To what extent do the negative implications of a
psychiatric diagnosis outweigh the benefits?
Subject: Mental Health
The idea that a diagnosis of mental illness can be more
harmful than beneficial is a concept which many might find surprising. However if
we examine the emergence of sociological theories originating from the symbolic
interactionist movement of the 1960s we
can construct an argument based on these theoretical insights as to how a
diagnosis of being mentally ill might be harmful outside of the implications
for possible treatment with which such a diagnosis would bring. In this manner
we consider what the most effective strategy of treatment should be.
Emerging from dissatisfaction with the structural
functionalist’s theories drawing on symbolic interactionists are interested in
analysing how the various interactions between people within social situations
are played out (Rogers and Pilgrim, 2001). In the works of Goffman this is
portrayed as a drama with actors of sorts and his work on stigma for example
showed how the rules of the game varied for people perceived as being different
in some way (Goffman, 1968a, 1968b). Thus in relation to mental health it is
the possible societal reactions arising out of a diagnosis of mental illness
which is the vital element. The theory which developed out of these ideas hence
became known as labelling theory and it became strongly associated with the
anti-psychiatry movement of the late 1960s and 1970s (Cockerham, 1992).
At the heart of this theory are two concepts related to
deviance or mental disorder these being called primary deviance and secondary
deviance. Primary deviance refers to those symptoms which do indeed have a
basis and grounding in clinical symptoms. These are the actual incidences of
disease. Labelling theorists have some interesting things to say about this, in
that namely much of primary deviance goes undiagnosed (Pilgrim and Rogers,
1999). The reasons for this is the reaction of those around the sufferer
attempting to make sense of the individuals behaviour, rationalising it until a
certain point is reached when it is impossible to dismiss the behaviour as
aberrant anymore. Indeed labelling theorists argued that it was not just family
members or other people close to suffers who displayed this sort of behaviour
but also medical practitioners demonstrating a wide range and extensive set of
either mis-diagnosis or non-diagnosis of mental illness (Yarrow et al, 1955).
However it is the realm of secondary deviance in which
labelling theory has the most interesting things to say and it is here this
essay argues that the most harmful aspects of a diagnosis of mental illness can
be found. For labelling theorists secondary deviance refers to ways in which
other members of society, the psychiatric and medical profession and eventually
the person who has been diagnosed act as a result of the category of mentally
ill being applied to them (Pilgrim and Rogers, 2001).
Working from this supposition then a number of factors are
critical for labelling theorists and one of the most important is how
conformist a particular society is. The reason for this is that the higher a
level of conformity is found in a society the greater the chance that a
particular behaviour which breaks the rules of that society will be labelled as
deviant. A particularly interesting feature of this idea built upon
subsequently by social constructivist theories is that concepts of deviancy also
change as the conformity levels of a society alter, thus while homosexuality
was a deviant behaviour for western societies in the 19th century and
psychiatric treatment was recommended for those who were ‘afflicted’ with the
disorder the changing prevalent views on homosexuality have lessened its
perception as a deviant behaviour, though not completely dispelled it
(Cockerham, 1992).
In a series of studies it was demonstrated that otherwise
sane people who mentioned specific circumstances of strange behaviour were
labelled as insane and where those people did normal behaviours these other
behaviours in turn then became labelled as insane and became seen as part of
the behavioural pattern of the insane person. Thus in Rosenham’s (1973) study
his fake patients who gained admission into institutions and who were taking
notes of their own observation and treatment by doctors had in the observations
kept on them notes on how they displayed incessant note taking behaviour. Thus
patients who are labelled as mentally ill face difficulties when they try to
escape the label and the behaviours which are the objects of labelling. Even
where for example patients have been cured they will carry the stigma of such a
label and the consequent reactions of people who learn of the past status of
the individual will labelling theory argues lead to a vicious cycle of
reinforcement of both label and behaviour.
However while labelling theory was a powerful critique of
psychiatric practice which was popular also it has since fallen out of favour
and its concepts can be critiqued on a number of grounds. In Yarrow’s study case it was found that
subsequent to the experiment that his patients in fact did not continue to
display aberrant behaviours for long after the study. Thus we can argue that
there is a weakness in the idea of a secondary deviance, that for those who are
not mentally ill the labelling of being mentally ill which while it might have
an effect may not be as strong as the theory suggests (Rogers and Pilgrim,
1999).
But it remains to be said that the practice of diagnosis and
cure of the mentally ill must be aware of the broader social environments in
which those who are mentally ill will operate in, thus a primarily bio-medical
model of mental health, i.e. in that there is a specific cause which when cured
will make the patient better, is inadequate and as labelling theory and more
recently the field of health psychology suggests we must consider a holistic
type therapy which factors in the effects of wider social phenomenon such as
the reactions of people and clinicians to the patient in order that effective
strategies of cure can be developed which benefit the person involved (Heller,
1996). As such while moves away from institutional care can be commended as
ceasing to separate the mentally ill from society and thus stigmatising them in
a highly visible manner the effectiveness of community care must be judged
against both successful curative techniques and levels of effective integration
with the community setting in which the care is provided.
2)A full stop to child abuse? Analyse and evaluate the
development and impact of recent social policy and legislation Subject: Social
Policy
Child abuse has become a site of major public concern over
the last ten years with a number of major scandals both within the UK and
further afield bringing the issue into the media spotlight and resulting in a
flurry of legislative and statutory activity. However to portray these
developments as novel or new is to ignore the long history of what we may call
moral panics in relation to child abuse (Lawrence and Starkey, 2001). At the
turn of the 20th century there was as is the case now a perceived epidemic of
child abuse which prompted official governmental investigation and led to the
establishment of policy based on their findings. Then as now an alliance of
charities, concerned members of the public and governmental agencies have been
at the vanguard of introducing legislative change (Thane, 1982).
However while the continuities between the past and the
present must be acknowledged we must similarly take account of the differences
in tone and tenor of the debates and contexts which this moral panic is
occurring (Harding, 1997). Perhaps the most important of these differences in
relation to social policy is the discourse of rights which now operates in
relation to child abuse and guides social policy legislation on the issue.
Perhaps the defining document in relation to a new
articulation of children’s rights is the United Nations document Declaration on
the Rights of the Child which has become one of the most widely ratified UN
documents at a national level. This document set out a wide range of rights
which it held was the responsibility of states to uphold through a variety of
measures (Smith, 1998). In the UK while the UN document was ratified it was the
Children’s Act of 1989 which set out the legislative statutes which have
dominated child policy recently. We can best summarise these twin developments
by considering first what outlines have been made concerning the rights of the
child and look then towards might be call the responsibilities of the state and
parents.
Rights of the Child
Children’s rights have been a developing feature of
discourse concerning children since the start of the 20th century yet it is
only recently that a definite articulation of what the rights of the child
should be has emerged. While early commentators such as Locke for example had
in common a view that children were ‘emergent citizens’ passive receptors for
the civic upbringing which would turn them into adults that view has now become
challenged (Archard, 1993:2). While rights in general are nebulous with very
little concrete agreement on most rights outside of the basic ones we can
outline some of the more important ones which have emerged in relation to
children in terms of child abuse (Archard, 1993). As Archard discusses the
right to a best possible upbringing might is argued in this essay be the
strongest critique we can make of child abuse and an effective source of rights
for children in society, (Archard, 1993:152-153).
Yet how does the ascription a right to a best possible
upbringing match with the policy which exists presently. With the Children’s
Act we can see definite legislative action on the incidences of physical harm
to a child. We can also see action on the emotional harms associated with abuse
but it is abuse which forms the central operation of the act (O’Halloran,
1999). Thus it can be argued that policy at present in the UK is a
protectionist one, it attempts to ensure that children are free from harm. Yet
that act does not go beyond this in either trying to prevent harm which might
arise due to a child not being able to exercise social rights (Waterhouse and
McGhee, 1998). While the wording of the
act states that the best possible interests of a child must be taken into
account, this account takes places within a judicial setting related to court
orders which are undertaken to protect children from instances of physical,
mental and emotional abuse, (O’Halloran, 1999).
Thus we can categorise the Children’s act as being
representative of a freedom from rather than a freedom to perspective on what
rights should accrue to children. While this is of course laudable and the Act
represents a significant achievement in terms of child protection and a first
step towards concrete and legally supported rights for children it is still a
minor step. Indeed there have been strong criticisms of the act even on the
grounds where it can be claimed to have the most impact by proceduralising the
care of children rather than take an integrated approach as to how best
children can be protected from harm (Brandon, Schofield and Triner, 1998).
Allied to these concerns is the point made above that while
the act can be argued to succeed at protecting children from abuse it does
little to support and enhance the rights of children. While for example
participation of children in key decisions related to their care is supported
within the act and represent a good development enhancing the quality of life
of children as a means of combating abuse is not a feature or within the remit
of the act. Thus while the family is viewed as the best place for children no
conception of how the enhancements of children’s rights other than a protection
of harm is within the act (Farmer and Owen, 1995).
Thus it can be argued that while to protect children from
harm is a good we must seek to develop and formulate policies which not only
give children the freedom from harm component but also a policy which seeks to
give freedom to children to exercise rights which we ascribe to them in
society. This is a challenging thing to attempt and it is hoped that the
Children’s Act and subsequent policy developments arising out of the
experiences of the act represent first steps along the road of protecting and
enhancing the quality of life of children in society.
References
Archard, D. (1993); Children: Rights and Childhood,
Routledge, London UK
Brandon, M., Schofield, G. and Trinder, L. (1998); Social
Work with Children; Macmillan, London UK
Cockerham, W. C. (1992); Sociology of Mental Disorder; 3rd
Ed., Simon and Schuster Co.; New Jersey US
Farmer, E. and Owen, M. (1995); Child Protection Practice:
Private Risks and Public Remedies; HMSO, London UK
Goffman, E. (1968a); Asylums: Essays on the Social Situation
of Mental Patients and Other Inmates, Penguin, Harmondsworth UK
Goffman, E. (1968b); Stigma, Penguin, Harmondsworth UK
Harding, L. F. (1997); Perspectives in Child Care Policy,
Longman Group, Essex UK
Heller, T. [ed] (1996); Mental Health Matters, Macmillan,
London UK
Lawrence, J. and Starkey P. [eds](2001) Child Welfare and
Social Action in the 19th and 20th Centuries, Liverpool University Press,
Liverpool UK
O’Halloran, K. (1999); The Welfare of the Child: The
Principle and the Law; Ashgate Publishing Co., Aldershot UK
Pilgrim, D. and Rogers, A. (1999); A Sociology of Mental
Illness, 2nd Ed., Open University Press, NY US
Rogers, A. and Pilgrim, D. (2001); Mental Health Policy in
Britain, Palgrave, Basingstoke UK
Rosenham, D.L. (1973); ‘On Being Sane in Insane Places’;
Science, Vol 179 Jan
Smith, R.; (1998); ‘Children’s Rights: How are we doing?’,
Children and Society, Vol. 12 Issue 5
Waterhouse, L. and McGhee, J. (1998); ‘Social Work with
Children and Families’ in Adams, R., Dominelli, L. and Payne, M. [eds]; Social
Work: Themes, Issues and Critical Debates, Macmillan, London UK
Thane, P. (1982); The Foundations of the Welfare State,
Longman, London UK
Waterhouse, L. and McGhee, J. (1998); ‘Social Work with
Children and Families’ in Adams, R., Dominelli, L. and Payne, M. [eds]; Social
Work: Themes, Issues and Critical Debates, Macmillan, London UK
Yarrow, M., Schwartz, C, Murphy, H. and Deasy, L. (1955);
‘The Psychological Meaning of Mental Illness in the Family’, Journal of Social
Issues, Vol 11 No. 12
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