The social dimension in mental health social work

Social workers and theorists interested in the social dimension began usually from the assumption that inequality in opportunities and in civic participation due to poverty may increase the rate of mental illness among poor people. This assumption follows Merton's classical matrix of the reactions to the gap between social goals and means, in which mental illness is a reaction of people who accept socially desirable goals, but withdraw from obtaining them after being frustrated in gaining them, whilst at the same time not adopting antisocial means (as in criminal behaviour) or developing an alternative model of society (social rebels).

This strand of thinking was reinforced in the 1960s and 1970s by the application of Marxist thinking (2!„) and the combined impact of the deviancy and antipsychiatry orientations/2,23) Discrimination on the basis of age, ethnicity, gender, or sexual orientation was added in the 1980s to the likely social factors which foster inequality.

Social workers accepted the logic presented by sociologists such as Goffman and Scheff that the stigma attached to mental illness is largely irreversible—that it is accepted both by others and by the individual concerned who in turn internalizes his or her poor social status. (2 2 and 24

Interestingly, although accepting the enormity of the labelling process, social workers did not count themselves among the labellers.

The appeal of the antipsychiatry approach for social workers related to acknowledging the price of labelling for the individual concerned, and the considerable shortcomings of a system focused on the psychiatric hospital and medication in which psychological and social factors were largely ignored. The highly emotive language used within antipsychiatry, its egalitarian streak, and the promise of a more empowering alternative were additional attractions.

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