Textbook Notes (363,508)
Canada (158,391)
Sociology (1,471)
SOC446H5 (17)

Reading Notes

29 Pages
Unlock Document

University of Toronto Mississauga
Nikolay Shchitov

Reading Notes Sept 16, 2013  The Myth of Mental Illness 1. Please elaborate T.Szasz’s idea: ‘there are diseases of the brain, not of the mind’. o He is saying that we cannot label mental illness because we know about  diseases of the brain, but we do not know anything about the domain of  the mind. Diseases of the brain have physical symptoms, whereas diseases  of the mind are just ‘problems in living’ 2. What are ‘the two fundamental errors’? (p. 113) o The view that diseases of the brain have physical symptoms whereas  diseases of the mind should have mental symptoms. o First, physical symptoms can be associated to a neurological defect, a  disease of the skin or bone. Problems with thinking/living cannot be  associated to a defect or disease of the nervous system o The second error is epistemological. It is an error pertaining not to any  mistakes in observation or reasoning, but rather to the way in which we  organize and express our knowledge. The error lies in making a  symmetrical dualism between mental and physical symptoms, a dualism  which is merely a habit of speech and to which no known observations can  be found to correspond. 3. Why is ‘the concept of mental illness unnecessary and misleading’? o For those who regard mental symptoms as signs of brain disease, the  concept of mental illness is unnecessary and misleading. For what they  mean is that people so labeled suffer from diseases of the brain; and, if that  is what they mean, it would seem better for the sake of clarity to say that  and not something else. 4. Please analyze the meaning of the concept ‘problems in living’. o The norm from which deviation is measured whenever one speaks of a  mental illness is a psycho­social and ethical one  Yet, the remedy is sought in terms of medical measures which – it  is hoped and assumed – are free from wide diffs of ethical values o Man’s awareness of himself and of the world about him seems to be a  steadily expanding one, bringing in its wake an ever large burden of  understanding. This burden is to be expected and must not be  misinterpreted. 5. Please explain how the practice of medicine is intimately tied to ethics. o Issues such as birth control, abortion, suicide, and euthanasia are ethical  debates in the field of medicine 6. Please summarize the text under subtitle CHOICE, RESPONSIBILITY, AND  PSYCHIATRY (p. 117 – 118). What is the main argument here? o We cannot hide behind the skirt of an all­explaining conception of mental  illness. Man must be able to take responsibility for his actions instead of  blaming his problems on issues such as mental illness. •  “Is there a such thing as mental illness?” o Argues that there is not • What is meant when it is asserted that someone is mentally ill? o Believes that this notion now functions merely as a convenient myth • For those who regard mental symptoms as signs of brain disease, the concept of  mental illness is unnecessary and misleading o For what they mean is that people so labeled suffer from diseases of the  brain; and, if that is what they mean, it would seem better for the sake of  clarity to say that and not something else • Mental illness as a name for problems in living o Mental illness – as a deformity of the personality, so to speak – is then  regarded as the cause of the human disharmony o The concept of mental illness, whether bodily or mental, implies deviation  from some clearly defined norm o The norm from which deviation is measured whenever one speaks of a  mental illness is a psycho­social and ethical one  Yet, the remedy is sought in terms of medical measures which – it  is hoped and assumed – are free from wide diffs of ethical values  The def of the disorder and the terms in which its remedy are  sought are therefore at serious odds with one another  Since medical action is designed to correct only medical  deviations, it seems logically absurd to expect that it will help  solve problems who very existence had been defined and  established on nonmedical grounds • The role of ethics in psychiatry • Aim is to suggest that the phenomena now called mental illnesses be looked at  afresh and more simply, that they be removed from the category of illnesses, and  that they be regarded as the expressions of man’s struggle with the problem of  how he should live Psychiatry and the control of dangerousness: on the apotropaic function  of the term “mental illness” • We attempt to ‘incarcerate’ mentally ill people in psych hospitals and call it  ‘treatment’, whereas it is just the same as imprisoning someone o Psychiatrists do this by ‘declaring the offending individual mentally ill an  dangerous to him or herself or others’ o This declaration allows family members, courts, and society as a body, to  separate themselves from individuals who exhibit, or are claimed to  exhibit, certain behaviours identified as ‘dangerous mental illnesses’ o Why are psychiatrists expected to prevent suicide by depriving the  ‘suspect’ of liberty? o The right to kill oneself is the supreme symbol of personal autonomy  Psychiatry, as an arm of the state, prohibits the act and ‘treats’ it as  if it were a symptom of an underlying disease  The deprivation of liberty intrinsic to such an intervention is  viewed not as a human rights violation but as a human rights  protection   Psychiatric diagnosis, psychiatric power and psychiatric abuse 1. What is ‘psychiatric power’? o Is related to the political power intrinsic to the social role of the  psychiatrist in totalitarian and democratic societies alike o Psychiatrists have the power to assign the role of mental patient to  persons against their will 2. Why is the political abuse of psychiatry not merely possible but inevitable? o Psychiatric power makes the political abuse of psychiatry not merely  possible but inevitable o Because of the power that psychs have to assign the role of mental patient  to persons against their will o 3. Why is the infantilization of ‘insane’ wrong conception?  o 4. What is the difference between psychiatric and ‘ordinary’ medical patients? o Medical patients must consent to treatment • The fact that psychiatric patients are admitted involuntarily changes the nature of  the relationship b/w the psychiatrist and his patient, as compared to other doctors • When psychiatrists deprive innocent persons of freedom (civil commitment), they  abuse the right to liberty; and when they excuse persons of crimes (diminished  capacity and the insanity defence), they pervert the principle that persons are  moral agents who should be held accountable for their actions Ideology and Insanity (Thomas Szasz) 1. What are the differences between mental and physical diseases and between  medical hospital and psychiatric hospital? a. Closely resembles that of the criminal sentenced to imprisonment b. There is evidence that, from the subject’s pov, confinement in a mental  hospital is more unpleasant than imprisonment in jail 2. What the difference between power position of medical patient and psychiatric  patient? a. Consent  3. Please peruse p. 112 and explain what the meaning of the phrase: Do we want to  be free men or slaves? a. Mental hospitals are slavery disguised as therapy.  b. Do we want to be free men or slaves? i. If we choose freedom, we cannot prevent our fellow man from also  choosing to be free; whereas, if we choose slavery, we cannot  permit him to be anything but a slave 4. Please briefly describe 4 types of “evidence”. (p. 115 – 117). a. Medical evidence i. Persons said to be suffering from such disorders are social deviant  or inept, or in conflict with inds, groups, or insts. Since they don’t  suffer from disease, it is impossible to ‘treat’ them for any  sickness. ii. The commitment of persons suffering from ‘functional psychoses  serves moral and social, rather than medical and therapeutic  purposes. b. The moral evidence i. The individual ‘owns’ his body and his personality. The physician  can examine and treat a patient only with his consent. c. The historical evidence i. Madness or mental illness was not always a necessary condition  for commitment. d. The literary evidence i. In no literary piece has commitment been portrayed as helpful to  the hospitalized person; it is always depicted as an arrangement  serving the interests antagonistic to those of the so­called patient. 5. Why did T. Szasz compare treatment of mentally ill to slavery? (p. 123  ­ 139) a. They are both a method of exerting power over a group of people. b. Existing social insts and practices, especially if honoured by prolonged  usage, are generally experienced and accepted as good and valuable. c. Similarities b/w slavery and inst psychiatry i. Today, the existence of mental patients is taken for granted in the  same way as the ‘existence’ of slaves was taken for granted (this is  their natural state and they are meant to be subdued) ii. Parallel b/w master and slave vs institutional psychiatrist and  involuntarily hospitalized patient 1. In each instance, the former member of the pair defines the  social role of the latter, and casts him in that role by force iii. Basic assumption of American slavery: Negro was racially inferior  to Caucasian iv. Basic assumption of institutional psychiatry: mentally ill person is  psychologically and social inferior to the mentally healthy v. Perspective of paternalism has played an imp role in justifying  both vi. Psychiatrists now create involuntary mental patients just as  slaveholders used to create slaves is likely to lead to a cleavage in  the psychiatric profession, and perhaps in society generally,  between those who condone and support the relationships b/w  psychiatrist and involuntary mental patient, and those who  condemn and oppose it (138) The Insanity Plea and the Insanity Verdict • M’Naghten rule: asserts that to establish a defense on the ground of insanity it  must be clearly proved that at the time of committing the act the party accused  was labouring under such a defect of reason, from disease of the mind, as not to  know the nature and quality of the act he was doing, or, if he did know it, that he  did not know he was doing what was wrong. • Durham Rule: an accused is not criminally responsible if his unlawful act was the  product of mental disease or mental defect • Judge Kaufman’s ruling: a person is not responsible for criminal conduct if at the  time of such conduct as a result of mental disease or defect he lacks substantial  capacity either to appreciate the wrongfulness of his conduct or to conform his  conduct to the requirements of the law • If an individual is pressed into the role of mental patient against his will – for  example, by being committed to a mental hospital – then his social role most  closely resembles that of the criminal sentenced to imprisonment • There is evidence that, from the subject’s pov, confinement in a mental hospital is  more unpleasant than imprisonment in jail • Excepting death, involuntary psychiatric hospitalization imposes the most severe  penalty that our legal system can inflict on a human being: namely, loss of liberty • The judge recognizes the defendant as mentally competent to stand trial; he  allows him to enter a plea and defend himself as best he can, and he considers the  defendant sane enough to be sentenced to the penitentiary if found guilt. But  should the defendant be found ‘not guilty by reason of insanity,’ that verdict  transforms him into a truly ‘incompetent’ person, whom the judge feels justified  in committing to a mental hospital (p108) • Tests of criminal responsibility cannot be evaluated without knowing whether  ‘acquittal’ means freedom or commitment  • Does not believe that insanity should be an ‘excusing condition’ for crime (109) • Believes that psych hospitalizations are ‘slavery disguised as therapy’ (110) Involuntary Mental Hospitalization: A Crime Against Humanity • Commitment is a form of imprisonment • Existing social insts and practices, especially if honoured by prolonged usage, are  generally experienced and accepted as good and valuable. o Ie. Slavery • ‘Therapeutic desirability and social necessity of institutional psychiatry’ asserted  by physicians, lawyers, and the laity • Arguments for commitment o It is beneficial for the mentally ill  Reliance solely on voluntary hospital admission procedures  ignores the fact that some persons may desire care and custody but  cannot communicate their desire correctly o It is necessary for the protection of the mentally health members of society • The commitment of persons suffering from ‘functional psychoses’ serves moral  and social, rather than medical and therapeutic, purposes (116) • It may be argued that the use of state power is legit when law­abiding citizens  punish lawbreakers (122) o What is the diff b/w this use of state power and its use in commitment?  First, the diff b/w committing the ‘insane’ and imprisoning the  ‘criminal’ is the same that b/w the rule of man and the rule of law  Second diff lies in their professed aims • Similarities b/w slavery and inst psychiatry o Today, the existence of mental patients is taken for granted in the same  way as the ‘existence’ of slaves was taken for granted (this is their natural  state and they are meant to be subdued) o Parallel b/w master and slave vs institutional psychiatrist and involuntarily  hospitalized patient  In each instance, the former member of the pair defines the social  role of the latter, and casts him in that role by force o Basic assumption of American slavery: Negro was racially inferior to  Caucasian o Basic assumption of institutional psychiatry: mentally ill person is  psychologically and social inferior to the mentally healthy o Perspective of paternalism has played an imp role in justifying both o Psychiatrists now create involuntary mental patients just as slaveholders  used to create slaves is likely to lead to a cleavage in the psychiatric  profession, and perhaps in society generally, between those who condone  and support the relationships b/w psychiatrist and involuntary mental  patient, and those who condemn and oppose it (138) Sept 23, 2013  T. Scheff. Preferred Errors in Diagnosis 1. What is the main goal (the argument) of the article? a. Purpose is describe one important norm for handling uncertainty in medical diagnosis, that judging a sick person well is more to be avoided than judging a well person sick, and to suggest some of the consequences of the application of this norm in medical practice 2. What is a Type-I error? a. Rejecting a hypothesis which is true 3. What is a Type-2 error? a. Accepting a hypothesis which is false 4. Which type of errors is the most dangerous for the justice? Why? a. Accepting a hypothesis which is false (type-2) i. Convicting someone who is innocent (Better a thousand guilty men should go free than one innocent man be convicted) (167) 5. Which type of errors is the most dangerous for the medicine? Why? a. Rejecting a hypothesis which is true (type-1) i. Dismissing a patient when he is actually ill 6. How do the types of errors relate to psychiatric diagnosis? a. In psychiatry, the assumption that medical diagnosis can cause no irreversible harm to the patient’s status is dubious i. Psychiatric treatment, in many segments of the population and for many occupations, raises a question about the person’s social status b. One might argue that the type-2 error in psychiatry, of judging a well person sick, is at least as much to be avoided as the type-1 error, of judging the sick person well. c. Yet the psychiatrist’s moral orientation, since he is first and foremost a physician, is guided by the medical, rather than the legal, decision rule d. 7. What is the difference between psychiatry and general medicine in reversibility/irreversibility of diagnosis? Please explain in details. a. Social stigma of being diagnosed with a mental disorder/illness, whereas there is no social stigma attached to other medical diagnoses • Two basic assumptions o Disease is a determinate process (if undetected, disease will grow to a  point where it endangers the life or limb of the individual, and in the case  of contagious diseases, the lives of others) o Medical treatment does not have irreversible effects (unlike legal  judgement, it will not do untold damage to the reputation of the patient) o Psychiatric diagnosis and treatment are influenced by the payoff for the psychiatrist as well as for the patient T. Scheff. The Role of the Mentally Ill and the Dynamics of Mental Disorder:AResearch Framework 1. What is ‘the residual deviance’? Please describe it briefly. a. Residual deviance is the violation of norms about which consensus is so complete that people regard non-conformity as unnatural and thus a manifestation of mental illness b. The diverse kinds of deviation for which our society provides no explicit label, and which, therefore, sometimes lead to the labeling of the violator as mentally ill 2. Please give several examples of ‘the residual deviance’based on your personal experience. How did you react to it? a. Hallucinations b. Depression c. Delusions d. Mania 3. What is ‘the sociological conception of mental illness’? Please define and explain the main points of the theory. a. 4. Please read and analyze 9 propositions of the author. Try to explain every proposition in a few words. 1. Residual deviance arises from fundamentally diverse sources. i. Some types of mental disorder are the result of organic causes. It  appears likely, therefore, that there are genetic, biochemical or  physiological origins for residual deviance. 2. Relative to the rate of treated mental illness, the rate of unrecorded  residual deviance is extremely high. i. There is evidence that grossly deviant behaviour is often not  noticed or, if it is noticed, it is rationalized as eccentricity ii. Their deviance is unrecognized, ignored, or rationalized 3. Most residual deviance is "denied" and is transitory. i. More residual deviancy is unrecognized or rationalized away ii. Transitory – “Glass reports that combat neurosis is often self­ terminating if the soldier is kept with his unit and given only the  most superficial medical attention” (442) 4. Stereotyped imagery of mental disorder is learned in early childhood. i. Ex. Image of the ‘boogie man’ ii. Children learn a considerable amount of imagery concerning  deviance very early, and much of the imagery comes from their  peers rather than from adults (445) 5. The stereotypes of insanity are continually reaffirmed, inadvertently, in  ordinary social interactions. i. The stereotypes of insanity receive continual support from the  mass media and in ordinary social discourse 6. Labeled deviants may be rewarded for playing the stereotyped deviant  role. i. Patients who manage to find evidence of ‘their illness’ in their past  and present behaviour, confirming the medical and societal  diagnosis, receive benefits 1. The physician and others inadvertently cause the patient to  display symptoms of the illness the physician thinks the  patient has 7. Labeled deviants are punished when they attempt to return to the  conventional role. i. Systematic blockage of entry to nondeviant roles once the label has  been publicly applied ii. The labeled deviant is rewarded for deviating, and punished for  trying to conform 8. In the crisis occurring when a primary deviant is publicly labeled, the  deviant is highly suggestible and may accept the proffered role of the  insane as the only alternative. i. 9. Among residual deviants, labeling is the single most important cause of  careers of residual deviance. i. Most residual deviance, if it does not become the basis for entry  into the sick role, will not lead to a deviant career ii. 5. Please think about strong and weak points of T.Scheff’s theory of the residual deviance. a. 6. Please compare T. Shceff’s conception of mental illness with that of T. Szsasz. Can you find some similarities in them? What are main differences between them? a. •   The Labelling Theory Of Mental Illness 1. What is Gibb’s argument against the labeling theory? a. Suggests that the labeling theory is not really a scientific theory, in that it is not sufficiently explicit and unambiguous b. The concepts used in the theory are ambiguous, since they are not defined denotatively (in a way which allows for only a single meaning for each concept) i. This ambiguity leaves open many alternative meanings and implications 2. What are Gove’s objections to the labelling theory? a. The available evidence … indicates that the societal reaction formulation of how a person becomes mentally ill is substantially incorrect b. The majority of the evidence failed to support labeling theory through two kinds of distortion: i. By overstating the implications of those studies he thought refuted labeling theory and ii. By misrepresenting those studies he thought support labeling theory E. Goffman.Asylums. 1. What is the definition of the total institutions? a. Total institutions are insts that are encompassing to a greater degree than others. Their encompassing character is symbolized by the barrier to social intercourse with the outside and to departure that is often built right into the physical plant, such as locked doors, high walls, barbed wire, etc. 2. Please name 5 total institutions according to E. Goffman a. Institutions meant to care for persons felt to be both incapable and harmless i. Homes for the blind, the age, the orphaned, and the indegent b. Places established to care for persons felt to be both incapable of looking after themselves and a threat to the comm, albeit an unintended one i. TD sanitaria, mental hospitals, leprosaria c. Ones organized to protect the comm against what are felt to be intentional dangers to it, with the welfare of the persons thus sequestered not the immediate issue i. Jails, POW camps, concentration camps d. Those purportedly established the better to pursue some worklike task and justifying themselves only on these instrumental grounds i. Army barracks, ships, boarding schools, work camps e. Those designed as retreats from the world even while often serving also as training stations for the religious i. Abbeys, monasteries, convents 3. Please describe relations between the inmates and the stuff in the total institutions. a. Staff see inmates as bitter, secretive, and untrustworthy while inmates often see staff as condescending, highhanded, and mean. Staff tend to feel superior and righteous; inmates tend to feel inferior, weak, blameworthy, and guilty. 4. How does inmate undergo a mortification of self? a. The recruit comes into the establishment with a conception of himself made possible by certain stable social arrangements in his home world. Upon entrance, he is immediately stripped of the support provided by these arrangements. He begins a series of abasements, degradations, humiliations, and profanations of self. His self is systematically, if often unintentionally, mortified. He begins some radical shifts in his moral career. b. Process i. Barrier that total insts place b/w the inmate and the wider world marks the first curtailment of self. ii. Role depression occurs, because the normal scheduling of everyday life is disrupted. The inmate is thrust into a 24/7 role in the inst. iii. Finds certain roles are lost to him by virtue of the barrier that separates him rom the outside world. The process of entrance typically brings other kinds of loss and moritifation as well. 5. What is called “messing up’? Please give several examples. a. Messing up involves a complex process of engaging in forbidden activity, getting caught, and receiving something like full punishment. There is usually an alteration in privilege status, categorized by a phrased such as ‘getting busted.’ i. Ex. Fighting, drunkenness, attempted suicide, failure at exams, gambling, etc 6. What are the ‘secondary adjustments’? Please describe their functions. a. Practices that do not directly challenge staff but allow inmates to obtain forbidden satisfactions or to obtain permitted ones by forbidden means. They provide the inmate with important evidence that he is still his own man, with some control of his environment. 7. Please describe ‘the dominant themes of inmates culture’according to Goffman. a. Apeculiar kind of level of self-concern is engendered. b. Among inmates in many total insts there is a strong feeling that time spent in the establishment is time wasted or destroyed or taken from one’s life. Sept 30, 2013  On Being Sane in Insane Places - David Rosenhan 1. What is the main research question of Rosenhan’s article? a. He looks at the question of whether the sane can be distinguished from the insane (and whether degrees of insanity can be distinguished from each other) 2. Does Rosenhan refuse the existence of mental illness? a. Rosenhan believes that mental illness does exist. He believes that “normality and abnormality, sanity and insanity, and the diagnoses that flow from them may be less substantive than many believe them to be” (179-80) 3. What are his objections to psychiatric diagnosis? a. He believes that if a sane person is not detected as being sane inside a psychiatric hospital, then that psychiatric diagnosis betrays little about the patient but much about the environment in which an observer finds him (251) 4. Please describe the design of Rosenhan experiment. a. Eight sane people gained secret admission to 12 different hospitals b. Their diagnostic experiences constitute the data of the first part of this article c. The remainder is devoted to a description of their experiences in psychiatric institutions 5. How many people did participate in the experiment? a. 8 people 6. How many mental hospitals did hospitalize pseudopatients? a. 12 hospitals 7. How many pseudopatients were detected by the hospital’s stuff? a. None of the pseudopatients were detected. 8. Please describe the procedure of hospitalisations of pseudopatients. a. The pseudopatient booked an appt w/ the hospital and upon arriving there, complained that he had been hearing voices. b. Asked what the voices said, he replied that they were often unclear, but as far as he could tell they said ‘empty,’‘hollow,’and ‘thud.’(the symptoms of existential psychoses, because there is no literature on the topic) 9. Please nameALL diagnoses, which were acquired by pseudopatients. a. Admitted, except in one case, with a diagnosis of schizophrenia, each was discharged with a diagnosis of schizophrenia ‘in remission.’ 10. Please describe the routine activities of some pseudopatients while they were in hospitals. a. Behaved as they normally would b. Took their pills, answered attendants’calls, etc. c. In their spare time, took notes of their surrounding environment, staff, etc d. Most tried to start conversations with other patients and staff 11. Why most of pseudopatients felt some psychological stress when they where hospitalized? How would you feel if you were pseudopatient? a. Each pp was told that he would have to get out by his own devices, essentially by convincing the staff that he was sane. The psychological stresses associated with hospitalization were considerable, and all but one of the pps desired to be discharged almost immediately after being admitted. 12. What is ‘the existential psychosis’? a. 13. How did pseudopatients describe their relationships with doctors, nurses and the ward? a. 14. How many pseudopatients were admitted to hospitals in the ‘reverse experiment’? How many of them were suspected by doctors/nurses/the ward? a. No pps were admitted to hospitals in the ‘reverse experiment’ 15. What was the main result of the reverse experiment? a. Reverse experiment: i. The experiment was arranged at a research and teaching hospital whose staff had heard these findings but doubted that such an error could occur in their hospital. The staff was informed that at some time during the following 3 months, one or more pseudopatients would attempt to be admitted into the psychiatric hospital. b. Results: i. 41 patients were alleged, with high confidence, to be pseudopatients by at least one member of the staff. ii. 23 were considered suspect by at least one psychiatrist iii. 19 were suspected by one psychiatrist and one other staff member iv. No genuine pp was actually presented during this period v. Experiment shows that the tendency to designate sane people as insane can be reversed when the stakes (prestige and diagnostic acumen) are high vi. 16. What type of error did psychiatrists make when they evaluated pseudopatients? a. Type 2 error i. Physicians are more inclined to call a healthy person sick than a sick person healthy ii. ‘Better to err on the side of caution, to suspect illness even among the healthy’ 17. How diagnoses were affected by the relative health of the circumstances of a pseudopatient's life? a. 18. Who did recognize that pseudopatients were “sane”? Why? a. The other patients recognized that pseudopatients were sane. Some would claim they were journalists or professors due to their continual note- taking. 19. What were the main sources of depersonalization in hospitals? a. The staff did not see the patients as ‘persons’, they were pretty much dehumanized b. The hierarchical structure of the psych hospital facilitates depersonalization i. Those who are at the top have least to do with patients, and their behaviour inspires the rest of the staff 20. What is the main conclusion of the article? Do you agree/disagree with Rosenhan? Please elaborate your argumentation. a. D • The data speak to the massive role of labeling in psychiatric assessment o Having once been labeled schizo, there is nothing the pp can do to overcome the tag o The tag profoundly colours others’perceptions of him and his behaviour Robert L. Spitzer 1. How R. Spitzer does criticise Rosenhan’s research question? a. He believes that Rosenhan’s study, which proves that pseudopatients are not detected by ps
More Less

Related notes for SOC446H5

Log In


Don't have an account?

Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.