UNIVERSITY
OF FLORIDA
LIBRARIES
COLLEGE UBRAR
CURRENT CONCEPTS
OF POSITIVE MENTAL HEALTH
Digitized by the Internet Archive
in 2010 with funding from
Lyrasis Members and Sloan Foundation
http://www.archive.org/details/currentconceptsoOOjaho
Joint Commission
on Mental Illness and Health
MONOGRAPH SERIES / NO. I
Qurrmt QonccYts
of
Positive Mental Health
MARIE JAHODA
A REPORT TO THE STAFF DIRECTOR, JACK R. EWALT
1958
Basic Books, Inc., Publishers, New York
FIRST PRINTING SEPTEMBER I958
SECOND PRINTING FEBRUARY I959
COPYRIGHT © 1958 BY BASIC BOOKS, INC.
LIBRARY OF CONGRESS CATALOG CARD NO. 58-I1681
MANUFACTURED IN THE UNITED STATES OF AMERICA
DESIGNED BY SIDNEY SOLOMON
Foreword
Ihis is the first of a series of monographs to be published by the Joint Commission on Mental Illness and Health as part of a national mental health survey that will culminate in a final report containing findings and recommendations for a national mental health program.
The present document constitutes a report of the project director to the staff director of the Joint Commission.
Titles of the monograph series, together with the senior authors, are listed here in the approximate order of scheduled publication:
1. Current Concepts of Positive Mental Health Marie Jahoda, Ph.D.
2. Economics of Mental Illness Rashi Fein, Ph.D.
3. Mental Health Manpower George W. Albee, Ph.D.
4. Nationwide Sampling Survey of People's Mental Health Angus Campbell, Ph.D., and Gerald Gurin, Ph.D.
5. The Role of Schools in Mental Health Wesley Allinsmith, Ph.D., and George W. Goethals, EdD.
[v]
[ vi ] FOREWORD
6. Research Resources in Mental Health William F. Soskin, Ph.D.
7. Religion in Mental Health Richard V. McCaiin, PhX).
8. Nonpsychiatric Community Resources in Mental Health
Reginald Robinson, Ph.D., David F. DeMarche, PhX).,
and Mildred K. Wagle, M.S.SA.
9. Epidemiology and Etiology of Mental Illness
Richard J. Plunkett, M.D., and John E. Gordon, M.D.
10. Patterns of Patient Care:
A. THE OUT-PATIENT
B. THE IN-PATIENT
C. THE EX-PATIENT
Morris S. Schwartz, Ph.D., Warren T. Vaughan, M.D., and Charlotte Greene Schwartz, M.A.
These monographs, each a part of an over-all study design,will contain the detailed information forming the basis of a final report. From the data in the individual studies and other relevant information, the headquarters staff will pre-pare a summary document incorporating its findings and recommendations for national and state mental health pro-grams. This summary document will have the approval of the Joint Commission before its pubHcation in the form of an ofl&cial report.
This final report will be pubHshed by Basic Books and transmitted to the United States Congress, the Surgeon Gen-eral of the Public Health Service, and the Governors of the States, together with their representatives in the pubHc health and mental health professions, in accordance with the pro-visions of the Mental Health Study Act of 1955.
FOREWORD [ vii ]
Participating organizations, members, and officers of the Joint Commission, as well as headquarters and project staffs, are listed in the appendix at the end of the book.
The Joint Commission, it may be seen, is a nongovern-mental, multidisciplinary, nonprofit organization represent-ing a variety of national agencies concerned with mental health. Its study was authorized by a unanimous resolution of Congress and is financed by grants from the National Institute of Mental Health and from private sources.
Additional copies of Current Concepts of Positive Mental Health may be obtained from the Joint Commission head- quarters, from the publisher, or from book dealers.
Joint Commission on Mental Illness and Health
Sujf%c
CVICW
1 HE NEED for a clearer understanding of what we mean by "mental health" is obvious to anyone who has attempted to cope with the role of schools and the numerous community agencies involved in mental health promotion, prevention of mental illness, and other phases of the mental health move-ment now in progress in the United States. Any possible clarification of the subject should be of help to mental health program-makers.
We commonly use "mental health" as a term interchange-able with "mental illness," in the same euphemistic way that "public health" generally refers to the prevention or control of disease by mass methods. The behavioral scientists who have joined the mental health team and are making in-creasingly important contributions to the mental health movement have expressed dissatisfaction with a primary focus on "sick behavior." They argue that a new and broader perspective is needed if interest in mental health, as a posi-tive force, is to be made conceptually clear and practically useful. They make a telHng point when they propose that progress in understanding health and illness requires much research based on the study of hiunan behavior as a natural phenomenon.
[ix]
[ X ] STAFF REVIEW
In approaching the subject of this monograph, we have thought primarily of the promotion of mental health as a positive state, rather than of the cure of mental illness, or its prevention.
We asked Dr. Marie Jahoda, the author, who is Professor of Social Psychology, New York University, and Director of the N.Y.U. Research Center for Human Relations, to conduct a review of the pertinent literature and also hold an interdiscipHnary seminar during the academic year 1956-57 for the purpose of evaluating the theoretical, experimental, and empirical evidence of the psychological nature of mental health.
Dr. Jahoda's fulfillment of this assignment has resulted in a thoughtful and extensive analysis of mental health concepts, written by her in consultation with leading pubHc health workers, sociologists, psychologists, and others.
No abstract can take the place of the total document — a process of critical examination of existing views and issues and of where they lead. However, it may be helpful to have a summary of some of the prominent features of her report. These points are made, among others:
1. Mental health is an individual and personal matter. It involves a living human organism or, more precisely, the condition of an individual human mind. A social environ-ment or culture may be conducive either to sickness or health, but the quality produced is characteristic only of a person; therefore, it is improper to speak of a "sick society" or a "sick community."
2. In speaking of a person's mental health, it is advisable to distinguish between attributes and actions. The individ-ual may be classified as more or less healthy in a long-term
STAFF REVIEW [ xi ]
view of his behavior or, in other words, according to his en-during attributes. Or, his actions may be regarded as more or less healthy — that is, appropriate — from the viewpoint of single, immediate, short-term situation.
3. Standards of mentally healthy, or normal, behavior vary with the time, place, culture, and expectations of the social group. In short, different peoples have different stand-ards.
4. Mental health is one of many human values; it should not be regarded as the ultimate good in itself.
5. No completely acceptable, all-inclusive concept exists for physical health or physical illness, and, likewise, none exists for mental health or mental illness. A national pro-gram against mental illness and for mental health does not depend on acceptance of a single definition and need not await it.
6. Many scientific investigators have thought about the psychological content of positive mental health. A review of their contributions reveals six major approaches to the sub-ject.
a. Attitudes of the individual toward himself.
b. Degree to which person realizes his potentialities through action.
c. Unification of function in the individual's personality.
d. Individual's degree of independence of social in-fluences.
e. How the individual sees the world around him.
f. Ability to take life as it comes and master it.
7. One value in American culture compatible with most approaches to a definition of positive mental health appears to be this: An individual should be able to stand on his own two feet without making undue demands or impositions on others.
8. The need for more intensive scientific research in mental health is underscored.
[ xii ] STAFF REVIEW
Among the biologists and physicians who read this mono-graph, there may be some discomfort at not finding more about the biologic and physiologic components of mental health. They might even take their cue from the fact that Dr.Jahoda states that "mental health must be thought of as per-taining to a Hving organism with mental faculties." How-ever, it is the purpose of her monograph to discuss the concepts of positive mental health from a psychological view-point. She assumes that a certain physiologic or physio-chemical homeostasis is necessary for good health.
The laboratory showed us long ago that severe emotional stress can profoundly alter the physiology of the body. More recent research supports this evidence — chemical-physiologic disturbances can affect behavior and perception. In fact, some evidence indicates that a genetic, or at least fundamen-tally biologic, "set" of the body, in terms of its chemical con-stituents, may determine the way the individual deals with external stress and other life experiences.
In addition, deterioration of the brain from disease, aging, nutritional disturbances, or toxins such as alcohol and drugs can produce profound mental changes. Adequate nutrition and maintenance of a high state of oxygenation of the fetus during dehvery and in the immediate post-partum phase may, in themselves, promote a better integrated nervous sys-tem and a higher state of mental health in the future.
For those who contend that mental health is a unitary state to which all must conform, it may be pointed out that Dr.Jahoda suggests that good physical health is a necessary but not sufl&cient condition of good mental health.
Some, however, feel that mental health is a more relative term. For example, they beUeve that mental health would
STAFF REVIEW [ xiii ]
be possible in a genius and a moron as well. They may con-tend that a person with a brain injury who has recovered with only a few neurologic disturbances can, in spite of this, with proper rehabiHtation and proper mental attitudes, have good mental health. Speculation almost requires such a point of view, else, from a biologic point of view, we could never be certain that any man is healthy. Who knows what or-dinary mortals among us might have been an Einstein or Edison, had a few more cubic centimeters of oxygen been
infused into our lungs, or had our mothers ingested a few more vitamins or particular constellations of protein during our gestation period .^^
None knows that he is as intact as he might have been. Perhaps the biologic view would be adequately represented if, to Dr. Jahoda's psychological concepts and notions of mental health, were merely added a phrase — "with a physio-logic function consistent with the demands made by the so-ciety and the psychologic state of the individual."
The final chapter in this monograph was written by Dr. Walter E. Barton, one of the members of Dr. Jahoda's ad-visory panel, in order to present what might be termed a more typical clinical view of the organic facets in this prob- lem. This staif review. Dr. Jahoda's presentation, and Dr.Barton's all help confirm Dr. Jahoda's contention that mental health indeed means different things to different people.
Jack R. Ewalt, M.D., Director
Jic]inowlcdgcmcnts
1 HIS REPORT was Written for the Joint Commission on Men-tal Illness and Health. The Director of the Commission, Dr.Jack R. Ewalt, and his senior staff, particularly Drs. Fill-more H. Sanford and Gordon W. Blackwell, did much more than entrust me with a piece of work; their continuous en-couragement, and the generous and thoughtful manner in which they permitted me to enlist the cooperation of others, have been of considerable help.
Work on this report was planned and carried through in a manner which required several revisions of ideas, formula-tions, and organization. When a preliminary draft of a sec-tion was finished, it was first submitted to my colleagues at New York University for criticism and suggestions. Drs.Robert R. Holt, Murray Horwitz, George S. Klein, Robert S. Lee, Eva Rosenfeld, M. Brewster Smith (Vice-President of the Joint commission), Miss Claire Selltiz, and especially Drs. Isidor Chein and Stuart W. Cook gave their time and
ideas unsparingly. Their individual contributions cannot be identified. Jointly they made it possible to produce interim working papers which led to an immeasurable improvement of the draft they had received from me. These working
[XV]
[ Xvi ] ACKNOWLEDGEMENTS
papers were then submitted to a highly selected group of professional persons who acted as consultants to the project. They are as follows:
Alfred L. Baldwin, Ph.D., Professor and Chairman of the Department of Child Development and Family Relation-ships, Cornell University, Ithaca, N. Y.
Walter E. Barton, M.D., Associate Professor of Psychiatry, Boston University School of Medicine, and Superintendent, Boston State Hospital, Boston, Mass.
Kenneth D. Benne, Ph.D., Professor of Human Relations, Boston University, Boston, Mass.
John A. Clausen, Ph.D., Chief of the Laboratory of Socio- Environmental Studies of the National Institute of Mental Health, Bethesda, Md.
Ernest M. Gruenberg, M.D., Technical Staff, Milbank Memorial Fund, New York.
Irving L. Janis, Ph.D., Associate Professor of Psychology, Yale University, New Haven, Conn.
Ernst Kris, Ph.D., Clinical Professor of Psychology, Child Study Center, Yale University, New Haven, Conn. (Now deceased).
Lionel TrilHng, Ph.D., Professor of English, Columbia University, New York.
After having studied the working paper, the consultants met with me for a meeting lasting about five hours. These seminars were also attended by Drs. Chein and Smith. All participants agreed that these meetings should serve as spring-boards for ideas and advanced criticism. The notion that in-tellectual efforts can be furthered by consensus or majority opinion was expHcitly ruled out. The ensuing spirited dis-
ACKNOWLEDGEMENTS [ Xvii ]
cussions greatly enriched my knowledge and thinking about mental health.
Throughout the period of work on this report I had the competent and enthusiastic help of Mrs. Lillian Robbins and Mr. Nicholas Freydberg who, under the modest title of graduate student assistants, helped in every way, from tak-ing notes at the meetings with consultants (much more eco-nomically and intelligently than a tape recorder could have done), to reading, excerpting, and discussing. In the final revision and organization of the report, Mrs. Robbins and I worked closely together. Miss Mary Insinna coped grace-fully and efiBciently with the secretarial duties inherent in the task.
To all of them my warm thanks.
Marie Jahoda
Qontmts
Foreword v
Staff Review ix
Acknowledgements xv
I. Introduction 3
Purpose and Scope 5
7^ a Concept of Mental Health Necessary? 5
The Nature of Mental Health Propositions 7
II. Clearing the Air: Unsuitable Conceptualizations
of Positive Mental Health 10
The Absence of Mental Disease as a Criterion
for Mental Health 10
Normality as a Criterion for Mental Health 15
Various States of Well-Being as Criteria for
Mental Health 18
III. The Psychological Meaning of Various Criteria
for Positive Mental Health 22
Six Approaches to a Concept 25
[xix]
[ XX ] CXJNTENTS
Attitudes toward the Self as Criteria for Mental
Health 24
Growth, Development, and Self-Actualization
as Criteria for Mental Health jo
Integration as a Criterion for Mental Health ^^
A Note on Reality-Orientation 4^
Autonomy as a Criterion for Mental Health 4$
Perception of Reality as a Criterion for Mental
Health 4g
Environmental Mastery as a Criterion for
Mental Health 53
IV. An Effort at Further Clarification 6^
Different Types of Mental Health 66
The Multiple Criterion Approach yo
Mental Health and Mental Disease 73
The Value Dilemma y6
V. From Ideas to Systematic Research 81
Empirical Indicators for Positive Mental
Health 82
Some Suggestions for Research 100
Conditions for Acquisition and Maintenance of
Mental Health 104
VI. In Conclusion log
VII. Viewpoint of a CHnician, by Walter E. Barton,
M.D. ///
CONTENTS [ Xxi ]
References 121
Appendix
Joint Commission on Mental Illness and
Health. Participating Organizations, Mem-
bers, Officers, and Staff 727
Index /J/
4
Ihere are two ways of being interested in health; the common one is that of making a Hst and plan of all things that are good and desirable in life and giving the best possible description of Utopia and of perfec-tion with recommendations as to how to get there. The way of the worker in modern hygiene is that of making a survey of the actual activities and condi-tions, and then of taking up definite points of difi&culty, tracing them to an understanding in terms of causes and effects and to factors on which fruitful experi-mental, analytical and constructive work can be done. The first type leads mainly to moralizing; the second type leads to a conscientious and impartial study, and to constructive experimentation.
Adolf Meyer, 1925. ^$1^-%
I
Introduction
Ihere is hardly a term in current psychological thought as vague, elusive, and ambiguous as the term "mental health." That it means many things to many people is bad enough. That many people use it v^ithout even attempting to specify the idiosyncratic meaning the term has for them makes the situation worse, both for those v^ho w^ish to promote mental health and for those v^^ho wish to introduce concern with mental health into systematic psychological theory and re-search.
PURPOSE AND SCOPE
The purpose of this review is to clarify a variety of efforts to give meaning to this vague notion. In doing so we shall have to examine the assumptions about the nature of man and society underlying such efforts by making expHcit some of their implications and consequences. This should lead first to a description of various types of human behavior called mentally healthy and second to a critical discussion of mental health concepts suggested in the Hterature.
[3]
[ 4 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
Definitions of mental health to some extent must be mat-ters of convenience. A definition in itself solves no problems and does not add to know^ledge; all that can be expected from it is usefulness in achieving the purposes of science. Yet, as we shall see, there are many efforts to define mental health in v^ays that go far beyond this scientific approach to definition. They often contain implicitly personal or general philosophies — they often specify hov^ human beings ought to be. Such "definitions" also v^ill have to be examined.
In a sense, the attempts to give meaning to the idea of mental health are efforts to grapple v^ith the nature of man as he ought to or could be. Every historical period probably has its ov^n characteristic v^^ay of searching for expressions incorporating its ideals of a good man in a good society. In our time and in this country positive mental health is one focus for this search. Why this should be the case would be an interesting study in itself. Here we must limit ourselves to noting that the inevitable closeness of ideas about mental health to fundamental values should temper scientific im-patience with concepts that do not immediately suggest to the reader how they can enter into theoretical or practical work.
Since our goal is the development of a rational approach to the problem of defining mental health, we shall have to choose what seems best among those definitions intermin-gling value and fact. In sorting unnecessary from necessary connotations, and in indicating where necessary elements are still lacking, we will aim at definitions useful for both re-search and application.
INTRODUCTION [ 5 ]
IS A CONCEPT OF MENTAL HEALTH
NECESSARY?
Whether we Hke it or not, the term mental health, or men-tal hygiene, is firmly estabHshed in the thought and actions of several groups: First, under the guidance of voluntary and governmental agencies, the pubHc has taken hold of the term in spite of (or, perhaps, because of) its am-biguity. Funds are being raised and expended to promote mental health; educational campaigns are being conducted to teach people hov^ to attain this goal for themselves, for their children, for the conmiunity. But is there substance behind the notion? Can a useful concept of mental health be established?
If substance can be lent to the term, the effort v^ill benefit the public, even if mental health emerges as less of a panacea than the public v^ould like. From this situation, a moral obligation to deal v^ith the matter arises.
Specialists also use the term mental health, particularly those professions trying to help people in trouble or to pre-vent them from getting into trouble. Thoughtful members of these groups feel that they need clarity about the con-cept of mental health because they want to use it to define realistic goals for their efforts and as a help in the develop-ment of techniques that, in application, will lead to these goals. It is the business of science to explore human poten-tiaHties and the conditions furthering their realization. The helping professions often turn to the behavioral sciences, therefore, to provide them with basic knowledge about hu-
[ 6 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
man functioning. They demand a mental healtii concept compatible with scientific knowledge of man.
Finally, the term mental health is used by scientists them-selves (such as psychiatrists, psychologists, sociologists, and anthropologists). Their concern with mental health is often justified by pointing to what appears to be a one-sided de-velopment in the sciences of man. Knowledge about devia-tions, illness, and malfunctioning far exceeds knowledge of healthy functioning. Even apart from the issue of appHca-tion, they maintain, science requires that the previous con-centration on the study of inappropriate functioning becorrected by greater emphasis on appropriate functioning, if for no other reason than to test such assumptions as that health and illness are different only in degree.
Other members of the scientific community oppose scien-tific concern with mental health. In part such opposition is based on an unwillingness to work with a notion so vague and ill-defined. In part it is rooted in the conviction that the science of behavior advances best by studying behavior, with-out reference to whether it is "good" or "bad." Only in this manner, they argue, can science remain free from "con-tamination by values" and a resulting distortion in the choice and study of scientific problems.
This argument rests upon the implicit assumption that as a rule scientists select the topic of their interests in accordance with the rational requirements of the discipline within which they work. This does happen, of course; a well-developed theory is, on occasion, the only guide to the choice of a re-search topic. But the very one-sidedness of current psycho-logical knowledge testifies to the fact that, in their choice of topics, scientists are responsive to social demands being made
INTRODUCTION [ 7 ]
of them, whether psychological theory will benefit more by correcting an earlier bias in favor of the study of disease through a current bias in favor of the study of health, or by a strict avoidance of concern w^ith "good" or "bad," healthy or sick functioning, is a matter of strategy. Fortunately, both strategies are presently being pursued by different people. Only the future v^ill tell v^hich v^as more profitable.
In any case, it does not detract from the value of a piece of work if it is chosen for other than theoretical reasons. Alexander Leighton (1949) has incisively stated the place of values in the science of man:
Within an area marked off for scientific investigation, the values of science reign supreme over each step in the process toward conclusions and in the conclusions themselves. Moral values when pertinent dominate scientific values at three contiguous points: the selection of the problem to be investigated, the limitation of the human and other materials that may be used, and the de- termination of what shall be done with the results.
From this point of view, mental health is a possible con-cern for scientific inquiry notwithstanding its value connota-tions. Earlier we argued that mental health is a needed con-cept, and one that can be given clear meaning only by scientific work. Perhaps it is best to let the argument rest here. Whether or not an individual scientist wants to engage in research related to mental health is up to him.
THE NATURE OF MENTAL HEALTH
PROPOSITIONS
It may be helpful in appraising the following review of concepts to keep in mind that one has the option of defining
[ 8 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
mental health in at least one of two ways: as a relatively constant and enduring function of personality, leading to predictable differences in behavior and feelings depending on the stresses and strains of the situations in which a person finds himself; or as a momentary function of personality and situation.
Looking at mental health in the first way will lead to a classification of individuals as more or less healthy; looking at it in the second way, will lead to a classification of actions as more or less healthy. The relevance of this distinction can be illustrated with an example concerning physical health. Take a strong man with a bad cold. According to the first, he is healthy; according to the second, he is sick. Both state-ments are justifiable and useful. But utter confusion will re-sult if either of these correct diagnoses is made in the wrong context — that is, if he is regarded as a permanently sick per-son or as one who is functioning healthily. Much of the con-fusion in the area of mental health stems from the failure to establish whether one is talking about mental health as an enduring attribute of a person or as a momentary attribute of functioning. In the following discussion, we shall keep the distinction in mind without at this moment choosing be-tween either position.
In the mental health literature a third type of statement occurs frequently: situations or societies are called healthy or sick. The German culture under national-socialist domina-tion has been called paranoid; totalitarian systems are often regarded as unhealthy in democracies; one of Fromm's re-cent books bears the title The Sane Society (1955).
On closer examination, however, all these examples (and many other possible ones) present merely a linguistic trap
INTRODUCTION [ 9 ]
in the discussion of mental health. To call a situation healthy or unhealthy is nothing but a colloquial ellipsis meaning that it is conducive to healthy or unhealthy behavior. In other words, mental health must be thought of as pertaining to a living organism with mental faculties; it cannot be attributed to any other entity.
This is, of course, not to say that the examination of aspects of a situation conducive to mentally healthy or unhealthy behavior is irrelevant. On the contrary: it is of the greatest importance, as will become clear in a later section. In the present context, however, where we are concerned with establishing the premises upon which mental health criteria can be established, the discussion of the situation is saper-fluous. The relation of environment to mental health — in other words, the conditions under which a person acquires enduring mental health or will act in a mentally healthy way — must be postponed until the legitimate meaning, if any, of mental health as an attribute of human behavior has been explored.
n
(^learing the Air:
Unsuitable Qonccvtualizations of Positive ^Mental Health
NIental health as the opposite of mental disease is per-haps the most widespread and apparently simplest attempt at definition. To accept this approach presupposes a defini-tion of mental disease. Notwithstanding the fact that mental disease is at present much better understood than mental health, efforts to define mental disease meet with consider-able diflEculties.
THE ABSENCE OF MENTAL DISEASE
AS A CRITERION FOR MENTAL HEALTH
At the present stage of our knowledge, mental disease in many cases cannot be inferred from physiological changes in the functioning of the organism. When psychiatrists agree among themselves that they are deaUng with a mentally sick person, they use as the basis for inference highly complex [lo]
UNSUITABLE CONCEPTUALIZATIONS [ II ]
behavior patterns whose physiological correlates are usually not known.
When a person has lost "contact with reality," hallucinates, or is completely unable or unwilling to perform essential functions for survival, general agreement is quickly achieved. But there are many mentally ill persons who do not (at least not consistently) show such extreme symptoms. Here, diagnosis is not nearly as unanimous. On the other hand, there are situations in which apparently healthy persons may show one or several of these severe symptoms. Whether or not to call such persons sick will depend on whether the classification is made in terms of enduring personality at-tributes or in terms of currently observed actions.
To make explicit all the criteria leading to the diagnosis of disease is a bafHing task. By and large, practitioners prefer to think in terms of personality attributes, whereas classifica-tion of actions has proved more useful in many research efforts. This question was debated in a Milbank Fund sym-posium (1953). Definitions of the following kind were re-ported: "A case is a person under the care of a psychiatrist"; or, with reference to children, "a 'case' is a child about whom the schoolteacher says, 'This child's behavior is not like most children's. The child is making trouble or having trouble.' "
These crude rule-of-thumb definitions actually served a purpose for research; at least they permitted it to get off the ground. But those who used these definitions were ready to admit severe limitations. For instance, probably many very sick people are not under the care of a psychiatrist; also, a much higher rate of mental disease was implied in com-munities having a psychiatrist than elsewhere. These defini-tions were adopted not out of a lack of sophistication, cer-tainly, but in the realization that they provided an expedient of starting research. The suggestion wsls also made that in our present state of knowledge a comprehensive concept of mental disease v^as perhaps premature.
[ 12 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
Such self-critical restraint on the part of people v^ell- qualified to define mental disease receives much support from anthropological studies. Some of these throv;^ doubt on the use of some symptoms for the diagnosis of disease.
Anthropologists tell us of generally accepted behavior in some cultures that Western civilization v^ould regard a.n symptomatic of mental disease. According to Ruth Benedict (1934), the Kwakiutl Indians of British Columbia engage in behavior that is, by our standards, paranoid and megalo-maniacal. Their viev7 of the v^orld is similar to a delusion of grandeur in our culture. Alexander interprets the Buddhistic self-absorption of mystics in India, with its physical mani-festations of rigidity and immobility, as an artificial schizo-phrenia of the catatonic type (Klineberg, 1954). However, it is apparently true that the Buddhist can control the onset and end of his "symptoms," a feat the schizophrenic person in our culture cannot perform.
The example suggests that similarities in symptoms must not be mistaken for identical disturbances of functions. It also illustrates — and this is important here — that whereas identical observable symptoms are regarded in one culture as achievement, in another they are regarded as a severe debility. In our culture, adolescent boys who are exposed to homo-sexual advances often take this as a sign that there is some-thing fundamentally wrong with them. In some cultures, the absence of a homosexual approach is interpreted in the same fashion. Examples could be multiplied to indicate that the
UNSUITABLE CONCEPTUALIZATIONS [ ^3 ]
evaluation of actions as sic\, or normal, or extraordinary in a positive sense often depends largely on accepted social con-ventions.
Some anthropologists, however, have taken a strong stand against cultural relativism in the identification of mental disease. Devereux (1956), for example, argues that the shaman is mentally sick, even though his illness takes a culturally approved form. Linton's idea of culturally pre- scribed "patterns of misconduct" points in the same direction. The fact that there are in various cultures different "proper ways to be insane" need not imply that the functional dis-turbance in itself varies from culture to culture. Only with regard to the manifestations of the disease is cultural rela-tivism appropriate.
Devereux bases his argument on psychoanalytic theory, thinking of mental disease as the expression of conflicts in the unconscious. But it has not yet been demonstrated that there are any human beings who are free from unconscious conflicts. If it is reasonable to assume that such conflicts are universal, we are all sick in different degrees. Actually, the difference between anyone and a psychotic may lie in the way he handles his conflicts and in the appearance or lack of certain symptoms. If this is so, mental disease must in-evitably be inferred from behavior. But, apart from extremes, there is no agreement on the types of behavior which it is reasonable to call "sick."
The differential evaluation of symptoms is not limited to cross-cultural comparisons. Within our society, a farmers' community may well regard as symptoms of mental dis-order the behavior of, say, an urban artists' colony. It follows,then, that human behavior cannot be understood in terms of
[ 14 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
isolated symptoms but must rather be viewed in conjunction with the social norms and values of the community in which the symptoms are observed (Asch, 1952). Whether empirical and theoretical work on mental disorder will one day result in the identification of certain disturbances re-garded as "disease" in all known cultures is as yet an open question.
Furthermore, the borderline between what is regarded as normal and as abnormal is dim and ill-defined in all but the extreme cases. Character disorders of various types, for ex-ample, belong to that large area where the label "mental disease" is not much more appropriate than that of the label "mental health," unless we can discover more rigorous criteria for one or the other than are implied by the current usage of these terms.
In discussions of these complex issues, a daring thought has recently been put forward that makes the definition of psy-chological health as the absence of mental disease even more doubtful. Such a definition is based on the assumption that health is the opposite of disease, or that health and disease form the extreme poles of a continuum. What if this as-sumption should turn out to be unjustified and misleading ? Some psychiatrists now speak of different health potentials in seemingly equally sick patients, as if they were deaHng with two quaUtatively different continua. We shall return to this idea later on.
At this moment, however, the apparent difficulty in clearly circumscribing the notion of mental disease makes it un-likely that the concept of mental health can be usefully de-fined by identifying it with the absence of disease. It would
UNSUITABLE CONCEPTUALIZATIONS [ ^5 ]
seem, consequently, to be more fruitful to tackle the con-cept of mental health in its more positive connotation, noting, however, that the absence of disease may constitute a necessary, but not a sufficient, criterion for mental health.
NORMALITY AS A CRITERION FOR
MENTAL HEALTH
As far as normality is concerned, w^hat has been learned from cultural anthropologists can hardly be overestimated. Their entire w^ork can be regarded as a series of variations on the theme of the plasticity of human nature and, accord-ingly, on the vast range of v^^hat can be regarded as normal. They have convincingly demonstrated a great variety of social norms and institutions in different cultures in different parts of the world; and that in different cultures different forms of behavior are regarded as normal.
It is generally accepted that the term normaHty covers two different concepts: normality as a statistical frequency con-cept and normality as a normative idea of how people ought to function. In the statistical sense of the term it is correct to say, for example, that normal adults are married. Whether or not the statement makes sense in the normative connota-tion is another matter. It may well be that for this example there is a coincidence of statistical and normative correctness. But such coincidence would be fortuitous. To believe that the two connotations always coincide leads to the assertion that whatever exists in the majority of cases is right by virtue of its existence. The failure to keep the two connotations of normality separate leads straight back into an extreme cul-
[ l6 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
tural relativism according to vi^hich the storm trooper, for example, must be considered as the prototype of integrative adjustment in Nazi culture.
Insofar as normality is used in the normative sense, it is a synonym for mental health, and the problems of concept definition are, of course, identical.
It remains to be seen vi^hat can be learned from the frequency concept. ImpHcitly, if not explicitly, many per-sons regard what the majority of people feel, think, and do as healthy, and deviations from the average as not healthy. This belief is fostered by the unquestionable fact that, v^ith regard to many human attributes, the distribution of the population follows a normal or approximately normal curve; that is, the majority manifests a medium course, with progressively smaller proportions of cases as we move toward either extreme of behavior. This is true, for instance, for many biological functions (height, weight, and so forth).
However, a majority does many things we hesitate to call mentally healthy; for example, experiments have indicated that under conditions of hunger, people tend to see food where there is none. That the majority may respond in such fashion would perhaps be perfectly understandable; but this is different from regarding as psychologically abnormal those who, in spite of their hunger, maintain the abihty to perceive correctly, because they are at the extreme end of this particular distribution curve. Psychological health may, but need not, be the status of the majority of people.
Moreover, statistical definitions of psychological health in-volve basically nonstatistical considerations. As Ernest Jones (1942) has pointed out, "If once the statistically normal mind is accepted as being synonymous with the psychologically
UNSUITABLE CONCEPTUALIZATIONS [ I7 ]
healthy mind (that is, the mind in which the full capacities are available for use), a standard is set up which has a most fallacious appearance of objectivity." Davis (1938), Wegrocki (1939), Mowrer (1948), and Redlich (1952) also deal with the concept of statistical normalcy.
In order to establish a statistical norm, one has to define the population from which it is to be derived. And the choice of a population inevitably contains, at least implicitly, a non-statistical concept of health. One would not, for example, develop a set of statistical norms for an arbitrarily merged population including both so-called primitive and civilized societies, males and females, children and adults. Why not ? Because it seems evident that the determining conditions of the same behaviors, the contexts, their consequences, and
hence their meanings, to either the actors or observers, are often likely to be quite different in different types of society,or in the two sex groups, or in different age groups. It fol-lows that in deciding upon a reference population, one is at least tacitly considering the determinants, contexts, conse-quences, and/or meanings of behavior relevant to its evalua-tion from the viewpoint of mental health.
Similarly, even when one has selected and defined there levant reference population, one would not give equal weight to all measurable psychological functions — say, the speed with which a person can cancel all of the as in a page of print, on the one hand, and the frequency of hallucinatory experiences, on the other — in developing a set of norms against which to evaluate the mental health status of individ-uals. For it seems clear that, whatever "mental health" may mean, not all psychological functions are equally relevant to it. We thus again find that some, at least tacit, nonstatistical considerations must precede the application of the statistical approach.
[ l8 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
The concept does not offer us any clues as to how to select and define a reference population or how to select and weight the psychological functions to be measured in an effort to evaluate positive mental health. If and when more appropriate criteria are discovered, their frequency distribu-tion in any population will become an interesting empirical question. But as a criterion in itself, normaHty is of no use.
VARIOUS STATES OF WELL-BEING AS
CRITERIA FOR MENTAL HEALTH
Many persons think of psychological health as manifested in a state of well-being. The World Health Organization, for example, defines health as "the presence of physical and emo-tional well-being." In this phrase written for international audiences, the term "emotional well-being" is but another label for mental health. Without a specification of what is meant by it, the phrase is of Httle help for our purposes.
Others have specified various criteria for an individual's different feeUng-states. Karl Menninger (1947), for example, says :
Let us define mental health as 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 to-gether. It is the ability to maintain an even temper, an alert in-telligence, socially considerate behavior, and a happy disposition. This, I think, is a healthy mind.
UNSUITABLE CONCEPTUALIZATIONS [ ^9 ]
This description contains a variety of criteria. Recognizing
that we are not deaHng with the full overtones and connota-
tions in Menninger's rich language, it is reasonable for pur-
poses of classification to select from his description, first, the
terms happiness and contentment; they have wide currency
as criteria of mental health. Menninger actually also assumes
"that the unhappy are always (at least partly) 'wrong' "! To
regard the unhappy as wrong or sick was apparently al-
ready prevalent about 1500 B.C., when the friends of Job told
him that the reasons for his utter misery must be sought in
himself.
Jones (1942) also talks of happiness as a criterion of nor-
mahty. Others prefer the term "satisfaction." Boehm (1955),
for example, writes: ''Mental health is a condition and level
of social functioning which is socially acceptable and per-
sonally satisfying"
In an informal inquiry conducted by the director of the
Joint Commission on Mental Illness and Health to ascertain
the meaning attached to mental health by a group of experts,
a fair number described their ideas in terms of happiness,
well-being, and contentment. There are obvious differences
in degrees and quality among these various highly desirable
states of being. To distinguish among them is, however, a
minor matter compared to a major problem inherent in all
efforts to regard various states of well-being as criteria for
mental health. This difl&culty has to do with the tacit as-
sumption that happiness or contentment need no special
referent or qualification.
In this global sense, people are happy if what they want
from life is in harmony with what life offers. Such happiness
[ 20 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
is clearly not only a function of the individual but also of
the course of external events over v^hich the individual has
no control. The use of unquaUfied euphoric states as criteria
of mental health leads to a difficulty perhaps most obvious
in Boehm's concept of mental health: What if social ac-
ceptability and personal satisfaction are incompatible ? What
if happiness or v^ell-being, satisfaction or contentment, free-
dom from conflict or tension is inappropriate in a life situa-
tion? Do individuals then have to be considered mentally
unhealthy? To answer this question in the affirmative be-
trays a naive belief in the moral justice of all existing
conditions.
But obviously, the persons quoted above are not naive.
Their formulations make it clear that they mean to speak in
terms of more or less enduring personality attributes. Thus
Menninger speaks not only of happiness but of a happy
disposition. And Jones, in recognizing the impact of ex-
ternal events on the degree of happiness a human being
experiences, is compelled to define happiness in a highly
idiosyncratic fashion as the ability to hold impulses in check,
w^ithout renouncing them, until they can be gratified. To
regard the unhappy disposition as a criterion of poor mental
health is one thing. To regard unhappiness, regardless of
the circumstances in v^hich it occurs, as such an indication
is a different matter.
To be sure, to some extent man selects and creates his ov^n
environment, and to that extent even the unqualified term
"happiness" appears as a possible criterion. But there are
many facets of the environment beyond the conscious or un-
conscious choice and creation of the individual. Misfortune
and deprivation are not necessarily of our own making. To
UNSUITABLE CONCEPTUALIZATIONS [ 21 ]
be happy under such conditions cannot seriously be regarded
as a criterion for mental health. Only when happiness or
well-being are clearly conceived of as personality predisposi-
tions, rather than as momentary feeling states depending on
circumstances, do these criteria appear useful. In this con-
notation they will enter into the subsequent discussion.
Ill
The ^sycholoncal '^caning of
Various QriUria for Positive
^Mentol Health
bo FAR, three efforts to give psychological meaning to the
notion of positive mental health have been examined and
found more or less v^anting. To regard the absence of mental
disease as a criterion has proved to be an insufficient indica-
tion in viev^ of the difficulty of defining disease. Normality,
in one connotation, is but a synonym for mental health; in
another sense it was found to be unspecific and bare of psy-
chological content. Various states of w^ell-being proved un-
suitable because they reflect not only individual functioning
but also external circumstances.
A survey of the relevant literature reveals a host of other
approaches to the subject v^hich seem more promising; at
least, at first sight, it appears that the objections raised in the
preceding pages do not apply to them. Although no claim
can be made that this survey discovered every contribution
to the topic, the search v^as extensive. It is hoped that no
major idea in the area has escaped our attention.
[22]
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ ^3 ]
SIX APPROACHES TO A CONCEPT
From an inspection of the diverse approaches uncovered,
six major categories of concepts emerge.
1. There are several proposals suggesting that indicators
of positive mental health should be sought in the attitudes of
an individual toward his own self. Various distinctions in
the manner of perceiving oneself are regarded as demon-
strating higher or lov^er degrees of health.
2. Another group of criteria designates the individual's
style and degree of growth, development, or self -actualization
as expressions of mental health. This group of criteria, in
contrast to the first, is concerned not with self -perception but
with what a person does with his self over a period of time.
3. Various proposals place the emphasis on a central
synthesizing psychological function, incorporating some of
the suggested criteria defined in (i) and (2) above. This
function will here be called integration.
The following three groups of criteria concentrate more
exclusively than the preceding ones on the individual's rela-
tion to reality.
4. Autonomy singles out the individual's degree of in-
dependence from social influences as most revealing of the
state of his mental health.
5. A number of proposals suggest that mental health is
manifested in the adequacy of an individual's perception of
reality.
6. Finally, there are suggestions that environmental mas-
tery be regarded as a criterion for mental health.
All ideas on positive mental health examined can be as-
[ 24 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
signed to one of these six categories with relative ease, even
though there is a certain amount of overlap. As v^ill become
apparent, many authors have made contributions to several
of the categories. And it could be argued that there exists an
empirical or theoretical relationship betw^een these groups.
But the purpose of this reviev^ is to present current thoughts
on criteria of positive mental health; not — at least, not yet —
to inquire into the relationship of these criteria to each
other, to an author's other contributions, or to theories.
One consequence of this emphasis on criteria is that sim-
ilarities may appear v^here theoretical differences have not
led one to expect them. Another is that it v^^ill be possible to
examine these criteria from the point of viev^ of mental
health, rather than of the fruitfulness of the general approach
of which they form part.
ATTITUDES TOWARD THE SELF AS
CRITERIA FOR MENTAL HEALTH
A recurring theme in many efforts to give meaning to the
concept of mental health is the emphasis on certain qualities
of a person's self. The mentally healthy attitude toward the
self is described by terms such as self-acceptance, self-con-
fidence, or self-reliance, each with sHghtly different connota-
tions. Self-acceptance impUes that a person has learned to
live with himself, accepting both the limitations and pos-
sibilities he may find in himself. Self-confidence, self-esteem,
and self-respect have a more positive slant; they express the
judgment that in balance the self is "good," capable, and
strong. Self-reliance carries the connotation of self-confidence
and, in addition, of independence from others and of initia-
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ ^5 ]
tive from within. However, the terms have become en-
trenched in everyday language in a manner leading to a
large overlap in their connotations.
There exists also an overlap in meaning with other terms
that indicate qualities of an attitude toward the self. Such
terms are, for example, self-assertion, self-centeredness or
egotism, and self-consciousness. These latter terms, however,
have not been proposed as criteria for mental health.
A number of different dimensions or components appear
to run through the various proposals. Those aspects of the
self -concept that stand out most clearly are: (i) accessibility
to consciousness, (2) correctness, (3) feeling about the self,
and (4) sense of identity. Although not all of these com-
ponents are made explicit by the writers who use attributes
of the self as criteria for mental health, they are impHcit in
many of their contributions. Inevitably, there is a certain
amount of overlap between these aspects.
Accessibility of the Self to Consciousness
In discussing attitudes toward the self, several writers refer
predominantly to the breadth of content encompassed by the
self -concept. For example, Mayman (1955), in speaking
about the self -determining attitude, says : "An intact sense of
selfhood or self-determination indicates a successful synthesis
by the individual of all that he has been and done, with all
that he wants to be and do, with all that he should and is
able to be and do, without his disowning any major feehngs,
impulses, capacities or goals in the interest of inner har-
mony."
In the course of his discussion of objectivity of self -percep-
tion, to which we shall return, Gordon W. Allport (1937)
[ 26 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
indicates that the mature personaHty shows ''self-objectifica-
tion, that pecuHar detachment of the mature person when
he surveys his own pretensions in relation to his abihties, his
present objectives in relation to possible objectives for him-
self, his own equipment in comparison with the equipment
of others, and his opinion of himself in relation to the opinion
others hold of him."
Both Mayman's and Allport's descriptions of a healthy
self-concept include a large variety of content, such as actions,
values, desires, obligations, and feelings in the past and
present and in anticipation of the future. Clearly the quota-
tions indicate that both authors regard a self-concept as de-
sirable — that is, healthy — when it contains an image of all
important aspects of the person. Mayman and Allport
require awareness of the self in a healthy person.
Barron, on the other hand, appears to regard self-aware-
ness as a counterindication of mental health (1955). He
says: "We pay no attention to our self when we are in the
best of health. It is when we are sick that the self comes to
our notice. A person just being himself is not self-conscious.
Self-consciousness arises from malfunction. . . ."
There is no necessary contradiction between the two views.
Allport and Mayman do not stipulate that the self-concept
must permanently dominate consciousness. There is in All-
port's statement an important quaHfication {"when he sur-
veys . . .") ; and Mayman's "intact sense of selfhood or self-
determination" may be close in meaning to Barron's "being
oneself." Nor does Barron require that the healthy person be
unable to be consciously aware of his own self. However, the
juxtaposition of these views on self-awareness brings into
sharp focus the fact that this criterion can serve as an in-
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ ^7 ]
dicator of mental health not at every moment but only when
concern with the self is appropriate.
Kubie (1954) makes the point clearly: "[This does not]
imply that in order to be healthy we must be self-consciously
aware either of our every act or of our every purpose, but
rather that the predominant forces must be accessible to
introspection on need."
Correctness of the Self-Concept
The idea that it is good to see the self realistically and
objectively is one of the most common in the mental health
literature, Gordon Allport, in the passage already quoted,
stipulates that self -inspection must be objective to be healthy.
Such objectivity requires an ability for detachment. The
temptation is strong to mistake what we would like to be
for what we are. Cattell sees the ideal self as tending to
merge with the real self (Hall and Lindzey, 1957). However,
negative distortions of the self-concept are certainly also
familiar in clinical settings. Whatever the direction, such
distortion is based on an inabiHty to control rationally the
wishes and fears that thus color the perception of the self.
It is in this sense that Fromm (1955) writes about mental
health as characterized "by the grasp of reaHty inside and
outside of ourselves, that is, by the development of objectivity
and reason."
Feelings about the Self-Concept
The fact that each self, and presumably therefore each
healthy self-concept, will contain some elements the owner
will be, and others he will not be, proud of gives rise to the
question of how he feels about himself. The most common
[ 28 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
proposal in the mental health literature is that he should
accept himself — presumably his self-concept — including his
shortcomings — i.e,, those elements of which he might not be
expected to be proud. Maslow (1950) affords a typical ex-
ample of this point of view:
Our healthy individuals find it possible to accept themselves and
their own nature without chagrin or complaint or, for that mat-
ter, even without thinking about the matter very much.
They can accept their own human nature with all its discrepan-
cies from the ideal image without feeling real concern. It would
convey the wrong impression to say that they are self-satisfied.
What we must rather say is that they can take the frailties and
sins, weaknesses and evils of human nature in the same unques-
tioning spirit that one takes or accepts the characteristics of na-
ture.
It is not clear whether Maslow takes the position that the
healthy person does not experience ego-alien impulses or that
his self-acceptance encompasses them too. His reference to
sins and weaknesses suggests the latter interpretation.
In any case, he and others who emphasize self-acceptance
are apparently referring to one's feeUng about the total con-
figuration of the self-concept rather than any single attribute
of it. Presumably, recognized shortcomings are accepted in
their relation to recognized strengths, and are realistically
evaluated in terms of the possibilities and costs of changing
the self.
Sense of Identity
Closely related to such balanced self-acceptance is another
aspect of the self -concept which is frequently discussed in the
mental health hterature: the sense of identity. What Cattell
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [29]
calls the self sentiment, or what McDougall calls the senti-
ment of self-regard apparently refers not to any specific
aspect of the self-image but rather to this integrative at-
tribute of the self (Hall and Lindzey, 1957). They mean a
global benevolent view of the whole self, a positive feeling
that pervades and integrates all other aspects of the self-
concept. The distinguishing mark of this aspect as com-
pared to self-acceptance is its more cognitive emphasis on
the clarity of the self-image. A healthy person knows who
he is and does not feel basic doubts about his inner identity.
The sense of identity as an indicator of positive mental
health has been particularly emphasized in Erikson's work
(1950). He talks about it as the fifth stage in the develop-
ment of a healthy person. (The preceding stages are basic
trust, autonomy, initiative, industry.) Ego-identity, he says,
"is the inner capital accrued from all the experiences of each
successive stage, when successful identifications led to a suc-
cessful alignment of the individual's basic drives with his
endowment and his opportunities. . . . The sense of ego
identity, then, is the accrued confidence that one's ability to
maintain inner sameness and continuity (one's ego in the
psychological sense) is matched by the sameness and con-
tinuity of one's meaning for others."
He contrasts this sense of identity with "a sense of self-
diffusion which is unavoidable at a time of Hfe when the
body changes its proportions radically . . . ," here implying
the close relationship between the sense of identity and the
body-image. As a consequence of ego-identity, "real intimacy
with the other sex (or, for that matter, with any other per-
son or even with oneself) is possible. . . . The youth who is
not sure of his identity shies away from interpersonal in-
[ 30 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
timacy; but the surer he becomes of himself, the more he
seeks it in the forms of friendship, combat, leadership, love
and inspiration."
Most v^Titers dealing v^ith the sense of identity emphasize
that its acquisition is the result of a long period of develop-
ment, thus implying that a sense of identity is a suitable
criterion for mental health probably only in adulthood, cer-
tainly not in childhood. Robert White (1952), relating his
ideas to those of Erikson and Henry Murray, says: "There
are many vicissitudes in the development of ego identity, but
the overall trend is toward an increase of stabihty. . . .
When one takes a long enough span of time, continuing v^ell
into adulthood . . . ego identity can be seen to become not
only more sharp and clear but also more consistent and free
from transient influences. It becomes increasingly determined
by accumulated personal experiences. In this v^ay it progres-
sively gains autonomy from the daily impact of social judg-
ments and experiences of success and failure."
GROWTH, DEVELOPMENT, AND SELF-
ACTUALIZATION AS CRITERIA
FOR MENTAL HEALTH
A number of authors see the essence of mental health in
an ongoing process variously called self-actualization, self-
realization, growth, or becoming. The idea that the organism
strives permanently to realize its own potentiaUties is old.
Fromm (1947) credits Spinoza with having seen the process
of development as one of becoming what one potentially is.
"A horse would be as much destroyed if it were changed
into a man as if it were changed into an insect," Spinoza
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 3^ ]
said. Fromm continues: "We might add that, according to
Spinoza, a man would be as much destroyed if he became
an angel as if he became a horse. Virtue is the unfolding of
the specific potentialities of every organism; for man it is the
state in vi^hich he is most human."
The term self-actuaHzation probably originated with Gold-
stein (1940). He spoke about the process of self-actuaHzation
as occurring in every organism and not only in the healthy
one: "There is only one motive by which human activity is
set going: the tendency to actualize oneself." The idea is
echoed in Sullivan's dictum, "the basic direction of the or-
ganism is forward," and it also dominates the thinking of
authors such as Carl Rogers, Fromm, Maslow, and Gordon
Allport. Sometimes the term is used as implying a general
principle of life, holding for every organism; at other times
it is applied specifically to mentally healthy functioning.
It is not always easy to distinguish these two meanings in
the mental health literature. This lack of clarity probably has
something to do with the controversial philosophical concept
of Aristotelian teleology, to which the notion of realizing
one's potentialities is related. The need for making the dis-
tinction in a discussion of mental health becomes urgent if
one realizes that not only the development of civilization but
also self-destruction and crime, from petty thievery to geno-
cide, are among the unique potentialities of the human
species.
Mayman (1955) is of the opinion that some of the pro-
ponents of self-actuaHzation as a criterion of health have not
succeeded in making the distinction. In a critical discussion
of Rogers' use of the term, he says: "This position is insuf-
ficient in several respects: it presumes that this growth force
[ 32 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
is equally potent in all people; that if given the right of v^ay,
this force will inevitably assert itself for good ; but most im-
portant of all it treats this force v^^ith almost religious awe
rather than scientific curiosity. This urge to grow and be
healthy is treated as an irreducible essence of life."
To make this life force an aspect of positive mental health
requires that certain quaHfications be introduced to dis-
tinguish its manifestations in healthy persons.
The process of self-actualization, as a rule, is described in
rather global terms that make it difl&cult to identify con-
stituent parts. Nonetheless, the various authors who regard
it as a criterion of positive mental health seem to emphasize
one or more of the following aspects: (i) self-concept
(which has already been discussed and is mentioned here
only to indicate the breadth of the term self -actualization) ;
(2) motivational processes; and (3) the investment in living,
referring to the achievements of the self-actualizing person
as demonstrated in a high degree of differentiation, or max-
imum of development, of his basic equipment.
Motivational Processes
As indicated, Goldstein regards self-actualization as the
only motive of the organism. Fromm (1941) seems to share
this view when he says that the healthy individual recognizes
that "there is only one meaning to life: the act of living it-
self." The qualification of this general motivational process,
so that degrees of health can be distinguished, is more clearly
made by Maslow (1955). He distinguishes deficiency motiva-
tion from growth motivation. Everyone, he assumes, has a
need for safety, belongingness, love, respect, and self-esteem.
Deficiency motivation serves to satisfy these needs; it avoids
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 33 ]
illness but does not yet create positive mental health. Growth
motivation leads beyond such tension reduction to self-
actualization of potential capacities and talents, to devotion
to a mission in life or a vocation, to activity rather than rest
or resignation. A self-actualizing person experiences the
maintenance of tensions in these areas as pleasurable; he
cannot be understood as being motivated here by the need
for tension reduction. The greater the amount of growth
motivation, the healthier a person is.
Gordon Allport (1955) concurs with Maslow's distinction.
He says that growth motives "maintain tension in the interest
of distant and often unattainable goals. As such they dis-
tinguish human from animal becoming and adult from in-
fant becoming. By growth motives we refer to the hold that
ideals gain upon the process of development. Long-range
purposes, subjective values, comprehensive systems of in-
terest are all of this order." He regards the dynamics of
conscience as an example of growth motives.
Mayman (1955), too, suggests as one criterion of mental
health the concept of growth and direction tow^ard goals
higher than the mere satisfaction of basic needs. Mayman
calls this drive to change and development the heterogenic
attitude. He contrasts it with "the immobilization of those
patients who seem to prefer the security of their illness to
the prospect of change, who seem not only to fear their own
spontaneity, but even try to stifle this spontaneity. People
with minimal evidence of the heterogenic drive seem to feel
no wistful yearning for freedom or a richer life, but cling
desperately to their imprisonment, like Lorenz's quasi-
domesticated animals who refuse to part with their cages."
Mayman links this inner push toward new experiences to
[ 34 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
Freud's life instinct: "We view the self -actualizing pro-
pensities of a person as aspects of the Ufe-long cycle of
growth and decline. They are expressions of what Freud
has called the 'life instinct,' that set of forces which tends to
upset established levels of equilibrium and move the in-
dividual toward new and more complex equilibria. . . .
The 'life instinct' comprises all the impulses which tend
toward pleasureful contact with others, synthesis and growth.
These are the pressures which we presume to be responsible
for the restless dissatisfaction with one's psychological status
quo which we are here calhng the heterogenic impetus.' "
Investment in Uving
Pervading many of the passages already quoted is an im-
plied criterion that mental health shows itself in a rich, dif-
ferentiated life, involvement in various pursuits not restricted
to what must be done for sheer survival. Several authors have
been quite expHcit on the point. Gordon Allport (1937), for
example, speaks about the extension of the self as an attribute
of maturity, describing it as an ability to lose oneself in work,
in contemplation, in recreation and in loyalty to others.
Maslow (1955) found that self-actualizing people "in general
focused on problems outside themselves"; they have "feel-
ings for mankind ... a genuine desire to help the human
race"; they are capable of "deeper and more profound inter-
personal relations than any other adults"; they are "strongly
ethical, they have definite moral standards."
Mayman (1955) formulates much the same idea as a
process characterizing mentally healthy persons in speaking
of their investment in living; by this, he means the range and
quality of a person's concern with other people and the
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 35 ]
things of this world, the objects and activities that he con-
siders significant. With such investment in Hving goes a
"capacity to evoke an empathic, w^arm or compassionate re-
sponse from others," he states. This observation is related to
Maslow's finding that self-actualizing people seem to at-
tract friends and admirers.
Lindner (1956) uses the term "employment" for this aspect
of self-actuaUzation. He describes it as "an attitude of affirma-
tive dedication to existence, of profound and complete par-
ticipation in living."
In Jung's optimistic psychology, "Self -actualization means
the fullest, most complete differentiation and harmonious
blending of all aspects of man's total personaUty" (Hall and
Lindzey, 1957). Implicit in Jung's general formulation, and
explicit in those of the other authors, is the notion that the
healthy individual demonstrates concern for others and does
not center all his strivings on satisfying his own needs. We
shall meet this idea again in a later section.
It should be noted that the investment-in-living aspect of
self-actualization can hardly be separated from its motiva-
tional aspects. Presumably the individual must be committed
to these higher goals — concern with others, with work, ideas,
and interests — and motivated to realize them, in order to
achieve them.
INTEGRATION AS A CRITERION FOR
MENTAL HEALTH
In the proposals suggesting certain qualities of the self-
concept or self-actualization, or both, as criteria for mental
health, there is as a rule, implicit or expUcit, another crite-
[ 36 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
rion: this is generally called integration of the personality.
Indeed, some writers clearly treat this additional criterion as
part of either the self -concept or of self -actualization. Others
single it out for special treatment. In view of its great im-
portance to some, it will be treated here as a major category
in its own right.
Integration refers to the relatedness of all processes and
attributes in an individual. The coherence of personality,
often referred to as the unity or continuity of personality, is
an axiomatic assumption in much psychological thought. In-
deed, psychological treatment of mental patients as a rule is
predicated on the search for a unifying principle in terms of
which the apparently most bizarrely inconsistent manifesta-
tions of personaUty can be understood to hang together.
When integration is proposed as a criterion for positive
mental health, something additional or different is implied.
Some authors suggest that integration as a criterion for
mental health refers to the interrelation of certain areas of
the psyche; others, that it lies in the individual's awareness
of the unifying principle. Still others imply that there are
distinctions in the degree or strength of the integrating fac-
tor. And some are silent on this point.
Integration as a criterion for mental health is treated, as a
rule, with emphasis on one of the following aspects: (i) a
balance of psychic forces in the individual, (2) a unifying
outlook on life, emphasizing cognitive aspects of integration,
and (3) resistance to stress.
Balance of Psychic Forces
As a consequence of the psychoanalytic orientation of
writers who speak about this criterion, it is formulated either
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 37 ]
as a specific balance of ego, superego, and id, or of uncon-
scious, preconscious, and conscious psychic events. Earlier
psychoanalytic formulations of health implied the exclusive
domination of the ego rather than the notion of a balance
between ego, superego, and id. Heinz Hartmann (1947)
takes exception to this idea, w^hich takes too Hterally Freud's
programatic statement: "Where Id v^as, there shall Ego be."
Hartmann regards complete ego-domination as an un-
healthy type of balance. According to him, the notion of a
totally rational human being (i.e., complete ego control) is
a caricature of man, even though one takes for granted "the
positive value of rational thinking and action for the in-
dividual's adjustment to the environment." His notion of the
proper balance suggests an ego that can accommodate its
corresponding id and superego and does not aim at eUm-
inating or, perhaps, denying their demands. Thus he agrees
vv^ith Kris (1936), v^ho speaks of "regression in the service of
the ego" as a preferred form of human functioning under
certain circumstances, for example in the reUnquishing of
ego control when one wants to fall asleep.
Hartmann argues that rationalism is not synonymous
with health, even though "it still plays a role where standards
of health ... are discussed. Thus it is often maintained
that the freedom of the individual to subordinate other ten-
dencies to what is useful for him makes the difference be-
tween healthy and neurotic behavior. Actually this is too
small a basis to build upon it a definition of health. The
ego-interests are only one set of ego-functions among others;
and they do not coincide with that ego-function that also
considers the demands of the other psychic systems . . . ;
their prevalence in an individual does not warrant that the
[ 38 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
drives are harmoniously included in the ego, nor that the
super-ego demands have been integrated into it."
Expanding on these ideas in another paper, Hartmann
(1939) speaks of the plasticity of the ego as "one prerequisite
of mental health. . . . But we v^ould add that a healthy ego
is not only and at all times plastic. Important as is this
quahty, it seems to be subordinated to another of the ego's
function ... a healthy ego must evidently be in a position
to allow some of its most essential functions, including its
'freedom,' to be put out of action occasionally, so that it may
abandon itself to 'compulsion' (central control)."
Here, the idea of balance is further modified. Not only
does the healthy balance encompass id and superego, but
the balance is changeable. Perhaps most of the time it is
anchored in the ego; at other times the anchorage shifts to
one of the other two systems.
Kubie (1954), too, sees the criterion of mental health in
a specific balance of psychic forces; in his view, a balance
among unconscious, preconscious, and conscious forces, with
the unconscious reduced to a minimum. "The implicit ideal
of normality that emerges ... is an individual in whom
the creative alliance between the conscious and preconscious
systems is not constantly subjected to blocking and distortion
by the counterplay of preponderant unconscious forces,
whether in the prosaic affairs of daily Hving, in human re-
lations, or in creative activity." This healthy balance will
result in flexibility: "Thus the essence of normality is flexi-
bility, in contrast to the freezing of behavior into patterns
of unalterabihty that characterizes every manifestation of
the neurotic process, whether in impulses, purposes, acts,
thoughts or feelings. Whether or not a behavioral event is
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 39 ]
free to change depends not upon the quality of the act itself,
hut upon the nature of the constellation of forces that has
produced it. No moment of behavior can be looked upon as
neurotic unless the processes that have set it in motion pre-
determine its automatic repetition irrespective of the situa-
tion, the utility, or the consequences of the act!'
The similarity between the approaches of Hartmann and
Kubie is clearest in the former's emphasis on a changeable
balance and the latter 's emphasis on flexibility.
A Unifying Outloo\ on Life
A different tone and terminology is used by those who
talk about integration on the cognitive level. Allport (1937),
for example, speaks about a unifying philosophy of life as
a sign of maturity. He regards this unifying philosophy as
reconciling two otherwise conflicting tendencies. Self-exten-
sion — i.e., losing oneself in the things of the world — and
self-objectification — i.e., looking at one's self with detach-
ment — present an antithesis requiring resolution by an in-
tegrative factor.
Such a philosophy is not necessarily articulate, at least not
in words. But a mature person "participates and reflects,
lives and laughs, according to some embracing philosophy
of life developed to his own satisfaction and representing to
himself his place in the scheme of things."
Allport discusses several types of unifying philosophies.
The first is religion, the "search for a value underlying all
things, and as such . . . the most comprehensive of all the
possible philosophies of life." There is also the esthetic phi-
losophy, where the quest for beauty is the prime value. All-
port views these outlooks as "autonomous master-sentiments
[ 40 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
that give objective coherence and subjective meaning to all
the activities of their possessors' lives."
Apparently, the unifying philosophy of life results in the
individual's feeling that there is purpose and meaning to
his life. On a time dimension, the unity theme is presented
by Allport as the intentions of the present which commit
the individual to strive for specific aspects of the future. In
Becoming (1955), Allport introduces a nev^ concept, the
proprium, for this integrating function. The proprium repre-
sents all regions of hfe regarded as central to the self and in-
cludes all aspects of personality making for inner unity.
Propriate striving distinguishes itself from other forms
of motivation in that, however beset by conflicts, it makes
for unification of personality. "The possession of long-range
goals, regarded as central to one's personal existence, dis-
tinguishes the human being from the animal, the adult from
the child, and in many cases the healthy personaHty from
the sick."
Similar ideas occur in Maslow (1954), v^ho speaks of the
self-actualizers as "being the most ethical of people even
though their ethics are not necessarily the same as those of
the people around them," and in Barron (1955), who em-
pirically found "character and integrity in the ethical sense"
in persons judged to have a high degree of personal sound-
ness. In both statements there is a clear implication that
healthy persons possess a unifying outlook on life.
Thus, it is in the light of this aspect of integration — the
unifying outlook on life — that the criterion of self-actualiza-
tion becomes further qualified. The self-actuaHzed person's
investment in living is strong not because he was predestined
to develop it but because he has a unifying outlook which
PSYCHOLOGICAL MEANING OF VARIOUS CRITERLA [ 4^ ]
guides his actions and feelings so that he shapes liis future
accordingly.
In the discussion of integration as a criterion for mental
health Erikson's concept of identity, mentioned previously
as an aspect of the self, must be mentioned again. In addi-
tion to the meaning of identity pointed out before, this mas-
ter concept encompasses the balance of psychic forces as well
as the notion of a unifying outlook on Hfe. The former is
clearly demonstrated where Erikson (1950) talks about the
function of the sense of identity: "Psychologically speak-
ing, a gradually accruing ego identity is the only safeguard
against the anarchy of drives as well as the autocracy of con-
science, . . ." And his concern with a unifying outlook be-
comes clear when he speaks of ego-integration (practically
synonymous with ego-identity) as the crowning stage of
development in terms such as, "It is the acceptance of one's
one and only life cycle and of the people who have become
significant to it as something that had to be and that, by
necessity, permitted of no substitutions. ... It is a sense of
comradeship with men and women of distant times and of
different pursuits, who have created orders and objects and
sayings conveying human dignity and love."
Resistance to Stress
Those who discuss mental health as manifested in a par-
ticular response to stressful situations are actually concerned
with distinguishing healthy from less healthy degrees of
integration. The use of terms connoting behavior under
stress — resilience, anxiety- or frustration-tolerance, and the
like — leads to greater concreteness in specific criteria than
does the use of the more general concept integration. Jack
[ 42 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
R. Ewalt (1956) defines mental health as "a kind of resili-
ence of character or ego strength permitting an individual,
as nearly as possible, to find in his world those elements he
needs to satisfy his basic impulses in a v^ay that is acceptable
to his fellovi^s or, failing this, to find a suitable sublimation
for them. . . . This resilience of character should be such
that he can adapt himself to the vicissitudes of fortune, bounc-
ing back to find nev^^ ways of satisfaction or sublimation
after defeat. . . ."
Similarly, Wesley Allinsmith and George W. Goethals
(1956) regard abiUty to withstand adverse events without
inner damage as a criterion of health when they say: "When
in conflict and unable to solve the matter rationally, the per-
son has strong enough personaHty organization ('ego
strength') or, as some would say, is 'secure' enough, to be
able to stand the tension. A person with these characteristics
is often spoken of as having 'frustration tolerance' or being
able to 'delay gratification'; tension does not put the person
into a panic."
All authors who talk about this aspect agree that tension,
anxiety, frustration, or unhappiness occur in normal and
in sick persons. The difference lies not in the presence of
symptoms but rather in whether these symptoms can seri-
ously unbalance the degree of integration an individual has
achieved.
Thus Glover (1932) says, "a normal person must show
some capacity for anxiety tolerance."
In an interesting empirical study on the behavior of pa-
tients under pre- and postsurgical conditions, Janis (1956)
goes perhaps even a step further. Not only does the mentally
healthy person tolerate anxiety without disintegration but.
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 43 ]
he suggests (at least by implication), the healthy person
must be able to produce and experience anticipatory anxiety
in order to cope better with subsequent danger.
Thus, the once popular notion that the absence of anxiety
could serve as a criterion for mental health has fallen into dis-
repute. Whether or not one agrees with TilHch (1952), in his
distinction of existential (healthy) from nonessential (patho-
logical) anxiety, most authors in the field assume anxiety to
be a universal experience. The individual's manner of coping
with it is taken as the health criterion. TiUich thinks of self-
affirmation and courage as the appropriate way of facing
one's anxiety.
A NOTE ON REALITY-ORIENTATION
Three criteria — autonomy, perception of reaHty, and en-
vironmental mastery — share an explicit emphasis on reality-
orientation. To be sure, this also has played a role in the
criteria for positive mental health already presented. But as
reality becomes the focus of attention, discussion in the
mental health Hterature leads not infrequently into philo-
sophical problems about its nature. This eternal question we
wish to avoid. This is made easier by the fact that some
relevant central and tangential aspects of this question ac-
tually are no longer controversial. The central aspect con-
cerns the shift brought about by the development of modern
science from a concept of static to a concept of changing
reality. Says Wendell Johnson (1946) : "No other fact so un-
relentingly shapes and reshapes our hves as this : that reaHty,
in the broadest sense, continually changes; once we grasp
clearly what has been 'known' for centuries and what is, in
[ 44 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
fact, the central theme of modern science, that no two things
are identical and that no one thing is ever twice the same,
that everywhere is change, flux, process, we understand that
we must live in a world of differences. . . ."
The tangential aspect of the philosophic question directly
bearing on mental health — the dispute over whether there
exists an essential hostility or a compatibility between man
and the reaUty he is born into — no longer spHts various
schools of psychological thought into opposed camps. With
the development of psychoanalytic ego-psychology and its
conception of ego-forces and conflict-free ego functions
as part of the native equipment (Hartmann, 1951), the psy-
choanalytic school has clearly indicated that it does not sub-
scribe to the unqualified view of reality as hostile to man.
Academic psychology, which long has accused psychoanaly-
sis of just this sin, always has had room for aspects of reality
both supporting and thwarting the individual's needs.
The positive aspect of reaHty as a pleasurable challenge
and stimulation to the individual has recently been restated
by Charlotte Biihler (1954). Taking note of psychoanalytic
ego-psychology, Biihler says: "This concept of a positive
reality would also imply the postulation of pleasurable ac-
tivity ('function pleasure,' K. Biihler) ; that is, a pleasure in
the stimulating process as such, not only in its elimination.
Coping or mastery is from this point of view not identical
with abolishment of stimulation, which is only one of two
possible resolutions. Only harmful stimuli are mastered by
way of elimination. The mastery of 'positive stimuli' lies in
the integrative utilization of the organism's building process
by means of which the living being becomes active in struc-
turaHzing material and imposing its own law on it."
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 45 ]
The thought that the enjoyment of reality is good in itself
is already embodied in the wisdom of the Talmud; it states
that everyone v^ill have to justify himself in the Ufe here-
after for every failure to enjoy a legitimately offered pleasure
in this w^orld.
The emphasis on the positive aspects of reality is called
for because, although the controversy has virtually been re-
solved on the theoretical level, it still lingers in discussions of
mental health. Here the tacit assumption frequently still is
that the w^orld is fundamentally hostile to the individual.
This may be the result of the fact that, historically, concern
v^ith health grew out of concern with disease.
The point has been raised here to avoid repetitive interpre-
tation in the following sections. Unless there are good reasons
to the contrary, we will assume that the authors quoted do
not take an either-or position with regard to the relation
of man to reaUty and that they are aware of the complexity
of human experience in which positive and negative aspects
of reality are not neatly separated.
AUTONOMY AS A CRITERION FOR
MENTAL HEALTH
Many persons regard an individual's relation to the world
as mentally healthy if it shows what is referred to variously
as autonomy, self-determination, or independence. Most
often, these terms connote a relation between individual
and environment with regard to decision-making. In this
sense, autonomy means a conscious discrimination by the
individual of environmental factors he wishes to accept or
reject. But occasionally autonomy is interpreted as a with-
[46] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
drawal from reality, as less need for the stimulation offered
by the world, or as a small degree of involvement in external
matters.
Expositions of the criterion of autonomy deal with one or
both of two aspects: (i) The nature of the decision-making
process, emphasizing the regulation of behavior from within,
in accordance with internaHzed standards; (2) The out-
come of the decision-making process in terms of independ-
ent actions.
Regulation of Behavior from Within
Foote and Cottrell (1955) describe autonomy as referring
to "the clarity of the individual's conception of self (iden-
tity) ; the extent to which he maintains a stable set of internal
standards for his actions; the degree to which he is self-
directed and self -controlled in his actions; his confidence in
and reliance upon himself; the degree of self-respect he main-
tains; and the capacity for recognizing real threats to the self
and of mobilizing realistic defenses when so threatened."
Hartmann (1947) speaks of "a general trend of human de-
velopment, the trend toward a growing independence from
the immediate impact of present stimuli, the independence
from the hie et nunc"; and, somewhat later, of the "growing
independence from the outside world, insofar as a process
of inner regulation replaces the reactions and actions due
to fear of the social environment (social anxiety)."
Mayman's description (1955) of what he calls the self-
determining attitude avoids the connotation that autonomy
manifests itself only when reality is threatening: "One's be-
havior should not be determined by external exigency alone,
but dictated also from within, based upon that inner organi-
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 47 ]
zation of values, needs, beliefs, accomplishments and still
unrealized goals, which together comprise that individual's
world view."
Independent Behavior
Maslow (1954) starts his description of autonomy much
like Hartmann when he says it means a "relative independ-
ence of the physical and social environment." But he goes
on to describe, not the inner processes which make such in-
dependence possible, but rather their consequences. Accord-
ing to him, autonomous people more than others "are not
dependent for their main satisfactions on the real world, or
other people or culture or means-to-ends or, in general, on
extrinsic satisfactions. Rather they are dependent for their
own development and continued growth upon their own
potentialities and latent resources. . . . This independence
of environment means a relative stabihty in the face of hard
knocks, blows, deprivations, frustrations and the like. These
people can maintain a relative serenity and happiness in
the midst of circumstances that would drive other people to
suicide. They have also been described as 'self-contained.' "
Here there is a connotation that autonomy is a safeguard
against the badness of the world, as if the only external
events to be taken into account were those in conflict with
internal standards and needs.
David Riesman (1950), on the other hand, explicitly recog-
nizes that autonomy can manifest itself in going along with
the world as well as in opposing it. In The Lonely Crowd,
Riesman distinguishes various forms of characterological
adjustment to the demands of society (tradition-directed,
inner-directed, other-directed). These types of adjustment
[ 48 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
are different alternatives to the malad justed, whom he calls
anomic. The autonomous persons are those who on the
whole are capable of conforming to the behavioral norms of
their society — a capacity the anomics usually lack — but who
remain free to choose whether to conform or not. Whatever
their choice, they are less the creatures of circumstance than
any of the other characterological types.
These conflicting interpretations of autonomy as a criterion
of positive health are, perhaps, the result of contamination
by another aspect of autonomy: not only how decisions are
made and what consequences they have in behavior but also
the content and aim of the decisions. This last aspect has
actually been selected by Andras Angyal (1952) in his use
of the term. Angyal describes the over-all pattern of per-
sonality functioning as a two-directional orientation: ''self-
determination on the one hand and self-surrender on the
other." Both tendencies exist in all persons.
The goal of the former, which he calls the trend toward
increased autonomy, is "to organize . . . the objects and the
events of his world, to bring them under his own jurisdiction
and government." The goal of the latter "to surrender him-
self wilHngly, to seek a home for himself in and to become
an organic part of something that he conceives as greater
than himself!' And later: "It is only in the counterfeit, the
unhealthy behavior that one or the other of these basic
orientations is partially obliterated; in a well-integrated per-
son the behavioral items always manifest both orientations
in varying degrees." Riesman's description of autonomous
persons is compatible with Angyal's balance of the two
trends.
At this point, the notion that mental health criteria have
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 49 ]
an optimal, rather than a maximal, degree becomes particu-
larly relevant. This idea, applicable also to other criteria and
particularly to multiple criteria of health, has been proposed
by M. Brewster Smith (1950). We shall return to it in an-
other context.
PERCEPTION OF REALITY AS A CRITERION
FOR MENTAL HEALTH
Pervading many efforts to conceptualize mental health is
the idea that the way an individual perceives the world
around him supplies an important criterion for his mental
health. As a rule, the perception of reality is called mentally
healthy when what the individual sees corresponds to what
is actually there. In the mental health literature, perception
is discussed invariably as social perception, meaning that the
conditions under which perception occurs or the object of per-
ception, or both, involve other human beings. This has an
implication for terminology. Even if it makes sense under
different conditions to speak of perception as distinguish-
able from other cognitive processes such as attention, judg-
ment, and thinking, social perception cannot be so isolated.
The term perception will here be used as implying various
modes of cognition.
Two aspects of reality perception are suggested as criteria
for mental health : perception free from need-distortion, and
empathy or social sensitivity.
Perception Free from Need-distortion
At first glance the stipulation that reality perception be
correct in a mentally healthy person appears so self-evident —
[ 50 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
perhaps as contrasted with the psychotic's loss of contact
with reality — that many authors present the criterion in an
almost axiomatic fashion. Indeed, it is often treated as the
sine qua non for reality adaptation. John Porterfield defines
mental health as "that state of mind in which the perception
of the environment, if not objectively accurate, is approxi-
mate enough to permit efficient interaction between the per-
son and his milieu; . . ." (Ewalt, 1956).
Jahoda (1950) introduces correct perception as a criterion
also in close conjunction with adaption to reaUty: ". . . cor-
rect perception of reality (including, of course, the self) may
serve as another useful criterion of mental health. Unless
active adjustment involving the modification of the environ-
ment is to rely on hit-or-miss methods, it must be based on
correct perception of the environment." Maslow (1954) ac-
cepts the same position: "Recently Money-Kyrle, an English
psychoanalyst, has indicated that he beHeves it possible to
call a neurotic person not only relatively inefficient but ab-
solutely inefficient, simply because he does not perceive the
real world as accurately or as efficiently as does the healthy
person. The neurotic is not only emotionally sick — he is cog-
nitively wrong T
Barron (1955), too, speaks of correct perception of reality
as one of his criteria for mental health.
Yet there is a major difficulty inherent in this apparently
self-evident criterion of mental health: it lies in the word
"correct." Particularly when the object of perception is social
in nature — ^but even when it is physical stimuli — who is to say
what is "correct".? If one perceives a landscape in terms of
form, another perceives it in terms of color, and a third in
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 5^ ]
terms of both these or of other facets, who is most "correct" ?
Or, with regard to a social object, if a teacher sees in a child
his limitations while another sees his potentialities, which
one is "correct"? Correctness as a criterion seems to carry
the implication that reality is static and limited and that
there is only one way of looking at it. Yet seeing new hith-
erto unnoticed things in the world around us which, while
they remain new, may appear incorrect to others, is cer-
tainly not mentally unhealthy in the opinion of the writers
on the subject.
The point at issue here is that "correctness" of perception
cannot mean that there is one and only one right way of
looking at the world around us. But whatever the individual,
and perhaps peculiar, way of perceiving the world, there
must be some objective cues to fit the resulting percept. This
is what accuracy or correctness mean when one speaks of
mentally healthy perception.
To avoid the connotation that there is one correct way of
seeing the world, the effort has been made to eliminate the
word "correct" altogether from the mental health criterion
and replace it by "relative freedom from need-distortion."
The author uses this phrase in suggesting that mentally
healthy perception means a process of viewing the world
so that one is able to take in matters one wishes were dif-
ferent, without distorting them to fit these wishes — that is,
without inventing cues not actually existing (Jahoda, 1953).
To perceive with relative freedom from need-distortion does
not mean, of course, that needs and motives are eliminated;
nor that they have no function in perception. The require-
ment is of a different nature: the mentally healthy person
[ 52 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
will test reality for its degree of correspondence to his wishes
or fears. One lacking in mental health will assume such cor-
respondence without testing.
Parents, for example, ordinarily wish that their children
will do well in school or fear that they may fail. A mentally
healthy parent will seek objective evidence and accept it, even
if it goes against his wishes. One lacking in mental health
will not seek evidence, or will reject it if it is presented to
him and it does not suit him.
As a mental health criterion, perception free from need-
distortion reveals itself in a person's concern for evidence to
support what he sees and anticipates.
Empathy or Social Sensitivity
Perception free from need-distortion is, perhaps, most diffi-
cult when the object of perception is a person — the self or
others. The former has aheady been discussed as the correct-
ness aspect of the self-concept. The latter, the perception of
the feelings and attitudes of others, has been suggested as a
separate criterion for positive mental health.
The major requirement of the healthy person in this area
is that he treat the inner life of other people as a matter
worthy of his concern and attention. Implicitly, he is also
expected to arrive at conclusions about others that are free
from distortion. Foote and Cottrell (1955) make this one
of the ingredients of interpersonal competence, a term they
use synonymously with mental health. They say: "People
appear to differ in their ability correctly to interpret the atti-
tudes and intentions of others, in the accuracy with which
they can perceive situations from others' standpoint, and
thus anticipate and predict their behavior. This type of social
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 53 ]
sensitivity rests on what we call the empathic responses."
It is perhaps worth noting that this criterion, although
appearing quite rarely in the mental health literature, has
received a good deal of attention from research psycholo-
gists. They have demonstrated by their errors and successes
the enormous difficulties in discovering its presence or ab-
sence. This is a point one suspects to be true for most of
these criteria, but there is evidence for this instance.
ENVIRONMENTAL MASTERY AS A CRITERION
FOR MENTAL HEALTH
Perhaps no other area of human functioning has more
frequently been selected as a criterion for mental health
than the individual's reality orientation and his efforts at
mastering the environment.
There are two central themes pervading the relevant
literature: the theme of success and the theme of adaptation.
As a rule, the former is specified as achievement in some
significant areas of living; the latter is a toned-down version
of the former, implying appropriate functioning with the
emphasis more often on the process than on its result.
In the mental health literature adaptation and environ-
mental mastery are treated on different levels of specificity.
Ordering these emphases roughly from most to least specific
forms of human functioning, these aspects can be distin-
guished: (i) the ability to love; (2) adequacy in love, work
and play; (3) adequacy in interpersonal relations; (4) effi-
ciency in meeting situational requirements; (5) capacity for
adaptation and adjustment; (6) efficiency in problem-
solving.
[ 54 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
The Ability to Love
In at least one instance the ability to love is entertained
as a criterion for mental health in the most narrow sense
of the word — as the ability to experience sexual pleasure.
Hacker (1945) says: "The biological concept as formulated
by Reich appears to be by far the most logical because it is
a medical concept of normality, derived from a theory
gained by the study of mental diseases. It states that the
attainment of full orgastic genital gratification is the only
yardstick of normality for the individual. This does not
necessarily imply that the sexual function is the most im-
portant one for man, though it recognizes sexuaHty as an
extremely sensitive indicator of the personality functioning
as a whole. The difficulty is to define what is meant by full
orgastic pleasure in every instance."
It may not be amiss to point out that orgastic pleasure
appears to be within the range of experiences open to the
rapist and other sex criminals who, by such a criterion, would
have to be regarded as mentally healthy.
But Hacker's paper, devoted to an eflfort to deal with the
difficulty of defining what is actually meant by full orgastic
pleasure, goes beyond it. Although he regards sexuahty as
the most sensitive criterion of health, he arrives at the con-
clusion that "the extent and form of integration in the total
personality is the criterion ; not whether one particular trend
accords with current social views on' sexual morality, or
religious teachings. Full integration of the personality, the
form and scope of which varies, according to the individual's
possibilities, becomes the yardstick of normality."
Erikson's formulation with its emphasis on sexual gratifica-
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 55 ]
tion experienced with a loved partner of the opposite sex
clearly meets the possible objection to a narrow view of
sexuality as a criterion of mental health (1950). He regards
sexual gratification as a sequel to the previously mentioned
stages in the normal psychic development: "Psychiatry, in
recent years, has emphasized genitality as one of the chief
signs of a healthy personality. Genitality is the potential
capacity to develop orgastic potency in relation to a loved
partner of the opposite sex. Orgastic potency here means not
the discharge of sex products in the sense of Kinsey's 'out-
lets' but heterosexual mutuality, with full genital sensitivity
and with an over-all discharge of tension from the whole
body . . . the idea clearly is that the experience of the
climactic mutuaHty of orgasm provides a supreme example
of the mutual regulation of complicated patterns and in some
way appeases the potential rages caused by the daily evidence
of the oppositeness of male and female, of fact and fancy, of
love and hate, of work and play. Satisfactory sex relations
make sex less obsessive and sadistic control superfluous."
Adequacy in Love, Wor\, and Play
Another group of authors regard environmental mastery
as manifested in success in three crucial areas of Hving: love,
work, and play. Ginsburg (1955) puts forward this proposi-
tion in the most direct manner: "My coworkers and I have
settled for some such simple criteria as these: the abiHty to
hold a job, have a family, keep out of trouble with the law,
and enjoy the usual opportunities for pleasure."
Much of Alfred Adler's Individualpsychologie w^as based
on the same notion. It is in keeping with the obvious im-
portance of these areas of life that successful behavior in
[ 56 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
this respect enters into the mental health concept of quite
diverse schools of thought. Mayman (1955) speaks of men-
tally healthy attitudes as contributing "to the formation of
self-fulfilling patterns of love, v^ork and play/' and Blau
(1954) describes the healthy individual as one v^ho "is able
to work adequately and to create v^ithin the Umitations of
his capacities, to relax after v^ork and enjoy recreation. He
can carry on his essential biologic functions of sleeping, eat-
ing, excreting, and so on, v^ithout any sense of disturbance or
discomfort."
Adequacy in Interpersonal Relations
On a less specific level, a general competence in inter-
personal relations is suggested as a criterion for mental
health. Based on the theoretical and empirical ^oik of
Sullivan, Horney, and other neo-Freudians, the relationship
to others is singled out as a criterion. Sullivan assumes that
the major human goal is security resulting from satisfactory
interpersonal relations. Foote and Cottrell (1955) build their
concept of interpersonal competence largely on Sullivanian
premises. They consider that "competence in interpersonal
relations is a means by vi^hich members of the family are
able to interact effectively in achieving their common ends
and their individual self-expression and development."
A sHghtly different aspect of interpersonal relations as a
criterion for mental health is among the eight items making
up the World Health Organization's concept (Washington
State Conference, 1951). There the statement is made that
"the healthy person has the ability to be reasonably aggres-
sive when the occasion demands. But he is free from any
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 57 ]
inner necessity to dominate other people, to lord it over
them, or push them around."
Much in line with this notion are the views of the British
psychiatrist H. V. Dicks, who regards "failure in human
relationships" as the major reason for poor mental health,
and "secure, affectionate and satisfying human relationships,
. . . love and the elimination of hate . . ." as criteria for
positive mental health (Ginsburg, 1955).
Following Erich Fromm (1941, 1947, 1955), a number of
authors see the crux of the current mental health problem
in man's alienation from nature, from himself, and from
his fellow men. Mental health efforts must in their opinion
be partly directed toward improving interpersonal relations.
Rollo May (1954), for example, in his diagnosis of aHena-
tion in the modern world, describes it as a "characteristic
of modern people in emotional difficulties . . . that they
have become alienated from their fellow men. They have
lost the experience of community . . . people really are
afraid of one another. . . ."
Implicit in this statement of disturbance is the assump-
tion that positive mental health consists in absence of aliena-
tion from others. But May does not spell out the positive
aspect of interpersonal relations as a criterion of health.
However, Dorothy C. Conrad (1952) gives an exphcit state-
ment of these positive aspects, after she has dealt with nega-
tive formulations. She stipulates among other aspects the
following manifestations in the area of interpersonal rela-
tions. An individual shows positive mental health to the
extent that he :
"Has positive a-ffective relationship: The person who is
[ 58 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
able to relate affectively to even one person demonstrates
that he is potentially able to relate to other persons and to
society. ...
"Promotes another's v^^elfare: Affective relationships make
it possible for the person to enlarge his v^orld and to act for
the benefit of another, even though that person may profit
only remotely. . . .
"Works v^ith another for mutual benefit: The person is
largely formed through social interaction. Perhaps he is most
completely a person when he participates in a mutually
beneficial relationship. . . ."
Meeting of Situational Requirements
One of the difficulties in arriving at criteria for mental
health comes from the impact of the situation on behavior.
As has aheady been pointed out, to speak of situations as
healthy means stretching the meaning of the concept beyond
permissible Hmits. Health refers to a Hving organism. The
problem is particularly acute in the area of environmental
mastery. Efforts at mastery will take widely differing con-
crete forms if we look at a child at home or in the school-
room.
To do justice to these differences while adhering as closely
as possible to concrete forms of behavior, a number of per-
sons suggest that positive mental health is manifested in the
individual's manner of meeting the requirements of a situa-
tion. These requirements have to be specially assessed for
every situation in which mental health is to be judged. Fill-
more H. Sanford (1956) does this, for example, with the
school situation. He distinguishes three situational require-
ments: to estabUsh appropriate relations with authority
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 59 ]
(teacher), with peers, and to acquire knowledge and skills.
A child is mentally healthy to the degree that he func-
tions effectively with regard to these three basic require-
ments of the schoolroom situation.
Other writers, too, speak of the efficiency demonstrated in
meeting the requirements of a situation as a criterion of
health without, however, specifying these requirements in
detail. Julius Wishner (1955), for example, proposes that
"psychological health and psychopathology be conceived as a
continuum and defined in terms of the eflEciency with which
environmental requirements are met. For the present, how-
ever, this definition can be useful only in a relatively narrow
laboratory situation because of the difficulties involved in
the specification of objective requirements in the social
sphere."
There is a troublesome implication in regarding efficiency
in meeting situatonal requirements as a sign of health even
when the requirements are specified, let alone when they
are not. Some situational requirements, if met, can call for
behavior that must be deemed unhealthy when viewed in
terms of some other criteria. Severe deprivations, a harsh
and demanding teacher, a prison, and the like, all may re-
quire behavior precluding self-actuaHzation, autonomy, or
perception free from need distortion. The impHcations
pointed up by these examples are that the criterion be appHed
only when there is some consensus on the reasonableness
of the requirement.
Adaptation and Adjustment
Those who discuss environmental mastery from the point
of view of meeting situational requirements are either care-
[ 6o ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
ful to spell out generally acceptable requirements or are in
danger of assuming the invariable reasonableness of such
requirements. Adaptation, v^ith its connotation of modifying
environmental factors, is not bound by a similar assumption.
Here, there is no need to regard hard reality as unchange-
able and only the individual as modifiable. Adaptation im-
plies that a workable arrangement between reality and in-
dividual can be achieved by modifications of either or both
through individual initiative.
From the psychoanalytic point of view, Hartmann (1939)
has made the process of adaptation the focus of his discussion
of mental health. He says; "Where many of the conceptions
of health and illness . . . stand most in need of amplifica-
tion [is] in the direction of the subject's relations with and
adaptation to reality. . . . What we designate as health or
illness is intimately bound up with the individual's adapta-
tion to reality . . . with his sense of self-preservation."
Hartmann unfortunately does not discuss concretely the
course adaptation might take. He does suggest, however,
that "we often learn to find our bearings in relation to
reality by devious ways. . . . There is evidently a typical se-
quence here, withdrawal from reality leading to an increased
mastery over it. . . ." The article does not distinguish such
healthy withdrawal from that of the mentally ill. Whether
there is a fundamental difference, and, if so, what, is a ques-
tion for research.
It is, perhaps, not an overinterpretation of his position to
say that withdrawal from reality is one way of modifying it.
That adaptation to reality is conceived by him as an active
effort by the individual to choose or create an environment
most suitable to his psychic conditions becomes clear when
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ ^^ ]
he uses pioneers and adventurers as an example: "The adven-
turer-explorer, the pioneer settler, and the man on the fron-
tier are extreme but good examples of men maladjusted to
their homeland v^^ho went out to find a new environment to
which they could adjust."
The fact that this particular modification of the environ-
ment can legitimately be regarded as defensive has, accord-
ing to Hartmann, nothing to do with its classification as
healthy: "Nor does the distinction between healthy and
pathological reactions correspond to that between behavior
originating or not originating in defense. . . ."
It is true that the word adaptation is often used in mental
health discussions synonymously with meeting environ-
mental requirements. Hunt, for example, does so (Washing-
ton State Conference, 1951). He defines adaptive efficiency
as the efifective carrying on of the roles and tasks before an
individual. The task before us, however, is not to settle dif-
ferences in linguistic usage, but rather to draw attention to
psychologically meaningful aspects in the mental health
discussion. One such aspect is the idea that a healthy person
can change his inner balance of psychic forces as well as
the external world. This idea is conveyed by the term adap-
tation.
The idea is inherent in Freud's statements about the ego
as an active agent: "[A normal or healthy ego] denies reality
as little as neurosis, but then, like a psychosis, is concerned
with effecting a change in it. This expedient normal attitude
leads naturally to some active achievement in the outer
world and is not content, Hke a psychosis, with estabUshing
the alteration within itself; it is no longer auto-plastic but
olio-plastic," Isidor Chein (1944) fully discusses the idea.
[ 62 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
The term "adjustment" is actually used more frequently
than adaptation, particularly in the popular mental health
literature, but often in an ambiguous manner that leaves to
anyone's whim v^hether it should be understood as passive
acceptance of whatever life brings — that is, as meeting situa-
tional requirements indiscriminatingly — or as a synonym
for adaptation. It might be noted that Jean Piaget's (1952)
concept of adaptation is actually a synthesis or proper bal-
ance of the active and the passive component in man's ar-
rangements with the environment. He calls the active com-
ponent "assimilation," which means that the environment
is made to provide the satisfactions one wants. The passive
component is labeled "accommodation," implying that one
learns to like whatever the environment has to offer.
Problem-Solving
One is again faced with two connotations of another term
frequently used in the mental health literature: problem-
solving. Some authors talk about problem-solving with
emphasis on its end-product — namely, the finding of a solu-
tion. If such a criterion is applied to realistic life problems,
it easily leads to the idea that success is the hallmark of
mental health. In this sense, problem-solving meets the type
of objection that earlier led us to exclude various states of
well-being from further consideration.
Success is certainly a function not only of the individual's
behavior but also of circumstances outside his control. To
regard successful problem-solving as a criterion for mental
health introduces an ambiguity in meaning, since success
cannot be regarded either as an attribute of a person or as an
attribute of his actions. Be that as it may, it may still be cor-
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ ^3 ]
rect — and should be verified by research — that in our society
people v^ho are mentally healthy are more Hkely to be suc-
cessful than those v^ho are not.
The other meaning emphasizes the process of problem-
solving rather than its end-product. In this sense, a case
could actually be made that problem-solving is in many w^ays
similar to adaptation or active adjustment. There are, how-
ever, differences in the usage of these terms v^hich help to
differentiate them from each other. Adaptation, normally a
long drav^n-out process, is one in v^hich the individual can
be engaged without being clearly aware of its occurrence,
let alone its beginning or end. On the other hand, problem-
solving can occur over both long and short time periods
and is used in the mental health literature as presupposing
a conscious awareness of a problem and an initial intention
to deal with this problem. These differences seem sufficiently
relevant to regard problem-solving as a criterion in its own
right.
Whereas some persons make the assumption that the very
fact that one is wrestling with a problem is a sufficient indi-
cation of mental health, others specify particular modes of
problem-solving as criteria. The author's effort (Jahoda,
1953) distinguishes three dimensions of the process:
First, there is the time sequence of certain stages : awareness
of the problem, followed by a consideration of means toward
its solution, a decision for one or the other of the considered
means, and finally the implementation of the decision. This
sequence corresponds closely to several formal descriptions
of the thinking process (Duncker, 1945). It is understood,
of course, that in the course of problem-solving the sequence
is usually less neat, with earlier stages being resumed in the
[ 64 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
light of subsequent ones, and often with all of them simul-
taneously in the mind of the problem-solver.
The second dimension is the f eeUng tone that accompanies
the various stages. It is assumed that some discontent must be
maintained in the earHer stages or, at least, that there must
be an abihty to delay gratification. These feehngs serve as
an incentive for proceeding to the following stages. Suppose
a man experiences his current work situation as a problem.
He intends to change it. But, as he faces the various possible
ways of doing this, without proceeding to select one or the
other, his intention dies out. He gets used to his situation.
The likelihood is that he will not proceed to further stages
of problem-solving. On the other hand, if he continues to
maintain his intention and the appropriate feeling tone, he
may follow such a mentally healthy mode as finding more
suitable work. Here the appropriate feeling tone will be posi-
tive.
The third dimension of the process concerns the directness
or indirectness with which a person approaches the root of
the annoying experience. If he perceives his work as un-
satisfactory a direct approach would lead to the considera-
tion of other work; an indirect approach would consist, for
example, of seeking substitute satisfactions in leisure-time
activities.
The author suggests that a maximal degree of healthy
problem-solving combines the three dimensions: a tendency
to go through all stages, the maintenance of an appropriate
feeUng tone, and a direct attack on the problem. Going
through this process, rather than finding a successful resolu-
tion, is taken as the indication for mental health.
IV
An Sjjort at Fwrtker Qanjication
Ihe preceding survey of positive mental health concepts is
encouraging in more than one v^ay. The number of ideas is
relatively Hmited; they can be reasonably v^ell grouped un-
der a few headings. In spite of diversified theoretical posi-
tions taken by the authors in the field, one gains the impres-
sion that there is among many of them a large overlap in
meaning and intent v^hen they talk about mental health ; cer-
tainly, there are few, if any, contradictions between the various
proposals. A case could even be made that several of them
tap identical concepts on different levels of concreteness.
But, notwithstanding such encouraging features, the sur-
vey of the literature does not resolve the complex problem of
clarifying the psychological meaning of positive mental
health. Indeed, the review makes it quite clear that the least
fruitful approach to the subject consists in assuming that
anyone has the answer to the problem. We shall have to be
content with recognizing that there are many tentative an-
swers or approaches available and that none of them is as
yet based on so solid a body of knowledge and facts that it
can definitely be singled out as the most promising approach.
To say that there is as yet no entirely satisfactory approach
[65]
[66] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
available in the conceptualization of mental health is one
thing. To conclude from this state of affairs that all further
clarification has to await the results of empirical research is
quite another matter. To be sure, empirical research is ur-
gently required. Its success, however, will to no small degree
depend on further clarification of some general ideas in the
mental health field. Some of them will be discussed.
DIFFERENT TYPES OF MENTAL HEALTH
Since one obviously faces considerable difficulty in estab-
Hshing systematic relations in the psychological content of
ideas often expressed in poetic, rather than scientific, terms,
the question arises whether there is not some merit in the
diversity of concepts.
Perhaps the most cogent argument for accepting a variety
of ideas about the nature of mental health is the recognition
(Hartmann, 195 1) that "theoretical standards of health are
usually too narrow insofar as they underestimate the great
diversity of types which in practice pass as healthy . . !'
[italics supplied]. If there are different types of health, is
it not possible that at least some of the concepts discussed
refer to such different types, and that they therefore need
not, or should not, be brought to a common denominator.'^
Robert White (1952) illustrates the variety of points of
views from which a person can be regarded as healthy. He
bases his discussion of mental health and related concepts
on the empirical study of "normal" people, meaning persons
who have never needed professional psychological help to
deal with the problems of living.
One of the persons studied, "Hartley Hale," was a physi-
AN EFFORT AT FURTHER CLARIFICATION [ ^ ]
cian and scientist of great ambition. He achieved mightily.
He was devoted to his v^ork, successful and well-respected
in the profession. On the other hand, as a husband and
father Hartley Hale was less successful. Whenever work and
family life conflicted, he decided in favor of work. In which
area of life should one appraise his mental health? White
points out that different interpretations emerge when one
makes some, rather than other, aspects of Hale's life salient.
If one assessed Hale in terms of certain aspects of self-
actuahzation, he might be given a clean bill of health; if one
assessed him by his abiHty to "love, work, and play" he
would be judged lacking in mental health.
It could be argued that this is as it should be. And the
argument can be bolstered by an analogy with physical
health and physical illness. Apparently there, too, no single
concept has as yet been proposed. The medical profession is
content to operate with a variety of dimensions of physical
health whose relations to each other remain so far unknown.
The dimension of resistance to disease, for example, is
relevant to epidemiologists; it has no known relation to the
dimension of physical strength, a relevant health considera-
tion among athletes and their medical advisors. Longevity,
yet another dimension of interest to medical science, may or
may not vary with the former. It is in this sense that William
Alanson White (1926) speaks of health as a relative notion:
"Disease and health are relative terms: in order to under-
stand the nature of health and disease we must decide on
just how we are to approach the study of the human or-
ganism. . . ."
Neither is physical disease a unitary concept. As knowledge
advances, concepts which first appeared unitary are revealed
[ 68 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
as comprising a variety of discrete notions; in a discussion
of delinquency, Merton (1957) makes this general point:
"This is not too remote, in logical structure, from the as-
sumption of a Benjamin Rush or a John Brown that there
must be a theory of disease, rather than distinct theories of
disease — of tuberculosis and arthritis, of Meniere's syndrome
and syphilis. Just as classifying enormously varied conditions
and processes under the one heading of disease led some
zealous medical systematists to beHeve that it was their
task to evolve a single over-arching theory of disease, so, it
seems, the estabhshed idiom, both vernacular and scientific,
of referring to 'juvenile deliquency' as though it were a
single entity, leads some to believe that there must be a basic
theory of 'its' causation. Perhaps this is enough to suggest
what is meant by referring to crime or juvenile delinquency
as a blanket-concept which may get in the way of theoretical
formulations of the problem."
If one replaces in the above paragraph the word "delin-
quency" with the words "mental health," the appropriate-
ness of Merton's statement is evident. Yet science does not
stop at this point. Having dissolved an oversimplifying syn-
thesis into independent aspects, a new and more systematic
synthesis becomes possible. There is not one theory of disease.
But medical research makes it possible to develop a theory
for illnesses created by germs, for example. In the field of
mental health, some beHeve that the dissolution of the
"blanket concept" is the next strategic step.
To follow this strategy may bring an additional advan-
tage. The idea has been expressed in discussions of mental
health that people vary so much in terms of their native
equipment that it is unreasonable to assume they could all be
AN EFFORT AT FURTHER CLARIFICATION [ ^9 ]
measured by the same yardstick. The genius and the moron
as well as the average man may have their special types of
mental health. There may be sex differences in this respect,
even though industrialized society tends to even out some
differences in the functioning of men and women.
But, ultimately, the adoption of different criteria of
mental health for groups with different constitutional en-
dowment is a question of how one wishes to look at such
groups. For, as Kluckhohn and Murray (1948) have pointed
out, every man is in some respects like no other man, in
some respects like some other men, and in some respects
like all other men. Those who speak of different types of
health obviously prefer the middle position.
One way, then, of dealing with the relationship between
the various concepts is to assert their possible independence
from each other. They may designate various types of posi-
tive mental health. An individual may manifest mental
health according to one concept but not according to an-
other. A gangster may be judged healthy as far as his self-
image is concerned; unhealthy with regard to meeting the
requirements of a situation. Or, for that matter, WiUiam
Blake, the mystical poet and painter, may score high in
terms of aspects of self-actualization, low in terms of per-
ception free from need-distortion.
The idea that there are several different types of health
is not imiver sally accepted in the field. To be sure, most
writers clearly recognize that what they regard as the es-
sence of positive mental health is compatible with a wide
range of behavior and styles of life. They do not assume
that one healthy person will resemble the next as one egg the
other. But they regard such different manifestations as com-
[ 70 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
patible with one concept of mental health rather than as
requiring the assumption of diverse concepts.
If one accepts, however, the idea that there are various
types of mental health, concepts in any one or all six areas
may be worked with, and their relation to each other be-
comes a matter for empirical research, much as the relation
between athletic strength and longevity is an empirical prob-
lem. But it will still be necessary to heed WilHam White's re-
quest for deciding on just how to approach a study of mental
health. There may be some who find it easy to select one
of the many ideas which have been presented for practical
application or research work. Others will hesitate to choose
without further thought about what it is they are deciding
for; with them, we turn to the next approach toward clarifi-
cation.
THE MULTIPLE CRITERION APPROACH
When judging such a case as that of Hartley Hale, those
who come to the conclusion that he is lacking in mental
health are not necessarily bHnd to the positive aspects in his
functioning. They may credit him with self-actualization,
for example, but they regard this only as one element in
mental health. He would be called a mentally healthy person
only if he combined with self-actuaHzation other healthy
aspects, such as appropriate concern for interpersonal rela-
tions. In other words, they use a multiple criterion.
The relation of various components to each other in a
multiple criterion can be understood in a variety of ways.
Some authors regard a multiple criterion as composed of the
various ways in which the underlying quaUty of mental
AN EFFORT AT FURTHER CLARIFICATION [ 7^ ]
health can manifest itself. Of this type, Maslow's idea of
self-actualization is the outstanding example. A self-actual-
izing person not only is motivated to strive for always higher
goals but also has an adequate self-image, is autonomous,
creative, and spontaneous, has a reality-oriented perception of
the world, enjoys love, work, and play, and has a well-
developed individualistic ethic. In this sense, the multiple
criterion approach is similar to the notion of a syndrome —
as used in medicine, for example, when one speaks about the
TB syndrome.
Another type of multiple criterion is presented, for ex-
ample, in Erikson's developmental approach. It will be re-
called that the various components of mental health that he
specifies are each acquired in a definite stage of a person's
development.
Allport's multiple criterion approach is of yet another
kind. He combines various psychological functions jointly
producing specified consequences: self -extension, and self-
objectification, synthesized by a unifying philosophy of Hfe,
are necessary so that maturity can result.
A fourth type of multiple criterion does not assume a
unitary cause or temporal lawful sequence but is empirically
constituted. It is a cluster of related characteristics. Mayman,
for example, assumes four components of mental health : the
self-determining attitude, the heterogenic attitude, the allo-
plastic attitude and investment in living. The author, also a
proponent of the multiple criterion approach — proposing
active adjustment (environmental mastery), integration, and
perception as jointly constituting mental health — suggests a
different way in which these criteria may relate to each
other: "It is easy to imagine social conditions which favor
[ 72 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
one or two but exclude others. Heroic efforts in fighting for
a lost cause, for example, obviously exclude correct percep-
tion which, in self-defense, is replaced by illusions. Under
conditions of unemployment active adjustment may be im-
possible. . . . Under the conditions of a polysegmented so-
ciety with many incompatible values and norms, the unity
of personality may be abandoned for the sake of opportun-
istic adjustment in terms of correct perception" (Jahoda,
1950).
According to this view, perception relatively free from
need-distortion can be increased to the Hmit only at the ex-
pense of active adjustment. This multiple criterion approach
to the concept of mental health would thus draw attention
to the psychological price people may have to pay for de-
veloping one component at the expense of another under
unfavorable environmental circumstances. In theory, of
course, this quid pro quo idea of psychological functioning
could also be ascertained if a variety of types of mental health
were established and their antecedents and consequences in-
vestigated singly and jointly. In practice, however, such re-
search might well be neglected unless the concept of health
was so formulated as to make the question mandatory.
This idea has been elaborated by Smith (1950), who in-
troduces the notion of optimum mental health, in contrast
to other assumptions that every component of a mental
health pattern could and should be maximized, whatever the
psychological or situational context. Actually, he implies that
the multiple criterion approach which uses components that
can vary inversely with each other is based on an underlying
unitary function which is available in a given quantity. If too
much of the available energy goes into active adjustment,
AN EFFORT AT FURTHER CLARIFICATION [ 73 ]
not enough is left for perception of reality. What the opti-
mum combinations of components are under any given set of
conditions he regards as a question for empirical research.
As one reviews these various ways of using a multiple
criterion, it becomes clear that there is, of course, no incom-
patibility between the idea of diverse types of health and the
use of such a criterion. Each specified type could be assessed
by a combination of indicators. At the present state of our
knowledge it may well be best to combine the idea of various
types of health with the use of a multiple criterion for each.
The former will prevent over generalizations; the latter will
permit us to do justice to the complexity of human func-
tioning.
MENTAL HEALTH AND MENTAL DISEASE
Early in this report, we committed ourselves to the idea
that the absence of mental disease is not a sufficient criterion
of mental health. The major argument presented at that time
was that no satisfactory concept of mental disease exists as
yet and that little would be gained by defining one vague
concept in terms of the absence of another which is not
much more precise. To reject this type of definition mainly
on practical grounds disguises an issue of importance: the
question of the relationship between health and disease. A
few remarks on this subject are in order.
The traditional view that health is the absence of disease
has recently been opposed by the idea that mental health
and mental disease are qualitatively different. The point is
most strongly made by Rumke (1955), who disagrees with
the notion that "there exists between health and sickness an
[ 74 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
almost imperceptible progressive transition. . . ." In his
opinion, "The understanding of the disturbances of the sic\
man hardly contributes to the understanding of the normal
man." This formulation seems to deny ho^ much general
psychology owes to the study of the mentally sick as well as
the possibility that increased knowledge of mental health
may one day significantly contribute to the understanding of
mental disease.
Yet, the idea that mental health and mental disease are
qualitatively different seems to gain currency with many
professional persons. It appeals to those who are puzzled by
the existing evidence that similar pathogenic events lead to
mental disease in one case but not in another; to those who
are convinced of the organic nature of mental disease; and to
those who are aware of similarities in experiences and de-
fense mechanisms between persons who feel in need of treat-
ment and persons who do not. Assuming that health is
quahtatively different from disease, the extreme pole of sick-
ness would be absence of disease; of health, absence of health.
Such a view enables one to conceive of patients with healthy
features, nonpatients with sick features.
Conrad (1952), for example, finds it useful to distinguish
positive health from nonhealth as well as from negative
health: "Positive health consists in ways of Hving that are
beyond the frontiers of mere social existence implied by
negative health. . . . This category (positive health) applies
when there is evidence that the individual fully utilizes a
capacity or is working in that direction." By negative health
she means not pathology but some form of vegetating, with-
out either positive health or disease.
To think of mental health and mental disease as two in-
AN EFFORT AT FURTHER CLARIFICATION [ 75 ]
dependent but contrasting conditions means to treat them as
ideal types (in Max Weber's sense). As with every other
typological classification, pure types do not exist. Every hu-
man being has simultaneously healthy and sick aspects, with
one or the other predominating. The advantage of having
established the pure types, and of conceiving of them as
quaUtatively different, consists in drawing attention to the
health potential in patients and the sickness potential in
healthy persons. Mayman, for example, has found this useful
(1955). In his clinical experience, he has apparently en-
countered each of the four health components developed to
some degree in various patients and has been able to use these
health components as a lever in his therapeutic efforts.
It appears, then, that the definition of health as the absence
of disease can be rejected on other than just pragmatic
grounds.
What are the implications of this conclusion for the use of
mental health criteria when dealing with the diverse dis-
turbances which we call mental disease ? In principle, at least,
all the criteria are applicable to everyone, mental patient or
not. Those who are professionally qualified to deal with
patients are understandably more sensitive to the manifesta-
tions of disease than to those of health. It will take special
efforts to introduce concern with health into clinical work
with the sick. But such efforts may well be worth while.
The issue of the relation of mental health and mental
disease is still exceedingly complex. Take, for example, the
notorious judgment once made in a criminal case which held
that "apart from an unshakable belief that he is the Messiah,
the accused is perfectly normal." The statement offends com-
mon sense, inasmuch as this unshakeable belief appears to be
[y6] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
a crucial disturbance in the man. But does it actually say
anything but that there are sick features in an otherwise
healthy person ?
Or take the artistic production of mental patients. Some of
Van Gogh's greatest pictures were painted while he was
sick. Some of Hoelderlin's or Ezra Pound's greatest poems
were created in an asylum. Some of Bruckner's greatest
symphonies were produced while he felt under the desperate
compulsion to count the leaves on the trees of Vienna's parks.
Do such examples support the popular notion that you have
to be crazy to be an artist or the equally widespread assump-
tion that psychotherapy will eliminate extraordinary talent ?
Or can it be interpreted as an indication of a strong health
potential among these artists who, in a different aspect of
their personality, were also disturbed? Did they actually
produce when in the full grip of a terrible disease or in the
intermissions between attacks ?
These and many other questions cannot yet be answered.
The relation of mental health to mental disease remains one
of the most urgent areas for future research.
THE VALUE DILEMMA
Throughout the preceding discussion we have attempted
as far as possible to ignore one major problem, the problem
of values. The postponement was deliberate. Hopefully, the
discussion of values will profit from having first dealt with
ideas of mental health in other contexts.
Actually, the discussion of the psychological meaning of
various criteria could proceed without concern for value
premises. Only as one calls these psychological phenomena
AN EFFORT AT FURTHER CLARIFICATION [ 77 ]
"mental health" does the problem of values arise in full force.
By this label, one asserts that these psychological attributes
are "good." And, inevitably, the question is raised : Good for
w^hat? Good in terms of middle class ethics? Good for de-
mocracy ? For the continuation of the social status quo? For
the individual's happiness? For mankind? For survival?
For the development of the species ? For art and creativity ?
For the encouragement of genius or of mediocrity and con-
formity ? The list could be continued.
Different persons will prefer different values and the
criteria discussed here have differing relations to these values.
A prima facie case could be made, for example, that meet-
ing the requirements of the situation is more closely related
to the maintenance of the status quo or to conformity than
to creativity; or that the criterion of adaptation may automat-
ically discriminate in favor of the economically secure w^ho
are in a better position to modify their environment than
are those v^ho live in less privileged circumstances.
The selection of criteria in terms of their relation to the
high values of our civilization — or, for that matter, any other
— seems so difficult that one is almost tempted to claim the
privilege of ignorance. While it is easy to speculate about the
relation of each criterion to a vast number of high values,
v^e do not know whether such relations actually obtain. Does
self-actualization really benefit the development of the
species, as Fromm would claim? Is interpersonal com-
petence a prerequisite for the happiness of the individual?
Is happiness or productivity the value underlying an active
orientation to problem-solving? Is altruism necessarily re-
lated to empathy ?
Or, to put the difficulty of extricating the values under-
[ 78 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
lying the selection of various psychological phenomena as
criteria for mental health into a different perspective: How
culture- or social class-bound is the value orientation of those
v^ho have suggested the criteria ? Would people living in an
Oriental civilization have considered contemplation and de-
tachment as suitable criteria ? Would the mental health label
be more appropriately attached to self-assertive aggressive-
ness, to fit dominant values in the v^orking class in Western
civilizations ?
Not only are the ansv^ers to these questions unknov^n;
w^hat is w^orse, there is no logically tight method of thought
or analysis available through v^hich the value impHcations of
the various health ideas could be teased out v^ith some degree
of confidence.
There are tv^o considerations, hov^ever, that help to reduce
the value dilemma to one of somev^hat more manageable
size. First, we suggest that mental health is one goal among
many; it is not the incarnation of the ultimate good. Sec-
ond, the search for the values underlying mental health
need not involve one in the megalomaniacal task of blue-
printing the values for the distant future, or for all civiUza-
tions.
The discussion of mental health often makes, implicitly
or expHcitly, the assumption that a mentally healthy person
is one who is "good" in terms of all desirable values. This
assumption is, curiously enough, shared by proponents as
well as opponents of the mental health movement.
People who are devoted to mental health work, often with
an enthusiasm akin to religious fervor, see in it a panacea for
all evil and all social problems or for the wholesale improve-
ment of mankind.
AN EFFORT AT FURTHER CLARIFICATION [ 79 ]
The Opposition against the mental health movement simi-
larly assumes that mental health is suggested as the ultimate
good. Humanists often oppose the movement because they
fear that it will lead to a neglect of other high values. They
ridicule mental health standards as incompatible with the
appreciation of greatness, unique achievements, or the depth
of human experience.
The assumption that mental health be compatible with all
high values is actually not necessary. Human beings can
never serve all the highest values simultaneously. To deny
conflicts of values by setting up such global standards for
mental health leads to a denial of the condition of being
human. Only hypocrites or the inexperienced can assert that
the choices in life are always between "the good" and "the
bad." So simple an alternative is rarely posed. Conflict occurs
in every life, and most frequently it is about alternatives
good in themselves but incompatible with one another.
There are, then, other good things in life, apart from
mental health. It is perfectly possible and plausible in these
terms to maintain one's high admiration for William Blake,
for example, and to regard him as not mentally healthy in
terms of, say, reality perception. It is also possible for a
teacher to specify as his goal that students acquire knowl-
edge and to evaluate them in these terms even if the most
brilliant student shows Httle self -awareness. Similarly, as we
have seen in the case of Hartley Hale, it is possible to be an
outstanding and devoted scientist without meeting the crite-
rion of adequacy in love, play, and work or perhaps even of
a balance of psychic forces. To consider such a person as
lacking in mental health means neither condemning him to
a mental hospital nor establishing his moral inferiority.
[ 8o ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
If this position is granted^ all that is required from those
working in the mental health field is to make expHcit the
values v^hich induce them to select certain criteria, w^ithout
aiming for the moon.
By W2Ly of an example, one value strikes us as being com-
patible v^ith almost all of the mental health concepts dis-
cussed here: an individual should be able to stand on his
ow^n feet v^ithout making undue demands or impositions on
others. Some such value underlies most clearly Ginsburg's
idea that mental health consists of being able to hold a job,
have a family, keep out of trouble v^ith the law, and enjoy
the usual opportunities for pleasure. Although this modest
value is not as clearly implied in other concepts of mental
health, it seems compatible with them. It appears relevant to
different social classes, but whether it is meaningful out-
side the orbit of Western civihzation is a moot question.
Others may feel that this value is not compatible with their
notion of mental health, or that it is of too low an order; it
is offered here only as an example — extricated from the Htera-
ture intuitively rather than systematically.
Such a modest value premise takes the grandeur (and also
the horror) out of the value preoccupation of the many
mental health discussions that attempt to specify now the
values by which the next generation shall live. Not that this
task is unimportant or can be ignored. After all, whatever it
is that a current generation does, it will inevitably affect
what the next generation will regard as good. The experts in
the mental health field have no special right to usurp this
weighty decision. Politicians, humanists, natural scientists,
philosophers, the man in the street, and the mental health
expert must jointly shoulder this responsibiHty.
V
From Ideas to Systematic ^^search
lo CONDUCT systematic research in the area of mental health
requires a translation of the ideas presented into concepts
suitable for treatment by current research procedures. We
now turn to the question whether and to what extent this
is feasible.
The study of human behavior, Hke every other science, is
based on observation. The purpose of all research procedures
is to increase as much as possible the accuracy of observa-
tions. The crucial test for the soundness of research tech-
niques is that several observers can arrive at similar judg-
ments as the result of having independently applied the
same procedures. To adapt the mental health concepts to
these requirements means that the empirical basis for infer-
ences about mental health, according to one or more criteria,
be spelled out and that the conditions for the making of
observations be explicit. Accordingly, we shall first discuss
this question of empirical indicators for the various mental
health criteria.
To establish empirical indicators — if it can be done — is
only a first step in acquiring further knowledge about mental
[8i]
[ 82 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
health. Neither scientific nor practical purposes in this field
are adequately met by mere accuracy of descriptions. To
understand mental health, and to apply such understand-
ing, demands that the conditions under which it is ac-
quired and maintained become known. The discussion of
empirical indicators will, hence, be followed by some sug-
gestions for seeking such understanding.
EMPIRICAL INDICATORS FOR POSITIVE
MENTAL HEALTH
By and large, empirical indicators are not well developed
in the mental health literature. As a consequence, the as-
sessment of an individual in this respect is often left to the
intuitive insight of an observer. The vast research literature
on human behavior, on the other hand, presents many
empirical indicators and ingenious devices for observation,
but it rarely deals with the complex problem of what con-
stitutes mental health.
The task before us is to attempt a rapprochement between
these two fields. It would be fooHsh, of course, to attempt
here a comprehensive overview of research techniques, let
alone of the major unsolved problems in the science of man
having intimate bearing on techniques for observation and
measurement. All that can be done is to revert to the mean-
ing of the major criteria and present selectively some re-
search techniques which might do justice to them.
Inevitably, the discussion will touch upon some general
issues and controversies in the study of human behavior;
they will be identified where they first occur.
FROM IDEAS TO SYSTEMATIC RESEARCH [ ^3 ]
Attitudes Toward the Self
A variety of research tools and strategies for observation
are currently available to deal with aspects of the self -concept.
The basic design consists of a comparison between self-
description and performance, or self-description and de-
scription by others.
Self-descriptions are elicited or inferred from relatively
unstructured and unstandardized material such as autobio-
graphical sketches or protocols of therapeutic sessions, from
projective tests such as the Rorschach or Thematic Appercep-
tion Test, or from highly structured personality inventories
and other paper-and-pencil tests, such as the Minnesota
Multiphasic Personality Inventory or the Taylor Anxiety
Scale.
Whatever the instrument used, the content of such self-
descriptions consists of many different items : traits, motives,
feelings, interests, or values. This raises a major question left
unanswered by the mental health Hterature: Is every item
referring to the self equally relevant for mental health?
Take the accessibility of the self to consciousness: Is the
awareness of what induced a passing mood as relevant as the
awareness of what prompted one's choice of a marriage part-
ner ? And if not, which areas of the self should be accessible
to consciousness ? All ? And what are these areas ?
Or take the aspect of correctness of the self-concept: some
studies have tested a person's abiHty to identify his own ex-
pressive movements, such as his gait, from a number of
photographs. Is this a test of correctness of the self -concept ?
Or should mental health be inferred from the correctness of
other features of the self -concept ? And if so, which ?
[ 84 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
Or with regard to feelings about the self and sense of
identity: Should pride in one's achievements be given the
same v^^eight as one's acceptance of grey hair ?
All these questions point to the need for a theory v^hich
specifies dimensions of the self and their hierarchical rela-
tions to each other. They also imply that the mental health
hterature has insuflBciently specified the concrete nature of
aspects of the self that enter into calling a person healthy.
Depending on the characteristic of the self -concept under
study, variations in the basic observational strategy are in-
dicated. One way of arriving at a judgment about the ac-
cessibility of the self to consciousness, for example, consists
of confronting a person with an assessment of his personaUty
arrived at by competent observers. The person's reaction to
such judgments may be acceptance, denial, surprise, or the
like. These reactions then form the basis for evaluating the
extent of his self -awareness.
Ingenious as this method is, it draws attention to two
major problems, both of crucial concern to psychology. One
is contained in the distinction between the self as it appears to
others and the self -concept (the way the person sees him-
self). The distinction is akin to that between conscious and
unconscious portions of the self, or the "real" self and the
self-concept.
The other problem concerns the validity of assessments
by others. However qualified an observer, however subtle
his methods, is what he observes actually what he aims at
observing? Applied to the self -concept, is the way the ob-
server sees a person actually the way this person is? In
scientific procedure the question is answered affirmatively if
the observer makes a prediction based on what he has found
FROM IDEAS TO SYSTEMATIC RESEARCH [ 85 ]
and demonstrates the correctness of his prediction. He might
state, for example, that a person who accepts himself as he
is — other things being equal — will set himself achievable
goals. Experiments can be conducted to verify this prediction.
But the mental health practitioner is rightly not entirely
satisfied with this demonstration of validity. To make such
predictions seems to him a relatively easy matter but not yet
a guarantee that the observation, made under the very
special circumstances of a research study, will be an indicator
of what a man might do or feel under the pressures and in-
fluences of daily living. Since the practitioner is interested
in mental health as manifested in daily experience, he oc-
casionally becomes wary of research conducted in the rare-
fied atmosphere of a laboratory. In other words, he raises
the question: Can research conducted under special condi-
tions be generalized .f^
The question is crucial. Earlier in this report a distinction
was introduced which has some bearing on finding an an-
swer to it: the distinction between mental health as a more
or less enduring attribute of a person or as an attribute of a
specific action in a specific setting. It is generally agreed that
we can know what people are only by inference from what
they do. But every action is to varying degrees a function not
only of the acting person but also of the situation in which
he finds himself.
Scientific observation of human beings uses several ways
of arriving at generalizations from specific actions. Perhaps
the most frequent one consists in observing people under
conditions that reduce situational influences as much as pos-
sible. One who takes a Rorschach test, for example, has no
situational cues of what a "right" response is. In the absence
[ 86 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
of specific guidance from the outside, he is thrown back on
cues from the inside. In this manner he reveals his personaHty
predispositions. This is, of course, not entirely so. One might
be frightened or attracted by the test administrator or pick
out cues from his expressive behavior. No clinician, there-
fore, will want to rely on one test performance only for his
personality diagnosis. But according to the theory underlying
these tests, they present a good approximation of what a
person is when relatively free from external influences.
Another way to approach generalizations about what a
person is, beyond what he reveals in one concrete act, is to
search for consistent trends in his behavior in a variety of
situations. If a test score, a personality inventory, and clinical
observation all indicate a well-developed sense of identity, the
result inspires a greater degree of confidence that a per-
sonaHty attribute has been identified than when results differ
in three situations.
Clinicians often approach the problem of generalization
by making their inferences from a person's action in situa-
tions central to him. They regard the self as revealed in re-
lation to a life partner as a better indicator of its actual
nature than the self revealed while using the subway.
All these approaches are, of course, tenuous. But only an
unreahstic perfectionist would look for more than an ap-
proximation in this area. GeneraUzations about an individual
from behavior in one situation to that in another presupposes
always that the psychological meaning of the two situations
is understood. Where this is not the case, the psychologist
will be as helpless in predicting as is the chemist when a
substance he knows meets with one whose qualities are un-
known to him.
FROM IDEAS TO SYSTEMATIC RESEARCH [ ^7 ]
To return to the self -concept: it is reasonable to assume
that certain of its aspects will be more appropriately assessed
under complex conditions. These are available for research
through the use of therapeutic sessions dealing with the
full complexity of life problems, in field experimentation and
in special assessment situations that retain the flavor of un-
contrived experience.
Growth, Development, and Selj -actualization
To the extent that the mental health Hterature specifies
this criterion, two aspects are distinguished: (i) motivational
processes expressed in full utilization of an individual's
abilities, his orientation toward the future and in differentia-
tion, (2) and investment in living.
If one were to take these specifications too literally, an
assessment of self-actualization might consist in establish-
ing a person's abiUties, comparing them to his actual work
and leisure activities, and using the discrepancy, if any, as a
sign of the degree of his self-actuaHzation. By that token, a
man with musical and mathematical gifts who becomes a
great musician without doing anything about his mathe-
matical talents would be judged lacking in mental health.
But surely, this is not what those who suggest self-actuaHza-
tion as a criterion of health have in mind. Utilization cannot
refer to all potentialities. Differentiation must be taken as
occurring within one area of interests and not as synonymous
with diffusion.
With regard to utilization of abiHties, educational psy-
chology has perhaps developed some concepts suitable for
research. There, it has become customary to identify "under-
achievers" and "overachievers" among students. An under-
[ 88 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
achiever is a student whose I.Q. v^ould lead one to expect
certain grades; his actual grades are below this empirically
estabUshed expectation. In such a situation, the assumption
is frequently made that the motives of the student are such
that he does not give his best to schoolwork.
Other assumptions are possible and have to be ruled out be-
fore this situation can be used as an empirical indicator for
the degree of self-actualization. When all the children in a
class are underachievers, the teacher might be incompetent.
A single underachiever may be motivated to utilize his
abiUties, but physical fatigue may prevent this. Nevertheless,
the identification of achievement level in schools holds
promise for the development of empirical work on self-
actualization among children.
In other life situations, empirical standards such as are
available in school are much more difficult to obtain. And
intelhgence is not always the best yardstick for evaluating
achievement in life. It might be more in the spirit of the
mental health Hterature to compare a person's ambitions and
goals with the direction in which he is actually moving — that
is, to replace the objective assessment of abilities by subjec-
tive goals, and to appraise these against the effort actually
being made to achieve them.
Self-actualization is also expressed in a person's time per-
spective and in differentiation. Research techniques with re-
gard to both are in a very rudimentary stage. Notwithstand-
ing the fact that they play a significant role in Kurt Lewin's
topological theory of the life space, empirical indicators have
not been elaborated.
With regard to the other aspect of self-actuaUzation, in-
FROM IDEAS TO SYSTEMATIC RESEARCH [89]
vestment in living, some approximation of what the criterion
means can probably be gleaned from time-budgets of a per-
son. If one time budget indicates that an individual does
little apart from what is necessary for survival whereas an-
other is involved in his work beyond the requirements of a
job, or is concerned with ideas, or is active in social relations,
it is a fair guess that the second person has invested more in
matters outside himself than the first.
But this is a very crude approximation. For we know too
well that many activities and concerns are pursued not be-
cause they form a genuine link between the world and the
self, but for purposes of self-aggrandizement, to escape other
problems, to win approval, and the like. Such motivation
indicates concern with the self rather than with object rela-
tions, as the criterion requires. The distinction between
genuine and apparent concern with objects outside the self
will perhaps be made easier once the psychoanalytic concept
of "cathexis" is better understood and more amenable to
empirical research.
Integration
Empirical indicators and research strategy are particularly
difficult to suggest for this complex criterion. With regard
to the balance of psychic forces it may be best to turn to the
psychoanalysts who use the concept most frequently. Here a
study of their modes of thinking may be the most promising
next step. The goal would be to codify the way psycho-
analysts transform the concrete data presented to them into
the abstract notion of balance of psychic forces. What has
been said about accessibility of the self to consciousness may
[ 90 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
perhaps apply when this balance is conceived of as a pre-
ponderance of preconscious and conscious over unconscious
determination of behavior.
In order to arrive at generally appUcable empirical in-
dicators, it will be a wise precaution to use, in such co-opera-
tive research with psychoanalysts, material from patients as
they appear after a successful analysis, rather than data from
troubled persons only.
The assessment of a unifying outlook on life is com-
plicated, and rightly so, by Gordon Allport's emphasis on
the fact that such an outlook need not be an articulate
philosophy. It is perhaps not too difl&cult to ascertain from
prolonged interviews a man's basic tenets, if he can verbaUze
them. If he cannot, some sort of performance rating is in-
dicated. Role-playing techniques might be useful for such
efforts.
The empirical indicators for resistance to stress are more
specifically formulated in the mental health literature.
Anxiety- and frustration-tolerance and resihence are terms
containing a clear directive as to the type of situation in
which they should be studied : a situation presenting stress.
It is at this point, however, that we come up against an-
other major theoretical problem of psychology in general:
the problem of how to distinguish between the external
stimulus and the experience of, or response to, that stimulus.
To hear one's views attacked in a discussion may be experi-
enced as stress by one person, whereas another may regard
this as a pleasant stimulant. This same second man, however,
may experience being alone at night in a dark wood as stress
whereas the first man may deliberately seek out this situation.
Should resistance to stress be observed when stress is sub-
FROM IDEAS TO SYSTEMATIC RESEARCH [ 9^ ]
jectively present or when independent consensus agrees that
stress has been imposed ? In more general terms, the problem
is known as the question of equivalence of stimuH. It has
considerable philosophical and theoretical implications.
To the extent that research has been conducted on anxiety-
and frustration-tolerance, the dilemma was avoided rather
than solved by studying situations in which some corre-
spondence between stimulus and experience was either di-
rectly ascertained or could reasonably be assumed in view of
the intensity of the external stress. A case in point is the
series of studies on resistance to stress in natural disasters,
such as floods, prolonged isolation from other human beings,
and the like (Chapman, 1954; G.A.P. Symposium No. 3,
1956). So are the previously cited study of anxiety and sur-
gery and Clausen's (1955) study of wives whose husbands
have been institutionalized for mental illness.
Similar situations offer strategic opportunities for the
study of resilience. A crucial empirical indicator here may be
the amount of time an individual needs before he can re-
sume his usual patterns of living after change under the
impact of stress.
Autonomy
The meaning of this criterion prescribes the situation in
which observations must be made, namely, decision-making
situations. Where the aim is to ascertain whether behavior
is directed from within, it will be advantageous to use situa-
tions permitting alternative decisions, neither of which is
encouraged or approved, on the assumption that the self-
rehant person will be able to decide with relative ease and
speed what suits his own needs best. Those lacking in self-
[ 92 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
reliance will find it difficult to decide and will search for
external support.
Independent behavior, on the other hand, must be tested
where some social pressure favors an alternative that the in-
dividual would not select if left to his own devices. Asch
(1952) has designed an experimental situation lending it-
self admirably to this purpose.
Although the situational context for obtaining empirical
indicators is relatively clear in this case, a number of other
problems remain. Self-reliance can be demonstrated in
choosing between coffee or tea or in making a vocational
choice. Are both items of equal significance as indicators of
autonomy? Independent behavior can show itself in the
manner one dresses or in Luther's break with Catholicism.
And, depending on many other factors, what is for one per-
son an insignificant decision may be of great importance for
another. We have met this difficulty already in discussing
the problem of stimulus equivalence; what has been said
there applies here too.
In addition, here as elsewhere, sensitive empirical indica-
tors must be constructed so as to permit distinctions of the
degree of positive mental health attributed to an individual.
For this purpose a combination of various measures is in-
dicated. The use of several observations which lead to a
profile or a combined general score is a problem in its own
right.
Ferception of Reality
No other area in psychology has as long a tradition in
experimental work, or has used a greater variety of observa-
tional strategies, than the area of perception. Yet the riddles
FROM IDEAS TO SYSTEMATIC RESEARCH [ 93 ]
of perception are far from understood and new techniques
and ideas are pushing ahead the frontiers of knowledge. It
is no wonder, then, that in research on perception most of
the general issues and controversies in the science of man
come to a head. Each of the general problems of research on
human behavior mentioned before could be illustrated with
reference to perception. We shall not, however, repeat them
here. It must suffice to point out that the aspects of percep-
tion singled out by the mental health literature as criteria
are intimately related to current research problems in per-
ception.
Perception relatively free from need-distortion is a con-
cept springing from the realization that although motives
(needs) are always involved in perceiving, they are not, or
at least need not be, the major determinant of the perceptual
product. It also assumes that other cognitive processes —
thinking, judgment, memory — are intimately linked to
perceiving.
The situation for appropriate observations must be, of
course, one in which an individual is emotionally involved
with the percept in such a way that a distortion of its at-
tributes would suit his inner needs better than the perception
of what is. Perhaps the greatest difficulty here is the ascer-
taining of emotional involvement leading to a need to dis-
tort. Sometimes this need has simply been assumed without
definite evidence. At other times, needs have been experi-
mentally created. For example, persons have been deprived
of water for some length of time and then been asked to
identify ambiguous pictures. Those identifications having to
do with liquids were taken as evidence of distortion. Tests
of syllogistic reasoning have used the discrepancy, if any,
[ 94 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
between reasoning on neutral topics and reasoning on emo-
tionally colored material as an indication that the emotional
involvement created a need to distort cognitive processes.
The perception of the feelings and motives of others is
appraised with the help of a strategy similar to that described
for assessing aspects of the self-concept. A person's insight
into the thoughts and feelings of others is compared with the
latters' self-descriptions. The same tools for personaHty de-
scriptions mentioned there can be used here.
The generality of empathy presents a special problem.
One would like to know not only whether empathy trans-
fers from one situation to the next but also whether it ap-
pHes to understanding of all other persons or is restricted to
special groups — for example, to people one likes or to people
who are similar to oneself.
Environmental Mastery
Several of the aspects of environmental mastery are
formulated in the mental health Hterature in such a manner
that only the study of the full complexity of an individual's
life history will suffice as empirical indication. Accordingly,
data collection has to rely largely on case-study methods and
therapeutic and diagnostic interviews, supplemented by time
budgets and projective techniques.
The problems in this area arise mainly with regard to
specifying the extent to which environmental mastery is a
function of good or bad luck and to what extent it can be
regarded as the individual's achievement. This means that
the various case-study methods must not only deal with inner
dynamics but must also pay attention to external events in
their own right. Even though common sense alone would
require such an approach, a surprising number of judgments
FROM IDEAS TO SYSTEMATIC RESEARCH [ 95 ]
of environmental mastery remain insensitive in this respect
and engage in an unv^arranted amount of psychologizing
about hard facts. Such partial blindness is the result not only
of overenthusiasm for psychological explanations but also
of the considerable difficulty in sifting events provoked by an
individual's inner dynamics from those occurring independ-
ently.
With regard to three aspects of environmental mastery —
adequacy in love, v^ork, and play, adequacy in interpersonal
relations, and efl&ciency in meeting situational requirements
— situational analyses are particularly important. What is
needed here is research on vs^hat adequacy or situational re-
quirements mean concretely. The conceptual approaches of
sociology and cultural anthropology v^ill have to be used
tov^ard this end.
Problem-solving is the one aspect of environmental mastery
on which there exists extensive experimental research. The
problems such experiments deal v^ith are, how^ever, mostly
problems in logic or reasoning that in themselves are emo-
tionally neutral. Further research v^^ill have to estabHsh the
extent that problem-solving tendencies, as demonstrated in
dealing v^ith these experimental tasks, have bearing on the
approach to life problems. There is little doubt that some of
the concepts used in such experimentation are relevant for
establishing empirical indicators for problem-solving as a
criterion for mental health. Duncker's concept of "functional
fixedness," for example, refers to the tendency to use tools in
the same manner in v^hich one usually encounters them
(1945). It may be as appropriate for describing approaches
to life problems as it is for describing behavior under ex-
perimentally contrived conditions.
The accompanying chart summarizes what has been said
[ 100 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
SO far about the translation of mental health concepts into
empirical indicators and presents several suggestions for
further research.
SOME SUGGESTIONS FOR RESEARCH
Throughout the preceding discussion, tv^^o types of research
questions have been mentioned. One has to do v^ith technical
matters such as the estabhshment of empirical indicators,
the other v^ith the advancement of substantive know^ledge.
This is not the place to go further into technical details;
competent research v^^orkers must handle them empirically.
These are not matters fruitfully advanced by speculation.
Instead, wc novi^ turn to a brief discussion of some of the
questions that should become ansv^erable once the tools and
techniques are available.
The Analysis of Mental Health Clusters
In the interest of economy of effort in research and prac-
tical application, perhaps the most urgently needed study is
one of the interrelationship of the criteria. Consider, for ex-
ample, the possibility that autonomy exists only v^^hen an in-
dividual has a v^ell-developed sense of identity or self-ac-
ceptance, or that adaptation follov^s from a balance of psychic
forces.
If a cluster analysis of the criteria v^ould demonstrate such
relations, the Hst of mental health concepts might be con-
solidated. A cluster analysis v^ould have another advantage,
too, that of permitting the estabhshment of a multiple crite-
rion based on knov^ledge, rather than guessv^ork, about the
relation of the components.
FROM IDEAS TO SYSTEMATIC RESEARCH [ 10^ ]
A word of caution is in order on the degree of generality
that can be attributed to empirically discovered clusters.
There is no reason to believe that the interrelations appear-
ing in one case need necessarily be the same for every group.
Differences in culture, social class, sex, or age may well ex-
press themselves in diflferent clusters. Comparative studies in
all these groups are indicated with regard to the frequency
distribution of the criteria and their interrelations.
Mental Health Criteria for Di^erent Age Groups
The study of mental health in different age groups is a
research problem in its own right. In their current formula-
tion, several criteria are applicable only to adults. Yet the
need for mental health evaluation is just as great for chil-
dren, adolescents, and the very old. Erikson alone among
the various authors we have reviewed has given full attention
to the maturational appropriateness of mental health criteria.
To extend this concern beyond Erikson's formulation will
require much research.
For example, the comprehensiveness and correctness of the
self-image is a criterion of limited usefulness for children and
young people. The rate of change in the self is undoubtedly
much greater for them than it is at later stages in life, a fact
that may easily lead to discovering apparent inconsistencies
when the child is observed in various situations. What is
more, self-description as a necessary tool for ascertaining
aspects of the self is a task that may exceed the development
of a child's cognitive abilities. To a lesser degree, the same
holds for self-acceptance and the sense of identity. The latter,
it should be remembered, is suggested by Erikson as a late
step in a temporal sequence of development.
[ 102 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
It may well be that parents and teachers, who are able to
observe children continuously over long periods of time,
could note possible indicators for growth, development, and
self -actualization. However, as we have seen, the elaboration
of empirical indicators in this category has not progressed
very far. Much the same is true for the indicators of auton-
omy as applicable to children. Furthermore, the process of
early education contains inevitably strong emphasis on curb-
ing the child's autonomy. A minimal requirement for the
application of this criterion to the behavior of children is
identification of the areas in which autonomy must be curbed,
so that they can be excluded as situations for gauging the
child's mental health.
Perception of reality, meeting the requirements of the
situation, and problem-solving are the criteria par excellence
having meaning for all age groups, even though their em-
pirical study will, of course, have to take age into considera-
tion. Adaptation as the sense of actively selecting an environ-
ment to suit one's own needs is only occasionally open to
young children in our civilization. To describe adequately
the forms adaptation can take in childhood will require the
elaboration of age-specific indicators.
Research in this area can be conducted from two points of
view. Childhood can be regarded as a stage of life in its
own right; in that case, clues for the establishment of criteria
of health must come from what is known in child psy-
chology. Or one can start with the model of the healthy adult
and ask which behavior tendencies in childhood hold the
greatest promise of health in adulthood. Taking extreme
positions in this matter has led to the controversy between
the proponents of "progressive" and traditional methods of
FROM IDEAS TO SYSTEMATIC RESEARCH [ 103 ]
education. This controversy continues to rage bitterly in the
absence of facts demonstrating conclusively the impact of
either method on the child or the adult-to-be.
Actually, the extremely child-centered approach to mental
health criteria for this stage of hfe is as untenable as the ap-
proach regarding the child as a small adult. In the life of
the child, present, past, and future shade imperceptibly into
each other. The individual v^ill function tomorrow accord-
ing to the goodness and adequacy of his total equipment
today. The next moment may deeply affect this equipment
and it is reasonable to postulate that the nature of this effect
will be to a considerable extent determined by the current
state of affairs.
The mentally healthy child — healthy in terms of his age
group — will be best equipped to deal with the subsequent
events and thus with the gradual unfolding of the course of
his life. But, however different the empirical indicators for
mental health in childhood may be from those for adult-
hood, they must be conceived of as having a lawful sequential
relation to each other. The need for research in this area is
considerable. It will have to develop criteria appropriate for
different stages in life and demonstrate how mental health
in one stage leads to mental health in the next.
Research with Mental Fatients
Another area of research concerns the possible application
of these criteria to work with mental patients. Perhaps most
immediately needed in this area are descriptions of the degree
to which various mental health criteria co-exist with various
types of disturbances. A systematic effort in this direction
could lead to a series of other studies. For example, many
[ 104 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
efforts are currently being made to assess what progress or
movement in therapy actually connotes.
The tranquilizing drugs apparently produce one type of
effect. Many psychiatrists are of the opinion that the lessened
anxiety and increased contact v^ith others do not constitute
a cure, but estabUsh a condition making further therapeutic
efforts possible. It would be of considerable interest to in-
vestigate whether the effects produced by the drugs, by sub-
sequent psychotherapy, or both, are movements toward the
mere elimination of symptoms of disease or toward the
acquisition of health.
Other suggestions for the use of mental health criteria in
the study of mental disease have already been made in a
previous section. Their further elaboration should be at-
tempted in close co-operation with psychiatrists.
CONDITIONS FOR ACQUISITION AND
MAINTENANCE OF MENTAL HEALTH
There is ready agreement between all concerned that a full
understanding of mental health demands that conditions
under which it is acquired and maintained be specified. In
order to meet this demand, research must single out some
such conditions. And here the difficulty begins. A virtually
unending number of conditions may affect the degree to
which an individual possesses or displays any of the at-
tributes constituting mental health.
Should one search for relations to genetic factors ? Or bio-
chemical processes ? Does living in urban or rural areas make
the difference? Or membership in a particular social class
or ethnic group .^^ Is it the standard of living or the level of
FROM IDEAS TO SYSTEMATIC RESEARCH [ IO5 ]
education? The geographical location or the physical quali-
ties of one's home ? Or the pace of life in the home town ?
The composition of the neighborhood or the family? The
relation between mother and child or between child and
siblings? The early socialization process? Or a combination
of some or all of these factors ?
For reasons of economy of effort as well as theoretical
elegance, it would be highly desirable to have some principle
available to help us sift these and many other possible factors
according to their psychological relevance for mental health.
The problem involved in the search for such a principle is
no less than the conceptualization of what is meant by
'environment."
This problem has challenged the great philosophers of
past centuries; it continues to challenge current theorists.
It is akin to the problem of distinguishing between stimulus
and response, between what is inside and what is outside the
organism (F. H. Allport, 1955).
Though the distinction between what is inside and what
is outside the organism is fundamental and clear-cut with
regard to objects, it is difficult to apply it to psychological
functions. Light is outside the organism; the visual nerve,
inside. Seeing, a psychological function, is equally depend-
ent on both. In the sciences of man, the distinction is always
to some extent arbitrary. Even though various schools of
thought have made systematic efforts to deal with the rela-
tion between man and his environment, the great issue re-
mains unresolved, at least to the extent that none of these
efforts provides a guide for choosing among the factors pos-
sibly influencing mental health.
In this situation a more modest empirical approach will
[ I06 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
have to guide research on the conditions for the acquisition
and maintenance of mental health. Here help is forthcoming
in a variety of v^ays.
First, general consensus based on much empirical evidence
holds that a crucial aspect of man's environment consists of
those persons v^^ith v^hom he intimately interacts. For the
infant and young child, the only other aspect to rival the
human element in the environment may be his constitutional
equipment. The fact that the infant lives in slum or palace,
in city or country, in peace or v^artime, affects him only to
the extent that such conditions lead first to changes in his
human environment. As the child groves, tv^o important de-
velopments take place: he enlarges the radius of his activities,
so that he directly experiences contact with objects, and his
cognitive abihties develop so that aspects of the environment
need no longer be physically present — that is, they can in-
fluence him via symbolic representation.
These processes of maturing infinitely complicate the
manner in v^hich the environment can affect mental health.
The environment nov^ can have an impact through a variety
of channels. Yet new channels do not replace the earlier one;
they supplement it. There is no vi^ay of saying v^ith con-
fidence that the mental health of a schoolchild is more cru-,
cially influenced by the personality of his parents, siblings,
teacher, or classmates than by the fact that he is a Negro or
hves in a rural area or comes from an educated family; even
so, it is safe to say that the human beings around him are
one crucial aspect of his environment.
A second set of conditions related to mental health is sug-
gested by the results of interdisciplinary research. Psychia-
trists and psychologists are more and more av^are of the
fact that certain regularities of behavior can be understood
FROM IDEAS TO SYSTEMATIC RESEARCH [ I^ ]
not only in terms of individual dynamics but also in terms
of group memberships and identifications. Such regularities,
the result of similar social conditions, lead them to be con-
cerned with the wider human environment of a person as
well as with his intimate human relations.
Collaborative research between psychiatrists or clinical
psychologists on the one hand and sociologists or anthropolo-
gists on the other has demonstrated that it is worth while
to extend the range of environmental factors in this way.
Research teams, such as Paris and Dunham (1939), Kardiner
and others (1945), Hollingshead and RedUch (1953), and
Stanton and Schwartz (1954), have contributed to our
knowledge of mental disturbance by identifying ecological,
cultural, or class determinants. This approach could profit-
ably be appHed to questions of mental health. The newly
emerging profession of social psychiatry and the estabUsh-
ment of therapeutic communities (Jones, 1953) are translat-
ing such research into practice.
A third approach to the identification of conditions con-
ducive to mental health stems from the observation that man
adjusts his behavior not only in interaction with other indi-
viduals but also in response to situations and institutions more
or less independently of the particular individuals who hap-
pen to play a role in them. As one enters a drugstore or a
theater, goes to work or to bed, a whole set of prescribed re-
sponses are called forth by the situation. Wright and Barker
(1950) use the term "behavior setting" for locales having the
attribute of eHciting largely standardized behavior. It is
reasonable to assume that the behavior settings a person
spends a good deal of time in will have a lasting influence
on his psychic make-up. The school system a teacher operates
in, or the specific requirements of any other occupation.
[ I08 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
present behavior settings of long duration that may signifi-
cantly affect mental health.
A fourth set of environmental factors appears relevant for
research on mental health. It is different from those already
mentioned, inasmuch as it can apply to each of them as v^ell
as to many others. It is the factor of change in environmental
conditions. It is a truism that environmental conditions
change continuously and continuously provoke changes in
the individual. Imperceptible changes are easily taken into
one's stride. Sudden, major, or unexpected changes require a
general reorientation. Constancy of environmental condi-
tions, as much as frequent radical change, may be a good or
bad influence on mental health. The direction of the change
from "good" to "bad" conditions, or the other v^ay round,
may be as important as change per se. But there are some
indications in the Hterature (Bettelheim and Janov^itz, 1950)
that one's sense of identity may be threatened, v^^hatever the
direction of change. In any case, the stability or instability of
environmental conditions appears to be a psychologically
relevant attribute of the environment.
In these directions, research on the conditions of mental
health might proceed. There are undoubtedly others. Every
serious piece of work in this field WAX have to come to terms .
v^ith the fact that the various sets of conditions always exist
simultaneously and that concentration on one or the other
inevitably means a violation of the actual conditions of living.
Those dissatisfied with this unending search for better and
better approximations to an unattainable goal will have to
turn away from science and seek elsewhere for their insight
into the conditions for mental health.
VI
In Qondusion
At the beginning of this report stands a statement by Adolf
Meyer contrasting two approaches to the field of mental
health: the Utopian way, which leads to moraUzing, and
the scientific way, which leads to experimentation and de-
liberate action.
As one reviews the field of mental health more than thirty
years later, he finds that no final choice between the two
ways has yet been made. Today, too, there is a danger of
mental health becoming a popular movement that Hves by
slogans and presents ten easy rules for being mentally healthy
ever after. The final comment on the moraHzing approach
to the problems of hving was made by the Austrian satirist,
Nestroy, who made one of his most pompous characters say,
"Better rich and healthy than poor and sick," and made him
eloquently silent on how.
The present report should have made it abundantly clear
that the complex problems of mental health will not be
brought nearer to solution by exhortations. By far the most
urgent need in the field is for more knowledge. Research is
a slow and costly enterprise. It can fail. Or it can fail to be
appHed. However, in the long run, we do not know a better
[109]
[ no ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
way to help policy decisions in the field than to strive for
more and better knov^ledge about the conditions conducive
to mental health.
If poHcy makers open the w^ay to the acquisition of further
knov^ledge, if practitioners in the mental health field co-
operate with scientists in thoughtful experimentation, if the
fruits of research can be applied without losing respect for
the infinite diversity of human beings, concern with mental
health may improve the quaHty of Hving.
VII
Vicwj^oint of a Qlinician
by WALTER E. BARTON, M.D.
Conceptually, it is difficult to see how a national program
to reduce mental illness and increase mental health can be
operated on any other base line than a straight one. In this
continuum, illness is the point of departure and health is
the goal. We work away from one and toward the other.
If we had solved, or even partially solved, the problems of
preventing or treating major and minor mental illness, we
could then justifiably concern ourselves with the issue of
superlative mental health, or the degrees of goodness in good
mental health. Unfortunately, we still have far to go in re-
ducing illness. This is a practical concern, rather than a
theoretical one.
We must recognize, of course, that Dr. Jahoda's purpose
in this monograph is not to write poUcy for a national health
movement, but to analyze and evaluate what different think-
ers mean when they speak of mental health. Her concern
is with the psychological — or, one might add, spiritual and
intellectual — content of positive mental health. Such clarifica-
tion is desirable. Dr. Jahoda has ably pursued the various
[III]
[ 112 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
theories about the psychological content of positive mental
health and has shed a good deal of light on the issues in-
volved.
Many physicians v^^ill find her approach a novel one. Some
may instinctively oppose an approach divorcing health from
illness as aHen to their ov^n understanding of health.
Dr. Jahoda's fundamental position appears to be that the
absence of illness and the presence of health overlap but do
not coincide. The physician, quite typically, I think, v^orks
on the basis that they do coincide, for all practical purposes.
He sees health as the objective in the prevention, cure, or
management of disease to the extent that he can help the
individual avoid it, recover from it, or compensate for it.
The living organism so rarely presents itself, at all times
or in all v^ays, in a complete state of biological, physiologi-
cal, psychological, and — in sum — ecological harmony, and
yet so characteristically strives for such a balance, that the
clinician may still hold to his viev^ that the absence of ill-
ness and capacity for achieving or restoring balance are
consonant v^ith sound health principles, as he must apply
them. The pathologist at autopsy frequently observes so
much pathology that he is far less struck that a patient died
than that his diseased organs functioned as long and as well
as they did.
All of us can benefit, hov^ever, from attempts to define
and measure good health, whether psychological or physical,
and should welcome heterodox efforts to do so. Perhaps,
through the mind of social science, unencumbered by medi-
cal tradition, research may be designed that will eventually
quantify the psychological content of mental health. The
phenomenon of a superstate of good mental health, well
VIEWPOINT OF A CLINICIAN [ 1^3 ]
beyond and above the mere absence of disabling illness, has
yet to be scientifically demonstrated. We know little of it
beyond occasional subjective, euphoric impressions of the
subject that he is "bursting with good health," "feeling
grand," or that "all is right with the world," meaning his
world.
In contrast, the benefits of disease prevention and control
have been tangibly demonstrated in increased ability to work
and carry out social obligations, longer life, and individual
morale.
Medicine has developed this useful way of looking at
health and the normal to the extent that health as the an-
tonym of disease has become a part of the philosophy, or
tradition, of physicians.
The idea first was propounded by Hippocrates who held
health to be a state of universal harmony, and the role of
the physician to be that of restoring equiHbrium between
the various components of the body and the whole of Na-
ture. This approach was encompassed by Walter Cannon
in his principle of homeostasis, meaning a tendency toward
uniformity or stability in the normal body states of the
organism relating to the fluid balance and, more generally,
the so-called "internal environment." By extension, the same
idea of equilibrium permeates observation of such matters
as "nitrogen balance" and various other physiological or
biochemical states.
The inference of good health, or the normal state, as a
manifestation of harmony or balance with the external en-
vironment can be found in biology as well as physiology. Out
of Spencer's idea of evolution as the "survival of the fittest"
came the notion of "nature in the raw" and eternal aggres-
[ 114 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
sion and defense, which influenced the older conception of
the germ theory of disease and made us appear victims of
a kind of microbial v^arfare. But Darv^^in pointed out in
Descent of Man that commonly in nature "struggle is re-
placed by co-operation." The concept of "a balance of na-
ture" again emerged as a unifying idea.
In modern microbiology, the older idea of infectious dis-
ease as a "fight" against foreign "invasion" has been to a
great extent superseded by the concept of man and his bac-
teria and viruses as habitually Hving together in various
states of symbiosis or germ-host relationships involving in-
fection, Wixh. or w^ithout apparent disease. Accompanying
this has been a strong revival of the mutiple-cause theory of
disease at the expense of the one-germ-one-disease viev^point.
Rene J. Dubos, for instance, regards "invasion" or "attack"
as less characteristic of the relationship of man's pathogens
to man than is "peaceful co-existence."
Subclinical or inapparent infection appears to be the
rule, with periodic epidemics or individual imbalances due
to lowered resistance of the human organism or heightened
virulence of the microorganism actually occurring as ex-
ceptions.
So we see that a unifying concept of health and disease
does run through medical thought, founded in biology and
physiology as well as in biochemistry and microbiology. The
tendency of the organism is to serve its structural, functional,
and species purposes and, internally or externally, to strike
some kind of balance that will permit it to do so. It is normal
for the organism to do this.
Leston L. Havens (1958) has pointed out:
"Usually in medicine we say an organ is healthy if it does
VIEWPOINT OF A CLINICIAN [ 1^5 ]
its job within the normal range and over the usual time. We
do not expect too much, although the usual range is not
the range of the average man but of the average healthy man.
Statistical norms are useful in this context and should not
be dismissed despite the difficulties of agreeing on a normal
population in the mental health area. Without such a point
of reference, one carmot tell what is a toxic experience and
what is normal tolerance. Without norms there is also the
danger of unreal goals of treatment. This may be a signifi-
cant clinical hazard. Ideal or even 'potential' health criteria
are too easily spun out of theories or brief glimpses of people
at their momentary best."
Both gross and cellular pathology have well-defined con-
cepts of normal and abnormal. The tissue and cell are
normal if they exhibit no disturbance of structure as com-
pared to most tissues or cells of like kind. Precisely the same
understanding extends from structure to function. Granted,
the physician's estimate of what is normal sometimes has
been of far too narrow a range, as for example in determin-
ing what constitutes abnormal blood pressure.
M. Ralph Kaufman (1956) sums up the issue this way:
"The organism and its relationship to its environment is
in a constant state of flux which nevertheless involves a con-
tinuous series of processes utilizing all aspects of its function-
ing in an interrelated series of procedures aimed at the
establishing of an equilibrium.
"The ontogenesis of the individual is of tremendous sig-
nificance since within the potentials and limitations of the
genus and species, the organism develops in a progressive
and integrated way with each system (digestive, cardio-
vascular, central nervous, autonomic, psychic), shunting in.
[ Il6 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
after functional maturation, to take over that role which its
structure and function calls for in the total functioning of
the organism. From the very beginning at the level of the
sperm and ovum the processes have an adaptive equilibrium
between organism and environment, each playing its essen-
tial role which involves the ultimate for survival. With the
development and integration of the various systems, of which
the psyche is one, the systems relate to each other in a kind
of syncytium which means that no activity within one sys-
tem can be isolated and unrelated to the total integrative,
homeostatic, if you will, function of the organism. . . ."
Jacques S. GottHeb and Roger W. Howell (1957) under-
score the predominate note of disease prevention in the
public health approach :
"The success of public health measures has been in large
part dependent first upon the identification of specific im-
portant etiological agents and other variables in the illness
process. It is Hke protecting our water supply against con-
tamination with the typhoid bacillus or strengthening the
defenses of an individual against a noxious agent as in inocu-
lation with poHo. This general technique has a certain simi-
larity to the objectives of our previously described mental
health goals ; that is, removal of conditions of stress, of frus-
tration, of deprivation on the one hand, (the etiological
agent) while strengthening the ego defenses on the other
(the inoculation). In the preventive program for physical
illness this can be readily done, for the strategy is directed
toward a specific objective. For mental illness, unfortunately,
we cannot isolate a single variable, a single point of attack,
but must be prepared to deal with multiple factors of etio-
logical import. For prevention of physical disorders, success
VIEWPOINT OF A CLINICIAN [ I^?]
has come only after the knowledge of the etiology or of the
important variables. For mental and emotional disorders,
we may not have the knowledge as yet to really develop
preventive programs."
Francis J. Braceland (1957) emphasizes the relationship of
normal psychological development to disease prevention in
certain situations. Rubella in the first three months of preg-
nancy may be a prologue to a mental defect in the child.
Eclampsia may be a factor in cerebral palsy, or a metabohc
disorder in a mother may contribute to the development of
epilepsy in an offspring. Prenatal injury affecting later be-
havior is one possible consequence of poor maternal nutri-
tion. Said Braceland:
"It is self-evident that increased alertness to these various
possibilities would pay rich dividends in mental health, but
the sad thing is that the psychologic aspect of such situations
is not always kept in mind.
"Improved obstetrics, better use of protective services by
all prospective mothers, the prevention of prematurity and
its causes, and optimum care for the premature infant would
cut the mental deficiency segment of our mental health
problems by a sizeable amount. Multiple pregnancies, com-
plicated delivery procedures, and stressful obstetric situations
call for greater vigilance, as does the prevention of anoxia.
"The importance of diagnosing cretinism during the first
year is of course obvious, in view of the good response to
treatment at this time and the fact that later treatment will
fail to overcome mental retardation. Steinfeld's hypothetical
'hunger trauma' in babies and its relation to later schizo-
phrenia offers another challenge for prophylaxis. There
should be joint obstetric and pediatric responsibility for fetus
[ Il8 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
and infant and child, so that a clearer view emerges of the
mental, as well as the physical, hazards of various complica-
tions from the time of conception and ways and means of
combatting them. All of these things are important for the
mental health of both mother and baby.
"There are at least three mental health problems which
could be mitigated by more intensive development of exist-
ing pubHc health emphases; the nutritional problems of
pregnancy; the toxic deUria associated with certain vitamin
deficiencies; and some of the confusions of elderly persons
associated with both drug intoxications and malnutrition.
"Similar considerations pertain to infectious diseases which
may directly damage the brain tissue. Encephalitis lethargica,
even if so mild that it easily escapes detection, may result in
mental impairment which, contracted in childhood, may be
expressed in antisocial and irresponsible behavior. Inocula-
tions against contagious diseases in children are essential to
lessen the incidence of contagious diseases. Some of the
formerly fatal cerebrospinal meningitides are now being
restrained by antibiotics; unfortunately, however, we may
be left with a defective individual requiring long and prob-
lematic rehabilitative periods. Early diagnosis and treatment
of these infections is therefore essential.
"In adult life a psychopathic development may occur after
brain damage, especially in the frontal cortex, the hypothala-
mus, and the midbrain. If cerebral contusion is at all exten-
sive, it is likely to produce personality changes with neur-
asthenic, hysterical, or paranoid reactions, inadequate con-
trol of mood variations, and a general lack of initiative and
energy. In the light of these observations we need to
strengthen those features of environmental sanitation work
VIEWPOINT OF A CLINICIAN [ 119 ]
which reduce the incidence of head and brain injury. These
are a few of the areas in which good preventive and re-
habihtative work may be done, provided that we are ever
mindful of the close interaction of psyche and soma."
This summarizes what I believe is the typical physician's
understanding of health. It is difficult for me, as a clinician,
to separate the presence of health from those preventive
measures that reduce the likelihood of the development of
disease and illness. I believe most patients would settle for
the absence of illness. If they are not sick, they are well.
There would be no Joint Commission if there were no men-
tal illness.
In this discussion, I have looked upon health as a product
of disease prevention and treatment. It is proper, of course,
for the scientific investigator to study behavior as a natural
phenomenon, without a pathologic orientation.
The viewpoint I have expressed is tangential to Dr.
Jahoda's discussion of the content of positive psychological
health. Yet I feel sure she would agree that mental illness is
the primary threat to positive psychological health.
^Cfi
acnccs
Allinsmith, W. and Goethals, G. W., 1956. Cultural factors in
mental health. Rep. Educ. Res., 26: 431.
Allport, F. H., 1955. Theories of Perception and the Concept of
Structure. Wiley.
Allport, G. W., 1937. Personality. Holt, pp. 213, 214, 226.
, 1955. Becoming. Yale University Press, pp. 49, 51, 68.
Angyal, A., 1952. A theoretical model for personality studies. In
D. Krech and G. S. Klein (Eds.), Theoretical Models and Per-
sonality Theory. Duke University, pp. 132, 135.
Asch, S. E., 1952. Social Psychology. Prentice-Hall.
Barron, F., 1952. Personality style and perceptual choice. /. Pers.,
20: 385.
, 1954. Personal soundness in university graduate students.
University of California Press.
-, September 1955. Tow^ard a positive definition of psycho-
logical health. Paper read before American Psychological As-
sociation.
Benedict, Ruth, 1934. Patterns of Culture. Houghton Mifflin.
Bettelheim, B. and Janowitz, M., 1950. Dynamics of prejudice.
Harper.
Blau, A., 1954. The diagnosis and therapy of health. Amer. f.
Psychiat., no: 594.
Boehm, W. W., 1955. The role of psychiatric social work in
mental health. In A. M. Rose (Ed.), Mental Health and Mental
Disorder. Norton, p. 537.
[121]
[ 122 ] REFERENCES
Braceland, Francis J., September 1957. Putting available tools to
work. In Better Mental Health, Nat'l. Health Council.
Biihler, Charlotte, 1954. The reality principle. Amer. J. Psycho-
ther., 8: 626, 640.
Burgess, E. W., 1954. Mental health in modern society. In A. M.
Rose (Ed.), Mental health and mental disorder. Norton, p. 3.
Cantor, N., 1941. What is a normal mind? Amer. f. Orthopsy-
chiat., 11: 6^6.
Chapman, D. W., 1954. (Issue Ed.) Human behavior in disaster:
A new field of social research. /. Soc. Issues, 10: No. 3.
Chein, I. 1944. The awareness of self and the structure of the ego.
Psychol. Rev., 5/; 312.
Clausen, J. A., 1956. Sociology and the Field of Mental Health.
Russell Sage Foundation.
, and Yarrow, Marian R., 1955. (Issue Eds.) The impact of
mental illness on the family. /. Soc. Issues, 11: No. 4.
Conrad, Dorothy C, 1952. Toward a more productive concept of
mental health. Mental Hygiene, 56; 456, 466.
Davis, K., 1938. Mental hygiene and the class structure. Psychiat.,
i: 55.
Devereux, G., 1956. Normal and abnormal: The key problem of
psychiatric anthropology. In J. B. Casagrande and T. Gladwin
(Eds.), Somes Uses of Anthropology: Theoretical and Applied.
The Anthropological Society of Washington, p. 23.
Duncker, K., 1945. On problem solving. Psychol. Monogr., 58:
No. 5, I.
Eaton, J. W., 1951. The assessment of mental health. Amer. J.
Psychiat., 108: 81.
Eliot, T. D., May 1929. Standards of living, planes of living, and
normality. The Family, 10: p. 87.
Erikson, E. H., 1950. Growth and crises of the "healthy personal-
ity." In M. J. E. Senn (Ed.), Symposium on the Healthy Per-
sonality. Josiah Macy Jr. Foundation, pp. 135, 138, 139, 141, 142,
143.
Ewalt, J. R., 1956. Personal communication.
REFERENCES [ 1^3 ]
Paris, R. E. L. and Dunham, H. W., 1939. Mental Disorders in
Urban Areas. University of Chicago Press.
Foote, N. N. and Cottrell, L. S., Jr., 1955. Identity and Interper-
sonal Competence. University of Chicago Press, p. 55.
Friedenberg, E., 1957. The mature attitude. Adult Leadership, 5:
248.
Fromm, E., 1941. Escape from Freedom. Farrar and Rinehart, p.
263.
, 1947. Man for Himself. Rinehart, p. 26.
, 1955. The Sane Society. Rinehart.
Ginsburg, S. W., 1955. The mental health movement and its
theoretical assumptions. In Ruth Kotinsky and Helen Witmer
(Eds.), Community Programs for Mental Health. Harvard
University Press, pp. 7, 21.
Glover, E., 1932. Medico-psychological aspects of normality. Brit.
J. Psychol., 25: 165.
Goldstein, K., 1940. Human Nature in the Light of Psychopa-
thology. Harvard University Press.
Gottlieb, J. S. and Howell, R. W., 1957. The concepts of preven-
tion and creative development as applied to mental health. In
Ralph H. Ojemann (Ed.). Four Basic Aspects of Preventive
Psychiatry. State University of Iowa.
Group for the Advancement of Psychiatry, December 1956, Fac-
tors Used to Increase the Susceptibility of Individuals to Force-
ful Indoctrination. Symposium No. 3.
Hacker, F. J., 1945. The concept of normality and its practical
significance. Amer. J. Orthopsychiat., ly. 53, 55.
Hall, C. S., and Lindzey, G., 1957. Theories of Personality. Wiley,
pp. 96, 404.
Hartmann, H. 1939. Psychoanalysis and the concept of health.
Int. J. Psychoanal., 20: 308, 312, 314, 315, 316, 318.
, 1947. On rational and irrational action. In Geza Roheim
(Ed.), Psychoanalysis and the Social Sciences, i. International
Universities Press, pp. 363, 379, 390, 391.
, 1951. Ego psychology and the problem of adaptation.
[ 124 ] REFERENCES
In D. Rapaport (Ed.), Organization and Pathology of
Thought. Columbia University Press, pp. 362, 373.
Havens, L. L., January 5, 1958. Personal communication.
Hollingshead, A. B. and Redlich, F. C, 1953. Social stratification
and psychiatric disorders. Amer. Sociol. Rev., 18: 163.
Jahoda, Marie, 1950. Toward a social psychology of mental health.
In M. J. E. Senn (Ed.), Symposium on the Healthy Personality.
Josiah Macy Jr. Foundation, pp. 211, 219, 220.
, 1953. The meaning of psychological health. Social Case-
wor\, ^4: 349.
Janis, I. L., 1956. Emotional inoculation: Theory and research on
the effectiveness of preparatory communications. Paper to ap-
pear in Psychoanalysis and the Social Sciences. International
Universities Press.
Johnson, W., 1946. People in Quandaries. Harper, p. 24.
Jones, E., 1942. The concept of a normal mind. Int. J. Psycho-
analysis, 2j: I.
Jones, M., 1953. The Therapeutic Community. Basic Books.
Kardiner, A., 1945. (With the collaboration of R. Linton, Cora
DuBois and J. West). The Psychological Frontiers of Society.
Columbia University Press.
Kaufman, M. R., September 27, 1956. The problem of psychiatric
symptom formation. Paper presented before Michigan State
Medical Society.
Klineberg, O., 1954. Social Psychology (rev. ed.), Henry Holt, p.
397-
Kluckhohn, C. and Murray, H. A. (Eds.), 1948. Personality in
Nature, Society and Culture. Alfred Knopf.
Kris, E., 1936. The Psychology of caricature. Int. f. PsychoanaL,
ly: 290.
Kubie, L. S., 1954. The fundamental nature of the distinction be-
tween normality and neurosis. PsychoanaL Quart., 2j: 187, 188.
Leighton, A. H., 1949. Human Relations in a Changing World.
Button.
Lewis, A., 1953. Health as a social concept. Brit. f. Sociol., 4: 109.
Lindner, R., 1956. Must you conform? Rinehart, pp. 3, 205.
REFERENCES [ 1^5 ]
Maslow, A. H., 1950. Self-actualizing people: A study of psy-
chological health. Personality Symposia, i: 16.
, 1956. PersonaHty problems and personality growth. In
Moustakas, C. (Ed.), The Self. Harpers.
-, 1955. Deficiency motivation and growth motivation. In
M. R. Jones (Ed.), Nebraska Symposium on Motivation. Uni-
versity of Nebraska Press, pp. 8, 20, 24, 25, 27.
May, R., 1954. A psychologist looks at mental health in today's
world. Mental Hygiene, ^8: i.
Mayman, M., 1955. The diagnosis of mental health. UnpubHshed.
Menninger Foundation.
Menninger, K. A., 1930. What is a healthy mind? In N. A. Craw-
ford and K. A. Menninger (Eds.), The Healthy-Minded Child.
Coward-McCann.
, 1945. The Human Mind. (3rd ed.) Knopf, p. i.
Merton, R. K., 1957. Continuities in the theory of social structure
and anomie. In Social theory and social structure (Rev. Ed.),
The Free Press, p. 177.
Meyer, A., 1925. Suggestions of Modern Science Concerning Edu-
cation (with H. S. Jennings and J. B. Watson). Macmillan, p.
118.
Milbank Memorial Fund, 1953. Interrelations Between the Social
Environment and Psychiatric Disorders, p. 125.
, 1956. The Elements of a Community Mental Health Pro-
gram.
Mowrer, O. H., 1948. What is normal behavior? In L. A. Penning-
ton and I. A. Berg (Eds.), An introduction to clinical psy-
chology. Ronald, p. 17.
Piaget, J., 1952. The Origins of Intelligence in Children. Interna-
tional Universities Press.
Powell, J. W., 1957. The maturity vector. Adult Leadership, 5;
252.
Redlich, F. C, 1952. The concept of normality. Amer. J. Psycho-
ther., 6: 551.
Riesman, D., Glazer, N., and Denney, R., 1950. The Lonely
Crowd. Yale University Press.
[ 126 ] REFERENCES
Riimke, H. C, 1955. Solved and unsolved problems in mental
health. Mental Hygiene, ^g: 183.
Sanford, F. H., 1956. Proposal for a study of mental health in
education. First annual report, Joint Commission on Mental
Illness and Health, Appendix H.
Shoben, E. J., Jr., 1957. Toward a concept of the normal personal-
ity. Amer. Psychol., 12: 183.
Smith, M. B., 1950. Optima of mental health. Psychiatry, ly. 503.
Stanton, A. H., and Schwartz, M. S., 1954. The Mental Hospital.
Basic Books.
Tillich, P., 1952. The Courage To Be. Yale University Press.
Washington State Department of Health, June 195 1, Conference
on research and evaluation of community mental health pro-
grams.
Wegrocki, H. J., 1939. A critique of cultural and statistical con-
cepts of abnormality. /. Abnorm. and Soc. Psychol., j^: 166.
White, R. W., 1952. Lives in progress. Dryden, p. 333.
White, W. A., 1926. The Meaning of Disease. The Williams and
Wilkins Company, p. 18.
Wishner, J., 1955. A concept of efficiency in psychological health
and in psychopathology. Psychol. Rev., 62: no. i, 69.
Wright, H. F., and Barker, R. G., 1950. Methods in Psychological
Ecology. University of Kansas.
Aj^-pcndix
joint Qommission
on Rental Illness and Health
PARTICIPATING ORGANIZATIONS
American Academy of Neurology
American Academy of Pediatrics
American Occupational Therapy
Association
American Association for the Ad-
vancement of Science
American Association of Mental
Deficiency
American Association of Psychi-
atric Clinics for Children
American College of Chest Physi-
cians
American Hospital Association
American Legion
American Medical Association
American Nurses Association
and The National League
for Nursing (Coordinating
Council of)
American Orthopsychiatric As-
sociation
American Personnel and Guid-
ance Association
American Psychiatric Association
American Psychoanalytic Associ-
ation
American Psychological Associa-
tion
American Public Health Asso-
ciation
American Public Welfare Associ-
ation
Association for Physical and Men-
tal Rehabihtation
[127]
[128]
Association of American Medical
Colleges
Association of State and Territo-
rial Health Ofl&cers
Catholic Hospital Association
Central Inspection Board, Amer-
ican Psychiatric Association
Children's Bureau, Dept. of
Health, Education and Wel-
fare
Council of State Governments
Department of Defense, U.S.A.
National Association for Mental
Health
National Association of Social
Workers
APPENDIX
National Committee Against
Mental Illness
National Education Association
National Institute of Mental
Health
National Medical Association
National Rehabilitation Associa-
tion
Ofl&ce of Vocational Rehabilita-
tion, Department of Health,
Education and Welfare
United States Department of Jus-
tice
Veterans Administration
MEMBERS
Kenneth E. Appel, M.D.
Philadelphia, Pa.
Walter H. Baer, M.D.
Peoria, Illinois
Leo H. Bartemeier, M.D.
Baltimore, Maryland
Walter E. Barton, M.D.
Boston, Massachusetts
Otto L. Bettag, M.D.
Springfield, IlHnois
Mr. George Bingaman
Purcell, Oklahoma
Kathleen Black, R.N.
New York, New York
Daniel Blain, M.D.
Washington, D.C.
Francis J. Braceland, M.D.
Hartford, Connecticut
Hugh T. Carmichael, M.D.
Chicago, Illinois
J. Frank Casey, M.D.
Washington, D.C.
James M. Cunningham, MJ).
Dayton, Ohio
JOINT COMMISSION ON MENTAL ILLNESS AND HEALTH [ I29 ]
John E. Davis, Sc.D.
Rehoboth Beach, Delaware
Neil A. Dayton, M.D.
Mansfield Depot, Conn.
Miss Loula Dunn
Chicago, Illinois
Howard D. Fabing, M.D.
Cincinnati, Ohio
Rev. Patrick J. Frawley, Ph.D.
New York, New York
Mr. Mike Gorman
Washington, D.C.
Robert T. Hewitt, M.D.
Bethesda, Maryland
Herman E. Hilleboe, M.D.
Albany, New York
Nicholas Hobbs, Ph.D.
Nashville, Tennessee
Bartholomew W. Hogan, Rear
Adm. M.C., U.S.N., Washing-
ton, D.C.
Louis Jacobs, M.D.
Washington, D.C.
M. Ralph Kaufman, M.D.
New York, New York
William S. Langford, M.D.
New York, New York
Miss Madeleine Lay
New York, New York
Jack Masur, M.D.
Bethesda, Maryland
Berwyn F. Mattison, M.D.
New York, New York
Ernst Mayr, Ph.D.
Cambridge, Mass.
Robert T. Morse, M.D.
Washington, D.C.
Ralph H. Ojemann, Ph.D.
Iowa City, Iowa
Winfred Overholser, M.D.
Washington, D.C.
Howard W. Potter, M.D.
New York, New York
Mr. Charles Schlaifer
New York, New York
Lauren H. Smith, M.D.
Philadelphia, Pa.
M. Brewster Smith, Ph.D.
New York, New York
Mr. Sidney Spector
Chicago, Illinois
Mesrop A. Tarumianz, M.D.
Farnhurst, Delaware
David W. Tiedman, Ed.D.
Cambridge, Mass.
Harvey J. Tompkins, M.D.
New York, New York
Beatrice D. Wade, O.T.R.
Chicago, Illinois
Mr. E. B. Whitten
Washington, D.C.
Helen Witmer, Ph.D.
Washington, D.C.
Luther E. Woodward, Ph.D.
New York, New York
[ 130 ] APPENDIX
OFFICERS
President: Kenneth E. Appel, M.D.
Philadelphia, Pa.
Chairman, Board of Trustees: Leo H. Bartemeier, M.D.
Baltimore, Md.
Vice-President: M. Brewster Smith, Ph.D.
New York, N.Y.
Secretary-Treasurer: Mr. Charles Schlaifer
New York, N.Y.
Vice-Chairman, Board of Trustees: Nicholas Hobbs, Ph.D.
Nashville, Tenn.
STAFF
Director: Jack R. Ewalt, M.D.
Boston, Mass.
Consultant for Scientific Studies: Fillmore H. Sanford, Ph.D.
Austin, Texas.
Consultant in Social Sciences: Gordon W. Blackwell, Ph.D.
Chapel Hill, North Carolina
Consultant tn Epidemiology: John E. Gordon, M.D.
Boston, Mass.
Associate Director for Administration: Richard J. Plunkett, M.D.
Boston, Mass.
Director of Information: Greer WilHams
Boston, Mass.
Associate Director and Consultant on Law: Charles S. Brewton, LL.B.
Boston, Mass.
Librarian: Mary R. Strovink
Boston, Mass.
Index
accommodation, 62
achievement level, as measure of
self-actualization, 87-88
acquisition of mental health, 104
adaptation
problem-solving and, 63
reality and, 60-62
(see also environmental mas-
tery)
adjustment
adaptation and, 62-63
to environment, autonomy and,
47-48
Adler, Alfred, 55
age groups, mental health cri-
teria and, 101-103
Alexander, Franz, 12
alienation, 57
AUinsmith, Wesley, 42
alloplastic attitude, 71
Allport, F. H., 105
AUport, Gordon W., 25-26, 27, 31,
Angyal, Andras, 48
anthropology
mental disease and, 12-14
normality and, 15
anxiety, 42-43
anxiety tolerance, 41-43
measurement of, 90-91
(see also stress)
Asch, S. E., 14, 92
assessment, of mental health, 81-
100
assimilation, 62
attitude
alloplastic, 71
heterogenic, 33-34
(see also self, attitude toward)
autonomy, 23, 43, 45-49, 71
measurement of, 91-92
B
Barker, R. G., 107
Barron, F., 26, 40, 50
Barton, Walter E., 111-119
becoming (see self -actualization)
Benedict, Ruth, 12
Bettelheim, B., 108
Blau, A., 56
Boehm, W. W., 19, 20
Braceland, Francis J., 117-119
[131]
[132]
Biihler, Charlotte, 44
Biihler, K., 44
Cannon, Walter, 113
Cattell, Raymond B., 27, 28
Chapman, D. W., 91
Chein, Isidor, 61
child, mental health of, 58-59, loi-
103, 106
childbirth, mental health and,
117-118
Clausen, J. A., 91
clusters, of mental health criteria,
loo-ioi (^see also multiple
criterion)
cognition (^see perception, of re-
ality)
community, mental disease and,
13-14
concern for others, self-actualiza-
tion and, 35
conflict, as mental disease, 13
conformity, 47-48
Conrad, Dorothy C, 57-58, 74
conscious, in integrated person-
ality, VJ, 38
consciousness, of self, 25-27 {^see
also self, attitude toward)
contentment, 19-21
Cottrell, L. S., Jr., 46, 52, 56
cultural relativism, 13
cultural values, 76-80
culture, mental disease and, 12-13
{see also society)
D
Darw^in, Charles, 114
Davis, K., 17
INDEX
decision-making process, 45-46,
48
assessment of, 91-92
development, 71
sense of identity and, 30
{see also growth)
Devereux, G., 13
Dicks, H. v., 57
disease, physical, 67-68 {see also
illness; mental disease)
Dubos, Rene J., 1 14
Duncker, K., 63, 95
Dunham, H. W., 107
ego
in integrated personality, 37-38
reality and, 61
{see also self)
ego-identity {see identity)
ego-psychology, reality-orientation
and, 44
empathy
measurement of, 94
in perception of reality, 52-53
empirical assessment of mental
health, 81-100
environment
maintenance of mental health
and, 105-108
well-being and, 20-21
{see also situation)
environmental mastery, 23, 43,
53-64
assessment of, 94-95
Erikson, Erik H., 29-30, 41, 54-55,
71, lOI
Ewalt, Jack R., 42, 50
INDEX
[133]
Paris, R. E. L., 107
flexibility, in integrated person-
ality, 38-39
Foote, N. N., 46, 52, 56
frequency concept of normality,
15-18
Freud, Sigmund, 34, 37, 61
Fromm, Erich, 8, 27, 30, 31, 32,
57> n
genitality {^see orgastic pleasure)
Ginsburg, S. W., 55, 57, 80
Glover, E., 42
Goethals, George W., 42
Goldstein, K., 31, 32
Gottlieb, Jacques S., 116-117
growth, 23, 30-35, 71
measurement of, 87-89
H
Hacker, F. J., 54
happiness, 18-21
Hall, C. S., 27, 29, 35
Hartmann, Heinz, 37-39, 44, 46,
47, 60-61, ^()
Havens, Leston L., 114-115
health, mental {^see mental
health)
health, physical {see physical
health)
health potential, 14
heterogenic attitude, 33-34, 71
HoUingshead, A. B., 107
Horney, Karen, 56
Howell, Roger W., 11 6-1 17
Hunt, J. McV., 61
id, in integrated personality, 37-38
identity, sense of, 28-30
integrated personality and, 41
independence {see autonomy)
illness, health and, 112-119 {see
also mental disease)
integration of personality, 23,
35-43. 54. 71-72
measurement of, 89-91
interpersonal relations
assessment of, 95
environmental mastery and, 53,
56-58
sense of identity and, 29-30
investment in living
measurement of, 87, 89
self -actualization and, 32, 34-35,
J
Jahoda, Marie, 50, 51, 63, 72
Janis, I. L., 42
Janowitz, M., 108
Johnson, Wendell, 43-44
Joint Commission on Mental Ill-
ness and Health, 19, 127-
130
Jones, Ernest, 16-17, 19, 20
Jones, M., 107
Jung, Carl, 35
K
Kardiner, A., 107
Kaufman, M. Ralph, 115-116
Klineberg, Otto, 12
Kluckhohn, Clyde, 69
[134]
Kris, E., 37
Kubie, L. S., 27, 38-39
Leighton, Alexander, 7
Lewin, Kurt, 88
Lindner, R., 35
Lindzey, G., 27, 29, 35
Linton, Ralph, 13
love, ability to, 53, 54-55
assessment of, 95
M
McDougall, William, 29
maintenance of mental health,
104-108
majority concept (^see frequency
concept)
Maslow, A. H., 28, 31, 32-33, 34,
40. 47> 50j 70
mastery of environment {see en-
vironmental mastery)
May, RoUo, 57
Mayman, M., 25, 26, 31-32, 33-35,
46-47, 56, 71, 75
Menninger, Karl, 18-19, 20
mental disease, 6, 73-76
definitions of, 10-14
anthropological, 12-14
diagnosis of, 10-12
{see also illness)
mental health
concepts of, 5-66, 76-110
empirical indicators for, 82-
100
research in, 81-110
unsuitable, 10-21
INDEX
values and, 76-80
definitions of, 3-4
mental disease and, 10-15,
73-76
types of, 66-73
mental patients, mental health
criteria and, 103-104
Merton, Robert K., 68
Meyer, Adolf, 109
Money-Kyrle, Roger E., 50
moral values {see values)
motivational processes, self-actu-
alization and, 32-35
Mowrer, O. H., 17
multiple criterion of mental
health, 70-73 {see also
clusters)
Murray, Henry, 30, 69
N
need distortion, in perception of
reality, 51-52
negative health, 74
nonhealth, 74
normality, 15-18
case study of, 66-67
O
objectivity, toward self, 27
observation, as measurement of
health, 84-86
optimum mental health, 49, 72-73
orgastic pleasure, 54-55
perception, of reality, 23, 43,
49-53. 7^-7^
measurement of, 92-94
INDEX
personality, integration of (see
integration)
physical health, 67-68, 112-116
Piaget, Jean, 62
plasticity, in integrated person-
ality, 38
play
assessment of, 95
environmental mastery and,
55-56
Porterfield, John, 50
positive mental health {see mental
health)
preconscious, in integrated per-
sonality, 37, 38
problem-solving
as environmental mastery, 53,
62-64
measurement of, 95
proprium, 40
psychoanalytic theory
mental disease and, 13
reality-orientation and, 44
(see also Freud)
R
reality
adaptation and, 60-62
attitude tow^ard self and, 27, 28
reality-orientation, 43-45 {see also
perception)
Redlich, F. C, 17, 107
Reich, Wilhelm, 54
research
requirements for, 81-82
suggestions for, 100-104
resistance, to stress {see stress)
Riesman, David, 47, 48
[135]
Rogers, Carl, 31
Riimke, H. C, 73-74
Sanford, Fillmore H., 58
satisfaction, 19
Schwartz, M. S., 107
self, attitude toward, 23, 24-30,
observation of, 83-87
{see also autonomy; self-ac-
tualization)
self-acceptance, 28
self-actualization, 23, 30-35, 70-71
measurement of, 87-89
unifying outlook and, 40-41
self -concept {see self, attitude to-
ward)
self-consciousness, 25, 26-27
self-determination, 46, 71 {see
also autonomy)
self-extension, 34, 39
self-objectification, 39
sense of identity {see identity)
sexual pleasure, 54-55
situation
assessment of, 95
behavior and, 58-59, 85
{see also environment)
Smith, M. Brewster, 49, 72
social values {see values)
society, health of, 8-9 {see also
culture)
Stanton, A. H., 107
stress, resistance to, 36, 41-43
measurement of, 90-91
success {see environmental mas-
tery; problem-solving)
[136]
Sullivan, Harry Stack, 31, 56
superego, in integrated person-
ality, 37-38
testing, of reality, 51-52
tests, for self-descriptions, 83-86
therapy, mental health criteria
and, 104
Tillich, Paul, 43
tranquilizing drugs, 104
U
unconscious, in integrated person-
ality, 37, 38
unifying philosophy, 71
in integrated personality, 36,
39-41
measurement of, 90
INDEX
value judgment, in science, 6-7
values, 76-80
W
Weber, Max, 75
Wegrocki, H. J., 17
well-being, as mental health con-
cept, 18-21
White, Robert, 30, 66-67
White, William Alanson, 6'jj 70
Wishner, Julius, 59
work
assessment of, 95
environmental mastery and,
55-56
World Health Organization, 18,
56
Wright, H. F., 107
Date Due
Current concepts of positive m mam
131.306J74mno 1 C2 3 lEbE D3S72 lbb3
0 komentar:
Posting Komentar