Sick, deviant or just looking for a better community?

Sociological approaches to social difference (‘deviance’) in the light of

health and human rights goals

Durkheim on deviance (A functionalist approach)

• Shared norms and values are the basis of the social order

• Deviance is a necessary part of all societies

• It performs positive functions for societies by pointing out their unifying values

• All social change begins with deviance

• Today’s deviance is tomorrow’s normality

Karl Marx: A conflict perspective on crime

• Society is the crime; its rules are made and driven in the interests of the ‘ruling class’. People become sick or criminal because of this inequality.

• The key state repressive apparatus (e.g. police) and ideological apparatus (e.g. schools) primarily reflect the views and interests of the powerful

• The powerful are protected, the powerless are exploited or punished.

Talcott Parsons’ sick role (A functionalist perspective)

• Sickness is the only available alternative to the criminal role as a means of providing people with opportunities to avoid stresses associated with their expected social functions

The sick role

• People may escape normal responsibilities through sickness but they must deny the wish to be sick, do something about, accept the help of others, and try to get better

• The health professional is there to help them (but do they really do so?)

From priest to health practitioner (Szasz)

• The reciprocally opposing voices of angels and the devil reflect the ancients’ view that the struggle for self control was a moral problem with a religious solution

• Today it is primarily conceived of as a psychiatric problem with a pharmacological solution(Thomas Szasz, Professor of Psychiatry, New York Uni.)

Szasz on ‘Mental illness’

• One of the most important political-philosophical features of the concept of mental illness is that it removes motivation from action, adds it to illness, and thus destroys the very possibility of distinguishing disease from non-disease.

The brain and the mind (Szasz)

• If mental illnesses are diseases of the central nervous system, then they are diseases of the brain, not the mind. If mental illnesses are the names of (mis)behaviours, then they are behaviours, not diseases.

On the physiological model of mental illness(Szasz)

• We say that chemicals is the brain cause depression and suicide; but we don’t say that chemicals in the ovaries or testes cause lust and marriage.

• Our environment and our related choices determine who we are

Thomas Szasz on drugs

Drugs may function as chemical straightjackets…

A diagnosis and drug relieves the providers of the necessity to convince themselves that they may not be acting altogether on behalf of their patient

Herein lies the danger to the patient

On drugs and doctors

• Giving oneself a controlled substance is a crime.• Accepting it from a physician is a treatment• The truth is that coercive psychiatry serves the

interests of the coercers and contractual psychiatry serves the interests of the contracting parties. Acknowledging this is taboo intellectually, professionally and politically.

Cohen on deviance

• Deviance can be a social safety valve providing for comparatively harmless expressions of social discontent

• Deviance is a warning device to indicate that an aspect of society is malfunctioning

• But who has the right to define and punish what is ‘deviant’?

Foucault on normality

• The confinement of ‘the mad’ in asylums and ‘the bad’ in prisons has historically allowed subversive elements in a population to be controlled

• Modern professional knowledge often constitutes a form of repression, in which people are defined by professionals who make a living wielding their controlling discourse

Goffman on Stigma (An interactionist perspective)

• Goffman contrasts status symbols, such as possessions, trappings of high office or good looks with stigma symbols, such as disfigurement, physical or mental disability, ‘criminal appearance’ or being from a subordinated ethnic background

• Goffman believed stigmatised people usually seek to pass as ‘normal’ and that this is a great strain upon them because of the humiliation of their constant, potential rejection by the ‘normals’.

Merton on the American Dream

• Crime (breaking of social norms) is the result of the tension which exists between shared social goals, and access to the means to achieve them, which is distributed unequally across the social structure

• In unequal societies individuals tend to reject ‘the rules of the game’ and strive to achieve common goals (success and status) by any available means

Merton on responses to unequal chances of success

• Individuals may conform to normal success goals and strive through accepted channels.

• They may ‘innovate’ (crime) to succeed• They may become ritualists (‘going through the

social motions’ or becoming sticklers for rules)• They may become retreatists (abandon goals and

means to achieve them) or rebels against the social order

The interactionist perspective and labeling theory

• Cohen pointed out that a delinquent subculture not only rejects the mainstream culture but may also reverse it

• Those who conform successfully gain recognition in the eyes of peers

• Once individuals join an organised subculture they are more likely to define themselves primarily through belonging to this group

Becker and social interactionism

• Social groups create deviance through the process of making the rules and labeling people who break them as deviant. The label is not neutral, but contains an evaluation. The label also has a ‘master status’ in colouring all the other statuses of the individual

Becker and social interactionism

• An individual self concept is largely derived from the responses of others

• Labeled people often define themselves in terms of their label

• This may produce a self-fulfilling prophecy where the deviant identification becomes the controlling one

Braithwaite on community management

• Communities often know more about their crime problems than the police do.

• When communities act broadly and restoratively rather than focusing punitively on a single individual they can have a linking and flow-on effect. Punishing individuals may be a less effective deterrence strategy than opening up discussion with a wide range of actors with preventive capabilities. (Accountability is vital.)

Restorative justice

• Any process in which victims, offenders and/or other stakeholders participate actively in the resolution of matters arising from crime, often with the help of a fair and impartial third party. Stakeholder deliberation determines what restoration means in the specific context.

Braithwaite on restorative justice

• When there is a high degree of value consensus that recognizes offences are not permissible, then there is a chance that shaming will succeed in making the offender repent the offence and join the broader moral community (This should be tried in the light of relevant international and regional community standards.)

Requirements of good health care management

• The aim of client autonomy and self management in the broad community interest

• An evidence based approach to treatment

• Transparent service provision based on ‘open disclosure’ principles and necessary protections for clients and communities.

A multicultural society requires an international perspective

• The UN Declaration of human rights and related standards provide a moral framework which has been agreed internationally and which ideally may be sensitively applied in a wide variety of individual and community contexts