In fact, you would be amazed at the number of wealthy people given more mild, socially acceptable, temporary, and/or victim diagnoses versus poor people, and how many men are diagnosed with more mild, socially acceptable, temporary, and/or victim diagnoses versus women.
How do I know?
I first noticed this during my initial education in clinical social work, after reading the few studies that exist on it and we discussed it in class - and since then, I previously typed notes for inpatient hospital admissions for 25 years as a medical transcriptionist - including psychiatric admissions.
HISTORY OF PRESENT ILLNESS: This 15-year-old white female was admitted after telling her mother of passive suicidal ideation without a plan, as well as thoughts of self-harm in the form of cutting.
She states that she had these feelings for a long time, but initially didn't tell her mother for fear of burdening her, going through a divorce and financial struggle.
She attempted to talk to a guidance counselor at school, but abruptly ended her appointment, stating she felt like she was whining, after the counselor seemed dismissive and didn't take her seriously.
She said she finally told her mother because the thoughts were starting to scare her, and she didn't know "the right way to tell people how bad she felt inside" or what to do about it, and expressed perhaps she was "just lazy, stupid, and crazy."
She states that she has always struggled with self-esteem, chronic emptiness, and a sense of abandonment, especially when her parents separated, and that she can't remember the last time she felt happy, but only just recently was having suicidal thoughts and thoughts of self-harm.
She has been sleeping 16 hours a day, not showering, and overeating. She struggles with shame from overeating and her appearance.
SOCIAL HISTORY: She was an average student previously, but her grades have dropped to failing, mostly due to not attending school. She formed childhood friendships, but claims to have lost all of her friends after isolating herself, and "not being normal" like they are. Her mother appears supportive and concerned, but admits she has to work much, and the father is uninvolved due to a new relationship.
PHYSICAL EXAMINATION: Patient is alert and oriented x3, disheveled in appearance, morbidly obese. Pupils were equal, round, and reactive to light and accommodation. Cranial nerves II through XII are intact. Mood is sullen and withdrawn, and she gives rare and brief eye contact. When encouraged by her mother to speak and express herself, she speaks, but becomes tearful, emotional, and increasingly agitated and animated; however, this examiner was able to redirect her, assure her of treatment, and calm her down. By the end of the evaluation, her mood had improved and she appeared to brighten. Judgment and insight are poor, thoughts were tangential and somewhat disorganized.
She appears to show no remorse for the suicidal gestures with her guidance counselor and mother, and openly admits she still has suicidal ideation, but no plan.
AXIS I: Rule out bipolar depression.
AXIS II: Rule out borderline personality disorder.
AXIS III: None.
AXIS IV: Recent divorce of parents, family financial issues, weight gain.
AXIS V: GAF score not assessed.
HISTORY OF PRESENT ILLNESS: This 16-year-old white male was admitted after his teacher noted that he had carved the words "I WANT TO DIE" on his arms.
He also expressed aloud to his class that he had a gun and was either going to kill them or himself.
He admitted to this examiner that he had no gun, he didn't mean it, and admitted he did it to "get attention" and "get more help."
SOCIAL HISTORY: His parents, who were both present during the examination, were supportive and attentive, and stated that there had been no recent changes to the family environment. They stated he often does and says things like this at home, but this was the first time he'd done so at school.
The parents stated that there were no known triggers, other than they'd noticed it was at its worst when he felt they were giving more attention to his brother than him, and when he was "bored."
The patient corroborated his parents' perception, stating that though he likes his brother, he can't stand when he gets more attention than he does from his parents, and they "have a very competitive family."
When asked if the patient ever became aggressive or violent, his parents stated that his only aggression was directed towards his brother, in the form of sudden outbursts, and that he had engaged in kicking, punching, and hitting him, which the patient corroborated, stating he doesn't hate his brother, he just hates the attention he gets.
He added that he has trouble concentrating for too long, and often does these things out of boredom.
The patient and his parents stated that he was previously a straight-A student and on the honor roll at his private school, but recently states he has been bored in class and not provided with enough intellectual stimulation.
He denies trouble with sleeping too much or too little or changes in appetite.
PHYSICAL EXAMINATION: Patient is alert and oriented x3, well-groomed in appearance. Pupils are equal, round, and reactive to light and accommodation. He gives good eye contact with the examiner throughout the examination. He is wearing a short-sleeve shirt, and his arms are covered with cuts, including the words "I WANT TO KILL MYSELF," which prompted this visit. His wounds were treated by the medical staff. Mood was stable, but he appeared anxious and fidgety. Judgement and insight are intact, thoughts were linear and goal directed. He stated that now that he was receiving attention, he felt better.
AXIS I: ADHD, rule out ASD (autism spectrum disorder).
AXIS II: None.
AXIS III: None.
AXIS IV: None.
AXIS V: GAF not assessed.
In fact, there's some movement in the psychiatric community to wait until 21, or even age 26, considering what we know now about the human brain not fully developing until age 26 via CAT scans and SPECT scans.
And her motivation for suicidality isn't rejection or abandonment, which is a prerequisite of borderline personality disorder - it's feeling trapped in her current weight and life?
Thirdly, why is he suspected for an autism spectrum disorder when he gave eye contact the whole time (and she didn't), when inability to sustain eye contact is a known feature of autism (as well as depression and anxiety)?
So, here's some background.
It is well known that almost all patients diagnosed with borderline personality disorder are women, and that almost all patients diagnosed with narcissistic personality disorder are men.
This, of course, is gender biased, unfair, and untrue - I can guarantee you I've met men who are suspect for being borderlines and women suspect for being narcissists, and I'm sure whomever is reading has, too.
But let's presume that's true - that more women are borderlines and more men are narcissists.
Why would that be?
Gee, it wouldn't be because our culture favors assertive men with the outward appearance of strong self-esteem, and vilifies assertive women with strong self-esteem, creating personality problems, would it?
Nah, of course not ;)
Also, until the DSM-V was published in 2013, the criteria list for borderline personality disorder was 14 items long (the longest of any personality disorder) and included things like "promiscuity," when no such feature existed on any personality disorder for men.
This aspect of the disorder in particular was a subject of debate in the mental health community for years (I remember a heated class debate about it an abnormal psychology class in college, with many young women objecting to this item, and the male professor agreeing it was sexist, but that was the criterion by the DSM-III, at that time).
Also, before the DSM-V, it became a well-known problem in the mental health community that when a female patient expresses suicidality or engages in self-harm, regardless of age - or when they don't feel like the patient is progressing (which could be due to their own incompetence) - or even when they simply don't know what to diagnose a patient with, but have to put something on their insurance claims to continue to pay for therapy - clinicians would previously throw them in the grab-bag diagnosis of borderline personality disorder.
Now, that is not to say that there aren't real bunny-boiling, fatal attraction borderlines, out there, that hit the full criterion, there certainly are - but the psychiatric community finally realized this was being overly diagnosed - much like bipolar disorder was being overly diagnosed in the 2000s, and autism-spectrum disorders are being over-diagnosed today.
They also finally officially recognized the gender bias that existed in that diagnosis, and after further trauma studies, that suicidality among women was not always in response to rejection or abandonment, and did not automatically mean a personality disorder. especially in teenage females.
Thus, to their credit, in 2013 with the DSM-V, they shortened the list - and either took certain points out completely (like inability to take responsibility for behavior, because that's become a common American problem for both men and women), or revised them.
For instance, the "promiscuity" language was changed to "excessive sexual behavior," and is now listed under the umbrella of "impulsive behavior," rather than being off as its own criterion by itself.
The "suicidality" and "self-harm" aspects were clarified in that they must be in response to perceived rejection or abandonment.
(For example, workaholic Lady Gaga has admitted to self-harm, which began after her rape 15 years ago.)
These changes have occurred because we have studied more about trauma, especially after the Iraq/Afghanistan war.
As a result, we've learned the most common motivation for suicidality in most women (and gay men) is NOT rejection or abandonment, actually, nor always a manipulation - the motivation is often the same as heterosexual men - trauma reaction and/or he or she either feels either "permanently damaged" or trapped in a situation from which they see no way out.
And yet, we, as a culture, still cling to these antiquated ideas about men and women, nonetheless, even in clinicians who supposedly now know better, as you can see above.
Now - why does this happen?
Well, IMO, as I said, the psychiatric/psychological community is still semi-consciously enabling our broken socioeconomic culture which assumes that wealthy people - especially white males - are sane and stable, and thus receive temporary or mild, less stigmatized diagnoses - even PTSD is considered by our society as more justified in male soldiers versus women who have been raped or abused, and is empathized with more.
The other problem is, as you can see in AXIS V, the psychiatric/psychological community focuses their definitions of mental illness solely around a patient's ability to function in daily activities and in society, as well as their grooming and their mood during the actual session (as you can see in the PHYSICAL EXAMINATION).
(Mind you, judgment, insight, and thought processes are not assessed by any sort of objective testing tools, they're a subjective assessment by the clinician.)
So essentially, if a person either has great-paying commercial insurance or pays out of pocket for the full fee (to avoid a psychiatric claim on their insurance), never misses work or school, appears well groomed, and never cries or seems angry during a session (even though that's the goal of therapy, to uncover those raw emotions), then they're perceived as "stable" in mood and function, and thus less likely to receive a diagnosis.
Never mind they could be terrorizing everybody else in their home, class, or office so badly that they end up seeking therapy - according to mental health definitions, they're stable, simply because they can function - which essentially only means they eat normally, sleep normally, shower, and go to school or work everyday.
So guess who gets diagnosed with something chronic then?
Their victims :)
However, I can report that I know a few therapists who started to wake up to these issues in the psychiatric/psychological community, after Trump - realizing how many people assumed wealthy people, especially white men, were sane, despite obviously unhealthy behavior - and are beginning to reassess whether "global assessment of functioning" may not be the best indicator of mental illness, after all, because they may be treating the the victims of the sickest power abusers in society.
Clinicians have already known for years that the sickest power abusers in our society never see the inside of a therapist's office, or at least don't stay in therapy, because they think it's everyone else with the problem, and others' reactions to their behavior are "oversensitivity," "weakness," or "they're crazy, not me."
If the wealthy do enter therapy, many expect to be coddled, waited on, and patted on the back, as if therapists are their servants, because they're paying them - and many therapists comply, do nothing but tell them they have every right to everything they do, rather than confront them on their behavior, out of both assumption of stability and fear of loss of a big paycheck.
For the record, I wouldn't trust any therapist that never confronts me, because they're not being honest, we all can be shitty sometimes.
Plus being confronted is the only way you'll see change, which is what therapy is for - to change your behavior, since you can't always change your environment.
Even if truly a victim of something, a good therapist will confront you on overly avoiding things or handling things in unhealthy ways, and new coping skills to handle these feelings.
Regardless, I think we can all agree that our society is sicker than ever - and IMO, we're not going to see any marked improvement in the antiquated cultural ideas until the mental health community itself recognizes its own socioeconomic bias - and if you've got a good therapist, they'll admit this exists to you.
I think a good indication that there may be change on the way, however, is how many therapists openly expressed in articles their shock of how much sicker society as a whole was than they realized, after Trump.
Because remember, they're only seeing those that seek help, and the sickest people out there never will ;)