Sociology of Health and Illness: SOC 325 Mental health and mental illness

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Sociology of Health and Illness SOC 325Mental
health and mental illness

• Historical and cultural context.
• Social patterning of mental disorder / distress.
• Sociological approaches
• social causation
• mental illness as deviance
• social construction of mental illness
• feminist critiques
• studies of mental institutions
• lived experiences ? chronic illness.
• Stigma / media portrayals of mental illness.

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Societal responses to madness

• distinction between mental illness and mental
  deficiency
• fear of madness c.f. leprosy
• demonic possession / witchcraft
• creativity / wisdom / religious visionary
• folly
• beyond reason
• moral deficiency
• a spectacle e.g. St Marys of Bethlehem.

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Forms of mental illness / mental distress
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Medicalization of mental illness

• Illness
• Diagnosis on basis of comparison with normal
  behaviour
• Medical / genetic explanations remove blame from
  the individual
• Confinement safety?
• Treatments physical and moral.
• BUT...
• ...mental illness is socially patterned
• ...social processes shape concepts, environments
  and practices.

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Social patterning of mental disorder

• Data from hospital admissions, community
  studies, suicide rates.
• Differences in routes to treatment and responses
  from medical profession make comparisons
  difficult.
• Effects of social class? gender? ethnicity? age?
  environment? social position? life events?
• Vulnerability trigger / aggravating factors

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Social class and mental illness

• Social class gradient for most forms of mental
  illness.
• Some exceptions e.g. suicide rates, eating
  disorders, alcohol misuse.
• Explanations
• genetic
• social selection
• social stress ? vulnerability
• social labelling

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Social Class and SuicideData from Scambler
1997 on standardised mortality rates, England
Wales
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Social causation approaches

• Focus on life events.
• Variety of measurement instruments but the
  meaning and significance of an event will vary
  for each person.
• Impact of less severe but more common sources of
  stress?
• Connection between the consequences of life
  events, lack of social support and the onset of
  depression (Brown Harris 1978)
• Complex relationship between mental health and
  societal position.

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The Social Origins of DepressionBrown and Harris
(1978)

• Social economic circumstances associated with
  onset of depression in women.
• Long term implications of life events?
• 4 vulnerability factors
• absence of a close confiding relationship loss
  of mother before age of 11 lack of employment
  outside home 3 or more children under 15 living
  at home.
• Low self-esteem/inability to cope interacts with
  life events to produce depression.
• Working class women at greatest risk.

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Ethnicity and health

• Classification may be problematic.
• Dearth of good data.
• Younger age structure of most minority groups.
• Specificity of migration history and relationship
  with material disadvantage.
• Disentangling ethnicity and social class.
• Differences in genetic risk?
• Lifestyle / cultural factors.
• Access to and use of health services.
• Ecological effects of community.
• Racism / fragmented identities.

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Migration and mental illness

• Hospital admission rates higher among ethnic
  minority population as a whole but variations
  between groups.
• Highest rates of hospital admissions among Irish
  migrants followed by people born in Caribbean.
• Rate of mental illness among South Asian
  population lower than UK-born white population.
• Higher rates of mental illness for women than men
  in all groups except Caribbean-born.
• Higher admission rates for schizophrenia and
  paranoia among Caribbean-born men and women.
• Effects of migration racism disadvantage.

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Treatment by psychiatric services

• Independent Inquiry into death of David Bennett,
  1998 ? Census of inpatients, 31st March 2005
• 9 of in-patients were black or mixed black-white
  ethnicity (3 of national pop)
• black patients were 44 more likely to have been
  sectioned 50 more likely to have been put in
  seclusion
• black Caribbean men were 29 more likely to have
  been subject to control and restraint.
• Association with use of substances?
• South Asian population healthy migrants?
  Barriers to obtaining help? Expression of
  emotional distress through physical symptoms?

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Mental illness as deviance

• Relationship between the normal and the
  pathological (Durkheim).
• Deviance as labelled behaviour
• The deviant is one to whom the label has
  successfully been applied deviant behaviour is
  behaviour that people so label (Becker 1963)
• Primary and secondary deviation (Lemert 1967)
• Residual rule-breaking / deviance (Scheff 1966)
• Long term effects of attaching psychiatric labels
  (Scheff 1966 Rosenhan 1973).
• Types and stages of stigmatization (Goffman
  1968).

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• Once the impression has been formed that the
  patient is schizophrenic, the expectation is that
  he will continue to be schizophrenic. When a
  sufficient amount of time has passed, during
  which the patient has done nothing bizarre, he is
  considered to be in remission and available for
  discharge. But the label endures beyond
  discharge, with the unconfirmed expectation that
  he will behave as a schizophrenic again. Such
  labels, conferred by mental health professionals,
  are as influential on the patient as they are on
  his relatives and friends, and it should not
  surprise anyone that the diagnosis acts on all of
  them as a self-fulfilling prophecy. Eventually
  the patient himself accepts the diagnosis, with
  all of its surplus meanings and expectations, and
  behaves accordingly.
• (Rosenhan, 1973)

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The social construction of mental illness

• Medical practice embedded within patriarchal and
  capitalist society.
• Example of hysteria.
• Anti-psychiatrist movement e.g. Laing, Szasz,
  Eysenck.
• Absence of organic signs or genetic markers for
  some forms of mental illness.
• Hospitals treatment focused on behaviour.
• Assessing fitness to participate fully in social
  life.

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Anti-psychiatry movement

• R.D.Laing - The Divided Self (1959) Sanity,
  Madness and the Family (1964)
• Rejection of positivist approach.
• Schizophrenia as understandable reaction to inner
  conflicts brought on by family dynamics or
  trauma.
• Thomas Szasz - The Myth of Mental Illness (1961)
• Mental illness only illness by metaphor
• Deviation from social norms
• Problems in living
• Psychiatry as a tool of social and political
  control.
• Implications for treatments and institutions

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• The expression mental illness is a metaphor
  that we have come to mistake for fact. We call
  people physically ill when their body-functioning
  violates certain anatomical and physiological
  norms similarly, we call people mentally ill
  when their personal conduct violates certain
  ethical, political, and social norms. (Szasz
  (1974) Ideology and Insanity)
• The term mental illness is a metaphor. Bodily
  illness stands in the same relation to mental
  illness as a defective television set stands to a
  bad television programme. ... It is as if the
  television viewer were to send for a TV repairman
  because he dislikes the programme he sees on the
  screen.
• (Szasz (1971) The Manufacture of Madness)

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Feminist approaches to understanding mental
illness

• EITHER.... a consequence of social oppression
• OR... a social construct? OR BOTH?
• Processes of socialization.
• Medicalization of reproductive health.
• Gendered dichotomy between male female psyches.
• Frustration, unhappiness or rebellion labelled as
  mental illness.

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• the female is a female by virtue of a certain
  lack of qualities
  (Aristotle)
• she is largely without moral sense, inclined to
  be less ethically rigorous, have less perception
  of judgement, is more subject to emotional bias
  and unable to contribution to culture
  (Freud)
• (Source Penfold and Walker 1984)

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Foucault

• Madness and Civilization (1965)
• Discipline and Punish (1977)
• Birth of the Clinic (1973)
• Historical perspective.
• Effect of Enlightenment on societal responses to
  mental illness.
• Institutional context of the asylum.
• Benthams Panoptican - exercise of extensive
  repressive power.
• Surveillance ? self restraint / self-discipline.

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Goffman - Total Institutions

• Asylums (1961)
• Mental hospitals, prisons, boarding schools,
  monasteries, merchant ships, military barracks.
• Large group. Place of residence and work.
• Disappearance of private life.
• Communal activities highly structured.
• Activities provided according to plan for the
  organisation.
• Divisions between staff inmates stereotypes.
• Mortification of the self loss of external
  roles.

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Media portrayal of mental illness

• In 1996.... (Health Education Authority Making
  Headlines)
• 48 of press coverage linked mental distress to
  harm to others, crime or harm to self.
• Negative coverage outnumbered more balanced
  reporting by almost 3 to 1.
• 75 of tabloid editorials about mental health
  linked mental distress to violence.
• 40 of daily tabloid articles and 45 of Sunday
  tabloid articles about mental health used words
  like nutter looney.
• Effects on help-seeking? (Shift survey 2005)
• Concern about mental health of children young
  people.

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Visual images of mental illness

• Reinforcing gender stereotypes.
• Playing on racist fears - e.g. The Suns coverage
  of Frank Bruno story, summer 2003.
• The stereotype of the big, black and dangerous
  man is not new, but it has recently been
  powerfully reshaped into the image of the man who
  is big, black, mad and dangerous, an image that
  has become part of a strong racist undercurrent
  in public debates on mental health. (Sayce
  1995)
• BUT evidence of changing public responses?
• Bonkers Bruno locked up? Sad Bruno in mental
  home
• Backlash against normalization of mental illness?
  e.g. Wainright 2003 Crazy Nation?