Mental health and mental distress, like sex and gender, and impairment and disability, sit uncomfortably at the intersection between biology, personality and social experience. They represent a site at which power relations operate and a politics of difference may be enacted – ruthless processes of ‘othering’ which have the potential to permeate both one's social relationships and the entirety of one's being. But these are processes that may be resisted and transcended through individual and collective struggle – not only can the inter-personal be made political, so too can the intra-personal. Developing a conceptual vocabulary to make sense of mental distress is important to these struggles – both theoretically and politically – if we are to move beyond the limiting perspectives provided by biomedicine.

The social model of disability has been remarkably successful in shifting thinking and practice in relation to the situations faced by people with impairments, challenging the implicit tragedy/deficit model that was underpinned by a medicalised form of understanding. Its validity and impact has stemmed from being rooted in the situated knowledge of those with direct experience of impairments. However, as has been discussed in the other chapters, this model – although useful in many respects – has not proved quite able to address some of the key issues that have been seen as important by people with mental distress who have sought to make sense of their experience.

Mental health has had its own history of activism and, although willing to consider alliances with the wider disability movement, there have been concerns about the specific priorities of mental health users becoming lost if mental distress were to become subsumed as just another instance of impairment. Furthermore, the notion of impairment has never quite seemed to capture the actuality of mental distress – although disabling societal and (medicalised) professional responses to mental distress can be just as discriminatory and debilitating as those towards physical and mental impairments.

Within the field of mental health a number of alternative perspectives have emerged – both challenging the reduction of experience to medical diagnosis and recasting the idea of ‘recovery’ in social/existential terms, rather than equating it with remission of ‘symptoms’.