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Sociology, Culture and Psychiatry Dr Alex Hunt Clinical Psychologist.

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Presentation on theme: "Sociology, Culture and Psychiatry Dr Alex Hunt Clinical Psychologist."— Presentation transcript:

1 Sociology, Culture and Psychiatry Dr Alex Hunt Clinical Psychologist

2 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

3 Conceptions of Mental Health Social causation Critical theory Social constructivism (constructionism) Critical realism (medical) anthropology

4 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

5 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

6 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

7 Conception of mental health Bad NormalAbnormal Mad

8 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.

9 Response to Stigma Information control – Unlikely to be discovered conceal Compensate Exaggerate (generalise) Pass, get by Switch styles

10 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)

11 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

12 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

13 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

14 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

15 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

16 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

17 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

18 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

19 Sick Roles Variety of sick roles culturally – Baby – Corpse role – Angry – Scapegoat – Sometimes not allowed any

20 Sick Roles Active Chronic Patient as sacred Patient as shameful Passive Acute “Angry” “Scapegoated” “Baby” “Corpse”

21 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)

22 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

23 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

24 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

25 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!

26 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?

27 Culture and Mental Health Emic vs etic approaches Culture bound syndromes – Category fallacy? – Cultures undeveloped – Variant of western diagnoses?

28 Variation in presentation of symptoms / epidemiology across cultures BiologicalSocialCultural Hypothesised influence on presentation Amok Latah “psychosis” Depression Personalistic Culture and Category Anorexia & Bulimia

29 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

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