Sociological issues in the conceptualization of mental illness

Abstract

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.

The philosophical and sociological context of mental health care legislation

“…The doubts about having correctly identified the indispensable features of insanity are shared by other critics (Ingleby 1981, Sedgwick 1982, Busfield 1986, Symonds 1991) who have increasingly challenged the ‘taken for granted’ medical and legal assumptions that psychiatry is an objective, value‐free, scientific venture. It is this doubtful element states Ingleby (1982) which reinforces the view that psychiatry is so obviously ‘socially constructed.’ This perspective proposes that psychiatry is a socially constructed enterprise managed by the medical profession, using legal definitions of ‘insanity’ as a convenient and useful method of social control.…”

The origins of insane asylums in England during the 19th century: a brief sociological review

“…The early cure optimism has been shown by Skultans (1979) to be based more on hope than reality ('Select Committee' 1844) Nevertheless, Skultans (1979) echoes Jones (1972) m agreeing that there were genuine reformers who were concemed for the plight of many unfortunate people and spent a great deal of time visiting the institutions that existed prior to the 1845 Lunacy Act Nevertheless, the received version appears naive in presenting the notion that the building of county asylums on a grand scale was the best solution to the abuses that had been witnessed pnor to 1845, especially when for the most part the asylums were a response to the pauper lunatic problem, which was a growing problem Allied to this, the therapeutic optimism that is most widely reported upon at that time was that of the moral reformers, who believed m the creation of small family-like wards in a stimulating environment and early detection of mental health problems Civen the alternative radical perspective, at best the reformers appear to have been working agamst a structural transformation whereby the altematives undermined the new social relations which worked against 'human entitlement' Polanyi's study of 19th century England appears acutely relevent here m his eissertion that to separate labour from other activities in life and to subject it to the laws of the market, was to annihilate all organic forms of existance and to replace them by a different type of organisation, an atomistic and individual one (Polanyi 1957) The effect of the market economy upon social relations appears more plausible m respect of explammg asylum buildmg and the incarceration of deviants, especially m relation to segregating those who undermined a 'work ethic' where control, predictahihty and responsihility were mcreasmgly necessary m the workforce This 'intelligibility' cntenon (Inglehy 1982), remains the most widely used cntenon for definmg the 'mentally ill' today (Symonds 1991), and as such reinforces the helief that the market system, which requires individuals who helieve themselves to he fi"ee, rational and self-determmmg, cannot tolerate a dialogue with unreason…”