SOCIAL CLASS, SCHIZOPHRENIA AND THE PSYCHIATRIST

In recent years increasing attention has focused on the effect social class has on the clinical picture of various mental disorders as well as the relation of the social class of the psychiatrist to the social class of the patient. Often there has been a tendency to confuse the effects of two variables—social class and diagnosis—on symptom complexes and the choice of who is to be treated by particular methods. To avoid this, a group of 200 schizophrenic women admitted for the first time and for at least 30 days to the Neuropsychiatric Institute of the University of Michigan Medical Center were studied. Social class was determined by the Hollingshead Two Factor Index of Social Position.

Comparison of 90 upper class women (classes I, II, and III) with 110 lower class women (classes IV and V) at time of admission shows a significantly higher number of upper class women came for help because of psychic suffering (P = .01) and a significantly higher number of lower class women came because of physical suffering (P = .05). Upper class women were more anxious (P>.05) and lower class women were more likely to hallucinate (P>. 05).

Once hospitalized, the psychiatrist reacted quite differently to the groups, being more likely to rely on drugs (P = .02) or having a transfer to a state hospital arranged (P<.05) for the lower class group, whereas he used psychotherapy more often with the upper class women (P>.01). The upper classes at discharge had a greater chance of being improved (P<.05).

However, the crucial variable that determines the psychiatrist's reaction seems to be the patient's attitude toward the mature of her illness (psychological compared to physical or social). Comparing these attitudes, unrelated to social class, demonstrates those with a psychological view of their illness were more likely treated with psychotherapy (P = .01) and more likely to improve (P>.05). Thus, the significance of social class to the psychiatrist seems to be primarily as it influences the patient's view of her illness.

The psychiatrist places great emphasis on the patient's willingness to see her illness as the psychiatrist sees it. The patient from the same social class as the psychiatrist sees her illness as he does and thus is more effectively treated by him. This demonstrates how necessary it is for psychiatrists to be more familiar with the attitudes of lower class patients toward mental illness and psychiatric treatment, if more effective treatment is to be made available.