Sociology of Mental Illness Exam 1

What are the “Three D’s” of mental illness?

1. Diagnoses

2. Deinstitutionalization

3. Drugs

Explain diagnoses

• Classification of different kinds of illnesses

• By the 5th edition of the DSM manual, there are more than 360 classifications of illnesses

Explain Deinstitutionalization

Over the last 50 years, there has been a movement to get the chronically ill out of large state-run mental hospitals into community based care

What are three major changes that led to the push for deinstitutionalization?

• Development of new medications

• New funding for outpatient treatment

• Creation of Medicaid

Explain drugs

Shift from “asylum psychiatry” to “pharmaceutical psychiatry”

Examples of how the label “mentally ill” has been used as a form of social control against minorities in different societies

• Routinely justifies inhumane treatment of a relatively powerless social group

• Viewed as having little sense of suffering

• “Drapetomania” diagnosis was used to explain the tendency of black slaves to try to flee captivity

• Husbands could easily have their wives committed

• Homosexuality

How did some cultures view mental disorders?

• Glorified mental illness as unrecognized genius

• Shasta Indians and Native People of Siberia viewed seizures as signs of supernatural powers that marked individuals for leadership

• Several Native Americans consider it natural for the bereaved to hallucinate visions and talk with dead relatives

How did Hippocrates define mental illness?

The body is out of balance and needs to be recalibrated

What are the four categories of the human body that Hippocrates believed played a role in mental illness?

1. Blood

2. Yellow Bile

3. Black Bile

4. Phlegm

What did yellow bile cause?

Too much caused anxiety and manic behavior

What did black bile cause?

Too much of this caused depression

What was Aristotle’s view of the role Greek plays had in helping promote mental health in the Greek population?

Plays were an act of catharsis, the emotions the play would trigger could help you release any pent up feelings and let them go

What are the three main categories of treatments that have occurred across human history?

1. Religious

2. Physical

3. Socioemotional

What does the term “The Great Confinement” refer to?

The mentally ill getting segregated from the general population in Europe during the 18th and 19th centuries

During “The Great Confinement”, where were the mad sent to?

1. Put onto “ships of fools” and set adrift upon European waterways

2. Public institutions like workhouses or prisons

What were some of the treatments for mental illness that were advocated by the early U.S. physician and founding father, Dr. Benjamin Rush?

• Bloodletting

• Tranquilizing chair

• Ice baths

• Shock treatments

What is a tranquilizing chair?

Immobilized by straps at the shoulders, arms, waist, and feet with a box-like apparatus to contain the head, and a bucket under the seat.

What are the two main types of shock treatments discussed in the course material?

1. Insulin injections that induce comas, then patients would be shocked awake

2. Electrocompulsive therapy

Who was Philippe Pinel and what did he contribute?

Popularized moral therapy which was the blueprint for how asylums were built and run.

What does the term “moral therapy” refer to?

Physicians at the time were beginning to realize that many mental illnesses were caused by stress and bad influences, so if the mentally insane were moved to calm settings away from stress, they could naturally recover after a 3-4 month stay.

How were the buildings of asylums influenced by moral therapy?

Asylums would be built on large expenses of land that was quiet and away from the hustle and bustle of the city. Asylums became self-sufficient towns.

Who was Dorothea Dix and why is she important?

A school teacher who took on the responsibility of teaching at local asylums, after seeing the conditions in which patients were living, she took it upon herself to advocate for better treatments and is credited with having 32 asylums built.

What were some of the kinds of new treatments for mental illness that were developed in the 20th century?

• Thorazine medication becoming widely available

• Moral Therapy

• Occupational Therapy

What are some types of occupational therapy that patients would do during their asylum stays?

• Taking care of livestock

• Gardening

• Laundry

• Kitchens

What was Thorazine?

The first widely available drug to hit the market in the 1950s. It produced a calming effect that allowed many patients to return to the care of their families and community to lessen the load of the asylums.

What were the long term side-effects for Thorazine and what is it used for now?

• Pseudoparkinsonism

• Irreversible motor impariment

• Potentially fatal neuroleptic malignant syndrome

• Now used as an anti-emetic for dogs and larger pets

What does the term “pharmaceutical optimism” mean?

Tendency of patients, doctors, and the public to overestimate the benefits of medical drugs while underestimating their potential risks, side effects, and costs.

What was life like in the U.S. mental asylums and how were the patients treated?

• The U.S. adopted the British “poor law” model and asserted that the community had responsibility to provide basic care for those unable to care for themselves

• Many mentally disturbed were held in jails and prisons similar to Europe during The Great Confinement

What were the two research activities conducted in David Rosenhan’s famous research project?

1. Students and friends pretending to be insane to get admitted to the mental institutions in order to conduct empirical research on patients and how the institutions were run

2. Pseudopatients admitted to mental asylums where the challenge to the institutions were to identify the “normals” who had been admitted (this was a trick)

What were the basic research strategies that Rosenhan used in the study and the findings of the study?

1. Empirical observation

2. They were researching two main things

   1. To test the criteria of getting admitted

   2. Getting data on what it’s like to be a patient

3. Results

   1. None of the individuals that participated in the study were ever detected by the hospital staff

What did Erving Goffman report about the experience of hospitalized mental patients in his book?

Lack of privacy and control over one’s life, he came to this conclusion using ethnographic fieldwork

What were the main characteristics of mental asylums as total institutions?

• Daily life conducted in one place under one authority

• Activities are carried out in the company of a large batch of others

• Activities are tightly scheduled by rules and officials

• A split between the staff and the patients/inmates/conscripts

What were the main ways that Goffman said people responded to, or adapted to, their treatment in mental asylums?

• Depersonalization

• Role engulfment

  • Being engulfed into the patient role and adapting to the identity

• Institutionalism

  • Lost ability to take care of themselves

• Resistance

What were the main kinds of treatments for mental illness that were used in mental asylums?

1. Immobilization

2. Hydrotherapies

3. Convulsive therapies

4. Surgeries

What are some examples of immobilization treatment?

1. Tranquility chair

2. Lunatic box

3. Utica crib

4. Being wrapped tightly into beds

What are some examples of hydrotherapies?

Heat saunas and ice baths

What are the two types of convulsive therapies?

1. Insulin (ICT)

2. Electroconvulsive therapy (ECT)

How was ICT administered?

Patients would be injected with insulin 5-6 times a week, when patients went into a coma, they would be shocked awake. This was so debilitating on the body, it could only be done on healthy patients.

What are some of the most notable surgeries performed?

1. Clitoridectomies

2. Forced sterilization connected to Eugenics

3. Lobotomies

What were the main forces that led to deinstitutionalization and the closing of large state mental hospitals?

• World War II

• State legislatures

• Civil Rights Attorneys

• Drug companies

• Social scientists

• New funding for outpatient treatment

What was the argument made in the Alabama mental hospital court case, Wyatt vs Stickney?

It is illegal to incarcerate anyone who is mentally ill without providing adequate treatment

What are some underlying themes related to women patients in Victorian mental asylums?

• Moral management

• Brutal medical treatments

• Management and regulation of periods and sexuality

• The “sexual obscenity” of female patients

• Patience and kindness to foster “ladylike” behavior

What were some activities deemed appropriate for women in Victorian mental asylums?

• Not being outside to exercise or be in the sunlight

• Cleaning, laundry, sewing

• Supplied the asylum thousands clothing garments

What kinds of treatments were women subjected to?

• Ice and cold water on the rectum

• Ice into the vagina

• Leeching the labia and cervix

• Removal of the labia

• Laundry separated into categories and assigned to patients according to the nature of their madness

What was Dr. Hugh Diamond’s goal with photography of women in asylums?

He had a fascination with the female patients, in the reading it’s also implied that he did find the madness attractive (wild), but, he mainly showed the difference between a “mad woman” and a “healed woman.” By providing props and having the women clean up, to be more feminine and “ladylike.”

Who was Frances Farmer and what was her experience with treatment for mental illness?

• A famous actress who struggled with alcoholism and depression, she was jailed and institutionalized

• Challenged the movie industry and fought for social justice

• Experienced insulin shock treatment and was routinely assaulted by staff and army men

• When she was let out, she became a human rights activist and became a talk show host on TV

Where was the Utah State Mental Asylum opened and what activity occurred there from the 70s to 90s that caused NAMI to protest?

• Located in Provo, Utah

• They would have haunted houses during the month of October where the patients were expected to act as witches, ghosts, and chainsaw murderers to scare kids

• It was protested for reinforcing negative stereotypes

• Ticket sales when back to the hospital to cover different costs

Where are patients from asylums now?

• With their families

• In Nursing Homes

  • 1.7 Million beds across america

• Incarcerated in Jails and Prisons

  • Approx. 2 million mentally ill jailed per year

  • 20-40% of prison inmates are diagnosed

What is a proposed “triangulating” diagnostic points that the professor lists in his presentation for module 4?

• Record of treatment for mental illness

• Peers think the person is mentally ill

• Starkly bizarre thoughts and behavior

Main points from the short film “The Lobotomist”

• Walter Freeman is widely considered the father of the lobotomy who wanted a quick fix to mental illnesses

• It was already suspected widely that the frontal lobe was the cause of mental illnesses

• Portuguese neurosurgeon was the first to attempt a lobotomy and received the Nobel Prize for it, which was later considered the worst mistake in Nobel history

• Failed lobotomy on Rosemary Kennedy

• Lobotomies would clip nerves of the thalamus

• Went from 250 lobotomies a year to 5000 after he simplified it down to an ice pick

• Long-term results came out and the practice was condemned

• Was stripped of his hospital license after a patient died in California

Main points from Asylum: A History

• Schedules were very strict where everything was planned out down to the minute

• Workers never got holidays, pay was low, and patients were erratic

• Before nursing homes, the elderly were brought to asylums

• Many patients released from hospitals became homeless because they did not know how to adapt to society

• Believed a 3-4 month stay in an ideal countryside would help them

• Because asylums were isolated, no one knew what was going on until some whistleblowers revealed the true nature of what was occurring