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This thesis provides a sociological critique of contemporary social epidemiology in explaining the health and social problems consequential on life in unequal societies. It accomplishes this through an empirical study exploring shame and social comparison, revealed through the accounts of a small group of women in Salford, in the north of England. Inequality has been increasing in many developed countries in recent decades and it is well established that unequal societies have higher rates of morbidity and premature mortality than more equal ones. What is less well understood - and more contested, in both psychosocial 1 and neo-material explanations for health inequalities - are the processes by which inequality gets inside the body and the social body, and what it is about inequality that is health damaging. This study set out to make a contribution to the literature through a qualitative exploration of shame and social comparison, seen by psychosocial theorists as central to the above process. A psycho-social (Free Association Narrative Interview) approach was utilised to explore the place of shame and social comparison in women's lives. Shame is a painful emotion, likely to be denied or avoided and hard to speak of, and this approach was chosen to facilitate in-depth exploration. Individuals are not passive recipients of inequality; they may resist and endeavour to protect themselves. Understanding these processes, frequently missing from contemporary epidemiological explanations, was a key aspect of this study. The findings of this study and particularly the no legitimate dependency discourse, extend the existing explanations for the damages of inequality. Being of low social status or class, in societies placing a premium on wealth and financial success, is known to be health damaging, and there was evidence of this in this study. However, shame was not present in quite the ways that might be anticipated, and I argue that class was found to be both protective and constraining. Including class and neoliberalism enhances understanding of inequality.

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This dissertation will explore the lives, experiences and medical histories of diseased almshouse women living in late eighteenth and early nineteenth century Philadelphia. During this period Philadelphia matured from being a relatively small colonial city into a major manufacturing metropolis. Venereal disease was omnipresent in America’s major port city, and diseased residents were surrounded by a thriving medical marketplace. Historians have identified the “who and why” of prostitution, however the scope of the prostitute experience has yet to be fully explored. This dissertation will address a considerable and important gap in the historiography of prostitutes’ lives as it actually affected women. Venereal disease was an ever present threat for women engaging in prostitution, however casual, and historians have yet to illuminate the narrower aspects of the already shadowy lives of such women. Whether intentionally or by omission, historians have often denied agency to prostitutes and the diseased women associated with them, the effect of which has drained this group of sometimes assertive women of any individuality. While some women lived in circumstances and carried out activities that came to the attention of the courts, others lived more understated lives. A large proportion of the women in this study led the lives of “ordinary” women, and prostitution per se was not the only focal point of their existence. For many almshouse women their only unifying variables were disease, time and place. While prostitutes were often victims of economic adversity, they made a choice to engage in prostitution in the face of hardship and sickness. The overall aim is to consider the diseased female patient’s perspective, in an effort to illuminate how she confronted venereal infection within the context of the medical marketplace. This includes the actions she took, and how she negotiated with those in positions of authority, whose aim was sometimes -although not always- to curtail her activities. As many diseased women became more acquainted with the poor relief system of medical welfare, they were able to manipulate the lack of coherent strategy “from above”, which left room for assertive behaviour “from below”. Diseased women did not always use the almshouse as a last resort-institution as historians often have us believe. Many selected the infirmary wing as opposed to other outlets of healthcare in Philadelphia, a city that was often labelled the crucible of medicine. There is also an oft-believed notion that prostitutes and lower class women suffering from venereal disease were habitually saturated with mercury “punitive-style” as treatment for their condition. This argument does not hold for those women who were cared for in the venereal ward of the almshouse’s infirmary wing. Broadly speaking, almshouse doctors did not sanction drastic depletion and the use of mercury compounds unless deemed absolutely necessary. Many almshouse doctors adopted a different therapeutic approach as compared with that of Benjamin Rush and his followers who dominated therapy at the Pennsylvania Hospital, a voluntary institution mostly closed off to venereal women. Such medical differences reflected wider transformations in ideas of disease causation, therapeutic approaches, medical education as well as doctor-patient relationships.