Notions like 'mental illness' and 'mental disorder' are sometimes defined negatively. That is to say that the presence of 'illness' or 'disorder' is often defined as the absence of 'health' or 'flourishing'. But what is this elusive notion of 'health' or 'flourishing'?

Axis V of the Diagnostic System is concerned with just this notion. According to the 'Global Assessment of Functioning' scale (GAF) mental illness is defined as being on a continuum with mental health as follows:

91-100 Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms

81-90 Absent or minimal symptoms ( e.g., mild anxiety before an exam ), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns ( e.g., an occasional argument with family members )

71-80 If symptoms are present, they are transient and expectable reactions to psychosocial. stressors ( e.g., difficulty concentrating after family argument ); no more than slight impairment in social occupational, or school functioning ( e.g., temporarily falling behind in schoolwork ).

61-70 Some mild symptoms ( e.g., depressed mood and mild insomnia ) OR some difficulty in social occupational, or school functioning ( e.g., occasional truancy or theft within the household ), but generally functioning pretty well, has some meaningful interpersonal relationships.

51-60 Moderate symptoms ( e.g., flat affect and circumstantial speech, occasional panic attacks ) OR moderate difficulty in social, occupational, or school functioning ( e.g., few friends, conflicts with peers or co-workers ).

41-50 Severe symptoms ( e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting ) OR any serious impairment in social, occupational or school functioning ( e,g., no friends, unable to keep a job ).

31-40 Some impairment in reality testing or communication ( e.g., speech is at times illogical, obscure, or irrelevant ) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood ( e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school ).

21-30 Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment ( e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation ) OR inability to function in almost all areas ( e.g., stays in bed all day, no job, home, or friends ).

11-20 Some danger of hurting self or others ( e .g., suicidal attempts without clear expectation of death; frequently violent; manic excitement ) OR occasionally fails to maintain minimal personal hygiene ( e.g., smears feces ) OR gross impairment in communication ( e.g., largely incoherent or mute ).

1-10 Persistent danger of severely hurting self or others ( e.g., recurrent violence ) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.

0 Inadequate information.

So, people: mild anxiety and an occasional argument with family members means that you are not functioning optimally. Says the American Psychiatric Association. Do people find the values implicit in this definition of human 'flourishing', 'health', or 'functioning' to be problematic?

I do.

I think that the description in the 91-100 category is something that I do not wish to aspire to (sounds mechanical and not emotionally responsive to me).

'The GAF Report decision tree is designed to guide clinicians through a methodical and comprehensive consideration of all aspects of a patients symptoms and functioning to determine a patients GAF rating in less than 3 minutes'.

'Less than 3 minutes'...

How much is the spread of western psychiatry and western psychiatric treatment to the third world a matter of colonalisation of values...

And how much is the spread of western psychiatry and western psychiatric treatment to the third world a matter of providing much needed treatment according to their values...

Difficult questions...

Are psychotic symptoms MALFUNCTIONAL becuase they are so in western culture (typically)?

Are psychotic symptoms DIF-FUNCTIONAL (JUST DIFFERENT) because they are so in some third world places?

Are psychotic symptoms SUPER-FUNCTIONAL (BETTER) because they are positively valued in some third world places?

Colonalisation of values...
Or value-neutral treatment for objectively debilitating conditions (that are debilitating whether they are recognised as such or not)...

Any thoughts?