Meaning, Measurement, and Implications for Psychotherapy Research

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Special Article

Psychotherapy

and Psyehosomatics Psychother Psychosom 1996;65:14-23

Carol D. Ryff*

Burton Singerb a Department of Psychology.

University of Wisconsin, Madison, Wise., b Office of Population Research,

Princeton University, Princeton, N.J., USA

Psychological Well-Being:

Meaning, Measurement, and Implications for Psychotherapy Research

Key Words Self-acceptance Purpose in life Positive relationships Personal growth Autonomy

Environmental mastery Sociodemographic differences Vulnerability

Resilience Quality of life

Abstract

A model of positive psychological functioning that emerges from diverse domains of theory and philosophy is presented. Six key dimensions of wellness are defined, and empirical research summarizing their empirical translation and sociodemographic correlates is presented. Variations in well-being are explored via studies of discrete life events and enduring human experiences.

Life histories of the psychologically vulnerable and resilient, defined via the cross-classification of depression and well-being, are summarized. Implica

tions of the focus on positive functioning for research on psychotherapy, quali

ty of life, and mind/body linkages are reviewed.

Introduction

Historically, mental health research is dramatically weighted on the side of psychological dysfunction. That is, studies of positive psychological functioning are minus

cule compared to investigations of mental problems. In fact, the meaning of basic terms, such as mental health, are negatively biased - typical usage equates health with the absence o f illness rather than the presence o f wellness.

Such formulations ignore human capacities and needs for flourishing as well as the protective features associated with being well.

This article summarizes the development of a multidi

mensional model of positive psychological functioning and reviews empirical research folllowing from it. The key components of well-being are first presented, with empha

sis given to their theoretical and philosophical underpin

nings. Operational definitions of the six dimensions are provided, and empirical research regarding their mea-

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sûrement properties and sociodemographic correlates is briefly described. Life event and life history studies attempting to explain variations in well-being are also reviewed. Pertinent to psychotherapy research, final sec

tions examine the implications of a focus on well-being for studies of vulnerability to psychological dysfunction, re

covery from psychological disorders (resilience), and the need to expand quality of life indicators to include assess

ment of the positive in people’s lives.

The Meaning and Measurement of Well-Being

An extensive theoretical literature has addressed the meaning of positive psychological functioning. This work includes Maslow’s [1] conception of self-actualization Roger’s [2] view of the fully functioning person, Jung’s [3, 4] formulation of individuation, and Allport’s [5] concep

tion of maturity. A further domain of theory for defining

Carol D. Ryff. PhD Institute of Aging 2245 Medical Sciences Center

1300 University Avenue

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psychological well-being comes from life-span develop

mental perspectives, which emphasize the differing chal

lenges confronted at various phases of the life cycle.

Included here are Erikson’s [6] psychosocial stage model, Buhler’s [7, 8] basic life tendencies that work toward the fulfillment of life and Neugarten’s [9, 10] descriptions of personality change in adulthood and old age. Jahoda’s [11] positive criteria of mental health, generated to re

place definitions of well-being as the absence of illness, also offer extensive descriptions of what it means to be in good psychological health.

When one reviews the characteristics of well-being described in these formulations [12], it becomes apparent that many theorists were writing about similar features of positive psychological functioning. These points of con

vergence in the prior theories constitute the core dimen

sions of the model of well-being pursued in the following program of research. Each dimension is briefly described below.

Self-Acceptance. The most recurrent criterion of well

being evident in the previous perspectives is the individu

al’s sense of self-acceptance. This is defined as a central feature of mental health as well as characteristic of self- actualization, optimal functioning, and maturity. Life

span theories also emphasize acceptance of one’s self and one’s past life. Thus, holding positive attitudes toward oneself emerges as a central characteristic of positive psy

chological functioning.

Positive Relations with Others. Many of the preceding theories emphasize the importance of warm, trusting interpersonal relations. The ability to love is viewed as a central component of mental health. Self-actualizers are described as having strong feelings of empathy and affec- ton for all human beings and as being capable of greater love, deeper friendship, and more complete identification with others. Warm relating to others is posed as a criterion of maturity. Adult developmental stage theories also em

phasize the achievement of close unions with others (inti

macy) and the guidance and direction of others (genera- tivity). Thus, the importance of positive relations with others is repeatedly stressed in conceptions of psychologi

cal well-being.

Autonomy. There is considerable emphasis in the prior literature on such qualities as self-determination, inde

pendence, and the regulation of behavior from within.

Self-actualizers are described as showing autonomous functioning and resistance to enculturation. The fully functioning person is described as having an internal locus of evaluation, whereby one does not look to others for approval, but evaluates oneself by personal standards.

Psychological Well-Being: Meaning, Measurement, and Implications for

Individuation is seen to involve a deliverance from con

vention, in which the person no longer clings to the collec

tive fears, beliefs, and laws of the masses. The process of turning inward in the later years is also seen by life-span developmentalists to give the person a sense of freedom from the norms governing everyday life.

Environmental Mastery. The individual’s ability to choose or create environments suitable to his or her psy

chic conditions is defined as a characteristic of mental health. Maturity is seen to require participation in a sig

nificant sphere of activity outside of oneself. Life-span development is described as requiring the ability to ma

nipulate and control complex environments. These theo

ries emphasize one’s ability to advance in the world and change it creatively through physical or mental activities.

Successful aging also emphasizes the extent to which the individual takes advantage of environmental opportuni

ties. These combined perspectives suggest that active par

ticipation in and mastery of the environment are key ingredients in an integrated framework of positive psy

chological functioning.

Purpose in Life. Mental health is defined to include beliefs that give one the feeling that there is purpose and meaning to life. The definition of maturity also empha

sizes clear comprehension of life’s purpose, a sense of directedness, and intentionality. The life-span develop

ment theories refer to a variety of changing purposes or goals in life, such as being productive and creative or achieving emotional integration in later life. Thus, one who functions positively has goals, intentions, and a sense of direction, all of which contribute to the feeling that life is meaningful.

Personal Growth. Optimal psychological functioning requires not only that one achieve the prior characteris

tics, but also that one continue to develop one’s potential, to grow and expand as a person. The need to actualize oneself and realize one’s potential is central to clinical perspectives on personal growth. Openness to experience, for example, is a key characteristic of the fully functioning person. Such an individual is continually developing, rather than achieving a fixed state wherein all problems are solved. Life-span theories also give explicit emphasis to continued growth and to facing new challenges to tasks at different periods of life. Thus, continued growth and self-realization are prominent themes in the aforemen

tioned theories.

In sum, the integration of mental health, clinical, and life-span developmental theories points to multiple con

verging aspects of positive psychological functioning.

Conceptually, these criteria are distinct from prominent

Psychothcr Psychosom 1996,65:14-23 15

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empirical indicators of well-being such as happiness and life satisfaction [13, 14], most of which lack theoretical foundation. There are, however, notable parallels between the formulation of wellness emerging from the literature and philosophical perspectives on the meaning of ‘the good life’ [15]. Diverse philosophical frameworks give emphasis to the individual’s potential to choose and then carry out projects that are valuable; that is, to have active pursuits that give life dignity [16-18], akin to the above formulation of a purpose in life. Mastery is also evident in philosophical descriptions of self-command, which in

volve decision-making and taking action. Ideas of self- love, self-esteem, and self-respect are also evident in lists of criterial goods [16], showing parallels to self-accep

tance. Philosophical writing about benevolence, involving the concern and affection one feels for others [16], com

panionship [18], love [17], and deep personal relations [19] underscore the importance of positive relations with others. The dimension of personal growth parallels Aristo

telian conceptions of human excellence, human flourish

ing, and the realization of one’s true potential [20], Eudai- monistic accounts of ethics and the good life [21 ] point, in fact, to the imperative to know onself (one’s daimon) and to choose to turn it, as completely as possible, from an ideal to an actuality. Finally, philosophers emphasize a focus on whole lives, that is, the importance of looking at all aspects of an individual’s life through time - an argu

ment elaborated in a long succession of texts on the histo

ry of ethics [16].

Definitions of the good life that emphasize happiness, pleasure, and satisfaction (more hedonistic and epicurean views) have been criticized by philosophers, using well- known historical figures who experienced pleasure in their lives, but were so unjust, evil, or pointless in the pur

suit of their lives as to preclude a description of being good. Alternatively, other historical figures led desolate lives in terms of personal well-being, but were nonetheless profoundly noble, creative, courageous, self-sacrificial [16]. John Stuart Mill [22] extends the critique of happi

ness, arguing that it is not to be attained if made an end in itself. It is rather a byproduct of other pursuits - ‘Those only are happy who have their minds fixed on some object other than their own happiness, on the happiness of oth

ers, on the improvement of mankind, even on some art or pursuit, followed not as a means, but as itself in ideal end.

Aiming thus at something else, they find happiness by the way [p. 115].

Taken together, these many lines of philosophical and scientific inquiry converge in their depiction of the good and healthy life as one that involves processes of setting

and pursuing goals, attempting to realize one’s potential, experiencing deep connections to others, managing sur

rounding demands and opportunities, exercising self- direction, and possessing positive self-regard. We posit that such features of human wellness are not culture- bound, although their phenotypic forms (i.e., how pur

pose is expressed), and the relative emphasis given to dif

ferent components, may be quite varied. Life purpose in Africa, as we have described elsewhere [15], may be expressed with a focus on maintaining the social order, in contrast to more individualized pursuits in our own con

text. Similarly, people everywhere have abiding needs for deep, meaningful connections to others, although external manifestations of these social ties may vary from expres

sions of obligation and responsibility to experiences of companionship, intimacy, and love.

Empirical Translation

Scale Construction and Evaluation. Self-descriptive items were generated to operationalize both high and low scorers for each of the six dimensions of psychological well-being (table 1). Extensive item analyses were con

ducted to refine the final measurement scales [23], The 20-item parent scales demonstrate high internal consis

tency reliability (alpha range = 0.86-0.93) and temporal reliability (test-retest coefficients range from 0.81 to 0.88). The scales also correlated modestly and positively with existing measures of positive functioning (e.g. life satisfaction, affect balance, self-esteem, internal control) and negatively with extant measures of negative function

ing (e.g. depression, powerful others, control, chance con

trol), thereby demonstrating convergent and discriminant validity. Recent data from a national probability sample [24], using a dramatically reduced version of the well

being scales, supported, via confirmatory factor analyses, the hypothesized six-factor structure.

Among the many descriptive questions that can be asked about well-being, we have addressed whether pro

files of positive functioning vary' across the life course, whether men and women differ in basic dimensions of wellness, and whether well-being varies by social class sta

tus and across cultures.

Age Differences. To explore differences, we have asked young, middle-aged and old adults to rate themselves on each of the dimensions of well-being [23, 25, 26]. Ratings from the original validation study revealed a diverse pat

tern of cross-sectional differences (see top half of fig. 1).

Certain aspects of well-being, such as environmental mas-

16 Psychothcr Psychosom 1996;65:14-23 Ryff/Singer

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Table 1. Definitions of theory-guided dimensions of well-being

Self-acceptance

High scorer Possesses a positive attitude toward the self; acknowl

edges and accepts multiple aspects of self including good and bad qualities; feels positive about past life Low scorer Feels dissatisfied with self; is disappointed with what

has occurred in past life; is troubled about certain per

sonal qualities; wishes to be different than what he or she is

Positive relations with others

High scorer Has warm, satisfying, trusting relationships with oth

ers; is concerned about the welfare of others; capable of strong empathy, affection, and intimacy; understands give and take of human relationships

Low scorer Has few close, trusting relationships with others; finds it difficult to be warm. open, and concerned about oth

ers; is isolated and frustrated in interpersonal relation

ships; not willing to make compromises to sustain important ties with others

Autonomy

High scorer Is self-determining and independent; able to resist social pressures to think and act in certain ways; regu

lates behavior from within; evaluates self by personal standards

Low scorer Is concerned about the expectations and evaluations of others; relies on judgments of others to make impor

tant decisions; conforms to social pressures to think and act in certain ways

Environmental mastery

High scorer Has a sense of mastery and competence in managing the environment; controls complex array of external activities; makes effective use of surrounding opportu

nities; able to choose or create contexts suitable to per

sonal needs and values

Low scorer Has difficulty managing everyday affairs; feels unable to change or improve surrounding context; is unaware of surrounding opportunities; lacks sense of control over external world

Purpose in life

High scorer Has goals in life and a sense of dircctedness; feels there is meaning to present and past life; holds beliefs that give life purpose; has aims and objectives for living Low scorer Lacks a sense of meaning in life; has few goals or aims,

lacks sense of direction; does not see purpose in past life; has no outlooks or beliefs that give life meaning Personal growth

High scorer Has a feeling of continued development; sees self as growing and expanding; is open to new experiences;

has sense of realizing his or her potential; sees im

provement in self and behavior over time; is changing in ways that reflect more self-knowledge and effective

ness

Low scorer Has a sense of personal stagnation; lack sense of improvement or expansion over time; feels bored and uninterested with life; feels unable to develop new atti

tudes or behaviors

Fig. 1. Significant age differences in the validation (a) and national (b) samples. Dimensions of well-being: □ = Positive rela

tions; A = personal growth; A = purpose in life; • = environmental mastery; O = autonomy.

tery and autonomy, showed incremental patterns with age, particularly from young adulthood to midlife. Other aspects, such as personal growth and purpose in life, showed décrémentai patterns, especially from midlife to old age. Still other aspects, notably positive relations with others and self-acceptance, showed no significant age dif

ferences across the three age periods and thus are not shown in the figure. Initial samples were based on com

munity volunteers, and as such, lacked generalizability.

Data from a probability sample [24] further underscore the consistency of the cross-sectional age patterns (see lower portion of fig. I ). Environmental mastery continued to show incremental patterns with age, purpose in life and personal growth showed declines with aging, and self

acceptance revealed no age differences. For self-ratings of

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autonomy and positive relations with others, the results across studies varied between no differences and incre

mental age patterns.

Longitudinal studies are needed to clarify whether these age patterns reflect developmental changes or co

hort differences. Whatever the explanation, the recurring reports of lower self-ratings among older adults on pur

pose in life and personal growth warrants attention. These patterns point to possibly important psychological chal

lenges of later life, and related arguments that contempo

rary social structures lag behind the added years of life many people now enjoy. That is, opportunities for contin

ued growth and development and for meaningful experi

ence may be limited for current cohorts of older persons.

An alternative hypothesis is that older persons place less value on personal growth and purpose in life than younger age groups. We have also had respondents rate their ideals of well-being, and these data challenge the notion that the aged no longer idealize continued self-development or purposeful living.

Sex Differences. Across multiple datasets, we have found that women of all ages consistently rate themselves higher on positive relations with others than do men, and that women tend to score higher than men on personal growth. The remaining four aspects of psychological well

being have consistently shown no significant differences between men and women [25]. These findings are particu

larly relevant in light of prior mental health research, which repeatedly documents a higher incidence of certain psychological problems such as depression among women [27], When the positive end of the mental health spectrum is considered, however, women are shown to have greater psychological strength compared to men in certain aspects of well-being, and comparable profiles with regard to oth

er dimensions. To miss these findings is to tell an incom

plete story about the mental health of women.

Class Differences. Whether socioeconomic status, typi

cally defined in terms of education, income, and occupa

tional standing, is linked with profiles of psychological well-being has been examined in the Wisconsin Longitu

dinal Study of educational and occupational attainment.

Based on a sample of midlife adults who have been fol

lowed since their senior year in high school, the research shows higher profiles of well-being for those with higher educational attainment [28], with differences particularly evident for the dimensions of purpose in life and personal growth (for both men and women). Education remains strongly linked with well-being, even after controlling for prior life history variables (e.g., high school IQ; parental education, income, and occupational status). Higher well

being is also evident for those with higher occupational status [29], Findings from The National Survey of Fami

lies and Households, a nationally representative US sam

ple, also show large education differences on all six mea

sures of well-being [30]. Viewed from the perspective of the growing scientific literature that links social class standing to health, these findings indicate that lower posi

tions in the social order not only increase the likelihood of negative health outcomes, they also decrease the likeli

hood of positive well-being [31]. We submit that the pres

ence of these goods in life affords important protective factors in the face of stress, challenge, and adversity, and for those lacking such goods, creates vulnerabilities.

Cultural Differences. How culture bears on fundamen

tal conceptions of self, self-in-relation-to-others, and health is an increasingly prevalent theme in social scien

tific inquiry [28].

Much discussion involves contrasts between individu- alistic/independent cultures with those that are more col- lectivistic/interdependent. These ideas suggest that more self-oriented aspects of well-being, such as self-acceptance or autonomy, may have greater salience in Western cul

tural contexts, while others-oriented dimensions of well

being, such as positive relations with others, might be of greater significance in Eastern, interdependent cultures.

To examine these issues, self-reported psychological well

being was investigated in a midlife sample of US adults and a sociodemographically comparable sample of adults from South Korea [33].

It was found that, on the whole, Americans were much more likely to see positive qualities in themselves than Koreans, a finding consistent with formulations of un

derlying cultural variation in self-presentation (i.e., ten

dencies toward modesty in the East, proclivities for hono

rific self-evaluation in the West). Despite these main effects of culture, analyses within cultures revealed that Koreans, as predicted, showed highest self-ratings on the measure of positive relations with others, and lowest rat

ings for self-acceptance and personal growth. Among US respondents, personal growth was rated highest, especially for women, while autonomy, contrary to the purported emphasis on self-determination in our own culture, was rated lowest. Sex differences were the same in both cul

tures - women rated themselves significantly higher than men on positive relations with others and personal growth. Supportive of cultural similarities in basic fea

tures of wellness, qualitative data revealed themes of self

hood (e.g., self-realization, self-knowledge, self-reliance) as well as connection to others (e.g., faithfulness, responsi

bility, kindness, trust) in both Korean and US responses.

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Understanding Variations in Well-Being

The above sociodemographic profiles point to social structural variations in psychological well-being. Prior research on subjective well-being [14] suggests that these broad factors, even in combination, rarely account for more than 10% of the variance in reports of happiness and life satisfaction. We propose that understanding who does and does not possess high well-being requires closer examination of the actual substance of people’s lives, that is, their life experiences. The findings from two avenues of empirical inquiry are briefly summarized. The first per

tains to studies of particular life events or experiences and their effects on well-being. The second addresses more complex life history analyses, and how they have been linked with psychological vulnerability and resilience.

Life Event/Experience Studies. In a series of studies, we have investigated life experiences, and individuals’

interpretations of these experiences, as key influences on psychological well-being [34-40], The experiences range from the having and raising of children, to growing up with an alcoholic parent, to health problems and reloca

tion experiences in later life. These experiences vary by their location in the life course, by the nature of the chal

lenge or task posed, and by their typicality (whether the experience is shared by many or few). Our formulation of how experiences are interpreted draws extensively on social psychological theory. For example, we are inter

ested in how people make sense of their life experiences by comparing themselves with others (social comparison processes), by evaluating the feedback they perceive from significant others (reflected appraisals), by their under

standing of the causes of their experiences (attributional processes), and by the importance they attach to such experiences (psychological centrality). Specific hypothe

ses regarding the influence of these interpretive processes on well-being outcomes are detailed in each study.

Collectively, these investigations demonstrate that life experiences and how they are interpreted provide useful avenues for understanding human variations in well

being. The research on midlife parenting shows, for exam

ple, that considerable variance in adults’ environmental mastery, purpose in life, self-acceptance, and depression is accounted for by parents’ perceptions of how their grown children have 'turned out’ and how these children compare with themselves. In later life, we have found that the physical health problems of aging women, combined with their assessments of how they compare with other older women, explain substantial variation in reports of personal growth, positive relations with others, autono

my, depression, and anxiety. Importantly, this work shows that older women in poor physical health who engage in positive social comparison processes, have com

parable psychological well-being to that of women in good physical health. Our longitudinal research on community relocation among aging women shows how changes in central features of the self-concept can enhance well-being during a life transition. Thus, multiple experiences and diverse avenues for interpreting them point to gains or losses in psychological well-being through time.

Life History Agenda: Pathways to Vulnerability and Resilience. The above works focus on particular life events or experiences and how they influence well-being.

Individual’s lives are, however, a composite of many events and experiences. To capture this richer, more com

plex set of antecedents, we are currently conducting life history research with the members of the Wisconsin Lon

gitudinal Study (WLS). We approach the life histories from the perspective of the limited differences theory [41], which emphasizes the events to which individuals are exposed over their lives and their reactions to these events. Over short time intervals, events and reactions to them produce small, or limited, differences in outcome measures. Such small differences tend to accumulate, however, and over the life course, these cumulative effects can substantially influence mental health.

We elaborate and extend these conceptual principles in the WLS [42], Key hypotheses are that: (a) adversity and its cumulation over time have negative metal health con

sequences; (b) advantage and its cumulation over time have positive mental health consequences; (c) reactions to adversity and advantage can heighten or reduce the im

pact of life experiences; (d) position in social hierarchies through time has consequences for mental health, and (e) social relationships can heighten or reduce the impact of life experiences and enduring conditions. The life histo

ry data to which we apply these principles consist of 36 years of information regarding the respondents’ family background, intelligence, adolescent aspirations and re

sources, education and training, job characteristics, mar

riage and parenting, social support and social participa

tion, health and health-related behaviors, social compari

sons, and acute events.

Using the above conceptual guides, we examine the life histories of four specific mental health groups that emerge from the cross classification of positive and negative men

tal health indicators. The depressed/unwell are those with prior episode(s) of major depression who also lack high psychological well-being (across the six dimensions). The healthy are those with high levels of well-being and who

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have no history of depression. The resilient are individu

als with a prior history of depression, but who report high current well-being. The vulnerable arc those with no histo

ry of depression and who have low levels of well-being.

Our methodology begins with detailed biographies of individuals and progresses toward a formulation of gener

ic life histories within each of these four groups (as well as separately for men and women) [43]. The central objec

tive of the life history analyses is to understand how a giv

en outcome (e.g., depression, resilience) came about; that is, what particular experiences of adversity, advantage, social position, and so on, are associated with each of the four mental health groups.

Analyses to date have characterized the life histories of vulnerable men and resilient women [44]. Vulnerable men are distinguished from other men in the mental health typology by their low starting resources (family background) and persistently high work stress. These cumulative adversity factors are not offset by the presence of significant advantage experiences. With regard to so

cial orderings, these men tend to lack post high school education, are in consistently low-status jobs, and have low perceived success about their own lives. Finally, they tend to have little closeness with a spouse or confidante and have experienced conflictual relationships (some

times because of drinking). Such profiles of negative cumulative experience provide a partial explanation for the men’s lack of positive well-being in midlife. We pro

pose that the absence of positive ‘goods’ in these men’s lives creates in them a vulnerability to possible future adversities, particularly those associated with aging pro

cesses. We will test such ideas as their mental and physical health is tracked through the transition to old age.

Resilient women have lives that also include adversity, typically growing up with an alcoholic parent or exper

iencing early family deaths, but these women possess important factors of advantage (high IQ, high grades in high school, good physical health). With regard to social orderings, many have experienced upward mobility in the workplace and tend to have supervisory work status.

Their social relationships are also frequently character

ized by closeness with a spouse or confidante as well as high participation in social organizations. We propose that the presence of these positive work and relational experiences have contributed to their high profiles of life purpose, mastery, growth, and quality connections to oth

ers. Further, we predict that such features of well-being will offer important protective resources as these women confront the vicissitudes of growing old.

While not described here, we emphasize that our life history analyses elaborate within-group variability (e.g., different routes to resilience) as well as between-group dif

ferences (e.g., how life histories of the healthy and vulner

able differ from those of the resilient). The larger aim is to utilize the tensions created by working simultaneously with thickly described, finely nuanced details of individu

al lives and thinner, less textured summaries of groups of lives. Other dialectics are embodied in the general ap

proach as well, such as our efforts to work inductively up from the life history data and deductively down from the guiding principles, and back and forth between qualita

tive and quantitative data sources. These combined strat

egies, we believe, advance understanding of the diverse human pathways to psychological well-being, depression, resilience, and vulnerability.

Implications for Psychotherapy Research

What are the implications of the above program of research on largely healthy community and national sam

ples for the study and treatment of mental disorders in clinical populations? Does the study of wellness offer any

thing of merit to those attempting to alleviate psychologi

cal distress and dysfunction? We propose four avenues of linkage. A first point pertains to the evaluation o f treat

ments, be they pharmacological or psychotherapeutic, for mental problems. To determine the effectiveness of such interventions, researchers often assess quality of life. Cur

rent and evolving indicators of quality of life [45,46] give emphasis to patients’ self-reported problems or com

plaints across multiple domains (physical, cognitive, af

fective, social, economic). Much less attention is paid to their self-reported strengths or gains. Understanding the presence of the positive in patients’ lives provides a more complete picture of their overall functioning, and thereby, a more comprehensive analysis of treatment effective

ness. Interventions that bring the person out of negative functioning into a neutral position are one form of suc

cess. Facilitating progressions toward restoration o f the positive (e.g., possessing mastery, self-regard, purpose,

quality relations) is quite another.

Second, knowledge of psychological well-being pro

vides insight and direction regarding the factors that influence the occurrence o f mental disorders. Etiologically speaking, most formulations include both genetic and enviromental influences. The latter are frequently con

strued in terms of life stresses in the workplace, the home, the neighborhood, or community. An underlying assump

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tion is that the presence of such adversity is part of what contributes to the incidence of depression, anxiety, and other disorders. Recognition of the positive in human experience suggests another etiological route: that the absence o f goods in people’s lives may also affect why they become despondent about their lives. Viewed in this light, the explanatory task is broadened to encompass how the presence of the negative as well as the absence of the posi

tive work together to influence mental health.

Such a dual emphasis has further implications for understanding recovery from psychological dysfunction [47], Feelings of mastery and self-regard, the possession of quality relations with others, the capacity to set goals for living, and a sense of self-realization may play critical roles in the process of regaining mental health. Again, the message is that the route to recovery is not exclusively about alleviating the negative, but about engendering the positive. It may be the appearance (or reappearance) of such salubrious goods in life that provides a critical impe

tus in the capacity to rebound from distress. Recognition of these pluses may also define important protective fac

tors in the face of future challenges and adversity.

Our life history studies give emphasis to understanding the cumulation o f adversity and advantage experiences from the distant past. Psychotherapy, particularly in the psychoanalytic tradition, emphasizes the need to examine critical experiences from early childhood, although the focus is primarily on negative, traumatic events. We pro

pose that there is much to be gained in therapeutic con

texts from investigating lives of the mentally healthy and the resilient. Our data show that among the healthy are individuals who have experienced considerable adversity over the course of their lives. Understanding the factors that protect them from becoming physically or mentally ill provides critical preventive knowledge. Such factors, we note, are not restricted to early life events, nor are they limited to experiences in the family sphere (i.e., adult experiences, including those in work and community con

texts are also relevant). The lives of the resilient convey further important information about factors involved in the recovery from depression. In sum, life history data about the healthy, the distressed, and those who traverse both realms over the course of their lives enriches think

ing about relevant influences and targets in the treatment of mental illness.

Future Studies of Well-Being:

The Connection of Mind and Body

A final implication of the study of well-being is that knowledge of positive mental health poses new directions for age-old quandaries about how the mind and body are connected. Existing knowledge of physical health, like mental health, is dramatically skewed toward the nega

tive, focusing almost entirely on indicators of disease, chronic conditions, functional impairment, and general dysfunction. Building on theoretical and empirical work summarized herein, we reconfigure the meaning of posi

tive human health and suggest new scientific agendas regarding the physiological substrates of human flourish

ing [15]. The challenge in such future inquiries is to map the biochemical and neurophysiological underpinnings of positive mental states; that is, what occurs in the body when the mind is actively engaged in meaningful pursuits, quality relationships, and salubrious self-regard.

Animal and human literature on stress demonstrates extensive links of mental perceptions and behavioral responses to stress with physiological and biochemical processes, and ultimately neuroendocrine, immune and autonomic systems tied to disease outcomes [42]. McEw- en and Stellar [48] propose, for example, that a high ‘allo- static load’ (i.e., the strain on multiple organs and tissues resulting from repeated fluctuations in physiological re

sponse to perceived threat) leads to organ-system break

down, compromised immune response, elevated cortisol and insulin secretion, and thereby to disease. The impact of stress on biological function is not, however, explained in strictly physical terms, but involves emotions, thoughts, and an array of psychological factors. Mood states associated with depression illustrate this linkage via dysrégulation of the pituitary-adrenal system and chroni

cally elevated levels of glucocorticoids in the blood [49].

Generally missing in this prior literature is the positive counterpoint in mind/body research, although there are glimmers in the direction of beneficial connections. For example, while overshadowed by the pervasive focus on negative emotions and immune responsiveness, there is a growing body of work on positive emotions and immune modulation [50], Included are studies that demonstrate links between positive feelings and spontaneous remis

sions of cancers, intensive daily meditation and regres

sion of metastatic sarcomas, positive life outlooks and wound healing, quality social relationships and increased survival from cancer. Such investigations underscore the power of positive beliefs, emotions, and relationships in recovery from physical health challenges.

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Positive experience, we assert, plays further, perhaps more important roles in protecting and enhancing the integrity of the organism. Optimal human functioning, embodied by individuals who lead lives of purpose, pos

sess deeply felt and meaningful ties to others, exercise mastery over their environments, engage and realize their true capacities, has, in short, its own biological underpin

nings. These are the least understood of the mind/body connections, but again there are hopeful signs on the hori

zon. Research on the transformation from rural to urban industrial society indicates that a purpose in life, stable social relations and social position, and individual moti

vation provide protection against excessive neuroendo

crine response [51]. While such radical social changes dis

rupt familiar environments and pose new demands, those with positive social and psychological assets are buffered against emotional upheavals and ensuing neuroendocrine disturbances involving release of catecholamines, orcorti- coids, or both, that may eventuate in cardiovascular and coronary heart disease.

The benefits of social assets also appear in church societies such as monastic orders and other religious groups showing a lower incidence of coronary heart dis

ease. The stable, orderly life of these societies successfully blunts potentially harmful psychosocial stimuli, thereby maintaining the intensity of neuroendocrine responses below levels that would lead to pathophysiologic change [52], Meditation and prayer activities play further physio

logically protective roles by leading to reduced oxygen consumption, heart rate, and blood pressure, all conse

quences of reduced activity of the sympathetic nervous systems. Interestingly, the incidence of coronary heart dis

ease is much lower in cloistered Benedictine Brothers than in Benedictine Priests who eat the same food at refectory tables (i.e., dietary control) [53]. The Priests’

parochial and teaching duties in a competitive environ

ment were seen to produce Type A persons in Type A environments.

Evolutionary perspectives emphasize the prepro

grammed ‘biogrammar’ that governs flexible behavior used to attain desired goals [54]. This biogrammar is seen as a vital but prerational element of behavior dependent on subcortical structures. The limbic and striatal regions of the brain are the locus for neuronal complexes mediat

ing the emotions and behavior critical for self- and species preservation [55]. These complexes are the result of genet

ically determined wiring and result in the organism engag

ing in territorial and attachment behavior appropriate for the occasion. Illustrating such substrates, neuroendocrine changes associated with the mother’s care of her young

shift abruptly when patterns of the attachment bond are disrupted. In man, attachment behavior persists for years after the young have become self-sufficient and with mod

ifications by symbolism motivates a lifetime of socialized behavior [56].

Positive psychological functioning, exemplified by the acquisition of mastery over the environment, possession of quality relations with others, utilization of innate capa

bilities, etc., represents elaborated versions of complex adaptive behaviors requisite to survival. These latter re

finements, like their evolutionary predecessors (e.g., terri

torial protection, caring for the young), have behavioral components, mental components, and underlying physio

logical profiles. Modern day science provides unprece

dented opportunities thus to map these multiple facets of healthy, adaptive functioning. Viewed from the vantage points of psychiatry and psychotherapy, well-established practice treats mental and behavioral problems with phar

macological agents intended to alter the chemistry of the brain. Mind/body connections, in short, are far from nov

el in the clinical context. What is innovative is the call to shift the treatment focus to that of fostering positive human experience, which sets in motion its own biochem

istry. Quality ties to others, feelings of purpose and self- realization engender unique mind/body spirals, but un

like those in the realm of stress, these move toward protec

tion and enhancement of the organism.

Acknowledgements

This research was supported by the John D. and Catherine T.

MacArthur Foundation Research Network on Successful Midlife Development and a grant from the National Institute on Aging (1R01AG08979) (C.D.R.) and the MacArthur Foundation planning initiative and Socioeconomic Status and Health (B.S.).

22 Psychother Psychosom 1996;65:14-23 Ryff/Singer

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Measurement, and Implications for