The First International Conference on Social Identity and Health

The social cure

It's become a truism that we humans are an inherently social species, and yet the profound implications of this fact for our health have yet to be fully realised. Consider a visit to the family doctor. She'll take your blood pressure and your weight as a matter of routine, but she's unlikely to ask you how many groups you belong to.

Thankfully the situation is improving. Introducing the first ever international conference on social identity and health, Alex Haslam, Professor of Social and Organisational Psychology at the University of Exeter, highlighted that there were just a handful of papers published in the area in 1990s, compared with nearly 300 published last year. 'I think this is a really exciting point in the intellectual development of ideas,' he said. 'I'm sure that in 10, 20 years time we'll look back on this as the point when we really moved things forward.'

Haslam's claim was borne out in a session on the role of social identity in the lives of older people and people with dementia. Jolanda Jetten (University of Queensland) spoke first, reporting some counterintuitive findings from an investigation into well-being among care home residents with mild or severe dementia, compared with healthy community controls. The participants with more severe dementia were found to have higher life satisfaction than the participants with milder dementia, even though their autobiographical memory was poorer. This surprising result was explained by the fact that the participants with more severe dementia scored higher on personal identity strength, driven by their belief that they were still a part of many important social groups from earlier in their lives. Their lack of awareness was in a sense protecting their well-being.

'This fits the idea that people with advanced forms of dementia still have the ability to reclaim their identities or build identities,' Jetten said. 'As that affects well-being, that might be an important route for working [therapeutically] with such people.'

Next up, Catherine Haslam lamented the trend for so much emphasis to be placed on 'smart homes' and 'smart technologies' for improving the lives of care home residents, whilst neglecting basic ideas around people's social lives. Her research has shown how cognitive deficits can impair people's feelings of social identity; and in turn how social identity can have an effect on cognitive performance.

A study of 53 stroke survivors, for instance, found that more severe cognitive impairments had adverse effects on well-being partly because those impairments compromised the patients' ability to maintain their social groups after their stroke. Another study with 68 healthy participants (aged 60 to 70) involved priming them to self-identify as elderly or young; and to believe that ageing leads specifically to memory deficits or to more general cognitive decline. Self-identifying as being old harmed performance, in line with the particular negative expectations that had been created. So, performance was worst on the test of general cognitive ability among those participants primed to identify as old and informed that ageing leads to general cognitive decline – indeed, 72 per cent of them met the criteria for a dementia diagnosis. 'Feeling older may actually increase the risk that you might be diagnosed with dementia on these sorts of tests,' Haslam said.

In the end people want to know if psychological insights can be turned into effective interventions to improve people's lives. Alex Haslam addressed that question, presenting a series of studies suggesting that social identity theory can be leveraged to improve outcomes. One study found that life satisfaction was higher among care home residents who'd moved to a new facility, if they were given control, as a group, over the design and décor of their new home – a benefit mediated by their stronger feelings of social identity as a group compared with participants who had the decisions made for them (see 'Big picture', April 2011). Another study showed how reminiscence therapy only led to memory benefits if it was conducted in a group setting. Yet another showed how the health benefits of water clubs (designed to encourage drinking among the elderly) are due largely to their group nature, rather than just the rehydration element.

'Rather than being peripheral,' Haslam said, 'rather than being the wrapping, the group is the treatment, the group is the core, and the group is the gift – that's a very important message.'   

An 'exhilarating experience'

The Magh Mela, a month-long Hindu religious festival held in Prayag, India, is a photographer's dream. Millions of pilgrims in multicoloured saris descend on the confluence of the Ganga, Yamuna and the (invisible) Saraswati rivers to bathe and pray, creating an epic scene. The occasion also provides an opportunity for psychologists to investigate the role of social identity at a gathering of immense proportions.

Nick Hopkins (University of Dundee) and his colleagues Mark Levine (University of Exeter), Sammyh Khan (University of Dundee), Clifford Stevenson (University of Limerick) and Steve Reicher (University of St Andrews) have done just that over a number visits to the Mela starting in 2006 (see 'Big picture', January 2011). The research has been an 'exhilarating experience' Hopkins told us, but one that posed 'nightmarish' logistical challenges, the greatest of which were borne by the team's Indian colleagues at the Centre of Behavioural and Cognitive Sciences, Allahabad. Led by Dr Shruti Tewari they had to walk miles throughout the Mela and criss-cross rural India keeping track of participants.

The Mela festival tends to be associated with health risks, including crushing and illness, but through a longitudinal study run between December 2010 and March last year, Hopkins and his colleagues found that self-reported mental and physical health was actually improved among the Kalpwasis (pilgrims who stay for a whole month) during, and a month after the festival, as compared with control participants who stayed behind.

Sammyh Khan presented data focused on the question of why health was higher during the festival than it was before or afterwards. He found a direct relationship between scores of 'relationality' (how much a Kalpwasi perceived relations between the pilgrims to be understanding and supportive) and self-reported health. In turn, that association was dependent on experiencing a sense of shared identity with other Kalpwasis.

An unmissable characteristic of the Magh Mela event, Clifford Stevenson explained in his talk, is the deafening noise of prayers, chants and music – around 80–85 decibels, with only some respite at night, where 85 decibels is the level at which hearing damage can occur. Previous psychology research has tended to associate excessive noise with stress and ill-health, so how come this project had uncovered health benefits in such a noisy environment?

Again, social identity was key. Stevenson played 32 male Kalpwasis the equally cacophonous sounds from the Mela and from the city over headphones, and afterwards asked them to rate their mood. The mood ratings were consistently more positive in the Mela condition. Why? Clues came from interviews with the pilgrims. 'It's God's name ringing in your ears,' one of them said. 'This is pure joy,' said another. Non-religious sounds, for example from traders, were frowned upon and experienced negatively, but any noises that supported their Kalpwasi identity were enjoyed, even heightening the religious experience. 'The chronic noise of the Mela is experienced as overwhelmingly positive,' Stevenson said, 'especially when it accords with the identity, beliefs and practices of the participants.'

The benefits of a survivor identity

Recognising the importance of social identity helps make sense of a curious finding outlined in a talk at the conference by Janelle Jones (Simon Fraser University). She studied 630 people recovering from brain injury, observing that those who'd suffered more serious injuries tended to report being more satisfied with their lives. This association was mediated by the more seriously injured tending to identify more strongly as a survivors, to say that they had more social support and that their relationships had improved.

This prompted Jones to wonder if it was the visibility and salience of the more serious injuries that helped those individuals to forge new identities and contacts. In a follow-up study of 367 brain-injured patients, she found that it was those people who found it difficult to disclose their injuries to others who suffered lower well-being and life satisfaction, regardless of injury severity, and that this was explained partly by their finding it difficult to acquire a new identity as a survivor, and to attract the social support they needed. Jones said it was important to provide brain injury patients 'with access to new social groups, but also to support social relationships that might be in trouble, so that when people have to adapt…they have a network from which they can understand what they are going through and who they are.'

In brief from icsih
Social contact is not the same thing as social identity, as illustrated by Fabio Sani's (University of Dundee) research. A study of 150 members of an army unit in Eastern Europe found that identifying more strongly with the unit was associated with less depression and more life satisfaction. Amount of contact with other unit members, by contrast, was unrelated to these outcomes.

When people get together in large numbers, there's a myth that they transform into mindless mobs. John Drury's (University of Sussex) research with survivors of the 2005 London bombings and other major emergencies has shown that widespread helping and civility is common, including between strangers, and is more likely to arise among people who feel a sense of shared identity and destiny with the rest of the crowd.

Feeling a part of social groups may be important for psychological health, but it has a dark side, warned Orla Muldoon (University of Limerick) – it also forms the basis for prejudice and discrimination. For a concrete example of how social identity relates to health, she pointed to how the issue of ambulances crossing the border remained a pressing concern for statutory agencies in Northern Ireland and the Irish Republic.

Our health priorities vary moment to moment according to the particular social identity that's salient in our mind, explained Mark Tarrant (University of Exeter). For example, young people say that healthy eating is less important to them if they think they're taking part in a survey of students, as compared with a British survey. 'We need to take these group-based influences into account,' said Tarrant.