Sociology, Culture and PsychiatryDr Alex HuntClinical Psychologist

Conceptions of Mental HealthPsychiatricBiomedical model mental illness approachdeveloped from physical medicinePsychoanalyticConflicts Deficits PsychologicalStatistical notionIdeal notion Presence or absence of specific behavioursDistorted cognitions

Conceptions of Mental HealthSocial causationCritical theorySocial constructivism (constructionism) Critical realism(medical) anthropology

Conceptions of Mental HealthLay conceptionsLay conceptions and psychiatrics labels concur (in western societies)Mental health viewed along a continuum up to a pointSome mental health problems viewed as normal experience stress depressionMore severe mental health problems viewed differently based upon stereotype

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

StigmaElements involved in defining and stereotyping mental illness:Dangerousness IntelligibilityHow intelligible is person behaviour has to make sense within the current contextCompetenceCreativity Obsessionality Religion

Conception of mental health BadNormal Abnormal Mad

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

Response to Stigma

Information control Unlikely to be discovered concealCompensateExaggerate (generalise)Pass, get bySwitch styles

Role of Mass Media Media on the whole supports and strengthens stereotypeViolence, otherness, Dont concur with psychiatric descriptionsPathetic dependence or sillinessHumane biographical accounts (films, documentaries)

Social ExclusionSocietal discrimination Rights can be suspended compulsory detention and involuntary treatmentPoorer housingLess chance of employment Psychosis 1 in 4 poverty Less likely to be involved / included in community

Stigma Discrimination for people with mental health difficulties high (social exclusion unit)ONS positive attitudes about mental illness deceasedFear of mental health users increasedTolerance of people with MH problems decreased

Anti StigmaAnti-stigma (discriminatory) campaignsRCPsychChanging minds mental illness is an illness like any other illnessBiological not persons faultUser movement Psychological oppression and social causes

Social Class & Mental HealthBlack report Lower SES associated with greater morbidity and mortalityMental health poverty and mental health Affective disorders diagnosed evenly across social classesStrong correlation between low SES and schizophrenia

Relationship Between SES and MHSocial drift theoryLife events Greater negative life events in low SES Social causationMaterial deprivationLess access to resourcesPoorer environmentHealth behaviour

MH and EmploymentBetter prognosis for those diagnosed with psychosis who are employedWork factor in depressionrelationship between anxiety and depression and SES dependent on employment statusUnemployed men more likely to have MH problems than unemployed women

Sick Role & Illness BehaviourExit sick role (get better)Chronic conditioncorpseBecoming illSICK!Medical profession

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

Sick RolesVariety of sick roles culturallyBabyCorpse roleAngryScapegoat Sometimes not allowed any

Sick RolesActiveChronic Patient as sacredPatient as shameful Passive Acute AngryScapegoatedBabyCorpse

Gender & MH Some diagnoses not gendered, schizophrenia and bi-polar

Some inevitably limited to women Post-natal and post partum psychosis

Overwhelmingly female Anorexia & bulimiaBPD

Overwhelmingly maleantisocial personality disorderSex offenders

Substance misuse more likely in menAnxiety and depression more likely in women Dementia (women live longer)

Overrepresentation of Women Society causes excessive mental illnessIncreased social demands and lack of structureEntrapment and humiliationIncreased vulnerability adverse childhood events CSA, rapeMeasurement artefactResearch toolsHelp seeking

Women and Mental Health Labelling theory Feminist influence Women labelled more often than menGPs more likely to label psychological problems in women than menSexism in psychiatryMedicalisation of female experienceThe great tranqulizer debate

Men & Mental Health Men are viewed as more dangerous weak stereotypeMen over represented in prison, women in mental health population social judgementsGender expectations Externalising vs internalising

Culture & Mental HealthHow universal are psychiatric diagnoses?Historical context NY vs LondonCategorisation WHO studyCross culturally something approximating schizophrenia in each country (this can be debated)Prognosis, better level of care and input = better outcomes? NO!

Culture and Mental health Two parts The symptomsSocial responses to the symptons social processWestern medicalised internalised internal stable attribution.controllable? Developing spirit possession external, unstable explanation.uncontrollable?

Culture and Mental HealthEmic vs etic approachesCulture bound syndromesCategory fallacy?Cultures undevelopedVariant of western diagnoses?

Culture and CategoryAnorexia & Bulimia

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

*Psychiatric - Biomedical model mental illness approached the same as physical medicinediagnosis, prognosis, aetiology and treatment; some conditions are linked to viruses and bacteria, however the great bulk of what is termed mental illness has no proven bodily cause. Deals with symptoms, not signs. There are no biological signs as such. High rise, and unemployed and depressed, stress of circumstance has triggered biochemical changes, which can be treated by antidepressants.

Szasz mental illness is a myth, bodies can be ill, minds cannot, it is like a metaphor, like the economy, a s sytem that is not working properly, that doesnt have balalnace a equilibruim.

Psychoanalytic we are all somewhere on a continuum between normal and abnormal, or all somewhat screwed up. Conceptual model which leads to ideas about treatment; but tends to psychologise everything

PsychologicalStatistical notion frequently occurring behaviours are normal, infrequent are nottempo of speechpressured speech, pressure of thought or high, slow speech might be described as slow or depressed, may not hold steady across cultures or within one culture. Bi or unidirectional - intelligenceIdeal notion humanistic self actualising, or psychoanalytic conscious over unconscious characteristicsPresensce or absence of specific behaviours maladative behaviour who defines what is adaptive orf maladative, desired or undesired, again cultural relativism Distorted cognitions thoughts which aare unhelpful or undisarable

*Social causation - Concepts of mental health (illness) are held to be valid, however social factors are implicated in their causation. Psychiatric epidemiology correlations between categories and antecedent variables. Social class gender etc.

Critical theory mix of psychoanalytic and Marxist theory seeking to explore the links between societies and individuals in a particular time and place the type of society influences the individual which then influences society western society a culture of narcissism and the fragmented self represented by the metaphor of schizophrenia

Social constructionism reality is not self evident, stable and waiting to be discovered, but instead is a product of human activity 1. understanding the social forces which define a phenomenon2. post structuralist ideas and Foucault radical, reality is constructed entirely through language and discourse. It doesnt exist until talked about. Pluralistic, relay is what is constructed within human interaction. Bound up with power relationships3. the production of scientific knowledge how scientific knowledge is produced and constructed

Critical realism reality does exist society exits prior to the existence of agents but they become agents who reproduce or transform society can accommodate the different positions.temporal lobe epilepsy and the critical analysis of the way in which problems are described at a particular point in time is a society, whose interests are being served. **Stigma a form of stereotypeThe tendency for human beings to attribute fixed and common characteristics to whole social groups Stereotype to stigma Prejudicial social typing - enlargement of the stereotype to cast the person as a deviatitive or undesirable social groupEmotion reaction anxiety, hostility, pityMoral reaction - paternalism, revulsion, horrorStigmatised person is set apart from others, the labelling vs the labelled.

Stigmatised person becomes isolated and develops a spoiled identity.

Negative stereotypes underlying the stigmatisation of those labelled as mentally ill are based upon three elements:

*In any given situations there are meta rules about how one should behave and act, transgressions of these should be able to be understood, or at least the person should be able to give an intelligible account of what has happened. If all follows the roles and rules expected of them, intelligibity is not often demanded. Lacking insightdo not provide an intelligible account. Starts with others and then is rubber stamped by psychiatry

Global and trans historical.however, what is intelligible in one culture or set of belief systems does not necessarily transfer to anotherhallucinations and voice hearing. Only a building block of stereotype where it is disvalued.

Only some psychiatric patients are intelligible Some psychotic patients are largely intelligible most of the timeMadness is episodic, rarely persistent

Creativity and madness, creativity transcends conventions, - bi-polar people are successful and creativenovel ideas and the energy to carry them through

Obsessionality, prized in some regards and can out perform others; features of obsessive personality disorder read like Victorian virtues

Spirituality and religious leadership 10-15 percent religious delusions, however the charismatic figureheads of main world religions could be diagnoses retrospectively as suffering some form of psychosis christ in the desert, Mohamed in a cave. *Positive effects access to treatment / normalising Negative effects hierachy of stigma mentally ill are disvalued, below prostitution, eplipsey and alcoholism

Fear of violence and need to keep social distance reduces with contact

Modified labelling theory social rejection based upon shared cultural assumption about mental illness. Extent to which the person takes on board these ideas of social distance. Born with the stereotype, person with mental illness takes this on board and begins to act accrodlingly as well as others labelling and prejucing the person. Often the stigma is more in the persons own mind and experience than in others.

*****Faris 1939 7 times the rate of schizophrenia in poor neighbourhoods in Chicago compared to middle class districts hypothesized poverty and lack of social cohesion social isolation hypothesis

Social drift theory **Those in high social *Parsons was a functionalist sociologist, who argued that being sick means that the sufferer enters a role of 'sanctioned deviance'. This is because, from a functionalist perspective, when you are ill you are not being a productive member of society. Therefore this deviance needs to be policed, which is the role of the medical profession.The general idea is that the individual who has fallen ill is not only physically sick, but now adheres to the specifically patterned social role of being sick. Being Sick is not simply a state of fact or condition, it contains within itself customary rights and obligations based on the social norms that surround it. The theory outlined two rights of a sick person and two obligations: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 there are three versions of sick role 1.conditional 2.unconditionally legitimate sick role. 3.illegitimate role:condition that is stigmatized by others.

****New slide; Gender Specific Risk Factors

New slide; Gender Bias**Womens Mental Health; The Facts****