Lecture 9 Labelling madness and the production of

Mental health & Social policy: 

Mental health & Social policy Lectures 9: Labelling madness & the production of deviance

On being sane in insane places: 

On being sane in insane places However much we may be personally convinced that we can tell the normal from the abnormal, the evidence is simply not compelling Rosenhan, 1973

Rosenhan ‘On being sane in insane places’: 

Rosenhan ‘On being sane in insane places’ Are mental health professionals able to tell the difference between those who are mentally healthy and those who aren’t? What are the consequences of misdiagnosis? Do the characteristics that lead to diagnoses reside in the patients themselves or in the situations and contexts in which the observers (those who do the diagnosing) find the patients?

‘Pseudopatient’ study: 

‘Pseudopatient’ study Eight pseudopatients pretend to be mentally ill and try to gain admittance into various psychiatric institutions. There were five men and three women from various backgrounds used in the study. There were three psychologists, one graduate student, one psychiatrist, one homemaker, and one painter.

How to become a schizophrenic: 

How to become a schizophrenic Participants were instructed to call the 12 different hospitals on both the east and west coasts and set up an appointment. All participants complained of the same thing… hearing voices saying “empty”, “hollow”, and “thud”. All participants were admitted into the institutions and all but one were diagnosed as schizophrenic. Immediately after being admitted to the hospitals the pseudopatients stopped showing any symptoms of abnormality.

I’m not a celebrity, get me out of here: 

I’m not a celebrity, get me out of here The pseudo patients had no idea of when they were going to be released, when being admitted they were told they would have to get out on their own devices. The patients would commonly try to engage other patients and staff into conversation. Only the inmates spotted the ruse Each person was discharged with the label of schizophrenia in remission. The length of hospitalization was 7 to 52 days with an overall average of 19 days.

So what’s new already?: 

So what’s new already? Each pseudo patient took notes on their observations while being in the hospitals. This was interpreted by staff as ‘symptomatic’. Many times the patients would witness physical abuse of other patients. Powerlessness became a huge issue with the pseudopatients. Rosenhan found that the average daily contact with psychiatrists, psychologists, residents, and physicians combined ranged from 3.9 to 25.1 minutes with a mean of 6.8.

Follow up study: 

Follow up study In a 3 month period 193 patients were admitted. Staff rated patients on a 10-point scale, 1 being very confident that the patient was a pseudopatient. 23 were suspected by at least 1 psychiatrist 41 were rated with a 1 by at least 1 member of the staff 19 by 1 psychiatrist and 1 staff member No pseudopatients tried to gain admittance.

Thomas Scheff ‘On being mentally ill’: 

Thomas Scheff ‘On being mentally ill’ Particular reference should be made to the question of whether they [mental health practitioners –LG] are unknowingly aligning themselves with the social status quo; for example by accepting unexamined the diagnosis of schizophrenia, they may be inadvertently providing the legitimacy of science to what is basically a social value judgement Scheff 1970

Rules of conduct: 

Rules of conduct Explicit rules of conduct and labels for transgressive behaviour (e.g. theft, adultery, perversion) Implicit, culture bound assumptions regarding appropriate conduct (‘residual rules) Mental illness as ‘residual rule violation’

Residual rule breaking: 

Residual rule breaking Offences against residual rules lumped together as ‘mental illness’ No scientific verification of cause, course, site, invariant signs and symptoms and treatment for major mental illnesses Mental health industry ‘ a spirited defense of the social order’ (Scheff, 1970)

Slide12: 

The mental health researcher may protest that he is interested not in the preservation of the status quo but in a scientific question: “What are the causes of mental illness?”…however his (sic) question is loaded- like “When did you stop beating your wife” or, more to the point, “what are the causes of witchcraft?” Scheff 1970

Schizophrenia as ‘residue of residues’: 

Schizophrenia as ‘residue of residues’ Broadly defined symptoms (e.g. inappropriateness of affect, bizarre behaviour etc) are offences against social understandings Mental health procedure and medical model posit internal states based on external events

Slide14: 

Residual rule breaking (RRB) arises from diverse sources RRB is high relative to treated mental illness Most RRB is denied and transitory Stereotyped imagery of mental illness learned early in life

Slide15: 

Stereotypes are continually reaffirmed inadvertently in everyday social life Labelled deviants are ‘rewarded’ for playing deviant roles Labelled deviants are punished when they attempt to return to conventional roles (e.g. Laing, 1970)

Denial & Labelling: 

Denial & Labelling Societal reaction is the key process determining outcome in instances of RRB Denial ‘normalises’ RRB (‘boys will be boys’) and deals with transient instances If labelling occurs ‘deviance is stabilised’ leading to a ‘career of chronic mental illness’

The production of ‘chronicity’: 

The production of ‘chronicity’ Concerns the conditions which give rise to labelling Visibility of rule breaking Power of the rule breaker Tolerance level of the community Availability of other cultural responses

Schizophrenia as a label: 

Schizophrenia as a label Single most widely used diagnostic category in US in 1960s and 1970s Causes and course vary significantly Diagnostic reliability very low Doubts about existence of ‘disease entity’ (e.g. Boyle 1990) Schizophrenia is a label applied to residual rule breakers whose behaviour is difficult to classify

Critique of labelling theory: 

Critique of labelling theory Gove, (1980, 1982) Studies found little or no support for theory The original theory was highly specialized, yet insufficiently detailed It omitted most inner events, both those concerning mental illness and those concerning the societal reaction. The causal links between its key concepts were not specified. The theory described the societal reaction as a system without defining the major subsystems or the links between them

Slide20: 

The original labelling theory was also oriented toward the formal labelling process, court hearings, and psychiatric examinations. Labelling (and non-labelling) in these contexts was crude and overt. Most labelling is actually covert, context bound and implicit