d. kecmanovic - psihijatri i mentalno zdravlje

8/14/2019 d. Kecmanovic - Psihijatri i Mentalno Zdravlje

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1Curr op Neurol Psychiatr Relat Discip. Vol 19, No. 1, March 2011

EDIORIALUDC 616.89:613.86

WHY PSYCHIATRISTS ARE NOT INTERESTED ANDWHY THEY SHOULD BE INTERESTED IN MENTAL HEALTH

ZATO PSIHIJATRE NE INTERESUJE IZATO BI TREBALO DA IH INTERESUJE MENTALNO ZDRAVLJE

Duan Kecmanovi1

Abstract:Mental pathology is the primary focus of psychiatrists attention. Yet it is diffi cult to get a betterunderstanding of mental disorders without knowing what mental health is, what its manifestation are, howit can be dened and recognized. Hence, psychiatrists should be more interested in mental health. So longas 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

Saetak:U centru panje psihijatara je mentalna patalogija. Ipak, teko je razumeti mentalne poremeajeukoliko ne znamo ta je mentalno zdravlje, kako se ispoljava, kako se moe denisati i prepoznati. Stogabi psihijatri trebalo da se vie interesuju za mentalno zdravlje. Sve dok ignoriu znaaj mentalnog zdravljaza psihijatriju psihijatri ne mogu stei znanje o njemu, a stoga ni biti kompetentni za pruanje adekvatnepomoi onima kojima je ta pomo potrebna.

Kljune rei:mentalni poremeaj, mentalno zdravlje

1 Correspondence to: Duan Kecmanovi, MD, PhD. E-mail: [email protected]* Received March 1, 2011; accepted March 14, 2011.

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2 Curr op Neurol Psychiatr Relat Discip. Vol 19, No. 1, March 2011

Kecmanovi D.

A review o the titles o papers published in mostprestigious psychiatric journals over the lasttwenty or thirty years suffi cies to demonstratehow scanty interest psychiatrists have in mentalhealth as compared to their interest in mentalpathology. One comes to the same conclusion, i

they inspect the most requent topics o psychiatricconerences, seminars, and congresses held in thisperiod. Furthermore, psychiatry textbooks devotevery limited space to mental health, its dimensionand its denition. With the exception o very ewtextbooks or example, Signs and Symptomsin Psychiatry1 and Comprehensive extbook oPsychiatry2 there is no psychiatric textbookin which a chapter deals with mental health andthe numerous questions that arise when trying to

dene it.

In this text I will indicate why psychiatrists shouldbe more interested in mental health. Prior todoing this I will point at the possible reasons whypsychiatrists do not pay due attention to mentalhealth or even pay lip service to it.

Why Are Psychiatrists Not Interested in MentalHealth?

First, the majority o psychiatrists are moreinterested in practical aspects o their job than theyare keen on pondering issues related to the basicnotions o psychiatry, such as mental disorder andmental health. Psychiatrists leave the deliberationabout these topics to those among them whomthey consider as theoretically-minded. And theyare certain these people deal with less importantissues than they do. Tey themselves care or thosein need, as they put it, all day long, without asking

themselves and others how to tell the differencebetween mentally sound and mentally derangedpeople, what kind o general concepts underpinthis or that denition o mental disorder and/ormental health, and what are conceptual grounds opsychiatry. Question as what is mental disorderare considered purely theoretical and as suchhave nothing to do with their day-to-day clinicalpractice.

Second, any deliberation about the citedquestions cannot help but to imply a criticalview o psychiatry because psychiatrists have notprovided satisactory answers to those questions.

Te key psychiatric concepts are in question. Tepaired concept normal and abnormal are thekey concepts o psychiatry, and the determinationo the exact locus o the boundary between themis the crucial problem o psychiatry, as Devereux3 put it. (Devereux means pathological by

abnormal.) Since these questions are relatedto the basics o psychiatry, the majority opsychiatrists believe that considering suchquestions is, in act, criticism o psychiatry. Andno one likes to have the undamentals o the jobthey do disputed. Tereore, psychiatrists preerto keep away rom discussing the key concepts opsychiatry including mental health.Tird, psychiatrists ofen mention that mental

health is the topic o psychology rather thanthat o psychiatry. Te wide-spread belie is thatpsychologists, with the exception o clinicalpsychologists, deal with undisturbed, andpsychiatrists with disturbed psyche. Tough thereis a ring o truth in such a belie, the questionmight be raised why clinical psychologists treatissues related to mental health more requentlyand more studiously than psychiatrists do. I onesurveys the titles o papers published in clinical

psychology journals, it is not diffi cult to inerthat this is the case. Te possible answer is thatpsychology students are thought more subjectsrelated to the mental sides o human beings thanpsychiatrists are, and thereby psychologists aremore amiliar with mental health issues, morequalied to discuss them, and more interested inthem. When these circumstances are taken intoconsideration, it becomes clear why psychologistsmore than psychiatrists deal with mental health,and why psychiatrists are not intent on changing

anything in such a division o labour regardingdeliberations about mental health.

Fourth, mental health has more numerous andmore various meanings than mental disorder.And what is particularly important, the categoryo mental health is used in more areas o sociallie than the category o mental disorder. Here aresome meanings o mental health. Mental healthis a norm; a orm o behaving, eeling, relating to

onesel and others that is most widespread in agiven society; mental health is an ideal belie andbehaviour pattern; it is one o the key dimensionsor maniestations o a human being; it is built


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into the oundations o the social lie insoar as amentally healthy individual is the individual whois able to love and work (S. Freud), and there isno community where people are not able to loveand work. Also, mental health is a state o mentalhomeostasis, as well as resistance to stress, and the

capability o living with ones own contradictionsand railties. Tose who are in power in a givensociety rely on mentally healthy, as in the sense omentally normal individuals. Tey cannot stay inpower without mentally normal people who arecrucial to keeping the social status quo alive andwell.

Psychologists, philosophers, sociologists, andanthropologists are much more interested than

psychiatrists in these trans-psychiatric dimensionso mental health. On the other hand, psychiatristsare mostly happy with a disease or medicaldenition o mental health according to whichmental health is absence o disease. Tis kind odenition is also called a negative denition omental health.

Fifh, psychiatrists cannot charge the services theyprovide to mentally healthy people. Insurance

companies are reluctant to cover the bill or servicesprovided to mentally healthy people. Insurancecompanies merely disregard the act that a goodnumber o the mentally healthy people have mentalproblems, and that they need assistance o generalpractitioner, clinical psychologist, or psychiatrist.Since they cannot have the bill covered or theservices provided to mentally healthy people whoare in need o psychological-psychiatric help,psychiatrists pathologize the mental diffi cultieso healthy people, their problems in living. Tey

diagnose their problems as mental disorders.Over time, they orget that they have pathologizedproblems in living o healthy people. Tus, evenwhen they treat mentally healthy people it is arrom them that they deal with people who are notmentally disturbed, and that consequently theyshould show interest in mental health, study it,analyze its various maniestations or states.

Sixth, psychiatrists tend to misidentiy mental

health states as pathological states. A goodexample is conating sadness with cause, ornormal sadness, and depressive disorder whichdevelops or no apparent reason. Allan V. Horwitz

and Jerome C. Wake eld 4 have shown that therecent epidemic o depressive disorder resultsrom covering quite normal states o sadnesswhich develop secondary to some loss with thenotion o depressive disorder. Te guess is that ipsychiatrists were more cognizant o mental health

and its various maniestations, they would notconuse sadness (mental health) with depression(mental disorder).

Seventh, questioning the very existence o mentaldisorder has a long history, as long as the history opsychiatry is. It goes without saying that those whoquestion mental disorder are actually questioningpsychiatry. A number o psychiatrists reactedangrily to this questioning and published papers

and books, showing that claims about the dubiousexistence o mental disorder are unsubstantiated.Tus psychiatrists, or at least a number o them,were orced into thinking and re-thinking aboutmental disorder, analyzing its denition, tryingto gure out what mental disorder is all about.Antipsychiatrists were the leading gures o suchattacks on psychiatry in the 1960s and 1970s. Yetthe existence o mental health has rarely beenquestioned; in any case much less requentlythan the existence o mental disorder. So the

psychiatrists did not eel prompted to explainmental health, what it consists o, how it is dened.When someone challenges mental disorder,psychiatrists as proessionals eel threatened.Questioning the existence o mental health doesnot cause the same eeling among psychiatrists. 5

Eighth, the costs o mental health services aremounting. So are the costs incurred by workabsenteeism, diminished productivity, andinvalidity o mentally ill people.6As a result, thesignicance o mental illnesses or the society isenormous. Since thus mental disorders are in theocus o public attention, mental health is givensecond-rate importance. Psychiatrists mainlyespouse such way o looking at mental health.Tey tend to overlook or completely disregardthe mental health concept and accordinglycontroversies and dilemmas associated with it.

Why Psychiatrists Should Be Interested in

Mental Health

Is there any need or a denition o mental health,be it scientic or non-scientic? Furthermore,


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is it better to have one universally agreed-upondenition o mental health, or is it more appropriateto have many different denitions? John K. Wingwrote that he is not sure that a scientic denitiono mental health should be sought. Virtually allthat is scientically useul seems to be better dealt

with by discussing the prevention o disease, andhere various concepts o tness may be useul. Teremaining component is the denition o mentalhealth can then be seen or what it ispertainingto art, myth, and social tradition, rather than toscience.7

Indeed, opinions are split as to whether thereshould by a denition o mental health. Someauthors (or example, David Freides 8) are o

the view that the notion o mental health shouldbe eliminated. Tey cite the multitude o thedenitions o mental health as corroborating theirposition. Others (or example, Maurice Korman 9)are o the opinion that the notion o mental healthshould be kept, and that an operational denitionshould be ormulated.

My view is that mental health workers need toknow what mental health is all about. Tey should

deliberate about the nature o mental health,about its dimensions and maniestations as well asabout its denition. Mental health should be highon the agenda o those who provide care to thementally healthy and mentally ill people alike. Iwill substantiate my claim as ollows.

First, there is belie that no one is totally mentallyhealthy or mentally disturbed, but rather bothat the same time, only to various extents. Tusthe relationship between mental disorder and

mental health should be inspected. Can they bepresented dimensionally, or are mental healthand mental illness qualitatively different, andcannot be presented on one dimension? Whenthey treat people with mental illness psychiatriststry to boost health potential in patients, to makeit stronger. Te idea is that it will develop andeventually prevail. In order to know what thehealth potential is like psychiatrists should getacquainted with the concept o mental health, with

mental health dimensions; briey, they shouldknow what mental health is all about. Jahodamaintained that it will take special efforts tointroduce concern with health into clinical work

with the sick. And she added: But such effortsmay well be worthwhile.10

Second, in psychiatric research the notion omental health cannot be avoided, at least not inany research in which control group is used as a

methodological device. A control group consistso mentally healthy subjects. Since in terms omethodology the control group is as importantas the experimental group, one could expectresearchers to pay as much attention to mentalhealth as they do to mental disorder. Members oexperimental groups are required to be the samein regard to as many variables as possible, rst oall in regard to diagnosis. Tey have to suffer romthe same mental disorder. It is extremely rare or

the question to be raised whether the memberso the control group are the same as ar as theirmental health is concerned. It is taken or grantedthat they are the same due to the mere act thatthey are mentally healthy, that is, that they donot display the symptoms o any mental disorder.However, that is not the case. Te maniestationso mental health are numerous and various. Imentally healthy people are the same, they arenot the same in the same way. o date, psychiatric

researchers have been ocused on mental disorder,on diagnostics and the classication o mentaldisorders. It is high time they paid more attentionto mental health, i or no other reason than tomake the members o the control group as similarto one another as possible. And this cannot bedone without knowing what mental health is, andwho healthy subjects are.

Tird, as demonstrated by Corey L.M. Keyes 11,a great many individuals who are not mentally

disordered do not eel healthy and do not unctionwell. Nearly hal o adults receive mental healthservices annually because a mental health problemis inerred, meaning that there was no diagnosabledisorder. Since they so ofen treat mental healthproblems in people who have no diagnosabledisorder psychiatrists should learn more aboutmental health, its maniestations, its decienciesand imperections.

Fourth, mental health is the key category o anykind o psychiatric treatment. Te same questionre-emerges all the time: what is the goal o thetreatment? o reduce the number and intensity


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o symptoms, or to make the patient as healthyas they were beore they ell ill, or to make themhealthier than they were beore they ell ill, or tomake them as healthy as the normal mean (Tislast goal is quite ofen mentioned in the contexto psychodynamic psychotherapy). Ernest Jones,

the most renowned biographer o Sigmund Freud,also thinks that the denition o mental healthwill be helpul in the assessment o the result othe therapeutic intervention. What constitutesa normal mind, and whether such a thing canactually exist, are questions o considerabletechnical, and sometimes o practical, interest.Even i we conclude that in an absolute sense nomind can be entirely and completely normal, it isnevertheless worth asking what the attributes o

such a mind would be. For, with such a standardbeore us, it would be easier to determine howar a given mind under treatment had progressedin the direction o normality.12 Obviously thenotion o mental health is unavoidable wheneverthe goal o the treatment is discussed, wheneverthe question is raised: what do we want to achieveby the use o a particular treatment. In this senseAubrey Lewis13 appropriately remarked that ipsychiatrists could agree on the concept o mental

health, there would be more accordance in regardto therapeutic effi cacy and treatment goals.

Fifh, an agreed-upon denition o mental healthis a prerequisite or designing programs aimed atimproving the mental health o the population.And how can mental health o the population getimproved i there is no knowledge o what mentalhealth is, i we do not know what we would liketo improve and consequently what the expectedresult o epidemiological endeavours should be.

Sixth, a better knowledge o numberless variantso mental health is essential in early interventionin psychosis. I psychiatrists are not well-inormedabout numerous maniestations o mental health,i they are not skilul enough at recognizing them,and are not keen on studying them in depth, theyrun the risk o conusing oddity, eccentricity,developmental variations, prodromal symptoms,and risk syndromes. Tere is no need to stress how

serious consequences might have psychiatric andparticularly medical intervention in states that all(more) at the site o normality than pathology orrisk o pathology. 14

Seventh, a classication o mentally normal statesis long overdue. Te statement that there is onemental health and many mental disorders is aulty.Te same as there are many orms o mentaldisorder, there are many kinds o mental health.Normatology, the science o mental normality,

deals with the latter.15, 16Many misunderstandingsand misnomers would be eschewed i psychiatristsmade efforts to identiy various orms o mentalhealth, i they gave them the particular names, andi they classied them. And they cannot achievethis, i they deem that research on mental healthand dealing with mental health is not their cup otea.

Conclusion

In spite o its relevance to their proession,psychiatrists do not reect on mental health asmuch as they should do. Tere are numerousreasons or their comparatively scanty interestin mental health. Te act that psychiatrists areprimarily trained to deal with mental disorderrather than mental health seems to underpinpsychiatrists disregard o mental health. Giventhe importance o the notion o mental health not

only or the consideration o conceptual issues butalso or day-to-day clinical practice psychiatristsare due to pay more attention to mental health.Te rst step they should take in the rightdirection is to stop considering themselves asexperts at pathology and nothing but pathology.Corresponding changes in psychiatric curriculawould be instrumental in making psychiatristsamiliar with mental health issues. Tose whoapproach psychiatrists seeking help will be themajor beneciaries o such change o perspective.

Disclosure

Te author reports no conicts o interest. Teauthor alone is responsible or the content andwriting o this paper.

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d. kecmanovic - psihijatri i mentalno zdravlje

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