Inequality and Access to Mental Health Care

Mahala Miller on April 1, 2021
Image: A black woman sits on the floor, leaning against a sofa, in a low-lit room. Her head is in her hands, obscuring her face. Courtesy of pixabay, Pixabay License.

We recently featured new research documenting a broad-based increase in mental health treatment-seeking in the United States. Access to such care remains unequal, however, presenting  real and persistent challenges to those in need. Sociologists, and other social scientists, offer important information about these inequalities and the barriers to equitable mental health care.

Over the past few decades there has been growing concern that people are being “overtreated” for mental health issues given increasing rates of mental health treatment and diagnosis in the population. Nevertheless, there are still many people with mental health conditions who are being “undertreated.” Specifically, there are large gaps between the number of people who have a diagnosable disorder and the number of people who actually receive treatment, particularly for serious mental health issues such as schizophrenia or substance abuse disorder.
Research in the sociology of mental health has often focused on the stigma around seeking or receiving mental health care, particularly for marginalized racial or ethnic groups. In fact, white men may be the most likely to have negative perceptions of care when compared to other demographic groups, as Ojeda and Bergstresser report. As the stigma related to mental illness decreases overall, additional research is needed to examine how, why, and for whom this stigma persists.
Access to mental health care is also limited by mental health practitioners and the mental health care system. In a recent experimental audit study, Heather Kugelmass found that patients with less education and black patients were less likely to receive a response when they sought help from a mental health care provider. In addition, Lincoln and colleagues found that patients with lower levels of literacy found it more challenging to navigate the mental health care system, struggling to fill out paperwork and make health-care decisions along with their care provider. Both the structure of mental health care, and the actions of mental health care providers, can create inequality for patients even after they have decided to seek care.

As we’ve recently emphasized, more people are accessing mental health care now than ever before. As the stigma around care decreases, and more people are seeking care, it is particularly important to ensure equitable access. By shedding light on how factors like disability, class, and race affect mental health care, social scientists can ultimately play a role in addressing inequities and alleviating mental distress.

The Politics of Public Memorials

Daniel Cueto-Villalobos on March 5, 2021
Image: A small American flag placed within the Vietnam Veteran’s Memorial in Washington, D.C. Image courtsey of InSapphoWeTrust, CC BY-SA 2.0.

On January 19, 2021, less than 24 hours before their swearing-in, Joe Biden and Kamala Harris, and their spouses, Dr. Jill Biden and Douglas Emhoff, stood at the foot of the Lincoln Memorial to light the first COVID-19 memorial. Looking out over the Reflecting Pool, they led a moment of silence to honor the more than 400,000 American lives lost to the deadly virus. Following months of government inaction and widespread denial,  this ceremony marked the first national commemoration of COVID victims. Despite its immediacy and ephemerality, the memorial shares much in common with other public memorials commemorating events of mass violence and loss of life. An interdisciplinary body of literature sheds light on public memorials’ complex, contested, and inherently political nature.  

Temporality, Immediate response, and Grassroots memorials

Many memorials begin organically, in the immediate aftermath of a traumatic event that captures public attention. For instance, in 1997, following Princess Diana’s sudden death, Londoners left more than 60 million flowers outside her homes at Kensington and Buckingham Palaces. Similarly, in the wake of 9/11, grassroots memorials to the victims sprang up on streetlights and walls throughout New York, in open areas near the Pentagon, and in the fields near the Flight 93 crash site outside Pittsburgh. These spontaneous and temporary memorials reflected the visceral public grief experienced and mediated in real time, in public and collective ways.

Official Memorials

When the immediate shock of traumatic events wears off, plans for official memorializations begin taking shape, often led by governmental bodies with input from both the public and private sectors. Around the globe, from Seoul, to Berlin, to Lower Manhattan, decisions about public memorials have grown increasingly democratic, as leaders seek out input and participation from community members and engaged groups. As with any other democratic process, memorial developments are subject to group conflicts and financial constraints. Decisions for public memorials such as the Vietnam Veterans Memorial in Washington, the Flight 93 National Memorial in Southeast Pennsylvania, or  the Memorial to Murdered Jews of Europe in Berlin, were  shaped by the interests of commemorated groups, long-term urban master plans, the goals of the tourism industry and the larger social significance memorials invoke among the broader public. 

The Contested Politics of Memory 

While highlighting traumatic events and experiences, permanent and temporary memorials often shape public discourse around politically charged topics. For example, the NAMES Project AIDS Memorial Quilt, which blanketed the National Mall from 1987 to 1996, commemorating the predominantly queer victims of HIV/AIDS, helped break the silence around the deadly disease. Located immediately off the National Mall, the subterranean Vietnam Veterans Memorial – designed by the American sculptor Maya Lin – incited a public reckoning over an unpopular war that continues to stoke controversy. 
Still, various communities affected by AIDS – including BIPOC and working class communities – have expressed concern over the installment’s predominantly-gay focus, arguing non-queer AIDS victims’ expereinces were being overlooked. Just last summer, following the killing of George Floyd at the hands of Minneapolis Police, cities across the US painted messages of support for global Black Lives Matter movement on city streets, sparking robust public debate on police violence and the use of public dollars on law enforcement. These debates are ongoing, signalling that rituals of commemoration are inherently fraught and contested processes.
Alongside loss of life, new forms of public commemorations have highlighted ‘experiences’ of trauma, abuse, and human rights violations and the survivors. With similar political goals, these politically-motivated installments aim to harness political energy around these salient topics in support of policy change, reparations, and broader societal awareness.

A Woman’s Place is in the Octagon

Jillian LaBranche on March 2, 2021
Image: A black female fighter braces for a tackle, a white female fighter wrapped around her center. Image courtesy of Matt Brouse, Porrada Photography.

On a recent podcast, ESPN commentator, Stephen A. Smith, expressed his dislike for women’s participation in combat sports. He said, “… I don’t want to see women punching each other in the face. I don’t want to see women fighting in the octagon and stuff like that, but that’s just me.”  Female fighters like Kaitlin Young have expressed outrage at his comments, as they often do when men question the validity of their participation in combat sports. This public exchange highlights the contentious balancing act between female fighters and the masculine combat sports in which they partake — shedding light on the intricate ways women navigate gender norms in hyper-masculine spaces.

Female fighters in mixed martial arts transgress patriarchal gender norms by merely participating in violence, which often elicits responses like those from Smith. Men and women with essentialist views of gender difference, such as the belief that women are weak, often struggle to view women as capable of violence. Although sociologists and those studying gender have rebuked these essentialist claims, arguing instead that gender is socially constructed and continuously performed, society struggles to conceptualize women not only as fighters but as physically powerful.
Women’s participation in combat sports often results in individual empowerment and sometimes even progressive social change. But viewing female fighters as solely women who transgress gender norms can also overlook the many ways some female fighters uphold gender norms in their sport. Female fighters often grapple with displaying an “appropriate” amount of femininity. Wearing pink boxing gloves, for example, is an appropriate display of femininity, but wearing make-up or crying while sparring is generally not. 
While women may employ their femininity to encourage other women to join the gym, commercialize their sport, and challenge sexist beliefs about women’s capabilities, the pressure to conform to gender norms while engaging in gender-transgressing activities, like combat sports, may enforce the very gender norms and sexist beliefs that women often fight against. 
Image: Black and white nude silhouettes of Ronda Rousey and Miesha Tate face off at the center of an advertisement for their upcoming fight. Image used under fair use guidelines, for educational purposes only.
It is worth highlighting how gender and sexuality are conflated in the media coverage of women’s combat sports as well. When women compete professionally, their bodies often become sexualized by the media. A recent study found that when female athletes were sexualized in fight promotions, men reported more positive attitudes toward the ad. This also resulted in respondents finding the female fighter less talented, successful, and tough than those not sexualized in the combat ads. 

Women in combat sports have come a long way since UFC President Dana White declared women would never fight in the UFC, but both recent events and research suggest that the sports world and society itself still have a long way to go when it comes to gender equity and inclusion in sport.

Historical Roots of Racialized Mass Incarceration

Hannah Schwendeman on February 22, 2021
A black and white image of a jail cell, bars in the foreground. Image via pixabay, Pixabay License.

The United States, with only 5% of the world’s population, incarcerates nearly 20% of the world’s prisoners. At the peak of the mass incarceration era in 2000, one in three Black men was projected to be incarcerated in his lifetime, compared to 1 in 17 White men. The racial disparities of the criminal-legal system are well-documented, particularly for Black populations. How can we understand the origins of these racial disparities in mass incarceration in order to reduce or eliminate them? 

Arguably the most famous account of anti-black racism and mass incarceration, The New Jim Crow remains a watershed work in literature on prisons. By tracing parallels between slavery, Jim Crow, and mass incarceration, law professor Michelle Alexander connects present-day criminal justice to the long history of American racial control to demonstrate how incarceration targets the Black community. Alexander’s argument draws from key sociological findings about racial control, including the scholarship of Loïc Wacquant, Michael Tonry, and others.
Alexander traces the history of voting rights to show the connections between slavery, Jim Crow, and mass incarceration. Although Black men gained the right to vote following the abolition of slavery, during Jim Crow these voting rights were systematically violated. In 1940, only 3% of African Americans in Louisiana were registered to vote. While the Voting Rights Act of 1965 reaffirmed these rights, issues of disenfranchisement remained, particularly as mass incarceration unfolded and more Black individuals lost their right to vote. Today, an estimated one in 16 Black adults in the United States cannot vote due to a felony conviction. From Alexander’s perspective, prisons are merely the latest iteration of racial control in the United States which limit the rights and livelihood of Black Americans.
Historian Khalil Gibran Muhammad offers an alternative vision that centers the myth of “the Black criminal” as a source of racial oppression in the modern United States. Muhammad connects this myth to the long history of false ideas that have perpetuated white supremacy, such as biological notions of racial superiority, eugenics, and social-Darwinism. Blackness was intricately connected to crime in the late 19th century as a justification for discrimination and inequality in the United States. In this way, the very category of crime was racialized so that Black people were associated with criminal activity. This myth continues to influence perceptions of crime; for example, White people overestimate the level of crime committed by Black and Hispanic people and media representations consistently reinforce this image. 
Law professor James Forman presents a different history by chronicling how Black leaders advocated for tough-on-crime policies to protect their own communities. When seeing the damage that drugs and violence wrought on their communities, Black voters and politicians sought solutions, including policies that inevitably contributed to mass incarceration such as harsher punishments. In doing so, Forman shows that African Americans were not solely the victims of the law-and-order movement. By chronicling the nuances of these policies, he argues that The New Jim Crow oversimplifies the origins of mass incarceration, even while it helps shed light on its injustice. 

After four decades of increases, the long wave of racialized mass incarceration may be receding. Since 2009, the overall U.S. imprisonment rate has dropped by about 17% and the Black imprisonment rate has declined by 29%. Nevertheless, enormous racial disparities remain, with the Black community continuing to suffer disproportionately from U.S. mass incarceration. How did this era come to be, and how can we stop it?  These different visions of the racial disparities of mass incarceration are meaningful because they can help scholars, activists, and the public consider potential paths towards justice. Social science has greatly advanced the understanding of the historical causes of mass incarceration, which is essential for imagining a different and more just future.

Gender and Participation in the College Classroom

Jean Marie Maier on February 10, 2021
Image: An empty lecture hall, seats in the foreground. Image courtesy of Kai Schreiber, CC BY-SA 2.0.

Two years ago we published Gender, Confidence, and Who Gets to Be an Expert, which covered some of the research on why women are less likely to volunteer for the “expert” role and are sanctioned more for doing so. How has it held up to new research on the college classroom? 

According to analysis of 95 hours of observation across several disciplines at one elite school, men still speak more than women in the college classroom. Specifically, men speak 1.6 times more than women, including being more likely to interrupt or offer prolonged comments. Men are also more likely to speak assertively, whereas women are more likely to be hesitant or apologetic. These findings parallel what Michaela Musto found in middle-school classrooms in her flagship journal article.
The gender gap in participation doesn’t just stem from women being less likely to volunteer in front of a large lecture hall, it is also present in activities designed to elicit participation from underrepresented groups and assist learning. A new  study of introductory biology classrooms found that within a course built around active participation exercises, including group work, small-group discussion, clicker questions, and other structured activities, men still participated more than women in six out of seven categories of participation. 

We don’t know yet whether the shift in modalities from the covid-19 pandemic will ultimately shift gendered patterns of participation in college courses. Some writing suggests that the same inequalities are present in Zoom as in in-person meetings, while other writing is more optimistic that tools like the chat function will raise the percentage of female student participation. 

In general, nothing much has changed. Men still speak and participate more — demonstrating that the “chilly climate” of college classrooms still matters for how we think about gender inequality in education.

Culture, Inequality, and Multilevel Marketing

Daniel Cueto-Villalobos on February 4, 2021
Image: A black and white photo of a white woman standing in the center of a circle of women, holding tupperware. Image via wikimedia commons, creative commons usage. Tupperware was one of the first direct sales companies that targeted women, specifically.

As the COVID-19 recession deepens, many of us have been receiving more calls from long-lost friends or relatives selling energy drinks, workout videos, jewelry, or various household goods. In the absence of social insurance policies to soften the pandemic’s devastating toll, more and more Americans desperate for financial stability are turning to multilevel marketing (MLM), also known as direct sales or network marketing to provide for themselves and their loved ones. For decades, MLMs have offered participants flexible hours, a support network of other dedicated sellers, and the tantalizingly elusive promise of getting rich to those facing uncertainty.

But these programs promise more than just an opportunity to flex your entrepreneurial skills. Apart from selling, these multilevel marketing programs offer participants the promise of luxury cars, tropical getaways, and an end to financial squalor for those who work hard enough. But how does this industry work? Social science research points to this decades-old business model’s potential pitfalls for disadvantaged participants.

Business structure

From essential oils to protein powder to plus-sized clothing and just about everything in between, MLMs sell a wide range of consumer goods. Here’s the catch: you can’t buy these items online or in stores. Sellers – “distributors” in direct sales parlance – purchase product in bulk from companies (think Avon, Herbalife, LulaRoe, Plexus) to sell to friends, family, and contacts. While companies profit from these transactions, sellers seldom see these dollars themselves. To profit, these distributors must recruit new team members. The more members – or “downlines” – on their “team,” the higher commission the “upline” – the recruiters – receives. Perhaps unsurprisingly, given the high start-up cost and lack of benefits, research from the AARP suggests that 73 percent of those who participate in MLMs lose or make no money at all, deepening the vulnerability of already disadvantaged participants. 

Direct sales and gender

Since its inception at the turn of the 20th century, the predominantly male traveling sales industry evolved into the female-dominated MLM model we know today. To curb the unsavory reputation itinerant sellers engendered – reputations commonly laced with antisemitic tropes and xenophobic stereotypes – companies began culling vendors from a more acceptable population: middle-class, predominantly white women and, at first, young college students. With companies pledging flexible hours and easy sales to their social circles, this business model took off following WWII. Tupperware revolutionized the way products were sold; instead of door to door sales or sales calls, buyers — mostly unemployed housewives — attended parties filled with product demonstrations and socializing. While social media and the internet have changed the nature of direct marketing, feminized notions of work and domestic responsibility still permeate this market, from the products sold (cleaning products, kitchen supplies) to the emotion-laden bonds forged within teams of distributors. Such MLM opportunities remain attractive, in part, due to the persistence of sex discrimination in employment, and the antiquated expectations that still limit women’s earning potential, self-image, and job prospects.

Charisma and Risk

Much to the chagrin of regulatory agencies, many MLM products have been marketed as “cure-alls” for all manner of maladies and ailments. In April 2020, the FDA publicly chastised seven direct sales companies about misleading claims, arguing their products protected against coronavirus. Alongside these audacious claims, these companies have long used self-empowerment rhetoric to energize distributors and build their following. This charismatic language has drawn often vulnerable populations seeking economic stability and community into the MLM orbit. Research demonstrates how these emotion-laden themes work alongside promises of socioeconomic advancement to make multilevel marketing a promising career path for a wide variety of aspiring entrepreneurs and desperate sellers alike. Instead of offering financial security, MLMs dangle audacious promises and a competitive environment for individuals to pursue prosperity, often with little success.

Suicide and Adolescents

Mahala Miller on January 26, 2021
Image: Backlit profile of a young girl, sitting next to a body of water, with her head down in her arms. Image courtesy of Pixabay License.

This past Sunday the New York Times reported that Las Vegas was reopening its schools, despite the ongoing threat of covid-19, in response to a “surge of student suicides.” Educators and parents shared concerns that school closures have left young people isolated, hopeless, and vulnerable, but this action was a real clarion call. Conversation about the link between school closures and adolescent suicide is politically charged and the recency of covid and virtual learning leaves us without strong evidence to assess this situation. However, sociology has long been interested in suicide, and social science offers us important tools for considering the nature and causes of adolescent suicide.

In a classic sociological work, Émile Durkheim examined suicide as a social fact, exploring how suicide was caused by social, rather than individual, forces. In particular, Durkheim attributed rates of suicide to differing levels of “integration,” or social belonging and inclusion, and “moral regulation,” or external monitoring, oversight and guidance in communities. Durkheim’s work is particularly relevant when considering the link between school closures and adolescent suicide. Adolescents may be missing the sense of belonging, and the external oversight from trusted adults, that the school environment can provide.
Contemporary sociologists are reexamining the relationship between integration, regulation, and suicide in light of changing social institutions. For instance, sociologists have examined how, in a community valuing high academic achievement and discouraging professional psychological support, adolescents’ integration and regulation may leave them vulnerable to intense feelings of academic failure that put them at-risk for suicide.
The news media is reporting that school districts are experiencing “suicide clusters” since the lockdowns, instances where several individuals connected by social relationships all commit suicide. This may not be quite as unusual or unexpected as it sounds. Social scientific research supports the idea that suicide might be “contagious,” in that certain peer relationships can increase suicidal ideation among individuals connected with someone who committed or attempted suicide, or experienced thoughts of suicide. This contagion effect is particularly strong for adolescent girls.
Social media is one way that knowledge of friends’ or peers’ suicidal ideation or suicide attempts can spread. It is this knowledge (rather than expressed negative emotion) that contributes to the “contagion” effect. Media, such as news reporting or television shows, can also “suggest suicide” to adolescents. However, the nature and strength of the relationship between media reporting and suicidal thoughts and behaviors warrants further research. Overall, the potential for suicide contagion suggests that media, social scientists, and social networks need to use caution when discussing, and reporting on, suicide
Sociologists can also describe, and explain the cause of, disparities in suicide risk according to gender, race, and socioeconomic status. For instance, research suggests that higher rates of suicide among adolescents living in poorer communities may result from differential exposure to violence or lack of safety. Higher rates of suicide among Native American youth may result, in part, from frequent racial misclassification, denying these youth access to racial pride and racial support networks. There are especially high rates of suicide among LGBTQ youth, and LGBTQ youth report higher levels of suicidal ideation. However, despite media coverage of the relationship between sexual orientation, bullying, and suicide, there is not clear evidence that experiencing bullying more frequently is associated with greater suicidal ideation.
For all that we know, individual suicides still often defy understanding. However, working together, social scientists can help explain the complex causes of suicide and, especially, suicide risks and rates. This is particularly important to consider for adolescents. Although media reporting is now focused on the relationship between school closures and suicide among young people, the reality is that rates of adolescent suicide have been increasing over the past decades. Concern for youth suicide is not new. This calls for careful attention to how social scientific tools can contribute to understanding of this complex problem.

We All Hate to Wait; Research Explains Why

Nick Mathews on December 14, 2020
Image: A group of people wait in line, it’s raining. Image via Lars Plougmann, CC BY-SA 2.0.

At this very moment, as you read this, you are waiting on something. We all are waiting on something, always. As anthropologist Ghassan Hage wrote, we wait for “an ice cream and for final judgment.” The coronavirus pandemic has illuminated waiting. We waited to hear guidelines from government and health officials. We waited for our stimulus checks. And, now, we wait for our turn to get a vaccination.

A difficult part of waiting is that we often do not know how long we will wait. For example, how long will we wait for a coronavirus vaccine? Research has found the importance of temporal specificity, meaning the presence or absence of a deadline as an assurance of action. A specific timeframe, telling a person when the waiting will end, gives “some degree of control over the situation, through knowledge” (Rotter, 2016).
Time is an irreplaceable and finite resource. Waiting can feel like a waste of time. Researchers have observed that, thanks to technology, waiting can be “more than empty time” (Sebald, 2020). Digital media and “speed of connectivity is the antipode to waiting” (Wexler, 2015). Digital connection makes waiting more tolerable.
While waiting is universal, the experience of waiting is not the same for everyone–and, in fact, waiting is rife with inequalities. Sociologist Barry Schwartz perhaps has done the most to illustrate these inequalities, writing “the distribution of waiting time coincides with the distribution of power” (1974). Pierre Bourdieu (2000) writes that “making people wait” – or “delaying without destroying hope” and “adjourning without totally disappointing” – are primary elements of domination. Ultimately, those who have the power to make others wait demonstrate that their time is more valuable than someone else’s time.

Shifting Memories and Meanings of Pearl Harbor

Jillian LaBranche on December 7, 2020
Image: An American Flag flies in the foreground. In the background lies Pearl Harbor. Image courtesy of Ms_Spinwax, CC BY-NC-ND 2.0.

On the 7th day of each December, Americans are reminded of Pearl Harbor — the 1941 attack on an American naval base that killed 2,400 Americans. This event has become an icon in American memory. The events of that day have been told and retold by the media and amongst families. It has been featured in history books and the focal point of Hollywood movies, museums, and memorials. In fact, sociologists suggest that iconic events like Pearl Harbor have come to define the nation.

Sociologists also insist that memories are socially constructed. To say that a memory is socially constructed means that our recollections of events such as Pearl Harbor are not natural or unfiltered history but in fact mediated and filtered through social institutions like the media and politics. Some sociologists argue that this construction of memory is motivated by contemporary  interests. For example, at the time, media reports on Pearl Harbor highlighted national security and portrayed Japan as America’s enemy. These accounts were used to invoke American anger and pride. Both political actors and the media created moral depictions of the event, emphasizing American victimhood and the need for immediate action.
Yet over time, our collective recollection and interpretation of events may change, and sometimes, we use past events to understand current events. For instance, in the aftermath of 9/11, memories of Pearl Harbor were invoked to both give meaning to and to make sense of the surprise attacks on American soil. The use of a past event, Pearl Harbor, to understand a contemporary event like 9/11 is what has been called a bridging metaphor. And politicians often use bridging metaphors to inspire new emotional responses by connecting current events to memories and sentiments of past events.

Sociologists think of history, memories, and the commemoration of iconic events such as Pearl Harbor as interrelated. History is not an unbiased and fixed account of past events and people, but rather, something that is actively, collectively remembered and reconstructed. History, in this sense, does not simply exist, but has to be made and remade. This process is inevitably shaped by the conditions and concerns of both the past and the present, and the narratives that emerge are key in creating a collective, American identity. What other iconic historical events can you think of that shape how Americans understand themselves and current events today? How do you think they may shift and change in the coming years?

Inequality and Opportunity in Online Dating

Mahala MIller on December 3, 2020


Although Covid-19 has made dating more difficult, people are still finding ways to make connections and initiate more intimate relationships. Like a lot of life right now, people are using the internet to meet and date potential partners. But, unlike zoom birthday parties or virtual weddings, online dating is nothing new. Even before the pandemic, 3 in 10 Americans reported having ever used a dating website or app. Sociological research shows us both the promises of online dating and its potential to entrench existing inequalities.

The internet has expanded the dating pool, potentially displacing “traditional” ways of meeting partners in school or through family connections. This is particularly impactful for people who might have “thin” dating markets where they live and in their community including LGBTQ people and middle-aged heterosexual people. Online dating provides a way for people to seek connection, love, or monogamy with a broader social network, one that is connected to geography and place in both new and familiar ways.
The “online” in online dating introduces concerns about authenticity that are not necessarily present in face-to-face interactions. Users worry that their online dates are not who they say they are, and carefully analyze date’s online profiles to try to determine “the truth.” Individuals with stigmatized identities, such as disabled people, worry about how to “disclose” this identity in cyberspace, a concern that is not necessarily present in the embodied offline world.
Although it is tempting to view online dating as transformative, it can also entrench existing inequalities. “Assortive mating” in which people seek partners similar to them in terms of race, educational experience, and class happens online, too. For instance, users set their preferences and search profiles in ways that reinforce racial segregation and hierarchy. The inequalities of the “real world” are also present online, with the added barrier that only those who can access computers and the internet can participate.