Status Syndrome by Michael Marmot

Author:Michael Marmot
Language: eng
Format: epub
Publisher: Bloomsbury Publishing
Published: 2004-04-20T04:00:00+00:00

Putting the two together: social supports and susceptibility to disease – the case of marriage

For years, if someone gave a paper on social relationships, summarising the effects of marriage (or a stable relationship) on health, they would say: ‘marriage is good for men, not so good for women’. The predictable reaction was an ironic laugh of recognition from the women in the audience and embarrassed, slightly guilty, we’ve-been-found-out type noises from the men. No one doubts the sex difference. And everyone can think of a good reason why it might be true. You probably just did.

There is one slight problem. It is not true. At least, the story is not quite as neat as marriage protecting men but not women. It is worth enquiring into the apparent protective effects of marriage, because marriage is a potentially important source of social support and the research on social supports and health follows in this tradition. Much of the argument as to whether marriage is protective, and whether it is protective for women as well as for men, illuminates the whole study of social relationships and health. Like so much else in studying social patterns of illness, we learn by going back to two great scientists of the nineteenth century.

One was a Frenchman, the sociologist Emile Durkheim, and one an Englishman, the medical statistician William Farr who, among other things, was interested in France. Farr wrote a treatise in 1858 on The Influence of Marriage on the Mortality of the French People in which he said:

The family is the social unit; and it is founded in its perfect state by marriage. The influence of this form of existence is therefore one of the fundamental problems of social science. A remarkable series of observations, extending over the whole of France, enables us to determine for the first time the effect of conjugal condition on the life of a large population … If unmarried people suffer from disease in undue proportion, the have-been-married suffer still more … This is the general result: Marriage is a healthy estate. The single individual is more likely to be wrecked on his voyage than the lives joined together in matrimony.27

All the research since confirms Farr’s accuracy and the unfortunate lot of the single individual.

Durkheim’s study of suicide was a pioneering work in the study of social integration and health.28 He teases us by starting out with the observation that more suicides in France in the 1870s occurred among the married than the unmarried, and hence certain authors concluded that the burdens and responsibilities of marriage drove people to the ultimate end of suicide.

But the ‘facts’ are false. Durkheim points out that these authors make the elementary error of not accounting for the proportions in the population. (To use a contemporary illustration, it would be like saying that more car crashes occur among people with driving licences than among people without.) Once Durkheim takes account of the higher proportion of married people in the population, he shows that married people have a lower rate of suicide than unmarried.

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