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CURRENT CONCEPTS
OF POSITIVE MENTAL HEALTH
Lyrasis
http://www.archive.org/details/currentconceptsoOOjaho
Joint
on Mental
Commission
Illness
M ONOGRAPH
and Health
SERIES / NO.
Qurrmt
QonccYts
of
Positive Mental Health
MARIE JAHODA
A REPORT TO THE STAFF DIRECTOR, JACK
R.
1958
New
York
EWALT
COPYRIGHT
MANUFACTURED
IN
Foreword
Ihis
is
the
first
of a series of
monographs
to be published
Illness
and Health
as
and recommendations
The
document
present
monograph
series,
Commission.
publication:
1.
3.
Economics of Mental
Rashi Fein, Ph.D.
George
4.
5.
Illness
W.
Albee, Ph.D.
The Role
of Schools in
Mental Health
W.
Goethals,
EdD.
[v]
vi
FOREWORD
6.
7.
Community Resources
Nonpsychiatric
8.
in
Mental Health
9.
Richard
10.
J.
Plunkett, M.D.,
Illness
THE OUT-PATIENT
B.
THE IN-PATIENT
C.
THE EX-PATIENT
Morris
S.
From
forming the
basis of
pare a
summary document
incorporating
an
summary document
Commission before
its
state
its
findings
and
ofl&cial report.
professions, in accordance
1955.
FOREWORD
Participating organizations,
Joint
Commission,
as well as
members, and
The
Joint
Commission,
it
officers of
vii
the
staffs,
may
be seen,
is
nongovern-
Health
may
quarters,
from the
publisher, or
Joint Commission
from book
on Mental
dealers.
Illness and
Health
Sujf%cCVICW
we mean by
"mental health"
is
obvious to anyone
who
has attempted to
mental
illness,
ment now
Any
possible
program-makers.
a term interchange-
that
scientists
who
movement have
focus
on
is
needed
tive force, is to
useful.
"sick behavior."
perspective
to
be
They make
if
They argue
interest in
made
that a
new and
mental health,
broader
as a posi-
a telHng point
when
in-
much
as a natural
phenomenon.
[ix]
STAFF REVIEW
this
monograph, we have
mental
illness,
as a
or
its
prevention.
We
of Social Psychology,
New York
who
is
Professor
University,
and Director
Human
Relations, to
and extensive
this
analysis of
No
document
lead.
However,
it
may
and
issues
be helpful to
1.
ment or
culture
may
is
therefore,
"sick
2.
to distinguish
ual
is
may
between
attributes
be classified as more or
and
less
actions.
it is
The
advisable
individ-
healthy in a long-term
STAFF REVIEW
view of
during
attributes.
or less healthy
may
that
is,
xi
appropriate
be regarded as more
from
viewpoint
the
3.
ards.
Mental health
4.
one of
is
many human
No
5.
values;
it
should
itself.
exists for
illness.
none
national pro-
gram
await
6.
it.
Many
scientific investigators
major approaches
review of
to the sub-
ject.
a.
b.
Degree
to
which person
through action.
Unification of function in the individual's personality.
c.
d. Individual's
fluences.
7.
e.
How
f.
Ability to take
One
it.
be
this:
two
feet
An
own
others.
8.
The need
health
is
for
more intensive
underscored.
scientific research in
mental
STAFF REVIEW
xii ]
Among
graph, there
may
be some discomfort
who
at
Jahoda
states that
from the
as per-
How-
ever,
it
is
point.
chemical homeostasis
The
stress
laboratory
is
can profoundly
alter the
More
chemical-physiologic
some evidence
indicates that
may
stituents,
external stress
body, in terms of
determine the
and other
life
way
its
chemical con-
experiences.
and drugs
state of
tem and
For those
to
which
who
all
must conform,
it
may
is
a unitary state
is
a necessary but
Some, however,
feel that
mental health
is
more
relative
would
STAFF REVIEW
moron
as well.
They may
who
good mental
con-
has recovered
xiii
spite of this,
attitudes,
have
of view, else,
from a
man
among
dinary mortals
is
healthy.
Who
we
could never
knows what
or-
of oxygen been
more vitamins
None knows
.^^
that he
is
as intact as
and notions of
mental health, were merely added a phrase "with a physiologic function consistent
ciety
The
more
so-
typical clinical
lem. This
Barton's
all
staif
and Dr.
health indeed
means
Jic]inowlcdgcmcnts
Men-
staff,
me
Work on
this report
carried through in
tion
When
and organization.
was
finished,
it
was
first
submitted to
my
colleagues at
New
W. Cook
made
to
it
an immeasurable improvement
Xvi
ACKNOWLEDGEMENTS
They
who
are as follows:
N. Y.
of
Human
Relations,
John A. Clausen, Ph.D., Chief of the Laboratory of SocioEnvironmental Studies of the National Institute of Mental
Health, Bethesda,
Ernest
Md.
Memorial Fund,
New
Staff,
Milbank
York.
Yale University,
New
Haven, Conn.
New
Haven, Conn.
(Now
deceased).
New
York.
met with
me
These
The
The ensuing
spirited dis-
ACKNOWLEDGEMENTS
my
Xvii
mental health.
title
of
graduate student assistants, helped in every way, from taking notes at the meetings with consultants
(much more
eco-
worked
fully and
I
with the
report, Mrs.
Robbins and
grace-
the task.
To
all
of
them
my warm
thanks.
Marie Jahoda
Qontmts
Foreword
Staff
Review
ix
xv
Acknowledgements
I.
Introduction
The Nature
II.
of
The Absence
of
10
Mental Disease
as a Criterion
10
15
18
Mental Health
III.
The
Psychological
for Positive
Meaning
of Various Criteria
Mental Health
22
25
[xix]
XX
CXJNTENTS
Health
24
Mental Health
jo
^^
4^
Note on Reality-Orientation
Autonomy
as a Criterion for
Mental Health
4$
Health
4g
Mental Health
IV.
V.
An
53
6^
66
The Multiple
yo
Criterion
Approach
73
y6
From
Empirical
Indicators
for
Positive
81
Mental
Health
Some
82
100
Mental Health
VI.
VII.
In Conclusion
104
log
///
CONTENTS
Xxi
References
121
Appendix
Joint
Commission
on
Mental
Illness
Index
and
Staff
and
Mem727
/J/
common
one
is
that of
making
a Hst
and plan of
life
all
and giving
The way
making
tions,
of the
worker
in
modern hygiene
them
effects
to
and
first
is
that of
and condi-
on which
The
to get there.
tracing
and
recommendations as to how
fruitful experi-
Adolf Meyer,
1925.
^$1^-%
Introduction
Ihere
is
as vague, elusive,
That
it
and ambiguous
it
to
as the
many
is
bad enough.
for
them makes
the
promote mental
re-
search.
of this review
is
we
shall
man
to give
and
meaning
to this
human
first
behavior called
critical discussion of
mental
convenience.
from
it is
Yet, as
we
A definition
can be expected
many
efforts to define
mental
They
philosophies
Such "definitions"
be.
also v^ill
have to be examined.
he ought
has
its
efforts to
to or could be.
ov^n characteristic
incorporating
Every
v^^ay
ideals of a
its
this
probably
good
man
in a
good
society.
Why this
an interesting study in
historical period
itself.
man
is
one
Here we must
limit ourselves
mental
health to fundamental values should temper scientific impatience with concepts that do not immediately suggest to
the reader
how
work.
Since our goal
is
lacking,
fact.
and
we
in indicating
will
aim
are
both
re-
INTRODUCTION
IS
Whether we Hke
tal
hygiene,
is
it
men-
and governmental
agencies, the
Funds
biguity.
(or,
ampromote
and expended
of
its
to
But
is
there substance
if
like.
From
v^ill
as less of a
benefit
panacea
this situation, a
moral
members
of these groups feel that they need clarity about the con-
ment
and
want
to use
it
to define
goals. It
tiaHties
is
human
poten-
their realization.
The
them with
basic
man
They demand
functioning.
compatible with
Finally, the
knowledge of man.
scientific
is
used by
scientists
them-
selves
is
often
and malfunctioning
far exceeds
knowledge of
centration
on appropriate functioning,
if
scientific
scien-
based on an unwillingness to
and
community oppose
ill-defined.
In part
it is
work with
a notion so vague
is
it is
this
manner, they argue, can science remain free from "contamination by values" and a resulting distortion in the choice
and study of
scientific
This argument
rests
problems.
upon the
is,
on
knowledge
testifies to
INTRODUCTION
of them,
by correcting an
will benefit
more
sick functioning,
is
v^hich v^as
In any
work
v^ill tell
case, it
if
it
is
more profitable.
from the value of a
piece of
man:
From
mental health
cept,
a possible con-
its
value connota-
scientific
here.
we
is
work. Perhaps
Whether or not an
it is
clear
best to let
is
needed con-
meaning only by
the argument rest
is
up
to
him.
may
concepts to keep in
mind
mental health in
at least
as a relatively
and
on the
and
stresses
feelings
momentary function
finds himself; or as a
of
depending
which a person
personality and
situation.
Looking
at
classification of individuals as
first
more
way
will lead to a
at
it
as
more
or less healthy.
The
Take
he
is
a strong
man
ments are
justifiable
and
useful.
that
son or as one
he
is, if
who
is
is
is
made
functioning healthily.
whether one
state-
in the
is
wrong
Much
of the con-
from the
failure to
as a
momentary
attribute
we shall keep
moment choosing
tween
re-
Both
context
is sick.
first,
mind without
at this
the
be-
either position.
The German
On
many
title
The Sane
closer examination,
however,
re-
Society (1955).
all
INTRODUCTION
is
To
call a situation
ellipsis
healthy
meaning
that
any other
This
is,
it
cannot be attributed
entity.
behavior
is
irrelevant.
On
the contrary:
it is
of the greatest
we
The
relation of
is
criteria
saper-
in
been explored.
human
meaning,
if
behavior has
(^learing the
Air:
Unsuitable Qonccvtualizations of
Positive ^Mental Health
NIental health
as the opposite of
mental disease
is
per-
To
is
at present
much
mental
able diflEculties.
many
among
When
psychiatrists agree
UNSUITABLE CONCEPTUALIZATIONS
II
not known.
is
many
mentally
ill
quickly achieved.
is
who do
persons
not (at
diagnosis
is
not to
show one
On
Whether
or
call
classification is
made
To make
disease
is
a bafHing task.
By and
more
classifica-
many research
Milbank Fund sym-
useful in
posium (1953). Definitions of the following kind were reported: "A case is a person under the care of a psychiatrist";
or,
'case' is a child
The
child
is
making
is
about
whom
"
admit severe
who
much
they permitted
it
limitations.
at least
psychiatrist; also,
sophistication, cer-
12
tainly,
The
made
that
Such
restraint
self-critical
much
v^ell-
support
some
tell
Western
cultures that
symptomatic of mental
civilization v^ould
behavior that
is,
a.n
Ruth Benedict
Columbia engage in
According
disease.
regard
to
is
similar to a delusion of
and immobility,
as
physical mani-
its
an
artificial schizo-
and end of
his
"symptoms," a
The example
symptoms must
and
identical observable
this
is
important here
symptoms
that
It
whereas
who
are exposed to
thing fundamentally
is
homo-
is
cultures, the
interpreted in the
some-
same
UNSUITABLE CONCEPTUALIZATIONS
^3
Some
disease.
The
same
direction.
ways
to be insane"
turbance in
from
itself varies
Only with
culture to culture.
is
dis-
cultural rela-
tivism appropriate.
Devereux bases
his
human
conflicts. If it is
universal,
we
it
lie
in the
evitably be inferred
is
from unconscious
there
are free
way he
who
beings
is
so,
in-
no agreement on the
types of behavior
which
it is
The
human
of, say,
an urban
artists'
colony.
It
follows,
14
isolated
day
garded
known
as "disease" in all
cultures
is
as yet
an open
question.
normal and
extreme
as
cases.
abnormal
dim and
is
is
regarded as
is
not
much more
we can
discover
more rigorous
issues, a
makes the
definition of psy-
health
is
poles of a continuum.
Some
is
more
psychiatrists
now
to be unjustified
What
if this
as-
and misleading ?
We shall return to
At
this
difficulty in clearly
fined by identifying
it
it
un-
disease. It
would
UNSUITABLE CONCEPTUALIZATIONS
^5
more
its
connotation,
positive
may
constitute
far as normality
is
ingly,
plasticity of
as a series of variations
human
and that in
a great variety of
cultures in different
as
normal.
is
there
is
term
makes
it is
correct to
another matter.
It
may
a coincidence of statistical
and normative
people ought
how
exists in the
existence.
The
majority of cases
failure to
To
correctness.
is
right by virtue of
l6
synonym
is
it is
remains to be seen
vi^hat
if
explicitly,
many
per-
as healthy,
This belief
is
sons regard
regard to
fostered
by the unquestionable
many human
is,
majority manifests
the
either
many
is
and
so forth).
hesitate to call
where there
fashion
is
would perhaps be
different
those
is
food
respond in such
from regarding
who, in
may
see
spite of their
as
psychologically abnormal
may, but
statistical definitions
As Ernest Jones
statistically normal mind
UNSUITABLE CONCEPTUALIZATIONS
mind
healthy
(that
is,
mind
the
in
which the
Mowrer
full capacities
is set
(1939),
I7
In order to establish a
the population
statistical
from which
it is
to
be derived.
And
to define
the choice
concept of health.
statistical
develop a
set of statistical
One would
norms
an
for
merged
arbitrarily
societies,
Because
the
Why
not ?
it
and
Similarly, even
when one
all
its
evalua-
health.
weight to
at
is
would not
give equal
all
say, the
of the as in a page
against
uals.
which
For
it
mean, not
it.
We
to evaluate the
seems clear
all
that,
mental health
status of individ-
may
tacit, nonstatistical
l8
considerations
statistical
approach.
The
how
how
to
to select
select
and
mental health.
If
itself,
normaHty
is
of
no
use.
Many
in a state of well-being.
as "the
Organization, for
meant by
is
but another
the phrase
is
is
criteria for
an individual's
Menninger (1947),
for example,
says
as the
adjustment of
maximum
Not
is
game
beings to
of effectiveness
or
contentment
cheerfully. It
is all
and
the grace
of these to-
This,
human
think,
is
a healthy mind.
and a happy
disposition.
UNSUITABLE CONCEPTUALIZATIONS
This description contains a variety of
that
we
are not
full
from
^9
criteria.
Recognizing
his description,
first,
the
him
B.C.,
when
must be sought
in
himself.
Boehm
a condition
and
level
socially acceptable
and
per-
is
(1955),
is
sonally satisfying"
the
Commission on Mental
meaning attached
a fair
number
to ascertain
states of being.
To
distinguish
and Health
well-being,
in degrees
to
Illness
regard various
to a
among them
is,
however, a
states of
difl&culty
all
tacit as-
special
referent or qualification.
from
life is
in
if
life offers.
Such happiness
20
is
no
The
control.
most obvious
and personal
ceptability
if
What
if
social ac-
What
dom from conflict or tension is inappropriate in a life situation? Do individuals then have to be considered mentally
unhealthy? To answer this question in the affirmative betrays
moral
of all existing
justice
conditions.
make
less
it
mean
enduring personality
to speak in
attributes.
And
ternal events
experiences,
is
Thus
happy
human
being
To
is
one thing.
To
it
occurs, as such
an indication
a different matter.
To
man
selects
and
many
facets of the
own making. To
UNSUITABLE CONCEPTUALIZATIONS
21
when
happiness or
than
as
momentary
feeling states
depending on
Ill
The
^sycholoncal '^caning of
Various QriUria
for Positive
^Mentol Health
bo
meaning
to the
found more or
less v^anting.
To regard
an
insufficient indica-
in one connotation,
another sense
it
is
was found
to
chological content. Various states of w^ell-being proved unsuitable because they reflect not only individual functioning
this
is
hoped that no
SIX
From an
^3
APPROACHES TO A CONCEPT
six
There are
1.
manner
own
self.
Various distinctions in
demon-
Another group of
style
as
contrast to the
first, is
self
self -perception
but
some of
The following
on the
more
individual's rela-
tion to reality.
4.
Autonomy
dependence from
state of his
5.
social influences as
mental health.
number
is
mental health.
as-
24
though there
apparent,
is
amount
a certain
many
authors have
And
of the categories.
As
of overlap.
made
v^ill
become
contributions to several
it
on
criteria of positive
at least,
not yet
other, to
thoughts
theories.
One consequence of this emphasis on criteria is that similarities may appear v^here theoretical differences have not
led one to expect them.
Another
examine these
criteria
is
that
it v^^ill
be possible to
viev^ of
mental
of
recurring theme in
many
self.
is
the emphasis
The mentally
tions. Self-acceptance
to the
certain qualities
to
sibilities
and
on
meaning
live
efforts to give
he
may
self-respect
judgment
is
^5
from within. However, the terms have become entrenched in everyday language in a manner leading to a
tive
There
exists also
terms
are,
self.
Such
A
to
number
as criteria for
mental health.
self-concept that
made
Although not
identity.
explicit
by the writers
all
of these com-
who
use attributes
many
amount
is
a certain
self,
about the
For example,
Mayman
(1955), in speaking
"An
intact sense of
by the individual of
that
he wants
able to be
to be
all
his
all
that he should
and
all
is
mony."
In the course of his discussion of objectivity of
tion, to
which we
shall return,
self-percep-
26
''self-objectifica-
tion, that
he surveys
his
own
when
own equipment
his
of others,
and
equipment
desires,
and
obligations,
and
present and in anticipation of the future. Clearly the quotations indicate that
sirable
that
is,
when
healthy
contains an image of
it
Mayman and
all
Allport
Barron, on the other hand, appears to regard self-awareness as a counterindication of mental health
says:
"We
best of health. It
our notice.
is
when we
is
when we
comes
not self-conscious.
is
from malfunction.
."
Mayman do
.")
and Mayman's
determination"
oneself."
to
Allport and
veys
He
are in the
Self-consciousness arises
There
self
(1955).
Nor
may
Allsur-
on
own
self.
However, the
sharp focus the fact that this criterion can serve as an in-
moment
but only
^7
when
appropriate.
self is
must be
accessible to
on need."
introspection
The
idea that
objectively
literature,
it
is
good
is
Gordon
must be
an
objectivity requires
temptation
is
common
Such
and
objective to be healthy.
ability for
detachment.
what we would
strong to mistake
The
like to be
Whatever the
direction, such
is
Fromm
self.
is,
by the development of
objectivity
and reason."
Feelings about the Self-Concept
The
and others he
question of
how he
feels
proud of gives
about himself.
rise to
the
28
presumably
accept himself
shortcomings
i.e,,
ample of
Our
this
own
his
Maslow (1950)
point of view:
their
including
his self-concept
those elements of
expected to be proud.
that he should
is
it
and
mat-
It is
Maslow
encompasses them
In any
case,
he and others
too.
His reference to
latter interpretation.
who emphasize
self-acceptance
it.
and are
realistically
self.
Sense of Identity
Closely related to such balanced self-acceptance
aspect of the self -concept
which
is
is
another
identity.
What
Cattell
[29]
McDougall
ment
sentiment, or what
any
specific
that pervades
The
and
he
is
distinguishing
The
feel basic
He
talks about
it
ment
of a healthy person.
trust,
autonomy,
"is
(The preceding
when
successive stage,
cessful
from
develop-
work
he
says,
all
endowment and
identity, then,
is
his opportunities.
The
sense of ego
He
is
meaning
for others."
diffusion
which
body changes
its
is
proportions radically
,"
when
self-
the
here implying
is
possible.
is
30
more he
and
it
inspiration."
Most
that
v^Titers
acquisition
its
is
is
a suitable
criterion for
cer-
ideas to those of
are
many
vicissitudes in the
is
development of ego
toward an increase of
but
identity,
stabihty.
continuing
v^ell
only more sharp and clear but also more consistent and free
from
transient influences. It
this v^ay
it
progres-
failure."
SELF-
ACTUALIZATION AS CRITERIA
FOR MENTAL HEALTH
number
growth, or becoming.
permanently
Fromm
to realize
horse would be as
into a
its
own
potentiaUties
is
old.
of development as one of
"A
The
self-actualization, self-
man
as if
it
much
destroyed
if it
potentially
is.
were changed
insect,"
Spinoza
3^
said.
an angel
as if
the unfolding of
is
The term
he
is
the
most human."
He
as occurring in every
set
it is
stein (1940).
one: "There
man
is
human activity
oneself." The idea
is
is
ganism
is
forward," and
it
also
principle of
it is
life,
It is
one's potentialities
The need
is
related.
tinction in a discussion of
one
realizes that
making
the dis-
if
also self-destruction
cide, are
for
realizing
among
to geno-
human
species.
Mayman
(1955)
is
critical discussion
presumes that
this
is
insuf-
growth force
32
is
equally potent in
all
people; that
if
portant of
force
v^^ith
grow and be
healthy
is
To make
tinguish
The
its
make
is
difl&cult to identify
it
as a criterion of positive
described in
who
con-
regard
(i)
aspects:
self-concept
is
self-actualization)
mentioned here
living,
imum
Motivational Processes
As
Fromm
that "there
self."
The
is
life:
it-
made by Maslow
(1955).
He distinguishes
is
more
clearly
deficiency motiva-
it
avoids
and
talents, to
Growth
33
self-
devotion
or resignation.
self-actualizing
as
he
The
as pleasurable;
greater the
amount
growth
is.
of
distinction.
As such they distinguish human from animal becoming and adult from infant becoming. By growth motives we refer to the hold that
ideals gain upon the process of development. Long-range
of distant
goals.
purposes, subjective values, comprehensive systems of interest are all of this order."
He
Mayman
attitude.
patients
Mayman
He contrasts
who seem to
it
who seem
stifle
this spontaneity.
People
no wistful yearning
desperately
to
for
their
life,
feel
but cling
quasi-
who
domesticated animals
Mayman
freedom or a richer
own
"
34
Freud's
life
"We
instinct:
view the
pro-
self-actualizing
growth and
They
decline.
'life instinct,'
The
'life
instinct'
what Freud
which tends to
are expressions of
comprises
all
move
the in-
equilibria.
the impulses
which tend
we presume
to be responsible
quo which we
Investment in Uving
Pervading
many
is
an im-
life,
it
as
an
self as
an
attribute
in contemplation, in recreation
and in
work,
loyalty to others.
Mayman
formulates
much
by
this,
and the
35
things of this world, the objects and activities that he considers significant.
in Hving goes a
states.
This observation
related to
is
to
at-
and admirers.
ticipation in living."
blending of
all aspects
not center
shall
It
meet
this idea
on
satisfying his
needs.
We
tional aspects.
interests
from
its
motiva-
and
own
and
achieve them.
MENTAL HEALTH
In the proposals suggesting certain qualities of the
self-
is
another
crite-
36
rion: this
is
it
portance to some,
in
its
own
it
its
great im-
major category
right.
all
processes
and
much
an axiomatic assumption in
is
is
When
integration
is
Some
is
implied.
it lies
Still
And some
are silent
on
this point.
is
treated, as a
outlook on
and (3)
life,
resistance to stress.
As
writers
who
speak about
this criterion, it is
formulated either
and
id,
scious, preconscious,
37
or of uncon-
events. Earlier
id.
Hartmann
Ego
be."
human
being
(i.e.,
is
a caricature of
positive
its
corresponding id and superego and does not aim at eUminating or, perhaps, denying their demands.
vv^ith
Thus he
agrees
ego control
... are
"it still
discussed.
not synonymous
plays a role
Thus
it
is
where standards
often maintained
what is useful for him makes the difference between healthy and neurotic behavior. Actually this is too
small a basis to build upon it a definition of health. The
dencies to
one
set of
ego-functions
among
others;
their prevalence in
also
.
38
super-ego
quahty,
it
But
all
we
is
this
some of
most
its
abandon
itself to
it
its
may
is
further modified.
Not only
is
at other
it
is
Kubie (1954),
mental health in
among
minimum. "The
...
is
implicit ideal
an individual in
whom
systems
is
affairs of daily
result in flexibility:
bility,
Hving, in
forces,
human
re-
of normality
is flexi-
is
39
free to
produced
it.
No moment
determine
its
similarity
Kubie
motion presitua-
as
is
in
The
it
upon
flexibility.
different tone
and terminology
is
on the cognitive
used by those
level.
Allport (1937),
a sign of maturity.
reconciling
sion
He
who
life as
two otherwise
and
looking at one's
self-objectification
with detachmentpresent an antithesis requiring resolution by an ini.e.,
i.e.,
tegrative factor.
Such
a philosophy
is
least
not
to
The
first is religion,
things,
and
as
such
the
There
is
for beauty
is
losophy,
all
40
and
subjective
meaning
to all
life.
On
by Allport
life results
in the
is
theme
is
presented
which commit
proprium, for
The proprium
cludes
all
aspects of personality
making
regarded
and
in-
itself
however beset by
makes
"The
possession of long-range
as central to one's
repre-
tinguishes the
the child,
the sick."
though
Maslow
same
as those of
and in Barron (1955), who emfound "character and integrity in the ethical sense"
is
Thus,
it is
unifying outlook on
tion
life
becomes further
investment in living
to develop
it
life.
is
the
qualified.
The
self-actuaHzed person's
liis
4^
future
accordingly.
an aspect of the
as
tion to the
ter
self,
meaning
must be mentioned
again. In addi-
on
Hfe.
The former
is
clearly
function of the sense of identity: "Psychologically speaking, a gradually accruing ego identity
is
comes
clear
."
And
his concern
when he
synonymous with
ego-identity)
life
significant to
it
as the
as, "It is
crowning stage of
cycle
as
necessity, permitted of
no
substitutions.
...
It is
a sense of
Resistance to Stress
Those who
discuss
mental health
as
manifested in a par-
likeleads
stress
The
less
concerned
healthy degrees of
and the
than
integration. Jack
42
resili-
needs to
is
acceptable
for them.
Similarly,
nev^^
ways of
satisfaction or sublimation
."
W.
Goethals
characteristics
All authors
who
in sick persons.
The
difference
lies
normal and
in whether these
symptoms can
seri-
he suggests
(at least
must be able
to
43
Whether
dis-
most authors in
be a universal experience.
with
it is
The
individual's
manner
of coping
and courage
affirmation
as the appropriate
way
self-
of facing
one's anxiety.
A NOTE ON REALITY-ORIENTATION
criteria
en-
reality-
orientation.
To
be sure,
reality
this also
as
mental health Hterature leads not infrequently into philosophical problems about
is
its
made
easier
and tangential
no longer
by the
fact that
reality.
controversial.
The
modern
relentingly shapes
some
we
for centuries
we
and what
grasp
is,
in
44
fact,
are identical
modern
that everywhere
is
change,
is
we
flux, process,
an
the
no two things
science, that
understand that
."
question directly
between
is
no
born into
man
With
and
conception of ego-forces
as part of the native
its
ego functions
conflict-free
view of
it
reality as hostile to
man.
Academic psychology, which long has accused psychoanalysis of just this sin, always has had room for aspects of reality
both supporting and thwarting the individual's needs.
The
and stimulation
been restated
would
also
K. Biihler)
that
is,
Coping or mastery
is
from
this point of
Only harmful
way
The mastery
of elimination.
its
ac-
a pleasure in
elimination.
of 'positive stimuli'
lies
by
in
its
active in struc-
own law on
it."
The thought
is
that the
enjoyment of
that everyone
have to
v^ill
wisdom
reality
of the
is
good
Talmud;
45
in itself
it
states
in this w^orld.
The emphasis on
is
called
solved
on the
theoretical level,
This
may
tacit
lingers in discussions of
assumption frequently
still is
v^ith health
The
is
it still
disease.
we
will
good reasons
man to
human
mentally healthy
if it
shows what
is
referred to variously
between individual
to decision-making. In this
is
interpreted as a with-
[46]
drawal from
reality, as less
by the world, or
as a small degree of
involvement in external
matters.
The
come
The
(2)
out-
ent actions.
the extent to
which he maintains
and
and
reliance
tains;
upon himself;
Hartmann
self-
confidence in
and of mobilizing
is
realistic
defenses
when
so threatened."
human
de-
et
later,
of the "growing
Mayman's
environment
(social anxiety)."
description (1955) of
what he
calls
the
self-
itself
only
when
reality
is
but dictated also from within, based upon that inner organi-
"
47
still
world view."
Independent Behavior
on
dependence
in-
Accord-
satisfactions
on the
real world, or
and
of environment
latent resources.
means
on
own
This independence
like.
These
They have
Here there
is
also
would
been described
a connotation that
as 'self-contained.'
autonomy
internal standards
if
is
a safeguard
were those in
conflict
with
and needs.
David Riesman (1950), on the other hand, explicitly recognizes that autonomy can manifest itself in going along with
the world as well as in opposing
Riesman
distinguishes
it.
48
anomic.
The autonomous
malad justed,
whom
he
calls
who on
to the behavioral
the
norms of
their society
remain free
to choose
whether
to
conform or
not.
Whatever
types.
as a criterion
how
decisions are
aspect has
actually
in his use
Angyal
of the term.
''self-
Both tendencies
other."
The
increased autonomy,
is
"to organize
wilHngly, to seek a
them under
home
own
latter "to
for himself in
jurisdiction
surrender him-
and
to
become
is
persons
is
autonomous
trends.
At
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA
49
criteria
and
We
shall return to
in an-
it
other context.
many
efforts to conceptualize
way an
mental health
healthy
As
when what
is
is
his
mental
called mentally
what
is
is
conditions under
meaning
human
Even
if it
that the
object of per-
makes
an
sense under
able
The term
modes
Two
social perception
cannot be so isolated.
of cognition.
aspects of reality perception are suggested as criteria
empathy or
social sensitivity.
At
first
50
with
reality
loss of contact
qua non
mental health
as "that state of
of the environment,
mate enough
it is
mind
if
."
is
approxi-
(Ewalt, 1956).
may
ment
is
to rely
on
hit-or-miss methods,
same
it
must be based on
Maslow (1954)
call
possible to
it
an English
ac-
world
person.
The
nitively
wrong T
neurotic
is
he
is
is
cog-
reality
self-evident criterion of
mental health:
it
lies
in the
word
"correct." Particularly
in nature
what
is
"correct".? If
it
in terms of color,
and
a third in
facets,
if
who
is
which
is
most "correct" ?
one
5^
only one
is
way
of looking at
static
is
may
that
new
hith-
it.
Yet seeing
is
cer-
on the
subject.
The
mean
cannot
looking
that there
peculiar,
must be some
is
is
world around
at the
and perhaps
is
way
us.
objective cues to
what accuracy or
fit
correctness
speaks of
To
word
"correct" altogether
and replace
The
it
by
is
made
to eliminate the
"relative
criterion
one
so that
ferent,
is
fit
were
these wishes
dif-
that
is,
ment
is
52
or fears.
One
its
respondence without
testing.
do well in school or
may
fail.
A mentally
One
even
it,
it if it is
presented to
from need-
Empathy
or Social Sensitivity
is,
perhaps, most
diffi-
the feelings
and
been suggested
as a
worthy of
his concern
and
attention. Implicitly,
he
is
also
from
distortion.
They
say: "People
atti-
which
on what we
call the
this criterion,
although
literature,
has
received a
the
empathic responses."
gists.
53
enormous
sence. This
is
difficulties in
their errors
discovering
its
and
successes
presence or ab-
is
human
efforts
at
As
theme of
success
is
specified as
is
achievement in some
a
toned-down version
its result.
levels of specificity.
human
to least specific
work
relations; (4)
effi-
54
The
Love
Ability to
In at
least
as a criterion for
of the
word
as the ability to
most
logical because
it is
from a theory
It states
is
that the
the only
it
is
recognizes sexuaHty as an
The
as a whole.
difficulty is to define
what
is
meant by
full
may
have to be regarded
as
criterion,
would
mentally healthy.
to
an
eflfort
to deal
with the
difficulty of defining
pleasure,
the most sensitive criterion of health, he arrives at the conclusion that "the extent
personality
is
total
of
which
varies,
its
emphasis on sexual
gratifica-
55
narrow view of
He
regards
is
the potential
means not
and with an
body
climactic
is
supreme example
way
and in some
of the oppositeness of
love
of the
and
make
hate, of
work and
Adequacy
in Love,
fact
and fancy, of
and
sadistic control
superfluous."
work, and play. Ginsburg (1955) puts forward this proposition in the most direct manner: "My coworkers and I have
settled for
hold a job, have a family, keep out of trouble with the law,
Much
for pleasure."
It is
life
56
Mayman
(1955) speaks of
men-
tally
He
eat-
ing, excreting,
and
so on, v^ithout
and enjoy
discomfort."
Adequacy
On
in Interpersonal Relations
personal relations
health.
is
Sullivan,
to others
is
the major
human
goal
is
security resulting
from
satisfactory
and
common
ends
and development."
criterion for
mental health
is
among
making
when
is
free
from any
it
57
over
Much
psychiatrist
relationships" as the
and
.
and
satisfying
human
love
human
"secure, affectionate
"failure in
."
relationships,
as criteria for
positive
in man's alienation
his
May
tion in the
modern world,
describes
as a "characteristic
it
afraid of
one another.
."
is
the assump-
from
others.
But
May
ment
gives
an exphcit
state-
tive formulations.
She
stipulates
among
An
extent that he
"Has
is
58
that he
is
society.
...
"Promotes another's
it
v^^elfare:
and
"Works
largely
to
make
Affective relationships
only remotely.
and
to act for
may
profit
formed through
mutual
social interaction.
when he
completely a person
beneficial relationship.
benefit:
The person
Perhaps he
is
is
most
participates in a mutually
."
.
One
health comes
of the situation
on behavior.
is
forms
if
we
look
at a child at
home
or in the school-
room.
To do
as possible to concrete
while adhering
manner
manifested in the
He
is
school situation.
as closely
this,
is
to be judged. Fill-
child
is
and
knowledge and
59
skills.
with regard
tions effectively
to acquire
situation.
demonstrated in
as a criterion of
Julius
environmental requirements are met. For the present, however, this definition
social
sphere."
There
is
when
are not.
Some
alone
let
and demanding
criteria.
when
can
they
call for
when viewed
in
teacher, a prison,
and the
like, all
may
re-
perception
free
from need
distortion.
The impHcations
only
when
there
is
of the requirement.
Those who
6o
requirements or are in
environmental
factors,
Here, there
no need
able
is
is
connotation of modifying
hard
to regard
plies that a
its
reality as
unchange-
Adaptation im-
as modifiable.
reality
and
in-
through individual
initiative.
and
illness
adaptation to reality.
Hartmann
with
What we
"we
He
by devious ways.
reality
individual's adapta-
designate as health or
illness is intimately
tion to reality
There
it.
."
The
is
evidently a typical
article
is
se-
an increased
reality leading to
with and
if so,
ill.
what,
Whether
is
a ques-
That adaptation
effort
most
from
reality
to reality
is
is
conceived by
him
as
it.
an active
becomes
clear
when
as
their
^^
and the
tier are
new environment
to find a
to
The fact that this particular modification of the environment can legitimately be regarded as defensive has, according to Hartmann, nothing to do with
healthy:
"Nor does
classification as
its
health
the
discussions
word adaptation
is
."
He
individual.
The
on
of the roles
and
is
tasks before
not to
draw
an
settle dif-
attention to
One
such aspect
is
is
tation.
The
as
idea
is
world and
is
some
it.
is
reality
concerned
active
itself; it is
Chein (1944)
no longer
auto-plastic but
62
actually used
is
more frequently
anyone's
whim
v^hether
for adaptation. It
that as meeting
indiscriminatinglyor as a synonym
acceptance of whatever
tional requirements
it
life
brings
situa-
is,
concept of adaptation
is
Piaget's (1952)
He
calls
ar-
made
component
is
environment has to
offer.
Problem-Solving
One
is
Some
solving.
emphasis on
tion. If
it
its
authors
talk
end-product
such a criterion
is
applied to realistic
mental health. In
this sense,
is
life
problems,
the hallmark of
is
To
Be that
as
it
may,
it
may
still
be cor-
^3
The
meaning emphasizes
could actually be
its
made
that problem-solving
is
many
in
There
are,
w^ays
how-
differentiate
is
alone
its
normally a
other. Adaptation,
beginning or end.
On
occurrence,
its
solving can occur over both long and short time periods
and
is
with
this
and an
initial
intention
sufficiently
its
own
right.
problem-solving as
criteria.
The
author's
effort
modes
of
(Jahoda,
means, and
finally the
means toward
It is
understood,
64
taneously in the
mind
It is
of
all
them simul-
of the problem-solver.
is
must
man
He
intends to change
ways of doing
this,
it.
likelihood
is
Suppose
situation as a problem.
without proceeding to
The
work
stages.
He
select
one or the
of problem-solving.
On
if
he continues to
may
mode
as finding
more
suitable
tive.
The
or indirectness with
tion of other
work
as
un-
work; an
indirect approach
would
consist, for
The
go through
all stages,
through
tion, is
IV
An
Sjjort at Fwrtker
Qanjication
v^ell
is
is
grouped un-
meaning and
among many
of
them
a large overlap in
proposals.
is
field,
on
made
that several of
them
the psychological
meaning
makes
it
of positive
mental
to the problem.
We
shall
many
have
on
so solid a
be
tentative an-
to
is
as
facts that it
To
is
as yet
no
entirely satisfactory
approach
[65]
[66]
thing.
To
one
is
gently required.
Its success,
depend on further
mental health
To
Some
ur-
clarification of
field.
is
is
of
them
some general
ideas in the
will be discussed.
is
diversity of concepts.
is
the recognition
which
least
some
!'
is
common
denominator.'^
who
of "normal" people,
meaning persons
One
was
a physi-
and
He was
scientist of great
father Hartley
On
life
less successful.
husband and
when one
makes some,
If
life salient.
him by
is
bill
of health;
if
self-
one
achieved mightily.
Hale was
life conflicted,
area of
He
in the profession.
family
ambition.
health.
as
it
And
should be.
the
The medical
profession
is
The dimension
unknown.
relevant to epidemiologists;
it
has no
known
is
relation to the
among
athletes
and
It is
may
or
William
how we
ganism.
Neither
is
we must
decide on
human
or-
."
first
As knowledge
68
as
of delinquency,
"This
is
as-
must be a theory of
disease
and
disease, rather
of tuberculosis and
arthritis, of
Meniere's syndrome
disease led
some
was
their
it
it
though
theory of
what
as a
is
'its'
some
meant by
is
it
were a
must be a
enough
basic
to suggest
may
blanket-concept which
get in the
way
of theoretical
quency" with the words "mental health," the appropriateness of Merton's statement
stop at this point.
thesis into
synthesis
Having
independent
becomes
aspects, a
possible.
There
is
it
is
systematic
field of
To
tage.
is
The
may
equipment that
it is
much
all
be
AN EFFORT AT FURTHER
CLARIFICATION
^9
mental health.
But,
adoption of different
the
ultimately,
of
dowment
is
a question of
how one
One way,
from each
tive
other.
is
They may
mental health.
An
independence
individual
may
manifest mental
gangster
image
is
may
may
self-
WiUiam
score high in
The
is
from need-distortion.
To
be sure, most
field.
is
as the es-
styles of life.
egg the
as
com-
70
patible
one
accepts,
may
athletic strength
lem. But
it
will
still
and longevity
is
be necessary to heed
as the relation
an empirical prob-
WilHam
White's
re-
There may be
health.
many
of the
ideas
for practical
with them,
we
it is
clarifi-
cation.
who come
as that of
They may
bHnd
credit
he
is
lacking in mental
him with
self-actualization,
mental health.
only
if
aspects,
tions.
He would be called
as appropriate
rela-
The
relation of various
components
to each other in a
Some
various
AN EFFORT AT FURTHER CLARIFICATION
health can manifest
self-actualization
is
itself.
Of
this type,
is
motivated to
self-actual-
always higher
strive for
Maslow's idea of
7^
autonomous,
is
reality-oriented perception of
the world, enjoys love, work, and play, and has a well-
developed individualistic
criterion
as
approach
is
In
ethic.
syndrome
when one
TB syndrome.
Another type of multiple
criterion
is
It
will be re-
development.
Allport's multiple criterion approach
kind.
He
is
of yet another
self -extension,
and
self-
by a unifying philosophy of
Hfe,
is
is
empirically
Mayman,
and investment in
living.
The
author, also a
proposing
other: "It
way
is
in
which
these criteria
may
suggests
relate to
and
a
each
which favor
72
possible.
replaced by illusions.
is
Under
ciety
of
conditions of
Heroic
others.
istic
with
1950).
According
from
may
environmental
vestigated singly
and
In
theory,
of
circumstances.
if
and consequences
in-
re-
their antecedents
jointly.
was
so formulated as to
make
This idea has been elaborated by Smith (1950), who introduces the notion of optimum mental health, in contrast
to other assumptions that every
component of
a mental
which
much
is
is
uses
components that
based on an underlying
AN EFFORT AT FURTHER
not enough
is left
CLARIFICATION
What
73
the opti-
As one reviews
these various
becomes
of course,
no incom-
criterion,
it
patibility
by a combination of
knowledge
it
may
Each
is,
indicators.
At
The former
permit us to do
justice to the
complexity of
human
func-
tioning.
we committed
of mental health.
was
yet
that
no
much more
on
practical
satisfactory concept of
at that
mental disease
time
exists as
and that
concept in
is
little
precise.
To
mainly
few remarks on
The
traditional
is
and mental
Rumke
(1955),
who
The
point
is
disagrees with
74
man
"The understanding
."
In his
to
ho^ much
deny
general
as well as
disease.
and mental
who
disease are
many
with
are puzzled
by
to those
those
who
fense
are
aware of
similarities in experiences
feel in
who
and
to
and de-
need of
treat-
to conceive of patients
with healthy
beyond the
frontiers of
negative health.
when
there
capacity or
she
is
is
mere
ways of Hving
social existence
that are
implied by
working in
that direction."
By
negative health
of vegetating, with-
To
Max
them
as
man
to treat
75
do not
Every hu-
exist.
as
healthy persons.
Mayman,
found
this useful
some degree
in various patients
to use these
on other than
just
pragmatic
grounds.
What
mental health
criteria
turbances which
all
we
call
when
at least,
not.
Those who
more
with the
The
disease
But such
efforts
that "apart
the accused
sense,
made
in a criminal case
from an unshakable
is
mon
may
work
perfectly normal."
inasmuch
as this
belief that
The
he
is
which held
the Messiah,
[y6]
it
actually say
Do
to
felt
trees of
Vienna's parks.
be crazy to be an
artist
Or can
it
among
potential
these artists
were
their personality,
produce
when
who, in a
also disturbed?
different aspect of
Did they
actually
The
of the
one
of values.
from having
first
dealt with
meaning
of
Only
as
one
calls these
psychological
phenomena
By
this label,
are "good."
w^hat?
one
And,
Good
77
is
for
de-
social status
quo? For
mankind? For
survival?
Good
Good for
raised
species
For
art
and
creativity
The
formity ?
could be continued.
list
prima
and the
is
more
closely related
automat-
may
modify
their
environment than
The
seems so
civilization
difficult that
privilege of ignorance.
one
While
is
it is
self-actualization
species,
as
really
number
of high values,
benefit
Fromm would
the
claim?
Does
development of the
Is
interpersonal
com-
empathy ?
78
phenomena
criteria for
is
as
How
criteria
Would
people living in an
tachment
as suitable criteria
Would
fit
Not only
is
self-assertive aggressive-
civilizations
w^hat
class in
Western
unknov^n;
method
of thought
w^orse, there is
no
logically tight
some degree
of confidence.
There are
the value
dilemma
size. First,
we
many;
it is
to
is
need not involve one in the megalomaniacal task of blueprinting the values for the distant future, or for
all
civiUza-
tions.
The
who
one
assumption
is
is,
"good" in terms of
all
People
who
an enthusiasm akin
all evil
ment
and
of
all social
mankind.
it
a panacea for
AN EFFORT AT FURTHER
The
larly
CLARIFICATION
ridicule
it
simi-
movement because
is
movement
79
they
They
as
human experience.
The assumption that mental
high values
is
never serve
all
Human
beings can
by
conflicts of values
up such
setting
all
To deny
life
are always
is
life,
is
it
about alternatives
mental health.
It is
good things in
perfectly possible
life,
apart
from
terms
and
to regard
him
shows
if
the most
it is
possible to be
we
an
crite-
To
him
to
8o
working
them
make
to
is
expHcit the
By
com-
dis-
Some such
others.
have a family, keep out of trouble v^ith the law, and enjoy
the usual opportunities for pleasure. Although this modest
value
is
health,
it
Others
whether
Western civihzation
this value is
It
is
it
is
appears relevant to
meaningful out-
moot
question.
it is
of too
low an order;
it
also
many
now the
is
shall live.
philosophers, the
all,
no
that this
whatever
it
weighty decision.
it
Not
The
special right to
experts in
usurp this
man
in the street,
From
Ideas to Systematic
^^search
now
is
We
feasible.
The
study of
human
is
based on observation.
is
to increase as
tions.
The
niques
is
ments
as the result of
more criteria,
the making of
we
health
To
only a
mental
criteria.
if
it
can be done
is
82
some sug-
MENTAL HEALTH
By and
As
is
often
left to
the
literature
it
stitutes
The
these
mental health.
task before us
two
fields. It
is
to attempt a
rapprochement between
would be fooHsh, of
course, to attempt
let
man
criteria
is
to revert to the
and present
which might do
justice to
selectively
mean-
some
re-
them.
first
occur.
FROM
Toward
Attitudes
^3
the Self
and
The
description and
comparison between
self-
by others.
scription
from
relatively
from
tion Test, or
tests,
Thematic Appercep-
personality inventories
many
descriptions consists of
different items
This
raises
traits,
self-
motives,
a major question
left
every item
Is
Take the
mood
Is
the
as relevant as the
And
if
not,
to consciousness
Or
which
All ?
And what
studies
own
ex-
number
of
pressive
movements, such
photographs.
Is this a test
Or should mental
as his gait,
from
some
And
if so,
which ?
84
Or with
self
and sense of
identity:
same
v^^eight as one's
dimensions of the
specifies
They
self
also
and
Depending on the
under
One way
of arriving at a
ac-
example, consists
such judgments
like.
may
The
person's reaction to
to
two
One
is,
it
draws attention
and the
others
self).
The
self -concept
distinction
is
(the
way
self as it
appears to
self,
and the
self-concept.
The
by
his
However qualified an
methods, is what he observes
others.
scientific
the observer
actually
self-concept, is
however
observer,
way
subtle
what he aims
the
this
way
at
the ob-
person is? In
answered affirmatively
if
FROM
state, for
is
other
goals.
his prediction.
who
will
with
this
demonstration of
predictions seems to
him
is
this prediction.
validity.
To make
what
made under
observation,
man might do
such
of
He might
himself achievable
satisfied
accepts himself as he
set
85
the very
an indicator
and
is
in-
interested
the question:
Can
question
is
raises
tions be generalized
The
rare-
.f^
was introduced which has some bearing on finding an answer 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
we
can
know what
is
is
he finds himself.
Scientific observation of
human
of arriving at generalizations
from
Perhaps
One who
takes a Rorschach
situational cues of
test,
much
as pos-
is.
no
In the absence
86
administrator or pick
test
No
want
to rely
on one
test
clinician, there-
tests,
person
is
person
is,
beyond what he
one concrete
reveals in
act, is to
observation
all
and
clinical
when
results differ
in three situations.
by making
their inferences
problem of generalization
from a
tions central to
self as
revealed in re-
self
its
actual
more than an
unreahstic perfectionist
would look
proximation in
from behavior
this area.
for
ap-
understood.
Where
this
is
substance he
known
to
is
the chemist
him.
when
qualities are
un-
FROM
To
that certain of
its
it is
reasonable to assume
more appropriately
aspects will be
^7
assessed
complexity of
life
sessions dealing
with the
contrived experience.
To
this criterion,
processes
tion, (2)
two
abilities, his
If
Selj-actualization
and investment in
one were
and
in differentia-
living.
an
and
leisure activities,
man
gifts
By
if
any, as a
that token, a
who becomes
matical talents
But
surely, this
must be taken
as
with diffusion.
With regard
it
among
students.
An
under-
88
achiever
is
whose
a student
below
one to expect
this empirically
frequently
made
to
When
all
the children in a
might be incompetent.
single underachiever
abiUties,
but physical
the identification
of achievement
level
in
holds
schools
In other
among
life
children.
much more
intelhgence
is
self-
such
as are
difficult to obtain.
And
achievement in
life.
It
spirit of the
which he
is
actually
moving
tive goals,
being
and
made
to achieve
and in
by subjec-
Self-actualization
spective
that
is
them.
also expressed in a person's
differentiation.
time per-
stage.
re-
Notwithstand-
ing the fact that they play a significant role in Kurt Lewin's
topological theory of the
life space,
With regard
FROM
vestment in
living,
[89]
other
is
job, or
it is
from what
involved in his
is
is
work beyond
well that
form
activities
more
in
first.
we know
too
be-
many
cause they
self,
is
the requirements of a
But
of a per-
son. If
little
criterion
a genuine link
like.
Such motivation
indicates concern with the self rather than with object relations,
as
The
distinction
between
of "cathexis"
is
made
easier
self
better understood
to
empirical research.
Integration
psychoanalysts
who
it
step.
The
next
may
With regard
goal
would be
may
Here
to codify the
way
psycho-
them
into
What
has
may
90
perhaps apply
when
balance
this
is
conceived of as a pre-
it
in-
tive research
as
The
plicated,
and
rightly so,
life
is
com-
philosophy.
It is
difl&cult to ascertain
If
he cannot, some
sort of
tenets, if
from
he can verbaUze
performance rating
might be useful
is
in-
for such
efforts.
The
specifically
formulated
the
in
mental health
more
literature.
It is at this point,
however, that
we come up
against an-
how
to distinguish
To
of,
or response
to,
that stimulus.
may be
whereas another may
enced as
stress
by one person,
may
first
wood
Should resistance
to stress
regard
whereas the
experi-
be observed
when
as stress
situation.
stress is sub-
FROM
IDEAS
TO SYSTEMATIC RESEARCH
when independent
jectively present or
stress
is
known
9^
To
and
frustration-tolerance, the
on
anxiety-
rather
on
stress.
assumed in view of
case in point
like
is
the
and the
di-
(Chapman,
1954; G.A.P.
human
beings,
Symposium No.
and
3,
sur-
situations
study of resilience.
offer
strategic
illness.
opportunities
for
the
amount of time an individual needs before he can resume his usual patterns of living after change under the
the
impact of
stress.
Autonomy
The meaning
which
is
self-
suits his
own
needs
best.
Those lacking in
self-
92
it
difficult to
external support.
where some
dividual
would not
own
Asch
devices.
admirably to
Although the
indicators
it-
this purpose.
is
in-
problems remain.
Self-reliance
number
of other
can be demonstrated in
We
have met
in the
itself
other factors,
show
may
what
is
for
one per-
said
In addition, here
tors
must be constructed
For
this
dicated.
The
profile or a
is
which lead
problem
in
its
is
in-
to a
own
right.
Ferception of Reality
No
experimental work, or has used a greater variety of observational strategies, than the area of perception.
FROM
is
93
no wonder,
man
to a head.
human
It
on perception most of
come
and
reference to perception.
must
here. It
suffice to
We
shall not,
from the
cept springing
is
a con-
need not
product.
also
It
thinking,
be, the
judgment,
memory are
intimately
linked
to
perceiving.
The
course,
is
must
of
what
would
is.
suit his
of
emotionally involved
be,
its
at-
difficulty
here
is
the ascer-
Sometimes
this
definite evidence.
At other
identify
ambiguous
do with
liquids
pictures.
were taken
Those
identifications
having
to
to
if
any,
94
topics
The
is
and
feelings of others
latters' self-descriptions.
scriptions
The same
is
person's insight
fers
pHes to understanding of
special
who
groups
all
other persons or
whether
is
it
ap-
restricted to
Environmental Mastery
Several
of
the
aspects
of
environmental mastery
are
therapeutic
The problems
function of
regarded as
also
own
right.
FROM
95
facts.
Such
partial blindness
is
individual's inner
ently.
With regard
adequacy in
relations,
situational
efl&ciency in
adequacy in interpersonal
play,
research
mean
quirements
and
love, v^ork,
and
needed here
on
vs^hat
concretely.
What
adequacy or situational
The
is
re-
conceptual approaches of
v^ill
have
used
to be
Problem-solving
on which
is
The
mostly
problems in logic or reasoning that in themselves are emotionally neutral. Further research
v^^ill
approach to
problems. There
life
is little
the same
(1945).
to life
It
manner
may
them
problems
as
it
is
under ex-
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chart summarizes
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100
discussion,
One
tv^^o
types of research
This
is
competent research
v^^orkers
wc
novi^
fruitfully
empirically.
advanced by speculation.
become
and
The
criteria.
exists
is
from
a balance of psychic
forces.
If a cluster analysis of the criteria
solidated.
too, that of
rion based
crite-
FROM
A word
of caution
is
in order
on the degree of
is
no reason
generality
There
10^
clusters.
ing in one case need necessarily be the same for every group.
Differences in culture, social
class, sex,
or age
may
well ex-
Comparative studies in
all
Mental Health
The
and
their interrelations.
Criteria for
research problem in
its
own
we have
To
extend
require
this
much
formula-
is
among
full attention
mental health
criteria.
research.
is
self is
undoubtedly
stages in
life,
a fact
that
more, self-description
aspects of the self
is
a task that
ascertaining
should be remembered,
is
The
latter,
102
It
may
who
are able to
However,
we have
as
Much
the same
very
far.
omy
as applicable to children.
is
on curb-
minimal requirement
for the
is
gauging the
mental health.
and problem-solving
situation,
all
Adaptation
an environ-
Research in
this area
own
life
in
its
of health
chology.
Or one can
start
is
known
in child psy-
Taking extreme
between
FROM
103
method on
is
as
as a
life
of
The
each other.
individual
v^ill
and
The
it is
next
moment may
by the current
state of affairs.
The mentally
group
will
healthy child
age
life.
But,
however
may
as
The need
is
and demonstrate
how
mental health
immediately needed in
to
patients.
Perhaps most
types of disturbances.
possible application
criteria co-exist
degree
with various
many
104
being
made
to assess
what progress or
Many psychiatrists
type of
vestigate
would be
whether the
effects
making
further therapeutic
disease or
toward the
acquisition of health.
criteria in
made
in a
tempted in
close co-operation
with
psychiatrists.
is
all
concerned that a
full
under which
it is
And
such conditions.
which an individual
tributes constituting
affect the
possesses or displays
virtually
degree to
any of the
at-
mental health.
Should one search for relations to genetic factors ? Or biochemical processes ? Does living in urban or rural areas
the difference?
Or membership
or ethnic group
.^^
Is it the
make
FROM
IO5
The geographical location or the physical qualities of one's home ? Or the pace of life in the home town ?
The composition of the neighborhood or the family? The
education?
relation
The
siblings?
some or
of
all
of these factors
it
would be highly
available to help us
sift
these
a combination
Or
desirable to have
some
possible factors
principle
The problem
no
less
is
meant by
is
'environment."
it
It is
is
inside
and what
regard to objects,
functions. Light
it is
is
is
is
apply
it
outside the
inside
fundamental and
difficult to
is
and what
clear-cut
to psychological
ent
to
on both. In the
some extent
sciences of
arbitrary.
man, the
between
man and
mains unresolved,
efforts provides a
sibly influencing
In
distinction
with
efforts to deal
dependis
always
schools of
with the
rela-
among
none of these
mental health.
this situation a
will
I06
is
forthcoming
in a variety of v^ays.
First, general
consensus based on
much
empirical evidence
and young
infant
v^hom he intimately
v^^ith
For the
interacts.
human
first
him only
to changes in his
to
activities,
and
objects,
his
that
is,
infinitely
complicate the
new
of channels. Yet
they supplement
it.
variety
There
is
no
vi^ay
health.
is
more
by the
fact that
he
is
cru-,
siblings,
Negro
or
his
human
beings around
him
are
environment.
to
mental health
is
sug-
can be understood
FROM
IDEAS
TO SYSTEMATIC RESEARCH
I^
human environment
intimate human relations.
them
to be con-
of a person as
sociologists or anthropolo-
gists
that
it is
worth while
Dunham
(1939), Kardiner
emerging profession of
ment
ecological,
social psychiatry
profit-
The newly
man
and
institutions
pen
who
more
hap-
to play a role in
work
theater, goes to
(1950) use the term "behavior setting" for locales having the
attribute of eHciting largely
standardized behavior.
It
is
I08
may
signifi-
research
as to
many
conditions.
others. It
It
is
is
much
may
be a good or
from "good"
may
to
be as important
change per
as
se.
direction of change. In
any
may
and
Janov^itz, 1950)
work
in this field
WAX have
to
come
to terms
v^ith the fact that the various sets of conditions always exist
Those
means a
dissatisfied
with
this
better approximations to
unending search
for better
and
to
turn away from science and seek elsewhere for their insight
into the conditions for mental health.
VI
In Qondusion
As one
more than
ways has
yet
no
final choice
thirty
too, there
is
a danger of
The
final
The
that the
made
it
abundantly clear
field is for
It
can
fail.
Or
we do
it
not
can
fail to
know
is
be
a better
[109]
no ]
way
more and
to
mental health.
If
knov^ledge,
if
practitioners in the
mental health
field co-
the
health
if
human
VII
Vicwj^oint of a Qlinician
by
WALTER
Conceptually,
to reduce
it is
mental
E.
BARTON, M.D.
difficult to see
illness
how
a national
program
continuum,
the goal.
we had
If
illness is the
is
other.
problems of
we
illness,
This
illness.
is
we
still
good
have far to go in
re-
theoretical one.
We
to analyze
mean when
intellectual
is
different think-
tion
Her concern
spiritual
desirable. Dr.
and
clarifica-
112
mental
health and has shed a good deal of light on the issues involved.
aHen
understanding of health.
to their ov^n
not coincide.
on the
He
The
do
think, v^orks
management
individual avoid
The
or in
cal,
living
it,
recover
from
it,
or compensate for
all v^ays,
itself, at all
it.
times
psychological,
and
in
sum
ecological
harmony, and
may
still
ill-
ness
at
much
is
pathology that he
as
long and
as well
as they did.
health,
efforts to
social science,
may
do
so.
Perhaps,
unencumbered by medi-
phenomenon
The
VIEWPOINT OF A CLINICIAN
1^3
has
illness,
We know
of
little
it
beyond occasional
subject that he
is
is
meaning
his
world.
work
ability to
and individual
way
of looking at
morale.
useful
this
health and the normal to the extent that health as the an-
tonym
of disease has
or
tradition, of physicians.
The
idea
first
uniformity or
stability in the
organism relating
meaning
a tendency toward
normal body
By
states
more
of the
generally,
extension, the
same
biochemical
The
states.
inference of
manifestation of
good
harmony
health, or the
normal
state, as
as well as physiology.
Out
of "nature in the
raw" and
eternal aggres-
114
sion
Man
Descent of
placed
ture" again
that
emerged
as a
re-
na-
unifying idea.
dis-
and
teria
states of
viruses as habitually
his bac-
man and
Rene
as less
to
J.
or
rule,
So
we
and
disease
and
is
to serve
its
The
structural, functional,
some kind
do
it
to
do
so. It is
normal
this.
if it
does
VIEWPOINT OF A CLINICIAN
its
1^5
job within the normal range and over the usual time.
norms
We
not
is
agreeing on a normal
difficulties of
what
normal
is
tell
tolerance.
what
is
may
also the
is
be a
signifi-
momentary best."
normal
cellular
if
tissue
and
cell
are
pared to most
same
what
is
as for
to
its
environment
ing in an interrelated
series
all
aspects of
of procedures
its
is
a con-
function-
aimed
at the
establishing of an equilibrium.
"The ontogenesis
of the individual
genus and
species, the
is
of tremendous sig-
and
limitations of the
(digestive,
cardio-
Il6
which
and function
structure
From
sperm and ovum the
the organism.
calls for in
role
its
for survival.
essen-
its
With
the
is
of syncytium
tem can be
isolated
homeostatic,
Jacques
which means
S.
if
you
that
no
and unrelated
will,
activity
within one
sys-
W. Howell
."
.
(1957) under-
"The
part dependent
is
upon the identification of specific imagents and other variables in the illness
first
portant etiological
process. It
been in large
is,
removal of conditions of
stress,
of frus-
tration, of deprivation
illness this
toward a
we
specific objective.
cannot
For mental
illness,
is
directed
unfortunately,
etio-
VIEWPOINT OF A CLINICIAN
has
come only
after the
I^?]
we may
preventive programs."
J.
may
to a
months of preg-
child.
disorder in a mother
may
havior
is
tion. Said
"It
is
possibilities
would pay
is
"Improved
all
its
by
and
would
and
"The importance
year
is
first
good response
to
treatment at this time and the fact that later treatment will
fail to
its
Steinfeld's hypothetical
Il8
of conception
"There are
at least three
exist-
deficiencies;
may
directly
even
if
so
damage
mild that
it
may
result in
may
be
expressed in antisocial and irresponsible behavior. Inoculations against contagious diseases in children are essential to
Some
of the
now being
however, we may
be
left
by
antibiotics; unfortunately,
"In adult
life
is
therefore essential.
a psychopathic development
may
occur after
If cerebral
contusion
is
at all exten-
energy.
mood
variations,
initiative
we need
and
to
work
VIEWPOINT OF A CLINICIAN
119
mindful of the
believe
we
are ever
and soma."
is
It is difficult
that
for
me,
as a clinician,
and
illness. I believe
the absence of
illness. If
settle for
if
there were
no men-
tal illness.
In this discussion,
of disease prevention
and treatment.
It is
as a
product
proper, of course,
phenomenon, without
The viewpoint
a pathologic orientation.
have expressed
is
tangential
to
Dr.
I feel
sure she
would agree
is
^Cfiacnccs
Allinsmith,
W. and
of
Structure. Wiley.
Allport,
,
68.
Duke
sonality Theory.
Asch, S.
Psychology. Prentice-Hall.
/.
Pers.,
20: 385.
,
September
1955.
logical health.
sociation.
Houghton Mifflin.
Dynamics of prejudice.
Harper.
Blau, A., 1954.
Psychiat.,
Boehm,
W.
The
no:
W.,
Amer.
f.
594.
1955.
mental health. In
[121]
122
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S.,
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Redlich, F.
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1950.
The Lonely
126
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Shoben, E.
ity.
M.
1957.
J., Jr.,
Amer.
Smith,
Commission on Mental
Toward
a concept of the
normal personal-
B., 1950.
Optima
M.
S.,
1954.
The Mental
Hospital.
Basic Books.
Tillich, P., 1952.
The Courage To
Washington
Wegrocki, H.
J.,
1939.
cepts of abnormality.
critique of cultural
/.
Abnorm. and
and
statistical
con-
Wishner,
and
J.,
1955.
Wright, H.
F.,
and Barker, R.
G., 1950.
Methods
i,
69.
in Psychological
Aj^-pcndix
joint
on
Qommission
Rental
Illness
and Health
PARTICIPATING ORGANIZATIONS
American Academy of Neurology
American Academy of
Pediatrics
American
Orthopsychiatric
As-
sociation
ance Association
Deficiency
Children
ciation
Men-
Rehabihtation
Council of)
[127]
APPENDIX
[128]
Association of American Medical
Mental
Committee
National
Colleges
Against
Illness
Health Ofl&cers
National
of
Institute
Mental
Health
Amer-
Bureau,
Children's
Dept.
of
tion
of
Ofl&ce
fare
Department of Health,
Education and Welfare
tion,
Health
National
Association
of
Social
Workers
MEMBERS
Kenneth E. Appel, M.D.
Philadelphia, Pa.
Washington, D.C.
Peoria, Illinois
Francis
Hugh
Boston, Massachusetts
Oklahoma
J.
Braceland,
M.D.
Hartford, Connecticut
T. Carmichael, M.D.
Chicago,
J.
Illinois
Miss Loula
Chicago,
Dunn
Fabing, M.D.
Ohio
Cincinnati,
Rev. Patrick
J.
Frawley, Ph.D.
Cambridge, Mass.
Washington, D.C.
Howard W.
M.D.
York
Potter,
Bethesda, Maryland
Herman E.
Albany,
Hilleboe,
M.D.
New York
Bartholomew
W. Hogan,
Rear
Adm. M.C., U.S.N., Washington, D.C.
Washington, D.C.
M.D.
Bethesda, Maryland
Berwyn
New
M.D.
York
F. Mattison,
York,
New
I29
Illinois
Howard D.
Philadelphia, Pa.
York
Illinois
Harvey
New
Tompkins, M.D.
York, New York
Beatrice
J.
D. Wade, O.T.R.
Chicago,
Illinois
Mr. E. B. Whitten
Washington, D.C.
130
APPENDIX
OFFICERS
President:
Philadelphia, Pa.
New
Md.
M. Brewster Smith, Ph.D.
York, N.Y.
New
York, N.Y.
STAFF
Director: Jack R. Ewalt,
M.D.
Boston, Mass.
Chapel
Hill,
W.
Blackwell, Ph.D.
North Carolina
J.
Plunkett,
M.D.
Boston, Mass.
Boston, Mass.
Librarian:
Mary
R. Strovink
Boston, Mass.
WilHams
S.
Brewton, LL.B.
Index
accommodation, 62
achievement level, as measure of
S. E., 14,
92
problem-solving and, 63
reality and, 60-62
100
environmental mas-
assimilation, 62
attitude
tery)
alloplastic, 71
adjustment
adaptation and, 62-63
to environment,
autonomy and,
Adler, Alfred, 55
age groups, mental
heterogenic, 33-34
(see also self, attitude toward)
47-48
teria
of, 90-91
Asch,
adaptation
(see
measurement
self-actualization, 87-88
also
anxiety, 42-43
health
cri-
and, 101-103
Alexander, Franz, 12
alienation, 57
AUinsmith, Wesley, 42
alloplastic attitude, 71
becoming
Benedict, Ruth, 12
Angyal, Andras, 48
anthropology
Boehm, W. W.,
Blau, A., 56
19,
Braceland, Francis
20
J.,
117-119
[131]
INDEX
[132]
Biihler, Charlotte,
Biihler, K.,
decision-making
44
process,
45-46,
48
44
assessment
91-92
of,
development, 71
sense of identity and, 30
Raymond
Cattell,
28
B., 27,
Chapman, D. W.,
{see also
91
Dicks,
Chein, Isidor, 61
child,
mental health
103, 106
mental
childbirth,
health
and,
117-118
Clausen,
J.
clusters, of
A., 91
mental health
loo-ioi
growth)
Devereux, G., 13
(^see also
H.
v., 57
disease, physical, 67-68 {see also
criteria,
multiple
criterion)
cognition
perception, of re-
(^see
ality)
and, 44
mental disease, 13
conformity, 47-48
integrated
ality, VJ,
person-
self,
25-27
{^see
toward)
contentment, 19-21
Cottrell, L. S., Jr., 46, 52,
56
cultural relativism, 13
cultural values, 76-80
culture,
empathy
measurement
of,
94
empirical
38
consciousness, of
ego-psychology, reality-orientation
tion and, 35
conscious,
reality and, 61
13-14
conflict, as
ego
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
Davis, K., 17
INDEX
[133]
ality,
Foote,
integrated person-
in
flexibility,
38-39
N. N.,
46, 52, 56
frequency concept of normality,
15-18
Erich,
57>
Fromm,
37-38
8, 27,
integration
mental disease)
of
personality,
23,
measurement
of, 89-91
interpersonal relations
genitality {^see orgastic pleasure)
Ginsburg,
S.
W.,
55, 57, 80
Glover, E., 42
Goethals, George W., 42
Goldstein, K., 31, 32
assessment of, 95
environmental mastery and, 53,
56-58
sense of identity and, 29-30
investment in living
measurement
89
and, 32, 34-35,
of, 87,
self-actualization
measurement
of,
87-89
H
Hacker, F.
54
Janis,
happiness, 18-21
Hall, C.
S.,
27, 29, 35
Hartmann, Heinz,
47, 60-61,
L.,
42
^()
Joint
health)
health,
I.
{see
physical
health)
health potential, 14
K
Kardiner, A., 107
Kaufman, M. Ralph, 115-116
Klineberg, Otto, 12
Kluckhohn, Clyde, 69
INDEX
[134]
Kris, E., 37
Kubie, L. S., 27, 38-39
mental
and,
10-15,
mental
health
disease
73-76
types of, 66-73
Leighton, Alexander, 7
Lewin, Kurt, 88
mental
Lindner, R., 35
Lindzey, G., 27, 29, 35
Linton, Ralph, 13
assessment
of,
patients,
and, 103-104
criteria
95
Mowrer, O. H., 17
McDougall, William, 29
maintenance of mental health,
104-108
multiple
70-73
mental
{see
also
clusters)
majority concept
(^see
frequency
concept)
Maslow, A. H.,
vironmental mastery)
51-52
May, RoUo, 57
negative health, 74
nonhealth, 74
Mayman, M.,
normality, 15-18
mental disease,
of
criterion
health,
6,
73-76
anthropological, 12-14
mental health
objectivity,
toward self, 27
measurement of
observation, as
health, 84-86
optimum mental
100
research in, 81-110
unsuitable, 10-21
perception,
of
reality,
49-53. 7^-7^
measurement
of,
92-94
23,
43,
INDEX
[135]
integration
personality,
of
(see
Rogers, Carl, 31
Riimke, H.
integration)
C,
73-74
integrated
in
ality,
person-
38
Schwartz, M.
play
assessment
of,
self,
95
environmental
mastery
107
and,
observation
55-56
also
{see
Porterfield, John, 50
positive
S.,
of,
83-87
autonomy;
self-ac-
tualization)
self-acceptance, 28
health)
preconscious, in integrated personality, 37, 38
measurement
of,
87-89
problem-solving
as environmental mastery, 53,
62-64
measurement
of,
95
proprium, 40
ward)
self-determination,
psychoanalytic theory
also
46,
71
autonomy)
self-extension, 34,
39
reality-orientation and, 44
(see also Freud)
self-objectification,
39
situation
assessment of, 95
behavior and, 58-59, 85
reality
C,
17,
107
Reich, Wilhelm, 54
Brewster, 49, 72
society,
culture)
research
requirements
M.
Smith,
perception)
Redlich, F.
{see
for, 81-82
measurement
41-43
of, 90-91
INDEX
[136]
Sullivan,
Harry Stack,
superego, in
ality,
56
31,
integrated
person-
37-38
values, 76-80
W
testing, of reality, 51-52
tests,
for self-descriptions,
therapy,
mental
health
83-86
criteria
Weber, Max, 75
Wegrocki, H. J., 17
well-being, as mental health con-
and, 104
cept, 18-21
Tillich, Paul, 43
Wishner,
Julius,
assessment
38
unifying philosophy, 71
environmental
ality, 37,
integrated
personality,
39-41
measurement
70
work
in
6'jj
59
of,
90
of,
95
mastery
and,
55-56
36,
F.,
107
18,
Date
Due
Current concepts
m mam
C2
of positive
131.306J74mno