Social class and psychiatric treatment

Abstract

Social class significantly influences the occurence, duration and success of psychiatric treatment. Mental health of 223 psychiatric patients, established independently of social class and to some extent of patient status, was found to be closely linked to the mental health standards of 1437 ‘normal’ nonpatients of the corresponding socio-economic level. Seventy-nine patients of the upper socio-economic status (SES) third of the sample, who by the criterion of the investigation were no longer in treatment, showed far better mental health than twenty-four patients still in therapy. By contrast, only four of the low SES third remained in treatment and the mental health of those no longer in treatment did not differ from that of patients still in treatment. Psychoneurotic reactions prevailed in upper SES patients, psychotic, organic and character disorder reactions in patients of low SES. When the sample was standardized to contain only neurotic type reactions, treatment rates were conspicuously higher in the upper SES third even though impairment from symptoms was more severe in the low. The difficulties encountered in treatment of lower class patients are interpreted as originating from lower standards of mental health functioning of the ‘normal’ nonpatient population of this class which set goals of therapy below the more exacting expectations of the therapists. Lower class patients also tend to develop psychopathological reactions and defenses which promote resistance in the therapeutic process.