Abstract
This paper explores lay and psychiatric actors' definitions of mental illness by focusing on several aspects of emergency psychiatric diagnosis. First, it considers psychiatric diagnosis as a social and cultural process in which mental illnesses are defined with increasing specificity as individuals move from lay to psychiatric contexts. Second, the paper considers variation in psychiatric residents' conceptions of mental illness, their role in emergency contexts, and lastly, their diagnostic styles. Diagnostic styles are shown to exist and to be grounded in residents' definitions of the situation. It is suggested that the variation in psychiatrists' definitions of the psychiatric situation, especially as regards etiology, plays a prominent, but as yet unnoted, role in producing variability in psychiatric diagnosis. It is also argued that actors' definitions are cultural, grounded in non-professional. lay ideology, and are not products of secondary professional socialization.
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References
Abrams, Harry and Clifton Meador 1976 Introduction: The patient, the physician and the psychiatrist. In Basic Psychiatry for the Primary Care Physician. Harry S. Abram, ed. Boston: Little, Brown and Company.
American Psychiatric Association 1952 Diagnostic and Statistical Manual, Mental Disorders. 1st edition. Washington, D.C. (DSMI).
1968 Diagnostic and Statistical Manual, Mental Disorders. 2nd edition. Washington, D.C. (DSMII).
1979 Diagnostic and Statistical Manual, Mental Disorders. 3rd edition. Washington, D.C. (DSMIH, Draft).
Armor, D. and G. Klerman 1968 Psychiatric treatment: Orientations and professional ideology. J Health and Social Behavior 9: 243–55.
Beck, A. T. 1962 Reliability of psychiatric diagnosis: A critique of systematic studies. American J Psychiatry 119: 210–216.
Becker, Ernest 1963 Outsiders: Studies in the Sociology of Deviance. New York: The Free Press.
Brill, N. and H. Storrow 1960 Social class and psychiatric treatment. Archives of General Psychiatry 3: 340–345.
Chapman, Charlotte 1971 Milocca: A Sicilian Village. Cambridge: Schenkman.
Chrisman, Noel 1977 The health seeking process. Culture, Medicine and Psychiatry 1: 351–378.
Cooper, J. E. 1967 Diagnostic change in a longitudinal study of psychiatric patients. British J Psychiatry 113: 129–142.
Crapanzano, Vincent 1973 Moroccan Ethnopsychiatry. Berkeley: University of California Press.
Derogatis, L., L. Covi, R. Lipman, et al. 1971 Neurotic symptom dimensions as perceived by psychiatrists and patients of various social classes. Archives of General Psychiatry 42: 454–464.
Devereux, George 1969 Mohave Ethnopsychiatry: The Psychic Disturbances of an Indian Tribe. Washington, D. C.: Smithsonian Institution Press.
1958 Cultural thought models in primitive and modern psychiatry. Psychiatry 21: 359–374.
Dohrenwend, Bruce and E. Chin-Shong 1967 Social status and attitudes toward psychological disorder: The problem of tolerance of deviance. American Sociological Review 32: 417–433.
Dorfman, D. and R. Kliner 1962 Race of examiner and patient in psychiatric diagnosis and recommendations. J Consulting Psychology 26: 393.
Duehn, W. and N. Mayadas 1967 The effect of practice orientations on clinical assessment. American J of Orthopsychiatry 46: 629–638.
Eickelman, Dale 1978 Moroccan Islam. Austin: University of Texas Press.
Enright, John and Walter Jaeckle 1963 Psychiatric symptoms and diagnosis in two subcultures. International J Social Psychiatry 9: 12–17.
Erickson, Carolee 1976 The Medieval Vision: Essays in History and Perception. New York: Oxford University Press.
Foulks, Edward, Daniel Freeman, F. Kaslow and Leo Madow 1977 The Italian evil eye. J Operational Psychiatry 8: 28–34.
Freedman, Alfred, Harold Kaplan and Benjamin Sadock, eds. 1976 Modern Synopsis of Comprehensive Textbook of Psychiatry II. New York: Williams and Wilkins Co.
Freidson, Elliot 1970 Profession of Medicine: A Study of the Sociology of Applied Knowledge. New York: Harper and Row.
Gaines, Atwood 1979 The Word and the Cross: Ascendent Alsatian Ethnicity and Religious Affiliation in Strasbourg, France. Ann Arbor, Michigan: University Microfilms International.
Geertz, Clifford 1973a Ideology as a cultural system. In The Interpretation of Cultures. Clifford Geertz. New York: Basic Books.
1973b Thick description. In The Interpretation of Cultures. Clifford Geertz. New York; Basic Books.
1975a Common sense as a cultural system. Antioch Review, November, 1975.
1975b The nature of anthropological understanding. American Scientist. January–February 1975.
Gilbert, Doris and Daniel Levinson 1956 Ideology, personality and institutional policy in the mental hospital. Am J Abnormal and Social Psychology 53: 263–271.
Hall, Arthur and Peter Bourne 1973 Indigenous therapists in a southern black urban community. Archives of General Psychiatry 28: 137–142.
Hufford, David 1977 Christian Religious Healing. J Operational Psychiatry 8: 22–27.
Katz, Martin, Kenneth Sanborn and Howard Gudeman 1969 Characterizing differences in psychopathology among ethnic groups in Hawaii. In Social Psychiatry. F. Redlich, ed. Baltimore: Williams and Wilkins.
Katz, Martin, Jonathan Cole and Henry Lowery 1969 Studies of the diagnostic process: The influence of symptom perception, past experience, and ethnic background on diagnostic decisions. Am J Psychiatry 125: 937–947.
Kendell, R. E. 1974 The stability of psychiatric diagnoses. British J Psychiatry 124: 352–356.
Kernberg, Otto 1967 Borderline personality organization. J Am Psychoanalytic Association 15: 641.
1975 Borderline Conditions and Pathological Narcissism. New York: Jason Aronson.
1976 Object Relations Theory and Clinical Psychoanalysis. New York: Jason Aronson.
Kiev, Ari 1968 Curanderismo: Mexican American Folk Psychiatry. New York: The Free Press.
Kleinman, Arthur, Leon Eisenberg and Byron Good 1978 Culture, illness and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88: 251–258.
Kleinman, Arthur 1977 Problems and prospects in comparative cross-cultural medical and psychiatric studies. In Culture and Healing in Asian Societies: Anthropological, Psychiatric and Public Health Studies. A. Kleinman, P. Kunstadter, E. Alexander and J. Gale, eds. Cambridge: Schenkman.
1979 Family-based popular health care. In Patients and Healers in the Context of Culture. Arthur Kleinman. Berkeley: University of California Press (in Press).
Lazare, Aaron 1973 Hidden conceptual models in clinical psychiatry. New England J Medicine 288: 345–351.
Lemert, Edwin 1967 Human Deviance, Social Problems, and Social Control. Englewood Cliffs. New Jersey: Prentice-Hall.
Light, Donald 1970 The socialization and training of psychiatrists. Unpublished PhD. dissertation in sociology. Brandeis University.
1976 Work styles among American psychiatric residents. In Anthropology and Mental Health. J. Westermeyer, ed. The Hague: Mouton.
Mechanic, David 1962 Some factors in identifying and defining mental illness. Mental Hygiene 46: 66–74.
Menninger, Karl Jr., (with) M. Mayman and P. Pruyser 1963 The Vital Balance. New York: The Viking Press.
Morrison, James and Thomas Flanagan 1978 Diagnostic errors in psychiatry. Comprehensive Psychiatry 19: 109–117.
Myers, Jerome and Leslie Schaffer 1958 Social Stratification and psychiatric practice: A study of an out-patient clinic. In Patients, Physicians and Illness. E. Jaco, ed. Glencoe, Illinois: The Free Press.
Rosenhahn, D. L. 1973 On Being Sane in Insane Places. Science 79: 250–258.
Roth, M. 1976 Schizophrenia and the theories of Thomas Szasz. British J Psychiatry 129: 317–326.
Sanborn, Kenneth and Martin Katz 1977 Perception of symptom behavior across ethnic groups. In Basic Problems in Cross-Cultural Psychology. Ype H. Poortinga, ed. Amsterdam and Lisse: Swets and Zeitlinger B. V.
Scheff, Thomas 1966 Being Mentally Ill. Chicago: Aldine.
1975 Labeling Madness. Englewood Cliffs, New Jersey: Prentice-Hall.
Scheflen, Albert 1966 An analysis of a thought model which persists in psychiatry. In Issues and Problems in Social Psychiatry. Bernard Bergen and Claudwell Jones, eds. Springfield, Illinois: Charles C. Thomas.
Sharaf, M. and D. Levinson 1957 Patterns of ideology and role definition among psychiatric residents. In The Patient and the Mental Hospital. M. Greenblatt, D. Levinson and R. Williams, eds. New York: The Free Press.
Snow, Loudell 1977 Popular medicine in a black neighborhood. In Ethnic Medicine in the Southwest. Edward Spicer, ed. Tucson, Arizona: University of Arizona Press.
Spitzer, Robert and Paul Wilson 1975 Classification in psychiatry. In Comprehensive Textbook in Psychiatry II. A. Freedman, H. Kaplan and B. Sadock, eds. New York: Williams and Wilkins Co.
Stone. A. A. 1973 Psychiatry kills: A critical evaluation of Dr. Thomas Szasz. J. Psychiatry and Law 1: 23–27.
Strauss, Anselm, et al. 1964 Psychiatric Ideologies and Institutions. New York: The Free Press.
Szasz, Thomas 1961 The Myth of Mental Illness. New York: Hoeber and Harper.
1970 Ideology and Insanity: Essays on the Psychiatric Dehumanization of Man. New York: Anchor Books.
Townsend, J. Marshall 1975a Cultural conceptions and mental illness: A controlled comparison of Germany and America. J Nervous and Mental Disease 160: 409–421.
1975b Cultural conceptions, mental disorder and social roles: A comparison of Germany and America. American Sociological Review 40: 739–752.
Turner, Victor 1969 The Ritual Process. Chicago: Aldine.
Turner, Victor and Edith Turner 1978 Image and Pilgrimage in Christian Culture. New York: Columbia University Press.
Wallace Anthony F. 1961 Culture and Personality. New York: Random House.
Weber, Max 1958 The Protestant Ethic and the Spirit of Capitalism. T. Parsons, trans. New York: Charles Scribner and Sons.
Weber, Max 1964 The Sociology of Religion. E. Fischoff, trans. Boston: Beacon Press.
Wylie, Lawrence 1964 Village in the Vaucluse. New York: Harvard University Press.
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Gaines, A.D. Definitions and diagnoses: Cultural implications of psychiatric help-seeking and psychiatrists' definitions of the situation in psychiatric emergencies. Cult Med Psych 3, 381–418 (1979). https://doi.org/10.1007/BF00051465
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DOI: https://doi.org/10.1007/BF00051465