Current Concepts Considered Inadequate
PSYCHIATRISTS, psychologists, and other professional workers in the behavioral sciences are not satisfied with current definitions of mental health. Sol W. Ginsburg stated:
One of the great theoretical lacks in mental hygiene activity seems to me to be that we do not have an adequate definition of mental health?
In 1956 the National Association for Mental Health recognized that there will have to be a clarification of the concept of mental health before educational programs to promote "positive mental health" can be evaluated.'
In a statement on concepts and practices in mental health education by the Program Evaluation Project Committee of Pennsylvania Mental Health, Inc., a relevant question was dealt with as follows:
Why has there been so little validation of means to enhance mental health? Basic to all is perhaps the fact that there has not yet been developed an accepted scientific concept of either mental health or illness.°
Commenting on community programs in mental health, Louisa Howe shares the opinion of many workers:
At the present time most programs in the field of mental health seem to be proceeding largely on an empirical, trial-and-error basis. . . . No definite pattern as yet exists, nor is there, in my opinion, an adequately developed and coherent theoretical structure on the basis of which it would be possible to derive a general pattern of mental health objectives. . . .4
In her recent monograph Marie Jahoda5 points out that there exists no completely acceptable concept of mental health or mental illness. While she categorizes several major facets of the subject relating to psychological content, she ably shows that mental health means different things to different people.
Existing definitions state merely the results or the effects of mental health. Those quoted in the subsequent paragraphs are typical:
The mentally healthy person is one who is developing toward personal maturity. Maturity is reached in the same degree as the individual can independently and in a fruitful way overcome his internal conflicts, realize his own aims in life, and responsibly live in fellowship with others .°
Mental health is a condition and a level of social functioning which is socially acceptable and personally satisfying.'
Mental health is the adjustment of human beings to the world and to each other with a maximum of effectiveness and happiness. Not just efficiency, or just contentment—or the grace of obeying the rules of the game cheerfully. It is all of these together. It is the ability to maintain an even temper, and alert intelligence, socially considerate behavior, and a happy disposition .°
Mental health can be defined as a state of wellbeing, of efficiency at work, and of harmony in human relationships.°
. . . the freedom from psychiatric symptomatology and the optimal functioning of the individual in his social setting."
Mental health may be defined as that state of mind which enables one to meet and cope with life's crises??
Mental health in its broadest sense has come to mean the measure of a person's ability to shape his environment, to adjust to life as he has to face it and to do so with a reasonable amount of satisfaction, success, efficiency and happiness?'
These definitions describe certain manifestations of mental health. Such terms as "success" and "aims of life" can be interpreted in the framework of widely differing moral and ethical values. A "level of social functioning which is socially acceptable" presents no firm ground whatsoever. We are evidently expected to assume that the mores of all societies are conducive to mental health. Indeed, it is widely believed by sociologists and taught in the universities that there are no "absolutes."
Is "developing toward personal maturity" a sign of mental health? Much depends upon one's idea of "personal maturity." Brock Chisholm, a psychiatrist who until 1953 was director general of the World Health Organization and who has aptly been called "a fearless leader of men's minds," believes that the concept of right and wrong is the "consistent thread running through the weave of all civilizations . . . preventing the development of all or almost all the people to a state of maturity." Morality, he believes, "prevents the rational use of intelligence . . . produces inferiority, guilt, fear, . . . makes controlling other people's behavior emotionally necessary . . . encourages prejudice . . ." 15
Regarding the "sin concept," Chisholm warns:
It appears that a system which imposes an early belief in one's own sinfulness, or unacceptability in one's natural state, with its consequent feeling and anxiety, must be harmful to interhuman relationships and to the ability of the human race to survive in the kind of world this has become.16
It is apparent that there are problems in the utilization of current definitions. Difficulties stem from value differences, but probably the most important deterrent to program planning in mental health has been the failure to identify the cause or causes of mental health.
If mental health is a "state of mind which enables one to meet and cope with life's crises," one may ask, "What is the cause of such a desirable state of mind?" The answer to this question should hold the key to the successful pursuit of mental health.
(To be continued)
Notes:
1 Sol W. Ginsburg, "The Mental Health Movement: Its Theoretical Assumptions," in Community Programs for Mental Health.
2"Mental Health Education: A Critique." Pennsylvania Mental Health, Inc., 1601 Walnut St., Philadelphia 3, Pa., 1950, Xiii.
3 Ibid., p. 106.
4 Louisa Howe, "Problems in the Evaluation of Mental Health Programs." in Community Programs for Mental Health (Cambridge, Mass.: Harvard University Press, 1955), p. 269.
5 Marie Jahoda, Current Concepts of Positive Mental Health (New York: Basic Books, Inc., Publishers, 1958).
6 Dana L. Farnsworth, Mental Health in College and University (Cambridge, Mass.: Harvard University Press, 1957), pp. 6, 218.
7 W. W. Boehm, The Role of Psychiatric Social Work in Mental Health," in Mental Health and Mental Disorder (New York: W. W. Norton and Co., 1955), p. 537.
8 K. A. Menninger, The Human Mind, third ed. (New York: Alfred A. Knopf, 1955), p. 1.
9 "An Outline for Evaluation of a Community Program in Mental Hygiene," Group for the Advancement of Psychiatry, Report No. 8 (April), 1949, p. 2.
10 P. Kirkpatrick, and S. T. Michael, Mental Health in the Metropolis (New York: The McGraw-Hill Book Company, Inc., 1962), p. 61.
11 Rex B. Hersey, "The Mental Health of Workers," Mental Hygiene, 18:462 (July), 1934.
12 Mental Hygiene in the Classroom, report of the Joint Committee on Health Problems in Education of the National Education Assn. and the American Medical Assn., et al., Chicago. American Medical Association, 1954, p. 9.
13 Edward G. McGavran, Foreword in Lectures by Brock Chisholm, M.D., School of Public Health, University of North Carolina, Chapel Hill, North Carolina, March, 1959.
14 Brock, Chisholm, "The Re-establishment of Peacetime Society" Psychiatry, Vol. IX, No. 1 (February). 1946, 965-969.
15 Ibid., pp. 964-969.
16 "Social Responsibility," Science, vol. 109.
