32
1948, and the Diagnostic and Statistical Manual
(DSM-IV)
from the
American Psychiatric Association has undergone four revisions since 1952.
As in other areas of health, notions of mental health are gendered.
Men and women think differently about their mental health and feeling
of well-being, as it is shown by studies of psychiatric
morbidity in the
community and of patterns of helps-seeking behavior (Anson et al.,
1993). Women more often define problems as “illness” than do men,
and health professionals are more likely to medicalise women’s
problems than men’s (Jebali, 1995).
The public perception of mental disorder is based in culturally
constructed concepts of normality, abnormality, health and illness. In
general, are mentally
healthy in any given society, the persons who
manage to find personal fulfillment while being integrated socially and
economically into that society at whatever level suits them. People who
find themselves unduly stressed or isolated by the norms and expecta-
tions of their social situation have to find acceptable means of expre-
ssing their mental distress; otherwise they will become more isolated or
more stressed.
According to Shorter (1990) the social historian of psychiatry must
pursue three separate narratives:
first,
that
of underlying biology;
se-
cond,
the story of the stress and life experiences of individual patients;
third,
the story of changes in the models which the culture holds out for
the communication of inner distress.
The main diagnoses associated with women are depression, neuro-
sis, and eating disorders.
Views on how to „treat” people with mental disorders vary accor-
ding to the position taken, by the proponents of these views, on what
constitutes mental disorders. Those who view
it as a medical problem
will base their discussions on existing health care provision. Those who
view it as a socio-economic problem will look for ways of changing
social situations in order to provide more support and less stress for the
individuals concerned.
Others, of course, view the situation from a completely different
perspective, one that is interested only in the negative effects on society
caused by individuals who display antisocial conduct as a result of men-
tal disturbance. For the latter group, the discussion will revolve around
the issue of public safety and the need for
surveillance and protective
custody for people with mental disorders.
33
Early texts on the treatment of mental disorder show pictures of
swinging chairs, of bloodletting and of (cold) baths as effective modes
of treatment, but even these sometimes bizarre
approaches were only
available to a small minority of patients. In reality, there was very little
attention from medical staff. For some asylum „inmates”, work and dis-
cipline were the main forms of therapy, while for others, it was cruel
physical punishment and detention in substandard conditions.
As medical science developed in the
early part of the twentieth
century, infection was commonly associated with mental disorder, and a
variety of physical treatments were pioneered. These included the fol-
lowing: shock treatment, surgery, water therapy and the most generally
used approach to therapy manual work. However, for the majority of
people in the public health care system and psychiatry had little to offer
patients before the „drug revolution” of the 1950 s. As we entered the
twenty first century, medication has replaced physical restraint, surgery
and psychotherapy as the main method of treatment in hospital.
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