Giving Health Purpose
Historically, the discipline of psychology has been devoted to the practice of healing. Aligned with a disease model of human functioning in which ‘mental health’ is described purely as the absence of illness, traditional psychological study has prioritised the alleviation of mental disorder. However, this approach fails to consider the importance and value of pre-emptively strengthening individuals. An alternative yet complementary perspective is that of positive psychology, which aims not to heal what is broken, but to proactively protect against future harm. Primarily concerned with building strength via the identification and development of positive personal traits and civic virtues (Gillham & Seligman, 1999; Seligman & Csikszentmihalyi, 2000) positive psychology enables society to flourish.
A philosophy which acknowledges the importance of prevention and optimisation is equally valuable to the domain of physical health. Whilst the most significant contribution to global mortality arises from a group of conditions known as non-communicable diseases (NCDs), the development of these conditions is primarily driven by four key lifestyle factors; poor diet, low physical activity, tobacco use and alcohol harm (WHO, 2014). The pervasive yet preventable nature of NCDs presents a clear need for individuals to engage in preclusive activity, such as healthy eating and physical exercise (Feo, Tomaro & Annuzzi, 2016). Is is essential therefore, to target the underlying cause of NCDS, both physical and psychological, rather than just the symptoms. Yet is is not only the underlying philosophy of positive psychology which presents a promising route to NCD alleviation. Recent research suggests that specific strategies and techniques which develop mental resilience may also play a role in the motivation of early healthcare behaviour.
For example, one characteristic which has been associated with both psychological well being and a healthy lifestyle is a sense of purpose in life (Huppert & So, 2013; Zika & Chamberlain, 1992; Diener, Suh, Lucas & Smith, 1999; Hooker & Masters, 2016). Described as a belief that life is meaningful, and filled with valuable and worthwhile activities (Boyle et al., 2009), purpose in life can also be thought of as a motivational framework via which to identify, stimulate and organise goals (Damon, 2008; McKnight & Kashdan, 2009). Importantly, the desire to contribute to the wellbeing of others is also thought to be central to PIL; those with a strong sense of purpose consider life to be meaningful not just because their activities build toward their own values, but because they also contribute to something other than the immediate self (Machell, Disabato & Kashdan, 2015; Damon, Menon & Cotton Bronk, 2003).
Recent exploratory work has demonstrated a significant, positive correlation between PIL and physical activity using both self-report (Holahan et al., 2008; Holahan et al., 2011; Holahan & Suzuki, 2006) and objective measurements (Hooker & Masters, 2016). Although further investigation is needed to determine a causal relationship between these variables, such findings have catalysed speculation as to why PIL might encourage healthcare behaviour. One explanation, is that those who live with awareness of their PIL are more motivated to take care of their physical health because a live which has purpose presupposes a “life that is worth taking care of” (Ryff & Singer, 1998, p. 22). Additionally, those who are aware of and working toward purposeful goals may view strong physical health as an important element of reaching these goals, even if a very direct relationship does not exist (eg. “If I am healthier, I am more able to play with my children”). Lastly, it is possible that a sense of PIL displaces other activities which are perceived to bring about happiness. For example, high-calorie foods are innately rewarding (Killgore et al., 2003) and are more commonly sought during periods of heightened negative emotion (Killgore & Yurgelun-Todd, 2006). However, empirical investigation has suggested the fallibility of instant gratification in providing sustained happiness (Diener, 2000; Steger, Kashdan & Oishi, 2008), and repeatedly engaging in some forms of instant gratification have maladaptive consequences for long-term physical health (Cherukupalli, 2010; Daugherty & Base, 2010; Dittmar & Bond, 2010). In contrast, the promotion of psychological well being via the identification and development of a sense of purpose, has the potential to replace hedonic gratification as a more enduring, and healthier mood regulation strategy.
Displacement of Behaviour
The lifestyle behaviours which contribute to the development of NCDs are characterised by the instant gratification they deliver. Cigarettes, alcohol and high-calorie foods are all innately rewarding, and provide a sense of pleasure upon consumption. Empirical investigation has repeatedly demonstrated an association between negative mood states and increased cravings for food, in particular carbohydrates (Lyman, 1982; Lieberman et al, 1986; Christensen & Pettijohn, 2001). High-carbohydrate foods increase the concentration of tryptophan in the body, which, as a precursor to serotonin, is thought to play a role in alleviating dysphoric mood (Wurtman, 1987). Therefore, increased carbohydrate consumption as a result of negative affect can be seen as one form of “self-medication” (Killgore & Yurgelun-Todd, 2006), whereby individuals subconsciously seek activities or substances previously associated with positive affect. This behaviour can be described as ‘hedonic’ in the sense that it delivers a sense of pleasure and reduces feelings of pain. Similar patterns of behaviour have also been observed for alcohol consumption to alleviate tension, depression and fatigue (Beckman & Bardsley, 1981; Graham, 1988) and tobacco use to relax and relieve stress (Russell, Peto & Patel, 1974; Parrott & Winder, 1984).
An alternative strategy to the hedonic pursuit of psychological well being is that of eudaimonia. Eudaimonic behaviours are defined as those which help individuals to live life at its fullest potential, contribute to personal growth and are consistent with one’s personal intrinsic values (Waterman, 1993; Seligman, 2002). Alternatively, this could be conceptualised as the pursuit of goals which fufil the core psychological needs of autonomy, relatedness and competence. For example cultivating healthy relationships with others creates a resource that may be valuable to draw upon in the future and delivers feelings of mastery and competence (Gable et al., 2004). This activity is also likely to enhance an individual’s well being if they value the skill of social interaction, and strive to be a person who gets on well with others. Importantly, a sense of purpose in life considered to be one of six factors which comprise eudaimonia, in addition to autonomy, environmental mastery, positive relations with others, self-acceptance and personal growth (Ryff, 2006).
Whilst the self-medication of negative affect via tobacco, alcohol or comfort eating might provide a quick and easy solution to emotional difficulty, the nature of these effects is transitory. Indeed, one major criticism levelled at positive psychology as a discipline, is that an individual’s subjective well being is stubbornly resistant to change, and that even after experiencing potentially life-changing events such as winning the lottery or losing a limb, our happiness levels shortly return to baseline (Brickman, Coates & Janoff-Bulman, 1978). This concept is also known as the ‘Hedonic Treadmill’ (Brickman & Campbell, 1971), whereby despite continually accruing experiences and objects that provide happiness, an individual’s overall level of well-being tends to remain fairly static (Helson, 1964). A conceptual parallel is readily observed when considering drug or alcohol tolerance, whereby continued delivery and or increasing levels of pleasurable stimuli are needed in order to deliver the same degree of satisfaction.
Whilst an unquenchable thirst for happiness-providing stimuli might initially seem problematic, the importance of distinguishing hedonic from eudaimonic is crucial. The transient pleasure of hedonic indulgence although not in itself an issue, can become unhealthy if the objects of such pleasure seeking our maladaptive in large or frequent quantity, such as unhealthy food or alcohol. However in contrast, the continual pursuit of eudaimonic activities such as studying, health-promotion, sports participation or helping others are unproblematic both in terms of their effect on our physical health, and their absoluteness. Whilst for example, a growing tolerance to alcohol pose physically dangerous implications, the opportunities for personal growth via eudaimonia are beneficial rather than destructive, and are limitless. Even if an activity which once delivered feelings of personal growth begins to lose it’s appeal, a general orientation toward achieving happiness via self-development allows an individual to continue to seek pleasure from numerous sources of challenge (Waterman, 2007).
Most modern models of happiness propose that both hedonia and eudaimonia are important in maintaining psychological well being, and that those who experience both are happier than those who live a life dedicated to pleasure or purpose alone (Anić & Tončić, 2013; Huta & Ryan, 2010; Peterson et al., 2005). However, empirical evidence specifically investigating the contributions of particular activities to happiness, has observed a positive correlation between hedonic behaviour and negative affect (Steger et al., 2008). Regardless of whether this relationship is driven by increased pleasure seeking in those experiencing negative affect, as proposed by Chua, Touyz and Hill (2004), or that negative affect is a consequence of hedonic behaviour, this finding suggests that whilst hedonic indulgence may be gratifying in the short term, pleasure-seeking alone is a poor strategy by which to achieve an enduring sense of happiness. Additional support for this theory is provided by research indicating those who display a strong orientation toward meaningful activities tend to demonstrate more life satisfaction than those who display a strong orientation toward pleasure (Peterson, Park & Seligman, 2005) and that participants who were asked to add at least one eudaimonic activity (eg. cheering up a friend, exercising) to their lives over a ten day period, demonstrated significantly higher well being at three-month follow-up than those asked to engage in hedonic activities such as sleeping more or watching TV (Huta & Ryan, 2010).
By engaging in behaviours which enable them to fulfil their potential, individuals are more likely to develop and maintain perceptions that life is meaningful and satisfying (Steger et al., 2008). Therefore, identifying and practicing behaviours which build towards an individual’s life goals, and in particular, targeting one element of eudaimonia by developing an orientation toward purposeful activities may not only contribute to wellbeing in a manner which is more sustainable, but also alleviate some of the negative affect which acts as a driver for the gratifying but unhealthy behaviour associated with NCDs.
With the behavioural antecedents of NCDs most likely to cluster in communities of low socioeconomic status, it is possible to argue that those most likely to benefit from a strong sense of purpose are paradoxically those least likely to attain one. For example, prior research has documented an association between low income and purposelessness (Zeitchick, 2000). However, this relationship isn’t necessarily direct; Aristotle argued that; ‘‘we can do noble acts without ruling earth and sea; for even with moderate advantages one can act virtuously’’. Perhaps then, in a society where energy-dense food exists in ample supply, and sedentary lifestyles are afforded by continual technological advancement, it is not only important to equip individuals with the financial resources to sustain a healthy lifestyle, but also psychological advantages such as the self-efficacy and optimism needed to strive for and achieve life goals which deliver a sense of purpose. Given the outlined theory, the development of psychological constructs which enable individuals to derive a sense of purpose from life can be expected to enhance psychological well being, and indirectly but powerfully influence lifestyle behaviours which contribute to the development of NCDs.
Importantly, in alignment with the underlying philosophy of positive psychology it may be particularly pertinent to cultivate a sense of purpose in the young. For one reason, the attitudes and emotions of children are developing and therefore particularly malleable. In addition to this, purposeful activities help us to identify opportunities to acquire resources important to our future, and as a result, further engagement in purposeful activities becomes more accessible. Given the human tendency to measure our abilities and self-worth in relation to others, a reluctance to expose deficiency in performance may occur if children are denied the opportunity to identify with any purposeful domain from an early age. This hinders their ability to derive a sense of meaning in life, and their opportunities to personally grow, creating an escalating chasm between the purposeful and the purposeless.
Taken together, this research suggests that whilst those who experience the highest levels of negative affect are most likely to seek pleasure, their happiness may be more effectively enhanced by obtaining meaning. This makes a strong case for interventions and programmes which are able to reorientate individuals towards more meaningful activities and goal pursuit.