The Ladder of Wellbeing: Four Steps to THRIVE
Last time on the blog, we discussed the two types of wellbeing that are necessary to achieve true and lasting wellbeing (as opposed to temporary happiness).
The field of wellbeing has significantly expanded the study of the spectrum of human experience. Instead of having only two polarizing options—wellbeing and illness—there are intermediate states where neither true wellbeing nor illness are present.
Wellbeing is a spectrum, not a yes or no question
In a study by Corey Keyes (1), mental health is not only the absence of mental illness, but rather a spectrum. Beginning with people with diagnosable mental illness, then people without mental illness who are languishing, then people with moderate mental health who are not flourishing, and finally people who are flourishing.
Keyes Spectrum of Wellbeing:
Diagnosable Mental Illness
Languishing
Moderate Mental Health
Flourishing
A significant number of people languish even in the absence of mental illness, this has never been more observably true than in the past year when many external factors worked together to cause additional mental stress. Full mental health in Keyes’ study means humans must flourish, not simply be devoid of mental illness.
In another study by Rowe and Kahn (2), instead of classifying aging participants into individuals with or without disease, a further classification is added. Individuals without disease are further split into having two categories: “usual” aging and “successful” aging.
Successful aging has three main components:
Low probability of disease and disease-related disability
High cognitive and physical functional capacity
Active engagement with life
Successful aging goes beyond absence of disease, and mere maintenance of functional capacities. While both are important components of successful aging, it is their combination with active engagement that fully represents the concept of successful aging. Successful aging goes beyond potential; it involves activity.
Pushing this idea further, it is not the presence or absence of illness that describes wellbeing at all. Rather, a more realistic way of defining wellbeing is as a broader concept which includes a person’s level of coping and adaptation. With this definition, a person can have wellbeing in the presence of illness or illbeing without diagnosable disease.
Wellbeing is not Synonymous with Happiness
Wellbeing goes beyond the surface-level “happy-ology”.
This exercise helps clarify distinctions.
Think of a time in your life when you initially perceived a negative experience which later turned positive and added to your sense of wellbeing.
Alternately, think of a time in your life when you initially perceived a positive experience which later turned negative and added to your sense of illbeing.
Most people can describe both kinds of experiences. For example, while people often have negative consequences of trauma (i.e. PTSD, depression, and alcohol/substance use), a subset of people experience post traumatic growth (3). This exercise underlines the concept that having negative emotions does not mean that they are wrong or bad. For example, anger can help with creativity, guilt can spark improvement, self-doubt can improve performance, and mindlessness can lead to better decisions (4).
The key lies in emotional agility, the ability to access a full range of emotions, not just the "good" ones, to respond most effectively to whatever situation a person might encounter (4). Therefore, given a set of life circumstances, a person would fall on one of the rungs of the following metaphorical ladder depending on their level of adaptation or coping.
As a person moves up on the ladder, wellbeing increases, and as they move down the ladder, illbeing increases.
Fig. 1: Wellbeing Ladder
Succumbing. This is the lowest rung on the ladder. Here, dysfunction is present in one or more domains of life. An illness, disease or disorder is usually, but not always, present. Being here does not imply that a person is weak or incompetent. Rather there is an understanding that the individual bio-psycho-social circumstances have overwhelmed a person’s ability to adapt and cope. This is no different than an experience with the flu. The flu is not just a biological event (5). The disease process is modified if a person was vaccinated or not. Having comorbidities such a COPD or diabetes further modify the course of the illness. Having access to healthcare or the ability to afford healthcare adds another layer of complexity. All this combines to create one individual’s experience of the flu. Similarly, a person succumbing to the state of illbeing is not able to function. Another example is a physician experiencing burnout, but due to stigma and lack of support structures at work or home, they are not able to seek help. Recent studies show that in these cases, phenomenologically there is no difference between having burnout and depression (6).
Surviving. This is the second rung on the ladder. At this level, there is deficit in functioning that does not meet the criteria for disease, disorder, or illness. There is distress that keeps people at risk of succumbing to the problems. An example would be the physician who experiences burnout at work, but has support at home, and is able to recover from the adverse effects of the work environment when they are not at work. Such a physician is at risk of but has not yet succumbed to depression, anxiety, alcohol abuse, or even suicide. Another factor would be if this physician is struggling at work but in an environment where they can seek help for their problems. Studies from the field of coaching psychology show that between 26-52% of executives who seek out coaching due to work related issues do so due to significant distress (7).
Existing. This rung is what Keyes would call people with moderate mental health (1). The people at this level have no dysfunction or deficit and would be described as normal. This population is not well studied for illbeing beyond risk factors for illnesses. However, positive psychology research has studied such people, and found they are able to thrive and flourish if they use interventions that are empirically shown to increase different aspects of wellbeing.
Thriving. The level where humans continue to grow with or without additional stressors (8, 9, 10). Flourishing is another commonly used term in positive psychology literature (11). Humans can thrive even with an illness or disease. In fact, a person’s response to disease will define how they cope and adapt and if they can thrive despite their diagnosis. An example would be a person with mental illness who overcomes the illness, then becomes an advocate for people with mental illness (12). They draw Psychological Wellbeing (PWB) from helping others, a strength recognized in wellbeing literature.
As the field of wellbeing has grown, it aims to complement rather than replace traditional psychological approaches (13). Traditional approaches, despite their accomplishments with the relief of mental illness symptoms and the development of various effective treatments, fail to provide the means for a more fulfilling life. Positive psychology interventions have always had a strong emphasis on practical applications. This is also true of organizational psychology and coaching psychology where applying and implementing interventions is part and parcel of field work.
Next time, we’ll discuss the distinction between individual and organizational work in the field of wellbeing. Looking forward to hearing your thoughts in the comments below!
In fact, we have created just the program you need to succeed. If you’re ready to maximize your leadership potential and provide opportunities for your team to thrive in the workplace, contact me to get started. Let’s create a customized program that’s perfect for your organization!
Sources:
Keyes CL. The mental health continuum: from languishing to flourishing in life. J Health Soc Behav. 2002;43(2):207‐222.
Rowe JW, Kahn RL. Human aging: usual and successful. Science. 1987;237(4811):143‐149. doi:10.1126/science.3299702
Tedeschi, R.G., & Calhoun, L.G. (2004). Posttraumatic Growth: Conceptual Foundations and Empirical Evidence.
Kashdan T, Biswas-Diener R. The Power of Negative Emotion: How Anger, Guilt, and Self Doubt Are Essential to Success and Fulfillment. Richmond: Oneworld; 2015.
Flowers P, Davis M, Lohm D, Waller E, Stephenson N. Understanding pandemic influenza behaviour: An exploratory biopsychosocial study. J Health Psychol. 2016;21(5):759‐769.
Bianchi R, Schonfeld IS. Burnout-depression overlap: Nomological network examination and factor-analytic approach. Scand J Psychol. 2018;59(5):532‐539.
Cavanagh MJ. Evidence Based Coaching. Bowen Hills: Australian Academic Press; 2005. p22
Bergland, Å.. and Kirkevold, M.. (2001), Thriving – a useful theoretical perspective to capture the experience of well‐being among frail elderly in nursing homes?. Journal of Advanced Nursing, 36: 426-432.
Spreitzer, Gretchen & Sutcliffe, Kathleen & Dutton, Jane & Sonenshein, Scott & Grant, Adam. (2005). A Socially Embedded Model of Thriving at Work. Organization Science - ORGAN SCI. 16. 537-549.
Richard M. Lerner, Elizabeth M. Dowling & Pamela M. Anderson (2003) Positive Youth Development: Thriving as the Basis of Personhood and Civil Society, Applied Developmental Science, 7:3, 172-180
Seligman MEP. Flourish: a Visionary New Understanding of Happiness and Wellbeing. New York: Free Press; 2013.
Slade M. Mental illness and wellbeing: the central importance of positive psychology and recovery approaches. BMC Health Serv Res. 2010;10:26. Published 2010 Jan 26. doi:10.1186/1472-6963-10-26
Wong, P. T. P. (2011). Positive psychology 2.0: Towards a balanced interactive model of the good life. Canadian Psychology/Psychologie canadienne, 52(2), 69–81