Pilgrim and Rogers have given us the key text in the sociology of mental health and illness over the past twenty years. Mentally disturbed offenders and the criminal justice system 146 The prison as a specific place and space for mental health care 147.
Preface to the fifth edition
1 Perspectives on mental health and illness
Clinical perspectives on mental health and illness
When diagnosing a physical illness, the diagnosis can often be confirmed by physical signs of changes in the body (for example, the visible inflammation of tissue and the patient reporting pain). The latter tends to reduce psychological phenomena to biology, while psychoanalysis tends to psychologize everything (i.e. the biological, the social and the personal).
Discussion of the clinical perspectives
Humanistic psychology emerged from North American philosophy (William James and James Dewey) and was developed in mental health by Abraham Maslow, Carl Rogers and Rollo May. The clinical perspectives have difficulty maintaining notions of mental health and illness that are stable, secure or invariant.
Perspectives within sociology
Sociologists have difficulty recognizing the limitations of their discipline – the depressive position – one of the reasons being that we do not actually exercise power over anyone; social constructionism enables us to convince ourselves that the opposite is true, that we know everything about how people become the way they are that we don't have to pay attention to. 2 The second approach is more closely linked to Foucault's poststructuralism and deals with deconstruction – the critical examination of language and symbols in order to illuminate the creation of knowledge, its relationship to power and the unstable variations of reality that accompany the human. activity ('discursive practices').
Discussion of the clinical and sociological perspectives
In the case of mental health problems and their management, then the complex reality of economic, socialization and welfare systems are all relevant to understanding it (Pilgrim 2012). In the particular case of mental health, so much research of the epidemiological variety was intertwined with medical research.
Discussion
The existence of such a wide range of views underlines that the field of mental health and illness is highly contested. 4. Compare and contrast social constructivism with social realism when conducting sociological studies of mental health and illness.
2 Social stratification and mental health
The general relationship between social class and health status
There is evidence that attachment style in childhood can influence prospects for social mobility and mental health in later years. Traditionally, inequalities in both physical and mental health have been explained by four main factors, which have their origins in the Black Report (DHSS 1980).
The relationship between social class and diagnosed mental illness
This is thought to lead to anxiety and guilt problems that are more common in non-lower class groups. Emphasis on self and identity was also found to be a stronger concern during upbringing in non-lower-class families.
Social capital and mental health
Despite these finer distinctions, it is generally accepted that generating or regenerating social capital is good for mental health. Bridging social capital (intimate contact between local friends) was found to be associated with lower reporting of symptoms, while bonding social capital (where people are attached to their local neighborhood) was found to be associated with higher reporting of symptoms.
The relationship between poverty and mental health status
Homeless young people have higher levels of mental health problems than young people in stable accommodation. Young homeless people do not associate positively with facilities labeled as 'mental health services' (O'Reilly et al. 2009).
Social class and mental health professionalism
This highlights experiences of mental health problems that often begin in childhood and are linked to family breakdown, parental abuse and violence, and poor educational performance. Taking a symptom approach to identifying and improving mental health problems among homeless people may worsen rather than improve mental health problems.
Lay views about mental health and social class
In addition, evidence changes over time and the picture of class inequalities and mental health fluctuates. 5 Have changes in sociological interest in social class produced changes in sociological work on mental health and illness.
3 Gender, sexuality and mental health
The over-representation of women in psychiatric diagnosis
Because women live longer than men, the higher prevalence of dementia and depression in old age among women also contributes to the overrepresentation of women. For example, Walter Gove and colleagues, focusing on higher rates among married women than men, argue that women experience more psychological distress than men (Gove and Tudor 1972).
Does society cause excessive female mental illness?
The reasons for the overrepresentation of women in mental health statistics are highly contested, and a number of competing explanations are evident in the literature. Similarly, work on the prevention of mental health problems in the wake of Brown and Harris' study does not question psychiatric knowledge (eg Newton 1988).
Is female over-representation a measurement artefact?
40 A SOCIOLOGY OF MENTAL HEALTH AND ILLNESS. 1995) compared clinical and non-clinical populations in Islington, north London. In general, women are more likely than men to access health care when they face minor or moderate mental health problems.
Are women labelled as mentally ill more often than men?
Metzl and Angell (2004) examined the impact of these new drugs on popular notions of women's depressive illness. Their greater contact with services and the lesser problem of sedatives being labeled as a 'women's problem' may mean that this is the case.
Men, distress dangerousness and mental health services
According to Scambler (1998), these women's services maintained a collective idea and awareness of the social by providing group support aimed at resocializing women to reject a subordinate position within domestic and social life. It is mainly men who are overrepresented in the most stigmatized and policed part of the mental health system, the 'special hospitals'.
Masculinity meets femininity
Gender and sexuality
A further possibility is that feminist scholarship itself may be a factor in the construction of women and mental health as a subject of study. 4 What The Social Origins of Depression (Brown and Harris 1978) taught us about gender and mental health.
4 Race and ethnicity
Theoretical presuppositions and approaches to race and ethnicity
This works on the premise of challenging the stereotypical and negative views of minority ethnic groups held by influential individuals, including professionals. Cross-cultural psychiatry began by focusing on the different manifestations of mental disorders in different societies.
Race and health
Cross-cultural or cross-cultural psychiatry, for example, is concerned with how different ethnic groups are treated by mental health workers socialized in 'dominant' ways. Second, the indirect effect is that racial discrimination in the housing and labor market produces lower health outcomes.
The epidemiology of mental health, race and ethnicity
Consequently, they may be a poor indicator of the incidence and prevalence of mental disorder in the community. This pattern was confirmed by studies in the 1990s, which found that black people were overrepresented in psychiatric hospital admissions (Bhui et al. 2003).
South Asian women and the somatization thesis
In the latter group, "depression" was framed as an affliction that was collectively acquired and experienced (Kokanovic et al. 2008). However, empirical evidence of distress in the latter (mostly from family origins in Pakistan and Bangladesh).
Migration and mental health
This chapter summarizes the arguments and evidence about the mental health of Afro-Caribbean, Asian and Irish people in Britain. 6 discuss the role of racism in creating mental health problems and the nature of psychiatric services.
5 Age, ageing and mental health over the life course
Age and the life course
Using an analysis of coroner data, they show how patterns of suicide intersect with more conventional features of a socially structured life course. This opens up broader social contextual features, going beyond just the psychological struggles of young men and instead highlights the life course as a whole, linked to other social relationships, networks and positions.
Childhood and mental health
There has been some interest in people's conceptions of health and illness across subjectively defined stages of the life course (Buckett and Davison 1995) and in the impact of mental health risk at different points in childhood, adolescence and adulthood (Power et al 2002). . For example, early puberty has been found to be associated with increased mental health problems (Kaltiala-Heino et al. 2003).
Childhood sexual abuse and mental health problems
The focus of clinical discourse on sexual abuse is on male perpetrators and, with the exceptions just cited, female victims. Baker and Duncan (1985) suggest child sexual abuse rates of 0.25 per cent for kin and 10 per cent (12 per cent female and 8 per cent male) for non-relative abuse in Britain.
Social competence in adulthood
If these estimates are accurate, around 4.5 million British adults are victims of past sexual abuse. In contrast, if the Baker and Duncan data are more accurate, it would appear that childhood sexual abuse is more closely reflected in the prevalence rates of psychiatric disorder.
Adolescence, social media and mental health
In terms of social context, urban versus rural environments appear to be important in influencing mental health (as in higher suicide rates among Chinese adolescents (Meng et al. 2013)). Within a relatively short period of time, social media has revolutionized the way in which young people in particular interact with their peers and the social world.
The ‘Third Age’, retirement and mental health
A London study of 12 nursing homes found that about 40 percent of residents were depressed (Mann et al. 1984). What are the social implications of data from the psychiatric epidemiology of depression in the elderly.
6 The organization of mental health work
The rise of the asylum and its legacy
Scull (1979), a Marxist, suggested that mass incarceration (of which the asylum system was an integral part) was a product of urbanisation, industrialization and professional forces during the first half of the nineteenth century. These changing values were influenced by the exposure of the cruel treatment of those in madhouses.
The crisis of the asylum
Martin found that some organizational goal (such as staff comfort or public safety) implicitly usurped the goal of caring ('the subordination of care'). However, what can be pointed out is that hospital scandals have continued where large hospitals exist - they are predictable sites of abuse and 'the corruption of care'.
Responses to the crisis
At the same time, it became clear that conditions such as 'depression' ('the common cold of psychiatry at once familiar and mysterious' (Seligman 1975)) and 'anxiety' could be contained in primary care. Prior perceives 'the therapy of mental illness at the end of the asylum age' as being widely dispersed.
Community care and re-institutionalization
There was also slow progress on the timetable for implementing the National Mental Health Service Framework (Department of Health/Home Office 1999). A look at the distribution of spending on mental health services reveals socio-political priorities.
Primary care, open settings, ehealth and psychological therapies: a new focus of mental health work
This has emerged as an unpredictable and important force in the global organization of mental health care. In addition to recognizing the changing management of treatments, the concept of 'therapeutic landscape' has implicitly taken a more central place in the discourse on mental health and wellbeing treatment.
7 Mental health work and professions
Theoretical frameworks in the sociology of the professions
Observers from the field of sociology of professions (Saks 1983; Abel 1988) emphasize a certain version of the course of events. The latter, convinced of the need for the service offered or requested, are dependent on professionals.
Mental health professionals and other social actors
Attacking the body and constructing the self represent two key ways of understanding the activities of mental health professionals. 3 professionals who are part of the time involved in work in the field of mental health (general practitioners, police, priests), but do not have the role of a specialist;.
Sociology and the mental health professions
This role of the confessional is discussed in more detail in relation to mental health work by Rose (1990). Work in mental health care leads to 'the subjectification of work', 'the psychologization of the everyday', 'a therapy of finitude' and a 'neuroticization of social intercourse'.
Legislative arrangements, service redesign and the social practice of diagnosis
In the field of mental health, psychology graduates have been brought in to support low capacities in primary mental health care. The increasing integration of health and social care has generated new models of mental health support workers.
The survival of psychiatry?
As we note in the last part of the chapter, sociological currents outside work in the professions have also been influential in some investigations of mental health work. 1 Compare and contrast two perspectives from the sociology of the professions and apply them to mental health work.
8 The treatment of people with mental health problems
Therapeutics
A brief social history of psychiatric treatment
The second was Barak Obama's announcement that $100 million would be invested in the neuroscience initiative BRAIN. A similarly eclectic mix can be found in the approach to treatment taken by clinical psychologists (Cheshire and Pilgrim 2004).
A critical appraisal of psychiatric treatment
The reviewer concludes that 'the general utility [of neuroleptics] in the treatment of schizophrenia . Expanding on the supposed usefulness of drugs, major sedatives have been seen as the primary means of preventing the "revolving door patient" phenomenon.
The moral sense of ‘treatment’
None of us can be aware of everything relevant to our existence all the time. Practitioners have also acted immorally in cases of abuse of patients by psychotherapists.
The social distribution of treatment
This means that the owner can be separated from his damaged work for a period of time until it is repaired.
The impact of evidence-based practice on treatment
In the field of mental health there are particular problems with the application of the experimental conditions of the RCT to services:. There is also evidence that the rhetorical devices of quality and evidence can be deployed to empower mental health users to challenge mainstream psychiatric practices.
Alternative and complementary therapies
In the psychiatric literature, cannabis use is most prominently associated with adverse effects and mental health risk (e.g. the onset of psychosis). For the foreseeable future, sociologists are likely to continue to be interested in both aspects of mental health professional work.
9 Prisons, criminal justice and mental health
Mentally disordered offenders and the criminal justice system
Are they concerned with risk assessment and risk management or with enabling mental health. In its current manifestation, forensic 'mental health work', now carried out by doctors, psychologists, nurses and occupational therapists, remains contentious in this regard, and Foucault's observations remain highly relevant.
The prison as a dedicated mental health place and space
This aspiration to promote the mental health of prisoners has become a core activity and claimed focus for the prison service in the UK and US. The tension between medical and punitive solutions for those with a mental health problem is reflected in the criminalization versus psychiatry debate discussed now.
Patients as prisoners or prisoners as patients?
By definition, the mentally disturbed offender qualifies for access to both the criminal justice system and mental health systems. There has been a shift in both mental health and criminal justice facilities to an actuarial policy (Armstrong 2002; Gray et al. 2004).
Treatment in prison: medication, therapeutic communities and other approaches
The intersection of mental health professionals with the implicit role of generic work in the criminal justice system can also be seen in the conclusion of this section. For example, prison officers have been found to be able to detect mental health problems (Birmingham 1999).
Police officers as street-level bureaucrats
This is a cue for the next section on community settings and offenders with mental health problems. 2 The extent to which the management of mental health problems in criminal justice systems may be determined by the activities of agents such as the police or prison officers.
10 Mental health and legalism
Introduction
The suggested antecedents are simply a restatement of dysfunction in the mind or brain (use of the words 'disability' and . 'disorder'). In 1974, Judge Lawton said that the words "mental illness" are "ordinary words of the English language".
Legal versus medical control of madness
The use of the law in the field of mental health has also been criticized by some social scientists. For example, the use of the term "psychopathy" in the law approximates that of "antisocial personality disorder."
Socio-legal aspects of compulsion
In the US, involuntary outpatient civil commitment (IOC) is now widely accepted as a principle in mental health care. Pols (2001) studied this clash of functions and ideologies in the work of mental health nurses in their interactions with inpatients.
The globalization of compulsion and human rights legislation
This was part of the rationale in the bill to move towards statutory community control measures, but continued an older theme in the discourse of professional mental health work. On the one hand is the assumption that coercion increases the chances that a patient will receive treatment that will improve their quality of life in the long term (Torrey and Zdannowicz 2001).
Professional interests and legislative reforms
This was evident in the position attributed to social workers in mental health legislation. There are further indications of role dispersion and blurring within mental health care.
Dangerousness
In contrast, many psychiatric patients, who pose no proven threat to others, are compulsorily detained under the Mental Health Act. 4 How has mental health legislation in Britain changed since the early twentieth century?
11 Stigma and recovery
Lay views of psychological differences and attributions of stigma
The latter were more likely to follow a Western model of mental illness (Stone and Finlay 2008). As we noted in Chapter 10, the relationship between 'mental illness' and dangerous acts is complex.
Stereotyping and stigma
They are seen as an extension of normal existence and are not necessarily seen as a mental illness (Pilgrim and Bentall 1999). For example, early traditional psychiatric descriptions of mental illness focused predominantly on insanity (the functional diagnostic categories of "schizophrenia" and "manic depression") and portrayed anxiety and depression as stress reactions rather than true mental illnesses (Fish 1968).
