A Handbook for the Study of Mental Health Social Contexts, Theories, and Systems

The sociological approach focuses on the factors external to the individual – the environmental or social context – and views mental illness as a breakdown in the face of overwhelming environmental stress. Thoits overviews three dominant theories, or models, and describes their basic assumptions, advantages and limitations, and implications for treating or preventing mental illness. Stress theory is based upon evidence that accumulations of social stressors can precipitate mental health problems. However, the relationship between stress exposure and psychiatric symptoms is not strong because individuals have extensive coping resources to help them handle stress. Researchers focus on the relationship between stress and coping mechanisms, and also on the unequal distribution of chronic strains and a variety of coping resources in the population. One reason that higher rates of mental disorder and psychological distress are found in lower-status, disadvantaged groups is that these groups are more likely to be exposed to stressors and less likely to have important coping resources. In order to treat mental illness, one needs to eliminate or reduce stressors, teach the individual different coping resources, and bolster their personal resources. Structural strain theory locates the origins of disorder and distress in the broader organization of society. Mental illness may be an adaptive response to structural strain, or to one's degree of integration into society. For example, during periods of high unemployment admissions to treatment for psychosis increase, while periods of economic upturns are associated with lower rates of hospitalization. A structural condition, hard economic times, caused people to experience major stressors and provoked mental illness. Society's organization places some groups at a social or economic disadvantage. In order to prevent or reduce mental illness, society must be restructured in a fairly major way; for example, creating a guaranteed minimum income to eliminate the strains of unemployment. A third approach to mental illness is labeling, or societal reaction, theory. The logic behind labeling theory is that people who are labeled as mentally ill, and who are treated as mentally ill, become mentally ill. Symptoms of mental illness are viewed as violations of the normative order whereby individuals violate taken-for-granted rules about how one should think, feel, and behave.