Abstract
As with Chap. 6, this chapter starts with sociability as one of the six ontological features of the human condition, identified in Chap. 2, via The Ontology of Well-Being Thesis (TOWT), and defended throughout the book. The argument here maintains an important sociological distinction between the social causation and the social construction of mental health/illness. The socially causation of mental health, focuses on its social epidemiology, so on what kind of social determinants lead to or produce mental health/illness. Whereas the social construction of mental health/illness focuses on how notions of illness, health and care are ‘given meaning’ within and between societies, so on those social determinants that socially define certain people as mentally ill, which, in turn, affects how this group is publicly viewed and treated. Drawing from this sociological distinction, the main claim here is that promoting mental health must accommodate the six ontological features of the human condition identified in Chap. 2, and in TOWT – these features being, in no prioritised order, human embodiment, finiteness, sociability, cognition, evaluation, and agency. Therefore, when exploring the social causation and social construction of mental health/illness, any epistemological and normative implications for people diagnosed as mentally ill must, in some way, reflect these ontological features. For example, the claim here is that a person who is socially constructed as ‘mentally ill’ should also be viewed publicly as someone who can exercise agency, cognition, and evaluation. That is, with these features underpinning a non-determinist epistemological and normative account of mental health/illness and well-being. The further argument is that this account should be central to the co-productive development of mental health policies and practices (notably concerning the practice of social prescription), so opening-up new ways for viewing and treating those people who are socially constructed as ‘mentally ill’.
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Notes
- 1.
Berger and Luckmann (1967) were the first to use the term ‘social construction’. However, their central treatise concerning the sociology of knowledge and how public or shared meaning is socially created is also traceable to the other primary sources referenced here, and more besides.
- 2.
As explored in Chap. 2, these lists do not imply that emotions are entirely caused by these biological and physical characteristics. Merely that aspects of our emotional responses are caused by these characteristics, reflecting human embodiment. Precisely how our physical bodies and experiences are interpreted and viewed as members of social groups is highly debated, particularly within the social constructionist literature (see, for example, Rabinow 1984; Lechte 1994; Joseph 2003; MacKenzie 2004; Lloyd 2004).
- 3.
This raises very difficult questions about the meaning of ‘transcendence’. So, following the arguments in this chapter (and in Chap. 2 and TOWT) none of the six ontological features of the human condition, arise entirely independently of social context. Nevertheless, insofar as these ontological features of the human condition are universal (and therefore are ontological qualities which are shared across time and between cultures), they also transcend social context. Once this, admittedly controversial move is made, we can accommodate the social constructionist account of mental health, but without reducing explanations about human behaviour and experience to the social construction of language and discourse solely. Accommodating a ‘non-reductionist’ understanding of social constructionism can also be found in Smith (2011, pp. 107–132), and in Chap. 6 here, which explore how different interpretations of the social model of disability can be understood via this ‘non-reductionist’ understanding of social constructionism.
- 4.
- 5.
For example, Alan Gewirth, in his 1998 book Self-fulfillment, regards ‘mental equilibrium’ as a constituent of ‘basic well-being’, as he calls it (alongside life and health), and so is a precondition of what he defines as the purposes of successful actions: “The fullest development of basic well-being requires that there be adequate protections of life, health, mental equilibrium, and other preconditions of successful action. The purposes of action must provide, at least implicitly, for these preconditions” (Gewirth 1998, p. 121). The point here is that notions of ‘mental equilibrium’ are themselves socially constructed, which is a point often missed in these philosophical discussions (and see Smith 2001a, b).
- 6.
Also see Chaps. 4 and 6, where the ontological condition of sociability is explored as related to disability issues. Two broad interpretations of the social model of disability were found within the Disability Rights Movement’s (DRM’s) position. One interpretation – the Politics of Disablement (POD) – stresses the above kind of epistemology regarding what we know about disability. So, POD focusses on the social causation of disablement reflecting disabled people’s lack of access to social resources. Whereas, the Social Construction of Disablement (SCOD) interpretation of the social model, focusses on how disability is normatively defined or ‘given meaning’ which can often undermine the value of disabled people’s identities, related to their ‘impairments’ which are socially constructed wholly negatively by the medical model of disability as, ‘abnormal’, ‘dysfunctional’, ‘deficient’, and so on.
- 7.
For a discussion concerning ‘future selves’ and the promotion of well-being over a whole life see Chap. 3. One of the main claims defended is that interpersonal comparisons of well-being are notoriously problematic as the levels and quality of well-being is often hard to meaningfully measure between persons. Moreover, Chap. 3 also explores how these problems occur with intrapersonal comparisons of wellbeing if plural identities occur over time for one person (which, for many commentators, they often do). These latter problems have important implications for social policy debates about well-being enhancement across time and between generations, for example, as related to pensions policy.
- 8.
It could be argued that evaluation is a form of cognition, insofar as evaluation is a mental process culminating in a normative judgement in the ways just described. However, the contention here, in Chap. 2 and in TOWT, is that evaluation has such a significant effect on well-being – concerning how a person evaluates her own life – that it should be treated separately to this person’s more general capacity for cognition, that may, or may not, include evaluation.
- 9.
According to Jason Raibley, when understanding how life is defined as ‘meaningful’ various factors come into play, including the admiration and inspiration of others (Raibley 2016, p. 351). Moreover, for Raibley, when considering how fulfilling values relate to well-being, it is important to assess, not only the degree to which an individual agent is suited to and engaged with these values. But also, the degree to which this person’s valued projects reflects a balanced and coherent understanding of her life led as a whole. The point here is that this ‘holistic coherency’, as it might be called, cannot be achieved without also acknowledging the deeply socialised contexts in which the values themselves are formed and implemented.
- 10.
In contrast, biological and/or social determinists argue that human beings exercise little, or no agency as human lives are shaped or ‘determined’ by their natural and/or nurtured environments (for a recent defence of this view see Miles 2015). Agency is also debated extensively within the social constructionist literature explored here. The central question is, whether or the extent to which human beings can exercise agency, given the influence of public discourse and language in shaping how we view and experience our lives (for example, see Rabinow 1984; Mackenzie 2004).
- 11.
And see Kavedžija (2021) for a more general account of how the process of care to enhance well-being involves engaging in mutual acts of conviviality, care, and creativity. Also see Chap. 6 for an exploration of how the promotion of co-production in these ways can be conducive to the positive development of disability policy and practice.
- 12.
References
Angner, Erik. 2011. The evolution of eupathics: The historical roots of subjective measures of well-being. International Journal of Well-Being 1: 4–41.
Ball, Carolyn. 2009. What is transparency? Public Integrity 11: 293–308.
Begum, Nasa. 1996. General practiti1rs’ role in shaping disabled women’s lives. In Exploring the divide, ed. Colin Barnes and Geoff Mercer, 157–172. Leeds: The Disability Press.
Berger, Peter, and Thomas Luckmann. 1967. The social construction of reality: A treatise on the sociology of knowledge. New York: Anchor Books.
Bickerdie, L., A. Boot, P.M. Wilson, K. Farley, and K. Wright. 2016. Social prescribing: Less rhetoric and more reality. A systematic review of the evidence. British Medical Journal Open 7: 1–17. https://doi.org/10.1136/bmjopen-2016-013384.
Blakemore, Ken. 2003. Social policy: An introduction. 2nd ed. Milton Keynes: Open University Press.
Bonfils, I.S., and O.P. Askheim. 2014. Empowerment and personal assistance – Resistance, consumer choice, partnership or discipline? Scandinavian Journal of Disability Research 16: 62–78. https://doi.org/10.1080/15017419.2014.895414.
Bovaird, T. 2007. Beyond engagement and participation: User and community coproduction of public services. Public Administration Review: 846–860. https://doi.org/10.1111/j.1540-6210.2007.00773.
Boylan, Michael. 2014. Natural human rights: A theory. Cambridge: Cambridge University Press.
Boyle, David, and Michael Harris. 2009. The challenge of co-production: How equal partnerships between professionals and the public are crucial to improving public services. London: Nesta and New Economics Foundation.
Braddon-Mitchell, David, and Carolyn West. 2001. Temporal phase pluralism. Philosophy and Phenomenological Research 62: 59–83.
Brink, David O. 2003. Prudence and authenticity: Intrapersonal conflicts and values. The Philosophical Review 112: 215–245.
Burr, Vivien. 2003. Social constructionism. 2nd ed. Sussex: Routledge.
Busfield, Joan. 2008. Mental illness as social product or social construct: A contradiction in feminists’ arguments? Sociology of Health and Illness 10: 521–542.
Clarke, John, and Alan Cochrane. 1998. The social construction of social problems. In Embodying the social: Constructions of difference, ed. Esther Saraga, 3–42. London: Routledge.
Clayton, Matthew, and Andrew Williams, eds. 2004. Social justice. Oxford: Blackwells.
Clifton, Andrew, Julie Repper, Debbie Banks, and Jen Remnant. 2013. Co-producing social inclusion: The structure/agency conundrum. Journal of Psychiatric and Mental Health Nursing 20: 514–524.
Daniels, Norman, and James Sabin. 1998. The ethics of accountability in managed care reform. Health Affairs 17: 1–15.
Davies, Julie, Mark Sampson, Frank Beesley, Debra Smith, and Victoria Baldwin. 2014. An evaluation of knowledge and understanding framework personality disorder awareness training: Can a co-production model be effective in a local NHS mental health trust? Personality and Mental Health 8: 161–168.
Diener, Ed, and Robert Biswas-Diener. 2008. Happiness: Unlocking the mysteries of psychological wealth. Oxford: Blackwell.
Drury, John, Tom Healing, Richard Williams, Catherine Haslam, and Verity Kemp. 2019. Agency as a source of recovery and creativity. In Social scaffolding: Applying the lessons of contemporary social science to health and healthcare, ed. Richard Williams, Verity Kemp, Alexander S. Haslam, Kamaldeep S. Bhui, and Sue Bailey, 205–212. Cambridge: Cambridge University Press.
Durkheim, Emile. 2006 – originally published in 1897. On suicide. London: Penguin Classics.
Elder-Woodward, James. 2014. Living well vs neo-liberal social welfare. Ethics and Social Welfare 8: 306–313.
Elliot, Megan, David Pontin, Steven R. Smith, and Carolyn Wallace. 2022. Conceptualising social wellbeing using an international Group Concept Mapping study. International Journal of Well-Being 12: 1–15.
Foucault, Michel. 1954. Mental illness and psychology. Paris: Presses Universitaires.
———. 1989. Madness and civilisation: A history of insanity in the age of reason. London: Routledge.
———. 2001. The order of things. London: Routledge.
Fricker, Miranda. 2007. Epistemic injustice: Power and the ethics of knowing. New York: Oxford University Press.
Gergen, Kenneth J. 2011. Relational being: Beyond self and community. Oxford: Oxford University Press.
Gergen, Mary, and Kenneth J. Gergen. 2003. Social construction: A reader. London: Sage Publications.
Gewirth, Alan. 1981. The basis and content of human rights. Nomos 23: 119–147.
———. 1986. Why rights are indispensable. Mind 95: 329–344.
———. 1988. Rights and duties. Mind 97: 441–445.
———. 1998. Self-fulfillment. Princeton: Princeton University Press.
———. 2001. Are all rights positive? Philosophy and Public Affairs 30: 321–333.
Godlee, F. 2013. Editor’s choice. Promises of transparency? Hold the applause. BMJ. https://www.jstor.org/stable/23494191
Griffin, James. 1988. Well-being: Its meaning, measurement, and moral importance. Oxford: Oxford University Press.
———. 2008. On human rights. Oxford: Oxford University Press.
Harrison, Stephen, and George Dowswell. 2002. Autonomy and bureaucratic accountability in primary care: What English practitioners say. Sociology of Health and Illness 24: 208–226.
Haslam, Catherine, and S. Alexander Haslam. 2019. Social sciences and health: A framework for building and strengthening social connectedness. In Social scaffolding: Applying the lessons of contemporary social science to health and healthcare, ed. Richard Williams, S. Verity Kemp, Alexander Haslam, Kamaldeep S. Bhui, and Sue Bailey, 23–30. Cambridge: Cambridge University Press.
Haslam, S. Alexander, Jolanda Jetten, and Catherine Haslam. 2019. The social identity approach to health. In Social scaffolding: Applying the lessons of contemporary social science to health and healthcare, ed. Richard Williams, S. Verity Kemp, Alexander Haslam, Kamaldeep S. Bhui, and Sue Bailey, 31–39. Cambridge: Cambridge University Press.
Haybron, Daniel M. 2008. The pursuit of unhappiness: The elusive psychology of well-being. Oxford: Oxford University Press.
Ho, Anita. 2011. Trusting experts and epistemic humility in disability. International Journal of Feminist Approaches to Bioethics 4: 102–123.
Heidegger, Martin. 1996 – originally published 1927. Being and time. New York: State University of New York Press.
Horwitz, Alan. 2012. Social constructions of mental illness. In The Oxford handbook of philosophy of social science, ed. Harold Kincaid, 559–578. Oxford: Oxford University Press.
Hunt, J. (Secretary of State for Health 2014) Speech 19th November 2014. Transparent and accountable healthcare: Why the culture in the NHS still needs to change. https://www.gov.uk/governmentspeeches/transparent-and-accountable-healthcare
Husk, Keryn, Kelly Blockley, Rebecca Lovell, Allison Bethel, Dan Bloomfield, Sara Warber, Mark Pearson, Iain Lang, Richard Byng, and Ruth Garside. 2016. What approaches to social prescribing work, for whom, and in what circumstances? A protocol for a realist review. Systematic Reviews. https://doi.org/10.1186/s13643-016-0269-6.
Joseph, Jonathan. 2003. Social theory: Conflict, cohesion and consent. Edinburgh: Edinburgh University Press.
Kagan, Shelly. 1986. The present-aim theory of rationality. Ethics 6: 746–759.
Kavedžija, Iza. 2021. The process of wellbeing: Conviviality, care, creativity. Cambridge: Cambridge University Press.
Kittay, Eva Feder. 1999. Love’s labor: Essays on women, equality, and dependency. New York: Routledge.
Klussman, Kristine, Austin Lee Nichols, Julia Langer, and Nicola Curtin. 2020. Connection and disconnection as predictors of mental health and wellbeing. International Journal of Well-Being 10: 89–100.
Kopf, Gereon. 2002. Temporality and personal identity. Philosophy East and West 52: 224–245.
Leadbetter, Charles. 2004. Personalisation through participation: A new script for public services. London: Demos.
Lechte, John. 1994. Fifty key contemporary thinkers: From structuralism to postmodernity. London: Routledge.
Levay, Charlotta, and Caroline Waks. 2009. Professions and the pursuit of transparency in healthcare: 2 cases of soft autonomy. Organization Studies 30: 509–527.
Lloyd, Moya. 2004. The body. In Contemporary social and political theory: An introduction, ed. Fidelma Ashe, James Martin, Alan Finlayson, Moya Lloyd, Iain Mackenzie, and Shane O’Neil, 111–130. Milton Keynes: Open University Press.
Lukes, Steven. 2005. Power: A radical view. 2nd ed. Basingstoke: Palgrave.
MacKenzie, Iain. 2004. Power. In Contemporary social and political theory: An introduction, ed. Fidelma Ashe, James Martin, Alan Finlayson, Moya Lloyd, Iain Mackenzie, and Shane O’Neil, 69–87. Milton Keynes: Open University Press.
MacKenzie, Catriona, and Natalie Stoljar, eds. 2000. Relational autonomy: Feminist perspectives on autonomy. New York: Oxford University Press.
Mankiewicz, Pawel D., David M. Gresswell, and Colin Turner. 2013. Subjective well-being in psychosis: Mediating effects of psychological distress on happiness levels amongst individuals diagnosed with paranoid schizophrenia. International Journal of Well-Being 3: 35–59.
Miles, James B. 2015. The free-will delusion: How we settled for the illusion of morality. Leicester: Matador.
Mill, John Stuart. 1991 – originally published 1859. On liberty and other essays. Oxford: Oxford University Press.
Morton, Liza, Marie Ferguson, and Frances Baty. 2015. Improving wellbeing and self-efficacy by social prescription. Public Health 129: 286–289.
Mruk, Christopher J. 2018. Feeling good by doing good: A guide to authentic self-esteem and well-being. Oxford: Oxford University Press.
Nagel, Thomas. 1991. Equality and partiality. New York: Oxford University Press.
NHS Digital. 2017. Supporting open data and transparency. https://digital.nhs.uk/supporting-opn-data-and-transparency. Accessed 11 Nov 2017.
NHS Wales. 2011. Together for health: A 5-year vision for the NHS in Wales. Cardiff: Welsh Government.
Nozick, Robert. 1974. Anarchy, state and utopia. Oxford: Blackwells.
Parfit, Derek. 1987. Reasons and persons. Oxford: Clarendon Press.
Persson, Ingmar. 1988. Rationality and maximization of satisfaction. Nous 22: 537–554.
Polley, Marie, James Fleming, Tim Anfilogoff, and Andrew Carpenter. 2017. Making sense of social prescribing. London: University of Westminster.
Rabinow, Paul, ed. 1984. The Foucault reader. New York: Pantheon Books.
Raffay, J., E. Wood, and A. Todd. 2016. Service user views of spiritual and pastoral care (chaplaincy) in NHS Mental Health Services: A co-produced constructivist grounded theory investigation. Bio-Med Central Psychiatry, published online, 1–11. https://doi.org/10.1186/s12888-016-0903-9.
Raibley, Jason. 2016. Atomism and holism in the theory of personal well-being. In The Routledge handbook of philosophy of well-being, ed. Guy Fletcher, 342–354. London: Routledge.
Rawls, John. 1973. A theory of justice. Oxford: Oxford University Press.
———. 2001. Justice as fairness: A restatement. Cambridge Mass: Harvard University Press.
Raz, Joseph. 1988. The morality of freedom. Oxford: Clarendon Press.
Russo, Jasna, and Peter Beresford. 2015. Between exclusion and colonisation: Seeking a place for mad people’s knowledge in academia. Disability & Society 30: 153–157.
Ryff, Carol D. 1989. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology 57: 1069–1108.
Ryff, Carol D., and Corey Lee M. Keyes. 1995. The structure of well-being revisited. Journal of Personality and Social Psychology 69: 719–727.
Saraga, Esther, ed. 1998. Embodying the social: Constructions of difference. London: Routledge.
Scanlon, Thomas M. 1998. What we owe to each other. Cambridge, MA: Harvard University Press.
Seligman, Martin. 2002. Authentic happiness: Using the new positive psychology to realize your potential for lasting fulfillment. New York: Free Press/Simon and Schuster.
Sen, Amartya. 1985. Well-being, agency and freedom: The Dewey lectures 1984 – Amartya Sen. The Journal of Philosophy 82: 169–221.
Shoemaker, David W. 1996. Theoretical persons and practical agents. Philosophy and Public Affairs 25: 318–332.
Shortell, Stephen, Rachael Addicott, Nicola Walsh, and Chris Ham. 2014. Accountable care organisations in the United States and England: Testing, evaluating and learning what works. London: The King’s Fund.
Slade, Mike, Lyndsay Oades, and Aaron Jarden, eds. 2017. Wellbeing, recovery and mental health. Cambridge: Cambridge University Press.
Smith, Steven R. 2001a. Distorted ideals: The ‘problems of dependency’ and the mythology of independent living. Social Theory and Practice 27: 579–598.
———. 2001b. The social construction of talent: A defence of justice as reciprocity. Journal of Political Philosophy 9: 19–37.
———. 2002. Defending justice as reciprocity: An essay on political philosophy and social policy. Lampeter: Edwin Mellen.
———. 2011. Equality and diversity: Value incommensurability and the politics of recognition. Bristol: Policy Press.
Sobel, David. 1994. Full information accounts of well-being. Ethics 104: 784–810.
Social Care Institute for Excellence (SCIE). 2013. Co-production in social care: What it is and how to do it? London: SCIE.
Spencer, Mike, Ruth Dineen, and Andrew Phillips. 2013. Tools for improvement 8 – Co-producing services: Co-creating health. Cardiff: NHS Wales 1000 Lives Improvement.
Stickly, Theodore, and Ada Hui. 2012. Social prescribing through arts on prescription in a UK city: Referrers’ perspective (part 2). Public Health 126: 580–586.
Sullivan, Michael. 2012. Social democracy, health inequalities and the welfare state. In Changing directions of the British welfare state, ed. Gideon Calder, Jeremy Gass, and Kirsten Merrill-Glover, 44–64. Cardiff: University of Wales Press.
Sumner, L.W. 1999. Welfare, happiness and ethics. Oxford: Clarendon Press.
Taylor, Charles. 1991. The ethics of authenticity. Cambridge, MA: Harvard University Press.
Taylor, David. 2011. Wellbeing and welfare: A psychosocial analysis of being well and doing well enough. Journal of Social Policy 40: 777–794.
Theiss, Jennifer A. 2018. Contemporary studies on relationships, health, and wellness. Cambridge: Cambridge University Press.
Thompson, Neil. 2018. Mental health and well-being: Alternatives to the medical model. London: Routledge.
Tiberius, Valerie. 2008. The reflective life: Living wisely with our limits. New York: Oxford University Press.
Voorberg, William H., Victor Bekkers, and Lars Tummers. 2015. A systematic review of co-creation and co-production: Embarking on the social innovation journey. Public Management Review 9: 1333–1357.
Walker, Michael T. 2006. The social construction of mental illness and its implications for the recovery model. International Journal of Psychosocial Rehabilitation 10: 71–87.
Wieners, Leonie, Llewellyn Ellardus Van Zyl, Mirjam Radstaak, and Marijke Schotanus-Dijkstra. 2021. To whom should I be kind? A randomized trial about kindness for strong and weak social ties on mental wellbeing and its specific mechanisms of change. International Journal of Well-Being 11: 1–23.
Williams, Richard, Verity Kemp, S. Alexander Haslam, Kamaldeep S. Bhui, and Sue Bailey, eds. 2019. Social scaffolding: Applying the lessons of contemporary social science to health and healthcare. Cambridge: Cambridge University Press.
Wilson, Paul, and Alison Booth. 2015. Evidence to inform the commissioning of social prescribing. York: Centre for Reviews and Dissemination, University of York.
Yeager, Diane M. 2008. The deliberate holding of unproven beliefs: Judgment post-critically considered. Political Science Reviewer 37: 96–121.
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Smith, S.R. (2023). Well-Being, Mental Illness, Co-Production and Social Prescription: Social Constructionism, Relational Integrity, and Agency. In: The Ontology of Well-Being in Social Policy and Welfare Practice . Library of Public Policy and Public Administration, vol 18. Springer, Cham. https://doi.org/10.1007/978-3-031-18142-9_7
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