Two days before Bell’s annual Let’s Talk day, The Medium sat down with professor Melissa Milkie from the Department of Sociology at UTM. Milkie teaches SOC318: Sociology of Mental Health and Mental Disorders. The course explores the relationship between mental health and sociological predictors.

According to the SOC318 syllabus, the students begin the course learning about the medical or biological model of mental illness: “What a lot of people understand, in our society as a [. . .] common understanding is that if people have anxiety, or depression, [or] anger, these things are internal, they are in the body. Maybe chemicals or hormones or genetics. And that [if] something goes wrong, there’s a malfunction. And then the disease appears or problem appears. Then the sickness or illness as we call it, might be in the person’s body, in the individual,” explains Milkie.

The medical model of mental illness then individualizes the problem and ignores the structural causes of deteriorating mental health. To challenge conventional thought associated with the medical model, the students are encouraged to use their sociological imagination to think about mental health.

“A structural sociological view is that we see that the problem is in the structure of society—in the everyday roles that we have neighbourhoods, communities [. . .] that’s built right in, which is a shock to a lot of people because it’s a normal functioning society and yet it’s not working,” Milkie continues, “In a lot of ways it doesn’t allow a lot of people to be as healthy as they should be. And so the sickness is in the society, not in the person.”

In addition, the stress process models incorporate stress and support at the individual, family, and community level. Milkie describes that looking at structures, the institutions, and roles form the social constructionist perspective. When asked about this perspective, the professor explains, “Whatever different behaviours we see exhibited by different people get labelled as a certain kind of disorder, like anxiety disorder or ADD [. . .]. We‘ve come as a society to say ‘Okay, the people exhibiting these behaviours are different or odd in some way. And we’re going to lump them together and give them this label.’”

According to the American Psychiatric Association, the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the “authoritative guide” for healthcare professionals in diagnosing mental disorders, with the latest edition being DSM-5.

“It’s a massive book [and] it has grown overtime. We see large portions of people being diagnosed. And there’s an industry [. . .]. They’re selling their drugs that ‘treat’ people,” says Milkie.

When asked about the fluidity of mental disorders and how they get added or removed, such as homosexuality being a mental disorder according to the DSM until 1974, the professor explains: “It changes overtime. The specific one change over time, as you mentioned, was considered mental illness in prior generations—to not be heterosexual. Now we see new ‘disorders’ coming up, like video gaming disorder is one. That, of course, we would have never talked about in the past. What is a video gaming disorder and do we all have it? And if so, are we all diseased? So, it’s quite important to follow the social changes that have occurred and look at the political context.” Milkie further questions, “Why are the powerful in society labelling particular behaviours as this disorder? Then, how are we treating people in that category?”

Since the interview preceded Bell’s annual Let’s Talk day, and among the flurry of #LetsTalkUTM events promoting the importance of mental health, it does not escape notice that many campaigns focus solely on removing mental health stigma.

“I don’t pay so much attention to the campaigns. I think there’s definitely a place for them. And we’ve seen on campuses increases in anxiety and different problems. Whether that is because of awareness, less stigma than the past, that might be a good thing,” the professor continues, “But I guess as a sociologist, I want to [. . .] look at some fundamental inequalities that produce differences in distress.”

Milkie gave an example of young adults who are not on campus or away from university: “Those students probably have more stressors. And they have a lot of difficulties [and] distress that we might not be focusing on. And they may have fewer resources to get themselves help. So maybe that campaign, and again I don’t know because I don’t really tune into it too much, maybe they’re just like ‘Oh, that’s such an easy thing—to just get help.’ But what if you’re not on a campus or where there’s a resource like that. Or what if you don’t have money for that kind of visit to a professional? Or what if you’re in a neighbourhood where you don’t have easy access to the kind of people who would help you?”

Since the #LetsTalk campaign on campus centres around the different problems that students face while speaking out, The Medium asked Milkie her opinion on how to start viewing solutions from a socioeconomic lens. She replies, “It’s important to have available resources and multiple types, probably not just one type of resource. And multiple pathways for people who are having difficulties linked to distress, to be able to focus on their health, and not be penalized somehow—come back into the system.”

The professor also adds, “We know inequalities exacerbate some of these things. Youth have a whole host of stressors that they are experiencing related to their future. The future is ambiguous and the future doesn’t promise certain kinds of jobs, even now with a degree. [. . .] What can we do to alleviate that pressure?“ She mentions how restructuring education to support health may have benefits, along with restructuring “neighbourhoods and so on, before we go on trying to treat more and more individuals that end up having distress.”

Milkie continues, “But also, again, we sort of want to go upstream to the problem. We can just keep fixing people, or we can fix the society. If there’s a lot of people suffering from anxiety because of excess work expectations, overload, financial strains, family problems, what can we do to alleviate that as a society?”