Mental Hygiene and Family Counselling

M ENTAL hygiene and family counselling are both comparatively new and Protean arts, each lacking an adequate formulation of its scientific concepts in theory and a clear delimitation of its field in practice. The topic assigned to me for discussion is therefore by nature such that I must begin by criticising one of its terms and defining the other. Let us first attempt the easier task of defining our second term. Family counselling is often too narrowly centered upon problems of marital discord. But conflict between husband and wife is rarely due to factors arising wholly within the marriage situation, and its effects are rarely confined to strain or disruption of the marriage bond. If family counselling is not to operate in a vacuum, it must consider the family as a dynamic unity of interacting personalities, and must become the inclusive art of social guidance concerning all the interpersonal relationships that arise within it, including the relations of parents and children, as well as those of parents to one another and of children among themselves. But the criticism of our first term can not be so summarily disposed of, for mental hygiene is a good term gone wrong. It is generally employed with the assumption that it expresses an attitude toward mental health strictly analogous to that expressed toward bodily health by the older term physical hygiene. But nothing could be further from the facts. For physical hygiene is the art concerned with the preservation and the improvement of health in both individuals and communities. It is primarily concerned, not with the pathological, but with the normal, and it is primarily addressed, not to the sick, but to the well. As the art of personal and social sanitation, it is not a monopoly of the medical profession. In its social aspects, it is quite as much the professional responsibility of physiologists, engineers, home economists, nurses, social workers, educators, etc., as of physicians, and in its individual aspects every citizen must become his own hygienist if the art of personal hygiene is to be practiced at all. It requires no specifically professional training to advise a neighbor about the undrained puddle in his back yard or the drained bottles under his back stoop, however much it may require tact! And no professional body objects to any citizen giving such counsel, though one's neighbors may! But the emphasis of mental hygiene has from the first been upon the pathological, not the normal; and its informational content as well as its practical techniques have been devoted to better understanding, treatment, and management of the actually or incipiently ill, not to a system of sanitation for those who have no need of a physician. It is fortunately true that mental hygiene has latterly come to include this positive phase of concern about improving the conditions that make for better mental health in the general population, but it is still largely absorbed in its earlier negative phase of treatment, so that "the mental hygiene approach" to any problem is still almost universally understood to mean the approach to that * Read before the fourth Annual Conference on Conservation of Marriage and the Family, University of North Carolina, Chapel Hill, April I3, I938.