A strategy for mental health policy and the process theory of psychology
By Dr Graham R. Little PhD AFNZIM
© 2002 Graham Little: This paper as with all others at this site is copyright, but parts may be copied and reproduced consistent with review and discussion provided recognition given the author of the ideas.
Note: this paper is not intended as a stand alone paper and must be read in conjunction with the other papers at this site, in particular Psychological theory and its impact on mental health policy, and Definitions of insanity and mental illness and the impossibility of temporary insanity.
The issues *
First two type of malfunction as arising from theory *
The third type of malfunction arising from the theory *
The process theory of psychology *
Definition of mental health *
Skills and understanding *
Emergent strategy for mental health policy *
Managing mental ill health *
The management model *
Developing greater mental health *
Issues in developing community mental health as emergent from process theory *
In the earlier paper Psychological theory and its impact on mental health policy I began discussion of several issues in the conceptual landscape surrounding mental health, insanity and social policy, for example:
I will not aim to respond to all these issues in this paper, and will only focus on three.
The three issues the focus of this paper are summarized as follows.
There are many subsidiary issues within each of these broader questions. For example, if the definition of mental health we develop does not fit popular usage and understanding, what should be done about that? If we develop a focused mental health policy that does not include dealing with mental ill health, which should get priority for funding and how do we decide? Where do we draw the line, or where should Government draw the line between funding mental health and encouraging certain norms and values as a way of life? Can we in fact build mental health understanding and social policies and strategies that are non-partisan, non-political and non-cultural?
First two types of malfunction as arising from theory
Mental illness is the most direct and most simple definition that arises from the theory; mental illness is precisely failure of the mechanisms that underlie our psychology, so mental illness is solely neurological and damage to neurological systems; and with inclusion of damage, a person mentally impaired as result of an accident falls within the broader definition of mentally ill, in exactly the same way someone with a broken leg from an accident is ‘ill and needing hospitalized’.
Mental illness relates to the failure in the ‘normal’ functioning of the mechanism, with the other type of functioning relating to the values taken by the variables in the theory, so that insanity then becomes the exhibition of values of the variables that fall outside the range of ‘acceptable’ by the society. Someone defined as insane is typically a danger to themselves or to others in the society. I do not intend to explore further here issues surrounding insanity, personality disorders and counseling, and will leave that to a forthcoming paper, but I must point out that the definition based simply on the values of variables is not quite sufficient for insanity and for personality disorders, since there is another important aspect to the living reality of the theory, and it is to that I now turn.
The third type of malfunction arising from the theory
In preparing earlier papers, and in earlier thinking about mental illness, and other forms of mental disorder and maladaptive conduct, the first two ways the system could malfunction were immediately evident, that is the mechanism could fail, or the values of the variables could fall outside the range of that acceptable to the society, so mental illness and insanity/disorders would seem to be defined directly from the theory and in part they are.
The third way in which the theory could malfunction is somewhat subtler, less immediately obvious, and is best understood by example. Imagine a person with a quality to their mental sets that tended to make the sets inflexible. Now imagine the person in a situation that changes requiring them to adapt different roles and actions, they are slow to make the transition to the new mental sets and new habits and reactions arising from the role necessary in the situation, as a result their behavior is not ‘at ease’ not quite appropriate, in sufficiently severe cases the person would be described as having a ‘personality disorder’, but not one arising from mechanisms or values to the variables which could both be within the range ‘normal’. Imagine another person who rather than make slow transitions, made the transition in rapid jumps, so they exhibit one role and reaction at one point, then suddenly are in some other quite different state. Both of these examples could arise by a lack of skill and understanding at the nature of roles and nature of self so that the person allowed or did not allow new and more relevant mental sets to emerge as appropriate.
In yet another example the person does not understand the fallibility of their own attitudes, that is they think that because it arises in them and feels right it is right, with the level of this potential problem being only at one extreme end of the normal, then combine this with weak self management skills, so that when inappropriate attitudes arise the person is not certain that they are wrong and is poorly equipped to deal with them even if they do think they are wrong.
Elsewhere I have discussed these self-management skills (Nouskills: skills of the mind), referring to them as nouskills. In effect nouskills are the means of managing the processes of the model, they describe managing knowledge, emotions, reactions, habits, and relating all these to outside situations. They also describe how we do or do not deal with inner tensions, stress, and our ability to calm ourselves as needed by social and relationship circumstances.
The first two ways in which the system could malfunction describe static malfunction, mechanisms and values of the variables, the third manner of malfunctions describes how the theory in action, the very movement among parts of the structure that describe a person can itself malfunction, and the theory also proposes that the skills of translation of one state – one set of mental sets in operation – to another state with a second set of mental sets in operation is significantly learned and can be improved by developing in the person better nouskills appropriate to their circumstances. At the point where nouskills are not learned, where they are genetic, effectively begins to describe the ‘hard wiring’ of the brain and nervous system. But sufficient is now understood of the immense plasticity of the brain and nervous system, that where in fact a person has inadequate natural development of ‘smooth flow and function’ then they can be taught nouskills that will and can impress upon the plasticity of the system to good effect to improve the ‘flow and functioning’.
Consider a third example, one combining both inadequate skills at self management with mental sets that are extreme, for much of the life the person got by, merely showing occasional slight signs of instability and extreme behavior, then in some circumstance, the two factors collided into causal thrust that resulted in the person exhibiting behavior not previously exhibited, say extreme violence. The extreme mental set can be said to be ‘insane’, but the person is not, for they know better, and have generally been able to restrain themselves, except for the one occasion when extreme emotions combined with extreme response from the extreme mental set combined with poor self management skills, and perhaps only moderate desire to moderate themselves resulting in the unleashing of extreme behavior..
There is an important proviso to the above comments that is the person must understand what a nouskill is and how it can and will help them, and must be to some degree committed to helping themselves. Without the backdrop of self-help, merely offering nouskills as ‘knowledge’ to be learned as one might learn history will not help the person. Nouskills are to be lived, and need to be part of and seen to be part of the tools of effect living.
The process theory of psychology
It is from these considerations that the name emerges for the theory of psychology I have developed, I call it the ‘process theory of psychology’, because the living dynamic of it is ‘process’, flow, movement and transitions from one inner state to another. The management of the transitions, the management of the inner processes whereby our very existence comes to be and is exhibited to the world outside of us is likely something important to us, and is the very essence of what is intended to be conveyed by the term nouskills which are the conceptualized techniques for better managing our inner transitions, states and processes.
Definition of mental health
A prescriptive definition of mental health implies a manner of functioning of the psychological processes within the person, so that the following applies in a mentally healthy person.
The first, and most important issue is that these factors traverse a fine line between values of the variables, and value independent aspects of the system. For example, a complete lack of integration and poise is an appropriate state, but not one likely to result in harmonious social circumstances. Normative decisions are an integral aspect of social policy on mental health, insanity is normative, hence the degree of normative determination here is slight when compared to other normative aspects, but it is there, for example, the choice of balance and poise are choices of one set of values of the variables, when others could have been chosen, and this set of choices does represent a set of human values. (Note that in adopting such a set of choices challenge and protest are not excluded, nor is conformity encouraged, the factors of conformity and protest involve more of the selection of values of variables, not transitions between states a consequence of those values.).
If ‘person in their environment’ describes a complete system then ‘mental sets’ describes sub systems of that system, with the three factors of integration, poise and transitions describing how one subsystem relates and translates to others. It is this focus on ‘movement and relationships’ that encouraged adoption of the term ‘process theory of psychology’.Essentially, such a view of mental health states ‘if you use nouskills to seek greater integration of your thoughts and attitudes, develop greater poise as a result, use the skills to enable smoother and easier transitions between roles and mental sets, and if you finally seek to be at peace with yourself and how you conduct yourself, then you will live a more satisfying life for you, and this regardless of the goals/values you might set for yourself’ (so the drug czar killer can be as content and mentally healthy as the vigorous, really normal and nice neighbor next door).
The full theory does not distinguish between integration and poise and total lack of integration and absolutely no poise they are both legitimate when we choose one over the other, then we insert norms and values into the situation, but from within the chosen set of parameters, then a Government can offer tools to enhance the mental health of normal people and those who are insane (in that an insane person can be mentally healthy and can improve upon their mental health in the sense of living more effectively according to the goals and values important to them, this despite those values being outside the society in which they live). A Government is then adopting the broadest based philosophy and strategy available.1
Skills and understanding
Seldom do skills exist without necessary understanding and judgment. Developing nouskills in the areas as outlined above will involve necessary understanding of the theory behind the application of the skills. The knowledge to support the nouskills must answer questions like: why do I have different sorts of thoughts? Where do my thoughts come from? Why is it I act this way one day and a different way another day in same sort of situation? How do I manage my thoughts, why should I? How I feel is how I feel, it is me? At another level, the theory must also settle the issue of ‘who?’ Who is running me? Who is in charge? Can I help myself? What is I and what is my spirit?
The theory does point to the Thought as core determinant of human behavior, and Thought in a person arises from at least in part the society and culture of the person. But equally, the theory stresses multiplicity and choice of mental sets allowed, mental sets are not causal and not necessarily emergent, they are allowed, or colluded with in their emergence. Causality of our conduct rests with us as individuals, society laid in us the core framework of Thought, but the very multitude of mental sets within any adult precludes the essential causal nature of any one, without active involvement of the deciding ‘I’.Without strong theoretical and explanatory backdrop these questions will overpower application not so rooted in theory and explanation resulting in no improvements.
Emergent strategy for mental health policy
From within the theory there are immediately two crucial aspects to any mental health policy.
It should be apparent that in any circumstances which fails to differentiate between these two elements, then funding will be wasted, and effort, no matter how well intentioned will be less effective than it otherwise could be.The two elements do interact, in that if the second is done well, it could have a positive impact on reducing the first. But likely efforts to develop greater social mental health will be slow, and will need to be truly strategic and long term since social attitudes and philosophies of psychology and self and self control form such a potent aspect of the issue.
Managing mental ill health
Management of mental illness, insanity and serious personality disorders has been and is the current main focus of ‘mental health policy’. No attempt is made here to review or provide a comprehensive assessment of these services as they currently exist, sufficient to note that it is an area of general health that is currently a struggle for many nations their being much debate in New Zealand, and evidence of uncertainty and debate in the United States with the establishment and brief for the Presidents New Freedom Commission on Mental Health (www.MentalHealthCommission.gov). I suggest that part of the problem, if not a significant part is due the divisive and fractious nature of understanding in psychology, cause and the etiology of human activity.
The following are notes and observations of the situation from within the framework of the process theory of psychology.
Technological issues: There are three technical issues of considerable significance.
The management model
People with serious mental illness are different, not easy to communicate with, and typically not people the general population will gravitate to and make friends with; and frequently the family does not have the skills to cope and care for them. There is a body of thought that sees the ‘stigma’ of mental illness as handicapping such people in society, the issue is whether or not the opening statement has any validity, if so then seeking to ‘overcome’ the stigma is likely to be of limited impact with people correctly perceiving the reality (as in opening sentence). Mental illness as a break down or damage to the underlying neural mechanism is precisely parallel to a broken leg or common cold, circumstances beyond the control of the individual, sad, often tragic, and requiring professional care and support. Simply placing such people back in the general community will leave them lonely and distressed. They certainly often need community, which might suggest something akin to the retirement village rather than a hospital, but a community of kindred folk with professional support close by.
Issues of insanity and personality disorder raise different questions, since from within the model these are issues that while difficult, are not beyond the management and control of the person. The model suggests that to some degree the person is able to choose, and can make progress although it may easily be a difficult fight within themselves. Depression, for example, is a common social disorder; it seems to me unlikely that a person will reach forty-five without experiencing depression to some level. Elsewhere I have referred to depression as an ‘affliction of the spirit’ (Definitions of insanity, mental illness and the impossibility of temporary insanity ).
An important issue is the self-fulfilling potential of humanity, the model makes this very clear, therefore if ideas are promoted that suggest ‘depression is normal and an illness’ will this in and of itself promote depression, causing people themselves to fight less? What if Government adopted a different philosophy, namely that depression is common, not a big deal, and can be managed by applying these effective nouskills, going to these seminars where one can share with people wrestling with their own spiritual hope and security, or going to these counselors recognized and trained in dealing with depression.
From this analysis emerges a strategy offering a graded response to mental disorders in the community. First, forensic retention centers, then hospitals for the most acute and those necessarily requiring full professional care, then communities of care, and finally the offering of support, encouragement and coaching for those able to take care of themselves, this bringing us to the next significant topic of developing greater mental health in the community.
Developing greater mental health
At one level, the distinction being drawn between managing mental ill health and developing mental health is the same as managing physical ill health, and building physical health. As policy there is emerging distinctions in normal health, the smoking campaign for example, and constant promotion of healthy eating and exercise are all promoting positive health. In normal health it is better understood and accepted that some illness can be prevented, and that good physical self-management practice will help, even if the advice is often ignored. For mental health, without a strong orienting theory the issues are much more blurred and less clear in the minds of people. First there remains the strong view that causality is linear, derived from deep issues like ego, id, and unconscious, cemented by external parameters like the ‘system’ and society, with little justification or serious scientific support for such views. The fragmentation of psychological schools and the burgeoning treatment styles and regimes, each with its adherents, all adds to the confusion in the popular mind. This, right down to fundamentals such as ‘what does cause my conduct?’, and ‘how can I understand me?’. Little wonder the policy area of ‘mental health’ is dominated by concerns over managing mental ill health. With the fragmentation and divisions of psychology, for any Government, for example, to promote any system of thought would be seen as ‘favoritism’ for one group over another, and any promotion of any set of ideas as regards mental good health likely to become a political minefield.
The only solution to the issues is for the development of a comprehensive and clear orientating theory that prescribes and enables adoption of one system over others. With the emergence of an orientating theory, a paradigm for psychology then what to do to best effect will emerge and be clear and specified. Achieving a paradigm for psychology requires the theory measure up to the issues and factors relating to judgment in science as spelled out at this site. The factors relating to judgment of theory and science extend far beyond the naive issues of empiricism, positivism or falsification, demanding a balanced and comprehensive view of the elements that might bear to the validity of a theory, and to the detailed understanding of what a theory can and cannot tell us, and to the careful distinction between a variable and the range of values available to that variable.
Very few if any theories of psychology yet developed have sought to match themselves to the range of detailed issues and elements of judgment here outlined. The only one to date being process theory outlined at this site: whether right or wrong, and the jury is still out, it points the only way forward, it is the only system of thinking that even begins to deal with the range and complexity of issues that underlie and are intertwined with the a theory of psychology (it is a mission just unraveling the issues and how they relate to the theory). See Psychological theory and its impact on mental health for a brief description of the elements of the process theory, and see previous papers at the site for detailed elaboration of the items and issues.
Issues in developing community mental health as emergent from process theory
The following issues and analysis is derived solely from the process theory, and no attempt made in this paper to relate the discussion to prior literature in any detailed way. Previously, above was stated the following
.…‘if you use nouskills to seek greater integration of your thoughts and attitudes, develop greater poise as a result, use the skills to enable smoother and easier transitions between roles an mental sets, and if you finally seek to be at peace with yourself and how you conduct yourself, then you will live a more satisfying life for you, and this regardless of the goals/values you might set for yourself’
As discussed, the theory is value neutral, it does not offer choices nor solutions; actual living demands we adopt some set of values in the range available, and then those describe our states, but in so choosing we deselect other values in the range, which is to deselect other ways of being in the world.
The emphasis here is on the processes of living, and it is argued represent the least value laden group of choices available, and represents the group of choices most likely to applicable to the widest possible group of people. It follows that a form of greater good is implicated when these choices, that of developing effect nouskills are adopted.
Developing greater mental health then involves the following.
The strategy is focused on developing the mental coping resources of the society, and suggests that if this done, more people will have less mental disorder, and enjoy life more and more fully. The facilitation of the option for greater peace and contentment by more people is surely one of the prime directives of all democratic government, and a directive that hopefully, form within accepted and orientating theory as here offered, is a directive able to be implemented and applied without fractious debate, and by parties from all sides of the political divides.