The Standards of Conventional Society for the Social Worker - Research Paper Example

Madness Introduction Madness is a relative term which is often applied to the manifest condition of being crazy, demented, or mentally ill. It is ageneric term which can refer to various conditions of the human mind ranging from a temporary moment of unconventional and unusual thought processes to extreme and prolonged moments of serious mental illness. The way such ‘madness’ is perceived is also a relative consideration. Pepper and Perkins (Repper & Perkins, 2003: vii) mention that “...the way in which madness is constructed determines the value attached to those deemed ‘mad’ and the options available to them”. This paper shall now discuss the preceding statement, examining the implications of such statement for social work practice. It shall define madness based on a technical and operational definition of the term as will now be used and applied in this paper. It shall then discuss where madness originated from, focusing on the evolution of the thought processes related to the current concept and understanding of madness. This paper shall apply madness and its concepts to social work and their work with service users. It shall also cover relevant legislation. Finally, this paper shall discuss the ethics and values of social work in relation to madness. This paper is being undertaken in order to assess and evaluate the current subject matter and how it affects the current social work practice. It ultimately aims to ensure a more profound, academics, scholarly application, and evidence-based application of the subject matter. Discussion The Cambridge Dictionaries Online (2010) defines madness as “the state of being mentally ill or unable to behave in a reasonable way”. This definition is again another generic definition of madness, one that can even easily be interchanged with the term crazy or insane. Nevertheless, the definition points out important elements about one’s state of mind in this condition of madness – which it relates to a state of being in an unreasonable or illogical state of mind. The mental processes and the normal logical thoughts of a person are compromised in times of madness; hence, in instances when one is not logically processing ideas and thoughts, some people are prone to label such person as ‘mad.’ The Encyclopedie (as cited by Foucault, 2005, p. 98) sets forth that madness means to “depart from reason with confidence and in the firm conviction that one is following it”. There is a broken relationship between man and his reason and the person believes that his mind is within the bounds of logic; however, the truth of the matter is that he is already far removed from reason and from logic. Foucault (as cited by Guven, 2005, p. 130) also defines madness as the impossibility of thought. Foucault (in Guven, 2005, p. 130) focuses on the “continuity of thought, the possibility of a subject meditating, remaining the substrate of meditation, not only having control over discourse, but also being present to itself”. There is a pattern of thought which has to be sustained in order to determine that one is not mad; and manifestations of the lack of logical flow of thought and the lack of control over the course of one’s thoughts implies some madness, some insanity, or some mental disturbance. It is difficult to exactly determine when madness was discovered. Many experts claim that it is a condition which has emerged as early as the human race itself. Nevertheless, the earliest discovery of madness has been manifest in bones dating as far back as 3000 BC which were dug up by Archaeologists (Porter, 2010). These bones bore the marks of a trephine, as manifested by the small cylindrical tools in the bones. The most likely explanation of various experts is that this method was used to drive away evil spirits which was said to possess the person; such holes were used to allegedly allow the evil spirits to escape the person who was possessed. The earliest notion or perception of madness at this time was that a person who displayed madness was possessed by devils and by evil (Porter, 2010). The Greeks believed that it is not safe to go near mad people because such demons may leap from the person afflicted on to other people. The same thought process was seen for Christians. Madness was seen as a condition which was manifest in the way they ran wild, the way people talked nonsensically, and the way they cursed or blasphemed (Porter, 2010). The Christians however had a more positive view of madness because they viewed it as a divine experience; they believed that it was a good madness which came from God, not a bad one which came from Lucifer (Porter, 2010). The so-called good madness was seen in poets and painters because of their indifference to worldly goods and because they saw the world differently. They were considered mad geniuses (Porter, 2010). In the nineteenth century, among the Romantics, madness was attributed to rock singers because of their extreme antics. At present, with the available medical technologies and advancements, a proper diagnosis of ‘madness’ has been made possible. The abnormal brain patterns seen among ‘mad’ people can now be designated properly with adequate assessment and appropriate interventions. Application to social work and their work with service users As was previously mentioned, Repper and Perkins (2003: vii) point out that “the way in which madness is constructed determines the value attached to those deemed ‘mad’ and the options available to them”. The label of madness has largely influenced how these ‘mad’ people have been treated and the choices which have been made available to them. The label has also affected people differently based on their culture and with the passage of time. Some authors point out that the label of schizophrenia and other forms of madness and mental health disorders have had different outcomes for those living in developed which was in sharp contrast to those living in developing countries (Warner, as cited by Repper & Perkins, 2003, p. vii). For those who live in developing countries, being labelled as mad has not always led to a loss of status, exclusion from work or from one’s social set. In developed countries, the trend of losing status, being dismissed from work, and being shunned by one’s peers and by one’s community occurs at a greater frequency. The individualized treatments made available in the exclusive treatment centres in the United States, United Kingdom, and the rest of Western Europe come in stark contrast to the treatments and interventions in African, Native American, and Lapland cultures which usually involve the entire community (Repper & Perkins, 2003, p. vii). In modern Europe and North America, madness is understood as a form of illness or a disease affecting one’s brain. And since these people are considered ill, they were also relieved of the usual responsibilities and roles expected of normal people (Repper & Perkins, 2003, p. vii). The responsibility of supporting and treating these ‘ill’ people often fell on the doctors, nurses, psychiatrists, and other mental health experts. The label of mental illness is given and decided by these so-called mental health experts. It is often unfortunate that these mental health experts define mentally ill people as those who are different or apart from the normal people (Repper & Perkins, 2003, p. vii). These mentally ill individuals often end up not only being labelled as mentally ill, but also ‘becoming’ the illness they are labelled as having. They become schizophrenics and manic depressives, and are “deprived of all identities other than that of mental patient” (Repper & Perkins, 2003, p. vii). They are deprived of the right to participate in social activities and to live lives aside from being schizophrenics or manic depressives. Such mental label and mentally warped identity often became the justification for not including them in the daily activities which other people participate in (Repper & Perkins, 2003, p. vii). There is a preconceived notion attributed to these patients by mental health professionals themselves which prevent those who are mentally ill from ever realizing their hope of eventually living normal lives. The label of madness must always be taken at face value – especially by the social worker. The label of madness, when considered and taken as gospel by the social worker can be largely detrimental to the client. Authors and mental health experts point out that labelling is a major determinant of people manifesting chronic mental illness (Zastrow, 2010, p. 147). Scheff’s analysis also echoes Zastrow’s evaluation and he goes further in his analysis by saying that the mental illness label is often a source of embarrassment for those who are labelled with a mental illness. Society often ends up pre-judging a person because of the label (as cited by Zastrow, 2010, p. 147). Scheff also emphasizes that the appropriate evaluation of mental illness should be from a sociological perspective – not a medical perspective – in order to ensure that appropriate interventions are carried out on for the patient (as cited by Zastrow, 2010, p. 147). The application of this concept of labelling finds a crucial application when a person who is deemed mentally ill manifests behaviour which society labels as ‘mad.’ In these instances, these persons are labelled as mentally ill and are treated as mentally ill. “Being highly suggestible to cues from others, they then begin to define and perceive themselves as mentally ill” (Zastrow, 2010, p. 149). However, when such behaviour, labelled as mad or crazy, is manifested by the ‘normal’ people, these acts and these people are just described as unconventional or eccentric. And these people can go about their lives behaving in such a way and not be labelled, or possibly be called ‘mad.’ For the social worker dealing with patients who are labelled as mad, it is important to not define one’s client by one’s mental affectation. It is possible in some ways to achieve a semblance of normality in a person’s life and to ensure that a person functions well as an individual in the community. Psychology is an essential part of the social work practice (Minnesota State University, n.d). In the 1940s, social work became much more than a religious and charitable practice; it also became focused on counselling clients and improving their mental state by addressing issues related to their poverty or their homelessness (Minnesota State University, n.d). It is also important to note that social work is focused on improving a person’s individual habits through psychology and mental health in order to make the general circumstances of the individual ‘better.’ As a social worker, the labelling of the mentally ill into specific categories can interfere with the counselling and community placement process. It can sometimes lead to an unimproved and less positive patient or client outcomes and the inhibition of the person’s future normal functioning in society. A study by Link, et.al., (1987, p. 1461) sought to evaluate why labels for mental health patients or clients matter. In the simple assessment of labelling, results indicate that it has little effect on the social distancing scale. However, in assessing the perceived danger presented by the mental health patient, the effects of labelling are strong (Link, et.al., 1987, p. 1461). The study also established that being labelled with previous hospitalization often causes people to distance themselves even further from such person labelled with a ‘mental illness.’ The study was able to successfully point out that “labels play an important role in how former mental patients are perceived and that labelling theory should not be dismissed as a framework for understanding social factors in mental illness (Link, et.al., 1987, p. 1461). This study was able to establish how important it is for mental health workers and for social workers to disregard labels and preconceived notions in dealing with ‘mad’ or mentally ill patients. The process of ensuring their welfare is a task which revolves around helping these clients acquire skills to function well in society. And it is a task which would fall heavily on the social worker in the community setting. In a paper by Segal and Baumohl (1981, p. 16) they discuss that when mental health professionals and other individuals move away from the traditional and scientific conceptualization of mental illness, “the reliability of assessment of mental status becomes poorer and the risk of inappropriately problems of living as mental disorders becomes greater” (Segal & Baumohl, 1981, p. 16). And in approaching mental health problems which seem to be ambiguous, mental health service often becomes a problem. The current empirical concept does not exactly promote a clear understanding of mental health and illness in general because these problems are sometimes defined in general or narrow terms (Segal & Baumohl, 1981, p. 16). A dilemma is created when mental service and mental illness is used as a basis for state legislatures and other concerned agencies in terms of financial allocations (Segal & Baumohl, 1981, p. 16). It is therefore important for mental health professionals, even social workers, to ensure that inappropriate labels are not used for judicial and legislative ends. There is a danger of treating and managing mentally ill clients in generic ways if labels are allowed to become the basis of legislation and policies. It is sometimes necessary for mental health institutions to assume labels which conceal their goals or dismiss the seriousness of their client’s issues (Segal & Baumohl, 1981, p. 17). In several cases mental health professionals have been prompted to treat meaningful diagnosis as a parody for the daily problems of a mentally ill client. In turn, this prevents the mental health professional and the social work from drawing meanings from the patient’s or client’s behaviour (Segal & Baumohl, 1981, p. 17). The social worker has therefore an obligation and a responsibility to his client – that of helping him adjust in the community and ensuring that the process of counselling would be based on a more objective and substantive assessment of the client – not based on labels and other preconceived notions. The Mental Health Act specifies that social workers have the responsibility of assessing people’s needs and of developing individual care plans in order to meet these needs (Mental Health Act, 2008). These services are designed to meet the daily needs of the mentally ill client. “In mental health, some social workers are given extra, specific training and approval by the local authority under the Mental Health Act” (Mental Health Act, 2008). The participation of a social worker is also important and is sought in instances of compulsory emergency detention for up to 72 hours. This detention is necessary in order to allow client assessment and this only takes place with the approval of a doctor (Mental Health Act, 2008). Although the social worker’s approval is not compulsory, his approval is still sought in order to ensure that the client is cleared through the process of assessment and of continued detention. It is important for the social worker in these instances to thoroughly assess the client and ensure that the decision or mental ill health is based on an appropriate assessment, not on any labels of preconceived notions. The Human Rights Act of 1998 which was adopted by the European Convention on Human Rights is the main international law on the protection of people’s fundamental rights. Before this law was passed, the Convention did not provide enough remedies for the protection of human rights and for the punishment of violators. The 1998 Human Rights Act provided stronger legislation on compulsory detention, detention and treatment, protection of the vulnerable, privacy, and right to family life (Human Rights Act, 1998). Through this act, the role of the social worker in mental health was given more teeth and the rights of the patient to be treated according to the basic provisions of law were emphasized. The pressure is once again of the social worker to ensure that the client being detained is not deprived of his rights as a human being and as a mental health patient. A study by Rowitz, (1981, p. 50) was able to emphasize that labelling is not a static event. It has a previous history and also an aftermath for the client. The study pointed out that labelling can be seen both in a positive and a negative light. Labelling, in the case of handicapped children, can give more control in the delivery of services (Rowitz, 1981, p. 50). It is also useful when it can be used to ensure that individuals who are in dire need of services for their affliction receive the care they need. However, the study also points out some of that labelling can often lead to the punishment of retarded individuals when they attempt to return to their conventional lives and roles (Rowitz, 1981, p. 49). It is also important to note that in case a rule breaker is labelled as retarded, he now becomes extremely vulnerable to suggestion; and he may then accept such label as fact and may continue to manifest behaviour in order to live up to such label. Consequently, these mentally retarded individuals may feel like they are being rewarded for playing the deviant role perfectly (Rowitz, 1981, p. 49). It is dangerous to continually affirm stereotypes and stereotypical behaviour. The role of the social worker in this instance is to resist stereotypes in practice. The interventions and counselling required for those who are labelled mentally ill or ‘mad’ should not be based on the conventions and traditions of labelling. Each patient or client may manifest with symptoms and qualities favourable for an intervention or counselling session different from the label. For this reason, although labels can assist in the allocation process and the diagnostic process, ultimately, these labels cause the mentally afflicted client to be subjectively judged and cornered into a particular box which he may not actually fit into. In this case, as a social worker, it is important to contemplate if the labelling is made for the benefit of the client or for the convenience and benefit of mental health professionals and social workers. Counselling and social work strategies and methods which focus on the deficits limit a person’s view of people who experience mental illnesses or madness. It also limits the intervention which may be formulated for these individuals. The existing treatments and interventions for those who are mentally ill are not being abandoned, only that the different models which are being used in their assessment do not constitute a holistic and comprehensive model for their thorough and unbiased assessment (Repper & Perkins, 2003, p. viii). People are more than the label or the perception that other people have of them; they are dynamic and adaptable individuals. The important and crucial elements which are needed in order to unveil the facets of an individual are just there, underneath the surface. From a social worker’s point of view, it is important to note that in dealing and in counselling such clients, “people whose symptoms continue or recur can, and do, live satisfying lives and contribute to their communities in many different ways, and the alleviation of such symptoms does not necessarily result in the reinstatement of valued roles and relationships” (Repper & Perkins, 2003, p. viii). These vacillating between two extremes for these clients must be noted by the social worker and he must use such qualities in order to make the necessary adjustments in his role in the client’s life. The more debilitating experience for the client is often not about the symptoms which refer to his illness; but “the major barriers lie in prejudice; the belief that anyone who experiences such things cannot possibly do the things that normal people do” (Repper & Perkins, 2003, p. viii). Conclusion Madness is a relative and dynamic term. It is also a prejudiced label placed on those individuals who are deemed ‘abnormal’ based on the standards of conventional society. For the social worker, he needs to overcome such prejudice and labels in order to be effective in carrying out his duties to the client and to ensure that the rights of the patient as an individual are protected. 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