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3.5 Understanding Well-being

by Professor Phil Hanlon, Dr Sandra Carlisle & Gregor Henderson

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3.5

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Understanding Well-being

Introduction Many disciplines have a broad interest in the concept of well-being,

not least philosophy, which has studied the topic since the time
of Aristotle and before. In public health, well-being has long been
understood to provide a way in which thinking about, and inquiry
into, human health can be broadened. It has therefore been used in
contrast with narrower disciplinary ideas which relate to individual
physical functioning. This broader thinking has been in evidence from
the 1948 declaration by the World Health Assembly (World Health
Assembly 1948) to the recent report by the Commission on the Social
Determinants of Health (CSDH, 2008).
The concept of well-being performs a similar broadening function in other
disciplines, such as economics, where it provides a way of thinking about
how the success and progress of nations can be measured, beyond the
usual focus on GDP (Gross Domestic Product) (Layard, 2006; Shah
& Marks, 2004). In policy terms, the concept has recently been used
to focus attention on how governments can promote good mental and
emotional health (Scottish Government, 2007), thus extending the
context beyond the treatment of mental illness or disorder.
In contemporary academic research and theorising, various definitions
of well-being have currency, which potentially attracts much conceptual
confusion (Bowling, 2001). Well-being has been thought of, for example,
as: happiness; quality of life; life satisfaction; subjective well-being;
objective well-being; psychological well-being; hedonic well-being;
eudaimonic well-being; positive affect; positive emotions; and the
good life. The concept has been explored by many disciplines, such
as philosophy, economics, psychology, geography and sociology,
to name only a few.
Whilst we can only highlight certain key strands in this paper,
it is apparent from much of the scientific literature that well-being
is a complex and contestable construct and that, despite intense academic
scrutiny and a voluminous literature, its definition remains unresolved
(Carlisle & Hanlon, 2008). Given this breadth, our intention is not
to provide a literature review but to synthesise1 some complex evidence,
contentious theories and speculative conclusions from a range
of disciplines and a variety of thinkers.

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Inevitably, much is over-simplified in our deliberate framing of these

literatures in terms of two main strands or themes. These differ in terms
of how the problem and its solutions are conceptualised, depending
on whether researchers are drawing on psycho-biological, economic,
socio-cultural or other forms of knowledge. Although both strands draw
on scientific (and other) forms of knowledge, the first strand in the
debates might best be described as the quantitative application of science
to the individualised problem. This is, arguably, the dominant strand
in the debates we outline. The use of numbers and evidence of an
orthodox nature has an obvious appeal for public health.
Less obviously, a second strand, derived from socio-cultural and political
theory, suggests that both scientific and popular conceptualisations
of well-being are culturally constructed, often in line with the demands
of a capitalist economic system. Many within public health will be familiar
with arguments based on social constructionism. Insights from social
and cultural theory suggest, paradoxically, consumer capitalism may
be pathological for individual and social well-being yet fulfils particular
psychological needs that arise from modern forms of society.
Synthesis involves the drawing together and critical analysis,
by individuals or groups, of knowledge from different fields (including
the sciences, humanities and arts) in order to address social issues and
scientific questions that cross traditional disciplinary boundaries. Synthesis
is more than a summary because it can draw together different (competing
or even incommensurable) forms of knowledge

Objective Well-being There seems to be consensus that the pursuit of measuring well-being
in the Western world first began in the 1950s and 60s with the realisation
that happiness could not be measured just by looking at material
standards. Indeed, there is a body of literature that shows the decline
in happiness in the USA at the same time as standards of living have
risen, proving that money really doesnt equal happiness (Kahn and Juster,
2002). The social indicators movement was the result.
This movement developed as a means of monitoring change in noneconomic aspects of American life, and included a vast array of activities,
life events and characteristics of individuals. Examples include the level
of educational attainment, income, housing circumstances, health
measures, crime statistics and so on. The key point is that these indicators
were monitored by governmental and social institutions, and did not
depend on the individuals description of his or her own life.

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The approach assumes that there are standard needs common to all
individuals and that these can be determined by experts (Prince and
Prince, 2001). Objective indicators remain valuable at a population level
and for policy-making: populations are assessed by the same indicators,
thus permitting comparability. The standard needs approach can also
be used to assess the welfare of vulnerable and disadvantaged people,
for example those with learning disabilities, who may not be able
to adequately conceptualise and articulate their level of well-being.
Nevertheless, objective indicators are limited because they cannot reflect
the individuals experience and assessment of the conditions that influence
that individuals life. Moreover, social indicators alone do not define
quality of life: people may react differently to the same circumstances,
and they evaluate conditions based on their unique expectations, values
and previous experiences. So, although indicators such as income levels
or the incidence of crime, for example, are relevant to discussions
of quality of life, research which focuses on subjective elements is also
believed to be essential (Diener, Saptya and Suh, 1998).
The New Science of Contemporary evidence about well-being in its various forms has largely
(Individualised) Well-Being been generated through survey work and experimental approaches.
Neuroscience, genetics, psychiatry, political science and evolutionary
psychology are just some of the disciplines involved (Huppert, Bayliss
& Keverne, 2005). Much of the evidence in this field, however,
is generated through research in psychology and economics.
Contemporary psychological research on well-being derives from two
perspectives: the hedonic approach, which focuses on happiness and
defines well-being in terms of the attainment of pleasure and avoidance
of pain; and the eudaimonic approach, which focuses on the realisation
of human potential (Ryan & Deci, 2001). Both have antecedents within
the philosophical schools of Aristippus and Aristotle: contemporary
research thus extends ancient debates about the nature of optimal human
experience and the good life.
Hedonic and eudaimonic philosophies have given rise to two relatively
distinct, yet overlapping, paradigms for empirical enquiry, based on
different views of human nature and the good society (Waterman, 1993).
Hedonic psychologists tend to take the view that well-being consists of
subjective happiness. Hedonic psychology thus has the goal of research
and intervention to maximise happiness and minimise misery. Most
research based on the hedonic perspective involves assessing subjective
well-being (SWB) in terms of three components: the presence of positive
mood, the absence of negative mood and life satisfaction (Diener, Saptya
& Suh, 1998).

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For the eudaimonic psychologist, however, subjective happiness cannot

be equated with well-being: whilst some actions and outcomes may
be pleasurable, they may not ultimately be good for people or able to
promote wellness (Ryan and Deci, 2001). Eudaimonic well-being typically
involves constructs such as autonomy, growth, self-acceptance, mastery
and positive relatedness (Ryff & Keyes, 1995; Kasser & Ryan, 1999).
Thus it is not just the experience of positive emotions which matters
but the extent to which a person is fully functioning, within the context
of his or her society (Huppert et al., 2005). Research in this vein often
focuses on what enables people to live authentically and in accordance
with personal values, sometimes termed psychological well-being (PWB).
PWB is often operationalised as happiness-plus-meaningfulness (e.g.
Seligman, Parks & Steen, 2005).
For those within the hedonic paradigm, PWB models and criteria enable
experts to define well-being, whereas bottom-up SWB research invites
people to make their own evaluations about the good life (Diener, Sapyta
& Suh, 1998). Those within the eudaimonic paradigm contend that
SWB neglects aspects of life such as positive functioning and is a fallible
indicator of healthy living.
Economists also have a steadily increasing interest in well-being (Easterlin,
1974; Kahneman & Krueger, 2006). To over-simplify an equally complex
body of evidence, economic research has demonstrated that, within
societies, wealthier individuals are nearly always happier than poorer
individuals (although it is often suggested that this is because wealth
buys status, which is the real cause of happiness) (Clark, Frijters & Shields,
2008; Cummins, 2000).
This seems to support the disciplines basic proposition, that wealth
is a self-evident good, increasing choice and permitting the individual
to maximise his/her utility. However, some have also shown that
increases in income, once past a threshold where basic needs are satisfied,
produces diminishing returns in average levels of well-being in a society
(Easterlin, 1974).
A related point is that, in such societies, many people apparently
do feel miserable, even though some of the most serious health and
social problems which afflicted us in the past have been resolved, and
such societies have seen an overall trend in economic growth (until very
recently) (Shah & Marks, 2004; Layard, 2005; Lane, 2000). Such research
remains an area for considerable debate, not least because it throws doubt
on the value of social policies based on continued economic growth
in already affluent societies.

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Well-being Research: The ways in which well-being has been conceived by the above and
Influenced by other disciplines, and the nature of the treatments proposed (such
Western Culture? as pharmacological or psychological therapies), have been subject to
critique by a number of commentators. Some critical responses to the
conclusions of well-being science coalesce around the perceived cultural
dominance of North America, from whence most well-being research hails.
Wierzbicka (1997), amongst others, has argued that North American
culture, which places a high value on happiness, has implicitly shaped
how its researchers understand human emotions. Such understandings
have then been exported world-wide as human universals.
Others agree that the values cultivated by a culture strongly characterised
by its individualism become dubious when applied to other cultures
which may place a higher value on social relationships (Schwartz,
2000; Kitayama & Marcus, 1997). In North America, the experience
of positive emotions is viewed as evidence of personal and social success,
whilst negative emotions can be seen as evidence of failure, requiring
treatment (Schwartz, 2000). For critics, this cultural script nurtures
an unrealistic and potentially damaging psychological view of the world
(Galtung, 2005).
Christopher argues that both hedonic and eudaimonic understandings
of psychological well-being are more informed by Western culture than
researchers realise, and are shaped by the individualised moral visions
of the good or ideal person found in most Western societies (Christopher,
1999). For example, he argues that the hedonic approach appears
to preserve the neutrality of mainstream social science in seeming
to avoid imposing particular cultural values and norms.
Nevertheless, this approach is still directly linked to certain Western
individualistic assumptions and values. SWB places the onus of well-being
on the individual, who determines the standards and criteria by which
to evaluate his or her life, and refrains from making claims about the good
life or the good person. The good life consists mainly in the utilitarian
value of freedom to choose, to pursue happiness as defined by the
individual. Thus, the SWB researcher has adopted the prevailing attitude
of the liberal, individualistic society.
Christopher also points out that in modern societies most of emotional
life focuses on the individual whereas in more traditional societies cultures
much of emotional life focuses on other people (Christopher, 1999).
Western researchers general neglect of interpersonal emotions is consistent
with an individualistic moral vision in which the interpersonal dimensions
of reality and the self are downplayed in favour of a view of the self
as independent and autonomous.

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Eudaimonic researchers concerns for purpose in life thus seem tightly

linked to modern individualism, with its stress on human freedom.
By focusing on the inner psychological world and on the means
of satisfying subjectively defined goals and purposes, eudaimonic
research also fits with the liberal, individualist tradition of the West.
Summary In sum, there is now a substantial and growing evidence base about the
factors which contribute to, or detract from, positive mental health and
well-being. Over 3,000 studies on this topic have been published since
the 1960s (Nettle, 2005). This suggests that the field of well-being is
a significant human problem which spans the boundaries of many fields
of knowledge (Ehrlich, 2000).
Even from the brief outline provided above, two points will be obvious.

Firstly, research on subjective and psychological forms of well-being

has much to tell us about the various components of happiness, life
satisfaction etc thus contributing to our knowledge of what might
constitute the good life, the life worth living.

Yet a second point is that lay peoples common-sense understanding

of terms such as happiness, well-being and life satisfaction
is curiously absent from this body of research and theorising,
largely because of fairly narrow concerns with measuring
particular foci of research interest. Phrases such as happiness,
well-being and life satisfaction have become technical terms
which fall within the domain of experts (Pavis, 1996).

Claims are based on empirical evidence generated primarily through

survey work and experimental approaches though it is evident that
there are tensions within the science(s) and that a degree of speculation
and moral judgement creeps in. Much of the evidence about well-being
remains correlational and even where a causal relationship is believed
to exist, its direction may be unclear.
A further problem, for a public health audience, is the conflation of the
determinants of individual well-being with the determinants of population
well-being. A focus on individual well-being may view social inequalities
as unproblematic; a focus on social or population well-being would not.
As a useful counter to the individualised focus of much research, some
personal well-being measures (such as the multi-domain Personal Wellbeing Index) now capture satisfaction with personal relationships and
connection with the community (Lau, Cummins & McPherson, 2005).

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A third strand in the literatures, which forms the content of a separate

paper, draws together evidence and theories from such diverse fields
as ecology, ethics, philosophy and spirituality to suggest yet a different
understanding of the problem, based on the emerging environmental
critique and alternative views of the human condition.
This article draws on papers previously published in the Journal
of Public Mental Health and the Journal of Social Science & Medicine:
1. Carlisle S, Henderson G and Hanlon P (2009) Wellbeing:
a collateral casualty of modernity? Social Science & Medicine.
2. Carlisle S and Hanlon PW (2007) The complex territory of well-being:
contestable evidence, contentious theories and speculative conclusions.
Journal of Public Mental Health 6(2), 813.

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Understanding Well-being

AUTHORS

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Dr Sandra Carlisle & Professor Phil Hanlon

Public Health Section, University of Glasgow
Gregor Henderson
Independent Consultant in Mental Health and Well-being, Edinburgh;
Well-Being and Population Mental Health Programme Lead, National
Mental Health Development Unit, Department of Health; Chair, Young
Scotland in Mind.

ACKNOWLEDGEMENTS

CONTACT DETAILS

Our work is funded by the National Programme for Improving Mental

Health and Well-being in Scotland and supported by the Glasgow
Centre for Population Health.
Dr Sandra Carlisle
Research Associate
Public Health & Health Policy Section Community-based Sciences
University of Glasgow
1 Lilybank Gardens
Glasgow G12 8RZ
Email: s.carlisle@clinmed.gla.ac.uk

This paper has been written for the website of the research project, The Influence of Culture on
Mental Health and Wellbeing, based in the Public Health Section of the University of Glasgow
and funded by the Mental Health Division of the Scottish Government. www.afternow.org

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