Positive Mental Health
POSITIVE MENTAL HEALTH
The concept of positive mental health was developed by Marie Jahoda, who argues that positive mental health can be viewed as an enduring personality characteristic or as a less permanent function of personality and the social situation (Jahoda 1958). This article summarizes Jahoda's approach to positive mental health, reviews other discussions of the concept, describes a challenge to the assumption that positive mental health requires the accurate perception of reality, examines the value assumptions inherent in the concept, and compares the notions of normality and positive mental health.
In her classic book, Current Concepts of Positive Mental Health (1958), Jahoda identified the following six approaches to the definition of positive mental health, which are described in detail below: (1) attitude toward own self; (2) growth, development, and self-actualization; (3) integration; (4) autonomy; (5) perception of reality; and (6) environmental mastery.
- Acceptance of self, self-confidence, and self-reliance characterize the mentally healthy person. An important attribute of positive mental health includes the understanding of one's strengths and weaknesses, coupled with the conviction that one's positive characteristics outweigh the negative traits. Independence, initiative, and self-esteem are other indictors of positive mental health.
- The realization of one's potential is the underlying assumption of this dimension of positive mental health. Maslow (1954) explains that self-actualization is a motive that encourages the person to maximize capabilities and talents. It is hypothesized that growth motivation is related to positive mental health. Rather than meeting basic human needs, self-actualization implies movement toward higher goals. This dimension of positive mental health also implies an investment in living—a concern with other people and one's environment, rather than a primary focus on satisfying one's own needs.
- The person with positive mental health has a balance of psychic forces, a unified outlook on life, and resistance to stress. Psychoanalysts view integration as the balance of the id, the ego, and the superego. This balance is viewed as changeable, with flexibility as the desired end result. Positive mental health refers to integration at the cognitive level, which implies a unifying philosophy of life that shapes feelings and behaviors. Finally, resistance to stress characterizes the integrated person. The mentally healthy person can adapt to stress without deteriorating. Everyone experiences anxiety when encountering a stressful situation. A mentally healthy response to anxiety and stress suggests some tolerance of tension, ambiguity, and frustration.
- Autonomy refers to self-determination and independence in decision making. The concept suggests that the person with positive mental health is self-directed and self-controlled. The individual acts independently of the outside world; behavior is not dictated by environmental circumstances.
Jahoda points out that some authors have a different interpretation of autonomy. Autonomy may be defined as having freedom of choice about conforming to societal norms. This perspective implies that the person is not independent of the environment, but does have free choice to decide how to respond to societal demands.
- "As a rule, the perception of reality is called mentally healthy when what the individual sees corresponds to what is actually there" (Jahoda 1958, p. 49). Mentally healthy reality perception includes perception free from need distortion. A mentally healthy person views the world without distortions, fitting the perception to objective cues that are present, and does not reject evidence because it does not fit his or her wishes or needs.
Jahoda argues that this dimension of positive mental health implies the ability to perceive others in an empathetic manner. This social sensitivity enables a healthy person to put himself or herself in another person's place and anticipate that person's behavior in a given social situation.
- Mastery of the environment refers to achieving success in some social roles and appropriate function in those roles. Positive mental health also includes the ability to have positive affective interpersonal relations. The social roles involved in environmental mastery may include sexual partner, parent, and worker. Environmental mastery suggests the ability to adapt, adjust, and solve problems in an efficient manner.
OTHER DEFINITIONS OF POSITIVE MENTAL HEALTH
Jourard and Landsman propose similar criteria for positive mental health: positive self-regard, ability to care about others, ability to care about the natural world, openness to new ideas and to people, creativity, ability to work productively, ability to love, and realistic perception of self (1980, p. 131).
Jensen and Bergin (1988) conducted a nationwide survey of 425 professional therapists (clinical psychologists, marriage and family therapists, social workers, and psychiatrists) to determine values associated with mental health. Eight themes were identified as important for a positive, mentally healthy lifestyle: (1) competent perception and expression of feelings (sensitivity, honesty, openness with others); (2) freedom/autonomy/responsibility (self-control, appropriate feelings of guilt, responsibility for one's actions, increasing one's alternatives at a choice point); (3) integration, coping, and work (effective coping strategies, work satisfaction, striving to achieve); (4) self-awareness/growth (awareness of potential, self-discipline); (5) human relatedness/interpersonal and family commitment (ability to give and receive affection, faithfulness in marriage, commitment to family needs, self-sacrifice); (6) self-maintenance/physical fitness (healthful habits, self-discipline in use of alcohol, drugs, tobacco); (7) mature values (purpose for living, having principles and ideals); and (8) forgiveness (making restitution, forgiving others) (Jensen and Bergin 1988, p. 292). They found a high level of consensus among the practitioners. Many of these values are consistent with the six approaches identified by Jahoda in 1958.
ILLUSIONS AND POSITIVE MENTAL HEALTH
The validity of one of the components of positive mental health has been questioned (Snyder 1989). Is accurate reality perception the hallmark of positive mental health? Taylor and Brown argue that "certain illusions may be adaptive for mental health and well being" (1988, p. 193). They explain that mentally healthy persons have an unrealistic positive self-evaluation. Normal individuals are more aware of their strengths and less aware of their weaknesses, perceiving themselves as better than the average person and viewing themselves more positively than others see them.
Another illusion held by mentally healthy persons is an exaggerated sense of self-control. Taylor and Brown (1988) cite evidence that depressed individuals are more likely to have realistic perceptions of personal control than are nondepressed persons. Positive illusions of personal control over the environment, self-worth, and hopefulness about the future imply mental health, and these illusions enable people to function in an adaptive manner.
According to Taylor and Brown (1988), illusions can promote several criteria of mental health, including happiness or contentment, the ability to care for others, and the capacity for intellectually creative and productive work. While mentally healthy people learn from negative experiences, their illusions help them to cope with stresses and strains (Taylor et al. 1989).
Taylor and Brown conclude, "the mentally healthy person appears to have the enviable capacity to distort reality in a direction that enhances self-esteem, maintains beliefs in personal efficacy, and promotes an optimistic view of the future" (1988, p. 204).
THE ROLE OF UNDERLYING VALUE ASSUMPTIONS
Jahoda (1980) argues that the definition of positive mental health depends upon underlying value assumptions. Schwartz and Link explain, "What is viewed as good and functional is often dependent on who is doing the viewing and what value hierarchy is being applied" (1991, p. 240). The definition of positive mental health varies across societies. In addition, there may be variance across social groups within one society (e.g., social class, gender, race, and ethnicity). It is also the case that the definition of positive mental health may be a function of the situation.
Different societies have their own definition of positive mental health. In some societies, a mentally healthy individual is supposed to be autonomous, while in other societies, the mentally healthy person is expected to be compliant, conforming to particular rules imposed by others.
Variance across social groups within one society is illustrated by evidence that there are different standards of positive mental health for men and women. Broverman et al. (1981) report sex role stereotypes in the clinical judgments of mental health among seventy-nine psychotherapists. The therapists were asked to identify the characteristics that portrayed healthy, mature, and socially competent adults. Broverman et al. found "that healthy women differ from healthy men by being more submissive; less independent; less adventurous; more easily influenced; less aggressive; less competitive" (1981, p. 92).
The definition of positive mental health is situational. While a particular behavior is mentally healthy in one situation, it may represent mentally ill behavior in another situation. For example, behavior in a life-threatening situation may be defined as adaptive, given the stresses of the environment. In normal everyday life the same behavior may be defined as bizarre. This observation leads Foote and Cottrell to ask, "What are the psychologically relevant attributes of an environment which permit the manifestations of psychologically healthy behavior?" (1959, p. 44).
Finally, according to Jahoda (1988), the definition of positive mental health is also influenced by the following four assumptions: (1) the criteria for judging health and illness are debatable; (2) neither mental illness nor mental health can be defined by the absence of the other; (3) there are degrees of mental health; and (4) a low level of mental health is not synonymous with mental illness.
NORMALITY OR POSITIVE MENTAL HEALTH?
There is continued debate on the definition of and relationship between normality and positive mental health. There is general agreement among researchers who study normatology that the definition of psychopathology is more precise than the definition of normal behavior (Offer and Sabshin 1991; Strack and Lorr 1997). While psychiatrists have developed sets of very specific criteria for defining mental illness (American Psychiatric Association 1994), there are no set criteria for defining either normal behavior or positive mental health. As is the case for the definition of positive mental health, the determination of normality varies across societies, subgroups within one society, and situations. What is normal (or positive mental health) in one time and place is abnormal (or mentally ill) in another. Both concepts are fluid in nature. Additional research is needed to understand how the definitions of positive mental health and normality are created. What are the underlying assumptions of these definitions, and how do they vary across societies and situations?
While normality implies the absence of psychopathology, positive mental health goes beyond normality. Researchers agree that positive mental health is more than the absence of mental illness; it represents the enhancement of human potential. Although a person may not have symptoms of mental illness, he or she may not have positive mental health, especially in the absence of self-confidence, self-actualization, integration, autonomy, reality perception, and environmental mastery. To have positive mental health implies fulfilling one's potential to the fullest. One might argue that positive mental health is a moving target, representing goals that are established, evaluated, and then revised as a person's circumstance change. The concept of positive mental health is utopian. While many strive to achieve positive mental health, only a few fulfill the goal of maximizing their potential.
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