The Sociology of Health and Illness

1. The Sociology of Health and Illness Mad, bad and dangerous to know? The story of mental health

2. Plan for session • Disease or behaviour? • Social aspects of mental disorder • Age variations • Gender variations • Social class variations • Ethnic variations • Becoming mentally ill – accepting the label • Care or control?

3. Disease or behaviour? • In any social situation there are expectations about how people should normally behave. Sociologists use term deviance to describe behaviour that departs radically from what most people in social group consider acceptable • In past deviant behaviour explained in terms of possession by spirits, devils etc • Behaviours seen as immoral or criminal also seen as proof of mental illness and treated accordingly

4. Disease or behaviour? • Are modern attitudes to mental health more humane and compassionate because we treat mental illness now as an illness (i.e. we have medicalised it)? • Or is ascription of deviance as ‘illness’ counterproductive because it denies people responsibility for actions, restricts ability of mentally disordered to lead normal lives, legitimises forms of oppressive social control etc?

5. Disease or behaviour? Taylor and Field’s classification of mental disorder: • Those suffering impaired brain functions, e.g. learning disability, senile dementia • Those with behavioural problems, e.g. eating disorders, alcohol abuse • Those with mental illnesses, e.g. schizophrenia, depression

6. Disease or behaviour? • Mental illness further broken down into: • Psychoses (involve distorted perception of reality – often very frightening for sufferers and relatives – e.g. schizophrenia • Neuroses (sufferers usually have insight into problems and seek treatment – e.g. obsessive behaviour, phobias) • This distinction important because locks into debate about care or control…

7. Disease or behaviour? • Psychiatry, as a branch of medicine, draws heavily on the biomedical model in its conceptualisation of mental disorder, i.e. • Focus on symptoms being related to biomedical dysfunction of the body (and therefore susceptible to intervention by drugs, surgery etc) • Focus of intervention is single patient • Object of treatment is to return patient to ‘normal state’ • Members of medical professions seen as most appropriate for dealing with problem

8. Disease or behaviour? • This view challenged by many, who point out that:: • Often impossible to identify objective indicators of brain malfunction • Low levels of consensus amongst psychiatrists about relationship between diagnosis and treatment • Factors such as race, class, age, gender clearly shown to affect clinicians’ reading of ‘objective signs’ • Value neutrality of classifications challenged by fact that some behaviours clearly seen as deviant or immoral in certain culturally or historically specific settings, e.g. political dissidence in USSR, giving birth to illegitimate child in 1950s Britain

9. Social aspects of mental disorder • Social research tends to suggest that mental illness may be understood in terms of wider social influences… • Age • Gender • Social class • Race

10. Social aspects of mental disorder Age • Mental disorder largest source of morbidity in children, but prevalence inflated by medicalisation of forms of disruptive/anti-social behaviour • Adolescence associated with period when ‘organic’ disease first manifest, but may just be period of storm and stress • Gender differences strong in adolescence with young women prey to neuroses and young men more prone to schizophrenia, alcoholism etc • Neurotic disorders more common in mid life • Disorder rates increase markedly in later life, though many things put down to Alzheimers, for instance, may simply be cause by confusion resulting from isolation, poor diet, drug interactions etc

11. Social aspects of mental disorder Gender • Women more likely to be suffering from neurotic disorders, men from alcoholism/ drug dependence • Divorce /marital separation associated with higher rates of disorder for both sexes • Gender differences least marked amongst singletons, most marked between married men/women. Pattern of gendering roles directly implicated? • Artefactual reasons often give for women’s higher rates of illness, e.g. may be more willing to admit distress, may have more contact with health services than men because of children etc

12. Social aspects of mental disorder Social class • Mental disorders highest among lowest social classes and lowest in higher social classes • Do adverse social conditions produce higher levels of stress and disorder? Brown et al (1978) showed working class women more likely to suffer marriage breakdown and poverty • Types of treatment also related to social class. Middle classes more likely to be offered ‘talking treatments’, working classes more institutional forms of care and physical forms of treatment, e.g. ECT

13. Social aspects of mental disorder Ethnicity • Overall rates of mental disorder higher for Asian/Afro-Caribbean groups • Rates of compulsory admission of young black males higher than other groups, and, once admitted, more likely to be diagnosed as psychotic than general population • Explanations? • The difference is real and caused by greater stress (of migration, cultural position, poverty, etc) • The difference is not real but a clear consequence of labelling and stigma. Pilgrim and Rogers (1993) argue that apparent strong associations between ethnicity and ‘madness’ is part of a ‘new racism’ • The difference is not real but a consequence of health professionals misunderstanding culturally different behaviour (e.g. loudness, shyness etc)

14. Becoming mentally ill - accepting the label Scheff (1966) argued that mental illness not a disease state but rather a labelapplied to people displaying regularly aberrant behaviour (temporary deviance caused by drink, for example, is overlooked)

15. Becoming mentally ill - accepting the label • In this view, it is not symptoms per se, but public reaction to them that determines whether the label is applied • Labelling influenced by amount, visibility and intrusiveness of symptoms, so… • Some behaviours tolerated more in some communities than in others • Different responses may be given to same sets of symptoms dependent on social status • Other labels may be available which help people resist label of mental illness (e.g. lovable eccentric, a bit fey, witchdoctor)

16. Becoming mentally ill - accepting the label • Key role in labelling played by stereotypes of mental illness/madness learned in childhood and reinforced by media • Ill person may also incorporate stereotypes into behaviour – what does this say about keenness to adopt labels and to use them? • Compliant or expected behaviour may have its own rewards in hospital or therapeutic settings

17. Becoming mentally ill - accepting the label • Theories abut labelling probably underplay the extent to which people willingly embrace the label or the sick role • Accepting the label legitimates patients giving up their struggle to lead a normal life • Accepting the label may draw down stigma on oneself, but undoubtedly also attracts services and resources and sympathy

18. Care or control? • Underlying growth of psychiatric care is assumption that mental disorders are diseases which an be managed and treated by health professionals • This assumption questioned by Szasz (1987) who argues that very notion of mental illness is a myth • Szasz claims that whereas physicians make scientific diagnoses about patients’ bodies, psychiatrists are simple making value judgements about people’s behaviour • He claims the majority of sufferers are people who have ‘problems in living’ and not mental illnesses, and that it makes little sense to offer them treatment designed to correct deviation from biological norms, when their problem is really deviance from behavioural norms • The net effect of this is to divert attention from the real causes of problems which lie in adverse social circumstances, moral conflicts, social intolerance etc

19. Care or control? • Breggin (1991) argues that by defining deviant behaviour as illness, psychiatric professions legitimate treatment and compulsory detention of those who deviate from the norm – more about social control than care or cure • These theories of the anti-psychiatry movement criticised for not crediting effectiveness of modern psychiatric interventions,and for overplaying its social control function, but they do raise important ethical questions

20. Care or control? • Debate continues over issues like compulsory powers of detention, about handling of people with so –called ‘non treatable’ personality disorders etc • Debate fuelled by media hysteria over violent attacks by schizophrenics or bizarre acts by those with personality disorders • Victims, sufferers join with relatives of those with mental health problems in questioning levels of care of those who are vulnerable

21. Care or control? • Olstead reports (2002) how the Canadian media fuel negative views about mental illness, linking it to ideas about violence and criminality • Projection of ‘them’ being a danger to ‘us’ • Rare tragic violent acts skew public view • Despite these, Walsh and Fahy conclude, based on review of variety of statistics that people with mental disorder no more likely to be violent than general population