2014-6SL508

100052398

Sociology of Health and Illness

Doctor Phil Burton-Carteledge

3835 words (without title and references)

To what extent do ‘lay’ understandings of medicine

pose a threat to the authority and dominance of the

medical profession?

1 | P a g e

In this essay, using both an ‘autobiographical’ and objective

approach, I hope to assess the impact of the ‘lay’

understandings of Schizophrenia on psychiatry, and see how

this thesis challenges the standing orthodoxy of the

conventional psychiatric profession. I also intend to look at

the impact lengthy hospital admissions have, with the final

summation attempting to make a synthesis between these

different narratives/models in a mutually accommodating way.

Schizophrenia is something of a modern chimera. With no

one knowing either its epidemiology or causes (Tsuang, 2000),

beyond a few theories. It is very much a disease which is

realised by its presence, and dealt with in a reactionary

(cause and effect in the immediate situation), and risk (Beck,

1992) basis. Yet be this as it may, psychiatry continues to be

looked down upon as the ‘underdog’ of the medical profession,

at least from some quarters (Bracken et al. 2012). Bracken

(ibid) argues that the vast majority of mental health problems

should be understood as ‘normal, human responses to difficult

social circumstances’ (Kinderman, 2014, loc 740). It is my

intention, throughout the course of this essay, to assess both

the aetiology (causes) of this condition, and using both a

subjective and more academic approach better understand this

illness. I also intend to address this mental illness and

reaction to it, from both a personal, feminist and racial

(black) perspective.

Conventional Wisdom

2 | P a g e

The conventional role of a sick person (Parson’s, 1951) is one

who falls ill, spends some time in recovery, either at

hospital or at home, and then gets better and returns to work.

Thus continuing to maintain part of the overall successful

functioning of the organism which is society. As one ex-

patient recalls, ‘It is the moral duty to recover one’s

health’ (Herzlich and Pierret, 1987: 194). So goes the

conventional wisdom on an individual’s health. But for

schizophrenia: ‘a complex, chronic, lifelong condition’

(Falvo, 2009: 227), both with ‘no specific cause’ (Tsuang,

2000 cited in Falvo 2009: 228) or cure (Gillam, 2006 cited in

Falvo 2009: 229) things, initially at least, look very bleak

for people suffering from it.

However, this analysis of the ‘sick role’ has been

subject to ‘extensive and detailed criticism over six decades

of sociological research’, (Turner, 1995: 51) and ‘the major

practical proposal for resolving the competence gap has been

to encourage doctors to treat seriously the lay knowledge of

their patients and to listen more carefully to what is said’

(ibid:48). And so in this way, in theory, the medical

professionals have learnt from their wards.

Habermas (1972) developed a theory of cognition based

around the idea of democratic dialogue from communication. His

view of the ‘ideal speech’ situation, also pertains to this

medical discourse, which McCarthy (1978:328) alludes to

expressing that, ‘interests… are shaped and discovered in

processes of communication’. This relates to the medical

encounter on both a cold, sterile and theoretical level, in

3 | P a g e

that over the doctor’s surgery symptoms can be expressed, and

relationships can be formed and diagnoses explored at that

level, and on the ‘hotter’ more immediate and critically

intimate level of an inpatient crisis, which experience I was

to discover.

One critique of this ‘ideal’ situation being that, unlike

Day’s (1993:12) persuasion that ‘no person should be excluded

from potential transformative processes’, clearly from my

experience of the ‘underdog’ in the medical encounter, this

‘ideal’ is not always attained.

The experience and management of schizophrenia, from clinic to

the wards

Ten years after my first diagnosis, and several long term

hospital admissions, I have recently been able to take the

time to research, not just my own, but other sufferers

conditions, and have discovered some remarkable findings over

this time. The first of which being: that I am not alone in my

suffering. This ‘disease’ which is symptomatic of flattening

of empathy and cognitive hallucinations, is actually common

(‘1% of the general population’ Schiffer, 2004) and so too are

the sufferings its victims experience. To call a patient of

this phenomena a ‘victim’, could be debated however, for

whereas we should not consider ourselves helpless sheep in our

lived lives, but rather active creators of our destiny.

‘Social and cultural realities are not determined, but rather

4 | P a g e

they are socially constructed’ (Douglas and Johnson 1977:142.

However after a given time locked away on these wards, it is

all too easy to lose sight of this fact, and fall in to the

trap of becoming the very creature you are supposed to abhor.

My understanding of this illness, both in terms of myself

and other fellow sufferers, both on the wards and outside in

the larger community, is a home grown, personal one. Created

by the experience ten years diagnosed with it, on and off the

wards, and also the contacts and friends I have made across

this time. This is supported by the counter-culture, both

professional and lay, which oppose this orthodoxy.

The Psychiatric convention, which from consultants to

nurses, have verified to me, both verbally and unvoiced, over

the years, have contrasted my own inner held convictions over

this disorder. Which I hope to, if not dissect, then at least

assess afresh, in this essay. ‘They’ believe that concepts

such as: ‘Schizophrenia is a genetic disease and hence

incurable’ (ibid, 2009). And also that this health status,

makes one, some-how an inferior human being, and there is

nothing that we can do about it. It was inferred ‘that

psychotic experiences are permanent conditions, with either a

recurring or deteriorating course and little hope for the long

term’ (British Psychological Survey, 2000: 14). This despite

the fact that ‘one in seven… British (mental health) patients

received this diagnosis’ (Taylor and Field:2003).

The contrast between the bio-medical etiology (that

‘mental illnesses are diagnosed by doctors in terms of clearly

5 | P a g e

defined criteria and are symptoms of underlying bodily

disease’), and the sociological ones, concerning both societal

cause and reaction (Scheff, 1966 cited in Taylor and Field

2003: 141), is acute as it is chronic, excuse the synonym.

The sentiment that both me, and many other vulnerable

individuals like me, have felt throughout lengthy hospital

admissions, is the ‘stigma’ Goffman identified (1968). Which

once labelled, sticks to us, and continues to affects social

encounters, from our family to our charge nursing, our

education and employment (if we are able to find any) self-

confidence, and other critical aspects of our life, for an

indeterminable time after release from our first admission.

Despite all of this, I have over the past few years

developed a good working relationship with my consultant and

psychiatric nurse, both of whom, despite making up part of the

orthodoxy mentioned above, have softened somewhat in their

approach and attitude to me over the years. And I am still

hopeful of reaching a much lower medicine input in the future.

This is supported by evidence that the comparatively high

treatment and admission rates of countries such as the U.K.

actually compare much worse than less well developed countries

such as India, who’s recovery rates for this illness are much

better. ‘The over aching message (is that) schizophrenia is

largely an episodic disorder for a significant proportion of

those afflicted’ (British Psychological Survey, 2000: 17), and

‘outcomes… have reliably been strongly in favour of those not

using standard Western psychiatric treatment, something that

6 | P a g e

is likely to come as quite a surprise to many.’ (Williams,

2012: 41) There is a definite problem with staff struggling to

create a therapeutic milieu in acute units (Baruch and

Treacher, 1978), with medications still predominating the

medical gaze (Lelliot and Quirk, 2004).

Encountering anti-psychiatry for the first time

Laing (2010) presents us, the interested reader with a whole

new field of ‘anti-psychiatry’.

The presumption used to be, that once you are cursed with

the label of psychotic, you have to be enslaved to these

medications for the rest of your life. From the clinical use

of such ‘ego distortion’ or ‘psychopathology’ data, which

despite seeing the ‘signs’, without ever being able to

‘understand’ him or her. ‘Such data are all ways of not

understanding him. To look and to listen to a patient and to

see ‘signs’ of schizophrenia and to look and to listen to him

simply as a human being are to see and to hear in… radically

different ways’ (Laing, 2010: 33). After all the psychotic,

‘is more than anything else ‘simply human’ (ibid: 34). So that

in the anti-orthodox challenge to the authority of the

orthodox psychiatric profession.

As for what the medics say, we can firstly appreciate

that a diagnosis of schizophrenia means a lack of grip on

reality, be it an auditory (hearing voices) hallucinations,

7 | P a g e

tactile or memory (ibid: 33). The worst thing is, that once

cursed with such a label, the individual tends to suffer

discrimination, and stigma which can last a lifetime (Goffman,

1968). Then a forty-eight hour holding assessment, turns in to

weeks, months, and eventually even years. Reference my two

year admission. And these wards, complete with fire escapes

which don’t open and charge nurses, who’s steely eye only

betrays the gap between cigarette breaks and the next jab in

the bum, really create the very epitome of asylums these ‘mad-

houses’ represent (Goffman, 1961).

The numerous psychical assaults I have both witnessed,

and been victim to, over these times, seems to be less the

oddity to this system, and more endemic of the ‘animals’ at

the bottom of the ‘system’, lashing out amongst themselves,

when the opportunities presented themselves.

I have written numerous letters to the various

consultants, bargaining with them for my freedom. Which is

very much an enactment of the power struggles, Foucault talked

about in his book (1980:155). This was engaging with the

dialogue of psychiatric medicine on a very real, lived basis

of my life. Using what I had read, and my day to day progress

and personal management, as a means to my case. Despite the

fact that I eventually achieved this freedom, it was not

without a great deal of suffering on my part. And if this kind

of treatment is being conducted across the asylums of the U.K.

there is no question as to why Psychiatry is held as the

underdog of the medical professions.

8 | P a g e

What is the most disconcerting thing after this whole

experience is over, is the feeling of belittlement and

degradation one is left with from the whole affair. From the

minute you step foot in the doctor’s presence, to many years

after you leave the hospital, you are left with the sense that

you are both an inferior human being, and somehow less of a

man. This was what Goffman talked about when he mentioned

Stigma (1968), the way an individual’s identity and self

confidence is stripped away from by this institutionalizing

‘total’ process (1961), so that the hollow shell of a self

that remains after this experience is survived, is but a

shadow of its formal self. From social, to physical, mental

and verbal, most if not all areas of the individual are

affected by this kind of long term detainment. And for those

who do make it out, the road to recovery can be a long one

indeed. So whereas people can, and do get better, this is

actually a long and painful journey. And Indeed quite a few

don’t make it out (die in either in, or shortly after leaving,

hospital), be this from Iatragenetic (medical origin) causes,

(Médecin Psychiatre Homéopathe, 2013) or some other

complications. Certainly the life expectancy figures for ex-

patients of long term hospitalisations is reduced from

anywhere between 11 to 20 years (Laursen, et al.

2013:abstract).

Williams (2012: 61) points out that actually it is a myth that

‘Schizophrenia is a degenerative brain disease’ with the

‘medical model treatment’ actually causing the illness. This

9 | P a g e

has certainly been my experience of this disability, both in

and out of hospital.

The Female Perspective

Despite my own androcentric model and experience of this

disease, I think that it would be valuable to spend a moment

considering the Female encounter with psychiatry. Throughout

the Nineteenth and Twentieth centuries, women were undermined

and looked down upon by a misogynistic emerging (male)

psychiatric profession. Their illnesses were portrayed as

being firstly weak, and also sexual. Hysteria, the vapours,

and insubordinate to husbands were among typical diagnoses

(Ehrenreich and English 1979). With treatment ranging from a

‘slapping with a wet towel’ to bring a woman to her senses, to

a removal of the clitoris.

Prior (1999) tells us that the patriarchal psychoanalytic

theory, has put some women in a ‘catch 22’ situation, where

they are deemed as mentally unstable if they comply to the

stereotypical female norm, or again even more so if they

deviate from it. The dominant discourse of psychiatry seems to

support the male characteristics of dominance of

competitiveness, whereas the typically female traits of

submissiveness and conformity are seen as ‘unhealthy’. The

‘medicalisation of female unhappiness’ with over-prescription,

and a reliance of pharmacological solutions, sadly persists to

this day (Scambler, 2003: 139).

10 | P a g e

Men on the other hand, are much more likely to be unable

to express their mental difficulties in the same way as women,

and also are much more likely to be deemed criminal in their

intent. Thus the more serious label ‘psychosis’ is more

likely to be used to determine a man’s mental illness,

compared to the female ‘softer’ neurotic diagnoses of

‘depression’ or ‘anxiety’ (MacIntyre et al 1996). Equally men

are twice as likely to be sectioned as women (Prior 1999), and

four times more likely to be taken to prison then psychiatric

hospital, on initial arrest, then young women (Payne 2001).

Whilst there does still seem to be a distortion between

the patriarchal model of this disease, with women both more

likely to be subordinated as patients, and less likely to work

in senior roles within the profession (Gamarnikow 1978, Hearn,

1982 and Crompton 1987) the issue of discrimination within the

mental health setting, does still apply for both genders, and

the drug centric treatment contemporary treatment model of

Schizophrenia, used today by most UK professionals (get ebook

reference here), needs to find solutions which work for both

women and men alike, across the scale.

Looking at the racial minority, (black), perspective

Having addressed this illness/condition in general, from my

own personal perspective and that of women/feminists, I now

11 | P a g e

intend to address Schizophrenia from the black/ethnic minority

outlook. Black people are both over represented in admissions

to psychiatric hospitals (Bhui et al. 2003), more likely to be

admitted compulsorily and placed on locked wards (Koffman at

al. 1997), and more likely to have been in conflict with the

police (Commander et al. 1999). We need to look at both

possible reasons for this state of affairs, from a

sociological perspective, and also the relation between the

‘black experience’ and that of the mentally ill ‘other’.

Finishing this section by addressing the state’s response

(Althusser, 1971) to this situation.

Whilst a greater prevalence to Schizophrenia has been

used as an explanatory factor for the high rates of compulsory

detention of psychotic black patients (Cope, 1989), there are

a number of other possible causes, ranging from pre-natal to

social causes. So for example a higher unemployment rate

amongst black men, leads to poor housing and almost inevitably

worst physical and mental health (Harrison et al, 1988).

Returning to the medical discourse, we can also see that

the ‘ethnocentric’ view of psychiatrists (Fernando 1988), has

resulted in a misattribution of labels, such as

‘schizophrenia’ or ‘cannabis psychosis’, where black people

display disturbed behaviour (Littlewood and Lipsedge 1982).

There is also the argument which equates both being

‘mentally ill’ and being black, as the ‘other’ (Foucault,

1965). So just as having a severe thought disorder, or hearing

voices, equates one in society’s eyes at least, with the

12 | P a g e

‘alien’ (social outcast), becoming strangers to ‘themselves

and others’ (Barham and Hayward, 1991: 2), so to being black

(or indeed any ethnic minority), makes one the potential

subject of the ‘new racism’ (Gilroy 1987: 45), where one is

subject to segregation or even banishment, for reasons of

their ‘origin, sentiment or citizenship’ (ibid).

Indeed far from tackling this problem, mental health

legislation is actually seen, as contributing to it

(Althusser, 1971), as part of the ‘repressive state

apparatus’.

On towards finding a synthesis of the opposing models

So we have addressed both the conventional view of psychiatry

to this illness, and that of the counter culture view, and

their applied model as experienced by the author himself. But

what then can be a synthesis to these two very diametrically

opposing models? I cannot say where the Psychiatric revolution

of present will end. And for every service user I know who has

made it without medications (recovered) (Spowage, 2015), there

are four more I know, who are still on them.

I can speak from personal experience to how I believe

that recovery is not just possible, but can be actively worked

towards. And I am a strong believer that many if not most of

the sufferers of this condition, can with hard work and good

13 | P a g e

care, make good improvements in their health. However equally

we need to remember that each Schizophrenic patient is an

individual, with an individual situation, symptoms and

recovery model.

I am actually at present three years in to a medical

discourse/dialectic with my present consultant Psychiatrist,

who is well aware of not just the risks I pose my self, family

and others around me, but also what I can offer to them and

society in general (my honours degree for example), and thus

the importance of managing my situation on a week to week

basis, with the whole team. This is the kind of personalized

and focused work that the psychiatric profession carries out

across the country, on a daily basis, to maintain the health

and minimize the risks, for all those concerned. From staff to

families and members of the general public. Just as my

consultant and nurse should try to learn more about me and my

condition, every time we convene, so to should I can use these

meetings to learn about both my condition, and Psychiatry in

general.

This ‘discourse’ is ‘created through the language and

practices which surround it’ and is ‘composed of a whole

assemblage of facts, events and epistemological precepts’.

(Prior, 1983:3), which combined with my current and active

agency, goes to make up a positive matrix, with assertive set

of events, as opposed to the negative outcomes usually

associated with this condition.

14 | P a g e

Whether or not other sufferers of this condition are

privy to such engagement, remains to be seen. And

unfortunately given the strict confidentiality of today’s

health systems, there is no way of me knowing the details of

other such patients on a professional basis. But on an

informal one, I can confirm both from the positive attitudes

conveyed to me by the medics and my friends who I have

maintained contact with since leaving hospital, that the

general outcomes are generally positive ones. Indeed my

history and active cognitive difficulties would seem to place

me as one of the worst of the lot. And so things can’t be that

bad.

Whilst the worst patients detained and out of public

life, we have no way of reporting on them. Although we may

consider that a psychiatric approach in detention will be more

humane, this is not necessarily the case (Rogers and Pilgrim,

2014). My own work to reintegrate back in to societies norms

and expectations, has been an ongoing, steep learning curve,

since leaving hospital at the end of 2011. And has also been a

steep learning curve, with the judges of normality, from the

medics, to the university teaching team and on to my parents

and wife (Foucault, 1979: 304) may have not always been the

easiest journey to take, but it has benefited both my psyche

and overall well being in the long run. Now enabling for me to

take some care over my step-daughter. Which I don’t have to

space to go in to further here, suffice to say that my

home/family life is now going well, which is a victory to go

alongside the rest, given someone with my health status. Don’t

15 | P a g e

forget that this illness is a chronic condition, of which

there is no cure, and generally lasts a lifetime, as mentioned

earlier. (Falvo, 2009: 227, Tsuang, 2000 cited in Falvo 2009:

228, Gillam, 2006 cited in Falvo 2009: 229). So the fact that,

at least on my personal level, that I have been able to make

these small steps forward, is really a big achievement in the

long run.

We can return to Habermas (1972), who’s philosophy has

been to ‘provide a critique of those elements of the social

structure… which deny individual freedom and growth’ by

enacting archaic and powerful methods of social control, and

run with the themes Williams (2012) and the British

Psychological Survey (2000: 17) suggested to support this,

that mental illness is at best only a temporary affliction,

and at worst not as critical as once thought. In determining

that my own recovery model, as important as it has been for

me, and those around me, can also stand as a good example of a

response to this bad situation, from both an individual and

social/medical response, and find a good way forwards in to

the future in this way. This can serve as a model for those

around me and other sufferers of this affliction as well.

To conclude, I have not solved the chimera or mental

illness in this short essay. However what I have attempted to

do is take a fresh perspective on both the medical, feminist

and racial minority outlook upon this disease. And whilst I

appreciate that there are many more hidden areas of this

illness which could be broken down and more fully appreciated

given the correct onus, mental health legislation within the

16 | P a g e

legal framework, and the longitudinal outlooks of patients

both in the UK and also worldwide being two possible examples,

time and space have prevented me from expanding to such scope.

Whilst it is true that both much more work does need to be

done in this area, and indeed exciting papers are being

written all the time, very much creating the revolution I have

already mentioned, it is also true that the divide been the

orthodox authority of psychiatry proper, and the more

subversive outlooks of those of the lay profession and its

advocates, also is as strong as ever.

Synthesis is possible between these two camps, to a

certain extent, as I have attempted to demonstrate in this

essay. But equally I fear that the imbalances of power and

wealth, between these two groups, on both a class and

occupational basis (something else which would benefit from

further study), will ensure that the division between the

haves and the have nots, for women and men alike, on the

spectrum on mental health and stability (here the focus being

on Schizophrenia), continues long in to the future.

17 | P a g e

References

Algazi, J. (2013) ‘Iatrogénie en psychiatrie’ Médecin Psychiatre

Homéopathe, 4(2) :60-62 available on http://www.em-

consulte.com/article/813702/article/iatrogenie-en-psychiatrie

accessed 15.04.15 Doi : 10.1016/j.revhom.2013.03.010

Althusser, L. (1971) Lenin and Philosophy and Other Essays. London:

New Left Books

Barham, P. and Hayward, R. (1991) From the Mental Patient to

the Person. London: Routledge

Baruch, G. and Treacher, A. (1978) Psychiatry Observed.

London: Routledge and Kegan Paul cited in Rogers, A. and

Pilgrim, D. (2014) A Sociology of Mental Health and Illness

fifth edition Maidenhead: Open University Press

Beck, U. (1992) Risk Society: Towards a New Modernity, London: Sage

Bhui, K. Stansfield, S. Hull, S. Preibe, S. Mole, T. and

Feder, G. (2003) Ethnic variations in pathways to and use of

specialist mental health services in the UK. British Journal of

Psychiatry, 82: 105-16

Bracken, P. Thomas, S. Timimi, E. Asen, G. et al. (2012)

Psychiatry Beyond the Current Paradigm. British Journal of Psychiatry,

201(6): 430:434. Doi: 10.1192/bjp.bp.112.109447

British Psychological Society (2000) Recent advances in understanding

mental illness and psychotic experiences. Leicester: The British

Psychological Society

18 | P a g e

Commander, M. J. Cochrane, R. Sashidaran, S. P. Akilu, F. and

Wildsmith, E. (1999) Mental health care for Asian, black and

white patients with non-affective psychoses: pathways to the

psychiatric hospital, in-patient and after-care. Social

Psychiatry and Psychiatric Epidemiology, 32(9): 484-91

Cope, R. (1989) The compulsory detention of Afro-Caribbeans

under the Mental Health Act. New Community, 15(3): 343-56

Crompton, R. (1987) Gender, status and Professionalism.

Sociology, 21(3): 413-28

Day, M. M. (1993) ‘Habermasian Ideal Speech: Dreaming the

(Im)possible Dream’, Accounting & Finance 93(13)

Douglas, J. D. and Johnson, J. M. (1977) Existential Sociology cited

in Jacobsen, M. H. 2009: 142

Ehrenreich, B. and English, D. (1979) For her own good, 150

years of the expert’s advice to women. London: Pluto Press

Falvo, D. R. (2009) Medical and Psychosocial aspects of

Chronic Illness and Disability 4th edition. London: Jones and

Bartlett Publishers International

Fernando, S. (1988) Race and Culture in Psychiatry. London:

Routledge

Foucault, M. (1965) Madness and Civilisation. New York: Random

House

Foucault, M. (1980) The Eye of Power, in C. Gordon (ed.),

Power/Knowledge: Selected Interviews and Other Writings 1972-

1977 by Michael Foucault, Brighton: Harvester

19 | P a g e

Gamarnikow, E. (1978) Sexual division of labour: the case of

nursing cited in Kuhn, A. and Wolpe, A. (eds) Feminism and

Materialism: Women and Modes of Production. London: Routledge

and Kegan Paul

Gillam, T. (2006) ‘Positive approaches to schizophrenia’.

Mental Health Practice, 10(4): 30-33 cited in Falvo, D. R.

(2009) Medical and Psychosocial aspects of Chronic Illness and

Disability 4th edition. London: Jones and Bartlett Publishers

International: 229

Gilroy, P. (1987) There Ain’t No Black in the Union Jack.

London: Hutchinson

Goffman, E. (1961) Asylums, Harmondsworth: Penguin

Goffman, E. (1968) Stigma: Notes on the Management of Spoiled Identity,

Harmondsworth: Penguin

Habermas, J. (1972) Knowledge and Human Interests. London:

Heinemann

Harrison, G. Owens, D. Holton, A. et al. (1988) A prospective

study of severe mental disorder in Afro-Caribbean patients.

Psychological Medicine, 11: 289-302

Hearn, J. (1982) Notes on patriachry, professionalization and

the semi-professions. Sociology, 16(2):184-202

Herzlich, C. and Pierret, J. (1987) Illness and Self in Society,

Baltimore, MD: Johns Hopkins University Press

Kinderman, P. (2014) A Prescription for Psychiatry: Why We

Need a Whole New Approach to Mental Health and Wellbeing.

20 | P a g e

London: Palgrave Macmillan Available at:

http://www.amazon.co.uk/Prescription-Psychiatry-Approach-

Mental-Wellbeing-ebook/dp/B00NC4QT0G/ref=sr_1_1_twi_2_kin?

s=books&ie=UTF8&qid=1432158269&sr=1-

1&keywords=A+Prescription+for+Psychiatry

%3A+Why+We+Need+a+Whole+New+Approach+to+Mental+Health+and+Well

being (downloaded 4.2.2015)

Koffman, J. Fulop, N. J. Pashley, D. and Coleman, K. (1997)

Ethnicity and the use of psychiatric beds: a one day survey in

North and South Thames regions. British Journal of Psychiatry,

171: 238-41

Laing, R. D. (2010) The Divided Self. London: Penguin Classics

Laursen, T. M. Wahlbeck, K. Hallgren, J. Westman, J. Osby, U.

Alinaghizadeh, H. Gissler, M. and Nordentoft, M. ‘Life

Expectancy and Death by Diseases of the Circulatory System in

Patients with Bipolar Disorder or Schizophrenia in the Nordic

Countries’. PLoS ONE. June 2013, 8(6):1-7

Lelliott, P. and Quirk, A. (2004) ‘What is life like on acute

psychiatric wards?’ Current Opinion in Psychiatry, 17(4) :

297-310

Littlewood, R. and Lipsedge, M. (1982) Aliens and Alienists.

Harmondsworth: Penguin

McCarthy, T., (1978) The Critical Theory of Jurgen Habermas

London: Hutchinson, cited in Day, M. M. (1993) ‘Habermasian

Ideal Speech: Dreaming the (Im)possible Dream’, Accounting &

Finance 93(13)

21 | P a g e

Parsons, T. (1951) The Social System Glencoe, IL: Free Press

Payne, S. (2001) Masculinity and the redundant male:

explaining the increasing incarceration of young men. In

Heller, T. Muston, R. Sidell, M. and Lloyd, C. (eds) Working

for health. London: Sage publications

Prior, L. (1989) The Social Organisation of Death: Medical Discourses and

Social Practises in Belfast, London: Macmillan

Prior, P. (1999) Gender and mental health. London: Macmillan

Rogers, A. and Pilgrim, D. (2014) A Sociology of Mental Health

and Illness fifth edition Maidenhead: Open University Press

Scambler, G. (ed.) (2003) Sociology as Applied to Medicine.

London: Saunders

Scheff, T. (1966) Being Mentally Ill: a Sociological Theory. Chicago:

Aldine cited in Taylor, S. and Field, D. (ed.) (2003)

Sociology of Health & Health Care 3rd ed. Oxford: Blackwell

publishing limited

Spowage, W. (2015) Telephone conversation with the author, 27

March

Taylor, S. and Field, D. (eds.) Sociology of Health and Social

Care third edition. Oxford: Blackwell Publishing limited

Tsuang, M. (2000) ‘Schizophrenia: genes and environment’.

Biological Psychiatry, A journal of Psychiatric Neuroscience

and Therapeutics. February 2000 47(3): 210-220 cited in Falvo,

D. R. (2009) Medical and Psychosocial aspects of Chronic

22 | P a g e

Illness and Disability 4th edition. London: Jones and Bartlett

Publishers International: 228

Turner, B. S. Medical Power and Social Knowledge second edition.

London: Sage Publications limited

Williams, P. (2012) Rethinking Madness: Towards a Paradigm

Shift in Our Understanding and Treatment of Psychosis. San

Rafael: Sky’s Edge Publishing

23 | P a g e