Aspects of mental health; What is mental health?

The following program is produced by the University of Michigan broadcasting service under a grant of aid from the National Educational Television and Radio Center in cooperation with the National Association of educational broadcasters. What is mental health a program from the series human behaviors social and medical research produced by the University of Michigan broadcasting service with special assistance from the Mental Health Research Institute of the University of Michigan. The people you will hear today are doctors Lawrence Cobb who is head of the Department of Psychiatry at Columbia University. Harry Levinson of Topeka Kansas at the Menninger foundation Dr. John C. Whitehorn a psychiatrist in chief at the John Hopkins Hospital in Baltimore Maryland. And Leonard Jade Duell of the professional service branch at the National Institute of Mental Health in Bethesda Maryland. And my name is Glenn Philips. The leading cause of disability in the United States are mental and emotional disorders. Patients

with these diseases fail over half the hospital beds in this country. There are 16 million sufferers in the United States for this program. We are considering only one question what is mental health. First Dr. Lawrence Cobb of Columbia University stated mental health is defined in many many many ways. I doubt if any of the definitions are satisfactory to any single individual. Many people would say that mental health was the absence of mental illness. This is certainly not a sufficient expression of mental health since the borderlands of illness and health are. Obscure and not very clear even to those of us who are in the field itself some of our people would say that mental health is connected with the

presence or the physical and emotional well-being which would lead to the maximum degree of happiness. However here one could argue too because there are times when happiness is most inappropriate and sadness is the most emotion that one should feel. So why would doubt that this would be utterly satisfactory definition. I think one could be considered mentally healthily if he is capable of developing a gratifying relationship with other people and particularly having at least a such a satisfying life with a person of the opposite sex. If he's able to accept the responsibilities of parenthood. If he's capable of pursuing his own goals and recognizing at the same time when he needs help and advice from others and. If he's able to satisfy his desires in accordance with the socially

approved attitudes of the society in which he lives. I think a mature individual and I would say it was but if we're speaking about a mental health of an adult a mature individual should be able to postpone his players in the time separate himself from the group in order to pursue what he feels is proper and right. And I'd also say he's to be and he should be flexible both in regards to himself and his attitudes and those of other people. Flexible and tolerant. You know this is obviously a set of propositions which are gained by very few of us and we have to recognize that none of us can attain to perfection that there will be moments when even the healthiest will find himself on able to reach the goals of maturity that I've stated here and certainly most of us while highly able in certain areas are not so capable in others.

Dr Levinson at the Menninger foundation answered this question. What are the differences if any between mental health and mental disorders. This is a problem with which we in our research are immediately concerned. That is we think mental illness and mental health are not necessarily the opposite of each other. We know that in any person who is mentally ill there are aspects of his personality which are well that as he struggles to become better if you will. There are components of his personality which are very strong and very active if that weren't so then people couldn't recover from illness and part of our task in treatment is to strengthen the healthy aspects of the person. And on the other hand there are people whom we may regard as mentally healthy but this doesn't mean that they are

completely free of any symptoms or any path ology. Our concern with mental health is how can we go about strengthening the healthy aspects of people. And we were kind of reluctant to say that mental health and mental illness are opposites. We find it in mentally healthy people some aspects which may not be altogether healthy and we find mentally ill people some aspects which are healthy. Dr. Levinson Dr. Cobbe and Dr. John C. Whitehorn in turn gave these comments when I asked them if the occurrences of mental problems were on the increase or decrease in the United States. That's a hard question to answer because we don't have very good comparative statistics. We know that when you open a child guidance clinic or a mental hygiene clinic in the community. Before very long it has a heavy caseload. We know that when you take an Old Line State Hospital which

has been primarily custody Oh and make a good hospital out of it that many more people come much earlier in the course of their illness for help. Now if you look at the statistics alone and make judgments from them it would seem as if there is an increase in the incidence of mental illness. As a matter of fact however I think more people are coming earlier for help and more people are recognizing that they don't need to continue to suffer with some of the problems that they have over the years. That is they're recognizing that help is available for some of the things that they've been struggling with alone. There are increasing referrals from ministers from family doctors from teachers from law enforcement agencies of people who in years gone by would not have been recognized as having psychiatric problems. So I think the best we can say at the moment is that. There is a greater awareness

of psychiatric and psychological help. A greater willingness to use it. And we don't as yet have any way of saying whether mental illness as such is increasing or whether what we're saying is merely greater awareness and willingness to use services. I think our recognition of them is certainly expanding. I don't think that there is really good evidence that the numbers of such problems per unit of population whatever unit you wish is in measurably greater from the figures of persons and these figures are probably the only worthwhile ones we have who are entering mental hospitals one might assume that the there was an increase but we need to remember that now many people are going to and going to a much older age and this group of individuals because of the. Impairments of the brain that follow disease in the older age groups increase and

swell the numbers of those who need hospitalization. Well I want to be able to answer this because I have been here long enough to find out to see the differences. If you mean emotional problems and emotional illnesses Well the evidence that serious illnesses amounting to a psychosis. The evidence seems to be that oh they're not significantly on the increase. If you take the figures for the last two studies over a century and over a 17 year period the number of patients admitted to. The mental hospitals with serious emotional disturbances in the younger age groups was not apparently increasing in those in Massachusetts. Political differences were in the older age groups in the proportions of patients admitted in the older age groups increased very considerably in recent years.

So I'd say if you if you look for evidence there in the statistical studies that have been made there's not convincing evidence of any marked change in the incidence of psychotic reactions you know as compared with a century ago. If this problem is so great as these three men have agreed why didn't it used to be recognizing Dr. Whitehorn answer that question in the first place. Until provision is made for the care of such patients with hospitals and nurses and doctors. Time is not my Recha point recognizing and the incidence of psychotic troubles seems to Perro all the provisions for their care. That is a critical factor in controlling the statistically published information that is to say the admission rates. The estate gives a new hospital admission rate rises. Obviously there were patients not get recognized there.

Who wants to find a facility that can be recognized and put there to see to be the limiting factor is the facilities available. Terms used most frequently in connection with psychiatry and psychology are neurotic and psychotic. Unfortunately they have also become Les terms without sufficient knowledge as to their meaning. I asked Dr Whitehorn for their explanation. Roughly it's useful to distinguish between those whose jersey wouldn't be here are so upset as to make them Christian or really able to get along with other people than those who shall we say still in harness. But I'm happy and I'm comfortable tense and anxious about it and most of us would at one time or another be ready. Let's see by this definition of being tense and anxious but still in arms yeah. There's a psychotic tends to kick over the traces and not stay in harness so rough and

ready differentiation. You know there's another Tarion too. You could say the psychotic person has gone haywire mental which would be a way of say that his thinking seems to be confused. Master hard to follow. There's the thinking processes of the neurotic as he displays them to your questions. Same order but maybe say assume for too rigid but you can fall. Oh you know it's not where I use the word payware for the psychotic in preference to cracked which is the classical term you use is cracked represents a discontinuity as if he's thinking he's cut off here here here. I don't. He gets cut off. There's an internal thread which if you could carefully trace it through follows like a wire. If you get on to the strand a wire which is haywire. You know it's all mixed up. You can funnel the strand through and

through various convolutions and it is not discontinuous to tell you I think the mental processes of the psychotic patients are not really cracked to the extent it has been presented in the textbook but are who are in the sense that they give an impression of confusion although it's possible to trace it through to find the continuity. An old adage which states that if one thinks he has mental or emotional problems and difficulties Usually he does not. The inference presumably being here that it is the person that insists that he has no problems but he will be the one that may need assistance. I asked Dr Leonard do for his feelings on this. Really he said. Of course there are always some people who never see their difficulty because they don't recognize the difficulty until they come into conflict with some sort of authority and then the authority defines the difficulty for them. We may have to say that when they get in

trouble with the official agencies of our community then that's the time to step in. For example when these people find that they suffer economic deprivations and have to turn to welfare maybe this is the time for welfare to give them the health board to give them a referral so that the people themselves don't have to recognize it or when these people start having difficulty in school or when they get into the army and have difficulty with a first court martial. This is the time when one can step in because the court or because some official body can refer them to you without too much difficulty. But on the other hand there are a large number of people who recognise that they have problems they may never define them as mental health problems but they may define them as purely medical problems even though they have a mental health component. I think we should leave the people. Alone and allow them to go to the people they will most naturally turn to and in a sense increase the ability of those people to help.

And this is one of the reasons why we're expending so much effort nationally in training the general practitioner to more adequately deal with the everyday problems of his practice of medicine. We're doing the same thing with ministers. There is an awful lot of pastoral counseling going on. We're doing this in school systems where we're having programs of mental health for school personnel for teachers not to do a continuous by answering this question. At what point is it decided that one is mentally ill. A crude way to put it might be to say it's when he begins to disturb somebody or bother somebody or when somebody's in some sort of official position or another. Begins to get concerned. For example the mentally retarded weren't considered retarded until the industrial revolution took place and we had to worry about having people to man the factories and to send people

through school. This was the period when IQ tests were developed and in fact the IQ tests I think were developed in order to find which people were and which people weren't capable of producing in our society. This meant there was a concern and as soon as people become concerned as to whether people have abstract intellectual ability or not then they start moving out or defining people as mentally retarded. If you go into India today you may ask the Indians how much mental retardation do you have when they shrug their shoulders. There are just too many people are not really concerned about the number of retarded that are present. The same thing may be said to be true about mental illness. You may have a person who at home with his wife is behaving in a way that you or I or some other professional person might be calling mentally ill. His wife may be able to accept that it may be pretty well limited so it doesn't bother him at work or his colleagues

or his friends and he'll never be listed as a mentally ill. However if he begins to disturb neighbors or people who work or what have you that he gets to get the label of mental illness he might ask the question about when is a guy an alcoholic. It's just the number of drinks he brings and what he make come from one part of the country and he takes just one drink. He's labeled a noun. He may live in another part of our community where taking lunch and drinks and afternoon cocktails and cocktails before dinner and wine with dinner and drinks after dinner. It's a perfectly normal procedure and if everybody around him does this and it doesn't bother him in any way he'll never be labeled as an alcoholic until something happens which brings attention to him or disturbs somebody around him. If it begins to disturb his ability to produce in his work then he'll be liable if he begins to bother someone around him by his

behavior. He'll be so late. If he begins to have some sort of neurological disorder that secondary now and somebody notices this then he'll be labeled. I think what I'm really saying is that so many of the things that we deal with under the broad rubric of mental illness are socially defined conditions. You might even add to the ones I've mentioned juvenile delinquency. Our society may label kids as delinquent but many of these kids may be operating in a group of a gang of their own peers in which this may be the most healthy thing they can do to preserve their integrity. Changing the direction of this discussion somewhat. Dr. Whitehorn talks about the future. I asked him what the most fruitful approach might be to mental health research. I would hesitate to map out any one field to the neglect or assume superiority of some other field.

I don't know where the most significant answers will be coming from at any particular moment. We've been through a period in which the people interested in drugs made a significant contribution. We've also had a period in which people interested in social interactions of people and in group therapy have made a distinctive contribution. This is included improvements in the interpersonal meal you know of hospitals. Better thought to what constitutes the true meaning of the psychotherapeutic process where the most significant gains will come in the future from one area of research and I wouldn't be able to answer in a competitive way that this is better than that. I think it's sensible if we have the resources to. Help people. In any and all of the fields that seem to offer possible leads president to try to focus on one which is going to be it.

Dr. white horn was also asked for his impressions and his thinking about the behavioral science approach. He commented Well yes this is a term which does apply to a number of scientifically trained people working in different ways with problems of human interrelationships how people get along with each other. There'd be anthropologists and sociologists surely would be included in the behavioral sciences. Perhaps even physiologists you would be concerned with mechanisms physiological nature involved. Interpersonal transactions those of you who have listened to these programs will have heard me ask frequently this question. If one could be given the answer to one question but intrigued him in his particular area what would that one question be. Dr Levinson answered this way. I think the single most pressing question in

our profession is why do people behave as they do. We think we found some of the answers to that but we don't yet know why some people break down under certain circumstances and other people don't. We don't yet know why some people can serve Mt the most difficult kinds of psychological ODs and other people can't. I think that's a basic question with which we're struggling and toward which all of our research is directed. I asked Dr. Levinson if there was truth to the thought that a person who develops mental illness may be prone to this sort of thing because of a weak membrane so to speak just as a person who develops tuberculosis or cancer has a weak membrane due a somewhat involved question. Dr. Levinson replied We know just by looking around us and by living with each other that some of us are more capable of abstract thinking than other people are. Some of us are capable of greater judgment greater reasoning greater intelligence

and because we have those assets. Perhaps we are more capable of dealing with some of the problems of living than other people might be who let's say has brain functioning is not as affective. We know for example that mentally retarded people have impairments of brain functioning. Any aspect of our body can be the weakest link in the chain for any of us. For some of us. Perhaps our stomach is the weakest link and we may be prone to stomach disorders where given the same kind of stress the next person may reflect a man let's say in his arteries and veins and have hypertension or the next person might reflect them in his skin or something else of that sort. For each of us there is one part of our bodies which presumably is not as effective were not as strong as others. And of course we have a good deal of evidence from studies in

genetics to indicate that some aspects of our physical capacities are transmitted through from father to son and so what if this weren't true then we couldn't very well breed race horses. Concluding this program Dr. Levin Some speculated about the future when I ask him how current research findings may be applied. He expressed these views. We think that there are a number of things we're seeing which will become principals if you will which later can be applied in business and industry. One of the things we've been most impressed with so far is what it means to people to be able to participate in the decisions about their work which relate to them. When people do have an opportunity to use their brains as well as their hands and in the course of their work to contribute ideas to assume some of the responsibility for decision making. They feel

a much greater investment on their part in what they're doing. They have a good deal more self-respect. In the course of their work they feel that they are acting fully as adults with some responsibility for what is happening to them. We also feel from our observations that one of the critical aspects of a man's work is his ability to relate to those people who exercised power over him that is to the bosses whether they be first level foreman or the heads of companies. Each one of us I think has the need to feel part of something which is larger than himself and to know that those people who exercise some degree of control over what it is he does in the course of his work will be considerate and thoughtful of him will recognize his needs and try as best he can to help meet them in the course of work.

West requires on the part of people in some position of responsibility a degree of personal contact with those who work under them. It requires a. Opportunity to talk with those people to know what they feel and what they'd like to get out of their lives and to be able to communicate to those people that one is thinking about them. You know perhaps there's yet a third thing which we might be able to specify with further research. But at the moment we can talk about as perhaps a hypothesis or suggestion. And that is the way in which power is used or not used. It's quite evident as you look in business organizations and other organizations for that matter that when people in positions of power are having differences with each other these differences are felt all the way down the line.

People who are subordinates feel that there is conflict going on. They get upset about this and troubled about it and of course they can't do anything about it. And as a result you can only have turmoil and tension. You see the same sort of thing in a family when father and mother of quarreling of course the kids are. I'm quite upset about it it's nothing new but we see it just as much in business and industrial situations as you see it in the family. Now we think from our clinical experience and from what we've seen that if people can learn to get conflicts and differences out in the open and work together on them that this will go a long way toward resolving the tension and the people who are subordinates. I don't mean to say that everything should be rosy and there should be no differences of opinion there should be no quarrels but people are able to tolerate differences and quarrels when they know that the people who are at

odds with each other are trying to do something about their differences. As long as we are dealing with a problem in an effort to solve it then. The sharp edge of the difference is doled somewhat and people have some kind of evidence that a resolution will be ultimately achieved. But so long as the coral remains buried or so long as it continues simply on a quarrelsome basis rather than an effort to reach solution then everybody is in turmoil and this and turning creates tensions perhaps. Various kinds of symptoms and difficulties and people up and down the line. The course of our study we did come across a situation in which one man who said his wife had told him if he didn't stop coming home complaining about the quarrels of his bosses that she would force him to quit his job. This illustration is only one of

the feelings of the whole group of people with whom he was working. Reflecting the same kind of problems the two bosses in this case were differing and were quarreling but nobody was attempting a resolution. And as a result nobody underneath them could have any degree of comfort at all. Our thanks to Dr. Levinson and also to Dr. Lawrence Cobb of Columbia University Dr. John C. Whitehorn of Johns Hopkins Hospital and Dr. Leonard J duel of the National Institute of Mental Health in Bethesda Maryland for their participation on this program. Next week you will hear doctors Cobb Levinson and Whitehorn who will be joined by doctors Robert Felix director of the National Institute of Mental Health but and Dr. Edith Vigers a psychiatrist from Chevy Chase Maryland as they discuss new approaches to mental health. On the next program from the series human behavior social and medical research

consultant for this program was Dr. James Miller of the University of Michigan. We extend our special thanks to the Mental Health Research Institute of the University of Michigan for their assistance. Glenn Phillips speaking asking that you join us next week and thanking you for being with us at this time. This program has been produced by the University of Michigan broadcasting service under a grant in aid from the National Educational Television and Radio Center in cooperation with the National Association of educational broadcasters. This is the national educational radio network.