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Although many disciplines study mental health, not every discipline thinks of mental health in the same way. This chapter considers how decisions regarding outcomes – that is, what scientists are trying to explain or, in quantitative studies, the dependent variable – affect conclusions regarding what we think causes mental illness. The chapter considers various axes along which outcomes are considered, focusing on three of the most prominent: categorical versus dimensional, symptoms versus syndromes, and functioning versus disorders. The chapter then reviews the consequences of decisions regarding these axes. Decisions regarding outcomes have important consequences, many of which are quite subtle. Yet decisions are often justified on an ad hoc basis and, indeed, there may be no objectively correct way to measure psychiatric disorders. To be sure, the natural sciences can reveal something about the true nature of mental illness, including research on genes that speaks to the boundaries between psychiatric disorders, but much of the emerging evidence in this regard fails to provide clear guidance. Long-standing controversies regarding outcomes are unlikely to be resolved anytime soon, but research will continue to study psychiatric disorders. In the end, what is the best way to conceptualize and measure mental health?
Introduction
A core aspect of the sociology of mental health is to understand the social and environmental determinants of mental illness. This distinguishes sociology from much of, say, psychology or genetics, where the emphasis is on influences internal to the individual. Many chapters in this handbook explore this focus, discussing research on the effects of, for example, social support, socioeconomic status, and life events. In this chapter, I want to take a step back and think about how decisions regarding what to explain – that is, decisions regarding the outcome or the dependent variable – influence conclusions about what causes it. In this way, this chapter attempts to bridge two strands of research: research on what constitutes mental illness – including, for example, research on the history of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) or, more generally, research on medicalization – and research on the causes of mental illness. These two areas of study are rarely in dialog – most research on the causes of major depression, for example, accepts the DSM criteria for the disorder as given – but it is important to think about how the two intersect.
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