LAUSR

Psychiatry, like rest of medicine, has traditionally focused on study, diagnosis, and treatment of diseases. Whereas positive psychology has become a part of the lay lexicon, positive psychiatry has received far less attention even among professionals. Positive psychiatry may be defined as the science and practice of psychiatry that seeks to understand and promote well-being through assessment and interventions involving positive psychosocial factors.1 It differs from positive psychology in having a greater focus on biology, medicine, and healthcare including mental illnesses. Multiple metaanalyses have shown that higher levels of positive factors such as social support, resilience, and optimism have a significant beneficial impact on health and longevity.2 The effect sizes for the influence of social relationships on mortality equal or exceed the effect sizes of interventions to treat traditional risk factors like smoking, obesity, sedentary behavior, and hypertension.3 The overall US healthcare system, focused on treatment of diseases in individual patients by individual clinicians, has proven largely inefficient, and has created major disparities. These problems will only worsen as the population grows and the gap between the need for and the supply of healthcare professionals expands. Moreover, our goal should not be merely to reduce severity of psychopathology but also to enhance well-being. It is thus important to increase research on promoting mental health and preventing mental illnesses—ie, positive psychiatry. This does not mean replacing the current healthcare system including pharmacological and psychosocial interventions, but rather to supplement it with greater emphasis on wellness-focused factors at individual and public health levels. Prevention of all types—primary, secondary, and tertiary, will reduce the number of people requiring healthcare, thereby making the system less expensive and more efficient. In 1998, the World Health Organization (WHO) highlighted the role of social determinants of health—ie, nonmedical factors that influence health outcomes and health disparities, such as education, income, employment, access to nutrition and healthcare, and living environment.4 There are also unique social determinants of mental health including social isolation/loneliness, homelessness, stigma against mental illnesses, mental healthcare inequities, and a flawed American legal system that tends to criminalize psychopathology.5 Equally important are positive psychosocial determinants mentioned earlier, which impact physical, cognitive, and mental health in people with or without illnesses. The study by Hettwer et al. (this issue) is an excellent illustration of the neurobiology of positive psychiatry, specifically resilience in persons at high risk for schizophrenia.6 Using structural magnetic resonance imaging (MRI), these investigators found a significant correlation between an established schizophrenia polygenic resilience score (PRSResilience) and cortical volume, especially in the fusiform gyrus, in healthy individuals. This finding provides a novel link between the vulnerability–stress model, visual cognition, and schizophrenia resilience model. The authors postulate that impaired perceptual organization can negatively affect adaptive behavior and social interactions, producing a vicious cycle of increasing psychosocial stress, defective information processing, and risk of psychosis. In contrast, resilience mechanisms may increase perceptual and cognitive capabilities, thereby reducing the stress induced by perceptual impairments, and initiate a virtuous cycle. Thus, resilience is not just the flip side of vulnerability but a positive and protective factor that prevents progression of neuropsychopathology. Similar phenomena are likely in individuals at risk for bipolar and other mental disorders too, and have clear intervention implications.