Sociological studies point to a social pattern of psychopathology. Although anyone, whatever their social background, can experience varieties of fear, sadness or madness, this does not mean that these states occur randomly. Research findings mainly based upon epidemiological data indicate that social class and poverty (Bromley 1983, 1994) influence physical and mental health, as well as gender (Ussher 1991), sexual orientation (Rothblum 1990), race (Pillay 1993), and age. People in these groups are particularly vulnerable to distress, and are more likely to receive biological or physical treatments and much less likely to receive psychotherapy. When they do they tend to drop out earlier and more frequently (Yamamoto et al. 1968). The one issue that these disparate groups have in common is that they are members of groups differing in some aspect from the dominant culture. They are further disadvantaged by institutions including health systems, which have been developed and are largely organized to meet the needs and requirements of those groups that reflect the power structure of society generally (Clarke and Brindley 1993). The sociological model contains three main perspectives on psychopathology. These are social causation, labelling theory/social constructivism and critical theory. (For a full review of sociological perspectives, see Pilgrim 1997, and Pilgrim and Rogers 1999.) Within the literature on psychopathology, studies are frequently influenced by versions of more than one perspective (Bury 1986).

Critical theory

During the twentieth century a number of attempts were made to account for the relationship between socio-economic structures and the inner lives of individuals. One example is Sartre when he developed his ‘progressive-regressive method’ (1963). This was an attempt to understand biography in relation to its social context and understand the social context via the accounts of people’s lives. This existential development of humanistic Marxism competed with another set of discussions about the relationship between unconscious mental life and societal determinants and constraints. Within Freud’s early circle, a number of analysts took an interest in using their psychological insights in order to illuminate societal processes, which set a trend for later analysts. Out of this tradition emerged a group of Freudian-Marxists, known as ‘critical theorists’, many of whom were associated with the Frankfurt School, which largely relocated to the States with the rise of Nazism. The difference between this work and most clinical psychoanalysis was the focus on the interrelationship between psyche and society. Horkheimer outlined the question behind its aims:

What connections can be established, in a specific social group, in a specific period in time, in specific countries, between the group, the changes in the psychic structures of its individual members and the thought and institutions that are a product of that society, and that have, as a whole, a formative effect upon the group under consideration? (1931: 14)

The interrelationship between the material environment of individuals and their cultural life and inner lives was subsequently explored by a number of writers in this group including Marcuse, Adorno, Fromm and Reich – the latter a Marxist psychoanalyst. Within this school, Freudianism was viewed as the legitimate form of psychology that was potentially philosophically compatible with Marxism, although their integration of Freud’s views was selective.

The role of this group seems paradoxical. For a theory that drew heavily if selectively upon clinical psychoanalysis, their work focused not on mental illness but on what Fromm called the ‘pathology of normalcy’. Psychoanalysis is concerned with the notion that we are all ill, with psychopathology varying between individuals only in degree and type. Accordingly, the concerns of this group were about life negating cultural norms associated with authoritarianism and the capitalist economy and the ambiguous role of the superego as a source of conformity and mutuality. These norms were mediated by intrapsychic mechanisms – especially repression highlighted in Freud’s theory of a dynamic unconscious.

Critical theory is evident in studies of the authoritarian personality (Adorno et al. 1950) and the mass psychology of fascism (Reich 1933; Fromm 1942). Aspects of critical theory can be found in a variety of studies that continue to explore the relationship between economics, culture and the psychopathology of the individual (Jacoby 1975; Holland 1978; Lasch 1978; Richards 1984; Kovel 1988; see also the ‘anti-psychiatry’ writings of Cooper 1968 and Laing 1967). There is a continuing body of work that examines the way in which contemporary western society is developing in a pathological direction – through the culture of narcissism, or the fragmented self represented in the metaphor of schizophrenia (Harvey 1989). These post-war writers have been part of a theoretical tradition that is still psychoanalytically oriented but reflects changes such as the impact of Klein and later object-relations theorists. Another Freudian-Marxist hybrid can be found in the French intellectual world, especially following the work of Althusser and Lacan (Elliot 1992).

Social class and mental health

Sociologists have long debated the exact definitions of social class, highlighting the conceptual problems relating to social class and economic status and the relationship between the two. There is an overall consensus that there is a relationship between social stratification and advantage and disadvantage within society. Social class is a good predictor of a number of outcomes that shape people’s lives including mental and physical health. Poverty and poor mental health are correlated (Breen and Rottman 1955; Pahl 1993). Sociologists have drawn our attention to how behaviour is shaped by the social structure. The French sociologist Emile Durkheim (1858–1917) described the sets of values and norms that guide people’s behaviour in society so that they behave according to these norms and values. However, when our own values no longer match those of the society in which we live, then our ties with that society are weakened, resulting in anomie. Durkheim related this loss of social cohesion to feelings of anomie and alienation that were linked to some forms of suicide. His study of suicide is held up as the classic study of social causation:

Durkheim’s view that external social reality impinges on human action and shapes human consciousness.
Largely based on psychiatric epidemiological studies, sociologists conclude that social class and mental health are correlated. However, they differ in views on why there is such a relationship. The relationship was first studied systematically in the 1930s, by a group of sociologists called The Chicago School (Faris and Dunham 1939). Over a period of 12 years, they studied psychiatric hospital admission, diagnosis and locality of origin in the city. They found the incidence of schizophrenia to be seven times greater in poor, socially disorganized neighbourhoods than in stable suburbs. This work instigated further studies on psychiatric epidemiology that tend to confirm that there is a positive relationship between low social class and psychopathology (Hollingshed and Redlich 1958; Dohrenwend and Dohrenwend 1977; Brown and Harris 1978; Bebbington et al. 1981; Goldberg and Huxley 1992). Overall, the epidemiological evidence points to over-representation of people diagnosed as schizophrenic in lower-class samples (Tietze et al. 1941; Stein 1957; Goldberg and Morrison 1963). These patients are particularly over-represented at the lower end of the social Read the rest of this entry »