Chapter Content
Okay, so, let's talk about how you're not one-dimensional. And, you know, it's easy to think about health as just, like, not being sick, right? But it's way more than that. It's about, well, being well.
The ancient Greeks had this awesome story about Asclepius, who was like, the god of medicine. And he had these two daughters, Panacea and Hygeia. Panacea, she was all about curing diseases, you know, finding remedies when you got sick. But Hygeia, she was focused on how to, like, boost your health and keep you feeling good in the first place.
And, get this, the symbol of medicine, that staff with the snake wrapped around it? That snake is actually super important! It's because snakes shed their skin, right? They get rid of the old, and they reveal, like, this new, healthy skin. So, the snake, it represents taking care of your health and keeping it up.
So, medicine, from the beginning, was supposed to have these two parts. One was, like, fighting off illness, and the other was about creating health. One was focused on what made you suffer, the other on what made you thrive. Think of it like this, vaccinations, right? They're not gonna cure you once you're already sick. What they do is strengthen your immune system so you don't get seriously ill in the first place. They kinda trick your body into building up its natural defenses. You know, introducing a tiny bit of the bad stuff so your body can fight it off and become stronger.
And the thing is, it's not just physical health, either. Your mental health, it works the same way. So, there's this idea that mental health is just the absence of mental illness. And all the effort goes into figuring out what causes mental illness so you can, like, fix it. But there's also the idea that good mental health is about, you know, feeling good, having a positive outlook, and functioning well. And so, you focus on, like, building that up, creating a flourishing life.
And then there's this third idea, being "hale," which means whole. Which is kind of, like, the perfect way to look at your life, right? Like, are you whole?
So, you know, as a scientist, I needed ways to measure this stuff. And back when I started out, there were tons of ways to measure mental illness, but there was, like, nothing to measure good mental health. That's why I created this questionnaire, the one you probably filled out. To measure both at the same time.
You see, a lot of people used to think that depression and well-being were, like, super connected. So, if you could just lower someone's depression, they'd automatically feel better, right? Well, the research showed that's not really true. The connection between depression and well-being? It's surprisingly weak. So, lowering your depression, it doesn't automatically boost your well-being.
What it means is your mental wellness has, like, two parts: mental illness and mental health. You can have low mental illness and low mental health. And the opposite is also true! You can have high mental illness and still have high mental health. It's all over the place.
So, here's the thing, even if we had a cure for mental illness, people still might not be flourishing. Remember that song about feeling numb? About waiting for medication? Well, sometimes medications, you know, they can numb all your emotions. They might turn down the sadness, which is good if you're depressed. But they also turn down the good stuff, leaving you feeling, like, meh.
It turns out our brains are kinda built that way. The parts of your brain that light up when you're sad, they're not the same parts that go dark when you're happy. There's some overlap, sure. But basically, happiness isn't just the opposite of sadness.
So, not having the negative, it doesn't automatically mean you have the positive. And having the negative, it doesn't mean you can't have the positive. Mental health? It's not just black and white. It's a whole rainbow.
And, you know, this idea, it's inside us. Think about it. We all have, like, "bad" stuff inside us, right? But if our immune system is strong, it doesn't hurt us. When you're stronger than your vulnerabilities, you stay healthy. You might even get stronger from the fight!
Cholesterol, same deal. You got "bad" and "good" cholesterol. And you're healthiest when the bad is low and the good is high. It's "flourishing cholesterol," basically.
And then there are telomeres. They're, like, the caps on the ends of your chromosomes. Every time your cells divide, they get a little shorter. That's just part of life, you know? Experiencing a lot of stress, it damages your telomeres.
But there's this thing called telomerase. It protects your telomeres. So, high telomerase, more protection. Low telomerase, more damage.
There was this study about moms who were caring for kids with disabilities. It's super stressful, right? And chronic stress, that's the worst kind for your health. But the moms who were in social support groups? They had higher telomerase levels than the moms who were isolated. So, the support didn't get rid of the stress, but it protected them from some of the damage.
And you know, since 1995, I've been studying twins to see if this mental health scale I created, if it measured something genetic. And it turns out, flourishing and languishing, they're just as heritable as depression or anxiety. Like, around 60 percent genetic.
But listen, just because something's heritable, it doesn't mean it's all in your genes. There's very little proof of genetic determinism when it comes to depression. You can have a high genetic risk and never get depressed. Or a low risk and still get it. It takes stressful experiences to activate the risk.
And, here's some good news. The genes that predict mental illness, some of them overlap with the genes that predict mental health! So, having a genetic risk for mental illness, it doesn't mean you're destined to have low well-being. And not having a risk for mental illness, it doesn't guarantee you'll flourish. It means that this dual-continua model, it's in our DNA.
And there's this whole idea of neurogenesis and neuroplasticity, which is the ability to grow new neurons and create new connections in the brain. This is the regenerative capacity of our bodies. Our bodies are literally capable of generating new neurons and new connections between them. You can literally help build new neurons and shape where they grow in your brain. Someone who is suffering from a mental illness can move up the scale from languishing to flourishing and increase their mental wellness.
There was this study, the Nun Study, where they looked at nuns who had brain damage that should have caused dementia, but they were still functioning well. And the researchers discovered that it was because the nuns were engaged with life! They were active, mentally, socially, spiritually. They were stimulating neurogenesis and neuroplasticity, helping their brains stay healthy despite the damage.
And another thing, there's this therapy called constraint-induced movement therapy. For stroke patients who lost the use of limbs. It was thought they couldn't recover. But they constrain their good limb and force them to use the damaged one. And, gradually, they recover some use.
So, the positive side of health, it's about our ability to regenerate, restore, and strengthen ourselves. In our immune system, our cardiovascular system, our brain, our cells, we can build strength and resilience.
When your body can repair and grow faster than the damage, you stay healthy. When the damage is too much, that's when illness starts. It's gradual. It's when the bad stuff outweighs your ability to rebuild.
But strength isn't just physical, it's mental too. Think about pain, right? It's not just in your body. It's in your brain too. Your thoughts and emotions can make it worse. Stress, anxiety, depression, negative thinking, all that makes pain worse.
And a placebo, it's the opposite. It's the expectation that you'll get better. So, it encourages healing.
So, you can work on strengthening your mental health, your wellness, your positivity. The stronger you are, the more ready you'll be to fight whatever comes your way.
The dual-continua model, it's a reason for optimism. If we see our life on that languishing-to-flourishing line, and we focus not just on mental illness, but on our mental health, we can imagine a different path. We can focus less on how we feel and more on how we function well.
What we need to cultivate is hope. When you have hope, you plant a seed. You start to believe that something better is possible.
Okay, so, the World Health Organization did this big study, right? Called the Global Burden of Disease study. And it looked at how much different illnesses contributed to something called the disability-adjusted life year. Basically, how much time people spent living with a disability.
Before that, they only looked at how many years an illness cut short your life. Mortality. That was the gold standard. And mental illness never made the top ten.
But then they realized that living longer didn't necessarily mean living well. So, they added disability to the equation. And suddenly, depression showed up! It was right up there with heart disease and cancer. And, you know, depression is now the leading cause of disability in many countries.
It's kind of crazy, right? So, we have a healthcare system that encourages Americans to deprioritize maintaining our health in the hope that a brilliant doctor or expensive procedure will be able to fix it for us later. But deprioritizing our health is too costly for too many families, and it costs our economy millions in lost productivity and ingenuity. Now that we have made some progress with the Affordable Care Act, it is time to take the next step. We need a system that will encourage and support our right and responsibility to maintain our own good health and use it to live a better life. Americans should invest in a system that focuses more on flourishing and health than only illness.
And get this, the average age for first experiencing mental illness? It's getting lower. Anxiety, around fourteen. Substance abuse, twenty. Mood disorders, twenty-six. And it's the same all over the world.
We really need to pay attention to this. For so long, politicians said mental illness wasn't their problem. But it is!
Over time, some governments started putting more money toward treating depression. But most of us, we've just assumed that those treatments are effective, beneficial, and the best option.
But are they? Nothing could be further from the scientific truth—we cannot in good faith call any mental disorder treatment a “cure.”
And in the U.S. a director of the National Institute of Mental Health, publicly said that the current effect of all known treatments for mental illness was palliative at best.
So, researchers were just trying to make small improvements to existing medications. Incremental change.
And the thing is, no medication for mental disorder has ever been designed in the correct sequence of understanding the problem.
Normally, to create a true cure, you have to understand the underlying cause of an illness. But with mental illness, scientists have been doing it backward from the start.
All the current medications, they came from observing potentially beneficial side effects of treatments created for something else.
During World War II, the Germans created hydrazine for rocket fuel. And after the war, chemists made drugs from it to treat tuberculosis. But doctors noticed that the patients became more energized, and their mood improved. So, they used it to treat depression.
Next, scientists figured out that it increased serotonin levels. So, they said, "Aha! Serotonin deficiency, that's the problem!" But, you know, there's still no scientific evidence to support the chemical imbalance theory. The public has been convinced by TV ads, not science.
And if you're wondering why you felt better when you started taking Prozac, it could be because you're one of the 25 percent who actually benefits from the medication. Or maybe it was the placebo effect. You believed it would help, so it did.
Hundreds of studies showed that 50 percent of the improvement in patients with depression is due to their expectation that the medication they are taking will indeed make them feel better. Another 25 percent of improvement in patients taking antidepressants is due to what is called “natural recovery,” meaning that some patients feel better with time and being put on medication has nothing to do with the improvement. At most, the studies suggest, 25 percent of improvement in depression can be attributed to the effects of the medication.
But it makes sense, right? That all the medications are palliative at best.
We're no closer to understanding the underlying causes of depression or any other mental disorder. The medications are still based on this chemical imbalance theory.
The truth is, depression is like a chronic disease. It comes and goes.
If you have depression once, you have a 50 percent chance of having it again. And if you have it twice, you have a 70 percent chance of having it a third time. And so on.
The question isn't whether mental illness is serious. We know it is. The question is, how do we reduce the suffering?
And that's where the dual-continua model comes in. Languishing might be an even bigger problem than depression. And if we can move people from languishing to flourishing, their mental health can increase, even if they have a mental illness. Flourishing helps prevent depression, too. So, why aren't we paying attention to languishing?
So, even as we throw around terms like mental health and depression, we aren't looking at the issue the right way. Changing our mindset or treating the mind as a cocktail of chemicals won't unlock sustained mental health. We need different tools.
So much of our life is lived out of our consciousness, our understanding of ourselves, not just our physical bodies. Changing our thoughts can affect our physical and neurological states. If you tell students they're good at math, they score higher. If you tell housecleaners their job is a good workout, they lose weight.
The medicalization of mental illness, it strips hope from people. "I am depressed." But that's not all you are! People with mental disorders can still achieve good mental health. They can even flourish.
We are not one-dimensional creatures. We're not just mentally ill or not mentally ill. The second dimension, the mental health continuum, it gives us a better language for our lives and a new approach to creating a mentally healthier world.
So, what should people be prioritizing in their daily lives in order to be flourishers?
So, there was this study called "A Tuesday in the Life of a Flourisher."
Every Tuesday, participants remembered the day before. What moments had made up their Monday? Had they learned something new, helped someone, or socialized? Did they pray, worship, or meditate? Did they play a game or practice a hobby?
They also said how they felt while doing those activities. Playing, spirituality, connecting, learning, helping. And people who did more of those activities had a better day. They felt more joy, excitement, hope, and interest in life when they had done little or none of the five activities. It didn't matter if the participant was depressed, languishing, or flourishing. If they continued the activities each week, people moved closer to flourishing.
And if they did very few or none of the activities, they had a poor day. It didn't matter if they were flourishing, languishing, or depressed. If participants were flourishing and they cut back or stopped the activities, they began slipping into languishing.
Of course, bad days will happen. Flourishing can't protect you from stress. But it stops bad experiences from turning into a really bad mood.
In one study, on the days with more stress, people reported more negative moods. But even on the days when nothing went wrong, the people who were flourishing reported a better mood than those who were languishing. Flourishing doesn't protect you from bad things, but it prevents them from creating a really bad mood that ends in a bad day.
When you're flourishing, bad things have trouble getting inside you and sticking around. Flourishing is like having a base camp on a difficult mountain. When bad weather strikes, you can just go back to base camp, regroup, and try again.
My work has shown me that people pursue happiness along two paths. The external path, where you become good at something to make a living. You create a resume of skills and accomplishments.
That's where you keep count of your worth. You count scores and wins, you count salaries, you count belongings.
But the internal path is different. It's about the kind of person you are or trying to become. It's about ethics, not economics. It values substance and sharing. You earn happiness not by being admired for your stuff, but for the quality of your virtues. Becoming a better person, for others.
People who are functioning and feeling well incorporate five simple activities into their lives. They're lifelong learners. They have psychologically satisfying friendships. They practice acceptance and kindness toward themselves and others. They find purpose in fulfilling an unmet need. And they find small moments for free play. I call these the five vitamins of flourishing.
And these vitamins can help us balance the internal and external paths.
For example, you can learn something new to show off your knowledge or you can embrace your imperfections.
You can connect with others to look cool, or you can connect deeply and provide care.
You can engage in spiritual practices to get to heaven, or you can immerse yourself to become a better person.
You can help others because it makes you look selfless, or you can help others because it's your purpose.
Lastly, you can play to win, or you can play because it's enjoyable.
The clarity of your intentions affects the purity of your actions. It's simple, really. A thoughtful life comes down to intentions and actions. Think about living more in the moment. Instead of adding things to your life, you might need to subtract them.
Flourishing is your North Star. It's your guide out of languishing. The flourishing vitamins are the five activities you can practice each day. Set your intention each time you take your vitamins. You might find something more beautiful than you ever imagined.