The dangerous ideal of mental health
Simon Keller is a professor of Philosophy at Victoria University of Wellington.
We are in the midst of a significant change in the way we think about mental health.
For most of medical history, mental health has been understood as the absence of mental disorder – and any progress in mental health has meant progress in understanding the varieties of mental illness and other forms of mental distress, and how they can be prevented and treated.
Today, however, mental health is increasingly understood as a positive state: as something to aspire to.
Led by the new academic field of positive psychology and by popular trends like the mindfulness movement, we are coming to see mental health as an ideal that we can work to achieve. As you might go to the gym or change your diet to get a healthy body, people now will meditate or practice mindfulness or write gratitudes, with the goal of attaining a healthy mind.
This new positive conception of mental health should be treated with suspicion. Beyond our understanding of mental illnesses and other negative mental conditions, we do not have much of a clue about what mental health is.
We have a decent understanding of bodily health, because we have a decent understanding of the function of the body and its parts. Lungs are for breathing; legs are for walking; a heart is for pumping blood. Mostly, a body is healthy if its parts perform their functions well. But what is the function of the human mind? What is the true purpose of our thoughts, feelings, emotions and beliefs?
We might find the function of the human mind in its evolutionary history, in a story about what the human mind was selected to do. But it is doubtful that evolution selected us for mental health. We are not designed by evolution to be stress-free, well-adjusted, tranquil and compassionate. Rage, jealousy, self-doubt and cruelty are all equally components of the evolved human mind. What helped us to survive evolutionary selection does not guarantee a healthy life in the modern world.
A different story about the function of the human mind can be found at the beginnings of Western philosophy, in Aristotle. Humans are special, Aristotle says, because humans are rational, and so the function of the human mind is to display excellence in rationality. As Aristotle is aware, however, this story raises as many questions as it answers. To explain what it takes to achieve excellence in rationality, we need an account of good human reasoning, and this is a matter of values. The ideal of mental health quickly becomes a moral ideal.
Many public health bodies see mental health simply as happiness, or as "wellbeing". The World Health Organisation defines mental health expansively, saying that a mentally healthy person "realises his or her own potential", "can work productively and fruitfully", and "is able to make a contribution to his or her community", among other things.
That definition sounds benign, but in its way, it is quite judgmental. Most of us probably do not realise our own potential; do we then fall short of full mental health?
Why connect the healthy mind so closely with productive work? And if you are unable to contribute to your community, perhaps the problem lies with the community, not with your mind.
No matter how it is understood, a positive conception of mental health always expresses a moral or political ideal, entailing a view about how humans should live and how we should relate to each other. People of different ideologies, religions, and cultures will naturally disagree about what true mental health looks like.
But that is not how the positive conception of mental health is usually presented. The positive conception of mental health is dangerous, because it takes the concept of health, which we usually treat as objective and scientific, and applies it to the questions of how we should think and how we should live. It hides moral and political ideals beneath a veneer of medical inevitability.
It is one thing to understand and treat mental illness and distress. It is another thing to choose a vision of human life and present it as the ideal of mental health.
Before thinking about what it means to achieve mental health, you need to think about what kind of person you would like to be. Mindfulness or meditation might help you become the person you want to be. So might playing bridge, reading novels, hanging out with friends, doing well at your job, helping others, playing computer games or watching cricket. None of these activities has an intrinsically greater claim to be the key to mental health.
The question of how to achieve mental health comes down ultimately to an ancient, difficult, personal and thoroughly moral question: the question of how we ought to live. It is not a question that science or medicine can answer.
Written by Simon Keller. First appeared on Stuff.co.nz.
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