9780131114784

Summarizing mental health research conducted by sociologists over the last 30 years,A Sociology of Mental Illness provides a consistent narrative that emphasizes how social statuses and social roles affect mental health. The mental health treatment system and the public's reaction to mental illness are also comprehensively discussed. Topics include social causes and consequences of mental illness; social statuses, such as gender, socioeconomic status, race/ethnicity, age, and community; deviant behavior; and the challenges of community mental health. For those in the fields of sociology, psychology, nursing, and social workers.

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PREFACE

xi

CHAPTER 1 INTRODUCTION: SOCIAL CAUSES AND CONSEQUENCES OF MENTAL ILLNESS

1

(10)

Biological and Psychological Perspectives

1

(2)

The Medical Model

2

(1)

The Sociological Perspective

3

(4)

The Origins of the Sociological Study of the Stress Process

4

(2)

The Current Sociological Study of the Stress Process

6

(1)

Statuses and Roles as Causes of Distress

7

(1)

Social Reactions to Mental Illness

8

(5)

The Labeling of Deviant Behavior as Mental Illness

9

(1)

The Relationship between Public Attitudes and Professional Labels

10

(1)

The Medicalization of Deviant Behavior as Mental Illness

11

(1)

Mental Hospitals and Community-Based Care

12

(1)

A Sociology of Mental Illness

13

(1)

A Note on Terminology

14

(1)

Distress, Deviance, and Mental Illness

14

PART I: SOCIAL CAUSES OF MENTAL ILLNESS

CHAPTER 2 THE STRESS PROCESS AND MENTAL ILLNESS

11

(14)

The Biological Basis of Stress

17

(3)

The Biosocial Basis of Stress

20

(1)

The Sociomedical Model

20

(1)

The Sociological Model

21

(2)

Linking Stress with Mental Illness

23

(1)

Summary

23

(2)

CHAPTER 3 SOCIAL STATUS: GENDER

25

(7)

How Gender Is Defined

25

(1)

The Relationship between Gender and Mental Health

26

(1)

Social Status Explanations of Distress

26

(2)

Social Role Explanations of Distress

28

(3)

Role Occupancy

28

(1)

Role Fulfillment

28

(1)

Multiple Roles

29

(1)

Role Strain

30

(1)

Summary

31

(1)

CHAPTER 4 SOCIAL STATUS: SOCIOECONOMIC STATUS AND RACE/ETHNICITY

32

(14)

Socioeconomic Status and Well-Being

33

(8)

Explaining the Relationship

34

(3)

The Socioeconomic Distribution of Stressors

37

(1)

The Socioeconomic Distribution of Resources

37

(4)

Race/Ethnicity and Distress

41

(5)

CHAPTER 5 SOCIAL STATUS: AGE

46

(12)

The Age Trajectory of Distress

46

(2)

Age, Resources, and Distress

48

(6)

Children and Adolescents

49

(2)

Young Adults

51

(1)

Middle-Aged Adults

52

(1)

Older Adults

53

(1)

The Cumulative Nature of Well-Being

54

(3)

Cumulative Advantage

55

(1)

Cumulative Adversity

56

(1)

Summary

57

(1)

CHAPTER 6 SOCIAL STATUS: COMMUNITY

58

(10)

Community-Wide Trauma: 9/11 and Other Tragedies

59

(5)

The Impact of Trauma

59

(2)

Evidence of Historical Linkages

61

(1)

The Aftermath of 9/11

62

(2)

The Neighborhood Context: Chronic Stressors

64

(4)

CHAPTER 7 SOCIAL ROLES: SPOUSE, PARENT

68

(12)

Marriage, Marital Roles, and Emotional Well-Being

69

(2)

Aggregate Changes in Family Structure as a Source of Distress

71

(1)

Marital Status Transitions

72

(2)

The Impact of Parental Roles on Emotional Well-Being

74

(2)

Gender Differences

76

(2)

Summary

78

(2)

CHAPTER 8 SOCIAL ROLES: WORKER

80

(11)

The Economy, Labor Markets, and Distress

81

(5)

The Effects of Unemployment

82

(1)

Economic Cycles and Unemployment

83

(1)

Downsizing

83

(1)

Shifts in the Economic Distribution of Jobs

83

(2)

The Deskilling of Jobs

85

(1)

Temporary and Contingent Jobs

85

(1)

Job Conditions and Distress

86

(4)

Job Demands and Decision Latitude

87

(2)

Job Complexity, Coworker Support, and Job Security

89

(1)

The Effects of the General Economy on Job Conditions

90

(1)

Gender, Socioeconomic Status, Race, and Job Conditions

90

(5)

Gender Effects

91

(2)

Effects of Socioeconomic Status

93

(1)

Race/Ethnicity Effects

94

(1)

Summary

95

CHAPTER 9 THE INTERSECTION OF STATUSES AND ROLES

91

(23)

The Intersection of Gender, Work, and Family

99

(3)

Some Non-Normative Cases

102

(6)

Single Mothers

103

(2)

Caregivers

105

(3)

Combining Statuses and Roles to Predict Distress

108

(4)

A Note on the Limitations of This Discussion

112

(2)

PART II: SOCIAL REACTIONS TO MENTAL ILLNESS

CHAPTER 10 LABELING DEVIANT BEHAVIOR AS MENTAL ILLNESS

114

(17)

Deviant Behavior as Mental Illness

114

(2)

Societal Reactions to Deviant Behavior: Social Control

115

(1)

The Labeling of Deviant Behavior and Deviants

116

(7)

Critique and Modifications

120

(3)

Family Reactions to Deviant Behavior

123

(3)

Non-Family Reactions to Deviant Behavior

126

(1)

Social Status and Labeling

127

(2)

Summary

129

(2)

CHAPTER 11 THE RELATIONSHIP BETWEEN PUBLIC ATTITUDES AND PROFESSIONAL LABELS

131

Public Attitudes

132

(5)

Reactions to Being Labeled

135

(1)

Why a Negative Stereotype Develops

136

(1)

Professional Labels

137

(7)

The Classification of Mental Disorders

138

(3)

Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

141

(1)

Delirium, Dementia, and Amnestic and Other Cognitive Disorders

142

(1)

Substance-Related Disorders

142

(1)

Schizophrenic Disorders

142

(1)

Mood Disorders

143

(1)

Anxiety Disorders

143

(1)

Sexual and Gender Disorders, Eating Disorders, Sleep Disorders, Impulse-Control Disorders, Adjustment Disorders, and Personality Disorders

143

(1)

How Changes Are Made in the DSM

144

(2)

The Objectivity of Diagnosis

146

(1)

Summary

147

CHAPTER 12 THE MEDICALIZATION OF DEVIANT BEHAVIOR AND MENTAL ILLNESS

14

(154)

Deviant Behavior and Its Control

151

(2)

Illness as Deviant Behavior

152

(1)

The Medicalization of Deviant Behavior

153

(5)

The Medicalization Process

154

(3)

Benefits of Medicalization

157

(1)

Costs of Medicalization

157

(1)

The Medicalization of Madness

158

(1)

The Prevalence of Mental Illness in the General Population

159

(3)

The Social Distribution of Mental Illness

162

(1)

Deviant Behavior or Biological Dysfunction?

163

(3)

Summary

166

(2)

CHAPTER 13 THE HISTORY OF SOCIETAL REACTIONS TO MENTAL ILLNESS

168

(16)

Definitions of Deviance and Societal Responses across Cultures

168

(4)

Common Explanations

169

(1)

Non-Western Definitions and Societal Responses

170

(2)

Definitions and Societal Responses in Western Culture

172

(6)

Ancient Greece and Rome

172

(1)

The Middle Ages

173

(2)

Industrialization, Enlightenment, and the Need for Order

175

(2)

The Growth of Large: Public Hospitals

177

(1)

Modern Medical and Psychological Explanations

178

(5)

The End of the Hospital Era

180

(1)

The Shift to Community-Based Care

181

(2)

Summary

183

(1)

CHAPTER 14 THE CHALLENGE OF COMMUNITY MENTAL HEALTH

184

(25)

The Roots of Community Care

185

(3)

The State of Public Mental Hospitals

185

(1)

The Availability of Psychotropic Drugs

185

(1)

The Economics of Custodial Care

186

(1)

Mental Illness in the General Community

186

(1)

Legal Requirements

187

(1)

New Philosophical Orientations to Treatment

187

(1)

Deinstitutionalization

188

(1)

The Community Ideal

188

(2)

Characteristics of Community Mental Health Services

190

(4)

The Implementation of Community Mental Health Services

191

(1)

Refocusing on the Chronic Patient

192

(2)

Deinstitutionalization and Community Mental Health; Persistent Problems

194

(5)

The Financing of Mental Health Services and the Growth of Managed Care

199

(3)

Current Trends in Community Mental Health

202

(7)

The Family and Community Mental Health Care

203

(1)

Family Reactions to Mental illness

204

(1)

Family Burden

205

(1)

Alternative Forms of Community-Based Care

206

(3)

CHAPTER 15 THE CONTRIBUTION OF SOCIOLOGY

209

(14)

Other Explanations

210

(6)

The Biological Basis of Psychological Disorder

211

(2)

The Psychological Basis of Psychological Disorder

213

(2)

The Social Base of Psychological Disorder

215

(1)

The Place of Sociological Explanations

216

(3)

Social Causes of Psychological Distress

219

(1)

Societal Reactions to Mental Illness

220

(3)

BIBLIOGRAPHY

223

(23)

INDEX

246

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If Alice, caught in Wonderland, ran as fast as she could just to stay in the same place, then many of us feel we are losing ground in our own fast-paced wonderland. Stress is everywhere. No one has enough time. No one has enough money. No one is sure if they will keep their job. There are drugs, crime, AIDS, divorce, suicide, pollution, threats of war, and now threats of terrorist acts. We worry for ourselves and our children. It is no wonder, in our wonderland, that being "stressed out" and "burned out" are commonly understood expressions and commonly observed reactions to modern life. Life can drive us crazy. Reliable estimates suggest that an adult has a fifty-fifty chance of experiencing a mental illness in his or her lifetime. But everyone''s chance is not the same. Rather the frequency of mental illness varies by such factors as gender, socioeconomic status, marital status, neighborhood context, and work status. While some would explain these differences as being due to biological predispositions, sociologists wonder if these social factors themselves might cause people to feel distressed or to become mentally ill. Sociologists have long recognized that the organization of society affects the life chances of its members. The sociology of mental illness suggests that the organization of society also affects the mental health of its members. Economic hardship arising from membership in the lower class, for example, can be demoralizing, and it doesn''t take much imagination to conclude that poverty might cause distress. This perspective often implicates as direct causes of disorder the day-to-day experiences of individuals that are related to their membership in one social stratum or another. In the past thirty years, a distinctive sociological perspective on the meaning, origins, and treatment of mental illness has emerged to address these concerns. The perspective is intended to explain how we get stressed out by considering how the organization of social life affects our psychological states. This impressive body of knowledge adds important insights into human behavior and into collective responses to certain forms of social behavior. Each of the authors has taught courses in our respective college or university utilizing a sociological approach for understanding mental illness, and we felt it was time to create a new summary of this research. We do not claim that our book represents a complete summary of such research, nor that all scholars would agree with our interpretation and organization of the material. Hence this book is asociology of mental illness, not thesociology of mental illness. The modern world (our wonderland) is a vastly complex place. It is also full of contradictions stemming from that complexity. For instance, contemporary societies create opportunities for people to realize their dreams. There seems to be no end to the things people can do to make a living and to the chances for people to be who they want to be. But this limitless freedom is an illusion. Complex systems require high degrees of control in order to function well; they put limits, therefore, on what people can actually do. Norms of acceptable behavior serve important limiting functions; hence the contradiction that we sometimes experience between personal autonomy and social constraint. This is what Sigmund Freud called "civilization and its discontents." Whatever its origins, mental illness can be described as behavior and thought patterns that are not normative and that require control or constraint because of their potential to disrupt individual and collective arrangements. We would mostly agree that mental illness can have negative effects on individual life chances, disrupt families, and, in some instances, threaten the general community and the continuity of social systems. One means for constraining undesirable behavior is to punish it. Another option is to "treat" it. A casual review of the listing of official diagnostic categories currently used by professional mental health practitioners to treat mental illness is enough to suggest that much of what is considered to be mental illness also represents violations of social norms of behavior. Hence sociologists view mental illness as a way to categorize forms of behavioral deviance for the purpose of controlling them. This perspective emphasizes the idea that mental illness is a social construction or idea, and from there we regard mental illness and its treatment from a sociological perspective as part of a system for the social control of deviance. Our teaching experience has also made us realize that students do not easily accept the notion that mental illness can have social causes. Although we agree with some of our colleagues that social causes may actually be more important for explaining mental illness than other factors such as genetics and cognitive impairments, we will not make this claim. Rather, our intent is to demonstrate the basis for such a claim and let the readers decide (if they feel the need to do so). If one in two adults will experience symptoms of mental illness during their lifetime (and this proportion goes up every time the definitions of mental illness expand), then it seems important to understand how this situation arises and how we deal with it. Alice, after all, was threatened with beheading. In our wonderland we may keep our heads but lose our minds. Mark Tausig Janet Michello Sree Subeda

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A Sociology of Mental Illness

A Sociology of Mental Illness

0131114786

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