The main purpose of this chapter is to develop and illustrate the concept of "routes to psychological wellness," which, I believe, has much orienting value in framing fruitful questions for psychologists and others to pose and fruitful activities for psychologists and others to undertake. I use the term to identify what Rappaport (1987) called the phenomena of interest, i.e., "the entire class of phenomena that we want our research to undertake, predict, explain or describe; that we want our applications and interventions to stimulate, facilitate or create; and our social policies to encourage" (p. 129).
Although the concept of routes to psychological wellness remains amply fuzzy, it is broader and more integrative than the phenomena of interest that have occupied the mental health fields and the emergent field of community psychology. At the same time there are domains of overlap between its issues and the focal issues of those two fields. The concept is sufficiently comprehensive to enfold other concepts, such as primary prevention, empower- ment, competence, and heightened resilience (invulnerability) in children, that have them- selves been advanced either as significant orienting concepts or, indeed, as the phenomena of interest for community psychology. It also vivifies a point made by Rappaport (1981) and underscored by others (Levine & Perkins, 1987; Sarason, 1987), i.e., that intrinsically complex human and social problems require multiple, divergent, and changing solutions.
Although the chapter's primary focus is neither on mental health nor community psychol- ogy, the concept of routes to psychological wellness can best be developed by considering briefly some of its historical antecedents in those fields. Mental health's unifying themes, starting with its vestigial precursors in primitive man and continuing to the present time, have been the quests to understand and repair things that go wrong psychologically (Zax & Cowen, 1976). Although the field has, to be sure, changed over time, those changes have primarily involved: (1) a broadening in the number and types of conditions considered to fall within its
Portions of this chapter were presented in an invited address to the First Biennial Conference on Community Research and Action, Columbia, South Carolina, May 21, 1987.
EMORY L. COWEN' Center for Community Study, University of Rochester, Rochester, New York 14620.
Handbook o/Community Psychology, edited by Julian Rappaport and Edward Seidman. Kluwer Academic/Plenum Publishers, New York, 2000.
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realm-a point punctuated by the bulk of DSM III-R, (2) an evolution in the explanatory concepts used to comprehend diverse forms of psychological dysfunction, and (3) a growing sophistication in the methods used to contain or repair such dysfunction. Within mental health's own defining context, some ofthose changes have been seen as sufficiently sweeping as to be called revolutions (Hobbs, 1964; Zax & Cowen, 1976). I personally doubt that noteworthy revolutions have occurred, as the field's energies and resources, its transmitted wisdoms, and its training practices have centered unswervingly around a self-limiting search for fuller understandings of the vagaries of damaged psyches and better ways to fix them.
I do not mean to imply that mental health has been unconcerned with psychological wellness. Rather, the particular way it has construed issues of wellness, i.e., that psychological wellness is, or should be, a matter of concern when it breaks down-indeed, the more flagrant the breakdown the greater the reason for concern (Joint Commission on Mental Illness and Health, 1961; Goldstein, 1982)-is narrow and restrictive. That de facto definition of phenom- ena of interest, and the foci and activities that derive from it, has obscured a broader, potentially more useful proposition-that greater progress toward the ideal of psychological wellness can be achieved by building and enhancing steps than by the sum of society'S most powerful and effective efforts to repair established deficits in wellness. Implicit in the concept of routes to psychological wellness is the conviction that wellness must be a matter of prime concern at all times, not just when it fails. Indeed, the occurrence of a genuine, as opposed to a pseudo mental health revolution may depend on that conceptual leap or redefinition of phenomena of interest.
Domains are susceptible to ferment and re-examination when their guiding concepts and practices fail to address satisfactorily a field's problems as defined (or redefined). Thus, the need to resolve refractory problems and/or to encompass new knowledge lead to paradigm shifts (Kuhn, 1970; Rappaport, 1977, 1987) that entail major refocusings of phenomena of interest and derivative activities. Growing dissatisfaction with the classically defined mental health field has long been apparent. Indeed, expressed in somewhat different words, such dissatisfaction has been a focal theme of three major national reports, spanning several decades, which have reviewed and made recommendations about the state of the field (Joint Commission on Mental Health of Children, 1969; Joint Commission on Mental Illness and Health, 1961; President's Commission on Mental Health, 1978).
Given that the concerns reflected in those reports, and related ones, have been considered in detail in many sources (e.g., Cowen, 1973, 1977, 1980, 1983; Levine & Perkins, 1987; Pre- vention Task Panel Report, 1978; Rappaport, 1977; Zax & Cowen, 1976), only a brief summary is provided here. (1) Mental health (repair) resources were insufficient to meet spontaneous demand for services, much less underlying need (Albee, 1959; Arnhoff, Rubenstein, &
Speisman, 1969; Levine & Perkins, 1987; Zax & Cowen, 1976). (2) De facto allocations of mental health services, for overdetermined reasons, followed the rule that help was least available where it was most needed (Cowen, Gardner, & Zax, 1967; Lorion, 1973, 1974;
Manson, 1982; Rappaport, 1977; Ryan, 1971; Sanua, 1966; Schofield, 1964). Such glaring distributional inequities led the President's Commission on Mental Health (1978) to highlight the unmet needs of the "unserved and underserved" throughout its final report. (3) Major mismatches between mental health's traditional service-delivery modes and the ways in which large segments of the population defined, perceived, and dealt with their problems, created conditions under which those groups saw traditional mental health services as inappropriate or irrelevant (Rappaport, 1977; Reiff, 1967; Reiff & Riessman, 1965; Ryan, 1971; Zax & Cowen, 1976). (4) Notwithstanding a dedicated effort by competent, committed mental health profes- sionals, the serious problems that major mental disorders (e.g., schizophrenia) posed could not be solved (Cowen, 1982b; Goldstein, 1982; Zax & Cowen, 1976). (5) Mental health's most
finely honed repair strategies (e.g., psychotherapy) had limited efficacy, less because of default in skills or effort, and more because the very conditions they were called on to remediate were rooted and change-resistant (Albee, 1982; Cowen, 1973; Levine & Perkins, 1987; Rappaport, 1977). Under such circumstances even the most sophisticated, costly and time-consuming repair efforts have a guarded prognosis.
Ensuing searches for viable alternatives have reflected different implicit views of the root causes of those unresolved problems. The first and simplest competing notion, without challenging mental health's past underlying assumptions, emphasized the need to augment the reach, improve the timing, and increase the efficacy of restorative services for the psycho- logically troubled. This was the thrust of the early community mental health movement, highlighted in the very first sentence of the Swampscott Conference report marking the birth of this new field: "Traditional approaches to the mental health problem are being challenged today by new concepts of community service" (emphasis added) (Anderson et a!., 1966, p. 1).
In the new regime, services, still primarily restorative, were to be located in community settings where people in need could find them sooner, more readily, at lower cost, and hopefully in more ecologically valid formats.
Moving one important step beyond, new community psychology thrusts began to ques- tion whether repairing dysfunction was the only or best approach to psychological wellness, and whether there might not be viable alternatives to mental health's passive-receptive mode of waiting for dysfunction to find its way into society's formal repair system. Harbingers of this broadened view also appeared in the Swampscott report when, for example, it envisioned appealing new, professional roles such as "change agents, social system analysts, consultants in community affairs and students generally of the whole man in relation to all his environ- ments" (Anderson et aI., 1966, p. 26). This later development, closer to community psychol- ogy's present core, turned attention to person-environment relationships, social policy and planning, justice and empowerment and, to some extent, programs to promote wellness (Levine & Perkins, 1987; Rappaport, 1977). In so doing, it tilted an axis away from mental health's classic repair loci-office, clinic, hospital, consulting room-to the community and its important settings (schools, churches, informal groups, etc.). A cautionary note however:
the word "community" in community psychology refers to a locus and perhaps an instrumen- tality, not ipso facto to a specific way to redefine phenomena of interest or derivative assumptions and practices.
If one recasts the Procrustean question that has long guided the mental health fields, i.e., How can we best repair psychological malfunction? into the broader questions of: How does psychological wellness come about and how can it be promoted?, then (1) community institu- tions, settings, and processes become important study foci in their own right insofar as they relate to wellness; and (2) the community offers settings that are more relevant and functional than the consulting room to actions and interventions that can enhance the well-being of large numbers of people. For those reasons, the community and its key settings must be one significant action-arena in a comprehensive approach to routes to psychological wellness.
Several points implied in the preceding discussion bear highlighting. The first is that there is, or should be, some continuity in what has transpired in mental health for many centuries and the broadening developments of the past quarter century in community mental health and community psychology, including some of the latter's intriguing evolutionary buds. One key continuity element lies in the prime dependent variables, i.e., psychological wellness-related variables, on which these fields have focused. A noteworthy difference, however, is the shift in emphasis in viewing such variables-away from a heroic, if socially doomed, effort to undo established deficit, to the promotion of wellness in different life stages, settings, and circum- stances. That shift is powered by several gnawing concerns: What if repairing deficits in
wellness can, at best, account (for whatever reasons) for only a small fraction of the universe of instances relevant to psychological wellness? And what if it is easier, farther reaching, and more effective to facilitate wellness, whether through steps in person formation and/or education, or by modifying settings, practices, and social policies, than to struggle after the fact to remediate failings in wellness (Cowen, 1985).
Although community psychology has, to be sure, moved in those new directions, it has done so more in ad hoc than planful ways. The planful emergence of a field is catalyzed by a set of guiding concepts or views that some call "theory." Although theory can range in breadth, it has orienting value, whatever its scope. This is what Lewin had in mind when he observed that there is nothing as practical as a good theory. But theory does not develop in a vacuum; it is theory about something. As Rappaport (1987) suggested, theory coheres around phenomena of interest. Phenomena of interest reflect values. To the extent that people have different phenomena of interest in mind, or even if related phenomena of interest differ in breadth, planful inputs deriving from theory will differ, although they may be ascribed to a common generic banner. Presently, community psychology is indeed a common generic banner for which there are many referents. Too little, as Rappaport (1987) stressed, has been done to develop unifying theory and that gap has hampered the field's development.
Although one important goal of this chapter is to sketch further orienting theory, my position is strongly shaped by two limiting considerations. The type of theory I have in mind (1) does not start with the concept of community psychology, though community is important to it; and (2) is intended to reflect and embrace domains (i.e., dependent variables or outcomes) that have been central to the roots and phenomena of interest both of the classic mental health field and the community-psychology movement. To address meaningfully the problems that result from the restrictiveness of prior frameworks, however, requires redefinition of the phenomena of interest to the more comprehensive, proactive concept of routes to psychologi- cal wellness-how it comes about and the potentially diverse ways in which psychological and other knowledge can be developed and applied to enhance it.
To understand the full panorama of routes to psychological wellness will require ways of framing issues, knowledge bases, and methodologies that differ substantially from those that have guided the inquiry and activities of the mental health fields and community psychology (Cowen, 1982a, 1984b). On the other hand, relevant feeder-strands from both those fields, especially community psychology's more recent thrusts, can be meaningfully applied to the redefined phenomena of interest and profitably extended. In the final reckoning, however, the concept of routes to psychological wellness is proposed, unlike empowerment, not as a way to construe community psychology's phenomena of interest (Rappaport, 1987), but rather as an overarching phenomenon of interest in its own right. Within that enlarged frame, a key question for community psychology is: How can its present and future knowledge bases illuminate the broader topic of routes to psychological wellness? Kelly (1986) reflected a similar orientation when he described the purpose of community research as "understanding those social processes that promote the health and well-being of individuals and organiza- tions" (p. 584).
PSYCHOLOGICAL WELLNESS:
A CLOSER LOOK
Having proposed the concept of routes to psychological wellness as a unifying theme around which to coalesce future efforts, let me try to clarify my use of the term, if only in a preliminary and approximate way. One thing such usage points to is the domain's prime
dependent variables or, in layman's tenns, what we hope to see happen as a result of our inquiry and efforts.
Although I have, thus far, referred to psychological wellness as if it were an entity or state, in fact, I see it as a continuous rather than a binary concept. Moreover, it is a concept with significant developmental, cultural, situational, temporal, and, no doubt, value detenninants.
Precisely because of those realities, many essays have been written (e.g., Jahoda, 1958), and many more will be written, about the definition and manifestations of psychological wellness.
Enduringness and breadth are important aspects of the concept of psychological wellness I am proposing. Its basic temporal stability differs from (i.e., considerably transcends) the momentary satisfaction of seeing a good movie or watching one's favorite football team win the Super Bowl. It implicates important facets of a person's life and involves recuperability in the face of adversity. Even so, the tenn is used to describe a predominant condition, not a flawless or invariant state. I recognize that happenings ranging from hassles of daily living to, more importantly, the (often) unpredictable and uncontrollable occurrence of stressful life events and circumstances act to disrupt wellness.
I use the tenn broadly and accept, indeed urge, considerable latitude in how it is assessed and inferred. I do not at all mean to restrict it to specific indicators such as Rorschach records, teachers' ratings of school children's adjustment, or self-reports of anxiety or depression, which some have found to be unsatisfying, if not downright irritating (Bronfenbrenner, 1977;
Rappaport, 1981). On the other hand, I believe that the concept implies: (1) the presence of
"name, rank, and serial number" marker-outcomes, such as eating well, sleeping well, and working well-mindful perhaps of Freud's earthy notion of adaptation, i.e., Leben und Arbeiten; and (2) higher-order elements, such as a sense of control over one's fate, a feeling of purpose and belonging, and a basic satisfaction with oneself and one's existence-each of the latter backed by external validating signs.
Were I to be taken to court and sued over the i-dottings and t-crossings of that gross concept definition, I would not fight the case. It is simply a loose mark-up of a set of outcomes that help to place boundaries around the phenomena of interest. If outcome tenns such as wellness, adaptation, or adjustment produce allergic reactions, widely used alternatives such as "life satisfaction" (Rappaport, 1987) or "gratifications in living," i.e., the obverse of problems in living (Rappaport, 1981), can be substituted.
Let me next advance several position statements, or perhaps, more accurately, assertions, that seem at this time to pertain importantly to the overarching concept of psychological wellness:
1. Psychological wellness, as I have suggested, is a more-or-Iess, rather than an either- or, condition. Using the tenn as an absolute is simply a shorthand of convenience. Appropriate goals for psychologists and others to pursue are to develop knowledge about the nature of wellness and routes to wellness, and to apply such knowledge in ways that strengthen wellness in many people. Kelly (1975) made much the same point: "If we as community psychologists are going to prevent distress, we must understand the variety of conditions, processes and events that produce conditions of healthiness" (p. 206).
2. The literal factors that define psychological wellness differ at different ages and under different environmental circumstances. Hence, specific routes to wellness may differ for different groups at different times.
3. Psychological wellness is not a "once-and-forever" condition (Werner & Smith, 1982). Just as early wellness can be undermined by later adversities, natural or engineered conditions, processes, and events, to use Kelly's (1975) tenns, can enhance wellness.
4. It is easier and more promising to promote wellness from the start than to repair rooted defects in wellness.
5. Input strands to psychological wellness become more complex as one passes from early childhood to adulthood, both because of the greater number of systems in which a person interacts and the importance of those systems to wellness at later times. This point can be cast within Bronfenbrenner's (1977, 1979) ecological-system framework. Wellness for the infant, to the extent that it is even perceived as relevant, is defined largely by behavior within the family micro system. For children, the school experience and the mesosystems that reflect interrelationships among school, family, and peer groups are of central importance to psycho- logical wellness. Later, society's influence is less immediately obvious; exosystems and macro systems underlying the formal and informal social structures that relate, for example, to justice, empowerment, and life opportunity, have greater and more direct impact on psycho- logical wellness.
6. Psychological wellness has significant person-related (both dispositional and experi- ential), transactional, and environmental determinants. A comprehensive theory of wellness requires that each of these strands be seriously reflected, and their relevance at different time points and under different conditions be understood.
7. A person's psychological wellness, at all stages of development, is affected by multiple, cross-setting, interaction systems that significantly reflect "aspects of the environ- ment beyond the immediate situation containing the subject" (Bronfenbrenner, 1977, p. 514).
Indeed, even within delimited system (e.g., the family), wellness outcomes are shaped by transactional elements that transcend individuals (Cicchetti & Toth, 1987; Sameroff, 1977;
Sameroff & Chandler, 1975; Werner, 1987), i.e., ways in which "specific characteristics of the child transact with the caretaker's mode of functioning" (Sameroff, 1977, p. 49).
8. Many factors either contribute to, or impede, psychological wellness. Some, but not all, of those factors are psychological. Examples of non-psychological factors include such
"taken-for-granteds" as having a job, food to eat, and a decent place to live. Accordingly, a rich understanding of the roots of, and routes to, psychological wellness will require major inputs from other than mental health sources and collaboration among groups that have not frequently interacted in the past (Cowen, 1982a).
Sources of Impact on Psychological Wellness
To the extent that routes to psychological wellness is the shared phenomenon of interest, any variable that bears on such wellness is theoretically pertinent. Qualifying the verb "bears on" with the adverbs "significantly" and "enduringly" helps to prioritize domains on which to focus and to end-run a legion of potential wellness-related variables, such as the titanium paints, yoghurts, and unpolished rices spoofingly cited in Kessler and Albee (1975).
The following sources of influence have important and enduring effects in advancing or restricting people's psychological wellness: (1) the family context in which a child grows up and the nature of the child's formation and early experiences; (2) the effectiveness of the child's total educational experience, a good deal of which takes place in schools; (3) the nature and shaping impact of the significant social settings and systems in which a person interacts;
(4) the extent to which the broad societal surround, i.e., its exosystems and macrosystems (Bronfenbrenner, 1977), as well as its specific mediating structures, including family, neigh- borhood, church, volunteer organizations (Rappaport, 1981), are just, empowering, and pro- vide opportunities consonant with a person's abilities.
Sometimes nature's normal course leads spontaneously to early wellness. When that happens, we should click our heels and shout "Hallelujah!" Natural routes to wellness must be