Mental health as an important aspect of heath system comes directly under the scope of health sociology where it has an important role to play in trying to understand the full intricacies of mental illness, especially when it comes to the way in which society influences and frames both how we see mental health and illness and how society creates situations that can negatively impact on individual’s mental health.
There are complexities and uncertainties that surrounded the whole processes of diagnosis and identifying mental illness. Unlike physical illness, there is often no clear‐cut objective sign that someone is experiencing a mental illness. McPherson and Armstrong (2006:50) this concern well, when they say:
What is pneumonia or appendicitis or cancer can be agreed internationally with reference to the presence or absence of certain clearly defined physical characteristics. In psychiatry, however, there is no such external biological referent to act as an anchor for diagnosis. Essentially, psychiatry classifies on the basis of a patient’s patterns of symptoms which might vary according to how they are elicited and interpreted.
Because then it cannot always clearly identified what mental illness is, this makes the search for a cause all the harder. Broadly speaking, explanations for mental illness fall into one of two camps: biological explanations and social explanations. These look in very different directions and see quite different reasons for the existence of mental illness.
· Biological explanations focus on faulty genes or imbalance in the chemistry of the brain. There is, for instance an association between low levels of serotonin and depression. This way of thinking, of looking for biological cause, in increasingly reinforced by the proliferation of pharmaceutical interventions such as SSRIs (selective serotonin reuptake inhibitors) for treating depression which suggest that if an illness can be treated by chemicals, than it must have a biological, organic basis.
Social explanations fall into two general categories: Social causation and Socialconstructionist.
· Social causation perspective refers to how the various inequalities in society (mainly to do with ethnicity, gender and class) produce toxic levels of stress for some people. As a result of this stress, people may be ‘tripped’ into mental illness, whether it is a woman expected to bring up children on her own and keep down a job; or the experience someone from an ethnic minority group has of being racially abused by a neighbor; or the constant soul destroying grind of poverty and not being able to lead the life of that others enjoy.
· Social constructionist explains mental illness is something that does not exist as a ‘fact’ or something that is ‘real’ and has absolutely no organic basis. This sociological view is influenced by the work of Foucault, who has argued that there is no single incontestable truth that can be discovered and agreed on by everyone. Rather, society is constructed by the idea and conceptualizations of both individual people and also, more importantly, certain powerful groups. Some groups, such as psychiatrists, are able to construct a discourse that privileges a certain view point of others, which allow them to effectively rule out and rule in ways of conceptualizing, for example what constitutes mental illness. Constructing such discourses allows such groups to become dominant in society and allows them to regulate and control the activities of others.
Thus, both biological explanations and social explanations explain about mental illness. But these two are not sufficient to address the complexity of mental health and illness. Rather there is a complex interweaving of both society and biology, where both have to be understood as often working together in complex and dynamic ways. As captured by Rose (2005) in his discussion of causes of mental illness and how biology and society interact. He points out that just because a change in the chemistry of the brain takes place does not mean that the chemical change caused the illness. To illustrate this point he gives a beautiful example: if someone has a headache, he takes an aspirin. If we
were then to check the chemicals in the person’s brain in order to discover the chemical basis of a headache, we would find aspirin. Thus, according to the biological explanation, we would claim that aspirin causes headache, because people who do not have headaches do not have the chemical aspirin present in their brains. Now, obviously, this not to be the case. So, Rose concluded that chemical changes do occur, but that could equally be the result of other (in this case social) factors.
Pilgrim and Rogers (1994) acknowledges and develops the social and cultural factors responsible for mental health in their studies. According to them the misery and sufferings of the world is related to the complexities of human life: that humans are simultaneously organic biological and social beings. This critical realist perspective fully acknowledges the strong and influential role of culture, but does not say that it is all down to society. It also accepts the importance of medical information and research, but crucially, questions how diagnoses are framed by the social influences on the medical professions. Finally, a critical realist perspective accepts that biological processes are at work but, like Rose (2005) attempts to place those processes in a wider context where social factors may be the cause of biological changes.
Stigma refers to an attitude that ‘discredits’ or prevents someone’s full acceptance in aparticular situation. Social stigmas increase the stress of those with mental illness and exacerbate feeling of social exclusion and social distance.
Goffman is one of the best known sociologists to have studied and theorized how certain groups of people attract stigma. His humanistic and sympathetic work focuses on why certain attributes of an individual or group deny them full acceptance in given situations and lead them either to be excluded or to be left with a feeling of not ‘fitting in’. He classifies stigma into three broad groups:
· Physical stigma ‐ mainly to do with aspects visible ‘on the surface’ of people, for example facial scarring, a physical impairment or an amputation.
· Personal/character stigma ‐ mainly to do with aspects ‘below the surface’, for example drug use, sexuality or mental health.
· Social stigma ‐ belonging to a particular group or ethnic minority. (Goffman, 1968)
The ‘counting the cost’ survey by Baker and Macpherson (2000) for MIND highlighted the extent of stigmatizing images and the effects they had on people with mental illness. For many respondents to the survey the social stigma was harder to deal with than the symptoms of their particular condition.
There are a number of explanations for why people from Black and other ethnic backgrounds appear to have higher rates of mental illness and a different, often coercive, relationship with services. These explanations include:
· racist and prejudiced attitude on the part of service providers and agencies of the state, such as the police;
· lack of cultural sensitivity
· more frequent exposure to stressors in the form of, for example, unemployment; adjusting to a new society if recently arrived;
· racism generally.
However, Pilgrim and Rogers (1993) pointed out another related concept regarding the relationship of ethnicity and health. They draw on Foucault’s concept of seeing madness as a part of the ‘other’, that is the groups of people who are regarded as being outside the norm of society and as constituting a threat to the order of society.
Every review of literature concerning sociology and mental health reaches the same conclusion when discussing gender – that women always display higher rates of certain mental illness than man (Foster 1995; Bebbington (1996).
In substantial review of literature relating to women and depression Bebbington (1996) and Nazoo et al. (1998) demonstrated the following points:
· Women did report more depressive episodes – whether distant, mild or exaggerated episodes. Whereas there is little evidence for men masking their depression by turning to alcohol or substance abuse.
· The chance of depression is higher in case of woman because of her role identity. For example: a woman feels a particularly close attachment to and sense of responsibility for children and because of her role identity, then the chance of depression is much greater if there is child related problem, such as difficulties at school or drug misuse.
One of the best known pieces of sociological research on women and mental health was carried out by Brown and Harris (1978). Key component of the model are:
Current vulnerability factors – these factors relate to events that have happened in a woman’s past and indicates whether or not she may be more susceptible to depression. There are four vulnerable factors:
· losing a mother before the age of 11;
· presence at home of three or more children under the age of 15years;
· absence of any confiding relationship, particularly with the husband;
· lack of full or part‐time job.
Provoking agents – there are various events that could occur in a woman’s life, which could then trigger a depressive episode. The events mainly relate to loss and disappointment, e.g. death, losing a job or discovering a partner’s unfaithfulness.
Symptom – formation factors‐ women over 50 years of age and women with low self‐esteem were at greatest risk of developing depression.