The largest sociological fields related to sociotherapy are the sociology of health and medical sociology. However, these fields primarily focus on informing policy and certain practices followed by physicians and psychiatrists, yet the connection to actual practice is indirect, since sociology is not the main focus of physicians’ or psychiatrists’ training or thinking.
There are several different theoretical frameworks that examine mental health: social constructivism, social realism, hermeneutics (including critical theory and Freudo, Marxists), and social causation (Roger & Pilgrim, 2014). Several factors have been identified as influencing mental health within this field of research: a sense of coherence, integration, and norm, breaking; social support; position of power; network position; resources and capital; use of medication; the models used to understand people by key professionals such as doctors and psychiatrists; life events ranging from trauma to “daily hassles”; inequality; poverty, modernity, cultural values and their relationship to other factors, education and learning in society, genes, views on the body, the economic system, the welfare model, the level of corruption and trust in a society, the degree of citizenship, the development of various capabilities, generational differences, age, identity, work, stress, self, esteem, coping strategies, etc. (Aneshensel, Phelan, Beirman, 2013; Rogers, 2014; Antonovsky, 1987; Thoits, 2010; Thoits & Hewitt, 2001; Offer, 2020; Bradby, 2012; Turner, 1995, 2008).
A sense of coherence is influenced by social and cultural integration and how it is structured within the specific culture for the specific individual with that life story. Research on social integration traces back to Durkheim’s study on suicide and anomie (Horwitz, 2012). Social integration enables the social regulation of individuals. This creates greater emotional security for the individual. The more diverse the groups with which an individual is connected through frequent contact, and with which they simultaneously identify, the higher their level of mental health (Haslam et al., 2016; Thoits & Hewitt, 2001). For example, “difficult relationships” can lead to “social negativity” (Offer, 2020). Offer demonstrates that social roles can create conflicts and overload (Offer, 2020). More socially integrated individuals generally have access to a wider variety of resources to cope with adversity that may arise and experience positive experiences more frequently. Communities with greater social integration also support mental health. The opposite includes alienation, anomie, and atomism, for example.
Genes are something that some sociologists have been highly reluctant to include in sociological analysis because social and cultural factors influence the brain so significantly due to its plasticity, making it possible to neglect genes in the analysis. Proponents of the new field of neurosociology argue that this leads to a significant lack of understanding of human behavior (Franks & Turner, 2013). Nikolas Rose, who has played a central role in sociology’s analysis of psychology, argues that genes likely play some role, but that they must be part of a broader research program in which social and cultural factors are genuinely and sophisticatedly taken into account (Rose, 2019).
Stress has a major impact, accounting for as much as 25, 40% of the variation in mental health and depressive symptoms, and the ways in which different groups are exposed to stress can largely explain the differences between these groups (Thoits, 2010).
Medical sociology has studied what it is like to be a patient and to encounter various types of care (Anashensel, 2013). Encounters with experts and professionals are viewed through a clinical lens, a mix of goodwill and self, interest, and involve discussions about the extent to which professionals act in their own interests and how much they are influenced by the economic system, etc. (Hallerstedt, 2006). The experience of receiving and having a diagnosis has been analyzed in terms of the power that psychiatrists wield; however, the diagnosis can simultaneously serve as a source of power for patients and strengthen their bargaining position when seeking assistance with insurance matters (Hallerstedt, 2006). In this way, diagnoses can become institutionalized and indispensable to all parties involved (Hallerstedt, 2006). Biologically based psychiatric diagnoses have destigmatized mental health issues and illness, yet for many, they can also become a label that is self, perpetuating through what is known as “secondary deviance”, a process in which the psychiatrist confirms that the individual fits the diagnosis, often leading to passivity (Scheff, 1999). At the same time, some sociologists are careful to point out that something genuine is happening in the body and that psychiatric diagnoses are not merely a myth or a construct disconnected from the body, designed to establish social control and enhance the prestige of the psychiatric profession (Scull, 2022).
For some, the number of diagnoses can increase, becoming something that exacerbates their difficulties rather than helping them. There is awareness of the problems associated with overdiagnosis, so a common practice among psychologists in Sweden is to focus on a few diagnoses and not disclose every diagnosis they believe they could assign to the person.
The body was “discovered in the 1980s” in sociology by sociologists who began to analyze the body as part of the social realm rather than simply taking it for granted (Bradby, 2012, 98). The body is a cultural object in many different ways (Turner, 1995). One way the body is treated is through the hegemonic medical model, which is applied to various parts of the body, making the body dependent on this way of understanding it. Turner argues that modern societies are “somatic”; the body has become the central arena for politics and cultural activity (Turner, 1992, in Bradby, 2012, 102). Rather than a transformation of culture, societal development involves a transformation of the body in order to manage society (Turner, 1992). The body becomes central to “governance,” a concept that Foucault and sociologists in that tradition have termed “biopolitics” (Rose, 2007). Rose (2007) argues that biopolitics and “biosocialities” should not be viewed solely as negative and oppressive; rather, there may be new positive developments such as gene therapies and other interventions in the body, as well as contraceptives (most recently, male contraceptives yielded such promising results that the study was terminated early). There are also risks that should be taken into account; for example, what would happen if pre, symptomatic diagnosis were applied to psychiatric diagnoses, which, under the current psychiatric system, could create problems for, say, a child who receives an early pre, diagnosis (Rose, 2019). Illich was an early advocate of the view that the structure of medicine has significant iatrogenic effects, that is, unforeseen negative consequences of interventions that are social, clinical, and cultural (Illich, 1977). Iatrogenesis involves the creation of more vulnerable individuals who lose trust in themselves and their community and become dependent on experts “from the cradle to the grave” (Illich, 1975; Alvesson, 2019; Furedi, 2004, 2019).
Inequality, oppression, and discrimination also appear to affect people’s mental well, being. This inequality is linked to power dynamics and economic conditions in society and, for example, in the workplace. Higher levels of inequality generally have a negative impact on a society, with the positive effect diminishing as equality increases. Those with higher social status generally have better mental health. Young, attractive, intelligent, wealthy, and articulate individuals tend to have better outcomes from therapy (Moloney, 2013, ; Link & Phelan, 1995; Phelan, Link & Tehranifar, 2010,). Research is ongoing regarding whether relative or absolute resources influence (Horwitz, 2012). There is some support for the idea that relative resources have an influence, based on correlation studies with certain limitations (Pickett & Wilkinson, 2010, 2015). Marxist theory posits that relations of production are central to the formation of consciousness in the individual (Marcuse, 1968; Fromm, 1993). Oppression (domination) leads to shame, internalization, and self, punishment, “internalized oppression, marks of oppression” (Foster, 1993), or a “negation of the self” (Fanon, 1963). Depression, for example, is linked to powerlessness, alienated wage labor, dependency, isolation, meaninglessness, and anomie (Mirowsky & Ross, 1989). Furthermore, there are various dimensions of inequality that have an impact; for example, the experience of love is more equal in modern societies than, say, economic dimensions, if one has more resources in a dimension such as love, economic inequality does not affect them as much (Turner, 2010). A lack of love and money can converge, for example, in the much, discussed group known as “incels” (involuntary celibates), who are often young men struggling with mental health issues. The impact of work on mental health is such that the more controlled and the less power you have, the more stressful it is, and the worse you feel as a result of your job (Reynolds & Buffel, 2020).
Boundless work may appear to offer greater flexibility and autonomy, but this comes with an increased degree of uncertainty about how much and when one should work and what is actually expected (Allvin et al., 2006). Social stratification also occurs along lines of, for example, ethnicity and gender. Women have a higher prevalence of various psychological disorders, such as burnout syndrome, depression, and anxiety. Minority stress is stress associated with being a minority in a society, caused by both poorer socioeconomic conditions and a lower degree of recognition, that is, a higher degree of misrecognition, as well as the need to perform better than the majority population in order to succeed in areas such as one’s career and the housing market (Andersson, Bengtsson & Myrberg, 2016). Network analyses of mental health can be understood as epidemics that are contagious and transmissible through networks, that is, a form of “contagion” (Smith & Christakis, 2008).
Cultural values also influence an individual’s mental health and can create challenges in various areas of life, such as work and romance, that the individual must navigate (Horwitz, 2012; Illouz, 2020). Cultural goals and ideals that are clear and attainable are preferable, since cultural goals that are unattainable lead to frustration and unhappiness. For example, the ideals of autonomy and recognition can create significant strain for dating couples, which can become even greater in a psychologized and individualized culture (Illouz, 2020). Some studies suggest that cultures with more collectivist values generally have better mental health, but there may be drawbacks in that excessive social integration can leave the individual feeling alienated and overwhelmed (Horwitz, 2012). Group cohesion, meaning, and purpose in life are central to cultural values having a positive effect on mental health (Horwitz, 2012). Integration with cultural values that are unrealistic will create problems; disidentification can create space for change where new cultural values can be introduced (Horwitz, 2012). Integration with cultural values that are difficult to attain can create heavy feelings of failure and frustration. At the same time, research suggests that social integration is never fully possible; there is always a certain tension that manifests within the individual, a “pre-sociality”, a point emphasized particularly by existential sociologists (Touraine, 1995). Sociologists have focused specifically on how “culture” acts as a mediating factor in how we cope with various stressors, where identity formation and views on human agency, strengths, and weaknesses play a role (e.g., Furedi, 2019). Paulsen, for example, incorporates the longue durée into his analysis of our well, being in modernity, where long, term trends such as an increase in counterfactual thinking, production requiring more planning, the rationalization of society, an increased emphasis on thinking, a decline in animism, i.e., a form of disenchantment with the world and nature specifically, an increased belief in control over everything, the advent of science, what appears to be a decline in the sense of meaningfulness the higher a country’s GDP is, new risks, and “risk territories” that are difficult for society to manage (Paulsen, 2020, 61, 62, 102, 120, 207).
A sociological focus on emotions has highlighted that patients may feel shame, which can lead them into a shame/anger spiral that makes it harder for them to engage in successful social interactions, a dynamic that can reinforce a negative spiral, in which the individual may employ defensive strategies as a way to protect themselves but which actually exacerbate the difficulties (Scheff, 1999, 2008; Collins, 2004; Summers, Effler, 2004). Self, confidence and self, esteem are factors that sociologists have incorporated into their research, though there is ongoing debate regarding the exact extent to which these factors influence outcomes (Strandell, 2017; Scheff, 2008; Collins, 2004).
Attempts have been made to incorporate various factors into a theoretical framework. Rogers and Pilgrims (2014) point to Albee’s model (1993), which posits that the prevalence of mental health issues is a result of stress, exploitation, and “organic factors,” balanced by social support, self, esteem, and coping strategies.
Education and school are also factors that influence mental health (Allelin, 2019; Persson, 2012; Hiltunen, 2017). In her dissertation, Hiltunen uses various studies to show how Swedish teenagers navigate the “tyranny of perfectionism” by striving to be “just right” in different dimensions: being happy, looking good by societal standards, having many strong friendships, succeeding in school, and possessing an interesting personality (Hiltunen, 2017). Independent variables in her model include social background, social relationships, and social status (2017, 126). Striving to be “just the right amount of perfect” places significant demands on students, who employ various coping strategies, both proactive and reactive. Physical activity, distancing, reflection through conversation, relaxation techniques, seeking help, preventive planning, and positive self, esteem. Hiltunen argues that these students can use these strategies to mitigate the effects of being unable to live up to the expectation of being “just perfect.” Hiltunen’s study shows how deeply high school life can be permeated by a strong status consciousness that revolves around a micro, struggle over social status.