The contributions of sociology to psychiatry

The contributions of sociology to psychiatryIn the past two decades sociologists have carried out a wide variety of studies examining factors related to the occurrence and course of psychiatric and behaviour disorders, reactions to illness and deviance in the population, the help-seeking and help-giving process, the organization and functioning of psychiatric facilities, community processes affecting the provision and character of mental health services, and the larger moral and institutional influences affecting definitions of mental health and mental illness and the social uses of psychiatry.The strengths and weaknesses of the sociological contribution are in large part a product of the ambiguities of psychiatric practice itself, and particularly existing confusion concerning concepts of psychiatric disorder, diagnostic variabilities, and problems of reliability (Jahoda, 1958; Sells, 1968;Dohrenwend and Dohrenwend, 1969;Mechanic, 1970).Epidemiological approaches in social psychiatry have depended on varying concepts of disease, disorder, and disability, and it has been difficult to achieve comparability across studies and among nations having varying diagnostic approaches.Existing epidemiological studies provide data on a variety of dependent variables that are in no sense comparable, including such diverse indicators as happiness (Bradburn and Noll, 1969), psychophysiological complaints (Srole, Langner, Michael, Opler, andRennie, 1962; Leighton, Harding, Macklin, Macmillan, and Leighton, 1963;Langner and Michael, 1963), psychotic symptomatology (Cooper, 1970), behaviour problems (Robins, 1966), and social functioning (Freeman and Simmons, 1963).Despite the difficulties of these investigations, they have clearly given evidence of the importance of such variables as social class, age and sex roles, residence, social mobility, ethnic and cultural differences, and community networks for psychiatric efforts, although the precise role of each of these factors in various disorders remains an issue requiring continued research (Dohrenwend and Dohrenwend, 1969).Although awareness of such factors presently informs the psychiatrist's perspectives and practice, future efforts must be organized around more precise conceptions of psychiatric phenomena and more adequate and sophisticated case-finding.More attention must be given also to the interactions between genetic, biological, and social influences (Rosenthal and Kety, 1968; Rosenthal, 1970), and the work in each of these areas can be enhanced by awareness of the contributions and limitations of each perspective.Although efforts in psychiatric epidemiology have been limited by difficulties in measurement of disorder, sociologists have had wider scope in the study of community definitions and reactions to mental illness (Clausen and Yarrow, 1955; Eaton and Weil, 1955; Foucault, 1965;Mechanic, 1968) and the performance of psychiatric institutions (Caudill, 1958; Goffman, 1961; Grob, 1966;Wing and Brown, 1970).It is clear from a wide variety of investigations that social, cultural, and situational factors affect the recognition and response to illness (Mechanic, 1966), the inclination to seek psychological assistance, and choice of practitioner (Kadushin, 1969).Existing evidence suggests that the impact of such variables is most pronounced in situations where the symptoms are less dramatic but declines with increasing severity and disruption of activity (Mechanic, 1968).Although mental patients generally perform poorly in instrumental roles and maintain a relatively low level of social functioning, hospitalization is dependent much less on these factors than on the manifestation of bizarre, disruptive, and frightening behaviour (Freeman and Simmons, 1963;Brown, Bone, Dalison, and Wing, 1966;Michaux, Katz, Kurland, and Gansereit, 1969).A major aspect of sociological effort deals with the social processes through which patients are identified and treated and the consequences for the patient's self-identity and future social performance (Lemert, 1951;Scheff, 1966).The impact of labelling has been exaggerated at times (Gove, 1970), but work in this area has served to sensitize practitioners and administrators to the importance 1