Mental Illness And Social Theory

psychic Illness And Social TheoryThroughout history, there break been differing views of how genial sneezyness was thought to occur, and how it should be subsequently set. For practice Greek and Roman philosophers such as Hippocrates and Plato advocated that abnormal deportment resulted from an internal disease, with Hippocrates believing it was an imbalance of the four humours that were thought to flow through the body (Comer, 2005). As such, physicians of the time treated it accordingly, using a mixture of methods such as bleeding and restraining (Comer, 2005 8) to to a greater extent supportive techniques such as calming atmospheres and music. so far with the decline of the Roman Empire from roughly 500 A.D., a variegate in perceptions of abnormal behaviour occurred with religion dominating thought over science. As such, amiable complaint became viewed as arising through possession of the Devil, with the only cure being an exorcism by clergymen, or beating and starving the individual (Comer, 2005). that it was only around the 1400s that cordial illness became viewed as a sickness inwardly the mind (Comer, 2005 10), and as such the asylum was created as an institution to care for the psychogenicly ill, and bandage oftentimes a cruel place, it was seen as the establishment charged with caring for those deemed noeticly ill (Scull, 2006).Yet the main so called change in reform of the mentally ill was attributed to the work of Tuke and Pinel (Comer, 2005 11) where instead of promoting intercession involving beatings and restraint, they used methods where the mentally ill were allowed to be unrestrained and encouraged to monitor their profess behaviour, in methods known as moral treatment (Scull, 2006 115). These methods transformed the way mental illness was handled, yet, into the twentieth atomic number 6 many of the mentally ill were becalm being confined to long term stays in asylums (Comer, 2005). piece this is a very shortened histor y of mental illness, the changing perceptions of the causes and subsequent treatment of the mentally ill throughout history raises several important issues. Firstly, the definition of mental illness has non remained constant and therefore mental illness it self has been called madness, insanity (Comer, 2005 10) and in the field of psychology, is studied as abnormal psychology. This raises the second issue, in that mental illness is still defined as somewhatthing which could be go throughed aberrant or not normal, and as such requires the individual to receive treatment. The field that has been associated and subsequently dominated diagnosis and treatment of mental illness in the 20th century (Summerfield, 2001) is abnormal psychology. Psychiatry typically draws upon positivist mentation, in that a mental illness is a real and apparent phenomenon (Eisenberg, 1988 2) that must(prenominal) be diagnosed and subsequently treated, with the usual assumption that the illness has ma nifested due to some biologic abnormality (Fisher, 2003).However while this view continues to dominate thinking within psychiatry, it fag end be argued that these concepts of mental illness know been heavily criticised and indeed, the institution of psychiatry itself has also been criticised. Therefore the aims of this essay are to firstly establish the hassles of the psychiatrical approach and how social theory has profferd a profitable evaluation of how mental illness, rather than existing as real and observable illnesses which psychiatrists must view and treat, could really be seen as socially haveed. This allow for then lead into a discussion of the debates around how useful a social constructionist linear survey is, onward evaluating the institution of psychiatry as a whole, drawing on the work of Foucault and associated theorists, arguing that the psychiatric institution, instead of being a liberating force for the mentally ill, very exercises methods of social keep back. Finally this will allow for an assessment of whether these evaluations are much useful to consider than continuing adopting the dominant positivist methods forwarded by psychiatry.The Problem of psychiatrical Approaches to Mental IllnessThe on-going system which psychiatry utilizes in order to define and diagnose mental illness is the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual, currently in its fourth edition lists what it has defined as mental illness onto 5 axes. For modelling Axis 1 contains all disorders considered to be associate to mental health, from mood disorders to sexual disorders with the exception of personality disorders and what is termed mental retardation, which is placed on Axis 2 (Comer, 2005). In addition to this, certain criteria are listed, in order to determine if an individual can be diagnosed with a specific mental illness. For representative, depression would be classified as a mood disorder and in order to be diagnosed as having a major depressive episode, an individual would need to exhibit five out of eight symptoms listed persistently for at to the lowest degree two weeks, with one symptom being either depressed mood or loss of interest or pleasure (Davidson and Neale, 2001 242)While this is a useful approach, should a positivist stance be taken in that mental illness is an observable fact, waiting to be uncovered in an individual (Eisenberg, 1988), it poses knotted when considering two issues. Firstly what has been defined as mental illness has not remained constant within psychiatry and has also faced criticism over how it is diagnosed, and secondly, the motley of an individual as mentally ill can have serious social consequences such as producing stigma (Thornicroft, 2006).In addressing the first issue, at the source of the DSM in 1952, sixty categories were listed as being mental illnesses, and this number increased to one hundred and forty five illnesses in the second editi on in 1968 (Balon, 2008), however it was perhaps in the third edition, published in 1980, where the biggest change occurred. Not only has 230 illnesses been identified and classified as illnesses, but a change occurred in which homosexuality was removed as being a mental disorder after campaigning from Gay activist groups (Silverstein, 2008). However the DSM in its current form continues to cause controversy over classifications, especially with those surrounding sexuality, for example it has been questioned as to whether issues such as female orgasmic disorder or certain fetishes should very be classified as disorders (Ussher, 1997 5). Similarly, classifications for diagnosis have also been close to vague. For example, while diagnoses for depression typically include a timeframe in which the symptoms must be present, there is no such temporal criterion for sexual disorders, meaning that diagnosis could be somewhat ambiguous (Balon, 2008 190).This idea of the DSMs criteria making diagnosis somewhat vague was highlighted in the classic study by Rosenhan (1973) in which eight participants were each sent to twelve different psychiatric hospitals and instructed, at admissions, to say they had been hearing voices, and had heard the words empty, hollow and thud (Rosenhan, 1973 251). Each participant was subsequently admitted to the respective hospital, and upon admission, apart from general nervousness of their situation, continued to behave normally and t doddering staff they were no longer experiencing any symptoms. Despite this, participants were admitted to the hospitals for periods ranging between 7 and 52 days, and all but one was discharged with the diagnosis Schizophrenia in pardon (Rosenhan, 1973 252). While this study is flawed due to its deception and would not have been ethically allowed in redbrick times, it did raise some serious issues about psychiatric evaluation and diagnosis, with perhaps one of the most troubling fonts being that perfectly sane individuals were scoreled as schizophrenic, and likely would have been stuck with that label (Rosenhan, 1973 252).This leads onto the second problem of psychiatric definitions of mental illness, in that individuals become labelled as having an illness, meaning they are more readily seen as deviating from social norms and as such, reactions to the individual with the mental illness change radically (Bowers, 19987). This can often produce a stigma of mental illness meaning once individuals are classified as being mentally ill, they may suffer problems with their family and friends or discrimination at work and this can often be fuelled by media interpretations of mental illness (Thornicroft, 2006).For example because a mental illness such as schizophrenia is classified by the DSM as having at least 2 symptoms including hallucinations, delusions disorganised speech etc, for a significant proportion of time for a least a month (Comer, 2005 360), it becomes simplified by the med ia as meaning a person with a mental illness will be mad and dangerous (Thornicroft, 2006 113). Similarly this transfers into the public who are found to have a profound ignorance (Thornicroft, 2006 231) over what it means to be mentally ill and also problems for mentally ill individuals who are often targets for discrimination and, as such, find their lives change as a result of the label of mentally ill that is imposed upon them.Alternative Methods of Defining Mental IllnessGiven the problems that appear to arise from the dominant psychiatric methods of defining and diagnosing mental illness, it would seem that alternative methods should be considered as to how mental illness should be viewed. One method is to take the definitions of mental illnesses themselves and determine how they have arisen through plow and how they can be subsequently viewed as socially constructed (Ussher, 1997, 4). For example, the psychiatric viewpoint of mental illness is framed as objectively diagnosin g an individual with a mental illness, which is seen to be real and specifiable. However if a stockmodern approach was adopted, which asserts that there are no absolute truths, e.g. a mental illness doesnt provided exist, but instead is different interpretations are formed through language (Walker, 2006 71). This would imply that instead of psychiatry objectively discovering a mental illness within an individual, they have actually created a perspective whereby someone who has a mental illness is ill and deviating form the norm, and as such needs to be diagnosed and treated (Walker, 2006 72).This social construction of mental illness is done so through the utilization of treatment. In the case of the psychiatric perspective, the view that mental illness is identifiable and diagnosable is taken as truth, with the psychiatrist patient relationship dominated by the psychiatrist who diagnoses the illness and proceeds to medicate the individual (Armstrong, 1994 19 Walker, 2006 74). However while the tonusings that an individual presents to a psychiatrist may be very real, the associated labels such as schizophrenia or depression only exist as they have been agreed upon as taking a certain meaning through language. This can also be the case in viewing mental illness as a whole the psychiatric discourse has created these categories of mental illness, which become associated with wholly negative connotations, producing severe consequences for the individual. For example, if Foucauldian discourse perspective is taken, this categorisation would provide a definition of how the individual understands their identity, and perhaps more importantly how others view their identity (Roberts, 2005 38). However this can also end up becoming their identity. For example, instead of being an individual with schizophrenia, they become schizophrenic and that is their identity.However if the postmodern perspective of mental illness is copyed through, it suggests that mental illn ess does not actually exist, nor do the labels that follow it, such as schizophrenia or depression. Instead these are just constructions formed by psychiatry to allow them to categorise people as they feel necessary (Walker, 2006 75). However this also suggests that individuals who experience these symptoms should not merely be categorised as psychiatry dictates, because, as has been discussed previously, this often produces stigma. Instead, by adopting a postmodernist perspective, subjective accounts of individuals experiences should be used to determine how they construct their illness, rather than viewing them as ill patients who are deviating from the norm.For example by allowing individuals who have been diagnosed with, say, depression to construct their own discourse around their experiences, more useful information may be sought about how they feel in relation to this diagnosis and may also help to reduce stigma that is associated by the categorisation process employed by psy chiatry. For example a study by LaFrance, (2007) utilized the discourse of women, to examine how they constructed their experiences of depression having received a medical diagnosis of depression. The findings from adopting a discourse analytic approach found that the women, upon receiving a diagnosis of depression often felt relieved as they could then interpret it as its not my fault (LaFrance, 2007 134), however in relation to more physical illnesses, they felt it was nasty to gain a legitimacy for their pain as the actual illness was not readily observable what I wish we could do is like impersonate a thermometer in your ear and check your serotonin level (LaFrance, 2007 134).By allowing individuals who are diagnosed with depression to discuss more openly their experiences of having being labelled as such, it can allow for a reinterpretation of what these illnesses are. Rather than being objectively defined as a pathological entity within the body, using a postmodernist perspe ctive utilizing discourse, mental illness can be viewed from the perspective of the individuals experiences of the pain, illness and distress (LaFrance, 2007 137) they encounter. This allows for a removal of mere categorisation and may also help to derogate stigma.However it should also be noted that while taking a postmodern perspective by deconstructing the labels of mental illness could be useful in providing more insight into individuals experiences and as such, minimise stigma, it can have limitations. For example as Ussher (1997) notes, if you take an extreme deconstructionist perspective, a situation is created whereby nobody is real, everything is just a social label an invention of those in power (Ussher, 1997 5). This could have consequences, in that there are no longer categories which define a sexual problem or a crime, as they merely become constructions of language. If this argument was followed through, it would mean that issues such as paedophilia would be justifie d as there would no longer be any reason to warrant criminalising sexual acts with children (Ussher, 1997 6) and this is clearly wrong. However if a certain level of deconstruction is ac acquaintanced, as mentioned above, it could be useful in creating a shift away from the dominant psychiatric view of an objective diagnosis and labelling system of mental illness.The Continuing effectiveness of PsychiatrySocial Control of PsychiatryIt has been outlined above that drawing on a postmodern perspective of utilizing discourse to deconstruct categories of mental illness forwarded by psychiatry could be useful, particularly in gaining insight into those who experience mental illness and also using that to help reduce the stigma which evolves from labelling and categorising. However, in spite of the clear faults the psychiatric methods have in defining and diagnosing mental illness, these alternative approaches have not been introduced. It could be said that this is due to the power that psychiatry yields over the mentally ill.For example, Scull (2006) notes, in the early 19th century, reform of how mental illness was treated occurred by which it became a condition which could only be authoritatively diagnosed, certified and treated by a group of legally recognised experts (Scull, 2006 111). While this change occurred as to who could legitimately deal with the mentally ill, a change, as mentioned above, also occurred into how the mentally ill should be treated, with Pinel and Tuke advocating the notion of treating the mentally ill rationally and humanely (Scull, 2006 114). This may therefore suggest that the 19th century revolutionised how mental illness was viewed and treated, with the idea of the mentally ill being liberated. However, in drawing on the works of Foucault, it could be said that this view is quite misguided.While Foucaults work is complex and wide ranging, his concepts of power/knowledge and the body have been central to providing an alternative acco unt of the domination of psychiatry and how society views mental illness. For example in Foucaults (1967 2001) work Madness and Civilization, a detailed history is provided on how madness has been changed and redefined throughout history. In brief, it is argued that a transformation occurred in that there was a change from the sane person being able to communicate efficaciously with the madman, to a state whereby the madman is segregated and not to be communicated with (Matthews, 1995 24). This occurred, as from the nerve center Ages to the Renaissance period, madness was seen as moving from an entity which was beyond human life, to something that was inherent within the self. As such, it was seen as something that required individuals with the affliction of madness to be confined, and indeed by the 17th century those who were considered aberrant were to be segregated, including the mad, the unemployed, prisoners etc (Matthews, 1995 25). However, it was seen that they were not co nfined for their own wellbeing or safety, but instead because they were not contributing effectively to society as normal citizens. Towards the 18th century, it is argued that even with the introduction of more humane methods of treating the mentally ill, such as those forwarded by Pinel and Tuke, this was still seen as a method of run, feating to transform the mad individual into someone deemed socially normal (Matthews, 1995 25).For example, Foucault (1967 2001 255-256) notes thatthe asylum of the age of positivism, which is Pinels glory to have founded, is not a free domain of observation, diagnosis and therapeutics it is a juridical space where one is accused, judged and condemned, and from which one is never released except by the version of this trial in psychological depth -that is, by remorseThis implies that the methods considered as being the electric arc of the mentally ill in the 19th century, which pre-empted modern psychiatry, were actually methods of controlling t he mentally ill. They are labelled as having an illness such as depression or schizophrenia, which is a deviation from normal functioning, reasonable individuals, and as such, require treatment in order to attempt to return to them to normative state. With this view of modern psychiatry, it could be said that as it is the dominiant institution responsible for mental illness, it acts as a method of social control by having the power to identify deviant individuals and attempt to treat them, subsequently cure them of their illness and return them to normality.Social Control through SurveillanceHowever, life-and-death to understanding this method of social control, is to also understand the power that the psychiatric institution holds over the mentally ill, and it could be argued that it is through Foucaults (Rabinow, 1991) ideas of disciplinary power. For example, Foucault argued that instead of old methods of control of deviant bodies being used, such as physical punishment (Armstro ng, 1994 21), new methods were created which allowed for bodies to be observed and analysed (Armstrong, 1994 21) through methods of control. To garnish this idea, Foucault uses the idea of Benthams design for an idol prison, known as the panopticon, where a central watchtower looks over cells distributed in a circular fashion (Roberts, 2005 34). The method of the panopticon was to be able to continuously observe inmates, however from the inmates point of view, they would never know when they were being watched, or if they were being watched at all. This allows for a dynamic in which a power relation is created and maintained, whereby the individual is make a subject, never free from knowing when they are being observed and thus having to correct and monitor their behaviour accordingly (Roberts, 2005 34).For example as Foucault notes, it must be possible to hold the prisoner under permanent observation, every report that can be made about him must be record and computed (Foucault, cited in Rabinow, 1994 217). While this was referring to prisoners being held as criminals, the concept can also be identified and analysed in relation to psychiatric institutions. For example after a diagnosis of a mental illness has been made, individuals become analysed and evaluations for treatment made, and this becomes documented within medical records. While, as Roberts (2005) notes, that this is standard procedures for care, from a Foucauldian perspective, it could be seen as a panoptic method of ensuring the individual is continually watched and assessed, and should any deviations occur, interventions may used, to correct the deviancy (Roberts, 2005 36).However this does not merely occur within an institution, but the levels of panoptic command may occur within an individuals community. For example if someone is given the identity of schizophrenic, they will be monitored by many different commerceal staff that will assess their treatment and symptoms but they will also b e subject to oversight from family members or friends (Roberts, 2005 36). This would imply that the methods of psychiatric social control extend beyond simply having the authority to correct deviancy, but instead psychiatric disciplinary power infiltrates many aspects of an individuals life, meaning they may never be free from surveillance of their illness or having an identity of being mentally ill.This Foucauldian perspective is rather critical of the psychiatric institution, however when considering the stigma that those with a mental illness encounter, it could be a useful theoretical approach to take when considering the dominance of psychiatry. For example, as mentioned previously and highlighted by the Rosenhan (1973) study, a diagnosis and labelling of being mentally ill can become a lifelong issue and often, while being subject to surveillance by psychiatric and medical institutions, individuals are also subject to surveillance by their friends, family and peers, however if what is viewed is negatively perceived, or if the individual does not correct their behaviour this can have consequences. For example as Thornicroft (2006 25) states from an individual with mental illness, I have lost all my friends since the onset of my illnessI lost my career, my own flat, my car. Mental illness has destroyed my life. This suggests that again, the dominance of psychiatry, even in modern times, if taken from a Foucauldian perspective, can have drastic consequences for those who are diagnosed with mental illness.Other Power Relations as Explanations for Psychiatric DominanceFoucauldian perspectives clearly illustrate that psychiatry can be considered the dominant institution for monitoring those with mental illness, as they are able to correct them by means of social control and also the very manner in which psychiatry functions, allows them to survey those with a mental illness indefinitely, through the ideas of disciplinary power. However one other aspect that sh ould be considered as to why psychiatry has continued to be the dominant institution for identifying those who are mentally ill, is their intrinsic affiliations to the pharmaceutical companies (Scull, 2006 127). For example, in returning to the methods of the psychiatric institution, they take a positivist view that mental illness is real and observable and requiring treatment and they usually identify it as underlying a biological abnormality of brain functioning, such as serotonin deficencies in depression (Comer, 2005).However it could be argued that it is pharmaceutical industry that continues to allow this approach to be taken. For example, if classifying a mental illness as real and observable with an underlying biological cause, this allows for the assumption that it can be treated, and the pharmaceutical industry fuels this, by providing the medication (Fisher, 2003 66). However this view is also advocated by psychiatry, because as Scull (2006) and Fisher (2003) argue, the p rofits that pharmaceutical companies make contribute towards funding research, the journals and the departments of psychiatry (Fisher, 2003 66). As such, the psychiatric profession have an invested interest in maintaining their positivist standpoint, and as this happens to conform to the positivist natural model of scientific research, it has asserted itself as the only reality, due to belongings this power (LaFrance, 2007 128).Usefulness of the Critical Evaluation of PsychiatryAs can be seen in the discussions above, the evaluations of psychiatry drawing on social theory perspectives have been quite critical, both in terms of how psychiatry defines and diagnoses mental illness, but also how the institution of psychiatry as a whole functions. For example it has pinched from post modern perspectives to suggest that the very notion of mental illness is socially constructed through discourse (Walker, 2006) and from a Foucauldian perspective, the psychiatric institution serves to cont rol the deviant population by attempting to renormalise them again through the use of disciplinary power (Roberts, 2005). However, while these evaluations are certainly useful and provide a perspective into how psychiatry and mental illness can be viewed, to take this wholly negative view may be just as disputable as adopting the purely positivist assumptions forwarded by psychiatry.For example, in addressing the first evaluation that mental illness can be considered to be socially constructed through discourse, as explained by Ussher (1997), if this is taken to the point of an extreme social constructionist perspective, then nothing will actually be considered real, just multiple realities created through discourse. This could be problematic for those who do suffer from mental illness. For example interpreting mental illness as something that doesnt actually exist, or is not definable but merely a social construction is not very helpful for an individual with real symptoms which they experience. For example as Bowers (1998) mentions, to take a view that mental illness is something that could be considered beneficial or non existent is a failing to accept the reality of their suffering and disability (Bowers, 1998 104). As such, theoretically it may be useful to consider mental illness as socially constructed, and indeed given the study by Rosenhan (1973), diagnosis can often be difficult or misinterpreted, for those who actually suffer from mental illness, a diagnosis may actually be comforting. For example, in an excerpt from an individual with mental illness, it can be seen that often a diagnosis means that it feels something can then be done. The individual, when discussing her initial diagnosis of schizophrenia recalls it was so enormously helpful to think (a) this was something diagnosable, and (b) there are self help groups (Thornicroft, 2006 48).As such, while the psychiatric methods of defining and diagnosing mental illness could be seen as theoreti cally problematic, as they are known, individuals who are diagnosed may feel comforted to know that the symptoms they experience are not simple constructions, but an actual treatable illness.In addressing the second criticism social theory has levelled at psychiatry, in that from a Foucauldian perspective, it can be seen as an institution of continual surveillance and social control (Roberts, 2005). This implies that psychiatry exists with a unidirectional form of power, selecting deviant individuals and attempting to normalise them through treatment and surveillance. However it could be said that this power/knowledge approach to psychiatry is somewhat simplistic, implying only psychiatric experts are gnarled in addressing the diagnosis and treatment of lay peoples mental illness, however this may not be the case. As mentioned in the LaFrance (2007) study, sufferers of mental illness have been invited to comport their views on their experiences of mental illness and how they viewe d their treatment and this can often be used to inform and re-evaluate how these with mental illness should be treated by experts.For example Pilgrim and Rogers (1997) highlight that often those who had experienced mental illness could not contribute the onset to a singular cause but, identified numerous causes such as a loss of a child, previous abuse, having a broken engagement etc (Pilgrim and Rogers, 1997 42). However psychiatrists typically noted onset as originating from something which was termed biomedical (Pilgrim and Rogers, 1997 43) and as such, by identifying how sufferers view their illness, this can help further inform the experts. Similarly, Pilgrim and Rogers (1997) also highlight that there is not expert knowledge of mental illness and lay knowledge of mental illness but often the two are often intertwined, with expert knowledge becoming subject to layification (Pilgrim and Rogers, 39). Therefore to simply assert that psychiatry exerts social control and surveillanc e over mental illness suffers appears to be ignoring the notion that individuals may not be passive patients and may have their own interpretations and views on their illness.ConclusionIt is somewhat difficult to determine whether the critical evaluation social theory provides in reaction to the methods psychiatry uses to define and treat mental illness are more useful. For example, while the positivist methodology currently adopted by psychiatry has been problematic given their changing of what constitutes as mental illness (Balon, 2008) and also the reported difficulties in diagnosis (Rosenhan, 1973), it is unclear whether adopting a social constructionist approach would be useful in practice. While it certainly has highlighted the faults of positivist notions of schizophrenia and depression simply existing (Walker, 2006) and this may help to reduce stigma, given that it is such a widely accepted approach, people in some cases may find comfort in being given a diagnosis (Thornicro ft, 2006).Similarly, while the works of Foucault are certainly insightful in suggesting that the liberation of the insane was merely a different form of confinement through social control, it does provide an assumption that psychiatry is merely an institution whose aims are to normalise individuals through medication and view them as simple, passive recipients of care. However as Pilgrim and Rogers (1997) highlighted, often knowledge which lay and experts hold of mental illness can become intertwined and, indeed, psychiatrists have utilized research into patients experiences in order to provide a better standard of care for them.Therefore this essay would advocate, in a correspondent manner to Ussher (1997) that neither the psychiatric positivist methods are completely flawless and neither are social theory approaches, such as post modernism or a Foucauldian analysis. However a combination of the two may not provide a better system either, therefore while it is acknowledged that so cial theory has provided a useful critical evaluation of psychiatry, it is not necessarily a correct one. As such, it may be more useful to consider the individuals who suffer from mental illness as the ones who should advocate h