Folk Psychiatry: Lay Thinking about Mental Disorder

PSYCHOLOGICAL abnormality holds a great fascination in the public mind. People regard the mad, the odd, the miserable, and the intemperate with a mixture of amusement, alarm, and repugnance . We gossip about them, demonize some and romanticize others, stare or avert our eyes, show concern or contempt. Laypeople pay engrossed attention to psychological deviance and they have well-developed but often poorly articulated understandings of its manifestations. Making sense of these understandings has great practical importance. It is lay rather than professional conceptions of mental disorder that determine whether professional help is sought by those directly or indirectly affected by psychological disturbance, and that decide how sufferers are treated by their families and peers. Lay conceptions guide public attitudes of tolerance or repudiation toward sufferers. Discrepancies between lay and professional conceptions impede the necessary alliance between sufferers and those charged with treating them. Discrepancies between indigenous understandings of deviancy and imported systems of psychiatric diagnosis produce deeper conflicts. For all these reasons, lay conceptions of mental disorder demand empirical and theoretical attention. Social and behavioral scientists have approached laypeople’s understandings of psychological abnormality from several distinct perspectives. Three approaches predominate, which I dub the ethnopsychiatric, the sociological, and the attributional. The tradition of anthropological work on indigenous understandings SOCIAL RESEARCH, Vol. 70, No. 2 (Summer 2003) Folk Psychiatry: Lay Thinking about Mental Disorder NICK HASLAM of mental disorder, or ethnopsychiatry (Gaines, 1992), stretches back for a century. Ethnographic studies have traced the variant manifestations of psychiatric phenomena around the globe, and charted the conceptual resources and healing practices that cultures deploy to deal with them. Sociologists and epidemiologists embody another tradition, drawing on community surveys of public beliefs about and attitudes towards mental disorder (for example, Angermeyer and Matschinger, 1999; Link et al., 1999). Their studies, conducted chiefly in the industrialized West, yield quantitative descriptions of lay conceptions and how they depart from contemporary psychiatric knowledge and practice. Psychologists working from the standpoint of attribution theory (for example, Corrigan, 2000), finally, have pursued a research program that explores lay beliefs about the causes of mental disorder . A particular focus of study in this tradition is how the attribution of disorder to controllable versus uncontrollable and temporally stable versus unstable causes bears on attitudes toward the disordered. Inevitably, these three dominant perspectives offer complementary insights and have complementary limitations. Ethnopsychiatric studies offer rich qualitative description and forceful reminders of the extent and depth of cross-cultural variation in lay thinking about psychological abnormality, but their particularism discourages attempts to draw general conclusions or make systematic cross-cultural comparisons. Sociological surveys yield precise snapshots of lay conceptions, affording comparisons across locales and historical periods and capturing the conceptual variance within cultures. However, their assessment of lay understandings as sets of declarative statements about disorder lacks psychological depth and they are often associated with a “mental health literacy” perspective (Jorm, 2000) that views lay conceptions simply as deficient approximations of professional beliefs. Attribution theory locates lay thinking about psychiatric phenomena within a more systematic and less normative account of causal understanding, but it also reflects an impoverished model 622 SOCIAL RESEARCH of lay explanation. How people explain and interpret social behavior cannot be reduced to their intuitions about the controllability and malleability of its causes without leaving a large, unexamined remainder. In this paper I will sketch a new approach to laypeople’s thinking about mental disorder that has enough points of difference from these alternatives to warrant a new label. “Folk psychiatry” nods to recent cognitive psychological research on lay understandings of normal mental processes, conducted under the rubric of “folk psychology” (D’Andrade, 1995; Fletcher, 1995). In some respects, my approach is an interdisciplinary hybrid. I intend the folk psychiatry approach to supply a framework for ethnographic inquiry that is sensitive to cultural variation but also, unlike much ethnopsychiatric work, universally applicable and useful for cross-cultural comparison. The approach aspires to give shape and direction to sociological survey research on lay conceptions, which has tended to lack an integrative theoretical perspective or any recognition of the psychological structures and dynamics that underlie the public beliefs that it describes. The folk psychiatry approach also shares with the attributional approach a...