Home Language & Literature The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health
As presented above, there are clear and significant differences between SWB (i.e. a measure for assessing the subjective success of a life) and PWB (a more substantive way of understanding what it means for a human being to flourish). However, it is also important to recognise the commonalities between the concepts which derive from their shared disciplinary grounding in North American quantitative psychology. First, they both have an unquestioning commitment to a methodological and ontological individualism. The individual is the unit of analysis, and the individual is psychological, affected by the material, social, and cultural milieu but not fundamentally constituted through these. This is typically criticised in terms of a cultural bias, drawing attention to the fact that people in other geographical locations see relational- ity as fundamental to personhood (e.g. Christopher 1999; Christopher and Hickinbottom 2008). While there is a cultural dimension to this, it is also a disciplinary bias. Qualitative sociological work approaches subjectivities of wellbeing as much more fluid, provisional, and relational constructions, a matter, to quote Atkinson (2013), of ‘assemblages’ rather than ‘components’. Indeed within psychology itself, feminist writers such as Mama (2002) and Benjamin (1988), along with the whole tradition of psychoanalysis, clearly contest simplistic models of personhood that are mobilised by positive psychology. The key issue here is whether it is such a simple thing to know and speak one’s true feelings or make an assessment of one’s life.
Secondly, both PWB and SWB are governed by the culture and institutions of statistical research: disciplinary rules about the generation of data, forms of analysis and model validation, and the reporting of results. This builds in a conservative bias, not necessarily in terms of ideological politics, but in the logic of research. For example, scales that have already been ‘validated’ raise fewer questions from potential reviewers and conventional measures allow comparison with other studies and contexts. This betrays a structural commitment to universalist approaches over contextual ones: a scale ‘proves’ itself by being ‘validated’ in multiple settings. But the fact that people can be induced to respond to a given scale does not mean that it necessarily reflects anything about how they actually think about their lives. This construct validity can be present but relevance and meaning relatively absent. And the strong bias towards existing measures limits the potential for innovation and restricts the scope for something quite unexpected to be discovered.
Thirdly, and following on from this, the dominant methods used in such research—closed questions or statements which are answered on a Likert scale—are highly limiting and disciplining to respondents. Ordinary people in most parts of the world do not live their lives in the general, but the particular, not in the abstract, but the concrete and embodied. However sensitive one seeks to be in reflecting the contexts in which lives are lived (and the rules of the game as set out in the previous paragraph place strict limits on this) the structure of these questions and their requirement to abstract from and generalise about one’s life are very far from the ‘natural’ way that people choose to express themselves (White and Jha 2014). You cannot capture the texture of the lived experience of wellbeing through a number on a scale of 1—10! Schwarz (1999) argues persuasively how ‘the questions shape the answers’ in questionnaire research, because respondents seek to pick up from the structure and format exactly what is required. This raises the question as to whether the relative stability of SWB [Cummins (2009) reports a global norm of around 75%] might be as much a property of the scale—people’s choice to represent themselves as happier rather than unhappier but not ecstatic—as a reflection of inner feelings. In addition, average scores vary according to whether cultural norms encourage positive (ideal-type North American) or modest (ideal-type East Asian) statements about the self (Diener et al. 2000). Differences in average levels of response across societies might thus not tell us anything about people’s actual ‘happiness’, but rather social and cultural norms about the ‘presentation of self’ (Goffman 1959).
Going one step further, it is possible to see how the fact of undertaking a survey itself is placing strict limits on what you can and cannot discover: you can only allow what will fit the categories you have pre-determined. Qualitative methods that allow people to define their own categories or to present their well-being without such prescribed classifications provide openings for exploring how people present their lived experiences (Camfield et al. 2009; White and Jha 2014). Ethnographic methods, for example, facilitate opportunities for researchers to gain insight into complex emic perspectives on wellbeing and mental health (see also chapter 10 by Mills and White in this volume).
Fourthly, their commitment to the individual as unit of analysis severely limits the ability of these approaches to recognise the social and political. Seligman (2011, p. 16) provides an extreme example of this, as with extraordinary naivety he characterises his (new) wellbeing theory as:
essentially a theory of uncoerced choice and its five elements comprise what free
people will choose for their own sake.
As the work of Lukes (1974) and many others shows, ‘choices’ are never completely ‘free’ but reflect values, preferences, and opportunities, all of which are shaped and made available or unavailable to different kinds of people through complex social and political processes. The social and political context also constructs differential aspirations and feelings of satisfaction or acceptance (Appadurai 2004). High scores may reflect the low expectations of internalised oppression, rather than genuinely positive experience. This also affects the ratings of the same individuals over time. The use of subjective measures in policy evaluation is bedevilled by ‘adaptation’—the way that expectations shift with experience.
Choice is also foundational to SDT through its stress on autonomy:
Autonomous self-regulation is central in allowing the individual to choose and most fully develop preferred ways of being, and in doing so to satisfy basic psychological needs which in turn lead to vitality and happiness. (Ryan and Deci
2011, p. 45)
The importance of a sense of autonomy or personal agency to wellbeing is not in doubt. The issue is how this is conceived. Devine et al. (2008) consider whether autonomy emerges as significant to wellbeing in various pieces of research in Bangladesh, as an example of an environment which is poor in material resources but relationally dense and rich. They find that autonomy is important, but suggest that this is expressed through:
a complex array of situated autonomies that embrace a wide range of covert as well as overt behaviour patterns, decisions, and actions. (Devine et al. 2008,
Importantly, they go beyond the individual to argue:
autonomy is determined not only by the agential capacities of an individual but also by the nature of relationships he or she may enjoy with others. (Devine et al. 2008, p. 28)
Underlying all of this are epistemological questions about whether any approach to wellbeing can serve across all contexts, and ontological questions about the role of culture in the formation of personhood. Such questions apply, of course, to all characterisations of mental health or illness which claim to be universal. Obeyesekere (1985, p. 134) poses the problem neatly:
Faced with generalised feelings of loss and sense of hopelessness labelled depression in the USA, in Sri Lanka [we] would say that we are not dealing with a depressive but a good Buddhist.
Similarly, Fernando (2012) recounts her encounter with a Tamil woman who had been tortured by the Sri Lankan military. Her lack of distress was interpreted by Fernando to be the process of psychological denial. When asked what the torture experience meant to her, the woman replied: ‘Well, I am really looking forward to my next life. I must have done some terrible things to have deserved this horrible suffering. I know that in my next birth I will have the most wonderful life. This knowledge makes me happy’ (Fernando 2012, p. 397). Constructs of the experience and meaning of distress and mental health and illness cannot be understood through a universalist framework but are instead intertwined with context, culture, and beliefs of people and societies.
While theorists of PWB may recognise the importance of the social, material, cultural, and political environment in promoting, supporting, or undermining autonomy, this is conceived as an external relationship, in the mode of ‘the social determinants of health’. Such a framing cannot capture the ways that constructions of well-being or happiness are themselves implicated in relations of power. And yet this is critical if we are to understand what people are saying as they respond to the questionnaires. As Ahmed (2010, p. 5) points out, the context of happiness research is anything but neutral. If happiness is what everyone wants, then to be asked how happy you are is a very loaded question. Furthermore, if analysis centres on the individual, where is the space to consider
feminist critiques of the figure of ‘the happy housewife,’ black critiques of the myth of ‘the happy slave,’ and queer critiques of the sentimentalization of heterosexuality as ‘domestic bliss’ ____which expose the unhappy effects of happiness, teaching us how happiness is used to redescribe social norms as social goods. (Ahmed 2010, p. 2)
The ideological character of the promotion of happiness is similarly criticised by Held (2002) who talks of the ‘tyranny’ of the positive attitude and Ehrenreich (2009) amongst many others. Fernando (2012), in his reflection on the GMH research agenda, makes a different kind of critique as she questions who benefits from the focus on the suffering of communities in ‘low-power’ countries such as Sri Lanka: GMH researchers and their institutions benefit, journals who publish the findings, the research community as a whole, and the funders gain from the research. Notably less obvious is the benefit that participating communities themselves derive from these large- scale research studies on mental health and wellbeing, and Fernando argues that community benefit and wellbeing is as important as individual benefit.
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