Health Psychology. Michael Murray
as we shall see in Chapter 2. A broad spectrum of evidence from many scientific fields suggests that homeostasis is an organizing principle of considerable generality, not simply at the level of physiological need, but throughout the psychological universe of regulation of thought, feeling and action (Marks, 2018).
Throughout history, philosophers have discussed the nature of a good and happy life or what, in health care, is termed ‘quality of life’ (QoL). For Aristotle, happiness was viewed as ‘the meaning and the purpose of life, the whole aim and end of human existence’. For utilitarians such as Jeremy Bentham, happiness was pleasure without pain. To individuals suffering from cancer or other conditions with pain, unpleasant physical symptoms and treatment options, and an uncertain prognosis, QoL has special relevance.
QoL has been defined by WHO as (take a deep breath):
An individual’s perception of their position in life, in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns. It is a broad ranging concept, affected in a complex way by the person’s physical health, psychological state, level of independence, social relationships, and their relationship to salient features of their environment. (WHOQoL Group, 1995: 1404)
A sixth domain, concerning spirituality, religiousness and personal beliefs, was later added by the WHOQoL Group (1995). The Collins dictionary defines QoL more simply as: ‘The general well-being of a person or society, defined in terms of health and happiness, rather than wealth.’ The QoL concept overlaps with that of subjective well-being (SWB), which has been defined by a leader in the field, Ed Diener (‘Dr Happiness’), as: ‘An umbrella term for different valuations that people make regarding their lives, the events happening to them, their bodies and minds, and the circumstances in which they live’ (Diener, 2006: 400). The evidence linking SWB with health and longevity is strong and plentiful.
With a global population of more than seven billion unique individuals of diverse cultures, religions and social circumstances, one wonders whether QoL can ever be assessed using a single yardstick. A few courageous individuals and organizations have given it a try and, since the 1970s, many scales and measures have been constructed. A few examples are listed in Table 1.2.
By far, the most utilized scale to date has been the SF-36, which accounts for around 50% of all clinical studies (Marks, 2013). These ‘happiness scales’ are diverse and consist of items about what makes a ‘good life’. For example, Diener et al.’s (1985) brief Satisfaction with Life Scale (SWLS) uses a seven-point Likert scale with five items:
In most ways my life is close to my ideal.
The conditions of my life are excellent.
I am satisfied with my life.
So far I have gotten the important things I want in life.
If I could live my life over, I would change almost nothing.
Table 1.2
Using the 1–7 scale below, testees indicate their agreement with each item by placing the appropriate number on the line preceding that item. They are asked to ‘be open and honest’ in their responding.
7 Strongly agree
6 Agree
5 Slightly agree
4 Neither agree nor disagree
3 Slightly disagree
2 Disagree
1 Strongly disagree
For the vast majority of people, SWB is relatively stable over the long term. Using longitudinal data, Headey and Wearing (1989) reported that when the level of SWB changed following a major event, it tended to return to its previous level over time. To account for this, the authors proposed that each person has an ‘equilibrium level’ of SWB, and that ‘personality’ restores equilibrium after change by making certain kinds of events more likely. Restoration of equilibrium is nothing to do with personality; it’s a fundamental stabilizing process across all living systems, called ‘homeostasis’.
Diener and Chan (2011) review evidence that having high SWB adds four to ten years to life. The evidence for an association between SWB and all-cause mortality is mounting. As always, there could be a mysterious third variable influencing both SWB and mortality (e.g., foetal nutrition, social support, lifestyle) and, if the relationship between SWB and mortality did prove to be causal, the possible mediating processes would be a matter for speculation and further research. For the time being, it seems safe to assume that happy people live longer.
Subjective Well-Being Homeostasis
The most basic property of SWB is that it is normally positive. On a rating scale from ‘feeling very bad’ to ‘feeling very good’, only a few people lie below the scale mid-point. General population data from over 60,000 people gathered over 13 years by the Australian Unity Wellbeing Index surveys (Cummins, 2013) found that only 4% of scores lie below 50 percentage points. Feeling good about yourself is the norm.
While it has been generally agreed that SWB consists of both affect and cognition, it is thought that SWB mainly comprises mood (Cummins, 2016). Russell (2003) coined the term ‘Core Affect’ to describe a neurophysiological state experienced as a feeling, a deep form of affect or mood. Russell considered it analogous to felt body temperature in that it is always present, can be accessed when attended to, existing without words to describe it.
Robert A. Cummins introduced the idea that homeostasis is operating on SWB, as it does in biological systems of the body: ‘It is proposed that life satisfaction is a variable under homeostatic control and with a homeostatic set-point ensuring that populations have, on average, a positive view of their lives’ (Cummins, 1998: 330). Cummins suggested the concept of ‘Homeostatically Protected Mood’ (HPMood) as the most basic feeling state of SWB (Cummins, 2010). The concept of ‘HPMood’ places the regulation of mood in the same framework as physiological homoeostasis, which controls body temperature, blood pressure, and a thousand and one other bodily systems (Cannon, 1932). Cummins’ describes HPMood as follows:
1 It is neurophysiologically generated consisting of the simplest, constant, non-reflective feeling, the tonic state of affect that provides the underlying activation energy, or motivation, for routine behavior.
2 It is not modifiable by conscious experience, yet it is a ubiquitous, background component of conscious experience. It is experienced as a general feeling of contentment, but also comprises aspects of related affects, including happy and alert.
3 When SWB is measured using either the Satisfaction with Life Scale (Diener et al., 1985) or the Personal Wellbeing Index (International Wellbeing Group, 2013), HPMood accounts for over 60% of the variance.
4 Under normal conditions of rest, the average level of HPMood for each person represents their ‘set-point’, a genetically determined, individual value. Within the general population, these set-points are normally distributed between 70% and 90% along the 0–100-point scale.
5 For each person’s set-point there is a ‘set-point-range’, the limits within which homeostatic processes normally maintain HPMood for each individual.
6 HPMood ‘perfuses all cognitive processes to some degree, but most strongly the rather abstract notions of self (e.g., I am a lucky person). Because of this, these self-referent perceptions are normally held at a level that approximates each set-point range’ (Cummins, 2016: 63).
7 Under resting conditions, SWB is a proxy for HPMood. However, SWB can vary outside the set-point-range for HPMood when a strong emotion is generated by momentary experience. ‘When this occurs, homeostatic forces are activated, which attempt to return experienced affect to set-point-range. Thus, daily affective experience normally oscillates