In his book "Violence: Reflections on a National Epidemic", James Gilligan defines "structural violence" as "the increased rates of death and disability suffered by those who occupy the bottom rungs of society, as contrasted with the relatively lower death rates experienced by those who are above them." Gilligan largely describes these "excess deaths" as "non-natural" and attributes them to the stress, shame, discrimination, and denigration that results from lower status. He draws on Richard Sennett and Jonathan Cobb (i.e., "The Hidden Injuries of Class", 1973), who examine the "contest for dignity" in a context of dramatic inequality.