Dependency Denied; Health Inequalities in the Neoliberal Era

It is now well established that unequal societies have higher rates of health and social problems than more equal ones. Those adopting a psychosocial perspective see shame and invidious social comparison as one means by which inequality impacts the body, and the social body (Wilkinson & Pickett 2009). Whilst social epidemiology supports this, it  has been critiqued for theoretical "thinness" and marginalising of agency. For example, people are not passive recipients of inequality, they resist and endeavour to protect themselves, and there are debates about the place of political discourses such as neoliberalism in this process.

In this paper, findings are presented from a study of women in northern  England which used Free Association Narrative Interviews (FANI) to explore the experience of life in an unequal, neoliberal society.  Shame and social comparison were present in their accounts, but not in the ways anticipated. Women in the study did not 'know their place' in a hierarchy, and detailed knowledge of the extent of inequality was sparse. Women reported various shame avoidance strategies focused on protecting children from the stigmatising impacts of living with a lack of appropriate goods, and shame and shame avoidance were also seen in relation to the women's bodies and homes.  Most  striking was a discourse of no legitimate dependency - an often painful discourse, where all aspects of dependence were disavowed and self-reliance valorised,  leading to considerable strain and distress.

We argue that this discourse represents a partial internalisation of neoliberalism; often expressed colloquially, using the language of therapy. It is manifested by the holding of the self to impossible standards of non-dependence, and through the "othering" of those considered insufficiently responsible. This is an unstable and unhappy discourse, but one which seemed unavoidable for participants, in the absence of available, alternative explanations for inequalities.