Chapter 1:

Madness
and Society
Mental Disorder Worldwide*
• According to the World Health Organization (2017), 10% of all adults
worldwide experience a mental disorder at some point in their
lifetime**
• Also, according to WHO, 1 in 4 people will have a mental disorder at
some point in their lifetime
• On any given day, 10% of adults worldwide are experiencing a mental
disorder
Mental Disorder – United States*
• Between a third to nearly half of the US adult population between 18-
54 has a diagnosable mental disorder*
• Another study argues that 46.4% of the US population meet the criteria
for 1 or more mental disorders in their lifetime*
• About 25% of the US population meets the criteria in any given year

• Most experience mental health problems beginning in childhood or

adolescence*
• Mental disorders are not unusual
• Almost everyone becomes depressed, sad, or anxious at some point…like now?
• Plus the classification categories are very broad (mild, not serious)
Mental Disorder – United States*
• Serious Mental Disorders: 3.9% of the US adult population (2018)
• Problem is that it is hard to count…*
• We can count those in mental hospitals and mental health facilities both in and
out-patient but we cannot count those that never seek help
• We cannot count those that go undetected

• Mental disorders are damaging to the victims and their families

• Causes issues such as suicide, divorce, alcoholism, drug abuse, unemployment,
child abuse, damaged social relationships, pain and mental anguish
Mental Disorder – United States*
• Why is this a sociological problem?
• The identification of the majority of mental disorders is dependent on social
criteria
• Is the person breaking the norm?
• Is the person unable to follow the social rules?
• Psychiatrists and psychologists usually focus on individual cases of mental
disorder
• Sociologists look at the societal process that affect people and their mental state
• They investigate the consequences of social structures and relationships on
mental health*
• “Sociological interest in mental health and disorder is rooted in its mission to
identify elements of social life that have dysfunctional consequences.”
(Pearlin)
Mental Disorder – Sociological View*
• Mental Disorder is seen as a significant deviation from standards of behavior generally
regarded as “normal” by the majority of people in a society.*
• Psychiatric diagnosis is often dependent on one’s social functioning.
• Includes understanding sociological concepts such as norms, roles, and social
status
• These establish and define appropriate behavior in different social situations
and settings
• KEY POINT: Mental disorder diagnosis is often dependent on the disruption or
disregard of the taken-for-granted understandings of how people should
conduct themselves socially that causes a person’s state of mind to be
questioned.
Mental Disorder – Sociological View
• We cannot tell what is in someone’s mind. We can only watch their behavior and listen
to their words. This makes the diagnosis of mental disorders inherently social.
• We focus on overt behaviors

• SO, according to this premise, how do we not be mentally ill or pretend to be

mentally healthy?
• Is mental health a social behavior?
• Think about being homosexual in the 1950s or with the Mormon Church….
• Apply what you know now
• Homosexuality was considered a
mental disorder until the early 1970s
• Why?
 Defining Mental Disorder
• The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook
of mental health
• It lists a multitude of disorders that are used for labeling, diagnosing, and treatment
• Editions 1 and 2 never gave a definition of mental disorder

• Definition of mental disorder (DSM III-IV):

• 1) a condition that is primarily psychological and alters behavior (can include changes in
physiological functioning such as personality, motivation, or conflict;
• 2) a condition that in its “full-blown” state is regularly and intrinsically associated with
subjective stress, generalized impairment in social functioning, or behavior that one
would like to stop voluntarily because it is associated with threats to physical heal; AND
• (includes an inability to function in social situations)
• 3) a condition that is distinct from other conditions and that responds to treatment
 Defining Mental Disorder*
• Current definition of Mental Disorder in DSM-V
• A significant dysfunction in a person’s mental processes

• What does this mean?

• What counts?
• What doesn’t count?
• Does it matter what I look like
for it to count?
• Does it matter how much money I have?
• Does it matter who my family is or what position I hold?
• Does my education mitigate this?
• Is this why Dr. Potts got a PhD????
 Madness through the Ages*
• “If prostitution is the oldest profession, then psychotherapy must be the second
oldest.” (Torrey, 1973:202)
• Witch Doctors: largely relied on intuition and cause-and-effect
• If an illness could not be explained easily then it was said to have supernatural powers
• Example: a belief that a curse can cause death
• Issue of evil spirits and black magic are believed to cause death and illness, thus white magic is
used to counteract its effects*
• Brings about Shaman as the role of healer
 The History of Madness*
• Similarities between Witch Doctors and Psychiatrists*
• 1) both provide a shared worldview to the patient that allows the naming of
pathological factors to be understood within his/her culture
• 2) both have a personal relationship with the patient that makes the therapist's
personality characteristics a part of the healing process
• 3) both engender hope in the patient with the expectation that they can be cured
with the reputation of the therapist and the therapeutic setting
• 4) both share techniques of psychotherapy
• Drug therapy, shock therapy, confession, suggestion, hypnosis, dream
interpretation, conditioning, etc.
 The History of Madness-21st Century*
• Even in preliterate times, the mentally ill were stigmatized as people believed them to
be victims of witchcraft, evil spirits, and diseases caused by spirits (all thought to be
contagious).
• Does this have an impact on our behavior today?

• GREEKS AND ROMANS developed modern concepts of mental illness

• The Greeks formulated a rational approach to understanding nature and society.
• The supernatural was replaced with the explainable through cause-and-effect
• Hippocrates (400 BC) developed a rational, systematic mode of treating patients through
observation of symptoms and a logical plan of treatment according to proven procedures
• He insisted that diseases of the mind were no different that any other disease and from natural causes*
• Galen (130-200 AD), Roman physician, was influenced by Hippocrates he was a strong advocate
of active sexuality and organisms and believed it contributed to mental health
• Soranus, Roman physician, believed that the relationship between the physician and the patient
were of most importance
 The History of Madness-21st Century
GREEKS AND ROMANS
• Galen (130-200 AD), Roman physician, was influenced by Hippocrates he was a
strong advocate of active sexuality and orgasms and believed it contributed to mental
health
• Soranus, Roman physician, believed that the relationship between the physician and
the patient were of most importance
• Argued physicians should be supportive of their patients
• Particularly known for his humanitarian treatment of the mentally ill

• Roman Law- redefined insanity as a condition that could decrease an individual’s

responsibility for having committed a criminal act*
• However, state of mind was defined by a judge not a physician
• Other laws were put in place to determine the ability of the mentally ill to marry, divorce, testify
in court* (insanity plea), and make wills
• We still have this…
The History of Madness-Middle Ages, Renaissance, & Post-
Renaissance*
The progressive ideas started by the Romans and Greeks ceased with the fall of Rome
(476 AD)
• At this time the Roman Catholic Church became the center for learning and
knowledge
• This was a time of great uncertainty and war
• Brought the return of the supernatural (the Devil and witches) were again responsible
for the afflictions of the mind
• Do we still see this today?

• Exorcism was performed by the Catholic clergy

• Not until the 18th century did scientific thought
and logic prevail and demonology was rejected
-Physicians healed the body while theologians healed the mind*
The History of Madness-Middle Ages, Renaissance, & Post-
Renaissance
However, centuries of superstitions were difficult to overcome
• There also existed an agreement between the church and medical science that gave
the church jurisdiction over the investigation of the mind
• Thus, human reason was defined with regards to religion.
• Physicians largely focused on the body and left the process of the mind to theologians*
Western Witchcraft
• The church defined those who did the Devil’s work as witches
• Witches tended to be powerless and easy scapegoats
• Generally, they were women and included heretics, nonbelievers, eccentrics, the mentally ill, and
those who were regarded as odd

• Suspected witches were arrested, tried by a court, and punished

• Punishment was usually death
• The Witch Trials began in 1245 in France and peaked between 1450 and 1670
• In 1486 a how-to-do-it manual was written for witch hunters by 2 Dominican monks
• It was called “The Hammer of Witches”
• It had 29 editions and was last published in 1669
• The authors argued that to question the existence of witches was a sign of being a witch….do we
apply this thinking today????
Western Witchcraft
• The document argued that women were chiefly addicted to evil superstition since
they were responsible for carnal lust (this was the foundation of witchcraft)
• How does this influence our ideas of promiscuity today?

• Men, however, were protected from witchcraft because Jesus Christ was a man
• This built the foundation for male superiority, demanding persecution of women as
inferior, sinful, and dangerous
• If you were sick, physicians had to either explain your illness or if they could not, it
was considered evidence of witchcraft
• One estimate claims that nearly 200,000 people were put to death in Germany and
France
Western Witchcraft
• One of the final occurrences considering witchcraft occurred in the New World-
Salem, Massachusetts- pushed by Protestants in 1692
• Based on a group of young girls acting silly and thus labelled as “bewitched” after a
physician could not explain the cause with medical knowledge
• 19 alleged witches were executed out of 15 brought before the court
• Those who lost their lives were largely societal outcasts with little social standing
• However, as more people of higher social standing were accused, the trials began to
decline as the evidence was seen as unfit- the public became appalled and eventually
the Catholic and Protestant churches and local governments withdrew support
Treatment of the Mentally Ill*
• 1st mental hospital founded in Spain in 1409 by a Catholic priest, Father Gilabert
Jofre´*
• Arab countries had much more humanitarian view of the mentally ill as the Muslim
view was that the insane are loved by Allah and are especially chosen to tell the truth
(12th century)
• Rich and poor were given access to the same facilities and treatment

• 1st psychiatrist, Johann Weyer (1515-1588) Dutch, rejected the idea of witchcraft.
Believed in kindness and understanding.
• Father of modern psychology from Spain. Juan Luis Vives (1492-1540) spoke out
against demonology
• All of these led to the separation of psychology and psychiatry from theology
18th Century: Age of the Great Confinement*
• The Great Confinement was the creation of “hospitals” intended to house and control
people thought to be social problems- Europe*
• Included anyone thought to be a public nuisance
• Idea that the state should take care of the poor but only if they give up their freedom and were
removed from mainstream society

• This bled over into the US. – idea that people with chronic health problems need
long-term hospitalization (the insane, the incurable, those with highly infectious
diseases)
• Another influence in Europe and US is the Protestant Ethic (Weber)
• This equates productive labor with goodness and morality
• Idleness and unemployment were sinful
• Turned mental institutions into places of cheap labor

• During this time, the insane were regarded as little more than animals
• Locked away from society or put on display for money
End of the 18th Century*
• During this time, public outrage grew due to the mistreatment of the mentally ill
• More publicity about the use of the institutions (i.e. husbands who no longer wanted their wife
put them away)

• Reform was beginning to shift the treatment of the mentally ill towards the end of the
18th century
• At this time, a new program was put into place “moral treatment”

• Moral Treatment was prevalent in Europe and New England but was largely reserved
for middle and upper class families with money*
• Those who were poor, violent, or non-white were often sent to jails or workhouses
Decline of Moral Treatment -1800s*
• Mental hospitals beginning to form in New England around the turn of the century
were based on Moral Treatment
• However, this began to fail for 5 reasons:*
• 1. no cohesive treatment plan ever existed
• 2. critics thought the plan just enforced patient conformity (reward good behavior and punish
bad)
• 3. mental asylums were overcrowded with not only the insane but also criminals, alcoholics,
vagrants, and the poor
• 4. there was an increasingly popular view beginning to take over that madness was incurable
• 5. some psychiatrists viewed mental disorder as a disease brought on by organic causes: abnormal
behavior was derived from brain disease that came from the brain's blood vessels
• All of this together, meant the demise of humane care under the moral treatment model
20th Century: Therapies*
• The most influential developments in mental health in the 1900s were the work of
Sigmund Freud, the use psychoactive drugs, and the community mental health
movement.
• Freud (1856-1939) was a neurologist, established the basis for modern psychiatry:
focused on the role of instincts and the unconscious in shaping behavior*
• Psychoanalysis was largely reserved for the white middle and upper class

• Psychoactive Drugs: (1960s) since psychoanalysis was expensive, time consuming

and not effective with seriously deranged patients the discovery and use of
psychoactive drugs became successful with the support of biochemical medicine
• Positive results with drugs led to a significant decrease in mental patients in hospitals from 1956
on (not cured but symptom reduction)
20th Century: Therapies*
• 1950 – 512,000 patients in state and county mental hospitals
• 1955 – 559,000 patients in state and county mental hospitals
• 1956 – 551,000 patients (1st year of using psychoactive drugs)
• Today, about 30,000 patients across US
• Average length of hospitalization from 6 months in 1955 to less than 2 weeks today
• These changes encouraged the formation of new therapies: family therapy, crisis intervention, and
brief psychotherapy

• Psychoactive drugs do not cure; they relieve symptoms and make social life
possible*
Community Mental Health*
• Large numbers of mental health patients are back into the community sustained by
psychoactive drugs*
• Government commissioned a report that recommended the establishment of local
community mental health centers (1961)
• Goal is to create a social environment for patient that can be supported at the
community level (out-patient treatment)
• In 2015, there were over 1,000 community mental health centers in the US
• Face issues of funding and overpopulation of out-patients*
• No widespread success to this model but has created a new problem of out-patient
mentally ill persons unable to live on their own
• Creation of mentally ill slum environments
21st Century – Where we’re at today
• The mapping of the human genome system was completed in 2003*
• Mental disorders are genetically transmitted from one generation to the next
• Thus, gene therapy involving alteration or changes in a person’s genetic code may be
able to prevent an inherited mental disorder
• Genetic information may be able to produce “designer” drugs
• Problem is perception: studies show that knowing a mental disorder is genetic
actually increases the stigmatization of the individual and their family
• They are seen as fundamentally different or flawed
• Bottom-line: Humans are still idiots
On to Chapter 2: Types of Mental Disorders