Abstract Mental health stigma operates in society, is internalized by individuals, and is attributed by health professionals. This ethics-laden issue acts as a barrier to individuals who may seek or engage in treatment services. The dimensions, theory, and epistemology of mental health stigma have several implications for the social work profession. Introduction Inthe World Health Organization WHO reported that an estimated 25 percent of the worldwide population is affected by a mental or behavioral disorder at some time during their lives.
What is Mental Illness? While there is debate over how to define mental illness, it is generally accepted that mental illnesses are real and involve disturbances of thought, experience, and emotion serious enough to cause functional impairment in people, making it more difficult for them to sustain interpersonal relationships and carry on their jobs, and sometimes leading to self-destructive behavior and even suicide.
The most serious mental illnesses, such as schizophrenia, bipolar disorder, major depression, and schizoaffective disorder are often chronic and can cause serious disability. What we now call mental illness was not always treated as a medical problem.
Descriptions of the behaviors now labeled as symptomatic of mental illness or disorder were sometimes framed in quite different terms, such as possession by supernatural forces.
Anthropological work in non-Western cultures suggests that there are many cases of behavior that Mental illness and social theory psychiatry would classify as symptomatic of mental disorder, which are not seen within their own cultures as signs of mental illness Warner,p.
One may even raise the question whether all other cultures even have a concept of mental illness that corresponds even approximately to the Western concept, although, as Kleinman points out, this question is closely tied to that of adequately translating from other languages, and in societies without equivalent medical technology to the west, it will be hard to settle what counts as a concept of disease.
The mainstream view in the West is that the changes in our description and treatment of mental illness are a result of our increasing knowledge and greater conceptual sophistication. On this view, we have conquered our former ignorance and now know that mental illness exists, even though there is a great deal of further research to be done on the causes and treatment of mental illness.
Evidence from anthropological studies makes it clear that some mental illnesses are expressed differently in different cultures and it is also clear that non-Western cultures often have a different way of thinking about mental illness.
For example, some cultures may see trance-like states as a form of possession. This has led some to argue that Western psychiatry also needs to change its approach to mental illness.
Kleinman,Simons and Hughes, However, the anthropological research is not set in the same conceptual terms as philosophy, and so it is unclear to what extent it implies that mental illness is primarily a Western concept. A more extreme view, most closely associated with the psychiatrist Thomas Szasz, is that there is no such thing as mental illness because the very notion is based on a fundamental set of mistakes.
While it is not always easy to delineate the different arguments in Szasz's voluminous work, Reznek, for instance, separates out at least six different arguments within his work [Reznek,Chapter 5]Szasz has compared psychiatry to alchemy or astrologypp. He has also argued that the concept of mental illness is based on a confusion.
Although Szasz's position has not gained widespread credence, his writings have generated debate over questions such as whether disease must, by definition, refer to bodily disease.
More recent critics of psychiatry have been more focused on particular purported mental illnesses. The most heated controversies about the existence of particular mental illnesses are often over ones that seem to involve culturally-specific or moral judgments, such as homosexuality, pedophilia, antisocial personality disorder, and premenstrual dysphoric disorder.
Other controversies exist over disorders that are milder in character and are on the borderline between normality and pathology, such as dysthymia, a low level chronic form of depression Radden, To reiterate, however, the dominant view is that mental illness exists and there is a variety of ways to understand it.
Modern psychiatry has primarily embraced a scientific approach, looking for causes such as traumatic experiences or genetic vulnerabilities, establishing the typical course of different illnesses, gaining an understanding of the changes in the brain and nervous system that underlie the illnesses, and investigating which treatments are effective at alleviating symptoms and ending the illness.
One of the central issues within this scientific framework is how different kinds of theory relate to each other Ghaemi, ; Perring, As alternatives to reductionist approaches there is also the first-person phenomenology and narrative understanding of mental illness.
These focus on the personal experience of living and struggling with mental illness, and give careful descriptions of the associated symptoms. Some see a careful phenomenology as essential to scientific psychiatry e.
The work in this phenomenological tradition is especially important in pressing the question of what it is to understand or explain mental illness, and how a phenomenological approach can relate to scientific approaches.
See for example, Ratcliffe, and Gallagher, 2.
There has been considerable discussion of how to draw a distinction between the two. Given the current debate, the prospects of finding a principled way of drawing the distinction that matches our current practices may be slim.
The main practical reason for trying to draw distinctions between physical and mental illnesses comes from demarcating boundaries between professional competencies, and, in particular, from distinguishing the domain of neurology from that of psychiatry.
However, this boundary is not sharply drawn and has moved over time. It is likely that as neuroscience progresses, the domains of neurology and psychiatry will start to merge.
Most agree that the distinction between mental and physical illness cannot be drawn purely in terms of the causes of the condition, with mental illnesses having psychological causes and physical illnesses having non-psychological causes.
While we have not identified the causes of most mental disorders, it is clear that many non-psychological factors play a role; for example, there is strong evidence that a person's genetic make-up influences his or her chances of developing a mood or psychotic disorder.
Conversely, psychological factors such as stress are reliably associated with increased susceptibility to physical illness, which strongly suggests that those psychological factors are, directly or indirectly, part of the cause of the illness. Nor can we draw any simple distinction between mental and physical illnesses in terms of the conditions' symptoms.
First, it is often unclear whether to categorize symptoms as mental or physical. For example, intuitions are mixed as to whether pain is a physical or mental symptom.
It is also unclear whether we would want to classify insomnia and fatigue as physical or mental symptoms. However we classify fatigue, it is a symptom of illnesses normally characterized as physical such as influenza and those characterized as mental such as depression. Furthermore, distinguishing between physical and mental illness in terms of symptoms may give counterintuitive results.Mental health stigma operates in society, is internalized by individuals, and is attributed by health professionals.
This ethics-laden issue acts as a barrier to individuals who may seek or engage in treatment services.
The dimensions, theory, and epistemology of mental health stigma have several. Therefore the aims of this essay are to firstly examine the problems of the psychiatric approach and how social theory has provided a useful evaluation of how mental illness, rather than existing as real and observable illnesses which psychiatrists must find and treat, could actually be .
As can be seen in the discussions above, the evaluations of psychiatry drawing on social theory perspectives have been quite critical, both in terms of how psychiatry defines and diagnoses mental illness, but also how the institution of psychiatry as a whole functions.
Here the focus is on the macro structures of power and resources, the social construction of what constitutes illness and which individuals are socially sanctioned to declare who is mentally ill. Mental illness, as the eminent historian of psychiatry Michael MacDonald once aptly remarked, “is the most solitary of afflictions to the people who experience it; but it is the most social of maladies to those who observe its effects” (MacDonald 1).
The terms “mental illness” and “mental disorder” normally refer to conditions such as major unipolar depression, schizophrenia, manic depression, and obsessive compulsive disorder.
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