What is Mental Health?
Currently the World Health Organization defines mental health as: “A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”
Love, Work and Play
How does one achieve that state of well-being? Well, Freud’s famous definition of mental health as the ability to love, work and play is still absolutely valid.
The ability to love refers to the possibility of establishing authentic and intimate relationships with other people and being able to give and receive affection without excessive fear. The ability to work refers to the possibility of feeling generative, to feel that what one does has meaning and to take a certain pride in the tasks that one accomplishes. The ability to play refers to the possibility of enjoying symbolic activity, at whatever level it may be, and to be able to enjoy these activities with others.
Mental Health in Detail
Psychologists in Madrid divide these three general capacities in 12 other more detailed categories of psychological functioning. These categories must be understood as being dimensional and interrelated, and different people will have more of one than the other.
Secure attachment to others
Secure attachment refers to the ability to be able to separate from others relatively easily and to enjoy reuniting with them. It has to do with a basic trust in others and a general feeling of security. Individuals who have secure attachment styles will derive inner strength from their bonds to important people in their lives and will be able to bear absences and reencounters without too much anxiety or sadness. When this ability has not been able to be established the individual will maintain clinging, insecure or disorganized bonds and will feel a generalized and diffuse fear.
Autonomy refers to a feeling of efficacy, of being able to decide at least partially in what direction one’s life will go, being able to take responsibility for decisions that are not necessarily those that other individuals would take. It’s the difference between feeling that one has options or one doesn’t and feeling that one has enough inner freedom to be able to chose according to one’s own criteria. Needless to say, there is an element of cultural norms that every individual will have to juggle with as well. If the ability for autonomy has not been established the individual will not know why he does the things he does, or will do things he doesn’t want to do solely to please others.
This refers to the ability to feel several different things ––good and bad, for instance–– towards oneself, others or situations one might find oneself in, being able to see them in three dimensions and maintaining that view of them. The temporal element is also important, to have an integrated awareness of how one was in the past, how one is in the present and how one may come to be. This includes the integrated awareness of life-events in the passage of time. If the identity has not been able to integrate the individual will perceive himself, others and life-events in a fragmented way, with extreme changes and without continuity or nuance.
Resilience is an inner strength that allows one to overcome some kind of traumatic experience and find an adaptive response without breaking down too much. It implies the ability to take the inevitable punches of life and get back up. It is frequently described with the metaphor of a bulrush that is solidly rooted in the ground, bends with strong winds but stands straight at the end. At a more specific level, there are significant cultural differences with respect to how to handle failure: some cultures perceive failure dramatically and dwell on it while others emphasize the need to try again. When an individual lacks a certain amount of resilience he will tend to regress excessively to primitive ways of functioning, will act in non-adaptive ways or will get sick.
Realistic and reliable self-esteem
Realistic self-esteem is the capacity to see and appreciate oneself according to the exact measure of what one is, without being too hard on oneself nor self-complacent, being able to recognize one’s strong and weak points in a consistent manner. It implies a certain tolerance towards one’s limitations, being able to laugh about them, and the security of one’s competence in certain areas. Self-esteem will tend to consolidate as the individual maintains good bonds with others and makes efforts to achieve what he aspires to (as long as what he aspires to is realistic and possible). When self-esteem is not well rooted the most common result is that the individual will have very little self-esteem but, at the same time and more subtly, he will greatly overvalue other aspects of himself.
Abiding values imply a personal sense of ethics, an inner moral that guides the behavior of the individual who feels that he acts with integrity. Naturally this element of mental health depends a great deal on socio-cultural contexts that will encourage certain values more than others. This aspect of mental health is closely linked to self-esteem because the individual’s inner moral consciousness will praise him when he acts according to his ethics and will make him feel bad when he doesn’t. From a social perspective, it’s a kind of inner regulator that allows human beings to live in society. If an individual lacks values he will act exclusively for his own benefit (which, paradoxically, is usually not very beneficial at all), he will not take others into account and he will harm them. These individuals are also those people who least perceive their need for help.
Affect and thought regulation and tolerance
This refers to the ability to feel and think a wide range of emotions and thoughts without fear, nor the need to act on them immediately. It is a constituting fact of human beings that they feel and think many more things than they actually do ––often of sexual or aggressive content–– and that they can feel anxious or sad. It is important to have the inner space to be able to hold those feelings and decide if they will be expressed or not. When this ability fails the individual’s potential to feel and to think will be significantly limited by the fear of what could happen if he thought or felt them.
Insight is the ability to understand oneself and the reasons for which one feels, thinks and behaves in a certain way. It allows the individual to know himself enough to be able to direct his life in a beneficial direction and be able to avoid situations that are detrimental to his well-being. This ability is not necessarily present in everyone who enjoys mental health but it will be in all those that have undergone psychoanalytically oriented treatment since it is a sine qua non condition for psychic change.
Mentalization is the ability to appreciate that others are distinct beings from oneself, with minds entirely different from one’s own. It implies being able to understand how others function and to appreciate that they may act on motives that have nothing to with oneself. Mentalization can be seen as an imaginative mental activity in which the other person’s behavior is perceived and interpreted according to intentional mental states that motivate him in a certain direction (needs, desires, beliefs, goals etc.). If the ability to mentalize has not been able to form the individual will have trouble understanding others and will tend to think that everything they do has to do with him.
Flexibility of defenses
The flexibility of defenses is the ability to use a wide variety of defense mechanisms in different situations according to the needs of the moment. Defense mechanisms are necessary to protect the individual from certain unbearable mental contents that inevitably occur through life. However, each situation is different and deserves a response specifically adapted to it, preferably a response that solves the difficulty with the least amount of energy and distorts reality as little as possible. The systematic and excessive use of the same defense will impoverish the individual’s personality and will force him to respond rigidly the same way to all threatening situations.
This refers to the ability to be deeply close to someone and also to be able to be alone. Most people are closer to one pole than to the other but what is important is the ability to be able to move between the two. Human beings are profoundly social and they need contact with others in order to be able to function emotionally; however, another intrinsic need of human beings is to maintain a certain individuality and in order to do so they must be able to separate to a certain degree. This requires a dynamic equilibrium of coming and going according to the specific circumstances of life in that moment. There will be moments that are more relational and moments that are more individual. When a person has trouble navigating this dynamic equilibrium he will not be able to separate from others or he will be alone all the time.
Ability to mourn
The ability to mourn consists in being able to accept things that one cannot change (be it people that one has lost or desires that cannot be fulfilled), being able to mourn them and, later on, invest those emotions in other relationships. Although it is very adaptive to have a fighting spirit in order to try to change things, it is also necessary to be able to give up trying to have something that cannot be –– otherwise one runs the risk of uselessly wasting energy and feeling frustrated. Life is inherently full of mourning as individuals go from one stage of life to another and lose and gain relationships. At the beginning of life mourning is generally easier because one loses things in order to move onto others that are generally perceived as better. As time goes by, however, the things that are mourned for are of greater significance to the individual and in order to be able to accept their loss it is important for him to have been able to enrich himself enough emotionally.