NEUROSIS AND SOCIAL CLASS
I: Social Interaction
LAWRENCE Z. FREEDMAN M. D.1, and
AUGUST B. HOLLINGSHEAD PH. D.2
1 The department of psychiatry, Yale University, New Haven II, Conn.
2 The department of sociology, Yale University, New Haven II, Conn.
We advance the hypothesis that the diagnosis of neurosis is the resultant of an interaction process involving the patient, the doctor, and the social group. A psychiatric census shows that the prevalence of neurosis is positively correlated with social level and that there are important differences in method of referral of neurotics from the various social classes. [SEE SOURCE PDF FOR TABLE 5] By use of a psychological symptom scale, we describe a class configuration, ranging from subjective, introversive symptoms in the top classes to somatic complaints and behavioral difficulties in the lower classes. A social interaction index reveals that the locus of conflict progressed through increasingly wider areas of social dislocation—ranging from intrapersonal symptoms in Classes I and II to severe social and legal collisions in lower Classes IV and V. Correlation of all psychological symptoms and social interaction shows this consistent increase in social difficulties. The correlation of character disorder and social interaction illustrate these relationships in a striking manner.
Several operations now in process add to their significance: (a) Professional orientation of the psychiatrist, whether analytic, analytically oriented, or eclectic, is positively correlated with class; (b) patterns of symptoms are positively correlated with class; (c) symptom pattern and social interaction index are also being correlated.
From these findings, and from complementary results of the over-all investigation, we adduce that treated neurosis is a process within a social context which can be best understood by systematic observation not alone of the individual but of his interpersonal gestalt. Certain distinguishing characteristics of the social classes are reflected in the neurosis itself.
