The Sociological Model of Mental Illness

The sociological model of mental illness questions each of these assumptions. Perhaps most important, sociologists argue that definitions of mental illness, like the definitions of physical illness and disability discussed in Chapters 5 and 6, reflect subjective social judgments more than objective scientific measurements of biological problems.

What do we mean when we say someone is mentally ill? Why do we diagnose as mentally ill people as disparate as a teenager who uses drugs, a woman who hears voices, and a man who tries to kill himself? According to sociologist Allan Horwitz, behavior becomes labeled mental illness when persons in posi- tions of power consider that behavior both unacceptable and inherently incom- prehensible. In contrast, we tend to define behavior as crime when we consider it unacceptable but comprehensible; we don’t approve of theft, but we understand greed as a motive. (The judgment of “not guilty by reason of insanity” falls on the border between crime and mental illness.) Similarly, we might not understand why, for example, physicists might check and recheck measurements multiple times per hour, but we assume that those with appropriate training consider these behaviors reasonable.

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According to Peggy Thoits, behavior leads to the label of mental illness when it violates cognitive norms, performance norms, or feeling norms. Someone who thinks he is Napoleon Bonaparte, for example, breaks cognitive norms (i.e., norms regarding how a person should think), and someone who can’t hold a job breaks norms regarding proper role performance. Thoits argues that the last category—breaking feeling norms—accounts for most behavior labeled mental illness. Feeling norms refer to socially defined expectations regarding the “range, intensity, and duration of feelings that are appropriate to given situations” and regarding how people should express those feelings. For example, laughing is highly inappropriate at a Methodist funeral but perfectly acceptable at an Irish wake, and feeling sad that your pet cat died is considered reasonable for a few days but unreasonable after a year.

Different social groups consider different behaviors comprehensible and ac- ceptable. The friends of a drug-using teenager, for example, might consider drug use a reasonable way to reduce stress or have fun. Their views, however, have little impact on public definitions of drug use. Similarly, members of one church might consider a woman who reports talking to Jesus a saint, whereas members of another church would consider her mentally ill. The woman’s fate will depend on how much power these opposing groups have over her life. The definition of mental illness, then, reflects not only socially accepted ideas regarding behavior but also the relative power of those who hold opposing ideas.