Skip to main content Accessibility help
Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-05-28T08:52:03.089Z Has data issue: false hasContentIssue false

7 - Class exploitation and psychiatric disorders: from status syndrome to capitalist syndrome

Published online by Cambridge University Press:  25 August 2009

Carles Muntaner
Social Equity and Health Centre, Social Policy and Prevention, Department Centre for Addictions and Mental Health, Toronto, Canada
Carme Borrell
Agencia de Salut Publica de Barcelona, Barcelona, Spain
Haejoo Chung
Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltmiore, MD, USA
Carl I. Cohen
SUNY Downstate Medical Center
Sami Timimi
Lincolnshire Partnership NHS Trust
Get access


Psychiatric epidemiologists were among the first scientists to document that the poor suffer from a higher rate of psychiatric disorders than the affluent. Psychiatric disorders and, more precisely, psychiatric research have propelled many studies on social class and psychiatric disorders which reflect the humanistic concerns of psychiatrists. These studies were motivated by a desire to improve the living conditions of workers, immigrants, and racial or ethnic minorities (e.g., Blazer et al., 1994; Eaton et al., 2004; Jacobi et al., 2004; Lahelma et al., 2005; Regier et al., 1988; Roberts & Lee, 1993). The absence or poor quality of psychiatric care for poor working class, immigrant, or racial and ethnic minority populations (Muntaner et al., 1995a; Alegria et al., 2000; Cohen et al., 2006) raised a related set of concerns about the implications of economic inequality for the treatment of psychiatric disorders.

The psychiatric and public health perspective on social class has been characteristically “pragmatic” (e.g., Asthana et al., 2004). Following the ethos of public health and medical care, the goal has been to “act upon the world” to reduce suffering and increase well-being (Navarro & Muntaner, 2004). Psychiatric disorders, which have a major worldwide impact on disability, are the leading cause of disability among women and, by 2020, are expected to become the main cause of years lost to disability (Murray & Lopez, 1996).

Liberatory Psychiatry
Philosophy, Politics and Mental Health
, pp. 131 - 146
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Alegria, M., Bijl, R. V., Lin, E., Walters, E. E., & Kessler, R. C. (2000). Income differences in persons seeking outpatient treatment for mental disorders: a comparison of the United States with Ontario and The Netherlands. Archives of General Psychiatry, 57, 383–391.Google Scholar
Artazcoz, L., Benach, J., Borrell, C., & Cortes, I. (2004). Unemployment and mental health: Understanding the interactions among gender, family roles, and social class. American Journal of Public Health, 94(1), 82–88.Google Scholar
Artazcoz, L., Benach, J., Borrell, C., & Cortes, I. (2005). Social inequalities in the impact of flexible employment on different domains of psychosocial health. Journal of Epidemiology and Community Health, 59(9), 761–767.Google Scholar
Asthana, S., Gibson, A., Moon, G., Brigham, P., & Dicker, J. (2004). The demographic and social class basis of inequality in self reported morbidity: An exploration using the health survey for England. Journal of Epidemiology and Community Health, 58(4), 303–307.Google Scholar
Bartley, M. & Marmot, M. (2000). Social class and power relations at the workplace. Occupational Medicine: State of the Art Reviews, 15, 73–78.Google Scholar
Blazer, D. G., Kessler, R. C., McGonagle, K. A., & Swartz, M. S. (1994). The prevalence and distribution of major depression in a national community sample: The national comorbidity survey. American Journal of Psychiatry, 151, 979–986.Google Scholar
Borrell, C., Muntaner, C., Benach, J., & Artazcoz, L. (2004). Social class and self-reported health status among men and women: What is the role of work organisation, household material standards and household labour?Social Science and Medicine, 58(10), 1869–1887.Google Scholar
Breeze, E., Fletcher, A. E., Leon, D. A., Marmot, M. G., Clarke, R. J., & Shipley, M. J. (2001). Do socioeconomic disadvantages persist into old age? Self-reported morbidity in a 29-year follow-up of the Whitehall study. American Journal of Public Health, 91(2), 277–283.Google Scholar
Cohen, A., Houck, P. R., Szanto, K., Dew, M. A., Gilman, S. E., & Reynolds, C. F. (2006). Social inequalities in response to antidepressant treatment in older adults. Archives of General Psychiatry, 63(1), 50–56.Google Scholar
Conley, D. & Bennett, N. G. (2001). Birth weight and income: Interactions across generations. Journal of Health and Social Behavior, 42(4), 450–465.Google Scholar
Chung, H. & Muntaner, C. (2006). Political and Welfare State determinants of population health: an analysis of wealthy countriesSocial Science Medicine, 63(3), 829–842.Google Scholar
Eaton, W. W. (2001). The Sociology of Mental Disorders, 3rd edn. London, UK: Praeger.
Eaton, W. W. & Muntaner, C. (1999). Socioeconomic stratification and mental disorder. In A Handbook for the Study of Mental Health: Social Contexts, Theories and Systems, ed. Horwitz, A. V. & Scheid, T. L.. New York, NY: Cambridge University Press.
Eaton, W. W., Muntaner, C., Bovasso, G., & Smith, C. (2001). Socioeconomic status and depression. Journal of Health and Social Behavior, 42, 277–293.Google Scholar
Eaton, W. W., Buka, S., Addington, A. M. et al. (2004). Risk factors for major mental disorders. A review of the epidemiologic literature. Retrieved January 24th, 2005, from
Eibner, C., Sturn, R., & Gresenz, C. R. (2004). Does relative deprivation predict the need for mental health services?Journal of Mental Health and Policy Economics, 7(4), 167–175.Google Scholar
Ferrie, J. E., Shipley, M. J., Stansfeld, S. A., Smith, Davey G., & Marmot, M. (2003). Future uncertainty and socioeconomic inequalities in health: the Whitehall ii study. Social Science Medicine, 57, 637–646.Google Scholar
Fryers, T., Melzer, D., Jenkins, R., & Brugha, T. (2005). The distribution of the common mental disorders: social inequalities in Europe. Clinical Practical Epidemology and Mental Health, 1, 14.Google Scholar
Geyer, S., Haltenhof, H., & Peter, R. (2001). Social inequality in the utilization of in- and outpatient treatment of non-psychotic/non-organic disorders: a study with health insurance data. Social Psychiatry and Psychiatric Epidemiology, 36(8), 373–380.Google Scholar
Jacobi, F., Wittchen, H. U., Holting, al. (2004). Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychological Medicine, 34(4), 597–611.Google Scholar
Kessler, R. C., McGonagle, K. A., Zhao, al. (1994). Lifetime and 12-month prevalence of DSM-III-R mental disorders in the United States. Archives of General Psychiatry, 51, 8–19.Google Scholar
Kim, I. H., Muntaner, C., Khang, Y. H., Paek, D., & Cho, S. I. (2006). The relationship between nonstandard working and mental health in a representative sample of the South Korean population. Social Science Medicine,Google Scholar
Kohn, M. L. & Schooler, C. (1983). Work and Personality: An Inquiry into the Impact of Social Stratification. Norwood, NJ: Ablex Pub. Corp.
Krieger, N., Williams, D. R., & Moss, N. E. (1997). Measuring social class in us public health research: concepts, methodologies, and guidelines. Annual Review of Public Health, 18, 341–378.Google Scholar
Krieger, N., Waterman, P. D., Hartman, al. (2006) Social hazards on the job: workplace abuse, sexual harassment, and racial discrimination – a study of Black, Latino, and White low-income women and men workers in the United States. International Journal of Health Services, 36(1), 51–85.Google Scholar
Lahelma, E., Martikainen, P., Rahkonen, O., Roos, E., & Saastamoinen, P. (2005). Occupational class inequalities across key domains of health: results from the Helsinki health study. European Journal of Public Health, 15(5), 504–510.Google Scholar
Lamont, M. (2000). The Dignity of Working Men. New York, NY: Russell Sage.
Last, J. A. (1995). Dictionary of Epidemiology. New York: Oxford University Press.
Lewis, G., Bebbington, P., Brugha, al. (1998). Socioeconomic status, standard of living, and neurotic disorder. Lancet, 352, 605–609.Google Scholar
Lewis, G., Bebbington, P., Brugha, al. (2003). Socio-economic status, standard of living, and neurotic disorder. International Review of Psychiatry, 15, 91–96.Google Scholar
Link, B. G., Schwartz, S., Moore, al. (1995). Public knowledge, attitudes, and beliefs about homeless people: Evidence for compassion fatigue. American Journal of Community Psychology, 23(4), 533–555.Google Scholar
Lorant, V., Deliege, D., Eaton, W., Robert, A., Philippot, P., & Ansseau, M. (2003). Socioeconomic inequalities in depression: a meta-analysis. American Journal of Epidemiology, 157(2), 98–112.Google Scholar
Lynch, J. W. & Kaplan, G. A. (2000). Socioeconomic position. In Social Epidemiology, ed. Berkman, L. F. & Kawachi, I.. New York: NY: Oxford University Press, pp. 76–94.
Lynch, J. W., Smith, G. D., Kaplan, G. A., & House, J. S. (2000). Income inequality and mortality: Importance to health of individual income, psychosocial environment, or material conditions. British Medical Journal, 320, 1200–1204.Google Scholar
Macleod, J., Smith, Davey G., Heslop, P., Metcalfe, C., Carroll, D., & Hart, C. (2002). Psychological stress and cardiovascular disease: Empirical demonstration of bias in a prospective observational study of Scottish men. British Medical Journal, 324, 1247–1251.Google Scholar
Marmot, M. (2004). The Status Syndrome: How Social Status Affects our Health and Longevity. New York: Times Books.
Melzer, D., Fryers, T., Jenkins, R., Brugha, T., & McWilliams, B. (2003). Social position and the common mental disorders with disability: Estimates from the national mental survey of Great Britain. Social Psychiatry and Psychiatric Epidemiology, 38(5), 238–243.Google Scholar
Muntaner, C. (2004). Commentary: social capital, social class, and the slow progress of psychosocial epidemiology. International Journal of Epidemiology, 33(4), 674–680.Google Scholar
Muntaner, C., & Lynch, J. (1999). Income inequality, social cohesion, and class relations: a critique of Wilkinson's neo-Durkheimian research program. International Journal of Health Services, 29(1), 59–81.Google Scholar
Muntaner, C. & O'Campo, P. J. (1993). A critical appraisal of the demand/control model of the psychosocial work environment: epistemological, social, behavioral and class considerations. Social Science Medicine, 36(11), 1509–1517.Google Scholar
Muntaner, C. & Parsons, P. E. (1996). Income, social stratification, class, and private health insurance: a study of the Baltimore metropolitan area. International Journal of Health Services, 26(4), 655–671.Google Scholar
Muntaner, C., Anthony, J. C., Crum, R. M., & Eaton, W. W. (1995a). Psychosocial dimensions of work and the risk of drug dependence among adults. American Journal of Epidemiology, 142(2), 183–190.Google Scholar
Muntaner, C., Wolyniec, P., McGrath, J., Pulver, A. E. (1995b). Differences in social class among psychotic patients at inpatient admission. Psychiatric Services, 46(2), 176–178.Google Scholar
Muntaner, C., Eaton, W. W., Diala, C., Kessler, R. C., & Sorlie, P. D. (1998). Social class, assets, organizational control and the prevalence of common groups of mental disorders. Social Science Medicine, 47(12), 2043–2053.Google Scholar
Muntaner, C., Eaton, W., & Diala, C. (2000). Socioeconomic inequalities in mental health: A review of concepts and underlying assumptions. Health, 4, 89–15.Google Scholar
Muntaner, C., Borrell, C., Benach, J., Pasarin, M. I., & Fernandez, E. (2003). The associations of social class and social stratification with patterns of general and mental health in a Spanish population. International Journal of Epidemiology, 32(6), 950–958.Google Scholar
Muntaner, C., Eaton, W. W., Miech, R., & O'Campo, P. (2004a). Socioeconomic position and major mental disorders. Epidemiology Reviews, 26, 53–62.Google Scholar
Muntaner, C., Li, Y., Xue, X., O'Campo, P., Chung, H. J., & Eaton, W. W. (2004b). Work organization, area labor-market characteristics, and depression among U.S. nursing home workers: a cross-classified multilevel analysis. International Journal of Occupational Environmental Health, 10(4), 392–400.Google Scholar
Murray, C. J. & Lopez, A. D. (1996). Evidence-based health policy – lessons from the global burden of disease study. Science, 274(5288), 740–743.Google Scholar
Navarro, V. & Muntaner, C. (2004). Political and Economic Determinants of Population Health and Well-being: Controversies and Developments. Amityville: The Baywood Publishing Company.
Nisbett, R. E. (2003). The Geography of Thought. New York, NY: The Free Press.
O'Campo, P., Eaton, W. W., & Muntaner, C. (2004). Labor market experience, work organization, gender inequalities and health status: results from a prospective analysis of US employed women. Social Science Medicine, 58(3), 585–594.Google Scholar
Outram, S., Mishra, G. D., & Schofield, M. J. (2004). Sociodemographic and health related factors associated with poor mental health in midlife Australian women. Women Health, 39(4), 97–115.Google Scholar
Pearce, N. & Davey Smith, G. (2003). Is social capital the key to inequalities in health?American Journal of Public Health, 93(1), 122–129.Google Scholar
Pearlin, L. I. (1989). The sociological study of stress. Journal Health and Social Behavior, 30(3), 241–256.Google Scholar
Poulton, R., Caspi, A., Milne, B. al. (2002). Association between children's experience of socioeconomic disadvantage and adult health: a life-course study. Lancet, 360, 1640–1645.Google Scholar
Regier, D. A., Boyd, J. H., Burke, J. D. al. (1988). One-month prevalence of mental disorders in the United States. Based on five epidemiologic catchment area sites. Archives of General Psychiatry, 45(11), 977–986.Google Scholar
Resnick, S. & Wolff, R. D. (1982). Classes in marxian theory. Review of Radical Political Economics, 13(4), 1–18.Google Scholar
Roberts, R. E. & Lee, E. S. (1993). Occupation and the prevalence of major depression, alcohol, and drug abuse in the United States. Environmental Research, 61(2), 266–278.Google Scholar
Schneiders, J., Drukker, M., Ende, J., Verhulst, F. C., Os, J., & Nicolson, N. A. (2003). Neighbourhood socioeconomic disadvantage and behavioural problems from late childhood into early adolescence. Journal of Epidemiology and Community Health, 57(9), 699–703.Google Scholar
Stafford, M. & Marmot, M. (2003). Neighbourhood deprivation and health: Does it affect us all equally?International Journal of Epidemiology, 32(3), 357–366.Google Scholar
Stansfeld, S. A., Head, J., Fuhrer, R., Wardle, J., & Cattell, V. (2003). Social inequalities in depressive symptoms and physical functioning in the Whitehall II study: exploring a common cause explanation. Journal of Epidemiology and Community Health, 57(5), 361–367.Google Scholar
Thoits, P. J. A. (2005). Differential labeling of mental illness by social status: A new look at an old problem. Journal of Health and Social Behavior, 46(1), 102–119.Google Scholar
Turner, R. J.Wheaton, B., & Lloyd, B. (1995). The epidemiology of social stress. American Sociological Review, 60, 104–225.Google Scholar
Wainwright, N. W. & Surtees, P. J. G. (2004). Area and individual circumstances and mood disorder prevalence. British Journal of Psychiatry, 185, 227–232.Google Scholar
Weich, S. & Lewis, G. (1998). Material standard of living, social class, and the prevalence of the common mental disorders in Great Britain. Journal of Epidemiology and Community Health, 52(1), 8–14.Google Scholar
Wilkinson, R. (2005). The Impact of Inequality. New York: The New Press.
Wilkinson, R. G. & Pickett, K. E. (2006). Income inequality and population health: a review and explanation of the evidence. Social Science and Medicine, 62(7), 1768–1784.Google Scholar
Wohlfarth, T. (1997). Socioeconomic inequality and psychopathology: are socioeconomic status and social class interchangeable?Social Science Medicine, 45(3), 399–410.Google Scholar
Wohlfarth, T. & Brink, W. (1998). Social class and substance use disorders: the value of social class as distinct from socioeconomic status. Social Science Medicine, 47(1), 51–58.Google Scholar
Wright, E. O. (1996). Class Counts. Cambridge: Cambridge University Press.
Wright, E. O. (2005). Approaches to Class Analysis. Cambridge: Cambridge University Press.

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats