Sociology of Mental Health

The sociology of mental health and illness

The sociology of mental health and illness is dominated by a number of ideas:

• The social construction of mental illness
• The different theories and approaches to mental illness, including the sociological and conventional models
• The distribution of mental illness by social groupings such as class, gender, and ethnicity

To understand sociological perspectives on mental health, we must first understand what we men by mental health, as well as the types of mental health conditions and illnesses people can suffer from.

The sociological definition of mental health

According to the Cambridge Dictionary, mental health refers to "the condition of someone's mind and whether or not they are suffering from any mental illness".¹

While there is no universal sociological definition of mental health, Allan V. Horwitz (2012) effectively summarises like so:

Types of mental health issues

There are dozens of mental health conditions, all with their own definitions, classifications, and symptoms. To simplify this a bit, Joan Busfield’s (2002) typology of psychiatric disorders categorises mental health issues into three broad types:

1. Disorders of thought, e.g. psychosis, schizophrenia, sociopathy

2. Disorders of emotion, e.g. depression, anxiety, phobias

3. Disorders of behaviour, e.g. alcohol and drug dependence

Sociological analysis of mental health attempts to understand how social factors influence and perhaps directly shape mental health and illness and experiences of it.

The role of sociology in the study of mental health: Mental illness as a social construct

Social constructionism has been very influential in the sociological conception of mental illness. It is based on the argument that what is considered "normal" or "mentally ill" behaviour varies over time and from society to society.

Key theorists who espouse social constructionism are Michel Foucault (1965), Thomas Szasz (1973) and T.J. Scheff (1974).

Sociology of Mental Health: Foucault

According to Foucault, our modern conception of mental illness is a direct result of social changes during the 18th century. In the Age of Enlightenment, more traditional ways of thinking based on religion and emotion were gradually replaced by more rational, intellectually disciplined ways of thinking and acting.

Foucault argues that this shift was illustrated by the rising number of asylums created to contain those considered "mad" i.e. irrational. Madness and/or mental illness as we know and treat it today is therefore a relatively modern invention that emerged from the development of ‘rational’ ways of thinking and acting.

Sociology of Mental Health: Scheff

Scheff argued that the label "mental illness" is simply a convenient way to deal with behaviour that people find disruptive or socially unacceptable.

He points out that in society, there is always a group of people who refuse to abide by social norms and conventions or who cannot conform. This behaviour is seen as "bizarre" and these people are labelled "mentally ill" to explain away or justify that which cannot be made sense of or explained any other way.

The label of mentally ill forces people to adopt the "insanity role", reinforcing the cycle of mental illness.

Sociology of Mental Health: Szasz

According to this theorist, the role of psychiatry is to control deviant behaviour – behaviour that the powerful (as represented by doctors and psychiatrists) dislike, but which is not inherently pathological.

Szasz also argued that judgements made by psychiatrists may be based on social values and cultural norms rather than scientific criteria. Thus, mental illness is a myth manufactured by psychiatry to justify its existence. It doesn't exist as a fact because it isn't diagnosed based on any biological symptoms or evidence.

Sociological theories and approaches to mental health

There are a number of perspectives through which we can understand mental health:

• The conventional model that seeks to explain mental health through scientific and medical knowledge is known as the biomedical perspective.

• The sociological model, which focuses on social circumstances and explanations, includes interactionist and structuralist perspectives.

Let's go over each of these views in turn.

The biomedical approach to mental health

The biological or biomedical approach to mental health sees the causes of illness as situated in the physical or biological body.

It postulates that mental illnesses are the result of medical issues e.g. brain damage, tumours and lesions, faulty genes, chemical and hormonal imbalances, etc.

The biomedical-psychiatric approach generally believes that most symptoms of mental illness can therefore be scientifically diagnosed and categorised. As for treatment for mental illness, it favours cure-orientated treatments focused on the individual such as:

• counselling,

• psychotherapy,

• medication, and in extreme cases,

• electroconvulsive or shock treatment,

• surgery, and

• detainment.

The sociological model of mental health

As we have mentioned, the sociological approach is based on the idea that external social factors shape mental health/illness.

Let's look at the two main perspectives on mental health in sociology: interactionism and structuralism.

The interactionist approach

Labelling theory points out that once a person has been labelled as mentally ill, there are a number of negative consequences for them. This is because it is then assumed that all their behaviour is evidence of their mental state.

Erving Goffman's (1968) research found that, once they are admitted to a psychiatric institution, people are stripped of all individuality and forced to conform to the label of "mentally ill".

He observed that after isolating them and systematizing all of their daily routines, mentally ill patients lose their sense of self and are coercively made to accept their "mentally ill" identities for fear of punishment.

The structuralist approach

Structuralists argue that there is a social pattern to mental illness. A range of cultural and material factors that structure society and can contribute to poor mental health explain these patterns. This suggests that mental illness cannot stem purely from biological or individual factors.

R. D. Laing (1960) challenged the biomedical approach to mental illness and methods of psychiatry upheld by the medical establishment at the time. He rejected the idea that mental illness originated in the physiological organs, pointing to structuralist explanations.

Laing suggested that the causes of mental illness, particularly deeply misunderstood disorders such as schizophrenia, are located in the structure of society and in people's relationships with others, particularly the nuclear family.

Anne-Marie Barry and Chris Yuill (2008) add that experiences of oppression can be especially isolating and cause mental distress, saying:

The social distribution of mental illness

Sociologists also focus on examining how society can negatively impact an individual’s mental health. Therefore, it is important to study social inequalities based on factors such as class, gender, and ethnicity; and how they can cause or contribute to mental illness.

Social class and mental illness

When looking at which subsections are most likely to suffer from high rates of mental illness, the poorest groups in society are massively over-represented.

J.C. Phelan and B.G. Link's (1995) research on the relationship between social class and mental illness concluded that there is a close relationship between high levels of deprivation and bad mental health.

Sociologists argue that the poor are less likely to have large social networks of support (Wilkinson and Pickett, 2009), as well as less access to the educational, social and economic resources that the middle class take for granted (Myers, 1975).

The stress of trying to cope with struggles or life crises on their own therefore manifests as mental illness, especially depression.

Gender and mental illness

Statistics show that women are more likely than men to exhibit signs of mental ill-health. Overall, women's rates of mental illness are about a third higher than men's but are much higher for specific illnesses; for example, younger women are at least three times more likely than men to be treated for depression.

Sociologists such as George W. Brown et al. (1975) argue that this is because women are more likely to lead stressful lives due to:

• poverty

• debt

• unemployment

• poor housing conditions

• having to work whilst also being responsible for childcare, etc

On the other hand, Graham Scrambler (2009) notes that male mental health is invisible in comparison due to stigma. Instead of reaching out, men tend to express their emotions through aggressive and/or criminal behaviour and are consequently punished rather than receiving treatment.

Ethnicity and mental illness

Members of ethnic minority groups have significantly different chances of mental illness compared to the majority white population:

• British-Pakistani and Indian women experience more depression than men and women of other ethnicities (McCrone, 2008).

• Men of African-Caribbean descent are between three and five times more likely to have schizophrenia than the population overall (Nazroo, 2001).

This can be explained in part by experiences of prejudiced attitudes, racist attacks, poverty, unemployment and other stressors faced by ethnic minorities.

However, Nazroo (2001) also found that other minorities who are equally deprived as African-Caribbean groups have much lower levels of mental illness. Therefore, poor mental health cannot always be explained by experiences of discrimination alone.

Rather, according to Nazroo, young Black men are particularly vulnerable due to institutional racism within criminal justice agencies and psychiatry that exaggerate their criminality, send them to mental health wards at much higher rates, and punish them more harshly.