Mental illness

Reading a recent post by Matthew triggered a whole bunch of questions in my mind...

In the Sociology course I teach we address the issue that statistically there are way more psychotic people among the "lower class" strata of our society than in other segments. There are two basic theories why this is the case:

1) SOCIAL IMPACT says that the stress of living in poverty, possibly experiencing homelessness, and generally living in more dangerous / unhealthy environments creates pressure that causes some people with a predisposition to mental illness to have a major break that they might not have had if they had experienced a more supportive environment. Meanwhile, according to this theory, there are plenty of people in the middle and upper classes that are more mentally fragile, but because they have reasonably comfortable lives with access to resources, they never fully break out into what we would consider psychosis.

2) SOCIAL DRIFT theory, on the other hand, says that ALL socio-economic groups have an equal occurrence of originally becoming mentally ill, but those that do from the higher classes are more likely to "drift down" in social mobility to the lower classes due to their illness interfering with their ability to cope with life's responsibilities and the healthy folk born into lower classes have the chance to "drift up" through hard work & education, leaving behind those who were ill equipped to make that transition. End result of both sorts of social mobility is more psychotics at the bottom of the ladder.

I suspect there is some of each of these factors at play...

Still others say that there is no such thing as mental illness at all, that it's all a social construct based on certain norms being acceptable and others not but who is to really say what "normal" is?? What is considered flaming crazy in one society may be very acceptable in another. Or, different times in history within the same society will name different types of behavior as "sick" or "ok".

At what point do we think of someone as "sorta quirky" and when do they cross the line into "mental illness"? To what degree should "bad behavior" or criminal acts be excused due to a diagnosed mental illness? How much mental anguish and difficulty should we expect simply because we live in a fallen, mortal world full of adversity and when does personal angst and misery cross over to "clinical depression"?

Lots of question...no clear answers. There is such a trend to medicalize behavior these days in order for individuals to qualify for "help". Things like "adolescent oppositional defiant disorder" used to be called being an out of control kid that needed some discipline. Alcoholism has run the gambit from being viewed as sin or weakness to being a disease. Homosexuality used to be viewed as a form of mental illness. Norms change, those in power take a new vote and suddenly it isn't anymore. Multiple Personality Disorder (now named Disocciative Identity Disorder) was once thought of as a very strange and rare thing.... the diagnostic criteria changed, a few workshops and organizations got popular and suddenly there were hundreds of cases being discovered all across the nation. Specialized units were opened in hospitals and a whole new subspecialty in treatment modalities was born. To what extent do we CREATE conceptions of mental illness in order to generate jobs/industry?

The DSM manual in all it's many incarnations tries to spell everything out clearly and tie it up with a bow....life, in my mind, is more complicated than that.