Written by: Michelle Clarke- September 2003. Final essay BESS Third Year at Trinity College Dublin.
Mental illness must be first defined in the context of legislation.-1- Account is required of the predominantly medical input and the challenge that is faced by Sociologists and other disciplines. It is the biomedical model that has made such an impact on our cultural ideas about the body. The body is determined to be well or ill.-2- This in turn reflects the attitudes and beliefs of people. History reflects its assumptions to interpretations of mental illness and these interpretations prove valid for some people still. Bio-medicine looks to the body and separates other aspects of the human being.-3- Herein lies the conflict necessary to invoke challenge and bring about change. The body is predominant: social, psychological and behavioural factors of the illness stand apart. The illness is pathologised and the disease is allocated to some part of the body (physical reductionism). -4- The Body is seen as the object of regime and control (Foucault, 1979).
This essay will review the historical social construction of mental illness – the pathologised version as enacted by legislation. It will review the myth imbibed by capitalism and science to the stigmatized illness that presently exists. I review the impact of fear as the powerful hidden component. Challenge exists and the entry of sociologists like Comte, Durkheim, Weber, Simmel, to the Chicago School in 1924 like Goffman are discussed in terms of their approach to Deviance. The introduction of Social Movements in line with concept of civil rights in the 1960’s and taking hold in the UK from the 1980’s onwards. For the first time, we saw the opportunity for those designated ‘mentally’ ill to become stakeholders in their own future. The stage where the person who was once the patient (inmate) can refer to themselves as ‘survivor of mental illness’ or just survivor. Children, Education, Amnesty International, the United Nations, the EU and their Quality of Life research programmes are essential to provide the empowerment for the mentally ill to engage and disengage (with the understanding of people). This is vital. Only could those with mental illness have been so poorly treated and disregarded, if people conjured them as ‘deviant’ and not worth input.
Historical Social Construction of Mental illness – the assumptions
The ‘Struggle against Psychiatry’ has a long history. In 1620, the House of Lords received the ‘Petition of the Poor Distracted People in the House of Bedlam’ – the complaint was against inhumane treatment to the inmates. In 1845, the ‘Alleged Lunatics’ Friends Society was formed by ex-patients (Mind, 2003).-5-
The Middle Ages, saw the disappearance of leprosy in the Western World. Between the High Middle Ages and the end of the Crusades, leprosariums multiplied in the cities of Europe. The 17th century saw the creation of the houses of confinement established in Paris and other cities. Ironically, the Great Confinement made the human being – a social being and identity, subject to classification. It would have been economically viable to use the vacated buildings and to use them for the purpose of those held to be deviant, (Foucault,1967).
This period coincided with birth of Capitalism. Power and vanity became the new driving force. In England, the merchant class engaged in speculative ventures – those expectations driven by financial motivation involving commerce with emphasis on the emotions: fear and hope. Core to commerce is competition, envy and avarice and this has a price. The Renaissance period was the time of growth in individualism and this can incubate despotism. A schism arose in the Church dividing the Catholic Church and the Protestant Church.-6- The protestant work ethic, accumulation of capital, and a belief in a pre-destination created a suitable ethos to ignite in people the motivation required to embed Capitalism and class structure (Foucault, 1967: 74)
Mythology origin –Pathologised-Capitalism-Science
‘Suddenly, in a few years in the middle of the 18th century, a fear arose – a fear formulated in medical terms but animated, basically, by a moral myth’.
(Foucault, 1967: 192)
People were in ‘dread’ of a mysterious disease that spread from the houses of confinement that would soon threaten the cities. The disease became pathologised – fears, hallucinations, absent-mindedness all became identifiable symptoms.-7- (The symptoms in the footnote need to be seen in the context of what the Mental Health Act 2001 provides today). (Foucault, 1967: 199). Unreason and mental illness became intermingled. Unreason involves real fear. ‘Dread’ and the implications of fear compounded with the shame, stigma and ‘panopticism’ ensured segregation. Power and control enforce the dogma.
Contradiction and Challenge:-8-
Madness began to invoke thought. It became an issue of raising ‘the original truth’ but rather than it remaining hidden, this truth could ‘hang’ in history forever….This endorsed fear for some, both sides of the divide, but for different motives and different reasons. Fear and its internal impact and method of control and containment are hidden topics for discussion. The inference is weakness, the reality is fear can be used to control the vulnerable. Fear is pervasive in its implications.-9-
‘The truth of madness is what madness is…What madness is, is a form of vision that destroys itself by its own choice of oblivion in the face of existing forms of social tactics and strategy’ (Cooper, D. in Foucault, 1967: Intro)
The Reality is: Madness fascinates: The question stands – Is it madness or is it Vision?
‘It is of little importance on exactly which day in the autumn of 1888, Nietzche went mad for good, and after which his texts no longer afford philosophy but psychiatry: All of them, including the postcard to Strindberg, belong to Nietzche, And all are related to the Birth of Tragedy’. Our view of Nietzche is what he gave and continues to give to the Modern World’ (Blum, 273).
Sociologists’ Definition – Deviance:
‘Deviance always refers to conduct that is in violation of the rules
constructed by a given society or group. In other words, the concept of deviance implies a moral difference. It refers to the refusal or perhaps inability of an individual or group to abide by the moral norms that prevail in the social context in question’
(Berger and Berger, 1972: 305)
The group have defined the rules but the outsider remains outside looking in.-10- The outsider is the source of much speculation, scientific study and theorizing. The question is why does he not want to comply with societal rules?-11-
Sociology and its Origins
Sociology arose in the 19th century.-12- The basics of sociology related to the discovery of the laws of social order and the methodology required to maintain such order. (Berger, 1972; Berger, 1972)
Durkheim (1858-1917) understood deviance in terms of the functioning of society and deemed it preferable to study the society as distinct from individuals. The conduct of a person has categorized them in the minds of others. They are deviant and can be placed in a sub-category thereafter. In his book, Division of Labour, Durkheim highlighted the need for solidarity as people have an inherent need to belong. He wrote of the evolution from the basic operating mechanical society to the more organic society. Durkheim also researched and wrote ‘The Rules of Sociological Society’ in which he established the identity of sociology as distinct from psychological facts. Social facts represent ‘things’ – the approach is objective. (Berger, 1972; Berger, 1972).
Functionalism is the model applied by Durkheim and further progressed by Talcott Parsons in the US. Functionalism is closely applied to the medical model that promotes patient compliance and the bureaucratic structure to the services provided. Illness is seen as a social deviance when social expectations and norms are not achieved. Illness is an unnatural state hence the imperative function is to alleviate the person from it as quickly as possible. The assumption stands that stigma, shame and vulnerability pertain to many illnesses. Functionalists view health as a social commodity; a resource that is essential for individual achievement and the smooth performance of society (Annadale, 1998:10). The medical model is the Institution for Social Control.
Durkheim established views on Suicide and stated that this method of self-destruction was not only a personal tragedy but his findings were that it was a sociological consequence to which one is integrated in society – rare among married people, rarer in a more closely knit religious establishments and more frequent when rapid social change disrupts the social fabric. Social connectedness matters to our life in a profound way. Social networks reinforce healthy norms (Putnam, 2000).
Merton’s work has been productive in that it links with Durkheim’s concept of anomie and the analysis of social class. There have been investigations that link certain class positions to mental illness.
Weber examined the role of ideas in history; Marx focused on the economic aspects. Weber and Durkheim both reviewed the impact of Religion. Weber wrote on ‘The Protestant Ethic and the Spirit of Capitalism. It was Georg Simmel who reviewed the role of the Stranger – the dyads and triads. Simmel sought to establish ‘a formal sociology’. These sociologists are European.-13-
Goffman links back to the Chicago School of the 1920’s – America.-14-
Deviance is measured against a perception as to what is reality. The perception of reality is that defined by Society. Perceptions differ, they change. Both normality and deviance are important components of ‘reality’. One must be aware that Society is protective against challenges as to how they define reality:-15-
‘The total institution is a social hybrid, part residential, part community, part formal organization, there in lies its special sociological interest’ (Goffman, 1968: 22)
Goffman engaged with the concept of symbolic interactionism. To Goffman, mental hospitals and prisons are ‘total institutions’. Stigma looks at how people actually cope with ‘spoilt identities’. He exhibits a strong feeling of compassion with the victims of negative ‘social designations’. (Goffman: 1961: 22)
Following the trend set by Mills and Goffman, ‘labelling theory’ emerged. Howard Becker is the most well known representative of this new school. It creates a platform for a hierarchy to develop permitting different levels of authority. It is about distinguishing the social worker from the sociologist, from the psychiatrist or the law enforcement officer from the Doctor. It is important to note that what is called deviant today may be deemed normal in the future.
Another aspect to consider about Deviance is that it is understood as simply one way in which people define a situation. It’s ‘reality’ depends upon the power of the people who do the defining to impose their definition upon others.-16-(Goffman, 1961).
Stigmatization in the context of Mental Illness ensures it is referred to as deviant – the modus operandi is a process which one group of people inflicts upon another. The definition will ‘stick’, depending upon the power of the definers. In that case, those who are thus defined, the stigmatized will have to come to terms both socially and psychologically with the ‘spoilt identity’.-17-
CHALLENGE TO SOCIOLOGISTS:-18-
Medicalisation dictates legislation. The 1945 Mental Health Act-19- was only altered in 2001 with much grassroots activity of social movements and charities at a variety of levels. The issue of Rights for the mentally ill remains in limbo in Ireland. However, social movements are in existence.
Social Movements – Nick Crossley
‘Social movements can be viewed as collective enterprises seeking to establish a new order of life…The career of a social movement depicts the emergence of a new order of life.
(Blumer 1969: 99)-20-
Contention Humanities versus Science – US Sociological View 1974
People Question – Can humanity survive with science so prevalent? Sociologists and other social scientists are divided in opinion as to how to best position themselves to address the science versus the humanities issue in the 20th century. The major challenges concern proceeding with research under subsidies from those in power or should they only be investigators committed solely to their own humanist goals. Can they merge both together was the issue? (McClung Lee, 1973)-21-. The reality is that if science provides the genetic proof, it still stands that triggers and environmental factors play a large part in mental illness.
Education – the key factor to effect change: Multiple intelligences exist yet the school curriculum is weighted against non scientific approach students.
Bourdieu defines the sociology of education ‘specifically in terms of its role in understanding; the contribution made by the education system to the reproduction of the structure of power relationships and symbolic relationships between classes’. (Banks, O, 1968:115)
View of Education – US 1974:
‘Students caught up willingly in the regimenting routines of such specialized trade schools and college as those of business, engineering and military, appear to be heedless to their dehumanization’ (McClung Lee, 1974 pg. 1)-22-
And
‘Our educational procedures are more often geared to the development of believers and technicians rather than independent investigators and thinkers
the mass culture that pervades’ (McClung Lee, 1974: 67)
Representation 1980’s: the approach was more that of a ‘consumerist’ for the patient as distinct from service users or survivor.
The objective is to create social inclusion for people diagnosed with a mental health problem.
Nottingham Advocacy Group was one of the first established in 1986. The movement was towards Survivors speaking out, having a voice and challenging false conceptions perpetuated through mythology and ignorance.
A forward thinking psychiatrist and his client – Dr. Anthony Clare, St. Patrick’s Hospital, Dublin and Spike Milligan, Writer, Comedian with a Manic Depression diagnosis, worked in conjunction to produce a book to provide evidence from both sides. The comparison was drawn that both Cancer and Mental illness are pathologised but the reaction is most likely one of shame in relation to depression, even though a severe depression is life-threatening illness. (Clare, Milligan, 1993).-23-
‘Images of madness in our culture make it starkly clear that it is best avoided or denied – not just because the experience can be alarming, but because it is hard to see oneself simultaneously as ‘crazy’ and as a valid person with a liveable future’ (Sayce, 2002: 8)-24-
‘It addresses one central question: how, and on what basis, do we move beyond the physical de-segregation of hospital closure programmes towards the chance of full participation in social and economic life’. (Sayce, 2002)-25-
Why penalize people who cannot work at 100% range or even a 50% range?-26- Cordis, cordis.europa.eu/ an arm of the EU is currently researching Quality of Life perspectives.-27- Demographics may cause policy makers to change their attitudes and view people as potential (albeit limited) contributors to taxation.
Empowerment and mental health – the need for ‘Academics with Attitude’ .
This is a movement of ‘passive recipients’ to ‘active subjects’. The approach is to challenge the way we think about ‘mental illness’ mental health and what it means to live with madness. -28-(Barnes, 2001; bowl; 2001:). This is about Changing Attitudes. Mind in the UK run successful campaigns like 1 in 4, with descriptive footage of a severely depressed person. These are areas that need consideration. Essential is the use of the internet and system of email both for self-knowledge and innovative type work consistent with ‘diagnosis’.
Points to realistically consider:
Integration implies the individual will fit in with the system
The person has to change. Inclusion means that system itself will develop self-criticism; acknowledge the way in which it excludes and denies access; and dismantle barriers (Shakespeare 1997 in Sayce 31). -29- Anxiety – Valium, Librium – the wonder drugs-30- of the 1960’s are addictive. Consultants are afraid of insurance actions so are much more controlled in what they prescribe. There is no alternative now for the patient with anxiety i.e. except cigarettes/alcohol. Public policy is to prevent smoking in public places. Both cigarettes and tranquilizers are being restricted at the same time. This has implications for increased intake of alcohol. Mental illness also must be described as a physical illness. There is a need to have the service user as a stakeholder in policy making.-31-
Power of Language – Control
‘Language is itself a site of struggle and one of the purposes of user or survivor movements is to reclaim the right to define and name their own experiences’.-32-
Perspective
‘The emphasis on science is important. First it implies that the origin of mental illness and the role of intervention can be studied using the methods of observation and logical inference that form the basis of natural science. As such it is based on ‘fact’, not value, and its definition is seen as independent of Culture or social context.-33- This has both a political and organizational implications. It provides justification for the separation of medicine as a discipline and the retention of power over defining and treating mental illness outside political and popular control……Medicine has a non precise definition .
Reduction of stigma and discrimination is starting to appear high on the public policy agenda in a number of countries. The Australian Government have a major Education programme in place. The New Zealand government have adopted a programme based on studies into other marginalized groups e.g. HIV/Aids.
More Enlightened approach – World Perspective
The Universal Declaration of Human Rights encompasses
civil, political, economic and cultural rights.-34-
Community care is deemed more humane than inpatient stays. Ireland, Israel, Netherlands and Spain have 80-90% of the beds in psychiatric hospitals, France, Germany and Japan have 60-75% occupancy in psychiatric hospitals. The difference is found in Australia, Canada and the USA at 40%. (World Health Organisation page 17)
Amnesty International Ireland www.amnesty.ie/mentalhealth. Sociologically challenges Ireland’s treatment of the mentally ill. (The News on mental health issues from around the world) reports:-)
‘The support for children with, or at risk of mental health from successive Irish governments has not been adequate. The Amnesty publication, Mental Health – the Neglected Quarter, has as its objectives to increase awareness that children’s mental health is a human rights issue, to place this fact firmly before Government, and to lobby much needed reform in Government policy, practice and legislation (Sean Love, Director of Amnesty’s Irish Section).-35-
Gender issues/cultural issues – social factors:
Mental illness must be about multi-disciplinary teams. Psychiatrists opened up to the inclusion of psychology over the past 20 years and it is stated that if trigger events can be limited in a person susceptible to mental illness, and particularly after one event only, it is probable that they will avoid major mental health issues (Aware lecture 2003).www.aware.ie. 75% of those who commit suicide are men.-36- Black men have above average admittance in to psychiatric hospital in the UK and also to high security areas. Most divorces and separations are started by women and fathers tend to lose contact with their children. There is growing evidence that unemployment has an impact on mental. These are social issues impacting on family structure and society: http//www.mind.org/Information/Factsheets/Men/.
THE WAY FORWARD (Denial, Stigma, Shame, Education, Multi-disciplinary teams, Respect for difference)
Education is core to understanding and change.
‘The traditional conceptual framework in the subject is that of functionalism, and derives primarily from the writings of the French sociologist Emile Durkheim. The functionalist approach, as Durkheim used it, is to seek for the social function performed by an institution; that is for the part played by the institution in the promotion and maintenance of social cohesion and social unity’. (page etc).
Durkheim referred to the ‘socialization of the young generation’. He sought to imbibe the young generation with values and certain intellectual and physical skills.-37-
The Bright Futures Initiative –
In 1997, the Mental Health Organisation in the UK undertook a major study into the mental health of children and young people. They reviewed the requirements for the emotional and healthy development of children. The 1999 reports Bright Futures was published. Factors that cause children to be susceptible include poverty, poor housing, parental conflict, parental psychiatric problems and abuse.-38- It acknowledges the importance of early intervention. Other reports include The Mental Health of Young Offenders, August 2002 and the Mental Health of Looked After Children, August 2002. http://www.mentalhealth.org.uk/page.cfm?pagecode=PIBF -39-
Dr. Fernandez (Amnesty Member),-40- states the need to distinguish between ‘’mental health problems’’ induced by homelessness and ‘’mental illness’’ that may be a factor in becoming or remaining homeless (Amnesty International, 2003: 17). Psychiatric and rehabilitative services but with limited funding are provided at St. Brendan’s Psychiatric Hospital. The main objective is to ‘preserve and regain social function’. The separation from the rest of society in large institutions only ensures exclusion.-41-
IRELAND – Equality and the system of education are formally challenged. It is not inclusive. Is there a link to Mental Illness! Is the scope of the curriculum broad enough?
4500 are now hospitalized in psychiatric hospitals in Ireland. This has reduced from over 21,000 in 1958. By the 1980’s, institutions were costing large sums of money and government policy sought alternatives. Market forces determined the 1980’s de-institutionalisation policies.-42- In the year 2000, admissions were over 20,000 however the issue to be concerned about is that 70% of these were re-admissions. This speaks volumes about the recurrent nature.-43- Dr. Kennedy from Central Mental Hospital in a presentation made a point of the differentiation between those problems that were social i.e. over 80% and those that were psychiatric.-44-
‘To speak of the unspeakable is the beginning of action’ (Millett, 1994)-45-
Who is willing to listen, to hear, to activate change? The Irish psychiatric policy is based on the consumer model and thus adopted by the social movement organizations e.g. Aware and Schizophrenia Ireland. The approach is Top-Down as distinct from user-led action.
‘It is possible to propose a theoretical framework which moves the sociological perspective on from limitations inherent in other sociological traditions within the sociology of health and illness literature, such as psychiatry as a social system (Foucault 1965), or the deviance or the Marxian approaches of Scheff (1999 or Scull (1979 respectively‘ (Speed, E, 2002, 64). Irish peculiarities mean the model requires adaptation.
Schizophrenia Ireland was set up in 1981. http://www.sirl.ie/other/repository_docs/13.pdf -46- Aware, the voluntary organization was established in 1985. Aware Ireland, Sanewww.sane.org.uk in the UK and NAMI https://www.nami.org/ in America support the biological basis of mental ‘illness’. Aware is involved in the ‘promotion of research into biological, psychological and social aspects of Depression’ (Aware, 2001).-47- The Minister of Health has put in place an appointed study group to review analytically psychiatric services and community based service (Foreward iii) is now in place.
‘There has been a lack of any concerted mental health service users’ movement within the Republic of Ireland. Mental Health service users’ movements have a marked orientation towards strategies of empowerment and the provision of peer advocacy and support mental health service users’ (Speede, 2002). This is only acceptable if the objective is to change educational policy and introduce multi-disciplinary teams to work in the best interests of the service-user. If this occurs and with the distinct advantage of the internet, survivors can become empowered.
Research – What do we know? What does the future hold?
1997 The Trinity Horizon Project of the Centre of Women Studies covered a period of 4 years and developed a pro-type training and counseling programme for the women recovering from depression to facilitate their re-entry to the workplace. The research was carried out in collaboration with Aware, IBEC, ICTU and FAS.
The stance was from the humanitarian and social perspective. This was aimed at creating survivors. It was concerned with confronting the hidden secret associated with mental illness, dealing with the stigma that pertained and to emphasize just how under-resourced mental health services are. Funds were provided by the EU. A conference was held by the Trinity Horizon project – titled Mental Health and the Workplace: Challenges and Opportunites. It had access to transnational models – this provided a cross cultural dimension. Norbert Tietz, Director, EX+JOB in Wunstorf, Germany.
Immediately receptive is the term social firm. The firm was based on a philosophy of work and part of this was about integration of the participants with the public. Work experience included bar/restaurant work open to the public, fridge recycling plant, used children’s clothes shops, furniture shop and a music shop. The innovation of work came from the community as a whole in collaboration with the psychiatric hospital. The re-cycling dimension proved very successful. It appealed on the environmentally friendly factor. German companies must employ 6% of people with disabilities. If they choose not to pay, they must pay and fine and the money is paid into a fund for people with disabilities.
Professor McKeon, Psychiatrist of St. Patrick’s hospital and founding member of Aware reiterated that people with mental health difficulties, especially those with depression, make excellent employees. If anything, he stressed that this group with their over-anxiety to do well are exemplary employees. ‘Their exaggerated sense of responsibility and loyalty, traits which sometimes contribute to their difficulties, are positive elements for an employer. They are the first at work and have a commitment to any task they undertake. In dealing with their illness, they have already proven their ability to face and overcome difficulties and demonstrated their tenacity and courage’ (Trinity Horizon Project, Centre for Women Studies, 2000: viii)-48-
Yet, such a daring programme proved too expensive for the NRB to undertake. The NRB was subsequently subsumed into FAS – no rehabilitative programme as per the research was in put place yet. In fact, community employment which provided a meager alternative, but an alternative form of rehabilitation is being drastically cut back by Government policy.
CONCLUSION
National Policy framework – stakeholders – Survivors. Rights based Mental Health legislation is needed. Expenditure in psychiatric services has been reduced since 1976 by 20%. Mental illness is about social implications, coping strategies, psychological services and engaging with denial, particularly within the family context.-49- Power and control needs to be monitored.-50- Mental illness merits a consensual approach if people are to be integrated in society. Social workers need to interact with sociologists, psychologists, psychiatrists, educationalists, and most important in line with the wisdom of Carl Jung, Psychiatrist, Psychologist – they must involve the patient. -51-The Trinity Horizon Research proved too costly an approach but a new direction and approach is in place the National Flexi-Work Partnership Work-Life Balance Project
Comte named a new dimension called sociology; Durkheim elaborated and defined society as an integrated whole; Weber, shared Durkheim’s interest in religions and structure but also was concerned with ideals; and Simmel spoke of the ‘Stranger’. The intervening years saw institutionalization, medicalisation, of people who are ‘Different’. Why should an idealist be different, there might be a latent talent, that is inhibited by structure yet innovation lies there untapped. The challenge rests with Education and incorporation of a broader syllabus, to the Universities to take in hand those non-conformists and educate them and add the dimension to their education,-52- and the education of other students. People are mental health survivors but they must be given a chance. Denial, stigma, shame, must be removed and if it takes the conflict of referring to a person as socially deviant, for the reaction to come – ‘but no you are not in horror’. This is the step forward to dealing with denial. This is reality brought about by fear that no-one cares to acknowledge – hence the suicides are dismissed in shame, in silence, in fear. The medical profession live in fear that they too ‘will break the threshold’ that applies to every human being. This can be intuitively sensed from them. Sociologists need to take stock of the heritage of their founding fathers – perhaps it is time not to seek the credibility of being totally scientific and consider a more humanistic, open, consensual and interactive approach and work within multi-disciplinary teams with the objective of improving society.-53-
My parting comment is about Suicide. Dr. Kelly, (Iraq war 2003) leading scientist in search of nuclear arms in Iraq had the choice to conform to the status quo – to have his knuckles wrapped. He was an individual, deliberated, he knew the outcome if he conformed. Perhaps the issue is – could he have lived with his conscience? Durkheim reviewed suicide in this context. Yet our society does not see that people differ, a ‘Stranger’, -54-holding intuitive sentiments similar to what Shakespeare wrote in Hamlet ‘there is something rotten in the State of Denmark.
March 2015-Contextualised over a decade: Deviance is deviance surely not as defined by mental health. The shocking murder of Elaine O’Hara by a man who was socially deviant and so arrogant that he believed he could not be convicted and who was not going to use the defence of Insanity.
Dwyer did not plead insanity. He is found guilty of Murder. He preyed on a vulnerable woman called Elaine O’Hara who had been admitted to Ireland’s most elite psychiatric hospital, St Edmundsbury, on 14 occasions, under the most eminent of psychiatrists including Dr Anthony Clare. The paradox, the person with a mental illness the victim of society’s inability to provide for her mental health need and the murderer, the narcissist, the psychopath, devoid of conscience who saw vulnerable women as objects for his gratification. The question is will people abuse the term mental health and include him as mentally ill. I sincerely hope not. This social deviance stands apart from what mental illness is about. Again I say lets use the term Manic Depression again instead of the sanitised Bipolar. The manic applies to the high but also to the low.
Endnotes
1 An act to provide the involuntary admission to approved centres of persons suffering from mental disorders, to provide for the involuntary admission of such persons and, for the those purposes, to provide for the establishment of a Mental Health Commission and the appointment of Mental Health Commission tribunals and an Inspector of Mental Health Services, to repeal in part the Mental Treatment Act 1945 and to provide for related matters. “Mental Illness” means a state of mind of a person which affects the person’s thinking, perceiving, emotion and judgement and which seriously impairs the mental functions of the person to the extent that he or she requires care and medical treatment in his or her own interest or in the interest of other persons (Mental Health Act 2001)(return)
2 Distribution of wellness and illness throughout population does not fall in equal proportions (return)
3 Western medicine: science puts forward the belief that the body is separate from the mind and spirit (return)
4 Etiology is about identifying causes for each disease and scourcing cures. A machine capable of repair is the metaphor (return)
5 Exhibitions of inmates would be held and people paid to see those deemed ‘Mad’ (return)
6 Certain earlier sociologists particularly Durkheim and Weber, who carried out considerable research into different religions, linked it closely with the regimented system of values and rules relating to societies (return)
7 It was confinement of the debauched; the spendthrift fathers; prodigal sons; blasphemers, men who “seek to undo themselves”, libertines….One tenth of all the arrests were in Paris for the Hospital General concern “the insane”< “demented” men< individuals of “wandering mind” and persons who have become “completely mad” Foucault, 1967). No mention of alcohol or drugs. (return)
8 Lord Byron: Van Gogh; Churchill; Don Quioxte; Goya personalised mood distortion to black periods. Churchill referred to “Black Dog”. Aware St Patrick’s Hospital run a website titled “Black Dog” (return)
9 ‘Fear of fear refers to the anticipation of anxiety and thoughts that the mental and physical symptoms of anxiety will lead to worse consequences – a thought that in turn generates more anxiety. For example, mounting feelings of anxiety often make the patient anticipate that he or she will lose control and behave in a dis-inhibited way, or even become insane; while rapid heart action may lead the patient to expect a cardiac arrest or coronary thrombosis (Mathews A, Gelder M, Johnston D, 1981:5) (return)
10 Normal personality: how to define it? Perhaps – efficient self perception, realistic self-esteem and acceptance; voluntary control over behaviour; a true perception of the world; sustaining relationships and giving affection; self direction and productivity (Social psychology notes 2nd yr Business Economics and Social Studies Trinity notes (return)
11 Having been institutionalised and detache from society on numerous occasions, you are the outsider looking in (personal comment). Some explanations of psychosis use these exact words’ (return)
12 The name ‘Sociology’ was invented by Auguste Comete (1798-1857) – Philosophy (Positivism) (return)
13 Robert Merton sought to explain deviant behaviour in terms of social structure. He puts forward the idea that all forms of deviant behaviour ‘from differentials in the access to the success goals of a society by legitimate means….Deviance thus occurs as a result of discrepancy between the aspirations which society has socialised into its members and the way that society has provided for realising such aspirations. Merton uses the Durkheimian concept of anomie to refer to such a situation’. This reflects the goal oriented, materialistic strain in America (return)
14 Malfunction appears to determine deviance. ‘Agoraphobia is illness because one should not be afraid of open spaces. Homosexuality is illness because heterosexuality is the social norm. Divorce is illness because it signals failure of marriage….all these and many more have been said to be signs of mental illness (Berger 1963:6) (return)
15 It was then and still is my belief that any group of persons – prisoners, primitives, pilots, or patients – develop a life of their own that becomes meaningful, reasonable and normal once you get close to it, and that a good way to learn about any of these worlds is to submit oneself in the company of the members to the daily round of petty contingencies to which they are subject (Goffman) (return)
16 Mental illness/mood disorder is about lapses to weakness in moral and physical health – this inherent vulnerability is exploited (this includes family; employers, corporates, insurance companies, regimented bodies like education, the legal profession; the Church; non conformists too are not acceptable. Yet medical ethics was horrifically breached by Mengele with use of humans for scientific experiments (NAZI Germany) (return)
17 Victor Frankl (1962) Survivor from Auchwitz (Psychiatrist, Psychologist, Logotherapist, writer. ‘When we describe a responsible person we mean that in every area of his life he is able to meet the demands of this world’. Logotherapy concerns expanding the scope of visions (psychologically) for the patient. Here is the challenge to society. (return)
18 Comment from House of Lords UK: Quite evidently explanations for mental illness and institutionalisation were unclear to those engaged in scrutiny “As we get to know more about the complexity of the human mind, so we try to make our shades of responsibility more complext, and so I thing we get into deeper and deeper muddles Baroness Wootton of Abiger, House of Lords 1962 (return)
19 Irish 1945 Act was based on the earlier English legislation (return)
20 Examples include: Mind UK, (Aware, Grow, Irish Mental Health Advocacy in Ireland and Ireland Mental Health Association of Ireland etc) (return)
21 This was 1974. Now in the UK it is the medical profession who are linking to Humanities for medical conferences (return)
22 What about the social impact of science on man as a social creature? The most obvious is the impact of domestic gadgetry, healt-care facilities, urban and industrial structures and the ultimate threat of nuclear war (McClung Lee, 1974) (return)
23 Surprisingly I sought the implication and definition of fear in his book – there was none. Doctors have an issue with fear (return)
24 Denial is corrosive. Aware now operate a ‘Beat the Blues’ campaign in secondary schools. This is successful. Parents may have very fixed interpretations and refuse to encourage a child to engage at the expense of the child. (return)
25 This book includes several sources including the survivors together with lawyers, policy makers, activists, medical health professions. Primarily the research was completed in the US and UK in the late 1990’s. Reference is made to systems in Europe, Australia and New Zealand. (return)
26 Vincent Van Gogh. His pre-occupation was to give, not to receive financially. His paintings were sold after his death and amrketing applied to accumulate worth. The same applied to letters he wrote. He was socially oriented. (return)
27 Presently, the Centre for Women Studies in Trinity College Dublin are carrying out research which is part of the Equal Community Initiative and the European Social Fund. It involves a mental health advisory committee. University of Dublin; Aware: Age Action; IBEC; Congress of Trade Unions; FAS and mental health survivors will convene over the next two years. The June meeting was a bilateral meeting: Working party of employers and the Mental Health Advisory group including mental health survivors. The focus is National Flexi work – Work Life Balance. (return)
28 Marian Barnes is a member of National Health Action Zone evaluation team focusing on community involvement. (return)
29 ‘People who are seriously disadvantaged in society rarely have just single problems – they have multiple interlocking problems. They do not compete on a level playing field. Empowerment must address all their problems together if it is to be meaningful’. (Davy, 1999, 37) (return)
30 Drugs have side affects; muscle wastage ensures body weakness; anorexia/bulimia can be side affects related to mood disorder or just a manifestation of self-harm, vision, co-ordination, perception, judgment, attention deficits etc (return)
31 The Barr Tribunal (John Carthy RIP): Labeled a Manic Depressive. Somehow anxiety has been removed from language of mental health otherwise he would likely not have been shot dead by An Gardai Siochana. Anxiety drugs (Benzos) are now causing negative reporting as they are deemed too addictive and there are basically no alternatives. It could be said that the cigarettes were used to taunt John Carthy RIP, cigarettes could have calmed his anxiety. Many people go contrary to regulations and even legislation especially relating to drugs and alcohol to help them cope with stress, anxiety, depression. This is a social issue and was addressed by Dr Harry Kennedy (Psychiatrist) who has accommodation problems at the Central Mental Hospital. It is linked to crime. (return)
32 Mental Act of England and Wales defines ‘Mental Disorder’ as mental illness, personality disorder, severe mental impairment. (return)
33 Perhaps this should mean it is a component part of a spectrum that deals with those diagnosed mentally ill. A more equitable distribution of funds in terms of time input would be required. hroughout population does not fall in equal proportions (return)
34 All persons have the right to the best available mental health care, which shall be part of the health and social care system. MI Principle Amnesty Mental Health Report – the Neglected Quarter). (return)
35 Ireland ratified the UN Convention on Rights of the Child in 1992, whereby it undertook to provide a specialised mental health regime to identify, treat and protect children under 18 years or at risk of mental illness. http://www.mentalhealth.org.uk/page.cfm?pagecode=NENE (return)
36 The State in Ireland and the Church are prejudiced in regard to a person with mental illness. Denial applies. (return)
37 ‘The most sensible way to lower rates of depression and suicide is …to spread accurate information among the general public about what depression is’ Dr Fernandex (Amnesty) and St. Brendan’s Hospital; Breaking the Cycle of Depression; (Joe Griffin and Ivan Tyrrell), The European Studies Institute. http://www.clinical-depression.co.uk (return)
38 see 37 (return)
39 17th September 2003: Psychiatrist Dr Kay Redfield Jamieson (US psychiatrist, a manic depressive) is in Ireland. New breakthrough relating to the prediction of suicide is announced. It involves hospital, an MRI scan, a Pet scan. The question is how probable it is that suicidal people will proceed through the functional medical channel. (return)
40 Dr Fernandez – Psychiatrist, St Brendan’s Psychiatric hospital, Dublin (return)
41 Serious findings: 70% re-admission each year. This strongly indicates hostile social situations: alcoholism, marital conflict, drug addicts etc. Each psychiatric admission involves a review of cocktail medications and monitoring. New drugs, new side effects, new body hostility limitations and re-adjustment. Each hospital admission means there is possibly a new psychiatric label, the range is manic depression to borderline personality disorder to manic depression. It is important to note that many doctors in psychiatric are in temporary postings and often from overseas (return)
42 Driven by former Prime Minister Margaret Thatcher (Conservative Party) (return)
43 The social aspects, alcohol, drug abuse, family strife, lack of occupation to regain acceptance in a community. (return)
44 Irish Penal Reform Trust. Former President Ireland – Dr Mary Robinson dated December 2002 (return)
45 The Arts address the social issues. Jack Nicholson in One Flew over the Cuckoos Nest, and As Good as it Gets, drew considerable attention to institutional care and to obsessive compulsive disorder. A Beautiful Mind says so much more about Schizophrenia and brilliance. ‘Strangers’ can contribute. (return)
46 Interested patients, family members, professionals, advocates (return)
47 Similar stance by MHAI, Department of Health and Regional health boards (return) Education as distince from the workplace appealed to a number of ‘guinea pigs’ One student is accepted for her PhD in psychology; others opted for community projects in the arts. 48 (return)
49 This is real. It involves children; family court – referred to recently by a Judge as an Armageddon for children; the Catholic Church that acts without a cheecks and balances system provided by the State re people diagnosed with manic depression, schizophrenia. Proper education is essential. We are told that as many as one in four people will suffer from depression in their lifetime. (return)
50 Forfeiture of control of self, family affairs, the need of an ally as distinct from a carer to assuage the difference in personality and preent abusive use of power relations. Relatives seeking the advice from the medical team disempowers the individual. Mind – Respect campaign. Stigma reduced but inclusion is a different issue. Mental health provides no security for those within the Irish court system. The courts have power to seek discovery of documents in the context of divorce leaving the person with severe mental health problems discriminated against. The system is adversarial and damaging. The Annulment by the Catholic Church, a male dominated court again discriminates. (return)
51 Account must be taken that the stakeholder may be subject to health limitations that are greater at different times (return)
52 European social funds opened the gates in the 1990’s but a lack of understanding, prejudice, fear, shame, stigma resulted in people gaining access to Trinity College Dublin but health provisions not in place for crisis situations. Many students left without completing their degrees and more men than women (return)
53 Goya painted ‘the Madhouse’ ‘he must have experienced before that grovel of flesh in the void, that nakedness among bare walls, something related to a contemporary pathos; the symbolic tinsel that crowned the insane kings….left in view suppliant bodies, bodies vulnerable to chains and whips, which contradicted the delirium of the faces…The man in the tricorne is not made because he has stuck an old hat upon his nakedness…(Foucault 1967; 265) (return)
54 Perhaps Simmel perceived the Stranger as an individual – the outlier who would take the risk to restore an equilibrium(return)
Bibliography:
Amnesty International, 2003. Mental Illness, the Neglected Quarter. Dublin. Irish Division Report
Amnesty International, 2003. Mental Illness, the Neglected Quarter – Homelessness. Dublin. Irish Division Report
Banks, O. (ed) 1968, 1969, 1970, 1971. The Sociology of Education. B.T.
Barnes M, and Bowl R, 2001. Taking over the asylum – empowerment and mental health. Palgrave Press. Hampshire
Bursford Limited. Guildford, London, and Winchester.
Becker, H.. 1963. Outsiders Studies in the Sociology of Deviance. The Free Press. New York
Becker, P. and B. Becker 1974 (ed), Sociology: A Biographical Approach. Penguin: USA
Barnes n, and r bowl, Taking over the Asylum Empowerment and Mental Health: London:. Palgrave
Centre for Women Studies, 2003. National Flexi-Work Partnership Work-Life Balance Project. Dublin. University of Dublin.
Clare A, and Milligan, (ed) 1989, 1993. Depression and How to Survive it. London. Ebury Press.
Cohen, S. 2001. .States of Denial Knowing about Atrocities and Suffering. Cambridge: Polity press in association with Blackwell Publishing
Crossley, N. 2002. Making Sense of Social Movements. London: Open University press
Foucault, M. 1967. Madness and Civilisation. London: Ruthledge Publishers
Goffman, E. 1966, 1968, 1987, 1991. Asylums. London: Penquin.
Goffman, E. 1963, 1968, 1990 Stigma – Notes on the Management of Spoilt Identity. New Jersey: Penquin
Hunt, P, 1966. Stigma – The experience of Disabilility. Dublin. Geoffrey Chapman and Co.
Mathews, A and Gelder, M, and Johnston, D 1981 Agoraphobia Nature and Treatment. New York: The Guilford Press
Millett, K. 1994. The Politics of Cruelty. An Essay on the Literature of Political Imprisonment. New York and London. W.W. Norton and Co.
McClung Lee, A, 1973. Toward Humanist Sociology. New Jersey, Prentice Hall.
Putnam, Robert D. Bowling Alone – The collapse and Revival of American Community. New York: Touchstone.
Sayce, L. 2000. Fron Psychiatric Patient to Citizen – Overturn discrimination and Social Exlusion). London. Palgrave.
CAN MENTAL ILLNESS BE UNDERSTOOD AS A FORM OF SOCIAL DEVIANCE?
Written by: Michelle Clarke- September 2003
Mental illness must be first defined in the context of legislation.-1- Account is required of the predominantly medical input and the challenge that is faced by Sociologists and other disciplines. It is the biomedical model that has made such an impact on our cultural ideas about the body. The body is determined to be well or ill.-2- This in turn reflects the attitudes and beliefs of people. History reflects its assumptions to interpretations of mental illness and these interpretations prove valid for some people still. Bio-medicine looks to the body and separates other aspects of the human being.-3- Herein lies the conflict necessary to invoke challenge and bring about change. The body is predominant: social, psychological and behavioural factors of the illness stand apart. The illness is pathologised and the disease is allocated to some part of the body (physical reductionism). -4- The Body is seen as the object of regime and control (Foucault, 1979).
This essay will review the historical social construction of mental illness – the pathologised version as enacted by legislation. It will review the myth imbibed by capitalism and science to the stigmatized illness that presently exists. I review the impact of fear as the powerful hidden component. Challenge exists and the entry of sociologists like Comte, Durkheim, Weber, Simmel, to the Chicago School in 1924 like Goffman are discussed in terms of their approach to Deviance. The introduction of Social Movements in line with concept of civil rights in the 1960’s and taking hold in the UK from the 1980’s onwards. For the first time, we saw the opportunity for those designated ‘mentally’ ill to become stakeholders in their own future. The stage where the person who was once the patient (inmate) can refer to themselves as ‘survivor of mental illness’ or just survivor. Children, Education, Amnesty International, the United Nations, the EU and their Quality of Life research programmes are essential to provide the empowerment for the mentally ill to engage and disengage (with the understanding of people). This is vital. Only could those with mental illness have been so poorly treated and disregarded, if people conjured them as ‘deviant’ and not worth input.
Historical Social Construction of Mental illness – the assumptions
The ‘Struggle against Psychiatry’ has a long history. In 1620, the House of Lords received the ‘Petition of the Poor Distracted People in the House of Bedlam’ – the complaint was against inhumane treatment to the inmates. In 1845, the ‘Alleged Lunatics’ Friends Society was formed by ex-patients (Mind, 2003).-5-
The Middle Ages, saw the disappearance of leprosy in the Western World. Between the High Middle Ages and the end of the Crusades, leprosariums multiplied in the cities of Europe. The 17th century saw the creation of the houses of confinement established in Paris and other cities. Ironically, the Great Confinement made the human being – a social being and identity, subject to classification. It would have been economically viable to use the vacated buildings and to use them for the purpose of those held to be deviant, (Foucault,1967).
This period coincided with birth of Capitalism. Power and vanity became the new driving force. In England, the merchant class engaged in speculative ventures – those expectations driven by financial motivation involving commerce with emphasis on the emotions: fear and hope. Core to commerce is competition, envy and avarice and this has a price. The Renaissance period was the time of growth in individualism and this can incubate despotism. A schism arose in the Church dividing the Catholic Church and the Protestant Church.-6- The protestant work ethic, accumulation of capital, and a belief in a pre-destination created a suitable ethos to ignite in people the motivation required to embed Capitalism and class structure (Foucault, 1967: 74)
Mythology origin –Pathologised-Capitalism-Science
‘Suddenly, in a few years in the middle of the 18th century, a fear arose – a fear formulated in medical terms but animated, basically, by a moral myth’.
(Foucault, 1967: 192)
People were in ‘dread’ of a mysterious disease that spread from the houses of confinement that would soon threaten the cities. The disease became pathologised – fears, hallucinations, absent-mindedness all became identifiable symptoms.-7- (The symptoms in the footnote need to be seen in the context of what the Mental Health Act 2001 provides today). (Foucault, 1967: 199). Unreason and mental illness became intermingled. Unreason involves real fear. ‘Dread’ and the implications of fear compounded with the shame, stigma and ‘panopticism’ ensured segregation. Power and control enforce the dogma.
Contradiction and Challenge:-8-
Madness began to invoke thought. It became an issue of raising ‘the original truth’ but rather than it remaining hidden, this truth could ‘hang’ in history forever….This endorsed fear for some, both sides of the divide, but for different motives and different reasons. Fear and its internal impact and method of control and containment are hidden topics for discussion. The inference is weakness, the reality is fear can be used to control the vulnerable. Fear is pervasive in its implications.-9-
‘The truth of madness is what madness is…What madness is, is a form of vision that destroys itself by its own choice of oblivion in the face of existing forms of social tactics and strategy’ (Cooper, D. in Foucault, 1967: Intro)
The Reality is: Madness fascinates: The question stands – Is it madness or is it Vision?
‘It is of little importance on exactly which day in the autumn of 1888, Nietzche went mad for good, and after which his texts no longer afford philosophy but psychiatry: All of them, including the postcard to Strindberg, belong to Nietzche, And all are related to the Birth of Tragedy’. Our view of Nietzche is what he gave and continues to give to the Modern World’ (Blum, 273).
Sociologists’ Definition – Deviance:
‘Deviance always refers to conduct that is in violation of the rules
constructed by a given society or group. In other words, the concept of deviance implies a moral difference. It refers to the refusal or perhaps inability of an individual or group to abide by the moral norms that prevail in the social context in question’
(Berger and Berger, 1972: 305)
The group have defined the rules but the outsider remains outside looking in.-10- The outsider is the source of much speculation, scientific study and theorizing. The question is why does he not want to comply with societal rules?-11-
Sociology and its Origins
Sociology arose in the 19th century.-12- The basics of sociology related to the discovery of the laws of social order and the methodology required to maintain such order. (Berger, 1972; Berger, 1972)
Durkheim (1858-1917) understood deviance in terms of the functioning of society and deemed it preferable to study the society as distinct from individuals. The conduct of a person has categorized them in the minds of others. They are deviant and can be placed in a sub-category thereafter. In his book, Division of Labour, Durkheim highlighted the need for solidarity as people have an inherent need to belong. He wrote of the evolution from the basic operating mechanical society to the more organic society. Durkheim also researched and wrote ‘The Rules of Sociological Society’ in which he established the identity of sociology as distinct from psychological facts. Social facts represent ‘things’ – the approach is objective. (Berger, 1972; Berger, 1972).
Functionalism is the model applied by Durkheim and further progressed by Talcott Parsons in the US. Functionalism is closely applied to the medical model that promotes patient compliance and the bureaucratic structure to the services provided. Illness is seen as a social deviance when social expectations and norms are not achieved. Illness is an unnatural state hence the imperative function is to alleviate the person from it as quickly as possible. The assumption stands that stigma, shame and vulnerability pertain to many illnesses. Functionalists view health as a social commodity; a resource that is essential for individual achievement and the smooth performance of society (Annadale, 1998:10). The medical model is the Institution for Social Control.
Durkheim established views on Suicide and stated that this method of self-destruction was not only a personal tragedy but his findings were that it was a sociological consequence to which one is integrated in society – rare among married people, rarer in a more closely knit religious establishments and more frequent when rapid social change disrupts the social fabric. Social connectedness matters to our life in a profound way. Social networks reinforce healthy norms (Putnam, 2000).
Merton’s work has been productive in that it links with Durkheim’s concept of anomie and the analysis of social class. There have been investigations that link certain class positions to mental illness.
Weber examined the role of ideas in history; Marx focused on the economic aspects. Weber and Durkheim both reviewed the impact of Religion. Weber wrote on ‘The Protestant Ethic and the Spirit of Capitalism. It was Georg Simmel who reviewed the role of the Stranger – the dyads and triads. Simmel sought to establish ‘a formal sociology’. These sociologists are European.-13-
Goffman links back to the Chicago School of the 1920’s – America.-14-
Deviance is measured against a perception as to what is reality. The perception of reality is that defined by Society. Perceptions differ, they change. Both normality and deviance are important components of ‘reality’. One must be aware that Society is protective against challenges as to how they define reality:-15-
‘The total institution is a social hybrid, part residential, part community, part formal organization, there in lies its special sociological interest’ (Goffman, 1968: 22)
Goffman engaged with the concept of symbolic interactionism. To Goffman, mental hospitals and prisons are ‘total institutions’. Stigma looks at how people actually cope with ‘spoilt identities’. He exhibits a strong feeling of compassion with the victims of negative ‘social designations’. (Goffman: 1961: 22)
Following the trend set by Mills and Goffman, ‘labelling theory’ emerged. Howard Becker is the most well known representative of this new school. It creates a platform for a hierarchy to develop permitting different levels of authority. It is about distinguishing the social worker from the sociologist, from the psychiatrist or the law enforcement officer from the Doctor. It is important to note that what is called deviant today may be deemed normal in the future.
Another aspect to consider about Deviance is that it is understood as simply one way in which people define a situation. It’s ‘reality’ depends upon the power of the people who do the defining to impose their definition upon others.-16-(Goffman, 1961).
Stigmatization in the context of Mental Illness ensures it is referred to as deviant – the modus operandi is a process which one group of people inflicts upon another. The definition will ‘stick’, depending upon the power of the definers. In that case, those who are thus defined, the stigmatized will have to come to terms both socially and psychologically with the ‘spoilt identity’.-17-
CHALLENGE TO SOCIOLOGISTS:-18-
Medicalisation dictates legislation. The 1945 Mental Health Act-19- was only altered in 2001 with much grassroots activity of social movements and charities at a variety of levels. The issue of Rights for the mentally ill remains in limbo in Ireland. However, social movements are in existence.
Social Movements – Nick Crossley
‘Social movements can be viewed as collective enterprises seeking to establish a new order of life…The career of a social movement depicts the emergence of a new order of life.
(Blumer 1969: 99)-20-
Contention Humanities versus Science – US Sociological View 1974
People Question – Can humanity survive with science so prevalent? Sociologists and other social scientists are divided in opinion as to how to best position themselves to address the science versus the humanities issue in the 20th century. The major challenges concern proceeding with research under subsidies from those in power or should they only be investigators committed solely to their own humanist goals. Can they merge both together was the issue? (McClung Lee, 1973)-21-. The reality is that if science provides the genetic proof, it still stands that triggers and environmental factors play a large part in mental illness.
Education – the key factor to effect change: Multiple intelligences exist yet the school curriculum is weighted against non scientific approach students.
Bourdieu defines the sociology of education ‘specifically in terms of its role in understanding; the contribution made by the education system to the reproduction of the structure of power relationships and symbolic relationships between classes’. (Banks, O, 1968:115)
View of Education – US 1974:
‘Students caught up willingly in the regimenting routines of such specialized trade schools and college as those of business, engineering and military, appear to be heedless to their dehumanization’ (McClung Lee, 1974 pg. 1)-22-
And
‘Our educational procedures are more often geared to the development of believers and technicians rather than independent investigators and thinkers
the mass culture that pervades’ (McClung Lee, 1974: 67)
Representation 1980’s: the approach was more that of a ‘consumerist’ for the patient as distinct from service users or survivor.
The objective is to create social inclusion for people diagnosed with a mental health problem.
Nottingham Advocacy Group was one of the first established in 1986. The movement was towards Survivors speaking out, having a voice and challenging false conceptions perpetuated through mythology and ignorance.
A forward thinking psychiatrist and his client – Dr. Anthony Clare, St. Patrick’s Hospital, Dublin and Spike Milligan, Writer, Comedian with a Manic Depression diagnosis, worked in conjunction to produce a book to provide evidence from both sides. The comparison was drawn that both Cancer and Mental illness are pathologised but the reaction is most likely one of shame in relation to depression, even though a severe depression is life-threatening illness. (Clare, Milligan, 1993).-23-
‘Images of madness in our culture make it starkly clear that it is best avoided or denied – not just because the experience can be alarming, but because it is hard to see oneself simultaneously as ‘crazy’ and as a valid person with a liveable future’ (Sayce, 2002: 8)-24-
‘It addresses one central question: how, and on what basis, do we move beyond the physical de-segregation of hospital closure programmes towards the chance of full participation in social and economic life’. (Sayce, 2002)-25-
Why penalize people who cannot work at 100% range or even a 50% range?-26- Cordis, cordis.europa.eu/ an arm of the EU is currently researching Quality of Life perspectives.-27- Demographics may cause policy makers to change their attitudes and view people as potential (albeit limited) contributors to taxation.
Empowerment and mental health – the need for ‘Academics with Attitude’ .
This is a movement of ‘passive recipients’ to ‘active subjects’. The approach is to challenge the way we think about ‘mental illness’ mental health and what it means to live with madness. -28-(Barnes, 2001; bowl; 2001:). This is about Changing Attitudes. Mind in the UK run successful campaigns like 1 in 4, with descriptive footage of a severely depressed person. These are areas that need consideration. Essential is the use of the internet and system of email both for self-knowledge and innovative type work consistent with ‘diagnosis’.
Points to realistically consider:
Integration implies the individual will fit in with the system
The person has to change. Inclusion means that system itself will develop self-criticism; acknowledge the way in which it excludes and denies access; and dismantle barriers (Shakespeare 1997 in Sayce 31). -29- Anxiety – Valium, Librium – the wonder drugs-30- of the 1960’s are addictive. Consultants are afraid of insurance actions so are much more controlled in what they prescribe. There is no alternative now for the patient with anxiety i.e. except cigarettes/alcohol. Public policy is to prevent smoking in public places. Both cigarettes and tranquilizers are being restricted at the same time. This has implications for increased intake of alcohol. Mental illness also must be described as a physical illness. There is a need to have the service user as a stakeholder in policy making.-31-
Power of Language – Control
‘Language is itself a site of struggle and one of the purposes of user or survivor movements is to reclaim the right to define and name their own experiences’.-32-
Perspective
‘The emphasis on science is important. First it implies that the origin of mental illness and the role of intervention can be studied using the methods of observation and logical inference that form the basis of natural science. As such it is based on ‘fact’, not value, and its definition is seen as independent of Culture or social context.-33- This has both a political and organizational implications. It provides justification for the separation of medicine as a discipline and the retention of power over defining and treating mental illness outside political and popular control……Medicine has a non precise definition .
Reduction of stigma and discrimination is starting to appear high on the public policy agenda in a number of countries. The Australian Government have a major Education programme in place. The New Zealand government have adopted a programme based on studies into other marginalized groups e.g. HIV/Aids.
More Enlightened approach – World Perspective
The Universal Declaration of Human Rights encompasses
civil, political, economic and cultural rights.-34-
Community care is deemed more humane than inpatient stays. Ireland, Israel, Netherlands and Spain have 80-90% of the beds in psychiatric hospitals, France, Germany and Japan have 60-75% occupancy in psychiatric hospitals. The difference is found in Australia, Canada and the USA at 40%. (World Health Organisation page 17)
Amnesty International Ireland www.amnesty.ie/mentalhealth. Sociologically challenges Ireland’s treatment of the mentally ill. (The News on mental health issues from around the world) reports:-)
‘The support for children with, or at risk of mental health from successive Irish governments has not been adequate. The Amnesty publication, Mental Health – the Neglected Quarter, has as its objectives to increase awareness that children’s mental health is a human rights issue, to place this fact firmly before Government, and to lobby much needed reform in Government policy, practice and legislation (Sean Love, Director of Amnesty’s Irish Section).-35-
Gender issues/cultural issues – social factors:
Mental illness must be about multi-disciplinary teams. Psychiatrists opened up to the inclusion of psychology over the past 20 years and it is stated that if trigger events can be limited in a person susceptible to mental illness, and particularly after one event only, it is probable that they will avoid major mental health issues (Aware lecture 2003).www.aware.ie. 75% of those who commit suicide are men.-36- Black men have above average admittance in to psychiatric hospital in the UK and also to high security areas. Most divorces and separations are started by women and fathers tend to lose contact with their children. There is growing evidence that unemployment has an impact on mental. These are social issues impacting on family structure and society: http//www.mind.org/Information/Factsheets/Men/.
THE WAY FORWARD (Denial, Stigma, Shame, Education, Multi-disciplinary teams, Respect for difference)
Education is core to understanding and change.
‘The traditional conceptual framework in the subject is that of functionalism, and derives primarily from the writings of the French sociologist Emile Durkheim. The functionalist approach, as Durkheim used it, is to seek for the social function performed by an institution; that is for the part played by the institution in the promotion and maintenance of social cohesion and social unity’. (page etc).
Durkheim referred to the ‘socialization of the young generation’. He sought to imbibe the young generation with values and certain intellectual and physical skills.-37-
The Bright Futures Initiative –
In 1997, the Mental Health Organisation in the UK undertook a major study into the mental health of children and young people. They reviewed the requirements for the emotional and healthy development of children. The 1999 reports Bright Futures was published. Factors that cause children to be susceptible include poverty, poor housing, parental conflict, parental psychiatric problems and abuse.-38- It acknowledges the importance of early intervention. Other reports include The Mental Health of Young Offenders, August 2002 and the Mental Health of Looked After Children, August 2002. http://www.mentalhealth.org.uk/page.cfm?pagecode=PIBF -39-
Dr. Fernandez (Amnesty Member),-40- states the need to distinguish between ‘’mental health problems’’ induced by homelessness and ‘’mental illness’’ that may be a factor in becoming or remaining homeless (Amnesty International, 2003: 17). Psychiatric and rehabilitative services but with limited funding are provided at St. Brendan’s Psychiatric Hospital. The main objective is to ‘preserve and regain social function’. The separation from the rest of society in large institutions only ensures exclusion.-41-
IRELAND – Equality and the system of education are formally challenged. It is not inclusive. Is there a link to Mental Illness! Is the scope of the curriculum broad enough?
4500 are now hospitalized in psychiatric hospitals in Ireland. This has reduced from over 21,000 in 1958. By the 1980’s, institutions were costing large sums of money and government policy sought alternatives. Market forces determined the 1980’s de-institutionalisation policies.-42- In the year 2000, admissions were over 20,000 however the issue to be concerned about is that 70% of these were re-admissions. This speaks volumes about the recurrent nature.-43- Dr. Kennedy from Central Mental Hospital in a presentation made a point of the differentiation between those problems that were social i.e. over 80% and those that were psychiatric.-44-
‘To speak of the unspeakable is the beginning of action’ (Millett, 1994)-45-
Who is willing to listen, to hear, to activate change? The Irish psychiatric policy is based on the consumer model and thus adopted by the social movement organizations e.g. Aware and Schizophrenia Ireland. The approach is Top-Down as distinct from user-led action.
‘It is possible to propose a theoretical framework which moves the sociological perspective on from limitations inherent in other sociological traditions within the sociology of health and illness literature, such as psychiatry as a social system (Foucault 1965), or the deviance or the Marxian approaches of Scheff (1999 or Scull (1979 respectively‘ (Speed, E, 2002, 64). Irish peculiarities mean the model requires adaptation.
Schizophrenia Ireland was set up in 1981. http://www.sirl.ie/other/repository_docs/13.pdf -46- Aware, the voluntary organization was established in 1985. Aware Ireland, Sanewww.sane.org.uk in the UK and NAMI https://www.nami.org/ in America support the biological basis of mental ‘illness’. Aware is involved in the ‘promotion of research into biological, psychological and social aspects of Depression’ (Aware, 2001).-47- The Minister of Health has put in place an appointed study group to review analytically psychiatric services and community based service (Foreward iii) is now in place.
‘There has been a lack of any concerted mental health service users’ movement within the Republic of Ireland. Mental Health service users’ movements have a marked orientation towards strategies of empowerment and the provision of peer advocacy and support mental health service users’ (Speede, 2002). This is only acceptable if the objective is to change educational policy and introduce multi-disciplinary teams to work in the best interests of the service-user. If this occurs and with the distinct advantage of the internet, survivors can become empowered.
Research – What do we know? What does the future hold?
1997 The Trinity Horizon Project of the Centre of Women Studies covered a period of 4 years and developed a pro-type training and counseling programme for the women recovering from depression to facilitate their re-entry to the workplace. The research was carried out in collaboration with Aware, IBEC, ICTU and FAS.
The stance was from the humanitarian and social perspective. This was aimed at creating survivors. It was concerned with confronting the hidden secret associated with mental illness, dealing with the stigma that pertained and to emphasize just how under-resourced mental health services are. Funds were provided by the EU. A conference was held by the Trinity Horizon project – titled Mental Health and the Workplace: Challenges and Opportunites. It had access to transnational models – this provided a cross cultural dimension. Norbert Tietz, Director, EX+JOB in Wunstorf, Germany.
Immediately receptive is the term social firm. The firm was based on a philosophy of work and part of this was about integration of the participants with the public. Work experience included bar/restaurant work open to the public, fridge recycling plant, used children’s clothes shops, furniture shop and a music shop. The innovation of work came from the community as a whole in collaboration with the psychiatric hospital. The re-cycling dimension proved very successful. It appealed on the environmentally friendly factor. German companies must employ 6% of people with disabilities. If they choose not to pay, they must pay and fine and the money is paid into a fund for people with disabilities.
Professor McKeon, Psychiatrist of St. Patrick’s hospital and founding member of Aware reiterated that people with mental health difficulties, especially those with depression, make excellent employees. If anything, he stressed that this group with their over-anxiety to do well are exemplary employees. ‘Their exaggerated sense of responsibility and loyalty, traits which sometimes contribute to their difficulties, are positive elements for an employer. They are the first at work and have a commitment to any task they undertake. In dealing with their illness, they have already proven their ability to face and overcome difficulties and demonstrated their tenacity and courage’ (Trinity Horizon Project, Centre for Women Studies, 2000: viii)-48-
Yet, such a daring programme proved too expensive for the NRB to undertake. The NRB was subsequently subsumed into FAS – no rehabilitative programme as per the research was in put place yet. In fact, community employment which provided a meager alternative, but an alternative form of rehabilitation is being drastically cut back by Government policy.
CONCLUSION
National Policy framework – stakeholders – Survivors. Rights based Mental Health legislation is needed. Expenditure in psychiatric services has been reduced since 1976 by 20%. Mental illness is about social implications, coping strategies, psychological services and engaging with denial, particularly within the family context.-49- Power and control needs to be monitored.-50- Mental illness merits a consensual approach if people are to be integrated in society. Social workers need to interact with sociologists, psychologists, psychiatrists, educationalists, and most important in line with the wisdom of Carl Jung, Psychiatrist, Psychologist – they must involve the patient. -51-The Trinity Horizon Research proved too costly an approach but a new direction and approach is in place the National Flexi-Work Partnership Work-Life Balance Project
Comte named a new dimension called sociology; Durkheim elaborated and defined society as an integrated whole; Weber, shared Durkheim’s interest in religions and structure but also was concerned with ideals; and Simmel spoke of the ‘Stranger’. The intervening years saw institutionalization, medicalisation, of people who are ‘Different’. Why should an idealist be different, there might be a latent talent, that is inhibited by structure yet innovation lies there untapped. The challenge rests with Education and incorporation of a broader syllabus, to the Universities to take in hand those non-conformists and educate them and add the dimension to their education,-52- and the education of other students. People are mental health survivors but they must be given a chance. Denial, stigma, shame, must be removed and if it takes the conflict of referring to a person as socially deviant, for the reaction to come – ‘but no you are not in horror’. This is the step forward to dealing with denial. This is reality brought about by fear that no-one cares to acknowledge – hence the suicides are dismissed in shame, in silence, in fear. The medical profession live in fear that they too ‘will break the threshold’ that applies to every human being. This can be intuitively sensed from them. Sociologists need to take stock of the heritage of their founding fathers – perhaps it is time not to seek the credibility of being totally scientific and consider a more humanistic, open, consensual and interactive approach and work within multi-disciplinary teams with the objective of improving society.-53-
My parting comment is about Suicide. Dr. Kelly, (Iraq war 2003) leading scientist in search of nuclear arms in Iraq had the choice to conform to the status quo – to have his knuckles wrapped. He was an individual, deliberated, he knew the outcome if he conformed. Perhaps the issue is – could he have lived with his conscience? Durkheim reviewed suicide in this context. Yet our society does not see that people differ, a ‘Stranger’, -54-holding intuitive sentiments similar to what Shakespeare wrote in Hamlet ‘there is something rotten in the State of Denmark.
March 2015-Contextualised over a decade: Deviance is deviance surely not as defined by mental health. The shocking murder of Elaine O’Hara by a man who was socially deviant and so arrogant that he believed he could not be convicted and who was not going to use the defence of Insanity.
Dwyer did not plead insanity. He is found guilty of Murder. He preyed on a vulnerable woman called Elaine O’Hara who had been admitted to Ireland’s most elite psychiatric hospital, St Edmundsbury, on 14 occasions, under the most eminent of psychiatrists including Dr Anthony Clare. The paradox, the person with a mental illness the victim of society’s inability to provide for her mental health need and the murderer, the narcissist, the psychopath, devoid of conscience who saw vulnerable women as objects for his gratification. The question is will people abuse the term mental health and include him as mentally ill. I sincerely hope not. This social deviance stands apart from what mental illness is about. Again I say lets use the term Manic Depression again instead of the sanitised Bipolar. The manic applies to the high but also to the low.
Endnotes
1 An act to provide the involuntary admission to approved centres of persons suffering from mental disorders, to provide for the involuntary admission of such persons and, for the those purposes, to provide for the establishment of a Mental Health Commission and the appointment of Mental Health Commission tribunals and an Inspector of Mental Health Services, to repeal in part the Mental Treatment Act 1945 and to provide for related matters. “Mental Illness” means a state of mind of a person which affects the person’s thinking, perceiving, emotion and judgement and which seriously impairs the mental functions of the person to the extent that he or she requires care and medical treatment in his or her own interest or in the interest of other persons (Mental Health Act 2001)(return)
2 Distribution of wellness and illness throughout population does not fall in equal proportions (return)
3 Western medicine: science puts forward the belief that the body is separate from the mind and spirit (return)
4 Etiology is about identifying causes for each disease and scourcing cures. A machine capable of repair is the metaphor (return)
5 Exhibitions of inmates would be held and people paid to see those deemed ‘Mad’ (return)
6 Certain earlier sociologists particularly Durkheim and Weber, who carried out considerable research into different religions, linked it closely with the regimented system of values and rules relating to societies (return)
7 It was confinement of the debauched; the spendthrift fathers; prodigal sons; blasphemers, men who “seek to undo themselves”, libertines….One tenth of all the arrests were in Paris for the Hospital General concern “the insane”< “demented” men< individuals of “wandering mind” and persons who have become “completely mad” Foucault, 1967). No mention of alcohol or drugs. (return)
8 Lord Byron: Van Gogh; Churchill; Don Quioxte; Goya personalised mood distortion to black periods. Churchill referred to “Black Dog”. Aware St Patrick’s Hospital run a website titled “Black Dog” (return)
9 ‘Fear of fear refers to the anticipation of anxiety and thoughts that the mental and physical symptoms of anxiety will lead to worse consequences – a thought that in turn generates more anxiety. For example, mounting feelings of anxiety often make the patient anticipate that he or she will lose control and behave in a dis-inhibited way, or even become insane; while rapid heart action may lead the patient to expect a cardiac arrest or coronary thrombosis (Mathews A, Gelder M, Johnston D, 1981:5) (return)
10 Normal personality: how to define it? Perhaps – efficient self perception, realistic self-esteem and acceptance; voluntary control over behaviour; a true perception of the world; sustaining relationships and giving affection; self direction and productivity (Social psychology notes 2nd yr Business Economics and Social Studies Trinity notes (return)
11 Having been institutionalised and detache from society on numerous occasions, you are the outsider looking in (personal comment). Some explanations of psychosis use these exact words’ (return)
12 The name ‘Sociology’ was invented by Auguste Comete (1798-1857) – Philosophy (Positivism) (return)
13 Robert Merton sought to explain deviant behaviour in terms of social structure. He puts forward the idea that all forms of deviant behaviour ‘from differentials in the access to the success goals of a society by legitimate means….Deviance thus occurs as a result of discrepancy between the aspirations which society has socialised into its members and the way that society has provided for realising such aspirations. Merton uses the Durkheimian concept of anomie to refer to such a situation’. This reflects the goal oriented, materialistic strain in America (return)
14 Malfunction appears to determine deviance. ‘Agoraphobia is illness because one should not be afraid of open spaces. Homosexuality is illness because heterosexuality is the social norm. Divorce is illness because it signals failure of marriage….all these and many more have been said to be signs of mental illness (Berger 1963:6) (return)
15 It was then and still is my belief that any group of persons – prisoners, primitives, pilots, or patients – develop a life of their own that becomes meaningful, reasonable and normal once you get close to it, and that a good way to learn about any of these worlds is to submit oneself in the company of the members to the daily round of petty contingencies to which they are subject (Goffman) (return)
16 Mental illness/mood disorder is about lapses to weakness in moral and physical health – this inherent vulnerability is exploited (this includes family; employers, corporates, insurance companies, regimented bodies like education, the legal profession; the Church; non conformists too are not acceptable. Yet medical ethics was horrifically breached by Mengele with use of humans for scientific experiments (NAZI Germany) (return)
17 Victor Frankl (1962) Survivor from Auchwitz (Psychiatrist, Psychologist, Logotherapist, writer. ‘When we describe a responsible person we mean that in every area of his life he is able to meet the demands of this world’. Logotherapy concerns expanding the scope of visions (psychologically) for the patient. Here is the challenge to society. (return)
18 Comment from House of Lords UK: Quite evidently explanations for mental illness and institutionalisation were unclear to those engaged in scrutiny “As we get to know more about the complexity of the human mind, so we try to make our shades of responsibility more complext, and so I thing we get into deeper and deeper muddles Baroness Wootton of Abiger, House of Lords 1962 (return)
19 Irish 1945 Act was based on the earlier English legislation (return)
20 Examples include: Mind UK, (Aware, Grow, Irish Mental Health Advocacy in Ireland and Ireland Mental Health Association of Ireland etc) (return)
21 This was 1974. Now in the UK it is the medical profession who are linking to Humanities for medical conferences (return)
22 What about the social impact of science on man as a social creature? The most obvious is the impact of domestic gadgetry, healt-care facilities, urban and industrial structures and the ultimate threat of nuclear war (McClung Lee, 1974) (return)
23 Surprisingly I sought the implication and definition of fear in his book – there was none. Doctors have an issue with fear (return)
24 Denial is corrosive. Aware now operate a ‘Beat the Blues’ campaign in secondary schools. This is successful. Parents may have very fixed interpretations and refuse to encourage a child to engage at the expense of the child. (return)
25 This book includes several sources including the survivors together with lawyers, policy makers, activists, medical health professions. Primarily the research was completed in the US and UK in the late 1990’s. Reference is made to systems in Europe, Australia and New Zealand. (return)
26 Vincent Van Gogh. His pre-occupation was to give, not to receive financially. His paintings were sold after his death and amrketing applied to accumulate worth. The same applied to letters he wrote. He was socially oriented. (return)
27 Presently, the Centre for Women Studies in Trinity College Dublin are carrying out research which is part of the Equal Community Initiative and the European Social Fund. It involves a mental health advisory committee. University of Dublin; Aware: Age Action; IBEC; Congress of Trade Unions; FAS and mental health survivors will convene over the next two years. The June meeting was a bilateral meeting: Working party of employers and the Mental Health Advisory group including mental health survivors. The focus is National Flexi work – Work Life Balance. (return)
28 Marian Barnes is a member of National Health Action Zone evaluation team focusing on community involvement. (return)
29 ‘People who are seriously disadvantaged in society rarely have just single problems – they have multiple interlocking problems. They do not compete on a level playing field. Empowerment must address all their problems together if it is to be meaningful’. (Davy, 1999, 37) (return)
30 Drugs have side affects; muscle wastage ensures body weakness; anorexia/bulimia can be side affects related to mood disorder or just a manifestation of self-harm, vision, co-ordination, perception, judgment, attention deficits etc (return)
31 The Barr Tribunal (John Carthy RIP): Labeled a Manic Depressive. Somehow anxiety has been removed from language of mental health otherwise he would likely not have been shot dead by An Gardai Siochana. Anxiety drugs (Benzos) are now causing negative reporting as they are deemed too addictive and there are basically no alternatives. It could be said that the cigarettes were used to taunt John Carthy RIP, cigarettes could have calmed his anxiety. Many people go contrary to regulations and even legislation especially relating to drugs and alcohol to help them cope with stress, anxiety, depression. This is a social issue and was addressed by Dr Harry Kennedy (Psychiatrist) who has accommodation problems at the Central Mental Hospital. It is linked to crime. (return)
32 Mental Act of England and Wales defines ‘Mental Disorder’ as mental illness, personality disorder, severe mental impairment. (return)
33 Perhaps this should mean it is a component part of a spectrum that deals with those diagnosed mentally ill. A more equitable distribution of funds in terms of time input would be required. hroughout population does not fall in equal proportions (return)
34 All persons have the right to the best available mental health care, which shall be part of the health and social care system. MI Principle Amnesty Mental Health Report – the Neglected Quarter). (return)
35 Ireland ratified the UN Convention on Rights of the Child in 1992, whereby it undertook to provide a specialised mental health regime to identify, treat and protect children under 18 years or at risk of mental illness. http://www.mentalhealth.org.uk/page.cfm?pagecode=NENE (return)
36 The State in Ireland and the Church are prejudiced in regard to a person with mental illness. Denial applies. (return)
37 ‘The most sensible way to lower rates of depression and suicide is …to spread accurate information among the general public about what depression is’ Dr Fernandex (Amnesty) and St. Brendan’s Hospital; Breaking the Cycle of Depression; (Joe Griffin and Ivan Tyrrell), The European Studies Institute. http://www.clinical-depression.co.uk (return)
38 see 37 (return)
39 17th September 2003: Psychiatrist Dr Kay Redfield Jamieson (US psychiatrist, a manic depressive) is in Ireland. New breakthrough relating to the prediction of suicide is announced. It involves hospital, an MRI scan, a Pet scan. The question is how probable it is that suicidal people will proceed through the functional medical channel. (return)
40 Dr Fernandez – Psychiatrist, St Brendan’s Psychiatric hospital, Dublin (return)
41 Serious findings: 70% re-admission each year. This strongly indicates hostile social situations: alcoholism, marital conflict, drug addicts etc. Each psychiatric admission involves a review of cocktail medications and monitoring. New drugs, new side effects, new body hostility limitations and re-adjustment. Each hospital admission means there is possibly a new psychiatric label, the range is manic depression to borderline personality disorder to manic depression. It is important to note that many doctors in psychiatric are in temporary postings and often from overseas (return)
42 Driven by former Prime Minister Margaret Thatcher (Conservative Party) (return)
43 The social aspects, alcohol, drug abuse, family strife, lack of occupation to regain acceptance in a community. (return)
44 Irish Penal Reform Trust. Former President Ireland – Dr Mary Robinson dated December 2002 (return)
45 The Arts address the social issues. Jack Nicholson in One Flew over the Cuckoos Nest, and As Good as it Gets, drew considerable attention to institutional care and to obsessive compulsive disorder. A Beautiful Mind says so much more about Schizophrenia and brilliance. ‘Strangers’ can contribute. (return)
46 Interested patients, family members, professionals, advocates (return)
47 Similar stance by MHAI, Department of Health and Regional health boards (return) Education as distince from the workplace appealed to a number of ‘guinea pigs’ One student is accepted for her PhD in psychology; others opted for community projects in the arts. 48 (return)
49 This is real. It involves children; family court – referred to recently by a Judge as an Armageddon for children; the Catholic Church that acts without a cheecks and balances system provided by the State re people diagnosed with manic depression, schizophrenia. Proper education is essential. We are told that as many as one in four people will suffer from depression in their lifetime. (return)
50 Forfeiture of control of self, family affairs, the need of an ally as distinct from a carer to assuage the difference in personality and preent abusive use of power relations. Relatives seeking the advice from the medical team disempowers the individual. Mind – Respect campaign. Stigma reduced but inclusion is a different issue. Mental health provides no security for those within the Irish court system. The courts have power to seek discovery of documents in the context of divorce leaving the person with severe mental health problems discriminated against. The system is adversarial and damaging. The Annulment by the Catholic Church, a male dominated court again discriminates. (return)
51 Account must be taken that the stakeholder may be subject to health limitations that are greater at different times (return)
52 European social funds opened the gates in the 1990’s but a lack of understanding, prejudice, fear, shame, stigma resulted in people gaining access to Trinity College Dublin but health provisions not in place for crisis situations. Many students left without completing their degrees and more men than women (return)
53 Goya painted ‘the Madhouse’ ‘he must have experienced before that grovel of flesh in the void, that nakedness among bare walls, something related to a contemporary pathos; the symbolic tinsel that crowned the insane kings….left in view suppliant bodies, bodies vulnerable to chains and whips, which contradicted the delirium of the faces…The man in the tricorne is not made because he has stuck an old hat upon his nakedness…(Foucault 1967; 265) (return)
54 Perhaps Simmel perceived the Stranger as an individual – the outlier who would take the risk to restore an equilibrium(return)
Bibliography:
Amnesty International, 2003. Mental Illness, the Neglected Quarter. Dublin. Irish Division Report
Amnesty International, 2003. Mental Illness, the Neglected Quarter – Homelessness. Dublin. Irish Division Report
Banks, O. (ed) 1968, 1969, 1970, 1971. The Sociology of Education. B.T.
Barnes M, and Bowl R, 2001. Taking over the asylum – empowerment and mental health. Palgrave Press. Hampshire
Bursford Limited. Guildford, London, and Winchester.
Becker, H.. 1963. Outsiders Studies in the Sociology of Deviance. The Free Press. New York
Becker, P. and B. Becker 1974 (ed), Sociology: A Biographical Approach. Penguin: USA
Barnes n, and r bowl, Taking over the Asylum Empowerment and Mental Health: London:. Palgrave
Centre for Women Studies, 2003. National Flexi-Work Partnership Work-Life Balance Project. Dublin. University of Dublin.
Clare A, and Milligan, (ed) 1989, 1993. Depression and How to Survive it. London. Ebury Press.
Cohen, S. 2001. .States of Denial Knowing about Atrocities and Suffering. Cambridge: Polity press in association with Blackwell Publishing
Crossley, N. 2002. Making Sense of Social Movements. London: Open University press
Foucault, M. 1967. Madness and Civilisation. London: Ruthledge Publishers
Goffman, E. 1966, 1968, 1987, 1991. Asylums. London: Penquin.
Goffman, E. 1963, 1968, 1990 Stigma – Notes on the Management of Spoilt Identity. New Jersey: Penquin
Hunt, P, 1966. Stigma – The experience of Disabilility. Dublin. Geoffrey Chapman and Co.
Mathews, A and Gelder, M, and Johnston, D 1981 Agoraphobia Nature and Treatment. New York: The Guilford Press
Millett, K. 1994. The Politics of Cruelty. An Essay on the Literature of Political Imprisonment. New York and London. W.W. Norton and Co.
McClung Lee, A, 1973. Toward Humanist Sociology. New Jersey, Prentice Hall.
Putnam, Robert D. Bowling Alone – The collapse and Revival of American Community. New York: Touchstone.
Sayce, L. 2000. Fron Psychiatric Patient to Citizen – Overturn discrimination and Social Exlusion). London. Palgrave.
CAN MENTAL ILLNESS BE UNDERSTOOD AS A FORM OF SOCIAL DEVIANCE?
Written by: Michelle Clarke- September 2003 (Hard copy available on request which contains footnotes).
Mental illness must be first defined in the context of legislation.-1- Account is required of the predominantly medical input and the challenge that is faced by Sociologists and other disciplines. It is the biomedical model that has made such an impact on our cultural ideas about the body. The body is determined to be well or ill.-2- This in turn reflects the attitudes and beliefs of people. History reflects its assumptions to interpretations of mental illness and these interpretations prove valid for some people still. Bio-medicine looks to the body and separates other aspects of the human being.-3- Herein lies the conflict necessary to invoke challenge and bring about change. The body is predominant: social, psychological and behavioural factors of the illness stand apart. The illness is pathologised and the disease is allocated to some part of the body (physical reductionism). -4- The Body is seen as the object of regime and control (Foucault, 1979).
This essay will review the historical social construction of mental illness – the pathologised version as enacted by legislation. It will review the myth imbibed by capitalism and science to the stigmatized illness that presently exists. I review the impact of fear as the powerful hidden component. Challenge exists and the entry of sociologists like Comte, Durkheim, Weber, Simmel, to the Chicago School in 1924 like Goffman are discussed in terms of their approach to Deviance. The introduction of Social Movements in line with concept of civil rights in the 1960’s and taking hold in the UK from the 1980’s onwards. For the first time, we saw the opportunity for those designated ‘mentally’ ill to become stakeholders in their own future. The stage where the person who was once the patient (inmate) can refer to themselves as ‘survivor of mental illness’ or just survivor. Children, Education, Amnesty International, the United Nations, the EU and their Quality of Life research programmes are essential to provide the empowerment for the mentally ill to engage and disengage (with the understanding of people). This is vital. Only could those with mental illness have been so poorly treated and disregarded, if people conjured them as ‘deviant’ and not worth input.
Historical Social Construction of Mental illness – the assumptions
The ‘Struggle against Psychiatry’ has a long history. In 1620, the House of Lords received the ‘Petition of the Poor Distracted People in the House of Bedlam’ – the complaint was against inhumane treatment to the inmates. In 1845, the ‘Alleged Lunatics’ Friends Society was formed by ex-patients (Mind, 2003).-5-
The Middle Ages, saw the disappearance of leprosy in the Western World. Between the High Middle Ages and the end of the Crusades, leprosariums multiplied in the cities of Europe. The 17th century saw the creation of the houses of confinement established in Paris and other cities. Ironically, the Great Confinement made the human being – a social being and identity, subject to classification. It would have been economically viable to use the vacated buildings and to use them for the purpose of those held to be deviant, (Foucault,1967).
This period coincided with birth of Capitalism. Power and vanity became the new driving force. In England, the merchant class engaged in speculative ventures – those expectations driven by financial motivation involving commerce with emphasis on the emotions: fear and hope. Core to commerce is competition, envy and avarice and this has a price. The Renaissance period was the time of growth in individualism and this can incubate despotism. A schism arose in the Church dividing the Catholic Church and the Protestant Church.-6- The protestant work ethic, accumulation of capital, and a belief in a pre-destination created a suitable ethos to ignite in people the motivation required to embed Capitalism and class structure (Foucault, 1967: 74)
Mythology origin –Pathologised-Capitalism-Science
‘Suddenly, in a few years in the middle of the 18th century, a fear arose – a fear formulated in medical terms but animated, basically, by a moral myth’.
(Foucault, 1967: 192)
People were in ‘dread’ of a mysterious disease that spread from the houses of confinement that would soon threaten the cities. The disease became pathologised – fears, hallucinations, absent-mindedness all became identifiable symptoms.-7- (The symptoms in the footnote need to be seen in the context of what the Mental Health Act 2001 provides today). (Foucault, 1967: 199). Unreason and mental illness became intermingled. Unreason involves real fear. ‘Dread’ and the implications of fear compounded with the shame, stigma and ‘panopticism’ ensured segregation. Power and control enforce the dogma.
Contradiction and Challenge:-8-
Madness began to invoke thought. It became an issue of raising ‘the original truth’ but rather than it remaining hidden, this truth could ‘hang’ in history forever….This endorsed fear for some, both sides of the divide, but for different motives and different reasons. Fear and its internal impact and method of control and containment are hidden topics for discussion. The inference is weakness, the reality is fear can be used to control the vulnerable. Fear is pervasive in its implications.-9-
‘The truth of madness is what madness is…What madness is, is a form of vision that destroys itself by its own choice of oblivion in the face of existing forms of social tactics and strategy’ (Cooper, D. in Foucault, 1967: Intro)
The Reality is: Madness fascinates: The question stands – Is it madness or is it Vision?
‘It is of little importance on exactly which day in the autumn of 1888, Nietzche went mad for good, and after which his texts no longer afford philosophy but psychiatry: All of them, including the postcard to Strindberg, belong to Nietzche, And all are related to the Birth of Tragedy’. Our view of Nietzche is what he gave and continues to give to the Modern World’ (Blum, 273).
Sociologists’ Definition – Deviance:
‘Deviance always refers to conduct that is in violation of the rules
constructed by a given society or group. In other words, the concept of deviance implies a moral difference. It refers to the refusal or perhaps inability of an individual or group to abide by the moral norms that prevail in the social context in question’
(Berger and Berger, 1972: 305)
The group have defined the rules but the outsider remains outside looking in.-10- The outsider is the source of much speculation, scientific study and theorizing. The question is why does he not want to comply with societal rules?-11-
Sociology and its Origins
Sociology arose in the 19th century.-12- The basics of sociology related to the discovery of the laws of social order and the methodology required to maintain such order. (Berger, 1972; Berger, 1972)
Durkheim (1858-1917) understood deviance in terms of the functioning of society and deemed it preferable to study the society as distinct from individuals. The conduct of a person has categorized them in the minds of others. They are deviant and can be placed in a sub-category thereafter. In his book, Division of Labour, Durkheim highlighted the need for solidarity as people have an inherent need to belong. He wrote of the evolution from the basic operating mechanical society to the more organic society. Durkheim also researched and wrote ‘The Rules of Sociological Society’ in which he established the identity of sociology as distinct from psychological facts. Social facts represent ‘things’ – the approach is objective. (Berger, 1972; Berger, 1972).
Functionalism is the model applied by Durkheim and further progressed by Talcott Parsons in the US. Functionalism is closely applied to the medical model that promotes patient compliance and the bureaucratic structure to the services provided. Illness is seen as a social deviance when social expectations and norms are not achieved. Illness is an unnatural state hence the imperative function is to alleviate the person from it as quickly as possible. The assumption stands that stigma, shame and vulnerability pertain to many illnesses. Functionalists view health as a social commodity; a resource that is essential for individual achievement and the smooth performance of society (Annadale, 1998:10). The medical model is the Institution for Social Control.
Durkheim established views on Suicide and stated that this method of self-destruction was not only a personal tragedy but his findings were that it was a sociological consequence to which one is integrated in society – rare among married people, rarer in a more closely knit religious establishments and more frequent when rapid social change disrupts the social fabric. Social connectedness matters to our life in a profound way. Social networks reinforce healthy norms (Putnam, 2000).
Merton’s work has been productive in that it links with Durkheim’s concept of anomie and the analysis of social class. There have been investigations that link certain class positions to mental illness.
Weber examined the role of ideas in history; Marx focused on the economic aspects. Weber and Durkheim both reviewed the impact of Religion. Weber wrote on ‘The Protestant Ethic and the Spirit of Capitalism. It was Georg Simmel who reviewed the role of the Stranger – the dyads and triads. Simmel sought to establish ‘a formal sociology’. These sociologists are European.-13-
Goffman links back to the Chicago School of the 1920’s – America.-14-
Deviance is measured against a perception as to what is reality. The perception of reality is that defined by Society. Perceptions differ, they change. Both normality and deviance are important components of ‘reality’. One must be aware that Society is protective against challenges as to how they define reality:-15-
‘The total institution is a social hybrid, part residential, part community, part formal organization, there in lies its special sociological interest’ (Goffman, 1968: 22)
Goffman engaged with the concept of symbolic interactionism. To Goffman, mental hospitals and prisons are ‘total institutions’. Stigma looks at how people actually cope with ‘spoilt identities’. He exhibits a strong feeling of compassion with the victims of negative ‘social designations’. (Goffman: 1961: 22)
Following the trend set by Mills and Goffman, ‘labelling theory’ emerged. Howard Becker is the most well known representative of this new school. It creates a platform for a hierarchy to develop permitting different levels of authority. It is about distinguishing the social worker from the sociologist, from the psychiatrist or the law enforcement officer from the Doctor. It is important to note that what is called deviant today may be deemed normal in the future.
Another aspect to consider about Deviance is that it is understood as simply one way in which people define a situation. It’s ‘reality’ depends upon the power of the people who do the defining to impose their definition upon others.-16-(Goffman, 1961).
Stigmatization in the context of Mental Illness ensures it is referred to as deviant – the modus operandi is a process which one group of people inflicts upon another. The definition will ‘stick’, depending upon the power of the definers. In that case, those who are thus defined, the stigmatized will have to come to terms both socially and psychologically with the ‘spoilt identity’.-17-
CHALLENGE TO SOCIOLOGISTS:-18-
Medicalisation dictates legislation. The 1945 Mental Health Act-19- was only altered in 2001 with much grassroots activity of social movements and charities at a variety of levels. The issue of Rights for the mentally ill remains in limbo in Ireland. However, social movements are in existence.
Social Movements – Nick Crossley
‘Social movements can be viewed as collective enterprises seeking to establish a new order of life…The career of a social movement depicts the emergence of a new order of life.
(Blumer 1969: 99)-20-
Contention Humanities versus Science – US Sociological View 1974
People Question – Can humanity survive with science so prevalent? Sociologists and other social scientists are divided in opinion as to how to best position themselves to address the science versus the humanities issue in the 20th century. The major challenges concern proceeding with research under subsidies from those in power or should they only be investigators committed solely to their own humanist goals. Can they merge both together was the issue? (McClung Lee, 1973)-21-. The reality is that if science provides the genetic proof, it still stands that triggers and environmental factors play a large part in mental illness.
Education – the key factor to effect change: Multiple intelligences exist yet the school curriculum is weighted against non scientific approach students.
Bourdieu defines the sociology of education ‘specifically in terms of its role in understanding; the contribution made by the education system to the reproduction of the structure of power relationships and symbolic relationships between classes’. (Banks, O, 1968:115)
View of Education – US 1974:
‘Students caught up willingly in the regimenting routines of such specialized trade schools and college as those of business, engineering and military, appear to be heedless to their dehumanization’ (McClung Lee, 1974 pg. 1)-22-
And
‘Our educational procedures are more often geared to the development of believers and technicians rather than independent investigators and thinkers
the mass culture that pervades’ (McClung Lee, 1974: 67)
Representation 1980’s: the approach was more that of a ‘consumerist’ for the patient as distinct from service users or survivor.
The objective is to create social inclusion for people diagnosed with a mental health problem.
Nottingham Advocacy Group was one of the first established in 1986. The movement was towards Survivors speaking out, having a voice and challenging false conceptions perpetuated through mythology and ignorance.
A forward thinking psychiatrist and his client – Dr. Anthony Clare, St. Patrick’s Hospital, Dublin and Spike Milligan, Writer, Comedian with a Manic Depression diagnosis, worked in conjunction to produce a book to provide evidence from both sides. The comparison was drawn that both Cancer and Mental illness are pathologised but the reaction is most likely one of shame in relation to depression, even though a severe depression is life-threatening illness. (Clare, Milligan, 1993).-23-
‘Images of madness in our culture make it starkly clear that it is best avoided or denied – not just because the experience can be alarming, but because it is hard to see oneself simultaneously as ‘crazy’ and as a valid person with a liveable future’ (Sayce, 2002: 8)-24-
‘It addresses one central question: how, and on what basis, do we move beyond the physical de-segregation of hospital closure programmes towards the chance of full participation in social and economic life’. (Sayce, 2002)-25-
Why penalize people who cannot work at 100% range or even a 50% range?-26- Cordis, cordis.europa.eu/ an arm of the EU is currently researching Quality of Life perspectives.-27- Demographics may cause policy makers to change their attitudes and view people as potential (albeit limited) contributors to taxation.
Empowerment and mental health – the need for ‘Academics with Attitude’ .
This is a movement of ‘passive recipients’ to ‘active subjects’. The approach is to challenge the way we think about ‘mental illness’ mental health and what it means to live with madness. -28-(Barnes, 2001; bowl; 2001:). This is about Changing Attitudes. Mind in the UK run successful campaigns like 1 in 4, with descriptive footage of a severely depressed person. These are areas that need consideration. Essential is the use of the internet and system of email both for self-knowledge and innovative type work consistent with ‘diagnosis’.
Points to realistically consider:
Integration implies the individual will fit in with the system
The person has to change. Inclusion means that system itself will develop self-criticism; acknowledge the way in which it excludes and denies access; and dismantle barriers (Shakespeare 1997 in Sayce 31). -29- Anxiety – Valium, Librium – the wonder drugs-30- of the 1960’s are addictive. Consultants are afraid of insurance actions so are much more controlled in what they prescribe. There is no alternative now for the patient with anxiety i.e. except cigarettes/alcohol. Public policy is to prevent smoking in public places. Both cigarettes and tranquilizers are being restricted at the same time. This has implications for increased intake of alcohol. Mental illness also must be described as a physical illness. There is a need to have the service user as a stakeholder in policy making.-31-
Power of Language – Control
‘Language is itself a site of struggle and one of the purposes of user or survivor movements is to reclaim the right to define and name their own experiences’.-32-
Perspective
‘The emphasis on science is important. First it implies that the origin of mental illness and the role of intervention can be studied using the methods of observation and logical inference that form the basis of natural science. As such it is based on ‘fact’, not value, and its definition is seen as independent of Culture or social context.-33- This has both a political and organizational implications. It provides justification for the separation of medicine as a discipline and the retention of power over defining and treating mental illness outside political and popular control……Medicine has a non precise definition .
Reduction of stigma and discrimination is starting to appear high on the public policy agenda in a number of countries. The Australian Government have a major Education programme in place. The New Zealand government have adopted a programme based on studies into other marginalized groups e.g. HIV/Aids.
More Enlightened approach – World Perspective
The Universal Declaration of Human Rights encompasses
civil, political, economic and cultural rights.-34-
Community care is deemed more humane than inpatient stays. Ireland, Israel, Netherlands and Spain have 80-90% of the beds in psychiatric hospitals, France, Germany and Japan have 60-75% occupancy in psychiatric hospitals. The difference is found in Australia, Canada and the USA at 40%. (World Health Organisation page 17)
Amnesty International Ireland www.amnesty.ie/mentalhealth. Sociologically challenges Ireland’s treatment of the mentally ill. (The News on mental health issues from around the world) reports:-)
‘The support for children with, or at risk of mental health from successive Irish governments has not been adequate. The Amnesty publication, Mental Health – the Neglected Quarter, has as its objectives to increase awareness that children’s mental health is a human rights issue, to place this fact firmly before Government, and to lobby much needed reform in Government policy, practice and legislation (Sean Love, Director of Amnesty’s Irish Section).-35-
Gender issues/cultural issues – social factors:
Mental illness must be about multi-disciplinary teams. Psychiatrists opened up to the inclusion of psychology over the past 20 years and it is stated that if trigger events can be limited in a person susceptible to mental illness, and particularly after one event only, it is probable that they will avoid major mental health issues (Aware lecture 2003).www.aware.ie. 75% of those who commit suicide are men.-36- Black men have above average admittance in to psychiatric hospital in the UK and also to high security areas. Most divorces and separations are started by women and fathers tend to lose contact with their children. There is growing evidence that unemployment has an impact on mental. These are social issues impacting on family structure and society: http//www.mind.org/Information/Factsheets/Men/.
THE WAY FORWARD (Denial, Stigma, Shame, Education, Multi-disciplinary teams, Respect for difference)
Education is core to understanding and change.
‘The traditional conceptual framework in the subject is that of functionalism, and derives primarily from the writings of the French sociologist Emile Durkheim. The functionalist approach, as Durkheim used it, is to seek for the social function performed by an institution; that is for the part played by the institution in the promotion and maintenance of social cohesion and social unity’. (page etc).
Durkheim referred to the ‘socialization of the young generation’. He sought to imbibe the young generation with values and certain intellectual and physical skills.-37-
The Bright Futures Initiative –
In 1997, the Mental Health Organisation in the UK undertook a major study into the mental health of children and young people. They reviewed the requirements for the emotional and healthy development of children. The 1999 reports Bright Futures was published. Factors that cause children to be susceptible include poverty, poor housing, parental conflict, parental psychiatric problems and abuse.-38- It acknowledges the importance of early intervention. Other reports include The Mental Health of Young Offenders, August 2002 and the Mental Health of Looked After Children, August 2002. http://www.mentalhealth.org.uk/page.cfm?pagecode=PIBF -39-
Dr. Fernandez (Amnesty Member),-40- states the need to distinguish between ‘’mental health problems’’ induced by homelessness and ‘’mental illness’’ that may be a factor in becoming or remaining homeless (Amnesty International, 2003: 17). Psychiatric and rehabilitative services but with limited funding are provided at St. Brendan’s Psychiatric Hospital. The main objective is to ‘preserve and regain social function’. The separation from the rest of society in large institutions only ensures exclusion.-41-
IRELAND – Equality and the system of education are formally challenged. It is not inclusive. Is there a link to Mental Illness! Is the scope of the curriculum broad enough?
4500 are now hospitalized in psychiatric hospitals in Ireland. This has reduced from over 21,000 in 1958. By the 1980’s, institutions were costing large sums of money and government policy sought alternatives. Market forces determined the 1980’s de-institutionalisation policies.-42- In the year 2000, admissions were over 20,000 however the issue to be concerned about is that 70% of these were re-admissions. This speaks volumes about the recurrent nature.-43- Dr. Kennedy from Central Mental Hospital in a presentation made a point of the differentiation between those problems that were social i.e. over 80% and those that were psychiatric.-44-
‘To speak of the unspeakable is the beginning of action’ (Millett, 1994)-45-
Who is willing to listen, to hear, to activate change? The Irish psychiatric policy is based on the consumer model and thus adopted by the social movement organizations e.g. Aware and Schizophrenia Ireland. The approach is Top-Down as distinct from user-led action.
‘It is possible to propose a theoretical framework which moves the sociological perspective on from limitations inherent in other sociological traditions within the sociology of health and illness literature, such as psychiatry as a social system (Foucault 1965), or the deviance or the Marxian approaches of Scheff (1999 or Scull (1979 respectively‘ (Speed, E, 2002, 64). Irish peculiarities mean the model requires adaptation.
Schizophrenia Ireland was set up in 1981. http://www.sirl.ie/other/repository_docs/13.pdf -46- Aware, the voluntary organization was established in 1985. Aware Ireland, Sanewww.sane.org.uk in the UK and NAMI https://www.nami.org/ in America support the biological basis of mental ‘illness’. Aware is involved in the ‘promotion of research into biological, psychological and social aspects of Depression’ (Aware, 2001).-47- The Minister of Health has put in place an appointed study group to review analytically psychiatric services and community based service (Foreward iii) is now in place.
‘There has been a lack of any concerted mental health service users’ movement within the Republic of Ireland. Mental Health service users’ movements have a marked orientation towards strategies of empowerment and the provision of peer advocacy and support mental health service users’ (Speede, 2002). This is only acceptable if the objective is to change educational policy and introduce multi-disciplinary teams to work in the best interests of the service-user. If this occurs and with the distinct advantage of the internet, survivors can become empowered.
Research – What do we know? What does the future hold?
1997 The Trinity Horizon Project of the Centre of Women Studies covered a period of 4 years and developed a pro-type training and counseling programme for the women recovering from depression to facilitate their re-entry to the workplace. The research was carried out in collaboration with Aware, IBEC, ICTU and FAS.
The stance was from the humanitarian and social perspective. This was aimed at creating survivors. It was concerned with confronting the hidden secret associated with mental illness, dealing with the stigma that pertained and to emphasize just how under-resourced mental health services are. Funds were provided by the EU. A conference was held by the Trinity Horizon project – titled Mental Health and the Workplace: Challenges and Opportunites. It had access to transnational models – this provided a cross cultural dimension. Norbert Tietz, Director, EX+JOB in Wunstorf, Germany.
Immediately receptive is the term social firm. The firm was based on a philosophy of work and part of this was about integration of the participants with the public. Work experience included bar/restaurant work open to the public, fridge recycling plant, used children’s clothes shops, furniture shop and a music shop. The innovation of work came from the community as a whole in collaboration with the psychiatric hospital. The re-cycling dimension proved very successful. It appealed on the environmentally friendly factor. German companies must employ 6% of people with disabilities. If they choose not to pay, they must pay and fine and the money is paid into a fund for people with disabilities.
Professor McKeon, Psychiatrist of St. Patrick’s hospital and founding member of Aware reiterated that people with mental health difficulties, especially those with depression, make excellent employees. If anything, he stressed that this group with their over-anxiety to do well are exemplary employees. ‘Their exaggerated sense of responsibility and loyalty, traits which sometimes contribute to their difficulties, are positive elements for an employer. They are the first at work and have a commitment to any task they undertake. In dealing with their illness, they have already proven their ability to face and overcome difficulties and demonstrated their tenacity and courage’ (Trinity Horizon Project, Centre for Women Studies, 2000: viii)-48-
Yet, such a daring programme proved too expensive for the NRB to undertake. The NRB was subsequently subsumed into FAS – no rehabilitative programme as per the research was in put place yet. In fact, community employment which provided a meager alternative, but an alternative form of rehabilitation is being drastically cut back by Government policy.
CONCLUSION
National Policy framework – stakeholders – Survivors. Rights based Mental Health legislation is needed. Expenditure in psychiatric services has been reduced since 1976 by 20%. Mental illness is about social implications, coping strategies, psychological services and engaging with denial, particularly within the family context.-49- Power and control needs to be monitored.-50- Mental illness merits a consensual approach if people are to be integrated in society. Social workers need to interact with sociologists, psychologists, psychiatrists, educationalists, and most important in line with the wisdom of Carl Jung, Psychiatrist, Psychologist – they must involve the patient. -51-The Trinity Horizon Research proved too costly an approach but a new direction and approach is in place the National Flexi-Work Partnership Work-Life Balance Project
Comte named a new dimension called sociology; Durkheim elaborated and defined society as an integrated whole; Weber, shared Durkheim’s interest in religions and structure but also was concerned with ideals; and Simmel spoke of the ‘Stranger’. The intervening years saw institutionalization, medicalisation, of people who are ‘Different’. Why should an idealist be different, there might be a latent talent, that is inhibited by structure yet innovation lies there untapped. The challenge rests with Education and incorporation of a broader syllabus, to the Universities to take in hand those non-conformists and educate them and add the dimension to their education,-52- and the education of other students. People are mental health survivors but they must be given a chance. Denial, stigma, shame, must be removed and if it takes the conflict of referring to a person as socially deviant, for the reaction to come – ‘but no you are not in horror’. This is the step forward to dealing with denial. This is reality brought about by fear that no-one cares to acknowledge – hence the suicides are dismissed in shame, in silence, in fear. The medical profession live in fear that they too ‘will break the threshold’ that applies to every human being. This can be intuitively sensed from them. Sociologists need to take stock of the heritage of their founding fathers – perhaps it is time not to seek the credibility of being totally scientific and consider a more humanistic, open, consensual and interactive approach and work within multi-disciplinary teams with the objective of improving society.-53-
My parting comment is about Suicide. Dr. Kelly, (Iraq war 2003) leading scientist in search of nuclear arms in Iraq had the choice to conform to the status quo – to have his knuckles wrapped. He was an individual, deliberated, he knew the outcome if he conformed. Perhaps the issue is – could he have lived with his conscience? Durkheim reviewed suicide in this context. Yet our society does not see that people differ, a ‘Stranger’, -54-holding intuitive sentiments similar to what Shakespeare wrote in Hamlet ‘there is something rotten in the State of Denmark.
March 2015-Contextualised over a decade: Deviance is deviance surely not as defined by mental health. The shocking murder of Elaine O’Hara by a man who was socially deviant and so arrogant that he believed he could not be convicted and who was not going to use the defence of Insanity.
Dwyer did not plead insanity. He is found guilty of Murder. He preyed on a vulnerable woman called Elaine O’Hara who had been admitted to Ireland’s most elite psychiatric hospital, St Edmundsbury, on 14 occasions, under the most eminent of psychiatrists including Dr Anthony Clare. The paradox, the person with a mental illness the victim of society’s inability to provide for her mental health need and the murderer, the narcissist, the psychopath, devoid of conscience who saw vulnerable women as objects for his gratification. The question is will people abuse the term mental health and include him as mentally ill. I sincerely hope not. This social deviance stands apart from what mental illness is about. Again I say lets use the term Manic Depression again instead of the sanitised Bipolar. The manic applies to the high but also to the low.
Endnotes
1 An act to provide the involuntary admission to approved centres of persons suffering from mental disorders, to provide for the involuntary admission of such persons and, for the those purposes, to provide for the establishment of a Mental Health Commission and the appointment of Mental Health Commission tribunals and an Inspector of Mental Health Services, to repeal in part the Mental Treatment Act 1945 and to provide for related matters. “Mental Illness” means a state of mind of a person which affects the person’s thinking, perceiving, emotion and judgement and which seriously impairs the mental functions of the person to the extent that he or she requires care and medical treatment in his or her own interest or in the interest of other persons (Mental Health Act 2001)(return)
2 Distribution of wellness and illness throughout population does not fall in equal proportions (return)
3 Western medicine: science puts forward the belief that the body is separate from the mind and spirit (return)
4 Etiology is about identifying causes for each disease and scourcing cures. A machine capable of repair is the metaphor (return)
5 Exhibitions of inmates would be held and people paid to see those deemed ‘Mad’ (return)
6 Certain earlier sociologists particularly Durkheim and Weber, who carried out considerable research into different religions, linked it closely with the regimented system of values and rules relating to societies (return)
7 It was confinement of the debauched; the spendthrift fathers; prodigal sons; blasphemers, men who “seek to undo themselves”, libertines….One tenth of all the arrests were in Paris for the Hospital General concern “the insane”< “demented” men< individuals of “wandering mind” and persons who have become “completely mad” Foucault, 1967). No mention of alcohol or drugs. (return)
8 Lord Byron: Van Gogh; Churchill; Don Quioxte; Goya personalised mood distortion to black periods. Churchill referred to “Black Dog”. Aware St Patrick’s Hospital run a website titled “Black Dog” (return)
9 ‘Fear of fear refers to the anticipation of anxiety and thoughts that the mental and physical symptoms of anxiety will lead to worse consequences – a thought that in turn generates more anxiety. For example, mounting feelings of anxiety often make the patient anticipate that he or she will lose control and behave in a dis-inhibited way, or even become insane; while rapid heart action may lead the patient to expect a cardiac arrest or coronary thrombosis (Mathews A, Gelder M, Johnston D, 1981:5) (return)
10 Normal personality: how to define it? Perhaps – efficient self perception, realistic self-esteem and acceptance; voluntary control over behaviour; a true perception of the world; sustaining relationships and giving affection; self direction and productivity (Social psychology notes 2nd yr Business Economics and Social Studies Trinity notes (return)
11 Having been institutionalised and detache from society on numerous occasions, you are the outsider looking in (personal comment). Some explanations of psychosis use these exact words’ (return)
12 The name ‘Sociology’ was invented by Auguste Comete (1798-1857) – Philosophy (Positivism) (return)
13 Robert Merton sought to explain deviant behaviour in terms of social structure. He puts forward the idea that all forms of deviant behaviour ‘from differentials in the access to the success goals of a society by legitimate means….Deviance thus occurs as a result of discrepancy between the aspirations which society has socialised into its members and the way that society has provided for realising such aspirations. Merton uses the Durkheimian concept of anomie to refer to such a situation’. This reflects the goal oriented, materialistic strain in America (return)
14 Malfunction appears to determine deviance. ‘Agoraphobia is illness because one should not be afraid of open spaces. Homosexuality is illness because heterosexuality is the social norm. Divorce is illness because it signals failure of marriage….all these and many more have been said to be signs of mental illness (Berger 1963:6) (return)
15 It was then and still is my belief that any group of persons – prisoners, primitives, pilots, or patients – develop a life of their own that becomes meaningful, reasonable and normal once you get close to it, and that a good way to learn about any of these worlds is to submit oneself in the company of the members to the daily round of petty contingencies to which they are subject (Goffman) (return)
16 Mental illness/mood disorder is about lapses to weakness in moral and physical health – this inherent vulnerability is exploited (this includes family; employers, corporates, insurance companies, regimented bodies like education, the legal profession; the Church; non conformists too are not acceptable. Yet medical ethics was horrifically breached by Mengele with use of humans for scientific experiments (NAZI Germany) (return)
17 Victor Frankl (1962) Survivor from Auchwitz (Psychiatrist, Psychologist, Logotherapist, writer. ‘When we describe a responsible person we mean that in every area of his life he is able to meet the demands of this world’. Logotherapy concerns expanding the scope of visions (psychologically) for the patient. Here is the challenge to society. (return)
18 Comment from House of Lords UK: Quite evidently explanations for mental illness and institutionalisation were unclear to those engaged in scrutiny “As we get to know more about the complexity of the human mind, so we try to make our shades of responsibility more complext, and so I thing we get into deeper and deeper muddles Baroness Wootton of Abiger, House of Lords 1962 (return)
19 Irish 1945 Act was based on the earlier English legislation (return)
20 Examples include: Mind UK, (Aware, Grow, Irish Mental Health Advocacy in Ireland and Ireland Mental Health Association of Ireland etc) (return)
21 This was 1974. Now in the UK it is the medical profession who are linking to Humanities for medical conferences (return)
22 What about the social impact of science on man as a social creature? The most obvious is the impact of domestic gadgetry, healt-care facilities, urban and industrial structures and the ultimate threat of nuclear war (McClung Lee, 1974) (return)
23 Surprisingly I sought the implication and definition of fear in his book – there was none. Doctors have an issue with fear (return)
24 Denial is corrosive. Aware now operate a ‘Beat the Blues’ campaign in secondary schools. This is successful. Parents may have very fixed interpretations and refuse to encourage a child to engage at the expense of the child. (return)
25 This book includes several sources including the survivors together with lawyers, policy makers, activists, medical health professions. Primarily the research was completed in the US and UK in the late 1990’s. Reference is made to systems in Europe, Australia and New Zealand. (return)
26 Vincent Van Gogh. His pre-occupation was to give, not to receive financially. His paintings were sold after his death and amrketing applied to accumulate worth. The same applied to letters he wrote. He was socially oriented. (return)
27 Presently, the Centre for Women Studies in Trinity College Dublin are carrying out research which is part of the Equal Community Initiative and the European Social Fund. It involves a mental health advisory committee. University of Dublin; Aware: Age Action; IBEC; Congress of Trade Unions; FAS and mental health survivors will convene over the next two years. The June meeting was a bilateral meeting: Working party of employers and the Mental Health Advisory group including mental health survivors. The focus is National Flexi work – Work Life Balance. (return)
28 Marian Barnes is a member of National Health Action Zone evaluation team focusing on community involvement. (return)
29 ‘People who are seriously disadvantaged in society rarely have just single problems – they have multiple interlocking problems. They do not compete on a level playing field. Empowerment must address all their problems together if it is to be meaningful’. (Davy, 1999, 37) (return)
30 Drugs have side affects; muscle wastage ensures body weakness; anorexia/bulimia can be side affects related to mood disorder or just a manifestation of self-harm, vision, co-ordination, perception, judgment, attention deficits etc (return)
31 The Barr Tribunal (John Carthy RIP): Labeled a Manic Depressive. Somehow anxiety has been removed from language of mental health otherwise he would likely not have been shot dead by An Gardai Siochana. Anxiety drugs (Benzos) are now causing negative reporting as they are deemed too addictive and there are basically no alternatives. It could be said that the cigarettes were used to taunt John Carthy RIP, cigarettes could have calmed his anxiety. Many people go contrary to regulations and even legislation especially relating to drugs and alcohol to help them cope with stress, anxiety, depression. This is a social issue and was addressed by Dr Harry Kennedy (Psychiatrist) who has accommodation problems at the Central Mental Hospital. It is linked to crime. (return)
32 Mental Act of England and Wales defines ‘Mental Disorder’ as mental illness, personality disorder, severe mental impairment. (return)
33 Perhaps this should mean it is a component part of a spectrum that deals with those diagnosed mentally ill. A more equitable distribution of funds in terms of time input would be required. hroughout population does not fall in equal proportions (return)
34 All persons have the right to the best available mental health care, which shall be part of the health and social care system. MI Principle Amnesty Mental Health Report – the Neglected Quarter). (return)
35 Ireland ratified the UN Convention on Rights of the Child in 1992, whereby it undertook to provide a specialised mental health regime to identify, treat and protect children under 18 years or at risk of mental illness. http://www.mentalhealth.org.uk/page.cfm?pagecode=NENE (return)
36 The State in Ireland and the Church are prejudiced in regard to a person with mental illness. Denial applies. (return)
37 ‘The most sensible way to lower rates of depression and suicide is …to spread accurate information among the general public about what depression is’ Dr Fernandex (Amnesty) and St. Brendan’s Hospital; Breaking the Cycle of Depression; (Joe Griffin and Ivan Tyrrell), The European Studies Institute. http://www.clinical-depression.co.uk (return)
38 see 37 (return)
39 17th September 2003: Psychiatrist Dr Kay Redfield Jamieson (US psychiatrist, a manic depressive) is in Ireland. New breakthrough relating to the prediction of suicide is announced. It involves hospital, an MRI scan, a Pet scan. The question is how probable it is that suicidal people will proceed through the functional medical channel. (return)
40 Dr Fernandez – Psychiatrist, St Brendan’s Psychiatric hospital, Dublin (return)
41 Serious findings: 70% re-admission each year. This strongly indicates hostile social situations: alcoholism, marital conflict, drug addicts etc. Each psychiatric admission involves a review of cocktail medications and monitoring. New drugs, new side effects, new body hostility limitations and re-adjustment. Each hospital admission means there is possibly a new psychiatric label, the range is manic depression to borderline personality disorder to manic depression. It is important to note that many doctors in psychiatric are in temporary postings and often from overseas (return)
42 Driven by former Prime Minister Margaret Thatcher (Conservative Party) (return)
43 The social aspects, alcohol, drug abuse, family strife, lack of occupation to regain acceptance in a community. (return)
44 Irish Penal Reform Trust. Former President Ireland – Dr Mary Robinson dated December 2002 (return)
45 The Arts address the social issues. Jack Nicholson in One Flew over the Cuckoos Nest, and As Good as it Gets, drew considerable attention to institutional care and to obsessive compulsive disorder. A Beautiful Mind says so much more about Schizophrenia and brilliance. ‘Strangers’ can contribute. (return)
46 Interested patients, family members, professionals, advocates (return)
47 Similar stance by MHAI, Department of Health and Regional health boards (return) Education as distince from the workplace appealed to a number of ‘guinea pigs’ One student is accepted for her PhD in psychology; others opted for community projects in the arts. 48 (return)
49 This is real. It involves children; family court – referred to recently by a Judge as an Armageddon for children; the Catholic Church that acts without a cheecks and balances system provided by the State re people diagnosed with manic depression, schizophrenia. Proper education is essential. We are told that as many as one in four people will suffer from depression in their lifetime. (return)
50 Forfeiture of control of self, family affairs, the need of an ally as distinct from a carer to assuage the difference in personality and preent abusive use of power relations. Relatives seeking the advice from the medical team disempowers the individual. Mind – Respect campaign. Stigma reduced but inclusion is a different issue. Mental health provides no security for those within the Irish court system. The courts have power to seek discovery of documents in the context of divorce leaving the person with severe mental health problems discriminated against. The system is adversarial and damaging. The Annulment by the Catholic Church, a male dominated court again discriminates. (return)
51 Account must be taken that the stakeholder may be subject to health limitations that are greater at different times (return)
52 European social funds opened the gates in the 1990’s but a lack of understanding, prejudice, fear, shame, stigma resulted in people gaining access to Trinity College Dublin but health provisions not in place for crisis situations. Many students left without completing their degrees and more men than women (return)
53 Goya painted ‘the Madhouse’ ‘he must have experienced before that grovel of flesh in the void, that nakedness among bare walls, something related to a contemporary pathos; the symbolic tinsel that crowned the insane kings….left in view suppliant bodies, bodies vulnerable to chains and whips, which contradicted the delirium of the faces…The man in the tricorne is not made because he has stuck an old hat upon his nakedness…(Foucault 1967; 265) (return)
54 Perhaps Simmel perceived the Stranger as an individual – the outlier who would take the risk to restore an equilibrium(return)
Bibliography:
Amnesty International, 2003. Mental Illness, the Neglected Quarter. Dublin. Irish Division Report
Amnesty International, 2003. Mental Illness, the Neglected Quarter – Homelessness. Dublin. Irish Division Report
Banks, O. (ed) 1968, 1969, 1970, 1971. The Sociology of Education. B.T.
Barnes M, and Bowl R, 2001. Taking over the asylum – empowerment and mental health. Palgrave Press. Hampshire
Bursford Limited. Guildford, London, and Winchester.
Becker, H.. 1963. Outsiders Studies in the Sociology of Deviance. The Free Press. New York
Becker, P. and B. Becker 1974 (ed), Sociology: A Biographical Approach. Penguin: USA
Barnes n, and r bowl, Taking over the Asylum Empowerment and Mental Health: London:. Palgrave
Centre for Women Studies, 2003. National Flexi-Work Partnership Work-Life Balance Project. Dublin. University of Dublin.
Clare A, and Milligan, (ed) 1989, 1993. Depression and How to Survive it. London. Ebury Press.
Cohen, S. 2001. .States of Denial Knowing about Atrocities and Suffering. Cambridge: Polity press in association with Blackwell Publishing
Crossley, N. 2002. Making Sense of Social Movements. London: Open University press
Foucault, M. 1967. Madness and Civilisation. London: Ruthledge Publishers
Goffman, E. 1966, 1968, 1987, 1991. Asylums. London: Penquin.
Goffman, E. 1963, 1968, 1990 Stigma – Notes on the Management of Spoilt Identity. New Jersey: Penquin
Hunt, P, 1966. Stigma – The experience of Disabilility. Dublin. Geoffrey Chapman and Co.
Mathews, A and Gelder, M, and Johnston, D 1981 Agoraphobia Nature and Treatment. New York: The Guilford Press
Millett, K. 1994. The Politics of Cruelty. An Essay on the Literature of Political Imprisonment. New York and London. W.W. Norton and Co.
McClung Lee, A, 1973. Toward Humanist Sociology. New Jersey, Prentice Hall.
Putnam, Robert D. Bowling Alone – The collapse and Revival of American Community. New York: Touchstone.
Sayce, L. 2000. Fron Psychiatric Patient to Citizen – Overturn discrimination and Social Exlusion). London. Palgrave.
