Foucalt’s historical analysis of madness in ‘Madness and Civilization’, is overtly concerned with the practical expression of society’s wish to marginalise and exclude the mentally ill. Foucault eloquently argues that the creation of deviant labels such as ‘mentally ill’/ ‘insane’ can only be understood by comparing it with their opposing counterparts. In other words, both concepts ‘sanity’ and ‘insanity’ are interdependent, as it is impossible for madness to exist as a deviant label without thee also being something society understands as ‘normality’. Fundamentally, both categories are born in history at the same time, despite the fact that similar modes of alleged ‘insane’ behaviour existed long before the creation of such controlling categories, and was mire tolerated on an everyday basis. Subsequently, for Foucault the birth of madness is linked to the creation of asylums, aimed at the exclusion of these deviants from ‘normal’ society. Thus the birth of the clinic asylum gives rise to the birth of insanity, as deviance can only exist in the eyes of society once it has been labelled.
Both Goffman and Foucault demonstrate the rake of society as an integral part in the creation of mental illness as it is understood today in wider society, and emphasise in particular the manner in which such asylums contribute to the ‘mortification of self’- in which the outside self is stripped away and replace by an institutional self, which conforms to the modes of wider social representations of mental illness. Consequently, the inpatient is no longer able to participate in everyday ‘routine’ activities, and through accepting the ‘mentally ill’ role demonstrates a willingness to be ‘treated’ and ‘cured’. In a subversive manner, the implications if such theories suggest that mental illness is the application of a kind of residual category of secondary deviance. In other words, psychiatrists act as moral policing agents, who label ‘norm-breaking’ behaviour, which is deemed unexplainable, as ‘madness’, as if to diffuse the threat posed by others, whose reality challenges our own. Respectively, Scehff employs the ‘mental illness’ schizophrenia as a means of demonstrating the unreliability of psychiatric diagnosis. There is little agreement on whether a disease entity of schizophrenia even exists, what constitutes schizophrenia’s basic signs and symptoms if it does exist and how these signs symptoms are to be reliably and positively identified. As a result of the overwhelming uncertainties and ambiguities inherent in its definition schizophrenia can be deemed an appellation or ‘label’ which may easily be applied to those residual rule breakers, whose deviant behaviour is difficult to classify. Therefore not only is ‘mental illness’ as social construct it is also a powerful agency of social control. This argument heightened by Trowler who illustrates some of the trend in the social distribution of madness. Firstly, male Afro-Caribbean’s appear to be over-represented in those defined as mentally ill, as are the working classes. Finally, more women than men are likely to die from mental disorders, however this may be a result of their greater life dependency and likelihood to suffer degenerative diseases associated with age.
Another study that challenges the predominantly assumed notion of madness is that of the anthropologist Jane Murphy. In her study of the Bering Sen Eskimo and the Yoruba of Nigeria she addresses issues of cultural relativism, which were previously implicated by Foucault. In developing her approach, Murphy exhibits the impact of stigmatizing or labelling upon the likelihood of ‘abnormal’ behaviour, escalating into chronic ‘mental illness’. Her study revealed that almost all of the symptoms that psychiatrists would see as indicative of schizophrenia were primarily regarded s signs of madness in both cultures. But two important cultural differences were emphasised. Firstly, the responses to such episodes were fewer alarmists than might be the case in the UK for example, and this had the effect of lessening the severity of the illness of the individual. Secondly, certain symptoms of schizophrenia, such as disassociation, if controlled at will and integral to religious activities, were not seen as abnormal but actually of value to the society. This illustrates the discrepancies encountered when applying culturally specific concepts of mental illness universally, as well as highlighting the need for physiatrists to adopt alternative culturally sensitive approaches to healthcare.
The critique of the role of psychiatry outlined above is predominantly centred on the policy of confinement used in dealing with those who are considered to be mentally ill. Goffma, Foucalt and Scheff all appear to be expressing the challenge that society faces in deconstructing the barriers erected by social representations of the mentally ill. All three theorists make many valid points, particularly with respect to the way in which madness is a culturally, socially and historical concept, however their contributions must be interpreted in the appropriate context. It has been suggested that the clinical asylum/ institutionalisation is the birthplace of insanity as we understand it today, however it seems that this argument is far too simplistic and at times fatalistic, in that there are no distinctions made between types of madness, the active role of the ‘patient’ is not really considered and neither is there an appreciation of the possibilities in variation in psychiatric treatment which can offered. As a result this theory falls into the same trap of the stereotyped social representation of mental illness. This highlights an important consideration for the entirety of the essay, in that all researchers carry with them into their own work social representations of madness. Furthermore, all theorists appear to present a kind of causal relationship between merely ‘odd’ behaviour which may transgress beyond social norms, and the illegitimate labelling and subsequent treatment offered by psychiatrists at the expense of truly assessing some of the undeniable achievements psychiatrists have accomplished. Indeed there have been many disease in the past, like epilepsy, where it was unknown what caused them, however by arguing that all mental illnesses are social constructs, one is limiting the explanatory confines behind such behaviour. Moreover, there is considerable evidence, which suggests that organic diseases can affect cognition and mental diseases can affect bodily functioning. Furthermore, it seems that the premise of the critique readily condemns the role of psychiatrists in treating ‘odd’ behaviour without in certain circumstances the permission of the ‘labelled’ patient, and as a result infringing upon one’s civil liberty. However if psychiatry were only to operate entirely voluntary places, this would give birth to a number of ethical considerations. For instance, in sensitive matters whereby the ‘patient’s sense of reality may be impaired, is it justifiable to intervene at the gain of saving one’s life? Social constructionists may argue that there is no real identifiable ‘mental illness’ however if the patient is somehow driven to drastic measures, surely one must recognize that there is a problem, which needs to be addressed. Indeed, there is no greater abuse than when a society allows its vulnerable citizens to injure or destroy themselves, or to wound or murder innocent people. Perhaps the most recent criticism has derived from they very arguments imitated by Foucault. In recent years, there appears to be a highly significant decline in the use of asylums and as a result, new forms of care have arisen-which evokes one to question ‘how valid Foucault and Goffman’s argument’s remain?’ The latter part of this essay will discuss rthe developments in psychiatry and its role in the construction of mental illness, with respect to the cortical allegations placed against them.
The latter part of this essay will discuss the role of psyciatry in the constructing of mental illness, alongside contemporary developments in psychiatric treatments of the mentally ill, with respect to the critical allegations placed against them. Morant studied the social representations among mental health parishioners in the UK and France. She argues that it is extremely import5ant to look at this perspective since: ‘Mental health practioners…as society’s experts have the power to define who is mentally unwell and how they should be treated.’
It is assumed that such professionals will conceptualise mental health in a complex but clearly articulate manner, a and that, given that knowledge and practice is based within society, their representations will broadly resemble those of wider public. It is observed that practitioners do indeed see mental illness as a complex category, comprising various forms of problems, but they also have the same difficulty in expressing views about the nature of ill health as lay people do. This difficulty is the expression of non-verbal belief systems held in wider society, and mental health professionals conceptualise mental illness on three dimensions of difference, distress and disruption. The concept of difference is common outside the professional representations, that’s ensue of the other is a central theme in the literature on social representations of illness. They, like wider society perceive a discrepancy between their own experiences and those of their patients. However, the understanding of difference between practitioner’s perceptions is more complex and can be divided into psychosis and neurosis. Neurotic patients are seen as experiencing more ‘curable’ problem, they are essentially grounded in reality and their difficulties are temporary, in this sense there is more room for similarity with social norms and understanding and how they deviate from these. For the practioner there remains a form of mental illness, psychosis that remains outside the understanding and familiarity, although they can relate to neurotic patients, who are not categorised entirely as the other. This distinction is not entirely unproblematic, as the terms do not have a common definition across all field of practice.
The second main theme from, her study is that of disruption. This refers to they way in which mental illness interferes with the sufferer’s ability to cope with everyday life. This affects the relationships and functioning within socially accepted bounds of behaviour. However, some would argue that reduced social functioning is merely a reaction or coping strategy employed when faced with high levels of stress, and is therefore ‘normal’ in particular social contexts.
Thirdly the theme of distress is important to mental health practioners definitions of mental illness. This encompasses a sense of fear, loss of control, hopelessness and depression. Often these emotions are linked to societal reactions to mental illness and their stigmatizing shameful effects. The recognition of distress in people who are mentally ill shows how of practioners the patient is not simply an incomprehensible ‘other’, as it provides a link to one’s own experience. This also contrasts with the wider societal representations by seeing mentally ill as ‘distressed’ rather than ‘distressing’. This lay representation stems from a fear of the mentally ill, which despite regular exposure to the risks of violence and suicide, professionals do not hold. So, in general, the representation held by mental health practioners of the mentally ill are less rejecting than commonly held beliefs.
Subsequently, the increased practice of care in the community can now be regarded, in part, a reaction to some of the criticisms that have been levelled at mental healthcare in the past and also because it raises some new important questions for society as a whole. In recent decades the adoption of such a policy across Europe and North America has seen the closure of large institutions. Estimates show that in the UK, between 1980 and 1990, the number of psychiatric hospital beds has fallen from 88,000 to 55,000, and in the same period, from 107,965 to 60,000 in West Germany, and from 54,000 to 25,000 in Italy. [Ramon, 1996] Out-patient based treatment located in the community has replaced institutional care in the majority of mental health problems, and the range of treatment has increased with an emphasis on care being provided by the patient’s social network. This raises the question of a societal re-evaluation of its response to the mentally ill, since the previously hidden, institutionalised mental patient is now an integrated part of society. This is the challenge facing society today in regards to mental illness. Although in principle ‘care in the community’ appears to be a humane and pragmatic solution to the problem of asylums, in reality however it seems that such individuals have not assimilated into society, as well as psychiatrists may have initially hoped. In fact in the UK ex-mental patients are twice as likely to be homeless than the general population, often because their families find it difficult to cope with ‘irregular’ outbursts o behaviour. Finally, the closing of mental hospitals in Italy led to a simultaneous increase in the number of people imprisoned. This raises the issue of whether people who are labelled as mentally ill, truly are experiencing greater liberty outside the asylum.
Busfield argues that an important consequence of de-institutionalisation of clinical madness, did not simply lead to a switch to community healthcare, but also shifted the focus of psychiatric enquiry from being concerned exclusively with the ‘insane’, to ‘mental health’ in general. In an ironic sense, Foucalt’s arguments about the interdependence of concepts such as ‘sanity’ and ‘insanity’, have been emphasised by psychiatrist’ attempts to breakdown the barriers between the ‘mentally ill’ and ‘completely well’. Kirk argues that we ‘all’ seem to be suffering from different phobias, anxieties, and effectively different kinds of ‘madness’ otherwise perhaps deemed slightly irrational modes of behaviour. This point is further validated by the fact that the DSMMD documented 106 mental illnesses in 1980 and this increased rapidly to 300 in 2000. This account shows a highly sensitive and at times ironic view of psychiatry, which is not necessarily compatible with certain criticisms made against it.
In answering the question of whether madness is an individual attribute or process of social construction, we can essentially say tat it is both. In abstract terms, there really cannot be any such entity as ‘madness’ since all experience is subjective, and no-one individual can proclaim which experiences are valid and which are not. It is however reasonable to argue that before the emergence of society, given man in isolation, madness could not exist- this is of course due to its relative and interdependent nature. However, with the birth of society and the necessity to order things around us, the representation of madness is reified and come to exist as reality, and whilst it is more fluid/ dynamic than many of the other categories we create such as gender, it is not something which can be ignored. On the other hand, it is crucial to recognize the growing body of evidence which suggests that some mental illnesses can be attributed to biological defects in the brain, which I would argue can become more or less pronounced depending wider society’s representation of madness. Critiques of mental healthcare, such s that of Foucalt, are specific to time and perhaps slightly outdated. The fact is that mental health practioners actually hold more positive representations of the mentally ill and it is they who are entering into the dialogue Foucault argued for. Additionally, it is the mental health practioners who appear to be deconstructing the traditional confines pf what constitutes and what ‘ought’ to constitute 'normal’ behaviour. Undoubtedly, there is a greater level of understanding to be reached in this area, and for the most part it is the lay representations of the mentally ill, that prevent these individuals from becoming the valid and recognized members of a society that they deserve to be.
