Presentation on theme: "Sociology, Culture and Psychiatry Dr Alex Hunt Clinical Psychologist."— Presentation transcript:
Sociology, Culture and Psychiatry Dr Alex Hunt Clinical Psychologist
Conceptions of Mental Health Psychiatric Biomedical model – mental illness approach developed from physical medicine Psychoanalytic Conflicts Deficits Psychological Statistical notion Ideal notion Presence or absence of specific behaviours Distorted cognitions
Conceptions of Mental Health Social causation Critical theory Social constructivism (constructionism) Critical realism (medical) anthropology
Conceptions of Mental Health Lay conceptions Lay conceptions and psychiatrics labels concur (in western societies) Mental health viewed along a continuum – up to a point – Some mental health problems viewed as normal experience ‘stress’ ‘depression’ – More severe mental health problems viewed differently – based upon stereotype
Stigma Stigma a form of stereotype – The tendency for human beings to attribute fixed and common characteristics to whole social groups Stereotype to stigma – Prejudicial social typing – Emotion reaction – Moral reaction
Stigma Elements involved in defining and stereotyping mental illness: Dangerousness Intelligibility – How intelligible is person behaviour – has to make sense within the current context Competence – Creativity – Obsessionality – Religion
Conception of mental health Bad NormalAbnormal Mad
Labelling Theory (Scheff, 1966) Positive effects – access to treatment / normalising Negative effects – hierarchy of stigma mentally ill are disvalued, below prostitution, epilepsy and alcoholism Modified labelling theory (Link & Phelan, 1999) – – social rejection based upon shared cultural assumption about mental illness.
Response to Stigma Information control – Unlikely to be discovered conceal Compensate Exaggerate (generalise) Pass, get by Switch styles
Role of Mass Media Media on the whole supports and strengthens stereotype – Violence, otherness, – Don’t concur with psychiatric descriptions – Pathetic dependence or silliness Humane biographical accounts (films, documentaries)
Social Exclusion Societal discrimination – Rights can be suspended –compulsory detention and involuntary treatment Poorer housing Less chance of employment – Psychosis 1 in 4 poverty Less likely to be involved / included in community
Stigma Discrimination for people with mental health difficulties high (social exclusion unit) ONS – positive attitudes about mental illness deceased – Fear of mental health users increased – Tolerance of people with MH problems decreased
Anti Stigma Anti-stigma (discriminatory) campaigns RCPsych – Changing minds – mental illness is an illness like any other illness – Biological not persons fault User movement – Psychological – oppression and social causes
Social Class & Mental Health Black report – Lower SES associated with greater morbidity and mortality Mental health – poverty and mental health Affective disorders diagnosed evenly across social classes Strong correlation between low SES and schizophrenia
Relationship Between SES and MH Social drift theory Life events – Greater negative life events in low SES Social causation – Material deprivation – Less access to resources – Poorer environment – Health behaviour
MH and Employment Better prognosis for those diagnosed with psychosis who are employed Work factor in depression – relationship between anxiety and depression and SES dependent on employment status – Unemployed men more likely to have MH problems than unemployed women
Sick Role & Illness Behaviour Sick role – sanctioned deviance, Policed by medical profession Exit sick role (get better) Chronic condition corpse Becoming ill SICK! Medical profession
Sick Role Talcott Parsons (1951) Contract with rules: – Rights: The sick person is exempt from normal social roles The sick person is not responsible for their condition – Obligations: The sick person should try to get well The sick person should seek technically competent help and cooperate with the medical professional
Sick Roles Variety of sick roles culturally – Baby – Corpse role – Angry – Scapegoat – Sometimes not allowed any
Sick Roles Active Chronic Patient as sacred Patient as shameful Passive Acute “Angry” “Scapegoated” “Baby” “Corpse”
Gender & MH Some diagnoses not gendered, schizophrenia and bi-polar Some inevitably limited to women – Post-natal and post partum psychosis Overwhelmingly female – Anorexia & bulimia – BPD Overwhelmingly male – antisocial personality disorder – Sex offenders Substance misuse more likely in men Anxiety and depression more likely in women Dementia (women live longer)
Over–representation of Women Society causes excessive ‘mental illness’ – Increased social demands and lack of structure – Entrapment and humiliation Increased vulnerability – adverse childhood events –CSA, rape Measurement artefact – Research tools – Help seeking
Women and Mental Health Labelling theory – Feminist influence – Women labelled more often than men – GP’s more likely to label psychological problems in women than men – Sexism in psychiatry – Medicalisation of female experience – The great tranqulizer debate
Men & Mental Health Men are viewed as more dangerous – weak stereotype Men over represented in prison, women in mental health population – social judgements Gender expectations – – Externalising vs internalising
Culture & Mental Health How universal are psychiatric diagnoses? – Historical context – NY vs London – Categorisation WHO study – Cross culturally something approximating schizophrenia in each country (this can be debated) – Prognosis, better level of care and input = better outcomes? NO!
Culture and Mental health Two parts – The symptoms – Social responses to the symptons – social process Western medicalised – internalised –internal stable attribution….controllable? Developing – spirit possession – external, unstable explanation….uncontrollable?
Culture and Mental Health Emic vs etic approaches Culture bound syndromes – Category fallacy? – Cultures undeveloped – Variant of western diagnoses?
Variation in presentation of symptoms / epidemiology across cultures BiologicalSocialCultural Hypothesised influence on presentation Amok Latah “psychosis” Depression Personalistic Culture and Category Anorexia & Bulimia
Ethnicity and Mental health Different ethnicities over represented in psychiatric populations Irish and Afro-Caribbean over represented why not others? – Genetics – Migration – Racism Cultural explanations – belonging / fragmentation