Six features of the human condition: The social causation and social construction of mental health

Drawing from sociology and social philosophy, and key findings and conclusions presented throughout the book, the argument defended in this chapter has three parts:

(a) When considering the social determinants of mental health, we should not only uncover the processes of socially causation so focusing on the social epidemiology of mental illness/health, but also those processes of social construction which affect how notions of illness, health and ‘care’ are defined within professional contexts and wider society. Identifying these as distinct social processes helps clarify two principle social dimensions of mental health. First, there are those social determinants which give rise to the phenomena of mental illness and health. Second, there are ways these phenomena are variously conceptualized, affecting how those who are defined as ‘mentally ill’ are viewed and treated by ‘caring professionals’, family members, and the broader community.

(b) Whatever social conceptions of well-being and mental health are used and developed, all must accommodate six features of the human condition as identified here. Moreover, the precise relationship between these features will vary, depending on (i) the philosophical meanings of well-being and their relationship to our understanding of ‘positive’ and ‘negative’ mental health outcomes, and (ii) how these meanings are, in turn, socially constructed which affect the way ‘health’ and ‘illness’ are defined, explained and addressed across different social contexts.

(c) When both medicalised and social causation and/or construction explanations of mental health are used in (b) above, the roles that individual agency, cognition, and evaluation play in people’s lives should be accommodated. That is, defending a broadly non-determinist account of well-being and mental health which, it is argued here, should be central to developing mental health care. This accommodation, then, also allows scope for individual choice and agency, opening-up new possibilities for both viewing and treating those individuals defined as mentally ill. In short, ‘patients’ or ‘service-users’ are seen not as ‘passive victims’ of circumstances beyond their control, but as active participants or co-producers in (i) how their care is defined, managed and implemented, and (ii) how their mental health/illness is subjectively defined and given meaning in their lives.