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Sociology, Culture and Psychiatry

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Presentation on theme: "Sociology, Culture and Psychiatry"— 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 Psychiatric - Biomedical model – mental illness approached the same as physical medicine diagnosis, 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 everything Psychological Statistical 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 - intelligence Ideal notion – humanistic – self actualising, or psychoanalytic – conscious over unconscious characteristics Presensce or absence of specific behaviours – maladative behaviour – who defines what is adaptive orf maladative, desired or undesired, again cultural relativism Distorted cognitions – thoughts which aare unhelpful or undisarable

3 Conceptions of Mental Health
Social causation Critical theory Social constructivism (constructionism) Critical realism (medical) anthropology Social 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 schizophrenia Social constructionism – reality is not self evident, stable and waiting to be discovered, but instead is a product of human activity 1. understanding the social forces which define a phenomenon 2. 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 relationships 3. 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.

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 Stereotype to stigma
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 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 - enlargement of the stereotype to cast the person as a deviatitive or undesirable social group Emotion reaction – anxiety, hostility, pity Moral reaction - paternalism, revulsion, horror Stigmatised 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:

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 In 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 psychiatry Global 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 time Madness is episodic, rarely persistent Creativity and madness, creativity transcends conventions, - bi-polar people are successful and creative…novel ideas and the energy to carry them through Obsessionality, prized in some regards and can out perform others; features of obsessive personality disorder read like Victorian virtues Spirituality 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.

7 Conception of mental health
Bad Abnormal Normal 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. Positive effects – access to treatment / normalising Negative effects – hierachy of stigma mentally ill are disvalued, below prostitution, eplipsey and alcoholism Fear of violence and need to keep social distance reduces with contact Modified 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.

9 Response to Stigma Information control Compensate
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 Faris times the rate of schizophrenia in poor neighbourhoods in Chicago compared to middle class districts hypothesized poverty and lack of social cohesion – social isolation hypothesis Social drift theory

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 Those in high social

17 Sick Role & Illness Behaviour
Sick role – sanctioned deviance, Policed by medical profession Exit sick role (get better) Becoming ill SICK! Chronic condition Parsons 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 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 there are three versions of sick role 1.conditional 2.unconditionally legitimate sick role. 3.illegitimate role:condition that is stigmatized by others. corpse 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 Patient as sacred “Baby” “Angry” Passive Acute Active
Chronic “Corpse” “Scapegoated” Patient as shameful

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) New slide; Gender Specific Risk Factors New slide; Gender Bias

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 Women’s Mental Health; The Facts

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 Culture and Category Personalistic
Variation in presentation of symptoms / epidemiology across cultures Biological Social Cultural Hypothesised influence on presentation Amok Latah “psychosis” Depression Personalistic 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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