This document discusses sociological approaches to understanding mental health and illness. It covers several key topics: 1) It examines lay understandings of health and illness and how sociologists make sense of how people experience illness using approaches like illness trajectories and biographical disruption. 2) It explores how mental illness is a significant social issue in Australia, affecting nearly half the population at some point. 3) It analyzes sociological perspectives on mental illness including labeling theory, which views it as a social process rather than individual pathology, and stigma theory, which examines how deviation from norms leads to a spoiled identity.

1. SOC108 – TOPIC 9
The Illness Experience and
Sociology of Mental Health

2. Learning and teaching objectives
• Recognise the significance of lay understandings
of health and illness.
• Identify the different ways in which sociologists
make sense of how people experience illness.
• Explain why mental illness is a serious social issue
in Australian society, and how it is socially
distributed.
• Understand how mental health policy and
treatment has changed historically, and the
consequences for those defined as ‘mentally ill’.
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3. Why Focus on Lay
Experiences of Illness?
• Illness not only has biophysical manifestations. It
impacts on a sufferers’ daily living, their relationships
and their identity/sense of self.
• Responses to illness and coping strategies are shaped
by a persons’ social, cultural and biographical context.
• Lay understandings of health risks influence how health
promotion messages are received and acted upon (or
resisted/ignored).
 “...illness is at once both a very personal and a very
public phenomenon” (Nettleton, 2006, p. 72).
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4. Sociological Approaches:
Illness Trajectory and Biographical Disruption
• These ‘interpretive’ approaches are interested in
the ways in which people make sense of, manage,
and adjust to serious illnesses that may not
receive legitimacy of access to the sick role.
• Illness trajectory – focuses on the biographical
work by patients to adjust to changes in their
health status.
• Biographical disruption – focuses on the ways in
which chronic illness disrupts a persons’ self-
identity and dislocates existing social
relationships and arrangements.
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5. Sociological Approaches:
Narrative Reconstruction
• The ways in which people make sense of, adjust to, and
incorporate their illness into their identity, frequently
takes a narrative form.
• For example, Arthur Frank identifies three types of
illness narratives:
– Restitution: a ‘master narrative’ – a person is ill, finds out
what is wrong and seeks to return to a state of health
through medication.
– Quest: a narrative in which the illness becomes a ‘journey’
that is used to gain greater self-awareness or give advice to
others.
– Chaos: an ‘anti-narrative’ – emphasises despair,
contingency, loss of control and the futility of medication.
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6. Mental Health in Australia
• Mental illness is one of the most serious health
problems in Australia today.
• According to the National Survey of Mental Health and
Wellbeing (ABS, 2007):
– 45% of the population have had a mental disorder at some
point in their life.
– Among all age groups, anxiety disorders have the highest
prevalence with the highest rate in the 35-44 year age
group (18%).
– Approximately 5.1% of the population have a substance
use disorder.
– Mental illness is strongly associated with suicidal thoughts
and behaviour.
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7. Mental Illness as a Biomedical and
Sociological Problem
• Mental illness from a biomedical perspective is a
clinically diagnosable disorder (using the DSM-IV
classification guide) that has its basis in a person’s
biological make-up.
• While this model acknowledges the role of social
factors (such as stress) in contributing to mental illness,
there tends to be an over-reliance on diagnosable
symptoms.
• In contrast, sociologists focus on: (a) the influence of
the social environment in the distribution of mental
illness, and (b) the different ways in which mental
illness is socially constructed and experienced.
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8. Sociological Approaches:
Labelling Theory
• Focuses on mental illness as a social process rather than an
individualised pathological condition.
• Interested in mental illness as a type of residual deviance
which does not break laws, but violates established social
norms.
• Deviance refers not to the quality of an act a person
commits but is a consequence of the application by others
of rules and sanctions – i.e. labelling ‘creates’ and amplifies
deviance.
• Having a deviant (in this case mentally ill) label applied
results in a change in self-identity. A person may ‘take on’
the status of being mentally ill since it affords them
reassurance, rewards and the hope of resolution.
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9. Sociological Approaches:
Shame and Stigma
• Based on the work of Erving Goffman, stigma is a social
process where deviation from established social norms
leads to the imposition of a ‘spoiled’ or tainted identity.
• The likelihood of stigmatisation varies according to: (a)
the visibility of the condition; (b) the extent to which
others are aware of the condition; and (c) the extent to
which the condition impedes the flow of interaction.
• While stigma is often imposed by the reactions of
others (enacted stigma), self-stigmatisation (felt
stigma) can also occur where people feel shame as a
result of fear of enacted stigma.
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10. Sociological Approaches:
Post-structuralism
• Interested in the changing ways in which ‘mental
illness’ is categorised and governed historically, and the
consequences for those defined as ‘mentally ill’.
• From this perspective, the growing diagnosis of mental
illness is associated with the rise of psychiatry as a
form of power/knowledge.
• Psychiatry, and biomedicine more broadly, is crucial in
the medicalisation of conditions as mental ‘disorders’,
and in exercising surveillance over the mentally ill
through therapy and pharmaceuticals.
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