A proposed new definition of mental health

Abstract

The authors propose a new approach to the definition of mental health, different than the definition proposed by the World Health Organization, which is established around issues of person's well-being and productivity. It is supposed to reflect the complexity of human life experience.

Full text

Psychiatr. Pol. 2017; 51(3): 407–411
PL ISSN 0033-2674 (PRINT), ISSN 2391-5854 (ONLINE)
www.psychiatriapolska.pl
DOI: https://doi.org/10.12740/PP/74145
A proposed new denition of mental health
Silvana Galderisi1, Andreas Heinz2, Marianne Kast r u p 3, Julian B e e z h o l d 4,
Norman Sartorius5
1 Department of Psychiatry, University of Naples SUN, Naples, Italy
2 Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin,
Berlin, Germany
3 Specialist in Psychiatry, Own rm, Denmark
4 Hellesdon Hospital and Norwich Medical School, University of East Anglia, Norwich, UK
5Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
Summary
The authors propose a new approach to the denition of mental health, dierent than the
denition proposed by the World Health Organization, which is established around issues of
person’s well-being and productivity. It is supposed to reect the complexity of human life
experience.
Key words: mental health, denition
Introduction
The denition of mental health proposed by the World Health Organization (WHO)
[1]1 is organized around a hedonic and eudaimonic perspective, in which a key role
is assigned to person’s well-being and productivity. While regarding well-being as
a desirable goal for many people, its inclusion in the denition of mental health raises
concerns. According to Keyes [2], well-being includes emotional, psychological and
social well-being, and involves positive feelings (e.g., happiness, satisfaction), positive
attitudes towards own responsibilities and towards others, and positive functioning
(e.g., social integration, actualization and coherence).
1 Mental Health is a state of well-being in which the individual realizes his or her own abilities, can cope with
the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or
her community [1].

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408
However, people in good mental health experience a wide range of emotions, such
as sadness, anger or unhappiness; most adolescents are often unsatised, unhappy
about present social organization and may lack social coherence. Does this mean that
they are not in good mental health? A person responsible for her/his family might feel
desperate after being red from his/her job, especially in a situation characterized by
scarce occupational opportunities; should we question her/his mental health? Actually,
raising the bar of mental health may create unrealistic expectations, encourage people
to mask most of their emotions while pretending constant happiness, and even favor
their isolation when they feel sad, angry or worried.
Also the concept of positive functioning (“can work productively and fruitfully”),
in line with the eudaimonic tradition [3], raises concerns, as it implies that a person
at an age or in a physical or even political condition preventing her/him from working
productively is not by denition in good mental health.
The denition of mental health is clearly inuenced by the culture that denes it.
However, as also advocated by Vaillant [4], an eort can be made to identify elements
that have a universal importance for mental health, as for example, vitamins and the
four basic food groups are universally given a key role in eating habits, in spite of
cultural dierences.
A new denition of mental health
In the light of the above considerations we proposed the following denition:
Mental health is a dynamic state of internal equilibrium which enables individuals
to use their abilities in harmony with universal values of society. Basic cognitive and
social skills; ability to recognize, express and modulate one’s own emotions, as well
as empathize with others; exibility and ability to cope with adverse life events and
function in social roles; and harmonious relationship between body and mind represent
important components of mental health which contribute, to varying degrees, to the
state of internal equilibrium [5].
In the denition, the internal equilibrium is regarded as a “dynamic state” mainly
to reect the fact that dierent life epochs (adolescence, becoming a parent, retirement)
challenge the achieved equilibrium and may require changes.
Mental health components
The elements of the denition cited above are regarded as important but not man-
datory resources. They may contribute to a varying degree to mental health, so that
fully developed resources may oset an impairment in another component. A very
empathetic person, for instance, may compensate for a moderate degree of cognitive
impairment, develop a very good social network, a satisfactory equilibrium and pur-
sue her/his life goals. Basic cognitive and social skills are regarded as an important
component of mental health in the light of their impact on all aspects of everyday life

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A proposed new denition of mental health
[6]. They include the ability to pay attention, remember and organize information,
solve problems, make decisions, and use one’s own repertoire of verbal/non-verbal
abilities to communicate and interact with others. The term “basic” is meant to clarify
that mild degrees of impairment are compatible with mental health, while moderate to
severe degrees of impairment, especially if not balanced by other aspects, may require
social support and incentives, such as facilitated job opportunities, nancial benets
or ad hoc training programs.
The ability to recognize, express and modulate one’s own emotions is also re-
garded as an important component of mental health [7]; it represents a mediator of
stress adjustment [8–10] and its impairment is a risk factor for mental and physical
disorders [11]. Empathy, i.e., the ability to experience and understand what others
feel, is important in communicating and interacting in eective ways and to predict
actions, intentions, and feelings of others [12]. Poor empathy is a risk factor for
violence, a feature of antisocial personality disorder, and may impair social interac-
tions at all levels. Flexibility refers to the ability to modify one’s own behavior or
ideas in the light of unpredicted events or new evidence. Poor exibility may result
in great distress for a person undergoing sudden and/or important life changes, and
is an important aspect of several psychiatric disorders, such as obsessive personal-
ity or delusional disorder [13]. The basic ability to function in social roles and to
participate in meaningful social interactions is reported in the denition and deemed
an important aspect of mental health, as it contributes to resilience against distress;
however, a careful analysis of factors impairing social participation and favoring
social exclusion is always needed to avoid confusing the results of stigmatization,
discrimination and scarce opportunities with individual’s poor ability to participate
in the life of the community [14–16].
The mind is embodied, and heavily interconnected with the brain, organism and
environment. [17]. Disturbances of these interactions may result in psychotic experi-
ences, eating disorders, self-harm, body dysmorphic disorder or poor physical health.
Conclusions
The proposed denition aims to overcome perspectives based on ideal norms or
hedonic and eudaimonic theoretical traditions, in favor of an inclusive approach, reect-
ing as much as possible the complexity of human life experience, which is sometimes
joyful, and at other times sad or disgusting or frightening, sometimes satisfactory,
and at other times challenging or unsatisfactory. The denition contains reference to
universal values of human society. While this aspect remains controversial due to the
diculty of conceiving a denition free of culture-bound statements, all eorts were
made to minimize this aspect and provide examples of largely shared values, such
as respect and care for oneself and other living beings; recognition of connectedness
between people; respect for the environment; respect for one’s own and others’ free-
dom. The reference to values is deemed important, given the importance of values

Silvana Galderisi et al.
410
in building individual’s identity, but the possibility of improving this aspect of the
denition deserves attention.
Our denition is also in line with the current perspective of recovery after an ill-
ness, regarded as a process through which the person may attain a fullled and valued
life by building on the functions spared by the illness [18].
Acknowledgment
This article is a modied version of the article published in World Psychiatry [5].
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Address: Silvana Galderisi
University of Campania “Luigi Vanvitelli”
Largo Madonna delle Grazie
80138 Naples
Italy