Table 3

Theme—Positionality

CategoriesParticipant responses
Binary/conflicting dynamic“There are two options represented in the philosophy of mental health. EITHER the absence of mental illness/disease/disorder where that is defined in some either value-laden or value-free way. It may be a simple definition (such as endogenous failure of ordinary doing or harmful dysfunction) or a cluster concept. Health is then its absence. Typically such definitions unify mental and physical health. OR the positive presence of something like flourishing. This underpins approaches to recovery in mental healthcare. It risks equating health and wellbeing” (ie, Directions A and B)
“The core concepts of mental health can be organized as a binary and conflicting dynamic that is seeking integration and resolution. On the one hand we have inequity, adversity, trauma, alienation, exclusion, discrimination, stigma, loneliness, stress and mental overwhelm. On the other we have empathy, compassion, dignity, honesty, innovation, peer support, economic equity, social justice, community involvement, mindfulness and recovery” (ie, Directions B–C)
Complexity“The term means little to me. It is too general and is used, either in the negative or the positive, to indicate such a range of states of being that the term is almost without meaning”
“Not located only in the person, but in the interaction between the person and her/his environment”
“Mental health does not exist within the individual, within the brain, within the neurons or within brain chemicals, or within genes. Mental health is both affected by them all but also has effect upon them all. That relation extends also to everything outside the individual: eg, my relations with myself, other individuals, the human world, my immediate environment, my neighbourhood, culture, society, socio-political-economic systems, my environment and the planet we live on” (ie, Direction A; Directions B–C–E)
Dichotomy vs continuum“The mental wellbeing of the individual as well the ‘health’ of the community in which they exist—social determinants that lead to good or poor mental health—mental health = continuum between mental wellbeing and mental illness—prevention as well as treatment” (ie, Directions B–C–E)
“Health and illness belong to distinct continuous dimensions”
Descriptive vs prescriptive
(Hume's law*)
“The key is to shoot for a definition which is in the middle: not to high, so that perfect is required, nor too low…it must have something to do with reasonably good functioning, where reasonably is conceived in terms of the legal standard as average quality. Clearly, you're not mentally well, if you have below-average mental functioning, such that your ability to perform average tasks is impaired”
“Moreover, what includes too much. The references to spiritual well-being have got to go, as if non-believers have defective mental health by definition—The third [definition] is good, except for the excessively demanding realization of potential. There's a difference between perfect mental health, and just simply mental health, and too many definitions conflate the two…the offered definition is too much and too contested qua definition (as opposed to theory)”
“I think all of these definitions are too broad. The first, third, and fourth [definitions] look closer to definitions of the good life, or good community, than of health. Lots of things can cause people problems—poverty, vices, social injustice, stupidity—a definition of health should not end up defining these as medical problems”
“There is no definition of positive mental health nor will there be in my view because too many issues are at stake and the most important is the absence of a serious mental illness or other emotional, psycho-physical, and moral problems”
“Most of these [definitions] have too much stuff, creating unattainable goals and sounding like they were crafted by a committee wanting to cover all the bases and to be politically correct”
  • *Hume's law, that is, an “ought” cannot be derived from an “is” (Segal and Tauber).22