SOC 224 Mental Health + Illness

Mental Disorders

“Alterations in thinking, mood or behaviour associated with significant distress + impaired functioning, judgments and behaviours”

1. Experience of the disorder itself: how it might effect our thoughts, feelings + behaviours

2. How people perceive + treat those with mental illnesses

Difference comes from magnitude + duration

Prevalence

Canada”

• 20% of adults have a mental disorder

• 80% of adults know someone with a mental disorder

• 50% will experience a mental disorder by 40, 65-70% by age 90

Worldwide:

• 450 million people at any given time

• 1/3 of all disabilities

Mental Health commission of Canada 2013

#1: Mood + anxiety Disorders: 11.7% of population

#2: Substance abuse disorders: 5.9% of population

#3: Cognitive impairment + dementia: 2.2% of population

Variations in Mental illness

Significant variation in prevalence/type of mental illness across social groups

• reveals how social factors can contribute to mental disorders

• Interplay of economic, environmental, individual attributes, cultural, political + social factors to mental illness

Rates of Mental Disorder: Gender

Equal overall rates for women + men

Differences:

• men: antisocial personality disorder, substance abuse disorder + conduct disorder (3x more common)

• Women: depression + anxiety (common mental disorders); connects to sociocultural factors

Rates of Mental Disorder: SES

Greatest predator of mental illness + physical health

Higher rates among lower SES groups

2 hypothesis: social causation + social selection

Social causation hypothesis

More life stresses + fewer resources characterize the lives of lower class: contributing to the emergence of mental disorders

• potential ties to strain theory; disconnect between goals + means to attain them

Social selection hypothesis

People with mental disorders fall into lower socioeconomic strata because of difficulties of daily functioning

Rates of Mental disorder: age

Higher rates in adolescents/young adults (first emerges during this time of life)

• biological factors

• Social stresses

• Psychological factors: identity formation, difficult transition period, making “adult” choices

• University pressures

Variations in risk to youth

Impoverished youth: ex. Houselessness

LBGTQ2+

Fleeing conflict/trauma + refugees

Indigenous youth:

• considerable variation in risk

• 90% of indigenous suicides - 10% of communities

• Attawapiskat: severe ongoing mental health crisis

Social Control of mental illness

Measures can have both negative + positive outcomes

Primary measures of social control:

• stigmatization

• Medicalization

Stigmatization

Negative attitudes haven’t improved: even among mental health professionals

Discrimination in employment, housing + health care

• media = portraying them as violent, evil, dangerous + unpredictable

Personal experiences aren’t necessary for (-) consequences: mere knowldge decreases self esteem, increases feelings of demoralization (Self stigma)

• internalization of label “mentally ill”

• Less likely to seek or adhere to treatment

Medicalization

Stigmatization of mental illness in society → lack of funding (enacts social control)

Treatments have changed:

• religious rituals (exorcisms)

• Family care

• “Madhouses”: “society needs to feel safe”; placing people in a warehouse

• Asylums: Medicalization began: trained to conform to society’s norms

• Psychiatric care: barbaric practices

Total Institutions

Erving Goffman

• a place of residence + work where a large number of like situated individuals, cut off from the wider society for a period of time, together lead an enclosed formally administered round of life

Exercise total control over their inmates

Punish, brainwash, re-socialize uncooperative citizens (struggle to make it on own after discharge)

All aspects of life, conducted in same place + under same single authority

Deinstitutionalization

Began in 1960s

Treatment within communities > institutions (push to socially control those with mental illnesses)

Has improved the lives of many people

• quality of life

• Improved functioning

• Medical superiors + psychosocial supports = critical

Many have also fallen through the cracks

Effective deinstitutionalization requires

Supportive family network

An accepting community

Adequate community resources: but there’s a lack of

A place to live

• responsibility largely falls on the family

Insufficient deinstitutionalization resources

Can lead to:

• homelessness: 25-50% of people experiencing have mental disorders (unable to take meds + criminality)

• Criminality: 700 mental health beds in CJS vs 1500 inmates who require care

Crime + Mental illness

Disproportionate amount of inmates suffer from mental disorders + severe mental disorders

Adds an additional later of stigma + more difficulties

Oftentimes: blocked from accessing community resources

• hydraulic relationship between mental health care system + CJS

Vincent Li

Committed a greyhound bus beheading: stabbed a man then beheaded + cannibiliazed them

Not criminally responsible by reason of mental disorder (NCRMD)

NCRMD

Less than 1% of cases deemed so: 3 different levels + often multiple different mental illnesses at play at the same time

Low chance of relapse

Those who need more help more likely better with health system than judicial

9% = serious violent crimes

Victims = often known to the person

Deviance dance + Resisting stigmatization

Embedded within the discrimination paradigm: emphasizes role played in daily experiences of people with mental illnesses

Formal level + informal level

Resisting stigmatization: formal level

Public education

Human rights legislation

• how it leads to discriminatory practices against people with mental illnesses

Resisting stigmatization: informal level

Stigma management techniques: resisted via informal ways

• trying to pass: hide disorder

• Dividing social worlds: managing who knows/doesn’t about illness

• Deflecting: distancing self from the label or denying it

• Challenging: fighting back/educating others or trying to compensate

Deviance dance + resisting Medicalization (DSM)

Debates over categories of mental disorder

• problems with criteria

• Ex. ADHD: increase in diagnosis for adults, boys far more likely to be diagnosed + many (-) life outcomes associated, over diagnosis in children?

Role of power in the creation + revision in DSM

• who writes criteria (what to include/exclude)

• Role of economics/money

Rosenhan (1973)

1 of first to document the influence of social factors + other biases in psychiatric diagnoses

8 pseudo patients institutionalized with schizophrenia

Released with psychiatric diagnosis

Other patients detected the “sanity” of pseudo patients (but psychiatrists couldn’t)

Rosenhan Conclusion

Factors outside of the individual influence diagnosis

Psychiatric diagnosis is precarious

Perception

Ability to see, hear or becomes aware of something through the senses

• our way of regarding, understanding or interpreting something: a mental impression

Disposition of personality or lived experience