Further reflections on defining ‘mental health’
This is written in dialogue with, and in partial response to the WHO Quality Rights training modules, version released in March 2017, in particular module 5 on ‘Realizing recovery and the right to health in mental health and related services.’ I am taking part in a review of these materials. It is also written with appreciation to Sarah Knutson for our dialogues on mental health and human rights.
- Mental health, like recovery, is individual and subjective. It cannot be judged externally or with reference to any universal criteria. Various ideas or visions or values of what anyone considers to be mentally healthy can be promoted and cultivated the way that ethical and spiritual values can be promoted and cultivated. To attempt to universalize such criteria and judge others according to them is to impose hegemony of certain beliefs and values over others, and most importantly to create a hierarchy of those who are in a position to authoritatively proclaim the hegemony of these beliefs and values, and to judge others according to how well they meet the criteria.
- For me, mental health is a sense of internal well-being and congruence with one’s own beliefs and values. This is an internal reference, my personal idea of what I would envision, or abstract from what it means to me to see some habit or pattern as mentally healthy or unhealthy. Nevertheless, it is not for anyone else to take that from me and judge me according to whether they think I am fulfilling this in my own life.
- There can be dialogue and interchange about what we consider to be mentally healthy, just as we can exchange views about ethics and spiritual beliefs and values. Such interchange is worthwhile but will never amount to, or should aim to create, an objective universal standard. In other words mental health is an aspirational personal value that can be meaningful in individuals’ lives. When used as a yardstick for one person to measure another, it is the enactment of a power inequality and hierarchy, contrary to the values that underlie CRPD Article 12, in particular what I have referred to as the incommensurability of persons or impossibility for one person to ‘assess the inner-workings of the human mind, and when the person does not pass the assessment, to deny him or her a core human right.’ (CRPD General Comment No. 1 para 15).
- In my view, giving any hegemonic weight to such assessment in law or social practice is enough to deny the person the human right to be treated as a member of his or her community of equal worth and dignity as others. I consider that the logical implication of Article 12 is a radical mutuality and respect for worldview as developed by Shery Mead in the framework of Intentional Peer Support. See Mead’s papers and other materials on intentionalpeersupport.org, and my papers CRPD and Transformative Equality, Rethinking Criminal Responsibility, Alternative to Functional Capacity, and Norms and Implementation of CRPD Article 12 on academia.edu, and blog posts ‘Decision-making and moral injury’ on madinamerica.com and ‘Guiderails and reparation’ on tastethespring.wordpress.com. These values underlie the work that has been done since the 1970s on peer support as a practice of sharing, exploration and co-creation of knowledge by and for people who have been labeled by others as mentally unhealthy and denied our human rights on that basis. To embrace the idea that mental health is individual and subjective, an aspirational value akin to spiritual and ethical values, reasserts our ownership of policy as well as legal norms in an area that has deeply affected us and that we have contemplated and studied to remedy the injustices that have been done.