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SOCIAL CLASS AND MENTAL ILLNESS
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SOCIAL CLASS AND MENTAL ILLNESS

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  1. SOCIAL CLASS AND MENTAL ILLNESS

  2. WHAT IS SOCIAL CLASS? • PEOPLE SIMILAR IN ECONOMIC AND SOCIAL STATUS, EDUCATION, WAYS OF LIFE, ATTITUDES AND BELIEFS • TWO MAJOR ASPECTS • MATERIAL RESOURCES – FINANCIAL • CULTURE - EDUCATION, TASTE

  3. MEASURES • INCOME • EDUCATION • COMBINATION (UPPER; MIDDLE; WORKING; LOWER) • STATUS INCONGRUITY

  4. CAUSE AND EFFECT • CAUSATION - SOCIAL CLASS PRECEDES M.I. • IF CAUSE -RESOURCES OR CULTURE? • SELECTION - M.I. PRECEDES SOCIAL CLASS • DOWNWARD DRIFT

  5. THEORIES • PSYCHOLOGICAL - USUALLY IGNORE • BIOLOGICAL – EMPHASIZE SELECTION

  6. SOCIOLOGICAL • SOCIAL CAUSATION • SOCIAL CLASS INVERSE WITH MENTAL ILLNESS • EXPOSURE TO MORE STRESSORS • MORE VULNERABILITY • LESS ACCESS TO TREATMENT

  7. PSYCHOSIS

  8. FARIS AND DUNHAM • CHICAGO 1939 • AREAS OF CITY • NO ASSOCIATION BETWEEN RESIDENCE AND BI-POLAR • STRONG ASSOCIATION BETWEEN RESIDENCE IN CENTRAL CITY AND SCHIZOPHRENIA (9x DIFFERENCE)

  9. FARIS AND DUNHAM • ORIGINALLY SAID ISOLATION OF CENTRAL CITY CAUSES SCHIZ. • CHANGED MIND AFTER LATER STUDY TO SAY PEOPLE FIRST BECOME SCHIZ AND THEN MOVE TO CENTRAL CITY • SELECTION

  10. RECENT STUDIES • SCHIZ ALWAYS ASSOCIATED WITH LOWER SOCIAL CLASS • HOW DECIDE CAUSATION? • LOOK AT PARENTS’SOCIAL CLASS • SELECTION MORE THAN CAUSATION • DOWNWARD DRIFT • BIPOLAR NOT RELATED TO S.C.

  11. CONCLUSION FOR PSYCHOSES • STRONG ASSOCIATION OF LOWER CLASS STATUS AND SCHIZOPHRENIA • SELECTION SEEMS MORE IMPORTANT THAN CAUSATION • NO ASSOCIATION BETWEEN SOCIAL CLASS AND BIPOLAR DISORDER

  12. NON-PSYCHOTIC

  13. INCOME AND M.I.

  14. INCOME AND M.I.

  15. NON-PSYCHOTIC • LOWER CLASS ALWAYS HIGHEST • SOMETIMES INVERSE, SOMETIMES NOT • STRONGEST FOR ANXIETY • WEAKEST FOR SUBSTANCE ABUSE • LOWER CLASS ESPECIALLY LIKELY TO HAVE COMORBID DISORDERS

  16. REASONS FOR NON-PSYCHOTIC • CAUSATION NOT SELECTION • STRESSORS • MODEST RELATIONSHIP WITH ACUTE LIFE EVENTS • STRONGER RELATIONSHIP WITH CHRONIC STRESSORS

  17. COSTELLO STUDY • COMPARE DEPRESSION AND FAMILY INCOME FOR CHILDREN • DURING STUDY HALF (NATIVE AMERICANS) GOT $ WINDFALL • SYMPTOMS DECLINED BY ABOUT HALF • ABOUT HALF OF HIGHER RATES AMONG POOR CHANGE WHEN INCOMES CHANGE

  18. OCCUPATIONAL REASONS (LENNON) • HIGHER SOCIAL CLASSES HAVE MORE AUTONOMY AND CONTROL OVER WORK • HIGHER SOCIAL CLASSES HAVE FEWER PHYSICAL STRESSORS OF WORK • HIGHER SOCIAL CLASSES HAVE MORE JOB STABILITY

  19. VULNERABILITY • LOW SOCIAL CLASS ESPECIALLY VULNERABLE TO STRESSORS • LESS ADEQUATE MATERIAL SUPPORT AND COPING • LEADS TO LONGER DURATION AND POORER PROGNOSIS FOR LOWER CLASSES

  20. SUMMARY • SOCIAL CLASS RELATED TO NON-PSYCHOTIC • SOCIAL CAUSATION BEST EXPLANATION • MORE EXPOSURE, ESPECIALLY TO CHRONIC STRESSORS • MORE VULNERABILITY

  21. TREATMENT

  22. SOCIAL CLASS AND TREATMENT • INCIDENCE = NEW CASES • PREVALENCE = ALL CASES • PREVALENCE = INCIDENCE + REENTRY + CONTINUOUS • HOLLINGSHEAD AND REDLICH STUDY OF NEW HAVEN IN 1950s

  23. TREATMENT OF PSYCHOSES

  24. TREATMENT OF PSYCHOSES • NO S.C. DIFFERENCES IN INCIDENCE EXCEPT LOWER CLASS HAS MORE • STRONG INVERSE RELATIONSHIP OF SOCIAL CLASS AND PREVALENCE OF PSYCHOSES

  25. EXPLANATIONS • LITTLE TREATMENT FOR LOWER CLASS - MORE CUSTODIAL • MORE COMMUNITY SUPPORT FOR HIGHER CLASSES • LONGER DURATION AND WORSE PROGNOSIS FOR LOWER CLASSES

  26. TREATMENT OF NEUROSES

  27. TREATMENT OF NEUROSIS • NO DIFFERENCE IN NEW CASES • HIGHER CLASSES HAVE MUCH GREATER TREATED PREVALENCE • HIGHER CLASSES STAY MUCH LONGER IN TREATMENT • RELATIONSHIP OPPOSITE FOR NEUROSES AND PSYCHOSES

  28. REASONS • CULTURE OF HIGHER CLASSES MORE CONGRUENT - ESPECIALLY EDUCATION • LESS STIGMA FOR HIGHER CLASSES • RESOURCE DIFFERENCES • RESPONSE OF M.H. PROFESSIONALS

  29. SUMMARY • SOCIAL CLASS HAS STRONG RELATIONSHIP TO M.I. AND TO TREATMENT • PSYCHOSES - SELECTION • NEUROSIS - CAUSE • HIGHER CLASSES MORE OUTPATIENT AND LESS INPATIENT

  30. SUMMARY (CONT.) • LOWER CLASSES MORE INPATIENT AND LESS OUTPATIENT

  31. McGUIRE’S STUDY • MEASURED SEROTONIN LEVELS IN LEADERS AND FOLLOWERS IN MONKEY TROOPS • LEADERS HAD HIGHER LEVELS OF SEROTONIN AND FOLLOWERS LOWER LEVELS • MOVED LEADERS TO NEW TROOP

  32. McGUIRE’S STUDY • FORMERLY DOMINANT MONKEYS HAD LOWER SEROTONIN WHEN BECAME SUBORDINATE • FORMERLY DEPENDENT MONKEYS HAD HIGHER SEROTONIN WHEN BECAME DOMINANT • SOCIAL POSITION PREDICTS SEROTONIN NOT VICE VERSA

  33. IMPLICATIONS • POSITIONS OF DOMINANCE RELATED TO WELL-BEING • POSITIONS OF SUBORDINATION RELATED TO POOR MENTAL HEALTH • POSITION MORE IMPORTANT THAN INDIVIDUAL CHARACTERISTICS