One of the key themes of this book is that human action cannot be understood outside the matrix of social relations and cultural frameworks of which people are a part. Context matters deeply. Further, what people know about themselves and their world is shaped by the systems of language and meaning available to them. In this chapter, we argue that this is true for mental health practitioners and their clients, as well as for researchers who study matters of mental health and illness. This chapter, which addresses psychological suffering – what is ordinarily called mental illness – turns its attention to ways in which such suffering is embedded in culture, social context, and language. In earlier chapters, we introduced several ideas about language and linguistic practices that are relevant here. One general point is that social categorizations seldom “carve Nature at its joints,” as we pointed out in Chapter 2. Such categorizations are best understood as products of ongoing collective efforts to order and make sense of the world. Social categorizations create and convey meanings; they also conceal meanings. Psychiatric diagnoses are potent social categorizations.

We discuss the history and function of psychiatric diagnosis in the first part of the chapter. Building upon that discussion, we then examine how psychological suffering, deviance, and dysfunction are intimately bound up with cultural contexts, as well as with the inequitable distribution of social and material power and resources across social groups, including gender and ethnic groupings. Stepping back to examine the categorizations and language systems in use in psychiatry and psychology does not mean that psychological suffering is no more than a language game. Nor does such an examination imply that people who receive psychiatric categorizations do not suffer. However, judgments about suffering, dysfunction, and deviance are necessarily made through the lens of culture. Moreover, such judgments often serve to shore up the prevailing social structure and norms. In modern societies, the mental health professions have become a prime regulatory force, offering judgments of what is normal versus abnormal, as well as pronouncements about what makes people healthy, happy, and fulfilled. As feminist critics have pointed out, these judgments often encode gender imperatives, as well as class, cultural, and ethnic biases.