Jahoda Texto Completo

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OF FLORIDA
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CURRENT CONCEPTS
OF POSITIVE MENTAL HEALTH
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Joint
on Mental
Commission
Illness
M ONOGRAPH
and Health
SERIES / NO.
Qurrmt
QonccYts
of
Positive Mental Health
MARIE JAHODA
A REPORT TO THE STAFF DIRECTOR, JACK
R.
1958
Basic Books, Inc., Publishers,
New
York
EWALT
FIRST PRINTING SEPTEMBER I958
SECOND PRINTING FEBRUARY I959
COPYRIGHT
1958 BY BASIC BOOKS, INC.
LIBRARY OF CONGRESS CATALOG CARD NO. 58-I1681
MANUFACTURED
IN
THE UNITED STATES OF AMERICA
DESIGNED BY SIDNEY SOLOMON
Foreword
Ihis
is
the
first
of a series of
monographs
by the Joint Commission on Mental
to be published
Illness
and Health
as
part of a national mental health survey that will culminate

in a final report containing findings
and recommendations
for a national mental health program.
The
document
present
constitutes a report of the project
director to the staff director of the Joint

Titles of the
monograph
series,
Commission.
together with the senior
authors, are listed here in the approximate order of scheduled
publication:
1.
Current Concepts of Positive Mental Health
Marie Jahoda, Ph.D.

2.
3.
Economics of Mental
Rashi Fein, Ph.D.
Mental Health Manpower
George
4.
5.
Illness
W.
Albee, Ph.D.
Nationwide Sampling Survey of People's Mental Health

Angus Campbell, Ph.D., and Gerald Gurin, Ph.D.
The Role
of Schools in
Mental Health
Wesley Allinsmith, Ph.D., and George
W.
Goethals,
EdD.
[v]
vi
FOREWORD
Research Resources in Mental Health
6.
William F. Soskin, Ph.D.

Religion in Mental Health
7.
Richard V. McCaiin, PhX).
Community Resources
Nonpsychiatric
8.
in
Mental Health
Reginald Robinson, Ph.D., David F. DeMarche, PhX).,
and Mildred K. Wagle, M.S.SA.

Epidemiology and Etiology of Mental
9.
Richard
10.
J.
Plunkett, M.D.,
Illness
and John E. Gordon, M.D.
Patterns of Patient Care:

A.
THE OUT-PATIENT
B.
THE IN-PATIENT
C.
THE EX-PATIENT
Morris
S.
Schwartz, Ph.D., Warren T. Vaughan, M.D.,
and Charlotte Greene Schwartz, M.A.
These monographs, each a part of an

will contain the detailed information
a final report.
From
over-all study design,
forming the
basis of
the data in the individual studies and
other relevant information, the headquarters staff will pre-
pare a
summary document
incorporating
recommendations for national and

grams. This
the Joint
an
summary document
Commission before
its
state
its
findings
and
mental health pro-
will have the approval of
pubHcation in the form of
ofl&cial report.
This final report will be pubHshed by Basic Books and

transmitted to the United States Congress, the Surgeon General of the Public
States, together
Health Service, and the Governors of the
with their representatives in the pubHc health
and mental health

visions of the
professions, in accordance
Mental Health Study Act of
with the pro-
1955.
FOREWORD
Participating organizations,
Joint
Commission,
as well as
members, and
headquarters and project
are listed in the appendix at the
The
Joint
Commission,
it
officers of
vii
the
staffs,
end of the book.
may
be seen,
is
nongovern-
mental, multidisciplinary, nonprofit organization represent-
ing a variety of national agencies concerned with mental
was authorized by a unanimous resolution

of Congress and is financed by grants from the National
Institute of Mental Health and from private sources.
Additional copies of Current Concepts of Positive Mental
health. Its study
Health
may
quarters,
be obtained from the Joint Commission head-
from the
publisher, or
Joint Commission
from book
on Mental
dealers.
Illness and
Health
Sujf%cCVICW
we mean by
1 HE NEED for a clearer understanding of what
"mental health"
is
obvious to anyone
who
has attempted to
cope with the role of schools and the numerous community

agencies involved in mental health promotion, prevention of
mental
illness,
ment now
and other phases of the mental health move-
in progress in the United States.
clarification of the subject
Any
possible
should be of help to mental health
program-makers.
We commonly use "mental health" as

able with "mental illness," in the
a term interchange-
same euphemistic way
that
"public health" generally refers to the prevention or control

of disease
by mass methods. The behavioral
scientists
who
have joined the mental health team and are making

creasingly important contributions
movement have
focus
on
is
needed
tive force, is to
useful.
the mental health
expressed dissatisfaction with a primary
"sick behavior."
perspective
to
be
They make
if
They argue
interest in
made
that a
new and
mental health,
broader
as a posi-
conceptually clear and practically
a telHng point
when
they propose that
progress in understanding health and illness requires

research based
in-
on the study of hiunan behavior
much
as a natural
phenomenon.
[ix]
STAFF REVIEW
In approaching the subject of
this
monograph, we have
thought primarily of the promotion of mental health

positive state, rather than of the cure of
mental
illness,
as a
or
its
prevention.
We
asked Dr. Marie Jahoda, the author,
of Social Psychology,
New York
who
is
Professor
University,
and Director
Human
Relations, to
of the N.Y.U. Research Center for
conduct a review of the pertinent literature and also hold an

interdiscipHnary seminar during the academic year 1956-57
for the purpose of evaluating the theoretical, experimental,
and empirical evidence of the psychological nature of mental

health.
Dr. Jahoda's fulfillment of

a thoughtful
and extensive
this
assignment has resulted in
analysis of
mental health concepts,
written by her in consultation with leading pubHc health
workers, sociologists, psychologists, and others.
No
abstract can take the place of the total
document
process of critical examination of existing views
and of where they
lead.
However,
it
may
and
issues
be helpful to
have a summary of some of the prominent features of her

report.
These points are made, among others:
an individual and personal matter.

It involves a living human organism or, more precisely, the
condition of an individual human mind. A social environMental health
1.
ment or
culture
may
is
be conducive either to sickness or health,
but the quality produced

it is improper
community."
therefore,
"sick
2.
characteristic only of a person;
to speak of a "sick society" or a
In speaking of a person's mental health,
to distinguish
ual
is
may
between
attributes
be classified as more or
and
less
actions.
it is
The
advisable
individ-
healthy in a long-term
STAFF REVIEW
view of
his behavior or, in other
during
attributes.
or less healthy
words, according to his en-
may
Or, his actions
that
is,
xi
appropriate
be regarded as more
from
viewpoint
the
of single, immediate, short-term situation.
Standards of mentally healthy, or normal, behavior
3.
vary with the time, place, culture, and expectations of the

social
group. In short, different peoples have different stand-
ards.
Mental health
4.
one of
is
many human
not be regarded as the ultimate good in
No
5.
values;
it
should
itself.
completely acceptable, all-inclusive concept exists
for physical health or physical illness, and, likewise,
mental health or mental
exists for
illness.
none
national pro-
gram
against mental illness and for mental health does not

depend on acceptance of a single definition and need not
await
6.
it.
Many
scientific investigators
have thought about the
psychological content of positive mental health.

their contributions reveals six
major approaches
review of
to the sub-
ject.
Attitudes of the individual toward himself.
a.
b.
Degree
to
which person
realizes his potentialities
through action.
Unification of function in the individual's personality.
c.
d. Individual's
degree of independence of social in-
fluences.
7.
e.
How
f.
Ability to take
One
the individual sees the world around him.

life as it
comes and master
it.
value in American culture compatible with most
approaches to a definition of positive mental health appears to
be
this:
two
feet
An
individual should be able to stand on his
own
without making undue demands or impositions on
others.
8.
The need
health
is
for
more intensive
underscored.
scientific research in
mental
STAFF REVIEW
xii ]
Among
the biologists and physicians
graph, there
may
be some discomfort
who
at
mononot finding more

read this
about the biologic and physiologic components of mental

health.
They might even
Jahoda
states that
take their cue
from the
fact that Dr.
"mental health must be thought of
as per-
taining to a Hving organism with mental faculties."
How-
monograph to discuss the

concepts of positive mental health from a psychological view-
ever,
it
is
the purpose of her
She assumes that a certain physiologic or physio-
point.
chemical homeostasis
The
stress
laboratory
is
necessary for good health.
showed us long ago
can profoundly
alter the
that severe emotional
physiology of the body.
recent research supports this evidence
More
chemical-physiologic
and perception. In fact,

a genetic, or at least fundamen-
disturbances can affect behavior
some evidence
indicates that
tally biologic, "set" of the
may
stituents,
external stress
body, in terms of
determine the
and other
life
way
its
chemical con-
the individual deals with
experiences.
In addition, deterioration of the brain from disease, aging,

nutritional disturbances, or toxins such as alcohol
and drugs
can produce profound mental changes. Adequate nutrition
and maintenance of a high
state of
oxygenation of the fetus
during dehvery and in the immediate post-partum phase
may, in themselves, promote a
tem and
a higher state of mental health in the future.
For those
to
better integrated nervous sys-
which
who
all
contend that mental health
must conform,
it
may
is
a unitary state
be pointed out that Dr.
Jahoda suggests that good physical health
is
a necessary but
not sufl&cient condition of good mental health.
Some, however,
feel that
mental health
is
more
term. For example, they beUeve that mental health
relative
would
STAFF REVIEW
be possible in a genius and a
moron
as well.
tend that a person with a brain injury
They may
who
good mental
con-
has recovered
with only a few neurologic disturbances can, in

with proper rehabiHtation and proper mental
xiii
spite of this,
attitudes,
have
health. Speculation almost requires such a point
of view, else,
from a
biologic point of view,
man
be certain that any
among
dinary mortals
Edison, had a few
is
healthy.
Who
we
could never
knows what
or-
us might have been an Einstein or
more cubic centimeters
of oxygen been
infused into our lungs, or had our mothers ingested a few

or particular constellations of protein during
more vitamins
our gestation period
None knows
.^^
that he
is
as intact as
he might have been.
Perhaps the biologic view would be adequately represented

if,
to Dr. Jahoda's psychological concepts
and notions of
mental health, were merely added a phrase "with a physiologic function consistent
ciety
with the demands made by the
and the psychologic
The
state of the individual."
monograph was written by Dr.

the members of Dr. Jahoda's adpresent what might be termed a
final chapter in this
Walter E. Barton, one of

visory panel, in order to
more
so-
typical clinical
lem. This
Barton's
all
staif
view of the organic
facets in this prob-
review. Dr. Jahoda's presentation,
and Dr.
help confirm Dr. Jahoda's contention that mental
health indeed
means
different things to different people.
Jack R. Ewalt, M.D., Director
Jic]inowlcdgcmcnts
1 HIS REPORT was Written for the Joint Commission on

tal Illness
Men-
and Health. The Director of the Commission, Dr.
Jack R. Ewalt, and his senior
staff,
particularly Drs. Fill-
more H. Sanford and Gordon W. Blackwell, did much more

than entrust me with a piece of work; their continuous encouragement, and the generous and thoughtful manner in
which they permitted
me
to enlist the cooperation of others,
have been of considerable help.
Work on
this report
was planned and
carried through in
a manner which required several revisions of ideas, formulations,
tion
When
and organization.
was
finished,
it
was
first
a preliminary draft of a sec-
submitted to
my
colleagues at
New
York University for criticism and suggestions. Drs.

Robert R. Holt, Murray Horwitz, George S. Klein, Robert
S. Lee, Eva Rosenfeld, M. Brewster Smith (Vice-President
of the Joint Commission), Miss Claire Selltiz, and especially
Drs. Isidor Chein and Stuart
W. Cook
gave their time and
ideas unsparingly. Their individual contributions cannot be

identified. Jointly they
made
working papers which led

of the draft they
to
it
possible to produce interim
an immeasurable improvement
had received from me. These working

[XV]
Xvi
ACKNOWLEDGEMENTS
papers were then submitted to a highly selected group of

professional persons
They
who
acted as consultants to the project.
are as follows:
Alfred L. Baldwin, Ph.D., Professor and Chairman of the
Department of Child Development and Family Relation-
N. Y.
ships, Cornell University, Ithaca,
Walter E. Barton, M.D., Associate Professor of Psychiatry,

Boston University School of Medicine, and Superintendent,
Boston State Hospital, Boston, Mass.
Kenneth D. Benne, Ph.D., Professor
of
Human
Relations,
Boston University, Boston, Mass.
John A. Clausen, Ph.D., Chief of the Laboratory of SocioEnvironmental Studies of the National Institute of Mental
Health, Bethesda,
Ernest
Md.
M. Gruenberg, M.D., Technical
Memorial Fund,
New
Staff,
Milbank
York.
Irving L. Janis, Ph.D., Associate Professor of Psychology,
Yale University,
New
Haven, Conn.
Ernst Kris, Ph.D., Clinical Professor of Psychology, Child
Study Center, Yale University,
New
Haven, Conn.
(Now
deceased).
Lionel TrilHng, Ph.D., Professor of English, Columbia

University,
New
York.
After having studied the working paper, the consultants
met with
me
for a meeting lasting about five hours.
These
seminars were also attended by Drs. Chein and Smith. All

participants agreed that these meetings should serve as spring-
boards for ideas and advanced criticism.

tellectual efforts
The
notion that in-
can be furthered by consensus or majority
opinion was expHcitly ruled out.
The ensuing
spirited dis-
ACKNOWLEDGEMENTS
cussions greatly enriched
my
Xvii
knowledge and thinking about
mental health.
Throughout the period of work on this report I had the

competent and enthusiastic help of Mrs. Lillian Robbins and
Mr. Nicholas Freydberg who, under the modest
title
of
graduate student assistants, helped in every way, from taking notes at the meetings with consultants
(much more
eco-
nomically and intelligently than a tape recorder could have

done), to reading, excerpting, and discussing. In the final
revision
and organization of the
worked
fully and
I
closely together. Miss

efiBciently
with the
report, Mrs.
Robbins and
Mary Insinna coped
grace-
secretarial duties inherent in
the task.
To
all
of
them
my warm
thanks.
Marie Jahoda
Qontmts
Foreword
Staff
Review
ix
xv
Acknowledgements
I.
Introduction
Purpose and Scope

7^
a Concept of Mental Health Necessary?
The Nature
II.
of
Mental Health Propositions
Clearing the Air: Unsuitable Conceptualizations

of Positive Mental Health
The Absence
of
10
Mental Disease
as a Criterion
for Mental Health
10
Normality as a Criterion for Mental Health
15
Various States of Well-Being as Criteria for
18
Mental Health
III.
The
Psychological
for Positive
Meaning
of Various Criteria
Mental Health
Six Approaches to a Concept
22
25
[xix]
XX
CXJNTENTS
Attitudes toward the Self as Criteria for Mental
Health
24
Growth, Development, and Self-Actualization

as Criteria for
Mental Health
jo
Integration as a Criterion for Mental Health
^^
4^
Note on Reality-Orientation
Autonomy
as a Criterion for
Mental Health
4$
Perception of Reality as a Criterion for Mental
Health
4g
Environmental Mastery as a Criterion for
Mental Health
IV.
V.
An
53
Effort at Further Clarification
6^
Different Types of Mental Health
66
The Multiple
yo
Criterion
Approach
Mental Health and Mental Disease
73
The Value Dilemma
y6
From
Ideas to Systematic Research
Empirical
Indicators
for
Positive
81
Mental
Health
Some
Suggestions for Research
82
100
Conditions for Acquisition and Maintenance of
Mental Health
VI.
VII.
In Conclusion
104
log
Viewpoint of a CHnician, by Walter E. Barton,

M.D.
///
CONTENTS
Xxi
References
121
Appendix
Joint
Commission
on
Mental
Illness
Health. Participating Organizations,

bers, Officers,
Index
and
Staff
and
Mem727
/J/
Ihere are two ways
common
one
is
of being interested in health; the
that of
making
a Hst
things that are good and desirable in
and plan of
life
all
and giving
the best possible description of Utopia and of perfection with
The way
making
tions,
of the
worker
in
modern hygiene
them
effects
to
and
first
is
that of
and condi-
definite points of difi&culty,
an understanding in terms of causes

to factors
on which
mental, analytical and constructive
The
to get there.
a survey of the actual activities
and then of taking up
tracing
and
recommendations as to how
fruitful experi-
work can be done.
type leads mainly to moralizing; the second
type leads to a conscientious and impartial study, and

to constructive experimentation.
Adolf Meyer,
1925.
^$1^-%
Introduction
Ihere
is
hardly a term in current psychological thought
as vague, elusive,
That
it
and ambiguous
means many things
That many people use

the idiosyncratic
it
to
as the
many
term "mental health."

people
is
bad enough.
vîthout even attempting to specify
meaning the term has
for
situation worse, both for those v^ho wîsh to
them makes
the
promote mental
health and for those v^^ho wish to introduce concern with
mental health into systematic psychological theory and
re-
search.
PURPOSE AND SCOPE

The purpose
of this review
is
to clarify a variety of efforts
we
shall
have to examine the assumptions about the nature of
man
to give
and
meaning
to this
vague notion. In doing so
society underlying such efforts
by making expHcit some
of their implications and consequences. This should lead

to a description of various types of
mentally healthy and second to a
human
first
behavior called
critical discussion of
mental
health concepts suggested in the Hterature.

[3]
CURRENT CONCEPTS OF POSITIVE MENTAL HEALTH
some extent must be matin itself solves no problems
Definitions of mental health to

ters of
convenience.
and does not add
from
it is
Yet, as
we
A definition
to know^ledge; all that
can be expected
usefulness in achieving the purposes of science.

shall see, there are
many
efforts to define
mental
health in vâys that go far beyond this scientific approach to

definition.
They
philosophies
often contain implicitly personal or general
they often specify hov^ human beings ought to
Such "definitions"
be.
also vîll
have to be examined.
In a sense, the attempts to give meaning to the idea of
mental health are

as
he ought
has
its
efforts to
to or could be.
ov^n characteristic
incorporating
grapple vîth the nature of
Every
v^ây
ideals of a
its
In our time and in
this
focus for this search.
probably
of searching for expressions
good
man
in a
good
society.
country positive mental health
Why this
an interesting study in
historical period
itself.
man
is
one
should be the case would be
Here we must
limit ourselves
to noting that the inevitable closeness of ideas about
mental
health to fundamental values should temper scientific impatience with concepts that do not immediately suggest to
the reader
how
they can enter into theoretical or practical
work.
Since our goal
is
the development of a rational approach
problem of defining mental health, we shall have to

choose what seems best among those definitions interminto the
gling value and

connotations,
still
lacking,
fact.
and
we
In sorting unnecessary from necessary
in indicating
will
search and application.
aim
where necessary elements
are
both
re-
at definitions useful for
INTRODUCTION
IS
A CONCEPT OF MENTAL HEALTH

NECESSARY?
Whether we Hke
tal
hygiene,
is
it
men-
or not, the term mental health, or
firmly estabHshed in the thought and actions
of several groups: First, under the guidance of voluntary
and governmental
agencies, the
the term in spite of
Funds
biguity.
(or,
pubHc has taken hold
ampromote
perhaps, because of)
are being raised
and expended
of
its
to
mental health; educational campaigns are being conducted

to teach people hov^ to attain this goal for themselves, for
their children, for the conmiunity.
But
is
there substance
behind the notion? Can a useful concept of mental health

be established?
If substance
can be lent to the term, the effort
the public, even
if
mental health emerges
than the public vôuld
like.
From
vîll
as less of a
benefit
panacea
this situation, a
moral
obligation to deal vîth the matter arises.

Specialists also use the
term mental health, particularly
those professions trying to help people in trouble or to pre-
vent them from getting into trouble. Thoughtful
members
of these groups feel that they need clarity about the con-
cept of mental health because they

realistic goals for their efforts
ment
and
want
to use
it
to define
as a help in the develop-
of techniques that, in application, will lead to these
goals. It
tiaHties
is
the business of science to explore
and the conditions furthering
human
poten-
their realization.
The
helping professions often turn to the behavioral sciences,

therefore, to provide
them with
basic
knowledge about hu-
man
They demand
functioning.
compatible with
Finally, the
a mental healtii concept
knowledge of man.
scientific
term mental health
is
used by
scientists
them-
(such as psychiatrists, psychologists, sociologists, and
selves
anthropologists). Their concern with mental health

justified
is
often
by pointing to what appears to be a one-sided de-
velopment in the sciences of man. Knowledge about deviations, illness,
and malfunctioning
far exceeds
knowledge of
healthy functioning. Even apart from the issue of appHcation,
they maintain, science requires that the previous con-
centration
on the study of inappropriate functioning be
corrected by greater emphasis

for
no other reason than
on appropriate functioning,
if
to test such assumptions as that
health and illness are different only in degree.
Other members of the

tific
scientific
scien-
concern with mental health. In part such opposition
based on an unwillingness to
and
community oppose
ill-defined.
In part
it is
work with
a notion so vague
rooted in the conviction that the
science of behavior advances best
out reference to whether
is
it is
by studying behavior, with-
"good" or "bad." Only in
this
manner, they argue, can science remain free from "contamination by values" and a resulting distortion in the choice
and study of
scientific
This argument
rests
problems.
upon the
implicit assumption that as
a rule scientists select the topic of their interests in accordance
with the rational requirements of the discipline within which

they work. This does happen, of course; a well-developed
theory
is,
on
occasion, the only guide to the choice of a re-
search topic. But the very one-sidedness of current psychological
knowledge
testifies to
the fact that, in their choice of
topics, scientists are responsive to social
demands being made
INTRODUCTION
of them,
whether psychological theory
by correcting an
will benefit
more
earlier bias in favor of the study of disease
through a current bias in favor of the study of health, or by a

strict
avoidance of concern wîth "good" or "bad," healthy or
sick functioning,
is
a matter of strategy. Fortunately, both
strategies are presently
being pursued by different people.
Only the future
v^hich vâs
In any
work
vîll tell
case, it
if
it
is
does not detract
more profitable.
from the value of a
piece of
chosen for other than theoretical reasons.
Alexander Leighton (1949) has

values in the science of
incisively stated the place of
man:
Within an area marked off for scientific investigation, the values

of science reign supreme over each step in the process toward
conclusions and in the conclusions themselves. Moral values when
pertinent dominate scientific values at three contiguous points:
the selection of the problem to be investigated, the limitation of
the human and other materials that may be used, and the determination of what shall be done with the results.
From
this point of view,
mental health
cern for scientific inquiry notwithstanding

tions. Earlier
cept,
a possible con-
its
value connota-
argued that mental health
and one that can be given
scientific
here.
we
is
work. Perhaps
Whether or not an
it is
clear
best to let
is
needed con-
meaning only by
the argument rest
individual scientist wants to engage
in research related to mental health
is
up
to
him.
THE NATURE OF MENTAL HEALTH

PROPOSITIONS
It
may
be helpful in appraising the following review of
concepts to keep in
mind
that one has the option of defining
mental health in
one of two ways:
at least
as a relatively
constant and enduring function of personality, leading to
and
predictable differences in behavior
on the
and
stresses
feelings
strains of the situations in
momentary function
finds himself; or as a
of
depending
which a person
personality and
situation.
Looking
mental health in the
at
classification of individuals as
first
more
way
will lead to a
or less healthy; looking
in the second way, will lead to a classification of actions
at
it
as
more
or less healthy.
The
relevance of this distinction can
be illustrated with an example concerning physical health.
Take
he
is
a strong
man
with a bad cold. According to the
healthy; according to the second, he
ments are
justifiable
and
useful.
that
son or as one
he
is, if
who
is
is
is
made
functioning healthily.
whether one
state-
in the
is
wrong
Much
of the con-
from the
failure to
talking about mental health as an
enduring attribute of a person or
as a
momentary
attribute
we shall keep
moment choosing
of functioning. In the following discussion,

distinction in
tween
re-
regarded as a permanently sick per-
fusion in the area of mental health stems

establish
Both
But utter confusion will
sult if either of these correct diagnoses
context
is sick.
first,
mind without
at this
the
be-
either position.
In the mental health literature a third type of statement

occurs frequently: situations or societies are called healthy or
sick.
The German
culture under national-socialist domina-
tion has been called paranoid; totalitarian systems are often
regarded as unhealthy in democracies; one of Fromm's

cent books bears the
On
many
title
The Sane
closer examination,
however,
re-
Society (1955).
all
these examples (and
other possible ones) present merely a linguistic trap
INTRODUCTION
in the discussion of mental health.

or unhealthy
it is
is
To
call a situation
nothing but a colloquial
ellipsis
healthy
meaning
that
conducive to healthy or unhealthy behavior. In other
words, mental health must be thought of as pertaining to a

living organism with mental faculties;
to
any other
This
is,
it
cannot be attributed
entity.
of course, not to say that the examination of aspects
of a situation conducive to mentally healthy or unhealthy
behavior
is
irrelevant.
On
the contrary:
it is
of the greatest
importance, as will become clear in a later section. In the

present context, however, where
establishing the premises
we
are concerned with
upon which mental health
can be established, the discussion of the situation

fluous.
The
relation of
is
criteria
saper-
environment to mental health
in
other words, the conditions under which a person acquires
enduring mental health or will act in a mentally healthy
way must be postponed
until the legitimate
any, of mental health as an attribute of
been explored.
human
meaning,
if
behavior has
(^learing the
Air:
Unsuitable Qonccvtualizations of
Positive ^Mental Health
NIental health
as the opposite of
mental disease
is
per-
haps the most widespread and apparently simplest attempt

at definition.
To
accept this approach presupposes a defini-
tion of mental disease. Notwithstanding the fact that mental

disease
is
at present
much
better understood than
health, efforts to define mental disease
mental
meet with consider-
able diflEculties.
THE ABSENCE OF MENTAL DISEASE

AS A CRITERION FOR MENTAL HEALTH
At
many
the present stage of our knowledge, mental disease in

cases
cannot be inferred from physiological changes in
the functioning of the organism.
among
When
psychiatrists agree
themselves that they are deaUng with a mentally sick
person, they use as the basis for inference highly complex

[lo]
UNSUITABLE CONCEPTUALIZATIONS
II
behavior patterns whose physiological correlates are usually
not known.
When a person has lost "contact with reality," hallucinates,

or
is
completely unable or unwilling to perform essential
functions for survival, general agreement
many
But there are

least
mentally
ill
quickly achieved.
is
who do
persons
not (at
not consistently) show such extreme symptoms. Here,
diagnosis
is
not nearly as unanimous.
not to
the other hand,
which apparently healthy persons may
there are situations in
show one
On
or several of these severe symptoms.
Whether
or
such persons sick will depend on whether the
call
classification is
made
in terms of enduring personality at-
tributes or in terms of currently observed actions.
To make
disease
is
explicit all the criteria leading to the diagnosis of
a bafHing task.
By and
large, practitioners prefer to
think in terms of personality attributes, whereas

tion of actions has proved
efforts.
more
classifica-
many research
Milbank Fund sym-
useful in
This question was debated in a
posium (1953). Definitions of the following kind were reported: "A case is a person under the care of a psychiatrist";
or,
with reference to children, "a
'case' is a child
the schoolteacher says, 'This child's behavior

children's.
The
child
is
making
is
about
whom
not like most
trouble or having trouble.'
"
These crude rule-of-thumb definitions actually served a

purpose for research;
ground. But those
admit severe
who
much
they permitted
it
to get off the
used these definitions were ready to
limitations.
sick people are not
at least
For instance, probably many very
under the care of a
psychiatrist; also,
higher rate of mental disease was implied in com-
munities having a psychiatrist than elsewhere. These definitions
were adopted not out of a lack of
sophistication, cer-
12
tainly,
but in the realization that they provided an expedient
vây of starting research.

in our present state of
The
suggestion wsls also
made
that
knowledge a comprehensive concept
of mental disease vâs perhaps premature.
Such
on the part of people
restraint
self-critical
much
qualified to define mental disease receives
vêll-
support
from anthropological studies. Some of these throv;^ doubt on

the use of some symptoms for the diagnosis of disease.
Anthropologists
some
tell
us of generally accepted behavior in
Western
cultures that
symptomatic of mental
civilization vôuld
(1934), the Kwakiutl Indians of British
behavior that
is,
a.n
Ruth Benedict
Columbia engage in
According
disease.
regard
to
by our standards, paranoid and megalo-
maniacal. Their viev7 of the vôrld
is
similar to a delusion of
grandeur in our culture. Alexander interprets the Buddhistic

self-absorption of mystics in India, with
festations of rigidity
and immobility,
as
physical mani-
its
an
artificial schizo-
phrenia of the catatonic type (Klineberg, 1954). However,

it is
apparently true that the Buddhist can control the onset
and end of
his
"symptoms," a
feat the schizophrenic person
in our culture cannot perform.
The example
suggests that similarities in
symptoms must
not be mistaken for identical disturbances of functions.

also illustrates
and
identical observable
this
is
important here
symptoms
that
It
whereas
are regarded in one culture as
achievement, in another they are regarded as a severe debility.
In our culture, adolescent boys
who
are exposed to
sexual advances often take this as a sign that there
thing fundamentally
wrong with them. In some
absence of a homosexual approach

fashion.
is
homo-
is
cultures, the
interpreted in the
Examples could be multiplied
some-
same
to indicate that the
^3
evaluation of actions as sic\, or normal, or extraordinary in
a positive sense often depends largely on accepted social conventions.
Some
anthropologists, however, have taken a strong stand
against cultural relativism in the identification of mental
Devereux (1956), for example, argues that the

shaman is mentally sick, even though his illness takes a
disease.
culturally approved form. Linton's idea of culturally pre-
scribed "patterns of misconduct" points in the
The
same
direction.
fact that there are in various cultures different "proper
ways
to be insane"
turbance in
need not imply that the functional
from
itself varies
Only with
culture to culture.
regard to the manifestations of the disease
is
dis-
cultural rela-
tivism appropriate.
Devereux bases
his
argument on psychoanalytic theory,
thinking of mental disease as the expression of conflicts in

the unconscious. But
there are any
human
conflicts. If it is
universal,
we
it
has not yet been demonstrated that
and a psychotic may
lie
in the
handles his conflicts and in the appearance or lack
evitably be inferred
is
from unconscious
are all sick in different degrees. Actually, the
of certain symptoms. If this
there
are free
reasonable to assume that such conflicts are
difference between anyone
way he
who
beings
is
so,
mental disease must
in-
from behavior. But, apart from extremes,
no agreement on the
types of behavior
which
it is
reasonable to call "sick."
The
symptoms is not limited to

cross-cultural comparisons. Within our society, a farmers'
community may well regard as symptoms of mental disdifferential evaluation of
order the behavior

then, that
human
of, say,
an urban
artists'
colony.
It
follows,
behavior cannot be understood in terms of
14
symptoms but must rather be viewed in conjunction

with the social norms and values of the community in
which the symptoms are observed (Asch, 1952). Whether
empirical and theoretical work on mental disorder will one
isolated
day
result in the identification of certain disturbances re-
garded
known
as "disease" in all
cultures
is
as yet
an open
question.
Furthermore, the borderline between what
normal and
extreme
as
cases.
abnormal
dim and
is
is
regarded as
ill-defined in all but the
Character disorders of various types, for ex-
ample, belong to that large area where the label "mental

disease"
is
not
much more
"mental health," unless

criteria for
appropriate than that of the label
we can
discover
more rigorous
one or the other than are implied by the current
usage of these terms.

In discussions of these complex
recently been put forward that
issues, a
daring thought has
makes the
definition of psy-
chological health as the absence of mental disease even
doubtful. Such a definition
health
is
based on the assumption that
the opposite of disease, or that health and disease
form the extreme
poles of a continuum.
sumption should turn out
Some
is
more
psychiatrists
now
to be unjustified
What
if this
as-
and misleading ?
speak of different health potentials

if
they were deaHng
with two quaUtatively different continua.
We shall return to
in seemingly equally sick patients, as
this idea later on.
At
this
moment, however, the apparent
difficulty in clearly
circumscribing the notion of mental disease makes

likely that the concept of
fined by identifying
it
it
un-
mental health can be usefully de-
with the absence of
disease. It
would
^5
seem, consequently, to be more fruitful to tackle the concept of mental health in
more
its
connotation,
positive
noting, however, that the absence of disease
may
constitute
a necessary, but not a sufficient, criterion for mental health.
NORMALITY AS A CRITERION FOR

MENTAL HEALTH
As
from
far as normality
is
concerned, w^hat has been learned
cultural anthropologists can hardly be overestimated.
Their entire wôrk can be regarded
on the theme of the

on the
ingly,
plasticity of
as a series of variations
human
vast range of v^^hat can be regarded as normal.
They have convincingly demonstrated

social norms and institutions in different
parts of the world;
and that in
forms of behavior are regarded

It is
nature and, accord-
a great variety of
cultures in different
different cultures different
as
normal.
generally accepted that the term
normaHty covers two
different concepts: normality as a statistical frequency con-
cept and normality as a normative idea of

to function. In the statistical sense of the
say, for
is
there
is
term
makes
it is
correct to
another matter.
It
sense in the normative connota-
may
well be that for this example
a coincidence of statistical
and normative
But such coincidence would be fortuitous.
two connotations always coincide

whatever
its
people ought
example, that normal adults are married. Whether
or not the statement

tion
how
exists in the
existence.
The
believe that the
leads to the assertion that
majority of cases
failure to
To
correctness.
is
right by virtue of
keep the two connotations of
normality separate leads straight back into an extreme cul-
l6
tural relativism according to vi^hich the storm trooper, for
example, must be considered as the prototype of integrative
adjustment in Nazi culture.

Insofar as normality
a
synonym
is
used in the normative sense,
for mental health,
it is
and the problems of concept
definition are, of course, identical.

It
remains to be seen
vi^hat
frequency concept. ImpHcitly,
can be learned from the

not
if
explicitly,
many
per-
as healthy,
what the majority of people feel, think, and do

and deviations from the average as not healthy.
This belief
is
sons regard
regard to
fostered
by the unquestionable
many human
fact that, vîth
attributes, the distribution of the
population follows a normal or approximately normal curve;

that
is,
majority manifests
the
progressively smaller proportions
medium course, with

of cases as we move toward
a
either
extreme of behavior. This
many
biological functions (height, weight,
is
true, for instance, for
and
However, a majority does many things we
so forth).
hesitate to call
mentally healthy; for example, experiments have indicated

that
under conditions of hunger, people tend to
where there
fashion
is
none. That the majority
would perhaps be
different
those
is
food
respond in such
perfectly understandable; but this
from regarding
who, in
may
see
spite of their
as
psychologically abnormal
hunger, maintain the abihty to
perceive correctly, because they are at the extreme end of this

particular distribution curve. Psychological health
need not, be the

Moreover,
may, but
status of the majority of people.
statistical definitions
of psychological health in-
As Ernest Jones
statistically normal mind
volve basically nonstatistical considerations.
(1942) has pointed out, "If once the

is
accepted as being synonymous with the psychologically
mind
healthy
(that
is,
mind
the
in
are available for use), a standard
which the
Mowrer
full capacities
up which has a most

Davis (1938), Wegrocki
is set
fallacious appearance of objectivity."
(1939),
I7
(1948), and Redlich (1952) also deal with
the concept of statistical normalcy.
In order to establish a
the population
statistical
from which
it is
to
norm, one has
be derived.
And
to define
the choice
of a population inevitably contains, at least implicitly, a non-
concept of health.
statistical
develop a
set of statistical
One would
norms
an
for
not, for example,
merged
arbitrarily
population including both so-called primitive and civilized
males and females, children and adults.
societies,
Because
the
Why
not ?
seems evident that the determining conditions of
it
same behaviors, the
contexts, their consequences,
and
hence their meanings, to either the actors or observers, are

often likely to be quite different in different types of society,
or in the
two sex groups, or in
different age groups. It fol-
lows that in deciding upon a reference population, one

least tacitly
from the viewpoint of mental
Similarly, even
when one
all
its
evalua-
health.
has selected and defined the
relevant reference population, one
weight to
at
considering the determinants, contexts, conse-
quences, and/or meanings of behavior relevant to

tion
is
would not
give equal
measurable psychological functions
speed with which a person can cancel
all
say, the
of the as in a page
on the one hand, and the frequency of hallucinatory

experiences, on the other in developing a set of norms
of print,
against
uals.
which
For
it
mean, not
it.
We
to evaluate the
seems clear
all
that,
mental health
status of individ-
whatever "mental health"
may
psychological functions are equally relevant to
thus again find that some, at least
tacit, nonstatistical
l8
must precede the application of the
considerations
statistical
approach.
The
how
concept does not offer us any clues as to
and define a reference population or
how
to
to select
select
and
weight the psychological functions to be measured in an

effort to evaluate positive
mental health.
If
and when more
appropriate criteria are discovered, their frequency distribution in
any population will become an interesting empirical
question. But as a criterion in
itself,
normaHty
is
of
no
use.
VARIOUS STATES OF WELL-BEING AS

CRITERIA FOR MENTAL HEALTH
Many
persons think of psychological health as manifested
in a state of well-being.
The World Health
example, defines health
as "the
Organization, for
presence of physical and emo-
tional well-being." In this phrase written for international
audiences, the term "emotional well-being"

label for
meant by
is
but another
mental health. Without a specification of what

it,
the phrase
is
is
of Httle help for our purposes.
Others have specified various

different feeUng-states. Karl
criteria for
an individual's
Menninger (1947),
for example,
says
Let us define mental health
as the
adjustment of
maximum
the world and to each other with a

happiness.
Not
just efficiency, or just
of obeying the rules of the

gether. It
is
game
beings to
of effectiveness
or
contentment
cheerfully. It
is all
and
the grace
of these to-
the ability to maintain an even temper, an alert in-
telligence, socially considerate behavior,
This,
human
think,
is
a healthy mind.
and a happy
disposition.
This description contains a variety of
that
we
are not
deaHng with the
full
tions in Menninger's rich language,
from
poses of classification to select
^9
criteria.
Recognizing
overtones and connotait is
reasonable for pur-
his description,
first,
the
terms happiness and contentment; they have wide currency

as criteria of
mental health. Menninger actually also assumes
unhappy are always (at least partly) 'wrong' "! To

regard the unhappy as wrong or sick was apparently al"that the
ready prevalent about 1500
him
B.C.,
when
the friends of Job told
that the reasons for his utter misery
must be sought
in
himself.
Jones (1942) also talks of happiness as a criterion of nor-
Boehm
mahty. Others prefer the term "satisfaction."
a condition
and
level
socially acceptable
and
per-
for example, writes: ''Mental health
of social functioning which
is
(1955),
is
sonally satisfying"
In an informal inquiry conducted by the director of the

Joint
the
Commission on Mental
meaning attached
a fair
number
to ascertain
mental health by a group of experts,
described their ideas in terms of happiness,
and quality among
states of being.
To
these various highly desirable
distinguish
minor matter compared

efforts to
and Health
and contentment. There are obvious differences
well-being,
in degrees
to
Illness
regard various
mental health. This
to a
among them
is,
however, a
major problem inherent in
states of
difl&culty
all
well-being as criteria for
has to do with the
tacit as-
sumption that happiness or contentment need no
special
referent or qualification.
In this global sense, people are happy
from
life is
in
harmony with what
if
what they want
life offers.
Such happiness
20
clearly not only a function of the individual but also of
is
the course of external events over v^hich the individual has
no
The
control.
use of unquaUfied euphoric states as criteria
most obvious
of mental health leads to a difficulty perhaps

in
Boehm's concept of mental health:
and personal
ceptability
if
What
if
social ac-
satisfaction are incompatible
What
happiness or vêll-being, satisfaction or contentment, free-
dom from conflict or tension is inappropriate in a life situation? Do individuals then have to be considered mentally
unhealthy? To answer this question in the affirmative betrays
moral
a naive belief in the
of all existing
justice
conditions.
But obviously, the persons quoted above are not naive.

Their formulations
terms of more or
make
less
it
clear that they
mean
enduring personality
to speak in
attributes.
Menninger speaks not only of happiness but of a

disposition.
And
ternal events
experiences,
is
Thus
happy
Jones, in recognizing the impact of ex-
on the degree of happiness
human
being
compelled to define happiness in a highly
idiosyncratic fashion as the ability to hold impulses in check,
wîthout renouncing them, until they can be gratified.
To
regard the unhappy disposition as a criterion of poor mental

health
is
one thing.
To
regard unhappiness, regardless of
the circumstances in v^hich

is
it
occurs, as such
an indication
a different matter.
To
be sure, to some extent
man
selects
and
creates his ov^n
environment, and to that extent even the unqualified term

"happiness" appears as a possible criterion. But there are
many
facets of the
environment beyond the conscious or un-
conscious choice and creation of the individual. Misfortune
and deprivation are not necessarily of our
own making. To
21
be happy under such conditions cannot seriously be regarded

as a criterion for
mental health. Only
when
happiness or
well-being are clearly conceived of as personality predispositions, rather
than
as
momentary
feeling states
depending on
circumstances, do these criteria appear useful. In this con-
notation they will enter into the subsequent discussion.
Ill
The
^sycholoncal '^caning of
Various QriUria
for Positive
^Mentol Health
bo
FAR, three efforts to give psychological
meaning
to the
notion of positive mental health have been examined and
found more or
less vânting.
To regard
disease as a criterion has proved to be
the absence of mental
an
insufficient indica-
tion in viev^ of the difficulty of defining disease. Normality,
in one connotation,
another sense
it
is
but a synonym for mental health; in
was found
to
be unspecific and bare of psy-
chological content. Various states of wêll-being proved unsuitable because they reflect not only individual functioning
but also external circumstances.
survey of the relevant literature reveals a host of other
approaches to the subject v^hich seem more promising; at

least, at first sight, it
appears that the objections raised in the
preceding pages do not apply to them. Although no claim
can be made that
this
survey discovered every contribution
to the topic, the search vâs extensive. It
is
hoped that no
major idea in the area has escaped our attention.

[22]
PSYCHOLOGICAL MEANING OF VARIOUS CRITERIA
SIX
From an
^3
APPROACHES TO A CONCEPT
inspection of the diverse approaches uncovered,
major categories of concepts emerge.
six
There are
1.
several proposals suggesting that indicators
of positive mental health should be sought in the attitudes of
an individual toward his

the
manner
own
self.
Various distinctions in
of perceiving oneself are regarded as
demon-
strating higher or lovêr degrees of health.

2.
Another group of
criteria designates the individual's
and degree of growth, development, or self -actualization

expressions of mental health. This group of criteria, in
style
as
contrast to the
first, is
concerned not with
with what a person does with his

3.
self
self -perception
but
over a period of time.
Various proposals place the emphasis on a central
synthesizing psychological function, incorporating
some of
the suggested criteria defined in (i) and (2) above. This
function will here be called integration.
The following
three groups of criteria concentrate
exclusively than the preceding ones
on the
more
individual's rela-
tion to reality.
4.
Autonomy
singles out the individual's degree of in-
dependence from
state of his
5.
social influences as
most revealing of the
mental health.
number
of proposals suggest that mental health
is
manifested in the adequacy of an individual's perception of

reality.
6.
Finally, there are suggestions that environmental mas-
tery be regarded as a criterion for
mental health.
All ideas on positive mental health examined can be
as-
24
signed to one of these six categories with relative ease, even
though there
apparent,
is
amount
a certain
many
authors have
And
of the categories.
As
of overlap.
made
vîll
become
contributions to several
could be argued that there exists an
it
empirical or theoretical relationship betwêen these groups.
But the purpose of
on
this reviev^ is to present current
criteria of positive
mental health; not
at least,
not yet
of these criteria to each
to inquire into the relationship
an author's other contributions, or to
other, to
thoughts
theories.
One consequence of this emphasis on criteria is that similarities may appear v^here theoretical differences have not
led one to expect them.
Another
examine these
from the point of
criteria
is
that
it v^îll
be possible to
viev^ of
mental
health, rather than of the fruitfulness of the general approach
of
which they form part.
ATTITUDES TOWARD THE SELF AS

CRITERIA FOR MENTAL HEALTH
recurring theme in
many
concept of mental health

of a person's
self is
self.
is
the emphasis
The mentally
tions. Self-acceptance
to the
certain qualities
healthy attitude toward the
with sHghtly different connota-
impUes that a person has learned
to
with himself, accepting both the limitations and pos-
sibilities
and
on
meaning
described by terms such as self-acceptance, self-con-
fidence, or self-reliance, each
live
efforts to give
he
may
self-respect
judgment
find in himself. Self-confidence, self-esteem,
have a more positive
that in balance the self
is
slant; they express the
"good," capable, and
strong. Self-reliance carries the connotation of self-confidence
and, in addition, of independence from others and of initia-
^5
from within. However, the terms have become entrenched in everyday language in a manner leading to a
tive
large overlap in their connotations.
There
an overlap in meaning with other terms
exists also
that indicate qualities of
terms
are,
an attitude toward the
self.
Such
for example, self-assertion, self-centeredness or
egotism, and self-consciousness. These latter terms, however,
have not been proposed
A
to
number
as criteria for
mental health.
of different dimensions or components appear
run through the various proposals. Those aspects of the
self-concept that
stand out most clearly are: (i) accessibility
to consciousness, (2) correctness, (3) feeling about the self,
and (4) sense of

ponents are
made
Although not
identity.
explicit
by the writers
all
of these com-
who
use attributes
of the self as criteria for mental health, they are impHcit in
many
of their contributions. Inevitably, there
amount
is
a certain
of overlap between these aspects.
Accessibility of the Self to Consciousness
In discussing attitudes toward the
self,
several writers refer
predominantly to the breadth of content encompassed by the

self-concept.
about the
For example,
Mayman
(1955), in speaking
self-determining attitude, says
"An
intact sense of
selfhood or self-determination indicates a successful synthesis
by the individual of
that
he wants
able to be
to be
all
that he has been
and do, with
and do, without
his
all
and done, with
that he should
and
all
is
disowning any major feehngs,
impulses, capacities or goals in the interest of inner har-
mony."
In the course of his discussion of objectivity of
tion, to
which we
shall return,
self-percep-
Gordon W. Allport (1937)
26
indicates that the
mature personaHty shows
''self-objectifica-
pecuHar detachment of the mature person
tion, that
he surveys
his
own
when
pretensions in relation to his abihties, his
present objectives in relation to possible objectives for himself,
own equipment
his
of others,
and
equipment
in comparison with the
his opinion of himself in relation to the opinion
others hold of him."
Both Mayman's and Allport's descriptions of a healthy

self-concept include a large variety of content, such as actions,
values,
desires,
and
obligations,
feelings in the past
and
present and in anticipation of the future. Clearly the quotations indicate that
sirable
that
is,
both authors regard a self-concept as de-
when
healthy
contains an image of
it
Mayman and
important aspects of the person.
all
Allport
require awareness of the self in a healthy person.
Barron, on the other hand, appears to regard self-awareness as a counterindication of mental health
says:
"We
pay no attention to our
best of health. It
our notice.
is
when we
is
when we
comes
not self-conscious.
is
from malfunction.
."
Mayman do
not stipulate that the self-concept
must permanently dominate consciousness. There is in

port's statement an important quaHfication {"when he
.
.")
and Mayman's
determination"
oneself."
to
no necessary contradiction between the two views.
Allport and
veys
He
are in the
are sick that the self
person just being himself
Self-consciousness arises
There
self
(1955).
Nor
may
Allsur-
"intact sense of selfhood or self-
be close in meaning to Barron's "being
does Barron require that the healthy person be
unable to be consciously aware of his

juxtaposition of these views
on
own
self.
However, the
self-awareness brings into
sharp focus the fact that this criterion can serve as an in-

dicator of mental health not at every
concern with the
moment
but only
^7
when
appropriate.
self is
Kubie (1954) makes the point clearly: "[This does not]

imply that in order to be healthy we must be self-consciously
aware either of our every
act or of our every purpose, but
rather that the predominant forces
must be
accessible to
on need."
introspection
Correctness of the Self-Concept
The
idea that
objectively
literature,
it
is
good
one of the most
is
Gordon
must be
an
objectivity requires
temptation
is
common
in the mental health
Allport, in the passage already quoted,
stipulates that self-inspection
Such
and
to see the self realistically
objective to be healthy.
ability for
detachment.
what we would
strong to mistake
The
like to be
what we are. Cattell sees the ideal self as tending to

merge with the real self (Hall and Lindzey, 1957). However,
for
negative distortions of the self-concept are certainly also

familiar in clinical settings.
distortion
Whatever the
direction, such
based on an inabiHty to control rationally the
is
wishes and fears that thus color the perception of the

It is
in this sense that
Fromm
self.
(1955) writes about mental
health as characterized "by the grasp of reaHty inside and

outside of ourselves, that
is,
by the development of
objectivity
and reason."
Feelings about the Self-Concept
The
fact that each self,
and presumably therefore each
healthy self-concept, will contain some elements the owner

will be,
and others he
question of
how he
will not be,
feels
proud of gives
about himself.
rise to
the
The most common
28
proposal in the mental health literature
presumably
accept himself
shortcomings
i.e,,
ample of
Our
this
own
his
which he might not be
Maslow (1950)
affords a typical ex-
point of view:
healthy individuals find
their
including
his self-concept
those elements of
expected to be proud.
that he should
is
it
possible to accept themselves
nature without chagrin or complaint
or, for that
and
mat-
ter, even without thinking about the matter very much.

They can accept their own human nature with all its discrepancies from the ideal image without feeling real concern. It would
convey the wrong impression to say that they are self-satisfied.
What we must rather say is that they can take the frailties and
sins, weaknesses and evils of human nature in the same unques-
tioning spirit that one takes or accepts the characteristics of nature.
It is
not clear whether
Maslow
takes the position that the
healthy person does not experience ego-alien impulses or that

his self-acceptance
sins
encompasses them
and weaknesses suggests the
In any
case,
he and others
too.
His reference to
latter interpretation.
who emphasize
self-acceptance
are apparently referring to one's feeUng about the total con-
figuration of the self-concept rather than any single attribute

of
it.
Presumably, recognized shortcomings are accepted in
their relation to recognized strengths,
and are
realistically
evaluated in terms of the possibilities and costs of changing

the
self.
Sense of Identity
Closely related to such balanced self-acceptance
aspect of the self -concept
which
is
is
another
frequently discussed in the
mental health hterature: the sense of
identity.
What
Cattell
[29]
McDougall
calls the senti-
calls the self
ment
sentiment, or what
of self-regard apparently refers not to
any
specific
aspect of the self-image but rather to this integrative at-
and Lindzey, 1957). They mean a

global benevolent view of the whole self, a positive feeling
tribute of the self (Hall
that pervades
The
and
integrates all other aspects of the self-
mark of this aspect as compared to self-acceptance is its more cognitive emphasis on

the clarity of the self-image. A healthy person knows who
concept.
he
is
distinguishing
and does not
The
doubts about his inner identity.
feel basic
sense of identity as an indicator of positive mental
health has been particularly emphasized in Erikson's

(1950).
He
talks about
it
ment
of a healthy person.
trust,
autonomy,
"is
as the fifth stage in the
(The preceding
when
successive stage,
cessful
from
develop-
stages are basic
initiative, industry.) Ego-identity,
the inner capital accrued
work
he
says,
the experiences of each
all
successful identifications led to a suc-
alignment of the individual's basic drives with his
endowment and
identity, then,
is
his opportunities.
The
sense of ego
the accrued confidence that one's ability to
maintain inner sameness and continuity (one's ego in the

psychological sense)
tinuity of one's
He
is
matched by the sameness and con-
meaning
for others."
contrasts this sense of identity
diffusion
which
body changes
its
is
with "a sense of
unavoidable at a time of Hfe
proportions radically
,"
when
self-
the
here implying
the close relationship between the sense of identity and the
body-image. As a consequence of ego-identity, "real intimacy
with the other sex
(or, for that matter,
son or even with oneself)
is
possible.
with any other per.
The youth who
is
not sure of his identity shies away from interpersonal in-
30
more he
timacy; but the surer he becomes of himself, the

seeks
and
in the forms of friendship, combat, leadership, love
it
inspiration."
Most
that
v^Titers
dealing vîth the sense of identity emphasize
acquisition
its
is
the result of a long period of develop-
ment, thus implying that a sense of identity
is
a suitable
mental health probably only in adulthood,
criterion for
cer-
White (1952), relating his

Erikson and Henry Murray, says: "There
tainly not in childhood. Robert
ideas to those of
are
many
vicissitudes in the
the overall trend
is
development of ego
toward an increase of
When one takes a long enough span of time,

into adulthood
but
identity,
stabihty.
continuing
vêll
ego identity can be seen to become not
only more sharp and clear but also more consistent and free
from
transient influences. It
becomes increasingly determined
by accumulated personal experiences. In

sively gains
autonomy from the
this vây
it
progres-
daily impact of social judg-
ments and experiences of success and
failure."
GROWTH, DEVELOPMENT, AND
SELF-
ACTUALIZATION AS CRITERIA
FOR MENTAL HEALTH
number
of authors see the essence of mental health in
an ongoing process variously called

realization,
strives
growth, or becoming.
permanently
Fromm
to realize
horse would be as
into a
its
idea that the organism
own
potentiaUties
is
old.
(1947) credits Spinoza with having seen the process
of development as one of
"A
The
self-actualization, self-
man
as if
it
becoming what one
much
destroyed
if it
were changed into an
potentially
is.
were changed
insect,"
Spinoza
3^
Fromm continues: "We might add that, according to

Spinoza, a man would be as much destroyed if he became
said.
an angel
as if
he became a horse. Virtue
the unfolding of
is
the specific potentialities of every organism; for

state in vi^hich
The term
he
is
the
most human."
He
spoke about the process of self-actuaHzation
as occurring in every
set
it is
self-actuaHzation probably originated with Gold-
stein (1940).
one: "There
man
is
organism and not only in the healthy
human activity
oneself." The idea
only one motive by which
going: the tendency to actualize
is
is
echoed in Sullivan's dictum, "the basic direction of the or-
ganism
is
forward," and
it
also
authors such as Carl Rogers,

Allport.
Sometimes the term
principle of
it is
life,
dominates the thinking of
Fromm, Maslow, and Gordon

is
used as implying a general
holding for every organism; at other times
applied specifically to mentally healthy functioning.
It is
not always easy to distinguish these two meanings in
the mental health literature. This lack of clarity probably has
something to do with the controversial philosophical concept

of Aristotelian teleology, to
which the notion of
one's potentialities
The need
is
related.
tinction in a discussion of
one
realizes that
making
the dis-
mental health becomes urgent
if
not only the development of civilization but
also self-destruction
cide, are
for
realizing
among
and crime, from petty thievery
the unique potentialities of the
to geno-
human
species.
Mayman
(1955)
is
of the opinion that
some of the pro-
ponents of self-actuaHzation as a criterion of health have not

succeeded in making the distinction. In a
critical discussion
of Rogers' use of the term, he says: "This position

ficient in several respects: it
presumes that
this
is
insuf-
growth force
32
is
equally potent in
all
people; that
if
given the right of vây,
this force will inevitably assert itself for
portant of
force
all it treats this
v^îth
good but most im;
almost religious awe
grow and be
rather than scientific curiosity. This urge to
healthy
is
treated as an irreducible essence of life."
To make
this life force
an aspect of positive mental health
requires that certain quaHfications be introduced to dis-
tinguish
The
its
manifestations in healthy persons.
process of self-actualization, as a rule,
make
rather global terms that
is
difl&cult to identify
it
stituent parts. Nonetheless, the various authors

it
as a criterion of positive
described in
who
con-
regard
mental health seem to emphasize
one or more of the following
(i)
aspects:
self-concept
(which has already been discussed and
is
only to indicate the breadth of the term
self-actualization)
(2) motivational processes;
mentioned here
and (3) the investment in
living,
referring to the achievements of the self-actualizing person

as
demonstrated in a high degree of differentiation, or max-
imum
of development, of his basic equipment.
Motivational Processes
As
indicated, Goldstein regards self-actualization as the
only motive of the organism.

this
Fromm
(1941) seems to share
view when he says that the healthy individual recognizes
that "there
self."
The
is
only one meaning to
life:
the act of living
it-
qualification of this general motivational process,
so that degrees of health can be distinguished,
made by Maslow
(1955).
He distinguishes
is
more
clearly
deficiency motiva-
from growth motivation. Everyone, he assumes, has a

need for safety, belongingness, love, respect, and self-esteem.
tion
Deficiency motivation serves to satisfy these needs;
it
avoids

illness
motivation leads beyond such tension reduction to
and
talents, to
Growth
but does not yet create positive mental health.
actualization of potential capacities
33
self-
devotion
to a mission in life or a vocation, to activity rather than rest
or resignation.
self-actualizing
person experiences the
maintenance of tensions in these areas

cannot be understood
as
he
being motivated here by the need
The
for tension reduction.
as pleasurable;
greater the
motivation, the healthier a person
amount
growth
is.
Gordon Allport (1955) concurs with Maslow's
He says that growth motives
of
distinction.
"maintain tension in the interest
As such they distinguish human from animal becoming and adult from infant becoming. By growth motives we refer to the hold that
ideals gain upon the process of development. Long-range
of distant
and often unattainable
goals.
purposes, subjective values, comprehensive systems of interest are all of this order."
He
regards the dynamics of
conscience as an example of growth motives.
Mayman
(1955), too, suggests as one criterion of mental
health the concept of growth and direction towârd goals
higher than the mere satisfaction of basic needs.

calls this drive to
attitude.
patients
Mayman
change and development the heterogenic
He contrasts
who seem to
it
with "the immobilization of those
prefer the security of their illness to
the prospect of change,
who seem
spontaneity, but even try to
not only to fear their
stifle
this spontaneity.
People
with minimal evidence of the heterogenic drive seem to
no wistful yearning
desperately
to
for
their
life,
feel
but cling
imprisonment, like Lorenz's
quasi-
who
refuse to part with their cages."
links this inner
push toward new experiences to
domesticated animals
Mayman
freedom or a richer
own
"
34
Freud's
life
"We
instinct:
view the
pro-
self-actualizing
pensities of a person as aspects of the Ufe-long cycle of
growth and
They
decline.
has called the
'life instinct,'
that set of forces
upset established levels of equilibrium and

dividual toward
The
'life
new and more complex
instinct'
what Freud
which tends to
are expressions of
comprises
all
move
the in-
equilibria.
the impulses
which tend
toward pleasureful contact with others, synthesis and growth.
These are the pressures which
we presume
to be responsible
for the restless dissatisfaction with one's psychological status
quo which we
are here calhng the heterogenic impetus.'
Investment in Uving
Pervading
many
of the passages already quoted
is
an im-
plied criterion that mental health shows itself in a rich, differentiated
life,
involvement in various pursuits not restricted
what must be done for sheer survival. Several authors have

been quite expHcit on the point. Gordon Allport (1937), for
to
example, speaks about the extension of the

of maturity, describing
it
as
an
self as
an
attribute
ability to lose oneself in
in contemplation, in recreation
and in
work,
loyalty to others.
Maslow (1955) found that self-actualizing people "in general

focused on problems outside themselves"; they have "feelings for mankind ... a genuine desire to help the human
race"; they are capable of "deeper and more profound interpersonal relations than any other adults"; they are "strongly
ethical, they
Mayman
have definite moral standards."

(1955)
formulates
much
the same idea as a
process characterizing mentally healthy persons in speaking

of their investment in living;
by
this,
he means the range and
quality of a person's concern with other people
and the
35
things of this world, the objects and activities that he considers significant.
With such investment
in Hving goes a
"capacity to evoke an empathic, wârm or compassionate re-
sponse from others," he
states.
This observation
related to
is
Maslow's finding that self-actualizing people seem

tract friends
to
at-
and admirers.
Lindner (1956) uses the term "employment" for this aspect

of self-actuaUzation. He describes it as "an attitude of affirmative dedication to existence, of
profound and complete par-
ticipation in living."
In Jung's optimistic psychology, "Self-actualization means

the fullest, most complete differentiation and harmonious
blending of
all aspects
of man's total personaUty" (Hall and
Lindzey, 1957). Implicit in Jung's general formulation, and

explicit in those of the other authors, is the notion that the
healthy individual demonstrates concern for others and does
not center
shall
It
meet
all his strivings
this idea
on
satisfying his
needs.
We
again in a later section.
should be noted that the investment-in-living aspect of
self-actualization can hardly be separated
tional aspects.
interests
from
its
motiva-
Presumably the individual must be committed
to these higher goals
and
own
and
concern with others, with work, ideas,
motivated to realize them, in order to
achieve them.
INTEGRATION AS A CRITERION FOR
MENTAL HEALTH
In the proposals suggesting certain qualities of the
self-
concept or self-actualization, or both, as criteria for mental

health, there
is
as a rule, implicit or expUcit,
another
crite-
36
rion: this
is
generally called integration of the personality.
Indeed, some writers clearly treat this additional criterion as

part of either the self-concept or of self-actualization. Others
single
it
out for special treatment. In view of
portance to some,
in
its
own
will be treated here as a
it
its
great im-
major category
right.
Integration refers to the relatedness of

attributes in
all
processes
and
an individual. The coherence of personality,
often referred to as the unity or continuity of personality,
much
an axiomatic assumption in
is
psychological thought. In-
deed, psychological treatment of mental patients as a rule
is
predicated on the search for a unifying principle in terms of
which the apparently most

tions of personaUty
When
integration
is
bizarrely inconsistent manifesta-
can be understood to hang together.

proposed as a criterion for positive
mental health, something additional or different
Some
is
implied.
authors suggest that integration as a criterion for
mental health refers to the interrelation of certain areas of

the psyche; others, that
it lies
of the unifying principle.
in the individual's awareness
Still
others imply that there are
distinctions in the degree or strength of the integrating factor.
And some
are silent
on
this point.
Integration as a criterion for mental health

rule,
is
treated, as a
with emphasis on one of the following aspects: (i) a
balance of psychic forces in the individual, (2) a unifying
outlook on
and (3)
life,
emphasizing cognitive aspects of integration,
resistance to stress.
Balance of Psychic Forces
As
a consequence of the psychoanalytic orientation of
writers
who
speak about
this criterion, it is
formulated either

as a specific balance of ego, superego,
and
id,
and conscious psychic
scious, preconscious,
37
or of uncon-
events. Earlier
psychoanalytic formulations of health implied the exclusive
domination of the ego rather than the notion of a balance
between ego, superego, and
id.
Heinz Hartmann (1947)
takes exception to this idea, w^hich takes too Hterally Freud's
programatic statement: "Where Id
Hartmann
vâs, there shall
Ego
be."
regards complete ego-domination as an un-
healthy type of balance. According to him, the notion of a

totally rational
human
being
(i.e.,
complete ego control)
is
man, even though one takes for granted "the

value of rational thinking and action for the in-
a caricature of
positive
dividual's adjustment to the environment."
His notion of the
proper balance suggests an ego that can accommodate
its
corresponding id and superego and does not aim at eUminating or, perhaps, denying their demands.
vvîth
Thus he
agrees
Kris (1936), v^ho speaks of "regression in the service of
the ego" as a preferred
form of human functioning under
certain circumstances, for
example in the reUnquishing of
when one wants to fall asleep.

Hartmann argues that rationalism is
ego control
with health, even though

of health
that the
... are
"it still
discussed.
not synonymous
plays a role
Thus
freedom of the individual
it
is
where standards
often maintained
to subordinate other ten-
what is useful for him makes the difference between healthy and neurotic behavior. Actually this is too
small a basis to build upon it a definition of health. The
dencies to
ego-interests are only
one
set of
ego-functions
among
others;
and they do not coincide with that ego-function that

considers the demands of the other psychic systems
.
their prevalence in
also
.
an individual does not warrant that the
38
drives are harmoniously included in the ego, nor that the
demands have been integrated into it."

Expanding on these ideas in another paper, Hartmann
super-ego
(1939) speaks of the plasticity of the ego as "one prerequisite

of mental health.
is
not only and at
quahty,
it
But
all
we
vôuld add that a healthy ego
times plastic. Important as
is
this
seems to be subordinated to another of the ego's
function ... a healthy ego must evidently be in a position

to allow
some of
most
its
essential functions, including
'freedom,' to be put out of action occasionally, so that
abandon
itself to
it
its
may
'compulsion' (central control)."
Here, the idea of balance
is
further modified.
Not only
does the healthy balance encompass id and superego, but

the balance
is
changeable. Perhaps most of the time
anchored in the ego;
at other
it
is
times the anchorage shifts to
one of the other two systems.
Kubie (1954),
too, sees the criterion of
mental health in
a specific balance of psychic forces; in his view, a balance
among
unconscious, preconscious, and conscious forces, with
the unconscious reduced to a

of normality that emerges
minimum. "The
...
is
implicit ideal
an individual in
whom
the creative alliance between the conscious and preconscious
systems
is
not constantly subjected to blocking and distortion
by the counterplay of preponderant unconscious

whether in the prosaic
affairs of daily
lations, or in creative activity."
result in flexibility:
bility,
Hving, in
forces,
human
re-
This healthy balance will
"Thus the essence
of normality
is flexi-
in contrast to the freezing of behavior into patterns
of unalterabihty that characterizes every manifestation of
the neurotic process, whether in impulses, purposes, acts,
thoughts or feelings. Whether or not a behavioral event
is
39
change depends not upon the quality of the act itself,

hut upon the nature of the constellation of forces that has
free to
produced
it.
No moment
of behavior can be looked
neurotic unless the processes that have set
determine
its
similarity
Kubie
motion presitua-
between the approaches of Hartmann and

emphasis on a changeable
balance and the latter 's emphasis on
as
consequences of the act!'
clearest in the former's
is
in
automatic repetition irrespective of the
tion, the utility, or the
The
it
upon
flexibility.
Unifying Outloo\ on Life
different tone
and terminology
talk about integration
is
on the cognitive
used by those
level.
Allport (1937),
for example, speaks about a unifying philosophy of
a sign of maturity.
reconciling
sion
He
who
life as
regards this unifying philosophy as
two otherwise
conflicting tendencies. Self-exten-
and
looking at one's
self-objectification
with detachmentpresent an antithesis requiring resolution by an ini.e.,
losing oneself in the things of the world

self
i.e.,
tegrative factor.
Such
a philosophy
is
not necessarily articulate, at
least
not
in words. But a mature person "participates and reflects,
and laughs, according
some embracing philosophy

of life developed to his own satisfaction and representing to
himself his place in the scheme of things."
lives
to
Allport discusses several types of unifying philosophies.
The
the "search for a value underlying all
first is religion,
things,
and
as
such
the most comprehensive of
where the quest
the
There
is
also the esthetic phi-
for beauty
is
the prime value. All-
possible philosophies of life."
losophy,
all
port views these outlooks as "autonomous master-sentiments
40
that give objective coherence
and
subjective
meaning
to all
the activities of their possessors' lives."
Apparently, the unifying philosophy of

individual's feeling that there
his
life.
On
by Allport
life results
in the
purpose and meaning to
is
a time dimension, the unity
theme
as the intentions of the present
is
presented
which commit
the individual to strive for specific aspects of the future. In
Becoming (1955), Allport introduces
a nev^ concept, the
proprium, for
The proprium
this integrating function.
sents all regions of hfe regarded as central to the self
cludes
all
aspects of personality
making
Propriate striving distinguishes

of motivation in that,
regarded
and
in-
for inner unity.
itself
however beset by
from other forms

conflicts, it
makes
"The
possession of long-range
as central to one's
personal existence, dis-
for unification of personality.

goals,
repre-
human being from the animal, the adult from

and in many cases the healthy personaHty from
tinguishes the
the child,
the sick."
Similar ideas occur in

self-actualizers as
though
Maslow
(1954), v^ho speaks of the
"being the most ethical of people even
their ethics are not necessarily the
same
as those of
and in Barron (1955), who emfound "character and integrity in the ethical sense"
the people around them,"

pirically
in persons judged to have a high degree of personal soundness.
In both statements there
is
a clear implication that
healthy persons possess a unifying outlook on
Thus,
it is
in the light of this aspect of integration
unifying outlook on
tion
life
becomes further
investment in living
to develop
it
life.
is
the
that the criterion of self-actualiza-
qualified.
The
self-actuaHzed person's
strong not because he was predestined
but because he has a unifying outlook which
PSYCHOLOGICAL MEANING OF VARIOUS CRITERLA
guides his actions and feelings so that he shapes
liis
4^
future
accordingly.
In the discussion of integration as a criterion for mental

health Erikson's concept of identity, mentioned previously
an aspect of the
as
tion to the
ter
self,
meaning
must be mentioned
again. In addi-
of identity pointed out before, this mas-
concept encompasses the balance of psychic forces as well
as the notion of a unifying outlook
on
Hfe.
The former
is
demonstrated where Erikson (1950) talks about the
clearly
function of the sense of identity: "Psychologically speaking, a gradually accruing ego identity
is
the only safeguard
against the anarchy of drives as well as the autocracy of conscience,
comes
clear
."
And
his concern
when he
synonymous with
speaks of ego-integration (practically
ego-identity)
development in terms such

one and only
life
significant to
it
with a unifying outlook be-
as the
as, "It is
crowning stage of
the acceptance of one's
and of the people who have become

something that had to be and that, by
cycle
as
necessity, permitted of
no
substitutions.
...
It is
a sense of
men and women of distant times and of

different pursuits, who have created orders and objects and
sayings conveying human dignity and love."
comradeship with
Resistance to Stress
Those who
discuss
mental health
as
manifested in a par-
ticular response to stressful situations are actually
with distinguishing healthy from

integration.
likeleads
stress
The
less
concerned
healthy degrees of
use of terms connoting behavior under
resilience, anxiety- or frustration-tolerance,
and the
to greater concreteness in specific criteria
does the use of the
more general concept
than
integration. Jack
42
R. Ewalt (1956) defines mental health as "a kind of
resili-
ence of character or ego strength permitting an individual,

as nearly as possible, to find in his
needs to
satisfy his basic
world those elements he
impulses in a vây that
is
acceptable
to his fellovi^s or, failing this, to find a suitable sublimation
for them.
This resilience of character should be such
that he can adapt himself to the vicissitudes of fortune, bounc-
ing back to find

after defeat.
Similarly,
nev^^
ways of
satisfaction or sublimation
."
W.
Wesley Allinsmith and George
Goethals
(1956) regard abiUty to withstand adverse events without
damage as a criterion of health when they say: "When

in conflict and unable to solve the matter rationally, the person has strong enough personaHty organization ('ego
strength') or, as some would say, is 'secure' enough, to be
inner
able to stand the tension.

is
A person with these
characteristics
often spoken of as having 'frustration tolerance' or being
able to 'delay gratification'; tension does not put the person

into a panic."
All authors
who
talk about this aspect agree that tension,
anxiety, frustration, or unhappiness occur in
in sick persons.
The
symptoms but rather
difference
lies
normal and
not in the presence of
in whether these
symptoms can
seri-
ously unbalance the degree of integration an individual has

achieved.
Thus Glover (1932) says, "a normal person must show

some capacity for anxiety tolerance."
In an interesting empirical study on the behavior of pa-
under pre- and postsurgical conditions, Janis (1956)

goes perhaps even a step further. Not only does the mentally
tients
healthy person tolerate anxiety without disintegration but.
he suggests
(at least
must be able
to
43
by implication), the healthy person
produce and experience anticipatory anxiety
in order to cope better with subsequent danger.
Thus, the once popular notion that the absence of anxiety

could serve as a criterion for mental health has fallen into
repute.
Whether
dis-
or not one agrees with TilHch (1952), in his
from nonessential (pathothe field assume anxiety to
distinction of existential (healthy)

logical) anxiety,
most authors in
be a universal experience.
with
it is
The
individual's
manner
of coping
taken as the health criterion. TiUich thinks of
and courage
affirmation
as the appropriate
way
self-
of facing
one's anxiety.
A NOTE ON REALITY-ORIENTATION
autonomy, perception of reaHty, and

vironmental mastery share an explicit emphasis on
Three
criteria
en-
reality-
orientation.
To
be sure,
criteria for positive
reality
this also
has played a role in the
mental health already presented. But
becomes the focus of
as
attention, discussion in the
mental health Hterature leads not infrequently into philosophical problems about
wish to avoid. This

relevant central
tually are
is
its
nature. This eternal question
made
easier
and tangential
no longer
by the
fact that
reality.
controversial.
The
central aspect con-
modern
from a concept of static to a concept of changing

Says Wendell Johnson (1946) "No other fact so un:
relentingly shapes
and reshapes our hves
as this : that reaHty,
in the broadest sense, continually changes; once

clearly
some
aspects of this question ac-
cerns the shift brought about by the development of

science
we
what has been 'known'
for centuries
we
and what
grasp
is,
in
44
fact,
the central theme of
are identical
modern
and that no one thing
that everywhere
is
change,
is
ever twice the same,
we
flux, process,
we must live in a world of differences.

The tangential aspect of the philosophic
.
bearing on mental health

exists
an
the
no two things
science, that
understand that
."
question directly
dispute over whether there
between
essential hostility or a compatibility
and the reaUty he
is
no
born into
man
longer spHts various
With
schools of psychological thought into opposed camps.
the development of psychoanalytic ego-psychology and
and
conception of ego-forces
as part of the native
its
ego functions
conflict-free
equipment (Hartmann, 1951), the psy-
choanalytic school has clearly indicated that

scribe to the unqualified
view of
it
does not sub-
reality as hostile to
man.
Academic psychology, which long has accused psychoanalysis of just this sin, always has had room for aspects of reality
both supporting and thwarting the individual's needs.
The
positive aspect of reaHty as a pleasurable challenge
and stimulation
to the individual has recently
been restated
by Charlotte Biihler (1954). Taking note of psychoanalytic

ego-psychology, Biihler says: "This concept of a positive
reality
would
also
imply the postulation of pleasurable
tivity ('function pleasure,'
K. Biihler)
that
is,
the stimulating process as such, not only in
Coping or mastery
is
from
this point of
with abolishment of stimulation, which

possible resolutions.
Only harmful
way
The mastery
of elimination.
its
ac-
a pleasure in
elimination.
view not identical

is
only one of two
stimuli are mastered
of 'positive stimuli'
lies
by
in
the integrative utilization of the organism's building process
by means of which the living being becomes

turaHzing material and imposing
its
active in struc-
own law on
it."
The thought
is
that the
enjoyment of
already embodied in the
that everyone
have to
vîll
after for every failure to
wisdom
reality
of the
is
good
Talmud;
45
in itself
it
states
justify himself in the Ufe here-
enjoy a legitimately offered pleasure
in this wôrld.
The emphasis on
the positive aspects of reality
is
called
for because, although the controversy has virtually been re-
solved
on the
theoretical level,
mental health. Here the

that the wôrld
This
may
tacit
lingers in discussions of
assumption frequently
still is
fundamentally hostile to the individual.
be the result of the fact that, historically, concern
vîth health
The
is
it still
grew out of concern with
disease.
point has been raised here to avoid repetitive interpre-
tation in the following sections. Unless there are

to the contrary,
we
will
good reasons
assume that the authors quoted do
not take an either-or position with regard to the relation

of
of
man to
human
reaUty and that they are aware of the complexity
experience in which positive and negative aspects
of reality are not neatly separated.
AUTONOMY AS A CRITERION FOR

MENTAL HEALTH
Many
as
as
persons regard an individual's relation to the world
mentally healthy
if it
shows what
is
referred to variously
autonomy, self-determination, or independence. Most
often, these terms connote a relation
and environment with regard

sense,
between individual
to decision-making. In this
autonomy means a conscious discrimination by the
individual of environmental factors he wishes to accept or

reject.
But occasionally autonomy
is
interpreted as a with-
[46]
drawal from
need for the stimulation offered
reality, as less
by the world, or
as a small degree of
involvement in external
matters.
Expositions of the criterion of
both of two aspects: (i)

process,
The
autonomy deal with one or
nature of the decision-making
emphasizing the regulation of behavior from within,
in accordance with internaHzed standards;
come
The
(2)
out-
of the decision-making process in terms of independ-
ent actions.
Regulation of Behavior from Within
Foote and Cottrell (1955) describe autonomy as referring

to "the clarity of the individual's conception of self (identity)
the extent to
which he maintains
a stable set of internal
standards for his actions; the degree to which he

directed
and
and
reliance
tains;
self-controlled in his actions; his
upon himself;
Hartmann
self-
confidence in
the degree of self-respect he main-
and the capacity for recognizing
and of mobilizing
is
realistic
defenses
real threats to the self
when
so threatened."
(1947) speaks of "a general trend of
human
de-
velopment, the trend toward a growing independence from

the immediate impact of present stimuli, the independence
from the hie
et
nunc"; and, somewhat
later,
of the "growing
independence from the outside world, insofar as a process

of inner regulation replaces the reactions and actions due
to fear of the social
Mayman's
environment
(social anxiety)."
description (1955) of
what he
calls
the
self-
determining attitude avoids the connotation that autonomy

manifests
itself
only
when
reality
is
threatening: "One's be-
havior should not be determined by external exigency alone,
but dictated also from within, based upon that inner organi-
"
zation of values, needs, beliefs, accomplishments and
47
still
unrealized goals, which together comprise that individual's
world view."
Independent Behavior
Maslow (1954) starts his description of autonomy much

like Hartmann when he says it means a "relative independence of the physical and social environment." But he goes
on
to describe, not the inner processes
dependence
which make such
possible, but rather their consequences.
in-
Accord-
ing to him, autonomous people more than others "are not
dependent for their main
satisfactions
on the
real world, or
other people or culture or means-to-ends or, in general,

extrinsic satisfactions.
Rather they are dependent for their
own development and

potentialities
and
of environment
continued growth upon their
latent resources.
means
on
own
This independence
a relative stabihty in the face of hard
knocks, blows, deprivations, frustrations and the
like.
These
people can maintain a relative serenity and happiness in

the midst of circumstances that
suicide.
They have
Here there
is
also
would
been described
a connotation that
events to be taken into account
as 'self-contained.'
autonomy
against the badness of the world, as
internal standards
drive other people to
if
is
a safeguard
the only external
were those in
conflict
with
and needs.
David Riesman (1950), on the other hand, explicitly recognizes that autonomy can manifest itself in going along with
the world as well as in opposing
Riesman
distinguishes
it.
In The Lonely Crowd,
various forms of characterological
adjustment to the demands of society (tradition-directed,

inner-directed, other-directed).
These types of adjustment
48
are different alternatives to the
anomic.
The autonomous
malad justed,
whom
persons are those
whole are capable of conforming
he
calls
who on
to the behavioral
the
norms of
a capacity the anomics usually lackbut who
their society
remain free
to choose
whether
to
conform or
not.
Whatever
their choice, they are less the creatures of circumstance than
any of the other characterological
types.
These conflicting interpretations of autonomy
as a criterion
of positive health are, perhaps, the result of contamination
how
by another aspect of autonomy: not only
made and what consequences
decisions are
they have in behavior but also
aim of the decisions. This last

been selected by Andras Angyal (1952)
the content and
aspect has
actually
in his use
Angyal
of the term.
describes the over-all pattern of per-
sonality functioning as a two-directional orientation:
''self-
determination on the one hand and self-surrender on the
Both tendencies
other."
The
exist in all persons.
goal of the former, which he calls the trend toward
increased autonomy,
is
"to organize
events of his world, to bring
wilHngly, to seek a
them under
and government." The goal of the

self
home
the objects and the

his
own
latter "to
for himself in
jurisdiction
surrender him-
and
to
become
an organic part of something that he conceives as greater

than himself!' And later: "It is only in the counterfeit, the
unhealthy behavior that one or the other of these basic
orientations
is
partially obliterated; in a well-integrated per-
son the behavioral items always manifest both orientations

in varying degrees." Riesman's description of
persons
is
autonomous
compatible with Angyal's balance of the two
trends.
At
this point, the
notion that mental health criteria have

49
an optimal, rather than a maximal, degree becomes particularly relevant.
This idea, applicable also to other
criteria
and
particularly to multiple criteria of health, has been proposed
by M. Brewster Smith (1950).
We
shall return to
in an-
it
other context.
PERCEPTION OF REALITY AS A CRITERION
FOR MENTAL HEALTH

Pervading
many
the idea that the
efforts to conceptualize
way an
mental health
individual perceives the world
around him supplies an important criterion for

health.
healthy
As
a rule, the perception of reality
when what
is
is
his
mental
called mentally
the individual sees corresponds to
what
is
actually there. In the mental health literature, perception
is
discussed invariably as social perception,
conditions under
meaning
which perception occurs or the
ception, or both, involve other
implication for terminology.
human
Even
if it
that the
object of per-
beings. This has
makes
an
sense under
different conditions to speak of perception as distinguish-
able
from other cognitive
ment, and thinking,
The term
modes
Two
processes such as attention, judg-
social perception
cannot be so isolated.
perception will here be used as implying various
of cognition.
aspects of reality perception are suggested as criteria
for mental health
empathy or
perception free from need-distortion, and
social sensitivity.
Perception Free from Need-distortion
At
first
glance the stipulation that reality perception be
correct in a mentally healthy person appears so self-evident
50
perhaps as contrasted with the psychotic's
with
reality
that many authors present the criterion in an
almost axiomatic fashion. Indeed,

sine
loss of contact
qua non
for reality adaptation.
mental health
as "that state of
of the environment,
mate enough
often treated as the
it is
mind
John Porterfield defines

in
which the perception
not objectively accurate,
if
to permit efficient interaction
son and his milieu;
."
is
approxi-
between the per-
(Ewalt, 1956).
Jahoda (1950) introduces correct perception as a criterion

also in close conjunction with adaption to reaUty: ".
cor.
may
rect perception of reality (including, of course, the self)
serve as another useful criterion of mental health. Unless

active adjustment involving the modification of the environ-
ment
is
to rely
on
hit-or-miss methods,
correct perception of the environment."

cepts the
same
it
must be based on
Maslow (1954)
call
possible to
it
a neurotic person not only relatively inefficient but ab-
solutely inefficient, simply because

real
an English
position: "Recently Money-Kyrle,
psychoanalyst, has indicated that he beHeves
ac-
world
he does not perceive the
as accurately or as efficiently as does the healthy
person.
The
nitively
wrong T
neurotic
is
not only emotionally sick
he
Barron (1955), too, speaks of correct perception of

as one of his criteria for mental health.
Yet there
is
is
cog-
reality
a major difficulty inherent in this apparently
self-evident criterion of
mental health:
it
lies
in the
word
when the object of perception is social

^but even when it is physical stimuli
who is to say
"correct." Particularly
in nature
what
is
"correct".? If
one perceives a landscape in terms of
form, another perceives
it
in terms of color,
and
a third in

terms of both these or of other
facets,
Or, with regard to a social object,
if
who
is
a teacher sees in a child
which
"correct"? Correctness as a criterion seems to carry
is
the implication that reality

there
most "correct" ?
his limitations while another sees his potentialities,
one
5^
only one
is
way
of looking at
erto unnoticed things in the
they remain new,
static
is
may
and limited and
that
new
hith-
it.
Yet seeing
world around us which, while
appear incorrect to others,
is
cer-
tainly not mentally unhealthy in the opinion of the writers
on the
subject.
The
point at issue here
mean
cannot
looking
that there
peculiar,
must be some
is
one and only one right way of
is
world around
at the
and perhaps
that "correctness" of perception
is
way
us.
of perceiving the world, there
objective cues to
what accuracy or
But whatever the individual,
fit
correctness
the resulting percept. This
mean when one
speaks of
mentally healthy perception.
To
avoid the connotation that there
seeing the world, the effort has been
word
"correct" altogether
and replace
The
it
by
is
one correct way of
made
to eliminate the
from the mental health
"relative
criterion
freedom from need-distortion."
author uses this phrase in suggesting that mentally
healthy perception means a process of viewing the world
one
so that
ferent,
is
able to take in matters one wishes
without distorting them to
fit
were
these wishes
dif-
that
is,
without inventing cues not actually existing (Jahoda, 1953).

To perceive with relative freedom from need-distortion does
not mean, of course, that needs and motives are eliminated;
nor that they have no function in perception. The require-
ment
is
of a different nature: the mentally healthy person
52
will test reality for
or fears.
One
its
degree of correspondence to his wishes
lacking in mental health will assume such cor-
respondence without
testing.
Parents, for example, ordinarily wish that their children

will
do well in school or
fear that they
may
fail.
A mentally
healthy parent will seek objective evidence and accept

if it
goes against his wishes.
One
even
it,
lacking in mental health
will not seek evidence, or will reject
it if it is
presented to
him and it does not suit him.

As
a mental health criterion, perception free
from need-
distortion reveals itself in a person's concern for evidence to
support what he sees and anticipates.
Empathy
or Social Sensitivity
Perception free from need-distortion
is,
perhaps, most
diffi-
when the object of perception is a person the self or

others. The former has aheady been discussed as the correctness aspect of the self-concept. The latter, the perception of
cult
the feelings
and
attitudes of others, has
been suggested
as a
separate criterion for positive mental health.
The major requirement

is
of the healthy person in this area
that he treat the inner life of other people as a matter
worthy of
his concern
and
attention. Implicitly,
he
is
also
expected to arrive at conclusions about others that are free
Foote and Cottrell (1955) make this one

of the ingredients of interpersonal competence, a term they
from
distortion.
use synonymously with mental health.
They
say: "People
appear to differ in their ability correctly to interpret the

tudes and intentions of others, in the accuracy with
atti-
which
they can perceive situations from others' standpoint, and

thus anticipate and predict their behavior. This type of social

sensitivity rests
It is
on what we
call the
perhaps worth noting that
this criterion,
although
literature,
has
good deal of attention from research psycholo-
received a
the
empathic responses."
appearing quite rarely in the mental health
gists.
53
They have demonstrated by
enormous
sence. This
is
difficulties in
their errors
discovering
its
and
successes
presence or ab-
a point one suspects to be true for most of
these criteria, but there
is
evidence for this instance.
ENVIRONMENTAL MASTERY AS A CRITERION

FOR MENTAL HEALTH
Perhaps no other area of
human
functioning has more
frequently been selected as a criterion for mental health
than the individual's reality orientation and his
efforts
at
mastering the environment.
There are two central themes pervading the relevant

literature: the
As
theme of
a rule, the former
success
is
and the theme of adaptation.
specified as
significant areas of living; the latter
is
achievement in some
a
toned-down version
of the former, implying appropriate functioning with the
emphasis more often on the process than on
its result.
In the mental health literature adaptation and environ-
mental mastery are treated on different
levels of specificity.
Ordering these emphases roughly from most

forms of
human
to least specific
functioning, these aspects can be distin-
guished: (i) the ability to love; (2) adequacy in love,
and play; (3) adequacy in interpersonal
work
relations; (4)
effi-
ciency in meeting situational requirements; (5) capacity for

adaptation and adjustment; (6) efficiency in problemsolving.
54
The
Love
Ability to
In at
one instance the
least
as a criterion for
of the
word
ability to love is entertained
mental health in the most narrow sense

experience sexual pleasure.
as the ability to
Hacker (1945) says: "The

by Reich appears to be by
biological concept as formulated

far the
most
logical because
a medical concept of normality, derived
gained by the study of mental diseases.
it is
from a theory
It states
attainment of full orgastic genital gratification
is
that the
the only
yardstick of normality for the individual. This does not

necessarily
imply that the sexual function
portant one for man, though
it
is
the most im-
recognizes sexuaHty as an
extremely sensitive indicator of the personality functioning
The
as a whole.
difficulty is to define
what
is
meant by
full
orgastic pleasure in every instance."

It
may
not be amiss to point out that orgastic pleasure
appears to be within the range of experiences open to the

rapist
and other sex criminals who, by such a
have to be regarded
as
criterion,
would
mentally healthy.
But Hacker's paper, devoted
to
an
eflfort
to deal
with the
what is actually meant by full orgastic

goes beyond it. Although he regards sexuahty as
difficulty of defining
pleasure,
the most sensitive criterion of health, he arrives at the conclusion that "the extent
personality
is
and form of integration in the
total
the criterion ; not whether one particular trend
accords with current social views on' sexual morality, or

religious teachings. Full integration of the personality, the
form and scope

possibilities,
of
which
varies,
according to the individual's
becomes the yardstick of normality."
Erikson's formulation with
its
emphasis on sexual
gratifica-
55
tion experienced with a loved partner of the opposite sex
narrow view of
clearly meets the possible objection to a
He
sexuality as a criterion of mental health (1950).
regards
sexual gratification as a sequel to the previously mentioned

stages in the
normal psychic development: "Psychiatry, in
recent years, has emphasized genitality as one of the chief

signs of a healthy personality. Genitality
is
the potential
capacity to develop orgastic potency in relation to a loved
partner of the opposite sex. Orgastic potency here
means not
the discharge of sex products in the sense of Kinsey's 'outlets'
but heterosexual mutuality, with
and with an
body
climactic
over-all discharge of tension
the idea clearly
full genital sensitivity
from the whole
that the experience
is
mutuaHty of orgasm provides
supreme example
of the mutual regulation of complicated patterns
way
and in some
appeases the potential rages caused by the daily evidence
of the oppositeness of
love
of the
and
make
hate, of
male and female, of
work and
sex less obsessive
Adequacy
in Love,
fact
and fancy, of
play. Satisfactory sex relations
and
sadistic control
superfluous."
Wor\, and Play
Another group of authors regard environmental mastery

as manifested in success in three crucial areas of Hving: love,
work, and play. Ginsburg (1955) puts forward this proposition in the most direct manner: "My coworkers and I have
settled for
some such simple
criteria as these: the abiHty to
hold a job, have a family, keep out of trouble with the law,
and enjoy the usual opportunities
Much
for pleasure."
of Alfred Adler's Individualpsychologie wâs based
on the same notion.
It is
in keeping with the obvious im-
portance of these areas of
life
that successful behavior in
56
this respect enters into the
diverse schools of thought.
mental health concept of quite
Mayman
(1955) speaks of
men-
healthy attitudes as contributing "to the formation of
tally
self-fulfilling patterns of love,
vôrk and play/' and Blau
(1954) describes the healthy individual as one v^ho "is able

to work adequately and to create vîthin the Umitations of
recreation.
He
can carry on his essential biologic functions of sleeping,
eat-
his capacities, to relax after vôrk
ing, excreting,
and
so on, vîthout
and enjoy
any sense of disturbance or
discomfort."
Adequacy
On
in Interpersonal Relations
a less specific level, a general competence in inter-
personal relations
health.
is
suggested as a criterion for mental
Based on the theoretical and empirical ôik of
Sullivan,
Horney, and other neo-Freudians, the relationship
to others
is
the major
singled out as a criterion. Sullivan assumes that
human
goal
is
security resulting
from
satisfactory
interpersonal relations. Foote and Cottrell (1955) build their
concept of interpersonal competence largely on Sullivanian

premises.
relations
They consider that "competence in interpersonal

is a means by vi^hich members of the family are
able to interact effectively in achieving their
and
their individual self-expression
common
ends
and development."
sHghtly different aspect of interpersonal relations as a
criterion for
mental health
is
among
the eight items
making
up the World Health Organization's concept (Washington

State Conference, 1951). There the statement is made that
"the healthy person has the ability to be reasonably aggressive
when
the occasion demands. But he
is
free
from any
inner necessity to dominate other people, to lord
it
57
over
them, or push them around."
Much
in line with this notion are the views of the British
H. V. Dicks, who regards
psychiatrist
relationships" as the
and
.
and
satisfying
human
and the elimination of hate
love
human
major reason for poor mental health,
"secure, affectionate
"failure in
."
relationships,
as criteria for
mental health (Ginsburg, 1955).

Following Erich Fromm (1941, 1947, 1955), a number of
positive
authors see the crux of the current mental health problem
from nature, from himself, and from

fellow men. Mental health efforts must in their opinion
in man's alienation
his
be partly directed toward improving interpersonal relations.

Rollo
May
(1954), for example, in his diagnosis of aHena-
tion in the
modern world,
describes
as a "characteristic
it
modern people in emotional difficulties

that they
have become alienated from their fellow men. They have
lost the experience of community
people really are
of
afraid of
one another.
."
Implicit in this statement of disturbance
is
the assump-
tion that positive mental health consists in absence of alienation
from
others.
But
May
does not spell out the positive
aspect of interpersonal relations as a criterion of health.
However, Dorothy C. Conrad (1952)
ment
gives
an exphcit
state-
of these positive aspects, after she has dealt with nega-
tive formulations.
She
stipulates
among
other aspects the
following manifestations in the area of interpersonal relations.
An
individual shows positive mental health to the
extent that he
"Has
positive a-ffective relationship:
The person who
is
58
able to relate affectively to even one person demonstrates

potentially able to relate to other persons
that he
is
society.
...
"Promotes another's
it
v^êlfare:
and
the benefit of another, even though that person
"Works
largely
to
make
Affective relationships
possible for the person to enlarge his vôrld
only remotely.
and
to act for
may
profit
vîth another for
formed through
mutual
social interaction.
when he
completely a person
beneficial relationship.
benefit:
The person
Perhaps he
is
is
most
participates in a mutually
."
.
Meeting of Situational Requirements
One
of the difficulties in arriving at criteria for mental
health comes
from the impact
of the situation
on behavior.
As has aheady been pointed out, to speak of situations as

healthy means stretching the meaning of the concept beyond
permissible Hmits. Health refers to a Hving organism. The
problem
is
particularly acute in the area of environmental
mastery. Efforts at mastery will take widely differing concrete
forms
if
we
look
at a child at
home
or in the school-
room.
To do
justice to these differences
as possible to concrete
while adhering
forms of behavior, a number of per-
sons suggest that positive mental health

individual's
tion.
manner
manifested in the
to be specially assessed for
every situation in which mental health
more H. Sanford (1956) does
He
is
of meeting the requirements of a situa-
These requirements have
school situation.
as closely
this,
is
to be judged. Fill-
for example, with the
distinguishes three situational require-
ments: to estabUsh appropriate relations with authority

(teacher), with peers,
child
is
and
knowledge and
59
skills.
mentally healthy to the degree that he func-
with regard
tions effectively
ments of the schoolroom

Other
to acquire
to these three basic require-
situation.
writers, too, speak of the efficiency
meeting the requirements of a situation
demonstrated in
as a criterion of
health without, however, specifying these requirements in
Wishner (1955), for example, proposes that

"psychological health and psychopathology be conceived as a
continuum and defined in terms of the eflEciency with which
detail.
Julius
environmental requirements are met. For the present, however, this definition
can be useful only in a relatively narrow
laboratory situation because of the difficulties involved in

the specification of objective requirements in the
social
sphere."
There
is
a troublesome implication in regarding efficiency
in meeting situatonal requirements as a sign of health even
when
the requirements are specified,
are not.
Some
alone
let
situational requirements, if met,
behavior that must be deemed unhealthy
terms of some other
and demanding
criteria.
when
can
they
call for
when viewed
in
Severe deprivations, a harsh
teacher, a prison,
and the
like, all
may
re-
quire behavior precluding self-actuaHzation, autonomy, or
perception
free
from need
distortion.
The impHcations
pointed up by these examples are that the criterion be appHed
only
when
there
is
some consensus on the reasonableness
of the requirement.
Adaptation and Adjustment
Those who
discuss environmental mastery
from the point
of view of meeting situational requirements are either care-
6o
requirements or are in
ful to spell out generally acceptable
danger of assuming the invariable reasonableness of such

requirements. Adaptation, vîth
environmental
factors,
Here, there
no need
able
is
is
connotation of modifying
not bound by a similar assumption.
hard
to regard
and only the individual
plies that a
its
reality as
unchange-
Adaptation im-
as modifiable.
workable arrangement between
reality
and
in-
dividual can be achieved by modifications of either or both
through individual
initiative.
From the psychoanalytic point of view, Hartmann (1939)

has made the process of adaptation the focus of his discussion
of mental health. He says; "Where many of the conceptions
of health
and
illness
stand most in need of amplifica-
tion [is] in the direction of the subject's relations
adaptation to reality.
Hartmann
with
What we
"we
unfortunately does not discuss concretely the
He
does suggest, however,
often learn to find our bearings in relation to
by devious ways.
reality
individual's adapta-
his sense of self-preservation."
course adaptation might take.

that
designate as health or
bound up with the
illness is intimately
tion to reality
There
quence here, withdrawal from

mastery over
it.
."
The
is
evidently a typical
article
is
se-
an increased
reality leading to
does not distinguish such
healthy withdrawal from that of the mentally

there
with and
a fundamental difference, and,
if so,
ill.
what,
Whether
is
a ques-
tion for research.

It is,
perhaps, not an overinterpretation of his position to
say that withdrawal
That adaptation
effort
most
from
reality
to reality
is
is
one way of modifying
conceived by
him
as
it.
an active
by the individual to choose or create an environment

suitable to his psychic conditions
becomes
clear
when
he uses pioneers and adventurers
as
turer-explorer, the pioneer settler,
homeland v^^ho went out

which they could adjust."
their
^^
an example: "The adven-
man on the fronmen maladjusted to
and the
extreme but good examples of
tier are
new environment
to find a
to
The fact that this particular modification of the environment can legitimately be regarded as defensive has, according to Hartmann, nothing to do with
healthy:
"Nor does
classification as
its
the distinction between healthy and
pathological reactions correspond to that between behavior

originating or not originating in defense.
It is true that
health
the
discussions
word adaptation
is
."
often used in mental
synonymously with meeting environ-
mental requirements. Hunt, for example, does so (Washing-
He
ton State Conference, 1951).

as the efifective carrying
individual.
The
on
defines adaptive efficiency
of the roles
and
task before us, however,
ferences in linguistic usage, but rather to
is
tasks before
not to
draw
an
settle dif-
attention to
psychologically meaningful aspects in the mental health

discussion.
One
such aspect
is
the idea that a healthy person
can change his inner balance of psychic forces as well as

the external world. This idea
is
conveyed by the term adap-
tation.
The
as
idea
is
inherent in Freud's statements about the ego
an active agent: "[A normal or healthy ego] denies
as little as neurosis, but then, like a psychosis,
with effecting a change in

leads naturally to
world and
is
some
it.
is
reality
concerned
This expedient normal attitude
active
achievement in the outer
not content, Hke a psychosis, with estabUshing
the alteration within

olio-plastic," Isidor
itself; it is
Chein (1944)
no longer
auto-plastic but
fully discusses the idea.
62
The term "adjustment"
actually used
is
more frequently
than adaptation, particularly in the popular mental health

literature,
anyone's
but often in an ambiguous manner that leaves to
whim
v^hether
for adaptation. It
should be understood as passive
that as meeting
indiscriminatinglyor as a synonym
acceptance of whatever
tional requirements
it
life
brings
situa-
is,
might be noted that Jean
concept of adaptation
is
Piaget's (1952)
actually a synthesis or proper bal-
ance of the active and the passive component in man's
rangements with the environment.
He
calls
ar-
the active com-
ponent "assimilation," which means that the environment

is
made
to provide the satisfactions
component
is
one wants. The passive
labeled "accommodation," implying that one
learns to like whatever the
environment has to
offer.
Problem-Solving
One
is
again faced with two connotations of another term
frequently used in the mental health literature: problem-
Some
solving.
emphasis on
tion. If
it
its
authors
talk
end-product
such a criterion
is
about problem-solving with
namely, the finding of a solu-
applied to realistic
easily leads to the idea that success
mental health. In
this sense,
is
life
problems,
the hallmark of
problem-solving meets the type
of objection that earlier led us to exclude various states of
well-being from further consideration.

Success
is
certainly a function not only of the individual's
behavior but also of circumstances outside his control.
To
regard successful problem-solving as a criterion for mental

health introduces an ambiguity in meaning, since success
cannot be regarded either as an attribute of a person or as an

attribute of his actions.
Be that
as
it
may,
it
may
still
be cor-

rect
^3
and should be verified by researchthat in our society
people v^ho are mentally healthy are more Hkely to be successful
The
than those v^ho are not.

other
meaning emphasizes
solving rather than
could actually be
its
made
the process of problem-
end-product. In this sense, a case
that problem-solving
is
many
in
There
similar to adaptation or active adjustment.
are,
wâys
how-
ever, differences in the usage of these terms v^hich help to
differentiate
them from each
long drav^n-out process,
is
one in v^hich the individual can
be engaged without being clearly aware of

let
alone
its
normally a
other. Adaptation,
beginning or end.
On
occurrence,
its
the other hand, problem-
solving can occur over both long and short time periods
and
is
used in the mental health literature as presupposing
a conscious awareness of a problem

to deal
with
this
and an
initial
problem. These differences seem
intention
sufficiently
relevant to regard problem-solving as a criterion in
its
own
right.
Whereas some persons make the assumption that the very

fact that one is wrestling with a problem is a sufficient indication of mental health, others specify particular
problem-solving as
criteria.
The
author's
effort
modes
of
(Jahoda,
1953) distinguishes three dimensions of the process:

First, there is the
time sequence of certain stages awareness

:
of the problem, followed by a consideration of

its
solution, a decision for
means, and
finally the
means toward
one or the other of the considered
implementation of the decision. This
sequence corresponds closely to several formal descriptions

of the thinking process (Duncker, 1945).
It is
understood,
of course, that in the course of problem-solving the sequence

is
usually less neat, with earlier stages being resumed in the
64
light of subsequent ones,
taneously in the
mind
It is
of
all
them simul-
of the problem-solver.
The second dimension

the various stages.
and often with
is
the f eeUng tone that accompanies
assumed that some discontent must be
maintained in the earHer stages
or, at least, that there
must
be an abihty to delay gratification. These feehngs serve as
an incentive for proceeding to the following

a
man
He
experiences his current
intends to change
ways of doing
this,
it.
likelihood
is
Suppose
situation as a problem.
But, as he faces the various possible
without proceeding to
other, his intention dies out.
The
work
stages.
He
select
one or the
gets used to his situation.
that he will not proceed to further stages
of problem-solving.
On
the other hand,
if
he continues to
maintain his intention and the appropriate feeling tone, he
may
follow such a mentally healthy
mode
as finding
more
work. Here the appropriate feeling tone will be posi-
suitable
tive.
The
third dimension of the process concerns the directness
or indirectness with
which a person approaches the root of
the annoying experience. If he perceives his

satisfactory a direct
tion of other
work
as
un-
approach would lead to the considera-
work; an
indirect approach
would
consist, for
example, of seeking substitute satisfactions in leisure-time

activities.
The
author suggests that a maximal degree of healthy
problem-solving combines the three dimensions: a tendency

to
go through
all stages,
the maintenance of an appropriate
feeUng tone, and a direct attack on the problem. Going
through
tion, is
this process, rather
than finding a successful resolu-
taken as the indication for mental health.
IV
An
Sjjort at Fwrtker
Qanjication
Ihe preceding survey of positive mental health concepts

encouraging in more than one vây. The number of ideas
relatively
Hmited; they can be reasonably
vêll
is
is
grouped un-
der a few headings. In spite of diversified theoretical positions taken
by the authors in the
sion that there
meaning and
among many
of
one gains the impres-
them
a large overlap in
intent v^hen they talk about mental health ; cer-
tainly, there are
proposals.
is
field,
few, if any, contradictions between the various
case could even be
tap identical concepts
on
made
that several of
them
different levels of concreteness.
But, notwithstanding such encouraging features, the sur-
vey of the literature does not resolve the complex problem of

clarifying
the psychological
health. Indeed, the review

fruitful
meaning
makes
it
of positive
mental
quite clear that the least
approach to the subject consists in assuming that
anyone has the answer
to the problem.
We
content with recognizing that there are
shall
many
have
on
so solid a
body of knowledge and
be
tentative an-
swers or approaches available and that none of them

yet based
to
is
as
facts that it
can definitely be singled out as the most promising approach.
To
say that there
is
as yet
no
entirely satisfactory
approach
[65]
[66]
available in the conceptualization of mental health
thing.
To
conclude from this
one
is
state of affairs that all further
clarification has to await the results of empirical research
quite another matter.
gently required.
be sure, empirical research
Its success,
depend on further
mental health
To
Some
ur-
however, will to no small degree
clarification of
field.
is
is
of
them
some general
ideas in the
will be discussed.
DIFFERENT TYPES OF MENTAL HEALTH

Since one obviously faces considerable difficulty in estab-
Hshing systematic relations in the psychological content of

ideas often expressed in poetic, rather than scientific, terms,
the question arises whether there
is
not some merit in the
diversity of concepts.
Perhaps the most cogent argument for accepting a variety

of ideas about the nature of mental health
is
the recognition
(Hartmann, 195 1) that "theoretical standards of health are

usually too narrow insofar as they underestimate the great
diversity of types
which
in practice pass as healthy
[italics supplied]. If there are different types of health,

it
not possible that at
least
some
refer to such different types,
!'
is
of the concepts discussed
and that they therefore need
not, or should not, be brought to a
common
denominator.'^
Robert White (1952) illustrates the variety of points of

views from which a person can be regarded as healthy. He
bases his discussion of mental health
on the empirical study
who
and related concepts
of "normal" people,
meaning persons
have never needed professional psychological help to
deal with the problems of living.
One
of the persons studied, "Hartley Hale,"
was
a physi-
AN EFFORT AT FURTHER CLARIFICATION

cian
and
He was
scientist of great
father Hartley
On
life
less successful.
husband and
Whenever work and
he decided in favor of work. In which
should one appraise his mental health? White
when one
points out that different interpretations emerge
makes some,
If
rather than other, aspects of Hale's
life salient.
one assessed Hale in terms of certain aspects of
actuahzation, he might be given a clean

assessed
him by
could be argued that this
is
bill
of health;
if
self-
one
work, and play" he
his abiHty to "love,
would be judged lacking in mental

It
achieved mightily.
the other hand, as a
Hale was
life conflicted,
area of
He
devoted to his vôrk, successful and well-respected
in the profession.
family
ambition.
health.
as
it
And
should be.
the
argument can be bolstered by an analogy with physical

health and physical illness. Apparently there, too, no single
concept has as yet been proposed.
The medical
profession
is
content to operate with a variety of dimensions of physical

health whose relations to each other remain so far
The dimension
unknown.
of resistance to disease, for example,
relevant to epidemiologists;
it
has no
known
is
relation to the
dimension of physical strength, a relevant health consideration
among
athletes
and
their medical advisors. Longevity,
yet another dimension of interest to medical science,
may not vary with the former.
It is
in this sense that
may
or
William
Alanson White (1926) speaks of health as a relative notion:

"Disease and health are relative terms: in order to understand the nature of health and disease
just
how we
ganism.
Neither
is
we must
are to approach the study of the
decide on
human
or-
."
physical disease a unitary concept.
advances, concepts which
first
As knowledge
appeared unitary are revealed
68
as
comprising a variety of discrete notions; in a discussion
of delinquency,
"This
is
Merton (1957) makes
this general point:
not too remote, in logical structure, from the
as-
sumption of a Benjamin Rush or a John Brown that there
must be a theory of
disease
and
disease, rather
of tuberculosis and
than distinct theories of
arthritis, of
Meniere's syndrome
enormously varied conditions
syphilis. Just as classifying
and processes under the one heading of
disease led
some
was
their
zealous medical systematists to beHeve that
it
task to evolve a single over-arching theory of disease, so,
it
seems, the estabhshed idiom, both vernacular and scientific,
though
of referring to 'juvenile deliquency' as

single entity, leads
theory of
what
as a
is
'its'
some
to believe that there
causation. Perhaps this
meant by
is
it
were a
must be a
enough
basic
to suggest
referring to crime or juvenile delinquency
may
blanket-concept which
get in the
way
of theoretical
formulations of the problem."

If
one replaces in the above paragraph the word "delin-
quency" with the words "mental health," the appropriateness of Merton's statement
stop at this point.
thesis into
synthesis
Having
independent
becomes
dissolved an oversimplifying syn-
aspects, a
possible.
There
But medical research makes

for illnesses created
evident. Yet science does not
is
it
new and more
is
systematic
not one theory of disease.
possible to develop a theory
by germs, for example. In the
field of
mental health, some beHeve that the dissolution of the

"blanket concept"
To
tage.
is
the next strategic step.
follow this strategy
The
may
bring an additional advan-
idea has been expressed in discussions of mental
health that people vary so
equipment that
it is
much
in terms of their native
unreasonable to assume they could
all
be
AN EFFORT AT FURTHER
CLARIFICATION
^9
measured by the same yardstick. The genius and the moron
man may have their special types of

There may be sex differences in this respect,
as well as the average
mental health.
even though industrialized society tends to even out some

differences in the functioning of
But,
adoption of different
the
ultimately,
men and women.

criteria
of
mental health for groups with different constitutional en-
dowment
is
a question of
how one
wishes to look at such
Kluckhohn and Murray (1948) have pointed

out, every man is in some respects like no other man, in
some respects like some other men, and in some respects
like all other men. Those who speak of different types of
groups. For, as
health obviously prefer the middle position.
One way,
then, of dealing with the relationship between
the various concepts
from each
tive
other.
is
to assert their possible
They may
mental health.
An
independence
designate various types of posi-
individual
may
manifest mental
health according to one concept but not according to another.
gangster
image
is
concerned; unhealthy with regard to meeting the
may
be judged healthy as far as his
requirements of a situation. Or, for that matter,

Blake, the mystical poet and painter,
may
self-
WiUiam
score high in
terms of aspects of self-actualization, low in terms of perception free
The
is
from need-distortion.
idea that there are several different types of health
not imiver sally accepted in the
writers clearly recognize that
To
be sure, most
what they regard
sence of positive mental health
range of behavior and
field.
is
as the es-
compatible with a wide
styles of life.
They do not assume
that one healthy person will resemble the next as one

other.
But they regard such different manifestations
egg the
as
com-
70
with one concept of mental health rather than as
patible
requiring the assumption of diverse concepts.

If
one
accepts,
however, the idea that there are various
types of mental health, concepts in any one or all six areas
may
be worked with, and their relation to each other be-
comes a matter for empirical research, much

between
athletic strength
lem. But
it
will
still
and longevity
is
be necessary to heed
as the relation
an empirical prob-
WilHam
White's
re-
how to approach a study of mental

some who find it easy to select one
quest for deciding on just
There may be
health.
many
of the
ideas
which have been presented
for practical
application or research work. Others will hesitate to choose
without further thought about what

for;
with them,
we
they are deciding
it is
turn to the next approach toward
clarifi-
cation.
THE MULTIPLE CRITERION APPROACH

When
judging such a case
who come
as that of
to the conclusion that
health are not necessarily

functioning.
They may
bHnd
credit
he
Hartley Hale, those
is
lacking in mental
to the positive aspects in his
him with
self-actualization,
for example, but they regard this only as one element in
mental health.
only
if
aspects,
tions.
He would be called
a mentally healthy person
he combined with self-actuaHzation other healthy

such
as appropriate
concern for interpersonal
rela-
In other words, they use a multiple criterion.
The
relation of various
components
to each other in a
multiple criterion can be understood in a variety of ways.
Some
authors regard a multiple criterion as composed of the
various
ways in which the underlying quaUty of mental

health can manifest
self-actualization
is
itself.
Of
this type,
is
motivated to
and spontaneous, has a
self-actual-
always higher
strive for
goals but also has an adequate self-image,

creative,
Maslow's idea of
the outstanding example.
izing person not only
7^
autonomous,
is
reality-oriented perception of
the world, enjoys love, work, and play, and has a well-
developed individualistic
criterion
as
approach
is
In
ethic.
this sense, the multiple
syndrome
similar to the notion of a
used in medicine, for example,
when one
speaks about the
TB syndrome.
Another type of multiple
criterion
is
presented, for ex-
ample, in Erikson's developmental approach.

called that the various
specifies are
It
will be re-
components of mental health that he
each acquired in a definite stage of a person's
development.
Allport's multiple criterion approach
kind.
He
is
of yet another
combines various psychological functions jointly
producing specified consequences:

objectification, synthesized
self -extension,
and
self-
by a unifying philosophy of
Hfe,
are necessary so that maturity can result.
fourth type of multiple criterion does not assume a
unitary cause or temporal lawful sequence but

constituted. It
is
is
empirically
a cluster of related characteristics.
for example, assumes four
Mayman,
components of mental health the

:
self-determining attitude, the heterogenic attitude, the alloplastic attitude
and investment in
living.
The
author, also a
proponent of the multiple criterion approach
proposing
active adjustment (environmental mastery), integration,
perception as jointly constituting mental health

different
other: "It
way
is
in
which
these criteria
may
suggests
relate to
easy to imagine social conditions
and
a
each
which favor
72
one or two but exclude

a
lost cause, for
possible.
replaced by illusions.
is
Under
unemployment active adjustment may be imUnder the conditions of a polysegmented so-
many incompatible values and norms, the unity

personality may be abandoned for the sake of opportun-
ciety
of
efforts in fighting for
example, obviously exclude correct percep-
tion which, in self-defense,
conditions of
Heroic
others.
istic
with
adjustment in terms of correct perception" (Jahoda,
1950).
According
to this view, perception relatively free
from
need-distortion can be increased to the Hmit only at the ex-
pense of active adjustment. This multiple criterion approach

to the concept of
mental health would thus draw attention
to the psychological price people
may
have to pay for de-
veloping one component at the expense of another under

unfavorable
environmental
course, this quid pro
vestigated singly
and
In
theory,
of
quo idea of psychological functioning
could also be ascertained
were established and
circumstances.
if
a variety of types of mental health
and consequences
in-
In practice, however, such
re-
their antecedents
jointly.
search might well be neglected unless the concept of health
was
so formulated as to
make
the question mandatory.
This idea has been elaborated by Smith (1950), who introduces the notion of optimum mental health, in contrast
to other assumptions that every
component of
a mental
health pattern could and should be maximized, whatever the

psychological or situational context. Actually, he implies that
the multiple criterion approach
which
can vary inversely with each other

unitary function which
much
is
is
uses
components that
based on an underlying
available in a given quantity. If too
of the available energy goes into active adjustment,
not enough
is left
CLARIFICATION
for perception of reality.
What
73
the opti-
mum combinations of components are under any given set of

conditions he regards as a question for empirical research.
As one reviews
ways of using a multiple
these various
becomes
clear that there
of course,
no incom-
criterion,
it
patibility
between the idea of diverse types of health and the
use of such a criterion.
by a combination of
knowledge
it
may
Each
is,
specified type could be assessed
indicators.
At
the present state of our
well be best to combine the idea of various
types of health with the use of a multiple criterion for each.
The former
will prevent over generalizations; the latter will
permit us to do
justice to the
complexity of
human
func-
tioning.
MENTAL HEALTH AND MENTAL DISEASE

Early in this report,
we committed
that the absence of mental disease
of mental health.
was
yet
that
no
much more
on
practical
not a sufficient criterion
The major argument presented
satisfactory concept of
at that
mental disease
time
exists as
would be gained by defining one vague

terms of the absence of another which is not
and that
concept in
is
ourselves to the idea
little
precise.
To
reject this type of definition
mainly
grounds disguises an issue of importance: the
question of the relationship between health and disease.
few remarks on
The
this subject are in order.
traditional
view that health
is
the absence of disease
has recently been opposed by the idea that mental health
and mental
disease are qualitatively different.
most strongly made by
Rumke
(1955),
who
The
point
is
disagrees with
the notion that "there exists between health and sickness an
74
almost imperceptible progressive transition.

opinion,
man
"The understanding
."
In his
of the disturbances of the sic\
hardly contributes to the understanding of the normal
man." This formulation seems
to
ho^ much
deny
psychology owes to the study of the mentally sick
general
as well as
the possibility that increased knowledge of mental health
may one day

mental
significantly contribute to the understanding of
disease.
Yet, the idea that mental health
and mental
qualitatively different seems to gain currency
who
professional persons. It appeals to those
disease are
many
with
are puzzled
by
the existing evidence that similar pathogenic events lead to
mental disease in one case but not in another;
to those
are convinced of the organic nature of mental disease;
those
who
fense
mechanisms between persons who
are
aware of
similarities in experiences
feel in
who
and
to
and de-
need of
treat-
ment and persons who do not. Assuming that health is

quahtatively different from disease, the extreme pole of sickness would be absence of disease; of health, absence of health.
Such a view enables one
features, nonpatients
to conceive of patients
with healthy
with sick features.
Conrad (1952), for example, finds it useful to distinguish

positive health from nonhealth as well as from negative
health: "Positive health consists in
beyond the
frontiers of
negative health.
when
there
capacity or
she
is
is
mere
ways of Hving
social existence
that are
implied by
This category (positive health) applies
evidence that the individual fully utilizes a
working in
that direction."
means not pathology but some form
By
negative health
of vegetating, with-
out either positive health or disease.
To
think of mental health and mental disease as two in-
dependent but contrasting conditions means
Max
ideal types (in
them
as
Weber's sense). As with every other
typological classification, pure types
man
to treat
75
do not
Every hu-
exist.
being has simultaneously healthy and sick aspects, with
one or the other predominating. The advantage of having

established the pure types,
and of conceiving of them
as
quaUtatively different, consists in drawing attention to the
health potential in patients and the sickness potential in
healthy persons.
Mayman,
for example, has
found
this useful
(1955). In his clinical experience, he has apparently en-
countered each of the four health components developed to
some degree
and has been able
in various patients
to use these
health components as a lever in his therapeutic efforts.

It
appears, then, that the definition of health as the absence
of disease can be rejected
on other than
just
pragmatic
grounds.
What
are the implications of this conclusion for the use of
mental health
criteria
turbances which
all
we
call
when
dealing with the diverse dis-
mental disease ? In principle,
at least,
the criteria are applicable to everyone, mental patient or
not.
Those who
are professionally qualified to deal with
patients are understandably
more
sensitive to the manifesta-
tions of disease than to those of health. It will take special

efforts to
with the
The
disease
introduce concern with health into clinical

sick.
But such
efforts
issue of the relation of

is still
that "apart
the accused
sense,
made
mental health and mental
in a criminal case
from an unshakable
is
well be worth while.
exceedingly complex. Take, for example, the
notorious judgment once
mon
may
work
perfectly normal."
inasmuch
as this
belief that
The
he
is
which held
the Messiah,
statement offends com-
unshakeable belief appears to be
[y6]
a crucial disturbance in the
man. But does
it
actually say
anything but that there are sick features in an otherwise

healthy person ?
Or take the artistic production of mental patients. Some of

Van Gogh's greatest pictures were painted while he was
sick. Some of Hoelderlin's or Ezra Pound's greatest poems
were created in an asylum. Some of Bruckner's greatest
symphonies were produced while he
compulsion to count the leaves on the
Do
to
felt
under the desperate
trees of
Vienna's parks.
such examples support the popular notion that you have
be crazy to be an
artist
or the equally widespread assump-
tion that psychotherapy will eliminate extraordinary talent ?
Or can
it
be interpreted as an indication of a strong health
among
potential
these artists
were
their personality,
produce
when
who, in a
also disturbed?
different aspect of
Did they
actually
in the full grip of a terrible disease or in the
intermissions between attacks
These and many other questions cannot yet be answered.
The
relation of mental health to mental disease remains
of the
one
most urgent areas for future research.
THE VALUE DILEMMA

Throughout the preceding discussion we have attempted
as far as possible to ignore
of values.
one major problem, the problem
The postponement was
discussion of values will profit
deliberate. Hopefully, the
from having
first
dealt with
ideas of mental health in other contexts.
Actually, the discussion of the psychological
meaning
of
various criteria could proceed without concern for value

premises.
Only
as
one
calls these
psychological
phenomena
"mental health" does the problem of values
By
this label,
are "good."
w^hat?
one
And,
Good
77
arise in full force.
asserts that these psychological attributes
inevitably, the question
is
in terms of middle class ethics?
For the development of the
for
de-
social status
quo? For
mankind? For
survival?
mocracy ? For the continuation of the

the individual's happiness? For
Good
Good for
raised
species
For
art
and
creativity
For the encouragement of genius or of mediocrity and con-
The
formity ?
could be continued.
list
Different persons will prefer different values

criteria discussed
prima
here have differing relations to these values.
facie case could be
made, for example, that meet-
ing the requirements of the situation

to the
and the
is
more
closely related
maintenance of the status quo or to conformity than
to creativity; or that the criterion of adaptation
automat-
economically secure w^ho
ically discriminate in favor of the
are in a better position to
may
modify
their
environment than
are those v^ho live in less privileged circumstances.
The
selection of criteria in terms of their relation to the
high values of our
seems so
civilization
difficult that
privilege of ignorance.
one
While
or, for that
is
almost tempted to claim the
it is
easy to speculate about the
relation of each criterion to a vast

vê
do not know whether such
self-actualization
species,
as
really
number
of high values,
relations actually obtain.
benefit
Fromm would
matter, any other
the
claim?
Does
development of the
Is
interpersonal
com-
petence a prerequisite for the happiness of the individual?

Is
happiness or productivity the value underlying an active
orientation to problem-solving? Is altruism necessarily related to
empathy ?
Or, to put the difficulty of extricating the values under-
78
phenomena
lying the selection of various psychological
mental health into a different perspective:
criteria for
culture- or social class-bound
v^ho have suggested the
is
as
How
the value orientation of those
criteria
Would
people living in an
Oriental civilization have considered contemplation and de-
tachment
as suitable criteria
Would
be more appropriately attached to

ness, to
fit
Not only
is
self-assertive aggressive-
dominant values in the vôrking
civilizations
w^hat
the mental health label
class in
Western
are the ansvêrs to these questions
unknov^n;
method
of thought
wôrse, there is
no
logically tight
or analysis available through v^hich the value impHcations of

the various health ideas could be teased out vîth
some degree
of confidence.
There are
tvô considerations, hovêver, that help to reduce
the value
dilemma
size. First,
we
many;
it is
to
one of somev^hat more manageable
suggest that mental health
is
one goal among
not the incarnation of the ultimate good. Sec-
ond, the search for the values underlying mental health
need not involve one in the megalomaniacal task of blueprinting the values for the distant future, or for
all
civiUza-
tions.
The
discussion of mental health often makes, implicitly
or expHcitly, the assumption that a mentally healthy person

is
who
one
assumption
is
is,
"good" in terms of
all
desirable values. This
curiously enough, shared by proponents as
well as opponents of the mental health movement.
People
who
are devoted to mental health work, often with
an enthusiasm akin
all evil
ment
and
of
to religious fervor, see in
all social
mankind.
it
a panacea for
problems or for the wholesale improve-
The
larly
CLARIFICATION
Opposition against the mental health
assumes that mental health
ridicule
it
simi-
movement because
will lead to a neglect of other high values.
mental health standards
suggested as the ultimate
is
good. Humanists often oppose the

fear that
movement
79
they
They
incompatible with the
as
appreciation of greatness, unique achievements, or the depth

of
human experience.
The assumption that mental
high values
is
never serve
all
health be compatible with
Human
actually not necessary.
beings can
the highest values simultaneously.
by
conflicts of values
up such
setting
all
To deny
global standards for
mental health leads to a denial of the condition of being
human. Only hypocrites

the choices in
life
or the inexperienced can assert that
between "the good" and "the
are always
bad." So simple an alternative

in every
is
rarely posed. Conflict occurs
and most frequently
life,
is
it
about alternatives
good in themselves but incompatible with one another.

There
are, then, other
mental health.
It is
good things in
perfectly possible
life,
apart
from
and plausible in these
terms to maintain one's high admiration for William Blake,

for example,
terms
and
to regard
him
as not mentally healthy in
of, say, reality perception. It is
also possible for a
teacher to specify as his goal that students acquire knowl-
edge and to evaluate them in these terms even

brilliant student
shows
if
the most
Httle self-awareness. Similarly, as
have seen in the case of Hartley Hale,
it is
possible to be
outstanding and devoted scientist without meeting the

rion of adequacy in love, play,
a balance of psychic forces.
we
an
crite-
and work or perhaps even of
To
consider such a person as
lacking in mental health means neither condemning
him
a mental hospital nor establishing his moral inferiority.
to
8o
required from those
If this position is granted^ all that is
working
in the mental health field
values v^hich induce
them
make
to
is
expHcit the
to select certain criteria, wîthout
aiming for the moon.
By
W2Ly of an example, one value strikes us as being
patible vîth almost all of the
com-
mental health concepts
dis-
cussed here: an individual should be able to stand on his
ow^n feet vîthout making undue demands or impositions on
Some such
others.
value underlies most clearly Ginsburg's
idea that mental health consists of being able to hold a job,
have a family, keep out of trouble vîth the law, and enjoy
the usual opportunities for pleasure. Although this modest
value
is
health,
not as clearly implied in other concepts of mental
it
seems compatible with them.
different social classes, but

side the orbit of
Others
whether
Western civihzation
may feel that
this value is
notion of mental health, or that

is
offered here only as an example
It
is
it
is
appears relevant to
meaningful out-
moot
question.
not compatible with their
it is
of too
low an order;
it
extricated from the Htera-
ture intuitively rather than systematically.
Such a modest value premise takes the grandeur (and
also
many
now the
the horror) out of the value preoccupation of the
mental health discussions that attempt to specify

values by
task
is
is
which the next generation
shall live.
unimportant or can be ignored. After
that a current generation does,
what the next generation
philosophers, the
all,
no
that this
whatever
it
will inevitably affect
will regard as good.
the mental health field have
weighty decision.
it
Not
The
special right to
experts in
usurp this
Politicians, humanists, natural scientists,
man
in the street,
and the mental health
expert must jointly shoulder this responsibiHty.
From
Ideas to Systematic
^^search
lo CONDUCT systematic research in the area of mental health

requires a translation of the ideas presented into concepts
suitable for treatment
now
is
We
by current research procedures.
turn to the question whether and to what extent this
feasible.
The
study of
human
behavior, Hke every other science,
is
The purpose of all research procedures

much as possible the accuracy of observa-
based on observation.
is
to increase as
tions.
The
crucial test for the soundness of research tech-
that several observers can arrive at similar judg-
niques
is
ments
as the result of
having independently applied the
same procedures. To adapt the mental health concepts to

these requirements means that the empirical basis for infer-
more criteria,
the making of
ences about mental health, according to one or
be spelled out and that the conditions for
we
observations be explicit. Accordingly,
shall first discuss
this question of empirical indicators for the various
health
To
only a
mental
criteria.
establish empirical indicators

first
step in acquiring further
if
it
can be done
is
knowledge about mental

[8i]
82
health. Neither scientific nor practical purposes in this field
met by mere accuracy of descriptions. To

understand mental health, and to apply such understanding, demands that the conditions under which it is acquired and maintained become known. The discussion of
are adequately
empirical indicators will, hence, be followed by
some sug-
gestions for seeking such understanding.
EMPIRICAL INDICATORS FOR POSITIVE
MENTAL HEALTH
By and
large, empirical indicators are
in the mental health literature.
As
not well developed
a consequence, the as-
sessment of an individual in this respect

intuitive insight of
is
often
left to
an observer. The vast research
the
literature
on human behavior, on the other hand, presents many

empirical indicators and ingenious devices for observation,
but
rarely deals with the
it
stitutes
The
these
complex problem of what con-
mental health.
task before us
two
fields. It
is
to attempt a
rapprochement between
would be fooHsh, of
course, to attempt
here a comprehensive overview of research techniques,

alone of the major unsolved problems in the science of
let
man
having intimate bearing on techniques for observation and
measurement. All that can be done

ing of the major
search techniques
criteria
is
to revert to the
and present
which might do
justice to
Inevitably, the discussion will touch

issues
selectively
mean-
some
re-
them.
upon some general
and controversies in the study of human behavior;
they will be identified where they
first
occur.
FROM
IDEAS TO SYSTEMATIC RESEARCH
Toward
Attitudes
^3
the Self
variety of research tools
and
strategies for observation
are currently available to deal with aspects of the self-concept.
The
basic design consists of a
description and
comparison between
self-
performance, or self-description and de-
by others.
scription
from
Self-descriptions are elicited or inferred
relatively
unstructured and unstandardized material such as autobio-
from
graphical sketches or protocols of therapeutic sessions,

projective tests such as the Rorschach or
tion Test, or
from highly structured
and other paper-and-pencil
tests,
Thematic Appercep-
personality inventories
such as the Minnesota
Multiphasic Personality Inventory or the Taylor Anxiety

Scale.
Whatever the instrument used, the content of such
many
descriptions consists of
feelings, interests, or values.
different items
This
raises
traits,
self-
motives,
a major question
unanswered by the mental health Hterature:
left
every item
Is
referring to the self equally relevant for mental health?
Take the
accessibility of the self to consciousness:
awareness of what induced a passing
mood
Is
the
as relevant as the
awareness of what prompted one's choice of a marriage partner
And
if
not,
to consciousness
Or
which
All ?
areas of the self should be accessible
And what
are these areas
take the aspect of correctness of the self-concept:
studies
own
ex-
number
of
have tested a person's abiHty to identify his
pressive
movements, such
photographs.
Is this a test
Or should mental
as his gait,
from
some
of correctness of the self -concept
health be inferred from the correctness of
other features of the self-concept ?
And
if so,
which ?
84
Or with
self
and sense of
Should pride in one's achievements be given the
identity:
same
regard to feelings about the
v^êight as one's
acceptance of grey hair ?
All these questions point to the need for a theory v^hich
dimensions of the
specifies
tions to each other.
They
self
also
and
their hierarchical rela-
imply that the mental health
hterature has insuflBciently specified the concrete nature of

aspects of the self that enter into calling a person healthy.
Depending on the
characteristic of the self-concept
under
study, variations in the basic observational strategy are indicated.
One way
judgment about the
of arriving at a
cessibility of the self to consciousness, for
ac-
example, consists
of confronting a person with an assessment of his personaUty
arrived at by competent observers.
such judgments
like.
may
The
person's reaction to
be acceptance, denial, surprise, or the
These reactions then form the
basis for evaluating the
extent of his self-awareness.
Ingenious as this method
major problems, both of

is
to
two
crucial concern to psychology.
One
is,
it
draws attention
contained in the distinction between the
and the
others
self).
The
self -concept
distinction
is
(the
way
self as it
appears to
the person sees him-
akin to that between conscious and
unconscious portions of the
or the "real" self
self,
and the
self-concept.
The
by
his
other problem concerns the validity of assessments
However qualified an
methods, is what he observes
others.
observing? Applied to the
scientific
procedure the question
the observer
actually
self-concept, is
server sees a person actually the

is
however
observer,
way
subtle
what he aims
the
this
way
at
the ob-
person is? In
answered affirmatively
if
makes a prediction based on what he has found
FROM
and demonstrates the correctness of

example, that a person
state, for
is
other
goals.
things being equal
his prediction.
who
will
with
this
demonstration of
predictions seems to
him
a guarantee that the
is
this prediction.
rightly not entirely
validity.
To make
what
made under
observation,
man might do
such
a relatively easy matter but not yet
special circumstances of a research study, will be
of
He might
himself achievable
Experiments can be conducted to verify
satisfied
accepts himself as he
set
But the mental health practitioner
85
the very
an indicator
and
or feel under the pressures
fluences of daily living. Since the practitioner
is
in-
interested
in mental health as manifested in daily experience, he occasionally

fied
becomes wary of research conducted in the
atmosphere of a laboratory. In other words, he
the question:
Can
question
is
raises
research conducted under special condi-
tions be generalized
The
rare-
.f^
crucial. Earlier in this report a distinction
was introduced which has some bearing on finding an answer to it: the distinction between mental health as a more
or less enduring attribute of a person or as an attribute of a
specific action in a specific setting. It
we
can
know what
is
generally agreed that
people are only by inference from what
they do. But every action
is
to varying degrees a function not
only of the acting person but also of the situation in which
he finds himself.
Scientific observation of
human
of arriving at generalizations
from
beings uses several ways

specific actions.
Perhaps
the most frequent one consists in observing people under

conditions that reduce situational influences as
sible.
One who
takes a Rorschach
situational cues of
test,
much
as pos-
for example, has
what a "right" response
is.
no
In the absence
86
from the outside, he is thrown back on

cues from the inside. In this manner he reveals his personaHty
predispositions. This is, of course, not entirely so. One might
of specific guidance
be frightened or attracted by the
administrator or pick
test
No
out cues from his expressive behavior.

fore, will
want
to rely
on one
test
clinician, there-
performance only for his
personality diagnosis. But according to the theory underlying

these
they present a good approximation of what a
tests,
when relatively free from external influences.

Another way to approach generalizations about what
person
is
person
is,
beyond what he
one concrete
reveals in
act, is to
search for consistent trends in his behavior in a variety of

situations. If a test score, a personality inventory,
observation
all
and
clinical
indicate a well-developed sense of identity, the
result inspires a greater degree of confidence that a per-
sonaHty attribute has been identified than
when
results differ
in three situations.
Clinicians often approach the
by making
their inferences
problem of generalization
from a
person's action in situa-
him. They regard the
tions central to
self as
revealed in re-
lation to a life partner as a better indicator of
nature than the
self
its
actual
revealed while using the subway.
All these approaches are, of course, tenuous. But only an
more than an
unreahstic perfectionist
would look
proximation in
GeneraUzations about an individual
from behavior
this area.
for
ap-
in one situation to that in another presupposes
always that the psychological meaning of the two situations

is
understood.
Where
this
is
not the case, the psychologist
will be as helpless in predicting as
substance he
known
to
is
the chemist
knows meets with one whose
him.
when
qualities are
un-
FROM
To
return to the self-concept:
that certain of
its
it is
reasonable to assume
more appropriately
aspects will be
^7
assessed
under complex conditions. These are available for research

through the use of therapeutic
full
complexity of
life
sessions dealing
with the
problems, in field experimentation and
in special assessment situations that retain the flavor of un-
contrived experience.
Growth, Development, and
To
the extent that the mental health Hterature specifies
this criterion,
processes
tion, (2)
two
aspects are distinguished: (i) motivational
expressed in full utilization of an individual's
abilities, his
If
Selj-actualization
orientation toward the future
and investment in
one were
and
in differentia-
living.
to take these specifications too literally,
an
assessment of self-actualization might consist in establish-
ing a person's abiUties, comparing them to his actual work
and
leisure activities,
and using the discrepancy,
sign of the degree of his self-actuaHzation.
man
with musical and mathematical
gifts
By
if
any, as a
that token, a
who becomes
great musician without doing anything about his mathe-
matical talents
But
surely, this
would be judged lacking in mental health.

is not what those who suggest self-actuaHza-
tion as a criterion of health have in
mind. Utilization cannot
refer to all potentialities. Differentiation
must be taken
as
occurring within one area of interests and not as synonymous
with diffusion.
With regard
to utilization of abiHties, educational psy-
chology has perhaps developed some concepts suitable for

research. There,
it
has become customary to identify "under-
achievers" and "overachievers"
among
students.
An
under-
88
achiever
is
whose
a student
I.Q. vôuld lead
certain grades; his actual grades are
below
one to expect
this empirically
estabUshed expectation. In such a situation, the assumption

is
frequently
made
that the motives of the student are such
that he does not give his best to schoolwork.
Other assumptions are possible and have
to
be ruled out be-
fore this situation can be used as an empirical indicator for
the degree of self-actualization.
When
class are underachievers, the teacher
all
the children in a
might be incompetent.
may be motivated to utilize his

fatigue may prevent this. Nevertheless,
single underachiever
abiUties,
but physical
the identification
of achievement
level
in
holds
schools
promise for the development of empirical work on

actualization
In other
among
life
children.
situations, empirical standards
much more
available in school are
intelhgence
is
self-
such
as are
difficult to obtain.
And
not always the best yardstick for evaluating
achievement in
life.
It
might be more in the
spirit of the
mental health Hterature to compare a person's ambitions and

goals with the direction in
is,
which he
is
actually
moving
to replace the objective assessment of abilities
tive goals,
being
and
made
to achieve
and in
by subjec-
to appraise these against the effort actually
Self-actualization
spective
that
is
them.
also expressed in a person's
differentiation.
time per-
Research techniques with
gard to both are in a very rudimentary
stage.
re-
Notwithstand-
ing the fact that they play a significant role in Kurt Lewin's
topological theory of the
life space,
empirical indicators have
not been elaborated.
With regard
to the other aspect of self-actuaUzation, in-
FROM
vestment in
living,
[89]
some approximation of what the
means can probably be gleaned from time-budgets

apart
other
is
job, or
it is
from what
involved in his
is
is
necessary for survival whereas an-
work beyond
concerned with ideas, or
matters outside himself than the

this is a
well that
active in social relations,
form
activities
more
in
first.
we know
too
and concerns are pursued not
be-
very crude approximation. For
many
cause they
self,
is
the requirements of a
a fair guess that the second person has invested
But
of a per-
one time budget indicates that an individual does
son. If
little
criterion
between the world and the
a genuine link
but for purposes of self-aggrandizement, to escape other
problems, to win approval, and the
like.
Such motivation
indicates concern with the self rather than with object relations,
as
The
the criterion requires.
distinction
between
genuine and apparent concern with objects outside the

will perhaps be
of "cathexis"
is
made
easier
self
once the psychoanalytic concept
better understood
and more amenable
to
empirical research.
Integration
Empirical indicators and research strategy are particularly

difficult to
suggest for this complex criterion.
to the balance of psychic forces
psychoanalysts
who
it
step.
The
be best to turn to the
use the concept most frequently.
study of their modes of thinking
next
may
With regard
goal
would be
may
Here
be the most promising
to codify the
way
psycho-
analysts transform the concrete data presented to
them
into
the abstract notion of balance of psychic forces.
What
has
been said about
accessibility of the self to consciousness
may
90
perhaps apply
when
balance
this
is
conceived of as a pre-
ponderance of preconscious and conscious over unconscious

determination of behavior.
In order to arrive at generally appUcable empirical

dicators,
it
in-
will be a wise precaution to use, in such co-opera-
tive research
with psychoanalysts, material from patients
as
they appear after a successful analysis, rather than data from

troubled persons only.
The
assessment of a unifying outlook on
plicated,
and
rightly so,
life
is
com-
by Gordon Allport's emphasis on
the fact that such an outlook need not be an articulate
philosophy.
perhaps not too
It is
difl&cult to ascertain
prolonged interviews a man's basic

them.
If
he cannot, some
sort of
dicated. Role-playing techniques
tenets, if
from
he can verbaUze
performance rating
might be useful
is
in-
for such
efforts.
The
empirical indicators for resistance to stress are
specifically
formulated
the
in
mental health
more
literature.
Anxiety- and frustration-tolerance and resihence are terms

containing a clear directive as to the type of situation in
which they should be studied a

:
It is at this point,
situation presenting stress.
however, that
we come up
against an-
other major theoretical problem of psychology in general:

the problem of
how
to distinguish
stimulus and the experience
To
of,
between the external
or response
to,
that stimulus.
may be
whereas another may
hear one's views attacked in a discussion
enced as
stress
by one person,
this as a pleasant stimulant.
may
first
wood
man may deliberately seek out this
Should resistance
to stress
regard
This same second man, however,
experience being alone at night in a dark
whereas the
experi-
be observed
when
as stress
situation.
stress is sub-
FROM
IDEAS
TO SYSTEMATIC RESEARCH
when independent
jectively present or
stress
is
has been imposed
known
9^
consensus agrees that
In more general terms, the problem
as the question of equivalence of stimuH. It has
considerable philosophical and theoretical implications.
To
and
the extent that research has been conducted
frustration-tolerance, the
on
anxiety-
dilemma was avoided
rather
than solved by studying situations in which some corre-
spondence between stimulus and experience was either

rectly ascertained or could reasonably be
the intensity of the external

series of studies
on
stress.
assumed in view of
case in point
like
is
the
resistance to stress in natural disasters,
such as floods, prolonged isolation from other
and the
di-
(Chapman,
1954; G.A.P.
human
beings,
Symposium No.
1956). So are the previously cited study of anxiety
and
3,
sur-
gery and Clausen's (1955) study of wives whose husbands
have been institutionalized for mental

Similar
situations
study of resilience.
offer
strategic
illness.
opportunities
for
the
A crucial empirical indicator here may be
amount of time an individual needs before he can resume his usual patterns of living after change under the
the
impact of
stress.
Autonomy
The meaning
of this criterion prescribes the situation in
which observations must be made, namely, decision-making

situations. Where the aim is to ascertain whether behavior
is directed from within, it will be advantageous to use situations permitting alternative decisions, neither of
which
encouraged or approved, on the assumption that the
is
self-
rehant person will be able to decide with relative ease and

speed what
suits his
own
needs
best.
Those lacking in
self-
92
reliance will find
it
difficult to
decide and will search for
external support.
Independent behavior, on the other hand, must be tested
where some
dividual
social pressure favors
would not
an alternative that the
select if left to his
own
Asch
devices.
(1952) has designed an experimental situation lending

self
admirably to
Although the
indicators
it-
this purpose.
situational context for obtaining empirical
relatively clear in this case, a
is
in-
problems remain.
Self-reliance
number
of other
can be demonstrated in
choosing between coffee or tea or in making a vocational
Are both items of

autonomy? Independent
manner one dresses or in
And, depending on many
choice.
equal significance as indicators of

behavior can
We
have met
in the
itself
Luther's break with Catholicism.
other factors,
son an insignificant decision

another.
show
may
what
is
for
one per-
be of great importance for
this difficulty already in discussing
the problem of stimulus equivalence;
what has been
said
there applies here too.
In addition, here
tors
as elsewhere, sensitive empirical indica-
must be constructed
so as to permit distinctions of the
degree of positive mental health attributed to an individual.
For
this
dicated.
purpose a combination of various measures
The
profile or a
use of several observations
combined general score
is
which lead
problem
in
its
is
in-
to a
own
right.
Ferception of Reality
No
other area in psychology has as long a tradition in
experimental work, or has used a greater variety of observational strategies, than the area of perception.
Yet the riddles

FROM
is
93
ideas are pushing ahead the frontiers of knowledge.
no wonder,
man
Each of the general problems of research on
to a head.
human
It
on perception most of
then, that in research
the general issues and controversies in the science of
come
from understood and new techniques
of perception are far
and
behavior mentioned before could be illustrated with
reference to perception.
must
here. It
suffice to
We
shall not,
however, repeat them
point out that the aspects of percep-
tion singled out by the mental health literature as criteria
are intimately related to current research problems in perception.
Perception relatively free from need-distortion
from the
cept springing
is
a con-
realization that although motives
(needs) are always involved in perceiving, they are not, or

at least
need not
product.
major determinant of the perceptual
assumes that other cognitive processes
also
It
thinking,
be, the
judgment,
memory are
intimately
linked
to
perceiving.
The
course,
situation for appropriate observations
one in which an individual
is
must
of
what
would
is.
suit his
of
emotionally involved
with the percept in such a way that a distortion of

tributes
be,
its
at-
inner needs better than the perception
Perhaps the greatest
difficulty
here
is
the ascer-
taining of emotional involvement leading to a need to distort.
Sometimes
this
definite evidence.
need has simply been assumed without
At other
times, needs have been experi-
mentally created. For example, persons have been deprived

of water for
some length of time and then been asked
identify
ambiguous
do with
liquids
pictures.
were taken
Those
identifications
having
to
to
as evidence of distortion. Tests
of syllogistic reasoning have used the discrepancy,
if
any,
94
between reasoning on neutral

tionally colored material as
topics
and reasoning on emo-
an indication that the emotional
involvement created a need to distort cognitive processes.
The
perception of the feelings and motives of others
is
appraised with the help of a strategy similar to that described

for assessing aspects of the self-concept.
into the thoughts
and
feelings of others
latters' self-descriptions.
scriptions
The same
is
person's insight
compared with the
tools for personaHty de-
mentioned there can be used here.
The generality of empathy presents a special problem.

One would like to know not only whether empathy transfrom one
fers
situation to the next but also
pHes to understanding of
special
who
groups
all
other persons or
whether
is
it
ap-
restricted to
for example, to people one likes or to people
are similar to oneself.
Environmental Mastery
Several
of
the
aspects
of
environmental mastery
are
formulated in the mental health Hterature in such a manner

that only the study of the full complexity of an individual's
life
history will suffice as empirical indication. Accordingly,
data collection has to rely largely on case-study methods and
and diagnostic interviews, supplemented by time
therapeutic
budgets and projective techniques.
The problems
in this area arise mainly with regard to
which environmental mastery is a

good or bad luck and to what extent it can be
the individual's achievement. This means that
specifying the extent to
function of
regarded as
the various case-study methods
dynamics but must
also
must not only deal with inner
pay attention to external events in
Even though common sense alone would

require such an approach, a surprising number of judgments
their
own
right.

FROM
95
of environmental mastery remain insensitive in this respect
and engage in an unvârranted amount of psychologizing

about hard
facts.
Such
partial blindness
is
the result not only
of overenthusiasm for psychological explanations but also

of the considerable difficulty in sifting events provoked by an
dynamics from those occurring independ-
individual's inner
ently.
With regard
adequacy in
relations,
situational
efl&ciency in
adequacy in interpersonal
play,
meeting situational requirements
analyses are particularly important.

is
research
mean
quirements
and
love, vôrk,
and
needed here
to three aspects of environmental mastery
on
vs^hat
concretely.
What
adequacy or situational
The
is
re-
conceptual approaches of
sociology and cultural anthropology
vîll
have
used
to be
tovârd this end.
Problem-solving
on which
is
the one aspect of environmental mastery
The
there exists extensive experimental research.
problems such experiments deal
vîth are, howêver,
mostly
problems in logic or reasoning that in themselves are emotionally neutral. Further research
v^îll
have to estabHsh the
extent that problem-solving tendencies, as demonstrated in
dealing vîth these experimental tasks, have bearing on the
approach to
problems. There
life
is little
doubt that some of
the concepts used in such experimentation are relevant for

establishing empirical indicators for problem-solving as a
criterion for
mental health. Duncker's concept of "functional
fixedness," for example, refers to the tendency to use tools in
the same
(1945).
to life
It
manner
may
in v^hich one usually encounters
them
be as appropriate for describing approaches
problems
as
it
is
for describing behavior
under ex-
perimentally contrived conditions.
The accompanying
chart summarizes
what has been
said
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100
SO far about the translation of
mental health concepts into
empirical indicators and presents several suggestions for

further research.
SOME SUGGESTIONS FOR RESEARCH

Throughout the preceding
discussion,
questions have been mentioned.
One
tv^ô
types of research
has to do vîth technical
matters such as the estabhshment of empirical indicators,

the other vîth the advancement of substantive know^ledge.
This
is
not the place to go further into technical details;
competent research
v^ôrkers
These are not matters

Instead,
wc
novi^
must handle them
fruitfully
empirically.
advanced by speculation.
turn to a brief discussion of some of the
questions that should
become
ansvêrable once the tools
and
techniques are available.
The
Analysis of Mental Health Clusters
In the interest of economy of effort in research and practical application,
perhaps the most urgently needed study
one of the interrelationship of the
criteria.
ample, the possibility that autonomy
exists
is
Consider, for ex-
only v^^hen an in-
dividual has a vêll-developed sense of identity or self-acceptance, or that adaptation follov^s
from
a balance of psychic
forces.
If a cluster analysis of the criteria
relations, the Hst of
solidated.
too, that of
rion based
vôuld demonstrate such
mental health concepts might be con-
cluster analysis vôuld
have another advantage,
permitting the estabhshment of a multiple
crite-
on knov^ledge, rather than guessvôrk, about the
relation of the components.
FROM
A word
of caution
is
in order
on the degree of
is
no reason
generality
that can be attributed to empirically discovered
There
10^
clusters.
to believe that the interrelations appear-
ing in one case need necessarily be the same for every group.
Differences in culture, social
class, sex,
or age
may
well ex-
Comparative studies in
press themselves in diflferent clusters.
these groups are indicated with regard to the frequency
all
distribution of the criteria
Mental Health
The
and
their interrelations.
Diêrent Age Groups
Criteria for
study of mental health in different age groups
research problem in
its
own
right. In their current
tion, several criteria are applicable
need for mental health evaluation
we have
only to adults. Yet the

is
just as great for chil-
reviewed has given
to the maturational appropriateness of
To
extend
require
this
much
formula-
dren, adolescents, and the very old. Erikson alone

the various authors
is
among
full attention
mental health
criteria.
concern beyond Erikson's formulation will
research.
For example, the comprehensiveness and correctness of the

self-image
is
a criterion of limited usefulness for children and
young people. The rate of change in the

much greater for them than it is at later
self is
undoubtedly
stages in
life,
a fact
may easily lead to discovering apparent inconsistencies

when the child is observed in various situations. What is
that
more, self-description
aspects of the self
is
as a necessary tool for
a task that
of a child's cognitive abilities.
ascertaining
may exceed the development

To a lesser degree, the same
holds for self-acceptance and the sense of identity.

it
should be remembered,
is
The
latter,
suggested by Erikson as a late
step in a temporal sequence of development.
102
It
may
well be that parents and teachers,
who
are able to
observe children continuously over long periods of time,
could note possible indicators for growth, development, and

self-actualization.
However,
we have
as
seen, the elaboration
of empirical indicators in this category has not progressed
Much
the same
true for the indicators of auton-
very
far.
omy
as applicable to children.
is
Furthermore, the process of
early education contains inevitably strong emphasis
ing the child's autonomy.
on curb-
minimal requirement
for the
application of this criterion to the behavior of children

identification of the areas in
which autonomy must be curbed,
so that they can be excluded as situations for

child's
is
gauging the
mental health.
Perception of reality, meeting the requirements of the
and problem-solving
situation,
having meaning for
all
age groups, even though their em-
pirical study will, of course,

tion.
Adaptation
are the criteria par excellence
have to take age into considera-
as the sense of actively selecting
an environ-
ment to suit one's own needs is only occasionally open to

young children in our civilization. To describe adequately
the forms adaptation can take in childhood will require the
elaboration of age-specific indicators.
Research in
this area
can be conducted from two points of
view. Childhood can be regarded as a stage of
own
life
in
its
right; in that case, clues for the establishment of criteria
of health
chology.
must come from what
Or one can
start
is
known
in child psy-
with the model of the healthy adult
and ask which behavior tendencies in childhood hold the

greatest promise of health in adulthood.
Taking extreme
positions in this matter has led to the controversy
between
the proponents of "progressive" and traditional methods of
FROM
103
education. This controversy continues to rage bitterly in the
absence of facts demonstrating conclusively the impact of

either
method on
the child or the adult-to-be.
Actually, the extremely child-centered approach to mental
health criteria for this stage of hfe
proach regarding the child
is
as
untenable as the ap-
small adult. In the
as a
life
of
the child, present, past, and future shade imperceptibly into
The
each other.
individual
vîll
function tomorrow accord-
ing to the goodness and adequacy of his total equipment

today.
and
The
it is
next
moment may
deeply affect this equipment
reasonable to postulate that the nature of this effect
will be to a considerable extent determined
by the current
state of affairs.
The mentally
group
will
healthy child
healthy in terms of his
age
be best equipped to deal with the subsequent
events and thus with the gradual unfolding of the course of

his
life.
But,
however
different the empirical indicators for
mental health in childhood
may
hood, they must be conceived of

relation to each other.
as
The need
be from those for adult-
having a lawful sequential

for research in this area
is
considerable. It will have to develop criteria appropriate for

different stages in life
and demonstrate
how
mental health
in one stage leads to mental health in the next.
Research with Mental Fatients
Another area of research concerns the

of these criteria to
work with mental
immediately needed in
to
patients.
Perhaps most
this area are descriptions of the
which various mental health
types of disturbances.
possible application
criteria co-exist
degree
with various
systematic effort in this direction
could lead to a series of other studies. For example,
many
104
efforts are currently
being
made
to assess
what progress or
movement in therapy actually connotes.

The tranquilizing drugs apparently produce one
effect.
Many psychiatrists
type of
are of the opinion that the lessened
anxiety and increased contact vîth others do not constitute
a cure, but estabUsh a condition

efforts possible. It
vestigate
would be
whether the
effects
making
further therapeutic
of considerable interest to in-
produced by the drugs, by sub-
sequent psychotherapy, or both, are movements toward the
mere elimination of symptoms of
disease or
toward the
acquisition of health.
Other suggestions for the use of mental health

the study of mental disease have already been
criteria in
made
in a
previous section. Their further elaboration should be at-
tempted in
close co-operation
with
psychiatrists.
CONDITIONS FOR ACQUISITION AND

MAINTENANCE OF MENTAL HEALTH
There
is
ready agreement between
all
concerned that a
full
understanding of mental health demands that conditions
under which
it is
acquired and maintained be specified. In
order to meet this demand, research must single out some
And
such conditions.
here the difficulty begins.
unending number of conditions may
which an individual
tributes constituting
affect the
possesses or displays
virtually
degree to
any of the
at-
mental health.
Should one search for relations to genetic factors ? Or biochemical processes ? Does living in urban or rural areas
the difference?
Or membership
or ethnic group
.^^
Is it the
make
in a particular social class
standard of living or the level of
FROM
IO5
The geographical location or the physical qualities of one's home ? Or the pace of life in the home town ?
The composition of the neighborhood or the family? The
education?
relation
between mother and child or between child and
The
siblings?
some or
of
all
early socialization process?
of these factors
it
would be highly
available to help us
sift
these
a combination
For reasons of economy of

elegance,
Or
effort as well as theoretical
desirable to have
some
and many other
possible factors
principle
according to their psychological relevance for mental health.
The problem
no
less
involved in the search for such a principle
than the conceptualization of what
is
meant by
is
'environment."
This problem has challenged the great philosophers of

past centuries;
continues to challenge current theorists.
it
akin to the problem of distinguishing between stimulus
It is
and response, between what
is
inside
and what
organism (F. H. Allport, 1955).

Though the distinction between what
is
outside the organism
regard to objects,
functions. Light
it is
is
is
is
apply
it
outside the
inside
fundamental and
difficult to
is
and what
clear-cut
to psychological
outside the organism; the visual nerve,
inside. Seeing, a psychological function, is equally
ent
to
on both. In the
some extent
sciences of
arbitrary.
man, the
between
man and
mains unresolved,
efforts provides a
sibly influencing
In
distinction
Even though various
thought have made systematic

tion
with
efforts to deal
dependis
always
schools of
with the
rela-
his environment, the great issue re-
at least to the extent that
guide for choosing
among
none of these
the factors pos-
mental health.
this situation a
more modest empirical approach
will
I06
have to guide research on the conditions for the acquisition
and maintenance of mental health. Here help
is
forthcoming
in a variety of vâys.
First, general
consensus based on
much
empirical evidence
holds that a crucial aspect of man's environment consists of

those persons
and young
infant
v^hom he intimately
v^îth
For the
interacts.
child, the only other aspect to rival the
human element in the environment may be his constitutional

equipment. The fact that the infant lives in slum or palace,
in city or country, in peace or vârtime, affects
the extent that such conditions lead
human
first
him only
to changes in his
environment. As the child groves, tvô important de-
velopments take place: he enlarges the radius of his

so that
to
he directly experiences contact with
activities,
and
objects,
his
cognitive abihties develop so that aspects of the environment
need no longer be physically present

fluence
that
they can in-
is,
him via symbolic representation.
These processes of maturing
infinitely
complicate the
manner in v^hich the environment can affect mental

The environment nov^ can have an impact through a
new
of channels. Yet
they supplement
it.
variety
channels do not replace the earlier one;
There
is
no
viây
of saying vîth con-
fidence that the mental health of a schoolchild

cially influenced
health.
is
more
by the personality of his parents,
teacher, or classmates than
by the
fact that
he
is
cru-,
siblings,
Negro
or
hves in a rural area or comes from an educated family; even

so, it is safe to
say that the
one crucial aspect of
his
human
beings around
him
are
environment.
A second set of conditions related
to
mental health
is
sug-
gested by the results of interdisciplinary research. Psychiatrists
and psychologists are more and more avâre of the
fact that certain regularities of behavior
can be understood
FROM
IDEAS
TO SYSTEMATIC RESEARCH
I^
not only in terms of individual dynamics but also in terms

of group memberships and identifications. Such regularities,
the result of similar social conditions, lead
human environment
intimate human relations.
cerned with the wider

well as with his
them
to be con-
of a person as
Collaborative research between psychiatrists or clinical

psychologists
on the one hand and
sociologists or anthropolo-
on the other has demonstrated
gists
that
it is
worth while
to extend the range of environmental factors in this way.
Research teams, such as Paris and
Dunham
(1939), Kardiner
and others (1945), Hollingshead and RedUch (1953), and

Stanton and Schwartz (1954), have contributed to our
knowledge of mental disturbance by identifying
cultural, or class determinants.
This approach could
ably be appHed to questions of mental health.
emerging profession of
ment
ecological,
social psychiatry
profit-
The newly
and the estabUsh-
of therapeutic communities (Jones, 1953) are translat-
ing such research into practice.
third approach to the identification of conditions con-
ducive to mental health stems from the observation that
man
adjusts his behavior not only in interaction with other indi-
viduals but also in response to situations
and
institutions
or less independently of the particular individuals
pen
who
more
hap-
to play a role in
them. As one enters a drugstore or a
work
or to bed, a whole set of prescribed re-
theater, goes to
sponses are called forth by the situation.
Wright and Barker
(1950) use the term "behavior setting" for locales having the
attribute of eHciting largely
standardized behavior.
It
is
reasonable to assume that the behavior settings a person
spends a good deal of time in will have a lasting influence
on his psychic make-up. The school system a teacher operates

in, or the specific requirements of any other occupation.
I08
present behavior settings of long duration that
may
signifi-
cantly affect mental health.
A fourth set of environmental factors
appears relevant for
on mental health. It is different from those already

mentioned, inasmuch as it can apply to each of them as vêll
research
as to
many
conditions.
others. It
It
the factor of change in environmental
is
a truism that environmental conditions
is
change continuously and continuously provoke changes in

the individual. Imperceptible changes are easily taken into
one's stride. Sudden, major, or unexpected changes require a
general reorientation. Constancy of environmental conditions, as
much
as frequent radical change,
may
be a good or
bad influence on mental health. The direction of the change
from "good"
may
to
"bad" conditions, or the other vây round,
be as important
change per
as
se.
indications in the Hterature (Bettelheim

that one's sense of identity
direction of change. In
any
may
But there are some
and
Janovîtz, 1950)
be threatened, v^^hatever the
case, the stability or instability of
environmental conditions appears to be a psychologically

relevant attribute of the environment.
In these directions, research on the conditions of mental

health might proceed. There are undoubtedly others. Every
serious piece of
work
in this field
WAX have
to
come
to terms
vîth the fact that the various sets of conditions always exist
simultaneously and that concentration on one or the other

inevitably
Those
means a
dissatisfied
violation of the actual conditions of living.
with
this
better approximations to
unending search
for better
and
an unattainable goal will have
to
turn away from science and seek elsewhere for their insight
into the conditions for mental health.
VI
In Qondusion
At the beginning of this report stands a statement by Adolf

Meyer contrasting two approaches to the field of mental
health: the Utopian way, which leads to moraUzing, and
the scientific way, which leads to experimentation and deliberate action.
As one
more than
reviews the field of mental health
years later, he finds that
ways has
yet
no
between the two
final choice
been made. Today,
thirty
too, there
is
a danger of
mental health becoming a popular movement that Hves by

slogans and presents ten easy rules for being mentally healthy
The
comment on the moraHzing approach

to the problems of hving was made by the Austrian satirist,
Nestroy, who made one of his most pompous characters say,
"Better rich and healthy than poor and sick," and made him
ever after.
final
eloquently silent on how.
The
present report should have
that the
made
it
abundantly clear
complex problems of mental health will not be
brought nearer to solution by exhortations. By far the most

urgent need in the
field is for
a slow and costly enterprise.
more knowledge. Research
It
can
appHed. However, in the long run,
fail.
Or
we do
it
not
can
fail to
know
is
be
a better
[109]
no ]
way
to help policy decisions in the field than to strive for
more and
to
better knov^ledge about the conditions conducive
mental health.
If
poHcy makers open the wây
knov^ledge,
if
to the acquisition of further
practitioners in the
mental health
field co-
operate with scientists in thoughtful experimentation,

fruits of research
the
can be applied without losing respect for
the infinite diversity of
health
if
human
beings, concern with mental
may improve the quaHty of Hving.
VII
Vicwjôint of a Qlinician
by
WALTER
Conceptually,
to reduce
it is
mental
E.
BARTON, M.D.
difficult to see
illness
how
a national
program
and increase mental health can be
operated on any other base line than a straight one. In this
continuum,
the goal.
We work away from one
we had
If
point of departure and health
illness is the
and toward the
solved, or even partially solved, the
is
other.
problems of
preventing or treating major and minor mental
we
illness,
could then justifiably concern ourselves with the issue of

superlative mental health, or the degrees of goodness in
mental health. Unfortunately,

ducing
This
illness.
is
we
still
good
have far to go in
re-
a practical concern, rather than a
theoretical one.
We
must recognize, of course, that Dr. Jahoda's purpose

in this monograph is not to write poUcy for a national health
movement, but
ers
is
to analyze
mean when
intellectual
is
different think-
they speak of mental health.
with the psychological
tion
and evaluate what

or,
one might add,
Her concern
spiritual
content of positive mental health. Such
desirable. Dr.
and
clarifica-
Jahoda has ably pursued the various

[III]
112
mental
theories about the psychological content of positive
health and has shed a good deal of light on the issues involved.
Many physicians v^îll find her approach a novel one. Some

may instinctively oppose an approach divorcing health from
illness as
aHen
understanding of health.
to their ov^n
Dr. Jahoda's fundamental position appears to be that the

absence of illness and the presence of health overlap but do
not coincide.
on the
He
The
basis that they
do
think, vôrks
coincide, for all practical purposes.
sees health as the objective in the prevention, cure, or
management
of disease to the extent that he can help the
individual avoid
The
or in
cal,
physician, quite typically,
living
it,
recover
from
it,
or compensate for
organism so rarely presents
all vâys,
itself, at all
it.
times
in a complete state of biological, physiologi-
psychological,
and
in
sum
ecological
harmony, and
yet so characteristically strives for such a balance, that the

clinician
may
still
hold to his viev^ that the absence of
ill-
and capacity for achieving or restoring balance are

consonant vîth sound health principles, as he must apply
ness
them. The pathologist
at
autopsy frequently observes so
much
is
far less struck that a patient died
pathology that he
than that his diseased organs functioned
as
long and
as well
as they did.
All of us can benefit, hovêver, from attempts to define
and measure good
health,
whether psychological or physical,
and should welcome heterodox

through the mind of
cal tradition, research
efforts to
social science,
may
do
so.
Perhaps,
unencumbered by medi-
be designed that will eventually
quantify the psychological content of mental health.
phenomenon
The
of a superstate of good mental health, well
VIEWPOINT OF A CLINICIAN
beyond and above the mere absence of disabling

yet to be scientifically demonstrated.
1^3
has
illness,
We know
of
little
it
beyond occasional
subjective, euphoric impressions of the
subject that he
"bursting with good health," "feeling
is
grand," or that "all
right with the world,"
is
meaning
his
world.
In contrast, the benefits of disease prevention and control
work
have been tangibly demonstrated in increased
ability to
and carry out
social obligations, longer life,
and individual
way
of looking at
morale.
Medicine has developed
useful
this
health and the normal to the extent that health as the an-
tonym
of disease has
become a part of the philosophy,
or
tradition, of physicians.
The
idea
first
was propounded by Hippocrates who held
health to be a state of universal harmony, and the role of

the physician to be that of restoring equiHbrium between
the various components of the
ture.
body and the whole of Na-
This approach was encompassed by Walter Cannon
in his principle of homeostasis,
uniformity or
stability in the
organism relating
meaning
a tendency toward
normal body
to the fluid balance and,
the so-called "internal environment."
By
states
more
of the
generally,
extension, the
same
idea of equilibrium permeates observation of such matters

as
"nitrogen balance" and various other physiological or
biochemical
The
states.
inference of
manifestation of
good
harmony
health, or the
normal
state, as
or balance with the external en-
vironment can be found in biology
as well as physiology.
Out
of Spencer's idea of evolution as the "survival of the fittest"
came the notion
of "nature in the
raw" and
eternal aggres-
114
and defense, which influenced the older conception of

the germ theory of disease and made us appear victims of
a kind of microbial vârfare. But Darv^în pointed out in
sion
Man
commonly in nature "struggle is

by co-operation." The concept of "a balance of
Descent of
placed
ture" again
that
emerged
as a
re-
na-
unifying idea.
In modern microbiology, the older idea of infectious
dis-
ease as a "fight" against foreign "invasion" has been to a
great extent superseded by the concept of
and
teria
states of
viruses as habitually
his bac-
Hving together in various
symbiosis or germ-host relationships involving in-
fection, Wixh. or wîthout

this
man and
apparent disease. Accompanying
has been a strong revival of the mutiple-cause theory of
disease at the expense of the one-germ-one-disease viev^point.
Rene
as less
to
Dubos, for instance, regards "invasion" or "attack"

characteristic of the relationship of man's pathogens
J.
man than is "peaceful co-existence."

Subclinical
or
inapparent infection appears to be the
with periodic epidemics or individual imbalances due

to lowered resistance of the human organism or heightened
rule,
virulence of the microorganism actually occurring as exceptions.
So
we
see that a unifying concept of health
and
disease
does run through medical thought, founded in biology and

physiology as well as in biochemistry and microbiology.
tendency of the organism
and
is
to serve
its
The
structural, functional,
species purposes and, internally or externally, to strike
some kind
of balance that will permit
for the organism to
do
it
to
do
so. It is
normal
this.
Leston L. Havens (1958) has pointed out:

"Usually in medicine we say an organ is healthy
if it
does
its
1^5
job within the normal range and over the usual time.
do not expect too much, although the usual range

the range of the average
Statistical
norms
man but of the
We
not
average healthy man.
are useful in this context
be dismissed despite the
is
and should not
agreeing on a normal
difficulties of
population in the mental health area. Without such a point

of reference, one carmot
what
normal
is
tell
tolerance.
what
a toxic experience and
is
Without norms there
danger of unreal goals of treatment. This
may
also the
is
be a
signifi-
cant clinical hazard. Ideal or even 'potential' health criteria

are too easily
at their
spun out of theories or
momentary best."
Both gross and

cepts of
normal
brief glimpses of people
cellular
pathology have well-defined con-
normal and abnormal. The
if
tissue
and
cell
are
they exhibit no disturbance of structure as com-
pared to most
tissues or cells of like kind. Precisely the
same
understanding extends from structure to function. Granted,

the physician's estimate of
what
been of far too narrow a range,
is
normal sometimes has

example in determin-
as for
ing what constitutes abnormal blood pressure.
M. Ralph Kaufman (1956) sums up

"The organism and its relationship
in a constant state of flux
to
its
environment
which nevertheless involves
tinuous series of processes utilizing
ing in an interrelated
the issue this way:
series
all
aspects of
of procedures
its
is
a con-
function-
aimed
at the
establishing of an equilibrium.
"The ontogenesis
of the individual
nificance since within the potentials
genus and
species, the
is
of tremendous sig-
and
limitations of the
organism develops in a progressive
and integrated way with each system
(digestive,
cardio-
vascular, central nervous, autonomic, psychic), shunting in.
Il6
which
after functional maturation, to take over that role
and function
structure
From
sperm and ovum the
the organism.
calls for in
the total functioning of
the very beginning at the level of the

processes have an adaptive equilibrium
between organism and environment, each playing

tial
role
its
which involves the ultimate
for survival.
essen-
its
With
the
development and integration of the various systems, of which

the psyche
one, the systems relate to each other in a kind
is
of syncytium
tem can be
isolated
homeostatic,
Jacques
which means
S.
if
you
that
no
and unrelated
will,
activity
within one
to the total integrative,
function of the organism.
GottHeb and Roger
sys-
W. Howell
."
.
(1957) under-
score the predominate note of disease prevention in the
public health approach
"The
success of public health measures has
part dependent
is
upon the identification of specific imagents and other variables in the illness
first
portant etiological
process. It
been in large
Hke protecting our water supply against con-
tamination with the typhoid bacillus or strengthening the

defenses of an individual against a noxious agent as in inoculation
with poHo. This general technique has a certain simi-
larity to the objectives of
health goals ; that
is,
our previously described mental
removal of conditions of
stress,
of frus-
on the one hand, (the etiological

agent) while strengthening the ego defenses on the other
(the inoculation). In the preventive program for physical
tration, of deprivation
illness this
toward a
we
can be readily done, for the strategy
specific objective.
cannot
For mental
illness,
is
directed
unfortunately,
isolate a single variable, a single point of attack,
but must be prepared to deal with multiple factors of

logical import.
etio-
For prevention of physical disorders, success
has
come only
after the
I^?]
knowledge of the etiology or of the
important variables. For mental and emotional disorders,
we may
not have the knowledge as yet to really develop
preventive programs."
Braceland (1957) emphasizes the relationship of

normal psychological development to disease prevention in
Francis
J.
certain situations. Rubella in the first three
nancy may be a prologue

Eclampsia
may
to a
months of preg-
mental defect in the
child.
be a factor in cerebral palsy, or a metabohc
disorder in a mother
may
contribute to the development of
epilepsy in an offspring. Prenatal injury affecting later be-
havior
is
tion. Said
"It
is
one possible consequence of poor maternal nutriBraceland:
self-evident that increased alertness to these various
possibilities
would pay
the sad thing

is
is
rich dividends in mental health, but
that the psychologic aspect of such situations
not always kept in mind.
"Improved
all
its
obstetrics, better use of protective services
prospective mothers, the prevention of prematurity

causes,
and optimum care
for the premature infant
by
and
would
cut the mental deficiency segment of our mental health
problems by a sizeable amount. Multiple pregnancies, complicated delivery procedures,
and
call for greater vigilance, as
does the prevention of anoxia.
"The importance
year
is
stressful obstetric situations
of diagnosing cretinism during the
of course obvious, in view of the
first
good response
to
treatment at this time and the fact that later treatment will
fail to
overcome mental retardation.
'hunger trauma' in babies and
its
Steinfeld's hypothetical
relation to later schizo-
phrenia offers another challenge for prophylaxis. There
should be joint obstetric and pediatric responsibility for fetus
Il8
and infant and
child, so that a clearer
view emerges of the
mental, as well as the physical, hazards of various complications
from the time
of conception
and ways and means of
combatting them. All of these things are important for the
mental health of both mother and baby.
"There are
at least three
mental health problems which
could be mitigated by more intensive development of
exist-
ing pubHc health emphases; the nutritional problems of
pregnancy; the toxic deUria associated with certain vitamin
and some of the confusions of elderly persons
deficiencies;
drug intoxications and malnutrition.
associated with both
"Similar considerations pertain to infectious diseases which
may
directly
even
if
so
damage
mild that
the brain tissue. Encephalitis lethargica,
it
may
easily escapes detection,
result in
mental impairment which, contracted in childhood,
may
be
expressed in antisocial and irresponsible behavior. Inoculations against contagious diseases in children are essential to
Some
lessen the incidence of contagious diseases.
of the
now being
however, we may
formerly fatal cerebrospinal meningitides are

restrained
be
left
by
antibiotics; unfortunately,
with a defective individual requiring long and prob-
lematic rehabilitative periods. Early diagnosis and treatment

of these infections
"In adult
life
is
therefore essential.
a psychopathic development
may
occur after
brain damage, especially in the frontal cortex, the hypothala-
mus, and the midbrain.

sive, it is likely to
If cerebral
contusion
is
at all exten-
produce personality changes with neur-
asthenic, hysterical, or paranoid reactions, inadequate control of
energy.
mood
variations,
and a general lack of
In the light of these observations
initiative
we need
strengthen those features of environmental sanitation
and
to
work
119
which reduce the incidence of head and brain injury. These

are a few of the areas in which good preventive and rehabihtative
work may be done, provided
mindful of the
close interaction of psyche
This summarizes what

understanding of health.
believe
we
are ever
and soma."
the typical physician's
is
It is difficult
to separate the presence of health
that
for
me,
as a clinician,
from those preventive
measures that reduce the likelihood of the development of

disease
and
illness. I believe
the absence of
illness. If
most patients would
settle for
they are not sick, they are well.
There would be no Joint Commission
if
there were
no men-
tal illness.
In this discussion,
of disease prevention
have looked upon health
and treatment.
It is
as a
product
proper, of course,
for the scientific investigator to study behavior as a natural
phenomenon, without
The viewpoint
a pathologic orientation.
have expressed
is
tangential
to
Dr.
Jahoda's discussion of the content of positive psychological

health. Yet
I feel
sure she
would agree
that mental illness
the primary threat to positive psychological health.
is
^Cfiacnccs
Allinsmith,
W. and
Goethals, G. W., 1956. Cultural factors in
mental health. Rep. Educ. Res., 26: 431.

Allport, F. H., 1955. Theories of Perception
and the Concept
of
Structure. Wiley.
Allport,
,
G. W., 1937. Personality. Holt, pp. 213, 214, 226.

1955. Becoming. Yale University Press, pp. 49, 51,
68.
Angyal, A., 1952. A theoretical model for personality studies. In

D. Krech and G. S. Klein (Eds.), Theoretical Models and Per-
Duke
sonality Theory.
Asch, S.
E., 1952. Social
University, pp. 132, 135.
Psychology. Prentice-Hall.
Barron, F., 1952. Personality style and perceptual choice.
/.
Pers.,
20: 385.
,
1954. Personal soundness in university graduate students.
University of California Press.

-,
September
1955.
Towârd a positive definition of psycho-
Paper read before American Psychological As-
logical health.
sociation.
Houghton Mifflin.
Dynamics of prejudice.
Benedict, Ruth, 1934. Patterns of Culture.
Bettelheim, B. and Janowitz, M., 1950.
Harper.
Blau, A., 1954.
Psychiat.,
Boehm,
W.
The
no:
W.,
diagnosis and therapy of health.
Amer.
f.
594.
The role of psychiatric social work in

A. M. Rose (Ed.), Mental Health and Mental
1955.
mental health. In
Disorder. Norton, p. 537.
[121]
122
REFERENCES
September 1957. Putting available tools

J.,
Health, Nat'l. Health Council.
Mental
work. In Better
to
Braceland, Francis
Biihler, Charlotte, 1954.
The
reality principle.
Amer.
J.
Psycho-
ther., 8: 626, 640.
Burgess, E. W., 1954. Mental health in modern society. In A. M.

Rose (Ed.), Mental health and mental disorder. Norton, p. 3.
Cantor, N., 1941.
What
is
normal mind? Amer.
f.
Orthopsy-
chiat., 11: 6^6.
Chapman, D. W.,
new
Chein,
I.
1954. (Issue Ed.)
Human
behavior in disaster:
field of social research. /. Soc. Issues, 10:
1944.
The awareness
of self
No.
3.
and the structure of the ego.
Psychol. Rev., 5/; 312.
Clausen,
J.
A., 1956. Sociology
and the Field
of
Mental Health.
Russell Sage Foundation.
and Yarrow, Marian R., 1955. (Issue Eds.) The impact of

mental illness on the family. /. Soc. Issues, 11: No. 4.
Conrad, Dorothy C, 1952. Toward a more productive concept of
mental health. Mental Hygiene, 56; 456, 466.
Davis, K., 1938. Mental hygiene and the class structure. Psychiat.,
,
i: 55.
Devereux, G., 1956. Normal and abnormal: The key problem of

psychiatric anthropology. In J. B. Casagrande and T. Gladwin
(Eds.), Somes Uses of Anthropology: Theoretical and Applied.
Anthropological Society of Washington,
The
Duncker, K.,
No.
1945.
On
1951.
The
p. 23.
problem solving. Psychol. Monogr., 58:
5, I.
Eaton,
J.
W.,
assessment of mental health. Amer.
J.
Psychiat., 108: 81.

Eliot,
T. D.,
May
1929. Standards of living, planes of living,
normality. The Family, 10:
and
p. 87.
Growth and crises of the "healthy personality." In M. J. E. Senn (Ed.), Symposium on the Healthy Personality. Josiah Macy Jr. Foundation, pp. 135, 138, 139, 141, 142,
Erikson, E. H., 1950.
143.
Ewalt,
J.
R., 1956. Personal
communication.
REFERENCES
1^3
and Dunham, H. W., 1939. Mental Disorders in

Urban Areas. University of Chicago Press.
Foote, N. N. and Cottrell, L. S., Jr., 1955. Identity and Interpersonal Competence. University of Chicago Press, p. 55.
Friedenberg, E., 1957. The mature attitude. Adult Leadership, 5:
Paris, R. E. L.
248.
Fromm,
E., 1941.
Escape from Freedom. Farrar and Rinehart,
p.
263.
,
1947.
Man
1955.
The Sane
for Himself. Rinehart, p. 26.

Society. Rinehart.
Ginsburg, S. W., 1955. The mental health movement and its

theoretical assumptions. In Ruth Kotinsky and Helen Witmer
(Eds.),
Community Programs
Mental Health. Harvard
for
University Press, pp. 7, 21.

Glover, E., 1932. Medico-psychological aspects of normality. Brit.
J.
Psychol., 25: 165.
Goldstein, K., 1940.
Human
Nature
in the
Light of Psychopa-
Harvard University Press.

Gottlieb, J. S. and Howell, R. W., 1957. The concepts of prevention and creative development as applied to mental health. In
Ralph H. Ojemann (Ed.). Four Basic Aspects of Preventive
thology.
Psychiatry. State University of Iowa.
Group
tors
for the
Used
Advancement
December
1956, Fac-
to Increase the Susceptibility of Individuals to Force-
ful Indoctrination.
Hacker, F.
of Psychiatry,
J.,
1945.
Symposium No. 3.
The concept of normality and
significance. Amer. J. Orthopsychiat., ly.

Hall, C. S., and Lindzey, G., 1957. Theories
its
practical
53, 55.
of Personality. Wiley,
pp. 96, 404.
Hartmann, H.
1939. Psychoanalysis
and the concept of
health.
Int. J. Psychoanal., 20: 308, 312, 314, 315, 316, 318.

,
1947.
On
and irrational action. In Geza Roheim

and the Social Sciences, i. International
rational
(Ed.), Psychoanalysis
Universities Press, pp. 363, 379, 390, 391.

,
1951. Ego psychology and the problem of adaptation.
124
REFERENCES
D. Rapaport (Ed.), Organization and Pathology

Thought. Columbia University Press, pp. 362, 373.
Havens, L. L., January 5, 1958. Personal communication.
In
Hollingshead, A. B. and Redlich, F.
and psychiatric
disorders.
Jahoda, Marie, 1950.
In
M.
Josiah
,
J.
Amer.
C,
of
1953. Social stratification
Sociol. Rev., 18: 163.
Toward a social psychology of mental health.

Symposium on the Healthy Personality.
E. Senn (Ed.),
Macy Jr. Foundation,

1953. The meaning of
pp. 211, 219, 220.
psychological health. Social Case-
wor\, ^4: 349.

Janis,
I.
L., 1956.
Emotional inoculation: Theory and research on
the effectiveness of preparatory communications. Paper to ap-
pear in Psychoanalysis and the Social Sciences. International

Universities Press.
Johnson, W., 1946. People in Quandaries. Harper, p. 24.

Jones, E., 1942. The concept of a normal mind. Int. J. Psychoanalysis, 2j:
I.
Jones, M., 1953.
The Therapeutic Community.
Basic Books.
Kardiner, A., 1945. (With the collaboration of R. Linton, Cora

DuBois and J. West). The Psychological Frontiers of Society.
Columbia University Press.

Kaufman, M. R., September 27,
symptom
1956.
The problem
of psychiatric
formation. Paper presented before Michigan State
Medical Society.
Klineberg, O., 1954. Social Psychology (rev. ed.),
Henry
Holt, p.
397-
Kluckhohn, C. and Murray, H. A. (Eds.), 1948. Personality

Nature, Society and Culture. Alfred Knopf.
Kris, E., 1936.
The Psychology
of caricature. Int.
f.
in
PsychoanaL,
ly: 290.
Kubie, L.
S.,
1954.
The fundamental
tween normality and

Leighton, A. H., 1949.
neurosis.
Human
nature of the distinction be-
PsychoanaL Quart., 2j:
187, 188.
Relations in a Changing World.
Button.
Lewis, A., 1953. Health as a social concept. Brit. f. Sociol., 4: 109.
Lindner, R., 1956. Must you conform? Rinehart, pp. 3, 205.
REFERENCES
1950. Self-actualizing people:
Maslow, A. H.,
1^5
study of psy-
chological health. Personality Symposia, i: 16.

,
1956. PersonaHty
problems and personality growth. In
Moustakas, C. (Ed.), The Self. Harpers.

-,
1955. Deficiency motivation and growth motivation. In
M. R. Jones (Ed.), Nebraska Symposium on Motivation. University of
May,
Nebraska
R., 1954.
Press, pp. 8, 20, 24, 25, 27.

psychologist looks at mental health in today's
world. Mental Hygiene, ^8:
Mayman,
M., 1955.
The
i.
diagnosis of mental health.
UnpubHshed.
Menninger Foundation.
Menninger, K. A., 1930. What is a healthy mind? In N. A. Crawford and K. A. Menninger (Eds.), The Healthy-Minded Child.
Coward-McCann.
(3rd ed.) Knopf, p. i.
, 1945. The Human Mind.
Merton, R. K., 1957. Continuities in the theory of social structure
and anomie. In Social theory and social structure (Rev. Ed.),
The Free Press, p. 177.

Meyer, A., 1925. Suggestions of Modern Science Concerning Education (with H. S. Jennings and J. B. Watson). Macmillan, p.
118.
Milbank Memorial Fund, 1953. Interrelations Between the Social

Environment and Psychiatric Disorders, p. 125.
1956. The Elements of a Community Mental Health Program.
Mowrer, O. H., 1948. What is normal behavior? In L. A. Pennington and I. A. Berg (Eds.), An introduction to clinical psy,
chology. Ronald, p. 17.

Piaget,
J.,
1952.
The Origins
of Intelligence in Children. Interna-
tional Universities Press.
Powell,
J.
W.,
1957.
The
maturity vector. Adult Leadership, 5;
C,
1952.
The
concept of normality. Amer.
252.
Redlich, F.
J.
Psycho-
ther., 6: 551.
Riesman, D., Glazer, N., and Denney,

Crowd. Yale University Press.
R.,
1950.
The Lonely
126
REFERENCES
Riimke, H. C, 1955. Solved and unsolved problems in mental

health. Mental Hygiene, ^g: 183.
Sanford, F. H., 1956. Proposal for a study of mental health in
education. First annual report, Joint
Illness
and Health, Appendix H.
Shoben, E.
ity.
M.
1957.
J., Jr.,
Amer.
Smith,
Commission on Mental
Toward
a concept of the
normal personal-
Psychol., 12: 183.
B., 1950.
Optima
of mental health. Psychiatry, ly. 503.
Stanton, A. H., and Schwartz,
M.
S.,
1954.
The Mental
Hospital.
Basic Books.
Tillich, P., 1952.
The Courage To
Be. Yale University Press.
Washington
State Department of Health, June 195 1, Conference

on research and evaluation of community mental health programs.
Wegrocki, H.
J.,
1939.
cepts of abnormality.
critique of cultural
/.
Abnorm. and
and
statistical
con-
Soc. Psychol., j^: 166.
White, R. W., 1952. Lives in progress. Dryden, p. 333.

White, W. A., 1926. The Meaning of Disease. The Williams and
Wilkins Company, p. 18.
Wishner,
and
J.,
1955.
concept of efficiency in psychological health
in psychopathology. Psychol. Rev., 62: no.
Wright, H.
F.,
and Barker, R.
G., 1950.
Ecology. University of Kansas.
Methods
i,
69.
in Psychological
Aj^-pcndix
joint
on
Qommission
Rental
Illness
and Health
PARTICIPATING ORGANIZATIONS
American Academy of Neurology
American Academy of
American Occupational Therapy

Association
Pediatrics
American Association for the Advancement of Science
American
Orthopsychiatric
As-
sociation
American Personnel and Guid-
American Association of Mental
ance Association
Deficiency
American Psychiatric Association
American Association of Psychiatric Clinics for
Children
American Psychoanalytic Association
American College of Chest Physicians
American Psychological Association
American Hospital Association
American Public Health AssoAmerican Legion

American Medical Association
American Nurses Association

and The National League
for Nursing (Coordinating
ciation
American Public Welfare Association
Association for Physical and

tal
Men-
Rehabihtation
Council of)
[127]
APPENDIX
[128]
Association of American Medical
Mental
Association of State and Territorial
Committee
National
Colleges
Against
Illness
National Education Association
Health Ofl&cers
National
Catholic Hospital Association
Central Inspection Board,
of
Institute
Mental
Health
Amer-
National Medical Association
ican Psychiatric Association
National Rehabilitation Associa-
Bureau,
Children's
Dept.
of
tion
Health, Education and WelVocational Rehabilita-
of
Ofl&ce
fare
Department of Health,
Education and Welfare
tion,
Council of State Governments
Department of Defense, U.S.A.
United States Department of Justice
National Association for Mental

Veterans Administration
Health
National
Association
of
Social
Workers
MEMBERS
Kenneth E. Appel, M.D.
Philadelphia, Pa.
Walter H. Baer, M.D.
Kathleen Black, R.N.

New York, New York
Daniel Blain, M.D.
Washington, D.C.
Peoria, Illinois
Leo H. Bartemeier, M.D.

Baltimore, Maryland
Francis
Walter E. Barton, M.D.
Hugh
Boston, Massachusetts
Otto L. Bettag, M.D.

Springfield, IlHnois
Mr. George Bingaman

Purcell,
Oklahoma
J.
Braceland,
M.D.
Hartford, Connecticut
T. Carmichael, M.D.
Chicago,
J.
Illinois
Frank Casey, M.D.

Washington, D.C.
James M. Cunningham, MJ).

Dayton, Ohio
JOINT COMMISSION ON MENTAL ILLNESS AND HEALTH

John E. Davis, Sc.D.
Rehoboth Beach, Delaware
Ernst Mayr, Ph.D.
Neil A. Dayton, M.D.
Robert T. Morse, M.D.
Mansfield Depot, Conn.
Miss Loula
Chicago,
Dunn
Fabing, M.D.
Ohio
Cincinnati,
Rev. Patrick
J.
Frawley, Ph.D.
New York, New York
Cambridge, Mass.
Washington, D.C.
Winfred Overholser, M.D.

Washington, D.C.
Howard W.
M.D.
York
Potter,
New York, New
Mr. Mike Gorman

Washington, D.C.
Mr. Charles Schlaifer
Robert T. Hewitt, M.D.
Lauren H. Smith, M.D.
New York, New York
Bethesda, Maryland
Herman E.
Albany,
Hilleboe,
M.D.
New York
Nicholas Hobbs, Ph.D.

Nashville, Tennessee
Bartholomew
W. Hogan,
Rear
Adm. M.C., U.S.N., Washington, D.C.
Louis Jacobs, M.D.
Washington, D.C.
M. Ralph Kaufman, M.D.

New York, New York
William S. Langford, M.D.
New York, New York
Miss Madeleine Lay
New York, New York

Jack Masur,
M.D.
Bethesda, Maryland
Berwyn
New
M.D.
York
F. Mattison,
York,
New
I29
Ralph H. Ojemann, Ph.D.

Iowa City, Iowa
Illinois
Howard D.
Philadelphia, Pa.
M. Brewster Smith, Ph.D.
New York, New
York
Mr. Sidney Spector

Chicago,
Illinois
Mesrop A. Tarumianz, M.D.

Farnhurst, Delaware
David W. Tiedman, Ed.D.
Cambridge, Mass.
Harvey
New
Tompkins, M.D.
York, New York
Beatrice
J.
D. Wade, O.T.R.
Chicago,
Illinois
Mr. E. B. Whitten
Washington, D.C.
Helen Witmer, Ph.D.

Washington, D.C.
Luther E. Woodward, Ph.D.
New York, New York
130
APPENDIX
OFFICERS
President:
Kenneth E. Appel, M.D.
Philadelphia, Pa.
Chairman, Board of Trustees: Leo H. Bartemeier, M.D.

Baltimore,
Vice-President:
New
Md.
M. Brewster Smith, Ph.D.
York, N.Y.
Secretary-Treasurer: Mr. Charles Schlaifer
New
York, N.Y.
Vice-Chairman, Board of Trustees: Nicholas Hobbs, Ph.D.

Nashville, Tenn.
STAFF
Director: Jack R. Ewalt,
M.D.
Boston, Mass.
Consultant for Scientific Studies: Fillmore H. Sanford, Ph.D.

Austin, Texas.
Consultant in Social Sciences: Gordon
Chapel
Hill,
W.
Blackwell, Ph.D.
North Carolina
Consultant tn Epidemiology: John E. Gordon, M.D.

Boston, Mass.
Associate Director for Administration: Richard
J.
Plunkett,
M.D.
Boston, Mass.
Director of Information: Greer

Boston, Mass.
Associate Director
and Consultant on Law: Charles
Boston, Mass.
Librarian:
Mary
R. Strovink
Boston, Mass.
WilHams
S.
Brewton, LL.B.
Index
mental disease and, 12-14

normality and, 15
accommodation, 62
achievement level, as measure of
S. E., 14,
92
assessment, of mental health, 81-
problem-solving and, 63
reality and, 60-62
100
environmental mas-
assimilation, 62
attitude
tery)
alloplastic, 71
adjustment
adaptation and, 62-63
to environment,
autonomy and,
Adler, Alfred, 55
age groups, mental
heterogenic, 33-34
(see also self, attitude toward)
autonomy, 23, 43, 45-49, 71

measurement of, 91-92
47-48
teria
of, 90-91
(see also stress)
Asch,
adaptation
(see
anxiety tolerance, 41-43
measurement
self-actualization, 87-88
acquisition of mental health, 104
also
anxiety, 42-43
health
cri-
and, 101-103
Alexander, Franz, 12
Barker, R. G., 107
alienation, 57
AUinsmith, Wesley, 42
Barron, F., 26, 40, 50

Barton, Walter E., 111-119
alloplastic attitude, 71
becoming
Allport, F. H., 105
Benedict, Ruth, 12
AUport, Gordon W., 25-26, 27, 31,
Bettelheim, B., 108
Angyal, Andras, 48
anthropology
Boehm, W. W.,
(see self -actualization)
Blau, A., 56
19,
Braceland, Francis
20
J.,
117-119
[131]
INDEX
[132]
Biihler, Charlotte,
Biihler, K.,
decision-making
44
process,
45-46,
48
44
assessment
91-92
of,
development, 71
sense of identity and, 30
Cannon, Walter, 113
Raymond
Cattell,
28
B., 27,
Chapman, D. W.,
{see also
91
Dicks,
Chein, Isidor, 61
child,
mental health
of, 58-59, loi-
103, 106
mental
childbirth,
health
and,
117-118
Clausen,
J.
clusters, of
A., 91
mental health
loo-ioi
growth)
Devereux, G., 13
(^see also
H.
v., 57
disease, physical, 67-68 {see also
illness; mental disease)

Dubos, Rene J., 1 14
Duncker, K., 63, 95
Dunham, H. W., 107
criteria,
multiple
criterion)
cognition
perception, of re-
(^see
in integrated personality, 37-38
ality)
community, mental disease and,

concern for others, self-actualiza-
and, 44
mental disease, 13
conformity, 47-48
Conrad, Dorothy C, 57-58, 74

in
integrated
ality, VJ,
person-
self,
25-27
also self, attitude
{^see
toward)
contentment, 19-21
Cottrell, L. S., Jr., 46, 52,
56
cultural relativism, 13
cultural values, 76-80
culture,
empathy
measurement
mental disease and, 12-13
{see also society)
of,
94
in perception of reality, 52-53
empirical
38
consciousness, of
ego-identity {see identity)
ego-psychology, reality-orientation
tion and, 35
conscious,
reality and, 61
{see also self)
13-14
conflict, as
ego
assessment of mental
health, 81-100
environment
maintenance of mental health
and, 105-108
well-being and, 20-21
{see also situation)
environmental
mastery,
23,
43,
53-64
Darwîn, Charles, 114
assessment of, 94-95

Erikson, Erik H., 29-30, 41, 54-55,
71, lOI
Davis, K., 17
Ewalt, Jack R., 42, 50
INDEX
[133]
Paris, R. E. L., 107
ality,
Foote,
id, in integrated personality,
integrated person-
in
flexibility,
integrated personality and, 41
38-39
N. N.,
46, 52, 56
frequency concept of normality,
independence {see autonomy)

illness,
15-18
Erich,
57>
health and, 112-119 {see

also
Freud, Sigmund, 34, 37, 61
Fromm,
37-38
identity, sense of, 28-30
8, 27,
integration
30, 31, 32,
mental disease)
of
personality,
23,
35-43. 54. 71-72
measurement
of, 89-91
interpersonal relations
genitality {^see orgastic pleasure)
Ginsburg,
S.
W.,
55, 57, 80
Glover, E., 42
Goethals, George W., 42
Goldstein, K., 31, 32
assessment of, 95
environmental mastery and, 53,
56-58
sense of identity and, 29-30
investment in living
measurement
Gottlieb, Jacques S., 116-117
89
and, 32, 34-35,
of, 87,
self-actualization
growth, 23, 30-35, 71
measurement
of,
87-89
H
Hacker, F.
Jahoda, Marie, 50, 51, 63, 72

J.,
54
Janis,
happiness, 18-21
Hall, C.
S.,
27, 29, 35
Hartmann, Heinz,
47, 60-61,
L.,
42
Johnson, Wendell, 43-44
37-39, 44, 46,
^()
Havens, Leston L., 114-115

mental
health,
mental
{^see
physical
Joint
Commission on Mental Illness and Health, 19, 127130
Jones, Ernest, 16-17, 19, 20
health)
health,
I.
Janowitz, M., 108
{see
physical
health)
health potential, 14
heterogenic attitude, 33-34, 71
HoUingshead, A. B., 107

Horney, Karen, 56
Howell, Roger W., 11 6-1 17
Hunt, J. McV., 61
Jones, M., 107

Jung, Carl, 35
K
Kardiner, A., 107
Kaufman, M. Ralph, 115-116
Klineberg, Otto, 12
Kluckhohn, Clyde, 69
INDEX
[134]
Kris, E., 37
Kubie, L. S., 27, 38-39
values and, 76-80

definitions of, 3-4
mental
and,
10-15,
mental
health
disease
73-76
types of, 66-73
Leighton, Alexander, 7
Lewin, Kurt, 88
mental
Lindner, R., 35
Lindzey, G., 27, 29, 35
Linton, Ralph, 13
Merton, Robert K., 68

Meyer, Adolf, 109
love, ability to, 53, 54-55
Money-Kyrle, Roger E., 50

moral values {see values)
assessment
of,
patients,
and, 103-104
criteria
95
motivational processes, self-actualization and, 32-35
Mowrer, O. H., 17
McDougall, William, 29
maintenance of mental health,
104-108
multiple
70-73
mental
{see
also
clusters)
majority concept
(^see
frequency
Murray, Henry, 30, 69
concept)
Maslow, A. H.,
28, 31, 32-33, 34,
40. 47> 50j 70

mastery of environment {see en-
vironmental mastery)
need distortion, in perception of

reality,
51-52
May, RoUo, 57
negative health, 74
nonhealth, 74
Mayman, M.,
normality, 15-18
25, 26, 31-32, 33-35,
46-47, 56, 71, 75

Menninger, Karl, 18-19, 20
mental disease,
of
criterion
health,
6,
case study of, 66-67
73-76
definitions of, 10-14
anthropological, 12-14
diagnosis of, 10-12

{see also illness)
mental health
objectivity,
toward self, 27
measurement of
observation, as
health, 84-86
optimum mental
health, 49, 72-73
orgastic pleasure, 54-55
concepts of, 5-66, 76-110

empirical indicators for, 82-
100
research in, 81-110
unsuitable, 10-21
perception,
of
reality,
49-53. 7^-7^
measurement
of,
92-94
23,
43,
INDEX
[135]
integration
personality,
of
(see
Rogers, Carl, 31
Riimke, H.
integration)
C,
73-74
physical health, 67-68, 112-116

Piaget, Jean, 62
plasticity,
integrated
in
ality,
person-
Sanford, Fillmore H., 58

satisfaction, 19
38
Schwartz, M.
play
assessment
of,
self,
95
environmental
mastery
107
attitude toward, 23, 24-30,
and,
observation
55-56
also
{see
Porterfield, John, 50
positive
S.,
mental health {see mental
of,
83-87
autonomy;
self-ac-
tualization)
self-acceptance, 28
health)
preconscious, in integrated personality, 37, 38
self-actualization, 23, 30-35, 70-71
measurement
of,
87-89
unifying outlook and, 40-41
problem-solving
as environmental mastery, 53,
62-64
self-concept {see self, attitude to-
measurement
self-consciousness, 25, 26-27
of,
95
proprium, 40
ward)
self-determination,
psychoanalytic theory
also
46,
71
autonomy)
mental disease and, 13
self-extension, 34,
39
reality-orientation and, 44
(see also Freud)
self-objectification,
39
sense of identity {see identity)
sexual pleasure, 54-55
situation
adaptation and, 60-62
assessment of, 95
behavior and, 58-59, 85
attitude towârd self and, 27, 28
{see also environment)
reality
reality-orientation, 43-45 {see also
C,
17,
107
Reich, Wilhelm, 54
Brewster, 49, 72
society,
health of, 8-9 {see also
culture)
Stanton, A. H., 107
research
requirements
M.
Smith,
social values {see values)
perception)
Redlich, F.
{see
for, 81-82
suggestions for, 100-104

resistance, to stress {see stress)
Riesman, David, 47, 48
stress, resistance to, 36,
measurement
41-43
of, 90-91
success {see environmental mastery; problem-solving)
INDEX
[136]
Sullivan,
Harry Stack,
superego, in
ality,
56
31,
integrated
person-
value judgment, in science, 6-7
37-38
values, 76-80
W
testing, of reality, 51-52
tests,
for self-descriptions,
therapy,
mental
health
83-86
criteria
Weber, Max, 75
Wegrocki, H. J., 17
well-being, as mental health con-
and, 104
cept, 18-21
Tillich, Paul, 43
White, Robert, 30, 66-67

White, William Alanson,
tranquilizing drugs, 104
Wishner,
Julius,
assessment
38
unifying philosophy, 71
environmental
ality, 37,
integrated
personality,
39-41
measurement
70
work
unconscious, in integrated person-
in
6'jj
59
of,
90
of,
95
mastery
and,
55-56
36,
World Health Organization,

56
Wright, H.
F.,
107
18,
Date
Due
Current concepts
m mam
C2
of positive
131.306J74mno
lEbE D3S72 lbb3

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UNIVERSITY

Digitized by the Internet Archive

2010 with funding from

Members and Sloan Foundation

Basic Books, Inc., Publishers,

FIRST PRINTING SEPTEMBER I958

SECOND PRINTING FEBRUARY I959

1958 BY BASIC BOOKS, INC.

LIBRARY OF CONGRESS CATALOG CARD NO. 58-I1681

THE UNITED STATES OF AMERICA

DESIGNED BY SIDNEY SOLOMON

by the Joint Commission on Mental

part of a national mental health survey that will culminate

for a national mental health program.

constitutes a report of the project

director to the staff director of the Joint

together with the senior

authors, are listed here in the approximate order of scheduled

Current Concepts of Positive Mental Health

Marie Jahoda, Ph.D.

Mental Health Manpower

Nationwide Sampling Survey of People's Mental Health

Wesley Allinsmith, Ph.D., and George

Research Resources in Mental Health

William F. Soskin, Ph.D.

Richard V. McCaiin, PhX).

Reginald Robinson, Ph.D., David F. DeMarche, PhX).,

and Mildred K. Wagle, M.S.SA.

and John E. Gordon, M.D.

Patterns of Patient Care:

Schwartz, Ph.D., Warren T. Vaughan, M.D.,

and Charlotte Greene Schwartz, M.A.

These monographs, each a part of an

over-all study design,

the data in the individual studies and

other relevant information, the headquarters staff will pre-

recommendations for national and

mental health pro-

will have the approval of

pubHcation in the form of

This final report will be pubHshed by Basic Books and

Health Service, and the Governors of the

with their representatives in the pubHc health

and mental health

Mental Health Study Act of

with the pro-

headquarters and project

are listed in the appendix at the

end of the book.

mental, multidisciplinary, nonprofit organization represent-

ing a variety of national agencies concerned with mental

was authorized by a unanimous resolution

be obtained from the Joint Commission head-

1 HE NEED for a clearer understanding of what

cope with the role of schools and the numerous community

and other phases of the mental health move-

in progress in the United States.

clarification of the subject

should be of help to mental health

We commonly use "mental health" as

same euphemistic way

"public health" generally refers to the prevention or control

by mass methods. The behavioral

have joined the mental health team and are making