3 Feb 08 – Mental Illness: A Social Construction?

3 February 2008

On this day in 1845, Dorothea Dix presented a document to the Pennsylvania state legislature describing her 2-year survey of the state’s treatment of people with mental illness.  She found people with mental illnesses in jails, alms-houses, and cellars of public buildings.  As a result of her presentation, the Pennsylvania State Lunatic Hospital was created.

This story brings up the question of what is mental illness.  How did Dix determine that the mentally ill were to be found in these different locations?  How do we define mental illness? 

We can read a lot about the typical definitions, to be found in our diagnostic manual, The Diagnostic and Statistical Manual of Mental Disorders (DSM) now in its 4^th edition (with a text revision).  Essentially, disorders are defined based on expert consensus and research conduct on these professionally accepted constructs. 

An alternative view, however, was presented by Thomas Szasz in his book entitled, Myth of Mental Illness (which was originally published as an article in the American Psychologist).  Szasz traced the history back to the Middle Ages and a pair of monks named Sprenger and Kramer, which always makes me think of a bad daytime talk show.   

[SIDE NOTE: In fact, Sprenger and Kramer did have a bit of a scam going on where they claimed to be clairvoyant.  They would set up a tent.  One of the two would gather information from the people outside the tent.  The people would be ushered in and the one who gathered information would go around the back of the tent and feed information to the one in the tent doing the “clairvoyancy,” thus making the people believe that they knew things they couldn’t know.]

Though the history of people being conceived of as mentally odd probably goes back further than Sprenger and Kramer, these two codified a specific category of mental deviance in a book entitled Malleus Maleficarum (which means “Hammer of Witches”).  In this book, Sprenger and Kramer developed means of determining who witches were.  They defined them based on certain features, which are relatively unimportant to the present discussion.  What is important is that this book was used to determine who were witches.  Then, individuals used it to go out and find witches.  Unfortunately, those finding the witches were paid on a sort of commission, wherein they received the lands of those found guilty of witchery.  So, it is probably not surprising that a number of single women were found to be witches.

 

At any rate, in the 1960s, Zilboorg discovered the Malleus Maleficarum and made the following statement, “the Malleus Maleficarum might with a little editing serve as an excellent modern textbook of descriptive clinical psychiatry of the fifteenth century, if the word witch were substituted by the word patient, and the devil eliminated.” Essentially, Zilboorg felt that Sprenger and Kramer, who happened to be a couple of con artists, had created a document, which happened to be used selectively to fabricate witchery and claim riches, was an excellent frame of reference for defining mental illness – if only we were to change the word witch to patient and take the devil out of it.

Szasz came along and interpreted both the Malleus Maleficarum and our current diagnostic system as social fabrications.  The point of both were to control people that did not fit neatly into the current social system.  In essence, Szasz said that “mental illness” was a social construction.  Szasz also felt like the “treatment” of this social construction was borderline abusive.  For example, he described the treatment of the “father of modern psychiatry” whose face appears on the DSM, Benjamin Rush.  Benjamin Rush was a signer of the Declaration of Independence, the personal physician of George Washington (and probably bled him – a common treatment at the time – to death), and a psychiatrist.  Rush’s treatments sometimes involved spinning people excessively until they said they no longer were experiencing the aberrant thoughts/behaviors.  He also devised specific treatments for specific individuals.  One person thought he had snakes in his intestines and Rush gathered some snakes from his garden, put them in a bucket, and had the person defacate in the bucket – now the snakes were out!  Another thought he was a plant and Rush urinated on him to kill the plant (or some such).  This, for Szasz, was evidence enough of the origin of poor treatment of those deemed “mentally ill.”

I guess, given this, it is not a far stretch that Dix would find the mentally ill in such destitute locations.  Still, we might benefit from some better understandings of what mental illness truly is.  Instead of accepting particular framings, we might benefit more from understanding the humanity and inhumanity that is involved in such designations and the treatment that stems from it.  What, for example, does it mean for those individuals, without words such as “crazy,” “depressed,” “anxious,” etc., to feel what they feel?  What does it mean for them to be told they are depressed, anxious, crazy, etc.?  What does it mean for them to be treated the way they are?  What are their relationships like?  How do they feel they fit into the world?  How do they conceive of the world?  What do the hallucinations and delusions of schizophrenics mean to them?  If there are some meanings to them, should we dismiss them as the result of a biochemical imbalance and treat them, as a result, with some psychotropic medication and ignore the meaning that these individuals do have?

Fuel for thought, I guess… head to my website GivingPsychologyAway.net for more fuel for thought regarding psychology.