Understanding Mental Disorders: Debunking Myths and Exploring Causes, Study notes of Sociology of Deviance

Download Understanding Mental Disorders: Debunking Myths and Exploring Causes and more Study notes Sociology of Deviance in PDF only on Docsity! 1 SOC 3290: Deviance: Lecture 29: Mental Disorder I: It can be very scary to a person when they sense that something is wrong with them. One's life can seem to be going nowhere and one can turn inward. Plans can come and go, one can become agitated, and jobs never seem to last. One can want relationships and a family but have no real friends. Then something can snap and one can do something outrageous - like push someone under a train under the influence of urges, forces, or "voices" beyond one's control. Even though this is an extreme example, such agitation and irrational behaviour happens to people. Schizophrenia affects 1-2% of the population, and, if other, far less serious psychiatric problems are considered, mental disorder is indeed very common. A recent survey indicates that nearly 50% of adult Americans have experienced at least one episode of psychiatric disorder in their lifetime (30% in the past year). Indeed, most of us have been mentally ill at one time or another, just as we have been physically sick (e.g. mild depression "the common cold of mental illness"). Yet, because a strong social stigma is attached to mental illness, most people associate it with the most severe forms such as schizophrenia and major depression. Thus, if we feel down and call in sick we tend to say "I'm ill," not mentally ill. The boss would assume one is physically ill - not dying from cancer, but sick. If we said "I'm mentally ill," however, the boss would think we're nuts. While the general public equates "mental illness" with only the relatively severe and uncommon forms of mental disorder, most other forms that occur every day are far from severe and quite common. These are basically the problems of everyday life, ranging from being sad, anxious, irritable or antisocial to being dependent on drugs, alcohol, or coffee to doing poorly in reading, writing and math as a kid. Psychiatrists define all such problems as mental disorders, but we would not if we associate mental illness with only its relatively serious forms. Tonight we will discuss a number of popular myths about mental disorder, take a look at its various types, and examine a number of the social forces behind mental disorder. Then we will follow up with a film about the myths of mental illness. Some Popular Myths: The mentally ill are popularly believed to be very weird. In reality, most are far from greatly disturbed. Only a few institutionalized patients spend their time screaming and yelling, coloring with crayons, talking to people who aren't there, hearing voices, etc. Even among schizophrenics the flamboyant symptoms of hallucinations and delusions are not the most important characteristics of their disorder - the less demonstrative symptoms of apathy and inertia are the core. 2 Secondly, mental illness is commonly regarded as hopeless - as essentially incurable. Indeed, even after discharged as recovered, many view individuals with suspicion. In reality, the majority (70-80%) of hospitalized mental patients can recover and live relatively normal lives if their treatment has been adequate and received in time. Even many schizophrenics can eventually recover. According to studies, about half of all schizophrenics spontaneously get better over 20 years, and professional treatment with support from family and friends further makes the recovery easier and faster. A third misconception is that there is a sharp, clear distinction between "mentally ill" and "mentally healthy." This is only true if we compare the few, most seriously disturbed patients with average "normal" people. Most of the time even a psychiatrist cannot clearly differentiate the vast majority of the mentally ill from the healthy. Thus, the dividing line is extremely arbitrary. This is not only because the behavior of different people ranges by imperceptible degrees from normal to abnormal, but also because an individual can shift at different times to different positions along that range - appearing normal at one time and abnormal at another. Fourthly, the mentally ill are often portrayed in the media as crazed, violent people. In fact, the great majority (90%) of mental patients are not prone to violence and criminality, and are more likely to harm themselves than others. Although they have a higher risk of violence than the general population, they are still less violent than alcoholics, drug abusers and young, lower class men. Finally, the fifth popular myth is about midwinter depression, which psychiatrists call SAD (seasonal affective disorder). Many people assume that we are more likely to become depressed in the winter due to the relative cold and dark. Research has actually shown that depression is more likely to strike people in the summer - presumably because we spend less time with our loved ones than we do in the winter (?) Types of Mental Disorder: Psychiatry has two opposing views on what constitutes a mental disorder. One is the medical view, which defines mental disorder chiefly as a biologically caused disorder - similar to physical disease. This view dominates psychiatry today, as expressed in the DSM. The other view of mental disorder is psychoanalytic, which defines mental disorder primarily as an emotional problem that is psychological in origin. This view dominated in the 1950's and '60's, but is less popular today. Traditional Classification: In the traditional classification system, mental illness is divided into organic and functional disorders. Both may show the same symptoms (e.g. hallucinations), but they can be differentiated on the basis of their underlying causes. Organic disorders are caused by damage to the brain by any variety of factors (e.g. head injury, infection, old age, drug abuse). Functional disorders, on the other hand, are believed to result from psychological and social factors (e.g. 5 various types of mental disorder by explaining in some detail how they differ. It also encourages psychiatrists to analyze their patient's life in order to find and eliminate the causes of their mental disorder. However, to more medically oriented psychiatrists, this traditional system is too broadly and ambiguously defined. Disorders cannot be precisely identified in terms of specific symptoms. Moreover, this approach presents only a small number of disorders, thereby missing a large number of more specific ones that have emerged. Thus, a much greater number of mental disorders (over 300) can be found in the DSM- IV. Each mental disorder therein is defined as having a list of specific symptoms (e.g. panic disorder is characterized by shortness of breath, dizziness, heart palpitations, trembling, sweating, choking, nausea, chest pain and fear of dying). By checking a patient against a specific list of symptoms like this, psychiatrists can determine what mental disorder their patient is possibly suffering. Using this mechanical, routine method of diagnosis, they can dispense with the time-consuming psychoanalysis required by the traditional classification system. More importantly, by using this parallel with how doctors diagnose physical illnesses, psychiatrists can also efficiently collect payment for their services from insurance companies or government health plans - both of which insist that the DSM be used. Yet the scientific value of the DSM falls short. One issue is that this manual is merely descriptive, describing various disorders through lists of symptoms without explaining how they differ from one another (see chart on p.178 for list of major types). It also arbitrarily defines disorders in terms of a specific number of symptoms (e.g. at least 3 out of a list of 7 for mania). This doesn't explain why 3, not 5 or 6 is required. Further, the focus on symptoms inevitably encourages psychiatrists to eliminate the symptoms rather than the underlying cause of the patient's problem. Influenced by the view of mental disorder as a biologically caused disease, the elimination of symptoms often involves prescribing medication - but the disorder usually persists because its non-biological cause remains. Since its first edition in 1952, the DSM has been criticized for promoting the medical view of mental disorder as a biologically caused disease. But in its more recent editions, psychiatrists are encouraged to see social factors as possibly additional causes of mental disorder. Thus, after identifying the symptoms and disorder, users of DSM-IV are instructed to question whether the patient has suffered any "environmental" problems in their social context (e.g. unemployment, divorce). Still, the main emphasis remains on diagnosing mental disorder as a disease with specific symptoms. DSM-IV has also been criticized for defining too many ordinary problems in our lives as mental disorders (e.g. the "disorder of written expression" in poor writing). It's possible that some students who have this trait are mentally ill, but not all of them - they just write poorly. Other examples include "oppositional defiant disorder" in children who are difficult or uncooperative. While in a heated moment some parents may say their unruly kids are mentally ill, but most would merely think that's part of being a kid. 6 Social Factors in Mental Disorder: In contrast to the primarily psychological and biological positions elucidated by psychologists and psychiatrists, sociologists have long emphasized the influence of various social factors on mental disorder. The first of these is social class. This has been clearly and consistently demonstrated by studies to be related to mental disorder. More specifically, those from the lower classes are more likely than those from other classes to be mentally ill. Although mental illness among the lower classes is more likely to be reported to the authorities, surveys on random samples of the population have consistently found a greater percentage of lower class people suffering from psychiatric symptoms. There are two conflicting explanations of this. One, called social causation, suggest that lower class people are more prone to mental disorder because they are more likely to experience social stress (e.g. unemployment, divorce), to suffer from psychic frailty, infectious diseases, neurological impairments, and to lack good medical treatment, coping ability and social support. Through an accumulation of these problems, and the stresses that result, low social status becomes a cause of mental illness. The other explanation emphasizes social selection or drift. This suggests that mentally ill people from higher social classes often drift downward into the lower class areas, helping to increase the rate of mental illness in such neighbourhoods. This explanation suggests that being lower class is a consequence of mental illness among formerly higher status individuals. Both explanations may be true to some extent. The next social factor associated with mental illness is gender. There are conflicting findings as to which gender is more likely to become mentally ill. In most studies women are found to have a higher rate of mental disorder, but some others find men to more predominant or no difference between the sexes. These conflicting findings, however, refer to mental illness most generally. Studies on specific types of disorders, however, do indicate gender differences. These usually show that women predominate in depression and anxiety disorders, while men more commonly have antisocial personalities, paranoia, drug and alcohol abuse disorders. How can we explain this? Most sociologists attribute this difference to differences is gender roles. The female role is relatively restrictive and oppressive, likely to confine the woman to her inner self, such that she tends to keep her frustration and anger to herself rather than aggressively pour it out on others. Hence women are more likely to fall victim to depression and anxiety. Men, on the other hand, have a more liberated role, and they are encouraged to be bold, assertive and aggressive in social relations. If frustrated and angry, they are more likely to take it out on others - behaving as antisocial and paranoid individuals. In Durkheimian terms, women respond as they do because they are more socially integrated and regulated; men because they are less so. 7 Research has also suggested that the female role has taught women to value emotional attachment to others and be sociable, while the male role has encouraged men to be emotionally detached and aggressive. Women, therefore, become more vulnerable to social losses such as the death of a loved one, while men are more vulnerable to material loss such as unemployment. Yet, as more women enter the competitive, male workforce, they will suffer less depression and anxiety like men. Similarly, with the relative decline in mens' employment over the last 30 years, there has been a rise in anti-social personality disorders among men. Hence, the traditional gender difference in psychological distress has narrowed over time. A third social factor in mental disorders is race and ethnicity. Like gender, these have not been consistently found to be related to mental illness in general. While many studies have shown higher rates of psychiatric stress among minorities, the standard explanation has been that these groups experience more social stresses stemming from discrimination, poverty and cultural conflict. On the other hand, there are studies showing no significant difference in psychiatric problems between minorities and whites. An equally plausible explanation emerges for this finding: minority group identification, group solidarity, or social networks protect them against these social stresses. The same explanation has been proffered to account for the lower rate of mental illness among British minorities. More consistent data are available on the relationship between race or ethnicity and specific forms of mental disorder. In the U.S., Puerto Ricans and African Americans are more likely than Irish or Jewish Americans to have sociopathic inclinations or paranoid tendencies. Jewish Americans, in contrast, tend more to manifest depressive disorders. In addition, Americans of Korean ancestry, have more depressive symptoms than whites. A fourth social factor implicated in mental illness is the urban environment itself. Community surveys indicate higher rates of mental disorders in urban areas, particularly the inner city, than in rural areas, including the suburbs and small towns. It is argued that the urban environment produces a lot of mental problems because it generates an abundance of physical and social stresses (e.g. traffic congestion, noise, population density, tenuous social relations, loneliness and lack of social support). Some community studies also reveal a link between urban living and specific psychiatric problems (e.g. neurotic and personality disorders). In contrast, more serious psychotic conditions are more prevalent among rural and small town residents. This could be explained by the argument that rural and small-town residents find their lives too restrictive, and they are not able to express frustration and anger in the presence of others - who may easily find out who the troublemakers are. By suppressing their frustration, they may get deeper and deeper into themselves until they become psychotic. In contrast, urban dwellers can get away from family and friends, are freer to express frustration in the midst of strangers, and tend more to tolerate unconventional behaviour. If they persist in doing so, urbanites may become neurotics, who, unlike psychotics, retain their grip on conventional reality. Otherwise, they may develop an antisocial psychopathic personality, which is essentially an "acting out" disorder.