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Mental Illness as a Socially Constructed Disease
Sarah R. Brand
What we now define as mental illness has a long and twisting history. We find mental
illness depicted in cave drawings (men having sexual intercourse with animals, now given the
name of paraphilia). Madmen, depicted in paintings with Christ, were put on “ships of the
insane” during the Middle Ages and were publicly whipped during the Renaissance. We have
through recorded history many examples of the mentally ill receiving harsh treatment. This
paper examines why we view mental illness differently than we do other illnesses, such as flu
or bronchitis. In important respects, mental illness is as much a socially constructed disease as
it is a physiological one.
Consider schizophrenia, one of the oldest, most documented, and least understood of
all the behaviors that fall under society’s category of mental illness. Nearly 1 in 100 people
will develop schizophrenia during their lifetime, usually during late adolescence or early
adulthood. Beyond dispute, schizophrenia has physiological causes. Schizophrenia has been
linked with brain abnormalities and genetic predisposition to the condition. Postmortem brain
examinations have shown excessive receptors for dopamine, which may explain the
hallucinations and paranoia often experienced by schizophrenics. Abnormal brain structures
have also been speculated to play a role in many of the symptoms of schizophrenics. If a
person has an immediate family member with schizophrenia, his or her chances of developing
the disorder become 1 in 10 and almost 1 in 2 if that person has an afflicted identical twin,
even if the twins are reared apart (Myers, 2001).
In order to examine mental illness, one must first look at the symptoms that cause the
patient to be diagnosed with a disorder. In every society, there are cultural norms, which are
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both implicitly and explicitly stated. When a violation of one of these norms occurs, the
violator is regarded as deviant. According to Becker (cited in Scheff, 1966, p.32), “deviance is
not a quality of the act the person commits, but rather a consequence of the application by
others of rules and sanctions to an ‘offender.’ The deviant is one to whom that label has
successfully been applied.”
Take the classic case of a man talking to God. Hearing voices and responding is a
classic symptom of schizophrenia, a condition we know to have physiological causes. If the
circumstances surrounding the situation were that the man was homeless and wearing dirty
and torn clothes, he would be viewed one way. Were that man actually the Pope talking to
God during the Easter service in Rome, he would be viewed quite differently. In order for the
act of talking to God not to be labeled as deviant, it must take place under a socially proper
circumstance, and must be conducted by a person recognized as legitimate. People who do not
conform to these norms break the rules of our society. The classic behaviors of schizophrenia
violate social norms. They are not necessarily underlying pathologies. By defining what
behaviors are considered culturally acceptable, by deciding who can legitimately perform
these behaviors, and by labeling norm-breakers as deviant, our society constructs mental
illness.
Almost all of the symptoms listed in the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV) can be viewed not as psychological disturbances but as violations of
cultural norms. According to Scheff (1975, p. 8), these symptoms “can be redefined as
offenses against implicit social understandings.” According to the DSM-IV (American
Psychological Association, 1994), in order to be diagnosed with schizophrenia, the person
must meet the following criteria:
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1. At least two of the following symptoms, each present for a significant portion of time during
a one month period:
a. Delusions.
b. Hallucinations.
c. Disorganized speech.
d. Grossly disorganized or catatonic behavior
e. Negative symptoms
2. Functioning markedly below the level achieved prior to onset.
3. Continuous signs of the disturbance for at least six months, at least one month of which
includes symptoms in full and active form (p. 312).
In many non-Western cultures, both delusions and hallucinations are regarded as signs
of extreme religious power. It could even be argued that in the Bible, a core text of Western
culture, Moses suffered from hallucinations when he thought he was talking to God or seeing
someone in the burning bush. The same argument can be made about someone who exhibits
disorganized speech or disorganized behavior today. Normality is a cultural construct.
Symptoms that violate agreed-upon rules are viewed as abnormal. The person with more than
two such symptoms for a predetermined amount of time is labeled mentally ill.
What happens to the person so labeled? According to Scheff (1975, p. 10) and his
labeling theory, “If labeling occurs (that is, if the rule breaker is segregated as a stigmatized
deviant), the rule breaking that would otherwise have been terminated, compensated for, or
channeled may be stabilized; thus the offender, through the agency of labeling, is launched on
a career of ‘chronic mental illness.’” In our society, a career of chronic mental illness has
many social stigmas attached to it that other physiologically caused conditions (like cancer)
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do not. Examined in terms of this paper, the label of insanity may become self-fulfilling. On
seeing everyone he contacts treat him as a "madman," the schizophrenic may retreat further
into his condition in an effort to insulate himself from harsh social judgments.
Through the example of schizophrenia, a disease with clear physiological causes, we
have seen that mental illness can be understood as much as a socially constructed ailment as it
can a physical one. That this is so exacerbates the illness and makes recovery that much more
difficult: not only must sufferers deal with their illness, they have harsh societal judgments to
overcome.
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References
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th
ed.). Washington, DC: APA.
Myers, D. G. (2001). Psychology (6th ed.). Holland, MI: Worth Publishing.
Scheff, T. (1975). Labeling madness. Englewood Cliffs, NJ: Prentice-Hall.
Scheff, T. (1966). Being mentally ill: A sociological theory. Chicago, IL: Aldine Publishing
Company.