In tandem with the shift from biomedical to biopsychosocial models of health and the rise of psychosomatic research, another major move has been the increasing focus on mental health. In the first half of the twentieth century, the dominance of psychoanalytics had led to a focus on mental illness, with recovery associated with the absence of symptoms. However, among certain psychologists, this absence of mental illness in itself was not enough to constitute mental health, and this led to the rise of a new kind of psychology: humanistic psychology.(25) This movement returned to ideas of the ancient Greeks and Renaissance, which had advocated the importance of happiness, fulfilling one’s potential and expressing oneself through creativity. Socrates, for example, had cited self-knowledge as key to happiness. Happiness became a central theme of different philosophical movements, including Epicureanism and Stoicism, and religions, including Judaism and Christianity, which draw on the Divine command theory of happiness (that happiness comes from following the commands of the Divine). Building on some of these earlier ideas, humanists took a holistic view of life, believing that as well as our biochemistry and environments affecting our health, we are also influenced and motivated internally to fulfil our human potential.
One of these humanist psychologists was Abraham Maslow. Maslow said of the humanist movement ‘it is as if Freud supplied us the sick half of psychology and we must now fill it out with the healthy half’. (26) Maslow built on the work of his colleagues to study ‘self-actualization’: the motive to realize one’s full potential through the pursuit of knowledge, giving to society, a quest for spiritual enlightenment, and expressing oneself creatively. Maslow proposed that there was a ‘hierarchy of needs’ among humans. On a basic level, we require physiological things, such as food, water, and sleep. Beyond this, our next priorities are for safety and a sense of love and belonging. Once we have these things, we then require esteem, including feeling confident and respected. If we achieve these things, we can then enjoy self-actualization and peak experiences of euphoria: feeling in perfect harmony with ourselves and our surroundings (see Figure 2.1).
In 1954, Maslow coined the term ‘positive psychology, and in 1996, the newly elected President of the American Psychological Association, Martin Seligman, picked up on this term and chose it as the central theme for his term of presidency. This was an important step for positive psychology as it helped move the field away from humanism and into a scientific and epistemological domain. Seligman, in collaboration with his colleague Mihaly Csikszentmihalyi, defined positive psychology as ‘the scientific study of
Figure 2.1 Abraham Maslow's Hierarchy of Needs. Reproduced from Maslow, Abraham H., Frager, robert D. Faidman, James, Motivation and Personality, 3rd ed., ©1987. reprinted by permission of Pearson education, Inc., new York, new York.
positive human functioning and flourishing on multiple levels that include the biological, personal, relational, institutional, cultural, and global dimensions of life’.(27) Seligman followed on from Maslow in wanting to shift the focus away from just mental illness into positive aspects of health. So the new positive psychology focused on positive experiences, relationships, institutions, and psychological traits.
In 1999, the first Positive Psychology Summit took place, followed shortly afterwards by the First International Conference on Positive Psychology in 2002. In 2006, a course at Harvard University used the positive psychology framework, which led to greater attention among the general public. And in 2009 the First World Congress on Positive Psychology took place at the University of Pennsylvania. As the field has evolved, positive psychology has arguably shifted in direction. In 2011, Seligman published his book Flourish, in which he wrote ‘I used to think the topic of positive psychology was happiness ... I now think the topic of positive psychology is wellbeing’.(28) Wellbeing, like health, has proved difficult to define, although it is often split into different dimensions such as hedonic wellbeing, which includes happiness and positive affect; eudaimonic wellbeing, which includes feeling a sense of purpose and meaning in life; and evaluative wellbeing, which includes general satisfaction with life.(29) Broadly, it is now widely recognised that good mental health is about both the absence of mental illness and the presence of wellbeing.(30)
Not only have wellbeing and wider positive psychology research broadened the way we approach mental health, but research has demonstrated that these positive states can in themselves impact on our wider physical health. For example, even among people who have the same level of exercise, drinking, sleep, and smoking, happier people have longer life expectancies, and positive emotions are associated with greater resistance to colds and flu.(31) In return, healthy behaviours such as eating fruit and vegetables are associated with greater happiness and life satisfaction.(32,33)
This research into mental health returns us to the WHO definition of health from 1946 as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. In 1946, and for decades afterwards, this definition was viewed in certain circles as idealistic. However, the gradual challenges to the biomedical model of health that was dominant in the nineteenth century, the (re-)rise of the biopsychosocial model and the increasing prominence of wellbeing have turned the ideal into a more tangible concept and one that now lies at the heart of the research and policy agendas of many governments globally.