Not Ill is Not Necessarily Well
Updated: Aug 19
Is Absence of Mental Illness Reflective of True Mental Health?
Mental health is frequently defined as absence of mental illness.
Recent advocacy and research efforts have established it otherwise.
Mental health is described by The World Health Organization (WHO) as a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community (WHO 2001, p.1). In this positive sense mental health is the foundation for well-being and effective functioning for an individual and for a community (1). Mental health then, is more than absence from mental illness.
Mental illness and mental health are highly correlated but belong to separate continua, and therefore the prevention and treatment of mental illnesses will not necessarily result in more mentally healthy individuals (2)
The two continua model of mental illness and health holds that both are related, but distinct dimensions: one continuum indicates the presence or absence of mental health (Flourishing - Languishing), the other the presence or absence of mental illness (Mental illness - No Mental illness)
The Two Dimensions of Mental Health
Mental Illness - No Mental Illness Dimension
Empirically, mental health and mental illness are not opposite ends of a single measurement continuum. Measures of symptoms of mental illness (viz. depression) correlate negatively and modestly with measures of subjective well-being (2).
Mental illness can be understood as a persistent and substantial deviation from normal functioning, which impairs the execution of social roles (e.g., employment) and it is associated with emotional suffering (2).
Mental, behavioral and neuro-developmental disorders are syndromes characterized by clinically significant disturbance in an individual's cognition, emotional regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes that underlie mental and behavioral functioning. These disturbances are usually associated with distress or impairment in personal, family, social, educational, occupational, or other important areas of functioning (4)
Absence of mental illness is merely the absence of the above mentioned disturbances and dysfunctions. Not having dysfunctions, does not, however guarantee a fully-functional living.
To live fully is to experience flourishing along with an absence of a debilitating disorder, though flourishing may sometimes occur with an episode of mental illness & moderate mental health. Languishing can both occur with and without a mental illness (5).
Flourishing - Languishing Dimension
To be flourishing, is to be filled with positive emotion and to be functioning well psychologically and socially. Adults with incomplete mental health are languishing in life with low well-being. Thus, languishing may be conceived of as emptiness and stagnation, constituting a life of quiet despair that parallels accounts of individuals who describe themselves and life as "hollow", "empty", "a shell", and "a void" (Cushman 1990) (6).
Flourishing and languishing are a continuum that differs from the continuum of mental illness and not having an illness.
Keyes (2002) has argued that it takes a combination of emotional, psychological, and social well-being to be considered mentally healthy. He distinguishes flourishing as a state where individuals combine a high level of subjective well-being with an optimal level of psychological and social functioning. Similarly, languishing refers to a state where low levels of subjective well-being are combined with low levels of psychological and social well-being (2)
In a study conducted by Keyes (2002) it was found that, pure languishing is associated with substantial psycho-social impairment at levels comparable to an episode of pure depression. Second, pure languishing is as prevalent as pure episodes of major depression in this study (2).
Whereas the presence of mental health is described as flourishing, the absence of mental health is characterized as languishing in life (6) Flourishing individuals function markedly better than all others (2). and hence achieving a state of flourishing is more important than merely being free of mental illness.
WHO (2001a). Strengthening mental health promotion. Geneva, World Health Organization (Fact sheet, No. 220). https://www.who.int/news-room
Keyes, C. L. M. (2002). The mental health continuum: From languishing to flourishing in life. Journal of Health and Social Behavior, 43(2), 207–222. https://doi.org/10.2307/3090197
Westerhof, G. J., & Keyes, C. L. (2010). Mental Illness and Mental Health: The Two Continua Model Across the Lifespan. Journal of adult development, 17(2), 110–119. https://doi.org/10.1007/s10804-009-9082-y
World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th Revision). Retrieved from https://icd.who.int/browse11/l-m/en
Keyes, C. L. M. (2007). Promoting and protecting mental health as flourishing: A complementary strategy for improving national mental health. American Psychologist, 62(2), 95–108. https://doi.org/10.1037/0003-066X.62.2.95
Cushman, P. (1990). Why the self is empty: Toward a historically situated psychology. American Psychologist, 45(5), 599–611. https://doi.org/10.1037/0003-066X.45.5.599