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Mental Health and Human Evolution
G. M. C A R S T A I R S The Seventh World Congress on Mental Health was heralded by a service in a cathedral, it started formally in London's Albert Hall, and it continued throughout the ensuing week in the buildings of a modern coeducational school. These three locations symbolize rather clearly the essentially catholic, multidisciplinary nature of the World Federation for Mental Health. Ours is an association of a wide diversity of groups and individuals united by the belief that human mental life, the development of which has made possible the proudest achievements of our species, also holds the key to its future triumphs or disasters. For some people, the mental health movement tends to become identified with a concern for the welfare and care of the mentally ill and the mentally handicapped. As one well-meaning citizen put it a year or t w o ago in the course of a radio interview: "People should know more about mental health; it's an illness like any other." This identification with mental illness is partly true, for two good reasons: first, that emotional or mental illness, together with bodily diseases that affect the mind, clearly impose severe limitations upon the optimal development of human capabilities; hence the relief of G. M. CARSTAIRS,M.D., Professor of Psychiatry at the University of Edinburgh; Fellow of the Royal College of Physicians of Edinburgh; member of the Expert Advisory Panel on Mental Health of the World Health Organization, was elected President of the World Federation for Mental Health in 1968 for a three-year term. This paper was his inaugural address delivered at the Seventh World Congress on Mental Health in London, August 12, 1968.
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mental illness is an important aspect of the promotion of mental health. Secondly, an awareness of the unhappiness that mental illness can bring, both to the sufferer himself and to his family and friends, has been the driving force behind a great deal of devoted voluntary work in this field. In many countries throughout the ages the mentally ill have been viewed with a mixture of fear and repulsion and have all too often suffered from rejection, neglect, and even ill treatment. This has not been true of all cultures. In the Moslem world, the "afflicted of Allah" have traditionally been given special consideration; indeed, the earliest known hospitals for their care were founded in Baghdad and Cairo. There are some tribal peoples who regard a psyehotic's hallucinations as communications from the spirit world; and there are some cultures, like that of the Hindu world, that show a remarkable tolerance for bizarre behavior. Our own Judaeo-Christian culture, however, inherited a belief in demoniacal possession that reached its height during the long preoccupation with witchcraft that coincided with the Reformation and Counter-Reformation. It would be difficult today to find anyone in Britain who believes in devilpossession as a cause of mental illness--difficult, but not impossible; only ten years ago this contention was seriously advanced by a rural dean during a Convocation of the Church of England. Although few of his fellow-churchmen share this eccentric opinion, the order of service for exorcism can still be found in that church's liturgy. In many other parts of the world, perhaps especially in the developing countries, such beliefs are still very much alive; and wherever this is the case, patients are all too often subjected to violent, sometimes cruel procedures. One of the commonest traditional forms of exorcism consists of branding the skin with red-hot irons. I have seen the scars of such treatment on the bodies of schizophrenic patients in China, Malaysia, Ceylon, and India--and also among American Indians in the foothills of the Andes. The practice is so widespread and the availability of modern psychiatric care so scarce in the vast developing countries that it is probably still true to say that more schizophrenics in the world are treated by exorcism than by phenothiazine drugs.
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In these developing countries there are, of course, many other diseases, and in the selection of priorities for public health the death-dealing ones demand first attention. It is, however, remarkable how quickly age-old patterns of mortality can be transformed by the introduction of environmental sanitation and potent modern drugs. For example, the population explosion, which has been an immediate resulv of better medical care, itself presents new problems. In all previous generations of mankind, sickness and early death have kept our numbers down--but at what a cost of suffering! Today we can order things differently, if we are allowed to do so. Recently the Pope has told his followers that it is legitimate to practice family limitation by using our medical knowledge in order to exploit the so-called "safe period," but not to use other medical knowledge that permits much more certain control of fertility. I personally share the concern that many people, both within and without the Catholic Church, have expressed about the adverse effects this teaching may have not only upon worldwide campaigns for family limitation, but also upon personal relationships within families. The Dutch Federation for Mental Health has already addressed itself to a study of the mental health aspects of different methods of birth control, and its example could well be followed by all our member associations. The fight against killing and disabling physical illness is itself a contribution to mental health. Recent research has confirmed what intuitive wisdom has long maintained, namely that sick bodies tend to harbor sick minds. We have every reason to admire the work of the World Health Organization in its fight against disease, and that of the Food and Agriculture Organization in its fight against malnutrition. We have, of course, a direct interest in the work of the Mental Health Unit of WHO. Both its present director, Dr. Pieter Baan, and his colleague, Dr. Tsung-yi Lin, have given invaluable support to the World Federation for Mental Health over the years, as did their predecessors, Dr. Eddie Krapf and Dr. Ronald Hargreaves, and especially Dr. Brock Chisholm, who played an important part in the formation of both these organizations. Among our members there are many doctors,
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nurses, educators, and social scientists who have served on W H O ' s panel of advisers and on its expert committees. I want to make it quite clear that although W F M H bears initials rather similar to those of W H O , we are radically different bodies. W H O is a very large agency of the United Nations, serving all the countries that form the UN. It covers the entire globe (with the unhappy, and one hopes temporary, exception of China) and deals with the whole range of diseases and problems of environmental health. W F M H , in comparison, is tiny: a league of voluntary bodies concerned with one--but we think a crucially important --aspect of health, but also with the much wider theme of the fullest development and realization of human potentialities. Being nongovernmental, we are free to act as a pressure group in aid of the causes we support. W e are able to do this, in spite of our extremely modest financial resources, because we are able to enlist the help of influential citizens, leaders in the mental health professions and in other walks of life, in all our member countries. W e have, then, two main fields of interest, one strictly practical, the other more in the realm of ideas. Let me consider first our practical concerns, because they are very great indeed, and very pressing. W e know only too well how inadequate are the resources--hospitals, clinics, availability of drugs, and above all availability of trained manpower-to meet the immediate needs of the mentally afflicted in vast and populous countries. Where mental hospitals exist, they are often grossly overcrowded and understaffed; all too often their installations are of such poor quality that they endanger the physical health of their inmates. In a good many countries, what few mental hospitals exist are built like prisons and compare unfavorably with the prisons themselves. These are relics from an earlier age, when the only mentally ill patients to reach any institution were those whose behavior had become socially intolerable. The. great majority of such patients have been cared for, if at all, by traditional herbalists, medicine men, priests, or exorcists. Until quite recent years, Western-trained psychiatrists had relatively little in the way of effective help to offer them; but now the situation is different. W e know that there are
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literally millions of epileptics, of schizophrenics, of acutely agitated or depressed patients to whom modern methods of treatment could bring relief; that there are millions of mentally retarded children and young adults whose handicaps are aggravated by the lack of any training appropriate to their needs; and that there are millions more suffering from psychosomatic complaints and crippling neuroses who simply endure their unhappy lot because they have no alternative. In the face of so much suffering, where can we begin? It is of little use to wait for these countries' governmental health services to meet these needs-they often have even more pressing demands, presented by endemic communicable diseases, that claim prior attention. In the past, religious bodies have sometimes befriended the mentally ill, as did the movement created by St. Vincent de Paul in seventeenth-century France and the Quakers in England; but in recent years, the first major impetus toward improving the lot of these patients has generally come from the local or national Association for Mental Health. One of the striking differences between the 1968 World Mental Health Congress and that of 1948 was the great increase in the number of member associations represented from 22 in 1948 to 169 today. These associations have created clinics for adults and children, sheltered workshops, teams of volunteer workers visiting neglected hospital wards. But this is by no means their only function. Wherever the physical conditions of patient care leave a great deal to be desired, this very neglect of patients' welfare is invariably a reflection of public attitudes toward mental illness and the mentally ill. Old, negative attitudes and misconceptions die hard. We know well how much popular ignorance and prejudice still prevail--and not only in the developing countries. It constantly astonishes me to find, in both Europe and America, that even distinguished scientists, surgeons, and physicians are willing to display a remarkable degree of ignorance of the workings of the human mind and of the factors influencing human behavior. Future leaders of the medical profession in developing countries who come to Europe or America for
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advanced training are all too often influenced by their teachers' disregard for their patients' mental health and resume their work with their prejudices on this score reinforced, even though their expertise in other fields has been increased. It is interesting to note that during the last twenty years it has been the general practitioners (who are in closest contact with their patients)who have been most active in drawing attention to the high prevalence of emotionally determined illness. Doctors who work in industry have also become increasingly aware o f the importance of psychosocial factors in health and sickness, and those involved in industrial planning and management have responded with interest to their findings. Industrialists are becoming aware of the gains in productivity, as well as in health and happiness, that result when adverse psychological factors in the working environment--personal as well as material--are recognized and steps are taken i n time to put things right. No one will dispute that doctors of today and of the future must be well grounded in the principles and methods of scientific inquiry; but it is still necessary to insist that medical scientists who remain illiterate with respect to human psychology and social interactions will never make good doctors. Fortunately, the climate of opinion in medical education is slowly changing in favor of a greater emphasis on the behavioral sciences and on the study of social and psychological factors in illness. But we may have to wait for another generation before we can rely upon our doctors to be as alert to the significance of emotional disturbances in their patients as they are now to the signs of infection or to the presence of a tumor. Medicine is not alone, nor has it been the first, to recognize the relevance of including the study of human personality and human behavior in its basic training; such studies are being given increasing importance in the training of nurses, social workers, and clinical psychologists. Many other professions whose members have to deal with people in distress or difficulty, such as education, the clergy, the law, the police, personnel management, marriage counselors, and a wide variety of voluntary "helping agencies" in the community, are also turning to the mental health services for help in preparation for their tasks.
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If ignorance, indifference, and even hostility toward the subject of mental health are still to be found among some members of the medical and other professions, it is not surprising that such attitudes are widespread among the general public; and so long as they persist, public acceptance of the need for better treatment of the mentally afflicted will be harder to achieve. This is why the aim of education for mental health features prominently in the activities of every mental health association. I was vividly reminded of the importance of this task in April, 1968, while taking part in a seminar organized by W F M H in Hong Kong and attended by some forty psychiatrists, nurses, educators, and social workers from nine Far Eastern countries. Again and again the participants told us of the obstacles of prejudice and misinformation they had to overcome; and in some instances--particularly; in Dr. Aldaba Lim's account of a snowballing series of parents' discussion groups on problems of bringing up young children that she had helped to initiate in the Philippine school systemqwe heard of progress being made in this task of public education. This was a useful contribution toward the prevention of the behavior disorders and symptoms of maladjustment exhibited by children whose parents--sometimes with the best intentions--have handled them unwisely. Another example of timely preventive action--this time from Great Britain-was the initiative recently taken by the celebrated singer Frankie Vaughan, who offered to mediate between the leaders of a number of teen-age gangs in Glasgow and the police and corporation of that city. He has not only succeeded in halting the violence of gang warfare, but has promised to help them organize a Youth Center for these young people and has enlisted their active participation in this project. We still know too little about the etiology of most forms of mental and social pathology to make large claims about our ability to prevent their occurrence; but it is possible to identify some of the impediments to mental health and try to remove them. All such ventures in prevention, clearing the way for the optimal development of young people's constructive potentialities, command the fullest support of the World Federation for Mental Health.
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So far, I have been discussing, in rather concrete terms, the humanitarian and educational tasks on which all our member associations are engaged. But the phrase that set the theme of the Seventh World Congress--"Keys to Progress--Education for Mental Health"---implies that we already know what we mean by that elusive concept "mental health." I should like to consider for a moment whether this is indeed the case. This is far from being a merely rhetorical or academic question. In my opinion, one of the major sources of hostility and opposition to our movement has been our too-hasty assumption that we know all the answers, that we can define the attributes of mental health and know how they can be attained. Any such claim, I believe, is premature and indeed quite mistaken. As workers in our several fields, we know much about various forms of mental illness and personality deviation; and we are beginning to know a little about how these illnesses are caused and how they can be prevented. Outstanding instances in the progress of such knowledge during the past twenty years have taken place in fields as far apart as cytogenetics, psychopharmacology, and ethology. Discoveries in the first two fields have contributed significantly to the care of the mentally retarded and the mentally ill; and thanks to the work of biologically informed psychiatrists, such as John Bowlby, David Hamburg, and Charles Kaufman, methods borrowed from the ethologists have made it possible to observe, measure, and demonstrate the effects of early parent-child interactions upon later personality development. Already this last area of research has had important practical repercussions upon the way we treat young children in hospitals or in foster homes. These are all examples--and one could cite many more--of gains in knowledge about mental ill health that contribute to the prevention or the treatment of such conditions; but they bring us only fractionally nearer to an understanding of mental health, rather as the Hindu mystic defines ultimate reality by a series of negations: "Not that, not that." In other words, one way to define mental health is to do so by exclusion of all the recognized forms of mental illness; but this, although practical, is rather uninspiring. When we look back over recorded history, we find many different for-
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mulations of mental health in the ideal sense, that is, as the realization of man's highest potentialities. These potentialities have been revealed to us in their several ways by poets, philosophers, and perhaps even more often by religious teachers. Professor Radhakrishnan has actually defined religion as "an attempt to discover the ideal possibilities of human life." Once a culture has arrived at its version of the paradigm of human nature, all its formative and normative institutions are brought into play in order to try to mould its members into conformity with this ideal pattern. From prehistoric times--and still today, in many societies--these concepts of man and nature have found expression in the myths and legends of tribal religion. Primitive man was notoriously insular in his outlook, regarding his own group as the exemplars of mankind and all other groups as barbarians. Unhappily, in our own lifetime we have seen revivals of the same attitude. Whether in Nazi Germany or South Africa or among some misguided racists nearer home, we see the same processes at work: first, large sectors of our fellow-men are designated as inferior species, and then they are made the subjects of discrimination or ill treatment. As tribes gave place to larger societies, there emerged religions of universal scope, such as Lao-Tzu's teaching that man should abstain from strife and struggles, contemplating instead the beauty of nature and the changing seasons and seeking to identify himself with the natural world around him. This W a y of Life (the Tao T~ Ching), which inspired many magnificent paintings in the Sung period, has remained a leit-motif of Chinese philosophy over the centuries. In contrast, the recurrent theme of Indian religious philosophy has been the belief that each living creature harbors a spark of the divine flame; but man alone has the faculty of being aware of this and of heightening his awareness until he achieves a direct intuition of the suprapersonal, timeless Reality behind our transient physical experiences. The aim of Hindu and Buddhist disciplines is similar, despite apparent diversity: to enable each individual, by freeing himself from worldly distractions, to discover his real self. The Christian view of human nature is based on the belief that man is
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built in God's image; and the concept of that image has been influenced in turn by three important legacies: Hebraic monotheism, the teachings of Jesus Christ, and the Greek philosophers' exaltation of reason as man's highest gift. These elements do not easily, o r even necessarily, fuse; each has continued an independent existence. The humanists of today, for example, still aspire to the state of open-minded, active inquiry that was taught by Socrates. They, like the Hindus, believe that man must exert himself mentally; but they differ in believing that it is b y applying all his faculties to a clearer perception of the external world, of which he himself forms a part, that man will advance his self-knowledge. (It is interesting to recall that Cicero used the phrase "the humanities" to refer to those studies that served to educate a person so that he might become a perfect human being by developing to the full his spiritual and mental capacities. This was a fine ideal, but in order to see how imperfectly it was realized we have only to read our Roman history.) In the relatively short recorded history of mankind, we have seen the rise and fall of a number of major cultures, as first Oswald Spengler and then Arnold Toynbee have described. Each culture had its characteristic world view, its own interpretation of man's nature. Each developed its respective styles of art, architecture, and handiworks--in archaeological language, its "material culture." If we take a still more distant view of human history, we can see that there have been a few really crucial discoveries such as the invention of printing, or that of gunpowder, that have spread rapidly from one culture to another. This process of the rapid sharing of discoveries that have practical utility suddenly assumed a new importance during the nineteenth century as a result of the inventions that created the industrial revolution, and during the present century the process has been moving faster. In the case of earlier world cultures, great achievements of political organization and military prowess were usually needed before a new system of ideas and a new style of artifacts became widely disseminated. Today, thanks to the electronic revolution that has succeeded the industrial revolu. tion, we are in a quite new situation. In the modern world, chemical formu-
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las, electrical circuit diagrams, mathematical symbols, and methods of statistical analysis are the hardest currency of international exchange. Scientific theories recognize no national boundaries. Previous cultures have been localized to :one nation, or continent, and their characteristics have emerged only in the course of several generations. But today a new style is apparent all over the world. Unlike its predecessors, this cultural wave is not linked with any one country, religion, or political ideology. It is simply the expression of the forward surge of technology that has taken place in the last half-century. Its artifacts are buildings of concrete, steel, and glass; airplanes and automobiles; transistors and T V sets--all of which take forms dictated by the most efficient use of the materials of which they are built. W e have been accustomed to call these products Western, but the West has long since lost its monopoly of their manufacture and their enjoyment. W e now find ourselves, with bewildering rapidity, surrounded by the artifacts and the implicit ideas of a new, unprecedentedly worldwide culture that has not yet had time to become aware of its own identity. Its recognition has been delayed (but cannot be much longer prevented) by the persistence of outmoded forms, such as nation-states, factional alliances and ideological conflicts, and the stock-piling of gigantic, unusable armories of atomic weapons. Undoubtedly, the instant mass communications of the cinema, radio, and T V have been especially important in bringing about this new condition of our race--sometimes with unexpected results. As Dr. Sukarno has said: "The motion picture industry has provided a window on the world, and the colonized nations have looked through that window and have seen the things of which they have been deprived. It is perhaps not generally realized that a refrigerator can be a revolutionary symbol--to a people who have no refrigerators. A motor car owned by a worker in one country can be a symbol of revolt to a people deprived of even the necessities of life. 'u What Dr. Sukarno said a year or two ago of the movies is even more true of television, which brings distant events into the intimacy of one's own living room. Soon we shall have an array of "stationary" satellites that will make live T V transmission possible from any part of the world to any other.
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To quote that ecstatic, sometimes almost incoherent, prophet of the electronic age, Marshall McLuhan: "Ours is a brand-new world of all-at-oncehess. 'Time' (as we used to know it) has ceased, 'space' has vanished. W e now live in a global village, a simultaneous happening. W e are back in acoustic space. [He means that we are once again in an era of eyewitness accounts, of oral traditions.] W e have begun again to structure the primordial feeling, the tribal emotions from which a few centuries of literacy divorced us. ''~ As usual, McLuhan is breathlessly rushing ahead, maddeningly scattering half-truths among his startling insights; but his virtue is precisely in his ability to shock and startle us into realizing that a whole new world of the mind is forming about us. The idea, or ideal, of one world, of a community of all mankind has been bandied about for centuries; but now it has suddenly ceased to be an idea and has become a reality, which we are already experiencing before we are mentally attuned to it. Quite recently during a W F M H workshop held in Edinburgh, one of our participants--Dr. Pefia of Perum expressed this very neady. He said that in his travels he has already encountered a number of people who themselves exemplify the development of a new, emerging supranational personality--and many others who still seem to be stuck in a rather restricting psychological nationalism. W e really should not have needed McLuhan's shock treatment, because for years more sober prophets have been)telling us what to expect. Biologists like Julian Huxley, C. H. Waddington,/and Sir Peter Medawar have reiterated that in man the evolutionary prqcess is no longer merely biological, but is increasingly taking the form of the transmission of learned behavior. Theodosius Dobzhansky, the author of Mankind Evolving, has put it thus: "Man has not only evolved, he is evolving . . . Man, and man alone, knows that the world evolves and that he evolves with it. By changing what he knows about the world, man changes the world that he knows; and by changing the world in which he lives man changes himself. Evolution need no longer be a destiny imposed from without; it may conceivably be controlled by man, in accordance with his wisdom and his values. ''3 It was this line of thought that prompted the anthropologist Edmund
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Leach to begin his 1967 Reith Lectures with the words: "Men have become like gods. Isn't it about time that we understood our dignity? Science offers us total mastery over our environment and over our destiny, and yet instead of rejoicing we feel deeply afraid. W h y should this be? H o w might these fears be resolved?" This lecture concludes: "Since, god-like, we can now alter nature including that part of nature which is man himself, we can no longer console ourselves with the thought that a search for scientific knowledge is its own justification. It has ceased to be true that nature is governed by immutable laws external to ourselves. W e ourselves have become responsible.'4 Leach spoke as an evolutionary humanist, but his interpretation of man's emerging state is not unlike the vision of that remarkable priest, Father Teilhard de Chardin (who might best be described as the lyric poet of the evolutionary process), who wrote: "Man is not the centre of the universe, as was naively believed in the past, but something much more beautiful--Man the arrow of the great biological synthesis. Man is the last-born, the keenest, the most complex, the most subtle of the successive layers of life. ''~ I began this talk on a strictly mundane level, reminding you of the practical, humanitarian tasks of the mental health movement, If I seem since then to have strayed into the stratosphere--or as Teilhard de Chardin would say, into the no/Ssphere--this is simply to express my sense of excitement at witnessing and participating in the birth of a new self-concept of man. The institutions of this great society are already in being, in the form of the United Nations and its agencies UNESCO, W H O , FAO, and ILO. The basic values of this society have been spelled out in the charters of these organizations. Because I have drawn attention to the increasing intrusion into our lives of this new global culture, it may seem that I am placing undue emphasis upon the role of external, cultural forces on personality development. This would be to repeat the error of the "cultural determinists" of the late nineteen-twenties and early 'thirties. At that time, there was an unfortunate parting of the ways between geneticists and environmentalists. In more recent years, however, genetic theory has been enriched by a fuller understanding
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of the structure of the genetic code and by the development of biochemical genetics and behavioral genetics. The ethologists have also greatly extended our ability to recognize, in every species, discrete elements of behavior that appear to be genetically determined. The science of epigenetics, which studies the interaction of genetic and environmental factors in the form of expression of inherited traits, has much in common with the ethologists' analyses of innate behavior patterns and "releasers" in animal life. The study of culture and personality tended for some years to minimize the importance of biological factors as determinants of human behavior; but this need no longer be the case. Both genetics and learning theory--deepened by psychoanalytic concepts, such as those of the role of the unconscious and of ambivalence in human interrelationships--can illuminate the complex processes of social learning by means of which cultural values are transmitted. W e are, I believe, on the threshold of a new synthesis that will bring together all these essential elements of human growth and development. The influence of the latest additions to man's cultural inheritance will be better understood when it is based on a fuller understanding of the biological substratum upon which all new learning takes place. W e have to remember that, since man acquired the gift of speech and developed symbolic communication, his cultural development has far outstripped the slow pace o f purely genetic change. Biologically, we are still very close to our paleolithic ancestors; and this is part of the reason for our adapting so imperfectly to the conditions of urban life in technologically advanced societies. The last twenty years have been a period not only of accelerating knowledge and accelerating material accomplishments, but also a time in which some of mankind's dreams began to come true--the dream of being able to see things happening on the other side of the world, the dream of flying to the moon, the dream of self-determination of subject peoples; but also the threat that unchecked increases of population may cause the poorest and hungriest peoples of the world to become even poorer and hungrier; and the nightmare of knowing that enough atomic weapons are in existence today to wipe out all human life from this planet. But this is also a time in which
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great masses of the world's population can aspire to higher levels of nutrition, health, and education than ever before. Experiences that once were reserved for a privileged minority--such as adequate nutrition, protection against disease, access to education--are now coming to be recognized as basic human rights. It seems to me that these basic rights will provide the launching pad for the next upward surge of man's development. In recent years, education has been associated with ever increasing advances in technology; for the individual, it has been linked with material and social betterment but not necessarily with a gain in confidence or in peace of mind. On the contrary, studies in rapidly developing societies show that they have the highest rates for emotional maladjustment and social pathology, because individuals have lost the support that used to be given them by participation in stable, traditional social groups. If this diagnosis is correct, what must be done to help the coming generations to enjoy their new privileges without succumbing to anxiety, bewilderment, or despair? Access to literacy has enabled the great masses of mankind to enjoy a fuller share of the legacy of human knowledge. But is literacy enough? Even in higher education, have we got our priorities right? Most of us are still only at the threshold of understanding a little about our own personalities, our own motivations--and those of our fellow-men. Only if we become literate in self-knowledge will we learn how to make the most of ourselves; and by literacy in self-knowledge I refer to the synthesis of understanding of our biological endowment, of the innate characteristics we share (within a range of individual variation) with the rest of our species, and of the processes by which we incorporate our separate life experiences and our social learning into the very structure of our personalities. This is a task large enough to keep us all busy for at least the next twenty years! Summary
The World Federation for Mental Health, which celebrated its twentieth anniversary in August, 1968, is unique among international organizations be-
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cause of its interdisciplinary character. It brings together clergymen, teachers, lawyers, doctors, nurses, and psychiatrists to work for the promotion of mental health. Its member associations do a great deal to alleviate the lot of the mentally afflicted in countries all over the world. They also promote public and professional education about mental health because all too often ignorance and prejudice intervene to aggravate the sufferings of the mentally ill. In developing countries, first priority has to be given to combatting malnutrition, infections, and illiteracy; but no sooner are these handicaps overcome than attention has to be directed to the emotional and mental disorders. The prevention and cure of mental illness clears the way for new attainments of the human mind and spirit. Each culture has redefined mental health in terms of its most cherished values. Today we are on the threshold of a new global culture unified by the worldwide dissemination of scientific knowledge and of the scientific method of advancing that knowledge. The artifacts of this new culture are already recognizable in every country. Spectacular advances in technology are changing the quality of life for millions; mass communication is turning the dream of "one world" into a reality. Yet rapid technological advance has been accompanied by an increase in emotional maladjustment and social pathology. What we need now is to become literate in the area of self-understanding. Only if we have a better understanding of our own and our fellow-men's motivations and emotional needs will we be able to apply our intelligence to fulfilling those needs. References
1. McLuhan, Marshall, The Medium Is the Message. London, Penguin Books, Ltd., 1967. (New York, Random House, 1967.) 2. Ibid.
3. Dobzhansky, Theodosius, Mankind Evolving. New Haven, Yale University Press, 1962. 4. In Runaway World. London, BritishBroadcastingCorporation, 1968. 5. Teilhard de Chardin, Pierre, The Phenomenon of Man. New York, Harper & Bros., 1959.
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G. M. C A R S T A I R S The Seventh World Congress on Mental Health was heralded by a service in a cathedral, it started formally in London's Albert Hall, and it continued throughout the ensuing week in the buildings of a modern coeducational school. These three locations symbolize rather clearly the essentially catholic, multidisciplinary nature of the World Federation for Mental Health. Ours is an association of a wide diversity of groups and individuals united by the belief that human mental life, the development of which has made possible the proudest achievements of our species, also holds the key to its future triumphs or disasters. For some people, the mental health movement tends to become identified with a concern for the welfare and care of the mentally ill and the mentally handicapped. As one well-meaning citizen put it a year or t w o ago in the course of a radio interview: "People should know more about mental health; it's an illness like any other." This identification with mental illness is partly true, for two good reasons: first, that emotional or mental illness, together with bodily diseases that affect the mind, clearly impose severe limitations upon the optimal development of human capabilities; hence the relief of G. M. CARSTAIRS,M.D., Professor of Psychiatry at the University of Edinburgh; Fellow of the Royal College of Physicians of Edinburgh; member of the Expert Advisory Panel on Mental Health of the World Health Organization, was elected President of the World Federation for Mental Health in 1968 for a three-year term. This paper was his inaugural address delivered at the Seventh World Congress on Mental Health in London, August 12, 1968.
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mental illness is an important aspect of the promotion of mental health. Secondly, an awareness of the unhappiness that mental illness can bring, both to the sufferer himself and to his family and friends, has been the driving force behind a great deal of devoted voluntary work in this field. In many countries throughout the ages the mentally ill have been viewed with a mixture of fear and repulsion and have all too often suffered from rejection, neglect, and even ill treatment. This has not been true of all cultures. In the Moslem world, the "afflicted of Allah" have traditionally been given special consideration; indeed, the earliest known hospitals for their care were founded in Baghdad and Cairo. There are some tribal peoples who regard a psyehotic's hallucinations as communications from the spirit world; and there are some cultures, like that of the Hindu world, that show a remarkable tolerance for bizarre behavior. Our own Judaeo-Christian culture, however, inherited a belief in demoniacal possession that reached its height during the long preoccupation with witchcraft that coincided with the Reformation and Counter-Reformation. It would be difficult today to find anyone in Britain who believes in devilpossession as a cause of mental illness--difficult, but not impossible; only ten years ago this contention was seriously advanced by a rural dean during a Convocation of the Church of England. Although few of his fellow-churchmen share this eccentric opinion, the order of service for exorcism can still be found in that church's liturgy. In many other parts of the world, perhaps especially in the developing countries, such beliefs are still very much alive; and wherever this is the case, patients are all too often subjected to violent, sometimes cruel procedures. One of the commonest traditional forms of exorcism consists of branding the skin with red-hot irons. I have seen the scars of such treatment on the bodies of schizophrenic patients in China, Malaysia, Ceylon, and India--and also among American Indians in the foothills of the Andes. The practice is so widespread and the availability of modern psychiatric care so scarce in the vast developing countries that it is probably still true to say that more schizophrenics in the world are treated by exorcism than by phenothiazine drugs.
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In these developing countries there are, of course, many other diseases, and in the selection of priorities for public health the death-dealing ones demand first attention. It is, however, remarkable how quickly age-old patterns of mortality can be transformed by the introduction of environmental sanitation and potent modern drugs. For example, the population explosion, which has been an immediate resulv of better medical care, itself presents new problems. In all previous generations of mankind, sickness and early death have kept our numbers down--but at what a cost of suffering! Today we can order things differently, if we are allowed to do so. Recently the Pope has told his followers that it is legitimate to practice family limitation by using our medical knowledge in order to exploit the so-called "safe period," but not to use other medical knowledge that permits much more certain control of fertility. I personally share the concern that many people, both within and without the Catholic Church, have expressed about the adverse effects this teaching may have not only upon worldwide campaigns for family limitation, but also upon personal relationships within families. The Dutch Federation for Mental Health has already addressed itself to a study of the mental health aspects of different methods of birth control, and its example could well be followed by all our member associations. The fight against killing and disabling physical illness is itself a contribution to mental health. Recent research has confirmed what intuitive wisdom has long maintained, namely that sick bodies tend to harbor sick minds. We have every reason to admire the work of the World Health Organization in its fight against disease, and that of the Food and Agriculture Organization in its fight against malnutrition. We have, of course, a direct interest in the work of the Mental Health Unit of WHO. Both its present director, Dr. Pieter Baan, and his colleague, Dr. Tsung-yi Lin, have given invaluable support to the World Federation for Mental Health over the years, as did their predecessors, Dr. Eddie Krapf and Dr. Ronald Hargreaves, and especially Dr. Brock Chisholm, who played an important part in the formation of both these organizations. Among our members there are many doctors,
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nurses, educators, and social scientists who have served on W H O ' s panel of advisers and on its expert committees. I want to make it quite clear that although W F M H bears initials rather similar to those of W H O , we are radically different bodies. W H O is a very large agency of the United Nations, serving all the countries that form the UN. It covers the entire globe (with the unhappy, and one hopes temporary, exception of China) and deals with the whole range of diseases and problems of environmental health. W F M H , in comparison, is tiny: a league of voluntary bodies concerned with one--but we think a crucially important --aspect of health, but also with the much wider theme of the fullest development and realization of human potentialities. Being nongovernmental, we are free to act as a pressure group in aid of the causes we support. W e are able to do this, in spite of our extremely modest financial resources, because we are able to enlist the help of influential citizens, leaders in the mental health professions and in other walks of life, in all our member countries. W e have, then, two main fields of interest, one strictly practical, the other more in the realm of ideas. Let me consider first our practical concerns, because they are very great indeed, and very pressing. W e know only too well how inadequate are the resources--hospitals, clinics, availability of drugs, and above all availability of trained manpower-to meet the immediate needs of the mentally afflicted in vast and populous countries. Where mental hospitals exist, they are often grossly overcrowded and understaffed; all too often their installations are of such poor quality that they endanger the physical health of their inmates. In a good many countries, what few mental hospitals exist are built like prisons and compare unfavorably with the prisons themselves. These are relics from an earlier age, when the only mentally ill patients to reach any institution were those whose behavior had become socially intolerable. The. great majority of such patients have been cared for, if at all, by traditional herbalists, medicine men, priests, or exorcists. Until quite recent years, Western-trained psychiatrists had relatively little in the way of effective help to offer them; but now the situation is different. W e know that there are
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literally millions of epileptics, of schizophrenics, of acutely agitated or depressed patients to whom modern methods of treatment could bring relief; that there are millions of mentally retarded children and young adults whose handicaps are aggravated by the lack of any training appropriate to their needs; and that there are millions more suffering from psychosomatic complaints and crippling neuroses who simply endure their unhappy lot because they have no alternative. In the face of so much suffering, where can we begin? It is of little use to wait for these countries' governmental health services to meet these needs-they often have even more pressing demands, presented by endemic communicable diseases, that claim prior attention. In the past, religious bodies have sometimes befriended the mentally ill, as did the movement created by St. Vincent de Paul in seventeenth-century France and the Quakers in England; but in recent years, the first major impetus toward improving the lot of these patients has generally come from the local or national Association for Mental Health. One of the striking differences between the 1968 World Mental Health Congress and that of 1948 was the great increase in the number of member associations represented from 22 in 1948 to 169 today. These associations have created clinics for adults and children, sheltered workshops, teams of volunteer workers visiting neglected hospital wards. But this is by no means their only function. Wherever the physical conditions of patient care leave a great deal to be desired, this very neglect of patients' welfare is invariably a reflection of public attitudes toward mental illness and the mentally ill. Old, negative attitudes and misconceptions die hard. We know well how much popular ignorance and prejudice still prevail--and not only in the developing countries. It constantly astonishes me to find, in both Europe and America, that even distinguished scientists, surgeons, and physicians are willing to display a remarkable degree of ignorance of the workings of the human mind and of the factors influencing human behavior. Future leaders of the medical profession in developing countries who come to Europe or America for
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advanced training are all too often influenced by their teachers' disregard for their patients' mental health and resume their work with their prejudices on this score reinforced, even though their expertise in other fields has been increased. It is interesting to note that during the last twenty years it has been the general practitioners (who are in closest contact with their patients)who have been most active in drawing attention to the high prevalence of emotionally determined illness. Doctors who work in industry have also become increasingly aware o f the importance of psychosocial factors in health and sickness, and those involved in industrial planning and management have responded with interest to their findings. Industrialists are becoming aware of the gains in productivity, as well as in health and happiness, that result when adverse psychological factors in the working environment--personal as well as material--are recognized and steps are taken i n time to put things right. No one will dispute that doctors of today and of the future must be well grounded in the principles and methods of scientific inquiry; but it is still necessary to insist that medical scientists who remain illiterate with respect to human psychology and social interactions will never make good doctors. Fortunately, the climate of opinion in medical education is slowly changing in favor of a greater emphasis on the behavioral sciences and on the study of social and psychological factors in illness. But we may have to wait for another generation before we can rely upon our doctors to be as alert to the significance of emotional disturbances in their patients as they are now to the signs of infection or to the presence of a tumor. Medicine is not alone, nor has it been the first, to recognize the relevance of including the study of human personality and human behavior in its basic training; such studies are being given increasing importance in the training of nurses, social workers, and clinical psychologists. Many other professions whose members have to deal with people in distress or difficulty, such as education, the clergy, the law, the police, personnel management, marriage counselors, and a wide variety of voluntary "helping agencies" in the community, are also turning to the mental health services for help in preparation for their tasks.
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If ignorance, indifference, and even hostility toward the subject of mental health are still to be found among some members of the medical and other professions, it is not surprising that such attitudes are widespread among the general public; and so long as they persist, public acceptance of the need for better treatment of the mentally afflicted will be harder to achieve. This is why the aim of education for mental health features prominently in the activities of every mental health association. I was vividly reminded of the importance of this task in April, 1968, while taking part in a seminar organized by W F M H in Hong Kong and attended by some forty psychiatrists, nurses, educators, and social workers from nine Far Eastern countries. Again and again the participants told us of the obstacles of prejudice and misinformation they had to overcome; and in some instances--particularly; in Dr. Aldaba Lim's account of a snowballing series of parents' discussion groups on problems of bringing up young children that she had helped to initiate in the Philippine school systemqwe heard of progress being made in this task of public education. This was a useful contribution toward the prevention of the behavior disorders and symptoms of maladjustment exhibited by children whose parents--sometimes with the best intentions--have handled them unwisely. Another example of timely preventive action--this time from Great Britain-was the initiative recently taken by the celebrated singer Frankie Vaughan, who offered to mediate between the leaders of a number of teen-age gangs in Glasgow and the police and corporation of that city. He has not only succeeded in halting the violence of gang warfare, but has promised to help them organize a Youth Center for these young people and has enlisted their active participation in this project. We still know too little about the etiology of most forms of mental and social pathology to make large claims about our ability to prevent their occurrence; but it is possible to identify some of the impediments to mental health and try to remove them. All such ventures in prevention, clearing the way for the optimal development of young people's constructive potentialities, command the fullest support of the World Federation for Mental Health.
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So far, I have been discussing, in rather concrete terms, the humanitarian and educational tasks on which all our member associations are engaged. But the phrase that set the theme of the Seventh World Congress--"Keys to Progress--Education for Mental Health"---implies that we already know what we mean by that elusive concept "mental health." I should like to consider for a moment whether this is indeed the case. This is far from being a merely rhetorical or academic question. In my opinion, one of the major sources of hostility and opposition to our movement has been our too-hasty assumption that we know all the answers, that we can define the attributes of mental health and know how they can be attained. Any such claim, I believe, is premature and indeed quite mistaken. As workers in our several fields, we know much about various forms of mental illness and personality deviation; and we are beginning to know a little about how these illnesses are caused and how they can be prevented. Outstanding instances in the progress of such knowledge during the past twenty years have taken place in fields as far apart as cytogenetics, psychopharmacology, and ethology. Discoveries in the first two fields have contributed significantly to the care of the mentally retarded and the mentally ill; and thanks to the work of biologically informed psychiatrists, such as John Bowlby, David Hamburg, and Charles Kaufman, methods borrowed from the ethologists have made it possible to observe, measure, and demonstrate the effects of early parent-child interactions upon later personality development. Already this last area of research has had important practical repercussions upon the way we treat young children in hospitals or in foster homes. These are all examples--and one could cite many more--of gains in knowledge about mental ill health that contribute to the prevention or the treatment of such conditions; but they bring us only fractionally nearer to an understanding of mental health, rather as the Hindu mystic defines ultimate reality by a series of negations: "Not that, not that." In other words, one way to define mental health is to do so by exclusion of all the recognized forms of mental illness; but this, although practical, is rather uninspiring. When we look back over recorded history, we find many different for-
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mulations of mental health in the ideal sense, that is, as the realization of man's highest potentialities. These potentialities have been revealed to us in their several ways by poets, philosophers, and perhaps even more often by religious teachers. Professor Radhakrishnan has actually defined religion as "an attempt to discover the ideal possibilities of human life." Once a culture has arrived at its version of the paradigm of human nature, all its formative and normative institutions are brought into play in order to try to mould its members into conformity with this ideal pattern. From prehistoric times--and still today, in many societies--these concepts of man and nature have found expression in the myths and legends of tribal religion. Primitive man was notoriously insular in his outlook, regarding his own group as the exemplars of mankind and all other groups as barbarians. Unhappily, in our own lifetime we have seen revivals of the same attitude. Whether in Nazi Germany or South Africa or among some misguided racists nearer home, we see the same processes at work: first, large sectors of our fellow-men are designated as inferior species, and then they are made the subjects of discrimination or ill treatment. As tribes gave place to larger societies, there emerged religions of universal scope, such as Lao-Tzu's teaching that man should abstain from strife and struggles, contemplating instead the beauty of nature and the changing seasons and seeking to identify himself with the natural world around him. This W a y of Life (the Tao T~ Ching), which inspired many magnificent paintings in the Sung period, has remained a leit-motif of Chinese philosophy over the centuries. In contrast, the recurrent theme of Indian religious philosophy has been the belief that each living creature harbors a spark of the divine flame; but man alone has the faculty of being aware of this and of heightening his awareness until he achieves a direct intuition of the suprapersonal, timeless Reality behind our transient physical experiences. The aim of Hindu and Buddhist disciplines is similar, despite apparent diversity: to enable each individual, by freeing himself from worldly distractions, to discover his real self. The Christian view of human nature is based on the belief that man is
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built in God's image; and the concept of that image has been influenced in turn by three important legacies: Hebraic monotheism, the teachings of Jesus Christ, and the Greek philosophers' exaltation of reason as man's highest gift. These elements do not easily, o r even necessarily, fuse; each has continued an independent existence. The humanists of today, for example, still aspire to the state of open-minded, active inquiry that was taught by Socrates. They, like the Hindus, believe that man must exert himself mentally; but they differ in believing that it is b y applying all his faculties to a clearer perception of the external world, of which he himself forms a part, that man will advance his self-knowledge. (It is interesting to recall that Cicero used the phrase "the humanities" to refer to those studies that served to educate a person so that he might become a perfect human being by developing to the full his spiritual and mental capacities. This was a fine ideal, but in order to see how imperfectly it was realized we have only to read our Roman history.) In the relatively short recorded history of mankind, we have seen the rise and fall of a number of major cultures, as first Oswald Spengler and then Arnold Toynbee have described. Each culture had its characteristic world view, its own interpretation of man's nature. Each developed its respective styles of art, architecture, and handiworks--in archaeological language, its "material culture." If we take a still more distant view of human history, we can see that there have been a few really crucial discoveries such as the invention of printing, or that of gunpowder, that have spread rapidly from one culture to another. This process of the rapid sharing of discoveries that have practical utility suddenly assumed a new importance during the nineteenth century as a result of the inventions that created the industrial revolution, and during the present century the process has been moving faster. In the case of earlier world cultures, great achievements of political organization and military prowess were usually needed before a new system of ideas and a new style of artifacts became widely disseminated. Today, thanks to the electronic revolution that has succeeded the industrial revolu. tion, we are in a quite new situation. In the modern world, chemical formu-
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las, electrical circuit diagrams, mathematical symbols, and methods of statistical analysis are the hardest currency of international exchange. Scientific theories recognize no national boundaries. Previous cultures have been localized to :one nation, or continent, and their characteristics have emerged only in the course of several generations. But today a new style is apparent all over the world. Unlike its predecessors, this cultural wave is not linked with any one country, religion, or political ideology. It is simply the expression of the forward surge of technology that has taken place in the last half-century. Its artifacts are buildings of concrete, steel, and glass; airplanes and automobiles; transistors and T V sets--all of which take forms dictated by the most efficient use of the materials of which they are built. W e have been accustomed to call these products Western, but the West has long since lost its monopoly of their manufacture and their enjoyment. W e now find ourselves, with bewildering rapidity, surrounded by the artifacts and the implicit ideas of a new, unprecedentedly worldwide culture that has not yet had time to become aware of its own identity. Its recognition has been delayed (but cannot be much longer prevented) by the persistence of outmoded forms, such as nation-states, factional alliances and ideological conflicts, and the stock-piling of gigantic, unusable armories of atomic weapons. Undoubtedly, the instant mass communications of the cinema, radio, and T V have been especially important in bringing about this new condition of our race--sometimes with unexpected results. As Dr. Sukarno has said: "The motion picture industry has provided a window on the world, and the colonized nations have looked through that window and have seen the things of which they have been deprived. It is perhaps not generally realized that a refrigerator can be a revolutionary symbol--to a people who have no refrigerators. A motor car owned by a worker in one country can be a symbol of revolt to a people deprived of even the necessities of life. 'u What Dr. Sukarno said a year or two ago of the movies is even more true of television, which brings distant events into the intimacy of one's own living room. Soon we shall have an array of "stationary" satellites that will make live T V transmission possible from any part of the world to any other.
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To quote that ecstatic, sometimes almost incoherent, prophet of the electronic age, Marshall McLuhan: "Ours is a brand-new world of all-at-oncehess. 'Time' (as we used to know it) has ceased, 'space' has vanished. W e now live in a global village, a simultaneous happening. W e are back in acoustic space. [He means that we are once again in an era of eyewitness accounts, of oral traditions.] W e have begun again to structure the primordial feeling, the tribal emotions from which a few centuries of literacy divorced us. ''~ As usual, McLuhan is breathlessly rushing ahead, maddeningly scattering half-truths among his startling insights; but his virtue is precisely in his ability to shock and startle us into realizing that a whole new world of the mind is forming about us. The idea, or ideal, of one world, of a community of all mankind has been bandied about for centuries; but now it has suddenly ceased to be an idea and has become a reality, which we are already experiencing before we are mentally attuned to it. Quite recently during a W F M H workshop held in Edinburgh, one of our participants--Dr. Pefia of Perum expressed this very neady. He said that in his travels he has already encountered a number of people who themselves exemplify the development of a new, emerging supranational personality--and many others who still seem to be stuck in a rather restricting psychological nationalism. W e really should not have needed McLuhan's shock treatment, because for years more sober prophets have been)telling us what to expect. Biologists like Julian Huxley, C. H. Waddington,/and Sir Peter Medawar have reiterated that in man the evolutionary prqcess is no longer merely biological, but is increasingly taking the form of the transmission of learned behavior. Theodosius Dobzhansky, the author of Mankind Evolving, has put it thus: "Man has not only evolved, he is evolving . . . Man, and man alone, knows that the world evolves and that he evolves with it. By changing what he knows about the world, man changes the world that he knows; and by changing the world in which he lives man changes himself. Evolution need no longer be a destiny imposed from without; it may conceivably be controlled by man, in accordance with his wisdom and his values. ''3 It was this line of thought that prompted the anthropologist Edmund
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Leach to begin his 1967 Reith Lectures with the words: "Men have become like gods. Isn't it about time that we understood our dignity? Science offers us total mastery over our environment and over our destiny, and yet instead of rejoicing we feel deeply afraid. W h y should this be? H o w might these fears be resolved?" This lecture concludes: "Since, god-like, we can now alter nature including that part of nature which is man himself, we can no longer console ourselves with the thought that a search for scientific knowledge is its own justification. It has ceased to be true that nature is governed by immutable laws external to ourselves. W e ourselves have become responsible.'4 Leach spoke as an evolutionary humanist, but his interpretation of man's emerging state is not unlike the vision of that remarkable priest, Father Teilhard de Chardin (who might best be described as the lyric poet of the evolutionary process), who wrote: "Man is not the centre of the universe, as was naively believed in the past, but something much more beautiful--Man the arrow of the great biological synthesis. Man is the last-born, the keenest, the most complex, the most subtle of the successive layers of life. ''~ I began this talk on a strictly mundane level, reminding you of the practical, humanitarian tasks of the mental health movement, If I seem since then to have strayed into the stratosphere--or as Teilhard de Chardin would say, into the no/Ssphere--this is simply to express my sense of excitement at witnessing and participating in the birth of a new self-concept of man. The institutions of this great society are already in being, in the form of the United Nations and its agencies UNESCO, W H O , FAO, and ILO. The basic values of this society have been spelled out in the charters of these organizations. Because I have drawn attention to the increasing intrusion into our lives of this new global culture, it may seem that I am placing undue emphasis upon the role of external, cultural forces on personality development. This would be to repeat the error of the "cultural determinists" of the late nineteen-twenties and early 'thirties. At that time, there was an unfortunate parting of the ways between geneticists and environmentalists. In more recent years, however, genetic theory has been enriched by a fuller understanding
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of the structure of the genetic code and by the development of biochemical genetics and behavioral genetics. The ethologists have also greatly extended our ability to recognize, in every species, discrete elements of behavior that appear to be genetically determined. The science of epigenetics, which studies the interaction of genetic and environmental factors in the form of expression of inherited traits, has much in common with the ethologists' analyses of innate behavior patterns and "releasers" in animal life. The study of culture and personality tended for some years to minimize the importance of biological factors as determinants of human behavior; but this need no longer be the case. Both genetics and learning theory--deepened by psychoanalytic concepts, such as those of the role of the unconscious and of ambivalence in human interrelationships--can illuminate the complex processes of social learning by means of which cultural values are transmitted. W e are, I believe, on the threshold of a new synthesis that will bring together all these essential elements of human growth and development. The influence of the latest additions to man's cultural inheritance will be better understood when it is based on a fuller understanding of the biological substratum upon which all new learning takes place. W e have to remember that, since man acquired the gift of speech and developed symbolic communication, his cultural development has far outstripped the slow pace o f purely genetic change. Biologically, we are still very close to our paleolithic ancestors; and this is part of the reason for our adapting so imperfectly to the conditions of urban life in technologically advanced societies. The last twenty years have been a period not only of accelerating knowledge and accelerating material accomplishments, but also a time in which some of mankind's dreams began to come true--the dream of being able to see things happening on the other side of the world, the dream of flying to the moon, the dream of self-determination of subject peoples; but also the threat that unchecked increases of population may cause the poorest and hungriest peoples of the world to become even poorer and hungrier; and the nightmare of knowing that enough atomic weapons are in existence today to wipe out all human life from this planet. But this is also a time in which
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great masses of the world's population can aspire to higher levels of nutrition, health, and education than ever before. Experiences that once were reserved for a privileged minority--such as adequate nutrition, protection against disease, access to education--are now coming to be recognized as basic human rights. It seems to me that these basic rights will provide the launching pad for the next upward surge of man's development. In recent years, education has been associated with ever increasing advances in technology; for the individual, it has been linked with material and social betterment but not necessarily with a gain in confidence or in peace of mind. On the contrary, studies in rapidly developing societies show that they have the highest rates for emotional maladjustment and social pathology, because individuals have lost the support that used to be given them by participation in stable, traditional social groups. If this diagnosis is correct, what must be done to help the coming generations to enjoy their new privileges without succumbing to anxiety, bewilderment, or despair? Access to literacy has enabled the great masses of mankind to enjoy a fuller share of the legacy of human knowledge. But is literacy enough? Even in higher education, have we got our priorities right? Most of us are still only at the threshold of understanding a little about our own personalities, our own motivations--and those of our fellow-men. Only if we become literate in self-knowledge will we learn how to make the most of ourselves; and by literacy in self-knowledge I refer to the synthesis of understanding of our biological endowment, of the innate characteristics we share (within a range of individual variation) with the rest of our species, and of the processes by which we incorporate our separate life experiences and our social learning into the very structure of our personalities. This is a task large enough to keep us all busy for at least the next twenty years! Summary
The World Federation for Mental Health, which celebrated its twentieth anniversary in August, 1968, is unique among international organizations be-
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cause of its interdisciplinary character. It brings together clergymen, teachers, lawyers, doctors, nurses, and psychiatrists to work for the promotion of mental health. Its member associations do a great deal to alleviate the lot of the mentally afflicted in countries all over the world. They also promote public and professional education about mental health because all too often ignorance and prejudice intervene to aggravate the sufferings of the mentally ill. In developing countries, first priority has to be given to combatting malnutrition, infections, and illiteracy; but no sooner are these handicaps overcome than attention has to be directed to the emotional and mental disorders. The prevention and cure of mental illness clears the way for new attainments of the human mind and spirit. Each culture has redefined mental health in terms of its most cherished values. Today we are on the threshold of a new global culture unified by the worldwide dissemination of scientific knowledge and of the scientific method of advancing that knowledge. The artifacts of this new culture are already recognizable in every country. Spectacular advances in technology are changing the quality of life for millions; mass communication is turning the dream of "one world" into a reality. Yet rapid technological advance has been accompanied by an increase in emotional maladjustment and social pathology. What we need now is to become literate in the area of self-understanding. Only if we have a better understanding of our own and our fellow-men's motivations and emotional needs will we be able to apply our intelligence to fulfilling those needs. References
1. McLuhan, Marshall, The Medium Is the Message. London, Penguin Books, Ltd., 1967. (New York, Random House, 1967.) 2. Ibid.
3. Dobzhansky, Theodosius, Mankind Evolving. New Haven, Yale University Press, 1962. 4. In Runaway World. London, BritishBroadcastingCorporation, 1968. 5. Teilhard de Chardin, Pierre, The Phenomenon of Man. New York, Harper & Bros., 1959.
