Post on 21-Dec-2015
transcript
WHAT IS SOCIAL CLASS?
• PEOPLE SIMILAR IN ECONOMIC AND SOCIAL STATUS, EDUCATION, WAYS OF LIFE, ATTITUDES AND BELIEFS
• TWO MAJOR ASPECTS
• MATERIAL RESOURCES – FINANCIAL
• CULTURE - EDUCATION, TASTE
CAUSE AND EFFECT
• CAUSATION - SOCIAL CLASS PRECEDES M.I.
• MORE ACUTE AND CHRONIC STRESSORS
• MORE VULNERABILITY
• WORSE TREATMENT
• IF CAUSE -RESOURCES OR CULTURE?
FARIS AND DUNHAM
• CHICAGO 1939• ADMISSIONS TO MENTAL HOSPITALS
BY AREAS OF CITY• NO ASSOCIATION BETWEEN
RESIDENCE AND BI-POLAR• STRONG ASSOCIATION BETWEEN
RESIDENCE IN CENTRAL CITY AND SCHIZOPHRENIA (9x DIFFERENCE)
FARIS AND DUNHAM
• ORIGINALLY SAID ISOLATION OF CENTRAL CITY CAUSES SCHIZ.
• LATER CHANGED MIND AND SAID PEOPLE FIRST BECOME SCHIZ AND THEN MOVED TO CENTRAL CITY
• SELECTION
RECENT STUDIES
• SCHIZ ALWAYS ASSOCIATED WITH LOWER SOCIAL CLASS
• WHAT IS CAUSE AND WHAT EFFECT?
• LOOK AT PARENTS’ SOCIAL CLASS
• SELECTION MORE THAN CAUSATION
• DOWNWARD DRIFT
• BIPOLAR NOT RELATED TO S.C.
INCOME AND M.I.
INCOME DEPRESSION ANXIETY
0 – 19 1.56 2.00
20 - 34 1.19 1.52
35 - 69 1.19 1.48
70 1.00 1.00
INCOME AND M.I.
INCOME S.U. ANY > ONE
0 - 19 1.27 1.46 2.46
20 - 34 1.06 1.21 1.71
35 - 69 1.06 1.21 1.55
> 70 1.00 1.00 1.00
NON-PSYCHOTIC
• LOWER CLASS ALWAYS HIGHEST
• SOMETIMES INVERSE, SOMETIMES NOT
• STRONGEST FOR ANXIETY
• WEAKEST FOR SUBSTANCE ABUSE
• LOWER CLASS ESPECIALLY LIKELY TO HAVE COMORBID DISORDERS
REASONS FOR NON-PSYCHOTIC
• CAUSATION NOT SELECTION
• STRESSORS
• MODEST RELATIONSHIP WITH ACUTE LIFE EVENTS
• STRONGER RELATIONSHIP WITH CHRONIC STRESSORS
OCCUPATIONAL REASONS (LENNON)
• HIGHER SOCIAL CLASSES HAVE MORE AUTONOMY AND CONTROL OVER WORK
• HIGHER SOCIAL CLASSES HAVE FEWER PHYSICAL STRESSORS OF WORK
• HIGHER SOCIAL CLASSES HAVE MORE JOB STABILITY
VULNERABILITY
• LOW SOCIAL CLASS ESPECIALLY VULNERABLE TO STRESSORS
• LESS ADEQUATE MATERIAL SUPPORT AND COPING
• LEADS TO LONGER DURATION AND POORER PROGNOSIS FOR LOWER CLASSES
SOCIAL CLASS AND TREATMENT
• INCIDENCE = NEW CASES
• PREVALENCE = ALL CASES
• PREVALENCE = INCIDENCE + REENTRY + CONTINUOUS
• HOLLINGSHEAD AND REDLICH STUDY OF NEW HAVEN IN 1950s
TREATMENT OF PSYCHOSES
• NO S.C. DIFFERENCES IN INCIDENCE EXCEPT LOWER CLASS HAS MORE
• STRONG INVERSE RELATIONSHIP OF SOCIAL CLASS AND PREVALENCE OF PSYCHOSES
EXPLANATIONS
• MORE CONTINUING STRESSORS FOR LOWER CLASS
• WORSE PSYCHIATRIC TREATMENT FOR LOWER CLASS
• MORE COMMUNITY SUPPORT FOR HIGHER CLASSES
• LONGER DURATION AND WORSE PROGNOSIS FOR LOWER CLASSES
TREATMENT OF NEUROSIS
• NO DIFFERENCE IN NEW CASES• HIGHER CLASSES HAVE MUCH
GREATER TREATED PREVALENCE• HIGHER CLASSES STAY MUCH
LONGER IN TREATMENT• RELATIONSHIP FOR PREVALENCE
OPPOSITE FOR NEUROSES AND PSYCHOSES
REASONS
• CULTURE OF HIGHER CLASSES MORE CONGRUENT - ESPECIALLY EDUCATION
• LESS STIGMA FOR HIGHER CLASSES
• RESOURCE DIFFERENCES
• RESPONSE OF M.H. PROFESSIONALS
SUMMARY
• SOCIAL CLASS HAS STRONG ASSOCIATION TO M.I.
• PSYCHOSES - SELECTION
• NON-PSYCHOTIC – CAUSATION
• STRESSORS AND VULNERABILITY
• HIGHER CLASSES MORE OUTPATIENT AND LESS INPATIENT