The Impact of Exclusion: from 'fomo' to long term health
Updated: May 26, 2020
Making the case for an increased emphasis on social inclusion, specifically for refugee communities
We humans are social beings. We are obsessed with social status and our deep-rooted fear of exclusion. The rise of social media - bringing with it a constant reminder of everyone else’s social lives and with this, fomo - has undoubtably exacerbated our social status anxiety. We crave acceptance from our peers and fear their judgement to the point where it threatens to destabilise the self-worth which we have tried so hard to construct.
Imagine the end of the first day at school. A young child cries to his parents because the other children belittled him for having different shoes; his teenaged brother undergoes an internal panic about where to sit on the bus, knowing it may determine which friendship group will establish him to be worthy; a mother nervously attempts to make small talk with a group of parents, hoping they might accept her. The shattering effects of feeling excluded are not limited to being from a certain background, or even age bracket. Social evaluative threats, meaning the negative judgements of others which we perceive to undermine our own social status, play a major role in our self-esteem and overall happiness.
The social self-preservation model relates social threats to a unique psychobiological response, namely an increased level of cortisol, which is a stress hormone. In fact, lab tests designed to assess stress levels incorporate a social evaluative threat to participants, for instance creating a situation where the participant feels excluded. Social evaluative judgements have the power to affect not only our mental health, but our physical health too. Prolonged impacts on our cortisol levels can affect our immune and cardiovascular system, creating a plethora of physical health problems, including premature ageing, which itself increases vulnerability to disease.
In The Spirit Level, Wilkinson and Pickett present findings on health and social problems such as increased violence, infant mortality, a lack of trust in fellow citizens, and decreased mental health in various societies. Perhaps counterintuitively, their discoveries show that it is not how rich or poor a country is that impacts the commonality of such problems, but instead, how unequal their society is, or the size of the disparity between rich and poor. They identify status anxiety as the cause of such problems, referring for instance to the common feelings of shame - comparing countries such as India, the UK and Norway where poverty has vastly different material meanings - amongst children who cannot afford the same possessions as their peers. Concern over how others perceive them challenges their social self, and such threats elicit a physiological as well as a psychological response.
Interestingly, social hierarchies can have far-reaching negative impacts on everyone’s health, not just those at the bottom. Psychologist Sheri Johnson posits that in any status hierarchy, various struggles - such as to achieve dominance, avoid subordination, or even accept subordination - all contribute to mental illness. In unequal societies, the constant vigilance toward status has detrimental effects and can shape a child’s life from early on. As humans, we crave acceptance from our peers. Inequality is damaging to the very fabric of society and in a country as unequal as the UK, social identity threats are ubiquitous, presenting a particular risk to the mental and physical health of us all.
Refugees arriving in the UK are challenged with settling into a host country entrenched in inequality. Thus, it is crucial that social acceptance, and all its nuances, be understood as principal for their healthcare and overall wellbeing. Refugee children are the same as all children: they want to belong; they want to make friends. Psychiatrist Mina Fazel drew attention to the commonality of refugee children identifying the most important moment in their lives not as the day they were granted asylum, for instance, but the day that their peers accepted them. After refugees are forced to make a treacherous journey fleeing their homeland and culture, the alleviation of their suffering is intertwined with achieving social acceptance.
Refugees are already faced with the seemingly impossible task of ‘fitting in’, confronted with language barriers, cultural differences and for children, not arriving at the beginning of a school year, to highlight a small but critical element of segregation. Many more factors, as well as unjust media representation, place refugee families in a uniquely difficult position from the outset. The effect of unjust representation can be highlighted through citing Stereotype Threats. These refer to the psychological phenomenon that people tend to perform worse in certain tasks when they strongly identify with a negatively stereotyped group and expect discrimination. Stereotypes cause performance anxiety, which prevents individuals from reaching their true potential. A biased media and uneducated communities mean refugees are exposed to many more social threats than those who have ‘jus soli’, or, attained citizenship through birth.
Social evaluative judgements can have crushing effects on us all, but refugees - integrating into communities which are already suffering the effects of inequality - are uniquely threatened. In the UK, many segments of society suffer in different ways from inequality but are aligned in their temptation to blame the ‘other’, or those who they perceive to be the most different from themselves, a burden of judgement which can often fall on refugees. When considering healthcare interventions for refugees we must ask how our entire society can facilitate a truly welcoming social environment. There are myriad healthcare initiatives in place for refugees upon arrival to the UK, but it is crucial that initiatives look more broadly, to society as a whole. We must teach our children, teachers, professionals, and all citizens the importance of empathy if we are to reject the normalcy of social evaluative judgements and foster an environment which is truly able to accept refugees. Exclusion and social judgement have harrowing effects. We must work to generate a less judgemental space for refugees to enter into, and perhaps, to be a little kinder to one another as well.
 I will be terming citizens with a migratory background from this point ‘refugees’. I deemed this easiest as I am specifically talking about their experience coming from refugee status to settling in as citizens, and because it is the term used by the psychologists referenced here.
Savannah is a graduate from the University of Oxford, working for a non-partisan political campaign movement at the time of writing. Her key areas of interest include political philosophy, migration and current government policy.