Mental Illness as Social Deviance:
A Closer Look at Cross Cultural Psychiatry
Daniel T Saenz * New Mexico Highlands University * Spring 2005
For nearly a century, sociologists have studied social deviance, loosely defined as the deviation of human behavior from social norms. This relativistic perspective of deviant behavior differs greatly from the positivistic perspective championed by many psychiatrists and western trained medical professionals. However, more recent research has shown that the psychiatric model lacks cross cultural validity. Analyzing mental illness as social deviance can: increase understanding of what abnormal behavior is, explain why there is so much cross-cultural variation in mental disorders, as well as increase the utility of psychiatric diagnosis and treatments.
What is Deviant Behavior?
In contemporary social theory, deviant behavior is often looked at in three distinct parts. First is the existence of a social norm for example the Christian moral belief that people should not kill other people. Second is the behavior or act for example one man shooting and killing another man with a gun. Last, a social response to the behavior for example, legal punishment for shooting another person. The scientific orientation of the person doing an analysis tends to depend on which of the three aspects of social deviance they focus on. Relativists look at the first (the existence of social norms) positivists tend to focus on first and second (the existence of social norms and the act or behavior), and a pragmatic approach would be to focus at the third aspect of social deviance (a social response to the behavior). These three aspects of social deviance can be used to analyze mental illness from a classical psychiatric paradigm as well as a more contemporary culturally sensitive paradigm.
Cultural relativists perspective of social deviance
Relativists tend to focus on the first aspect of social deviance, which is the existence of a social norm. They often contend that a behavior cannot be considered abnormal or deviant if a society accepts it. Cross cultural variation in social norms makes these norms culture specific and thus makes social deviance culture specific.
Positivists perspective of social deviance
Positivists tend to focus on the first and second aspects of social deviance, norms and behaviors. They look for cultural universals to help define reality in highly tangible terms. The amount of cross cultural commonness in social response to a behavior helps solidify something as real. For example, a positivist might focus on the social response to violent and delusional behaviors. This specific behavior has a high degree of cross cultural social response and is thus seen as abnormal or deviant.
A pragmatic approach to social deviance
A pragmatic approach to social deviance focuses on the social response to a behavior. For example, a behavior may violate a social norm, but not elicit a social response because it is undetected. From this perspective the consequences of a behavior in part determine its functionality. If a man murders another man in secret then there are no social consequences for the behavior.
What is Abnormal Behavior?
Using a psychiatric approach, abnormal behavior differs from deviant behaviors in two ways. First it is possible for an individual to display abnormal behaviors or a mental disorder, and not violate any social norms. It is also possible to violate social norms and not be considered mentally ill. Abnormal behavior can be defined in terms of personal experience, with regards to an individual’s adaptiveness, safety, anxiety and distress levels, or comfort. From this perspective we must look at abnormal behaviors in terms of diagnostics for measuring the maladaptiveness of a behavior or set of behaviors. Moreover, an understanding of how these measures are obtained and how much external validity they have cross culturally must also be assessed.
Psychiatric diagnosis of abnormal behavior
For a psychiatrist, diagnosing mental disorders is similar to diagnosing other medical disorders, such as skin cancer or even a broken leg. This approach emphasizes that mental disorders are biologically based, naturally occurring conditions that are fairly stable throughout cultures. Psychiatrists tend to use statistical techniques that compare patient’s symptoms with the general population. In this sense, mental disorders are largely based on the degree to which a patient deviates from normative measures of behaviors.
Methodological issues with psychiatric diagnoses
Cross cultural comparisons of mental disorders have shown that the experience of a specific mental illness can vary greatly between cultures. This cross cultural variance is often explained in two ways. First that the differences in course are dependent on environment, which individuals exist in for example individuals who exist in a nurturing and supportive social environment tend to have better prognosis then those who do not. The positivists perspective allows for variation in the course of mental disorders because there is a basic assumption that there is a biological cause of a disorder that is shaped by environment. Second, cross cultural variance in symptomotology is due to differences in the way different constructs are measured. For example, a measure of anxiety levels may be obtained using certain symptoms in one culture, but anxiety may manifest itself differently in another culture. In this example, anxiety is still the factor in question, but the behaviors that signify anxiety are different between cultures.
Cross cultural variation in abnormal behavior
Cross cultural comparisons of mental disorders have found significant differences in the course, outcome, symptomotology and experience of mental disorders between cultures. The traditional positivist’s psychiatric model fails to account for several issues raised by these findings. First, failure to notice that the same behavior can be considered normal or abnormal depending on social response (as well as internalized social responses), second, a failure to recognize that the same disorder can have more than one etiological mechanism. A closer examination of an individual’s social and cultural environment related to mental illness can also help explain cross cultural variation.
Pragmatic Approach to Mental Illness and Social Deviance
One of the major problems with the positivists perspective of mental illness is that is does not allow for much cross cultural variation that has been consistently found in cross cultural studies of psychopathology. On the other hand, the problem with a relativistic perspective is that it reduces mental disorders to social constructions, created entirely out of abstract meaning systems. A more pragmatic approach to explaining mental illness is to affirm that social consequences are very important for diagnosing and treating mental illness. While it could be argued that mental illness is a social construction, the consequences to the individual are very real. Moreover, certain environmental factors such as cultural-meaning have real consequences on individual experiences. Similarly social relationships have significant effects on both the experience and course of mental disorders.
Abnormal behaviors have real consequences
There are several factors that relate directly to social consequences. Among them are cultural meanings, and interpersonal relationships. While each of these can be seen as social constructions, they have real consequences for individuals and thus should be reviewed carefully when trying to understand abnormal behavior.
Interpersonal relationships and mental illness. Social relations have notable affects on the onset, course and outcome of mental illness. Increases in social support networks and stable interpersonal relationships have positive effects on the course of mental illness. Contrarily, social disorganization, unstable relationships and low social identity can have detrimental effects on the course of mental illness. These issues become especially important to note when comparing two cultures with significantly different social climates.
Cultural meanings and mental disorders. While cultural meanings are social constructions entirely, they can have real consequences for mental illness. This is often particularly important when looking at abnormal behavioral symptomotology. Differences in meaning systems will help manifest different behaviors for displaying anger, anxiety and depression depending that the cultures specific idioms of distress. Many eating disorders, for example, are only found in western cultures. This could be a result of the social meanings associated with thinness and attractiveness. These cultural meanings do not exist in some cultures and neither does the disorder. Cultural meaning can also have significant affects on the onset course, and outcome of mental disorders and are important to consider when comparing mental disorder cross culturally.
Treating Abnormal Behaviors as Diseases or Disorders
The treatment of mental illness is one of the best applications of a pragmatic and person centered approach is psychiatry. It is however important to analyze the relationship between the psychiatrists personal orientation and the clients needs. And it is easy to see how the use of social deviance theories in mental illness can be helpful for providing the most utility in the treatment of mental suffering.
The role of the psychiatrist in treating abnormal behavior
The psychiatrist uses scientific reasoning, statistical principles and medical science to help alleviate or correct mental illnesses. But what works well in some cultures may not work as well in other cultures. This may result from conflicts between the psychiatrist’s professional values and the cultural values of the patient.
Professional values. Psychiatrists are trained in a very positivistic empirically grounded science of healing. They are able to treat patients using the principles of medical science and the diagnostic tools normalized in western society. A problem arises when the application of these very western values are given to patients from other cultures. The differences in social norms can greatly impact the effectiveness of psychiatric treatment, as well as the accuracy of both diagnosis and treatment plans.
Mental Illness as Social Deviance
The relationship between social sciences and psychiatry should include an understanding of the basic principles of social deviance. Unlike the more positivistic “Abnormal behavior" deviant behavior has three key components that can be used to improve the overall utility of psychiatric treatments. First in understanding the formulation of social norms, the psychiatrist must appreciate cultural differences and the process of socialization. Second in looking at the act as independent of both rules and responses, the psychiatrist can understand that the meanings and consequences of a behavior are dependent on both social norms and social response. And finally, looking at the social response to a behavior helps the psychiatrist appreciate and understand issues related to diagnosis and treatment. If there are no real consequences for a behavior, neither social nor internalized, then the need for treatment may be marginal or nonexistent.
References
Carson R., Butcher J., Mineka S. (1998). Abnormal Psychology and Modern Life.
New York: Long Man.
Goode E. (2001). Social Deviance. Boston: Free Press.
Kleinman, A. (1988). Rethinking psychiatry: From cultural category to personal experience.
New York: Free Press.
