Negative implications of psychiatric diagnosis

Negative implications of psychiatric diagnosis

To what extent do the negative implications of a psychiatric diagnosis outweigh the benefits?

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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