SOCIAL CLASS AND MENTAL ILLNESS

1. SOCIAL CLASS AND MENTAL ILLNESS

2. ORIGINS IN MARX • HOW DOMINANCE AND SUBORDINATION REFLECT ECONOMIC POSITION • RESOLUTION ONLY WITH TOTAL EQUALITY - COMMUNISM

3. PRIMATES • PRIMATE STUDIES SHOW IMPORTANCE OF DOMINANCE • DEPENDENT MONKEYS HAVE MORE STRESS HORMONES AND LESS SEROTONIN • DOMINANT MONKEYS HAVE FEWER STRESS HORMONES AND MORE SEROTONIN

4. PRIMATES • PREVIOUSLY DOMINANT MONKEYS HAVE WORSE MENTAL HEALTH WHEN BECOME SUBORDINATE • NEWLY DOMINANT MONKEYS HAVE BETTER MENTAL HEALTH • MENTAL HEALTH FUNCTION OF SOCIAL POSITION

5. WHAT IS SOCIAL CLASS? • 1. RELATIONSHIPS OF DOMINANCE AND DEPENDENCE • POWER, STATUS, MONEY • 2. ATTITUDES, BELIEFS, TASTES, CULTURE • EDUCATION

6. MEASURES • INCOME – measures resources • EDUCATION – measures culture • COMBINATION (UPPER; MIDDLE; WORKING; LOWER) • STATUS INCONGRUITY

7. CAUSE AND EFFECT • CAUSATION - SOCIAL CLASS PRECEDES M.I. • SOCIAL CLASS INVERSE WITH MENTAL ILLNESS • EXPOSURE TO MORE STRESSORS • MORE VULNERABILITY • LESS ACCESS TO TREATMENT

8. CAUSE AND EFFECT • SELECTION - M.I. PRECEDES SOCIAL CLASS • DOWNWARD DRIFT

9. PSYCHOSIS

10. FARIS AND DUNHAM • CHICAGO 1939 • ADMISSIONS TO MENTAL HOSPITALS BY AREAS OF CITY • NO ASSOCIATION BETWEEN RESIDENCE AND BI-POLAR

12. FARIS AND DUNHAM • STRONG ASSOCIATION BETWEEN RESIDENCE IN CENTRAL CITY AND SCHIZOPHRENIA (9x DIFFERENCE)

13. 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

14. 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.

15. CONCLUSION FOR PSYCHOSES • STRONG ASSOCIATION OF LOWER CLASS STATUS AND SCHIZOPHRENIA • SELECTION SEEMS MORE IMPORTANT THAN CAUSATION • NO ASSOCIATION BETWEEN SOCIAL CLASS AND BIPOLAR DISORDER

16. NON-PSYCHOTIC

17. INCOME AND M.I. (NCS)

18. INCOME AND M.I.

19. 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

20. REASONS FOR NON-PSYCHOTIC • CAUSATION NOT SELECTION • STRESSORS • MODEST RELATIONSHIP WITH ACUTE LIFE EVENTS • STRONGER RELATIONSHIP WITH CHRONIC STRESSORS

21. VULNERABILITY • LOW SOCIAL CLASS ESPECIALLY VULNERABLE TO STRESSORS • LESS ADEQUATE MATERIAL SUPPORT AND COPING • LEADS TO LONGER DURATION AND POORER PROGNOSIS FOR LOWER CLASSES

22. 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

23. FORM OF RELATIONSHIP • POOR ARE WORST BUT LITTLE DIFFERENCE OTHERWISE (DICHOTOMOUS) • HIGHER THE POSITION, BETTER THE MENTAL HEALTH (CONTINUOUS) • STATUS AS RELATIVE CONCEPT – DEGREE OF INEQUALITY

25. FORM OF RELATIONSHIP • NO CONCLUSIVE EVIDENCE FOR DICHOTOMOUS OR CONTINUOUS

26. HAPPINESS • SOMEWHAT DIFFERENT THAN M.I. • SEEMS DICHOTOMOUS, NOT CONTINUOUS • LOWER CLASS HAS LESS • OTHER CLASSES SAME (50 K > 20K; 5M = 100K) • “MONEY CAN’T BUY HAPPINESS”

27. HAPPINESS • IMPORTANCE OF BASIC NEEDS • IMPORTANCE OF REFERENCE GROUPS • WHY DO PEOPLE WORK SO HARD? • “The desire for food is limited in every man by the narrow capacity of his stomach; but the desire of the conveniences and ornaments of building, dress, and furniture seems to have no limit or boundary” (Adam Smith 1776).

28. SUMMARY • SOCIAL CLASS STRONGLY RELATED TO PSYCHOSES - SELECTION • SOCIAL CAUSATION FOR NON-PSYCHOTIC • MORE EXPOSURE AND VULNERABILITY, JOBS • HAPPINESS – OTHER THAN BOTTOM, LITTLE RELATIONSHIP