Problems of Mental Illness and Treatment

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					Problems of Mental Illness
     and Treatments

        Chapter 3
   Mental Illness as a Social Problem

• Until the mid part of the twentieth century many
  people who had physical problems were classified
  as mentally ill
• Social institutions are under strain in dealing with
  the enormity of the problem
• The severely mentally ill who cannot take care of
• The social impact of deinstitutionalization
      Perspectives on Mental Illness

• Interactionist perspective – focus is on the social
  construction of mental illness
• How definitions of “normal” and “deviant”
  behavior in social situations lead to definitions of
  mental illness
• Conflict perspective – focus is on how mental
  illness is associated with economic and social
  inequality in society
      Perspectives on Mental Illness

• Functionalist perspective – focus is on how
  mental illness challenges our ability to provide
  effective treatment
        Suicide and Mental Illness

• Suicide ranks third as the cause of death for young
• Suicide second highest cause of death among
  college students
• Men and women report suicidal thoughts with the
  same frequency
• Young males are three times more likely to
  commit suicide than women
        Suicide and Mental Illness

• Mental illness is a major contributor of suicide
• Half of those diagnosed with bipolar disorder will
  attempt suicide
• Depression and suicide
• Dementia among the elderly and suicide
         The Social Construction
            of Mental Illness
• Defining Mental Illness
• Three different models of mental illness
            » 1. Medical model and mental illness as
              a disease
            » 2. Mental illness as deviance
            » 3. Mental illness as a method by
              which governments define and control
              certain types of people
         The Social Construction
            of Mental Illness
• The Medical Model
• Mental illness is a disease with biological
• Mental illness as a disease ignores the role
  of environment as a possible factor
          The Social Construction
             of Mental Illness
• Mental Illness as Deviance
• Mental illness as a departure from social
  expectations within society
• Thomas Scheff – mental disorders as a form of
  residual deviance in society
             » Society labels and defines a behavior,
               person or condition as mental illness
             » Once labeled a person is offered the
         The Social Construction
            of Mental Illness
• Mental illness as problems with living
• Thomas Szasz – mental illness is a myth
             » Mental illness stems from unresolved
               conflicts with problems with living
• Thomas Szasz’s approach focuses on the issues of
  justice and freedom of those that are labeled
  mentally ill
          The Social Construction
             of Mental Illness
• Social construction of mental illness focuses on all
  three approaches
• 1. Biological basis of mental illness
• 2. Mentally ill are often treated as deviants
• 3. Labeling someone mentally ill is often a
  convenient way for society to rid itself of those
  that are seen as socially undesirable
   Classification of Mental Disorders

• American Psychiatric Association
• Diagnostic and Statistical Manual of Mental
            » Affective Disorders
            » Anxiety Disorders
            » Somatoform disorders
            » Psychosexual disorders
             Diagnosis or Label?

• Culture and the definition and classification of
  mental disorders
            » Just like some physical disorders are
              culturally defined so are mental
            » Mental diagnoses often reflect the
              cultural values
             Diagnosis or Label?

• There are three problems with labeling people
  mentally ill
             » 1. We begin to perceive the behavior
               as sick rather than something to
             » 2. Gives public agencies the right to
             » 3. Allows the mentally ill to see
               themselves as rule breakers and
     Mental Illness Among Combatants
         in Afghanistan and Iraq
• Once called shell shock or combat fatigue, what is
  now known as post-traumatic stress disorder, or
  PTSD, is a severe problem in war, including the
  most recent conflicts in Iraq and Afghanistan.
    Inequality, Conflict, and Mental
• Distinction between incidence and prevalence of
  mental disorders
• Conflict theory and mental health
             » Inequalities of wealth and power
               produce inequalities in access to
               effective treatment
             » Poverty and its relationship to stress
               and mental health
   Social Class and Mental Disorder

• Rate of severe mental illness is higher among
  those with lower socioeconomic status
• Socioeconomic status as cause or effect of severe
  mental disability
            » Social stress hypothesis- stress of
              poverty as a cause of severe mental
            » Drift hypothesis – mental illness leads
              to a drift into poverty
    Mental Disorder and Urban Life

• Urban environments and mental illness
• Household crowding is related to mental health
           » Objective crowding - number of
             persons per room
           » Subjective crowding - excessive
             demands and lack of privacy or space
                 Other Factors

• Race – social class is more salient than race in
  explaining mental illness
            » Higher rate of poverty among
• Sex – overall rates for men and women are about
  the same
• Chesler’s study- gender roles and mental illness
            » Women that depart from traditional
              roles are more likely to be defined as
                  Other Factors

•   Sex and mental illness
•   Women have higher rates of depression
•   Men have higher rates of personality disorders
•   Age and mental illness
•   In contrast to most severe and disabling diseases,
    mental illness begins early in life.
          Institutional Problems
          of Treatment and Care
• Methods of Treatment
• Nonmedical Forms of Treatment
• Primary form of nonmedical treatment is talk
• Psychotherapy
• Client-centered therapy
• Hypnosis
            Methods of Treatment

•   Medical Approaches to Treatment
•   Psychotropic drug treatment and chemotherapy
•   Shock treatment
•   Psychosurgery
        Changes in Mental-Health
          Treatment and Care
• Lack of treatment is one of the most persistent
  social problems associated with mental illnesses
• Despite an increase in the rate of treatment, most
  patients with a mental disorder do not receive
• To effectively address the needs of people with
  mental disorders, a variety of institutions and
  approaches, all working together, are necessary
          Treatment Institutions

• Mental Hospitals
• Nineteenth and early Twentieth century mental
  care meant being committed to a mental hospital
• Erving Goffman – Mental hospital as a total
• Rosenhan study – placement of pseudopatients in
  mental hospitals
• The sane patients could not be distinguished from
  the insane patients by the hospital staff
           Treatment Institutions

• Community Psychology
• Community Mental Health Centers Construction
  Act of 1963 (halfway houses)
• Community psychology movement emerged from
  two directions
             » 1. Social conditions and institutions
               need to be taken into account in
               treating the mentally ill
             » 2. Psychologist and psychiatrists
               should play a role
          Treatment Institutions

• Community Psychology
• Halfway houses are the mainstay of community
  based treatment
• Cost shifting and the subsidizing of mental
  health treatment
• Public vs. private forms of treatment
        Deinstitutionalization and
• Deinstitutionalization is a function of:
             » The discovery and use psychotropic
               drugs in treating mental illness
             » Expansion of federal health and
               welfare programs
             » Community based mental health
        Deinstitutionalization and
• Mentally ill among the homeless
• Thirty to sixty percent of the homeless are thought
  to suffer from severe mental disorders
                  Social Policy

• A central theme of the politics of mental illness is
             » Eliminating the discrimination that is
               inherent in insurance policies between
               physical illnesses and mental illnesses
• Policies of coordinating the efforts of treating the
  mentally ill
• Politics and patient rights

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