(WARNING: This is not a short easy read article, though there will be short ones to come, this one is a part of a lengthy series)
The purpose of this article is, to delve in-depth and distinguish a clear path and strong connection from the definition of health and mental health, translated to action, in order to establish its value and meaning. I must point out, that while I explore international definitions of happiness, I emphasize its impact on the US. Most importantly however, I address the practical uses of defining health and its implications for day-to-day life. In this article, I will list several organizations that influence the US national, and also international perspectives of health, as it relates to mental health, as well as my own professional organization. These organizations are listed below in the same order they are discussed in this article, and include:
- The World Health Organization (WHO)
- The Center for Disease Control and Prevention (CDC)
- The Substance Abuse and Mental Health Service Administration (SAMHSA)
- The National Alliance on Mental Illness (NAMI)
- The National Institute of Mental Health (NIMH)
- The British Psychological Society (BPS)
- The International Self-Care Foundation (ISF)
- The Happiness Research Institute (HRI)
- The American Occupational Therapy Association (AOTA)
An Introduction to Defining Health
Have you ever been diagnosed with a mental illness? Have you ever met anyone diagnosed with a mental illness? In America, it would be quite difficult to not know someone diagnosed with a mental illness. The highest rate of mental illness occurs in nearly 1 in 4 (in the past year) of those ages 18-24 (SAMHSA, 2017). Trailing closely behind the young adults, are the rates of those ages 25-49. It’s not an age or generational thing. The percentage of those with a mental illness, or multiple, is increasing across all generations with no sign of stopping.
But have you ever wondered if anything about the whole mental health situation is strange? Have you ever wondered about questions such as:
- Does everyone really have a mental illness?
- At what point do you consider something a mental illness?
- Are more medications really the answer?
- Was I actually born this way?
- Can it be cured, or do I have to live with this the rest of my life?
- Why, with all our medical advances and healthcare costs, are rates increasing?
It seems the public culture in the United Kingdom (UK) is picking up on this healthcare epidemic faster than the United States (US) demonstrated by the organization now holding events called A Disorder For Everyone! There is growing momentum towards changing the definition of diagnosis altogether, of which several examples, I will list in this article.
Unfortunately, I believe most of these changes are just trading in one set of carrots, for another set of carrots to chase. I do not believe the solution is complex, in fact, I believe it is quite simple.
A Conjecture For Everyone
Definition of conjecture:
1a : inference formed without proof or sufficient evidence
- b : a conclusion deduced by surmise or guesswork
It seems difficult to make a useful conjecture in today’s opinion infatuated age, but then maybe it has always been difficult to make conjectures. Maybe the difficulty with conjectures is defining at what point “sufficient evidence” evolves a conjecture to something more.
I have not been an effective consistent producer of writing because I have a desire to escape conjecture for grounded, evidence-based, quality writing. Yet, I find myself extensively deep with books and journal articles into topics such as mindfulness, focus, self-esteem, motivation, goal setting, mental health, and change, with more questions than when I began.
Today, I shall break this cage of conjecture-fear for a 3-point thesis statement:
- The meaning of life may be unique for everyone, but finding it is the same.
- Meaning in life is found through purpose, which is defined by the act of a person to focus on priority.
- The practice of focusing on priority, also defines purpose, which is where we will find our meaning.
I also believe, mental health is directly, and fully related to purpose. Positive mental health is the ability to pursue purpose. Negative mental health, is any barrier that prevents that pursuit; and that pursuit being comprised of the ability to focus on one’s priorities. This is to say, without digressing further; a drug dealer may have great mental health, while someone with no diagnosis may have poor mental health, even worse than those deemed “mentally ill” by medical standards. Specifically, purpose and mental health, is not the pursuit of “happiness.” One could define happiness as their purpose, but their mental health would still be related to the ability to pursue it, not the happiness itself. The difference being; purpose and positive mental health can exist without happiness, or even well-being, as I shall argue.
This perspective was echoed long before my time, by Viktor Frankl in his book Man’s Search for Meaning (1946). Frankl states “Man’s search for meaning is the primary motivation in his life and not a “secondary rationalization” of instinctual drives.” (pg.105) and continues to say “This meaning is unique and specific in that it must and can be fulfilled by him alone; only then does it achieve a significance which will satisfy his own will to meaning.” (pg.105)
Viktor Frankl was a psychiatrist who survived the Holocaust, including Auschwitz. Afterwords, he developed a Psychotherapy termed Logotherapy. Frankl describes the emphasis on meaning in relation to mental health in Logotherapy when he stated:
“According to Logotherapy, this striving to find a meaning in one’s life is the primary motivational force in man.”
I believe as a culture both national and international, we have forgotten the value of meaning and purpose as primary determinates of health. Instead we have come to as Merriam-Webster reflects in the first definition of each word below, an unrealistic, hopeless, and demoralizing standard:
Definition of well-being : the state of being happy, healthy, or prosperous : welfare
Definition of health : 1 a : the condition of being sound in body, mind, or spirit; especially : freedom from physical disease or pain
Definition of welfare : 1 a : the state of doing well especially in respect to good fortune, happiness, well-being, or prosperity
As for an argument that this so called state of “health” is not achievable; I argue, has it truly ever been achieved? When you boil down the definition to it’s roots, I argue “the state” of welfare is superficial way to describe a happiness-filled immortality. If not, then how much longer must we wait? Secondly, particularly in America, the standard of living has increased to amazing proportions. Yet, despite this, in the US there is:
- Epidemically increasing rates of mental illness (SAMHSA, 2017)
- Epidemically increasing rates of chronic conditions (CDC, 2017)
- The world’s highest healthcare cost per person, and still increasing (Keehan, 2016)
- Current decreasing rates of life expectancy (Tinker, 2017)
- And decreasing rates of life satisfaction? (Helliwell, Layard, & Sachs, 2017)
To provide the foundations for one other cornerstone assumption guiding my perspective in writing this article, is evidence supporting the idea that meaningful life can be lived by those with mental illness. I must first ask; do you think those with mental illness can live meaningful lives? If so, why? I am not arguing we should forget the suffering of those with mental illness and stop treatment. I am arguing that treatment itself may either be in most cases, not effective, worsening the problem, or engraining in society the idea that those with mental illness are broken until “fixed and free of suffering.” Lastly, what sufficient proof do we have that there is scientific and grounded evidence for deeming all those mentally ill as, mentally ill? I shall use one example, though I could use many, for this point.
Recovering from Schizophrenia
I chose schizophrenia for this point, because as Jobe and Harrow (2005) explain it, “schizophrenia patients as a group show poorer outcome than patients with other types of psychiatric disorders; in this sense, schizophrenia is a poor-outcome disorder.” Yet even with this poor-outcome disorder and a strict sense, and as I argue, terrible sense, of how recovery has historically been defined, Jobe and Harrow (2005) state “only 16.3% of subjects with schizophrenia and 35.8% of subjects with other psychoses in the incidence groups qualified as recovered. Even using the strictest criteria for recovery, there remained some level of symptoms and disability among some recovered patients.”
By modern definitions of health then, while recovery may have been possible for a select few of those with schizophrenia in these studies, there would be a near 0% chance of achieving health and well-being, so long as health and well-being included having no level of symptoms and disability.
However, Two counter-cultural and hard to understand themes emerged throughout the conclusions of several of these systematic and longitudinal studies:
- Those with schizophrenia have higher rates of positive outcomes in less developed countries (Jobe & Harrow, 2005; Jääskeläinen et al., 2013).
- There is a large population of those with Schizophrenia who gave up on medication and treatment and recovered better than those that didn’t stop receiving “help” (Davidson et al., 2007; Harrow & Jobe, 2007).
This is not sufficient evidence to declare all medication and mental health treatment is fraudulent and worth stopping, which is not what I believe. For those with Schizophrenia, there were other factors influencing the success rate of those that “gave up” on treatment. Then again, of the influencing factors supporting recovery, was the lack of time on medications and in treatment. This implies the correlation (not causation); the longer a person received treatment, the more dependent upon it they become (Davidson et al., 2007; Harrow & Jobe, 2007). These are however, among a great multitude of studies that demonstrate that there is a sense of “learned helplessness” and poor definitions of what recovery is, or at least what recovery is needed to live meaningful and purposeful lives. My point is summarized by Davidson et al., (2008) when stating people with a poor-outcome disorder such as schizophrenia are by many means, still able “to live meaningful and gratifying lives in the face of an enduring mental illness.”
The Influential Organizations That Define Health
The World Health Organization (WHO)
The World Health Organization (WHO) is arguably, the primary influence on national and international healthcare, as well as cultural perspectives, on the definitions of health, mental-health, and general well-being. Why WHO is arguably the primary influence, is that the following organizations use or derive their definitions from WHO.
- The Center for Disease Control and Prevention (CDC)
- The National Institute of Mental Health (NIMH)
- National Alliance on Mental Illness (NAMI)
My own professional organization, the American Occupational Therapy Association (AOTA), also derives its definitions of health from WHO (AOTA, 2014). Again, there are aspects I can greatly appreciate in the definitions provided by WHO, yet I argue there are fundamental errors that negate the whole understanding of mental health as we know it today.
Interestingly enough, the constitution of the WHO was adopted in the same year Viktor Frankl published his book Man’s Search for Meaning, which was 1946 (Frankl’s quotes used in this article come from a later version printed in English in 1959). Considering WHOs constitution was written the same year immediately after World War II, it’s quite an advancement for international human rights, given the atrocity and devastation of World War II.
Unfortunately, it seems Frankl’s value of “meaning” did not influence WHO’s constitution at its inception, enough, though the constitution would have benefited from it. While the principles were possibly effective at the start, it is time we either change the definitions of “well-being” and “health” or change the constitution itself. WHO lists an entire 9 principles in their guiding constitution, of which I list the first two below:
- “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”
I do greatly appreciate this idea that health is “not merely the absence of disease or infirmity.” Unfortunately, as its used; it seems that anyone with disease or infirmity can only enjoy the “highest attainable standard of health” at some lower level than those without disease or infirmity. Yet who can live a life without disease or infirmity? Let health be measured in dedication to purpose.
Without digressing into the negative impacts of the highlight reel phenomenon that occurs with the current use of social media; comparisons matter. Meik Wiking, the CEO of The Happiness Institute and author, points out in his TED talk The Dark Side of Happiness, that despite having arguably the world’s highest standard of living in Denmark, suicide rates rank Denmark at average globally (TEDxCopenhagen, 2016). His point: comparisons matter. When everyone else is supposedly happy and working, then not having that experience can be incredibly demoralizing. Yet, if the definition of health is expected to be at the extreme end of constant happiness and well-being, we compare ourselves to unrealistic, unachievable, fictional expectations.
I do not believe health as a state of “complete physical, mental and social well-being” will ever be achievable. In fact, the belief that this is a noble cause is, in my opinion, a major contributor to poor mental health and mental illness. Again, while the words and terminology may differ, this idea of “free from suffering” is blatantly, a guiding vision of what health is supposed to be as directed by science and the medical community, which will be a remerging point of contention throughout this article.
Center for Disease Control and Prevention (CDC)
In the United States, the Center for Disease Control and Prevention (CDC), directly cites their definitions by WHO. Maybe the words don’t matter to some, and it’s all opinion. Yet, I believe there is a great and notable problem with these definitions. They all imply that those with mental illness, which are those labeled and diagnosed, cannot achieve “health” until medically shedding the label or diagnosis. If one is unable to medically shed the label or diagnosis, then your life, as WHO or simply stated, “the world”, is merely measured in your ability to achieve the “highest attainable standard of health” at some second best, second rate level. No wonder people are so afraid of being diagnosed, and so desperate for a cure! In many ways, the world defines health as not being diagnosed.
An often-cited book of great value, written by scientist and researcher, Carol Dweck, titled Mindsets (2006), address this cultural battle of perspectives. Dweck argues we need to practice the growth mindset rather than the fixed mindset.
Pg.6 Believing that your qualities are carved in stone – the fixed mindset – creates an urgency to prove yourself over and over. If you have only a certain amount of intelligence, a certain personality, and a certain moral character – well, then you’d better prove that you have a healthy dose of them. It simply wouldn’t do to look or feel deficient in these most basic characteristics.
Pg.7 This growth mindset is based on the belief that your basic qualities are things you can cultivate through your efforts. Although people may differ in every which way – in their initial talents and aptitudes, interests, or temperaments – everyone can change and grow through application and experience.
Dweck does NOT argue those with the growth mindset will not experience mental illness or depression. However, her research did find that “…students with the fixed mindset had higher levels of depression” (Dweck, 2006). Of value is her earlier point that, with fixed mindset behaviors, we believe we have certain qualities that cannot be changed, so we try to “prove” what we have and don’t have. Thus, in a world defining your health and standard of living as having or not having mental illness, we try to prove or disprove what we have or do not have, rather than addressing our actual needs regardless. This is simply, a classic division of the haves and have-nots. The world, says you are either born healthy, or born destined to be not healthy. That is, unless, “SCIENCE CAN FIND A CURE” and as T. Collin Campbell argues in his book Whole (Campbell & Jacobson, 2013), “BANISH UNPREDICTABILITY.” This of course, comes at the price of an endless supply of increasing research funds, medical bills, medications, and of course, your hope.
I am not arguing that the practice of science and research is bad, nor the use of medications. These can be wonderful things. What they are not, is an answer to life, purpose, meaning, or health. We should not place our hope in science, research, or medicine. We should not allow lives to be defined be these things.
To reinforce the influence of one organizational definition on another, I have listed below, what Mental Health is, as found on the CDC website, as well as the CDC mental health indicators as based on their own research.
What is mental illness?
Mental illnesses are conditions that affect a person’s thinking, feeling, mood or behavior, such as depression, anxiety, bipolar disorder, or schizophrenia. Such conditions may be occasional or long-lasting (chronic) and affect someone’s ability to relate to others and function each day.
What is mental health?
Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.
Although the terms are often used interchangeably, poor mental health and mental illness are not the same things. A person can experience poor mental health and not be diagnosed with a mental illness. Likewise, a person diagnosed with a mental illness can experience periods of physical, mental, and social well-being (CDC, 2016).
Mental Health Indicators
Researchers suggest that there are indicators of mental health, representing three domains. (citations 6-8). These include the following:
- 1. Emotional Well-being: Such as perceived life satisfaction, happiness, cheerfulness, peacefulness.
- 2. Psychological well-being: Such as self-acceptance, personal growth including openness to new experiences, optimism, hopefulness, purpose in life, control of one’s environment, spirituality, self-direction, and positive relationships.
3. Social well-being: Social acceptance, beliefs in the potential including openness to new experiences, optimism, hopefulness, purpose in life, control of one’s environment, spirituality, self-direction, and positive relationships.
These may be indicators in sum. But as I made the statement earlier, I believe mental health can exist outside of the majority of these definitions. The most useful of the terms listed include “purpose in life”, “hopefulness” and possibly “positive relationships.” This is to say, I am not arguing against all means of defining mental health or the indicators of it. I am arguing against the idea of mental illness being so fully defined by “happiness” or “the absence of mental illness.”
Substance Abuse and Mental Health Service Administration (SAMHSA)
I must appreciate, in a positive light, a more fruitful definition of mental health. Or, as the Substance Abuse and Mental Health Service Administration (SAMHSA) advocates for; Recovery. SAMHSA’s sense of mental health defined as Recovery is listed below:
“Working definition of recovery from mental disorders and/or substance use disorders: A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”
SAMHSA, in their 10 Guiding Principles, explains hope “That people can and do overcome the internal and external challenges, barriers, and obstacles that confront them” (SAMHSA, 2012), which is similar to Carol Dweck’s Growth Mindset. Again, as terms change, ideas and meaning can be similar. As I argue for valuing purpose, many of these ideals are described by SAMHSA’s person-driven point as stated “define their own life goals and design their unique path(s) towards those goals” (SAMHSA, 2012). The use of goals in this sense, is similar and related to how I use prioritization in my initial thesis conjecture at the beginning of this article.
Previously, I just listed SAMHSA’s principles of recovery to reflect their guiding beliefs behind health. Below are what SAMHSA has identified through its research sources, as the ingredients for recovery called the Four Major Dimensions:
Health—overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem—and, for everyone in recovery, making informed, healthy choices that support physical and emotional well-being
Home—having a stable and safe place to live
Purpose—conducting meaningful daily activities, such as a job, school volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society
Community—having relationships and social networks that provide support, friendship, love, and hope
I list all these, not to the ease of any readers of this article. Rather, I have determined it necessary for my own sanity, to begin a more comprehensive approach to addressing topics related to mental health. It’s difficult to write articles on topics such as mindfulness, goal setting, horticulture, coping skills, and other positive mental health practices, without first clarifying where they all fit into the greater picture of health and life itself. The effort of this article, is to provide several lists and sources of the major influences on what defines our national and international perspectives of health. While I certainly give my own opinion and perspective on the value of these definitions, I have found it necessary personally, to be able to see several in order to weigh and evaluate. I hope in the same way, regardless of my opinion, you too, can find a wholistic and comprehensive expression of health, possibly informed by the resources listed.
The National Alliance on Mental Illness (NAMI)
The National Alliance on Mental Illness (NAMI) is an insightful resource and valuable organization to the US public, in understanding and moving forward. I will not discuss NAMI in depth, as it’s definitions, though not directly stated, are derived near verbatim, from WHO and SAMHSA (NAMI, 2018). However, despite my argument against WHO’s definitions, I still value NAMI as a patient empowering and resource providing approach, and I highly recommend visiting their website to browse. I agree with NAMI’s interpretation:
“Recovery, including meaningful roles in social life, school and work, is possible, especially when you start treatment early and play a strong role in your own recovery process.”
The National Institute of Mental Health (NIMH)
The National Institute of Mental Health (NIMH) is another leading organization, though it’s role is primarily involved in research, and reflects and cites SAMHSA and the CDC for their definitions and statistics.
In a recent article by NIMH titled Different Approaches to Understanding and Classifying Mental Disorders (NIMH, 2017), the entire concept of diagnosis itself is challenged by leading US researchers and scientists themselves (Clark et al., 2017). NIMH points out “three existing approaches” to how individuals are diagnosed with mental illness listed below.
The three existing approaches—
- the International Classification of Diseases (ICD),
- the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the
- National Institute of Mental Health (NIMH)’s Research Domain Criteria (RDoC)
“…these systems often result in comorbid diagnoses (i.e., when people are diagnosed with multiple disorders at one time), and are sometimes criticized for the seemingly arbitrary boundaries they set between disorders and nondisorders.
According to Dr. Cuthbert , “we now understand that the categories are not specific diseases (like Lyme’s Disease or influenza) but rather are broad syndromes – loose collections of symptoms that tend to occur together to some extent, and involve dysregulation in multiple domains.” (NIMH, 2017).
The first two current approaches called the ICD and DSM are summarized as “outdated.” The new approach that NIMH calls Research Domain Criteria (RDoC), will be a “different way to conceptualize mental disorders” that will not be “bound by specific categories or classifications of disorders or by thresholds of diagnosis” (NIMH, 2017). While this sounds like a step in the right direction, is it not disheartening to recognize that our entire cultural conception of mental illness, as I have argued throughout this article, is going to be changed simply because of “what we now understand”?
I return to my point regarding reductionist science, and the ever-eluding hope of a cure. Science and research are, maybe helpful things; but it’s chasing a carrot. Time and time again, we will return to a point of “what we now understand.” Is it worth experimenting with the increasing suicide rates and futures of the next generation? Is it all worth our hope, meaning, and purpose? All for scientific advancement and medicine? I argue simply, we will never be “free from suffering” and we will never “banish unpredictability.“ Therefore, no “better classification” of mental illness, will fix our suffering. This is NOT to say, that classifications, medicine, science, or research, are themselves the problem. Instead, this is to reiterate the problem of defining health, purpose, and the value of life, on the “lack of illness” or Merriam-Webster’s definitions of health, well-being, and welfare.
The British Psychological Society
In addition to the US based organization NIMH, which is soon proposing the new Research Domain Criteria (RDoC) approach to mental illness instead of the historical DSM diagnosis, there is also a UK based proposition. This UK based proposition is called the ‘Power Threat Meaning Framework’ described in a 2018 publication by the British Psychological Society (Johnstone et al., 2018). In their article, the authors explain:
Power Threat Meaning Framework
“The Framework invites psychologists to understand distress and troubling behavior as the product of life experiences as they impact upon embodied people”
He reports “the main aspects of the Framework are summarized by a set of questions which can be applied to individuals, families or social groups:
1. ‘What has happened to you?’ (How is power operating in your life?)
2. ‘How did it affect you?’ (What kind of threats does this pose?)
3. ‘What sense did you make of it?’ (What is the meaning of these situations and experiences?)
4. ‘What did you have to do to survive?’ (What kinds of threats response are you using?)
This work, was in fact influenced by Viktor Frankl’s Logotherapy, which I described at the beginning of this article, among several others. I appreciate most the “what sense did you make of it?” Component of the framework. What has happened to you, does possibly over emphasize the component we in America perseverate on known as “trauma.” However, as Carol Dweck (2006) points out in Mindset, there is strong evidence that implies having even 1 positive relationship is more influential than trauma, on the outcome of a person. While reflection may be necessary in the process of finding purpose, I worry that placing too much focus on that component will not over-turn the “learned helpless” that I have argued against with the implications of current standards of Health. Instead, I argue for greater inclusion of the growing concept; it’s not “what’s the matter with you?” But rather “what matters to you?” This appears to have come first from Barry & Edgman-Levitan (2012) in their article Shared decision making—the pinnacle of patient-centered care and advocated for by UK based Institute for Healthcare Improvement.
The International Self-Care Foundation (ISF)
“The International Self-Care Foundation (ISF) is a registered UK Charity with a global focus.”
“ISF’s Vision: is of a world in which people live long healthy lives, taking personal responsibility for their own wellness by adopting healthy lifestyle and self-care behaviours.”
I argue, ISF’s definition exemplifies a few of the primary misconceptions about mental health. Though much in the debate of mental health is related to definitions and words that carry different meaning across cultures, I believe the fundamental elements of error remain the same. Words such as “long healthy” and “wellness” are broad and vague, but also eventually, despite more noble sounding words, relate primarily to a medically defined form of “happiness.” This then, being the idea of always being “free from suffering”, which is evident despite any variance in the terminology or meaning.
One author of several, to which I shall return to many times in the next few comprehensive articles I have already written like this one, is the scientist and researcher T. Collin Campbell who wrote the book Whole. In his book, Campell argues against the current state of science, being a practice of trying to solve all the variables to achieve some type of enlightenment, somewhere in a fantasy future. He argues instead, science can look at the big picture of what already works in a Wholistic approach. Instead, many cultures have lived long healthy lives before modern medicine. Longer lives than we live in American today. Instead, Campbell argues, we should emulate and study them, instead of studying what is wrong with us. I believe he captures the essence of my argument against “happiness and health” being the idea of “free from suffering” when he states:
“What we really want from science is an end to randomness. We want to know why diseases strike some people and not others. We want to know how to protect ourselves against the scourges that have our names on them. We want, in short, to banish unpredictability.” – T. Collin Campbell
Put simply; we want to be God.
As I move forward in this article, I still want to share a few comprehensive lists provided by leading and influential organizations, as they define mental health. Again, terms vary such as
- mental health,
- happiness, etc.
Yet I believe the picture and idea that many of these organizations, and most people influenced by culture, have on what this “health” is supposed to look like, is the same. Regardless, I still appreciate an attempt to begin to break down valuable components of health. I do not believe engaging in these practices to achieve health will allow any individual to achieve health. What I do believe is, the ability to focus on priority, which is purpose, is health. In which case, having these lists, can certainly help someone make informed prioritizations. The “7 Pillars” as the ISF lists them are:
- 1. Health literacy – includes: the capacity of individuals to obtain, process and understand basic health information and services needed to make appropriate health decisions
2. Self-awareness of physical and mental condition – includes: knowing your body mass index (BMI), cholesterol level, blood pressure; engaging in health screening.
3. Physical activity includes– practicing moderate intensity physical activity such as walking, cycling, or participating in sports at a desirable frequency.
4. Healthy eating – includes: having a nutritious, balanced diet with appropriate levels of calorie intake.
5. Risk avoidance or mitigation – includes: quitting tobacco, limiting alcohol use, getting vaccinated, practicing safe sex, using sunscreens.
6. Good hygiene – includes: washing hands regularly, brushing teeth, washing food.
7. Rational and responsible use of products, services, diagnostics and medicines – includes: being aware of dangers, using responsibly when necessary.
In defining self-care, the ISF does clarify its own purpose as not for “practical uses” but instead for “policy and spending in order to change behaviour at a population level.” However, I believe this step away from “practical” is what makes health care extremely costly, while also failing to meet the needs of the human condition at the basic level of finding meaning and purpose (Webber, Zhenyi, & Mann, 2013). However, the self-care pillar 7, provides an often missed component of healthcare; using medical-care appropriately. Though, what is deemed appropriate then becomes quite debatable.
The Happiness Research Institute
I was Inspired to review this resource, after the organizations CEO, Meik Wiking, gave his TED talk The Dark Side of Happiness (TEDxCopenhagen, 2016). While not affiliated with a government agency, this literature produced by the Happiness Research Institute is non-the-less, valuable. In fact, its place in this article may be more valuable, because of its independent status. Of its publications, is the World Happiness Report (Helliwell, Layard, & Sachs, 2017). They explain their purpose; “(pg.9) Its central purpose was to survey the science of measuring and understanding subjective well-being.” Technically, the definitions for the purposes of this article, are stated in the report, to be from The Organization for Economic Co-operation and Development (OECD). The OECD Guidelines on Measuring Subjective Well-being (2013, p.10) is listed below:
“Good mental states, including all of the various evaluations, positive and negative, that people make of their lives and the affective reactions of people to their experiences…. This definition of subjective well-being hence encompasses three elements:
Life evaluation—a reflective assessment on a person’s life or some specific aspect of it.
Affect—a person’s feelings or emotional states, typically measured with reference to a particular point in time.
Eudaimonia—a sense of meaning and purpose in life, or good psychological functioning.”
The report describes the paradox I stated at the beginning of this article; that while the American standard of living is increasing, health and happiness are decreasing, and mental illness has a specific role in this (Easterlin 1964; Easterlin, 2016; Helliwell, Layard, & Sachs, 2017). As Sachs states it at the end of the report “America’s crisis is, in short, a social crisis, not an economic crisis”, he goes on to say “In sum, the United States offers a vivid portrait of a country that is looking for happiness “in all the wrong places” Helliwell, Layard, & Sachs, 2017). My argument is, that those “wrong places” is looking for happiness in happiness itself. However, this report is useful in light of the OECD’s definitions of life evaluation, affect, and eudaimonia. If anything, eudaimonia reflects the epitome of what I would consider health. Life evaluation, then would be the belief that one had health. I believe the US culture, on top of already over emphasizing the value of happiness itself, especially confuses affect with happiness. Affect being the experience of emotions from Joy to Sadness. Truthfully, a healthy life should include or not limit sadness.
Yet one might argue against my point that “it’s not sadness that’s the problem, it’s chronic, lasting, long-term sadness that’s the sign of mental illness.” Also then, the current state of medicine implies, that this chronic, lasting, long-term sadness, is the result of ” a variety of factors” but mostly “genetic and biological factors”, “trauma”, “social pressure”, “poverty” and “chemical imbalances”, which is ultimately mental illness. Which is again to imply, those born into mental illness are broken, unfixed, and unhealthy, until all those other barriers are removed; which will likely not be removed in any near lifetime.
I contend here, that in fact, chronic, lasting, long-term sadness, is rather, in large (but not entirely), a result of the misdirection of cultural values and understanding of what health is. That is to say simply, a good part of the problem is the problem itself. The engrained belief system of mental illness and what it determines. That ultimately, the broad and large scale answer, is to revert our belief back to; a purpose-driven health.
American Occupational Therapy Association (AOTA)
Within my own profession, health, well-being, participation, and engagement in occupation, are defined as the World Health Organization (WHO) presents them. To which I have previously given my opinion. Yet, I am thankful to work for the profession I do, as an occupational therapist. One of the primary defining documents by the American Occupational Therapy Assocation known currently as the 3rd Practice framework, states:
“Achieving health, well-being, and participation in life through engagement in occupation is the overarching statement that describes the domain and process of occupational therapy in its fullest sense.”
While I have thus disagreed with the current definitions of health and well-being, I appreciate the value that occupational therapy gives to “participation in life through engagement in occupation.” This idea does revert back to the emphasis on meaning and purpose. Occupation as occupational therapy uses it, I believe, are best explained by these two (of several) definitions listed in the 3rd Practice Framework.
“In occupational therapy, occupations refer to the everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to and are expected to do” (World Federation of Occupational Therapists, 2012).
“Goal-directed pursuits that typically extend over time, have meaning to the performance, and involve multiple tasks” (Christiansen et al., 2005, p. 548).
In the two definitions listed above, are the words and phrases “meaning and purpose to life” and “pursuits…have meaning to the performance.” This is where I begin to value the work I do. In my own efforts to seek purpose and find meaning, I find it equally important to do the work that also supports this perspective. It is my job to support others in, as my professional organization states, “achieving health, well-being, and participation in life through engagement in occupation.” To do this, I find it all the more important, to know what health, well-being, and life itself is.
What Then is, Positive Mental Health?
Positive mental health is “not merely the absence of disease or infirmity” but arguably also, neither is mental illness the addition of “disease or infirmity.” Rather, mental health is the ability to focus on priority, which is in many other terms, to “live and pursue”, “goal-oriented”, “self-directed”, “purpose-driven”, “meaningful lives.” Mental health, is to know purpose, not happiness. Quality of life should not be measured by the absence or even reduction of suffering for comfort, but rather for the addition of purpose and meaning.
I shall argue, our mental health is mutually related to life as we experience it, and is determined by where our focus is placed. Changing where our focus directs, is the act of prioritization. Therefore, positive mental health behavior, is taking any action to focus on positive priorities. The way I argue, this impacts day to day life is: You must first identify your purpose or else identify what you’re willing to prioritize. Neither of these elements have to be fully framed, but are likely to be an organic growing process. What you focus on and prioritize, informs purpose, and that purpose, should also inform what you prioritize.
Someone might argue,
“Well how do I know what my purpose is? That is too complicated, too large a task to figure out, and even anxiety producing itself.”
Here then, I respond, it may not be fully realized upon first attempt, but the human must move. That is to; move in body and thought. Certainly, while not scientifically backed or evidence based, I make the conjecture; that at least beginning to contemplate your purpose cannot be more overwhelming than attempting to organize what health behaviors you should begin with, given the enormous variety of often contradicting ideas provided by modern medicine.
If some, even the faintest amount, of purpose is identified first, then those positive health behaviors fall into place. Ideally one at a time, with a downstream effect on the others. That is to say, if your greatest purpose was to “spend time with my grandkids”, then exercising so that you can have the energy to do so becomes only a part of your health, but not the sole determinant of your health. If purpose was to “pursue God”, then a good sleep schedule to begin the day in prayer may be necessary.
How this influences day-to-day health behavior change is, as explained by Stephen Covey (1989) to “Put first things first.”
That leaves the health factors such as those listed below, valuable informers of what behaviors could contribute to your purpose. To conclude the primary heath factor lists covered in this article are:
- 7 Pillars of Self-Care by ISF
- Mental Health Indicators by CDC
- The 4 Major Dimensions by SAMHSA
One thing I have learned through the development of this article, is recognizing just how far a thread can be pulled. For example, one might see a popular magazine site publish a trending article on mental health. This article in turn, cites another popular website article such as Psychologytoday.com, as its source of information. If you go to that next article for that source of information, it may cite the CDC as its source. If you then continue clicking the links, and go to the CDC website, you might find that the CDC cites NIMH as its source. NIMH then cites the WHO as its source, and WHO then cites a series of articles as it source. Even yet, if you click the peer-reviewed research articles and take the effort to find them on a database and read them as I have, they might be a meta-analysis of a series of other articles to which the primary information was produced. To which you would then, need to pull up the original article, which is often decades or more, old.
That is the problem with waiting for science and medicine alone, to fix our problems. It takes decades for information to catch up with us. By the time science and medicine does “catch-up”, it’s often outdated and irrelevant to current needs. Which is why, I believe, the true answers, as I will discuss in future articles, are always – simple. These simple answers, I believe, go unchanged through the course of human history. Things that go unchanged; are truths.
Conclusion: The Next Step
I postulate, the deep wounds, hurt, and fear, that exist in society today regarding addressing mental illness thus relates to the emphasis we place on responsibility, change, willpower, and fault.
It is no wonder an epidemic of depression exists; if we are all told our meaning in life is to be free of suffering. What disappointment often comes to those that try; for what they expect as a product and outcome of their vulnerable effort to change at all. It is thought that happiness is the product of positive mental health. Though I believe the reality is for many, happiness is an experience often far and in-between.
We as humans share a common experience. To be awoken in the midst of a wreckage we call life. We see our ancestors floating away as if taken by the ocean tide. They are all gone before we can ask enough questions, but, if we could ask all the questions in the world, they wouldn’t have them all. We don’t know who or what to blame, and guilt can so easily overcome us, as though we were brought here by the fault of each of our own individual decisions to become suddenly awoken to consciousness and birthed. So how then do we make use of our situation?
I return to my thesis statement:
- The meaning of life may be unique for everyone, but finding it is the same.
- Meaning in life is found through purpose, which is defined by the act of a person to focus on priority.
- The practice of focusing on priority, also defines purpose, which is where we will find our meaning.
To live a meaningful life, is to focus with blistering intensity on the right priorities for the right purpose. Of what is right, is for debate, but our responsibility to take action for change, if we are to find purpose and meaning, is not. This will be done through effective delegating of automatic behaviors to habit and intentional efforts to willpower. We have limited reserves of time, attention, and willpower. How we harness these three elements determines where our focus goes. Intentional use of habit and willpower determines what we focus on, which determines our priorities, which ultimately, determines our purpose and meaning.
Let’s not blame each other for the past misuse of time, attention, and willpower that we have each been allotted. Let’s not give up on purpose yet. Let’s keeping trying, together, today.
“Woe to him who saw no more sense in his life, no aim, no purpose, and therefore no point in carrying on. He was soon lost.” (pg.85) by Viktor Frankl in his book Man’s Search for Meaning (1946)
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