health/medicine: mental illness

Cross-posted at CNN.

For the past few days, Americans have been weeping together and wringing our hands once again at the senseless tragedy of a mass murder inside a school. The horrific scene in Newtown, Connecticut, is now seared permanently in our collective conscience, as we search for answers. We’ll look at the photograph of Adam Lanza and ask over and over again how he could have come to such a deadly crossroads.

We still know nothing about his motives, only the devastating carnage he wrought. And yet we’ve already heard from experts who talk about mental illness, Asperger’s syndrome, depression, and autism. The chorus of gun boosters has defensively chimed in about how gun control would not have prevented this.

Former Arkansas Gov. Mike Huckabee offered the theory that since “we have systematically removed God from our schools, should we be so surprised that schools would become a place of carnage?” (As if those heathen children deserved it?)

All the while, we continue to miss other crucial variables — even though they are staring right back at us when we look at that photograph. Adam Lanza was a middle class white guy.

If the shooter were black and the school urban, we’d hear about the culture of poverty; about how inner-city life breeds crime and violence; perhaps even some theories about a purported tendency among blacks towards violence.

As we’ve seen in the past week, it’s not only those living on the fringes of society who express anger through gun violence.

Yet the obvious fact that Lanza — and nearly all the recent mass murderers who targeted non-work settings — were middle class white boys seems to barely register. Look again at the pictures of Jared Lee Loughner (Tucson), James Eagan Holmes (Aurora) and Wade Michael Page (Oak Creek) — a few of the mass killers of the past couple of years. (Yes, the case of Seung-Hui Cho, the perpetrator at Virginia Tech, the worst school shooting in our history, stands out as the exception. And worth discussing.)

Why are angry young men setting out to kill entire crowds of strangers?

Motivations are hard to pin down, but gender is the single most obvious and intractable variable when it comes to violence in America. Men and boys are responsible for 95% of all violent crimes in this country. “Male criminal participation in serious crimes at any age greatly exceeds that of females, regardless of source of data, crime type, level of involvement, or measure of participation” is how the National Academy of Sciences summed up the extant research.

How does masculinity figure into this? From an early age, boys learn that violence is not only an acceptable form of conflict resolution, but one that is admired. However the belief that violence is an inherently male characteristic is a fallacy. Most boys don’t carry weapons, and almost all don’t kill: are they not boys? Boys learn it.

They learn it from their fathers. They learn it from a media that glorifies it, from sports heroes who commit felonies and get big contracts, from a culture saturated in images of heroic and redemptive violence. They learn it from each other.

In talking to more than 400 young men for my book, Guyland: The Perilous World Where Boys Become Men, I heard over and over again what they learn about violence. They learn that if they are crossed, they have the manly obligation to fight back. They learn that they are entitled to feel like a real man, and that they have the right to annihilate anyone who challenges that sense of entitlement.

This sense of entitlement is part of the package deal of American manhood — the culture that doesn’t start the fight, as Margaret Mead pointed out in her analysis of American military history, but retaliates far out of proportion to the initial grievance. They learn that “aggrieved entitlement” is a legitimate justification for violent explosion.

The easy availability of guns is another crucial variable. After the terrible school shooting in Dunblane, Scotland, in 1996, Great Britain enacted several laws that effectively made owning handguns illegal in that country. The murder rate in the U.S. is more than three times higher than Britain.

And yes, boys have resorted to violence for a long time, but sticks and fists and even the occasional switchblade do not create the bloodbaths of the past few years. In 2011, more than 80% of all homicides among boys aged 15 to 19 were firearm related.

We need a conversation about gun control laws. And far more sweeping — and necessary — is a national meditation on how our ideals of manhood became so entangled with violence.

It’s also worth discussing why so many of these young mass murderers are white. Surely boys of color have that same need to prove their masculinity, and a similar sense of entitlement to annihilate those who threaten it. Perhaps the only difference is that it seems to be nearly the exclusive province of white boys to so dramatically expand the range of their revenge and seek to destroy the entire world, not simply the person or group that committed the supposed offense. Perhaps. It’s a conversation worth having.

I am not for a moment suggesting we substitute race or gender for the other proximate causes of this tragedy: lax gun laws, mental illness. I am arguing only that we can never fully understand it, unless we also add these elements to our equation. Without them, the story is entirely about him, the shooter. But the bigger story is also about us.

In the coming weeks, we’ll learn more about Adam Lanza, his motives, his particular madness. We’ll hear how he “snapped” or that he was seriously mentally ill. We’ll try to explain it by setting him apart, by distancing him from the rest of us.

And we’ll continue to miss the point. Not only are those children at Sandy Hook Elementary School our children. Adam Lanza is our child also. Of course, he was mad — as were Eric Harris and Dylan Klebold, and Seung-Hui Cho, Jared Lee Loughner, James Eagan Holmes, and Wade Michael Page — and the ever-longer list of boys and young men who have exploded in a paroxysm of vengeful violence in recent years. In a sense, they weren’t deviants, but over-conformists to norms of masculinity that prescribe violence as a solution. Like real men, they didn’t just get mad, they got even. Until we transform that definition of manhood, this terrible equation of masculinity and violence will continue to produce such horrific sums.

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Michael Kimmel is a professor of sociology at the State University of New York at Stonybrook.  He has written or edited over twenty volumes, including Manhood in America: A Cultural History and Guyland: The Perilous World Where Boys Become Men.  You can visit his website here.

Cross-posted at Neuroskeptic.

“Personality differences” between people from different countries may just be a reflection of cultural differences in the use of “extreme” language to describe people.

That’s according to a very important paper just out from an international team led by Estonia’s René Mõttus.

There’s a write up of the study here. In a nutshell, they took 3,000 people from 22 places and asked them to rate the personality of 30 fictional people based on brief descriptions (which were the same, but translated into the local language). Ratings were on a 1 to 5 scale.

It turned out that some populations handed out more of the extreme 1 or 5 responses. Hong Kong, South Korea and Germany tended to give middle of the road 2, 3 and 4 ratings, while Poland, Burkina Faso and people from Changchun in China were much more fond of 1s and 5s.

The characters they were rating were the same in all cases, remember.

Crucially, when the participants rated themselves on the same personality traits, they tended to follow the same pattern. Koreans rated themselves to have more moderate personality traits, compared to Burkinabés who described themselves in stronger tones.

Whether this is a cultural difference or a linguistic one is perhaps debatable; it might be a sign that it is not easy to translate English-language personality words into certain languages without changing how ‘strong’ they sound. However, either way, it’s a serious problem for psychologists interested in cross-cultural studies.

I’ve long suspected that something like this might lie behind the very large differences in reported rates of mental illness across countries. Studies have found that about 3 times as many people in the USA report symptoms of mental illness compared to people in Spain, yet the suicide rate is almost the same, which is odd because mental illness is strongly associated with suicide.

One explanation would be that some cultures are more likely to report ‘higher than normal’ levels of distress, anxiety — a bit like how some make more extreme judgements of personality.

So it would be very interesting to check this by comparing the results of this paper to the international mental illness studies. Unfortunately, the countries sampled don’t overlap enough to do this yet (as far as I can see).

Source: Mõttus R, et al (2012). The Effect of Response Style on Self-Reported Conscientiousness Across 20 Countries. Personality and Social Psychology Bulletin PMID: 22745332

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Neuroskeptic blogs anonymously here.  You can also follow him on Twitter.

Autism appears to be on the rise. The U.S. Centers for Disease Control and Prevention reports that there are 20 times more cases of autism today than there were in the 1980s.  This figure, from the Los Angeles Times, shows a 200% increase in California:

The rise in cases of autism led scientists to ask whether there was an actual increase in incidence or if we were just getting better at identifying it.  The evidence seems to suggest that it’s (at least mostly) the latter.  Said anthropologist Roy Richard Grinker: “Once we are primed to see something, we see it and wonder how we could have never seen it before.”

But how to explain disparities like this?

Often regional differences in health and mental health can be traced to heavier environmental toxin loads.   In most of those cases, though, clusters of illness occur in poor and often disproportionately non-white neighborhoods.  Autism clusters were happening in class-privileged places.

Sociologist Peter Bearman discovered that these clusters were the result of conversation.  Class-privileged parents had the resources to get their child diagnosed, then they talked to other parents.  Some of these parents would recognize the symptoms and take their child to the doctor and… voila… a cluster.  “Living within 250 meters [of a child diagnosed with autism], reports the Los Angeles Times, boosted the chances by 42%, compared to living between 500 and 1,000 meters away.”

Lisa Wade, PhD is a professor at Occidental College. She is the author of American Hookup, a book about college sexual culture, and a textbook about gender. You can follow her on Twitter, Facebook, and Instagram.

In an earlier post we reviewed research by epidemiologists Richard Wilkinson and Kate Pickett showing that income inequality contributes to a whole host of negative outcomes, including higher rates of mental illness, drug use, obesity, infant death, imprisonment, and interpersonal trust.

She summarizes these findings in this quick nine-minute talk at a Green Party conference:

See Dr. Pickett making similar arguments as to why raising the average national income in developed countries doesn’t make people happier or enable them to live longer, why unequal societies are more violent, and how status inequality increases stress.

And see more about income inequality and national well-being at Equality Trust.

Lisa Wade, PhD is a professor at Occidental College. She is the author of American Hookup, a book about college sexual culture, and a textbook about gender. You can follow her on Twitter, Facebook, and Instagram.

The mysterious SocProf, who writes The Global Sociology Blog, offered a nice review of Richard Wilkinson and Kate Pickett‘s book, The Spirit Level: Why More Equal Societies Almost Always Do Better.  Wilkinson and Pickett offer transnational research showing how, exactly, income inequality is related to bad outcomes on average.  In other words, as SocProf puts it, “…egalitarianism is not a bleeding heart’s wet dream but rather the only rational course of action in terms of public policy.”  The 11 graphs, available at the Equality Trust website, speak for themselves.

Societies with more income inequality have higher infant death rates than other societies:

Societies with more income inequality have higher rates of mental illness than other societies:

Societies with more income inequality have a higher incidence of drug use than other societies:

Societies with more income inequality have a higher high school drop out rate than other societies:

Societies with more income inequality imprison a larger proportion of their population than other societies:

Societies with more income inequality have a higher rate of obesity than other societies:

Individuals in societies with more income inequality are less likely to be in a different class than their parents compared to other societies:

Individuals in societies trust others less than people in other societies:

Societies with more income inequality have higher rates of homicide than other societies:

Societies with more income inequality give less in foreign aid than other societies:

Children in societies with more income inequality do less well than children in other societies:

The authors sum it up pretty simply: : “Th[e] dissatisfaction [measured in this data is] a cost which the rich impose on the rest of society.”

And they have a clear policy proposal relevant to the current economic crisis.

[This is] a clear warning for those who might want to place low public expenditure and taxation at the top of their priorities. If you fail to avoid high inequality, you will need more prison and more police. You will have to deal with higher rates of mental illness, drug abuse and every other kind of problems. If keeping taxes and benefits down leads to wider income differences, the need to deal with ensuing social ills may  force you to raise public expenditure to cope.

Readers Ana and Dmitriy T.M. sent in a TED talk of Richard Wilkinson discussing the relationship between income inequality and social problems:

Lisa Wade, PhD is a professor at Occidental College. She is the author of American Hookup, a book about college sexual culture, and a textbook about gender. You can follow her on Twitter, Facebook, and Instagram.

The World Health Organization (WHO) defines neurological disorders as physical diseases of the nervous system and psychiatric illnesses as disorders that manifest as abnormalities of thought, feeling, or behaviour. In fact, however, there are longstanding unresolved debates on the exact relationship between neurology and psychiatry, including whether there can be any clear division between the two fields.

Related to this, Brandy B. sent us a figure from the blog Neuroskeptic graphing the proportion of journal articles on various disorders included in The American Journal of Psychiatry versus the journal Neurology over the past 20 years. The image is interesting from a sociological standpoint in that, as Brandy writes, “it says far more about the sociology of these fields than about which disorders can be considered neurological or psychiatric.”

While debates regarding the neurological roots of psychiatric illnesses such as depression and schizophrenia are far from settled, the graph shows that the two disciplines have maintained varying levels of intellectual authority over different disorders. Some fall clearly into one domain or the other, while others are covered in both. Depression, for example, receives more attention than mania in Neurology, despite the fact that mania often occurs alongside depression as a symptom of bipolar disorder.

The information in this graph serves as a reminder that what gets published in academic journals, and the topics over which disciplines exercise authority, are the results of social processes. Disciplines are artificial categories of knowledge, solidified through the creation of institutional structures like university departments, degree programs, and academic journals. Psychiatry, for example, didn’t emerge as a discipline until the 19th century; this emergence was rooted in a social context in Western Europe where rising numbers of people were being institutionalized and attitudes regarding the treatment of mental illness were changing. By claiming membership in disciplines based on common academic backgrounds, research methodologies, and topics of study, scholars contribute to the reproduction of these disciplinary boundaries.

The peer-review process is one facet of this social reproduction of disciplinary boundaries that is particularly relevant to the image above. Research and papers that are submitted, accepted, and funded must appeal to reviewers and conform to the criteria set out by the journal or discipline within which researchers wish to publish. In the case of neurology and psychiatry, it appears based on this graph that the peer-review process may uphold disciplinary boundaries, as reviewers for each discipline’s journal appear to favour articles on certain disorders.

The divisions between neurology and psychiatry suggested in the image above stir up lots of interesting questions not only about what we consider to be “neurological” or “psychiatric”, but more generally about the social production of knowledge.

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Hayley Price has a background in sociology, international development studies, and education. She recently completed her Masters degree in Sociology and Equity Studies in Education at the University of Toronto.

If you would like to write a post for Sociological Images, please see our Guidelines for Guest Bloggers.

Cross-posted at Jezebel and AOL’s Black Voices.

In a new book called “The Protest Psychosis: How Schizophrenia became a Black Disease,” psychiatrist and cultural critic Jonathan Metzl draws on a variety of sources — patient records, psychiatric studies, racialized drug advertisements, and popular metaphors for madness — to contend that schizophrenia transformed from being a mostly white, middle-class affliction in the 1950s, to one that identified with blackness, volatility, and civil strife at the height of the Civil Rights movement.

The racialized resonance between emerging definitions of schizophrenia and anxieties about black protest seem clear in pharmaceutical advertisements and essays appearing in leading American psychiatric journals during the 1960s and 70s.  For instance, the advertisement for the major tranquilizer Haldol that ran in the Archives of General Psychiatry shows an angry, hostile African American man with a clenched, inverted, Black Power fist.

The deranged black figure literally shakes his fist at the assumed physician viewer, while in the background a burning, urban landscape appears to directly reference the type of civil strive that alarmed many in the “establishment” at that time.  The ad compels psychiatrists to conflate black anger as a form of threatening psychosis and mental illness.  Indeed the ad seems to play off presumed fears of assaultive and belligerent black men.

As the urban background suggests, this fear extended beyond individual safety to social unrest.  In a 1969 essay titled “The Protest Psychosis,” after which Metzl’s book is named, psychiatrists postulated that the growing racial disharmony in the US at the height of the Civil Rights Movement, reflected a new manifestation of psychotic behaviors and delusions afflicting America’s black lower class.  Accordingly, “paranoid delusions that one is being constantly victimized” drew some men to fixate on misguided ventures to overthrow the establishment.  Luckily, pharmaceutical companies proposed that chemical interventions could directly pacify the masculinzed, black threat depicted in advertisements like the above.  “Assaultive and belligerent?” it asks.  “Cooperation often begins with Haldol.”

Moreover, ads for Thorazine and Stelazine during this period often conjured up images of the “unruly” and “primitive” precisely at a time when the demographic composition of this diagnosis was dramatically shifting from a mostly white clientele, to a group of predominately black, confined, mental patients.  It is telling that within this context, the makers of Thorazine would choose to portray the drug’s supposed specificity to schizophrenia in their advertisements by displaying a variety of war staffs, walking sticks, and other phallic artifacts from African descent.

The below ad for Thorazine, for example, exclaims western medicine’s superiority in treating mental illness with modern pharmaceuticals, by contrasting the primitive tools used by less enlightened cultures.

Notably, these claims of superiority and medical efficacy drew from a particular set of pejorative ideas of the “primitive” that were already well established within some sectors of psychiatry that equated mental illness with primitive, animalistic and regressive impulses.   As Metzl contends in his book:

…pharmaceutical advertisements shamelessly called on these long-held racist tropes to promote the message that social “problems” raised by angry black men could be treated at the clinical level, with antipsychotic medications.

These adds are in sharp contrast to previous marketing campaigns that framed schizophrenia in the 1950s as a mental condition affecting mostly middle class patients, and especially women.  Also shown below, ideas of schizophrenia were at that time an amorphous collection of psychotic and neurotic symptoms that were thought to afflict many women who struggled to accept the routines of domesticity.

While schizophrenia is certainly a real, frightening, debilitating disease, Metzl reminds us that cultural assumptions of the “other” shape how psychiatry understands and treats the condition.

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Arturo Baiocchi is a doctoral student in Minnesota interested in issues of mental health, race, and inequality.  He is writing his dissertation on how young adults leaving the foster care system understand their mental health needs.  He is also a frequent contributor to various Society Pages podcasts and wanted to post something related to a recent interview he did about the racialization of mental illness.

If you would like to write a post for Sociological Images, please see our Guidelines for Guest Bloggers.

 

Back in December, Carly S. sent in an ESPN video about NFL player Bart Scott, nicknamed the “Mad Backer.” The video illustrates a number of noteworthy themes:

  • The glorification of violence, with Scott reveling in the chance to dish it out.
  • Equating being able to play through pain caused by this violence as proof of masculinity — particularly disturbing given concerns about the long-term effects the physical punishment players take has on their health.
  • Through the “Mad Backer” persona and the presence of a straight jacket and stretcher, Scott associates mental illness with violence and danger as a way to prove his own superiority on the field. Not only is he “mad,” he depicts himself as a villain who enjoys brutality.

See for yourself: