Thursday, 14 June 2012

Vaillant, G.E. (2012) ‘Positive mental health: is there a cross-cultural definition?’

I’ve been reading

Vaillant, G.E. (2012) ‘Positive mental health: is there a cross-cultural definition?’ World Psychiatry 11: 93-99

and it suggests a general dilemma for any cross-cultural definition of mental health.

Vaillant outlines seven different empirical models of mental health.

First, mental health can be conceptualized as above normal, as epitomized by a DSM-IV’s Global Assessment of Functioning (GAF, 6) score of over 80. Second, it can be regarded as the presence of multiple human strengths rather than the absence of weaknesses. Third, it can be conceptualized as maturity. Fourth, it can be seen as the dominance of positive emotions. Fifth, it can be conceptualized as high socio-emotional intelligence. Sixth, it can be viewed as subjective well-being. Seventh, it can be conceptualized as resilience. [Vaillant 2012: 93]

He says that he contrasts them. But in fact there is no critical assessment of them. Instead:

To avoid quibbling over which traits characterize mental health, it is helpful to adopt the analogy of a decathlon champion. What constitutes a “track star”? A decathlon star must possess muscle strength, speed, endurance, grace and competitive grit, although the combinations may vary. Amongst decathlon champions, the general definition will not differ from nation to nation, or century to century. The salience of a given facet of a decathlon champion, or of mental health, may vary from culture to culture, but all facets are important. [ibid: 93-4]

That is, also, pretty much all says about the question of whether any or all of the approaches might serve as cross cultural definitions. But the paper implicitly raises a few questions about the very idea of this.

First, there is the distinction between a definition of mental health and an instance of the definition. Are the brisk accounts offered supposed to be definitions of what mental health is? Or are they supposed to be examples of the way in which mental health might be instanced? The former claims generality. The latter may be 7 from a potentially infinite list. Vaillant’s relaxed attitude to lumping them together suggests the latter but if so there’s no attempt at the definition promised in the title.

Second, the obvious worry about a cross-cultural definition of mental health is parochialism. One may draw up an account that presupposes or expresses merely a local view of what matters. This worry is increased the more substance there is to it. Roughly, the more one says, the more likely it is to draw on a local view. But if one avoids this through greater abstraction, the risk is that of vacuity. One will end up saying very little about what mental health is.

Third, one might succeed in arriving a cross-cultural definition which is merely contingently cross-cultural. One way of doing that would be to take as many locally specific conceptions of mental health as there are cultures and construct a disjunction of them all. That would then be a cross-cultural account (akin to a Tarskian enumeration of truths) but (like Tarki’s account) would be subject to the counter-factual worry that had there been a further community it would not have been covered by the enumeration. (The enumeration offers no inductive warrant for further extension.)

Given these points, and given the title of the article, I would expect Vaillant to draw to offer some sort of theoretical backing for the substance he offers. For example, if one connected a concept of mental health to mental functioning underpinned by evolutionary theory, one would have the start of an account of what was essential (that is, on the temporary assumption that one get a non-question-begging account of human mental functioning from evolutionary theory: an assumption I do not share).

Failing that Nature’s eye perspective, how else might one attempt such a justification? One possibility would be to offer a conception of human flourishing without appeal to a reductionist base. So one might offer a richly normative account of how humans ought to function in the way that Aristotle does (an Vaillant mentions). But now the worry returns that this is merely a local perspective. Let me sketch just one exampe of this from Vaillant’s paper, not his Aristotle section in truth, but his sketch of Erikson’s model of maturity.

In Erikson’s model, adult maturity is achieved over time through the mastery of the four sequential tasks of “identity”, “intimacy”, “generativity”, and “integrity”.
Identity is not just a product of egocentricity, of running away from home, or of marrying to get out of a dysfunctional family. There is a world of difference between the instrumental act of running away from home and the developmental task of knowing where one’s family values end and one’s own values begin...
Next, young adults should develop intimacy, which permits them to become reciprocally, and not selfishly, involved with a partner. Living with just one other person in an interdependent, reciprocal, and committed fashion may seem neither desirable nor possible to a young adult. Once achieved, however, the capacity for intimacy may seem as effortless and desirable as riding a bicycle... Career consolidation is a task that is usually mastered together with or that follows the mastery of intimacy...There are four crucial developmental criteria that transform a “job” into a “career”: contentment, compensation (i.e., useful to others, not just a hobby), competence and commitment. Failure to achieve career consolidation is almost pathognomonic of severe personality disorder.
Mastery of the fourth task, generativity, involves the demonstration of a clear capacity to care for and guide the next generation. Existing research reveals that sometime between age 35 and 55 our need for achievement declines and our need for community and affiliation increases.
The penultimate life task is to become a “keeper of the meaning”. This task, often part of grand-parenthood, involves passing on the traditions of the past to the future. The focus of a keeper of the meaning is on conservation and preservation of the collective products of mankind. Generativity and its virtue, care, requires taking care of one person rather than another. In contrast, keeper of the meaning and its virtues of wisdom and justice are less selective; for justice, unlike care, means not taking sides.
The last life task is integrity, the task of achieving some sense of peace and unity with respect to both one’s own life and the whole world, and the acceptance of one’s life cycle as something that had to be and that, by necessity, permitted of no substitutions. [ibid: 95-6]

This seems a plausible account of the stages that instance good mental health in the UK in the C21 but also seem tied to biological underpinnings and the nature of societal living (shades of Aristotle). But at the same time, one can easily imagine someone for whom these stages of family, career and elder statesman seem a bourgeois straight-jacket and that other ways of going on would be more life affirming. Even if this does, as a matter of fact, instance good mental health for many of us now, there seems no reason to think it defines it. Especially for mental health, rational disagreement and new ways of living seem ongoing possibility.

In other words, there seems no obvious way of balancing the requirement of substance and non-contingent universality.