1. Defining Mental Illness
1.1. The Medical Model of Mental Illness
1.1.1. Composed of 4 assumptions about the nature of mental illness
1.1.1.1. Objectively measurable conditions define mental illness, in the same way that the presence of a specific bacterium defines syphilis.
1.1.1.2. Mental illness stems largely or solely from something within individual psychology or biology, even if doctors do not yet know its sources.
1.1.1.3. Mental illness, will worsen if left untreated but may diminish or disappear if treated promptly by a medical authority.
1.1.1.4. Treating mental illness rarely harms patients, so it is safer to treat someone who might really be healthy than to refrain from treating someone who might really be ill.
1.2. The Sociological Model of Mental Illness
1.2.1. Questions the assumptions of the medical model.
1.2.2. Behavior leads to the label of mental illness when it violates cognitive norms, performance norms or feeling norms.
1.3. The Problem of Diagnosis
1.3.1. The problems with diagnosis are particularly acute when a therapist and patient do not share the same culture.
1.4. The Politics of Diagnosis
1.4.1. Diagnostic and Statistical Manual of Mental Disorders (DSM): Psychiatrists use this manual for assigning diagnoses. (Insurers require a DSM diagnosis)
1.4.2. Reliability: The likelihood that different people who use the same measure will reach the same conclusions.
1.4.3. Validity: The likelihood that a given measure accurately reflects what those who use the measure believe it reflects.
2. A History of Treatment
2.1. Before the Scientific Era
2.1.1. Families would attempt to normalize mental illness by describing it as eccentric.
2.1.2. Societies viewed mental illness as punishment for sin.
2.1.3. People were sent to madhouses.
2.2. The Rise and Decline of Moral Treatment
2.2.1. Moral Treatment: Teaching individuals to live in society by showing them kindness, giving them opportunities to work and play and in general treating mental illness more as a moral than a medical issue.
2.2.2. The Great Confinement: A shift away from moral treatment while hospitals and asylums continued to grow.
2.3. Freud and Psychoanalysis
2.3.1. Used mostly upper middle class patients.
2.3.2. Most could not afford psychoanaysis
2.4. The Antipsychiatry Critique
2.4.1. Symbolic Interactionism - Individual identity develops through an ongoing process in which individuals see themselves through the eyes of others and learn through social interactiosn to adopt the values of their community and to measure themselves against those values.
2.4.2. Total Institutions: Instiutions where a large number of individuals lead highly regimented lives segregated from the outside world.
2.4.3. Mortification - A process through which a person's self-image is damaged and is replaced by a personality adapted to institutional life.
2.4.4. Master Status - A status considered so central that it overwhelms all other aspects of individual identity.
2.4.5. Depersonalization - A feeling that they no longer are fully human, or no longer are considered fully human by others.
2.5. Deinstitutionalization
2.5.1. Deinstitutionalization - the process of moving mental health care away from large institutions and into outpatient settings.
2.5.2. Due to finances and drugs.
2.5.3. Rise of individualism - A set of sociocultural beliefs and practices that encourage and legitimate the autonomy, equality and dignity of individuals.
2.5.4. Individuals could avoid as much stigma.
2.6. Remedicalization of Mental Illness
2.6.1. New techniques for diagnosis and treatment as well as new theories of mental illness.
2.6.2. Biological revolution
2.6.3. Drugs are often relied on.
2.7. The Rise of Managed Care
2.7.1. MCOs - Any system that controls health care spending by closely monitoring where patients receive health care, what sort of providers patients use what treatments they receive and with what consequences.
2.7.2. Affects how mental illness is diagnosed.
3. The Experience of Mental Illness
3.1. Becoming a Mental Patient
3.1.1. Self-Labeling
3.1.1.1. Individuals downplay mental illnesses.
3.1.1.2. Feeling Work
3.1.1.2.1. Individuals can change or reinterpret the situation that is causing them to have feelings others consider inappropriate.
3.1.1.2.2. Individuals can change their emotions physiologically through drugs, medication, biofeedback or other methods.
3.1.1.2.3. Individuals can change their behavior, acting as if they feel more appropriate emotions than they really do.
3.1.1.2.4. Individuals can reinterpret their feelings, telling themselves that they only feel tired rather than anxious (or other forms of covering).
3.1.2. Labeling by Family, Friends and the Public
3.1.2.1. Families and friends can ignore behavior for two reasons
3.1.2.1.1. Those who share cultural values, close personal relationships and similar behavior patterns have a context for interpreting unusual behavior.
3.1.2.1.2. Families often hesitate to label one of their own for fear others will reject or devalue both the individual and the family.
3.1.2.2. Accomodation
3.1.2.2.1. Refers to interactional techniques that people use to manage persons they view as persistent sources of trouble.
3.1.3. Labeling by the Psychiatric Establishment
3.1.3.1. Mental Health Professionals tend to assume illness for three reasons
3.1.3.1.1. The medical model of mental illness stresses that treatment usually helps and rarely harms.
3.1.3.1.2. Mental health workers see prospective patients outside of any social context, behavior that might seem reasonable in context often seem incomprehensible.
3.1.3.1.3. Mental health workers assume that individuals would not have been brought to their attention if they did not need care.
3.2. The PostPatient Experience
3.2.1. Those considered mentally ill are often feared or rejected by others.
3.2.2. Some who accept the label become more depressed and experience more social isolation.
4. The Epidemiology of Mental Illness
4.1. The Extent of Mental Illness
4.1.1. All societies from simple to complex, include some individuals who behave in ways considered unacceptable and incomprehensible.
4.1.2. Symptoms of mental disorder are fairly common.
4.1.3. Most common are depression and alcohol abuse.
4.2. Social Stress and Mental Illness
4.2.1. Sociologists are interested in the link between mental illness and stress and laregely focus on the acute stresses of life events
4.2.2. Some people have resources to reduce the stress of life events while others do not.
4.2.3. Chronic stress is more important than acute stress for predicting poor physical health and the same is true for mental health.
4.3. Ethnicity, Gender, Social Class and Rates of Mental Illness
4.3.1. Ethnicity
4.3.1.1. African Americans are less likely than whites to develop anxiety and mood disorders.
4.3.1.2. Psychological distress in African Americans is likely the result of chronic stress.
4.3.1.3. Hispanic Americans are less likely to develop anxiety disorders, mood disorders or substance abuse problems.
4.3.2. Gender
4.3.2.1. Men have higher rates of schizophrenia, substance abuse, and impulse control disorders.
4.3.2.2. Women have higher rates of anxiety disorders and mood disorders
4.3.2.3. These differences can be explained through gender roles.
4.3.3. Social Class
4.3.3.1. As social class increases, mental illness and psychological distress decreases.
4.3.3.2. Schizophrenia is highly linked with social class.