human flourishing - duke university · pdf file“human flourishing is a relatively recent...

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HUMAN FLOURISHING:HUMAN FLOURISHING:An EpidemiologistAn Epidemiologist’’s Perspectives Perspective

Jeff Levin, Ph.D., M.P.H.Jeff Levin, Ph.D., M.P.H.Adjunct Professor of Psychiatry and Behavioral SciencesAdjunct Professor of Psychiatry and Behavioral Sciences

Duke University Medical CenterDuke University Medical CenterDurham, North CarolinaDurham, North Carolina

Closing Plenary Address, Closing Plenary Address, ““Spirituality, Health and Human Flourishing: Spirituality, Health and Human Flourishing: Meaning? Measurement? Implications?,Meaning? Measurement? Implications?,”” 11stst Annual Meeting of the Annual Meeting of the

Society for Spirituality, Theology, and Health, Durham, NC, JuneSociety for Spirituality, Theology, and Health, Durham, NC, June 27, 2008.27, 2008.

OUTLINEOUTLINE1)1) MeaningMeaning

2)2) MeasurementMeasurement

3)3) ImplicationsImplications

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OUTLINEOUTLINE1)1) MeaningMeaning

Origins & usages of HFOrigins & usages of HFDefinitions of HFDefinitions of HF

2)2) MeasurementMeasurementDimensions of HFDimensions of HFResearch on HFResearch on HF

3)3) ImplicationsImplicationsWhatWhat’’s next for the study of HFs next for the study of HF

I. MEANINGI. MEANING

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Limitations of Limitations of ““Exposure Exposure AssessmentAssessment”” in R&H Fieldin R&H FieldLimitations of current usages of Limitations of current usages of religiousnessreligiousness

avoidance of experiential componentsavoidance of experiential components

reductionistic, mostly unidimensionalreductionistic, mostly unidimensional

Limitations of alternatives, e.g. Limitations of alternatives, e.g. spiritualityspiritualitycontextual: unique construction within respective contextual: unique construction within respective faith traditions makes comparative research difficultfaith traditions makes comparative research difficult

What we need in a constructWhat we need in a constructbenefits of benefits of spiritualityspirituality (i.e., broader take on the realm (i.e., broader take on the realm of the human spirit, incl. the domain of experience)of the human spirit, incl. the domain of experience)

without the drawbacks (e.g., incomparability: meaning without the drawbacks (e.g., incomparability: meaning different things to different people)different things to different people)

HUMAN HUMAN FLOURISHINGFLOURISHING

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What is human What is human flourishing?flourishing?

Aristotle on HFAristotle on HFNicomachean EthicsNicomachean Ethics (c. 350 BCE): a (c. 350 BCE): a meditation on what Aristotle termed meditation on what Aristotle termed ““eudaimoniaeudaimonia,,”” which he considered the which he considered the ultimate end or goal of human lifeultimate end or goal of human life

EudaimoniaEudaimonia:: ““happinesshappiness”” (lit. (lit. ““good good spiritspirit””), or sometimes rendered ), or sometimes rendered ““the good the good lifelife””

EudaimoniaEudaimonia ≈≈ character + balance + character + balance + wisdom, in service to the common goodwisdom, in service to the common good

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Components of Components of EudaimoniaEudaimonia

The goodThe goodMorality & virtueMorality & virtueTemperance & courageTemperance & courageVirtues (moderation of appetites) in service of right Virtues (moderation of appetites) in service of right action, to further liberality and to produce people of action, to further liberality and to produce people of magnificence, honor, and tactmagnificence, honor, and tact(Social) justice & reciprocity(Social) justice & reciprocityIntellect & practical wisdom: rationality + intuitionIntellect & practical wisdom: rationality + intuitionPleasure with continence, including life satisfactionPleasure with continence, including life satisfactionFriendship, via good character, good relations with Friendship, via good character, good relations with all, being a good neighborall, being a good neighborSocial & political (legislative) ethicsSocial & political (legislative) ethics

According to Aristotle inAccording to Aristotle in Nicomachean EthicsNicomachean Ethics::

““Human flourishing is a relatively recent Human flourishing is a relatively recent term in ethics. It seems to have developed in term in ethics. It seems to have developed in the last two decades because the traditional the last two decades because the traditional translation of the Greek term translation of the Greek term eudaimoniaeudaimonia as as ““happinesshappiness”” failed to communicate clearly failed to communicate clearly

that that eudaimoniaeudaimonia was an objective good, not was an objective good, not merely a subjective good.merely a subjective good.””

DB Rasmussen, DB Rasmussen, Social Philosophy & PolicySocial Philosophy & Policy 1999; 16(1), Special Issue 1999; 16(1), Special Issue on Human Flourishing, pp. 1on Human Flourishing, pp. 1--2.2.

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Diversity of Philosophical Diversity of Philosophical Perspectives on HFPerspectives on HF

Some philosophers are Some philosophers are teleologicalteleological in orientation, like in orientation, like Aristotle, but differ as to what constitutes HFAristotle, but differ as to what constitutes HF

Others are Others are deontologicaldeontological, but differ as to the virtues , but differ as to the virtues required to achieve HF (e.g., reason, submission to required to achieve HF (e.g., reason, submission to God)God)

Some interpret HF in Some interpret HF in religiousreligious context, others do notcontext, others do not

Some are Some are internally focusedinternally focused, on HF as about self, on HF as about self--actualization; others are actualization; others are externally focusedexternally focused, on HF as , on HF as about acting toward a communal goodabout acting toward a communal good

Contemporary philosophers, too, are all over the map. Contemporary philosophers, too, are all over the map. Good places to start: Charles TaylorGood places to start: Charles Taylor’’s s A Secular AgeA Secular Ageand Alasdair MacIntyreand Alasdair MacIntyre’’s s After VirtueAfter Virtue..

A Tibetan Buddhist A Tibetan Buddhist Perspective on HFPerspective on HF

B. Alan WallaceB. Alan Wallace::EudaimoniaEudaimonia as as ““genuine happiness,genuine happiness,””a life a life ““devoted to the devoted to the pursuit of virtue and pursuit of virtue and understandingunderstanding”” and and productive of productive of ““empathic joy,empathic joy,””““unconditional unconditional compassion,compassion,”” and and ““equanimityequanimity””

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An Integral YogaAn Integral YogaPerspective on HFPerspective on HF

Sri AurobindoSri Aurobindo::LifeLife’’s goals goal: : ““integral realisation of the integral realisation of the Divine BeingDivine Being”” →→ ““integral liberationintegral liberation”” →→““perfect harmony of the results of perfect harmony of the results of Knowledge, Love and Works.Knowledge, Love and Works.””This This ““is of the nature not only of freedom, is of the nature not only of freedom, but of purity, beatitude and perfection. An but of purity, beatitude and perfection. An integral purity which shall enable on the one integral purity which shall enable on the one hand the perfect reflection of the divine hand the perfect reflection of the divine Being in ourselves and on the other the Being in ourselves and on the other the perfect outpouring of its Truth and Law in us perfect outpouring of its Truth and Law in us in the terms of life and through the right in the terms of life and through the right functioning of the complex instrument we functioning of the complex instrument we are in our outer parts, is the condition of an are in our outer parts, is the condition of an integral liberty.integral liberty.””

JewishJewishPerspectives on HFPerspectives on HF

AshreiAshrei:: ““Happy are Happy are those who dwell in Your those who dwell in Your house; they forever house; they forever praise You./Happy the praise You./Happy the people who have it so; people who have it so; happy the people whose happy the people whose God is the Lord.God is the Lord.””(Psalms 84:5, 144:15 (Psalms 84:5, 144:15 [NJPS])[NJPS])

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JewishJewishPerspectives on HFPerspectives on HF

AshreiAshrei:: ““Happy are Happy are those who dwell in Your those who dwell in Your house; they forever house; they forever praise You./Happy the praise You./Happy the people who have it so; people who have it so; happy the people whose happy the people whose God is the Lord.God is the Lord.””(Psalms 84:5, 144:15 (Psalms 84:5, 144:15 [NJPS])[NJPS])

Pirke AvotPirke Avot:: 33--legged legged stool of stool of torahtorah (learning), (learning), avodahavodah (devotion to (devotion to God), and God), and gg’’milut milut chasadimchasadim (acts of (acts of lovingkindess). These lovingkindess). These include include tzedakahtzedakah(justice), (justice), chesedchesed (mercy), (mercy), and and tikkun olamtikkun olam (repair (repair of the world). Together, of the world). Together, these actions produce these actions produce emetemet (truth)(truth), shalom, shalom(peace), and (peace), and dindin (justice).(justice).

A Humanistic Psychology A Humanistic Psychology Perspective on HFPerspective on HF

Abraham MaslowAbraham Maslow::A founder of humanistic A founder of humanistic psychology in the 1950s, psychology in the 1950s, an alternative to the an alternative to the psychodynamic and psychodynamic and behaviorist schools. behaviorist schools. Called it a Called it a ““3rd force3rd force”” or or ““3rd psychology.3rd psychology.””Its goal is HF (Its goal is HF (““human human potentialpotential””). Described a ). Described a ““hierarchy of human hierarchy of human needs,needs,”” identifying basic identifying basic requirements for requirements for flourishing.flourishing.

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A Transpersonal Psychology A Transpersonal Psychology Perspective on HFPerspective on HF

Charles TartCharles Tart::A founder of transpersonal A founder of transpersonal psychology, an outgrowth of psychology, an outgrowth of humanistic psychology in humanistic psychology in the 1970s.the 1970s.Focuses on a nexus of Focuses on a nexus of themes: states of themes: states of consciousness, human consciousness, human potential, spirituality, & potential, spirituality, & transcendence.transcendence.Tart identifies Tart identifies ““awakeningawakening””out of our out of our ““consensus consensus trancetrance”” as a key to fulfilling as a key to fulfilling our potential. Strongly our potential. Strongly influenced by Gurdjieff.influenced by Gurdjieff.

An Integral Psychology An Integral Psychology Perspective on HFPerspective on HF

Ken WilberKen Wilber::A perspective heA perspective he’’s been s been developing since the 1970s.developing since the 1970s.Based on an evolutionary Based on an evolutionary view of consciousness, and view of consciousness, and integrative of themes & integrative of themes & concepts from science, concepts from science, philosophy, and mysticism. philosophy, and mysticism. Thus, Thus, ““more encompassing.more encompassing.””

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An Integral Psychology An Integral Psychology Perspective on HFPerspective on HF

Ken WilberKen Wilber::A perspective heA perspective he’’s been s been developing since the 1970s.developing since the 1970s.Based on an evolutionary Based on an evolutionary view of consciousness, and view of consciousness, and integrative of themes & integrative of themes & concepts from science, concepts from science, philosophy, and mysticism. philosophy, and mysticism. Thus, Thus, ““more encompassing.more encompassing.””

Elliott DacherElliott Dacher::Applies WilberApplies Wilber’’s integral s integral philosophy to medicine. philosophy to medicine. Describes Describes ““integral healthintegral health””as a path to HF.as a path to HF.Integral (Integral (““AesclepianAesclepian””) ) healinghealing: holistic, : holistic, evolutionary, intentional, evolutionary, intentional, personperson--centered, dynamic.centered, dynamic.

A Positive Psychology A Positive Psychology Perspective on HFPerspective on HF

Martin SeligmanMartin Seligman::A founder of positive A founder of positive psychology in the 1990s.psychology in the 1990s.

The study of the The study of the ““essential essential capacities,capacities,”” ““virtues,virtues,”” or or ““classical sources of classical sources of strengthstrength”” that enable that enable personal & communal personal & communal thriving. Resonant with thriving. Resonant with understandings of HF. understandings of HF.

E.g., hope, selfE.g., hope, self--control, control, forgiveness, love, gratitude, forgiveness, love, gratitude, humility, wisdom, humility, wisdom, optimism, spirituality.optimism, spirituality.

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A Positive Psychology A Positive Psychology Perspective on HFPerspective on HF

Martin SeligmanMartin Seligman::A founder of positive A founder of positive psychology in the 1990s.psychology in the 1990s.

The study of the The study of the ““essential essential capacities,capacities,”” ““virtues,virtues,”” or or ““classical sources of classical sources of strengthstrength”” that enable that enable personal & communal personal & communal thriving. Resonant with thriving. Resonant with understandings of HF. understandings of HF.

E.g., hope, selfE.g., hope, self--control, control, forgiveness, love, gratitude, forgiveness, love, gratitude, humility, wisdom, humility, wisdom, optimism, spirituality.optimism, spirituality.

Character Strengths & Character Strengths & Virtues (CSV)Virtues (CSV):: A schema A schema of the positiveof the positive--psychological psychological virtues (a la DSM). Contains virtues (a la DSM). Contains 6 6 ““core virtuescore virtues”” (containing (containing 24 24 ““character strengthscharacter strengths””):):

Wisdom & KnowledgeWisdom & KnowledgeCourageCourageHumanityHumanityJusticeJusticeTemperanceTemperanceTranscendenceTranscendence

Developed by Developed by Christopher Christopher PetersonPeterson (UM)(UM) & Martin & Martin SeligmanSeligman (Penn).(Penn).

Medical Literature on HFMedical Literature on HFKeyes, Keyes, JHSBJHSB (2002)(2002)

HF = presence of mental health = positive feelings + HF = presence of mental health = positive feelings + positive functioning (= social coherence + social positive functioning (= social coherence + social actualization + social integration + social acceptance + actualization + social integration + social acceptance + social contribution); social contribution); ““languishinglanguishing”” = the opposite= the opposite

Kalbian & Shepherd, Kalbian & Shepherd, Am J BioethAm J Bioeth (2003)(2003)HF = function of meaning + happiness, marked by the HF = function of meaning + happiness, marked by the state of our relationships, as indicated by our state of our relationships, as indicated by our engagement of issues related to community & justiceengagement of issues related to community & justice

Frederickson & Losada, Frederickson & Losada, Am PsycholAm Psychol (2005)(2005)HF = life within an optimal range of functioning = HF = life within an optimal range of functioning = goodness + generativity + growth + resilience; goodness + generativity + growth + resilience; ““languishinglanguishing”” = hollowness + emptiness, > just pathology= hollowness + emptiness, > just pathology

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In sum . . .In sum . . .

PhilosophyPhilosophyAristotelian views on Aristotelian views on the good lifethe good life and its characteristicsand its characteristics

Humanistic, transpersonal, & integral psychologyHumanistic, transpersonal, & integral psychologyHolismHolism, , interdependenceinterdependence, , selfself--actualization, integrationactualization, integration

Positive psychologyPositive psychologyThe The virtues:virtues: wisdom, morality, humility, love of otherswisdom, morality, humility, love of othersAffects of Affects of ““positivepositive”” polarity, e.g. polarity, e.g. happinesshappiness

Moral theologyMoral theologyCommunal dimensionCommunal dimension of wellof well--beingbeingCovenantal obligationsCovenantal obligations: wellness contingent on justice, : wellness contingent on justice, compassion, othercompassion, other--regardregard

““Human flourishingHuman flourishing”” resonates with themes in:resonates with themes in:

II. MEASUREMENTII. MEASUREMENT

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What are the What are the dimensions of dimensions of

human human flourishing?flourishing?

Hypothetical Dimensions of Hypothetical Dimensions of Human FlourishingHuman Flourishing

IntegralityIntegralityHolismHolismOtherOther--regardregardVirtuousnessVirtuousnessActualizationActualizationPositive affectPositive affect

Hard to say, as confirmatory psychometric research on HF has Hard to say, as confirmatory psychometric research on HF has not been done. Based on a selective reading of sources.not been done. Based on a selective reading of sources.

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IntegralityIntegrality:: affirmation of interconnectedness affirmation of interconnectedness & interdependence of all life, of essential wholeness & & interdependence of all life, of essential wholeness & oneness of all manifestation (oneness of all manifestation (““all is oneall is one””))

HolismHolismOtherOther--regardregardVirtuousnessVirtuousnessActualizationActualizationPositive affectPositive affect


IntegralityIntegralityHolismHolism:: affirmation that the function & worth of a affirmation that the function & worth of a human life cannot be captured by reductionistic focus human life cannot be captured by reductionistic focus on component pieces or levels (on component pieces or levels (““the whole > the sum the whole > the sum of the partsof the parts””) ) andand that a life should be lived in balance that a life should be lived in balance & moderation (& moderation (““keep it between the lineskeep it between the lines””))

OtherOther--regardregardVirtuousnessVirtuousnessActualizationActualizationPositive affectPositive affect

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IntegralityIntegralityHolismHolismOtherOther--regardregard:: altruistic, selfless concern for the altruistic, selfless concern for the wellwell--being of other people or living beings, especially being of other people or living beings, especially above oneself (above oneself (““putting other people firstputting other people first””))

VirtuousnessVirtuousnessActualizationActualizationPositive affectPositive affect


IntegralityIntegralityHolismHolismOtherOther--regardregardVirtuousnessVirtuousness:: devotion to acting in devotion to acting in consonance with a moral code, in both personal & consonance with a moral code, in both personal & interpersonal behavior (interpersonal behavior (““itit’’s right to be goods right to be good””))

ActualizationActualizationPositive affectPositive affect

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IntegralityIntegralityHolismHolismOtherOther--regardregardVirtuousnessVirtuousnessActualizationActualization:: commitment to inner growth, commitment to inner growth, selfself--improvement, & moral development in order to improvement, & moral development in order to reach full human potential (reach full human potential (““be all that you can bebe all that you can be””))

Positive affectPositive affect


IntegralityIntegralityHolismHolismOtherOther--regardregardVirtuousnessVirtuousnessActualizationActualizationPositive affectPositive affect:: experience of an aggregate of experience of an aggregate of moodmood--elevating feelings associated with gratification elevating feelings associated with gratification & contentment (& contentment (““dondon’’t worry, be happyt worry, be happy””))

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How can we study How can we study human human

flourishing?flourishing?

THE EPIDEMIOLOGIC THE EPIDEMIOLOGIC APPROACHAPPROACH

WHATWHATConceptual & measurement issuesConceptual & measurement issues

Case definitions, inclusionary/exclusionary criteria, nosology, Case definitions, inclusionary/exclusionary criteria, nosology, taxonomytaxonomy

WHO, WHERE, WHENWHO, WHERE, WHENDescribing patterns (descriptive epidemiology)Describing patterns (descriptive epidemiology)

PrevalencePrevalenceDistribution by PPTDistribution by PPT

HOWHOWIdentifying associations (analytic epidemiology)Identifying associations (analytic epidemiology)

Empirical findingsEmpirical findingsExplaining associationsExplaining associations

Postulating Postulating ““mechanismsmechanisms””

WHYWHYContext, implications, application, relation to theoryContext, implications, application, relation to theory

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How prevalent is How prevalent is human flourishing?human flourishing?

PREVALENCE OF HF:PREVALENCE OF HF:Empirical EvidenceEmpirical Evidence

Keyes, Keyes, JHSBJHSB (2002)(2002)N = 3,032, 1995 Midlife in the United States N = 3,032, 1995 Midlife in the United States study (funded by the MacArthur Foundation)study (funded by the MacArthur Foundation)““FlourishingFlourishing”” & & ““languishinglanguishing”” based on scores on based on scores on 2 measures of pos. feelings & 11 of functioning2 measures of pos. feelings & 11 of functioningPoint prevalence (in past year)Point prevalence (in past year)::

17.2% of U.S. adults 17.2% of U.S. adults ““flourishingflourishing””12.1% of U.S. adults 12.1% of U.S. adults ““languishinglanguishing””4.7% of U.S. adults 4.7% of U.S. adults ““languishinglanguishing”” w/depressionw/depression

By PPTBy PPT::““FlourishingFlourishing”” significantly greater in males, 45significantly greater in males, 45--6464--yearyear--olds, college graduates, marriedolds, college graduates, married

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Does human Does human flourishing impact flourishing impact

on physical or on physical or mental health?mental health?

HF & LIFE SATISFACTION:HF & LIFE SATISFACTION:Empirical EvidenceEmpirical Evidence

Park, Peterson, & Seligman, Park, Peterson, & Seligman, JSCPJSCP (2004)(2004)N = 5,299, recruited from 3 internet samples in N = 5,299, recruited from 3 internet samples in 20022002--2003, Values in Action Inventory of 2003, Values in Action Inventory of Strengths (VIAStrengths (VIA--IS)IS)Correlates of life satisfaction (DienerCorrelates of life satisfaction (Diener’’s 5s 5--item item SWLS) (ageSWLS) (age-- and sexand sex--adjusted)adjusted)ResultsResults::

Hope, zest, gratitude, curiosity, & love most strongly Hope, zest, gratitude, curiosity, & love most strongly associated with lifesatassociated with lifesatModesty & various intellectual strengths (creativity, Modesty & various intellectual strengths (creativity, judgment, love of learning, appreciation of beauty) only judgment, love of learning, appreciation of beauty) only weakly associated with lifesatweakly associated with lifesatNo evidence that No evidence that ““too muchtoo much”” of a strength is harmfulof a strength is harmful

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HF & DEPRESSION:HF & DEPRESSION:Empirical EvidenceEmpirical Evidence

Keyes, Keyes, JHSBJHSB (2002)(2002)N = 3,032, Midlife in the United States studyN = 3,032, Midlife in the United States study““FlourishingFlourishing”” & & ““languishinglanguishing”” based on scores on based on scores on 2 measures of pos. feelings & 11 of functioning2 measures of pos. feelings & 11 of functioningMajor depressive episode according to DSMMajor depressive episode according to DSM--IIIIII--RRResultsResults::

Risk of major depression is 2.1 times greater among Risk of major depression is 2.1 times greater among languishing than languishing than ““moderately mentally healthymoderately mentally healthy”” adultsadultsRisk is 5.7 times greater among languishing than Risk is 5.7 times greater among languishing than flourishing adultsflourishing adultsNot a simple calculusNot a simple calculus: there were respondents who : there were respondents who were flourishing yet depressed, and respondents who were flourishing yet depressed, and respondents who were languishing yet not depressedwere languishing yet not depressed

Why should Why should human flourishing human flourishing

impact on impact on physical or mental physical or mental

health?health?

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HF & POPULATION HF & POPULATION HEALTH: HypothesesHEALTH: Hypotheses

IntegralityIntegrality hypothesishypothesis:: affirming oneness, affirming oneness, affiliation with others affiliation with others →→ empathy empathy →→ healthhealth--related related behavior in service to others, benefiting the populationbehavior in service to others, benefiting the populationQ. Is there a healthQ. Is there a health--related instrumentality to a related instrumentality to a sense of transpersonal connection with others?sense of transpersonal connection with others?

Holism hypothesisHolism hypothesisOtherOther--regard hypothesisregard hypothesisVirtuousness hypothesisVirtuousness hypothesisActualization hypothesisActualization hypothesisPositive affect hypothesis Positive affect hypothesis


Integrality hypothesisIntegrality hypothesisHolism hypothesisHolism hypothesis:: affirming a holistic view affirming a holistic view of self of self →→ sense of balance & equilibrium + practice of sense of balance & equilibrium + practice of selfself--care care →→ greater functioning & wellgreater functioning & well--beingbeingQ. We hear about Q. We hear about ““wholenesswholeness”” & & ““wholewhole--person careperson care””; ; does affirming that view of self & healthcare matter?does affirming that view of self & healthcare matter?

OtherOther--regard hypothesisregard hypothesisVirtuousness hypothesisVirtuousness hypothesisActualization hypothesisActualization hypothesisPositive affect hypothesis Positive affect hypothesis

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Integrality hypothesisIntegrality hypothesisHolism hypothesisHolism hypothesisOtherOther--regard hypothesisregard hypothesis:: selflessness & selflessness & right action toward others right action toward others →→ greater wellgreater well--being for being for both others & oneselfboth others & oneselfQ. Does doing good for others benefit both others & Q. Does doing good for others benefit both others & oneself?oneself?

Virtuousness hypothesisVirtuousness hypothesisActualization hypothesisActualization hypothesisPositive affect hypothesisPositive affect hypothesis


Integrality hypothesisIntegrality hypothesisHolism hypothesisHolism hypothesisOtherOther--regard hypothesisregard hypothesisVirtuousness hypothesisVirtuousness hypothesis:: behaving behaving morally morally →→ sense of being in accord with onesense of being in accord with one’’s highest s highest values values →→ greater wellgreater well--beingbeingQ. Are there physical or mental health consequences Q. Are there physical or mental health consequences of being a good person?of being a good person?

Actualization hypothesisActualization hypothesisPositive affect hypothesis Positive affect hypothesis

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Integrality hypothesisIntegrality hypothesisHolism hypothesisHolism hypothesisOtherOther--regard hypothesisregard hypothesisVirtuousness hypothesisVirtuousness hypothesisActualization hypothesisActualization hypothesis:: selfself--actualization actualization →→ mobilization of salutary psychophysiological resources mobilization of salutary psychophysiological resources →→ transcendence of symptoms & pain transcendence of symptoms & pain →→ greater PWBgreater PWBQ. Is not being disposed to personal growth, Q. Is not being disposed to personal growth, psychologically or spiritually, a risk factor for adverse psychologically or spiritually, a risk factor for adverse outcomes?outcomes?

Positive affect hypothesisPositive affect hypothesis


Integrality hypothesisIntegrality hypothesisHolism hypothesisHolism hypothesisOtherOther--regard hypothesisregard hypothesisVirtuousness hypothesisVirtuousness hypothesisActualization hypothesisActualization hypothesisPositive affect hypothesisPositive affect hypothesis:: positive mood positive mood →→ physiological & psychophysiological sequelae physiological & psychophysiological sequelae →→ host host resistance, health, salutogenesisresistance, health, salutogenesisQ. Are happy people (& populations) healthier people Q. Are happy people (& populations) healthier people (& populations)? Is this an important public health (& populations)? Is this an important public health value?value?

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III. IMPLICATIONSIII. IMPLICATIONS

A PROMISING RESEARCH A PROMISING RESEARCH FRONTIERFRONTIER

HF is aHF is a provocative alternative to spiritualityprovocative alternative to spirituality,, with with classical roots in religion and philosophy.classical roots in religion and philosophy.HF has an existing theoretical basisHF has an existing theoretical basis, in various , in various schools of psychology, considerably more schools of psychology, considerably more interesting than the norm for this field.interesting than the norm for this field.HF is a blank slateHF is a blank slate:: we need creative conceptual we need creative conceptual work and development & validation of measures.work and development & validation of measures.HF can be studiedHF can be studied in relation to healthin relation to health——clinically, clinically, epidemiologically, behaviorally, in the lab . . . epidemiologically, behaviorally, in the lab . . . and and must be studiedmust be studied if weif we’’re ever to fully address the re ever to fully address the healthhealth--related needs of people & populations related needs of people & populations ALL pertinent questions are waiting to be answered:ALL pertinent questions are waiting to be answered:What, Who, Where, When, How, WhyWhat, Who, Where, When, How, Why..

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??? ??? MORE QUESTIONS MORE QUESTIONS ??????1)1) Are there Are there period effectsperiod effects (historical shifts) in HF?(historical shifts) in HF?2)2) Does HF follow a predictable Does HF follow a predictable lifelife--course trajectorycourse trajectory??3)3) Are there Are there crosscross--cultural, crosscultural, cross--national, or crossnational, or cross--

religious differencesreligious differences in HF?in HF?4)4) Are there Are there age, gender, or socialage, gender, or social--class differencesclass differences in in

HF?HF?5)5) Does HF differentially Does HF differentially impact on health or wellimpact on health or well--beingbeing

by any moderating influencesby any moderating influences——e.g., social resources, e.g., social resources, psychological resources, financial resources?psychological resources, financial resources?

6)6) Are there Are there physiological or psychophysiological physiological or psychophysiological correlatescorrelates of HF that mediate its impact on health?of HF that mediate its impact on health?

7)7) Can Can interventionsinterventions be designed to increase HF?be designed to increase HF?

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THE EPIDEMIOLOGY OF THE EPIDEMIOLOGY OF HUMAN FLOURISHING:HUMAN FLOURISHING:

The Last WordThe Last Word““Protective processesProtective processes””that mitigate morbiditythat mitigate morbidity::

uniqueness, autonomy, & uniqueness, autonomy, & selfself--esteemesteem →→ honest selfhonest self--assessmentassessmentwisdomwisdom →→ coping resourcecoping resourceforgivenessforgiveness →→ humility & humility & less hostilityless hostilitysociabilitysociability →→ healthy healthy attachmentsattachments““[T]he most neglected [T]he most neglected

dimension is the capacity dimension is the capacity to love and be lovedto love and be loved..”” BH Kaplan, BH Kaplan, J Behav MedJ Behav Med 1992; 15:31992; 15:3--14.14.

human flourishing - duke university · pdf file“human flourishing is a relatively recent...

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