This paper explores mental health legislation from a philosophical and sociological perspective. It is argued that mental health law exists primarily as a coercive social control instrument and that the maintenance of a separate legislative framework for the mentally ill is based upon dubious legal and philosophical grounds. The need for changes in mental health law has been accelerated by the move in Britain toward care in the community. One of the most important issues at the centre of the debate revolves around the concept of 'dangerousness' and mental disorder. The research into the extent to which the risk of violence can be predicted appears problematic from a reform perspective. Prediction is considered to be the overriding problem that leads to a violation of patients' civil rights, especially in relation to black and ethnic minority groups. Equity in law is necessary for the protection of patient's rights and particularly for the protection of those people who enter mental health care systems concerned with issues of control at the expense of care.
This paper explores the origins of insane asylums in 19th century England by comparing the official 'received' medically dominated perspective with an alternative sociological perspective. The major structural changes in provision are addressed as the focus for analysing the differing histories. A brief review is presented of the responses to insane people prior to the national asylum programme following the 1845 Lunacy Act, and of the reform logic that underpinned asylum care. The alternative sociological perspective presents the origins of psychiatric asylums as part of the social and economic changes occurring generally at that time. As such the origins of insane asylums are presented as part of a state-guided 'sanitary' movement which included poor, criminal and insane people within its remit. The effect of state-guided correction was the segregation of insane people from both the general population and other deviants who were formerly classed together. Insane people are thus presented as a group of deviants who departed most radically from the 'rational individualist' qualities of self-control, predictability and responsibility required in the industrialized world of capital social relations that emerged during the last century.
This paper explores the conceptual knowledge base underpinning 'mental illness type behaviour' and offers a sociological and philosophical perspective. The role of values in concepts of health and illness is presented as widespread not only within psychiatry, but also in regard to general/physical health. The controversial nature of the psychiatric enterprise is believed to be due to the lack of consensus regarding notions of mental health and mental illness. Psychiatry is presented as a form of social control, akin to the legal system, dictated by moral norms. These are presented as value-loaded and maintained in accordance with the dictates of particular interest groups. Social control concepts are explored and Freud's psychodynamic model is presented as a legitimate model that incorporates a meaningful concept of 'illness'. No theory, though, is presented as value-free. Psychiatry is thus presented as being socially and politically constructed. The implication for health care professionals is presented as that of trying to liberate professional work from the narrow responsibility of the 'individual', whilst also trying to create a more democratic enterprise.
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