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The Factors that Underlie the Understanding of Mental Disorders
Cianna Carvalho
0620596
Trent University, Department of History
HIST/SOCI 2601: History of Medicine
April 5, 2021
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Mental health is a concept that has been of interest since the consideration of the
importance of public health. Mental health can be defined as a condition which fluctuates in
response to biological and social factors and enables an individual to maintain a balance of
instinctive drives, relationships with others, and to advocate for constructive change in their life
(Bertolote, 2008). The mentally healthy individual is able to maintain control of their instinctive
drives, have positive relations with others, and welcomes constructive change in their lives in
response to the biological and social factors that drive change in one’s life. The individuals that
were unable to maintain the expectations of what every individual should be competent of doing,
they were declared to be in a state of mental illness. The treatment of mental disorders has
changed in response to level of understanding of the etiology of mental illness. The factors that
have been most influential in the understanding of mental disorders have been recognizing
cultural impacts on mental health, the events that precede mental illness, and the increase in
social awareness of the importance of mental health. These factors illustrate the importance of
considering the circumstances unique to the individual, including society’s perception of mental
illness, when diagnosing an individual with a mental illness.
The understanding of mental health began with determining what represented an
abnormal presentation of behaviour. One of the abnormal behaviours that was debated was
mania. Mania was described as being sudden and resulting from an extreme emotion that can
result from consuming excessive alcohol or from being incarcerated for long periods of time
(Sankey, 1873). Mania was said to take time to reach its peak (Sankey, 1873). The definition of
disorders was debated amongst psychiatrists due to the need to have observed similar behaviour
in one of their patients in order to confirm the definition to be adequate in addressing the
symptomology of a disorder (Sankey, 1873). The professionals in the mental health field differed
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in the focus of their definitions of mental illnesses due to some focusing on the prominent
symptoms of a disorder and others focusing on what was believed to be the cause (Tuke, 1856).
The preferred way of considering the cause of mental illness is to focus on the affected function
due to the structure of the mind being undetermined (Tuke, 1856). Therefore, the exploration of
mental health and what constitutes mental illness must consider the circumstances that result in
individuals experiencing impaired functioning.
The cultural impact of mental health became relevant when considering the needs and
mental health of all people rather than on only the burdens to society. This is exemplified in the
realization that there are many contributing factors that enable an individual to be classified as
mentally ill. Individuals may have to deal with circumstances outside of their control such as
grief from the loss of a loved one or anxiety from the pressure to be able to afford to survive can
contribute to a situation in which an individual is unable to cope (Bucknill, 1877). The ability for
an individual to cope may be limited based on their own needs. Individual may turn to selfmedicalization, especially in instances prior to the development of drug therapies. Individuals
would use alcohol as a coping mechanism in order to make the situation that they were in
bearable and to be able to continue through their difficult experiences (Bucknill, 1877). Alcohol
was known to be able to partially paralyze the nervous system and allow for people to escape
their reality (Bucknill, 1877). The ability of being able to rest and not be concerned with the
symptoms of a mental illness becomes a powerful tool when an individual is struggling to cope.
This is especially true if there are no services accessible to them to be able to receive treatment.
However, men are twice as susceptible to becoming alcohol-dependent than women (Haggett,
2015). Therefore, men chose a coping mechanism which can be as dangerous as their mental
health concerns. This was also demonstrated by fifteen of thirty-four patients that experienced
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hallucinations in a psychiatric facility having their mental illness attributed to alcohol use
(Robertson, 1875).
The barriers to being able to receive help in times of mental distress were becoming more
salient in the awareness of the public health officials (Bertolote, 2008). One example of a
situation where an individual may feel overwhelmed by their situation is in a flooding. One way
for the individuals facing this situation to be assisted would be the recognition that individuals
that had been evacuated from their homes due to flooding would benefit from the support of
mental health workers (Bains, 2005). The mental health workers assisted those affected by
providing for their basic needs and concerns in order to reduce stress (Bains, 2005). This
demonstrated that a situation can be the cause of stress in an individual’s life and present
reasoning for being deserving of extra assistance. This is an instance where individuals were not
able to control the events in their lives and were viewed as deserving of help when considering
how another person in the same situation would react and cope. Stress became known as a
negative health consequence and that it resulted from the pressure to maintain the societal
standard of living (Haggett, 2015). Stress presented itself during the war through abdominal
illness. It was known that anxiety, cold, fatigue, and deficient diets increased the likelihood of
developing a stomach ulcer. However, the effects of long-term stress on the body had not yet
been investigated. The incidence rates of abdominal issues had increased significantly since the
beginning of the war both for soldiers fighting and for the civilians (Miller, 2010).
The barriers to accessing services are not the only barriers for consideration. Once an
individual receives treatment, they may not want to leave the facility. This is due to the potential
for the individual to remain at a facility for a long period of time and no longer recall how life
was prior to their entrance in the facility. The individuals that receive help may become reliant
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on the assistance and lose the ability to self-regulate due the structure of psychiatric facilities.
The facilities provide a high level of structure for the patients that would be difficult to replicate
in a household, especially if the individual were required to hold themselves accountable. This
was demonstrated by a patient recovering from their mental illness and deciding not to leave the
facility (Robertson, 1875). The patient did not know how to return to the community and became
anxious about re-entering society without the ability to have the same level of support as the
facility (Robertson, 1875). The support from the individual’s family was lacking initially, which
caused the individual to be admitted to the facility to receive adequate care.
The cultural impact on mental health was also relevant when considering what would be
expected within one culture would differ from another. The need to create exemplars of what a
mental illness would present itself as in a given society was important so that the diagnostic
criteria could be modified based on the cultural norms (Bains, 2005). It was thought that
psychological differences between races presented themselves as a result of differences between
cultures and their expectations within communities (Bains, 2005). The discussion of culture
resulted in race being a consideration for the ability for non-white people to have the same
mental capacity (Bains, 2005). However, the discussion allowed for the reflection of the effects
of oppression on an individual’s mental state (Bains, 2005). The ethnic minorities that
experienced mental illness had difficulties in other aspects of their lives. The minority groups
struggled to find employment, make friends, and engage in everyday activities (Haggett, 2015).
This suggests that ethnic minorities with mental illnesses were unable to seek treatment. The
issue of racism in mental health was remedied by the individuals who practiced in areas with
ethnic minority populations were an ethnic minority themselves (Bains, 2005). The issue that
may arise with this is that the psychiatrists that continue to practice in the white communities
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would not gain experience with the issues unique to ethnic minorities and how those issues
would present themselves. It is possible that certain demographics would present symptoms in
different ways. The doctors of ethnic minorities were not capable of recognizing symptoms of
mental illness in their patients (Haggett, 2015). The doctors were likely not trained or
accustomed to examining disorders of a psychological origin. Furthermore, ethnic minorities do
not believe that their doctors are capable of treating their mental health concerns (Haggett, 2015).
This is exemplified by men presenting symptoms of mental illness somatically rather than
symptoms related to mood and motivation (Haggett, 2015). Those with mental illness in minority
groups feel as if they cannot discuss their mental health concerns (Haggett, 2015). This
resembles men feeling compelled to self-medicalize rather than seeking treatment for their
mental illness. Therefore, not only would the issues that may act as the cause of the mental
illness differ between ethnic groups, but also the presentation of symptoms which the
psychiatrists that practice exclusively on white patients would not be capable of identifying.
Race becomes an important consideration with diagnosis because of the different
precognitions which a psychiatrist or other medical professional may have about a culture and
their behaviours. These precognitions can arise from the ideas and ideals within society of what
is and is not considered to be normal. For example, ethnic minorities were diagnosed with
schizophrenia more frequently than white people (Bains, 2005). The diagnosis of schizophrenia
caused individuals to be involuntarily admitted into psychiatric hospitals (Bains, 2005). This is
significant because it allowed for ethnic minorities to be removed from the community without
requiring them to be convicted of a crime. The psychiatrists were trusted to diagnose people
accurately and according to the knowledge of the symptomology of mental illnesses. The
primary forms of treatment within the facilities relied on communication between a psychiatrist
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and the patient, which would require that the patients spoke English (Bains, 2005). However,
ethnic minorities may not have been able to speak English to communicate with the psychiatrist
and would also experience difficulty in explaining their symptoms because of this (Bains, 2005).
The events that precede mental illness do not guarantee an individual will experience a
mental illness in their lifetime, but they do increase the likelihood that the individual will
experience some form of mental illness. Mental illness was thought to exclusively occur in those
that were unfit for society. The individuals who were struggling with mental illness became
grouped with the individuals with intellectual disabilities. This was done because society was
unable to find facilities to effectively care for and treat those that required accommodations in
order to meet the societal standards. Therefore, the ability to place both the individuals with
mental illnesses and the individuals with intellectual disabilities into one facility that would rid
the community of caring for unproductive members of society was viewed to be the best option.
The goal was to allow for society to be free of any individuals that did not conform to the norms.
The label associated with being diagnosed with a mental illness carried significant
stigma. There were perceptions that individuals with mental illnesses were weak and unable to
bear the strains of daily life. However, this perception was shifted when there were soldiers
returning from their time serving in the war with mental health concerns. The juxtaposition of a
strong man that was able to fight for their country in a war with many casualties and then to
return home and be unable to reintegrate into society caused people to recognize that mental
illness can affect anyone. Mental illness did not only target the weaker portions of society, but
rather the admired individuals that chose to risk their lives to serve their country (Haggett, 2015).
This allowed for the perception of individuals with mental illnesses to no longer be focused on
the burdens within society that could be neglected.
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The individuals affected were those that should be respected for their efforts in serving
their country. Additionally, the individuals that were in need of help were no longer the women
that were ruled by irrationality and lacking the functional capacity to co-exist in society with
others (Haggett, 2015). The ones in most need of help were the men of the community that were
thought to be strong and powerful. Women were excused for being unable to cope with daily life,
but with men it became a concerning issue. Women were expected to hide any struggle that they
encountered with mental illness to match the restraint and rationality that was exemplified by
men (Haggett, 2015). This was possible due to the woman’s role in the home and being able to
keep themselves away from society. Women that care for the home and the children have a lack
of structure in their lives which allows for time to think about one’s issues and troubles in life
(Gove, 1972). However, the men had a more valuable role. Men were required to work for the
family to act as the source of income. Men were necessary to being able to contribute to the
demands of their workplace and the time consumed by the work environment does not allow for
the man to think about the issues in his life as often because he is occupied (Gove, 1972).
Therefore, due to the value of their daily work, when men began to encounter mental health
issues it became the concern of the community. This demonstrates that men were viewed to have
a more foundational role in society compared to the women. Men were given more privileges
and considerations in all aspects, especially when considering health. The importance of mental
health was not at the forefront of society until there were men that returned from war and were
unable to contribute to society. This indicates that men are the source of the welfare of the
community. When women are unable to cope with their life circumstances they are disregarded
and believed to be overdramatic. Men are the ones that are able to prove that there is a legitimate
concern with the well-being of people in society.
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In conclusion, the factors that have been most influential in the understanding of mental
illness have been the consideration of cultural impacts on mental health, the events that precede
mental illness, and the increase in social awareness of the importance of mental health. The
cultural impacts on mental health have manifested themselves both through culture within
society, but also in ethnicity and the importance of recognizing the unique circumstances for
individuals in ethnic minority groups. The events that precede mental illness can be influential in
the development of a mental illness due to the potential of developing trauma related to an event.
Additionally, the events that an individual experiences should be considered when making a
diagnosis because the event could have made a significant impact on the individual. The increase
in awareness of the importance of mental health in society allows for individuals with mental
illnesses to feel less isolated from their community. This is important for allowing for the reintegration of individuals with mental illness into society. Therefore, the understanding of mental
illness has been enriched by the consideration of culture, individual circumstances, and societal
ideals.
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References
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