It is no wonder that the few who rise above their class cannot live with the shame of having distinguished themselves. They can neither be who they are nor stay where they are: many will marry outside their social circle; most will leave the neighbourhood for good. That is how class society operates: “In turning people against each other, the class system of authority and judgement-making goes itself into hiding; the system is left unchallenged as people enthralled by the enigmas of its power battle one another for respect.”

In an unequal society that professes equality for all, shame rears its head at every turn; for the poor and working classes in particular substance use becomes a ready consolation. Indeed, South Africa - with the second highest Gini coefficient for income inequality - also has one of the highest alcohol consumptions in the world.

Yet shame by itself, Gilligan continues, is not a sufficient condition for the exercise of violence. In order to construct a comprehensive account of violence, one must consider additional factors. From a developmental perspective, for example, a person who has been charmed but has not yet developed the capacity for other feeling states - such as love, empathy, guilt or simply the fear of retribution - is more likely to project feelings of humiliation outwards. As for the social determinants of violence, a similar result can be expected when a person lacks other means of earning respect, such as formal education, occupational skills, financial options, or even some standing within the community. It is these social factors that prove decisive in highly unequal societies such as South Africa, for, without personal resources of any kind, one does not need to have been shamed as a child - whether the medium was physical abuse, sexual abuse, emotional abuse or neglect. As described in the previous section, a society can be sufficiently shaming all by itself for the affected individual to act out in horrific ways.

The thing is, poverty in its absolute sense does not generate shame - it is relative poverty that does the damage. It is not for nothing, therefore, that South Africa - one of the most unequal societies in the world - is known also for being the protest capital of the world.

This individualisation of trauma is typical of medical model thinking, but its unfortunate consequence is that our society is disinclined to regard the victims of structural violence as being the victims of trauma. Accordingly, the empathy we ordinarily show survivors of (individual) traumas is withheld from those who are victims of social trauma. It is no wonder, then, that we think nothing of confining offenders with the most traumatic social histories to the most traumatising places on earth.

While there is little data being generated in low- and middle-income nations, a study of a nationally representative sample of South African adults yielded similar findings - that is, a clear association between socio-economic status and psychological distress.