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SOCI 377 (1)
Eran Shor (1)

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McGill University
Sociology (Arts)
SOCI 377
Eran Shor

Deviance readings: Week 11 The Myth of Mental Illness, Thomas S. Szasz Today mental illness is widely regarded as the cause of innumerable diverse happenings (similar to such explanatory concepts as deities and witches, etc) Goal: describe the main uses to which the concept of mental illness has been put, argue that it has outlived it‟s usefulness and that it now functions merely as a convenient truth. Mental Illness as a Sign of Brain Disease If mental illness is a sign of brain disease this implies that people cannot have troubles from anything but disease. All problems in living are attributed to physiochemical processes Mental illnesses are thus regarded as basically no different than all other diseases 2 fundamental errors with this: 1. A person‟s beliefs cannot be explained by a defect or disease of the nervous system 2. Epistemological: an error pertaining not to any mistakes in observation or reasoning, as such, but rather to the way in which we organize and express our knowledge. a. The statement “x is a mental symptom” involves rendering a judgment b. The notion of a mental symptom is tied to the social context in which it is made Mental symptoms definition: a patient‟s communications about himself, others, and the world about him SUM: What they mean is that people labeled as mentally ill suffer from diseases of the brain and it would be clearer if they said that instead. Mental Illness as a Name for Problems in Living Implicit in this view (of mental illness as the cause of human disharmony) that social intercourse between people is regarded as something inherently harmonious, its disturbance being due solely to the presence of “mental illness” in many people. Concept of illness implies deviation from some clearly defined norm The norm from which deviation is measured whenever one speaks of a metnal illness is a psycho-social and ethical one YET the remedy is sought in terms of medical measures. What defines the norms and hence the deviation? 2 basic answers 1. May be the person himself who decides he is deviant 2. May be someone other than the patient who decides the patient is deviant  Whose agent is the psychiatrist? This changes the ethical concerns The Role of Ethics in Psychiatry  Anything that people do takes place in a context of value  By making the practice of medicine neutral in regard to some specific issues of value need not, and cannot, mean that it can be kept free from all such values. o It does make a difference what the psychiatrist‟s socioethical orientations happen to be; for these will influence his diagnosis/treatment of the patient. o Also, people seek psychiatric help in accordance with their social status and ethical beliefs.  What is intended by the idea that mental illness is some sort of disease entity is that it can somehow be transmitted to others o No support for this idea o Author believes that what we call mental illness are for the most part communications expressing unacceptable ideas.  This disease model doesn‟t accept that o Human relations are inherently fraught with difficulties and to make them even relatively harmonious requires much patience and hard work. Choice, Responsibility, and Psychiatry Mental illnesses do not exist BUT the social and psychological occurrences to which this label is currently attached do exist. Authors Aim: phenomena now called mental illnesses should be looked at afresh and removed from the category of illness and regarded as expressions of a man’s struggle with the problem of how he should live. Man suffers a burden of understanding and this burden is to be expected. Our only rational means for lightening it is more understanding. Conclusions  The notion of mental illness now functions as a convenient myth.  The role of all these belief-systems was to act as a social tranquilizer.  Life for most people is a continuous struggle.  It is the making of good choices in life that others regard, retrospectively, as good mental health o NOT that mental health automatically insures the making of right and safe choices in one‟s conduct of life  What we have are problems of living. On Being Sane in Insane Places, D.L. Rosenhan Normality and abnormality are not universal  What is normal in one culture may be abnormal in another DSM/APA view:  Patients present symptoms, those symptoms can be categorized, and, implicitly, that the sane are distinguishable from the insane.  Psychiatric diagnoses, in this view, are in the minds of the observers and are not valid summaries of characteristics displayed by the observed. o Diagnoses betray little about the patient but much about the environment in which an observer finds him 8 sane people gained secret admission to 12 different hospitals. Pseudopatients and Their Settings  Varied group, some studying psych or in health profession, some not.  All employed pseudonyms, kept everything else the same  Hospitals were located in 5 different states on east and west coast  At admission the patients said they heard voices, often unclear but sometimes saying “empty”, “hollow”, “thud”  Voices were unfamiliar but of same sex as patient  Beyond alleging the symptoms and falsifying name, vocation, and employment, no further altercation of person, history, or circumstances were made.  Immediately after admission to the psychiatric ward the pseudopatient ceased simulating any symptoms of abnormality. The Normal are Not Detectably Sane  The pseudopatients were never detected  Each was discharged with a diagnosis of schizophrenia “in remission”  Once labeled schizophrenic the pseudopatient was stuck with that label  Uniform failure to recognize sanity o Cannot be attributed to  Quality of the hospital because they varied in quality and some were considered excellent  Length of stay, which varied from 7-52 days. Avg 19 days  Fact that they weren‟t behaving sanely  Quite common for other patients to “Detect” the pseudopatients sanity o Possible causes  Physicians operate with strong bias toward type 2 error  More inclined to call healthy person sick a sick person health Another experiment  Staff at hospital informed that in next 3 months a pseudopatient would be arriving.  Staff rated each patient with a 10 point-scale reflecting confidence that a patient was a fake o 41/193 patients were alleged, with high confidence, to be pseudopatients by at least one member of the staff o 23 were considered suspect by at least one psychiatrist o 19 were suspected by one psychiatrist AND one other staff member o No pseudopatient was actually presented during this period  This is instructive: o Tendency to designate sane people as insane can be reversed when the stakes are high o But what of the 19 suspected to be sane by 1 psychiatrist and 1 other staff member?  Were they truly sane or were the staff making more errors of the first sort – calling the crazy “sane”?  Any diagnostic process that can have such massive errors cannot be very reliable!!! The Stickiness of Psychodiagnostic Labels  Elements are given meaning by the context in which they occur  Once a person is designated abnormal all of his other behaviors and characteristics are colored by that label  The perception of a pseudopatients‟ circumstances was shaped entirely by the diagnosis  Even the patients‟ note taking was characterized as suspicious “writing behaviour”  Notes taken by pseudopatients are full of (non-pseudo) patient behaviours that were misinterpreted by well-intentioned staff  The label endures well beyond discharged, with the unconfirmed expectation that he will behave as a schizophrenic again.  This label also affects relatives and friends, as well as the patient himself, as a self-fulfilling prophecy  It seems much more useful to limit our discussions to behaviors, the stimuli that provoke them, and their correlates. The Experience of Psychiatric Hospitalization The mentally ill are society‟s lepers This attitude affects the general population as well as health professionals  Staff and patients are very segregated – as if the disorder is catching  Staff spend most of their time in “the cage”  Percent of time spent outside cage: Attendants: 11.3  # of times left cage: o Daytime nurses: 11.5 o Nighttime nurses: 9.4 o Physicians (emerged onto ward): 6.7  Most power = least time with patients Powerlessness and Depersonalization Powerlessness:  Patients are deprived of many legal rights by dint of psychiatric commitment o Ex: freedom of movement, loss of credibility, privacy, etc Depersonalization:  Pseudopatients had the sense they were invisible or at least unworthy of account  Initial examinations sometimes in semipu
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