Towards a General Theory of Mental Health and Wellbeing

The mind in its own place, and in itself

Can make a heav’n of hell, a hell of heav’n.

– John Milton, Paradise Lost

We have known for a long time that pain causes aggression (Ulrich, 1966) and hurt people hurt others (Wilson, 2015). That is why no amount of positive education on happiness (Seligman 2003, 2011) or emotional intelligence (Goleman, 2005) can resolve the mental health issue of violence against self and others without a deep understanding the mystery of suffering (Wong, Mayer et al., 2021; Wong et al., in press).

 This timely book introduces a provocative pain-brain theory of preventing suicide through developing the zest for living a meaningful life as a way of coping with unbearable pain. In a broader sense, this book is not just about suicide prevention, but also about a general theory of positive mental health and human flourishing. 

For many years, I have worked on a general theory of wellbeing to integrate two inextricably linked human needs for happiness and the ending of suffering. I have also argued that any general theory needs to be based on (a) psychological universals (Norenzayan & Heine, 2005) and (b) the emic and etic research of the unique experience and expression of psychological universals in indigenous cultures (Wong 2020b; Wong, 2021a; Wong, Mayer et al., 2021). 

Therefore, when I reviewed Soper (2022), I was overjoyed to discover that someone unfamiliar with my existential positive psychology approach has independently developed a more compelling general theory of wellbeing from an evolution perspective with a different set of concepts and terms. Now that I have confessed my positive bias towards this book, I can proceed to critique this book in a more objective and balanced way.

What this Book is All About

At the very outset, the author clearly states that this book presents his answers to two important questions: Why do we choose to live? And why do we choose to die when life is no longer meaningful or too painful? At a time when there is an increase in medically assisted deaths (Bryden, 2021) and suicide remains the number one cause of death in the US (Center for Disease Control and Prevention, 2022), there is an urgency to learn why people choose suicide and how to prevent it. In spite of some progress in how to assess and intervene with patients at risk of suicide (Clay, 2022), there is still no breakthrough in reducing unnecessary suicides and medical assistance in dying (MAID; Government of Canada, 2022).

Soper’s evolutionary hypothesis provides a new perspective to understand the underlying reasons why some choose to die and why some choose to live in the face of overwhelming and unbearable suffering. The most innovative part of this new model is his scientific and spiritual insight that our loss of innocence and gaining of knowledge is responsible for our present predicament. His hypothesis is very similar to the biblical account of how Adam and Even were expelled from Paradise after eating the forbidden fruit of knowledge. Since we cannot turn back the clock and restore a childlike innocence, Soper proposes the wisdom of the soul as one of the solutions to suicide. 

More specifically, happiness and meaning in life began to matter to human beings only when the human brain somehow perceived (a) the futility of life’s endless struggles which inevitably end in death, and (b) the dark option that one has both the intellect and the means to end one’s own life. Life is often painful or not enjoyable.  But even when it is not enjoyable, I still can find it worthwhile; happiness or satisfaction can result from taking up the challenge and completing it makes it all the more worthwhile (Ho, 2014, p. 64). 

This theory is important because it provides the missing link in positive psychology or the psychology of wellbeing. It can account for the bidirectionality of suffering, which may lead to suicide or flourishing. Happiness is seen as a product of natural selection primarily to prevent people from killing themselves. Metaphorically speaking, if there were no hell, there would be no need for heaven with all its blessings. According to Vaillant (1998), the language of metaphor from the humanities is needed to help us understand the deeper things in life or the big questions. Throughout the book, the author uses logical arguments, empirical evidence, real-life examples, and metaphors to support this new theory.

The unique contribution of this book is that “suicide is an ugly topic, but by equal measure, its evolutionary flipside is breathtakingly beautiful. This astonishing payoff is that

Homo sapiens acquired a zest for life.” (Soper, 2022, p. 2). Thus, one’s passion for life or quest for meaning is an evolved primary motivation to make life worth living in times of suffering or existential vacuum, as proposed by Viktor Frankl (1946/1985) and expanded by Wong (Wong, 2019; Wong, Arslan et al., 2021).

Yes, we are made for happiness, and the pursuit of happiness is a universal desire just as

Seligman and colleagues have articulated (Seligman, 2002; Seligman & Csikszentmihalyi, 2000). But in real life, happiness can be disrupted by misfortunes, prolonged disabilities, and inescapable pain. In short, suffering happens to all human beings, from the cavemen of the stone age to the city dwellers in their high-rise condos. Soper proposes that people may be tempted to choose death when they are going through hell or meaningless and inescapable suffering, unless they learn how to turn hell into heaven as suggested by opening quote by John Milton (1667).

In sum, “the possibility of suicide is part of what makes us human” (Soper, 2022, p. 3), but at the same time, human beings are also endowed with the spiritual capability to live in “a heaven on earth, where the tenets of unconditional love, not Darwinism, hold sway. We are spiritual beings. The outermost shield against self-destruction is our yearning for a life worth living.” (Soper, 2022, p. 5).

The summary statement of his first chapter, that “the brightest aspects of human experience arise from the darkest of possibilities” (Soper, 2022, p. 3), is a more eloquent statement than my view that our best selves come from overcoming our worst selves (Wong, 2021a). For both of us, we attempt to correct people’s knee-jerk reaction to pain and show them pain’s noble mission in teaching and healing. 

From an existential positive psychology perspective, the main thesis of this book makes perfect sense. I hasten to add that Soper and I are not the only ones holding the view that wellbeing and flourishing come from our need to end or transcend suffering. I can cite many prominent psychologists and psychiatrists who have articulated similar views – William James’

(1902/1912) rebirth from sick soul, Alfred Adler’s (2009) social interest to overcome inferiority,

Viktor Frankl’s (1946/1985) meaning of suffering, Joseph Campbell’s (2008) hero’s journey, Scott Peck’s (1978) road less travelled, Jordan Peterson’s (2018) 12 rules of life as antidote to chaos and suffering, and Robert Emmons’ (2003) deepest desires for the good life. I only have space to cite from one of the above:

“‘The good life’ is not one that is achieved through momentary pleasures or defensive illusions, but through meeting suffering head on and transforming it into opportunities for meaning, wisdom, and growth, with the ultimate objective being the development of the person into a fully functioning mature being. On this formula for happiness, age-old wisdom and modern science are in agreement.” (Emmons, 2003, p. 156)

Although the main focus of this book is on suicide prevention, it would be great if Soper could cite some of the related research and theories to expand his pain-brain theory to human flourishing. In the following sections, I will focus on some of the difficulties I have experienced in reviewing this book and suggest possible solutions. 

What Shall we do to Prevent Suicide? Two Type of Solutions

Soper points out that before suicide takes place, there is an inner battle within us between a life force and a death drive. We need to understand this intrapsychic conflict in order to come out in favor of life. A cautionary note is that “balances have to be struck, because too much of a good thing, even of a life force, can be pathological” (Soper, 2022, p. 35). Life is a balancing act. We cannot survive without experiencing any pain in our lives; it is not in our best interest to try living a happy and stress-free life.

Here are at least two reasons why pain or suffering has adaptive advantages: (a) it serves as a warning signal to inform us that there is something wrong in our lives, and (b) it motivates us to make sense of the pain and do something to end it. Regarding the full benefits of suffering, see Wong, Mayer and colleagues (2021). For a new science of pain, we need to develop a taxonomy for pain and suffering. We need to at least differentiate between meaningful and meaningless suffering. 

To me, meaningful suffering means at least suffering which is inescapable and contributing to our wholeness. Suffering is the essence of human existence, and point recognized by Buddhism, Christianity, as well as psychology (Frankl, 1946/1985; James, 1902/1912; Vaillant, 1993). It is not possible to truly love someone without suffering and sacrifice. Similarly, it is not possible to achieve something worthwhile without delay of gratification, frustration, and the struggle to overcome failures. It is all the more impossible to love God and do His will without carrying the cross and denying ourselves. In sum, to be whole and mentally healthy, we need suffering as our teacher.

Soper observes that “meaningless pain can feel all the more unbearable precisely because of its meaninglessness.” (Soper, 2022, p. 38). In other words, one’s private hell is meaningless pain. That is why Viktor Frankl (1946/1985) often quotes Nietzsche: “He who know the why can bear any how” and proposes that the key to reduce suffering is to discover the meaning of suffering. Wong and Weiner (1981) confirmed empirically that when unexpectedly bad things happen to people, they automatically engage in attribution search, trying to figure out why it happened and for what reason or purpose it happened so that they could do something about it – either to change the situation or change themselves. 

Pain is not always physical or external. According to Erwin Shneidman (1993), the father of suicidology, a “psychache” refers to all kinds of psychological pains, from Durkheim’s feeling of not belonging (anomie), stressful states, and the common negative emotions of shame, guilt, and fear. There are many names for the same mental illness, according to Soper. Therefore, he is opposed to DSM classifications.  According to Ho (2014), a psychache may be considered as “mental bads” and we need physical goods and mental goods in order to flourish.

Like most social animals, “a network of supportive relationships is a lifelong survival necessity for us.” (Soper, 2022, p. 40). The most common human suffering is social pain from rejection, loneliness, marginalization, or ostracization, and it can be the most powerful drivers for suicide. Social pain can also explain why discrimination against minorities is a social evil, contributing to mental illness. 

Soper points out that “bodily pain and emotional pain, while not identical, use similar circuitry in the brain.” (Soper, 2022, p. 39). Both physical and psychological pain can be resolved by the pain-type or the brain-type. The former type focuses on numbing the pain by reducing the intensity of the emotive or affective reaction. The latter type confuses or redirects the cognitive or intellectual process in order to prevent people from planning and carrying out the action of ending one’s life. Our solution to the pain problem can be either pain-type or brain-type. This is the pain-brain theory of suicide prevention in a nutshell. Soper’s main contribution is to recognize the centrality of suffering; we need happiness, compassion, love, hope, and faith because we need to ameliorate and transform suffering.

Soper’s main argument for the pain-brain theory is based on the fact there is no credible empirical evidence of animals, or children under ten years old committing suicide (According to Ho, there are reports of suicides by children as young as six years old, but there is a lack of scientific documentation [Bizarrepedia, 2016]). In other words, natural selection determined a long time ago that both intense pain and a well-developed brain need to be present before suicide could happen in human beings. 

The best outcome from natural selection is balance because we cannot survive for long without feeling any pain, as in the case of leprosy. Therefore, we need some pain to keep us from getting injured or sick. In terms of mental health, we also need some amount of suffering to tell us what is lacking in our lives and the need to make some positive change (Wong, 2020a). Paradoxically, complete absence of pain and frustration may lead to pain and disaster (Kundera, 1984). In other words, mental health depends on maintaining a proper balance between too much suffering and too little suffering in each context. 

It is not difficult to understand why reducing pain helps prevent suicide because no one in their right mind wants to die; they choose death only when the pain becomes unbearable. The pain-type solution functions as a painkiller or a placebo. We can reduce pain either chemically by taking painkillers such as aspirin and opiate, or psychologically: “Humans also use various psychological tricks for pain relief.” (Soper, 2022, p. 95). Some of the common mind games include distractions, finding some meaning or benefits for the suffering, reappraisal (Peacock & Wong, 1990), and pursuing a self-transcendental goal (Wong, Arslan et al., 2021). There is already a considerable literature on meaning-focused coping (Eisenbeck et al., 2021; Park & Folkman, 1997; Riley & Park, 2014; Wong et al., 2006).

Since these mind-games clearly involve the cerebral cortex, they can also be classified as brain-type solutions. Research has also shown that mindfulness meditation is effective in reducing pain (Harvard Heath Publishing, 2019; Inamdar, 2020); mindfulness reduces the sensorial and emotional reaction to pain by training the mind to observe the here and now with the mental skills of focused attention and detachment from self, thus involving both the pain type and the brain type. Therefore, the boundary between these two types of solutions can easily break down. That is why I have a very difficult time deciding whether a particular pain control mechanism mentioned in this book is a pain type or brain type.

It does not help when Soper specifies that the brain type involves the function of degrading or denying the intellectual means to carry out the plan of suicide. Various kinds of mental disorders such as delusion and psychosis actually save people from committing suicide. However, many brain-type solutions, such as mindfulness meditation or Christian contemplative prayer (Center for Action and Contemplation, 2020), cannot be considered as degraded mental states; on the contrary, they rather reflect an enlightened mental state, higher consciousness or a fully developed relational and spiritual brain (see Siegal, 2016, 2018). 

We need a better way to differentiate these two types of solution to pain. For example, we can rename the “brain-type” as the “wisdom-type” to highlight the cognitive aspects of pain control and the wisdom of the ego (Vaillant, 1994). We may also rename “pain-type” as the “emotive-type” to highlight the affective aspects of pain management. Soper knows very well that there are different pathways to reduce or block pain: 

“The central nervous system is a complex network of channels and gates, with checkpoints where the intensity of incoming pain messages can be turned up or down, and sometimes blocked altogether, depending on the organism’s wider needs at the time.” (Soper, 2022, p. 92).

Pain control is a complex process with more than one kind of mechanism and feedback loop. Therefore, it is difficult to employ a binary approach to decide whether the mechanism at work is of the pain type or the brain type. Most likely, it involves both pain and brain mechanisms in different degrees. In any given context, pain can be best managed by either focusing on the numbing of sensorial and emotional reaction or by transforming the perception and cognitive processing of painful reality with wisdom of the ego (Vaillant, 1998) or wisdom of the mind and soul (Siegal, 2016, 2018).

 

The Dual Systems of Life Protection and Life Expansion

Another area of difficulty for me is Soper’s football metaphor of the two levels of defense – “keeper” represents the last line of defense and “fender” the first line of defense. But in an actual football game, the best defense is offence. Teamwork and a versatile strategy of playmaking are important for winning the game. A good last line of defense can be quickly turned into an offence when there is an opportunity to score against the rival team. Similarly, for pain control, we also need a more fluid way of conceptualizing the process of preventing and transforming pain. 

It may be helpful to consider some kind of dialectically interactive dual systems such as avoidance (Yin) and approach (Yang). The two basic physiological or psychological systems represent the basic adaptive functions of life protection and life expansion, or Yin and Yang coping strategies (Wong, 2012).

When times are good or when people feel that they have sufficient resources, they naturally want to expand their life force and life field, not worrying about obstacles or failures. However, when they encounter serious danger or opposition, and when nothing seems to work, it may be wise for them to resort to the life protection function of retreat and regroup. A time of pause, wu-wei (or doing what is natural, spontaneous, and meritorious without expecting anything in return; Wikipedia, 2022), may be needed in order to figure out a better strategy to turn defeat into triumph. Thus, our happiness is relative to both the degree of adversity we encounter and the level of wisdom of adaptation we possess. 

At the physiological and mechanistic level, the dual-systems involves the wisdom of the body according to Walter Cannon (1963), who theorized that the body knows how to balance the sympathetic and parasympathetic systems in order to maintain homeostasis. It also involves Hans

Selye’s (1956/1978) fight-or-flight coping mechanism.

However, in a complex, digital society, the instinctual mechanisms may not work in some situation. For example, we often do not have a single visible enemy like a dangerous predator in the jungle because we are fighting against external threats such as artificial intelligence and robots outside of human control. Similarly, we cannot escape from ourselves, and we have to confront and come to terms with our inner demons, such as the evils of greed, pride, envy, and power hunger.

Freud’s Ego defenses may seem to be irrational and pathological to an observer but may protect health and save lives. Vaillant (1994) identified four levels of defenses: 1) Psychotic: Delusion and Denial, 2) Immature: Projection and Fantasy, 3) Neurotic: Displacements and Repression; and 4) Mature: Altruism and Sublimation. All four levels of defense mechanisms may be employed and combined in a creative manner to turn suffering and tragedy to happiness and suffering, due to the brain’s marvelous capacity for synthesis and creativity. 

Both Vaillant and Soper recognize the importance of organized religion, theistic and nontheistic spirituality, personal myth, meaning/purpose, and self-transcendence, which are typically considered as manifestation of the spiritual dimension of personhood (Frankl, 1946/1985; Emmons, 2003; van Deurzen, 2011). Therefore, they may be also considered as wisdom of the soul for their contributions to personal growth and the betterment of humanity (Moore, 1994; Needleman, 2012; Wong, 2021b).

 It is especially worth noting that some of Soper’s fenders are related to the three classical Christian ideals (faith, hope and love), which are the hallmarks of the wisdom of the soul. The following quotes clearly illustrate these fenders as also function as the highest kind of life intelligence – wisdom of the soul.

 Regarding love, Soper recognizes that “it is good for our mental health to have a daily agenda setter, preferably outside of our direct egoistic needs – that is, something or someone to love” (Soper, 2022, p. 149). Since most pain is social, anything we do to care for others contribute to pain-reduction and healing. The Golden Rule of loving others as ourselves represent a universal moral law to have compassion for others as for ourselves. Self-help groups, faith communities, altruism, prosocial behavior, or self-transcendence (Mayer & Vanderheiden, 2021; Wong, Arslan et al., 2021) are examples of activities one can get involved in to reduce pain, mental illness, and suicide. Love is also related to the God archetype: 

“A bright future awaits because God(s), karma, the Great Spirit, or what you will, is good. Maybe not completely good, but at least steered by a moral compass. In this light, we can see the divine agents of religions not as parasites or cognitive errors, but as personifications of a benevolent order.” (Soper, 2022, p. 179).

Faith in God(s) or a Higher Power is not just an option, but an imperative for mental health: “It is not that we can’t help but see a super-natural purpose — it is that we need to believe it. Human thriving, sanity, indeed our survival, depend on our conviction that some benign order holds sway over our lives.” (Soper, 2022, p. 177).

“The universal solution to emotional pain, and the unifying offer of all therapeutic paradigms, and all religions, is hope.” (Soper, 2022, p. 207). Faith gives us a sense of calling or purpose for living (Wong, 2014). Faith also gives us a sense of tragic optimism, which is hope against hope (Leung et al., 2021).

In sum, faith in God(s) plays an over-arching role for both life protection and life expansion at all three levels of wisdom in order to reduce pain and suicide. Faith helps us transcend our inherent human limitations in learning how to know our true self, how to relate to others, and how to connect with the vast unknown and unknowable transcendental realm. Faith gives us hope in a happy future and it also deepens our empathy and compassion for ourselves and others (Mayer, 2021). Together, faith, hope, and love are the spiritual origin of happiness. There is already some empirical support that the origin of happiness may be from the soul (Yang et al., 2021).

 

Conclusions

Soper’s pain-brain theory may be considered a new framework for both suicide prevention and a general theory of relativity for mental health and wellbeing. It is surprisingly similar to my existential positive psychology perspective (Wong, 2021c). Yes, happiness is the first principle, and it can trump suffering as Seligman (2003) proposed almost two decades ago. But Soper shows us that happiness can trump suffering not by avoiding it or working around it, but by confronting and overcoming it with all the happiness-enhancing resources (Ho, 2014), especially the wisdom of the soul (faith, hope, and love).

To better understand the importance of this spiritual triad, I have conceptualized it as the golden triangle of self-transcendence (see Figure 1; Wong, 2019). The golden triangle explains why faith, hope, and love are needed to meet our basic mental health needs for meaningful work, loving relationship, and spiritual faith, resulting in true happiness and fulfillment. 

Figure 1

The Golden Triangle of Self-transcendence

 

Another important contribution from Soper is that balance or harmony is the essence of happiness (World Happiness Report, 2022). The important lesson to achieve life intelligence in general and wisdom of the soul in particular is learning how to navigate an adaptive balance between realism and idealism, suffering and happiness, self-care and self-sacrifice. We need “an honest facing of facts – a getting real that could bring practical benefits in reducing misery and saving lives.” (Soper, 2022, p. 196). But this needs to be balanced by cultivating our resources

(Wong, 1993) and affirming our triumphant idealism: “Each of us has the task of nurturing our own faith in the goodness of the world and its people – and living up to that belief.” (Soper, 2022, p. 208). This is the same argument I have made for years that we need to face and embrace the dark side of human existence (Wong, 2021c). 

The benefit of this realism is that it will not lead us to sadness and despair. Quite the contrary, it actually deepens our need to create and maintain an invisible paradigm of a benign and beautiful world. There is actually no contradiction between Seligman’s positive psychology (PP) and my existential positive psychology (PP2.0) because both are two sides of the same coin, or two ways of finding happiness when times are good or when times are bad. In times of suffering, PP2.0 is more needed. A general theory of mental health and wellbeing must integrate both sides, as argued more compellingly by Soper in his book. 

To recap, fulfilling our need for happiness is made much more difficult by the rapid progress in science and technology and inevitable process of materialism and secularization. The change has become too fast and too much to adapt to for the ordinary mind without advanced training in science and technology. That is because the traditional values and ways of living has been displaced, and there is no adequate replacement to meet the basic human need for meaning, love, and faith. 

As a result of the above changes, our basic psychological needs for significance and connections are not met, and we are like fish without water (Wong, 2020b; Wong, Arslan et al., 2021). A general theory of wellbeing, according to both Soper and I, points to the direction of meeting our basic needs for meaningful work, loving relationships, and spiritual faith to restore positive mental health (Figure 2). Both of us have also emphasized that we need to navigate an adaptive balance between happiness and suffering so that we can achieve positive mental health and flourishing. From rather different perspectives, Soper and I independently arrive at the same conclusion that we need to develop a relativity theory of mental health and wellbeing, which posits that whether suffering leads to suicide or flourishing depends on the wisdom of the soul and social interest or a caring community (Adler, 2009). This general theory suggests that a fully happy brain (Breuning, 2015), even in times of suffering, depend on developing the wisdom of the soul (McLaughlin & McMinn, 2022; Siegal, 2018; Vaillant, 1998).

Figure 2

Basic Physical Health and Mental Health Needs

 

My parting thought is that we really need more research to discover why people have the uncanny propensity and ability to turn heaven into hell, and to create hell for themselves for no apparent reasons (Cowden et al., 2021; Ho et al., 2022). The general theory of mental health and wellbeing is to enable people to live the best possible bittersweet life (Cain, 2022) of turning hell into heaven and preventing the self-destructive act of turning heaven into hell

The general theory also teaches us how to meet our basic needs for mental health as illustrated by the golden triangle. Most peoples’ assumptions about the self, others, and God are misguided because they are either too idealistic or too pessimistic. This general theory shows us a way of navigating an optimal balance even in the worse possible situations. 

In view of the above, I highly recommend this book. In fact, I suggest that this book or this review should be recommended to anyone who is struggling with the problem of “to be or not to be.”