Social Class, Mental Hygiene, and Psychiatric Practice

A discussion of 2 important problems of mental health work: how to help more effectively & how to induce people to seek help. The discussion, centered mainly on the Ur child-guidance clinic, is assumed to be generally applicable to other psychiatric agencies. It is fairly well established that child-guidance clinics serve a largely Mc clientele, & that Mc clients are served better than Lc clients. The message of mental-hygiene advocates, though directed to all, reaches & is palatable to Mc individuals mainly, because of the content & the mechanisms of dissemination. Mc persons are more likely to feel the need for child-guidance services because of the nature of Mc family, comparative SE stability; & leisure which allows time to do something about parent-child problems. Mc value orientations correspond with mental health propositions; Lc values do not. There is a highly probability that it will be an essentially Mc group which reaches the clinic even for initial contact. Evidence exists that Lc applicants are selected out proportionately once they reach the clinic. The reason for this & lower quality service for Lc clients is explaned by Hollingshead & Redlich, (See SA 6992), & probably correctly, in terms of convergence of Mc standards & the frames of reference of clinic personnel. Proposals by Hollingshead & Redlich for the development of a new kind of psychotherapist to work with Lc clients are, however, criticized. Skepticism is expressed as to the suggestion that soc workers could play a role in this approach, because of status insecurity, status-striving, & Mc identification. The mental-health movement has come to grips only in peripheral ways with the issue of Lc mental health. Rather than trying to devise means of reaching the Lc with preventive mental health messages, the movement might better proceed to influence legislation aimed at eradication of soc problems that contribute to high incidence of psychiatric breakdown in the Lc. C. S. Harm.