The SAGE Handbook of Mental Health and Illness


Edited by: David Pilgrim, Anne Rogers & Bernice Pescosolido

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    The field of mental health is now an ideological and terminological battle ground. The diagnostic categories, and the terms used to refer to the people affected, are all strongly and validly contested. This important book helps policy makers, practitioners and researchers to pick their way across this minefield relatively unscathed, to appreciate in fine grain detail the social context within which mental illnesses unfurl, and how this context shapes (often in profoundly socially excluding ways) the lives of people with mental health problems. As a corrective to biological reductionism, this wise book actively expands our understanding of how social forces permeate all aspects of mental illness.

    Professor Graham Thornicroft, Institute of Psychiatry, UK

    Pilgrim, Rogers and Pescosolido's volume is a wide-ranging and cross-national examination of many core issues in the sociology of mental health. It presents a variety of perspectives on fundamental substantive and policy issues in mental health and illness. Its scope and range make it ideal for scholars and students in a variety of disciplines concerned with social aspects of psychological distress and disorder.

    Professor Allan Horwitz, Rutgers University, USA

    This book provides the reader with an updated, in-depth yet comprehensive, overview of key issues in our understanding of mental ill health and mental health. The text illustrates well changes in the way we conceptualise mental ill health and health over the last twenty years, referring us to past and present reasons for these changes, such as a greater emphasis on mental wellbeing, mental health promotion, recovery, and social inclusion. A number of countries, professions and disciplines are represented in the book by both well known authors in this field, and some newcomers to it. Together they have succeeded in offering the reader an impressive range of ideas, knowledge and evidence that challenge some of the cherished notions we have as a culture about mental ill health and mental health.

    Professor Shula Ramon, Anglia Ruskin University, UK


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    The editors would like to offer their profound gratitude to Mary Elizabeth Hannah for her extensive support during the production of this Handbook.

    List of Editors

    David Pilgrim is Professor of Mental Health Policy in the School of Social Work at the University of Central Lancashire and Visiting Professor, University of Liverpool, UK. He has higher degrees in both psychology and sociology and his career has been divided between clinical work in the British National Health Service and research and teaching in academia, with a particular interest in professionalization, service innovations and service users’ views. His A Sociology of Mental Health and Illness (Open University Press, 2005, with Anne Rogers), was winner of the 2006 British Medical Association's Medical Book of the Year Award. His other books include Examining Trust in Health Care: A Multi-Disciplinary Perspective (Palgrave, 2010, with Floris Tomasini and Ivalyo Vassilev), Key Concepts in Mental Health (SAGE, 2009), A Straight Talking Introduction to Psychological Treatment (PCCS Books, 2009) and Mental Health and Inequality (Palgrave, 2003, with Anne Rogers).

    Anne Rogers is Professor of Sociology of Health Care at the University of Manchester. Her research interests lie broadly within the sociology of health care, mental health and most recently social networks, relationships and personal long term condition management. Her research has included exploring patients’ experience of psychiatric services, the social patterning of mental health problems, lay epidemiology, professional knowledge and sociological analysis of old and new forms of treatment. She has published extensively in peer reviewed journal articles and has been an author or co-author of a number of books. These include Experiencing Psychiatry: Users’ Views of Services (Macmillan, 1993, with David Pilgrim and Ron Lacey), Demanding Patients? Analysing Primary Care Use (Open University, 1998, with Karen Hassell and Gerry Nicolaas) and Mental Health and Inequality (Palgrave, 2003, with David Pilgrim). Her A Sociology of Mental Health and Illness (Open University Press, 2005, with David Pilgrim) was winner of the 2006 British Medical Association's Medical Book of the Year Award.

    Bernice Pescosolido is Distinguished and Chancellor's Professor of Sociology and Director of the Indiana Consortium for Mental Health Services Research at Indiana University, USA. Pescosolido's research and teaching focus on how social networks connect individuals to their communities and institutional structures. Her Network Episode Model, developed in the early 1990s, focuses on how individuals recognize, respond to the onset of health problems and use health care services, providing new insights to understanding patterns and pathways to care, adherence to treatment and outcomes of health care. She initiated the first major national study of stigma of mental illness in the US in over 40 years, and with funding from the Fogarty International Center, led a team of researchers in the first international study of stigma.

    List of Contributors

    Gillian Bendelow is Professor of Sociology at the University of Sussex, UK, and worked as a community mental health nurse in East London before entering academia. She is an established medical sociologist who has made research contributions to the fields of chronic illness, pain and ‘contested’ conditions, lay concepts of health and illness and integrated models of mental and emotional health. She is regularly invited as a keynote/plenary speaker to international academic and policy-oriented events and is author of Health, Emotion and the Body (Polity, 2009), Pain and Gender (Pearson Education, 2000) and co-author of Emotions in Social Life and The Lived Body (Routledge, 1998) as well as many edited books and journal articles.

    Richard Bentall is Professor of Clinical Psychology at the University of Bangor, UK. He is interested in the problem of classification of mental illness and in the relationship between psychopathology and normal variations in human personality. This interest has led him to challenge traditional research strategies in psychopathology, which have focused on broadly defined syndromes such as ‘schizophrenia’, and to advocate research which focuses on particular classes of abnormal behaviour and experience (‘symptoms’). In 1989, he was awarded the May Davidson Award from the British Psychological Society for contributions to the field of clinical psychology. He has edited and authored several books, most notably Madness Explained (Penguin, 2003), which was winner of the British Psychological Society Book Award 2004. The ideas in this were developed subsequently in his Doctoring the Mind (Allen Lane, 2009).

    Michael Bloor is Professor of Sociology at the Universities of Cardiff and Glasgow, UK. His research interests include occupational health and safety, global governance, risk behaviour and health services research. His Keywords in Qualitative Methods: a Vocabulary of Research Concepts was published in 2006 (SAGE, with F. Wood).

    Peter Campbell is a British mental health system survivor. He has been receiving services consistently for more than forty years and has been involved in action towards positive change since the mid-1980s. He works as a freelance teacher in the mental health field and has an Honorary Doctorate in Education at Anglia Ruskin University. He was a founder member of Survivors Speak Out (1986) and Survivors’ Poetry (1991). He is particularly interested in mental health nursing and in mental health legislation. Peter has provided chapters for a variety of mental health textbooks and contributes regularly to Open Mind and other magazines. He is co-editor (with Phil Barker and Ben Davidson) of From the Ashes of Experience (Whurr Publishers, 1999).

    Carolyn Chew-Graham is Professor of Primary Care at the University of Manchester, UK and also works as a general practitioner in the city. She is a qualitative researcher and has published on general practitioners’ attitudes to their work, particularly in the care of patients with distress, chronic illness and multiple symptoms, and care across the primary/secondary interface. Her externally funded work consists of developing and testing new interventions for patients with mental health problems in primary care. Carolyn has a particular interest in the mental health of older people. She is Royal College of General Practitioners’ Clinical Champion, Mental Health, and co-Chair of the Forum for Primary Care Mental Health, a partnership between the RCGP and Royal College of Psychiatrists, aiming to influence policy, develop educational materials for GPs and improve care of people with mental health problems.

    Angus Clarke is Professor and Consultant in Clinical Genetics in Cardiff University, UK. He studied medical sciences and genetics at Cambridge and qualified in medicine from Oxford University. After registration, he worked in general medicine and then paediatrics. He studied the clinical and molecular genetics of ectodermal dysplasia in Cardiff and then worked in clinical genetics and paediatric neurology in Newcastle upon Tyne, developing an interest in Rett syndrome and neuromuscular disorders. He returned to Cardiff in 1989 and has maintained these interests and developed further interests in genetic screening, the genetic counselling process and the social and ethical issues around human genetics. He represents the Chief Medical Officer for Wales on the UK Human Genetics Commission. He has (co)authored and edited six books, including Genetics, Society and Clinical Practice (Bios Scientific Publishers, 1997) and Living with the Genome (Palgrave, 2006). He established and directs the Cardiff MSc course in Genetic Counselling.

    Jonathan Gabe is Professor of Sociology at Royal Holloway, University of London, UK. He has research interests in medical controversies, social relations of health care and patients’ experience of chronic illness. Amongst his most reccent books are The New Sociology of the Health Service (Routledge, 2009, edited with Michael Calnan), Pharmaceuticals and Society (Wiley Blackwell, 2009, edited with Simon Williams and Peter Davis) and Challenging Medicine (Routledge, 2006, edited with Davide Kelleher and Gareth Williams). He is currently an editor of the international journal Sociology of Health and Illness.

    Helen Herman is Professor of Psychiatry at the University of Melbourne and Director of the World Health Organization (WHO) Collaborating Centre for Mental Health in Melbourne, Australia. She is a psychiatrist and public health practitioner with a particular interest in promoting mental health through population-based public health interventions as well as better health services for people living with mental illnesses. Her recent books include Promoting Mental Health: Concepts, Evidence and Practice (WHO, 2005, with Saxena and Moodie), Depressive Disorders, Third Edition (World Psychiatric Association (WPA) – Series Evidence and Experience in Psychiatry, Wiley-Blackwell, 2009 with Maj and Sartorius), Contemporary Topics in Women's Mental Health (WPA Series, Wiley-Blackwell, 2009 with first editor Chandra, Kastrup, Niaz, Rondon and Okasha), Parenthood and Mental Health (WPA Series, Wiley-Blackwell, 2010 with first editor Tyano, Keren and Cox) and Substance Abuse (WPA Series Evidence and Experience in Psychiatry, Wiley-Blackwell, 2010 with first editor Ghodse, Maj and Sartorius).

    Karen Iley is Lecturer in Nursing in the School of Nursing Midwifery and Social Work at the University of Manchester, UK. She is a registered nurse having worked as a nurse manager in the British National Health Service before moving into an academic career. Her post-graduate degree is in the Sociology of Health and Healthcare. Her research interests include ethnic inequalities in mental healthcare, the organization and delivery of healthcare services and how patients access and use health care services.

    Renata Kokanovic is Monash Fellow at the School of Political and Social Inquiry at the Monash University, Melbourne and Honorary Senior Research Fellow at the Department of General Practice at University of Melbourne, Australia. Her research is in the sociology of health and illness, focusing on medicalization of everyday life and cultural research on experiences of emotional distress. She has her work published in a number of academic journals, including Sociology of Health and Illness Social Sciences Medicine and Qualitative Health Research.

    Ann McCranie is a PhD candidate in Sociology at Indiana University, Bloomington, USA. Her dissertation examines the scientific/intellectual movement of recovery, mental health services research and the impact that ‘recovery-oriented’ academic researchers in the United States have had on federal and state mental health policy. She is currently involved in a long-term NIMH-funded qualitative evaluation of a clinical and academic collaboration in community mental health. Her other research spans medical sociology, organizational research and social networks, but is focused on the treatment and lives of people with severe mental health problems.

    Nick Manning is Professor of Social Policy and Sociology, and Director of the Institute of Mental Health at University of Nottingham/Nottinghamshire Healthcare NHS Trust, UK. He has higher degrees in sociology and social policy. His research interests are in the application of sociology to the field of mental health, social change in Eastern Europe and social theory. His recent books include Health and Healthcare in the New Russia (Ashgate, 2009), Global Social Policy, (SAGE, 2008), Social Policy (Oxford University Press, 2007), International Encyclopaedia of Social Policy, 3 volumes (Routledge, 2006), A Culture of Enquiry: Research Evidence and the Therapeutic Community (Jessica Kingsley, 2004) (translated into Italian in 2007), and Poverty and Social Exclusion in the New Russia (Ashgate, 2004).

    Alison Munro is currently a Research Fellow in the Institute for Applied Social and Health Research at the University of the West of Scotland. She has a PhD in the area of attitudes of nurses and social workers to working with alcohol users and alcohol problems, and has a wide range of experience in alcohol, drugs and co-morbidity research.

    James Nazroo is Professor of Sociology and Director of the Cathy Marsh Centre for Census and Survey Research, University of Manchester, UK. Much of his research has focussed on ethnic inequalities in health, with a concern to go beyond describing differences in health to assessing the contribution that social disadvantage might make to observed differences. Central to this has been developing an understanding of the links between ethnicity, racism, class and inequality. His research in this field has covered a variety of elements of social disadvantage, including socioeconomic position, racial discrimination and harassment, and ecological effects. It also covers a variety of health outcomes, including general health, mental health, cardiovascular disease and sexual health. He has taken an increasing focus on comparative analysis (across groups, time and place) to investigate underlying processes, research that has involved collaborations with colleagues in the US, Canada, Europe and New Zealand – as well as the UK.

    Sigrun Olafsdottir is Assistant Professor of Sociology at Boston University, USA. She received her PhD from Indiana University in 2007. Her research focuses on medical sociology, sociology of mental health, political sociology and cultural sociology. Her dissertation, Medicalizing Mental Health: A Comparative View of the Public, Private, and Professional Construction of Illness, was selected the Best Dissertation in Mental Health by the Mental Health Section of the American Sociological Association and was awarded the Esther L. Kinsley PhD Dissertation Award for the Most Outstanding Dissertation by Indiana University. Her research articles have appeared in The Journal of Health and Social Behavior, Social Science and Medicine, Sociological Perspectives, Sociological Forum and the Journal of the American Academy of Child and Adolescent Psychiatry.

    Brea Perry is Assistant Professor of Sociology and Faculty Associate in the Center for the Study of Violence Against Children at the University of Kentucky, USA. Her research focuses on the interrelated roles of social networks and interaction, social structure, culture and biological systems in disease etiology and the illness career. She has published research on dynamic social network processes, stigma and its consequences, youth in foster care, mental illness in children and adults, and gene-environment interactions in disease pathways. In 2009, she was honoured with two awards from the American Sociological Association for her dissertation. In addition, she is the recipient of the 2009 Eliot Freidson Outstanding Publication Award from the American Sociological Association Medical Sociology Section for ‘Under the Influence of Genetics: How Transdisciplinarity Leads Us to Rethink Social Pathways to Illness’ (American Journal of Sociology, 2008, with Bernice Pescosolido, J. Scott Long, Jack Martin, John Nurnberger and Victor Hesselbrock).

    Benedikt Rogge is Research Associate in the Institute of Empirical and Applied Sociology at the University of Bremen, Germany. He has higher degrees in both psychology (University of Tuebingen) and sociology (University of Essex). He is particularly interested in the relationships between social inequalities and life events on the one hand and people's mental health and stress on the other. He is currently completing his PhD on a longitudinal interview study on how unemployment alters people's identity process and well-being. His forthcoming publications in English include ‘Time structure or meaningfulness? Critically reviewing research on mental health and everyday life in unemployment’ (in T. Kieselbach, T. and S. Mannila (eds), Persistent Unemployment and Precarious Work: Research and Policy Issues. Wiesbaden: VS) and ‘Unemployment and its association with health-relevant actions: investigating the role of time perspective with German census data’ (International Journal of Public Health, with Reinhard Schunck).

    Diana Rose is an Academic Social Scientist and had a brief career from 1972 to 1984 in mainstream academia but lost that position because of her mental illness diagnosis. In 1996, she resumed an academic career, first in an NGO and then at the Institute of Psychiatry, King's College London where she is now Senior Lecturer in User-Led Research. Prior to this, she first became involved in the UK mental health services user movement in 1986 when she saw an advertisement for her local user group in a well-known London magazine. The meeting turned her view of services on its head – from a self-understanding of being manipulative and attention-seeking (the message from services) she came to understand that her human rights were being violated.

    Susan Roxburgh is Associate Professor of Sociology at Kent State University, USA. She has published on topics such as gender differences in the work and well-being, relationship, race/gender differences in mental health, and parenthood and well-being have appeared in a number of journals including Journal of Health and Social Behavior, Journal of Family and Economic Issues, Journal of Family Issues, Addictive Behaviors and Sociological Forum. Her research on time pressure and health has been funded by the National Institutes of Health.

    She has been a two-term member of the Journal of Health and Social Behavior editorial board and served on the American Sociological Association's distinguished book award committee between 2008 and 2010. Her current research projects include the relationship between childhood adversity and adult depression among the incarcerated and variations in the marriage-mental health relationship by race/ethnicity and gender.

    Graham Scambler is Professor of Medical Sociology in the Research of Infection and Population Health, at University College London, UK. He is a member of the standing committee of the International Consortium for Research and Action Against Health-Related Stigma. His current research interests include comparative study of stigma as a barrier to health interventions with sex workers; sexual trafficking; the impact of biological, psychological and social mechanisms on epilepsy-related quality of life; class and health inequality; the differential prestige attaching to medical diagnoses; and patient education and empowerment. His books include Coping with Chronic Illness and Disease (London: Routledge) and Sociology as Applied to Medicine (London: Saunders).

    Scott Schieman is Professor of Sociology at the University of Toronto, Canada. He is also the editor of Sociology of Religion and deputy editor at Society and Mental Health. His research interests focus on the personal and social conditions that influence stress processes and health. Recent projects deal with substantive areas in religion, work and the work-family interface. He recently received a grant award from the Canadian Institutes of Health Research to conduct a national survey of work, family, stress and well-being in Canada. He is also writing a book that investigates beliefs about God's involvement and causal influence in everyday life.

    Mark Schmitz is Associate Professor in the School of Social Work in the College of Health Professions and Social Work at Temple University, USA. He has a PhD in sociology and primarily teaches research methods and statistics. His research interest has emphasized the evaluation of methods for diagnosing mental disorder, primarily through examining the validity of the diagnostic criteria for major depressive disorder used in the DSM. Studies of the bereavement exclusion for MDD and the clinical significance criterion have been recently published. His further work includes the examination of episode duration as a diagnostic criterion for MDD and a comparison of DSM-III-R and DSM-IV criteria for distinguishing depressive disorder from normal sadness episodes.

    Andrew Scull is Distinguished Professor of Sociology and Science Studies at the University of California, San Diego, USA. Educated at Balliol College, Oxford and at Princeton, he has held faculty positions at the University of Pennsylvania, Princeton and UCSD. He has written extensively on the history of psychiatry in Britain and North America. His books include Decarceration (1977, 1984), Museums of Madness (1979), Social Order/Mental Disorder (1989), The Asylum as Utopia (1991), The Most Solitary of Afflictions (1993), Masters of Bedlam (1996), Undertaker of the Mind (2001), Customers and Patrons of the Mad Trade (2003), Madhouse (2005), The Insanity of Place/The Place of Insanity (2007) and Hysteria (2009). He has held fellowships from the American Council of Learned Societies and the Guggenheim Foundation, and is a past president of the Society for the Social History of Medicine.

    Jenny Secker is Professor of Mental Health at Anglia Ruskin University, UK and the South Essex Partnership University NHS Foundation Trust, UK. She trained in Edinburgh, first as a mental health nurse and later as a social worker. After completing her PhD in the Department of Social Work and Social Policy at Edinburgh University, she worked as a researcher in a number of academic and practice organizations. Her main research interests are in the area of mental health and social inclusion. Her study of arts participation, Mental Health, Social Inclusion and Arts: Developing the Evidence Base, was awarded the Royal Society of Public Health 2009 Arts and Health Award for Arts and Mental Health Research. She has also published widely on employment and mental health, including New Thinking about Mental Health and Employment (Radcliffe, 2005, with Bob Grove and Patience Seebohm).

    Philip Thomas is British psychiatrist and currently an Honorary Visiting Professor in the University of Bradford, UK and a Non Executive Director of Mersey Care NHS Trust. His interests include philosophy (post-structuralism and critical theory) and their application to psychiatry, psychology and medicine. He served as a Professor of Philosophy, Diversity and Mental Health in the University of Central Lancashire until May 2009, and is a founder member and co-chair of the Critical Psychiatry Network. He has published over 100 scholarly papers mostly in peer reviewed journals, and authored or co-authored three books including The Dialectics of Schizophrenia (Free Associations Books, 1997) and Postpsychiatry: Mental Health in a Postmodern World (with Pat Bracken, 2005, Oxford University Press, 2005).

    Jane Ussher is Professor of Women's Health Psychology, and leader of the Gender Culture and Health Research Unit: PsyHealth, at the University of Western Sydney, Australia. She has published widely on the subject of the material-discursive construction and experience of health, in particular associated with women's mental health, the reproductive body and sexuality. She is editor of the Routledge Women and Psychology book series. She is author of a number of books, including The Psychology of the Female Body (Routledge, 1989), Women's Madness: Misogyny or Mental Illness? (Harvester Wheatsheaf, 1991), Fantasies of Femininity: Reframing the Boundaries of Sex (Penguin, 1997), Managing the Monstrous Feminine: Regulating the Reproductive Body (Routledge, 2006) and The Madness of Women: Myths and Experience (Routledge 2011). Her current research focuses on sexual and reproductive health, with particular emphasis on premenstrual experiences, sexuality and cancer, and gendered issues in caring.

    Jerome Wakefield is University Professor, Professor of Social Work and Professor of Psychiatry and Affiliate Faculty in Bioethics, in the Center for Ancient Studies, and in InSPIRES (Institute for Social and Psychiatric Initiatives – Research, Education and Services), at New York University, USA. He holds two doctorates, in Social Work and Philosophy, both from University of California at Berkeley, and has previously held faculty positions at University of Chicago, Columbia University, and Rutgers University. He writes primarily on the conceptual foundations of the mental health professions, especially the concept of mental disorder and the validity of psychiatric diagnostic criteria in distinguishing disorder from normal forms of suffering, with over 170 scholarly and publicintellectual publications. He is co-author with Allan Horwitz of The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder (Oxford, 2007), named the best psychology book of 2007 by the Association of Professional and Scholarly Publishers.


    We are grateful to all the contributors of this Handbook and hope that its readers find the chapters useful, informative and stimulating. Although not an exhaustive list of topics are covered (our field of interest is very broad and virtually unending), enough are available in the following pages to mirror much of the way in which mental health and mental disorder are currently explored in the Anglophone academy by and for social science. The book could be considered in its entirety as a fair sample of the work being done in the field indicated by its title or it could be used as a reference book by students of mental health and mental disorder with a particular interest.

    Our choice of topics has been broadly divided into one section on mental health in its social context and another in which clinical and mental health policy matters are addressed more pointedly. This division is somewhat arbitrary and the allocation of a chapter in this or the other part of the book might be open to fair challenge. However, the partition is offered as a way of signalling the distinction between the general and the particular even if the two need to, or can, always be considered fruitfully in relation to one another. The two parts are merely the first of a few signposts for the reader picking up the book for the first time, which could have seemed a large picture to comprehend, if we had merely listed one chapter after another.

    Each of the two parts will contain their own introduction to note the key points of each chapter and at times to offer our own commentary on points of contact or contrast between the contributions. As editors, we have made no demands on any of the contributors to write in this or that way about the topic they address. Our role has merely been one of feedback and trimming rather than academic guidance, as they are all experienced specialists in their field. In other words, when commissioning the chapters at the outset, our concern was to have a series of topics represented in the book and we turned to those we trusted to write well about the one allocated to them. We hope that the reader is rewarded by our policy of trust in the writers. Finally, we have taken the editors’ privilege of supplying our own contributions at points in the book (with some help from friendly colleagues) and so that policy of trust also extends to ourselves.


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