The Sociology of Mental Illness

  • The Sociology of Mental Health
    • Look at the social aspects of mental illness AND mental health.  This includes:
    • A few examples of how mental illness is investigated sociologically:
    • Environmental influences on mental health
      • If you live in a poor neighborhood, your psychological distress can increase
      • Due to higher crime, higher police surveillance etc
    • Social/Cultural differences in conceptions of good/bad mental health
      • What’s considered a mental illness is different in the US
    • The lived experience of having mental illness 
      • What it's like to have schizophrenia in a rural environment
    • How mental illness/health is portrayed in media, online, fiction, etc!
    • And of course…much more
  • Durkheim: Suicide
    • Durkheim was a structural functionalist
    • Argued structural/social forces influence suicide rates
    • Argued that this was the trend for mental health as well
    • Most people thought that mental illness originated within the person itself
    • Argued even “the sane” could commit suicide.
    • Social influences in suicide patterns: 
    • Religion
    • Marital Status
    • Economic Forces
    • Suicide was linked to social integration
    • When countries are at war, they are unified since they are seen as going against a common enemy
      • There can be negative effects such as racism and ethnocentrism
      • But suicide rates decline
    • People who are married have lower rates of suicide
    • Looked at different religions
      • Tightly knit religions with more rules allow for less deviation which leads to lower rates of suicide
  • An Intro to Social Constructivism
    • A sociological lens that looks at phenomena that are shaped by the social forces present in the time and place of its creation. Shapes how we view said phenomenon.
    • Look at it in a certain context (1800s vs 2020s)
    • Mental illness categories change across time & place
    • These are not considered illness today:
      • “Hysteria” in women
      • Increased emotions, arguments etc.
      • Some people say that elements may be linked to actual mental illnesses  (etc. bipolar depression)
      • “Homosexuality” and “gender identity disorder” 
      • 1973: Homosexuality removed
      • Symptom: being afraid of the opposite sex
      • Gender identity disorder: still considered a diagnosable mental illness
        • Argument: Having it in the Diagnostic and Statistical Manual allows doctors to treat it and bill for it
        • Having it in the DSM could promote stigma among people who experience gender dysphoria
  • Erving Goffman: Social Constructionism
    • Could be described as a social constructivist
    • Mental illness is socially constructed  (controversial oops)
    • Context: 1950s, didn’t know a lot about mental illness 
    • how staff view the patients
    • how patients view themselves.
    • Famous for work on asylums
    • Before deinstitutionalization
      • Before they were allowed to go into mental health clinics instead of being hospitalized 
      • Found hierarchies
      • Argued that mental institutions were total institutions
        • Institutions is which you enter and it regulates your everyday life
        • Yourself, your behavior etc.
        • Eg: monasteries, nunnery, etc.
        • Your old way of thinking is cut off and you are resocialized to become a socially acceptable self
        • \n
    • Medicalized lens
    • Medicalization: a process by which human problems come to be defined and treated as medical problems. 
      • Everyday behavior and past events are pathologized
      • Past events used against patient to justify their mental illness even if the events were symptoms of mental illness
      • Normal behavior was pathologized
        • If you go into an institution and are used to doing whatever you want, being regulated is difficult
    • Label becomes permanent
    • Goffman defines the stigma of mental illness to be a “blemish of individual character in terms of mental illness” (Goffman 4)
    • He said that the stigma of mental illness is a status that sticks
      • Once you’re labeled as mentally illness you will always be viewed as such
      • Past self is over written by mentally ill self
      • Affects how other people view you in society and how you view yourself
      • May result in negative treatment, assumptions of incompetency
      • Stigma in hospitals
      • Hierarchies
        • Physician on top, patient on bottom
        • Patients ordered based on compliance with treatment
        • If problem patient, then at the bottom of hierarchy
          • Can’t do a lot
          • Very limited freedom
        • If higher level floor: more privilege
  • A more current example of stigma
    • 2013 research study
    • Asked people how likely they would be able to do something with a person based on a vignette (brief description of a fictionalized event)
      • 60% of people said that they wouldn't want someone with depression to marry into family
      • 90% wouldn’t want some with a substance dependence to marry into
      • 30% were unwilling for their child to be friends with a child with depression
  • Rosenhan Experiment
    • Famous researcher in terms of mental illness
    • Aware of Goffman’s work
    • Went into a mental institution as a pseudopatient
    • Faked initial symptoms of schizophrenia
    • Said that they were hearing voices in their heads
    • Stayed till they were cleared to leave
      • Left in 6-7 days
    • Did not exhibit symptoms once in facility
    • Staff justified diagnosis based on reinterpreting normal behavior
    • Used real life history to justify schizophrenia
    • Eg: close to mom not dad
      • Apparently ambivalent relationship that is a symptom
    • Only actual patients saw through the act!
    • Staff attributed behaviors to mental illness
    • Such as note taking and bad moods
    • “Having once been labeled schizophrenic, there is nothing the pseudopatient can do to overcome the tag. The tag profoundly colors others' perceptions of him and his behavior.”
  • Constructed Meanings (models to explain how people understand causes of mental illness)
    • Dictates how people react to mental illness
    • Most people believe in the overlap on some models
      • Determines how people react
      • Can change between conditions (eg: depression vs schizophrenia)
    • Biomedical model
    • Mental illness as originating within the physical body
      • Treat body = treat illness
    • Body over the social
    • Social context/life events
    • What happened in your life or past
      • Goffman and Rosenhan
    • This happened in the past, causing this to happen
    • OR this is CURRENTLY happening, causing this
    • Personological
    • Doesn’t even see it as a condition but just a weakness in character
    • It’s my (your?)  fault - something is wrong with me (you) as a person
    • Cultural
    • Specific to each culture/country
    • Not everything is westernized or medicalized
  • Social Construction and Content Analysis
    • Content analysis:  Researchers interpret information/content from cultural artefacts, identifying  themes and patterns. May make suggestions on how this influences the audience (if there is one) and how they perceive what is being presented.
    • Shapiro 2016 - Looked at top selling video games from 2011 - 2013 and how mental illness was depicted (and the themes they followed)
    • Made several categories based on tropes found by other studies: ex. “homicidal maniac,” “zoo specimen”,  “female patient as seductress” wasn’t found, etc.
    • Found most representations were often negative and characters were minor in plot/game relevance.
    • Leistedt & Linkowski 2014 
    • Looked specifically at villains in movies (over the course of 100 years) and how these representations align with historical conceptions of mental illness and psychopathy as well as what was happening at the time
      • When Ted Bundy came into media, that trope became popularized
    • “Early representations of psychopaths in film were often created with a poor or incomplete understanding of psychopathic personalities… The public’s overall unfamiliarity with mental illness or psychological disorders led them to accept this depiction and even perceive it as almost ‘realistic’.” (Leistedt and Linkowski 2) 
      • Applicable to early cases
      • If you have a low education in terms of mental illness and your only source of education is media, you may believe
  • Direct to Consumer Advertising
    • Common Narrative
    • Introducing Patient’s Problem → Go see you doctor by scheduling a doctor’s Visit → Proposed as solution
    • Important to note which symptoms are highlighted (not as serious) and which are diminished (fatal ones)
      • Oversimplified the disease
      • Most ads only have women (to make the medication more appealing)