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SOC*2070 Readings Week 7.doc

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SOC 2070
Linda Hunter

Deviant Identity and Stigma Mental Disorders (Bereska Ch 7 pg. 209-234) - the concept of mental disorder consists of 2 different dimensions: (1) it entails the ex- perience of the disorder itself, the ways that the illness affects people’s thoughts, feel- ings or behaviour, (2) a social dimensions - the way others perceive and treat those with mental illness - in both dimension, mental disorder enters the realm of deviance Mental Disorder - a psychological, biological, or behavioural dysfunction that interferes with daily life (alterations in thinking, mood or behaviour) associated with significant dis- tress and impaired functioning, such as impaired judgment, behaviour, capacity to rec- ognize reality or ability to meet the ordinary demands of life Who Has Mental Disorders? - can strike anyone - some social groups are more susceptible than others - men more likely to get ASPD, substance abuse dependency disorders and conduct disorders - depression and anxiety more common in women - having a lower SES increases risk of mental illness Social Causation Hypothesis - more life stresses and fewer resources characterize the lives of the lower class, contributing to the emergence of mental disorders - this was mentioned in Merton’s strain theory, mental illness is a form of retreatism where people give up pursuing the goals and the means of attaining goals Social Selection Hypothesis - people with mental disorders fall into lower economic strata because of their difficulties in daily functioning - age is also correlated with mental illness, it is more prevalent among adolescents and young adults - biological, psychological and social factors play a role The Costs of Mental Illness - research from the more objective end shows that having a mental disorder can contrib- ute to a wide range of negative life outcomes e.g. teen pregnancy, low education levels, lower employment, physical ailments - insufficiently treated mental disorders also have a considerable impact on society - 2/3 of people who have mental disorders are never treated because of a lack of ser- vices, perceptions of treatment being inadequate, discomfort with self-disclosure, per- ceptions of stigmatization - coming from a more subjectivist perspective, cost-of-illness estimates should be viewed with some level of caution - these estimates are not just a product of biochemistry, it interacts with economics and social norms - these estimates fail to account the many ways individuals with mental disorder contrib- ute to society as parents, neighbours, and volunteers Controlling Mental Disorder: Perceptions, Stigmatization, and Treatment - the reactions of other people are an integral part of the experience of having a mental disorder Stigmatization and Perceptions of Mental Illness - mental illness in the media is portrayed in an exceedingly negative light - media imagery has an impact on people’s own perceptions of mental illness - public attitudes toward mental illness are negative as well - people with mental disorders are perceived as being unpredictable, violent, dangerous and uncontrollable - these attitudes are also found in the medical community - at a personal level, stigmatization has a negative impact on the quality of life of people with mental disorders - the sense of loneliness and isolation that accompanies social rejection can amplify psychological symptoms, actually making mental illnesses worse - simply being aware of negative social perceptions of mental illness lowers self-esteem and increases feelings of demoralization - this can contribute to self-stigma and consequences similar to those in labeling theory - stigmatization affects program and policy development - policies and programs that do exist are embedded with 2 different paradigms of mental disorder - disease and discrimination Discrimination Paradigm - proposes that the experience of mental illness is primarily one of prejudice, discrimination and stigmatization, policies constitute forms of resis- tance to stigmatization Disease Paradigm - proposes that the experiences of mental illness is primarily one of experiencing illness - the signs and symptoms of the disorder, which subsequently hin- der the individual’s effective functioning and quality of life, policies revolve around the medicalization of mental disorder The Medicalization of Mental Disorder - psychiatrists determine which thoughts or behaviours constitute mental illness and then incorporate that into the DSM - these particular thoughts and behaviours are deviant because they cause significant distress and impairments in daily functioning - the provide measures of social control - treatments for mental disorders The History of Social Control of Mental Illness - mental illness was seen as demonic possession and treatment was physical torture - science took over and “madhouses” were created for those with mental illnesses in the 18th century, the purpose was not treatment or rehabilitation but simply warehousing the disordered - in the late 19th century, madhouses were replaced by asylums which included some treatment - this was the era when the medicalization of mental illness came to predomi- nate in Wester cultures - asylums later to be known as mental hospitals or psychiatric institutions in the 1950s - treatment in psychiatric institutions was almost barbaric - e.g. lobotomies - in the 1950s, people began to wonder how placing people in institutions where they were dehumanized and isolated could help recover from mental illness - this led to deinstitutionalization - the social control of mental illness in community- based programs rather than in institutions Treating Mental Illness Today - medicalization s offers an extensive range of treatment options - psychotherapy, cogni- tive-behavioural therapy, medication, occupational therapy and social supports - the combination of medical support and psychosocial support is particularly effective for even the most severe mental illnesses - as a result of deinstitutionalization, hospitalization is reserved for only the most severe cases of mental illness, and even then is perceive as a short-term intervention - hospitalization is primarily voluntary The Legacy of Deinstitutionalization - it was perceived as an evolution in treatment that would bring nothing but benefits - treatment in the community is generally more effective in the long term and less expen- sive - it emerged during an era when the image of the “ideal” family was everywhere - one of the key assumptions of deinstitutionalization is shifting the care of people with mental illnesses into the community - was perceived as non-problematic because it was assumed that they would have loving families to help them - many do not have that type of network - one of the biggest problems that has plagued the deinstitutionalization movement is funding for community resources - having a place to live can be a considerable challenge for some people with mental disorders - being socially typed as homeless has other consequences - the rate of criminal activity among people with major mental disorders is higher - criminality adds another dimension to the social typing process with consequences - as the mental health care system contract, the prison population expanded - another problem is the reduction in hospital services for those people who may benefit form such services - unintended negative consequences of deinstitutionalization include homelessness, criminality, suicide, substance abuse and a lower quality of life The Deviance Dance: Resisting Stigmatization, Inadequate Care, and Psychiatry Itself - policies and programs addressing treatment and support available to people with men- tal disorders arise from the disease paradigm which emphasizes ameliorating symp- toms that distress and impair individuals’ functioning - other policies and programs emerge out of the discrimination paradigm which empha- sizes the role that stigmatization plays in the daily experiences of people with mental ill- nesses - these programs and policies constitute part of the “deviance dance” - people resisting and fighting back against the stigmatization of mental illness and the social rejection or discrimination faced by individuals with mental disorders Resisting Stigmatization - many nations have instituted legislation and policies prohibiting discrimination against people with mental disorders in housing, employment, health care etc - medical campaigns to reduce misconceptions - self-help groups for people with mental illnesses - governments, the medical community and self-help groups are also involved in the re- sistance to inadequate care for individuals with mental illnesses Resisting Inadequate and Insufficient Care - self-help groups lobby governments for better funding and improved services - support groups provide detailed information about new medications - the medical community is continually engaged in research on new and improved treat- ments and monitor the professional behaviours of their members - groups like the World Health Organization integrate their anti-stigmatization efforts with efforts to increase government funding for mental health and improve the training of mental health professionals - trying to change aspects of the social typing process - working toward removing the label of “crazy” - trying to improve the ways that persons with mental disorders are treated in the mental health system Resisting Medicalization - can occur at a number of levels, from criticisms of the DSM to criticisms of the daily practices of mental health professionals Criticizing the DSM - much criticism has been based on the inclusion of particular disorders in the DSM (ho- mosexuality) - more recently, controversy has emerged over ADHD - other critics express concerns over the DSM itself and the power it holds - suggest it is just as much a political document as a medical document Being Sane in Insane Places: Criticizing Mental Health Professions - influence of social factors and other biases on psychiatric diagnoses - in one study, 8 research associates attempted to have themselves admitted to psychia- try hospitals claiming they had been hearing voices - underlying assumption was if their sanity was not detected, it would indicate that the salient characteristics involved in psychiatric diagnosis reside more in the environment than the individual - all associated were admitted with the diagnosis of “schizophrenia”, once admitted they began acting normally and tried to get discharged - the psychiatrists never detected the pseudo-patients sanity and they were discharged with diagnoses of “schizophrenia in remission” - other patients detected the sanity of pseudo-patients - normal behaviours were overlooked or misinterpreted through the lens of the diagnosis of mental illness - one factor that might contribute to misdiagnosis is the desire of mental health profes- sionals to err on the side of caution - it may be safer to mistakenly label a person as ill than to mistakenly label an ill person as healthy - lack of interaction between mental health professionals and patients could explain the misdiagnosis - another reason is the power that a diagnosis of mental illness carries - the label provides staff with a schema or mental framework which affected their inter- pretations of the pseudo-patients’ behaviours - the conclusions of this study were that the salient characteristics in the diagnosis of mental illness lie more within the social context or the environment, than within the indi- vidual - his research showed that even mental health professionals can’t tell the different be- tween the sane and insane - he also described the dehumanizing treatment that patients in psychiatric hospitals fre- quently faced e.g. being ignored by staff, prescribed large numbers of pills - this research illustrates important aspects of labeling theory - also pointed to the unintentional influence of social factors on diagnostic processes The Role of Social Factors in Diagnosis and Treatment - sex and race both influence the diagnosis - women more likely to be diagnosed with depression - we have looked at resistance to the medicalization of mental disorder in 3 ways: (1) the ways that some normals social behaviours have been deviantized within the DSM,(2) broader critiques against the DSM, (3) inaccuracies and biases that occur in the daily practices of mental health professionals - one last form of resistance criticizes the concept of “mental illness” itself as being a fals
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