Skip to main content

Advertisement

SpringerLink
Log in

Hierarchy and Quality of Life Among Psychiatric Service Users

  • Review Article
  • Published:
Journal of Psychosocial Rehabilitation and Mental Health Aims and scope Submit manuscript

Abstract

Psychiatric service users, as all other human groups, form social hierarchies that may influence quality of life in hospital or in rehabilitation services. The aim of this review is to explore social hierarchies among patients to determine their advantages and disadvantages. Psychiatry, psychology, sociology, occupational therapy, and management databases were searched with terms linking status to psychiatric service use. Clinical examples were taken from three inpatient wards and two community clinics in Toronto, Canada. The literature suggests that high social rank among psychiatric patients is linked to preferred access to the resources that mental health service users particularly value, namely safety, quality care, and autonomy. High status patients are those who procure these resources for themselves, and also facilitate access for their peers. A hierarchical structure benefits the psychiatric service user community as a whole, but may serve as either benefit or drawback to individual leaders of the community.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kesey K. One flew over the Cuckoo’s Nest. New York: Viking Press; 1962.

    Google Scholar 

  2. Magee JC, Galinsky AD. Social hierarchy: the self-reinforcing nature of power and status. Acad Manag Ann. 2008;2(1):351–98.

    Article  Google Scholar 

  3. Edgley A, Stickley T, Wright N, Repper J. The politics of recovery in mental health: a left libertarian policy analysis. Soc Theory Health. 2012;10(2):121–40.

    Article  Google Scholar 

  4. Van Berkel L, Crandall CS, Eidelman S, Blanchar JC. Hierarchy, dominance, and deliberation: egalitarian values require mental effort. Pers Soc Psychol Bull. 2015;41(9):1207–22.

    Article  PubMed  Google Scholar 

  5. Ridgeway CL, Boyle EH, Kuipers KJ, Robinson DT. How do status beliefs develop? The role of resources and interactional experience. Am Sociol Rev. 1998;63(3):331–50.

    Article  Google Scholar 

  6. Colbert AE, Judge TA, Choi D, Wang G. Assessing the trait theory of leadership using self and observer ratings of personality: the mediating role of contributions to group success. Leadership Quart. 2012;23(4):670–85.

    Article  Google Scholar 

  7. Anderson C, John OP, Keltner D, Kring AM. Who attains social status? Effects of personality and physical attractiveness in social groups. J Pers Soc Psychol. 2001;81(1):116–32.

    Article  PubMed  Google Scholar 

  8. Magee JC, Galinsky AD, Gruenfeld DH. Power, propensity to negotiate, and moving first in competitive interactions. Pers Soc Psychol Bull. 2007;33(2):200–12.

    Article  PubMed  Google Scholar 

  9. Schmid Mast M. Dominance as expressed and inferred through speaking time. Hum Commun Res. 2002;28(3):420–50.

    Google Scholar 

  10. Ensari N, Riggio RE, Christian J, Carslaw G. Who emerges as a leader? Meta-analyses of individual differences as predictors of leadership emergence. Pers Indiv Differ. 2011;51(4):532–6.

    Article  Google Scholar 

  11. Hall JA, Coats EJ, LeBeau LS. Nonverbal behavior and the vertical dimension of social relations: a meta-analysis. Psychol Bull. 2005;131(6):898–924.

    Article  PubMed  Google Scholar 

  12. Schmid Mast M, Hall JA. Who is the boss and who is not? Accuracy of judging status. J Nonverb Behav. 2004;28(3):145–65.

    Article  Google Scholar 

  13. Smith JA, Foti RJ. A pattern approach to the study of leader emergence. Leadership Quart. 1998;9(2):147–60.

    Article  Google Scholar 

  14. Paunova M. The emergence of individual and collective leadership in task groups: a matter of achievement and ascription. Leadership Quart. 2015;26(6):935–57.

    Article  Google Scholar 

  15. Balthazard PA, Waldman DA, Warren JE. Predictors of the emergence of transformational leadership in virtual decision teams. Leadership Quart. 2009;20(5):651–63.

    Article  Google Scholar 

  16. Bartholomew ME, Johnson SL. Nonverbal dominance behavior among individuals at risk for mania. J Affect Disord. 2014;159:133–8.

    Article  PubMed  Google Scholar 

  17. Johnson SL, Edge MD, Holmes MK, Carver CS. The behavioral activation system and mania. Annu Rev Clin Psychol. 2012;8:243–67.

    Article  PubMed  Google Scholar 

  18. Tang-Smith E, Johnson SL, Chen S. The dominance behavioural system: a multidimensional transdiagnostic approach. Psychol Psychother. 2015;88(4):394–411.

    Article  PubMed  Google Scholar 

  19. Akiskal KK, Akiskal HS. The theoretical underpinnings of affective temperaments: implications for evolutionary foundations of bipolar disorder and human nature. J Affect Disord. 2005;85(1–2):231–9.

    Article  PubMed  Google Scholar 

  20. Gilbert P. The relationship of shame, social anxiety and depression: the role of the evaluation of social rank. Clin Psychol Psychother. 2000;7(3):174–89.

    Article  Google Scholar 

  21. Gilbert P, McEwan K, Hay J, Irons C, Cheung M. Social rank and attachment in people with a bipolar disorder. Clin Psychol Psychother. 2007;14(1):48–53.

    Article  Google Scholar 

  22. Birchwood M, Meaden A, Trower P, Gilbert P, Plaistow J. The power and omnipotence of voices: subordination and entrapment by voices and significant others. Psychol Med. 2000;30(2):337–44.

    Article  PubMed  Google Scholar 

  23. Thomson LDA, Hamilton R. Attitudes of mental health staff to protected therapeutic time in adult psychiatric wards. J Psychiatr Ment Health Nurs. 2012;19(10):911–5.

    Article  PubMed  Google Scholar 

  24. Anderson C, Spataro SE, Flynn FJ. Personality and organizational culture as determinants of influence. J Appl Psychol. 2008;93(3):702–10.

    Article  PubMed  Google Scholar 

  25. Fragale AR. The power of powerless speech: the effects of speech style and task interdependence on status conferral. Organ Behav Hum Dec. 2006;101(2):243–61.

    Article  Google Scholar 

  26. Hogg MA. A social identity theory of leadership. Pers Soc Psychol Rev. 2001;5(3):184–200.

    Article  Google Scholar 

  27. Jones J, Nolan P, Bowers L, et al. Psychiatric wards: places of safety? J Psychiatr Ment Health Nurs. 2010;17(2):124–30.

    Article  PubMed  Google Scholar 

  28. McGeorge M, Lelliott P, Stewart J. Managing violence in psychiatric wards: preliminary findings of a multi-centre audit. Ment Health Learn Disab Care. 2000;31(11):366–9.

    Google Scholar 

  29. Stenhouse RC. ‘Safe enough in here?’ patients’ expectations and experiences of feeling safe in an acute psychiatric inpatient ward. J Clin Nurs. 2013;22(21–22):3109–19.

    Article  PubMed  Google Scholar 

  30. Allan S, Gilbert P. Anger and anger expression in relation to perceptions of social rank, entrapment and depressive symptoms. Pers Indiv Differ. 2002;32(3):551–65.

    Article  Google Scholar 

  31. Quirk A, Lelliott P, Seale C. Service users’ strategies for managing risk in the volatile environment of an acute psychiatric ward. Soc Sci Med. 2004;59(12):2573–83.

    Article  PubMed  Google Scholar 

  32. Fenton K, Larkin M, Boden ZV, Thompson J, Hickman G, Newton E. The experiential impact of hospitalisation in early psychosis: service-user accounts of inpatient environments. Health Place. 2014;30:234–41.

    Article  PubMed  Google Scholar 

  33. Stewart D, Bowers L. Inpatient verbal aggression: content, targets and patient characteristics. J Psychiatr Ment Health Nurs. 2013;20(3):236–43.

    Article  PubMed  Google Scholar 

  34. Birchwood M, Trower P, Brunet K, Gilbert P, Iqbal Z, Jackson C. Social anxiety and the shame of psychosis: a study in first episode psychosis. Behav Res Ther. 2007;45(5):1025–37.

    Article  PubMed  Google Scholar 

  35. Andersen AJ, Larsen IB, Topor A. Caring through discipline? Analyzing house rules in community mental health services in Norway. Scand Psychol. 2016;3:e1.

    Google Scholar 

  36. Muir-Cochrane E, Oster C, Grotto J, Gerace A, Jones J. The inpatient psychiatric unit as both a safe and unsafe place: implications for absconding. Int J Ment Health Nurs. 2013;22(4):304–12.

    Article  PubMed  Google Scholar 

  37. Quirk A, Lelliott P. What do we know about life on acute psychiatric wards in the UK? A review of the research evidence. Soc Sci Med. 2001;53(12):1565–74.

    Article  PubMed  Google Scholar 

  38. Quirk A, Lelliott P, Seale C. Risk management by patients on psychiatric wards in London: an ethnographic study. Health Risk Soc. 2005;7(1):85–91.

    Article  Google Scholar 

  39. Malterud K, Thesen J. When the helper humiliates the patient: a qualitative study about unintended intimidations. Scand J Pub Health. 2008;36(1):92–8.

    Article  Google Scholar 

  40. Doherty C, Stavropoulou C. Patients’ willingness and ability to participate actively in the reduction of clinical errors: a systematic literature review. Soc Sci Med. 2012;75(2):257–63.

    Article  PubMed  Google Scholar 

  41. Sutton E, Eborall H, Martin G. Patient involvement in patient safety: current experiences, insights from the wider literature, promising opportunities? Pub Manag Rev. 2015;17(1):72–89.

    Article  Google Scholar 

  42. Lorem GF, Hem MH, Molewijk B. Good coercion: patients’ moral evaluation of coercion in mental health care. Int J Ment Health Nurs. 2015;24(3):231–40.

    Article  PubMed  Google Scholar 

  43. Schmid Mast M, Jonas K, Hall JA. Give a person power and he or she will show interpersonal sensitivity: the phenomenon and its why and when. J Pers Soc Psychol. 2009;97(5):835–50.

    Article  PubMed  Google Scholar 

  44. Johansson IM, Skärsäter I, Danielson E. The meaning of care on a locked acute psychiatric ward: patients’ experiences. Nord J Psychiatry. 2009;63(6):501–7.

    Article  PubMed  Google Scholar 

  45. Sandhu S, Arcidiacono E, Aguglia E, Priebe S. Reciprocity in therapeutic relationships: a conceptual review. Int J Ment Health Nurs. 2015;24(6):460–70.

    Article  PubMed  Google Scholar 

  46. Larsen IB, Terkelsen TB. Coercion in a locked psychiatric ward: perspectives of patients and staff. Nurs Ethics. 2013;21(4):426–36.

    Article  PubMed  Google Scholar 

  47. Stenhouse RC. ‘They all said you could come and speak to us’: patients’ expectations and experiences of help on an acute psychiatric inpatient ward. J Psychiatr Ment Health Nurs. 2011;18(1):74–80.

    Article  PubMed  Google Scholar 

  48. Angermeyer MC, Matschinger H. Public attitude towards psychiatric treatment. Acta Psychiatr Scand. 1996;94(5):326–36.

    Article  PubMed  Google Scholar 

  49. Lauber C, Nordt C, Falcato L, Rössler W. Lay recommendations on how to treat mental disorders. Soc Psychiatry Psychiatr Epidem. 2001;36(11):553–6.

    Article  Google Scholar 

  50. Prins MA, Verhaak PF, Bensing JM, van der Meer K. Health beliefs and perceived need for mental health care of anxiety and depression—the patients’ perspective explored. Clin Psychol Rev. 2008;28(6):1038–58.

    Article  PubMed  Google Scholar 

  51. Allen MH, Currier GW, Hughes DH, Docherty JP, Carpenter D, Ross R. Treatment of behavioral emergencies: a summary of the expert consensus guidelines. J Psychiatr Pract. 2003;9(1):16–38.

    Article  PubMed  Google Scholar 

  52. Kowlessar OA, Corbett KP. The lived experience of mental health service users in a UK community rehabilitation scheme. Int J Ther Rehab. 2009;16(2):85–95.

    Article  Google Scholar 

  53. Klerman GL. The psychiatric patient’s right to effective treatment: implications of Osheroff v. Chestnut lodge. Am J Psychiatry. 1990;147(4):409–18.

    Article  PubMed  Google Scholar 

  54. Smith L. Psychotherapy, classism, and the poor: conspicuous by their absence. Am Psychol. 2005;60(7):687–96.

    Article  PubMed  Google Scholar 

  55. Thompson M, Diestelmann J, Cole O, Keller A, Minami T. Influence of social class perceptions on attributions among mental health practitioners. Psychother Res. 2014;24(6):640–50.

    Article  PubMed  Google Scholar 

  56. Clark JA, Potter DA, McKinlay JB. Bringing social structure back into clinical decision making. Soc Sci Med. 1991;32(8):853–66.

    Article  PubMed  Google Scholar 

  57. Stone J, Moskowitz GB. Non-conscious bias in medical decision making: what can be done to reduce it? Med Educ. 2011;45(8):768–76.

    Article  PubMed  Google Scholar 

  58. Adler PS, Kwon SW. Social capital: prospects for a new concept. Acad Manag Rev. 2002;27(1):17–40.

    Google Scholar 

  59. Goffman E. Asylum. New York: Doubleday; 1961.

    Google Scholar 

  60. Petersen K, Hounsgaard L, Borg T, Nielsen CV. User involvement in mental health rehabilitation: a struggle for self-determination and recognition. Scand J Occup Ther. 2012;19(1):59–67.

    Article  PubMed  Google Scholar 

  61. Skorpen A, Anderssen N, Oeye C, Bjelland AK. The smoking-room as psychiatric patients’ sanctuary: a place for resistance. J Psychiatr Ment Health Nurs. 2008;15(9):728–36.

    Article  PubMed  Google Scholar 

  62. Wood VJ, Curtis SE, Gesler W, et al. Creating ‘therapeutic landscapes’ for mental health carers in inpatient settings: a dynamic perspective on permeability and inclusivity. Soc Sci Med. 2013;91:122–9.

    Article  PubMed  Google Scholar 

  63. Phillips P, Johnson S. Drug and alcohol misuse among in-patients with psychotic illnesses in three inner-London psychiatric units. Psychiatrist. 2003;27(6):217–20.

    Google Scholar 

  64. Quirk A, Lelliott P, Seale C. The permeable institution: an ethnographic study of three acute psychiatric wards in London. Soc Sci Med. 2006;63(8):2105–17.

    Article  PubMed  Google Scholar 

  65. Wheatley M. The prevalence and relevance of substance use in detained schizophrenic patients. J Forensic Psychiatry. 1998;9(1):114–29.

    Article  Google Scholar 

  66. Leufstadius C, Gunnarsson BA, Eklund M. Meaningfulness in day centers for people with psychiatric disabilities: gender and empowerment aspects. Occup Ther Ment Health. 2014;30(2):178–95.

    Article  Google Scholar 

  67. Townsend E, Galipeault JP, Gliddon K, Little S, Moore C, Klein BS. Reflections on power and justice in enabling occupation. Can J Occup Ther. 2003;70(2):74–87.

    Article  PubMed  Google Scholar 

  68. Davidson L, Bellamy C, Guy K, Miller R. Peer support among persons with severe mental illnesses: a review of evidence and experience. World Psychiatry. 2012;11(2):123–8.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Boydell KM, Gladstone BM, Crawford ES. The dialectic of friendship for people with psychiatric disabilities. Psychiatr Rehab J. 2002;26(2):123–31.

    Article  Google Scholar 

  70. Kastner S, Linden M. Relations between patients in psychiatric and psychotherapeutic inpatient care: a literature review and conclusions for clinical practice and research. Int J Psychiatry Clin Pract. 2014;18(4):222–8.

    Article  PubMed  Google Scholar 

  71. Warner J, Pitts N, Crawford MJ, Serfaty M, Prabhakaran P, Amin R. Sexual activity among patients in psychiatric hospital wards. J R Soc Med. 2004;97(10):477–9.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Regan PC, Levin L, Sprecher S, Christopher FS, Cate R. Partner preferences: what characteristics do men and women desire in their short-term sexual and long-term romantic partners? J Psychol Hum Sex. 2000;12(3):1–21.

    Article  Google Scholar 

  73. Mannix EA, Sauer SJ. Status and power in organizational group research: acknowledging the pervasiveness of hierarchy. In: Thye SR, Lawler EJ, editors. Advances in group processes (vol 23). Bingley: Emerald Group Pub Ltd; 2006. p. 149–82.

    Google Scholar 

  74. Van Vugt M, Hogan R, Kaiser RB. Leadership, followership, and evolution: some lessons from the past. Am Psychol. 2008;63(3):182–96.

    Article  PubMed  Google Scholar 

  75. Gesquiere LR, Learn NH, Simao MC, Onyango PO, Alberts SC, Altmann J. Life at the top: rank and stress in wild male baboons. Science. 2011;333(6040):357–60.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Sapolsky RM. The influence of social hierarchy on primate health. Science. 2005;308(5722):648–52.

    Article  PubMed  Google Scholar 

  77. Maner JK, Mead NL. The essential tension between leadership and power: when leaders sacrifice group goals for the sake of self-interest. J Pers Soc Psychol. 2010;99(3):482–97.

    Article  PubMed  Google Scholar 

  78. Sherman GD, Lee JJ, Cuddy AJC, et al. Leadership is associated with lower levels of stress. Proc Nat Acad Sci. 2012;109(44):17903–7.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Demakakos P, Nazroo J, Breeze E, Marmot M. Socioeconomic status and health: the role of subjective social status. Soc Sci Med. 2008;67(2):330–40.

    Article  PubMed  Google Scholar 

  80. van Vugt M, Ronay R. The evolutionary psychology of leadership: theory, review, and roadmap. Organ Psychol Rev. 2014;4(1):74–95.

    Google Scholar 

  81. Zwingmann I, Wolf S, Richter P. Every light has its shadow: a longitudinal study of transformational leadership and leaders’ emotional exhaustion. J Appl Soc Psychol. 2016;46(1):19–33.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, University of Toronto, # 605, 250 Heath St. West, Toronto, ON, M5P 3L6, Canada

    Mary V. Seeman

Authors
  1. Mary V. Seeman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mary V. Seeman.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seeman, M.V. Hierarchy and Quality of Life Among Psychiatric Service Users. J. Psychosoc. Rehabil. Ment. Health 3, 53–60 (2016). https://doi.org/10.1007/s40737-016-0054-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40737-016-0054-9

Keywords

Search

Navigation