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Part I
Social identity, health, and
well-being
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1 The case for a social identity
analysis of health and well-being
Jolanda Jetten
University of Queensland
S. Alexander Haslam
Catherine Haslam
University of Exeter
To understand just how important social contact is for humans, it is instructive to consider situations in which opportunities for social interaction and engagement are lacking. Social isolation can have devastating consequences with profound negative effects on our resilience, health, and well-being. For example, in prison settings, solitary confinement is perceived to be the ultimate punishment - and denying a person contact with others is often the most effective way to break down his or her resistance. Stories about castaways (e.g., Robinson Crusoe) tell a similar tale: To be deprived of human contact for an extended period of time is extremely challenging and is the main obstacle that people face when adjusting to uninhabited environments. We also know that people are psychologically vulnerable when they are no longer able to pursue an active social life (e.g., as a result of illness or old age). Indeed, considerable evidence suggests that being cut off from social contact with friends, family, and other social groups is not just extremely upsetting, it can have significant negative consequences for health and even lead to an early death.
Given all this, it seems pertinent to ask why it is that we rarely use our understanding of the causes of social isolation as the basis for cures that can counter its harmful consequences. In the Western world at least, the idea that family, friends, work colleagues, and social groups more generally have a key role to play in helping us overcome a range of stressors - including illness, traumatic life-changes, and discriminatory treatment - does not appear to be all that intuitive. Thus, even though it is well understood that being socially isolated makes us vulnerable and represents a considerable health hazard, there is often a reluctance to acknowledge the other side of the coin: that being embedded in a social network provides real benefits for health and well-being. Indeed, this can be seen to constitute a major āblind spotā in the way that relevant parties (e.g., practitioners, theorists, and members of the general public) approach these issues. A key goal of this book is to expose - and take steps to eliminate - this blind spot.
The fact that this blind spot persists seems all the more remarkable in light of the wealth of evidence demonstrating the positive impact of social connectedness on health and well-being (see Haslam, Jetten, Postmes, & Haslam, 2009, for a review). For example, a recent meta-analysis has demonstrated that the magnitude of the effect of social relationships on mortality is comparable to quitting smoking, and exceeds that for obesity, high blood pressure, and physical inactivity (Holt-Lunstad, Smith, & Layton, 2010). Indeed, the fundamental message that emerges from this study is that people with adequate social relationships have a 50 percent greater likelihood of survival than those with poor relationships. Moreover, these effects appear to hold strong even after controlling for variables that are typically associated with adverse health (e.g., initial health status; for a review, see House, Umberson, & Landis, 1988).
All this highlights the fact that social relationships make an independent contribution to health outcomes. Thus, after reviewing the research evidence, in his book Bowling Alone, Robert Putnam concludes: āAs a rough rule of thumb, if you belong to no groups but decide to join one, you cut your risk of dying over the next year in halfā (2000, p. 331). This conclusion underlines the profound way in which we are affected by our social environment and the social relationships that we form with others. It also suggests that participating in group life is an important means by which we can inoculate ourselves against, and repel, threats to our mental and physical health.
Accepting that our mental and physical health is supported by social factors opens a whole new spectrum of curative possibilities. However, to apply these new cures effectively we must also understand the mechanisms through which social networks offer such protection. For even though the finding that social networks protect mental and physical health is well documented - and hence may not come as a complete surprise - the question that is more difficult to answer is why this is the case. Indeed, until recently, there was no clear theoretical framework that might allow us to understand the processes that underlie the relationship between social relationships and well-being. Yet over the last couple of years, this void has been partly filled through the development of psychological theorizing concerning the way in which identity processes impact on health and well-being. More particularly, this work proposes that an understanding of the dynamics of social identity holds great promise in providing the necessary theorizing to help us understand when and why social connections affect well-being.
Social identity refers to the sense of self that people derive from their membership in social groups (e.g., family, work, community, etc.; Tajfel, 1978; Tajfel & Turner, 1979). It therefore reflects the fact that in thinking about who we are, we can define ourselves (and our sense of self) not just as āIā and āmeā, but also (and often more importantly) as āweā and āusā. Historically, social identity research has tended to focus on the way in which these group-based identities determine how people from different groups relate to each other (e.g., to explain processes involved in stereotyping and discrimination). As a result, until recently, other consequences of group-based belonging - in particular, those that relate to well-being - were largely unexplored. Of late, however, there has been increasing interest in the specific role that group memberships (and the social identities associated with them) play in determining people's health and well-being. The scale of this growth can be gauged by considering the fact that since 1990 there has been a logarithmic increase in the number of research articles whose titles, abstracts or keywords reference āsocial identityā or āsocial identificationā together with āhealthā or āwell-beingā (and a quadratic increase in the number of times that these publications have themselves been cited; see Haslam et al., 2009, for further details).
It seems highly likely that these trends will continue in the years ahead. Accordingly, our hope is that this edited book will serve a dual function: first, to document the progress that has recently been made in understanding the interplay between identity, health, and well-being and, second, to stimulate and inform future interest among researchers, practitioners, and policy makers. With this in mind, in compiling this volume, our purpose has been to bring together a variety of perspectives and views from leading researchers representing a range of disciplines (clinical, health, social, organizational, economic) as a means of providing theoretical and empirical insights into the ways in which social interactions and social connections affect health and well-being. More specifically, in the chapters that follow, the contributions all examine how social identities (and factors associated with them; e.g., social support, a sense of solidarity, and community) have the capacity to contribute to a āsocial cureā that is capable of promoting adjustment, coping, and well-being among individuals who are dealing with a range of illnesses, injuries, traumas, and stressors. The nature of the research that the various chapters cover is extremely diverse, but at their heart there is a clear focus on the way in which different aspects of group life interact with other factors (e.g., psychological, biological, medical) to determine health and well-being.
We realize that some readers may already be quite familiar with the social identity approach, but that others may not have had much exposure to this theoretical framework. Accordingly, we need to ensure a basic understanding of this approach before we can appreciate how this bears upon issues of well-being and health. In the next section, we therefore provide a short theoretical overview of key social identity principles and we discuss how these apply to health. Along the way, we will also identify the potential for a social identity analysis to address current āneedsā in the field. In short, we argue that the value of a social identity analysis of health and well-being lies in the fact that this framework (a) provides a social analysis of health and well-being, (b) provides a coherent framework for understanding health and well-being, and (c) provides theoretical tools that allow us to design and implement interventions that can capitalize on our understanding of the importance of social relationships for health.
THE VALUE OF A SOCIAL IDENTITY APPROACH TO HEALTH AND WELL-BEING
The social identity approach is comprised of two related theories: social identity theory (SIT; Tajfel & Turner, 1979, 1986) and self-categorization theory (SCT; Turner, 1985; Turner, Hogg, Oakes, Reicher, & Wetherell, 1987). As noted above, both theories are central to our current purpose, and we therefore need to provide a short introduction to their core principles. For more extensive accounts, we refer readers either to the original writings by Tajfel and Turner (1979, 1986; Turner, 1982; Turner et al., 1987), or to more recent reviews and overviews (e.g., Haslam, 2004; Postmes & Branscombe, 2010; Turner, Oakes, Haslam, & McGarty, 1994).
Social identity theory was initially developed to explain group behaviour relating to intergroup conflict and discrimination. It does this with specific reference to the sense of self that individuals derive from membership of social groups - that is, their social identity. A key idea here is that in order to understand behaviour in various social contexts (in particular, those in which there is conflict, prejudice, and discrimination), it is necessary to recognize that individuals can define their sense of self (āwho they think they areā) in social and not just personal terms (i.e., as āusā and āweā, not just āIā and āmeā).
Some of the assumptions that are central to the theory are: (a) that people generally strive to achieve or maintain a positive sense of self; (b) that in many social contexts an individual's self-concept will derive from significant group memberships and hence be defined in terms of social identity; and therefore (c) that when a particular social identity is salient, individuals strive to maintain positive social identity by positively differentiating their own group (the ingroup; e.g., as a woman, as an Australian) from other groups (outgroups; e.g., men, Americans; Tajfel & Turner, 1986).
These ideas were initially derived from a series of experiments in which Tajfel and colleagues randomly assigned people to one of two previously meaningless groups (e.g., groups supposedly defined on the basis of their liking for the abstract painters Klee and Kandinsky) and then asked them to allocate points signifying small amounts of money to members of their ingroup and members of the outgroup (Tajfel, Billig, Bundy, & Flament, 1971). In these experiments - which became known as the minimal group experiments - it was found that participants did not allocate points equally, but rather tended to display ingroup favouritism by giving more points to the ingroup than the outgroup. It appeared that through ingroup favouritism participants gained a positive social identity; an outcome that is all the more powerful when we consider that this was achieved via creation of groups that had no prior meaning.
These ideas about the importance of social identity for understanding social behaviour were subsequently refined and extended within self-categorization theory (Turner et al., 1987, 1994). This theory asserts that there are multiple levels at which we can define ourselves and that each has distinct implications for our behaviour. At the subordinate level people define themselves, and act, as individuals (compared to other individuals and in terms of personal identity; Turner, 1982); at the intermediate level they define themselves, and act, in terms of their membership of a specific group (compared to relevant outgroups and in terms of social identity); and at the superordinate level they define themselves, and act, as human (in contrast to other species).
The fact that there are different levels of self-categorization suggests that to understand individualsā interactions with the social world around them - including those interactions that have implications for mental and physical health and well-being - we need to appreciate the way in which people define and understand themselves in a given context or situation. Such an analysis suggests that individuals will respond differently depending on whether they define themselves as unique individuals (in terms of personal identity) or as group members (in terms of social identity; e.g., as stroke sufferers, older adults, or as students). As we will see in the chapters that follow, amongst other things, this will determine their perceptions of particular stressors, their responses to health messages, their interactions with health care providers, and their reactions to different forms of social support. For example, the particular group membership in terms of which a woman defines herself (e.g., as a patient, an employee, or a mother) will determine the significance of the stressors she confronts, the effectiveness of the health messages to which she is exposed, and the value of the care and support she receives.
However, these insights about the way in which individualsā behaviour is dictated by identity concerns (and the social contexts in which these are embedded) are rarely taken into account when studying health. Typically, health outcomes and behaviours are studied at the individual level and the role of group membership, shared group memberships, and shared social identity is left unexplored. One reason for this is that it is ultimately individuals who engage in health-related behaviours (e.g., smoking, drinking, exercising), individuals who suffer from an illness, and individuals who are exposed to health risks. More particularly, it is as individuals that they are often treated (e.g., in hospital or when visiting the doctor). Given this, it is perhaps not surprising that research into these various topics has been informed by approaches that focus largely - if not exclusively - on the abilities and capacities of individuals as individuals. For example, such approaches have explored the role of individual differences (e.g., in personality traits such as āhardinessā, āresilienceā, or āextroversionā) that might buffer people against stressors and threats to health. Other research has focused on individualsā personal thinking styles in explaining variation in their ability to cope (e.g., examining the way in which individuals cope by cognitively reappraising stressful transitions; Brammer, 1992). This individual-level understanding is then translated into interventions that are equally individualistic. For example, these involve helping individuals to make lifestyle changes to minimize stress (Friedman & Rosenman, 1974), to relax in times of change, to assist in coping (see Cooper, 1990), or to foster a sense of optimism rather than pessimism (Brissette, Scheier, & Carver, 2002; Seligman, 2006).
Nevertheless, it is equally (if not more) true, that all the above activities are also structured by group membership. People engage in health behaviours in groups (e.g., clubs, families) and different groups engage in different types of health behaviour; people suffer illnesses in groups (e.g., at work, at school) and different groups are exposed to different types of illness (e.g., as a function of their social class, their occupation); and, finally, people's health is also managed in groups (e.g., in clinics, hospitals, and through various health campaigns). Thus, while health is always personal, it always has a social dimension too. Indeed, this insight is central to fields such as epidemiology, population health, health economics, and medical sociology.
Unfortunately, then, psychological or other accounts that focus only on the individual as an individual are limited in scope because they fail to come to grips with the social underpinnings of health and well-being. Indeed, the few studies that have measured both personality and social relationships (e.g., Cohen & Wills, 1985) all show that, on their own, individual-level accounts are incapable of explaining the all-important contribution of social relationships to individualsā well-being. At a theoretical level, such accounts cannot explain why it is the quality and diversity in our relationship with others that crucially ...
