sociology, culture and psychiatry dr alex hunt clinical psychologist
TRANSCRIPT
Sociology, Culture and Psychiatry
Dr Alex HuntClinical Psychologist
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
Conceptions of Mental Health
• Social causation• Critical theory• Social constructivism (constructionism) • Critical realism• (medical) anthropology
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
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
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
Conception of mental health Bad
Normal 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 alcoholism
• Modified labelling theory (Link & Phelan, 1999)– – social rejection based upon shared cultural
assumption about mental illness.
Response to Stigma
• Information control – Unlikely to be discovered conceal
• Compensate• Exaggerate (generalise)• Pass, get by• Switch styles
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)
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
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
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
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
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
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
Sick Role & Illness Behaviour
• Sick role – sanctioned deviance, Policed by medical profession
Exit sick role (get better)
Chronic condition
corpse
Becoming ill
SICK!
Medical profession
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
Sick Roles
• Variety of sick roles culturally– Baby– Corpse role– Angry– Scapegoat – Sometimes not allowed any
Sick Roles
Active
Chronic
Patient as sacred
Patient as shameful
Passive
Acute
“Angry”
“Scapegoated”
“Baby”
“Corpse”
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)
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
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
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
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!
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?
Culture and Mental Health
• Emic vs etic approaches• Culture bound syndromes
– Category fallacy?– Cultures undeveloped– Variant of western diagnoses?
Variation in presentation of symptoms / epidemiology across cultures
Biological Social Cultural
Hypothesised influence on presentation
Amok
Latah
“psychosis”
Depression
Personalistic
Culture and Category
Anorexia & Bulimia
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