What exactly is mental health?

Health is not an objective reality, but a concept with varying meanings according to the beliefs of the time, social and political structures, or medical practices. For example, being overweight was long seen as a sign of good health, whereas today it is seen as a health risk. To understand it, you can think of health as a state of equilibrium, a balance that a person may experience within their culture, their representations of the world, their relationship with their body, and so on. It is an important subjective dimension in addition to the “proper” functioning of organs. In his writings on medicine - Écrits sur la médecine - the philosopher Georges Canguilhem wrote: “I feel well insofar as I feel able to take responsibility for my actions [...]”.

The biomedical model of medicine, which began to take shape in the 19th century, was less concerned with health than with disease. It is that normal state which appears “in the silence of the organs,” as the surgeon René Leriche wrote in 1936 to indicate that health is quite simply the absence of pathology. In this context, mental health is perceived as an objective reality that does not take into account the subjectivity of the individual, and contrasts the insane with so-called “normal” or “healthy” people. This notion was gradually transformed, notably by the bio-psycho-social model.

 

Developed during the latter half of the 20th century, the bio-psycho-social model supports a more encompassing, positive conception of health. Moreover, the treatment of chronic illnesses supports the idea that health is more than just the absence of disease. Why? Because I can, for example, be an insulin-dependent diabetic in good health. The antagonism between body and mind is diminishing. This means that mental health is not just about the mind, but about wider interdependencies involving the body, the economic and social environment, and so on. Similarly, the divide between insane and healthy is replaced by a continuum of varied states. Finally, the objective/subjective duality is challenged to take into consideration both biological and medical data and the individual’s lived experience.

• Medicine is the science of physicians, whose specialty is preventing and curing disease.
• Health is a concept that belongs to everyone – Canguilhem would call it “vulgar” – and reflects the biological and psychosocial balance of individuals.
• In this sense, health is not just a matter for doctors, but for everyone.

The notion of mental health has undergone profound changes over the last 80 years. Its evolution is sometimes confusing, and makes it far less easy to understand than when “crazy people” were pitted against “normal people”! The sociologist Alain Ehrenberg points out that it is “one of the most confusing notions,” since it lumps together very different elements under the same label, ranging from mental disorders such as schizophrenia, to personal development and the quest for well-being. It’s sometimes hard to identify a common reference point in this complex array! So how do you find your way around? Mental illness, well-being... what are we really talking about?

So, in the field of mental health, we find mental disorders. The WHO’s International Classification of Diseases (ICD), which sets the standard, divides them into 11 major categories, including schizophrenia, anorexia, depression, addictions, etc. Why do we talk about “disorders” rather than “illnesses”? Because this concept avoids the sick/not sick opposition and replaces it with a graduated scale which, to varying degrees, can affect the entire population. This is why so-called “clinical significance” thresholds have been set to identify when a situation is pathological (Doron, 2008). We can understand it better with this example: Depression is marked by a feeling of sadness, but not all sadness is a sign of depression. So we need to assess when sadness, combined with other symptoms, becomes a marker of depression. So, depending on what a person is experiencing, the doctor may diagnose disorders that “are characterized by affective, cognitive and behavioral disruptions leading to psychological suffering and/or problems with personal and social functioning” (Carre et al. 2018).

Since its redefinition, the field of mental health includes positive mental health. In contrast to the aspect of mental health described above – which could be described as “negative” because it focuses on mental disorders – positive mental health seeks to identify the resources that enable people to thrive. This includes well-being, resilience and adaptability, social belonging... (Carre et al. 2018), all things related to personal development.

 

Mental health is therefore a complex concept that is built around these two dimensions. To describe it, the psychologist Corey Keyes proposes a cross-shaped diagram, with one axis representing the continuum of “mental illness” and the other that of “mental health”. The illustration shows that flourishing mental health is not simply characterized by the absence of mental disorders. It includes a positive dimension. What are the consequences? First of all, the absence of mental disorders does not automatically imply good mental health. It is possible not to be ill and still feel sad or bad about yourself. And, by the same token, having a mental disorder doesn’t necessarily mean you are not mentally healthy. Finally, whether or not we are affected by illness, mental health is an important resource for people to function at their best. (Doré & Caron, 2017).

Where does this quick overview take us? It helps us understand why the WHO definition perfectly captures what mental health means today. It’s “a state of well-being in which a person can fulfill his or her potential, overcome the normal pressures of life, do productive work and contribute to the life of their community. In this positive sense, mental health is the foundation of an individual’s well-being and the proper functioning of a community”. This definition serves to outline a “vision” of mental health that is no longer defined negatively by illness, but rather by a dynamic of self-fulfillment and social inclusion. Rather than saying what mental health is, as what it can do for everyone, the WHO is rejecting a normative stance that determines what is normal and what is not.