The first conceptualization of mental health can be traced back to 1948, when J.C. Flugel, Chairman of the First International Congress of Mental Health, proposed to define it as “a condition which permits the optimal development, physical, intellectual and emotional, of the individual, so far as this is compatible with that of other individuals”. In 1950, at the second session of the Expert Committee on Mental Health of the World Health Organization (WHO), mental health was defined as “a condition subject to fluctuations due to biological and social factors, which enables the individual to achieve a satisfactory synthesis of his own potentially conflicting, instinctive drives; to form and maintain harmonious relations with others; and to participate in constructive changes in his social and physical environment”. Neither definition included the concept of well-being (and neither was very influential).

In 2004, the WHO provided a definition of mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”¹. This definition has been highly influential, and several subsequent definitions of mental health have been organized within the same framework, in which a key role is assigned to the person's well-being (the “hedonic” perspective) and his/her self-actualization (the “eudaimonic” perspective).

According to the American Psychological Association, for instance, mental health is “a state of mind characterized by emotional well-being, good behavioral adjustment, relative freedom from anxiety and disabling symptoms, and a capacity to establish constructive relationships and cope with the ordinary demands and stresses of life”². For the Public Health Agency of Canada, mental health is “the capacity 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 well-being that respects the importance of culture, equity, social justice, interconnections and personal dignity”³.

This emphasis on positive feelings and self-actualization in the definition of mental health has been a matter of debate. First, this view is difficult to reconcile with the many challenging life situations in which well-being may even be regarded as unhealthy (indeed, people in good mental health are often sad, angry or unhappy; and it would be problematic to regard as unhealthy a person feeling desperate after being fired from his/her job in a situation in which occupational opportunities are scarce). Second, this view would exclude from the definition of mental health the many adolescents who struggle to find their place in the community, the many elderly people who are not able anymore to work productively and fruitfully, and the many migrants and other members of minority groups who are marginalized and therefore unable to make a contribution to their community.

To overcome the above emphasis on the hedonic and eudaimonic perspectives, a group of experts proposed in 2015 a new definition of mental health as “a dynamic state of internal equilibrium”, to which several components contribute in varying degrees, including “basic cognitive and social skills; ability to recognize, express and modulate one's own emotions, as well as empathize with others; flexibility and ability to cope with adverse life events and function in social roles; and harmonious relationship between body and mind”⁴. This definition allows for the possibility of experiencing crises (e.g., adolescence, retirement) which certainly do not generate a state of well-being, but may lead to a new equilibrium, with a higher level of complexity. Moreover, the definition acknowledges the fact that mentally healthy people may experience negative emotions such as fear, anger, sadness or grief, while at the same time possessing sufficient resilience to timeously restore their state of internal equilibrium.

In 2022, the WHO's World Mental Health Report redefined mental health as “a state of mental well-being that enables people to cope with the stresses of life, to realize their abilities, to learn well and work well, and to contribute to their communities”⁵. This definition confirms the emphasis on well-being (apart from adding the specifier “mental”) and seems to soften the emphasis on productivity of the previous definition by replacing the expression “work productively and fruitfully” with “learn well and work well”. Furthermore, when describing “the intrinsic and instrumental value” of mental health, the report mentions several aspects of the alternative definition proposed in 2015⁴, including cognitive skills, understanding and managing emotions, and empathizing with others.

However, the statement that mental health is “a state of mental well-being” remains a matter of concern. In fact, although a comprehensive review has reported as many as 191 components of the well-being construct⁶, the concept is still conceived by many within a hedonic perspective. For instance, the American Psychological Association defines well-being as “a state of happiness and contentment, with low levels of distress, overall good physical and mental health and outlook, or good quality of life”².

Thus, there is not a consensus at the moment about the definition of mental health, in spite of the increasing popularity of this concept and the high frequency with which it is used in the literature, in public health and clinical contexts, and in policy documents. Sometimes the fuzziness of a concept may favor its success, but this is certainly not what all the stakeholders involved in the field wish to pursue.

It seems to be agreed that mental health is not just the mere absence of mental illness, but the relationship of the concept with that of mental well-being remains unclear or equivocal; the requirement for productivity and/or contribution to the community may lead to regard entire sections of the population as mentally unhealthy, thus “blaming the victims” of stigmatization, discrimination and exclusion; and the acknowledgement that healthy human life experience may be sometimes joyful and satisfactory, but at other times sad, disgusting or frightening seems to be lacking in several definitions.

On the other hand, the importance of components such as basic cognitive skills (i.e., paying attention to a task, remembering past and recent information, being able to solve simple problems and make decisions); the basic ability to function in social roles and to entertain social relationships; emotional regulation (i.e., being able to recognize, express and modulate one's own emotions); flexibility (i.e., being able to modify one's own goals and plans in the light of new events or unpredicted difficulties, and adapt to changes required by different life periods or contingent situations); and a harmonious relationship between body and mind (since the quality of this interaction is instrumental to the overall experience of being in the world⁷) does not seem to be sufficiently recognized.

Future developments in the definition of mental health would benefit from a more systematic and substantial contribution of experts by experience, as well as from a greater conceptual sophistication.

心理健康的首次概念化可以追溯到1948年，第一届国际心理健康大会主席JC Flugel提出将心理健康定义为“一种允许个体在身体、智力和情感上得到最佳发展的状态”。 ，只要这与其他人的兼容”。1950年，世界卫生组织（WHO）心理健康专家委员会第二次会议将心理健康定义为“由于生物和社会因素而波动，使个体能够达到满意的综合状态的状态”。他自己潜在的冲突、本能的驱动力；与他人建立并保持和谐的关系；并参与其社会和物质环境的建设性改变”。这两个定义都没有包含幸福感的概念（而且都不是很有影响力）。

2004年，世界卫生组织将心理健康定义为“一种幸福状态，在这种状态下，个人认识到自己的能力，能够应对生活中的正常压力，能够富有成效地工作，能够对他或她的社区的贡献” ¹ . 这个定义具有很大的影响力，随后的几个心理健康定义都在同一框架内组织起来，其中关键作用被分配给人的福祉（“享乐”观点）和他/她的自我实现（ “eudaimonic”观点）。

例如，根据美国心理学会的说法，心理健康是“一种心理状态，其特征是情绪健康、良好的行为调整、相对没有焦虑和残疾症状、建立建设性关系和应对日常需求的能力”。和生活压力” ² . 对于加拿大公共卫生局来说，心理健康是“我们每个人感受、思考和行动的能力，以增强我们享受生活和应对所面临挑战的能力。这是一种积极的情感和精神幸福感，尊重文化、公平、社会正义、相互联系和个人尊严的重要性” ³。

在心理健康的定义中强调积极情绪和自我实现一直是一个有争议的问题。首先，这种观点很难与许多具有挑战性的生活情境相调和，在这些情境中，幸福感甚至可能被视为不健康（事实上，心理健康的人经常感到悲伤、愤怒或不快乐；而将幸福感视为不健康则是有问题的）在职业机会稀缺的情况下被解雇后感到绝望的人）。其次，这种观点将许多努力在社区中找到自己位置的青少年、许多无法再进行富有成效的工作的老年人以及许多移民和其他少数群体成员排除在心理健康的定义之外。他们被边缘化，因此无法为社区做出贡献。

为了克服上述对享乐和幸福观点的强调，一组专家于2015年提出了心理健康的新定义：“内部平衡的动态状态”，其中几个组成部分在不同程度上做出了贡献，包括“基本认知和社会能力”。技能；识别、表达和调节自己情绪以及同情他人的能力；应对不利生活事件和履行社会角色的灵活性和能力；以及身心之间的和谐关系” ⁴．这个定义允许经历危机（例如，青春期、退休）的可能性，这当然不会产生幸福状态，但可能导致新的平衡，具有更高的复杂性。此外，该定义承认心理健康的人可能会经历恐惧、愤怒、悲伤或悲痛等负面情绪，同时又具有足够的恢复能力，可以及时恢复内部平衡状态。

2022年，世界卫生组织《世界心理健康报告》将心理健康重新定义为“一种心理健康状态，使人们能够应对生活压力、发挥自己的能力、好好学习、好好工作、为社区做出贡献” ” ⁵ . 这个定义确认了对福祉的强调（除了添加了“精神上的”这一说明词之外），并且通过将“富有成效地工作”替换为“好好学习、好好工作”，似乎软化了之前定义中对生产力的强调。此外，在描述心理健康的“内在和工具价值”时，报告提到了2015年提出的替代定义的几个方面⁴，包括认知技能、理解和管理情绪以及同情他人。

然而，心理健康是“一种心理健康状态”的说法仍然令人担忧。事实上，尽管一项全面的审查报告了幸福感结构的多达 191 个组成部分⁶，但许多人仍然从享乐的角度来构想这个概念。例如，美国心理学会将幸福定义为“一种幸福和满足的状态，痛苦程度较低，身心健康和前景总体良好，或者生活质量良好” ²。

因此，尽管心理健康这一概念越来越受欢迎，并且在文献、公共卫生和临床环境以及政策文件中使用频率很高，但目前对于心理健康的定义尚未达成共识。 。有时，一个概念的模糊性可能有利于其成功，但这肯定不是该领域所有利益相关者所希望追求的。

人们似乎一致认为，心理健康不仅仅是没有精神疾病，而且这个概念与心理健康的关系仍然不清楚或模棱两可；对生产力和/或对社区贡献的要求可能会导致人们认为整个群体精神不健康，从而“指责受害者”遭受污名化、歧视和排斥；健康的人类生活经历有时可能是快乐和令人满意的，但有时是悲伤、恶心或恐惧的，这种认识似乎在几个定义中都缺乏。

另一方面，诸如基本认知技能（即关注任务、记住过去和最近的信息、能够解决简单问题并做出决策）等组成部分的重要性；履行社会角色和处理社会关系的基本能力；情绪调节（即能够识别、表达和调节自己的情绪）；灵活性（即能够根据新的事件或不可预见的困难修改自己的目标和计划，适应不同人生阶段或突发情况所需的变化）；身心之间的和谐关系（因为这种互动的质量对于身处世界的整体体验至关重要⁷）似乎没有得到充分认识。

心理健康定义的未来发展将受益于专家们根据经验做出的更系统、更实质性的贡献，以及更复杂的概念。