It may seem reckless for someone with no direct training or clinical experience in psychiatry, psychopathology, or abnormal psychology to embark on a project which critically confronts much of the dominant thinking in those very areas. But the situation is hardly new. Sociologists have made significant contributions to the conceptual, empirical, and policy-oriented problems within mental health research, and it was developments in feminist theory, deviance studies, and symbolic interactionism, broadly conceived, that defined the sociological legacy in the area primarily in terms of external critique and reform advocacy. However, in the 1960s and '70s, when more explicit lines were being drawn within debates about psychiatric diagnosis, stigma, and institutionalization, it was often those in the psychological sciences and in mental health work who themselves became most noticeable in their opposition to developments within their own fields. This volume reflects contemporary developments in both of these realms of inquiry.

It is my sense that there is a renewed and widespread desire to explore and question established positivist approaches to mental disorder and its contemporary expositions. This claim might seem questionable when considering the recent influx of psychopharmacology and other technologies that are, in some sense, attempting to ‘conquer inner space,’ as Jackie Orr discusses in her chapter here. However, despite these developments – and perhaps, ironically, in part because of them – an implicit part of the old critiques is haunting many of those currently invested in the field of mental health, whether they be therapists, researchers, activists, or, frequently now, patients – namely that mental illness, in addition to whatever else it may be, is a problem of knowledge. Put simply, it is now more often assumed or suspected that we can no longer simply describe what is ‘out there’ in terms of the ‘problem of mental illness,’ nor what is ‘in there’ with respect to ‘aberrant’ subjectivities and behaviors, without considering epistemological issues. Therefore, the recent expansion of the biomedical revolution has, partly through its own force alone, placed matters of context and legitimacy at the center of scientific claims. Whether ‘for’ or ‘against’ psychiatry (and unqualified, immutable positions seem harder to assume), the problem of knowledge obligates us to consider on what basis we make claims to truth, with what authority, and with what consequences. It also requires a new critical reflexivity about the ‘truth’ of our own suffering. Now often radically invested in our own mental states, we cannot escape the unsettling [Page xii]question of how far the discourses of disorder practically extend. In hyper-mediated and increasingly medicalized social worlds, can we even trust our own pain?

New historical, epistemological, and, indeed, bodily struggles, of course, require new accountings of the empirical conditions that seem to be behind them. While sections of the book locate institutional changes and track shifts in expert knowledges, many of the chapters present explicit or implicit strategies for change – in theory, method, and research. Some of the authors also address potential ways to reconfigure persons as historical subjects within the changes we are only beginning to understand. Beyond theoretical debates about the status of ‘the subject,’ the concern here is about working toward more creative and critical engagements with an environment characterized by expanding and increasingly refined systems of psychotherapeutic expertise, ongoing reconstruction of the boundaries of the pathological (and therefore the ‘normal’), and more stark, often market-driven, efforts to codify and colonize the intrapsychic realm – all movements with durable histories that now forge on, relatively unimpeded. But again, this book is a product of its time: an era that affords the opportunity to realize the full significance and possibility that comes with aggressively positioning the knowledges that were once virtually positionless within the guise of an innocuous, free-floating objectivity that guaranteed relative immunity from both ‘internal’ or ‘external’ inquests. The only certainty, of course, is that this is a portentous moment, and it requires new and sometimes unpopular commitments.

I would like to thank the many people who offered assistance and encouragement throughout the duration of this project. The editorial staff at Sage, London, have my sincere appreciation for their efforts and flexibility throughout. Ziyad Marar provided early encouragement at the proposal stage, and was chiefly responsible for giving this project a chance. I can imagine no better publishing editor than Naomi Meredith, whose practical help and patience made the process a smooth one for me, a first-time editor with lots of questions. I would also like to thank Rosemary Campbell and Kate Scott for their help in the latter stages of the manuscript preparation, and to Lucy Robinson, my first contact with Sage, for her editorial assistance as well.

In preparing the manuscript, my assistant Christy E. Gell provided invaluable assistance with proofreading, but her insights also helped me to consider larger editorial and conceptual issues about the project as a whole. The assistantship was partially funded by a small grant from the Faculty Professional Development Fund at Middlebury College. More generally, the College quickly provided the support and facilities necessary to finish the project during my recent move to Vermont.

I would like to acknowledge the influence of David D. Franks, Thomas J. Scheff, Jackie Orr, and, more recently, Gerald C. Davison, for his comments on the Introduction and for his overall encouragement. Thank you to Houghton Mifflin for permission to reproduce extracts from Prozac Nation.[Page xiii]Kenneth J. Gergen has been an intellectual inspiration, and his support helped the book to find this fortunate place in the Inquiries in Social Construction Series. I would also like to thank students in my ‘sociology of mental illness’ courses over the past several years who have pushed my thinking and helped me to originally formulate this project. My friends at Vassar, Andrew Davison and William Hoynes, offered regular incentives and motivation, as did my family. My greatest appreciation goes to Eve H. Davison for her uncompromising assurance and loving support, to which I am continually indebted. Finally, I would like to express my appreciation to the authors themselves for their creative efforts, but also for their patience and conscientiousness throughout the course of the project.