Sociology and Concepts of Mental Illness

Differing sociological perspectives of mental health and illness can be linked to theoretical contributions from Durkheim, Weber, Freud, Foucault, and Marx (social causation, labeling theory, critical theory, social constructivism, and social realism, respectively) but sociology in general, and medical sociology in particular, has often been accused of neglecting the field of mental health and illness. Certainly, as a discipline, it is unable to provide an overarching explanatory framework; rather, as Pilgrim and Rogers describe, "'sedimented layers of knowledge which overlap unevenly in time and across disciplinary boundaries and professional preoccupations" (1999, 11).

Nevertheless, since Durkheim's (1964/1895) path-breaking insights as to the role of social processes on the norms and values of any society, sociologists have been concerned with distinctions between the normal and the pathological, as in Parsons' (1951) analysis of illness as deviance. Although the limitations of functionalism have since been well documented, the implication that mental disorder as socially and culturally relative was developed further by Scheff's concept of labeling theory (1999/1967) and, of course, was highly influential in the work of the anti-psychiatrists such as Laing (1963) and Szasz (1970) in viewing mental illness as the breaking of social, political, and ethical norms. In collaboration with sociologists of science, there is a strong tradition of challenging DSM and other psychiatric classifications to examine the social and political shaping of categories of mental disorder, including how they disappear and reappear (Brown 1990; Manning 2001).

Busfield (2001, 2002) has made the distinction between disorders of behavior and disorders of thought, and, although Foucault's (1967) analysis of reason and madness can be placed firmly in the latter camp, the emphasis on the social and cultural relativity remains. As a paradigm, social constructivism has been highly influential in the 'deconstruction' of psychiatric diagnosis and treatment, particularly in the development of feminist and anti-racist critiques and within other vulnerable social groups. It has probably also generated the most controversy—the notion of mental illness as a 'social construct' is widely used in lay terminology and even by some mental health professionals, as Fulford and Colombo's research reveals.

Whereas there have been enormous benefits in identifying the socially and politically controlling aspects of psychiatry which at worst, are an abuse of human rights, more recently, the dangers of the extremes of cultural reductionism have been recognized, not just by doctors, sufferers, and their families, but by sociologists themselves. Before his own tragic suicide, Peter Sedgwick (1982) pointed out the perils of rejecting the reality of pain, difficulty, and suffering involved in mental disorder/emotional disturbance or whatever we decide may be the appropriate term.

Fulford and Colombo's work on models of mental disorder can perhaps be identified with more recent theoretical developments under the critical realist rubric. This theoretical stance, inspired by the philosophical position of Bhaskar (1998), allows for a recognition of realist epistemologies and ontologies combined with an understanding of the variation of time and place. When applied to understandings of illness, the reality of disease or disorder is not denied as in Rosenberg's conceptualization of the "framing" (1992), or Figert's notion of the "structuring" (1996) of illness, but at the same time, sociological insights and processes are able to be included in a much more viable way than the reductionism of social constructionism (Busfield 2001, 5).

The work of Fulford and others in developing values-based medicine (as complementary rather than oppositional to evidence-based medicine) is a crucial strand in this rather more sophisticated and interactionist theorization of illness processes, and Fulford and Colombo's work on models of mental disorder can be situated within this productive fusion.

In the early twenty-first century, advances in medical science, through genetics, the neurosciences, and pharmacology, can be argued to have eclipsed the explanatory value of social scientific understandings of mental illness (Busfield 2001), as the tendency to portray genetic factors as the ultimate solution is reinforced by the media and the social hegemony (Conrad 1997). If we are to avoid the dangers of both ends of the biological/cultural reductionist spectrum, continuing to develop and refine...