[2 A Sociopsychological Model’ In order for a human activity to be desig- nated as abnormal, a social situation must be involved. The prologue of this book noted the mutual interdependence of people and the importance of their being able to predict each other's behavior. This position has a number of implications. The first is in terms of definitions: in the prologue deviance was defined as failure to act in ac 1'The present chapter draivs on but also is a modi fieation and extension of previows work (UNmann and Krasner, 1965a; Ullmann, 1967a, 1967b, 1968), The work is deeply indebted to sociologists such ax Becker (1969), Cohen (1966), Homans (1961), Lemert (1967), and Schefl (196). This chapter, however, will move among schools of sociological thought in a manner that may well horrify sociologists, The explication and of distinctions drawn. by different. so iewpoints is beyond the scope of this book, ‘and not infrequently beyond the scope of laymen, ‘such as the present authors, no matter ho well in- tentioned they may he. Different professions at mes ‘ise the sime words to denote different things. For example, some sociologists call psychoanalysis the psychological model. To avoid semantic confusions, 186, cordance with the expectations of others, and abnormality as the type of deviance that sanctioned the professional attention of sociological insighis have been recast within ¢ framework adopted for this book, One major diff 5 between the present authors and majority of sociologists and social psychologists ‘write about social movements and related phenomena. ‘The present authors eschew concepts such as m and cognitions and endeavor to define the spec reinforcing stimuli contingent upon behavior. same data may be described in more than one and may be placed in more than one theo system, What cannot be changed is the actual ob vation, the empirical data, A variety of observ will be presented in this chapter from the intelli domain of sociologists, and to a lesser extent soci psychologists, anthropologists, anil —_psychiatt Hopefully, the behavioral viewpoint wil i worthwhile integration of this material. 2 What appears at first to be an obvious exceptia is the behavior of a person already designated abnormal, As will be seen in Chapter 20, this isa necessarily an exception because the “sick role” i ‘one that is learned. A person who docs not pl properly may be punished and one who plays it @ rectly may be reinforced,le sich a psychologits and psychin: ini This tel to the observation thar what expected and what way deviant de f variables of time place, and per. An unlerstanding of abnormality must Ahercfore take imo account the sociologice| ext of the act and ite evaluation, nnd tis the task to which this chapter is ese LABELING AS BEHAVIOR ven the considerations of time, place, and 28 crucial variables in the formula ‘of abnormality, itis impossible to dex te either a particular act or a paticular ‘8 abnormal ger se. In many respects, mas the burden of the presentation of Tormality has been devise. Ie was aso noted a different profesional groupe or situs ons called forth special definitions of ab- ‘ormality, Labeling behavior is a social act like any otter social ac, is one that is fiewloped and maintained. by reinforcing “totingencies, This point has been aptly expressed by ko (1955, p. $4): “ClasiGcation i, rot “oll, «human activiy. 1¢ always involves ‘enon observing phenomena in which he perceive similarities and dillerences These is always another exential but easly ‘overlooked point: the observer sa purpose $01 move scaly, the prea ae, cou tion, dsb “Phe yeaa yas Thong ep Rt att oem The sean tees Tah ile lw cane a ca eae fi he au rns nal eh ase “Se cto any sods poms eens Hin ce oe Sant onan Sieh stp ng ie Sissel ome en oft br aes Sie ene aan Qian ap 9 A Seciopychological Model 181 or aim in ordering those same data.” Chap ter 2, dealing with diagnostic labels, pre sented an outline of che differences between, supposedly normal and abnormal pepe anil the siiarties shered by people in the same category of abnormality. Further dis: ‘cussion of the diagnostic process will oceue {in Chapter 18 of this book, Chapters 2 and 13 deal with the location end ordering of data: that is, they deal with stepy in the dliagnostc act. The present chapter is mate involved with whit Pronko calls the “pur ose” or “aim of the act The Labeler's Problem ‘An important anaiysis of the diagnostic act thas been made by Scheff (19660, pp. 10S 127), Consider the physician's situation of having to decide whether to hospitalize a enon or not. There are esentally ‘xo ‘matural verifications of his decisions the person was inderd! sie, or the penton was Rot sick. Te is possible to make a fourfold table inthe manner of Figure | Following the letter designation of ells n Figure 1, it is possible to evaluate the various outcomes for physical ill, ‘A, the patient iy indeed sick and the physi cian has hospitalized! him, the physician has done the proper thing and his judement bas been verified. If, at in G the physician how: Ditalirs the person and itis found that the ‘person was not ill, the physician hay not Tost a grest deal: he fas practiced! sound, ‘conservative medicine, und, If anything, the ‘Patent will-be gratefal wo him for his com zm and care. If, 2s iD, the physician does not hespitalie and the person is im. deed no ill, the physician has mot made any visible profesional gain and has had {0 reject the patient's complains. If finally, 4s in B, the physician does not hoepitalige ‘he patient and it is found that there ‘wasW884 Sociopsyehologicad Atodel indeed am illness justifying hospitalization, the physiclin isa bad diagnostician a has ootly served both the patient and his pro. fewsion. Because there is nc stigma attached 10 being phvically ill, becauee a careful Dhysical checkup cakes only = few days, and Decawse there is relatively litle expense, the ‘meitcal patient bas litle 0 ose hy bets Hhowpitalired. When in doubt, the physician lacs the rational thing, he hospitlias, the patient ‘The situation is different for the patient in the case of pychiatic hospitalization, While there is a strong camyover of the ‘oncept “When i donb, hospitalze” py. ‘chiatric hospitalization may lead to increased rather than decrecsed behavioral problems ‘These problems may occur through the ain. fing received inthe hospital miliew (Som ‘er and Osmond, 1951; Barton, 1959; Wing, 1062) and the stigma atsched to having been a_puient in a. psychiatric hospital (Lamy, 1966) Additional frobleins are raised bby the greater length of pychiairie hos Ditalization. For these reasons, contemporary ‘community mental health programs an at ‘keeping the person out of the hospital and abla cha de paints were “mealy "fe ‘orig w die eiteia sated by the jugs fn terviews). Indeed, the bev an fespernes of 4 of the patients at the besringy seemed com pletely unesceptinnable. Yet the phate ex miner had not recommended the teleae of @ Single one o€ these patents Exttining the coure cons 50 adational eee, we fund sll not a single ecnonmendaion for reese, 1865p, 19] The Social Function of Labeling Ke hte been pointed out that prychiairic agnosis isa socal act made in the ligt of A Sociopsyehelogicel Model 180 prior training that is manifest! by. biases towaed the conservative or “sek” decision, ‘The next question is why sued behavior maintained, or 1 pat the ‘ssve bluntly, ‘what are the conditions that ke social agencies to pay psychiatrists for such be: avior? What function is served by sich lagnoves? ‘This chapter started with a recapitulation fof abnormality used ok: abnormal behavior is behavior is cleviant in such a manner that a mem "al health professionals intervention i sanc- oned. Szasz (1966, p. 153) makes this point when he writes, "When people perform thei tocial roles properly—in other words, the social expectations ate adequately met~ their beliavior is considered normal” Accurate predietion of the response of another person, an especially being able to predict whet {sa response adequate to evoke a favorable response from another, is a act for which the individval. has been frequently rei foreed. In Chapter 4, it wis ove how bring ing a coat to a volunteer was sifclent 0 have her take a patient for a walk. There is 4 cin (ee Chapter 4) in whieh one per son's behavior becomes a stimulus for a ‘other person's response, which in eurn fs seriminative stimulus or acquired nei forcer. The verbal condicioning wilies cited in Chapter 4 and Brackbills (1958) work on infants! smiling ciscused! in Chapter 6,are ther examples. A person wha aes in a manner chat i unexpected in an area in ‘which someone ele hes a stoke poses a probe Jem for the oter person, This problem ean be solved in 2 number of ways, one of wich {8 t0 cal the person mentally il Seasz (19566, pp, 180, 158) pons out that terms like “waiter,” “stenographer,” and “judge” not only. laity occupations but alo define role expacations. He then offers fam example: “The waiter rekuses to. wait1804 Soriopnyological Model fon tables. He sits in the back of the cafe and scribbles endlesly om scraps of paper. When asked what he is doing, be either scowls condescendingly 2nd refuses to. am ‘over, oF confides to friends that he is vit ing a treatise on philosophy that will save the world. He is taken to a mental hospital by the police.” First of all, the mam rained a problem. but i might have been solved by coercing bin to wait on tables or by fring him. He might have bacn begged by his wife and children who depended on his ‘wages. Calling the police and having the ‘man taken 10 the psychiatric hospital was Dat one posible solution. The second aspect of this example is that the act of calling the police and the steps in the sequence of hospitaliztion represent Thuman behaviors. As described in Chapters 4 through 6, the acts must be in the indi vidual's repertoire and mist, whether learned through direct oF various reinforcement, ular situation. Tn fale owner as one fiting the category “Call the cops to take the auy to the loony bin. ‘As with any other ct, if prior experiences in similsr situations have not worked out wwell=for example, led to endlew red tape and court appearances~ihe cafe owner would not emit the acs. If, however, through his reading of the mass meds oF prior personal ‘experience, the cafe owner has learned that this is the effective and comet act, he will perforant, ‘A third iste touched on by the example fof the waiter is that he broke no. specifi ‘written, Jegislted rule. He commited no ivinal act On the other and, his be havior was upsetting. In this instance, psy ‘lati intervention permits a form of socal fonirol where no control hay been legally legislated. The peychiauic intervention is a selution. The situ the Shaw case in England. Shaw published 4 Ladies Directory ii which were paid ad- ‘yertisemenis by women whose monetary 4p ‘proach to sex was at variance with oficial ‘moral expectations, There wat involved an alleged conspiracy to corrupt public morals: an olfense that broke no statute, The judges in the House of Lords permiced the charge to stand, and one of the judges advanced the view dha the Court of Kings Bench was custos mor of the people and had superintendency ot offences contra Bones ‘mores... there isin that Court a residual power, where no statute has yet intervened fo supenede the common Law, 10 super intend those offences which are_prejudilal {to the common welfare. Suck occasions will bbe rare, for Parliament has not been slow to legislate when attention has been sul ficiently aroused. But gags remain and will always remain, since no one cin. forese every way in whieh dhe wickedness of man may disrupt the onder of society.” (Hart, 1966, p. 8.) The use of psychiatric intervention may Permit controls to be extend in much the same way 3 illustrated by the Court of King’s Bench: where na writen rues exis social control may be ellected through psy chiatric intervention, ‘The particular value that is sacrifieed or creunwvented, depending ‘on one's viewpoint, is that offenses should be carefully defined 20 that an individual may know beforehand what act are criminal and what are not. The ise of the concept of renal illnes in this manner fe in vith empirical observation. For example, Katt Menninger (1963, p, 77) writes"... we fan define illness 2s being a certain state of existence which is uncomfortable to sone fone and for which medical science offers or is believed by the public to oller relief, The sullering may be in the acted person or in Mose around him oF both, but a disturbancehas occu ‘oral in the toal economies of a pr which become the focus of our Slinical tention ‘Up to the point of the last clause, starting with "but a disturbance has occurred,” the quotation is not contradictory t0 the view point taken in this volume. ‘Toe agreement fn that there isa dificult social situation for which the mental health profession is be Tieved to offer an answer, A second aspect of this quotation in that the term "ness" i fiven a very broad. meaning. “an_unKom: ortable wate of existence” Sraxe (19668, 40) has correctly pointed out that this per init. intervention in literally any_ area of Thuman activity. Sueh incervention might be jestifed # meneal Alnees actually exsed fn mature se entities im the manner tha stom and bacterin exist factually and die tinet from social evaluations. The diference imay he exprewed in another way: if one alls a rock granite, it does not change; but fone calls 4 person schizophrenic, bot his Ichavior andthe behavior of tow who ‘ome in contact with him may be changed ‘The third aspect of the quotation, them, i the cline that indicates the presence of @ deviation in personality” Gee comments Chapser 10 about this concept). A diagnons fof deviation frosa an accepted standard of functioning would conceivably permit the Imervention of the specialist. Such interven: ion Nae social advantages: it becomes pos: til co sy thatthe perton was sek and that fhe actions which followed were not matters of control, and inleingeysent on personal leedom, but rather actions, scientifialy rounded, taken for the person's own ood. ‘Aes result, » medical modal offers chance to have one's cake and eat it: one can. com: tool orhers while feeling yiswous rather than ity over mot being democratic. A towollary i chat treatmene rather than puss Ishent will be given: the reality at the A Sociopiyhological Model 191 majority of lange asehiatric Hoopitals and prions belies thi. hope Public Information and Labeling The second point derived trom the ample of the waiter who wrote rather than ferved at table was that calling the police ‘vasa learned response tothe situation, This point in turn lead) to eto considerations The frst is that such an act is the zight, the proper, the humane thing t0 do, In gem cra (Nunnally, 1961, the opinion of the Public about mental ils is mot very di Fevent from that of experts in the fel such as payhitsins and psychologists How: tet the atteles ofthe public (as measuned boy semantic 10) Complexity of culture aay be considered 84 situation in which alternative bebavion. ae likely to be svallable, and. when the traditional or normal acte are extnguited, few available vole enactments are emia “This is considerably diferent from « notion that cultural complexity in and. ef elt leads to sien. eyond the problems of diagnostic rei. ability, to be discus in the next chapter, the vole of the physieian imvelf mint be ‘brouehi into consideration in evaluting the social implications of the diagnonte situation. Lin (1966, p. 28) noted; “seems1864 Secopycholgial Modet {ome that the education and taining back round of the pexchistrst Is more decisive than cultural variations in the identifies: tion of symptem-complexes”* Loudon (1968), reviewing his work in South Wales notes the important role of the general procth Honer in the referral-lebeling procesn The feneral pratcioners attitudes toward the Foychitsic specialist tovenced public cow pt about payehlatits in general and typey of symptoms about whic pryehiatrints should be consulted. Further, Loudon sugxcas tht ‘atiations berween sccioeconomic segments ‘of the population affect the general prec tioners concepts of both prevalence of pay ‘iatric problems and appropriate elerale Awareness of the idiidual’s vocal chan. acteristics may have at rauch influence. on the phvsician asthe purely cinta! picture ‘The piysician ie noe alone im the ding nostic interchange, and Rubin (1968, 'p 4358) comments thst in order to incract wth the: pmchiatintanthropologit, the, native ‘muse anign a role to him ‘The andhte. Pologist may, theretore, frst be eatcyoraed 4s, for imsance, 2 Voodoo ries: after this has bem done, the peaple have role avai able for imveraction with him, but it as they would interact with 2: Veoroo. priest ther than ax they would interact with a "xentist” or our type of pyehiatiat aicher of which they have conceptualized When disensing the waiter: who would ot serve, it was noted that the rafe owner had to have had various experiences. prior {0 the ace of calling the police, On a brader eve, there must be some overlap of label ing proceares so at whatever behavior fhe professional calls mental iloes ful the soci function of suc labels. While th ‘ovetlap is far from peneet, both in specie es (eter reliability) an in longer to. dal values (Sess, 1961, 1963), it sll ust st There are in the final simation two immediate participants The fist isthe nom profesional publie which does the maforiy of ase fining, and. which may ensluate ‘symptoms very diferenty from the medal specalit whether physical or behavioral. Murphy and Leighton (1965) poin: out that the “nomWedem groups nay describe wide range of behaviors that would fallin the province of peychiatrias, bu they’ do ot neceusrily use the same coneepe em ployed in our ealtate, Similatly, Lelghton ‘olns out that (1) behaviors say be agreed ‘pon, but (2) conceptisliraions (and hence, feventual evaluations) may dlifer: “An in wiguing fact bere is that there is ne word for dlepresion in Yoruba. When we descibed individual symproms-ceyrg spelly feeling biue, oss of appetie. waking early in the morning 2nd 0 on-these were immediately Tevogniaad. by the Yorub, although the whole constellation of symptoms stl did not form a syndrome in their minds: to us the various features all isd together, but it had not occurted to our informants that they made a pattem. On the other band, here was one diworler, puzling to uy that ‘was frequentiy reported, both by the native Healers who were our key souree of infor mation and als by certain members of our sample who. mere” questioned about. their Previous illoeses. They would quite often Sy that they sullered oom inoren, which, ‘was tansated to us as heavenly fire. Zora ‘Quite clearly is x syndrome in their med, althougi sill cannot make it form + pat fern in mine."® (1005, p88, st he hx agement 3 {ng sont 4 doen ase. Males in geal She of tear angi fe peat ee sant sgh compare ig * pie Me cain ot te aay naeEpidemioiogical Studies ‘Thee conceptual dificulties are crucial in epidemiolouical studies: studies “of che health condition of « population 0 amy conceivable factors existing in ot alcting that population which may Alyence the health state or affect its distribu: tion in that population.” (Leman and Groceti, 1967, p, 225) Epidemiological stud jes are correlational in natures” they en dleavor 10 find what factors are associated with high or low rates of mental illness ‘These procedures hase served mankind well =for example, in public health mecsures again cholera—but they are dependent ‘upon a clear diagnosis. White diagnostic and sampling procedures vary from one study to another, the rates Of mental iliness found on such surveys of the general population ave been alarmingly high. A quotation from Alexander Leighton, tho hs been a6 responsible as anyother [penn for serious work in this fcld, provides 2 summary: In his connenion. nme gure may be quoted In aural eer Noth Ameria ae of ou sud Jes thw tat eon 29 pr cof ea Jopelaon have phn simp so ae Fed by dae to signa degree (D.C Teignon eal, 1988)" stedy i tam (Stl et al, 1968) ilar 29 pt Ai Acer sampling wey (ont et pu) ‘ts small comme i rane shos per eo Mice. The inveniation ofthe ote popula timo oro eu panies Sweden (Een ll Ie, 16. Hagel 190 ines ha 25 pee fae pen dictie Suaer notte sas accompa Rseanh wort conducted by fo, foyer Lan ad mye (AH. aigton ta 166s, bn ike Weer regan ot Niger pots {16 per cea ofthe ate nual elage and A percent he sds ins spins ofa Ser i mp sun te acon sone bre to fk tl Sion of wer popundoes muh dacs om considerable range appeae, Thay, in ome Communities inthe Novih American raat ae, 2 percent ofthe populatb were estimated Ihave a significant degre of dvorer. In Nigeria the range was from 6 10 50 per cnt. [99 pu 29s) ‘The work by Srole et al, (1962) isthe ment widely cited one in this atea and deserves some description. Apart of Manhattan's East Side including 174,000 people was selected 25 the area to be studied. Blocks homes the blocks, and people in the homes were randomly sampled. People over 60 and transients were sstematially excluded, and of 1.911 people drawn, 1.600 answered ‘rather long structured questionnaire about their past and present physical and mental symptoms. Symptoms were categorical as Absent, mild, moderate, and serious, anid e lerference with life djnsiment 2 none, ome, reat, and incapacitating. The base dats were collected by eained: nonmedieal professionals and then evaluated by psychi atrie clinicians. Sources of unreliability (ee Ghapter 3) may arise from daca gathering ot interviewer methods, from variability of the interviewee, amd the method of evalua tion by the psychiatric clinician. ‘The bies toward diognosing illness noted earlier in this ‘chapter could operate, and, in fact, rater reliability was far and away greatest in the area. of incapacity of functioning. ‘Socio xomomie satus was estimated from father's felucation and occupation, and it was found that the percentage of people rated "healthy declined and the percentage of people rated “impaired” rose as socioeconomic status declined. In addition, as age increased, rated incapacity increased. But the most generally fnceresting finding was that fewer an one in four people was “well” anid close to one in five was “incapacieated aio 8 Psananle Hy nd" hip om198 4 Soriopschotopee! Aodel The repeated finding of large percentage ff the general population as acting ta ‘manner suitable for labeling se "mentally All” emphasaes the importance of the evalu ative process noted above, This finding an the additional atm thae relatively few yy Kind are spmpiowree also ‘problem encounter by thoxe wo attempt tb dafine mental ilness opera tionally in terms of positive mental health Intensive studies of simples whose adjust, ‘ment should have beea superior to that of the general population have found diseour aginely few people manifesting ‘positive rental health?” Heath (1945) found shat ‘only 60 per cent of Harvsrd sophomores fad welhintegrated personalities ond (1952) found that only 30 of 64 student council ‘members ol three Philadelphia colleges were wellbalanced or Inid strengths oot nneighing their liabilities. Bond noted that 57 per cent of is simple could benefit from psychiatric help, while 14 per cene were in lurgent need of help. Golden et al. (1962) found that of 1,988 sdolecent males who took the Minnesota Multiphase: Personality Inventory, only 78 gave no significant ini cation of pathology. When 50 of these 78 igh were extensively interviewed and tested 12 years later, only 93 were found to be ‘without significme symptomatology, and pethape more disturbing, these men vere found to have litle imagination, generally limited social interesis, and. were mow no: fable for theie contentment with their spouses 1 seems clear that i€ an investigator seeks symptomatology, he will slmest cor tainly find ie tha ot ner and Set (04d pe the degree eo nih genta meal fate tap [eines qmpiome ata pry eer Sec, Za: aed Daviaae 66) ww prvi on ellen review and ew da, might he pt highs beeen 50 a per co Sila i Feological end Social Class Studies of Mental Disorders “Tuo areas of investigation that have yielded Interesting reste are those of geograpbial location and social lst, The former hat 2 called ecological study. ‘The seminal work in dhs aren was by Robert Faris, and the single mont iimpertane publietion is that of Faris and Dunhaw 1988) The tech- hique’wses admission co pryehiatete institu ‘ons as an index of mental health, » dein: tion which, while open to question Gee ‘Chapter If this book), s both reliable and culturally relevant. It was found by these authors, an frequently substantiated there after. that a disproportionate number of Sehiplenics entered hospitals from “ie nani” ecological areas, Faris argue that where soeial contacts are “adequate” and the person is neither sheltered nor ostracized from the mainstsearn of his culture, acim phen i rare, and where it does arise, the espome co it by the individal's social milew is generally therapeutic. ‘The basic datum, of sncremed rates of schizophrenic admitted 1 hospitals from deteriorating see tions of a city and a decrease of tate of ad- mission as distance of evidence increases from this ceter, has-been replicated: these studies have been reviewed by Farle (1944) and by Dunharo (1955, 1966). Associated seth ecological research are studies of the asceiation of socal class with ‘mental illness. As noted in the discussion of the work by Srole etal. (1962) om the prevae Tence of mental illness 19 the point of im plement in Manhattan, Tower social cass ws asociated with higher percentages of pairment and lower percentages of people ina repre te by Sere 14) and Dewacy cal {486 whe rasa 7 mae te pene ae fhe pittoner in phys eeccine teqer ae ing fn idening poche chores‘evaluated as “well” While there have Been ‘exceptions to this rule (kleiner and Parker, 1968), in brood outline it has, been sub ‘eantiated by a number of independent is- ‘The sty that ts deservedly the most Widely cite im this area i by Hollingshecd ‘and Redlich (1953), The frst step taken im this project was to delineate the social class siructure of the population (New Haven, Connecticut, and surrounwling town). Five discs were defined: Clas T were ewentially wealthy, higissociakprestige business and profesional men; Clase 11, managers and fewer ranking protesionals; Clas {1 small proprietors, white collar workers, and skilled laborers: Class 1, semiskilled workers: and Glass V, factory Taborers ard unskilled tae borers. While the occupation of those being, Studie was highlighted, factors such as x tation and place of residence were also tsken limo consideration. Next, a psychiatric census eas taken to aicerain which residents were reaziving. prychiatric care on a given day. December 1, 1950. A control growp was ex tablished by taking 2 5 per cent simple of fenmmunity households from the City Direc ton. The psychiatric and normal samples ‘were categorized on the basis of the social lass system described above. A highly sig nificant asociation was found between social lass and Being onder prychiatric care. A smaller percentage of the higher classes ( 1V) were under pryehiarie care than would have been expected by the fequency of sch people in the population, and a far renter number of the people’ under psy fhiatic care came from the lowest socal flats (V) than would have been expected by ‘chance. Class V comprised 17.8 per cent of the general. population but aecoumted for 353 per cent of the people under payehiatrie fare, The diagnosis of the person under Dichintric care was also significantly as A Socipyeheiogcal Mode! 190 fociated with his sodal staat. The uppar classes (J and LI) were likely to be diagnosed as neurotic, while people fom the lower clases (IV and.) were likely tobe ding nosed peychotic. The respective percentages fof each clas disgnosed nevrotie and. pay chotie were as follows: I; 88 per cent me otic and 47 por cent pevchoties I: 57 per ‘ent neuroti and 33 per cent psychotic; Wk: AM per cent neurotic andl 56 per eM py otic: IV: 28 per cent neurocie and 77 per cent prychotie: Wi 8 per ent neurodc and 92 par cent psychotic. Finally, the type of therapy given members of the social clases difered, the upper classes being more likely to receive prycotherapy, the lower clases boeing mote likely to receive physical treat ‘ments sueh as shock or no specifi weatment ‘other than custody, ‘Two obvious soci) variables which de. serve mention, albeit in passing are sex and ace. Dillrent rates of sexual incidence for varying diagnoses have been frequently noted. (Rose and Stub, 1955). While these Aliflerences are striking, at present litle practical or theoretical ise hoe been made fof them other than in piychoanalvie the fries. Perhaps an illustration of how such differences may best be used is indicated by Frumkin (1958), who presented correlations among income, occupations} prestige, ancl rates of first admission psychiatric hos pital separaeely for men and women, The correlation between Income and_ prestige ‘wat 90 and 74 respectively for men snd ‘women; that between rate of adimision snd prestige wos $81 and 58; and that between rate of adminion and income was 71 and 18 ‘The anciation of cceupational prestige a Income wih admission to prycatrie hor pitals is greater for males dhan females These data indicate that ie would probably be wiser to look for the correlates of vari- ables such as occupational satus than to2104 Socopeychologial Mode Stop with the sociological variable. itself. ‘Tuckman amd Kleiner (1969) iluserate his oi, using an index of ciserepancy betwecn ‘education as an indicator of aspiration ‘and ‘ccupation 28 an indicator of achievement, Rates of admision to hospitals for schizo. Dhrenia were more accurately predicted by Such an index than by measures of social ts alone. ‘This finding seems o have par. lar relevance to Negres, who as a r0up Probably face this Lind of problem more frequently ham whites. Kleiner, ‘Tuckman, and Lavell (1960) replicated the broad findings of the. New Haven study (Hollingshead ancl Redlich, 1953) in Philadelphia, buc also reported dil ferences becween males and females, whites and nonwhites. The schizophrenic dingnens vas applied 0 one in thnce white perions, smile it was given to one in rio nonwhites, This finding was true for both males and females. te was also of interest that across nine diagnostic ‘catgoris, for males and females separately (ie, 18 compsarluns, every ease nonvhites were younger at the tte of first admision tan whites of the same sex and diagnosis Before leaving this topic, itis worth noting that the belief thac a drifé toward lover socioeconomic satus is positively associated ith mental ines, either ay a cause oF 29 an effect is not borne out by the date @Hlciner and. Parker, 1968; “Turner and ‘Wagenfeld, 1967). Nor ie there an increase in mental iMneses, such as psychosis, found among chose individuals who have riten in ‘tlomilp OF he patents cel as me ae fei topeme Qty sad nate Hs Nee Bascel. and Wate 66 Ancor’ ae 96H ant bac, Tr, Val Cacray and ose [ey surveying 128 Sarl acres éy eau LEARNING TO BE NORMALLY ABNORMAL Both in the definition of abnormal behavior tweed in this book and in frequent quam. tions from other authors the point fa been made that being normal i acting ia @ ‘manner expected ot valued by other people, ‘twas noted that mental health profesdonls fulfil a socisl function by providing « mea of social contiol over behavior that violets expectations and causes discomfort tthe iuvicual, his signifeane others, or both ‘The act of diagnosing someone it 2 socal ‘ct, involving the material om which this Aecision is based, the pressimes on the prot sional person making the diagnosis, and a special set of ‘concepts. Sociologists and Avilropologsts have sought to. determine hiether there are specif types of social situations likely 10 lead to a greater number of people acing in an abnormal mater, ta ‘cvemce the question is whether there. are conditions under whieh” the professional ‘10up will apply the label more frequent. {eis clear froon the reports of crosseultal stues thatthe emission of deviant acts and their labeling are learned. General. practi tdoners, mass media, and other social in uences work to delineate when & person {5 to be labeled abnormal and how he Br ts be handled. Heyond this, all the problem of formulating concepts of abnormality are also involved in epidemiology. If one were to take the view of the uppermiddleclaa Professional with his curent concepts of pla Toad wae ‘aaucated with eroocews jut Shes oor cunt showed higher ingoege Sad Pcvslne of majo mental ince he a Se {Bhnite Eeampls of ew cher tess eee h Gwellingunie dency abn sed Fee Ph Sat tne Chcriminaton (Wigan Kops) 1.‘menial illness, it would be easy to acepe the ‘conclusions of the many studies that Gnd that a quarter of the population is mentally ill and that only a minority, perhaps one in six, s well adjusted. As has been described above, people from dicorganized slum ateas and people in the lower scxioeconomie soups are mote likely to receive diagnones {indicating social impairment in general, and in particular to be designated schloplirenic. Yet these findings are thentwelves manifesta tions of the current socal concepts of mental illness and clo not weet am accurate pictine ‘of behavior in American society, since they do not take into consideration the rales of the game by whi they were derived. ‘This section will approach the question ‘of the conditions of ehe indivigual, relatable to Inoader groupe such st clas, residence fares, sex, race, that are likely o lea! to be- havior called abnormal 1f sboormal_be- havior is defined as deviance (rule snd/or ‘expectation breaking) that sanctions poy chitric intervention, then the obvious place (0 sant a diseusion of abormality is not vith the people who break the rules, but Wsith the rules therelves and the ways i vihieh they are lerned, Rules ‘The frst thing about rulet 38 that they are constantly changing. Opportunities for he: havior that previously did not exist now do, And some behaviors that only x shore ime ago were frowned upon sre touaycormidered ormal. In our society the area of sextal fxpresion is the mow novable example. Sues deve fa mu the se way a4 the em Ga, of sina several in this wesne Se ng ed i Sayer tp) 4 Scioprehologiel Moiel 291 ‘There are many ways of focusing on social change, but the following law pasted By the Dritish’ Parliament In 1770. dramatically Points up the diference in socal res them and now. “All women, of whatever age, rank, rofesion or degree, whether virging, maids fo widows, that shall impose upemy seduce ‘or beray into matrimony any of his Majesty's subjects, by scents, paints, coumetics, washes, aifiial teh, false hair, inon stove hoops, high heeled shoes, bolstered hips oF pale oioms shall incur the penalty of the law enforced against witchcraft and. like’ mis emeanors, and upon conviction, that mar faze shall stand nll and void” Another example of changes im roles this fone in the area of religion, deals with how 2 small New Ene the reputation of “godles Harvard". « the very limits of religious irresponsibility sere not reached until 1780, when. the Harvard foculey granted permission to An siican students to attend Chis. Church, Cambridge, instead of the Congregations) smeetinghouse.” (Rudolph, 1968, p. 17) Dur {ng the same exa Yale demonstrated groper atitude by expelling twa students for at tending a revival with their parenis during ‘The secont! thing abour rule ie that there fare many of them. At 2 formal, legal level, the complexity of weitten rule ie basic 10 he existence of professions such as law and accounting. Because there are 50 rmny of ‘them, iti obvious that rules may conf. I Chapter 6 it was noted that 4 person ‘might act in a manner that was unexpected and upsetting to those around im it he fuided his behavior by discriminative stim 1 that were temporally oF geographically sistant and ot shared by those immeditely present, Proper behavior for a. tratemity brother may lead ta role enactments that fre not expected from a good churehaoing$24 Seclopychotogieal Model son who is alo s gentleman and a serious sent At times academic advisers help ewe red ‘ape and break rules so chat the very pur Pose of the institution responsible for the ales may be served. Sich nonconformnity in the service of the organkation is perhaps haractristie of much of bureaucratic soe! ty, an is certainly a necesary feature of Taree paychiattic hospitale ce Ullma 1867s). Confcs among rules are male more likely by the varied mature of our sce ‘The cultural richness and pluralism of Amer fea asa “melting pot" and its telative deree ‘f openness oF opportunity for upwarl mo. Dility mcrease the opeortunity for the ind Vidal to be faced with choices in terms of religion, occupation, and personal conduct ‘There is even the choice to reject the domi nant value structure of the saciety, as mani fested by the “hippies” Conversely the sym bole of having mde a choice may im and of themselves lead 10 aversive consequences ‘There ate periodic reports of court battles over whether igh schoo! students should ‘cut their halr. ‘The ultimate of auch. ynew sures is exemplified by om lowa court’ der. sion (reported in Time, February 25, 1966, o. 48-8) to ree permission for a wn to return (9 father who was a politcal liberal, 8 reader of works on Zen Buddhism, and a writerphotographor without concern for format religious training, s0 that his son ‘could be raised by more conventional grand. parent. ‘tis practically impenible to obey all the rile. Again, the area of sex is one that most Feadily offers illustrations, There is the The cumple touches on tno glo whi ace ged foto de follwing mate, ta et “rk cific Yh Sean tat pon, il ct teak ts‘ there i opened ee ain pl though “egdnte teste (Ceca in. repeated observation, biel om work such a8 the Kinsey report, that in thle sexual behavior atleast 95 per cont of the Amer ‘an population has “broken. some. written rule at some time oF ocher. Wallerstem atid Wile (1947) repor: 99 per cen of respondents from the general population admitted w haying commicted one or more oflcmes serious enough to draw & maxismim sentence of not less than a year, For example, among men, 84 per cent had committed malicious mischiet, 88 per cent disorderly conduc, and 89 per cent larceny. OF the men, 87 pet ene admitted to tax evasion, while only 40 er cont of women admitted to this offense, Among the women 81 per cent admitted to malicious mischief, 76 percent e disorderly fonduct, and 89 per cent to larceny. Ap. Droximately three-fourths of both men. and ‘women admit vo imleceney. Rules stan! functionally in the same light 1 the concepe of postive mental est pevfoct aherence 16 the criteria is rarely found. 1 a policeman enforced all the minor violations he noticed in his rounds, he would spend so much time testifying in cour that he would not be able to fulfil his fometion of protection against and detec: ‘don of major crimes, Further, rigorous and. complete enforcement of the laws would fil Texond capacity the communicys mental hospitals and jails Finally, complete en forcement of rules would probably bring & Teaction that would lead to the termination ‘of many rules and aversive consequences the promualgators all rules cannoc be enforced, there are {wo jmportamt considerations The fist is that breaking the role ie not sufficient for the Tabel of deviant or abnormal. can wel bee argued that being caught. and publicly Tabele san integral and possibly even nec sary step in a cancer of deviance. ‘The second consideration is that justethe form of apprehension and public la ig is omevenly administered. Many breaches of rules are ovetiooked or minimnelly Punished becuse they are not "worth the trouble” of enforcing. Specieally in the realm of aboormal behavior, the ssime ac ons may meee with wlerance or with fofesional ceaunene depending onthe Aegiee w which significant others are an nye Associated with the unenforceability of all rules isthe concept that rules may be x0 breached that their violation iy itself instt Sonalized. Rule following. ike any other behavior, must be worthwhile. Ifthe co af breaking’a rule iy Tew than he cont of fol Jowing i. the rule is Hikely vo be. broker Lament (1907, p. 11) makes ehie point terms of compliance sith weight regula. tions by trucks om northern California high aps Ifthe cost of two trip i greater than the cox ofa single tip plus fine, the aw is likely to be broken, and fines for vioat will be accepted as a normal com of bus ness. This is accepted by state offal to the fxtent chat trucking companies are sent monthly statements of fines de, ‘The fact shat change in che expectations f individuals i¢ controled by subsequent reinforcement is lusrated on a community Wide scale by two parallel studies, Leighton (2965, pp. 251282) tells how a power com: any built a dam and provided employment ‘ver three years for a poverty-stricken com. munity. The people discovered. credit and tppliances, particularly television, whieh introduced then to general American values. 'The breadwinners ako discovered some ‘hing else about television sets: if they did ‘ot retain their jobs and. pay premiums on the set, somebody came along and took then away. They were shun trapped inso working steadily, One result ofthis was that the men {40m this community, who had. previously 4 Sociopseholgial Model 208, ‘nad a reputation for being poor employees, fradually developal the opposite Kind of reputation” The parallel instance ss where employment ceases Cottrell (1951) relates Dow a shift to the use of diel engines dix rupted the economy of @ town. The lower lasses, lacking a major investment, auld more to other places, but the mote tle, propertid classes shifted. cowand! radicalism and ideological rebellion Rules, informal expectations, and writen Janes are discriminative stil. That i. they cate the conditions under sehich certain behaviors will have reinforcing conse quences. With asocation, ether sul taneous oF chained, they become scired reinforcers, But as such, they may be ex tinguished. An overwhelming ination such 8 that in Germany during the 1920' is an ‘example of one of Western cullzation’s most widely used secondaty reinforcers be- ‘coming invalid for an entire population. Roles sill be adhered to only if adher ence is worthwhile. Lemert (1967, p. 15) for example, notes that the Naval supply se tion in San Francisco observed weight die tribution guidelines om axles of trucks in 2 ‘manner pot slone by private concerns, The private firms could write off trucks as de recited equipment, while the Navy eould ‘ot do this and ada low budget for min tenance. Thus the lacter were involved in a slovation in which there was reinforcement for rule adherence which was not true for the former, ‘A hey point on the development of ues was made by Leighton's example of che men who were tapped into work. Not only ‘must the Yole enactment be physically por sible, but its continuance must be worth- while. A. good example of this is King’s (0950, p. 116) quotation of a ananifeso by an American Indian ibe that seas back sliding in terms of the rolex laid down ByBt Secioprehological Moet missionary workers: “Nov more blanket, no ‘more hallelujah!" There is in rules an, ine plied reciprocal obligation that when per on enacts a role, he will be reinforced for it by other people. When this contrat i broken, altcnacive behaviors are. emned, The Indians bad been shaped into religious Bructicesdeviane (or them. namely, Ch nity, but they were not adequately main tines by sobuequent reinforcement Riots im the Negro ghetin display simi principles If 9 person fas studied and iol, lowed the rules properly and then eanmot ‘ind 2 job, he may question the entire pro: secure. As one young man std, "t put my faith in the Man and he didn't come hrough.” A ric iy am alternative behavior to playing by the rule. In addition, sone ows hhave obtained shorcrun benefits that should hhave been forthcoming without the riot bu A third point about rales is that fre- quently virtue isis own reward, there blige 0 other. The likelihood of reinforcement for rulefollowing behavior is not as qreat 4 might be desirable. While the. mais media glorty the self mate man, and while the religious ethos of the country is one of selfzesponsibility and opportunity, Irmived fly by personal cffore Fromm, 1941, 1947, Tawney, 1926), the face of life are th. ‘om at the top is restricted rather than ume limited. ‘The majority of the large organi ons in which Americans increasingly live, Yeork, worship. and play are pyramidal, oy that the farther ome se, the fewer are the Positions available above him. Axide from limitations in opportunity, there ave limite ions in aitivy which have Hite Mf anything todo with effort. There i frequently 4 gop beoncen aspiration (what one label ay the 4001 lie) and accomplishenent. The cultne fnifoences what the good life will be. In the United siates dey mats mia such as tele, vision provide meiels of the good life few. appliances) which are frequently unstte able by the general public A fourth festure of rules is that they are mace by people in power, that ix by people who are in positions to dispense reftforces ‘To make a formal rule, especially 4 writen ‘one nich as a la, i a'major enterprise on the pare of many people. 2) implication ‘here are conditions that hese in power wih to perpetuate aid other condition, acts by people (nwally specific individual) ‘hat they wish to minimize, The English Jaw aginst the use of deceit by women in the auraction of imen was mace by men Jn terms of unwritten rules, there ss be 4 standard of what is expected and nora behavior. As note! in the review of prev. lence studies earlier in the chapier, there are rnany individuals in the population who ‘mighe be termed mentally il het who aan fe to make some sort of socially appropriate ‘juste. ‘The societal agent who Sniposes Tales is likely to be a member of the lass currently holding power. If «person has not ben taught the rules of & particular group, he will be considered strange and abnormal by members of it: On the one hand, he iy have ad, at bet. minimal exposine to such les, oF having ‘had such exposure, lite ‘portonity or reinforcement fer following sch rules It is in thie tegaed. that fe ‘essonable that lower socioeconomic: Cases should have higher rate: of both prevalence And incidence of severe “abnormalities” In similar fashion, ie te restorable. thet the Detter onganived the perton’s soctal group, “and the mote reinforcing contact he has with ‘ther people, the lower will be the tater af incidence amd prevalence of mental len Finally, the closer the person ts in socio, economic, educational, amd common salve sacem t© the socieeally ssnetioned labeler, "Oe more likely itis that is behavior wilbe understandeble to the labeler and hence ot as readily diagnosed ax mentally iL” Rule Learning and Social Movements Comidering the side range of behaviors that are appropriate across ditlerent cultures, the specie acceptable pattern of behavior Jin any given time and place is severely ve suite, The conformity of college stents an! peofemors isan example: college educe tion i an elaborate preparation covering ‘any years and many couries. Some of the cours hive title immediate valve, either In terms of the students? ca fwcare jobs, Healthy, iatelligene young people delay the acquisition of various mate- tial goods and of centsin interpersonal rls ion i order to maser this material. In similar fashion the typicelcollere profesor leads alle of unparalleled poverty, chastity, tnd obedience in which scholarly aedvity 38 highly valued, although his more esoteric Publications are rately read and bis more fopular productions such as textbooks ate requently understooi. To an objective tbserves, student and profestorial behavior fm formate the developraen! of a "normat™ ferson, be he student or professor, ame will Daye description end se of principles for dealing with ony leorned bizerre behavior. ‘Timothy Leary made this point cogently when he eid there nothing 4 far out 36 2 square. ‘Laxming to be normal or abnormal fol: ows the model outlined in Chapters 4 nd IK AL this poine it ncods only to be recapitu Edwatio, relon, and rie ae expe of A Swcopochologial Model 205 Tated that the cues must be present, the mem sagen attended to, acted pom, an reir forced. A person may emit “abnormal” be: Inavior Because he ha failed to learn the acepied normal pattern of behavior oe bee cause, having leaned i, he was extinguished {or Its emiston and reinforced for emision of sltemaive beKiavior. Ullmann (1968) has pointed out tha just os there ie no cleer definition of abnormal be havior, 40 there is no clear defrition of & social movement. Working with definitions of various social movements Ullmann noted 4 marked similarity between debnitions of ‘members of a social movement and. dei ons of abnormality such as that of Rosen. and Gregory (1965, p. 1), cited in the frst chapter of this book): members of socil movements are statistically ferent from the majority oF dominant group of the cul. te; ate upset or unhappy with current affairs 3b tndicaued by thelr working toward social change; and donot conform to all aspects of the dominant culture. A. perion joining or detecting from 2 social move ‘ment may be used as a model for a person starting or ceasing to follow the accepted form. In this regard, some quotations from ‘Toch are enlighten [Unwed of dhe monement i hus wen ed gredualy Fits fem eupon ae sacefccd fovbir about minor matters come to the fre Diner "weakneses” are peeved and evenly, the Bonde linking rtcaer 1 movement become fsckcienty tenons to map under are (Tach, 1965, p 165} The converts diloned person, tnd dullionment isa low, eaepious pe fof ange Ie base with undercover resets te the efot of reruaning lal. represent 4 umutaive record of the cons of adaptation ‘Wheier i dies fo Ts sappresed wate or becomes peblideed in avarenes depends on the Mumber nd the amport of diloioning expelencr that fre encountered. 2 perzon will fond 10 be:B08 Sciopeychologial Mods! come dsisioned he becomes eetioel imcoived fn lite siteations for shich he har been ibpne ‘ered by secalation 1963, p. 138] A god illustration of these concepts was presented by Rosenthal (1954), who. de- Secibed the abandonment of the traditional Jewish pattern by young lower-class people in a small Polish town between the two World Wars The main determinant of status for the total growp lay in learning, anid gon deeds. Being able ro pay this soe epended in carn on wealth and leisure, and young people in the lover clas were at a severe disadvantage, Since they could not compete in a way of life in which the cen- tual values were clfeul if not imposible 0 auain, they were more Ukely wo forsake the ‘nay of life altogether. ‘The development of behrsviors that sre labeled abnormal may teach a great deal about the development of ehaviors la beled normal. ‘This is the import of many ff the case examples in Chapters 4 and 5. ‘The areas in which shaping to a recognized abnormal pattern have heen most exten: sively presented (see Chapter 20) are in term of marijuana smoking. (Recker, 1968) and schbophirenia (Ullmann, 19672). ‘To become 2 marijuana smoker, fist of all 2 person must physically be in a. geo raphieal, temporal, and social environment ‘where marijuana is available, A. stixdent Tived in a protected environment ijmama yeas not available and who had therefore followed other patteris ‘may, upon entering collere, find that his previous patterns of social behavior, sel 28 dependence on parents and teachers, serious and dedicated wnemorization of textbooks, an the lke, e no longer rewarded a they ere im igh school. He may be extinguished for square bebaviors and go to pot. After haying the role available, he rst smoke {ennet the role) And even that isnot enough the must learn eo smoke marijuana properly jn onder to get the kick Next he nu identity the effect of the drug, and finaly the must label the clanges (note the Schachter and Singer, 1962 work cited in Chapter §) 00d and pleasurable, These com: represent siccesive stages, and failure to enact or be reinforced for any stage is likely o lead to a decreate of the Dehiavior This model is directly applicable to the use of aleohol or indulgence in sexi inter: course and involves seduction of ties 10 6 prior evaluative system and. of aversive con sequences jor deviation jrom it, Such 8 step ‘wise progression was called shaping in Chap: ter 4, but st may also be called a career. To become a physician a person mins get into college, take presmed courses, then move through medical school snd internship. Failure (cessation of reinforcement) at amy point will trminate the corees, Ac the point of being extinguished or, in Toch’s terms. disillusioned, the person. may it many dillerent behaviors, The ones that are reinforced are likely to increase fn emissidn, while those not reinforced are likely to Uecrease. Once again the important clement making for the stability of a pat tem of behavior, whether labels! normal or abnormal, is reinforcement. The fact that prevalence rates (the number of people who might be labeled) are so much higher than incidence rates (the number of people who are actually. Jabeled, hospitalize, and treated) is ken by Schell (1986) to be in icative of the fugacious nature of much ‘mental ines.” From this datum, the great amount of "residual deviance,” the ile ference between prevalence and incidence, and, more generally. the mear_aniversa Dresence of some deviant jrule-breaking) be Iavior, Scheff, lke a number of other soe: