Defining Wellness

by Peggy Swarbrick, PHD, OTR, CPRP

The term wellness is not new in society, although it is considered a relatively new framework as it relates to mental health recovery. Wellness is now being viewed as an important construct as it relates to personal recovery and mental health systems transformation. We use the term wellness quite broadly and often tend to focus on the physical dimension. Programs and state authorities are viewing wellness narrowly on the physical health. While physical health is important, it is critical to understand the wellness framework as a bigger concept, so that services and programs can be organized, and outcomes measured, more effectively.

The following will provide a brief history of the term wellness followed by a wellness framework. We hope you will consider this framework as a guideline, whether you are managing your life, seeking and using services, delivering services, or helping to manage and oversee a wellness-oriented service system.

Background
Wellness is an inspiring and powerful word in the English language. However it is one of the least understood, and therefore most open to interpretation and personal definition. Wellness is not a popular or exotic fad, but rather a philosophy of living that can help people live a more satisfying, productive, and happy life. Wellness offers a person a philosophy that supports healthy lifestyle habits that have positive effects on quality of life.

Aristotle surmised “the development of personal strengths (potentials) in the context of a balanced life may be the key to well being.” Hippocrates wrote “a wise person should consider that health is the greatest human blessings and learn to, by his/her own thought derive benefit from his/her illness.”

For centuries, philosophies of good living and health and well being have evolved within societies. Since early times, the ancient Greek people went to temples to remove themselves from stress and pulls of life. They focused on diet relaxation, self-examination that was believed to help restore energy and vitality as well as a sense of wholeness, harmony, and balance. There was a holistic view of individuals. Music, arts, exercise, healthy nutrition, play, and imagery were seen to promote healing and health.

Things such as art, philosophy, humor and spirituality were seen as lifestyle practices to replace

• Stress with harmony
• Anger with peace
• Despair with hope
• Isolation with community.

In 1961, Halbert Dunn started lecturing and writing articles about an idea he called “high level wellness.” Dr. Dunn stressed the importance of mind/body/spirit connections, the need for satisfactions and valued purposes, and a view of health as dramatically more than non-illness. He coined the term “high level wellness” and defined it as “an integrated method of functioning of which the individual is capable within the environment.” In this definition, there is no optimal level of wellness, but rather recognition that wellness is a direction in the progress toward an ever-higher potential of functioning (Dunn, 1961[3]). Wellness is not the absence of disease, illness, and stress but the presence of:

• purpose in life,
• active involvement in satisfying work and play,
• joyful relationships,
• A healthy body and living environment, and
• presence of happiness

During the 1960’s, 1970’s and 1980’s a variety of theoretical frameworks for wellness emerged. Dr Travis[4] published the Wellness Workbook and Dr Hettler [5] proposed a six 6 dimensional wellness model.

Wellness Defined Wellness approaches for mental health practice have been proposed in recent years (Copeland, 2002[6]; Hutchinson, 1996[7]; Swarbrick, 1997[8]; Weed, 1999[9]).

Wellness is a conscious, deliberate process that requires a person to become aware of and make choices for a more satisfying lifestyle. A wellness lifestyle includes a self defined balance of health habits such as adequate sleep and rest, productivity, exercise, participation in meaningful activity, nutrition, productivity, social contact, and supportive relationships[10]. It is important to note self defined because everyone has individual needs and preferences, and the balance of activity, social contact, and sleep varies from person to person. Wellness is the process of creating and adapting patterns of behavior that lead to improved health in the wellness dimensions (see the 8 Dimensional Model of Wellness below outlined by the Institute for Wellness and Recovery Initiative, CSP-NJ[11]). The following attempts to outline a framework for mental health recovery. Throughout 2010 we will highlight many aspects of these dimensions as they relate to personal and professional practices.

Eight Wellness Dimensions
(1) Physical

• Recognizing the need for physical activity, diet, and nutrition while discouraging the use of tobacco, drugs, and excessive alcohol consumption.
• Attention to physical and physiological signs of stress.
• Balancing the physical dimension by creating a self defined daily routine that includes adequate sleep and rest, walking or exercise, appropriate levels of activity and productivity, and involvement in creative or structured activity that counteracts negative stress responses.
• Learning to assume personal responsibility and care for minor illnesses and also knowing when professional medical attention is needed.

(2) Spiritual

• A broad concept that represents one’s personal beliefs and values; having meaning and purpose, and developing a sense of balance and peace. Our spiritual dimension recognizes our search for meaning and purpose in human existence. It includes the development of a deep appreciation for the depth and expanse of life and natural forces that exist in the universe.
• For many people healing and health is enhanced by exploring, respecting, and incorporating personal values and beliefs and awareness of a being or force that transcends the material world and gives a sense of connectedness to the universe.
• For many people, the spiritual dimension is closely related to cultural, religious, and/or spiritual traditions.

(3) Social

• The social dimension encourages contributing to the environment and community and emphasizes the interdependence between ourselves, others, and nature.
• Our ability to communicate our needs and ideas with people who support and care about us.
• Personal relationships, important friendships, and connection with people, pets, and the community.
• Like all other dimensions, people’s social connectedness and social wellness varies greatly. Some people have a few relationships, others have many. Some people have most of their relationships in one area of their lives, others have broader relationships.
• For many people, relationships involve a sense of reciprocity and equality.

(4) Intellectual

• Recognize our creative abilities and find ways to expand our knowledge and skills while discovering the potential for sharing those gifts with others. Lifelong learning, application of knowledge learned, and sharing knowledge.
• The intellectual dimension can be activated through a wide array of activities. Many people find it useful to set aside time regularly to pursue personal interests, such as reading books, magazines, and newspapers and engaging in other means of keeping abreast of current issues and ideas.

(5) Emotional/Mental

• The capacity to recognize our feelings; involves the ability to express feelings, adjust to emotional challenges, cope with life’s stressors.
• Ability to assess our strengths, limitations, and areas we want to develop further. Tolerance, and the awareness of and acceptance of a wide range of feelings in ourselves and others.
• The ability to live and work independently while realizing the importance of seeking and appreciating the support and assistance of others.
• The ability to take on challenges and recognize conflict as being potentially healthy.

(6) Occupational

• The opportunity to participate in activities that are meaningful and rewarding, and provide meaning and purpose.
• Activities that reflect personal values, interests and beliefs.
• Personal satisfaction and enrichment in one's life is derived from participation in work and volunteer activity as well as other activities and tasks from which we derive pleasure and satisfaction.

(7) Environmental

• The environment includes our living, learning, and working spaces and the larger communities where we participate as citizens.
• Good health can be fostered by occupying pleasant, stimulating environments that support our well-being. Additionally, good health can be enhanced by places and spaces that promote learning, contemplation and elicit the relaxation response.
• Being able to be and feel physically safe, in safe and clean surroundings, and able to access clean air, food, and water.

(8) Financial

• Refers to the objective perceptions and subjective indicators of individuals’ personal financial status. Objective indicators may include measures such as income, debt, savings and aspects of financial capability such as knowledge of financial products and services, planning ahead and staying on budget. Subjective indicators may include an individuals’ perception of satisfaction with current and future financial situation

[3] Dunn, H.L. (1961). High-Level Wellness. Arlington, VA: Beatty Press; Dunn, H.L. (1977). What High Level Wellness Means. Health Values, 1(1), 9-16.
[4] The Wellness Workbook, coauthored with Regina Ryan (Ten Speed Press, 1981, 1988, Celestial Arts, 2004)
[5] Dr Bill Hettler 6 dimensions of wellness http://www.hettler.com/OriginsoftheHettler6DimensionalModel.mht
[6] Copeland, M. E. (2002). Wellness Recovery Action Plan. West Dummerston, VT: Peach Press.
[7] Hutchinson, D.S., (1996) “Promoting Wellness in Rehabilitation and Recovery - A Call to Action”. Community Support Network News, Vol. 11, No. 2.
[8] Swarbrick, M. (1997, March). A wellness model for clients. Mental Health Special Interest Section Quarterly, 20, 1-4.
[9] Weed, D. (1999). Health Lifestyle Workbook for Consumers of Mental health Services. Fall River Health and Human Services Coalition, Inc., Massachusetts Health Research Institute.
[10] Swarbrick, M. (1997, March). A wellness model for clients. Mental Health Special Interest Section Quarterly, 20, 1-4.
[11] Collaborative Support Programs of New Jersey