Positive Psychiatry Comes of Age
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International Psychogeriatrics (2018), 30:12, 1735–1738 © International Psychogeriatric Association 2018 doi:10.1017/S1041610218002211 GUEST EDITORIAL Positive psychiatry comes of age Positive psychiatry is the science and practice As important as healthy lifestyle but rarely of psychiatry that focuses on psycho-bio-social attended to in the arena of preventive healthcare study and promotion of well-being and health is the role of positive personality traits such through enhancement of positive psychosocial as resilience, optimism, compassion, self-efficacy, factors (such as resilience, optimism, wisdom, and wisdom as well as social and environmental and social support) in people with illnesses or support. There is strong empirical evidence for disabilities as well as the in community at large the association of these positive factors with better (Jeste and Palmer, 2015). It is based on the mental and physical health, cognitive function, and principles that there is no health without mental even longevity. Who are the experts in assessing and health and that mental health can be improved enhancing these positive psychosocial factors? Once through preventive, therapeutic, and rehabilitative again, it is mental health experts. Thus, positive interventions to augment positive psychosocial psychiatry should be at the center of the new factors. Positive psychiatry is not a naïve, feel-good healthcare system. pseudoscience that views the world through rose- This issue of International Psychogeriatrics is the colored glasses. It is an evidence-based approach first ever issue of our journal with the theme of to understanding normal behavior as well as positive psychiatry. The current issue contains three psychopathology and to improving well-being by data-based research articles (Bailly et al., 2018; measuring and enhancing positive psychosocial Ihle et al., 2018; Montross-Thomas et al., 2018) factors (Jeste et al., 2015). from France, USA, and Switzerland, respectively. Today most of the articles in most of the geriatric These papers report stability of spirituality in psychiatry journals are focused on neuropsychiatric older adults followed over a five-year period (Bailly disorders and disabilities in later life. This is not et al., 2018), response of hospice patients to the surprising as these conditions are indeed associated diagnosis of terminal illness by cultivating wisdom with clinically significant functional impairments through a balance between active acceptance of and are a major cause of adverse mental, physical, the current situation and continued push for a social, and financial outcomes for the patients and galvanized growth (Montross-Thomas et al., 2018), their families. Research on and treatment of these and significant contributions of close friends and maladies should, therefore, be a priority for our leisure activity engagement to better cognitive field. However, a near exclusive focus on disorders performance in old age (Ihle et al., 2018). is not just unhelpful but also counter-productive There are accompanying commentaries (Baiyewu, for psychiatry in general and geriatric psychiatry in 2018; Forlenza and Vallada, 2018; Pachana and particular. Mitchell, 2018) from Brazil, Australia, and Nigeria, With rapidly growing numbers of older people respectively, which discuss both limitations and across the globe, healthcare systems that are implications of those studies. dependent on individual-level treatment of diseases In the future, as we continue publishing many are painfully inefficient and unsustainable. There papers on neuropsychiatric diseases of aging, we is now a growing consensus that prevention is the will also include, from time to time, articles on key to revolutionizing healthcare. This has led to a topics related to positive psychiatry. We hope discussion about promoting healthy lifestyle, such to have papers and commentaries from different as physical activity, calorie restriction, and stopping parts of the world with articles on various smoking and substance use. Changing the lifestyle positive topics including successful aging, mind- involves changing a person’s behavior. Who are the body interventions, and age-friendly communit- experts in interventions to modify behavior? The ies, among others. I welcome input from our answer is mental health practitioners. We treat the readers. most serious behavior problems such as delusions, Thanks to pioneers like Seligman (Seligman hallucinations, and suicidal behaviors. We have and Csikszentmihalyi, 2000), positive psychology is at least reasonable knowhow about biological now well accepted even by lay public. Yet, there are and psychotherapeutic tools for helping modify few papers on positive constructs such as optimism, unhealthy behaviors. resilience, and wisdom in psychiatric journals 1736 Dilip V. Jeste and few chapters on these topics in psychiatric in healthy religious coping strategies and who textbooks. The goal of positive psychiatry is valued spirituality experienced less severe negative to enrich psychiatric literature and practice by symptoms and better interpersonal functioning and incorporating positive psychosocial factors in quality of life than other patients. the study and treatment of people with and In addition to their effects on emotional and without mental illnesses. Moreover, being a branch cognitive health, positive psychosocial factors are of medicine, positive psychiatry will emphasize closely related to physical health and specific health as well as biology along with psychology, biomarkers of health as well (Edmonds et al., sociology, and (in the case of psychogeriatrics) 2018). Empirical evidence supports links between gerontology. biomarkers and measures of positive psychiatry, Positive psychiatry is not a geographically local- including allostatic load, telomere length, in- ized phenomenon but a global movement. There flammation, and genes (Schutte et al., 2016; is now a formal section on Positive Psychiatry in Wiley et al., 2017), although such research in the World Psychiatric Association and a Caucus people with serious mental illnesses has so far on Positive Psychiatry in the American Psychiatric been sparse. One study reported that self-efficacy Association. Other national organizations are moderated the relationship between subjective beginning to get involved too. During the last stress and interleukin-6 levels among dementia few years, a number of symposia in this area caregivers (Mausbach et al., 2007). In a two- have been presented at different national and year randomized controlled trial in adults with international conferences. At least two books have chronic schizophrenia, Eack et al. (2010) showed been published (Jeste and Palmer, 2015; Summers that, compared to a control group, a multimodal and Jeste, 2018) and several others are in the intervention approach – cognitive enhancement works. therapy – not only improved cognitive performance In terms of measurements, we already have but also seemed to protect against gray matter loss access to a number of reliable and validated on MRI. self-report inventories for various positive factors Chronological aging is associated with increases (Eglit et al., 2018). Self-report measures have been in both physical and cognitive impairments. criticized for having both conscious (e.g. deliberate However, a large number of older adults report deception) and unconscious (e.g. impression “successful aging” (Jeste et al., 2013). This management) biases in human introspection and concept was originally defined as absence of subsequent reporting. However, research has significant disease burden, but – consistent with shown a significant association between subjective the positive psychiatry movement – more recent and objective measures of constructs such as well- data suggest that successful aging does not require being. Self-report inventories for internal states absence of illness, but rather the overall positive such as happiness and subjective recovery are psychological outlook of the individual. There inherently tied to an individual’s introspective is a frequently observed paradox of aging – feelings rather than to an external biological proxy, as physical health declines, mental well-being at least at the present time. For example, most improves. The importance of emotional health of us will agree that the best way to determine in aging is illustrated by the “positivity effect” individuals’ level of happiness is by asking them – i.e., a tendency for older adults to experience about their current inner experiences and feelings a higher ratio of positive to negative emotions rather by measuring cerebrospinal fluid levels of relative to younger adults (Mather and Carstensen, catecholamines (although these may correlate with 2005). While there is considerable research on subjective happiness). the so-called longevity genes, positive personality Positive psychiatry applies even more import- traits including resilience, optimism, and wisdom antly to people with serious mental illnesses such may also be of relevance for exceptional longevity as schizophrenia and major depression, serious (Scelzo et al., 2018). physical illnesses such as cancer and HIV-AIDS, There is also a wealth of neurobiological and serious cognitive disorders including dementias data showing that, contrary to traditional beliefs, or major neurocognitive disorders (Palmer et al., neuroplasticity continues into old age (albeit 2014; Cohen et al., 2017; Sharma et al., 2017; to a lesser degree than in youth, enabling Moore