Mental wellbeing: disciplinary and historical context
Mental wellbeing is of interest to many different disciplines with different starting points and different needs in terms of measurement. These disciplines include psychology, philosophy, social science, economics and public health, and health and social care [1]. The last decade has witnessed a considerable debate between and within disciplines on the nature of mental wellbeing. We provide an overview of the viewpoints of these different disciplines as they pertain to WEMWBS.
Health
In 1946, the World Health Organisation defined health as
physical, mental and social wellbeing, not merely the absence of disease" [2].
This definition implicitly defined health as:
- Holistic - recognising the interplay between the physical, mental and social self, was a profoundly important step. Although it had little impact at the time on the practice of medicine or public health, it has had a gradual and subtle impact on the way we think about health.
- A positive concept - this step enabled the gradual emergence of the discipline of health promotion from health education and disease prevention. It also influenced public health practice on the ground in schools and communities.
- Synonymous with wellbeing - this last attribute created confusion because the word ‘health’ is linked to health services and disease. As a result, most people - scholars, professionals and the public - now use the term 'wellbeing' to describe the positive end of the spectrum of health, with illness at the other end. Other words which are used include flourishing, positive mental health and wellness.
In practice, the term 'wellbeing' is often used to refer to the mental health component of wellbeing alone.
In 2001 the WHO [3] defined mental health as
a state of wellbeing in which every individual realises his or her own potential can cope with the normal stresses of life can work productively and fruitfully and is able to make a contribution to his or her community."
This definition was consistent with the 1946 definition of health as synonymous with wellbeing and therefore attracts similar confusion in terms of links with health services and disease. The definition is also notable in that it covers the functioning but not the feeling components of mental wellbeing (see below). The implicitly valued functions are those which enable a thriving economy, low health care costs and the wellbeing of others.
Social science and economics
Broadly speaking the social scientists and economists have adopted simple definitions of wellbeing, focusing on feelings and measured with questions about happiness and life satisfaction [4,5]. The Cambridge English Dictionary definition of well-being - ‘a state of feeling healthy and happy’ echoes this approach. Using the language of the ancient Greek philosophers, this view corresponds to hedonic wellbeing [6]. Social scientists make the distinction between these outcomes, which they refer to as subjective wellbeing and objective wellbeing which focuses on the social circumstances and structures that they regard as necessary for subjective wellbeing. Their research interests lie in demonstrating how the latter impact wellbeing and how these circumstances and structures can be changed. Social scientists have been less interested in personal development or improvements in psychological functioning and how these can be supported.
Psychology
In contrast, psychologists [7,8,9] are interested in defining and researching the different components/attributes of mental wellbeing, particularly those related to functioning. As a result, they have developed multidimensional measurement scales, which provide scores for different components of functioning like autonomy, agency, purpose in life, self-acceptance and interpersonal relationships.
As clinicians, they are also interested in ways of helping people develop insights, personal characteristics, and behavior which enable positive functioning. Different schools of thought offer different labels and perspectives to describe this, for example, ‘psychological wellbeing’ [10] or 'self-determination’ theory [11]. Positive psychologists have often used the term positive mental health [7] in the place of mental wellbeing and the two terms can be regarded as synonymous. They have also introduced the concept of ‘flourishing’ [12] to the wellbeing debate. Psychological functioning enables the skills to build positive relationships and implies that personal wellbeing is related to the wellbeing of others and therefore also to social wellbeing.
Psychologists have described 'traits' or stable psychological characteristics and 'states' which fluctuate according to what is going on externally. The latter has more in common with the feeling aspects of mental wellbeing and the former with the functioning aspects. In the past traits were regarded as primarily genetic, but now are recognised to be partly developmental. They can be honed even in adulthood through a variety of personal developmental practices or therapeutic interventions like emotional and social education, anger management, mindfulness-based approaches which develop self-awareness and self-regulation, and cognitive behaviour approaches which challenge negative beliefs, attitudes or mindsets. Positive functioning affords resilience to stressful life events and so supports positive feelings.
Philosophers and spiritual leaders
The psychologists' interest in mental wellbeing is more in line with that of the ancient philosophers and spiritual leaders who also aimed to help individuals develop themselves. Broadly speaking psychological wellbeing corresponds to the concept of eudemonic wellbeing. Aristotle suggested that this is achieved through the cultivation of the character traits and behaviours that maximise happiness for self and others. Many other spiritual texts offer advice for the cultivation of personal and social wellbeing [13].
Childhood
The literature on wellbeing in childhood is written from the perspective of educational psychologists and tends to refer to emotional and social wellbeing rather than mental wellbeing. The key positive attributes covered in writing on emotional and social wellbeing are self-esteem and positive relationships with peers. Emotional intelligence [14], and the closely related concept of emotional literacy, key skills for positive relationships with others, are recognised as important for wellbeing in childhood. Beyond these concepts, childhood wellbeing is largely defined in teh academic literature as the absence of emotional and behavioural problems [15].
Emotional and social development in childhood is a determinant of mental health in adulthood. This development is heavily influenced by the quality of relationships between parents and other carers, and their children. The capacity of parents to relate to their children in a way which enhances wellbeing is in turn influenced by parents' mental health.
Interdisciplinary perspective
The interdisciplinary perspective on which WEMWBS is based covers all these components. Whilst seemingly derived from different approaches and disciplines, the feeling and functioning aspects of mental wellbeing are inextricably linked. It can be surprisingly difficult when faced for example with the items in mental wellbeing inventories [16]' to decide whether an item measures feeling or functioning. For example, self-acceptance is an aspect of psychological functioning often measured by items like ‘I feel confident in myself’. But self-confidence is also a feeling which can fluctuate depending on external circumstances. Similarly, optimism is both a way of looking at the world or character trait and a feeling which comes and goes depending on external circumstances. The personal development required in enhancing psychological functioning is difficult to achieve when someone has negative feelings about their capabilities, but when it is achieved the accomplishment brings pleasure and the new skills increase emotional resilience to negative life events. Combining both feeling and functioning in a single scale-like WEMWBS, therefore, has conceptual as well as practical validity. It also supports the positioning of mental wellbeing at one end of a mental health spectrum with mental illness or disorder at the other because mental illnesses are diagnose on the basis of the ways in which an individual is feeling bad or functioning poorly.
References
1. Mental Health Today…. And Tomorrow: Exploring current and future trends in mental health. Ed David Crepaz-Keay. Mental Health Foundation; Pavilion Publishing and Media Limited; 2015
2. World Health Organisation. Preamble to the Constitution of the World Health Organisation. Geneva; WHO. 1948
3. World Health Organisation. The world health report – mental health: New understanding new hope. Geneva; World Health Organisation. 2001
4. Stewart-Brown, S., “Population level: Wellbeing in the general population” in eds Mike Slade, Lindsay Oades and Aaron Jarden. P. Wellbeing, Recovery and Mental Health. Cambridge, Cambridge University Press. 2015
5. Clark, A. E., Flèche, S., Layard, R., Powdthavee, N. and Ward, G., The Origins of Happiness; How new science can transform our priorities. Forthcoming 2017
6. Ryan RM, and Deci EL. On Happiness and Human Potentials: A Review of Research on Hedonic and Eudaimonic Well-Being. Annual Review of Psychology Volume 2001;52:41-166
7. Albee G W. Preventing psychopathology and promoting human potential. American Psychologist 1982; 37:1043-1050.
8. Huppert, F., & Ruggeri, K. (2017, in print). 16. The controversy of well-being. In D. Bhugra, K. Bhui, S. Wong, & S. Gilman (Eds.), Oxford Textbook of Public Mental Health. Oxford University Press.
9. Ryff C D. Happiness is everything, or is it. J Personality and Social Psychology 1989;57:1069-1081
10. Ryff, C., & Keyes, C. (1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69, 719–727
11. Ryan RM and Deci EL. Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness Guilford Press 2017
12. Hone, L.C., Jarden, A., Schofield, G.M., & Duncan, S. Measuring flourishing: The impact of operational definitions on the prevalence of high levels of wellbeing. International Journal of Wellbeing, 2014; 4: 62-90.(
13. Schoch R. The Secrets of Happiness: Three Thousand Years of Searching for the Good Life Simon and Schuster 2008
14. Salovey, P.; Mayer, J.D. (1989). "Emotional intelligence". Imagination, Cognition, and Personality. 9 (3): 185–211.
15. Stewart-Brown S, Edmunds L. Assessing Emotional and Social Competence in Early Years and Primary School Settings. Perspectives in Education2003;21:17-41
16. Theda Rose, Sean Joe, George Warren Brown, Ashlie Williams, Ryan Harris, Gail Betz, Sarah Stewart-Brown Measuring mental wellbeing among adolescents: A systematic review of instruments". Journal of Child and Family Studies 2017;26(9):2349-2362.