In this paper I will present a commonly held view about mental health—indeed, one I am disposed to endorse—and then present an apparent dilemma it affords. The view on offer, briefly, is contextualism according to which mental health should be understood as values based psychological flourishing. Contextualism is consilient with a popular framework in clinical psychiatry known as values-based practice (Fulford & Van Staden, 2013). It also, as I have argued previously (Washington, 2018), makes sense of the philosopher’s notion that prudential goods are relational goods. Endorsing a contextualist claim like this is to deny objectivism about mental health, according to which a set list of goods plays the same role for everyone (as for example with Aristotelian eudaimonia).

Of course, it is common practice in therapeutic settings (not to mention in everyday conversations with friends and loved ones) to critique each other’s values. Values critique, in the sense I’m interested in, is the practice of making counterfactual claims about how a person would be ‘doing better’ with a different set of values from the ones that they currently have. For example, when disposed to say something like, “I know you care about this, but it’s making you miserable. You would be better off if you changed careers.”

Here, then, is the dilemma. If values based psychological flourishing is constitutive of mental health, then a counterfactual claim like the one above seems incoherent. The options on offer: (A) give up contextualism, or (B) give up values critique. Ultimately, I argue that B is the preferrable option, but making this argument requires clearing the conceptual territory around cases like these. I short, I believe that the critical intuitions we have about each other’s mental health and wellbeing (the proverbial baby in the bathwater) can be saved despite rejecting values critique itself. Nearby counterfactual dependencies that highlight external features of a situation (for example the relationship between hours of sleep and hours in one’s shift during residency) serve just as well to underwrite these intuitions. And this is all to the good, since rejecting values critique should encourage epistemic humility in thinking about human being’s diverse ways of valuing and flourishing.

Natalia Washington, Associate Professor of Philosophy, and an Adjunct Professor of Internal Medicine at the University of Utah
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