Social Theory & Health

, Volume 16, Issue 4, pp 326–341 | Cite as

Contemporary public perceptions of psychiatry: some problems for mental health professions

  • Jeremy DixonEmail author
  • Dirk Richter
Original Article


Social constructionist critiques of psychiatry have primarily focussed on the function of diagnosis for society. Less attention has been paid to the diverse ways that service users and carers have come to construct mental disorder. Social movements led by service users/survivors have worked to contest biomedical models whilst carer groups have campaigned for a greater emphasis on biomedicine. However, population-based research reveals a more complex picture, indicating that whilst public acceptance of biomedicine has grown, the public continue to see mental disorder as being highly influenced by social factors and display a high degree of ambivalence towards psychiatric treatment. Through focussing on debates in psychiatry, social work and nursing in the UK, we argue that public perceptions have particular consequences for the mental health professions. Specifically, they impact on the way that professionals can present themselves as holding a specialist knowledge base. Professional mental health workers therefore need to be transparent about the assumptions and limitations of psychiatric knowledge and base therapeutic decisions around the way in which service users and carers construct mental disorder.


Mental health Organisation of health services Profession and professionalism Theory Social constructionism 


  1. Ahola, K., T. Honkonen, E. Isometsa, R. Kalimo, N. Nykyri, S. Koskinen, A. Aromaa, and J. Lonnqvist. 2006. Burnout in the general population. Results from the Finnish Health 2000 Study. Social Psychiatry and Psychiatric Epidemiology 41 (1): 11–17.CrossRefGoogle Scholar
  2. Allen, R. 2014. The role of the social worker in adult mental health services. London: The College of Social Work.Google Scholar
  3. Angermeyer, M.C., and S. Dietrich. 2006. Public beliefs about and attitudes towards people with mental illness: A review of population studies. Acta Psychiatrica Scandinavica 113 (3): 163–179.CrossRefGoogle Scholar
  4. Angermeyer, M.C., S. van der Auwera, M.G. Carta, and G. Schomerus. 2017. Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: A systematic review and meta-analysis of population surveys. World Psychiatry 16 (1): 50–61.CrossRefGoogle Scholar
  5. Barker, P., and P. Buchanan-Barker. 2011. Myth of mental health nursing and the challenge of recovery. International Journal of Mental Health Nursing 20 (5): 337–344.CrossRefGoogle Scholar
  6. Beck, A.T., E. Baruch, J.B. Balter, R.A. Steer, and D.M. Warman. 2004. A new instrument for measuring insight: The Beck Cognitive Insight Scale. Schizophrenia Research 68 (2–3): 319–329.CrossRefGoogle Scholar
  7. Berger, P.L., and T. Luckman. 1966. The social construction of reality. New York: Anchor Books.Google Scholar
  8. Bracken, P., and P. Thomas. 2001. Postpsychiatry: A new direction for mental health. British Medical Journal 322: 724–727.CrossRefGoogle Scholar
  9. British Association of Social Workers. 2014. The code of ethics for social work. Statement of principles. Birmingham: BASW.Google Scholar
  10. Brown, P., S. Zavestoski, S. McCormick, B. Mayer, R. Morello-Frosch, and R. Gasior Altman. 2004. Embodied health movements: New approaches to social movements in health. Sociology of Health & Illness 26 (1): 50–80.CrossRefGoogle Scholar
  11. Carter, L., J. Read, M. Pyle, and A.P. Morrison. 2016. The impact of causal explanations on outcome in people experiencing psychosis: A systematic review. Clinical Psychology Psychotherapy 24: 332–347.CrossRefGoogle Scholar
  12. Cavelti, M., E.M. Beck, S. Kvrgic, J. Kossowsky, and R. Vauth. 2012. The role of subjective illness beliefs and attitude toward recovery within the relationship of insight and depressive symptoms among people with schizophrenia spectrum disorders. Journal of Clinical Psychology 68 (4): 462–476.CrossRefGoogle Scholar
  13. Chamberlin, J. 1990. The ex-patients’ movement: Where we’ve been and where we’re going. Journal of Mind and Behavior 11: 323–336.Google Scholar
  14. Clarke, L. 1999. Challenging ideas in psychiatric nursing. London: Routledge.Google Scholar
  15. Cohen, A.N., A.L. Drapalski, S.M. Glynn, D. Medoff, L.J. Fang, and L.B. Dixon. 2013. Preferences for family involvement in care among consumers with serious mental illness. Psychiatric Services 64 (3): 257–263.CrossRefGoogle Scholar
  16. Cook, T.M., and J. Wang. 2011. Causation beliefs and stigma against depression: Results from a population-based study. Journal of Affective Disorders 133 (1–2): 86–92.CrossRefGoogle Scholar
  17. Craddock, N., D. Antebi, M.J. Attenburrow, A. Bailey, A. Carson, P. Cowen, B. Craddock, J. Eagles, K. Ebmeier, A. Farmer, S. Fazel, N. Ferrier, J. Geddes, G. Goodwin, P. Harrison, K. Hawton, S. Hunter, R. Jacoby, I. Jones, P. Keedwell, M. Kerr, P. Mackin, P. McGuffin, D.M. Macintyre, P. McConville, D. Mountain, M.C. O’Donovan, M.J. Owen, F. Oyebode, M. Phillips, J. Price, P. Shah, D.J. Smith, J. Walters, P. Woodruff, A. Young, and S. Zammit. 2008. Wake-up call for British psychiatry. British Journal of Psychiatry 193 (1): 6–9.CrossRefGoogle Scholar
  18. Currid, T.J., and S. Mutsatsa. 2013. What effect will pharmacogenomics have on mental health nursing? Neuropsychiatry 3 (3): 309–320.CrossRefGoogle Scholar
  19. Cutcliffe, J., C. Stevenson, and R. Lakeman. 2013. Oxymoronic or synergistic: Deconstructing the psychiatric and/or mental health nurse. International Journal of Mental Health Nursing 22 (2): 125–134.CrossRefGoogle Scholar
  20. Cuthbert, B.N., and M.J. Kozak. 2013. Constructing constructs for psychopathology: The NIMH research domain criteria. Journal of Abnormal Psychology 122 (3): 928–937.CrossRefGoogle Scholar
  21. Deegan, P. 2011. Recovery and the conspiracy of hope. Presented at there’s a person in here: the sixth annual mental health services conference of Australia and New Zealand. Brisbane, Australia, 16 Sep 1996. (accessed July 21, 2017).
  22. Department of Health. 1999. A national service framework for mental health. London: Department of Health.Google Scholar
  23. Department of Health. 2004. The ten shared capabilities framework. A framework for the whole mental health workforce. London: Department of Health.Google Scholar
  24. Dixon, J. 2016. Balancing risk and recovery in mental health: An analysis of the way in which policy objectives around risk and recovery affect professional practice in England. In Medicine, risk, discourse and power, ed. M. Chamberlain. London: Routledge.Google Scholar
  25. Duggan, M., A. Cooper, and J. Foster. 2002. Modernising the social model in mental health: A discussion paper. London: TOPPS England.Google Scholar
  26. Dumit, J. 2006. Illnesses you have to fight to get: Facts as forces in uncertain, emergent illnesses. Social Sciences & Medicine 62 (3): 577–590.CrossRefGoogle Scholar
  27. Eassom, E., D. Giacco, A. Dirik, and S. Priebe. 2014. Implementing family involvement in the treatment of patients with psychosis: A systematic review of facilitating and hindering factors. British Medical Journal Open 4 (10): e006108.Google Scholar
  28. Engel, G.L. 1977. The need for a new medical model: A challenge for biomedicine. Science 196: 129–136.CrossRefGoogle Scholar
  29. Ewertzon, M., K. Lutzen, E. Svensson, and B. Andershed. 2010. Family members’ involvement in psychiatric care: experiences of the healthcare professionals’ approach and feeling of alienation. Journal of Psychiatric and Mental Health Nursing 17 (5): 422–432.CrossRefGoogle Scholar
  30. Foucault, M. 1967. Madness and civilization. A history of insanity in the age of reason. London: Tavistock.Google Scholar
  31. Freidson, E. 1988. Profession of medicine. A study of the sociology of applied knowledge. Chicago: University of Chicago Press.Google Scholar
  32. Furedi, F. 2004. Therapy culture: Cultivating vulnerability in an uncertain age. London: Routledge.Google Scholar
  33. Ghaemi, S.N. 2009. The rise and fall of the biopsychosocial model. British Journal of Psychiatry 195 (1): 3–4.CrossRefGoogle Scholar
  34. Goffman, E. 1961. Asylums: Essays on the social situation of mental patients and other inmates. Garden City: Doubleday.Google Scholar
  35. Gooding, P. 2013. Supported decision-making: A rights-based disability concept and its implications for mental health law. Psychiatry, Psychology and Law 20: 431–451.CrossRefGoogle Scholar
  36. Gournay, K. 2001. Mental health nursing in 2001: What happens next? Journal of Psychiatric and Mental Health Nursing 8 (6): 473–476.CrossRefGoogle Scholar
  37. Gournay, K. 2005. The changing face of psychiatric nursing. Advances in Psychiatric Treatment 11 (1): 6–11.CrossRefGoogle Scholar
  38. Gray, R., D. Bressington, A. Ivanecka, S. Hardy, M. Jones, M. Schulz, S. von Bormann, J. White, K.H. Anderson, and W. Chien. 2016. Is adherence therapy an effective adjunct treatment for patients with schizophrenia spectrum disorders? A systematic review and meta-analysis. BMC Psychiatry 16 (1): 90.CrossRefGoogle Scholar
  39. Hacking, I. 1999. The social construction of what?. Cambridge: Harvard University Press.Google Scholar
  40. Haslinger, S. 2012. Resisting reality: Social constructionism and social critique. Oxford: Oxford University Press.CrossRefGoogle Scholar
  41. HM Government. 2011. No health without mental health: A cross governmental outcome strategy for people of all ages. London: Department of Health.Google Scholar
  42. Insel, T.R., and B.N. Cuthbert. 2015. Brain disorders? Precisely. Science 348 (6234): 499–500.CrossRefGoogle Scholar
  43. Kessler, R.C., O. Demler, R.G. Frank, M. Olfson, H.A. Pincus, E.E. Walters, P. Wang, K.B. Wells, and A.M. Zaslavsky. 2005. Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine 352: 2512–2523.CrossRefGoogle Scholar
  44. Kinderman, P. 2005. A psychological model of mental disorder. Harvard Review of Psychiatry 13 (4): 206–217.CrossRefGoogle Scholar
  45. Kinderman, P. 2014. A prescription for psychiatry: Why we need a whole new approach to mental health and wellbeing. Basingstoke: Palgrave Macmillan.CrossRefGoogle Scholar
  46. Lysaker, P.H., J. Vohs, J.D. Hillis, M. Kukla, R. Popolo, G. Salvatore, and G. Dimaggio. 2013. Poor insight into schizophrenia: Contributing factors, consequences and emerging treatment approaches. Expert Review of Neurotherapeutics 13 (7): 785–793.CrossRefGoogle Scholar
  47. McKeown, M., and J. White. 2015. The future of mental health nursing: Are we barking up the wrong tree? Journal of Psychiatric and Mental Health Nursing 22 (9): 724–730.CrossRefGoogle Scholar
  48. McLean, A. 1990. Contradictions in the social production of clinical knowledge: The case of schizophrenia. Social Sciences & Medicine 30 (9): 969–985.CrossRefGoogle Scholar
  49. Mojtabai, R., M. Olfson, N.A. Sampson, R. Jin, B. Druss, P.S. Wang, K.B. Wells, H.A. Pincus, and R.C. Kessler. 2011. Barriers to mental health treatment: Results from the National Comorbidity Survey Replication. Psychological Medicine 41 (8): 1751–1761.CrossRefGoogle Scholar
  50. Moth, R., and M. McKeown. 2016. Realising Sedgwick’s vision: Theorising strategies of resistance to neoliberal mental health and welfare policy. Critical and Radical Social Work 4 (3): 375–390.CrossRefGoogle Scholar
  51. Parsons, T. 1951. The social system. Glencoe, IL: Free Press.Google Scholar
  52. Pickersgill, MD (2014) Debating DSM-5: diagnosis and the sociology of critique. Journal of Medical Ethics 40 (8):521–525CrossRefGoogle Scholar
  53. Pilgrim, D. 2015. Understanding mental health: A critical realist exploration. London: Routledge.Google Scholar
  54. Pilgrim, D., and F. Tomasini. 2012. On being unreasonable in modern society: Are mental health problems special? Disability and Society 27: 631–646.CrossRefGoogle Scholar
  55. Richter, D. 1999. Chronic mental illness and the limits of the biopsychosocial model. Medicine, Health Care and Philosophy 2: 21–30.CrossRefGoogle Scholar
  56. Rieff, P. 1966. The triumph of the therapeutic. Chicago: University of Chicago.Google Scholar
  57. Schaffner, A.K. 2016. Exhaustion: A history. New York: Columbia University Press.Google Scholar
  58. Scheff, T.J. 1966. Being mentally ill: A sociological theory. Chicago: Aldine.Google Scholar
  59. Schnittker, J. 2008. An uncertain revolution: Why the rise of a genetic model of mental illness has not increased tolerance. Social Sciences and Medicine 67 (9): 1370–1381.CrossRefGoogle Scholar
  60. Schomerus, G., H. Matschinger, and M.C. Angermeyer. 2006. Public beliefs about the causes of mental disorders revisited. Psychiatry Research 144 (2–3): 233–236.CrossRefGoogle Scholar
  61. Schomerus, G., C. Schwahn, A. Holzinger, P.W. Corrigan, H.J. Grabe, M.G. Carta, and M.C. Angermeyer. 2012. Evolution of public attitudes about mental illness: A systematic review and meta-analysis. Acta Psychiatrica Scandanavia 125 (6): 440–452.CrossRefGoogle Scholar
  62. Schramme, T. 2013. On the autonomy of the concept of disease in psychiatry. Frontiers in Psychology 4: 457.CrossRefGoogle Scholar
  63. Shanafelt, T.D., S. Boone, L. Tan, L.N. Dyrbye, W. Sotile, D. Satele, C.P. West, J. Sloan, and M.R. Oreskovich. 2012. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Archives of Internal Medicine 172 (18): 1377–1385.CrossRefGoogle Scholar
  64. St. John-Smith, P., D. McQueen, A. Michael, G. Ikkos, C. Denman, M. Maier, R. Tobiansky, H. Pathmanandam, T. Davies, V.S. Babu, O. Thachil, F. Iqbal, and R. Rao. 2009. The trouble with NHS psychiatry in England. The Psychiatrist 33: 219–225.Google Scholar
  65. Szasz, T.S. 1961. The myth of mental illness: Foundations of a theory of personal conduct. New York: Harper and Row.Google Scholar
  66. Szmukler, G., R. Daw, and F. Callard. 2014. Mental health law and the UN Convention on the rights of persons with disabilities. International Journal of Law and Psychiatry 37 (3): 245–252.CrossRefGoogle Scholar
  67. Tomes, N. 2006. The patient as a policy factor: A historical case study of the consumer/survivor movement in mental health. Health Affairs 25 (3): 720–729.CrossRefGoogle Scholar
  68. Wang, P.S., S. Aguilar-Gaxiola, J. Alonso, M.C. Angermeyer, G. Borges, E.J. Bromet, R. Bruffaerts, G. de Girolamo, R. de Graaf, O. Gureje, J.M. Haro, E.G. Karam, R.C. Kessler, V. Kovess, M.C. Lane, S. Lee, D. Levinson, Y. Ono, M. Petukhova, J. Posada-Villa, S. Seedat, and J. Elisabeth Wells. 2007. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370 (9590): 841–850.CrossRefGoogle Scholar
  69. Weinstein, J. 2014. Mental health. Bristol: Policy Press.Google Scholar
  70. Wunderink, L., R.M. Nieboer, D. Wiersma, S. Sytema, and F.J. Nienhuis. 2013. Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: Long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry 70 (9): 913–920.CrossRefGoogle Scholar
  71. Zachar, P., and K.S. Kendler. 2007. Psychiatric disorders: A conceptual taxonomy. American Journal of Psychiatry 164 (4): 557–565.CrossRefGoogle Scholar

Copyright information

© Macmillan Publishers Ltd., part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of Social & Policy SciencesUniversity of BathBathUnited Kingdom
  2. 2.University Bern Psychiatric Services, Center for Psychiatric RehabilitationBernSwitzerland
  3. 3.Bern University of Applied Sciences, Department of HealthBernSwitzerland

Personalised recommendations