A colleague and friend of mine who is a retired professor of pathophysiology with a longstanding interest in psychiatry and human behavior made a very important point to me in our conversations about mental health.
“When I was learning about what constituted a diseased liver,” he said, “one of the most important pieces of knowledge I had was what a healthy liver looks like to serve as a comparison. Yet, in mental health and psychiatry, basically what you have are descriptors of dysfunction but no real comparison or reference models of what constitutes psychological health. Instead, there is just a vague claim that the current presentation must not be ‘normal’.”
This is an excellent point. Although this has changed some in recent years with the emergence of positive psychology, it remains the case that far less attention has been paid to clarifying what constitutes psychological health than psychopathology. And, for far too long, psychological health was essentially defined in terms of the absence of psychopathology.
In recognizing this point, however, it must also be acknowledged that understanding psychological health is quite tricky and complicated. Consider it this way: It is much more straightforward to answer the question of what is a healthy liver than what is a healthy person. The latter feels (and is) much more value-laden and culturally bound. But that does not mean we are paralyzed and the goal of this blog post is to help readers think more explicitly about what it is that constitutes psychological health.
To begin with, let’s start with the most general definitions and conceptions of mental health. The World Health Organization explicitly defines mental health as “a state of well-being in which [an] individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community."
I believe we can also think about mental health and illness on a continuum that is represented in the depiction below. Here the key is to think about mental health on two related but separable dimensions of subjective experience and functionality. Thus, mental illness is broadly characterized in terms of mental distress and dysfunction, whereas mental health can be thought of in terms of mental satisfaction/happiness and optimal functioning.
We can break this continuum model down further via the Nested Model of Human Well-Being, depicted here.
The Nested Model maps the construct into four related but also separable nested domains: 1) the subjective domain, which includes the first-person phenomenological state of being; 2) the biological and psychological health and functioning of the individual; 3) the material and social environmental context; and 4) the values and ideology of the evaluator.
From this conception, well-being is achieved when there is a positive alignment of these domains. That is, an individual is high in well-being when they are happy and satisfied with their lives, are functioning well psychologically and biologically, have access to necessary and desired material resources and social connections to meet their needs (and the relative absence of damaging or dangerous stressors), and are engaging in life with a purpose and a direction that is deemed by the evaluator to be good and moral.
It is worth noting that we can if we “invert” the focus of the Nested Model, an outline of the key domains of illness and pathology emerges. From an "inverted" perspective, domain one corresponds to subjective feelings of distress, misery or dissatisfaction with life; domain two would involve maladaptive or dysfunctional psychological and biological processes; domain three would involve material and social contextual factors that threaten to disrupt functional processes (e.g., toxins or emotional abuse) and fail to meet basic biophysical and psychosocial needs all in a way that is deemed to be problematic by the evaluator.
Some psychologists have attempted to specify the ingredients and outcomes that capture healthy psychological functioning. An earlier blog post I did (see here) reviews Carol Ryff’s six domains that, according to her make up optimal psychological functioning and it also offers a brief survey that you can take to see where you fall.
Finally, I will offer the perspective from the Psychodynamic Diagnostic Manual (PDM). The PDM was developed by psychologists who wanted a contrast to the psychiatric-based DSM. Unlike the DSM which is essentially is devoid of all notions of mental health, the PDM does include a fairly well-specified list that attempts to capture good psychological functioning, which are included in the following slide.
In sum, understanding psychological health is as crucial as understanding psychopathology. Indeed, as my friend the pathologist noted, if we are really going to understand psychopathology, we must also understand psychological health. Doing so can provide us a clear guide as to what we are striving for when we attempt to increase human well-being.