Michael McCubbin

Medications as social phenomena

This article discusses medications as socially embedded phenomena, using the class of psychoactive medications as a primary example. The analytical perspective is systemic, constructivist, and critical. We suggest that the ‘rational use of drugs’ paradigm fails to appreciate various legitimate rationalities motivating medication usages and is therefore inadequate to understand the place of medications in society. Medications have complex life cycles, with diverse actors, social systems, and institutions determining who uses what medications, how, when and why. Such understanding permits analyzing medications simultaneously as entities and representations. We outline recent changes in usage patterns of psychoactive medications (notably prescriptions to children), in pharmaceutical marketing practices (notably direct-to-consumer advertising), and in the construction of knowledge about drugs (notably the role of the Internet in legitimating consumers’ viewpoints). These changes indicate that medication life cycles evolve and mutate with social and technological change. These life cycles are viewed, then, as systems – part of other social, cultural, and economic systems, themselves in constant change. This perspective provides fertile ground to raise several research questions in order to understand better the nature of medications, their effects, and their place in society.

Civil commitment due to mental illness and dangerousness: the union of law and psychiatry within a treatment-control system

This article discusses the use of ‘dangerousness’ as a legal criterion for civil commitment. The notion of dangerousness is defined within the perspective of the relationship between judicial and medical-psychiatric institutions. By reviewing empirical evidence concerning the possibility of a link between mental illness and dangerousness, we critically evaluate the main postulate supporting the inclusion of this notion in the civil laws. We then examine empirical studies of psychiatric expertise in dangerousness assessment and risk prediction. By using observational studies of civil commitment proceedings, we examine how the legal criterion of danger to self or others is actually operationalised into a series of heuristic criteria. These criteria are teleological statements: if being mentally ill and being dangerous are, in this context, interchangeable, so are the finalities of treating and controlling. We conclude that, at the psychiatry-justice interface exemplified by civil commitment, treatment and control have been equated conceptually and in practice, even if the written law clearly distinguishes the concepts. With respect to civil commitment, the institutions of mental health and justice are not, as usually depicted in sociological analysis, two different systems that meet and compete at this junction. Rather, they join together – becoming, in effect, one actor – within a treatment-control system which has as its function and aim to ‘take care of’ residual cases viewed as problematic for society.

Representations of Elderly with Mental Health Problems Held By Psychosocial Practitioners from Community and Institutional Settings

SUMMARY This article aims to clarify crucial issues pertaining to community and institution-based psychosocial care provided to elders suffering from mental health problems, and to the role of professional and lay systems of beliefs—i.e., representations—in this area of intervention. First, we review epidemiological, clinical, and evaluative data assessing the prevalence of mental health problems (both situational or transitional distress and severe mental health problems, with a special emphasis on the latter) among persons aged 65 and older, the specific situations and needs of this population, and the services provided to them. We then examine three promising and interrelated trends in psychosocial intervention aimed at seniors with mental health problems, that is, practices oriented toward recovery, empowerment, and social integration. Finally, we tackle the cumulative impacts of social representations of aging and the aged and of mental illness and the mentally ill, and how they can impede the implementation of interventions, services and programs based on recovery, empowerment and social integration approaches.

Cheminements et situations de vie des personnes âgées présentant des troubles mentaux graves: perspectives d'intervenants psychosociaux

Services for elders with severe mental illness (SMI) have major deficiencies, among them a lack of adequate psychosocial services. Some analysts have attributed this situation to “double stigmatization” targeting both ageing and mental illness in our societies. Using qualitative methods (23 semi-directed interviews, theme-based content analysis), our exploratory research aims to understand better the perceptions of psychosocial practitioners working in community and institutional settings about the elderly with SMI and their living situations. Our informants evoke living situations marked by a lack of support (isolation), of resources (financial precariousness/poverty) and of power (learned passivity), traits that are related not only to mental illness per se, but also to long term psychiatric institutionalization. For them, the current situation of elders with SMI is the end product of biographies in which life-course, illness-course and life in services and/or institutions join and, sometimes, become indistinguishable. Implications for psychosocial practices are discussed.