Positive mental health means the absence of mental illness…or does it?

Written By Michael Roberts

All too often when we talk about ‘mental health’, the conversation invariably leads to discussions around mental illness: conditions such as anxiety, obsessive-compulsive disorder (OCD), depression and bipolar disorder will all likely spring to mind and dominate the discourse. Thus, in many spheres, the narrative on mental health has connotations to it, ignoring the fact that health is more than just the absence of illness.

The traditional medical model through which we diagnose and view mental health is reflective of the ‘absence of illness’ discourse that is often perpetuated in western society. However, challenges to this traditional approach have emerged, with increasing recognition that the absence of mental illness does not mean the presence of positive mental health. A potentially more useful way of looking at this is through the ‘dual continuum’ lens, which holds that both mental health and mental illness are related, but also distinct dimensions: with one continuum indicating the presence or absence of mental health and the other the presence or absence of mental illness. Ultimately, it postulates that an individual’s ability to thrive and flourish is not negated by a diagnosis of a mental illness.

Figure 1. Dual Continuum Model (CACUSS & Canadian Mental Health Association, 2013)

Figure 1. Dual Continuum Model (CACUSS & Canadian Mental Health Association, 2013)

Applying this model to ourselves can be particularly beneficial for three main reasons:

  1. Developing optimal mental health is a skill which we can learn and develop with support.

  2. We can experience mental illness, whilst at the same time, experience optimal mental health. As such, it is supposed that we have the capacity to choose an approach to self-care that isn’t defined by a diagnosis. Many people with a mental illness can live rich and rewarding lives, a possibility which is perhaps not the common narrative at the moment.

  3. The model helps break down the stigma attached with mental illness diagnoses. When mental health is viewed as the opposite of mental illness, we might be less likely to discuss and embrace the challenges experienced as the implication is that we aren’t mentally healthy. However, when we realise that we can still be mentally healthy at the same time as experiencing mental illness, we might be more likely to discuss our challenges.

The key question therefore is, how can we develop optimal mental health? Although there are various ways to facilitate this, we can thank Carol Ryff for pointing us in a particularly useful direction. Ryff examined earlier psychological theories on optimal functioning and self-actualisation (e.g. Abraham Maslow and Carl Rogers), and on positive mental health (Marie Jahoda), finding six basic, but common themes of positive functioning (Ryff & Keyes, 1995). Together, these make up Ryff’s idea of Psychological Well-Being, with each element being an important factor in striving for optimal mental health (Westerhof & Keyes, 2010). 

  1. Self-acceptance: a positive and acceptant attitude toward aspects of self in the past and present;

  2. Purpose: goals and beliefs that affirm a sense of direction and meaning in life;

  3. Autonomy: self-direction as guided by one’s own socially accepted internal standards;

  4. Positive relations: having satisfying personal relationships in which empathy and intimacy are expressed;

  5. Mastering our environment: the capability to manage the complex environment according to one’s own needs, helping us feel a greater sense of control in an ever-changing world;

  6. Personal growth: the insight into one’s own potential for self-development.

These six notions will be looked at in further detail over the course of our next blog posts, in order to provide useful strategies that could be used in everyday life.

References:

Keyes, C. L. M. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73, 539–548.

Ryff, C. D., & Keyes, C. L. M. (1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69, 719–727.

Westerhof, G.J. & Keyes, C. L. (2010). Mental illness and mental health: the two continua model across the lifespan. Journal of Adult Development, 17, 110–119.

Michael Roberts