Peace of mind: The science and philosophy of mental health

Peace of mind: The science and philosophy of mental health

Interview with Faculty Fellow Anya Plutynski

What is mental health? Expert responses from the Centers for Disease Control and U.S. Substance Abuse and Mental Health Services Administration quickly turn to a discussion of mental illness. The terms have not always been conflated. “Mental health is not — or not only — the mere absence of mental illness,” says Anya Plutynski, professor of philosophy and a scholar of the history of science. Her research on early 20th-century “mental hygiene” practitioners shows that some providers of the era operated under a definition of mental health that was equally concerned with identifying factors and skills that promoted mental health and prevented symptoms of mental illness from arising. Over time, however, their ideas have been forgotten or dismissed as bad science. “It’s common for folks to think that science makes progress and so ‘new’ ideas are better,” she says, whether or not those assumptions have been evaluated.
With her new book project, “Making Mental Health,” Plutynski, a Faculty Fellow in the Center for the Humanities, is not only writing a narrative history of the concept of mental health but shedding new light on larger debates in the philosophy of science concerning evidence, explanation and the role of values in science. Below, she offers an early look at her book-in-progress.

Briefly, what is your book about?

I’m writing about the history of the concept of mental health and of the history of ideals for a science of mental health promotion. Different scientists and clinicians have endorsed very different ideals for a science of mental health over the course of the 20th century. A common assumption is that science makes progress by getting rid of bias and becoming more “objective.” I’m curious what this means in a context where reliance on individual judgment, clinician’s and client’s subjective reports, case studies and value-laden ideals like “resilience” or “emotional stability” seem impossible to avoid.

When and in what context did the idea of “mental health” become widely popular?

This is a tricky question to answer because analogous concepts were “widely popular” in the early 20th century, used interchangeably with “mental health,” but not the same. “Mental hygiene” was a popular topic of concern for psychiatrists, psychologists, social workers, educators and the general public in the early 20th century, well into the 1940s and ’50s. Many folks dismiss this work as “junk science,” because many of the ideas sound so confused or unfamiliar to us now, but one of the central arguments of my book is that this is a mistake.

The National Committee for Mental Hygiene published a guide to accompany its 1913 exhibit on mental hygiene. Public domain, courtesy the Wellcome Collection.

The concept of mental health in clinical research has become progressively “narrower,” and while there have been improvements in our scientific understanding of mental health and illness, this came with a loss. Clinical research today often simply identifies mental health with absence of symptoms of mental illness, in contrast to a more expansive concept of the sort endorsed by many “mental hygienists.” While we might disagree with their language or methods, many of the capacities they identified as key to “mental hygiene” have been rediscovered and relabeled today as impulse control, higher order cognition, goal-setting, or social and emotional education. One of my aims is to explore how this concept evolved over time, alongside efforts at developing a science of mental health promotion.

As a philosopher, what kinds of questions about mental health/emotional well-being are you asking in this book?

Psychologists, economists, sociologists, geographers and anthropologists who study “well-being” are a pretty motley group. They’re not all concerned with the same thing, and many of them would deny that they are concerned with the “emotions” or “mental health.” Many economists, for instance, are concerned with developing international measures of “well-being” to address policy questions.

My book is concerned with something different. (If you’re curious, several philosophers have already written books on the science of well-being: Anna Alexandrova wrote a book called A Philosophy for the Science of Well-being, where she discusses what well-being scientists are measuring.) The kind of research I’m interested in is research that informs clinical mental health care. As a historian and philosopher of science, my questions are about what clinicians and scientists know, and how we know about it. 

The kind of research I’m interested in is research that informs clinical mental health care. As a historian and philosopher of science, my questions are about what clinicians and scientists know, and how we know about it.

Your last book, Explaining Cancer: Finding Order in Disorder, examines conceptual and methodological challenges that arise in cancer research. How did you move from cancer to psychology? What drew your interest to this particular area of human health?

I spent about 12 years researching and writing about cancer. It was fascinating but also a difficult topic to both keep up with, and frankly, remain optimistic about.

I turned to mental health because I found it fascinating and because many of my students were interested in it. While there’s a lot of philosophical work about mental illness, there is relatively little on mental health, and most philosophers of science writing on this topic ignore clinical research or practice. This led me to start reading and taking classes in clinical psychotherapy and interviewing clinical psychotherapists.

I’ve become fascinated with what mental health care does, and how, as well as how we know. Alleviation of symptoms of disorder is the typical goal of randomized clinical trials for most talk therapies, and there are protocols that work for these purposes. But what many of the clinicians I interviewed were doing in therapy was not reducible to following a protocol. Indeed, it turns out that the most effective clinicians are not perfectly “compliant” with protocols. Their work is client-specific and ranges over a variety of goals — identifying and communicating about emotions, resolving conflict, mourning loss, identifying and healing trauma or simply gaining some critical distance on one’s life.

I started to wonder if the “goal” of psychotherapy is prevention, rather than treatment. Psychotherapists are not like physicians, alleviating symptoms, but more like physical therapists — healing injuries and developing capacities to prevent symptoms from arising in the first place. This led me to wonder about models for thinking about effective mental health care, where they come from and how the science of mental health care evolved.