Anyone familiar with the world of mental health would read Veronika Decides to Die (Coelho, 1998) with some surprise. Veronika, a young woman from Slovenia, whose life appears to be otherwise ‘good’, tries to kill herself. When she wakes up, her psychiatrist tells her that the medicine she took triggered a toxic reaction that has only postponed her death. She will pass away in a few weeks. During these weeks, Veronika reflects on her situation, meets some patients from her ward, falls in love with one of them, and, ultimately, learns to appreciate life. The twist of this story is unveiled at the end. Her psychiatrist admits that he lied. Veronika will live.

In many respects, this novel runs counter to psychiatric common sense. Firstly, what motivates Veronika's suicide attempt is not adversity, distress or trauma, but the meaninglessness of her trouble-free existence – a lack of stress. That said, it is through pressuring Veronika into an irreversible death sentence that her psychiatrist provides the much-needed shock that would give meaning to her life and spark some vital energy.

This story offers a counter-narrative to a major trend in the sociology of mental health: the stress paradigm. The stress paradigm incorporates a vast range of works that study how various difficulties, from discrimination to car accidents through sexual abuse and other traumas, generate stress; and how stress, when not buffered with the appropriate, material and ‘psychological’ resources, is a catalyst for mental disorders.

One of the oldest explanations in the history of ideas seeking to make sense of ‘madness’, though phrased initially as pressure or overburdening, stress was introduced to sociology through biology. Armed with this multiform concept, quantitative sociologists were able to measure various pathways towards mental distress. The set of factors they identified enabled collaborations with psychology and psychiatry, facilitating the integration of social factors into mainstream interpretations of mental health. However, although the stress paradigm provided some ground on which to imagine how social factors generate individual troubles through unequal exposure to adversity, some major gaps tarnish its explanatory power.