This short paper addresses insanity from a sociological perspective. It is hoped that this insight may bring balance into the debate about 'mental illness' and help towards a better understanding of the problem.

The sociologist begins at a disadvantage. One is dealing with, and trying to explain, a process that is so integral to human understanding as to appear entirely natural and factual. This process is called by William Isaac Thomas 'the definition of the situation'. Thomas famously said "situations that are defined as real are real in their consequences". What we mean here is that the definition of 'mental illness' is of such long duration and backed by society at large and by powerful lobbies within society that to question its existence would seem to be fatuous or even to smack itself of mental aberration.

Society, through the ages, has dealt with behaviour it did not wish to countenance by stigmatizing those that behaved so and by ostracizing them. At various times, certain key players or institutions have established themselves as judges of 'normal behaviour'. At first it was the various religious institutions, from shamans to established religions, who played this role and the lunacy of the inquisition and the trial of the witches of Salem is a warning to all to beware of the type of orthodoxy that sets itself up as an arbiter of normality. The sententiousness of the statements made, for instance at the trial of Joan of Arc and in Salem, is very clear to us now and we can spare a wry smile at the foolishness of all involved in the tragic events.

That, of course, was then. But, as the French put it, 'plus cá change, plus le méme chose'. Today, members of a very powerful profession, psychiatrists and psychologists, have established themselves as judges of what is or is not 'normal' behaviour, to the extent that one needs be very courageous to dispute their dictates. One person who does this is Dr.Thomas Szasz.

Thomas Szasz is Professor Emeritus of Psychiatry at the Upstate Medical Center in Syracuse, New York and he is in no doubt whatsoever about the position of psychiatry and 'mental illness'.. The titles of some of his books witness to his position, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct (1961); The Manufacture of Madness: a Comparative study of The Inquisition and The Mental Health Movement (1963); The Myth of Psychotherapy: Mental Healing as Religion, Rhetoric and Repression (1990) and Cruel Compassion: Psychiatric Control of Society's Unwanted (1994). Need one remark that he is not popular with certain members of the psychiatric or psychology professions?

Thomas Szasz is not alone among psychiatrists in adopting this stance. Among those who call for a destigmatization of mental illness are Professor Arthur Kleinman of the Harvard Medical School, the Royal College of Psychiatrists in their campaign 'Changing Minds: Every Family in the Land', the Royal Society of Medicine and organizations such as Stigma.org, an initiative of the Sir Robert Mond Memorial Trust whose website is www.depression.org.uk. William Glasser is another psychotherapist who has rejected the psychoanalytic approach in favour of behaviour modification with great success. A single quote from Szasz may allow us to conclude this section: "No further evidence is needed to show that 'mental illness' is not the name of a biological condition whose nature awaits to be elucidated, but is the name of a concept whose purpose is to obscure the obvious".

We must now turn to look at the concept of stigmatization. Erving Goffman's book Stigma: Notes on the Management of Spoiled Identity (1963) is the classic work on this subject. The word stigma is Greek and denoted a mark that was put on criminals and others who had incurred the odium of powerful elements of society. Then, as now, the mark was imposed by external agents and marked the wearer as ostracized, alien, unworthy, possibly dangerous. Stigmatization is possible because it fits in with our ordinary everyday process of understanding.

It is not possible for us, in our everyday lives, to deal with every individual thing or person we meet. Instead, we categorize sense data. So when we walk along a street and meet people, we initially categorize them by gender. The first thing we note about another is whether one is male or female. This, in great measure, dictates how we behave towards them. The next thing we categorize is race or colour. In Kerry at the moment, this may actually be the first category we employ. The next category is age, then social class and so on. This categorization is basic to our understanding of the world around us and is the basis of our behaviour. We like to be able to 'place' people; this has been essential to our adaptation and evolution through the years. Being able to recognize friend or foe has been essential to survival.

While categorization is an essential to our living, it has its negative side. We tend to divide the world into 'them' and 'us'. When we meet people whose behaviour we do not understand, we tend to categorize them as less than worthy. Behaviour that we find unsettling we tend to stigmatize and ostracize. Next, we blame the person for the stigma we have imposed. Finally, the stigmatized person takes on the stigmatized role as one's personal identity and suffers guilt and shame for the assumed condition. This has been the story with those we have labeled mentally ill; we have exiled them, we have exorcised them, we have burnt them at the stake, we have locked them up for life, we have operated on them and we have tortured them. We have changed little.

Unquestionably, there are conditions of the brain and nervous system that require medical intervention; such are inappropriate levels of serotonin or dopamine which affect behaviour and can be regulated by certain psychotropic drugs. Apart from these clear medical conditions of the brain and nervous system, the major factor impacting 'mental illness' is the attitude of the general public in categorizing and stigmatizing those whose behaviour we regard as abnormal. E. Schur, (Labeling Deviant Behavior, 1971) speaks of a role that is so salient in one's identity as to be an 'engulfing role'. Such a role label is that of mental patient. Once this label is successfully applied it becomes the primary definition of one's identity to which all else is secondary.

The establishment of the spoiled identity of the mental patient is socially based and the resolution must also be socially based. This will involve several elements. First, stereotypical presentations in the media must be controlled. G. Philo (Media and Mental Distress, 1996) has documented stereotypical treatment of mental patients in various media. He found that in 66% of portrayals of mental illness on television, violence was the central element. Steve Hyler, an American psychiatrist, (Homicidal Maniacs and Narcissistic parasites: Stigmatization of Mentally Ill Persons in the Movies, 1991) found that mentally ill persons were most commonly portrayed as homicidal maniacs, to the extent that most people accepted the stereotype without question. In the survey by the Royal College of Psychiatrists, already mentioned, 70% of respondents believed that schizophrenics were violent and unpredictable.

Secondly, following on the previous point, education is required to overcome the prejudice that surrounds the stereotypes of mental patients. Many studies have shown the positive effects of education in reducing prejudice towards those labeled mentally ill.

Thirdly, and finally, direct contact with mental patients has been shown to be the best antidote to the prejudice and stigmatization we have been discussing. One might mention the names of Link, Cullen, Huxley, Brockington, Wolff and Murphy and others as testifying through their studies to the efficacy of direct contact with those who have been diagnosed as mentally ill in reducing prejudice and countering stereotypical attitudes.

In conclusion, the major problem in dealing with the deviant behaviour commonly labeled mental illness is the attitudes and actions of the general public who label and stigmatize these persons. The greatest advance to be made is not in the treatment of the 'patients' but in the education and enlightenment of the general public.