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Full text of "Current concepts of positive mental health"

UNIVERSITY 
OF FLORIDA 
LIBRARIES 




COLLEGE UBRAR^ 



CURRENT CONCEPTS 
OF POSITIVE MENTAL HEALTH 



Digitized by the Internet Archive 

in 2010 with funding from 

Lyrasis Members and Sloan Foundation 



http://www.archive.org/details/currentconceptsoOOjaho 



Joint Commission 
on Mental Illness and Health 



M 



ONOGRAPH SERIES / NO. I 



Qurrmt QonccYts 

of 
Positive Mental Health 



MARIE JAHODA 

A REPORT TO THE STAFF DIRECTOR, JACK R. EWALT 

1958 



Basic Books, Inc., Publishers, New York 



FIRST PRINTING SEPTEMBER I958 



SECOND PRINTING FEBRUARY I959 



COPYRIGHT © 1958 BY BASIC BOOKS, INC. 



LIBRARY OF CONGRESS CATALOG CARD NO. 58-I1681 



MANUFACTURED IN THE UNITED STATES OF AMERICA 



DESIGNED BY SIDNEY SOLOMON 



Foreword 



Ihis is the first of a series of monographs to be published 
by the Joint Commission on Mental Illness and Health as 
part of a national mental health survey that will culminate 
in a final report containing findings and recommendations 
for a national mental health program. 

The present document constitutes a report of the project 
director to the staff director of the Joint Commission. 

Titles of the monograph series, together with the senior 
authors, are listed here in the approximate order of scheduled 
publication: 

1. Current Concepts of Positive Mental Health 

Marie Jahoda, Ph.D. 

2. Economics of Mental Illness 

Rashi Fein, Ph.D. 

3. Mental Health Manpower 

George W. Albee, Ph.D. 

4. Nationwide Sampling Survey of People's Mental Health 

Angus Campbell, Ph.D., and Gerald Gurin, Ph.D. 

5. The Role of Schools in Mental Health 

Wesley Allinsmith, Ph.D., and George W. Goethals, EdD. 

[v] 



[ vi ] FOREWORD 

6. Research Resources in Mental Health 

William F. Soskin, Ph.D. 

7. Religion in Mental Health 

Richard V. McCaiin, PhX). 

8. Nonpsychiatric Community Resources in Mental Health 

Reginald Robinson, Ph.D., David F. DeMarche, PhX)., 
and Mildred K. Wagle, M.S.SA. 

9. Epidemiology and Etiology of Mental Illness 

Richard J. Plunkett, M.D., and John E. Gordon, M.D. 

10. Patterns of Patient Care: 

A. THE OUT-PATIENT 

B. THE IN-PATIENT 

C. THE EX-PATIENT 

Morris S. Schwartz, Ph.D., Warren T. Vaughan, M.D., 
and Charlotte Greene Schwartz, M.A. 

These monographs, each a part of an over-all study design, 
will contain the detailed information forming the basis of 
a final report. From the data in the individual studies and 
other relevant information, the headquarters staff will pre- 
pare a summary document incorporating its findings and 
recommendations for national and state mental health pro- 
grams. This summary document will have the approval of 
the Joint Commission before its pubHcation in the form of 
an ofl&cial report. 

This final report will be pubHshed by Basic Books and 
transmitted to the United States Congress, the Surgeon Gen- 
eral of the Public Health Service, and the Governors of the 
States, together with their representatives in the pubHc health 
and mental health professions, in accordance with the pro- 
visions of the Mental Health Study Act of 1955. 



FOREWORD [ vii ] 

Participating organizations, members, and officers of the 
Joint Commission, as well as headquarters and project staffs, 
are listed in the appendix at the end of the book. 

The Joint Commission, it may be seen, is a nongovern- 
mental, multidisciplinary, nonprofit organization represent- 
ing a variety of national agencies concerned with mental 
health. Its study was authorized by a unanimous resolution 
of Congress and is financed by grants from the National 
Institute of Mental Health and from private sources. 

Additional copies of Current Concepts of Positive Mental 
Health may be obtained from the Joint Commission head- 
quarters, from the publisher, or from book dealers. 

Joint Commission on Mental Illness and Health 



Sujf%c 



CVICW 



1 HE NEED for a clearer understanding of what we mean by 
"mental health" is obvious to anyone who has attempted to 
cope with the role of schools and the numerous community 
agencies involved in mental health promotion, prevention of 
mental illness, and other phases of the mental health move- 
ment now in progress in the United States. Any possible 
clarification of the subject should be of help to mental health 
program-makers. 

We commonly use "mental health" as a term interchange- 
able with "mental illness," in the same euphemistic way that 
"public health" generally refers to the prevention or control 
of disease by mass methods. The behavioral scientists who 
have joined the mental health team and are making in- 
creasingly important contributions to the mental health 
movement have expressed dissatisfaction with a primary 
focus on "sick behavior." They argue that a new and broader 
perspective is needed if interest in mental health, as a posi- 
tive force, is to be made conceptually clear and practically 
useful. They make a telHng point when they propose that 
progress in understanding health and illness requires much 
research based on the study of hiunan behavior as a natural 

phenomenon. 

[ix] 



[ X ] STAFF REVIEW 

In approaching the subject of this monograph, we have 
thought primarily of the promotion of mental health as a 
positive state, rather than of the cure of mental illness, or its 
prevention. 

We asked Dr. Marie Jahoda, the author, who is Professor 
of Social Psychology, New York University, and Director 
of the N.Y.U. Research Center for Human Relations, to 
conduct a review of the pertinent literature and also hold an 
interdiscipHnary seminar during the academic year 1956-57 
for the purpose of evaluating the theoretical, experimental, 
and empirical evidence of the psychological nature of mental 
health. 

Dr. Jahoda's fulfillment of this assignment has resulted in 
a thoughtful and extensive analysis of mental health concepts, 
written by her in consultation with leading pubHc health 
workers, sociologists, psychologists, and others. 

No abstract can take the place of the total document — a 
process of critical examination of existing views and issues 
and of where they lead. However, it may be helpful to 
have a summary of some of the prominent features of her 
report. These points are made, among others: 

1. Mental health is an individual and personal matter. 
It involves a living human organism or, more precisely, the 
condition of an individual human mind. A social environ- 
ment or culture may be conducive either to sickness or health, 
but the quality produced is characteristic only of a person; 
therefore, it is improper to speak of a "sick society" or a 
"sick community." 

2. In speaking of a person's mental health, it is advisable 
to distinguish between attributes and actions. The individ- 
ual may be classified as more or less healthy in a long-term 



STAFF REVIEW [ xi ] 

view of his behavior or, in other words, according to his en- 
during attributes. Or, his actions may be regarded as more 
or less healthy — that is, appropriate — from the viewpoint 
of single, immediate, short-term situation. 

3. Standards of mentally healthy, or normal, behavior 
vary with the time, place, culture, and expectations of the 
social group. In short, different peoples have different stand- 
ards. 

4. Mental health is one of many human values; it should 
not be regarded as the ultimate good in itself. 

5. No completely acceptable, all-inclusive concept exists 
for physical health or physical illness, and, likewise, none 
exists for mental health or mental illness. A national pro- 
gram against mental illness and for mental health does not 
depend on acceptance of a single definition and need not 
await it. 

6. Many scientific investigators have thought about the 
psychological content of positive mental health. A review of 
their contributions reveals six major approaches to the sub- 
ject. 

a. Attitudes of the individual toward himself. 

b. Degree to which person realizes his potentialities 
through action. 

c. Unification of function in the individual's personality. 

d. Individual's degree of independence of social in- 
fluences. 

e. How the individual sees the world around him. 

f. Ability to take life as it comes and master it. 

7. One value in American culture compatible with most 
approaches to a definition of positive mental health appears to 
be this: An individual should be able to stand on his own 
two feet without making undue demands or impositions on 
others. 

8. The need for more intensive scientific research in mental 
health is underscored. 



[ xii ] STAFF REVIEW 

Among the biologists and physicians who read this mono- 
graph, there may be some discomfort at not finding more 
about the biologic and physiologic components of mental 
health. They might even take their cue from the fact that Dr. 
Jahoda states that "mental health must be thought of as per- 
taining to a Hving organism with mental faculties." How- 
ever, it is the purpose of her monograph to discuss the 
concepts of positive mental health from a psychological view- 
point. She assumes that a certain physiologic or physio- 
chemical homeostasis is necessary for good health. 

The laboratory showed us long ago that severe emotional 
stress can profoundly alter the physiology of the body. More 
recent research supports this evidence — chemical-physiologic 
disturbances can affect behavior and perception. In fact, 
some evidence indicates that a genetic, or at least fundamen- 
tally biologic, "set" of the body, in terms of its chemical con- 
stituents, may determine the way the individual deals with 
external stress and other life experiences. 

In addition, deterioration of the brain from disease, aging, 
nutritional disturbances, or toxins such as alcohol and drugs 
can produce profound mental changes. Adequate nutrition 
and maintenance of a high state of oxygenation of the fetus 
during dehvery and in the immediate post-partum phase 
may, in themselves, promote a better integrated nervous sys- 
tem and a higher state of mental health in the future. 

For those who contend that mental health is a unitary state 
to which all must conform, it may be pointed out that Dr. 
Jahoda suggests that good physical health is a necessary but 
not sufl&cient condition of good mental health. 

Some, however, feel that mental health is a more relative 
term. For example, they beUeve that mental health would 



STAFF REVIEW [ xiii ] 

be possible in a genius and a moron as well. They may con- 
tend that a person with a brain injury who has recovered 
with only a few neurologic disturbances can, in spite of this, 
with proper rehabiHtation and proper mental attitudes, have 
good mental health. Speculation almost requires such a point 
of view, else, from a biologic point of view, we could never 
be certain that any man is healthy. Who knows what or- 
dinary mortals among us might have been an Einstein or 
Edison, had a few more cubic centimeters of oxygen been 
infused into our lungs, or had our mothers ingested a few 
more vitamins or particular constellations of protein during 
our gestation period .^^ 

None knows that he is as intact as he might have been. 
Perhaps the biologic view would be adequately represented 
if, to Dr. Jahoda's psychological concepts and notions of 
mental health, were merely added a phrase — "with a physio- 
logic function consistent with the demands made by the so- 
ciety and the psychologic state of the individual." 

The final chapter in this monograph was written by Dr. 
Walter E. Barton, one of the members of Dr. Jahoda's ad- 
visory panel, in order to present what might be termed a 
more typical clinical view of the organic facets in this prob- 
lem. This staif review. Dr. Jahoda's presentation, and Dr. 
Barton's all help confirm Dr. Jahoda's contention that mental 
health indeed means different things to different people. 

Jack R. Ewalt, M.D., Director 



Jic]inowlcdgcmcnts 



1 HIS REPORT was Written for the Joint Commission on Men- 
tal Illness and Health. The Director of the Commission, Dr. 
Jack R. Ewalt, and his senior staff, particularly Drs. Fill- 
more H. Sanford and Gordon W. Blackwell, did much more 
than entrust me with a piece of work; their continuous en- 
couragement, and the generous and thoughtful manner in 
which they permitted me to enlist the cooperation of others, 
have been of considerable help. 

Work on this report was planned and carried through in 
a manner which required several revisions of ideas, formula- 
tions, and organization. When a preliminary draft of a sec- 
tion was finished, it was first submitted to my colleagues at 
New York University for criticism and suggestions. Drs. 
Robert R. Holt, Murray Horwitz, George S. Klein, Robert 
S. Lee, Eva Rosenfeld, M. Brewster Smith (Vice-President 
of the Joint Commission), Miss Claire Selltiz, and especially 
Drs. Isidor Chein and Stuart W. Cook gave their time and 
ideas unsparingly. Their individual contributions cannot be 
identified. Jointly they made it possible to produce interim 
working papers which led to an immeasurable improvement 
of the draft they had received from me. These working 

[XV] 



[ Xvi ] ACKNOWLEDGEMENTS 

papers were then submitted to a highly selected group of 
professional persons who acted as consultants to the project. 
They are as follows: 

Alfred L. Baldwin, Ph.D., Professor and Chairman of the 
Department of Child Development and Family Relation- 
ships, Cornell University, Ithaca, N. Y. 

Walter E. Barton, M.D., Associate Professor of Psychiatry, 
Boston University School of Medicine, and Superintendent, 
Boston State Hospital, Boston, Mass. 

Kenneth D. Benne, Ph.D., Professor of Human Relations, 
Boston University, Boston, Mass. 

John A. Clausen, Ph.D., Chief of the Laboratory of Socio- 
Environmental Studies of the National Institute of Mental 
Health, Bethesda, Md. 

Ernest M. Gruenberg, M.D., Technical Staff, Milbank 
Memorial Fund, New York. 

Irving L. Janis, Ph.D., Associate Professor of Psychology, 
Yale University, New Haven, Conn. 

Ernst Kris, Ph.D., Clinical Professor of Psychology, Child 
Study Center, Yale University, New Haven, Conn. (Now 
deceased). 

Lionel TrilHng, Ph.D., Professor of English, Columbia 
University, New York. 

After having studied the working paper, the consultants 
met with me for a meeting lasting about five hours. These 
seminars were also attended by Drs. Chein and Smith. All 
participants agreed that these meetings should serve as spring- 
boards for ideas and advanced criticism. The notion that in- 
tellectual efforts can be furthered by consensus or majority 
opinion was expHcitly ruled out. The ensuing spirited dis- 



ACKNOWLEDGEMENTS [ Xvii ] 

cussions greatly enriched my knowledge and thinking about 
mental health. 

Throughout the period of work on this report I had the 
competent and enthusiastic help of Mrs. Lillian Robbins and 
Mr. Nicholas Freydberg who, under the modest title of 
graduate student assistants, helped in every way, from tak- 
ing notes at the meetings with consultants (much more eco- 
nomically and intelligently than a tape recorder could have 
done), to reading, excerpting, and discussing. In the final 
revision and organization of the report, Mrs. Robbins and 
I worked closely together. Miss Mary Insinna coped grace- 
fully and efiBciently with the secretarial duties inherent in 
the task. 

To all of them my warm thanks. 

Marie Jahoda 



Qontmts 



Foreword v 

Staff Review ix 

Acknowledgements xv 

I. Introduction 3 

Purpose and Scope 5 

7^ a Concept of Mental Health Necessary? 5 

The Nature of Mental Health Propositions 7 

II. Clearing the Air: Unsuitable Conceptualizations 

of Positive Mental Health 10 
The Absence of Mental Disease as a Criterion 

for Mental Health 10 

Normality as a Criterion for Mental Health 15 
Various States of Well-Being as Criteria for 

Mental Health 18 

III. The Psychological Meaning of Various Criteria 

for Positive Mental Health 22 

Six Approaches to a Concept 25 

[xix] 



[ XX ] CXJNTENTS 

Attitudes toward the Self as Criteria for Mental 

Health 24 

Growth, Development, and Self-Actualization 

as Criteria for Mental Health jo 

Integration as a Criterion for Mental Health ^^ 
A Note on Reality-Orientation 4^ 

Autonomy as a Criterion for Mental Health 4$ 
Perception of Reality as a Criterion for Mental 

Health 4g 

Environmental Mastery as a Criterion for 

Mental Health 53 

IV. An Effort at Further Clarification 6^ 

Different Types of Mental Health 66 

The Multiple Criterion Approach yo 

Mental Health and Mental Disease 73 

The Value Dilemma y6 

V. From Ideas to Systematic Research 81 

Empirical Indicators for Positive Mental 

Health 82 

Some Suggestions for Research 100 

Conditions for Acquisition and Maintenance of 

Mental Health 104 

VI. In Conclusion log 

VII. Viewpoint of a CHnician, by Walter E. Barton, 

M.D. /// 



CONTENTS [ Xxi ] 

References 121 

Appendix 

Joint Commission on Mental Illness and 
Health. Participating Organizations, Mem- 
bers, Officers, and Staff 727 

Index /J/ 



4 



Ihere are two ways of being interested in health; the 
common one is that of making a Hst and plan of all 
things that are good and desirable in life and giving 
the best possible description of Utopia and of perfec- 
tion with recommendations as to how to get there. 
The way of the worker in modern hygiene is that of 
making a survey of the actual activities and condi- 
tions, and then of taking up definite points of difi&culty, 
tracing them to an understanding in terms of causes 
and effects and to factors on which fruitful experi- 
mental, analytical and constructive work can be done. 
The first type leads mainly to moralizing; the second 
type leads to a conscientious and impartial study, and 
to constructive experimentation. 

Adolf Meyer, 1925. ^$1^-% 



I 



Introduction 



Ihere is hardly a term in current psychological thought 
as vague, elusive, and ambiguous as the term "mental health." 
That it means many things to many people is bad enough. 
That many people use it v^ithout even attempting to specify 
the idiosyncratic meaning the term has for them makes the 
situation worse, both for those v^ho w^ish to promote mental 
health and for those v^^ho wish to introduce concern with 
mental health into systematic psychological theory and re- 
search. 



PURPOSE AND SCOPE 

The purpose of this review is to clarify a variety of efforts 
to give meaning to this vague notion. In doing so we shall 
have to examine the assumptions about the nature of man 
and society underlying such efforts by making expHcit some 
of their implications and consequences. This should lead first 
to a description of various types of human behavior called 
mentally healthy and second to a critical discussion of mental 
health concepts suggested in the Hterature. 

[3] 



[ 4 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

Definitions of mental health to some extent must be mat- 
ters of convenience. A definition in itself solves no problems 
and does not add to know^ledge; all that can be expected 
from it is usefulness in achieving the purposes of science. 
Yet, as we shall see, there are many efforts to define mental 
health in v^ays that go far beyond this scientific approach to 
definition. They often contain implicitly personal or general 
philosophies — they often specify hov^ human beings ought to 
be. Such "definitions" also v^ill have to be examined. 

In a sense, the attempts to give meaning to the idea of 
mental health are efforts to grapple v^ith the nature of man 
as he ought to or could be. Every historical period probably 
has its ov^n characteristic v^^ay of searching for expressions 
incorporating its ideals of a good man in a good society. 
In our time and in this country positive mental health is one 
focus for this search. Why this should be the case would be 
an interesting study in itself. Here we must limit ourselves 
to noting that the inevitable closeness of ideas about mental 
health to fundamental values should temper scientific im- 
patience with concepts that do not immediately suggest to 
the reader how they can enter into theoretical or practical 
work. 

Since our goal is the development of a rational approach 
to the problem of defining mental health, we shall have to 
choose what seems best among those definitions intermin- 
gling value and fact. In sorting unnecessary from necessary 
connotations, and in indicating where necessary elements are 
still lacking, we will aim at definitions useful for both re- 
search and application. 



INTRODUCTION [ 5 ] 



IS A CONCEPT OF MENTAL HEALTH 
NECESSARY? 

Whether we Hke it or not, the term mental health, or men- 
tal hygiene, is firmly estabHshed in the thought and actions 
of several groups: First, under the guidance of voluntary 
and governmental agencies, the pubHc has taken hold of 
the term in spite of (or, perhaps, because of) its am- 
biguity. Funds are being raised and expended to promote 
mental health; educational campaigns are being conducted 
to teach people hov^ to attain this goal for themselves, for 
their children, for the conmiunity. But is there substance 
behind the notion? Can a useful concept of mental health 
be established? 

If substance can be lent to the term, the effort v^ill benefit 
the public, even if mental health emerges as less of a panacea 
than the public v^ould like. From this situation, a moral 
obligation to deal v^ith the matter arises. 

Specialists also use the term mental health, particularly 
those professions trying to help people in trouble or to pre- 
vent them from getting into trouble. Thoughtful members 
of these groups feel that they need clarity about the con- 
cept of mental health because they want to use it to define 
realistic goals for their efforts and as a help in the develop- 
ment of techniques that, in application, will lead to these 
goals. It is the business of science to explore human poten- 
tiaHties and the conditions furthering their realization. The 
helping professions often turn to the behavioral sciences, 
therefore, to provide them with basic knowledge about hu- 



[ 6 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

man functioning. They demand a mental healtii concept 
compatible with scientific knowledge of man. 

Finally, the term mental health is used by scientists them- 
selves (such as psychiatrists, psychologists, sociologists, and 
anthropologists). Their concern with mental health is often 
justified by pointing to what appears to be a one-sided de- 
velopment in the sciences of man. Knowledge about devia- 
tions, illness, and malfunctioning far exceeds knowledge of 
healthy functioning. Even apart from the issue of appHca- 
tion, they maintain, science requires that the previous con- 
centration on the study of inappropriate functioning be 
corrected by greater emphasis on appropriate functioning, if 
for no other reason than to test such assumptions as that 
health and illness are different only in degree. 

Other members of the scientific community oppose scien- 
tific concern with mental health. In part such opposition is 
based on an unwillingness to work with a notion so vague 
and ill-defined. In part it is rooted in the conviction that the 
science of behavior advances best by studying behavior, with- 
out reference to whether it is "good" or "bad." Only in this 
manner, they argue, can science remain free from "con- 
tamination by values" and a resulting distortion in the choice 
and study of scientific problems. 

This argument rests upon the implicit assumption that as 
a rule scientists select the topic of their interests in accordance 
with the rational requirements of the discipline within which 
they work. This does happen, of course; a well-developed 
theory is, on occasion, the only guide to the choice of a re- 
search topic. But the very one-sidedness of current psycho- 
logical knowledge testifies to the fact that, in their choice of 
topics, scientists are responsive to social demands being made 



INTRODUCTION [ 7 ] 

of them, whether psychological theory will benefit more 
by correcting an earlier bias in favor of the study of disease 
through a current bias in favor of the study of health, or by a 
strict avoidance of concern w^ith "good" or "bad," healthy or 
sick functioning, is a matter of strategy. Fortunately, both 
strategies are presently being pursued by different people. 
Only the future v^ill tell v^hich v^as more profitable. 

In any case, it does not detract from the value of a piece of 
work if it is chosen for other than theoretical reasons. 
Alexander Leighton (1949) has incisively stated the place of 
values in the science of man: 

Within an area marked off for scientific investigation, the values 
of science reign supreme over each step in the process toward 
conclusions and in the conclusions themselves. Moral values when 
pertinent dominate scientific values at three contiguous points: 
the selection of the problem to be investigated, the limitation of 
the human and other materials that may be used, and the de- 
termination of what shall be done with the results. 

From this point of view, mental health is a possible con- 
cern for scientific inquiry notwithstanding its value connota- 
tions. Earlier we argued that mental health is a needed con- 
cept, and one that can be given clear meaning only by 
scientific work. Perhaps it is best to let the argument rest 
here. Whether or not an individual scientist wants to engage 
in research related to mental health is up to him. 

THE NATURE OF MENTAL HEALTH 
PROPOSITIONS 

It may be helpful in appraising the following review of 
concepts to keep in mind that one has the option of defining 



[ 8 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

mental health in at least one of two ways: as a relatively 
constant and enduring function of personality, leading to 
predictable differences in behavior and feelings depending 
on the stresses and strains of the situations in which a person 
finds himself; or as a momentary function of personality and 
situation. 

Looking at mental health in the first way will lead to a 
classification of individuals as more or less healthy; looking 
at it in the second way, will lead to a classification of actions 
as more or less healthy. The relevance of this distinction can 
be illustrated with an example concerning physical health. 
Take a strong man with a bad cold. According to the first, 
he is healthy; according to the second, he is sick. Both state- 
ments are justifiable and useful. But utter confusion will re- 
sult if either of these correct diagnoses is made in the wrong 
context — that is, if he is regarded as a permanently sick per- 
son or as one who is functioning healthily. Much of the con- 
fusion in the area of mental health stems from the failure to 
establish whether one is talking about mental health as an 
enduring attribute of a person or as a momentary attribute 
of functioning. In the following discussion, we shall keep the 
distinction in mind without at this moment choosing be- 
tween either position. 

In the mental health literature a third type of statement 
occurs frequently: situations or societies are called healthy or 
sick. The German culture under national-socialist domina- 
tion has been called paranoid; totalitarian systems are often 
regarded as unhealthy in democracies; one of Fromm's re- 
cent books bears the title The Sane Society (1955). 

On closer examination, however, all these examples (and 
many other possible ones) present merely a linguistic trap 



INTRODUCTION [ 9 ] 

in the discussion of mental health. To call a situation healthy 
or unhealthy is nothing but a colloquial ellipsis meaning that 
it is conducive to healthy or unhealthy behavior. In other 
words, mental health must be thought of as pertaining to a 
living organism with mental faculties; it cannot be attributed 
to any other entity. 

This is, of course, not to say that the examination of aspects 
of a situation conducive to mentally healthy or unhealthy 
behavior is irrelevant. On the contrary: it is of the greatest 
importance, as will become clear in a later section. In the 
present context, however, where we are concerned with 
establishing the premises upon which mental health criteria 
can be established, the discussion of the situation is saper- 
fluous. The relation of environment to mental health — in 
other words, the conditions under which a person acquires 
enduring mental health or will act in a mentally healthy 
way — must be postponed until the legitimate meaning, if 
any, of mental health as an attribute of human behavior has 
been explored. 



n 



(^learing the Air: 

Unsuitable Qonccvtualizations of 

Positive ^Mental Health 



NIental health as the opposite of mental disease is per- 
haps the most widespread and apparently simplest attempt 
at definition. To accept this approach presupposes a defini- 
tion of mental disease. Notwithstanding the fact that mental 
disease is at present much better understood than mental 
health, efforts to define mental disease meet with consider- 
able diflEculties. 

THE ABSENCE OF MENTAL DISEASE 
AS A CRITERION FOR MENTAL HEALTH 

At the present stage of our knowledge, mental disease in 
many cases cannot be inferred from physiological changes in 
the functioning of the organism. When psychiatrists agree 
among themselves that they are deaUng with a mentally sick 
person, they use as the basis for inference highly complex 
[lo] 



UNSUITABLE CONCEPTUALIZATIONS [ II ] 

behavior patterns whose physiological correlates are usually 
not known. 

When a person has lost "contact with reality," hallucinates, 
or is completely unable or unwilling to perform essential 
functions for survival, general agreement is quickly achieved. 
But there are many mentally ill persons who do not (at 
least not consistently) show such extreme symptoms. Here, 
diagnosis is not nearly as unanimous. On the other hand, 
there are situations in which apparently healthy persons may 
show one or several of these severe symptoms. Whether or 
not to call such persons sick will depend on whether the 
classification is made in terms of enduring personality at- 
tributes or in terms of currently observed actions. 

To make explicit all the criteria leading to the diagnosis of 
disease is a bafHing task. By and large, practitioners prefer to 
think in terms of personality attributes, whereas classifica- 
tion of actions has proved more useful in many research 
efforts. This question was debated in a Milbank Fund sym- 
posium (1953). Definitions of the following kind were re- 
ported: "A case is a person under the care of a psychiatrist"; 
or, with reference to children, "a 'case' is a child about whom 
the schoolteacher says, 'This child's behavior is not like most 
children's. The child is making trouble or having trouble.' " 

These crude rule-of-thumb definitions actually served a 
purpose for research; at least they permitted it to get off the 
ground. But those who used these definitions were ready to 
admit severe limitations. For instance, probably many very 
sick people are not under the care of a psychiatrist; also, 
a much higher rate of mental disease was implied in com- 
munities having a psychiatrist than elsewhere. These defini- 
tions were adopted not out of a lack of sophistication, cer- 



[ 12 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

tainly, but in the realization that they provided an expedient 
v^ay of starting research. The suggestion wsls also made that 
in our present state of knowledge a comprehensive concept 
of mental disease v^as perhaps premature. 

Such self-critical restraint on the part of people v^ell- 
qualified to define mental disease receives much support 
from anthropological studies. Some of these throv;^ doubt on 
the use of some symptoms for the diagnosis of disease. 

Anthropologists tell us of generally accepted behavior in 
some cultures that Western civilization v^ould regard a.n 
symptomatic of mental disease. According to Ruth Benedict 
(1934), the Kwakiutl Indians of British Columbia engage in 
behavior that is, by our standards, paranoid and megalo- 
maniacal. Their viev7 of the v^orld is similar to a delusion of 
grandeur in our culture. Alexander interprets the Buddhistic 
self-absorption of mystics in India, with its physical mani- 
festations of rigidity and immobility, as an artificial schizo- 
phrenia of the catatonic type (Klineberg, 1954). However, 
it is apparently true that the Buddhist can control the onset 
and end of his "symptoms," a feat the schizophrenic person 
in our culture cannot perform. 

The example suggests that similarities in symptoms must 
not be mistaken for identical disturbances of functions. It 
also illustrates — and this is important here — that whereas 
identical observable symptoms are regarded in one culture as 
achievement, in another they are regarded as a severe debility. 
In our culture, adolescent boys who are exposed to homo- 
sexual advances often take this as a sign that there is some- 
thing fundamentally wrong with them. In some cultures, the 
absence of a homosexual approach is interpreted in the same 
fashion. Examples could be multiplied to indicate that the 



UNSUITABLE CONCEPTUALIZATIONS [ ^3 ] 

evaluation of actions as sic\, or normal, or extraordinary in 
a positive sense often depends largely on accepted social con- 
ventions. 

Some anthropologists, however, have taken a strong stand 
against cultural relativism in the identification of mental 
disease. Devereux (1956), for example, argues that the 
shaman is mentally sick, even though his illness takes a 
culturally approved form. Linton's idea of culturally pre- 
scribed "patterns of misconduct" points in the same direction. 
The fact that there are in various cultures different "proper 
ways to be insane" need not imply that the functional dis- 
turbance in itself varies from culture to culture. Only with 
regard to the manifestations of the disease is cultural rela- 
tivism appropriate. 

Devereux bases his argument on psychoanalytic theory, 
thinking of mental disease as the expression of conflicts in 
the unconscious. But it has not yet been demonstrated that 
there are any human beings who are free from unconscious 
conflicts. If it is reasonable to assume that such conflicts are 
universal, we are all sick in different degrees. Actually, the 
difference between anyone and a psychotic may lie in the 
way he handles his conflicts and in the appearance or lack 
of certain symptoms. If this is so, mental disease must in- 
evitably be inferred from behavior. But, apart from extremes, 
there is no agreement on the types of behavior which it is 
reasonable to call "sick." 

The differential evaluation of symptoms is not limited to 
cross-cultural comparisons. Within our society, a farmers' 
community may well regard as symptoms of mental dis- 
order the behavior of, say, an urban artists' colony. It follows, 
then, that human behavior cannot be understood in terms of 



[ 14 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

isolated symptoms but must rather be viewed in conjunction 
with the social norms and values of the community in 
which the symptoms are observed (Asch, 1952). Whether 
empirical and theoretical work on mental disorder will one 
day result in the identification of certain disturbances re- 
garded as "disease" in all known cultures is as yet an open 
question. 

Furthermore, the borderline between what is regarded as 
normal and as abnormal is dim and ill-defined in all but the 
extreme cases. Character disorders of various types, for ex- 
ample, belong to that large area where the label "mental 
disease" is not much more appropriate than that of the label 
"mental health," unless we can discover more rigorous 
criteria for one or the other than are implied by the current 
usage of these terms. 

In discussions of these complex issues, a daring thought has 
recently been put forward that makes the definition of psy- 
chological health as the absence of mental disease even more 
doubtful. Such a definition is based on the assumption that 
health is the opposite of disease, or that health and disease 
form the extreme poles of a continuum. What if this as- 
sumption should turn out to be unjustified and misleading ? 
Some psychiatrists now speak of different health potentials 
in seemingly equally sick patients, as if they were deaHng 
with two quaUtatively different continua. We shall return to 
this idea later on. 

At this moment, however, the apparent difficulty in clearly 
circumscribing the notion of mental disease makes it un- 
likely that the concept of mental health can be usefully de- 
fined by identifying it with the absence of disease. It would 



UNSUITABLE CONCEPTUALIZATIONS [ ^5 ] 

seem, consequently, to be more fruitful to tackle the con- 
cept of mental health in its more positive connotation, 
noting, however, that the absence of disease may constitute 
a necessary, but not a sufficient, criterion for mental health. 

NORMALITY AS A CRITERION FOR 
MENTAL HEALTH 

As far as normality is concerned, w^hat has been learned 
from cultural anthropologists can hardly be overestimated. 
Their entire w^ork can be regarded as a series of variations 
on the theme of the plasticity of human nature and, accord- 
ingly, on the vast range of v^^hat can be regarded as normal. 
They have convincingly demonstrated a great variety of 
social norms and institutions in different cultures in different 
parts of the world; and that in different cultures different 
forms of behavior are regarded as normal. 

It is generally accepted that the term normaHty covers two 
different concepts: normality as a statistical frequency con- 
cept and normality as a normative idea of how people ought 
to function. In the statistical sense of the term it is correct to 
say, for example, that normal adults are married. Whether 
or not the statement makes sense in the normative connota- 
tion is another matter. It may well be that for this example 
there is a coincidence of statistical and normative correctness. 
But such coincidence would be fortuitous. To believe that the 
two connotations always coincide leads to the assertion that 
whatever exists in the majority of cases is right by virtue of 
its existence. The failure to keep the two connotations of 
normality separate leads straight back into an extreme cul- 



[ l6 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

tural relativism according to vi^hich the storm trooper, for 
example, must be considered as the prototype of integrative 
adjustment in Nazi culture. 

Insofar as normality is used in the normative sense, it is 
a synonym for mental health, and the problems of concept 
definition are, of course, identical. 

It remains to be seen vi^hat can be learned from the 
frequency concept. ImpHcitly, if not explicitly, many per- 
sons regard what the majority of people feel, think, and do 
as healthy, and deviations from the average as not healthy. 
This belief is fostered by the unquestionable fact that, v^ith 
regard to many human attributes, the distribution of the 
population follows a normal or approximately normal curve; 
that is, the majority manifests a medium course, with 
progressively smaller proportions of cases as we move toward 
either extreme of behavior. This is true, for instance, for 
many biological functions (height, weight, and so forth). 

However, a majority does many things we hesitate to call 
mentally healthy; for example, experiments have indicated 
that under conditions of hunger, people tend to see food 
where there is none. That the majority may respond in such 
fashion would perhaps be perfectly understandable; but this 
is different from regarding as psychologically abnormal 
those who, in spite of their hunger, maintain the abihty to 
perceive correctly, because they are at the extreme end of this 
particular distribution curve. Psychological health may, but 
need not, be the status of the majority of people. 

Moreover, statistical definitions of psychological health in- 
volve basically nonstatistical considerations. As Ernest Jones 
(1942) has pointed out, "If once the statistically normal mind 
is accepted as being synonymous with the psychologically 



UNSUITABLE CONCEPTUALIZATIONS [ I7 ] 

healthy mind (that is, the mind in which the full capacities 
are available for use), a standard is set up which has a most 
fallacious appearance of objectivity." Davis (1938), Wegrocki 
(1939), Mowrer (1948), and Redlich (1952) also deal with 
the concept of statistical normalcy. 

In order to establish a statistical norm, one has to define 
the population from which it is to be derived. And the choice 
of a population inevitably contains, at least implicitly, a non- 
statistical concept of health. One would not, for example, 
develop a set of statistical norms for an arbitrarily merged 
population including both so-called primitive and civilized 
societies, males and females, children and adults. Why not ? 
Because it seems evident that the determining conditions of 
the same behaviors, the contexts, their consequences, and 
hence their meanings, to either the actors or observers, are 
often likely to be quite different in different types of society, 
or in the two sex groups, or in different age groups. It fol- 
lows that in deciding upon a reference population, one is at 
least tacitly considering the determinants, contexts, conse- 
quences, and/or meanings of behavior relevant to its evalua- 
tion from the viewpoint of mental health. 

Similarly, even when one has selected and defined the 
relevant reference population, one would not give equal 
weight to all measurable psychological functions — say, the 
speed with which a person can cancel all of the as in a page 
of print, on the one hand, and the frequency of hallucinatory 
experiences, on the other — in developing a set of norms 
against which to evaluate the mental health status of individ- 
uals. For it seems clear that, whatever "mental health" may 
mean, not all psychological functions are equally relevant to 
it. We thus again find that some, at least tacit, nonstatistical 



[ l8 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

considerations must precede the application of the statistical 
approach. 

The concept does not offer us any clues as to how to select 
and define a reference population or how to select and 
weight the psychological functions to be measured in an 
effort to evaluate positive mental health. If and when more 
appropriate criteria are discovered, their frequency distribu- 
tion in any population will become an interesting empirical 
question. But as a criterion in itself, normaHty is of no use. 

VARIOUS STATES OF WELL-BEING AS 
CRITERIA FOR MENTAL HEALTH 

Many persons think of psychological health as manifested 
in a state of well-being. The World Health Organization, for 
example, defines health as "the presence of physical and emo- 
tional well-being." In this phrase written for international 
audiences, the term "emotional well-being" is but another 
label for mental health. Without a specification of what is 
meant by it, the phrase is of Httle help for our purposes. 

Others have specified various criteria for an individual's 
different feeUng-states. Karl Menninger (1947), for example, 
says : 

Let us define mental health as the adjustment of human beings to 
the world and to each other with a maximum of effectiveness and 
happiness. Not just efficiency, or just contentment — or the grace 
of obeying the rules of the game cheerfully. It is all of these to- 
gether. It is the ability to maintain an even temper, an alert in- 
telligence, socially considerate behavior, and a happy disposition. 
This, I think, is a healthy mind. 



UNSUITABLE CONCEPTUALIZATIONS [ ^9 ] 

This description contains a variety of criteria. Recognizing 
that we are not deaHng with the full overtones and connota- 
tions in Menninger's rich language, it is reasonable for pur- 
poses of classification to select from his description, first, the 
terms happiness and contentment; they have wide currency 
as criteria of mental health. Menninger actually also assumes 
"that the unhappy are always (at least partly) 'wrong' "! To 
regard the unhappy as wrong or sick was apparently al- 
ready prevalent about 1500 B.C., when the friends of Job told 
him that the reasons for his utter misery must be sought in 
himself. 

Jones (1942) also talks of happiness as a criterion of nor- 
mahty. Others prefer the term "satisfaction." Boehm (1955), 
for example, writes: ''Mental health is a condition and level 
of social functioning which is socially acceptable and per- 
sonally satisfying" 

In an informal inquiry conducted by the director of the 
Joint Commission on Mental Illness and Health to ascertain 
the meaning attached to mental health by a group of experts, 
a fair number described their ideas in terms of happiness, 
well-being, and contentment. There are obvious differences 
in degrees and quality among these various highly desirable 
states of being. To distinguish among them is, however, a 
minor matter compared to a major problem inherent in all 
efforts to regard various states of well-being as criteria for 
mental health. This difl&culty has to do with the tacit as- 
sumption that happiness or contentment need no special 
referent or qualification. 

In this global sense, people are happy if what they want 
from life is in harmony with what life offers. Such happiness 



[ 20 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

is clearly not only a function of the individual but also of 
the course of external events over v^hich the individual has 
no control. The use of unquaUfied euphoric states as criteria 
of mental health leads to a difficulty perhaps most obvious 
in Boehm's concept of mental health: What if social ac- 
ceptability and personal satisfaction are incompatible ? What 
if happiness or v^ell-being, satisfaction or contentment, free- 
dom from conflict or tension is inappropriate in a life situa- 
tion? Do individuals then have to be considered mentally 
unhealthy? To answer this question in the affirmative be- 
trays a naive belief in the moral justice of all existing 
conditions. 

But obviously, the persons quoted above are not naive. 
Their formulations make it clear that they mean to speak in 
terms of more or less enduring personality attributes. Thus 
Menninger speaks not only of happiness but of a happy 
disposition. And Jones, in recognizing the impact of ex- 
ternal events on the degree of happiness a human being 
experiences, is compelled to define happiness in a highly 
idiosyncratic fashion as the ability to hold impulses in check, 
w^ithout renouncing them, until they can be gratified. To 
regard the unhappy disposition as a criterion of poor mental 
health is one thing. To regard unhappiness, regardless of 
the circumstances in v^hich it occurs, as such an indication 
is a different matter. 

To be sure, to some extent man selects and creates his ov^n 
environment, and to that extent even the unqualified term 
"happiness" appears as a possible criterion. But there are 
many facets of the environment beyond the conscious or un- 
conscious choice and creation of the individual. Misfortune 
and deprivation are not necessarily of our own making. To 



UNSUITABLE CONCEPTUALIZATIONS [ 21 ] 

be happy under such conditions cannot seriously be regarded 
as a criterion for mental health. Only when happiness or 
well-being are clearly conceived of as personality predisposi- 
tions, rather than as momentary feeling states depending on 
circumstances, do these criteria appear useful. In this con- 
notation they will enter into the subsequent discussion. 



Ill 



The ^sycholoncal '^caning of 

Various QriUria for Positive 

^Mentol Health 



bo FAR, three efforts to give psychological meaning to the 
notion of positive mental health have been examined and 
found more or less v^anting. To regard the absence of mental 
disease as a criterion has proved to be an insufficient indica- 
tion in viev^ of the difficulty of defining disease. Normality, 
in one connotation, is but a synonym for mental health; in 
another sense it was found to be unspecific and bare of psy- 
chological content. Various states of w^ell-being proved un- 
suitable because they reflect not only individual functioning 
but also external circumstances. 

A survey of the relevant literature reveals a host of other 
approaches to the subject v^hich seem more promising; at 
least, at first sight, it appears that the objections raised in the 
preceding pages do not apply to them. Although no claim 
can be made that this survey discovered every contribution 
to the topic, the search v^as extensive. It is hoped that no 
major idea in the area has escaped our attention. 

[22] 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ ^3 ] 



SIX APPROACHES TO A CONCEPT 

From an inspection of the diverse approaches uncovered, 
six major categories of concepts emerge. 

1. There are several proposals suggesting that indicators 
of positive mental health should be sought in the attitudes of 
an individual toward his own self. Various distinctions in 
the manner of perceiving oneself are regarded as demon- 
strating higher or lov^er degrees of health. 

2. Another group of criteria designates the individual's 
style and degree of growth, development, or self -actualization 
as expressions of mental health. This group of criteria, in 
contrast to the first, is concerned not with self -perception but 
with what a person does with his self over a period of time. 

3. Various proposals place the emphasis on a central 
synthesizing psychological function, incorporating some of 
the suggested criteria defined in (i) and (2) above. This 
function will here be called integration. 

The following three groups of criteria concentrate more 
exclusively than the preceding ones on the individual's rela- 
tion to reality. 

4. Autonomy singles out the individual's degree of in- 
dependence from social influences as most revealing of the 
state of his mental health. 

5. A number of proposals suggest that mental health is 
manifested in the adequacy of an individual's perception of 
reality. 

6. Finally, there are suggestions that environmental mas- 
tery be regarded as a criterion for mental health. 

All ideas on positive mental health examined can be as- 



[ 24 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

signed to one of these six categories with relative ease, even 
though there is a certain amount of overlap. As v^ill become 
apparent, many authors have made contributions to several 
of the categories. And it could be argued that there exists an 
empirical or theoretical relationship betw^een these groups. 
But the purpose of this reviev^ is to present current thoughts 
on criteria of positive mental health; not — at least, not yet — 
to inquire into the relationship of these criteria to each 
other, to an author's other contributions, or to theories. 

One consequence of this emphasis on criteria is that sim- 
ilarities may appear v^here theoretical differences have not 
led one to expect them. Another is that it v^^ill be possible to 
examine these criteria from the point of viev^ of mental 
health, rather than of the fruitfulness of the general approach 
of which they form part. 

ATTITUDES TOWARD THE SELF AS 
CRITERIA FOR MENTAL HEALTH 

A recurring theme in many efforts to give meaning to the 
concept of mental health is the emphasis on certain qualities 
of a person's self. The mentally healthy attitude toward the 
self is described by terms such as self-acceptance, self-con- 
fidence, or self-reliance, each with sHghtly different connota- 
tions. Self-acceptance impUes that a person has learned to 
live with himself, accepting both the limitations and pos- 
sibilities he may find in himself. Self-confidence, self-esteem, 
and self-respect have a more positive slant; they express the 
judgment that in balance the self is "good," capable, and 
strong. Self-reliance carries the connotation of self-confidence 
and, in addition, of independence from others and of initia- 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ ^5 ] 

tive from within. However, the terms have become en- 
trenched in everyday language in a manner leading to a 
large overlap in their connotations. 

There exists also an overlap in meaning with other terms 
that indicate qualities of an attitude toward the self. Such 
terms are, for example, self-assertion, self-centeredness or 
egotism, and self-consciousness. These latter terms, however, 
have not been proposed as criteria for mental health. 

A number of different dimensions or components appear 
to run through the various proposals. Those aspects of the 
self -concept that stand out most clearly are: (i) accessibility 
to consciousness, (2) correctness, (3) feeling about the self, 
and (4) sense of identity. Although not all of these com- 
ponents are made explicit by the writers who use attributes 
of the self as criteria for mental health, they are impHcit in 
many of their contributions. Inevitably, there is a certain 
amount of overlap between these aspects. 

Accessibility of the Self to Consciousness 

In discussing attitudes toward the self, several writers refer 
predominantly to the breadth of content encompassed by the 
self -concept. For example, Mayman (1955), in speaking 
about the self -determining attitude, says : "An intact sense of 
selfhood or self-determination indicates a successful synthesis 
by the individual of all that he has been and done, with all 
that he wants to be and do, with all that he should and is 
able to be and do, without his disowning any major feehngs, 
impulses, capacities or goals in the interest of inner har- 
mony." 

In the course of his discussion of objectivity of self -percep- 
tion, to which we shall return, Gordon W. Allport (1937) 



[ 26 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

indicates that the mature personaHty shows ''self-objectifica- 
tion, that pecuHar detachment of the mature person when 
he surveys his own pretensions in relation to his abihties, his 
present objectives in relation to possible objectives for him- 
self, his own equipment in comparison with the equipment 
of others, and his opinion of himself in relation to the opinion 
others hold of him." 

Both Mayman's and Allport's descriptions of a healthy 
self-concept include a large variety of content, such as actions, 
values, desires, obligations, and feelings in the past and 
present and in anticipation of the future. Clearly the quota- 
tions indicate that both authors regard a self-concept as de- 
sirable — that is, healthy — when it contains an image of all 
important aspects of the person. Mayman and Allport 
require awareness of the self in a healthy person. 

Barron, on the other hand, appears to regard self-aware- 
ness as a counterindication of mental health (1955). He 
says: "We pay no attention to our self when we are in the 
best of health. It is when we are sick that the self comes to 
our notice. A person just being himself is not self-conscious. 
Self-consciousness arises from malfunction. . . ." 

There is no necessary contradiction between the two views. 
Allport and Mayman do not stipulate that the self-concept 
must permanently dominate consciousness. There is in All- 
port's statement an important quaHfication {"when he sur- 
veys . . .") ; and Mayman's "intact sense of selfhood or self- 
determination" may be close in meaning to Barron's "being 
oneself." Nor does Barron require that the healthy person be 
unable to be consciously aware of his own self. However, the 
juxtaposition of these views on self-awareness brings into 
sharp focus the fact that this criterion can serve as an in- 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ ^7 ] 

dicator of mental health not at every moment but only when 
concern with the self is appropriate. 

Kubie (1954) makes the point clearly: "[This does not] 
imply that in order to be healthy we must be self-consciously 
aware either of our every act or of our every purpose, but 
rather that the predominant forces must be accessible to 
introspection on need." 

Correctness of the Self-Concept 

The idea that it is good to see the self realistically and 
objectively is one of the most common in the mental health 
literature, Gordon Allport, in the passage already quoted, 
stipulates that self -inspection must be objective to be healthy. 
Such objectivity requires an ability for detachment. The 
temptation is strong to mistake what we would like to be 
for what we are. Cattell sees the ideal self as tending to 
merge with the real self (Hall and Lindzey, 1957). However, 
negative distortions of the self-concept are certainly also 
familiar in clinical settings. Whatever the direction, such 
distortion is based on an inabiHty to control rationally the 
wishes and fears that thus color the perception of the self. 
It is in this sense that Fromm (1955) writes about mental 
health as characterized "by the grasp of reaHty inside and 
outside of ourselves, that is, by the development of objectivity 
and reason." 

Feelings about the Self-Concept 

The fact that each self, and presumably therefore each 
healthy self-concept, will contain some elements the owner 
will be, and others he will not be, proud of gives rise to the 
question of how he feels about himself. The most common 



[ 28 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

proposal in the mental health literature is that he should 
accept himself — presumably his self-concept — including his 
shortcomings — i.e,, those elements of which he might not be 
expected to be proud. Maslow (1950) affords a typical ex- 
ample of this point of view: 

Our healthy individuals find it possible to accept themselves and 
their own nature without chagrin or complaint or, for that mat- 
ter, even without thinking about the matter very much. 

They can accept their own human nature with all its discrepan- 
cies from the ideal image without feeling real concern. It would 
convey the wrong impression to say that they are self-satisfied. 
What we must rather say is that they can take the frailties and 
sins, weaknesses and evils of human nature in the same unques- 
tioning spirit that one takes or accepts the characteristics of na- 
ture. 

It is not clear whether Maslow takes the position that the 
healthy person does not experience ego-alien impulses or that 
his self-acceptance encompasses them too. His reference to 
sins and weaknesses suggests the latter interpretation. 

In any case, he and others who emphasize self-acceptance 
are apparently referring to one's feeUng about the total con- 
figuration of the self-concept rather than any single attribute 
of it. Presumably, recognized shortcomings are accepted in 
their relation to recognized strengths, and are realistically 
evaluated in terms of the possibilities and costs of changing 
the self. 

Sense of Identity 

Closely related to such balanced self-acceptance is another 
aspect of the self -concept which is frequently discussed in the 
mental health hterature: the sense of identity. What Cattell 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [29] 

calls the self sentiment, or what McDougall calls the senti- 
ment of self-regard apparently refers not to any specific 
aspect of the self-image but rather to this integrative at- 
tribute of the self (Hall and Lindzey, 1957). They mean a 
global benevolent view of the whole self, a positive feeling 
that pervades and integrates all other aspects of the self- 
concept. The distinguishing mark of this aspect as com- 
pared to self-acceptance is its more cognitive emphasis on 
the clarity of the self-image. A healthy person knows who 
he is and does not feel basic doubts about his inner identity. 

The sense of identity as an indicator of positive mental 
health has been particularly emphasized in Erikson's work 
(1950). He talks about it as the fifth stage in the develop- 
ment of a healthy person. (The preceding stages are basic 
trust, autonomy, initiative, industry.) Ego-identity, he says, 
"is the inner capital accrued from all the experiences of each 
successive stage, when successful identifications led to a suc- 
cessful alignment of the individual's basic drives with his 
endowment and his opportunities. . . . The sense of ego 
identity, then, is the accrued confidence that one's ability to 
maintain inner sameness and continuity (one's ego in the 
psychological sense) is matched by the sameness and con- 
tinuity of one's meaning for others." 

He contrasts this sense of identity with "a sense of self- 
diffusion which is unavoidable at a time of Hfe when the 
body changes its proportions radically . . . ," here implying 
the close relationship between the sense of identity and the 
body-image. As a consequence of ego-identity, "real intimacy 
with the other sex (or, for that matter, with any other per- 
son or even with oneself) is possible. . . . The youth who is 
not sure of his identity shies away from interpersonal in- 



[ 30 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

timacy; but the surer he becomes of himself, the more he 
seeks it in the forms of friendship, combat, leadership, love 
and inspiration." 

Most v^Titers dealing v^ith the sense of identity emphasize 
that its acquisition is the result of a long period of develop- 
ment, thus implying that a sense of identity is a suitable 
criterion for mental health probably only in adulthood, cer- 
tainly not in childhood. Robert White (1952), relating his 
ideas to those of Erikson and Henry Murray, says: "There 
are many vicissitudes in the development of ego identity, but 
the overall trend is toward an increase of stabihty. . . . 
When one takes a long enough span of time, continuing v^ell 
into adulthood . . . ego identity can be seen to become not 
only more sharp and clear but also more consistent and free 
from transient influences. It becomes increasingly determined 
by accumulated personal experiences. In this v^ay it progres- 
sively gains autonomy from the daily impact of social judg- 
ments and experiences of success and failure." 

GROWTH, DEVELOPMENT, AND SELF- 
ACTUALIZATION AS CRITERIA 
FOR MENTAL HEALTH 

A number of authors see the essence of mental health in 
an ongoing process variously called self-actualization, self- 
realization, growth, or becoming. The idea that the organism 
strives permanently to realize its own potentiaUties is old. 
Fromm (1947) credits Spinoza with having seen the process 
of development as one of becoming what one potentially is. 
"A horse would be as much destroyed if it were changed 
into a man as if it were changed into an insect," Spinoza 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 3^ ] 

said. Fromm continues: "We might add that, according to 
Spinoza, a man would be as much destroyed if he became 
an angel as if he became a horse. Virtue is the unfolding of 
the specific potentialities of every organism; for man it is the 
state in vi^hich he is most human." 

The term self-actuaHzation probably originated with Gold- 
stein (1940). He spoke about the process of self-actuaHzation 
as occurring in every organism and not only in the healthy 
one: "There is only one motive by which human activity is 
set going: the tendency to actualize oneself." The idea is 
echoed in Sullivan's dictum, "the basic direction of the or- 
ganism is forward," and it also dominates the thinking of 
authors such as Carl Rogers, Fromm, Maslow, and Gordon 
Allport. Sometimes the term is used as implying a general 
principle of life, holding for every organism; at other times 
it is applied specifically to mentally healthy functioning. 

It is not always easy to distinguish these two meanings in 
the mental health literature. This lack of clarity probably has 
something to do with the controversial philosophical concept 
of Aristotelian teleology, to which the notion of realizing 
one's potentialities is related. The need for making the dis- 
tinction in a discussion of mental health becomes urgent if 
one realizes that not only the development of civilization but 
also self-destruction and crime, from petty thievery to geno- 
cide, are among the unique potentialities of the human 
species. 

Mayman (1955) is of the opinion that some of the pro- 
ponents of self-actuaHzation as a criterion of health have not 
succeeded in making the distinction. In a critical discussion 
of Rogers' use of the term, he says: "This position is insuf- 
ficient in several respects: it presumes that this growth force 



[ 32 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

is equally potent in all people; that if given the right of v^ay, 
this force will inevitably assert itself for good ; but most im- 
portant of all it treats this force v^^ith almost religious awe 
rather than scientific curiosity. This urge to grow and be 
healthy is treated as an irreducible essence of life." 

To make this life force an aspect of positive mental health 
requires that certain quaHfications be introduced to dis- 
tinguish its manifestations in healthy persons. 

The process of self-actualization, as a rule, is described in 
rather global terms that make it difl&cult to identify con- 
stituent parts. Nonetheless, the various authors who regard 
it as a criterion of positive mental health seem to emphasize 
one or more of the following aspects: (i) self-concept 
(which has already been discussed and is mentioned here 
only to indicate the breadth of the term self -actualization) ; 
(2) motivational processes; and (3) the investment in living, 
referring to the achievements of the self-actualizing person 
as demonstrated in a high degree of differentiation, or max- 
imum of development, of his basic equipment. 

Motivational Processes 

As indicated, Goldstein regards self-actualization as the 
only motive of the organism. Fromm (1941) seems to share 
this view when he says that the healthy individual recognizes 
that "there is only one meaning to life: the act of living it- 
self." The qualification of this general motivational process, 
so that degrees of health can be distinguished, is more clearly 
made by Maslow (1955). He distinguishes deficiency motiva- 
tion from growth motivation. Everyone, he assumes, has a 
need for safety, belongingness, love, respect, and self-esteem. 
Deficiency motivation serves to satisfy these needs; it avoids 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 33 ] 

illness but does not yet create positive mental health. Growth 
motivation leads beyond such tension reduction to self- 
actualization of potential capacities and talents, to devotion 
to a mission in life or a vocation, to activity rather than rest 
or resignation. A self-actualizing person experiences the 
maintenance of tensions in these areas as pleasurable; he 
cannot be understood as being motivated here by the need 
for tension reduction. The greater the amount of growth 
motivation, the healthier a person is. 

Gordon Allport (1955) concurs with Maslow's distinction. 
He says that growth motives "maintain tension in the interest 
of distant and often unattainable goals. As such they dis- 
tinguish human from animal becoming and adult from in- 
fant becoming. By growth motives we refer to the hold that 
ideals gain upon the process of development. Long-range 
purposes, subjective values, comprehensive systems of in- 
terest are all of this order." He regards the dynamics of 
conscience as an example of growth motives. 

Mayman (1955), too, suggests as one criterion of mental 
health the concept of growth and direction tow^ard goals 
higher than the mere satisfaction of basic needs. Mayman 
calls this drive to change and development the heterogenic 
attitude. He contrasts it with "the immobilization of those 
patients who seem to prefer the security of their illness to 
the prospect of change, who seem not only to fear their own 
spontaneity, but even try to stifle this spontaneity. People 
with minimal evidence of the heterogenic drive seem to feel 
no wistful yearning for freedom or a richer life, but cling 
desperately to their imprisonment, like Lorenz's quasi- 
domesticated animals who refuse to part with their cages." 

Mayman links this inner push toward new experiences to 



[ 34 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

Freud's life instinct: "We view the self -actualizing pro- 
pensities of a person as aspects of the Ufe-long cycle of 
growth and decline. They are expressions of what Freud 
has called the 'life instinct,' that set of forces which tends to 
upset established levels of equilibrium and move the in- 
dividual toward new and more complex equilibria. . . . 
The 'life instinct' comprises all the impulses which tend 
toward pleasureful contact with others, synthesis and growth. 
These are the pressures which we presume to be responsible 
for the restless dissatisfaction with one's psychological status 
quo which we are here calhng the heterogenic impetus.' " 

Investment in Uving 

Pervading many of the passages already quoted is an im- 
plied criterion that mental health shows itself in a rich, dif- 
ferentiated life, involvement in various pursuits not restricted 
to what must be done for sheer survival. Several authors have 
been quite expHcit on the point. Gordon Allport (1937), for 
example, speaks about the extension of the self as an attribute 
of maturity, describing it as an ability to lose oneself in work, 
in contemplation, in recreation and in loyalty to others. 
Maslow (1955) found that self-actualizing people "in general 
focused on problems outside themselves"; they have "feel- 
ings for mankind ... a genuine desire to help the human 
race"; they are capable of "deeper and more profound inter- 
personal relations than any other adults"; they are "strongly 
ethical, they have definite moral standards." 

Mayman (1955) formulates much the same idea as a 
process characterizing mentally healthy persons in speaking 
of their investment in living; by this, he means the range and 
quality of a person's concern with other people and the 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 35 ] 

things of this world, the objects and activities that he con- 
siders significant. With such investment in Hving goes a 
"capacity to evoke an empathic, w^arm or compassionate re- 
sponse from others," he states. This observation is related to 
Maslow's finding that self-actualizing people seem to at- 
tract friends and admirers. 

Lindner (1956) uses the term "employment" for this aspect 
of self-actuaUzation. He describes it as "an attitude of affirma- 
tive dedication to existence, of profound and complete par- 
ticipation in living." 

In Jung's optimistic psychology, "Self -actualization means 
the fullest, most complete differentiation and harmonious 
blending of all aspects of man's total personaUty" (Hall and 
Lindzey, 1957). Implicit in Jung's general formulation, and 
explicit in those of the other authors, is the notion that the 
healthy individual demonstrates concern for others and does 
not center all his strivings on satisfying his own needs. We 
shall meet this idea again in a later section. 

It should be noted that the investment-in-living aspect of 
self-actualization can hardly be separated from its motiva- 
tional aspects. Presumably the individual must be committed 
to these higher goals — concern with others, with work, ideas, 
and interests — and motivated to realize them, in order to 
achieve them. 

INTEGRATION AS A CRITERION FOR 
MENTAL HEALTH 

In the proposals suggesting certain qualities of the self- 
concept or self-actualization, or both, as criteria for mental 
health, there is as a rule, implicit or expUcit, another crite- 



[ 36 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

rion: this is generally called integration of the personality. 
Indeed, some writers clearly treat this additional criterion as 
part of either the self -concept or of self -actualization. Others 
single it out for special treatment. In view of its great im- 
portance to some, it will be treated here as a major category 
in its own right. 

Integration refers to the relatedness of all processes and 
attributes in an individual. The coherence of personality, 
often referred to as the unity or continuity of personality, is 
an axiomatic assumption in much psychological thought. In- 
deed, psychological treatment of mental patients as a rule is 
predicated on the search for a unifying principle in terms of 
which the apparently most bizarrely inconsistent manifesta- 
tions of personaUty can be understood to hang together. 
When integration is proposed as a criterion for positive 
mental health, something additional or different is implied. 
Some authors suggest that integration as a criterion for 
mental health refers to the interrelation of certain areas of 
the psyche; others, that it lies in the individual's awareness 
of the unifying principle. Still others imply that there are 
distinctions in the degree or strength of the integrating fac- 
tor. And some are silent on this point. 

Integration as a criterion for mental health is treated, as a 
rule, with emphasis on one of the following aspects: (i) a 
balance of psychic forces in the individual, (2) a unifying 
outlook on life, emphasizing cognitive aspects of integration, 
and (3) resistance to stress. 

Balance of Psychic Forces 

As a consequence of the psychoanalytic orientation of 
writers who speak about this criterion, it is formulated either 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 37 ] 

as a specific balance of ego, superego, and id, or of uncon- 
scious, preconscious, and conscious psychic events. Earlier 
psychoanalytic formulations of health implied the exclusive 
domination of the ego rather than the notion of a balance 
between ego, superego, and id. Heinz Hartmann (1947) 
takes exception to this idea, w^hich takes too Hterally Freud's 
programatic statement: "Where Id v^as, there shall Ego be." 

Hartmann regards complete ego-domination as an un- 
healthy type of balance. According to him, the notion of a 
totally rational human being (i.e., complete ego control) is 
a caricature of man, even though one takes for granted "the 
positive value of rational thinking and action for the in- 
dividual's adjustment to the environment." His notion of the 
proper balance suggests an ego that can accommodate its 
corresponding id and superego and does not aim at eUm- 
inating or, perhaps, denying their demands. Thus he agrees 
vv^ith Kris (1936), v^ho speaks of "regression in the service of 
the ego" as a preferred form of human functioning under 
certain circumstances, for example in the reUnquishing of 
ego control when one wants to fall asleep. 

Hartmann argues that rationalism is not synonymous 
with health, even though "it still plays a role where standards 
of health ... are discussed. Thus it is often maintained 
that the freedom of the individual to subordinate other ten- 
dencies to what is useful for him makes the difference be- 
tween healthy and neurotic behavior. Actually this is too 
small a basis to build upon it a definition of health. The 
ego-interests are only one set of ego-functions among others; 
and they do not coincide with that ego-function that also 
considers the demands of the other psychic systems . . . ; 
their prevalence in an individual does not warrant that the 



[ 38 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

drives are harmoniously included in the ego, nor that the 
super-ego demands have been integrated into it." 

Expanding on these ideas in another paper, Hartmann 
(1939) speaks of the plasticity of the ego as "one prerequisite 
of mental health. . . . But we v^ould add that a healthy ego 
is not only and at all times plastic. Important as is this 
quahty, it seems to be subordinated to another of the ego's 
function ... a healthy ego must evidently be in a position 
to allow some of its most essential functions, including its 
'freedom,' to be put out of action occasionally, so that it may 
abandon itself to 'compulsion' (central control)." 

Here, the idea of balance is further modified. Not only 
does the healthy balance encompass id and superego, but 
the balance is changeable. Perhaps most of the time it is 
anchored in the ego; at other times the anchorage shifts to 
one of the other two systems. 

Kubie (1954), too, sees the criterion of mental health in 
a specific balance of psychic forces; in his view, a balance 
among unconscious, preconscious, and conscious forces, with 
the unconscious reduced to a minimum. "The implicit ideal 
of normality that emerges ... is an individual in whom 
the creative alliance between the conscious and preconscious 
systems is not constantly subjected to blocking and distortion 
by the counterplay of preponderant unconscious forces, 
whether in the prosaic affairs of daily Hving, in human re- 
lations, or in creative activity." This healthy balance will 
result in flexibility: "Thus the essence of normality is flexi- 
bility, in contrast to the freezing of behavior into patterns 
of unalterabihty that characterizes every manifestation of 
the neurotic process, whether in impulses, purposes, acts, 
thoughts or feelings. Whether or not a behavioral event is 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 39 ] 

free to change depends not upon the quality of the act itself, 
hut upon the nature of the constellation of forces that has 
produced it. No moment of behavior can be looked upon as 
neurotic unless the processes that have set it in motion pre- 
determine its automatic repetition irrespective of the situa- 
tion, the utility, or the consequences of the act!' 

The similarity between the approaches of Hartmann and 
Kubie is clearest in the former's emphasis on a changeable 
balance and the latter 's emphasis on flexibility. 

A Unifying Outloo\ on Life 

A different tone and terminology is used by those who 
talk about integration on the cognitive level. Allport (1937), 
for example, speaks about a unifying philosophy of life as 
a sign of maturity. He regards this unifying philosophy as 
reconciling two otherwise conflicting tendencies. Self-exten- 
sion — i.e., losing oneself in the things of the world — and 
self-objectification — i.e., looking at one's self with detach- 
ment — present an antithesis requiring resolution by an in- 
tegrative factor. 

Such a philosophy is not necessarily articulate, at least not 
in words. But a mature person "participates and reflects, 
lives and laughs, according to some embracing philosophy 
of life developed to his own satisfaction and representing to 
himself his place in the scheme of things." 

Allport discusses several types of unifying philosophies. 
The first is religion, the "search for a value underlying all 
things, and as such . . . the most comprehensive of all the 
possible philosophies of life." There is also the esthetic phi- 
losophy, where the quest for beauty is the prime value. All- 
port views these outlooks as "autonomous master-sentiments 



[ 40 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

that give objective coherence and subjective meaning to all 
the activities of their possessors' lives." 

Apparently, the unifying philosophy of life results in the 
individual's feeling that there is purpose and meaning to 
his life. On a time dimension, the unity theme is presented 
by Allport as the intentions of the present which commit 
the individual to strive for specific aspects of the future. In 
Becoming (1955), Allport introduces a nev^ concept, the 
proprium, for this integrating function. The proprium repre- 
sents all regions of hfe regarded as central to the self and in- 
cludes all aspects of personality making for inner unity. 

Propriate striving distinguishes itself from other forms 
of motivation in that, however beset by conflicts, it makes 
for unification of personality. "The possession of long-range 
goals, regarded as central to one's personal existence, dis- 
tinguishes the human being from the animal, the adult from 
the child, and in many cases the healthy personaHty from 
the sick." 

Similar ideas occur in Maslow (1954), v^ho speaks of the 
self-actualizers as "being the most ethical of people even 
though their ethics are not necessarily the same as those of 
the people around them," and in Barron (1955), who em- 
pirically found "character and integrity in the ethical sense" 
in persons judged to have a high degree of personal sound- 
ness. In both statements there is a clear implication that 
healthy persons possess a unifying outlook on life. 

Thus, it is in the light of this aspect of integration — the 
unifying outlook on life — that the criterion of self-actualiza- 
tion becomes further qualified. The self-actuaHzed person's 
investment in living is strong not because he was predestined 
to develop it but because he has a unifying outlook which 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERLA [ 4^ ] 

guides his actions and feelings so that he shapes liis future 
accordingly. 

In the discussion of integration as a criterion for mental 
health Erikson's concept of identity, mentioned previously 
as an aspect of the self, must be mentioned again. In addi- 
tion to the meaning of identity pointed out before, this mas- 
ter concept encompasses the balance of psychic forces as well 
as the notion of a unifying outlook on Hfe. The former is 
clearly demonstrated where Erikson (1950) talks about the 
function of the sense of identity: "Psychologically speak- 
ing, a gradually accruing ego identity is the only safeguard 
against the anarchy of drives as well as the autocracy of con- 
science, . . ." And his concern with a unifying outlook be- 
comes clear when he speaks of ego-integration (practically 
synonymous with ego-identity) as the crowning stage of 
development in terms such as, "It is the acceptance of one's 
one and only life cycle and of the people who have become 
significant to it as something that had to be and that, by 
necessity, permitted of no substitutions. ... It is a sense of 
comradeship with men and women of distant times and of 
different pursuits, who have created orders and objects and 
sayings conveying human dignity and love." 

Resistance to Stress 

Those who discuss mental health as manifested in a par- 
ticular response to stressful situations are actually concerned 
with distinguishing healthy from less healthy degrees of 
integration. The use of terms connoting behavior under 
stress — resilience, anxiety- or frustration-tolerance, and the 
like — leads to greater concreteness in specific criteria than 
does the use of the more general concept integration. Jack 



[ 42 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

R. Ewalt (1956) defines mental health as "a kind of resili- 
ence of character or ego strength permitting an individual, 
as nearly as possible, to find in his world those elements he 
needs to satisfy his basic impulses in a v^ay that is acceptable 
to his fellovi^s or, failing this, to find a suitable sublimation 
for them. . . . This resilience of character should be such 
that he can adapt himself to the vicissitudes of fortune, bounc- 
ing back to find nev^^ ways of satisfaction or sublimation 
after defeat. . . ." 

Similarly, Wesley Allinsmith and George W. Goethals 
(1956) regard abiUty to withstand adverse events without 
inner damage as a criterion of health when they say: "When 
in conflict and unable to solve the matter rationally, the per- 
son has strong enough personaHty organization ('ego 
strength') or, as some would say, is 'secure' enough, to be 
able to stand the tension. A person with these characteristics 
is often spoken of as having 'frustration tolerance' or being 
able to 'delay gratification'; tension does not put the person 
into a panic." 

All authors who talk about this aspect agree that tension, 
anxiety, frustration, or unhappiness occur in normal and 
in sick persons. The difference lies not in the presence of 
symptoms but rather in whether these symptoms can seri- 
ously unbalance the degree of integration an individual has 
achieved. 

Thus Glover (1932) says, "a normal person must show 
some capacity for anxiety tolerance." 

In an interesting empirical study on the behavior of pa- 
tients under pre- and postsurgical conditions, Janis (1956) 
goes perhaps even a step further. Not only does the mentally 
healthy person tolerate anxiety without disintegration but. 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 43 ] 

he suggests (at least by implication), the healthy person 
must be able to produce and experience anticipatory anxiety 
in order to cope better with subsequent danger. 

Thus, the once popular notion that the absence of anxiety 
could serve as a criterion for mental health has fallen into dis- 
repute. Whether or not one agrees with TilHch (1952), in his 
distinction of existential (healthy) from nonessential (patho- 
logical) anxiety, most authors in the field assume anxiety to 
be a universal experience. The individual's manner of coping 
with it is taken as the health criterion. TiUich thinks of self- 
affirmation and courage as the appropriate way of facing 
one's anxiety. 

A NOTE ON REALITY-ORIENTATION 

Three criteria — autonomy, perception of reaHty, and en- 
vironmental mastery — share an explicit emphasis on reality- 
orientation. To be sure, this also has played a role in the 
criteria for positive mental health already presented. But as 
reality becomes the focus of attention, discussion in the 
mental health Hterature leads not infrequently into philo- 
sophical problems about its nature. This eternal question we 
wish to avoid. This is made easier by the fact that some 
relevant central and tangential aspects of this question ac- 
tually are no longer controversial. The central aspect con- 
cerns the shift brought about by the development of modern 
science from a concept of static to a concept of changing 
reality. Says Wendell Johnson (1946) : "No other fact so un- 
relentingly shapes and reshapes our hves as this : that reaHty, 
in the broadest sense, continually changes; once we grasp 
clearly what has been 'known' for centuries and what is, in 



[ 44 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

fact, the central theme of modern science, that no two things 
are identical and that no one thing is ever twice the same, 
that everywhere is change, flux, process, we understand that 
we must live in a world of differences. . . ." 

The tangential aspect of the philosophic question directly 
bearing on mental health — the dispute over whether there 
exists an essential hostility or a compatibility between man 
and the reaUty he is born into — no longer spHts various 
schools of psychological thought into opposed camps. With 
the development of psychoanalytic ego-psychology and its 
conception of ego-forces and conflict-free ego functions 
as part of the native equipment (Hartmann, 1951), the psy- 
choanalytic school has clearly indicated that it does not sub- 
scribe to the unqualified view of reality as hostile to man. 
Academic psychology, which long has accused psychoanaly- 
sis of just this sin, always has had room for aspects of reality 
both supporting and thwarting the individual's needs. 

The positive aspect of reaHty as a pleasurable challenge 
and stimulation to the individual has recently been restated 
by Charlotte Biihler (1954). Taking note of psychoanalytic 
ego-psychology, Biihler says: "This concept of a positive 
reality would also imply the postulation of pleasurable ac- 
tivity ('function pleasure,' K. Biihler) ; that is, a pleasure in 
the stimulating process as such, not only in its elimination. 
Coping or mastery is from this point of view not identical 
with abolishment of stimulation, which is only one of two 
possible resolutions. Only harmful stimuli are mastered by 
way of elimination. The mastery of 'positive stimuli' lies in 
the integrative utilization of the organism's building process 
by means of which the living being becomes active in struc- 
turaHzing material and imposing its own law on it." 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 45 ] 

The thought that the enjoyment of reality is good in itself 
is already embodied in the wisdom of the Talmud; it states 
that everyone v^ill have to justify himself in the Ufe here- 
after for every failure to enjoy a legitimately offered pleasure 
in this w^orld. 

The emphasis on the positive aspects of reality is called 
for because, although the controversy has virtually been re- 
solved on the theoretical level, it still lingers in discussions of 
mental health. Here the tacit assumption frequently still is 
that the w^orld is fundamentally hostile to the individual. 
This may be the result of the fact that, historically, concern 
v^ith health grew out of concern with disease. 

The point has been raised here to avoid repetitive interpre- 
tation in the following sections. Unless there are good reasons 
to the contrary, we will assume that the authors quoted do 
not take an either-or position with regard to the relation 
of man to reaUty and that they are aware of the complexity 
of human experience in which positive and negative aspects 
of reality are not neatly separated. 

AUTONOMY AS A CRITERION FOR 
MENTAL HEALTH 

Many persons regard an individual's relation to the world 
as mentally healthy if it shows what is referred to variously 
as autonomy, self-determination, or independence. Most 
often, these terms connote a relation between individual 
and environment with regard to decision-making. In this 
sense, autonomy means a conscious discrimination by the 
individual of environmental factors he wishes to accept or 
reject. But occasionally autonomy is interpreted as a with- 



[46] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

drawal from reality, as less need for the stimulation offered 
by the world, or as a small degree of involvement in external 
matters. 

Expositions of the criterion of autonomy deal with one or 
both of two aspects: (i) The nature of the decision-making 
process, emphasizing the regulation of behavior from within, 
in accordance with internaHzed standards; (2) The out- 
come of the decision-making process in terms of independ- 
ent actions. 

Regulation of Behavior from Within 

Foote and Cottrell (1955) describe autonomy as referring 
to "the clarity of the individual's conception of self (iden- 
tity) ; the extent to which he maintains a stable set of internal 
standards for his actions; the degree to which he is self- 
directed and self -controlled in his actions; his confidence in 
and reliance upon himself; the degree of self-respect he main- 
tains; and the capacity for recognizing real threats to the self 
and of mobilizing realistic defenses when so threatened." 
Hartmann (1947) speaks of "a general trend of human de- 
velopment, the trend toward a growing independence from 
the immediate impact of present stimuli, the independence 
from the hie et nunc"; and, somewhat later, of the "growing 
independence from the outside world, insofar as a process 
of inner regulation replaces the reactions and actions due 
to fear of the social environment (social anxiety)." 

Mayman's description (1955) of what he calls the self- 
determining attitude avoids the connotation that autonomy 
manifests itself only when reality is threatening: "One's be- 
havior should not be determined by external exigency alone, 
but dictated also from within, based upon that inner organi- 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 47 ] 

zation of values, needs, beliefs, accomplishments and still 
unrealized goals, which together comprise that individual's 
world view." 

Independent Behavior 

Maslow (1954) starts his description of autonomy much 
like Hartmann when he says it means a "relative independ- 
ence of the physical and social environment." But he goes 
on to describe, not the inner processes which make such in- 
dependence possible, but rather their consequences. Accord- 
ing to him, autonomous people more than others "are not 
dependent for their main satisfactions on the real world, or 
other people or culture or means-to-ends or, in general, on 
extrinsic satisfactions. Rather they are dependent for their 
own development and continued growth upon their own 
potentialities and latent resources. . . . This independence 
of environment means a relative stabihty in the face of hard 
knocks, blows, deprivations, frustrations and the like. These 
people can maintain a relative serenity and happiness in 
the midst of circumstances that would drive other people to 
suicide. They have also been described as 'self-contained.' " 
Here there is a connotation that autonomy is a safeguard 
against the badness of the world, as if the only external 
events to be taken into account were those in conflict with 
internal standards and needs. 

David Riesman (1950), on the other hand, explicitly recog- 
nizes that autonomy can manifest itself in going along with 
the world as well as in opposing it. In The Lonely Crowd, 
Riesman distinguishes various forms of characterological 
adjustment to the demands of society (tradition-directed, 
inner-directed, other-directed). These types of adjustment 



[ 48 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

are different alternatives to the malad justed, whom he calls 
anomic. The autonomous persons are those who on the 
whole are capable of conforming to the behavioral norms of 
their society — a capacity the anomics usually lack — but who 
remain free to choose whether to conform or not. Whatever 
their choice, they are less the creatures of circumstance than 
any of the other characterological types. 

These conflicting interpretations of autonomy as a criterion 
of positive health are, perhaps, the result of contamination 
by another aspect of autonomy: not only how decisions are 
made and what consequences they have in behavior but also 
the content and aim of the decisions. This last aspect has 
actually been selected by Andras Angyal (1952) in his use 
of the term. Angyal describes the over-all pattern of per- 
sonality functioning as a two-directional orientation: ''self- 
determination on the one hand and self-surrender on the 
other." Both tendencies exist in all persons. 

The goal of the former, which he calls the trend toward 
increased autonomy, is "to organize . . . the objects and the 
events of his world, to bring them under his own jurisdiction 
and government." The goal of the latter "to surrender him- 
self wilHngly, to seek a home for himself in and to become 
an organic part of something that he conceives as greater 
than himself!' And later: "It is only in the counterfeit, the 
unhealthy behavior that one or the other of these basic 
orientations is partially obliterated; in a well-integrated per- 
son the behavioral items always manifest both orientations 
in varying degrees." Riesman's description of autonomous 
persons is compatible with Angyal's balance of the two 
trends. 

At this point, the notion that mental health criteria have 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 49 ] 

an optimal, rather than a maximal, degree becomes particu- 
larly relevant. This idea, applicable also to other criteria and 
particularly to multiple criteria of health, has been proposed 
by M. Brewster Smith (1950). We shall return to it in an- 
other context. 

PERCEPTION OF REALITY AS A CRITERION 
FOR MENTAL HEALTH 

Pervading many efforts to conceptualize mental health is 
the idea that the way an individual perceives the world 
around him supplies an important criterion for his mental 
health. As a rule, the perception of reality is called mentally 
healthy when what the individual sees corresponds to what 
is actually there. In the mental health literature, perception 
is discussed invariably as social perception, meaning that the 
conditions under which perception occurs or the object of per- 
ception, or both, involve other human beings. This has an 
implication for terminology. Even if it makes sense under 
different conditions to speak of perception as distinguish- 
able from other cognitive processes such as attention, judg- 
ment, and thinking, social perception cannot be so isolated. 
The term perception will here be used as implying various 
modes of cognition. 

Two aspects of reality perception are suggested as criteria 
for mental health : perception free from need-distortion, and 
empathy or social sensitivity. 

Perception Free from Need-distortion 

At first glance the stipulation that reality perception be 
correct in a mentally healthy person appears so self-evident — 



[ 50 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

perhaps as contrasted with the psychotic's loss of contact 
with reality — that many authors present the criterion in an 
almost axiomatic fashion. Indeed, it is often treated as the 
sine qua non for reality adaptation. John Porterfield defines 
mental health as "that state of mind in which the perception 
of the environment, if not objectively accurate, is approxi- 
mate enough to permit efficient interaction between the per- 
son and his milieu; . . ." (Ewalt, 1956). 

Jahoda (1950) introduces correct perception as a criterion 
also in close conjunction with adaption to reaUty: ". . . cor- 
rect perception of reality (including, of course, the self) may 
serve as another useful criterion of mental health. Unless 
active adjustment involving the modification of the environ- 
ment is to rely on hit-or-miss methods, it must be based on 
correct perception of the environment." Maslow (1954) ac- 
cepts the same position: "Recently Money-Kyrle, an English 
psychoanalyst, has indicated that he beHeves it possible to 
call a neurotic person not only relatively inefficient but ab- 
solutely inefficient, simply because he does not perceive the 
real world as accurately or as efficiently as does the healthy 
person. The neurotic is not only emotionally sick — he is cog- 
nitively wrong T 

Barron (1955), too, speaks of correct perception of reality 
as one of his criteria for mental health. 

Yet there is a major difficulty inherent in this apparently 
self-evident criterion of mental health: it lies in the word 
"correct." Particularly when the object of perception is social 
in nature — ^but even when it is physical stimuli — who is to say 
what is "correct".? If one perceives a landscape in terms of 
form, another perceives it in terms of color, and a third in 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 5^ ] 

terms of both these or of other facets, who is most "correct" ? 
Or, with regard to a social object, if a teacher sees in a child 
his limitations while another sees his potentialities, which 
one is "correct"? Correctness as a criterion seems to carry 
the implication that reality is static and limited and that 
there is only one way of looking at it. Yet seeing new hith- 
erto unnoticed things in the world around us which, while 
they remain new, may appear incorrect to others, is cer- 
tainly not mentally unhealthy in the opinion of the writers 
on the subject. 

The point at issue here is that "correctness" of perception 
cannot mean that there is one and only one right way of 
looking at the world around us. But whatever the individual, 
and perhaps peculiar, way of perceiving the world, there 
must be some objective cues to fit the resulting percept. This 
is what accuracy or correctness mean when one speaks of 
mentally healthy perception. 

To avoid the connotation that there is one correct way of 
seeing the world, the effort has been made to eliminate the 
word "correct" altogether from the mental health criterion 
and replace it by "relative freedom from need-distortion." 
The author uses this phrase in suggesting that mentally 
healthy perception means a process of viewing the world 
so that one is able to take in matters one wishes were dif- 
ferent, without distorting them to fit these wishes — that is, 
without inventing cues not actually existing (Jahoda, 1953). 
To perceive with relative freedom from need-distortion does 
not mean, of course, that needs and motives are eliminated; 
nor that they have no function in perception. The require- 
ment is of a different nature: the mentally healthy person 



[ 52 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

will test reality for its degree of correspondence to his wishes 
or fears. One lacking in mental health will assume such cor- 
respondence without testing. 

Parents, for example, ordinarily wish that their children 
will do well in school or fear that they may fail. A mentally 
healthy parent will seek objective evidence and accept it, even 
if it goes against his wishes. One lacking in mental health 
will not seek evidence, or will reject it if it is presented to 
him and it does not suit him. 

As a mental health criterion, perception free from need- 
distortion reveals itself in a person's concern for evidence to 
support what he sees and anticipates. 

Empathy or Social Sensitivity 

Perception free from need-distortion is, perhaps, most diffi- 
cult when the object of perception is a person — the self or 
others. The former has aheady been discussed as the correct- 
ness aspect of the self-concept. The latter, the perception of 
the feelings and attitudes of others, has been suggested as a 
separate criterion for positive mental health. 

The major requirement of the healthy person in this area 
is that he treat the inner life of other people as a matter 
worthy of his concern and attention. Implicitly, he is also 
expected to arrive at conclusions about others that are free 
from distortion. Foote and Cottrell (1955) make this one 
of the ingredients of interpersonal competence, a term they 
use synonymously with mental health. They say: "People 
appear to differ in their ability correctly to interpret the atti- 
tudes and intentions of others, in the accuracy with which 
they can perceive situations from others' standpoint, and 
thus anticipate and predict their behavior. This type of social 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 53 ] 

sensitivity rests on what we call the empathic responses." 
It is perhaps worth noting that this criterion, although 
appearing quite rarely in the mental health literature, has 
received a good deal of attention from research psycholo- 
gists. They have demonstrated by their errors and successes 
the enormous difficulties in discovering its presence or ab- 
sence. This is a point one suspects to be true for most of 
these criteria, but there is evidence for this instance. 

ENVIRONMENTAL MASTERY AS A CRITERION 
FOR MENTAL HEALTH 

Perhaps no other area of human functioning has more 
frequently been selected as a criterion for mental health 
than the individual's reality orientation and his efforts at 
mastering the environment. 

There are two central themes pervading the relevant 
literature: the theme of success and the theme of adaptation. 
As a rule, the former is specified as achievement in some 
significant areas of living; the latter is a toned-down version 
of the former, implying appropriate functioning with the 
emphasis more often on the process than on its result. 

In the mental health literature adaptation and environ- 
mental mastery are treated on different levels of specificity. 
Ordering these emphases roughly from most to least specific 
forms of human functioning, these aspects can be distin- 
guished: (i) the ability to love; (2) adequacy in love, work 
and play; (3) adequacy in interpersonal relations; (4) effi- 
ciency in meeting situational requirements; (5) capacity for 
adaptation and adjustment; (6) efficiency in problem- 
solving. 



[ 54 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

The Ability to Love 

In at least one instance the ability to love is entertained 
as a criterion for mental health in the most narrow sense 
of the word — as the ability to experience sexual pleasure. 
Hacker (1945) says: "The biological concept as formulated 
by Reich appears to be by far the most logical because it is 
a medical concept of normality, derived from a theory 
gained by the study of mental diseases. It states that the 
attainment of full orgastic genital gratification is the only 
yardstick of normality for the individual. This does not 
necessarily imply that the sexual function is the most im- 
portant one for man, though it recognizes sexuaHty as an 
extremely sensitive indicator of the personality functioning 
as a whole. The difficulty is to define what is meant by full 
orgastic pleasure in every instance." 

It may not be amiss to point out that orgastic pleasure 
appears to be within the range of experiences open to the 
rapist and other sex criminals who, by such a criterion, would 
have to be regarded as mentally healthy. 

But Hacker's paper, devoted to an eflfort to deal with the 
difficulty of defining what is actually meant by full orgastic 
pleasure, goes beyond it. Although he regards sexuahty as 
the most sensitive criterion of health, he arrives at the con- 
clusion that "the extent and form of integration in the total 
personality is the criterion ; not whether one particular trend 
accords with current social views on' sexual morality, or 
religious teachings. Full integration of the personality, the 
form and scope of which varies, according to the individual's 
possibilities, becomes the yardstick of normality." 

Erikson's formulation with its emphasis on sexual gratifica- 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 55 ] 

tion experienced with a loved partner of the opposite sex 
clearly meets the possible objection to a narrow view of 
sexuality as a criterion of mental health (1950). He regards 
sexual gratification as a sequel to the previously mentioned 
stages in the normal psychic development: "Psychiatry, in 
recent years, has emphasized genitality as one of the chief 
signs of a healthy personality. Genitality is the potential 
capacity to develop orgastic potency in relation to a loved 
partner of the opposite sex. Orgastic potency here means not 
the discharge of sex products in the sense of Kinsey's 'out- 
lets' but heterosexual mutuality, with full genital sensitivity 
and with an over-all discharge of tension from the whole 
body . . . the idea clearly is that the experience of the 
climactic mutuaHty of orgasm provides a supreme example 
of the mutual regulation of complicated patterns and in some 
way appeases the potential rages caused by the daily evidence 
of the oppositeness of male and female, of fact and fancy, of 
love and hate, of work and play. Satisfactory sex relations 
make sex less obsessive and sadistic control superfluous." 

Adequacy in Love, Wor\, and Play 

Another group of authors regard environmental mastery 
as manifested in success in three crucial areas of Hving: love, 
work, and play. Ginsburg (1955) puts forward this proposi- 
tion in the most direct manner: "My coworkers and I have 
settled for some such simple criteria as these: the abiHty to 
hold a job, have a family, keep out of trouble with the law, 
and enjoy the usual opportunities for pleasure." 

Much of Alfred Adler's Individualpsychologie w^as based 
on the same notion. It is in keeping with the obvious im- 
portance of these areas of life that successful behavior in 



[ 56 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

this respect enters into the mental health concept of quite 
diverse schools of thought. Mayman (1955) speaks of men- 
tally healthy attitudes as contributing "to the formation of 
self-fulfilling patterns of love, v^ork and play/' and Blau 
(1954) describes the healthy individual as one v^ho "is able 
to work adequately and to create v^ithin the Umitations of 
his capacities, to relax after v^ork and enjoy recreation. He 
can carry on his essential biologic functions of sleeping, eat- 
ing, excreting, and so on, v^ithout any sense of disturbance or 
discomfort." 

Adequacy in Interpersonal Relations 

On a less specific level, a general competence in inter- 
personal relations is suggested as a criterion for mental 
health. Based on the theoretical and empirical ^oik of 
Sullivan, Horney, and other neo-Freudians, the relationship 
to others is singled out as a criterion. Sullivan assumes that 
the major human goal is security resulting from satisfactory 
interpersonal relations. Foote and Cottrell (1955) build their 
concept of interpersonal competence largely on Sullivanian 
premises. They consider that "competence in interpersonal 
relations is a means by vi^hich members of the family are 
able to interact effectively in achieving their common ends 
and their individual self-expression and development." 

A sHghtly different aspect of interpersonal relations as a 
criterion for mental health is among the eight items making 
up the World Health Organization's concept (Washington 
State Conference, 1951). There the statement is made that 
"the healthy person has the ability to be reasonably aggres- 
sive when the occasion demands. But he is free from any 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 57 ] 

inner necessity to dominate other people, to lord it over 
them, or push them around." 

Much in line with this notion are the views of the British 
psychiatrist H. V. Dicks, who regards "failure in human 
relationships" as the major reason for poor mental health, 
and "secure, affectionate and satisfying human relationships, 
. . . love and the elimination of hate . . ." as criteria for 
positive mental health (Ginsburg, 1955). 

Following Erich Fromm (1941, 1947, 1955), a number of 
authors see the crux of the current mental health problem 
in man's alienation from nature, from himself, and from 
his fellow men. Mental health efforts must in their opinion 
be partly directed toward improving interpersonal relations. 
Rollo May (1954), for example, in his diagnosis of aHena- 
tion in the modern world, describes it as a "characteristic 
of modern people in emotional difficulties . . . that they 
have become alienated from their fellow men. They have 
lost the experience of community . . . people really are 
afraid of one another. . . ." 

Implicit in this statement of disturbance is the assump- 
tion that positive mental health consists in absence of aliena- 
tion from others. But May does not spell out the positive 
aspect of interpersonal relations as a criterion of health. 
However, Dorothy C. Conrad (1952) gives an exphcit state- 
ment of these positive aspects, after she has dealt with nega- 
tive formulations. She stipulates among other aspects the 
following manifestations in the area of interpersonal rela- 
tions. An individual shows positive mental health to the 
extent that he : 

"Has positive a-ffective relationship: The person who is 



[ 58 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

able to relate affectively to even one person demonstrates 
that he is potentially able to relate to other persons and to 
society. ... 

"Promotes another's v^^elfare: Affective relationships make 
it possible for the person to enlarge his v^orld and to act for 
the benefit of another, even though that person may profit 
only remotely. . . . 

"Works v^ith another for mutual benefit: The person is 
largely formed through social interaction. Perhaps he is most 
completely a person when he participates in a mutually 
beneficial relationship. . . ." 

Meeting of Situational Requirements 

One of the difficulties in arriving at criteria for mental 
health comes from the impact of the situation on behavior. 
As has aheady been pointed out, to speak of situations as 
healthy means stretching the meaning of the concept beyond 
permissible Hmits. Health refers to a Hving organism. The 
problem is particularly acute in the area of environmental 
mastery. Efforts at mastery will take widely differing con- 
crete forms if we look at a child at home or in the school- 
room. 

To do justice to these differences while adhering as closely 
as possible to concrete forms of behavior, a number of per- 
sons suggest that positive mental health is manifested in the 
individual's manner of meeting the requirements of a situa- 
tion. These requirements have to be specially assessed for 
every situation in which mental health is to be judged. Fill- 
more H. Sanford (1956) does this, for example, with the 
school situation. He distinguishes three situational require- 
ments: to estabUsh appropriate relations with authority 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ 59 ] 

(teacher), with peers, and to acquire knowledge and skills. 
A child is mentally healthy to the degree that he func- 
tions effectively with regard to these three basic require- 
ments of the schoolroom situation. 

Other writers, too, speak of the efficiency demonstrated in 
meeting the requirements of a situation as a criterion of 
health without, however, specifying these requirements in 
detail. Julius Wishner (1955), for example, proposes that 
"psychological health and psychopathology be conceived as a 
continuum and defined in terms of the eflEciency with which 
environmental requirements are met. For the present, how- 
ever, this definition can be useful only in a relatively narrow 
laboratory situation because of the difficulties involved in 
the specification of objective requirements in the social 
sphere." 

There is a troublesome implication in regarding efficiency 
in meeting situatonal requirements as a sign of health even 
when the requirements are specified, let alone when they 
are not. Some situational requirements, if met, can call for 
behavior that must be deemed unhealthy when viewed in 
terms of some other criteria. Severe deprivations, a harsh 
and demanding teacher, a prison, and the like, all may re- 
quire behavior precluding self-actuaHzation, autonomy, or 
perception free from need distortion. The impHcations 
pointed up by these examples are that the criterion be appHed 
only when there is some consensus on the reasonableness 
of the requirement. 

Adaptation and Adjustment 

Those who discuss environmental mastery from the point 
of view of meeting situational requirements are either care- 



[ 6o ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

ful to spell out generally acceptable requirements or are in 
danger of assuming the invariable reasonableness of such 
requirements. Adaptation, v^ith its connotation of modifying 
environmental factors, is not bound by a similar assumption. 
Here, there is no need to regard hard reality as unchange- 
able and only the individual as modifiable. Adaptation im- 
plies that a workable arrangement between reality and in- 
dividual can be achieved by modifications of either or both 
through individual initiative. 

From the psychoanalytic point of view, Hartmann (1939) 
has made the process of adaptation the focus of his discussion 
of mental health. He says; "Where many of the conceptions 
of health and illness . . . stand most in need of amplifica- 
tion [is] in the direction of the subject's relations with and 
adaptation to reality. . . . What we designate as health or 
illness is intimately bound up with the individual's adapta- 
tion to reality . . . with his sense of self-preservation." 

Hartmann unfortunately does not discuss concretely the 
course adaptation might take. He does suggest, however, 
that "we often learn to find our bearings in relation to 
reality by devious ways. . . . There is evidently a typical se- 
quence here, withdrawal from reality leading to an increased 
mastery over it. . . ." The article does not distinguish such 
healthy withdrawal from that of the mentally ill. Whether 
there is a fundamental difference, and, if so, what, is a ques- 
tion for research. 

It is, perhaps, not an overinterpretation of his position to 
say that withdrawal from reality is one way of modifying it. 
That adaptation to reality is conceived by him as an active 
effort by the individual to choose or create an environment 
most suitable to his psychic conditions becomes clear when 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ ^^ ] 

he uses pioneers and adventurers as an example: "The adven- 
turer-explorer, the pioneer settler, and the man on the fron- 
tier are extreme but good examples of men maladjusted to 
their homeland v^^ho went out to find a new environment to 
which they could adjust." 

The fact that this particular modification of the environ- 
ment can legitimately be regarded as defensive has, accord- 
ing to Hartmann, nothing to do with its classification as 
healthy: "Nor does the distinction between healthy and 
pathological reactions correspond to that between behavior 
originating or not originating in defense. . . ." 

It is true that the word adaptation is often used in mental 
health discussions synonymously with meeting environ- 
mental requirements. Hunt, for example, does so (Washing- 
ton State Conference, 1951). He defines adaptive efficiency 
as the efifective carrying on of the roles and tasks before an 
individual. The task before us, however, is not to settle dif- 
ferences in linguistic usage, but rather to draw attention to 
psychologically meaningful aspects in the mental health 
discussion. One such aspect is the idea that a healthy person 
can change his inner balance of psychic forces as well as 
the external world. This idea is conveyed by the term adap- 
tation. 

The idea is inherent in Freud's statements about the ego 
as an active agent: "[A normal or healthy ego] denies reality 
as little as neurosis, but then, like a psychosis, is concerned 
with effecting a change in it. This expedient normal attitude 
leads naturally to some active achievement in the outer 
world and is not content, Hke a psychosis, with estabUshing 
the alteration within itself; it is no longer auto-plastic but 
olio-plastic," Isidor Chein (1944) fully discusses the idea. 



[ 62 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

The term "adjustment" is actually used more frequently 
than adaptation, particularly in the popular mental health 
literature, but often in an ambiguous manner that leaves to 
anyone's whim v^hether it should be understood as passive 
acceptance of whatever life brings — that is, as meeting situa- 
tional requirements indiscriminatingly — or as a synonym 
for adaptation. It might be noted that Jean Piaget's (1952) 
concept of adaptation is actually a synthesis or proper bal- 
ance of the active and the passive component in man's ar- 
rangements with the environment. He calls the active com- 
ponent "assimilation," which means that the environment 
is made to provide the satisfactions one wants. The passive 
component is labeled "accommodation," implying that one 
learns to like whatever the environment has to offer. 

Problem-Solving 

One is again faced with two connotations of another term 
frequently used in the mental health literature: problem- 
solving. Some authors talk about problem-solving with 
emphasis on its end-product — namely, the finding of a solu- 
tion. If such a criterion is applied to realistic life problems, 
it easily leads to the idea that success is the hallmark of 
mental health. In this sense, problem-solving meets the type 
of objection that earlier led us to exclude various states of 
well-being from further consideration. 

Success is certainly a function not only of the individual's 
behavior but also of circumstances outside his control. To 
regard successful problem-solving as a criterion for mental 
health introduces an ambiguity in meaning, since success 
cannot be regarded either as an attribute of a person or as an 
attribute of his actions. Be that as it may, it may still be cor- 



PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA [ ^3 ] 

rect — and should be verified by research — that in our society 
people v^ho are mentally healthy are more Hkely to be suc- 
cessful than those v^ho are not. 

The other meaning emphasizes the process of problem- 
solving rather than its end-product. In this sense, a case 
could actually be made that problem-solving is in many w^ays 
similar to adaptation or active adjustment. There are, how- 
ever, differences in the usage of these terms v^hich help to 
differentiate them from each other. Adaptation, normally a 
long drav^n-out process, is one in v^hich the individual can 
be engaged without being clearly aware of its occurrence, 
let alone its beginning or end. On the other hand, problem- 
solving can occur over both long and short time periods 
and is used in the mental health literature as presupposing 
a conscious awareness of a problem and an initial intention 
to deal with this problem. These differences seem sufficiently 
relevant to regard problem-solving as a criterion in its own 
right. 

Whereas some persons make the assumption that the very 
fact that one is wrestling with a problem is a sufficient indi- 
cation of mental health, others specify particular modes of 
problem-solving as criteria. The author's effort (Jahoda, 
1953) distinguishes three dimensions of the process: 

First, there is the time sequence of certain stages : awareness 
of the problem, followed by a consideration of means toward 
its solution, a decision for one or the other of the considered 
means, and finally the implementation of the decision. This 
sequence corresponds closely to several formal descriptions 
of the thinking process (Duncker, 1945). It is understood, 
of course, that in the course of problem-solving the sequence 
is usually less neat, with earlier stages being resumed in the 



[ 64 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

light of subsequent ones, and often with all of them simul- 
taneously in the mind of the problem-solver. 

The second dimension is the f eeUng tone that accompanies 
the various stages. It is assumed that some discontent must be 
maintained in the earHer stages or, at least, that there must 
be an abihty to delay gratification. These feehngs serve as 
an incentive for proceeding to the following stages. Suppose 
a man experiences his current work situation as a problem. 
He intends to change it. But, as he faces the various possible 
ways of doing this, without proceeding to select one or the 
other, his intention dies out. He gets used to his situation. 
The likelihood is that he will not proceed to further stages 
of problem-solving. On the other hand, if he continues to 
maintain his intention and the appropriate feeling tone, he 
may follow such a mentally healthy mode as finding more 
suitable work. Here the appropriate feeling tone will be posi- 
tive. 

The third dimension of the process concerns the directness 
or indirectness with which a person approaches the root of 
the annoying experience. If he perceives his work as un- 
satisfactory a direct approach would lead to the considera- 
tion of other work; an indirect approach would consist, for 
example, of seeking substitute satisfactions in leisure-time 
activities. 

The author suggests that a maximal degree of healthy 
problem-solving combines the three dimensions: a tendency 
to go through all stages, the maintenance of an appropriate 
feeUng tone, and a direct attack on the problem. Going 
through this process, rather than finding a successful resolu- 
tion, is taken as the indication for mental health. 



IV 



An Sjjort at Fwrtker Qanjication 



Ihe preceding survey of positive mental health concepts is 
encouraging in more than one v^ay. The number of ideas is 
relatively Hmited; they can be reasonably v^ell grouped un- 
der a few headings. In spite of diversified theoretical posi- 
tions taken by the authors in the field, one gains the impres- 
sion that there is among many of them a large overlap in 
meaning and intent v^hen they talk about mental health ; cer- 
tainly, there are few, if any, contradictions between the various 
proposals. A case could even be made that several of them 
tap identical concepts on different levels of concreteness. 

But, notwithstanding such encouraging features, the sur- 
vey of the literature does not resolve the complex problem of 
clarifying the psychological meaning of positive mental 
health. Indeed, the review makes it quite clear that the least 
fruitful approach to the subject consists in assuming that 
anyone has the answer to the problem. We shall have to be 
content with recognizing that there are many tentative an- 
swers or approaches available and that none of them is as 
yet based on so solid a body of knowledge and facts that it 
can definitely be singled out as the most promising approach. 

To say that there is as yet no entirely satisfactory approach 

[65] 



[66] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

available in the conceptualization of mental health is one 
thing. To conclude from this state of affairs that all further 
clarification has to await the results of empirical research is 
quite another matter. To be sure, empirical research is ur- 
gently required. Its success, however, will to no small degree 
depend on further clarification of some general ideas in the 
mental health field. Some of them will be discussed. 

DIFFERENT TYPES OF MENTAL HEALTH 

Since one obviously faces considerable difficulty in estab- 
Hshing systematic relations in the psychological content of 
ideas often expressed in poetic, rather than scientific, terms, 
the question arises whether there is not some merit in the 
diversity of concepts. 

Perhaps the most cogent argument for accepting a variety 
of ideas about the nature of mental health is the recognition 
(Hartmann, 195 1) that "theoretical standards of health are 
usually too narrow insofar as they underestimate the great 
diversity of types which in practice pass as healthy . . !' 
[italics supplied]. If there are different types of health, is 
it not possible that at least some of the concepts discussed 
refer to such different types, and that they therefore need 
not, or should not, be brought to a common denominator.'^ 

Robert White (1952) illustrates the variety of points of 
views from which a person can be regarded as healthy. He 
bases his discussion of mental health and related concepts 
on the empirical study of "normal" people, meaning persons 
who have never needed professional psychological help to 
deal with the problems of living. 

One of the persons studied, "Hartley Hale," was a physi- 



AN EFFORT AT FURTHER CLARIFICATION [ ^ ] 

cian and scientist of great ambition. He achieved mightily. 
He was devoted to his v^ork, successful and well-respected 
in the profession. On the other hand, as a husband and 
father Hartley Hale was less successful. Whenever work and 
family life conflicted, he decided in favor of work. In which 
area of life should one appraise his mental health? White 
points out that different interpretations emerge when one 
makes some, rather than other, aspects of Hale's life salient. 
If one assessed Hale in terms of certain aspects of self- 
actuahzation, he might be given a clean bill of health; if one 
assessed him by his abiHty to "love, work, and play" he 
would be judged lacking in mental health. 

It could be argued that this is as it should be. And the 
argument can be bolstered by an analogy with physical 
health and physical illness. Apparently there, too, no single 
concept has as yet been proposed. The medical profession is 
content to operate with a variety of dimensions of physical 
health whose relations to each other remain so far unknown. 

The dimension of resistance to disease, for example, is 
relevant to epidemiologists; it has no known relation to the 
dimension of physical strength, a relevant health considera- 
tion among athletes and their medical advisors. Longevity, 
yet another dimension of interest to medical science, may or 
may not vary with the former. It is in this sense that William 
Alanson White (1926) speaks of health as a relative notion: 
"Disease and health are relative terms: in order to under- 
stand the nature of health and disease we must decide on 
just how we are to approach the study of the human or- 
ganism. . . ." 

Neither is physical disease a unitary concept. As knowledge 
advances, concepts which first appeared unitary are revealed 



[ 68 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

as comprising a variety of discrete notions; in a discussion 
of delinquency, Merton (1957) makes this general point: 
"This is not too remote, in logical structure, from the as- 
sumption of a Benjamin Rush or a John Brown that there 
must be a theory of disease, rather than distinct theories of 
disease — of tuberculosis and arthritis, of Meniere's syndrome 
and syphilis. Just as classifying enormously varied conditions 
and processes under the one heading of disease led some 
zealous medical systematists to beHeve that it was their 
task to evolve a single over-arching theory of disease, so, it 
seems, the estabhshed idiom, both vernacular and scientific, 
of referring to 'juvenile deliquency' as though it were a 
single entity, leads some to believe that there must be a basic 
theory of 'its' causation. Perhaps this is enough to suggest 
what is meant by referring to crime or juvenile delinquency 
as a blanket-concept which may get in the way of theoretical 
formulations of the problem." 

If one replaces in the above paragraph the word "delin- 
quency" with the words "mental health," the appropriate- 
ness of Merton's statement is evident. Yet science does not 
stop at this point. Having dissolved an oversimplifying syn- 
thesis into independent aspects, a new and more systematic 
synthesis becomes possible. There is not one theory of disease. 
But medical research makes it possible to develop a theory 
for illnesses created by germs, for example. In the field of 
mental health, some beHeve that the dissolution of the 
"blanket concept" is the next strategic step. 

To follow this strategy may bring an additional advan- 
tage. The idea has been expressed in discussions of mental 
health that people vary so much in terms of their native 
equipment that it is unreasonable to assume they could all be 



AN EFFORT AT FURTHER CLARIFICATION [ ^9 ] 

measured by the same yardstick. The genius and the moron 
as well as the average man may have their special types of 
mental health. There may be sex differences in this respect, 
even though industrialized society tends to even out some 
differences in the functioning of men and women. 

But, ultimately, the adoption of different criteria of 
mental health for groups with different constitutional en- 
dowment is a question of how one wishes to look at such 
groups. For, as Kluckhohn and Murray (1948) have pointed 
out, every man is in some respects like no other man, in 
some respects like some other men, and in some respects 
like all other men. Those who speak of different types of 
health obviously prefer the middle position. 

One way, then, of dealing with the relationship between 
the various concepts is to assert their possible independence 
from each other. They may designate various types of posi- 
tive mental health. An individual may manifest mental 
health according to one concept but not according to an- 
other. A gangster may be judged healthy as far as his self- 
image is concerned; unhealthy with regard to meeting the 
requirements of a situation. Or, for that matter, WiUiam 
Blake, the mystical poet and painter, may score high in 
terms of aspects of self-actualization, low in terms of per- 
ception free from need-distortion. 

The idea that there are several different types of health 
is not imiver sally accepted in the field. To be sure, most 
writers clearly recognize that what they regard as the es- 
sence of positive mental health is compatible with a wide 
range of behavior and styles of life. They do not assume 
that one healthy person will resemble the next as one egg the 
other. But they regard such different manifestations as com- 



[ 70 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

patible with one concept of mental health rather than as 
requiring the assumption of diverse concepts. 

If one accepts, however, the idea that there are various 
types of mental health, concepts in any one or all six areas 
may be worked with, and their relation to each other be- 
comes a matter for empirical research, much as the relation 
between athletic strength and longevity is an empirical prob- 
lem. But it will still be necessary to heed WilHam White's re- 
quest for deciding on just how to approach a study of mental 
health. There may be some who find it easy to select one 
of the many ideas which have been presented for practical 
application or research work. Others will hesitate to choose 
without further thought about what it is they are deciding 
for; with them, we turn to the next approach toward clarifi- 
cation. 

THE MULTIPLE CRITERION APPROACH 

When judging such a case as that of Hartley Hale, those 
who come to the conclusion that he is lacking in mental 
health are not necessarily bHnd to the positive aspects in his 
functioning. They may credit him with self-actualization, 
for example, but they regard this only as one element in 
mental health. He would be called a mentally healthy person 
only if he combined with self-actuaHzation other healthy 
aspects, such as appropriate concern for interpersonal rela- 
tions. In other words, they use a multiple criterion. 

The relation of various components to each other in a 
multiple criterion can be understood in a variety of ways. 
Some authors regard a multiple criterion as composed of the 
various ways in which the underlying quaUty of mental 



AN EFFORT AT FURTHER CLARIFICATION [ 7^ ] 

health can manifest itself. Of this type, Maslow's idea of 
self-actualization is the outstanding example. A self-actual- 
izing person not only is motivated to strive for always higher 
goals but also has an adequate self-image, is autonomous, 
creative, and spontaneous, has a reality-oriented perception of 
the world, enjoys love, work, and play, and has a well- 
developed individualistic ethic. In this sense, the multiple 
criterion approach is similar to the notion of a syndrome — 
as used in medicine, for example, when one speaks about the 
TB syndrome. 

Another type of multiple criterion is presented, for ex- 
ample, in Erikson's developmental approach. It will be re- 
called that the various components of mental health that he 
specifies are each acquired in a definite stage of a person's 
development. 

Allport's multiple criterion approach is of yet another 
kind. He combines various psychological functions jointly 
producing specified consequences: self -extension, and self- 
objectification, synthesized by a unifying philosophy of Hfe, 
are necessary so that maturity can result. 

A fourth type of multiple criterion does not assume a 
unitary cause or temporal lawful sequence but is empirically 
constituted. It is a cluster of related characteristics. Mayman, 
for example, assumes four components of mental health : the 
self-determining attitude, the heterogenic attitude, the allo- 
plastic attitude and investment in living. The author, also a 
proponent of the multiple criterion approach — proposing 
active adjustment (environmental mastery), integration, and 
perception as jointly constituting mental health — suggests a 
different way in which these criteria may relate to each 
other: "It is easy to imagine social conditions which favor 



[ 72 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

one or two but exclude others. Heroic efforts in fighting for 
a lost cause, for example, obviously exclude correct percep- 
tion which, in self-defense, is replaced by illusions. Under 
conditions of unemployment active adjustment may be im- 
possible. . . . Under the conditions of a polysegmented so- 
ciety with many incompatible values and norms, the unity 
of personality may be abandoned for the sake of opportun- 
istic adjustment in terms of correct perception" (Jahoda, 

1950). 

According to this view, perception relatively free from 
need-distortion can be increased to the Hmit only at the ex- 
pense of active adjustment. This multiple criterion approach 
to the concept of mental health would thus draw attention 
to the psychological price people may have to pay for de- 
veloping one component at the expense of another under 
unfavorable environmental circumstances. In theory, of 
course, this quid pro quo idea of psychological functioning 
could also be ascertained if a variety of types of mental health 
were established and their antecedents and consequences in- 
vestigated singly and jointly. In practice, however, such re- 
search might well be neglected unless the concept of health 
was so formulated as to make the question mandatory. 

This idea has been elaborated by Smith (1950), who in- 
troduces the notion of optimum mental health, in contrast 
to other assumptions that every component of a mental 
health pattern could and should be maximized, whatever the 
psychological or situational context. Actually, he implies that 
the multiple criterion approach which uses components that 
can vary inversely with each other is based on an underlying 
unitary function which is available in a given quantity. If too 
much of the available energy goes into active adjustment, 



AN EFFORT AT FURTHER CLARIFICATION [ 73 ] 

not enough is left for perception of reality. What the opti- 
mum combinations of components are under any given set of 
conditions he regards as a question for empirical research. 

As one reviews these various ways of using a multiple 
criterion, it becomes clear that there is, of course, no incom- 
patibility between the idea of diverse types of health and the 
use of such a criterion. Each specified type could be assessed 
by a combination of indicators. At the present state of our 
knowledge it may well be best to combine the idea of various 
types of health with the use of a multiple criterion for each. 
The former will prevent over generalizations; the latter will 
permit us to do justice to the complexity of human func- 
tioning. 

MENTAL HEALTH AND MENTAL DISEASE 

Early in this report, we committed ourselves to the idea 
that the absence of mental disease is not a sufficient criterion 
of mental health. The major argument presented at that time 
was that no satisfactory concept of mental disease exists as 
yet and that little would be gained by defining one vague 
concept in terms of the absence of another which is not 
much more precise. To reject this type of definition mainly 
on practical grounds disguises an issue of importance: the 
question of the relationship between health and disease. A 
few remarks on this subject are in order. 

The traditional view that health is the absence of disease 
has recently been opposed by the idea that mental health 
and mental disease are qualitatively different. The point is 
most strongly made by Rumke (1955), who disagrees with 
the notion that "there exists between health and sickness an 



[ 74 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

almost imperceptible progressive transition. . . ." In his 
opinion, "The understanding of the disturbances of the sic\ 
man hardly contributes to the understanding of the normal 
man." This formulation seems to deny ho^ much general 
psychology owes to the study of the mentally sick as well as 
the possibility that increased knowledge of mental health 
may one day significantly contribute to the understanding of 
mental disease. 

Yet, the idea that mental health and mental disease are 
qualitatively different seems to gain currency with many 
professional persons. It appeals to those who are puzzled by 
the existing evidence that similar pathogenic events lead to 
mental disease in one case but not in another; to those who 
are convinced of the organic nature of mental disease; and to 
those who are aware of similarities in experiences and de- 
fense mechanisms between persons who feel in need of treat- 
ment and persons who do not. Assuming that health is 
quahtatively different from disease, the extreme pole of sick- 
ness would be absence of disease; of health, absence of health. 
Such a view enables one to conceive of patients with healthy 
features, nonpatients with sick features. 

Conrad (1952), for example, finds it useful to distinguish 
positive health from nonhealth as well as from negative 
health: "Positive health consists in ways of Hving that are 
beyond the frontiers of mere social existence implied by 
negative health. . . . This category (positive health) applies 
when there is evidence that the individual fully utilizes a 
capacity or is working in that direction." By negative health 
she means not pathology but some form of vegetating, with- 
out either positive health or disease. 

To think of mental health and mental disease as two in- 



AN EFFORT AT FURTHER CLARIFICATION [ 75 ] 

dependent but contrasting conditions means to treat them as 
ideal types (in Max Weber's sense). As with every other 
typological classification, pure types do not exist. Every hu- 
man being has simultaneously healthy and sick aspects, with 
one or the other predominating. The advantage of having 
established the pure types, and of conceiving of them as 
quaUtatively different, consists in drawing attention to the 
health potential in patients and the sickness potential in 
healthy persons. Mayman, for example, has found this useful 
(1955). In his clinical experience, he has apparently en- 
countered each of the four health components developed to 
some degree in various patients and has been able to use these 
health components as a lever in his therapeutic efforts. 

It appears, then, that the definition of health as the absence 
of disease can be rejected on other than just pragmatic 
grounds. 

What are the implications of this conclusion for the use of 
mental health criteria when dealing with the diverse dis- 
turbances which we call mental disease ? In principle, at least, 
all the criteria are applicable to everyone, mental patient or 
not. Those who are professionally qualified to deal with 
patients are understandably more sensitive to the manifesta- 
tions of disease than to those of health. It will take special 
efforts to introduce concern with health into clinical work 
with the sick. But such efforts may well be worth while. 

The issue of the relation of mental health and mental 
disease is still exceedingly complex. Take, for example, the 
notorious judgment once made in a criminal case which held 
that "apart from an unshakable belief that he is the Messiah, 
the accused is perfectly normal." The statement offends com- 
mon sense, inasmuch as this unshakeable belief appears to be 



[y6] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

a crucial disturbance in the man. But does it actually say 
anything but that there are sick features in an otherwise 
healthy person ? 

Or take the artistic production of mental patients. Some of 
Van Gogh's greatest pictures were painted while he was 
sick. Some of Hoelderlin's or Ezra Pound's greatest poems 
were created in an asylum. Some of Bruckner's greatest 
symphonies were produced while he felt under the desperate 
compulsion to count the leaves on the trees of Vienna's parks. 
Do such examples support the popular notion that you have 
to be crazy to be an artist or the equally widespread assump- 
tion that psychotherapy will eliminate extraordinary talent ? 
Or can it be interpreted as an indication of a strong health 
potential among these artists who, in a different aspect of 
their personality, were also disturbed? Did they actually 
produce when in the full grip of a terrible disease or in the 
intermissions between attacks ? 

These and many other questions cannot yet be answered. 
The relation of mental health to mental disease remains one 
of the most urgent areas for future research. 

THE VALUE DILEMMA 

Throughout the preceding discussion we have attempted 
as far as possible to ignore one major problem, the problem 
of values. The postponement was deliberate. Hopefully, the 
discussion of values will profit from having first dealt with 
ideas of mental health in other contexts. 

Actually, the discussion of the psychological meaning of 
various criteria could proceed without concern for value 
premises. Only as one calls these psychological phenomena 



AN EFFORT AT FURTHER CLARIFICATION [ 77 ] 

"mental health" does the problem of values arise in full force. 
By this label, one asserts that these psychological attributes 
are "good." And, inevitably, the question is raised : Good for 
w^hat? Good in terms of middle class ethics? Good for de- 
mocracy ? For the continuation of the social status quo? For 
the individual's happiness? For mankind? For survival? 
For the development of the species ? For art and creativity ? 
For the encouragement of genius or of mediocrity and con- 
formity ? The list could be continued. 

Different persons will prefer different values and the 
criteria discussed here have differing relations to these values. 
A prima facie case could be made, for example, that meet- 
ing the requirements of the situation is more closely related 
to the maintenance of the status quo or to conformity than 
to creativity; or that the criterion of adaptation may automat- 
ically discriminate in favor of the economically secure w^ho 
are in a better position to modify their environment than 
are those v^ho live in less privileged circumstances. 

The selection of criteria in terms of their relation to the 
high values of our civilization — or, for that matter, any other 
— seems so difficult that one is almost tempted to claim the 
privilege of ignorance. While it is easy to speculate about the 
relation of each criterion to a vast number of high values, 
v^e do not know whether such relations actually obtain. Does 
self-actualization really benefit the development of the 
species, as Fromm would claim? Is interpersonal com- 
petence a prerequisite for the happiness of the individual? 
Is happiness or productivity the value underlying an active 
orientation to problem-solving? Is altruism necessarily re- 
lated to empathy ? 

Or, to put the difficulty of extricating the values under- 



[ 78 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

lying the selection of various psychological phenomena as 
criteria for mental health into a different perspective: How 
culture- or social class-bound is the value orientation of those 
v^ho have suggested the criteria ? Would people living in an 
Oriental civilization have considered contemplation and de- 
tachment as suitable criteria ? Would the mental health label 
be more appropriately attached to self-assertive aggressive- 
ness, to fit dominant values in the v^orking class in Western 
civilizations ? 

Not only are the ansv^ers to these questions unknov^n; 
w^hat is w^orse, there is no logically tight method of thought 
or analysis available through v^hich the value impHcations of 
the various health ideas could be teased out v^ith some degree 
of confidence. 

There are tv^o considerations, hov^ever, that help to reduce 
the value dilemma to one of somev^hat more manageable 
size. First, we suggest that mental health is one goal among 
many; it is not the incarnation of the ultimate good. Sec- 
ond, the search for the values underlying mental health 
need not involve one in the megalomaniacal task of blue- 
printing the values for the distant future, or for all civiUza- 
tions. 

The discussion of mental health often makes, implicitly 
or expHcitly, the assumption that a mentally healthy person 
is one who is "good" in terms of all desirable values. This 
assumption is, curiously enough, shared by proponents as 
well as opponents of the mental health movement. 

People who are devoted to mental health work, often with 
an enthusiasm akin to religious fervor, see in it a panacea for 
all evil and all social problems or for the wholesale improve- 
ment of mankind. 



AN EFFORT AT FURTHER CLARIFICATION [ 79 ] 

The Opposition against the mental health movement simi- 
larly assumes that mental health is suggested as the ultimate 
good. Humanists often oppose the movement because they 
fear that it will lead to a neglect of other high values. They 
ridicule mental health standards as incompatible with the 
appreciation of greatness, unique achievements, or the depth 
of human experience. 

The assumption that mental health be compatible with all 
high values is actually not necessary. Human beings can 
never serve all the highest values simultaneously. To deny 
conflicts of values by setting up such global standards for 
mental health leads to a denial of the condition of being 
human. Only hypocrites or the inexperienced can assert that 
the choices in life are always between "the good" and "the 
bad." So simple an alternative is rarely posed. Conflict occurs 
in every life, and most frequently it is about alternatives 
good in themselves but incompatible with one another. 

There are, then, other good things in life, apart from 
mental health. It is perfectly possible and plausible in these 
terms to maintain one's high admiration for William Blake, 
for example, and to regard him as not mentally healthy in 
terms of, say, reality perception. It is also possible for a 
teacher to specify as his goal that students acquire knowl- 
edge and to evaluate them in these terms even if the most 
brilliant student shows Httle self -awareness. Similarly, as we 
have seen in the case of Hartley Hale, it is possible to be an 
outstanding and devoted scientist without meeting the crite- 
rion of adequacy in love, play, and work or perhaps even of 
a balance of psychic forces. To consider such a person as 
lacking in mental health means neither condemning him to 
a mental hospital nor establishing his moral inferiority. 



[ 8o ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

If this position is granted^ all that is required from those 
working in the mental health field is to make expHcit the 
values v^hich induce them to select certain criteria, w^ithout 
aiming for the moon. 

By W2Ly of an example, one value strikes us as being com- 
patible v^ith almost all of the mental health concepts dis- 
cussed here: an individual should be able to stand on his 
ow^n feet v^ithout making undue demands or impositions on 
others. Some such value underlies most clearly Ginsburg's 
idea that mental health consists of being able to hold a job, 
have a family, keep out of trouble v^ith the law, and enjoy 
the usual opportunities for pleasure. Although this modest 
value is not as clearly implied in other concepts of mental 
health, it seems compatible with them. It appears relevant to 
different social classes, but whether it is meaningful out- 
side the orbit of Western civihzation is a moot question. 

Others may feel that this value is not compatible with their 
notion of mental health, or that it is of too low an order; it 
is offered here only as an example — extricated from the Htera- 
ture intuitively rather than systematically. 

Such a modest value premise takes the grandeur (and also 
the horror) out of the value preoccupation of the many 
mental health discussions that attempt to specify now the 
values by which the next generation shall live. Not that this 
task is unimportant or can be ignored. After all, whatever it 
is that a current generation does, it will inevitably affect 
what the next generation will regard as good. The experts in 
the mental health field have no special right to usurp this 
weighty decision. Politicians, humanists, natural scientists, 
philosophers, the man in the street, and the mental health 
expert must jointly shoulder this responsibiHty. 



V 



From Ideas to Systematic ^^search 



lo CONDUCT systematic research in the area of mental health 
requires a translation of the ideas presented into concepts 
suitable for treatment by current research procedures. We 
now turn to the question whether and to what extent this 
is feasible. 

The study of human behavior, Hke every other science, is 
based on observation. The purpose of all research procedures 
is to increase as much as possible the accuracy of observa- 
tions. The crucial test for the soundness of research tech- 
niques is that several observers can arrive at similar judg- 
ments as the result of having independently applied the 
same procedures. To adapt the mental health concepts to 
these requirements means that the empirical basis for infer- 
ences about mental health, according to one or more criteria, 
be spelled out and that the conditions for the making of 
observations be explicit. Accordingly, we shall first discuss 
this question of empirical indicators for the various mental 
health criteria. 

To establish empirical indicators — if it can be done — is 

only a first step in acquiring further knowledge about mental 

[8i] 



[ 82 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

health. Neither scientific nor practical purposes in this field 
are adequately met by mere accuracy of descriptions. To 
understand mental health, and to apply such understand- 
ing, demands that the conditions under which it is ac- 
quired and maintained become known. The discussion of 
empirical indicators will, hence, be followed by some sug- 
gestions for seeking such understanding. 



EMPIRICAL INDICATORS FOR POSITIVE 
MENTAL HEALTH 

By and large, empirical indicators are not well developed 
in the mental health literature. As a consequence, the as- 
sessment of an individual in this respect is often left to the 
intuitive insight of an observer. The vast research literature 
on human behavior, on the other hand, presents many 
empirical indicators and ingenious devices for observation, 
but it rarely deals with the complex problem of what con- 
stitutes mental health. 

The task before us is to attempt a rapprochement between 
these two fields. It would be fooHsh, of course, to attempt 
here a comprehensive overview of research techniques, let 
alone of the major unsolved problems in the science of man 
having intimate bearing on techniques for observation and 
measurement. All that can be done is to revert to the mean- 
ing of the major criteria and present selectively some re- 
search techniques which might do justice to them. 

Inevitably, the discussion will touch upon some general 
issues and controversies in the study of human behavior; 
they will be identified where they first occur. 



FROM IDEAS TO SYSTEMATIC RESEARCH [ ^3 ] 

Attitudes Toward the Self 

A variety of research tools and strategies for observation 
are currently available to deal with aspects of the self -concept. 
The basic design consists of a comparison between self- 
description and performance, or self-description and de- 
scription by others. 

Self-descriptions are elicited or inferred from relatively 
unstructured and unstandardized material such as autobio- 
graphical sketches or protocols of therapeutic sessions, from 
projective tests such as the Rorschach or Thematic Appercep- 
tion Test, or from highly structured personality inventories 
and other paper-and-pencil tests, such as the Minnesota 
Multiphasic Personality Inventory or the Taylor Anxiety 
Scale. 

Whatever the instrument used, the content of such self- 
descriptions consists of many different items : traits, motives, 
feelings, interests, or values. This raises a major question left 
unanswered by the mental health Hterature: Is every item 
referring to the self equally relevant for mental health? 
Take the accessibility of the self to consciousness: Is the 
awareness of what induced a passing mood as relevant as the 
awareness of what prompted one's choice of a marriage part- 
ner ? And if not, which areas of the self should be accessible 
to consciousness ? All ? And what are these areas ? 

Or take the aspect of correctness of the self-concept: some 
studies have tested a person's abiHty to identify his own ex- 
pressive movements, such as his gait, from a number of 
photographs. Is this a test of correctness of the self -concept ? 
Or should mental health be inferred from the correctness of 
other features of the self -concept ? And if so, which ? 



[ 84 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

Or with regard to feelings about the self and sense of 
identity: Should pride in one's achievements be given the 
same v^^eight as one's acceptance of grey hair ? 

All these questions point to the need for a theory v^hich 
specifies dimensions of the self and their hierarchical rela- 
tions to each other. They also imply that the mental health 
hterature has insuflBciently specified the concrete nature of 
aspects of the self that enter into calling a person healthy. 

Depending on the characteristic of the self -concept under 
study, variations in the basic observational strategy are in- 
dicated. One way of arriving at a judgment about the ac- 
cessibility of the self to consciousness, for example, consists 
of confronting a person with an assessment of his personaUty 
arrived at by competent observers. The person's reaction to 
such judgments may be acceptance, denial, surprise, or the 
like. These reactions then form the basis for evaluating the 
extent of his self -awareness. 

Ingenious as this method is, it draws attention to two 
major problems, both of crucial concern to psychology. One 
is contained in the distinction between the self as it appears to 
others and the self -concept (the way the person sees him- 
self). The distinction is akin to that between conscious and 
unconscious portions of the self, or the "real" self and the 
self-concept. 

The other problem concerns the validity of assessments 
by others. However qualified an observer, however subtle 
his methods, is what he observes actually what he aims at 
observing? Applied to the self -concept, is the way the ob- 
server sees a person actually the way this person is? In 
scientific procedure the question is answered affirmatively if 
the observer makes a prediction based on what he has found 



FROM IDEAS TO SYSTEMATIC RESEARCH [ 85 ] 

and demonstrates the correctness of his prediction. He might 
state, for example, that a person who accepts himself as he 
is — other things being equal — will set himself achievable 
goals. Experiments can be conducted to verify this prediction. 

But the mental health practitioner is rightly not entirely 
satisfied with this demonstration of validity. To make such 
predictions seems to him a relatively easy matter but not yet 
a guarantee that the observation, made under the very 
special circumstances of a research study, will be an indicator 
of what a man might do or feel under the pressures and in- 
fluences of daily living. Since the practitioner is interested 
in mental health as manifested in daily experience, he oc- 
casionally becomes wary of research conducted in the rare- 
fied atmosphere of a laboratory. In other words, he raises 
the question: Can research conducted under special condi- 
tions be generalized .f^ 

The question is crucial. Earlier in this report a distinction 
was introduced which has some bearing on finding an an- 
swer 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 is generally agreed that 
we can know what people are only by inference from what 
they do. But every action is to varying degrees a function not 
only of the acting person but also of the situation in which 
he finds himself. 

Scientific observation of human beings uses several ways 
of arriving at generalizations from specific actions. Perhaps 
the most frequent one consists in observing people under 
conditions that reduce situational influences as much as pos- 
sible. One who takes a Rorschach test, for example, has no 
situational cues of what a "right" response is. In the absence 



[ 86 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

of specific guidance from the outside, he is thrown back on 
cues from the inside. In this manner he reveals his personaHty 
predispositions. This is, of course, not entirely so. One might 
be frightened or attracted by the test administrator or pick 
out cues from his expressive behavior. No clinician, there- 
fore, will want to rely on one test performance only for his 
personality diagnosis. But according to the theory underlying 
these tests, they present a good approximation of what a 
person is when relatively free from external influences. 

Another way to approach generalizations about what a 
person is, beyond what he reveals in one concrete act, is to 
search for consistent trends in his behavior in a variety of 
situations. If a test score, a personality inventory, and clinical 
observation all indicate a well-developed sense of identity, the 
result inspires a greater degree of confidence that a per- 
sonaHty attribute has been identified than when results differ 
in three situations. 

Clinicians often approach the problem of generalization 
by making their inferences from a person's action in situa- 
tions central to him. They regard the self as revealed in re- 
lation to a life partner as a better indicator of its actual 
nature than the self revealed while using the subway. 

All these approaches are, of course, tenuous. But only an 
unreahstic perfectionist would look for more than an ap- 
proximation in this area. GeneraUzations about an individual 
from behavior in one situation to that in another presupposes 
always that the psychological meaning of the two situations 
is understood. Where this is not the case, the psychologist 
will be as helpless in predicting as is the chemist when a 
substance he knows meets with one whose qualities are un- 
known to him. 



FROM IDEAS TO SYSTEMATIC RESEARCH [ ^7 ] 

To return to the self -concept: it is reasonable to assume 
that certain of its aspects will be more appropriately assessed 
under complex conditions. These are available for research 
through the use of therapeutic sessions dealing with the 
full complexity of life problems, in field experimentation and 
in special assessment situations that retain the flavor of un- 
contrived experience. 

Growth, Development, and Selj -actualization 

To the extent that the mental health Hterature specifies 
this criterion, two aspects are distinguished: (i) motivational 
processes expressed in full utilization of an individual's 
abilities, his orientation toward the future and in differentia- 
tion, (2) and investment in living. 

If one were to take these specifications too literally, an 
assessment of self-actualization might consist in establish- 
ing a person's abiUties, comparing them to his actual work 
and leisure activities, and using the discrepancy, if any, as a 
sign of the degree of his self-actuaHzation. By that token, a 
man with musical and mathematical gifts who becomes a 
great musician without doing anything about his mathe- 
matical talents would be judged lacking in mental health. 
But surely, this is not what those who suggest self-actuaHza- 
tion as a criterion of health have in mind. Utilization cannot 
refer to all potentialities. Differentiation must be taken as 
occurring within one area of interests and not as synonymous 
with diffusion. 

With regard to utilization of abiHties, educational psy- 
chology has perhaps developed some concepts suitable for 
research. There, it has become customary to identify "under- 
achievers" and "overachievers" among students. An under- 



[ 88 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

achiever is a student whose I.Q. v^ould lead one to expect 
certain grades; his actual grades are below this empirically 
estabUshed expectation. In such a situation, the assumption 
is frequently made that the motives of the student are such 
that he does not give his best to schoolwork. 

Other assumptions are possible and have to be ruled out be- 
fore this situation can be used as an empirical indicator for 
the degree of self-actualization. When all the children in a 
class are underachievers, the teacher might be incompetent. 
A single underachiever may be motivated to utilize his 
abiUties, but physical fatigue may prevent this. Nevertheless, 
the identification of achievement level in schools holds 
promise for the development of empirical work on self- 
actualization among children. 

In other life situations, empirical standards such as are 
available in school are much more difficult to obtain. And 
intelhgence is not always the best yardstick for evaluating 
achievement in life. It might be more in the spirit of the 
mental health Hterature to compare a person's ambitions and 
goals with the direction in which he is actually moving — that 
is, to replace the objective assessment of abilities by subjec- 
tive goals, and to appraise these against the effort actually 
being made to achieve them. 

Self-actualization is also expressed in a person's time per- 
spective and in differentiation. Research techniques with re- 
gard to both are in a very rudimentary stage. Notwithstand- 
ing the fact that they play a significant role in Kurt Lewin's 
topological theory of the life space, empirical indicators have 
not been elaborated. 

With regard to the other aspect of self-actuaUzation, in- 



FROM IDEAS TO SYSTEMATIC RESEARCH [89] 

vestment in living, some approximation of what the criterion 
means can probably be gleaned from time-budgets of a per- 
son. If one time budget indicates that an individual does 
little apart from what is necessary for survival whereas an- 
other is involved in his work beyond the requirements of a 
job, or is concerned with ideas, or is active in social relations, 
it is a fair guess that the second person has invested more in 
matters outside himself than the first. 

But this is a very crude approximation. For we know too 
well that many activities and concerns are pursued not be- 
cause they form a genuine link between the world and the 
self, but for purposes of self-aggrandizement, to escape other 
problems, to win approval, and the like. Such motivation 
indicates concern with the self rather than with object rela- 
tions, as the criterion requires. The distinction between 
genuine and apparent concern with objects outside the self 
will perhaps be made easier once the psychoanalytic concept 
of "cathexis" is better understood and more amenable to 
empirical research. 

Integration 

Empirical indicators and research strategy are particularly 
difficult to suggest for this complex criterion. With regard 
to the balance of psychic forces it may be best to turn to the 
psychoanalysts who use the concept most frequently. Here a 
study of their modes of thinking may be the most promising 
next step. The goal would be to codify the way psycho- 
analysts transform the concrete data presented to them into 
the abstract notion of balance of psychic forces. What has 
been said about accessibility of the self to consciousness may 



[ 90 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

perhaps apply when this balance is conceived of as a pre- 
ponderance of preconscious and conscious over unconscious 
determination of behavior. 

In order to arrive at generally appUcable empirical in- 
dicators, it will be a wise precaution to use, in such co-opera- 
tive research with psychoanalysts, material from patients as 
they appear after a successful analysis, rather than data from 
troubled persons only. 

The assessment of a unifying outlook on life is com- 
plicated, and rightly so, by Gordon Allport's emphasis on 
the fact that such an outlook need not be an articulate 
philosophy. It is perhaps not too difl&cult to ascertain from 
prolonged interviews a man's basic tenets, if he can verbaUze 
them. If he cannot, some sort of performance rating is in- 
dicated. Role-playing techniques might be useful for such 
efforts. 

The empirical indicators for resistance to stress are more 
specifically formulated in the mental health literature. 
Anxiety- and frustration-tolerance and resihence are terms 
containing a clear directive as to the type of situation in 
which they should be studied : a situation presenting stress. 

It is at this point, however, that we come up against an- 
other major theoretical problem of psychology in general: 
the problem of how to distinguish between the external 
stimulus and the experience of, or response to, that stimulus. 
To hear one's views attacked in a discussion may be experi- 
enced as stress by one person, whereas another may regard 
this as a pleasant stimulant. This same second man, however, 
may experience being alone at night in a dark wood as stress 
whereas the first man may deliberately seek out this situation. 
Should resistance to stress be observed when stress is sub- 



FROM IDEAS TO SYSTEMATIC RESEARCH [ 9^ ] 

jectively present or when independent consensus agrees that 
stress has been imposed ? In more general terms, the problem 
is known as the question of equivalence of stimuH. It has 
considerable philosophical and theoretical implications. 

To the extent that research has been conducted on anxiety- 
and frustration-tolerance, the dilemma was avoided rather 
than solved by studying situations in which some corre- 
spondence between stimulus and experience was either di- 
rectly ascertained or could reasonably be assumed in view of 
the intensity of the external stress. A case in point is the 
series of studies on resistance to stress in natural disasters, 
such as floods, prolonged isolation from other human beings, 
and the like (Chapman, 1954; G.A.P. Symposium No. 3, 
1956). So are the previously cited study of anxiety and sur- 
gery and Clausen's (1955) study of wives whose husbands 
have been institutionalized for mental illness. 

Similar situations offer strategic opportunities for the 
study of resilience. A crucial empirical indicator here may be 
the amount of time an individual needs before he can re- 
sume his usual patterns of living after change under the 
impact of stress. 

Autonomy 

The meaning of this criterion prescribes the situation in 
which observations must be made, namely, decision-making 
situations. Where the aim is to ascertain whether behavior 
is directed from within, it will be advantageous to use situa- 
tions permitting alternative decisions, neither of which is 
encouraged or approved, on the assumption that the self- 
rehant person will be able to decide with relative ease and 
speed what suits his own needs best. Those lacking in self- 



[ 92 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

reliance will find it difficult to decide and will search for 
external support. 

Independent behavior, on the other hand, must be tested 
where some social pressure favors an alternative that the in- 
dividual would not select if left to his own devices. Asch 
(1952) has designed an experimental situation lending it- 
self admirably to this purpose. 

Although the situational context for obtaining empirical 
indicators is relatively clear in this case, a number of other 
problems remain. Self-reliance can be demonstrated in 
choosing between coffee or tea or in making a vocational 
choice. Are both items of equal significance as indicators of 
autonomy? Independent behavior can show itself in the 
manner one dresses or in Luther's break with Catholicism. 
And, depending on many other factors, what is for one per- 
son an insignificant decision may be of great importance for 
another. We have met this difficulty already in discussing 
the problem of stimulus equivalence; what has been said 
there applies here too. 

In addition, here as elsewhere, sensitive empirical indica- 
tors must be constructed so as to permit distinctions of the 
degree of positive mental health attributed to an individual. 
For this purpose a combination of various measures is in- 
dicated. The use of several observations which lead to a 
profile or a combined general score is a problem in its own 
right. 

Ferception of Reality 

No other area in psychology has as long a tradition in 
experimental work, or has used a greater variety of observa- 
tional strategies, than the area of perception. Yet the riddles 



FROM IDEAS TO SYSTEMATIC RESEARCH [ 93 ] 

of perception are far from understood and new techniques 
and ideas are pushing ahead the frontiers of knowledge. It 
is no wonder, then, that in research on perception most of 
the general issues and controversies in the science of man 
come to a head. Each of the general problems of research on 
human behavior mentioned before could be illustrated with 
reference to perception. We shall not, however, repeat them 
here. It must suffice to point out that the aspects of percep- 
tion singled out by the mental health literature as criteria 
are intimately related to current research problems in per- 
ception. 

Perception relatively free from need-distortion is a con- 
cept springing from the realization that although motives 
(needs) are always involved in perceiving, they are not, or 
at least need not be, the major determinant of the perceptual 
product. It also assumes that other cognitive processes — 
thinking, judgment, memory — are intimately linked to 
perceiving. 

The situation for appropriate observations must be, of 
course, one in which an individual is emotionally involved 
with the percept in such a way that a distortion of its at- 
tributes would suit his inner needs better than the perception 
of what is. Perhaps the greatest difficulty here is the ascer- 
taining of emotional involvement leading to a need to dis- 
tort. Sometimes this need has simply been assumed without 
definite evidence. At other times, needs have been experi- 
mentally created. For example, persons have been deprived 
of water for some length of time and then been asked to 
identify ambiguous pictures. Those identifications having to 
do with liquids were taken as evidence of distortion. Tests 
of syllogistic reasoning have used the discrepancy, if any, 



[ 94 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

between reasoning on neutral topics and reasoning on emo- 
tionally colored material as an indication that the emotional 
involvement created a need to distort cognitive processes. 

The perception of the feelings and motives of others is 
appraised with the help of a strategy similar to that described 
for assessing aspects of the self-concept. A person's insight 
into the thoughts and feelings of others is compared with the 
latters' self-descriptions. The same tools for personaHty de- 
scriptions mentioned there can be used here. 

The generality of empathy presents a special problem. 
One would like to know not only whether empathy trans- 
fers from one situation to the next but also whether it ap- 
pHes to understanding of all other persons or is restricted to 
special groups — for example, to people one likes or to people 
who are similar to oneself. 

Environmental Mastery 

Several of the aspects of environmental mastery are 
formulated in the mental health Hterature in such a manner 
that only the study of the full complexity of an individual's 
life history will suffice as empirical indication. Accordingly, 
data collection has to rely largely on case-study methods and 
therapeutic and diagnostic interviews, supplemented by time 
budgets and projective techniques. 

The problems in this area arise mainly with regard to 
specifying the extent to which environmental mastery is a 
function of good or bad luck and to what extent it can be 
regarded as the individual's achievement. This means that 
the various case-study methods must not only deal with inner 
dynamics but must also pay attention to external events in 
their own right. Even though common sense alone would 
require such an approach, a surprising number of judgments 



FROM IDEAS TO SYSTEMATIC RESEARCH [ 95 ] 

of environmental mastery remain insensitive in this respect 
and engage in an unv^arranted amount of psychologizing 
about hard facts. Such partial blindness is the result not only 
of overenthusiasm for psychological explanations but also 
of the considerable difficulty in sifting events provoked by an 
individual's inner dynamics from those occurring independ- 
ently. 

With regard to three aspects of environmental mastery — 
adequacy in love, v^ork, and play, adequacy in interpersonal 
relations, and efl&ciency in meeting situational requirements 
— situational analyses are particularly important. What is 
needed here is research on vs^hat adequacy or situational re- 
quirements mean concretely. The conceptual approaches of 
sociology and cultural anthropology v^ill have to be used 
tov^ard this end. 

Problem-solving is the one aspect of environmental mastery 
on which there exists extensive experimental research. The 
problems such experiments deal v^ith are, how^ever, mostly 
problems in logic or reasoning that in themselves are emo- 
tionally neutral. Further research v^^ill have to estabHsh the 
extent that problem-solving tendencies, as demonstrated in 
dealing v^ith these experimental tasks, have bearing on the 
approach to life problems. There is little doubt that some of 
the concepts used in such experimentation are relevant for 
establishing empirical indicators for problem-solving as a 
criterion for mental health. Duncker's concept of "functional 
fixedness," for example, refers to the tendency to use tools in 
the same manner in v^hich one usually encounters them 
(1945). It may be as appropriate for describing approaches 
to life problems as it is for describing behavior under ex- 
perimentally contrived conditions. 

The accompanying chart summarizes what has been said 





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[ 100 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

SO far about the translation of mental health concepts into 
empirical indicators and presents several suggestions for 
further research. 

SOME SUGGESTIONS FOR RESEARCH 

Throughout the preceding discussion, tv^^o types of research 
questions have been mentioned. One has to do v^ith technical 
matters such as the estabhshment of empirical indicators, 
the other v^ith the advancement of substantive know^ledge. 
This is not the place to go further into technical details; 
competent research v^^orkers must handle them empirically. 
These are not matters fruitfully advanced by speculation. 
Instead, wc novi^ turn to a brief discussion of some of the 
questions that should become ansv^erable once the tools and 
techniques are available. 

The Analysis of Mental Health Clusters 

In the interest of economy of effort in research and prac- 
tical application, perhaps the most urgently needed study is 
one of the interrelationship of the criteria. Consider, for ex- 
ample, the possibility that autonomy exists only v^^hen an in- 
dividual has a v^ell-developed sense of identity or self-ac- 
ceptance, or that adaptation follov^s from a balance of psychic 
forces. 

If a cluster analysis of the criteria v^ould demonstrate such 
relations, the Hst of mental health concepts might be con- 
solidated. A cluster analysis v^ould have another advantage, 
too, that of permitting the estabhshment of a multiple crite- 
rion based on knov^ledge, rather than guessv^ork, about the 
relation of the components. 



FROM IDEAS TO SYSTEMATIC RESEARCH [ 10^ ] 

A word of caution is in order on the degree of generality 
that can be attributed to empirically discovered clusters. 
There is no reason to believe that the interrelations appear- 
ing in one case need necessarily be the same for every group. 
Differences in culture, social class, sex, or age may well ex- 
press themselves in diflferent clusters. Comparative studies in 
all these groups are indicated with regard to the frequency 
distribution of the criteria and their interrelations. 

Mental Health Criteria for Di^erent Age Groups 

The study of mental health in different age groups is a 
research problem in its own right. In their current formula- 
tion, several criteria are applicable only to adults. Yet the 
need for mental health evaluation is just as great for chil- 
dren, adolescents, and the very old. Erikson alone among 
the various authors we have reviewed has given full attention 
to the maturational appropriateness of mental health criteria. 
To extend this concern beyond Erikson's formulation will 
require much research. 

For example, the comprehensiveness and correctness of the 
self-image is a criterion of limited usefulness for children and 
young people. The rate of change in the self is undoubtedly 
much greater for them than it is at later stages in life, a fact 
that may easily lead to discovering apparent inconsistencies 
when the child is observed in various situations. What is 
more, self-description as a necessary tool for ascertaining 
aspects of the self is a task that may exceed the development 
of a child's cognitive abilities. To a lesser degree, the same 
holds for self-acceptance and the sense of identity. The latter, 
it should be remembered, is suggested by Erikson as a late 
step in a temporal sequence of development. 



[ 102 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

It may well be that parents and teachers, who are able to 
observe children continuously over long periods of time, 
could note possible indicators for growth, development, and 
self -actualization. However, as we have seen, the elaboration 
of empirical indicators in this category has not progressed 
very far. Much the same is true for the indicators of auton- 
omy as applicable to children. Furthermore, the process of 
early education contains inevitably strong emphasis on curb- 
ing the child's autonomy. A minimal requirement for the 
application of this criterion to the behavior of children is 
identification of the areas in which autonomy must be curbed, 
so that they can be excluded as situations for gauging the 
child's mental health. 

Perception of reality, meeting the requirements of the 
situation, and problem-solving are the criteria par excellence 
having meaning for all age groups, even though their em- 
pirical study will, of course, have to take age into considera- 
tion. Adaptation as the sense of actively selecting an environ- 
ment to suit one's own needs is only occasionally open to 
young children in our civilization. To describe adequately 
the forms adaptation can take in childhood will require the 
elaboration of age-specific indicators. 

Research in this area can be conducted from two points of 
view. Childhood can be regarded as a stage of life in its 
own right; in that case, clues for the establishment of criteria 
of health must come from what is known in child psy- 
chology. Or one can start with the model of the healthy adult 
and ask which behavior tendencies in childhood hold the 
greatest promise of health in adulthood. Taking extreme 
positions in this matter has led to the controversy between 
the proponents of "progressive" and traditional methods of 



FROM IDEAS TO SYSTEMATIC RESEARCH [ 103 ] 

education. This controversy continues to rage bitterly in the 
absence of facts demonstrating conclusively the impact of 
either method on the child or the adult-to-be. 

Actually, the extremely child-centered approach to mental 
health criteria for this stage of hfe is as untenable as the ap- 
proach regarding the child as a small adult. In the life of 
the child, present, past, and future shade imperceptibly into 
each other. The individual v^ill function tomorrow accord- 
ing to the goodness and adequacy of his total equipment 
today. The next moment may deeply affect this equipment 
and it is reasonable to postulate that the nature of this effect 
will be to a considerable extent determined by the current 
state of affairs. 

The mentally healthy child — healthy in terms of his age 
group — will be best equipped to deal with the subsequent 
events and thus with the gradual unfolding of the course of 
his life. But, however different the empirical indicators for 
mental health in childhood may be from those for adult- 
hood, they must be conceived of as having a lawful sequential 
relation to each other. The need for research in this area is 
considerable. It will have to develop criteria appropriate for 
different stages in life and demonstrate how mental health 
in one stage leads to mental health in the next. 

Research with Mental Fatients 

Another area of research concerns the possible application 
of these criteria to work with mental patients. Perhaps most 
immediately needed in this area are descriptions of the degree 
to which various mental health criteria co-exist with various 
types of disturbances. A systematic effort in this direction 
could lead to a series of other studies. For example, many 



[ 104 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

efforts are currently being made to assess what progress or 
movement in therapy actually connotes. 

The tranquilizing drugs apparently produce one type of 
effect. Many psychiatrists are of the opinion that the lessened 
anxiety and increased contact v^ith others do not constitute 
a cure, but estabUsh a condition making further therapeutic 
efforts possible. It would be of considerable interest to in- 
vestigate whether the effects produced by the drugs, by sub- 
sequent psychotherapy, or both, are movements toward the 
mere elimination of symptoms of disease or toward the 
acquisition of health. 

Other suggestions for the use of mental health criteria in 
the study of mental disease have already been made in a 
previous section. Their further elaboration should be at- 
tempted in close co-operation with psychiatrists. 

CONDITIONS FOR ACQUISITION AND 
MAINTENANCE OF MENTAL HEALTH 

There is ready agreement between all concerned that a full 
understanding of mental health demands that conditions 
under which it is acquired and maintained be specified. In 
order to meet this demand, research must single out some 
such conditions. And here the difficulty begins. A virtually 
unending number of conditions may affect the degree to 
which an individual possesses or displays any of the at- 
tributes constituting mental health. 

Should one search for relations to genetic factors ? Or bio- 
chemical processes ? Does living in urban or rural areas make 
the difference? Or membership in a particular social class 
or ethnic group .^^ Is it the standard of living or the level of 



FROM IDEAS TO SYSTEMATIC RESEARCH [ IO5 ] 

education? The geographical location or the physical quali- 
ties of one's home ? Or the pace of life in the home town ? 
The composition of the neighborhood or the family? The 
relation between mother and child or between child and 
siblings? The early socialization process? Or a combination 
of some or all of these factors ? 

For reasons of economy of effort as well as theoretical 
elegance, it would be highly desirable to have some principle 
available to help us sift these and many other possible factors 
according to their psychological relevance for mental health. 
The problem involved in the search for such a principle is 
no less than the conceptualization of what is meant by 



'environment." 



This problem has challenged the great philosophers of 
past centuries; it continues to challenge current theorists. 
It is akin to the problem of distinguishing between stimulus 
and response, between what is inside and what is outside the 
organism (F. H. Allport, 1955). 

Though the distinction between what is inside and what 
is outside the organism is fundamental and clear-cut with 
regard to objects, it is difficult to apply it to psychological 
functions. Light is outside the organism; the visual nerve, 
inside. Seeing, a psychological function, is equally depend- 
ent on both. In the sciences of man, the distinction is always 
to some extent arbitrary. Even though various schools of 
thought have made systematic efforts to deal with the rela- 
tion between man and his environment, the great issue re- 
mains unresolved, at least to the extent that none of these 
efforts provides a guide for choosing among the factors pos- 
sibly influencing mental health. 

In this situation a more modest empirical approach will 



[ I06 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

have to guide research on the conditions for the acquisition 
and maintenance of mental health. Here help is forthcoming 
in a variety of v^ays. 

First, general consensus based on much empirical evidence 
holds that a crucial aspect of man's environment consists of 
those persons v^^ith v^hom he intimately interacts. For the 
infant and young child, the only other aspect to rival the 
human element in the environment may be his constitutional 
equipment. The fact that the infant lives in slum or palace, 
in city or country, in peace or v^artime, affects him only to 
the extent that such conditions lead first to changes in his 
human environment. As the child groves, tv^o important de- 
velopments take place: he enlarges the radius of his activities, 
so that he directly experiences contact with objects, and his 
cognitive abihties develop so that aspects of the environment 
need no longer be physically present — that is, they can in- 
fluence him via symbolic representation. 

These processes of maturing infinitely complicate the 
manner in v^hich the environment can affect mental health. 
The environment nov^ can have an impact through a variety 
of channels. Yet new channels do not replace the earlier one; 
they supplement it. There is no vi^ay of saying v^ith con- 
fidence that the mental health of a schoolchild is more cru-, 
cially influenced by the personality of his parents, siblings, 
teacher, or classmates than by the fact that he is a Negro or 
hves in a rural area or comes from an educated family; even 
so, it is safe to say that the human beings around him are 
one crucial aspect of his environment. 

A second set of conditions related to mental health is sug- 
gested by the results of interdisciplinary research. Psychia- 
trists and psychologists are more and more av^are of the 
fact that certain regularities of behavior can be understood 



FROM IDEAS TO SYSTEMATIC RESEARCH [ I^ ] 

not only in terms of individual dynamics but also in terms 
of group memberships and identifications. Such regularities, 
the result of similar social conditions, lead them to be con- 
cerned with the wider human environment of a person as 
well as with his intimate human relations. 

Collaborative research between psychiatrists or clinical 
psychologists on the one hand and sociologists or anthropolo- 
gists on the other has demonstrated that it is worth while 
to extend the range of environmental factors in this way. 
Research teams, such as Paris and Dunham (1939), Kardiner 
and others (1945), Hollingshead and RedUch (1953), and 
Stanton and Schwartz (1954), have contributed to our 
knowledge of mental disturbance by identifying ecological, 
cultural, or class determinants. This approach could profit- 
ably be appHed to questions of mental health. The newly 
emerging profession of social psychiatry and the estabUsh- 
ment of therapeutic communities (Jones, 1953) are translat- 
ing such research into practice. 

A third approach to the identification of conditions con- 
ducive to mental health stems from the observation that man 
adjusts his behavior not only in interaction with other indi- 
viduals but also in response to situations and institutions more 
or less independently of the particular individuals who hap- 
pen to play a role in them. As one enters a drugstore or a 
theater, goes to work or to bed, a whole set of prescribed re- 
sponses are called forth by the situation. Wright and Barker 
(1950) use the term "behavior setting" for locales having the 
attribute of eHciting largely standardized behavior. It is 
reasonable to assume that the behavior settings a person 
spends a good deal of time in will have a lasting influence 
on his psychic make-up. The school system a teacher operates 
in, or the specific requirements of any other occupation. 



[ I08 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

present behavior settings of long duration that may signifi- 
cantly affect mental health. 

A fourth set of environmental factors appears relevant for 
research on mental health. It is different from those already 
mentioned, inasmuch as it can apply to each of them as v^ell 
as to many others. It is the factor of change in environmental 
conditions. It is a truism that environmental conditions 
change continuously and continuously provoke changes in 
the individual. Imperceptible changes are easily taken into 
one's stride. Sudden, major, or unexpected changes require a 
general reorientation. Constancy of environmental condi- 
tions, as much as frequent radical change, may be a good or 
bad influence on mental health. The direction of the change 
from "good" to "bad" conditions, or the other v^ay round, 
may be as important as change per se. But there are some 
indications in the Hterature (Bettelheim and Janov^itz, 1950) 
that one's sense of identity may be threatened, v^^hatever the 
direction of change. In any case, the stability or instability of 
environmental conditions appears to be a psychologically 
relevant attribute of the environment. 

In these directions, research on the conditions of mental 
health might proceed. There are undoubtedly others. Every 
serious piece of work in this field WAX have to come to terms . 
v^ith the fact that the various sets of conditions always exist 
simultaneously and that concentration on one or the other 
inevitably means a violation of the actual conditions of living. 
Those dissatisfied with this unending search for better and 
better approximations to an unattainable goal will have to 
turn away from science and seek elsewhere for their insight 
into the conditions for mental health. 



VI 



In Qondusion 



At the beginning of this report stands a statement by Adolf 
Meyer contrasting two approaches to the field of mental 
health: the Utopian way, which leads to moraUzing, and 
the scientific way, which leads to experimentation and de- 
liberate action. 

As one reviews the field of mental health more than thirty 
years later, he finds that no final choice between the two 
ways has yet been made. Today, too, there is a danger of 
mental health becoming a popular movement that Hves by 
slogans and presents ten easy rules for being mentally healthy 
ever after. The final comment on the moraHzing approach 
to the problems of hving was made by the Austrian satirist, 
Nestroy, who made one of his most pompous characters say, 
"Better rich and healthy than poor and sick," and made him 
eloquently silent on how. 

The present report should have made it abundantly clear 
that the complex problems of mental health will not be 
brought nearer to solution by exhortations. By far the most 
urgent need in the field is for more knowledge. Research is 
a slow and costly enterprise. It can fail. Or it can fail to be 
appHed. However, in the long run, we do not know a better 

[109] 



[ no ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

way to help policy decisions in the field than to strive for 
more and better knov^ledge about the conditions conducive 
to mental health. 

If poHcy makers open the w^ay to the acquisition of further 
knov^ledge, if practitioners in the mental health field co- 
operate with scientists in thoughtful experimentation, if the 
fruits of research can be applied without losing respect for 
the infinite diversity of human beings, concern with mental 
health may improve the quaHty of Hving. 



VII 



Vicwj^oint of a Qlinician 

by WALTER E. BARTON, M.D. 



Conceptually, it is difficult to see how a national program 
to reduce mental illness and increase mental health can be 
operated on any other base line than a straight one. In this 
continuum, illness is the point of departure and health is 
the goal. We work away from one and toward the other. 

If we had solved, or even partially solved, the problems of 
preventing or treating major and minor mental illness, we 
could then justifiably concern ourselves with the issue of 
superlative mental health, or the degrees of goodness in good 
mental health. Unfortunately, we still have far to go in re- 
ducing illness. This is a practical concern, rather than a 
theoretical one. 

We must recognize, of course, that Dr. Jahoda's purpose 
in this monograph is not to write poUcy for a national health 
movement, but to analyze and evaluate what different think- 
ers mean when they speak of mental health. Her concern 
is with the psychological — or, one might add, spiritual and 
intellectual — content of positive mental health. Such clarifica- 
tion is desirable. Dr. Jahoda has ably pursued the various 

[III] 



[ 112 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

theories about the psychological content of positive mental 
health and has shed a good deal of light on the issues in- 
volved. 

Many physicians v^^ill find her approach a novel one. Some 
may instinctively oppose an approach divorcing health from 
illness as aHen to their ov^n understanding of health. 

Dr. Jahoda's fundamental position appears to be that the 
absence of illness and the presence of health overlap but do 
not coincide. The physician, quite typically, I think, v^orks 
on the basis that they do coincide, for all practical purposes. 
He sees health as the objective in the prevention, cure, or 
management of disease to the extent that he can help the 
individual avoid it, recover from it, or compensate for it. 

The living organism so rarely presents itself, at all times 
or in all v^ays, in a complete state of biological, physiologi- 
cal, psychological, and — in sum — ecological harmony, and 
yet so characteristically strives for such a balance, that the 
clinician may still hold to his viev^ that the absence of ill- 
ness and capacity for achieving or restoring balance are 
consonant v^ith sound health principles, as he must apply 
them. The pathologist at autopsy frequently observes so 
much pathology that he is far less struck that a patient died 
than that his diseased organs functioned as long and as well 
as they did. 

All of us can benefit, hov^ever, from attempts to define 
and measure good health, whether psychological or physical, 
and should welcome heterodox efforts to do so. Perhaps, 
through the mind of social science, unencumbered by medi- 
cal tradition, research may be designed that will eventually 
quantify the psychological content of mental health. The 
phenomenon of a superstate of good mental health, well 



VIEWPOINT OF A CLINICIAN [ 1^3 ] 

beyond and above the mere absence of disabling illness, has 
yet to be scientifically demonstrated. We know little of it 
beyond occasional subjective, euphoric impressions of the 
subject that he is "bursting with good health," "feeling 
grand," or that "all is right with the world," meaning his 
world. 

In contrast, the benefits of disease prevention and control 
have been tangibly demonstrated in increased ability to work 
and carry out social obligations, longer life, and individual 
morale. 

Medicine has developed this useful way of looking at 
health and the normal to the extent that health as the an- 
tonym of disease has become a part of the philosophy, or 
tradition, of physicians. 

The idea first was propounded by Hippocrates who held 
health to be a state of universal harmony, and the role of 
the physician to be that of restoring equiHbrium between 
the various components of the body and the whole of Na- 
ture. This approach was encompassed by Walter Cannon 
in his principle of homeostasis, meaning a tendency toward 
uniformity or stability in the normal body states of the 
organism relating to the fluid balance and, more generally, 
the so-called "internal environment." By extension, the same 
idea of equilibrium permeates observation of such matters 
as "nitrogen balance" and various other physiological or 
biochemical states. 

The inference of good health, or the normal state, as a 
manifestation of harmony or balance with the external en- 
vironment can be found in biology as well as physiology. Out 
of Spencer's idea of evolution as the "survival of the fittest" 
came the notion of "nature in the raw" and eternal aggres- 



[ 114 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

sion and defense, which influenced the older conception of 
the germ theory of disease and made us appear victims of 
a kind of microbial v^arfare. But Darv^^in pointed out in 
Descent of Man that commonly in nature "struggle is re- 
placed by co-operation." The concept of "a balance of na- 
ture" again emerged as a unifying idea. 

In modern microbiology, the older idea of infectious dis- 
ease as a "fight" against foreign "invasion" has been to a 
great extent superseded by the concept of man and his bac- 
teria and viruses as habitually Hving together in various 
states of symbiosis or germ-host relationships involving in- 
fection, Wixh. or w^ithout apparent disease. Accompanying 
this has been a strong revival of the mutiple-cause theory of 
disease at the expense of the one-germ-one-disease viev^point. 
Rene J. Dubos, for instance, regards "invasion" or "attack" 
as less characteristic of the relationship of man's pathogens 
to man than is "peaceful co-existence." 

Subclinical or inapparent infection appears to be the 
rule, with periodic epidemics or individual imbalances due 
to lowered resistance of the human organism or heightened 
virulence of the microorganism actually occurring as ex- 
ceptions. 

So we see that a unifying concept of health and disease 
does run through medical thought, founded in biology and 
physiology as well as in biochemistry and microbiology. The 
tendency of the organism is to serve its structural, functional, 
and species purposes and, internally or externally, to strike 
some kind of balance that will permit it to do so. It is normal 
for the organism to do this. 

Leston L. Havens (1958) has pointed out: 

"Usually in medicine we say an organ is healthy if it does 



VIEWPOINT OF A CLINICIAN [ 1^5 ] 

its job within the normal range and over the usual time. We 
do not expect too much, although the usual range is not 
the range of the average man but of the average healthy man. 
Statistical norms are useful in this context and should not 
be dismissed despite the difficulties of agreeing on a normal 
population in the mental health area. Without such a point 
of reference, one carmot tell what is a toxic experience and 
what is normal tolerance. Without norms there is also the 
danger of unreal goals of treatment. This may be a signifi- 
cant clinical hazard. Ideal or even 'potential' health criteria 
are too easily spun out of theories or brief glimpses of people 
at their momentary best." 

Both gross and cellular pathology have well-defined con- 
cepts of normal and abnormal. The tissue and cell are 
normal if they exhibit no disturbance of structure as com- 
pared to most tissues or cells of like kind. Precisely the same 
understanding extends from structure to function. Granted, 
the physician's estimate of what is normal sometimes has 
been of far too narrow a range, as for example in determin- 
ing what constitutes abnormal blood pressure. 

M. Ralph Kaufman (1956) sums up the issue this way: 

"The organism and its relationship to its environment is 
in a constant state of flux which nevertheless involves a con- 
tinuous series of processes utilizing all aspects of its function- 
ing in an interrelated series of procedures aimed at the 
establishing of an equilibrium. 

"The ontogenesis of the individual is of tremendous sig- 
nificance since within the potentials and limitations of the 
genus and species, the organism develops in a progressive 
and integrated way with each system (digestive, cardio- 
vascular, central nervous, autonomic, psychic), shunting in. 



[ Il6 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

after functional maturation, to take over that role which its 
structure and function calls for in the total functioning of 
the organism. From the very beginning at the level of the 
sperm and ovum the processes have an adaptive equilibrium 
between organism and environment, each playing its essen- 
tial role which involves the ultimate for survival. With the 
development and integration of the various systems, of which 
the psyche is one, the systems relate to each other in a kind 
of syncytium which means that no activity within one sys- 
tem can be isolated and unrelated to the total integrative, 
homeostatic, if you will, function of the organism. . . ." 

Jacques S. GottHeb and Roger W. Howell (1957) under- 
score the predominate note of disease prevention in the 
public health approach : 

"The success of public health measures has been in large 
part dependent first upon the identification of specific im- 
portant etiological agents and other variables in the illness 
process. It is Hke protecting our water supply against con- 
tamination with the typhoid bacillus or strengthening the 
defenses of an individual against a noxious agent as in inocu- 
lation with poHo. This general technique has a certain simi- 
larity to the objectives of our previously described mental 
health goals ; that is, removal of conditions of stress, of frus- 
tration, of deprivation on the one hand, (the etiological 
agent) while strengthening the ego defenses on the other 
(the inoculation). In the preventive program for physical 
illness this can be readily done, for the strategy is directed 
toward a specific objective. For mental illness, unfortunately, 
we cannot isolate a single variable, a single point of attack, 
but must be prepared to deal with multiple factors of etio- 
logical import. For prevention of physical disorders, success 



VIEWPOINT OF A CLINICIAN [ I^?] 

has come only after the knowledge of the etiology or of the 
important variables. For mental and emotional disorders, 
we may not have the knowledge as yet to really develop 
preventive programs." 

Francis J. Braceland (1957) emphasizes the relationship of 
normal psychological development to disease prevention in 
certain situations. Rubella in the first three months of preg- 
nancy may be a prologue to a mental defect in the child. 
Eclampsia may be a factor in cerebral palsy, or a metabohc 
disorder in a mother may contribute to the development of 
epilepsy in an offspring. Prenatal injury affecting later be- 
havior is one possible consequence of poor maternal nutri- 
tion. Said Braceland: 

"It is self-evident that increased alertness to these various 
possibilities would pay rich dividends in mental health, but 
the sad thing is that the psychologic aspect of such situations 
is not always kept in mind. 

"Improved obstetrics, better use of protective services by 
all prospective mothers, the prevention of prematurity and 
its causes, and optimum care for the premature infant would 
cut the mental deficiency segment of our mental health 
problems by a sizeable amount. Multiple pregnancies, com- 
plicated delivery procedures, and stressful obstetric situations 
call for greater vigilance, as does the prevention of anoxia. 

"The importance of diagnosing cretinism during the first 
year is of course obvious, in view of the good response to 
treatment at this time and the fact that later treatment will 
fail to overcome mental retardation. Steinfeld's hypothetical 
'hunger trauma' in babies and its relation to later schizo- 
phrenia offers another challenge for prophylaxis. There 
should be joint obstetric and pediatric responsibility for fetus 



[ Il8 ] CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH 

and infant and child, so that a clearer view emerges of the 
mental, as well as the physical, hazards of various complica- 
tions from the time of conception and ways and means of 
combatting them. All of these things are important for the 
mental health of both mother and baby. 

"There are at least three mental health problems which 
could be mitigated by more intensive development of exist- 
ing pubHc health emphases; the nutritional problems of 
pregnancy; the toxic deUria associated with certain vitamin 
deficiencies; and some of the confusions of elderly persons 
associated with both drug intoxications and malnutrition. 

"Similar considerations pertain to infectious diseases which 
may directly damage the brain tissue. Encephalitis lethargica, 
even if so mild that it easily escapes detection, may result in 
mental impairment which, contracted in childhood, may be 
expressed in antisocial and irresponsible behavior. Inocula- 
tions against contagious diseases in children are essential to 
lessen the incidence of contagious diseases. Some of the 
formerly fatal cerebrospinal meningitides are now being 
restrained by antibiotics; unfortunately, however, we may 
be left with a defective individual requiring long and prob- 
lematic rehabilitative periods. Early diagnosis and treatment 
of these infections is therefore essential. 

"In adult life a psychopathic development may occur after 
brain damage, especially in the frontal cortex, the hypothala- 
mus, and the midbrain. If cerebral contusion is at all exten- 
sive, it is likely to produce personality changes with neur- 
asthenic, hysterical, or paranoid reactions, inadequate con- 
trol of mood variations, and a general lack of initiative and 
energy. In the light of these observations we need to 
strengthen those features of environmental sanitation work 



VIEWPOINT OF A CLINICIAN [ 119 ] 

which reduce the incidence of head and brain injury. These 
are a few of the areas in which good preventive and re- 
habihtative work may be done, provided that we are ever 
mindful of the close interaction of psyche and soma." 

This summarizes what I believe is the typical physician's 
understanding of health. It is difficult for me, as a clinician, 
to separate the presence of health from those preventive 
measures that reduce the likelihood of the development of 
disease and illness. I believe most patients would settle for 
the absence of illness. If they are not sick, they are well. 
There would be no Joint Commission if there were no men- 
tal illness. 

In this discussion, I have looked upon health as a product 
of disease prevention and treatment. It is proper, of course, 
for the scientific investigator to study behavior as a natural 
phenomenon, without a pathologic orientation. 

The viewpoint I have expressed is tangential to Dr. 
Jahoda's discussion of the content of positive psychological 
health. Yet I feel sure she would agree that mental illness is 
the primary threat to positive psychological health. 



^Cfi 



acnccs 



Allinsmith, W. and Goethals, G. W., 1956. Cultural factors in 
mental health. Rep. Educ. Res., 26: 431. 

Allport, F. H., 1955. Theories of Perception and the Concept of 
Structure. Wiley. 

Allport, G. W., 1937. Personality. Holt, pp. 213, 214, 226. 

, 1955. Becoming. Yale University Press, pp. 49, 51, 68. 

Angyal, A., 1952. A theoretical model for personality studies. In 
D. Krech and G. S. Klein (Eds.), Theoretical Models and Per- 
sonality Theory. Duke University, pp. 132, 135. 

Asch, S. E., 1952. Social Psychology. Prentice-Hall. 

Barron, F., 1952. Personality style and perceptual choice. /. Pers., 
20: 385. 

, 1954. Personal soundness in university graduate students. 

University of California Press. 

-, September 1955. Tow^ard a positive definition of psycho- 



logical health. Paper read before American Psychological As- 
sociation. 

Benedict, Ruth, 1934. Patterns of Culture. Houghton Mifflin. 

Bettelheim, B. and Janowitz, M., 1950. Dynamics of prejudice. 
Harper. 

Blau, A., 1954. The diagnosis and therapy of health. Amer. f. 
Psychiat., no: 594. 

Boehm, W. W., 1955. The role of psychiatric social work in 
mental health. In A. M. Rose (Ed.), Mental Health and Mental 
Disorder. Norton, p. 537. 

[121] 



[ 122 ] REFERENCES 

Braceland, Francis J., September 1957. Putting available tools to 
work. In Better Mental Health, Nat'l. Health Council. 

Biihler, Charlotte, 1954. The reality principle. Amer. J. Psycho- 
ther., 8: 626, 640. 

Burgess, E. W., 1954. Mental health in modern society. In A. M. 
Rose (Ed.), Mental health and mental disorder. Norton, p. 3. 

Cantor, N., 1941. What is a normal mind? Amer. f. Orthopsy- 
chiat., 11: 6^6. 

Chapman, D. W., 1954. (Issue Ed.) Human behavior in disaster: 
A new field of social research. /. Soc. Issues, 10: No. 3. 

Chein, I. 1944. The awareness of self and the structure of the ego. 
Psychol. Rev., 5/; 312. 

Clausen, J. A., 1956. Sociology and the Field of Mental Health. 
Russell Sage Foundation. 

, and Yarrow, Marian R., 1955. (Issue Eds.) The impact of 

mental illness on the family. /. Soc. Issues, 11: No. 4. 

Conrad, Dorothy C, 1952. Toward a more productive concept of 
mental health. Mental Hygiene, 56; 456, 466. 

Davis, K., 1938. Mental hygiene and the class structure. Psychiat., 
i: 55. 

Devereux, G., 1956. Normal and abnormal: The key problem of 
psychiatric anthropology. In J. B. Casagrande and T. Gladwin 
(Eds.), Somes Uses of Anthropology: Theoretical and Applied. 
The Anthropological Society of Washington, p. 23. 

Duncker, K., 1945. On problem solving. Psychol. Monogr., 58: 
No. 5, I. 

Eaton, J. W., 1951. The assessment of mental health. Amer. J. 
Psychiat., 108: 81. 

Eliot, T. D., May 1929. Standards of living, planes of living, and 
normality. The Family, 10: p. 87. 

Erikson, E. H., 1950. Growth and crises of the "healthy personal- 
ity." In M. J. E. Senn (Ed.), Symposium on the Healthy Per- 
sonality. Josiah Macy Jr. Foundation, pp. 135, 138, 139, 141, 142, 
143. 

Ewalt, J. R., 1956. Personal communication. 



REFERENCES [ 1^3 ] 

Paris, R. E. L. and Dunham, H. W., 1939. Mental Disorders in 
Urban Areas. University of Chicago Press. 

Foote, N. N. and Cottrell, L. S., Jr., 1955. Identity and Interper- 
sonal Competence. University of Chicago Press, p. 55. 

Friedenberg, E., 1957. The mature attitude. Adult Leadership, 5: 
248. 

Fromm, E., 1941. Escape from Freedom. Farrar and Rinehart, p. 
263. 

, 1947. Man for Himself. Rinehart, p. 26. 

, 1955. The Sane Society. Rinehart. 

Ginsburg, S. W., 1955. The mental health movement and its 
theoretical assumptions. In Ruth Kotinsky and Helen Witmer 
(Eds.), Community Programs for Mental Health. Harvard 
University Press, pp. 7, 21. 

Glover, E., 1932. Medico-psychological aspects of normality. Brit. 
J. Psychol., 25: 165. 

Goldstein, K., 1940. Human Nature in the Light of Psychopa- 
thology. Harvard University Press. 

Gottlieb, J. S. and Howell, R. W., 1957. The concepts of preven- 
tion and creative development as applied to mental health. In 
Ralph H. Ojemann (Ed.). Four Basic Aspects of Preventive 
Psychiatry. State University of Iowa. 

Group for the Advancement of Psychiatry, December 1956, Fac- 
tors Used to Increase the Susceptibility of Individuals to Force- 
ful Indoctrination. Symposium No. 3. 

Hacker, F. J., 1945. The concept of normality and its practical 
significance. Amer. J. Orthopsychiat., ly. 53, 55. 

Hall, C. S., and Lindzey, G., 1957. Theories of Personality. Wiley, 
pp. 96, 404. 

Hartmann, H. 1939. Psychoanalysis and the concept of health. 
Int. J. Psychoanal., 20: 308, 312, 314, 315, 316, 318. 

, 1947. On rational and irrational action. In Geza Roheim 

(Ed.), Psychoanalysis and the Social Sciences, i. International 
Universities Press, pp. 363, 379, 390, 391. 

, 1951. Ego psychology and the problem of adaptation. 



[ 124 ] REFERENCES 

In D. Rapaport (Ed.), Organization and Pathology of 
Thought. Columbia University Press, pp. 362, 373. 

Havens, L. L., January 5, 1958. Personal communication. 

Hollingshead, A. B. and Redlich, F. C, 1953. Social stratification 
and psychiatric disorders. Amer. Sociol. Rev., 18: 163. 

Jahoda, Marie, 1950. Toward a social psychology of mental health. 
In M. J. E. Senn (Ed.), Symposium on the Healthy Personality. 
Josiah Macy Jr. Foundation, pp. 211, 219, 220. 

, 1953. The meaning of psychological health. Social Case- 

wor\, ^4: 349. 

Janis, I. L., 1956. Emotional inoculation: Theory and research on 
the effectiveness of preparatory communications. Paper to ap- 
pear in Psychoanalysis and the Social Sciences. International 
Universities Press. 

Johnson, W., 1946. People in Quandaries. Harper, p. 24. 

Jones, E., 1942. The concept of a normal mind. Int. J. Psycho- 
analysis, 2j: I. 

Jones, M., 1953. The Therapeutic Community. Basic Books. 

Kardiner, A., 1945. (With the collaboration of R. Linton, Cora 
DuBois and J. West). The Psychological Frontiers of Society. 
Columbia University Press. 

Kaufman, M. R., September 27, 1956. The problem of psychiatric 
symptom formation. Paper presented before Michigan State 
Medical Society. 

Klineberg, O., 1954. Social Psychology (rev. ed.), Henry Holt, p. 

397- 
Kluckhohn, C. and Murray, H. A. (Eds.), 1948. Personality in 

Nature, Society and Culture. Alfred Knopf. 

Kris, E., 1936. The Psychology of caricature. Int. f. PsychoanaL, 
ly: 290. 

Kubie, L. S., 1954. The fundamental nature of the distinction be- 
tween normality and neurosis. PsychoanaL Quart., 2j: 187, 188. 

Leighton, A. H., 1949. Human Relations in a Changing World. 
Button. 

Lewis, A., 1953. Health as a social concept. Brit. f. Sociol., 4: 109. 

Lindner, R., 1956. Must you conform? Rinehart, pp. 3, 205. 



REFERENCES [ 1^5 ] 

Maslow, A. H., 1950. Self-actualizing people: A study of psy- 
chological health. Personality Symposia, i: 16. 

, 1956. PersonaHty problems and personality growth. In 

Moustakas, C. (Ed.), The Self. Harpers. 

-, 1955. Deficiency motivation and growth motivation. In 



M. R. Jones (Ed.), Nebraska Symposium on Motivation. Uni- 
versity of Nebraska Press, pp. 8, 20, 24, 25, 27. 

May, R., 1954. A psychologist looks at mental health in today's 
world. Mental Hygiene, ^8: i. 

Mayman, M., 1955. The diagnosis of mental health. UnpubHshed. 
Menninger Foundation. 

Menninger, K. A., 1930. What is a healthy mind? In N. A. Craw- 
ford and K. A. Menninger (Eds.), The Healthy-Minded Child. 
Coward-McCann. 

, 1945. The Human Mind. (3rd ed.) Knopf, p. i. 

Merton, R. K., 1957. Continuities in the theory of social structure 
and anomie. In Social theory and social structure (Rev. Ed.), 
The Free Press, p. 177. 

Meyer, A., 1925. Suggestions of Modern Science Concerning Edu- 
cation (with H. S. Jennings and J. B. Watson). Macmillan, p. 
118. 

Milbank Memorial Fund, 1953. Interrelations Between the Social 
Environment and Psychiatric Disorders, p. 125. 

, 1956. The Elements of a Community Mental Health Pro- 
gram. 

Mowrer, O. H., 1948. What is normal behavior? In L. A. Penning- 
ton and I. A. Berg (Eds.), An introduction to clinical psy- 
chology. Ronald, p. 17. 

Piaget, J., 1952. The Origins of Intelligence in Children. Interna- 
tional Universities Press. 

Powell, J. W., 1957. The maturity vector. Adult Leadership, 5; 
252. 

Redlich, F. C, 1952. The concept of normality. Amer. J. Psycho- 
ther., 6: 551. 

Riesman, D., Glazer, N., and Denney, R., 1950. The Lonely 
Crowd. Yale University Press. 



[ 126 ] REFERENCES 

Riimke, H. C, 1955. Solved and unsolved problems in mental 
health. Mental Hygiene, ^g: 183. 

Sanford, F. H., 1956. Proposal for a study of mental health in 
education. First annual report, Joint Commission on Mental 
Illness and Health, Appendix H. 

Shoben, E. J., Jr., 1957. Toward a concept of the normal personal- 
ity. Amer. Psychol., 12: 183. 

Smith, M. B., 1950. Optima of mental health. Psychiatry, ly. 503. 

Stanton, A. H., and Schwartz, M. S., 1954. The Mental Hospital. 
Basic Books. 

Tillich, P., 1952. The Courage To Be. Yale University Press. 

Washington State Department of Health, June 195 1, Conference 
on research and evaluation of community mental health pro- 
grams. 

Wegrocki, H. J., 1939. A critique of cultural and statistical con- 
cepts of abnormality. /. Abnorm. and Soc. Psychol., j^: 166. 

White, R. W., 1952. Lives in progress. Dryden, p. 333. 

White, W. A., 1926. The Meaning of Disease. The Williams and 
Wilkins Company, p. 18. 

Wishner, J., 1955. A concept of efficiency in psychological health 
and in psychopathology. Psychol. Rev., 62: no. i, 69. 

Wright, H. F., and Barker, R. G., 1950. Methods in Psychological 
Ecology. University of Kansas. 



Aj^-pcndix 



joint Qommission 
on Rental Illness and Health 



PARTICIPATING ORGANIZATIONS 

American Academy of Neurology 
American Academy of Pediatrics 



American Occupational Therapy 
Association 



American Association for the Ad- 
vancement of Science 

American Association of Mental 
Deficiency 

American Association of Psychi- 
atric Clinics for Children 

American College of Chest Physi- 
cians 

American Hospital Association 

American Legion 

American Medical Association 

American Nurses Association 
and The National League 
for Nursing (Coordinating 
Council of) 



American Orthopsychiatric As- 
sociation 

American Personnel and Guid- 
ance Association 

American Psychiatric Association 

American Psychoanalytic Associ- 
ation 

American Psychological Associa- 
tion 

American Public Health Asso- 
ciation 

American Public Welfare Associ- 
ation 

Association for Physical and Men- 
tal Rehabihtation 

[127] 



[128] 

Association of American Medical 
Colleges 

Association of State and Territo- 
rial Health Ofl&cers 

Catholic Hospital Association 

Central Inspection Board, Amer- 
ican Psychiatric Association 

Children's Bureau, Dept. of 
Health, Education and Wel- 
fare 

Council of State Governments 

Department of Defense, U.S.A. 

National Association for Mental 
Health 

National Association of Social 
Workers 



APPENDIX 

National Committee Against 
Mental Illness 

National Education Association 

National Institute of Mental 
Health 

National Medical Association 

National Rehabilitation Associa- 
tion 

Ofl&ce of Vocational Rehabilita- 
tion, Department of Health, 
Education and Welfare 

United States Department of Jus- 
tice 

Veterans Administration 



MEMBERS 



Kenneth E. Appel, M.D. 
Philadelphia, Pa. 

Walter H. Baer, M.D. 
Peoria, Illinois 

Leo H. Bartemeier, M.D. 
Baltimore, Maryland 

Walter E. Barton, M.D. 
Boston, Massachusetts 

Otto L. Bettag, M.D. 
Springfield, IlHnois 

Mr. George Bingaman 
Purcell, Oklahoma 



Kathleen Black, R.N. 
New York, New York 

Daniel Blain, M.D. 
Washington, D.C. 

Francis J. Braceland, M.D. 
Hartford, Connecticut 

Hugh T. Carmichael, M.D. 
Chicago, Illinois 

J. Frank Casey, M.D. 
Washington, D.C. 

James M. Cunningham, MJ). 
Dayton, Ohio 



JOINT COMMISSION ON MENTAL ILLNESS AND HEALTH [ I29 ] 



John E. Davis, Sc.D. 

Rehoboth Beach, Delaware 

Neil A. Dayton, M.D. 
Mansfield Depot, Conn. 

Miss Loula Dunn 
Chicago, Illinois 

Howard D. Fabing, M.D. 
Cincinnati, Ohio 

Rev. Patrick J. Frawley, Ph.D. 
New York, New York 

Mr. Mike Gorman 
Washington, D.C. 

Robert T. Hewitt, M.D. 
Bethesda, Maryland 

Herman E. Hilleboe, M.D. 
Albany, New York 

Nicholas Hobbs, Ph.D. 
Nashville, Tennessee 

Bartholomew W. Hogan, Rear 
Adm. M.C., U.S.N., Washing- 
ton, D.C. 

Louis Jacobs, M.D. 
Washington, D.C. 

M. Ralph Kaufman, M.D. 
New York, New York 

William S. Langford, M.D. 
New York, New York 

Miss Madeleine Lay 
New York, New York 

Jack Masur, M.D. 
Bethesda, Maryland 

Berwyn F. Mattison, M.D. 
New York, New York 



Ernst Mayr, Ph.D. 
Cambridge, Mass. 

Robert T. Morse, M.D. 
Washington, D.C. 

Ralph H. Ojemann, Ph.D. 
Iowa City, Iowa 

Winfred Overholser, M.D. 
Washington, D.C. 

Howard W. Potter, M.D. 
New York, New York 

Mr. Charles Schlaifer 
New York, New York 

Lauren H. Smith, M.D. 
Philadelphia, Pa. 

M. Brewster Smith, Ph.D. 
New York, New York 

Mr. Sidney Spector 
Chicago, Illinois 

Mesrop A. Tarumianz, M.D. 
Farnhurst, Delaware 

David W. Tiedman, Ed.D. 
Cambridge, Mass. 

Harvey J. Tompkins, M.D. 
New York, New York 

Beatrice D. Wade, O.T.R. 
Chicago, Illinois 

Mr. E. B. Whitten 
Washington, D.C. 

Helen Witmer, Ph.D. 
Washington, D.C. 

Luther E. Woodward, Ph.D. 
New York, New York 



[ 130 ] APPENDIX 

OFFICERS 

President: Kenneth E. Appel, M.D. 

Philadelphia, Pa. 
Chairman, Board of Trustees: Leo H. Bartemeier, M.D. 

Baltimore, Md. 
Vice-President: M. Brewster Smith, Ph.D. 

New York, N.Y. 
Secretary-Treasurer: Mr. Charles Schlaifer 

New York, N.Y. 
Vice-Chairman, Board of Trustees: Nicholas Hobbs, Ph.D. 

Nashville, Tenn. 

STAFF 

Director: Jack R. Ewalt, M.D. 

Boston, Mass. 
Consultant for Scientific Studies: Fillmore H. Sanford, Ph.D. 

Austin, Texas. 
Consultant in Social Sciences: Gordon W. Blackwell, Ph.D. 

Chapel Hill, North Carolina 
Consultant tn Epidemiology: John E. Gordon, M.D. 

Boston, Mass. 
Associate Director for Administration: Richard J. Plunkett, M.D. 

Boston, Mass. 
Director of Information: Greer WilHams 

Boston, Mass. 
Associate Director and Consultant on Law: Charles S. Brewton, LL.B. 

Boston, Mass. 
Librarian: Mary R. Strovink 

Boston, Mass. 



Index 



accommodation, 62 
achievement level, as measure of 

self-actualization, 87-88 
acquisition of mental health, 104 
adaptation 

problem-solving and, 63 

reality and, 60-62 

(see also environmental mas- 
tery) 
adjustment 

adaptation and, 62-63 

to environment, autonomy and, 
47-48 
Adler, Alfred, 55 
age groups, mental health cri- 
teria and, 101-103 
Alexander, Franz, 12 
alienation, 57 
AUinsmith, Wesley, 42 
alloplastic attitude, 71 
Allport, F. H., 105 
AUport, Gordon W., 25-26, 27, 31, 

Angyal, Andras, 48 
anthropology 



mental disease and, 12-14 

normality and, 15 
anxiety, 42-43 
anxiety tolerance, 41-43 

measurement of, 90-91 

(see also stress) 
Asch, S. E., 14, 92 
assessment, of mental health, 81- 

100 
assimilation, 62 
attitude 

alloplastic, 71 

heterogenic, 33-34 

(see also self, attitude toward) 
autonomy, 23, 43, 45-49, 71 

measurement of, 91-92 

B 

Barker, R. G., 107 

Barron, F., 26, 40, 50 
Barton, Walter E., 111-119 
becoming (see self -actualization) 
Benedict, Ruth, 12 
Bettelheim, B., 108 
Blau, A., 56 
Boehm, W. W., 19, 20 
Braceland, Francis J., 117-119 

[131] 



[132] 

Biihler, Charlotte, 44 
Biihler, K., 44 



Cannon, Walter, 113 

Cattell, Raymond B., 27, 28 

Chapman, D. W., 91 

Chein, Isidor, 61 

child, mental health of, 58-59, loi- 
103, 106 

childbirth, mental health and, 
117-118 

Clausen, J. A., 91 

clusters, of mental health criteria, 
loo-ioi (^see also multiple 
criterion) 

cognition (^see perception, of re- 
ality) 

community, mental disease and, 

13-14 

concern for others, self-actualiza- 
tion and, 35 

conflict, as mental disease, 13 

conformity, 47-48 

Conrad, Dorothy C, 57-58, 74 

conscious, in integrated person- 
ality, VJ, 38 

consciousness, of self, 25-27 {^see 
also self, attitude toward) 

contentment, 19-21 

Cottrell, L. S., Jr., 46, 52, 56 

cultural relativism, 13 

cultural values, 76-80 

culture, mental disease and, 12-13 
{see also society) 

D 

Darw^in, Charles, 114 
Davis, K., 17 



INDEX 

decision-making process, 45-46, 

48 

assessment of, 91-92 
development, 71 

sense of identity and, 30 

{see also growth) 
Devereux, G., 13 
Dicks, H. v., 57 
disease, physical, 67-68 {see also 

illness; mental disease) 
Dubos, Rene J., 1 14 
Duncker, K., 63, 95 
Dunham, H. W., 107 



ego 

in integrated personality, 37-38 
reality and, 61 
{see also self) 
ego-identity {see identity) 
ego-psychology, reality-orientation 

and, 44 
empathy 

measurement of, 94 
in perception of reality, 52-53 
empirical 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 
assessment of, 94-95 
Erikson, Erik H., 29-30, 41, 54-55, 

71, lOI 
Ewalt, Jack R., 42, 50 



INDEX 



[133] 



Paris, R. E. L., 107 

flexibility, in integrated person- 
ality, 38-39 

Foote, N. N., 46, 52, 56 

frequency concept of normality, 
15-18 

Freud, Sigmund, 34, 37, 61 

Fromm, Erich, 8, 27, 30, 31, 32, 

57> n 



genitality {^see orgastic pleasure) 
Ginsburg, S. W., 55, 57, 80 
Glover, E., 42 
Goethals, George W., 42 
Goldstein, K., 31, 32 
Gottlieb, Jacques S., 116-117 
growth, 23, 30-35, 71 
measurement of, 87-89 

H 

Hacker, F. J., 54 
happiness, 18-21 
Hall, C. S., 27, 29, 35 
Hartmann, Heinz, 37-39, 44, 46, 

47, 60-61, ^() 
Havens, Leston L., 114-115 
health, mental {^see mental 

health) 
health, physical {see physical 

health) 
health potential, 14 
heterogenic attitude, 33-34, 71 
HoUingshead, A. B., 107 
Horney, Karen, 56 
Howell, Roger W., 11 6-1 17 
Hunt, J. McV., 61 



id, in integrated personality, 37-38 
identity, sense of, 28-30 

integrated personality and, 41 
independence {see autonomy) 
illness, health and, 112-119 {see 

also mental disease) 
integration of personality, 23, 

35-43. 54. 71-72 
measurement of, 89-91 
interpersonal relations 
assessment of, 95 
environmental mastery and, 53, 

56-58 

sense of identity and, 29-30 
investment in living 
measurement of, 87, 89 
self -actualization and, 32, 34-35, 

J 

Jahoda, Marie, 50, 51, 63, 72 

Janis, I. L., 42 

Janowitz, M., 108 

Johnson, Wendell, 43-44 

Joint Commission on Mental Ill- 
ness and Health, 19, 127- 
130 

Jones, Ernest, 16-17, 19, 20 

Jones, M., 107 

Jung, Carl, 35 

K 

Kardiner, A., 107 
Kaufman, M. Ralph, 115-116 
Klineberg, Otto, 12 
Kluckhohn, Clyde, 69 



[134] 

Kris, E., 37 

Kubie, L. S., 27, 38-39 



Leighton, Alexander, 7 
Lewin, Kurt, 88 
Lindner, R., 35 
Lindzey, G., 27, 29, 35 
Linton, Ralph, 13 
love, ability to, 53, 54-55 
assessment of, 95 

M 

McDougall, William, 29 
maintenance of mental health, 

104-108 
majority concept (^see frequency 

concept) 
Maslow, A. H., 28, 31, 32-33, 34, 

40. 47> 50j 70 
mastery of environment {see en- 
vironmental mastery) 
May, RoUo, 57 
Mayman, M., 25, 26, 31-32, 33-35, 

46-47, 56, 71, 75 
Menninger, Karl, 18-19, 20 
mental disease, 6, 73-76 
definitions of, 10-14 

anthropological, 12-14 
diagnosis of, 10-12 
{see also illness) 
mental health 

concepts of, 5-66, 76-110 

empirical indicators for, 82- 

100 
research in, 81-110 
unsuitable, 10-21 



INDEX 

values and, 76-80 
definitions of, 3-4 
mental disease and, 10-15, 

73-76 
types of, 66-73 
mental patients, mental health 

criteria and, 103-104 
Merton, Robert K., 68 
Meyer, Adolf, 109 
Money-Kyrle, Roger E., 50 
moral values {see values) 
motivational processes, self-actu- 
alization and, 32-35 
Mowrer, O. H., 17 
multiple criterion of mental 
health, 70-73 {see also 
clusters) 
Murray, Henry, 30, 69 

N 

need distortion, in perception of 

reality, 51-52 
negative health, 74 
nonhealth, 74 
normality, 15-18 
case study of, 66-67 

O 

objectivity, toward self, 27 
observation, as measurement of 

health, 84-86 
optimum mental health, 49, 72-73 
orgastic pleasure, 54-55 



perception, of reality, 23, 43, 

49-53. 7^-7^ 
measurement of, 92-94 



INDEX 

personality, integration of (see 

integration) 
physical health, 67-68, 112-116 
Piaget, Jean, 62 

plasticity, in integrated person- 
ality, 38 
play 

assessment of, 95 
environmental mastery and, 

55-56 
Porterfield, John, 50 
positive mental health {see mental 

health) 
preconscious, in integrated per- 
sonality, 37, 38 
problem-solving 
as environmental mastery, 53, 

62-64 
measurement of, 95 
proprium, 40 
psychoanalytic theory 
mental disease and, 13 
reality-orientation and, 44 
(see also Freud) 

R 

reality 

adaptation and, 60-62 

attitude tow^ard self and, 27, 28 
reality-orientation, 43-45 {see also 

perception) 
Redlich, F. C, 17, 107 
Reich, Wilhelm, 54 
research 

requirements for, 81-82 

suggestions for, 100-104 
resistance, to stress {see stress) 
Riesman, David, 47, 48 



[135] 



Rogers, Carl, 31 
Riimke, H. C, 73-74 



Sanford, Fillmore H., 58 

satisfaction, 19 

Schwartz, M. S., 107 

self, attitude toward, 23, 24-30, 

observation of, 83-87 
{see also autonomy; self-ac- 
tualization) 

self-acceptance, 28 

self-actualization, 23, 30-35, 70-71 
measurement of, 87-89 
unifying outlook and, 40-41 

self -concept {see self, attitude to- 
ward) 

self-consciousness, 25, 26-27 

self-determination, 46, 71 {see 
also autonomy) 

self-extension, 34, 39 

self-objectification, 39 

sense of identity {see identity) 

sexual pleasure, 54-55 

situation 
assessment of, 95 
behavior and, 58-59, 85 
{see also environment) 

Smith, M. Brewster, 49, 72 

social values {see values) 

society, health of, 8-9 {see also 
culture) 

Stanton, A. H., 107 

stress, resistance to, 36, 41-43 
measurement of, 90-91 

success {see environmental mas- 
tery; problem-solving) 



[136] 

Sullivan, Harry Stack, 31, 56 
superego, in integrated person- 
ality, 37-38 



testing, of reality, 51-52 

tests, for self-descriptions, 83-86 

therapy, mental health criteria 

and, 104 
Tillich, Paul, 43 
tranquilizing drugs, 104 



U 

unconscious, in integrated person- 
ality, 37, 38 
unifying philosophy, 71 

in integrated personality, 36, 

39-41 
measurement of, 90 



INDEX 



value judgment, in science, 6-7 
values, 76-80 

W 

Weber, Max, 75 
Wegrocki, H. J., 17 
well-being, as mental health con- 
cept, 18-21 
White, Robert, 30, 66-67 
White, William Alanson, 6'jj 70 
Wishner, Julius, 59 
work 

assessment of, 95 

environmental mastery and, 

55-56 
World Health Organization, 18, 

56 

Wright, H. F., 107 



Date Due 






Current concepts of positive m mam 
131.306J74mno 1 C2 



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