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'Science' in the Social Sciences

5. Psychiatric Epidemiology

Although certain epidemiological enterprises have wholly legitimate etiological aspirations, one area of epidemiological inquiry has generated a variety of significant interpretive problems, and this is the field of psychiatric epidemiology. Psychiatric syndromes are often "functional" ones: i.e., there is no organic marker for their diagnosis which must therefore depend solely upon behavioral (including communicative) data, so they do not fit into the broader epidemiological category of "diseases of the organism."

“...it has been widely claimed that the highest overall rates of mental disorders of all kinds are found among members of the lowest socio-economic groups...”

Since the pioneering work of Robert E. Faris and H. Warren Dunham (1939) and August B. Hollingshead and Frederick C. Redlich (1958), it has been widely claimed that the highest overall rates of mental disorders of all kinds are found among members of the lowest socio-economic groups, a finding which Ronald Kessler and his colleagues (1994) have more recently described as remarkably persistent over time and geography.

This research raises the questions:

  • Are psychiatric syndromes differentially present in lower socio-economic groups (i.e., is their prevalence class-based)?
  • Or does the research rather show that psychiatrists are more apt to diagnose mental disorders in such groups than in other ones in a society?

There are further questions to be raised:

  • Are community standards of tolerance for systematically aberrant behavior narrower and stricter among members of lower socio-economic groups such that persons exhibiting such behavior are more likely to be referred for psychiatric diagnosis and treatment?
  • Are psychiatric professionals dealing with members of lower socio-economic strata more likely to construe lower-class deviances of conduct in psychiatric terms than the behavioral anomalies of members of other social groups?

Given the well-documented fact that levels of inter-clinician diagnostic reliability are much lower for psychiatric syndromes than for organic ones (see Kirk and Kutchins, 1992, Chapter One), interpretive problems loom large for the results of psychiatric epidemiological studies.

Perhaps the most pressing issue remains:

  • If such syndromes do have discoverable etiologies, will these be organic or social-environmental in nature?
  • If the latter, what sort of variables or factors could be postulated to have causal efficacy, given that the social environment is largely experienced through the ways in which it is conceptualized by its members?
Faris, Robert E. & H. Warren Dunham (1939). Mental disorders in urban areas. Chicago: University of Chicago Press.
Hollingshead, August B. and Frederick C. Redlich (1958). Social Class and Mental Health. New York: John Wiley & Sons, Inc.
Kirk, Stuart A. & Herb Kutchins (1992). The selling of DSM: the rhetoric of science in psychiatry. N.Y.: Aldine de Gruyter.