Sociology, Culture and Psychiatry

1. Sociology, Culture and Psychiatry Dr Alex Hunt Clinical Psychologist

2. Conceptions of Mental Health • Psychiatric • Biomedical model – mental illness approach • developed from physical medicine • Psychoanalytic • Conflicts • Deficits • Psychological • Statistical notion • Ideal notion • Presence or absence of specific behaviours • Distorted cognitions

3. Conceptions of Mental Health Social causation Critical theory Social constructivism (constructionism) Critical realism (medical) anthropology

4. Conceptions of Mental Health • Lay conceptions • Lay conceptions and psychiatrics labels concur (in western societies) • Mental health viewed along a continuum – up to a point • Some mental health problems viewed as normal experience ‘stress’ ‘depression’ • More severe mental health problems viewed differently – based upon stereotype

5. Stigma • Stigma a form of stereotype • The tendency for human beings to attribute fixed and common characteristics to whole social groups • Stereotype to stigma • Prejudicial social typing • Emotion reaction • Moral reaction

6. Stigma • Elements involved in defining and stereotyping mental illness: • Dangerousness • Intelligibility • How intelligible is person behaviour – has to make sense within the current context • Competence • Creativity • Obsessionality • Religion

7. Conception of mental health Bad Abnormal Normal Mad

8. Labelling Theory (Scheff, 1966) • Positive effects – access to treatment / normalising • Negative effects – hierarchy of stigma mentally ill are disvalued, below prostitution, epilepsy and alcoholism • Modified labelling theory (Link & Phelan, 1999) • – social rejection based upon shared cultural assumption about mental illness.

9. Response to Stigma Information control Unlikely to be discovered conceal Compensate Exaggerate (generalise) Pass, get by Switch styles

10. Role of Mass Media • Media on the whole supports and strengthens stereotype • Violence, otherness, • Don’t concur with psychiatric descriptions • Pathetic dependence or silliness • Humane biographical accounts (films, documentaries)

11. Social Exclusion • Societal discrimination – • Rights can be suspended –compulsory detention and involuntary treatment • Poorer housing • Less chance of employment • Psychosis 1 in 4 • poverty • Less likely to be involved / included in community

12. Stigma Discrimination for people with mental health difficulties high (social exclusion unit) ONS positive attitudes about mental illness deceased Fear of mental health users increased Tolerance of people with MH problems decreased

13. Anti Stigma Anti-stigma (discriminatory) campaigns RCPsych Changing minds – mental illness is an illness like any other illness Biological not persons fault User movement Psychological – oppression and social causes

14. Social Class & Mental Health Black report Lower SES associated with greater morbidity and mortality Mental health – poverty and mental health Affective disorders diagnosed evenly across social classes Strong correlation between low SES and schizophrenia

15. Relationship Between SES and MH • Social drift theory • Life events • Greater negative life events in low SES • Social causation • Material deprivation • Less access to resources • Poorer environment • Health behaviour

16. MH and Employment • Better prognosis for those diagnosed with psychosis who are employed • Work factor in depression • relationship between anxiety and depression and SES dependent on employment status • Unemployed men more likely to have MH problems than unemployed women

17. Sick Role & Illness Behaviour Sick role – sanctioned deviance, Policed by medical profession Exit sick role (get better) Becoming ill SICK! Chronic condition corpse Medical profession

18. Sick Role • Talcott Parsons (1951) • Contract with rules: • Rights: • The sick person is exempt from normal social roles • The sick person is not responsible for their condition • Obligations: • The sick person should try to get well • The sick person should seek technically competent help and cooperate with the medical professional

19. Sick Roles • Variety of sick roles culturally • Baby • Corpse role • Angry • Scapegoat • Sometimes not allowed any

20. Sick Roles Patient as sacred “Baby” “Angry” Passive Acute Active Chronic “Corpse” “Scapegoated” Patient as shameful

21. Gender & MH Some diagnoses not gendered, schizophrenia and bi-polar Some inevitably limited to women Post-natal and post partum psychosis Overwhelmingly female Anorexia & bulimia BPD Overwhelmingly male antisocial personality disorder Sex offenders Substance misuse more likely in men Anxiety and depression more likely in women Dementia (women live longer)

22. Over–representation of Women Society causes excessive ‘mental illness’ Increased social demands and lack of structure Entrapment and humiliation Increased vulnerability – adverse childhood events –CSA, rape Measurement artefact Research tools Help seeking

23. Women and Mental Health • Labelling theory • Feminist influence • Women labelled more often than men • GP’s more likely to label psychological problems in women than men • Sexism in psychiatry • Medicalisation of female experience • The great tranqulizer debate

24. Men & Mental Health Men are viewed as more dangerous – weak stereotype Men over represented in prison, women in mental health population – social judgements Gender expectations – Externalising vs internalising

25. Culture & Mental Health How universal are psychiatric diagnoses? Historical context NY vs London Categorisation WHO study Cross culturally something approximating schizophrenia in each country (this can be debated) Prognosis, better level of care and input = better outcomes? NO!

26. Culture and Mental health Two parts The symptoms Social responses to the symptons – social process Western medicalised – internalised –internal stable attribution….controllable? Developing – spirit possession – external, unstable explanation….uncontrollable?

27. Culture and Mental Health • Emic vs etic approaches • Culture bound syndromes • Category fallacy? • Cultures undeveloped • Variant of western diagnoses?

28. Culture and Category Personalistic Variation in presentation of symptoms / epidemiology across cultures Amok Latah Depression “psychosis” BiologicalSocialCultural Hypothesised influence on presentation Anorexia & Bulimia

29. Ethnicity and Mental health Different ethnicities over represented in psychiatric populations Irish and Afro-Caribbean over represented why not others? Genetics Migration Racism Cultural explanations – belonging / fragmentation