Pol130 categorised illness as a trio of perspectives: phenomenological, behavioral, and biological.131 The first - phenomenological - is a discontinuation in a person’s life founded in experiential change where being ill imposes feelings of passivity, powerlessness, loss of autonomy, dependency and loss of freedom, giving rise to feelings including fear, worry, resentment, anger, anxiety, suspicion and guilt.132 For the person experiencing a mental illness, the experiential change of being ill does not necessarily occur as a result of feeling physically unwell but may arise as a consequence of performing socially unacceptable behaviours, being assessed at being at risk of performing socially unacceptable behaviours, and psychiatric labelling. The prognosis is powerlessness, loss of autonomy, dependency, a loss of freedoms, state intervention, and the traumatic events associated with deprivation of liberty and forcible treatment. Experiential changes and negative value judgments result in all facets of suffering that is a necessary condition for being ill although suffering of itself is not a sufficient condition for being ill.133
The second category - behavioral - is a discontinuity in the behaviour and
functioning of the person who is being ill. The person will typically remain in bed, stay home from work, hand over their responsibilities such as the parenting of children to others; withdraw from social contact and generally, perform their normal
127 Barbara L Paterson, ‘The Shifting Perspectives Model of Chronic Illness’ (2001) 33 Journal of Nursing
Scholarship 21, 23.
128 Pols, above n 125, 123. 129
World Health Organisation, ‘Investing in Mental Health’(Research Paper, World Health Organization, 2003) <http://www.who.int/mental_health/en/investing_in_mnh_final.pdf>. 130 Pols, above n 125. 131 Ibid. 132 Ibid. 133 Ibid.
behaviors and functions less well, as a certain degree of dysfunction is a necessary condition for being ill. Dysfunction alone, however, is not sufficient for being ill.134
Taken from the biological angle, being ill is a discontinuity in living. In this context, illness is an ‘abnormality of form, structure, and/or function of some part, process or system of the individual.’135 How is the person behaving differently when they are ill to the way they behaved when they were healthy, or to how healthy people behave in general? In this respect, abnormality is identified via a comparative measure against matters that are typified as either static-normal or ideal-normal. Abnormality of form, structure or function is a necessary condition for labeling a person as ill but abnormality alone is not a sufficient condition for being ill. Suffering, dysfunction and abnormality although independent of each other must all be present if a person is ill, and to qualify as an illness, the three factors must all be present at a certain level of severity.136
If a person has an illness, then their social role as an ill person is typified by their right to be free from normal responsibilities and obligations at a measure that is dependent on the severity of their illness. It is a normal expectation that a person who is ill with a head cold might take a day off work but taking a month off work for the same severity of head cold is entirely unacceptable unless the severity of the illness increases in tandem with the right to be free from the responsibility to go to work i.e. head cold develops into bronchitis which in turn develops into pneumonia. It seems that the reverse is true with regard to a mental illness.
The stereotypical expectation is that a person experiencing a mental illness will be hospitalised, often for long periods of time, and often against their will. They may be forcibly required to undergo extreme regimes of psychotropic medication. They will be incapable, or deemed incapable of holding down jobs, maintaining
relationships and sustaining stable accommodation. The state will statutorily free them, most often forcibly, from their responsibility to manage their financial affairs and their right to make autonomous decisions. It is the condition of their illness which marks them as socially different which excludes them from the normal society of the well. Stereotypically, they are expected to think, feel and act in 134 Ibid. 135 Ibid. 136 Ibid.
certain ways. An example of this is the belief that parents who experience a mental illness are unable to have a ‘meaningful’ relationship with their children (see Chapter Sixwith regard to Family Law Act 1975 parenting orders).
4.
CONCEPTUALISING STIGMA
The French sociologist, Émile Durkheim was the first to examine stigma as a social phenomenon in 1895.137 Since that time, social scientists have attempted to
conceptualise the phenomenon with particular attention given to its study during the past few decades.138 Despite the attention, the concept remains vaguely defined and an examination of the recent literature also exposes the expanse of definitional variability. Link and Phelan139 suggest that there are two predominant reasons for this. First, the stigma concept has been applied to a vast range of unique
circumstances which has resulted in researchers conceptualising stigma differently and secondly, that the investigation has been multidisciplinary with psychologists, sociologists, anthropologists, political scientists, and social geographers
contributing to the research.
There is an overlap in interests across the disciplines and the approaches researchers have taken toward establishing a stigma concept appear to have come from different frames of reference and the placement of different emphases. Even researchers from the same discipline have different theoretical orientations. Some researchers have refrained altogether from providing an explicit definition and have turned instead to the dictionary for ordinary language definitions of stigma as a mark of shame, disgrace, infamy and reproach, or have turned toward related aspects of stigma such as rejection or stereotyping.140 ‘Stigma’ has the same conceptual and definitional vagaries and inconsistencies as ‘mental illness’ and ‘mental health’ which relegates many studies of ‘mental health stigma’ to its consequences rather than to its causes.
137
Émile Durkheim, Rules of Sociological Method (The Free Press, 1966) 68.
138
Jo C Phelan and Bruce G Link, ‘Conceptualizing Stigma’ (2007) 27 Annual Review of Sociology 363. Phelan and Link found that the number of articles in PsychInfo and Medline which mentioned the word stigma in their titles or abstracts dramatically increased between 1980 and 1999.
139
Jo C Phelan and Bruce G Link, ‘Conceptualizing Stigma’ (2007) 27 Annual Review of Sociology 363.
140