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Given that we're getting close to the end of the semester, it seems appropriate indeed to be looping back to where we started, to a fragmented mental health system and the apparent need to come up with a more coherent and useful definition of mental health. Adi's list is interesting, but none of the people on it had the benefit either of knowing about contemporary work on the brain nor of a semester's exploration of a variety of mental health phenomena. Given that, we ought to be able to come up with something ... less wrong?

I actually think we've been making progress in that direction, with at least small steps every Monday session, including our last one. And that, interestingly, they are beginning to suggest one can indeed find a place to start "without defining a tea kettle reality."

Marty's point Monday evening seems to me an important one in that regard. We all have our own largely unconscious and somewhat different notions of what "mental health" is, and verbalizations of it are always incomplete approximations. Ryan (and Sophie's) idea that mental health workers should "help the individuals who want help to achieve their goals" is a good case in point. The underlying ideas, that "mental health" is individualized rather than stereotyped (one size fits all) and needs to include some considerations of individual agency, seem to me important ones consistent with our discussions of a variety of particular situations. At the same time, they fail to capture unconscious feelings many of us have about additional situations, particularly the person who doesn't ask for help but seems for some reason to need it, and the person who asks for a kind of help that we are, for one reason or another, disinclined to provide them.

It is, perhaps, because of these sorts of additional issues that one feels a need to appeal to some kind of "tea kettle reality." But "tea kettle reality" is, I suspect, itself nothing more (and nothing less) than a name for a set of unconscious understandings that also varies from person to person. Just like "normative reality" it has, for any given set of people, some similarities and some differences, so one can't ever be sure "tea kettle reality" is well defined and fully agreed to. At least as importantly "tea kettle reality," just like "normative reality," has the additional problem that it too tends to encourage a one size fits all approach, ignoring the possibility that an individual (Einstein?) might in fact have a "tea kettle reality" understanding less wrong than the existing consensus.

So where could one start in thinking about mental health without either "normative" or "tea kettle" reality? Perhaps with the notion that all humans are engaged in an ongoing creative process of making sense of the world and their place in it, and that human well-being (both individual and collective) is measured not by proximity to any particular ideal state but rather by the efficacy of that process itself, not by where one is at any given time but rather by change over time, by the ability to detect problems and create new ways of dealing with them?

Such a starting point is appealling not only because it values individual variation but also because it makes sense is terms of what we know (or currently think we know) about the brain, that it is organized to look for and make productive use of conflict (including conflict about what constitutes either "normative" or "tea kettle" reality).

What I also find appealing about such a starting point is that it obviates the need to make a sharp distinction between "health" and "illness." Yes, indeed, we all hold "dual citizenship." We all have some ability to engage in a "ongoing creative process of making sense of the world and our place in it" and some deficiencies along those lines. And so the issue isn't who is "ill" and hence needs help and who isn't and so doesn't. The issue is instead "reciprocity," as it emerged form the discussion of attachment theory: what can others do for me to enhance my ability to engage in the creative process and what can I do for others? The answers will, as seems to me appropriate, be highly individualized, fully contingent on where one is/others are rather than determined by any pre-existing fixed story.

None of this denies the usefulness of "tea kettle reality", nor of "normative reality" for that matter. But it does reposition them in an interesting way. "Normative" and "tea kettle" realities are not prescriptive ideals but rather starting points, tools that can be used up to the point where they prove inadequate, at which point they become part of the conflicting grist from which new realities are conceived. Maybe that's what distinguishes in a useful way "mental health" from "medicine" in general? That it is largely about stories, and the ability of stories to promote ongoing change?

Perhaps instead of giving adolescents special dispensations to explore an effective mental health system would encourage everyone to be continuing explorers? And it would give people a secure attachment to ... change, and to the role their own unconscious understandings, however imperfectly verbalized at any given time, play in change both of stories and of the unconscious understandings themselves?