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Mental disorders in the metropolitan area: an ecological analysis
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Mental disorders in the metropolitan area: an ecological analysis
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MENTAL DISORDERS IN THE METROPOLITAN AREA AN ECOLOGICAL ANALYSIS by Muriel Constance Schuerman Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (Sociology) February, 1977 Copyright Muriel Constance Schuerman 1977 UMI Number: DP31779 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation PWMisWng UMI DP31779 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 UNIVERSITY OF SOUTHERN CALIFORNIA T H E G R A D U A T E S C H O O L U N IV E R S IT Y P A R K LO S A N G E L E S , C A L IF O R N IA 9 0 0 0 7 Si o i '•y S38S<-t This dissertation, written by MURIEL__ CONST ANCE__SCH^^ ..... under the direction of hQX.... Dissertation Com mittee, and approved by all its members, has been presented to and accepted by The Graduate School, in partial fulfillment of requirements of the degree of D O C T O R O F P H I L O S O P H Y / Dean Date... J-anuaxy.. .L4.,.. T9.7.7..... DISS] :^TATION COMMIXTEi: . ACKNOWLEDGMENTS Without Dick Elpers, Program Chief of the Orange County Department of Mental Health, this study would not have come into being. Therefore, I would like to thank him (belatedly) for having hired me several years ago and there in sending me down the Road to Community Mental Health. I would also like to thank him for services rendered as the study’s Social Psychiatrist Consultant. My appreciation to Leo A. Schuerman, spouse and colleague, is boundless-- so great was his contribution to all phases of the study’s execution. By extension, thanks are due to members of his staff at the Program for Data Research (of the Social Science Research Institute) who permitted me to use their computer programs and to otherwise take advantage of their programming know-how. Finally, my appreciation is extended to the members of my dissertation committee whose support and encouragement were undiminished throughout the two years during which this study was in progress. I am indebted to Don Van Arsdol for his valuable counsel and words of wisdom which he offered at always the right moments. Particular thanks are due Herman Turk for his critical evaluation and perceptive suggestions: the study was better for his interest and contributions. 11 TABLE OF CONTENTS Page ACKNOWLEDGMENTS .............................. ii LIST OF TABLES ...................................... LIST OF ILLUSTRATIONS ................................ Chapter I. STUDY ORIENTATION AND THEORETICAL FORMULATION ................................ 1 Introduction ................................ 1 An Organic-Mechanical Model of Community Mental Disorders ......................... 6 Introduction The Durkheim model Explication of the Theoretical Argument . . 17 Ethnic and racial minorities in organic society The elderly in organic society Ethnic and racial minorities and the unmarried adult subpopulations in mechanical society Research Hypotheses................... . 31 II. RESEARCH DESIGN.......... 40 General Components ......................... Area of Study Level and unit of analysis Data utilized in the study Creation of Categories of Mental Disorders ......................... 43 Census D a t a ............................... 48 Estimating Social Structural Variables . . . 52 An Index of Urban Maturation ............... S3 Maturation Area Profiles ................... 61 Validation of the Index of Urban Maturation............................. 68 Statistical Hypotheses ..................... 71 111 Chapter Page III. ANALYSIS AND DISCUSSION..................... 81 Rates of Organic and Mechanical Disorders in the Metropolitan A r e a ............... 81 Statistical Interaction ................... 86 Spatial Segregation and Organic Mental Disorders................................ 86 Rate of Mechanical Disorders in the Ethnic Population ....................... 94 Rate , of Mechanical Disorders in the Single Population 45-64 Years Old .... 96 Summary of the Analysis . . . . ........ 101 IV. SUMMARY AND CONCLUSION ................... 107 Summary of the Findings................... 107 Limitations of the S t u d y ................. 114 Implications of the Study............ 116 Topics for Future Research.......... 118 APPENDIX............................................. 122 BIBLIOGRAPHY ........................................ 124 IV LIST OF TABLES Table Page 1. Principal Components Factor Structure for Rates of Mental Disorders in the Total Population 18 Years Old and Over in Orange County: 1973-1974 ................... 46 2. Overview of Mental Health Cases, 1973-1974: Orange County Department of Mental Health . . 49 3. Mean Rates of Social Structural Variables By Six Urban Maturation Areas ........ 69 4. Mean Percentages of Organic and Mechanical Mental Disorders by Maturation Areas in Orange County : 1973-1974 ................... 82 5. Mean Rates of Organic Mental Disorders in Ethnic and Anglo Population in all Sub- areas of Each Maturation Area in Orange County : 1973-1974 ........ ................. 85 6. Product-Moment Correlations Between the Percent of Organic and Mechanical Mental Disorders in the Ethnic Population and the Percent Ethnic Population Over 18 Years Old in All Subareas of Each Matura tion Area in Orange County: 1973-1974 . . . 88 7. Zero-Order Correlation Coefficients Among Five Selected Variables for All Subareas in Orange County: 1973-1974 91 8. Mean Percentages of Organic and Mechanical Mental Disorders in the Ethnic Population by Maturation Areas in Orange County : 1973-1974 . . . . . . . . . . . ............. 95 9. Mean Percentages of Organic and Mechanical Disorders in the Single Population 45-64 Years Old by Maturation Areas in Orange County: 1973-1974 98 V Table Page 10. Simple and Partial Standardized Regressions for Mechanical Disorders in the Single Population 45-64 Years Old by Selected Characteristics of the Single Population in all Subareas of Each Maturation Area in Orange County: 1973-1974 .... .......... 100 VI LIST OF ILLUSTRATIONS Page 1. Urban Maturation Index ......................... 62 Vll CHAPTER I STUDY ORIENTATION AND THEORETICAL FORMULATION Introduction The purpose of this study is to develop a theoretical explanation of the spatial distribution of mental disorders in the metropolitan area. The basic argument presented in the study is that the urban-rural continuum generally em ployed is not a sufficient predictor. Rather, the explana tion is found in the patterns of metropolitan growth and development that are reflected in social structural condi tions which have a differential impact on populations-at- risk. Through the interaction of these factors, specific kinds of mental disorders emerge and their spatial distri bution may be predicted. The theoretical framework used in this study and that will be tested is a special application of Durkheim’s organic-mechanical continuum. Specific hypotheses to be discussed are generated from two general postulates devel oped from the typology. They are: 1. As a general phenomenon, community mental disorders are distributed in specific patterns in a metropolitan area. 2. The distribution of specific kinds of mental disorders results from particular social structural conditions that affect sub populations in different parts of the metropolitan area. Studies concerned with the spatial distribution of mental disorders have been extremely sparse since the seminal work of Paris and Dunham.^ In addition to the studies undertaken by their students at the University of 2 3 Chicago, there was Dunham’s study of Detroit, the recent re-examination of Chicago by Levy and Rowitz,^ and an ecological analysis of Baltimore.^ Technically, all these studies concentrated on but a limited aspect of the urban area: the city. Furthermore, of necessity the population analyses always focused on institutionalized patients. In view of the advent of the metropolitan area--in lieu of city dominance--and given the de-emphasis on institutional- ization inherent in the community mental health movement, the models used in the early studies do not fit current urban development and are not particularly useful in ex plaining the spatial distribution of mental disorders in the metropolitan area. The early studies had other problems as well. To some extent, all of the studies were methodological exercises that examined city ecological patterns and the distribution of mental disorders. The usual frame of reference involved testing the applicability of the Chicago School’s ecological approach to the examination of the distribution of mental disorders.^ However, since the studies did not contain substantive theory but only a methodological approach to city growth, their conclusions could not be abstracted to fit the variegated patterns of metropolitan areas that did not necessarily conform to the basic zonal model of the "classic" Chicago city. On the other hand, while some of the later studies abandoned the concentric zone model, they became elaborate data analyses whose nontheoretical con clusions were relevant only to the particular cities studied. In the present study it will be argued that a metro politan area’s patterns of growth and development have an impact on the social structure and therefore are germane to understanding the spatial distribution of mental disorders. As a result of ecological processes, subpopulations with particular kinds of characteristics and vulnerabilities to certain kinds of pressures become differentially located in the metropolitan social structure. Thus, their spatial dis tribution is patterned and predictable. Furthermore, assuming they are vulnerable to certain kinds of pressures and problems, this study argues that the mental disorders through which they manifest their adaptation (or coping) form specific and predictable spatial distributions. In this regard Dohrenwend and Dohrenwend, for example, point out the vulnerability of certain populations by noting that those in the lower socioeconomic classes experience greater deprivation and more uncertainty than those in the upper 7 classes. On the other hand, it is expected that those in the upper social classes suffer greater stress and anxiety about their job performance and social status. While based on a social stratification model, these kinds of explana tions do not deal with the total spatial distributions and have no areal predictive value for a total metropolitan area of analysis. What seems desirable, then, is to develop a theoretical model that can explain the spatial distribution of mental disorders by linking metropolitan growth processes to metropolitan social structure. A special application of Durkheim’s organic-mechanical framework is formulated for this purpose. In providing a theoretical framework that can be used to reflect stages of metropolitan growth and development, Durkheim’s work in The Division of Labor in Society describes the kinds of social structure or context typically associated with the polar g types of societal milieux. He suggests that societies are organized in particular manners. For example, at one end of his societal continuum is organic structure which emphasizes specialization, individual autonomy, interdependence, and heterogeneity. Contractual arrangements prevail in this kind of society, which is epitomized by the division of labor. On the other hand, at the other extreme mechanical structure emphasizes tradition, custom, homogeneity, and stability. Conformity is encouraged and enforced through a variety of repressive mechanisms. In this study Durkheim’s organic-mechanical framework is applied to the metropolitan area and describes the con tinuum of social structures that characterize the metro politan area. The fit is not perfect, but what is implic itly argued in this theoretical application is that the suburbs or newer areas manifest elements of Durkheim’s mechanical milieu while the inner cities or the older areas reflect elements of organic society. The subareas in be tween the polar types reflect elements of both mechanical and organic social structure. It is assumed in this study with respect to the above model that, first, the respective milieux located along the continuum have social structures that emerge from dynamic ecological processes. Second, mental disorders represent aberrant patterned responses subpopulations develop to cope with or adapt to social conditions in their milieux. Thus, from this perspective mental disorders will not be random occurrences in spadë but create specific spatial distri butions that can be predicted and explained within the context of the specialized Durkheim framework. An Organic-Mechanical Model of Community Mental Disorders Introduction For the sake of clarity it should be emphasized that while the theoretical perspective is based on Durkheim’s work, it is not the study’s intention to test Durkheim, or to apply his theory to the study of mental disorders. Rather, specific aspects of Durkheim’s model are extended and applied in this study to an analysis of a metropolitan area’s social structure. Throughout his work Durkheim presented social struc tural complexity within the organic-mechanical framework.^ The present study of community mental disorders uses the same general framework, but with the understanding that it is an idealized dichotomized conceptualization that ignores the structural configuration occupying the middle of the dichotomy. Following Durkheim, this discussion focuses on the ideal types at either pole, although in reality the interim is also of interest to this study. The Durkheim Model In his model Durkheim distinguished between the polar types of social structure by characterizing ’’organic’’ structure as the most complex type. Employing terminology such as differentiation, specialization, and individualism Durkheim applied the concept of organicity to society as a whole and to the kind of solidarity that dominated that kind of milieu. While originally intended to refer to society, Boskoff argues that as a concept organic structure has general application. Boskoff, for example, suggests that "bureaucratic organizations in modern society consti tute excellent illustrations of organic solidarity on a limited scale.Following Boskoff s argument for greater conceptual flexibility and application, in the present study Durkheim’s concept of organic social structure is applied to a particular part of the urban area, specifically the most highly developed and therefore most complex parts of the urban milieu. By the same token, Durkheim’s concept of mechanical social structure will be reserved in this study for those parts of the urban milieu that are less developed and therefore less structurally complex. Organic Society and Mental Disorders In an environment characterized by differentiation, specialization, individualism, rapid change, and conflicting norms, disequilibrium becomes a real possibility that 12 threatens to hamper the functioning of society. To counteract this tendency and to maintain society as a going concern, organic society develops mechanisms of social control that are part of the social organization and serve to regulate the parts. In this way social breakdown is avoided. One of the primary mechanisms of social control in organic society is the body of codified formalized rules 13 that govern the social processes. Among the rules, for example, is the specification of the rights and duties of the various positions in society, as well as the correspond ing rewards. Social control is also sustained by the societal ideology which supports the rules and provides the moral basis for adherence to the rules. For example, it is the ideology that associates role performance with the re wards, just as it is the ideology that encourages aspirants to compete for various positions in society. The ideology also fosters the belief that competition is open to all, that the selection procedure is unbiased, and that the most qualified aspirant is selected. The ideological foundation of society is important be cause it forms part of the contractual arrangement that exists between [organic) society and the members. For its part, society establishes rules and procedures that the members follow in order to secure rewards; but in so doing society is also obligated to adhere to the rules that it has established. Durkheim notes that just as the members have duties and obligations to society, so must society reciprocate.^^ In short, the members and society have formed a bond. Under the bond and according to the rules that prevail--or are assumed to prevail--in organic society, the aspirants have a right to expect open competition, unbiased selection, and appropriate rewards. Given these conditions, personal and/or social characteristics are not relevant in the competitive process in organic society. Everyone has a fair chance to compete and be chosen, and therefore everyone has a fair chance at garnering society’s rewards. This study argues that problems occur in the social control mechanism when there is a breakdown in the contrac tual arrangement. For example, while the rules indicate open competition and unbiased selection, the implementation of the competitive process may deviate from expectation. Referring to the forced division of labor, Durkheim observed that ’’sometimes the rules themselves are the cause of 15 evil.’’ They may actually block certain subpopulations from freely participating in society’s competitive process. In elaborating on the forced division of labor, Durkheim observed that social solidarity in organic society is prem ised on individuals occupying roles and statuses that are consistent with their natural faculties.However, when individuals are forced to occupy roles and statuses that bear little if any relationship to their own inclinations and talents, the rules established by society become contra dictory and lose some of their moral authority. In the process the social bonds also become weakened, along with some of the social controls that maintained equilibrium in organic society. While Durkheim’s major argument is that anomie is created by the failure of individuals to be regulated, in this case social problems occur because the rules fail to operate as they should. It is suggested that the situation becomes especially dysfunctional when particular subpopu lations are singled out and coerced into occupying certain roles and statuses in society. Durkheim presented examples of societal obstructions, 17 but they tended to focus on ascribed characteristics. His argument has general application, however. It can refer to any obstruction that restrains a subpopulation from freely competing for positions in organic society and, indirectly, for the rewards associated with various posi tions. Spatial segregation has this effect in that it can control a subpopulation’s access to opportunities. Hawley was one of the first human ecologists to con ceptualize spatial or residential segregation as a means of social containment that interferes with the opportunity structure.Hawley views spatial segregation as a mechan ism whose function it is to prevent particular minority 10 populations from competing against the majority population for limited resources.However, spatial segregation also defines life space and establishes psychological as well as physical boundaries for their interaction with the majority population, As a result, spatial segregation has other repercussions that affect their participation in the com petitive process. For example, because a barrier exists, knowledge and experience do not flow freely between the minority and majority populations. Gordon views this as especially damaging to the assimilation of the minority population into the larger society and their participation in society because the minority population is hampered from acquiring the social skills and techniques that are crucial 20 in the competitive process. Thus, discrimination and spatial segregation often curtail occupational and edu cational opportunities, with the result that the minority group is forced into a lower class status: spatial iso lation is the prerequisite which maintains the population in a subordinate societal position. Furthermore, segrega tion serves to impede minority assimilation into the total reward structure of society because it heightens visual differences and maintains the minority group’s unique 21 behavioral traits and social structure. For example, in our current society, if one is in a minority group that speaks a foreign language (e.g., Spanish), it becomes 11 difficult to participate as a full citizen in social re wards , get advancements in occupational and educational 2 2 status, or marry outside the ethnic group. By the same token, in heightening the visual dif ferences of the ethnic group, social control is facilitated, thus making it easier for society to maintain the status quo. Finally, it enhances the potential for stereotyping 2 3 the entire minority population. While some minority popu lations may elect to voluntarily withdraw from the main stream of organic society and isolate themselves into enclaves, Hawley argues that the net effect remains the same insofar as the acquisition of social rewards is con cerned. If spatial segregation modifies opportunity, as Hawley suggests, then within the context of Durkheim’s framework the rules and regulations in organic society are biased. By erecting barriers to prevent particular subpopulations from entering the competitive process, subpopulations are re strained into assuming statuses that do not necessarily emerge from the natural faculties of the members. If so, then some kind of reaction can be expected from the members. This study argues that mental disorders are such a response. Specifications of the kinds of mental disorders that would characterize a spatially segregated population in organic society turns on the issue of how the subpopulation 12 assesses its situation. It is a matter of determining where the subpopulation "lays the blame" for the situation. As Cloward and Ohlin observe, "Whether the ’failure’ blames the social order or himself is of central import to the understanding of deviant behavior.Following Hawley’s theme, this study suggests that segregated subpopulations in organic society blame the social order, because it is society that creates obstructions which block their oppor tunities to compete. Given their situation, certain kinds of mental dis orders would be more likely to occur than others. Concep tualizing mental disorders as part of their response pat tern, disorders that reflect frustration, helplessness, confusion, hostility, suspicion, and persecution would be expected. Mechanical Society and Mental Disorders Mechanical society is at the opposite pole in 2 5 Durkheim’s typology of social structures. In contrast to the heterogeneity and change of organic society, mechanical society is based on homogeneity and stability. Thus, the rules governing social processes derive not from the intri cacies of contractual arrangements and the division of labor but from custom and tradition. Common sentiments, norms, values, and expectations pervade mechanical society and 13 provide the population with a superordinate belief system that binds them into a unified whole. This system comprises the "collective conscience" and is the basis of social solidarity in the mechanical milieu.' In maintaining a homogeneous environment social control measures are utilized to encourage conformity and discourage deviation. In mechanical society conformity is associated with the reward system, such as prestige, status, and esteem, whereas deviation implies repressive and coercive measures ranging from rebuke and ridicule to ostracism and expulsion. In discussing the problems of eliciting conformity Durkheim referred to internal and external pressures. External pres sures take the form of public opinion; internal pressures derive from the population’s having internalized the col- 2 7 lective conscience. As Durkheim notes, the collective 2 8 conscience is "the authority of society in us." In an environment oriented to homogeneity Dobriner sug gests that the "principle of visibility" is an inducement to 2 9 conform. Under this principle the community’s members are open to observation, a factor that facilitates social monitoring. Thus, Cans implies that much pressure focuses on creating uniformity in external appearance. He describes how pressure is exerted to ensure that neighbors on a street maintain their homes and front lawns "to a common standard 3 0 of upkeep." Sargent found that conformity permeated one 14 community to the point where social class differentials were 31 eradicated both inside and outside the homes. However, although conformity should lead to rewards, this is not necessarily the case for some subpopulations whose social and/or personal attributes distinguish them from the majority population. They may be defined as 3 2 deviant, as social outsiders. As a result, they may be denied social rewards, a denial that occurs in spite of their internalization of the norms and values which Sanders argues is implicit in the very fact that they are located in that milieu. To Sanders, "the mere fact of moving into a community implies a willingness to conform to its prevailing 33 patterns." Nevertheless, while they may conform to the general norms and values, social outsiders may still be the object of social sanctions such as hostility, resentment and 34 ostracism. For subpopulations in mechanical society who have pre sumably accepted the norms and values, nonacceptance - - if not rejection--may create stress and anxiety. It may also spur the members to "try harder" by increasing their efforts to conform to social expectations and thus try to elicit social status and esteem. In such an environment various mental disorders could be expected to emerge as reactions to or manifestations of their stresses. Among these would be dis orders related to feelings of inadequacy, reduced 15 self-esteem, or inferiority, all of which could be expected to characterize a subpopulation rejected by society and regarded as social outsiders. Disorders which the psychi atric literature traces to an individual’s failure to achieve recognition in spite of his/her conformity to social 3 5 expectations would also be expected. Last, disorders where anxiety and stress become manifest in physical dis orders such as ulcers, colitis, and so forth, would also be expected. To summarize then, because of the failure of the rules to operate according to expectation, in organic society sub populations affected by the situation would reflect mental disorders characterized by hostility, aggression, frustra tion, confusion, suspicion, persecution, and helplessness. In general, society would be regarded as the source of the problem. On the other hand, in mechanical society the sub population would direct its anxieties and frustrations in ward. In this case the mental disorders would revolve around diminished self-esteem, inferiority, inadequacy, and concerns about personal achievement and recognition. Society is not blamed for the situation ; that the sub population accepts responsibility is reflected in the expectation that the mental disorders will be intropunitive. The following section is devoted to explicating this general theoretical model by applying it to some specific 16 examples of subpopulations. For the organic society the discussion focuses on ethnic racial minorities and the elderly. In the mechanical milieu the discussion focuses on ethnic racial minorities and the unmarried adult sub population . Explication of the Theoretical Argument Ethnic and Racial Minorities in Organic Society As noted earlier, Hawley argues that spatial segrega tion is one of the mechanisms employed by society to block ethnic and racial minorities’ access to opportunities and the reward system. For ethnic and racial minorities in the organic milieu, spatial segregation results from push-pull pressures that affect their choice of areas of residence. Several factors converge in this process. Among these is their lack of experience in dealing with the dominant struc tural forms that operate in organic society.In many cases their immediate rural background has failed to equip 3 7 them for the organic milieu. However, because of spatial segregation even those who have had long tenure in the organic society may not have acquired the social skills needed to successfully bargain with the dominant society. Another factor is that their lack of financial resources (and their inability to gain access to those resources) 17 gives them little leverage in determining where in the 3 8 metropolitan area they would like to reside. Lacking both social and financial resources, ethnic and racial minorities are in no position to counter the pressures exerted by institutions responsive to organized real estate, commercial,and financial interests of the majority commu nity who are able to use formal and informal means to di rect ethnic and racial minorities into certain parts of the metropolitan area. Ethnic and racial minorities are not the only groups that are segregated in society. Through the ecological pro cesses that impact the social structure, the lower class as a whole is propelled into certain parts of the metropolitan area, primarily into the older areas that are undesirable to Other groups that can live elsewhere. However, even within the older areas ethnic and racial minorities are 39 spatially segregated into enclaves. While spatial segregation may appear to focus on resi dential location, its impact is pervasive. For ethnic and racial minorities spatial segregation is a condition that influences all aspects of life. It transcends physical location in space by outlining life space and by establish ing implicit boundaries as to the amount and kind of out side stimuli that reach them or they can reach. Mendelson describes their situation as a vicious circle, a means of 18 entrapment where one area of discrimination feeds the others and all are directed to a single end: an iron-ring of law and custom that forces an inferior status on its victims.40 Since 1954 ethnic and racial minorities have improved their situation, at least legally and therefore formally. However, in reality their position as an inferior and segre gated subpopulation has persisted through informal processes that continue to block their access to opportunities and control their participation in the reward system. In spite of their abilities and inclinations to work, for example, the "natural functioning of the market does not by itself ensure every man with will and ambition a place in the pro ductive process.In the event that ethnic and racial minorities are employed, they often operate under the in formal rule of "last hired, first fired." While blocked opportunities via spatial segregation generally characterize the ethnic and racial community as a whole, a special case of blocked opportunities is particu larly evident among the highly educated ethnic and racial minority population with low occupation. In this society the ideology is promoted that high education leads to re wards, both material and social. Thus, high education becomes a means to a desired and desirable end. From the point of view of the ideology, high education "means" 19 material possessions, but it also holds out the promise of high status jobs, which themselves are part of the reward system. But the promise does not hold for the highly edu cated ethnic and racial minorities with low occupation. Having accepted society’s ideology of how to succeed and of how to gain access to society’s rewards and participate in the "good life," the highly educated ethnic and racial minorities with low occupation are left behind, are left out. In the end the rewards they acquire are essentially little different from those of the ethnic population who did not make the effort to have a better life. From this point of view, disappointment, anger, and frustration would be expected among a population denied access to social rewards. Certainly their anger would be directed against society. It is expected that the situation would be very difficult for highly educated but low occupa tion ethnic and racial minorities who wind up living in the minority ghettos where they do not belong and do not fit in. Theirs is a double problem. On the one hand they are blocked out of the societal reward system by being denied access to opportunities, and on 'the other hand they are alienated from the rest of the ethnic and racial population in the segregated parts of the metropolitan area. Were social inequalities distributed throughout society, ethnic and racial minorities would share their 20 situation with other subpopulations. Were the problem simply one of their having lower social class status, the matter of their being contained in particular areas of the metropolitan area--and spatially isolated within those areas--would not affect them differently than other sub populations similarly situated. But this study argues that ethnic and racial minorities who are spatially segregated into enclaves in the older parts of the metropolitan area are in a unique position and are subject to pressures and stress that are not shared by other populations. In addi tion to being lower class, they are further penalized by their visible minority status. By virtue of the mass media, if nothing else, spatially segregated ethnic and racial minorities--and particularly those with high education but low occupation--are aware of the disparity between their living conditions and their opportunities and those that are available to other popu lations. It is the recognition of the disparity and the element of unfairness coupled with their powerlessness to combat the situation that combine to produce the frustra tion, anger, helplessness, confusion, despair, and suspicion that not only leads to the emergence of mental disorders but to the emergence of certain kinds of mental disorders. 21 The Elderly in Organic Society^^ In the case of the elderly mental disorders also derive from the violation of the contractual arrangement, although in the case of the elderly the problem does not rest on blocked opportunities. Rather, their problems stem from society’s failure to honor its implicit commitment to the elderly that they would be cared for and protected, in re turn for their earlier contributions to society. From this perspective, the elderly entered into an implicit contrac tual arrangement wherein they contributed to society (by participating in the labor force, by raising families) and society, in return, held out the promise of future rewards (e.g.,. protection and continuing care). Upon reaching old age, however, the elderly are not rewarded, according to expectation. As Nader observes, the elderly discover they have been "structured out" of the system in terms of not receiving "their just share of material, psychological, and • T U ,,44 social benefits. ’ That they are "structured out" is reflected in partic ular social changes that move many of the elderly out of the mainstream of society and into segregated parts of the metropolitan area. Two social changes have been especially instrumental in this respect. The first change involves the breakdown of the extended family, while the second focuses on the mandatory retirement . rule adopted by the economic 22 institution.^ ^ Because of the shift to the nuclear family model, there is neither room nor role for the elderly. Particularly within metropolitan areas where there is a premium on land, housing costs tend to ensure that a family purchases only as much housing as is needed for the immediate family. Also, because of the nuclear family’s need to be able to compete effectively in the metropolitan environment and thus maintain its potential to be mobile, no provision is made for inclusion of extra family members. Insofar as the elderly’s role is concerned, as other social institutions have assumed increasing responsibility for much of the socialization of the young, the role once played by the elderly relatives has diminished.Thus, they have little opportunity to be needed. In effect, while the elderly may require the protection and intimate environment of the family, changes in the family structure leave them to their own devices. The basic shift in the economic institution that affects the elderly is the mandatory retirement rule that requires those in the labor force to retire upon reaching 4 7 65. Within recent years this policy has been extended to early retirement, where those approaching retirement age are encouraged (usually through inducements) to leave the labor 48 force earlier than they have to. While the mandatory 23 retirement rule is aimed at making the labor force more fluid (i.e., freeing jobs that have been frozen by senior ity and permitting newcomers to enter the introductory 49 positions), for the elderly forced to retire the effect is to separate them from a functional social role, separate them from job-related friends, and reduce their income. Also, since the retirement rule is a general phenomenon, it is applicable to the entire age group, regardless of indi vidual differences (such as an individual’s ability to continue working). Both of these changes converge on the elderly and in the process of restricting their alternatives and choices, many elderly are encouraged to move to certain parts of the metropolitan area. First, because mandatory retirement often involves the loss of income, the elderly are often financially constrained to select those areas of the metro politan area they can afford. On the other hand, as areas become associated with the elderly and develop structures to accommodate them, the areas become attractive not only in terms of holding out the promise of peer-group companion ship (as an alternative to the family) but also because the areas have over time developed social and cultural struc tures that are responsive to the needs of the elderly. While spatial segregation may occur because of push- pull pressures, for some elderly it automatically 24 accompanied the metropolitan area’s processes of natural growth and change. Here, segregation occurred as the metro politan area matured and underwent structural change. As in the case of Firey’s Italian community in Boston, some elderly never moved out of the areas they originally set tled in.^^ As Other populations departed the area to estab lish residency elsewhere, the elderly--accustomed to their neighborhoods--remained behind and thus experienced de facte spatial segregation. In spite of the social changes that affect the elderly and indirectly create spatial segregation, society has created mechanisms designed to compensate for some of those changes. Total institutions fall into this category. However, while the erection of such structures may be well- intentioned, they generally do not provide the elderly with the kind of emotional support, warmth, and security gener ated by the family. Also, the total institutional environ ment deprives the elderly of the kind of independence they enjoyed when they were part of the labor force, a factor that affects their own self-concept. It is argued here that in assessing their situation, the elderly (1 ike the ethnic and racial minorities) place much of the blame on society because of society’s failure to maintain its part of the contractual agreement. However, unlike the minorities who were denied the opportunity to 25 participate, the elderly participated in and contributed to society on the assumption that rewards would be forthcoming. Instead of being rewarded, they are "structured out" of the reward system. From a micro point of view, ethnic and racial minor ities and the elderly may appear to be subject to unique pressures and problems. From a macro perspective, on the other hand, although the specific details may differ, ethnic and racial minorities and the elderly in organic society may both be spatially segregated. Thus, they would find them selves in much the same position vis-a-vis the social struc ture and the reward system. Because of this common denomi nator, their behavioral responses should also be similar within the sphere of community mental disorders. For both ethnic and racial minorities and the elderly in organic society one of the basic problems that should generate stress is the gap between reality and ideology as reflected in the violation of the contractual arrangements. Aside from the anxiety, frustration, and disappointment created by society’s failure to maintain its part of the social contract, confusion is generated because of the sub- populations’ difficulties in accurately discerning between 5 2 reality and unreality. Thus, schizophrenia becomes an appropriate behavioral reaction. Furthermore, the suspi cion aroused against society as a result of society’s 26 failure to honor the contract and society's efforts to keep the subpopulations in inferior positions could be manifested 5 3 in the form of paranoia. Additional mental health problems may derive from the same basic source, particularly from the anxiety, frustra tion, and disappointment that occur because of society’s failure to make opportunities available to ethnic and racial minorities and reward the elderly, Ethnic and racial minor ities may react by acting out their frustration or by re treating from their frustration. In either case, persona lity disorders which include such diverse problems as anti social personality, drug addiction, and alcholism (to specify a few of the disorders in the category) would be ^ , 54 expected. For the elderly, the acting out disorders would not be an appropriate means through which to manifest their frus tration. Rather, they would more likely express their frustration and disappointment by sublimating them.^^ This would be reflected in the depressive disorders (neurotic and psychotic). The elderly might also be characterized by one other mental disorder unique to them: senile psychoses. Because of the social conditions that surround them, because of their separation from real functional roles in society, and because of the social isolation that often character izes the elderly in organic society, they would be expected 27 to be characterized by senile psychoses. In summary then, ethnic and racial minorities would be characterized by schizophrenia, paranoia, and the person ality disorders. The elderly would be characterized by schizophrenia, paranoia, neurotic and psychotic depres sion, and senile psychoses. For convenience, these dis orders (both for the ethnic-racial minorities and for the elderly) will be referred to as "organic disorders" because in this study they are associated with Durkheim’s organic milieu/^ Ethnic and Racial Minorities and the Unmarried Adult Sub” populations in Mechanical Society In the process of emphasizing the virtue of homogeneity mechanical society implicitly establishes standards against which conformity and deviation can be measured. The basic model, as far as population composition is concerned, is the 5 7 white middle class family. Unmarried adults are essen tially not welcome in the mechanical milieu, nor are single parents. Hahn emphasizes the point by noting that mechan ical society is the "domain of nuclear families and any other kind of residential unit--be it single, extended, or 5 8 communal--is socially undesirable. The single parent and divorced person in general are socially stigmatized in an 5 9 area devoted to family life. 28 That ethnic and racial minorities are generally un welcome in mechanical society is reflected in the attempts of realtors and residents alike to dissuade them from moving into the community.Yet they appear to be a self-selected subpopulation whose values are similar to those of the 61 ' majority population in the mechanical milieu. They are upwardly mobile, young, and successful ;^^ they take pride in their homes, have relatively small families, are educated, are in the middle income bracket, are either skilled workers or are in the professions, and have accumulated cash savings.Hughes and Watts refer to them as "self- integrators"’ : once they move into a community they adapt their lives to the tempo and character of the majority population. That the subpopulations are in the mechanical milieu is indicative of their acceptance of the norms and values. However, in both cases the subpopulations have attributes that identify them as social outsiders. Regardless of their preferences, inclinations or value orientations, they are in violation of the conformity rule dominant in the mechanical milieu. Furthermore, as Dobriner might note, their non conformity is visible to the community and therefore subject to social pressure.However, while some pressure might be applied in subtle or not-so-subtle ways, the real pressure might come not from the external environment as much as from 29 within the members’ own consciousness and recognition of their peculiar position in the social milieu* Thus, because of the stress, pressure, and anxiety that emerge, particular mental disorders could be expected to develop as responses to their situation. The responses would include the psychoneuroses, the major affective disorders, and the psychophysiological disorders. Together, these are referred to as ’’ mechanical disorders’’ since in this study they are associated with Durkheim’s mechanical milieu- The psychoneuroses would be expected because they are generally associated with feelings of inadequacy, self depreciation, and inferiority.^^ They would be expected to emerge in a subpopulation concerned about social status but rejected by the society. The major affective disorders, usually identified with manic-depression, are discussed in the psychiatric literature in terms of the depression that emerges from the failure of a conforming individual to achieve recognition and status.This would apply to the social outsiders discussed in this study. The psychophysi- ological disorders would be expected to characterize social outsiders since these disorders represent sublimation of anxiety, which becomes manifest in the form of physical T T 6 8 problems. In summary, different kinds of mental disorders should be associated with different subpopulations, depending on 30 where the subpopulations are located and the kinds of pressures that impinge on them. According to the arguments presented earlier, ’ ’organic disorders’’ should characterize ethnic minorities, specifically ones with high education but low occupation in the organic milieu. For them, the disorders would include schizophrenia, paranoia, and the personality disorders [which include alcoholism and drug addiction). Organic disorders would also characterize the elderly, but for them organic disorders would consist of the depressive neuroses and psychoses, schizophrenia, paranoia, and senile psychoses. On the Other hand, mechanical disorders should charac terize the ethnic minorities in the mechanical milieu, as well as the unmarried adults living there. In this case mechanical disorders would include the psychoneuroses, the major affective disorders, and the psychophysiological dis orders , Re s e a r c h Hy p o t h e s e s On the basis of the preceding discussion the following research hypotheses are presented; Hypothesis 1 The more socially complex the areas of the metropolitan region are, the more they will be characterized by organic mental disorders, and the less they will be characterized by 31 mechanical mental disorders. The more socially complex the areas of the metropolitan area, the greater will be the effects of organic disorders on ethnic as opposed to Anglo populations. Hypothesis 2 Specific kinds of mental disorders are joint functions of the area's social complexity and the relative size of the subpopulations with blocked opportunities. Subareas (census tracts) constitute the units of analysis. a. The prevalence of organic mental disorders in the population is a joint function of how socially complex the area is and the size of the ethnic population. Derived: The more developed the metropolitan area, the more positive will be the association between the relative size of the ethnic population and the rate of organic dis orders in the ethnic population. b. The prevalence of organic mental disorders in the highly educated ethnic population with low occu pation is a joint function of how socially complex the area is and the size of that ethnic population. Derived: The more developed the metropolitan area, the more positive will be the association between the relative size of the highly 32 educated ethnic population with low oc cupation and the rate of organic dis orders in that ethnic population. Hypothesis 5 Specific kinds of mental disorders are joint functions of the area’s social noncomplexity and the relative size of the subpopulations that are socially excluded. a. The prevalence of mechanical mental disorders in the ethnic population is a joint function of how socially noncomplex the area is and the size of the ethnic population. Derived: The less developed the metropolitan area, the more positive the association between the size of the ethnic population and the rate of mechanical mental disorders for that population. b. The prevalance of mechanical mental disorders in the single population 45-64 years old is a joint function of how socially noncomplex the area is and the size of that population. Derived: The less developed the metropolitan area, the more positive the association between the size of the single population 45-64 years old and the rate of mechanical mental disorders for that population. 33 CHAPTER I FOOTNOTES 1. Robert E. L. Paris and H. Warren Dunham, Menta1 Dis - orders in Urban Areas : An Ecological Study Schizophrenia and Other Psychoses [Cbicago; Uniyersity oT~Chicago Press, 1939). 2. Clarence W.Schroeder, "Mental Disorders in Cities,” American Journal of Sociology, 4 8 (July, 1942), 3. H, Warren Dunham, Community and Schizbpbrenia; An Epidemiological Analysis (DetroitT Wayne State University press, 1965). 4. Leo Levy and Louis Rowitz, The Ecology of Mental Disorder (New York: Behavioral Publications, 1973), 5. Gerald D, Klee e_t , "An Ecological Analysis of Diagnosed Mental Illness in Baltimore," Psychiatric Epidemiology and Mental Health Planning, ed, Russell R, Monroe, Gerald D. Klee, and Eugene B. Brody, Psychiatric Research Report, No. 2 2 (New York: American Psychiatric Association, 1967), pp. 107-139. 6. Robert E. Park and Ernest W. Burgess, The City (Chicàgô: University of Chicago Press, 19 2 5). 7. Barbara Snell Dohrenwend and Bruce P. Dohrenwend, "Class and Race as Status-Related Sources of Stress," in Social Stress, ed. Sol Levine and Norman A. Scotch (Chicago: Aldine Publishing Co., 1970), pp. 117-119. 8. Emile Durkheim, The Division of Labor in Society, trans., George Simpson (New York: The Free Press, 1968), pp. 63-66. 9. Emile Durkheim, Suicide: A Study in Sociology, trans., John A. Spaulding and George Simpson (New York: The Free Press, 1967). 10. Durkheim, The Division of Labor, pp. 296-301. 11. Alvin Boskoff, The Sociology of Urban Regions (New York; Appleton~Century-Crofts, 1962), p. 282. 34 12. Emile Durkheim, The Elementary Forms of the Religious Life, trans., Joseph Ward Swain (New York; Collier Books, 1961). 13. Durkheim, The Division of Labor, pp. 181 -182. 14. Ibid., p. 228. 15. Ibid., p. 374. 16. Ibid., pp. 376-37 7. 17. Ibid., pp. 375-376. 18. Amos Hawley, "Dispersion versus Segregation: Apropos of a Solution of Race Problems," Papers of the Michigan Academy of Science, Arts, and Letters, 30 (1944), cited in Edgar T. Thompson and Everett C. Hughes, Race: Individuai and Collective Behavior (GlencoeT The Free Press, 1958), pp. 199-204. 19. Ibid., p. 2 02. 20. Milton M. Gordon, Assimilation in American Life: The Role of Race, Religion, and Natural Origins (New York: Oxford University Press, 1964), pp. 235-238. 21. Hawley, o£. cit., p. 200. 22. Stanley Lieberson, "The Impact of Residential Segre gation," Social Forces 40 (October, 1961), 52-57. 23. Ibid., p. 200. 24. Richard A. Cloward and Lloyd E.Ohlin, Delinquency and Opportunity: A Theory of Delinquent Gangs (Glencoe: The Free Press of Glencoe, 1963), p. Ill. 25. Durkheim, The Division of Labor, pp. 70-110. 26. Ibid., p. 79. 27. Durkheim, The Elementary Forms, p. 30. 28. Ibid:, p. 30. 29. William Dobriner , Class in Suburbia (New York : G. P. Putnam, 1958), p. 8. 35 30. Herbert Cans, "The Suburban Community and Its Way of Life,” Nelghbofhoody City, and Metropolis : An Integrated Reader in Urban Sbciology, edV Robert Gutman and David Ropenoe [New York; Random House, 1970), p. 299, 31. S. Stansfeld Sargent, ”Class and Class-Consciousness in a California Town,” Social Rrbb1ems, f [June, 1953), 22- 27. 32. David Glaser, Social Deviance (Chicago: Markham Publishing Company, 19 71), p. 21, 3 3. Irwin T. Sanders, The Community : An Introduction to a Social System, 2d ed. (New York: Ronald Press, 1966) , p, 378, “ 34. Jerome K. Myers, "Assimilation to the Ecological and Social Systems of a Community," Aimerican Sociological Review, 15 (June, 1950), 371. 35. James C. Coleman, Abnormal Psychology and Modern Life, 2d ed. (Chicago: Scott, Foresman and Company, 19 56), p. 312. 36. E. Franklin Frazier, "Race Contacts and the Social Structure," ^erican Sociological Review, 14, (February, 1949), 1-11, cited in E. Franklin Frazier: On Race Relations, ed, G. Franklin Edwards, 2d ed. (Chicago: University of Chicago Press, 1968), p. 53. 37. Lawrence B. deGraaf, "Negro Migration to Los Angeles, 1930 to 1950" (unpublished Ph.D. dissertation, Depart ment of History, University of California at Los Angeles, 1962). 38. Karl E. Taeuber and Alma F. Taeuber, Negroes in Cities (Chicago : Aldine Publishing Company , 1965), ppl 19 - 20. 39. Maurice D. Van Arsdol, Jr. and Leo A. Schuerman, ’’Redistribution and Assimilation of Ethnic Populations : The Los Angeles Case,” Demography, 8 (November, 1971), 459-480. 40. Wallace Mendelson, Discrimination (Englewood Cliffs : Prentice-Hall, 1962), p. 2, 41. John B. Turner and Whitney M. Young, Jr., ’’ Who Has The Revolution or Thoughts on The Second Reconstruction,” 36 The Negro American, ed. Talcott Parsons and Kenneth B. Clark (Boston : Kougliton Mifflin, 1965], pp. 678^684, 42, Bayard Rustin, ”prom Protest to Politics ; The Future of the Civil Rights Movement ^ ^ Commentary, 39 (February, 1965}, 26. 43, The theoretical argument regarding the elderly will be explicated in this study but it will not be tested. The discovery of a coding error in the mental health file led to the exclusion of the elderly from the analysis. 44, Ralph Nader, Foreward in Claire Townsend, Old Age: The Last Segregation (New York: Bantam Books, 1971 p, ix , - 45. H. Warren Dunham, ’’Sociological Aspects of Mental Disorders in Later Life,” Mental Disorders in Later Life, ed. Oscar J. Kaplan (Palo Alto: Stanford University Press, 1945], p, 128, 46. Ibid,, p. 123. 47. W. S, Williams and E. Gartly Jaco, ”An Evaluation of Functional Psychoses in Old Age,” American Journal of Psychiatry, CXIV (1958) , 914 ; John Ar s e ni an\ "Situa- tional Factors Contributing to Mental Illness in the Elderly,’’ Geriatrics (October , 1962) , p. 669. 48. Zena Smith Blau, Old Age in a Changing Society (New York : New Viewpoints, 1973), p. 9/ 49. Ibid., pp. 10-11; Dunham, ’’Sociological Aspects of Ment a1 Disorders,” p. 122. 50. Walter Firey, ’’Sentiment and Symbolism as Ecological Variables,” American Sociological Review, 10 (April, 1945), 140-148. 51. Erving Goffman, Asylums; Essays in the Social Situa tion of Mental Patients and Other Inmates (Garden City : Doubleday and Company, 1961), pp. 3-12. 52. Ephraim Rosen, Ronald E. Fox, and Ian Gregory, Abnormal Psychology, 2d ed. (Philadelphia: Wi B, Saunders Company, 1972), pp. 213-220; Marshall Clinard, Sociology of Déviant Behavior (New York: Rinehart and Company, 1957), pp. 323-325, 37 . 5 3 Rosen, Fox, and Gregory, 0£. cit., pp. 245-252; Coleman, o£, cit. , pp. 289-294. 54. Rosen, Fox, and Gregory, b£, cit., p. 256. 55. Robert W. White, The Abnormal Personality, 2d ed. Cflew York: Ronald Press, 1956} , p, 5 09. 56. Clinard, op. cit., pp. 419-421 ; White, op. cit., pp. 509-510. ' — ~ 57. Sylvia Fleis Fava, ’’Suburbanism As a Way of Life," American Sociological Review, 21 (February, 1956}, 34-35; william Dobriner, The Suburban Community, ed. William Dobriner (New York : G. P. Putnam, 1958), pp. 15-16. 8. Harlan Hahn, "Ethnic Minorities: Politics and The Family in Suburbia," The Urbanization of the Suburbs, ed. Louis H. Masotti and Jeffrey K. Hadden, Vol. 7 (Beverly Hills : Sage Publications, 1973), 186. 59. Ibid., p. 189. 60. S. Lynn Clark and James H. Kirk, "Characteristics of Minority Group Families Who Have Tried to Move Into White Neighborhoods," American Journal of Economics and Sociology, 183 (April, 1959), 243-248. 61. Ibid., pp. 243-244. 62. Morton Rubin, "The Negro Wish to Move: The Boston Case," Journal of Social Issues, 15 (1959), 12. 63. Clark and Kirk, op. cit., p. 246. 64. Helen MacGill Hughes and Lewis G. Watts, "Portrait of the Self-Integrator," Journal of Social Issues, 20 (April 1964), 109. 65. Supra, pp. 8-9. 66. William Malamud, "The Psychoneuroses," Persohality and the Behavidr Disorders, Vol. II, ed. J. McV. Hunt (New York: Ronald Press, 1944), 845-847 ; White, op. cit., 203-208; Alfred M. Freedman and Harold I. Kaplan/ Comprehensive Textbook of Psychiatry (Baltimore: The Williams and Wilkins Company, 1967), pp. 928, 859-860. 38 67. Rosen, Fox, and Gregory, cit., p. 192; Coleman, op. cit.. , pp. 311^312; Freedman and Kaplan, op, cit. , p. 681. 68. Freedman and Kaplan, pp. cit., pp. 1044-1048. 39 CHAPTER II RESEARCH DESIGN General Components Area of Study The area selected for study is the Anaheim-Santa Ana- Garden Grove Standard Metropolitan Statistical Area, an area coterminus with Orange County located southeast of but adjacent to the Los Angeles Standard Metropolitan Statis tical Area. Once primarily devoted to agriculture, within the past 20 years Orange County has experienced rapid population growth and industrialization. Whereas in 1950 the County had a population of 216,000 persons, it had 703,000 persons at the time of the 1960 decennial census and 1.4 million in 1970.^ Orange County remains one of the smallest geographic political units in California (782 square miles) but as a result of its population growth, it is the second most populous county in the State. Four factors recommend Orange County as the study's site. First, it has a diversified social structure that contains elements of the organic-mechanical spectrum. Nevertheless, while parts of the metropolitan area reflect some aspects of organic or mechanical social structure, no area fits the ideal type. That is, no area is totally 40 organic or totally mechanical. Second, Orange County has a comprehensive mental health program that de-emphasizes institutionalization. In addition, patient data pertinent to hypotheses raised in this study are available for analysis. A third consideration focuses on the availability of land use data necessary to the construction of an index used in the study's methodology. Fourth, social structural variables are available from the 1970 decennial census. Level and Unit of Analysis As emphasized in the previous chapter, social struc tural conditions are integral to the study's argument in terms of their impact on populations-at-risk. While patient data will be used in the study, the analysis occurs at the social structural level and not at the individual level. Thus, patient data will be aggregated to form ecological variables. Since this investigation is an outgrowth of the work 2 done by Duncan, Sabagh, and Van Arsdol and by Van Arsdol 3 and Schuerman, the study's unit of analysis follows their established usage. Accordingly, this investigation focuses attention on ecological subareas, represented by aggregates of census tracts. There are 320 census tracts in Orange County. Two census tracts were excluded from the study. One tract was totally uninhabited grazing land, while the other census 41 tract was a boat anchored in a marina. This tract contained nine persons. Data Utilized in the Study The mental health data used in the study were obtaihed from the Orange County Department of Mental Health and per tain to patients admitted between January 1, 1973 and July 1, 1974. Mental health data collected prior to January 1, 1973 were not used in the study since their reliability was suspect. During the period covered by the study, 31,418 patients were admitted to the Department. Of these, 7,062 duplicate admissions were eliminated from the study, as well as 5,579 cases lacking an Orange County address, and 1,748 cases that did not contain a diagnosis. As a result, the study is based on 17,029 cases. Information regarding the patient population was ob tained from the mental health file and included age, sex, ethnic background, marital status, occupation, education, diagnosis, and census tract of residence. For purposes of this study and because of the dearth of Black patients in the mental health file, the Black (n = 217) and Mexican- American (n = 1,879) categories were merged into a category referred to as "ethnic." Occupation was dichotomized into high and low occupation categories, with the high occupation category defined as including the professional, technical, and managerial- administrative positions. All other 42 occupations were defined as "low occupation." Unknowns were eliminated from this category as well as from all others used in the study. The education variable was also dichotomized with "at least a college graduate" defining the lower boundary of the "high education" category. All other education categories were defined as "low education." In constructing the "single" category from the marital status variable, four items were combined: those never married, those divorced, separated, and widowed. The organic and mechanical mental disorder categories employed in the study were constructed by combining the diagnostic codes used by the Department of Mental Health. These codes are outlined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.^ While a few codes were specifically excluded because they did not fall within the study's parameters (e.g., sex disorders), the majority of the approximately 200 disparate codes were included in the study. Creation of Categories of Mental Disorders The dichotomization of diagnoses into organic or mechanical categories was determined in consultation with a social psychiatrist specializing in community mental health. The determination of organic or mechanical rested on each diagnosis' clinical symptomatology.^ Using symptoms 43 or clinical characteristics, diagnoses were grouped accord ing to their clinical similarity or difference. The diag noses grouped together did not share all of the same charac teristics, but there was overlap of some of the major clinical symptoms. For the organic disorders of interest to this study (schizophrenia, paranoia, personality disorders, drug addiction, and alcoholism) there are two general threads: hostile and aggressive behavior and delusions and hallucinations.^ In addition, paranoia, schizophrenia, and personality disorders share the common factor of suspicion; alcoholism, drug abuse, and schizophrenia are generally characterized by memory impairment and disorientation to reality. As for alcoholism and drug abuse, both of these disorders are regarded as retreatist behaviors, while paranoia and schizophrenia both share elements of persecu tion. The mechanical disorders, composed of the psychoneu roses, major affective disorders, and the psychophysiologi cal disorders are characterized by conflict and involve the displacement and conversion of anxiety. The psycho- physiological disorders and the major affective disorders g are linked by the common denominator of depression. Thus, common symptoms probably caused covariation among the diagnostic categories to which patients were assigned 44 within each of the two broad types and encouraged the search for a multiple element indicator of each. Having constructed the categories from a logical- clinical perspective, a correlation matrix and a factor analysis were obtained to assess reliability within the two categories. The correlation matrix was calculated from the rates of the study's diagnoses for the 318 census tracts in Orange County used in the study. In general, the inter correlations were not high, ranging from .01 to .42, with eleven of the twenty-eight correlations above .20. A two- factor factor analysis was performed on the correlation matrix to determine if individual category rates loaded on the organic and mechanical categorization. Using an ortho gonal rotation in the principle components method, a simple structure analysis was performed. The correlation matrix is presented in Appendix A; the factor loadings are pre sented in Table 1. The factor loadings generally demonstrated a trend as hypothesized by identifying two groups of diagnoses. Never theless, in view of Schwartz' point that variables should load on one factor but not on the other (for pairs of 9 factors), there were disparities between expected and ob served factor loadings on some of the diagnoses. Using .30 as the criterion factor loading,^^it was expected that Factor I would reflect heavy loadings for the following 45 TABLE 1 PRINCIPAL COMPONENTS FACTOR STRUCTURE FOR RATES OF MENTAL DISORDERS IN THE TOTAL POPULATION 18 YEARS OLD AND OVER IN ORANGE COUNTY: 1973-1974 (N = 318 CENSUS TRACTS) Rotated Factor Loadings Factor I Factor II Category : Alcoholism Schi zophrenia Major Affective Disorders Paranoia Psychoneuroses Character Disorders Drug Addiction Psychophysiological Disorders 31 79 08 26 08 63 51 31 .26 .22 .42 .04 . 70 . 01 .31 . 59 Via orthogonal rotation. 46 diagnoses: alcoholism, schizophrenia, the character dis orders, and drug addiction. Factor II was expected to re flect heavy loadings for the major affective disorders, the psychoneuroses, and the psychophysiological disorders. It is suspected that the overlap in the categories may derive from the interchangeability of diagnostic labels that can be applied to some forms of behavior. The dis orders involve syndromes and the overlap in symptoms may be a source of confusion to and reveal disagreement among clinicians making the original diagnoses. Examination of the factor loadings reveals that the drug addiction and psychophysiological disorders diagnoses satisfy the criterion for inclusion in both factors, at least technically. Their factor loadings on the factor to which they theoretically belong are considerably higher than are the loadings on the factor to which they theoretically do not belong. Furthermore, given a criterion of .30 the factor loadings of the two diagnoses in question barely exceed the criterion level. For this reason, their devia tion is not considered serious-rand serves to lend a con servative bias to tests of the hypotheses., .Thus, it seems appropriate to accept the reliability of the diagnostic categories. Since the organic and mechanical disorder categories are composites of groups of mental disorders, the categories 47 may be described. Within the organic disorders category used in the study (and excluding those diagnoses pertinent to the elderly), the following composition is found : schizophrenia, 17.9 percent; paranoia, 0.5 percent ; and the character disorders (including alcoholism and drug dependence), 82.1 percent. The mechanical disorder cate gory is made up of the major affective disorders, 11.6 per cent ; the psychoneuroses, 8 5.0 percent ; and psychophysio- logical disorders, 3.4 percent. All of the variables obtained from the mental health file and pertaining to individual cases were aggregated to the census tract level and through the aggregation proce dure became summary representations of the mental health data. An overview of the mental health caseload for 1973- 1974 on those items that are pertinent to this study is presented in Table 2. Census Data The census data used as denominators for the dependent variables and that served as the study's independent vari ables to reflect the social conditions of the metropolitan area's subareas were structural variables obtained from the computerized census tract data file for the 1970 Decennial Census of Population and' Housing. The selection of the structural variables proceeded from the theoretical 48 TABLE 2 OVERVIEW OF MENTAL HEALTH CASES, 1973-1974: ORANGE COUNTY DEPARTMENT OF MENTAL HEALTH Total cases 17,029 Ethnie cases > 18 years old 2,096 Ethnic cases, high education, low occupation 307 Single cases 45-64 years old 684 Organic mental disorders 8,878 Mechanical mental disorders 2,474 Other mental disorders 5,679^ Ethnic cases, organic disorders 1,428 Ethnic cases, mechanical disorders 210 Single cases, 45-64 year old, mechanical disorders 103 ®Not included in study. 49 discussion in the first chapter and the two major themes presented there: that some subpopulations are blocked from the reward system while others are social outsiders in their neighborhoods. As suggested in Chapter I, spatially segre gated ethnic populations who are highly educated but have low occupational status are faced with an intensive kind of blocked opportunities. The structural variables selected to reflect the blocked opportunities of the ethnic population in the organic areas focus on their spatial separation and on the disparity between educational attainment and occupa tional achievement. The variables include the following: the percent ethnic population (in the subarea), the percent of the ethnic population with high education, and the per cent of the ethnic population with low occupation. In contrast to the argument concerning ethnic minor ities in the organic areas, in mechanical society the theoretical argument revolves around their being identified as social outsiders. Thus, in spite of their manifest con formity to the norms and values, they are still not ac cepted. In this study their conformity is implicit in their location in the mechanical milieu, but their rejection as outsiders derives from their ascribed characteristics. If so, the structural conditions of the area are not as much of a factor in their manifesting mechanical mental disorders as their own "deviant" characteristics which identify them 50 as outsiders. Accordingly, structural variables will not be employed in examining the mental disorders of ethnic minorities in the mechanical milieu. Similar to the situation of ethnic minorities, that unmarried adults are in mechanical society is taken as an indication in this study of their acceptance of mechanical norms and values. However, it is argued that achieved statuses are a factor in their exclusion: unmarried adults and particularly single parents do not fit into a milieu that is geared to and for family life. Thus, structural conditions are a factor in the emergence of mental illness in single adults in the mechanical milieu. However, of all the subpopulations in this study the decennial census pro vides few structural variables pertaining to the unmarried adult population. As a result, the choice of structural variables is necessarily guided more by what is available than by what provides a "best fit" to the theoretical argu ment. Recognizing this limitation, two structural variables were selected that were consistent with the argument that unmarried adults and single parents are regarded as social outsiders in the mechanical milieu. The variables are per cent single adults 45-64 years old and percent single parents. 51 Estimating Social Structural Variables Because the census and mental health data were col lected during and refer to different time periods, the numerators and denominators of the rates created for the study are not consistent. The inconsistency between the numerators and denominators creates a methodological pro blem that is recognized as having a potential impact on the analysis. While linear adjustments in the census data could have been made to "update" the variables to 1973, the use of a linear approach would have been more cosmetic than real. That is, the adjustments would have been relative and would have simply moved the data further along the scale. Another consideration that argued against introducing other ques tionable adjustment procedures was that the County's popu lation did not increase by more than one and one-half per cent (or 100,000 persons) in the three year interim (accord ing to estimates published by the Orange County Planning Department). Furthermore, the County's population growth was more or less concentrated in the newer parts of the metropolitan area; thus the effect on the analysis would be localized. A final consideration was that the newer areas do not provide the Department of Mental Health with the bulk of its patient caseload; by and large it would be expected that patients from the newer areas would be likely to seek clinical services from the private sector and V' 52 therefore never enter the Department’s system. While the methodological issue remains, and must be recognized, it is anticipated that these other factors will minimize the time gap problem. An Index of Urban Maturation Few if any precedents exist in the sociological liter ature for operationalizing the entire organic-mechanical typology. Durkheim himself did not utilize the entire ty pology in his explicative studies but dealt with the polar types of societies in separate investigations. In Suicide, for example, he focused on organic society, whereas mechani cal society was examined in The Elementary Forms of the Reli gious Life. In the absence of guidance from the existing jliterature the operationalization of the Durkheim model pro- |ceeds from the ecological literature. For example,Boskoff derives land use implications from Durkheim’s arguments con- 12 cerning the division of labor. To Boskoff the extension is logical: given the occupational specialization inherent in organic society, Boskoff argues that it "is necessarily accompanied by patterned differentiation in urban land uses, 13 first for economic, then for social purposes." What is of interest in the present study is the implicit linkage Boskoff makes between social structure and land use. This land use-social structure linkage is not a new concept in the urban literature, having historical roots in the 53 14 "Chicago School" of human ecology. The procedure used in this study to operationalize the Durkheim framework is an extension of the Chicago School of thought and was first presented in Hoover and Vernon’s modification of the con centric zone model. The procedure essentially creates an index of urban maturation based on Hoover and Vernon’s study of urban 15 growth and development. In Anatomy of a Me trop o1i s Hoover and Vernon modified the Chicago concentric zone model by accounting for patterns of development characteristic of modern metropolitan areas that grew up with or after the advent of the automobile. Thus, instead of neat concentric zones that radiate outward from the center of the city^^ Hoover and Vernon argue that growth occurs in leap-frog 17 fashion, emanating from several different centers. Part of the underpinning of the concentric zone model is the implication of evolution of growth and development through zones, beginning with the most inner zone and moving outward to the periphery. There is also an implication of the length of time areas in the different zones have been developed. The zonal divisions more or less correspond to successive time periods, with the outer zones more recently 19 developed. The Hoover and Vernon growth model is also evolutionary and temporal, but it is more directly and explicitly conceptualized in stages according to changes in 54 land use. Their model encompasses five stages: 1. The start of residential development, 2. the beginning and increase in multiple dwelling units, 3. conversion and downgrading of original structures, 4. thinning out through vacancy, abandonment, and demolition, and r . 20 5. renewal. While evolutionary, not all areas necessarily pass through all of the stages. Some areas may stop their progression at a particular stage; other areas may enter the process at a stage other than stage one. Throughout their study Hoover and Vernon emphasize the strong ties between land use and social structure. Not only is there a goodness of fit between land use and social structure cross - sectionally, but as areas age and pass through the different stages of urban growth, the social structure also gradually changes over time. Their con clusions stem from the earlier work of the Chicago School. For example. Park suggested in his discussion of ecological processes that different subpopulations compete for limited 21 resources in the urban milieu. In general, through the convergence of ecological processes and land use, metro politan social structure takes shape. For example, because 55 of the value placed on the land, a certain kind of living environment is created in the older areas that attracts some subpopulations while repelling or pushing other subpopula tions out. The sheer age and delapidated condition of the multiple housing, the general obsolescence of the utilities, lack of conveniences and amenities, the increasing traffic congestion, and the competition for open space between eco nomic -business -government establishments and the residents are all factors that drive away those who can afford to move 2 2 to other parts of the metropolitan area. The older areas are abandoned to subpopulations who cannot afford to live elsewhere in the metropolitan area, including the elderly, the ethnic minority groups, the lower class in general, single persons, and newly married couples. Park’s ecological arguments and the Hoover and Vernon model coalesce to firmly establish a linkage not only between land use and social structure but between the intensity of land use and the complexity of social struc ture. Since Durkheim did not explicitly define the meaning 23 24 pf complexity. Park, Hoover and Vernon, Duncan and Duncan,^^ and Van Arsdol and Schuerman^^ have variously operationalized complexity to mean the degree to which there is an intensive use of the land in terms of dwelling unit densities, mixtures of occupational categories, population heterogeneity, women in the labor force, and residential and 56 business mixtures as a reflection of competition for the land. Therefore, in this study complexity is defined in terms of the extent to which these phenomena occur. Accord ingly, if complexity is greater in the older areas than in the newer areas, it might be reflected in higher proportions of females in the labor force, greater diversity in popu lation composition, including the ethnic-racial, occupa tional and educational compositions, a higher proportion of land devoted to commercial and industrial use, and higher population densities. Both Park and Hoover and Vernon suggest that as intensity of land use increases, the above structural ele ments become more intense. Furthermore, since both models are evolutionary and temporal, it also follows that the longer areas have been developed, the more accentuated the land use, and the more complex the social structure. Thus, in the current study this ecological orientation is used to translate the implicit differentiation of Durkheim concern ing organic and mechanical milieux into an operational specification that assumes the longer areas have been devel oped, the more organic the social structure, and the more recent the development, the more mechanical the social structure. Empirical studies have explored in operational terms ways of isolating relationships suggested by Park and by 57 Hoover and Vernon. For example, Duncan, Sabagh, and Van-' Arsdol utilized the Hoover and Vernon arguments in Anatomy of a Metropolis to analyze the relationships between land 2 7 use and urban development in the City of Los Angeles. What had been called the "flight to the suburbs" was really found to be an expansion of the city’s sphere of influence boundaries (outward) beyond its political boundaries. In a later study Van Arsdol and Schuerman linked land use, urban development,and social structure to examine patterns of 2 8 ethnic segregation in Los Angeles County. In contrast to the earlier study, this investigation focused on longitu- . dinal structural change in subareas of the metropolitan area. Schuerman, Hansen, and Hubay further adapted the Hoover and Vernon typology in an investigation of poverty subareas in the Baltimore and the Los Angeles metropolitan 29 areas. The advantage of using the land use approach in the present study is that it provides a basis upon which to measure the entire organic-mechanical continuum. Since intensity of land use (i.e., the length of time subareas have been developed) has already been linked to social structure in the above studies, it would seem useful to apply this operational procedure to Durkheim’s framework. The index used in this study is thus based on the date of settlement index first developed by Duncan, Sabagh, and Van Arsdol.Their index was derived by classifying census 58 tracts --which may not be contiguous --according to the time period during which the tracts satisfied a density criterion of two single dwelling units per gross acre (a criterion 31 established by Hoover and Vernon). Schuerman, Hansen, and Hubay expanded this unidimensional classification scheme by incorporating the first two of Hoover and Vernon's stages. Thus, the index of urban maturation differentiated land use and settlement by multiple as well as single dwelling units. This study's index is a modification of the index developed by Schuerman, Hansen, and Hub ay. While the original index characterized a metropolitan area where population growth occurred before i960, the study's index retained the mul tiple-single dwelling unit matrix but modified it to accom modate an area where most of the population growth occurred after 1960. As a consequence of Orange County's recent growth pattern, the index of urban maturation was reduced from nine to six categories. This modification also affect ed the empirical range of the theoretical organic-mechanical continuum: whereas the original index ranged from 19 39 to 1970, the index used in this study ranged from 1959 to 1970. Following the density criteria established in the above earlier investigations, the study’s urban maturation index was obtained by classifying census tracts by type of dwell ing unit, either single or multiple. For single dwelling units the tracts were classified as to whether they achieved 59 a density criterion of two dwelling units per gross acre before 1969 or if the density criterion for single dwelling units had not been achieved as of 1970. For multiple dwelling units three categories were established, reflecting the assumption that multiple dwelling unit settlement, is a stronger indicator of urbanization than settlement by single dwelling units. Accordingly, in the case of multiple dwell ing units subareas were classified as to whether they satis fied a density criterion of one multiple dwelling unit per two gross acres that was achieved before 1959, between 1960 and 1969, or not achieved as of 19 70. (The one multiple dwelling unit per two gross acres criterion was used because higher densities are automatically achieved in multiple dwelling unit structures and the use of that criterion per mitted a more even distribution of census tracts across subareas.) A subarea was judged to have passed through a particular stage when it satisfied the joint criteria of the single and multiple dwelling unit categories. The most urbanized areas are those that have been developed the longest and therefore are those areas where multiple dwelling unit settlement occurred before 1960 and superceded single dwelling unit settlement. The most mechan ical areas are those where neither density criterion was satisfied as of 19 70. Rather than attach names to the six urban maturation areas, the areas will be identified in 60 terms of length of time each has been developed, beginning with urban maturation area 1 (Area 1). The index and its classification scheme are presented in Figure 1. It should be noted that the two variables use different time frames: whereas the single dwelling units dimension is dichotomized between pre-1969 and post-1970, the multiple dwelling unit dimension \ is trichotomized in terms of pre-1959, between 1960 and 1969, and post-1970. This introduced an element of imbalance into the index, but it was considered methodologically necessary since Orange County is a comparatively new metropolitan area whose major population growth did not occur until 1950. Alternative cutting points were explored (e.g., collapsing the six cells into three cells, or changing the time frames), but the cutting points and cell matrix adopted for the study pre served as much variance as possible and provided the most equitable distribution of census tracts across the matrix' cells. Maturation Area Profiles It should be noticed here that none of the indexes developed above, or for this study, are to be construed as "absolute" or discrete measures of urban development from simple to complex structural milieux. Rather, the indexes should be considered only as a way of roughly differenti ating into categories what is essentially a continuum of 61 FIGURE 1 URBAN MATURATION INDEX' Multiple Dwelling Units Built Up Single Dwelling Units Before 1959 Between I960 - 1970 After 1970 Built Up: Before 1969 Area 2 Area 3 Area 5 N=28 N=66 N=73 After 1970 Area I Area 4 Area 6 N=I6 N=38 N=97 ORGANIC Area I Area 2 Area 3 Area 4 Area 5 Area 6 MECHANICAL Multiple dwelling unit density achieved before 1959; single dwelling unit density not achieved as of 1970. Multiple dwelling unit density achieved before 1959; single dwelling unit density achieved before 1969. Multiple dwelling unit density achieved between I960 and 1970; single dwelling unit density achieved before 1969. Multiple dwelling unit density achieved between I960 and 1970; single dwelling unit density not achieved as of 1970. Multiple dwelling unit density not achieved as of 1970; single dwelling unit density achieved before 1969. Multiple and single dwelling unit density not achieved as of 1970. Adapted from Leo A. Schuerman, E. Wayne Hansen, and Charles Hubay, Jr., "Combining Ratio-correlation and Composite Methods for Intercensal Social and Economic Small Area Estimates." Paper presented at American Statistical Association Annual Meeting, St. Louis, August 26, 1974. 62 urban development over time. Therefore, while by necessity of index construction, there is an ordered presence to the index, in reality the different categories may be a mixture of the urban processes. This mixture is more apparent in the middle of the index as contrasted with the bi-polar extremes of the types. In contrast to the middle areas the indexes at either end of the continuum are least typical of urban processes in terms of revealing the greatest disparity be tween simple and complex social structures. One end of the index represents areas where complexity has reached its zenith, in terms of social and land utilization (Area 1). In this case land has generally become too valuable for residential use; thus commercial, industrial, and govern ment land use is dominant. At the other end of the con tinuum are areas where complexity has yet to begin (Area 6); thus much of the land area is still vacant. As a result, residential use of the land is most apparent in Areas 2 through 5, or the areas in the middle of the continuum. Although the continuum ranges from Areas 1 to 6, Areas 2 through 5 are actually most representative of the organic- mechanical spectrum. Recognizing that the areas are mixtures of urban processes, the specific categories are nevertheless de scribed below in the form of idealized sketches that reflect 63 both the unusual extremes as well as the more orderly pro cesses of urban development reflected in Areas 2 through 5. Area 1 is the oldest and most highly developed area in the County. Typically located in these areas are the city and county civic centers and most of the central business districts. Residential structures consist primarily of multiple dwelling units mixed in among the commercial and industrial buildings, with many living quarters located over the shops and stores. The area is characterized by a large daytime population who either work in the offices, shops, and stores or come to the area on business. As a result of the functional specialization of the area as a government and business center, various phenomena such as pay parking lots and parking meters are more pronounced in the area than in other parts of the County. There are other reflections of the specialized nature of the area such as the wider sidewalks, short-order restaurants, greater number of traffic lights, and the spatial clustering of similar kinds of activities (e.g., banks, law offices, bailbondsmen, and so forth). The area is primarily composed of buildings rather than population; thus population density in Area 1 is not as high as in the more recently developed parts of the County. In general, it is not a desirable residential area and attracts those who cannot afford to live elsewhere or who were there when the area was in the first stages of 64 development. Thus, among the population are the elderly, ethnic and racial minorities, single people, and those in the lower class as a whole. While unemployment of the residents is high, a high proportion of females are in the labor force, because.of the comparative ease with which they can get certain kinds of semi-skilled and clerical jobs and because of their access to employment centers. The census tracts in Area 2 reflect a shift toward residential living. In the traditional ecological litera ture, this was the ’’zone of transition.” While some single dwelling units dot the area, there is a greater inclination toward multiple dwelling unit living. The structures are generally older and more inadequate than in the newer areas in terms of plumbing, lighting, garage area,and other such amenities more or less taken for granted in the newer areas. Housing was originally intended for single family occupancy, in contrast to the situation in Area 1 where the buildings [shops and stores) were not intended for residential use. The area has greater intensity of singles with lower status occupations (e.g., clerk-typists, nurses aides, and general service workers); thus the labor force would be likely to contain a high proportion of ethnics and females in the labor force. Because of the propensity toward multiple dwelling unit living, the area can be expected to have the highest population density of any area in the County. 65 Area 3’s land is in less intensive use than in the two older areas, although this area is beginning to resemble a more recently developed Area 2. It has a more even mix of single and multiple dwelling units, but the single dwelling units are old (having been built before 1950) and were among the first to be built during the County's first phase of population growth. On the other hand, the multiple dwelling units are newer, having been erected between 1960 and 1969. The houses were specifically built for family living, but are relatively small and have single car garages. Area 3 is the working class area, populated by skilled workers and technicians. While blue collar workers and skilled workers (including ethnics) are more prominently evident in the labor force, there is a decline in the proportion of females in the labor force. Educationally, there is not much dis parity between Areas 2 and 3. There is a decline in the amount of land devoted to commericial and industrial use. Because of the working class characteristics of the area, there is greater tolerance of deviance and a greater incli nation toward "laissez-faire” living. In Area 4 the single dwelling units are fairly new, identifying Area 4 as the beginning of the family areas. The families are fairly young and are characterized by young children. Wives may or may not work. This area contains the first of the modern apartments that have the amenities to attract married couples. The ethnic population is 66 comparatively small, while the use of land for commercial and industrial purposes has stabilized. The population is well educated and well employed; they are young strivers and achievers epitomized by young professionals on the way up the status ladder. Area 4 is the beginning of the me chanical way of life, in the Durkheimian sense. Areas 5 is the true mechanical area. It has all the restrictions of the suburbs, a factor facilitated by the higher visibility of the population. Single dwelling units were built after 1969; there are no apartments. The popu lation is well educated ; their jobs are in the professions or high management. They are the strivers and achievers who ’’ have made it." The emphasis in this area is on civic duties and volunteer activities; thus instead of working in the labor force, the women engage in volunteer programs. The area is marked by greater informality than in other areas, as reflected in the absence of sidewalks and street lights. Area 6 is the unsettled rural area that might be called pre-mechanical. Neither single nor multiple dwelling units have established a pattern of land development. There is a scattering of new industrial parks trying to get a foothold in undeveloped areas in order to take advantage of low taxes and land values. The housing structures are dispersed and private; they are epitomized by small rancheros. The roads are narrow, two-laned, and often unpaved. Services into the ______67 area are poor; volunteer police and fire departments are prevalent. The population in the area consists of extremes, ranging from wealthy executives to retirees living in moun tain cabins to poor farmers. It is a matter of the wealthy encroaching on the domain of the poor. By way of summary, one might call Areas 2 and 5 the clearest extremes, respectively, along the organic-mechani- cal continuum, with Area 1 mainly non-residential and Area 6 only partly settled in small enclaves. Also recall that the distinctions between Areas 3 and 4, which are at the middle of the index, may be arbitrary--that is, more apparent than real. Validation of the Index of Urban Maturation In validating that the index of urban maturation cap tures ecological processes and differentiates among social structures, variables germane to the urban sociology litera ture were selected and analyzed through an analysis of variance. The variables included: high occupation, high education, females in the labor force, population density, ethnic population, commercial and industrial land. The mean percentages of the variables are presented in Table 3. In all cases, the analyses of variance revealed significant differences in the variables’ distributions across the six maturation areas. 68 < D o O o o o o o o o o o o Dh T —1 c c S V V V V V V > O O 00 . VÛ Tj- I —1 to O O r-H O O vO vO to C M C M 1 — i to to 1 — 1 to i-H < y > (N to O O 00 C T > vO vO to O O LO O i to O O to rH 1 — 1 O i to to rH I-H c c J (D Ph < t>~ C T > o <y C o vO to vO ■p" O C O •H o O O to Oi pq 4-> to to 1 —1 to c c S O Q U < PÎ 1 — 1 C O +-> < e g o rH PU < tq S o to c y t to to O > to < C to o to to rH C M m c d (N to I —1 to i-H I-H o < ^ X i p 2 o P h n w n 1 — { E-. c A y < O O o I —1 lO o to < o to o 00 O O > cc: n (N w E - E^ to o o to to P U C O < (M to 1 — 1 Tj- I-H I-H O Q O < E - C O t — 4 a s C O O O Q to o < T i to O O i , vO 00 r — 1 O O vO C O n I —1 < I —1 vO 00 O O (d) (d > PU % O i- i (N C M C M to I-H C O C O pq >4 E - O Q g nd g hJ p I —1 o p p •H o P PU P 4-> P I-H P u o •H P 3 P o • iH S O p nd 4-> •H o P p P P 4 -> •H l-H 1 - Q I-H U c tj 4 - > P P pH P I —1 P pH P P O P •H o cr O P •H cu C O ., o n j O C O o pq P P o p P I —1 • iH p rP rP P P PU C 3 0 Ù J H G •H •H O p 4 - > p 5 Z CP PU pq o < D •H I —1 4 - > 4 -> 4 - > + - > + - > P ’B c P P P P P o S < L > 0 > P p p I-H •H O o O o o P ÎH P p P u p PU P p P p p o > P h Dh P h cu cu P U 69 Compared to other areas, the data reveal a high con centration of land use for commercial and industrial pur poses in Area 1, as noted already, with a diminishing trend toward the newer areas. The upward shift in the mean in Area 6 reflects the movement of commercial and industrial estab lishments to areas currently undeveloped. Thus, the data suggest that the business community and other investors anticipate future growth and developed in those undeveloped, areas and have moved in ahead of rising land values and taxes. The occupation and education means both suggest greatei diversity in the occupational and educational composition of the population in the older areas than in the newer 32 areas. The mean in Area 4, for example, reflects the comments made in the maturation area sketches where the population was described as composed of young strivers on the way up the status ladder. On the other hand, those in Area 6 are generally of high education and high occupation: the wealthy executives and professionals who have achieved high social status. As noted. Area 4 is essentially an Anglo area; the data reflect the absence of the ethnic popu lation. Because of the time period during which the housing was erected, the lots in Area 4 were a little larger than was economically feasible as development continued and land 70 values increased. As a result of the size of the lots, separation of the houses, and greater open space, population density in Area 4 was not as high as in areas developed later (as in Area 5 and 6, where development began after 1970). The low density value in Area 6 is indicative of the proportion of still vacant land and sparse settlement, whereas the density data for Area 5 reflect the change in land use policy : lots were made smaller^ more homes were crowded into the housing tracts, and higher densities were made possible. On the other hand, because so little land is devoted to residential use in Area 1, population density is very low. In general, the empirical data support the more or less anecdotal sketches presented earlier. Statistical Hypotheses While mental disorders, as a generic phenomenon, may be pervasive throughout the metropolitan area, it is ex pected that particular kinds of mental disorders will form patterned distributions in the metropolitan area. That is, certain kinds of mental disorders should be found in certain parts of the metropolitan area and thus form disorder- specific distributions. This is analogous to Durkheim's work on suicide where anomic suicide was more likely to be found in organic society while altruistic suicide was found in mechanical society. If this is the case, then in the 71 present study organic mental disorders should be found primarily in those subareas that have organic social struc ture (i.e., that are the most "mature" according to the index of urban maturation). On the other hand, mechanical mental disorders should be found primarily in those subareas that have mechanical social structure (i.e., those areas that are most rural or most undeveloped according to the index). The main hypothesis is concerned with the distribution of the rates of specific mental disorder categories and is presented below: Rates of organic disorders vary positively with areal maturation and rates of mechanical disorders vary inversely with areal maturation. The effects of organic disorders will be greater among ethnic minorities than among Anglo populations. A one-way analysis of variance and Spearman’s rank order correlation will be used. The second problem in the study revolves around the argument that the spatial distribution of the types of mental disorders is patterned and can be explained within the context of the social conditions found in different parts of the metropolitan area. This contextual argument involves statistical interaction and can be analyzed through application of a multiplicative model. Given the contextual 72 argument and the study’s interest in the degree of relation ship between the independent and dependent variables, an analysis of covariance model will be used to examine the 3 3 second hypothesis, with the related hypotheses. The related hypotheses focus on the magnitude and direction of the relationships between the independent and dependent variables across the maturation areas. Regardless of whether or not interaction is found, it will be useful to assess the strength of the relationships between the vari ables. The independent variables used in the covariance analysis are the social structural variables derived from the 1970 decennial census. The rates were presented earlier in this chapter. As noted earlier, these variables reflect the social conditions that impinge on the particular sub populations . The dependent variables assume the form of distribution rates of mental disorders in the subpopulations - at-risk. As in the case of the analysis of variance, the index of urban maturation serves as the qualitative control variable. In testing for statistical interaction it is expected that the relationships between the independent and dependent variables will differ across the six urban maturation areas. If so, this should be reflected in significant differences in the within-class slopes. 73 The argument regarding the blocked opportunities of the ethnic minority population in the organic subareas is twofold and refers both to the second part of the first hypothesis and to the hypothesis to come. Part of the argu ment is concerned with the impact of spatial segregation on the ethnic population as a whole, while the second part of the argument focuses on a particular segment of the ethnic population : highly educated ethnics who have Tow occupa tion. The latter is a special case of the blocked oppor tunities phenomenon that characterizes spatially segregated ethnics. Following Hawley’s discussion this study argues that organic mental disorders emerge in the ethnic population as a response to the blocked opportunities created by spatial segregation. If so, the more spatially segregated they are, the higher their rate of organic mental disorders. Using the percent ethnic population as a measure of spatial segre gation it is hypothesized that: The correlation between percent ethnic population and the rate of organic disorders in the ethnic population will be positive and vary directly in magnitude with areal maturation. The special case of blocked opportunities involves the highly educated ethnic population with Tow occupation. It is expected that as the disparate statuses of high educatior 74 and low occupation increase in the ethnic population, there will be a corresponding increase in the proportion of organic mental disorders among that subpopulation. To test this hypothesis the numerator of the independent variable and the denominator of the dependent variable would be com posed of the percent ethnic population with high education and low occupation. This variable is not readily available from the decennial census in any of its published sources, nor is it available on accessible computerized data files. Therefore, the requisite percentages and rates cannot be computed, making it necessary to forego testing this parti cular hypothesis at this time. The second problem area of interest in this study focuses on populations that are socially excluded in the mechanical areas. By virtue of their living in the mechani cal areas, they have implicitly accepted the norms and values. This applies equally well to ethnic minorities and the single adult population. However, in the case of ethnic minorities their ethnicity bars them from social acceptance. As a result, they strive harder in order to elicit accept ance, a factor that leads to the emergence of mechanical mental disorders through which they express their frustra tion and anxiety. If so, the highest rates of mechanical disorders for the ethnic population should occur in the mechanical milieu. The hypothesis may be presented as 75 follows : The CO rr el at ion,' ' between percent ethnic population and the rate of mechanical disorders in the ethnic population will be positive and vary inversely in magnitude with areal maturation. The second population of interest in regard to the mechanical milieu is the single adult population 45-64 years old. Arguing that single adults and single parents are un welcome in the mechanical milieu, the study suggests that as the percent of these populations increases in the mechanical milieu, the rate of mechanical disorders in the single adult population 45-64 years old will also increase. The stastis - tical hypothesis may be presented as follows: The correlation between rates of mechanical dis orders among single adults and the relative pro portions of the population that are, respectively, single and single parents will vary inversely with areal maturation. 76 CHAPTER II FOOTNOTES 1. County of Orange, Planning Department, Progress Report, 1971, VII, 34-46. 2. Beverly Duncan, Georges Sabagh, and Maurice D. Van Arsdol, Jr., "Patterns of City Growth," American Journal of Sociology, 67 (January, 1962), 418-429. 3. Maurice D. Van Arsdol, Jr., and Leo A. Schuerman, "Redistribution and Assimilation of Ethnic Populations: The Los Angeles Case," Demography, 8 (November, 1971), 459-480. 4. Diagnostic and Statistical Manual of Mental Disorders, 2d ed. (Washington, D.C.: American Psychiatric Association, 1968). 5. It should be noted that the study’s use of the term "organic" is a reference to Durkheim’s model, not to the clinical concept of organicity which refers to dis orders caused by or associated with impairment of brain tissue function. 6. Ibid., pp. 25-26; pp. 33-35; pp. 37-38; pp. 41-44; p. 45. 7. Ibid., pp. 39-41; pp. 46-47. 8. Helen S. Kaplan and Harold I. Kaplan, "Current Concepts of Psychosomatic Medicine," Comprehensive Textbook of Psychiatry, ed. Alfred M. Freedman and Harold I. Kaplan (Baltimore : The Williams and Wilkins Company, 1967), pp. 1039-1044; Robert A. Cohen, "Manic-depressive Reactions," loc. cit., p. 681. 9. Ronald D. Schwartz, "Operational Techniques of a Factor Analysis Model," The American Statistician, 25 (October, 1971), 38. 10 Ibid. 11. The dependent variable for the single population is also less than ideal. While the theoretical argument suggests a dependent variable such as "rate of mechan ical disorders in the single parent population," the 77 mental health system does not inquire as whether or not adult patients have children. Therefore, the data are not available. 12. Alvin Boskoff, The Sociology of Urban Regions (New York: Appleton-Century-Crofts , 196 2) , p~^ 2 8 3. 13. Ibid. 14. Robert E. Park, "The Urban Community as a Spatial Pat tern and a Moral Order," in Robert E. Park: On Social Control and Coliective Behavior, ed. Ralph H. Turner (Chicago: The University of Chicago Press, 1967), pp. 5 5-68. 15. Edgar M. Hoover and Raymond Vernon, Anatomy of a Metropolis (Garden City, N.Y.: Doubleday and Co., Inc., 1962). 16. Park, 0£. cit., pp. 61-62. 17. Hoover and Vernon, 0£. cit., p. 184, p. 204. 18. Robert E. Park, "Human Ecology," in Robert E. Park: on Social Control and Collective Behavior, ed. Ralph H"! Turner (Chicago : The University of Chicago Press, 1967), p. 77. 19. Boskoff, 0£. cit., p. 110. 20. Hoover and Vernon, op^. cit. , pp. 183-198. 21. Park, "Human Ecology," p. 77. 22. Leo A. Schuerman, "Assimilation of Minority Subpopu lations in Los Angeles County," (unpublished Master's thesis. Department of Sociology, University of South ern California, 1969), pp. 29-30. 23. Park, "Human Ecology," pp. 76-77. 24. Hoover and Vernon, o£. cit., pp. 97-99, 198-207. 25. Otis Dudley Duncan and Beverly Duncan, "Residential Distribution and Occupational Stratification," American JournaT of Sociology, 60' (March, 1955), 493-503. 26. Van Arsdol and Schuerman, 0£. cit. 78 27. Duncan, Sabagh, and Van Arsdol, op. cit., p. 428. 28. Van Arsdol and Schuerman, o£. cit. 29. Leo A. Schuerman, E. Wayne Hansen, and Charles Hubay, Jr., "Combining Ratio-Correlation and Composite Methods for Intercensal Social and Economic Small Area Estimates." Paper presented at American Statistical Association Annual Meeting, St. Louis, August, lO'yA. 30. Duncan, Sabagh, and Van Arsdol, 0£. cit. 31. Hoover and Vernon, op. cit., p. 124. 32. The Bureau of Census occupation variable includes eleven categories of occupations, with professional- technical and managerial-administrative designations representing the two highest status categories. These two categories were used in this study as representa tive of "high occupation." By the same token, the Bureau’s education variable covers seven categories, with one to three years of college and four or more years of college at the upper end of the education continuum. In this study these two categories were combined into a "with at least some college" category and was used to indicate "high education." Neither the occupation nor education variable was dichotomized by using a measure of central tendency (to determine the cutting point). To meaningfully discriminate among the population both variables were skewed toward the high end of the continuum. This procedure has implications for evaluating dif ferentiation in the maturation areas; there is an inverse relationship between the degree of differentia tion in an area and the percentage of the population that is in the high occupation and high education cate gories. For example, if 10 percent of the population is classified as high occupation-- and therefore in the two highest occupation categories--90 percent of the population is distributed throughout the other nine occupational categories. Obviously, the higher the percentage of the population in different occupational categories, the greater the differentiation in the labor force. The same principle applies to the edu cation variable, where two categories are designated as high education and five are the residual low educa tion category. Were the variables dichotomized accord ing to central tendency, a different situation would 79 prevail, with the degree of differentiation deter mined by deviation from the 50 percent mark. 33. Karl F. Schuessler, Analyzing Social Data: A Statisti cal Orientation (Boston: Houghton Mifflin Co., 1971), pp. 196-198. 80 CHAPTER III ANALYSIS AND DISCUSSION Rates of Organic and Mechanical Disorders in the Metropolitan Areal It was expected that the highest rates of organic mental disorders would be found in the most complex or urbanized subareas and decline with declining areal matura tion, while rates of mechanical disorders would display the reverse pattern. Visual examination and statistical analysis of the means in Table 4 suggest that while the highest rates of 2 organic disorders characterize the older areas, the highest rates of mechanical disorders do not occur in the newer sub- areas. In absolute terms mechanical disorders do not con form to expectation. However, taken as a proportion, the rates of mechanical disorders prove to follow their pre dicted pattern. The Spearman rank order correlation co efficient (Rho) that related proportion of all disorders that were mechanical to area type proved to be .84 in the predicted direction, a value that is significant at the .05 level. Thus, on the basis of the first hypothesis, it is fair to conclude that (1) not only are categories of mental disorders not equally distributed across the metropolitan area but they are distributed according to the. patterns 81 00 (X I u n CO o o o ro C\J L T > C\J CM 00 LO c o o o o o co LO CM c o o o o LO o o LO CM c o CM Q Qf O CO O O 00 CM O I— CO L U CT» CM 0 0 CM O O C O 00 Q. Q. O C O 00 - o o o co c LU 00 CO CM O '"g ( _ ) t —t c /) Z <C CO c OO O o +-> T3 CD CXl OC t=C L u O O f —I 3 +-> CO -Q -O O C O 4 - "O Q C O c co c OO co Q_ - o co - o 4 - O T3 C O Q Cl. 4 - +-> c o Cl. C/0 OO co e u CM that the theory predicted. On the whole, organic mental disorders are relatively more likely to be found in the most complex or highly urbanized parts of the metropolitan area, while mechanical disorders are more likely to emerge in the less complex or newer areas of the metropolitan area. In examining the means it appears that the prevalence of mental illness as a whole varies with areal complexity. However, the proportion of disorders that are mechanical is lower in the more complex areas, as expected. With regard to the prevalence of disorders it should be noted that in 1973 and 1974 organic disorders exceeded mechanical disorders in the Orange County Department of Mental Health by a ratio of 3.5 to 1. The disparity was even higher in some of the maturation areas, such as in Area 1 where the ratio of organic to mechanical disorders was 4.5 to 1. The disparity of organic to mechanical dis orders applied as well to ethnic and Anglo cases, where the ratios of 6.8 to 1 and 7.3 to 1 were found respectively. As a result, the pattern for total disorders is necessarily a reflection of the distribution of organic disorders. Because of limited resources, the Department is committed to treat ment of organic rather than mechanical mental disorders ; therefore, the disparities revealed in the data are a re flection of deliberate departmental policy. Of the two kinds of mental disorders organic disorders are generally considered the more serious problems which require long- term treatment. Also, since organic disorders include most of the psychoses, they are less likely to be self-limiting problems. In general, organic mental disorders are less likely to be treated in the private sector and more likely to be found in the public sector. On the other hand, me chanical disorders (primarily the neuroses) are amenable to the treatment techniques pervasive in the private sector (e.g., psychodynamics, psychotherapy, and so forth). As a result, mechanical mental disorders tend to be underrepre sented in the public sector, overrepresented in the private sector. The underrepresentation poses problems for the current study in that comparatively few cases with mechan ical disorders are available for analysis. Also, it should be noted that tendency to use private rather than public facilities in general is a function of ability to pay, which, our data suggest, varies inversely with areal matur ation. The second part of the first hypothesis predicted the effect of areal maturation upon organic disorders to be greater in the case of ethnic minorities than for others. Table 5 shows this to be the case. While the ethnic popu lation has a higher mean organic disorder rate than does the white Anglo population, the difference between the two tends to diminish with declining areal maturation: .43, *94, .18, .61, .53, .27. The one exception is Area 1, 84 ,— O CM CO CD O o 0 0 c o CM c o LO LO OO o O 0 0 0 0 c o <iO «d- 0 0 Z «=ï- tO c o o o o rO 1-4 CD <D 1 — 1 — S- <C 1 <C __i r o =3 sz CM Q _ C T > o c o co OO O r — c o c o Q _ + - > c o o o rO O •• S- — I > - ■3 o H - + -> z z ta c =3 z; c o CM O CD o CD Q O c CM 0 0 Z r t S CM o <C LU Xi CD S- O Z CD OO t —1 «=c CD Z Q : 1 z o CD c o e o c o 1 — c o LO LU Z r — CO o 1 Q- CO 1 —4 <C cx. u n LU LO Q l LU OC ce 0 0 LO ta CL. _ _ i LU 1 — OO c o 0 0 LO eu Q. ÛÛ CD Z OC O <C co o o ta t — O 1 —1 CO CO h- sz S- t-4 o e u CD OC XJ ZD +J s- — 1 1 — ta o u co 1 — s: 3 z +J ■a LU Z ■a ■a S z: o E o o o CD LU c sz co co ta ta Z ü_ s- s- JD CD <C O fO ( T 3 s- s- CD C e u e u 3 o c c c o >ï >ï O <C 4- 4- LU JD 0 0 0 0 O O ü_ DC CO O <C S- C C CD eu •À A O o CO = ) ■o LU CO s- c +-> I— o o C < — 1 co O CM c sz OC _ J co +J 1 e t ta o ta +J 4 - 4- z O J ta e u <u> 4- e u e u S- O +J SZ + -> + - > O J LU <c CD JD e u e u e u E +J e u e u 3 fO LO en Z DC CM r t S JD 85 which has already been suggested to be so nonresldential as to lie outside the maturation continuum. Statistical Interaction Contrary to expectation, statistical interaction characterized only one of the relationships analyzed through the analysis of covariance procedure. That pertained to the relationship between the percent single parents and the rate of mechanical disorders in the single population 45-64 year old reported in Table 10. Unfortunately, none of the correlations were significantly different from zero; there fore, the results of test for interaction are not meaning ful. The issue of statistical interaction, while originally promising, lost much of its importance in this study as various data problems were discovered which made the inter action issue irrelevant to a great extent. Spatial Segregation and Organic Mental Disorders On the basis of Hawley’s discussion of spatial segre gation as an important factor in blocking the opportunities of the ethnic population, the study hypothesized a high positive relationship between the rate of organic disorders in the ethnic population and the percent ethnic population. Furthermore, as presented in the second hypothesis, higher correlations were expected in the most complex subareas of the metropolitan area (i.e.. Areas 1 and 2) than in the other areas. The correlations for the six urban maturation areas are presented in Table 6. For the sake of comparison and to demonstrate that spatial segregation is most appli cable to organic disorders, the corresponding correlations pertinent to the rates of mechanical disorders are also presented. With one exception (in Area 4) all of the correlations between the percent ethnic population and the rate of organic disorders in the ethnic population were positive, as predicted. The data in the table further reveal that, again according to prediction, the highest correlations between the two variables occur in the most complex subareas of the metropolitan area (Areas 1 and 2). While the correlations in the two transition Areas (3 and 4) are zero, the cor relations in Areas 5 and 6 increase slightly but do not represent a meaningful departure from the expected pattern. Also, recall that Area 6 had not yet fully entered the maturation continuum. Thus, both parts of the hypothesis are confirmed by the analysis, first regarding the positive relationship between spatial segregation and the rate of organic disorders in the ethnic population and the second aspect, which predicted that spatial segregation would have the greatest impact on ethnics in the most complex subareas in the metropolitan area. (D LO «d- D_ «d- LO O O cx: LU Q cc o Z cn C T i O O Lu c y > C O 1 — 1 Q Q _J O • = 3 , C O ^ 4 - 1 — D C 1 — C O o LO C O z « = C C T > cn C M o O LU LU z : > - 1 1 C O C O < C T i r< LO ro C O LO 1 — < 0 - C C 1 — o o to 1 z LU 03 C O < > 1 Q. z o > - fO O C _ 3 1 — LU zz fO C O LO to cu z : o z O ) «d- 00 o o o Q- o c. O O 4 - Q 1 — C D < 1 C O O Z < LO to < LU c 1 >> £- z CD o C O 03 C _ 3 D _ z LO Z O < C O LO O O o s- Z D_ D C r e s LO O C M 03 o « = C O ■ c . Q. 3 to CD C _ 3 3 CL c r D C z 4 -> 03 z O Z fO z z : t/3 .LU 1 — <c C M C O o to LO 03 03 LO O LU LU c C M C O o O 03 03 O D C ta S _ LU 1 — 1 — « = C z 1 1 03 c zz c. 03 C O LU LU Z z 3 03 z < O C _ 3 o 03 O 3 % ~ o 1 — cc D C 1 --- LO LO LO C T i O O 03 LU LU I— LO O 4 - > O E Q- D_ < = i; 03 -M to D C 1 1 £- O z 4 -3 4 -3 LU LU z 3 03 03 c to to z Z I— +J S _ 3 03 03 03 t— 1 — 4 - 03 03 4 -3 4 -3 z: r— C O C O o E -M 0 5 O z Q o o C > LU Z z •C C O c c LU < C D 1 03 LU 03 03 03 3 : Z 03 03 4 -3 4 -3 1 — Z LU £- O Z s- LU o 3 3 (D o 03 03 C O LU 03 03 SZ SZ 1 — o O 4 - 03 4 - o o C O < O S- O z C O c C 03 S- o z « = c O ) z z to > o to D _ LU o - o {/) 4 -> t/3 c O 4 - c 03 03 I— O D C & _ c c. LU O ) S - o o o > > < 0_ c O ) rO z O ) c. 03 03 03 03 _J C D D_ to z 03 Z - 1 - 3 4 - (D 4 -3 LU C D Z C O c. S- 2 £ - ■ O C D C C O c O ) o fO O c 03 c LO D Cz to < u z {/) t/3 4 -3 U O O o z_ 1 ta < u c c_ 4 - fO 4 - to 4 - C _ 3 1 —_ 1 O ) ■ 3 : o o Q O z Q 03 03 4 - 03 LU cC s_ 4 -> to Z 4 -3 Z 4 -3 4 -3 I— la O ) 4 - > C C 0 5 03 z LUz z C D 03 Q « 3 ol A03 S ~ ■ £ - o > £ - LU Z 3 o u C3 O O o 4 -3 4 -3 z : 1— en C 3 u + J 03 4 - 4 - to 4 - C C o o Q. c: c. z 3 0 5 03 z ;z 4 - O c < T 3 o c. 03 -M to 4 - +3 O U 1 o D_ Z fO Z z . o z X 03 O X 1 — 03 C C T ) (D ol AC3 03 3 03 4 - 4 - o c. (D fO c. O ) c. 0 3 -M 4 -3 z O ) O ) o z : Z Q z : 03 03 C C Q z c. •C & _ 03 ■ > >■ 03 05 05 O E c _ Z O ) 03 03 03 D C ■3 o 4 -> > C O LU Z C O t o D_ Z O LU O C M C O 0 3 Z O Z 03 4 - 8 8 That spatial segregation has little bearing on the rate of mechanical disorders in the ethnic population is empha sized by the correlations between that variable and the per cent ethnic population in the subareas. Not only are all of the correlations extremely low, but they are negative in the most complex areas (where the correlations of organic disorders are both positive and high). Therefore, assuming that spatial segregation is the initial element that blocks the ethnic population’s access to the opportunity struc ture - - as Hawley argues -- the impact on ethnics is more evi dent in the older parts of the metropolitan area, where organic mental disorders are the most likely response. It may be suggested that the relatioriship between spatial segregation and the rate of organic disorders in the ethnic population is really a function of socioeconomic status, particularly in the most complex parts of the metro politan area. If it is a matter of socioeconomic status rather than spatial segregation, the Anglo population should be similarly affected and reflect similar rates of organic disorders. But recall from Table 5 ' that the mean rates of the ethnic population are consistently higher than the mean rates of the Anglo population across the maturation areas. Therefore, the differences in the mean rates are attribut able to the higher magnitude of organic disorders in the ethnic as opposed to the Anglo population in the 89 metropolitan area. The partialling technique is k more concrete approach to determining the role variously played by socioeconomic status, the index of urban maturation, and spatial segrega tion in the relationships involving organic disorders in the ethnic and Anglo populations.^ Table 7 presents the. cor relation matrix of the two dependent and three independent variables. First-order partial correlations were calculated and suggest that while socioeconomic status may be somewhat of a factor in explaining the relationship between spatial segregation and the rate of organic disorders in the ethnic population, the index of urban maturation is not an inter vening variable. Partialling out either the index of urban maturation or the percent of the population with high edu cation hak the same effect: the correlations fell to -.12 but remained significant at the .05 level.^ However, when the socioeconomic status variable was partialled out, the relationship between the percent ethnic population and the rate of organic disorders in the ethnic population fell to a nonsignificant.09 first-order partial correlation. Another factor to consider in assessing the influence of socioeconomic status is that partialling out spatial segre gation also affected the relationship between socioeconomic status and the rate of organic disorders in the ethnic popu lation, dropping the correlation from -.17 to -.10. 90 00 o o LO 00 LO o o LO LO to O ) co OQ c o o o c o Q llj h- c r > o r— o o G\J o o u. 00 00 o U_l c o o ce o U _ l q; o CQ C L Q . Q . e n o ou o o Li e n o 1 0 1 0 CL § to CL to Q. 4 - > CO •O OO O Q _ O Q _ CO CO lO 91 Therefore, socioeconomic status apparently has no greater influence on the rate of organic disorders in the ethnic population than does spatial segretation. The problem is complex, the variables are intertwined; the issue warrants further research. In some respects the partial correlations of the Anglo population with organic disorders are more interesting because they present unanticipated results regarding the influence of socioeconomic status. Of the two populations (Anglo and ethnic) socioeconomic status may be a more interesting consideration for the Anglo population: in Ipartialling out the percent high education from the rela tionship between the maturation index and the Anglo popu lation with organic disorders, the correlation fell from -.18 to a nonsignificant level of -.08.^ On the other hand, partfalling out the maturation index had little effect on the relationship between the percent high edu cation and the rate of organic disorders in the Anglo population (the correlation dropping from -.31 to -.27). However, partialling out the spatial segregation variables (percent ethnic population) from the relationship between percent high education and the rate of organic disorders in the Anglo population had a phenomenal effect: the original correlation of -.31 dropped to .01. Whatever the dynamics, socioeconomic status does not have this impact when 92 partialled out of the relationship between spatial segre gation and the rate of organic disorders in the Anglo population: the original correlation of .58 falls to .51. Essentially, then, socioeconomic status and spatial segregation both seem to be factors in accounting for the rate of organic disorders in the ethnic population. Further research is warranted to explicate the relation ships - -preferably on data where low occupation does not contaminate the dependent variable, as was the case in this study. Of perhaps greater significance are the find ings regarding the rate of organic disorders in the Anglo population. It appears that socioeconomic status explains the relationship between urban maturation and the rate of organic disorders in the Anglo population; but the percent ethnic population in an area apparently has more of a bearing on the rate of organic disorders in the Anglo population than does socioeconomic status. This finding raises interesting theoretical mental health questions that focus on the possible "isolation” of Anglos who live in areas of the metropolis that are inhabited primarily or even to a large extent by ethnic minorities. Earlier, questions were raised about ethnics who live in the newer suburbs, where they theoretically do not belong. But what price do Anglos pay-- in mental health terms--for living in areas where, according to our social ethic, they do not 93 belong? Rate of Mechanical Disorders in the Ethnic Population Attention is now shifted to a consideration of mental disorders in the mechanical or less complex subareas in the metropolitan area. In general, it is anticipated that mechanical mental disorders will be most prevalent in the mechanical milieu, both for the ethnic as well as single populations discussed earlier. Reiterating the earlier discussion, it was argued that on the basis of their eth nicity the ethnic population is socially excluded in mech anical society. However, that they are there at all is taken as an indication of their acceptance of the prevail ing norms and values. The situation is one of social exclusion or rejection on the one hand and the expectation of acceptance if not tolerance on the other. This study argues that given the ethnic population's situation, mech anical disorders, which are intropunitive, would be the anticipated response. Accordingly, it was hypothesized that the highest rates of mechanical disorders in the ethnic population would occur in the less complex subareas of the metropolitan area. The mean rates of organic disorders (repeated from Table 4) and mechanical disorders are presented in Table 8. Examination of the mean rates of mechanical disorders 94 o O to C T ï ' o o C T i CO OJ LO CO 2: f O O o o t / î 1 —1 : r o ; 1 — < D C s - 0 0 o _I C = 3 . C CO D l ^ c C O o o O o Q_ . * ' 1 —' + - > O w C N J t o C D S - - t o O z 3 C O t o r C ' 4 - ) to o O I — < o : 1 U J C O t o L O r - . « t f - L U C C T i o = C f O C t l O O 1 — , : j . J O C V J o o Q - . S - C L Z O l i = 3 C T i o L O C O 1 o t o CO OO C O I — t o 1 & _ az o o C O 0 3 L U C T i L O 7 3 Q 1 — s - c x z o o C L CO CO • » I — 0 0 t o o r - . CL • —t >- CO C O 7 3 Q 1 — C C O z o o CO _J = ) t o t o C O . o > o 1 — ( _ ) S - t O c 00 L U L U t o s: C D c J C L U Z o o _ j cc 0 3 C O C a : 4 - 3 E <c C J > o 4 - 3 t o 1 — • —1 n s - * o Z t o 3 c c. c: 4 - 3 t o Z L U S _ t o o Q c : ( D E a L U ■ < > t o O S - - c c : z 0 3 t o t o Q O ■o 73 J 3 C O Z t —» c S - S - s - <C h - f O o . 3 o c t o ( _ ) oc 0 0 4- 4- 1 —t Q O O Z 1 — c c c J 3 CO CO C D Ï s: o CO t o c c C t T • 1 — s - a o o o 4 - 3 J 3 0 3 O O n y CO 73 c 4 - 3 4 - 3 L u . & _ t o o 3 0 3 o J= c £ = CO CL ■ o t o o •r— t o n j o S - 0 3 4- 4- L U < u D_ O Q 0 3 0 3 C D : t A 73 7 3 C r e s a c C M h - J3 • r ~ ' Q t t J o S _ S - z 3 C U + o o L U t o JC a 4 - ) 4- 4- ( _ ) 4 - 3 c O C T 4- LU c t o O 4 - 3 4 - 3 L U . O f t ) C L X X Q_ 4 - 3 C 7 > o O 0 3 0 3 S _ C S _ . 0 3 S - C M 4 - 3 4 - 3 Z < U O ) o 5 1 D _ c J3 a 0 3 0 3 L U E S - 0 3 0 3 s : 3 0 3 C O t o Z Q_ CM C O t o J 3 95 in the ethnic population reveals a pattern generally con sistent with expectation. However, the mean rate in the newest subarea not only does not conform to expectation but is approximately equal in magnitude to the mean rate in Area 1. (Remember, however, the idiosyncratic nature of this area.) Nevertheless, taken as a proportion of all dis orders the rates of both the mechanical and the organic dis orders for the ethnic population follow the predicted pattern. The Spearman rank order correlation coefficient (Rho) that related the proportion of all ethnic disorders that are mechanical to area type proved to be .94 in the predicted direction, a value that is significant at the .05 level. The outcome of this analysis is very similar to the analysis reported earlier regarding mechanical and organic disorders in the total population. Again, with some quali fication the theoretical expectation was confirmed ; the mean rates of mechanical disorders in the ethnic population tend to be higher in the less complex subareas. Rates of Mechanical Disorders in the . Single Population 45-64 Years Old The argument pertaining to the single adult population is that they are alien to the mechanical milieu where the dominant social form is the married state. Single parents are particularly unwelcome in an environment structured for family life. Therefore, it was expected that as the percent 96 single population 45-64 years old increases and as the per cent single parents increases, the rate of mechanical dis orders in the single adult population 45-64 years old would also increase. By extension, the highest correlations should be found in the less complex subareas. The rates will be examined first, to be followed by the analysis of the correlations. As has been the case with the other subpopulations, the mean rates in Table 9 show that organic disorders exceed the mean rates of mechanical disorders in every subarea. , They thus follow the overall departmental pattern, wherein organic disorders outnumber the mechanical disorders by a ratio of 3.5 to 1. However, interest here does not focus on the disparity between the rates but on the distribution of mechanical disorders. On the face of it, the mean rates of mechanical dis orders in the single adult population do not follow the - predicted pattern. The mean rates are essentially unpat terned, as are the organic disorders. Mechanical disorders apparently bear little relationship to urban complexity here. Conceptualizing the mean rates of mechanical dis orders as a proportion of total disorders in the single population 45-64 years old, a Spearman Rho was calculated to determine if they were proportionately higher in the less complex subareas. The Spearman Rho of .14 was not 97 O C D to L O CO C V J C D O O C V J CO L O co co o O o ca co 1 ^ to co L O CO ta OO O) O o L. z <C 1 — 1 • ' OO C C O <c O c e : L U C D L O L U œ 4- > co to o <d- Q < C ta to J ce: L. O o co o z ■C 3 co o 4- > ta Q h- s: cx < CL _J c e : c to C V J c Z3 n3 C V I 00 L O CVJ 00 f — 1 — Z cvj to tn z <c S- O o 1 s- L U s ; Z co < v s : L O z >- &_ _1 cû cr> o "=C 1 — Q. tn o Q 1 « v î - GvJ to Q. » —t __I CO 1 — to C V J z Z O < C C D C V J O o tn z CO I — «5 0 3 cs^ C _ 3 Q C eu o L U <c s- < L > L U •• ta sz >- >- ta JD Q h- to to c z ra Z Z 1 — co C V J o o 1 -: < C C O = D z l O « = C O O o o 4 - > E C _ 3 L O C _ 3 05 » - H < d - s- z Z LU 3 c C Z O 4 - > 0 3 C J 5 O Z 0 5 c e : w C E o o h- c e : tn < o s- c c L l--- 1 (U 0 5 0 3 o z z z C D C L . &_ s- L. co o Z o 3 O L U 0_ +J tn CD 4 - « + - C L U 2 Q o O 1 — — 1 Z C J 3 c z tn tn L U Z o tn ta c c C _ 3 L — 1 S - u o O ce: O O 4 - > z ( U L U ta tn z c 4 - > 4 - > Q _ L U L. L. 0 5 - t — 3 e u O Z c C Z 1 — tn O- z tn O < ta O i- ( U 4- M- L U e u o . o Q s : C V J ( U C U Z : s- tn z Z <a> +J O ta Z Q. X X 4 - > C D O O e u e u & _ C %- e u s- C V J 4 - > 4 - > Q J e u o Z: Q. Z o e u e u E & _ < u e u 3 (U O O O O Z Q. C V J CO 03 z 98 significant, again indicating very little relationship be tween the distribution of mechanical disorders in the single population and urban complexity. While the distribution of the mean rates of mechanical disorders does not conform to expectation, the correlations are a separate issue. Zero-order correlations between the two independent variables and the dependent variable and the standardized beta coefficients for the multiple correlation are presented in Table 10. The theoretical predictions called for positive correlations between each independent variable and the dependent variable. It was also expected that the highest correlations would be found in the less complex subareas. At the outset it should be noted that none of the cor relations or standardized betas were significantly different from zero, therein emphasizing doubts raised earlier about the utility of independent variables selected for their availability rather than their applicability to the problem. In view of their nonsignificance the correlations are basi cally unreliable, making the patterns (in Table 10) unstable Accordingly, little can be said about the correlations and the betas, since their interpretation would be highly sus pect. Still, if the troublesome Area 6 is removed from con sidération, the standardized partial regression coefficient LO e o LO e o o o e o e n 1 1z 1 I 4 - î ■ S Z e u • I — ' CVI a c o o C V J o C V J LO c o e + - 1 4 - 1 e u ■ M e u > C o e u e u u t o o < 3 - OO : C LO f d O o o LO O e u c o M - S - c o e j - : e n < c e u t o z o e u f d CO CO c o s - o c< _ 3 o c n z L U = 3 : s z e o - = 3 * e u e o < 3 - s z Q 1 — LU 4 - > o O s ~ O f d al CO ai f d c o e o o o < C S - e o + - > c oa: 3 f d f d Z f—r LU z + - > Q H —O fd e u 4 - > s z < _ ) & _ z e n _ _ l h - S - LO 0 0 f d 0 0 C 3 C al = 3 : c o O o z O t n O < C ai f d c v J co o c z = 3 _ o C V J 1 1 z 1 1 o z < _ 3H — S - . e u : e u c c = 3 : z N n rQ ^ Q . e u o LU E z 0 0 S - LU H —z • 1 — s - e o s :O( _ 3 c o o o f d e n 0 0 1 2 LU e 3 ; 'vj* 1— e o C V J z o c o - = 3 * o c___1 LU c LO 1 t n o LU e n 1 1 f d 1 1 c o e u s z U - CO L i 4 - > * 3 - > o e u 1 c o z e u c o> - c o a . e n z OO c o z t n o < c e n z LO e u Q LU c o o S - o c o___1 al r— OO LO LO f d e n c oO= 3 : o o O o e u e n e u LU c o <c c o s - S - z i _ L U Q Cc oz> - 1 1 1 1 f d e u f d _ J e uaic o1 — z CO LU = 3 : z sz S - z = 3 : Q C LU _ Jz o o c : f d h - > - o t n f d Q = 3 :o 4 - > o LU - » ; * • f d z z LO LU S - Z c : 1 e u 3 e u Q LO z f d ■ M f d sz al = 3 : o f d o e n u < o o c e n E o Z o c s z c e n z z O 1 — f d sz f d sz z = 3 : = 3 : z • • c o f d z o e u h —h - o z Z u s z o CO = 3 :z e u c z Ou S - e u o — I Q . E f d c c o 3 E e u _ J= 3O o S - s z C o _ Ou L f - O O 4 - 4 - e u o 1 —iO O -M 4 - > c o O O S 1 — Ou LU fd ■ M t n al Z e u 3 s z C C t n e n < LU e u 4 - ) Z 3 e u o o s z e u Q _— I z f d f d Q . S - o S - e u S - O f d ■ M 4 - î c n O zc o e u o _ o _ z e u Z s z 1 — C SZ f d S - < cc o LU c o e u e n e u e u Z f d e u s z 4 - 4 - e u z LU LU h - e u 3: * 1 “ e n e n e u e u s - e u _ Jzn S - 4 - > t O c s z z z s - N Q _h- Ll_ f d e u o O JD z c c o c o S - S - o z z 3 o o S - CO CO c 4 - > 4 _ > 4 - 4 - e u f d oz SZ SZ z M- • 1 — < / ) e u e u e n ■M Z Q- c O + J s - o o sz X X E f d f d e u s - S - o_ e u e u z S- r— Z e u e u c o c o 4 - J z t n t n cu e u s - Q . o_ c o OO z S - o e u e u II E S - t o e u e u 3 o * 1- c o c o c o z e _ ) z C V J c o f d z U z 1 0 0 does tend to vary inversely with areal maturation. Summary of the Analysis The outcome of the tests of hypotheses are summarized below. Hypothesis: Rates of organic disorders vary positively with areal maturation and rates of mechanical disorders vary inversely with areal maturation. Also, the effects of organic disorders will be greater among ethnic minorities than among the Anglo population. Finding: The rates of organic disorders in the total population were found to vary positively with areal maturation (as predicted), but the rates of mechanical disorders did not follow the expected pattern (by varying inversely with areal maturation). However, when taken as a proportion of all disorders, the rates of mech anical disorders followed the predicted pat tern. Allowing for this modification the hypothesis was confirmed for both categories of mental disorders in the total population. This same pattern applied as well to the rates of organic and mechanical disorders in the ethnic population. While the rates did not 101 vary exactly according to expectations, when taken as proportions of all disorders, they followed the predicted pattern. Again, with ^ some qualification the hypothesis was con firmed. On the other hand, the pattern did not hold for the single adult population and therefore the hypothesis was not confirmed for that particular population. As predicted, however, the effects of organic disorders were found to be greater among the ethnic minority population than among the Anglo population. Hypothesis: The correlations between percent ethnic popu lation and the rate of organic disorders in the ethnic population will be positive and vary directly in magnitude with areal maturation. Finding: Both parts of the hypothesis were confirmed : with one exception, all of the correlations were positive and--as predicted--the magnitude of the correlation coefficients tended to vary directly with areal maturation. Hypothesis: The correlations between percent ethnic popu lation and the rate of mechanical disorders in the ethnic population will be negative and vary in magnitude with areal maturation. 102 Finding; Contrary to expectation, the correlations were both positive and negative, but they were nega tive in the most complex areas, where the cor relations for organic disorders were positive. It might also be noted that compared to the corresponding correlations involving organic disorders, the correlations between percent ethnic population and mechanical disorders were all quite low, indicating a weak relationship between spatial segregation and mechanical dis orders. However, while they were low, the highest correlations tended to be found in the most complex areas. Hypothesis: The correlations between rates of mechanical disorders among single adults and the relative proportions of the population that are, respec tively, single and single parents will vary inversely with areal maturation. Finding : Because none of the correlation coefficients or standardized partial betas were significantly different from zero, the findings were viewed as unstable and unreliable. However, if the beta coefficient for Area 6 were ignored, the hypothesized inverse pattern would be confirmed for the ' ’single parents" variable. 10 3 Given these findings plus the ancillary analyses, the following section discusses the impact of the analyses on the study's theoretical formulation concerning urban com plexity and community mental disorders. 104 CHAPTER III FOOTNOTES 1. All rates of mental disorders are calculated per 100 population. 2. One way analysis of variance showed highly significant differences by area between mean rates of organic dis orders, with significance beyond the .001 level. 3. One of the assumptions in applying a first-order partia correlation is that all variables are at least interval in scale and have a demonstrable even distribution. As it was used in this study, the maturation index does not meet these minimum theoretical criteria for partial correlation analysis. However, empirical research has demonstrated that ordinal measurements can be used in conjunction with interval scales and valid conclusions can be drawn from the results. For example, see Sanford Labovitz, "The Assignment of Numbers to Rank Order Categories," American Sociological Review, 35 (June, 1970), 515-52Tj Sanford Labovitz, "In Defense of Assigning Numbers to Ranks," American Sociological Review, 36 (June, 1971), 521-522. The logic presented in the Labovitz papers is particularly applicable in this study's usage, because the absolute values of the correlations are not as relevant as are the comparative differences between different first-order partial cor relations . 4. In both cases t = 2.16, with 315 degrees of freedom. In all cases 315 degrees of freedom were used. 5. Here, t = 1.36, df = 315, p. < .05. 105 CHAPTER IV SUMMARY AND CONCLUSION Suininary of the Findings Throughout much of the psychological and psychiatric literature mental disorders are viewed as individual prob lems whose explanation and treatment are biologically or psychologically based.^ The present study adopted a dif ferent view, presenting mental disorders as part of a popu lation’s response pattern to pressures and problems created by social structural conditions. Because metropolitan social structure emerges from ecological growth processes, they have a bearing on the spatial distribution of mental disorders in terms of the degree of structural complexity evident in different parts of the metropolitan area. It is not suggested that structural complexity is bad in itself. It is the impact that structural conditions in different parts of the metropolitan area have on risk populations who have different vulnerabilities to pressures and problems that is important in this study. Thus, because of the blocked opportunities of the spatially segregated ethnic populations in the older subareas, high rates of organic disorders were expected. On the other hand, blocked oppor tunities would not have been an appropriate argument for the ethnic population in the newer areas. Social exclusion was 106 a more appropriate problem situation for a population whose ascribed characteristics identified the members as out siders. Social exclusion was also applied to a population whose single marital status was not in harmony with the family setting of the suburbs. Within this framework and given these assumptions, the spatial distribution of mental disorders was examined. Two issues were raised in the study : first, whether or not at a global level mental disorders followed theoreti cally predicted spatial distributions and, second, whether or not predicted patterns emerged when the theoretical argu ment focused on particular populations-at-risk and social conditions(e.g., blocked opportunities and social exclu sion) . The analytical results generally supported the hypotheses relevant to the first issue and partially sup ported the hypotheses pertinent to the second. Thus, the study determined that when mental disorders are examined in terms of the complexity of different parts of the metro politan area, specific spatial distributions of mental dis orders emerge. Organic disorders were more characteristic of the older subareas, while mechanical disorders tended to be more heavily represented in the newer subareas. The hypotheses concerned with subpopulations and social conditions also tended to be supported. Although some question may remain about socioeconomic status and blocked 107 opportunities, it seems reasonably clear that spatial segre gation is a factor in the high rate of organic disorders among the ethnic population in the older subareas. It is equally clear that spatial segregation is not an impetus for mechanical disorders in the ethnic population, although the percent ethnic population in an area seems to have some bearing on the rate of organic disorders in the Anglo popu lation. Considering the various analyses, the study reveals that the ethnic population in the older subareas is pecul iarly affected by structural problems and pressures which eventually become manifest in an unusually high rate of organic disorders. The results of the social exclusion hypotheses were partially confirmed, an outcome attributed somewhat to problems with the data. Throughout the study the analyses of mechanical disorders were affected by the small number of cases. The Department of Mental Health system is gener ally oriented toward the treatment of organic disorders, a factor reflected in the 3.5:1 ratio between the disorder 2 categories. It is a matter of Departmental policy (and part of the State mandate for the treatment of the mentally 3 disordered) that local programs not compete with the private sector by treating patients who have the resources to seek treatment with private practitioners. Also, indi vidual (as opposed to group) treatment modalities are more 108 prominent in the private sector, which makes the private sector more attractive to those who seek and can afford the intensive treatment and personal attention. As a result of the push-pull between the public and private sectors, the Department of Mental Health system is underrepresented in mechanical mental disorders. The underrepresentation, which characterized the subpopulation categories as well as the total caseload, made it difficult to adequately test the hypotheses based on mechanical disorders. It also made the interpretation of the analytical results ambiguous: do the comparatively weak results reflect a true situation or are they a specious result of poor data? Further, since matu ration and socioeconomic status varied inversely, it might also be that though mechanical disorders are inversely associated with complexity, seeking public rather than private aid for such disorders is positively associated with complexity. Two populations were examined in the analysis of mech anical disorders: the ethnic population viewed as social outsiders on the basis of their ethnicity, and single adults, outsiders in a milieu devoted to family life. Reasoning that their location in the newer subareas re flected their acceptance of the norms and values, this study argued that their rejection would lead to high rates of mechanical disorders (i.e., anxiety would be sublimated 10 9 and directed inward). Because of the underrepresentation, the highest rates of mechanical disorders were not found in the newer subareas. However, proportionately more mechanical disorders were found in the newer parts of the metropolitan area (i.e., relative to total disorders). Al though not the ideal measure, the relative rate of mechan ical disorders was taken as a tentative indication that their spatial distribution was in the expected direction. In view of this it is expected that if more data had been available the hypothesis would have been more adequately tested and more firmly confirmed. By contrast, the test of the hypotheses regarding the single population produced few conclusions. There was no pattern when the rates were examined, either in terms of their magnitude or their direction. There were fewer single cases 45-64 years old than ethnic cases, and the small number of ethnic cases created analytical problems. Aside from the analysis of the rates, the correlation analysis also proved largely to be unproductive, As noted in the discussion of the research design, the independent variables presumably symptomatic of social conditions that create pressures and problems for the single population were selected not for their appropriateness but for their avail ability from the decennial census. The results of the cor relation analysis --where none of the correlations were 110 significantly different from zero--emphasized the concerns raised in the research design chapter about the viability of the independent variables. In summary, the results were clear regarding the spatial distribution of organic and mechanical disorders in the ethnic population. There was less clarity regarding the spatial distribution of mechanical mental disorders in the ethnic population and in the single population 45-64 years old. In evaluating the results a question may be raised regarding the problem of having rate numerators and denomin- jators representing different time frames. In this study jthere was an average time differential of three years be tween the census data and the period covered by the mental health data. During the three years, population growth was most evident in the newer areas of the Orange County Metro politan Area. This would suggest that, if anything, the rates of mechanical disorders may be overstated, although they are already very low. By contrast, population growth in the older areas has remained relatively stable; therefore I the rates of organic disorders are not as likely to have peen affected by the temporal disparity. In discussing the rates it may also be useful to point (put that the numerators and therefore the rates may reflect the extension of the Department's service facilities. The 111 Department's program is only seven years old and thus far service facilities have been located so as to maximize efficiency. Thus, the Department has tended to locate service facilities in or near the population centers throughout the County (generally in the more established areas which would tend to be accessible for populations with organic disorders). As the Department matures and expands its facilities to provide services to the newer subareas, the ratio of organic to mechanical disorders should change. That mental health diagnostic codes were used at all in this study may generate criticism from "labelling school" theorists who argue that diagnoses are simply labels attrib uted to lower class patients by middle class clinicians. Although the accusation cannot be lightly dismissed, it has questionable application to the Orange County Department of Mental Health where approximately 90 percent of the patients who enter the system are voluntary admissions. If anything, it would seem to be a matter of self-labelling wherein the patient believes or recognizes that he/she has a problem which requires professional treatment. A second aspect of the labelling argument turns on the assumption of a middle class bias in the diagnostic process --after admission. Under this argument certain classes of patients are automatically diagnosed in a certain 112 manner; thus, for example, ethnics are consistently diag nosed as schizophrenic. The essentially random spatial distribution of the census tracts that comprise the six urban maturation areas argue against this accusation. For the kinds of rate patterns presented in this study to emerge as a result of bias in the diagnostic process, clinicians in the Orange County Department of Mental Health would have to be extremely familiar with the County's ecology of social disorganization. The data stand on their own merit and strongly suggest that the issues discussed in this study are not simply a product of labelling but that mental health problems of various subpopulations emerge from pressures in the social structure. Limitations of the Study One of the study’s major limitations is that the findings and conclusions do not pertain to all patient pop ulations. The private sector is excluded, and the study's generalizations do not extend to untreated mental illness. The study focuses on treated mental disorders in the public sector. However, even within the scope of mental disorders, some disorders were excluded. Among these were transient situational disturbances (i.e., crises situations), sex deviations, organic brain syndromes, childhood and adoles cent problems, and mental retardation (which does not come 113 under the Department’s purview, in any case). On the other hand, compared to other studies that focused on the institutional setting (e.g., Paris and 4 5 6 Dunham, Goffman, Scheff ), the current study covered the range of treatment programs available in the public sector (i.e., local inpatient, outpatient, day care, and State hospital inpatient programs). Thus, while the private sector was excluded, a range of programs within the public sector was included. Admittedly, this does not compensate for the absence of the private sector, but the public sector was thoroughly represented. A second limitation may focus on how generalizable the conclusions are to other metropolitan areas. This same issue was raised in the discussion of the Paris and Dunham study, but at that time the issue was directed at their lack of theoretical formulation. At issue here is the question of how typical the Orange County Metropolitan Area is. For example, only 15 percent of its population is com prised of ethnic and racial minorities, compared to at least 35 percent for neighboring Los Angeles County. While a minority population in Los Angeles, ethnic and racial groups are a more pronounced minority population in Orange County--a factor that might be conducive to their feeling persecuted, to their being suspicious, to their being highly segregated, to their withdrawing--all symptoms of organic 114 disorders. Their emphatic minority status might also be a factor in their social exclusion in the newer subareas. Other differences may make Orange County unique. For example, the data used in this study were obtained from a community mental health system where the emphasis is on the noninstitutionalization of patients and where a variety of mental illnesses are represented in the study population. By contrast, the majority of mental health facilities di rect attention to some degree of institutionalization, which usually implies a high degree of chronicity and great severity of symptoms. Of those who are institutionalized, the highest proportion are diagnosed as schizophrenic. This is not the case in the Orange County system, where only ten percent of its caseload consists of cases diagnosed as schizophrenic. While the study’s theoretical argument is applicable (with some modification) to other metropolitan areas, the peculiarities of the metropolitan area, the policies of the mental health system,and the relationship between the public and private sectors may well be variables that could produce different results. icatibns of the Study Within the past two decades few sociological studies of mental disorders have been structurally or ecologically oriented. Many of the studies reported in the literature 115 have adopted a social psychological perspective. Thus, for 7 example, they have focused on role problems, the problem g of reintegration following institutionalization, the basis for institutionalization,^ and the societal reaction to aberrant mental behavior.Other studies have been critiques of the community mental health movement and com- 11 munity or social psychiatry. While these topics have import and increase knowledge, the sociological perspective 12 presented by Blau seems to have been bypassed. The current study is structural, ecological,and theoretical. As a result of combining these factors, the study found that mental disorder categories follow spatial distributions related to the social structural complexity.of different parts of the metropolitan area. That distribu tions are patterned and follow predicted distributions for certain populations-at-risk suggests that structural condi tions may be of greater import than is evident in much of the current sociological literature. That the predicted distributions of mental disorder categories emerged also lends support to the conceptuali zation of mental disorders as part of a subpopulation’s adaptive mechanism. Mental disorders have generally been conceptualized as individual responses to internal or ex ternal stimuli. However, the results of the current study suggest that in coping with stress, subpopulations in 116 different parts of the social structure may adopt typical response patterns. If so, the emergency of certain kinds of mental disorders in a subpopulation may not be as much an individual or psychological matter as it is a product of group socialization wherein appropriate response patterns are learned. In some respects the study’s implications for com munity mental health are as basic as they are for sociology. If the social structure is as important a factor as this study suggests, directing treatment at the individual will not alleviate the problem. Changing the social structure 13 will 5 and Dunham to the contrary, perhaps this is where the community mental health movement should direct its efforts. Topics for Future Research In the process of executing this study problems emerged that hampered exploration of various topics. The examina tion of the elderly population and of mechanical disorders were particularly beset by problem data and would be topics worth pursuing. It would also be interesting to ungroup the categories of mental disorders into their component parts and study the distribution patterns that emerge when spe cific disorders (e.g., schizophrenia) are related to the social structure. 117 The issue of socioeconomic status was also deferred for future research. While the relationship between socio economic status and mental disorders derives from an analysis performed by Hollingshead and Redlich,^^ the relationship is a case of sui generis and remains a con stant issue. Unlike criminal or delinquent behavior where financial or status gain may be stimuli for the lower class, it is difficult to understand why those in the lower class would be expected to have higher rates of mental illness (which Hollingshead and Redlich did not demonstrate) than the middle or upper classes who are also subject to stress and anxiety, albeit a different kind. It might be pointed out that Hollingshead and Redlich were concerned primarily with the private sector; were their study conclusions cor rect, it would be a case where the lower class was greatly , overrepresented in the private sector system (which would be just the reverse of what would be expected). Neverthe less, the issue remains and is worth pursuing, if only to pursue the issues raised in this study regarding the rela tionship between socioeconomic status and the rate of organic disorders in the Anglo population. In this respect it should be emphasized that the theo retical argument developed in this study is not complete. The theory is not yet a general theory but has specific application to but a few situations. Nevertheless,the 118 argument as developed in its rudimentary form in this study appears promising and will hopefully open up an avenue of inquiry for further sociological research into the problem of mental disorders. 119( CHAPTER IV FOOTNOTES Alfred Adler, "The Individual Psychology of the Alcoholic Patient," Journal of Criminal Psychopath ology, 3 (1941), 74 - 77 ; J. Dl Armstrong, "The Search for the Alcoholic Personality," Annals of the American Academy of Political and Social Science, 315 (19 5 8) , ; MabTe~B~lake Cohen7~~et . , """TüT Intensive Study of Twelve Cases of Manic-Depressive Psychosis," Psychiatry, 17 (1954), 103-137; J. F. Casey, et al., "Drug Therapy in Schizophrenia," Archives of General Psychiatry, 2 (1960) 210-220; Pi rn,^go Psychblogy and the Psychosis, (New York Basic Booksl 1952);L. B. Hill, Psychotherapeutic Intervention in Schizdphrenia (ChicagoT University of Chicago Press, 19 55) ; ^nt Jordan and Dane G. Prugh, Schizophreniform Psychosis of Childhood," The American Journal of Psychiatry, 128 (August, 1971), 323-331;: P. 0’NniT"~andl7r~Nl Robins, "Childhood Patterns Pre dictive of Adults Schizophrenia," American Journal of Psychiatry, 114 (1958), 961-975; J. Rub ins, Early Development of the Self: Its Role in Neurosis," American Journal of Psychoanalysis, 22 (1962), 122-130. 2. Orange County Department of Mental Health/Three Year Plan: T975, pp. 1-20. 3. State of California, The California Mental Health Services Act, Division 5 : Part T, The Short-Doyle Act, Chapter I : ' General Provisions , Section TBlTUm 4. Faris and Dunham, op^. cit. 5. Erving Coffman, op^. cit. 6. Thomas J. Scheff, Being Mentally 111: A Sociological Theory (CHicago : AidineHPub 1 ishrng'^XompanyV 1966) . 7. A. H. Stanton and M. S. Schwartz, The Mental Hospital (New York: Basic Books, 1954) ; Erving "GoTîmanT" Stigma (Englewood Cliffs: Prentice Hall, 1963); Kai T. Erikson, "Patient Role and Social Uncertainty : A Dilemma of the Mentally 111," Psychiatry, 20 (1957), 263-270. 120 8. Howard Freeman and Ozzie Simmons, The Mental Patient Comes Home (New York: John Wiley and SdnT^ 1963); Howard Freeman and Ozzie Simmons, "Mental Patients in the Community: Family Settings and Performance Levels," American Sociological Review, 23 (April, 1958) 147-158 ; Mark Lefton” Simon Dinitz, Shirley S. Angrist, and Benjamin Pasamanick, "Former Mental Patients and Their Neighbors : A Comparison of Per formance Levels," in The Sociolbgy of Mental Disorders Analyses and Readings in Psychiatric Sociology, ed. ~ "ST Kifson Weinberg ^Chicago : Aldine Publishing Co., 1967), pp. 225-262. 9. S. Kirson Weinberg, "The Commitment of Patients to the Mental Hospital," in The Sbciblogy of Mental Disorders Analyses and Readings in Psychiatric Sociology, ed. Si Kirson Weinberg (Chicago : AldineTLLbTnTshing Co., 1967), pp. 182-183; Marjorie Fiske Lowenthal, "Social Isolation and Mental Illness in Old Age," American Sociblogical Review, 29 (February, 1964), 54-70. 10. W. R. Gove, "Societal Reaction as an Explanation of Mental Illness," Americah Sbciological Review, 35 (October, 1970), 8 7 3"^8 5 ; Thomas Jl ScEeTf, VThe Labeling Theory of Mental Illness," American Socio logical Review, 39 (June, 1974), 444-452'; C .~RTcïïahd FletcherT et~al., "The Labeling Theory and Mental Illness," in Explorations in Psychiatric Sociology, ed. Paul M. Roman ahd Harrison N. TrTce^^Phila.: F. A Davis and Co., 1974), pp. 43-62; Walter Gove, "The Stigma of Mental Hospitalization," Archives of General Psychiatry, 28 (April, 1973), 494-500. 11. H. Warren Dunham, "Community Psychiatry : The Newest Therapeutic Bandwagon," in H. Warren Dunham, Social Reali ties and Communi ty Psychiatry (New York : Human Sciences "Presh^, IVTSyypp. 9 3-124 . 12. Peter M. Blau, "Presidential Address: Parameters of Social Structure," Americah Sociological Review, 39 (October, 1974), 61 S^^bYoT ^ 13. Dunham, op. cit. 14. August B. Hollingshead and Frederick C. Redlich, Social Class and Mental Illness: A Community Study (New York) John Wiley and Sons, 19 58)’ ^ pp~n98-199. APPENDIX A œ m I— I o u w H < CJ CJ t —I E - h œ o ( L 3 < ^ 1 —4 Q T— I Q I W fO H r- U W T— I J m CO •• >H H g O % u p< o Ph o o oo I>- o o rH to o O OO r-4 o <N] csi \o • • • rH o rH en CNJ o rH rH CNJ un » • • • rH O I — 1 O CNl rH o I — 1 O O • • « • • r—1 O rH vO 1 — 1 cxi O o O csi (N rH rH bO • • • » • » T — 1 ( O LO oo O en CNJ O r-4 r H J —H hO hO O Cvj • • • * » » • I— 1 1 O oo LO vO rs j O (N r — 1 O O hO r H r H • • • • • • • ■ • i — l . t-H t / ) P i W P H U ( D < Z od S < e n P ■ ( D o % o e n e n O o •H w :z: P: Q H t - i u < % e n 1 —4 H - l e n Î H P W Pk < D U P i T3 •H Pi < D P bû o > O P Q CJ C T S •rH e n O iH •rH + - > •H •H Q Pi a u T 3 + - > •H m < D ( D U e n n e n u <-H P •H X Pi •H f! m e n (D nd PP o rH p. < •H < D ■M nd A t O o O e n U < O q X N H P O o3 rP Pi O •H O a H P bû U m u rP • r —^ u P o3 P X M rH U o J 0 3 (D rP P e n < CO IS P4 iz: CJ Q Pw rH csj hO LO vO cô 123 Bibliography Books Blau, Zena Smith. Old Age in a Changing Society. New York New Viewpoints, 1973. Clark, Kenneth B. Dark Ghetto: Dilemmas of Social Power. New York: Harper Torch Books, 196 7 . Clinard, Marshall. Sociology of Deviant Behavior. New York: Rinehart and Company, 19 51\ Cloward, Richard A. and Lloyd E. Ohlin. Delinquency and Opportunity: A Theory of Delinquehcy Gangs. Glencoe: The Free Press of Glencoe, 1963. Coleman, James C. Abhormal Psychology and Modern Life. 2d ed. Chicago : ^Scott, Fbresman and Company, 195 7 . Dobriner, William, Class in Suburbia. New York: G. P. Putnam, 1958, Dunham, H. Warren, Community and Schizophrenia : An Epidemi■ ological AnalysIS. Detroit: Wayne State University Press ” 19651 Durkheim, Emile. The Division of Labor in Society. Trans lated by George Simp son. N ew Ÿo rkl The Free Press, 1968 . The Elemehtary Forms of the Religious Life. Trans - Tasted by Joseph Ward SwainT” New Yorh: Collier Books, 1961. ' Suicide: A Study in Sociology. Translated by John Al Spaulding and George Simpson. 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"Race Contacts and the Social Structure," American Sociological Review, 14 (February, 1949) , 1-11. French, J. R. "The Social Environment and Mental Health," Journal of Social Issues, 19 (Spring, 1963), 39-56. Cans, Herbert. "The Suburban Community and Its Way of Life," in Neighborhood, City and Metropolis: An Integrated"%eader in Urban Sociology. Ed. Robert Gutman and David Popenoe. New York: Random House, 1970. pp. 297-308. Gruenberg, Ernest. "The Social Breakdown Syndrome : Some Origins," American Journal of Psychiatry, 123 (June, 1967), 1481-1489. Hare, M. H. "Mental Health in New Towns," Journal of Psychosomatic Research, 10 (July, 1966), 53-58. Myers, Jerome K. "Assimilation to the Ecological and Social Systems of a Community," American Socio logical Review, 15 (June, 1950), 367-372. Park, Robert E. "The Urban Community as a Spatial Pattern and a Moral Order," in Robert E. Park: On Social Control and Collective Behaviorl Ed. RalphH. Turner. 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"Negro Migration to Los Angeles, 1930 to 19 50," unpublished Ph.D. dissertation, Depart ment of History, University of California at Los Angeles, 1962. Diagnostic and Statistical Manual of Mental Disorders, 2d ed. Washington, D.C.: American PsychiatricAssoci ation, 1968. Hawley, Amos H. "Dispersion versus Segregation: Apropos of a Solution of Race Problems." Papers of the Michigan Academy of Science, Arts, and Letters, XXX (1944), 667-674. Schuerman, Leo A., E. Wayne Hansen, and Charles Hub ay, Jr. "Combining Ratio-Correlation and Composite Methods for Intercensal Social and Economic Small Area Estimates." Paper presented at American Statistical Association Annual Meeting, St. Louis, August, 1974 127 Freedman, Alfred M.,and Harold I. Kaplan. Comprehensive Textbook of Psychiatry. Baltimore: The Williams and~Wi1kins Company, T96 7. Glaser, Daniel. Social Deviance. Chicago: Markham Pub lishing Company, 1971. Coffman, Erving. Asylums : Essays in the Social Situation of Mental Pat ients and Other Inmates. Garden City : Doubleday and Company, T9ETC , Stigma. Englewood Cliffs, N.J.: Prentice-Hall, 1963. Golann, Stuart A.,and Carl Eisdorfer. Handbook of Com munity Mental Health. New York: Appleton-Century- Crofts,"T9 72. Gordan, Milton M. Assimilation in American Life: The Role of Race, Religibn, ahd Natural Origins. New York : Oxford IJniverEïTy~ PreTsl f?641 Hoover, Edgar M.,and Raymond Vernon. Anatomy of a Metro polis . Garden City , New York : Doubleday and Company, Inc., 1962. Killian, Lewis M. The Impossible Revolution : Black Power and the American Dream. New York : Random House, 1968. Levy, Leo, and Louis Rowitz. The Ecology of Mental Dis - order. New York : Behavibrai Publications, 19 73. Mendelson, Wallace. Discrimination. Englewood Cliffs, N.J.: Prentice-HalT^ Inc., 1962. Park, Robert E., and Ernest W. Burgess, The City. Chicago : University of Chicago Press, 1925. Rosen, Ephraim, Ronald E. Fox, and Ian Gregory. Abnormal Psychology. 2d ed. Philadelphia : W. B. Saunders Company, 19 72. Sanders, Irwin T. The Commun it y : An Introduction to a Social System. 2d ed . New York : Ronald Press, Ï9EE1 Scheff, Thomas J. Being Mentally 111 : A Sociological Theory. Chicago : Afdine Publishing Company, 1966. 128</a></u>
Abstract (if available)
Abstract
The purpose of this study is to develop a theoretical explanation of the spatial distribution of mental disorders in the metropolitan area. The basic argument presented in the study is that the urban-rural continuum generally employed is not a sufficient predictor. Rather, the explanation is found in the patterns of metropolitan growth and development that are reflected in social structural conditions which have a differential impact on populations-at-risk. Through the interaction of these factors, specific kinds of mental disorders emerge and their spatial distribution may be predicted.
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Asset Metadata
Creator
Schuerman, Muriel Constance
(author)
Core Title
Mental disorders in the metropolitan area: an ecological analysis
School
Graduate School
Degree
Doctor of Philosophy
Degree Program
Sociology
Degree Conferral Date
1977-02
Tag
OAI-PMH Harvest
Advisor
Turk, Herman (
committee chair
), illegible (
committee member
), Weston? (
committee member
)
Permanent Link (DOI)
https://doi.org/10.25549/usctheses-oUC11256387
Unique identifier
UC11256387
Legacy Identifier
DP31779
Document Type
Dissertation