A (Social) Class Apart: The Hidden Biases Shaping Psychiatry
- GAB NEWS
- 2 days ago
- 4 min read
Prejudices against the poor and marginalized have long influenced ideas about mental health.
In my last article, I talked about the New Haven Study, a psychiatric epidemiology project that examined the relationship between class and mental health in New Haven, Connecticut, during the 1950s. It demonstrated that people on the lower rungs of the social strata were much more likely to suffer from mental illness than those at the top. This social psychiatry study also showed that people representing the lower classes were more likely to be diagnosed with psychoses, rather than neuroses, and to be prescribed invasive, somatic treatments (such as electroconvulsive therapy, drugs, and lobotomy) rather than talk therapies, such as psychoanalysis.
The New Haven Study relied partly on mental health statistics, but it also included a qualitative element. Social psychiatrists investigated the conditions in which people lived and conducted interviews with them, in order to determine how these factors might impact their mental health. These researchers found that most people in the lowest class lived in “crowded old tenements.” The buildings were often dilapidated and lacked the pleasant gardens found in wealthier neighborhoods.
Such conditions should not be surprising. After all, these were people living in relative poverty. But details in the way researchers described such places—as well as those who lived there—indicated something else was going on.
Blame vs. Sympathy: How Judgment is Shaped By Social Class
One thing that these social psychiatrists (who tended to be white, upper-middle-class, male, and highly educated) tended to focus on was how a state of disrepair often characterized the buildings where those in the lower classes lived. If there were steps up to the door, they were likely to be wobbly or broken. Doors would hang on hinges and not close fully. Flooring would be worn through. Light bulbs were burnt out. Rather than laying blame on the landlords for such deficiencies, the researchers implied that they were the fault of the residents, even though they probably were not responsible for such conditions and likely couldn’t afford to repair anything.
The social psychiatrists also picked up on the dirty and unkempt nature of the tenements, mentioning broken bottles, uncut grass, cigarette butts, stained carpets, smeared countertops, and flies buzzing around. Again, such uncleanliness was put forward as a moral failing. The researchers didn’t think to mention that many of the upper-class homes would have employed housekeepers. Middle-class homes at this time (during the 1950s) were often maintained by a stay-at-home mom, who would have spent a great deal of her time cleaning up after her family.
In contrast, many men and women (and some adolescents) in the tenements would have been working long hours, possibly juggling multiple jobs. Those coping with ill-health, addictions, and/or chronic unemployment may have simply lacked the motivation or energy to clean up homes that were already in a poor state.
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When describing other aspects of the interviewees’ lives, the researchers seemed to be quicker to judge than sympathize. They sniffed at the fact that most apartments had televisions (mainly rented), suggesting that the money spent on such luxuries could be expended on more edifying things, such as books. They pointed out how noisy the apartments were, seeming to blame the residents, rather than the thin walls.
Finally, they were aghast at how residents dealt with the inadequate provision of toilets (typically only two for an apartment block housing 20 families). An interviewee explained to a researcher that sometimes men would simply urinate out of the windows. As he was explaining, he spied someone in an adjacent building doing just that. In his horror, the researcher failed to comment on the fact that, when there were only two toilets for nearly 100 people, such things were bound to happen.
Are Biases Still Blinding Us Today?
Other studies occurring at the same time, such as the Stirling County Study or the Midtown Manhattan Study, reveal a similar tendency to condemn the actions of lower-class people, rather than seek explanations in an unequal social system. So, why does this matter?
Simply put, by bringing their prejudices about working-class people to their research, social psychiatrists were lured into blaming them for their situation—and, by extension, their poor mental health—rather than questioning a social structure characterized by chronic inequality and racism. The result was that social psychiatrists were reluctant to suggest societal solutions to prevent mental illness, such as reducing poverty, inequality, and racism, and instead implied that people at society’s margins ought to “educate” themselves out of poverty. Such thinking was most evident in the approach to Black families in the 1960s, as Mical Raz’s research shows.
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Today, it’s not so different. We have even more evidence that social factors drive mental illness, but we remain largely unwilling to tackle these problems at the source, even as society grows more and more unequal. I have suggested that universal basic income could be a good way to change this mindset—but changing our mindset could itself be a good starting point. Rather than leaping to judgment, we should seek to ask why people do, and feel, the way they do—even when they are urinating out of a window.
References
Smith, M. (2023). The First Resort: The History of Social Psychiatry in the United States. New York: Columbia University Press.
Raz, M. (2016). What's Wrong With the Poor? Psychiatry, Race, and the War on Poverty. Chapel Hill: The University of North Carolina Press.
references
Plublished by Raphael Amorim
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