Presentation on theme: "Sociology, Culture and Psychiatry"— Presentation transcript:
1Sociology, Culture and Psychiatry Dr Alex HuntClinical Psychologist
2Conceptions of Mental Health PsychiatricBiomedical model – mental illness approachdeveloped from physical medicinePsychoanalyticConflictsDeficitsPsychologicalStatistical notionIdeal notionPresence or absence of specific behavioursDistorted cognitionsPsychiatric - Biomedical model – mental illness approached the same as physical medicinediagnosis, prognosis, aetiology and treatment;some conditions are linked to viruses and bacteria, however the great bulk of what is termed mental illness has no proven bodily cause. Deals with symptoms, not signs. There are no biological signs as such. High rise, and unemployed and depressed, stress of circumstance has triggered biochemical changes, which can be treated by antidepressants.Szasz – mental illness is a myth, bodies can be ill, minds cannot, it is like a metaphor, like the economy, a s sytem that is not working properly, that doesn’t have balalnace a equilibruim.Psychoanalytic – we are all somewhere on a continuum between normal and abnormal, or all somewhat screwed up. Conceptual model which leads to ideas about treatment; but tends to psychologise everythingPsychologicalStatistical notion – frequently occurring behaviours are normal, infrequent are not…tempo of speech…pressured speech, pressure of thought or high, slow speech might be described as slow or depressed, may not hold steady across cultures or within one culture. Bi or unidirectional - intelligenceIdeal notion – humanistic – self actualising, or psychoanalytic – conscious over unconscious characteristicsPresensce or absence of specific behaviours – maladative behaviour – who defines what is adaptive orf maladative, desired or undesired, again cultural relativismDistorted cognitions – thoughts which aare unhelpful or undisarable
3Conceptions of Mental Health Social causationCritical theorySocial constructivism (constructionism)Critical realism(medical) anthropologySocial causation - Concepts of mental health (illness) are held to be valid, however social factors are implicated in their causation. Psychiatric epidemiology – correlations between categories and antecedent variables. Social class gender etc.Critical theory – mix of psychoanalytic and Marxist theory seeking to explore the links between societies and individuals in a particular time and place – the type of society influences the individual which then influences society – western society – a culture of narcissism and the fragmented self represented by the metaphor of schizophreniaSocial constructionism – reality is not self evident, stable and waiting to be discovered, but instead is a product of human activity1. understanding the social forces which define a phenomenon2. post structuralist ideas and Foucault – radical, reality is constructed entirely through language and discourse. It doesn’t exist until talked about. Pluralistic, relay is what is constructed within human interaction. Bound up with power relationships3. the production of scientific knowledge – how scientific knowledge is produced and constructed…Critical realism – reality does exist – society exits prior to the existence of agents but they become agents who reproduce or transform society can accommodate the different positions….temporal lobe epilepsy and the critical analysis of the way in which problems are described at a particular point in time is a society, whose interests are being served.
4Conceptions of Mental Health Lay conceptionsLay conceptions and psychiatrics labels concur (in western societies)Mental health viewed along a continuum – up to a pointSome mental health problems viewed as normal experience ‘stress’ ‘depression’More severe mental health problems viewed differently – based upon stereotype
5Stigma Stigma a form of stereotype Stereotype to stigma The tendency for human beings to attribute fixed and common characteristics to whole social groupsStereotype to stigmaPrejudicial social typingEmotion reactionMoral reactionStigma a form of stereotypeThe tendency for human beings to attribute fixed and common characteristics to whole social groupsStereotype to stigmaPrejudicial social typing - enlargement of the stereotype to cast the person as a deviatitive or undesirable social groupEmotion reaction – anxiety, hostility, pityMoral reaction - paternalism, revulsion, horrorStigmatised person is set apart from others, the labelling vs the labelled.Stigmatised person becomes isolated and develops a spoiled identity.Negative stereotypes underlying the stigmatisation of those labelled as mentally ill are based upon three elements:
6Stigma Elements involved in defining and stereotyping mental illness: DangerousnessIntelligibilityHow intelligible is person behaviour – has to make sense within the current contextCompetenceCreativityObsessionalityReligionIn any given situations there are meta rules about how one should behave and act, transgressions of these should be able to be understood, or at least the person should be able to give an intelligible account of what has happened. If all follows the roles and rules expected of them, intelligibity is not often demanded. Lacking insight…do not provide an intelligible account. Starts with others and then is rubber stamped by psychiatryGlobal and trans historical….however, what is intelligible in one culture or set of belief systems does not necessarily transfer to another…hallucinations and voice hearing. Only a building block of stereotype where it is disvalued.Only some psychiatric patients are intelligible –Some psychotic patients are largely intelligible most of the timeMadness is episodic, rarely persistentCreativity and madness, creativity transcends conventions, - bi-polar people are successful and creative…novel ideas and the energy to carry them throughObsessionality, prized in some regards and can out perform others; features of obsessive personality disorder read like Victorian virtuesSpirituality and religious leadership …10-15 percent religious delusions, however the charismatic figureheads of main world religions could be diagnoses retrospectively as suffering some form of psychosis… christ in the desert, Mohamed in a cave.
8Labelling Theory (Scheff, 1966) Positive effects – access to treatment / normalisingNegative effects – hierarchy of stigma mentally ill are disvalued, below prostitution, epilepsy and alcoholismModified labelling theory (Link & Phelan, 1999)– social rejection based upon shared cultural assumption about mental illness.Positive effects – access to treatment / normalisingNegative effects – hierachy of stigma mentally ill are disvalued, below prostitution, eplipsey and alcoholismFear of violence and need to keep social distance reduces with contactModified labelling theory – social rejection based upon shared cultural assumption about mental illness. Extent to which the person takes on board these ideas of social distance. Born with the stereotype, person with mental illness takes this on board and begins to act accrodlingly as well as others labelling and prejucing the person. Often the stigma is more in the person’s own mind and experience than in others.
9Response to Stigma Information control Compensate Unlikely to be discovered concealCompensateExaggerate (generalise)Pass, get bySwitch styles
10Role of Mass MediaMedia on the whole supports and strengthens stereotypeViolence, otherness,Don’t concur with psychiatric descriptionsPathetic dependence or sillinessHumane biographical accounts (films, documentaries)
11Social Exclusion Societal discrimination – Rights can be suspended –compulsory detention and involuntary treatmentPoorer housingLess chance of employmentPsychosis 1 in 4povertyLess likely to be involved / included in community
12StigmaDiscrimination for people with mental health difficulties high (social exclusion unit)ONSpositive attitudes about mental illness deceasedFear of mental health users increasedTolerance of people with MH problems decreased
13Anti Stigma Anti-stigma (discriminatory) campaigns RCPsych Changing minds – mental illness is an illness like any other illnessBiological not persons faultUser movementPsychological – oppression and social causes
14Social Class & Mental Health Black reportLower SES associated with greater morbidity and mortalityMental health – poverty and mental healthAffective disorders diagnosed evenly across social classesStrong correlation between low SES and schizophreniaFaris times the rate of schizophrenia in poor neighbourhoods in Chicago compared to middle class districts hypothesized poverty and lack of social cohesion – social isolation hypothesisSocial drift theory
15Relationship Between SES and MH Social drift theoryLife eventsGreater negative life events in low SESSocial causationMaterial deprivationLess access to resourcesPoorer environmentHealth behaviour
16MH and EmploymentBetter prognosis for those diagnosed with psychosis who are employedWork factor in depressionrelationship between anxiety and depression and SES dependent on employment statusUnemployed men more likely to have MH problems than unemployed womenThose in high social
17Sick Role & Illness Behaviour Sick role – sanctioned deviance, Policed by medical professionExit sick role (get better)Becoming illSICK!Chronic conditionParsons was a functionalist sociologist, who argued that being sick means that the sufferer enters a role of 'sanctioned deviance'. This is because, from a functionalist perspective, when you are ill you are not being a productive member of society. Therefore this deviance needs to be policed, which is the role of the medical profession.The general idea is that the individual who has fallen ill is not only physically sick, but now adheres to the specifically patterned social role of being sick. ‘Being Sick’ is not simply a ‘state of fact’ or ‘condition’, it contains within itself customary rights and obligations based on the social norms that surround it. The theory outlined two rights of a sick person and two obligations:Rights:The sick person is exempt from normal social rolesThe sick person is not responsible for their conditionObligations:The sick person should try to get wellThe sick person should seek technically competent help and cooperate with the medical professionalthere are three versions of sick role 1.conditional 2.unconditionally legitimate sick role. 3.illegitimate role:condition that is stigmatized by others.corpseMedical profession
18Sick Role Talcott Parsons (1951) Contract with rules: Rights: The sick person is exempt from normal social rolesThe sick person is not responsible for their conditionObligations:The sick person should try to get wellThe sick person should seek technically competent help and cooperate with the medical professional
19Sick Roles Variety of sick roles culturally Baby Corpse role Angry ScapegoatSometimes not allowed any
20Sick Roles Patient as sacred “Baby” “Angry” Passive Acute Active Chronic“Corpse”“Scapegoated”Patient as shameful
21Gender & MH Some diagnoses not gendered, schizophrenia and bi-polar Some inevitably limited to womenPost-natal and post partum psychosisOverwhelmingly femaleAnorexia & bulimiaBPDOverwhelmingly maleantisocial personality disorderSex offendersSubstance misuse more likely in menAnxiety and depression more likely in womenDementia (women live longer)New slide; Gender Specific Risk FactorsNew slide; Gender Bias
22Over–representation of Women Society causes excessive ‘mental illness’Increased social demands and lack of structureEntrapment and humiliationIncreased vulnerability – adverse childhood events –CSA, rapeMeasurement artefactResearch toolsHelp seeking
23Women and Mental Health Labelling theoryFeminist influenceWomen labelled more often than menGP’s more likely to label psychological problems in women than menSexism in psychiatryMedicalisation of female experienceThe great tranqulizer debateWomen’s Mental Health; The Facts
24Men & Mental Health Men are viewed as more dangerous – weak stereotype Men over represented in prison, women in mental health population – social judgementsGender expectations –Externalising vs internalising
25Culture & Mental Health How universal are psychiatric diagnoses?Historical contextNY vs LondonCategorisationWHO studyCross culturally something approximating schizophrenia in each country (this can be debated)Prognosis, better level of care and input = better outcomes? NO!
26Culture and Mental health Two partsThe symptomsSocial responses to the symptons – social processWestern medicalised – internalised –internal stable attribution….controllable?Developing – spirit possession – external, unstable explanation….uncontrollable?
27Culture and Mental Health Emic vs etic approachesCulture bound syndromesCategory fallacy?Cultures undevelopedVariant of western diagnoses?
28Culture and Category Personalistic Variation in presentation of symptoms / epidemiology across culturesBiological Social CulturalHypothesised influence on presentationAmokLatah“psychosis”DepressionPersonalisticAnorexia & Bulimia
29Ethnicity and Mental health Different ethnicities over represented in psychiatric populationsIrish and Afro-Caribbean over represented why not others?GeneticsMigrationRacismCultural explanations – belonging / fragmentation