Sunday, October 11, 2009

On Mental Health Day (Oct 10), I would like to rerun through a great idea I read sometime back. Psychology has often been accused of being a reclusive hermit: one whose experiments are cut off from real life. Doing experiments in lab may not fully expose real human motivations, for example. Because if the same subject is thrown into a social situation, the outcomes may differ. Addressing this broadly, the pioneering psychologist George Miller wrote:

“…the real impact of psychology will be through its effects on the public at large, through a new and different public conception about what is humanly possible and humanly desirable”.

The aim of science-as well as psychology-is objective insights, the capacity to control and predict what will happen next. This was suggested by Raymond Cattell, another noted psychologist well-known for this personality theory that classified it into 16 traits. Cattell understood personality as a mechanical construct, to which another psychologist Kline objected saying that personality is a hypothetical construct, an abstract term that has no independent existence beyond the mind that constructed it. Kline argued that while control and prediction were part of pure sciences, psychology was different.

Miller also sees control as inapt. Rather, understanding and prediction are the proper aims. Indeed, self-understanding is what Miller believes psychology should strive to provide people with (what he terms as “giving psychology away”). Miller uttered this phrase in his famous 1969 American Psychological Association presidential address. Miller made a dramatic point of asking psychologists to "give psychology away" by sharing its findings with the general public in ways they could apply to their daily lives.

For this to happen, the nature of a psychological study must be understood. Another psychologist at Penn Univ, Martin Orne wrote that a psychological study comprises two experiments: “one the experimented intends and the one the subject perceives”. The subject is not a passive respondent, but actively works on what’s going on and how to perform the experiment.

Miller thought that by re-thinking psychology as a means of promoting social welfare, we can tackle its dehumanizing approach. This means letting people describe their behavior and helping them increase their self-understanding.

So does psychology ignore how people live in the real world? Knowing that people chose to act the way they want, must warn us from any approach that boasts of fully explaining them. We are “goal-seeking individuals and members of groups”. This makes the subject matter of psychology qualitatively different from natural science. Psychology doesn’t operate in a social and value-free vacuum.

An aside

Yesterday, being World Mental Health Day (as designated by World Federation for Mental Health (WFMH)), today the Magazine section of The Hindu carried a nice lead article. Somewhat, I found it not a moving article (more of stats and less on the details, more complaints and less solutions). It reiterates a widely known fact: 85% of India’s mentally ill do not have access to proper care.

Actually the WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” If whole healthcare is what the aim is then while treating medical conditions, ignoring behavioral health problems is ruinous. WFMH cites the findings of the Hogg Foundation that prescribes integration of medical and behavioral healthcare for a patient to holistic return to overall well-being. As it elaborates, “When mental health is integrated into primary care, people can access mental health services closer to their homes, thus keeping their families together and maintaining their daily activities. Primary care for mental health also facilitates community outreach and mental health promotion, as well as long-term monitoring and management of affected individuals.” Thereby, even anganwadi workers, panchayat members or even social volunteers can direct mentally ill people to treatment facilities.

Here’s something directly from WHO’s 2007 factsheet on mental health, worth citing in full for reference:

Mental health is more than the absence of mental disorders

• Mental health can be conceptualized 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.

• In this positive sense, mental health is the foundation for well-being and effective functioning for an individual and for a community. This core concept of mental health is consistent with its wide and varied interpretation across cultures.

• Mental health promotion covers a variety of strategies, all aimed at having a positive impact on mental health. Like all health promotion, mental health promotion involves actions that create living conditions and environments to support mental health and allow people to adopt and maintain healthy lifestyles. This includes a range of actions that increase the chances of more people experiencing better mental health.

Mental health is determined by socio-economic and environmental factors

• Mental health and mental health disorders are determined by multiple and interacting social, psychological, and biological factors, just as health and illness in general.

• The clearest evidence is associated with indicators of poverty, including low levels of education, and in some studies with poor housing and poor income. Increasing and persisting socio-economic disadvantages for individuals and for communities are recognized risks to mental health.

• The greater vulnerability of disadvantaged people in each community to mental health disorders may be explained by such factors as the experience of insecurity and hopelessness, rapid social change, and the risks of violence and physical ill-health.

• A climate that respects and protects basic civil, political, socio-economic and cultural rights is also fundamental to mental health promotion. Without the security and freedom provided by these rights, it is very difficult to maintain a high level of mental health.

Mental health is linked to behaviour

• Mental, social, and behavioural health problems may interact to intensify their effects on behaviour and well-being.

• Substance abuse, violence, and abuse of women and children on the one hand, and health problems such as HIV/AIDS, depression, and anxiety on the other, are more prevalent and more difficult to cope with in conditions of high unemployment, low income, limited education, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyle, and human rights violations.

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