I. Video: "One Flew Over the Cuckoo's Nest"

II. What are the effects of a mental illness label? (continued)

A. Goffman: "The Moral Career of a Mental Patient"

1. Mental patient defined sociologically = person who has been hospitalized

a. Many with symptoms not hospitalized

b. Normality on life on the ward

2. Focus on those who are involuntarily committed (in the 1950s, a majority; in 2000, ?)

3. Prepatient: begins with rights and relationships; ends up, at the beginning of his/her hospital stay, with hardly any of either.

"The moral aspects of this careeer, then, typically begin with the experience of abandonment, disloyalty, and embitterment."

4. Involuntary hospitalization often initiated by next-of-relation (spouse, parent, child), as part of what Goffman terms an "alienative coalition," that includes other kin, as well as medical personnel.

a. Next-of-relation presses him into coming to "talk things over" with a medical practitioner, psychiatrist, or counselor.

b. Arrives to find that he and his next-of-relation are no longer equals.

c. "The moral experience of being third man is such a coalition is likely to embitter the prepatient."

d. "Initial visits may temporarily strengthen his feeling of abandonment; he is likely to beg his visitor to get him out or at least to get him more privileges and to sympathize with the monstrousness of his plight--to which the visitor ordinarily can respond only by trying to maintain a hopeful note, by not 'hearing' the requests, or by assuring the patient that the medical authorities know best."

5. Parallels to other involuntary commitments: e.g. to a nursing home, where mental condition again may be an issue.

B. Link, et. al. "A Modified Labeling Approach to Mental Disorder: An Empirical Assessment" ASR June 1989

"...our approach does not assign to labeling the power to create mental illness directly."

Hospitalization>>>labeling>>>>fears and concerns by the ex-patient>>>>
secrecy/withdrawal>>>reduced social networks, job prospects, self-esteem

Their sample: 429 community residents and 164 psychiatric patients from the Washington Heights section of NYC

the psychiatric patients diagnosed with schizophrenia or major depression

Measures of belief in stigma: scale based on 12 questions

Measures of patient strategies: secrecy, education, withdrawal

Measures of social network

Results as predicted. For example, 75% of community members say employers will discriminate; 80% think it will affect close friendships...

Most of the items involving patient strategies strongly endorsed by patients.

Social networks diminished in those cases where patients endorse coping orientation of withdrawal.

Former patients in the general population had no reduction in social networks, BUT those who had been hospitalized did have such a reduction.

Could it be the behaviors of the mentally ill and not the labels that are the key to their reduced social networks? No, because patients being diagnosed for the first time did not show reduced networks.

Does all of this add up to increased likelihood of additional episodes of mental illness? At this point, we just don't know.

III. Mental Illness and Culture: Anorexia Nervosa--DSMIV

0.5-1% of the population, 90% female... modal age, 17 (some evidence for bi-modal: 14, 18)... of those hospitalized for this condition, about 10% die (suicide, starvation, electrolyte imbalance)

2 key facts from the point of view of discerning whether anorexia is a product of social factors or of biological origin

A. Twin studies support some degree of genetic causality

B. Rare outside "advanced" western societies

1. Jean Kilbourne video, "Slim Hopes" in UMD library

a. Trend with ideal body image

b. What incentive for advertisers to foster "impossible" ideal?

IV. Mental illness and social control

A. Medvedev: "A Question of Madness"

B. Recent examples in Russia and China

C. Anything similar in the U.S.? Charlotte Gilman--"The Yellow Wallpaper"