What is Positive Psychiatry?
(Written October 2022)
First, let’s start with what it’s not.
Positive psychiatry is not:
“Don’t think about the bad stuff, just look on the bright side!”
“Keep a smile on your face! Turn that frown upside down.”
“Happiness is a choice.”
“You should be grateful.”
Ugh, I shuddered just writing those. Toxic positivity is marked by dismissing negative feelings and addressing distress with false reassurance. There’s no room for empathy or nuance. Toxic positivity doesn’t help anxiety or depression and can even double-up on the suffering through guilt and self-judgment (“Why can’t I just feel better? I must be broken…”). It can lead us to hide our pain and ignore real problems that need to be dealt with.
So what is positive psychiatry, then?
Positive psychiatry (or psychology) focuses on enhancing well-being by developing resilience, optimism, wisdom, and social support. We do this through activities and conversation tailored to harness a person’s strengths, channel their core values, develop healthy relationships, and set up wellness habits. This framework was more formally developed by Martin Seligman*, who differentiated what it means strive for a “pleasant” vs. “good” vs. “meaningful” life. In my practice, I draw inspiration from across cultures and time periods, from Buddhism to Viktor Frankl to The Great British Bake Off.
While there will always be room to sit with sad, angry, or other negative feelings (exploring a patient’s painful experiences can be extremely important to healing), this form of treatment places an emphasis on, “So now what?” It respects what has been lost, but focuses on what’s possible to gain.
“Happiness does not consist in things themselves, but in the relish we have of them.”
What does that look like in my office?
If you’re an online quiz sort of person, we might fill out the Personal Strengths Inventory or Signature Strength Questionnaire. I usually find that talking through an assessment with you as you think about the questions yields more than just looking at your results, but I understand there is not always time for that. And we might get all that we need just from talking during your initial evaluation. The key thing I’ll be trying to understand is what is truly important to you: about yourself, your surroundings, and your place in the world.
Based on you and your goals, we can then learn techniques to help us recognize and savor what is already going well for you. We’ll identify challenges in your life and develop an initial plan of how to approach them, keeping your strengths and underlying values in mind. Depending on your symptoms, we may sprinkle in cognitive, mindfulness, mentalization, assertiveness, or other practices as well.
A central part of this plan will also focus on getting you support. This might mean feeling more comfortable with tapping your existing network of friends, colleagues, and family, or it might mean working on expanding (or pruning!) your social circle. And we’ll conduct an informal wellness inventory, which will allow us to see areas that could use a little TLC (sleep, nutrition, activity level, creative expression, technology and social media use, etc).
“Happiness is when what you think, what you say, and what you do are in harmony.”
More broadly…
Realism is important and even pessimism has a place in motivating us towards societal change. Any well-intentioned maxim can be weaponized; any word of comfort has the potential to invalidate. My motive will never be to force anyone to be positive, only to see them realistically and accompany them on their search for what they truly want and need in their lives.
* Seligman is not perfect, and there is plenty in his writings that I disagree with.
** Quotes and other concepts from this article in Current Psychiatry.
