November 7, 2012

Q&A, Corey Keyes, sociology professor, Emory University

Posted by: in North America

Our October trend report, “Health & Happiness: Hand in Hand,” examines the idea that happiness is increasingly coming to be seen as a core component of health and wellness. As part of our research, we spoke with Corey Keyes, a sociology professor at Emory University in Atlanta, who believes happiness is not just positive emotions and feeling good but also functioning well. He terms this combination “flourishing” and connects it with better mental and physical health. Keyes’ 2002 article “The Mental Health Continuum” introduced scientifically the concept of flourishing and the diagnosis of positive mental health. He explained some of his key ideas for us and why he believes governments and health care systems should work proactively to promote flourishing.

So does it make sense that “A happier you is a healthier you,” which is a notion that people increasingly seem to be embracing?

The way we’ve been approaching it, happiness is one of the key components of positive mental health. So you can’t separate happiness and health, at least when it comes to mental health.

When it comes to linkages having to do with physical health, the emphasis on emotional happiness is key. There’s a tendency to see [happiness] only one way, and that doesn’t do it justice—that is, as hedonic, as emotional, and only feeling good or seeking pleasure. Gratification and pleasure and all those things are fleeting. Happiness is way more than feeling good, and that’s the point of our work. You see this trend taken up now in positive psychology if you look at the number of articles coming out in the last five years around this different kind of happiness that was championed by Aristotle, which is about seeking to function well, to try to achieve an excellence in the way you live and how you function in life. That was happiness for him. It was about doing, not feeling.

The connections of happiness, both feeling good and functioning well, do have very important things to say about your physical health. It has a lot to do with how long you live as well. The relevance now that we’re moving toward is the realization that if you put your values into the right place, you can actually seek a happiness that’s far more sustainable in terms of how you function in life.

What’s contributing to that shift in how we view sustainable happiness?

There’s a sort of bankruptcy that happens in the same way that you can just pursue things that end up being vacuous. They don’t last. I think you get the sense that people want to hold onto something that’s far more durable in their lives and, as I like to say, tether themselves to something far more meaningful. You see that happening with the Baby Boomer generation, and you see that with the Millennials.

As the Boomers age into the last decades of their lives, they’re prioritizing much more meaning in life. And you see the Millennials saying, “Well, I’m looking out into a world that everyone’s expecting me to outdo my parents, but I don’t see that as possible. The only way I’ll do that is if I sacrifice every hour of sleep and try to get all A’s in college and go to the best schools and then have to pay back $150,000 in school debt and get the big house and the great job and have little time for my family.”

Do you think happiness is more important to people now than it was 5, 10 years ago?

It is in some respects. I get the sense that people prioritize it. Even parents, when you ask them what the top two aspirations for their children are—this is a study of midlife parents sending their kids off to college—both fathers and mothers said the top two things were education and happiness. But I don’t think our ordinary lives, our daily lives, nudge us to prioritize [happiness] in the way we carry out our work and our lives right now. So I see a huge disconnect.

Lots of us are arguing we need to move in the well-being direction because there are good public health reasons, but getting our health care system to even talk about more than just insurance coverage is a monumental undertaking. But it’s one we have to move toward because it’s all about preventing the things we can prevent because we have no fixes. And mental illness is one of those. We published a study two years ago showing that if you promote flourishing—which is a combination of feeling good and functioning well—you can prevent mental illness. So there’s lots of evidence to say that the government and public health needs to prioritize this and enable people to live this in their workplace and their community and their schools, but we’re a long way away from that.

Do you think governments will start to see well-being and happiness as a public health concern?

They are. I’ve worked for the last five years with the Public Health Agency of Canada, and they have what is called the Strategic Innovations Branch. Their first step was promoting positive mental health flourishing in order to prevent mental illness. Statistics Canada just released data from their annual survey, and they found over 70 percent of Canadians are flourishing. Compare that to the Netherlands, where we did a population study, and no more than 35 percent of adults were flourishing. We’ve done a major study of college students here in the U.S., and we can’t find more than half bursting in life.

What Canada did was fund nine projects in every province to the tune of over $2 million, each for five years, to engage in research that took on at-risk populations. So governments are doing this. We in the States are not. Canada is way ahead of everyone, and lots of people are talking about it in Australia, New Zealand, the U.K.

Could you talk a bit more about flourishing and why you use that precise word?

When I was involved with positive psychology in the very beginning, I was the only sociologist. And my interest was to take on some serious population health issues. One of the most serious and unappreciated is mental illness. Depression in and of itself is the single most problematic worldwide condition, and in 20 years it’s projected by the World Health Organization to be the leading cause of burden to every country if we don’t change what we’re doing.

I didn’t want to just go around promoting happiness for the sake of it. So I started doing a lot of reading, and when you look at the way in which people have approached well-being, there’s been two traditions that map beautifully the ancient Greek debates about happiness. The Greeks had two camps. One championed hedonism. That wasn’t a bad word—it was about pursuing pleasure or emotional well-being. The other was Aristotle’s camp, which said, no, it’s not about feeling good first, it’s about achieving excellence in the way you live your life, functioning well.

I devised a scale [to measure depression] that measures 14 signs and symptoms that map onto feeling good, feeling sad, having interest in life, and the rest measure functioning well. And you have to have one from emotional well-being combined with 6 out of the 11 positive functioning every day or almost every day in the past month to be flourishing. “Flourishing” was meant as a placeholder for “mental health,” but you can’t use the words “mental health” because everyone thinks you’re talking about either mental illness or merely the absence. I chose that term precisely to connote that we are talking about mental health as the presence of the combination of two kinds of well-being.

How do you see the role of positive psychology in all this?

I remember being at a meeting and introducing my work in 1999, and the reaction was that they were not comfortable with the way I was mixing up the positive with illness. See, I never wanted to separate the positive mental health to the understanding of mental illness. And, second, it was clear that they wanted to focus on emotions. There’s a lot we need to know and understand about emotions, but if feelings are our only comforts in life, not values and functioning well, I think we present a rather narrow view of humanity.

If you looked at the literature on mortality, all it focused on was how positive emotions protect against mortality. But we would show that there are lots of people who feel really good about life, but if you look at the flourishing criteria, functioning well, they don’t even come close. Even in America, 38 percent feel good about a life in which they’re not functioning well. Those people have twice the rate of mental illness as those who feel good about a life in which they meet the criteria for flourishing and functioning well. We just published a paper on mortality in the American Journal of Public Health showing it’s not positive emotions that are protecting against mortality, it’s the combination of feeling good with functioning well. So we have been trying to push the field, argue with them, to say stop thinking all the benefits are coming from feelings, emotions. There’s a lot of benefit that comes from having purpose in life, a sense of contribution, integration, autonomy, all the things that go into flourishing in terms of functioning.

So you start to see positive psychology move in this direction. We have got to find a way to help people function well in society, because lots of people can adapt emotionally to some of the worst circumstances—it’s great that we can do that, but it doesn’t mean we’re living a good life.

You mentioned you’ve just done some research into happiness and the connection to longevity?

There are 11 signs or symptoms of functioning well [in Keyes’ system]. And we measured this in a big national study of U.S. adults in 1995 and followed up 10 years later. These were adults between 25 and 74. What we saw was that flourishing—that is, the combination of feeling good and functioning well—was a predictor of death over that 10-year period, net or independent of things like AIDS, education, race, gender, smoking, diabetes, heart disease, cancer, obesity and exercising. If you were anything less than flourishing, you were at dramatic risk of premature death at all ages, even at the end of life. Flourishing protects against it, for males and females.

This paper is in the November issue of the American Journal of Public Health, and I think this will finally get the attention of the American public health. We focus on death a lot here, and if you can tie things to death, you know, you’ve legitimized something. All the prior studies had only measured emotional well-being. They were claiming, “Feeling good is all good.” We measured all three kinds [of well-being], and when you put feeling good in the equation with psychological well-being, for instance, all the effects of emotional well-being disappeared. So it was all attributable to functioning well. So people will begin to see that as a challenge, especially those who want to champion only feeling good.

Are you seeing more of a prescriptive approach to happiness?

You see more of that in the positive psychology pop literature. There are a lot of good books that have been written by the serious academics, but they end up talking about what they think the research tells you on how to pursue happiness. Again, most of it focuses only on emotional well-being, so it doesn’t present a really complete picture. You do get these prescriptions because it seems to be what helps move books, oddly enough. We’re a nation of “You can’t tell me what to do,” even though we oddly love these books with these prescriptions. I’ve been traveling a good bit, and it’s amazing, other countries, when they hear their government come out with something that says, “This is the thing we ought to be doing,” they’re far more likely to embrace it than to say, “You can’t tell me I shouldn’t smoke,” or “You can’t tell me I should exercise.”

Happiness is “Meet with five people in one week, have a good friend, find flow,” you know? It just isn’t that simple. That works for some people, and it’s part of a whole smorgasbord of things, but ultimately this prescriptive approach will be good in a stalling sense. When it starts to come from a public health perspective, we will begin to move toward what the book Nudge is all about. We’ll try to create a world of choices and things that encourage. It won’t be simply “You have to do this,” but there’s a good way to create a society that enables us to pursue happiness in a genuine way.

You also advocate for a more proactive approach rather than the current reactive one to public health?

We can’t fix our way out of things like mental illness. We’re better off preventing it in the first place.

I see this being the challenge of every nation that undergoes the developmental process. We live longer, but the causes of disease and death shift to chronic things we can’t necessarily fix our way out of. So we use the old system, which was medical, which was all about fixing and repairing to deal with challenges it’s not prepared to deal with. The point of going through that transition [to a developed nation] is to enable more people to add quality to life, not quantity. If you don’t add quality, you’re not going to prevent the things that are causing all kinds of problems to us right now.

China and India are going to go through this right now. The U.K. is doing slightly better [than the U.S.] because after World War II, they had the opportunity to foist on the people the National Health Service, and people embraced it. They love the system, even though they pick at it all the time. The whole point is changing the incentive to saving, not profiting—saving money by preventing, rather than creating more hospitals and treatments for people who have already fallen off the cliff.

Our system is designed to merely be reactive because it’s a business. But we can save money by promoting the very things we want people to have: good health, well-being. That’s where we need to get. If we don’t, the writing’s on the wall. Depression will be causing more problems for nations than cancer, heart disease, anything else.

3 Responses to "Q&A, Corey Keyes, sociology professor, Emory University"

1 | Sage Rainbow

November 13th, 2012 at 3:08 pm

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You analysis and insight confirms decades of research that positive emotions do indeed play a significant role in health and disease. I have worked with my patients with this approach for nearly five decades.

Thank you for your good work.

Sage

2 | Sage Rainbow

November 13th, 2012 at 3:09 pm

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Thank you for your good work.

3 | Janvier Rugira

December 9th, 2012 at 9:36 am

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Thank you for your excellent work in positive psychology, in my recent study I found a very interesting factor that may need to be explored further; among university students, the level of flourishing seems to be higher among the developing nations compared to the levels of flourishing available in the literatures tat I reviewed .

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