This article was originally published online by the London based Institute of Art & Ideas (IAI.tv) under the title: Everything you know about happiness is wrong, What does good mental health look like? (July 2021).
While I was in graduate school in the late 1970’s, a short-lived, student-run newsletter published under the banner: Freedom From Disabling Anxiety Press – a play on the common “Free Press” moniker.
We were training to diagnose the human condition in terms of a nosology founded on a medical model that defined “mental health” as the absence of psychiatric illness. The term “mental health” refers to disorder, disease and infirmity, and not actual health or well-being. Positive psychological health is referenced in the DSM (Diagnostic and Statistical Manual) only by way of a code number for “no diagnosis.”
As students of psychology (not psychiatry), we were also aware that “mental health” is a misnomer for another reason. Adaptive human functioning involves more than just thoughts and cognitions, our mental life. To identify both the healthy and the troubled souls among us, it is more accurate to refer to mental, emotional, behavioral, social and bio-psychological health.
The term psychological health includes all of the above, and it enables a discussion about what people who fall on the positive end of that axis actually look like.
In the 1960’s, the idea that people should expect something more from life than just freedom from disabling anxiety gave rise to the Human Potential Movement – a popular counterculture face for a series of emerging existential, humanistic, Jungian, Gestalt and self-psychology theories. The academic-intellectual face for the movement was provided by psychologist Abraham Maslow, whose seminal text Toward a Psychology of Being was published in 1968, edited from lectures dating back to 1954.
At midcentury, there were two central currents in psychology. The Freudian-analytic enterprise, broadly defined, was focused on the dynamics of psychopathology. The Behaviorists were intent on explaining human motivation and action as analogous to a “black box” with stimulus inputs and response outputs. Maslow argued that a “Third Force” was coalescing around the idea that individual consciousness is essential to the human experience and that psychology must consider “both the depths and the heights of human nature.”
In the deterministic Freudian and behavioral models, personality is created from a combination of instinct (nature) and influence (nurture or reinforcement). Maslow accepted that people have a given “inner nature” that becomes shaped by experience, but he added that because life involves a continual series of choices, the self is largely “a creation of the person himself … a ‘real’ person is his own main determinant.”
In Maslow’s construction, the most important shaping of a healthy personality comes from the gratification or satisfaction of innate needs and impulses, among which he includes an instinctual drive for growth, individuation and ultimately, self-actualization. In hierarchical fashion, a person must first meet their survival, safety and security needs, and the need for love, belongingness, self-esteem, dignity and self-respect, before reaching the higher stages of personal growth.
Individuals are said to look psychologically healthy when they are moving in the direction of self-actualization, either “being” or “becoming” an authentic self, with “unity of personality” and “full individuality.” In this formulation, the psychologically healthy individual is a moral person who is introspective, honest, creative, expressive, truth seeking and efficient at perceiving reality. Conversely, according to Maslow, “general-illness of the personality is seen as any falling short of growth or full humanness.”
With Maslow’s endorsement, the Human Potential Movement was expected to herald the dawning of a new age in human relations, with universal “harmony and understanding,” therapy groups, hot tubs and yoga.
The above conceptualization of psychological health did not, however, retain much currency into the 1970’s. The evolved, superordinary personalities imagined appeared to be detached from reality. Missing from the equation was the fact that in ordinary life, there is no freedom from fear and anxiety or any escape from stress. Anxiety is a consequence of sentience and stress is ubiquitous.
In 1977, existential psychologist Rollo May published his masterwork, the revised edition (from 1950) of The Meaning of Anxiety. In May’s view, anxiety is a force that animates life, providing the tension and creative motivation necessary for survival and health. May viewed anxiety as “an expression of the capacity of the organism to react to threats,” including the existential threats of non-being or of living a meaningless existence.
Following from Kierkegaard’s “school of anxiety” concept, Rollo May said that by confronting and working through anxiety experiences, individuals become better prepared to “move ahead” with courage, “without being overwhelmed.” It is an act of “courage that consists not of the absence of fear and anxiety, but of the capacity to move ahead even though one is afraid.” In May’s formulation, personal growth and psychological health are forged from that struggle: “it will release the individual’s capacities and permit greater expansion in the development of his own powers, as well as enhancement of his relations with other human beings.”
Rollo May was just as much a humanist as Maslow in rejecting “the belief that mental health is living without anxiety.” He differed, however, with respect to the belief that positive health is produced through an ascending gratification of intrinsic needs and values. According to May, psychological health is achieved through the process of engaging life as a challenge. People look psychologically healthy when they persist in seeking meaning and purpose, despite the vicissitudes of life and despite the anxieties that are a byproduct of our consciousness.
In the decade following the Human Potential Movement, it became apparent that if one engaged in experiences directed towards becoming healthy, relaxed, and one-with-one’s-own-self, that in itself would be an active and adaptive response to stress and anxiety. What also emerged at this time is the conviction that psychological health and medical health are intricately correlated.
In 1950, physician Hans Selye published his treatise Stress – introducing the concept of “wear and tear on the body” caused by a depletion of “adaptation energy.” By 1968, it had been shown that people who are free from distress use less medical care of all types and cost less to insure. What this means is that positive psychological health can be measured in relation to somatic complaints and healthcare seeking behavior.
In a series of insurance cost studies at the Rand Corporation, investigators developed inventories to measure both distress and well-being in normal populations. A factor analysis of their measures showed that psychometrically and for purposes of prediction, psychological health is represented by a balance between two positive and three negative emotional factors. The model is validated by its correlation with measures of general medical complaints and with healthcare utilization patterns.
From the Rand questionnaires, an individual looks psychologically healthy when they can say that during the past month, the amount of time they have felt happy and the amount of time they have felt calm and peaceful exceeds the amount of time they have felt either nervous, downhearted and blue, or “so down in the dumps that nothing can cheer them up.”
In other words, from the measured health perspective, individuals experience positive psychological health when they feel mostly calm, peaceful and happy, and mostly free from worry, sadness and despair.
This measurement, however, does not provide any theory about how individuals achieve that state of wellness or how it is represented psychologically. In 1979, Aaron Antonovsky, an Israeli medical sociologist published Health, Stress and Coping, the first of two efforts at a unified theory of well-being.
The starting point for Antonovsky was a health study that included concentration camp survivors. What puzzled Antonovsky was not that two thirds of them remained troubled years later, but that a full 29% had remained emotionally healthy. Antonovsky’s insight was that an understanding of health and resilience cannot be found by studying how people get sick. Instead, one must look at how people become healthy or how they create health, especially in the context of trauma and adversity.
Antonovsky presented a salutogenic model – a model focused on the genesis of health creating, salutary experiences. His argument was that the most salient coping resource an individual can possess is a confident, enduring and dynamic outlook on life based on a tripartite Sense of Coherence.
In Antovosky’s model, an individual experiences coherence and looks psychologically healthy when they (1) have a sense of comprehensibility – a feeling that life events are understandable and generally predictable; (2) a sense of manageability – a feeling that things can be handled and are within control; and (3) a sense of meaningfulness – a feeling that life is a source of pleasure and satisfaction and that life has purpose and is worth living. According to Antonovsky, an individual who is confused and overwhelmed will retain the capacity to survive and to thrive if they maintain the belief that life has meaning and purpose.
The concept of positive psychological health, as opposed to the medical-mental health model, has remained a consistent thread in psychological practice and theorizing throughout my professional career. Humanistic therapies are still prevalent. Mind-body, new age healing practices still permeate the popular culture. Hot tubs and yoga have survived. Consistently, however, the topic of positive psychology garners less attention than it deserves.
Perhaps that is good. Perhaps in the same way that “the mass of men lead lives of quiet desperation,” the mass of psychologically healthy individuals may just lead lives of peaceful calm, happiness and satisfaction, purpose and meaning, and freedom from disabling anxiety.
Copyright, Paul G. Mattiuzzi, Ph.D.
