Accentuate the Positive: Model Emphasizes Patient Strengths Rather Than Illness

The time has come to change the focus of psychiatry as a field, from the purely negative (psychopathology) to the positive: wellness, happiness, and positive traits such as resilience, optimism, and social engagement. These traits are associated with better physical and psychological outcomes and can be improved through psychosocial and biological interventions, according to Dilip Jeste, M.D., senior associate dean for healthy aging and senior care, distinguished professor of psychiatry and neurosciences, and director of the Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego.

Jeste made his remarks at the symposium “Positive Psychiatry Across the Lifespan,” held today at APA’s 2015 annual meeting in Toronto. Positive psychiatry, said session presenters, is well poised to provide major contributions to the positive mental health movement and impact the health care of the overall population.

Jeste studied a community-based sample of adults between 20 and 103 years of age, as well as samples of middle-aged and older persons with various mental disorders. The strongest predictors of well-being were resilience and absence of depression but not demographics, physical health, cognitive functioning, or severity of illness. He emphasized that aging can have a positive effect on overall health if optimal physical, cognitive, and psychosocial stimulation is provided.

David Rettew, M.D., of the University of Vermont described a clinical model, called the Vermont Family-Based Approach, that strives to assess key aspects of wellness in families of children presenting for evaluation and then to integrate them into the overall treatment plan. Such an approach provides for a number of new pathways for improvement beyond traditional psychotherapy and medication.

Jennifer Gatchel, M.D., Ph.D., of Harvard University discussed neuroplasticity of adulthood. One of the fundamental principles of the brain is its ability to change in response to a variety of experiences and stimuli, including insults or injury. The adult brain retains the capacity of structural and functional neuroplasticity throughout development and aging.

Piper Meyer, Ph.D., of the University of Minnesota reviewed the growing body of research on the clinical applications of positive psychological interventions, especially to outpatients with schizophrenia, suicidal inpatients, smokers trying to quit, and individuals experiencing chronic pain.

Samantha Boardman, M.D., of Weil Cornell Medical School described the use of positive psychiatry in everyday clinical practice. Using the “tools” of positive psychology, psychiatrists can expand their range of treatment options and better engage patients in the treatment process. A comprehensive approach to mental health increases the potential for wellness in the midst of illness.

Finally, Richard Summers, M.D., of University of Pennsylvania discussed the teaching of these principles to the next generation of psychiatrists during medical school, residency, and fellowship. He emphasized that the cumulative goal of these efforts is to reclaim psychiatrists as experts in true mental health rather than simply mental illness.

Jeste is the co-editor of Positive Psychiatry: A Clinical Handbook from American Psychiatric Publishing. APA members may purchase the book at a discount here.