SOC3040 Sociology of Mental Health
Rob Meadows
Wednesday 10am-12pm 72MS03
Week 1 – Introductions:
What is mental illness?
DSM – several different versions exist, used more in the US.
ICD – used more in the UK.
‘A mental disorder is a syndrome characterised by clinically significant disturbance in an
individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the
psychological, biological or developmental processes underlying mental function…’
Not just about what happens and how you’re feeling, but whether that’s allowed, approved
and expected. (eg it is expected you’d be sad after the death of a relative).
Starts as physical…but goes down to the social.
Socially deviant behaviours are not mental disorders (eg homosexuality).
DSM has huge influence – although the UK uses the ICD they state that the DSM is still very
much influential.
Idea that things have to be associated with distress to be a problem.
DSM, ICD but also definitions that come outside of these.
Criticisms:
DSM-5 criticised for an unhealthy influence of the pharmaceutical industry.
Increasing tendency to medicalise patterns of behaviour that aren’t considered to be
particularly extreme.
Dangerous and Severe Personality Disorder – a legal definition rather than a clinical one.
Its definition is ‘fluid’ and ‘contested’.
Mental Health Policy:
‘Madness’ as a domestic problem dealt with in the home for much of history.
‘Bedlam’ set up in 1377 in London. Separation of those who are mentally ill away from
others. Bedlam became an attraction for people to visit.
1774 Madhouses act – private business, became regulated.
1845 5,000 people housed in these asylums.
During 19th century number of asylums increased dramatically, so did the number of
inmates.
1890 Lunacy Act – rights of the individual but normally those outside of the asylum.
WWI – Shellshock: suggests that external forces can cause mental illness, no longer eugenic.
1930 Mental Treatment Act – legislative support to voluntary treatment.
NHS – assumed responsibility for mental health.
Mental deficiency hospitals – for those with learning disabilities were overcrowded and
underfunded, a shift to community care.
Pattern of community care, lack of funding, lack of support.
Shifts in the way that we respond to mental health as well as shifts in the way we talk about
it.
Experiences – from ‘upstream’ to ‘downstream’:
‘Sufferers’ – Cockerham.
Sociologised mental illness:
, Alienation from place: first stage of mental illness is an alienation/disruption
of place.
Mental health is fluid and contested on the micro level as well as the macro
level.
DSM – 5 Autism:
In DSM-4 there were four different categories of autism.
In DSM-5 there was a shrinking; into one category.
People had been defined as having one disorder that they suddenly didn’t have anymore.
Medicalisation and domain contraction:
Domain contraction: shrinking the amount of people coming into contact with medicine
because they no longer fit into definitions.
Service users demand re-medicalisation.
Conclusion:
Largely in the domain of psychiatry…
…but with a complex relationship with law.
Fluid and shifting/complex and contested.
With both ‘downstream’ and ‘upstream’ areas of interest.
Week 1 Reading Busfield, J. (2011) Mental Illness. Polity Press: Cambridge.
Summary:
Much contention around the contextual terrain of mental illness.
Lay ideas are informed by and interact with dominant cultural ideas.
Our thinking surrounding pathological mental functioning has been shaped mostly by the
medical profession. A long history of this.
Multiple different ways of defining mental illness; disease, disorder etc.
Key boundaries between bodily and mental illnesses, between normal and pathological
mental functioning and between mental illness and wrongdoing/social deviance.
Diagnoses of mental disorders provide many useful functions eg they help individuals
understand their feelings, they help policy makers plan services.
DSM and ICD as two hugely influential classifications.
DSM-III influenced by clinicians who wanted a larger range of mental disorders to be
included.
Issues with the reliability and validity of the DSM.
Both DSM and ICD provide a definition of mental disorder; both grounded in the medical
realm and not an impairment of normal social functioning.
Chapter goes on to discuss a few key disorders and the important elements within them, this
includes: dementia, schizophrenia, bipolar disorder, depressive disorders, alcohol disorders
and anti-social personality disorder.
Decision making around the construction and delineation of diagnostic categories is
contentious and confusing, and continuing revisions and additions in the ICD and DSM show
that this continues.
Notes:
Ch.1 Concepts and Classifications:
Pg.7
‘The conceptual terrain surrounding mental illness is complex and often confusing.’
Early ideas:
, Pg.8
‘Judgement’s of people’s mental functioning, whether of thought, emotion or behaviour, are
an integral part of everyday social interaction across different societies.’
‘Judgements of mental functioning are at the core of the terrain now termed mental illness.’
‘The terms used often reflect prevailing belief systems – for instance the term lunacy…
incorporated the idea that the disturbed behaviour was caused by the action of the moon.’
‘Lay ideas and beliefs are informed by, and interact with, dominant cultural ideas, and this
applies to current professional thinking about medical disorder no less than to earlier
understandings – lay beliefs and ideas underpinning professional ideas and practices, and
these in turn shaping lay ideas, the two existing in dynamic interaction.’
Present day thinking about pathological mental functioning has been shaped mostly by the
medical profession.
This stems from Greek and Roman ideas ‘mania and melancholia.’
Pg.9
MacDonald (1981) analysed case notes of Richard Napier a 17 th century physician.
Pg.10
MacDonald (1981) found that labels used for mental problems changed depending on the
individual’s social status. ‘Melancholia was the term usually applied to the complaints of
upper-classMu individuals, whereas persons of lower standing were often described, or
described themselves as ‘mopish’ – a lay, not medical term.’
‘Lay and medical thinking about madness was transformed in Western Europe in the
Enlightenment with a new emphasis on ‘reason’ – a time according to Foucault (1967) where
madness was increasingly sequestered in institutions and silenced.’
In the eighteenth and nineteenth century asylums were established.
Psychiatry developed out of medical professionals working in asylums.
Pg.11
‘The legal endeavours involved in the well-publicised trials of individual’s considered mad
who had committed major offences, such as murder, were associated with the development
of the insanity defence and also shaped thinking about madness.’ This happened in the
1800’s.
After this, there were three developments which had an impact on medical thinking about
mental problems:
1. There was activity outside of asylums for those with less severe problems.
2. A new generation of psychoactive medications were developed.
3. There was a move away from asylums to community health care.
Pg.12
In trying to align with other forms of medicine psychiatry had taken on influences from
biochemistry and genetics, but it has also had to draw on psychology and social sciences.
The conceptual terrain:
‘The terms mental disease and mental illness reflect the medical domination of the territory
of mental problems, established during the nineteenth and twentieth centuries but never
entirely secure.’
Both ‘disease’ and ‘illness’ suggest the condition isn’t permanent as ‘disability’ would be
used.
‘Sociologists typically consider disease, referring to the changes that occur in the body, and
illness referring to the experience of disease.’
Pg.13
‘Disease is a biological state, illness is a social one.’
Parsons (1951) ‘Sick Role’.
It has become common to talk about mental health rather than mental illness.
, World health organisation defines mental health as ‘a state of well-being in which the
individual realises his or her own abilities, can cope with the normal stressors of life, can
work productively and fruitfully, and is able to make a contribution to his or her community.’
(2005).
Focus on social functioning, linking to Parsons.
Pg.14
Distress as a key indicator or mental disorder.
Key boundaries: contrast between bodily and mental illnesses. Boundary between normal
and pathological mental functioning.
Pg.15
‘The increasing focus on classifying and measuring mental disorders in terms of symptoms,
without attention to their context, has rather undermined the distinction between distress
and disorder in psychiatric thinking.’
Third boundary: between mental illness and wrongdoing/social deviance.
Pg.16
‘This is an important boundary and relates to assumptions about agency and responsibility,
with illness ranking as ‘the perfect alibi for responsibility.’
Parsons sick role: a key feature is that the individual cannot get better by their own will,
there is a lack of agency that doesn’t apply to deviance.
Pg.17
‘On occasions a particular behaviour has moved from being defined as sinful (wrongdoing),
to the status of mental illness and then to the non-pathological – masturbation is one
instance.’
Psychiatric classifications, the categorical model and diagnosis:
‘Psychiatrists, as doctors with official jurisdiction over illness, set the formal, albeit highly
contested, boundaries of mental illness – they manage its boundaries.’
‘Classifications consist of sets of categories and provide frameworks through which
individual’s sort phenomena to help them order and make sense of the world.’
Psychiatric classifications based mostly on symptoms.
Pg.18
Both reliability and validity of psychiatric diagnoses have been criticised.
Pg.19
Although diagnosis is often considered the foundation of clinical decisions concerning the
individuals, there are cases in which treatment shapes diagnosis.
Diagnoses can help individual’s make sense of how they are feeling.
They also set boundaries to access; eg in the US healthcare system.
Diagnoses are also useful to ‘managers, funders, and policy makers’ who need statistics in
order to assess health needs and plan services.
They are also important to evaluate psychiatric treatments.
The DSM and ICD:
Pg.20
The two main classifications; DSM used widely in America, ICD more international.
Pg.21
Two main classifications have influenced each other.
The development of psychiatric classifications:
Early classifications listed fewer disorders and centred around severe illnesses those in
asylums had.
WW2 changed psychiatry; more psychiatrists working outside of asylums and the
acceptance that external events could trigger mental disorder.
Pg.22
Rob Meadows
Wednesday 10am-12pm 72MS03
Week 1 – Introductions:
What is mental illness?
DSM – several different versions exist, used more in the US.
ICD – used more in the UK.
‘A mental disorder is a syndrome characterised by clinically significant disturbance in an
individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the
psychological, biological or developmental processes underlying mental function…’
Not just about what happens and how you’re feeling, but whether that’s allowed, approved
and expected. (eg it is expected you’d be sad after the death of a relative).
Starts as physical…but goes down to the social.
Socially deviant behaviours are not mental disorders (eg homosexuality).
DSM has huge influence – although the UK uses the ICD they state that the DSM is still very
much influential.
Idea that things have to be associated with distress to be a problem.
DSM, ICD but also definitions that come outside of these.
Criticisms:
DSM-5 criticised for an unhealthy influence of the pharmaceutical industry.
Increasing tendency to medicalise patterns of behaviour that aren’t considered to be
particularly extreme.
Dangerous and Severe Personality Disorder – a legal definition rather than a clinical one.
Its definition is ‘fluid’ and ‘contested’.
Mental Health Policy:
‘Madness’ as a domestic problem dealt with in the home for much of history.
‘Bedlam’ set up in 1377 in London. Separation of those who are mentally ill away from
others. Bedlam became an attraction for people to visit.
1774 Madhouses act – private business, became regulated.
1845 5,000 people housed in these asylums.
During 19th century number of asylums increased dramatically, so did the number of
inmates.
1890 Lunacy Act – rights of the individual but normally those outside of the asylum.
WWI – Shellshock: suggests that external forces can cause mental illness, no longer eugenic.
1930 Mental Treatment Act – legislative support to voluntary treatment.
NHS – assumed responsibility for mental health.
Mental deficiency hospitals – for those with learning disabilities were overcrowded and
underfunded, a shift to community care.
Pattern of community care, lack of funding, lack of support.
Shifts in the way that we respond to mental health as well as shifts in the way we talk about
it.
Experiences – from ‘upstream’ to ‘downstream’:
‘Sufferers’ – Cockerham.
Sociologised mental illness:
, Alienation from place: first stage of mental illness is an alienation/disruption
of place.
Mental health is fluid and contested on the micro level as well as the macro
level.
DSM – 5 Autism:
In DSM-4 there were four different categories of autism.
In DSM-5 there was a shrinking; into one category.
People had been defined as having one disorder that they suddenly didn’t have anymore.
Medicalisation and domain contraction:
Domain contraction: shrinking the amount of people coming into contact with medicine
because they no longer fit into definitions.
Service users demand re-medicalisation.
Conclusion:
Largely in the domain of psychiatry…
…but with a complex relationship with law.
Fluid and shifting/complex and contested.
With both ‘downstream’ and ‘upstream’ areas of interest.
Week 1 Reading Busfield, J. (2011) Mental Illness. Polity Press: Cambridge.
Summary:
Much contention around the contextual terrain of mental illness.
Lay ideas are informed by and interact with dominant cultural ideas.
Our thinking surrounding pathological mental functioning has been shaped mostly by the
medical profession. A long history of this.
Multiple different ways of defining mental illness; disease, disorder etc.
Key boundaries between bodily and mental illnesses, between normal and pathological
mental functioning and between mental illness and wrongdoing/social deviance.
Diagnoses of mental disorders provide many useful functions eg they help individuals
understand their feelings, they help policy makers plan services.
DSM and ICD as two hugely influential classifications.
DSM-III influenced by clinicians who wanted a larger range of mental disorders to be
included.
Issues with the reliability and validity of the DSM.
Both DSM and ICD provide a definition of mental disorder; both grounded in the medical
realm and not an impairment of normal social functioning.
Chapter goes on to discuss a few key disorders and the important elements within them, this
includes: dementia, schizophrenia, bipolar disorder, depressive disorders, alcohol disorders
and anti-social personality disorder.
Decision making around the construction and delineation of diagnostic categories is
contentious and confusing, and continuing revisions and additions in the ICD and DSM show
that this continues.
Notes:
Ch.1 Concepts and Classifications:
Pg.7
‘The conceptual terrain surrounding mental illness is complex and often confusing.’
Early ideas:
, Pg.8
‘Judgement’s of people’s mental functioning, whether of thought, emotion or behaviour, are
an integral part of everyday social interaction across different societies.’
‘Judgements of mental functioning are at the core of the terrain now termed mental illness.’
‘The terms used often reflect prevailing belief systems – for instance the term lunacy…
incorporated the idea that the disturbed behaviour was caused by the action of the moon.’
‘Lay ideas and beliefs are informed by, and interact with, dominant cultural ideas, and this
applies to current professional thinking about medical disorder no less than to earlier
understandings – lay beliefs and ideas underpinning professional ideas and practices, and
these in turn shaping lay ideas, the two existing in dynamic interaction.’
Present day thinking about pathological mental functioning has been shaped mostly by the
medical profession.
This stems from Greek and Roman ideas ‘mania and melancholia.’
Pg.9
MacDonald (1981) analysed case notes of Richard Napier a 17 th century physician.
Pg.10
MacDonald (1981) found that labels used for mental problems changed depending on the
individual’s social status. ‘Melancholia was the term usually applied to the complaints of
upper-classMu individuals, whereas persons of lower standing were often described, or
described themselves as ‘mopish’ – a lay, not medical term.’
‘Lay and medical thinking about madness was transformed in Western Europe in the
Enlightenment with a new emphasis on ‘reason’ – a time according to Foucault (1967) where
madness was increasingly sequestered in institutions and silenced.’
In the eighteenth and nineteenth century asylums were established.
Psychiatry developed out of medical professionals working in asylums.
Pg.11
‘The legal endeavours involved in the well-publicised trials of individual’s considered mad
who had committed major offences, such as murder, were associated with the development
of the insanity defence and also shaped thinking about madness.’ This happened in the
1800’s.
After this, there were three developments which had an impact on medical thinking about
mental problems:
1. There was activity outside of asylums for those with less severe problems.
2. A new generation of psychoactive medications were developed.
3. There was a move away from asylums to community health care.
Pg.12
In trying to align with other forms of medicine psychiatry had taken on influences from
biochemistry and genetics, but it has also had to draw on psychology and social sciences.
The conceptual terrain:
‘The terms mental disease and mental illness reflect the medical domination of the territory
of mental problems, established during the nineteenth and twentieth centuries but never
entirely secure.’
Both ‘disease’ and ‘illness’ suggest the condition isn’t permanent as ‘disability’ would be
used.
‘Sociologists typically consider disease, referring to the changes that occur in the body, and
illness referring to the experience of disease.’
Pg.13
‘Disease is a biological state, illness is a social one.’
Parsons (1951) ‘Sick Role’.
It has become common to talk about mental health rather than mental illness.
, World health organisation defines mental health as ‘a state of well-being in which the
individual realises his or her own abilities, can cope with the normal stressors of life, can
work productively and fruitfully, and is able to make a contribution to his or her community.’
(2005).
Focus on social functioning, linking to Parsons.
Pg.14
Distress as a key indicator or mental disorder.
Key boundaries: contrast between bodily and mental illnesses. Boundary between normal
and pathological mental functioning.
Pg.15
‘The increasing focus on classifying and measuring mental disorders in terms of symptoms,
without attention to their context, has rather undermined the distinction between distress
and disorder in psychiatric thinking.’
Third boundary: between mental illness and wrongdoing/social deviance.
Pg.16
‘This is an important boundary and relates to assumptions about agency and responsibility,
with illness ranking as ‘the perfect alibi for responsibility.’
Parsons sick role: a key feature is that the individual cannot get better by their own will,
there is a lack of agency that doesn’t apply to deviance.
Pg.17
‘On occasions a particular behaviour has moved from being defined as sinful (wrongdoing),
to the status of mental illness and then to the non-pathological – masturbation is one
instance.’
Psychiatric classifications, the categorical model and diagnosis:
‘Psychiatrists, as doctors with official jurisdiction over illness, set the formal, albeit highly
contested, boundaries of mental illness – they manage its boundaries.’
‘Classifications consist of sets of categories and provide frameworks through which
individual’s sort phenomena to help them order and make sense of the world.’
Psychiatric classifications based mostly on symptoms.
Pg.18
Both reliability and validity of psychiatric diagnoses have been criticised.
Pg.19
Although diagnosis is often considered the foundation of clinical decisions concerning the
individuals, there are cases in which treatment shapes diagnosis.
Diagnoses can help individual’s make sense of how they are feeling.
They also set boundaries to access; eg in the US healthcare system.
Diagnoses are also useful to ‘managers, funders, and policy makers’ who need statistics in
order to assess health needs and plan services.
They are also important to evaluate psychiatric treatments.
The DSM and ICD:
Pg.20
The two main classifications; DSM used widely in America, ICD more international.
Pg.21
Two main classifications have influenced each other.
The development of psychiatric classifications:
Early classifications listed fewer disorders and centred around severe illnesses those in
asylums had.
WW2 changed psychiatry; more psychiatrists working outside of asylums and the
acceptance that external events could trigger mental disorder.
Pg.22
