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  • 1. Week 5 – Mental DisordersProfessor John Scott
  • 2. Sad, mad, or bad?• Is it social living or biological factorsthat create mental disorders?• There is no uniform psychiatric view of mentaldisorders with many psychiatrists disputing its causes“Although a great deal of confusion persists throughoutthe psychiatric profession about the identity of mentaldisorders as disease, medical training predisposes mostpsychiatrists to think in these terms and to look formedical diagnoses and treatments” (Goffman cited inClinard and Meier 2008, 457)
  • 3. Constructing mental disorders• Mental disorder replaces mental illness aspreferred term in psychiatric discourses• A person is no longer a schizophrenic –instead, they now show characteristics ofschizophrenia (Clinard and Meier 2008, 458)• Michel Foucault – Madness and Civilizationand The History of Madness
  • 4. Main diagnostic categories of DSM-IV• Disorders first diagnosed in infancy, childhood, or adolescence• Delirium, dementia, amnesic, other cognitive disorders; mental disordersdue to general medical conditions• Substance abuse disorders• Schizophrenic disorders• Mood disorders• Anxiety disorders• Somatoform disorders• Dissociative disorders• Sexual and gender identity disorders• Factitious disorders• Eating disorders• Sleep disorders• Impulse-control disorders• Personality disorders• Adjustment and other disorders {Source: Humphrey 2006,151}
  • 5. Organic v functional causes“Organic disorders trace their origins to identifiableorganic or physiological problems”• ie, “senile psychoses, paresis, and alcoholicpsychoses”Functional disorders have their causes in socialenvironments with the individual’s ability to adjustor adapt to this as the cause of the disorder• ie, compulsive disorders, phobias, manic-depressive behaviour, and schizophrenia(Clinard and Meier 2008, 459-460)
  • 6. • Senile psychosis -hardening of arteries and poor circulation affects brainfunction, eg, Alzheimer’s• Paresis - caused by untreated syphilis and degeneration of brain function• Chronic alcoholism - deficiencies in nutrients and vitamins cause physical andpsychological deteriorations• Compulsive behaviours - “repeated actions over which people think theyhave little or no control”• Manic-depressive behaviour or bipolar disorder - extreme mood swingsabruptly moving from euphoria or elation to extensive brooding and deepdepression• Paranoid behaviour - extreme suspicion of other people and their motives• Schizophrenia - the most commonly diagnosed disorder, affects young peoplethe most– No single behaviour associated with schizophrenia, a range of behavioursfor schizophrenic activity - emotional detachment and withdrawal,inability to perform expected roles, escape into an illusionary world,imagined voices, and urges that disrupt daily living(Source: Clinard and Meier 2008, 459-460)
  • 7. Problems of definition“While most definitions cite deviations from ‘normal’behavior, they simply raise more questions aboutstandards of normality” (Clinard and Meier 2008, 462)Statistical approaches measure degree to whichindividuals deviate from normality - “statisticalconceptions of mental illness can indicate only what mostpeople do, not what they ought to do” (Clinard and Meier2008, 462).Clinical definitions rely on judgment of practitioners - amental disorder is what a psychiatric practitioner says it is“the ability to maintain an even temper, an alertintelligence, socially considerate behaviour, and a happydisposition” represents “a healthy mind” (Menninger1946, 1 cited in Clinard and Meier 2008, 463)
  • 8. Cultural constructions of normalityDefinitions of disorder lack validity and reliabilityNorms for normality vary across societies and cultures“The dividing line between the two realms [ofnormality and disorder] varies … The function of thepsychiatrist is to search for the ‘causes’, to report onthe ‘whys’ of the illness, but society decides who thepatients will be” (Bastide 1972, 60 cited in Clinard andMeier 2008, 464).
  • 9. Syndrome Culture SymptomsAmok Malaysia, Laos,Papua New Guinea,Puerto Rico,NavajosBrooding, followed by violent behavior, persecutory ideas,amnesia, exhaustion. More often seen in men thanwomen.Ataque denerviosLatin America Uncontrollable shouting, crying, trembling, heat in thechest rising to the head, verbal or physical aggression,seizures, fainting.GhostsicknessNative Americans Nightmares, weakness, feelings of danger, loss of appetite,fainting, dizziness, hallucinations, loss of consciousness,sense of suffocation.Koro Malaysia, China,ThailandSudden and intense anxiety that the penis … or the vulvaand nipples … will recede into body and cause death.Latah East Asia Hypersensitivity to sudden fright, trancelike behavior mostoften seen in middle-aged women.Susto Mexico, CentralAmericaAppetite disturbances, sleep disturbances, sadness, loss ofmotivation, low self-worth, following a frightening event.Sufferers believe their soul has left their body.TaijinkyofushoJapan Intense fear that one’s body displeases, embarrasses, or isoffensive to others.{Source: Humphrey 2006,148}
  • 10. Sociological perspectives“groups establish norms that designate certainbehaviors as examples of deviance”“the normative violations of mental disorder oftenprove difficult to specify ahead of time” (Clinard andMeier 2008, 464)“normative violations qualify as mental disorderswhen they occur outside socially acceptablecontexts” (Clinard and Meier 2008, 465)we accept people whose behaviour conforms to ourideals of appropriate behaviour as normal and thosethat don’t as abnormal or disordered
  • 11. Varying perspectives• Social science - look at society and constructions of normality• Biological and genetic - look at individuals for inherent causes• Psychological - mental disorders are explained by personality types• Behavioural - mental disorders are defined through a rejection of anindividual’s behaviour by others around that person identifying thebehaviour as deviant• Social roles conflict - people develop mental disorders when they feelconflicted within their social roles - unable to shift between roles oradapt to new roles• mental disorders are learnt behaviours:“Many societies … develop shared conceptions of the criteria for insanity …Popular conceptions of mental disorders (behaviour labeled crazy) spreadthrough everyday conversations and mass media content, including advertising.All adults probably know how to ‘act crazy’. Just as any actor may becometypecast, someone may come routinely to play the mentally disturbed role inresponse to expectations imposed by and role taking of others” (Clinard andMeier 208, 476)
  • 12. Society’s role in development ofmental disorders• Socio-economic stratification – low socio-economicareas = higher rates of mental disorders in population• Gender – differences between genders and types ofmental disorders• Age – more prevalent in younger age groups, declineswith age• Ethnicity – intersects with socio-economic and culturalfactors and marginalisation• Marital status – divorced, separated, never-marriedrates 2-3 times higher than married people
  • 13. Stress and mental disordersSTRESS (due tolow SES, poverty,unemployment)Mental illnessMental illnessSTRESS (due todownward socialmobility)STRESS Mental illnessSocialcausationSocialselectionCombinedperspectives{Source: Humphrey 2006,159}
  • 14. StressEvent Life change scoreMarried 500Widowed 771Divorced 593Separated 516Pregnancy 284Birth of child 337Illness or injury 416Death of loved one or other important person 469Started school or job 191Graduated from school or training 191Retired from work 361Changed residence 140Took a vacation 74{Source: Clinard and Meier 2008, 469}.
  • 15. Complex intersections• 85% homeless people have mental disorders• 75% people with drug/alcohol problems alsohave mental disorders• Unemployment rates higher for people withmental disorders (4% v 2.7% / 8% for females v3% for males)• Strong links between mental disorders and:– Suicide– Crime– Child abuse
  • 16. {Source: Lubica Forsythe and Antonette Gaffney. 2012. “Mental disorder prevalence at the gateway to the criminal justicesystem”, Trends and Issues in crime and criminal justice, Australian Institute of Criminology}.Intersections between gender, crime and mental disorders
  • 17. Experience of child abuse bymental illness and gender (%)MentalillnessNo mentalillnessMalesNo abuse 48 72Abuse 52 28FemalesNo abuse 39 56Abuse 61 44{Source: Forsythe, Lubica and Kerryn Adams. 2009. “Mental health, abuse, drug use and crime:does gender matter?”, Trends and Issues in crime and criminal justice, Australian Institute ofCriminology, No. 384}.Intersectionsbetweenchildhoodsexual abuse,drug use, crimeand mentaldisorders
  • 18. Stigma• General belief that people cause their ownmental health disorders (victim blaming,individual deficit)• System of care separate from health systemmarks mental disorders as different fromgeneral health issues• People with mental disordersunstable and dangerous – risk thinking
  • 19. Addressing the problem• Medicalisation – invention of psychotropic drugsled to wide spread use of medicine to managemental disorders• Confinement – short term in psychiatric carefacilities – long term in forensic units fordangerous individuals• Deinstitutionalisation movement – strategy ofmoving care of mentally disordered persons intothe general community, institutions ofconfinement retained primarily for dangerousindividuals only
  • 20. Australian Statistics• Half total population will experience mental health disorderduring lifetime• 20% population aged 16-85 yrs experienced mental disorder inlast 12 months• 6.2% - affective mood disorders (depression)• 14.4% - anxiety disorders• 5.1% - substance use disorders• 14.2% of health burden or 374,541 years of healthy life lost• Mental disorders decrease with age: 1 in 4 people aged 16-24yrs have mental disorders reduces to 1 in 20 for 75-85 yrs agebracket(Source: Mental Health Council of Australia)
  • 21. If you, or someone you know isstruggling with mental health issues,UNE offers counselling andchaplaincy services for its studentsUNE counselling services ph 02 67732897 chaplaincy services
  • 22. Other support organisations:Beyond Blue 1300 22 4636Suicide Call Back Service 1300 65 94 67Lifeline 13 11 14Sane 1800 18 7263Headspace 1800 650 890
  • 23. ReferencesAustralian Bureau of Statistics. 1301.0 – Year Book Australia, 2009-10., Robert E. 2008. “Penis Panics”, in Deviance across cultures, edited by RobertHeiner, 79-85, Oxford, Oxford University Press.Forsythe, Lubica and Antonette Gaffney. 2012. “Mental disorder prevalence at the gateway tothe criminal justice system”, Trends and Issues in crime and criminal justice, AustralianInstitute of Criminology, No. 438.Forsythe, Lubica and Kerryn Adams. 2009. “Mental health, abuse, drug use and crime: doesgender matter?” Trends and Issues in crime and criminal justice, Australian Institute ofCriminology, No. 384.Humphrey, John A. 2006. “Mental illness”. In Deviant behavior, 144-165, New Jersey, PearsonPrentice Hall.Mental Health Council of Australia. 2007. Fact Sheet: statistics on mental, Frank, Vera Morgan, Joe Clare, Giulietta Valuri, Richard Woodman, Anna Ferrante,David Castle and Assen Jablensky. 2008. “Schizophrenia and offending: area of residence andthe impact of social disorganisation and urbanicity”, Trends and Issues in crime and criminaljustice, Australian Institute of Criminology, No. 365.Rosenhan, David L. 2008. “On being sane in insane places”, in Deviance across cultures, editedby Robert Heiner, 235-242, Oxford, Oxford University Press.
  • 24. Additional resourcesAustralian Government. Fact Sheet: mental health,wellbeing and suicide prevention initiativessupporting children and young people.Forsythe, Lubica. 2013. Measuring mental healthin crimological research: lessons from the Drug UseMonitoring in Australia program, AustralianGovernment, Australian Institute of Criminology.Kinsey, Brian. 2012. “Mental Disorders”. InSubstance abuse, addiction, and treatment.Tarrytown, Marshall Cavendish.Mental Health Council of Australia. Fact Sheet:statistics on mental health.