From Floundering to Flourishing:
Four States of Mental Illness and Health
By Gillian Hilscher

There’s been a lot of talk about mental health in recent years, and the social isolation of the COVID-19 pandemic has only made these discussions more common. Mental health issues are an epidemic all their own, leading to psychological turmoil, chronic physical diseases, and debilitating emotional and financial burdens. But what exactly do we mean by “mental health,” and how is that different from mental illness? Is the mere absence of a mental illness enough to assume you’re at your very best? Psychologists Corey L. M. Keyes and Shane J. Lopez tackled these questions and more in the fourth chapter of their 2001 book, Handbook of Positive Psychology; we’ll break it all down for you here.

Keyes and Lopez argue that mental health and mental illness are not opposite ends of the same spectrum—mental health isn’t just the absence of mental illness, and vice versa. They support this argument with studies that demonstrate modest (but not strong) negative correlations between measures of subjective well-being and scales of depression; if well-being and depression were perfect opposites (i.e., if mental illness and health were on the same continuum), one would expect a stronger negative correlation between them. Keyes and Lopez claim that genuine mental health consists of two criteria: the absence of mental illness, and the presence of high-level emotional, psychological, and social well-being. They explain that there is a complete and incomplete version of both mental health and mental illness, which means there are four possible states a person could be in: complete mental health, incomplete mental health, incomplete mental illness, and complete mental illness.

Keyes and Lopez call these four states “flourishing,” “languishing,” “struggling,” and “floundering,” respectively. Neither flourishing nor languishing people have a recent mental illness, but flourishing people have high levels of well-being whereas languishing people’s well-being levels are low. Both struggling and floundering people have a mental illness, but struggling people manage to report moderate to high levels of well-being whereas floundering people experience low levels.

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Keyes and Lopez say that the “languishing” state is where many mental health patients are left after their therapies/treatments are finished. This is why, Keyes and Lopez argue, psychiatrists should focus on positive mental health: promoting mental health in addition to reducing mental illness symptoms through talk and/or drug therapies. They describe several trials in which exercises about optimism, hope, and well-being had significant effects in preventing the development of a mental illness; intervening in an existing mental illness before it worsened; and promoting mental health until it surpassed an individual’s previous baseline.

With the social distancing and isolation of the current world we live in, it’s more important now than ever to prioritize mental health; Keyes and Lopez suggest how this can be done. There’s still a lot we don’t understand about mental health and mental illness, but with more research and greater access to the right resources, it can be possible for us all to flourish.