The foremost question relating to mental illness concerns about its very existence - whether mental illness actually exists or not? According to Thomas Szasz, mental illness is a mere myth (Szasz, 1960) and does not exist, as illness can be defined only in terms of physical pathology and most mental disorders have no such demonstrable pathology. In a similar viewpoint, it was argued that biology was not relevant to the disorders of mind and behavior and such disorders could be fully understood from a sociological point-of-view. (Laing, 1960) Another theory is that some forms of mental disorders are the result of social incompetence and can be cured by social skills training. (Tower, Bryant and Argyle, 1978)
However, the medical profession holds the opposite view and is satisfied that mental illness does exist and is usually divided into two major groups - the psychoses and the neuroses. (Roth and Kroll, 1986) Psychotic disorders, also knows as personality disorders include schizophrenia, manic-depressive disorder, psychotic (severe) depression, while neuroses comprise of anxiety disorders, obsessive-compulsive disorder, dissociative (hysterical) and somatoform disorders and neurotic (mild) depression. The rapid advances in clinical treatment of many of these disorders have strengthened the case of the medical view of mental illness.
However, Szasz discards the popular notion among medical professionals that mental illness is a sign of brain disease and cites two fundamental errors in such a view. First, diseases of the brain are due to neurological defects. For example, a defect in an individual's brain cells may be linked satisfactorily to some problems in the nervous system. But the individual's belief cannot be linked to any defect in the nervous system and hence cannot be a disease of the brain. A person's belief that he is on the threshold of death, despite medical evidence suggesting otherwise, cannot be linked to any defect or symptoms in nervous system. The second error is the way in which mental illness is observed and expressed.
According to Szasz, complex psycho-social behavior is the result of changes in communications between the individual with the environment and hence cannot be considered as mere symptoms of neurological functioning. Just as the notion of a body related symptom is linked to anatomy and genetics, mental symptom is tied to the social context. In a different perspective, Eysenck postulated that mental disorder does have biological roots; however, understanding the biology of mental illness is nothing but an extension of understanding the biology of personality traits. (Eysenck, 1960)
With a precise and complete definition proving to be elusive, the next question is that whether there is a unique model that can fully cover mental illness? Irrespective of whether there is a satisfactory definition for mental illness or not, it is generally debated that mental illness encompasses many elements - biology, physiology, sociology and psychology, not necessarily in that order. However, the models describing mental illness focus on a single theory and dismiss the others as unrealistic and irrelevant, thus generating more and more debates and arguments on the subject.
There is no ambiguity in the fact that mental illnesses carry a social stigma. In most societies, people with mental disorders are grouped under the general category of 'mad' or 'crazy'. The 'affected' persons are often isolated and treated with fear and suspicion. Such a behavior is not uncommon even among educated and otherwise well-meaning adults. To understand this behavior, it is necessary to understand how the common man perceives mental illness. From a sociological perspective, the concept of deviance comes into significance in the discussions relating to mental health.
Deviance is how the society defines aberrations from accepted norms. When a person thinks or acts outside the norm, he or she is said to be deviant; many societies view acts of deviance as unacceptable and even criminal. To cite an example, even developed societies brand homosexuality as deviance and do not accept such groups, at least in public. Individuals, while aspiring to be deviant in pursuit of extraordinary achievements, would still tend to subscribe to the society's framework and try not to be labeled as deviant for fear of isolation and persecution. But historically, the evolution and growth of mankind has always been based on free will and man's ability to deviate from accepted norms in pursuit of his objectives. However, when the framework of norm overlooks social and psychological factors, then individuals attempt to act outside the norm and such behavior is labeled deviant. (Macionis, 2001)
Deviation is one of the central concepts in defining mental illness. According to Goffman, what is referred to as mental illness is nothing but the failure to abide by the rules established for the conduct of face-to-face interaction. In Szasz's view, a person not following certain rules (deviance), which the majority follow is seen as mentally ill; when the person does not respond to the general requirements or punishments, then such a person is rated as seriously mentally ill. If this premise is accepted, then mentally ill patients cannot be treatment normally as in the case of other illnesses.
Physical illness is the deviation from the accepted norms of structural and functional state of the human body. Thus, health can be clearly defined in anatomical and physiological terms. Applying this concept to mental illness, what are the accepted norms from which the deviation can be observed in the so-called mentally affected individuals? Szasz is convinced that, if there is any norm to define the state of mental health, it must be only in terms of psycho-social, ethical and legal issues. Naturally this conclusion is not acceptable to the clinical profession. This leads to the important question: 'Who decides the norms of mental health and hence the deviation?'
There are two possible answers - either the individual himself is convinced that he is unhappy with the existing scenario and hence deviating from the norms or some other person, including but not limited to family members, physicians and legal authorities, who become unhappy with the behavior of the affected person. It is mostly in the latter case, when others decide that the individual is deviant, when they hire a psychiatrist to correct the perceived deviation. The downside of such a position is that what deviant behavior for one group is, need not be true for the other. Different people live by different rules and norms and thus the yardstick for deviant behavior cannot be uniform in all respects.
In his book, Society, the Basics, Macionis describes the example of a homeless individual wandering on a cold night and refuses help to be taken to a shelter. This is a classic example of how deviance in perceived by the society. In this case, the individual does not want to be taken to the shelter; he is probably right in refusing the help of shelter, as he knows that he can withstand the cold weather. It is highly likely that he is only exhibiting a difference from normal behavior, as many people often tend to do; for instance, having ice-cream in freezing weather, or dancing in heavy rain. But probably because he is homeless and people tend to get irritated or troubled at his helpless position; his behavior is viewed as deviant. Probably, if a wealthy man wanders without his shirt on a cold day, it would not have been seen as so much as deviant and the reaction would be nothing more than a mild surprise.
Szasz argues that mental illness is increasingly used to refer to the deformity of personality. Under this view, since mental illness produces undesirable behavior, it must be the root cause for human disharmony. (Szasz, 1960) However, this is not the case since there are two unstable elements in this version - one, the assumption that the society is harmonious, except for the presence of mental illness in some people and two, the definition of socially acceptable behavior, which is not uniform across all societies. This argument also leads to the inference that mental illness is a cause for something (disharmony), whereas the objective was to describe what mental illness is. In this context, the question that is to be addressed is: 'What kind of behavior can be classified under mental illness and by whom?"
One of the major areas of concerns voiced by sociologists and psychologists is the labeling effect of mental illness. The labeling theory stresses that deviance or conformity to norm, arises more from the response of society to the perceived behavior of individuals, rather than the actual behavior itself. For instance, once a psychiatrist gives opinion that a patient suffers from mental disorder, the labeling effect comes into play immediately. The attitude and reaction of the family members and close friends towards the individual, changes suddenly. This change can further upset the mental state of the patient. Another effect of labeling is that, it is common for the patient herself to expect symptoms of that disorder, although she may not be actually suffering from the symptoms. For instance, it may be difficult…