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The Sociocultural Approach, Social Labels, and Role Expectations
Abnormal Psychology · Chapter 8: Sociocultural Influences on Mental HealthSection 8.1 · lesson 29 of 9712 min · free with a free account
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In this lesson
What changes when the unit of analysis is the person-in-context.
- State the core claims of the sociocultural model
- Separate social causation from social selection
- Say what labeling theory does and does not support
- Match public, self and structural stigma to their remedies
Transcript
Everything said in the video, section by section (1,680 words). Read along, or search it.
Sociocultural Influences on Mental Health
The Sociocultural Approach, Social Labels, and Role Expectations
Picture someone exhausted, hopeless, sleeping badly, unable to concentrate. A purely individual account might describe altered neurotransmitter function. Or a pattern of negative self-referential thinking, or a history of loss. All of that may be perfectly accurate. But the same person may be working two insecure jobs, and facing eviction. And caring for a relative without any help. The sociocultural claim is that those last facts are not background color. They are part of the explanation. They predict who develops difficulty, and who recovers. A formulation that leaves them out is incomplete, in the same way one omitting biology would be. This section works out what follows from taking that seriously.
The Claim
Causes That Sit Outside the Person
The sociocultural model says difficulty is shaped by the social environment a person lives in. And that it cannot be fully explained by processes located inside the individual. Notice how careful that is. It does not deny that biology matters. It makes a narrower claim, and three parts sit at the center of it. First, social conditions are causes. Poverty and discrimination contribute to difficulty, rather than merely accompanying it. Second, social responses shape the course of a difficulty. How others react to it, including how they name it, influences how it develops. Third, the categories themselves are socially situated, and their boundaries move. One note before we go on. This material is educational, and is not a basis for diagnosis. Every case here is a composite, constructed for instruction.
Unit Of Analysis
What All Four Earlier Models Have in Common
The four models covered earlier differ sharply from each other. Each locates the primary explanatory machinery inside the individual. The biological model looks to genes, neurotransmission, and brain structure. The psychodynamic model looks to internal conflict and defensive processes. The behavioral model looks to an individual learning history. And the cognitive model looks to the person's own appraisals and beliefs. Environment enters all four, but only as an input. This model changes the unit of analysis, which is a much bigger move. It asks about the person-in-context, together with household, neighborhood and material circumstances. And here is what that changes. If the unit is the individual, treatment means changing the individual. If the unit is the person-in-context, then changing the context is a treatment.
Determinants
The Conditions People Live Under
Social determinants are the conditions in which people are born, grow, live, work, and age. Their role was set out in a widely cited international public-health report, published in twenty fourteen. The associations it describes are among the most consistently replicated findings in the field. Poverty operates through chronic uncertainty, restricted choice, and reduced access to care. Housing insecurity removes the physical base that routines, sleep and relationships depend on. Discrimination is a chronic stressor, and it also restricts access to housing, work, and care. Now two properties of the whole set, and both matter for how you read the evidence. They cluster. Someone facing one of these rarely faces only one. And they show a gradient rather than a threshold. Outcomes improve step by step as social position rises, all the way up. A gradient is much harder to explain away as a quirk of one extreme group.
Two Directions
Causation, Selection, and One Correlation
An association between adversity and difficulty can be read in two directions. The social causation hypothesis says adverse conditions contribute to difficulty. The adversity comes first, and it does causal work. The social selection hypothesis, sometimes called social drift, reverses that. Difficulty causes downward movement in social position. Here is the problem. Both hypotheses predict exactly the same correlation. So the correlation alone cannot choose between them, however large it is. The honest answer is that both operate, and their weight differs by condition. Dohrenwend and colleagues, reporting in nineteen ninety-two, compared conditions across social positions. They found selection playing a larger part for schizophrenia. And causation a larger part for depression in women, and for antisocial personality and substance problems in men.
Labeling
What Happens After the Name Is Applied
Labeling theory is a claim about what a diagnosis does, beyond describing. Applying a label changes how a person is perceived, how they are treated, and how they see themselves. Those changes can become part of what maintains the difficulty. The version most often cited here was set out by Thomas Scheff, in nineteen sixty-six. Primary deviance is behavior that departs from a norm before any label is applied. Most people do this at some point, and it usually passes without lasting consequence. Secondary deviance is behavior that follows from having been labeled. It arises from the new role the person now occupies. The claim is that the second kind is often the more consequential. Produced not by the original difficulty, but by the social response to it. And the loop feeds back, which is what makes it self-sustaining.
The Evidence
A Moderate Version Survives; a Strong One Does Not
Bruce Link and colleagues, from nineteen eighty-nine onward, developed modified labeling theory. It does not claim that labels create disorder. It claims that labels carry consequences. People absorb society's beliefs about a condition long before they are ever diagnosed. Once the label applies to them, those beliefs become self-relevant. The documented effects include withdrawal from contact, in anticipation of rejection. Once a label is known, ambiguous behavior is more readily read as a symptom. David Rosenhan's much-discussed report from nineteen seventy-three dramatized that. Though later scrutiny raised serious questions about how that study was conducted. Now the strong version, which says disorder is essentially a role created by labeling. Serious conditions are recognized across societies that never had contact with one another. Impairment occurs in people who have never been diagnosed, and symptoms often predate labels by years. And it is also not the thing that brings the object into being.
The Sick Role
Exemptions That Help, Then Stop Helping
A social role is a set of expectations attached to a position someone occupies. Talcott Parsons, writing in nineteen fifty-one, described one such role. The sick role, made available to people identified as unwell. The exemptions are release from some ordinary responsibilities, and relief from blame. The obligations are to regard the state as undesirable, to seek competent help, and to cooperate. It is what makes it possible to be unwell without being treated as lazy. But the structure carries a risk that matters clinically. Exemptions that are helpful at two weeks may be harmful at two years. As they accumulate, the person's life narrows, until resuming any of it is formidable. And roles are held in place by other people as much as by the person in them. A family reorganized around a difficulty has an investment in the arrangement continuing.
Identity And Setting
Something You Have, or Something You Are
Illness identity is understanding yourself primarily through your condition. The difficulty moves from something you have to something you are. Forms, appointments, benefits assessments, and the vocabulary of services all address the condition. Sociologists use the word career for the sequence of stages in relation to an institution. A total institution is a place where people live, sleep, work and take leisure under one authority. Erving Goffman described the type in Asylums, in nineteen sixty-one. Institutionalization is the set of changes long-term life there produces. For years those were read as the late stage of the disorder itself. Then John Wing and George Brown published work in nineteen seventy comparing hospital regimes. Severity tracked the poverty of the ward environment, not the severity of the illness. Hold the general question open. Is this behavior a feature of the person, or of the setting?
Construction
Made by Societies, or Found in Nature
Social construction says categories of disorder are produced by societies, rather than discovered in nature. It comes in a strong version and a moderate one, and the difference matters enormously. The strong version says the categories have no independent reality at all. The moderate version says real patterns of distress and impairment exist. But where the boundaries fall, and how thresholds are set, are shaped by social context. The clearest documented case in the model's favor is the classification of homosexuality. It was removed in nineteen seventy-three, by a vote of the professional membership. The argument was that the evidence for treating it as pathology had never existed. How far does it generalize? Some way, and not the whole way. What resists the strong version is persistence across very different value systems. A society's decision about what to call a pattern is one thing. The pattern is another.
Three Stigmas
Each Mechanism Needs Its Own Remedy
Stigma is the devaluation and exclusion attached to a characteristic. Bruce Link and Jo Phelan, writing in two thousand one, argued it operates through separable mechanisms. An intervention aimed at one may do nothing at all about the others. Public stigma is stereotypes held by the general population, endorsed and acted on. The remedy is contact-based education, which outperforms information campaigns alone. Self-stigma is the person applying those devaluing beliefs to themselves. It produces concealment, reduced help-seeking, and loss of confidence. Structural stigma is rules, laws, funding and institutional practice. It disadvantages the group whether or not any individual holds a prejudiced attitude. A campaign that successfully shifts public attitudes can change no outcomes at all. Because those outcomes were produced structurally, and were never going to respond to attitudes.
Two Composites
What Social Context Adds to a Formulation
If social conditions and roles are causes, then changing them is treatment. A clinician sitting with someone in distress cannot change their poverty this afternoon. And treating social causes as the whole story risks delaying treatment that would have worked. Take Daniel, thirty-four. Low mood, lost interest, poor sleep, poor concentration. Formulate it without context and you get a depressive episode, plus withdrawal and self-critical thinking. Now add the context. His hours were cut fourteen months ago. His tenancy is month-to-month, and the mail he has not opened includes arrears notices. His shift pattern rotates weekly, which explains the irregular sleep without invoking a symptom. That matters, because behavioral activation built on unavailable activities would just fail again. Now take Priya, twenty-two, with severe anxiety and panic episodes since she was seventeen. The first exemptions were appropriate. She genuinely could not manage the journey alone. Each exemption reduced the opportunity to practice the thing exempted. Her mother answers most questions in appointments. So she has had five years of practice at not describing her own experience. Treating the anxiety alone returns her to a household organized around her not coping.
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