Social Status and Psychological Disorder: An Issue of Substance and an Issue of Method

The most consistent demographic finding reported in social psychiatric field studies is an inverse relation between social class and psychological disorder. This relationship has been interpreted on the one hand as evidence of social causation, with low status producing disorder, and on the other as evidence of social selection, with pre-existing disorder determining social status. This substantive issue could turn on a simple question of fact: whether Negroes and Puerto Ricans in New York City have higher or lower rates of disorder than their class counterparts in more advantaged ethnic groups. The facts, however, are not available from existing research. The results of field studies contain clues to group differences in modes of expressing distress, including some that involve problems of response bias, but the evidence is far from clear about the relation of the symptoms reported to the underlying psychiatric condition of individuals. It would seem that the substantive issue of social causation vs. social selection must yield precedence to resolution of the central unsolved problem of psychiatric epidemiology-the measurement of untreated psychological disorder. EPIDEMIOLOGICAL studies have been held to support a variety of hypotheses about the social causation of psychological disorder. Most often, the causal role of social factors is inferred from rate differentials according to geographical location or social category. These correlations have been viewed as pointing to the etiological significance of such factors as social disorganization, social isolation, migration, accul