Descriptive Terms: Social Class, Socio-Economic Status and their Relevance to Psychiatric Disorder and Health Care Delivery

The general public and sociologists perceive that the term social class represents socioeconomic status or the financial category. However, the formal definition of social class refers to characteristics associated with a certain economic status that is less likely to change or are more difficult to change (Baumeister & Bushman, 2020). On the other hand, Chiu and Hong (2013) explained that social class can be defined as the cultural and social aspects of life, which may include character, knowledge, behaviour, and lifestyles of people in a family and a society. Moreover, social classes are often described as “lower class”, “upper class”, “working class”, or “middle class” as all these classes have different socioeconomic implications for how they lead their lives.

Socioeconomic status (SES) is also known as a socioeconomic class which represents the integration of various life factors such as occupation, education, wealth, health, and income of a person which determine a person’s status in relation to other people in a society. The term SES was proposed by the German sociologist named Max Weber (1864-1920), believing that social stratification results from the sum of economic classes, a social status reflected by a person’s level of prestige in relation to others, and group power or authoritative power. Weber further defined SES as the level of a person’s ability to get what they want to be characterized by financial stability for buying power (Jones, 2013).

Parker (2013) described that social class and SES are deeply rooted in mental health and psychiatry because these complex definitions of economic power take into account social status in certain professions considered noble, such as doctors, teachers, healthcare professionals, and psychiatrists. It also takes into account the lack of honour and even shame associated with SES that may be associated with different aspects of life such as education, work, social life, or service. This is why these aspects of life greatly impact the mental health of a person. The same goes for the stigma often associated with lower SES which may shape the mental health of the people living in lower SES. Psychiatrists often create SES models that use methods to measure and classify factors that impact mental health and these were used to identify characteristics associated with low, medium or high SES for each individual  (Baumeister & Bushman, 2020). It is important for psychiatrists and mental health professionals to assess the SES of their clients because its existence reflects the unequal access to rights, resources and power in society, represented by the social stratification which may trigger different psychiatric issues. Moreover, SES has a great influence on a person’s access to education, quality of life, and nutritional habits that may affect socially known individuals (Chiu & Hong, 2013). Similarly, it is also important for psychiatrists to examine to what extent these people can offer favourable economic and employment opportunities, political commitment, power, health, and longevity within a certain SES (Jones, 2013).

The Social Role of Doctors

The social role of doctors is exhibited by the effectiveness of doctor-patient interactions that have been inextricably linked to the social burden of illnesses. According to Chiu and Hong (2013), the social role of doctors can be divided into two types of interactions between doctors and patients which are patient-centred and doctor-patient-centred. Doctor-Patient-centered is the physician-directed approach in which interaction by doctors is viewed as the primary interaction because they are providers of care while patients are passive recipients, and doctors make decisions regarding illnesses and communicate in an authoritative way directly with patients. In a doctor-centred role, the format of social interaction is characterized by closed questions and prompts and more information is provided than shared.

However, recent researchers have moved towards the patient-centred social role of doctors because doctor-patient consultation is based on direct and logical communication between the doctor and patient. The doctor’s social role is evident in patient-centred care as he explores patients’ experiences and concerns through listening, reflecting, and leading questions. This is to encourage patients to participate in self-care and obtain their treatment plan so that they can also participate and play their role in their treatment and battling illnesses (Jones, 2013).  

The Sick Role

On the other hand, Parsons (1951) introduced the sick role of the patient which is described as the rights and duties of the patient. Rights of the patients include freedom from normal duties such as work, household chores or caring duties, as well as being free from illness. The duties of the patient include an obligation to participate and seek medical attention and treatment. These rights and duties are seen as transitory and universal and work together for the benefit of patients and the interests of society as a whole (Parker, 2013).

The sick role has been the subject of much criticism and debate over the years. Some have argued that the concept is too narrow and does not take into account the complex social, psychological, and economic factors that influence how individuals experience illness. Others have argued that the concept reinforces stereotypes and reinforces the idea that those who are ill are not fully functional members of society.

Despite these criticisms, the sick role remains an important concept in the sociological understanding of health and illness. It highlights the social norms and expectations that shape the experiences of individuals who are ill and provides a framework for understanding the ways in which society responds to illness and health.

The Illness Behaviour

The illness behaviour of the patients is evident by acute or short-term illnesses such as the flu or food poisoning, where they don’t work well. However, illness behaviour is very limited when it applies to chronic or long-term health conditions. This is because it makes assumptions about illness and recovery that don’t necessarily apply to chronic illness and that illnesses always lead to recovery. It also ignores the fact that relief from normal duties is not always necessary for all illnesses (Jones, 2013). Chiu and Hong (2013) argued that the concept of illness behaviour does not satisfactorily explain how patients with chronic diseases can cope with their social lives and their illnesses. Furthermore, illness behaviour also makes assumptions about the doctor-patient relationship reflecting that all patients are naturally unique and doctors should always be active for medical assistance and always helpful.

Illness behaviour refers to the ways in which individuals perceive, respond to, and cope with symptoms of illness. It encompasses the beliefs, attitudes, and actions that individuals exhibit in relation to their health.

Individuals with a high level of illness behaviour are more likely to seek medical help, follow doctor’s orders, and comply with treatment regimens. On the other hand, individuals with low levels of illness behaviour may ignore symptoms, avoid seeking medical care, and be less likely to comply with treatment recommendations.

Illness behaviour can be influenced by various factors, including personality, culture, and previous experiences with illness. For example, individuals who are more anxious or who have a history of negative experiences with the healthcare system may be more likely to avoid seeking medical help.

References:

(1) Baumeister, R. F., & Bushman, B. J. (2020). Social psychology and human nature. Cengage Learning.

(2) Chiu, C. Y., & Hong, Y. Y. (2013). Social psychology of culture. Psychology Press.

(3) Jones, M. (2013). Social psychiatry: A study of therapeutic communities. Routledge.

(4) Parker, I., 2013. The Crisis in Modern Social Psychology (Psychology Revivals): and how to end it. Routledge.