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Κοινωνιολογία της ψυχικής υγείας και ασθένειας
Η παρούσα έκδοση παρέχει μια σαφή ανασκόπηση των κύριων ζητημάτων που απασχολούν την κοινωνιολογία της υγείας και της ασθένειας. Εκτός από την αναφορά σε ένα εύρος κοινωνικών θεωριών και μεθόδων προκειμένου να δοθούν τα κατάλληλα παραδείγματα, το βιβλίο παρέχει στον αναγνώστη πληροφορίες που οργανώνονται βάσει των παραμέτρων της κοινωνικής τάξης, του φύλου, της φυλής και της ηλικίας. Τα επαγγέλματα ψυχικής υγείας αναλύονται με κριτικό πνεύμα, ενώ διερευνώνται και μακροχρόνια ερωτήματα που αφορούν το ρόλο του νομικισμού. Εξετάζονται οι οργανωτικές όψεις της ψυχιατρικής, καθώς και η αυξανόμενη σπουδαιότητα των υπηρεσιών ψυχικής υγείας. Το βιβλίο ολοκληρώνεται με μία συζήτηση σχετικά με τους διάφορους τρόπους με τους οποίους οι ψυχιατρικοί ασθενείς και οι συγγενείς τους μπορούν να γίνουν κατανοητοί στο κοινωνικό τους πλαίσιο.
408 pages, Paperback
First published September 1, 1993
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August 24, 2021
Κάκιστη η μετάφραση
November 15, 2025
This book adopted a social constructivist position regarding mental illness, where the authors believed that mental illnesses do not have an essentialistic existence (i.e. an existence of itself, by itself) but rather a “construction”, an artificial frame erected by the society in response to abnormal behavior.
While certainly observations and investigations from sociological perspectives enriched our understanding of abnormal behavior, in terms of acknowledging its historical or cultural aspects; the overarching position tends to oversimplify or overestimate certain things. One of the ready-stock example from sociologists against the existence of mental illness is their citation of hallucinations or delusions among primitive people are deemed as normal, or even as desirable with some of the shamans adopting important roles. But they forsake to also include that when the shamans went berserk and dysfunctional, they too will be banished or punished from the society. And this is true from Inuit “angakkuq”, among Amazonians shamans to Tungusic and Korean mudangs. Psychiatry acknowledges the variety of experiences in human life, and would only step in if there’s disruptive or dysfunctional behaviours.
The sociologists feel that there are underlying interplay of power, stigma or stereotyping behind mental illness, but it is exactly the function of feeling to assign values to an object- whether it is good or bad-, not to comment whether an object exists or not. And that’s the reason why they conflate discrimination in cognition with discrimination in values. We discriminate things, name things to make it tangible and to analyse it; and this is the primary function of human perception.
The authors quoted Link and Phelan’s paper which mentioned that the so-called “labelling” allows people with mental health problems to have better access to services and treatments, and whether the service has bad or good impacts to the patient it relies on shared cultural expectations. We can immediately see how the term and defining “single mother” or “orphans” allowed us to direct the help better to the needed populations. But whether the term incites positive and negative connotations, it depends on the societal perspective, which is secondary to the fact that there are really people needing help. It shows that discrimination is secondary, the object must exist prior.
Thus, the existence of mental illness is an actual entity or event. Even though they can exist in many forms: transient or continuous, episodic or chronic and so on- these occurrences nevertheless have tangible, observable behaviours. The diversity of its manifestations only highlight the range within its unity, rather than a proof denying its existence.
Diversity does not excludes unity, for it is the unity that is grasped in fulness first, before the diversity which is contained within the unity. The unity of an object is grasped immediately, while its diversity is only being given in reflexion. We all noticed abnormality first immediately, and only after we attribute it with explanations, gradations, classifications etc. a thought experiment would reveal this; when we see a single datum of color is given, we would say that it is “red” or “blue”, only in relation with other similar data, we can attach further explanations to it; e.g. light red or navy blue.
It thus follows that multiple contradictory explanations and debates between the worldview will not lead to the exclusion of the existence of the phenomena; in fact, the phenomena HAS to happen first in order for these explanations to arise. Phenomena of abnormality has already being accomplished in reality, and only then it will be attached with reflexion; e.g. manic or depression have several grades of severity and manifestations. It has already being given by itself first, and only then the explanations.
If you and I are talking about the same phenomenon, then we must be in an agreement about what event we are talking about. If it has happened, then it must have happened in a way that we both have sufficient understanding that we are talking about the same thing. If it has not happened, then there must be a base agreement on what we are talking about; we not need necessarily to know what road we are talking about, but we both have to understand the idea of road. Now the independent existence of idea of road has already showed that there exists a universal understanding which exists not subjectively in individual thinkers, quasi-subjectively in a group of like-thinkers but objectively outside all thinkers.
Phenomenological psychiatry is the a priori study of experiences of abnormality, or uncanniness, which its unity as an experience is given different from the normal experience. It can either be qualitatively different or quantitatively different.
What we call as different is firstly, at the phenomenological level, where the act-quality is given beyond the givenness of the object. The coincidence between the act-quality and givenness of object is the accomplishment of truth. If the going-beyond is reversible, then we would call it as illusion. It its irreversible, then this would be known as difference, or uncanniness. Hallucinations occur where there is an act-quality of perception, but there’s no perceptual object. Delusion is where there’s act-quality of imaginative on a perceptual object. We are not saying that the deluded people are imagining things. What the people with delusion are having is that their act-quality cannot advance from the givenness at imaginative level to the perceptual. The feeling of being unable to advance is what we called as perplexity, which can be translated eventually as frustration or aggression- when there’s desperate attempt to match the imaginative with the perceptual.
We termed a phenomenon to be quantitatively different when the mismatch does not lie in the absence of perceptual object, but rather in the intensity of the act-quality on perceptual object. Accomplishment has achieved, but there is fixation for the persistence of object. When the persistence is directed to an object which recedes back to imaginative or symbolic, it is called as grief. Grief is the unity of which the diversity of manifestation in neurosis occurs.
And this phenomenological foundation behind phenomenon of abnormality is what lies behind most well-known models. Some would mention about the loss of ideal self (object), some would say the escape from responsibility (of no longer need to fixate on the absence of object), some would note on the idiosyncratic and unique way of clinging to object (schema), some mention on the slaying on the fixation-archetype (Jungian psychoanalysis), some would say about the catharsis from the making-conscious of the fixation (Freudian psychoanalysis). The difference in explanation is the diverse way of explaining the same phenomenon, which exists prior to it.
In conclusion, after reading this book, unfortunately it only leave a field of problems, instead of solutions. It polemicizes and volatilizes the discipline and leave nonchalantly after wreak havoc. Most importantly, its claim of professional dominance of psychiatrists, social closure and labelling theory forsake the lived experience of people working who just wanted people to get better.
If the psychiatrist is merely a body driven by profit, what explains the community-based interventions which do not directly contributes into the purse of the psychiatrists and psychotherapists? No doubt sociology would find a name for this venture for recovery of the patients through community interventions through their Marxist dictionary, or simply blend something new through their alchemical cauldron of terms. But the fact remains, they cannot and will not prescribe solutions. And their cacophony of terms only describes permutations of ideas at the imaginative level, but never describes reality itself. It’s a bit like standing safely inside a lighthouse describing the dangers of the sea, while the rescuers are actually giving themselves in the rescue.
While certainly observations and investigations from sociological perspectives enriched our understanding of abnormal behavior, in terms of acknowledging its historical or cultural aspects; the overarching position tends to oversimplify or overestimate certain things. One of the ready-stock example from sociologists against the existence of mental illness is their citation of hallucinations or delusions among primitive people are deemed as normal, or even as desirable with some of the shamans adopting important roles. But they forsake to also include that when the shamans went berserk and dysfunctional, they too will be banished or punished from the society. And this is true from Inuit “angakkuq”, among Amazonians shamans to Tungusic and Korean mudangs. Psychiatry acknowledges the variety of experiences in human life, and would only step in if there’s disruptive or dysfunctional behaviours.
The sociologists feel that there are underlying interplay of power, stigma or stereotyping behind mental illness, but it is exactly the function of feeling to assign values to an object- whether it is good or bad-, not to comment whether an object exists or not. And that’s the reason why they conflate discrimination in cognition with discrimination in values. We discriminate things, name things to make it tangible and to analyse it; and this is the primary function of human perception.
The authors quoted Link and Phelan’s paper which mentioned that the so-called “labelling” allows people with mental health problems to have better access to services and treatments, and whether the service has bad or good impacts to the patient it relies on shared cultural expectations. We can immediately see how the term and defining “single mother” or “orphans” allowed us to direct the help better to the needed populations. But whether the term incites positive and negative connotations, it depends on the societal perspective, which is secondary to the fact that there are really people needing help. It shows that discrimination is secondary, the object must exist prior.
Thus, the existence of mental illness is an actual entity or event. Even though they can exist in many forms: transient or continuous, episodic or chronic and so on- these occurrences nevertheless have tangible, observable behaviours. The diversity of its manifestations only highlight the range within its unity, rather than a proof denying its existence.
Diversity does not excludes unity, for it is the unity that is grasped in fulness first, before the diversity which is contained within the unity. The unity of an object is grasped immediately, while its diversity is only being given in reflexion. We all noticed abnormality first immediately, and only after we attribute it with explanations, gradations, classifications etc. a thought experiment would reveal this; when we see a single datum of color is given, we would say that it is “red” or “blue”, only in relation with other similar data, we can attach further explanations to it; e.g. light red or navy blue.
It thus follows that multiple contradictory explanations and debates between the worldview will not lead to the exclusion of the existence of the phenomena; in fact, the phenomena HAS to happen first in order for these explanations to arise. Phenomena of abnormality has already being accomplished in reality, and only then it will be attached with reflexion; e.g. manic or depression have several grades of severity and manifestations. It has already being given by itself first, and only then the explanations.
If you and I are talking about the same phenomenon, then we must be in an agreement about what event we are talking about. If it has happened, then it must have happened in a way that we both have sufficient understanding that we are talking about the same thing. If it has not happened, then there must be a base agreement on what we are talking about; we not need necessarily to know what road we are talking about, but we both have to understand the idea of road. Now the independent existence of idea of road has already showed that there exists a universal understanding which exists not subjectively in individual thinkers, quasi-subjectively in a group of like-thinkers but objectively outside all thinkers.
Phenomenological psychiatry is the a priori study of experiences of abnormality, or uncanniness, which its unity as an experience is given different from the normal experience. It can either be qualitatively different or quantitatively different.
What we call as different is firstly, at the phenomenological level, where the act-quality is given beyond the givenness of the object. The coincidence between the act-quality and givenness of object is the accomplishment of truth. If the going-beyond is reversible, then we would call it as illusion. It its irreversible, then this would be known as difference, or uncanniness. Hallucinations occur where there is an act-quality of perception, but there’s no perceptual object. Delusion is where there’s act-quality of imaginative on a perceptual object. We are not saying that the deluded people are imagining things. What the people with delusion are having is that their act-quality cannot advance from the givenness at imaginative level to the perceptual. The feeling of being unable to advance is what we called as perplexity, which can be translated eventually as frustration or aggression- when there’s desperate attempt to match the imaginative with the perceptual.
We termed a phenomenon to be quantitatively different when the mismatch does not lie in the absence of perceptual object, but rather in the intensity of the act-quality on perceptual object. Accomplishment has achieved, but there is fixation for the persistence of object. When the persistence is directed to an object which recedes back to imaginative or symbolic, it is called as grief. Grief is the unity of which the diversity of manifestation in neurosis occurs.
And this phenomenological foundation behind phenomenon of abnormality is what lies behind most well-known models. Some would mention about the loss of ideal self (object), some would say the escape from responsibility (of no longer need to fixate on the absence of object), some would note on the idiosyncratic and unique way of clinging to object (schema), some mention on the slaying on the fixation-archetype (Jungian psychoanalysis), some would say about the catharsis from the making-conscious of the fixation (Freudian psychoanalysis). The difference in explanation is the diverse way of explaining the same phenomenon, which exists prior to it.
In conclusion, after reading this book, unfortunately it only leave a field of problems, instead of solutions. It polemicizes and volatilizes the discipline and leave nonchalantly after wreak havoc. Most importantly, its claim of professional dominance of psychiatrists, social closure and labelling theory forsake the lived experience of people working who just wanted people to get better.
If the psychiatrist is merely a body driven by profit, what explains the community-based interventions which do not directly contributes into the purse of the psychiatrists and psychotherapists? No doubt sociology would find a name for this venture for recovery of the patients through community interventions through their Marxist dictionary, or simply blend something new through their alchemical cauldron of terms. But the fact remains, they cannot and will not prescribe solutions. And their cacophony of terms only describes permutations of ideas at the imaginative level, but never describes reality itself. It’s a bit like standing safely inside a lighthouse describing the dangers of the sea, while the rescuers are actually giving themselves in the rescue.
August 3, 2021
From chapter 8:
"Goffman analyses the mental hospital and the medical model of treatment as if it were a service industry directed towards the repair of damaged parts of society (psychiatric patients). If we accept Goffman’s metaphor of psychiatry as a repair industry then we can examine how its ‘customers’ are treated. [...] In essence he argues that such a service would have the following features (with our queries about the gap between principle and practice in brackets):
1. The workshop of the industry would be benign and would prevent a deterioration in the condition that required repair; (Mental health services are clearly not always benign. Coercion is ever present and treatments can be damaging.)
2. Transporting the part in need of repair to the workshop would not introduce new forms of damage; (Entering services is stigmatizing and can be distressing.)
3. The damaged part is not linked inextricably to its possessor. That is, the owner can be separated from their damaged part for a defined period of time until it is repaired; (The damaged part and its possessor are one and the same. Mental illness is about a flawed or deviant self. This is why a psychiatric diagnosis has such profound implications, as a patient’s credibility as a social actor or citizen is questioned, possibly for life.)
4. Those providing the service and those using it enter into the repair contract voluntarily and with mutual respect. (Mental health law exists to enforce the relationship between service providers and service recipients.)"
Also eternally bitter about what appears to be a common occurrence:
"The recurrent complaint is that patients are not supplied with enough information about the advantages and disadvantages of the treatment offered or imposed."
"Goffman analyses the mental hospital and the medical model of treatment as if it were a service industry directed towards the repair of damaged parts of society (psychiatric patients). If we accept Goffman’s metaphor of psychiatry as a repair industry then we can examine how its ‘customers’ are treated. [...] In essence he argues that such a service would have the following features (with our queries about the gap between principle and practice in brackets):
1. The workshop of the industry would be benign and would prevent a deterioration in the condition that required repair; (Mental health services are clearly not always benign. Coercion is ever present and treatments can be damaging.)
2. Transporting the part in need of repair to the workshop would not introduce new forms of damage; (Entering services is stigmatizing and can be distressing.)
3. The damaged part is not linked inextricably to its possessor. That is, the owner can be separated from their damaged part for a defined period of time until it is repaired; (The damaged part and its possessor are one and the same. Mental illness is about a flawed or deviant self. This is why a psychiatric diagnosis has such profound implications, as a patient’s credibility as a social actor or citizen is questioned, possibly for life.)
4. Those providing the service and those using it enter into the repair contract voluntarily and with mutual respect. (Mental health law exists to enforce the relationship between service providers and service recipients.)"
Also eternally bitter about what appears to be a common occurrence:
"The recurrent complaint is that patients are not supplied with enough information about the advantages and disadvantages of the treatment offered or imposed."
Read
December 17, 2022DNF! Read a few chapters for my PhD application. Really good, will likely come back to it
February 12, 2026
Αρκετά χρήσιμο από την άποψη ότι αναπτύσσει τα θέματα ψυχικής υγείας από μια κοινωνική και κριτική θέση, ωστόσο για τον ίδιο λόγο οι συγγραφείς φαίνεται να είναι και προκατειλημμένοι ως προς κάποια συμπεράσματα τους. Σε διάφορα σημεία επικρατεί μια άποψη πλήρους απόρριψης της χρησιμότητας της ψυχιατρικής με πρόσχημα τα πολλά σφάλματα της κατά τον 19ο και 20ο αιώνα. Παρ'όλα αυτά, αναλύονται μακροσκοπικά εξαιρετικά σημαντικές εκφάνσεις της ψυχιατρικής και νοσοκομειακής περίθαλψης και εγείρονται σοβαροί προβληματισμοί για ζητήματα μέγιστης κοινωνικής σημασίας, τα οποία παραμένουν επίκαιρα (ακούσια νοσηλεία, κοινωνικός έλεγχος, όρια δικαιωμάτων...).
Σίγουρα δεν βοηθάει το γεγονός ότι διάβασα το βιβλίο αυτό 30 χρόνια μετά την αρχική έκδοσή του - πολλά δεδομένα και έρευνες που αναφέρονται είναι παρωχημένα και πλέον έχουμε γνώσεις για αρκετά θέματα για τα οποία στο βιβλίο διατυπώνονται αμφιβολίες ή έλλειψη δεδομένων. Επίσης, η μετάφραση είναι πολύ κακή και σημαντικοί όροι δεν αποδίδονται σωστά ούτε με σταθερό τρόπο, δυσχεραίνοντας την κατανόηση σε κάποια σημεία. Ως έργο, έχει περισσότερη αξία για επιστήμονες και προσωπικό του τομέα υγείας, κυρίως επειδή δίνει μια γενική εικόνα του ιστορικού και κοινωνικού-οικονομικού πλαισίου του 20ου αιώνα και αναδεικνύει κεντρικά ζητήματα θεραπείας.
Σίγουρα δεν βοηθάει το γεγονός ότι διάβασα το βιβλίο αυτό 30 χρόνια μετά την αρχική έκδοσή του - πολλά δεδομένα και έρευνες που αναφέρονται είναι παρωχημένα και πλέον έχουμε γνώσεις για αρκετά θέματα για τα οποία στο βιβλίο διατυπώνονται αμφιβολίες ή έλλειψη δεδομένων. Επίσης, η μετάφραση είναι πολύ κακή και σημαντικοί όροι δεν αποδίδονται σωστά ούτε με σταθερό τρόπο, δυσχεραίνοντας την κατανόηση σε κάποια σημεία. Ως έργο, έχει περισσότερη αξία για επιστήμονες και προσωπικό του τομέα υγείας, κυρίως επειδή δίνει μια γενική εικόνα του ιστορικού και κοινωνικού-οικονομικού πλαισίου του 20ου αιώνα και αναδεικνύει κεντρικά ζητήματα θεραπείας.
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