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Status contingencies of the legally labelled insane

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Status contingencies of the legally labelled insane
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Hodge, Kenneth Jack, 1943-
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xi, 173 leaves. : 28 cm.

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Alcohols ( jstor )
Analytics ( jstor )
Censuses ( jstor )
Counties ( jstor )
Employment statistics ( jstor )
Hospitals ( jstor )
Mental disorders ( jstor )
Pathology ( jstor )
Prestige ( jstor )
Radiocarbon ( jstor )
Insanity (Law) ( lcsh )
Social status ( lcsh )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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Thesis--University of Florida.
Bibliography:
Bibliography: leaves 165-172.
General Note:
Typescript.
General Note:
Vita.
Statement of Responsibility:
Kenneth J. Hodge.

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STATUS CONTINGENCIES OF THE LEGALLY LABELLED INSANE






By


KENNETH J. HODGE













A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF THE
UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF
THE REQUIRES FOR THE DEGREE
DOCTOR OF PHILOSOPHY






UNIVERSITY OF FLORIDA 1972


































To M. B.
















































aM









ACKNOWLEDGEMENTS


I would like to express my appreciation to several

individuals for their assistance and encouragement in writing this paper. The order of presentation is chronological and does not reflect importance. My thanks to Professor Walter Probert from whom I first learned that for an understanding of the law, one must understand the nature of both the society and the individual. I would like to acknowledge Dr. Richard F.

who first encouraged me to study sociology and whose continued encouragement and constructive criticism were invaluable to my graduate education.

A special note of thanks to Dr. Benjamin L. Gorman, the

Chairman of my Supervisory Committee, whose continual patience, assistance, and encouragement made it possible for me to complete this research.

This research was done under the auspices of National

Institute of Mental Health Grant number 15900-04 with John J. Schwab, M.D., as Principal Investigator and George J. Warheit as Project Director. My thanks to them for their support.

I am also grateful to Susan Josephson for her assistance in data collection and to Linda Johnston, Linda Darby, and Marilyn Allan for their patience and care in typing the









manuscript.

Care has been used in the preparation of this study; however, errors of omission and commission are possible, and for these I assume full responsibility.












































iv










TABLE OF CONTENTS


Page

ACKNOWLEDGEMENTS.iii LIST OF TABLES ...... ..... vi


ABSTRACT ..... .. ..... ix


CHAPTER


I THEORETICAL BACKGROUND 1


II STUDIES OF CIVIL COMMITMENT 34


III THE COMMUNITY AND ORGANIZATIONAL
SETTING OF THE STUDY ... 48


IV DATA AND HYPOTHESES .. 66


V DATA DESCRIPTION AND ANALYSIS 85


VI CONCLUSIONS, INTERPRETATIONS, AND
FURTHER RESEARCH .... 154












v










LIST OF TABLES

Table Page

I ONE-WAY DISTRIBUTION OF THE TOTAL SAMPLE 86

2 ONE-WAY DISTRIBUTION OF THE ANALYTIC SAMPLE 87

3 ONE-WAY FREQUENCY DISTRIBUTION OF TOTAL
SAMPLE 96

4 PER CENT ADJUDGED COMPETENT TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY PRIOR PSYCHIATRIC CARE, PRESENT PSYCHIATRIC CARE, AND
ALCOHOL PROBLEMS . . . . 100

5 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY AGE 0 0 103

6 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY AGE, CONTROLLING
FOR PRIOR PSYCHIATRIC CARE . . . 105

7 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY AGE, CONTROLLING
FOR PRESENT PSYCHIATRIC CARE . . 107

8 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY AGE, CONTROLLING
FOR ALCOHOL PROBLEMS . . . . 109

9 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY RACE . 0 ill

10 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY RACE,, CONTROLLING FOR PRIOR PSYCHIATRIC CARE 113

11 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY RACE, CONTROLLING FOR PRESENT PSYCHIATRIC CARE 114

12 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT,, OR INCOMPETENT BY RACE, CONTROLLING FOR ALCOHOL PROBLEMS 116


vi







LIST OF TABLES

Table Page

13 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY SEX 118

14 PER CENT ADJUDGED COMPETENT,, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY SEX, CONTROLLING FOR PRIOR PSYCHIATRIC CARE . 119

15 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT,, OR INCOMPETENT BY SEX, CONTROLLING FOR PRESENT PSYCHIATRIC CARE 120

16 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY SEX, CONTROLLING FOR ALCOHOL PROBLEMS . . . 122

17 PER CENT ADJUDGED COMPETENT,, TEMPORARILY
INCOMPETENT, OR INCOMPETENr BY MARITAL
STATUSt OF ALLEGED INCOMPETENT 123

18 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MARITAL
STATUS, CONTROLLING FOR PRIOR PSYCHIATRIC
CARE 125

19 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MARITAL
STATUS, CONTROLLING FOR PRESENT PSYCHIATRIC
CARE 126

20 PER CENT ADJUDGED COMPETENT., TEMPORARILY
INCOMPETENT., OR INCOMPETENT BY MARITAL
STATUS., CONTROLLING FOR ALCOHOL PROBLEMS 127

21 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT., OR INCOMPETENT BY EDUCATION o 129

.22 PER CENT ADJUDGED COMPErENr, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY EDUCATION,
CONTROLLING FOR PRIOR PSYCHIATRIC CARE 131


23 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY EDUCATION,
CONTROLLING FOR PRESENT PSYCHIATRIC CARE 132

vii






LIST OF TABLES

Table Page

24 PER CENT ADJUDGED COMPETENT,, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY EDUCATION,
CONTROLLING FOR ALCOHOL PROBLEMS ...134

.25 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MO)ST RECENT
OCCUPATION *. *. ...*.. a0 135

26 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMiPETENT BY MO3ST RECENT
OCCUPATION, CONTROLLING FOR PRIOR PSYCHIATRIC
CARE .......... 137

27 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MO3ST RECENT
-~ OCCUPATION, CONTROLLING FOR PRESENT PSYCI-I
ATRIC CARE.*~ .* 139

28 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MOST RECENT
OCCUPATION, CONTROLLING FOR ALCOHOL PROBLEMS 141

29 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT,, OR INCOMPETENT BY PRESENT
-OCCUPATIONAL STATUS . . . 143

30 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY PRESENT
OCCUPATIONAL STATUS, CONTROLLING FOR PRIOR
PSYCHIATRIC CARE . . .* . 144

31 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY PRESENT
OCCUPATIONAL STATUS, CONTROLLING FOR PRESENT
PSYCHIATRIC CARE . . . . 145

32 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCCMvPETENT, OR INCOMPETENT BY PRESENT
OCCUPATIONAL STATUS, CONTROLLING FOR ALCOHOL
PROBLEMS e o o .* o o o o. 147

33 PER CENT EMPLOYED OR UNEMPLOYED BY MOST
RECENT OCCUPATION . . _-149

34 SUMMARY ANALYTICAL TABLE: PERCENTAGE DIFFERENCE OF COMPETENT JUDGMENTS BETWEEN SELECTED
CATEGORIES OF INDEPENDENT VARIABLES . 150

viii








Abstract of Dissertation Presented to the
.Graduate Council of the University of Florida
in Partial Fulfillment of the Requirements
for the Degree of Doctor of Philosophy


STATUS CONTINGENCIES OF THE LEGALLY LABELLED INSANE


By

Kenneth J. Hodge

December, 1972

Chairman: Dr. Benjamin L. Gorman Major Department: Sociology


The purpose of the present study was to determine the relationship between an individual's status characteristics and the type of final judgment received from a judicial hearing for the determination of his legal competency.

Data were drawn from a total sampling of three years of case records from a court whose jurisdiction consisted of a county in the southeast United States. A total of 379 court cases were involved in the study. Eliminating all cases in which the individual was diagnosed as having an organically caused disorder yielded a final analytic sample of 278 cases. Additional data on these cases, when available, were drawn from hospital and mental health agency records. The dependent variable for this study was the court's judgment: a finding



ix








of competent, temporarily incompetent, or incompetent. The independent variables, which were conceptualized as status contingencies of the court's judgment were:. the age, race, sex, marital status, education, most recent occupation, and present employment status of the alleged incompetent. Dichotomous controls classified the individuals as either kes or no for three variables: a history of prior psychiatric care, a history of problems with alcohol, ahd having been under psychiatric care at the time of the proceedings. Associations between the dependent and independent variables were determined by the percentage distributions in contingency tables.

The literature in social stratification, social control, and deviant behavior offers a general hypothesis for this research; high-status characteristics will be associated wi h judgments of legal competency. A proposition from the social reactions perspective on mental illness suggests that judgments of the court will be unrelated to individual pathology. A finding that status characteristics are related to judgments of the court while controlling for psychiatric history would support the social reactions perspective.

The findings of this study follow. High status characteristics such as being young, male, white, married, employed,



x









and of upper white-collar occupational status were associated with -judgments of competency. Such associations were strongest under the control situation"of not having been under psychiatric care at the time of the proceedings. For those under psychiatric care at the time of the proceedings,

the associations were minimal.

The independent variables, in descending order of their importance for determining the cour-es judgment, were most recent occupation, present occupational status, sex, marital status, age, and race.

The findings were taken to support the general social

stratification proposition that high status individuals will receive more positive outcomes from social control decisionmaking processes than will low status individuals. The findings support a model of mental illness which takes into account both social reactions and individual pathology.














Xi









CHAPTER I


THEORETICAL BACKGROUND


Social Stratification


Phi losophers and social scientists alike have long been concerned with social inequalities. A major task of the sociologist interest ed in social stratification is to develop conceptual categories of the various dimensions of inequality and to empirically chart the consequences of inequality for

the individual and society.

The major concern of this work is to determine what

effect one's position on various dimensions of stratification has on the judicial decision concerning whether one is insane.

Two variables are central in this analysis. One, the

independent variable, is social stratification. The several dimensions and manifestations of individual position and identity will be analyzed as causal agents. The dependent variable is judicial fate, the legal judgment made about an individual's sanity, a judgment which becomes part of the individual's and the state's record and which affects his subsequent career--indefinite incarceration, temporary incarceration, or freedom.




2



Two other conceptual areas are related. Social control, is an intervening variable or a mediating concept which links stratification to judicial fate. The third concept is that of mental illness, the official legitimation of judicial fate. In this chapter we will consider each one of these concepts and the theoretical relationships among them--both generally and with specific reference to the problem at hand.

Individuals are unequal in many ways. Max Weber (Gerth

Mills, 1958:180-195) first recognized that a person's .position in the stratification order was based on not one but several criteria. For Weber the stratification order had three dimensions. The three dimensions of stratification were class, status, and party. Each dimension on an individual and group level was seen as influencing the other. Weber's model of the stratification system still serves as a starting point for any serious study of social inequality. Class

Weber's conception of the class-situation being grounded in the economic order or market-situation is very similar to Marx's idea of social class with the exception that, for Weber, class consciousness and class action do not necessarily follow from a specific class-situation.




3



We may speak of a Iclasst when (1) a number of
people have in common a specific causal component
of their life in so far as (2) this component is represented exclusively by economic interests in
the possession of goods and opportunities for
income, and (3) is represented under the conditions
of the commodity or labor markets.
(Gerth and Mills, 1958:181).

The best illustration of the impact of the economic or class factor on life chances is the demonstrated relationship between class and the probability of life itself. The official casualty lists of the Titanic disaster clearly demonstrated an inverse relationship between class of accommodations and drowning. Four of 143 first class female passengers drowned while 81 of the 179 female third class passengers were lost (Lord, 1955:107). Less dramatic but equally to the point are Antonovsky's (1972) findings on

class and mortality.

Despite the multiplicity of methods and indices
used in the 30 odd studies cited, and despite the variegated populations surveyed3,the inescapable conclusion is that class influences
one's chances of staying alive.
(Antonovsky, 1972:486).

The effects of class are not limited to the probabilities of staying alive. Blau and Duncan (1967) have demonstrated that one's class background, measured by father's occupational level, has a significant effect on the level of the individual's

-present occupation. Measuring effects by path coefficients,




4



Blau and Duncan found that the level of the father's occupation positively influenced the level of the son's education and first job. The level of the son's job and education each in turn separately affected the level of the son's present job. The father's occupational level also had an independent positive affect on the son's present occupation, while controlling for the effects of the son's education and first job (Blau and Duncan, 1967:170).

It is evident that one's class or economic situation

has great impact on the biography of the particular individual. The issue that is unsettled concerns the importance of the dimension relative to the other variables. Which, if any, dimension of stratification has the greatest effect on the individual situation or the stratification system as a whole? Most theorists assume the stratification variables are interrelated in both their individual and societal influences. The causal links and priorities are unclear.

The economic factor should be a very important determinantof the commitment decision-making process. The economically advantaged can afford private psychiatric care as an alternative to hospitalization in a state institution and can buy the services of legal counsel and expert witnesses in order to avoid commitment. The poor, if they wish to avoid commitment, are left to their own limited resources.




5



Status

The second dimension of stratification considered by

Weber concerned the prestige dimension, which he called the "status situation." The individual status situation depends on social honor and is often linked with his class situation.

0 We wish to designate as 'status situation' every typical component of the life fate of men
that is determined by a specific, positive or
negative, social estimation of honor. This honor
may be connected with any quality shared by a
plurality, and, of course, it can be knit to a class'situation; class distinctions are linked
in the most varied ways with status distinctions.
(Gerth and Mills, 1958:187).

Research involving primarily the status dimension of stratification has centered around locating and describing status strata in particular communities and charting occu.pational prestige rankings for national and international samples. Warner and his associates (1949) have been primarily concerned with prestige strata in communities. The basic findings of this group include: the existence of three basic strata with one or more substrata in each, depending on the community; a differentiation between strata on the basis of occupation and income; and an individual carryover from the prestige dimension to the other facets of the community such as the family, religious structure, organizational participation, and occupational structure. Warner's work, thou gh




6



subject to criticism (Pfautz and Duncan, 1950; -Kornhauser, 1953), should be considered when analyzing the effects of social stratification.

Weber (Gerth and Mills, 1958:193) mentioned that

occupational groups are also status groups because of their common life style. The object of the occupational prestige scale (North & Hatt, 1947) is to rank occupations on prestige by the use of opinion surveys. The results of the rankings give some support to Warner's prestige strata hierarchy in that the overall prestige ranking would, if collapsed into strata, resemble the occupational distribution found in Warner's prestige strata. The basic prestige rankings obtained have been shown to have changed little since 1947 (Hodge et al., 1968).

In addition to achieved characteristics such as income,

education and occupation, status and prestige may be determined by ascribed characteristics. The most obvious and best documented ascribed status determinants are race and ethnicity.The effects of race on social honor was noted by Weber in his treatment of "Ethhic Segregation and Castel' (Gerth and Mills, 1958:188). The racial status structure of a Southern community was studied by Dollard (1937) using participant observation. The Negro community was found to be composed of prestige




7



strata much like the whites but there were fewer strata, which were lower in prestige than comparable white strata, and the whole structure was separated from the white system by a caste line. Berreman (1969) reviewed the evidence for the existence of a Negro caste structure and concluded that caste is a reality.

In considering the process of evaluation, Tumin, (1967: 27) mentioned other important status characteristics,

0 in American society one is generally
considered better, superior, or mcre worthy
if he is male rather than female. . educated
rather than uneducated. . young rather than
old. . employed rather than unemployed.
married rather than divorced.

Clearly, any consideration of status characteristics and civil commitment should study these variables.

The functionalist theorists generally consider the status dimension to be the stratification variable most important for its influence on the other dimensions and the individual biography. One can easily see though, that untangling the effects and causal priorities of the various variables in an empirical study would be difficult if not impossible.

The status.dimension should affect commitment decisions through the linkage of status with deference behavior (Shils, 1970:421). We might expect the low status individual in a commitment hearing or examination to defer to the findings,




8



wishes, and authority of the high status psychiatrist or judge. The high status individual would not feel compelled to defer on the basis of a status differential, but might marshall his resources to avoid being placed in a stigmatized role.


Power

The party, according to Weber, was a group concerned with the acquisition of power. Power was generally defined as:

the chance of a man or of a number of men
;o realize their own will in a communal action
even against the resistance of others who are
participating in the action.
(Gerth and Mills, 1958:180).

Studies of the power variable do not generally concern situations when the fate of one man is at stake and power might influence the outcome, but usually involve issues which affect large collectivities and the power structure of a community (Hunter, 1953; Dahl, 1961; Presthus, 1964), or the nation (Mills, 1956; Domhoff, 1967). Such studies are concerned with the type of power structure and the membership of the structure. Though the issue of pluralism vs. power elite has not been.resolved on either a local or national level, it can be stated that most studies irrespective of the power concentration demonstrate that the influential and powerful are drawn disproportionately from the upper-middle and




9



higher social strata. The influence of power might best be examined within this higher occupational group. The dimension of power would appear to be a very important variable for consideration when examining civil commitment, for the situation could be conceived as one where the individual being committed is in a struggle against those who petition for his commitment. The problem remains, however, of separating power effects from those of other dimensions.


Associated Variables

Gordon (1958) has distinguished two additional variables, which are important for any inquiry into the effects of social stratification. Gordon's associated variables are called group life and cultural attributes. Group life refers to the extent that a class is:

an effective social system within which
the class member has most or all of his intimate
and meaningful social contacts.
(Gordon, 1958:18).

Cultural attributes are the patterns of behavior and attitudes which might serve to differentiate a particular social class. These associated variables are not hierarchical in nature-as are the stratif ication variables of class, status, and power--but are behavioral categories which are produced by the operation of the stratification variables.




10



It seems clear that the associated Variables should

have a great effect on how the hierarchical stratification variables influence a person's outcome in a decision-making process. For example, if the social status of an individual could possibly effect a judicial determination of his sanity, this effect would be more certain if the cultural attributes of his particular status were visible and distinctive or if the members of his particular status had social contact networks extending to the court officials or psychiatrists. For status to effect a decision, it-must be evident to the decision makers, either through obvious signs of status or through prior communication. To the extent the effects of income and power interact with status, their influence will

depend on the associated variables also.

The empirical data demonstrate that intimate social

contact within one's class or status group is the predominant occurrence. The highest frequency of intraclass contact seems to occur in the highest and lowest classes. Laumann (1966) found in his sample of a metropolitan area that 75 per cent of professional businessmen's close friends were at the same occupational level. Almost all close friends were middleclass or higher. Gordon and Anderson (1964) found that 90 per cent. of their manual worker respondent's close friends










were other manual workers. Warner's previously mentioned work (1949) also illustrates a predominance of intraclass social contact. Examination of cliques, voluntary associations, and families demonstrated a limitation on the

range of class contact.

A predominance of intraclass interaction should lead to or indicate a similar life style and value system for the class. Again, Warner's work (1949) serves to illustrate

--the point. Other research within individual strata bolsters the generalization of differential class life styles and values. The upper (Baltzell.1958), middle (Seeley et al., 1956; Riesman et al., 1952; Whyte, 1956) and lower strata (Gans, 1962; Miller and Riesman, 1961) have been studied and found to have somewhat distinctive behavior and values.

Kohn's (1969) work in socioeconomic status, socialization, and values considered class characteristics that might be important determinants of commitment hearing decisions.

The essence of high class positions is the
expectation that one's decisions and actions
can be consequential; the essence of lower
class position is the belief that one is at the mercy of forces and people beyond one's control, often, beyond one's understanding.
(Kohn, 1969:189).

The lower class person is basically pictured as conformist.

Conformity--following the dictates of authority focusing on external consequences to the exclu-




12



sion of internal consequences, being intolerant
of non conformity and dissent, being distrustful
.of others, having moral standards that strongly
em hasize obedience to the letter of the law. .
(Kohn, 1969:189).

One can suggest, from the value content of Kohn's findings, that a lower-class person, faced with a judicial hearing to determine his sanity, might have the burden of a conformist personality added to his low income, prestige, and power position. The subjective factor of conformity and low self confidence combined with the more objective factors of low income, status, and power indicate that socioeconomic status and judicial findings of sanity should be inversely related.

The present section has treated the individual position in the stratification system as an independent variable causally related to-aspects of one's biogrqhy. The following sections of this chapter will consider social control and mental illness as variables dependent on the stratification variables.





13



Social Control


As all societies are stratified and involve inequalities, so do all societies contain mechanisms of social control. It is an elementary principle of social science that because man's biological controls are minimal his social order must provide controls, which.,from a societal viewpoint make social life possible and from a phenomenological viewpoint make life meaningful.

Lemert (1972:53-54) has distinguished between passive social control and active social control. Passive social control was said to be the Sumnerian idea of automatic control by the folkways, mores and laws. (Sumner, 1907). Active social control, in contrast, is not automatic, but is a process which involves the implementation of goals and values.

. active social control is a continuous
process by which values are consciously
examined, decisions made as to those values
which should be dominant, and collective
action taken to that end.
(Lemert, 1972:54).

An example of passive social control would be an individual not accepting a friend's invitation to view pornographic materials because flit is not proper behavior.,' Active social control would be involved when the state's attorney in conjunction with other officials determines





14



and implements a policy for the control of pornography. The first example is individual and automatic, the second is collective, processual, and ultimately involves the differential power between the controllers and the controlled.

Lemert (1946) has placed legal commitment of the insane within the context of active social control. Lemert points out that only 50 per cent of the "mentally diseased" persons are institutionalized. Commitment must, therefore, involve a process of active social control. Lemert suggests that expectancies on age, sex, marital status, occupational, ethnic and locality affiliations, and their interaction with behavior symptoms are important for the understanding of the commitment process. According to Lemert, deviation from role expectations and the consequent social strain, leads to an individual's insanity hearing. Psychological pathology alone does not lead to involuntary commitment. There must be a reaction from some other person who initiates the proceedings. This reaction depends on role expectations. (Lemert, 1946:1).


Societal Reactions

Researchers interested in deviance and control have focused on many phenomena for the explanation of deviant behavior. Biological characteri stics of the individual




15



(Sheldon, 1949), the social structural gap between means and ends (Merton, 1957), the interactional milieu of the deviant (Sutherland, 1947) and a combination of social structure and milieu (Cohen, 1955), have all been used as explanations of deviant behavior. The purpose of this section is to present a relatively new perspective on deviance which suggests that an individual who seeks to understand deviance and control should focus not on the personal characteristics of the deviant or his social milieu, but on the definers of deviant behavior and the social reaction to deviant behavior.

In the Division of Labor in Society, Durkheim (1964:105) defined crime as an act "contrary to strong and defined states of the common conscience." Acts, according to Durkheim, are not inherently criminal but are so defined by society.

In other words, we must not say that an action
shocks the common conscience because it is
criminal, but rather that it is criminal because
it shocks the common conscience. We do not
reprove it because it is a crime, but it is a
crime because we reprove it.
(Durkheim, 1964:81).

In a later work, the Rules of Sociological Method, Durkheim continued to express similar ideas on the public construction of crime.




16



What confers this (criminal) character upon
.them (societal divergences) is not the
intrinsic quality of a given act but that
definition which the collective conscience
lends them. If the collective conscience
is stronger, if it has enough authority
practically to suppress these divergences,
it will also be more sensitive, more exacting; and reacting against the slightest deviations with the energy it otherwise displays only against more considerable
infractions, it will attribute to them-the
same gravity as formerly to crimes. In
other words, it will designate them as
criminal.
(Durkheim, 1938:202).

If one disregards Durkheim's insistence on a universal criminal definition by the collective conscience, one would see that in his statements lie the seeds of the deviance orientation which has come to be known as the social reactions approach, labeling theory, or the interactionist orientation. Contrary to other approaches to deviance, this orientation emphasizes the process by which acts and individuals become defined as deviant. In trying to understand this process, this perspective focuses more on the reaction of conforming society to deviance than on the social environment or the personality pathologies of individual deviants.

Though Durkheim's writings contained what could have

been the seeds of an early social reactions orientation, it was some decades before the deviance literature contained an




17



treatment of such an approach. After Frank Tannenbaum's (1938) early work, which did take into account the part of the deviant's audience in creating a deviant role, came five leaders in the reactions approach to deviance: Lemert (1951), Kituse (1962), Erickson (1962), Simmons (1965), and Becker (1963).

Lemert (1951) compiled one of the first systematic

treatments of the social reactions approach. Central to his theory were the concepts of social differentiation, deviation, and individuation. The deviant was defined as

*..one whose role, status, function and
self-definition are importantly shaped by
how much deviation he engages in, by the
degree of its social visibility, by the
particular exposure he has to the societal
reaction, and by the nature and strength
of the societal reaction.
(Lemert, 1951:23).

Kai T. Erickson presented a deviance position that falls within the labeling or interactionist perspective but remains unique. Drawing on Durkheim's writing on deviance, Erickson wrote that deviance is not pathological but functional for society. The deviant was seen as charting the boundary limits of the social system and providing a reference point for the typ e of behavior which belongs in the system. Erickson entered the fold of the labeling approach when he pursued




18




the question of how one becomes a deviant.

In the present case, how does a social structure
enlist actors to engage in deviant activity ...
sociologists should be interested in discovering
how a social unit manages to differentiate the
roles of its members and how certain persons are
chosen' to play the more deviant parts.
(Erickson, 1962:313).

Deviance was therefore seen as fulfilling a societal

need. One's behavior is not inherently pathological, for society chooses him to play the role of defining society's limits.

Kituse (1962) proposed that a central problem for

deviance theory is to determine which behavior is societally defined as deviant and how such definitions result in differentiating societal reactions. Kituse found that in defining individuals as sexually deviant, many different behaviors are interpreted as indications of the same deviation. The same behavior was found to be defined as normal or deviant by different individuals. Kituse concluded that the critical part of the process of defining deviants is the interpretations and re-interpretations others make of an individual's behavior rather than the individual's behavior alone (Kituse, 1962:255).

Simmons (1965) also found that deviance is not a consensually defined phenomenon but exists in the eyes of the beholder. His examination of the range of responses of 180 persons who had listed the things or type persons they




19



considered deviant led him to suggest that there may be

only one sense in which all deviants are alike; very simply, the fact that some social audience regards them and treats them as deviants (Simmons, 1965:225)."

Becker (1963) in his Outsiders, expounded what Schur (1969:311) calls "the central statement of the reactions

orientation.

social groups create deviance by making
rules whose infraction constitutes deviance, and by applying those rules to particular people and
labeling them outsiders. From this point of view,
deviance is not a quality of the act the person
commits, but rather a consequence of the application
by others of rules and sanctions to an offender.
The deviant is one to whom the label has successfully been applied; deviant behavior is behavior
that people so label. (Becker, 1963:9).

Schur (1969) critically examined the reactions orientation, and while concluding that even though the orientation might not meet the strict criteria for being a self-contained theory, he noted that it offers great promise for the integration of deviance theory due to its own diverse origins. The fact that the reaction's orientation, depending on the individual proponent, may contain elements of interactionism, functionalism, ethnomethodology, or conflict theory provides a basis for theory unification (Schur, 1969: 320).

Richard Quinney (1970) asserted that public reactions to

deviance and the social reality of deviance are in interaction,




20



each dependent on the other.

Without a social reality of crime, there would
be no reaction to crime. But on the other hand,
the reactions that are elicited in response to
crime are at the same time shaping the social reality of crime. As persons react to crime,
they develop patterns of responses of the
future. (Quinney, 1970:278).

If we are to ever understand deviance we must gain

knowledge of public reactions to deviant behavior. Quinney suggested that from the perspective of the individual, responses to crime are influenced by knowledge about deviance and how the individual perceives it (Quinney, 1970:279).




21



Stratification and Social Control

After the publication of Becker's Outsiders (1963.),,

researchers began to initiate studies of active social control and the process of labeling deviants. Among others, the works of Piliavin and Briar (1964), Black and Reiss (1970), Arnold (1971), and Cicourel (1-968) have considered the relationship between stratification variables and being defined as deviant.

Piliavin and Briar (1964) studied police discretion in

their encounters with juvenile offenders. Piliavin and Briar found that the officer often disposed of cases on the basis of the personal characteristics of offenders rather than their offenses. This resulted in differential treatment for some

classes of youths.

Compared to other youths, Negroes and boys whose
appearance matched the delinquent stereotype were
more frequently stopped and interrogated by
patrolmen--often even in the absence of evidence
that an offense had been committed and usually
were given more severe dispositions for the
same violations. (Piliavin and Briar, 1964:212).

Black and Reiss (1970) also found that Negroes fared worse than whites in police field dispositions. In all encounters with the police involving citizen complaints, 79 per cent of the Negroes were released in the field, while 92 per cent of the whites were released (Black and Reiss,




22



1970:71). Though much of this difference is explained by the complainant's preference for disposition, the fact remains that high caste offenders were released 21 per cent of the time more than low caste offenders.

Arnold (1971) studied judicial rather than police

dispositions of juveniles and found racial bias, and to a lesser extent, socioeconomic bias to be operative. Using controls for marital status of parents, seriousness of offense, prior record of offender, and delinquency rate of the offender's census tract, the percentage of offenders sent to the youth authority was significantly higher in almost all cases for Negroes and Latin Americans as opposed to Anglos (Arnold, 1971:223).

Cicourel (1968), though he did not make statistical

analysis of court dispositions and status characteristics, observed that middle income families were able to avoid the administrative labeling of their youth.

Middle-income families, because of their fear of
the stigma imputed to incarceration, mobilize
resources to avoid this problem. The familiar
ability to generate of command resources for
neutralization or changing probation and court
recommendations, as in adult cases, is a routine
feature of the social organization of juvenile
justice. (Cicourcel, 1968:331).




23



Mental Illness

In most fields of social scientific research there are competing paradigms (Kuhn, 1970) which define the units of analysis, the basic concepts, domain assumptions, and research techniques for the problem area. In mental illness theory and research, as previously noted in the areas of social deviance and social control, there are also competing frameworks. The purpose of this section is to introduce the basic conflict in perspectives on mental illness and consider some implications, for research in social stratification and mental illness.


Competing Models of Mental Illness

Angriest (1966) has specified four themes in the professional literature concerning the nature of mental illne-ss: mental illness as psychological disease or pathology, mental illness as deviant behavior, mental illness in some cases deviant behavior and in others pathology, and a fourth theme that specifies that mental illness involves social definitions that vary according to the status and training of the definers.

The mental illness as pathology or disease model focuses on the psychological structure of the individual. Certain behavior is symptomatic of underlying psychological pathology




24



or disease.

The abnormal person (i.e., one who had a mental
disorder) is so defined by reference to "universal
indicators" used in psychiatry. In this frame of
reference, certain behaviors are viewed as manifestation of anxiety, regression, senso-motor
dysfunction, reality distortion, depression,
excitement; these in turn are taken as evidence of personality abnormality. (Angrist, 1966:71).

This model is analytically closest to the disease model dominant in psychiatry for more than a century.

The deviant behavior approach conceives of mental illness as behavior that fails to fulfill the role expectations set for the individual. In this framework, the concern is most often with the deviant act. Parsons' (1951) work on the norms governing the sick role and Merton's (1957) anomie theory of deviance in which the mentally ill were classified as retreatists from both the culturally prescribed means and ends, are examples of the perspective.

The third perspective considered by Angrist classifies some mental disorder as deviant behavior but not all. An example of this approach would be Szasz's (1961) contention that only organic disorders can rightly be labeled mental illness. As in the deviance perspective, functional and neurotic disorders are seen as deviations from psychosocial, ethical, or legal norms.




25



The final viewpoint treated by Angrist is that which

sees mental illness labels as being dependent on the various definers. Illustrative of this viewpoint is Schwartz's (1957) consideration of the differing definitions of wives and psychiatrists regarding a husband's behavior. Mechanic's (1962) discussion of psychiatric definitions and the consequential internalization of the sick role also falls within this category. Erickson's (1957) conclusion that the mental patient faces role conflict from the divergent lay and professional expectations is clearly within this area of labeling. Not mentioned by Angrist, is Scheff's (1966) labeling and role analysis of the etiology of mental illness.

Angrist's analysis of the various perspectives is very useful in that it emphasizes the different ways that one phenomenon can be approached. With awareness of the different types of analysis available one is sensitized to the fallacy of claiming exclusive explanatory power for any single framework. Angrist points out that there is considerable overlap between the four perspectives but fails to mention that the history of mental illness conceptualizat ion and theory might be pictured as a series of various challenges to a dominant ideal--typical medical pathology model with each offering various amounts of sociocultural explanations and rejecting




26



certain aspects of the disease framework.

Taber et al. (1969) presented a picture of a dominant

"disease ideology" beset by several explanations alternative to the pathology model, each with the common theme that mental illness is behavior on which social judgment is passed. The disease model was said to consistof four propositions concerning nosology, pathology, etiology, and therapy. The practitioner or researcher who works under the disease model was said to implicitly or explicitly assume regarding mental illness: (1) that qualitatively different states of disorder exist and can be recognized; (2) that there is an illness process within the organism persisting over time;

(3) that there is a causal agent and causal sequence involved and; (4) that various therapeutic treatments can make a difference (Taber et al., 1969:350-352). Taber concludes that the disease model is largely unsubstantiated by evidence and partly controverted by research. t'Nevertheless, the disease ideology has shaped the social institutions of mental illness and is a pervasive influence on research (Taber et al., 1969:352)."


Societal Reactions and Mental Illness

Among the alternative formulations considered by Taber (1969) was the previously mentioned theory of Scheff (1966).




27



Scheff presents a synthesis of much of the sociological thought on role expectations and mental illness. Central to Scheff's theory are the concepts of residual deviance and labeling. Residual deviance is a category of acts for which the culture has failed to provide a clear label. Unlike acts of sin, criminality, and bad manners, these acts are placed in residual categories like witchcraft or mental illness (Scheff, 1966:32-34). Residual deviance on the part of an

individual may be stabilized if it is defined and labeled by others as being mental illness (Scheff, 1966:53-54). If instances of residual deviance are denied, that is accepted as being anything other than mental illness, the residual deviance will be transitory rather than a stabilized recurrent behavior (Scheff, 1966:51).

The labeling theories of mental illness, like similar theories of criminal deviance, have not gone uncriticized. Fletcher and Reynolds (1967) have stated that Scheff's concept of residual deviance has not been shown to have an empirical referent congruent with mental illness behavior and that it has not been causally linked with the labeling process (Fletcher and Reynolds, 1967:37). Scheff's theory remains a purely sociological alternative to the disease model but at

the present is not validated.




28



Lemert (1967), with his alternative explanation of

paranoia, negates a psychiatric conception of the disorder. Paranoia has been pictured as an individual response to unusual stress. The paranoid, in the traditional model, symbolically constructs a threatening pseudo-community without existential reality (Lemert, 1967:197). Lemert argued that the community is at least initially real and that the pseudo-community is a sequel to the initial isolation by the real community. The paranoid's construct is not entirely fiction.

To the contrary, many paranoid persons properly
realize that they are being isolated and excluded
by concerted interaction, or that they are being
manipulated. However, they are at a loss to
estimate accurately or realistically the dimensions
and form of the coalition arrayed against them.
(Lemert, 1967:207).

Gove (1970) analyzed the labeling perspective on mental illness and concluded that the evidence does not support the theory. The major objection with the perspective, according to Gove, is that there is no explanation for the occurrence of primary deviance (the deviant act before being labeled) and that it overstates the importance of the forces leading to secondary deviance (deviance due to labeling and the acceptance of the deviant role) (Gove, 1970:882-883). In a later article Gove (1970a) critically evaluated three




29



studies concerning hospital c commitment by Wilde (1968), Wenger and Fletcher (1968), and Scheff (1966). Gove suggested that if the labeling perspective on mental illness is correct there would

be only a slight relationship between degree
of Psychiatric disturbance and commitment to a
mental hospital, and 2) the more powerful a person
is, the more likely he is to be able to avoid
attempts to commit him to a mental hospital.
(Gove, 1970a;295).

Gove's hypothesis would seem to reasonably follow from the labeling perspective on mental illness. Gove and those he criticizes are considered for relevance to this study's hypotheses in a later chapter.

We might characterize the current theoretical situation in the field of mental illness as being a contest between two competing ideal-typical paradigms, the psychiatric pathology model, and the labeling or social reactions approach. Some empirical evidence could be interpreted to suggest one, both, or neither-of the models. No one has yet suggested the crucial test to disprove either model, if in fact such a test could be specified. The models are closely tied to particular professions and possibly world views, consequently they will not crumble from one or several critical articles. It is probably the fact that some validity is in each of the views and that a synthesis is in order. It has not been logically demonstrated that evidence for one perspective necessarily negates the other.




30



Mental Illness and Social Stratification

Studies of socioeconomic status and mental illness have often found an inverse association between serious mental illness and socioeconomic status.

This has been the finding from ecological correlations (Faris and Dunham, 1939), -admission studies (Clark, 1948) (Odegaard.,1956), examination of rates under treatment (Hollingshead and Redlich, 1958) and probability sample impairment studies of a population (Srole, et al., 1962). These studies see mental illness as a condition which can be either a cause or a result of low socioeconomic status. The studies of the prevalence of mental illness have not been particularly concerned with the defining or labeling process. It should be noted that in all but the probability sample studies, formal labeling of the sample has occurred prior to investigation. If social status is important for the defining process, it has operated prior to investigation so as to bias the sample towards the lower class. In the probability sample studies we must ask if possibly the rater or the rating instrument might be clas-s-biased.

Berger (1966) has stressed the importance of considering

the different reality frameworks from which one judges insanity.

Mental illness, according to Berger, is relative to a




31



socially-constructed reality.

questions of psychological status cannot
be decided without recognizing the realitydefinitions that are taken for granted in the social situation of the individual. To put it more sharply, psychological status is relative
to the social definitions of reality in general
and-is itself socially defined.
(Berger, 1966:176).

Therapy according to Berger, awaits those who slip from

the dominant reality.

Therapy entails the application of conceptual
machinery to ensure that actual or potential
deviants stay within the institutionalized
definitions of reality, or in other words, to prevent the "inhabitants" of a given universe from "emigrating" . Its specific institutional arrangements, from exorcism to psychoanalysis, from pastoral care to personnel
counseling programs, belong, of course, under
the category of social control.
(Berger, 1966:113).

Kingsley Davis (1938) recognized early. that the ideology of

the mental health hygiene movement was tied to the middle-class

Protestant ethic. Davis was also aware that class-linked

ideologies might have implications for social control.

In case of such divergence (fr om ultimate norms)
other classes will focus attention upon the errant
ones and will seek to control its thinking and
behavior through methods conforming to the sanctions of society. (Davis, 1938:63).

Gurslin- et al. (1960) went beyond Davis' work with a content

analysis of mental health movement literature. They found a





32



heavy bias in the publications for middle-class values at the expense of lower-class values. They concluded that the mental health message was functional for the middle-class sociocultural structure but contained dysfunctional potential for the lower-class structure.

To the extent, however, that more subtle and effective methods of social control are built
around the mental health movement in the
future, we may expect some pronounced dysfunctional consequences for the lower-class
social structure.
(Gurslinn, et al., 1960:216).

Hollingshead and Redlich (1958) have described what

might be the results of a class-linked ideology on the actual practice of psychiatry. They found that patients from the higher social cl-asses when seeking treatment for psychiatric disorder will more likely receive long-term intensive psychotherapy while lower-class patients more often receive shortterm psychotherapy, drug therapy, or other somatherapy rather than the more costly intensive psychotherapy. Schafer and Myers (1954) found the same relationship even when the cost of care was controlled by studying an indigents' clinic in a major teaching hospital. Hollingshead and Redlich also found that lower-class candidates for psychotherapy were not liked or understood by the therapists and quit treatment much more often than those from higher classes (Hollingshead and




33



Redlich, 1958,335-355).

A study which asks whether the clinician is class-biased

in terms of diagnosis was done by Haase (1964). Seventy-five

psychologists were asked to evaluate a series of Rorschach

protocols and to give impressions prior to diagnosis, a

diagnosis and a prognosis for each one. The diagnosticians

were.presented eight protocols consisting of four matched

pairs which differed only in terms of subtle clues to the

socioeconomic status of the client. The results showed a

strong class bias.

In every case except one, they were biased in
favor of the middle-class with a probability
beyond the .01 level. Whether we examine the clinicians impressions prior to diagnosis, the diagnosis itself, or the prognosis, the direction of the bias is always the same--it favors
the middle class. (Haase, 1964:244).

Haase concludes as follows:

The immediate interpretation is the one that
emphasized the formal academic preparation and the correlative social processes that inculcate
the class identification upon the noviate
professional. We would agree with Kingsley Davis that the content of mental hygiene is
predominantly middle-class and that there is
unverbalized agreement among the practitioners
of psychology that the lower class cannot
totally assimilate the ways of thinking and
behaving that alone can insure prevention and
cure of maladjustment (Haase, 1964:244).











CHAPTER II


STUDIES OF CIVIL COMMITMENT


Empirical research on the commitment of the insane is relatively scarce considering the thousands of people committed yearly and the implications of commitment for the societal reactions model of mental illness. This chapter will consider work in this area which focuses on two questions: (1) What is the nature of the commitment process and its effect on whether those committed in fact meet the requirements of commitment? (2) What are the status characteristics which differentiate those who are committed

from those who are not?


Process and Pathology

Luis Kutner (1962), a legal scholar, asked the question of whether the commitment process in action satisfied the requirements of legal due process. His examination of an Illinois commitment facility convinced him that it did not. Eventhough the statutory wording provided the framework for due process such as notice, physician's examination, and a hearing, the implementation of the statute reduced procedural safeguards. Kutner found that physicians' certificates to



34




35



start the commitment process were signed as a matter of course after the alleged incompetent was already confined, that the examinations by state physicians for evidence at the hearing were on an assembly-line basis never taking more than ten minutes, and that in 77 per cent of the cases there was a recommendation for confinement. The court hearing was no different. The patients were heavily sedated and incapable of defending themselves. Persons were not notified of their right to counsel or to a jury trial. In regard to the State physician's examination, Kutner (1962:385) concluded, "It appears that in practice, the alleged mentally ill is presumed to be insane and bears the burden of proving his sanity in the. few minutes allotted him."

In a general paper concerning social factors in identifying and defining mental illness, based on observations of two California hospitals, Mechanic (1962) mentioned how the situation of the examining physician could result in the practices observed by Kutner.

Both the abstract nature of the physician's
theories and the time limitations imposed upon him by the institutional structure of which he
is a part, make it impossible for him to make
a rapid study of the patient's illness or even
to ascertain if illness, in fact, exists.
(Mechanic, 1962:69).

Mechanic went on to say that in a period of three months'




36



observation at the two hospitals, he never saw an instance of a patient being advised by a psychiatrist that he did not need treatment (Mechanic, 1962:70).

Miller and Schwartz (1966) have reported their observations of 58 hearings of a county lunacy commission. Though-mainly concerned with the relationship between the pre-patients demeanor and the case outcomes, they did provide data which supports Kutner's and Mechanic's observations. Miller and Schwartz found that the physicians who had examined the prepatients prior to the hearing recommended commitment in almost all cases. Those few individuals not recommended for hospitalization were said to be emotionally disturbed and in need of out-patient psychiatric care. The length of time for the hearings was very short: 4.1 minutes mean, 3 minutes median. Forty-five cases or 78 per cent of the total were committed to the State hospital. The researchers made no attempt to judge the "illness" of the pre-patient and relate that to the case outcomes, but conclusions were reached on the effect of certain types of pre-patient behavior on case outcomes.

. those who were able to present themselves
in a controlled and effective manner were likely to be released. Those who either did not openly
object, or objected in violent or abusive ways, were committed to the state hospital . This
observational study found that those persons who were able to approach the judge in a controlled
manner., use proper eye contact, sentence structure,





37



posture, etc., and who presented their stories without excessive emotional response or blandness and with proper demeanor, were able to
obtain the decision they wanted--whether it was release or commitment--despite any "psychiatric
symptomatology.1" (Miller and Schwartz, 1966:34).

Scheff (1966) has gathered data on both the nature of

the commitment process and the degree of impairment of those committed. From observations of 116 judicial hearings Scheff reports that 86 of the hearings failed to establish the judge's criteria of mental illness. Forty-eight of the patients were said to exhibit behavior and responses which were "completely unexceptional." In none of the 116 cases did the psychiatric examiners recommend release of the patient.

An observation of 26 psychiatric examinations, given

prior to the judicial hearing, produced the following data. Of the 26 cases, the examiners recommended hospitalization in 24 cases. The non-psychiatrist observer rated the cases as to whether the statutory criteria for commitment were met. The observer rated 8 cases as meeting the criteria, 7 cases as not meeting the criteria, and 11 cases as inconclusive or potentially meeting the criteria with a more extensive investigation. The mean length of the examinations was 10.2 minutes.




38



The examinations were described as follows:

Most of the interviews were hurried, with
the questions of the examiner coming so
rapidly that the examiner often interrupted
the patient, or one examiner interrupted
the other. All of the examiners seemed
quite hurried. (Scheff, 1966:146).

As an additional measure of the degree to which admitted patients met legal criteria for admission, Scheff had 25 admission psychiatrists for the three largest public mental hospitals in a midwestern state fill out questionnaires for

-the first 10 patients they examined in one month in 1962. The questionnaire contained the psychiatrist's ratings of the patient's probability of harming himself or others and of the patient's present degree of mental illness. Scheff felt that to be clearly qualified for involuntary commitment, a patient

should be rated as "likely to harm himself or others" and/or as "severely mentally impaired." Scheff found that 63 per cent of the patients, as rated by the admitting psychiatrists, did not meet these criteria. Gove (1970a) has criticized the validity of Scheff's conclusion onthe grounds that Scheff's cutting points for meeting the criteria are not necessarily the "correct" ones. Gove suggests that the cutting point for dangerousness should be lowered two categories to #'somewhat unlikely to harm himself or others" and that for mental impair-




39



ment stiould be lowered to "moderate impairment." It is not possible, from Scheff's presentation, to ascertain the effect of changing the dangerousness cutting point, but changing the impairment cutting point as suggested by Gove would still result in about 40 per cent not meeting the legal criteria for involuntary confinement.

To test the social reactions position on mental illness, Wilde (1968), used available data in the form of official court commitment records and receiving hospital records.from a southern county. Wilde was interested in whether three variables were associated with approval of a petition for commitment. These variables were identity of the particular interviewer at the receiving center (indicating idiosyncratic criteria) the fact of the petitioners getting an appointment prior to the interview (a measure of petitioner's diligence), and the existence of committable mental illness (measured by an index derived from interviewer protocols). Wilde found a significant association between the identity of the interviewer and the approval of a petition, but this can probably be discounted as meaningless due to Gove's valid criticism that certain cases of higher pathology might have been assigned to a particular group of interviewers (Gove, 1970a:297). Wilde found a slight negative association between committable mental




40



illness and approval of a petition and a positive association between the petitioner's diligence and approval of the petition. Controlling for committable mental illness, the association between having an appointment and petition approval remained positive. The results were interpreted to be consistent with the societal reactions perspective. Gove (1970a:297-298) has challenged Wilde's conclusions on the grounds that the sample was not representative, that the low approval rate for petitions from the general public (33 per cent) was indicative of careful screening, and that the interview protocols offered a tenuous index of mental illness.


Status Characteristics and Commitment

The societal reactions perspective on deviance places considerable emphasis on the aspect of differential power between the deviant and the agencies and agents of social control. The effect of power on the outcome of commitment hearings has been incidentally studied by Wenger and Fletcher (1969). Though.not desigiied as a test of the social reactions perspective, their study examined the effect of legal counsel .on commitment. Retention of counsel is an index of power and, therefore, relevant to that perspective.

.The researchers in their study observed 81 commitment





41



hearings, noted the presence or absence of counsel for the patients and the length of the hearing, and classified the patients as to whether their condition met the criteria for commitment. The average length of the hearings was 8.13 minutes with a median of 5.03 minutes. The hearings with legal counsel were over twice as long as those without. Eighty per cent of the cases observed involved a commitment to the hospital. Having legal counsel was highly associated with not being committed, ninety-one per cent of those without legal counsel were committed while only 26 per cent of those with legal counsel were committed. Controlling for whether the patients' conditions met the legal criteria for commitment or not, the association still existed, though having counsel was associated with.the criteria not being met. The authors conclude that having counsel definitely affects the decision of whether one is admitted to a state mental hospital. The conclusions of Wenger and Fletcher's study, like those of Wilder and Scheff's, previously considered, were scrutinized by Gove (1970a). Govets major criticisms were that the psychiatric evaluations followed by the court were more sound than that of the lay observers since they were based on professional competence and private examination, and that court hearing was so brief as to preclude the lawyers




42



influencing the psychiatrists. Had Wenger and Fletcher been working from a social reactions perspective they might answer Govel s criticism by saying that psychiatric evaluation is influenced by a disease ideology with a presumption of illness, andthereforesuspect from the labeling perspective.

Past studies have shown that psychiatric commitment

evaluations are perfunctory at best, usually lasting a shorter time than the court hearing observed by the researchers. When Gove questions whether the lawyers could be so effective in such a short hearing, he ignores two points. The psychiatrists could very well have known of the fact of legal counsel well before the hearing, possibly prior to their own examination. Since the psychiatrists in such hearings are court-appointed and the court is generally aware of lawyer participation in advance of a hearing, it would be unlikely that the psychiatrists were not apprised of the existence of counsel before the hearing. Because of the possibility of.civil liability for an unwarranted commitment and the much higher probability of such a suit when the patient is already represented by counsel, it seems that the psychiatrists could easily be influenced in a short hearing, particularly if they were aware of counsel prior to the hearing.

One of the most extensive studies of the variables related to being committed to a mental hospital was carried out by




43



Haney and Michellute (1968). Their study considered two questions: (1).What demographic indices of a particular jurisdiction best predict the percentage of adjudged incompetents within a jurisdiction? (2) What individual characteristics best predict an individual's being judged incompetent rather than competent? Because of the limited relevance of the first question to this research, only the data for the second question will be considered here.

For the individual research, Haney and Michellute gathered data on every case of a judicial examination of incompetency in 'five representative Florida counties, in a three-month period. There were complete data on 571 cases. The independent variables were age, race and sex of the.individuals, the number of psychiatrists 6n the examining committee, and whether the petition for commitment was by the family of the alleged incompetent or not.

The dependent variable was whether the individual was adjudged incompetent, temporarily incompetent (six months commitment and no loss of civil rights), or competent.

The overall percentage of those found incompetent or temporarily incompetent was 75 per cent. Sex demonstrated very little effect on adjudged incompetency. There was a slightly higher percentage of non-whites adjudged incompetent




44



as opposed to whites, but the difference was not significant. The best predictors of adjudged incompetency were age, examining committee composition, and whether the petition for a hearing was from family or non-family persons. Those age 24 or under were adjudged competent 43 per cent of the time, while those over age 65 years of age were adjudged competent in only 8.5 per cent of the cases. Examining committees with no psychiatrists found incompetency in 59.7 per cent of the cases. Committees with psychiatrist members adjudged incompetency or temporary incompetency in 80.9 per cent of the cases. In cases where the petition for a

hearing was signed by other than a family member, 83.2 per cent of the individuals were adjudged incompetent or temporarily incompetent, while 68 per cent were so adjudged when a family member instituted the proceedings. Each of the associations remained when the other two independent

variables were used as controls.

The results of this study could be interpreted as supportive of the social reactions perspective on mental illness. The fact that who institutes the proceedings affects the judgment of incompetency is in agreement with the labeling perspective. The differential between psychiatric and non-psychiatrist committees could be explained by the proposition that one





45



trained to use certain labels will use them, what he sees being influenced by his conceptual categories. For instance, the general physician sees as a temporary marital problem what the psychiatrist might view as psychotic depression. The results could be compatible with a pathological perspective if serious "mental pathology" could be shown to be related to the predictive variables. Otherwise, the social reaction explanation fits quite well.

An early study by Friedsan et al. (1954) also demonstrated that status characteristics make a difference in which type of procedure a person is committed under. Friedsan compared the characteristics of individuals committed by jury trial, which involves indefinite hospitalization, with those committed for only ninety days by a purely administrative procedure. In every category, the temporary 90-day commitments had a higher percentage of individuals with high status characteristics. The percentage of males, youths, whites, and married was higher in the temporary commitments than in the indefinite commitments. The authors observed that the temporary commitment process seemed to be used by persons of higher economic status than the indefinite jury trial process (Friedsan et al", 1954:28).

Rushing (1971) has studied commitments to mental hospitals to specifically determine the applicability of the societal





46



reactions model. Rushing, though, does not feel that only one model of mental illness can have validity.

Probably both perspectives are valid. Behavior
pathology and societal reactions are probably
involved to some degree in most cases of mental
hospitalization, though their relative importance
may vary from case to case.(Rushing, 1971:511)

Rushing said that it is probably impossible to determine precisely the proportions of commitments due to behavior pathology versus societal reactions. Rushing suggested that studying the contingencies of the societal reaction might be a more fruitful approach (Rushing, 1971:512). Rushing was concerned with how individual resources, as indicators of power might affect the societal reaction. Individual resources were measured by the occupation of the patient and whether the patient was married, estranged or single. Occupation and marital status were examined as individual resource variables determining whether a patient was hospitalized voluntarily or as an involuntary commitment.

Rushing analyzed over 3,000 first admissions which covered a period of 10 years. As expected, the ratio of involuntary to voluntary admissions varied inversely with the socioeconomic status of the individual. The married were found to have the lowest ratio of involuntary to voluntary admissions followed by the estranged and the single who had a




47



rate almost twice that of the married. Rushing concludes,

A person's social and economic resources and degree of community integration appears to be significant contingencies in the tendency to
hospitalize. The results provide rather
consistent support for the societal reaction
perspective on deviance. (Rushing, 1971:524).

The present study is intended to complement Rushing's findings by examining similar contingencies of a person's either being released or found incompetent by a judicial commitment proceeding. Rushing's study did not examine the characteristics of those who avoided hospitalization, but only compared.the characteristics of those under voluntary and involuntary hospitalization. This study compares those who avoid involuntary commitment with those who do not. Rushing notes that since he had no measure of behavior pathology in his study, he could not determine the interaction, if any, between social reactions and pathology. This study will consider the effects of diagnosed pathology and psychiatric history along with other social contingencies on the final decision of a judicial competency hearing.










CHAPTER III


THE COMMUNITY AND ORGANIZATIONAL SETTING OF THE STUDY


The purpose of this chapter is to describe briefly the setting for the present research so that the data produced can be analyzed in a more meaningful context. The community will be described in general terms and by census statistics. The geographic area studied may then be compared on various measures to the res t of the state and the particular collection of alleged incompetents studied can be compared to the area population as a whole.

The mental health facilities in the area will be

separately considered because of their great importance to the subject matter of the study. Local facilities can provide therapeutic alternatives to commitment in a state hospital or might also serve as agencies for defining individual cases of mental illness therefore increasing the number of commitments.

The legal structure for commitment of the insane will be outlined both from the perspective of the state statutes and the local implementation of the state law.


48




49



The Community

The location for the present research is Southern County, a county geographically in the southeastern United States but not part of the "deep south." Southern County, a standard metropolitan statistical area 900 miles in area, has a total population of about 105,000; of which about 70,000 live in the urbanized area of Southern City.

Southern City is the location of a state land grant

--university with a student population of about 24,000 and a faculty of about 2,500. The county contains six small towns almost equidistant from the centrally located Southern City and ranging in size from 500 to 2,500 population. Several small rural settlements and rural farm residences account for the remainder of Southern County's population. The outlying towns have in the past been predominantly agricultural but now also serve as bedroom communities for Southern City's fast developing educational, medical, and technological economy. Twenty-eight per cent of Southern County's population are

classified as rural.





Sociodemographic figures for this section are from the U.S.
Bureau of the Census, 1970 Census of Population and Housing
for the Southern County standard metropolitan statistical area.





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As an illustration of the changing function of the small towns, only 3.5 per cent of the population are classified as rural-farm. Indicative of the changing characteristics of the population, 45 per cent of the county residents were born outside the county. Twenty-one per cent of the county and 17 per cent of the major city are black. The mean educational attainment for the county is 12.6 years. The city's mean educational level is 13.4 years. Further illustrative of the education of the area is the fact*that 30 per cent of the city and 23-.l per cent of the county as a whole have four years or more of college.

Some of the best descriptive characteristics of a

community are the indicators of the economic and occupational structure. The median family income for the county is $8,329 close to the corresponding state figure of $8,267. The percentage of county families with an income above $15,000 is 17.6, while the state has 16.8 per cent above $15,000.

The occupational structure of Southern County is heavily weighted towards professional and white-collar occupations. Thirty-five per cent of the county's employed people above the age of 16 are in professional-technical or managerial positions, according to census classification. Fifty-four per cent of those employed above the age of 16 are classified as white





51



collar and 42.9 per cent are Federal, State, or local government employees. Only 7.5 per cent of the county's employed work in manufacturing.

The income, educational and occupational characteristics of Southern County are heavily influenced by the fact that it is the location of a large state university which employs highly educated and well paid individuals while attracting other governmental and industrial employers who do the same. One would expect that the level of mental health care facilities for Southern County would also be influenced by the existence of a large state university.


Mental Health Care Resources

The mentAl health care resources for Southern County are quite extensive. Except possibly for the number of private practitioners, the alternatives for care in Southern County are more extensive than in other comparable size counties. This section briefly describes the different facilities for mental health care in the county.

The number of counselors in private practice in Southern County is not large but probably adequate to serve those who can afford the high cost of their service. In 1969, the last year covered by this study, there were three psychiatrists in




52



private practice in Southern County, all located in Southern City. The same year the number of practicing psychologists was seven. Two marriage co unselors were practicing in 1969 for a total of 12 private professionals engaged in counseling or approximately one for each 6,200 residents of Southern County who are above age 14.

The County Mental Health Service is the major supplier

of mental health care in Southern County. Funded by the state and county government, this facility is under the direction of the county health department. The major functions of the clinic are: (1) Providing professional counseling and drugs for patients on trial visit from the state mental hospitals,

(2) Consultation services for teachers and parents about emotional problems of children, (3) Diagnostic testing in consultation with school psychologists, (4) Individual and group short term therapyand.(5) Providing prescribed drugs for indigent patients.

The Mental Health Services Clinic is staffed by a

psychiatrist-director, one full-time psychologist, one halftime psychologist, two psychiatric nurses, two social workers, and two secretaries. Residents in psychiatry from the university medical school and interns in clinical psychology from the university are active in working at the clinic as part of




53



their training. The clinic sees patients who are referred from other agencies or practitioners and who appear without referral or appointment.

That the clinic might be an important factor in commitment proceeding is evident from its 1968 statistics. In 1968 the clinic had 4,001 individual visits for individual therapy and 2,365 for group therapy. There were 294 new patients seen in 1968 over the age of 18 and 154 under the age of 18. Most of the 44 persons on trial visit from state mental hospitals in 1968 were seen for after-care counseling and medication. There were 3,776 prescriptions filled at the clinic in 1968 of which 2,336 were for previous patients of state mental hospitals and 1,440 for indigent patients.

Southern City contains a division office of Southern

States division of vocational rehabilitation, which serves. 14 counties. One third of the cases of this local division come from Southern County. Vocational rehabilitation is funded by federal and state money, its services being available to individuals who are having employment problems due to a physical or mental impairment. The services provided include: (1) medical and nonmedical diagnosis to determine what should be done in order for the client to be employable,

(2) vocational counseling for the selection of suitable





54



employment, (3) medical, surgical, hospital and prosthetic services necessary for the client's being employed, (4) job training, (5) living expenses assistance while preparing for employment, and (6) assistance'in finding employment and adjusting to the work situation. The staff of Southern County's vocational rehabilitation program consists of the director, 26 counselors, and 24 clerical workers.

Most of the psychiatric work in the vocational rehabilitation office centers around two counselors, under the guidance of a consulting psychiatrist, who carry'a strictly psychiatric case load, of about 140; and a half-way house for individuals with psychiatric problems who need an unstructured buzt supervised residence. Southe rn County's vocational rehabilitation psychiatric services maintain a close relationship with the county's mental health services clinic. A client may be obtaining counseling from both agencies while living at the

half-way house.

The state university located in Southern City provides

two sources of mental health care in addition to its teaching hospital. The student mental health clinic provide s individual and group therapy for students with emotional difficulties. The permanent staff consists of four psychiatrists, five psychologists, and two psychiatric nurses. During a 12 month period in 1968 and 1969, 752 cases of emotional





55



disturbance were treated by the clinic. The clinic is

open 24 hours a day.

The state university counseling center is staffed by

six psychologists and several interns providing, in addition, vocational counseling for less severe emotional problems. Approximately one-half of the 24,000 annual case load consists of personal-emotional rather than vocational counseling.

Southern County has three hospitals providing psyQhiatric services, all located in Southern County: a countyowned general hospital, a university-run teaching hospital, and a federally-operated veterans hospital.

The county-owned hospital provides inpatient psychiatric care only in a 22-bed psychiatric unit. The unit is staffed by private psychiatrists with 7 registered nurses, 6 practical nurses, and 4 attendant s. In the 1968-1969 fiscal year a total of 363 patients were in the psychiatric unit. The rate for care in the psychiatric unit is $54.00 per day plus psychiatrist fees and drugs. This unit, besides being open for private patients, is used for holding some patients awaiting a commitment hearing or admittance to a state mental hospital.

The university teaching hospital offers outpatient





56



psychiatric care in addition to its 32 bed inpatient psychiatric unit. In 1965, 447 patients were admitted io the inpatient unit of which 57 per cent or 263 were Southern County residents.

The veteransthospital located in Southern City provides both inpatient and outpatient psychiatric care for qualified veterans. The 60 bed inpatient unit has on its staff five psychiatrists and five psychologists. In the 1968-1969 fiscal year 366 psychiatric patients were admitted.


The Legal Structure of Commitment

In colonial America there were no statutes providing for commitment of the mentally ill and until very late in the colonial period there were no hospitals for the care of the mentally ill. Until state statutes provided for commitment of the insane such cases were handled under English common law which permitted citizen's or police arrest of the "furiously insanely and confinement for the duration of their .dangerous condition. In 1752 the first colonial general hospital was funded and in 1772 the first asylum exclusively for the insane was opened in Williamsburg, Virginia (Deutsch, 1948). The first hospital admission of a mentally ill person in America was recorded in 1756 at the Pennsylvania Hospital in Philadelphia (Rock et al., 1968:1).





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An example of an early state commitment law would be

New York's statute of 1788, which reads much like the

English law of 1744.

Whereas, There are sometimes persons who
by lunacy or otherwise are furiously mad, or
are so far disordered in their senses that
they may be dangerous to be permitted to go
abroad: therefore,
Be it enacted, That it shall and may be
lawful for any two or more justices of the
peace to cause such a person to be apprehended and kept safely locked up in some secure place and, if such justices shall find it necessary,,
to be there chained.
(Deutsch, 1949:420).

Involuntary commitment to the early mental hospitals

was easily and informally accomplished.

The request of a friend or relative--or
perhaps even an enemy- -to a member of the hospital staff for an order of admission
would often suffice. The staff member
might then hastily scribble a few words on
a scrap of paper, sign his name, and the
procedure would be completed.
(Brakel and Rock, 1971:34).

Att'this time, thousands of persons--are involuntarily

hospitalized annually and every state has much more detailed

laws regulating such commitments. The provisions of the

formal state statute of Southern State covering involuntary

hospitalization will be briefly outlined and the implementation of the statute in Southern County will be described.

In ad dition to the provisions for judicial involuntary




58



commitment, Southern State's law provides for voluntary admission to state mental hospitals by direct application to the state hospital and for short term (15 days maximum) involuntary hospitalization based on medical certification alone. For a patient to be hospitalized involuntarily beyond the short term period he must be judicially declared incompetent or temporarily incompetent.

The major sections of the statute providing for adjudication of incompetency specify what types of incompetency are covered by the statute, who may petition to have incompetency determined, the hearing procedure, a particular medical examining committee and procedure, the effect of judgmentand the commitment procedure after judgment.

The state statute provides that petition for examination of incompetency may be made wher e one is believed to be incompetent because of mental illness, sickness, drunkenness, excessive use of drugs, insanity, or other mental or physical condition, or if one is believed to be incapable of caring for himself or managing his property, or likely to dissipate or to lose his property or to become the victim of designing persons, or inflict harm on himself or others. The petition is fiaed under oath in the county judge's court in the





59



alleged incompetent's county of residence or location.

The persons allowed to file such a petition are: the mother, father, brother, sister, husband, wife, child, or next of kin of the alleged incompetent; any three citizens of the state; the sheriff of the alleged incompetent's county of residence. A person may request self-examination if he presents a physician's certificate certifying he is incompetent under the statute. The petition--besides naming the alleged incompetent, his family members, and their addresses--states the nature of the disability and asks that the alleged incompetent be adjudged incompetent. The judge may, in the best interest of the alleged incompetent, before the hearing and after a petition is filed, order that the alleged incompetent be placed in protective custody of his family or other responsible citizen. If the judge feels that the public safety or the alleged incompetent's safety requires it, he may order the sheriff to confine the alleged in some specified place.

After the petition is filed, the statute prescribes, that the judge shall appoint an examining committee of a responsible citizen and two practicing physicians who are not associated with each other in practice. A petitioner cannot serve on the committee. The examining committee is to examine the alleged incompetent so as to thoroughly




60



ascertain his mental and physical condition and report to the court: whether the person is incompetent, temporarily incompetent (capable of speedy recovery with specialized care and treatment), or competent; if incompetent, whether the condition is acute or chronic; the apparent cause of the condition; and the age, propensities, and the hallucinations if any of the alleged incompetent. If the examining committee finds.the alleged incompetent is not mentally ill, the judge may terminate the proceedings.

When the petition is filed the judge is to set a date for an early hearing and give reasonable notice of such to the alleged incompetent and one or more members of his family. The hearing is to be as informal as orderly procedure will allow and in a physical setting not likely to have a harmful effect on the mental health of the proposed patient. An opportunity to be represented by counsel is to be afforded every alleged incompetent. The court may appoint counsel for the alleged incompetent if he or others do not. On request of an indigent person the judge shall appoint an attorney to represent such person at no cost to the indigent.

The judge, from the report of the examining committee and the hearing, may find and adjudge the person competent, incompetent, or if so.recommended by the examining committee,





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temporarily incompetent.

A person adjudged mentally incompetent is presumed

during his incompetency of being incapable of managing his own affairs, making a contract, gift or any binding instrument in writing. He cannot hold a driver's license or vote.

A person discharged from temporary incompetency is automatically restored to his civil rights. For one who is discharged from a regular incompetency judgment, certain formal procedures are necessary to regain his civil rights.

After a person is adjudged incompetent or temporarily incompetent, the judge may commit him to a state hospital, decree that he is harmless and release him, or deliver him to the custody of a guardian or any responsible person. Before any person bbove the age of 21 can have a legal guardian appointed for management of his affairs he must first be adjudged incompetent.

To understand the local implementation of the state incompetency statute in Southern County, one must first realize that incompetency proceedings are only a part of the court's duties. In addition to incompetency hearings, the county judge's court handles all of the county's probate of wills and estates, serves as the committing court for all criminal felonies, issues all arrest warrants for felonies




62



and misdemeanors, and serves as the juveni le court for the whole county. The court has only one judge, so much of the duties of the court except for hearings are handled by clerks.

The incompetency functions of the court are handled

almost exclusively by one clerk. If someone inquires at the court about instituting an incompetency proceeding, that clerk meets with them, explains the procedures and prepares the petition on a standard form which they sign. If it appears from talking to the petitioners that the alleged incompetent is dangerous to himself or others, a confinement order is prepared which authorizes the sheriff to confine the person at either the county jail or the county hospital psychiatric unit. In.almost every case where a confinement order is issued, the clerk obtains a one-sentence affidavit from the petitioners to the effect that they believe him dangerous to himself or others.

After the petition is prepared and signed a committee is appointed and notices of a hearing are served on the alleged incompetent and some member of his family. The examining committee almost always includes one psychiatrist and usually has two psychiatrists. The non-physician member of the committee is almost always the law officer who serves the





63



notice of an incompetency hearing on the alleged incompetent.

This is a matter of convenience for the court. The lay

committee member merely signs the committee report as prepared by one 'of the examining physicians. This practice would appear

contrary to the intent of the statute, for the lay member is

the same law officer in almost every instance and merely

rubber stamps the report. The examining committee report is

prepared on a standard printed one-page form which all the

---members sign. The cause of the alleged incompetent's

condition is usually given in standard psychiatric diagnostic

terms like paranoid schizophrenic. The committee reports always

either finds the person competent or incompetent. No temporary

incompetent forms are provided and neither does the committee

ever change the form to read temporarily incompetent. In

almost every case studied where the judge found the alleged incompetent temporarily incompetent, the person had signed a

petition for self-examination. But we cannot accept the

self-petitions as voluntary for in the 61 cases of self-petitions

studied there is evidence in 22 cases (over one-third) that

someone other than the self-petitioner initiated the proceeding.

In most of these cases the alleged incompetent signed a selfpetition after the committee had already found him to be incompetent. After signing the self-petition, the judge




64



signed a judgment of temporary incompetency. This practice seems to limit temporary incompetency to those who formally admit a need for care. There was not a physician's certificate, as required by statute, in any of the selfpetition cases studied. As previously noted, the statute provides that temporary commitments are to be made only on the basis of the committee recommendations.

The committee examinations are usually made at the

physician's office if the alleged incompetent can go there or, in case of confinement, at the hospital or jail. If the committee finds the person competent the judge immediately enters an order of competency.

The hearing usually occurs within 15 days of the initial petition and after the committee examination. Although the statute implies that the alleged incompetent should be present, in cases where the person is hospitalized or jailed, this is not always the case. The judge never finds anyone incompetent or temporarily incompetent who has not been found incompetent by the examining committee. There are cases where the committee finds the person incompetent and the judge either rules the person competent or never enters judgment in the case, which has the same legal effect as a ruling of competency. Notes in these case files generally indicate





65



that this-is in accord with the examining psychiatrists, wishes. In many of these cases there are indications that the psychiatrist feels that the patient can benefit from care outside the state hospital and that outpatient care will suffice. The hearings are private, being held in the judge's chambers. The examining psychiatrists or physicians are generally present orily if he or the alleged incompetent requests it. The hearing, actually a formality, hardly ever lasts beyond 15 minutes. If-a person is found incompetent and is to be admitted to a state hospital, the clerk applies to the administrator of the state hospital. When a place for the patient opens the court is notified. The court attempts to persuade the family of the patient to take him to the state hospital for admittance. If this is not possible a county sheriff's deputy transports the patient.










CHAPTER IV


DATA AND HYPOTHESES


This chapter will describe the sources of the data,

the methods used in collecting and analyzing the data, and the hypotheses to be tested.


The Data

The data for this study are drawn from archival sources rather than from a standard sociological survey. The use of available records offers both advantages and disadvantages. Measures drawn from archives are non-reactive in that the researcher's presence does not affect the content of the record. Where a crucial variable, as in this study, is the decision of a public agency, reliance on the record rather than a participant's memory can eliminate measurement error.

A major problem with archival data is that the general scope of the records and the detail of individual cases are not under the investigator's control. The archive might not contain the measures needed by the researcher or there might be missing information on particular cases.

With the strengths and weaknesses of archival data in




66




67



mind, it was decided that they still offered the best source of information for the present study.


The Cases Studied

This study consists of all the individual incompetency cases which were completed in the calendar years 1966, 1968, and 1969 in Southern County. The court's incompetency records are available to the public. Each case record is in one file. The files are numbered sequentially in the approximate chronological order that the cases began. Case files which were started six months before and completed six months after the years in question were checked to make certain that the sample was complete. The final sample numbered 379 cases. There were 139 cases from 1966, 117 cases from 1968, and 123 cases from 1969.


The Data Obtained

The data on each case are drawn mainly from the official court file for the case. The court records were supplemented by the patient records of those in the sample, if any, from the county's mental health services clinic, and from the three county hospitals' inpatient and outpatient psychiatric facilities. In the four facilities the records for all years were in one name index. After the court sample was drawn, the




68




patient indexes at the four facilities were checked for all names of those in the court sample. The records of those in the sample who had used the facility at any time were consulted for supplementary data. After all the data had been abstracted and coded all names were destroyed. Names were used initially only because that was the only method of access to the hospital and clinic data. The names in court files are, of course, a matter of public record.

The amount of information in a court file varies from

case to case, but each file contains the minimum court forms for the processing of a case.- Almost every file will contain: a petition giving the name, age, sex, race, and family members of the alleged incompetent and the petitioner or petitioners who ask that he be adjudged incompetent; a copy of the notice of incompEtency proceedings which will indicate the present address of the alleged incompetent and whether he is presently confined in a hospital or jail; an examining committee report which gives the names of members of the examining committee, their findings relative to the incompetency of the person and their diagnosis of his condition if they find him incompetent; a final judgment of the court which legally determines if the individual is competent, incompetent, or temporarily incompetent and which may spell




69




out a disposition alternative to commitment such as outpatient care; and a copy of a data sheet required by the state, which is filled out by the examining committee and contains demogr-Thic, occupational, and clinical information

on the alleged incompetent.

A court file may, in addition, contain an order

confining the individual prior to a hearing, various notes and correspondence by the clerk or judge concerning the case, and if the incompetentwas committed, forms specifying the place and time of commitment.

The hospital and clinic records contained varying

amounts of information depending on the length of treatment or hospitalization. Most of the records contained a patient history, diagnosis, and prognosis. These records were mainly used to supplement the demogr4hic and occupational data from the court records and to determine if the alleged incompetent had received psychiatric care prior to the commitment proceedings, been under psychiatric care at the time of the proceedings, and if he had a history of alcohol problems.


The Variables and Coding

The dependent variable for the study is the outcome of the incompetency proceeding. Cases were coded as competent,




70




temporarily incompetent, or incompetent depending on the final judgment of the court. In the few cases where a judgment of the court was not entered, the case was coded competent, for that is the legal effect of withholding judgment.

The independent variables for the study, conceptualized as status contingencies of the social reaction, are the age, sex, race, marital status, education, most recent occupation, and the present occupational situation of the alleged incompetent.

The age of the alleged incompetent was coded into four categories: 14 to 25 years of age, 25 to 44 years of age, 45 to 64.years of age, and 65 years and over.

Sex and race were coded into only two categories each, male or female, and black or white.

Marital status of the alleged incompetent as of the

start of the proceedings was also coded into two categories, single or married. The single category includes the unmarried, those not living with their spouse, and those divorced.

The educational attainment of the alleged incompetent

was coded into four categories: those diagnosed as mentally deficient, education of less than ninth grade, education of ninth through twelfth grade, and some college and above.




71



There are two occupational variables, the most recent occupation of the alleged incompetent, and the employment situation at the time the commitment proceeding was started.

The most recent occupation variable was used to obtain an indication of the occupational status and training of the alleged incompetent irrespective of the fact that he might be unemployed at the time the proceedings began. If the court and agency records did not list an occupation for the alleged incompetent, the city directory for Southern City was consulted to place the person in an occupational category. The reliability of the city directory classifications was checked against a sample of persons whose occupation was available from court and agency records. The reliability was 100 per cent. Those eighteen years of age and under were classified by the occupation of their father.

There are four occupation categories and three residual categories for the most recent occupation variable. The four employed categories are unskilled-working, skilled-working, lower white-collar, and upper white-collar. Three other categories are students, housewives, and never employed. The unskilled- working category is made up of manual workers whose jobs require little skill or training. Manual laborers, filling station attendants, local truck drivers, and garbage




72



collectors, porters, janitors, maids, and orderlies are examples of occupations that would be coded in this category. The skilled-working category encompasses all blue-collar occupations which involve an extended period of training or apprenticeship as a prerequisite to holding the job. Examples of such occupations would be carpenter, electrician, tool and dye maker, barber, and restaurant cook. The lower white-collar classification is for occupations which are white-clollar but do not require a college education for their performance and do not involve selfemployment. The bulk of the occupations coded in this category were clerical, retail sales or low-level technical positions. Examples from this classification are secretary, store clerk or cashier, bookkeeper, mailman, lab assistant, practical nurse, policeman, fireman, and teaching assistant for a public school. The u2per white-collar category is for the professional-technical positions which require a college education and for managers and proprietors of local businesses. Examples from this category are physician, lawyer, certified public accountant, schoolteacher, college professor, and owner .,of a restaurant. The three remaining categories are for those individuals whose records indicate that they have never been employed. Married females who had never been employed and




73



were not students were coded as housewives. Males and unmarried females who were not students, whose records so indicated, were coded never employed. Students over eighteen were coded students.

For the employment situation at the start of commitment proceedings variable, those unemployed at the time and housewives were coded unemployed, all students were coded students, those employed at the timewere coded employed and the retired were so classified.

For control purposes, three dichotomous indicators of

psychological pathology were collected from the records; prior psychiatric care, present psychiatric care, and alcohol problems. An individual was coded as having received psychiatric care prior to the commitment proceeding if the records indicated that prior to the start of the. proceedings and not as a result of any problem or incident which precipitated the proceedings the individual had received care from a physician, psychiatrist, or mental health clinic, for an emotional or mental problem, or had been hospitalized for such a problem. If the record indicated that he had not received such care, the case was so coded. If records did not specify either way

the case was coded as no information.

A separate control variable is whether the alleged




74



incompetent was receiving psychiatric care at the time the proceedings started. The care criteria are the same as the prior variable"; the time is different. A person could be coded as under care at the time the proceedings started and yet not be coded as receiving care prior to the start of the proceedings if all the care received was a result of an acute incident or illnesss, which precipitated the start of the proceedings. A person who had visited the mental health clinic regularly for a year or more up until the commitment proceeding would be coded yes on both care variables. A person hospitalized for three weeks prior to the petition for incompetency would be coded yes only on the care at the time of proceedings variable.

The third pathology control variable is whether or not the alleged incompetent has had a history of problems with the use of alcohol. If the examining committee report has a diagnosis of alcoholisn7 or any hospital or clinic record prior to the time of the proceedings mentions problems from the use of alcohol.the person is coded as having a history of alcohol problems. When the reports and records*rule out alcohol problems the case is coded no on the variable. Cases where the record does not indicate either way are

coded no information.




75




For descriptive purposes and for use as an indication of the pathology of those not adjudged incompetent, the diagnosis of the examining committee was coded. If there was no diagnosis from the examining committee, as was often the case with those found competent, any hospital or clinic diagnosis was coded if it was made at the same time as the incompetency proceedings. The diagnoses were coded as closely as possible to the actual diagnosis. Most diagnoses were in the form of specific diagnostic terms such as manicdepressive psychosis. Some we're in broad categories like psychosis, depression, or suicidal, and were so coded.


The Analytic Cases

An examination of the distribution of coded diagnoses revealed that a great many of the cases were diagnosed as conditions with organic cauGes. Most of these type cases were diagnosed as chronic brain syndrome, secondary to cerebral arteriosclerosis, a condition usually associated with old age. A few of these cases involved brain damage due to trauma. One hundred and one of the total sample of 379 cases were diagnosed as conditions with organic causes.

It was decided th.t an analysis that Was.--based in part on the social reactions model of mental illness should




76




eliminate from consideration those cases explicitly diagnosed as having a specific organic cause. Even the sharpest critics of the medical-model of mental illness, such as Szasz (1961) in his The Myth of Mental Illness, have conceded that certain organic conditions truly fit the medical-model. The testing of hypotheses will therefore be carried out using 278 cases, a result of eliminating the 101 organic diagnoses from the original 379 cases. A one-way frequently distribution of the analytic variables and the diagnoses will be presented for the total sample and for the analytic cases.

The hypotheses of the study will be tested by the

percentages of competent cases in two-way cross-tabulations of the dependent variable, the courts judgment, with each of the independent status variables. Percentages in three-way cross-tabulations of each independent variable and separately by each of the three control variables of prior psychiatric care, present psychiatric care, and alcohol problems will

also be examined.

The three-way control cross-tabulations will determine if the hypothesized relationships occur under each of the separate control categories. Though the control variables are not necessarily directly related to psychological pathology, we can assume that in a county where psychiatric treatment is




77




available at no cost for those who cannot afford it, that the care control variables are in part controlling for at least severe psychological-behavioral problems. The alcohol problems' control variable is important because of the possibility that cases of alcoholism might be handled in a special manner by the court. The cross-tabulations will be executed by an SPSS computer program.

Because the present study does not involve a probability sample of a larger population of cases, but the total number of cases for three specific years in a particular legal jurisdiction, certain advantages and disadvantages accrue relative to hypothesis testing and data interpretation.

If this study involved a random sample of a larger population, such as one year's incompetency cases for an entire state, or even a probability sample of one year's cases for one county, inferential statistics would be applicable and hypotheses could be tested by significance tests which would indicate the probability of drawing a sample with the observed distribution. One could simply accept or reject hypotheses on the basis of whether the .05 or .01 level was reached. S ignificance tests are based on sampling distributions, which are theoretical distributions of all possible random samples of a certain size (Siegel, 1956:11). Without a random




78




sample from a particular sampled population their inferential use is highly questionable. Significance tests will not be used for hypothesis testing in this study because the requirements for their meaningful use are not met.

The unavailability of significance tests does not

detract from the results of this study. With a total sample, as in this study, wecan be certain that any observed relationship between the independent and dependent variables is a real relationship for the population studied. For instance, for this study one could use a 50 per cent probability sample of the cases from the identical three years, test-hypotheses ty significance tests and the conclusions which could be drawn would be less certain than if one sampled the total population as was done here.

The hypotheses in this study concern the relationship

between adjudged competency and several social status variables. The hypotheses will be tested only for the population studied because data relative to any larger population is not available. The hypotheses do not posit any association between the status variables and judgments of temporary incompetency because the theory and prior empirical studies do not suggest any particular relationship.

The particular hypotheses tested in this study concern




79




only the population sampled, but the results of this study have implications beyond the limits of the cases studied. Though we cannot legitimately test hypotheses relative to it, there is implicit in this study a target population much larger than the three years of incompetency cases in Southern County. There is reason to believe the results of this study might be representative of most jurisdictions which employ psychiatrists as decision-makers for determining one's sanity and freedom. Psychiatrists everywhere receive uniform training and experience before being certified to practice their profession. There is no reason to suspect that the results of this study might be due to idiosyncratic practices of psychiatrists in Southern County.

The hypotheses of study are drawn from a large body of literature in social stratification, social control, and mental illness. To the extent the hypotheses are supported, this study has implications for all public decision-making processes where individuals with varying status characteristics are involved. When hypotheses drawn from a broad conceptual area are supported by a study in a limited domain the broader propositions from which the specific hypotheses are drawn are strengthened.

Though the hypotheses are accepted or rejected on the




80



basis of any percentage difference in the posited direction,

it is useful to have a summary measure of association between the independent and dependent variables. The contingency coefficient (C) is particularly well adapted for the data of this study because it is applicable to varying size contingency tables with unordered variables. The contingency coefficient will be computed for those tables or portions of tables where there are fewer than 20 per cent of the cells with an expected frequency of less than five and no cells with an expected frequency of less than one. (Siegel, 1956:201). Several limitations of the contingency coefficient should be mentioned. The contingency coefficient equals zero when there is no relationship but it cannot attain unity The upper limit of the coefficient depends on the size of the table; the upper limit is .707 for a 2x2 table and .816 for a 3x3 table. Therefore, the coefficients for different size tables are not directly comparable. Finally, the contingency coefficient is not directly comparable to any other measure of correlation or association (Siegel, 1956:201).

The hypotheses for this study will be tested on the basis of-whether any association exists in the posited direction. A contingency coefficient over zero or any percentage difference in adjudged competencies between the




81



categories will indicate that there is a relationship in*the table. The direction of the association will be determined by the direction of the percentage differences between the categories, Because any association in the hypothesized direction is supportive of the hypothesis in question, the relative strength of the various associations will be considered in a summary table. The value of chi square (X2 will also be presented for those tables where the contingency coefficient is calculated. Chi square is presented for those readers who might use it for comparative or evaluative purposes; the analyses will not focus on it.

The research hypotheses as suggested from the theory and empirical studies considered earlier are as follows:

1. The type of court judgment varies with age.
The young receive a higher proportion of
competent judgments than the old.

This hypothesis follows from the observation that youth is more valued in our society than age. Past studies have shown that the younger fare better in commitment proceedings.

2, The type of court judgment varies with sex.
Males receive a higher proportion of
competent judgments than females.

American society places a higher value on being male

than being female. Prior research indicates that this value preference might be expressed in differential treatment for males in.commitment proceedings.





82



3. The type of court Judgment varies with race.
Whites receive a higher proportion of
competent judgmuents than blacks,

Whites are characterized as composing a high-caste in American society. Prior research indicates that social control dispositions favor h'igh-caste individuals.

4. The type of court Judgment varies with
marital stat-1us. The married receive a
greater proportion of competent judgments
than the single9

The married in American society are more valued than the single. The married have also been pictured as having more

resources in the community to aid in avoiding commitment. Prior research indicates that higher prestige and greater resources will result in favorable court dispositions.

5. ,The type of court judgment varies with
education. The higher educated will receive a greater proportion of competent judgments than the lower educated.

Education is a highly valued asset in our society.

Greater education enables one to confront a decision-making body with a favorable vocabulary, demeanor, and logic. An individual with a. highly valued trait which is clearly present from demeanor should receive a favorable judgment.

6. The type of court Judgment varies with the
prestige of most recent occupation. Those
with high prestige occupations receive a greater proportion of competent judgments than those with low prestige occupations.




83



Occupational prestige in our society is related to the

skill.. training, and responsibility required by a job. Whitecollar occupations are generally more valued than blue-collar occupations, The employed receive more social honor than the unemployed. We would expect those who have never been empl6yed to have a lower status than those unemployed because of sex or student role obligations.

A prestige scale based on the above observations and

using this study's occupational categories would have upper white-collar as the highest prestige category followed by lower white-collar, skilled working, unskilled working, student and housewife as equal categories, and never employed.

The prestige factor alone should result in the higher categories having a higher percentage of competent. Those in the higher prestige classifications will also have higher economic resources for avoiding commitment. Social power should also be unevenly distributed towards the higher classifications with the upper white-collar having a disproportionate amount.

7. The type of court judgment varies with
present employment status. The employed
receive a greater proportion of competent judgments than the unemployed.





84



The employed, as previously mentioned, have more social status in American society than do the u employed. The unemployed person will probably have less economic resources than those that'are emPloyed. Social support from an employer and fellow workers is absent if one is unemployed. The unemployed individual is not a, functioning part of a, work-oriented society and, therefore, subject to be seen as a candidate for therapy.

The hypotheses in every instance posit that the

individuals with higher status characteristics will have a higher proportion of competency judgments than those

-with low-status characteristics. The next chapter, after first describing them vith 1970 census figures for Southern County, will present the data necessary to determine whether status, characteristics, and legal competency judgments are so related.










CHAPTER V


DATA DESCRIPTION AND ANALYSIS


This chapter will present separate frequency distributions for the total sample and for the analytic sample. A comparison of the distributions of the demographic variables with census information1 for the total po pulation of Southern County will give insight into the social control selection process operating prior to the formal decision-making process. The data analysis will determine whether statusrelated criteria are operative later in the judicial setting.


Description of the Cases

Aoe

A comparison of the Southern County age distribution with the total sample (Table 1), and the analytic sample (Table 2) demonstrates that age is a factor in the process that determines which persons are to have their competency examined. In 1970 the population of Southern County above the age of 14 was distributed as follows: 40.7 per cent be tween the ages of 14 and 24, 31.0 per cent between the ages



1Census figures for this chapter are from the U.S. Bureau of the Census, 1970 Census of Population and Housing, for the Southern County standard metropolitan statistical area.

.85




86

TABLE 1. ONE-WAY DISTRIBUTION OF THE TOTAL SAMPLE'


AGE (N=379) % MOST RECENT
OCCUPATION (N=282)
14-24 18.2
25-44 31.4 Unskilled-working 31.2
45-64 29.6 Skilled-working 10.6
65 & over 20.8 Lower White-collar 11.6
Upper White-collar 14.2
SEX (N=379) Housewives 17.0
Students 5.0
Male 50.1 Never Employed 10.3
Female 49.9 No information 25.6

RACE (N=375i PRESENT EMPLOYMENT STATUS (N=329)
White 74.1
Black 25.9 Employed 19.5
No information 1.0 Unemployed 56.2
Student 4.3
MARITAL Retired 20.9
STATUS (N=355) No information 13.2

Single 61.4 EDUCATION (N=215)
Married 38.6
No information 6.7 Mentally Deficient 2.3
Below 9th 35..8
PRIOR 9th 12th 39.1
PSYCHIATRIC Some College & above 22.8
CARE (N=257) No inf orma ti on 43.3

Yes 75.5 ALCOHOL
No 24.5 PROBLEMS (N=241)
No information 32.2
Yes 39.0
PRESENT No 61.0
PSYCHIATRIC No information 36.4
CARE (N=280) JUDGMENT (N=376)

Yes 46.1
No 53.9 Competent 26.3
No information 26.1 Temporarily
Incompetent 14.1
Incompetent 59.1
No information .8


1 No information percentagesare-based-on 379 cases. All other
percentages are based on the number of cases with valid information for the variable. Though this study involves an entire' population of cases., the term sample is used for ease of reference




87

TABLE 2. ONE-WAY DISTRIBUTION OF THE ANALYTIC SAMPLE 1


AGE (N=278) MOST RECENT
.OCCUPATION (N=231)
14-24 24.1
25-44 41.0 Unskilled-working 31.6
45-64 31.3 Skilled-working 11.7
65 & over 3.6 Lower White-collar 13.9
Upper White-collar 13.4
SEX (N=278) Housewives 13.9
Students 6.1
Male 50.0 Never Employed.,'- 9.5
Female 50.0 No information 16.9

RACE (N=275). PRESENT EMPLOYMENT STATUS (N=235)
White 76.0
Black 24.0 Employed 26.0
No information 1.1 Unemployed 64.7
Student 6.0
MARITAL Retired 3.4
STATUS (N=263) No information 15.5

Single 62.7 EDUCATION (N=201)
Married 39.3
No information 5.4 Mentally deficient 2.8
Below 9th 28.7
PRIOR 9th 12th 44.6
PSYCHIATRIC Some College & above 23.7
CARE (N=202) No information 34.9

Yes 81.7 ALCOHOL
No 18.3 PROBLEMS (N--188)
No information 27.3
Yes 42.0
PRESENT No 58.0
PSYCHIATRIC No information 32.4
CARE (N=207)
JUDGMENT (N=277)
Yes 46.8
No 53. 2 Competent 31.8
No information 25.5 Temporarily
Incompetent 18.8
Incompetent 49.4


No information percentages are based on 278 cases. All other percentages are based on the number of cases with valid information for the variable. Again, the term sample is used for
case of reference, though a total population of non-organically
diagnosed cases is involved.




88




of 25 and 44, 15.1 per cent between the ages of 45 and 65, and 6.3 per cent above the age of 6 5. The age distributions of the total sample and the analytic sample are weighted much heavier in the age brackets containing those 25 years of age and above. Only 18.2 per cent of the total sample and 24.1 per cent of the analytic sample are between age 14 and 24. There are 55.8 per cent fewer incompetency proceedings for those between the ages of 14 and 24 than is expected under the condition of a random selection from the population of

Southern County.

The distribution of the total sample is over-represented by those between 45 and 64.(29.6 per cent) and by those over 65 (20.8 per cent). The age bracket 25-44 (31.4 per cent) is almost the same as the'population percentage. Considering all cases with both functional and organic diagnoses, those below 25 and those above 45 are over-represented.

The analytic sample contains a smaller proportion of persons above 65 and below 25 and a larger proportion of persons between 25 and 64 than the population of Southern County. The shift in the percentages of those age 25 to 44 and age 65 and over is a result of eliminating 101 cases with organic diagnoses.

From a labeling or social reactions perspective one might




Full Text
74
incompetent was receiving psychiatric care at the time the
proceedings started. The care criteria are the same as
the prior variable; the time is different. A person could
be coded as under care at the time the proceedings started
and yet not be coded as receiving care prior to the start
of the proceedings if all the care received was a result of
an acute incident or "illness which precipitated the start
of the proceedings. A person who had visited the mental
health clinic regularly for a year or more up until the
commitment proceeding would be coded yes on both care
variables. A person hospitalized for three weeks prior to
the petition for incompetency would be coded yes only on the
care at the time of proceedings variable.
The third pathology control variable is whether or not
the alleged incompetent has had a history of problems with
the use of alcohol. If the examining committee report has a
diagnosis of a lcoholism, or any hospital or clinic record
prior to the time of the proceedings mentions problems from
the use of alcohol, the person is coded as having a history
of alcohol problems. When the reports and records rule out
alcohol problems the case is coded no on the variable.
Cases where the record does not indicate either way are
coded no information.


38
The examinations were described as follows:
Most of the interviews were hurried, with
the questions of the examiner coming so
rapidly that the examiner often interrupted
the patient, or one examiner interrupted
the other. All of the examiners seemed
quite hurried. (Scheff, 1966:146).
As an additional measure of the degree to which admitted
patients met legal criteria for admission, Scheff had 25
admission psychiatrists for the three largest public mental
hospitals in a midwestern state fill out questionnaires for
the first 10 patients they examined in one month in 1962.
The questionnaire contained the psychiatrist's ratings of the
patient's probability of harming himself or others and of the
patient's present degree of mental illness. Scheff felt that
to be clearly qualified for involuntary commitment, a patient
should be rated as "likely to harm himself or others" and/or
as "severely mentally impaired." Scheff found that 63 per
cent of the patients, as rated by the admitting psychiatrists,
did not meet these criteria. Gove (1970a) has criticized the
validity of Scheff's conclusion on the grounds that Scheff's
cutting points for meeting the criteria are not necessarily
the "correct" ones. Gove suggests that the cutting point for
dangerousness should be lowered two categories to "somewhat
unlikely to harm himself or others" and that for mental impair-


5
Status
The second dimension of stratification considered by
Weber concerned the prestige dimension, which he called the
'status situation." The individual status situation depends
on social honor and is often linked with his class situation.
... We wish to designate as 'status situation'
every typical component of the life fate of men
that is determined by a specific, positive or
negative, social estimation of honor. This honor
may be connected with any quality shared by a
plurality, and, of course, it can be knit to a
class situation; class distinctions are linked
in the most varied ways with status distinctions.
(Gerth and Mills, 1953:187).
Research involving primarily the status dimension of
stratification has centered around locating and describing
status strata in particular communities and charting occu
pational prestige rankings for national and international
samples. Warner and his associates (1949) have been primarily
concerned with prestige strata in communities. The basic
findings of this group include: the existence of three
basic strata with one or more substrata in each, depending
on the community; a differentiation between strata on the basis
of occupation and income; and an individual carryover from the
prestige dimension to the other facets of the community such
as the family, religious structure, organizational participa
tion, and occupational structure. Warner's work, though


BIBLIOGRAPHY
Angrist, Shirley S,
1966 "Mental illness and deviant behavior." The
Sociological Quarterly 7 ( Fall) .*436-448 .
Antonovsky, Aaron
1972
"Social class, life expectancy, and overall
mortality." Pp 467-498 in Paul Blumberg (ed.)
The Impact of Social Class. New York: Thomas
Crowell.
Arnold,
1971
William R.
"Race & ethnicity relative to other factors in
juvenile court dispositions." American Journal
of Sociology 77(September): 221-227.
Baltzell, E. Digby
1958
The Philadelphia Gentlemen. Glencoe, Illinois:
The Free Press.
Becker,
1963
Howard
Outsiders: Studies in the Sociology of Deviance
New York: The Free Press of Glencoe.
Berger,
1966
Peter L. and Thomas Luckmann
The Social Construction of Reality: A Treatise
in the Sociology of Knowledge. Garden City,
New York: Doubleday & Company, Inc. (Anchor
Edition).
Berreraan, Gerald D.
1969
"Caste in India and the United States." pp. 225-
233 in Jack Roach et_ al. (eds.) Social Stratifi
cation in the United States. Englewood Cliffs,
New Jersey: Prentice-Hall, Inc.
Black, Donald J. and Albert J. Reiss, Jr.
1970
"Police control of juveniles." American Socio
logical Review 35(February):63-77.
Blau, Peter M. and Otis Dudley Duncan
1967
The American Occupational Structure. New York:
John Wiley and Sons, Inc.
165


TABLE 12. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY RACE,
CONTROLLING
FOR ALCOHOL PROBLEMS.
RACE
Competent
YES
JUDGMENT
Tmporari1y
Incompetent
ALCOHOL PROBLEMS
Incompetent Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
White
38.2
27.3
34.5 (n=55) 26.8
23.2
50.0
(n=82)
Black
34.8
13.0
52.2 (n=23) 18.5
7.4
74.1
(n=27)
(N=78)
(N=109)
= .18
= 2,74
= 2
. 15j^p^>. 10
.21
5.29
2
05p>p^-.025
116


82
3. The type of court judgment varies with race.
Whites receive a higher proportion of
competent judgments than blacks.
Whites are characterized as composing a high-caste in
American society. Prior research indicates that social
control dispositions favor high-caste individuals.
4. The type of court judgment varies with
marital status. The married receive a
greater proportion of competent judgments
than the single.
The married in American society are more valued than the
single. The married have also been pictured as having more
resources in the community to aid in avoiding commitment.
Prior research indicates that higher prestige and greater
resources will result in favorable court dispositions.
5. The type of court judgment varies with
education. The higher educated will
receive a greater proportion of com
petent judgments than the lower educated.
Education is a highly valued asset in our society.
Greater education enables one to confront a decision-making
body with a favorable vocabulary, demeanor, and logic. An
individual with a highly valued trait which is clearly
present from demeanor should receive a favorable judgment.
6. The type of court judgment varies with the
prestige of most recent occupation. Those
with high prestige occupations receive a
greater proportion of competent judgments
than those with low prestige occupations.


37
(
posture, etc., and who presented their stories
without excessive emotional response or bland
ness and with proper demeanor, were able to
obtain the decision they wanted--whether it was
release or comraitment--despite any "psychiatric
symptomatology." (Miller and Schwartz, 1966:34).
Scheff (1966) has gathered data on both the nature of
the commitment process and the degree of impairment of those
committed. From observations of 116 judicial hearings
Scheff reports that 86 of the hearings failed to establish
the judge's criteria of mental illness. Forty-eight of the
patients were said to exhibit behavior and responses which
were "completely unexceptional." In none of the 116 cases
did the psychiatric examiners recommend release of the
patient.
An observation of 26 psychiatric examinations, given
prior to the judicial hearing, produced the following data.
Of the 26 cases, the examiners recommended hospitalization
in 24 cases. The non-psychiatrist observer rated the cases
as to whether the statutory criteria for commitment were met.
The observer rated 8 cases as meeting the criteria, 7 cases
as not meeting the criteria, and 11 cases as inconclusive or
potentially meeting the criteria with a more extensive
investigation. The mean length of the examinations was 10.2
minutes.


3
We may speak of a 'class* when (1) a number of
people have in common a specific causal component
of their life in so far as (2) this component is
represented exclusively by economic interests in
the possession of goods and opportunities for
income, and (3) is represented under the conditions
of the commodity or labor markets.
(Gerth and Mills, 1958:181).
The best illustration of the impact of the economic or
class factor on life chances is the demonstrated relation
ship between class and the probability of life itself. The
official casualty lists of the Titanic disaster clearly
demonstrated an inverse relationship between class of
accommodations and drowning. Four of 143 first class female
passengers drowned while 81 of the 179 female third class
passengers were lost (Lord, 1955:107). Less dramatic but
equally to the point are Antonovsky's (1972) findings on
class and mortality.
Despite the multiplicity of methods and indices
used in the 30 odd studies cited, and despite
the variegated populations surveyed,the ines
capable conclusion is that class influences
one's chances of staying alive.
(Antonovsky, 1972:486).
The effects of class are not limited to the probabilities
of staying alive. Blau and Duncan (1967) have demonstrated
that one's class background, measured by father's occupational
level, has a significant effect on the level of the individual's
present occupation. Measuring effects by path coefficients,


162
are often short and perfunctory; an attending psychiatrist,
however, may have consulted with a patient for many hours.
Two factors are probably operative to reduce the
effects of high status in the under present care situation:
(1) The more thorough examination in these cases results in
the examining psychiatrist basing his decision on medical-
pathological criteria rather than social criteria and,
(2) The high status patient who is under psychiatric care
will not gather his resources to contest a decision of his
own physician but probably accepts a situation which he does
not have the psychological strength to dispute, for which he
has been forewarned, and which he has possibly come to accept.
The factors at work in the not under care situation are
the reverse of those in under care situation: (1) A short
perfunctory examination could result in psychiatric decisions
being influenced by social criteria such as age, sex, race,
marital status, occupation, and employment. Ten or fifteen
minutes is not time enough for a complete psychiatric
diagnosis. The socio-demographic information is readily
available to the psychiatrist for it is required for state
records. A brief examination and the social distance between
the psychiatrist and the low status examinees, therefore,
probably works toward their receiving more unfavorable


TABLE 8. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY AGE, CONTROLLING FOR ALCOHOL PROBLEMS.
AGE
Competent
YES
JUDGMENT
Temporarily
Incompetent
ALCOHOL PROBLEMS
Incompetent Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
14-24
75.0
0.0
25.0
(n= 4)
27.3
21.2
51.5
(n=33)
25-44
31.4
28.6
40.0
(n=35)
20.0
20.0
60.0
(n=45)
45-64
41.0
20.5
38.5
(n=39)
25.9
18.5
55.6
(n=27)
65 & over
0.0
0.0
100.0
(n= 1)
0.0
0.0
50.0
(= 2)
(N=79)
(N=107)
C* = .17
X2*= 3.16
df = 4
. 35> p > 25
* Does not include 65 and over
category.
109


57
An example of an early state commitment law would be
New Yorks statute of 1788, which reads much like the
English law of 1744.
Whereas, There are sometimes persons who
by lunacy or otherwise are furiously mad, or
are so far disordered in their senses that
they may be dangerous to be permitted to go
bbroad: therefore,
Be it enacted, That it shall and may be
lawful for any two or more justices of the
peace to cause such a person to be apprehended
and kept safely locked up in some secure place
and, if such justices shall find it necessary,
to be there chained . .
(Deutsch, 1949:420).
Involuntary commitment to the early mental hospitals
was easily and informally accomplished.
The request of a friend or relative--or
perhaps even an enemy--to a member of the
hospital staff for an order of admission
would often suffice. The staff member
might then hastily scribble a few words on
a scrap of paper, sign his name, and the
procedure would be completed.
(Brakel and Rock, 1971:34).
AtLthis time, thousands of persons are involuntarily
hospitalized annually and every state has much more detailed
laws regulating such commitments. The provisions of the
formal state statute of Southern State covering involuntary
hospitalization will be briefly outlined and the implementa
tion of the statute in Southern County will be described.
In addition to the provisions for judicial involuntary


30
Mental Illness and Social Stratification
Studies of socioeconomic status and mental illness have
often found an inverse association between serious mental
illness and socioeconomic status.
This has been the finding from ecological correlations
(Faris and Dunham, 1939), admission studies (Clark, 1948)
(Odegaard,1956), examination of rates under treatment
(Hollingshead and Redlich, 1958) and probability sample
impairment studies of a population (Srole, et_ £l_. 1962).
These studies see mental illness as a condition which can be
either a cause or a result of low socioeconomic status. The
studies of the prevalence of mental illness have not been
particularly concerned with the defining or labeling process.
It should be noted that in all but the probability sample
studies, formal labeling of the sample has occurred prior to
investigation. If social status is important for the defining
process, it has operated prior to investigation so as to bias
the sample towards the lower class. In the probability sample
studies we must ask if possibly the rater or the rating
instrument might be class-biased.
Berger (1966) has stressed the importance of considering
the different reality frameworks from which one judges insanity.
Mental illness, according to Berger, is relative to a


84
The employed, as previously mentioned, have more social
status in American society than do the unemployed. The
unemployed person will probably have less economic resources
than those that are employed. Social support from an
employer and fellow workers is absent if one is unemployed.
The unemployed individual is not a functioning part of a
work-oriented society and, therefore, subject to be seen
as a candidate for therapy.
The hypotheses in every instance posit that the
individuals with higher status characteristics will have
a higher proportion of competency judgments than those
with low-status characteristics. The next chapter, after
first describing them with 1970 census figures for Southern
County, will present the data necessary to determine
whether status, characteristics, and legal competency
judgments are so related.


TABLE 31. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY PRESENT OCCUPATIONAL STATUS, CONTROLLING FOR PRESENT PSYCHIATRIC
CARE.
PRESENT CARE
PRESENT YES NO
OCCUPA
TIONAL JUDGMENT JUDGMENT
STATUS Competent Temporarily Incompetent Competent Temporarily Incompetent
Incompetent Incompetent
Employed
31.6
31.6
36.8
(n=19)
76.0
0.0
24.0
(n=25)
Unemployed
23.3
28.3
48.3
(n=60)
25.8
14.5
59.7
(n=62)
Student
12.5
50.0
37.5
(n= 8)
50.0
25.0
25.0
(n= 4)
Retired
100.0
0.0
0.0
-(n=
16.7
0.0
83.3
(n= 6)
(N=88)
(N=97)
C* = .10
X2* = .93
df = 2
,35^-p
25
C* = .43
X = 19.37
df = 2
.0005p-p
*
Does not
include
student or
retired
categories.
145


138
with 38.5 per cent, and the skilled-working with 25.0
per cent. The number of cases here is too low to infer
much from the rankings. It is significant that the upper
white-collar received twice the percentage of competent
judgments than that of any other category.
Table 27, controlling for present care, reveals a
similar relationship between competent judgments and
occupational prestige, with a few exceptions. The upper
white-collar category, as in previous tables, has the
highest percentage of competent judgments under both con
trol conditions; 40.0 per cent in the yes category and
66.7 per cent in the njo category. The major discrepancies
from the hypothesized relationships are the never employed
with 37.5 per cent competent judgments in the yes situation,
the students with 66.7 per cent in the no situation, and the
housewives with 37.7 per cent in the no situation. The
unexpected changes in the relative positions may be a result
of unstable percentages which are caused by missing cases.
In any event, the fact that the upper white-collar class
continues to have the highest proportion of competent
judgments under each control situation supports the con
tention that this might be a special class of individuals
in incompetency proceedings.


103
TABLE 5. PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY AGE
JUDGMENT
AGE
Competent
Temporarily
Incompetent
Incompetent
14-24
41.8
13.4
44.8
(n= 67)
25-44
25.7
23.0
51.3
(n=113)
45-64
33.3
18.4
48.3
(n= 87)
65 & over
20.0
10.0
70.0
1P.,-.10}..
(N=277)
C* = .15
X = 5.87
df = 4
. 15p> pz> 10
* Does not include 65 and over category


TABLE 6. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY AGE, CONTROLLING FOR PRIOR PSYCHIATRIC CARE.
AGE
Competent
YES
JUDGMENT
Temporarily
Incompetent
PRIOR CARE
Incompetent Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
14-24
37.1
14.3
48.6
(n=35)
25.0
25.0
50.0
(n= 8)
25-44
22.5
29.6
47.9
(n=72)
41.2
0.0
58.8
(n=17)
45-64
27.8
22.2
50.0
(n=54)
66.6
11.1
22.2
(n= 9)
65 & over
50.0
0.0
50.0
(n= 4)
0.0
0.0
100.0
(n= 3)
(N=165)
(N=37)
C* = .19
X2*= 5.82
df = 4
. 15p* p^> .10
*
Does not include 65 and over category
105


80
basis of any percentage difference in the posited direction,
it is useful to have a summary measure of association between
the independent and dependent variables. The contingency
coefficient (C) is particularly well adapted for the data
of this study because it is applicable to varying size
contingency tables with unordered variables. The contingency
coefficient will be computed for those tables or portions of
tables where there are fewer than 20 per cent of the cells
with an expected frequency of less than five and no cells with
an expected frequency of less than one. (Siegel, 1956:201).
Several limitations of the contingency coefficient should be
mentioned. The contingency coefficient equals zero when there
is no relationship but it cannot attain unity. The upper limit
of the coefficient depends on the size of the table; the upper
limit is .707 for a 2x2 table and .816 for a 3x3 table.
Therefore, the coefficients for different size tables are not
directly comparable. Finally, the contingency coefficient
is not directly comparable to any other measure of correlation
or association (Siegel, 1956:201).
The hypotheses for this study will be tested on the
basis of whether any association exists in the posited
direction. A contingency coefficient over zero or any
percentage difference in adjudged competencies between the


6
subject to criticism (Pfautz and Duncan, 1950; Kornhauser,
1953), should be considered when analyzing the effects of
social stratification.
Weber (Gerth and Mills, 1958:193) mentioned that
occupational groups are also status groups because of their
common life style. The object of the occupational prestige
scale (North & Hatt, 1947) is to rank occupations on prestige
by the use of opinion surveys. The results of the rankings
give some support to Warners prestige strata hierarchy in
that the overall prestige ranking would, if collapsed into
strata, resemble the occupational distribution found in
Warners prestige strata. The basic prestige rankings obtained
have been shown to have changed little since 1947 (Hodge et al.,
1968).
In addition to achieved characteristics such as income,
education and occupation, status and prestige may be determined
by ascribed characteristics. The most obvious and best
documented ascribed status determinants are race and ethnicity.
The effects of race on social honor was noted by Weber in his
treatment of Ethnic Segregation and Caste (Gerth and Mills,
1958:188). The racial status structure of a Southern community
was studied by Dollard (1937) using participant observation.
The Negro community was found to be composed of prestige


CHAPTER II
STUDIES OF CIVIL COMMITMENT
Empirical research on the commitment of the insane is
relatively scarce considering the thousands of people
committed yearly and the implications of commitment for the
societal reactions model of mental illness. This chapter
will consider work in this area which focuses on two ques
tions: (1) What is the nature of the commitment process and
its effect on whether those committed in fact meet the
requirements of commitment? (2) What are the status
(
characteristics which differentiate those who are committed
from those who are not?
Process and Pathology
Luis Kutner (1962), a legal scholar, asked the question
of whether the commitment process in action satisfied the
requirements of legal due process. His examination of an
Illinois commitment facility convinced him that it did not.
Even though the statutory wording provided the framework for
due process such as notice, physicians examination, and a
hearing, the implementation of the statute reduced procedural
safeguards. Kutner found that physicians certificates to
34


28
Lemert (1967), with his alternative explanation of
paranoia, negates a psychiatric conception of the disorder.
Paranoia has been pictured as an individual response to
unusual stress. The paranoid, in the traditional model,
symbolically constructs a threatening pseudo-community with
out existential reality (Lemert, 1967:197). Lemert argued
that the community is at least initially real and that the
pseudo-community is a sequel to the initial isolation by
the real community. The paranoid's construct is not entirely
fiction.
To the contrary, many paranoid persons properly
realize that they are being isolated and excluded
by concerted interaction, or that they are being
manipulated. However, they are at a loss to
estimate accurately or realistically the dimensions
and form of the coalition arrayed against them.
(Lemert, 1967:207).
Gove (1970) analyzed the labeling perspective on mental
illness and concluded that the evidence does not support the
theory. The major objection with the perspective, according
to Gove, is that there is no explanation for the occurrence
of primary deviance (the deviant act before being labeled)
and that it overstates the importance of the forces leading
to secondary deviance (deviance due to labeling and the
acceptance of the deviant role) (Gove, 1970:882-883). In
a later article Gove (1970a) critically evaluated three


23
Mental Illness
In most fields of social scientific research there are
competing paradigms (Kuhn, 1970) which define the units of
analysis, the basic concepts, domain assumptions, and research
techniques for the problem area. In mental illness theory
and research, as previously noted in the areas of social
deviance and social control, there are also competing frame
works. The purpose of this section is to introduce the basic
conflict in perspectives on mental illness and consider some
implications, for research in social stratification and mental
illness.
Competing Models of Mental Illness
Angrist (1966) has specified four themes in the pro
fessional literature concerning the nature of mental illness:
mental illness as psychological disease or pathology, mental
illness as deviant behavior, mental illness in some cases
deviant behavior and in others pathology, and a fourth theme
that specifies that mental illness involves social definitions
that vary according to the status and training of the definers.
The mental illness as pathology or disease model focuses
on the psychological structure of the individual. Certain
behavior is symptomatic of underlying psychological pathology


I
TABLE 14. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY SEX, CONTROLLING FOR PRIOR PSYCHIATRIC CARE.
SEX
Competent
YES
JUDGMENT
Temporarily
Incompetent
PRIOR CARE
Incompetent Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
Male
40.9
16.7
42.4 (n=93) 44.0
12.0
44.0
(n=25)
Female
19.4
27.6
53.0 (n=98) 33.3
0.0
66.7
(n=lgl
(N=191)
(N=37)
C = .24
X2 = 9.15
df = 2
.012* .005
119


13
Social Control
As all societies are stratified and involve inequal
ities, so do all societies contain mechanisms of social
control. It is an elementary principle of social science
that because man's biological controls are minimal his social
order must provide controls, which, from a societal viewpoint
make social life possible and from a phenomenological view
point make life meaningful.
Lemert (1972:53-54) has distinguished between passive
social control and active social control. Passive social
control was said to be the Sumnerian idea of automatic control
by the folkways, mores and laws. (Sumner, 1907). Active
social control, in contrast, is not automatic, but is a
process which involves the implementation of goals and values.
. . active social control is a continuous
process by which values are consciously
examined, decisions made as to those values
which should be dominant, and collective
action taken to that end.
(Lemert, 1972:54).
An example of passive social control would be an
individual not accepting a friend's invitation to view
pornographic materials because "it is not proper behavior."
Active social control would be involved when the state's
attorney in conjunction with other officials determines


24
or disease.
The abnormal person (i.e., one who had a mental
disorder) is so defined by reference to "universal
indicators" used in psychiatry. In this frame of
reference, certain behaviors are viewed as mani
festation of anxiety, regression, senso-motor
dysfunction, reality distortion, depression,
excitement; these in turn are taken as evidence
of personality abnormality. (Angrist, 1966:71).
This model is analytically closest to the disease model
dominant in psychiatry for more than a century.
The deviant behavior approach conceives of mental ill-
~ ness as behavior that fails to fulfill the role expectations
set for the individual. In this framework, the concern is
most often with the deviant act. Parsons' (1951) work on
the norms governing the sick role and Merton's (1957) anomie
theory of deviance in which the mentally ill were classified
as retreatists from both the culturally prescribed means and
ends, are examples of the perspective.
The third perspective considered by Angrist classifies
some mental disorder as deviant behavior but not all. An
example of this approach would be Szasz's (1961) contention
that only organic disorders can rightly be labeled mental
illness. As in the deviance perspective, functional and
neurotic disorders are seen as deviations from psychosocial,
ethical, or legal norms.


167
Durkheim, Emile
1964 The Division of Labor in Society. trans. George
Simpson. Glencoe, Illinois: The Free Press of
Glencoe.
Erickson, Kai T.
1957 "Patient role and social uncertainty: A dilemma
of the mentally ill." Psychiatry 20 (August):263-274.
1962 "Notes on the sociology of deviance." Social
Problems 9(Spring) :307-314.
Faris Robert E. L. and Warren II. Dunham.
1939 Mental Disorders in Urban Areas: An Ecological
Study of Schizophrenia and other Psychoses.
New York: Hafner.
Fein, Sarah and Kent S. Miller
1972 "Legal processes and adjudication in mental
incompetency proceedings." Social Problems
20(Summer): 57-64.
Fletcher, C. Richard and Larry T. Reynolds
1967 "Residual deviance labelling and the mentally sick
role: A critical review of concepts." Sociological
Focus 1(Winter):33-37.
Friedsan H. J. et^ a 1.
1954 "Some selected aspects of judicial commitments of
the mentally ill in Texas." Texas Journal of Science
6 :26-32.
Gans, Herbert
1962 The Urban Villagers. New York: The Free Press of
Glencoe.
Gerth, H. H. and C. Wright Mills (trans. and eds.)
1958 From Max Weber: Essays in Sociology. New York:
Oxford University Press.
Milton M.
Social Class in American Society. Durham,
Carolina: Duke University Press.
Gordon,
1958
North


39
ment should be lowered to "moderate impairment." It is not
possible, from Scheff's presentation, to ascertain the effect
of changing the dangerousness cutting point, but changing the
impairment cutting point as suggested by Gove would still
result in about 40 per cent not meeting the legal criteria
for involuntary confinement.
To test the social reactions position on mental illness,
Wilde (1968), used available data in the form of official
court commitment records and receiving hospital records from
a southern county. Wilde was interested in whether three
variables were associated with approval of a petition for
commitment. These variables were identity of the particular
interviewer at the receiving center (indicating idiosyncratic
criteria) the fact of the petitioners getting an appointment
prior to the interview (a measure of petitioner's diligence),
and the existence of committable mental illness (measured by
an index derived from interviewer protocols). Wilde found
a significant association between the identity of the inter
viewer and the approval of a petition, but this can probably
be discounted as meaningless due to Gove's valid criticism
that certain cases of higher pathology might have been assigned
to a particular group of interviewers (Gove, 1970a :297). Wilde
found a slight negative association between committable mental


32
heavy bias in the publications for middle-class values at
the expense of lower-class values. They concluded that the
mental health message was functional for the middle-class
sociocultural structure but contained dysfunctional potential
for the lower-class structure.
To the extent, however, that more subtle and
effective methods of social control are built
around the mental health movement in the
future, we may expect some pronounced dys
functional consequences for the lower-class
social structure.
(Gurslinn, et_ a_l. 1960:216).
Hollingshead and Redlich (1958) have described what
might be the results of a class-linked ideology on the actual
practice of psychiatry. They found that patients from the
higher social classes when seeking treatment for psychiatric
disorder will more likely receive long-term intensive psycho
therapy while lower-class patients more often receive short
term psychotherapy, drug therapy, or other somatherapy rather
than the more costly intensive psychotherapy. Schafer and
Myers (1954) found the same relationship even when the cost
of care was controlled by studying an indigents clinic in a
major teaching hospita1. Hollingshead and Redlich also found
that lower-class candidates for psychotherapy were not liked
or understood by the therapists and quit treatment much more
often than those from higher classes (Hollingshead and


47
rate almost twice that of the married. Rushing concludes,
A persons social and economic resources and
degree of community integration appears to be
significant contingencies in the tendency to
hospitalize. The results provide rather
consistent support for the societal reaction
perspective on deviance. (Rushing, 1971:524).
The present study is intended to complement Rushing's
findings by examining similar contingencies of a persons
either being released or found incompetent by a judicial
commitment proceeding. Rushing's study did not examine the
characteristics of those who avoided hospitalization, but
only compared the characteristics of those under voluntary
and involuntary hospitalization. This study compares those
who avoid involuntary commitment with those who do not.
Rushing notes that since he had no measure of behavior
pathology in his study, he could not determine the interaction,
if any, between social reactions and pathology. This study
will consider the effects of diagnosed pathology and psychia
tric history along with other social contingencies on the
final decision of a judicial competency hearing.


89
suggest that the role expectations for those below age 25
allow more varied behavior than do the expectations for the
older age groups. Violations of normative expectations by
this age group might be seen as passing phenomena rather
than as mental illness.
Sex
Sex does not appear to be a factor in one's being
brought before the court for an incompetency examination.
The 1970 census for Southern County shows that the population
over 14 years of age was distributed as follows: 49.4 per
cent males, and 50.6 per cent females. The comparable figures
for the total sample (Table 1) and for the analytic sample
(Table 2) are within one per cent of the census figures.
Race
Race is a factor in having one's competency examined
but it is not as important as age. The census breakdown for
race in Southern County is 79.3 per cent White and 20.7 per
cent Black. The percentages of Blacks for the total sample
(Table 1) and the analytic sample (Table 2) are 25.9 and
24.0 respectively. There are approximately 25 per cent more
incompetency examinations among Blacks than one would expect
if the variable, race, were not a factor in being selected


ACKNOWLEDGEMENTS
I would like to express my appreciation to several
individuals for their assistance and encouragement in writing
this paper. The order of presentation is chronological and
does not reflect importance. My thanks to Professor Walter
Probert from whom I first learned that for an understanding
of the law, one must understand the nature of both the society
and the individual. I would like to acknowledge Dr. Richard F
Larson who first encouraged me to study sociology and whose
continued encouragement and constructive criticism were
invaluable to my graduate education.
A special note of thanks to Dr. Benjamin L. Gorman, the
Chairman of my Supervisory Committee, whose continual patience
assistance, and encouragement made it possible for me to
complete this research.
This research was done under the auspices of National
Institute of Mental Health Grant number 15900-04 with John J.
Schwab, M.D., as Principal Investigator and George J. Warheit
as Project Director. My thanks to them for their support.
I am also grateful to Susan Josephson for her assistance
in data collection and to Linda Johnston, Linda Darby, and
Marilyn Allan for their patience and care in typing the
iii


149
TABLE 33. PER CENT EMPLOYED OR UNEMPLOYED BY MOST RECENT
OCCUPATION.
MOST RECENT EMPLOYMENT
OCCUPATION '
Employed Unemployed
Upper White-
collar
53.3
46.7
(n=30)
Lower White-
collar
Skilled-
40.0
60.0
(n=30)
working
36.0
64.0
(n=25)
Unskilled-
working
34.8
65.2
(n=66)
(N=15l)
= .14
= 3.12
= 3
25^-p-^. 15


72
collectors, porters, janitors, maids, and orderlies are
examples of occupations that would be coded in this
category. The skilied-working category encompasses all
blue-collar occupations which involve an extended period
of training or apprenticeship as a prerequisite to holding
the job. Examples of such occupations would be carpenter,
electrician, tool and dye maker, barber, and restaurant
cook. The lower white-collar classification is for occupa
tions which are white-collar but do not require a college
education for their performance and do not involve self-
employment. The bulk of the occupations coded in this
category were clerical, retail sales or low-level technical
positions. Examples from this classification are secretary,
store clerk or cashier, bookkeeper, mailman, lab assistant,
practical nurse, policeman, fireman, and teaching assistant
for a public school. The upper white-collar category is for
the professional-technical positions which require a college
education and for managers and proprietors of local businesses.
Examples from this category are physician, lawyer, certified
public accountant, school teacher, college professor, and owner
of a restaurant. The three remaining categories are for those
individuals whose records indicate that they have never been
employed. Married females who had never been employed and


121
not under present care, higher status is an important factor
in being found competent.
The association between sex and the courts judgment
remains under both control categories for alcohol problems
(Table 16), though the percentage discrepancy is smaller
under the no alcohol problems category. Of those cases
involving alcohol problems, 48.0 per cent of the males
were found competent compared to 20.7 per cent of the females
(0.26). When no alcohol problems were involved 34.1 per
cent of the males received competent dispositions compared
to 19.1 per cent of the females (0.19).
The hypothesis concerning sex and competent judgments
is supported. There is an exception; when in the situation
of being under psychiatric care at the time of the incom
petency proceedings, sex is a minimal factor in being
adjudged competent.
Marital Status
Table 17 presents the relationship between marital status
and the courts judgment without controls for psychiatric his
tory. (0.19). Those classified as married were adjudged compe
tent in 39.8 per cent of the cases, 11.8 per cent more than those
classified as single. The married received a higher percentage of


53
their training. The clinic sees patients who are referred
from other agencies or practitioners and who appear without
referral or appointment.
That the clinic might be an important factor in commit
ment proceeding is evident from its 1968 statistics. In
1968 the clinic had 4,001 individual visits for individual
therapy and 2,365 for group therapy. There were 294 new
patients seen in 1968 over the age of 18 and 154 under the
age of 18. Most of the 44 persons on trial visit from state
mental hospitals in 1968 were seen for after-care counseling
and medication. There were 3,776 prescriptions filled at the
clinic in 1968 of which 2,336 were for previous patients of
state mental hospitals and 1,440 for indigent patients.
Southern City contains a division office of Southern
States division of vocational rehabilitation, which serves
14 counties. One third of the cases of this local division
come from Southern County. Vocational rehabilitation is
funded by federal and state money, its services being avail-
*
able to individuals who are having employment problems due to
a physical or mental impairment. The services provided
include: (1) medical and nonmedical diagnosis to determine
what should be done in order for the client to be employable,
(2) vocational counseling for the selection of suitable


101
cent for those who were not under care.
The alcohol problems control variable is related to
the court's judgment. Of the group v/ith alcohol problems,
38.0 per cent were found competent compared to 24.8 per
cent for those without alcohol problems. The coefficient
of contingency (C) for this relationship is .17.
Each of the control variables is related to the court's
judgment. The present care variable has the strongest
relationship followed by the alcohol problems and prior
care variables. The fact that these variables are related
to the court's judgment justifies their use as control
variables. Their associations with the dependent variable
are not particularly strong; the largest percentage dif
ference between the yes and rro condition is 14.9 per cent
for the present care variable. We cannot say whether these
variables do an adequate job of controlling for individual
pathology. For purposes of this study, it would be desire-
able if all the individual subjects of the competency
hearings exhibited identical behavior or uniform degrees
of psychological pathology. Then, any differences in the
percentage of competent judgments between the various
categories of the independent variables could unambiguously


133
When the effects of alcohol problems are controlled
(Table 24), the some college group has the highest percen
tage of favorable judgments under both the control categories
55.6 per cent under the yes condition and 30.4 per cent under
the no condition (C=.26). As in the other education tables,
the below ninth grade group received the second highest
percentage of competent judgments; 43.8 per cent in the yes
category and 22.2 per cent in the no category. The ninth
through the twelfth grade group received 27.3 per cent
competencies in the yes category and 18.2 per cent in the
no category.
From the limited educational information available,
we can say that education has an effect on a person's
being adjudged incompetent. The effect is not linear; the
highest and lowest educational groups received the two
highest percentages of competent judgments in every
instance, The hypothesis concerning education and com
petency is supported, subject to the restrictions of
missing data and a non-linear relationship.
Occupation
Table 25 presents the uncontrolled relationship
between the prestige of the most recent occupation category


76
eliminate from consideration those cases explicitly diagnosed
as having a specific organic cause. Even the sharpest critics
of the medical-model of mental illness, such as Szasz (1961)
in his The Myth of Mental Illness, have conceded that certain
organic conditions truly fit the medical-model. The testing
of hypotheses will therefore be carried out using 278 cases,
a result of eliminating the 101 organic diagnoses from the
original 379 cases. A one-way frequency distribution of the
analytic variables and the diagnoses will be presented for
the total sample and for the analytic cases.
The hypotheses of the study will be tested by the
percentages of competent cases in two-way cross-tabulations
of the dependent variable, the courts judgment, with each of
the independent status variables. Percentages in three-way
cross-tabulations of each independent variable and separately
by each of the three control variables of prior psychiatric
care, present psychiatric care, and alcohol problems will
also be examined.
The three-way control cross-tabulations will determine
if the hypothesized relationships occur under each of the
separate control categories. Though the control variables
are not necessarily directly related to psychological pathology,
we can assume that in a county where psychiatric treatment is


63
notice of an incompetency hearing on the alleged incompetent.
This is a matter of convenience for the court. The lay
committee member merely signs the committee report as prepared
by one of the examining physicians. This practice would appear
contrary to the intent of the statute, for the lay member is
the same law officer in almost every instance and merely
rubber stamps the report. The examining committee report is
prepared on a standard printed one-page form which all the
members sign. The cause of the alleged incompetent's
condition is usually given in standard psychiatric diagnostic
terms like paranoid schizophrenic. The committee reports always
either finds the person competent or incompetent. No temporary
incompetent forms are provided and neither does the committee
ever change the form to read temporarily incompetent. In
almost every case studied where the judge found the alleged
incompetent temporarily incompetent, the person had signed a
petition for self-examination. But we cannot accept the
self-petitions as voluntary for in the 61 cases of seIf-petitions
studied there is evidence in 22 cases (over one-third) that
someone other than the self-petitioner initiated the proceeding.
In most of these cases the alleged incompetent signed a self
petition after the committee had already found him to be
incompetent. After signing the seIf-petition, the judge


12
sion of internal consequences, being intolerant
of non conformity and dissent, being distrustful
of others, having moral standards that strongly
emphasize obedience to the letter of the law. .
(Kohn, 1969:189).
One can suggest, from the value content of Kohn' s findings,
that a lower-class person, faced with a judicial hearing to
determine his sanity, might have the burden of a conformist
personality added to his low income, prestige, and power
position. The subjective factor of conformity and low self
confidence combined with the more objective factors of low
income, status, and power indicate that socioeconomic status
and judicial findings of sanity should be inversely related.
The present section has treated the individual position
in the stratification system as an independent variable
causally related to aspects of ones biogr^hy. The following
sections of this chapter will consider social control and
mental illness as variables dependent on the stratification
variables.


108
When not burdened with the pathology and labels associated
with being under psychiatric care, those in the age group
of 25 and under have a much higher percentage of individuals
adjudged competent than do the higher age groups.
Introducing a control for alcohol problems (Table 8),
we find the same relationship between age and being
adjudged competent. Though there were only four persons
*
under age 25 with alcohol problems mentioned in their court
or medical records, three of these or 75.0 per cent were
adjudged competent compared to 31.4 per cent of those 25-
44 and 41.0 per cent of those between the ages of 45 and
64. Considering the no alcohol problem category, the
relationship is not strong (C=.17); 27.3 per cent of the
youngest category being found competent compared to 20.0
per cent of the middle age category and 25.9 per cent of
the 45 to 64 category. The latter percentages are cer
tainly biased due to the 30 cases with missing information
in the below 25 age category. One would expect a much
stronger relationship if complete information on alcohol
problems were available.
In summary, a relationship between the age of the
alleged incompetent and adjudged competency was demon
strated. The association is present under the control


129
TABLE 21. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOM
PETENT, OR INCOMPETENT BY EDUCATION.
EDUCATION
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Some College
and above
38.1
28.6
33.3
3
II
W
9th 12th
27.2
17.3
55.5
(n=81)
Below 9th
30.8
13.5
55.8
(n=52)
Mentally
Deficient
0.0
25.0
75.0
(n= 4)
(N=179)
c* = -20
X *= 7.24
df = 4
. 10-^p p>.05
* Does not include mentally deficient category.


and of upper white-collar occupational status were associated
with judgments of competency. Such associations were
strongest under the control situation of not having been
under psychiatric care at the time of the proceedings.
For those under psychiatric care at the time of the proceedings,
the associations were minimal.
The independent variables, in descending order of their
importance for determining the courts judgment, were most
recent occupation, present occupational status, sex, marital
status, age, and race.
The findings were taken to support the general social
stratification proposition that high status individuals will
receive more positive outcomes from social control decision
making processes than will low status individuals. The
findings support a model of mental illness which takes into
account both social reactions and individual pathology.
xi


159
temporarily incompetent, or competent. Those under care
at the time of the proceedings received a lower percentage
of competent judgments, and a much higher percentage of
temporarily incompetent judgments that did the group who were
not under care. The effects of personal pathology were such
that, for those under care social status characteristics had
minimal associations with the court's judgment. One status
variable, most recent occupation, was related to the courts
judgment. The upper white-collar received a much higher
percentage of competent judgments than did the other occupational
categories. This indicates that a status characteristic which is
strongly associated with high education, income, prestige, and
power is n effective determinant of competency even when in the
situation of being under psychiatric care.
Social reactions are an important factor in involuntary
commitment proceedings. This is demonstrated by the previously
mentioned relationships between the social status variables and
the court's judgment; there was one relationship of moderate
strength in the under care situation and seven in the not under
care situation. Though personal pathologies are probably also
operating here, high status characteristics are in every
instance associated with being found competent when one is
not under care. A review of the literature on social status


51
collar and 42.9 per cent are Federal, State, or local
government employees. Only 7.5 per cent of the county's
employed work in manufacturing.
The income, educational and occupational characteristics
of Southern County are heavily influenced by the fact that
it is the location of a large state university which employs
highly educated and well paid individuals while attracting
other governmental and industrial employers who do the same.
One would expect that the level of mental health care facil
ities for Southern County would also be influenced by the
existence of a large state university.
Mental Health Care Resources
The mental health care resources for Southern County are
quite extensive. Except possibly for the number of private
practitioners, the alternatives for care in Southern County
are more extensive than in other comparable size counties.
This section briefly describes the different facilities for
mental health care in the county.
The number of counselors in private practice in Southern
County is not large but probably adequate to serve those who
can afford the high cost of their service. In 1969, the last
year covered by this study, there were three psychiatrists in


CHAPTER VI
CONCLUSIONS, INTERPRETATIONS, AND FURTHER RESEARCH
The purpose of this chapter is to relate the results of
this research to the theoretical and empirical work which
has gone before it, to go beyond the actual data in explaining
and interpreting the outcome of the study, and to suggest
directions for additional related research.
Prior Theory and Research
The previously-reviewed theoretical and empirical works
in social stratification, social control, and mental illness
have suggested that higher status individuals will fare better
in judicial incompetency proceedings than their lower status
counterparts. The data from this study unambiguously demon
strate that, for individuals not under psychiatric care at
the time of the incompetency proceeding, high status as
measured by seven variables is associated with adjudged
competency, For those under care at the time of the proceedings
occupational status is moderately related to adjudged competency
The effects of social inequality are among sociology's most
well documented relationships. Significantly, in this research
seven separate status variables were related to adjudged
154


of competent, temporarily incompetent, or incompetent.
The independent variables, which were conceptualized as
status contingencies of the court's judgment were: the
age, race, sex, marital status, education, most recent
occupation, and present employment status of the alleged
incompetent. Dichotomous controls classified the individuals
as either yes or no for three variables: a history of prior
psychiatric care, a history of problems with alcohol, and
having been under psychiatric care at the time of the
proceedings. Associations: between the dependent and indepen
dent variables were determined by the percentage distributions
in contingency tables.
The literature in social stratification, social control,
and deviant behavior offers a general hypothesis for this
research; high-status characteristics will be associated wi^h
j'udgments of legal competency. A proposition from the social
reactions perspective on mental illness suggests that judgments
of the court will be unrelated to individual pathology. A
finding that status characteristics are related to judgments
of the court while controlling for psychiatric history would
support the social reactions perspective.
The findings of this study follow. High status charac
teristics such as being young, male, white, married, employed,
x


117
Sex
The advantage of being a male when in an incompetency
proceeding is demonstrated by the relationship between sex
and court judgments in Table 13 (C=.25). Without controls
for psychiatric history, males were found competent in 43.1
per cent of the cases compared to 20.3 per cent for females.
Females received an advantage in judgments of temporary
incompetency by an 11.6 per cent margin.
When controlling for prior care (Table 14), the effect
of sex remains the same in the yes situation (C=.24) and
is reduced to a 10.7 per cent differential in the no cate
gory with its limited number of cases.
The discrepancy in competent judgments is reversed
slightly under the situation of being under care at the
time of the proceedings (Table 15: C=.ll), but is increased
substantially when considering the cases where the alleged
incompetent was not under care at the time of the proceedings
(C=.34). When examining only the cases not under care,
51.6 per cent of the males are found competent compared to
only 19.2 per cent of the females. As in the case of the
age and sex variables, being under psychiatric care
eliminates any substantial status advantage. When one is


78
sample from a particular sampled population their inferential
use is highly questionable. Significance tests will not be
used for hypothesis testing in this study because the
requirements for their meaningful use are not met.
The unavailability of significance tests does not
detract from the results of this study. With a total sample,
as in this study, we can be certain that any observed relation
ship between the independent and dependent variables is a
real relationship for the population studied. For instance,
for this study one could use a 50 per cent probability sample
of the cases from the identical three years, test.hypotheses
by significance tests and the conclusions which could be
drawn would be less certain than if one sampled the total
population as was done here.
The hypotheses in this study concern the relationship
between adjudged competency and several social status variables
The hypotheses will be tested only for the population studied
because data relative to any larger population is not available
The hypotheses do not posit any association between the status
variables and judgments of temporary incompetency because the
theory and prior empirical studies do not suggest any
particular relationship.
The particular hypotheses tested in this study concern


79
only the population sampled, but the results of this study
have implications beyond the limits of the cases studied.
Though we cannot legitimately test hypotheses relative to
it, there is implicit in this study a target population much
larger than the three years of incompetency cases in Southern
County. There is reason to believe the results of this study
might be representative of most jurisdictions which employ
psychiatrists as decision-makers for determining one's
sanity and freedom. Psychiatrists everywhere receive uniform
training and experience before being certified to practice
their profession. There is no reason to suspect that the
results of this study might be due to idiosyncratic practices
of psychiatrists in Southern County.
The hypotheses of study are drawn from a large body of
literature in social stratification, social control, and
mental illness. To the extent the hypotheses are supported,
this study has implications for all public decision-making
processes where individuals with varying status characteristics
are involved. When hypotheses drawn from a broad conceptual
area are supported by a study in a limited domain the broader
propositions from which the specific hypotheses are drawn
are strengthened.
Though the hypotheses are accepted or rejected on the


123
TABLE 17. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOM
PETENT, OR INCOMPETENT BY MARITAL STATUS, OF
ALLEGED INCOMPETENT.
MARITAL
STATUS
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Married
39.8
24.5
35.7
(n=98)
Single
28.0
15.8
56.1
(n=164)
(N=262)
.19
10.26
2
. 005^? p^>. 0005


96
TABLE 3. ONE-WAY FREQUENCY DISTRIBUTION OF TOTAL SAMPLE1
DIAGNOSIS (N=350) %
Simple Schizophrenia and Undifferentiated
Schizophrenia 18.9
Schizophrenia, Schizo-Affective 1.7
Paranoid Schizophrenia 16.3
Depression 14.0
Alcoholism 6.9
Chronic Brain Syndrome and Organic
Disorders 28.9
Suicidal 1.4
Personality Disorder 4.6
Manic Depressive Psychosis 1.7
Mental Deficiency 1.4
Drug Problems .6
Psychosis 2.6
Adolescent Adjustment Reaction .3
Sociopathic .6
Sexual Perversion .3
100.0
There were 29 cases with no diagnosis.


TABLE 32. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY PRESENT OCCUPATIONAL STATUS, CONTROLLING FOR ALCOHOL PROBLEMS.
ALCOHOL PROBLEMS
PRESENT YES NO
OCCUPA
TIONAL JUDGMENT JUDGMENT
STATUS Competent Temporarily Incompetent Competent Temporarily Incompetent
Incompetent Incompetent
Employed
56.6
23.8
19.6
Unemployed
30.4
23.9
45.7
Student
0.0
100.0
0.0
Retired
0.0
0.0
100.0
(n=21)
50.0
13.6
36.4
(n=22)
(n=46)
15.5
22.5
62.0
(n=71)
(n= 1)
28.6
14.3
57.1
(n= 7)
in=JJ_
66.6
0.0
33.3
(n= 3)
(N=69) (N=93)
c* =
.27
C* = .34
x2* =
5.38
X2* = 12.12
df =
2
df = 2
.05? p7^.025
. 005 0005
*
Does not include student or retired categories
147


118
TABLE 13. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOM
PETENT OR INCOMPETENT BY SEX.
SEX
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Male
43.1
13.0
43.9
(n=139)
Female
20.3
24.6
55.1
(n=138)
(N=277)
= .25
=18.20
=2
.ooos^p


4
Blau and Duncan found that the level of the father's
occupation positively influenced the level of the son's
education and first job. The level of the son's job
and education each in turn separately affected the level of
the son's present job. The father's occupational level also
had an independent positive affect on the son's present
occupation, while controlling for the effects of the son's
education and first job (Blau and Duncan, 1967:170).
It is evident that one's class or economic situation
has great impact on the biography of the particular individual.
The issue that is unsettled concerns the importance of the
dimension relative to the other variables. Which, if any,
dimension of stratification has the greatest effect on the
individual situation or the stratification system as a whole?
Most theorists assume the stratification variables are
interrelated in both their individual and societal influences.
The causal links and priorities are unclear.
The economic factor should be a very important determinant '
of the commitment decision-making process. The economically
advantaged can afford private psychiatric care as an alternative
to hospitalization in a state institution and can buy the
services of legal counsel and expert witnesses in order to
avoid commitment. The poor, if they wish to avoid commitment,
are left to their own limited resources.


20
each dependent on the other.
Without a social reality of crime, there would
be no reaction to crime. But on the other hand,
the reactions that are elicited in response to
crime are at the same time shaping the social
reality of crime. As persons react to crime,
they develop patterns of responses of the
future. (Quinney, 1970:278).
If we are to ever understand deviance we must gain
knowledge of public reactions to deviant behavior. Quinney
suggested that from the perspective of the individual,
responses to crime are influenced by knowledge about
deviance and how the individual perceives it (Quinney,
1970:279).


115
present psychiatric care, Whites are found competent somewhat
more than Blacks and are found to be capable of speedy
recovery a much greater percentage of the time. Under the
no care condition Whites were found competent in 14.9 per
cent more cases than Blacks (C=.16). The difference here
in temporary judgments is only 3.4 per cent.
Controlling for alcohol problems (Table 12), race has
a small influence on competency in the yes category (3.2
per cent difference: C=.18), but is of greater importance
in the no classification with an 8.3 per cent difference
between Whites and Blacks (C=.21). Whites have a much
higher proportion of temporary judgments in both instances.
Whites have a higher percentage of competent judgments
than Blacks in the uncontrolled situation and when controlling
for prior care, present care, and alcohol problems. When
the White advantage in being adjudged competent is small,
Whites are likely to have a compensatory advantage by
having a high proportion of their incompetents adjudged
as only temporary. The hypothesis concerning race and
adjudged competency is supported. There are two excep
tions. Under the conditions of being under present care
or having alcohol problems, the advantage in competent judg
ments is reduced and transferred to judgments of temporary
competency.


43
Haney and Michellute (1968). Their stud/ considered two
questions: (1) What demographic indices of a particular
jurisdiction best predict the percentage of adjudged incom
petents within a jurisdiction? (2) What individual
characteristics best predict an individual's being judged
incompetent rather than competent? Because of the limited
relevance of the first question to this research, only the
data for the second question will be considered here.
For the individual research, Haney and Michellute gathered
data on every case of a judicial examination of incompetency in
five representative Florida counties, in a three-month period.
There were complete data on 571 cases. The independent variables
were age, race and sex of the individuals, the number of
psychiatrists bn the examining committee, and whether the
petition for commitment was by the family of the alleged
incompetent or not.
The dependent variable was whether the individual was
adjudged incompetent, temporarily incompetent (six months
commitment and no loss of civil rights), or competent.
The overall percentage of those found incompetent or
temporarily incompetent was 75 per cent. Sex demonstrated
very little effect on adjudged incompetency. There was a
slightly higher percentage of non-whites adjudged incompetent


170
Merton,
1957
Robert K.
Social Theory and Social Structure.
Illinois: The Free Press.
Glencoe,
Miller, Dorth and Michael Schwartz
1966 "County lunacy commission hearings: Some observations
of commitments to a state mental hospital." Social
Problems 14(Summer):26-35.
Miller ,
1961
S. M. and Frank Riessman
"The working class subculture:
Problems 9(Summer) :86-97.
A new view." Social
Mills C. Wright
1956 The Power Elite. New York: Oxford University Press.
North, C. C. and Paul K. Hatt.
1947 "Jobs and occupations: A popular evaluation." Public
Opinion News 9(September):3-13.
Odegaard, 0.
1956 "The incidence of psychoses in various occupations."
International Journal of Social Psychiatry 26:315-351.
Parsons, Talcott H.
1951 The Social System. Glencoe, Illinois: The Free Press.
Piliavin, Irving and Scott Briar
1964 "Police encounters with juveniles." American Journal
of Sociology 70(September) :206-214.
Pfautz, Harold W. and Otis Dudley Duncan
1950 "A critical evaluation of Warners work in community
stratification. American Sociological Review l5(April):
205-215.
Presthus, Robert
1964 Men at the Top: A Study in Community Power. New York:
Oxford University Press.
Quinney, Richard
1970 The Social Reality of Crime. Boston: Little-Brown.
Riesman, David e_t_ a 1.
1952 The Lonely Crowd. New Haven: Yale University Press.


TABLE 27. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY MOST RECENT OCCUPATION, CONTROLLING FOR PRESENT PSYCHIATRIC CARE.
PRESENT CARE
YES NO
MOST RECENT
OCCUPATION
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Upper White-
collar
40.0
30.0
30.0
(n=10)
66.7
0.0
33.3
(n=12)
Lower White-
collar
25.0
18.8
56.3
(n=16)
37.5
25.0
37.5
(n= 8)
Skilled-
working
20.0
40.0
40.0
(n=10)
41.7
25.0
33.3
(n=12)
Unskilled-
working
22.2
16.7
61.1
(n=18)
39.5
7.9
52.6
(n=38)
Student s
12.5
50.0
37.5
(n= 8)
66.7
33.3
0.0
(n= 3)
Housewives
16.7
44.4
38.9
(n=18)
37.7
12.5
50.0
(n= 8)
Never
Employed
37.5
12.5
50.0
8)
8.3
8.3
83.3
(N=88) (N=93)
139


33
Redlich, 1958 :335-355) .
A study which asks whether the clinician is class-biased
in terms of diagnosis was done by Haase (1964). Seventy-five
psychologists were asked to evaluate a series of Rorschach
protocols and to give impressions prior to diagnosis, a
diagnosis and a prognosis for each one. The diagnosticians
were presented eight protocols consisting of four matched
pairs which differed only in terms of subtle clues to the
socioeconomic status of the client. The results showed a
strong class bias.

In every case except one, they were biased in
favor of the middle-class with a probability
beyond the .01 level. Whether we examine the
clinicians impressions prior to diagnosis, the
diagnosis itself, or the prognosis, the direc
tion of the bias is always the same--it favors
the middle class. (Haase, 1964:244).
Haase concludes as follows:
The immediate interpretation is the one that
emphasized the formal academic preparation and
the correlative social processes that inculcate
the class identification upon the noviate
professional. We would agree with Kingsley
Davis that the content of mental hygiene is
predominantly middle-class and that there is
unverbalized agreement among the practitioners
of psychology that the lower class cannot
totally assimilate the ways of thinking and
behaving that alone can insure prevention and
cure of maladjustment (Haase, 1964:244).


70
temporarily incompetent, or incompetent depending on the
final judgment of the court. In the few cases where a
judgment of the court was not entered, the case was coded
competent, for that is the legal effect of withholding
judgment.
The independent variables for the study, conceptualized
as status contingencies of the social reaction, are the age,
sex, race, marital status, education, most recent occupation,
and the present occupational situation of the alleged
incompetent.
The age of the alleged incompetent was coded into four
categories: 14 to 25 years of age, 25 to 44 years of age,
45 to 64 years of age, and 65 years and over.
Sex and race were coded into only two categories each,
male or female, and black or white.
Marital status of the alleged incompetent as of the
start of the proceedings was also coded into two categories,
single or married. The single category includes the unmarried,
those not living with their spouse, and those divorced.
The educational attainment of the alleged incompetent
was coded into four categories: those diagnosed as mentally
deficient, education of less than ninth grade, education of
ninth through twelfth grade, and some college and above.


2
Two other conceptual areas are related. Social control,
is an intervening variable or a mediating concept which links
stratification to judicial fate. The third concept is that
of mental illness, the official legitimation of judicial fate.
In this chapter we will consider each one of these concepts
and the theoretical relationships among them--both generally
and with specific reference to the problem at hand.
Individuals are unequal in many way s. Max Weber (Gerth
and Mills, 1958:180-195) first recognized that a person's
position in the stratification order was based on not one
but several criteria. For Weber the stratification order
had three dimensions. The three dimensions of stratification
were class, status, and party. Each dimension on an individual
and group level was seen as influencing the other. Weber's
model of the stratification system still serves as a starting
point for any serious study of social inequality.
Class
Weber's conception of the class-situation being grounded
in the economic order or market-situation is very similar to
Marx's idea of social class with the exception that, for
Weber, class consciousness and class action do not necessarily
follow from a specific class-situation.


TABLE 16. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY SEX, CONTROLLING FOR ALCOHOL PROBLEMS.
ALCOHOL PROBLEMS
YES NO
SEX
JUDGMENT JUDGMENT
Competent temporarily Incompetent Competent Temporarily Incompetent
Incompetent Incompetent
Ma le
48.0
18.0
34.0
(n=50)
34.1
12.2
Female
20.7
31.0
48.3
(n=29)
19.1
23.5
(N=79)
53.7 (n=4l)
57.4 (n=68)
(N=109)
C = .26
X2 = 5.93
df = 2
.05 ^p ;>.025
= .19
= 4.01
= 2
. 10^p^.05
122


169
j
Kituse,
1962
John
"Societal reactions to deviant behavior:
of theory and methods." Social Problems
247-256.
Problems
9(Winter):
Kohn, Melvin
1969 Class and
Illinois:
Conformity: A Study in Values.
Dorsey Press.
Homewood,
Kornhauser, Ruth Rostner
1953 "The Warner approach to social stratification."
Pp. 224-255 in Reinhard Bendix and Seymour Lipset
(eds.) Class, Status, and Power. Glencoe, Illinois:
The Free Press.
Kuhn, Thomas S.
1970 The Structure of Scientific Revolutions. Chicago:
University of Chicago Press.
Kutner, Luis
1962 "The illusion of due process in commitment proceedings."
Northwestern Law Review 57(September):383-399.
Laumann, Edward 0.
1966 Prestige and Association in an Urban Community.
Indianapolis: Bobbs-Merri11 Co.
Lemert, Edwin M.
1946 "Legal commitment and social control." Sociology and
Social Research 30:370-378.
1951 Social Pathology. New York: McGraw-Hill.
1967 Human Deviance, Social Problems and Social Control.
Englewood Cliffs, New Jersey: Prentice-Hall, Inc.
1972 Human Deviance, Social Problems and Social Control.
Englewood Cliffs, New Jersey: Prentice-Hall, Inc.
Lord, Walter
1955 A Night to Remember. New York: Henry Holt.
Mechanic, David
1962 "Some factors in identifying and defining mental
illness." Mental Hygiene 46 (January):66-74.


I
TABLE 18. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY MARITAL STATUS, CONTROLLING FOR PRIOR PSYCHIATRIC CARE.
MARITAL
STATUS
Competent
YES
JUDGMENT
Temporarily
Incompetent
PRIOR CARE
Incompetent Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
Married
33.9
29.0
37.1 (n=62) 58.3
0.0
41.7
(n=12)
Single
25.2
19.2
55.6 (n=99) 29.2
12.5
58.3
(n=24)
(N=161)
(N=36)
V JLO
X2 = 5.28
df = 2
05>p^-.025
125


68
patient indexes at the four facilities were checked for
all names of those in the court sample. The records of
those in the sample who had used the facility at any time
were consulted for supplementary data. After all the data
had been abstracted and coded all names were destroyed.
Names were used initially only because that was the only
method of access to ,the hospital and clinic data. The names
in court files are, of course, a matter of public record.
The amount of information in a court file varies from
case to case, but each file contains the minimum court forms
for the processing of a case. Almost every file will
contain: a petition giving the name, age, sex, race, and
family members of the alleged incompetent and the petitioner
or petitioners who ask that he be adjudged incompetent; a
copy of the notice of incompstency proceedings which will
indicate the present address of the alleged incompetent and
whether he is presently confined in a hospital or jail; an
examining committee report which gives the names of members of
the examining committee, their findings relative to the
incompetency of the person and their diagnosis of his condition
if they find him incompetent; a final judgment of the court
which legally determines if the individual is competent,
incompetent, or temporarily incompetent and which may spell


29
studies concerning hospital commitment by Wilde (1968), Wenger
and Fletcher (1968), and Scheff (1966). Gove suggested that
if the labeling perspective on mental illness is correct
there would . .
. .be only a slight relationship between degree
of psychiatric disturbance and commitment to a
mental hospital, and 2) the more powerful a person
is, the more likely he is to be able to avoid
attempts to commit him to a mental hospital.
(Gove, 1970a;295).
Goves hypothesis would seem to reasonably follow from
the labeling perspective on mental illness. Gove and those
he criticizes are considered for relevance to this study's
hypotheses in a later chapter.
We might characterize the current theoretical situation
in the field of mental illness as being a contest between two
competing ideal-typical paradigms, the psychiatric pathology
model, and the labeling or social reactions approach. Some
empirical evidence could be interpreted to suggest one, both, or
neither of the models. No one has yet suggested the crucial
test to disprove either model, if in fact such a test could be
specified. The models are closely tied to particular profes-
sions and possibly world views, consequently they will not
crumble from one or several critical articles. It is probably
the fact that some validity is in each of the views and that a
synthesis is in order. It has not been logically demonstrated
that evidence for one perspective necessarily negates the other.


73
were not students were coded as housewives. Males and
unmarried females who were not students, whose records so
indicated, were coded never employed. Students over
eighteen were coded studen ts.
For the employment situation at the start of commit
ment proceedings variable, those unemployed at the time and
housewives were coded unemployed, all students were coded
students, those employed at the time were coded employed and
the retired were so classified.
For control purposes, three dichotomous indicators of
psychological pathology were collected from the records; prior
psychiatric care, present psychiatric care, and alcohol
problems. An individual was coded as having received psychia
tric care prior to the commitment proceeding if the records
indicated that prior to the start of the proceedings and not as
a result of any problem or incident which precipitated the
proceedings the individual had received care from a physician,
psychiatrist, or mental health clinic, for an emotional or
mental problem, or had been hospitalized for such a problem.
If the record indicated that he had not received such care,
the case was so coded. If records did not specify either way
the case was coded as no information.
A separate control variable is whether the alleged


146
Controlling for alcohol problems (Table 32) the
eraployeds received the highest percentage of competent
judgments under both control situations. Considering
those with alcohol problems, the employed received 56.1
per cent competent judgments and the unemployed 30.4
per cent (C=.27). Under the no situation the employed
received 50.0 per cent competent judgments and the unem
ployed 15.5 per cent (C=.34). Based on a very small
number of cases, students received 28.6 per cent and the
retired 66.6 per cent.
Being employed is definitely related to one's being
found competent by a judicial decision. Except for the
students and retired, whose percentages were based on a
very small number of cases, the employed received a
much higher percentage of competent judgments than the
unemployed in every control condition. The hypothesis
concerning employment and competency is supported.
Employment and Occupation
Due to the high association between being employed
at the time of the proceedings and receiving a judgment of
competency, one might ask if the relationship between
one's most recent occupation and competency might be due


TABLE 23. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY EDUCATION, CONTROLLING FOR PRESENT PSYCHIATRIC CARE.
EDUCATION
YES
JUDGMENT
Competent Temporarily
Incompetent
PRESENT
Incompetent
CARE
Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
Some college
and above
34.8
39.1
26.1
(n=23)
54.5
18.2
27.3
(n=ll)
9th 12th
16.2
24.3
59.5
(n=37)
25.0
10.7
64.3
(n=28)
Below 9th
38.5
23.1
38.5
(n=13)
28.1
9.4
62.5
(n=32)
Mentally
Deficient
0.0
0.0
0.0
lf21
0.0
0.0
100.0
(n= 2)
(N=73)
(N=73)
C* = .32
X2* =9.70
df = 4
.025>p-J>.005
* Does not include mentally deficient
category.
132


65
that this'is in accord with the examining psychiatrists'
wishes. In many of these cases there are indications that
the psychiatrist feels that the patient can benefit from
care outside the state hospital and that outpatient care will
suffice. The hearings are private, being held in the judge's
chambers. The examining psychiatrists or physicians are
generally present only if he or the alleged incompetent requests
it. The hearing, actually a formality, hardly ever lasts
beyond 15 minutes. If a person is found incompetent and is to
be admitted to a state hospital, the clerk applies to the
administrator of the state hospital. When a place for the
patient opens the court is notified. The court attempts to
persuade the family of the patient to take him to the state
hospital for admittance. If this is not possible a county
sheriff's deputy transports the patient.


148
to the effects of employment. Table 33 presents the
percentage of those employed by the most recent occupa
tion in order to partially answer this question. There
is a definite relationship demonstrated between occupa
tional prestige and employment (C=.14) but not of such
strength or direction as to account for the relationship
between occupation and competency. The relationship in
Table 33 is approximately linear with the percentage of
employed increasing from 34.8 per cent in the unskilled-
working to 53.3 per cent in the upper white-collar. The
uncontrolled relationship between occupation and competency
(Table 25) is not linear and is stronger. We may conclude
that employment has some effect on the relationship between
occupation and competency but that the employment effect
is not of sufficient magnitude to account for all of the
occupational effects.
Summary of Analyses
Table 34 presents the percentage differences in compe
tent judgments between the categories of the independent
variables which demonstrated the highest and second highest
percentage of competent judgments in the uncontrolled tables.
This table, though lacking much of the information found in


LIST OF TABLES
Table
13
14
15
16
17
18
19
20
21
22
23
Page
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY SEX . 118
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY SEX, CONTROL
LING FOR PRIOR PSYCHIATRIC CARE . 119
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY SEX, CONTROL
LING FOR PRESENT PSYCHIATRIC CARE . 120
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY SEX, CONTROL
LING FOR ALCOHOL PROBLEMS 122
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MARITAL
STATUS, OF ALLEGED INCOMPETENT .... 123
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MARITAL
STATUS, CONTROLLING FOR PRIOR PSYCHIATRIC
CARE . 125
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MARITAL
STATUS, CONTROLLING FOR PRESENT PSYCHIATRIC
CARE 126
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MARITAL
STATUS, CONTROLLING FOR ALCOHOL PROBLEMS 127
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY EDUCATION 129
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY EDUCATION,
CONTROLLING FOR PRIOR PSYCHIATRIC CARE . 131
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY EDUCATION,
CONTROLLING FOR PRESENT PSYCHIATRIC CARE 132
vii


CHAPTER IV
DATA AND HYPOTHESES
This chapter will describe the sources of the data,
the methods used in collecting and analyzing the data, and
the hypotheses to be tested.
The Data
The data for this study are drawn from archival sources
rather than from a standard sociological survey. The use of
available records offers both advantages and disadvantages.
Measures drawn from archives are non-reactive in that the
researcher's presence does not affect the content of the
record. Where a crucial variable, as in this study, is the
decision of a public agency, reliance on the record rather
than a participant's memory can eliminate measurement error.
A major problem with archival data is that the general
scope of the records and the detail of individual cases are
not under the investigator's control. The archive might not
contain the measures needed by the researcher or there might
be missing information on particular cases.
With the strengths and weaknesses of archival data in
66


91
The 1970 census classifies 35.1 per cent of those 25
or older in Southern County as having completed one year or
more of college. In the present study only 22.8 per cent
of the total sample (Table 1) and 23.7 per cent of the
analytic sample (Table 2) are coded as having at least some
college experience or above. Forty-three per cent of
Southern Countys 1970 population who were 25 years and
older received between 1 and 4 years of high school education.
In this study 39.1 per cent of the total sample and 46.4 per
cent of the analytic sample are so classified. Only 19.0
per cent of the county's population above age 25 received only
between 1 and 8 years of schooling. In the present study,
38.1 per cent of the total sample and 31.0 per cent of the
analytic sample did not reach ninth grade or were mentally
deficient.
A comparison of the present study's educational attain
ment distribution with that of the census demonstrated a
lower educational distribution for the individuals who were
before the court. However, one should keep in mind the large
number of cases for which educational data are missing.
Occupation
The occupational distribution of the present sample


130
Controlling for prior care (Table 22) the relation
ship remains the same under the yes category (C=.23) and
is strengthened considerably in the njo situation where 100
per cent of those with some college were found competent.
The small number of cases in the no category makes this
association unreliable.
Table 23 presents the association between education
and the court's judgment while controlling for present
psychiatric care. The relationship under the situation
of being under care (C=.32) is such that those below ninth
grade received the highest percentage of competent judgments
(38.5). The category of some college received 34.8 per
cent competent judgments. The lowest percentage of com
petencies was obtained by the ninth through twelfth grade
category (16.2 per cent).
In the no present care category the some college
group received 54.5 per cent competent judgments, the
highest proportion for a group yet considered. The below
ninth grade group received 28.1 per cent competent judg
ments under the no condition; the ninth through twelfth
grade group received 25.0 per cent. It should be noted
that the some college group received the highest percen
tage of temporary judgments in both control categories.


19
considered deviant led him to suggest that ". .there may be
only one sense in which all deviants are alike; very simply,
the fact that some social audience regards them and treats
them as deviants (Simmons, 1965:225)."
Becker (1963) in his Outsiders, expounded what Schur
(1969:311) calls "the central statement of the reactions
orientation."
. . social groups create deviance by making
rules whose infraction constitutes deviance, and
by applying those rules to particular people and
labeling them outsiders. From this point of view,
deviance is not a quality of the act the person
commits, but rather a consequence of the application
by others of rules and sanctions to an offender.
The deviant is one to whom the label has success
fully been applied; deviant behavior is behavior
that people so label. (Becker, 1963:9).
Schur (1969) critically examined the reactions orientation,
and while concluding that even though the orientation might not
meet the strict criteria for being a self-contained theory, he
noted that it offers great promise for the integration of
deviance theory due to its own diverse origins. The fact that
the reaction's orientation, depending on the individual
proponent, may contain elements of interactionism, functional
ism, ethnomethodology, or conflict theory provides a basis for
theory unification (Schur, 1969: 320).
Richard Quinney (1970) asserted that public reactions to
deviance and the social reality of deviance are in interaction,


CHAPTER V
DATA DESCRIPTION AND ANALYSIS
This chapter will present separate frequency distri
butions for the total sample and for the analytic sample.
A comparison of the distributions of the demographic variables
with census information1 for the total population of Southern
County will give insight into the social control selection
process operating prior to the formal decision-making
process. The data analysis will determine whether status-
related criteria are operative later in the judicial setting.
Description of the Cases
Aae
A comparison of the Southern County age distribution
with the total sample (Table 1), and the analytic sample
(Table 2) demonstrates that age is a factor in the process
that determines which persons are to have thir competency
examined. In 1970 the population of Southern County above
the age of 14 was distributed as follows: 40.7 per cent
between the ages of 14 and 24, 31.0 per cent between the ages
^Census figures for this chapter are from the U.S. Bureau of
the Census, 1970 Census of Population and Housing, for the
Southern County standard metropolitan statistical area.
85


9
higher social strata. The influence of power might best
be examined within this higher occupational group. The
dimension of power would appear to be a very important
variable for consideration when examining civil commitment,
for the situation could be conceived as one where the
individual being commited is in a struggle against those
who petition for his commitment. The problem remains, however,
of separating power effects from those of other dimensions.
Associated Variables
Gordon (1958) has distinguished two additional variables,
which are important for any inquiry into the effects of social
stratification. Gordon's associated variables are called
group life and cultural attributes. Group life refers to
the extent that a class is:
. . an effective social system within which
the class member has most or all of his intimate
and meaningful social contacts.
(Gordon, 1958:18).
Cultural attributes are the patterns of behavior and attitudes
which might serve to differentiate a particular social class.
These associated variables are not hierarchical in nature--
as are the stratification variables of class, status, and
power--but are behavioral categories which are produced by the
operation of the stratification variables.


98
official reaction of the court is determined by factors
other than individual pathology. Ninety-three per cent
of the present cases were diagnosed as having psychiatric
disorders while only 73 per cent were found incompetent,
a fact which indicates that some individuals with similar
diagnostic labels receive different final judgments. A
more significant test of the two models of mental illness
would be to determine whether status-linked characteristics
which are unassociated with mental impairment in a general
population are associated with legal labeling once one is
before the court. If such associations are shown to exist,
while controlling for psychiatric history, the evidence would
support a model based in part on social reactions. The
analyses of the next section should provide such a test.
Data Analysis
This section will examine the percentages of cases
which resulted in legal judgments of competency in the
categories of the seven independent variables. Because
this study involves a complete sampling of a population,
the hypotheses will be considered in the light of the size
of the percentage differences between the categories of


52
private practice in Southern County, all located in Southern
City. The same year the number of practicing psychologists
was seven. Two marriage counselors were practicing in
1969 for a total of 12 private professionals engaged in
counseling or approximately one for each 6,200 residents of
Southern County who are above age 14.
The County Mental Health Service is the major supplier
of mental health care in Southern County. Funded by the state
and county government, this facility is under the direction of
the county health department. The major functions of the
clinic are: (1) Providing professional counseling and drugs
for patients on trial visit from the state mental hospitals,
(2) Consultation services for teachers and parents about
emotional problems of children, (3) Diagnostic testing in
consultation with school psychologists, (4) Individual and
group short term therapy, and (5) Providing prescribed drugs
for indigent patients.
The Mental Health Services Clinic is staffed by a
psychiatrist-director, one full-time psychologist, one half
time psychologist, two psychiatric nurses, two social workers,
and two secretaries. Residents in psychiatry from the univer
sity medical school and interns in clinical psychology from
the university are active in working at the clinic as part of


97
organic disorders have a much higher rate of adjudged
incompetence than do those with functional diagnoses.
The infrequent use of the judgment of temporarily incompetent,
14.1 per cent of the total sample and 18.8 per cent of the
analytic sample, is probably due to the previously mentioned
fact that the court limited temporary incompetence to those
individuals who signed their own petitions, often after
someone else had initiated the proceedings.
It is difficult to translate the observed percentage
of incompetent judgments in the present study to a statement
which either supports or casts doubt on the social reactions
model of mental illness. Some authors have cited high
percentages of commitments as evidence for the social
reactions model, but logically even a one hundred per-'cent
commitment rate would not support the social reactions model,
if the individuals committed were shown to have pathologies
which fit the medical model and the legal criteria for
hospitalization. Obviously social reactions are involved
in every instance of one being brought before the court for
an incompetency hearing. Someone must react to start the
proceedings; the judgment of the court is itself an official
societal reaction. The important question is not whether
social reactions are a part of commitment but whether the


71
There are two occupational variables, the most recent
occupation of the alleged incompetent, and the employment
situation at the time the commitment proceeding was started.
The most recent occupation variable was used to obtain
an indication of the occupational status and training of the
alleged incompetent irrespective of the fact that he might
be unemployed at the time the proceedings began. If the
court and agency records did not list an occupation for the
alleged incompetent, the city directory for Southern City
was consulted to place the person in an occupational category.
The reliability of the city directory classifications was
checked against a sample of persons whose occupation was
available from court and agency records. The reliability
was 100 per cent. Those eighteen years of age and under were
classified by the occupation of their father.
There are four occupation categories and three residual
categories for the most recent occupation variable. The four
employed categories are unskilled-working, skilled-working,
lower white-collar, and upper white-collar. Three other
categories are students, housewives, and never employed.
The unskilled-working category is made up of manual workers
whose jobs require little skill or training. Manual laborers,
filling station attendants, local truck drivers, and garbage


87
TABLE 2. ONE-WAY DISTRIBUTION OF THE ANALYTIC SAMPLE1
AGE (N=278)
%
MOST RECENT
OCCUPATION (N=231)
%
14-24
24.1
25-44
41.0
Unskilled-working
31.6
45-64
31.3
Skilled-working
11.7
65 & over
3.6
Lower White-collar
13.9
Upper White-collar
13.4
SEX (N=278)
Housewives
13.9
Students
6.1
Male
50.0
Never Employed t
9.5
Female
50.0
No information
16.9
RACE (N=275)
PRESENT EMPLOY-
MENT STATUS (N=235)
White
76.0
Black
24.0
Employed
26.0
No information
1.1
Unemployed
64.7
Student
6.0
MARITAL
Retired
3.4
STATUS (N=263)
.No information
15.5
Single
62.7
EDUCATION (N=201)
Married
39.3
No information
5.4
Mentally deficient
2.8
Below 9th
28.7
PRIOR
9th 12th
44.6
PSYCHIATRIC
Some College & above
23.7
CARE (N=202)
No information
34.9
Yes
81.7
ALCOHOL
No
18.3
PROBLEMS (N=188)
No information
27.3
Yes
42.0
PRESENT
No
58.0
PSYCHIATRIC
No information
32.4
CARE (N=207)
JUDGMENT (N=277)
Yes
46.8
No
53.2
Competent
31.8
No information
25.5
Temporarily
Incompetent
18.8
Incompetent
49.4
No information percentages are based on 278 cases. All other
percentages are based on the number of cases with valid infor
mation for the variable. Again, the term sample is used for
case of reference, though a total population of non-organically
diagnosed cases is involved.


88
of 25 and 44, 15.1 per cent between the ages of 45 and 65,
and 6.3 per cent above the age of 65. The age distributions
of the total sample and the analytic sample are weighted
much heavier in the age brackets containing those 25 years
of age and above. Only 18.2 per cent of the total sample
and 24.1 per cent of the analytic sample are between age 14
and 24. There are 55.8 per cent fewer incompetency proceedings
for those between the ages of 14 and 24 than is expected under
the condition of a random selection from the population of
Southern County.
The distribution of the total sample is over-represented
by those between 45 and 64.(29.6 per cent) and by those over
65 (20.8 per cent). The age bracket 25-44 (31.4 per cent) is
almost the same as the population percentage. Considering
all cases with both functional and organic diagnoses, those
below 25 and those above 45 are over-represented.
The analytic sample contains a smaller proportion of
persons above 65 and below 25 and a larger proportion of
persons between 25 and 64 than the population of Southern
County. The shift in the percentages of those age 25 to 44
and age 65 and over is a result of eliminating 101 cases with
organic diagnoses.
From a labeling or social reactions perspective one might




90
for examination.
Marital Status
Marital status is a factor in one's being before the
court for an incompetency hearing. Southern County in 1970
had 45.8 per cent of the above age 14 population in the
combined category of single, widowed, divorced, or separated,
while 61.4 per cent were so classified in the distribution
of the total sample (Table 1) and 62.7 per cent in the
distribution of the analytic sample (Table 2). There were
25 per cent more incompetency cases for those classified
as single than would be expected if marrieds and singles had
equal chances of being brought before the court.
Educa ti on
Conclusive statements about the effects of education on
selection for incompetency proceedings are not possible
because the census categories and the educational categories
are not identical. An additional reason for being uncertain
concerning educational effects is that educational information
is missing from 43 per cent of the total sample and from 35
per cent of the analytic sample. It does appear, though,
that the analytic sample and the total sample have a lower
overall educational attainment than the population of Southern
County.


26
certain aspects of the disease framework.
Taber et_ aj_. (1969) presented a picture of a dominant
disease ideology beset by several explanations alternative
to the pathology model, each with the common theme that
mental illness is behavior on which social judgment is passed.
The disease model was said to consist' of four propositions
concerning nosology, pathology, etiology, and therapy. The
practitioner or researcher who works under the disease
model was said to implicitly or explicitly assume regarding
mental illness: (1) that qualitatively different states of
disorder exist and can be recognized; (2) that there is an
illness process within the organism persisting over time;
(3) that there is a causal agent and causal sequence involved
and; (4) that various therapeutic treatments can make a
difference (Taber e^t a 1. 1969:350-352). Taber concludes
that the disease model is largely unsubstantiated by evidence
and partly controverted by research. Nevertheless, the
disease ideology has shaped the social institutions of mental
illness and is a pervasive influence on research (Taber £t^ aj^. ,
1969:352).
Societal Reactions and Mental Illness
Among the alternative formulations considered by Taber
(1969) was the previously mentioned theory of Scheff (1966).


17
treatment of such an approach. After Frank Tannenbaum's
(1938) early work, which did take into account the part of
the deviant's audience in creating a deviant role, came five
leaders in the reactions approach to deviance: Lemert (1951),
Kituse (1962), Erickson (1962), Simmons (1965), and Becker
(1963).
Lemert (1951) compiled one of the first systematic
treatments of the social reactions approach. Central to his
theory were the concepts of social differentiation, deviation,
and individuation. The deviant was defined as
. . one whose role, status, function and
self-definition are importantly shaped by
how much deviation he engages in, by the
degree of its social visibility, by the
particular exposure he has to the societal
reaction, and by the nature and strength
of the societal reaction.
(Lemert, 1951:23).
Kai T. Erickson presented a deviance position that falls
within the labeling or interactionist perspective but remains
unique. Drawing on Durkheim's writing on deviance, Erickson
wrote that deviance is not pathological but functional for
society. The deviant was seen as charting the boundary limits
of the social system and providing a reference point for the
type of behavior which belongs in the system. Erickson
entered the fold of the labeling approach when he pursued


75
For descriptive purposes and for use as an indication
of the pathology of those not adjudged incompetent, the
diagnosis of the examinings committee was coded. If there
was no diagnosis from the examining committee, as was often
the case with those found competent, any hospital or clinic
diagnosis was coded if it was made at the same time as the
incompetency proceedings. The diagnoses were coded as
closely as possible to the actual diagnosis. Most diagnoses
were in the form of specific diagnostic terms such as manic-
depressive psychosis. Some were in broad categories like
psychosis, depression, or suicidal, and were so coded.
The Analytic Cases
An examination of the distribution of coded diagnoses
revealed that a great many of the cases were diagnosed as
conditions with organic causes. Most of these type cases
were diagnosed as chronic brain syndrome, secondary to
cerebral arteriosclerosis, a condition usually associated
with old age. A few of these cases involved brain damage
due to trauma. One hundred and one of the total sample of
379 cases were diagnosed as conditions with organic causes.
It was decided that an analysis that was based in part
on the social reactions model of mental illness should


40
illness and approval of a petition and a positive association
between the petitioners diligence and approval of the
petition. Controlling for committable mental illness, the
association between having an appointment and petition
approval remained positive. The results were interpreted
to be consistent with the societal reactions perspective.
Gove (1970a:297-298) has challenged Wildes conclusions on
the grounds that the sample was not representative, that the
low approval rate for petitions from the general public (33
per cent) was indicative of careful screening, and that the
interview protocols offered a tenuous index of mental illness.
Status Characteristics and Commitment
The societal reactions perspective on deviance places
considerable emphasis on the aspect of differential power
between the deviant and the agencies and agents of social
control. The effect of power on the outcome of commitment
hearings has been incidentally studied by Wenger and Fletcher
(1969). Though not designed as a test of the social reaction
perspective, their study examined the effect of legal counsel
on commitment. Retention of counsel is an index of power and,
therefore, relevant to that perspective.
The researchers in their study observed 81 commitment


incompetency. Note that this question is not focused on
one theme of the reactions model which posits a relationship
between social reactions and the continuation of the actual
behavior indicative of mental illness. The question here
concerns the relative importance of social reactions and
personal pathology for official labeling. The implication
is that if the official use of psychiatric labels is unrelated
to personal pathology, then the medical model's ideas of
nosology and pathology are of questionable validity. If
official insanity is not related to psychologica1 disorder,
then social status and power will determine whether the
stigm3tic official labels are applied. If social factors of
the individual case determine its outcome, psychiatric justice
can, then, be demonstrated to be no more rational than
criminal justice.
The problem with this reasoning is that it assumes that
only one of the competing models can be valid. A goal of
scientific explanation is parsimony, but social reality
seldom corresponds to simple explanations. Psychiatric
concepts such as ego strength, regression, and fixation and
sociological concepts such as primary deviance, labeling, and
secondary deviance may all have validity as well as utility
in explaining mental illness; reference to both pathology and


35
start the commitment process were signed as a matter of course
after the alleged incompetent was already confined, that the
examinations by state physicians for evidence at the hearing
were on an assembly-line basis never taking more than ten
minutes, and that in 77 per cent of the cases there was a
recommendation for confinement. The court hearing was no
different. The patients were heavily sedated and incapable
of defending themselves. Persons were not notified of their
right to counsel or to a jury trial. In regard to the State
physician's examination, Kutner (1962:385) concluded, "It
appears that in practice, the alleged mentally ill is presumed
to be insane and bears the burden of proving his sanity in the
few minutes allotted him."
In a general paper concerning social factors in identify
ing and defining mental illness, based on observations of two
California hospitals, Mechanic (1962) mentioned how the
situation of the examining physician could result in the
practices observed by Kutner.
Both the abstract nature of the physician's
theories and the time limitations imposed upon
him by the institutional structure of which he
is a part, make it impossible for him to make
a rapid study of the patient's illness or even
to ascertain if illness, in fact, exists.
(Mechanic, 1962:69).
Mechanic went on to say that in a period of three months'


CHAPTER I
THEORETICAL BACKGROUND
Social Stratification
Philosophers and social scientists alike have long been
concerned with social inequalities. A major task of the
sociologist interested in social stratification is to develop
conceptual categories of the various dimensions of inequality
and to empirically chart the consequences of inequality for
the individual and society.
The major concern of this work is to determine what
effect one's position on various dimensions of stratification
has on the judicial decision concerning whether one is insane.
Two variables are central in this analysis. One, the
independent variable, is social stratification. The several
dimensions and manifestations of individual position and
identity will be analyzed as causal agents. The dependent
variable is judicial fate, the legal judgment made about an
individual's sanity, a judgment which becomes part of the
individual's and the state's record and which affects his
subsequent career-indefinite incarceration, temporary
incarceration, or freedom.
1


TABLE OF CONTENTS
CHAPTER
THEORETICAL BACKGROUND
Page
ACKNOWLEDGEMENTS
in
LIST OF TABLES
vi
ABSTRACT
IX
IT
STUDIES OF CIVIL COMMITMENT
34
III
THE COMMUNITY AND ORGANIZATIONAL
SETTING OF THE STUDY . .
48
IV
DATA AND HYPOTHESES
66
DATA DESCRIPTION AND ANALYSIS .
85
VI
CONCLUSIONS, INTERPRETATIONS, AND
FURTHER RESEARCH
154
v


86
TABLE 1. ONE-WAY DISTRIBUTION OF THE TOTAL SAMPLE1
AGE
(N=379)
%
14-24
18.2
25-44
31.4
45-64
29.6
65 & over
20.8
SEX
(N=379)
Male
50.1
Female
49.9
RACE
(N=375)
White
74.1
Black
25.9
No information
1.0
MARITAL
STATUS
(N=355)
Single
61.4
Married
38.6
No information
6.7
PRIOR
PSYCHIATRIC
CARE
(N=257)
Yes
75.5
No
24.5
No information
32.2
PRESENT
PSYCHIATRIC
CARE
(N=280)
Yes
46.1
No
53.9
No information
26.1
MOST RECENT
OCCUPATION (N=282)
%
Unskilled-working
31.2
Skilied-working
10.6
Lower White-collar
11.6
Upper White-collar
14.2
Housewives
17.0
Students
5.0
Never Employed
10.3
No information
25.6
PRESENT EMPLOY-
MENT STATUS (N=329)
Employed
19.5
Unemployed
56.2
Student
4.3
Retired
20.9
No information
13.2
EDUCATION
(N=215)
Mentally Deficient
2.3
Below 9th
35.8
9th 12th
39.1
Some College &
above
22.8
No information
43.3
ALCOHOL
PROBLEMS
(N=241)
Yes
39.0
No
61.0
No information
36.4
JUDGMENT
(N=376)
Competent
26.3
Temporarily
Incompetent
14.1
Incompetent
59.1
No information
.8
No information percentages re based on 379 cases. All other
percentages are based on the number of cases with valid infor
mation for the variable. Though this study involves an entire
population of cases, the term sample is used for ease of reference
1


TABLE 4. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY PRIOR PSYCHIATRIC CARE, PRESENT PSYCHIATRIC CARE AND ALCOHOL PROBLEMS.
JUDGMENT
Prior
Care
Present
Care
Alcohol
Problems
(N=
201)
(N=200)
(N=
=148)
Yes
No
Yes
No
Yes
No
Competent
28.0
40.5
22.9
37.8
38.0
24.8
Temporarily
Incompetent
23.2
8.1
30.2
9.9
22.8
19.3
Incompetent
48.8
51.4
46.9
52.3
39.2
56.0
(n=164)
(n=37)
(n=86)
(n=114)
(n=79)
(n=69)
C* = .15
C* = : .26
C* = .17
X2 = 4.95
X2 = 15.37
X2 = 5.52
df = 2
df = 2
df = 2
.05^-p^.025**
.0005>p**
.05y pp* .025**
* The C coefficients, here, are directly comparable for these three relationships
because the tables are of equal size. The coefficients from different size tables
are not comparable. Corrections for table size are not possible in this study
because such corrections require tables with an equal number of rows and columns.
** All probabilities are computed for a one-tailed test.
100


151
the individual tables, enables one to evaluate the relative
strength of the associations between the independent vari
ables and the dependent variable and to determine the overall
effects of the controls on the various associations.
All of the independent variables demonstrate a percentage
difference in the hypothesized direction in the uncontrolled
situation; only three, sex, most recent occupation, and
present occupational status exhibit percentage differences
larger than twenty.
When controlling for present care in the yes situation,
only one variable, most recent occupation, has a percentage
difference greater than nine. In the no present care
situation all the percentage differences except for one
are greater than twenty. Except for the most recent occupa
tion variable, the status variables have little effect on
adjudged competency when individuals are under psychiatric
care. When not under psychiatric care, the individuals in
the high status categories received from 14 to 52 per cent
more competent judgments than those in the low status cate
gories.
Having received psychiatric care in the past does not
seem to reduce the effects of having high status to any


21
Stratification and Social Control
After the publication of Beckers Outsiders (1963),
researchers began to initiate studies of active social con
trol and the process of labeling deviants. Among others, the
works of Piliavin and Briar (1964), Black and Reiss (1970),
Arnold (1971), and Cicourel (1968) have considered the rela
tionship between stratification variables and being defined
as deviant.
Piliavin and Briar (1964) studied police discretion in
their encounters with juvenile offenders. Piliavin and Briar
found that the officer often disposed of cases on the basis
of the personal characteristics of offenders rather than their
offenses. This resulted in differential treatment for some
classes of youths.
Compared to other youths, Negroes and boys whose
appearance matched the delinquent stereotype were
more frequently stopped and interrogated by
patrolmen--often even in the absence of evidence
that an offense had been committed and usually
were given more severe dispositions for the
same violations. (Piliavin and Briar, 1964:212).
Black and Reiss (1970) also found that Negroes fared
worse than whites in police field dispositions. In all
encounters with the police involving citiEen complaints, 79
per cent of the Negroes were released in the field, while
92 per cent of the whites were released (Black and Reiss,


TABLE 7. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY AGE, CONTROLLING FOR PRESENT PSYCHIATRIC CARE.
PRESENT CARE
AGE
Competent
YES
JUDGMENT
Tmpora rily
Incompetent
Incompetent
Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
14-24
22.2
29.6
48.2
(n=27)
59.1
4.5
36.4
(n=22)
25-44
22.2
33.3
44.4
(n=45)
33.7
13.0
54.3
(n=46)
45-64
27.3
27.3
45.5
(n=22)
36.8
10.5
52.6
(n=38)
65 & over
0.0
0.0
100.0
(n= 2)
0.0
0.0
100.0
(n= 4)
(N=96)
(N=110)
C* =.13
X *=1.580
df =4
C2 =
X *=8.
df =4
26
76
. 45^> .40 lO^t-p-^.05
* Does not include the 65 and over category
107


27
Scheff presents a synthesis of much of the sociological
thought on role expectations and mental illness. Central
to Scheff*s theory are the concepts of residual deviance
and labeling. Residual deviance is a category of acts for
which the culture has failed to provide a clear label. Unlike
acts of sin, criminality, and bad manners, these acts are
placed in residual categories like witchcraft or mental illness
(Scheff, 1966:32-34). Residual deviance on the part of an
individual may be stabilized if it is defined and labeled by
others as being mental illness (Scheff, 1966:53-54). If
instances of residual deviance are denied, that is accepted
as being anything other than mental illness, the residual
deviance will be transitory rather than a stabilized recurrent
behavior (Scheff, 1966:51).
The labeling theories of mental illness, like similar
theories of criminal deviance, have not gone uncriticized.
Fletcher and Reynolds (1967) have stated that Scheff's concept
of residual deviance has not been shown to have an empirical
referent congruent with mental illness behavior and that it
has not been causally linked with the labeling process
(Fletcher and Reynolds, 1967:37). Scheff*s theory remains a
purely sociological alternative to the disease model but at
the present is not validated.


TABLE 28. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY MOST RECENT OCCUPATION, CONTROLLING FOR ALCOHOL PROBLEMS.
ALCOHOL PROBLEMS
YES NO
MOST RECENT
OCCUPATION JUDGMENT JUDGMENT
Competent
Tmporarily
Incompetent
Incompetent
Competent
Temporarily
Incompetent
Incompetent
Upper White-
collar
89.9
11.1
0.0
(n= 9)
40.0
10.0
50.0
(n=10)
Lower White-
collar
50.0
12.5
37.5
(n= 8)
16.7
33.3
50.0
(n=18)
Skilled-
working
28.6
50.0
21.4
(n=14)
16.7
33.3
50.0
(n= 6)
Unskilled-
working
43.5
8.7
47.8
(n=23)
28.1
12.5
59.4
(n=32)
Students
0.0
0.0
0.0
(n= 0)
33.3
33.3
33.3
(n= 9)
Housewives
20.0
40.0
40.0
(n=10)
21.4
28.6
50.0
(n=14)
Never
Employed
0.0
50.0
50.0
(n= 4)
7.7
7.7
84.6
( n=13)
(N=68)
(N=102;
141


161
Interpretations Beyond the Data
A major question from this research which is yet
unanswered is why all the status variables have moderate
to high relationships with the court's judgment in the
not under present care situation while only one variable,
most recent occupation, has even a moderate relationship
in the under present care situation.
An interview with the court clerk who was responsible
for most of the details of the Southern County Court's
incompetency proceedings gave insights into the possible
causes of the differential effects of status between the
two present care controls. The clerk said, though his state
ment is not verifiable from the case records of this study,
that for individuals who were under psychiatric care at the
time of the proceedings, the treating psychiatrist was almost
always chosen as a member of the examining committee. The
second physician's participation as a member of these committees
was often a formality. We can assume that the psychiatric
examinations and decisions of a treating psychiatrist would be
much more thorough and precise than those of a psychiatrist who
was seeing the patient for the first time. We can be more
assured that this is the fact when we consider that prior commit
ment studies have reported that psychiatric commitment examinations


16
What confers this (criminal) character upon
them (societal divergences) is not the
intrinsic quality of a given act but that
definition which the collective conscience
lends them. If the collective conscience
is stronger, if it has enough authority
practically to suppress these divergences,
it will also be more sensitive, more exact
ing; and reacting against the slightest
deviations with the energy it otherwise
displays only against more considerable
infractions, it will attribute to them the
same gravity as formerly to crimes. In
other words, it will designate them as
criminal.
(Durkheim, 1938:202).
If one disregards Durkheim's insistence on a universal
criminal definition by the collective conscience, one would
see that in his statements lie the seeds of the deviance
orientation which has come to be known as the social reactions
approach, labeling theory, or the interactionist orientation.
Contrary to other approaches to deviance, this orientation
emphasizes the process by which acts and individuals become
defined as deviant. In trying to understand this process,
this perspective focuses more on the reaction of conforming
society to deviance than on the social environment or the
personality pathologies of individual deviants.
Though Durkheim's writings contained what could have
been the seeds of an early social reactions orientation, it
was some decades before the deviance literature contained an


BIOGRAPHICAL SKETCH
Kenneth J. Hodge was born August 16, 1943, at Tampa,
Florida. In June, 1961, he graduated from Gainesville High
School, Gainesville, Florida. In May, 1965, he received the
degree of Bachelor of Arts with a major in psychology from
the University of Florida. In December, 1967, he received
the degree Juris Doctor, cum laude, from the University of
Florida College of Law. After one year in the practice of
law, he enrolled in the Graduate School of the University of
Florida. As a graduate student, he worked as a research
assistant and teaching assistant. In December, 1969, he was
awarded an NDEA Title IV Fellowship. In the summer of 1970
he participated in the Summer Institute in Behavioral Science
and Law at the University of Wisconsin, Madison, Wisconsin.
He received his Master of Arts degree from the University of
Florida in March, 1971.
Kenneth J. Hodge is married to the former Mary Elizabeth
Norris. He is a member of the Florida Bar, the American
Sociological Association, the Southern Sociological Society,
and the Law and Society Association. He is presently employed
as a Graduate Research AssociateJwith the Department of
Psychiatry at the University of Florida.
173


45
trained to use certain labels will use them, what he sees
being influenced by his conceptual categories. For instance,
the general physician sees as a temporary marital problem
what the psychiatrist might view as psychotic depression. The
results could be compatible with a pathological perspective if
serious "mental pathology" could be shown to be related to the
predictive variables. Otherwise, the social reaction explana
tion fits quite well.
An early study by Friedsan e_t al_. (1954) also demonstrated
that status characteristics make a difference in which type of
procedure a person is committed under. Friedsan compared the
characteristics of individuals committed by jury trial, which
involves indefinite hospitalization, with those committed for
only ninety days by a purely administrative procedure. In
every category, the temporary 90-day commitments had a higher
percentage of individuals with high status characteristics.
The percentage of males, youths, whites, and married was higher
in the temporary commitments than in the indefinite commitments.
The authors observed that the temporary commitment process
seemed to be used by persons of higher economic status than the
indefinite jury trial process (Friedsan e_t aJU 1954:28).
Rushing (1971) has studied commitments to mental hospitals
to specifically determine the applicability of the societal


160
and psychological disorder (Dohrenwend and Dohrenwend, 1969:
3-31) indicates that none of the independent variables used
in this study has been found to be related to serious
psychologica1 disorder to such an extent as to account for
the associations found here in the not under care situation.
The Dohrenwends (1969:31).did conclude that the available
studies demonstrate that the highest rates of disorder are
generally riot found in the lowest age groups and that low
socioeconomic status is consistently found to be associated
with relatively high rates of disorder. Prevalence rates of
serious disorder between groups with the highest and lowest
rates in almost every instance differ by less than 3.0 per
cent. Differences this small cannot account for the different
proportions of competent judgments found here.
Both social reactions and psychological disorder appear
to both be important factors in the final judgment of an
incompetency court because of the invariant effect of high
status for those not under care and the minimal effect of high
status for those under care. An explanation of why this has
occurred requires one to make inferences beyond the specific
data analyzed here and to draw further on past research.


10
It seems clear that the associated variables should
have a great effect on how the hierarchical stratification
variables influence a persons outcome in a decision-making
process. For example, if the social status of an individual
could possibly effect a judicial determination of his sanity,
this effect would be more certain if the cultural attributes
of his particular status were visible and distinctive or if
the members of his particular status had social contact
networks extending to the court officials or psychiatrists.
For status to effect a decision, it must be evident to the
decision makers, either through obvious signs of status or
through prior communication. To the extent the effects of
income and power interact with status, their influence will
depend on the associated variables also.
The empirical data demonstrate that intimate social
contact within one's class or status group is the predominant
occurrence. The highest frequency of intraclass contact seems
to occur in the highest and lowest classes. Laumann (1966)
found in his sample of a metropolitan area that 75 per cent
of professional businessmens close friends were at the same
occupational level. Almost all close friends were middle-
class or higher. Gordon and Anderson (1964) found that 90 per
cent of their manual worker respondent's close friends


41
hearings, noted the presence or absence of counsel for the
patients and the length of the hearing, and classified the
patients as to whether their condition met the criteria for
commitment. The average length of the hearings was 8.13
minutes with a median of 5.03 minutes. The hearings with
legal counsel were over twice as long as those without.
Eighty per cent of the cases observed involved a commitment
to the hospital. Having legal counsel was highly associated
with not being committed, ninety-one per cent of those without
legal counsel were committed while only 26 per cent of those
with legal counsel were committed. Controlling for whether
the patients' conditions met the legal criteria for commitment
or not, the association still existed, though having counsel
was associated with the criteria not being met. The authors
conclude that having counsel definitely affects the decision
of whether one is admitted to a state mental hospital. The
conclusions of Wenger and Fletcher's study, like those of
Wilder and Scheff's, previously considered, were scrutinized
by Gove (1970a). Gove's major criticisms were that the
psychiatric evaluations followed by the court were more sound
than that of the lay observers since they were based on
professional competence and private examination, and that
court hearing was so brief as to preclude the lawyers


TABLE 10. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY RACE, CONTROLLING FOR PRIOR PSYCHIATRIC CARE.
RACE
Competent
YES
JUDGMENT
Temporarily
Incompetent
PRIOR CARE
Incompetent Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
White
31.2
26.4
42.4
9.1
40.9
(n=22)
Black
18.0
12.8
69.2
(n = 39) 26.7
6.7
66.7
(n=l5)
(N=164)
(N=37)
C = .21
X2 = 8.34
df = 2
.01^* .005
113


81
categories will indicate that there is a relationship in the
table. The direction of the association will be determined
by the direction of the percentage differences between the
categories. Because any association in the hypothesized
direction is supportive of the hypothesis in question, the
relative strength of the various associations will be con-
sidered in a summary table. The value of chi square (X2)
will also be presented for those tables where the contingency
coefficient is calculated. Chi square is presented for those
readers who might use it for comparative or evaluative
purposes; the analyses will not focus on it.
The research hypotheses as suggested from the theory
and empirical studies considered earlier are as follows:
1. The type of court judgment varies with age.
The young receive a higher proportion of
competent judgments than the old.
This hypothesis follows from the observation that youth
is more valued in our society than age. Past studies have
shown that the younger fare better in commitment proceedings.
2. The type of court judgment varies with sex.
Males receive a higher proportion of
competent judgments than females.
American society places a higher value on being male
than being female. Prior research indicates that this value
preference might be expressed in differential treatment for
males in commitment proceedings.


58
commitment, Southern State's law provides for voluntary
admission to state mental hospitals by direct application
to the state hospital and for short term (15 days maximum)
involuntary hospitalization based on medical certification
alone. For a patient to be hospitalized involuntarily
beyond the short term period he must be judicially declared
incompetent or temporarily incompetent.
The major sections of the statute providing for
adjudication of incompetency specify what types of
incompetency are covered by the statute, who may petition to
have incompetency determined, the hearing procedure, a
particular medical examining committee and procedure, the
effect of judgment, and the commitment procedure after
judgment.
The state statute provides that petition for examination
of incompetency may be made where one is believed to be
incompetent because of mental illness, sickness, drunkenness,
excessive use of drugs, insanity, or other mental or physical
condition, or if one is believed to be incapable of caring
for himself or managing his property, or likely to dissipate
or to lose his property or to become the victim of designing
persons, or inflict harm on himself or others. The petition
is filled under oath in the county judge's court in the


94
Forty-six per cent of both the total sample and the
analytic sample were under some form of psychiatric care at
the time the proceedings were started.
Alcohol problems v/ere a factor in 39 per cent of the
total samples cases and 42 per cent of the analytic samples
cases.
Clearly the collectivity involved in the incompetency
proceedings could not be characterized as victims of an
arbitrary system of social control which selects predominately
individuals without any psychiatric history. An overwhelming
majority of the cases have either sought out psychiatric care
or received psychiatric care at the behest of either public
agencies or close relations. Though census data on these
variables are not available for comparative purposes, we can
be assured that the individuals before the court in the years
studied have higher rates of psychiatric contact and alcohol
problems than the general public of Southern County. Two
factors might be operative here in fostering commitment:
(1) some form of psychological pathology from social or
medical causes, or both; and (2) the existence of a dossier
which serves to document prior and present mental problems
and to legitimate a decision which involuntarily deprives
one of his freedom.


55
disturbance were treated by the clinic. The clinic is
open 24 hours a day.
The state university counseling center is staffed by
six psychologists and several interns providing, in addition,
vocational counseling for less severe emotional problems.
Approximately one-half of the 24,000 annual case load
consists of personal-emotional rather than vocational
counseling.
Southern County has three hospitals providing psychi
atric services, all located in Southern County: a county-
owned general hospital, a university-run teaching hospital,
and a federally-operated veterans hospital.
The county-owned hospital provides inpatient psychiatric
care only in a 22-bed psychiatric unit. The unit is staffed
by private psychiatrists with 7 registered nurses, 6 practical
nurses, and 4 attendents. In the 1968-1969 fiscal year a
total of 363 patients were in the psychiatric unit. The rate
for care in the psychiatric unit is $54.00 per day plus
psychiatrist fees and drugs. This unit, besides being open
for private patients, is used for holding some patients
awaiting a commitment hearing or admittance to a state mental
hospital.
The university teaching hospital offers outpatient


93
who were unemployed at the time of the commitment proceedings.
In 1970, 51.6 per cent of Southern Countys population above
age 16 were employed. Considering the total sample (Table 1),
only 19.5 per cent were employed at the time of the proceedings.
Of the analytic sample (Table 2), only 26.0 per cent were
employed at the time of the proceedings.
It would appear that being unemployed could lead to
having ones competency legally determined. The question
of whether the over-representation of the unemployed among
those before the court is mainly a result of psychological
pathology or social reactions cannot be answered from the
present data. Obviously, psychological pathology can lead
to unemployment, but unemployment alone can lead to a strain
in role relations and to a societal reaction in the form of
a petition for inquisition of incompetency.
Psychiatric History
The distribution of the psychiatric history variables
(Tables 1 and 2) reveals that a high proportion of the cases
has had psychiatric care and/or problems with alcohol.
Over 75 per cent of total samples cases (Table 1) and
over 81 per cent of the analytic sample's cases (Table 2)
were exposed to prior psychiatric contact.


TABLE 26 PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY MOST RECENT OCCUPATION, CONTROLLING FOR PRIOR PSYCHIATRIC CARE.
PRIOR CARE
YES NO
MOST RECENT
OCCUPATION
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Upper White-
collar
58.6
11.8
29.4
(n=17)
80.0
20.0
0.0
(n= 5)
Lower White-
collar
27.3
31.8
40.9
(n=22)
40.0
0.0
60.0
(n= 5)
Skilled-
working
21.4
42.9
35.7
(n=l4)
25.0
25.0
50.0
(n= 4)
Unskilled-
working
29.2
12.5
58.3
(n=48)
38.5
7.7
53.8
(n=13)
Students
25.0
50.0
25.0
(n= 8)
0.0
0.0
0.0
(n= 0)
Housewives
20.8
33.3
45.8
(n=24)
50.0
0.0
50.0
(n= 2)
Never
Employed
17.6
17.6
64.7
0.0
0.0
100.0
(n= 3)
(N=150)
(N=32)
C = .35
X2 =21.60
df =12
025;p .01
137


166
Brakel, Samuel J. and Ronald S. Rock (eds.)
1971 The Mentally Disabled and the Law. Chicago:
University of Chicago Press.
Cicourel, Aaron V.
1968 The Social Organization of Juvenile Justice.
New York: John Wiley and Sons, Inc.
Clark, Robert E.
1948 The relationship of schizophrenia to occupational
income and occupational prestige. American
Sociological Review 13(June) 325-330.
Cohen, Albert K.
1955 Delinquent Boys: The Culture of the Gang.
Glencoe: The Free Press.
Dahl, Robert A.
1961 Who Governs: Democracy and Power in an American
City. New Haven: Yale University Press.
Davis, Kingsley
1938 Mental hygiene and the class structure.
Psychiatry 1:55-65.
Deutsch, Albert
1948 The Mentally Ill in America: A History of
Their Care and Treatment from Colonial Times.
New York: Columbia University Press.
Dohrenwend, Bruce P. and Barbara Snell Dohrenwend
1969 Social Status and Psychological Disorder: A
Causal Inquiry. New York: John Wiley and Sons, Inc.
Dollard, John
1937 Caste and Class in a Southern Town. New Haven:
Yale University Press.
Domhoff, G. William
1967 Who Rules America. Englewood Cliffs, New Jersey:
Prentice Hall, Inc.
Durkheim, Emile
1938 The Rules of Sociological Method. trans. Sarah A.
Solovay and John H. Mueller. Chicago: University
of Chicago Press.


1
2
3
4
5
6
7
8
9
10
11
12
LIST OF TABLES
Page
ONE-WAY DISTRIBUTION OF THE TOTAL SAMPLE 86
ONE-WAY DISTRIBUTION OF THE ANALYTIC SAMPLE 87
ONE-WAY FREQUENCY DISTRIBUTION OF TOTAL
SAMPLE 96
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY PRIOR PSYCHI
ATRIC CARE, PRESENT PSYCHIATRIC CARE, AND
ALCOHOL PROBLEMS 100
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY AGE . 103
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY AGE, CONTROLLING
FOR PRIOR PSYCHIATRIC CARE. ..... 105
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY AGE, CONTROLLING
FOR PRESENT PSYCHIATRIC CARE 107
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY AGE, CONTROLLING
FOR ALCOHOL PROBLEMS 109
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY RACE . Ill
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY RACE, CONTROL
LING FOR PRIOR PSYCHIATRIC CARE .... 113
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY RACE, CONTROL
LING FOR PRESENT PSYCHIATRIC CARE .... 114
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY RACE, CONTROL
LING FOR ALCOHOL PROBLEMS ....... 116


56
psychiatric care in addition to its 32 bed inpatient
psychiatric unit. In 1965, 447 patients were admitted to
the inpatient unit of which 57 per cent or 263 were Southern
County residents.
The veterans* hospital located in Southern City provides
both inpatient and outpatient psychiatric care for qualified
veterans. The 60 bed inpatient unit has on its staff five
psychiatrists and five psychologists. In the 1968-1969
fiscal year 366 psychiatric patients were admitted.
The Legal Structure of Commitment
In colonial America there were no statutes providing
for commitment of the mentally ill and until very late in
the colonial period there were no hospitals for the care of
the mentally ill. Until state statutes provided for commit
ment of the insane such cases were handled under English
common law which permitted citizen's or police arrest of the
'furiously insane" and confinement for the duration of their
dangerous condition. In 1752 the first colonial general
hospital was funded and in 1772 the first asylum exclusively
for the insane was opened in Williamsburg, Virginia (Deutsch,
1948). The first hospital admission of a mentally ill
person in America was recorded in 1756 at the Pennsylvania
Hospital in Philadelphia (Rock et_ al.,
1968:1)


59
alleged incompetent's county of residence or location.
The persons allowed to file such a petition are: the
mother, father, brother, sister, husband, wife, child, or
next of kin of the alleged incompetent; any three citizens
of the state; the sheriff of the alleged incompetent's
county of residence. A person may request self-examination
if he presents a physician's certificate certifying he is
incompetent under the statute. The petition--besides naming
the alleged incompetent, his family members, and their
addresses--states the nature of the disability and asks that
the alleged incompetent be adjudged incompetent. The judge
may, in the best interest of the alleged incompetent, before
the hearing and after a petition is filed, order that the
alleged incompetent be placed in protective custody of his
family or other responsible citizen. If the judge feels that
the public safety or the alleged incompetent's safety requires
it, he may order the sheriff to confine the alleged in some
specified place.
After the petition is filed, the statute prescribes,
that the judge shall appoint an examining committee of a
responsible citizen and two practicing physicians who are
not associated with each other in practice. A petitioner
cannot serve on the committee. The examining committee is
to examine the alleged incompetent so as to thoroughly


49
The Community
The location for the present research is Southern County,
a county geographically in the southeastern United States but
not part of the ''deep south. Southern County, a standard
metropolitan statistical area 900 miles in area, has a total
population of about 105,000; of which about 70,000 live in the
urbanized area of Southern City.1
Southern City is the location of a state land grant
university with a student population of about 24,000 and a
faculty of about 2,500. The county contains six small towns
almost equidistant from the centrally located Southern City
and ranging in size from 500 to 2,500 population. Several
\
small rural settlements and rural farm residences account for
the remainder of Southern County's population. The outlying
towns have in the past been predominantly agricultural but now
also serve as bedroom communities for Southern City's fast
developing educational, medical, and technological economy.
Twenty-eight per cent of Southern County's population are
classified as rural.
Sociodemographic figures for this section are from the U.S.
Bureau of the Census, 1970 Census of Population and Housing
for the Southern County standard metropolitan statistical area.


31
socially-constructed reality.
. . questions of psychological status cannot
be decided without recognizing the reality-
definitions that are taken for granted in the
social situation of the individual. To put it
more sharply, psychological status is relative
to the social definitions of reality in general
and'is itself socially defined.
(Berger, 1966:176).
Therapy according to Berger, awaits those who slip from
the dominant reality.
Therapy entails the application of conceptual
machinery to ensure that actual or potential
deviants stay within the institutionalized
definitions of reality, or in other words, to
prevent the "inhabitants" of a given universe
from emigrating" . Its specific institu
tional arrangements, from exorcism to psycho
analysis, from pastoral care to personnel
counseling programs, belong, of course, under
the category of social control.
(Berger, 1966:113).
Kingsley Davis (1938)recognized early that the ideology of
the mental health hygiene movement was tied to the middle-class
Protestant ethic. Davis was also aware that class-linked
ideologies might have implications for social control.
In case of such divergence (from ultimate norms)
other classes will focus attention upon the errant
ones and will seek to control its thinking and
behavior through methods conforming to the sanc
tions of society. (Davis, 1938:63).
Gurslin; et_ a_l. (1960) went beyond Davis work with a content
analysis of mental health movement literature. They found a


15
(Sheldon, 1949), the social structural gap between means
and ends (Merton, 1957), the interactional milieu of the
deviant (Sutherland, 1947), and a combination of social
structure and milieu (Cohen, 1955), have all been used as
explanations of deviant behavior. The purpose of this
section is to present a relatively new perspective on
deviance which suggests that an individual who seeks to
understand deviance and control should focus not on the
personal characteristics of the deviant or his social
milieu, but on the definers of deviant behavior and the
social reaction to deviant behavior.
In the Division of Labor in Society, Durkheim (1964:105)
defined crime as an act "contrary to strong and defined
states of the common conscience." Acts, according to
Durkheim, are not inherently criminal but are so defined
by society.
In other words, we must not say that an action
shocks the common conscience because it is
criminal, but rather that it is criminal because
it shocks the common conscience. We do not
reprove it because it is a crime, but it is a
crime because we reprove it.
(Durkheim, 1964:81).
In a later work, the Rules of Sociological Method, Durkheim
continued to express similar ideas on the public construction
of crime.


STATUS CONTINGENCIES OF THE LEGALLY LABELLED INSANE
By
KENNETH J. HODGE
A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF THE
UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE
DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
1972

To
M. B.


ACKNOWLEDGEMENTS
I would like to express my appreciation to several
individuals for their assistance and encouragement in writing
this paper. The order of presentation is chronological and
does not reflect importance. My thanks to Professor Walter
Probert from whom I first learned that for an understanding
of the law, one must understand the nature of both the society
and the individual. I would like to acknowledge Dr. Richard F
Larson who first encouraged me to study sociology and whose
continued encouragement and constructive criticism were
invaluable to my graduate education.
A special note of thanks to Dr. Benjamin L. Gorman, the
Chairman of my Supervisory Committee, whose continual patience
assistance, and encouragement made it possible for me to
complete this research.
This research was done under the auspices of National
Institute of Mental Health Grant number 15900-04 with John J.
Schwab, M.D., as Principal Investigator and George J. Warheit
as Project Director. My thanks to them for their support.
I am also grateful to Susan Josephson for her assistance
in data collection and to Linda Johnston, Linda Darby, and
Marilyn Allan for their patience and care in typing the
iii

manuscript.
Care has been used in the preparation of this study
however, errors of omission and commission are possible,
and for these I assume full responsibility.
iv

TABLE OF CONTENTS
CHAPTER
THEORETICAL BACKGROUND
Page
ACKNOWLEDGEMENTS
in
LIST OF TABLES
vi
ABSTRACT
IX
IT
STUDIES OF CIVIL COMMITMENT
34
III
THE COMMUNITY AND ORGANIZATIONAL
SETTING OF THE STUDY . .
48
IV
DATA AND HYPOTHESES
66
DATA DESCRIPTION AND ANALYSIS .
85
VI
CONCLUSIONS, INTERPRETATIONS, AND
FURTHER RESEARCH
154
v

1
2
3
4
5
6
7
8
9
10
11
12
LIST OF TABLES
Page
ONE-WAY DISTRIBUTION OF THE TOTAL SAMPLE 86
ONE-WAY DISTRIBUTION OF THE ANALYTIC SAMPLE 87
ONE-WAY FREQUENCY DISTRIBUTION OF TOTAL
SAMPLE 96
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY PRIOR PSYCHI
ATRIC CARE, PRESENT PSYCHIATRIC CARE, AND
ALCOHOL PROBLEMS 100
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY AGE . 103
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY AGE, CONTROLLING
FOR PRIOR PSYCHIATRIC CARE. ..... 105
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY AGE, CONTROLLING
FOR PRESENT PSYCHIATRIC CARE 107
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY AGE, CONTROLLING
FOR ALCOHOL PROBLEMS 109
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY RACE . Ill
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY RACE, CONTROL
LING FOR PRIOR PSYCHIATRIC CARE .... 113
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY RACE, CONTROL
LING FOR PRESENT PSYCHIATRIC CARE .... 114
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY RACE, CONTROL
LING FOR ALCOHOL PROBLEMS ....... 116

LIST OF TABLES
Table
13
14
15
16
17
18
19
20
21
22
23
Page
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY SEX . 118
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY SEX, CONTROL
LING FOR PRIOR PSYCHIATRIC CARE . 119
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY SEX, CONTROL
LING FOR PRESENT PSYCHIATRIC CARE . 120
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY SEX, CONTROL
LING FOR ALCOHOL PROBLEMS 122
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MARITAL
STATUS, OF ALLEGED INCOMPETENT .... 123
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MARITAL
STATUS, CONTROLLING FOR PRIOR PSYCHIATRIC
CARE . 125
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MARITAL
STATUS, CONTROLLING FOR PRESENT PSYCHIATRIC
CARE 126
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MARITAL
STATUS, CONTROLLING FOR ALCOHOL PROBLEMS 127
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY EDUCATION 129
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY EDUCATION,
CONTROLLING FOR PRIOR PSYCHIATRIC CARE . 131
PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY EDUCATION,
CONTROLLING FOR PRESENT PSYCHIATRIC CARE 132
vii

LIST OF TABLES
Table Page
24 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY EDUCATION,
CONTROLLING FOR ALCOHOL PROBLEMS . 134
25 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MOST RECENT
OCCUPATION 135
26 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MOST RECENT
OCCUPATION, CONTROLLING FOR PRIOR PSYCHIATRIC
CARE 137
27 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MOST RECENT
OCCUPATION, CONTROLLING FOR PRESENT PSYCHI
ATRIC CARE . . 139
28 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MOST RECENT
OCCUPATION, CONTROLLING FOR ALCOHOL PROBLEMS 141
29 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY PRESENT
-OCCUPATIONAL STATUS 143
30 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY PRESENT
OCCUPATIONAL STATUS, CONTROLLING FOR PRIOR
PSYCHIATRIC CARE 144
31 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY PRESENT
OCCUPATIONAL STATUS, CONTROLLING FOR PRESENT
PSYCHIATRIC CARE 145
32 PER CENT ADJUDGED COMPETENT TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY PRESENT
OCCUPATIONAL STATUS, CONTROLLING FOR ALCOHOL
PROBLEMS 147
33 PER CENT EMPLOYED OR UNEMPLOYED BY MOST
RECENT OCCUPATION -149
34 SUMMARY ANALYTICAL TABLE: PERCENTAGE DIF
FERENCE OF COMPETENT JUDGMENTS BETWEEN SELECTED
CATEGORIES OF INDEPENDENT VARIABLES . 150

Vlll

Abstract of Dissertation Presented to the
Graduate Council of the University of Florida
in Partial Fulfillment of the Requirements
for the Degree of Doctor of Philosophy
STATUS CONTINGENCIES OF THE LEGALLY LABELLED INSANE
By
Kenneth J. Hodge
December, 1972
Chairman: Dr. Benjamin L. Gorman
Major Department: Sociology
The purpose of the present study was to determine the
relationship between an individuals status characteristics
and the type of final judgment received from a judicial
hearing for the determination of his legal competency.
Data were drawn from a total sampling of three years
of case records from a court whose jurisdiction consisted
of a county in the southeast United States. A total of 379
court cases were involved in the study. Eliminating all cases
in which the individual was diagnosed as having an organically
caused disorder yielded a final analytic sample of 278 cases.
Additional data on these cases, when available, were drawn
from hospital and mental health agency records. The dependent
variable for this study was the court's judgment: a finding
ix

of competent, temporarily incompetent, or incompetent.
The independent variables, which were conceptualized as
status contingencies of the court's judgment were: the
age, race, sex, marital status, education, most recent
occupation, and present employment status of the alleged
incompetent. Dichotomous controls classified the individuals
as either yes or no for three variables: a history of prior
psychiatric care, a history of problems with alcohol, and
having been under psychiatric care at the time of the
proceedings. Associations: between the dependent and indepen
dent variables were determined by the percentage distributions
in contingency tables.
The literature in social stratification, social control,
and deviant behavior offers a general hypothesis for this
research; high-status characteristics will be associated wi^h
j'udgments of legal competency. A proposition from the social
reactions perspective on mental illness suggests that judgments
of the court will be unrelated to individual pathology. A
finding that status characteristics are related to judgments
of the court while controlling for psychiatric history would
support the social reactions perspective.
The findings of this study follow. High status charac
teristics such as being young, male, white, married, employed,
x

and of upper white-collar occupational status were associated
with judgments of competency. Such associations were
strongest under the control situation of not having been
under psychiatric care at the time of the proceedings.
For those under psychiatric care at the time of the proceedings,
the associations were minimal.
The independent variables, in descending order of their
importance for determining the courts judgment, were most
recent occupation, present occupational status, sex, marital
status, age, and race.
The findings were taken to support the general social
stratification proposition that high status individuals will
receive more positive outcomes from social control decision
making processes than will low status individuals. The
findings support a model of mental illness which takes into
account both social reactions and individual pathology.
xi

CHAPTER I
THEORETICAL BACKGROUND
Social Stratification
Philosophers and social scientists alike have long been
concerned with social inequalities. A major task of the
sociologist interested in social stratification is to develop
conceptual categories of the various dimensions of inequality
and to empirically chart the consequences of inequality for
the individual and society.
The major concern of this work is to determine what
effect one's position on various dimensions of stratification
has on the judicial decision concerning whether one is insane.
Two variables are central in this analysis. One, the
independent variable, is social stratification. The several
dimensions and manifestations of individual position and
identity will be analyzed as causal agents. The dependent
variable is judicial fate, the legal judgment made about an
individual's sanity, a judgment which becomes part of the
individual's and the state's record and which affects his
subsequent career-indefinite incarceration, temporary
incarceration, or freedom.
1

2
Two other conceptual areas are related. Social control,
is an intervening variable or a mediating concept which links
stratification to judicial fate. The third concept is that
of mental illness, the official legitimation of judicial fate.
In this chapter we will consider each one of these concepts
and the theoretical relationships among them--both generally
and with specific reference to the problem at hand.
Individuals are unequal in many way s. Max Weber (Gerth
and Mills, 1958:180-195) first recognized that a person's
position in the stratification order was based on not one
but several criteria. For Weber the stratification order
had three dimensions. The three dimensions of stratification
were class, status, and party. Each dimension on an individual
and group level was seen as influencing the other. Weber's
model of the stratification system still serves as a starting
point for any serious study of social inequality.
Class
Weber's conception of the class-situation being grounded
in the economic order or market-situation is very similar to
Marx's idea of social class with the exception that, for
Weber, class consciousness and class action do not necessarily
follow from a specific class-situation.

3
We may speak of a 'class* when (1) a number of
people have in common a specific causal component
of their life in so far as (2) this component is
represented exclusively by economic interests in
the possession of goods and opportunities for
income, and (3) is represented under the conditions
of the commodity or labor markets.
(Gerth and Mills, 1958:181).
The best illustration of the impact of the economic or
class factor on life chances is the demonstrated relation
ship between class and the probability of life itself. The
official casualty lists of the Titanic disaster clearly
demonstrated an inverse relationship between class of
accommodations and drowning. Four of 143 first class female
passengers drowned while 81 of the 179 female third class
passengers were lost (Lord, 1955:107). Less dramatic but
equally to the point are Antonovsky's (1972) findings on
class and mortality.
Despite the multiplicity of methods and indices
used in the 30 odd studies cited, and despite
the variegated populations surveyed,the ines
capable conclusion is that class influences
one's chances of staying alive.
(Antonovsky, 1972:486).
The effects of class are not limited to the probabilities
of staying alive. Blau and Duncan (1967) have demonstrated
that one's class background, measured by father's occupational
level, has a significant effect on the level of the individual's
present occupation. Measuring effects by path coefficients,

4
Blau and Duncan found that the level of the father's
occupation positively influenced the level of the son's
education and first job. The level of the son's job
and education each in turn separately affected the level of
the son's present job. The father's occupational level also
had an independent positive affect on the son's present
occupation, while controlling for the effects of the son's
education and first job (Blau and Duncan, 1967:170).
It is evident that one's class or economic situation
has great impact on the biography of the particular individual.
The issue that is unsettled concerns the importance of the
dimension relative to the other variables. Which, if any,
dimension of stratification has the greatest effect on the
individual situation or the stratification system as a whole?
Most theorists assume the stratification variables are
interrelated in both their individual and societal influences.
The causal links and priorities are unclear.
The economic factor should be a very important determinant '
of the commitment decision-making process. The economically
advantaged can afford private psychiatric care as an alternative
to hospitalization in a state institution and can buy the
services of legal counsel and expert witnesses in order to
avoid commitment. The poor, if they wish to avoid commitment,
are left to their own limited resources.

5
Status
The second dimension of stratification considered by
Weber concerned the prestige dimension, which he called the
'status situation." The individual status situation depends
on social honor and is often linked with his class situation.
... We wish to designate as 'status situation'
every typical component of the life fate of men
that is determined by a specific, positive or
negative, social estimation of honor. This honor
may be connected with any quality shared by a
plurality, and, of course, it can be knit to a
class situation; class distinctions are linked
in the most varied ways with status distinctions.
(Gerth and Mills, 1953:187).
Research involving primarily the status dimension of
stratification has centered around locating and describing
status strata in particular communities and charting occu
pational prestige rankings for national and international
samples. Warner and his associates (1949) have been primarily
concerned with prestige strata in communities. The basic
findings of this group include: the existence of three
basic strata with one or more substrata in each, depending
on the community; a differentiation between strata on the basis
of occupation and income; and an individual carryover from the
prestige dimension to the other facets of the community such
as the family, religious structure, organizational participa
tion, and occupational structure. Warner's work, though

6
subject to criticism (Pfautz and Duncan, 1950; Kornhauser,
1953), should be considered when analyzing the effects of
social stratification.
Weber (Gerth and Mills, 1958:193) mentioned that
occupational groups are also status groups because of their
common life style. The object of the occupational prestige
scale (North & Hatt, 1947) is to rank occupations on prestige
by the use of opinion surveys. The results of the rankings
give some support to Warners prestige strata hierarchy in
that the overall prestige ranking would, if collapsed into
strata, resemble the occupational distribution found in
Warners prestige strata. The basic prestige rankings obtained
have been shown to have changed little since 1947 (Hodge et al.,
1968).
In addition to achieved characteristics such as income,
education and occupation, status and prestige may be determined
by ascribed characteristics. The most obvious and best
documented ascribed status determinants are race and ethnicity.
The effects of race on social honor was noted by Weber in his
treatment of Ethnic Segregation and Caste (Gerth and Mills,
1958:188). The racial status structure of a Southern community
was studied by Dollard (1937) using participant observation.
The Negro community was found to be composed of prestige

7
strata much like the whites but there were fewer strata,
which were lower in prestige than comparable white strata,
and the whole structure was separated from the white system
by a caste line. Berreman (1969) reviewed the evidence for
the existence of a Negro caste structure and concluded that
caste is a reality.
In considering the process of evaluation, Tumin, (1967:
27) mentioned other important status characteristics,
. . in American society one is generally
considered better, superior, or mere worthy
if he is male rather than female. . educated
rather than uneducated. . young rather than
old. . employed rather than unemployed. .
married rather than divorced.
Clearly, any consideration of status characteristics and
civil commitment should study these variables.
The functionalist theorists generally consider the status
dimension to be the stratification variable most important for
its influence on the other dimensions and the individual
biography. One can easily see though, that untangling the
effects and causal priorities of the various variables in an
empirical study would be difficult if not impossible.
The status dimension should affect commitment decisions
through the linkage of status with deference behavior (Shils,
1970:421). We might expect the low status individual in a
commitment hearing or examination to defer to the findings,

8
wishes, and authority of the high status psychiatrist or
judge. The high status individual would not feel compelld
to defer on the basis of a status differential, but might
marshall his resources to avoid being placed in a stigmatized
role.
Power
The party, according to Weber, was a group concerned with
the acquisition of power. Power was generally defined as:
. . the chance of a man or of a number of men
to realize their own will in a communal action
even against the resistance of others who are
participating in the action.
(Gerth and Mills, 1958:180).
Studies of the power variable do not generally concern
situations when the fate of one man is at stake and power
might influence the outcome, but usually involve issues which
affect large collectivities and the power structure of a
community (Hunter, 1953; Dahl, 1961; Presthus, 1964), or the
nation (Mills, 1956; Domhoff, 1967). Such studies are
concerned with the type of power structure and the membership
of the structure. Though the issue of pluralism vs. power
elite has not been resolved on either a local or national
level, it can be stated that most studies irrespective of the
power concentration demonstrate that the influential and
powerful are drawn disproportionately from the upper-middle and

9
higher social strata. The influence of power might best
be examined within this higher occupational group. The
dimension of power would appear to be a very important
variable for consideration when examining civil commitment,
for the situation could be conceived as one where the
individual being commited is in a struggle against those
who petition for his commitment. The problem remains, however,
of separating power effects from those of other dimensions.
Associated Variables
Gordon (1958) has distinguished two additional variables,
which are important for any inquiry into the effects of social
stratification. Gordon's associated variables are called
group life and cultural attributes. Group life refers to
the extent that a class is:
. . an effective social system within which
the class member has most or all of his intimate
and meaningful social contacts.
(Gordon, 1958:18).
Cultural attributes are the patterns of behavior and attitudes
which might serve to differentiate a particular social class.
These associated variables are not hierarchical in nature--
as are the stratification variables of class, status, and
power--but are behavioral categories which are produced by the
operation of the stratification variables.

10
It seems clear that the associated variables should
have a great effect on how the hierarchical stratification
variables influence a persons outcome in a decision-making
process. For example, if the social status of an individual
could possibly effect a judicial determination of his sanity,
this effect would be more certain if the cultural attributes
of his particular status were visible and distinctive or if
the members of his particular status had social contact
networks extending to the court officials or psychiatrists.
For status to effect a decision, it must be evident to the
decision makers, either through obvious signs of status or
through prior communication. To the extent the effects of
income and power interact with status, their influence will
depend on the associated variables also.
The empirical data demonstrate that intimate social
contact within one's class or status group is the predominant
occurrence. The highest frequency of intraclass contact seems
to occur in the highest and lowest classes. Laumann (1966)
found in his sample of a metropolitan area that 75 per cent
of professional businessmens close friends were at the same
occupational level. Almost all close friends were middle-
class or higher. Gordon and Anderson (1964) found that 90 per
cent of their manual worker respondent's close friends

11
were other manual workers. Warner's previously mentioned
work (1949) also illustrates a predominance of intraclass
social contact. Examination of cliques, voluntary assoc
iations, and families demonstrated a limitation on the
range of class contact.
A predominance of intraclass interaction should lead
to or indicate a similar life style and value system for
the class. Again, Warner's work (1949) serves to illustrate
the point. Other research within individual strata bolsters
the generalization of differential class life styles and
values. The upper (Baltzell,1958), middle (Seeley et al.,
1956; Riesman et_ a_l_. 1952; Whyte, 1956) and lower strata
(Gans, 1962; Miller and Riesman, 1961) have been studied and
found to have somewhat distinctive behavior and values.
Kohn*s (1969) work in socioeconomic status, socialization,
and values considered class characteristics that might be
important determinants of commitment hearing decisions.
The essence of high class positions is the
expectation that one's decisions and actions
can be consequential; the essence of lower
class position is the belief that one is at
the mercy of forces and people beyond one's
control, often, beyond one's understanding.
(Kohn, 1969:189).
The lower class person is basically pictured as conformist.
Conformity--following the dictates of authority
focusing on external consequences to the exclu-

12
sion of internal consequences, being intolerant
of non conformity and dissent, being distrustful
of others, having moral standards that strongly
emphasize obedience to the letter of the law. .
(Kohn, 1969:189).
One can suggest, from the value content of Kohn' s findings,
that a lower-class person, faced with a judicial hearing to
determine his sanity, might have the burden of a conformist
personality added to his low income, prestige, and power
position. The subjective factor of conformity and low self
confidence combined with the more objective factors of low
income, status, and power indicate that socioeconomic status
and judicial findings of sanity should be inversely related.
The present section has treated the individual position
in the stratification system as an independent variable
causally related to aspects of ones biogr^hy. The following
sections of this chapter will consider social control and
mental illness as variables dependent on the stratification
variables.

13
Social Control
As all societies are stratified and involve inequal
ities, so do all societies contain mechanisms of social
control. It is an elementary principle of social science
that because man's biological controls are minimal his social
order must provide controls, which, from a societal viewpoint
make social life possible and from a phenomenological view
point make life meaningful.
Lemert (1972:53-54) has distinguished between passive
social control and active social control. Passive social
control was said to be the Sumnerian idea of automatic control
by the folkways, mores and laws. (Sumner, 1907). Active
social control, in contrast, is not automatic, but is a
process which involves the implementation of goals and values.
. . active social control is a continuous
process by which values are consciously
examined, decisions made as to those values
which should be dominant, and collective
action taken to that end.
(Lemert, 1972:54).
An example of passive social control would be an
individual not accepting a friend's invitation to view
pornographic materials because "it is not proper behavior."
Active social control would be involved when the state's
attorney in conjunction with other officials determines

14
and implements a policy for the control of pornography.
The first example is individual and automatic, the second
is collective, processual, and ultimately involves the
differential power between the controllers and the controlled.
Lemert (1946) has placed legal commitment of the insane
within the context of active social control. Lemert points
out that only 50 per cent of the "mentally diseased" persons
are institutionalized. Commitment must, therefore, involve
a process of active social control. Lemert suggests that
expectancies on age, sex, marital status, occupational,
ethnic and locality affiliations, and their interaction with
behavior symptoms are important for the understanding of
the commitment process. According to Lemert, deviation from
role expectations and the consequent social strain, leads to
an individual's insanity hearing. Psychological pathology
alone does not lead to involuntary commitment. There must
be a reaction from some other person who initiates the
proceedings. This reaction depends on role expectations.
(Lemert, 1946:1).
Societal Reactions
Researchers interested in deviance and control have
focused on many phenomena for the explanation of deviant
behavior. Biological characteristics of the individual

15
(Sheldon, 1949), the social structural gap between means
and ends (Merton, 1957), the interactional milieu of the
deviant (Sutherland, 1947), and a combination of social
structure and milieu (Cohen, 1955), have all been used as
explanations of deviant behavior. The purpose of this
section is to present a relatively new perspective on
deviance which suggests that an individual who seeks to
understand deviance and control should focus not on the
personal characteristics of the deviant or his social
milieu, but on the definers of deviant behavior and the
social reaction to deviant behavior.
In the Division of Labor in Society, Durkheim (1964:105)
defined crime as an act "contrary to strong and defined
states of the common conscience." Acts, according to
Durkheim, are not inherently criminal but are so defined
by society.
In other words, we must not say that an action
shocks the common conscience because it is
criminal, but rather that it is criminal because
it shocks the common conscience. We do not
reprove it because it is a crime, but it is a
crime because we reprove it.
(Durkheim, 1964:81).
In a later work, the Rules of Sociological Method, Durkheim
continued to express similar ideas on the public construction
of crime.

16
What confers this (criminal) character upon
them (societal divergences) is not the
intrinsic quality of a given act but that
definition which the collective conscience
lends them. If the collective conscience
is stronger, if it has enough authority
practically to suppress these divergences,
it will also be more sensitive, more exact
ing; and reacting against the slightest
deviations with the energy it otherwise
displays only against more considerable
infractions, it will attribute to them the
same gravity as formerly to crimes. In
other words, it will designate them as
criminal.
(Durkheim, 1938:202).
If one disregards Durkheim's insistence on a universal
criminal definition by the collective conscience, one would
see that in his statements lie the seeds of the deviance
orientation which has come to be known as the social reactions
approach, labeling theory, or the interactionist orientation.
Contrary to other approaches to deviance, this orientation
emphasizes the process by which acts and individuals become
defined as deviant. In trying to understand this process,
this perspective focuses more on the reaction of conforming
society to deviance than on the social environment or the
personality pathologies of individual deviants.
Though Durkheim's writings contained what could have
been the seeds of an early social reactions orientation, it
was some decades before the deviance literature contained an

17
treatment of such an approach. After Frank Tannenbaum's
(1938) early work, which did take into account the part of
the deviant's audience in creating a deviant role, came five
leaders in the reactions approach to deviance: Lemert (1951),
Kituse (1962), Erickson (1962), Simmons (1965), and Becker
(1963).
Lemert (1951) compiled one of the first systematic
treatments of the social reactions approach. Central to his
theory were the concepts of social differentiation, deviation,
and individuation. The deviant was defined as
. . one whose role, status, function and
self-definition are importantly shaped by
how much deviation he engages in, by the
degree of its social visibility, by the
particular exposure he has to the societal
reaction, and by the nature and strength
of the societal reaction.
(Lemert, 1951:23).
Kai T. Erickson presented a deviance position that falls
within the labeling or interactionist perspective but remains
unique. Drawing on Durkheim's writing on deviance, Erickson
wrote that deviance is not pathological but functional for
society. The deviant was seen as charting the boundary limits
of the social system and providing a reference point for the
type of behavior which belongs in the system. Erickson
entered the fold of the labeling approach when he pursued

18
the question of how one becomes a deviant.
In the present case, how does a social structure
enlist actors to engage in deviant activity. .
sociologists should be interested in discovering
how a social unit manages to differentiate the
roles of its members and how certain persons are
'chosen* to play the more deviant parts.
(Erickson, 1962:313).
Deviance was therefore seen as fulfilling a societal
need. One's behavior is not inherently pathological, for society
chooses him to play the role of defining society's limits.
Kituse (1962) proposed that a central problem for
deviance theory is to determine which behavior is societally
defined as deviant and how such definitions result in differen
tiating societal reactions. Kituse found that in defining
individuals as sexually deviant, many different behaviors are
interpreted as indications of the same deviation. The same
behavior was found to be defined as normal or deviant by
different individuals. Kituse concluded that the critical
part of the process of defining deviants is the interpretations
and re-interpretations others make of an individual's behavior
rather than the individual's behavior alone (Kituse, 1962:255).
Simmons (1965) also found that deviance is not a consen-
sually defined phenomenon but exists in the eyes of the
beholder. His examination of the range of responses of 180
persons who had listed the things or type persons they

19
considered deviant led him to suggest that ". .there may be
only one sense in which all deviants are alike; very simply,
the fact that some social audience regards them and treats
them as deviants (Simmons, 1965:225)."
Becker (1963) in his Outsiders, expounded what Schur
(1969:311) calls "the central statement of the reactions
orientation."
. . social groups create deviance by making
rules whose infraction constitutes deviance, and
by applying those rules to particular people and
labeling them outsiders. From this point of view,
deviance is not a quality of the act the person
commits, but rather a consequence of the application
by others of rules and sanctions to an offender.
The deviant is one to whom the label has success
fully been applied; deviant behavior is behavior
that people so label. (Becker, 1963:9).
Schur (1969) critically examined the reactions orientation,
and while concluding that even though the orientation might not
meet the strict criteria for being a self-contained theory, he
noted that it offers great promise for the integration of
deviance theory due to its own diverse origins. The fact that
the reaction's orientation, depending on the individual
proponent, may contain elements of interactionism, functional
ism, ethnomethodology, or conflict theory provides a basis for
theory unification (Schur, 1969: 320).
Richard Quinney (1970) asserted that public reactions to
deviance and the social reality of deviance are in interaction,

20
each dependent on the other.
Without a social reality of crime, there would
be no reaction to crime. But on the other hand,
the reactions that are elicited in response to
crime are at the same time shaping the social
reality of crime. As persons react to crime,
they develop patterns of responses of the
future. (Quinney, 1970:278).
If we are to ever understand deviance we must gain
knowledge of public reactions to deviant behavior. Quinney
suggested that from the perspective of the individual,
responses to crime are influenced by knowledge about
deviance and how the individual perceives it (Quinney,
1970:279).

21
Stratification and Social Control
After the publication of Beckers Outsiders (1963),
researchers began to initiate studies of active social con
trol and the process of labeling deviants. Among others, the
works of Piliavin and Briar (1964), Black and Reiss (1970),
Arnold (1971), and Cicourel (1968) have considered the rela
tionship between stratification variables and being defined
as deviant.
Piliavin and Briar (1964) studied police discretion in
their encounters with juvenile offenders. Piliavin and Briar
found that the officer often disposed of cases on the basis
of the personal characteristics of offenders rather than their
offenses. This resulted in differential treatment for some
classes of youths.
Compared to other youths, Negroes and boys whose
appearance matched the delinquent stereotype were
more frequently stopped and interrogated by
patrolmen--often even in the absence of evidence
that an offense had been committed and usually
were given more severe dispositions for the
same violations. (Piliavin and Briar, 1964:212).
Black and Reiss (1970) also found that Negroes fared
worse than whites in police field dispositions. In all
encounters with the police involving citiEen complaints, 79
per cent of the Negroes were released in the field, while
92 per cent of the whites were released (Black and Reiss,

22
1970:71). Though much of this difference is explained by the
complainants preference for disposition, the fact remains
that high caste offenders were released 21 per cent of the
time more than low caste offenders.
Arnold (1971) studied judicial rather than police
dispositions of juveniles and found racial bias, and to a
lesser extent, socioeconomic bias to be operative. Using
controls for marital status of parents, seriousness of offense,
prior record of offender, and delinquency rate of the offenders
census tract, the percentage of offenders sent to the youth
authority was significantly higher in almost all cases for
Negroes and Latin Americans as opposed to Anglos (Arnold,
1971:223).
Cicourel (1968), though he did not make statistical
analysis of court dispositions and status characteristics,
observed that middle income families were able to avoid the
administrative labeling of their youth.
Middle-income families, because of their fear of
the stigma imputed to incarceration, mobilize
resources to avoid this problem. The familiar
ability to generate of command resources for
neutralization or changing probation and court
recommendations, as in adult cases, is a routine
feature of the social organization of juvenile
justice. (Cicourcel, 1968:331).

23
Mental Illness
In most fields of social scientific research there are
competing paradigms (Kuhn, 1970) which define the units of
analysis, the basic concepts, domain assumptions, and research
techniques for the problem area. In mental illness theory
and research, as previously noted in the areas of social
deviance and social control, there are also competing frame
works. The purpose of this section is to introduce the basic
conflict in perspectives on mental illness and consider some
implications, for research in social stratification and mental
illness.
Competing Models of Mental Illness
Angrist (1966) has specified four themes in the pro
fessional literature concerning the nature of mental illness:
mental illness as psychological disease or pathology, mental
illness as deviant behavior, mental illness in some cases
deviant behavior and in others pathology, and a fourth theme
that specifies that mental illness involves social definitions
that vary according to the status and training of the definers.
The mental illness as pathology or disease model focuses
on the psychological structure of the individual. Certain
behavior is symptomatic of underlying psychological pathology

24
or disease.
The abnormal person (i.e., one who had a mental
disorder) is so defined by reference to "universal
indicators" used in psychiatry. In this frame of
reference, certain behaviors are viewed as mani
festation of anxiety, regression, senso-motor
dysfunction, reality distortion, depression,
excitement; these in turn are taken as evidence
of personality abnormality. (Angrist, 1966:71).
This model is analytically closest to the disease model
dominant in psychiatry for more than a century.
The deviant behavior approach conceives of mental ill-
~ ness as behavior that fails to fulfill the role expectations
set for the individual. In this framework, the concern is
most often with the deviant act. Parsons' (1951) work on
the norms governing the sick role and Merton's (1957) anomie
theory of deviance in which the mentally ill were classified
as retreatists from both the culturally prescribed means and
ends, are examples of the perspective.
The third perspective considered by Angrist classifies
some mental disorder as deviant behavior but not all. An
example of this approach would be Szasz's (1961) contention
that only organic disorders can rightly be labeled mental
illness. As in the deviance perspective, functional and
neurotic disorders are seen as deviations from psychosocial,
ethical, or legal norms.

25
The final viewpoint treated by Angrist is that which
sees mental illness labels as being dependent on the various
definers. Illustrative of this viewpoint is Schwartz's
(1957) consideration of the differing definitions of wives
and psychiatrists regarding a husband's behavior. Mechanic's
(1962) discussion of psychiatric definitions and the conse
quential internalization of the sick role also falls within
this category. Erickson's (1957) conclusion that the mental
patient faces role conflict from the divergent lay and pro
fessional expectations is clearly within this area of
labeling. Not mentioned by Angrist, is Scheff's (1966)
labeling and role analysis of the etiology of mental illness.
Angrist's analysis of the various perspectives is very
useful in that it emphasizes the different ways that one
phenomenon can be approached. With awareness of the different
types of analysis available one is sensitized to the fallacy
of claiming exclusive explanatory power for any single frame
work. Angrist points out that there is considerable overlap
between the four perspectives but fails to mention that the
history of mental illness conceptualization and theory might
be pictured as a series of various challenges to a dominant
ideal--typica1 medical pathology model with each offering
various amounts of sociocultural explanations and rejecting

26
certain aspects of the disease framework.
Taber et_ aj_. (1969) presented a picture of a dominant
disease ideology beset by several explanations alternative
to the pathology model, each with the common theme that
mental illness is behavior on which social judgment is passed.
The disease model was said to consist' of four propositions
concerning nosology, pathology, etiology, and therapy. The
practitioner or researcher who works under the disease
model was said to implicitly or explicitly assume regarding
mental illness: (1) that qualitatively different states of
disorder exist and can be recognized; (2) that there is an
illness process within the organism persisting over time;
(3) that there is a causal agent and causal sequence involved
and; (4) that various therapeutic treatments can make a
difference (Taber e^t a 1. 1969:350-352). Taber concludes
that the disease model is largely unsubstantiated by evidence
and partly controverted by research. Nevertheless, the
disease ideology has shaped the social institutions of mental
illness and is a pervasive influence on research (Taber £t^ aj^. ,
1969:352).
Societal Reactions and Mental Illness
Among the alternative formulations considered by Taber
(1969) was the previously mentioned theory of Scheff (1966).

27
Scheff presents a synthesis of much of the sociological
thought on role expectations and mental illness. Central
to Scheff*s theory are the concepts of residual deviance
and labeling. Residual deviance is a category of acts for
which the culture has failed to provide a clear label. Unlike
acts of sin, criminality, and bad manners, these acts are
placed in residual categories like witchcraft or mental illness
(Scheff, 1966:32-34). Residual deviance on the part of an
individual may be stabilized if it is defined and labeled by
others as being mental illness (Scheff, 1966:53-54). If
instances of residual deviance are denied, that is accepted
as being anything other than mental illness, the residual
deviance will be transitory rather than a stabilized recurrent
behavior (Scheff, 1966:51).
The labeling theories of mental illness, like similar
theories of criminal deviance, have not gone uncriticized.
Fletcher and Reynolds (1967) have stated that Scheff's concept
of residual deviance has not been shown to have an empirical
referent congruent with mental illness behavior and that it
has not been causally linked with the labeling process
(Fletcher and Reynolds, 1967:37). Scheff*s theory remains a
purely sociological alternative to the disease model but at
the present is not validated.

28
Lemert (1967), with his alternative explanation of
paranoia, negates a psychiatric conception of the disorder.
Paranoia has been pictured as an individual response to
unusual stress. The paranoid, in the traditional model,
symbolically constructs a threatening pseudo-community with
out existential reality (Lemert, 1967:197). Lemert argued
that the community is at least initially real and that the
pseudo-community is a sequel to the initial isolation by
the real community. The paranoid's construct is not entirely
fiction.
To the contrary, many paranoid persons properly
realize that they are being isolated and excluded
by concerted interaction, or that they are being
manipulated. However, they are at a loss to
estimate accurately or realistically the dimensions
and form of the coalition arrayed against them.
(Lemert, 1967:207).
Gove (1970) analyzed the labeling perspective on mental
illness and concluded that the evidence does not support the
theory. The major objection with the perspective, according
to Gove, is that there is no explanation for the occurrence
of primary deviance (the deviant act before being labeled)
and that it overstates the importance of the forces leading
to secondary deviance (deviance due to labeling and the
acceptance of the deviant role) (Gove, 1970:882-883). In
a later article Gove (1970a) critically evaluated three

29
studies concerning hospital commitment by Wilde (1968), Wenger
and Fletcher (1968), and Scheff (1966). Gove suggested that
if the labeling perspective on mental illness is correct
there would . .
. .be only a slight relationship between degree
of psychiatric disturbance and commitment to a
mental hospital, and 2) the more powerful a person
is, the more likely he is to be able to avoid
attempts to commit him to a mental hospital.
(Gove, 1970a;295).
Goves hypothesis would seem to reasonably follow from
the labeling perspective on mental illness. Gove and those
he criticizes are considered for relevance to this study's
hypotheses in a later chapter.
We might characterize the current theoretical situation
in the field of mental illness as being a contest between two
competing ideal-typical paradigms, the psychiatric pathology
model, and the labeling or social reactions approach. Some
empirical evidence could be interpreted to suggest one, both, or
neither of the models. No one has yet suggested the crucial
test to disprove either model, if in fact such a test could be
specified. The models are closely tied to particular profes-
sions and possibly world views, consequently they will not
crumble from one or several critical articles. It is probably
the fact that some validity is in each of the views and that a
synthesis is in order. It has not been logically demonstrated
that evidence for one perspective necessarily negates the other.

30
Mental Illness and Social Stratification
Studies of socioeconomic status and mental illness have
often found an inverse association between serious mental
illness and socioeconomic status.
This has been the finding from ecological correlations
(Faris and Dunham, 1939), admission studies (Clark, 1948)
(Odegaard,1956), examination of rates under treatment
(Hollingshead and Redlich, 1958) and probability sample
impairment studies of a population (Srole, et_ £l_. 1962).
These studies see mental illness as a condition which can be
either a cause or a result of low socioeconomic status. The
studies of the prevalence of mental illness have not been
particularly concerned with the defining or labeling process.
It should be noted that in all but the probability sample
studies, formal labeling of the sample has occurred prior to
investigation. If social status is important for the defining
process, it has operated prior to investigation so as to bias
the sample towards the lower class. In the probability sample
studies we must ask if possibly the rater or the rating
instrument might be class-biased.
Berger (1966) has stressed the importance of considering
the different reality frameworks from which one judges insanity.
Mental illness, according to Berger, is relative to a

31
socially-constructed reality.
. . questions of psychological status cannot
be decided without recognizing the reality-
definitions that are taken for granted in the
social situation of the individual. To put it
more sharply, psychological status is relative
to the social definitions of reality in general
and'is itself socially defined.
(Berger, 1966:176).
Therapy according to Berger, awaits those who slip from
the dominant reality.
Therapy entails the application of conceptual
machinery to ensure that actual or potential
deviants stay within the institutionalized
definitions of reality, or in other words, to
prevent the "inhabitants" of a given universe
from emigrating" . Its specific institu
tional arrangements, from exorcism to psycho
analysis, from pastoral care to personnel
counseling programs, belong, of course, under
the category of social control.
(Berger, 1966:113).
Kingsley Davis (1938)recognized early that the ideology of
the mental health hygiene movement was tied to the middle-class
Protestant ethic. Davis was also aware that class-linked
ideologies might have implications for social control.
In case of such divergence (from ultimate norms)
other classes will focus attention upon the errant
ones and will seek to control its thinking and
behavior through methods conforming to the sanc
tions of society. (Davis, 1938:63).
Gurslin; et_ a_l. (1960) went beyond Davis work with a content
analysis of mental health movement literature. They found a

32
heavy bias in the publications for middle-class values at
the expense of lower-class values. They concluded that the
mental health message was functional for the middle-class
sociocultural structure but contained dysfunctional potential
for the lower-class structure.
To the extent, however, that more subtle and
effective methods of social control are built
around the mental health movement in the
future, we may expect some pronounced dys
functional consequences for the lower-class
social structure.
(Gurslinn, et_ a_l. 1960:216).
Hollingshead and Redlich (1958) have described what
might be the results of a class-linked ideology on the actual
practice of psychiatry. They found that patients from the
higher social classes when seeking treatment for psychiatric
disorder will more likely receive long-term intensive psycho
therapy while lower-class patients more often receive short
term psychotherapy, drug therapy, or other somatherapy rather
than the more costly intensive psychotherapy. Schafer and
Myers (1954) found the same relationship even when the cost
of care was controlled by studying an indigents clinic in a
major teaching hospita1. Hollingshead and Redlich also found
that lower-class candidates for psychotherapy were not liked
or understood by the therapists and quit treatment much more
often than those from higher classes (Hollingshead and

33
Redlich, 1958 :335-355) .
A study which asks whether the clinician is class-biased
in terms of diagnosis was done by Haase (1964). Seventy-five
psychologists were asked to evaluate a series of Rorschach
protocols and to give impressions prior to diagnosis, a
diagnosis and a prognosis for each one. The diagnosticians
were presented eight protocols consisting of four matched
pairs which differed only in terms of subtle clues to the
socioeconomic status of the client. The results showed a
strong class bias.

In every case except one, they were biased in
favor of the middle-class with a probability
beyond the .01 level. Whether we examine the
clinicians impressions prior to diagnosis, the
diagnosis itself, or the prognosis, the direc
tion of the bias is always the same--it favors
the middle class. (Haase, 1964:244).
Haase concludes as follows:
The immediate interpretation is the one that
emphasized the formal academic preparation and
the correlative social processes that inculcate
the class identification upon the noviate
professional. We would agree with Kingsley
Davis that the content of mental hygiene is
predominantly middle-class and that there is
unverbalized agreement among the practitioners
of psychology that the lower class cannot
totally assimilate the ways of thinking and
behaving that alone can insure prevention and
cure of maladjustment (Haase, 1964:244).

CHAPTER II
STUDIES OF CIVIL COMMITMENT
Empirical research on the commitment of the insane is
relatively scarce considering the thousands of people
committed yearly and the implications of commitment for the
societal reactions model of mental illness. This chapter
will consider work in this area which focuses on two ques
tions: (1) What is the nature of the commitment process and
its effect on whether those committed in fact meet the
requirements of commitment? (2) What are the status
(
characteristics which differentiate those who are committed
from those who are not?
Process and Pathology
Luis Kutner (1962), a legal scholar, asked the question
of whether the commitment process in action satisfied the
requirements of legal due process. His examination of an
Illinois commitment facility convinced him that it did not.
Even though the statutory wording provided the framework for
due process such as notice, physicians examination, and a
hearing, the implementation of the statute reduced procedural
safeguards. Kutner found that physicians certificates to
34

35
start the commitment process were signed as a matter of course
after the alleged incompetent was already confined, that the
examinations by state physicians for evidence at the hearing
were on an assembly-line basis never taking more than ten
minutes, and that in 77 per cent of the cases there was a
recommendation for confinement. The court hearing was no
different. The patients were heavily sedated and incapable
of defending themselves. Persons were not notified of their
right to counsel or to a jury trial. In regard to the State
physician's examination, Kutner (1962:385) concluded, "It
appears that in practice, the alleged mentally ill is presumed
to be insane and bears the burden of proving his sanity in the
few minutes allotted him."
In a general paper concerning social factors in identify
ing and defining mental illness, based on observations of two
California hospitals, Mechanic (1962) mentioned how the
situation of the examining physician could result in the
practices observed by Kutner.
Both the abstract nature of the physician's
theories and the time limitations imposed upon
him by the institutional structure of which he
is a part, make it impossible for him to make
a rapid study of the patient's illness or even
to ascertain if illness, in fact, exists.
(Mechanic, 1962:69).
Mechanic went on to say that in a period of three months'

36
observation at the two hospitals, he never saw an instance of
a patient being advised by a psychiatrist that he did not need
treatment (Mechanic, 1962:70).
Miller and Schwartz (1966) have reported their observations
of 58 hearings of a county lunacy commission. Though mainly
concerned with the relationship between the pre-patients
demeanor and the case outcomes, they did provide data which
supports Kutner's and Mechanic's observations. Miller and
Schwartz found that the physicians who had examined the pre
patients prior to the hearing recommended commitment in almost
all cases. Those few individuals not recommended for hospital
ization were said to be emotionally disturbed and in need of
out-patient psychiatric care. The length of time for the
hearings was very short: 4.1 minutes mean, 3 minutes median.
Forty-five cases or 78 per cent of the total were committed
to the State hospital. The researchers made no attempt to
judge the "illness" of the pre-patient and relate that to the
case outcomes, but conclusions were reached on the effect of
certain types of pre-patient behavior on case outcomes.
. . those who were able to present themselves
in a controlled and effective manner were likely
to be released. Those who either did not openly
object, or objected in violent or abusive ways,
were committed to the state hospital . This
observational study found that those persons who
were able to approach the judge in a controlled
manner, use proper eye contact, sentence structure,

37
(
posture, etc., and who presented their stories
without excessive emotional response or bland
ness and with proper demeanor, were able to
obtain the decision they wanted--whether it was
release or comraitment--despite any "psychiatric
symptomatology." (Miller and Schwartz, 1966:34).
Scheff (1966) has gathered data on both the nature of
the commitment process and the degree of impairment of those
committed. From observations of 116 judicial hearings
Scheff reports that 86 of the hearings failed to establish
the judge's criteria of mental illness. Forty-eight of the
patients were said to exhibit behavior and responses which
were "completely unexceptional." In none of the 116 cases
did the psychiatric examiners recommend release of the
patient.
An observation of 26 psychiatric examinations, given
prior to the judicial hearing, produced the following data.
Of the 26 cases, the examiners recommended hospitalization
in 24 cases. The non-psychiatrist observer rated the cases
as to whether the statutory criteria for commitment were met.
The observer rated 8 cases as meeting the criteria, 7 cases
as not meeting the criteria, and 11 cases as inconclusive or
potentially meeting the criteria with a more extensive
investigation. The mean length of the examinations was 10.2
minutes.

38
The examinations were described as follows:
Most of the interviews were hurried, with
the questions of the examiner coming so
rapidly that the examiner often interrupted
the patient, or one examiner interrupted
the other. All of the examiners seemed
quite hurried. (Scheff, 1966:146).
As an additional measure of the degree to which admitted
patients met legal criteria for admission, Scheff had 25
admission psychiatrists for the three largest public mental
hospitals in a midwestern state fill out questionnaires for
the first 10 patients they examined in one month in 1962.
The questionnaire contained the psychiatrist's ratings of the
patient's probability of harming himself or others and of the
patient's present degree of mental illness. Scheff felt that
to be clearly qualified for involuntary commitment, a patient
should be rated as "likely to harm himself or others" and/or
as "severely mentally impaired." Scheff found that 63 per
cent of the patients, as rated by the admitting psychiatrists,
did not meet these criteria. Gove (1970a) has criticized the
validity of Scheff's conclusion on the grounds that Scheff's
cutting points for meeting the criteria are not necessarily
the "correct" ones. Gove suggests that the cutting point for
dangerousness should be lowered two categories to "somewhat
unlikely to harm himself or others" and that for mental impair-

39
ment should be lowered to "moderate impairment." It is not
possible, from Scheff's presentation, to ascertain the effect
of changing the dangerousness cutting point, but changing the
impairment cutting point as suggested by Gove would still
result in about 40 per cent not meeting the legal criteria
for involuntary confinement.
To test the social reactions position on mental illness,
Wilde (1968), used available data in the form of official
court commitment records and receiving hospital records from
a southern county. Wilde was interested in whether three
variables were associated with approval of a petition for
commitment. These variables were identity of the particular
interviewer at the receiving center (indicating idiosyncratic
criteria) the fact of the petitioners getting an appointment
prior to the interview (a measure of petitioner's diligence),
and the existence of committable mental illness (measured by
an index derived from interviewer protocols). Wilde found
a significant association between the identity of the inter
viewer and the approval of a petition, but this can probably
be discounted as meaningless due to Gove's valid criticism
that certain cases of higher pathology might have been assigned
to a particular group of interviewers (Gove, 1970a :297). Wilde
found a slight negative association between committable mental

40
illness and approval of a petition and a positive association
between the petitioners diligence and approval of the
petition. Controlling for committable mental illness, the
association between having an appointment and petition
approval remained positive. The results were interpreted
to be consistent with the societal reactions perspective.
Gove (1970a:297-298) has challenged Wildes conclusions on
the grounds that the sample was not representative, that the
low approval rate for petitions from the general public (33
per cent) was indicative of careful screening, and that the
interview protocols offered a tenuous index of mental illness.
Status Characteristics and Commitment
The societal reactions perspective on deviance places
considerable emphasis on the aspect of differential power
between the deviant and the agencies and agents of social
control. The effect of power on the outcome of commitment
hearings has been incidentally studied by Wenger and Fletcher
(1969). Though not designed as a test of the social reaction
perspective, their study examined the effect of legal counsel
on commitment. Retention of counsel is an index of power and,
therefore, relevant to that perspective.
The researchers in their study observed 81 commitment

41
hearings, noted the presence or absence of counsel for the
patients and the length of the hearing, and classified the
patients as to whether their condition met the criteria for
commitment. The average length of the hearings was 8.13
minutes with a median of 5.03 minutes. The hearings with
legal counsel were over twice as long as those without.
Eighty per cent of the cases observed involved a commitment
to the hospital. Having legal counsel was highly associated
with not being committed, ninety-one per cent of those without
legal counsel were committed while only 26 per cent of those
with legal counsel were committed. Controlling for whether
the patients' conditions met the legal criteria for commitment
or not, the association still existed, though having counsel
was associated with the criteria not being met. The authors
conclude that having counsel definitely affects the decision
of whether one is admitted to a state mental hospital. The
conclusions of Wenger and Fletcher's study, like those of
Wilder and Scheff's, previously considered, were scrutinized
by Gove (1970a). Gove's major criticisms were that the
psychiatric evaluations followed by the court were more sound
than that of the lay observers since they were based on
professional competence and private examination, and that
court hearing was so brief as to preclude the lawyers

42
influencing the psychiatrists. Had Wenger and Fletcher
been working from a social reactions perspective they might
answer Goves criticism by saying that psychiatric evaluation
is influenced by a disease ideology with a presumption of
illness, and,therefore,suspect from the labeling perspective.
Past studies have shown that psychiatric commitment
evaluations are perfunctory at best, usually lasting a shorter
time than the court hearing observed by the researchers. When
Gove questions whether the lawyers could be so effective in
such a short hearing, he ignores two points. The psychiatrists
could very well have known of the fact of legal counsel well
before the hearing, possibly prior to their own examination.
Since the psychiatrists in such hearings are court-appointed
and the court is generally aware of lawyer participation in
advance of a hearing, it would be unlikely that the psychiatrists
were not apprised of the existence of counsel before the hearing.
Because of the possibility of civil liability for an unwarranted
commitment and the much higher probability of such a suit when
the patient is already represented by counsel, it seems that
the psychiatrists could easily be influenced in a short hearing,
particularly if they were aware of counsel prior to the hearing.
One of the most extensive studies of the variables related
to being committed to a mental hospital was carried out by

43
Haney and Michellute (1968). Their stud/ considered two
questions: (1) What demographic indices of a particular
jurisdiction best predict the percentage of adjudged incom
petents within a jurisdiction? (2) What individual
characteristics best predict an individual's being judged
incompetent rather than competent? Because of the limited
relevance of the first question to this research, only the
data for the second question will be considered here.
For the individual research, Haney and Michellute gathered
data on every case of a judicial examination of incompetency in
five representative Florida counties, in a three-month period.
There were complete data on 571 cases. The independent variables
were age, race and sex of the individuals, the number of
psychiatrists bn the examining committee, and whether the
petition for commitment was by the family of the alleged
incompetent or not.
The dependent variable was whether the individual was
adjudged incompetent, temporarily incompetent (six months
commitment and no loss of civil rights), or competent.
The overall percentage of those found incompetent or
temporarily incompetent was 75 per cent. Sex demonstrated
very little effect on adjudged incompetency. There was a
slightly higher percentage of non-whites adjudged incompetent

44
as opposed to whites, but the difference was not significant.
The best predictors of adjudged incompetence were age,
examining committee composition, and whether the petition
for a hearing was from family or non-family persons. Those
age 24 or under were adjudged competent 43 per cent of the
time, while those over age 65 years of age were adjudged
competent in only 8.5 per cent of the cases. Examining
committees with no psychiatrists found incompetency in 59.7
per cent of the cases. Committees with psychiatrist members
adjudged incompetency or temporary incompetency in 80.9
'per cent of the cases. In cases where the petition for a
hearing was signed by other than a family member, 83.2
per cent of the individuals were adjudged incompetent or
temporarily incompetent, while 68 per cent were so adjudged
when a family member instituted the proceedings. Each of
the associations remained when the other two independent
variables were used as controls.
The results of this study could be interpreted as supportive
of the social reactions perspective on mental illness. The fact
that who institutes the proceedings affects the judgment of
incompetency is in agreement with the labeling perspective.
The differential between psychiatric and non-psychiatrist
committees could be explained by the proposition that one

45
trained to use certain labels will use them, what he sees
being influenced by his conceptual categories. For instance,
the general physician sees as a temporary marital problem
what the psychiatrist might view as psychotic depression. The
results could be compatible with a pathological perspective if
serious "mental pathology" could be shown to be related to the
predictive variables. Otherwise, the social reaction explana
tion fits quite well.
An early study by Friedsan e_t al_. (1954) also demonstrated
that status characteristics make a difference in which type of
procedure a person is committed under. Friedsan compared the
characteristics of individuals committed by jury trial, which
involves indefinite hospitalization, with those committed for
only ninety days by a purely administrative procedure. In
every category, the temporary 90-day commitments had a higher
percentage of individuals with high status characteristics.
The percentage of males, youths, whites, and married was higher
in the temporary commitments than in the indefinite commitments.
The authors observed that the temporary commitment process
seemed to be used by persons of higher economic status than the
indefinite jury trial process (Friedsan e_t aJU 1954:28).
Rushing (1971) has studied commitments to mental hospitals
to specifically determine the applicability of the societal

46
reactions model. Rushing, though, does not feel that only
one model of mental illness can have validity.
Probably both perspectives are valid. Behavior
pathology and societal reactions are probably
involved to some degree in most cases of mental
hospitalization, though their relative importance
may vary from case to case. (Rushing, 1971:511)
Rushing said that it is probably impossible to determine
precisely the proportions of commitments due to behavior
pathology versus societal reactions. Rushing suggested that
studying the contingencies of the societal reaction might be
a more fruitful approach (Rushing, 1971:512). Rushing was
concerned with how individual resources, as indicators of
power might affect the societal reaction. Individual resources
were measured by the occupation of the patient and whether the
patient was married, estranged or single. Occupation and
marital status were examined as individual resource variables
determining whether a patient was hospitalized voluntarily or
as an involuntary commitment.
Rushing analyzed over 3,000 first admissions which
covered a period of 10 years. As expected, the ratio of
involuntary to voluntary admissions varied inversely with
the socioeconomic status of the individual. The married
were found to have the lowest ratio of involuntary to voluntary
admissions followed by the estranged and the single who had a

47
rate almost twice that of the married. Rushing concludes,
A persons social and economic resources and
degree of community integration appears to be
significant contingencies in the tendency to
hospitalize. The results provide rather
consistent support for the societal reaction
perspective on deviance. (Rushing, 1971:524).
The present study is intended to complement Rushing's
findings by examining similar contingencies of a persons
either being released or found incompetent by a judicial
commitment proceeding. Rushing's study did not examine the
characteristics of those who avoided hospitalization, but
only compared the characteristics of those under voluntary
and involuntary hospitalization. This study compares those
who avoid involuntary commitment with those who do not.
Rushing notes that since he had no measure of behavior
pathology in his study, he could not determine the interaction,
if any, between social reactions and pathology. This study
will consider the effects of diagnosed pathology and psychia
tric history along with other social contingencies on the
final decision of a judicial competency hearing.

CHAPTER III
THE COMMUNITY AND ORGANIZATIONAL SETTING OF THE STUDY
The purpose of this chapter is to describe briefly the
setting for the present research so that the data produced
can be analyzed in a more meaningful context. The community
will be described in general terms and by census statistics.
The geographic area studied may then be compared on various
- measures to the rest of the state and the particular collec
tion of alleged incompetents studied can be compared to the
area population as a whole.
The mental health facilities in the area will be
separately considered because of their great importance to
the subject matter of the study. Local facilities can
provide therapeutic alternatives to commitment in a state
hospital or might also serve as agencies for defining
individual cases of mental illness therefore increasing the
number of commitments.
The legal structure for commitment of the insane will
be outlined both from the perspective of the state statutes
and the local implementation of the state law.
48

49
The Community
The location for the present research is Southern County,
a county geographically in the southeastern United States but
not part of the ''deep south. Southern County, a standard
metropolitan statistical area 900 miles in area, has a total
population of about 105,000; of which about 70,000 live in the
urbanized area of Southern City.1
Southern City is the location of a state land grant
university with a student population of about 24,000 and a
faculty of about 2,500. The county contains six small towns
almost equidistant from the centrally located Southern City
and ranging in size from 500 to 2,500 population. Several
\
small rural settlements and rural farm residences account for
the remainder of Southern County's population. The outlying
towns have in the past been predominantly agricultural but now
also serve as bedroom communities for Southern City's fast
developing educational, medical, and technological economy.
Twenty-eight per cent of Southern County's population are
classified as rural.
Sociodemographic figures for this section are from the U.S.
Bureau of the Census, 1970 Census of Population and Housing
for the Southern County standard metropolitan statistical area.

50
As an illustration of the changing function of the
small towns, only 3.5 per cent of the population are
classified as rural-farm. Indicative of the changing
characteristics of the population, 45 per cent of the county
residents were born outside the county. Twenty-one per cent
of the county and 17 per cent of the major city are black.
The mean educational attainment for the county is 12.6 years.
The citys mean educational level is 13.4 years. Further
illustrative of the education of the area is the fact that
30 per cent of the city and 23.1 per cent of the county as
a whole have four years or more of college.
Some of the best descriptive characteristics of a
community are the indicators of the economic and occupational
structure. The median family income for the county is $8,329
close to the corresponding state figure of $8,267. The per
centage of county families with an income above $15,000 is
17.6, while the state has 16.8 per cent above $15,000.
The occupational structure of Southern County is heavily
weighted towards professional and white-collar occupations.
Thirty-five per cent of the county's employed people above the
age of 16 are in professional-technical or managerial positions,
according to census classification. Fifty-four per cent of
those employed above the age of 16 are classified as white
i

51
collar and 42.9 per cent are Federal, State, or local
government employees. Only 7.5 per cent of the county's
employed work in manufacturing.
The income, educational and occupational characteristics
of Southern County are heavily influenced by the fact that
it is the location of a large state university which employs
highly educated and well paid individuals while attracting
other governmental and industrial employers who do the same.
One would expect that the level of mental health care facil
ities for Southern County would also be influenced by the
existence of a large state university.
Mental Health Care Resources
The mental health care resources for Southern County are
quite extensive. Except possibly for the number of private
practitioners, the alternatives for care in Southern County
are more extensive than in other comparable size counties.
This section briefly describes the different facilities for
mental health care in the county.
The number of counselors in private practice in Southern
County is not large but probably adequate to serve those who
can afford the high cost of their service. In 1969, the last
year covered by this study, there were three psychiatrists in

52
private practice in Southern County, all located in Southern
City. The same year the number of practicing psychologists
was seven. Two marriage counselors were practicing in
1969 for a total of 12 private professionals engaged in
counseling or approximately one for each 6,200 residents of
Southern County who are above age 14.
The County Mental Health Service is the major supplier
of mental health care in Southern County. Funded by the state
and county government, this facility is under the direction of
the county health department. The major functions of the
clinic are: (1) Providing professional counseling and drugs
for patients on trial visit from the state mental hospitals,
(2) Consultation services for teachers and parents about
emotional problems of children, (3) Diagnostic testing in
consultation with school psychologists, (4) Individual and
group short term therapy, and (5) Providing prescribed drugs
for indigent patients.
The Mental Health Services Clinic is staffed by a
psychiatrist-director, one full-time psychologist, one half
time psychologist, two psychiatric nurses, two social workers,
and two secretaries. Residents in psychiatry from the univer
sity medical school and interns in clinical psychology from
the university are active in working at the clinic as part of

53
their training. The clinic sees patients who are referred
from other agencies or practitioners and who appear without
referral or appointment.
That the clinic might be an important factor in commit
ment proceeding is evident from its 1968 statistics. In
1968 the clinic had 4,001 individual visits for individual
therapy and 2,365 for group therapy. There were 294 new
patients seen in 1968 over the age of 18 and 154 under the
age of 18. Most of the 44 persons on trial visit from state
mental hospitals in 1968 were seen for after-care counseling
and medication. There were 3,776 prescriptions filled at the
clinic in 1968 of which 2,336 were for previous patients of
state mental hospitals and 1,440 for indigent patients.
Southern City contains a division office of Southern
States division of vocational rehabilitation, which serves
14 counties. One third of the cases of this local division
come from Southern County. Vocational rehabilitation is
funded by federal and state money, its services being avail-
*
able to individuals who are having employment problems due to
a physical or mental impairment. The services provided
include: (1) medical and nonmedical diagnosis to determine
what should be done in order for the client to be employable,
(2) vocational counseling for the selection of suitable

54
employment, (3) medical, surgical, hospital and prosthetic
services necessary for the client's being employed, (4) job
training, (5) living expenses assistance while preparing for
employment, and (6) assistance in finding employment and
adjusting to the work situation. The staff of Southern
County's vocational rehabilitation program consists of the
director, 26 counselors, and 24 clerical workers.
Most of the psychiatric work in the vocational rehabili
tation office centers around two counselors, under the guidance
of a consulting psychiatrist, who carry a strictly psychiatric
case load of about 140; and a half-way house for individuals
with psychiatric problems who need an unstructured but super
vised residence. Southern County's vocational rehabilitation
psychiatric services maintain a close relationship with the
county's mental health services clinic. A client may be
obtaining counseling from both agencies while living at the
half-way house.
The state university located in Southern City provides
two sources of mental health care in addition to its teaching
hospital. The student mental health clinic provides individual
and group therapy for students with emotional difficulties.
The permanent staff consists of four psychiatrists, five
psychologists, and two psychiatric nurses. During a 12
month period in 1968 and 1969, 752 cases of emotional

55
disturbance were treated by the clinic. The clinic is
open 24 hours a day.
The state university counseling center is staffed by
six psychologists and several interns providing, in addition,
vocational counseling for less severe emotional problems.
Approximately one-half of the 24,000 annual case load
consists of personal-emotional rather than vocational
counseling.
Southern County has three hospitals providing psychi
atric services, all located in Southern County: a county-
owned general hospital, a university-run teaching hospital,
and a federally-operated veterans hospital.
The county-owned hospital provides inpatient psychiatric
care only in a 22-bed psychiatric unit. The unit is staffed
by private psychiatrists with 7 registered nurses, 6 practical
nurses, and 4 attendents. In the 1968-1969 fiscal year a
total of 363 patients were in the psychiatric unit. The rate
for care in the psychiatric unit is $54.00 per day plus
psychiatrist fees and drugs. This unit, besides being open
for private patients, is used for holding some patients
awaiting a commitment hearing or admittance to a state mental
hospital.
The university teaching hospital offers outpatient

56
psychiatric care in addition to its 32 bed inpatient
psychiatric unit. In 1965, 447 patients were admitted to
the inpatient unit of which 57 per cent or 263 were Southern
County residents.
The veterans* hospital located in Southern City provides
both inpatient and outpatient psychiatric care for qualified
veterans. The 60 bed inpatient unit has on its staff five
psychiatrists and five psychologists. In the 1968-1969
fiscal year 366 psychiatric patients were admitted.
The Legal Structure of Commitment
In colonial America there were no statutes providing
for commitment of the mentally ill and until very late in
the colonial period there were no hospitals for the care of
the mentally ill. Until state statutes provided for commit
ment of the insane such cases were handled under English
common law which permitted citizen's or police arrest of the
'furiously insane" and confinement for the duration of their
dangerous condition. In 1752 the first colonial general
hospital was funded and in 1772 the first asylum exclusively
for the insane was opened in Williamsburg, Virginia (Deutsch,
1948). The first hospital admission of a mentally ill
person in America was recorded in 1756 at the Pennsylvania
Hospital in Philadelphia (Rock et_ al.,
1968:1)

57
An example of an early state commitment law would be
New Yorks statute of 1788, which reads much like the
English law of 1744.
Whereas, There are sometimes persons who
by lunacy or otherwise are furiously mad, or
are so far disordered in their senses that
they may be dangerous to be permitted to go
bbroad: therefore,
Be it enacted, That it shall and may be
lawful for any two or more justices of the
peace to cause such a person to be apprehended
and kept safely locked up in some secure place
and, if such justices shall find it necessary,
to be there chained . .
(Deutsch, 1949:420).
Involuntary commitment to the early mental hospitals
was easily and informally accomplished.
The request of a friend or relative--or
perhaps even an enemy--to a member of the
hospital staff for an order of admission
would often suffice. The staff member
might then hastily scribble a few words on
a scrap of paper, sign his name, and the
procedure would be completed.
(Brakel and Rock, 1971:34).
AtLthis time, thousands of persons are involuntarily
hospitalized annually and every state has much more detailed
laws regulating such commitments. The provisions of the
formal state statute of Southern State covering involuntary
hospitalization will be briefly outlined and the implementa
tion of the statute in Southern County will be described.
In addition to the provisions for judicial involuntary

58
commitment, Southern State's law provides for voluntary
admission to state mental hospitals by direct application
to the state hospital and for short term (15 days maximum)
involuntary hospitalization based on medical certification
alone. For a patient to be hospitalized involuntarily
beyond the short term period he must be judicially declared
incompetent or temporarily incompetent.
The major sections of the statute providing for
adjudication of incompetency specify what types of
incompetency are covered by the statute, who may petition to
have incompetency determined, the hearing procedure, a
particular medical examining committee and procedure, the
effect of judgment, and the commitment procedure after
judgment.
The state statute provides that petition for examination
of incompetency may be made where one is believed to be
incompetent because of mental illness, sickness, drunkenness,
excessive use of drugs, insanity, or other mental or physical
condition, or if one is believed to be incapable of caring
for himself or managing his property, or likely to dissipate
or to lose his property or to become the victim of designing
persons, or inflict harm on himself or others. The petition
is filled under oath in the county judge's court in the

59
alleged incompetent's county of residence or location.
The persons allowed to file such a petition are: the
mother, father, brother, sister, husband, wife, child, or
next of kin of the alleged incompetent; any three citizens
of the state; the sheriff of the alleged incompetent's
county of residence. A person may request self-examination
if he presents a physician's certificate certifying he is
incompetent under the statute. The petition--besides naming
the alleged incompetent, his family members, and their
addresses--states the nature of the disability and asks that
the alleged incompetent be adjudged incompetent. The judge
may, in the best interest of the alleged incompetent, before
the hearing and after a petition is filed, order that the
alleged incompetent be placed in protective custody of his
family or other responsible citizen. If the judge feels that
the public safety or the alleged incompetent's safety requires
it, he may order the sheriff to confine the alleged in some
specified place.
After the petition is filed, the statute prescribes,
that the judge shall appoint an examining committee of a
responsible citizen and two practicing physicians who are
not associated with each other in practice. A petitioner
cannot serve on the committee. The examining committee is
to examine the alleged incompetent so as to thoroughly

60
ascertain his mental and physical condition and report to
the court: whether the person is incompetent, temporarily
incompetent (capable of speedy recovery with specialized
care and treatment), or competent; if incompetent, whether
the condition is acute or chronic; the apparent cause of
the condition; and the age, propensities, and the hallucin
ations if any of the alleged incompetent. If the examining
committee finds the alleged incompetent is not mentally ill,
the judge may terminate the proceedings.
When the petition is filed the judge is to set a date
for an early hearing and give reasonable notice of such to
the alleged incompetent and one or more members of his
family. The hearing is to be as informal as orderly
procedure will allow and in a physical setting not likely to
have a harmful effect on the mental health of the proposed
patient. An opportunity to be represented by counsel is to
be afforded every alleged incompetent. The court may appoint
counsel for the alleged incompetent if he or others do not.
On request of an indigent person the judge shall appoint an
attorney to represent such person at no cost to the indigent.
The judge, from the report of the examining committee
and the hearing, may find and adjudge the person competent,
incompetent, or if so recommended by the examining committee,

61
temporarily incompetent.
A person adjudged mentally incompetent is presumed
during his incompetency of being incapable of managing his
own affairs, making a contract, gift or any binding instru
ment in writing. He cannot hold a drivers license or vote.
A person discharged from temporary incompetency is
automatically restored to his civil rights. For one who
is discharged from a regular incompetency judgment, certain
formal procedures are necessary to regain his civil rights.
After a person is adjudged incompetent or temporarily
incompetent, the judge may commit him to a state hospital,
decree that he is harmless and release him, or deliver him
to the custody of a guardian or any responsible person.
Before any person 'above the age of 21 can have a legal
guardian appointed for management of his affairs he must
first be adjudged incompetent.
To understand the local implementation of the state
incompetency statute in Southern County, one must first
realize that incompetency proceedings are only a part of
the courts duties. In addition to incompetency hearings,
the county judges court handles all of the countys probate
of wills and estates, serves as the committing court for all
criminal felonies, issues all arrest warrants for felonies

62
and misdemeanors, and serves as the juvenile court for the
whole county. The court has only one judge, so much of the
duties of the court except for hearings are handled by
clerks.
The incompetency functions of the court are handled
almost exclusively by one clerk. If someone inquires at the
court about instituting an incompetency proceeding, that
clerk meets with them, explains the procedures and prepares
the petition on a standard form which they sign. If it
appears from talking to the petitioners that the alleged
incompetent is dangerous to himself or others, a confinement
order is prepared which authorizes the sheriff to confine
the person at either the county jail or the county hospital
psychiatric unit. In almost every case where a confinement
order is issued, the clerk obtains a one-sentence affidavit
from the petitioners to the effect that they believe him
dangerous to himself or others.
After the petition is prepared and signed a committee
is appointed and notices of a hearing are served on the
alleged incompetent and some member of his family. The
examining committee almost always includes one psychiatrist
and usually has two psychiatrists. The non-physician member of
the committee is almost always the law officer who serves the

63
notice of an incompetency hearing on the alleged incompetent.
This is a matter of convenience for the court. The lay
committee member merely signs the committee report as prepared
by one of the examining physicians. This practice would appear
contrary to the intent of the statute, for the lay member is
the same law officer in almost every instance and merely
rubber stamps the report. The examining committee report is
prepared on a standard printed one-page form which all the
members sign. The cause of the alleged incompetent's
condition is usually given in standard psychiatric diagnostic
terms like paranoid schizophrenic. The committee reports always
either finds the person competent or incompetent. No temporary
incompetent forms are provided and neither does the committee
ever change the form to read temporarily incompetent. In
almost every case studied where the judge found the alleged
incompetent temporarily incompetent, the person had signed a
petition for self-examination. But we cannot accept the
self-petitions as voluntary for in the 61 cases of seIf-petitions
studied there is evidence in 22 cases (over one-third) that
someone other than the self-petitioner initiated the proceeding.
In most of these cases the alleged incompetent signed a self
petition after the committee had already found him to be
incompetent. After signing the seIf-petition, the judge

64
signed a judgment of temporary incompetency. This practice
seems to limit temporary incompetency to those who formally
admit a need for care. There was not a physician's
certificate, as required by statute, in any of the self
petition cases studied. As previously noted, the statute
provides that temporary commitments are to be made only on
the basis of the committee recommendations.
The committee examinations are usually made at the
physician's office if the alleged incompetent can go there
or, in case of confinement, at the hospital or jail. If the
committee finds the person competent the judge immediately
enters an order of competency.
The hearing usually occurs within 15 days of the initial
petition and after the committee examination. Although the
statute implies that the alleged incompetent should be
present, in cases where the person is hospitalized or jailed,
this is not always the case. The judge never finds anyone
incompetent or temporarily incompetent who has not been
found incompetent by the examining committee. There are cases
where the committee finds the person incompetent and the judge
either rules the person competent or never enters judgment
in the case, which has the same legal effect as a ruling of
competency. Notes in these case files generally indicate

65
that this'is in accord with the examining psychiatrists'
wishes. In many of these cases there are indications that
the psychiatrist feels that the patient can benefit from
care outside the state hospital and that outpatient care will
suffice. The hearings are private, being held in the judge's
chambers. The examining psychiatrists or physicians are
generally present only if he or the alleged incompetent requests
it. The hearing, actually a formality, hardly ever lasts
beyond 15 minutes. If a person is found incompetent and is to
be admitted to a state hospital, the clerk applies to the
administrator of the state hospital. When a place for the
patient opens the court is notified. The court attempts to
persuade the family of the patient to take him to the state
hospital for admittance. If this is not possible a county
sheriff's deputy transports the patient.

CHAPTER IV
DATA AND HYPOTHESES
This chapter will describe the sources of the data,
the methods used in collecting and analyzing the data, and
the hypotheses to be tested.
The Data
The data for this study are drawn from archival sources
rather than from a standard sociological survey. The use of
available records offers both advantages and disadvantages.
Measures drawn from archives are non-reactive in that the
researcher's presence does not affect the content of the
record. Where a crucial variable, as in this study, is the
decision of a public agency, reliance on the record rather
than a participant's memory can eliminate measurement error.
A major problem with archival data is that the general
scope of the records and the detail of individual cases are
not under the investigator's control. The archive might not
contain the measures needed by the researcher or there might
be missing information on particular cases.
With the strengths and weaknesses of archival data in
66

67
mind, it was decided that they still offered the best
source of information for the present study.
The Cases Studied
This study consists of all the individual incompetency
cases which were completed in the calendar years 1966, 1968,
and 1969 in Southern County. The court's incompetency
records are available to the public. Each case record is
in one file. The files are numbered sequentially in the
approximate chronological order that the cases began. Case
files which were started six months before and completed six
months after the years in question were checked to make
certain that the sample was complete. The final sample
numbered 379 cases. There were 139 cases from 1966, 117 cases
from 1968, and 123 cases from 1969.
The Data Obtained
The data on each case are drawn mainly from the official
court file for the case. The court records were supplemented
by the patient records of those in the sample, if any, from
the county's mental health services clinic, and from the three
county hospitals' inpatient and outpatient psychiatric
facilities. In the four facilities the records for all years
were in one name index. After the court sample was drawn, the

68
patient indexes at the four facilities were checked for
all names of those in the court sample. The records of
those in the sample who had used the facility at any time
were consulted for supplementary data. After all the data
had been abstracted and coded all names were destroyed.
Names were used initially only because that was the only
method of access to ,the hospital and clinic data. The names
in court files are, of course, a matter of public record.
The amount of information in a court file varies from
case to case, but each file contains the minimum court forms
for the processing of a case. Almost every file will
contain: a petition giving the name, age, sex, race, and
family members of the alleged incompetent and the petitioner
or petitioners who ask that he be adjudged incompetent; a
copy of the notice of incompstency proceedings which will
indicate the present address of the alleged incompetent and
whether he is presently confined in a hospital or jail; an
examining committee report which gives the names of members of
the examining committee, their findings relative to the
incompetency of the person and their diagnosis of his condition
if they find him incompetent; a final judgment of the court
which legally determines if the individual is competent,
incompetent, or temporarily incompetent and which may spell

69
out a disposition alternative to commitment such as out
patient care; and a copy of a data sheet required by the
state, which is filled out by the examining committee and
contains demographic, occupational, and clinical information
on the alleged incompetent.
A court file may, in addition, contain an order
confining the individual prior to a hearing, various notes
and correspondence by the clerk or judge concerning the case,
and if the incompetent was committed, forms specifying the
place and time of commitment.
The hospital and clinic records contained varying
amounts of information depending on the length of treatment
or hospitalization. Most of the records contained a patient
history, diagnosis, and prognosis. These records were mainly
used to supplement the demogrqhic and occupational data from
the court records and to determine if the alleged incompetent
had received psychiatric care prior to the commitment
proceedings, been under psychiatric care at the time of the
proceedings, and if he had a history of alcohol problems.
The Variables and Coding
The dependent variable for the study is the outcome of
the incompetency proceeding. Cases were coded as competent,

70
temporarily incompetent, or incompetent depending on the
final judgment of the court. In the few cases where a
judgment of the court was not entered, the case was coded
competent, for that is the legal effect of withholding
judgment.
The independent variables for the study, conceptualized
as status contingencies of the social reaction, are the age,
sex, race, marital status, education, most recent occupation,
and the present occupational situation of the alleged
incompetent.
The age of the alleged incompetent was coded into four
categories: 14 to 25 years of age, 25 to 44 years of age,
45 to 64 years of age, and 65 years and over.
Sex and race were coded into only two categories each,
male or female, and black or white.
Marital status of the alleged incompetent as of the
start of the proceedings was also coded into two categories,
single or married. The single category includes the unmarried,
those not living with their spouse, and those divorced.
The educational attainment of the alleged incompetent
was coded into four categories: those diagnosed as mentally
deficient, education of less than ninth grade, education of
ninth through twelfth grade, and some college and above.

71
There are two occupational variables, the most recent
occupation of the alleged incompetent, and the employment
situation at the time the commitment proceeding was started.
The most recent occupation variable was used to obtain
an indication of the occupational status and training of the
alleged incompetent irrespective of the fact that he might
be unemployed at the time the proceedings began. If the
court and agency records did not list an occupation for the
alleged incompetent, the city directory for Southern City
was consulted to place the person in an occupational category.
The reliability of the city directory classifications was
checked against a sample of persons whose occupation was
available from court and agency records. The reliability
was 100 per cent. Those eighteen years of age and under were
classified by the occupation of their father.
There are four occupation categories and three residual
categories for the most recent occupation variable. The four
employed categories are unskilled-working, skilled-working,
lower white-collar, and upper white-collar. Three other
categories are students, housewives, and never employed.
The unskilled-working category is made up of manual workers
whose jobs require little skill or training. Manual laborers,
filling station attendants, local truck drivers, and garbage

72
collectors, porters, janitors, maids, and orderlies are
examples of occupations that would be coded in this
category. The skilied-working category encompasses all
blue-collar occupations which involve an extended period
of training or apprenticeship as a prerequisite to holding
the job. Examples of such occupations would be carpenter,
electrician, tool and dye maker, barber, and restaurant
cook. The lower white-collar classification is for occupa
tions which are white-collar but do not require a college
education for their performance and do not involve self-
employment. The bulk of the occupations coded in this
category were clerical, retail sales or low-level technical
positions. Examples from this classification are secretary,
store clerk or cashier, bookkeeper, mailman, lab assistant,
practical nurse, policeman, fireman, and teaching assistant
for a public school. The upper white-collar category is for
the professional-technical positions which require a college
education and for managers and proprietors of local businesses.
Examples from this category are physician, lawyer, certified
public accountant, school teacher, college professor, and owner
of a restaurant. The three remaining categories are for those
individuals whose records indicate that they have never been
employed. Married females who had never been employed and

73
were not students were coded as housewives. Males and
unmarried females who were not students, whose records so
indicated, were coded never employed. Students over
eighteen were coded studen ts.
For the employment situation at the start of commit
ment proceedings variable, those unemployed at the time and
housewives were coded unemployed, all students were coded
students, those employed at the time were coded employed and
the retired were so classified.
For control purposes, three dichotomous indicators of
psychological pathology were collected from the records; prior
psychiatric care, present psychiatric care, and alcohol
problems. An individual was coded as having received psychia
tric care prior to the commitment proceeding if the records
indicated that prior to the start of the proceedings and not as
a result of any problem or incident which precipitated the
proceedings the individual had received care from a physician,
psychiatrist, or mental health clinic, for an emotional or
mental problem, or had been hospitalized for such a problem.
If the record indicated that he had not received such care,
the case was so coded. If records did not specify either way
the case was coded as no information.
A separate control variable is whether the alleged

74
incompetent was receiving psychiatric care at the time the
proceedings started. The care criteria are the same as
the prior variable; the time is different. A person could
be coded as under care at the time the proceedings started
and yet not be coded as receiving care prior to the start
of the proceedings if all the care received was a result of
an acute incident or "illness which precipitated the start
of the proceedings. A person who had visited the mental
health clinic regularly for a year or more up until the
commitment proceeding would be coded yes on both care
variables. A person hospitalized for three weeks prior to
the petition for incompetency would be coded yes only on the
care at the time of proceedings variable.
The third pathology control variable is whether or not
the alleged incompetent has had a history of problems with
the use of alcohol. If the examining committee report has a
diagnosis of a lcoholism, or any hospital or clinic record
prior to the time of the proceedings mentions problems from
the use of alcohol, the person is coded as having a history
of alcohol problems. When the reports and records rule out
alcohol problems the case is coded no on the variable.
Cases where the record does not indicate either way are
coded no information.

75
For descriptive purposes and for use as an indication
of the pathology of those not adjudged incompetent, the
diagnosis of the examinings committee was coded. If there
was no diagnosis from the examining committee, as was often
the case with those found competent, any hospital or clinic
diagnosis was coded if it was made at the same time as the
incompetency proceedings. The diagnoses were coded as
closely as possible to the actual diagnosis. Most diagnoses
were in the form of specific diagnostic terms such as manic-
depressive psychosis. Some were in broad categories like
psychosis, depression, or suicidal, and were so coded.
The Analytic Cases
An examination of the distribution of coded diagnoses
revealed that a great many of the cases were diagnosed as
conditions with organic causes. Most of these type cases
were diagnosed as chronic brain syndrome, secondary to
cerebral arteriosclerosis, a condition usually associated
with old age. A few of these cases involved brain damage
due to trauma. One hundred and one of the total sample of
379 cases were diagnosed as conditions with organic causes.
It was decided that an analysis that was based in part
on the social reactions model of mental illness should

76
eliminate from consideration those cases explicitly diagnosed
as having a specific organic cause. Even the sharpest critics
of the medical-model of mental illness, such as Szasz (1961)
in his The Myth of Mental Illness, have conceded that certain
organic conditions truly fit the medical-model. The testing
of hypotheses will therefore be carried out using 278 cases,
a result of eliminating the 101 organic diagnoses from the
original 379 cases. A one-way frequency distribution of the
analytic variables and the diagnoses will be presented for
the total sample and for the analytic cases.
The hypotheses of the study will be tested by the
percentages of competent cases in two-way cross-tabulations
of the dependent variable, the courts judgment, with each of
the independent status variables. Percentages in three-way
cross-tabulations of each independent variable and separately
by each of the three control variables of prior psychiatric
care, present psychiatric care, and alcohol problems will
also be examined.
The three-way control cross-tabulations will determine
if the hypothesized relationships occur under each of the
separate control categories. Though the control variables
are not necessarily directly related to psychological pathology,
we can assume that in a county where psychiatric treatment is

77
available at no cost for those who cannot afford it, that
the care control variables are in part controlling for at
least severe psychological-behavioral problems. The alcohol
problems' control variable is important because of the
possibility that cases of alcoholism might be handled in a
special manner by the court. The cross-tabulations will be
executed by an SPSS computer program.
Because the present study does not involve a probability
sample of a larger population of cases, but the total number of
cases for three specific years in a particular legal juris
diction, certain advantages and disadvantages accrue relative
to hypothesis testing and data interpretation.
If this study involved a random sample of a larger
population, such as one year's incompetency cases for an
entire state, or even a probability sample of one year's
cases for one county, inferential statistics would be applicable
and hypotheses could be tested by significance tests which would
indicate the probability of drawing a sample with the observed
distribution. One could simply accept or reject hypotheses
on the basis of whether the .05 or .01 level was reached.
Significance tests are based on sampling distributions, which
are theoretical distributions of all possible random samples
of a certain size (Siegel, 1956:11). Without a random

78
sample from a particular sampled population their inferential
use is highly questionable. Significance tests will not be
used for hypothesis testing in this study because the
requirements for their meaningful use are not met.
The unavailability of significance tests does not
detract from the results of this study. With a total sample,
as in this study, we can be certain that any observed relation
ship between the independent and dependent variables is a
real relationship for the population studied. For instance,
for this study one could use a 50 per cent probability sample
of the cases from the identical three years, test.hypotheses
by significance tests and the conclusions which could be
drawn would be less certain than if one sampled the total
population as was done here.
The hypotheses in this study concern the relationship
between adjudged competency and several social status variables
The hypotheses will be tested only for the population studied
because data relative to any larger population is not available
The hypotheses do not posit any association between the status
variables and judgments of temporary incompetency because the
theory and prior empirical studies do not suggest any
particular relationship.
The particular hypotheses tested in this study concern

79
only the population sampled, but the results of this study
have implications beyond the limits of the cases studied.
Though we cannot legitimately test hypotheses relative to
it, there is implicit in this study a target population much
larger than the three years of incompetency cases in Southern
County. There is reason to believe the results of this study
might be representative of most jurisdictions which employ
psychiatrists as decision-makers for determining one's
sanity and freedom. Psychiatrists everywhere receive uniform
training and experience before being certified to practice
their profession. There is no reason to suspect that the
results of this study might be due to idiosyncratic practices
of psychiatrists in Southern County.
The hypotheses of study are drawn from a large body of
literature in social stratification, social control, and
mental illness. To the extent the hypotheses are supported,
this study has implications for all public decision-making
processes where individuals with varying status characteristics
are involved. When hypotheses drawn from a broad conceptual
area are supported by a study in a limited domain the broader
propositions from which the specific hypotheses are drawn
are strengthened.
Though the hypotheses are accepted or rejected on the

80
basis of any percentage difference in the posited direction,
it is useful to have a summary measure of association between
the independent and dependent variables. The contingency
coefficient (C) is particularly well adapted for the data
of this study because it is applicable to varying size
contingency tables with unordered variables. The contingency
coefficient will be computed for those tables or portions of
tables where there are fewer than 20 per cent of the cells
with an expected frequency of less than five and no cells with
an expected frequency of less than one. (Siegel, 1956:201).
Several limitations of the contingency coefficient should be
mentioned. The contingency coefficient equals zero when there
is no relationship but it cannot attain unity. The upper limit
of the coefficient depends on the size of the table; the upper
limit is .707 for a 2x2 table and .816 for a 3x3 table.
Therefore, the coefficients for different size tables are not
directly comparable. Finally, the contingency coefficient
is not directly comparable to any other measure of correlation
or association (Siegel, 1956:201).
The hypotheses for this study will be tested on the
basis of whether any association exists in the posited
direction. A contingency coefficient over zero or any
percentage difference in adjudged competencies between the

81
categories will indicate that there is a relationship in the
table. The direction of the association will be determined
by the direction of the percentage differences between the
categories. Because any association in the hypothesized
direction is supportive of the hypothesis in question, the
relative strength of the various associations will be con-
sidered in a summary table. The value of chi square (X2)
will also be presented for those tables where the contingency
coefficient is calculated. Chi square is presented for those
readers who might use it for comparative or evaluative
purposes; the analyses will not focus on it.
The research hypotheses as suggested from the theory
and empirical studies considered earlier are as follows:
1. The type of court judgment varies with age.
The young receive a higher proportion of
competent judgments than the old.
This hypothesis follows from the observation that youth
is more valued in our society than age. Past studies have
shown that the younger fare better in commitment proceedings.
2. The type of court judgment varies with sex.
Males receive a higher proportion of
competent judgments than females.
American society places a higher value on being male
than being female. Prior research indicates that this value
preference might be expressed in differential treatment for
males in commitment proceedings.

82
3. The type of court judgment varies with race.
Whites receive a higher proportion of
competent judgments than blacks.
Whites are characterized as composing a high-caste in
American society. Prior research indicates that social
control dispositions favor high-caste individuals.
4. The type of court judgment varies with
marital status. The married receive a
greater proportion of competent judgments
than the single.
The married in American society are more valued than the
single. The married have also been pictured as having more
resources in the community to aid in avoiding commitment.
Prior research indicates that higher prestige and greater
resources will result in favorable court dispositions.
5. The type of court judgment varies with
education. The higher educated will
receive a greater proportion of com
petent judgments than the lower educated.
Education is a highly valued asset in our society.
Greater education enables one to confront a decision-making
body with a favorable vocabulary, demeanor, and logic. An
individual with a highly valued trait which is clearly
present from demeanor should receive a favorable judgment.
6. The type of court judgment varies with the
prestige of most recent occupation. Those
with high prestige occupations receive a
greater proportion of competent judgments
than those with low prestige occupations.

83
Occupational prestige in our society is related to the
skill, training, and responsibility required by a job. White-
collar occupations are generally more valued than blue-collar
occupations. The employed receive more social honor than the
unemployed. We would expect those who have never been em
ployed to have a lower status than those unemployed because
of sex or student role obligations.
A prestige scale based on the above observations and
using this studys occupational categories would have upper
white-collar as the highest prestige category followed by
lower white-collar, skilled working, unskilled working,
student and housewife as equal categories, and never
employed.
The prestige factor alone should result in the higher
categories having a higher percentage of competents. Those
in the higher prestige classifications will also have higher
economic resources for avoiding commitment. Social power
should also be unevenly distributed towards the higher
classifications with the upper white-collar having a
disproportionate amount.
The type of court judgment varies with
present employment status. The employed
receive a greater proportion of compe
tent judgments than the unemployed.
7

84
The employed, as previously mentioned, have more social
status in American society than do the unemployed. The
unemployed person will probably have less economic resources
than those that are employed. Social support from an
employer and fellow workers is absent if one is unemployed.
The unemployed individual is not a functioning part of a
work-oriented society and, therefore, subject to be seen
as a candidate for therapy.
The hypotheses in every instance posit that the
individuals with higher status characteristics will have
a higher proportion of competency judgments than those
with low-status characteristics. The next chapter, after
first describing them with 1970 census figures for Southern
County, will present the data necessary to determine
whether status, characteristics, and legal competency
judgments are so related.

CHAPTER V
DATA DESCRIPTION AND ANALYSIS
This chapter will present separate frequency distri
butions for the total sample and for the analytic sample.
A comparison of the distributions of the demographic variables
with census information1 for the total population of Southern
County will give insight into the social control selection
process operating prior to the formal decision-making
process. The data analysis will determine whether status-
related criteria are operative later in the judicial setting.
Description of the Cases
Aae
A comparison of the Southern County age distribution
with the total sample (Table 1), and the analytic sample
(Table 2) demonstrates that age is a factor in the process
that determines which persons are to have thir competency
examined. In 1970 the population of Southern County above
the age of 14 was distributed as follows: 40.7 per cent
between the ages of 14 and 24, 31.0 per cent between the ages
^Census figures for this chapter are from the U.S. Bureau of
the Census, 1970 Census of Population and Housing, for the
Southern County standard metropolitan statistical area.
85

86
TABLE 1. ONE-WAY DISTRIBUTION OF THE TOTAL SAMPLE1
AGE
(N=379)
%
14-24
18.2
25-44
31.4
45-64
29.6
65 & over
20.8
SEX
(N=379)
Male
50.1
Female
49.9
RACE
(N=375)
White
74.1
Black
25.9
No information
1.0
MARITAL
STATUS
(N=355)
Single
61.4
Married
38.6
No information
6.7
PRIOR
PSYCHIATRIC
CARE
(N=257)
Yes
75.5
No
24.5
No information
32.2
PRESENT
PSYCHIATRIC
CARE
(N=280)
Yes
46.1
No
53.9
No information
26.1
MOST RECENT
OCCUPATION (N=282)
%
Unskilled-working
31.2
Skilied-working
10.6
Lower White-collar
11.6
Upper White-collar
14.2
Housewives
17.0
Students
5.0
Never Employed
10.3
No information
25.6
PRESENT EMPLOY-
MENT STATUS (N=329)
Employed
19.5
Unemployed
56.2
Student
4.3
Retired
20.9
No information
13.2
EDUCATION
(N=215)
Mentally Deficient
2.3
Below 9th
35.8
9th 12th
39.1
Some College &
above
22.8
No information
43.3
ALCOHOL
PROBLEMS
(N=241)
Yes
39.0
No
61.0
No information
36.4
JUDGMENT
(N=376)
Competent
26.3
Temporarily
Incompetent
14.1
Incompetent
59.1
No information
.8
No information percentages re based on 379 cases. All other
percentages are based on the number of cases with valid infor
mation for the variable. Though this study involves an entire
population of cases, the term sample is used for ease of reference
1

87
TABLE 2. ONE-WAY DISTRIBUTION OF THE ANALYTIC SAMPLE1
AGE (N=278)
%
MOST RECENT
OCCUPATION (N=231)
%
14-24
24.1
25-44
41.0
Unskilled-working
31.6
45-64
31.3
Skilled-working
11.7
65 & over
3.6
Lower White-collar
13.9
Upper White-collar
13.4
SEX (N=278)
Housewives
13.9
Students
6.1
Male
50.0
Never Employed t
9.5
Female
50.0
No information
16.9
RACE (N=275)
PRESENT EMPLOY-
MENT STATUS (N=235)
White
76.0
Black
24.0
Employed
26.0
No information
1.1
Unemployed
64.7
Student
6.0
MARITAL
Retired
3.4
STATUS (N=263)
.No information
15.5
Single
62.7
EDUCATION (N=201)
Married
39.3
No information
5.4
Mentally deficient
2.8
Below 9th
28.7
PRIOR
9th 12th
44.6
PSYCHIATRIC
Some College & above
23.7
CARE (N=202)
No information
34.9
Yes
81.7
ALCOHOL
No
18.3
PROBLEMS (N=188)
No information
27.3
Yes
42.0
PRESENT
No
58.0
PSYCHIATRIC
No information
32.4
CARE (N=207)
JUDGMENT (N=277)
Yes
46.8
No
53.2
Competent
31.8
No information
25.5
Temporarily
Incompetent
18.8
Incompetent
49.4
No information percentages are based on 278 cases. All other
percentages are based on the number of cases with valid infor
mation for the variable. Again, the term sample is used for
case of reference, though a total population of non-organically
diagnosed cases is involved.

88
of 25 and 44, 15.1 per cent between the ages of 45 and 65,
and 6.3 per cent above the age of 65. The age distributions
of the total sample and the analytic sample are weighted
much heavier in the age brackets containing those 25 years
of age and above. Only 18.2 per cent of the total sample
and 24.1 per cent of the analytic sample are between age 14
and 24. There are 55.8 per cent fewer incompetency proceedings
for those between the ages of 14 and 24 than is expected under
the condition of a random selection from the population of
Southern County.
The distribution of the total sample is over-represented
by those between 45 and 64.(29.6 per cent) and by those over
65 (20.8 per cent). The age bracket 25-44 (31.4 per cent) is
almost the same as the population percentage. Considering
all cases with both functional and organic diagnoses, those
below 25 and those above 45 are over-represented.
The analytic sample contains a smaller proportion of
persons above 65 and below 25 and a larger proportion of
persons between 25 and 64 than the population of Southern
County. The shift in the percentages of those age 25 to 44
and age 65 and over is a result of eliminating 101 cases with
organic diagnoses.
From a labeling or social reactions perspective one might

89
suggest that the role expectations for those below age 25
allow more varied behavior than do the expectations for the
older age groups. Violations of normative expectations by
this age group might be seen as passing phenomena rather
than as mental illness.
Sex
Sex does not appear to be a factor in one's being
brought before the court for an incompetency examination.
The 1970 census for Southern County shows that the population
over 14 years of age was distributed as follows: 49.4 per
cent males, and 50.6 per cent females. The comparable figures
for the total sample (Table 1) and for the analytic sample
(Table 2) are within one per cent of the census figures.
Race
Race is a factor in having one's competency examined
but it is not as important as age. The census breakdown for
race in Southern County is 79.3 per cent White and 20.7 per
cent Black. The percentages of Blacks for the total sample
(Table 1) and the analytic sample (Table 2) are 25.9 and
24.0 respectively. There are approximately 25 per cent more
incompetency examinations among Blacks than one would expect
if the variable, race, were not a factor in being selected

90
for examination.
Marital Status
Marital status is a factor in one's being before the
court for an incompetency hearing. Southern County in 1970
had 45.8 per cent of the above age 14 population in the
combined category of single, widowed, divorced, or separated,
while 61.4 per cent were so classified in the distribution
of the total sample (Table 1) and 62.7 per cent in the
distribution of the analytic sample (Table 2). There were
25 per cent more incompetency cases for those classified
as single than would be expected if marrieds and singles had
equal chances of being brought before the court.
Educa ti on
Conclusive statements about the effects of education on
selection for incompetency proceedings are not possible
because the census categories and the educational categories
are not identical. An additional reason for being uncertain
concerning educational effects is that educational information
is missing from 43 per cent of the total sample and from 35
per cent of the analytic sample. It does appear, though,
that the analytic sample and the total sample have a lower
overall educational attainment than the population of Southern
County.

91
The 1970 census classifies 35.1 per cent of those 25
or older in Southern County as having completed one year or
more of college. In the present study only 22.8 per cent
of the total sample (Table 1) and 23.7 per cent of the
analytic sample (Table 2) are coded as having at least some
college experience or above. Forty-three per cent of
Southern Countys 1970 population who were 25 years and
older received between 1 and 4 years of high school education.
In this study 39.1 per cent of the total sample and 46.4 per
cent of the analytic sample are so classified. Only 19.0
per cent of the county's population above age 25 received only
between 1 and 8 years of schooling. In the present study,
38.1 per cent of the total sample and 31.0 per cent of the
analytic sample did not reach ninth grade or were mentally
deficient.
A comparison of the present study's educational attain
ment distribution with that of the census demonstrated a
lower educational distribution for the individuals who were
before the court. However, one should keep in mind the large
number of cases for which educational data are missing.
Occupation
The occupational distribution of the present sample

92
indicates that persons with low prestige occupations are
over-represented in commitment proceedings. Southern County's
occupational structure in 1970 was heavily weighed with the
higher prestige positions. Fifty-four per cent of all those
employed above age 16 were in occupations classified as
white-collar. Only 39.2 per cent of the four employed
categories of the most recent occupation variable for this
study's total sample (Table 1) are white-collar. Of the
analytic sample (Table 2) 38.6 per cent of the occupations
are white-collar.
Considering the total sample of this study, 20.1 per
cent of the four employed occupational categories have cases
classified as upper white-collar. Of the analytic sample 19.0
per cent are so categorized. The 1970 census for Southern
County classifies 29.1 per cent of the occupations of people
above age 16 as professiona1-technica1, teachers, or managers
and administrators, a grouping roughly equal to the present
study's upper white-collar classification.
Occupational prestige seems to be a factor in the process
which determines who will be examined by an incompetency court.
Employment
Compared to the county population as a whole, the total
sample for this study is over-represented with individuals

93
who were unemployed at the time of the commitment proceedings.
In 1970, 51.6 per cent of Southern Countys population above
age 16 were employed. Considering the total sample (Table 1),
only 19.5 per cent were employed at the time of the proceedings.
Of the analytic sample (Table 2), only 26.0 per cent were
employed at the time of the proceedings.
It would appear that being unemployed could lead to
having ones competency legally determined. The question
of whether the over-representation of the unemployed among
those before the court is mainly a result of psychological
pathology or social reactions cannot be answered from the
present data. Obviously, psychological pathology can lead
to unemployment, but unemployment alone can lead to a strain
in role relations and to a societal reaction in the form of
a petition for inquisition of incompetency.
Psychiatric History
The distribution of the psychiatric history variables
(Tables 1 and 2) reveals that a high proportion of the cases
has had psychiatric care and/or problems with alcohol.
Over 75 per cent of total samples cases (Table 1) and
over 81 per cent of the analytic sample's cases (Table 2)
were exposed to prior psychiatric contact.

94
Forty-six per cent of both the total sample and the
analytic sample were under some form of psychiatric care at
the time the proceedings were started.
Alcohol problems v/ere a factor in 39 per cent of the
total samples cases and 42 per cent of the analytic samples
cases.
Clearly the collectivity involved in the incompetency
proceedings could not be characterized as victims of an
arbitrary system of social control which selects predominately
individuals without any psychiatric history. An overwhelming
majority of the cases have either sought out psychiatric care
or received psychiatric care at the behest of either public
agencies or close relations. Though census data on these
variables are not available for comparative purposes, we can
be assured that the individuals before the court in the years
studied have higher rates of psychiatric contact and alcohol
problems than the general public of Southern County. Two
factors might be operative here in fostering commitment:
(1) some form of psychological pathology from social or
medical causes, or both; and (2) the existence of a dossier
which serves to document prior and present mental problems
and to legitimate a decision which involuntarily deprives
one of his freedom.

95
Diagnosis
Table 3 reveals that the most frequent diagnoses in
this study are those of schizophrenia, chronic brain
syndrome or other organic disorders, and depression. Together
these categories account for 79.8 per cent of all diagnoses.
It should be noted, though, that 7.7 per cent of the total
sample were not diagnosed. It is interesting that over 50
per cent of the diagnoses of schizophrenia are of the simple
or undifferentiated types, categories which involve undeveloped
symptomatology. None of the remaining categories accounts for
more than 7 per cent of the diagnoses. Again, census figures
are not available for comparative purposes. Ninety-two
per cent of the individuals before the court were categorized
as having psychiatric disorders. We can be reasonably certain
this is a much higher rate than the population of Southern
County.
Judgment
Only 26.3 per cent (Table 1) of the total number of
persons before the court in the three-year period studied
were successful in avoiding the legal label of incompetency.
A lightly larger proportion of the analytic cases (Table 2)
were adjudged competent because cases with diagnoses of

96
TABLE 3. ONE-WAY FREQUENCY DISTRIBUTION OF TOTAL SAMPLE1
DIAGNOSIS (N=350) %
Simple Schizophrenia and Undifferentiated
Schizophrenia 18.9
Schizophrenia, Schizo-Affective 1.7
Paranoid Schizophrenia 16.3
Depression 14.0
Alcoholism 6.9
Chronic Brain Syndrome and Organic
Disorders 28.9
Suicidal 1.4
Personality Disorder 4.6
Manic Depressive Psychosis 1.7
Mental Deficiency 1.4
Drug Problems .6
Psychosis 2.6
Adolescent Adjustment Reaction .3
Sociopathic .6
Sexual Perversion .3
100.0
There were 29 cases with no diagnosis.

97
organic disorders have a much higher rate of adjudged
incompetence than do those with functional diagnoses.
The infrequent use of the judgment of temporarily incompetent,
14.1 per cent of the total sample and 18.8 per cent of the
analytic sample, is probably due to the previously mentioned
fact that the court limited temporary incompetence to those
individuals who signed their own petitions, often after
someone else had initiated the proceedings.
It is difficult to translate the observed percentage
of incompetent judgments in the present study to a statement
which either supports or casts doubt on the social reactions
model of mental illness. Some authors have cited high
percentages of commitments as evidence for the social
reactions model, but logically even a one hundred per-'cent
commitment rate would not support the social reactions model,
if the individuals committed were shown to have pathologies
which fit the medical model and the legal criteria for
hospitalization. Obviously social reactions are involved
in every instance of one being brought before the court for
an incompetency hearing. Someone must react to start the
proceedings; the judgment of the court is itself an official
societal reaction. The important question is not whether
social reactions are a part of commitment but whether the

98
official reaction of the court is determined by factors
other than individual pathology. Ninety-three per cent
of the present cases were diagnosed as having psychiatric
disorders while only 73 per cent were found incompetent,
a fact which indicates that some individuals with similar
diagnostic labels receive different final judgments. A
more significant test of the two models of mental illness
would be to determine whether status-linked characteristics
which are unassociated with mental impairment in a general
population are associated with legal labeling once one is
before the court. If such associations are shown to exist,
while controlling for psychiatric history, the evidence would
support a model based in part on social reactions. The
analyses of the next section should provide such a test.
Data Analysis
This section will examine the percentages of cases
which resulted in legal judgments of competency in the
categories of the seven independent variables. Because
this study involves a complete sampling of a population,
the hypotheses will be considered in the light of the size
of the percentage differences between the categories of

99
the independent variables. Any percentage difference in
the hypothesized direction will be accepted as supportive
of the hypothesis in question. Because a hypothesis might
be supported by a small percentage difference, the relative
strengths of the various associations will be considered
in detail.
The Control Variables
Table 4 presents the associations between each of
the control variables and the courts judgment so that
the analytic tables utilizing controls may be interpreted
in the light of these relationships.
The prior care variable is related to the courts
judgment. The contingency coefficient (C) for this rela
tionship is .15. Of those who had not received prior
care, 40.5 per cent were adjudged competent compared
to 28.0 per cent for those who had been under care in the
past.
The relationship between the present care variable
and the court's judgment is slightly stronger than that of
prior care; C for this association is .26. Considering
those who were under care at the time of the proceedings,
22.9 per cent were found competent compared to 37.8 per

TABLE 4. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY PRIOR PSYCHIATRIC CARE, PRESENT PSYCHIATRIC CARE AND ALCOHOL PROBLEMS.
JUDGMENT
Prior
Care
Present
Care
Alcohol
Problems
(N=
201)
(N=200)
(N=
=148)
Yes
No
Yes
No
Yes
No
Competent
28.0
40.5
22.9
37.8
38.0
24.8
Temporarily
Incompetent
23.2
8.1
30.2
9.9
22.8
19.3
Incompetent
48.8
51.4
46.9
52.3
39.2
56.0
(n=164)
(n=37)
(n=86)
(n=114)
(n=79)
(n=69)
C* = .15
C* = : .26
C* = .17
X2 = 4.95
X2 = 15.37
X2 = 5.52
df = 2
df = 2
df = 2
.05^-p^.025**
.0005>p**
.05y pp* .025**
* The C coefficients, here, are directly comparable for these three relationships
because the tables are of equal size. The coefficients from different size tables
are not comparable. Corrections for table size are not possible in this study
because such corrections require tables with an equal number of rows and columns.
** All probabilities are computed for a one-tailed test.
100

101
cent for those who were not under care.
The alcohol problems control variable is related to
the court's judgment. Of the group v/ith alcohol problems,
38.0 per cent were found competent compared to 24.8 per
cent for those without alcohol problems. The coefficient
of contingency (C) for this relationship is .17.
Each of the control variables is related to the court's
judgment. The present care variable has the strongest
relationship followed by the alcohol problems and prior
care variables. The fact that these variables are related
to the court's judgment justifies their use as control
variables. Their associations with the dependent variable
are not particularly strong; the largest percentage dif
ference between the yes and rro condition is 14.9 per cent
for the present care variable. We cannot say whether these
variables do an adequate job of controlling for individual
pathology. For purposes of this study, it would be desire-
able if all the individual subjects of the competency
hearings exhibited identical behavior or uniform degrees
of psychological pathology. Then, any differences in the
percentage of competent judgments between the various
categories of the independent variables could unambiguously

102
be ascribed to the workings of the particular status
variable of interest. This is clearly an impossible
condition, though several screens and controls lead
towards its approximation. The fact that all of the
individuals before the court have been labelled by some
individual or individuals as mentally incompetent is an
initial control for pathology, at least to the extent
that pathology is expressed as behavior which leads
someone to petition for an incompetency hearing. A
second control for pathology is the elimination of all
cases with a diagnosis of organically caused pathology.
The control variables should eliminate much of the
remaining variation in the degree of individual disorder
that is related to alcohol problems or psychiatric care.
Table 5 presents the cross-tabulation of age by judgment
without controls for psychiatric history. The coefficient of
contingency (C) for this table is .15. The largest percentage
of competent judgments is in the age category of 14 to 24,
which is 8.5 per cent more than the 45-64 group and 16.1 per
cent more than the 25-44 group. The lowest age group received
the lowest percentage of temporary incompetent judgments

103
TABLE 5. PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY AGE
JUDGMENT
AGE
Competent
Temporarily
Incompetent
Incompetent
14-24
41.8
13.4
44.8
(n= 67)
25-44
25.7
23.0
51.3
(n=113)
45-64
33.3
18.4
48.3
(n= 87)
65 & over
20.0
10.0
70.0
1P.,-.10}..
(N=277)
C* = .15
X = 5.87
df = 4
. 15p> pz> 10
* Does not include 65 and over category

104
which served to equalize the percentage of incompetent
judgments between the age groups. The relationship between
age and the court's judgment is not linear. The highest
percentage of competents are in the 14 to 24 and the 45 to
64 categories. The category of over age 65 demonstrated
the lowest percentage of competent cases; the small number
of cases in this category is a result of eliminating the
cases with organic diagnoses.
It should be noted that since the number of cases is
significantly reduced in the control tables, due to missing
information on the control variables, our conclusions from
these tables must be tentative at best. Our ability to
draw conclusions concerning the relationships under the
condition of no prior psychiatric care is extremely
limited because there are only 37 cases in this category.
If a hypothesized relationship is evident under the control
conditions, even with the limitations of reduced numbers
in the control tables, we can be more certain that the
relationship is not spurious.
V
When controlling for prior psychiatric care (Table 6) we
find that the relationship between age and the court's judg
ment remains under the situation of prior care (C=.19) and is

TABLE 6. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY AGE, CONTROLLING FOR PRIOR PSYCHIATRIC CARE.
AGE
Competent
YES
JUDGMENT
Temporarily
Incompetent
PRIOR CARE
Incompetent Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
14-24
37.1
14.3
48.6
(n=35)
25.0
25.0
50.0
(n= 8)
25-44
22.5
29.6
47.9
(n=72)
41.2
0.0
58.8
(n=17)
45-64
27.8
22.2
50.0
(n=54)
66.6
11.1
22.2
(n= 9)
65 & over
50.0
0.0
50.0
(n= 4)
0.0
0.0
100.0
(n= 3)
(N=165)
(N=37)
C* = .19
X2*= 5.82
df = 4
. 15p* p^> .10
*
Does not include 65 and over category
105

106
reversed under the no prior care category. The relationship
between age and the courts judgment is, therefore, true
only in the situation of having received prior care. Because
of the small number of cases in the no prior care condition
we cannot make definite statements about the relationship
between age and competency judgments for those with no
history of psychiatric care.
In Table 7 we find the relationship between age and
court judgments \vhile controlling for present psychiatric
care. It is apparent that, in the situation of being under
care at the time of the proceedings, age is not a large
factor in being adjudged competent (C=.13). There is only
a five per cent difference in competent judgments between
any of the age categories and this difference is not in the
hypothesized direction. In the situation of not being
under care the relationship is stronger than in the uncon
trolled table (C=.26). Of the group not under care at the
time of the proceeding, 59.1 per cent of those under 25
were adjudged competent compared to 33.3 per cent of the 25
to 44 group and 36*8 per cent of those 45 to 64. The com
bined effects of labelling and pathology when under psychiatric
care eliminate any status advantages of those under age 25.

TABLE 7. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY AGE, CONTROLLING FOR PRESENT PSYCHIATRIC CARE.
PRESENT CARE
AGE
Competent
YES
JUDGMENT
Tmpora rily
Incompetent
Incompetent
Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
14-24
22.2
29.6
48.2
(n=27)
59.1
4.5
36.4
(n=22)
25-44
22.2
33.3
44.4
(n=45)
33.7
13.0
54.3
(n=46)
45-64
27.3
27.3
45.5
(n=22)
36.8
10.5
52.6
(n=38)
65 & over
0.0
0.0
100.0
(n= 2)
0.0
0.0
100.0
(n= 4)
(N=96)
(N=110)
C* =.13
X *=1.580
df =4
C2 =
X *=8.
df =4
26
76
. 45^> .40 lO^t-p-^.05
* Does not include the 65 and over category
107

108
When not burdened with the pathology and labels associated
with being under psychiatric care, those in the age group
of 25 and under have a much higher percentage of individuals
adjudged competent than do the higher age groups.
Introducing a control for alcohol problems (Table 8),
we find the same relationship between age and being
adjudged competent. Though there were only four persons
*
under age 25 with alcohol problems mentioned in their court
or medical records, three of these or 75.0 per cent were
adjudged competent compared to 31.4 per cent of those 25-
44 and 41.0 per cent of those between the ages of 45 and
64. Considering the no alcohol problem category, the
relationship is not strong (C=.17); 27.3 per cent of the
youngest category being found competent compared to 20.0
per cent of the middle age category and 25.9 per cent of
the 45 to 64 category. The latter percentages are cer
tainly biased due to the 30 cases with missing information
in the below 25 age category. One would expect a much
stronger relationship if complete information on alcohol
problems were available.
In summary, a relationship between the age of the
alleged incompetent and adjudged competency was demon
strated. The association is present under the control

TABLE 8. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY AGE, CONTROLLING FOR ALCOHOL PROBLEMS.
AGE
Competent
YES
JUDGMENT
Temporarily
Incompetent
ALCOHOL PROBLEMS
Incompetent Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
14-24
75.0
0.0
25.0
(n= 4)
27.3
21.2
51.5
(n=33)
25-44
31.4
28.6
40.0
(n=35)
20.0
20.0
60.0
(n=45)
45-64
41.0
20.5
38.5
(n=39)
25.9
18.5
55.6
(n=27)
65 & over
0.0
0.0
100.0
(n= 1)
0.0
0.0
50.0
(= 2)
(N=79)
(N=107)
C* = .17
X2*= 3.16
df = 4
. 35> p > 25
* Does not include 65 and over
category.
109

110
conditions with the exception of the under present care
category and the no prior care category which had a small
number of cases. The hypothesis relative to age is sup
ported with two exceptions: 1) the association is not
linear and, 2) the association is minimal under two
control categories.
Because the present study eliminated from the analyses
cases diagnosed as organically caused, the number of the
over 65 age group was reduced by over 84 per cent which
effectively eliminated this group from analysis. Because
prior studies have not controlled for organic diagnoses,
their conclusions relative to old age and high rates of
adjudged incorapetency must be interpreted in the light
of the present findings.
Race
The relationship between race and the courts judgment
without controls for psychiatric history (Table 9) indicates
that the race of one before the court for an inquistion of incom
petence is a factor in determining the outcome of the case (C=.20).
Whites were adjudged competent in 34.1 per cent of their cases;
Blacks were adjudged competent in only 2402 per cent of their
cases. Whites were found temporarily incompetent in

Ill
TABLE 9. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOM
PETENT, OR INCOMPETENT BY RACE.
RACE
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
White
34.1
22.1
43.8 (n=208)
Black
24.2
9.1
66.7 (n= 66)
(N=274)
C = .20
X2=ll.36
df=2
.005^-p3^.0005

112
22.1 per cent of their cases; the corresponding figure
for Blacks is 9.1 per cent. Whites, therefore, have a
higher proportion of competent judgments; for those cases
not resulting in competency, Whites have a much higher
proportion resulting in judgments of temporary incompetence
rather than incompetence.
Controlling for prior care (Table 10) the same rela
tionship is found; Whites fare better than Blacks (C=.21).
Of those having received prior psychiatric care, Whites
were found competent in 31.2 per cent of the cases, and
Blacks were found competent in only 18.0 per cent of the
cases. The association under the condition of no prior
care is stronger; the number of cases, though, is small.
The percentage difference here between Blacks and Whites
is 23.3. Whites have a higher percentage of temporary
incompetent judgments under both control conditions.
Controlling for present care (Table 11), the rela
tionship between competency and race is reduced under the
yes condition to. a percentage difference of 5.0, but the
White advantage in temporary judgments is increased to
a difference of 21.2 per cent. Because of the difference
in judgments of temporary incompetence, the contingency
coefficient is .21. With the stigma of being under

TABLE 10. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY RACE, CONTROLLING FOR PRIOR PSYCHIATRIC CARE.
RACE
Competent
YES
JUDGMENT
Temporarily
Incompetent
PRIOR CARE
Incompetent Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
White
31.2
26.4
42.4
9.1
40.9
(n=22)
Black
18.0
12.8
69.2
(n = 39) 26.7
6.7
66.7
(n=l5)
(N=164)
(N=37)
C = .21
X2 = 8.34
df = 2
.01^* .005
113

TABLE 11. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY RACE, CONTROLLING FOR PRESENT PSYCHIATRIC CARE.
RACE
Competent
YES
JUDGMENT
Tmporarily
Incompetent
PRESENT
Incompetent
CARE
Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
White
23.8
33.7
42.5 (n=80)
43.1
11.1
45.8
(n=72)
Black
18.7
12.5
68.8 (n=16)
28.2
7.7
64.1
(n=39)
(N=96)
(N=lll)
= .21
= 3.9
= 2
. lO^p-yt .05
C2 = .16
X = 3.13
df = 2
. 10
114

115
present psychiatric care, Whites are found competent somewhat
more than Blacks and are found to be capable of speedy
recovery a much greater percentage of the time. Under the
no care condition Whites were found competent in 14.9 per
cent more cases than Blacks (C=.16). The difference here
in temporary judgments is only 3.4 per cent.
Controlling for alcohol problems (Table 12), race has
a small influence on competency in the yes category (3.2
per cent difference: C=.18), but is of greater importance
in the no classification with an 8.3 per cent difference
between Whites and Blacks (C=.21). Whites have a much
higher proportion of temporary judgments in both instances.
Whites have a higher percentage of competent judgments
than Blacks in the uncontrolled situation and when controlling
for prior care, present care, and alcohol problems. When
the White advantage in being adjudged competent is small,
Whites are likely to have a compensatory advantage by
having a high proportion of their incompetents adjudged
as only temporary. The hypothesis concerning race and
adjudged competency is supported. There are two excep
tions. Under the conditions of being under present care
or having alcohol problems, the advantage in competent judg
ments is reduced and transferred to judgments of temporary
competency.

TABLE 12. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY RACE,
CONTROLLING
FOR ALCOHOL PROBLEMS.
RACE
Competent
YES
JUDGMENT
Tmporari1y
Incompetent
ALCOHOL PROBLEMS
Incompetent Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
White
38.2
27.3
34.5 (n=55) 26.8
23.2
50.0
(n=82)
Black
34.8
13.0
52.2 (n=23) 18.5
7.4
74.1
(n=27)
(N=78)
(N=109)
= .18
= 2,74
= 2
. 15j^p^>. 10
.21
5.29
2
05p>p^-.025
116

117
Sex
The advantage of being a male when in an incompetency
proceeding is demonstrated by the relationship between sex
and court judgments in Table 13 (C=.25). Without controls
for psychiatric history, males were found competent in 43.1
per cent of the cases compared to 20.3 per cent for females.
Females received an advantage in judgments of temporary
incompetency by an 11.6 per cent margin.
When controlling for prior care (Table 14), the effect
of sex remains the same in the yes situation (C=.24) and
is reduced to a 10.7 per cent differential in the no cate
gory with its limited number of cases.
The discrepancy in competent judgments is reversed
slightly under the situation of being under care at the
time of the proceedings (Table 15: C=.ll), but is increased
substantially when considering the cases where the alleged
incompetent was not under care at the time of the proceedings
(C=.34). When examining only the cases not under care,
51.6 per cent of the males are found competent compared to
only 19.2 per cent of the females. As in the case of the
age and sex variables, being under psychiatric care
eliminates any substantial status advantage. When one is

118
TABLE 13. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOM
PETENT OR INCOMPETENT BY SEX.
SEX
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Male
43.1
13.0
43.9
(n=139)
Female
20.3
24.6
55.1
(n=138)
(N=277)
= .25
=18.20
=2
.ooos^p

I
TABLE 14. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY SEX, CONTROLLING FOR PRIOR PSYCHIATRIC CARE.
SEX
Competent
YES
JUDGMENT
Temporarily
Incompetent
PRIOR CARE
Incompetent Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
Male
40.9
16.7
42.4 (n=93) 44.0
12.0
44.0
(n=25)
Female
19.4
27.6
53.0 (n=98) 33.3
0.0
66.7
(n=lgl
(N=191)
(N=37)
C = .24
X2 = 9.15
df = 2
.012* .005
119

i
TABLE 15. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY SEX, CONTROLLING FOR PRESENT PSYCHIATRIC CARE.
PRESENT CARE
YES NO
SEX
JUDGMENT JUDGMENT
Competent Temporarily Incompetent Competent Temporarily Incompetent
Incompetent Incompetent
Male
21.2
24.2
54.6
(n=33)
51.6
10.9
37.5
(n=64)
Female
23.8
33.3
42.9
(n=63)
19.2
8.5
72.3
(n=47)
(N=96) (N^lll)
C_ = .11
X = 1.11
df = 2
.35^p^>-.25
2
X = 13.36
df = 2
.005>p>.0005
120

121
not under present care, higher status is an important factor
in being found competent.
The association between sex and the courts judgment
remains under both control categories for alcohol problems
(Table 16), though the percentage discrepancy is smaller
under the no alcohol problems category. Of those cases
involving alcohol problems, 48.0 per cent of the males
were found competent compared to 20.7 per cent of the females
(0.26). When no alcohol problems were involved 34.1 per
cent of the males received competent dispositions compared
to 19.1 per cent of the females (0.19).
The hypothesis concerning sex and competent judgments
is supported. There is an exception; when in the situation
of being under psychiatric care at the time of the incom
petency proceedings, sex is a minimal factor in being
adjudged competent.
Marital Status
Table 17 presents the relationship between marital status
and the courts judgment without controls for psychiatric his
tory. (0.19). Those classified as married were adjudged compe
tent in 39.8 per cent of the cases, 11.8 per cent more than those
classified as single. The married received a higher percentage of

TABLE 16. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY SEX, CONTROLLING FOR ALCOHOL PROBLEMS.
ALCOHOL PROBLEMS
YES NO
SEX
JUDGMENT JUDGMENT
Competent temporarily Incompetent Competent Temporarily Incompetent
Incompetent Incompetent
Ma le
48.0
18.0
34.0
(n=50)
34.1
12.2
Female
20.7
31.0
48.3
(n=29)
19.1
23.5
(N=79)
53.7 (n=4l)
57.4 (n=68)
(N=109)
C = .26
X2 = 5.93
df = 2
.05 ^p ;>.025
= .19
= 4.01
= 2
. 10^p^.05
122

123
TABLE 17. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOM
PETENT, OR INCOMPETENT BY MARITAL STATUS, OF
ALLEGED INCOMPETENT.
MARITAL
STATUS
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Married
39.8
24.5
35.7
(n=98)
Single
28.0
15.8
56.1
(n=164)
(N=262)
.19
10.26
2
. 005^? p^>. 0005

124
temporarily incompetent judgments. Being married and not
separated from ones spouse is associated with being adjudged
competent in commitment proceedings.
Controlling for prior care (Table 18), the relationship
remains (C=.18) but the percentage discrepancy within the
yes category is reduced to 8.7 per cent. In the no category,
with fewer cases, the differential is 29*1 per cent*
Table 19 presents the marital status and court judgment
relationship controlling for present care. As for all the
variables so far considered, being under present care reduces
the percentage differential of competent judgments to a very
low level. The contingency coefficient (.21) is at a moderate
level because of the discrepancy in temporary judgments
(17.4 per cent). Under the no_ category, without the stigma
and pathology related to present care, the married are found
competent 21.9 per cent more often than those classified
as single (C=.22).
Controlling for alcohol problems (Table 20) the rela
tionship is reversed to a 4.7 per cent differential in favor
of the single within the yes category (C=.18) but remains
with a substantial 22.4 per cent discrepancy within the no
category (C=,29). The married received a higher percentage

I
TABLE 18. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY MARITAL STATUS, CONTROLLING FOR PRIOR PSYCHIATRIC CARE.
MARITAL
STATUS
Competent
YES
JUDGMENT
Temporarily
Incompetent
PRIOR CARE
Incompetent Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
Married
33.9
29.0
37.1 (n=62) 58.3
0.0
41.7
(n=12)
Single
25.2
19.2
55.6 (n=99) 29.2
12.5
58.3
(n=24)
(N=161)
(N=36)
V JLO
X2 = 5.28
df = 2
05>p^-.025
125

I
TABLE 19. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY MARITAL STATUS, CONTROLLING FOR PRESENT PSYCHIATRIC CARE.
MARITAL
STATUS
Competent
YES
JUDGMENT
Temporarily
Incompetent
PRESENT CARE
Incompetent Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
Married
25.6
41.0
33.3
(n=39) 52.8
13.3
41.7
(n=36)
Single
21.8
23.6
54.6
(n=55) 30.9
11.8
57.4
(n=68)
(N=94)
(N=104
C = .21
X = 4.62
df= 2
.05t>-p 025
C = .22
X = 5.42
df = 2
.05:>p:> .025
126

I
TABLE 20. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY MARITAL STATUS, CONTROLLING FOR ALCOHOL PROBLEMS.
ALCOHOL
PROBLEMS
YES
NO
MARITAL
STATUS
JUDGMENT
JUDGMENT
Competent Temporarily
Incompetent
Competent
Temporarily Incompetent
Incompetent
Incompetent
Married
35.3
32.3
32.3 (n=34)
39.8
23.7
36.8
(n=38)
Single
39.0
17.1
44.0 (n=41)
17.4
16.0
66.7
(n=69)
(N=75) (N=107)
.18
2.52
2
. 15 yp 10
C2 = .29
X =9.76
df = 2
.005^P3> .0005
127

128
of temporary incompetent judgments in both alcohol control
categories.
The hypothesis concerning marital status and competent
judgments is supported except within the control categories
of being under psychiatric care and having had a history
of alcohol problems.
Education
Almost 35 per cent of the records for the analytic
sample do not have information on the educational attain
ment of the alleged incompetents. Statements concerning
the relationship between competent judgments and this vari
able should therefore be regarded as only suggestive of
what the actual relationship might be.
Without controls for psychiatric history (Table 21: C=.20)
those with some college received the highest percentage
of competent and temporarily incompetent judgments. Those
with some college received 38.1 per cent competent judg
ments while the ninth through twelfth grade group received
27.2 per cent, and the below ninth grade category 30.8
per cent. The some college group received 11.3 per cent
more temporary judgments than the next closest grouping.

129
TABLE 21. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOM
PETENT, OR INCOMPETENT BY EDUCATION.
EDUCATION
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Some College
and above
38.1
28.6
33.3
3
II
W
9th 12th
27.2
17.3
55.5
(n=81)
Below 9th
30.8
13.5
55.8
(n=52)
Mentally
Deficient
0.0
25.0
75.0
(n= 4)
(N=179)
c* = -20
X *= 7.24
df = 4
. 10-^p p>.05
* Does not include mentally deficient category.

130
Controlling for prior care (Table 22) the relation
ship remains the same under the yes category (C=.23) and
is strengthened considerably in the njo situation where 100
per cent of those with some college were found competent.
The small number of cases in the no category makes this
association unreliable.
Table 23 presents the association between education
and the court's judgment while controlling for present
psychiatric care. The relationship under the situation
of being under care (C=.32) is such that those below ninth
grade received the highest percentage of competent judgments
(38.5). The category of some college received 34.8 per
cent competent judgments. The lowest percentage of com
petencies was obtained by the ninth through twelfth grade
category (16.2 per cent).
In the no present care category the some college
group received 54.5 per cent competent judgments, the
highest proportion for a group yet considered. The below
ninth grade group received 28.1 per cent competent judg
ments under the no condition; the ninth through twelfth
grade group received 25.0 per cent. It should be noted
that the some college group received the highest percen
tage of temporary judgments in both control categories.

TABLE 22
PER CENT ADJUDGED COMPETENT, TEMPORARILY,INCOMPETENT, OR INCOMPETENT
BY EDUCATION, CONTROLLING FOR PRIOR PSYCHIATRIC CARE.
PRIOR CARE
YES NO
EDUCATION
JUDGMENT JUDGMENT
Competent Temporarily Incompetent Competent Temporarily Incompetent
Incompetent Incompetent
Some College
and above
35.3
32.3
32.5
(n=34)
100.0
o

o
0.0
(n= 3)
9th 12th
25.0
21.2
53.8
(n=52)
18.8
12.5
68,7
(n=16)
Below 9th
30.5
16.7
52.8
(n=36)
27.3
0.0
72.7
(n=ll)
Mentally
deficient
0.0
25.0
75.0
(n= 4)
25.0
0.0
0.0
(n= 0)
(N=166) (N=30)
C* = *23
X = 7.16
df = 4
. 10 p^.05
* Does not include mentally deficient
category.
131

TABLE 23. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY EDUCATION, CONTROLLING FOR PRESENT PSYCHIATRIC CARE.
EDUCATION
YES
JUDGMENT
Competent Temporarily
Incompetent
PRESENT
Incompetent
CARE
Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
Some college
and above
34.8
39.1
26.1
(n=23)
54.5
18.2
27.3
(n=ll)
9th 12th
16.2
24.3
59.5
(n=37)
25.0
10.7
64.3
(n=28)
Below 9th
38.5
23.1
38.5
(n=13)
28.1
9.4
62.5
(n=32)
Mentally
Deficient
0.0
0.0
0.0
lf21
0.0
0.0
100.0
(n= 2)
(N=73)
(N=73)
C* = .32
X2* =9.70
df = 4
.025>p-J>.005
* Does not include mentally deficient
category.
132

133
When the effects of alcohol problems are controlled
(Table 24), the some college group has the highest percen
tage of favorable judgments under both the control categories
55.6 per cent under the yes condition and 30.4 per cent under
the no condition (C=.26). As in the other education tables,
the below ninth grade group received the second highest
percentage of competent judgments; 43.8 per cent in the yes
category and 22.2 per cent in the no category. The ninth
through the twelfth grade group received 27.3 per cent
competencies in the yes category and 18.2 per cent in the
no category.
From the limited educational information available,
we can say that education has an effect on a person's
being adjudged incompetent. The effect is not linear; the
highest and lowest educational groups received the two
highest percentages of competent judgments in every
instance, The hypothesis concerning education and com
petency is supported, subject to the restrictions of
missing data and a non-linear relationship.
Occupation
Table 25 presents the uncontrolled relationship
between the prestige of the most recent occupation category

I
TABLE 24. PER'CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY EDUCATION, CONTROLLING FOR ALCOHOL PROBLEMS.
ALCOHOL PROBLEMS
YES NO
EDUCATION
JUDGMENT JUDGMENT
Competent Temporarily Incompetent Competent Temporarily Incompetent
Incompetent Incompetent
Some college
and above
55.6
22.2
22.2
(n= 9)
30.4
30.4
39.1
(n=23)
9th 12th
27.3
27.3
45.5
(n=22)
18.2
18.2
63.6
(n=44)
Below 9th
43.8
18.8
37.5
(n=16)
22.2
7.4
70.4
(n=27)
Mentally
Deficient
0.0
100.0
0.0
i.nf I.)
0.0
0.0
100.0
(n= 1)
(N=48) (N=95)
C* = .26
X = 6.92
df =4
. 10 3? p z*. 05
* Does not include mentally deficient
category.
134

TABLE 25
PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOM
PETENT, OR INCOMPETENT BY MOST RECENT OCCUPATION
MOST RECENT
OCCUPATION
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Upper White-
collar
61.3
12.9
25.8
(n=30)
Lower White-
collar
31.3
21.9
46.9
(n=32)
Skilled-
working
37.0
33.3
29.6
(n=27)
Unskilled-
working
32.9
11.0
56.2
(n=73)
Student s
28.6
35.7
35.7
(n=l4)
Housewives
22.6
35.5
41.9
(n=31)
Never
Employed
18.2
13.6
68.2
(n=22)
(N=229)
C2 = *34
X = 29.28
df = 12
. 00 5 j^-p 2? 000 5

136
and the courts judgment (C=.34). With the exception of
the lower white-collar classification, there is a perfect
relationship between occupational prestige and the per
centage of competent judgments. The upper white-collar
category received a much higher percentage of competent
judgments (61.3 per cent) than any other category in this
table or in any table so far considered. The very high
percentage in this category might be a result of the high
degree of social power and influence which is usually
attributed to this class. The percentage differences among
the other employed categories are minimal.
When controlling for prior psychiatric care (Table 26),
the relationship under the yes category is almost identical
to the uncontrolled situation, with the exception that all
the percentages are slightly lower (C=.35). The relative
position of the skilled-working category is somewhat lower;
this is compensated for by their having received the highest
percentage of temporary judgments (42.9 per cent) and the
second lowest percentage of incompetent judgments (35.7
per cent). Within the no category, the upper white-collar
received 80.0 per cent competent judgments followed by the
lower white-collar with 40.0 per cent, the unskilied-working

TABLE 26 PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY MOST RECENT OCCUPATION, CONTROLLING FOR PRIOR PSYCHIATRIC CARE.
PRIOR CARE
YES NO
MOST RECENT
OCCUPATION
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Upper White-
collar
58.6
11.8
29.4
(n=17)
80.0
20.0
0.0
(n= 5)
Lower White-
collar
27.3
31.8
40.9
(n=22)
40.0
0.0
60.0
(n= 5)
Skilled-
working
21.4
42.9
35.7
(n=l4)
25.0
25.0
50.0
(n= 4)
Unskilled-
working
29.2
12.5
58.3
(n=48)
38.5
7.7
53.8
(n=13)
Students
25.0
50.0
25.0
(n= 8)
0.0
0.0
0.0
(n= 0)
Housewives
20.8
33.3
45.8
(n=24)
50.0
0.0
50.0
(n= 2)
Never
Employed
17.6
17.6
64.7
0.0
0.0
100.0
(n= 3)
(N=150)
(N=32)
C = .35
X2 =21.60
df =12
025;p .01
137

138
with 38.5 per cent, and the skilled-working with 25.0
per cent. The number of cases here is too low to infer
much from the rankings. It is significant that the upper
white-collar received twice the percentage of competent
judgments than that of any other category.
Table 27, controlling for present care, reveals a
similar relationship between competent judgments and
occupational prestige, with a few exceptions. The upper
white-collar category, as in previous tables, has the
highest percentage of competent judgments under both con
trol conditions; 40.0 per cent in the yes category and
66.7 per cent in the njo category. The major discrepancies
from the hypothesized relationships are the never employed
with 37.5 per cent competent judgments in the yes situation,
the students with 66.7 per cent in the no situation, and the
housewives with 37.7 per cent in the no situation. The
unexpected changes in the relative positions may be a result
of unstable percentages which are caused by missing cases.
In any event, the fact that the upper white-collar class
continues to have the highest proportion of competent
judgments under each control situation supports the con
tention that this might be a special class of individuals
in incompetency proceedings.

TABLE 27. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY MOST RECENT OCCUPATION, CONTROLLING FOR PRESENT PSYCHIATRIC CARE.
PRESENT CARE
YES NO
MOST RECENT
OCCUPATION
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Upper White-
collar
40.0
30.0
30.0
(n=10)
66.7
0.0
33.3
(n=12)
Lower White-
collar
25.0
18.8
56.3
(n=16)
37.5
25.0
37.5
(n= 8)
Skilled-
working
20.0
40.0
40.0
(n=10)
41.7
25.0
33.3
(n=12)
Unskilled-
working
22.2
16.7
61.1
(n=18)
39.5
7.9
52.6
(n=38)
Student s
12.5
50.0
37.5
(n= 8)
66.7
33.3
0.0
(n= 3)
Housewives
16.7
44.4
38.9
(n=18)
37.7
12.5
50.0
(n= 8)
Never
Employed
37.5
12.5
50.0
8)
8.3
8.3
83.3
(N=88) (N=93)
139

140
Because the under present care condition eliminates
any significant variation between the other employed
occupational categories, one might conclude that the effect
of occupational prestige might be present only in the upper
white-collar occupations. This is not unreasonable consid
ering the fact that power and income are heavily weighted
in favor of this occupational category.
Controlling for alcohol problems (Table 28), we again
find the upper white-collar received the highest percentage
of competent judgments under both control conditions; 88.9
per cent within the yes group and 40.0 per cent within the
no group. The other percentages do not vary with occupa
tional prestige, though the lower white-collar class has
the second highest percentage of competent judgments within
the yes control category.
The occupation of the alleged incompetent affects the
ultimate outcome of an inquistion of incompetency. The
occupational factor is not a uniform effect of occupational
prestige as hypothesized but appears to be mainly apparent
in the upper white-collars relatively high percentage of
competent judgments under all control conditions.

TABLE 28. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY MOST RECENT OCCUPATION, CONTROLLING FOR ALCOHOL PROBLEMS.
ALCOHOL PROBLEMS
YES NO
MOST RECENT
OCCUPATION JUDGMENT JUDGMENT
Competent
Tmporarily
Incompetent
Incompetent
Competent
Temporarily
Incompetent
Incompetent
Upper White-
collar
89.9
11.1
0.0
(n= 9)
40.0
10.0
50.0
(n=10)
Lower White-
collar
50.0
12.5
37.5
(n= 8)
16.7
33.3
50.0
(n=18)
Skilled-
working
28.6
50.0
21.4
(n=14)
16.7
33.3
50.0
(n= 6)
Unskilled-
working
43.5
8.7
47.8
(n=23)
28.1
12.5
59.4
(n=32)
Students
0.0
0.0
0.0
(n= 0)
33.3
33.3
33.3
(n= 9)
Housewives
20.0
40.0
40.0
(n=10)
21.4
28.6
50.0
(n=14)
Never
Employed
0.0
50.0
50.0
(n= 4)
7.7
7.7
84.6
( n=13)
(N=68)
(N=102;
141

142
Employment
Those employed at the time of a commitment proceeding
have a favorable status compared to those who are unemployed.
This favorable status appears to be effective in the employed
receiving a much higher percentage of competent judgments.
In the uncontrolled situation (Table 29: 0.32) those employed
received 59.0 per cent competent judgments compared to 28.6
per cent for students, 25.0 per cent for the retired, and
23.2 per cent for those unemployed.
Controlling for prior care (Table 30), the same percent
age discrepancy between the employed and unemployed categories
remains, with the exception of the retired category under
the yes condition, which contained only three cases.
When considering only the cases where the individual
was under care at the time of the incompetency proceedings
(Table 31: 0.10), the percentage discrepancy between the
employed ard the unemployed competent judgments is reduced
to 8.3 per cent. The effect of being under care is opera
tive on this variable as well as the other variables. Under
the no present care situation the employed category has 76.0
per cent competent judgments and the unemployed only 25.8
per cent (C=.43).

143
TABLE 29. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOM
PETENT, OR INCOMPETENT BY PRESENT OCCUPATIONAL
STATUS.
PRESENT
OCCUPA
TIONAL
STATUS
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Employed
59.0
13.1
27.9
(n=61)
Unemployed
23.2
21.9
55.0
(n=l5l)
Student
28.6
35.7
35.7
(n=14)
Retired
25.0
12.5
62.5
(n= 8)
(N=214)
C* = .32
X2* =24.92
df = 2
. 005^-p^>. 0005
* Does not include student or retired categories.

TABLE 30. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY PRESENT OCCUPATIONAL STATUS,CONTROLLING FOR PRIOR PSYCHIATRIC CARE
PRIOR CARE
PRESENT
OCCUPA
TIONAL
STATUS
Competent
YES
JUDGMENT
Temporarily
Incompetent
Incompetent
Competent
NO
JUDGMENT
Tmpora rily
Incompetent
Incompetent
Employed
52.9
14.7
32.4
(n= 34)
63.6
0.0
36.4
(n=ll)
Unemployed
21.0
25.7
53.3
(n=105)
28.6
14.3
57.1
(n=21)
Student
30.0
30.0
40.0
(n= 30)
0.0
0.0
0.0
(n= 0)
Retired
66.7
0.0
33.3
(n= 3)
0.0
0.0
100.0
(n= 2)
(N=172)
(N=34)
C* =
X2* = 12
df = 2
.30
.83
.005;>p^*..0005
* Does not include student or retired
categories.

TABLE 31. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY PRESENT OCCUPATIONAL STATUS, CONTROLLING FOR PRESENT PSYCHIATRIC
CARE.
PRESENT CARE
PRESENT YES NO
OCCUPA
TIONAL JUDGMENT JUDGMENT
STATUS Competent Temporarily Incompetent Competent Temporarily Incompetent
Incompetent Incompetent
Employed
31.6
31.6
36.8
(n=19)
76.0
0.0
24.0
(n=25)
Unemployed
23.3
28.3
48.3
(n=60)
25.8
14.5
59.7
(n=62)
Student
12.5
50.0
37.5
(n= 8)
50.0
25.0
25.0
(n= 4)
Retired
100.0
0.0
0.0
-(n=
16.7
0.0
83.3
(n= 6)
(N=88)
(N=97)
C* = .10
X2* = .93
df = 2
,35^-p
25
C* = .43
X = 19.37
df = 2
.0005p-p
*
Does not
include
student or
retired
categories.
145

146
Controlling for alcohol problems (Table 32) the
eraployeds received the highest percentage of competent
judgments under both control situations. Considering
those with alcohol problems, the employed received 56.1
per cent competent judgments and the unemployed 30.4
per cent (C=.27). Under the no situation the employed
received 50.0 per cent competent judgments and the unem
ployed 15.5 per cent (C=.34). Based on a very small
number of cases, students received 28.6 per cent and the
retired 66.6 per cent.
Being employed is definitely related to one's being
found competent by a judicial decision. Except for the
students and retired, whose percentages were based on a
very small number of cases, the employed received a
much higher percentage of competent judgments than the
unemployed in every control condition. The hypothesis
concerning employment and competency is supported.
Employment and Occupation
Due to the high association between being employed
at the time of the proceedings and receiving a judgment of
competency, one might ask if the relationship between
one's most recent occupation and competency might be due

TABLE 32. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY PRESENT OCCUPATIONAL STATUS, CONTROLLING FOR ALCOHOL PROBLEMS.
ALCOHOL PROBLEMS
PRESENT YES NO
OCCUPA
TIONAL JUDGMENT JUDGMENT
STATUS Competent Temporarily Incompetent Competent Temporarily Incompetent
Incompetent Incompetent
Employed
56.6
23.8
19.6
Unemployed
30.4
23.9
45.7
Student
0.0
100.0
0.0
Retired
0.0
0.0
100.0
(n=21)
50.0
13.6
36.4
(n=22)
(n=46)
15.5
22.5
62.0
(n=71)
(n= 1)
28.6
14.3
57.1
(n= 7)
in=JJ_
66.6
0.0
33.3
(n= 3)
(N=69) (N=93)
c* =
.27
C* = .34
x2* =
5.38
X2* = 12.12
df =
2
df = 2
.05? p7^.025
. 005 0005
*
Does not include student or retired categories
147

148
to the effects of employment. Table 33 presents the
percentage of those employed by the most recent occupa
tion in order to partially answer this question. There
is a definite relationship demonstrated between occupa
tional prestige and employment (C=.14) but not of such
strength or direction as to account for the relationship
between occupation and competency. The relationship in
Table 33 is approximately linear with the percentage of
employed increasing from 34.8 per cent in the unskilled-
working to 53.3 per cent in the upper white-collar. The
uncontrolled relationship between occupation and competency
(Table 25) is not linear and is stronger. We may conclude
that employment has some effect on the relationship between
occupation and competency but that the employment effect
is not of sufficient magnitude to account for all of the
occupational effects.
Summary of Analyses
Table 34 presents the percentage differences in compe
tent judgments between the categories of the independent
variables which demonstrated the highest and second highest
percentage of competent judgments in the uncontrolled tables.
This table, though lacking much of the information found in

149
TABLE 33. PER CENT EMPLOYED OR UNEMPLOYED BY MOST RECENT
OCCUPATION.
MOST RECENT EMPLOYMENT
OCCUPATION '
Employed Unemployed
Upper White-
collar
53.3
46.7
(n=30)
Lower White-
collar
Skilled-
40.0
60.0
(n=30)
working
36.0
64.0
(n=25)
Unskilled-
working
34.8
65.2
(n=66)
(N=15l)
= .14
= 3.12
= 3
25^-p-^. 15

TABLE 34. SUMMARY ANALYTICAL TABLE: PERCENTAGE DIFFERENCE OF COMPETENT JUDGMENTS
BETWEEN SELECTED CATEGORIES1 OF INDEPENDENT VARIABLES.
Uncontrolled
Prior Care Present Care Alcohol
Problems
Yes No Yes No Yes No
Age 14-24/
45-64
8.5
9.3
-41.6*
-4.7
21.3
34.0*
1.4
White/Black
9.9
13.2
23.2
5.0
14.9
3.4
8.6
Male/Female
22.8
21.5
10.7
-2.6
32.4
27.3
15.0
Married/Single
11.8
6.7
29.1
3.8
21.9
-3.7
22.4
Some College/
Below 9th grade
7.3
4.4
72.7*
-3.7
26.4
11.8*
8.2
Upper White-collar/
Skilled-working
24.3
37.2
55.5*
20.0
24.0
61.3*
23.3*
Employed/
Unemployed
35.8
31.9
35.0
8.3
51.2
26.2
34.5
1 The categories presented are those with the highest and second highest percentage of
competent judgments in the uncontrolled situation.
* Indicates percentage difference based on a category with less than 10 cases.
150

151
the individual tables, enables one to evaluate the relative
strength of the associations between the independent vari
ables and the dependent variable and to determine the overall
effects of the controls on the various associations.
All of the independent variables demonstrate a percentage
difference in the hypothesized direction in the uncontrolled
situation; only three, sex, most recent occupation, and
present occupational status exhibit percentage differences
larger than twenty.
When controlling for present care in the yes situation,
only one variable, most recent occupation, has a percentage
difference greater than nine. In the no present care
situation all the percentage differences except for one
are greater than twenty. Except for the most recent occupa
tion variable, the status variables have little effect on
adjudged competency when individuals are under psychiatric
care. When not under psychiatric care, the individuals in
the high status categories received from 14 to 52 per cent
more competent judgments than those in the low status cate
gories.
Having received psychiatric care in the past does not
seem to reduce the effects of having high status to any

152
large extent. Because a large majority of the analytic
cases had received prior care (75 per cent), the prior
care control has very little effect on the relationships.
The control for alcohol problems has no systematic
effect on the associations between the status variables
and competency; some relationships are strengthened from
the uncontrolled situation and some are weakened. In the
yes category the percentage differences for age and most
recent occupation, sex, and education are increased; those
for race, marital status, and present occupational status
are decreased. For those with no alcohol problems the
percentage difference for marital status is increased,
those for age and sex are decreased, while the race,
education, most recent occupation, and present occupational
status associations are substantially unchanged from the
uncontrolled situation.
The most meaningful ranking of the status variables
in terms of their importance for determining competent
judgments can be formulated from their relative associations
with the dependent variable, while controlling for present
care. The present C3re control has a uniform effect of
reducing status variable associations in the yes condition

153
and increasing them in the no condition. The only variable
with a percentage difference greater than nine in the yes
control situation is the most recent occupation variable;
it must be considered the most important simply because of
its association under this control. Second in importance
is the present occupational status variable which has the
highest association in the no control situation. The
remaining variables in descending order of the strength
of their associations are sex, education, marital status,
age, and race. It is significant that the racial variable
has the weakest relationship with the courts judgment.
Because it is a characteristic obvious to decision-makers
and has been shown to be highly related to social rewards
in other studies, it is surprising that its association
was not stronger here. It is possible that the effect of
race is due to the associations between race, occupation,
and education; the racial variable may have no independent
effects.

CHAPTER VI
CONCLUSIONS, INTERPRETATIONS, AND FURTHER RESEARCH
The purpose of this chapter is to relate the results of
this research to the theoretical and empirical work which
has gone before it, to go beyond the actual data in explaining
and interpreting the outcome of the study, and to suggest
directions for additional related research.
Prior Theory and Research
The previously-reviewed theoretical and empirical works
in social stratification, social control, and mental illness
have suggested that higher status individuals will fare better
in judicial incompetency proceedings than their lower status
counterparts. The data from this study unambiguously demon
strate that, for individuals not under psychiatric care at
the time of the incompetency proceeding, high status as
measured by seven variables is associated with adjudged
competency, For those under care at the time of the proceedings
occupational status is moderately related to adjudged competency
The effects of social inequality are among sociology's most
well documented relationships. Significantly, in this research
seven separate status variables were related to adjudged
154

155
competency. Though the number of cases was not large enough
to permit simultaneous controls for psychiatric care and one
of the independent variable while observing the effects of
another independent variable, it does appear that the effects
of the seven status variables, except for the racial variable,
are relatively independent of each other. Education and
occupation are two variables that might be expected to be
very closely related, but their associations with the depen
dent variables are affected quite differently by the three
control variables. The mixture of independent and confounding
effects of the occupation and employment variables was
considered in Chapter Five.
Social status was also shown to be related to one's being
brought before the court for an incompetency hearing. A
comparison of the status characteristics of the cases under
study with the 1970 census statistics for Southern County
demonstrated that for every status variable except sex, low
status individuals were over-represented in incompetency
proceedings. With the selection process for a hearing and the
hearing decision itself being biased against those with a low
status, our public hospitals must contain a high proportion of
low status individuals. If a second decision--that of deter
mining the length of hospitalization--is equally biased, the

156
populations of public hospitals will be further weighted
towards individuals with low status characteristics. That
this might be the case is indicated by the higher proportion
of temporary incompetency judgments received by Whites
compared to Blacks, the married compared to the single and
the college educated compared to those with low education.
This study supports the general sociological proposition
that high status characteristics are associated with positive
outcomes in many areas of social interaction. A more specific
area of concern is how the data from this research relate to
the social reactions model of mental illness.
The major theme of the social reactions approaches to
mental illness is that mental illness in some way involves
behavior on which social judgment is passed and that the
reactions of conforming society have a great impact on the
existence, course and duration of the phenomena called mental
illness.
Studies of the involuntary commitment process offer a
unique opportunity to test certain aspects of the social
reactions model. The usual question asked in relating civil
commitment to the social reactions model is whether social
reactions or personal pathologies are of primary importance
in the assignment of the official label of insanity or

incompetency. Note that this question is not focused on
one theme of the reactions model which posits a relationship
between social reactions and the continuation of the actual
behavior indicative of mental illness. The question here
concerns the relative importance of social reactions and
personal pathology for official labeling. The implication
is that if the official use of psychiatric labels is unrelated
to personal pathology, then the medical model's ideas of
nosology and pathology are of questionable validity. If
official insanity is not related to psychologica1 disorder,
then social status and power will determine whether the
stigm3tic official labels are applied. If social factors of
the individual case determine its outcome, psychiatric justice
can, then, be demonstrated to be no more rational than
criminal justice.
The problem with this reasoning is that it assumes that
only one of the competing models can be valid. A goal of
scientific explanation is parsimony, but social reality
seldom corresponds to simple explanations. Psychiatric
concepts such as ego strength, regression, and fixation and
sociological concepts such as primary deviance, labeling, and
secondary deviance may all have validity as well as utility
in explaining mental illness; reference to both pathology and

158
social power might be useful in explaining commitment to a
mental hospital.
Certain aspects of the findings of this research
support both a medical-pathology model and a social
reactions model of mental illness as they are related to
involuntary commitment proceedings. If psychological
pathology were not involved in involuntary mental hospital
ization or the official labeling of incompetency, we would
expect a collection of individuals before an incompetency
court to have a low rate of prior or present psychiatric
consultation. This is clearly not the case in this study.
Over 80 per cent of the analytic sample had received
psychiatric care prior to the time of the incompetency
proceedings. Almost 50 per cent of the analytic cases for
which we have treatment information were under psychiatric
care at the time the incompetency proceedings started.
Personal psychological pathology, at least to the extent
that it is indicated by psychiatric consultation, is a factor
in being before a court to receive a determination of
competency or incompetency.
Personal psychological disorder, as indicated by being
under psychiatric care at the time of the court proceedings,
also effects the probability of being found incompetent,

159
temporarily incompetent, or competent. Those under care
at the time of the proceedings received a lower percentage
of competent judgments, and a much higher percentage of
temporarily incompetent judgments that did the group who were
not under care. The effects of personal pathology were such
that, for those under care social status characteristics had
minimal associations with the court's judgment. One status
variable, most recent occupation, was related to the courts
judgment. The upper white-collar received a much higher
percentage of competent judgments than did the other occupational
categories. This indicates that a status characteristic which is
strongly associated with high education, income, prestige, and
power is n effective determinant of competency even when in the
situation of being under psychiatric care.
Social reactions are an important factor in involuntary
commitment proceedings. This is demonstrated by the previously
mentioned relationships between the social status variables and
the court's judgment; there was one relationship of moderate
strength in the under care situation and seven in the not under
care situation. Though personal pathologies are probably also
operating here, high status characteristics are in every
instance associated with being found competent when one is
not under care. A review of the literature on social status

160
and psychological disorder (Dohrenwend and Dohrenwend, 1969:
3-31) indicates that none of the independent variables used
in this study has been found to be related to serious
psychologica1 disorder to such an extent as to account for
the associations found here in the not under care situation.
The Dohrenwends (1969:31).did conclude that the available
studies demonstrate that the highest rates of disorder are
generally riot found in the lowest age groups and that low
socioeconomic status is consistently found to be associated
with relatively high rates of disorder. Prevalence rates of
serious disorder between groups with the highest and lowest
rates in almost every instance differ by less than 3.0 per
cent. Differences this small cannot account for the different
proportions of competent judgments found here.
Both social reactions and psychological disorder appear
to both be important factors in the final judgment of an
incompetency court because of the invariant effect of high
status for those not under care and the minimal effect of high
status for those under care. An explanation of why this has
occurred requires one to make inferences beyond the specific
data analyzed here and to draw further on past research.

161
Interpretations Beyond the Data
A major question from this research which is yet
unanswered is why all the status variables have moderate
to high relationships with the court's judgment in the
not under present care situation while only one variable,
most recent occupation, has even a moderate relationship
in the under present care situation.
An interview with the court clerk who was responsible
for most of the details of the Southern County Court's
incompetency proceedings gave insights into the possible
causes of the differential effects of status between the
two present care controls. The clerk said, though his state
ment is not verifiable from the case records of this study,
that for individuals who were under psychiatric care at the
time of the proceedings, the treating psychiatrist was almost
always chosen as a member of the examining committee. The
second physician's participation as a member of these committees
was often a formality. We can assume that the psychiatric
examinations and decisions of a treating psychiatrist would be
much more thorough and precise than those of a psychiatrist who
was seeing the patient for the first time. We can be more
assured that this is the fact when we consider that prior commit
ment studies have reported that psychiatric commitment examinations

162
are often short and perfunctory; an attending psychiatrist,
however, may have consulted with a patient for many hours.
Two factors are probably operative to reduce the
effects of high status in the under present care situation:
(1) The more thorough examination in these cases results in
the examining psychiatrist basing his decision on medical-
pathological criteria rather than social criteria and,
(2) The high status patient who is under psychiatric care
will not gather his resources to contest a decision of his
own physician but probably accepts a situation which he does
not have the psychological strength to dispute, for which he
has been forewarned, and which he has possibly come to accept.
The factors at work in the not under care situation are
the reverse of those in under care situation: (1) A short
perfunctory examination could result in psychiatric decisions
being influenced by social criteria such as age, sex, race,
marital status, occupation, and employment. Ten or fifteen
minutes is not time enough for a complete psychiatric
diagnosis. The socio-demographic information is readily
available to the psychiatrist for it is required for state
records. A brief examination and the social distance between
the psychiatrist and the low status examinees, therefore,
probably works toward their receiving more unfavorable

163
diagnoses and recommendations. (2) The high status alleged
incompetent who is not- under care can more readily gather
resources to actively dispute his being labeled or committed;
he probably suffers from less pathology and has not yet come
to accept the possibility of a future stigmatized role of
incompetency.
Further Research
Research beyond the present study should focus on
explaining the different effects of status variables on
competency judgments under different present care controls.
Two questions need to be answered: (1) Were the differences
in the present study a methodological artifact of the reduced
number of cases when controlling for present care? and,
(2) What are the exact social mechanisms which product the
differential status effects? The first question might be
answered by a replication of the present study with complete
information on the present care variable. If results similar
to this study were obtained, then the possibility of missing
information accounting for the phenomenon could be ruled out.
To answer the second question will be more difficult. An
in-depth longitudinal study of a select group of cases might
provide insights which could be explored through interviews

164
with the examining psychiatrists, court personnel, and friends
of the patient. The plausibility of the explanation offered
in the prior section could be examined by determining if the
attending psychiatrist of one under care is in fact generally
appointed to the examining committee. A further determination
of the average length and scope of the psychiatric examinations
for those not under care would help to answer the question of
whether the thoroughness of the examination is an important
factor in causing the differential effects of the status
variables .
This study has explained many aspects of the commitment
process. A more complete understanding requires research in
the directions suggested here.

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BIOGRAPHICAL SKETCH
Kenneth J. Hodge was born August 16, 1943, at Tampa,
Florida. In June, 1961, he graduated from Gainesville High
School, Gainesville, Florida. In May, 1965, he received the
degree of Bachelor of Arts with a major in psychology from
the University of Florida. In December, 1967, he received
the degree Juris Doctor, cum laude, from the University of
Florida College of Law. After one year in the practice of
law, he enrolled in the Graduate School of the University of
Florida. As a graduate student, he worked as a research
assistant and teaching assistant. In December, 1969, he was
awarded an NDEA Title IV Fellowship. In the summer of 1970
he participated in the Summer Institute in Behavioral Science
and Law at the University of Wisconsin, Madison, Wisconsin.
He received his Master of Arts degree from the University of
Florida in March, 1971.
Kenneth J. Hodge is married to the former Mary Elizabeth
Norris. He is a member of the Florida Bar, the American
Sociological Association, the Southern Sociological Society,
and the Law and Society Association. He is presently employed
as a Graduate Research AssociateJwith the Department of
Psychiatry at the University of Florida.
173

I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree op Doctor of ^.fifailosophy.
n L. Gorman, Chairman
te Professor of Sociology
Assoc
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
:hard F. Larson
Professor of Sociology
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
George J
Associa
W#rhes
ofessor of Sociology
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
cer
rofe ssor of Sociology

I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
E. Wilbur Bock
Assistant Professor of Sociology
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
This dissertation was submitted to the Department of
Sociology in the College of Arts and Sciences and to the
Graduate Council, and was accepted as partial fulfillment
of the requirements for the degree of Doctor of Philosophy.
December, 1972
Dean, Graduate School



22
1970:71). Though much of this difference is explained by the
complainants preference for disposition, the fact remains
that high caste offenders were released 21 per cent of the
time more than low caste offenders.
Arnold (1971) studied judicial rather than police
dispositions of juveniles and found racial bias, and to a
lesser extent, socioeconomic bias to be operative. Using
controls for marital status of parents, seriousness of offense,
prior record of offender, and delinquency rate of the offenders
census tract, the percentage of offenders sent to the youth
authority was significantly higher in almost all cases for
Negroes and Latin Americans as opposed to Anglos (Arnold,
1971:223).
Cicourel (1968), though he did not make statistical
analysis of court dispositions and status characteristics,
observed that middle income families were able to avoid the
administrative labeling of their youth.
Middle-income families, because of their fear of
the stigma imputed to incarceration, mobilize
resources to avoid this problem. The familiar
ability to generate of command resources for
neutralization or changing probation and court
recommendations, as in adult cases, is a routine
feature of the social organization of juvenile
justice. (Cicourcel, 1968:331).


TABLE 11. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY RACE, CONTROLLING FOR PRESENT PSYCHIATRIC CARE.
RACE
Competent
YES
JUDGMENT
Tmporarily
Incompetent
PRESENT
Incompetent
CARE
Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
White
23.8
33.7
42.5 (n=80)
43.1
11.1
45.8
(n=72)
Black
18.7
12.5
68.8 (n=16)
28.2
7.7
64.1
(n=39)
(N=96)
(N=lll)
= .21
= 3.9
= 2
. lO^p-yt .05
C2 = .16
X = 3.13
df = 2
. 10
114


158
social power might be useful in explaining commitment to a
mental hospital.
Certain aspects of the findings of this research
support both a medical-pathology model and a social
reactions model of mental illness as they are related to
involuntary commitment proceedings. If psychological
pathology were not involved in involuntary mental hospital
ization or the official labeling of incompetency, we would
expect a collection of individuals before an incompetency
court to have a low rate of prior or present psychiatric
consultation. This is clearly not the case in this study.
Over 80 per cent of the analytic sample had received
psychiatric care prior to the time of the incompetency
proceedings. Almost 50 per cent of the analytic cases for
which we have treatment information were under psychiatric
care at the time the incompetency proceedings started.
Personal psychological pathology, at least to the extent
that it is indicated by psychiatric consultation, is a factor
in being before a court to receive a determination of
competency or incompetency.
Personal psychological disorder, as indicated by being
under psychiatric care at the time of the court proceedings,
also effects the probability of being found incompetent,


I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
E. Wilbur Bock
Assistant Professor of Sociology
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
This dissertation was submitted to the Department of
Sociology in the College of Arts and Sciences and to the
Graduate Council, and was accepted as partial fulfillment
of the requirements for the degree of Doctor of Philosophy.
December, 1972
Dean, Graduate School


168
Gordon, Milton M. and Charles H. Anderson
1964 "The blue collar worker at leisure." Pp. 407-415
in Arthur Shostak and William Gomberg (eds.) Blue
Collar World. Englewood Cliffs, New Jersey:
Prentice-Ha 11, Inc.
Gove, Walter R.
1970 "Societal reaction as an explanation of mental
illness: an evaluation." American Sociological
Review 35(October):873-884.
1970a "Who is hospitalized: a critical review of some
sociological studies of mental illness." Journal
of Health and Social Behavior 11(December):294-303.
Gursslin, Orville R. et al.
1960 "Social class and the mental health movement."
Social Problems. 7(Winter):210-218.
Haase, William
1964 "The role of socioeconomic class in examiner bias."
Pp. 241-244.in Frank Riessman et_ a 1 (eds.) The
Mental Health of the Poor. New York: The Free
Press of Glencoe.
Haney, C. Allen and Robert Michellute
1968 "Selective factors operating in the adjudication
of incompetency." Journal of Health and Social
Behavior 9(September) :233-242.
Hodge, Robert W. e_t_ a 1.
1964 "Occupational prestige in the United States, 1925-
1963." American Journal of Sociology 70 (November):
286-302.
Hollingshead, August B. and Fredrick C. Redlich
1958 Social Class and Mental Illness. New York: John
Wiley & Sons, Inc.
Hunter, Floyd
1953 Community Power Structure: A Study of Decision-Makers.
Chapel Hill, North Carolina: University of North
Carolina Press.


44
as opposed to whites, but the difference was not significant.
The best predictors of adjudged incompetence were age,
examining committee composition, and whether the petition
for a hearing was from family or non-family persons. Those
age 24 or under were adjudged competent 43 per cent of the
time, while those over age 65 years of age were adjudged
competent in only 8.5 per cent of the cases. Examining
committees with no psychiatrists found incompetency in 59.7
per cent of the cases. Committees with psychiatrist members
adjudged incompetency or temporary incompetency in 80.9
'per cent of the cases. In cases where the petition for a
hearing was signed by other than a family member, 83.2
per cent of the individuals were adjudged incompetent or
temporarily incompetent, while 68 per cent were so adjudged
when a family member instituted the proceedings. Each of
the associations remained when the other two independent
variables were used as controls.
The results of this study could be interpreted as supportive
of the social reactions perspective on mental illness. The fact
that who institutes the proceedings affects the judgment of
incompetency is in agreement with the labeling perspective.
The differential between psychiatric and non-psychiatrist
committees could be explained by the proposition that one


110
conditions with the exception of the under present care
category and the no prior care category which had a small
number of cases. The hypothesis relative to age is sup
ported with two exceptions: 1) the association is not
linear and, 2) the association is minimal under two
control categories.
Because the present study eliminated from the analyses
cases diagnosed as organically caused, the number of the
over 65 age group was reduced by over 84 per cent which
effectively eliminated this group from analysis. Because
prior studies have not controlled for organic diagnoses,
their conclusions relative to old age and high rates of
adjudged incorapetency must be interpreted in the light
of the present findings.
Race
The relationship between race and the courts judgment
without controls for psychiatric history (Table 9) indicates
that the race of one before the court for an inquistion of incom
petence is a factor in determining the outcome of the case (C=.20).
Whites were adjudged competent in 34.1 per cent of their cases;
Blacks were adjudged competent in only 2402 per cent of their
cases. Whites were found temporarily incompetent in


99
the independent variables. Any percentage difference in
the hypothesized direction will be accepted as supportive
of the hypothesis in question. Because a hypothesis might
be supported by a small percentage difference, the relative
strengths of the various associations will be considered
in detail.
The Control Variables
Table 4 presents the associations between each of
the control variables and the courts judgment so that
the analytic tables utilizing controls may be interpreted
in the light of these relationships.
The prior care variable is related to the courts
judgment. The contingency coefficient (C) for this rela
tionship is .15. Of those who had not received prior
care, 40.5 per cent were adjudged competent compared
to 28.0 per cent for those who had been under care in the
past.
The relationship between the present care variable
and the court's judgment is slightly stronger than that of
prior care; C for this association is .26. Considering
those who were under care at the time of the proceedings,
22.9 per cent were found competent compared to 37.8 per


106
reversed under the no prior care category. The relationship
between age and the courts judgment is, therefore, true
only in the situation of having received prior care. Because
of the small number of cases in the no prior care condition
we cannot make definite statements about the relationship
between age and competency judgments for those with no
history of psychiatric care.
In Table 7 we find the relationship between age and
court judgments \vhile controlling for present psychiatric
care. It is apparent that, in the situation of being under
care at the time of the proceedings, age is not a large
factor in being adjudged competent (C=.13). There is only
a five per cent difference in competent judgments between
any of the age categories and this difference is not in the
hypothesized direction. In the situation of not being
under care the relationship is stronger than in the uncon
trolled table (C=.26). Of the group not under care at the
time of the proceeding, 59.1 per cent of those under 25
were adjudged competent compared to 33.3 per cent of the 25
to 44 group and 36*8 per cent of those 45 to 64. The com
bined effects of labelling and pathology when under psychiatric
care eliminate any status advantages of those under age 25.


69
out a disposition alternative to commitment such as out
patient care; and a copy of a data sheet required by the
state, which is filled out by the examining committee and
contains demographic, occupational, and clinical information
on the alleged incompetent.
A court file may, in addition, contain an order
confining the individual prior to a hearing, various notes
and correspondence by the clerk or judge concerning the case,
and if the incompetent was committed, forms specifying the
place and time of commitment.
The hospital and clinic records contained varying
amounts of information depending on the length of treatment
or hospitalization. Most of the records contained a patient
history, diagnosis, and prognosis. These records were mainly
used to supplement the demogrqhic and occupational data from
the court records and to determine if the alleged incompetent
had received psychiatric care prior to the commitment
proceedings, been under psychiatric care at the time of the
proceedings, and if he had a history of alcohol problems.
The Variables and Coding
The dependent variable for the study is the outcome of
the incompetency proceeding. Cases were coded as competent,


142
Employment
Those employed at the time of a commitment proceeding
have a favorable status compared to those who are unemployed.
This favorable status appears to be effective in the employed
receiving a much higher percentage of competent judgments.
In the uncontrolled situation (Table 29: 0.32) those employed
received 59.0 per cent competent judgments compared to 28.6
per cent for students, 25.0 per cent for the retired, and
23.2 per cent for those unemployed.
Controlling for prior care (Table 30), the same percent
age discrepancy between the employed and unemployed categories
remains, with the exception of the retired category under
the yes condition, which contained only three cases.
When considering only the cases where the individual
was under care at the time of the incompetency proceedings
(Table 31: 0.10), the percentage discrepancy between the
employed ard the unemployed competent judgments is reduced
to 8.3 per cent. The effect of being under care is opera
tive on this variable as well as the other variables. Under
the no present care situation the employed category has 76.0
per cent competent judgments and the unemployed only 25.8
per cent (C=.43).


To
M. B.


25
The final viewpoint treated by Angrist is that which
sees mental illness labels as being dependent on the various
definers. Illustrative of this viewpoint is Schwartz's
(1957) consideration of the differing definitions of wives
and psychiatrists regarding a husband's behavior. Mechanic's
(1962) discussion of psychiatric definitions and the conse
quential internalization of the sick role also falls within
this category. Erickson's (1957) conclusion that the mental
patient faces role conflict from the divergent lay and pro
fessional expectations is clearly within this area of
labeling. Not mentioned by Angrist, is Scheff's (1966)
labeling and role analysis of the etiology of mental illness.
Angrist's analysis of the various perspectives is very
useful in that it emphasizes the different ways that one
phenomenon can be approached. With awareness of the different
types of analysis available one is sensitized to the fallacy
of claiming exclusive explanatory power for any single frame
work. Angrist points out that there is considerable overlap
between the four perspectives but fails to mention that the
history of mental illness conceptualization and theory might
be pictured as a series of various challenges to a dominant
ideal--typica1 medical pathology model with each offering
various amounts of sociocultural explanations and rejecting


TABLE 25
PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOM
PETENT, OR INCOMPETENT BY MOST RECENT OCCUPATION
MOST RECENT
OCCUPATION
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Upper White-
collar
61.3
12.9
25.8
(n=30)
Lower White-
collar
31.3
21.9
46.9
(n=32)
Skilled-
working
37.0
33.3
29.6
(n=27)
Unskilled-
working
32.9
11.0
56.2
(n=73)
Student s
28.6
35.7
35.7
(n=l4)
Housewives
22.6
35.5
41.9
(n=31)
Never
Employed
18.2
13.6
68.2
(n=22)
(N=229)
C2 = *34
X = 29.28
df = 12
. 00 5 j^-p 2? 000 5


163
diagnoses and recommendations. (2) The high status alleged
incompetent who is not- under care can more readily gather
resources to actively dispute his being labeled or committed;
he probably suffers from less pathology and has not yet come
to accept the possibility of a future stigmatized role of
incompetency.
Further Research
Research beyond the present study should focus on
explaining the different effects of status variables on
competency judgments under different present care controls.
Two questions need to be answered: (1) Were the differences
in the present study a methodological artifact of the reduced
number of cases when controlling for present care? and,
(2) What are the exact social mechanisms which product the
differential status effects? The first question might be
answered by a replication of the present study with complete
information on the present care variable. If results similar
to this study were obtained, then the possibility of missing
information accounting for the phenomenon could be ruled out.
To answer the second question will be more difficult. An
in-depth longitudinal study of a select group of cases might
provide insights which could be explored through interviews


128
of temporary incompetent judgments in both alcohol control
categories.
The hypothesis concerning marital status and competent
judgments is supported except within the control categories
of being under psychiatric care and having had a history
of alcohol problems.
Education
Almost 35 per cent of the records for the analytic
sample do not have information on the educational attain
ment of the alleged incompetents. Statements concerning
the relationship between competent judgments and this vari
able should therefore be regarded as only suggestive of
what the actual relationship might be.
Without controls for psychiatric history (Table 21: C=.20)
those with some college received the highest percentage
of competent and temporarily incompetent judgments. Those
with some college received 38.1 per cent competent judg
ments while the ninth through twelfth grade group received
27.2 per cent, and the below ninth grade category 30.8
per cent. The some college group received 11.3 per cent
more temporary judgments than the next closest grouping.


i
TABLE 15. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY SEX, CONTROLLING FOR PRESENT PSYCHIATRIC CARE.
PRESENT CARE
YES NO
SEX
JUDGMENT JUDGMENT
Competent Temporarily Incompetent Competent Temporarily Incompetent
Incompetent Incompetent
Male
21.2
24.2
54.6
(n=33)
51.6
10.9
37.5
(n=64)
Female
23.8
33.3
42.9
(n=63)
19.2
8.5
72.3
(n=47)
(N=96) (N^lll)
C_ = .11
X = 1.11
df = 2
.35^p^>-.25
2
X = 13.36
df = 2
.005>p>.0005
120


164
with the examining psychiatrists, court personnel, and friends
of the patient. The plausibility of the explanation offered
in the prior section could be examined by determining if the
attending psychiatrist of one under care is in fact generally
appointed to the examining committee. A further determination
of the average length and scope of the psychiatric examinations
for those not under care would help to answer the question of
whether the thoroughness of the examination is an important
factor in causing the differential effects of the status
variables .
This study has explained many aspects of the commitment
process. A more complete understanding requires research in
the directions suggested here.


14
and implements a policy for the control of pornography.
The first example is individual and automatic, the second
is collective, processual, and ultimately involves the
differential power between the controllers and the controlled.
Lemert (1946) has placed legal commitment of the insane
within the context of active social control. Lemert points
out that only 50 per cent of the "mentally diseased" persons
are institutionalized. Commitment must, therefore, involve
a process of active social control. Lemert suggests that
expectancies on age, sex, marital status, occupational,
ethnic and locality affiliations, and their interaction with
behavior symptoms are important for the understanding of
the commitment process. According to Lemert, deviation from
role expectations and the consequent social strain, leads to
an individual's insanity hearing. Psychological pathology
alone does not lead to involuntary commitment. There must
be a reaction from some other person who initiates the
proceedings. This reaction depends on role expectations.
(Lemert, 1946:1).
Societal Reactions
Researchers interested in deviance and control have
focused on many phenomena for the explanation of deviant
behavior. Biological characteristics of the individual


Ill
TABLE 9. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOM
PETENT, OR INCOMPETENT BY RACE.
RACE
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
White
34.1
22.1
43.8 (n=208)
Black
24.2
9.1
66.7 (n= 66)
(N=274)
C = .20
X2=ll.36
df=2
.005^-p3^.0005


11
were other manual workers. Warner's previously mentioned
work (1949) also illustrates a predominance of intraclass
social contact. Examination of cliques, voluntary assoc
iations, and families demonstrated a limitation on the
range of class contact.
A predominance of intraclass interaction should lead
to or indicate a similar life style and value system for
the class. Again, Warner's work (1949) serves to illustrate
the point. Other research within individual strata bolsters
the generalization of differential class life styles and
values. The upper (Baltzell,1958), middle (Seeley et al.,
1956; Riesman et_ a_l_. 1952; Whyte, 1956) and lower strata
(Gans, 1962; Miller and Riesman, 1961) have been studied and
found to have somewhat distinctive behavior and values.
Kohn*s (1969) work in socioeconomic status, socialization,
and values considered class characteristics that might be
important determinants of commitment hearing decisions.
The essence of high class positions is the
expectation that one's decisions and actions
can be consequential; the essence of lower
class position is the belief that one is at
the mercy of forces and people beyond one's
control, often, beyond one's understanding.
(Kohn, 1969:189).
The lower class person is basically pictured as conformist.
Conformity--following the dictates of authority
focusing on external consequences to the exclu-


95
Diagnosis
Table 3 reveals that the most frequent diagnoses in
this study are those of schizophrenia, chronic brain
syndrome or other organic disorders, and depression. Together
these categories account for 79.8 per cent of all diagnoses.
It should be noted, though, that 7.7 per cent of the total
sample were not diagnosed. It is interesting that over 50
per cent of the diagnoses of schizophrenia are of the simple
or undifferentiated types, categories which involve undeveloped
symptomatology. None of the remaining categories accounts for
more than 7 per cent of the diagnoses. Again, census figures
are not available for comparative purposes. Ninety-two
per cent of the individuals before the court were categorized
as having psychiatric disorders. We can be reasonably certain
this is a much higher rate than the population of Southern
County.
Judgment
Only 26.3 per cent (Table 1) of the total number of
persons before the court in the three-year period studied
were successful in avoiding the legal label of incompetency.
A lightly larger proportion of the analytic cases (Table 2)
were adjudged competent because cases with diagnoses of


92
indicates that persons with low prestige occupations are
over-represented in commitment proceedings. Southern County's
occupational structure in 1970 was heavily weighed with the
higher prestige positions. Fifty-four per cent of all those
employed above age 16 were in occupations classified as
white-collar. Only 39.2 per cent of the four employed
categories of the most recent occupation variable for this
study's total sample (Table 1) are white-collar. Of the
analytic sample (Table 2) 38.6 per cent of the occupations
are white-collar.
Considering the total sample of this study, 20.1 per
cent of the four employed occupational categories have cases
classified as upper white-collar. Of the analytic sample 19.0
per cent are so categorized. The 1970 census for Southern
County classifies 29.1 per cent of the occupations of people
above age 16 as professiona1-technica1, teachers, or managers
and administrators, a grouping roughly equal to the present
study's upper white-collar classification.
Occupational prestige seems to be a factor in the process
which determines who will be examined by an incompetency court.
Employment
Compared to the county population as a whole, the total
sample for this study is over-represented with individuals


153
and increasing them in the no condition. The only variable
with a percentage difference greater than nine in the yes
control situation is the most recent occupation variable;
it must be considered the most important simply because of
its association under this control. Second in importance
is the present occupational status variable which has the
highest association in the no control situation. The
remaining variables in descending order of the strength
of their associations are sex, education, marital status,
age, and race. It is significant that the racial variable
has the weakest relationship with the courts judgment.
Because it is a characteristic obvious to decision-makers
and has been shown to be highly related to social rewards
in other studies, it is surprising that its association
was not stronger here. It is possible that the effect of
race is due to the associations between race, occupation,
and education; the racial variable may have no independent
effects.


60
ascertain his mental and physical condition and report to
the court: whether the person is incompetent, temporarily
incompetent (capable of speedy recovery with specialized
care and treatment), or competent; if incompetent, whether
the condition is acute or chronic; the apparent cause of
the condition; and the age, propensities, and the hallucin
ations if any of the alleged incompetent. If the examining
committee finds the alleged incompetent is not mentally ill,
the judge may terminate the proceedings.
When the petition is filed the judge is to set a date
for an early hearing and give reasonable notice of such to
the alleged incompetent and one or more members of his
family. The hearing is to be as informal as orderly
procedure will allow and in a physical setting not likely to
have a harmful effect on the mental health of the proposed
patient. An opportunity to be represented by counsel is to
be afforded every alleged incompetent. The court may appoint
counsel for the alleged incompetent if he or others do not.
On request of an indigent person the judge shall appoint an
attorney to represent such person at no cost to the indigent.
The judge, from the report of the examining committee
and the hearing, may find and adjudge the person competent,
incompetent, or if so recommended by the examining committee,


I
TABLE 20. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY MARITAL STATUS, CONTROLLING FOR ALCOHOL PROBLEMS.
ALCOHOL
PROBLEMS
YES
NO
MARITAL
STATUS
JUDGMENT
JUDGMENT
Competent Temporarily
Incompetent
Competent
Temporarily Incompetent
Incompetent
Incompetent
Married
35.3
32.3
32.3 (n=34)
39.8
23.7
36.8
(n=38)
Single
39.0
17.1
44.0 (n=41)
17.4
16.0
66.7
(n=69)
(N=75) (N=107)
.18
2.52
2
. 15 yp 10
C2 = .29
X =9.76
df = 2
.005^P3> .0005
127


42
influencing the psychiatrists. Had Wenger and Fletcher
been working from a social reactions perspective they might
answer Goves criticism by saying that psychiatric evaluation
is influenced by a disease ideology with a presumption of
illness, and,therefore,suspect from the labeling perspective.
Past studies have shown that psychiatric commitment
evaluations are perfunctory at best, usually lasting a shorter
time than the court hearing observed by the researchers. When
Gove questions whether the lawyers could be so effective in
such a short hearing, he ignores two points. The psychiatrists
could very well have known of the fact of legal counsel well
before the hearing, possibly prior to their own examination.
Since the psychiatrists in such hearings are court-appointed
and the court is generally aware of lawyer participation in
advance of a hearing, it would be unlikely that the psychiatrists
were not apprised of the existence of counsel before the hearing.
Because of the possibility of civil liability for an unwarranted
commitment and the much higher probability of such a suit when
the patient is already represented by counsel, it seems that
the psychiatrists could easily be influenced in a short hearing,
particularly if they were aware of counsel prior to the hearing.
One of the most extensive studies of the variables related
to being committed to a mental hospital was carried out by


TABLE 30. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY PRESENT OCCUPATIONAL STATUS,CONTROLLING FOR PRIOR PSYCHIATRIC CARE
PRIOR CARE
PRESENT
OCCUPA
TIONAL
STATUS
Competent
YES
JUDGMENT
Temporarily
Incompetent
Incompetent
Competent
NO
JUDGMENT
Tmpora rily
Incompetent
Incompetent
Employed
52.9
14.7
32.4
(n= 34)
63.6
0.0
36.4
(n=ll)
Unemployed
21.0
25.7
53.3
(n=105)
28.6
14.3
57.1
(n=21)
Student
30.0
30.0
40.0
(n= 30)
0.0
0.0
0.0
(n= 0)
Retired
66.7
0.0
33.3
(n= 3)
0.0
0.0
100.0
(n= 2)
(N=172)
(N=34)
C* =
X2* = 12
df = 2
.30
.83
.005;>p^*..0005
* Does not include student or retired
categories.


CHAPTER III
THE COMMUNITY AND ORGANIZATIONAL SETTING OF THE STUDY
The purpose of this chapter is to describe briefly the
setting for the present research so that the data produced
can be analyzed in a more meaningful context. The community
will be described in general terms and by census statistics.
The geographic area studied may then be compared on various
- measures to the rest of the state and the particular collec
tion of alleged incompetents studied can be compared to the
area population as a whole.
The mental health facilities in the area will be
separately considered because of their great importance to
the subject matter of the study. Local facilities can
provide therapeutic alternatives to commitment in a state
hospital or might also serve as agencies for defining
individual cases of mental illness therefore increasing the
number of commitments.
The legal structure for commitment of the insane will
be outlined both from the perspective of the state statutes
and the local implementation of the state law.
48


171
Rock, Ronald S. et_ al.
1968 Hospitalization and Discharge of the Mentally Ill.
Chicago: University of Chicago Press.
Rushing, William A.
1971 "Individual resources, societal reactions and
hospital commitment. American Journal of
Sociology. 77(November):511-525.
Schafer, L. and J. K. Myers
1954 "Psychotherapy and social stratification: An
empirical study of practice in a psychiatric
out-patient clinic. Psychiatry 17(February):
83-93.
Scheff, Thomas S.
1966 Being Mentally Ill: A Sociological Theory.
Chicago: Aldine Publishing Co.
Schur, Edwin
1969 "Reactions to deviance: A critical assessment.
American Journal of Sociology 75(November):
309-322.
Schwartz, Charlotte
1957 "Perspectives on deviance--wives' definitions of
their husbands' mental illness. Psychiatry 20
(August): 275-291.
Seeley, John R. et al.
1956 Crestwood Heights. New York: Basic Books.
Sheldon, William H.
1949 Varieties of Delinquent Youth: An Introduction to
Constitutional Psychiatry. New York: Harpers.
ShiIs, Edward A.
1970 "Deference. Pp. 420-448 in Edward 0. Laumann
et al. The Logic of Social Hierarchies. Chicago:
Markham Publishing Co.
Siegel, Sidney
1956 Non-parametric Statistics for the Behavioral Sciences.
New York: McGraw-Hill.
Simmons, J. L.
1965 "Public stereotypes of deviants. Social Problems
13(Fall):222-232.


64
signed a judgment of temporary incompetency. This practice
seems to limit temporary incompetency to those who formally
admit a need for care. There was not a physician's
certificate, as required by statute, in any of the self
petition cases studied. As previously noted, the statute
provides that temporary commitments are to be made only on
the basis of the committee recommendations.
The committee examinations are usually made at the
physician's office if the alleged incompetent can go there
or, in case of confinement, at the hospital or jail. If the
committee finds the person competent the judge immediately
enters an order of competency.
The hearing usually occurs within 15 days of the initial
petition and after the committee examination. Although the
statute implies that the alleged incompetent should be
present, in cases where the person is hospitalized or jailed,
this is not always the case. The judge never finds anyone
incompetent or temporarily incompetent who has not been
found incompetent by the examining committee. There are cases
where the committee finds the person incompetent and the judge
either rules the person competent or never enters judgment
in the case, which has the same legal effect as a ruling of
competency. Notes in these case files generally indicate


61
temporarily incompetent.
A person adjudged mentally incompetent is presumed
during his incompetency of being incapable of managing his
own affairs, making a contract, gift or any binding instru
ment in writing. He cannot hold a drivers license or vote.
A person discharged from temporary incompetency is
automatically restored to his civil rights. For one who
is discharged from a regular incompetency judgment, certain
formal procedures are necessary to regain his civil rights.
After a person is adjudged incompetent or temporarily
incompetent, the judge may commit him to a state hospital,
decree that he is harmless and release him, or deliver him
to the custody of a guardian or any responsible person.
Before any person 'above the age of 21 can have a legal
guardian appointed for management of his affairs he must
first be adjudged incompetent.
To understand the local implementation of the state
incompetency statute in Southern County, one must first
realize that incompetency proceedings are only a part of
the courts duties. In addition to incompetency hearings,
the county judges court handles all of the countys probate
of wills and estates, serves as the committing court for all
criminal felonies, issues all arrest warrants for felonies


136
and the courts judgment (C=.34). With the exception of
the lower white-collar classification, there is a perfect
relationship between occupational prestige and the per
centage of competent judgments. The upper white-collar
category received a much higher percentage of competent
judgments (61.3 per cent) than any other category in this
table or in any table so far considered. The very high
percentage in this category might be a result of the high
degree of social power and influence which is usually
attributed to this class. The percentage differences among
the other employed categories are minimal.
When controlling for prior psychiatric care (Table 26),
the relationship under the yes category is almost identical
to the uncontrolled situation, with the exception that all
the percentages are slightly lower (C=.35). The relative
position of the skilled-working category is somewhat lower;
this is compensated for by their having received the highest
percentage of temporary judgments (42.9 per cent) and the
second lowest percentage of incompetent judgments (35.7
per cent). Within the no category, the upper white-collar
received 80.0 per cent competent judgments followed by the
lower white-collar with 40.0 per cent, the unskilied-working


8
wishes, and authority of the high status psychiatrist or
judge. The high status individual would not feel compelld
to defer on the basis of a status differential, but might
marshall his resources to avoid being placed in a stigmatized
role.
Power
The party, according to Weber, was a group concerned with
the acquisition of power. Power was generally defined as:
. . the chance of a man or of a number of men
to realize their own will in a communal action
even against the resistance of others who are
participating in the action.
(Gerth and Mills, 1958:180).
Studies of the power variable do not generally concern
situations when the fate of one man is at stake and power
might influence the outcome, but usually involve issues which
affect large collectivities and the power structure of a
community (Hunter, 1953; Dahl, 1961; Presthus, 1964), or the
nation (Mills, 1956; Domhoff, 1967). Such studies are
concerned with the type of power structure and the membership
of the structure. Though the issue of pluralism vs. power
elite has not been resolved on either a local or national
level, it can be stated that most studies irrespective of the
power concentration demonstrate that the influential and
powerful are drawn disproportionately from the upper-middle and


TABLE 22
PER CENT ADJUDGED COMPETENT, TEMPORARILY,INCOMPETENT, OR INCOMPETENT
BY EDUCATION, CONTROLLING FOR PRIOR PSYCHIATRIC CARE.
PRIOR CARE
YES NO
EDUCATION
JUDGMENT JUDGMENT
Competent Temporarily Incompetent Competent Temporarily Incompetent
Incompetent Incompetent
Some College
and above
35.3
32.3
32.5
(n=34)
100.0
o

o
0.0
(n= 3)
9th 12th
25.0
21.2
53.8
(n=52)
18.8
12.5
68,7
(n=16)
Below 9th
30.5
16.7
52.8
(n=36)
27.3
0.0
72.7
(n=ll)
Mentally
deficient
0.0
25.0
75.0
(n= 4)
25.0
0.0
0.0
(n= 0)
(N=166) (N=30)
C* = *23
X = 7.16
df = 4
. 10 p^.05
* Does not include mentally deficient
category.
131


7
strata much like the whites but there were fewer strata,
which were lower in prestige than comparable white strata,
and the whole structure was separated from the white system
by a caste line. Berreman (1969) reviewed the evidence for
the existence of a Negro caste structure and concluded that
caste is a reality.
In considering the process of evaluation, Tumin, (1967:
27) mentioned other important status characteristics,
. . in American society one is generally
considered better, superior, or mere worthy
if he is male rather than female. . educated
rather than uneducated. . young rather than
old. . employed rather than unemployed. .
married rather than divorced.
Clearly, any consideration of status characteristics and
civil commitment should study these variables.
The functionalist theorists generally consider the status
dimension to be the stratification variable most important for
its influence on the other dimensions and the individual
biography. One can easily see though, that untangling the
effects and causal priorities of the various variables in an
empirical study would be difficult if not impossible.
The status dimension should affect commitment decisions
through the linkage of status with deference behavior (Shils,
1970:421). We might expect the low status individual in a
commitment hearing or examination to defer to the findings,


156
populations of public hospitals will be further weighted
towards individuals with low status characteristics. That
this might be the case is indicated by the higher proportion
of temporary incompetency judgments received by Whites
compared to Blacks, the married compared to the single and
the college educated compared to those with low education.
This study supports the general sociological proposition
that high status characteristics are associated with positive
outcomes in many areas of social interaction. A more specific
area of concern is how the data from this research relate to
the social reactions model of mental illness.
The major theme of the social reactions approaches to
mental illness is that mental illness in some way involves
behavior on which social judgment is passed and that the
reactions of conforming society have a great impact on the
existence, course and duration of the phenomena called mental
illness.
Studies of the involuntary commitment process offer a
unique opportunity to test certain aspects of the social
reactions model. The usual question asked in relating civil
commitment to the social reactions model is whether social
reactions or personal pathologies are of primary importance
in the assignment of the official label of insanity or


155
competency. Though the number of cases was not large enough
to permit simultaneous controls for psychiatric care and one
of the independent variable while observing the effects of
another independent variable, it does appear that the effects
of the seven status variables, except for the racial variable,
are relatively independent of each other. Education and
occupation are two variables that might be expected to be
very closely related, but their associations with the depen
dent variables are affected quite differently by the three
control variables. The mixture of independent and confounding
effects of the occupation and employment variables was
considered in Chapter Five.
Social status was also shown to be related to one's being
brought before the court for an incompetency hearing. A
comparison of the status characteristics of the cases under
study with the 1970 census statistics for Southern County
demonstrated that for every status variable except sex, low
status individuals were over-represented in incompetency
proceedings. With the selection process for a hearing and the
hearing decision itself being biased against those with a low
status, our public hospitals must contain a high proportion of
low status individuals. If a second decision--that of deter
mining the length of hospitalization--is equally biased, the


I
TABLE 19. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY MARITAL STATUS, CONTROLLING FOR PRESENT PSYCHIATRIC CARE.
MARITAL
STATUS
Competent
YES
JUDGMENT
Temporarily
Incompetent
PRESENT CARE
Incompetent Competent
NO
JUDGMENT
Temporarily
Incompetent
Incompetent
Married
25.6
41.0
33.3
(n=39) 52.8
13.3
41.7
(n=36)
Single
21.8
23.6
54.6
(n=55) 30.9
11.8
57.4
(n=68)
(N=94)
(N=104
C = .21
X = 4.62
df= 2
.05t>-p 025
C = .22
X = 5.42
df = 2
.05:>p:> .025
126


83
Occupational prestige in our society is related to the
skill, training, and responsibility required by a job. White-
collar occupations are generally more valued than blue-collar
occupations. The employed receive more social honor than the
unemployed. We would expect those who have never been em
ployed to have a lower status than those unemployed because
of sex or student role obligations.
A prestige scale based on the above observations and
using this studys occupational categories would have upper
white-collar as the highest prestige category followed by
lower white-collar, skilled working, unskilled working,
student and housewife as equal categories, and never
employed.
The prestige factor alone should result in the higher
categories having a higher percentage of competents. Those
in the higher prestige classifications will also have higher
economic resources for avoiding commitment. Social power
should also be unevenly distributed towards the higher
classifications with the upper white-collar having a
disproportionate amount.
The type of court judgment varies with
present employment status. The employed
receive a greater proportion of compe
tent judgments than the unemployed.
7


36
observation at the two hospitals, he never saw an instance of
a patient being advised by a psychiatrist that he did not need
treatment (Mechanic, 1962:70).
Miller and Schwartz (1966) have reported their observations
of 58 hearings of a county lunacy commission. Though mainly
concerned with the relationship between the pre-patients
demeanor and the case outcomes, they did provide data which
supports Kutner's and Mechanic's observations. Miller and
Schwartz found that the physicians who had examined the pre
patients prior to the hearing recommended commitment in almost
all cases. Those few individuals not recommended for hospital
ization were said to be emotionally disturbed and in need of
out-patient psychiatric care. The length of time for the
hearings was very short: 4.1 minutes mean, 3 minutes median.
Forty-five cases or 78 per cent of the total were committed
to the State hospital. The researchers made no attempt to
judge the "illness" of the pre-patient and relate that to the
case outcomes, but conclusions were reached on the effect of
certain types of pre-patient behavior on case outcomes.
. . those who were able to present themselves
in a controlled and effective manner were likely
to be released. Those who either did not openly
object, or objected in violent or abusive ways,
were committed to the state hospital . This
observational study found that those persons who
were able to approach the judge in a controlled
manner, use proper eye contact, sentence structure,


172
Srole Leo et_ al.
1962 Mental Health in the Metropolis: The Midtown
Manhattan Study. New York: McGravv Hill.
Sumner, William Graham
1907 Folkways. Boston: Ginn and Co.
Sutherland, Edwin H.
1947
Principles of Criminology. New York: J. P.
Lippincott Co.
Sza sz ,
1961
Thomas S.
The Myth of Mental Illness: Foundations of a
Theory of Personal Conduct. New York: Hoeber-
Harper.
Taber,
1969
Merlin et al.
"Disease ideology and mental health research."
Social Problems 16(Winter):349-357.
Tannenbaum, Frank
1938
Crime & Community. Boston: Ginn & Co.
Tumin,
1967
Melvin M.
Social Stratification: The Forms and Functions
of Inequality. Englewood Cliffs, New Jersey:
Prentice-Ha 11, Inc.
Warner, W. Lloyd et a 1.
1949 Democracy in Jonesville. New York: Harper and
Brothers.
Wenger, Dennis L. & Richard C. Fletcher
1969 "The effect of legal counsel on admissions to a
state mental hospital: A confrontation of pro
fessions." Journal of Health & Social Behavior
lO(March):66-72.
Whyte,
1956
William H. Jr.
The Organization Man. Garden City, New York:
Doubleday.
Wilde,
1968
William A.
"Decision-making in a psychiatric screening agency."
Journal of Health and Social Behavior 9(September):
215-221.


62
and misdemeanors, and serves as the juvenile court for the
whole county. The court has only one judge, so much of the
duties of the court except for hearings are handled by
clerks.
The incompetency functions of the court are handled
almost exclusively by one clerk. If someone inquires at the
court about instituting an incompetency proceeding, that
clerk meets with them, explains the procedures and prepares
the petition on a standard form which they sign. If it
appears from talking to the petitioners that the alleged
incompetent is dangerous to himself or others, a confinement
order is prepared which authorizes the sheriff to confine
the person at either the county jail or the county hospital
psychiatric unit. In almost every case where a confinement
order is issued, the clerk obtains a one-sentence affidavit
from the petitioners to the effect that they believe him
dangerous to himself or others.
After the petition is prepared and signed a committee
is appointed and notices of a hearing are served on the
alleged incompetent and some member of his family. The
examining committee almost always includes one psychiatrist
and usually has two psychiatrists. The non-physician member of
the committee is almost always the law officer who serves the


140
Because the under present care condition eliminates
any significant variation between the other employed
occupational categories, one might conclude that the effect
of occupational prestige might be present only in the upper
white-collar occupations. This is not unreasonable consid
ering the fact that power and income are heavily weighted
in favor of this occupational category.
Controlling for alcohol problems (Table 28), we again
find the upper white-collar received the highest percentage
of competent judgments under both control conditions; 88.9
per cent within the yes group and 40.0 per cent within the
no group. The other percentages do not vary with occupa
tional prestige, though the lower white-collar class has
the second highest percentage of competent judgments within
the yes control category.
The occupation of the alleged incompetent affects the
ultimate outcome of an inquistion of incompetency. The
occupational factor is not a uniform effect of occupational
prestige as hypothesized but appears to be mainly apparent
in the upper white-collars relatively high percentage of
competent judgments under all control conditions.


Abstract of Dissertation Presented to the
Graduate Council of the University of Florida
in Partial Fulfillment of the Requirements
for the Degree of Doctor of Philosophy
STATUS CONTINGENCIES OF THE LEGALLY LABELLED INSANE
By
Kenneth J. Hodge
December, 1972
Chairman: Dr. Benjamin L. Gorman
Major Department: Sociology
The purpose of the present study was to determine the
relationship between an individuals status characteristics
and the type of final judgment received from a judicial
hearing for the determination of his legal competency.
Data were drawn from a total sampling of three years
of case records from a court whose jurisdiction consisted
of a county in the southeast United States. A total of 379
court cases were involved in the study. Eliminating all cases
in which the individual was diagnosed as having an organically
caused disorder yielded a final analytic sample of 278 cases.
Additional data on these cases, when available, were drawn
from hospital and mental health agency records. The dependent
variable for this study was the court's judgment: a finding
ix


18
the question of how one becomes a deviant.
In the present case, how does a social structure
enlist actors to engage in deviant activity. .
sociologists should be interested in discovering
how a social unit manages to differentiate the
roles of its members and how certain persons are
'chosen* to play the more deviant parts.
(Erickson, 1962:313).
Deviance was therefore seen as fulfilling a societal
need. One's behavior is not inherently pathological, for society
chooses him to play the role of defining society's limits.
Kituse (1962) proposed that a central problem for
deviance theory is to determine which behavior is societally
defined as deviant and how such definitions result in differen
tiating societal reactions. Kituse found that in defining
individuals as sexually deviant, many different behaviors are
interpreted as indications of the same deviation. The same
behavior was found to be defined as normal or deviant by
different individuals. Kituse concluded that the critical
part of the process of defining deviants is the interpretations
and re-interpretations others make of an individual's behavior
rather than the individual's behavior alone (Kituse, 1962:255).
Simmons (1965) also found that deviance is not a consen-
sually defined phenomenon but exists in the eyes of the
beholder. His examination of the range of responses of 180
persons who had listed the things or type persons they


143
TABLE 29. PER CENT ADJUDGED COMPETENT, TEMPORARILY INCOM
PETENT, OR INCOMPETENT BY PRESENT OCCUPATIONAL
STATUS.
PRESENT
OCCUPA
TIONAL
STATUS
Competent
JUDGMENT
Temporarily
Incompetent
Incompetent
Employed
59.0
13.1
27.9
(n=61)
Unemployed
23.2
21.9
55.0
(n=l5l)
Student
28.6
35.7
35.7
(n=14)
Retired
25.0
12.5
62.5
(n= 8)
(N=214)
C* = .32
X2* =24.92
df = 2
. 005^-p^>. 0005
* Does not include student or retired categories.


102
be ascribed to the workings of the particular status
variable of interest. This is clearly an impossible
condition, though several screens and controls lead
towards its approximation. The fact that all of the
individuals before the court have been labelled by some
individual or individuals as mentally incompetent is an
initial control for pathology, at least to the extent
that pathology is expressed as behavior which leads
someone to petition for an incompetency hearing. A
second control for pathology is the elimination of all
cases with a diagnosis of organically caused pathology.
The control variables should eliminate much of the
remaining variation in the degree of individual disorder
that is related to alcohol problems or psychiatric care.
Table 5 presents the cross-tabulation of age by judgment
without controls for psychiatric history. The coefficient of
contingency (C) for this table is .15. The largest percentage
of competent judgments is in the age category of 14 to 24,
which is 8.5 per cent more than the 45-64 group and 16.1 per
cent more than the 25-44 group. The lowest age group received
the lowest percentage of temporary incompetent judgments


77
available at no cost for those who cannot afford it, that
the care control variables are in part controlling for at
least severe psychological-behavioral problems. The alcohol
problems' control variable is important because of the
possibility that cases of alcoholism might be handled in a
special manner by the court. The cross-tabulations will be
executed by an SPSS computer program.
Because the present study does not involve a probability
sample of a larger population of cases, but the total number of
cases for three specific years in a particular legal juris
diction, certain advantages and disadvantages accrue relative
to hypothesis testing and data interpretation.
If this study involved a random sample of a larger
population, such as one year's incompetency cases for an
entire state, or even a probability sample of one year's
cases for one county, inferential statistics would be applicable
and hypotheses could be tested by significance tests which would
indicate the probability of drawing a sample with the observed
distribution. One could simply accept or reject hypotheses
on the basis of whether the .05 or .01 level was reached.
Significance tests are based on sampling distributions, which
are theoretical distributions of all possible random samples
of a certain size (Siegel, 1956:11). Without a random


STATUS CONTINGENCIES OF THE LEGALLY LABELLED INSANE
By
KENNETH J. HODGE
A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF THE
UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE
DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
1972


I
TABLE 24. PER'CENT ADJUDGED COMPETENT, TEMPORARILY INCOMPETENT, OR INCOMPETENT
BY EDUCATION, CONTROLLING FOR ALCOHOL PROBLEMS.
ALCOHOL PROBLEMS
YES NO
EDUCATION
JUDGMENT JUDGMENT
Competent Temporarily Incompetent Competent Temporarily Incompetent
Incompetent Incompetent
Some college
and above
55.6
22.2
22.2
(n= 9)
30.4
30.4
39.1
(n=23)
9th 12th
27.3
27.3
45.5
(n=22)
18.2
18.2
63.6
(n=44)
Below 9th
43.8
18.8
37.5
(n=16)
22.2
7.4
70.4
(n=27)
Mentally
Deficient
0.0
100.0
0.0
i.nf I.)
0.0
0.0
100.0
(n= 1)
(N=48) (N=95)
C* = .26
X = 6.92
df =4
. 10 3? p z*. 05
* Does not include mentally deficient
category.
134


I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree op Doctor of ^.fifailosophy.
n L. Gorman, Chairman
te Professor of Sociology
Assoc
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
:hard F. Larson
Professor of Sociology
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
George J
Associa
W#rhes
ofessor of Sociology
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
cer
rofe ssor of Sociology


112
22.1 per cent of their cases; the corresponding figure
for Blacks is 9.1 per cent. Whites, therefore, have a
higher proportion of competent judgments; for those cases
not resulting in competency, Whites have a much higher
proportion resulting in judgments of temporary incompetence
rather than incompetence.
Controlling for prior care (Table 10) the same rela
tionship is found; Whites fare better than Blacks (C=.21).
Of those having received prior psychiatric care, Whites
were found competent in 31.2 per cent of the cases, and
Blacks were found competent in only 18.0 per cent of the
cases. The association under the condition of no prior
care is stronger; the number of cases, though, is small.
The percentage difference here between Blacks and Whites
is 23.3. Whites have a higher percentage of temporary
incompetent judgments under both control conditions.
Controlling for present care (Table 11), the rela
tionship between competency and race is reduced under the
yes condition to. a percentage difference of 5.0, but the
White advantage in temporary judgments is increased to
a difference of 21.2 per cent. Because of the difference
in judgments of temporary incompetence, the contingency
coefficient is .21. With the stigma of being under


manuscript.
Care has been used in the preparation of this study
however, errors of omission and commission are possible,
and for these I assume full responsibility.
iv


TABLE 34. SUMMARY ANALYTICAL TABLE: PERCENTAGE DIFFERENCE OF COMPETENT JUDGMENTS
BETWEEN SELECTED CATEGORIES1 OF INDEPENDENT VARIABLES.
Uncontrolled
Prior Care Present Care Alcohol
Problems
Yes No Yes No Yes No
Age 14-24/
45-64
8.5
9.3
-41.6*
-4.7
21.3
34.0*
1.4
White/Black
9.9
13.2
23.2
5.0
14.9
3.4
8.6
Male/Female
22.8
21.5
10.7
-2.6
32.4
27.3
15.0
Married/Single
11.8
6.7
29.1
3.8
21.9
-3.7
22.4
Some College/
Below 9th grade
7.3
4.4
72.7*
-3.7
26.4
11.8*
8.2
Upper White-collar/
Skilled-working
24.3
37.2
55.5*
20.0
24.0
61.3*
23.3*
Employed/
Unemployed
35.8
31.9
35.0
8.3
51.2
26.2
34.5
1 The categories presented are those with the highest and second highest percentage of
competent judgments in the uncontrolled situation.
* Indicates percentage difference based on a category with less than 10 cases.
150


46
reactions model. Rushing, though, does not feel that only
one model of mental illness can have validity.
Probably both perspectives are valid. Behavior
pathology and societal reactions are probably
involved to some degree in most cases of mental
hospitalization, though their relative importance
may vary from case to case. (Rushing, 1971:511)
Rushing said that it is probably impossible to determine
precisely the proportions of commitments due to behavior
pathology versus societal reactions. Rushing suggested that
studying the contingencies of the societal reaction might be
a more fruitful approach (Rushing, 1971:512). Rushing was
concerned with how individual resources, as indicators of
power might affect the societal reaction. Individual resources
were measured by the occupation of the patient and whether the
patient was married, estranged or single. Occupation and
marital status were examined as individual resource variables
determining whether a patient was hospitalized voluntarily or
as an involuntary commitment.
Rushing analyzed over 3,000 first admissions which
covered a period of 10 years. As expected, the ratio of
involuntary to voluntary admissions varied inversely with
the socioeconomic status of the individual. The married
were found to have the lowest ratio of involuntary to voluntary
admissions followed by the estranged and the single who had a


104
which served to equalize the percentage of incompetent
judgments between the age groups. The relationship between
age and the court's judgment is not linear. The highest
percentage of competents are in the 14 to 24 and the 45 to
64 categories. The category of over age 65 demonstrated
the lowest percentage of competent cases; the small number
of cases in this category is a result of eliminating the
cases with organic diagnoses.
It should be noted that since the number of cases is
significantly reduced in the control tables, due to missing
information on the control variables, our conclusions from
these tables must be tentative at best. Our ability to
draw conclusions concerning the relationships under the
condition of no prior psychiatric care is extremely
limited because there are only 37 cases in this category.
If a hypothesized relationship is evident under the control
conditions, even with the limitations of reduced numbers
in the control tables, we can be more certain that the
relationship is not spurious.
V
When controlling for prior psychiatric care (Table 6) we
find that the relationship between age and the court's judg
ment remains under the situation of prior care (C=.19) and is


50
As an illustration of the changing function of the
small towns, only 3.5 per cent of the population are
classified as rural-farm. Indicative of the changing
characteristics of the population, 45 per cent of the county
residents were born outside the county. Twenty-one per cent
of the county and 17 per cent of the major city are black.
The mean educational attainment for the county is 12.6 years.
The citys mean educational level is 13.4 years. Further
illustrative of the education of the area is the fact that
30 per cent of the city and 23.1 per cent of the county as
a whole have four years or more of college.
Some of the best descriptive characteristics of a
community are the indicators of the economic and occupational
structure. The median family income for the county is $8,329
close to the corresponding state figure of $8,267. The per
centage of county families with an income above $15,000 is
17.6, while the state has 16.8 per cent above $15,000.
The occupational structure of Southern County is heavily
weighted towards professional and white-collar occupations.
Thirty-five per cent of the county's employed people above the
age of 16 are in professional-technical or managerial positions,
according to census classification. Fifty-four per cent of
those employed above the age of 16 are classified as white
i


67
mind, it was decided that they still offered the best
source of information for the present study.
The Cases Studied
This study consists of all the individual incompetency
cases which were completed in the calendar years 1966, 1968,
and 1969 in Southern County. The court's incompetency
records are available to the public. Each case record is
in one file. The files are numbered sequentially in the
approximate chronological order that the cases began. Case
files which were started six months before and completed six
months after the years in question were checked to make
certain that the sample was complete. The final sample
numbered 379 cases. There were 139 cases from 1966, 117 cases
from 1968, and 123 cases from 1969.
The Data Obtained
The data on each case are drawn mainly from the official
court file for the case. The court records were supplemented
by the patient records of those in the sample, if any, from
the county's mental health services clinic, and from the three
county hospitals' inpatient and outpatient psychiatric
facilities. In the four facilities the records for all years
were in one name index. After the court sample was drawn, the


152
large extent. Because a large majority of the analytic
cases had received prior care (75 per cent), the prior
care control has very little effect on the relationships.
The control for alcohol problems has no systematic
effect on the associations between the status variables
and competency; some relationships are strengthened from
the uncontrolled situation and some are weakened. In the
yes category the percentage differences for age and most
recent occupation, sex, and education are increased; those
for race, marital status, and present occupational status
are decreased. For those with no alcohol problems the
percentage difference for marital status is increased,
those for age and sex are decreased, while the race,
education, most recent occupation, and present occupational
status associations are substantially unchanged from the
uncontrolled situation.
The most meaningful ranking of the status variables
in terms of their importance for determining competent
judgments can be formulated from their relative associations
with the dependent variable, while controlling for present
care. The present C3re control has a uniform effect of
reducing status variable associations in the yes condition


54
employment, (3) medical, surgical, hospital and prosthetic
services necessary for the client's being employed, (4) job
training, (5) living expenses assistance while preparing for
employment, and (6) assistance in finding employment and
adjusting to the work situation. The staff of Southern
County's vocational rehabilitation program consists of the
director, 26 counselors, and 24 clerical workers.
Most of the psychiatric work in the vocational rehabili
tation office centers around two counselors, under the guidance
of a consulting psychiatrist, who carry a strictly psychiatric
case load of about 140; and a half-way house for individuals
with psychiatric problems who need an unstructured but super
vised residence. Southern County's vocational rehabilitation
psychiatric services maintain a close relationship with the
county's mental health services clinic. A client may be
obtaining counseling from both agencies while living at the
half-way house.
The state university located in Southern City provides
two sources of mental health care in addition to its teaching
hospital. The student mental health clinic provides individual
and group therapy for students with emotional difficulties.
The permanent staff consists of four psychiatrists, five
psychologists, and two psychiatric nurses. During a 12
month period in 1968 and 1969, 752 cases of emotional


LIST OF TABLES
Table Page
24 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY EDUCATION,
CONTROLLING FOR ALCOHOL PROBLEMS . 134
25 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MOST RECENT
OCCUPATION 135
26 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MOST RECENT
OCCUPATION, CONTROLLING FOR PRIOR PSYCHIATRIC
CARE 137
27 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MOST RECENT
OCCUPATION, CONTROLLING FOR PRESENT PSYCHI
ATRIC CARE . . 139
28 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY MOST RECENT
OCCUPATION, CONTROLLING FOR ALCOHOL PROBLEMS 141
29 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY PRESENT
-OCCUPATIONAL STATUS 143
30 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY PRESENT
OCCUPATIONAL STATUS, CONTROLLING FOR PRIOR
PSYCHIATRIC CARE 144
31 PER CENT ADJUDGED COMPETENT, TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY PRESENT
OCCUPATIONAL STATUS, CONTROLLING FOR PRESENT
PSYCHIATRIC CARE 145
32 PER CENT ADJUDGED COMPETENT TEMPORARILY
INCOMPETENT, OR INCOMPETENT BY PRESENT
OCCUPATIONAL STATUS, CONTROLLING FOR ALCOHOL
PROBLEMS 147
33 PER CENT EMPLOYED OR UNEMPLOYED BY MOST
RECENT OCCUPATION -149
34 SUMMARY ANALYTICAL TABLE: PERCENTAGE DIF
FERENCE OF COMPETENT JUDGMENTS BETWEEN SELECTED
CATEGORIES OF INDEPENDENT VARIABLES . 150

Vlll


124
temporarily incompetent judgments. Being married and not
separated from ones spouse is associated with being adjudged
competent in commitment proceedings.
Controlling for prior care (Table 18), the relationship
remains (C=.18) but the percentage discrepancy within the
yes category is reduced to 8.7 per cent. In the no category,
with fewer cases, the differential is 29*1 per cent*
Table 19 presents the marital status and court judgment
relationship controlling for present care. As for all the
variables so far considered, being under present care reduces
the percentage differential of competent judgments to a very
low level. The contingency coefficient (.21) is at a moderate
level because of the discrepancy in temporary judgments
(17.4 per cent). Under the no_ category, without the stigma
and pathology related to present care, the married are found
competent 21.9 per cent more often than those classified
as single (C=.22).
Controlling for alcohol problems (Table 20) the rela
tionship is reversed to a 4.7 per cent differential in favor
of the single within the yes category (C=.18) but remains
with a substantial 22.4 per cent discrepancy within the no
category (C=,29). The married received a higher percentage