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Psychiatry is one of the oldest specialties of medicine. For millennia we’ve tried to understand and modify abnormal behavior and care for those with mental disorders. During this time, the tradition has been to restore people to their regular level of functioning. In recent decades, along with psychology and psychotherapy, psychiatry has started to develop the expertise to understand and modify good performance in order to support people moving from their baseline to a higher level of functioning.

A New Science of Human Strengths

Officially, two presidential addresses mark the start of this new direction and tradition. First, in 1998 when Martin Seligman, as president of the American Psychological Association, talked about a new science of human strengths”. In that address, an infrastructure for Positive Psychology was sketched with support from the John Templeton Foundation.

Second, in 2013, psychiatrist Dilip Jeste called for a broader role in psychiatry in his presidential address as president of the American Psychiatric Association – thus officially launching the Positive Psychiatry movement.

What is Positive Psychiatry?

Positive Psychiatry is conceived as applying positive psychology tools to help those with, or at risk for, mental disorders. It has been defined as the science and practice of psychiatry that seeks to understand and promote well-being through assessment and interventions aimed at enhancing behavioral and mental wellness. It includes enhancing positive psychosocial factors among people who have or are at risk of developing mental and physical illnesses.

These Positive Psychosocial Factors (PPSFs) include psychological traits and environmental factors that mediate positive outcomes such as wellbeing, growth, and flourishing. The work of Seligman and Petersen validated a group of six virtues containing a total of twenty-four character strengths. Their research looked into virtue traditions throughout history including Confucian, Taoist, Buddhist, Hindu, Athenian, Judeo-Christian, and Islamic cultures.

The list of six major virtues includes wisdom, courage, humanity, justice, temperance, and transcendence. The components of each virtue are listed in the table below.

Virtue Character strengths components
Wisdom Creativity
Curiosity
Open-mindedness
Perspective
Courage Bravery
Persistence
Integrity
Vitality
Humanity Love
Kindness
Social intelligence
Justice Citizenship
Fairness
Leadership
Temperance Forgiveness
Humility
Prudence
Moderation
Self-regulation
Transcendence Appreciation of beauty
Gratitude
Hope
Humor
Spirituality

 

You can find out your character strength profile taking the free VIA test.

In short, these many aspects of the positive approach may be articulated in a more concise definition of Positive Psychiatry as the application of Positive Psychology principles and tools, including Positive Psychotherapy, to those with mental disorders or at risk of developing them.

The Deep Roots of Positive Psychiatry

It may be tempting to dismiss this positive movement, in psychology, psychotherapy, and psychiatry, as a new age fad or passing interest. In fact, religious texts that are foundational to several civilizations contain the seeds of positive psychological traits and ways to foster them.

As stated above, there is overlap on these traits across traditions and they form the basis of a universal theory of human strengths. At the source of Western Civilizations, in the works of Plato and Aristotle one finds extensive discussion on these virtues and character strengths. In his major classificatory effort, Aristotle organized not only biological specimens but also worked on a theory of virtues.

Aristotle’s Nicomachean Ethics

In the ten books composing the Nicomachean Ethics, Aristotle builds his theory of virtues around the doctrine of the mean. In it, virtues occupy the space between extremes of behavior in that courage stands between cowardice and recklessness, confidence between timidity and arrogance, generosity between miserliness and vulgarity and so on.

Aristotle’s ideas converge with the teaching of other foundational thinkers. In fact, these deep roots have been neatly summed by Lou Marinoff, a professor of philosophy at City College of New York, as the “ABC of happiness” with A obviously standing for Aristotle, B to Buddha, and C for Confucius. Accordingly, in his writings, Marinoff draws a parallel between Aristotle’s doctrine of the mean with Buddha’s Middle Way and Confucius’ Way – or Tao.

Why do we need Positive Psychiatry?

Clinical psychiatry has made tremendous progress over the last 150 years, from the Era of the Asylum, through the psychoanalytic heydays, to the age of Prozac. The table below contrasts it with the Positive Psychiatry perspective:

Clinical Psychiatry Positive Psychiatry
Target population Those with mental disorders and behavioral symptoms. Those with, and at risk for, mental disorders.
Immediate Goals Cure, management of symptoms, and return to baseline functioning. Improvement above the baseline level of functioning.
Long-term goals Relapse prevention Recovery in mental illness
Treatment approaches Psychotherapy and psychopharmacology Positive psychotherapy, executive coaching.
Focus of attention Symptoms, dysfunctions Strengths, capabilities, talent.
Theoretical foundation Psychopathology and phenomenology Positive Psychology and resilience

 

In short, we need Positive Psychiatry because we live in a time of increased prevalence of mental disorders and suffering. Moreover, recent demographic and epidemiological trends analyzed by Nobel Prize economist Angus Deaton and Anne Case show increases in drug overdoses, suicide, and alcohol-related mortality – what they called “deaths of despair” – as responsible for an overall increase in all-cause mortality among whites in the US.

Along with our sister disciplines of positive psychology and positive psychotherapy, we psychiatrists can expand our vocabulary from the description of symptoms to the identification of character strengths, from the restoration of baseline to the achievement of optimal performance, from the control of depression to the establishment of contentment and life satisfaction.

Developing Positive Interventions

Several Positive Psychology Interventions (PPI) have been developed and their application to those with mental disorders should be carefully titrated and studied. That is one of the ongoing tasks in the development and maturation of positive psychiatry. With that in mind, here is a short list of positive psychology approaches to give the reader an idea of its direction:

  • Gratitude Interventions
  • Forgiveness Interventions
  • Savoring interventions
  • Strengths interventions
  • Meaning-oriented interventions
  • Empathy-related interventions
  • Creativity interventions
  • Patience interventions
  • Courage interventions
  • Humor interventions
  • Engagement and Flow interventions
  • Mindfulness and Meditative Interventions

While Positive Psychiatry training programs are still to be created, a variety of positive psychology and positive psychotherapy programs are currently available.

The Future of Positive Psychiatry

Implementing positive approaches in psychiatry is still in its infancy. Its growth will depend on psychiatrists opening our practices to use, adapt, and contribute to the field. There are many bridges to be built with our colleagues in positive psychology, positive psychotherapy, and even other fields like philosophy and executive coaching.

When we listen carefully to our patients’ needs and the needs of our society today, we will have to go beyond traditional models of psychotherapy and psychopharmacology, and the lessons learned along the way will make us not only prepared for the task but also better humans ourselves.

Erick Messias, M.D., Ph.D., M.P.H.
Erick Messias was born and raised in Brazil, where he completed medical school and practiced family medicine in rural areas before moving to Baltimore for residency training. He completed a psychiatry residency at the University of Maryland, in 2001, and preventive medicine at the Johns Hopkins Bloomberg School of Public Health, in 2003. While at Hopkins he also received a master in public health and a PhD in Psychiatric Epidemiology. Since graduation he has held academic positions in medical schools in Brazil, and later in Georgia and Arkansas where he was medical director of the Walker Family Clinic and responsible for the House Staff Mental Health Service at the University of Arkansas for Medical Sciences (UAMS) in Little Rock. Dr. Messias has over 40 publications in scientific journals, has published several book chapters, and edited a volume on schizophrenia for psychiatrists; he’s the recipient of many research and teaching awards. He’s currently the Associate Dean for Faculty Affair for the UAMS College of Medicine.

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