Am J Psychiatry 160:1373-1384, August 2003
© 2003 American Psychiatric Association
Mental Health
George E. Vaillant, M.D.
OBJECTIVE: Only in the last 30 years has psychiatry begun to develop empirical approaches to conceptualizing and assessing positive mental health. Six models of mental health are reviewed here. METHOD: The author points out pitfalls in research on mental health, e.g., equating average with healthy, failing to distinguish trait from state, overlooking cultural norms, and conversely, blindly accepting the culture’s values. He describes the six models and provides history and research needs for each. RESULTS: The first model, being "above normal," is epitomized by DSM-IV’s axis V, the Global Assessment of Functioning Scale. High scores represent "superior functioning in a wide range of activities, life’s problems never seem to get out of hand, is sought out by others because of his or her many positive qualities." The goal of the second model, positive psychology, is intervention to maximize positive qualities, such as self-efficacy. Maturity and Erikson’s four developmental tasks (identity, intimacy, generativity, integrity) are the basis of the third model. The author adds two other tasks: career consolidation and "keeper of the meaning." The fourth model is emotional or social intelligence, the ability to read other people’s emotions. Surprisingly, subjective well-being, the fifth model, is as much a characteristic of temperament as of a benign environment. The last model, resilience, is epitomized by DSM-IV’s Defense Function Scale, which categorizes coping mechanisms in terms of adaptational value. CONCLUSIONS: As with the blind men and the elephant, each model describes only some aspects of mental health. Further research may reveal the contribution of each.
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