How the social becomes biological and pathological
- Enzo Cipriani
- 1 minute ago
- 5 min read
Exploring social determinants of health and bodily systems in Schizophrenia.
The question surrounding the innate and cultural forces that can shape an individual goes as far as biology and social sciences go.
Psychiatry can be understood as a hybrid medical speciality. While biological factors, such as genetics, hormones, and brain structure and function, play a crucial role in explaining the mechanisms of mental health disorders, the field is also deeply shaped by social influences. Our environment and life experiences profoundly affect how we feel and, by extension, our mental health.
Despite this, current approaches in psychiatry and neurosciences mostly focus on biological determinants. This has allowed for the development of medications that help improve mental health outcomes. However, focusing solely on biological systems does not encompass the breadth of the human experience, which is inherently social. Therefore, exploring the interactions between our social environment and biological systems would strengthen our understanding of the underlying mechanisms and offer new areas for treatment.
As a psychologist and PhD student in biomedical sciences, I have always been fascinated by the interface between our social environment, our bodily systems’ response to it, and our mental health. In this article, I will present how I tackle this in my doctoral research, focused on social determinants and bodily systems in Schizophrenia.
What are social determinants of health?
The World Health Organisation defines social determinants of health as “the conditions in which people are born, grow, live, work, age, and people’s access to power, money and resources”. This is a broad definition, so here are some examples in relation to mental health.
Economic hardship (at the individual and societal scale) is associated with lower reported well-being, higher rates of mental health disorders, substance use, and suicide rates.
Education is a strong protective factor against mental health disorders.
Social interactions and support are powerful protective factors against mental health disorders.
Access to mental healthcare is essential as it allows for timely treatment. Universal health care access is also associated with better emotional well-being and allows the prevention and promotion of mental health.
How do they influence mental health?
These social determinants can be understood as long-term stress factors. Chronic exposure to stress can keep the body’s stress system constantly activated, eventually throwing it out of balance and degrading other bodily systems at the same time. Therefore, acting on social determinants of health, through policies reducing inequalities and promoting access to care, education, and healthy social interactions, is a powerful way to improve mental health.
Why are social determinants left aside?
As evoked earlier, many factors can influence mental health, but assessing all of them properly would require large samples. Biological research is particularly expensive when considering the cost of analysing blood samples, brain scanners, etc. These costs oftentimes limit participants' recruitment, restricting the number of variables researchers can realistically include. As such, a method that condenses various social determinants into a smaller set of variables would make it far easier to incorporate them. This is exactly what I am doing in my doctoral project.
A proposition to include social determinants of health in biomedical research
French sociologist Pierre Bourdieu offered an interesting theory to determine how individuals are disseminated across the social space. In this theoretical framework called “La théorie de l’espace social” or “the theory of social space”, he posits that one’s position in society can be defined through 4 different dimensions. These dimensions are understood as “capitals,” referring to them as quantifiable in some way. Therefore, every individual in society possesses a quantity of social, economic, cultural, and symbolic capital. But what exactly do these terms mean?
Social capital: Defined as the value of belonging to a group of people who share common traits and are connected through stable, meaningful relationships. In other words, it can be understood as the crossroads between the size of someone’s social network and the support they receive from it.
Economic capital: Defined as the economic resources of an individual, which can be a factor of income through work (i.e., active income) or other sources (i.e., passive income), as well as movable and immovable property.
Cultural capital: Defined as an individual’s cultural knowledge and resources. presented in three forms: (1) embodied form, referring to the culture an individual has internalised (e.g., vocabulary used); (2) objectivized form, referring to the possession of cultural goods; and (3) institutionalised form, which reflects how institutions recognise a person’s own cultural knowledge (e.g., university diploma).
Symbolic capital: Defined as the prestige, honour, or recognition that an individual receives through the different “labels” they hold, often derived from other forms of capital. For example, the CEO of a large company or a university professor carries symbolic capital that reflects their status rooted in their economic, social, or cultural capital. Perception plays a key role here: symbolic capital depends on how others interpret and value these labels, which can vary across social groups and can be influenced not only by one’s other forms of capital but also by individual characteristics.
Interestingly, the social determinants of mental health fit within these capitals. Going back to the examples provided earlier, social interactions and support fit within the social capital, while the economic inequalities can be mapped within the economic capital. This approach could therefore offer a way to explore the interaction between social determinants and biological indicators.
My current project
In my doctoral project, I am investigating the ties between status and position within the social space and the severity of schizophrenia through biological alterations. Essentially, I aim to understand how the social becomes biological and pathological. To do so, I measure the capitals among patients diagnosed with schizophrenia and healthy controls in a large dataset (Signature Biobank). This biobank is composed of data from over 2000 patients who visited the emergency room of the largest psychiatric hospital in the Canadian province of Québec.
To quantify Bourdieu’s capitals, I explored the different sociodemographic variables in the biobank and adapted them, creating four scores for each participant.
I then investigated how these scores relate to various biological indicators and symptoms. I mainly focused on immune system activity, given the growing evidence that the immune system has an essential role, potentially explaining the emergence and severity of the disorder. The immune system is also tightly linked to the body’s stress system, which means prolonged stress can directly influence immune functioning. To do so, I measured concentrations of 9 cytokines, which are indicators of the immune system’s activity. These cytokines can be divided into three categories when considering their properties: pro-inflammatory (increases inflammation in the body), anti-inflammatory (reduces inflammation), and chemotactic (recruits immune cells to an infection site).
What have we learned so far in my project?
So far, preliminary results identified that a better social capital (i.e., being in a relationship, having children, living with relatives, and having friends) is related to less severe anxious, cognitive, and depressive symptoms, while a better economic capital is related to less severe delusions. These dimensions are also related to participants’ immune profiles. People with higher social capital had higher concentrations of anti-inflammatory cytokines, showing a potential protective effect through attenuation of immune inflammation.
So, the social seems to become biological and pathological through the immune system. In the next steps, I will investigate deeper how the social determinants and immune systems act individually or in synergy to explain schizophrenia’s severity.