The discussion by Maj ^{Reference Maj1} can be related to a recent article by Huber et al ^{Reference Huber, Knottnerus, Green, van der Horst, Jadad and Kromhout2} in the BMJ reviewing the definition of health. The authors propose a definition of health on the basis of an individual’s ability to react to perturbations in their physiological or psychological state – thus, a healthy individual can respond appropriately to the challenge of a viral infection or life event. Failure of the appropriate coping strategy, whether physiological (e.g. an inflammatory response) or psychological (e.g. a defence mechanism) leads to illness. Social health is proposed to be the ability to respond to opportunities despite limitations imposed by ill health. Huber et al suggest that health be measured through assessment of biological, psychological and social domains using instruments such as COOP/Wonca Functional Health Assessment Charts ^{Reference Nelson, Wasson, Kirk, Keller, Clark and Dittrich3} or World Health Organization measures. ⁴

A similar idea is contained in DSM-IV-TR, in the Global Assessment of Functioning Scale. ⁵ Perhaps an adaptation of this could be used to provide a unifying measure of severity and definition of mental disorder. Diagnosis could be based on the presence of symptoms and their duration, and the use of a uniform health rating scale for all disorders would allow for severity grading. Treatment would remain symptom directed, but the increased information provided by structured assessment would allow it to be focused on specific psychological and social domains. Overall distinction between mental health and disorder would be determined by the impact of symptoms on global assessment of health.