Psychiatry’s pursuit of euthymia: another wild goose chase or an opportunity for principle-based facilitation?

Abstract

The authors are encouraged that the field of psychiatry is moving towards including euthymia and its components (e.g., well-being, flourishing and resilience) as well as dysfunction (i.e., psychopathology and its symptoms) in its assessment and treatment. We are concerned, however, that to guide its pursuit of euthymia, psychiatry appears to be adopting the same ‘outside-in’ paradigm as positive psychology; that the positive must be ‘put into’ people via assisting them to adopt new positive beliefs and persistently practice psychotherapeutic techniques. We fear that if psychiatry continues to view the positive through this ‘outside-in’ lens, its pursuit of euthymia will bear small fruit. In this editorial, we posit that mental health and psychopathology can be viewed from the same basis because both are created in the same way; from the ‘inside-out’ via people’s use of three psycho-spiritual Principles—Universal Mind, Consciousness and Thought. We posit that people can use these Principles in a way that either creates distressing symptoms or releases innate euthymia. We further posit that via awareness and sufficient insight-based understanding of how these Principles manifest within everyone, psychiatry can achieve a deeper understanding of the source of all psychological experience that will facilitate its pursuit of euthymia.

Keywords:

• Euthymia
• innate mental health
• clinical psychiatry

For the bulk of the nineteenth century psychiatry and psychology focussed primarily on dysfunction and paid scant attention to mental well-being and flourishing. In 1954 Maslow (1954) lamented, ‘It is as if psychology has voluntarily restricted itself to only half its rightful jurisdiction, and that, the darker, meaner half’ (354). In 1998, a renewed interest in well-being and flourishing was ignited for psychology by Martin Seligman (1998) who implored the field to focus on strength, resilience and optimal human functioning. In 2000, the positive psychology movement was born and over the next two decades its contributors published thousands of papers regarding the conditions and processes that relate to optimal mental health. Recently, however, the efficacy of positive psychology’s interventions (PPIs) has been challenged. For example, a comprehensive meta-analysis (White et al. 2019) replicated the data from the original sources of two prominent meta-analyses regarding the efficacy of PPIs for increasing mental well-being. The findings revealed that for both oft-cited meta-analyses, the effect sizes were much smaller than initially reported and often were non-significant (White et al. 2019).

Psychiatry’s pursuit of euthymia

The proposition that a full recovery requires attending to the positive as well as the negative came much later for psychiatry (Jeste et al. 2015) and appears to be gaining momentum. Fava and Guidi (2020) called for psychiatry to consider euthymia ‘… as a transdiagnostic strategy to be incorporated in an individualized treatment plan’ (80). Fava and Guidi (2020) stated:

There is increasing evidence that the evaluation of euthymia and its components has major clinical implications… The findings indicate that flourishing and resilience can be promoted by specific interventions leading to a positive evaluation of one's self, a sense of continuing growth and development, the belief that life is purposeful and meaningful, satisfaction with one's relations with others, the capacity to manage effectively one's life, and a sense of self‐determination. (80)

The authors are heartened that psychiatry appears to be moving towards including euthymia as well as dysfunction in its assessment and treatment. We are fearful, however, that to guide its pursuit of euthymia, psychiatry appears to be adopting the same limited ‘outside-in’ paradigm that positive psychology adopted to direct its search for flourishing. In other words, psychiatry’s prevailing view appears to be that euthymia must be ‘put into’ people via assisting them to adopt new positive beliefs and persistently practice various psychotherapeutic techniques. For example, to promote euthymia, Fava and Guidi (2020) advocate the use of well-being therapy; a manualized strategy that emphasises self‐observation, the use of a structured diary, homework, taking on positive beliefs (e.g., ‘life has purpose and meaning’) and the development of satisfying relationships, effective life management and self-efficacy. The authors posit that if psychiatry continues to view the positive through this ‘outside-in’ lens, its pursuit of euthymia, like positive psychology’s search for flourishing, will bear small fruit.

The need for fundamental, universal principles

In their lead article in the inaugural issue of The Journal of Positive Psychology, Linley et al. (2006) expressed the same aspiration for positive psychology that William James expressed for psychology well over a century ago:

Looking into the future, our aspiration would be that positive psychologists may even be able to discover principles that unite different conceptions of the positive and good, thus allowing movement toward a taxonomic understanding of positive psychological phenomena that would provide a meta-theoretical foundation for optimal human experience. (14)

The authors posit that absent a principle-based foundation to guide its pursuit of euthymia, positive psychiatry, like positive psychology, will have limited success assisting people to realise and sustain euthymia. Without a commonly accepted principle-based foundation, positive psychiatry, like positive psychology, will inevitably splinter into separate and often competing theories, practices and areas of specialisation. In this regard, we posit that fundamental, universal Principles that unite different views of the positive and good have been uncovered by Sydney Banks (1998). Banks proposed that a deeper understanding of psychological experience is revealed by looking beyond the realm of form in which psychology and psychiatry have generally restricted their scopes of inquiry. Banks further asserted (1998) that there are fundamental, universal Principles that operate to create form and offered the constructs of Mind, Consciousness, and Thought as metaphors to point to the nature of these Principles. A brief description of these Principles follows.

The principle of universal mind

Banks (1998) referred to Universal Mind as the intelligent energy of all things—the intelligent life force energy that powers people’s psychological functioning. Banks (1998) stated, ‘Universal Mind is the intelligence of all things, whether in form or formless [and]… holds the secret to all psychological functioning’ (59).

The principle of consciousness

Banks (1998) referred to Consciousness as ‘… the gift of awareness … [which] allows for the recognition of form, form being the expression of Thought’ (39). Consciousness also animates people’s thinking through their physical senses forming their moment-to-moment psychological experiences (e.g., feelings, perceptions, states of mind). Banks (1998) stated, ‘Universal Consciousness… enables us to observe and experience the existence and workings of the world we live in’ (97). Banks (1998) also distinguished levels of consciousness stating:

… as our consciousness descends, we lose our feelings of love and understanding and experience a world of emptiness, bewilderment and despair. As our consciousness ascends, we regain purity of Thought and, in turn, regain our feelings of love and understanding. (p. 40)

The principle of thought

Thought, as a Principle, refers to the fact that everyone uses the power of Thought to create their psychological experiences from the ‘inside-out’ one thought at a time. Banks (1998) stated ‘Thought is the creative agent we use to direct us through life’ (47) and he asserted that the agency of Thought can be used in an infinite number of ways; to create happiness or sadness, forgiveness or anger, exhilaration or depression and everything in between. Banks (1998) stated ‘Thought is the master key that opens the world of reality to all living creatures… Thought is not reality, but it is through thought that our realities are created’ (49).

Innate euthymia

Banks (1998) further posited that well-being, flourishing and resilience exist within the core or essence of all people. In other words, people can realise and sustain euthymia because euthymia is their natural state. Taking on positive beliefs and practicing techniques to access and sustain euthymia is unnecessary. Even when techniques (e.g., meditation) are used successfully, we posit that the change always comes from within (Pransky and Kelley 2014). Euthymia arises in the feelings of the compassion, warmth, presence and hope that emerge in the therapeutic relationship.

Banks (1998) stated further, ‘Our feelings are the barometer of our thoughts’ (111). In other words, people’s feelings will inform them when they are operating from euthymia or obscuring this innate health with their own disordered personal thinking. Using the signal of a discomforting feeling to discern they are misusing the power of Thought, people can get back on track, so to speak, and allow euthymia to re-surface as the personal mind quiets.

Facilitating psychiatry’s pursuit of euthymia

Mental health education grounded in the Principles of Universal Mind, Consciousness and Thought assists people to become aware and experience sufficient insight-based understanding of the nature of these Principles; in marked contrast to feeding information to the personal intellect. Our research (Kelley et al. 2015) and clinical observations show that when people realise they are continually thinking and that their thoughts are translated into ‘apparent reality’ by their consciousness, they ‘see’ that every so-called reality is a fleeting, ephemeral product of their own minds at work. When people grasp the connection between their thinking and their feelings, perceptions, states of mind and behaviour, they gain perspective on life. Shifts in their experience show up as ‘thought events’ rather than effects of external circumstances or how others treat them. On the other hand, without awareness or sufficient insight-based understanding of the Principles, people are prone to innocently misuse the power of Thought and, in turn, to believe and act on the ideas, perceptions and feelings this disordered personal thinking creates. In this regard, voluminous psychopathology research shows that misusing the power of Thought (e.g., to worry, obsess, ruminate, judge, over-analyze) is a core factor in the aetiology and maintenance of numerous psychological and somatic symptoms and disorders (Verkuil et al. 2012).

Furthermore, when people realise they have euthymia already inside them, their personal thinking calms down. When they realise their feelings will inform them when they are operating from euthymia or obscuring their health with their own disordered personal thinking, they take their discomforting feelings less seriously and avoid chronic mental stress. In this regard, voluminous psychopathology research shows that multiple symptoms are initiated and sustained by the chronic activation of the stress response system (Mah et al. 2016). In sum, the authors posit that awareness and sufficient insight-based understanding of the Principles of Universal Mind, Consciousness and Thought can point psychiatry towards a deeper understanding of all psychological experience, from languishing to flourishing, and facilitate its pursuit of euthymia.

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No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.