6.6.6: The Medicalization of Deviance:

 6.6.6: The Medicalization of Deviance:

 Mental Illness When the woman drove her car into the river, drowning her two small children strapped to their little car seats, people said that she had “gone nuts,” “went bonkers,” and just plain “lost it.” 

Neither Mental Nor Illness? 

When people cannot find a satisfying explanation for why someone does something weird or is “like that,” they often say that a “sickness in the head” is causing the unacceptable behavior.

 To medicalize something is to make it a medical matter, to classify it as a form of illness that properly belongs in the care of physicians. 

For the past hundred years or so, especially since the time of Sigmund Freud (1856–1939), the Viennese physician who founded psychoanalysis, there has been a growing tendency toward the medicalization of deviance. 

In this view, deviance, including crime, is a sign of mental sickness. 

Rape, murder, stealing, cheating, and so on are external symptoms of internal disorders, consequences of a confused or tortured mind, one that should be treated by mental health experts. 

Thomas Szasz (1920–2012), a renegade in his profession of psychiatry, disagreed. 

He (1996, 1998, 2010) argued that what are called mental illnesses are neither mental nor illnesses.

 They are simply problem behaviors.

 Szasz broke these behaviors for which we don’t have a ready explanation into two causes: physical illness and learned deviance. 

Some behaviors that are called “mental illnesses” have physical causes. 

That is, something in an individual’s brain leads to unusual perceptions or behavior. 

For example, a chemical imbalance in the brain can cause depression. 

The individual’s behaviors—crying, long-term sadness, or lack of interest in family, work, school, or grooming—are symptoms of this physical problem, one that can be treated by drugs. 

Another example is attention-deficit hyperactivity disorder (ADHD), a “mental illness” that seems to have come out of nowhere. 

As Szasz said, “No one explains where this disease came from or why it didn’t exist 50 years ago. No one is able to diagnose it with objective tests.” 

A teacher or parent complains that a child is misbehaving, and a psychiatrist or doctor says the child is suffering from ADHD. 

Misbehaving children have been a problem throughout history, but now, with doctors looking to expand their territory, this problem behavior has become a sign of “mental illness” that they can treat (Komisar 2019). 

All of us have troubles. Some of us face a constant barrage of problems as we go through life. 

Most of us continue the struggle, perhaps encouraged by relatives and friends and motivated by job, family responsibilities, religious faith, or life goals. 

Even when the odds seem hopeless, we carry on, not perfectly, but as best we can.

 People whose behaviors violate norms are sometimes called mentally ill. 

“Why else would they do such things?” is a common response to deviant behaviors that we don’t understand.

 Mental illness is a label that contains the assumption that there is something wrong “within” people that “causes” their disapproved behavior.

 The surprise with this man, who changed his legal name to “Scary Guy,” is that he speaks at schools across the country, where he promotes acceptance, awareness, love, and understanding. 

Credit: WENN Rights Ltd/Alamy Stock Photo 

Some people, however, fail to cope well with life’s challenges.

 Overwhelmed, they become depressed, uncooperative, or hostile. 

Some strike out at others, while, in Merton’s term, others become retreatists and withdraw into their homes, refusing to come out. 

These may be inappropriate ways of coping, stressed Szasz, but they are behaviors, not mental illnesses.

 Szasz concluded that “mental illness” is a myth foisted on a naive public. 

Our medical profession uses pseudoscientific jargon that people don’t understand so it can expand its area of control and force nonconforming people to accept society’s definitions of “normal.” 

Researchers have hit upon an intriguing aspect of ADHD. 

Children born in August are 25 percent more likely to “have” ADHD than children born in September. 

What is it about August that creates so much ADHD? 

Maybe because it is a hotter month?

 I’m being sarcastic, of course.

 The dividing line for entering school is between those two months. 

The children born in August start school a year earlier than those born in September.

 The problem is the children’s relative maturity to handle situations—like sitting all day and following instructions.

The children born in August don’t “have” some mental illness that the other children don’t have (Layton et al. 2018).

 192 Szasz’s controversial claims force us to look anew at the forms of deviance that we usually refer to as mental illness.

 To explain behavior that people find bizarre, he directs our attention not to disorders deep within the “subconscious” but, instead, to how people learn those behaviors. 

To ask, “What is the origin of someone’s inappropriate or bizarre behavior?” then becomes similar to asking “Why do some women steal?” “Why do some men rape?” “Why do some teenagers cuss their parents and stalk out of the room?” 

The answers depend on those people’s particular experiences in life, not on an illness in their mind. 

Some sociologists find Szasz’s renegade analysis refreshing because it points us away from illnesses of the mind to social experiences. 

Others, however, are uncomfortable with it, and some disagree wholeheartedly. 

Regardless of these disagreements, Szasz’s analysis applies not just to mental illness but also to deviance in general. 

The Homeless Mentally Ill Jamie was sitting on a low wall surrounding the landscaped courtyard of an exclusive restaurant.

 She appeared unaware of the stares elicited by her layers of mismatched clothing, her matted hair and dirty face, and the shopping cart that overflowed with her meager possessions. 

After sitting next to Jamie for a few minutes, I saw her point to the street and concentrate, slowly moving her finger horizontally. 

I asked her what she was doing. “I’m directing traffic,” she replied. “I control where the cars go. Look, that one turned right there,” she said, now withdrawing her finger. “Really?” I said.

 After a while she confided that her cart talked to her. “Really?” I said again. “Yes,” she replied. “You can hear it, too.” 

At that, she pushed the shopping cart a bit. “Did you hear that?” she asked. When I shook my head, she demonstrated again. Then it hit me. 

She was referring to the squeaking wheels! I nodded. 

When I left Jamie, she was pointing a finger toward the sky, for, as she told me, she also controlled the flight of airplanes. 

To most of us, Jamie’s behavior and thinking are bizarre. 

They simply do not match any reality we know. 

Could you or I become like Jamie?

 Suppose for a bitter moment that you are homeless and have to live on the streets. 

You have no money, no place to sleep, no bathroom. 

You do not know if you are going to eat, much less where. 

You have no friends or anyone you can trust. 

You live in constant fear of being beaten and raped.

 Do you think this might be enough to drive you over the edge?

 Consider just the problems of not having a place to bathe. 

(Shelters are often so dangerous that many homeless people prefer to sleep in public settings.) 

At first, you try to wash in the restrooms of gas stations, bars, the bus station, or a shopping center. 

But you are dirty, and people stare when you enter and call the management when they see you wash your feet in the sink. You are thrown out and told in no uncertain terms never to come back. 

So you get dirtier and dirtier. 

Eventually, you come to think of being dirty as a fact of life.

 Soon, maybe, you don’t even care. 

The stares no longer bother you—at least not as much. 

No one will talk to you, and you withdraw more and more into yourself.

 You begin to build a fantasy life. 

You talk openly to yourself. 

People stare, but so what? 

They stare anyway. 

Besides, they are no longer important to you. 

Jamie might be mentally ill. 

Some organic problem, such as a chemical imbalance in her brain, might underlie her behavior. 

But perhaps not. How long would it take you to exhibit bizarre behaviors if you were homeless—and hopeless? 

The point is that living on the streets can cause mental illness—or whatever we want to label socially inappropriate behaviors that we find difficult to classify.

Homelessness and mental illness are reciprocal: Just as “mental illness” can cause homelessness, so the trials of being homeless, of living on cold, hostile streets, can lead to unusual thinking and behaviors. 

Mental illness and drug/alcohol addiction are common among the homeless. This photo was taken in Miami, Florida, but it could have been taken in any large city in the United States. Credit: JUICE/ILI/Juice Images/Alamy Stock Photo