Article of the Day: If Everyone Is Disturbed, Then Who’s Healthy?

We lack a definition of what psychological health looks like in today’s world.

Following a recent talk to a group of business people, a man cornered me and said, “I work hard, I’m pretty successful, I have stable, second marriage and kids who are doing well…and yet I often feel unsatisfied with my life and don’t know why. Am I disturbed?”

Dr. Allen Frances

His question reminded me of an ongoing controversy over the forthcoming revision of the Diagnostic & Statistical Manual of Mental Disorders, the DSM-5. Many are criticizing it for turning normal variations of human emotions and behavior into mental disorders. That’s likely to generate more diagnoses for depression or ADD, for example. Its most prominent critic is Allen Frances, the psychiatrist who chaired the committee that drafted the previous edition. Among his and others’ criticisms is that the revisions will lead to more drugs to “treat” ever-expanding definitions of mental disorder.

This drift towards defining mental disorder upwards is troubling. But I think it masks another important, but largely ignored, problem on the flip side: There’s no good definition of what psychological health looks like in today’s world, in contrast to disturbance.

In my view, the mental health field has largely ignored understanding what healthy thinking, emotions, spirit and behavior should look like in our 21st Century world of rapid change, interconnection, constant flux and unpredictability. Try Googling “mental health.” Most of what comes up are descriptions of mental illness or disorder, and how to treat it. Or, it’s described as the absence of disorder.

mhIn researching this I’ve been interviewing a range of people about their views of psychological health in today’s world. They include ordinary people, psychotherapy “consumers,” academic researchers, and mental health practitioners. (And I invite readers to offer their own views in the “Comments” section below).

I find that most draw a blank when attempting to offer a definition that’s more than vague, general phrases. The closest to a prevailing view of health among practitioners, to the extent there is one, is successful “management” and “coping” of old conflicts. The residue of emotional damage from early trauma and conflict that can occur during one’s early development or subsequent life experiences, if left unhealed and unconscious, becomes visible in definable symptoms and dysfunction, from mild to severe.

Creating greater consciousness about how one’s conflicts play out in life, and learning to manage and cope successfully with their residue are essential and valuable for a happier and better functioning life. But there are two problems with this view of “health.” One is that it lacks a view of what a psychologically healthy personality looks like beyond successful management and coping. It’s static. It has no picture of how or if a psychologically healthy person should continue to grow or evolve through life.

The second problem is that many men and women are able to manage and cope with the residue of old conflicts. But they suffer new conflicts as they seek to adapt to new challenges and circumstances in their relationships and working lives; as they try to find happiness within them.

…much of our thinking in psychology and psychiatry is frozen within a 20th Century mindset…

Then And Now…

The problem is that much of our thinking in psychology and psychiatry is frozen within a 20th Century mindset, and it has little relevance for today. To simplify for the sake of highlighting the contrast between past and present: Prior to 9-11 and the economic meltdown of 2008, people were more likely to experience adversity or disruptions that were more predictable, more linear. They followed a fairly understandable course, following which one could reasonably anticipate returning to some form of stability. Wars eventually ended. The economy went through recessions, then recovered. One might suffer a career or relationship setback but could assume that there was a path to recovery.

The growth of psychoanalysis and psychotherapy throughout the 20th Century, following the pioneering work of Freud, helped people uncover the roots of conflicts that impeded or undermined their successful adjustment to that world. Strengthening the ego served the aims of effectively managing internal conflicts, in order to adapt well and achieve one’s goals in life — as it then existed.

pfyOne downside, even there: Therapists equated psychological health with embracing the values and behavior that were culturally rewarded and “successful.” Those included adversarial competition; power-seeking for oneself; consuming material goods; living with trade-offs between your personal values and outward behavior; depleting resources in disregard for future generations. That often didn’t work so well as the 20th Century came to a close. Some years ago I documented the emotional downside of this kind of “successful” adaptation, in Modern Madness.

That 20th Century mindset is one that seeks to extract value for oneself, from the environment one operates in – at work or in one’s relationship; in contrast to creating value for all, within an interdependent environment in a state of constant flux and change. The latter marks today’s world. It’s an inter-connected, interdependent, diverse, unpredictable and unstable global community. Our lives and institutions are reeling in the face of a world turned upside down by the events of the first decade: terrorism that’s come home to roost; economic meltdown at home and abroad; rapid rise of previously “underdeveloped” nations; and social as well as political upheavals. We now live in a highly interconnected, unpredictable, digitalized world.

Ongoing disruptions, continuous uncertainties and insecurity have become the new normal. Seeking stability and acting on self-interest alone is no longer the ticket to success or well being. A person who’s too absorbed in his or her own self, own desires, conflicts, disappointments and the like is much less able to handle today’s flood of life dilemmas and challenges in positive, creative, solution-oriented ways. That deficiency circles back to create dysfunction, damaged relationships and career downturns.

So — What Is True Psychological Health Today?

povThe upshot is that our era calls for a new definition of psychological health and description of what promotes it. It must be relevant to the 21st Century context — the interdependence, rapid technological change, political and economic uncertainty; and the ongoing social-cultural shifts in people’s values, behavior and beliefs. That’s a tall order.

There are views of “new age” writers, but most are high on inspiration and abstraction but very low on practical application, let alone understanding psychological or social forces. So most of those are not helpful, in my view. The “positive psychology” movement attempts to understand how people may grow and evolve during their lifetimes. But it tends to be insufficiently grounded in empirical evidence, and therefore is less credible as a guide to describing the criteria for psychological health.

As far as where my own thinking is going, I find enormous relevance in melding psychology with the insights and teachings from Eastern perspectives, particularly Sufism and Buddhism. The psychological and spiritual views of those traditions coincide with much new research and clinical observation regarding the mind/body/spirit, including the nature of consciousness; the innate orientation to empathy and compassion; and evidence that one can free oneself from self-imposed constraints regarding one’s self-definition, and activate otherwise dormant capacities and qualities within oneself.

Douglas LaBier Ph.D.
is a business psychologist and psychoanalytic psychotherapist.

This article appeared in Psychology Today on 1 April 2013

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