Now publishing in a fully revised, updated and expanded fourth edition, Psychology of Physical Activity is the most authoritative, engaging and up-to-date introduction to exercise psychology currently available. It is essential reading for all students working in exercise and health sciences. Authors: Stuart J. Biddle, Nanette Mutrie, Trish Gorely. The positive benefits of physical activity for physical and mental health are now widely acknowledged, yet levels of physical inactivity continue to increase throughout the developed world.
Part IV: The politics of diagnosis How the psychiatric and associated professionals conceptualise, rationalise and utilise diagnostic constructions in their work, in spite of the continuing gaps in their knowledge on mental illness, is the focus for the fourth part of the book on the politics of diagnosis.
The authors outline in detail the ongoing problems of reliability and validity which have haunted the constructions of each edition of the DSM, as well as the regular distortions of double-blind random control trials focused on identifying the aetiology of mental disease. Cohen which, at best, is met with local amusement and, at worst, denies local coping strategies and seeks to pathologise survivors of war and natural disasters.
It is often assumed that what psychiatry lacks in knowledge of and effective treatment for mental illness can be compensated by turning to therapeutic interventions such psychoanalysis, group therapy, counselling, cognitive behavioural therapy CBT or any of the many other forms of talk therapy currently on the market.
Many critics of bio-psychiatry forward therapy as a means to develop a meaningful, trusting and compassionate relationship with clients through which trauma and distress can be successfully addressed and treated see, e. Breggin ; Davies However, for psychotherapy to aid true, revolutionary transformation, Parker concludes that it is necessary to link such practices to the wider socio-political struggles against the individualising tendencies of capitalism.
It also continues to offer highly important insights into the arrogant and dogmatic tendencies of talk therapists.
Burstow, B. New York: Palgrave Macmillan. Cockerham, W. New York: Routledge. Cohen, B. London: Palgrave Macmillan. Cooper, D. London: Tavistock. London: Routledge. Davies, J. London: Icon. Durkheim, E. Foucault, M. Goffman, E. London: Penguin. Illich, I. Middlesex: Penguin. Laing, R. Lieberman, J. New York: Little, Brown and Co.
Masson, J. New York: Ballantine. Parsons, T. Scheff, T. Chicago: Aldine. Shorter, E. Cohen Szasz, T. Szasz, T. Whitaker, R. Zola, I. It can be seen as a social constructivist approach with a kinship to notions such as medicalisation, stigma and normalisation.
This always involves certain power dynamics, and the labelling is often understood as a form of social control. Since its introduction in the early s, labelling theory has inspired empirical research into a wide variety of mental health issues investigating lay as well as professional settings.
This chapter discusses the labelling theory of mental illness as originally presented by Thomas Scheff in , as well as the debates and developments that have followed his work. His work was part of a broader strand of research on labelling and deviance founded in symbolic interactionism. The early contributions were primarily made by scholars interested in crime such as Tannenbaum and Lemert , but also with other deviant groups in focus such as the classic research on drug takers from Becker He notes that this happens when someone violates formal or informal rules.
Rules are broken constantly and very often without any reaction from others. Instead, Becker concluded that deviance should not be regarded as an inherent quality of rule infractions by deviants; the decisive factor determining when someone will be labelled as deviant is the reaction from others. This position has political implications, since it serves to relativise deviant acts and puts emphasis on the power dynamics involved when certain behaviours, individuals or groups are labelled as deviant.
Becker notes that, apart from legal powers, social structures and hierarchies in terms of ethnicity, social class, gender and generation form what is constructed as deviance in a given time and place. The negative reactions and potential sanctions to deviant behaviours are mediated through moral entrepreneurs, who in turn can be divided into rule creators and rule enforcers. Becker discusses the former in terms of moral crusaders who advocate that certain behaviours are unwanted and should be sanctioned by society.
Modern examples of behaviours that have been questioned by moral crusaders include excessive computer gaming and public smoking. If they are successful, the behaviours moral crusaders object to may become viewed as deviant by larger groups in society. For example, clergy in certain Islamic contexts create rules about what clothing is appropriate for women to wear. Under certain conditions, such rules will be enforced widely in a society or subculture.
The arbitrariness of such rules is obvious when we consider how the same items of clothes that are prescribed in some cultures may be banned in others.
Becker also argues that the actual labelling of a behaviour as deviant can feed back to the rule-breaker in a way that reproduces and reinforces patterns of deviant behaviour. Thomas Scheff on the labelling of the mentally ill Drawing from the work of Becker and others, Thomas Scheff then undertakes his comprehensive study of how mental illness can be understood in terms of labelling.
His theory of mental illness is contrasted against a medical model which conceptualises the source of mental illness as residing within the individual; consequently, treatment measures aim at modifying internal patterns, whether psychological or neurological. What is unique in how people are labelled as mentally ill, Scheff argues, is the type of rule-breaking that instigates reaction from others.
However, there also exists a residue of subtle, often unspoken rules that have no obvious connection to forms of deviance that already have a label. Scheff claims that most features that are viewed as psychiatric symptoms can be regarded as residual 16 Labelling theory rule-breaking.
For example, this would be the case when someone talks back to her internal voices, claims that she is the saviour of the world or insists that her life is so dull and meaningless that even her close family would be relieved if she was dead. He thus suggests that what Goffman has described as rules of engagement for instance, not to withdraw too much, having a purpose and so on qualify as residual rules. In developing his theory, Scheff presents nine fundamental propositions, some quite well grounded in empirical research, some more conjectural: 1.
Residual rule-breaking arises from fundamentally diverse sources. He shows how this transgresses a limited medical model understanding of mental illness as biological pathology and instead highlights the social sources of stress and volition. Other known external stressors include those related to working life and school settings.
As for volitional sources, Scheff refers to art movements such as the French impressionists and the Dadaists. A contemporary example of volitional rule-breaking can be seen in forms of body piercing that appear objectionable to the majority. Relative to the rate of treated mental illness, the rate of unrecorded residual rule-breaking is extremely high.
Scheff cites the then-contemporary literature from the s that indicates how psychiatric symptoms are, in fact, very common in the general population. This leads to the next proposition. Here, Scheff suggests that the normal response to strange behaviours is to ignore or forget about them without reacting against the rule-breaker.
This is what makes labelling theory so powerful — shifting the attention from symptoms themselves to the social responses to rule-breaking as the major determinant of when a person will be diagnosed with a mental illness. Stereotyped imagery of mental disorder is learned in early childhood. Although Scheff admits that this proposition lacks support in empirical research, it does appear plausible and on a par with what we know about the current negative perceptions of mental illness among the public Angermeyer and Dietrich , as well as the long history of ideas on madness Foucault ; Scull The taken-for-granted ideas about madness and mental illness that have been established in Western society are, then, reinforced through contemporary culture.
The stereotypes of insanity are continually reaffirmed, inadvertently, in ordinary social interaction. Scheff notices how terminology related to mental illness is incorporated in everyday language. Due to the high prevalence of residual rule-breaking in society in general, there will always be a pool of earlier infractions to look back at and reinterpret in light of the new label; the recent behaviour can be seen as only part of a progress towards insanity.
This process is facilitated by the fact that the labelled person, as part of the same culture, draws from the same cultural perceptions as those around her. The next three propositions deal with how the person labelled reacts on being labelled and how she thus becomes inclined to accept the deviant role: 6.
Labelled deviants may be rewarded for playing the stereotyped deviant role. Labelled deviants are punished when they attempt the return to conventional roles. In the crisis occurring when a residual rule-breaker is publicly labelled, the deviant is highly suggestible and may accept the proffered role of the insane as the only alternative.
In fact, accepting and adhering to the labelled role may be rewarded. It may open possibilities to solicit help with material matters such as housing and welfare payments.
Medical treatments such as tranquillisers can be attractive, and there may also be social and emotional rewards in the social engagement of professionals, family and friends in support of a person who accepts the role of being mentally ill. Moreover, alternative interpretations and labels of her behaviour may be even more stigmatising — for instance, no one wants to be seen as being evil or stupid. In fact, rejecting the label may even be seen as evidence that the person really is ill.
Scheff notes that, when residual rule-breaking occurs, there is likely to be some kind of crisis, both for the rule-breaker and the people around her. This last proposition constitutes a serious critique of the medical model and the measures psychiatry applies to treat people labelled as mentally ill. Within this broad movement objections were raised against the inhumane treatment at large institutions Belknap ; Labelling theory Goffman , but also against the legitimacy of coercive treatment Breggin ; Livermore et al.
A less radical but still critical approach to diagnosis was taken by those who argued that medical psychiatry failed to acknowledge the psychological and social aspects of mental illness Jones ; Laing and Esterson Goffman also applied a career perspective on patients, noting mechanisms that rewarded patients to remain in a sick role.
To Goffman, a stigma is an attribute of an individual that causes those around her to react negatively due to existing stereotypes. There are three types of stigma that are relevant to mental illness designations: stigma based on character traits, physical stigma and group identity stigma. Instead he is preoccupied with the social consequences of stigma and the stigma management of deviant individuals and groups. Goffman also distinguishes between different strategies for passing fabrication, concealment, discretion and revealing signalling, normalising, differentiating.
Stigmatisation may also lead to the creation of deviant subcultures. Traditionally, it has been rare for people with classic psychiatric diagnoses such as schizophrenia or depression to form positive group identities based on their mental illness label. However, with the expansion of identity politics since the turn of the millennium, the nature of stigma management may be moving more in that direction. The concept of stigma is perhaps the sociological notion that has had the most impact on other disciplines that take an interest in mental health.
In recent years, the notion has become operationalised into different measurement scales which are used to chart attitudes towards mental illness in the population as well as among professional groups.
A main protagonist in this debate was Walter Gove, who argued that it was the behaviour of the person rather than interpretive processes that had the decisive impact on whether someone would be diagnosed as mentally ill Gove , , Both Scheff and Gove conducted and cited empirical studies in support of their views Scheff , Later, Link et al.
They rejected the idea that labelling was a direct cause of mental disorder, but maintained that labelling could lead to negative outcomes. Faced with negative stereotypes and discrimination, claimed the researchers, individuals labelled with a mental illness might endorse strategies of secrecy and withdrawal that adds complexity to their problems.
In reviewing the Scheff—Gove controversy, Holstein has argued that the different approaches are restricted to empirical evaluation, yet they tend to agree on the same basic assumptions — even if Scheff prioritises societal reaction, he seems to agree with Gove about the existence of observable behaviours and symptoms that are specific to designations of mental illness.
Holstein thus alerts us to a fundamental distinction in how labelling theory has, and can, be understood. The nature of residual rule-breaking is another topic that has generated critical discussion.
In his book, Scheff does not expand on a definition of the nature of residual rules. In fact, his stated definition is somewhat paradoxical. Residual rule-breaking is the kind of norm violation that causes people to identify someone as mentally ill. Yet he defines residual rule-breaking as norm violations that are peculiar in the way that they are not associated to any specific label. One could also object that, in a given society, there are a number of behaviours that people in general would associate with mental illness or madness.
In the same vein, Smith has demonstrated the subtleness in the norm violations and interpretations that can be involved when people come to redefine a person as mentally ill. Nevertheless, it seems that a large number — if not most — of acknowledged symptoms of mental illness are not about breaking unspoken rules of everyday interaction for example, hallucinations, paranoia and suicidal thoughts. In his preface to the third edition of Being Mentally Ill , Scheff reflects on the above criticisms, agreeing with Gove that there is no clear evidence in support of labelling theory and favouring an approach that integrates insights from different disciplines such as sociology, psychology and biology.
In this edition, he increases the emphasis on the role that emotions have in the labelling process, particularly those of pride and shame. In a rare retrospective commentary, Scheff maintains that the theory has had little impact on disciplines other than sociology, or indeed the public at large Scheff, However, the reduced interest in labelling theory might not be taken as a sign of empirical and conceptual failure.
To some extent, some of its core ideas have been adopted and rephrased by various constructionist approaches to mental illness and psychiatric practice. Looking at current developments, it appears that it would be fruitful to apply labelling theory to the increased medicalisation of problems that previously were seen as everyday emotional or existential behaviour, or even entirely unproblematic Conrad and Slodden In particular, labelling theory has a potential to contribute to understanding the substantial growth in new psychiatric diagnoses in recent years.
Another phenomenon that could be analysed in terms of labelling is the increasing complexity and interaction between lay, service user and professional conceptions of mental illness Brown et al. Arrigo, B. New York: Garland.
Becker, H. London: Free Press of Glencoe. Belknap, I. New York: McGraw-Hill. Berring, L. Breggin, P. Brown, P. Chamak, B. Conrad, P. Dordrecht: Springer Netherlands, pp.
London: Paladin. Crossley, N. Diesfeld, K. New York: Random House. Garden City, NY: Anchor. New York: Free Press of Glencoe. Gove, W. Beverly Hills, CA: Sage, pp. Holstein, J. Interpretive Practice and Involuntary Commitment. Hawthorne, NY: Aldine de Gruyter. New York: Guilford Press, pp. Horwitz, A. New York: Academic Press. Jones, M. Koski, J. Lemert, E. Link, B. McSherry, B. Nasser, M. New York: Aldine. New York: Aldine de Gruyter.
London: Allen Lane. Scull, A. Smith, D. Solvang, P. New York: Harper. Tannenbaum, F. New York: Columbia University Press. Thornicroft, G. Oxford: Oxford University Press. They held that this was particularly the case when the diseases were psychiatric and no physical basis for them could be established. Furthermore, psychiatry was seen as a form of political oppression. Yet the label is a social fact. Indeed this label as a social fact is a political event. The book is both a sociological account of the social functions of psychiatry and a historical account of the emergence of insanity as a category in the West.
In particular the argument is that the late eighteenth-century reform of the asylum system under the influence of Philippe Pinel was not a breakthrough in the humane treatment of the mentally ill that progressive historians presented it as.
Rather it 24 The social construction of mental illness was the refinement of the incarceration of the mentally ill, sequestering them in asylums. So, for Foucault, the apparently naturally occurring and objective features of social life — sanity, in this instance — are cultural and historical products. In the medieval period, madness was not a distinct feature of social life. In the Renaissance it starts to become an identifiable characteristic of man and, with the great confinement in the classical age — , becomes antithetical to reason Foucault Medicalisation is the historical process in which medicine has replaced religion and law as the dominant institution of social control.
It also refers to the spread of medical definitions and processes into areas of life which have only a tangential relationship to the body and disease. Under the influence of Szasz, especially his book The Myth of Mental Illness , mental illness could be seen to be the effective labelling by someone in power the psychiatrist upon someone powerless the patient with a condition. These labels for example, attention deficit disorder ADD , bipolar disorder, oppositional defiant disorder ODD or schizophrenia occur in the absence of any physical evidence or test for a disease and are based upon professional judgement.
Hence, Szasz argued that labelling someone mad was accomplished in language and through professional intervention. It is these linguistic, structural and power-laden processes that then shape the reality of the situation.
Originally developed in the sociology of deviance, labelling theorists pointed to the way in which deviance was the product not of an act itself, but of the reactions of others to it. Sociologists of mental illness have used the theory to highlight the contextual nature of what it is — and who it is — that gets labelled as mentally ill Scheff The social construction of mental illness can be demonstrated in the institutional attempts by the American Psychiatric Association APA to consolidate a claim to be a rigorous part of the medical profession.
Diagnosing specific conditions was secondary to understanding their dynamics. This orientation was a weak base from which to define the medical speciality. It did not differentiate the occupation from a wide range of close competitors such as counsellors, psychologists and social workers. The solution was the DSM-III, where precise definition of specific disease categories provided medical respectability and drew clear enforceable boundaries around the profession: only psychiatrists could diagnose mental disease and prescribe drugs for them.
The strategy unravelled with the publication of the DSM-5 in After extensive revision, the new Manual came under major attack from within the psychiatric profession itself for 25 Kevin White labelling social conditions as diseases and for the influence of drug companies in spurring new disease categories for which drugs were the first point of treatment. It thus represents the medicalisation of human behaviour and its changing diagnostic criteria have been analysed to demonstrate the political and social construction of the disorder.
Although there are no biological tests for the condition it is treated with a prescribed drug, Ritalin Conrad It was named after Hans Asperger, who first diagnosed it in , though it was not a diagnostic category in the United States until the s when his work became available in translation. Once thought to be very rare, it became widely diagnosed, though the symptoms were said to be very mild and difficult to diagnose.
Because there are no clinically identifiable causes and because the diagnosis is so insecure, sociologists argue that it can be analysed as the medicalisation of socially inappropriate behaviour Conrad and Schneider Contemporary accounts of the social construction of mental illness by sociologists link the process of constructing, producing and distributing mental illness labels to specific power relationships in society.
In developing a social constructionist account of mental illness, the rest of this chapter will explore these issues of social class, gender and ethnicity in the social construction of mental illness in more detail. Mental illness and social position Sociologists have long demonstrated the social distribution and differential diagnosis of mental illness.
For instance, Faris and Dunham showed in that while manic-depressive psychosis appeared randomly distributed across the city of Chicago the diagnosis of schizophrenia, in contrast, was more common in poorer areas.
The debate over whether individuals diagnosed with some mental illnesses are more likely to be part of the lower classes because they have drifted down the social system as a result of their condition or whether mental illness is caused by poverty has been with us since the early twentieth century.
This is 26 The social construction of mental illness because of the political implications of the argument — if, on the one hand, mental illness causes downward social mobility then the implication is that it is an individual and biological condition, and therefore not amenable to community-directed policy intervention. In a period of conservative economic policy characterised by the withdrawal of the state from the provision of welfare services, this is a very attractive argument.
Studies demonstrating the social production and distribution of mental illness thus become highly charged political documents that show the role of inequality, class, gender and ethnicity as causes of mental illness in themselves. Of course, the policy implication is that what is socially, politically and economically caused can and should be ameliorated by state action.
In short, across all types of mental illness and, importantly, for the most severe, such as schizophrenia , economic stress, uncertain employment, homelessness and the experience of low social status results in mental illness. However, it is not the social causation of mental illness that is at issue but the labelling of the working class as mentally ill, as discussed below. Class position is significantly correlated to the diagnosis of mental illness and the form of treatment.
The lower classes are more likely to be labelled and diagnosed with psychosis, enter treatment through the legal system and are more likely to receive biological treatments for example, drugs and electroconvulsive therapy ECT than psychotherapy Hollingshead and Redlich In Marxian analysis, increases or decreases in those diagnosed as mentally ill are shown to be closely linked to the economy.
Increases in the number of those labelled mentally ill reflect the increase in surplus unemployed people at times of economic crisis, while in times of high economic demand they diminish.
Indeed, the statistics are quite staggering, with women having a 50 to per cent higher incidence of depression than men. Research in the United States suggests that women are twothirds more likely to be diagnosed as depressed as men Bertakis et al. Those women most at risk of being diagnosed as mad are the married, those with children and the unemployed Ussher There is no evidence that there are any biological explanations for the differences in depression rates between men and women Harris et al.
Sociologists of mental illness instead argue that the differences in the labelling rates of depression can be more accurately explained by women seeking health interventions more often than men when they experience poor 27 Kevin White health. This leads to the over-surveillance of women in ensuring conformity to social roles and policing gender roles through the psy-professions. Ethnicity and mental illness Ethnic groups are positively or negatively valued status-identities based on a shared culture, language or place of origin.
Negatively valued low-status groups face severe economic discrimination in life, including exclusions from health care and health insurance provision, from adequate schooling and from access to the legal system. This results in the explicit outcomes of lower wages and participation in the informal sector of the economy with its increased exposure to health hazards at work Krieger et al.
In a vicious causal circle, the outcome is segregated residential areas, increased exposure to the hazards of industrial zones, poisoning, environmental hazards and the corollaries of addictive and violent behaviour.
These political and economic inequalities are added to by a general disparagement and denigration of cultural values and health belief systems and a stereotypical representation of ethnic groups as responsible for their own problems Krieger et al. Ethnic stratification and social disadvantage are significantly linked with mental illness. For example, Australian Aboriginals receive diagnoses at two to three times the rate for mental illness as the general population Jorm et al.
Importantly for a social constructionist account, ethnicity unlike social class always precedes the onset of mental illness and thus cannot be the cause of it. It has also been established that the migrant groups are not bringing their mental illness diagnoses with them, since research has shown that these conditions are rare in the country of origin. Furthermore, the mental illness — of which schizophrenia tends to be the dominant one — is not manifest in first-generation migrants but in the second.
Thus, it is not the stress of migration that induces mental illness Eaton and Harrison This may be overlaid by the lack of attention paid by Western psychiatrists to the ethnic background of their patients, many of whose cultural beliefs involve the presence of spirits, the power of visions and the hearing of voices all symptoms of mental illnesses in the DSM as part of their religious and cultural beliefs.
Thus there is a likelihood of false diagnoses, but ones which, once made — as labelling theory suggests — become a master stigma and leaves these groups with the negative connotation of being prone to mental illness Selten et al. What is very clear is that the onset and diagnosis of mental illness have their origins in the social, political and economic relationship of ethnically stratified Western societies and not in nature or biology.
Conclusion This chapter has outlined the origins of the social constructionist approach to mental illness from the s onwards. It showed that mental illness is socially constructed in the sense of being the successful labelling of someone, or some condition, as mentally ill.
This labelling process operates inside a social system characterised by inequalities in social class, gender and ethnicity. Hence, rather than being a fact of biology, genes or nature, mental illness is socially constructed, produced and distributed. Bibliography American Psychiatric Association. American Psychiatric Association. Bertakis, K. Brenner, H. Brown, G. New York: Free Press. London: Hutchinson.
Boston, MA: D. Heath and Co. Eaton, W. Faris, R. Chicago: University of Chicago Press. Frances, A. New York: Anchor. Harris, T. Hollingshead, A. New York: Wiley. Hudson, C. Jorm, A. Kessler, R. Krieger, N. London: Pantheon. Nolen-Hoekscma, S. Selten, J. Thoits, P. What next? Ussher, J.
Herein lies a clue about the nature this chapter. As evident in my title itself, the chapter is antipsychiatry. Introduced by the group that coalesced around R. When associated with Thomas Szasz , it means rather a total rejection of psychiatric concepts.
When employed by activists today, however see, coalitionagainstpsychiatricassault. What is demonstrated is that something is being depicted and treated as medical which is in no way medical and, largely as a consequence, people are being profoundly damaged. Psychiatry is likewise revealed as self-interested, reductionistic, a form of power-over.
Moreover — what particularly distinguishes this piece — psychiatric reform itself emerges as problematic. Pivotal players in this ruling are psychiatrists 31 Bonnie Burstow themselves, their business partners e.
Whitaker , Like all regimes of ruling, psychiatry rules by texts. In this respect, the words spoken or written by a psychiatrist have the power of law, they make certain processes happen. This in itself is a problem of epic proportions, as is the transparently carceral and punitive nature of the psychiatric project, so brilliantly articulated by Foucault , The mind thinking is neither a body nor an organ.
Now, to be clear, it is not in itself problematic to employ health-based metaphors. We habitually do with no untoward consequences. Voss and Kirk I. Berchtold and Carl W. Riddell Chapter 23 Physical activity, stress, and immune function - Kate M. Edwards and Paul J. Sluka Chapter 26 Effects of acute and chronic physical activity on chronic pain conditions - Aaron J. Morgan R. Shields, Jacob D. Meyer and Dane B.
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