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The spectrum of mental health: part 2 - moderate & full wellbeing

(a slightly abbreviated version of this blog post is downloadable as both a Word doc & a PDF file)  

Mental illness & mental health:  In "The spectrum of mental health: part 1", I wrote "As the diagram (below) illustrates, mental health is distributed as a spectrum across the population.  The cut-off points between the four states are somewhat arbitrary, but overall the diagram highlights very important variations in levels of happiness, distress & overall functioning.  The prevalence of these four states will vary with the group being surveyed and the country in which the survey is being done.  Typically though, in developed countries, each year about 20% or more of the adult population will suffer from a full syndrome mental or substance use disorder.  A higher proportion will suffer a troublesome mix of mental symptoms causing significant distress and impairment, but not qualifying as a full clinical syndrome.  30 to 40% of the population can be classified as enjoying "moderate mental health", and less than 20% are flourishing with all the positive associated benefits for mood, resilience & functioning."

Moderate mental health:  I'm guilty in these two handouts on "The spectrum of mental health" of blurring two overlapping gradations.  One is the degree of mental illness or disorder (a measure of presence or absence of suffering) and the other is the degree of mental health (a measure of presence or absence of flourishing).  It is possible to have very little mental suffering without much flourishing and it's possible to have quite a degree of suffering and still, to an extent, flourish.  Mostly though "moderate mental health" is an adequate term for describing no current full or subsyndromal mental illness, but not enough positive mood, engagement and meaning in life to qualify as fully flourishing.  Those without full or subsyndromal mental illness, but with low levels of positive mood, engagement & meaning, are sometimes described as "languishing". 

Full mental health & "flourishing":  For mental illness we have two overlapping and carefully worked out diagnostic systems - one is a subsection of the World Health Organization's International Classification of Diseases (ICD) and the other the American Diagnostic and Statistical Manual of Mental Disorders (DSM).  Both are fairly continuously assessed and updated, so the DSM is in the process of developing into its fifth edition.  The http://www.dsm5.org/ website comments "This site provides information culminated from over 10 years of revision activities, made possible thanks to the generous dedication of more than 600 global experts in the field of mental health."   The academic field of positive psychology has nothing like such resources and - in a sense - is still developing its own first ICD or DSM classification system.  Just as there are linked, but separate, disorders in mental illness like depression, trauma and anxiety, so there are linked, but separate, aspects of mental health like positive emotion, high personal functioning, life satisfaction and excellent close & wider relationships.  For full mental health and flourishing, one would ideally want to do well in all these areas.

Three "paths to wellbeing":  Martin Seligman & colleagues have argued that it is useful to identify three interwoven "paths to wellbeing".  In their 2010 paper "Pursuit of pleasure, engagement, and meaning: Relationships to subjective and objective measures of well-being" they write "Pleasure, engagement, and meaning are all unique predictors of individuals' well-being. We explored the relationship between the pursuit of each of these pathways and well-being. Participants (N = 13,565) visited a website and completed a measure about their orientation toward pleasure, engagement, and meaning as a pathway to happiness as well as measures of subjective and objective well-being (OWB). All three pathways correlated with higher levels of subjective well-being (SWB). Pursuing engagement and meaning, however, were more strongly related to SWB than pursuing pleasure. Objective indicators of well-being, including measures of occupational and educational attainment, displayed a similar pattern, with engagement and meaning positively related, whereas pleasure was negatively related. Although these results are merely correlational, it suggests that engaging and meaningful activities may have stronger influences on well-being than pursuing pleasure." You can take part in this ongoing research yourself and find out how well you score on each of these three "paths" by logging into the "Authentic happiness"  website and completing the "Approaches to happiness questionnaire"

Self-determination theory:  Engagement & meaning are at the heart of self-determination theory (S-DT), another major approach to wellbeing.  For well-researched reasons, S-DT argues that human beings thrive when their basic needs for autonomy, competence & relatedness are being fulfilled.  I have written extensively about S-DT on this website and I constantly use its ideas both in my work and in my own life.  As examples see the blog post "Self-determination theory" and the handouts & questionnaires (and explanatory backgrounds) further down the page at "Wellbeing, time management & self-determination".  As a self-assessment exercise try completing the "Basic need satisfaction scale".  This 21-item questionnaire assesses how well needs for autonomy, competence & relatedness are being met.  With this scale - and the associated & more specific "Work need satisfaction scale" and "Relationship need satisfaction scale" - it's good for averaged scores to be in the 5 to 7 range. 

Ryff, Keyes & Huppert:  Carol Ryff has been another major figure in the development of wellbeing assessment.  She and colleagues have spent many years developing and testing a multi-dimensional model of wellbeing.  The "Ryff definitions handout" describes the six components they focus on - self-acceptance, positive relationships with others, autonomy, environmental mastery, purpose of life, and personal growth.  The "Wellbeing & calming skills" page of this website gives more information about Ryff's important work, including a series of self-assessment questionnaires.  Corey Keyes has extended Ryff's exploration of wellbeing to include relationship & social factors as well.  I've written before about Keyes's very interesting work.  He has well documented that high levels of mental health are associated with significantly reduced chance of subsequently slipping into mental illness - compared with those who only have moderate mental health (and certainly compared with people who are "languishing" or have subsyndromal disorders).  Keyes also points out that less than 20% of the populations he has studied qualify as being in "flourishing" mental health.  So & Huppert have studied wellbeing across Europe using a related but somewhat different assessment measure.  They found that, on average, 16.6% qualified as flourishing using a loose definition and only 5.7% using stricter criteria. 

High ratio of positive to negative emotion:  It makes a lot of sense that someone in "full mental health" is likely to feel pretty good.  Barbara Fredrickson - arguably currently the leading researcher in the field of positive emotion - has produced fascinating evidence (Fredrickson and Losada 2005) that a ratio of at least three times as much positive as negative emotion is associated with significantly increased resilience and functioning .  She comments however that "80% of Americans fall short of the ideal 3-to-1 positivity ratio".  You can quickly check out how you score by visiting http://www.positivityratio.com/

Ed Diener & new simple flourishing scales:  Ed Diener is a major figure in research on wellbeing - his Satisfaction with Life Scale is one of the most widely used measures in the field.  He and colleagues have just put together - and tested - a couple of new, short, easily usable flourishing questionnaires.  They are the "Flourishing scale" and the "Scale of positive & negative experience".  I think this development can be of real use.  There is still very considerable value in exploring scores on the more complex scales that I've already described, but in general these brief questionnaires are a good place to start.  Full details are given in the blog post "Two new, easily usable scales for assessing wellbeing".  And the overall message of this handout on moderate & full wellbeing is that working towards flourishing more is very worthwhile.  It helps us be more productive in our work, better able to relate with others, more resilient when we encounter difficulties, and it makes life more of a joy to live! 


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