A Handbook for the Study of Mental Health Social Contexts, Theories, and Systems

Mental health and mental disorder represent two different areas of theory, research, and policy implications, reflecting our common tendency to dichotomize healthy and sick, normal and abnormal, sane and insane. David Mechanic (2006) argues that the term “mental health” has no clear or consistent meaning, and in terms of the sociological literature, this is generally true. Mental health is not merely the absence of disease or disorder; it involves self-esteem, mastery, and the ability to maintain meaningful relationships with others. While most of us fall short of optimal well-being (or happiness), those who experience mental health problems or psychological distress have been the focus of most sociological research.

However, definitions of mental health problems, illnesses, or disorders are also not so straightforward. Following Horwitz (2002b), “mental diseases” reflect underlying internal dysfunctions that have universal features (i.e. schizophrenia and to a lesser degree bipolar disorder). A valid “mental disorder” reflects some internal psychological system that is unable to function as it should, and this dysfunction is socially inappropriate. For most disorders, symptoms are not specific indicators of discrete, underlying diseases (such as schizophrenia), instead many conditions arise from stressful social conditions (such as depression, anxiety, eating disorders). Cultural processes shape the symptoms associated with mental disorders, and it is important to distinguish mental disorders from normal reactions to social stressors. Horwitz (2002b) uses the terminology of “mental illness” to refer to those conditions which a particular group has defined as a mental illness (and often point to behaviors that are deemed deviant, for example homosexuality in previous psychiatric classifications). For simplicity, we will use the term mental health problem or disorder in this introduction – but students should keep in mind the implications of using the term mental illness. In Chapter 1, Horwitz argues that sociological approaches regard mental health and mental health problems as aspects of social circumstances. He provides a very thorough overview of how various social conditions affect levels of mental health and mental health problems, and in turn how social contexts shape the definition as well as the response to mental health problems. Chapter 1 develops a framework for a sociological understanding of mental disorder and mental health problems and also directs the reader to other chapters in the volume that illustrate Horwitz's arguments.