The science of well-being: an integrated approach to mental health and its disorders
C. ROBERT CLONINGER
Department of Psychiatry, Washington University School of Medicine, 660 South Euclid, St. Louis, MO 63110, USA
Psychiatry has failed to improve the average levels of happiness and well-being in the general population, despite vast expenditures on psychotropic drugs and psychotherapy manuals. The practical failure of psychiatry to improve well-being is the result of an excessive focus on stigmatizing aspects of mental disorders and the neglect of methods to enhance positive emotions, character development, life satisfaction, and spirituality. In this paper, a simple and practical approach to well-being is described by integrating biological, psychological, social, and spiritual methods for enhancing mental health. Evidence is presented showing that people can be helped to develop their character and happiness by a catalytic sequence of practical clinical methods. People can learn to flourish and to be more selfdirected by becoming more calm, accepting their limitations, and letting go of their fears and conflicts. People can learn to be more cooperative by increasing in mindfulness and working in the service of others. In addition, people can learn to be more self-transcendent by growing in self-awareness of the perspectives that lead to beliefs and assumptions about life which produce negative emotions and limit the experience of positive emotions. The personality traits of self-directedness, cooperativeness, and self-transcendence are each essential for well-being. They can be reliably measured using the Temperament and Character Inventory. A psychoeducational program for wellbeing has been developed, called “The happy life: voyages to well-being”. It is a multi-stage universal-style intervention by which anyone who wants to be happier and healthier can do so through self-help and/or professional therapy.
Key words: Well-being, character development, spirituality, happiness, psychobiology
World Psychiatry. 2006 June; 5(2): 71–76. By World Psychiatric Association
Despite vast expenditures on psychotropic drugs and extensive efforts to manualize psychotherapy methods, there has been as yet no substantial improvement in average levels of happiness and well-being in general populations, as well documented in Western societies like the USA (1,2).
The practical failure of psychiatry to improve well-being is not surprising for several reasons. First, the focus of psychiatry has been on mental disorders, not on the understanding or development of positive mental health. Morbidity and mortality are more strongly related to the absence of positive emotions than to the presence of negative emotions (3). It is possible to cultivate the development of positive emotions, as shown by recent randomized controlled trials (4).
Second, a focus on discrete categories of disease provides an easy way to label patients with disorders, but the validity of the categorical separation is doubtful (5). In addition to being of doubtful validity, categorical distinctions are inherently stigmatizing: some people are suggested to be defective, whereas others are normal. As a result, many people are ashamed of being mentally ill and avoid treatment. A focus on universal interventions to cultivate mental health for everyone can be destigmatizing, by recognizing that all people share much in common with one another.
Third, psychiatric methods of assessment and treatment often require prolonged training with complex jargon for psychotherapy or expensive medications and equipment for biological therapies. These cost and distribution characteristics limit the availability of effective treatments around the world. Integrative psychobiological treatments can be highly effective and inexpensive, harnessing the spontaneous resilience of human beings in a therapeutic milieu that can be provided by a wide range of mental health workers with varying levels of professional expertise.
Fourth, treatments that focus on the body and/or mind have usually been anti-spiritual in their orientation. This anti-spiritual bias in psychiatry has many roots, including questionable assumptions of Freudian psychoanalysis, behaviorism, and the overly simplistic reductionism of materialists. Yet, human beings are spiritual beings who spend more time in prayer or meditation than they do having sex (6). Cultivation of spirituality provides an inexpensive and powerful way to enhance well-being, as shown by recent randomized controlled trials of spiritual treatment methods that are reviewed later in this article.
These considerations have led me to develop a simple approach to helping people to be happy that can be made available to everyone. My approach is integrative, combining biological, psychological, social, and spiritual approaches to mental health. The scientific basis for this science of well-being has been summarized in a recent book (7). Now I am writing a more clinically oriented book to explain how to apply this approach in clinical practice and am developing a series of psychoeducational modules that can be distributed widely.
Here I will summarize available data about the need to reduce disability, the spiritual needs of people, and the effectiveness of spiritually-oriented well-being therapies. Then I will describe the key clinical concepts about the stages of self-awareness. Finally, I will describe the series of psychotherapy modules that are being produced, to illustrate an efficient catalytic sequence of interventions that help everyone become more mature and happy.