Sociology of Mental IllnessDalia Al-MansyUMBCPSYC 493

OverviewHistory of mental illnessStigma of mental illnessCulture & mental illness

History – Prehistoric TimesLimited evidence prior to written

recordsRelated behavioral abnormalities

have been found in non-human great apes

Evidence from Neolithic times of the practice of trepanation◦An attempt to cure ailments related

to mental disorders

History – Ancient CivilizationsEgyptian & Mesopotamian

◦ Ebers papyrus – describes disordered states of concentration and attention, and emotional distress in the heart or mind

◦ Somatic treatments included applying bodily fluids while reciting magical spells

◦ Hallucinogens used as part of healing rituals◦ Religious temples as therapeutic retreats

Facilitate sleep & interpret dreams

Early Navajo Indians◦ Many common techniques that are used today

were also used then◦ No records of killings or sending away of the

mentally ill

History – Ancient Civilizations Indian

◦ Ramayana & Mahabharata: fictional descriptions of depression and anxiety states

◦ Mental disorders were thought to reflect abstract metaphysical entities, supernatural agents, sorcery or witchcraft

◦ Caraka Samhita, circa 600 BC: ill health is a result of imbalance among 3 kinds of bodily fluids/forces

◦ Suggested causes: inappropriate diet; disrespect towards the gods, teachers or others; mental shock due to excessive fear or joy; faulty bodily activity

◦ Treatments: herbs & ointments, charms & prayers, moral/emotional persuasion, shocking the person

History – Ancient CivilizationsChinese

◦ Treatment under Traditional Chinese Medicine Herbs Acupuncture Emotional therapy

◦ Emphasis on the connections between bodily organs and emotions

◦ Conditions thought to comprise 5 stages/elements◦ Imbalance between Yin and Yang

Hebrew and Israelite◦ Mental disorders caused by problems in the

relationship between the individual and God◦ Mood disorders in Biblical figures in the Hebrew

Bible/Old Testament

History - Ancient CivilizationsGreek and Roman

◦ Diseases caused by an imbalance in 4 humours of the body

◦ Hippocrates: proposed a triad of mental disorders termed melancholia, mania, and phrenitis

◦ Plato: 2 types of mental illness Divinely inspired – person has prophetic powers Physical disease

◦ Aristotle: all mental illness caused by physical problems

◦ Stereotypical madness – aimless wandering and violence

◦ Treatments – ranged from drugs to beatings and religious rituals

History – Middle Ages Persia, Arabia and the Muslim Empire

◦ Greek texts were translated, analyzed, and integrated with religious thoughts

◦ Links were made to the brain in various ways, as well as to spiritual/mystical meaning

◦ Persian & Arabic scholars Al-Balkhi, Al-Tabari, Al-Razi (Rhazes), Al-Farabi (Alpharabius),

Al-Ghazali, Ibn-Sina (Avicenna), Al-Majusi (Haly Abbas), Abu al-Qasim al-Zahrawi (Abulcasis), and Averroes

◦ In Islam, the mentally ill were considered incapable yet deserving of humane treatment & protection

◦ Mental disorders thought to be caused by possession by a djin that was either good or demon-like

◦ The first psychiatric hospitals◦ Benevolent treatments – baths, drugs, music &

activities

History – Middle AgesChristian Europe

◦Concept of madness as a mixture of divine, diabolical, magical & transcendental

◦Theories of the 4 humors◦Arnaldus de Villanova: promoted trepanning as

a cure to let demons and excess humours escape the body

◦Madness seen as moral issue – either a punishment for sin or a test of faith/character

◦Episodes of mass mania – dancing in a way that gives the appearance of insanity

◦Care of the mentally ill was the responsibility of the family

History – Modern Period16th to 18th Centuries

◦ Many mentally ill were victims of witch-hunts, however, those judges insane were admitted to local workhouses, poorhouses, and jails

◦ End of 17th century: madness seen as an organic physical phenomenon – no longer involving the soul or moral responsibility

◦ New terminology for mental disorders and the mentally ill

◦ End of 18th century: Moral Treatment Movement Notable figures: Vincenzo Chiarugi, Phillipe Pinel,

Quakers in England led by William Tuke, and Dorothea Dix in the US

History – Modern Period19th Century

◦ “the Great Confinement” – massive expansion of the number & size of insane asylums

◦ Laws introduced to deal with the insane by the family and the hospital

◦ It was argued that the mad also has physical/organic problems, so that moral and medical treatments were implemented

◦ Classification schemes and diagnostic terms developed

◦ 1870s in North America – Lunatic Asylums renamed Insane Asylums

◦ Increased diagnosis of mental disorders

History – Modern Period20th Century

◦ Development of psychoanalysis, and later cognitive behavioral therapy

◦ Kraeplelin’s classification – separating mood disorders from schizophrenia

◦ “Inmates” became “patients, “asylums” became “hospitals”

◦ “Mental Hygiene” movement in the US◦ Development of clinical psychology and social

work◦ Need for a psychiatric manual for categorizing

mental disorders led to the firs DSM and the ICD◦ New treatments◦ Anti-psychiatry movement of the 1960s

Stigma of Mental IllnessGenerally when people hear of mental illness

they think of severe cases that are associated with bizarre behavior, violence, and a lack of caring about themselves.

People with mental illness are dehumanized in this sense.

Mentally ill often labeled as weak, fearful, violent, or flawed

Stigma also encompasses the family of the mentally ill, as well as the individual themselves

Video on personal experience with stigmahttp://www.youtube.com/watch?v=F2r8aXyCO5Q

Stigma of Mental IllnessStudy by Lauber, C. & Rossler, W. in

2007 on stigma towards people with mental illness ◦Fear of people w/ mental illness◦General attitudes towards people with

mental illness◦Attitudes towards treatment of mental

disorders◦Stigma among those affected◦Stigma towards families of people with

mental illness

Stigma of Mental IllnessStudy by Magliano et. al. (2004) on the

beliefs about schizophrenia in Italy◦Lay respondents recognized the case in

vignette as a pathological disorder and that it required psychiatric treatment – although not recognize it as schizophrenia

◦General public believed that persons with schizophrenia can recover from it, with little to no drugs given

◦Belief that psychiatric patients are unpredictable

◦General public cannot discriminate between different psychiatric disorders

Stigma of Mental IllnessStigma is also effected by culture and how

each culture deals with its mentally illVietnamese: person is punished for a

wrong doing in a previous life or b an angry ancestor who has returned to possess them.

India: women are sent away to less-than-adequate asylums by their families

Japan: mental illness is weakness of character

China: mentally ill source of humiliation for families

Culture & Mental IllnessIn addition to stigma that can be different

from one culture to another, there are mental disorders that are only specific to that culture

Culture bound disorders are disorders that are seen only within a specific culture◦ Could have psychotic or somatic symptoms

Causes of these disorders are mostly related to spiritual/religious beliefs

Treatments often take the form of religious ceremonies and rituals – mostly carried out by religious/spiritual Healers

Culture & Mental Illness In a study by Ally & Laher (2008) the

perceptions of mental illnesses were seen from the South African Muslim faith healers’ point of view on the understanding and treating mental disorders

Belief in witchcraft and sorcery – Sihr Ill will or the jealous intentions of others can

cause a person to become ill – nazrDemonic possession – jinnTreatments involve either sangoma (traditional

African healers), or Moulana’s, Sheikh’s, or Matawaa’s (traditional Islamic healers)

The Zaar

Culture & Mental IllnessCulture bound disorders & descriptionsAmok: Malaysia & SE Asia, Phillippines,

Ploynesia, New Guinea, Puerto Rico & Native Americans (Navajo)

Ataque de Nervios: Caribbean Latinos, Latin American & Latin Mediterranean groups

Falling Out: Ethnic groups in SE US, especially Miami – primarily African Americans & Afro-Caribbeans

Hmong Sudden Death Syndrome: LaosSusto: Hispanic cultures in both the Old and

New Worlds

ConclusionMental illnesses have been around since

prehistoric timesStigma of mental illnessCauses of mental illnesses among

different culturesDespite the many medical advancements

that have been made to treat mental illness, many still believe that mental illness is caused by spiritual or religious reasons and that rituals are still used as the means to treat the individuals

ReferencesAlly, Y., & Laher, S. (2008). South African muslim faith healers

perceptions of mental illness: Understanding, eatiology and treatment. Journal of Religion and Health. 47, 45-56.

Flaskerud, J. H. (2000). Ethnicity, culture, and neuropsychiatry. Issues In Mental Health Nursing. 21, 5-29.

History of mental disorders. (2009). History of mental disorders. In Wikipedia [Web]. Retrieved April 20, 2009, from http://en.wikipedia.org/wiki/History_of_mental_illness

Lauber, C., & Rossler, W. (2007). Stigma towards people with mental illness in developing countries in Asia. International Review of Psychiatry. 19, 157-178.

Magliano, L., Fiorillo, A., De Rosa, C., Malangone, C., & Maj, M. (2004). Beliefs about schizophrenia in Italy: A comparative nationwide survey of the general public, mental health professionals, and patients’ relatives. Canadian Journal of Psychiatry. 49, 322-330.

Shepherd, S. (2004, September 1). MedHunters. Retrieved April 27, 2009, from www.medhunters.com Web site: http://www.medhunters.com/articles/theyrePossessed.html