Flourishing vs Languishing Understanding Some Dynamics ...

Flourishing vs Languishing Understanding Some Dynamics ...

Health is Health is not simply the absence of disease: it is something positive . . . Henry Sigerist (1941, p. 100). Kinds of Happiness Hedonia Eudaimoni a Origins of Flourishing Hedonia Flourishi ng

Eudaimonia Signs of Mental Health (Keyes, 1999, 2002) Hedonic Well-Being 1. Satisfied with your life 2. Positive affect in life Eudaimonic Well-Being 3. Contribution to society 4. Social integration 5. Social growth and potential 6. Acceptance of others 7. Social interest and coherence 8. Self acceptance 9. Environmental mastery 10. Positive relations with others 11. Personal growth 12. Autonomy 13. Purpose in life Whats Your Mental

Health? High Level = Experience sign of mental health every day or almost every day Low Level = Experience a sign of mental health once or twice or never Flourishing High level on 1 or more hedonic wellbeing and High level on 6 or more eudaimonic wellbeing Languishing Low level on 1 or more hedonic well-being and Low level on 6 or more eudaimonic wellbeing Moderately Mentally Health if you are neither flourishing nor languishing

DSM 12 Month Mental Disorders MIDUS 1 Adults Keyes (2005a) Major Depression Generalized Anxiety Panic Disorder Alcohol Dependence 35 30 28 25 % 20 16 15 13.4 10.6 9.4

10 6 5 0 6.8 4.8 2.2 0.4 Languishing Moderately Mentally Healthy 1 Flourishing 2.7

Data Support the Two Continua Model High Mental Health High Mental Illness Low Low Complete State Approach DSM 12-Month Mental Illness Diagnosis No Yes

MHC-SF Mental Health Diagnosis Languishing Moderately Mentally Healthy Languishing Moderate Mental Health 3 2 Mental Illness and Languishing 6 Flourishing Flourishing:

Complete Mental Health 1 Mental Illness Mental Illness and Moderately and Flourishing Mentally Healthy 5 4 Anything Less Than Mental Health as Flourishing in Adults (Keyes, 2007) Productivity Missed days of work Workday cutbacks Chronic Physical Illness and Conditions Any CVD Number of conditions at all ages Disability

Health Limitations of IADLs Psychosocial Assets Report Being More Resilient Clearer Goals in Life Feel More Loved and Cared For (Intimacy) Low Sense of Helplessness Healthcare Utilization Few Overnight Hospitalizations Medical Visits (for physical or for emotional, psychological) Few Medical Prescriptions Flourishing Across the Life-Span (MIDUS 1995 and MIDUS 2005 Longitudinal Follow Up)

Cardiovascular Disease (CVD) CVD prevalent and costly +6o million Americans have at least one type of CVD 40% are above the age of 65 Highest combined direct and indirect costs cost ($180 billion in 1999) About 1 per 2.5 deaths directly result from CVD 47% of men 54% of women died from some CVD (1999) Deaths from CVD decreased by 30% Less recognizable risk factor in the is mental illness (MDE) Happy Heart Hypothesis (Keyes, 2004)

Happy Heart Hypothesis (Keyes, 2004) 2nd 1st 3rd Chronic Physical Conditions (27 possible) Keyes (2005b) 7 6 5 MDE and Languishing MDE Languishing Moderately Mentally Healthy Flourishing

4 3 2 1 0 Young 25-39 Midlife 40-59 Older 60-74 Mental Health and Illness: Which is Cause and Effect? Change in Adults Mental Health Status: Destinations and Origins Flourishing 1995 Flourishing

2005 19.2% 22.3% Flourishing 50.6% 46.3% 3.1% Moderate Mental Health Languishing 63.6% 17.2%

60.4% 17.3% Moderate Mental Health Languishing Change in Adults Mental Health Status: Destinations and Origins Moderate Mental Health 1995 Flourishing 2005 19.2% 22.3%

Flourishing 18.6% Moderate Mental Health 63.6% 67.5% 60.4% Moderate Mental Health 13.9% Languishing 17.2%

17.3% Languishing Change in Adults Mental Health Status: Destinations and Origins Languishing 1995 Flourishing Moderate Mental Health 2005 19.2% 22.3% 63.6%

60.4% Flourishing Moderate Mental Health 4.1% 50.2% 45.7% Languishing 17.2% 17.3% Languishing Adjusted* Odds Ratio of any 2005 Mental

Illness (MDE, GAD or Panic Disorder) by Change in Mental Health Status (Adjusted for Race, Age, Sex, Education, and Total Chronic Physical Illness in 2005) 10 9 8 7.7 7 6 5.5 5 4.5 4

3.8 3.5 3 2.3 2 1.4 1 1 0 Languishing 1995 Languishing 2005 Flourishing or Languishing Moderate MH 1995 Moderate 1995 Languishing MH 2005 2005

Moderate MH 1995 Moderate MH 2005 Flourishing 1995 Languishing or Flourishing 1995 Any Mental Illness Moderate MH Moderate MH Flourishing 2005 1995 2005 1995 Flourishing 2005 Keys to Aging Positive in Terms of Flourishing Mental Health in Middle School and High School Youth in the U.S. (CDS 2002 Data; Keyes, 2006) Languishing 70

65 60 55 50 45 40 35 30 25 20 15 10 5 0 Moderately Mentally Healthy Flourishing 54.5 48.8 45.2 39.9

6 5.6 12 to 14 Year Olds 15 to 18 Year Olds Keys of Aging Successfully Transition into adulthood Socially Engaged Generativity Recognize social contact goals change selectivity Compensate to continue things you love to do Adapt Try to new things as some things are no longer possible

Innovate 4 Things to look out for Loss of purpose in life Loss of social contribution Loss of social interest and coherence Loss of personal growth Why Governments, Public Health and Healthcare Must Change 1. Health is something specific; mental health includes two kinds of happiness Flourishing combines functioning well and feeling good 2. Absence of illness does not mean the presence of health Mental health and illness are on separate continua

3. Presence of mental illness is a burden (yes!); but, the absence of mental health is also a burden 4. The is too much mental illness (yes!); but there is also too little (flourishing) mental health 5. Increase in mental health (flourishing) causes a decrease in odds of mental illness; declines in mental health cause an increase in odds of mental illness Thus, increasing rates of flourishing will reduce mental illness 6. There is a wanting doing gap in public health We say we want health; we only focus on illness and disease Cant get to health through only illness reduction (see points 2-5) 7. What then is the greatest challenge facing our civilization this century and beyond ... presence of illness or the absence of health? It is the absence of health, which increases the risks of onset of illness Salutogenic Healthcare Must Take Priority -- Promote, Maintain, Respond to Early Deviations from, True Health Pathogenic Healthcare Has Its Place -- Cures, Treatments, and Risk Reduction for Illness and Disease

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