SSM - Mental Health 2 (2022) 100045
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SSM - Mental Health
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Flourishing and health in critical perspective: An invitation to
interdisciplinary dialogue
Sarah S. Willen a, b, *
a
Department of Anthropology, University of Connecticut, Storrs, CT, USA
b
Research Program on Global Health and Human Rights, Human Rights Institute, University of Connecticut, Storrs, CT, USA
What does it mean to flourish? Who has the opportunity to lead a
flourishing life, who does not, and why? These broad questions invite
others: How might our view of health—and health care, and health
policy—change if the promotion of human flourishing were defined as a
vital health-related objective? Could we—and should we—recalibrate
research, policy, or clinical practice along these lines?
These are timely and urgent questions. In recent years, flourishing has
become a topic of interest in fields as diverse as psychology (Diener et al.,
2010; Keyes, 2002; Ryff, 1989; Ryff & Singer, 2008; Seligman, 2011;
Witten, Savahl, & Adams, 2019), medicine (Levin, 2021; VanderWeele,
McNeely, & Koh, 2019), nursing (Agenor, Conner, & Aroian, 2017;
Hewitt, 2019), public health (Bethell, Gombojav, & Whitaker, 2019;
Marmot, 2017; Willen et al., 2021), bioethics (Parens and Johnston,
2019a), public health ethics (Prah Ruger, 2020), disability studies
(Berghs, Atkin, Hatton, & Thomas, 2019; Garland-Thomson, 2019;
Parens, 2017), autism research (Hilton, Ratcliff, Collins, Flanagan, &
Hong, 2019; Jaswal and Akhtar, 2019), and medical anthropology
(Mattingly, 2014; Willen, 2019). Efforts to promote flourishing are
emerging in multiple domains and at multiple levels, including clinical
interventions (Lanteigne, Genest, & Racine, 2021; VanderWeele et al.,
2019) as well as individual-level “do-it-yourself” exercises (Vander-
Weele, 2020) and corporate workplace measures (Aduro, 2021). Mean-
while, population-level efforts aim to assess and promote the flourishing
of groups, communities, or even countries as a whole (Hone, Jarden, &
Schofield, 2014; Huppert & So, 2013; Marmot, 2017; Orton, 2011;
Taylor, 2018; VanderWeele et al., 2019). Some have even suggested that
a strategic focus on flourishing could “open a national conversation that
reframes and reimagines traditional concepts of health” in a manner that
might yield “a more useful way to address policy and societal goals than
current options” (VanderWeele, 2017).
Given this burgeoning and wide-ranging interest, we argue in this
series that now is an opportune moment to step back and take stock of the
range of ways in which researchers, clinicians, activists, funders, and
* Corresponding author. Department of Anthropology, University of Connecticut, Storrs, CT, USA.
E-mail address: sarah.willen@uconn.edu.
https://doi.org/10.1016/j.ssmmh.2021.100045
Received 3 September 2021; Received in revised form 1 December 2021; Accepted 2 December 2021
Available online 5 December 2021
2666-5603/© 2021 The Author. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-
nd/4.0/).
policymakers are thinking about flourishing, especially in relation to
questions of mental health and well-being.
This stock-taking exercise is vital and urgent for several reasons.
Flourishing is fast emerging as a leading paradigm for research and policy
efforts involving health in general and mental health in particular. Ac-
cording to a recent article in the American Journal of Preventive Medicine,
“human flourishing has been indexed >200 times in the National Library
of Medicine's PubMed database, almost all since the year 2000, more
than half just in the past 3 years” (Levin, 2021). In addition, flourishing
research is garnering massive philanthropic investment, including a
US$60 million initiative by the Templeton World Charity Foundation and
a US$43 million, five-year, 22-country “Global Flourishing Study”
involving “approximately 240,000 participants” (Institute for the Study
of Religion, 2021; Templeton World Charity Foundation, 2021). The
implications of these initiatives for research, clinical care, and policy will
likely reverberate for years, if not decades, to come.
Yet despite this rapid uptake and broad appeal, no clear consensus exists
around what flourishing means or what is needed to promote it (Agenor
et al., 2017; Hone et al., 2014)—and, as we demonstrate in this series, a
number of key considerations are almost completely absent from today's
leading approaches (Cele, Willen, Dhanuka, & Mendenhall, 2021; Willen,
Williamson, Walsh, Hyman, & Tootle, 2022). Instead, conversations about
flourishing are multiple and divergent, often unfolding in parallel and with
limited cross-fertilization. In addition, flourishing often is used inter-
changeably with different but related concepts—including, above all,
“happiness” and “well-being” (Keyes, 2002; Ryff, 1989; Ryff & Singer,
2008; Seligman, 2011; VanderWeele, 2017)—in ways that sow confusion.
In light of these concerns, and with an eye toward powerful tides on
the rise, we offer this series as a call for broad-minded, interdisciplinary
discussion of what we collectively do and do not mean, and what we are
and are not talking about, when flourishing is the focus. In this conver-
sation, critical public health, critical medical anthropology, and other
critical social sciences of health have important roles to play.
S.S. Willen
Overall, the papers included here do not presume to offer an exhaustive
overview of how flourishing is currently engaged across disciplines. Nor do
we stake any singular position regarding how flourishing ought to be
conceptualized, investigated, or advanced. Rather, we aim to gather and
juxtapose disparate lines of inquiry; highlight notable points of conver-
gence, tension, and disagreement; and lay the groundwork for more
expansive conversation about what flourishing entails and how we can,
and should, approach it, especially as it involves issues of health in general,
and mental health in particular. Our task is not to pin down a universally
relevant set of “right answers,” but rather to sharpen our collective un-
derstanding by seeking “better questions to ask” (Fassin & Das, 2021: 7).
As intimated above, the implications of this task are potentially far-
reaching. Bioethicists Parens and Johnston are right in noting that one
reason “policymakers make the policies they do is to promote the
flourishing of their constituents as they understand it”—and, therefore,
that “public conversation about flourishing is deeply important for
making good public policy” (Parens and Johnston, 2019b: 8). Before
focused and fruitful public discussion can take place, those of us who
study flourishing have important work to do.
1. What are(n’t) we talking about when we’re talking about
flourishing?
A crucial first step is to recognize that flourishing has become what
sociologists Star & Griesemer (1989) call a “boundary object”—a concept
that “has different and quite specific meanings in intersecting commu-
nities but also … a common meaning to facilitate cooperation across
communities” (Timmermans, 2015: 4). Like other boundary objects, it is
“plastic enough to adapt to local needs and the constraints of several
parties employing them, yet robust enough to maintain a common
identity across sites” (Star and Griesemer, 1989: 393). In practice,
divergent stakeholders may agree that flourishing is important and
worthy of investment, even when deeper conversation would reveal
sharp definitional differences; or competing explanations for why some
people are more likely to flourish than others; or divergent views on what
would need to change in order for more people to flourish.
This lack of consensus is not a problem in itself; like many boundary
objects, flourishing's plasticity bolsters its strength as a flexible frame for
orienting scholarly, clinical, and practical efforts to improve human lives.
This plasticity becomes a problem, however, when elements that are inte-
gral to some understandings of the concept are wholly absent from others.
From a critical public health standpoint, three elements are notably
missing from today's leading approaches to flourishing: structure, power,
and dynamics of social (in)justice. As Willen and colleagues argue in this
series (2022), inattention to these factors highlights a troubling discon-
nect between leading work on flourishing, on one hand, and interdisci-
plinary scholarship on how marginalization, exclusion, and injustice can
harm health, on the other. By now, vast bodies of evidence have
demonstrated the myriad ways in which racism, xenophobia, ableism,
and other forms of discrimination and stigma can damage health and
well-being, especially among groups who are minoritized and otherwise
vulnerable (Bailey et al., 2017; Bourgois et al., 2017; Braveman, 2010;
Casta~neda et al., 2015; CSDH, 2008; Hansen, Bourgois, & Drucker, 2014;
Williams & Mohammed, 2009; Yearby, 2020). In addition, we know that
structural inequity in all its forms—including poverty itself as well as
food insecurity, housing insecurity, exposure to environmental hazards,
the absence of stable welfare protections, and other structural fac-
tors—also damages health, and that inequities can co-occur and com-
pound in intersectional ways (Benfer, 2015; Link & Phelan, 1995, Benfer,
Mohapatra, Wiley, & Yearby, 2020; Ortiz & Johannes, 2018; Yearby,
2020). Given the overwhelming evidence that inequity and injustice
harm health, it would be difficult to dispute the assertion that such harms
also impede individual and collective capacities to flourish.
Yet the linkages between external circumstances and internal dy-
namics, between politics and health, and between flourishing and justice
have been almost entirely neglected in current conversations. To some
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SSM - Mental Health 2 (2022) 100045
extent, this inattention may be a function of scale and unit of analysis.
Most leading work on flourishing focuses analytically on individuals and
individual psychology and thus lacks the tools for capturing the powerful
impact of material circumstances, structural conditions, and relations of
power on individual or collective chances of flourishing, however they
may be defined. Yet it is also a matter of intellectual genealogy (Where
does the concept of flourishing come from?), epistemological frame (What
kind of concept is it, and what does it mean?), and critical sensibility (Who
has the power to determine which definition will frame discourse and
debate?)—all topics of concern in the papers collected here.
One aim of the series is thus to ask: How would research on flour-
ishing look different if we were to take seriously the impact of inequity on
opportunities to flourish—including inequities in power, status, and ac-
cess to resources and life chances? How might health care and policy
recommendations change as a result? The inverse question merits
consideration as well: How might public health efforts to sharpen our
understanding of health inequities and promote health justice be
strengthened by investigating what people need to flourish, as in-
dividuals and as members of families and communities, as articulated in
their own words?
2. Why rethink flourishing?
With these questions in mind, our overall aim in this series is to cultivate
a more capacious understanding of flourishing and its relationship to health
in general, and to mental health in particular, by foregrounding several
considerations that should interest flourishing researchers in mental health
fields and across the disciplines. The first involves the polyvalence of the
concept itself. How has flourishing been, and how is it now, defined and
investigated in different scholarly traditions? What are the genealogical
roots of the term? How is flourishing related to and distinct from terms that
sometimes are used interchangeably, including “happiness” and “well-
being”? To these perennial questions, we add: How is flourishing under-
stood and used in everyday conversation, and how do vernacular concep-
tions of what it means—and what it takes—to flourish vary among groups
and across languages and cultural settings?
A second concern is methodological. What methods currently are being
used to investigate human flourishing? What are we actually study-
ing—and what might we be missing—by relying on prevailing ap-
proaches? How might our understanding of flourishing change—either in
general or in relation to particular populations, life stages, health issues,
or policy challenges—if we were to expand today's range of methods to
more fully engage qualitative and mixed-methods approaches? How, in
particular, might perspectives from the qualitative social sciences (and
humanities) enrich the way we think about flourishing, investigate it, and
work to promote it at different levels and in different domains?
A third and related concern involves questions of policy and practice.
How do conceptions of flourishing figure—and how might they, or
should they, figure—in efforts to improve mental and physical health, at
the individual and population levels? Could a focus on flourishing
strengthen efforts to improve clinical care, either for vulnerable pop-
ulations or more generally? How would policymaking change if the
promotion of flourishing were a central focus? Meaningful answers to
these questions will of course hinge on issues of definition—and, more-
over, on a willingness to recognize both the polyvalence of the term and
the usefulness of qualitative research methods. What definition(s) of
flourishing should undergird efforts to improve clinical care or re-
envision policy approaches? How can we ensure such guiding concep-
tions are locally salient? Culturally appropriate? Fair? Just?
Before proceeding, a brief overview of the landscape of current
flourishing research is helpful.
3. Flourishing, operationalized
At present, four strands of research on flourishing are especially
prominent. Three are rooted in positive psychology, where the concept of
S.S. Willen
flourishing plays a central role in research on a range of topics including
happiness, resilience, functioning, and well-being. The largest body of
scholarship involves the development, refinement, and deployment of
quantitative indexes to assess and investigate flourishing, primarily at the
population level (Diener et al., 2010; Hone et al., 2014; Huppert & So,
2013; Keyes, 2002; Ryff & Singer, 2008; Seligman, 2011; VanderWeele,
2017). Much of this work aims to rethink mental health by shifting away
from deficit models (e.g., models focused primarily on distress, suffering,
and trauma) to positive or asset-based models (e.g., Keyes’ focus on
“mental health as a syndrome of symptoms of positive feelings and positive
functioning in life” ((Keyes, 2002); emphasis added; see also Lee, Kub-
zansky, & VanderWeele, 2021; VanderWeele et al., 2019).
Two newer bodies of scholarship merit mention as well. The first aims
to develop an “integrative” scientific approach to flourishing by
leveraging findings from a national longitudinal study (MIDUS: Midlife in
the US National Survey) to investigate behavioral, biological, and
neuroscientific mechanisms and processes (Cole et al., 2015; Heller et al.,
2013; Ryff, Boylan, & Kirsch, 2021; Ryff, Heller, Schaefer, van Reekum,
& Davidson, 2016; Ryff, Singer, & Dienberg Love, 2004). Although
rooted in the scholarship of positive psychologist Carol Ryff, this work
extends well beyond the psychological domain to investigate the re-
lationships between quantitative measures of flourishing and biological
indicators such as neuroendocrine, immune, and cardiovascular function,
rapid eye movement (REM) sleep, and gene expression.
In a third tradition, flourishing has been proposed as a kind of a new
north star for health research, clinical care, and policy efforts. In this
emerging body of work, which includes the well-funded research ini-
tiatives mentioned earlier, epidemiologist and religion scholar Tyler
VanderWeele plays a leading role. Here, flourishing often is used inter-
changeably with “well-being,” typically in ways that focus tightly on
individual mental (and at times physical) health. Importantly, this work
on flourishing/well-being diverges sharply from a separate body of
scholarship that operationalizes “well-being” in ways that are attuned to
issues of structure, power, and (in)justice (see, e.g., Plough, 2018,
Plough, 2020; W ojcik, Miller, & Plough, 2020).1
This third strand of flourishing/well-being research exhibits a keen
interest in virtue, character, religious belief, and religious involvement.
At times, scholarship in this tradition appears to stake normative claims
about the relationship between specific (i.e., Christian, EuroAmerican)
conceptions of virtue and religious engagement and the capacity to
flourish (Institute for the Study of Religion, 2021; Lee, Białowolski, et al.,
2021; Lee, Kubzansky, et al., 2021; VanderWeele, 2017; Węziak-Biało-
wolska et al., 2021). In just a few short years, this approach to flourishing
has generated the long list of peer-reviewed publications mentioned
above; a thick (and internally contentious) interdisciplinary volume
focused on questions of theory and research method (Lee, Kubzansky,
et al., 2021); and spinoff fields of study (e.g., “positive epidemiology”
(VanderWeele et al., 2020) and “positive biology” (Farrelly, 2021)), in
addition to the five-year, 22-country, 240,000-person global survey
mentioned above.
Finally, flourishing is also an emerging theme in the critical social
sciences of health, including critical public health, critical medical an-
thropology, disability studies, human rights, and bioethics. While
scholars in these fields engage the concept in different ways, they differ
1
An important future task will be to similarly scrutinize the polyvalent
concept of “well-being.” Some usages focus narrowly on individual psychology
to the neglect of broader structural and political considerations—or even
redefine “well-being” in ways that directly contravene the core values of public
health and related health fields (e.g., Beets, 2019)—and thus warrant the same
kind of critiques offered here. Others, however, take an altogether different tack.
In particular, research and policy efforts grounded in the Robert Wood Johnson
Foundation's “culture of health” framework explicitly consider how power,
structure, ideology, and history affect individual and collective possibilities for
living a healthy and, in effect, a flourishing life (Chandra, 2020; Plough, 2018,
2020; Thomas and Fietje, 2020; Willen et al., 2022; W ojcik et al., 2020).
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SSM - Mental Health 2 (2022) 100045
from positive psychologists in putting questions of structure and power,
historical context and present-day questions of (in)justice front and
center. In addition, many resist the idea that flourishing can, or should,
be measured in the first place. In the critical social sciences of health,
invocations of flourishing extend well beyond the psychological and
mental health domains to include philosophical, moral, even existential
questions about what it means to pursue a “good life,” to reach one's
potential, and “to lead lives [people] have reason to value” (Marmot,
2017)—either as individuals, or for communities as a whole. Research
topics range widely, spanning issues as varied as chronic illness in chil-
dren, clinical care for migrant patients, and issues of gene editing and
justice (Mattingly, 2014; Parens and Johnston, 2019a; Willen, 2019;
Willen et al., 2021).
Across these four areas of scholarship, what aspects of flourishing are
held in common? First, it consistently is defined as a desired condition or
state that is entwined, but not contiguous, with health, broadly construed.
Second, it figures consistently as an interdisciplinary concept, although
disciplinary pairings and combinations range widely, involving fields as
diverse as psychology, philosophy, critical theory, anthropology,
disability studies, neuroscience, endocrinology, and theology, among
others. On both counts, we see clear evidence that flourishing is a flexible
boundary object that carries “different and quite specific meanings in
intersecting communities but also has a common meaning to facilitate
cooperation across communities” (Timmermans, 2015: 4).
At the same time, noteworthy differences limit opportunities for
cooperative engagement. One difference is especially prominent: of these
four bodies of work, just one pays substantive attention to how structural
conditions, relations of power and inequality, and present and historical
encounters with justice and injustice might affect flourishing now, or
how they bear relevance for efforts to promote human flourishing more
broadly.
4. Toward a more capacious understanding of flourishing and
health
In an effort to advance more fulsome critical engagement with
flourishing especially as it pertains to mental health, the papers in this
series engage three themes that are deeply significant from a critical
social science perspective, yet largely under-investigated in the broader
span of interdisciplinary scholarship on the topic. Below we consider
them in turn.
4.1. Flourishing in everyday perspective
First, what does flourishing mean to real people in real-world settings,
and how do everyday perspectives differ from scholarly definitions like
those introduced above? Most current research on flourishing gives short
shrift to vernacular—or what anthropologists would call
“emic”—perspectives. Rarely have everyday people (i.e., laypeople, or
nonspecialists) been asked to discuss, from their standpoint, what
flourishing looks or feels like, what makes flourishing possible, or what
might stand in the way and thwart their ability to flourish.
Two articles in the series (Cele et al., 2021; Willen et al., 2022)
respond directly to this critique by using qualitative research methods to
ask interviewees about their own views and experiences—i.e., whether
they would describe themselves as flourishing, why or why not, and what
has helped them or stood in the way. In a similar vein, Lanteigne and
colleagues (2021) call for qualitative research with adolescents facing
chronic health conditions, for whom the transition from pediatric to adult
care can pose significant challenges. Although transitional care itself has
received a good deal of scholarly and evaluative attention, young people
rarely have a chance to lend input in such evaluative efforts. What does
flourishing mean to these adolescents? What do they need, from their
perspective, to flourish? How do the broader contexts of their lives in-
fluence their possibilities for flourishing? How might their insights help
strengthen efforts to evaluate the institutional management of these
S.S. Willen
critically important moments of clinical transition? Investigating ques-
tions like these can have a significant impact on how clinical care is
designed, provided, and evaluated.
4.2. Flourishing and sociocultural context
Once we agree that vernacular perspectives on flourishing are worth
taking seriously, two things becomes immediately apparent: those per-
spectives vary widely, and they are deeply informed by context, espe-
cially sociocultural context. The paper by Cele and colleagues (Cele et al.,
2021) offers an especially clear illustration of how sociocultural values
and commitments can shape ideas about flourishing. For interviewees in
Soweto, an urban South African township outside of Johannesburg,
flourishing is regarded as something that must be pursued rather than
passively received. The English notion of flourishing, the authors find, is
best approximated using the IsiZulu term ukuphumelela, which roughly
translates as “becoming victorious.” This formulation reflects a constel-
lation of local values and priorities, and these values and priorities
diverge in important ways from abstract formulations of flourishing
developed by EuroAmerican researchers in Western research contexts.
In particular, the authors show how the pursuit of flourishing, or
“becoming victorious,” in Soweto is deeply entwined with local un-
derstandings of relational obligation and expectation that are connected
to the broader concept of ubuntu (i.e., the idea that “a person is a person
because of other people”). This interrelationship among sociocultural,
moral, and relational concerns is not unique to the South African context.
As medical anthropologist Cheryl Mattingly suggests, the pursuit of
flourishing often is entwined with questions of whether one can meet
one's obligations to others, including obligations associated with phys-
ical, emotional, and material care (Mattingly, 2014); see also (Willen,
2019; Willen et al., 2021)).
Other critical social sciences of health—disability studies, for
instance—similarly insist that one's capacity to flourish is affected by the
fundamental facts of human vulnerability and interdependence (Gar-
land-Thomson, 2005; Kittay, 1999). Some fields even argue for an
expanded conception of interdependence that extends beyond human
relationships to include other species, other aspects of nature (e.g., for-
ests), or even the natural world in full. From this standpoint, a strong
emphasis on discrete, autonomous individuals and internal psychological
processes occludes attention to vital sociocultural and relational di-
mensions of flourishing, and also to the forms of moral indebtedness and
obligation they entail. Anthropologists working in South America, for
instance, are inclined to find Western conceptions of flourishing trou-
blingly anthropomorphic. Some point to the indigenous South American
concept of buen vivir—a collective and pluralist concept that might be
translated as “good living together” (Acosta, 2012), “living well,” or
“living in harmony” (Severance, 2021)—as either corollary or even
counterpoint (Abadía-Barrero, 2020). Importantly, the notion of buen
vivir does not just signal the impact of the natural world on humans'
capacity to flourish, but goes a good deal further: it radically re-envisions
the relationship between humans and nature, in effect insisting that one
cannot flourish without the other (Walsh, 2018).
4.3. Flourishing as moral pursuit
A third theme of interdisciplinary relevance involves the relationship
between flourishing and ideas about what is good, right, and moral. Clas-
sical conceptions of flourishing—including the ancient Greek concept of
eudaimonia most associated with Aristotle—are rooted in universalizing
ideas of virtue, as addressed more fully below. In the contemporary
moment, we contend, it is both empirically and ethically problematic to
presume that the capacity to flourish could possibly hinge on a singular or
universal notion of what is morally virtuous, good, or right. In this respect,
the papers collected here align with bioethicist Bruce Jennings's claim,
drawing on philosopher Martha Nussbaum's capability theory (2011), that
“there is no single, uniquely right way to flourish as a human being” (2019:
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SSM - Mental Health 2 (2022) 100045
256). Locally salient understandings of flourishing vary widely and, once
again, are deeply influenced by prevailing social norms, religious views, and
cultural expectations. Formulations of flourishing that hold explanatory
power in one sociocultural setting may fail to translate across languages or
cultural contexts (Cele et al., 2021; Garland-Thomson, 2019; Jennings,
2019; Kono & Walker, 2020; Lewis, 2019; Mathews, 2009; Mathews and
Izquierdo, 2009; Parens and Johnston, 2019a; Roberts, 2019; Thomas and
Fietje, 2020; Willen, 2019; Willen et al., 2021). The question of how per-
spectives differ is an empirical one—and it merits qualitative inquiry.
Despite strong evidence of this variability, some flourishing scholarship
nonetheless seems to harbor an assumption that Western values and as-
sumptions are, or should be, universally salient (e.g., (Lee et al., 2021;
VanderWeele, 2017; Węziak-Białowolska et al., 2021)). For instance, some
identify virtue as a core aspect of a flourishing life, then proceed to define
virtue in ways that comport with a culturally particular—i.e., Western,
generally Christian—conception of moral value. Examples include studies
claiming that people who participate in a religious community, or who get,
or stay, married, are more likely to flourish than others. From an anthro-
pological standpoint, both the presumptions undergirding such claims and
the methods used to investigate them demand critical review.
On one hand, the papers collected here certainly do show that moral
values and commitments can inform local conceptions and pursuits of
flourishing. Yet they also demonstrate with equal clarity the local par-
ticularity of such moral foundations—i.e., how such moral commitments
emerge in real-world settings, and in the context of real people's
complicated and often messy lives. We call on fellow flourishing re-
searchers to avoid assuming that opportunities to flourish necessarily
hinge on any particular understanding of “virtue” or “character,” or any
particular moral outlook or orientation, and instead approach morality
and moral commitments through a broadly ecumenical and comparative
lens that engages qualitative research approaches.
Before introducing the papers themselves, let us turn briefly from the
task of critique toward the more forward-looking task of asking: How can
we build a bridge between flourishing research, on one hand, and the
critical social sciences of health, on the other?
5. Aristotle and an epigenetic analogy: Rethinking flourishing
and human potential
With this goal in mind, this section sketches out a flexible way of
thinking about flourishing that takes a deceptively simple question as
point of departure: What might we learn by revisiting the ancient Aris-
totelian understanding of flourishing, or eudaimonia as he called it,
through a contemporary critical lens?
Most contemporary work on flourishing has roots, to a greater or
lesser extent, in Aristotle's concept of eudaimonia, a term that has long
proven difficult to render in English. Although “flourishing” is a common
translation from the ancient Greek, alternatives—especially “happiness”
and “the good life”—carry markedly different and, some argue, deeply
misleading connotations (Kleinig & Evans, 2013; Mattingly, 2014; Ryff,
1989; Ryff & Singer, 2008). While a comprehensive discussion of these
translational debates lies beyond our scope, a few points are worthy of
note. First, considerable debate revolves around the question of whether
or not eudaimonia ought to be rendered in English as “happiness” (Diener
et al., 2010; Seligman, 2011). Opponents of this interpretation insist on
distinguishing between enduring positive dispositions, or eudaimonia,
and more fleeting experiences of affect and satisfaction, which they
suggest are better captured by the concept of hedonia. One leading critic
is Ryff, who laid the groundwork for the vast trove of scholarship on
“eudaimonic well-being” that sparked the “integrative science” approach
to flourishing mentioned above.
In fact, the concept of eudaimonia involves another form of defini-
tional ambiguity as well. In an important piece published over three
decades ago, Ryff argued that mistranslations of eudaimonia as “happi-
ness” set psychological research on a mistaken path that effectively dis-
rupted two decades of scholarly inquiry (Ryff, 1989). In a noteworthy
S.S. Willen
passage that merits renewed attention, she explores the etymology of the
ancient Greek notion of “daimon” at the root of the concept Aristotle
made famous, invoking a genealogy offered in a 1984 book by
Waterman, also a psychologist. The daimon, we learn, originally referred
to “a kind of guiding spirit provided at birth” (Waterman, 1984: 17) but
later was reconceptualized in internalized terms—as Heraclitus put it, as
“man's character” (ibid, citing (May 1969: 133)). Waterman reinterprets
the term for his late 20th century audience as follows: “To be consistent
with the standards for contemporary theories, the daimon should be
interpreted as being a number of interrelated psychological processes”
(Waterman, 1984: 17). Five years later, Ryff offered her own updated
definition, now linking flourishing to the realization of one's human
potential. Eudaimonia, she claims, refers to “the feelings accompanying
behavior in the direction of, and consistent with, one's true potential”
(Ryff, 1989 citing Waterman, 1984: 16; emphasis added). In her view,
“Had Aristotle's view of eudaimonia … been translated as realization of
one's true potential rather than as happiness, the past 20 years of research
on psychological well-being might well have taken different directions”
(Ryff, 1989: 1070).
Ryff's rereading of flourishing may support a conceptual bridge across
disparate fields of contemporary flourishing scholarship, but from a
critical social science perspective her reinterpretation does not go far
enough. For Aristotle, individuals were morally accountable for their
own flourishing, and both Waterman and, to a lesser extent, Ryff carry
forward Aristotle's original idea that individuals are morally obligated to
act in ways that will enable them to realize their potential. Waterman, for
instance, remains agnostic about whether individual potential is
inherent, yet he does suggest that some people exhibit moral failure by
“defaulting” on their potential (Waterman, 1984: 17). Troublingly, his
discussion of why some people “default” on their potential fails to
distinguish between causes rooted in personal decisions or conduct and
those rooted in adverse life circumstances. As suggested earlier, this sort
of troubling moralization of eudaimonia/flourishing/potential persists in
some circles today—including moralizing presumptions that certain
culturally-specific choices and actions should be encouraged, or even
promoted through government policies, in an effort to promote oppor-
tunities to flourish.
In short, while much can be gained by reclaiming Aristotle's under-
standing of flourishing as a matter of having the ability to realize one's
potential, we must reinterpret this insight with a twist—specifically, the
twist of an epigenetic analogy. Given all we now know about the inter-
play of individual proclivity and inhabited environments—structural,
political, economic, environmental, social, etc.—the time has come to
wrest older ideas of potential from their dependence on moralizing
concepts of “character” or “virtue.” We must recognize that people's
ability to realize their potential—to cultivate whatever intrinsic leanings
they regard as most meaningful or significant in life—will depend to a
significant extent on the structural, material, political, economic, social,
environmental, and ideological environments they inhabit, and in which
they form and develop. Bioethicist and disability scholar Rosemary
Garland-Thomson makes the vital importance of this interrelationship
clear when she notes that, “Hostile environments thwart flourishing,”
whereas “congenial environments promote it”
(Garland-Thomson, 2019: 24).
This expansive reconceptualization of what it means—and what it
takes—to realize one's potential can help bridge these two largely
disconnected bodies of research—flourishing on one hand, critical public
health, broadly defined, on the other—and scaffold new modes of
research, clinical intervention, and policy engagement, at multiple levels.
6. The papers
Each of the papers collected here advances this critical project in a
different way. In the first paper (“Rethinking Flourishing: Critical In-
sights and Qualitative Perspectives from the U.S. Midwest”), Willen et al.
(2022) issue an urgent call for interdisciplinary discussion about what
5
SSM - Mental Health 2 (2022) 100045
flourishing means, how we should study it, and how it can best be pro-
moted, especially in relation to mental health. Building on the frame
outlined in this introduction, they argue that the proposal to reorient
health research, care, and policy around the goal of promoting human
flourishing is intriguing, but that current proposals to this effect must be
met with caution—and preceded by robust interdisciplinary dialogue. As
a step in this direction, they critically examine leading conceptions of
flourishing in positive psychology and compare them to current ap-
proaches in the critical social sciences of health. In the second half of the
paper, they bolster their critique by analyzing original findings from
ARCHES | the AmeRicans’ Conceptions of Health Equity Study, a mixed
methods study conducted with a diverse sample in the Midwestern U.S.
city of Cleveland, Ohio (n¼167). These empirical findings, which are
analyzed both quantitatively and qualitative, reveal major gaps between
“emic” and “etic” conceptions of flourishing including, in particular, the
troubling inattention to structure, power, and and inequity noted above.
Robust interdisciplinary dialogue, the authors contend, can strengthen
the project of bridging disciplines and methodological approaches and, in
so doing, “bring us closer to an understanding of flourishing that can
reinvigorate our thinking around health in a way that bends toward
justice.”
In the second paper (“Ukuphumelela: Flourishing and the Pursuit of a
Good Life, and Good Health, in Soweto, South Africa”), Cele et al. (2021)
further demonstrate how qualitative inquiry into everyday struggles to
flourish can raise vital questions about the current state of flourishing
research, generate important critiques, and yield new forms of clinically-
and policy-relevant insight. The paper analyzes a series of qualitative
interviews conducted with 30 residents of Soweto using an adapted
version of the ARCHES interview guide. The authors highlight the
importance of probing vernacular understandings of flourishing—as well
as the challenges involved in doing so, especially across languages and
cultural settings. Their paper shows how the idea of flourishing can have
powerful currency in everyday contexts, even in a multicultural, multi-
lingual context where the term itself can be difficult to translate. Their
qualitative findings show how the very idea of flourishing, including the
words used to capture and communicate about it, are shaped and
informed by local sociocultural and political-economic context, yielding
grounded insights that call into question the possibility of asserting any
universal (or universalizing) definition of flourishing. Cele and col-
leagues foreground several considerations that are important to their
South African interlocutors but missing from prevailing conceptions of
flourishing, among them): (1) the impact of material and structural fac-
tors, (2) variation among and complexity of interpersonal relationships
(as opposed to the straightforward presence or absence of close social
ties), and (3) the powerful role of moral values, including moral obli-
gations associated with expectations of reciprocity under conditions of
material scarcity.
The third paper (“The Evaluation of Pediatric-Adult Transition Pro-
grams: What Place for Human Flourishing?”), by Lanteigne et al. (2021),
hinges on a very different question: the question of whether, and if so
how, a carefully operationalized construct of flourishing—in this
instance, the six-dimensional model developed by Ryff and Singer (Ryff
& Singer, 2008)—might help improve clinical care. Lanteigne and col-
leagues offer a scoping review designed to assess whether Ryff and
Singer's model is employed in efforts to assess a particularly sensitive
clinical moment: the moment in which young patients with chronic
health conditions transition from pediatric to adult care. The paper
presents a systematic review of 105 papers analyzed using a content
extraction strategy designed to assess which, if any, dimensions of Ryff
and Singer's model (self-acceptance, positive relations with others, per-
sonal growth, purpose in life, environmental mastery, and autonomy)
figure in current evaluation strategies. The authors find that some eval-
uation strategies assessed a few of these dimensions, but none evaluated
all six in any consistent or substantive way. Looking ahead, the authors
argue that participatory and collaborative research approaches can help
institutions and care providers better understand what their young
S.S. Willen
patients with chronic conditions want and need. Qualitative insight, they
suggest, can help improve assessment of transition care efforts, and in so
doing support the development of transition care strategies that can
support patients' flourishing and, by extension, their health.
7. Conclusion
Flourishing is not a static abstraction. Rather, it is a living concept,
rich with explanatory power and insight, that has deep genealogical roots
and significant implications for how we think about health in general and
mental health in specific. As a boundary object, it can be multiply
interpreted in ways that promote understanding at times while thwarting
it at others. Given its ancient roots and myriad contemporary usages,
flourishing is clearly a concept that requires periodic reevaluation over
time. At the moment, it is also a concept on the rise, garnering significant
attention from researchers, and significant investment from private
funders, including some whose framing and goals threaten to flood the
landscape with a narrow set of questions and approaches and crowd out
alternatives and critiques, including those articulated in this series. For
all of these reasons, the stock-taking exercise outlined here and advanced
in this series is both timely and important.
Against this changing backdrop, the papers collected here lend strong
support to the argument that it is neither reasonable nor helpful to
conceptualize flourishing as a purely internal matter. Neither can we
ignore the fact that opportunities to flourish are shaped and constrained,
advanced and thwarted by the broader circumstances of people's lives,
ranging from the structural circumstances in which they live, to the so-
ciocultural fabric of their communities, to their social position within
society’s power hierarchies. Critical medical anthropology, critical public
health, and related critical social science fields have vital roles to play in
clarifying the implications of these key insights.
Once again, our aim in this series is not to adjudicate among
competing understandings or definitions; to the contrary, our intent is to
pose new questions and lay the groundwork for interdisciplinary dia-
logue. The importance of expanding our field of vision along the lines
proposed here cannot be overstated. Indeed, the series prompts a ques-
tion that all flourishing researchers ought to ask themselves: How could
academic researchers, public health professionals, elected officials, or
policymakers possibly hope to develop substantive strategies for pro-
moting human flourishing without taking structure and power into
consideration, or without first taking time to really listen to those whose
opportunities to flourish have been limited or curtailed? Furthermore,
how could we possibly increase flourishing across communities and
populations without concerted effort to look upstream and confront the
root causes (Link & Phelan, 1995; Yearby, 2020) of existing inequities
that stand in the way?
We hope that the critical perspectives offered here, along with our
proposal for a critical rereading of flourishing's Aristotelian roots, will
spark new forms of thinking and dialogue about what it means to
flourish, and about how opportunities to flourish can, and ought to be,
promoted, especially in these trying pandemic times. In particular, we
hope that all those committed to the promotion of human flourishing—at
the individual or collective level, in clinical settings, policy conversa-
tions, or activist efforts—will remember Garland-Thomson’s powerful
insight. We can no longer ignore the fact that flourishing will be difficult,
if not impossible, in “hostile environments”—and if we genuinely want to
promote flourishing, we need to confront hostility at its source, even as
we mobilize to remediate its downstream effects.
We fully expect that the papers collected here will fall differently on
the ears of researchers, clinicians, and other stakeholders in various
fields. In rather typical anthropological fashion, we have sought to
critique a powerful and influential concept, to complicate it, and to
foreground the value of investigating it in “emic” terms, using qualitative
methods. In fields that prefer tightly constructed conceptual models
rooted in “etic” (analytic, researcher-generated) logic and quantifiable
components, these theoretical and methodological interventions may
6
SSM - Mental Health 2 (2022) 100045
seem perplexing, or frustrating, or unnecessary.
If we can agree, however, that clinical care and public policy in
mental health should support people's capacities to flourish, to be healthy,
and to achieve their potential, then scholars in diverse fields have much
to learn from one another. The time is ripe for cross-disciplinary ex-
change along these lines, and the present collection aims to help build a
strong bridge capable of supporting this kind of vital dialogue.
Funding
Support for this work was provided by the Robert Wood Johnson
Foundation (Grant No. 74898). The views expressed here do not neces-
sarily reflect the views of the Foundation.
Declaration of competing interest
The author declares that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
Acknowledgments
The author thanks Abigail Fisher Williamson, Colleen C. Walsh,
William Tootle, Jr., Mikayla Hyman, Sebastian Wogenstein, Micki McE-
lya, Emily Mendenhall, colleagues in the Research Program on Global
Health and Human Rights at the University of Connecticut's Human
Rights Institute—especially Kathryn Libal, Cesar Abadía-Barrero, Audrey
Chapman, Thomas Buckley, Molly Land, Sara Silverstein, Davis Chac on-
Hurtado, and Megan Berthold—and students in the Fall 2019 course
"Flourishing and Well-being in Interdisciplinary Perspective" for many
rich discussions, as well as two anonymous reviewers for their valuable
critical feedback.
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