Sociology of mental illness Week 22 Sociology of

Sociology of mental illness Week 22 Sociology of Health and Illness

Recap • Thought about how health and illness are structured by society • Considered the ‘sick role’, medicalisation, surveillance medicine and ‘lay’ understandings of health • Considered social inequalities and health • The impact of chronic illness and disability

Outline • Look at mental health and illness as social categories • Consider to what extent ‘diagnosis’ is linked to normative ideas • Look at the anti-psychiatry movement

What is mental illness? • What does the term mental illness mean to you?

Popular conceptions of mental illness • Often the vision we have of mental illness is linked to ideas of: – Hallucinations – Delusions – Threatening and/or disturbed behaviour – Acute withdrawal or anxiousness – Drug and/or alcohol dependency

Defining mental illness • The diagnosis of mental illness is not always straightforward • Identification of people who are finding difficulty with ‘normal’ expectations • Sociology of mental health looks at the ways in which categories come into existence, who gets diagnosed and how they are treated

Normative expectations? • What sort of behaviours count? • How are they linked to ideas current in wider society – Drapetomania – Homosexuality – Epilepsy – Sexual promiscuity

• What do you think about these historical categories of mental illness? • Do you think it is possible that behaviour which we define as mental illness will be seen in future as ‘wrong’?

Gender and mental health • Statistics show that the diagnosis of mental disorders is gendered • Women are more likely to be diagnosed as having depression, anxiety or somatic complaints. • Men are more likely to be diagnosed with antisocial personality disorder or be alcohol dependant • Risk factors for mental illness are gendered • For women: violence, socioeconomic disadvantage, subordinate social status and unremitting responsibility for the care of others have all been highlight

Feminist theories of mental health • Feminism has understood mental illness as: – a consequence of social oppression – a social construct • Both consider it as an outcome of social processes

Consequences of social oppression? • Social & economic circumstances associated with onset of depression in women. – Long term implications of life events? – Low self-esteem/inability to cope interacts with life events to produce depression. • Working class women at greatest risk.

Consequences of social oppression? • Post-Traumatic Stress Disorder is more common in women that men – Linked to high levels of sexual violence – DSM IV names ‘rape’ as a possible trigger for PTSD but not domestic violence – Women with PTSD reported have a greater symptom burden and longer course of illness

Mental illness as social construct • Studies have point out how frustration, unhappiness or rebellion labelled as mental illness in women. • Women who fail to comply with normative prescriptions of typical feminine behaviour judged as mentally ill.

Judged on femininity ‘Care with make-up and hair style were seen to be clear indications of getting better, likewise wanting marriage and children were viewed by some as part of recovery. I know of individuals who have been told that their problem would get easier if they acquired a boyfriend’ • In Foster, Women and the Health Care Industry

• To what extent do you think that normative ideas about feminine behaviour impact of the diagnosis and treatment of mental illness?

Racism and mental health • Statistics show that the diagnosis of mental disorders is related to ethnicity – Asian women high rates of depression and suicide – Black men higher rates of schizophrenia • Risk factors for mental illness have been related to racism – Socioeconomic disadvantage, subordinate social status and stereotyping

Racism and mental health • Institutional racism has been diagnosed within mental health care • Mental health outcomes for Black patients are shown to be poorer • Black groups are more likely than white people to go into specialist mental health care by coercion

David ‘Rocky’ Bennett • An African-Caribbean man who was eventually diagnosed with schizophrenia. – He made reports of being harassed and bullied by other patients – He was over-medicated (causing low blood pressure) particularly as he was seen as a nuisance – His cultural, racial, social needs were ignored – No attempt was made to engage his family in his care and treatment. – After a incident started by another patient he was restrained, collapsed and died

Treatment by psychiatric services • Independent Inquiry into death of David Bennett found institution racism • Census of inpatients in 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.

• How important do you think racism is in explaining the rates, diagnosis and treatment of mental illness in minorityethnic people?

Anti-psychiatry movement • The Anti-psychiatry has a long history. • It highlights psychiatry as using medical tools for social conditions • It focuses on coercion and the targeting of marginalised populations • Became prominent in the 1960 s and 1970 s and today often focuses on the role of pharmaceutical companies

Anti-psychiatry movement R. D. Laing • Schizophrenia as understandable reaction to conflicts between family and self or through trauma. Thomas Szasz • • Mental illness a ‘metaphor’ Label for deviation from social norms ‘Problems’ cause by rigid society Psychiatry as a tool of social and political control.

Summary • Consider how mental health and illness and closely linked to social categories • Considered gender and racism in diagnosis and treatment • Look at the opposition in the antipsychiatry movement