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Social constructionist studies of mental illness examine how cultural conceptions of mental illness arise, are applied, and change. Such studies address questions of how conceptions of mental illness emerge in particular social circumstances, which groups have the power to enforce definitions of normality and abnormality, and what social and cultural forces are responsible for why these conceptions change.
Thomas Scheff’s Being Mentally Ill (1966) was the first major social constructionist study of mental illness in American sociology. Scheff studied residual rule-breaking” that refers to how observers categorize rule-violating behaviors that they cannot explain through other culturally recognizable categories. For example, while an adolescent who throws rocks at streetlights might be viewed as a vandal, no cultural category defines a middle-aged person who engages in the same behavior so that the latter is at risk of being labeled as mentally ill.
Another type of social constructionist study examines how particular types of disorder either succeed or fail to gain the psychiatric profession’s recognition as official categories of mental disorder. For example, Scott (1990) shows how veterans of the Vietnam War successfully lobbied to have post-traumatic stress disorder considered as a mental disorder because of the therapeutic and financial benefits that would follow from such recognition. Conversely, other studies show how particular interest groups were able to have conditions previously considered as disorders such as homosexuality removed from the diagnostic manual or to prevent psychiatrists from incorporating new types of mental illness such as premenstrual syndrome into the manual.
Some research shows how the current system of psychiatric classification itself emerged from a variety of social factors. Since 1980 the psychiatric profession has relied upon definitions of several hundred specific types of mental illnesses. These definitions expanded the sorts of conditions that are considered to be legitimate objects of psychiatric concern. In addition, clinicians could use these diagnoses to justify reimbursement for the treatment of a broader range of patients than might otherwise qualify because insurers generally will pay to treat disorders but not problems of living. The drug industry also benefited from and promoted these symptom-based definitions. It relentlessly promoted the notion that common emotions such as depressed mood, agitation, anxiety, or inability to concentrate might be symptoms of mental illnesses.
The constructionist perspective has been subject to a number of criticisms. One, posed by the philosopher Ian Hacking (1999), asks: The social construction of what?” That is, social constructionists typically have difficulty answering the question of exactly what it is that is being socially constructed. In the case of mental illness, this means that constructionists usually ignore any constraints that biological processes such as hallucinations and delusions or massive amounts of alcohol consumption create in the definition of mental symptoms.
A second difficulty stems from the assumption that mental disorders are whatever conditions any group defines as such. Yet, culturally-specific concepts of mental disorder provide no logical or scientific grounds for claiming that any view of mental illness is any better, or worse, than any other view. In addition, if definitions of mental illness are culturally specific so that there are no universal standards for mental disorders, then no basis for comparison of mental illnesses in different settings exists. Finally, constructionist studies tend to ignore the experiences of persons who receive labels of mental illness and to view such persons as passive victims of the labeling process. However, people often actively seek psychiatric labels and willingly embrace them or, conversely, aggressively reject the labels that professionals attempt to apply to them.
Despite these criticisms social constructionist studies can make a powerful contribution to the understanding of mental illness. Indeed, they might even show that the social and cultural variation that social constructionists stress could be even more influential determinants of definitions, responses, and rates of mental illness than the biological universals that current research emphasizes.
- Bayer, R. (1987) Homosexuality and American Psychiatry: The Politics of Diagnosis. Princeton University Press, Princeton, NJ.
- Figert, A. E. (1996) Women and the Ownership of PMS: The Structuring of a Psychiatric Diagnosis. Aldine de Gruyter, New York.
- Hacking, I. (1999) The Social Construction of What? Harvard University Press, Cambridge, MA.
- Horwitz, A. V. (2002) Creating Mental Illness. University of Chicago Press, Chicago.
- Kirk, S. A. & Kutchins, H. (1992) The Selling of DSM: The Rhetoric of Science in Psychiatry. Aldine de Gruyter, New York.
- Scheff, T. J. (1966) Being Mentally Ill: A Sociological Theory. Aldine, Chicago, IL.
- Scott, W. (1990) PTSD in DSM-III: a case of the politics of diagnosis and disease. Social Problems 37: 294—310.