Mental Illness + Deviance 2023 with complete solution

Mental illness • Is unintentional deviance - involves breaking of normative rules - is widespread, yet treated as statistically unusual; is highly stigmatized • Debates over definition: - popularity and medically regarded as organic disorder - this disputed among anti-psychiatry perspective - argue = problems of daily living are increasingly medicalized Mental Illness during Medieval Period • 13th C right & duty of King to protect MI - included all subjects- protection not based on land ownership • crown (King) enjoyed "Perogative Regis" - authority, privilege, immunity that belong to sovereign alone - ie King's authority over mental illness - acted as a guardian • 2 categories of MI at this time - Determination of based on commonness abilities of individual i) natural foods ii) persons non compos mentis (not of sound mind) • Natural fool - individuals who were mentally delayed since birth - condition was congenital, permanent "born that way" • Non compos mentis - individuals who become mentally impaired post-natal • 15th C legal changes regarding King's rights and duties - classification of idiot replaced fool - classification of lunatic replaced non compose mentis • Idiot (congenital) - King's duties involved: - protect individual's property from exploitation - provide necessities of life - King entitled to custody and revenues of idiot's land (profits went to the crown) • Lunatic (post-natal) - King's duties involved: - Guardianship, protected individual's estate from waste/destruction, sustained individual and family with estate $ - However $ earned form estates did not belong to the King - these individuals fared much better than the "idiot" • King protected property rights of the MI - not the individual or civil rights of MI individuals - only mentally ill individuals with property are of concern • King not active in management of MI individuals - was the responsibility of the family and community - also responsbile for homeless, physically handicapped • Mentally ill left "at large" in community - while families responsible, rec'd some subsidies from community (usually local parish) • If families lacked financial means/unable to care for: - Mentally ill wandered country side - Many ended up in state run asylums/poorhouse/jails - many forced to labour (workhouses) • Mentally ill treated in same manner as other deviants - only most violent/troublesome confined • All other types of deviance managed in similar ways - little effort made to segregate by deviance- were tolerated unless violent Psychiatric Ideas During Medieval Period • Came from all social classes - not solely ideas of social and political elites, aristocracy • Explanations of MI included: - God's Will, punishment for one's sins - physical injury or illness, sudden emotional shocks - demonic appraisals of mental illness very rare - one exception = one women's idiocy result of evil spirits • Humeral theory of illness - explained both mental and physical illnesses - established by Hippocrates = father of western medicine • Involved balance of 4 vital fluids: - blood, phlegm, yellow and black bile - determined individual's disposition and general health - when in balance = health - when imbalance = illness • Mental illness result of imbalance of 4 humours - imbalance of black bile caused melancholy/depression - black bile "boiling" in the brain caused mania Medical Illness in Colonial Period • MI part of mystery of divine (God's) will - was punishment for sinful behaviour - however, mix of science, folklore + theology shaped attitudes + practices toward MI - insanity different from demonic possession - insane treated differently from devil worshippers - however, witchcraft very real for Puritans + others (EU) - involve willing covenant with devil - implied rational choice - individuals seen as purposefully cavorting with evil - witchcraft an offence against God and community (special protocols for determining demonic possession) - however, witchcraft incidental in history of mental illness in colonies (satanism and madness were distant and distinguishable) - lunatics not directly responsible for their condition or fate, did not involve purposeful embrace of evil - mentally ill under protection of the sane - if indigent, subject to town support (same tradition as British) • MI regarded as an inevitable part of life Medieval Asylums • Variety of settings existed across EU: - monasteries and hospitals - few towns had fools towers (buildings to house the insane) - created to get MI "off the streets" were really jails, no cures offered • Parisian hospital Hotel Dieu (small # cells set aside) • Germany = designated madhouse • Spain = hospitals Early Modern Asylums • MI remained a domestic problem - Families and parish authorities central to care - Lunatics "boarded out" to members of local community - or committed to private madhouses - few specialist institutions existed turn of 18th C - Violent confined to charitable asylums - Bedlam (or jails or workhouses) • All were warehouses for the insane - were retched places - most left there to die, were ignored/forgoten • Late 18th C formal solutions for MI begin to emerge - increased notion that mental illness and deviant behaviour curable - by allowing poor/insane/criminal with withdraw from society - offer discipline, regimentation, better living conditions (could function in contemporary life) • Massive structures built for specialized deviant populations - what Goffman called total institutions Included: - insane asylums and hospitals - workhouses for able bodied poor - orphanages and juvenile reformatories - however, the MI found throughout all of these institutions • Initial intent of asylums: - serve as enters of "moral treatment" - offer human, nonviolent, homelike environments - inmates taught religious values and occupation skills - receive medical treatment - were rehabilitative in focus - assure safety of the public - rid society of the inconvenient, troublesome • However, cure/rehabilitative goals unsuccessful - due to profound political, economic and social changes - increased industrialization, immigration, urbanization - conditions in asylum and poorhouses deteriorated - were overcrowded, filthy and disease ridden - cure goals unachievable, individuals not given proper care - institutions seen by reformers as inhumane and counterproductive Mental Hygiene Movement • 19 - 20 th Cs, increased criticism of asylums - lead to social reforms - mental hygeine movement - shift away from custodial care to prevention and intervention - new therapeutic optimism emerged (based on eugenic theories of disease and environmental causation) - insane asylums re-designated as hospitals - mental illness should be treated as separate, identifiable group • However, this too fails - series of treatment failures - no cures - mental hospitals become overcrowded (abysmal living conditions continue) • 1950 + 60s, optimism around these institutions - calls for non-institutional alternations - eliminates large custodial faciliites Deinstitutionalization • Emerges as next cycle of reform - promises cures for MI - Purpose = reduce inpatient population of public mental hospitals - hospitalization only for severely MI - those dangerous to self and others • Ideal of community-based mental health emerges - as centrepiece of patient care - doctors claim most mentally ill able to live in community if given community support, can return to hospital if necessary • Approached assumed: - individuals would successfully reintegrate into daily life - families would remain intact - employment minimally disrupted • Also promise of new treatment strategies - increased psycho active drugs (thorazine, lithium) - chemcial treatments for organic chemical disturbances - were cheap and portable - easily administered to patients living in community • However, surgery, electroshock, lobotomy still used for punitive purposes • Deinstitutionalization a colossal failure: - lack of funding for community-based treatment programs - programs not put in place - community MH centres financially strapped, couldn't cope - Many mentally ill lacked a supportive home to return to (left to fend for themselves in hostile communities) - many unable to care for themselves (incapable of managing meds, follow up care, unable to access coordinated community care) - these services privileged the affluent, and those with acute MI conditions - chronically mentally ill incapable of living in community without intense support - became more visible in community (lead to increased contact with police, not adequately trained to deal with MI); lead to increased criminalization of mentally ill (feared b/c of bizarre behaviour) - local jails and prisons became new asylums - more MI incarcerated than in hospitals - did not receive proper care and treatment • This "reform" a return to "Dark Ages" - jails replacing hospitals - society not caring for those who cannot care for selves - increased maltreatment placed in solitary confinement - are under and over medicated - beaten by guards and other inmates; preyed upon by violent predators Myth of Mental Illness • Thomas Szasz Anti-Psychiatric Approach - questions existence of mental illness, says it's a myth, can only exist theoretically Why? • Theories of MI... - have changed over time (were once assumed as real/fact, but no longer are) - differ across cultures (what is MI in one culture does not exist in another) - Mental illness unlike other organic disease of the brain; diseases are what individuals have, behaviour is what individuals do; diseases are malfunctions of the body, misbehaviour is not a disease • Disease model of MI assumes: - some type of neurological defect can be found - problems of daily living are due to physio-chemical processes (eventually will be discovered and cured by medical research) • Szasz argues MI not a sign of brain disease - this misleading and unnecessary - rather mental illness is a problem in living (troubles associated with getting along with others) • Szasz highly critical of medicine in general, and psychiatry in particular - its categorization as masturbation as a disease - its use of lobotomy to treat psychosis - use of medical discourses to describe misbehaviour • Mental illness and mental disorder - are pseudoscientific categories - are value judgements - support power of psychiatry • Schizoprehnia is: - a judgement of extreme psychiatric and social disapproval - the sacred symbol of psychiatry - provides justification for psychiatric theories, treatments, abuses and reforms • By calling people "diseased" - psychiatry denies individuals responsibility as moral agents - take on authority to control - via medical intervention • For Szasz, psychiatry a pseudoscience - it parodies and mimics medicine - uses medical sounding words invented over 100 years ago - are new priests (Deal with spiritual problems and vexations) - problems in living that have plagued people forever