Socio-cultural Explanations of Schizophrenia Labelling

Today’s session We are learning about... We are learning how to... We need to use... Labelling theory and the anti-psychiatry movement Understand how theories develop and change in the light of new research NoticingEvaluatingDistilling

The Anti-Psychiatry movement There was a critical movement of opposition against the dominant biomedical approach in psychiatry in the 1960’s. There was a critical movement of opposition against the dominant biomedical approach in psychiatry in the 1960’s. Important thinkers included: Important thinkers included: Szasz Szasz R.D Laing R.D Laing Scheff Scheff Rosenhan Rosenhan

Szasz (1960) “The Myth of mental illness." Mental illness is a metaphor (metaphorical disease). Mental illness is a metaphor (metaphorical disease). "disease“ - a demonstrable biological process that affects the bodies of living organisms "disease“ - a demonstrable biological process that affects the bodies of living organisms "mental illness“ - the undesirable thoughts, feelings, and behaviors of persons. "mental illness“ - the undesirable thoughts, feelings, and behaviors of persons. The classification of (mis)behaviour as an illness provides ideological justification for state- sponsored social control as medical ‘treatment’ The classification of (mis)behaviour as an illness provides ideological justification for state- sponsored social control as medical ‘treatment’

Embedded clip Madness: In Two Minds Madness: In Two Minds

Labelling Theory (Scheff, 1966) Schizophrenia is not a disease, but a learned social role. Schizophrenia is not a disease, but a learned social role. It is a label that is applied to ordinary people who have been caught breaking the residual rules of society. It is a label that is applied to ordinary people who have been caught breaking the residual rules of society.

Residual rules These are the rules of society that are not written down or taught. They are rules about what we do (and do not do) in all sorts of situations. For example: These are the rules of society that are not written down or taught. They are rules about what we do (and do not do) in all sorts of situations. For example: Talk to people not objects; Talk to people not objects; Talk only to people who are there; Talk only to people who are there; Respond to what they say, not to something else Respond to what they say, not to something else

Scheff (1966) Scheff (1966) People who have these labels applied to them behave accordingly, adopting the role of a crazy person. People who have these labels applied to them behave accordingly, adopting the role of a crazy person. Without the diagnostic label, the deviant behaviour would be transient. Without the diagnostic label, the deviant behaviour would be transient.

What about you? Think of at least one time that you have broken a residual rule. Think of at least one time that you have broken a residual rule. Could your behaviour could have been seen as symptom? Could your behaviour could have been seen as symptom? Can you remember seeing anyone else breaking a residual rule? Can you remember seeing anyone else breaking a residual rule?

Simply broken social rules? Becker (1963) suggests that psychiatric treatment is usually based on the application of middle class values regarding appropriate behaviour to, mostly, working class patients. Becker (1963) suggests that psychiatric treatment is usually based on the application of middle class values regarding appropriate behaviour to, mostly, working class patients. Consider also white, middle class values and expectations being applied inappropriately to different cultures/religions/ethnic groups. Consider also white, middle class values and expectations being applied inappropriately to different cultures/religions/ethnic groups.

Can we explain schizophrenia simply by calling it deviant behaviour (residual rule breaking)? Can we explain schizophrenia simply by calling it deviant behaviour (residual rule breaking)? Why? Why not? Why? Why not?

Rosenhan (1973) Discuss the claims made about Rosenhan’s pseudopatient study in your groups. Decide how far you agree with the statements

Problems with labelling theory Trivialises serious mental illness. Trivialises serious mental illness. There is little evidence that unusual behaviours (norm violations) that are not given a label, go away by themselves. There is little evidence that unusual behaviours (norm violations) that are not given a label, go away by themselves. Rejects genetic and neurological evidence. Rejects genetic and neurological evidence.

Interpretation of research put forward by Scheff to support the original labelling theory has been heavily criticised (e.g. Gove, 1970, 1975). Interpretation of research put forward by Scheff to support the original labelling theory has been heavily criticised (e.g. Gove, 1970, 1975). Developments and research since the original publication have made it clear that there is a biological component in Schizophrenia. Developments and research since the original publication have made it clear that there is a biological component in Schizophrenia.

Link et al. (1989) Link et al. (1989) proposed a ‘modified labeling approach’ How do they suggest labelling theory should be modified? How do they suggest labelling theory should be modified? What evidence do they suggest to support this approach? What evidence do they suggest to support this approach?

Scheff (1999, 2010) In more recent publications, Scheff has acknowledged these issues and presented modifications to the original theory. In more recent publications, Scheff has acknowledged these issues and presented modifications to the original theory.

Scheff (1999) modified his position and suggests an integrated approach, stating that: “The original labeling theory of mental illness, is only one of many partial points of view. Each of these points of view is useful, but in the long run, it will be necessary to integrate the differing standpoints, especially the psychological, sociological, and biological approaches.”

Scheff, 2010 Scheff suggests that a useful approach for therapy is ‘normalising’ those who break the residual (unstated) rules. Scheff suggests that a useful approach for therapy is ‘normalising’ those who break the residual (unstated) rules. This means interpreting their behaviour as normal and allowing them to feel they are accepted rather than labelled and rejected.

Read..... Szasz (1960) The Myth of Mental Illness Szasz (1960) The Myth of Mental Illness Szasz (1989) Manifesto Szasz (1989) Manifesto Scheff (1999) Extracts from the 3 rd edition of ‘Being Mentally Ill’ Scheff (1999) Extracts from the 3 rd edition of ‘Being Mentally Ill’ Scheff (2010) A more recent article, suggesting implications and applications of a modified labelling theory. Scheff (2010) A more recent article, suggesting implications and applications of a modified labelling theory.

Distilling Considering the points and arguments made and the evidence presented, is there any room for the labelling theory of Schizophrenia today?

Homework - Essay Plan ‘The Biomedical Model tells us all we need to know about the causes of schizophrenia’ Discuss. ‘The Biomedical Model tells us all we need to know about the causes of schizophrenia’ Discuss. Write an essay plan to address this statement. Write an essay plan to address this statement. Next lesson – Socio-cultural explanations of Schizophrenia cont. – Family Dysfunction (you will then add this to your plan!) Next lesson – Socio-cultural explanations of Schizophrenia cont. – Family Dysfunction (you will then add this to your plan!)