Lecture 18 - Mental Illness as a form of Deviance Flashcards
1950s - USA: mental illness
Did not have this aspect of medicalization down. Medical labels entered our discourse later on.
What is Mental illness? History of mental illness in the USA?
An increase in the number and range of conditions included in the DSM:
1952: 106 conditions.
1994: 300 conditions (diagnoses) (DSM-V from
2013 – about the same number
Some conditions were dropped (homosexuality) but many others were added
A (Short) History of Mental Illness
- Ancient times: A theological/demonological approach: Explained as being possessed by god or vengeance from god.
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Classical Greece: A medical model (Hippocrates – bodily humours)
- First time we see a medical model appear.
- Seen as a disease which has a medical cause and physical cause - physical model.
- Madness as the imbalance of body fluids -
Medieval Europe: The Theological model returns
- All diseases were seen as being sent by god as a form of punishment or as a warning to humanity to stop being sinful.
- Started treating this illness but the idea was that this is a way to communicate illness. -
The Age of enlightenment: The medical model and “the great confinement”
- Michelle Foucault: “Madness and Civilization” (1961) - main thinker in the idea of lightness.
- Dominance of the medical model (reason and rational thinking) → we are at the center of the world around us.
- Positive feeling associated with Rennaisance - but we see cruelty in the way they treat people that are “mad” → we don’t see a more human approach.
Foucalt
- Foucalt - involved in Post modern thinking.
- Published a book following the history of the madness in the west
- Treatment was often so harsh that they had to suffer through the medical treatment.
- Special role in the society as someone that was able to communicate with god
- Liminal position between being a fool and being someone that can communicate with higher power.
- Report back to people what the voices tell them - role to communicate truths to people (“the fools”)
Stultifera Navis - The Ship of Fools
- The Ship of Fools - a bunch of people doing weird things on a boat
- We as a society start to think of these individuals as needing to be isolated. Purifying function (we send them away to purify)
The Great Confinement
- Segregation and institutionalization individuals perceived as “mad,” “deviant,” or “anti-social” in Europe, particularly from the 17th to 19th centuries.
- Locking away the people defined as mad and criminals. People with leprosy were also sent away from society.- People who are “mad” are seen as less than humans - treated as animals.
- Instead of marginalizing individuals, society began to physically separate them from mainstream life
- 18th Century, 10% of the French population was locked up in either prisons or asylums
- England asylum population grew from 10,000 in 1800 to about 100,000 in 1900
- Diagnosis expansion
- Struggle between the state and the church, the state wins and identifies doctors
- The treatments are not better…they are insane treatments
Foucalt
- Interested in how the state becomes the main power (rather than the church)
- People are governed the best when they make rational decisions to follow orders from the state.
- Internalization of the rules
Late 19th Century: Rise of the Psychological Model – Hysteria
- Freud - looked at Hysteria
- A sex-selective disorder, affecting only those of us with a uterus.
- Mainly women from upper or middle class
- Intense symptoms: cramps, anxiety - Uteri were often thought to be the basis of a variety of health problems.
- Marriage (and its implied regular sexual intercourse) was the general recommendation.
- Cure = get married and become pregnant
Late 19th Century: the Psychological Model
– Freud and the structural model of personality
– A ‘psychological scar produced through trauma or repression’.
– Women experienced hysteria because they were unable to reconcile the loss of their (metaphoric) penis.
- Trauma of feeling that we used to have a penis and “lost it”
– Women should marry because that is how they regain their (metaphoric) penis
- Another solution, if you cannot be married then doctors can help you out (swedish man)
- Freuds attributes a lot of mental illnesses to societal pressures: society wants us to repress
Swedish Army Majornamed Thure Brandte
- Release of suppressed sexual energy through ‘paroxysmal convulsion’ → physically induced by massage
- Invention of vibrator came next
Hysteria
- Hysteria ‘everything that men found mysterious or unmanageable in women’
- Hysteria was deleted from official Diagnostic and Statistical Manual of Mental Disorders in 1980.
- The label survived to today. Women complaining about pain are also still seen as delusion - Symptoms did not disappear but the prognosis of doctors - hysteria was a catch all diagnosis for many disorders.
Mid-20th Century: A medical-physical model
- Electroconvulsive Therapy (ECT)
- Physical structure shapes our mental ilness.
- Electric current through the brain
- Memory loss, disorientation, - Brain Lobotomy - remove neural connection between frontal lobe and other parts of brain: antonio
- Results: loss most of their abilities, many died
- Women were subjected to more of these than men - Drug Therapy
- Treat mental disorders
- Grew in the 60s, quality of drugs also improved
Sociological Critic
- The theoretical assumptions of the medical and psychological models (Foucault, Rosenhan, Szasz, Becker and Labeling theory)
- The practical treatment of mental illness, in particular the idea of confinement (Foucault, Goffman, Rosenhan, Szasz)
- The strict dichotomy between “Normal” and “abnormal”.
Thomas Szasz (1960):“The Myth of Mental Illness”
– Mental illness as a social construct (not a medical reality)
* Critiques psychologist for treating them (not actually ill)
* If you talk to god, you are sane but if god talks to you you have schizophrenia
* Disease like hysteria is just a tool for the doctors to look into the behaviours involved
– Labeling and power relations
* Drapetomania
* When people diagnose people with a disease it is a way to control them
* Mental illness is socially constructed because we understand it through our lens that is socially constructed (it is not to say that the biological condition is not there) but instead that the way we look at is constructed
Ervin Goffman (1961): “Asylums”
– Total Institutions
* Authoritative staff that control the people
* No decisions are made themselves
* Detachment from society
* They have been taught a role of being a “good patient” in an asylum
– Disculturation
* Instead of improving peoples conditions, asylums make them less able to adapt and live in the real world
- They are taken out of society and then struggle when they are put back in society (ie:jail)
* Internalize specific characteristics from being in an asylum and being separated from society
David Rosenhan (1973): “Being Sane in Insane Places”
- Questions this idea that mental illness can be scientifically identified and diagnosed
- Sends people to pretend they have one symptoms of schizophrenia and admit themselves to mental institution = pseudopatients
- Behave normally (no symptoms) once admitted.
- They do not mention the voices anymore. - Kendall et al. (1971): Cultural differences in diagnoses
- The Power of labeling:how strong the label of “schizophrenia” is even though they no longer have symptoms. Even after they are released they are still labelled as patients in remision.
- There is strain due to this label
- Hard to get rid of it.
- The idea of Unreliable diagnosis - they look and find mental ilness even when it does not exist - the opposite can occur too.
- Doctors heard about these experiments and diagnose patients as pseudopatients
– The assumption of intrinsic illness
– The dichotomy between “normal” and “abnormal”
– Susannah Cahalan: “The Great Pretender”
- Rosenhan made up some findings
- Her body was attacking her brain causing significant ilness
Takeaway from Rosenhan:
- Power of labelling: once individuals are labelled everything they do from that point on is interpreted by that point of view (further evidence of sickness).
- Intrinsic disease - professionals tend to ignore the effect of total institutions on the behaviour of individuals. These shape our personal perception on ourself. Being excluded from society, being surrounded by others with mental illness and having to obey to authoritative staff.
Susanna Cahalan on psychiatric diagnoses:
- “During my hospitalization, one psychiatrist described my plain white shirt and black leggings as “revealing,”… and he used it as proof that I was hypersexual, a symptom that supported my bipolar diagnosis….
- Yet, the minute the doctors discovered my issues were neurological the quality of care improved. Sympathy and understanding replaced the largely distant attitude that had defined my treatment. As if a mental illness was my fault, whereas a physical illness was something unearned; something “real”.”
- Tendency for this bias (Szas does it in his explanation as well)
