Data Type: Journal Article

Social stratification and psychiatric practice: A study of an out-patient clinic

Myers, J. K., Schaffer, L. (1954). Social stratification and psychiatric practice: A study of an
out-patient clinic. American Sociological Review, 19(3), 307-310.

This paper (developed out of an earlier project that found that members of the upper class tended to receive more psychotherapy, while members of the lower class tended to receive more organic therapy) seeks to analyze “the relationship between social class and the selection and treatment of patients in psychiatric out-patient clinic” (307). This study was able to closely analyze class and treatment types because it limited the scope of the setting and the types of disorders studied.

The studies took place in a community clinic that offers “excessive” psychotherapy and scaled fees for individuals that make under $5,000 a year. Records were analyzed to see if social class influenced: “(1) acceptance for treatment, and (2) nature of treatment as measured by (a) training and status of the therapist, (b) duration of treatment, and (c) intensity of treatment” (307). After a review by the clinic staff, the patients that were taken had their data used for this study, and were coded for by a five-class system developed by Hollingshead. Moreover, a chi-square analysis revealed that other factors, such as sex, age, and profession did not play as relevant a role in treatment type and quality as did socio-economic status. The studies showed that social status was related to treatment type, as most of the individuals that were coded as members of the lowest class were most often turned away for treatment or treated by less-qualified psychotherapists as compared to members of the higher socio-economic classes. Additionally, higher intensity and duration of care was found among individuals that were found to be members of higher classes. Some of the author’s tentative explanations for this were possible cultural and semiotic differences between lower-class patients and upper-class trained psychologists.

This early study contributes to the sociology of clinical psychology by showing at least one sociological factor that influences quality of psychological treatment. The authors found that socio-economic status may affect the type and quality of treatment provided to patients—an important addition to the literature that suggests that social group can have an impact on treatment. However, interestingly, the authors noted that in this early work, other social attributes, such as sex, age, and profession, were found to have no significant impact on the quality of treatment.

Categories: Sociology of Mental Health and Illness
Publication Date: 1954