Understanding Psychological Disorders: The Neuropsychosocial Approach 63
(Graham, 1976). Had the Beale women not supported each other and shared
good times, the symptoms of psychological disorders that they displayed might
have been worse.
Social Stressors
Living in poverty is associated with a higher rate of psychological disorders. An-
other social factor associated with psychological disorders is discrimination. Let’s
examine these two factors—fi nancial hardship and discrimination—in more detail.
Socioeconomic Status
Socioeconomic groups are defi ned in terms of education, income, and occupational level;
these indicators are sometimes referred to collectively as socioeconomic status (SES).
People from low SES backgrounds have a higher rate of psychological disorders
than people from higher SES backgrounds (Costello et al., 1996, 2003; Kessler et al.,
1995; Mittendorfer-Rutz et al., 2004; Robins & Regier, 1991). Socioeconomic fac-
tors may contribute to the development of psychological disorders in several ways.
One theorized mechanism is through social causation: socioeconomic disadvantages
and stress cause psychological disorders (Freeman, 1994). Specifically, the daily
stressors of urban life, especially as experienced by people in a lower socioeconomic
level, trigger mental illness in those who are vulnerable. For instance, living with
inadequate housing, very limited fi nancial means, and few job opportunities corre-
sponds to the stress component of the diathesis–stress model discussed in Chapter 1
(Costello et al., 2003). Case 2.1 describes Anna, whose depression was precipitated
by fi nancial stressors.
CASE 2.1 • FROM THE OUTSIDE: Depression and Social Selection
Anna was a single mother in her 30s when she sought treatment for her depression. At
the time, she was having diffi culty getting out of bed and was struggling to maintain
order and basic routines at home for herself and her children. She had separated from
her husband and lost her job 5 years prior to her fi rst visit to the clinic. Since that time
she had been struggling fi nancially. She had a number of part-time jobs to try to make
enough money to keep her family fed and clothed. However, she was often short of
funds and felt very worried and stressed by their straitened [sic] fi nancial situation.
She noted she often felt worse after the summer as she became overwhelmed by the
demands of a new school year and the thought of Christmas. As a result of encounter-
ing diffi culty fi nding a permanent full-time position, her confi dence waned, and she
feared that she had lost her job skills. She had recently returned to school to take some
business courses to update and extend her qualifi cations....
Anna expressed regrets about her divorce. She had not realized at the time what a
massive and diffi cult journey it would prove to be. She regretted uprooting her chil-
dren and found her worries about money very stressful and disconcerting because she
had never had to worry about fi nances before. Anna was a committed and dedicated
mother who, even as she struggled to feed her children, put on a happy face to hide her
stress because she did not want to worry them.
(Watson, Goldman, & Greenberg, 2007, pp. 83–84)Another mechanism that may be responsible for the connection betweenpsychological disorders and low SES is social selection: The hypothesis that those who
are mentally ill “drift” to a lower socioeconomic level because of their impairments
(Mulvany et al., 2001; Wender et al., 1973); social selection is sometimes referred
to as social drift. In fact, research suggests that the relationship between psychological
disorders and SES cuts both ways: low SES both contributes to disorders and is a
consequence of having a disorder (Conger & Donnellan, 2007; Fan & Eaton, 2001;
Johnson et al., 1999; Shaw et al., 1998).
Social causation
The hypothesis that the daily stressors of
urban life, especially as experienced by
people in a lower socioeconomic level, trigger
mental illness in those who are vulnerable.Social selection
The hypothesis that those who are mentally
ill “drift” to a lower socioeconomic level
because of their impairments; also referred
to as social drift.