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EDITORIAL UDC 616.89:613.86
WHY PSYCHIATRISTS ARE NOT INTERESTED AND WHY THEY SHOULD BE INTERESTED IN MENTAL HEALTH ZAŠTO PSIHIJATRE NE INTERESUJE I ZAŠTO BI TREBALO DA IH INTERESUJE MENTALNO ZDRAVLJE Dušan Kecmanović1 Abstract: Mental pathology is the primary focus of psychiatrists’ attention. Yet it is difficult to get a better understanding of mental disorders without knowing what mental health is, what its manifestation are, how it can be defined and recognized. Hence, psychiatrists should be more interested in mental health. So long as they ignore the relevance of mental health to psychiatry, they cannot acquire knowledge about it, and consequently they cannot be competent to provide proper assistance to those in need. Key words: mental disorders, mental health Sažetak: U centru pažnje psihijatara je mentalna patalogija. Ipak, teško je razumeti mentalne poremećaje ukoliko ne znamo šta je mentalno zdravlje, kako se ispoljava, kako se može definisati i prepoznati. Stoga bi psihijatri trebalo da se više interesuju za mentalno zdravlje. Sve dok ignorišu značaj mentalnog zdravlja za psihijatriju psihijatri ne mogu steći znanje o njemu, a stoga ni biti kompetentni za pružanje adekvatne pomoći onima kojima je ta pomoć potrebna. Ključne reči: mentalni poremećaj, mentalno zdravlje
1 Correspondence to: Dušan Kecmanović, MD, PhD. E-mail: email@example.com * Received March 1, 2011; accepted March 14, 2011.
Curr Top Neurol Psychiatr Relat Discip. Vol 19, No. 1, March 2011
Here are some meanings of mental health. psychiatry textbooks devote very limited space to mental health. and thereby psychologists are more familiar with mental health issues. what kind of general concepts underpin this or that definition of mental disorder and/or mental health. it is built Curr Top Neurol Psychiatr Relat Discip. Prior to doing this I will point at the possible reasons why psychiatrists do not pay due attention to mental health or even pay lip service to it. If one surveys the titles of papers published in clinical psychology journals. it is not difficult to infer that this is the case. and the determination of the exact locus of the boundary between them is the crucial problem of psychiatry. psychiatrists often mention that mental health is the topic of psychology rather than that of psychiatry. And what is particularly important. criticism of psychiatry. They themselves care for those in need. such as mental disorder and mental health. it is one of the key dimensions or manifestations of a human being. Why Are Psychiatrists Not Interested in Mental Health? First. the category of mental health is used in more areas of social life than the category of mental disorder. The possible answer is that psychology students are thought more subjects related to the mental sides of human beings than psychiatrists are.” as Devereux 3 put it. psychiatrists prefer to keep away from discussing the key concepts of psychiatry including mental health. And no one likes to have the fundamentals of the job they do disputed. A review of the titles of papers published in most prestigious psychiatric journals over the last twenty or thirty years sufficies to demonstrate how scanty interest psychiatrists have in mental health as compared to their interest in mental pathology. and psychiatrists with disturbed psyche. with the exception of clinical psychologists. without asking themselves and others how to tell the difference between mentally sound and mentally deranged people. Question as “what is mental disorder” are considered purely theoretical and as such have nothing to do with their day-to-day clinical practice. 2 The key psychiatric concepts are in question. and why psychiatrists are not intent on changing anything in such a division of labour regarding deliberations about mental health. relating to oneself and others that is most widespread in a given society. a form of behaving. more qualified to discuss them. Mental health is a norm. When these circumstances are taken into consideration. the question might be raised why clinical psychologists treat issues related to mental health more frequently and more studiously than psychiatrists do. and what are conceptual grounds of psychiatry. the majority of psychiatrists believe that considering such questions is. Vol 19. any deliberation about the cited questions cannot help but to imply a critical view of psychiatry because psychiatrists have not provided satisfactory answers to those questions. all day long. its dimension and its definition. mental health has more numerous and more various meanings than mental disorder. the majority of psychiatrists are more interested in practical aspects of their job than they are keen on pondering issues related to the basic notions of psychiatry. mental health is an ideal belief and behaviour pattern. No. Furthermore. Therefore. In this text I will indicate why psychiatrists should be more interested in mental health. Psychiatrists leave the deliberation about these topics to those among them whom they consider as theoretically-minded. Fourth. as they put it. in fact. One comes to the same conclusion. With the exception of very few textbooks – for example. March 2011 . (Devereux means “pathological” by “abnormal. Though there is a ring of truth in such a belief. if they inspect the most frequent topics of psychiatric conferences. Third. And they are certain these people deal with less important issues than they do. 1. seminars. and more interested in them.Kecmanović D. and congresses held in this period. it becomes clear why psychologists more than psychiatrists deal with mental health. deal with undisturbed. feeling. “The paired concept ‘normal’ and ‘abnormal’ are the key concepts of psychiatry. Second.”) Since these questions are related to the basics of psychiatry. The wide-spread belief is that psychologists. Signs and Symptoms in Psychiatry1 and Comprehensive Textbook of Psychiatry2 – there is no psychiatric textbook in which a chapter deals with mental health and the numerous questions that arise when trying to define it.
as long as the history of psychiatry is. they would not confuse sadness (mental health) with depression (mental disorder). into the foundations of the social life insofar as a mentally healthy individual is the individual who is able to love and work (S. questioning the very existence of mental disorder has a long history. and anthropologists are much more interested than psychiatrists in these trans-psychiatric dimensions of mental health. Horwitz and Jerome C. or at least a number of them. Allan V. Thus psychiatrists. So are the costs incurred by work absenteeism. Wakefi eld 4 have shown that the recent epidemic of depressive disorder results from covering quite normal states of sadness which develop secondary to some loss with the notion of depressive disorder. as in the sense of mentally normal individuals. and there is no community where people are not able to love and work. and that consequently they should show interest in mental health. and depressive disorder which develops for no apparent reason. No. Vol 19. in any case much less frequently than the existence of mental disorder. as well as resistance to stress. Freud). the costs of mental health services are mounting.Kecmanović D. psychiatrists pathologize the mental difficulties of healthy people. and invalidity of mentally ill people. showing that claims about the dubious existence of mental disorder are unsubstantiated. what it consists of. sociologists. the significance of mental illnesses for the society is enormous. analyze its various manifestations or states. and the capability of living with one’s own contradictions and frailties. psychiatrists are mostly happy with a disease or medical definition of mental health according to which mental health is absence of disease. When someone challenges mental disorder. were forced into thinking and re-thinking about mental disorder. Psychologists. A number of psychiatrists reacted angrily to this questioning and published papers and books. how it is defined. Why Psychiatrists Should Be Interested in Mental Health Is there any need for a definition of mental health. philosophers. On the other hand. trying to figure out what mental disorder is all about. Insurance companies merely disregard the fact that a good number of the mentally healthy people have mental problems. Questioning the existence of mental health does not cause the same feeling among psychiatrists. mental health is given second-rate importance. diminished productivity. This kind of definition is also called a negative definition of mental health. 5 Eighth. They diagnose their problems as mental disorders. mental health is a state of mental homeostasis. A good example is conflating sadness “with cause. Since thus mental disorders are in the focus of public attention. Seventh. Antipsychiatrists were the leading figures of such attacks on psychiatry in the 1960s and 1970s. Insurance companies are reluctant to cover the bill for services provided to mentally healthy people. 1.6 As a result. It goes without saying that those who question mental disorder are actually questioning psychiatry. They tend to overlook or completely disregard the mental health concept and accordingly controversies and dilemmas associated with it. Over time. their problems in living. and that they need assistance of general practitioner. 3 Curr Top Neurol Psychiatr Relat Discip. psychiatrists cannot charge the services they provide to mentally healthy people. Sixth. So the psychiatrists did not feel prompted to explain mental health. or psychiatrist. even when they treat mentally healthy people it is far from them that they deal with people who are not mentally disturbed. psychiatrists as professionals feel threatened. The guess is that if psychiatrists were more cognizant of mental health and its various manifestations. Fifth. Also.” or normal sadness. be it scientific or non-scientific? Furthermore. Thus. Yet the existence of mental health has rarely been questioned. study it. Psychiatrists mainly espouse such way of looking at mental health. They cannot stay in power without mentally normal people who are crucial to keeping the social status quo alive and well. analyzing its definition. clinical psychologist. they forget that they have pathologized problems in living of healthy people. Since they cannot have the bill covered for the services provided to mentally healthy people who are in need of psychological-psychiatric help. March 2011 . psychiatrists tend to misidentify mental health states as pathological states. Those who are in power in a given society rely on mentally healthy.
It is taken for granted that they are the same due to the mere fact that they are mentally healthy. Others (for example.”10 Second. They have to suffer from the same mental disorder. and cannot be presented on one dimension? When they treat people with mental illness psychiatrists try to boost health potential in patients. and here various concepts of fitness may be useful. if for no other reason than to make the members of the control group as similar to one another as possible. psychiatric researchers have been focused on mental disorder. March 2011 .Kecmanović D. And this cannot be done without knowing what mental health is. its deficiencies and imperfections. at least not in any research in which control group is used as a methodological device. It is high time they paid more attention to mental health. The manifestations of mental health are numerous and various. Some authors (for example. but rather both at the same time. that is. Nearly half of adults receive mental health services annually because a mental health problem is inferred. first of all in regard to diagnosis. My view is that mental health workers need to know what mental health is all about. Fourth. First. The same question re-emerges all the time: what is the goal of the treatment? To reduce the number and intensity Curr Top Neurol Psychiatr Relat Discip. However. meaning that there was no diagnosable disorder. A control group consists of mentally healthy subjects. mental health is the key category of any kind of psychiatric treatment. briefly. In order to know what the health potential is like psychiatrists should get acquainted with the concept of mental health. Thus the relationship between mental disorder and mental health should be inspected. or is it more appropriate to have many different definitions? John K. The remaining component is the definition of mental health can then be seen for what it is—pertaining to art. Maurice Korman 9) are of the opinion that the notion of mental health should be kept. They cite the multitude of the definitions of mental health as corroborating their position.M. with mental health dimensions. there is belief that no one is totally mentally healthy or mentally disturbed. David Freides 8) are of the view that the notion of mental health should be eliminated. Can they be presented dimensionally. or are mental health and mental illness qualitatively different. Wing wrote that he is not sure that a scientific definition of mental health should be sought. only to various extents. “Virtually all that is scientifically useful seems to be better dealt with by discussing the prevention of disease. To date. The idea is that it will develop and eventually prevail.”7 Indeed. as demonstrated by Corey L. that is not the case. They should deliberate about the nature of mental health. 1. Members of experimental groups are required to be the same in regard to as many variables as possible. on diagnostics and the classification of mental disorders. its manifestations. and social tradition. about its dimensions and manifestations as well as about its definition. No. Jahoda maintained that “it will take special efforts to introduce concern with health into clinical work 4 with the sick. one could expect researchers to pay as much attention to mental health as they do to mental disorder. It is extremely rare for the question to be raised whether the members of the control group are the same as far as their mental health is concerned. a great many individuals who are not mentally disordered do not feel healthy and do not function well. they should know what mental health is all about. Vol 19. Third. I will substantiate my claim as follows. myth. in psychiatric research the notion of mental health cannot be avoided. they are not the same in the same way. and that an operational definition should be formulated. Mental health should be high on the agenda of those who provide care to the mentally healthy and mentally ill people alike. is it better to have one universally agreed-upon definition of mental health. Keyes 11. that they do not display the symptoms of any mental disorder. opinions are split as to whether there should by a definition of mental health. and who healthy subjects are. If mentally healthy people are the same. Since they so often treat mental health problems in people who have no diagnosable disorder psychiatrists should learn more about mental health. Since in terms of methodology the control group is as important as the experimental group. to make it stronger.” And she added: “But such efforts may well be worthwhile. rather than to science.
eds. Corresponding changes in psychiatric curricula would be instrumental in making psychiatrists familiar with mental health issues. The statement that there is one mental health and many mental disorders is faulty. there would be more accordance in regard to therapeutic efficacy and treatment goals. or to make the patient as healthy as they were before they fell ill. Ernest Jones. prodromal symptoms. eccentricity. 1983. 1. For.B. 1936. a classification of mentally normal states is long overdue. the most renowned biographer of Sigmund Freud. of symptoms. Brodie HKH. it is nevertheless worth asking what the attributes of such a mind would be. Fifth. it would be easier to determine how far a given mind under treatment had progressed in the direction of normality. Walker I. Lippincott. 2. and if they classified them. there are many kinds of mental health. Disclosure The author reports no conflicts of interest. Even if we conclude that in an absolute sense no mind can be entirely and completely normal. Conclusion In spite of its relevance to their profession. And how can mental health of the population get improved if there is no knowledge of what mental health is. Signs and Symptoms in Psychiatry. Sadock BJ. if we do not know what we would like to improve and consequently what the expected result of epidemiological endeavours should be. Normatology. 16 Many misunderstandings and misnomers would be eschewed if psychiatrists made efforts to identify various forms of mental health. There is no need to stress how serious consequences might have psychiatric and particularly medical intervention in states that fall (more) at the site of normality than pathology or risk of pathology. psychiatrists do not reflect on mental health as much as they should do. Kaplan and Sadock’s Curr Top Neurol Psychiatr Relat Discip. the science of mental normality. The author alone is responsible for the content and writing of this paper. Sadock VA. and whether such a thing can actually exist. or to make them healthier than they were before they fell ill. whenever the question is raised: what do we want to achieve by the use of a particular treatment. deals with the latter. with such a standard before us. 15. The fact that psychiatrists are primarily trained to deal with mental disorder rather than mental health seems to underpin psychiatrists’ disregard of mental health. The same as there are many forms of mental disorder. if they deem that research on mental health and dealing with mental health is not their cup of tea. Vol 19. If psychiatrists are not well-informed about numerous manifestations of mental health. And they cannot achieve this. and risk syndromes. a better knowledge of numberless variants of mental health is essential in early intervention in psychosis. No. There are numerous reasons for their comparatively scanty interest in mental health. developmental variations. Sixth. if they are not skilful enough at recognizing them. 14 Seventh.”12 Obviously the notion of mental health is unavoidable whenever the goal of the treatment is discussed. The first step they should take in the right direction is to stop considering themselves as experts at pathology and nothing but pathology. March 2011 5 . Philadelphia: J. REFERENCES 1. “What constitutes a normal mind. Normality. In: Cavenar JO. or to make them as healthy as the “normal mean” (This last goal is quite often mentioned in the context of psychodynamic psychotherapy). Those who approach psychiatrists seeking help will be the major beneficiaries of such change of perspective. interest. an agreed-upon definition of mental health is a prerequisite for designing programs aimed at improving the mental health of the population. Given the importance of the notion of mental health not only for the consideration of conceptual issues but also for day-to-day clinical practice psychiatrists are due to pay more attention to mental health. and sometimes of practical. In this sense Aubrey Lewis13 appropriately remarked that if psychiatrists could agree on the concept of mental health. and are not keen on studying them in depth. if they gave them the particular names. they run the risk of confusing oddity. Cavenar JO. are questions of considerable technical.Kecmanović D. eds. also thinks that the definition of mental health will be helpful in the assessment of the result of the therapeutic intervention.
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