Posted by: thealienist | September 25, 2014

What Is “Mental Health”?

People often talk of “mental health,” but I wonder if many have given much thought to just what that is.  I know that in my practice, my patients often have very different ideas about mental health than I do.  Some of the things that I often discuss with them is how I define mental health, how I see them deviating (if they do) from my standard of mental health, and how treatment is supposed to restore them to a healthy state.  Although the idea of mental health seems very elementary, I fear that very few have considered what it really means.  Many arguments in blogs between mental health care consumers (I really don’t like that term — sounds to impersonal), mental health care professionals, and others outside the day-to-day mental health area seem to hinge on a failure to agree on just what “mental health” is and its role in society.

First, I will give my definition of mental health.  I am not delusional enough to think that everyone will agree with this, but it has been a useful and generally agreeable definition for my patients and me.  I tell my patients that there are three components of good mental health.

1.  The ability to see the world realistically.

2.  The ability to freely choose one’s course of action in this realistically perceived world.

3.  The ability to enjoy (or at least tolerate) the results of one’s actions.


With regard to the first component, I tell my patients that they do not need to see the world the same way I do.  I do not hold myself up as the standard of mental health.  There are certain ways of viewing the world that we are likely to have in common.  There are other views that we might reasonably differ on.  Some differences, however, impair my patients’ abilities to understand the world around them and react in meaningful ways to the situations they find themselves in.  Now, I can anticipate some concern about what the word “realistically” means.  It does not mean that my patients and I have to agree on everything.  I am a religious man — a Christian from a fairly conservative branch of the faith.  Agreement or disagreement in matters of faith have no bearing on assessment of mental health.  Opinions about the effectiveness of medications or of the particular value of nutritional supplements have no bearing either.  Political opinions?  Irrelevant.  In contrast, many of my patients have very low opinions of themselves without any rational basis for them.  Some misinterpret the actions of family members or neighbors in ways that prevent effective interactions.  Some perceive actions accurately but interpret them using assumptions that distort their meaning.  These misperceptions or misinterpretations can be infrequent or common, conscious or unconscious, neurotic or psychotic, or problems of assessment of self or others.  One thing that all my patients with this problem have, though, is that their view of the world is limiting in ways that they find distressing.

The second component of mental health is somewhat tricky.  Some people with an intellectual, philosophical bent deny that any freedom is possible in a deterministic world.  Thank goodness I don’t often have to deal with that one in therapy.  What I am most interested in for my patients is that they are free to choose from among real, possible choices in their lives.  I want them to see options in solving their problems.  I want them to see themselves as able to act on their choices and direct their futures.  I don’t want them to be cognitively restricted in recognizing possible actions.  I don’t want them to be so influenced by irrational depression and anxiety that they feel forced to make unsatisfying choices for their lives.  I don’t want them to be so impulsive that they make unsatisfying choices without reflection.  And (related to component #1), I don’t want them to feel forced into choices based on unrealistic views of themselves or their surroundings.

The third component of mental health is usually fairly straightforward.  Patients come to me saying that they are doing things that have usually given them satisfaction or that seemed meaningful in the past.  Now, however, they are behaving in ways that have worked and been adaptive but find no pleasure or satisfaction in them.  They seem to be making good choices based on reasonable assessments of themselves and others, but the payoff just isn’t there.  For these patients, the solution is to find ways for them to either resume experiencing their pleasures or to help them find new activities that deliver the satisfaction that they desire.  Several of my patients have bigger problems than this, though.  They are in situations that will not deliver satisfying results no matter what my patients do.  There is no use in trying to convince them that they should be pleased with their condition — anyone dealing with their stressors would be similarly distressed.  For these patients, it is frequently my job to help them tolerate their condition until some action can be taken to improve their situation.

Of course, some patients can meet the above conditions completely.  When they can, I consider them well.  They may need continued treatment to keep them healthy, or they may be able to stop treatment.  Other patients (because of cognitive or adaptive limitations) cannot meet these criteria fully.  For these patients, if they meet these criteria to their satisfaction (and are not dangers to themselves or others), I am content.  If, however, they see themselves has having problems with any of these and think that I can be of help, I will gladly see if there is any psychological or psychiatric explanation for their distress and help to the extent I can.

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