Beyond Adjustment

Optimal Mental Health, Value Systems and Psychotherapy

or

How to Turn a Paranoid Schizophrenic into an Obsessive-Compulsive

"The study of crippled, stunted, immature and unhealthy specimens can yield only a cripple psychology and cripple philosophy."--- Abraham Maslow

This paper is intended as a preliminary theoretical exploration of the relationship between mental health, value systems and psychotherapy. Preliminary, because I believe that the understanding and clear conceptualization of how these three aspects of living relate to the human condition, in general, and life in our society, in particular, is likely a life-long process. This paper is theoretical because no effort will be made to present empirical or quantifiable data to support any assertions, but rather, the discussion will rely on logical arguments to support the conclusions reached.

To begin with we need to understand what the term "mental health" means. There is considerable controversy even in defining this term at the present time. Do we mean normality or adequate adjustment as our criteria for mental health? Do we mean the absence of illness? What about the idea of self-actualization or the fully functioning person that humanistic psychologists have written about?

In the minds of many people mental health is coincident with being well adjusted and approximating society's norms. Some cultural anthropologists have advocated "a relativism that equated mental health with conformity to the values and practices of one's particular cultural milieu". (Smith, 1950 p. 503). Behaviorists who intend to understand human behavior in a value-free context have written, "The designation of a behavior as pathological is dependent upon the individual's society .... Maladaptive behavior is behavior that is considered inappropriate by those key people in a person's life who control reinforcers". (Ullman & Kramer 1973, p. 297-8).

Both these definitions seem to imply that the criteria for adaptive or mentally healthy behavior, (although it is unlikely that a behaviorist would even use the term, "mental" health), lie outside the individual and within either the values of the culture or the values of those people who control reinforcers. These views clearly strip the individual of the possibility of his or her own being as a locus of valuation, regardless of society's unhealthy dictates, and imply an other-directed orientation to mental health.

The argument that adjustment to society is a sufficient definition of mental health is clearly a weak one. What about a society whose values and norms run counter to the basic needs of human beings and cause a more stressful struggle for survival than necessary among the members of the society? Helen Merrell Lynd (cited in Friedman 1974, p. 76) has written, "Psychologists frequently fail to give explicit recognition to the distinction between normal or healthy in terms of what are the generally accepted norms of the society and in terms of what is humanly desirable". Kohn (1978) has noted, "Erich Fromm, in speaking of a 'sane society' (1955) has implied that a not-so-sane society might very well exist, and this forces us to think of health as something qualitatively different from adjustment to one's culture".

In the play Equus (1974), Dr. Dysart comments, "The normal is ... the dead stare in a million adults. It both sustains and kills --- like a God". Jourard (1971, p. 87) has written, "Perhaps, normal people ... seldom know great joy, great enthusiasm, passionate dedication ...", and Rollo May (1969, p. 174) wrote: "No wonder patients prefer neurosis and psychosis to 'normality' for, at least their deviate existence had vitality and force".

Others have equated normalcy with neurosis. Bugental (1965, p. 187) maintained that "the average person is largely unaware in the conduct of his life and is much closer to the neurotic", and Andras Angyal (1965 pp 132-3) wrote, "If the person's neurosis is stably integrated and he also maintains an external social adaptation through conformity......he may be successful and 'well adjusted' from the point of view of his culture though his life is crippled and dwarfed". Laing (1967, p. 27) made rather strong statements about the relationship between adjustment, normalcy and mental health. "What we call 'normal' is a product of repression, denial, splitting, projection, introjection and other forms of destructive action on experience.....The 'normally' alienated person, by reason of the fact that he acts more or less like everyone else, is taken to be sane".

It should be clear from this discussion that, at the very least, the view that normalcy and adjustment constitute mental health is being questioned by many contemporary thinkers. If adjustment is not mental health, and does not adequately define mental health, what other views are there?

The medical model is another way of looking at mental health which seems to be closely related to the adjustment and normalcy school. This model tends to view mental health as the absence of disease.... "Illness is something that happens to the person, not something he is or does... This means: into what category of previously described illness does this patient best fit?"(Siegler and Osmond 1974, pp24) and "The physician.....works on the basis that(the absence of illness and the presence of health) do coincide, for all practical purposes......I believe most patients would settle for the absence of illness. If they are not sick, they are well." (Barton 1958, pp. 112, 119).

As far as psychiatry and psychotherapy are concerned, the medical model is currently under attack from many quarters, for various reasons, which are beyond the present scope of this paper. However, more germane to our discussion are the attitudes and values which this model generates in viewing disturbed individuals and treating those disturbances. Berne (1976, p. 24) states, "Personally I'm a head mechanic. -- that's all I am. Like you come in with wheels wrong in your head, and I'll say, okay we'll try and fix your head...." The question here for us, and it applies to all therapy, is: Fix your head to do what? Without an idea of what it means to be "fixed" (mentally healthy); toward what goals are we working?

The humanistic school of thought has developed some concept of what goals to work toward; that is, a notion of what a mentally healthy, fully-functioning person is. Charlotte Buhler (1962) has written that the function of therapy from a value standpoint is to aid the patient in recognizing how it is that he lives in the world with himself and others.

A key issue in defining mental health is the question of self. The humanistic school posits the existence of an inner self which unfolds or becomes "actualized" in a healthy individual. Other views of human beings, such as the behavioral school, acknowledge no such inner entity. Buhler (1959) writes, "I assume the self to be a core system, whose development I see in four directions.' 1) the development of what we want for ourselves, 2) the development of what we believe we owe to others and to the world at large, 3) the development of our self-expression and self-realizing potentials and 4) the development of our self-evaluation". She believes that certain basic tendencies interact and are integrated in the core system. The basic tendencies she has called need-satisfaction, self-limiting adaptation, creative expansion and upholding the internal order. She says, "This core system's thrust into life is that intentionality with which the individual strives toward hoped for fulfillment. In the ideal case, this is identical with the realization of the individual's best potentials." (1967).

Notice here that we still do not have a very clear-cut description of characteristics which the healthy self would manifest. Maslow (in Cofer & Appley, 1964) has gone further than most humanistic psychologists in specifying the characteristics of the "healthy" or self-actualizing or fully functioning person. He lists the following trends:

"1. More efficient perception of reality and more comfortable relations with it. This means that falseness,

spuriousness and incongruence are readily detected. The fresh, concrete and idiographic are easily distinguished from the generic, abstract and rubricized. The person can also tolerate uncertainty and ambiguity more easily than most people

2. Acceptance of self and others. The person has relatively little guilt, shame or anxiety; that is, they accept themselves and their various characteristics and are not defensive.

3. Spontaneity. They are especially spontaneous in their thoughts and other covert tendencies and are also in their behavior, but unconventionality is not a mark of their behavior, for their unconventionality is not put on to impress others and may even be suppressed in order not to distress others.

4. Problem Centering. They are not ego-centered but rather oriented to problems outside themselves, imporrtant problems to which they are devoted with a sense of commitment.

5. Detachment; the need for privacy. They do not mind solitude and often seek it.

6. Autonomy; independence of culture and environment. They have relative independence of their environments.

7. Continued freshness of appreciation ... "they derive ecstasy, inspiration and strength from the basic experiences of life". (Maslow, 1954, p. 215), even on occasion from things they have seen, heard or done many times.

8. Social interest. This is a "feeling of identification, sympathy and affection" for mankind (Maslow, 1954, p. 217), even though the person may be troubled by the many shortcomings of the species.

9. Interpersonal relations tend to be very deep and profound and are present with only a few rather than many individuals. Such hostility as is shown is reactive in a situation, rather than chronic.

10. Democratic character structure. They respect people and can learn

from and relate to them, irrespective of birth, race, blood, family, etc.

11. Discrimination between means and ends. The person distinguishes

what he is striving for from the means for accomplishing the end to

a degree that most people do not. On the other hand they can often

enjoy the means to the end which more impatient persons would dislike.

12. Sense of humor. These people tend to be philosophical and non-hostile in their humor.

13. Creativeness. Each person has his special kind of creativity and unique inventiveness.

14. Resistance to enculturation. They get along in the culture but are detached from it; they are basically autonomous although not particularly unconventional in a behavioral way."

It is important to note that these traits characterize a process rather than a fixed state. That is to say: according to this view, healthy human functioning is a growing, movement oriented, active process and not a static or defensive or merely an adjustment process.

We have thus far examined some concepts of mental health from the adjustment, medical and humanistic schools. However, none of these models provide a fully adequate definition or way of thinking about what optimal mental health is. I now want to propose the following definition of optimal mental health and discuss the concept and it's implications a bit further.

Optimal mental health is that condition of living and experiencing which occurs when a human being has had his or her physiological, emotional, social and psychological needs either sufficiently met from birth or remediated through later therapeutic or corrective experiences. This condition, in the growing and maturing stages, makes possible the transition from one developmental period of life to the next with minimal conflict. The condition of optimal mental health includes, at least, the following characteristics: 1) A feeling of being a separate self, distinct from all others, including a feeling of being emotionally and mentally separate from one's parents and siblings; 2) A feeling of comfort with one's body and physical appearance and functions; 3) Comfort with, understanding of, and enjoyment of, one's sexuality, sexual and sensual feelings, either with very minimal or no guilt or anxiety; 4) The ability to enjoy the other pleasures of the body; such as eating and motility, without either guilt, shame or anxiety; 5) The ability to control these pleasures and feelings so that they are engaged in without harm to the individual's health or other functions in the psychological, social and economic realms; 6) A feeling of pride and respect for one's self and one's abilities and an accurate assessment and knowledge of these abilities; 7) The ability to relate to other people in ways which meet one's own needs without unduly interfering with the rights, needs or feelings of others; 8) The ability to engage in productive and/or creative work of one's own choosing, reflective of one's interest level and ability; 9) The ability to play, laugh, be childlike and enjoy recreational activities; 10) The ability to respect and empathize with members of the human race of both sexes as full human beings with needs, feelings, thoughts, dreams, desires, goals, pains, confusions and stresses which are uniquely their own as well as universally human; ll) A feeling of compassion for, and an interest in, the human condition as a whole; 12) The desire and ability to seek new experiences and new learning; 13) The ability to communicate accurately with others about one's self and one's feelings and needs with maximum ease; 14) The ability to accept the reasonable and necessary frustrations of living with minimal emotional upset; 15) The ability to form relationships with members of both sexes based on mutuality of each other's enjoyment rather than exploitation of, or selfish manipulation of the other; 16) The ability to relax; 17) The ability to form relationships with others on an impersonal basis for business or other more formal purposes; 18) The ability to plan for the future as well as to enjoy the present; 19) The ability to accept responsibility and make commitments; 20) The ability to make one's own value judgments and reflect on the values and mores of one's culture without undue ethnocentrism; 21) The ability to sustain one's self in the economic system of the culture without undue stress; 22) The ability to think for one's self without undue fear of disapproval from other people; 23) The ability to function as part of a group without undue con- flict, 24) The ability to pursue one's concept of spirituality or lack of same as one wishes; 25) The ability to maintain one's productivity and "aliveness" and desire for new experiences and learning into old age; 26) An acceptance of death within one's personal belief system so that this event does not inhibit one's ability to live fully.

It should be noted that this is a definition of optimal mental health, which, given our present circumstances as a species, is rarely, if ever, achieved. We will inquire into some of the reasons for this in the next section but, before doing this, let's examine some of the features of this view of mental health. First, it describes characteristics or abilities the healthy person possesses and does not imply that they are always being manifested. It might be seen as a "gestalt of health" from which necessary abilities are free to emerge as the person needs them. In other words, the person is free to choose, he or she has the ability to behave, live and "be" in this way although he or she may not always choose it for various reasons. This definition shouldn't be thought of as "etched in stone" but open to growth, modification and criticism, just as a healthy person would be.

Also, it implies that mental health is an active process which is the resultant of proper growth-oriented conditions in the physiological, emotional, social and psychological spheres and not only a process of adjustment to one's culture or social subgroup. In most ways this view is trans-cultural because its focus is on the ability of the individual to fulfill self in the various spheres of existence discussed, including the process of evaluating one's culture, although it should be noted that the satisfactions of life must take place within the specific culture in which the individual is living. What is implied here is active adaptation and where necessary, transcendence of unhealthy aspects of the culture. The possibility of influencing change if one so desires, rather than mere adjustment to a prescribed set of norms and behaviors, is also implied. The individual is free within the limits of his or her adaptational abilities to live a life which fulfills oneself in the physical, emotional, social, psychological and spiritual realms.

Some people will no doubt complain that this definition of mental health is outrageously idealistic and utopian and that no such human being exists. However, the fact that something does not presently exist does not mean it always need be that way. It is one contention of this paper that the method of valuation which condemns high ideals as utopian and unrealistic in favor of the pragmatic, empirical and descriptive approach is itself a fundamental cause of our present unhealthy condition as a society and species. On a strictly clinical basis it is contended that we need a standard of mental health to help people grow toward, one which is specific, yet flexible and adaptive enough to individual needs, interests and problems to provide useful ideal standards even if these standards are not all reachable at the present time. At least, we will have some explicit directions to point people toward in the various areas in which they present problems. Granted, also, that most clinical problems present a picture even below the present norm of "adjustment", and nowhere near optimal health; nevertheless, with a standard of health beyond mere adjustment, we should not become trapped in enforcing adjustive norms which may not be in the best interests of our own clients.

Jourard (1971) has written eloquently on this topic, and May (1958 pp. 86-7) writes,

"The kind of cure that consists of adjustment, becoming able to fit the culture ... is compatible with the central theme of the culture that one live in a calculated, controlled, technically well-managed way. Then the patient accepts a confined world without conflict, for now his world is identical with the culture ... In this respect psychotherapists become the agents of the culture whose particular task it is to adjust people to it...

In another book (1969 p. 233) he has called such therapists "the psychic policemen of the society."

With a definition of mental health which focuses on the self-realization, satisfaction and growth of the individual without the sacrifice of the uniqueness and dignity of the individual to possible inhumane and restrictive adjustive norms, we can avoid this trap while still affirming those norms which operate to the benefit of the individual, the group and the society as a whole.

We are now ready to inquire into some contemporary value systems and see how they might be affecting human life and mental health. In our society we supposedly operate within a system which values individual achievement, productivity, competition and the making of profit. We value freedom and democratic decision making. These are some of the stated, or overt, values of our culture and, on the surface, these seem to be productive values. Yet, why are so many people unhappy, neurotic, sick, angry, disheartened, resigned or suffering from "existential neurosis"? The answer lies in the fact that our economic and political value systems do not translate into a way of living that promotes the meeting of the physiological, emotional, social and psychological needs of human beings in a way which promotes maximum growth and promotion of mental health.

Our ideas of individual achievement, for example, stress achievement through competition with one's fellows; our idea of productivity is very closely tied to economic productivity within our industrial-technocratic system whose goal it is to manufacture goods and entertain people for a monetary profit. In order to survive in our culture and economic system, most individuals are molded almost from birth to think in terms of "success" and fulfillment in economic and monetary terms. The operative term here is "molded"; taught to fit our culture's notion of what a good person is. It is contended that many of these norms are antithetical to full human functioning and mental health.

It is beyond the research for this paper to be able to effectively lay out in specific terms the many value systems which operate in our culture. What is important here is to sketch out some of the dominant themes and their effect on mental health and their implications for psychotherapists. Understand that the discussion of these value systems and their effect on mental health is based on the definition of mental health proposed in this paper.

First, in the sphere of the physiological and sexual needs, it seems that the majority of people are still being brought up with outmoded and negative sexual attitudes. Although this has changed since Freud's time and has continued since the so-called "sexual revolution" of the late 1960s and 70's , negative and repressive attitudes are still rampant in large portions of our society. This is in part due to our Calvinist-Protestant Ethic, anti-pleasure, excessively work-oriented heritage and the basic value system which is associated with it. This value system denies to the individual the right and privilege of sexual and sensual pleasure; it defines these pleasures as somehow "sinful" and to be disdained. As therapists, we know the devastating psychological effects of the repression and denial of sexual urges and feelings. How is an individual to have a healthy self-concept and positive self-feeling if he or she lives in a culture where the predominant value system condemns what are some of the most basic urges and needs of a human being? Why do we not have a cultural value system which defines sexual and sensual gratification as beautiful and desirable and "good", as parts of our nature to be understood, acknowledged and controlled for our benefit and that of our sexual partner's, rather than a part of ourselves to be denied, repressed, suppressed and felt guilty about. Clearly, these are rhetorical questions which would have a very long historical answer but, for our purposes, it is important to see that it is a system of values which supports the present attitudes toward, and problems with, this area of human functioning.(These observations are not meant to minimize the excessive emphasis on superficial sexuality in the media and advertising of the 1980's and 1990's. However, these can best be understood as a counter-reaction to the repressive norms of the past and not based on any healthy relationship to this realm of human functioning.)

Another area related to positive or optimal mental health is self-respect and esteem. What societal value systems are contributing to problems in this area? One is the notion of a person as having value basically as a producing or economic unit of the society. As a culture we do not grant people or raise our children with sufficient respect or esteem for "being" but rather we value "doing" and "producing" and "succeeding" and "winning". Many people see the world in two categories, "winners" and "losers". What is the effect on a child raised with this system of values? The "normal" product of such a value system is a person who doesn't fully accept self, a person who has never had the experience of being appreciated for his or her unique qualities and thus has little stable center from which to experience life. This would be a person who feels like a good person only when "doing" something, or "making" something or "producing" something or "pleasing" someone. We see many of these people clinically. The successful ones come in suffering from stress-related psychophysiological problems or, perhaps, complain of anxiety states or occasional feelings of emptiness and dissatisfaction. The less successful may be suffering from drug addictions or depressions or psychosis. Again, what we need to realize is that it is our system of values as a culture which is strongly influencing the development of these people who become clinical cases, and which really stands behind much of the disturbed behavior we see manifested.

Another area of devastation is the interpersonal one. In a system based on competition and economic exploitation, many people fail to learn so-called "pro-social" behaviors. People do not learn to be cooperative, non-hostile companions largely because they are still in the state of trying to meet their own esteem needs, deal with their own and others' hostility and defend themselves. Nowhere is this more clear than in the relationship between the sexes. Divorces are the norm, women are angry at "male chauvinism" and being treated as second class citizens, men are threatened by "aggressive" or assertive females and a climate of mutual suspicion prevails.

How many men and women can relate as friends and equals appreciating the fullness of their being and appreciating their sexual and temperamental differences, rather than being threatened by these and using various ploys and manipulative devices in their relations with one another? Again, using our definition of mental health, the sexes ought to be able to relate to one another in a way which brings mutual enjoyment. But our present value system teaches us to think of other people as objects to be used rather than people to be interacted with understood and appreciated.

This is not to say that there are not positive forces in society speaking out against some of the repressive anti-human value systems which we find ourselves currently experiencing. These forces, however, are a minority and do not control economic or governmental authority. What is the nature of the value system which dictates vast sums still being spent on nuclear and other weapons, rather than education and development of our healthy human potentials? What value system promotes the training of our young men for war rather than creative growth? At the very highest levels of our society, where is there a spirit of unity and concern for the human race, rather than merely for profit, pseudo-self-aggrandizement and personal power?

Before discussing the role of the psychotherapist in this situation, we should have some historical perspective. The conditions described above are not unique to 20th Century America.

In the 17th Century, the English philosopher, Robert Burton, wrote a book called The Anatomy of Melancholy (1936). The following passage is instructive:

"If Democritus were alive now, and should but see the superstition of our age, our religious madness, so many professed Christians, yet so few imitators of Christ, so much talk and so little conscience, so many preachers and such little practice, such variety of sects - how dost thou think he might have been affected? What would he have said to see, hear and read so many bloody battles, such streams of blood able to turn mills, to make sport for princes, without any Just cause? Men well proportioned, carefully brought up, able in body and mind, led like so many beasts to the slaughter in the flower of their years, without remorse and pity, killed for devils' food, 40,000 at once!

"At once? That were tolerable; but these wars last always; and for many ages, nothing so familiar as this hacking and hewing, massacres, murders, desolations! Who made creatures, so peaceable, born to love, mercy, meekness, so to rave like beasts and run furiously to their own destruction?

"How would our Democritus have been affected to see so many lawyers, advocates, so many tribunals, so little justice; so many laws, yet never more disorders; the tribunal a labyrinth; to see a lamb executed, a wolf pronounce sentence? What's the market but a place wherein they cozen one another, a trap? Nay, what's the world itself but a vast chaos, a theatre of hypocrisy, a shop of knavery, a scene of babbling, the academy of vice? A warfare, in which you must kill or be killed, wherein every roan is for himself; no charity, love, friendship, fear of God, alliance, affinity, consanguinity, can contain them. Our goddess is Queen Money, to whom we daily offer sacrifice. It's not worth, virtue, wisdom, valour, learning, honesty, religion, for which we are respected, but money, greatness, office, honour.

"All these things are easy to be discerned, but how would Democritus have been moved had he seen the secrets of our hearts! All the world is mad, and every member of it, and I can but wish myself and them a good physician, and all of us a better mind."

A more modern thinker, Ludwig Von Bertalanffy (1964), Professor of Theoretical Biology, echoes Burton in a more moderate and modern vein in the following:

"Why has life become devoid of meaning and goals at a time of affluence and high standards of living, whereas it apparently had meaning and goals in times incomparably poorer in their economic and technical resources?

"The best answer I am able to find is that the complex structure of symbols and values called 'human culture' is, besides many other things, an important psychohygienic factor. If man is surely a creature seeking satisfaction of his biological needs - food, shelter, sex, an amount of security for his biological and social existence - he also lives in the higher realm of culture, which is defined by the very fact that it transcends biological needs. Tradition, status in society, full realization of potentialities, religion, art, science - these are a few of the needs deriving from man's cultural existence. Starvation at this symbolic level leads to disturbances of the mental organism, just as starvation at the biologic level leads to disturbances of the physical organism. This is a well-established fact of psychopathology.

"The diagnosis of the sick society, then, is quite simply that it provides more or less abundantly for the biological needs but starves the spiritual ones."

Toward the end of a "better mind" and feeding our starvation at a symbolic level (changing our value systems), what can we as psychologists and psychotherapists do to effect this situation in a positive way, not only for the good of our society but for mankind as a whole?

The first thing is to recognize the role that certain of our cultural value systems have in producing "normal adjustment" and psychopathology and to acknowledge this in our research, educational and therapeutic endeavors. Many of us have become so enamored with scientific method that we have forgotten that the object of study is ourselves, human beings, and that human beings are beings who live by, live with, and create value systems. The scientific method itself is the creation of human beings and reflects a special value system or way of viewing and understanding life. We cannot allow the method we have created to turn against the deeper needs of its creators. We cannot be hypnotized by the false claim that science must be value-free and, so-called, "objective", and try to apply this to an "empirical" understanding of a being whose primary mode of existence is rooted in the values, symbols and attitudes he or she uses to guide behavior and thought and create meaning from the many facets and aspects of human life.

This is not to deny the place of empirical methods of investigation of human problems or human phenomena in general. This is not to deny the value of quantification or careful data collection and analysis. This is not to deny the utility of careful behavioral observations and the understanding of how environmental events and learning principles influence behavior. This is not to deny the uses of tests and measurements or other means of gathering "objective" information by which we shed light on ourselves and our situation. This is not to deny the validity of the whole system of values which holds in high esteem the search for the unbiased, objective truths of nature and human behavior. This is to emphatically affirm and remind ourselves that we psychologists are studying subjective, valuing, thinking, feeling, emotional, sensate beings who behave not only as a consequence of more easily measurable environmental events, so-called "real, observable events" (1979), as many of the more experimentally-minded psychologists assert but, also, and more fundamentally, we behave as a result of our not so easily measurable subjective impressions, feelings, values, perceptions, intuitions, interpretations, distortions, unconscious and conscious motivations, thoughts and symbols and that our uniqueness as individuals exists predominantly on these levels and must be studied in that realm.

Those psychologists who believe that to be a "legitimate", "hard" science, psychology must be based on deterministic principles much like other "real" sciences such as physics, are bogged down in an anachronistic view of physics and the idea of causality in science. Since the discovery of subatomic processes, the hard deterministic view put forth by the classical physicists of the 19th Century has been replaced in modern physics by what is referred to as "weak causation". Without going into great detail on this, physicists now know that the classical variables defining the state of a system cannot be used to predict what will happen to an electron. This has led in physics to what is called the uncertainty principle. The physicist, J.A. Ripley (1965), has written:

"Whether one refers to the consequence of the uncertainty principle as a 'breakdown' of causality is a matter of definition. We can, however, conclude that it is impossible to predict the result of an observation on a particle with certainty. In this sense, the type of determinism suggested by Laplace is not even conceivable. The argument about 'free will' has been thrown into a somewhat different focus. However, we shall not pursue this topic which would carry us too far into speculative philosophy. But even if the general principle of causality is given up as a philosophic tenet, it will still have its role to play as a regulative principle guiding the objectives of scientific research which is to discover which factors are relevant in determining the course of events in a given situation."

The key point for us in psychology is to note that even physics, the so-called "hard" science, recognizes that its goal is to discover the factors which are relevant in determining the course of events in a given situation. Surely, if we are to build an accurate science of psychology and psychotherapy, we cannot be bound to a narrow empiricism that examines only observable events and rules out some of the most significant factors in determining the course of human events; that is, man's subjectivity: his values, his symbols, his perceptions, his emotions, his senses, his thoughts - the processes which give man his uniqueness.

Psychotherapists must take a stand on issues of concern to our society and mankind as a whole and no longer hide behind narrow empiricism. We cannot grow, change or become more mentally healthy by describing only what is. We must actively strive and teach about what can be. We can use our empirical methods in the service of our growth but we must guide the direction of that growth based on a value system which promotes human welfare.

We must use our knowledge and our wisdom to provide a voice for society which speaks up for the needs, rights and dignity of the individual so far as we understand them at our present state of development. Just as we often hold up a mirror to our clients so they can see themselves and grow, so must we provide this same service for our society.

On a strictly clinical basis, having a firm definition of what mental health is and how our own, the client's and the culture's value systems affect this, should help us see more clearly what mental health is not, and give us more accurate guidelines as to what to work toward beyond mere adjustment, or readjustment to the aspects of our culture which contribute to psychopathology.

It is no doubt a grandiose illusion to believe that society may examine its destructive norms in the near future and make the changes necessary to promote healthy or optimal human mental health, just as we might find it difficult to believe that at present a paranoid schizophrenic can recover sufficiently to show optimal mental health. Perhaps, at present, we can only get the paranoid schizophrenic and the culture as far as obsessive-compulsive neurosis, but that is a start.

Bibliography

l. Angyal, Andras, Neurosis & Treatment: A Holistic Theory (New York, The

Viking Press 1965.)

2. Barton, Walter E. M.D.,"Viewpoint of a Clinician", in Current Concepts of

Positive Mental Health, Marie Jahoda, (New York: Basic Books 1958.)

3. Berne, Eric, Beyond Games and Scripts,(New York: Grove Press, 1976).

4. Bugental, James F.T., The Search for Authenticity: An Existential-Analytic

Approach to Psychotherapy, (New York: Holt, Rinehart and Winston 1965).

5. Buhler, Charlotte, Values in Psychotherapy, (New York: Free Press 1962).

6. Buhler, Charlotte, "Theoretical Observations About Life's Basic Tendencies".

American Journal of Psychotherapy. 1959, 13: pp 561-581.

7. Buhler, Charlotte, "Human Life as a Whole as a Central Concept of Humanistic

Psychology" in Challenges of Humanistic Psychology, James F.T.

Bugental ed. (McGraw Hill 1967 p. 87).

8. Burton, Robert, "The Anatomy of Melancholy" in Outline of Great Books, New

York 1936.

9. Cofer, C.W. and Appley, M.H., Motivation: Theory and Research, John Wiley and Sons Inc. New York 1964 pp 669-70.

10. Friedman, Maurice, The Hidden Human Image, (New York: Delta Books, 1974).

11. Jourard, Sidney M., The Transparent Self, revised editi.on, (New York: D. Van

Nostran Co. 1971).

12. Kohn, Alfred, "On Defining Mental Health: A De.fense of Normative Psychology".

Unpublished paper 1978.

13. Laing, R.D., The Politics of Experience, (New York: Ballantine Books 1967).

14. Lundin, Robert W., Theories & Systems of Psychology, D.C. Heath & Co.,

Lexington, Mass. 1979, p. 348.

15. May, Rollo, "Contributions of Existential Psychotherapy", in Existence, ed. May Angel and Ellenberger, (New York: Touchstone Books, 1958, pp 37-91).

16. May, Rollo, Love & Will, (New York: Delta Books 1969).

17. Ripley, J.A, Jr., The Elements and Structure of the Physical Sciences,

(New York: John Wiley & Sons, 1965 p. 391).

18. Shaffer, Peter, Equus, (New York: Eard Books 1974).

19. Siegler, Miriam and Osmond, Humphrey, Models of Madness, Models of Medicine,

(New York: Harper Colephon Books, 1974).

20. Smith, N. Brewster, "Optima of Mental Health: A General Frame of Reference", in Psychiatry, 1950; 13, pp 503-10.

21. Ullman, L.P. and Krasner, L., "The Psychological Model", reprinted in

Theories of Psychopathology and Personality, ed. T. Millon,

2nd Edition, (Philadelphia: W.B. Saunders Co., 1973) pp 294-305.

22. Von Bertalanffy, Ludwig, "The World of Science and The World of Value", inChallenges of Humanistic Psychology, James F.T. Bugental ed. (McGraw Hill 1967) p. 338.