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The article is in response to comments by the author G. Harvey on the research paper "Response Biases in Field Studies of Mental Illness." Most of his criticisms, however, concern issues which authors raised in an earlier draft of the paper and in more recent work. The study under scrutiny here was the first of a series of investigations authors have been conducting to explore bias and invalidity in survey research. It is important to note that the paper was not intended to answer all questions concerning response biases. Rather the purpose was to extend the work of author Bruce P. Dohrenwend, who in his provocative 1966 American Sociological Review article raised the spectre of response biases in field studies of psychiatric disorder. Harvey is incorrect when he claims that authors have taken the a priori position that association means error. A closer inspection of the paper will reveal that it was concerned with testing the two hypotheses outlined by Dohrenwend regarding the correlation between "social desirability" and symptom scores.

Major life changes and role transitions are often treated as stressors that create a generalized demand for adjustment by the individual. Empirically, however, these transitions have been shown to produce a wide range of effects on mental health. Two kinds of models have been proposed to explain this variation: differential access to coping resources for dealing with stressful situations, and variation in the characteristics of transitions, such as their undesirability, foreseeability, etc. This paper emphasizes a logically prior issue: the role context within which the transition event occurs, specifically, the level of pre-existing chronic stress in the social role. The model tested envisions life transition events as nonproblematic, or even beneficial to mental health, when preceded by chronic role problems -- a case where more "stress" is actually relief from existing stress. Nine transition events are studied: job loss, divorce, pre-marital break-up, retirement, widowhood, children moving out of the house, first marriage, job promotion, and having a child. Results support the hypothesis that prior role stress reduces the impact of life transition events on mental health for seven of nine events, with some differences in impact by gender. The findings provide a basic framework for interpreting the effects of varying types of life transitions, and argue against the presumption that life transitions are inherently stressful, suggesting instead a need to specify prior social circumstances that determine whether or not a transition is potentially stressful. [ABSTRACT FROM AUTHOR]

Traditional psychiatry for a long time emphasized clinical description. It was Kraepelin who first insisted that a patient's thoughts, so long as they remained abnormal, were of interest only for purposes of diagnosis. Undoubtedly, the description of symptoms facilitating diagnosis is important. The classification of the American Psychiatric Association contains twenty-two broad categories of mental disorder. These categories subsumes some eighty sub-varieties. Because this classification is based on an overlapping symptomatology, it will probably be revised in the next few years; but a classificatory system of some kind will always constitute the essence of clinical procedure. Besides nosological descriptions, we must have knowledge of environmental pressures affecting abnormal behavior. We must know more about the role of factors that come within the range of human ecology, dealing with the adjustments of groups and communities to their various habitats; cultural anthropology, dealing with the adjustments of individuals to the cultures of their groups; and social psychology, dealing with inter-individual adjustments, or the responses of individuals to social situations. Knowing the range of clinical variation, and the role of these factors in abnormal behavior, we can discover the environmental settings linked up with the appearance of the various clinical entities.

Review of research on social class and mental illness suggests the hypothesis of two patterns: (1) a discrete relationship with the lowest class having a higher rate than all others but with little difference in rates for other classes; (2) a continuous relationship, with rates systematically increasing with each drop in class status, but with an extremely large increase for the lowest class. Findings for 4,650 Washington male first admissions between 1954 and 1965 support this hypothesis. Alternative interpretations of the relationship between social class and mental illness are considered. Since most interpretations posit a discrete pattern, they will have to be modified or extended to account for both patterns. [ABSTRACT FROM AUTHOR]

The relationship between alienation and mental health is of interest to workers in mental health professions for another reason. This is the question of whether social values are affected by mental illness. It has often been assumed that they are, but there is a dearth of evidence on this question. It cannot be taken for granted that because a man enters a mental hospital, he has rejected the values of the dominant culture. On the basis of research on long stay patients, it appears more likely that large mental hospitals produce more alienation than they treat. Some patients on chronic wards have not visited a community in years. Many do not read a newspaper or receive mail. In such cases discussions of alienated mental patients should be centered on the disculturating effects of large isolated mental hospitals rather than the relationship between alienation and psychopathology. The task at hand is to investigate the degree of alienation of patients recently admitted to a large mental hospital.