Edward H. Thompson, Jr.
Department of Sociology & Anthropology
Holy Cross College
ethompson@holycross.edu

What does a sociological perspective bring to our understanding of mental health and illness?  The course is designed to encourage you to appreciate how our conceptions of mental health, mental illness, the mentally ill, and treatment are shaped by culture, history, and institutions.  Much of what we discuss will likely challenge assumptions about mental illness as a state of the “mind” or disordered brain.  This is because we will consider mental health and illness as constructs resting on a discourse that involves personal narratives, psychiatric claims, cultural and economic forces, and institutionalized agreements.   Much of the discourse about mental health and illness is key to social order and a fundamental part of both childhood socialization and adult belief systems.  Integrated into everyday life through conversation and depictions in poetry, drama, art, fiction, print advertisements, and movies, we are taught to feel and think in a different way about the mentally ill relative in the family closet, the mad artist, the frightening asylum, and the abject terror and misery with which a mentally ill person lives [Martha Lang, Perceptions of mental illness: Syllabus for Sociology 125.  Brown University]. We will critically examine mental health and illness from the perspectives of families, medicine, governments, and social theorists.  We will also examine the way that ill persons talk about their experiences with schizophrenia, depression, and mania, coming to appreciate how mental illness is a very ordinary possibility, affecting nearly one in five Americans in her or his lifetime.

The primary goal throughout the course is to make visible the social aspects of mental health and illness.  We critically examine the relationships between society and mental health policies, social organization and mental disorder, and patients and their caregivers.  We examine the way in which the medical model has succeeded in redefining “normalcy” and the causes and cures of mental illness.  We examine the variety of social factors—including social class, gender, and ethnicity—that contribute to the rates and the experiences of mental illness.  The course will acquaint you with the care our nation has provided and currently provides for the mental ill.  The sociological perspective also encourages us to recognize that discourses on mental health and mental health services are sociopolitical in nature. 

Whatever your long-range professional objective is, this course will further develop your appreciation of thinking sociologically and enable you a study the strengths and weakness of mental health care in American society and the voices of patients and the narratives of their illness careers. 

REQUIRED TEXTS

Horowitz, A., & Scheid, T.  1999.  A handbook for the study of mental health.  New York: Cambridge University Press.

Horowitz, A.  2003.  Creating mental illness.  Chicago: University of Chicago Press.

Jamison, K.  1995.  An unquieted mind: A memoir of moods and madness.  New York: Knopf.

Karp, D.  2001.  The burden of sympathy: How families cope with mental illness.  New York: Oxford University Press.

 

ADDITIONAL READINGS

There are articles regularly assigned which are only available through Electronic Reserve.  The authors and articles are designated on the syllabus.  As well, each of you will read one of the following.  The assignment of who reads which one of the memoires will be discussed on the third day of class.

Cheney, Terri.  2008.  Manic: A memoir.  New York: HarperCollins.  9780061430237
Hornbacher, Marya.  2008.  Madness: A bipolar disorder.  Boston: Houghton Mifflin.  9780618754458
Karp, David.  1997.  Speaking of sadness.  New York: Oxford University Press.  9780195113860
McLean, Richard.  2005.  Recovered, not cured: A journey through schizophrenia.  Boston: Allen & Unwin.  9781865089744
Saks, Elyn.  2007. The center cannot hold.  New York: Hyperion. 9781401301385

LEARNING OBJECTIVES

• become familiar with the biopsychiatric and social theories of mental health and illness
• examine how society perceives and responses to mental illness
• explore how mental illness definitions and experiences are continuously reproduced in our discourses about it
• develop a critical awareness of how social forces affect both psychiatric diagnosis and people’s experiences of mental illness
• appreciate how social policies relate to the mentally ill and mental health care
• understand major trends in the asylum as a social institution

ACADEMIC HONESTY & CLASS POLICY

Ground rules:  Because many people learn best when they learn together, you are encouraged to discuss the readings, concepts, and assignments with other members of the class.  But you are also expected at some point to stop collaborating and present your own original work.  The same applies to writing.  Collusion, plagiarism, fabrication of observations and findings, and other cheating violate academic integrity.  Few offenses against the academic community and the integrity of the faculty-student relationship are as serious as academic dishonesty.  Improper use of others’ work (whether obtained from printed, electronic, or oral sources) is a violation of standards.  The Department of Sociology & Anthropology adheres to the College’s policy on academic honesty.  If you are unfamiliar with the policy, consult the College Catalogue (pp. 13-14; http://www.holycross.edu/catalog/academic-honesty-policy.pdf).  Any act of academic dishonesty committed by a student enrolled in this class will be treated in accordance with college regulations. 

All exams are to be taken as scheduled and papers submitted on due dates. 

COURSE REQUIREMENTS

The requirements for this course:

(1) attend classes prepared, having read the assigned material beforehand
(2) submit a brief paper based on one of the memoires (10% course grade)
(3) take two examinations – a midterm and a final (each 30% course grade)
(4) develop an individually-authored research paper (30% course grade)

Participation and Attendance

The course is based on both lecture & discussion, and class attendance is expected.  Missing class once every other week is unacceptable and will affect your grade.  I expect you to have read & thought about the materials prior to class and participate actively in discussion.  The success of this course depends upon how engaged all students are in working with the ideas.  The reading assignments often provoke and encourage reflection and reconsideration of one’s opinions and beliefs.  You are encouraged to ask questions, make comments, bring up a reading, compare course materials to newspaper or magazine articles, and bring these ideas to the attention of the class.  Simply put, preparation and active participation are pivotal to the success the course and spirit of the class. 

Read the assigned materials for themes, oddities, public policy issues, unanswered questions, new ideas, troubling conclusions, alternative interpretations, and things that arouse feelings.  Class sessions never permit enough time to thoroughly discuss the readings.  To get the most out of each class session, reading beforehand and think about the reading(s) are absolutely essential.  Questions to think about while you are reading:

1.  What are the author’s main arguments or hypotheses?
2.  What evidence does the author present in support of her or his arguments?
3.  What are some implications of the author’s arguments or findings?
4.  What are the strength’s and weaknesses of the author’s arguments or research?
5.  Do you agree with the author’s conclusions? Why or why not?

Brief Paper

This paper is both a book review and reflective essay on the experience of mental illness presented in one of the illness narrative memoires assigned to the course.  Too frequently, patients’ perspectives have been slighted in the professional literature.  The assignment is to give voice to the mentally ill who have been too often marginalized.  The paper can address a specific construct (e.g., the narrator’s worries about stigma, the process of diagnosis, the medicalization of the experience, the ignorance of intimates and acquaintances to recognize mental illness).  Your assignment is to integrate your own understanding of the reading and one issue, which ought to be addressed using the theoretical and factual information provided in other course readings or library resources.  The paper is worth 10% of your course grade.  Hard copy is mandatory, and you should also send a copy electronically.

Examinations

One midterm examination and one final are scheduled, and each comprises 30% of the course grade.  The midterm will cover all assigned materials to that point of the course.  It will consist of two essays, designed to evaluate your ability to use course materials as you systematically analyze issues we have been addressing; and, some short answer questions, written to deter­mine how well you understand concepts and issues found in the readings and lectures.  The final exam also will be an in-class exam covering the latter part of the course.

Semester Research Project

This assignment is designed to provide you the freedom to select one topic/issue which is of interest to you and to study it in some depth—first in the library by reading about the topic/issue, then by analyzing existing “data” (e.g., observations, controversies).  The assignment involves at minimum a literature review yielding part of the 15-page manuscript.  The library work is equivalent to the first leg of the project—it is akin to a short “term paper” that summarize the research articles and theoretical essays you read on the topic/issue you are studying.  By its end, the paper must use a minimum of 12 scholarly references, and most are likely to be the sources you cite in the first part of the paper.  While you are welcome to use materials from popular-press magazines, newspapers, television programs, or personal observation, the foundation of the “literature review” should be based on the scholarly references.  These may be either articles in professional journals or books written by social and/or medical scientists. 

Your individualized research is the foundation for the second part of the paper.  During the semester, you will collect the data—you can use a variety of sources, as appropriate: first-person patient accounts, popular articles, patient group list-serves and blogs, films, art, TV commercials and print advertising material, and/or newspaper accounts. 

Choose a topic or issue of interest to you that relates to the sociology of mental health and illness.  Below are a few likely topics:

• mental illness and stigma
• the gains and strains of family caregiving; the caregiving conundrum
• the marketing of psychotropic medications (on TV; in medical journals)
• the insanity defense
• gender and madness (e.g., the “female malady”; ADHD)
• the frightening asylum
• stress among college students
• “manufacturing” mental illness and the anti-psychiatry movement
• PTSD
• homelessness and mental illness
• the epidemiology of suicide
• mental illness and art, or the art of mental patients
• gender identity disorder
• the presentation of mental illness (e.g., depression; bipolar) in Hollywood movies
• deinstitutionalization and “making it crazy” in the community
• how social relationships affect mental health
• mental disorder and the law

I have found that for students interested in health care and mental health, some type of hands-on research makes studying mental health and illness much more intriguing.  You will come away from the assignment with a deeper understanding.  I have also found that hardly ever can someone submit a quality paper earning at least a B- grade by trying to complete the work in the three weeks of a semester.  A research project requires a good number of invisible hours, initially in the library.  To assure the project begins with enough time to complete it, you must consult with me outside of class before September 25.  Following this, a one-page prospectus with at least the abstracts of 6 journal articles you will likely use as references is due no later than October 16.  The final paper is due December 5.  Guidelines and information will be further discussed during the initial office visit, and you are encouraged to consult me more than the one time.  Late papers will be penalized; this is a semester assignment and working on it continuously is expected.  The paper constitutes 30% of the course grade.  Hard copy is mandatory, and you should also send a copy electronically.

COURSE OUTLINE

Part I.  The Experience of Mental Illness

One sociological problem is the enigma of visualizing mental disorders.  Problems of physical health seem more real to most people; by comparison, mental health and mental disorder remain concepts based on uncommon experiences.  Thus, how do ill persons talk about their experiences?  A related problem is the patient’s family:  To what extent is the marriage contract “for better, for worse, in sickness and in health” an obligation, and are parents and siblings also expected to be care providers? How do family caregivers talk about their experiences?

Sep 4:         Film: Dialogues with Madwomen

Sep 9:         Manic-Depression or Bipolar
                  Jamison, The unquiet mind, entire book

Sep11:        Depression and Schizophrenia
                  Karp, “The dialectics of depression” (ER)
                  Larson, “Finding meaning in first episode psychosis” (ER)
                  Baker, Lavender, & Morant, “Client and family narratives on schizophrenia” (recommended, ER)

Sep 16:       Stigma
                  Goffman, “Stigma and social identity,” from Stigma (ER)
                  Corrigan, “How clinical diagnosis might exacerbate the stigma of mental illness” (ER)

Part II.  Perspectives on Mental Illnesses

Cross cultural studies reveal that mental disorders are found in all cultures.  But how are mental health and mental disorder now conceptualized?  If we are to eventually discuss mental health policy, we must be aware of the scope and limits of our topic.  Psychiatrists have developed descriptive diagnostic categories that they use to identify patients with similar narrative accounts of their everyday experiences.  But when it comes to reliably defining mental health and mental disorder, we face debate.  What has become the dominant perspective Americans use to make sense of mental health and illness?

Sep 18:       Defining mental health and mental illness
                  Horowitz & Scheid, “Approaches to mental health and mental illness,” pp. 1-6 in H&S
                  Mechanic, “Mental health and mental illness: Definitions and perspectives,” pp. 12-28 in H&S
                  Howowitz, Creating mental illness, Introduction and Chapter 1, pp. 1-37

Sep 23:       Mental disorders: A historical overview
                  Rothstein, “A historical analysis of the treatment of the mentally ill” (ER)
                  Horowitz, Creating mental illness, Chapter 2, pp. 38-55
                  Grob, “The severely and chronically mentally ill in America: Retrospect and prospect” (recommended, ER)

Sep 25:       Diagnostic accuracy and reliability
                  Rosenhan, “On being sane in insane places” (ER)
                  Wakefield, “The measurement of mental disorder,” pp. 29-57 in H&S

Sep 30:       Psychiatric discourse and the meanings of medication
                  Horowitz, Creating mental illness, Chapter 8, pp. 181-207
                  Garfield, Smith, & Francis, “The paradoxical role of anti-depressant medication” (ER)
                  Karp, “Taking anti-depressant medications: Resistance, trial commitment, conversion,
                           disenchantment” (recommended, ER)

Part III.  Theories of Etiology

The medical model generally assumes something has gone wrong with the brain or the cognitive capabilities of the person affected with a mental disorder.  It is concerned with the organic aspects of psychological disorders.  Social theories presume that when we talk about any behavioral disorder, we are primarily considering social behavior.   Even when the condition clear has an organic basis, as in neurosyphilis, social theorists are more interested in the person’s perceptions and behavior, what is ‘normality’ and abnormality’, and who determines what aspects of the illness experience are treated and how.  This focus on the social context has called attention stress, which is now a widely acknowledged explanation for why social conditions yield psychiatric symptoms and mental disorders.  What is stress, and what the relationship between stress and mental health and disorder?

Oct 2 :        Diagnostic psychiatry
                  Peterson, Psychological approaches to mental illness, pp. 104-120 in H&S
                  Horowitz, Creating mental illness, Chapter 3, pp. 56-82

Oct 7:         Medicalization and biopsychiatric theories
                  Horowitz, Creating mental illness, Chapters 4-6, pp. 83-157
                  Schwartz, Biological approaches to psychiatric disorders, pp. 79-103 in H&S
        
Oct 9:         Social theories
                  Thoits, Sociological approaches to mental illness, pp. 121-138 in H&S
                  Phelan & Link, The labeling theory of mental disorder (I), pp. 139-149 in H&S
                  Horowitz, Creating mental illness, Chapter 7 and Conclusion, pp. 158-180, 208-229
        
Columbus Break  (October 14)

Oct 16:       Social context of mental health and illness
                  Pearlin, Stress and mental health, pp. 161-175 in H&S
                  Wheaton, The nature of stressors, pp. 176-197 in H&S
                  Aneshensel, Outcomes of the stress process, pp. 211-227 in H&S

Midterm Exam (October 21)

Part IV.  Social Correlates of Mental Disorders

Psychiatric epidemiology not only defines who has what condition, it assists in the development of etiological explanation and distinctive treatments.  Sociologists have found that certain kinds of mental disorders are more likely to be found among people who have certain social characteristics.

Oct 23:       The female malady
                  Geller & Harris, “Francis Farmer,” excerpt from Women of the Asylum (ER). 
                  Film:  Means of Grace

Oct 28:       Gender and madness
                  Rosenfield, Gender and mental health, pp. 348-360 in H&S
                  Turner, Social support and coping, pp. 198-210 in H&S
                  Excursus: Discussion of Marya Hornbacher, Madness: A bipolar disorder 

 

Oct 30:       Patterns of disorder:  Age and marital status
                  Mirowski & Ross, Well-being across the life course, pp. 328-347 in H&S
                  Avison, Family structure and process, pp. 228-240 in H&S
                  Excursus: Discussion of Terri Cheney,  Manic: A memoir

Nov 4:        Patterns of disorder:  Social class and race
                  Eaton & Muntaner, Socioeconomic stratification & mental disorder, pp. 259-283 in H&S
                  Lennon, Work and unemployment as stressors, pp. 284-294 in H&S
                  Williams & Harris-Reed, Race and mental health, pp. 295-314 in H&S
                  Excursus: Discussion of Ellen Saks, The center cannot hold

 

Part IV.  The Mental Health System

A variety of mental health services are currently available, however commitment to a hospital or mental institution may be necessary when the mental disorder is serious and/or the behavior of the individual is regarded as unpredictable and dangerous.  Should the mental hospital (and earlier, the asylum) be viewed as a total institution with its own rules and culture?  Many professionals and policy makers believed so.  The transfer of care from mental institutions to community mental health agencies that began in the 1960s is known as deinstitutionalization.  One of the ironies of deinstitutionalization is treating the patient in the same social environment in which the disabling mental disorder was fostered.  Chronic patienthood is a formidable challenge facing the nation.

                Nov 6:     The flow of patients into treatment
       Pescosolido & Boyer, How do people come to use mental health services, pp. 392-411 in H&S
       Takenchi et al, Cultural diversity and mental health treatment, pp. 550-565 in H&S                  
       Excursus: Discussion of Richard McLean, Recovered, not cured
        

                           Nov 11:      Family caregivers experiences with their 24/7/365 commitment
                  Karp, The burden of sympathy, Chapters 1-3, pp. 3-108
                  Excursus: Discussion of David Karp, Speaking of sadness

       Nov 13:     The caregivers, continued
                       Karp, The burden of sympathy, Chapters 4-7, pp. 109-263

Nov 17:        Film Night:  One Flew Over the Cuckoo’s Nest  7pm
        
Nov 18:        Institutionalization
                  Prior, “Surviving psychiatric institutionalization: A case study” (ER)

Nov 20:       The mental hospital
                  Goffman, “The moral career of the mental patient,” from Asylums, pp. 127-169 (ER)
                  Horowitz & Scheid, Mental health systems and policy, pp. 377-391 in H&S

Nov 25:       The mental hospital, continued
                  Film: Titicutt Follies
        
Thanksgiving Break (November 27)
        
Dec 2:         Deinstitutionalization
                  Grob, “The paradox of deinstitutionalization” (ER)
                  Pickett et al, Psychiatric rehabilitation services and outcomes, pp. 484-492 in H&S 
                  Dowdall, “Mental hospitals and deinstitutionalization” (recommended, ER)
                  Film clip from:  West 47th Street   

Dec 4:         Managed care
                  Manderscheid et al, Contemporary mental health systems & managed care, pp. 412-426 in H&S
                  Schlesinger & Gray, Institutional change and its consequences for the delivery of mental health services, pp. 427-448 in H&S

Research papers due (December 5)

Dec 9:        The law
                  Hiday, Mental illness and the criminal justice system, pp. 508-525 in H&S
                  Fisher et al., “Beyond criminalization” (ER)

Final Exam – December 17th, 2:30 pm