There are six ways to understand mental health models which will contrast empirical approaches to mental health:
First, mental health can be conceptualized as above normal and as a mental state that is objectively desirable
Second, mental health can be conceptualized as positive psychology—as epitomized by the presence of multiple human strengths.
Third, from the viewpoint of healthy adult development, mental health can be conceptualized as maturity.
Fourth, mental health can be conceptualized as emotional intelligence.
Fifth, mental health can be conceptualized as subjective well-being—a mental state that is subjectively experienced as happy, contented, and desired.
Sixth, mental health can be conceptualized as resilience, as the capacity for successful adaptation and homeostasis. In such a view, mental health, analogous to a competent immune system, allows the individual to function well despite stressful or dangerous environments.
MODEL A: MENTAL HEALTH AS ABOVE NORMAL
The first perspective is the traditional medical approach to health and illness.
Jahoda suggested that mentally healthy individuals should (1) be in touch with their own identity and their own feelings. (2) They should be oriented toward the future, and, over time, they should remain fruitfully invested in life. (3) Their psyches should be integrated and should provide them resistance to stress. (4) They should possess autonomy and should recognize what suits their needs. (5) They should perceive reality without distortion and yet should possess empathy. (6) They should be masters of their environment—able to work, to love, to play, and to be efficient in problem solving. Instead of emphasizing the absence of negative symptoms,
Health is based on an active, joyous, energetic engagement with the world. Such a naturalistic model of health is congruent with the increasing attention to flow, a concept recently elaborated and empirically studied by psychologist Mihaly Csikszentmihalyi and his students. Flow involves the focused attention and psychic absorption that is characteristic of meditation, but, unlike meditation, with flow, the clutch is engaged, and skilled behavior takes place. With flow, the participant feels alive and in the world. In the flow experience, the emotions are not just contained and channeled, they are energized and aligned with consciousness of the task at hand. Action, cognition, and feeling are merged into one. Often, when manifested in intense experiences, such as advanced tennis, technical rock climbing, or violin playing, the flow experience has required hours of prior practice until much of the effort involved have become second nature.Flow occurs when a task is challenging and requires skill and concentration, when there are clear goals and immediate involvement, when time seems to stop and sense of self vanishes, and when one finds oneself deeply involved and in control. A species does not survive just by reproducing; it also has to produce and face new challenges.
MODEL B: MENTAL HEALTH AS POSITIVE PSYCHOLOGY
The second model conceives of mental health as the best possible and has provided the basis for the positive psychology movement. In the last 50 years, Abraham Maslow’s concept of self-actualization and his emphasis on humanistic psychology have drawn attention to “full use and exploitation of talents, capacities, potentialities.”
Positive psychology wishes to learn how to build the qualities that help individuals and communities not just to endure and survive but also to flourish. Formally introduced in the January 2000 issue of American Psychologist, positive psychology hopes to render the psychology of strength and well-being amenable to scientific study and intervention. In that issue, Seligman and Csikszentmihalyi wrote:
At the individual level, it is about positive individual traits; the capacity for love and vocation, courage, interpersonal skill, aesthetic sensibility, perseverance, forgiveness, originality, future mindedness, spirituality, high talent, and wisdom… Psychology is not just a branch of medicine concerned with illness or health; it is much larger. It is about work, education, insight, love, growth, and play. And in this quest for what is best, positive psychology does not rely on wishful thinking, faith, self-deception, fads, or hand waving; it tries to adapt what is best in the scientific method to the unique problems that human behavior presents to those who wish to understand it in all its complexity.
Over the past 30 years, cognitive therapists have demonstrated that altered cognition can not only change behavior, it can also alter brain function. If pessimism is the dominant cognition of the depressed, optimism appears to be the dominant cognition of the mentally healthy. If learned helplessness leads to depression, learned optimism and self-efficacy lead to mental health. Even if the depressed often appear to view reality more realistically, such accurate reality testing avails depressed individuals nothing.
MODEL C: MENTAL HEALTH AS MATURITY
In this model, six developmental stages have been outlined and the social radius of each adult developmental task fits inside the next.
First, adolescents must achieve an identity that allows them to become separate from their parents, for mental health and adult development cannot evolve through a false self. The task of identity requires mastering the last task of childhood: sustained separation from social, residential, economic, and ideological dependence on family of origin. Identity is not just a product of egocentricity, running away from home, or marrying to get out of a dysfunctional family, for there is a world of difference between the instrumental act of running away from home and the developmental task of knowing where one’s family values end and one’s own values begin. Such separation derives as much from the identification and internalization of important adolescent friends and nonfamily mentors as it does from simple biological maturation.
Next, young adults should develop intimacy, which permits them to become reciprocally, and not selfishly, involved with a partner. However, living with just one other person in an interdependent, reciprocal, committed, and contented fashion for years and years may seem neither desirable nor possible to a young adult. Once achieved, however, the capacity for intimacy may seem as effortless and desirable as riding a bicycle. Superficially, mastery of intimacy may take different guises in different cultures and epochs, but mating for life and marriage-type love are developmental tasks that are built into the developmental repertoires of many warm-blooded species, including humans.
Career consolidation is a task that is usually mastered together with intimacy or that follows the mastery of intimacy. Mastery of this task permits adults to find a career as valuable as they once found play. There are four crucial developmental criteria that transform a job or hobby into a career: contentment, compensation, competence, and commitment. Obviously, such a career can be wife and mother—or, in more recent times, husband and father.
Mastery of the fourth task, generativity, involves the demonstration of a clear capacity to care for and guide the next generation. Existing research reveals that, sometime between 35 years of age and 55 years of age, the need for achievement declines and the need for community and affiliation increases. Depending on the opportunities that the society makes available, generativity can mean serving as a consultant, guide, mentor, or coach to young adults in the larger society. Like leadership, generativity means to be in a caring relationship in which one gives up much of the control that parents retain over young children. Good mentors learn to hold loosely and to share responsibility. Generativity reflects the capacity to give the self—finally completed through mastery of the first three tasks of adult development—away. Its mastery is strongly correlated with successful adaptation to old age. This is because, in old age, there are inevitable losses, and these may be overwhelming if a person has not continued to grow beyond his or her immediate family.
The penultimate life task is to become a keeper of the meaning. Like grandparenthood, this task involves passing on the traditions of the past to the future. Generativity and its virtue, care, requires taking care of one person rather than another, whereas keeper of the meaning and its virtues of wisdom and justice are less selective, for justice, unlike care, means not taking sides. Indeed, mastery of this fifth task is epitomized by the role of the wise judge. The focus of a keeper of the meaning is with conservation and preservation of the collective products of mankind—the culture in which one lives and its institutions—rather than with just the development of its children.
Finally, in old age, it is common to feel that some life exists after death and that one is part of something greater than one’s self. Thus, the last life task, in Erikson’s words, is integrity, the task of achieving some sense of peace and unity with respect to one’s own life and to the whole world. Erikson described integrity as “an experience which conveys some world order and spiritual sense. No matter how dearly paid for, it is the acceptance of one’s one and only life cycle as something that had to be and that, by necessity, permitted of no substitutions.”
Finally, it must be kept in mind that mastery of one life task is not necessarily healthier than mastery of another, for adult development is neither a foot race nor a moral imperative. Rather, these six sequential tasks are offered as a road map to help physicians make sense of where they are and where their patients might be located. Acquiring a social radius that extends beyond the self, by definition, allows more flexibility and thus is usually healthier than self-preoccupation.
MODEL D: MENTAL HEALTH AS SOCIOEMOTIONAL INTELLIGENCE
High socioemotional intelligence reflects above average mental health in the same way that a high IQ reflects above average intellectual aptitude. Aristotle defined socioemotional intelligence as follows: “Anyone can become angry—that is easy. But to be angry with the right person, to the right degree, at the right time, for the right purpose, and in the right way—that is not easy.”
All emotions exist to assist basic survival. Although the exact number of primary emotions is arguable, seven emotions are currently distinguished by characteristic facial expressions connoting anger, fear, excitement, interest, surprise, disgust, and sadness. The capacity to identify these different emotions in ourselves and in others plays an important role in mental health. The benefits of being able to read feelings from nonverbal cues have been demonstrated in almost a score of countries. These benefits included being better emotionally adjusted, more popular, and more responsive to others.
Ethologically, emotions are critical to mammalian communication. Because such communications are not always consciously recognized, the more skilled that a person is in identifying his or her emotions, the more skilled that person is in communicating with others and in empathically recognizing their emotions. Put differently, the more that a person is skilled in empathy, the more that person is valued by others, and so the greater are his or her social supports, self-esteem, and intimate relationships.
Social and emotional intelligence can be defined by the following criteria:
Accurate, conscious perception and monitoring of one’s own emotions.
Modification of one’s emotions, so that their expression is appropriate. This involves the capacity to self-soothe one’s own anxiety and to shake off hopelessness and gloom.
Accurate recognition of and response to emotions in others.
Skill in negotiating close relationships with others.
Capacity for focusing emotions (motivation) toward a desired goal. This involves delayed gratification and adaptively displacing and channeling impulse.
Some behavioral scientists divide emotions into positive and negative, as if negative emotions were unhealthy. This is probably an error. As with pus, fever, and cough, so the negative emotions of sadness, fear, and anger are also important to healthy self-preservation. Positive emotions, such as joy, love, interest, and excitement, are associated with subjective contentment. Although negative emotions interfere with contentment, their expression can be equally healthy.
Where the passive study of positive mental health ends and active primary prevention begins is unclear, but, like the model of positive psychology, the model of socioemotional intelligence is potentially interventionist. Just as an individual can have above average musical skill or physical coordination and yet can train these strengths to be even higher, so can an individual learn to enhance emotional modulation.
MODEL E: MENTAL HEALTH AS SUBJECTIVE WELL-BEING
Positive mental health does not just involve being a joy to others; one must also experience subjective well-being. Thus, the capacity for subjective well-being becomes an important model of mental health. Subjective well-being is never categorical. Subjective well-being is not just the absence of misery but the presence of positive contentment.
On the one hand, “no man is happy who does not think himself so.” Happiness that comes from joy or that comes from unselfish love (agape), happiness that comes from self-control and self-efficacy, or happiness that comes from play and flow (deep but effortless involvement) reflects health. Happiness that comes from spiritual discipline and concentration, that comes from humor, or that comes from being relieved of narcissistic focus on shame, resentments, and self-pity is a blessing. Authentic happiness depends on achieving autonomy, forgiveness, close relationships, and self-efficacy.
A distinction can be made between pleasure and gratification. Pleasure is in the moment, is closely allied with happiness, and involves satisfaction of impulse and of biological needs. Pleasure is highly susceptible to habituation and satiety. In contrast, gratification can be equated with what Aristotle called eudaimania and Csikszentmihalyi terms flow. In such a distinction, if pleasure involves satisfaction of the senses and emotions, gratification involves joy, the satisfaction of “being the best you can be” and of meeting aesthetic and spiritual needs. This can be manifested by a child lost in play, a mountaineer transported by rock climbing, or a father marvelling at his daughter’s first solo on a bicycle.
Positive emotion generates exploration and promotes mastery. Unlike negative emotions, which generate zero-sum, win–lose situations, positive emotions generate win–win situations. However, tolerance of negative emotions may characterize some periods of the life cycle more than others. Increasing capacity to tolerate and to bear subjective depression and anxiety distinguishes healthy adolescents from healthy fifth graders and healthy (generative) submarine skippers from healthy enlisted men.
If subjective well-being were due largely to the meeting of basic needs, then there should be a relatively low correlation between subjective well-being in work settings and subjective well-being in recreational settings or between subjective well-being in social settings versus subjective well-being in solitary settings. However, in most studies, the correlations between subjective well-being in different facets of life are high—higher than the correlation between height and weight. People who are satisfied with their lives at one point in time are more likely to be satisfied with their jobs in the future, and people with high job satisfaction are more likely to report satisfaction with retirement. Admittedly, a few studies exist in which correlations are low between satisfaction with different facets of life. Again, more work is needed.
The maintenance of self-efficacy, -agency, and -autonomy makes additional environmental contributions to subjective well-being. Subjective well-being is usually higher in democracies than in dictatorships. Assuming responsibility for favorable or unfavorable outcomes (internalization) is another major factor leading to subjective well-being. Placing the blame elsewhere (externalization) significantly reduces subjective well-being. In other words, the mental mechanisms of paranoia and projection make people feel worse rather than better.
MODEL F: MENTAL HEALTH AS RESILIENCE
It is not stress that kills individuals but the healthy mastery of stress that permits individuals to survive.
In 1925, Meyer, a founder of modern American psychiatry, pointed out that although adaptive mental reaction patterns, such as denial, phobias, and even projections, can appear to reflect illness, they may, in fact, be “normal, vital phenomena” related to healing. Just as immune mechanisms, clotting mechanisms, and callus formation heal by distorting bodily equilibrium, so do equally involuntary coping mechanisms heal by distorting mental processes.
There are three broad classes of coping mechanisms that humans use to overcome stressful situations.
First, there are the ways in which an individual elicits help from appropriate others: namely, consciously seeking social support.
Second, there are conscious cognitive strategies that individuals intentionally use to master stress.
Third, there are adaptive involuntary coping mechanisms (often called defense mechanisms) that distort an individual’s perception of internal and external reality to reduce subjective distress, anxiety, and depression.This third class of adaptive involuntary coping mechanisms reduces conflict and cognitive dissonance during sudden changes in internal and external reality. If such changes in reality are not “distorted” and “denied,” they can result in disabling anxiety or depression, or both. In summary, such homeostatic mental defenses shield individuals from sudden changes in the four lodestars of conflict: affect reality, relationships, and conscience.
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