Mental illness and social class in Bristol.

Abstract

During the past 40 years a number of studies have supported the general hypothesis that the incidence of mental illness differs among people in various occupational groups. In particular, these studies suggest that schizophrenia is more common among the lower-paid groups but that manic-depressive psychosis is more or less equally distributed among all groups. The evidence for this is briefly summarized below. Tietze, Lemkau, and Cooper (1942) have reviewed some early investigations, but, as Clark (1948) points out, their conclusions can be criticized on the grounds that no allowance was made for differences in age-distribution among the occupational groups. Later studies, however, are not subject to this criticism. Tietze, Lemkau, and Cooper (1941) showed that, among 180 psychotic and 234 neurotic cases active during the year 1936 and resident in a district of the city of Baltimore, a significantly high proportion were drawn from the lower income groups. Studying over 12,000 male first admissions to Chicago mental hospitals during the years 1922 to 1934, Clark (1949) showed a high negative correlation between income and the incidence of schizophrenia in nineteen occupational categories; between income and manic-depressive psychosis, on the other hand, the correlation was practically zero. This author also showed that very similar correlations held when only the lowest ten of the nineteen occupational groups were considered, thus disposing of the criticism that schizophrenics in the highest income groups are missed because they are cared for outside the city, for of the families in his ten lowest groups, practically none would have been able to afford such private treatment. Hollingshead and Redlich (1953, 1954), in a study of nearly 2,000 psychiatric cases (including both inand outpatients) under treatment on a certain date in New Haven, Connecticut, found a very significant excess of schizophrenics among the lower social groups (defini d in terms of occupation, education, and place of residence). From G eat Britain the only evidence bearing on this ubject appears to be that of the RegistrarGeneral (1953), derived from analysis of the Mental Health Index Cards for the year 1949. The figures (for males only) show the schizophrenia rate to increase markedly from Social Class I to Social Class V; the rates for manic-depressive psychosis and for neurosis show the same trend but to a much