Sociology of Mental Health and Illness 1

Myth of Psyche & Cupid 

• Psyche: the personification of the human mind, soul, or life force

• A character in Greek mythology, as well as in Roman philosopher Apuleius’ famous

book entitled the Metamorphoses

• Guided by her jealous sisters who claim that Psyche is married to a monster, Psyche

betrays her husband Cupid by breaking his rule never to see him. He abandons her and

she seeks repentance from his mother, the Goddess Venus. After suffering many

hardships through Venus’s intervention, Cupid asks his father Zeus to intervene. The

princess Psyche then transforms in body and spirit into a goddess to enjoy pure

happiness through love (the God Cupid)

Sociology

• The scientific study of human social life, groups, and societies, including their behavior and interactions

• Term (“sociologie”) coined by Auguste Comte, a French philosopher and early founder of the field

Subfields of sociology

• Sociology of Health and Illness/medical sociology

• Sociology of gender

• economic sociology 

• sociology of education

• political sociology 

• sociology of race

• sociology of the family 

• sociology of deviance

• urban sociology 

• social movements

Sociological imagination 

• C. Wright Mills 

  • American sociologist who described sociological imagination

• Thinking about relationship between

  • Personal troubles: related to individual and range of immediate social life and connections

  • Public issues: matters that go beyond personal and local circumstances, relating to broader structural factors of social life

• social context that affects how an individual thinks, behaves

• We tend to focus on personal issues

• How are the ideas and practices of providers shaped by social factors

• Global and cultural differences: differences in treatment and diagnoses of the same issue

Psychology 

• Study of thought/behavior/mental process 

• Clinical (diagnosing, treating), experimental, educational, industrial, forensic

Psychoanalysis

• psychological theory about the cause of mental disorders AND method for teaching them 

• origins in the 1870s

• developed by Freud 

  • focused on unresolved issues from childhood (relationship with mother)

• grounded in repressed unconscious conflicts and fear 

Id

• An individual’s instinctual drive

• “I want to do this now”

• operates at unconscious level 

Superego

• internalization of societal norms/morality, one’s conscious

• right vs. wrong

• “good people don’t behave this way”

Ego

• Rationality, mediate id’s drive with prohibitions of the superego

• “Let’s try to find a compromise” 

• preconscious, conscious levels 

Deterministic theory 

• governed by unconscious process, out of our control

• explanations in dreams, slip in the tongue

• Freudian slip: unintentional slip that reveals subconscious feelings

Free association 

• central technique in psychoanalysis

• patients relax and say first thing that comes to mind 

• pay attention to dreams, fantasies

• emphasis on stream of conscious rather than interaction with analyst 

Psychotherapy

• “Talking therapies”

• less intensive, less frequent than psychoanalysis 

• less regulated 

• ex. CBT

  • goal: change negative thought patterns about self/world, break relationship between maladaptive thoughts, negative emotions, unwanted behaviors 

• Typically 1 on 1, could have small groups

Psychiatry 

• medical fields focusing on study, diagnosis, treatment of mental, emotional, behavioral disorders 

• Requires specialized training (medical degree, residency, licensure, board certification)

• Strong history of devising, shaping guidelines, definitions around mental disorder

• Heavy focus on biomedical model (not always the case today)

Psychiatric nursing

• mental health professional who can assess, diagnose, treat, manage mental, emotional, behavioral disorders 

• requires specialized treatment 

Neurology 

• medical model concerned with study and treatment of disorders of the nervous system 

• brain, spinal cord, nerves 

Nursing

• spend more time with family, caregivers

• greater focus on education and outreach

clinical social work

• non-medical field 

• assessment, diagnosis, treatment, prevention of mental illness, emotional + behavioral disturbances 

• works to connect patients to community-based support

• provide therapy, services but not medications 

• requires specialized training (can vary by state)

quantitative research methods

• collecting, analyzing numeric data using statistical procedures 

  • How much? many? often?

Incidence

Number of new cases at a particular time in a population

Prevalence

Number of existing cases at a particular time in a population 

Qualitative research methods

• collecting, analyzing, non-numeric data (interviews, images, descriptions of observations)

• what do ppl feel about x? how do they understand x?

Positivist

• Knowledge is objective, measured

• scientific method

• qualitative

Interpretivist

• knowledge is socially constructed, created and transferred through experiences, etc 

• qualitative 

schizophrenia 

• prominent features: delusions, hallucinations, thought disorder, social withdrawal, self-neglect 

• prevalence: ~1.1% (50/50 male female, males often affected earlier)

• onset: early adulthood 

bipolar disorder 

• profound disturbance of mood 

  • elation (mania) or depression, symptoms depend on mood

  • mania phase often more dramatic

  • depression phase more frequent and persistent

• prevalence: 1-3% (50/50)

• onset: early adulthood

Functional, non-organic disorder

• No clear underlying disease or organic cause

• Suspected cause: psychological dysfunction

Organic disorder

• Known underlying disease or organic cause (stemming from nervous system) 

  • ex. dementia, alzheimer’s, MS, epilepsy, Parkinson’s 

Workhouses

• Houses the mad alongside other social deviants

• Goal: often to protect, serve society

Asylum

• Separation from other social deviants

• care specifically for the mentally ill 

• 1st major public asylum in London (Bedlam 1694ish)

• 1st psychiatric hospital in the US = Eastern State Hospital, Williamsburg VA

• Types of services

  • not medical treatment

  • akin to workhouses first, some custodial care (help with washing, dressing, eating)

  • use of restraint

Moral Therapy 

• Reform movement of the 18th century

• Patients need protection from life’s stressors and society

• calm, predictable environment

• moral, spiritual development, character rehabilitation

• work, social activities were forms of treatment

• humane psychosocial care, based on moral standards

• asylums away from cities, more open space

• patients free to roam 

• no physical punishment 

• compassion, kindness

• control, authority, self-discipline 

• Drs. in charge

Miasma (pollution) theory

• View that noxious air (from garbage, filth) causes disease 

Phillipe Pinel

• (1745-1826)

• French Physician and superintendent of Bicetre hospital 

• coined term “moral treatment”

• removed chains, banned physical punishment 

William Tuke

• (1732-1822)

• English philanthropist, activist, businessman, Quaker

• Friend died from poor conditions/treatment 

• established and directed private asylums but not bc of moral imperative

  • need to contribute to society now seen as part of treatment

Nellie Bly

• (1864-1922)

• Investigative reporter, social reformer 

• had herself committed into NYC’s asylum system 

• reported unsanitary conditions, physical and verbal abuse 

Dorothea Dix

• (1802-1887)

• US social reformer 

• documented conditions for insane poor, went place to place taking notes

• lobbied for more and improved asylums, more humane care, better living conditions

Benjamin Rush

• (1746-1813)

• US physician (UPenn hospital), civic leader, professor 

• founder of US psychiatry 

• published 1st psychiatry textbook in the US

• considered founder of OT

• developed tranquilizing chair to calm excited patients

• developed “gyrator” board to stimulate people

• early medical model beliefs 

  • irritation of blood vessels in the brain causes mental disease

  • perceived benefits of bleeding, purging, hot/cold baths, mercury 

Emil Kraeplin

• (1856-1926)

• German psychiatrist

• worked at an Estonian asylum —> language barrier

• studied case notes, observed fluctuations in conditions 

• made distinction between dementia praecox (schizophrenia) and manic depressive disorder (bipolar)

• pessimistic view (poor outcomes) of schizophrenia 

• his distinctions were a foundation for diagnostic psychiatry 

• early medical model beliefs 

  • mental illness due to anatomical, toxic processes

  • pioneer of psychopharmacological research and treatment (chloroform, caffeine, alcohol)

Eugen Bleuler

• (1857-1939)

• Swiss psychiatrist, sister had schizophrenia 

• lived and worked at her hospital, interacted closely with patients

• 1st to use term schizophrenia

  • more positive, realistic outlook than Kraepelin

role of a dr in an asylum

• run the facility as a superintendent (administrative, disciplinary roles)

• accountable to board of governors

• did not admit or discharge patients (local magistrate took care of that)

Changing case loads in asylums

• initially: more acute cases and some optimism (moral therapy)

• overtime: asylums become overcrowded with chronic cases

• late 19th, early 20th century: recovery rate drops due to more severe cases 

• therapeutic optimism fades, moral therapy movement starts to decline

• conditions deteriorate

Pre-medical model psychiatry

• moral —> occupational —> psychotherapy 

• some diagnosis possible based on patterns 

• emphasis on relieving suffering vs. care

• lack of effective medical treatments 

Medical model

• early-mid 1900s (medicine’s golden age)

• biological abnormality within the body 

• doctrine of specific etiology (1 disease, 1 cause)

• mechanistic/functional view of body as fixable

Changing attitudes with the medical model

Restored optimism

Positive language: “Mental patient, hospital vs. lunatic, asylum”

Malaria Treatment

• Austrian psychiatrist Wagner Juaregg (won Nobel prize)

• Infect patient with malaria parasite to kill syphilis germs 

• Effective but risky

• helped restore optimism 

Electro-Convulsive Therapy

• Rationale

  • epilepsy uncommon in schizophrenia (thought they couldn’t co-exist)

  • epileptic seizures must cause mood change

  • epilepsy must protect against mental illness

• Artificially induce seizures to treat schizophrenia 

• Italian neurologist Ugo Cerletti used weak current (safer than chemicals) to induce

• Still used today (treating depression) just with a different theory 

David Rosenhan

• (1929 - 2012)

• Psychologist and professor, Stanford

• Famous 1973 study: On Being Sane in Insane Places

Rosenhan Study #1

• 8 pseudopatients are admitted into mental hospital 

• limitations, small and nonrandom sample

• little interactions with drs

• type I error as a result (false positives)

Rosenhan Study #2

• Told officials in mental hospitals that they would get fake patients, none actually admitted

• Staff tried to determine who they were

• Type II Error (false negatives)

Stickiness of labels

Label of “mentally ill” never actually leaves a person once they leave the hospital. Still dealing with personal, legal, social stigmas 

Depersonalization

Separation of doctors and patients, lack of privacy, limited human dignity 

Anti-psychiatry movement

• Criticism for over-diagnosis, move towards biological psychiatry, care in mental asylums

  • Emerged in 1960s, 70s. Consisted largely of physicians (including psychiatrists), psychologists, patients, academics 

Symbolic interactionism

Communication of meaning through symbols (arbitrary, varying across groups)

Individuals develop a sense of self as they learn to see themselves the way they believe others see them 

People involved in symbolic interactionism

• Max Weber: founder of symbolic interactionism 

• Herbert Blumer: coined the term 

• George H. Mead: brought to the US in the early 1900s

• Erving Goffman: adherent to the method 

Erving Goffman

• (1922 - 1982)

• Wrote Asylyms

• born in Canada

• sociologist (PhD university of Chicago)

• Chicago School: exploring city as a social laboratory during period of rapid change

• studying human relations

• heavily qualitative methodology. 

Goffman’s Asylums Research

• 1 yr ethnography at St. Elizabeth’s hospital (work supported by NIMH)

  • held minor staff role, upper level staff aware of his research

• done via ethnography

  • participant observation for a much longer period of time

  • studying of society in the context

  • some informal interviews

  • researcher develops social relationship and trust with participants

Social status 

socially defined positions people occupy in society (sister, daughter, student)

Master status 

One’s dominant status that tends to define their identity 

Social group 

collections of 2 or more people who share the same activity, bound through expectations (class, club sport, sorority)

Social role

set of behaviors expected given a particular status (a student goes to class, takes notes)

Social institution

statuses and roles organized to satisfy 1 or more basic need of society 

Total institutions

large number of like-situated individuals cut off from wider society for an appreciable period of time, together lead an enclosed, formally administered round of life 

resocialization 

being taught and adopting new values, attitudes, behaviors 

characteristics of a total institution

• physical, social , cultural isolation from outside world

• work, sleep, play in same place with the same people

• loss of freedom of action 

• overlap of work, sleep, play, all aspects of life conducted in the same place 

• separation between large patient group and small group of staff

• supervision and surveillance

• rules, roles, lives organized within bureaucratic, hierarchical power system

types of total institutions

• care: orphans, blind

• quarantine/isolation": mental, sanitarium, leprosarium

• penal: criminals, those perceived as a threat

• work: army barracks, ships, boarding schools?

• religion: monastery 

mortification of the self

• loss of/diminished self-identity, self-esteem, social roles (role dispossession)

• “stripping process” at onset of admission into institution

identity kit 

props, artifacts, tools that we use to perform our identities 

moral career of the patient

regular sequence of charges in one’s way of conceiving themselves and other before, during, and after admission in an institution 

betrayal funnel 

family brings a person to hospital, person feels betrayed 

primary adjustments

• cooperatively contributing to the institution 

• acting as expected, adopting new identity and role 

secondary adjustments

• strategies to defend one’s sense of self in an institution 

• practices compromising the “underlife” of social establishments

• disruptions can range from the individual to collective, contained to the disruptive 

Lobotomy

• surgical operation involving an incision in brain’s prefrontal lobe

• 2 holes in skill, cut fibers between prefrontal and the rest of the brain in attempt to stop obsessive behaviors

• criticism start to rise: people lost personality, zombie-like effect

Egas Maniz

Portuguese neurologist (1949 Nobel Prize) - developed lobotomy procedure

Walter Freeman

American neurologist who adopted, popularized lobotomy 

Mental Hygiene movement 

• early-mid 1900s

• emphasis on public health - prevention

• asylums as a back up option

• view insanity as a disease like all others (asylums = normal hospitals, psychiatrists = normal doctors)

Clifford Beers

• criticized asylum conditions based on personal experience

• helped found national committee for mental hygiene

National Committee for Mental Hygiene

• founded in 1909

• improve quality of psychiatric education

• improve conditions in mental health hospitals

• develop preventative measures

• popularize psychiatric, psychological perspectives

• support research

Adolf Meyer

• Psychiatrist (Hopkins)

• Thought mental illness resulted from dynamic interactions between person and their environment

• Maladjustment to challenges of everyday life

• more sociomedical model 

Sociomecial model

Viewing mental health and illness as influenced by various social factors - considering patient within broader social context 

Aims of psychopathic hospitals

• examination, observation, first care of all cases

• short, intensive inpatient treatment of acute, curable insanity 

• clinical instruction/teaching

• research promotion through clinical studies 

Reality of psychopathic hospitals

• first stop before state hospitals

• increasingly indistinguishable from state hospitals

• little to no effort to treat, cure (few options)

• increasingly chronic population 

• ward therapy 

• changing commitment laws

Changing commitment laws 

• laws enacted to simplify the commitment process

• rationale: psychiatrists shouldn’t face barriers to see patients 

• temporary commitment became an attractive, convenient, preferred route into the mental hospital for both chronic and acute cases

Ward therapy

patients assigned to different parts of the hospital based on behavior instead of illness, treatment, history 

Occupational therapy in psychopathic hospitals 

inmate labor benefited the institution more than anything: essential to day-to-day maintenance, operations, cost-management 

Staff in Psychopathic hospitals

• APA suggested 150 patients per doctor

  • reality: 150-250 per dr

• often understaffed

• low quality of staff

• avg tenure = 4-5 months, no continuity of care for patients 

• sometimes employed ex-patients 

• majority of staff was simply unsuccessful in other areas 

Why don’t patients leave psychopathic hospitals?

• economic advantage of staying in the institution

• sickness of labels makes it hard to find jobs, social support

• patients might be reluctant to go

• relatives reluctant to send patient to another family

• difficult to find people willing/able to take in patient without exploiting them

• financial incentive from states (lack of resources to support external groups)

• hospitals needed steady working inmates (most likely to be able to leave)