While I am influenced by Foucault and social constructionists, I would not argue hardline about most things, if not all things, being socially constructed. I think this is because the truth is somewhere in the middle, and so one explanation covers many things, but not everything.
However, when I think of social construction in relation to mental illness, I think of many things worth discussing, and at least some things worth considering.
I think mental illness is constructed socially in three ways: Stigma, society’s perception of what mental illness is, and the clinical definition of mental illness itself.
I’ll start with stigma. It seems to me that what society likes or doesn’t like, comes from specific tastes and attitudes of the time and culture. Context is important here as well. If something is feared or despised, this still says nothing about what is actually good or bad, it just reflects certain prejudices. Mental illness could actually be an indifferent thing, but no one would ever acknowledge this. I think social conceptions of anything are often this arbitrary, vague, and biased, and while we like to assume we are objective, humans are often irrational, and don’t always know what is actually good or bad.
In the unfortunate case of stigma, deciding that something is inherently bad, is just as arbitrary. Why is something, such as mental illness, so inherently bad? This is an inaccurate view of something with many different layers to complicate it.
Stigma is also similar to society’s perception of mental illness. In this case, the fact that society thinks they know what mental illness is, is very confusing, when most people don’t have it and thus, can’t actually know. Society assumes that mental illness is a malady and flaw of behavior and brain, but that does nothing to inform a perception of what mental illness is in real time. This is tied closely with stigma, in that people assume what something is without actually knowing what it is.
The perception can induce stigma, it can also create misinformation. I believe that society socially constructs what they think mental illness is. But this doesn’t mean the perception is correct, but because it is a social construction, true and accurate perceptions are unimportant.
And lastly, I think of the clinical definitions of mental illness. I believe this to be socially constructed as well.
I don’t often think we can explain the mind fully in psychiatric and/or scientific terms. Yet we try. This in and of itself is not bad. The problem, though, stems from when we assume that the definition of mental illness is fixed. In this case, I think specifically of pathology. Often, pathology is a problem to the doctor. But because this notion is bound up with our social constructions, we conflate pathology with the person. We assume because mental illness is bad, the person is bad, and this reinforces stigma and society’s inaccurate perceptions of what it is.
I don’t believe psychiatry to be the sole authority on what mental illness is, yet psychiatry dominates the discussion.
Of course none of this means that I dismiss biological considerations and actual facts. It seems that mental illness itself is biological, just as much as it is psychological. Social construction doesn’t mean every aspect is arbitrary. But I do think that mental illness is perceived a certain way by the public. The problem with narrow definitions and prescriptions (literally), is that they become rigid and unimaginative. Social construction doesn’t imply freedom, in this case, it is exactly the opposite. People impose their definitions on what it is, and because of stigma, coercion, and law, certain notions of mental illness are solidified, even if they shouldn’t be. They close off the possibilities. They become authoritarian and so rigid that there is no other competing notions in the debates and discourse about mental illness.
Mental illness itself is a very personal phenomenon, so the rigid social constructions make no sense. Psychology and biology are as self-enclosed as you get, yet the social definitions of mental illness control the narrative much more than personal accounts or anecdotes.
The problem with a scientific view of mental illness is the fixed ontology, which becomes itself a social construction, even though science itself is about the physical and objective world. How this works is complicated and confusing, and rarely questioned. But the definitions have taken root, and they are as sacrosanct as misinformed opinions of society about a personal and enigmatic phenomenon.
So I argue that social construction is about coercion and control. If you believe something is inherently bad, of course you will stigmatize it and treat it as a pathology to get rid of. But the brain is not just an object to be medicated, and this goes for human beings as well. Humans are not just objects and receptacles for certain behaviors. Dare I say mental illness is just as much a problem of the soul? It seems to me there are also historical, environmental, and other complex facets that help to explain mental illness, but that are barely part of the discourse, if at all. It seems to me that all of these notions are reinforced by social biases, and they thus control the actual quality of life for those suffering from, as I’ve said, a personal affliction.
I perceive the notions of deviancy in a lot of how I look at mental illness. This means that people don’t like what is different. But what is different is, again, not necessarily bad, yet the process of evolution has seemingly selected us to favor conformity and uniformity over chaos, differences, and even personality. This is a major problem. One of the criticisms often leveled against Marxist ideology is the totalizing, totalitarian metanarrative often employed, the idea that there is only one explanation for a given phenomenon. But such a determinism can never be the whole story, yet modern medicine so arrogantly assumes that they have the answers to what mental illness is. This is dangerous thinking.
Personally, these stereotypes, stigmas, rules, judgements, and authoritarian control over human behavior and mind, are very much destructive and devastating to me. I literally cannot talk about my own struggles without immediately challenging one of these dominant features of our social constructions, and because the constructions are social, groups, agencies, and institutions, not just individuals, can wield control and coercion over me in ways that prevent me from getting at the truth, and living with my mental illness in a positive, productive, and healthy way. The arrogance of our social prescriptions and anti-normative tendencies have made my life very, very difficult, but there is only so much I can do about it, given that I’m an individual privately suffering and because of social constraints, unable to talk about a confusing yet pervasive phenomenon.
My narrative is not a social narrative, and this is important. Yet it remains at odds with the world and is inherently social. Such facts of life increase my suffering, rather than mediating or even recognizing it, and the authoritarian hostility leveled against those with a different perspective is destructive, and it ruins lives. I bring up these points to embolden discussion and level the playing field. There is, in my opinion, a teleology to mental illness, rather than merely a pathology and disease called mental illness, and this point of view keeps me going. It helps me imagine future alternatives and scenarios. Something being considered bad just because of a totalitarian taste and forced social prescription, is demeaning, cruel, and unkind, and it literally destroys lives. It prevents the truth from being discovered. The assault on truth, in my estimation, is the biggest offense of them all.