David Pilgrim - Key Concepts in Mental Health (SAGE Key Concepts series)

Fourth Edition

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David Pilgrim 2017

First edition published 2005. Reprinted 2006, 2007 and 2008

Second edition published 2009. Reprinted 2010, 2011 and 2012

Third edition published 2014. Reprinted 2014 and 2015

This 4th edition first published 2017

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Library of Congress Control Number: 2016946487

British Library Cataloguing in Publication data

A catalogue record for this book is available from the British Library

ISBN 978-1-4739-7300-8

ISBN 978-1-4739-7301-5 (pbk)

Editor: Becky Taylor

Assistant editor: Charlne Burin

Production editor: Katie Forsythe

Indexer: Elske Janssen

Marketing manager: Tamara Navaratnam

Cover design: Wendy Scott

Typeset by: C&M Digitals (P) Ltd, Chennai, India

Printed in the UK

I am grateful for the opportunity to update this book. The feedback from colleagues at Sage about the strengths and weaknesses of the previous edition has been very helpful. New entries have been added in light of that feedback and adjustments have been made to some others in light of recent changes relevant to the subject outlined.

I want to repeat acknowledgments from earlier editions. I am particularly grateful to Anne Rogers for working with me since 1993 on editions of A Sociology of Mental Health and Illness, which has informed many entries here. I have also been helped in my editing task by conversations in recent years with Richard Bentall, Roy Bhaskar, Mary Boyle, Pat Bracken, Tim Carey, Jacqui Dillon, Chris Dowrick, Bill Fulford, John Hall, Dave Harper, Lucy Johnstone, Peter Kinderman, Eleanor Longden, Ann McCranie, Nick Manning, Joanna Moncrieff, Nimisha Patel, John Read, Helen Spandler, Nigel Thomas, Phil Thomas, Floris Tomasini and Ivo Vassilev. In the preface to the first edition of this book, I acknowledged an even longer list of helpers, who remain important here. As with the previous editions, any errors of omission or commission, which might be spotted in the coming pages by the reader, are my responsibility alone.

David Pilgrim

Definition

Mental health is used positively to indicate a state of psychological wellbeing, negatively to indicate its opposite (as in mental health problems) or euphemistically to indicate facilities used by, or imposed upon, people with mental health problems (as in mental health services).

• Three different uses of the phrase mental health are examined.
• Reasons for the use of mental health in preference to other terms, such as mental illness, are discussed.

Alternative connotations of the term mental health indicated in the above opening definition will be discussed below, in relation to positive mental health, mental health services and mental health problems.

• Mental health as a positive state of psychological wellbeing A sense of wellbeing is considered to be part of health according to the World Health Organization (WHO), which in 1951 described it as: the capacity of the individual to form harmonious relations with others and to participate in, or contribute constructively to, changes in his social or physical environment (WHO, 1951: 4). This has been built on over time (see entry on spiritual gift or a mental illness? Posing these sorts of questions highlights the impermanent dividing line between mental health and mental abnormality.
• Mental health as a prefix to describe one part of health services Since the Second World War, the term mental health services has now replaced that of psychiatric services (although the latter is still sometimes used). Prior to the Second World War, there were hospitals, clinics and asylums. These were either under parochial control, with a voluntary or charitable history, or they served a specialist regional or national function. At that time, though, they were not called services. As Webster (1988) notes, prior to the NHS in Britain, there was an admixture of charitable hospitals and medical relief offered to those in the workhouse system. This is why many of the older general hospitals were adapted poorhouse buildings. However, a major exception to this mixed picture was the network of dedicated mental illness and mental handicap hospitals which, since the Victorian period, had been funded and run by the state (Scull, 1979). The notion of a health service, post-1948, when the NHS was founded, reflects a shift towards a coherent system of organisation and a notion of a publicly available resource (at the service of the general population). Currently in Britain, most specialist mental health services are within the NHS. In addition, there are privately run mental health facilities. These vary from small nursing homes to large hospitals which receive NHS patients who cannot be accommodated by local NHS mental health services. With devolution in the UK, specific policies about mental health service organisation now vary from one country to another (Department of Health, 1998, 1999; Scottish Office, 1997; Welsh Assembly Government, 2002).