Wednesday, May 27, 2009

What the Hell is Well-being, Anyway, and Why Is It So GD Important?

Good title for a talk? Psychiatry tends to veer toward wonky titles, such as: "Developing a Positive Psychiatry of the Person."

Okay, let's go with that. Last week in San Francisco, at the American Psychiatric Association's annual meeting, I heard Robert Cloninger MD of Washington University (St Louis) deliver the type of lecture that justifies his reputation as a pioneer in that strange field that we simultaneously know everything and nothing about: personality and well-being.

"Well-being is the universal wish of human beings," Dr Cloninger opened. "We all want happiness, love, and a meaning of life that is greater than our individual self."

Obviously, this is something that you can't get in a pill, and therein lies the problem with our treatments. Response to acute (initial phase) treatment, whether with meds or talking therapy, is only moderate, and drop-outs, relapses, and recurrences are high.

But if clinicians are smart, Dr Cloninger went on to say, they will attend to what people want in life and build therapeutic alliances around that. On the other hand: "Getting people to do things they don't want to do doesn't work well."

There are four converging ways to measure well-being, Dr Cloninger told his audience:

  1. Emotions: Namely positive ones, ie being happy.
  2. Personality: It turns out that positive emotions relates to maturity in character. People who have a well-integrated personality also turn out to be happy.
  3. Life satisfaction: People who are content with their lives don't have a lot of complaints.
  4. Virtues: People who have them (courage, justice, moderation, honor, wisdom, patience, love, hope, and faith) also tend to be happy, mature, and satisfied with life. Reframing a goal to work on developing courage, for instance, may produce a better outcome than figuring out what to do with an anxiety disorder.

Well-being has little to do with income. Rather, there is an association with heritable personality traits, plus with meaningful work, mutually caring friendships, and spiritual values. Dr Cloninger cited Ed Diener's pioneering work that showed while personal income in the US has dramatically increased from the 1930s to the present, life satisfaction has remained static.

Over this time period, we have seen the introduction of all our psych meds and all our manualized therapies. We know these things are helpful, Dr Cloninger said, but "why isn't it making a dent" in these statistics?

So what's the key to well-being? It all starts with self-awareness, Dr Cloninger advised.

Check out the name of this blog. Much more on Dr Cloninger to come ...

1 comment:

John McManamy said...

Hi John. I tried a few times to leave a comment on today's blog, but I kept getting kicked off your site. So, I'll leave comment here....

Love the Cloninger piece. I hope you're not teasing and you will in fact talk more about his message. That's incredibly interesting stuff! Also, thank you for all the hard work you do.