Psychiatrists as social engineers: A study of an anti-stigma campaign
Introduction
The study of stigma by sociologists emerged in the 1950s and 1960s and was associated with classical labelling theory (Garfinkel, 1956; Goffman (1961), Goffman (1963)). Empirical critiques of the theory emerged in the 1970s (Gove, 1975; Jones & Cochrane, 1981) and it fell out of favour for a while but it was rehabilitated, in a modified form, in the 1980s (Thoits, 1985; Link, Cullen, Struening, Shrout, & Dohrenwend, 1989). Labelling (or societal reaction) theory marked an important departure in social science, especially in relation to mental health. It was linked to a shift from Durkheimian positivism, with its emphasis the on social causes of illness, to a neo-Weberian examination of the way in which illness was socially negotiated.
Whereas social causationism examined the aetiological role of social factors in mental illness, the study of labelling and stigma suggested that the reactions of others were of central significance. Not only causes were now of interest but also the exchanges of meanings attached to illness behaviour and the sick role. Medicine traditionally singled out primary deviance (the ‘push behind’ of assumed or proven pathology inside patients), whereas sociology increasingly emphasized secondary deviance; the psycho-social consequences of the ‘pull from the front’ of the reactions of others to perceived difference.
Classical labelling theory focused on stereotyping and the rejecting actions of others but the later, modified, version of the theory emphasized the anticipated need in both parties to avoid mutual social involvement. Both versions drew attention to the demoralization and social exclusion arising from negative labelling. Specific sociological interest in stigma, as well as modified labelling theory, has returned in recent years, suggesting that the classical work of those like Goffman retains contemporary relevance in the study of illness and disability (Link, 2000; Scambler, 2004).
Against this backdrop of shifts within the sociology of health, the social reform of mental health services in developed countries was leading to people with mental health problems not only becoming more numerous, and so visible, in public spaces but also to demands that their citizenship should be properly established and protected. As a consequence, both de-stigmatization and social inclusion became progressive social policy objectives for a range of interest groups concerned to improve the lives of those with mental health problems.
By the 1990s, one of these interest groups was the psychiatric profession- the focus of interest in this paper, which has two aims. First, a critical reading will be provided of an anti-stigma campaign led by the Royal College of Psychiatrists between 1998 and 2003. Second the campaign's intentions and ideology will be situated in a broader context of changes in professional and governmental interest in stigma on the one hand and psychiatry's credibility on the other.
Section snippets
The ‘Changing Minds’ Campaign
The authors could not naively approach the ‘Changing Minds: Every Family in the Land’ policy document (Royal College of Psychiatrists, 1998). The history of contention about the psychiatric profession, which we will address in the second part of the paper, is well known. Psychiatry has been extensively scrutinized by sociologists, and its dissident members and external critics have publicized their views well. This context of unrelenting contestation was likely to resonate in both the
The ‘Changing Minds’ campaign in context
This second part of the paper places the above reading of the ‘Changing Minds’ campaign in a broader social context. The checklist below summarizes the reading above and is an overture for the subsequent critical discussion about the prevalence of mental health problems, psychiatric positivism, the challenge of stigma for psychiatry, the profession's controversial image and the coalescence of medical and drug company interests.
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Much of the policy document is not about stigma. When it is about
Conclusion
The campaign discussed in this paper can be understood as part of a re-professionalization strategy for psychiatry. This is not to claim that the campaign document at its launch was nothing but a re-professionalization strategy or that its authors were being insincere in their social policy aspirations. The campaign also reflected an historical moment when a biopsychosocial approach to clinical care could be promoted within the professional leadership of psychiatry, even though such an approach
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