There’s an obvious answer, right? There isn’t.
Many people seem to live by the principle of the 1960s counterculture: ‘If it feels good, it is good.’ (In particular the corollary, ‘If it feels bad, it is bad.’) That would be really convenient, no? If I’m happy, if you’re happy, let’s go with it! Blog post done: health is being happy.
Not so fast.
There are countless examples where this ethos fails us. For example, schadenfreude, or pleasure in others’ suffering. It makes sense for our bodies to feel relief or pleasure when we escape pain, but this may get in the way of relationships. Or, ingesting psychoactive drugs or sugar: using them constantly would feel good; the effects on our bodies, and lives, however – not so much.
Happiness can definitely be a positive experience; equating it with health, however, may be dangerous. More on this later.
Okay, maybe it’s more simple: health = lack of illness. Not sick. Well, first off, now you have two terms reciprocally defining each other. Not helpful. Maybe illness is when you feel poorly? Then you go straight back to the happiness problem. “No pain, no gain” may not always be true, but it is sometimes true.
Statistical approach?
What is it, then? Let’s look at the research, that should help, right? Okay. I literature search “definition of mental health” and get this: “Mental health has long been defined as the absence of psychopathologies” (Westerhof and Keyes, 2009). Arg, not helpful. Okay, how is psychopathology defined? “Psychopathology refers, in a general sense, to the empirical and theoretical study of anomalous experience, expression, and action” (Parnas, Sass, and Zahavi, 2013). Anomalous is a fancy word for abnormal, and ‘normal’ is a statistical concept: falling less than 2 standard deviations from the mean. Essentially, modern psychiatry takes as its stance that mental illness is having psychological or behavioral experiences that are uncommon. So… mental health is the absence of uncommon experiences?
Sorry. If this were the case, only approximately 2.5% of people should receive any psychiatric diagnosis. Lifetime rates for many DSM (Diagnostic and Statistical Manual, published by the American Psychiatric Association) categories far exceed this bar: anxiety disorders, depressive disorders, behavioral control disorders, substance use disorders, etc. (e.g., Merikanagas et al., 2010; Steel et al., 2014). These cross-sectional surveys may underestimate (Moffitt et al., 2009). You may argue that the 2.5% bar should be taken as the rate at any given time, and that people can fluctuate in and out of this, just like getting a cold and then recovering. Yet this bar is still not met by those same studies.
Common anomalies?
Two additional points. First, the DSM persistently advises to make a diagnosis only when these issues cause a high degree of distress, and/or functional impairment. Think about the implication of this: the diagnostic bar is not the experience itself, but its impact. This is like saying you only have a Cold when it prevents you getting to work. When you instead look at the level of experience, for any of the experiences in the DSM, lifetime rates often exceed 50%. In other words, these experiences are the norm. And second, inclusivity is how we want it to be, right? If I’m struggling, I want access to support, not to have to wait till I fall apart so much that only 2.5% have become that dysfunctional.
To be continued…