SCHIZOPHRENIA AND SOCIAL STRUCTURE

In a previous report the authors and their co-workers found treated prevalence of schizophrenia in the lowest social class 11 times more frequent than in the upper class. The present paper analyzes this striking distribution. From our data it may be concluded that the difference is not due to downward social mobility. Tabulating approximate treated incidence of schizophrenics (patients in treatment for less than 1 year) we found that approximately twice as many schizophrenics occur in class V than in classes I and II combined. At the more chronic levels the ratio between upper- and lower-class schizophrenics is much higher. We found 31 times as many schizophrenics in class V as in classes I and II. This increase of chronic patients in class V appears to be related to significant differences in treatment. Our data demonstrate that schizophrenics in the upper and middle classes enter treatment earlier than those in the lower class. The upper- and middle-class schizophrenic is referred for treatment through medical channels; the lower-class schizophrenic through legal ones.

The schizophrenic of the upper and middle classes is more likely to be treated by psychotherapy; the lower-class patient by organic treatment and, in far too many cases, he is not treated at all. The patient in the upper and middle classes has a greater chance of being discharged to his family and community than has the lower-class schizophrenic. Implications of these findings for the pathology and therapy of schizophrenia need to be discussed more thoroughly than space allows us here.