Heroin addicts describe hours of intense warm pleasure after the initial rush of an intravenous injection.Again, this highlights the ambiguities surrounding the experience of distress in a social context, which maintains the Cartesian split between mind and body.The physical correction of healthy bodies for intended mental health gain. This is contentious in relation to both the behaviour of professionals and their patients.On the other hand, cosmetic surgeons are kept in business by the needs of patients, with no obvious disease, demanding and acquiring corrective intervention, such as facelifts and breast enlargement.All of these activities are aimed, among other things, at some form of mental health gain via individual expression, group identity and resistance to conformity.Some controversies arise from the above points.In relation to the last one, surgical intervention to alter appearance raises ethical and political questions about the mutilation of healthy tissue and the use of scarce health service resources for people whose medical needs can be queried.Psychogenic illnesses have also been surrounded by disputes.By definition, hypochondriacal patients are chronically disaffected with the medical profession.To the embarrassment of their treating psychiatrist, some patients with this label may transpire to have an unrecognised physical pathology.For this reason, the medical profession is increasingly using the more cautious description of medically unexplained symptoms.Some other patients described as somatisers have been involved in a collective opposition movement.An example is those with chronic fatigue syndrome, who sometimes resent their problems being ascribed to underlying psychological causes.A final example of a controversy about the somatisation thesis is that in some cultures, the presentation of physical illness has a different significance to that applying in the norms of Western medicine.This diagnostic tendency has not escaped without criticism.Pleasure is not discussed at length in most of the literature of mental health professionals.The two aspects of the dictionary definition point to pleasure as both an emotion and a motivation or intention.The pursuit of pleasure is a civil right in modern democracies In this sense, the achievement of pleasure could be seen as being close to the World Health Organizations definition of psychological wellbeing.Freud defined work and love as the two touchstones of positive mental health.The first was about infantile wish fulfilment, whereas the second was about adult adaptation.These transient experiences in those who misuse substances are so overwhelmingly addictive that they are sought repeatedly, often at the expense of all other social obligations or personal needs.Pleasure can be a precarious or absent state in some mental health problems The clearest example of this is in relation to bipolar disorder.Also, unrestrained mania can lead to exhaustion and even death.The depressive collapse that ensues after a manic episode is certainly not a pleasurable state.A lack of pleasure appears in psychiatric texts as loss of libido or anhedonia.In the first case, in reaction to the negative emphasis of psychoanalysis, which emphasised the abandonment of wish fulfilment and the need for the growing child to rescind its wishes, the growth movement was permissive and positive.People were encouraged to elaborate and pursue their fantasies.However, the human potential movement was not merely hedonistic, as it also encouraged people to find meaning in all forms of experience, not just pleasure.In the case of positive psychology, there is an emphasis on the study of how people achieve and succeed, rather than on studying their defects.This is a recent elaboration of the work of American humanistic psychologists, such as Carl Rogers and Abraham Maslow.Positive psychology puts personal wellbeing at the centre of benign interpersonal processes of support and tolerance.The experience of pleasure in this view of mental health is not an end in itself but a permitted outcome or experience.For example, Buddhism and existentialism tend to emphasise suffering and angst as integral to the human condition and that striving against this truth is futile.Paradoxically, they also argue that pleasure may be achieved for periods of time by not striving for it.The major deistic faiths tend to emphasise the denial of pleasure as a prerequisite of salvation or spiritual experience.Most faiths restrict access to types of food and encourage periods of restraint and abstinence.Muslims and Mormons are not permitted alcohol and the latter are denied caffeine.Some young male Hindus even seek castration as a path to religious fulfilment.Evolutionary psychology suggests that humans and other animals are not driven by pleasure but by the need to survive and to pass on their genes.Taken to its logical conclusion, the aggressive psychopath represents an evolutionary success.Indication of Freuds ambivalence about the role of pleasure, not only did he emphasise the reality principle, but he also introduced the competing death instinct Thanatos into his theory about the human condition.In doing this, he emphasised the role of aggression rather than pleasure in normal psychology and so came near to the evolutionist position.Imagination that leads to a solution to a problem or a novel form of artistic expression.The link between mental abnormality and creativity is explored.Psychological and sociological accounts for this link are examined.Retrospective analyses of successful historical figures, from different fields, highlight the creative potential that has come to be associated with their distress or madness.This is particularly true of painters, composers and writers but scientists also have high rates of reported psychopathology.Vincent van Gogh also committed suicide and would probably now be seen as suffering from bipolar disorder, although he appears in older psychiatric texts as a creative psychopath.However, collectively, composers have had high rates of mental health problems compared to those for the general population.Handel and Schumann were noted for their dramatic mood swings, with Schumanns work only appearing when he was manic.Schumann was diagnosed retrospectively as suffering from schizophrenia by Eugen Bleuler, the psychiatrist who invented that diagnosis.Debussy transformed a period of ill health and depression into bursts of creativity.