Insane Society: A Sociology of Mental Health

Peter Morrall

• Publisher: Taylor & Francis
• Year: 2020
• eBook ISBN: 9781351271141
• Edition: 1
• Topic: Social Sciences
• Subtopic: Health Care Delivery
• Index: Social Sciences

This book critiques the connection between Western society and madness, scrutinizing if and how societal insanity affects the cause, construction, and consequence of madness.

Looking beyond the affected individual to their social, political, economic, ecological, and cultural context, this book examines whether society itself, and its institutions, divisions, practices, and values, is mad. That society's insanity is relevant to the sanity and insanity of its citizens has been argued by Fromm in The Sane Society, but also by a host of sociologists, social thinkers, epidemiologists and biologists. This book builds on classic texts such as Foucault's History of Madness, Scull's Marxist-oriented works and more recent publications which have arisen from a range of socio-political and patient-orientated movements. Chapters in this book draw on biology, psychology, sociological and anthropological thinking that argues that where madness is concerned, society matters.

Providing an extended case study of how the sociological imagination should operate in a contemporary setting, this book draws on genetics, neuroscience, cognitive science, radical psychology, and evolutionary psychology/psychiatry. It is an important read for students and scholars of sociology, anthropology, social policy, criminology, health, and mental health.

1 Faulty individual

To remind the reader, the idea of this book is that society matters to madness,¹ in terms of how it is considered and how it should be resolved (or even respected), and ideas from sociology and accordant disciplines are crucial in understanding society’s connection to personal madness. Moreover, that society matters to madness should not be an addendum to or adornment of biological ideas. Society should be at the forefront of understanding insanity.

Medical considerations about madness have dominated the understanding and management of madness for centuries. Notwithstanding many challenges and challengers, this dominance is in the ascendant and not in retreat. There is a refurbishment of psychiatry’s scientific credentials based largely on biological propositions and related remedies (both physical and psychological). There is an alternative to gazing into the brains and at implicated genes and neurological processes. Rather than focusing on faults in the individual, the alternative gaze is to look outwards at the faults in society (Chapter 2). The focus then shifts to social processes, structures, and institutions. Furthermore, just as the biological gaze has intensified, the societal gaze increasingly must extend beyond the local towards the global.

Paralleling today’s invigorated biologism is the proclaiming of mental disorder ‘epidemics’ amongst adults and children globally, notably anxiety and depression ((Plant and Stephenson, 2009; WHO, 2017; American Psychiatric Association, 2018). But are these diagnoses justified or the consequence of commercial and professional interests which seeks to medicalise normality and personal problems (Whitaker, 2011; Allen, 2014; Pies, 2016)? Conventional psychiatrists, most psychologists and psychotherapists, and ‘structuralist’ sociologists, accept that psychological distress really does exist (although not all accept this should be medicalised as ‘mental disorder’), and that some aspects of this distress have reached plague proportions. However, there is a fundamental conundrum for those with fundamentalist conviction about biological causation. If any epidemic of any mental disorder has occurred over a somewhat short period of time (a matter of decades), how can this be attributed to biological faults let alone evolutionary maladaptation? Biology does not change that fast. But society can change that fast. Moreover, society can and does change biology (Nikolas Rose, 2018).

It is also important to point out that alternative modes of thinking and practicing are not wholly excluded by the supremacy of the biological paradigm. For sociologist Nikolas Rose (2018) There is no one ‘psychiatry’. Psychiatry, whilst dominated by biology, is heterogeneous in the sense that non-biological ‘talking treatments’ are prescribed (for example, cognitive behaviour therapy and mindfulness), and social factors in causation and recovery are not proscribed. Neuroscience has a social offshoot. ‘Social neuroscience’ acknowledges that humans are social species (Cacioppo and Decety, 2011). However, the goal of social neuroscience is to investigate the biological mechanisms which buttress the framework of society rather that how social structures, processes, and institutions might buttress biology. Western psychiatry, as with all medical specialities, legitimises its practices more-and-more on ‘scientifically valid and reliable evidence, frequently at the insistence of governments attempting to reign-in expenditure on health care (Cairney and Oliver, 2017; Parkhurst, 2017). Today most of the evidence being sought by psychiatry is biological not social.

‘Social prescribing’ refers to the formal recommendation by medical practitioners for their patients to engage in volunteering, art, sports, dancing, singing, gardening, cooking, eating healthy food, talking to friends and making fresh friends, walking and cycling. Environmental psychologists (Hunter et al., 2019) have monitored a reduction in stress hormones such as cortisol after at least 20mins a day walking in a park or garden. Their research underscores social prescribing in form of ‘nature pills’ to improve mental well-being. The prescribing of activities is intended to replace or supplement surgical interventions and drug treatments (Department of Health, 2006; King’s Fund, 2019). The UK government, therefore, is supporting social prescribing on the basis that it can reduce the occurrence of hypertension, diabetes, depression, and ‘complex social needs’ such as loneliness. There is also an economic saving compared with surgery and drugs (National Health Service England, 2019). Social prescribing is promoted as a ‘holistic’ approach to dealing with or preventing disease. It is also promoted as a variant of ‘personalised’ medicine with an emphasis on the patient taking control of her/his own health and ill-health. There is criticism of social prescribing for being more ‘rhetorical’ than justifiable based on empirical evidence (Bickerdike et al., 2017). Public health researcher Glen Stewart (2019), writing in the British Medical Journal, notes that social prescribing may distract attention from the ‘wider determinants’ of ill-health. Chapter 2 notes some of these wider social determinants.

This chapter is compiled of a series of biological and concomitant ideas (for example, from evolutionary psychology). These ideas arise in the main from empirical evidence (the notable exception is evolutionary psychology). Where it is obvious so to do, a critique of the idea in question is offered within this chapter. However, more attention is paid to critiquing the faulty individual approach in Chapter 2. Apart from that critique, Chapter 2 presents ideas resulting from gazing at the faults in society. These ideas arise from both empirical evidence and theoretical reasoning. As mentioned in the Introduction to the book, it is Fromm’s ‘insane society’ idea which forms much of the theoretical backdrop to the proposition of this book. It is his sociologically informed stance on psychological states and the state of society which informs this sociological examination of madness. Hence, Chapter 2 highlights Fromm as the principal counterpoint to gazing at faults in the individual.

Neuro everything

Sociologist Hilary Rose and neuroscientist Steven Rose comment on the infiltration of neurological notions in scientific endeavour generally:

Neuro occupies more and more space within mainstream science.

(Hilary Rose and Steven Rose, 2016, p. 1)

‘Neuro’ has assuredly infiltrated contemporary scientific discourse focused on the making and mending of madness. Neuroscientists, neurogeneticists, neuroendocrinologists, neuroimmunologists, neuropsychiatrists, psychoneuroimmunologists, neuropsychologists, cognitive neuropsychiatrists, and cognitive neuropsychologists, along with evolutionary psychologists, are offering abundant claims of actual or potential cause and thereby assuagement for many forms of madness.

Focusing on biological faults in the individual to fathom and mitigate madness has a long history and powerful presence presently in psychiatry (Jasanoff, 2018). For example, a founder of psychiatry as a medical speciality in nineteenth-century France Jean-Etienne Esquirol and his German equivalent Wilhelm Griesinger, were both convinced that the brain was the locus for much of madness (Morrall, 2017).

Early in the twenty-first century psychiatrist and geneticist Peter McGuffin was to argue that a ‘revitalised’ and more scientific psychiatry infused with and enthused by the empirical outpourings of neurotechnology, and neuroscientific and genetic research could secure the future of psychiatry (Rose and McGuffin, 2005; McGuffin and Murray, 2014). The number of diagnostic technologies is expanding and their scrutiny intensifying. Examples are computerised axial tomography, magnetic resonance imaging, functional magnetic resonance imaging, positron emission tomography, and gene mapping. There is now a disparate array of old, refurbished, novel, and prospective physical methods of treatment such as: anti-psychotic, antidepressant, mood stabilising, anxiolytic, and hypnotic drugs; electroconvulsive therapy; repetitive transcranial magnetic stimulation; deep brain stimulation; and gene editing (Gargiulo and Mesones-Arroyo, 2018; Higgins, 2018; Doudna and Sternberg, 2017; Kozubek, 2018). Psychiatry, psychotherapy, and clinical psychology are justifying some psychotherapies as neurologically remedial (Grawe, 2005; Cozolino, 2010).

The promise of technology, genomics, and neuroscience is that in-depth imaging can show neurological ‘functional’ changes rather than just physical pathology when the subject is experiencing hallucinations or delusions, and physical treatments can reverse some these brain aberrations. Sets of genes implicated in the cause of schizophrenia and manic-depression have been identified, and a further promise is that responsible mix of faulty genes for many other disorders will eventually be found and fixed. Neuropathological sites, it is prophesied could be normalised by inserting freshly brain material or chemicals, stimulating undamaged neurons to form new pathways, or reassembling damaged neurological matrixes (Heinrich et al. 2014; Greenfield, 2016; Amen, 2020).

The Maudsley Biological Research Centre (2018) is partner to the Institute of Psychiatry, Psychology & Neuroscience at King’s College London. This centre is a prime example of this shift in psychiatric theory and practice, and the expansion of psychiatry’s ‘neuro’ domain. Its research endeavours cover: depression; manic-depression: anxiety disorders: schizophrenia, and ‘other psychotic disorders and neurological diseases of the brain’; dementia and ‘related disorders’; child and neurodevelopmental disorders including autism, attention deficit hyperactivity disorder, and ‘other mental disorders which occur in children’ such as anxiety, depression, and conduct disorder; use and abuse of tobacco, alcohol and ‘illegal substances’; obesity; pain associated with mental disorder. There are displays of scanned brains and neurological structures in the link webpages to some research themes designed presumably purporting tangible or conceivable sites of neurologically-based mental malfunction.

What is also portended, mainly from researching rats, is that all aspects of the mind and madness can be pinned to brain activity. For example, neuroscientist Susan Greenfield (2016) proposes that the link between objective experience and subjective experience is the formation in the brain of neuronal ‘assemblies’ of varying sizes. Similarly, the proposition of neuropsychologists Peter Halligan and David Oakley (2018) is that both subjective experience of consciousness (personal awareness) and associated psychological processes (thoughts, beliefs, ideas, intentions and more) are products of non-conscious processes as are core biological processes (such as respiration and digestion). Human performance relies on ‘unconscious authoring’. Complex and intelligent design in living come from naturally selected adaptations. Consciousness (and free-will) is contained (only) in neurological activity, and certain assemblies of such activity can be correlated with certain types of madness.

The inference is that the mind and madness are only a matter of matter, and hence humans are afflicted with what sociologist Hilary Rose and neuroscientist Steven Rose describe as a ‘user illusion’:

For the neuroscientists of the twenty-first century, mental activity can be reduced to brain processes.… [I]n doing so, to make the mind, and the person it inhabits, merely ‘a user illusion’, fooling people into thinking that they are making decisions whereas it ...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• Introduction: Imagine
• 1. Faulty individual
• 2. Faulty society
• 3. Violence
• 4. Inequality
• 5. Selfishness
• 6. Insecurity
• 7. Stupidity
• 8. Conclusion
• Index