Dictionary(2002). Mental illness is one of the least understood illnesses, precisely
because the body seems to be “normal,” and yet behavior and expression are often
not at all normal. The causes of mental illness are as varied as the causes of bodily
illnesses. In some cases, genetic factors before birth affect brain or neurological
development; in other cases, mental illness can be caused by trauma (head injuries),
side effects of other diseases (AIDS-related dementia), chemical imbalances in the
brain (schizophrenia), or even aging.
The definition of any illness is strongly affected by social construction. Since the
1960s, studies have found the way odd or mentally ill people are perceived by the
medical profession as well as the public depends a great deal on the label that is
attached to their behavior (Jones et al., 1986; Scheff, 1984; Scott, 1969; Szasz, 1974).
In fact, in one landmark study, Rosenhan (1973) found if we are told a person is a
mental patient or mentally ill, we may perceive all his or her behavior as strange, no
matter what he or she does.
Those defined as mentally ill or even merely strange or neurotic are strongly stig-
matized in our society. Studies of public attitudes have arrived at the persistent con-
clusion that the public fears people with mental health problems (Martin,
Pescosolido, and Tuch, 2000) and desires to be socially distant from them (Pescosolido,
et al., 2000).
Since the 1960s, sociologists have encouraged mental health practitioners to
reconsider the nature of mental illness. Many argued that the label “mental patient”
or “mentally ill” had become too powerful and that people were being kept in asy-
lums who might be able to live in society if properly supervised. At the same time,
new drugs were developed that were proving effective against a number of disorders.
These factors resulted in the deinstitutionalization movement of the 1970s: Patients
were relocated to halfway houses and community-based organizations to help
reintegrate them into society. By the 1990s, the number of patients in mental hospi-
tals had decreased by 80 percent from what the number had been 40 years earlier
(Mechanic and Rochefort, 1990). Yet care alternatives were plagued by disorganiza-
tion and underfinancing, and many severely and persistently mentally ill people were
left without essential services (Mechanic and Rochefort, 1990). One effect has been
increasing numbers of mentally ill people on the streets or in prisons, because lack of
treatment and supervision have abetted their committing a crime or because there is
no place else for them to go (Kupers, 2003).
At the same time that deinstitutionalization reintegrated the mentally ill into “nor-
mal” life, mental illness began to be redefined more biologically and treated more med-
ically, especially with drugs. Mental illness was medicalized. Instead of people who
have “problems,” the mentally ill are increasingly seen as patients with symptoms.
Insurance companies and managed care require that most psychological problems be
treated not with therapy or counseling but with prescription medication, which is sig-
nificantly cheaper. Remarkable medical breakthroughs in managing psychiatric dis-
orders such as depression have been accompanied by even more dramatic increases
in the writing of prescriptions for antidepressants. Fewer people are institutionalized,
but far more are diagnosed with medically treatable conditions.
The mentally ill continue to suffer prejudice. Large numbers of Americans say
they would ostracize people with mental health problems. Martin and colleagues
(2000) found, on average, that nearly seven out of ten Americans are unwilling to
have someone suffering from depression, schizophrenia, or drug or alcohol depend-
ency marry a family member. A majority of Americans express an unwillingness to
have people suffering from these problems as co-workers, largely because they fear
the “disturbing behavior” more often directly observed by the public. Wealthier peo-
ple have long been more likely to say they would avoid the mentally ill. But urban540 CHAPTER 16THE BODY AND SOCIETY: HEALTH AND ILLNESS