Mental Illness 2nd Exam

residual rule-breaking

behaviors that violate implicit social rules but cannot be clearly recognized as norm violations, you don’t realize what the norm is until it’s broken; breaking an unnamed rule, the reaction sticks

virtual social identity

who we assume you are based on accent, clothes, name; assumptions before you’ve done anything

actual social identity

who you turn out to be; stigma lives in the gap between the two

discredited

condition is already known, problem is managing the tension

discreditable

they don’t know yet, problem is managing the information

passing

not disclosing at all; not applying for a certain job or not telling friends

covering

known, but kept from being the main thing in the room: FDR always being seated so that focus isn’t on his wheelchair

stigma power

instances when stigma processes achieve the aim of stigmatizers with respect to the exploitation, management, control, and exclusion of others

• achieved through keeping people down, in, away; five factors that make it - labeling, stereotyping, separating, status loss, discrimination; stigma is entirely contingent on power

role captivity

wanting to be elsewhere but having no way, not necessarily dissatisfied with current role but rather with their inability to achieve a higher goal

buffering model

support matters when stress is high, moderate blow, no stress no effect to find

main effects model

support all the time, good for you on it’s own, unconditional

medicalization

the process of turning a non-medical issue or condition into a medical one through language, diagnoses, treatment, and understanding

pharmaceuticalization

process by which social, behavioral, or bodily conditions are treated or deemed to be in need of medical drugs by doctors or patients; not contingent on medicalization

disease mongering

practice of widening diagnostic boundaries of illnesses and promoting public awareness of them to increase market for treatments and drugs; more people have a condition so more people need the drugs for it

overdiagnosis

individuals are diagnoses with medical condition or abnormality that would never cause harm or symptoms during lifetime; lowers threshold for what is ‘normal’

chronic strain

lives in roles, persistent ongoing hardship or conflict within a social role or environment or outside pressure that bears down on individual; bad marriage, single (working) parent

social construction

conceptual framework that emphasizes the cultural and historical aspects of phenomena widely thought to be exclusively natural: emphasis on how the meanings of phenomena are developed through interactions via social contexts - illness is not just a biological condition, but socially constructed through cultural beliefs, personal experiences, medical knowledge

labeling career

last step in why labeling sticks: behavior→ reaction→ label→ role—> career; each step narrows what else you’re allowed to be, the label doesn’t come off so it becomes a career, your main identity, you’re always managing it

modified labeling theory

Rosenhan’s ‘being sane in insane places’, label produces expectation of rejection

negative cultural conceptions lead to concerns with staying in lead to being kept away leads to being kept down

misrecognition

Bordieu, stigma can be most effective when the operation is not obvious even to those it harms, unconscious process where power relations are accepted as natural

structural discrimination

one form of discrimination, done through policies, laws, institutional practice, no individual has to act

nonevent mastery

capacity to cope and adapt with things that didn’t happen, an individual’s perception of ability to handle the stress of a nonevent: ex. not being married by certain age

perceived support

perception of how much support one has, their social ties and the strength of those

lead-time bias

statistical error that falsely makes it look like a medical intervention increases a patient’s survival time, but does not; survival time appears longer, usually from early-screening

why are medicalization and pharmaceuticalization not the same?

pharma uses already established medical conditions, it’s more about prescriptions and drug treatments rather than medical framework, medicalization asks if something is a medical problem and who has the authority to decide this, pharma asks if a drug is the answer to the problem and who benefits from the answer being yes, also pharma doesn’t always directly need a doctor, relies more on marketing and consumerism

what 3 cases can pharmaceuticalization not explain

ritalin - child already diagnosed with ADHD so the diagnoses doesn’t change, switches treatment from therapy to medicine, no new categories just more drugs

weight loss drugs - obesity already a medical issue, was managed by diet or surgery now by injection or pills

behind the counter - prescription drug is reclassified so can be bought in supermarket, usage goes up: in this case, medicalization goes down bc no doctor involved, while pharma goes up

Abraham’s 5 factors of pharamaceuticalization

biomedicalism - belief that science got better so more conditions can be treated

medicalization - more things count as medical problems

industry promotion, marketing - drugs sold to doctors, doctors sell it to you

consumerism - patients demanding access, or alleging harm; pharma takes away need for doctors by over the counter

regulatory state - what the gov requires before drugs can be sold

why is the biomedicalism claim/basis weak, what’s it’s claim

claim - more drugs reflect scientific advancement

if it were true or had more scientific evidence to back it up, there would be more money spent on research of new drugs rather than marketing and promotion but that’s not the case; real therapeutic advances have been declining

how does consumerism cut both ways

leads to increase of sales and pharma because more people want more drugs, but also de-pharma through campaigns and lawsuits that claim harm

Payton and Thoits work: what do they test, what’s the study?

tests if the assumption that medicalization reduces stigma using DTCA/tv advertising, specifically depression and schizophrenia

• controls how much TV people watch and their opinions about people with depression and schizophrenia in 1996 vs. 2006, how their attitudes have changed over 10 years; depression was more heavily advertised in 1996

result of Payton and Thoits study, what does it show

found no decrease in stigma of depression or schizophrenia, people only really took away the message of ‘talk to your doctor’, there was an increase in people thinking that those with these conditions should at least consult a doctor

• no change in perceived dangerousness or desired social distance

• shows that medicalizing a problem may not touch what produces stigma at all

• shows that people view ordinary unhappiness as medical problem

what does abraham conclude

marketing may not create false needs, it may create false claims and expectations about what pharmaceuticals can do for those needs; the need can be real and drugs can be the right answer, or the right answer to a question that no one should have asked

what are the four routes of medicalization, outlined by conrad?

1. defined - defining problem in medical terms

2. described - using medical langauge

3. understood - through medical framework

4. treated medically - treatment through medical intervention

• no physician needed, any one is enough

what is the greatest social control?

the power to define

sin —> crime —> sickness: deviance becomes illness

what comes first, definition or drug/treatment?

definition comes first; drug can sit for ages, without a diagnoses no one can be given it

what does Kaczmarek say about medicalization, what is her criticism?

offers a more neutral tone, says it’s not a verdict; it’s wrong when medicine oversteps it’s proper limits so the question is whether a case is warranted, when is it actually political, cultural, or not even an issue at all

her criticism - to call it ‘medicalization’ is to already criticize

how/where does medicalization overstep?

health - harm caused by treatment

economic - wasting money

psychological - stigma, loss of freedom

social - political cause is ignored

pros of medicalization when well-founded?

health - when using evidence-based tools

economic - treatment covered by insurance, sick leave

psychological - stops conditions from being viewed as shameful

social - increased public health awareness

what is the social gain of medicalization?

treating instead of punishing: treating instead of changing the arrangement is the social cost

can you settle the issue/debate of medicalization by defining health?

no - is health is complete well-being, then every part of life is a health problem so medicine would have no boundary to overstep

what four questions need to be asked about medicalization?

1. is this rightly recognized as a problem?

2. is it a problem only bc of exaggerated expectations? (is the need authentic or manufactured)

3. does medicine best explain it?

4. does medicine best solve it?

what’s the difference in these questions

• 1 and 2 ask whether there is a problem

• 3 and 4 ask whether medicine owns it

• more no’s means a weaker case, it’s a gradient not a verdict

question 2

two tests: does the case resemble medicine’s past errors, and is there a commerical interest

• male pattern baldness ex. passes the first one but fails second

• homosexuality fails all 4: case was proceeded by political fight, not a finding

how does gupta define overdiagnosis?

a true abnormality is discovered but detecting and treating it does not benefit the patient

• not misdiagnosis, and not overtreatment

how does the overdiagnosis definition widen?

by adding a pre-disease: pre diabetes, pre-hypertension, introduces category of not yet ill

lowers threshold: nobody gets sick, the line just moves; lowering threshold for what counts for hypertension

what is the signature of overdiagnosis?

incidence climbing while mortality stays flat

what is stress?

• the gap between a demand and the capacity to meet it, not an event or feeling

• arises from the dissonance between a condition and the ability to adapt to it

aspects of stress/what makes it: stressors, conditions not reactions, taxes adaptive capacity, requires some adjustment

what makes stress sociological, where does capacity come from?

when the same event happens to different people there are different levels of damage because capacities are unequal, and capacities are socially distributed

• capacity comes from money, position, education, and ties: these are unequal

what are the five stressor types?

1. life events - divorce, layoff, diagnosis

2. chronic stressors - job itself, r*pe example, bad marriage itself

3. traumatic events - severe, leaves residue

4. daily hassels - small, relentless, adds up

5. non-events - things that were supposed to happen but didn’t

• lack of change can be as stressful as change

what is the stress process model, one line?

sources —> mediator —> outcomes

sources = life events, chronic strain, role strains

mediator = coping, social support, mastery system

outcomes = depression, anxiety, physical illness, behavoir

• sociology is in the arrows, not boxes

where does chronic strain live and why?

chronic strain lives in roles because they last

examples of strain - role overload, personal conflict, role captivity, multiple roles, role reconstructing, gain and loss of roles

how does stress spread, what are the different types?

primary stress leads to secondary stress, named for order not size; it’s spillover between the roles, contagion to people close to you

primary stressor of job loss leads to secondary stressor of paying mortgage

Pearlin’s study, what did it test and reveal about stress? the finding no one expected?

tracked involuntary job disruption over 4 years, asked if it caused depression and if so, how?

job loss —> economic strain —> self esteem, mastery fail (eroded self) —> depression

+.34 rise in depression after involuntary job loss,

the event does not reach the symptom directly, it travels

coping and social support had no direct effect on depression: they do not block the symptom, they work upstream on what causes it

what are the four mediators in stress model?

1. coping - what you do about it, avoidance counts for a while

2. social support - what others do and what you believe they would do

3. mastery - whether you believe you can affect the outcome

4. belief systems - what the thing means and how much it’s allowed to matter

• each can turn into a stressor

what is the catch with these mediators?

avoidance works short term but can turn into suppression over long term; support can deplete or wound, also mastery can become delusion

how does mastery rise?

with socioeconomic status; the people facing the most stressors have the fewest resources

what are the three kinds of support?

1. structural - how many ties, how often, how dense; shape of social network

2. received - help that actually comes; rides, casseroles

3. perceived - the belief that you are loved, valued, can count on someone

what form of support beats the other?

perceived beats received by tenfold, weak correlation between the 2

Turner and Noh study: what did it measure and find?

measured young mothers, split by class, and their different levels of support and distress

middle class moms - support mattered on all 3 levels, consistent effect on low medium and high, exemplified the main effects model

lower class - support mattered only at high levels, nothing at low or medium, shows buffering model

Thoits: significant others vs. experientially similar others

significant others - best at providing emotional sustenance, practical help, mattering and self worth but worst at advice

experientially similar others - best at coping assistance, knowing what works, validation and proof of survival

what are the 3 kinds of stigma? what does goffman say stigma is?

body - physical, abominations of the body: wheelchair

character - blemishes of the individual character: addiction, mental illness

group (tribal) - race, nation, religion, can be spread through lineages

• stigma is an undesired differentness from what we the observer anticipated

what kind of stigma is mental illness? how does it read?

mental illness is a character stigma, so it reads as a verdict on the kind of person you are

is psychiatric history always discreditable?

psychiatric history is almost always discreditable, which is why disclosure decisions take so much work

is passing the same as disclosing?

no: passing is not disclosing at all, disclosing is openly revealing it

• covering is being known and keeping it from being the main thing in the room

what is mixed contact? explain it

contact between a mentally ill person and ‘normal’; moments when the stigmatized and normal are in the same social situation

• the stigmatized may feel self conscious about how they’re acting, whether or not the normal can tell if they’re stigmatized

• any reaction the person has becomes more evidence that they’re defective

what are Link and Phelan’s 5 components of stigma?

1. labeling - naming a human difference that matters

2. stereotyping - linking a label to undesirable characteristics

3. separating - us and them

4. status loss - down the ladder, importance goes down

5. discrimination - fewer jobs, houses, worst: follows you

• stigma is all five at once in a situation where someone has the power to make them stick

• without power, stigma does nothing

out of the three forms of stigma power, which is mainly used for mental illness?

keeping people in

what are the four ways to discriminate?

1. person to person - landlord not renting to someone

2. structural - policy, law, no individual has to act

3. interactional - the nurse hesitating over kindness

4. through the individual - he never applies for the job

what does bordieu say about misrecognition?

the arrangement stops looking like an arrangement and looks like how things are, natural, to everyone including those it harms

what is symbolic power, bordieu?

the power to make your picture of the world the official one

what is the twist in the study?

the coping is the mechanism: the 3 things the people had to do to protect themselves - staying in, away, and feeling down - were the 3 things the stigmatizers wanted, nobody had to do anything

what are the 2 routes out?

1. reduce the motivation to stigatize, requires cultural shift

2. take away the power to act on it, requires laws

what does constructed mean in terms of social construction?

constructed means the category was built by people at a date for reasons, does not mean it’s fake

what are conrad and baker’s 3 findings?

1. cultural meaning - meaning added to the biology

2. illness experience - what it’s actually like to live with it

3. medical knowledge - categories themselves are made by people

which of the 3 is most difficult and why?

medical knowledge - homosexuality left the DSM by a vote in 1973 and diabetes cut-off lowered/widened; no bodies changed

what does Freidson say about illness?

says that “doctors create illness” - illness as a social fact of being ill, not the disease

what makes residual rule breaking stick, Scheff?

the reaction makes it stick, not the actual behavior

Rosenhan’s ‘being sane in insane places’ what was the study?

• 8 healthy people, 12 mental hospitals, one fake symptom

• none were caught, all discharged ‘in remission’

• rewrote an ordinary family history as schizophrenic, no facts changed

• the perception of the patient’s behaviors and circumstances were shaped by diagnosis, label

what was the 2nd study by Rosenhan, what does it show?

• he warned a hospital that they were being sent fake patients

• they flagged 41 out of 193 real patients as fake, but he sent nobody

• the error flips when incentive flips

what does rosenhan conclude?

says that categories are not tied to anything stable and once a label is applied it’s all everyone sees including what the patient sees in himself

what does link say about labeling and illness (modified labeling theory)?

the label does not cause illness, it creates the expectation of rejection, leads to secrecy, withdrawal, not trying

what does Cahalan say about this?

challenged the pseudopatient accounts and their accuracies