What is wellbeing?

Is wellbeing a subject that can be approached scientifically? The following article is a based on a presentation to the 2012 NZ Skeptics Conference.

Why do we care about truth? Why do we attend conferences on skepticism and promote such ideas? One reason might be the simple beauty of the truth. A second reason might be that it enables us to live better lives. This second reason is particularly evident in skeptical activism challenging health-related pseudoscience and its associated dangers, as addressed in some of the other talks at the 2012 NZ Skeptics Conference. However, no matter what issue we deal with, we generally deal with it better if we see it more accurately.

'Wellbeing' is an overarching term for health and a good life, that is increasingly used in healthcare, education, economics, and government policy. In this article I offer some insight into differences between evidence-based and non-evidence-based models of wellbeing, and where some of the latest science and public policy is heading.

Skepticism about wellbeing and unwellness claims

It is evident from a quick google that health and wellbeing marketing is full of claims lacking in empirical support. Michael Edmonds and others did a great job discussing some of these at last year's conference (see NZ Skeptic 106). Also common though, are evidence-based claims marketed in a non-evidence-based way. I showed two examples at the conference - magazines with some evidence-based content, but with taglines such as "How to get everything done, ALWAYS", and "The most powerful relationship advice, EVER". Of course, in reality if you really did try to achieve 'everything' you will achieve precisely nothing except indecision and disaster - better to choose a small number of achievable tasks and actually achieve them. And what is helpful for a relationship depends on many contextual details; there is no cure-all.

These examples of limited and specific empirical claims being sold in a non-empirical way are unfortunately common and two effects often follow. Firstly, because the advertised expectations are overhyped and impossible to achieve, people can end up self-recriminating over their own failures, and worse off than before. Secondly, it often leads to unhelpful cynicism rather than skepticism, as people can dismiss useful evidence because it has become tarnished by association with aggressive marketing or non-evidence-based ideas. Navigating this web can be complex, though all the usual skeptical skills of checking the source and reliability of the information is helpful.

A healthy dose of skepticism is also helpful when examining more official-looking claims, including some of the most common 'unwellness diagnoses'. There is a concern among many psychologists and psychiatrists that we have overly medicalised normal human function. At the conference I showed an example of an antidepressant advertisement that stated "Depression is a flaw in chemistry not character (call 0800…)". Despite the appearance of a possible attempt at de-stigmatising depression, arguably this approach is ultimately unhelpful. Chemistry, character and culture are three different levels of explanation (bio-, psycho-, and social), which cannot be properly considered except holistically. Character (the set of strengths and skills one possesses) is still chemistry from the level of biological analysis, that takes its form based upon the wider culture in which it develops.

Developing stronger cultural institutions via evidence-based public policy, and teaching stronger character via skills, is an approach with arguably more evidence for many of the wellbeing problems we face. Pills do of course have an important place in clinical practice, but pills don't teach skills. The American Psychological Association has just started an extensive advertising campaign that emphasises this point.

R.A.T.ing Wellbeing?

What is a useful way of understanding wellbeing then? The science is complex, but some generalisations can be made. I often use a model with patients, where I explain human wellbeing as the balancing of three core neural motivational systems, focused respectively upon Resource, Affiliation, and Threat, as shown in Figure 1. These are evolutionarily old systems, but elaborated in humans1,2. The model is of course a simplification, but a useful one.

Figure 1 Here

The resource and competence system motivates us to be involved in activities such as play, learning and work, perceiving the world adaptively, and being able to achieve in it. It is a development of the foraging instinct present in all animals, a drive to acquire knowledge of the environment, food and other resources. Dopamine is an important chemical involved in the physiology of this system. It creates the striving emotions of feeling driven, vital, energetic (and often competitive) that motivate us to pursue these goals.

The affiliation and belonging system motivates us to have sharing and caring relationships with other people, and to care for ourselves also. It is an evolutionary development of the care-giving and fellowship instincts present in other social mammals, encouraging the seeking of social support and co-operation. Oxytocin and opioids are chemicals that create soothing emotions of feeling content, safe and connected, that motivate us to maintain these social bonds.

When successful functioning of resource or affiliation systems are endangered, the threat and autonomy system activates to defend against threats and transcend them, so that free action may continue. It does this using strategies of attacking and overcoming (fight), avoiding and escaping (flight), analysing and problem solving (freeze), or accepting and tolerating the threat (forbearance). Stressing emotions of anger, fear, worry, and sadness motivate these respective responses, and chemicals such as adrenaline, cortisol and serotonin are involved physiologically. Common threats include change, loss, injury, relationship disputes and so on. Stressing emotions are painful, but that is the evolutionary point - they make you pay attention to problems and deal with them.

It is not possible or desirable to completely deactivate the stressing system, because this is necessary for survival. The important factor is whether or not stress response patterns of attack, avoidance, analysis, or acceptance are well matched to the life challenges one faces. Many wellbeing difficulties occur when people become fixed in a mismatched strategy. They might be fighting a lost cause (eg unable to accept a loss), avoiding a challenge they must face (eg too afraid of making a mistake or feeling an unpleasant emotion or sensation), over-analysing an intractable problem (eg requiring certainty in an uncertain world), or accepting something that is unacceptable (eg an abusive situation). Intense and chronic activation of the stress system can cause a range of problems, including immune deficiencies, cognitive impairment, damage to limbic brain regions, increased pain, and general maladjustment3. Individuals with a lack of social affiliation also suffer increased pain and health problems4. Other common wellbeing problems might occur when people focus too much upon striving for achievement at the expense of affiliation and self-care (eg a workaholic) or when they lack sufficiently meaningful competence-related activities (eg a lack of personal growth). These systems are also vulnerable to chemical hijacking, with drugs like methamphetamine and cocaine intensely stimulating the dopamine system, and ecstasy and heroin stimulating the oxytonic and opiate systems, often leading to dependence and seeking of these drugs rather than more sustainable paths to wellbeing.

We need a balance of all three systems for optimal wellbeing, with evidence suggesting a ratio of 3:1 or greater of striving and soothing versus stressing emotions is an adaptive homeostatic state5. As suggested earlier, teaching adaptive skills and having adaptive public policy and culture are effective means towards this goal.

Public Policy and Wellbeing

Research has long shown the limitations of attempting to improve wellbeing via purely financial means6, with benefits appearing to plateau once a fairly minimal level of income is reached (approximately US$15,000). The spectrum of political discourse increasingly recognises the importance of attending to wellbeing in an empirically supported way.

Two recent books7,8 summarise some of the leading scholarship on this issue, where the ultimate goal is increasing the freedoms of individuals to lead lives they have substantive reason to choose. This work also forms the philosophical basis for the societal wellbeing framework, developed over a decade and newly implemented by the New Zealand Treasury in 20129. This framework focuses upon five key areas: (1) economic achievement, (2) macroeconomic stability (3) sustainability of the environment, physical and human resources, (4) social trust and affiliation, and (5) equity of resource distribution. Each domain has one to three key measurement indicators, selected for their simplicity, ready availability and international comparability.

While this New Zealand framework is new and likely to evolve, the move beyond a primary focus upon economic growth is arguably a substantive policy innovation. The framework is assessed independently of political control, but outcomes are dependent upon political policy. It is hoped the framework will create greater public understanding of factors beyond just economic growth that are important to everyone's wellbeing, and bring a more empirically verifiable dimension to politics in New Zealand.

Conclusion

Since 1948, the World Health Organization has defined health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." While there is still much to be learned, scientific understanding of the factors influencing wellbeing has developed a great deal over the intervening decades. Such research was the focus of the first New Zealand Wellbeing and Public Policy conference, held at Victoria University in Wellington in June 2012. The ideas I have presented here are necessarily just a brief introduction to the richness of this research and its application, but hopefully it will encourage some further skeptical inquiry and development of these concepts.

References

1. Deci, E. L., Ryan, R. M. (2000). Psychological Inquiry, 11(4), 227-268.
2. Gilbert, P. (2006). Clin. Neuropsych., 3(2), 139-153.
3. Schneiderman, N., Ironson, G., Siegel, S. D. (2005). Ann. Rev. Clin. Psych., 1, 607-628.
4. Heinrich, L. M., Gullone, E. (2006). Clin. Psych. Rev., 26, 695-718.
5. Fredrickson, B. L., Losada, M. F. (2005). Am. Psychologist, 60(7), 678-686.
6. Easterlin, R. A. (1974). Does economic growth improve the human lot? Some empirical evidence. In P. A. David & M. W. Reder (Eds.), Nations and Households in Economic Growth: Essays in Honour of Moses Abramovitz. New York: Academic Press.
7. Acemoglu, D., Robinson, J. A. (2012). Why nations fail: The origins of power, prosperity, and poverty. New York: Crown Business.
8. Sen, A. (2009). The idea of justice. London: Penguin Books.
9. Karacaoglu, G. (2012). Improving the living standards of New Zealanders: Moving from a framework to implementation www.treasury.govt.nz/publications/media-speeches/speeches/livingstandards