Abstract
Mental health does not exist on its own. It is an integral and essential part of overall health, which can be defined in at least three ways – as the absence of disease, as a state of the organism that allows the full performance of all its functions or as a state of balance within oneself and between oneself and one’s physical and social environment (Sartorius, 2002). Which of these three definitions is used depends on the level to which the basic health needs are satisfied. These needs include food, shelter, survival, protection, society, social support, and freedom from pain, environmental hazards, unnecessary stress and from any part of exploitation (Maslow, 1968).
The state of mental health implies that the individual has the ability to form and maintain affectionate relationships with others, to perform in the social roles usually played in their culture and to manage change, recognize, acknowledge and communicate positive actions and thoughts as well as to manage emotions such as sadness. Mental health gives an individual the feeling of worth, control and understanding of internal and external functioning. The Society for Health Education and Promotion Specialists (SHEPS, 1997) suggests that mental health also involves feeling positive about oneself and others, feeling glad and joyful and loving. Mental health, like mental illness, is also affected by biological, social, psychological and environmental factors. The individual at the core of functioning is surrounded by the social world – in the proximal world it will include family, kinship, employers, peers, colleagues, friends and, in the distal context, society and culture.
The interaction between individuals and society becomes critical in building healthy communities, which in turn can promote mental health.
Vulnerabilities to mental ill health (or, as the Health Education Authority report (HEA, 1997) calls it, mental health demotion) include internal factors such as a lack of emotional resilience, poor self-esteem and social status, feeling trapped and helpless, and problems associated with sexuality or sexual orientation, isolation and poor integration. External factors contributing to this vulnerability have been described as poor social conditions (housing, poverty, unemployment), discrimination or abuse, cultural conflict, stigma and poor autonomy, among other factors (HEA, 1997).
T. Y. Lin (personal communication) once told one of us that he was teaching his son about mental health, which for him meant being at ease when with others and when alone. An individual in a state of good mental health will have a strong sense of self and others; they will be able (and willing) to form positive relationships and yet be comfortable in their own company. The notions of self will be very strongly influenced by culture, and whether the individual is socio-centric or egocentric will be determined by culture and personality. Any attempts to change this notion of the self may well lead to culture conflict, individual dissonance and unhappiness. The core senses of mental health include trust, challenge, competency, accomplishment and humour, and the capacities that mental health offers include the ability to develop psychologically, emotionally, intellectually and spiritually; initiate, develop and sustain mutual emotionally satisfying relationships; the ability to be aware of others and to empathize with them; and to use psychological distress as a development process and learn from it so that it does not hinder or impair further development (HEA, 1997).
The Mental Health Foundation (MHF, 2008) notes that mental health is defined by how individuals think and feel about themselves and their life, and that it affects how an individual copes and manages in times of adversity. Mental health is seen as affecting one’s abilities to function and make the most of the opportunities that are available, and to participate fully with family, workplace, community and peers. There is a close link between physical and mental health, as they affect each other directly and indirectly.
It is thus possible to suggest that mental health is a state of equipoise where the individual is at peace with themself, is able to function effectively socially and is able to look after their own basic needs as well as higher function needs. Positive functionality means managing change, relationships and emotions in a constructive manner. The challenge for psychiatry is that it needs to encompass the preservation and promotion of mental health in its practice, research and teaching and that it becomes actively engaged in introducing these notions into the public health efforts.