It begins…

[CN: Insitutionalisation, the historical awfulness that went with it, Sanist terms]

A little while ago, I wrote about how I was sliding down to burn out. I still am. I get bursts of great productivity, and then long phases of screensaver mode where I just want to stare at a wall for an extended period of time.

(Hint to the critics of the neurodiversity movement: We don’t pretend that we don’t have challenges. We just don’t believe that our challenges make us less valuable as people.)

Anyway, so I’m dealing with this completely flat, no spoons, phase, but I still have stuff to do. I have my exams for university in a month’s time, and I have my son’s homeschooling reregistration meeting to plan for as well. Fun times!

Last night, I thought that actually a lot of what I’ve learned for one of my university courses could potentially be relevant for this blog.

Since the exam for this particular course is “short-answer format” (the lecturer’s definition of short answer is 500 words, but whatever), why not summarise what I’ve learned here?

In that way, I have created an artificial state of accountability, and I’m not completely abandoning my virtual home while I attend to stuff in my offline life.

So, the next ten posts or so will be summaries of my course notes. How is this related to this blog? The unit that I’m doing focuses on the sociology of mental health, and how it came to be what it is today. It involves discussions of normalcy, stigma, labelling, etc.

I’ll try to minimise the yucky language, but given the subject matter, some of it will still be included hence the CN on this post. So, here goes…

Mental health in Australian Society

Note: In this discussion, I use the term mental health challenges rather than mental illness; however, personally, I am not entirely satisfied with mental health as a concept so I’m also not entirely satisfied with mental health challenges, but it is probably a better descriptor than mental illness.

Distribution of Mental Health Challenges

When looking at the distribution of mental health challenges in Australia, there are a few factors which correlate, but it’s important to recognise that these factors do not cause challenges to mental health. Rather, there are several underlying reasons why these factors correlate, and much of that will be explored over the next several posts.

Social class is strongly related to mental health challenges. Generally, people in lower SES groups have a higher incidence of diagnosed conditions. There is also a correlation between the diagnoses that people in different SES groups have. In the lower SES groups, there is a higher incidence of conditions such as schizophrenia and anxiety than in higher SES groups.

Again, it’s important to stress that social class does not determine mental health. Related factors such as a poor standard of living, under employment, and low income impact negatively on mental wellbeing.

Gender has been found to be related to the diagnosis that people have even though the rates of mental health challenges in men and women are roughly equal. Unfortunately, no data concerning non-binary people in Australia have been collected, but comparing men to women reveals that women experience more anxiety and depression than men.

Ethnicity and migrant status is another factor that shows a correlation. I’m not going to go into the differences per country of origin because it’s not entirely relevant given the research in this area remains inconclusive. What is notable is that there are definite reasons that some migrant groups may experience more challenges to their mental wellbeing when their reasons for migrating are taken into consideration.

Aboriginal peoples have also been highlighted as a group of people who experience more challenges to their mental wellbeing than the overall Australian population. This is not surprising given the widescale, long-lasting oppression that they experience. This is a challenging correlation to explore because using a Westernised biomedical approach to do so is completely inadequate given that Aboriginal peoples subscribe to a far more holistic model of wellbeing than Westernised medicine does.

It’s also worth noting that there is intersectionality within groups of Aboriginal peoples because systematic inequality in Australia means that many Aboriginal peoples also belong to lower SES groups.

Explanations for mental health challenges

Three main models are relevant according to my course literature:

  1. The Medical Model: This is not a sociological explanation, but given that it is the dominant explanation, it is still worthwhile exploring. Importantly, this model focuses on the individual rather than considering whether mental health challenges are a social phenomenon.
  2. The Labelling Model: This model is based on symbolic interactionism which emphasises the importance of labelling and stigmatisation.
  3. The Stress Model: This model does not have theoretical linkage which has led to criticism from sociologists, but it focuses on the causative nature of the stress that arises from different social factors.

I would like to add a fourth explanation: the neurodiversity paradigm would also be a fantastic way in which to explore mental health. Given that the neurodiversity paradigm emphasises that neurodiversity is a natural and valuable form of human diversity, different forms of neurodivergence within different social groups could definitely be explored within this paradigm. Unfortunately, my university has not incorporated that into this course, so I will have to explore that in more detail at a later stage.

A brief history, focusing on New South Wales (NSW)

The treatment of mental health challenges, within NSW, can be divided into four distinct periods:

1. The early years of settlement (1788-1838)

During this time, there was very little in the way of services. The first recorded case of mental illness was recorded in 1805, and this had to do with a legal trial where a jury was instructed to consider whether the defendant was insane. Found to be insane, he was placed into the private care of two people rather than being incarcerated.

There were a few of these situations over the years until the first asylum for the mentally ill was established in 1811.

No therapy was provided at this facility, and the living conditions were exceptionally poor because it was overcrowded and lacked the resources to provide sufficient food, soap and other supplies.

2. The moral treatment era (1839-1860)

This period signalled a new approach to treating mental health challenges which was called moral therapy.

Moral therapy minimised restraint and coercion and emphasised treating patients with kindness, providing home-like living conditions, and keeping patients busy with “useful” arts and crafts. Importantly, it also advocated for returning patients to their communities as soon as possible.

While this approach was attempted with the opening of a new purpose-built asylum in 1839, it was a failure from the start. The reason why it failed was mainly due to the political conflict that the founder of the asylum had with members of the medical profession, but other factors such as lack of finances and staff also played a role.

3. The physical treatment era (1860-1945)

Three developments were significant in the physical treatment era:

  1. Massive growth of the asylum system. By 1894, there were eight psychiatric hospitals in NSW. Not only had the number of psychiatric hospitals increased, but their size had increased too: In 1940, more than 10,000 patients were housed in psychiatric hospitals.
  2. Attempts by psychiatry to establish its legitimacy within the medical field. At the time, mental health challenges weren’t perceived to be an illness in the same way in which physical ailments were. Because of this, psychiatrists attempted to develop physical treatments in order to change this perception.
  3. The discover of physical therapies to treat mental health challenges. Various “therapies” were tried (TW: it gets a bit ick here, so you might want to skip this) including draining spinal fluid and replacing it with horse serum, administration of purgatives and sedatives, and administration of electric shocks to various parts of the body. One of the reasons for this unusual mixture of treatments was that, at the time, the leading theory was that toxic secretions from glands in the body were responsible for mental health challenges, so removing those toxic secretions became the goal. For this reason, many patients also had their tonsils, adenoids, and gall bladders removed. By the 1940s, insulin shock therapy, electroconvulsive therapy and lobotomies were introduced as well.

Obviously, these treatments did not do much to legitimise the role of psychiatry within the medical field.

4. The modern era (1945-present)

There were a number of developments during this era, but the most significant of these is that there was a gradual shift away from the psychiatric hospital as the primary place of treating mental health challenges.

The reason for this lies in the development of psychoactive drugs in the 1950s and 1960s which made the management of patients outside of hospital settings possible.

Importantly, the development of the community mental health movement played a vital role in deinstitutionalisation by emphasising the rights of people with mental health challenges.

These days

The public sector still retains the primary role in treating mental health challenges, but the role of psychiatric hospitals has decreased with the majority of treatment taking place within psychiatric units of general public hospitals. Community services have increased (but definitely are not sufficient).

The private sector has grown significantly, both in the provision of psychiatric hospitals and private psychiatry consultations.

Finally, it’s important to note that there remain a number of social factors which impact on an individual’s admission to a psychiatric hospital. Admission is not based solely on an individual’s mental state. Women are more likely to be treated than men, but men are more likely to experience involuntary admissions. Aboriginal peoples are also more likely to experience involuntary admissions than other Australians.

That’s it for today. A brief introduction to the entire course. Over the following nine days, I will be unpacking each factor in the above in greater detail. I’m not intending to share this on social media, but if you’re reading, then I thank you for doing so.

This is part of a series of summaries that I am doing in order to revise Sociology of Mental Health. It won’t be shared on social media, but anyone is welcome to read these posts if they would be of interest.

If you would like to read more, most of this information came from this book.