Does Psychiatry’s Buzzword “Flourishing” Reflect the Real World?

The construct of “flourishing” may offer promising insights for mental health policy, but what is left out of its conceptualization?

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A new article published in SSM-Mental Health, an international, interdisciplinary mental health journal, offers critical perspectives on what it means to “flourish” mentally and what hinders flourishing in the United States. The authors make the case that the word “flourishing” is understood differently by the public than how it is used in academic, philosophical, and media spaces.

They write, “Before bold efforts to promote flourishing can be justified, we first must ask: Whose definitions of flourishing provide the roadmap? What assumptions undergird these definitions? Whose flourishing are they designed to support?”
They add, “Do scholarly definitions of flourishing resonate with everyday, real-world usages of the term, or are any essential dimensions overlooked, or left out? Above all, we must ask: Are prevailing conceptions of flourishing well-suited to the task of confronting the most urgent problems in current health research, policy, and clinical care—or, alternatively, might they risk leading us astray?”

Illustration depicting wellbeing

In 2021, an article in The New York Times discussed mental health in a new way—on a spectrum from languishing to flourishing. “Flourishing” represented “the peak of well-being.” However, research has shown that when we operationalize words for the sake of meaning-making in mental health, such as resilience, we may be doing more harm than good.

The authors of the current study sought to understand whether The New York Times got flourishing right by conducting an anthropological research project in Cleveland, Ohio. The researchers included Sarah S. Willen, Abigail Fisher Williamson, and William Tootle Jr. from the University of Connecticut, Colleen C. Walsh from Cleveland State University, and Mikayla Hyman, an independent researcher.

First, the team began a critical assessment of the leading conceptions of flourishing in positive psychology and comparing them to the understandings of flourishing in the critical social sciences of health, critical legal theory, bioethics, disability studies, and critical public health. Through this assessment the authors highlight that, of course, “people’s capacity to flourish depends heavily on the circumstances in which they live,” so “any account that limits itself to the psychological domain will necessarily fall short.”

Then the authors support their claim that the concept of flourishing, although an interesting departure from more medicalized understandings of mental wellness, still misses the mark on how everyday individuals understand their own personal wellbeing.

Their mixed-methods study was designed with the aid of Northeastern Ohio’s Health Improvement Partnership-Cuyahoga (HIP-Cuyahoga). The researchers interviewed 80 community members from the Cleveland area. They asked participants if they would describe themselves, personally, as flourishing, as well as what they thought people need, in general, to flourish.

Fifty-one percent of participants said that they were flourishing. Fourteen percent leaned toward flourishing, 15% felt mixed, 4% leaned away from flourishing, and 16% of participants responded that they were not flourishing. Wealthy, white, older, educated women were most likely to respond that they were flourishing.

“The differences by race and socioeconomic status were particularly stark,” the authors note.

Less than half of the Black interviewees reported flourishing, compared with more than two-thirds of their white counterparts.

“In terms of income, 88% of those with a family income over US$100,000 reported flourishing (14/16), compared with less than half of those with family earnings less than US$30,000 per year (46%; 11/24).”

As for the responses as to what people need in order to flourish, two of the most common mentioned factors were a stable income and the social determinants of health.

The authors end the article with the following summation:

“What is surprising—and what we want to emphasize here—is the persistent, and problematic, inattention to these issues in most research on flourishing. From a population health standpoint, there is no doubt that leading approaches to flourishing play an important role in facilitating comparison across large groups, with significant clinical and policy effects. But what do we learn—and what do we miss—when we draw comparisons in the aggregate using indexes that may miss vital aspects of what real people, in real-world settings, view as necessary to flourish? Whose flourishing are existing indexes designed to measure, improve and advance—and whose might be less well captured, or not captured at all?”

 

 

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Willen, S. S., Williamson, A. F., Walsh, C. C., Hyman, M., & Tootle, W. (2022). Rethinking flourishing: Critical insights and qualitative perspectives from the US Midwest. SSM-mental Health, 2, 100057. (Full text)

2 COMMENTS

  1. Apologies for my lengthy comment.

    It is amazing that these authors wrote such a thorough and thoughtful review of flourishing without once using the word “capitalism.”

    Their interviewees named income and social determinants of health (e.g., “access to food, housing, transportation, and education”) as most important to flourishing. We all know that within late-stage capitalist society, incomes have stagnated, inflation has risen, access to the basic necessities of life has grown more scare, and the rich are richer than ever and have designed and control societal structures that maintain the status quo. But the authors discuss these variables and their relationship to flourishing in terms of “health.”

    To their credit, the authors recognize the influence of social conditions on flourishing. They note: “…we cannot ignore the fact that people are—and inevitably will be—hard-pressed to reach their potential in environments of scarcity or risk, oppression, misrecognition, or violence. Without confronting these critical insights head-on, efforts to promote flourishing will inevitably miss the mark.” Alright authors, nice work, keep going, you’re so close to completing the puzzle…but there the story ends without naming the obvious cause of such environments: capitalism.

    This is akin to a group of tenured professors from ecology, zoology, and microbiology describing the ways animals adapt to their environment and change over time, and how some may be better equipped to survive and reproduce than others, without mentioning natural selection or mutation and using the theory of evolution to tie it all together. One could be helped for theorizing the authors avoided doing so on purpose given how obvious was the final piece of the puzzle.

    In his book Sedated, Jamies Davies had the courage lacked by these authors to directly address how late-stage capitalism causes the toxic social conditions that prevent flourishing, then locates lack of flourishing (many examples of which can be found in psychiatry’s DSM) within the individual and labels it as a health problem. The parallels with psychiatry’s biomedical model are obvious.

    Within this paradigm, both flourishing and “mental illness” are fundamentally “health” problems. Sure, they are related to social conditions, but the problem must be ultimately located within the individual. That way, toxic social conditions are mere “contributing factors” to individual-level health problems, and the cause of those social conditions is let off the hook. This same type of thinking has been brilliantly exposed in Mad in America blogs by Phil Hickey. He noted the example of how the Mayo Clinic describes the causes of depression as biogenetic factors like brain chemistry and relegates social conditions like “traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems” as mere “risk factors” (https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007). As with flourishing, environmental factors are “related” to the issue, but the nature of the issue is fundamentally one of the health of the individual, the “cause” of which is located in the person.

    The authors of this article on flourishing are surely smart and informed enough to understand the centrality of capitalism to this area of study. Which makes me wonder why it was not mentioned. The typically correct answer in such circumstances can be found by following the money, or more broadly, the incentives. I have no trouble believing these academics are incentivised to present flourishing as a health issue, heavily “influenced” by social conditions, but not “caused” by them in a manner that capitalism directly produces by design. This is the “third rail” that must not be touched. After all, these authors live in capitalistic societies and risk losing their resources if they question the societal order.

    The problem is, without naming the actual root cause and proposing solutions to address it, nothing changes.

    Want people to flourish? Start by ensuring they can comfortably access the essentials of life (food, housing, education, safety, community, etc.). But capitalism doesn’t do that. And capitalism doesn’t like people (like the authors of this article) saying that in public because if the public knew how badly they were getting screwed, capitalism might be in danger.

    Thought experiment: ask someone living in deep poverty if lack of money necessary to afford the essentials of life is a “contributing factor” or “direct cause” of their failure to flourish. Would they even endorse the idea that they have a problem of “failure to flourish” as opposed to a problem of “having no money”? Does it show privilege for people who have enough money and enjoy good social conditions (like the authors) to view such a person as “not flourishing” as opposed to being screwed by living in a social and economic system that has kicked them to the curb while funnelling society’s wealth to the super-rich and blaming poverty on poor people being lazy and undeserving of the necessities of life?

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