Mental	Health	Without	Wellbeing Sam	Wren-Lewis	and	Anna	Alexandrova Abstract:	What	is	it	to	be	mentally	healthy?	In	the	ongoing	movement	to promote	mental	health,	to	reduce	stigma	and	to	establish	parity	between	mental and	physical	health,	there	is	a	clear	enthusiasm	about	this	concept	and	a recognition	of	its	value	in	human	life.	However,	it	is	often	unclear	what	mental health	means	in	all	these	efforts	and	whether	there	is	a	single	concept	underlying them.	Sometimes	the	initiatives	for	the	sake	of	mental	health	are	aimed	just	at reducing	mental	illness,	thus	implicitly	identifying	mental	health	with	the absence	of	diagnosable	psychiatric	disease.	More	ambitiously,	there	are	highprofile	proposals	to	adopt	a	positive	definition,	identifying	mental	health	with psychic	or	even	overall	wellbeing.	We	argue	against	both:	a	definition	of	mental health	as	mere	absence	of	mental	illness	is	too	thin,	too	undemanding,	and	too closely	linked	to	psychiatric	value	judgments,	while	the	definition	in	terms	of wellbeing	is	too	demanding	and	potentially	oppressive.	As	a	compromise	we sketch	out	a	middle	position.	On	this	view	mental	health	is	a	primary	good,	that is	the	psychological	preconditions	of	pursuing	any	conception	of	the	good	life, including	wellbeing,	without	being	identical	to	wellbeing. Keywords:	mental	health,	wellbeing,	definition	of	health,	medicalisation, happiness,	psychological	flexibility 2 1. Introduction:	A	value	in	search	of	a	definition What	is	it	to	be	mentally	healthy?	In	the	ongoing	movement	to	promote	mental health	at	work	and	in	schools,	to	reduce	stigma	and	to	establish	parity	between mental	and	physical	health,	there	is	a	clear	enthusiasm	about	the	concept	of mental	health	and	a	recognition	of	it	as	a	central	value	in	human	life.	However,	it is	much	less	clear	what	mental	health	means	in	all	these	efforts	and	whether there	even	is	a	single	concept	underlying	them.	Sometimes	the	initiatives	for	the sake	of	mental	health	are	aimed	just	at	reducing	mental	illness,	thus	implicitly identifying	mental	health	with	the	absence	of	diagnosable	psychiatric	disease. More	ambitiously,	there	are	also	prominent	initiatives	in	public	health	and	policy that	adopt	positive	definitions	identifying	mental	health	with	psychic	or	even overall	wellbeing.	But	those	looking	for	an	explicit	agreed	upon	definition	will	be disappointed. In	academic	philosophy,	and	the	philosophy	of	psychiatry	in	particular, discussions	predominantly	focus	on	the	status	of	mental	illness	–	whether	it designates	a	natural	kind	or	instead	a	social	kind,	whether	classifications	of disorders	such	as	the	Diagnostic	Statistical	Manual	(DSM5)	should	be	based	on symptoms	rather	than	on	underlying	causes,	and	whether	pharmaceutically driven	interventions	have	too	high	of	a	profile	by	comparison	to	talk	therapy.1 These	are	important	and	fascinating	issues	and	mental	health	connects	with 1	For	DSM5	see	American	Philosophical	Association	2013,	for	general	philosophy	of	psychiatry see	Fulford	et	al	2013,	for	the	status	of	mental	illness	see	Murphy	2006,	for	the	influence	of	social factors	on	psychiatric	research	see	Cooper	2014a,	and	for	a	philosophical	overview	of	DSM5	see Cooper	2014b. 3 them	all. However,	in	the	case	of	mental	disorders, these	discussions	are	based on	psychiatric	practice:	for	example,	the	depressive	disorders	can	be	defined	by persistent	and	debilitating	sadness	and	listlessness.	But	there	is	no corresponding	uncontroversial	source	for	the	content	of	claims	about	mental health	–	there	is	no	DSM	for	health.	This	is	why	what	it	means	to	be	healthy	is	not at	the	forefront	of	today's	philosophy	of	psychiatry.2 At	the	same	time	the	definition	of	mental	health	is	of	deep	philosophical	as	well as	practical	importance.	On	the	practical	side,	if	mental	health	is	a	state	of wellbeing,	efforts	to	promote	it	will	likely	adopt	different	outcome	measures	and methods	of	management,	with	different	levels	of	trust	invested	in	traditional psychiatric	approaches.	On	the	philosophical	side,	it	is	critical	to	start	a conversation	that	while	implicit	throughout	the	history	of	philosophy,	has	yet	to happen	explicitly:	is	mental	health	identical	to	wellbeing,	is	it	one	of	its constituents,	or	a	precondition	for	it? The	goal	of	our	present	discussion	is	to	map	out	the	goalposts	of	such	a conversation.	We	do	so	by	adopting	something	of	a	Goldilocks	strategy.	We identify	a	definition	of	mental	health	that	is	clearly	too	thin	and	undemanding	– mental	health	as	absence	of	mental	illness	–	and	a	definition	that	is	too	ambitious and	too	demanding	–	mental	health	as	the	state	of	general	wellbeing	across	all aspects	of	social	and	personal	life.	There	are	compelling	reasons	to	reject	both: the	first	one	ties	mental	health	too	closely	to	the	controversial	concepts	and 2	We	note	in	particular	that	the	Stanford	Encyclopaedia	article	on	Philosophy	of	Psychiatry	does not	cover	this	issue	(Murphy	2017). 4 methods	of	psychiatry,	while	the	second	one	threatens	to	set	up	an	impossible ideal,	to	medicalise	unhappiness,	and	to	dress	up	controversial	philosophical judgments	about	the	good	life	in	the	pretense	of	scientific	objectivity. It	is	this	latter	reason	that	led	philosopher	Simon	Keller	to	pronounce	the positive	ideal	of	mental	health	to	be	dangerous	–	he	points	out	that	the	nature	of wellbeing	is	a	matter	of	ethical	and	personal	reflection	and	as	such	admits	of great	diversity.	But	once	wellbeing	becomes	a	condition	of	mental	health,	this invites	scientific	and	medical	recipes	for	good	life,	which	are	at	best	invalid	and at	worst	oppressive.3	We	readily	agree	that	this	is	the	danger	of	defining	mental health	in	terms	of	wellbeing,	but	it	doesn't	have	to	be	so. We	sketch	out	a	more attractive	middle	position.	On	this	view	mental	health	is	a	primary	good,	that	is the	psychological	preconditions	of	pursuing	any	conception	of	wellbeing. This definition,	we	argue,	is	independently	plausible	and	not	dangerous. 2.	The	Negative	Definition It	makes	sense	to	start	by	examining	the	minimalist	position.	It	is	based	on	a deeply	plausible,	almost	tautological,	observation:	it	is	the	business	of	medicine to	treat	disease	and	when	this	is	successful	we	have	health.	Since	psychiatry	is the	branch	of	medicine	dedicated	to	treating	mental	illness,	psychiatry	succeeds in	its	goal	of	restoring	patients	to	mental	health	when	it	treats	their	psychiatric illnesses,	where	these	illnesses	are	defined	relative	to	standard	classifications such	as	the	DSM5. 3	https://www.stuff.co.nz/life-style/well-good/teach-me/88591331/The-dangerous-ideal-ofmental-health 5 This	definition	is	often	endorsed	implicitly	rather	than	explicitly.	For	example, the	current	efforts	to	create	parity	between	mental	and	physical	health	typically aim	at	improving	access	to	treatment;	while	the	campaigns	promoting	'mental health	awareness'	often	mean	little	more	than	removing	the	stigma	around mental	illness	and	starting	conversations	about	its	causes	such	as	stress.4 Underlying	the	intuitions	that	mental	health	is	largely	about	tackling	mental illness	is	an	explicit	philosophical	position	and	it	exists	thanks	to	Christopher Boorse's	writings	from	1970s	onwards.	Boorse	is	well-known	for	his	so-called biostatistical	theory,	which	identifies	health	with	normal	species	functioning. One	statement	of	this	view	is	as	follows: An	organism	is	healthy	at	any	moment	in	proportion	as	it	is	not	diseased;	and a	disease	is	a	type	of	internal	state	of	the	organism	which: (i) Interferes	with	the	performance	of	some	natural	function	–	i.e.,	some species-typical	contribution	to	survival	and	reproduction	– characteristic	of	the	organism's	age;	and (ii) Is	not	simply	in	the	nature	of	the	species,	i.e.	is	either	atypical	of	the species	or,	if	typical,	mainly	due	to	environmental	causes	(Boorse 1976,	62-63). 4	For	examples	of	this	in	the	English	context	see	"Valuing mental health equally with physical health or "Parity of Esteem"". London: NHS England. Available at: https://www.england.nhs.uk/mentalhealth/parity/, and Mental Health Awareness Week by the Mental Health Foundations (https://www.mentalhealth.org.uk/campaigns/mental-health-awareness-week). 6 The	'biostatistical'	label	picks	out	the	simultaneous	importance	to	this	view	of	1) evolution	by	natural	selection	as	a	way	of	identifying	functions	and	2)	of typicality	of	a	given	condition	relative	to	others	in	this	population.	Boorse's	main goal	was	and	remains	a	purely	descriptive,	value-free	conception	of	health.	It	is	a theoretical	concept	in	physiology	rather	than	in	clinical	medicine	and	as	such	it	is sharply	separate	from	normative	questions	of	how	individuals	ought	to	function and	which	conditions	of	their	bodies	and	minds	medicine	should	attend	to (Boorse	1977,	1997).	For	these	latter	normative	questions,	Boorse	proposes	the notion	of	illness,	that	is	those	diseases	that	are	concerning	enough	to	warrant medical	treatment	(Boorse	1975).	Boorse	emphasises	that	it	is	a	further	question –	a	question	for	ethics	and	political	philosophy	–	whether	a	disease	should	be treated	by	doctors,	covered	by	healthcare,	and	be	subject	of	clinical	research.	He might say	the	same	for	mental	illness.	Whether	a	given	mental	pathology	should be	considered	a	mental	illness	is	ultimately	an	evaluative	question.	For	instance, homosexuality,	which	at	the	time	that	Boorse	was	writing	was	being	removed from	DSM-III,	may	well	be	a	disease	on	a	value	free	definition	because	it interferes	with	the	function	of	reproduction,	but	it	need	not	be	an	illness.	In contrast,	feminism	and	opposition	to	the	Vietnam	War	–also	controversies	in	the 1970s	–	have	no	basis	for	being	considered	psychiatric	diseases	no	matter	how abnormal	they	might	have	seemed	relative	to	prevailing	social	norms.	Boorse positioned	his	theory	against	'normativism',	which	attempted	to	ground	health	in some	normative	ideal	and	considered	the	value-freedom	of	his	view	to	be	its major	advantage. 7 In	a	less	known	paper	"What	a	Theory	of	Mental	Health	Should	Be"	Boorse extended	the	biostatistical	theory	to	the	case	of	mental	health	(Boorse	1976).	He argued	that	the	extension	is	not	problematic	in	principle.	So	long	as	we	are	able to	formulate	mental	as	opposed	to	physical	functions	of	the	organism,	the atypical	disfunction	of	one	or	more	of	these	processes	counts	as	a	mental disorder.	What	might	those	functions	be?	Boorse	recognised	that	it	is	easier	to identify	functions	that	underwrite	physical	health	–	heart	to	pump,	sweat	to maintain	body	temperature,	liver	to	filter	blood,	etc.	–	than	it	is	to	pin	down	the mental	functions	that	enable	reproduction	and	survival.	But	he	ventured	that	it	is possible	and	in	fact	rehearsed	one	such	theory	–	psychoanalysis.	He	wrote: Formally	speaking,	psychoanalytic	theory	is	the	best	account	of	mental health	we	have.	It	closely	follows	the	physiological	model	by	positing three	mental	substructures,	the	id,	ego,	and	superego,	and	assigning	fixed functions	to	each....	It	would	not	be	difficult	to	construe	psychoanalytic theory	as	a	set	of	theses	about	biological	functions	of	the	mind.	On	this view	the	id	might	emerge	as	a	reservoir	of	motivation,	the	ego	as	an instrument	of	rational	integration	and	cognitive	competence,	and	the superego	as	a	device	of	socialization.	One	could	then	give	a straightforward	argument	that	neurosis	is	disease	by	appealing	to	its disturbance	of	the	integrative	and	motivational	functions	of	the	ego	and the	id	(Boorse	1976,	78). It	is	a	notable	historical	irony	that,	just	as	psychoanalysis	and	all	its	attendant categories	of	trauma,	repression,	sublimation,	etc.	were	getting	purged	from 8 DSM-III5,	Boorse	chose	to	ground	his	account	of	mental	health,	ostensibly scientific	and	objective,	in	the	theory	that	was	quickly	losing	ground	in	the psychiatric	consensus.	But	in	his	view	there	were	strong	reasons	for	this	choice. He	was	taking	a	stance	against	'normativists'	who	identified	mental	health	with adjustment,	normality,	or	well-being.	The	biostatistical	theory	was	for	him	the only	viable	option	unless	one	was	willing	to	grant	psychiatry	the	power	to	judge people. For	us	the	question	is	not	whether	Boorse's	particular	account	of	mental	health is	plausible	–	forty	years	later	the	standing	of	psychoanalysis	in	psychiatry	is even	weaker	than	it	was	in	the	1970s.	Rather	our	question	is	whether,	despite Boorse's	conviction,	there	is	any	plausible	formulation	for	a	biostatistical	theory of	mental	health. 3.	Objections	to	the	Biostatistical	Theory Boorse's	formulation	of	the	fundamental	contrast	between	normativism	on	the one	hand	and	descriptivism	(sometimes	also	known	as	naturalism)	on	the	other, has	defined	philosophical	debate	ever	since.	This	discussion	has	predominantly focused	on	the	definition	of	physical	health.	There	are	still	defenders	of naturalism	(Hausman	2011,	2015),	but	also	of	normativism	(Cooper	2002),	of	a third	option	called	hybridism	(Wakefield	1992).	In	addition	to	this	there	are philosophers	who	reject	the	very	possibility	of	ever	settling	a	single	precise 5	See	Decker	2013	on	the	processes	and	motivations	that	lead	psychiatrists	such	as	Robert Spitzer	and	his	colleagues	to	remove	all	Freudian	language	from	the	standard	classification	of mental	disorders. 9 definition	of	what	might	be	a	messy	and	disordered	concept	of	disease (Ereshevsky	2009,	Worrall	and	Worrall	2001).	Those	who	criticise	the biostatistical	theory	do	so	on	the	grounds	that	it	lacks	a	defensible	and	value-free account	of	functions	and	of	the	right	reference	class	against	which	to	judge typicality.	Critics	have	argued	that	it	collapses	under	the	weight	of counterexamples;	that	is,	cases	where	malfunctioning	does	not	intuitively	count as	disease	or	good	functioning	that	does	intuitively	count	as	such	(Worrall	and Worrall	2001,	Kingma	2007,	2009). Little	of	this	large	literature	paid	any	attention	to	Boorse's	attempt	to	account	for mental	health.	However,	in	our	view	the	problems	that	philosophers	have uncovered	in	the	process	of	arguing	with	Boorse	about	physical	health	are	severe enough	to	make	it	unlikely	that	a	value-free	articulation	of	mental	functions	is possible.	Certainly	no	one	to	our	knowledge	has	tried	to	put	forward	an alternative	to	Boorse's	original	psychoanalytic	version	of	mental	health	and	the attempts	to	reduce	mental	disorders	to	disfunction	at	the	neurological	level	are, while	ongoing,	controversial	(Kendler	et	al	2011,	Cooper	2014b).	While	it	is eminently	plausible	that	some	psychological	capacities	for	judgment,	valuation and	choice	do	make	a	clear	contribution	to	survival	and	reproduction,	the	hard part	is	to	articulate	the	overall	set	and	to	map	this	set	on	the	existing	categories in	psychiatric	classifications.	Which	of	the	evolved	mental	functions	should operate,	at	what	level	and	in	which	environment	for	a	person	to	count	as mentally	healthy?	The	question	seems	intractable	as	our	contemporary environment	differs	so	much	from	our	ancestral	one	and	it	is	hard	to	know	how we	would	even	begin	to	find	out	whether,	say,	anxiety	–	clearly	an	evolved 10 response	to	dangerous	situations	–	will	emerge	as	a	disorder	on	this	picture	or not.	This	is	one	reason	to	reject	Boorse's	naturalism. Another	reason	is	his	implausible	insistence	on	value-freedom.	While	for	Boorse value-freedom	was	an	essential	guard	against	politicisation	of	medicine	in general	and	psychiatry	in	particular,	his	solution	of	distinguishing	between disease	(value-free)	and	illness	(value-laden)	only	delays	the	necessity	of	making value	judgments	to	another	stage,	without	eliminating	this	necessity.	Today's demands	on	the	concept	of	mental	health	are	very	much	action	guiding. Scientists	who	deploy	definitions	of	mental	health	deploy	them	for	the	most	part not	as	Boorsean	'theoretical	concepts'	relevant	only	to	dispassionate	and	pure scientific	research.	Instead	their	goal	is	deeply	practical	–	how	and	what	to diagnose,	how	and	what	to	manage,	how	and	what	to	prevent.	For	these purposes,	Boorse's	definition	of	mental	health	does	not	provide	the	required normative	guidance.	This	is	unsurprising	given	that	Boorse	does	not	think	such guidance	should	be	expected	from	the	concept	of	health,	so	from	his	point	of view	this	is	not	a	weakness.	But	this	lack	does	show	the	limited	usefulness	of	his account. Furthermore,	it	is	far	from	obvious	that	the	value-freedom	of	his	account prevents	politicisation	of	psychiatry. Despite	Boorse's	valiant	efforts	to articulate	a	value-free	definition	of	disease,	the	value-ladenness	of	the	DSM categories	is	by	now	well	documented.6	What	counts	as	a	'sufficient	impairment' 6	Jahoda	1958,	Hacking	2007,	Hawthorne	2013,	Cooper	2014a	and	2014b	among	many	others. 11 or	a	'clinically	significant'	symptom	are	all	locutions	that	conceal	value judgments	about	the	acceptable	range	of	suffering	and	of	deviation	from	norm. So	if	health	is	defined	as	absence	of	mental	illness,	then	this	definition	is	not	all neutral,	not	at	all	naturalistic,	because	it	inherits	all	the	value	judgments	that inform	definitions	of	depression,	anxiety,	ADHD,	etc. Finally,	we	should	question	the	very	desirability	of	even	aiming	at	valuefreedom.	Politicisation	of	mental	health	is	only	threatening	if	any	importation	of values	undermines	the	work	this	concept	can	do.	But	it	is	far	from	clear	that	just because	some	normative	judgments	have	led	psychiatry	astray,	any	one	of	them would.	Arguably	the	problem	was	not	that	these	judgments	are	normative,	but that	they	are	oppressive,	cruel,	and	stigmatising. So	there	are	three	reasons	to	be	concerned	with	Boorse's	version	of	valuefreedom:	first,	it	makes	the	concept	of	mental	health	ineffective	in	practice, second,	grounding	health	in	absence	of	disease	does	not	in	fact	secure	valuefreedom	if	the	existing	definitions	of	disease	are	value-laden,	and	third,	valueladenness	may	not	be	as	harmful	as	Boorse	says	it	is.	Together	with	the	fact	that a	plausible	account	of	mental	functions	does	not	exist,	these	create	compelling reasons	to	look	for	a	different	account	of	mental	health. But	to	arrive	at	such	an	account	we	need	to	consider	our	central	objection	to	the negative	definition	of	health	inherent	in	Boorse's	biostatistical	theory,	an objection	that	other	critics	have	left	entirely	untouched,	at	least	to	our knowledge.	That	is,	that	there	is	more	to	mental	health	than	the	absence	of 12 mental	illness.	This	issue	–	whether	mental	health	is	negative	or	positive	–	is entirely	orthogonal	to	the	previous	controversy	between	naturalism	and normativism.	Boorse	is	a	naturalist	and	a	negativist,	so	to	speak,	but	it	is conceivable	that	naturalism	can	be	paired	up	with	a	positive	definition	of	health or	that	normativism	be	paired	up	with	a	negative	one. We	have	seen	reasons	to	depart	from	naturalism	about	mental	health,	but	why depart	from	a	negative	definition?	Is	health	more	than	the	"silence	of	the organs"?7	Boorse	himself	rejected	the	calls	for	a	positive	definition	–	they	were prominent	already	in	the	1970s	–	as	entirely	confused	(Boorse	1977,	568-570). The	relevant	medical	concept	is	the	negative	one	and	the	positive	concept	is mostly	a	rhetorical	tool	for	enthusiasts	of	fitness,	dieting,	and	other	healthy living	movements.	Sure,	prevention	of	disease	is	important	and	these	activities might	be	effective	for	that	purpose,	but	nothing	more	than	the	standard	negative definition	is	needed	for	that.	Ideas	that	go	under	the	label	of	positive	health	are only	tools	for	reducing	disease. Those	who	insist	on	adding	a	positive	dimension	to	absence	of	disease	will	have to	deal	with	problems	that	to	Boorse	seemed	unsurmountable.	First,	any	positive characterisation	seems	utopian	because	there	is	no	natural	limit	to	it	in	the	way that	there	is	with	absence	of	disease.	You	can	cure	an	illness	but	it's	hard	to	see how	you	can	achieve	full	happiness,	or	full	fitness. Second,	different	positive dimensions	of	health	can	be	incompatible	with	each	other,	for	example,	being	a 7	This	is	an	expression	due	to	Rene	Leriche,	later	explored	by	George	Canguilhem	(Canguilhem 1991). 13 sprinter	and	being	marathon	runner. A	positive	definition	of	health	would	have to	find	a	way	of	balancing	them.	Finally,	he	sees	ethical	problems	with	mandating any	particular	ideal	of	positive	health: The	trouble	with	calling	physical	or	mental	or	moral	excellence	health	is that	it	tends	to	unite	under	one	term	a	value-neutral	notion,	freedom	from disease,	with	the	most	controversial	of	all	prescriptions	–	the	recipe	for	an ideal	human	being	(Boorse	1977,	572). Boorse's	critique	of	grand	and	ambitious	positive	definitions	of	health	is compelling	and	we	will	shortly	add	more	reasons	to	be	wary	of	them.	But,	just	as in	the	argument	for	value-freedom	Boorse	unfairly	saddled	normativists	with failings	of	oppressive	psychiatry,	similarly	here	he	is	saddling	the	advocate	of positive	definition	with	an	implausible	version	of	it.	If	the	positive	definition	is utopian	or	unattainable,	it	should	indeed	be	rejected.	But	must	it	be	utopian	and unattainable?	Is	there	a	version	that	is	positive	and	yet	realistic	and	attractive? There	is	good	reason	to	try	to	build	one.	The	negative	definition	ties	mental health	to	the	immensely	controversial	categories	of	mental	disorders	of contemporary	psychiatry	and	nothing	else.	We	have	already	seen	that value	judgments	are	already	part	and	parcel	of	definition	of	health	on	the 'absence	of	disease'	model.	If	so	why	not	rethink	them	with	positive	value judgments?	A	positive	definition	of	health	can	act	as	a	check	on	the	values	that ground	the	negative	one	and	it	can	explain	why	absence	of	disease	is	a	good	state to	aim	at.	This	promise	obviously	depends	on	the	availability	of	a	defensible 14 positive	conception	and	in	many	ways	we	have	already	jumped	ahead	of ourselves.	What	are	these	demanding	positive	conceptions	that	Boorse	is	so critical	of	and	what	exactly	is	wrong	with	them? 4.	The	Demanding	Positive	Definitions Perhaps	the	best	known	definition	of	mental	health	is	articulated	by	the	World Health	Organization: Mental	health	is	defined	as	a	state	of	well-being	in	which	every	individual realizes	his	or	her	own	potential,	can	cope	with	the	normal	stresses	of	life, can	work	productively	and	fruitfully,	and	is	able	to	make	a	contribution	to her	or	his	community. This	statement	harks	back	to	WHO's	definition	of	health	which	appeared	in	its inaugural	1948	Constitution:	"Health	is	a	state	of	complete	physical,	mental	and social	well-being	and	not	merely	the	absence	of	disease	or	infirmity."	Mental health	according	to	WHO	is	also	a	positive	state:	it	is	not	enough	to	be	free	of depression,	anxiety	or	schizophrenia,	or	any	other	diagnosable	psychiatric condition,	you	also	need	to	be	well	enough	to	thrive	and	flourish	in	your community. This	definition	is	remarkable	in	more	than	one	way.	First	of	all	it	is	incredibly demanding:	it	describes	a	life	in	which	individuals	realise	their	full	potential,	as well	as	working	productively	and	contributing	to	their	community.	Not	many people	meet	such	high	standards.	It	is	not	clear	exactly	how	high	of	a	standard 15 the	definition	endorses,	but	read	literally	the	standard	is	very	high.	A	lot	of seemingly	well-functioning	people	would	plausibly	fail	this	test.	It	is	possible that	that	many	of	us	are	indeed	mentally	unhealthy,	but	it	is	also	possible	that this	definition	sets	the	bar	too	high.	Secondly,	it's	an	explicitly	objective definition	in	that	it	demands	that	individuals	actually	meet	these	standards	not just	think	they	do.	Finally,	it	demands	functioning	in	harmony	with	distinctly modern	norms	–	these	norms	set	what	counts	as	normal	stress,	productive	work, and	contribution	to	society.	The	ethos	of	this	definition	is	that	a	person	should not	be	a	burden	to	their	community:	that	is,	when	bad	things	happen	to	them they	should	be	able	to	bounce	back	and	in	particular	they	should	be	able	to	hold a	job	and	do	their	bit.	Depending	on	how	the	expression	'normal	stresses	of	life' is	cashed	out,	the	definition	can	be	interpreted	as	demanding	that	people	do	or do	not	expect	to	be	rescued	from	unemployment	or	debilitating	disease	and	in this	sense	the	definition	implicitly	refers	to	the	modern	welfare	state.	This	is unsurprising:	the	1948	definition	of	health	was	born	just	after	World	War	II when	the	public	health	services	were	being	institutionalized	at	the	level	of	nation states	and	integrated	into	governance,	while	the	more	recent	definition	of	mental health	was	put	forward	with	heavy	participation	of	economists	from	the	World Bank.8 The	WHO	definition	is	not	unique	in	being	demanding.	In	1958,	following	a	wideranging	review	of	literature	on	mental	health	and	illness,	British-Austrian 8	For	a	history	of	public	health	see	Rosen	2015.	We	thank	Mildred	Cherfils	for	explaining	to	us	the role	of	the	World	Bank	and	economic	considerations	in	the	2016	WHO	campaign	"Out	of	the Shadows:	Making	Mental	Health	a	Global	Priority". 16 sociologist	Marie	Jahoda	articulated	an	influential	and	perhaps	an	even	more demanding	ideal,	encompassing	six	criteria: 1. Self-acceptance	and	self-confidence 2. Self-actualization 3. Integration	of	different	psychological	functions 4. Autonomy 5. Accurate	perception	of	reality 6. Environmental	mastery	(Jahoda	1958). Unlike	WHO	Jahoda	does	not	mention	work	and	community	contribution,	but	she adds	the	truth	and	accuracy	requirement.	Her	goals	are	distinctly	humanistic. She	wishes	to	move	beyond	the	emphasis	on	'adjustment'	as	the	key	aspect	of mental	health	in	the	tradition	of	Karl	Menninger	(Menninger	1930).	But	in rejecting	this	identification	of	mental	health	with	social	acceptability,	she introduces	an	individualistic	ideal	based	on	the	goals	of	excellence,	competence, and	autonomy. Today	positive	definitions	of	mental	health	have	taken	a	distinct	turn	inspired	by positive	psychology.	They	have	grounded	mental	health	in	wellbeing,	flourishing, and	happiness.	Scientists	in	this	tradition	refer	to	'flourishing',	'mental	wealth	of nations'	and	a	number	of	other	positive	concepts	that	describe	individuals' psychological	resources.9	These	definitions	are	weaker	in	some	sense	but 9	Keyes	2002,	Beddington	et	al	2008,	Huppert	and	So	2013,	Stewart-Brown	2013. 17 stronger	in	another.	They	are	weaker	in	that	the	wellbeing	in	question	is subjective	rather	than	objective,	but	stronger	in	articulating	specific	positive emotions	such	as	happiness,	life	satisfaction,	or	sense	of	flourishing. What	might	be	wrong	with	this? 5.	Against	Demanding	Definitions The	proposals	we	mentioned	above	differ	from	each	other	in	subtle	ways	and should	ideally	be	examined	individually.	But	for	present	purposes	it	is	sufficient to	identify	a	few	concerns.	Not	all	undermine	each	of	the	demanding	options	to the	same	extent	but	together	they	nicely	illustrate	the	problem. The	first	problem	is	medicalisation	of	unhappiness,	idleness,	dependence,	etc. Setting	a	given	level	of	a	positive	good	as	a	condition	of	mental	health	turns	this good	into	a	medical	category	when	it	was	not	previously	so.	Medicalisation	has	a complex	history	where	progress	and	humanism	are	intertwined	with	use	of medicine	for	control	and	oppression	(Conrad	2007).	Treating	substance addiction	as	a	medical	problem	rather	than	a	moral	failing	is	a	positive illustration,	but	it's	far	less	clear	whether	the	failure	of	a	child	to	conform	to	the modern	classroom	is	an	illness.	The	latter	worries	motivate	critics	of	the	modern scale	of	medicalisation	who	point	out	that	extending	the	domain	of	psychiatry actually	undermines	its	epistemic	and	moral	legitimacy	(Charland	2013). It	is	not	clear	that	any	of	the	advocates	of	the	demanding	positive	definitions	are aware	of	these	dangers.	Take	public	health	–	clearly	an	important	business	of 18 local	and	national	governments.	Political	theorists	of	all	stripes	agree	that	the pursuit	of	this	business	carries	dangers	of	oppression	such	as	when	a government-backed	ideal,	in	this	case	an	ideal	of	mental	health,	is	imposed	on individuals	in	violation	of	their	autonomy	and	self-determination.	In	the	liberal tradition	such	an	imposition	is	a	violation	of	the	much	valued	condition	of neutrality,	but	other	intellectual	traditions,	such	as	the	critical	theory, medicalisation	is	one	of	the	instruments	of	maintenance	and	reproduction	of	an existing	social	order. If	it	were	possible	to	formulate	a	non-oppressive	ideal	of	mental	health	(which we	believe	is	possible),	the	intent	to	identify	it	with	wellbeing	or	the	good	life raises	difficult	epistemic	and	conceptual	issues	regarding	which	notion	of wellbeing	to	use	and	which	elements	to	incorporate	into	'overall	wellbeing'. Philosophers	and	social	scientists	typically	treat	wellbeing	as	an	inclusive	good, encompassing	not	just	happiness,	but	also	goods	such	as	friendship,	love, achievement,	sense	of	purpose,	etc.	How	to	weigh	these	goods	in	relation	to	each other	is	surely	a	deeply	personal	matter,	and	it	is	not	clear	whether	a	defensible recipe	exists	at	the	population	level	(Hausman	2015,	Alexandrova	2017).	It	is precisely	this	problem	–	fitting	all	that	wellbeing	encompasses	in	one	valid	and practical	measurement	procedure	–	which	motivates	recent	criticisms	of wellbeing	interventions	in	public	health	such	as	the	one	articulated	by	England's Chief	Medical	Officer: After	reviewing	the	evidence	I	conclude	that	well-being	does	not	have	a sufficiently	robust	evidence	base	commensurate	with	the	level	of 19 attention	and	funding	it	currently	receives	in	public	mental	health	at national	and	local	government	level.	Well-being,	as	a	field	within	mental health,	has	not	evidenced	an	acceptable	definition	or	set	of	metrics.	It	is unclear	how	concepts	and	measures	that	do	exist	relate	to	populations with	mental	illness(Davies	2014,	15). This	harsh	verdict	is	not	uncontested	(Huppert	and	Ruggeri	in	press)	and	the measurement	of	wellbeing	remains	a	lively	project	in	the	social	and	medical sciences.	However,	whether	measures	of	mental	health	should	be	identical	to measures	of	wellbeing	is	and	should	be	controversial. Where	does	this	leave	us?	The	negative	conception	is	not	positive	enough,	while the	existing	positive	ones	are	too	positive,	so	to	speak.	Is	there	a	happy	medium? We	submit	there	is,	namely	a	relatively	value-neutral	definition	of	mental	health that	avoids	the	problems	associated	with	defining	mental	health	in	terms	of wellbeing.	To	see	where this	more	ecumenical	conception	lies	it	is	useful	to analyse	how	it	differs	from	common	definitions	of	mental	health.	For	instance, the	following	definition	by	the	Public	Health	Agency	of	Canada	is	a	fairly	typical instance	of	how	mental	health	is	conceptualised	by	health	practitioners	and within	public	policy: The	capacities	of	each	and	all	of	us	to	feel,	think,	and	act	in	ways	that enhance	our	ability	to	enjoy	life	and	deal	with	the	challenges	we	face.	It	is a	positive	sense	of	emotional	and	spiritual	wellbeing	that	respects	the 20 importance	of	culture,	equity,	social	justice,	interconnections,	and personal	dignity.10 How	does	our	definition	of	mental	health	differ	from	this	kind	of	conception?	We wish	the	authors	had	stopped	after	the	promising	first	sentence	and	skipped	the overly	grand	second	sentence	altogether.	What	if	we	identified	mental	health	not with	wellbeing,	but	rather	with	those	psychological	capacities	that,	if	developed and	maintained,	enable	individuals	to	pursue	any	conception	of	the	good	life	or wellbeing,	whatever	conception	of	it	they	adopt?	In	the	following	section	we flesh	out	the	idea	that	mental	health	is	a	precondition	of	wellbeing,	without	being identical	to	wellbeing. 6.	Mental	Health	as	a	Psychological	Primary	Good Let	us	begin	with	that	first	sentence	from	the	Public	Health	Agency	of	Canada definition,	which	takes	mental	health	to	consists	in	"the	capacities	of	each	and	all of	us	to	feel,	think,	and	act	in	ways	that	enhance	our	ability	to	enjoy	life	and	deal with	the	challenges	we	face." There	are	four	notable	features	of	this	onesentence	definition,	which	we	will	briefly	consider	in	turn	before	formulating	our more	general	definition	of	mental	health. Firstly,	mental	health	concerns	our	capacities	to	feel,	think,	and	act	in	certain ways	that	enhance	our	ability	to	attain	certain	states	of	affairs. It	is	not	defined by	how	we	actually	feel,	think,	and	act,	or	by	what	we	actually	attain. Already 10	https://www.canada.ca/en/public-health/services/health-promotion/mental-health/mentalhealth-promotion.html 21 these	qualifications	limit	the	scope	of	mental	health	in	a	liberal	direction. This has	much	in	common	with	the	"capabilities	approach"	towards	human development	and	justice	(Nussbaum	2000;	Sen	1999). According	to	the capability	approach,	the	good	life	is	not	about	having	a	set	of	goods,	but	rather about	having	a	set	of	valuable	capabilities. Valuable	capabilities	include freedoms	to	undertake	valuable	activities	(e.g.	holding	a	decent	job,	being	able	to engage	in	politics,	being	able	to	spend	time	in	unspoilt	nature)	or	freedoms	to enjoy	certain	states	of	being	(e.g.	being	healthy,	being	respected	for	one's religious	affiliation	or	sexual	orientation,	being	able	to	live	in	a	loving	family	and a	supportive	social	network)	(Robeyns	2017). The	advantage	of	focusing	on capabilities	–	the	abilities,	skills,	and	opportunities	–	rather	than	actual	states	of doing	and	being	is	that	people	remain	free	to	decide	whether,	and	how	best,	to use	them.	Out	of	all	capabilities	our	definition	of	mental	health	will	be	grounded in	the	psychological	ones	to	feel	and	to	think	and	we	shall	reserve	for	them	the term	'capacities'. This	focus	on	human	capacities	also	coheres	with	George	Graham's	definition	of mental	disorder	(Graham	2013). Graham	defines	mental	disorder	as	the	inability to	develop	and	exercise	psychological	capacities	for	'flourishing',	which	he further	defines	as	the	capacities	we	are	bound	to	need	no	matter	what	life	we decide	to	pursue. In	defining	mental	disorder	in	this	way,	Graham	is	drawing explicitly	upon	John	Rawls'	notion	of	primary	goods	–	all-purpose	goods	that people	need	whatever	their	plans. According	to	Rawls,	liberal	states	should provide	citizens	with	the	necessary	means	to	pursue	their	own	conceptions	of the	good. As	long	as	the	pursuit	of	one's	own	conception	of	the	good	does	not 22 result	in	harm	to	others,	it	is	not	the	business	of	the	state	to	deem	whether	or	not one's	own	conception	of	the	good	is	worthwhile. Although	Rawls	was	concerned with	the	material	and	social	basis	for	primary	goods,	his	theory	can	be	extended to	the	psychological	conditions	required	for	people	to	pursue	their	own conceptions	of	the	good	life. We	believe	this	way	of	defining	mental	health	is useful	and	avoids	the	problems	associated	with	definitions	that	ground	mental health	in	the	notion	of	wellbeing. The	second	notable	feature	of	the	above	one-sentence	definition	of	mental	health is	that	it	is	minimal. Instead	of	a	long	list	of	capacities,	it	consists	in	two:	namely the	ability	to	enjoy	life	and	to	deal	with	challenges	we	face. These	capacities	are broad	and	can	be	specified	in	a	number	of	ways. For	reasons	of	liberal	neutrality, we	consider	this	to	be	a	virtue	of	a	definition	of	mental	health	rather	than	a	vice. Recall	that	the	Public	Health	Agency	of	Canada	definition	goes	on	to	specify	how these	capacities	are	realised,	stating	that	mental	health	is	"a	positive	sense	of emotional	and	spiritual	wellbeing	that	respects	the	importance	of	culture,	equity, social	justice,	interconnections,	and	personal	dignity." We	can	see	how	outlining the	breadth	of	mental	health	in	this	way	can	be	useful	–	showing	how	it	may	be impacted	by	a	wide	range	of	conditions,	such	as	culture,	equity,	social	justice, interconnections	and	personal	dignity. But,	although	this	may	be	true	for	some individuals,	it	may	not	be	the	case	for	others. The	conditions	that	are	actually required	for	people	to	enjoy	life	and	deal	with	challenges	they	face	is	largely	an empirical	question	and	will	partly	be	determined	by	differences	in	personality, age,	context	and	culture. 23 Thirdly,	the	above	definition	concerns	capacities	to	feel,	think,	and	act	in	certain ways. This	emphasis	on	psychological	capacities	–	feeling,	thinking	and	acting	– distinguishes	it	from	definitions	of	physical	health. Definitions	of	physical	health (positively	construed)	are	concerned	with	the	physiological	capacities	that enhance	our	ability	to	enjoy	life	and	deal	with	the	challenges	we	face. This	does not	mean	to	say	there	aren't	significant	areas	of	crossover	between	the	two	e.g. diet,	exercise,	social	connection. However,	we	believe	the	above	distinction accounts	for	the	main	differences	between	physical	and	mental	health	treatment. Fourthly,	it	is	worth	noting	the	two	broad	capacities	that	mental	health	consists in	according	to	the	above	definition:	a)	to	enjoy	life;	and	b)	to	deal	with	the challenges	we	face. These	broad	capacities	get	to	the	heart	of	what	it	means	to	be mentally	healthy. However,	we	believe	they	can	be	even	more	broadly	construed to	qualify	as	a	psychological	primary	good.	Firstly,	we	can	re-construe	the	ability to	enjoy	life	as	the	ability	to	value	life	–	to	see	life	as	valuable	or	worth	living. Not everyone	needs	to	enjoy	life	to	pursue	their	own	conception	of	the	good	life. However,	the	ability	to	value	life	is	a	necessary	precondition	for	wellbeing.	We can	re-construe	the	second	capacity	in	a	similar	way.	The	ability	to	deal	with	the challenges	we	face	is	an	important	component	of	the	wider	ability	to	engage	in life	–	to	pursue	the	things	in	life	that	seem	valuable	or	worthwhile,	despite difficulties,	challenges,	setbacks,	failures,	losses,	and	so	on. Although	these	capacities	come	in	degrees,	they	nonetheless	can	fall	above	or below	certain	thresholds. For	instance,	one	symptom	of	depression	is	that patients	are	unable	to	see	value	in	themselves,	others,	or	their	environment. 24 Similarly,	patients	with	general	anxiety	disorder,	due	to	excessive	worry	and anticipation	of	disaster,	may	be	unable	to	cope	with	various	demands	and	threats concerning	the	things	they	care	about. In	both	cases,	patients	can	be	viewed	as slipping	below	a	certain	threshold	of	being	able	to	value	or	engage	in	life. On	the	basis	of	these	four	points,	we	can	offer	the	following	one-sentence definition	of	mental	health	as,	'the	capacities	of	each	and	all	of	us	to	feel,	think, and	act	in	ways	that	enable	us	to	value	and	engage	in	life.' In	the	next	section, we'll	outline	what	we	take	these	psychological	capacities	for	valuing	and engagement	to	consist	in. Note	that	we	only	offer	this	outline	as	a	way	of clarifying	the	scope	of	this	relatively	neutral	definition	of	mental	health. It	is	a starting	point	for	a	full,	empirically-informed	account,	which	is	however	beyond the	scope	of	this	article. 7.	Towards	a	Broad	Definition	of	Mental	Health We	maintain	that	mental	health	can	be	defined	as,	'the	capacities	of	each	and	all of	us	to	feel,	think,	and	act	in	ways	that	enable	us	to	value	and	engage	in	life.' In this	section,	we	will	expand	on	what	the	two	main	features	of	this	definition	– valuing	life	and	engaging	in	life	–	consist	in. Consider	valuing	life,	first. We	take	this	to	consist	in	capacities	to	care	about certain	states	of	affairs	–	features	of	ourselves,	others	and	our	environment. When	you	value	something,	you	are	positively	disposed	towards	it	(in	a psychological	sense)	in	various	ways	(Tiberius	2018). For	example,	when	you love	someone,	you	may	feel	a	sense	of	warmth	and	connection	around	them,	a 25 mild	form	of	separation	distress	when	they	leave,	be	motivated	to	care	for	them and	look	out	for	their	wellbeing,	and	so	on. This	is	different	to	merely	seeing something	as	good	or	valuable	in	some	way. Valuing,	in	addition,	involves	being disposed	or	committed	to	seeing	something	as	valuable. This	may	not	always take	the	form	of	an	explicit	value	judgement	towards	that	thing	(i.e.	"I	value	x"	or "I	believe	x	is	worthwhile")	but	nonetheless	influences	how	you	consistently	feel, think	and	act	in	relation	to	it	over	time.11 Our	capacities	to	value	certain	states	of	affairs	may	seem	relatively straightforward	or	foundational,	but	they	still	need	to	be	developed,	and	may remain	fragile	throughout	our	lives. Psychopathy,	for	instance,	can	be	viewed partly	as	an	inability	to	develop	certain	valuing	capacities,	in	particular	the ability	to	value	the	wellbeing	of	others. Alternatively,	individuals	may	lose	their valuing	capacities,	as	can	be	the	case	with	depression,	or	during	extreme	cases	of grief. To	be	able	to	appreciate	life	is	foundational	to	our	sense	of	agency,	but	it	is far	from	straightforward. Valuing	certain	states	of	affairs	–	features	of	ourselves, others,	and	our	environment	–	is	a	complex	endeavour,	which	may,	amongst other	things,	require	the	presence	of	basic	goods,	such	as	pleasure,	loving relationships,	moral	worth,	and	good	effects,	and	the	absence	of	their	opposites (Smuts	2017). 11	Sometimes	we	may	consistently	see	something	as	valuable	without	valuing	it. This	may	be	a result	of	habit	or	compulsion,	as	is	often	the	case	with	addictive	behaviours. In	such	cases, individuals	may	not	identify	with	their	feelings	towards	an	addictive	substance	or	behaviour, instead	seeing	them	as	alien	and	contrary	to	their	sense	of	agency. They	may	feel	shame	towards such	feelings,	pride	at	overcoming	them,	and	admiration	towards	others	who	manage	to	do	so. 26 Let	us	now	turn	to	the	second	part	of	our	proposed	definition	of	mental	health, namely	engaging	in	life. This	includes	the	ability	to	'deal	with	challenges	we face',	as	emphasised	in	the	Public	Health	Agency	of	Canada	definition	above. Again,	this	is	just	a	sketch,	but	we	take	engaging	in	life	to	at	least	partly	consist	in the	capacities	that	make	up	psychological	flexibility.12 Psychological	flexibility	is "the	ability	to	change	or	persist	in	behavior	when	doing	so	serves	valued	ends." (Hayes	et	al	2011)	In	the	pursuit	of	valued	ends,	we	often	come	across difficulties,	challenges,	setbacks,	failures	and	losses. In	response,	being psychologically	flexible	enables	us	to	shift	our	perspective,	successfully	adapt and	learn	from	our	situation. This	may	either	result	in	changing	or	persisting behaviour	depending	on	what	is	learned. For	instance,	the	practice	of mindfulness	often	involves	subjects	simply	paying	attention	to	their	sensations, thoughts	and	feelings	–	neither	ignoring	them	nor	seeing	them	as	the	full	picture. This	can	help	subjects	act	on	the	information	provided	by	those	sensations without	engaging	in	habitual	patterns	of	meaning	and	behaviour.13 As	with	our	capacities	to	value	life,	our	capacities	for	engaging	in	life	also	need	to be	developed,	and	may	remain	fragile	in	the	response	to	various	difficulties,	setbacks,	and	adversities. Mental	disorders	such	as	depression	and	general	anxiety disorders	often	involve	individuals	'getting	stuck'	in	certain	ways	of	thinking, feeling	and	acting. We	may	often	be	able	to	pursue	our	values	through	the formation	of	appropriate	goals	and	plans. However,	when	things	inevitably	do 12	For	a	review,	see	Kashdan	&	Rottenberg	2010. 13	For	related	notions	to	psychological	flexibility,	see	De	Young	2015	on	the	personality	metatraits	of	Stability	and	Plasticity,	and	McGilchrist	2012	on	the	divided	brain. 27 not	go	to	plan,	we	may	be	more	or	less	able	to	treat	our	situation	in	a psychologically	flexible	manner. Psychological	flexibility	involves	being	able	to see	such	situations	as	providing	us	with	worthwhile	–	if	not	predominantly negative	–	information. We	may	use	this	information	to	form	new	goals	and plans,	and	different	sets	of	skills,	habits	and	behaviours. These	abilities	to understand	and	act	within	any	given	situation,	or	within	any	area	of	life,	are foundational	to	a	person's	mental	health. In	summary,	our	definition	of	mental	health	builds	upon	existing	positive definitions	of	mental	health	while	stripping	them	down	to	their	foundations.	We focus	on	people's	basic	abilities	to	form	values	and	pursue	them	in	the	face	of life's	difficulties	and	challenges. In	short,	we	suggest	that	mental	health	consists in	people's	basic	psychological	capacities	to	value	and	engage	in	life.	These capacities	are	positive	psychological	features,	not	mere	absence	of	mental	illness, but	they	are	not	sufficient	for	wellbeing. The	definition	thus	offers	more	than	the negative	one	and	less	than	the	utopian	ones. 7.	Objections	and	Replies In	this	section,	we	will	consider	some	objections. According	to	our	definition, mental	health	concerns	the	capacities	of	each	and	all	of	us	to	feel,	think,	and	act in	ways	that	enable	us	to	value	and	engage	in	life. One	might	object	that	both	of these	two	main	features	of	the	definition	valuing	life	and	engaging	in	life	–	are problematic	notions. 28 Consider,	first,	the	notion	of	valuing	life. One	might	object	that	our	definition	of valuing	life	does	not	consist	in	capacities	for	valuing	things	that	are	actually valuable. For	example,	according	to	our	definition,	someone	might	qualify	as being	mentally	healthy	even	if	they	value	things	that	do	not	make	them	better	off, such	as	fame	and	fortune. This	is	problematic	insofar	as	mental	health	is typically	viewed	as	something	of	value,	either	in	an	intrinsic	or	instrumental sense	(Raibley	2012). Why	should	we	care	about	people's	mental	health	if	it consists	in	people	valuing	things	that	do	not	contribute	towards	their	wellbeing? In	response,	we	believe	we	should	embrace	the	potential	for	mentally	healthy individuals	to	develop	values	and	conceptions	of	the	good	life	that	may	not	in fact	be	good	for	them. Thus,	according	to	our	definition,	mental	health	is	a necessary	but	not	sufficient	precondition	for	wellbeing. Wellbeing	requires	not merely	the	ability	to	value	certain	states	of	affairs,	but	rather	the	ability	to	value states	of	affairs	that	are	good	for	us. Instead	of	viewing	this	as	a	weakness	of	our definition,	we	take	it	to	be	a	strength. In	contrast	to	the	notion	of	wellbeing which	is	defined	relative	to	some	substantive	good	such	as	pleasure,	success	or flourishing,	the	concept	of	mental	health	makes	reference	only	to	valuing	and engagement	and	these	capacities	are	neutral	with	respect	to	the	precise conception	of	wellbeing	that	an	individual	may	adopt.	We	hope,	or	rather	it's	an empirical	bet	we	are	making,	that	whether	one	is	a	hedonist,	an	Aristotelian	or	a desire	theorist,	certain	capacities	are	fundamental.	That	these	capacities	are,	as 29 we	outlined	above,	is	empirical	matter	we	want	science	or	medicine	to	answer.14 This	is	not	to	say	that	our	definition	is	purely	descriptive.	What	it	takes	to	value and	to	engage	may	well	require	value	judgments	(for	instance,	about	what counts	as	a	normal	setback	versus	an	insurmountable	obstacle	that	people should	not	be	expected	to	overcome),	but	these	judgments	are	less	contentious than	judgments	about	nature	of	wellbeing. Thus	our	definition	of	mental	health	steers	clear	of	normative	judgments	about what	is	good	for	us	and	how	we	ought	to	live. Mental	health	consists	in	being able	to	value	certain	features	of	ourselves,	others	and	our	environment,	rather than	certain	features	we	should	value	according	to	any	particular	prudential, moral	or	religious	theory. The	second	objection	relates	to	the	notion	of	engaging	in	life. The	ability	of individuals	to	effectively	pursue	the	things	they	value	requires	a	range	of attentional,	emotional	and	cognitive	capacities	(Bratman	2018,	Holton	2008, Mele	1997). In	contrast,	our	definition	of	mental	health	only	consists	in	the broad	capacities	that	make	up	psychological	flexibility	–	the	ability	to	change	or persist	in	behavior	when	doing	so	serves	valued	ends. One	might	object	that	this definition	is	relatively	uninformative. 14	It	is	possible	that	empirical	findings	will	reveal	that	there	is	no	single	set	of	psychological capacities	that	underlie	all	the	plausible	conceptions	of	wellbeing.	This	is	a	possibility	that	we should	certainly	allow	for,	but	equally	ours	is	a	justifiable	bet. 30 In	response,	although	it	is	tempting	to	expand	this	list	of	capacities	to	include other	psychological	capacities	(in	particular	those	related	to	the	formation	and maintenance	of	social	relationships),	we	want	to	resist	this	move. A	more expansive	list	may	include	the	kinds	of	psychological	capacities	outlined	in Jahoda's	definition	of	mental	health	discussed	above	–	things	such	as	selfacceptance	and	self-confidence,	self-actualization,	autonomy,	and	environmental mastery	(Jahoda	1958). However,	we	have	argued	that	these	more	demanding definitions	of	mental	health	are	problematic	in	various	ways. In	order	to	remain as	value-neutral	as	possible,	our	definition	of	mental	health	consists	in	broad psychological	capacities	which	can	then	be	further	specified,	on	a	case	by	case basis,	in	accordance	with	a	particular	individual's	values,	and	other,	more general,	factors	such	as	their	personality,	age,	context	and	culture. The	result	is	a	definition	of	mental	health	that	views	mental	health	as	a	necessary (but	not	sufficient)	precondition	for	wellbeing. Moreover,	it	leaves	considerable room	for	empirical	work	to	flesh	out	what	mental	health	consists	in	for	different cultures,	groups,	personalities,	ages,	etc.,	and	clinical	work	to	determine	the specific	capacities	that	impact	the	mental	health	of	any	given	individual. Being able	to	value	and	engage	with	life	is	likely	to	consist	in	a	complex	range	of attentional,	emotional	and	cognitive	capacities	that	will	vary	considerably	by context. Nonetheless,	our	definition	of	mental	health	provides	a	rough	outline	of the	broad	kinds	of	psychological	capacities	that	matter	and	why. 8.	Looking	ahead 31 We	have	argued	that	there	exists	a	happy	medium	between	the	insufficiently	and the	overly	demanding	definitions	of	mental	health.	Our	definition	has	the following	features: l It	is	positive	rather	than	negative	because	in	addition	to	absence	of disease	we	specify	a	further	requirement. l It	is	grounded	in	wellbeing	without	identifying	mental	health	with wellbeing. l It	is	politically	legitimate	or	at	least	has	a	better	chance	of	being	so	than the	more	demanding	definitions. By	way	of	conclusion	we	wish	to	raise	two	issues	we	have	not	discussed	in	this paper	but	that	may	well	be	affected	by	our	proposal.	Firstly,	the	issue	of measurement.	It	is	a	live	controversy	which	scales,	questionnaires	and	indicators best	capture	mental	health.	One	popular	scale	for	measuring	'mental	well-being' is	the	Warwick	and	Edinburgh	Mental	Well-being	Scale	which	asks	people	to judge	the	extent	to	which	they	feel	optimistic,	effective,	useful,	relaxed,	able	to get	along	with	other	people	and	to	make	up	their	mind	about	things	(StewartBrown	and	Janmohamed	2008).	Although	it	has	the	word	'well-being'	in	it,	in	fact it	measures	people's	own	sense	of	their	personal	effectiveness	for	going	through with	basics	of	life.	There	is	a	difference	between	this	sense	of	personal effectiveness	on	the	one	hand,	and	subjective	wellbeing	on	the	other.	Intuitively the	latter	refers	to	our	emotional	wellbeing,	our	happiness,	our	fullness	of	heart, joy	and	contentment.	Feeling	happy	takes	more	than	just	patting	yourself	on	the back	for	being	effective.	Quite	possibly	this	scale	captures	our	definition 32 reasonably	well,	but	this	is	ultimately	a	question	for	a	proper	psychometric investigation.15 The	second	issue	is	which	interventions	support	mental	health	on	our	definition. This	is	of	course	an	empirical	question. However,	it	seems	likely	that	mental health	as	a	precondition	of	wellbeing	would	need	more	than	medication	and	talk therapy.	The	development	and	the	maintenance	of	the	relevant	psychological skills	calls	for	interventions	at	social	rather	than	individual	levels,	anticipating structural	obstacles	to	exercise	of	agency	such	as	gender	norms,	racial	and	class discrimination,	and	generally	aim	at	empowerment,	rather	than	only	treatment and	prevention. 15	Böhnke	and	Croudace	2016	raise	significant	worries	about	validity	of	all	the	existing	measures of	positive	mental	health. 33 Works	Cited: Alexandrova,	A.	2017.	A	Philosophy	for	the	Science	of	Well-being.	New	York: Oxford	University	Press. 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