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Positive Psychiatry: A New Way to Approach Mental Health

Tackling serious mental illness with a one-two punch.

  • Positive psychiatry was developed in 2013, offering additional treatment options to patients with serious mental illness (SMI) that go beyond curing symptoms.
  • This new concept teaches those with SMI how to live meaningfully despite chronic symptoms.
  • Strategies for helping patients find meaning include joining a chosen community and focusing on small, thoughtful actions and goals.

For a long time, mental health practitioners — including psychologists, psychiatrists, and others who worked with people struggling with serious mental illness (SMI) — studied ways to improve outcomes by focusing only on symptoms and other things going wrong, as well as how to remove or reduce those difficult things. Those questions are important, but that narrow focus on removing things that are hard or painful can do a disservice to people with mental illness for a few reasons. One issue is that, for some people, chronic symptoms are very difficult to get rid of, so waiting for those symptoms to go away before they pursue other goals means they may never get to pursue those goals. Another issue is that reducing symptoms doesn’t necessarily lead to a “good” or enjoyable life.

As Dr. Martin Seligman, the father of positive psychology, puts it: “Curing the negatives does not produce the positives.”

So what does produce those positives?

Positive Psychiatry

The concept of positive psychiatry was developed in 2013 to answer that question (Jeste, 2013). Although positive psychology has existed for a longer period (since the 1990s), many health and mental health practitioners continue to be trained based on a medical model framework that doesn’t incorporate the whole person and identify how to promote positive psychosocial characteristics that help increase well-being and quality of life regardless of symptom severity.

Positive psychiatry especially focuses on how to produce those positives, especially for people who are experiencing SMI. This framework of mental health works to identify how to create those positives in each person’s life by asking: What is good? What is meaningful for a given individual? How can we work together to add those things to that person’s life? How can we improve positive psychosocial characteristics like resilience, social engagement, wisdom, and compassion to that individual’s life? How can we increase happiness, joy, meaning, purpose, satisfaction, and contentment?

Asking those questions doesn’t mean that you ignore the hard things like symptoms or trauma, or stop feeling negative emotions. One of the major misunderstandings about positive psychiatry is that it’s all about “thinking positive,” or being in a good mood, no matter what’s going on around you. But that’s not realistic! No one can be in a good mood all the time, and positive thoughts aren’t always accurate — just like negative thoughts aren’t always accurate. Positive and negative emotions can and do co-exist, although usually, people experience a decrease in negative emotions and an increase in positive emotions when more meaningful and enjoyable components are added to their lives.

Thus, we work towards a better life from two angles: by decreasing things that make life harder and more painful; and by increasing things that make life easier, more joyful, and more meaningful. These two goals can co-exist, and we can have difficulties and pain while also pursuing joy and meaning.

The Recovery Model

Another common misunderstanding about positive psychology is that it is only for people who are already doing pretty well, and not for folks with current mental health problems like SMI. Positive psychiatry can be an important part of everyone’s life, and can be an integral part of mental health treatment for people with SMI. A great example of this is the recovery model.

The recovery model originated among people with schizophrenia and other SMI. Through the traditional way of mental health treatment, focused on attempting to reduce symptoms or functional difficulties did not fully serve many people with SMI. Although some people with SMI do experience complete remission of symptoms, many people don’t and may continue to experience significant symptoms for their entire lives. The mental health system didn’t have an answer for these folks except to keep trying, with a new pill or therapy, or to stop trying and tell people to accept their current situation in life.

The people who created the recovery model did not accept this premise. Instead, they looked at their lives and sought to find hope, meaning, and purpose. They cultivated a life that was satisfying for themselves regardless of their continuing symptoms or functional difficulties. For example, Pat Deegan, a person living with schizophrenia and a clinical psychologist, wrote:

“It is important to understand that for most of us recovery is not a sudden conversion experience. Hope does not come to us as a sudden bolt of lightning that jolts us into a whole new way of being. Hope is the turning point that must quickly be followed by the willingness to act […] One day at a time, with multiple setbacks, we rebuilt our lives. We rebuilt our lives on the three cornerstones of recovery: hope, willingness, and responsible action.” (Deegan, 1988).

This is the recovery model in a nutshell: that symptoms and difficulties can remain, and that happiness, purpose, and health can co-exist at the same time. It’s not necessary to wait for symptoms to totally remit to pursue happiness and well-being — we can pursue it right now.

This pursuit often helps with symptom management, but regardless of whether it does or it doesn’t, life improves. By not assuming that symptom remission is the one and only goal of mental health treatment, we can start to prioritize the goals that matter to each individual most. Research shows that many people with SMI care more about having satisfying social relationships, being able to live independently, and being able to pursue personal and vocational goals effectively than total symptom remission.

5 Elements of Recovery & How You Can Use Them to Improve Your Wellness

A population recovery model is called CHIME (Bird et al., 2014), which covers five major elements that can help guide you as you work towards a more enjoyable, satisfying, and meaningful life.

1. Connectedness

Connectedness can include social, familial, and romantic relationships, being a part of a chosen community that matters to you, giving receiving support, and being a part of peer groups and support groups. Chosen communities are very important for people’s recovery (Treichler et al., 2015) and overall, for well-being. These communities could include social groups, groups based around your neighborhood, shared hobbies or activities like exercise or volunteering, shared values like spirituality or politics, or shared identity, including having a mental illness. Look at our previous blog post about loneliness for more details about creating connections.

2. Hope and optimism about the future

Looking toward the future and seeing the possibility for better days, and then taking thoughtful action to help create those days is a key part of recovery. For many people, this is about buy-in to the idea of recovery. Building hope can be hard, especially when you are struggling.

One way to do this is to start small and see what little improvement you can make. This might include trying a deep breathing practice for just a minute per day, texting a friend you haven’t talked to in a while, or taking a walk around the block. By starting with small goals and seeing the impact they can make, you can build hope around what you can accomplish.

3. Identity

When people experience setbacks, including psychiatric relapse, loss, trauma, or something else, it can sometimes cause them to question or even lose their sense of personal identity. For these people, regaining that sense of identity is critical. Your identity may have changed due to what you’ve experienced, or are experiencing now. Part of recovery is to accept that and find a positive sense of identity in the person you are now, rather than fighting against yourself to try and be someone else. Individual therapy can often help with exploring your sense of identity, and you may also find that activities to explore identity, like writing and art, can help as well.

4. Meaning in life

Meaning in life is personal and may be connected to different things, including religion or spirituality, other beliefs or values, family or other relationships, other social roles, connection to nature or animals, work, or hobbies. Identifying what gives your life meaning, and finding specific activities that help you add that meaning into your day-to-day life increases recovery and well-being.

For example, if you found meaning in your role in the military but are now a veteran, you might find meaning in a role where you can spend time with or serve other veterans or military families. If you find meaning through your connection to nature, you might find meaning through spending time outside, volunteering for the local or national parks service, or for a conservation non-profit.

5. Empowerment

Empowerment is all about feeling in control and using that sense to capitalize on what makes you strong and powerful to move yourself, and possibly others, forward. Sometimes people who are struggling feel like they don’t have any power and can’t make a change in their own lives. And it’s partially true — not everything is in our power.

To improve empowerment, look to find the things that are in your power, that you do have control of. Harness your strengths to cultivate a life you’ve chosen. Small changes can have a big impact. For example: Ask for the appointment time with your doctor that works best for you. During the appointment, ask clarifying questions to be sure you understand the treatment options and are on board with the decisions being made.

In short: Positive psychiatry is not just a feel-good idea but reflects evidence-based science wellness for all people.

References

Bird, V., Leamy, M., Tew, J., Le Boutillier, C., Williams, J., & Slade, M. (2014). Fit for purpose? Validation of a conceptual framework for personal recovery with current mental health consumers. Australian and New Zealand Journal of Psychiatry, 0004867413520046.

Deegan, P. E. (1988). Recovery: The lived experience of rehabilitation. Psychosocial rehabilitation journal, 11(4), 11.

Jeste DV. A Fulfilling Year of APA Presidency: From DSM-5 to Positive Psychiatry. American Journal of Psychiatry 170:1102-1105, 2013.

Jeste DV with Lafee S: Wiser: The Scientific Roots of Wisdom, Compassion, and What Makes Us Good. Sounds True Publishing, Boulder, CO, 2020r 3, 2020 .

Seligman, M. E. (2006). Learned optimism: How to change your mind and your life. Vintage.

Treichler, E. B. H., Evans, E. A., Johnson, J. R., O’Hare, M., & Spaulding, W. D. (2015). The relevance and implications of organizational involvement for serious mental illness populations. American Journal of Orthopsychiatry, 85(4), 352–361. https://doi.org/10.1037/ort0000051

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