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 or realised or brought about in particular cases? 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 is, link them all together with the word 'or' between each).
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 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 (and Vaillant mentions).
But now the worry returns that this is merely a local perspective. Let me
sketch just one example 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 possibilities.
In other words, there seems no obvious
way of balancing the requirement of substance and non-contingent universality.
