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This chapter integrates empirical research on the pains of imprisonment with psychological and neuroscientific insights into the nature, sources, and effects of social pain, including its connection to the fundamental human need to belong. It argues that social pain provides a comprehensive framework for situating the pains of imprisonment – outlined in Chapter 3– within a unified conceptual construct. This argument rests on three interrelated premises. First, the contexts of exclusion that elicit social pain – social isolation, rejection, and ostracism – closely mirror the layers of exclusion that define the various domains of prison life. Second, the effects of social pain – particularly when pervasive or prolonged – on psychological well-being, behavior, and health significantly overlap with those documented among incarcerated individuals, both during and after imprisonment. Third, the psychological mechanisms that lead people to cause social pain in others, while underestimating its consequences, similarly underpin the logic of punishment, including the tendency to minimize the actual harms of the prison experience. Building on these premises, the chapter develops the book’s central claim: that the real pain of carceral punishment ultimately resides in the systematic threat to the fundamental human need to belong.
Few studies have examined prospective or neurobiological predictors of suicidal thoughts and behaviors (STB) in Latino youth. We hypothesized that autonomic nervous system (ANS) activity at baseline and in response to social exclusion would distinguish Mexican-origin adolescents with versus without histories of suicidality, and would predict subsequent suicidality. Skin conductance responses and respiratory sinus arrhythmia, indicators of sympathetic and parasympathetic activity, respectively, were recorded at baseline and during Cyberball exclusion trials, in 229 Mexican-origin youths (M = 17.16 years, 110 females). STB was assessed 11 times across ages 10 to 20 years; 62 youths had histories of STB prior to the physiological measures, and 61 youths reported STB in the following 2.5 years. Cyberball elicited parasympathetic withdrawal without sympathetic activation, compared to baseline. Adolescents with histories of STB, compared to those without, had lower sympathetic activity during baseline and social exclusion. Lower basal sympathetic activity paired with greater uncoupled sympathetic activation during Cyberball predicted prospective STB. These findings support bioecological theories of stress vulnerability that suggest acute autonomic activity may serve as a biomarker for suicidality risk and extend prior work by identifying pathophysiology that could be the target of interventions to reduce risk in Mexican-origin youth.
Chapter 5 assesses harms that people with mental illness experience that are related to how their self is constituted. These include harms of de-individuation and mis-identification, but also, as this chapter focuses on, harms of social exclusion and dehumanization that result from status loss and moral distancing. Dehumanization occurs through both being reduced to a stereotyped trait and being viewed as lesser compared to others. Having a sense of belonging and being accepted as an equal member of a moral/epistemic/social community are important parts of being viewed as and viewing oneself as a full human being; these are also critical for developing and exercising autonomous agency as well as for well-being and flourishing. People with mental illness are often excluded from these communities as a result of public stigma, diminishing their autonomy and well-being. This chapter shows how dehumanization, social exclusion, and belonging uncertainty threaten belongingness and autonomy.
Chapter 1 examines what mental illness stigma is and analyzes the components of mental illness stigma to show how people with mental illness experience stigma in their daily lives. These components include labeling, stereotyping, prejudice, moral distancing, social exclusion, status loss, dehumanization, microaggressions, discrimination, and epistemic injustice. In each case, I use empirical evidence from the social psychology literature on stigma to show ways in which people with mental illness experience these forms of stigma. Next, I look at factors that affect the kind, degree, and scope of stigma associated with mental illness, including beliefs, political values, cultural values, socioeconomic status, education, and gender. Finally, I examine how many people experience compounding stigmas that come from multiple sources.
The introduction motivates the book’s arguments by showing how mental illness stigma remains pervasive despite greater awareness of mental health issues and more resources directed at mental health treatment and destigmatization. The forms of mental illness stigma most commonly expressed are stigma against people with severe mental illness who are perceived as homeless, and internalized stigma that people with mental illness project onto themselves. Mental illness stigma arises as a reaction to the violation of social norms of what a human being should be in the Western world in the twenty-first century. I give an account of stigma as the devaluing and discrediting of a person based on possessing a social trait that is seen as violating social norms, constituting a relationship of power. Components of stigma include labeling, stereotyping, prejudice, moral distancing, social exclusion, status loss, dehumanization, microaggressions, discrimination, and epistemic injustice. The chapter ends with a description of the book’s scope, methodology, and chapter outline.
Young people who are neither in employment nor in education or training (NEET) are at risk of long-term exclusion and poorer wellbeing. Besides individual costs and adverse later life consequences, NEET can impose significant societal costs, making it a major public policy concern and an important indicator of social exclusion. Using high-quality register data on Finnish birth cohorts born between 1987 and 1992, we compared the risk of being NEET at ages 21–27 amongst those born with very low birth weight (VLBW, < 1500 g), low birth weight (LBW, 1500–2499 g) and normal birth weight (NBW). We further studied whether the effects of birth weight on NEET were moderated by parental socioeconomic status (SES), measured as maternal education. To address potential confounding due to unobserved characteristics, we employed Poisson regression with sibling fixed effects. Results indicated that LBW was associated with an increased incidence rate ratio (IRR) of 1.26 (95% CI 1.15–1.38) and VLBW with an IRR of 2.02 (95% CI 1.66–2.40) for NEET status, compared with NBW. The relationship between birth weight and NEET did not vary by parental SES. Findings underline the importance of early health in contributing to the risk of NEET, regardless of parental SES.
Although mental health is a better understood, more widely discussed topic in our society today, a degree of stigmatization persists, especially in severe cases with links to homelessness, job loss, poverty and human rights. It is also still present in environments such as the workforce, healthcare settings and educational environments, and often internalized by the sufferer themselves. This book provides a philosophical account of what mental illness stigma is, why it persists, what harms it causes to people subject to public stigma or who internalize stigma in themselves, and what can be done about it. It analyzes the process of stigmatization, both public and internalized, in the twenty-first century Western culture, especially in the United States - including the process of stereotyping, the expressive harm of stereotypes, the role of social norms in creating adaptive preferences and shaping behaviour, the moral distancing and status loss involved with social exclusion and dehumanization, and the harm of discrimination.
Despite the centrality of national identity in the exclusionary discourse of the European radical right, scholars have not investigated how popular definitions of nationhood are connected to dispositions toward Muslims. Moreover, survey‐based studies tend to conflate anti‐Muslim attitudes with general anti‐immigrant sentiments. This article contributes to research on nationalism and out‐group attitudes by demonstrating that varieties of national self‐understanding are predictive of anti‐Muslim attitudes, above and beyond dispositions toward immigrants. Using latent class analysis and regression models of survey data from 41 European countries, it demonstrates that conceptions of nationhood are heterogeneous within countries and that their relationship with anti‐Muslim attitudes is contextually variable. Consistent with expectations, in most countries, anti‐Muslim attitudes are positively associated with ascriptive – and negatively associated with elective (including civic) – conceptions of nationhood. Northwestern Europe, however, is an exception to this pattern: in this region, civic nationalism is linked to greater antipathy toward Muslims. It is suggested that in this region, elective criteria of belonging have become fused with exclusionary notions of national culture that portray Muslims as incompatible with European liberal values, effectively legitimating anti‐Muslim sentiments in mainstream political culture. This may heighten the appeal of anti‐Muslim sentiments not only on the radical right, but also among mainstream segments of the Northwestern European public, with important implications for social exclusion and political behaviour.
Democracy seems to be inextricably linked to crisis. This is true since the ancient writings of Plato and Aristotle. More recently, the debate over the crisis of democracy goes on under the heading of “postdemocracy.” This article addresses the question of whether the crisis of democracy is an invention of theoretically complex but empirically ignorant theorists who adhere to an excessively normative ideal of democracy, on three levels: first, on the level of quality of democracy indices developed by experts; second, on the basis of the survey reports on the opinion of the demos; third, on a deeper analyses of crucial spheres of democracy. The results hint in different directions. According to expert indices and polls, the message is: there is no crisis of democracy. However, the partial analyses on participation, representation, and effective power to govern reveal unresolved democratic challenges, such as an increasing level of exclusion of the lower third of the demos from participation, an inferior representation of their interests, and a loss of democratic sovereignty in policy making.
Social participation is a key determinant of health and wellbeing in later life, yet older adults at risk of marginalization often face barriers that limit their inclusion in society. To promote health equitably, it is essential to take better account of the heterogeneity of older adults and foster their social participation. This study thus aimed to describe and synthesize knowledge about interventions that foster the social participation of older adults at risk of marginalization. Using 61 keywords across six databases, this scoping review identified 29 studies reporting on individualized and collective interventions. Peer assistance and grouping older adults according to interests or shared life experience were identified as key facilitators of participation in the interventions. Limited access to transportation and a lack of activities tailored to the diverse needs of older participants were significant barriers. The findings highlight the importance of collaborating with community organizations to develop sustainable, accessible and adaptable interventions, as well as the value of proximity-based support in individualized approaches. Further studies are needed to evaluate the effectiveness of such interventions. By highlighting strategies to include marginalized older adults in society, this study contributes to advancing health equity for all older adults, especially those at risk of marginalization.
Cognitive health is a major concern for older adults. Cognitive decline poses risks to individual wellbeing and the public health system; therefore, identifying modifiable social risk factors is crucial. Social exclusion among older adults can occur across multiple domains simultaneously; however, few studies assess the association between multidimensional exclusion and cognitive function. This study investigates the relationship between three domains of social exclusion – economic, social relations and civic participation – and cognitive performance, examining both individual and combined effects among middle-aged and older adults in Europe. The study uses data from 60,726 participants in the ninth wave of the Survey on Health, Ageing and Retirement in Europe. It assesses the independent and cumulative associations between social exclusion and cognitive function, while adjusting for socio-demographic and health-related variables. Cognitive function was most strongly associated with civic participation (β = −0.40), followed by social relationships (β = −0.36) and economic exclusion (β = −0.32), all of which were statistically significant (p < 0.001). A cumulative effect was found; individuals excluded from all three domains had the lowest cognitive scores (β = −1.12; p < 0.001), with cognitive performance declining progressively as the number of exclusion domains increased. These results highlight that multidimensional social exclusion is associated with worse cognitive outcomes, even after controlling for other relevant variables. Civic exclusion emerged as the domain with the most significant association, suggesting that encouraging civic participation – such as volunteering or participating in politics – may be a valuable strategy for supporting cognitive health in later life.
People with severe mental illness (SMI) (schizophrenia-spectrum and bipolar disorders) experience a 15–20-year reduction in life expectancy. The role of social determinants, including that of social exclusion, in contributing to excess mortality in SMI remains underexplored.
Methods
Retrospective cohort study, comprising 8098 people with clinician-diagnosed SMI, matched to 581,209 population controls, followed for 5.7 years using person-level linked health/ census records. A social exclusion index was derived from census indicators: marital status, social isolation, economic inactivity, education, tenure, housing stability, and material assets.
Results
Social exclusion was more common in SMI than in controls and strongly associated with higher mortality. Relative to the least socially excluded controls, adjusted hazard ratios (aHR) for mortality in SMI were: 16–44 years: aHR 7.58 (95% CI: 2.75–20.86) in the least socially excluded, increasing to 12.34 (7.92–19.24) in the most excluded; 45–64 years: 3.34 (1.98–5.64) [least excluded] increasing to 6.58 (5.32–8.14) [most excluded]; 65+ years: 2.71 (1.90–3.86) [least excluded], increasing to 3.07 (2.48–3.80)[most excluded]. Excess mortality among those with SMI was pronounced at younger ages if never married; by mid-life if living alone or economically inactive; and at 65+ years in those with SMI living alone, renting, or with no car ownership. Economic inactivity and lack of qualifications accounted for 16–35% of SMI mortality.
Conclusions
Social exclusion is an under-recognized contributor to premature mortality in SMI. Targeting social determinants through novel socially-focused interventions could improve survival in people with SMI.
Psychiatric disorders are highly comorbid and are not separated by sharp biological boundaries. Understanding the common mechanisms that explain symptom overlap in mental disorders is therefore clearly needed. Here, we briefly review impaired emotional processing and emotional dysregulation in affective disorders, with a special focus on unipolar depression. Affective disorders are characterized by abnormal emotion intensity, changes in the temporal dynamics of emotion and difficulties to influence the trajectory of emotions. Disruptions in emotion processing and emotional regulation are underlined at the neural level by abnormal interactions between cortical and limbic structures in terms of increased variance in functional connectivity. Emotional processes are also tightly linked to cognitive processes, which constitute main targets for therapeutic interventions in affective disorders.
This study addresses a critical gap in research on public services digitalization, specifically, how technology’s role and its relationship with ageing are framed within policy discourse. While digitalization holds the promise of enhanced accessibility, streamlined bureaucracy and greater transparency, it also has the potential to exacerbate social exclusion in ageing societies. Macro-level factors such as policy frameworks and societal values play a key role in either mitigating or intensifying these risks; they shape the way critical issues are defined and which responses are deemed conceivable. The study aims to critically examine how digitalization and ageing are framed in European and Italian policy documents, and assess the implications of these narratives for older adults. Methodologically, it analyses a corpus of 29 European and Italian policy documents on public service digitalization (2010–2023). Keywords extraction identified ten documents for critical discourse analysis, which revealed a dominant narrative of technological optimism where digitalization is presented as a universal solution, with limited acknowledgment of its potential downsides. At the European level, some documents recognize the rights of older adults, though such recognition remains sparse. Italian policies, in contrast, tend to prioritize technical and economic aspects, with little or no attention to digital exclusion or inequality. This study sheds light on how policy discourse can obscure structural inequalities and calls for more inclusive, reflective approaches to digitalization in ageing societies. It argues that policy discourse should be leveraged not only to promote innovation but also to foster social change and reduce exclusion among older adults.
We apply a synthesis review to revisit the concept, measurement, and operationalisation of social inclusion and exclusion in the context of comparative social policy, integrating the vast literature on the concepts, with the aim of elucidating a clearer understanding of the concepts for use by scholars and policymakers around the planet. In turn, we outline the conceptual development of the concepts, how they have been operationalised through social policy, and how they have been measured at the national and individual levels. Through our review, we identify limitations in extant conceptualisation and measurement approaches and suggest directions for refining conceptual and measurement frameworks to enhance their utility in social inclusion policy, emphasising the concepts’ multidimensional, multilevel, dynamic, and relational essence and highlighting their connection to related concepts such as social capital, social integration, and social citizenship.
This study explores the link between receiving basic income support (BIS) and political alienation in Germany, with a focus on political trust and satisfaction with democracy. We argue that receiving BIS is associated with experiences of material and social exclusion and impairs subjective social integration. Against the background of major structural welfare reforms in recent decades, we assume that BIS recipients are likely to attribute responsibility for their socio-economic disadvantages to the wider political system. We use data from the Panel Study Labour Market and Social Security (PASS) for the years 2019–2021 and employ multivariate regression analysis. We find that political alienation is more likely to occur among recipients of BIS, especially long-term recipients, than among non-recipients. Social exclusion is an important mechanism: With a higher risk of material deprivation and fewer opportunities for social participation and civic engagement than non-recipients, BIS recipients are more likely to experience subjective social exclusion, which, in turn, contributes to their political alienation. Moreover, our study offers indications that trustful and supportive interactions with welfare authorities can mitigate tendencies of political alienation among BIS recipients.
In this study we conduct a lab-in-the-field experiment with low-income Hispanics in three neighborhoods in a large city in the U.S. to investigate how identity and social exclusion influences individual contributions to fund local public goods. We find that while the strength of identity has a significant and positive impact on individual contributions to local public goods, the perception of social exclusion significantly decreases contributions. Our findings thus suggest factors that may impede full civic participation, and shed important light on potential policies to increase integration of immigrants and ethnic minorities into mainstream society.
A systematic review/meta-analysis synthesising the existing evidence regarding the prevalence of loneliness and social isolation among individuals with mild cognitive impairment (MCI) or dementia is lacking.
Aims
A systematic review and meta-analysis was conducted to investigate the prevalence and factors associated with loneliness and social isolation among individuals with MCI or dementia.
Method
A search was conducted in five established electronic databases. Observational studies reporting prevalence and, where available, factors associated with loneliness/isolation among individuals with MCI and individuals with dementia, were included. Important characteristics of the studies were extracted.
Results
Out of 7427 records, ten studies were included. The estimated prevalence of loneliness was 38.6% (95% CI 3.7–73.5%, I2 = 99.6, P < 0.001) among individuals with MCI. Moreover, the estimated prevalence of loneliness was 42.7% (95% CI 33.8–51.5%, I² = 90.4, P < 0.001) among individuals with dementia. The estimated prevalence of social isolation was 64.3% (95% CI 39.1–89.6%, I² = 99.6, P < 0.001) among individuals with cognitive impairment. Study quality was reasonably high. It has been found that living alone and more depressive symptoms are associated with a higher risk of loneliness among individuals with dementia.
Conclusions
Social isolation, and in particular loneliness, are significant challenges for individuals with MCI and dementia. This knowledge can contribute to supporting successful ageing among such individuals. Future research in regions beyond Asia and Europe are clearly required. In addition, challenges such as chronic loneliness and chronic social isolation should be examined among individuals with MCI or dementia.