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Social constructivist perspective for understanding schizophrenia, mental health and illness

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Spring, 2013
Contents:
1 INTRODUCTION 3

2 Social constructivist perspective of schizophrenia 4

3 CONCLUSION 7

REFERENCES 8

INTRODUCTION

In this paper we analyze the concept according to which mental illness is as much a socially constructed disease as it is a physiological one and especially the example of schizophrenia, one of the oldest, most documented, and least understood of all the behaviors that fall under society’s category of mental illness. One of the most influential theoretical positions evident in the sociology of health and illness over the past 30 years has been social constructivism. A central assumption within this broad approach is that reality is not self-evident, stable and waiting to be discovered, but instead it is a product of human activity. In this broad sense all versions of social constructivism can be identified as a reaction against positivism and naive realism. There are multiple intellectual roots of a social constructionist approach to illness. Some of the basic building blocks are evident in the writings of early sociological thinkers (Durkheim, Mannheim, Thomas), but one of the most important intellectual foundations of the social construction of illness is social problems theory and research from the 1960s and 1970s. Distancing themselves from positivist interpretations, scholars in this tradition asserted that what comes to be identified as deviant behavior or a social problem is not given, but rather is conferred within a particular social context and in response to successful “claims-making” and “moral entrepreneurialism” by social groups (Becker 1963).

Society’s conception of mental illness, and the mentally ill, greatly influences the success of the treatments provided to them - particularly those provided within the community. Mental health services need to be constructed in a manner which recognizes the influence of society on consumer recovery and their sustained mental stability. This, at times, proves difficult due to the problems of marrying a clinical approach to treatment, with the social aspects and nature of schizophrenia. Schizophrenics are not individual units, but exist within a complex social structure, requiring that they function adequately in this environment. Acknowledging this and putting appropriate measures in place, thereby protects them against undue discrimination and social oppression.

Social constructivist perspective of schizophrenia

Social constructionism may be defined as a perspective which believes that a great deal of human life exists as it does due to social and interpersonal influences (Gergen 1985). Although genetically inherited factors and social factors are at work at the same time, social constructionism does not deny the influence of genetic inheritance, but decides to concentrate on investigating the social influences on communal and individual life. The subjects that social constructionism is interested in are those to do with what anthropologists call culture, and sociologists call society: the shared social aspects of all that is psychological. There are several versions of social constructionism with different writers making different emphases. Brown (1995) suggests three main currents within social constructivism:

• The first approach is not concerned with demonstrating the reality or otherwise of a social phenomenon but with the social forces which define it. The approach is mainly traceable to sociological work on social problems (Spector and Kitsuse 1977). To investigate a social problem, such as drug misuse or mental illness, is to select a particular aspect of reality and thus, implicitly, concede the factual status of reality in general (Woolgar and Pawluch 1985). In particular, the lived experience of social actors, those inside deviant communities or those working with and labeling them, are the focus of sociological investigation. The social problems emphasis, which gave rise to this version of social constructivism, has been associated, like societal reaction theory, with methodologies linked to symbolic interactionism and ethnomethodology;

• The second approach is tied more closely to the post-structuralism of Foucault and is concerned with deconstruction – the critical examination of language and symbols in order to illuminate the creation of knowledge, its relationship to power and the unstable varieties of reality which attend human activity (‘discursive practices’). Foucault’s early work on madness, however, was not about such discursive concerns (Foucault 1965). The latter have been the focus of interest of later post-structuralists;

• The third approach is associated neither with the micro-sociology of social problem definition nor with deconstruction but with understanding the production of scientific knowledge and the pursuit of individual and collective professional interests (Latour 1987). This science-in-action version of sociology is concerned with the illumination of interest work. This version of social constructivism examines the ways in which scientists and other interested parties develop debate and use facts. It is thus interested in the networks of people involved in these activities. Unlike the post-structuralist version of social constructivism noted earlier, it places less emphasis upon ideas and more upon action and negotiation. This approach is thus compatible with both symbolic interactionism and social realism.

The basic tenets of this framework have been readily applied to illness. Specifically, medical sociologists point to the contingent processes by which certain behaviors and experiences come to be defined as medical conditions, and the way those definitions can function as a type of social control. Symbolic interactionism and phenomenology — two popular and overlapping intellectual trends in sociology in the 1960s — also significantly contributed to a social constructionist approach to illness. The key tenets of symbolic interactionism effectively lent themselves to a detailed exploration of illness as experienced within the context of daily social interactions, which in turn alter the performance of self. In a related fashion, phenomenological tenets were appropriated by medical sociologists to showcase how individuals make sense of their illness, how they cope with physical and social restrictions, and how they deflect self-erosion in the face of those restrictions. The writings of Michel Foucault and work in the Foucauldian tradition, albeit in a different vein, also emphasized the scrutiny of medical knowledge, and, in so doing, contributed significantly to a social construction of illness approach. Foucault regarded knowledge as a form of power. Specifically, he argued that expert knowledge about human “normality” and “abnormality,” which is not objective or naturally given is the principal form of power in modern societies: hence, his oft quoted expression, “knowledge/power.” Foucault stressed how medical discourse constructs knowledge about the body, including disease.

A social constructionist view of the processes of psychological, physical and relational healing is to concentrate on the meanings that stereotypical roles, behaviors phrases and gestures may have. Neurotic reactions are seen as being inappropriate to the situations in which they occur. The nature of neurosis is such that the irrational can be used as a guide for action, thought and feeling. Neurosis can also be classified as inauthentic as it is not about being true to one's self or others. The alienated, disowned and misunderstood nature of one's own preferences and motivations, which can be a part of neurotic experience, needs to be reconsidered by clients in re-evaluating themselves in the sessions. Neurosis and positive mental health stand in relation to each other, in relation to the local culture and its social, moral and semantic orders. Positive and negative also stand in relation to deciding not to change, or wishing to change through meeting with a therapist. As the immediate local culture, the people who we currently know face-to-face, and who we have known, are believed to be the main influences in this approach, then all matters, words and social practices are grounded by these inter-subjective experiences. Psychotherapy has several aims and performs various healing functions. Neurosis can also be viewed in many ways. Conventionally it is seen as a lack of flexibility in terms of action in the world, rigid habitual choices and the lack of new interpretations of the nature of self and others. Along these lines, therapy is therefore about helping clients see more than their current view, and so enables them to make freedoms for themselves which are harmonious with their home situations.

The term ‘mental illness’ covers a spectrum of different conditions, ranging from psychosis to addiction and less severe conditions such as neurosis. The effects of schizophrenia often affect the autonomy of its sufferers, but an important factor in respecting an individual’s autonomy involves the right to make informed choices about one’s own medical treatment. When looking at the concept of mental illness, one finds various arguments about whether illnesses classed as mental are in fact physical illnesses. How we can distinguish between a physical illness and a mental illness is a matter of some debate. However, the fact that individuals lose their ability to form intentions and utilize their judgment shows that schizophrenia, as an illness, definitely has a strong ‘mental’ component (Scruton 1981). An important part of behaving autonomously centers upon the ability to make decisions from the true perspective of oneself. If schizophrenia forces patients to continually adapt and change their values and ideals, it must have a vast influence on their ability to make decisions which truly reflect their beliefs. This is of concern not only in the short-term, such as when giving informed consent to medical treatment, but also in long term planning and life direction.

Social constructivism is a theory which claims that knowledge is not something we acquire but something we produce; that the objects in an area of inquiry are not there to be discovered, but are invented or constructed. Therefore social constructivists may claim that there is nothing wrong with the mentally ill, and “that madness is nothing more (and nothing less) than what we make of it” (Church 2007: 394). Although the social constructivist position certainly has relevance for the less-serious mental impairments such as forms of neurosis, the reality of conditions such as schizophrenia cannot be ignored and so society must have mechanisms in place to deal adequately with this illness and those suffering from it. In the labeling of individuals as schizophrenic, we are describing their condition and their particular forms of behavior. The concept of what mental illness is lies at the core of psychiatry. Questioning it permits us to view critically the place of mental illness in society, the role that psychiatrist’s play and the validity of the current treatments utilized. It also permits us to query the current procedures in place to deal with the issue of informed consent.

CONCLUSION

The anti-psychiatric movement’s claim that schizophrenia is merely a socially constructed concept, arguing that schizophrenia is not a “palpable falsehood propagated amongst the populace by power-mad psychiatrists, but a cruel and bitter reality” (Moore 1978: 234). The diagnosis of individuals as schizophrenic often occurs because it is considered that they are failing to act rationally. Therefore, anti-psychiatrists need to prove that schizophrenics are genuinely capable of being as rational as everyone else, if they are to dispute the current mechanisms in place to treat such individuals. In response to this, Szasz (1991) argues that the behavior of schizophrenics, if assessed, can be described as rational. For a schizophrenic to be considered as rational as the rest of society, they must be promoting desires we can relate to, and holding beliefs we consider rational. It can be argued that there is insufficient proof that the illness schizophrenia does not cause irrational behavior, which provides support for the utilization of coercive measures when individual’s rationality has been affected by their illness. This includes the processes involved with obtaining a valid informed consent from those with schizophrenia.

REFERENCES

1. Becker, H. (1963). Outsiders: Studies in the Sociology of Deviance. New York: Free Press.

2. Brown, P. (1995). Naming and framing: the social construction of diagnosis and illness. J Health Soc Behav., Spec No: 34-52.

3. Church, J. (2007). Social Constructionist Models: Making Order out of Disorder – On the Social Construction of Madness. In: J. Radden (ed). The Philosophy of Psychiatry: A Companion. New York: Oxford University Press.

4. Foucault, M. (1965). Madness and civilization: A history of insanity in the age of reason. New York: Pantheon Books.

5. Gergen, K.J. (1985). The social constructionist movement in modern psychology. American Psychologist, 40(3), 266-275.

6. Latour, B. (1987). Science in Action: How to Follow Scientists and Engineers through Society. Milton Keynes: Open University Press.

7. Moore, M.S. (1978). Some Myths about Mental Illness. Inquiry, vol. 18.

8. Scruton, R. (1981). ‘Mental Illness’. Journal of Medical Ethics, vol.7.

9. Spector, M., Kitsuse, J. I. (1977). Constructing Social Problems. Menlo Park: Cummings.

10. Szasz, T.S. (1991). The Myth of Mental Illness. In: T.A.Mappes and J.S.Zembaty (eds). Biomedical Ethics. New York: McGraw-Hill.

11. Woolgar, S., Pawluch, D. (1985). How shall we move beyond constructionism? Social Problems, 33:159-62.
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