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Excerpted from Hollingshead AB, Redlich FC. Social Class and Mental Illness: A Community Study. New York, NY: John Wiley; 1958.
AMERICANS PREFER TO AVOID the two facts of life studied in this book: social class and mental illness. The very idea of "social class" is inconsistent with the American ideal of a society composed of free and equal individuals, individuals living in a society where they have identical opportunities to realize their inborn potentialities. The acceptance of this facet of the "American Dream" is easy and popular. To suggest that it may be more myth than reality stimulates antagonistic reactions.
Although Americans, by choice, deny the existence of social classes, they are forced to admit the reality of mental illness. Nevertheless, the thought of such illness is abhorrent to them. They fear "mental illness," its victims, and those people who cope with them: psychiatrists, clinical psychologists, social workers, psychiatric nurses, and attendants. Even the institutions our society has developed to care for the mentally ill are designated by pejorative terms, such as "bug house," "booby hatch," and "loony bin," and psychiatrists are called "nutcrackers" and "head shrinkers."
Denial of the existence of social classes and derisive dismissal of the mentally ill may salve the conscience of some people. The suggestion that different social classes receive different treatment for mental illness may come as a shock, but to repress facts because they are distasteful and incongruent with cherished values may lead to consequences even more serious than those we are trying to escape by substituting fantasy for reality. . . .
Detailed evidence will be presented in this book to support the answers we have reached. If our answers support American ideals of equality, class status should have no effect upon the distribution of mental illness in the population. Neither should it influence the kind of psychiatric treatment mentally ill patients receive. However, the reader should remember that our ideals and our behavior are two different things.
Both social class and mental illness may be compared with an iceberg; 90% of it is concealed below the surface. The submerged portion, though unseen, is the dangerous part. This may be illustrated by recalling what happened when an "unsinkable" trans-Atlantic luxury liner, the Titanic, rammed an iceberg on...