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Social Class and Schizophrenia: A Critical Review

1974; Elsevier BV; Linguagem: Inglês

10.1016/b978-0-08-017738-0.50017-x

Melvin L. Kohn,

Mental Health Treatment and Access

MY INTENT in this paper is to review a rather large and all-too-inexact body of research on the relationship of social class to schizophrenia, to see what it adds up to and what implications it has for etiology.(r) Instead of reviewing the studies one by one, I shall talk to general issues and bring in whatever studies are most relevant. It hardly need be stressed that my way of selecting these issues and my evaluation of the studies represent only one person’s view of the field and would not necessarily be agreed to by others. Before I get to the main issues, I should like to make five prefatory comments: 1. When I speak of schizophrenia, I shall generally be using that term in the broad sense in which it is usually employed in the United States, rather than the more limited sense used in much of Europe. I follow American rather than European usage, not because I think it superior, but because it is the usage that has been employed in so much of the relevant research. Any comparative discussion must necessarily employ the more inclusive, even if the cruder, term. 2. I shall generally not be able to distinguish among various types of schizophrenia, for the data rarely enable one to do so. This is most unfortunate; one should certainly want to consider “process” and “reactive” types of disturbance separately, to distinguish between paranoid and non-paranoid, and to take account of several other possibly critical distinctions. Worse yet, I shall at times have to rely on data about an even broader and vaguer category than schizophrenia-severe mental illness in general, excluding only the demonstrably organic. The excuse for this is that since the epidemiological findings for severe mental illness seem to parallel those for schizophrenia alone, it would be a shame to ignore the several important studies that have been addressed to the larger category. I shall, however, rely on these studies as sparingly as possible and stress studies that focus on schizophrenia. 3. Social classes will be defined as aggregates of individuals who occupy broadly similar positions in the hierarchy of power, privilege and prestige. t2) In dealing with the research literature, I shall treat occupational position (or occupational position as weighted somewhat by education) as a serviceable index of social class for urban society. I shall not make any distinction, since the data hardly permit my doing so, between the concepts “social class” and “socio-economic status”. And I shall not hesitate to rely on less than fully adequate indices of class when relevant investigations have employed them.