SOCIETAL INFLUENCES ON PSYCHOPATHOLOGY: PREJUDICE AND

DISCRIMINATION IN RACE, GENDER AND ETHNICITY, SOCIAL

CLASS AND STRUCTURE, POVERTY AND UNEMPLOYMENT

INTRODUCTION

- The health and disease process is multifactorial in nature, so it is necessary to

understand that the presence of psychopathology does not occur individually or isolated
from an individual’s environment, but rather the environment influences the individual,
family and socio cultural factors that affect the ecosystem.
- The World Health Organisation in 2009 released a document on Mental Health,
Resilience and Inequalities. This document points out that the unequal distribution of
power, income, goods and services affect living conditions such as health care,
education, housing, work and environment. The importance of the determinants of health
is highlighted recognizing that morbidity and mortality are linked with social structure
which in turn includes economic, political and social influences that imprint a marked
health inequity.
- Mental health is influenced by a complex interrelation of sociocultural conditions,
which include poverty, disorderly urbanization, lack of housing, lack of education all of
them which are dependent on national and international government policies and
economies, responsible to a large extent for the inequity and injustice of the distribution
of resources.
- The factors that influence psychopathology range from social demographic aspects like
gender to macro social aspects like politics and economics. International research
indicates that these problems are of higher prevalence in the female population, with low
incomes and also belonging to indigenous communities.
- Looking into other aspects, lack of financial resources is associated with a greater
severity of mental illnesses. Economic recessions, unemployment and low income are
associated with mental health problems like anxiety, which tend to be more common
among women.
- When education is considered, unfinished education is related to substance abuse,
anxiety disorders, mood disorders and difficulties in impulse control.
 - When other social demographic aspects are considered, being separated, divorced or
widowed does increase the risk of developing mental illnesses.
- The term psychosocial takes into account the psychological or emotional or cognitive
impact of the social factors, which need to be distinguished from other factors. For
example, if unemployment is considered, the loss of income alone is not considered to be
a psychosocial factor, but the loss of self esteem that comes as a part of unemployment is
a psychosocial factor. Individual psychological variables like one’s confidence, self
efficacy, optimism etc. are all connected to that individual’s social circle. As social
position influences emotions, cognitions and behaviour it is challenging to separate other
contextual factors from them.

SOCIETAL INFLUENCES ON PSYCHOPATHOLOGY: PREJUDICE AND

DISCRIMIMNATION IN RACE, GENDER AND ETHNICITY

- When the role of discrimination, stigma and prejudice is considered in the

development of psychopathology, one aspect that needs to considered is the age at the
which the person first begins to understand and process the experience of discrimination,
prejudice and oppression. Thus, children’s experiences of discrimination, prejudice, and
oppression may begin to influence developmental trajectories, including those related
to psychopathology, at a young age. The parents’ experiences of discrimination,
prejudice and oppression can also affect the health of the children throughout the
development, possibly beginning at the earliest perinatal stages, where stress is known
to affect the development of the child.
- One of the models that need to be considered, is the diathesis stress model, which is
highly important when perceptions of discrimination, prejudice and oppression are
considered. This is considered to exacerbate psychological and physiological stress
systems. For example, the anticipation of potential experiences of prejudice has been
found to lead to responses that are similar to psychological stress. When research in
United States of America is considered, all minority ethnicities, report distress related to
discrimination both from peers as well as educational institutions. The model supports
that perception of discrimination, prejudice and oppression contributes to the onset as
well as maintenance of psychopathology by increasing environmental stress in
individuals from marginalized groups who have a biological predisposition.
- A lot of studies have been carried out to find a link between perceptions of
 discrimination, prejudice and oppression and internalizing symptoms in youth and
adults from ethnically and racially marginalized groups. EG- In a sample of African
American adolescents, perception of racial discrimination was correlated with lower
levels of psychological functioning, including increased perceived stress, increased
depressive symptoms and poorer general psychological well being. In African American
boys, perceived experiences of racism were related to internalizing symptoms and
depressive symptoms. A study that was conducted in a sample of adolescents from
Puerto Rico it was found that perceived discrimination had associations with increased
depression and stress. Some ethnic groups have also been found to be at greater risk.
Research suggests that the African American youth from the Caribbean, have a greater
vulnerability towards depressive symptoms when reporting of greater perceived
experiences of discrimination when compared to other African American youth. The
research of associations between discrimination and internalizing symptoms have found
that they persist, with longitudinal research which examined African American and the
Asian population finding that perceptions of discrimination from peers or others have
been linked towards depressive symptoms.
- Research has also linked perception of discrimination, oppression and stigma with
increased externalizing behaviour in youths. For example in a sample of African
American boys, perceived experiences of racism have been linked not only with
internalizing symptoms but also an increase in externalizing behaviours. Early perception
of discrimination have also been linked with conduct disorder diagnoses in African
American children. Among African American families, perception of racism has also
been linked with substance use in both parents and children of the family.
- Further research focused on whether there is a link between perceived discrimination
and cumulative ecological risk (neighborhood disadvantage or other stressful events)
and whether each might be linked with psychopathology in African American and
European American adolescents. Cumulative ecological risks were found to have
association with both internalizing and externalizing symptoms across both groups.
However in the group of African American adolescents only, perceived discrimination
was found to have a moderating effect between the ecological risk and externalizing
symptoms, especially delinquency. Higher the perceived discrimination, more stronger
the ecological risk and delinquency.
- Perceived racial discrimination has been found to significantly increase the likelihood of
 development of mental health symptoms in marginalized adults, up to 15% of the
variance in African American adults’ psychopathology symptoms can be explained by it
and also increase psychopathology rates in Asian, Hispanic and African American
adults. A metal analysis of 138 studies which looked into racism and health in adults
noted significant links between racism and negative mental health and health related
behaviours. For example, greater perceptions of racism have been linked with
greater psychiatric symptoms and increased frequency of cigarette smoking.

SOCIETAL INFLUENCES ON PSYCHOPATHOLOGY: SOCIAL CLASS AND

GENDER

- Among the first to identify the inverse correlation between socioeconomic status and
mental illness were Faris and Dunham who found a disproportionate rate of mental
illness in the poorest parts of Chicago (Faris and Dunham, 1939) The social
disorganization hypothesis was proposed by Faris and Dunham (1939), who observed
that the majority of psychiatric patients admitted to a mental hospital near Chicago, in
the United States, came mainly from inner-city areas. Based on this observation, they
speculated that extreme social disorganization, characterized by poverty,
communication breakdown, high mobility and transiency, racial conflict, social isolation
or other unfavourable social conditions that were often observed in urban settings may
contribute to high rates of psychopathology, particularly schizophrenia. The social-
disorganization hypothesis was questioned by many scholars, who pointed out that it was
not undesirable social conditions that contributed to major mental disorders, but that
severe mental patients, who have difficulty surviving in ordinary communities, tended to
drift into poor, disorganized community settings.
- Social attraction hypothesis was stated by Robert Hare which pointed out that the
inner city of Bristol contained both rich and poor people. Hare found that there were
areas where schizophrenic patients congregated. This phenomenon led him to
hypothesize that social disorganization in some inner-city areas can attract
schizophrenic individuals who find social contact aversive.
- Chance in 1964 focused on social cohesion instead of social disintegration. He
reported that there was a significant correlation between social cohesion and
depression, namely, severe feelings of worthlessness and guilt tended to occur among
members of highly cohesive groups.
 - After World War II the landmark study by Hollingshead and Redlich examined rates
of psychiatric disability in New Haven, Connecticut. They found that 1% of their
psychiatric cases were in the upper class, while this class consisted of 3.1% of the
population; in contrast, 36.8% of the psychiatrically disabled were from the lowest
class, while this group consisted of 17.8% of the population (Hollinghshead and
Redlich, 1958, p. 199). The inverse correlation was subsequently attributed to the
disproportionate numbers of mentally ill in the lowest two classes rather than
differences between the other three groups (Mishler and Scotch, 1965, pp. 258-305).
- A total of 21 studies conducted throughout the world between 1950 and 1980 reported
rates of psychiatric disorders according to class. While 10 of the 15 non-United States
(US) studies found the highest rates in the lowest class, five out of the six US studies
obtained the same finding. In the US studies the lowest class had 2.37 times the rate as
that in the highest, on average. Across all studies there was an average rate of
psychopathology in the lowest strata 2.73 times that which was found in the highest
class (Dohrenwend, et al., 1980, pp. 55-58).
- The relationship holds up not only between occupations of various prestige levels but
within occupational categories as well (Blauner, 1964). Blauner and Kornhauser both
found that lower status employment, that which is repetitive and menial and which
offers little opportunity for advancement, is associated with high rates of mental illness.
- The relationship of educational level with psychopathology is also fairly consistent.
Eaton found that while 3.8% of those with grade school education developed
schizophrenia, only 1.9% of those with a high school education, and 0.3% of the
college educated developed the same condition, and that this did not vary by urban or
rural location.
- Rushing and Ortega, similarly, found an inverse relation between education and both
schizophrenia and organic brain disorders, and that this did not vary by sex. They also
reported an inverse relationship between education and manic depressive psychoses,
neuroses, and personality disorders, and one which was of a more complex curvilinear
nature.

SOCIETAL INFLUENCES ON PSYCHOPATHOLOGY: POVERTY AND

UNEMPLOYMENT

- Most notable finding is that of a positive relationship between socioeconomic status and
 the neuroses,
- a strongly negative relationship with the psychoses and personality disorders
(Hollinghshead and Redlich, 1958).
- It was suggested that while lower classes externalize their pathology in the development
of "anti-reality" alloplastic psychoses and personality disorders,
- the upper classes tend to internalize conflict in the development of "anti-instinctual"
autoplastic neurotic conditions.
- Recent findings, however, have failed to confirm Hollingshead and Redlich
conclusion that there is a positive socioeconomic status-neurosis relationship.
However, the relationship does vary with type of psychopathology, with the strongest
relationship occurring with the most severe conditions, the personality disorders and
psychoses, in particular, schizophrenia. The correlation has typically been characterized
as being linear.
- Individuals who experience poverty, particularly early in life or for an extended period,
are at risk of a host of adverse health and developmental outcomes throughout their
life. Poverty in childhood is associated with lower school achievement; cognitive,
behavioral, and attention related outcomes; higher rates of delinquency, depressive and
anxiety disorders; and higher rates of almost every psychiatric disorder in adulthood.
Poverty in adulthood is linked to depressive disorders, anxiety disorders, psychological
distress, and suicide.
- Poverty affects mental health through an array of social and biological mechanisms
acting at multiple levels, including individuals, families, local communities, and nations.
- Individual-level mediators in the relationship between poverty and mental health
include financial stress, chronic and acute stressful life events exposure, hypothalamic-
pituitary-adrenal (HPA) axis changes, other brain circuit changes (e.g, language
processing, executive functioning), poor prenatal health and birth outcomes, inadequate
nutrition, and toxin exposure (e.g, lead).
- Family-level mediators include parental relationship stress, parental psychopathology
(especially depression), low parental warmth or investment, hostile and inconsistent
parenting, low-stimulation home environments, and child abuse and neglect.

- The evidence is strong for a causal relationship between poverty and mental health.
However, findings suggest that poverty leads to mental health and developmental
 problems that in turn prevent individuals and families from leaving poverty, creating a
vicious, intergenerational cycle of poverty and poor health.
- Economic inequality affects mental health independently of poverty. Both
internationally and within countries including the US, area-level income inequality has
been associated with mental health outcomes including more depression, poor self-
reported mental health, drug overdose deaths, incidence of schizophrenia, child mental
health problems, juvenile homicides, and adverse child educational outcomes.
- The relationship between unemployment and poor health has been well documented.
The unemployed tend to have higher levels of impaired mental health including
depression, anxiety, and stress, as well as higher levels of mental health hospital
admissions, chronic disease (cardiovascular disease, hypertension, and musculoskeletal
disorders), and premature mortality. Some longitudinal studies have shown that higher
levels of depression and unemployment are not just correlated, but that higher levels of
depression are a result of unemployment. Other prospective studies have found that
poor mental health contributes to unemployment. A study by Montgomery et al.
showed that subjects who had recently become unemployed had an adjusted relative
risk for depression and anxiety compared to those who had not recently become
unemployed. Additionally, unemployment is associated with unhealthy behaviors such
as increased alcohol and tobacco consumption and decreased physical activity.

CONCLUSION

Mental health is a key pathway through which social inequality impacts health. There is
overwhelming evidence that inequality is a key cause of stress in itself and also exacerbates the
stress of coping with material deprivation. Mental health itself is produced socially.
Opportunities for individuals and communities to retain or achieve social recognition and to stay
or become connected contribute significantly to resilience, but are frequent casualties of adverse
economic and cultural trends. The presence or absence of mental health is above all a social
indicator. Therefore policies and programmes are needed to support improved mental health for
the whole population.
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