A psychiatrist's failed attempt at defining mental health
- Anders Malkomsen
- Jan 1, 2018
- 7 min read
As psychiatrists, our words matter – they are our scalpel. As they have more potential to create harm than even the sharpest blade, we must use them wisely, and precisely. In this text, the definition of mental health is debated in classical Greek fashion to sharpen the blade. When Diogenes the Cynic enters the debate, chaos emerges – and an important lesson is learned.
In ancient Greece, philosophers often debated the definition of a human being. One well-known anecdote involves Plato defining a human as a "featherless biped," only for Diogenes the Cynic to pluck a chicken and declare: Here is a human! This famously highlights the challenge of reducing complex, multifaceted concepts to simple definitions – an issue that persists in the modern attempts to define mental health.
Let us imagine four modern psychiatrists engaged in a similar endeavor at a café, trying to work out the definition of mental health.
Debating mental health
The first psychiatrist, who is biologically oriented, argues that mental health must be defined through objective measurable markers, such as neuroanatomical structures, genetic predispositions, and biochemical balances. “Mental illness is rooted in neurochemistry and structural abnormalities”, he insists.
The second psychiatrist, a cognitive scientist, nods in partial agreement. "I see the appeal of a biological definition, but our understanding of the brain is still in its infancy. Defining it solely through biology is premature.” More important, he argues, is the mental functioning: "Mental health is not just about neurotransmitters, but about how we process information. Rational thinking, flexible cognitions and adaptive decision-making are central to mental health.”
The third psychiatrist, who is psychodynamically oriented, shakes her head with a deep breathe. "That is far too shallow," she interrupts. "Mental health is not just about having a well-functioning brain or flexible thinking. It is about the self, the ability to integrate emotions, and the capacity for insight. The ability to love, to trust, to maintain a coherent and dynamic self in relation to others. That this is the true foundation of mental health."
The fourth psychiatrist, an existentialist, sits in silence, gazing into his coffee as if it was the abyss. Just as the others begin to wonder if he’ll ever respond, he speaks: "You all make good points. Mental health is rooted in biology, shaped by cognition, and deeply affected by our relationships. But isn’t it also about how we confront the fundamental conditions of existence: freedom, responsibility, isolation, and death? Life is suffering, and the expectation that we should feel good, is misguided. Distress may be the only sane response to an absurd world."
Despite the frequent use of “mental health” in public discourse, policy, and clinical settings, its precise meaning remains elusive.
Diogenes enters the debate
Suddenly, an untidy man at the next table leans in with a smirk. "Ah, my dear featherless bipeds, I see you are still at it … trying to define the undefinable." The psychiatrists just stare at this strange man, startled by the intrusion. "You've stuffed mental health with so much that it now includes almost everything. When something includes everything, it means nothing."
The perplexed expressions of the psychiatrists only seem to amuse and arouse the old Diogenes. "Tell me, who actually meets all these criteria? Who has a perfectly balanced brain, flexible thinking, deep insight, fulfilling relationships, and a profound sense of meaning, all at once?"
Leaning back, he grins. "Congratulations, you’ve made us all into patients. A clever trick. Define mental health as an unattainable ideal, and suddenly, you’ll never run out of work.”
Two kinds of definitions
Although this scene is somewhat of a caricature, it is not far from discussions I have witnessed repeatedly about the definition of mental health in later years.
It is not the results of stupidity, but rather the fact that defining mental health is no simple task. Despite the frequent use of “mental health” in public discourse, policy, and clinical settings, its precise meaning remains elusive. Over the years, various institutions and scholars have attempted to define it.
Among the most widely recognized definitions, the World Health Organization (WHO) describes mental health as “a state of well-being in which the individual realizes his/her own abilities, can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his/her community.” While this definition rightfully emphasizes well-being, resilience, and social contribution, it may be criticized for being overly idealistic, lacking clinical precision, and reflecting a bias toward productivity and extroverted ideals.
While the WHO offers a positive definition of mental health, another approach is to define it negatively, by identifying what it is not. A useful analogy can be found in apophatic theology, where God is not defined by what he is, but by what he is not: not finite, not limited, not changing. Similarly, mental health could be understood as the absence of a clearly defined mental disorder: for example, not psychotic, not depressed, not manic. This shifts the focus from an aspirational ideal to a more practical and clinically useful definition. If a person does not suffer from a diagnosable condition, they can be considered to have good mental health.
While this definition is useful in clinical settings, it is less effective from a societal perspective. If mental health is understood merely as the absence of illness, it provides little guidance for public health policy, prevention efforts, and social interventions. Policymakers and institutions may struggle to justify investments that promote mental health if the goal is simply to prevent illness, rather than to actively promote psychological well-being and resilience.
A pragmatic balance
Given the challenges of both overly broad and overly narrow definitions of mental health, psychiatry must find a balanced definition that is clinically meaningful and flexible enough to account for individual and cultural differences, yet practical for both clinicians and public policy. Obviously, neither the positive nor negative definition alone is sufficient.
A more pragmatic approach would be to define mental health as both the absence of severe pathology and the presence of certain capacities. In other words, mental health is not simply the absence of mental illness, but neither does it require an idealized state of mental flourishing. Most importantly, it should be an achievable standard, not an unrealistic expectation of constant well-being or productivity. It must also promote autonomy and allow for individual differences.
A pragmatic definition that reflects this balance might be that “mental health is the capacity to think, feel, and behave in ways that allows an individual to function within their environment on their own terms, in alignment with their chosen values, to maintain relationships they find meaningful, and to adapt to life’s challenges in a way that suits their personal needs – without meeting the criteria for a mental illness”.
This definition places autonomy at the center of mental health, recognizing that mental health is not a one-size-fits-all concept but is shaped by an individual’s own values, relationships, and ways of adapting to challenges. By focusing on functional capacity rather than idealized well-being, it avoids unrealistic standards while still acknowledging the importance of cognitive, emotional, and behavioral flexibility. It also respects personal agency, allowing for diverse expressions of mental health rather than imposing rigid norms.
Furthermore, by setting the absence of diagnosable illness as a boundary, it maintains clinical precision, ensuring that mental health remains a meaningful and practical concept rather than an abstract ideal.
Policymakers and institutions may struggle to justify investments that promote mental health if the goal is simply to prevent illness, rather than to actively promote psychological well-being and resilience.
Lost in translation
Few phrases are as famous as Juliet’s words in Romeo and Juliet: “What’s in a name? That which we call a rose by any other name would smell as sweet.” Shakespeare suggests that the essence of something remains unchanged regardless of what we call it. He may have been right about roses, but when it comes to mental health, names matter greatly. In psychiatry, terminology does more than describe, it shapes perceptions, influences policy, and ultimately determines who receives care. Whether we call something a mental problem, a mental disorder, or simply poor mental health, is not a trivial matter.
When psychiatrists call for more resources in mental health, politicians may hear the call but misunderstand what is being asked for. A psychiatrist, who often have the negative definition of mental health in mind, might be advocating for increased funding for specialized treatment of severe mental disorders, such as schizophrenia. The politician, however, may be guided by the broad, positive WHO definition of mental health, and instead allocate resources to well-being initiatives, public awareness campaigns, or workplace stress reduction programs. The result is that while funding for mental health increases, it may not reach those who need it most. Thus, the misalignment of definitions leads to misallocation of resources.
A similar issue arises in clinical practice. A psychiatrist may tell a patient that she has a mental problem, but not a mental illness, implicitly suggesting that her distress does not require medical treatment. In his mind, he is drawing a distinction between a mental disorder that requires medical intervention and a psychological struggle that may improve with lifestyle changes, social support, or the patient’s own coping strategies. But to the patient, this distinction may be lost. Instead of the intended reassurance, the phrase “not a mental illness” may suggest that her suffering is not serious, unworthy of attention, or beyond the scope of professional help.
Diogenes re-enters
Just as I prepare to conclude this article, convinced I have found the perfectly balanced definition of mental health that will solve all problems, a familiar voice emerges. This time, it does not come from across the café, but from within my own mind.
"Ah, my dear featherless biped. Pleased with yourself, aren’t you?" I try to ignore him, but he presses on. "A fine effort, I agree, not too broad nor too narrow, with room for autonomy, values, and flexibility. But tell me, does this definition truly escape the eternal trap of definitions?"
The old cynic does not wait for an answer. "What of the capitalist whose values and actions come at the expense of others? The woman whose chosen relationships slowly tear her down? The monk who adapts by retreating from life rather than engaging with it?"
I sigh, staring at my own words. For all my efforts, my definition may be just as flawed as those that came before it. Still, the fading laugh of Diogenes brings a faint smile to my lips.
Psychiatry, like philosophy, is riddled with hopeless attempts to capture in language what transcends it. No definition will ever be perfect, no framework without its blind spots. That is precisely why we need an inner Diogenes: a voice that unsettles us just as we start feeling certain, that mocks our grand theories and forces us to see their cracks.
Mental health or mental illness will never be perfectly defined. However, if we keep questioning our own definitions and stay cynical about our own brilliance, that may be the closest we can get.
I would like to thank Carl Tollef Solberg for discussions on this topic, as well as Anne Kristine Bergem for comments on the article. □
