SCHIZOPHRENIA AND SOCIAL-CLASS
SCHIZOPHRENIA AND SOCIAL-CLASS
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DOI：
10.1192/bjp.109.463.785
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发表时间：
1963-01-01
影响因子：
10.5
通讯作者：
MORRISON, SL
中科院分区：
文献类型：
--
作者：
GOLDBERG, EM;MORRISON, SL
对英格兰和威尔士首次因精神分裂症入院的 25 至 34 岁男性全国样本进行的记录调查显示，社会阶层 V 的患者通常过多。然而，患者出生时父亲的社会阶层分布与整个人口的社会阶层分布非常相似。一项对居住在伦敦外城区社会混杂地区的 15-30 岁男性精神分裂症患者连续入院的一系列代表性临床研究证实了这些发现。它显示了从父亲到儿子以及患者自己的历史中职业地位的下降。个人向下“漂移”的主要证据是精神分裂症患者有能力在文法学校赢得学位，尽管他们最终从事的是半熟练和非熟练工作。就业史表明，许多患者在青春期从事不同的职业，其中相当一部分以专业或技术工作为目标；他们仍然大致符合家庭环境的职业期望。父子之间社会表现的差异主要归因于疾病过程。青春期起病隐匿的患者没有获得任何专业或技术技能；那些在入院前病情急性发作的人在入院前不久社会阶层下降；而那些精神不正常以及患有精神分裂症的人根本没有达到任何技能水平。这种社会漂移似乎对最高和最低社会阶层的影响最严重。 13 名文法学校男生中只有一名患者达到了社会 I 级或 II 级身份，而到调查结束时，超过一半的社会 V 级学生已经退出劳动力市场。另一方面，社会阶层 HI 和 IV 中三分之二的患者在需要中等技能水平的工作中生存下来。这些发现表明，严重的社会经济剥夺不太可能对精神分裂症具有重大的病因学意义。另一方面，尚未明确定义的职业因素似乎对疾病的病程有一定的影响。
A documentary survey of a national sample of males aged 25-34 on their first admission to a mental hospital in England and Wales for schizophrenia showed the usual excess of patients in social class V. However, the social class distribution of the fathers at the time of the patients'' birth was very similar to that of the population as a whole. A clinical study of a representative series of consecutive admissions of male schizophrenics aged 15-30 living in a socially mixed area in outer London confirms these findings. It shows decline in occupational status both from father to son and in the patients'' own history. The main evidence of individual downward "drift" is the ability of schizophrenic patients to win places at grammar schools, though they end in semi- and unskilled jobs. The employment histories showed that in their adolescence many patients pursued varied careers, a considerable proportion aiming at professional or technical jobs; they still fitted broadly with the career expectations of their home environment. The discrepancies in social performance between father and son could be mainly attributed to the disease process. Patients whose illness had an insidious onset at adolescence did not attain any professional or technical skill; those whose illness started acutely before admission dropped in social class shortly before admission; while those who were mentally subnormal as well as schizophrenic did not achieve any level of skill at all. This social drift appears to affect the highest and lowest social classes most severely. Only one patient out of 13 grammar school boys attained social class I or II status, and over half of those in social class V had dropped out of the labor market by the end of the survey. On the other hand, two-thirds of the patients in social classes HI and IV survived in jobs requiring a moderate degree of skill. These findings suggest that gross socioeconomic deprivation is unlikely to be of major etiological significance in schizophrenia. On the other hand, occupational factors, yet to be defined clearly, appear to exert some influence on the course of the disease.