Mental Health

UNIT 1 MENTAL HEALTH

Structure
1.1 Introduction
1.2 Objectives
1.3 Defining Mental Health
1.3.1 Model A – Mental Health as Above Normal
1.3.2 Model B – Mental Health as Maturity
1.3.3 Model C – Mental Health as Positive or Spiritual Emotions
1.3.4 Model D – Mental Health as Socio-Emotional Intelligence
1.3.5 Model E – Mental Health as Subjective Well-Being
1.3.6 Model F – Mental Health as Resilience

1.4 Let Us Sum Up

1.5 Answer to Self Asessment Questions
1.6 Unit End Questions
1.7 References

1.1 INTRODUCTION
In day to day language, the term “health” is often used to refer to the
absence or presence of disability or disease. People of different background
and cultures may have different concept of health. The concept may also
differ according to the circumstances. For example, an older person may
consider inner strength and ability to cope with life’s challenges as health. On
the other hand, a younger person would consider fitness, energy and strength
as more important, and as indicators of health. Those who live in good living
conditions tend to think of health in the context of enjoying life, while those
who do not live in so comfortable circumstances may consider essentials in
daily life as health. The World Health Organisation (WHO) has defined health
as “a state of complete physical, mental and social well-being and not merely
absence of disease or infirmity”.
A number of factors may enhance or threaten an individual’s or community’s
health status. Some of these may be under the control of an individual (e.g.,
smoking) and others may not be, such as social class, ethnicity, access to
education, gender, quality of housing, presence of supportive relationship etc.
(World Health Organization Report, 2004)
In today’s context, it is important to understand the meaning of mental health,
since in the last few decades, the employing institution is eager to know about
mental fitness of a person besides physical fitness for the job, a prospective
employee is going to a join. The mental health professional may be asked to
assess the mental health status of the prospective Candidate. The WHO
defines mental health as “a state of wellbeing, in which every individual
realises 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 Thus, the mental health refers to a broad group of activities 5
Concept of Mind directly or indirectly related to mental well-being. The activities include
promotion of wellbeing, the prevention of mental disorders, and the treatment
and rehabilitation of people affected by mental disorders (WHO, 2012).
There is no health without mental health.

The following section discusses the various concepts and issues related to the
mental health.

1.2 OBJECTIVES
After going through this Unit, you will be able:

 to define mental health;

 to understand the concept of mental health; and

 to understand the six empirical approaches to mental health.

1.3 DEFINING MENTAL HEALTH

Psychiatry has been preoccupied only with mental illness for long and that
there is a lack of attention given to the study of positive mental health. Mental
health is not just the absence of negatives (psychopathology or symptoms of
illness), but the presence of positives. To further elaborate, mental health is
conceptualised as a multifaceted construct. Defining mental health is not very
easy as it includes several issues that need to be considered carefully. Mental
health may be conceptualised along the following six constructs or the models
(Vaillant, 2003; Vaillant & Vaillant, 2009):

a) Mental health is above normal

b) Mental health as maturity

c) Mental health as positive or spiritual emotions

d ) Mental health as socio-emotional intelligence

e) Mental health as subjective well-being

f) Mental health as resilience

1.3.1 Model A – Mental Health as Above Normal

According to this model, mental health is something above normal. Normality
is perceived as being on a continuum, encompassing the major portion of the
adults on the continuum, while abnormality is the remainder. Thus, the normal
refers to the reasonable, rather than optimum level of functioning. However,
mental health would be considered as above average. For example, in the
military, a jet pilot must be required to be above average in mental health for
his occupational demands.

To understand this concept, it is important to trace the historical changes,

which have occurred in this concept in the past century. What is normal in
relation to mental health has been a matter of debate for a long time.
6
According to one prevalent concept it is the absence of psychosomatic Mental Health
symptoms. This concept was practiced from 1940s to 1970s. This definition
of mental health was initially used in the United States by John Clausen and
his co- workers in 1941 to assess the young men enlisted into the United
States army. Thus, the absence of psychopathology was considered as
synonymous with normal.

Changes in the procedure of assessment of mental health were seen after the
World War II. Normal adaptive behaviour of those who served in the army
was studied and the observations were published in scientific literature. There
was a focus on the adaptation of the army veterans into civilian life.

In 1958, Marie Johoda brought in a major change in the conceptualisation of

mental health. In this model, the criteria for assessing mental health focused on
positive aspects of mental health, rather than absence of symptoms of mental
illness. The criteria for assessing mentally healthy individuals included:

 One should be in touch with his/her identity and feelings.

 One should be oriented towards the future and overtime should be

fruitfully invested in life.

 One’s psyche should be integrated and provide him/her resistance to

stress.

 One should possess autonomy and recognise what suits one’s needs.

 One should perceive reality without distortion and yet possess empathy.

 One should be master of one’s environment. One should able to work,

love and play and be efficient in problem-solving.

Other important longitudinal studies showed that mental health characteristics

were predictable and that mental health could be empirically studied.

Eventually, the importance of defining mental health has been increasingly

recognised and attempts have been made to continue to describe and define
mental health.

American Psychiatric Association’s, Diagnostic and Statistical manual of Mental

Disorders, 4thedition, 1994 (DSM-IV) used the Global Assessment of
Functioning (GAF) scale to measure “above average” mental health. The GAF
scale was a modification of the Health Sickness Scale and the Global
Assessment Scale. On the GAF Scale, a score of 91–100 equals “superior
functioning in a wide range of activities. This level also includes ability to cope
effectively with various life’s problems, which never seem to get out of hand.
The functioning level, is sought out by others because of the many positive
qualities. The person obviously does not have any symptoms.” The 5th
edition of the American Psychiatric Association’s Diagnostic and Statistical
manual of Mental Disorders, 2013 (DSM-5) has, however, not included GAF
scale or any other specific measure of assessing the functioning status.

It is important to emphasise here that mental health should be defined broadly

and not narrowly, since it is difficult or even impossible to have uniform norms 7
Concept of Mind across the different societies or cultures. In any definition, cultural sensitivities
should be taken into consideration, and the definitions should be empirically
and longitudinally validated.
1.3.2 Model B – Mental Health as Maturity
This model conceptualises mental health as a state of maturity. The model is
based on the eight stages of human development, as described by Erik
Erikson in 1950 and the Harvard’s Study of Adult Development. The
association of mental health to maturity is probably mediated not only by
progressive brain myelinisation, as a person grows older, but also by the
evolution of emotional and social intelligence through experience. In the Indian
family system, looking to the elderly for advice in case of any crisis is an
example of looking to the mature mind (i.e. the perfectly healthy mind) for
finding a solution to the difficult situation.
This model of mental health as maturity includes 6 components: identity,
intimacy, generativity and integrity (4 concepts borrowed from Erikson), career
consolidation and keeper of the meaning (derived from the Harvard’s Study
of Adult Development). The concepts are further discussed as below:
1) Identity: Identity is a developmental task which emphasises that the
adolescents must achieve an identity which allows them to become
separate from their parents. Identity is not just a product of egocentricity,
such as running away from home or marrying to get out of a dysfunctional
family, but is the understanding of one’s own values as independently and
distinct from the values of family origin. For example, pursuing a career
of one’s choice rather than reluctantly taking up family’s choice. The
decision, if based on internalising family values as well as the values of
the society or the peer group with an independent judgement would
indicate developing a mature identity. Biological maturation also has an
important role here.
2) Intimacy: Development of an intimate relationship permits an individual
to reciprocate with the partner and not remain selfish or self centred.
There should be a commitment in the relationship. This capacity for
intimacy becomes effortless, as the relationship stabilises. Intimacy is
desirable in not just one-to one relationship but also in other interpersonal
relationships. Mastery of intimacy also depends on the cultural factors.
3) Career consolidation: Mastery of this task permits adults to find career
as valuable as one considered during earlier phases of life. This involves
being valuable not only to oneself but also to others. Contentment,
compensation, competence, and commitment play an important role in
career consolidation.
4) Generativity: Generativity refers to a demonstration of a clear capacity
to care for and guide the next generation. The phase comes sometime
during the age 35-55 and includes decline in one’s desire for one’s
achievement and an increasing inclination to serve the community in a
variety of ways.
5) Keeper of the meaning: This is one of the ultimate responsibilities
underlying maturity, which involves passing the tradition of the past to the
future. Conserving and preserving cultural values and passing it on to the
8 future generation is an indicator of mental health.
6) Integrity: Integrity refers to achieving some sense of peace and unity Mental Health
with respect to both one’s life as well as to the whole world.
These six sequential tasks are a kind of a general guidance to help clinicians
make an assessment of mental health as per the age of the person. One may
be a mature 21-year-old and healthy, or an immature 50-year-old, and
unhealthy.

Self Assessment Questions 1

State whether the statements are true or false:

1) Identity is a developmental task. ( )

2) The Global Assessment of Functioning (GAF) scale is used

to measure “below average” mental health. ( )

3) The model of mental health as maturity includes 4

components: identity, intimacy, generativity and integrity. ( )

4) Integrity refers to achieving some sense of peace and unity

with respect to both one’s life as well as to the whole world. ( )

1.3.3 Model C – Mental Health as Positive or

Spiritual Emotions
This model defines both mental and spiritual health as the amalgam of the
positive emotions that bind us to other human beings. Recent advances in
neuroscience and in the biological understanding of positive emotions have
brought out the significance of positive psychology.
This model comprises eight important positive emotions: love, hope, joy,
forgiveness, compassion, faith, awe and gratitude. They all involve human
connections and do not have anything to do just with self. All major religious
faiths emphasise the importance of these emotions.
Positive emotions have an effect on our autonomic (visceral) nervous system,
similar to the relaxation achieved with meditation. The positive emotions
reduce the basal metabolism by acting through the parasympathetic nervous
system. Functional magnetic resonance imaging (FMRI) studies on Kundalini
yoga practitioners have shown that meditation increases the activity of the
hippocampus and the right lateral amygdala, which further stimulates the
parasympathetic system, leading to a sensation of deep peacefulness.

1.3.4 Model D – Mental Health as Socio-Emotional

Intelligence
This model conceptualises mental health with socio-emotional intelligence.
Socio-emotional intelligence refers to accurate conscious perception and
monitoring of one’s emotions and ability to modify emotions so that the
expression of emotions is appropriate. This would also include an accurate
recognition of others’ emotions and an appropriate response. One should have
skills in negotiating close relationship with others and a capacity for focusing
emotions towards a desired goal.
9
Concept of Mind High socio-emotional intelligence reflects above average mental health. Emotional
intelligence lies at the heart of positive mental health. The capacity to identify
the different emotions in ourselves and in others has an important role in the
social interactions and relationships, and hence in mental health.

Self Assessment Questions 2

Fill in the blanks with suitable words:
1) Socio-emotional intelligence refers to accurate conscious perception
and .................................................................
2) Model C defines mental and spiritual health as the amalgam of the
...................................................... that bind us to other human beings.
3) Studies show that meditation increases the activity of the ..................
................................................................. and ...............................
........., which further stimulates the parasympathetic system, leading
to a sensation of deep peacefulness.
4) Positive emotions have an effect on our ..................................................
nervous system.
5) The eight important positive emotions comprises of ..............................
..............................................................................................................

1.3.5 Model E – Mental Health as Subjective Well-being

The capacity for subjective well-being is an important component of mental
health. Positive mental health is not just being a joy to others but also
experiencing subjective well-being. Subjective well-being is a complicated
concept, because mental health issues are influenced by value judgment and
illusion. What may be subjective well-being for a person may not be same for
another person. The primary function of positive emotions is to facilitate self
care. However, the primary functions of subjective negative emotions can also
be healthy, reminding one to seek environmental safety. Subjective well-being
is not just the absence of misery but the presence of positive contentment.
Earlier definitions suggested that a happy person is young, healthy, well
educated, well paid, optimistic, worry free, religious and married with high
self-esteem, holding a reasonably good job, is of good morale and has
modest aspirations. However, the later researchers have shown that this
definition is partly correct and they have suggested that the subjective well-
being could be partially inherited and is relatively not dependent on socio-
demographic variables. The maintenance of self-efficacy and autonomy make
additional environmental contributions to subjective well-being. For example
elders might decide to live on their pension money independently rather than
with relatives, an example of subjective well-being.

1.3.6 Model F – Mental Health as Resilience

Resilience is the ability to be flexible and to get back to normalcy when faced
with stressful situations. One needs to have an adaptive reactions pattern.
There are three broad classes of coping mechanisms for developing resilience:
10
 One may consciously seek social support in an appropriate manner. Mental Health

 One may employ conscious cognitive strategies (thinking patterns) to

master the stressful situations.
 One may have adaptive involuntary coping mechanisms called defense
mechanisms that distort perceptions of internal and external reality in
order to reduce subjective distress. Although it may appear that these
defense mechanisms are maladaptive patterns, these are normal coping
reactions to reduce conflict and cognitive dissonance. This helps in
maintaining internal homeostasis in mental health of an individual.
Healthy involuntary mechanisms include use of humour, altruism, sublimation,
suppression, and anticipation. These concepts are briefly discussed as follows:
 Humour makes life easier and permits discharge of emotions. It allows
one to even directly look at painful situations and deal with it.
 Altruism (getting pleasure from helping others) is used to master conflict
situations. For example, a former alcoholic wanting to help others to
overcome alcohol dependence gets mental satisfaction by being altruistic.
 Sublimation is a process of converting painful situations into triumph.
Examples include extreme sad feelings can be expressed through poetry
or music or a person with violent feelings joining the armed forces.
 Suppression minimizes and postpones facing the problem situations but
eventually deals with it. This is also a method of adaptive coping.
 Anticipation is the capacity to keep the affective response to an
unbearable future event in manageable doses in one’s mind, and use it at
the appropriate time.
The study of individuals with positive mental health is crucial in understanding
the vulnerability to mental illness. This is important from the point of developing
primary prevention, which is definitely better than treating the illness.
Currently, each mental illness is identified by a set of symptoms present or
elicited signs. This assembled set of clinical information invariably includes
variations arising from culture, language, geography, religion, country, etc. This
information is based on the view points of both the client and the psychiatrist
and therefore it varies according to each one’s perception. Sometimes there
may be variations even from the same person at different points of time and
also between people. These variations are often resolved by the process of
voting or consensus by a selected group of experts. Criteria for diagnosis of
mental illness are thereafter statistically derived, most often by some sort of
scoring system on a list of enumerated symptoms for each diagnosis. This is
an empirical approach, and may not be the ideal approach, since any illness
should be diagnosed on ascertaining the disease process. But since the exact
etiology of most psychiatric illnesses is not known, this practical approach has
got a world wide acceptance.
Mental health is then understood by the lack of these symptoms for each
diagnosis or by the principle of diagnostic exclusion. Even the so called
positive definitions of mental health seem to be constructed indirectly from
excluding what constitutes mental illness. 11
Concept of Mind
Self Assessment Questions 3
Choose the correct alternative:
1) Mental illness is identified by presence of a set of symptoms /
assumptions.
2) Suppression minimises / maximises and postpones facing the problem
situations but eventually deals with it.
3) Altruism is a process of getting pleasure from helping / hitting others.
4) The primary function of positive emotions is to facilitate self care /
care for others.
5) Resilience is the ability to be flexible / rigid and to get back to
normalcy.

1.4 LET US SUM UP

In the above discussion you should have understood that, Mental Health is an
intrinsic part of health for any individual or community. It is essential for well-
being and functioning of individuals, also it is an important resource to
individuals belonging to all levels of society. Various components of mental
health, factors affecting mental health and models of mental health have been
discussed in this chapter. Important points that can help you in summarising
the facts are as follows:
 WHO defines mental health as “a state of well-being, in which every
individual realises 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. Mental health can be conceptualised
as :
 Above normal; a mental state, that is objectively desirable;
 As maturity;
 In terms of positive psychology, implying presence of multiple human
strengths;
 As emotional intelligence;
 As subjective wellbeing, a mental state that is subjectively experienced as
happy, contented and desired; and
 As resilience – a capacity for successful “bouncing back” to normality,
i.e. a tendency to cope with stress and adversity.

1.5 ANSWER TO SELF ASESSMENT QUESTIONS

Self Assessment Questions 1
1) True
2) False
3) False
12 4) True
Self Assessment Questions 2 Mental Health

1) Monitoring of one’s emotions and ability to modify emotions so that the

expression of emotions is appropriate.
2) Positive emotions that bind us to other human beings.
3) Hippocampus and the right lateral amygdala.
4) Autonomic (visceral) nervous system.
5) Love, hope, joy, forgiveness, compassion, faith, awe and gratitude.
Self Assessment Questions 3
1) Symptoms
2) Minimizes
3) Helping
4) Care for others
5) Flexible

1.6 UNIT END QUESTIONS

1) What is the WHO definition of Mental Health?
2) Explain the factors that contribute to mental health.
3) Why is understanding and defining mental health important to the field of
psychiatry?
4) Enumerate different models of mental health.
5) What are the difficulties in the current criteria for mental illness?

1.7 REFERENCES
Vaillant GE (2003). Mental health. American Journal of psychiatry, 160:1373–
1384.
Vaillant GE, Vaillant CO (2009). Normality and mental health. In Kaplan &
Sadock’s Comprehensive textbook of psychiatry, 9th edn., Lippincott Williams
& Wilkins, NY.Pp 691-706.
World Health Organisation (2004) Promoting Mental Health: Concepts,
Emerging Evidence, Practice: Summary Report. World Health Organisation:
Geneva.
Websites: (http://www.who.int/features/factfiles/mental_health/en/accessed on
8 July 2013).

13