Turning to the power of positive psychiatry and psychology
In my career as a psychiatrist I have treated many patients with depressive disorder. Sometimes the patients have told me, “I am depressed, can you help me?” Some others said, “Can you make me happy?” I treated both requests the same.
I prescribed antidepressants. I believed that depression and happiness were opposites and if I were to treat the depression the patients would necessarily become happy. That is what Freud thought. He believed that at best what we can hope for in life, or in therapy, is to reduce misery as close as possible to zero.
A whole generation of psychiatrists have grown up with this view ingrained in their minds and training. Now I realise I am wrong. Our therapy was all about minimising misery and suffering and not about increasing wellbeing. We made the wrong assumption that reducing misery necessarily enabled patients to find their way back to wellbeing and happiness.
Recently I bought an interesting book titled Positive Psychiatry by Dilip Jeste, a distinguished Professor of Psychiatry, from the University of California. The titled intrigued me. What did he mean by the term positive psychiatry? Dilip Jeste defines positive psychiatry as ‘the science and practice of psychiatry that seeks to understand and promote wellbeing through assessment and interventions aimed at enhancing positive psychosocial factors among people who have or are at risk for developing mental or physical diseases.’
Positive psychiatry is an offshoot of positive psychology. Research, in the past 15 years in an entirely new branch of psychology called positive psychology, has shown that the skills of positive emotion, having better relationships, finding meaning in life need an entirely different set of skills from those needed for fighting depression.
Martin Seligman is the father of positive psychology. At 72 years, he continues to works as a Professor of Psychology in the University of Pennsylvania, USA. In 1998 he was elected President of the American Psychological Association (APA). In his Presidential address titled, ‘Building Human Strength: Psychology’s Forgotten Mission’ he pointed out that the APA had three missions; curing mental illness, making the lives of all people more fulfilling, and identifying and nurturing high talent. However it has concentrated only on the first and ignored the last two. He advocated the setting up of a task force to research the neglected two missions.
Since then positive psychology has come a long way. It is now the most popular undergraduate course in Harvard University. Aspects of positive psychology have been integrated into school curricula, the US Army has decided to teach positive psychology to its corps to help them become better officers. However we psychiatrists have failed to use these valuable lessons to treat mental illness.
In psychiatry we have two big books that classify all the mental diseases that afflict man. One is the International Classification of Diseases (ICD) sponsored by the WHO and the other, the DSM (Diagnostic and Statistical Manual of Mental Disorders) sponsored by the American Psychiatric Association. The number of disorders in DSM 5, the latest version, is 157, not counting sub categories. Using these books we can measure what is wrong with people, but do we have a book that shows how to measure what is right with people? Such a book did not exist until Martin Seligman with his colleague Chris Peterson decided to compile one. Over three years Seligman and his team studied all major religions and philosophical traditions and found six virtues shared across cultures.
The six virtues were: Wisdom and knowledge, courage, humanity, justice, temperance, and transcendence. Under these categories they also unidentified 24 sub categories which they named character strengths.
Wisdom and knowledge enable us to acquire and use knowledge. It includes the character strengths of creativity, curiosity, open-mindedness, love of learning, and perspective. Courage is the ability to accomplish goals in the face of opposition. The character strengths of courage are bravery, persistence, integrity, and vitality or enthusiasm. Humanity is the virtue of tending and caring for others and the strengths included are love, kindness and social intelligence. Strengths that accompany the virtue of justice help to create a healthy and stable community. They include, citizenship, fairness and leadership. Temperance protects us against excess and includes the character strengths of forgiveness, humility, prudence and self-regulation. The sixth virtue, transcendence forges our connection to the larger universe and enables us to find meaning to life. The strengths of this virtue are appreciation of beauty, gratitude, hope, humour, and spirituality. A detailed description of the virtues and strengths were published in the book Character Strengths and Virtues – A Handbook and Classification. The authors called this the manual of sanities, in contrast to the DSM, the manual of disease.
Positive psychology is a science and not a philosophy or common sense. Seligman and others have now developed rating scales for measuring character strengths, and also refined techniques for enhancing these characteristics in people. Some of these techniques have been tested in normal as well as in persons with mental illness and found to be effective. From these procedures a new psychotherapy called positive psychotherapy has been developed. This has been found to be effective in treating depression and other mental illnesses.
Some might say that positive psychology with its emphasis on pursuing the good life is a luxury that is available only for the privileged in society. It was thought that it was only possible to obtain the benefits of positive psychology in a society that was prosperous and at peace. This is no longer held to be true. Studies of happiness across countries have shown that the happiest people are not necessarily found in the most prosperous of countries. It has been found that people demonstrate the virtues of faith, hope and charity more when in adversity or in a crisis.
Though most of the studies on positive psychology were done in the West the themes were derived from the Eastern philosophies as well. Though yet to be tested extensively in Eastern cultures it is likely that we humans are not so different in our thinking and aspirations though we may differ in appearance and cultural practices.
In my future columns, in addition to talking about mental illness, I hope to share with you what I have learnt on how the findings of positive psychology and psychiatry can help us lead happier, more fruitful and meaningful lives.