Sociological Approaches to Sociological Approaches to Mental IllnessMental Illness

Focus on the External Focus on the External EnvironmentEnvironment

Three approaches to mental Three approaches to mental illnessillness

• Biological: Biological: – Determinants of mental illness are internal Determinants of mental illness are internal

(physical body)(physical body)

• PsychologicalPsychological– Determinants of mental illness are internal (in Determinants of mental illness are internal (in

the mind)the mind)

• SociologicalSociological– Determinants of mental illness are external (in Determinants of mental illness are external (in

environment or person’s social situation)environment or person’s social situation)

3 dominant theories in 3 dominant theories in sociological approach:sociological approach:

• Stress TheoryStress Theory

• Structural Strain TheoryStructural Strain Theory

• Labeling TheoryLabeling Theory

Stress Theory: Selye (1956)Stress Theory: Selye (1956)

• Selye studied animals exposed to negative Selye studied animals exposed to negative stimuli. Found 3 stages of response:stimuli. Found 3 stages of response:– Flight or fightFlight or fight– ResistanceResistance– ExhaustionExhaustion

• At exhaustion stage, animal develops At exhaustion stage, animal develops illness.illness.

• Demonstrated that prolonged exposure to Demonstrated that prolonged exposure to negative stress produces illness.negative stress produces illness.

Stress Theory: Holmes & Rahe Stress Theory: Holmes & Rahe (1967)(1967)

• Life events research—looked at Life events research—looked at major life events and people’s ability major life events and people’s ability to cope with themto cope with them

• Found 43 major life eventsFound 43 major life events• Discovered the more life events Discovered the more life events

individuals experienced in a given individuals experienced in a given time, the more likely they were to time, the more likely they were to experience injury, become ill, or dieexperience injury, become ill, or die

HOLMES AND RAHE SCALE OF LIFE EVENTS

•DEATH OF SPOUSE 100

•DIVORCE 73

•MARITAL SEPARATION 65

•JAIL TERM 63

•DEATH OF FAMILY MEMBER 63

•PERSONAL ILLNESS 53

•MARRIAGE 50

•PREGNANCY 40

•CHILD LEAVES HOME 29

•CHANGE IN SCHOOL 20

•MORTGAGE 31

Stress and mental illnessStress and mental illness

• Hundreds of studies associated major Hundreds of studies associated major life events and onset of anxiety, life events and onset of anxiety, depression, schizophrenia, and other depression, schizophrenia, and other mental disorders.mental disorders.

• Also discovered that undesirable Also discovered that undesirable events were more strongly events were more strongly associated with mental disorders associated with mental disorders than were desirable ones.than were desirable ones.

Stress and mental illnessStress and mental illness

• Brown and Harris (1978) found major Brown and Harris (1978) found major negative life events make people negative life events make people vulnerable to clinical depression.vulnerable to clinical depression.

• Other researchers found that certain types Other researchers found that certain types of life events are more likely to be of life events are more likely to be associated with development of mental associated with development of mental disorders than others—events that are disorders than others—events that are “nonnormative, unexpected, “nonnormative, unexpected, uncontrollable, clustered in time.”uncontrollable, clustered in time.”

Correlation is weakCorrelation is weak

• Most studies report a correlation of 0.3 Most studies report a correlation of 0.3 between stressors and symptoms of between stressors and symptoms of mental distress. This is modest. mental distress. This is modest. Researchers questioned why.Researchers questioned why.

• Found that many individuals have good Found that many individuals have good “coping resources” and are not so “coping resources” and are not so negatively affected as others. Coping negatively affected as others. Coping buffersbuffers negative effects of stress. negative effects of stress.

What is coping?What is coping?

• Using coping resources to handle Using coping resources to handle stressful demandsstressful demands– Social resources (social networks—Social resources (social networks—

family and friends)family and friends)– Personal resources (self-esteem and Personal resources (self-esteem and

sense of control or mastery over life)sense of control or mastery over life)

• Using coping strategiesUsing coping strategies– Behavioral or cognitive attempts to Behavioral or cognitive attempts to

manage stressful demandsmanage stressful demands

Some groups are more Some groups are more vulnerable to stress than vulnerable to stress than othersothers• Negative life events and chronic Negative life events and chronic

strains are unequally distributed in strains are unequally distributed in the population.the population.

• Some groups have fewer resources Some groups have fewer resources and are thus more vulnerable and are thus more vulnerable (women, the elderly, the very young, (women, the elderly, the very young, unmarried people, people of low unmarried people, people of low socioeconomic status).socioeconomic status).

Stress Theory: AdvantagesStress Theory: Advantages

• Focuses on aspects of individual’s Focuses on aspects of individual’s current social situation.current social situation.

• Helps to explain why some groups Helps to explain why some groups are more vulnerable to mental are more vulnerable to mental disorders than others.disorders than others.

Stress Theory: Stress Theory: DisadvantagesDisadvantages• Better at explaining group differences Better at explaining group differences

than individual differences.than individual differences.

• Can’t explain why some groups are Can’t explain why some groups are more prone to some disorders than more prone to some disorders than others.others.

• Doesn’t apply as well to more serious Doesn’t apply as well to more serious mental illnesses, such as schizophrenia.mental illnesses, such as schizophrenia.

Diathesis-Stress TheoryDiathesis-Stress Theory

• Better explains development of more Better explains development of more serious mental illnesses, such as serious mental illnesses, such as schizophrenia.schizophrenia.

• It seems there has to be something It seems there has to be something more than stress to develop these more more than stress to develop these more severe illnesses—genetic predisposition, severe illnesses—genetic predisposition, chemical imbalance, faulty childhood chemical imbalance, faulty childhood socialization, early trauma, etc.socialization, early trauma, etc.

Treatment/prevention Treatment/prevention implications of stress theory:implications of stress theory:

• Change environment Change environment – Eliminate/reduce stressorsEliminate/reduce stressors

• Teach coping Teach coping – Increase social supportIncrease social support– Raise self-esteemRaise self-esteem– Give a stronger sense of control Give a stronger sense of control

(empower)(empower)

Structural Strain TheoryStructural Strain Theory

• Assumes origins of stress are in broader organization Assumes origins of stress are in broader organization of society, where some groups are relatively of society, where some groups are relatively disadvantageddisadvantaged

• E.g., Merton’s anomie theoryE.g., Merton’s anomie theory– American culture emphasizes success and wealthAmerican culture emphasizes success and wealth– Educational system is route to success and wealthEducational system is route to success and wealth– Large segments of society see themselves as blocked Large segments of society see themselves as blocked

from education and therefore from successfrom education and therefore from success– Anomie is gap between aspirations and means to Anomie is gap between aspirations and means to

achieve goals achieve goals – This leads those who are blocked into other routes, This leads those who are blocked into other routes,

which may include crime, mental illness, or substance which may include crime, mental illness, or substance abuseabuse

Structural Strain Theory Structural Strain Theory Assumptions:Assumptions:

• Society’s organization puts some Society’s organization puts some groups at an economic disadvantagegroups at an economic disadvantage

• Economic disadvantage is a strain Economic disadvantage is a strain that leads to higher rates of that leads to higher rates of psychological breakdownpsychological breakdown

Treatment/prevention Treatment/prevention implications of Structural implications of Structural Strain Theory:Strain Theory:• To prevent psychological breakdown, To prevent psychological breakdown,

need large scale interventions—e.g., need large scale interventions—e.g., guaranteed income.guaranteed income.

• However, Seattle and Denver Income However, Seattle and Denver Income Maintenance Experiments showed Maintenance Experiments showed minimal benefit from income minimal benefit from income guarantee in preventing symptoms guarantee in preventing symptoms of psychological distressof psychological distress

Labeling TheoryLabeling Theory

• Assumption: people who are labeled as Assumption: people who are labeled as deviant become deviantdeviant become deviant

• Everyone violates social norms at some timeEveryone violates social norms at some time• When rule-breakers are low status, higher When rule-breakers are low status, higher

status agents of social control (police, social status agents of social control (police, social workers, judges, psychiatrists) can force workers, judges, psychiatrists) can force rule-breakers into treatmentrule-breakers into treatment

• People who are so labeled as mentally ill are People who are so labeled as mentally ill are then stereotyped as unpredictable, then stereotyped as unpredictable, dangerous, likely to behave in bizarre waysdangerous, likely to behave in bizarre ways

Labeling TheoryLabeling Theory

• Labeled people are:Labeled people are:– Treated as irresponsibleTreated as irresponsible– Denied access to normal activitiesDenied access to normal activities– Forced to spend time with other deviantsForced to spend time with other deviants– Get socialized into mental patient culture, Get socialized into mental patient culture,

adopting mental patient worldviewadopting mental patient worldview– Take on identity of a mental patientTake on identity of a mental patient

Labeling TheoryLabeling Theory

• Doesn’t explain initial causes of Doesn’t explain initial causes of deviant behavior—so theory has deviant behavior—so theory has limited usefulnesslimited usefulness

• Has, however, sensitized mental Has, however, sensitized mental health personnel to the dangers of health personnel to the dangers of “institutionalization”“institutionalization”

Sociological Theories:Sociological Theories:

• Don’t explain fully all causes of mental illnessDon’t explain fully all causes of mental illness• Does, however, demonstrate that mental Does, however, demonstrate that mental

illness is not randomly distributed among the illness is not randomly distributed among the population but tends to occur more in population but tends to occur more in disadvantaged groupsdisadvantaged groups

• Effective treatments are not equally availableEffective treatments are not equally available—some have better access than others—some have better access than others

• Therefore, sociological explanations are Therefore, sociological explanations are important for mental health policy makers.important for mental health policy makers.