Social Norms and Mental Disorder Prevalence
Saints, Scholars, and Schizophrenia
The Interaction between Social Norms and Mental Disease Prevalence
The Interaction between Social Norms and Mental Disorder Prevalence
The ethnography of an Clochan by Nancy Schepper-Hughes (2001) represents the attempt of a young psychological anthropologist to divine the inner world of a remote village in West Kerry, Ireland. Her original intention was to investigate the sexual lives of remote Irish villagers using the interpretive method, but when she stumbled upon statistics showing a shocking number of villagers being diagnosed with schizophrenia she could not resist tackling that topic. Although the original version was published in 1982, she revisited the hamlet in 1999 and wrote a lengthy prologue for the current version that provides valuable insights unavailable to a young scholar just beginning her career during in 1974.
The use of an interpretive methodology was, Schepper-Hughes (2001) argued, the only reasonable approach to studying the lives of Irish villagers. She supported her argument by pointing out that the demographic statistics had been thoroughly corrupted by well-intentioned efforts to mask the underlying societal problems eating away at a way of life ill-adapted to modern times. A diagnosis of schizophrenia was too easily dispensed when the underlying problems were familial estrangement, sexual dysfunction, and social isolation. Schizophrenia was therefore being used as a catch-all diagnosis for what she called "transient psychosis" due to being conferred second class citizenship (p. 40).
Suicide rates had also been historically massaged by the authorities to minimize the perception that Irish youth were largely immune to the lifetime poverty and servitude that many of them faced. The fires of discontent were further exacerbated as these young and intelligent men and women watched as a select few were chosen to emigrate to what was perceived to be a better future. Schepper-Hughes concluded that regardless of their fate, whether forced to go abroad or stay home to serve aging parents, these youth were destined to endure a life without any chance to experience fulfillment in marriage, career, and society. From their perspective, these young men and women had been designated second class citizens for no reason other than the order in which they were born into their families.
The trustworthiness of Irish suicide rates has increased since Saints, Scholars, and Schizophrenics was first published according to Schepper-Hughes (2001) and they reveal a 40% increase in assigning undetermined deaths to suicide. With the recent revelations about unethical and sometimes illegal behavior by Catholic priests, the Church sanctions against suicide no longer carry the weight they once did. For this reason, suicide rates are also believed by both the authorities and the medical profession to be increasing, as young Irish men and women facing a life of celibacy and servitude no longer view suicide as the worst choice they could make.
In the main body of the book, Schepper-Hughes (2001) launches into a demographic analysis in Chapter 2 that lays the foundation upon which her theories about an Clochan were based. Between 1970 and 1974, there were 2 marriages, 20 births, 71 deaths, and 42 emigrations (p. 98). When faced with such statistics, it's not hard to realize that this village is dying and fast. Most marriages, when they do occur, occur late in life and therefore tend to be childless. Families used to average between seven and nine children, but this practice had largely been abandoned by the time Schepper-Hughes' arrives in the village in 1974.
Young women frequently chose to emigrate permanently, based in part on their mother's desire for them to have a better life (p. 100-104). This has resulted in an excess of single men in rural areas. Over 25% of all households consisted of sibling only households in 1974, with the majority (66%) of these representing bachelors running farms. These men and women were living a life of celibacy on a farm equivalent to the lifestyle chosen by priests, thus the word "Saints" in the title.
The life lived by those who do conform to a community's expectations is grim by anyone's standards. For bachelor farmers with little to do during the winter months, alcoholism had become socially acceptable and rampant. For example, compared to British citizens the Irish were 12-times more likely to be hospitalized for alcoholism (Schepper-Hughes, 2001, p. 123). The use of the Thematic Apperception Test (TAT) revealed the men and boys of an Clochan readily conferred solitary and hopeless traits to figures in the thematic pictures. While women also imbibe during the long winters, this habit is often hidden in socially acceptable 'cures' for melancholia. Based on 1960 health statistics for developed nations, Ireland had the highest male celibacy and psychiatric hospitalization rates by a wide margin (p. 128). Of the men hospitalized, 89% were celibate and nearly half of these were diagnosed with schizophrenia (p. 135), thus the word "Schizophrenics" in the title.
On page 136 Schepper-Hughes (2001) presents the concept of 'labeling theory', which represents the labeling of abnormal behavior based on socially-defined behavioral norms and expectations. Such labels can have a significant impact on the prevalence rates for mental diagnoses and institutionalization. Clues about the influence of community norms on mental status can be found in the known statistics. For example, Irish men within the marriage-eligible age group of 25 to 44 are almost twice as likely to be found in a mental ward as their female counterparts. Unmarried status also increases the risk long stays in mental institutions, which is longer than 25 years. By comparison, the average stay length for married individuals is less than a month. When faced with such statistics, it's hard not to conclude that eligible young men are preferentially being warehoused in mental institutions under the dubious diagnosis of schizophrenia.
Based on her analysis, Schepper-Hughes (2001) concluded that the high prevalence of schizophrenia in rural Irish communities has its roots in social sanctions against expression of physical violence and sexuality and the rejection of parental and religious doctrines. Anyone who falls into this category would find themselves not only shunned by the community, but also headed to the local insane asylum if they couldn't control their behavior. The ability to conform to social norms within conservative rural Irish communities, even if it means second class citizenship, is therefore protective against mental illness as defined by the community.
Schepper-Hughes' (2001) 'Saints' in her ethnography, however, discusses the few rebels who escape institutionalization. They may talk to themselves and their livestock, dress in flamboyant colors, stalk motorized vehicles, and trap passersby with a retelling of their family tree, but never do they act in a physically violent, sexual, or rebellious way. As such, they are tolerated and allowed to remain within the community. In a real way, these individuals have carved out a life free of servitude and institutionalization, and as long as they maintain their eccentric ways they are free to live their lives accordingly.
While the social constraints that rural Irish communities imposed on their residents may seem unfair and even represent a form of violence, most local customs are rooted in a pragmatic solution to social problems (Schepper-Hughes, 2001). To avoid the loss of manpower needed for running farms, marriage was often arranged between households within the community. A common practice was to marry a brother and sister from one household to brother and sister from another. In contrast, marriage outside of the community and the village's chosen religion were forbidden. Even though the exact history of such customs is unknown, it seems readily apparent that these marriage customs provided a way to keep the community glued together and minimize conflicts. Tightly knit communities would tend to be more cooperative during the planting and harvesting seasons and better able to weather natural and manmade disasters. This would tend to explain why 96% and…