to strengthen the heart muscle and lower blood pressure (Hamer 2010). According to Barry (2002) women are far more likely to suffer from poverty and social exclusion because of single parenthood. Poverty is linked to ill health because it can lead to a lack of healthy food. In this case Mrs X became so depressed that it affected her ability to look after herself and her child. She felt that she had no control over her future and could not cope with daily life. She had no social support to speak of and spoke of feeling like she had no hope, no job and that her alcohol dependence and low social standing as a single mother would affect her ability to gain employment. She stated that she felt discriminated against and had nobody or nowhere to turn to. She wanted to abstain from alcohol which would enable her to rebuild friendships and social networks which would help to improve her chances of employment which would help to improve both her physical and mental health whilst also helping her abstain from drinking excessive amounts of alcohol.

Research suggests that social factors can have as much impact on a person’s physical health as smoking does (Martin 1997). Those who suffer from poor mental health are heavily discriminated against and have to endure the perception of their illness from others on a daily basis.

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The symptoms of their illness may add extra pressure upon relationships with family and friends.

Therefore discrimination from others is another battle they should not have to endure in today’s society.

According to the World Health Organisation (2011) Women are far more susceptible to mental health problems. This is due to women having a greater exposure to poverty than men. The health gradient shows that 70% of the worlds poor are women and when women are in employment they earn significantly less than men. With mental health problems experienced by one in six people in Britain, the health and well being of people of working age is of fundamental importance to our future. The Government believes that everyone, including employers, has a role to play in improving the mental health of society. Mental health problems, ranging from distress to severe illness, are extremely common. They can be made worse by the way people are perceived or treated by others, whether in the workplace or in their day to day contact with other members of society (DOH 2006). The government has currently developed an expansive guide to make the population aware of good mental health as well as good physical health thus making people aware of the services and support available to them until they regain their health (DOH 2006).

A study by Wilkinson (2001) stated that those people who are at the bottom end of the hierarchy are more susceptible to threat. Those who haven’t got the same opportunities as higher class individuals will have to work extremely hard to enable them to afford what is seen as “the norm” in high class society such as good healthy food and higher education which in turn will lead to a higher ranking job or place in society. Power and status mainly refers to situations, not individuals for example, not everyone within a low social class has to suffer low prospects or expectations.

Stigmatised norms can be broken by an individuals desire tosucceed or be successful. Fortunately Mrs X sought help for her alcohol dependence andanxiety attacks through using Cognitive Behavioural Therapy andusing The Good Lives Model (2004). CBT is recommended by NICE(National Institute for Health and Clinical Excellence 2011) as treatment for many Mental Health problems which includes depression and anxiety. CBT consists of two components, the behavioural and the cognitive. Through the process of this kind oftherapy patients learn to distinguish negative thoughts and think about how to inhibit them from occurring as an immediate reaction when faced with a stressful situation. They are then learning to manage stressful situations in a different and more positive way thus reducing their anxieties and fears.

The Good Life Model (GLM) (Ward and Brown 2004) Practices practical reasoning in therapy. One fundamental component of this is assessing a good life goal or incentive and determining its purpose .The Good Lives Model is a guideline to help individuals who wants to re-evaluate their life and find out how they can re-evaluate their goals and contribute to a society in a healthy and safe manner (Ward & Brown 2004).

Wilkinson (2001) stated that friendships and social networks have a profound effect on the physical health status of an individual. He stated that death or illness was four times higher to those with few friends or were socially isolated than those who had a good circle of friends around them. He also said that heart attack victims were three times more likely to survive with good social support around them than those who had a poor network of friends.

Mrs X had little to no social support or friends and was under constant stress due to lack of money and having no support or close friendships until she decided to seek help. By using the techniques she learned by having Cognitive Behavioural Therapy she was able to gain confidence and strength in her abilities rather than focusing on alcohol to cope with the activities of daily living. Social status or social class refers to refers to the hierarchical distinctions between individuals or groups within society. For example, working class, middle class and high or elite class (Argyle 1994). Social Darwinism follows a theory that believes ‘only the fittest or strongest survive’ including human issues (Darwin 1859). The Whitehall study of British civil servants begun in 1967, and it was found that disease and social rank had an effect on mortality rates. Between 1985 and 1988 there was another investigation on the causes of social class and the social gradient of mortality (Whitehall study 2). Male and female civil servants were asked to answer a questionnaire and attend a health examination. In the time lapsed between the two studies it was found that health diminished earlier in those who had a lower social class and lower ranking jobs. Health status was worse in lower status jobs as well as smoking and eating a bad diet being more prevalent in those who had lower ranking jobs.The Whitehall Study showed there is a social gradient in health even though the participants were neither very rich nor very poor. So the social gradient isn’t only related to poverty, it’s related to where you are in the hierarchy (Marmot 2010). However, people that are wealthier and lead a high class lifestyle are higher in the social hierarchy have more control over their lives. They can afford healthier foods because they have a greater income to enable them to have more control over their lives (Mirowsky 2003).

Marmot and his group tried to explain this gradient by reference to the important risk factors that we know about. He modified for diet and smoking, blood pressure and for physical activity and obesity and even social networks, as well as many other variables. But the gradient remained even after adjusting for these factors. Eventually they decided that the difference was control of destiny; the lower down you are in social class/rank, the less opportunity you have to influence the events that happen in your life, and that is what is causing chronic stress in people’s lives. (Marmot 2010).

In conclusion mental health problems can affect anyone regardless of gender or social rank. It can be extremely upsetting for the family and friends of someone suffering from mental ill health and although these problems can be stressful, with the correct treatment from professionals and understanding and awareness from friends and family ; stigma and judgement can be reduced. It seems that people with a higher social status deal with everyday stresses much easier than those of a lesser social rank due to lifestyle choices. With reduced stereotyping, respect and equality along with the support of professionals and close family and friends it is possible to overcome stigma and lead a better lifestyle, thus improving the quality of mental health as well as physical health.

References

Argyle, M (1994). The Psychology of Social Class. London:Routledge. p4.

Barry, B (2002). Social Exclusion, Social Isolation and the Distribution of Income. London: Oxford University Press. p187

Darwin, C. (1859). On the Origin of Species by Means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life. London: Forgotten Books. 162.

D.O.H. (2006). Action on stigma. Promoting mental health, ending discrimination at work. Available: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4139569.pdf. Last accessed 5th May 2011.

Hamer, M. (2010). Stress and Artery Health. Available: http://www.nhs.uk/news/2010/01January/Pages/Stress-and-heart-attacks.aspx. Last accessed 8th May 2011.

Jones, PB. et al. (1993). Premorbid social underachievement in schizophrenia. Results from the Camberwell Collaborative Psychosis Study. The British Journal of Psychiatry. 162 (6), 65-71.

Levin, J (2009). Anxiety and Panic Attacks. New York: The Rosen Publishing Group Inc. P8.

Marmot, M. (post 2010). Fair Society, Healthy lives. Available: http://marmotreview.org/AssetLibrary/Pdfs/Reports/FairSocietyHealthyLives.pdf. Last accessed 1st May 2011.

Martin,P (1997)a. The Sickening Mind. London: Flamingo. p134 -137.

Martin,P (1997)b. The Sickening Mind. London: Flamingo. p126-127.

Martin,P (1997)c. The Sickening Mind. London: Flamingo. p136

Mirowsky, J. Ross CE. (2003). Social Hierarchy and Health. London:

Aldine Transaction. p204. Nursing and Midwifery Council. (2008). The Code: Standards of conduct, performance and ethics for nurses and midwives. London. NMC.

Nursing and Midwifery Council. (2008). The Code: Standards of conduct, performance and ethics for nurses and midwives. London. NMCNursing and midwifery council. (2008). The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. London. NMC

Nursing and Midwifery Council. (2008). The Code: Standards of conduct, performance and ethics for nurses and midwives. London. NMC.

Nursing and Midwifery Council. (2008). The Code: Standards of conduct, performance and ethics for nurses and midwives. London. NMC.

Ward,T and Brown,M. (2004). The Good Lives Model and Conceptual Issues in Offender Rehabilitation. Psychology, Crime and Law. 10 (3),

Waugh, A Grant, G (2006). Anatomy and Physiology in Health and Illness. 10th ed. London: Churchill Livingstone Elsevier. p215.

WHO (2011). Management of Substance Abuse. Available: ttp://www.who.int/substance_abuse/terminology/who_lexicon/en/. Last acessed 10th may 2011.

Wilkinson, R.G., (2001)”The Biology of Chronic Stress” from Wilkinson, R.G., Mind the Gap: hierarchies, health and human evolution pp. 34-50, London: Yale University Press- London

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