MENTAL ILLNESS Sociological Perspectives

1. MENTAL ILLNESSSociological Perspectives “If you talk to God, you are praying. If God talks to you, you have schizophrenia.” (Thomas Szasz)

2. ISSUES: • Difficulty in classifying illnesses • Measuring issues • Validity in diagnosis • Social Factors • Social Class • Gender • Race & Ethnicity

3. Before we move on to this… • Classical school of criminology • Rational choice • Maximize pleasure/minimize pain • Punishment should fit crime • Be sufficiently harsh to deter but not overly harsh • This will lead to rational calculation to conform • What deviance does this not explain?

4. Classifications • Organic Disorders (brain damage, head injury, aging, drug abuse, etc.) • Functional disorders • Psychotic Disorders • Schizophrenia, manic-depressive • Neurotic Disorders • Anxiety, Obsessive-Compulsive, Depression, etc. • Character Disorders • Sociopathic, antisocial personality

5. How do we measure mental illness in a population? • Do we look at who is admitted to mental institutions? • Do we look at who visits therapists and psychiatrists? • Can you see why this might be problematic? • How else would we count the numbers and distribution of mentally ill? • How do we know the diagnostic categories we use really indicate mental illness?

6. Social Factors • Sociologists interested in patterns of distribution • Most consistent finding across studies is that lower socio-economic groups have greater amount of mental illness • Why?

7. Why? Well, two possibilities… • Social Selection: • Lower class position is a consequence of mental illness • Mentally ill people drift downward into lower income groups/neighborhoods • Social Causation: • Lower class position is a cause of mental illness • Social stress causes mental illness; lower income people experience more social stress • Which do you think it is?

8. GENDER • Studies conflict as to whether women or men have higher rates of mental illness and about which groups suffers more social stress • Men have higher rates of antisocial personality and paranoia, and substance abuse disorders • Women have higher rates of certain illnesses • Depression • Anxiety/panic

9. WHY the gender difference? • Socialization to Social Roles • Women more likely to turn stress inward • Men more likely to turn stress outward • Women believed to be more socially connected and integrated so less likely to act out aggressively against others • Men more vulnerable to “material loss” than women

10. Perspectives on What Mental Illness Is…

11. MEDICAL: Disease Model • HARD • Mental illness is a disease like any other • Has biological basis • Popular in early to mid 1900s • Many psychiatrists hold this view • SOFT • Mental illness is like a disease • Most do not have true bio basis but some do • After WWII thru late 60s: Psychosocial Model (psychoanalysts) • Mental illness is a result of unresolved conflict from childhood • Since 1960s, social stress like loss of loved one, etc.

12. LABELING: Socially Constructed • SOFT • Sociological View • Some mental illness exists but most is probably not biologically based • Over-diagnosed and over-medicated • Cultural tendency to create to treat behaviors medically • HARD • Mental illness is a myth • It does not exist at all; it is simply a label for behavior that is problematic or that we do not understand • The behaviors we associate with mental illness exist but there is no evidence they are caused by a mental problem • Simply non-normative behaviors!

13. Summary • Medical Model vs Labeling Model • These reflect expert opinions about the nature of mental illness • Most psychologists take soft medical view • Not actual illnesses in traditional sense but respond well to treatment so we treat! • Most sociologists take soft labeling view • Too many behaviors are labeled as illness • Pathologizes behavior, medicates people unncecessarily

14. In the Rosenhan reading, the author’s study would fit into which perspective? • Medical • Labeling

15. Rosenhan Study • What does this study demonstrate? • Expert medical authority/power in diagnosis • The “stickiness” of the label • Lack of clarity regarding indicators of mental illness • This study was from the 1970s--do you think this study would have relevance today?

16. Medicalization of Deviance • The process by which medical experts assert authority over an aspect of behavior previously seen as simply “deviant” • Has been a trend since the 1950s-60s

17. Medical-Industrial Complex • A term used to refer to the coinciding interests of physicians, and the pharmaceutical industry to expand diagnoses • American Medical Association and American Psychiatric Association have monopolies on diagnosing and treating illness

18. Some behaviors that were seen as prompted by “free will” or individual difference or character flaws that are now seen as illnesses: • Alcoholism/addiction • Attention deficit disorder (hyperkinesis) • Compulsive gambling • Compulsive shopping • Internet addiction • Sex addiction • Eating disorders • Learning disabilities

19. MEDICALIZATION OF DEVIANCE • Tendency since 1960s and increasingly to treat deviant behaviors as medical conditions • POSITIVES: • Many people helped by medications and educational accommodations • Illness diagnosis is less stigmatizing than a “deviant” label • Parents embrace the idea that behavior is “genetic” or “biochemical”—why?

20. Concerns • Pharmaceutical revolution • Since the 1950s • Medical Social Control • Problematic behavior medicated rather than addressed substantively • AMA/APA monopoly • Who has a lack on categorizing, diagnosing and prescribing?

21. Example • Person who is completely sane and functional in all aspects of life but… • Wants to amputate his leg • Has felt his whole life that he is in the wrong body • Called “Amputee Wannabes” Is this person mentally ill? What is normal? How do you know? Is he only if we create a diagnostic category for him? Do you think there is a diagnosis?

22. Body Integrity Identity Disorder • To get the diagnosis a person must be deemed otherwise mentally healthy (i.e. not psychotic) • Depression and sadness about not being an amputee • Feeling incomplete with all limbs • Wants elective amputation • Reports having felt this way since childhood • Do you think this is a mental disorder? • How would you know for sure? • Could it be just “difference”?

23. For more info… • www.CHADD.com • www.BIID.org • http://www.pbs.org/wgbh/pages/frontline/shows/medicating/