Carol Craig began by explaining that she was not an expert on drink or drugs and that that all she could say which might be helpful to the audience was an outline of the various perspectives which she found useful when writing The Tears that Made the Clyde as this is a book which tries to explain why Glasgow has copious health and social problems. You can read Carol's summary of these perspectives below and you can also access the few powerpoint slides she used in her talk.
1. Richard Wilkinson and Kate Pickett, The Spirit Level
Carol explained that she was inspired to write her book on Glasgow by Richard Wilkinson's original book The Impact of Inequality. Basically some of the recent research into Glasgow's problems suggests that it is no more unequal a city than Manchester and Liverpool which have much better outcomes. What she then wanted to pursue was whether there is 'a culture of inequality' in the city which goes back hundreds of years.
Wilkinson and Pickett argue that more equal societies have much better health and social outcomes than those with steep inequality. Their explanation for this (which is completely speculative) is that as human beings we have a need to feel respected and included and if we do not, which is the fate of those who languish at the bottom of a steep pyramid, we feel bad and lash out at anyone we can construe as even lower in the hierarchy. Thus societies with profound inequality are more macho, violent and racist as men indulge in risky behaviours to 'prove' themselves and are more likely to become involved in gangs and domestic violence. (There is copious evidence for the link between violence and inequality but less for some of the other factors.) If we substitute the word 'sectarian' for racist we can see that what Wilkinson and Pickett describe as the likely effects of inequality – macho culture, risky male behaviour (such as drinking), violence (e.g. gang warfare), domestic violence and sectarian bigotry – are precisely the negative factors which have characterised the city for centuries and which live on within the culture.
Scotland likes to pride itself on its egalitarian attitudes – we are the land of Burns and 'a man's a man for a' that'. But the history of Scotland tells a different story. Historically, and contemporarily, Scotland has the highest levels of concentrated land ownership in Europe. (See Andy Wightman's recent book The Poor Had No Lawyers). One of the reasons why historically Glasgow had such a housing crisis was because landowners had the power to evict people from their land once they no longer needed their labour. We tend to think this only happened in the highlands but in fact it happened throughout Scotland in the late 18th and 19th centuries.
Once in Glasgow workers who were cleared from the land were subjected to a different type of power – that of the authoritarian, industrial magnates who owned the heavy industries. Bearing in mind Wilkinson and Pickett's thesis it is not difficult to see why demarcation disputes and sectarianism became part of the warp and woof of Glasgow's working class culture.
2. Bruce Alexander, The Globalization of Addiction: A Study in the Poverty of the Spirit
The second perspective which had a large impact on Carol's analysis of Glasgow came from Bruce Alexander. What she found particularly useful is Bruce's idea (borrowed from the psychologist Erik Eriksson) of 'psychosocial integration'. What this means is that as human beings we have a simultaneous need to belong and have a sense that our lives have meaning to a wider group, while at the same time have the freedom for individual expression. Bruce points out that as capitalism develops it tends to break the links with what has gone before. Even if people do not relocate (and many did in the early stages of industrialisation) they often feel 'dislocated' from the culture and people they once belonged to. In the early days of industrialisation dislocation was so intense that it was accompanied by 'mass alcoholism'. People turned to alcohol to fill the void in their lives and to numb the pain of loss.
Socialism may be better at maintaining the sense of the collective and group ties, however Bruce argues that it has been particularly poor at allowing a sense of individual autonomy and self-expression. Part of Carol's analysis in her first book The Scots' Crisis of Confidence is that Scottish culture's particular collectivist values do not encourage a respect for individuality and make it difficult for people to express themselves. She finished this section by pointing out that the other European country struggling with similar levels of addiction to Scotland is Russia!
3. Family and gender relations (various researchers)
A third area of study which Carol outlined concerns family and male/female relationships. Carol had a limited amount of time to speak at the event and so what she mainly does here is highlight why Glasgow (an area of Scotland with a particular problem with drink and drugs) may have particularly poor gender relations and how this could predispose people to misuse substances.
Carol explained that when writing The Tears that Made the Clyde she was not particularly looking at gender relations yet one of the most striking aspects of Glasgow's social history is not just what a macho culture the city has had over decades, but also how poor relations between men and women have been. Carol explained that Glasgow's terrible overcrowding (which was worse than other cities) intensified men's pub/drinking culture. It also seems to have been common in Glasgow (in contrast with other areas of Scotland) for men not to hand over their pay packets and for them to drink a sizeable amount of their wages thus short changing their families. Until the first world war, fewer women in Glasgow worked than elsewhere in the UK and the idea of 'the companionate marriage' which became fashionable down south did not acquire currency in the west of Scotland. The stress, heavy drinking, women's dependence, and the effects of pronounced inequality (see first section on The Spirit Level) appears to have led to negative relationships and considerable levels of serious domestic violence.
Carol pointed out that current longitudinal studies, presented by Professor Andrew Oswald and colleagues, show that the single most important factor for men's physical and mental health and longevity is 'being married'. One of the reasons for this is known as 'the guardian effect'. This refers to the fact that married men tend to drink less than single men and have much healthier lifestyles. However, research in Glasgow did not find that men's drinking varied depending on marital status. In other words, married men in Glasgow drank as much as single men.
The last census showed that Scotland has fewer married people than England, implying more cohabitation here than south of the border. Research suggests that cohabitation is much less stable than marriage thus suggesting more relationship churn in Scotland than England. Acrimonious relationships may well encourage people to turn to alcohol and drugs to cope with the resultant stress. Alcohol also leads to relationship breakdown.
Adverse Childhood Experiences (Centres for Disease Control and Prevention, Robert F. Anda, MD, MS, and Vincent J. Felitti, MD)
One of the studies which could shed some light on why Glasgow has such a poor health record, and Scotland as a whole a problem with drink and drugs is a major American research project on Adverse Childhood Experiences, known as the ACE Study. This large-scale collaborative research project studied 17,000 adults’ responses to questions about childhood abuse and household dysfunction. They were mainly middle-class, employed Americans living in California. The average age was 57. The questionnaire also asked respondents to outline their current mental and physical health and their health behaviours. Individuals scored one point for each adverse experience they recalled. This gave a score between 0 (no adverse experiences) and 8. Its findings were startling:
The ACE Study reveals a powerful relationship between our emotional experiences as children and our physical and mental health as adults, as well as the major cause of adult mortality in the United States. IT documents the conversion of traumatic emotional experiences in childhood into organic disease later in life. How does this happen, this reverse alchemy, turning the gold of a newborn infant into the lead of a depressed, diseased adult? The Study makes it clear that time does not heal some of the adverse experiences we found so common in the childhoods of a large population of middle-aged, middle-class Americans. One does not ‘just get over’ some things, not even fifty years later.
Carol Craig's powerpoint for the event lists what the Study defines as 'adverse experience' and presents how the ACE scores broke down into percentages:
The Study showed a strong relationship between the number of adverse experiences and self-reports of cigarette smoking, obesity, physical inactivity, alcoholism, drug abuse, depression, attempted suicide, sexual promiscuity and sexually transmitted diseases in later life. Researchers speculated that smoking, drug taking, alcohol and so forth were coping devices to help alleviate stress. More importantly, the more adverse childhood experiences people reported, the more likely they were to have heart disease, bronchitis, cancer, stroke, diabetes, skeletal fractures, liver disease and poor health as an adult.
The relationship between the ACE score and medical problems is striking. For example a person who scores 4 is 260 per cent more likely to have a chronic obstructive pulmonary disease (such as bronchitis) than someone with an ACE score of 0. A male who gains 6 on the ACE questionnaire has a 4,600 per cent increase in the likelihood of using heroin intravenously than another who scored 0. An individual who scores 4 or more is 460 per cent more likely to be suffering from depression than an individual who scores 0. Those with high ACE scores are at much higher risk (3,000-5,100 per cent) of committing suicide. Researchers point out that there is a ‘strong graded relationship’ in the data between what happened in childhood and later health.
Looking at the list of what is considered an 'adverse experience' my hunch is that people growing up in Scotland, but particularly Glasgow, during the same period probably had similar levels of sexual abuse (given current estimates), even more alcohol consumption (given that Americans consume less on average than the Scots); more domestic violence given its prevalence in historical accounts of Glasgow, its link with alcohol. and the Scottish Government’s current estimates that 20 per cent of women suffer domestic abuse as opposed to the 13 per cent reported in the ACE Study. I also think that what the researchers define as 'emotional abuse' were fairly common given that Scotland has traditionally been a put down culture. We’re good at criticism and cutting people down to size – in fact, we think it is good for them.
Materialist culture (Tim Kasser and others)
For decades economists have equated money (Gross Domestic Product) with national well-being, making the assumption that the best way to improve people’s lives is to stimulate economic growth and make people wealthier. However, as the economies of western nations have grown substantially in recent years it has become clear that, while poverty is not good for well-being and happiness, continually increasing a country’s wealth is not necessarily beneficial. Indeed that in the past few decades the UK’s GDP has increased substantially while happiness levels have remained stubbornly flat. What’s going on is really simple: money is important for happiness and well-being but once basic economic needs are met and people have food on the table, a roof over their head, and some sense of economic stability then having more money does not mean more happiness.
Tim Kasser is a psychologist who has made a particular study of those who pursue a materialistic lifestyle. Kasser defines materialism as ‘buying in’ to a cluster of goals related to money, fame and image. People’s materialistic values can be measured in terms of their motivation towards ‘attaining possessions, attractiveness and popularity’. Kasser reports extensive and ‘consistent’ international research which shows that ‘People who are highly focussed on materialistic values have lower personal well-being and psychological health than those who believe that materialistic values are relatively unimportant.’ Kasser argues that everyone must place some value on material goods. We need food and shelter to survive. A sense of security and comfort adds enormously to the quality of our lives. From time immemorial people have placed some value on their appearance; wanted to feel some degree of pride in their accomplishments; and have cared to some extent on how they are viewed by others. So Kasser’s argument is that ‘materialism is relative. Materialistic values become unhealthy when they are highly important in comparison with other values for which we might strive. The question is one of balance … .’ Kasser’s rule of thumb is that materialism is detrimental to our well-being when it compromises the fulfilment of our fundamental psychological needs. For example, those with a materialistic orientation place less value on warm, intimate relationships and take a more instrumental view of others and they often care too much about status and their outer appearances and image. They are also less likely to do things because they are intrinsically interesting or stimulating but because they make the person look good or feel better than others. These behaviours and values are not helpful in creating a truly fulfilling and rewarding life.
Mrs Thatcher’s governments, and those which followed, have particularly promoted materialistic and individualistic values. One of the main purveyors of this philosophy of life is the mass media. Television now beams into people’s homes information about the lives of the rich and famous as well as giving people a daily diet of advertising designed to get them to want things they do not have. Research shows that the more people are exposed to television images of successful and attractive people the more dissatisfied they are with themselves and their partners.
Since materialism undermines well-being, and as well-being in the west of Scotland is not high, could it be the case that the local culture is particularly disposed to materialistic values? Kasser maintains that feelings of insecurity can lead people to pursue a materialistic lifestyle. Indeed contemporary international research shows that people whose needs for ‘security, safety and sustenance’ were not met by their childhood upbringing are much more like to develop a materialistic orientation to life.
Well-being research (various researchers)
Finally the well-being research, much of it branded self-determination theory or positive psychology, can help us understand what human beings need to thrive thus making them less likely to misuse alcohol and drugs.
The following is a basic list of some of the most important factors. I've added links to where you can read more about these topics on this website.
- Exercise/being outdoors
- Good relationships
- Work (but some jobs much better than others)
- Sense of autonomy/personal control
- Skills, competence, engagement, flow
- Meaning - serving a goal bigger than self