The self‐determination theory perspective on positive mental health across cultures
Authors: KENNON M. SHELDON
Journal: World Psychiatry (2012)

Vaillant provides an admirable historical and current overview of the concept of "positive mental health", outlining seven different conceptions of this fortuitous state. Interestingly, although the title of the article asks whether there is a cross-cultural definition of positive mental health, Vaillant does not spend much time addressing the cross-cultural issue. Are the seven models covered valid in other cultures? We don't really know. Vaillant does introduce a relevant metaphor in discussing champion decathloners, saying "All decathloners will share the positive characteristics of muscle strength, speed, endurance, grace and competitive grit, although the combinations may vary". This suggests that positive mental health might be characterized in the same basic ways in all cultures, even though particular cultures may differ in their amounts or mixtures of these characteristics (i.e., some cultures might have more "strength", others more "speed"). However, Vaillant does not speculate on how different cultural types might evidence more or less of the seven conceptions of positive mental health he reviews. In order to shed more light on these issues, I will briefly discuss self-determination theory, a theory of motivational health which has received extensive empirical support over the last four decades, which I believe provides an eighth (and perhaps most fundamental) conception of mental health 1,2,3. It is possible that some readers of this journal are unfamiliar with this theory, which fits into the broad umbrella of "positive psychology". An advantage of the theory is that it concerns not just the positive, but also the struggle to obtain the positive in the context of potentially negative conditions and constraints. The theory also makes firm claims about the nature of positive motivation across cultures, which have been well confirmed empirically. Self-determination theory assumes an inherently active individual, finding and following intrinsic motivations and in the process learning, growing, and thriving. Intrinsic motivations will emerge automatically, as long as environments support them (unfortunately, "controlling" environments can undermine them). The theory also proposes that all humans have three basic psychological needs, or experiential requirements, whose procurement supports intrinsic motivation, growth and health just as the procurement of basic physical requirements supports the growth and health of plants 4. The three needs are: autonomy (needing to be self-regulating; to own one's actions and to identify one's self with one's behavior); competence (needing to be effective; to be moving towards greater mastery and skill); and relatedness (needing to feel psychological connection with important others; to support, and be supported by, those others). Note that these three needs correspond to Freud's "Love and Work", with the stipulation that work must be meaningful and autonomously chosen. The three needs also correspond to Jahoda's definition of mental health, discussed in Vaillant's paper: that mental health includes "autonomy (being in touch with one's own identity and feelings); investment in life (self-actualization and orientation toward the future); efficient problem solving (accurate perception of reality, resistance to stress, environmental mastery); and ability to love, work and play". Self-determination theory would propose that life-investment and future orientation emerge automatically when the other three needs are satisfied. According to self-determination theory, these three needs evolved because humans who sought these psychosocial commodities, and who were psychologically reinforced when obtaining them, had a selective advantage compared to humans who did not. A large research literature now supports that these are three crucial components of health and well-being, which space limitations preclude me from covering. As just one example, a 2001 article tested ten candidate psychological needs as to their relative presence (or absence) within people's self-described "most satisfying events" 5. Autonomy, competence and relatedness emerged on top in this study; hedonic pleasure, financial success, popularity/status, safety/security, and even physical health and self-actualization, were not supported as basic needs by the study criteria. Turning to the cross-cultural issue, the proposal that these are evolved basic needs within human nature suggests that they should be universally important across cultures. The literature clearly supports this: as just one example, Sheldon et al 6 found that these three needs predicted positive emotion and life satis-faction to an equal extent within twenty different cultures, including African, Asian, European, Latin, and Australasian cultures. This empirical approach takes, as evidence of a candidate need's status as a true need, that it predicts positive emotion and subjective well-being (two of the seven conceptions of positive mental health covered by Vaillant). In the self-determination theory, positive emotion and subjective well-being are merely by-products of need satisfaction, rather than being the indicators of mental health themselves. In fact, self-determination theory might claim that all forms of mental health are ultimately supported by, and arise from, psychological need satisfaction. How, then, do cultures differ in their mental health? According to self-determination theory, cultures differ in the amount to which they support the satisfaction of peoples' basic needs, and thus some cultures will be thriving (on average) more than others. For example, the autonomy need is typically less well-supported in Asian societies, as evidenced by lower autonomy need satisfaction scores in those cultures, which partially accounts for the reduced levels of positive emotion and subjective well-being seen in those cultures. Returning to the decathlon metaphor, there are certain key experiential ingredients to mental health. Psychologically healthy people within all societies will evidence large quantities of these ingredients. However, societies will vary in the exact mix with which these ingredients are supplied and supported. For example, in their 2001 study, Sheldon et al 6 showed that South Koreans reported more relatedness than competence need satisfaction in their "most satisfying events", while the order was the opposite in the US. Nevertheless, competence and relatedness both predicted positive emotion to the same extent in the two cultures. In sum, self-determination theory attempts to specify the "psychological nutriments" necessary for all forms of mental health, in all cultures. Individual and cultural differences in need satisfaction can explain individual and cultural differences in many kinds of positive mental health 7.