There have been various studies relating to social class and schizophrenia, a good place to start would be to narrow the question down and begin on a more general level making clear our understanding of social class to do this I will describe how in the UK the present class system is formed and then go onto schizophrenia.
Then further going into detail of studies relating to social class and schizophrenia by listing some of the main studies then critically evaluating them, these will include Phelan who has put together forty years of work in medical sociology, Nettleton and Burrows show how “mortgage debt and insecure home ownership, Faris and Dunham where they studied the patients that came into a Chicago hospital, Lapouse et al. nd Hollingshead and Redlitch concerning social drift, Phillips reporting of negative experiences with no positive experiences to buffer against.
Wiggins et al the link between common psychiatric symptoms and work, Macintyre, Ellaway and Cummins show that in many cities there is a social difference, Ross and the effects peoples mental health in poor cities, and also take into consideration tying in with the previous studies mentioned like social class, there are studies of social class that clearly establish a link between social class and schizophrenia with aspects like socio economic status, inequalities in the work place, social capital in neighbourhood, poverty and mental health with a focus on schizophrenia and social class and mental health professionalism. And then finally I will make a informed conclusion.
Social class is a term which differs from society to society and it is also recognized that there are some societies that do not have a class stratification but most nation states do have some kind of class system, in the UK we have a very distinctive class system which is typically defined by the registrar general scheme, renamed by government in 1990 as social class based on occupation, every 10 years there is a nationwide census taken by the government a count of the population and then the population are split into eight groups of occupation the first being that of employers and managers in larger organisations like company directors, senior company managers, senior civil servants, senior officers in police and armed forces, then higher professionals like doctors, lawyers, clergy, teachers and social workers.
Secondly lower managerial and professional occupations like nurses and midwives, journalists, actors, musicians, prison officers, lower ranks of police and armed forces. Thirdly intermediate occupations like clerks, secretaries, driving instructors, telephone fitters. The fourth are small employers and own account workers like publicans, farmers, taxi drivers, window cleaners, painters and decorators. The fifth are lower supervisory, craft and related occupations like printers, plumbers, television engineers, train drivers, butchers. The sixth are semi-routine occupations like shop assistants, hairdressers, bus drivers, cooks.
The seventh are routine occupations like couriers, labourers, waiters and refuse collectors. And finally an eighth category was added recently to cover those who have never had paid work and the long term unemployed. But to most people we use the system of upper, middle, lower class and now the underclass. The reason we are discussing social class is to elaborate on its effects on mental health especially that of schizophrenia in a later part of this essay. Now moving on to schizophrenia, schizophrenia still to this day is a very contested idea and an enigma which has puzzled many of the top scholars whether they are involved in psychiatry, neurosciences, or sociology for at least a hundred years.
The importance of schizophrenia research is that it could help us to understand the mechanisms by which the brain filters, prioritizes and processes the relentless current of information available from the richness of its internal, social and natural environments. There is evidence of schizophrenia throughout history we can see this in the Egyptian times but they considered this to be the work of demons and evil spirits. Also we can see aspect of this in Greek, Roman, and Chinese scripts. Schizophrenia is a very serious mental illness and can effect how people think, feel, and behave, the person will find it difficult to realise what is reality and what is not, find it hard to grasp logic and to express feelings or behave appropriately.
People with schizophrenia may see things that are not there and hear things that are not heard by others. These can make the person feel threatened and become paranoid or a recluse, they can find it hard to organise there thoughts and have trouble with their speech. The reason that it is hard to pin schizophrenia down is that there are so many forms or variations in diagnosing this, if you had a sample of ten people that were diagnosed as schizophrenia you could easily think that these are ten different cases of something else, there is a wide range of traits of schizophrenia each person does not always display the same characteristics as each other.
Now going into detail of studies relating to social class and schizophrenia a key part to start with here is biomedical psychiatry, Emil Kraeplin is considered as the farther of modern psychiatry he tended to use the word dementia praecox instead of schizophrenia due to him believing that dementia praecox involved brain degeneration which he believed resulted from a metabolic disorder or “a tainted gene pool” Rogers and Pilgrim (2005:93). The reason for discussing this is that there are studies that believe schizophrenia is matter of bio medics or that the reason for schizophrenia can be understood as a physical matter, Rogers and Pilgrim talk of how there are studies like twin studies and family members which display same characteristics which try to confirm a link between genes but they argue that “upbringing in such families might equally point to learned behavior and the genetic evidence from twin studies remains contested” Rogers and Pilgrim (2005:3).
A key point to note here is that anti psychotic drugs and tranquilizer are used to help patients but this is not a cure, an example of this is “thieving can be prevented quite effectively by chopping of the hands of perpetrators, but hands do not cause the theft. Likewise, a person shocked following a car crash may feel better by taking a minor tranquillizer, but their state is clearly environmentally induced. The thief’s hands and the car crash victims brain are merely biological mediators in a wider set of personal, economic and social relationships. Thus, effective biological treatments cannot be invoked as necessary proof of biological causation. ” Rogers and Pilgrim (2005:3).
Now moving onto studies of social class, there are studies of social class that clearly establish a link between social class and schizophrenia with aspects like socio economic status, inequalities in the work place, social capital in neighborhood, poverty and mental health with a focus on schizophrenia and social class and mental health professionalism. The first study I will approach is that of Phelan (1995:81) who has put together forty years of work in medical sociology which supports the social causation of disease by saying that ” lower SES [socio-economic status] is associated with lower life expectancy, higher overall mortality rates and higher rates of infant and perinatal mortality” Rogers and Pilgrims (2005:44), and go on to state that low SES is found with 14 major causes of death categories in the international classification of diseases as well as mental disorders.
But the authors of this also state that it is not just social class that this effects but gender because men have higher mortality rates at all ages, and women have higher rates of mental illnesses that’s according to gender differences also there is the issue of race “African Americans have higher rates of mortality at all ages, renal failure and stroke but lower rates than whites of coronary heart disease” Rogers and Pilgrim (2005:44) and also go on to say that in Britain Irish and Caribbean people and their British born children have high rates of major mental illnesses. There are now other theories that have come about to indicate proxies for social class like the use of housing tenure and car ownership which have showed similar gradients in health.
A key study by Nettleton and Burrows (1998) show how “mortgage debt and insecure home ownership are part of their sense of identity and aspirations, which provide a basis for what Laing (1959) called ontological security” Rogers and Pilgrim (2005:46) this is furthered by him explaining that when mortgages are not met and arrears become a problem then this can have devastating effect on a persons mental health. Class and mental health have a very predictable correlation between each other ” the poorer a person is the more likely they are to have a mental health problem” Rogers and Pilgrim (2005:47), but also he talks of how there is a class gradient evident in mental health status across most of the diagnosis is quite even, but when it comes to schizophrenia there is a strong correlation that exist between low social class and the diagnosis of schizophrenia.
Using the studies of Faris and Dunham (1939) where they studied the patients that came into a Chicago hospital from different areas found that high rates of illness for schizophrenia from the poor areas, “the greatest difference was in the diagnosis of schizophrenia. Seven times the rate of schizophrenia diagnosis for people from poor inner city districts compared with middle class suburban areas” Rogers and Pilgrim (2005:47) this shows that the gap between middle class and low class is quite extensive in Chicago. They concluded that poverty and lack of social cohesion prompted schizophrenic breakdown so for them this was not just a case of poverty but an element of a lack of social cohesion.
Dunham (1957) showed several studies that confirmed the role of social isolation in the aetiology of schizophrenia but Clausen and Kohn (1959) and Weinberg (1960) did not find a pattern of social isolation but “Gerard and Houston (1953) found that divorced and single people who already had a diagnosis of schizophrenia moved to inner cities areas” Rogers and Pilgrim (2005:47) which says to me that it was not a result of living in inner cities but that schizophrenia pushed people into these areas called social drift and it is argued that people that are mentally ill drift into poverty. But Lapouse et al. (1956) and Hollingshead and Redlitch (1958) did not find results for this social drift, but did say that there is a class gradient in the diagnosis of schizophrenia. There are two main arguments that of social drift and the other one is that of patients drift down the social scale from all classes above the low class that they cannot maintain there status and drift down the scale of class these are on going debates but generally a compromise of the two is achieved.
Another study by “Phillips (1968) found no class differences in the reporting of negative experiences” Rogers and Pilgrim (2005:49) but found that there was marked difference between the presence of positive experiences between high and low class respondents and from this evaluated that low class people had less positive experiences to buffer themselves against negative ones the stresses of life. Which is true to the extent that if all you have is negative experiences it will effect your mental health because it is the gradient between positive and negative that keep you mentally healthy but does still leave room to investigate its connection between schizophrenia. Wiggins et al (2004) studied the link of “between common psychiatric symptoms and work.
They found a complex relationship of social class to anxiety and depression linked to changing employment status. ” Rogers and Pilgrim (2005:49). They use three different ways of describing social position income, social advantage and lifestyle and finally social class and found a relationship between mental health and social position and from this concluded that minor psychiatric morbidity depended on if you were employed or not. They did not find that it varied much in economically active men and women but the best results were seen in the really poor and that social class, status or income had limited effects on mental health. Social class, social capital and neighborhoods.
Macintyre, Ellaway and Cummins (2002) show that in many cities there is a social difference of one street to the other this can be seen in cities such as London, and that environmental issues impact on all residents without concern of there social class or SES, and that in poor areas what effect people are a high combination of environmental stressors and the lack of opportunities for healthy behavior. Is it social class or SES that effects peoples mental health in poor cities, well in a study by Ross (2000) explains that residents of the neighborhoods reported symptoms of depression independently of socio economic characteristics which you could use to say that people in the neighborhood did not see that their socio economic status had any thing to do with their health.
It is said that in poor areas or communities it is good for social capital to be increased for good mental health, and that it is good because it repairs the breakdown of trust networks and relationships in the area and that it reverses social inclusion which I true to the point that a closer community can bring people out of their homes and to communicate and converse with others in the neighborhood and build shared interests. But there are negative effects like that of “social reform strategy which is that it diverts attention away from the need to reverse structural inequalities” Rogers and Pilgrim (2005:52) and also politicians claim credit for social improvements for the work of the community.
The relationship between poverty and mental health status, here we explore the “interaction between disempowerment and material deprivation” Rogers and Pilgrim (2005:52), when studying depressed groups black people are more depressed than whites with low SES and this is a double case of low SES and being black.
If psychiatric services show that they are dealing with the problem of low SES and mental health are being treated, on the other hand the argument is that a lot of the low SES are diagnosed with mental ill, but even though most people are voluntary held there are many that are detained under the mental health act, and the aim is to help more the person more for his family and strangers. Social class and mental health professionalism, here we go on to discuss how professionals seem to reinforce class differences, but here it is also important to talk about race, ethnicity, sexuality and age but class is also very important because when poor low SES patients go for diagnosis they tend to be diagnosed as schizophrenia and rich people tend to be diagnosed with a less stigmatized neurotic label or a disorder like depression, mania, or manic depression, poor people receive moor biological treatments than psychological treatment.
And the reason explained for this is that professionals are middle or upper class and that they cannot relate to lower class they tend to miss diagnose patients as schizophrenia but when it comes to middle class people doctors and patients do relate to each other in backgrounds and personal experiences and so can relate to the patients and understand their life stresses but failing on the poor patients. To conclude I have found that there are various studies relating to social class and schizophrenia most have strengths and weaknesses of several of these have good assessment techniques currently in use and so I conclude that the exclusive use of any single technique will most likely provide a biased or inaccurate assessment of social class and schizophrenia. There is a critical need to empirically investigate the reliability and validity of these needs and assessment strategies.
Also there are some that have got to be transformed like more understanding of low SES people by doctors on diagnosing patients. And that some of the studies evaluated could do with more emphasis on patient care and more research done into community care some of the studies have shown good results with employment and poverty alongside social class and some detailed work on gender, race, age, ethnicity, also social drift which shows for and against with rival contradictions overall if I could I would study more studies with more emphasis on details of patients of schizophrenia and try to show more positive aspect of social class and schizophrenia.