Constructing a liberated and modern mind: six pathways from pathology to euthymia

Abstract

Traditional psychiatric nosology has been largely based on the idea that human psychological suffering reflects a latent disease1. As Fava and Guidi note in their paper2, this conception has interfered with a more balanced and positive approach. It is not just that the focus on psychological distress has overwhelmed needed attention to positive experience. It is also that the latent disease model underlying syndromal diagnoses provides minimal clinical guidance regarding the nature of psychological health. It is obvious that human thriving is not merely the absence of distress. However, without a more adequate approach, clinicians are not given guidance about how to pivot their attention from pathology toward psychological prosperity in a more meaningful and coherent way. If a process-based diagnostic approach is adopted, however, clear pathways arise from pathology to euthymia. More so than eudaimonic detachment, euthymia denotes the balanced satisfaction of human needs and yearnings. Just as distressing human emotions reflect the frustration of core yearnings, positive human emotions and well-being reflect their accomplishment. For that reason, we may be able to use the core human yearnings reflected inside pathological processes to provide a kind of roadmap for the creating of euthymia itself. In an extended evolutionary approach to process-based diagnosis, processes of change link to variation, selection, retention, and context sensitivity in at least six psychological dimensions: affect, cognition, attention, self, motivation, and overt behavior3. As a set, these psychological dimensions are then nested in between social/cultural and genetic/physiological levels of analysis. The psychological flexibility model (PFM) that underlies acceptance and commitment therapy (ACT) contains six known pathological processes of change that are paired with six known positive processes of psychological growth4, 5. These six pairs line up with the six dimensions just listed. In the area of affect, the negative change process of experiential avoidance pairs with the positive process of experiential acceptance; in the cognitive area, cognitive fusion and entanglement pairs with cognitive defusion; in attentional areas, rigid attention to the past and future, via rumination and worry, pairs with flexible, fluid and voluntary attention to the now; in the area of self, defense of a conceptualized self is paired with a perspective taking sense of self and ongoing self-awareness; in the motivational area, unhealthy forms of compliance, self-gratification, or aversive and avoidant rule-based demands are paired with chosen values; in the overt behavioral area, perfectionism, impulsivity or procrastination are paired with committed and step-by-step acquisition of broader patterns of values-based action. What is not usually noticed in these pairings inside the PFM is that they are connected by deep human yearnings6. Consider those focused on by self-determination theory, one of the best empirically supported approaches to human needs: belonging, autonomy and competence7. Entanglement with a conceptualized self can be thought of as the mental mismanagement of a yearning to belong, in which people attempt to gain group membership and social connection or support by presentation of a persona that is especially able or especially needy. Over time, the mental attachment to specialness undermines belonging by fostering narcissistic pretense and avoidant/self-aggrandizing forms of "self-esteem" , or coercive presentations of pathos. Either of these forms of adjustment lowers healthy connection and eventually drives others away. Perspective taking and shared awareness, conversely, are known to foster genuine connection, attachment and belonging. In a similar way, the yearning for autonomy or self-directed meaning is mismanaged by compliance, self-gratification and rule-based demands, but is satisfied by chosen values; while the yearning for competence is mismanaged by perfectionism, impulsivity or procrastination but is satisfied by the committed construction of larger and larger patterns of values-based action. In all of these pairs, the deep yearning underneath pathological processes of change is not the problem – pathology is just the wrong solution to the correct human challenge. What draws people into pathology is the one-two punch of short-term and more certain contingencies dominating over longer-term and more probabilistic ones, and an excessive reliance on the evolutionarily recent adaptation of symbolic thinking and problem solving. Those general features are managed in ACT by the three remaining pairs of change processes in the PFM. By learning cognitive defusion skills, the yearning for understanding and coherence, that becomes increasingly central as symbolic language is acquired, can be met in a more generally useful way. Instead of trying to achieve literal coherence, in which all thoughts line up neatly in a coherent and