What does mattering and fairness mean? And how can experiences of mattering and fairness improve wellbeing in people with mental health challenges? Why is it so important to feel valued, and to add value?
Recoverybloggen has interviewed Isaac Prilleltensky, who is a Professor of Educational and Psychological Studies and the Mautner Endowed Chair in Community Well-Being at the University of Miami. You can read more about professor Prilleltensky at his website.
Can you tell us about your work?
In general, my interests are in the promotion of wellbeing. And I have come to the realization that wellbeing is highly influenced by two important experiences in life. Experiences of fairness and experiences of mattering. One might say that wellness, or wellbeing, is highly influenced by fairness and worthiness. So worthiness is just another word for mattering. That people feel they have self-worth. Let me say a couple of things about wellbeing, and then I will try to explain how wellbeing is directly related to experiences of mattering, or worthiness, and what we call conditions of fairness.
Wellbeing is highly influenced by two important experiences in life. Experiences of fairness and experiences of mattering
I would like to focus on the relationship between wellness, fairness and worthiness/mattering. Let us start with wellness. Wellness – in our view – consists of several dimensions that we summarize in the acronym I COPPE. This stands for Interpersonal, Community, Occupational, Physical, Psychological and Economic wellbeing. There is a lot of research showing that they are all interrelated. For example, for people to experience psychological wellbeing we know that it is really crucial that they also experience interpersonal wellbeing. Social support, high quality relationships with friends and family and colleagues at work, in the community. So we know that psychological wellbeing is highly correlated with, and even predicted by, interpersonal wellbeing.
The same can be said about community wellbeing. If I am feeling a sense of belonging, a sense of community, that also impacts my psychological wellbeing. The same goes for economic wellbeing, I need to have my basic needs met. For example for housing, food, shelter and leisure.
You can be the richest person in the world materially, but you can be poor psychologically
We can think of wellbeing not only as multidimensional, but also as having two components. I call those subjective and objective wellbeing. Subjective wellbeing is my experience, my perceptions of how happy and healthy I am. But also objective wellbeing, for example; Am I free of illness and disease? Do I have a fever, or do I have cancer? Do I have enough financial resources? These are objective, measurable, quantifiable factors. So I like to say that wellbeing is both multidimensional, meaning interpersonal, community, etcetera, but also objective and subjective. And they are all important. This is really important to pay attention to. A person can be very wealthy and have a lot of material resources, but if the person doesn’t have any friends, or doesn’t experience any satisfaction at work, or doesn’t find any meaning in life, that’s not good. You can be the richest person in the world materially, but you can be poor psychologically. So they are all important. It is a holistic approach to wellness. I think when we are working with people with mental health challenges, it’s very important to supply them with the necessary objective resources, and subjective support.
So, that was about wellness. We know a little bit about its multidimensional, subjective and objective factors and that they are interrelated. Now, we have conducted some studies where we wanted to see what the impact is of both fairness and worthiness/mattering on wellness. And what did we find? In a study we conducted with a representative sample of the U.S population, people from different socioeconomic groups, ethnic backgrounds and so on, we found that the experience of mattering is highly predictive of wellbeing. So what is mattering, or worthiness? Feeling like you matter, that you count, that you are significant in society consists of two aspects. Feeling valued and adding value, or making a contribution to yourself or others. It is very important to feel valued also by yourself. To have a good sense of your self-worth, your self-concept, but also to be valued by others and not just by myself. My family, co-workers, community members, even the government. I have to feel valued by my municipality. When I require services and I come into contact with service providers, it’s very important that they treat me with dignity and respect, not just as a ‘needy citizen’ or a sick person or a person on welfare. I have to be treated with dignity and respect and feel valued.
I learn that if I make mistakes it is not the end of the world, and that I can learn from them
Now, the more I feel valued, the more confidence I have to add value. To contribute to the community. To volunteer in the community or to have an interesting job. So in summary, we can say that feeling like you matter, like you have social worth, consists of feeling valued and adding value by self and others. This can be a virtuous circle. Hopefully, most people in society grow up in families and go to schools where they are made to feel valued. They feel valued by their parents, their teachers, their soccer coach, their priest, whoever it is. We humans nourish our sense of self worth as babies through the messages we get from the environment. Because that is how we build our self worth. When our parents say that they love us, when they support us and nurture us and take care of our needs. So the more I feel valued, the more confident I am. To take risks, for example to learn something I don’t know, and to make mistakes. And I learn that if I make mistakes it is not the end of the world, and that I can learn from them. As opposed to growing up in schools and families where, if you make a mistake, you are made to feel ashamed. That you are not good enough. That you have failed.
If you have a negative experience you can learn from it, and it does not mean that you are a bad person
Fixed mindset or growth mindset
Eventually, people develop what we call either a fixed mindset or a growth mindset. But what is the difference? If you grow up in an environment where if you fail, people tell you that you are not smart enough or that you are not talented enough or that you are not good enough, then you develop a fixed mindset. Fixed meaning that you can’t change it. But if people tell you that it is okay, you tried, you will try again next time. It is all a learning process, it does not matter whether you fail or succeed because you are learning along the way. That is what we want everyone in society to feel. That if you have a negative experience you can learn from it, and it does not mean that you are a bad person. That is how we grow in society. We grow by failing. That is how people study to play the violin, and learn to play soccer or to speak other languages. By making mistakes and growing.
The more you have a growth mindset, the more you can feel that you want to add value to your life. How do you add value to your life? By learning, for example. By going to school, by learning hobbies. How do I add value to myself? By seeking good friends, for example. But also, people have a need to add value to others, and not just to themselves. You can add value to the community, to your workplace. And ideal workplaces are those where your colleagues, your boss recognize your contributions, and say ‘thank you, Isaac, for working hard’, and show you that you are appreciated. That creates a virtuous circle. I add value, I get made to feel valued. But it can also be a vicious circle. If I am not feeling valued I don’t feel confident to add value, because when I make a mistake people say ‘oh, you are terrible’.
So it turns out that when we measure mattering/worthiness, at a personal, interpersonal, occupational or community level, the higher people score on mattering in all these domains, the higher their level of wellbeing. So now we have talked about the role of worthiness in wellness. The more you feel respected, visible, appreciated and seen, the higher your wellbeing. But now, we have to consider the role of fairness in all of this.
Fairness makes me feel like I matter, and the more I matter the happier and healthier I am
We always think of fairness, wellness and worthiness across levels. It is not just interpersonal. It is not just ‘how do i feel about myself’, it is also relationships, work and more. When we measure fairness across relationships, work and the community, it turns out that fairness is a strong predictor of mattering/worthiness. The more fairness I experience, in my relationships, in the community, in dealing with the government, in dealing with work. The more people are fair with me, the higher the sense of worthiness and mattering, and the higher the sense of wellbeing. Interestingly enough, fairness sometimes impacts wellness directly. But most of the time it impacts wellness indirectly through experiences of mattering. In our study we found that when you live in a society where there are good economic resources, let us call it economic fairness, economic fairness impacts wellness directly. Going back to objective wellness that we talked about earlier. Objective fairness – like resources, healthcare, education, housing – impacts wellness directly. But all the other elements of wellness, psychological, communal, occupational, interpersonal, they are all mediated by mattering. This means that fairness makes me feel like I matter, and the more I matter the happier and healthier I am.
Inside out and outside in
So we did this with individuals. What did we learn? Fairness and mattering are very, very important of wellbeing. We might say that wellbeing now consists of elements that are from the inside out and the outside in. For example conditions of fairness, I am born into these conditions. If I am lucky, I am born in Trondheim. If I am unlucky, I am born in a terrible place where there is a lot of war and famine. We can say that these are external conditions to you. Your wellness is highly impacted by this, that I call the outside in, but also by the inside out.
What do I do with these experiences? And that is the part about my self-determination, autonomy and agency.
But before I get to that, let me complete the wellness and fairness story by saying that we also did a study across countries, not just comparing people, but comparing entire nations. There are databases from the OECD, from the World Values Survey, there are databases that compare countries. There is also a Social Justice Index that was developed in Germany that compares countries. So what did we find? We found that countries where there are better social justice policies like supporting immigrants, supporting the elderly, providing universal healthcare. Countries that uphold a lot of these policies make their citizens happier through two main mechanisms. They promote their autonomy. What is autonomy? Self determination, freedom, adding value. That I have an opportunity to explore my passion, my interests. That is called autonomy. But also countries that are high on social justice promote social capital. And what is social capital? Opportunities to engage in civic affairs. Volunteering in the community, like in the local hospital, welcoming refugees, coaching soccer or basketball, going to political meetings things like that. So what we are seeing is that the more autonomy and the more community building in a country, the higher the life satisfaction.
Those of us who work with people with mental health challenges, need to do whatever we can to make them feel that they matter
So what are the implications for people with mental health challenges? First of all, those of us who work with people with mental health challenges, need to do whatever we can to make them feel that they matter. Because they may have internalized negative views of themselves like ‘I am not a worthy person’, ‘nobody likes me’. A lot of people have this internal dialogue that says ‘you are not good’, ‘you are not worthy’, ‘you don’t belong in our family’, ‘you don’t belong in society’. And nothing could be worse for mental health.
It is also very important to help them to add value. First of all to themselves, because they are not feeling great about themselves. And there are different ways to do that. Now we are going back to the part about agency and the inside out. We have talked a lot about the outside in, how communities, relationships, workplaces impact our wellbeing. Now, how can we help people get healthier from the inside out? There are a number of effective techniques.
First of all is self-compassion. You know, just like we are compassionate to other people who are having problems, it is very important to restore a sense of self-compassion. That we can forgive ourselves. That we can love ourselves. That we have a share of humanity, that nobody is perfect. That we are all vulnerable. And that we are all in this world to grow and get healthier. So, helping people to accept themselves is one way.
And beyond that, to understand what it is that they want to achieve in life. Maybe they want to become a carpenter, or a basketball player or a great musician. What’s their passion? How can we support them to pursue their goals, their self-determination, so that they feel they are adding value to themselves and others? This is what is important – I think – when working with people with mental health challenges. That they are re-integrated into the community, and that they assume a helpful role. They shouldn’t just be in therapy forever for themselves, they should try to get out and to be helping other people. Because the more you help others, the more you help yourself. That is the great advantage of what is called the helper therapy principle. The more you help others, the more you help yourself, because you are adding value and you are feeling valued. And nothing could be more important in life than adding value and feeling valued.
It’s not just about a psychiatric problem. It’s about their whole lives
A good place to start
A good place to start when you are trying to help is to create a partnership with the people who are experiencing mental health challenges, to understand their goals and their aspirations. In other words; How to promote autonomy and self-determination. What is their wish? What do they want? Obviously, people want to get healthier, but it’s not just about a psychiatric problem. It’s about their whole lives. Some people are helped through therapy and medications, but I think it is really important to consider their whole lives and not just to see these individuals as sick people, as patients. They have full lives and dreams, and I think one of our goals is to understand deeply what their aspirations are, what they want to achieve.
There are a lot of proven methods to help people activate themselves. We know a lot from cognitive behavioural therapy, narrative therapy, positive psychology and behavioural economics, and interpersonal psychology, how people can set goals and pursue those goals.
Life is not just about suppressing bad emotions, managing bad things, but also about elevating happy moments
Fun for wellness
We developed a programme called funforwellness.com. It is free. In that programme we teach people how to leverage behaviours. For example how to set a goal and how to create a positive habit. Some people with mental health challenges are depressed, they have a problem getting up in the morning on time, and going to exercise, for example. So we help people to set goals and create positive habits. We also teach people how to leverage positive emotions. How do you cultivate positive emotions? Life is not just about suppressing bad emotions, managing bad things, but also about elevating happy moments. Gratitude, savouring, creativity, flow. How do we help people engage in happy activities. It can be a hobby, playing chess, going swimming, going fishing, whatever it is. We also teach people about how to create a new narrative for themselves, so they don’t just have the narrative that ‘I am a psychiatric patient’. They are full people. We work with them to journal, to define, a new life for themselves. That is one of the ways we can support them. We also teach people how to challenge negative assumptions. That is part of the thought process. If I have heard all my life that I am a failure, that I am no good, how could I learn to challenge that?
So, long story short, in this programme Fun For Wellness, which is freely available on the internet, we teach people all these dimensions that we call BET I CAN. And it stands for Leveraging Behaviors, you know, a goal, positive habits. Emotions, how to cultivate positive emotions, happiness, flow, savouring, gratitude and Thoughts. Then we teach people about Interactions – how to be a good listener, how to ask open-ended questions, how to interact in positive ways with others. We teach people about the importance of the Context, because the context of your life, the outside in, is very important. So we teach people to do what we call to read cues in the environment. Are you associating with people who are friendly to you, or that are negative to you? That is a cue in the environment, it is a signal. I don’t need people who put me down. I don’t need to be friends with people who bully me, right? That is a cue. A cue to change the environment. We also teach people self-Awareness. What makes me stressed out? And we teach people what we call “Next steps”. Next steps is about the change process. There is a science of what we call implementation intentions. If you want to make a change in your life, let us say you want to eat healthier, or start exercising, or doing yoga three times a week, or calling your mother three times a week because you always forget to call your mother. There are ways to help people to have achievable goals. That is implementation intentions. This creates the acronym BET I CAN. Leveraging Behaviors, Emotions, Thoughts, Interactions, Contect, Awareness and Next steps.
We have written a few books on this, one of them I have written with my wife, “The Laughing Guide to Wellbeing”. We combine humor with science to teach all these skills. You can see all of it in funforwellness.com, or you can go to my website professorisaac.com. So there are lots of ways in which we can help people to get better. Through behaviors, setting goals, through emotions, managing negative emotions, cultivating positive emotions, challenging negative thoughts, creating a new narrative about themselves, being a better listener, a better support for others, etcetera. So this is a little bit of the work that we have been doing, and that we think can be translated into helping people with mental health challenges.
What would you like to say to the people who need help?
My message number one is that we should resist the temptation to internalize the problems that we are having and blame ourselves for our challenges. All of us have challenges in life, and some of us are luckier than others in that we have more resources to cope with life. And some of us, through different periods of life, just have a hard time. But it’s not our fault. And we really should exercise a little self-compassion. Just as we are compassionate towards other people, when we see others having a problem we want to help them, we want to extend a hand and be empathic and good listeners. We should apply the same rule to ourselves, and forgive ourselves, and exercise self-compassion. Because we all go through difficulties in life. And as I said before, some of us are luckier, that we have more resources, more support and then we are able to cope better. But all of us need help. I think it is important that we understand that, first of all. That we treat ourselves kindly.
Message number two is: Try to surround yourself with supportive people, friends and family. And stay away from toxic relationships, because toxic relationships are going to put us down again and again and again. Sometimes it is hard to get out of these bad relationships, but you really have to think hard about whether the relationships you are in right now are healthy or unhealthy.
Change is like a sports activity, a team activity, you do it with other people
The third message is that you can learn how to get healthy. It may seem difficult right now, you may be having a hard time and that is ok, but there are ways to get healthier. And not all the ways suit every person, you have to find your own, individual way to get healthier and happier. And that is ok. You just have to explore them. For example, some people get happier by exercising. Doing physical activity. That is so important. Physical activity can come in many ways. You can just go for a walk in a park, or you can go swimming or jogging or playing racketball, whatever you like. But that is one way to get healthier: To do something. Now, this thing that you are going to do may not be the greatest thing. But it is important to be active. And to set a goal for yourself. If you want to quit smoking it is important to try to set a goal, and there are ways to have healthier habits, to quit bad habits. So I would recommend that people set a goal that is achievable. If you want to start exercising, or you want to stop eating junk food, if you want to eat healthier, set a goal. In funforwellness.com we teach people how to set a goal, and then work on that goal. And to group supporters to help you achieve that goal, because we know that it is always easier to change a behavior in a team than by yourself. Change is like a sports activity, a team activity, you do it with other people. For example, if you are trying to overcome an alcohol addiction, it is always better to do it in a group. Then you can help others, others can hold you accountable. And I think it is important to understand.
My fourth message is that getting involved back in society is really important. To fight isolation. Seek out opportunities to interact with friends and family and people in the community. And it doesn’t have to be perfect. You know, not just people with mental health challenges but, sometimes all of us want to get things perfect. Like if I am going to study something, I want to study the most important thing, and then I spend so much time planning that I never get around to the doing. The actual doing is really important. The process is as important as the outcome. And part of the process is to express your voice and choice.
Do not let other people dictate your life, because you know your life better than anybody else
Message number 5 is that when you are interacting with professionals or friends or family, it is important that you learn how to assert your needs. And that you express your voice. Do not let other people dictate your life, because you know your life better than anybody else. I obviously think it is important to be open to getting help, but also to asserting our needs. Because sometimes people with mental health challenges interact with professionals who like to tell them how to live their lives. That is not healthy. I think it is important to rehearse how to assert your voice and say that I don’t think that this is gonna work for me. Or ‘how about we try something else’.
What would you like to say to those who are going to help?
This is really the mirror image of what I just said. If you are a social worker, psychologist, counselor, doctor, a financial advisor, a teacher. How do you work with people who are having challenges? Well, I think it is important to help them to be self-compassionate. And you have to model that. Maybe you can share your own struggles with self-compassion, and just say that sometimes I am very hard on myself, for x, y or z reasons. So we have to help them feel valued, because there is nothing more important. Nothing, I want to underline this, is more important than feeling respected and being treated with dignity. A feeling of recognition. This goes a long way back in philosophy and psychology and moral theory. Few things are more important than respecting your identity. So what can we do to respect people’s unique identity and not just see them through the prism, through the lenses of sickness og psychiatric illness? People have whole lives, rich lives, and it’s important that we deal with them not just through the small lens of the psychiatric problem. We have to recognize them, give them a sense of value and worthiness for who they are and what they have achieved in life.
Nothing, I want to underline this, is more important than feeling respected and being treated with dignity
When you are struggling with schizophrenia, depression or bipolar disorders you have a lot of strength, because it is very hard to deal with this kind of situation. How can we acknowledge people’s strengths? And how can we build their voice and choice? That is part of empowerment. So how can we elicit their voice, and not impose our pre-conceived notions of what they need to do to get healthy? It is really a partnership. A partnership requires humility on the part of the helper. A partnership requires curiosity about the life of the person you are working with. And time to get to know them deeply. As opposed to treating them as one more patient or one more client. The best gift all of us who work with people with challenges can give is the gift of time. And listening, asking open-ended questions. Because that is how you give them voice and choice. And then create a plan of action. It is important to be expressive, to manifest your needs. But we also need to help them to get into action. So how we go from expressive individualism – which is good – to getting to a place they want to go? As I said before, that can be eating healthier, taking your medication, quitting an addiction, whatever that is. Getting back to a job, going to university again, going to school. How do we smartly create achievable goals? It is basically how do we create positive habits. Because people with mental health challenges often quit healthy habits. They stop exercising, they stop eating well, they consume alcohol or they quit their jobs. So how do we help them recover these positive habits? And how do we help them reintegrate into the community as soon as we can, as soon as they are ready? It is a process of accompaniment. I would define it as accompanying more that treating. It is walking alongside in a true partnership.
The best gift all of us who work with people with challenges can give is the gift of time
I have one final message. To all of us. Today we are helpers, tomorrow we can be the helpee. I think it is really important that every interaction, every action we take in society, in our families, at work, in the community is an opportunity to make people feel valued or devalued. To make them feel respected or disrespected. Let us take our actions seriously, because they have moral and psychological consequences. We can choose to create a ‘me-culture’ or a ‘we-culture’. A ‘me-culture’ says: I have the right to feel valued so that I can be happy. That is good, but that is only 50% of the problem. The other part is a ‘we-culture’. I would like to convince all of us that we all – not just me but all of us – have the right and the responsibility to feel valued and add value. So that all of us can experience not just wellness, but also fairness. So all of us have the responsibility to promote our own wellness and the wellness of others. All of us have the responsibility to claim fairness for ourselves, but also for others. And all of us have a responsibility to feel valued and add value. We have a responsibility to do this so that we feel that we matter, but also help other people feel that they matter.
So my message is: Let us practice fairness, wellness and worthiness not just towards ourselves, but towards other people. And that is how we create a healthy society.