An environmental approach to mental health.

Since the days of Freud, the major focus in the field of mental health has been on the individual and on his personality. It is now time to start moving toward a better balance in emphasis between host and environmental factors (W.H.O., 1960). In order to achieve this, some research groups that focus more on the environment than on the personality are needed. This is a natural approach for those of us in Public Health; for we know all too well that it is primarily in those areas where we have identified specific environmental factors that contribute to disease and where these factors have been amenable to mass change, that substantial prevention has been accomplished. Such things as the purification of water supplies by sand filtration and chlorination and the elimination of anopheline mosquitoes with DDT spraying come to mind. One wonders what would happen if we could, over the next couple of generations, make as much progress in the hygiene of interpersonal and social relations as was made in the first half of this century in the hygiene of the physical environment. Lest we ramble, it is essential to define our terms and the basic problems at issue. This is difficult when the orientation is to the positive aspect of mental health, because the whole concept of positive health is elusive. Elsewhere (French and Kahn, 1962), we have laid out our views on this matter and enumerated a set of relevant concepts. These concepts vary greatly in their measurability. For example, self-esteem is now becoming measurable thanks to the development of the concepts of multiplicity of the dimensions of self-identity and the centrality of these dimensions (Sherwood, 1962). On the other hand, measurement techniques for such things as degree of integration of the personality, the level of interpersonal competence, or extent of adjustment are still in their infancy. It seems appropriate, then, to suggest that for the immediate future, most field studies should focus on the more measurable negative side which will, for convenience, be called the problem of mental health. Our conceptualization of this problem of mental health is laid out in FIGURE 1. In this figure are found the major host and environmental factors contributing to “Dis-Ease,” the various behaviors resulting from “DisEase,” and finally the nature of the treatment elicited by the relevant behavior. The continuum, “Dis-Ease,” has at one end, somatic illness, which is characterized by lesions visible with usual pathological techniques and is derived primarily from genetic defects, microbial invasion, exposure to toxic substances, etc. At the other end of the continuum is social maladjustment which is derived primarily from the interaction of personality with the social environment. The fact that they may each contribute to each other is emphasized by the two-headed arrow between them. Both