Inequality as an Economic Disease, Violence as a Symptom

We need to reconsider our way of choosing to share, or not share, our wealth.

Posted Dec 07, 2018

The arguments ricochet back and forth after every mass shooting: too many guns, not enough guns in the right hands, overly high-powered weapons in circulation, Second Amendment rights, keeping guns from the mentally ill, and the need for careful vetting. From point to counterpoint, solutions small and large emerge, with further discussion and little substantive progress.

Lost in the emotional, physical, and legal melee is an economic issue directly linked to violence. It is not about the cost of buying guns back, but a more profound societal issue: income inequality.

Violence is one of the top causes of death and disability, especially at earlier ages where the loss of years of life is greatest. The tragedy of violence is so great, it seems imperative that we prevent it. To do that, we must understand what produces it.

While many causes contribute to violence, one overwhelms all the others. It so reliably forecasts the rise or fall of violence—including epidemics of violence—that we can eliminate all other factors and still predict accurately on the single factor of inequality.

Inequality in itself is a form of violence: the most lethal form. Insidiously, it causes tenfold more excess deaths than all the suicides, homicides, and collective violence combined. It also affects all other aspects of thriving and well-being, as Richard Wilkinson and Kate Pickett (2009) reveal in The Spirit Level: Why More Equal Societies Almost Always Do Better. Broader awareness of the issue began seven years ago with the first Occupy protest, on Wall Street, resulting in a worldwide movement touching nearly a thousand cities in over eighty countries. This social action brought with it slogans—the 1 percent and the 99 percent—and recognition of income inequality in society, only to have it fade to the background.

It reappeared with renewed vigor, the unlikely result of a weighty economic tome, Thomas Piketty’s (2013) Capital in the Twenty-First Century, surprisingly an international bestseller. Conversations at both national and global levels acknowledged that countries with greater inequality suffered lower growth rates of their gross domestic product (GDP), as Joseph Stiglitz (2015) had shown consistently, and most recently in The Great Divide: Unequal Societies and What We Can Do about Them.

One of us (Fisher) is a neurologist and a photographer. For a photography project, he met with Americans in the middle class—the lower middle, the middle middle, and the upper middle—all making trade-offs to at least stay where they were economically and socially. The individuals and families he spent time with represented the widest political spectrum of beliefs. His discussions, in their homes or workplaces, touched not on beliefs but on practicalities: What are you doing to accomplish the goals that you view as what middle-class people should have and do? What are the trade-offs? How fast are you treading water? How long can you keep it up? Where does this lead? What effect do these stresses have on individuals, families and daily life? The undercurrent of those discussions was a deep frustration, sense of shame and alienation from society. They were keeping violence at bay.

Through their words and stories, they provided real-life examples of what studies have shown, repeatedly, reliably, and conclusively. One might think that a rising economic tide should lift all boats, providing a better and safer society. To the contrary, studies over the past three decades continue to show that in the face of persisting or growing income inequality, ill health and social unhappiness remain unimproved. The tide may be up, but the people’s spirits and society’s wellbeing are not.

The other of us (Lee), who is a psychiatrist and expert on violence, has been studying the effects of inequality at both the clinical level, in the violent offenders she treats, and as a societal phenomenon, through the epidemics of violence that it causes. The most vulnerable segment of society succumb to violent behavior (suicide or homicide) in the face of inequality, but the population suffers as a whole through greater rates of trauma, obesity, substance use, and poorer child health overall, among other conditions. One sees more schizophrenia, bipolar disorder, and other illnesses emerge under conditions of stress and anxiety.

Violence levels are a good barometer of the current state of collective mental health: It is seldom an indication of individual mental disorder but almost always societal disorder. Since violence begets violence, a rise in inequality resulting from corruption, oppression, and exploitation fosters the conditions that breed violent behavior, including mass shootings.

Economists, political scientists, and historians acknowledge that the solutions to growing income inequality are not simple. Income redistribution is not the answer, nor is piecemeal government regulation. Rather, there needs to be a comprehensive reconsideration of our way of choosing to share income and wealth, and scholars and practitioners of all domains, and physicians—including psychiatrists—share a role in fixing this sickness of society.

Co-authored with Julian Fisher, M.D.

Julian Fisher, M.D., is a neurologist at Harvard Medical School and a photojournalist whose exhibit “Trapped in the Middle” was recently on view at Yale.  In response, students and faculty are developing a Democracy in America film and a course on income inequality.


Piketty, T. (2013). Capital in the Twenty-First Century. Cambridge, MA: Harvard University Press.

Stiglitz, J. E. (2015). The Great Divide: Unequal Societies and What We Can Do about Them. New York, NY: Norton and Company.

Wilkinson, R., and Pickett, K. (2009). The Spirit Level: Why More Equal Societies Nearly Always Do Better. London, U.K.: Allen Lane.