In May of last year, incoming president of the American Psychiatric Association, Dilip Jeste, urged psychiatry to aim higher:
“The goal will not be just to improve psychopathology but to help patients grow, flourish, develop, and be more satisfied with their lives. That is positive psychiatry; positive because it focuses on enhancing personal wellbeing through the use of positive psychosocial factors, such as resilience, optimism, wisdom, and social engagement.”
The field of positive psychology, initiated by Martin Seligman in the late 1990s, has helped begin to build and refine our scientific understanding of the positive end of the mental health spectrum or what makes people thrive.
Clinical psychiatry and psychology’s emphasis on alleviating suffering has neglected what makes life most worth living. Positive psychology is founded on the belief that people hope for more than an end to suffering, they hope to thrive and live the best things in life.
People want to lead meaningful and fulfilling lives, to find purpose, to nurture what is best within themselves, to strengthen areas of weakness, and to improve their experiences of love, work, and leisure.
Recently, Seligman changed the major focus of positive psychology from happiness to wellbeing. Therefore, positive psychology and positive psychiatry share the same vision.
Karl Menninger once said that mental health is to adapt to the external world with contentment and master the task of acculturation.
Concepts of wellbeing seem to differ between cultures. Older people tend to define health as inner strength and the ability to cope with life’s challenges. Younger people tend to emphasize fitness, energy and strength.
People with comfortable living conditions tend to think of health in terms of enjoying life, while people who are not so well off tend to conceive of health as just managing the essentials of daily life.
In the Western world we may emphasize rugged individualism, while in the East there is more concern for the wellbeing of the collective social group.
Abraham Maslow said that self-actualization is to realize one’s full potential, while self-transcendence means that the individual’s own needs are put aside to some degree in favor of service to others.
Resilience involves adapting to stress with coping skills, both intentional and unconscious, and social support.
Mental health is based on an active, joyous, energetic engagement with the world. It also includes strength of character, the capacity to deal with conflicting emotions, the ability to experience pleasure without conflict, to be flexible and to adapt to a changing environment, to achieve insight into oneself, to live without fear, guilt, or anxiety, to face anxiety with courage, emotional security resulting in flexibility and spontaneity in dealing with others, and to take responsibility for one’s own actions.
Seligman views wellbeing as positive emotion, engagement in activities, good relationships, meaning in life, and accomplishment. Optimal mental health should result in optimal longevity and quality of life.
Positive psychiatry’s goal to promote mental health may mean public policy changes.
It could result in centers for mental health promotion and prevention as well as clinical services for those who are ill, mental health promotion and prevention education in schools, and the use of a wellbeing index for communities to inform public policy.
This is a challenging goal, but positive psychology and psychiatry are using rigorous research to uncover the road to good health and wellbeing across the lifespan.
As Henry Kissinger once said, “If you don’t know where you are headed, any road will take you there.”
Jeremy Herschler, MD