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Mental health and mental illness

A flourishing debate continues to swirl around the meaning and practical implications of the terms “health,” “illness,” “promotion,” and “prevention.” Public policy decisions based on an understanding of these terms have an important impact on funding levels for scientific research, training, and public education as well as on the allocation of services. Is mental health the relative absence of mental illness? Is mental illness the relative absence of mental health? Can mental illness be prevented or alleviated? Can mental health be promoted? And do present research findings support a conclusion that efforts at preventing mental illness and promoting mental health are useful and valid, and not a waste of public funds? My short answer to those questions, based on a modest exposure to the relevant literature, is a qualified yes. The effectiveness of intervention programs is obviously contingent on such factors as demography; political will; public commitment; duraiion, extent, and severity of disorders; expansion and dissemination of research findings; skill in differential diagnosis; and sophistication in the application of educational techniques. I suggest that at any given phase of the life cycle, mental health generally may be defined as a state in which the individual is in proximate balance with the environment and reasonably able to cope with life’s goals, activities, and vicissitudes. Mental illnesses can be more fully comprehended by looking at the enormous diversity embodied in the DSM-II1-R classification system of psychiatric disorders. A quick glance at this formidable system clearly tells us that between the so-called “worried well” who fill the offices of mental illness practitioners and those with severe long-term mental illness are millions of people suffering from transient reactive depressions, phobias, obsessions, anxiety neurosis, substance abuse, AIDS, and sexual dysfunctions. These people need-and should have access to-quality treatment and rehabilitative care. What is called for, in my view, is a balanced approach to unmet human health needs across the total disability spectrum. That approach dictates sharply increased research funding for serious psychiatric disorders on a par with other major illnesses, with no diminution of support for lesser