health

Should Caring for Kids Be a Social Responsibility?

Mahala Miller on October 25, 2021

Image: A little white girl sits on an adult’s lap in front of a laptop, her small hands covering the adults as they use the computer. Image courtesy of Nenad Stojkovic CC BY 2.0

Democrats in Congress continue toward passing sweeping infrastructure legislation. Part of the infrastructure packages would provide funding for childcare including universal pre-K for three and four-year-olds, aid for working families to pay for the costs of daycare, and paid family leave. Social science research helps place this current debate in perspective, connecting it to larger conversations about who is responsible for paying the costs of raising kids, the consequences for families of the private responsibility for childcare, and what international comparison can show us about alternatives. 

Part of the question concerns whether we should think of raising children as a social, rather than individual, responsibility. Public investments in childcare, whether through public assistance to cover the cost of childcare or a public system of universal childcare, are one way that countries communicate who is responsible for reproductive labor: the work of having and caring for children. In the United States, this is often thought of as the responsibility of individual families and, historically, mothers. Feminist scholars, in particular, have critiqued the individualization of responsibility for raising children, emphasizing that the work of having and raising children benefits society across the board. Having kids creates the next generation of workers and tax-payers, carrying on both practical and cultural legacies. Scholars argue that because we all benefit from the work of reproducing the population we should all share its costs and responsibilities.

Other wealthy Western nations handle childcare differently. For instance, in Sweden there is subsidized childcare available for all children that is considered high quality and is widely utilized. In Germany, there is greater availability of well-paying part-time jobs that can enable two-parent households to better balance the responsibilities of work with the demands of raising kids. In the United States, there is now virtually no public support for childcare. Parents are left to their own devices to figure out how to cover the time before the start of public school at age five as well as childcare for before or after school, and during school vacations. The U.S. is not alone in expecting families to provide childcare, for instance, Italy has a culture of “familialism” that expects extended family and, in particular, grandparents to provide free childcare for working families. However, as Caitlyn Collins writes, the combination of little support for families, and cultural expectations that workers are fully devoted to their jobs, makes raising a child particularly challenging in America.

There are two important consequences to the lack of public support for childcare in the United States. The first is economic. Mothers experience a “motherhood penalty” in overall lifetime wages when they exit the labor force to provide childcare, or they may be placed on on “mommy tracks” in their professions, with lower-paying and less prestigious jobs that can better accommodate their caring responsibilities. Scholarship shows much smaller motherhood penalties in countries with more cultural and institutional support for childcare.

A second consequence of little support for caring responsibilities is emotional. As Caitlyn Collins writes, mothers in many nations feel guilt and struggle to balance the responsibility to care for their children and their jobs. However, in the United States this guilt and emotional burden is particularly acute because mothers are left almost totally on their own to bear both the practical and moral responsibility for raising children. The guilt parents feel, as well as the stress of balancing childcare responsibilities and full-time work, may be one reason that there is a larger “happiness gap” between parents and non-parents in the United States when compared to other wealthy nations that provide better public support for raising children.

The pandemic has brought a number of social realities into stark relief, including the fact that individual families have to navigate childcare on their own, never clearer than when school closings kept kids at home. As we imagine a post-pandemic future and the potential to “build back better,” we should consider what social research tells us about who should be responsible for caring for kids, the weight of that responsibility, and how public policy changes might provide better care for the nation’s youngest citizens.

Mental Health Co-Response Teams

Jacob Otis on October 14, 2021
Members of Mecklenberg County’s Crisis intervention Team demonstrate their response to a call, image courtesy of Mecklenberg County, CC BY-NC 2.0. Image: A young black man sits at a picnic table, his hood up, speaking to a black woman who is taking notes. Two white police officers are in the foreground, one squatting and one standing, looking on.

Since George Floyd’s murder in Minneapolis over one year ago, police reforms across the country continue to make headlines and shift the meaning of public safety. One important reform area involves responding to community members with mental health crises. Police officers have sometimes been described as  “street corner psychiatrists” because 10% – 40% of their total emergency calls involve persons with mental health concerns. 

As communities increasingly recognize that police are not mental health professionals, they have begun partnering police with mental health professionals to form Crisis Intervention Teams (CITs), sometimes known as Crisis Response Teams, or Co-Response Teams. 

‘CIT’ Programs and Effectiveness

CITs are joint responses to mental health crises by multidisciplinary teams including police, mental health providers, social workers, and hospital emergency services which have three key features: 1) community collaboration 2) training for police, and 3) accessibility to mental health services. 

Social scientists are now evaluating the effectiveness and benefits of these programs.  The National Alliance on Mental Illness reports over 2,700 CIT programs in different communities across the United States.  Research has shown that these programs increase diversion from jails and prisons to mental health services by 11% – 22%, relieve police workloads by 27%, and reduce the likelihood of people with mental illness to be arrested by 11% – 12%.  While these figures regarding CITs are promising as a short term intervention, future investments in long-term stabilization programs are needed to sustainably address mental health crises.

Promising Practice

As a promising practice, CIT has evolved over recent decades and has been successful in promoting improvements in mental health responses, increased officer confidence for working with people experiencing a mental health crisis, and reduced frequency and length of detention.  However, consistency across program elements within CITs is scattered and more exploration is needed.  Future evaluation, standardization, and regulation of CITs is necessary.

Societal responses to mental health impact every person in the US – whether it is a neighbor across the street, a colleague, a friend, or a family member.  Social science research is playing an important part in evaluating and refining policies and programs such as CITs.  Rather than punishing mental crises, CITs view them through a treatment lens – fostering healing and restoration. While this early research shows the promise of CITs as a short term “first response” intervention, this research also suggests that “second response” investments in long-term mental health care are needed to equitably and sustainably address mental health crises.

Imposter Syndrome and the Limits of Diversity

Daniel Cueto-Villalobos on October 6, 2021
A illustrated image of men’s faces in striped shirts and hats. All of the men except one, who is orange, are yellow. Image via pixabay, Pixabay License.

For many, the start of the school year brings a mixed bag of emotions, from budding anticipation to feelings of unease and anxiety about self-worth and competence, otherwise known as imposter syndrome. Imposter syndrome exists well beyond academia, disproportionately affecting minorities and women, groups underrepresented in fields like business and medicine. What does social science research tell us about what imposter syndrome is, how it works, and how it can be addressed?

What it Is

Imposter syndrome, first described as the “impostor phenomenon,” refers to individuals’ perceived fraudulence and unworthiness within high-pressure environments and workplaces–the feeling that they don’t fit or aren’t really supposed to be there. It appears to be most prevalent among systematically marginalized groups like women, first-generation students, and BIPOC and queer people. Imposter syndrome flourishes in spite of, or perhaps even because of, increased diversity and representation. Individuals with imposter syndrome doubt the validity of their achievements and fear being exposed as frauds. These feelings of self-doubt and unworthiness are often compounded by social anxiety and depression, which can lead to self-sabotage. Imposter syndrome may partially explain higher drop-out rates among undergraduate groups in fields historically dominated by white men like medicine, mathematics, and science.

Impression Management

To manage feelings of inadequacy, individuals rely on what Erving Goffman called impression management. Impression management is the practice of keeping up appearances and matching one’s identity and behavior with societal expectations for social roles, positions, and identities. Imposter syndrome can emerge in settings with conflicting roles or expectations or when someone’s background, identity, and interaction style does not fit well with what is expected. This can lead people to using perfectionism and workaholism to exhibit competence. For instance, research on female facilities managers shows that performing competence often leads to higher performance outcomes despite persistent feelings of inadequacy. Displaying competency despite feelings of inadequacy can exacerbate the role conflict individuals experience or the tension between self-doubt and high achievement.

The Challenges of Diversifying

Efforts to “diversify” high-status fields like academia, law, and medicine sometimes fail to address the subtle cultural factors that can marginalize and exclude underrepresented groups. Lack of familiarity with field-specific concepts like peer review and tenure track or norms like networking or mentoring can leave individuals feeling alienated. This unfamiliarity is often at the root of the unease associated with imposter syndrome. To address imposter syndrome schools and workplaces have proposed a range of solutions including targeted mentorship programs and additional support for nontraditional students and employees. Scholars emphasize that addressing imposter syndrome should involve solutions that emphasize flourishing and well-being over identity-based inclusion efforts.

When Trauma is Passed Down

Nikoleta Sremac on April 12, 2021
Image description: Mohammed, a Somali exile, sits in a chair on the right-hand side of the image. his children sit on the floor around him, as they discuss art. Art covers the wall. Creating cultural products is one way that communities process trauma. Image courtesy of UNHCR, CC BY-NC 2.0.

Scientific developments in the field of epigenetics have called attention to intergenerational transfers of trauma. We know now that traumatic experiences can be passed down through the genes— to children, and even grandchildren, of the survivors of horrific experiences like the Holocaust or American slavery. Sociology can help show how past trauma is passed down through social ties, and about its effects on current health and wellbeing. These social consequences of trauma could be even more powerful than the genetic impacts, affecting group dynamics, identity, history, and culture. In addition to what is passed down, sociological research also provides examples of how groups are managing these social effects, in both helpful and harmful ways. 

Cultural Trauma and Group Identity
Cultural sociologists assert that in addition to individual bodily and psychiatric trauma, there is also collective “cultural trauma” when groups experience horrific events. This collective trauma compounds and complicates individual effects. In order for the process of cultural trauma to occur, the group must first recognize that a great evil has been done to them, and construct a cohesive and shared narrative that includes perpetration and victimhood. Then this narrative becomes incorporated into that group’s collective memory as an enduring aspect of their identity, like the Holocaust has been for Jews or collective memory of slavery for Black Americans.
Both perpetrators and victims of violence must contend with the horrific event in some way, as it is now permanently associated with their group. This can occur either through avoidance of the difficult past, or stigma management practices like acknowledgment, denial, and silencing.

Cultural Trauma and Group Conflict: Violence Begets Violence

Sometimes, this cultural trauma process results in further violence. As the group comes to understand the harms they have suffered and assign responsibility, they can seek violent retaliation against the offending perpetrators. Examples include the bombing of Pearl Harbor (and subsequent Japanese internment and Hiroshima/Nagasaki bombings), and the 9/11 attacks leading to the U.S. War on Terror. In ex-Yugoslavia, ancient collective memories were stoked and reconstructed by elites to provoke inter-ethnic violence that led to ten years of war, genocide, and ethnic cleansing. In Hawai’i, Irwin and Umemoto trace the emotional and psychological effects of violent colonial subjugation, such as distress, outrage, and depression, to contemporary violence among Pacific Islander youth.

Memory Work: Social Solidarity and Empowerment

Sociological research also provides examples of people “making sense” of difficult pasts by doing “memory work,” which can include art, music, and other cultural production. For example, second-generation Sikhs in the U.S. are using internet spaces to challenge dominant narratives of the 1984 anti-Sikh violence in India, contributing to group solidarity, resilience, and identity within their communities here in the U.S. Similarly, the children of Vietnamese refugees are using graphic novels and hip-hop music to articulate how the Vietnam War contributes to current struggles in the Vietnamese community. This shared understanding and validation then empower communities to fight for recognition and social justice. 

When a group experiences a horrific event, the social effects live on to future generations. Understanding these effects is crucial for developing solutions to group suffering moving forward. Going through the cultural trauma process is necessary to overcome difficult pasts, but it is critical that this process occurs in a way that promotes justice and peace rather than further violence.

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.

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.

Best of 2020: Caring is Work

Allison Nobles on January 5, 2021
A woman helps an elderly man get up from his chair
Photo by Brian Walker, Flickr CC

Originally published May 4, 2020

When we talk about work, we often miss a type of work that is crucial to keeping the economy going and arguably more challenging and difficult than ever under conditions of quarantine and social distancing: care work. Care work includes both paid and unpaid services caring for children, the elderly, and those who are sick and disabled, including bathing, cooking, getting groceries, and cleaning.

Sociologists have found that caregiving that happens within families is not always viewed as work, yet it is a critical part of keeping the paid work sector running. Children need to eat and be bathed and clothed. Families need groceries. Houses need to be cleaned. As many schools in the United States are closed and employees are working from home, parents are having to navigate extended caring duties. Globally, women do most of this caring labor, even when they also work outside of the home. 
Photo of a woman cooking
Photo by spablab, Flickr CC
Globally, women do most of this caring labor, even when they also work outside of the home. Historically, wealthy white women were able to escape these caring duties by employing women of color to care for their children and households, from enslaved African Americans to domestic servants. Today people of color, immigrants, and those with little education are overrepresented in care work with the worst job conditions. 
In the past decade, the care work sector has grown substantially in the United States. However, care workers are still paid low wages and receive little to no benefits. In fact, care work wages are stagnant or declining, despite an overall rise in education levels for workers. Thus, many care workers — women especially — find themselves living in poverty.  

Caring is important for a society to function, yet care work — paid or unpaid — is still undervalued. In this time of COVID-19 where people are renegotiating how to live and work, attention to caring and appreciation for care work is more necessary than ever.

“We Are All In This Together,” Right?

Erika Sanborne on November 18, 2020
Image: Three white-appearing healthcare workers, “Thank you – You are our heroes” courtesy of 18371568 via pixabay CC0.  This imagery suggests our heroes are white, even though around 25% of nurses in the U.S. are people of color. Furthermore, signage that says we “thank our heroes” does not match up with how frontline workers have been unsupported by leadership. Images like this mask structural inequality (pun intended) under the guise of all being “in this together.”

We have seen many things described as “unprecedented” as the year 2020 has steamrolled over many of us. Among them, the pandemic has given the world an unprecedented illustration of U.S. racial inequalities. For example, Black people are more likely to die from COVID-19 infections than are people in any other racial group, and this is true even after controlling for income, housing conditions, and underlying health conditions. Yet not all Americans are able to see the racial inequalities that have been unmasked.

Sociologist and race scholar Eduardo Bonilla-Silva insists that the key to understanding race and racism in the United States is understanding how colorblind ideals shape Americans’ thinking and public discourse. Examples of what Bonillia-Silva calls color-blind racism are phrases such as “We are all in this together” or “Covid is the great equalizer” because they serve to draw attention away from the racial disparities that are otherwise so persistent and pronounced.

Color-blind racism is named after the hypothetical White observer who says they “do not see color” while they, simultaneously, fail to see existing racial inequalities. In other words, colorblind framings mask deep, structural inequalities. People may feel like they are saying unifying things with these tropes, but this sort of “all in this together” messaging serves to hide the structural nature of racism.

Even more, colorblind racism tends to minimize racism itself and, when confronted with racial injustices, constructs and accepts elaborate race-based explanations for racial inequality. For example, within a color-blind racism frame, Latinx workers might be said to be paid less than White workers because they do not work as hard, are unreliable as workers, or are less qualified. And White workers are said to get more raises because they are smarter and work harder. With racial blinders on, anything that results from structural causes is explained by deficiency in the minoritized party, and coincidental superiority in the privileged party. This negates the structural origins of inequality and allows the status quo to continue.
In terms of the COVID-19 mortality rate, the sometimes spoken explanation (i.e. 1, 2, 3) is that Black people must be weak, prone to illness, or make unhealthy choices in general. That shift in focus, from talking about racial inequality in the mortality rate associated with a virus to, somehow, talking about Black people as deficient, weak, sick, and making poor choices, illustrates how color-blind racism is alive and well amidst this pandemic. Colorblind racism serves as a mask, preventing the public from seeing the structural causes of health disparities experienced by Black people and other people of color.

Food Insecurity among U.S. Students – and How the COVID-19 Pandemic is Making It Worse

Hannah Schwendeman on October 13, 2020
A shopping cart full of groceries viewed from above. Eddie Welker via flickr, CCO.

The Wall Street Journal recently interviewed Estefani Iraheta, a mother of two who requested donated food from her local Salvation Army when the pandemic hit. Every time she goes to pick up the canned food and staples, more people are waiting in line with her, seeking food for their families. As of August 2020, an estimated 12 percent of U.S. households, or roughly 1 in 8 U.S. households, did not have enough food within the last week; for U.S. households with children, nearly 20% stated they did not have enough food the previous week. 

Food insecurity refers to inconsistent access to sufficient, nutritious food that is necessary to live a healthy life. While hunger is a related issue, food insecurity is fundamentally about a lack of household resources. And the COVID-pandemic has worsened U.S. food insecurity by increasing unemployment, raising food prices, and closing schools. 

Schools are a vital institution, not only for learning but also for access to social services, including regular meals. From kindergarten to college, many schools offer a dependable source of community support and reliable access to food. Even before the pandemic, however, food insecurity has been a critical issue for U.S. students. In recent years, researchers have investigated how educational institutions handle this issue.
More recently, scholars have focused on the prevalence of food insecurity among college students, who are often viewed as a privileged group. In particular, research has devoted attention to how colleges do, or do not, address food insecurity.
Food insecurity is only one consequence of a larger societal issue: poverty and precarity in the United States. In 2019, approximately 34 million Americans were living in poverty, or 10% of the U.S. population. It’s important to recognize that poverty is structured not just by income, but by race, gender, citizenship, and other factors. Here are some key sociological resources on the experience of living poverty in the United States.

For more news coverage on food insecurity during the COVID-19 crisis in the United States, view The New York Times’ recent article and photo essay.

Changes in How and When We Die

Jean Marie Maier on May 7, 2020

Covid-19 may be bringing long-term changes to workplaces and leisure activities as people become more attuned to potential infectious disease. But our shock, surprise, and general inability to deal with the virus also tells us something about how much our relationship with disease has changed. 

Graph showing the birth rates, death rate, and total population during each of the 5 stages of epidemiological transition. Image via Wikimedia Commons.

What scientists call the “epidemiological transition” has drastically increased the age of mortality. In other words, in the first two phases of the epidemiological transition lots of people died young, often of infection. Advancements in medicine and public health pushed the age of mortality back, and in later phases of the transition the biggest killers became degenerative diseases like heart disease and cancer. In phase four, our current phase, we have the technology to delay those degenerative diseases, and we occasionally fight emerging infections like AIDS or covid-19. Of course, local context matters, and although the general model above seems to fit the experience of many societies over a long period of time, it’s not deterministic. 

Inequality

Even before the epidemiological transition, not everyone had the same risk of contracting a deadly infection. Data from the urban U.S. shows that the level of mortality experienced by white Americans during the 1918 flu (a historic level considered to be a once-in-a-lifetime event by demographers), was the same level of mortality experienced by nonwhite Americans in every county in every year prior to 1918. 

Rise of new infectious diseases

Clearly, as we are seeing today, the epidemiological transition isn’t a smooth line. There is also considerable year-to-year and place-to-place variability, and new diseases can cause a sharp uptick in infectious disease deaths. For instance, the emergence of AIDS in the 1980s was responsible for a rise in infectious mortality and demonstrated the need to be prepared for new diseases. 

In just a few short weeks, covid-19 became a leading cause of death in the United States. The pandemic is a reminder that despite all of our health advances we aren’t beyond the disruptions of infectious disease, despite the broader long-term shift from high rates of childhood mortality to high rates of degenerative disease among elders.