MENTAL ILLNESSMENTAL ILLNESSSociological PerspectivesSociological Perspectives

““If you talk to God, you are If you talk to God, you are praying. If God talks to you, you praying. If God talks to you, you have schizophrenia.” (Thomas have schizophrenia.” (Thomas

Szasz)Szasz)

ISSUES:ISSUES:►Difficulty in classifying illnessesDifficulty in classifying illnesses

Measuring issuesMeasuring issues Validity in diagnosisValidity in diagnosis

►Social FactorsSocial Factors Social ClassSocial Class GenderGender Race & EthnicityRace & Ethnicity

Before we move on to this…Before we move on to this…►Classical school of criminologyClassical school of criminology

Rational choiceRational choice Maximize pleasure/minimize painMaximize pleasure/minimize pain Punishment should fit crimePunishment should fit crime

►Be sufficiently harsh to deter but not overly Be sufficiently harsh to deter but not overly harshharsh

►This will lead to rational calculation to conformThis will lead to rational calculation to conform

►What deviance does this not explain? What deviance does this not explain?

ClassificationsClassifications►Organic Disorders (brain damage, Organic Disorders (brain damage,

head injury, aging, drug abuse, etc.)head injury, aging, drug abuse, etc.)►Functional disordersFunctional disorders

Psychotic DisordersPsychotic Disorders►Schizophrenia, manic-depressive Schizophrenia, manic-depressive

Neurotic DisordersNeurotic Disorders►Anxiety, Obsessive-Compulsive, Depression, Anxiety, Obsessive-Compulsive, Depression,

etc.etc. Character DisordersCharacter Disorders

►Sociopathic, antisocial personalitySociopathic, antisocial personality

How do we measure mental How do we measure mental illness in a population?illness in a population?

►Do we look at who is admitted to mental Do we look at who is admitted to mental institutions?institutions?

►Do we look at who visits therapists and Do we look at who visits therapists and psychiatrists?psychiatrists?

Can you see why this might be problematic?Can you see why this might be problematic? How else would we count the numbers and How else would we count the numbers and

distribution of mentally ill?distribution of mentally ill? How do we know the diagnostic categories we How do we know the diagnostic categories we

use really indicate mental illness?use really indicate mental illness?

Social FactorsSocial Factors►Sociologists interested in patterns of Sociologists interested in patterns of

distributiondistribution Most consistent finding across studies is Most consistent finding across studies is

that lower socio-economic groups have that lower socio-economic groups have greater amount of mental illnessgreater amount of mental illness►Why?Why?

Why? Well, two possibilities…Why? Well, two possibilities…►Social SelectionSocial Selection::

Lower class position is a Lower class position is a consequenceconsequence of mental of mental illnessillness

Mentally ill people drift downward into lower income Mentally ill people drift downward into lower income groups/neighborhoodsgroups/neighborhoods

►Social CausationSocial Causation:: Lower class position is a Lower class position is a causecause of mental illness of mental illness Social stress causes mental illness; lower income Social stress causes mental illness; lower income

people experience more social stresspeople experience more social stress

►Which do you think it is? Which do you think it is?

GENDERGENDER►Studies conflict as to whether women or Studies conflict as to whether women or

men have higher rates of mental illness men have higher rates of mental illness and about which groups suffers more and about which groups suffers more social stresssocial stress Men have higher rates of antisocial Men have higher rates of antisocial

personality and paranoia, and substance personality and paranoia, and substance abuse disordersabuse disorders

Women have higher rates of certain illnessesWomen have higher rates of certain illnesses►DepressionDepression►Anxiety/panicAnxiety/panic

WHY the gender difference?WHY the gender difference?►Socialization to Socialization to Social RolesSocial Roles

Women more likely to turn stress inwardWomen more likely to turn stress inward Men more likely to turn stress outward Men more likely to turn stress outward

Women believed to be more socially Women believed to be more socially connected and integrated so less likely to connected and integrated so less likely to act out aggressively against othersact out aggressively against others

Men more vulnerable to “material loss” Men more vulnerable to “material loss” than womenthan women

Perspectives on What Mental Perspectives on What Mental Illness Is…Illness Is…

Hard Hard MedicaMedicall

Soft Soft MedicaMedicall

Soft Soft LabelinLabelingg

Hard Hard LabelinLabelingg

MEDICAL: Disease ModelMEDICAL: Disease Model► HARDHARD

Mental illness is a disease like any otherMental illness is a disease like any other Has biological basisHas biological basis

Popular in early to mid 1900sPopular in early to mid 1900s Many psychiatrists hold this viewMany psychiatrists hold this view

► SOFTSOFT Mental illness is Mental illness is likelike a disease a disease

► Most do not have true bio basis but some doMost do not have true bio basis but some do After WWII thru late 60s: Psychosocial Model After WWII thru late 60s: Psychosocial Model

(psychoanalysts)(psychoanalysts)► Mental illness is a result of unresolved conflict from childhoodMental illness is a result of unresolved conflict from childhood► Since 1960s, social stress like loss of loved one, etc. Since 1960s, social stress like loss of loved one, etc.

LABELING: Socially LABELING: Socially ConstructedConstructed

► SOFTSOFT Sociological ViewSociological View

►Some mental illness exists but most is probably not Some mental illness exists but most is probably not biologically basedbiologically based

Over-diagnosed and over-medicatedOver-diagnosed and over-medicated Cultural tendency to create to treat behaviors medically Cultural tendency to create to treat behaviors medically

► HARDHARD Mental illness is a mythMental illness is a myth

► It does not exist at all; it is simply a label for behavior that It does not exist at all; it is simply a label for behavior that is problematic or that we do not understandis problematic or that we do not understand

►The behaviors we associate with mental illness exist but The behaviors we associate with mental illness exist but there is no evidence they are caused by a mental there is no evidence they are caused by a mental problemproblem

Simply non-normative behaviors!Simply non-normative behaviors!

SummarySummary►Medical Model vs Labeling ModelMedical Model vs Labeling Model

These reflect expert opinions about the These reflect expert opinions about the nature of mental illnessnature of mental illness

Most psychologists take soft medical viewMost psychologists take soft medical view►Not actual illnesses in traditional sense but Not actual illnesses in traditional sense but

respond well to treatment so we treat! respond well to treatment so we treat! Most sociologists take soft labeling viewMost sociologists take soft labeling view

►Too many behaviors are labeled as illnessToo many behaviors are labeled as illness►Pathologizes behavior, medicates people Pathologizes behavior, medicates people

unncecessarilyunncecessarily

In the Rosenhan reading, the author’s In the Rosenhan reading, the author’s study would fit into which perspective?study would fit into which perspective?

50%50%

Medical Labeling

A.A. MedicalMedicalB.B. LabelingLabeling

Rosenhan StudyRosenhan Study►What does this study demonstrate?What does this study demonstrate?

Expert medical authority/power in Expert medical authority/power in diagnosisdiagnosis

The “stickiness” of the labelThe “stickiness” of the label Lack of clarity regarding indicators of Lack of clarity regarding indicators of

mental illnessmental illness

►This study was from the 1970s--do you think This study was from the 1970s--do you think this study would have relevance today?this study would have relevance today?

Medicalization of DevianceMedicalization of Deviance►The process by which medical experts The process by which medical experts

assert authority over an aspect of assert authority over an aspect of behavior previously seen as simply behavior previously seen as simply “deviant”“deviant”

Has been a trend since the 1950s-60sHas been a trend since the 1950s-60s

Medical-Industrial ComplexMedical-Industrial Complex►A term used to refer to the coincidingA term used to refer to the coincidinginterests of physicians, and the interests of physicians, and the

pharmaceutical industry to expand pharmaceutical industry to expand diagnosesdiagnoses

• American Medical Association and American Medical Association and American Psychiatric Association have American Psychiatric Association have monopolies on diagnosing and treating monopolies on diagnosing and treating illnessillness

► Some behaviors that were seen as prompted Some behaviors that were seen as prompted by “free will” or individual difference or by “free will” or individual difference or character flaws that are now seen as illnesses:character flaws that are now seen as illnesses: Alcoholism/addictionAlcoholism/addiction Attention deficit disorder (hyperkinesis)Attention deficit disorder (hyperkinesis) Compulsive gamblingCompulsive gambling Compulsive shoppingCompulsive shopping Internet addictionInternet addiction Sex addictionSex addiction Eating disordersEating disorders Learning disabilitiesLearning disabilities

MEDICALIZATION OF MEDICALIZATION OF DEVIANCEDEVIANCE

► Tendency since 1960s and increasingly to Tendency since 1960s and increasingly to treat deviant behaviors as medical conditionstreat deviant behaviors as medical conditions

► POSITIVES:POSITIVES:• Many people helped by medications and Many people helped by medications and

educational accommodationseducational accommodations

• Illness diagnosis is less stigmatizing than a Illness diagnosis is less stigmatizing than a “deviant” label“deviant” label

• Parents embrace the idea that behavior is Parents embrace the idea that behavior is “genetic” or “biochemical”—why?“genetic” or “biochemical”—why?

ConcernsConcerns► Pharmaceutical revolutionPharmaceutical revolution

Since the 1950sSince the 1950s►Medical Social Control Medical Social Control

Problematic behavior medicated rather Problematic behavior medicated rather than addressed substantivelythan addressed substantively

►AMA/APA monopolyAMA/APA monopoly Who has a lack on categorizing, Who has a lack on categorizing,

diagnosing and prescribing? diagnosing and prescribing?

ExampleExample► Person who is completely sane and Person who is completely sane and

functional in all aspects of life but…functional in all aspects of life but… Wants to amputate his legWants to amputate his leg Has felt his whole life that he is in the wrong bodyHas felt his whole life that he is in the wrong body

►Called “Amputee Wannabes”Called “Amputee Wannabes”

Is this person mentally ill?Is this person mentally ill?What is normal?What is normal?How do you know? How do you know? Is he only if we create a diagnostic category for him?Is he only if we create a diagnostic category for him?

Do you think there is a diagnosis? Do you think there is a diagnosis?

Body Integrity Identity Body Integrity Identity DisorderDisorder

► To get the diagnosis a person must be To get the diagnosis a person must be deemed otherwise mentally healthy (i.e. not deemed otherwise mentally healthy (i.e. not psychotic)psychotic)

► Depression and sadness about not being an Depression and sadness about not being an amputeeamputee Feeling incomplete with all limbsFeeling incomplete with all limbs Wants elective amputationWants elective amputation Reports having felt this way since childhoodReports having felt this way since childhood

►Do you think this is a mental disorder? Do you think this is a mental disorder? How would you know for sure? How would you know for sure?

► Could it be just “difference”?Could it be just “difference”?

For more info…For more info…►www.CHADD.comwww.CHADD.com►www.BIID.orgwww.BIID.org►http://www.pbs.org/wgbh/pages/http://www.pbs.org/wgbh/pages/

frontline/shows/medicating/frontline/shows/medicating/