As this chapter aims to demonstrate, and a number of classic studies have shown, social class is highly relevant to both counselling and forensic psychology, and crime and mental health more generally. We begin with the enduring idea that the working classes constitute a ‘dangerous class’, beset by social problems such as poverty and the breakdown of the family, and engaging in morally dubious or outright criminal behaviour. Various explanations are considered – the visibility of working-class crime, the role of labelling and the media, and the power of the criminal justice system. The chapter then moves onto issues of mental health, considering how rates vary by class. It suggests that since both mental health problems and crime are types of deviance, explanations of links with class are broadly similar, focusing on social causes and labelling. Finally, suggestions are offered for how the mental health treatment systems might more usefully incorporate issues of class into practice

What is social class?

It is first necessary to explore what is meant by social class since it is a much-contested concept, both within academia and among the general population. Nonetheless, objectively it is clear that, as a starting point, there exists some kind of socio-economic structure or hierarchy, e.g. different people have different occupations and have different levels of income and education. The concept of social class takes this one step further and argues that this structure is grouped into a number of classes (though exactly how this classing occurs, and how many different classes there are, is open to debate; see Savage, 2015).

It is useful to bear in mind that the concept of class refers specifically to this grouping, but there are of course overlaps with related terms and issues, such as poverty, socio-economic status, deprivation, and marginalisation, besides many others.

In recent years a very influential idea about class, associated with the sociologist Pierre Bourdieu, is that different classes not only have different levels of economic resources (economic capital), but other types of resources too (Bourdieu, 2002). Classes vary in terms of the social connections they have (social capital, or ‘who you know’), and also their cultural knowledge and understanding (cultural capital).

According to this perspective, a central idea underlying class is that different groups in the social hierarchy have differential power and access to resources – whether these resources are economic, social, or cultural – and that this grouping also influences the identities that people have. As will be shown in this chapter, class-related power and resources, as well as identities, influence whether people enact certain behaviours, whether these behaviours are classified as normal, deviant, or due to mental health problems, and how society responds to them.

We have seen in the previous chapters that the same is true of gender-, age- and ethnicity-related power, resources and identities (as well as other axes of inequality). To give an example, judges generally have more power than defendants, but especially so when the defendant has a certain social position and identity associated with a lack of power and resources, such as money, social relations (e.g. a good lawyer, support of family), or knowledge of the criminal justice system, which all influence court outcomes.

The dangerous classes

In August 2011 UK newspapers were replete with headlines such as ‘YOB RULE’, ‘ANARCHY IN THE UK’, and ‘LONDON’S BURNING’. That the English riots received sensationalist media attention is unsurprising; these were highly visible events with fire, looting and violence. The cost of the riots was estimated to be around £200–300 million. In 2012 HSBC were fined £1.2 billion in a money laundering case, and since then, Britain’s four big banks have been fined over £50 billion as a result of criminal wrong-doing. Following the riots, harsh sentences were handed out to make examples to others but not a single banker has been arrested. Although the HSBC scandal did receive media coverage, it was not nearly as extensive as that of the riots.

These disparities are stark, but are just one recent example of a long trend in working-class criminalisation, which noted criminologist Stuart Hall defined as ‘the attachment of the criminal label, to the activities of groups which the authorities deem it necessary to control’ (Hall et al., 1978, p. 189).

Not many people would argue that riots did not need to be controlled, but the question remains as to why the crimes of the relatively powerless are much more criminalised than those of the relatively powerful.

One possible explanation is that the crimes of the former tend to be much more visible, such as street crime, violent crime, or theft from property, while the crimes of the latter, such as fraud, tax avoidance or insider trading, take place away from the public eye. Indeed, visibility is one criterion used to distinguish ‘white collar’ (middle-class) crime from ‘blue collar’ (working-class) crime (Horsley, 2014). Reiman (2001) notes that white collar criminals are rarely arrested or charged, and when they are prosecuted and convicted, the sentences are very light relative to the costs for society.

Similarly, Tombs and Whyte (2015) contrast the huge (and growing) scale of corporate crime against the lack of investigations and prosecutions. The theme of visibility is also evident in historical accounts of working-class criminality.

One idea that has stuck is the notion of the ‘dangerous classes’. In 1851 Victorian social reformer Mary Carpenter used this phrase to describe children who grew up in poverty and learnt criminal behaviour at a young age. Similarly, in 1872 social reformer Charles Loring Brace wrote about the dangerous classes of New York, who he argued were a separate criminal class beset by social problems such as poverty, cramped housing and the breakdown of the family.

As Maffi (1995) argues, essentially the implied equation was ‘proletarians = criminals’. Such ideas persist today. In recent years the term ‘chav’ has become popular, used to describe people from the so-called underclass (Jones, 2012).

Similar terms may be ‘pikey’, ‘townie’, or ‘scally’. Arguably, the function of such words is to ‘other’ certain sections of the population and associate them with morally questionable behaviour so that they become scapegoats for wider, deeper-rooted social problems.

Social class and mental health

As this book has set out to demonstrate, the way that behaviour is categorised as deviant is not just limited to crime. Mental health problems are also a type of deviance in the sense that they involve the infraction of social norms and rules. Many early studies demonstrated a link between social class and mental health problems. One of the first was by Faris and Dunham (1939), who found that the poorest parts of Chicago had higher rates of treated schizophrenia and substance abuse disorder as measured by admission data. A classic US study by Hollingshead and Redlich (1958) found that those in lower class positions were over-represented in treatment, and were more likely to enter treatment via referral by official agencies such as the courts as opposed to choosing to enter treatment themselves.

They were also more likely to have physical treatments such as shock therapy rather than organic treatments such as psychotherapy. More recent evidence from the Adult psychiatric morbidity in England, 2007 survey shows that those with the highest household income were less likely to have common classified mental health problems than those with the lowest household income (McManus et al., 2009). For psychosis, prevalence rates were 0.1% among those in the highest income quintile compared with 0.9% in the lowest quintile.

How might social class differences in rates of mental health problems be explained? There are three main theories. The first is that it is something about lower social class circumstances that leads to poor mental health (social causation). For example, in their classic study, Faris and Dunham (1939) proposed that the poorest parts of Chicago had higher rates of classified mental health problems due to social isolation and loneliness, while Hollingshead and Redlich accounted for the association between class and mental health problems by reference to both adverse childhood experiences and differing levels of stress (Busfield, 2011).

Nowadays research would recognise a range of social causes (or ‘social determinants’ as it is now often framed) as influencing mental health across the life course, including childhood experience (and even pre-natal experience), work and family life, and older age (Marmot et al., 2010). These include material deprivation (e.g. damp housing; Clark et al., 2012), poor working conditions (e.g. little control or autonomy and low pay; Siegrist et al., 2009), neighbourhood conditions (O’Campo, Salmon & Burke, 2009) and wider socio-political factors (Mattheys et al., 2016). A comprehensive list of social determinants can be found in the report by the World Health Organisation (WHO, 2014).

The second explanation suggests that it is not that lower class circumstances lead to mental health problems, but that mental health problems lead to lower social class circumstances. Those who develop mental health problems ‘drift’ down the social hierarchy (social drift hypothesis).

According to Eaton (who was referring to schizophrenia in particular): ‘Drift is the process whereby schizophrenics undergo downward class mobility after the onset of schizophrenia due to disability in the competition for employment’ (1980, p. 149). Recent evidence suggests that social drift only explains a small part of the association between class and mental health problems (Hudson, 2005).

The third main type of explanation is that those in lower class positions are more likely to have their behaviours and actions labelled as mental health problems (labelling theory – see also Chapters 3 and 7), or in other words, pathologised. Hollingshead and Redlich (1958) found that the lower social classes were more likely to receive a diagnosis of psychosis (typically schizophrenia or bipolar disorder) whereas the higher social classes were more likely to receive a diagnosis of neurosis (typically depression or anxiety).

Once behaviour is viewed as a mental health problem it comes under the auspices of medical intervention and control, which in some cases can have more damaging effects than the behaviour/problem itself (so-called ‘iatrogenic’ effects). The starkest historic example of this was the institutionalisation of the ‘mentally ill’ in asylums, where they were often subject to all kinds of bizarre and often inhumane treatments (see Chapter 2), including hydrotherapy, sterilisation, malaria fever therapy, shock therapies, and lobotomy (Braslow, 1999).

In a well-known experiment, Rosenhan (1973) sent pseudo-patients to psychiatric hospitals to show how psychiatrists often mis-diagnosed them as having mental illnesses, and were therefore far from accurate in their diagnoses. Combined with Hollingshead and Redlich’s finding concerning the more likely diagnosis of schizophrenia among people the lower social classes, this suggests that people from such classes have suffered injustices in the mental health treatment system, and not necessarily due to the conscious or deliberate intentions of particular individuals.

Although asylums are now more or less a relic of history, critics of the psychiatry profession argue that it essentially remains a means of social control. For example, Hurvitz argued that psychotherapy has a latent purpose ‘in accord with the values of American capitalist society’ (1973, p. 232).

In other words, its purpose is to control people and bring them in line with the (usually white and middle-class) status quo, quelling defiance, rebellion or cultural diversity. Psychotherapy espouses values such as autonomy, individuality, self-sufficiency, self-realisation, and so on. However working-class values have traditionally been firmly centred around the idea of community, which is part of the reason why Freud (1919) argued that the poor are not well-suited to psychotherapy.

Freud suggested a watered-down version of psychoanalysis for the poor: a large-scale, state-sponsored treatment involving direct suggestion and hypnosis (Winter, 1999). There are some echoes here with the recent Improving Access to Psychological Therapies (IAPT) programme, a large-scale NHS initiative to provide short courses of cognitive behavioural therapy to help tackle widespread depression and anxiety disorders.