Mental Health as Positive Psychology

Model B: Mental Health 

as Positive Psychology

The second model, as old as Aristotle, conceives of men-tal health as a utopian ideal and has provided the impetus
for the recent positive psychology movement (33). In the
19th century mental health was viewed as related to mo-rality. Psychiatrists wrote of both “moral insanity”and
“good character.”But in the 20th century, as psychiatry be-came more concerned with pathology, only educational
psychology remained interested in character and “virtue.”
In psychology, interventions to improve already ade-quate intelligence and social skills are common, while in
medicine and psychiatry to meddle with adequate thyroid
function, a healthy hematocrit, or a normal mood is only
to invite trouble. It can be argued that in the healthy rested
individual virtually all psychopharmacological interven-tions will, over time, make the brain function worse; it can
also be argued that many nonpharmacological interven-tions (e.g., literacy training, stress management, and ten-nis lessons) will make the brain function better. Thus,
those with the medical goal of using medication to remove
pathology sometimes forget educational interventions to
enhance above average functioning.
Over the last 40 years, Maslow’s concept of self-actual-ization and his emphasis on humanistic psychology (9, 34)
have drawn attention to full use and exploitation of tal-ents, capacities, potentialities. But until very recently,
such humanistic psychology did not provide empirical re-search and ignored both predictive validity and follow-up.
As early as 1925, psychiatrist Adolf Meyer was already
warning psychologists of the difference between “moraliz-ing”about mental health and studying it by “conscien-tious and impartial study”and “constructive experimen-tation”(35, p. 118).
Recently, Seligman (36, 37) has served notice that posi-tive psychology will follow Meyer’s rules of conscientious
and impartial study and constructive experimentation.
Seligman’s concept of learned optimism incorporates the
empirical advances in cognitive psychology that have
taken place over the past three decades. Creating a posi-tive attributional style not only serves as a cognitive be-havior treatment for depression (36, 37) but can lead to
positive mental states.
Advocates of positive psychology wish to learn how to
build the qualities that help individuals and communities
not just to endure and survive but also to flourish. For-mally introduced in the January 2000 issue of American
Psychologist,positive psychology entails rendering “hu-manistic”psychology amenable to scientific study and
intervention.
Am J Psychiatry 160:8, August 2003 1377
GEORGE E. VAILLANT
http://ajp.psychiatryonline.org
At the individual level, it is about positive individual
traits; the capacity for love and vocation, courage, in-terpersonal skill, aesthetic sensibility, perseverance,
forgiveness, originality, future mindedness, spiritual-ity, high talent, and wisdom.…And in this quest for
what is best, positive psychology does not rely on
wishful thinking, faith, self-deception, fads, or hand
waving; it tries to adapt what is best in the scientific
method to the unique problems that human behavior
presents to those who wish to understand it in all its
complexity. (33, p. 5)
Recently, advocates of positive psychology have divided
positive mental health into four components: talents, en-ablers, strengths, and outcomes (20). Talents are inborn,
are genetic, and are not much affected by intervention
(e.g., high IQ, being an easy baby). Enablers reflect social
interventions and environmental good luck (e.g., strong
family, good school system); these can be experimentally
modified to enhance strengths. Strengths (Figure 1) are
character traits such as curiosity and openness that reflect
facets of mental health that are amenable to change. Out-comes reflect dependent variables (e.g., improved score on
the GAF Scale, positive social relationships, subjective
well-being) that can be used to provide evidence that clini-cians’efforts to alter strengths are not just wishful thinking.
As components of mental health, the specific ideal
strengths (or virtues) are subject to debate. Wisdom, kind-ness, and the capacity to love and be loved are strengths
over which few would argue. But should courage be in-cluded as a strength, and why were intelligence, perfect
musical pitch, and punctuality excluded? The answer is
that the 24 strengths listed in Figure 1 may be subjected to
a variety of tests. First, they have been recurrent positive
values across cultures and across centuries. Second, they
may be valued in their own right and not just as a means to
ends.
There are pitfalls with positive psychology. First, the
perspective of mental health as Utopia is one of the bogey-men of national health policy makers. They are afraid,
without directly expressing it, that this perspective, com-monly adhered to by some mental health specialists, will
put a backbreaking burden on health insurance. Is helping
people to become happier with themselves a process that
any health insurance program should be expected to
cover? Over time society will have to decide who should
pay for positive mental health: the individual, the educa-tional system, third-party payers, religious organizations,
or a combination of all four.
A second caution about positive psychology relates to
the danger of the culturally insensitive prescription of pa-rochial virtues. The dangers of value judgments are enor-mous. We need to distinguish virtues, even Aristotelian
virtues, from health. Keeping wounds clean is healthy but
not a virtue. Body hygiene in public places is a virtue but
not necessarily healthy.
A third controversial facet of positive psychology is its
emphasis on optimism. Since the late 19th century, many
social scientists, especially those in Europe, have mis-trusted optimistic cognition, especially religious opti-mism, as a maladaptive “American”illusion interfering
with accurate perception of reality. Nietzsche, Freud,
Marx, and Darwin all perceived optimism as evidence of
an ingenuous cultural adolescence, not of mature mental
health. It is healthier to face the hard facts of life. Besides,
there is a significant body of work suggesting that the de-pressed perceive the world more accurately (38).
Nevertheless, over the past 30 years cognitive therapists
have demonstrated that altered cognition can not only
change behavior, it can also alter brain function (39). If pes-simism is the dominant cognition of the depressed, opti-mism appears the dominant cognition of the mentally
healthy. If learned helplessness leads to depression, learned
optimism and self-efficacy lead to mental health (37).
In part, the importance of optimism to positive mental
health depends on an explanatory style that asserts, “The
good things that happen to me will last forever. They are
pervasive, and they are my own doing. The bad things that
happen to me occur by chance, are limited, and are un-likely to happen again.”The explanatory style of many
chronically depressed individuals is just the opposite (40,
41). In addition, optimism includes hope, a facet of mental
health as old as the Greek myth of Pandora. Yet hope is a
topic to which psychiatry up to now has given little formal
consideration. In addition, the illusion of optimism per-mits one to contemplate and plan for, rather than to deny,
the future. Longitudinal studies have repeatedly shown fu-ture-mindedness to be a critical ingredient of mental
health (7, 24). Finally, positive psychology is the only
model of mental health that suggests, even tentatively,
how a GAF Scale score of 75 might be raised to 90. The re-search agenda for positive psychology includes continu-ing to build bridges to medicine and to build on work (42)
that undergirds such humanistic ideas with Meyer’s “con-structive experimentation.”