As evidence grows of the direct links between social inequalities and mental wellbeing, Catherine Jackson talks to people in counselling and public mental health about what makes people happy
Happiness for all
Next month (November) sees the second anniversary of the launch of the Office for National Statistics (ONS) annual subjective wellbeing survey. The survey was commissioned by Prime Minister David Cameron in 2010 with the aim of exploring alternatives to Gross Domestic Product (GDP) as the sole measure of national prosperity. We have had one set of data already, in July this year, and are promised more next month.
The first set of data told us that machine operatives in Thurrock are unhappier with their lives than anyone else in Britain and that teachers, doctors and lawyers in Rutland and the Orkneys are among the happiest. We also learned that the average level of contentment with life in the UK is around seven out of 10, which isn’t so bad; in Botswana the comparable figure is 3.6 (see, for example, the World Happiness Report at www.earth.columbia.edu).
The ONS survey asks four simple questions to gauge people’s wellbeing: overall, how satisfied are you with your life nowadays; to what extent do you feel the things you do in your life are worthwhile; how happy did you feel yesterday, and how anxious did you feel yesterday? Only 10.9 per cent of people rated their levels of ‘happiness yesterday’ as less than five out of 10, and the UK average for ‘anxious yesterday’ was just 3.1 out of 10.
But there were marked differences between social groups. People in manual occupations and sales and customer services were less likely to rate their lives as satisfying and worthwhile in comparison with professionals, managers and directors. Black African, Caribbean and Black British people reported the lowest life satisfaction ratings. People in poor health were more likely to have higher levels of anxiety, and nearly two fifths of people with disabilities gave a lower than average rating for life satisfaction (almost twice the proportion of non-disabled people). Some 45 per cent of unemployed people (more than twice the proportion of employed people) rated their life satisfaction as below average.
The inescapable fact is that poorer, marginalised and disenfranchised people find their lives less enriching and are, on average, less happy.
The impact of income and social inequalities have been extensively researched by Richard Wilkinson and Kate Pickett in their book The Spirit Level: why equality is better for everyone. The book, published in 2009, opens with the telling observation: ‘It is a remarkable paradox that, at the pinnacle of human material and technical achievement, we find ourselves anxiety-ridden, prone to depression, worried about how others see us, unsure of our friendships, driven to consume and with little or no community life.’
It goes on to report hard evidence from statistical analyses to support the argument that the gap between the poorest and the richest in societies is a cause of major social ills.
Wilkinson and Pickett looked at data on national prosperity, relative incomes within nations, wellbeing, physical health, life satisfaction and more; their findings reveal a consistent trend. Inequality breeds unhappiness: countries with less income inequality generally do better on a whole range of health and social measures associated with a better quality of life, such as less crime, better mental and physical health and more trust, social cohesion and social mobility.
The implications for governments are immense. They are immense also for those who work in what could be termed the ‘happiness’ industries – mental health, counselling, psychology, psychiatry and psychotherapy – practitioners who work on the frontline with human misery and distress.
Wilkinson and Pickett’s statistical analyses have been challenged (see, for example, http://spiritleveldelusion.blogspot.co.uk/) but their conclusions are also widely accepted, certainly among those working in public mental health. And if their analysis is correct, this difference in life satisfaction and mental wellbeing is likely to worsen as the income gap between rich and poor grows ever larger in the current economic downturn.
Relative poverty is so much more damaging than absolute poverty because it ‘undermines social justice and corrodes the soul,’ says public mental health consultant Lynne Friedli. Friedli is the author of a report published by WHO Europe in 2009 titled Mental Health, Resilience and Inequalities. The report’s subject is mental health in its broadest sense, not just mental ill health but also mental wellbeing – how we feel about and experience our lives.
Friedli gathered evidence from research on mental and physical health and what influences them, from neurobiology, and from epidemiology and epigenetics. ‘Inequality exacerbates the stress of coping with poverty,’ she says. It has clear physiological as well as psychological effects. ‘People who are poor often refer to the pain of being made to feel socially worthless, of no account. Inequality injures our universal human needs for status, control over our lives and sense of belonging. This may explain why even the most resilient poor children rarely do as well as those from more affluent backgrounds. Supportive families, high quality primary schools and interventions like parenting programmes can help to compensate. But these efforts are still generally trumped by material advantage.’
Moreover, she argues, the very factors that can strengthen resilience in the face of disadvantage are those that the current Government’s economic and social policies appear hell-bent on destroying. ‘To survive adversity, people need respect, dignity, opportunities to influence the decisions that affect their lives and connectedness. These are issues of fairness and social justice. Governments have to address both the material and social aspects of deprivation. To be resilient against adversity, individuals and communities need opportunities to retain or gain social recognition and to stay connected. But social recognition and collective action are frequent casualties of today’s economic and cultural trends.’
Peter Morrall, senior lecturer in health sociology at Leeds University, makes a very similar argument in his book The Trouble with Therapy, published in 2009. Morrall’s views haven’t changed in the intervening years. Therapy is palliative care, Morrall says bluntly. ‘Probably 90 out of 100 times, therapists’ work is a sham. It is morally unjust to sit with a client with major illness, living in poverty, marginalised from society, and not recognise and seek to do something about the injustices in the world that are affecting that client. In a society like ours, where inequality is growing, it’s the structural things that matter.’
Morrall acknowledges that the scale of the challenge is beyond the influence of the individual practitioner. He believes it is for their professional organisations, like BACP, to pick up the gauntlet and tackle the fundamental causes of their clients’ unhappiness – the social conditions in which they live and the government policies that create them. ‘The “happiness” debate is blinding us to the reality that our world is in a mess. What right do we have to be happy when there is so much distress in the world and particularly when we, or our professional organisations, are doing nothing about it? It’s time they took social responsibility, moral action and political action for social change,’ he argues.
Existential psychotherapist Emmy van Deurzen has also explored the nature of happiness in relation to psychotherapy. In her book, Psychotherapy and the Quest for Happiness, published in 2009, van Deurzen, who is principal of the New School of Psychotherapy and Counselling (NSPC) in London, asks if it is the role of therapy to aim for ‘normality and adjustment’. ‘Should therapists try to eliminate unhappiness at all costs? Or should they make people think about their lives and how they live without trying to eliminate ordinary human misery? …Do we want counselling and therapy to be a brief intervention that targets happiness?’ she asks.
Her view is that philosophy has the answer: ‘Psychotherapy has to be about helping people to think clearly about their lives and to find the freedom they need to come to their own conclusions about how to live and, hopefully, how to live well. Indications are that if you live well and in the right way there will be happiness along your path. There will also be suffering and misery, but you will be better equipped to deal with it and not fear it so much.’
She argues that psychotherapy isn’t about teaching people to lead a happy life. ‘It’s about helping them live more courageously and take ownership of their life. We like to believe that for life to be pain-free and effortless is the best option. Instead we should be thinking, “What is it that would make me feel I have really accomplished something not just for myself but in order to make the world a better place?”’
Ways to wellbeing
Celia Atherton is Director of Social Justice at Dartington Hall, the independent education and learning trust in south Devon. She is also founder of the Dartington Interrogate! festivals, which take place there every autumn. Last year’s festival took as its theme income inequality; this year (13–14 October) the theme is happiness. The festivals provide a forum for people to explore the chosen theme from different perspectives and through different media, including the creative arts and social and community action.
‘I think we have lost sight of what brings us true happiness and contentment,’ Atherton says. ‘We’ve been encouraged to focus on the acquisition of material goods and social status. We have become much less focused on what it is about self-esteem that comes from real achievement through hard work. There is very little real focus on encouraging people to understand that if you put hard work in, you will get results, and if you do that in the context of looking out for each other and doing a good turn every day, the evidence is you will feel really good about yourself, and you will be healthier.’
‘We need to be more focused on each other’s wellbeing and less materialistic and individualistic,’ agrees Action for Happiness Director Mark Williamson. Action for Happiness is the brainchild of Sir Richard Layard, the econonomist whose work kick-started the national Improving Access to Psychological Therapies programme. In its own words, it’s a ‘movement for positive social change bringing together people from all walks of life who want to play a part in creating a happier society for everyone’. ‘The idea that everyone is just out for themselves or that we should all be aiming to succeed at the expense of others runs counter to what we know about human nature and how communities thrive,’ Williamson argues. ‘Western countries like the UK and US have got richer, but it hasn’t made us any happier. The research shows that, after a certain point, greater economic prosperity doesn’t necessarily improve people’s quality of life. People’s sense of wellbeing has flat-lined and if we and our governments aren’t improving quality of life, something surely is wrong. We need to focus more on our human relationships and what we can contribute to society, not just the size of our houses or the growth of our GDP.’
It was to provide a means for ordinary people to do something collectively to make their lives happier that community activists Mike and Liz Zeidler set up the Bristol-based Happy City initiative. Happy City is trying to engage individuals, organisations and communities in Bristol in making the city a happier place, as defined and measured by the people of Bristol themselves. It is run entirely by volunteers. Says Mike: ‘Happy City is all about bringing people together and helping them share what they know about increasing happiness. Marketeers have ruthlessly exploited our need for short-wave, instant gratification and pleasure, which some would call happiness. Our definition of happiness is what we call long-wave – fulfilment, having a sense of purpose, of place, of belonging and direction in life. That is where the public benefits are. The gains from happiness are at individual and community level, but it is the community elements that are really powerful.’
Zeidler says people feel powerless to make any real change. ‘People talk about the pursuit of happiness as if it will bring you to a final destination when in fact it’s a process. At the moment the environmental, social and economic crises give us a sense that we are travelling towards Armageddon. If you present people with the scale of the problem that they can’t relate to, they do what any animal does: they flee, fight or freeze. So what we need to do is change the direction of travel and make the problems feel more manageable. We set up this project to show people how they can play a part, in their own self-interest, in making a difference. It returns it to a more human scale. It creates a bridge over the chasm.’
In Kent, the arts organisation People United is attempting something very similar, but with a specific focus on ‘kindness’. Chief Executive Tom Andrews says: ‘People United is about how we live better together. Kindness links us with other people. It incorporates notions of compassion, social justice, neighbourliness and respect for others. We are interested in the conditions and factors that can help grow that.’
The arts are the perfect medium to communicate their message, he believes: ‘Arts hit the head and the heart at the same time. They are a superconductor. They allow people to connect with the subject in lots of different ways. And it’s fun.’ But they are also keen to develop a solid evidence base for their work; they are collaborating with the University of Kent on a paper, to be published shortly, that explores the relationship between the arts and kindness and what makes the arts potentially transformative.
People United works in and with Kent’s schools and communities and shares the results nationally, in the hope their successes will be replicated. They organised a three-year ‘We all do good things’ project that involved the whole of the town of Herne Bay in recording and celebrating in different art forms people’s individual stories of acts of kindness, given and received. The project ended with a giant picnic for over 1,000 people, which continues as an annual community celebration. A range of new initiatives have developed from the project, including the acquisition of a beach hut, which People United painted blue, because this was the colour local people said they associated with goodness, and which is available to groups and individuals who want to take time out to reflect on how to make the world a better place. ‘We all do good things’ has been trialled in other communities across the UK. ‘Our work is intended to encourage reflection and action at individual, institutional, community and society level,’ Andrews says. ‘We’re trying to communicate the message that everyone has the potential to do something through little acts of kindness. You don’t have to be Nelson Mandela to make a difference.’
Action for Happiness has extended the Government’s Five Ways to Wellbeing public mental health campaign (connect, be active, take notice, keep learning and give) into ‘10 keys to happier living’. The 10 keys include the aspirations to ‘Find ways to bounce back’, ‘Take a positive approach’ and ‘Be comfortable with yourself’. Mark Williamson doesn’t agree that a focus on individual resilience ignores the wider context of people’s lives. He points to the DIY Happiness project, a series of eight-week workshops, based on the Five Ways to Wellbeing, for women in deprived communities in South London. The workshops were part of the Big Lottery funded Well London initiative aimed at encouraging individuals and communities to work together to improve their health and wellbeing.
‘Many of the women said that, although they initially expected the project would be irrelevant to their lives, by the end it had been transformative,’ Williamson reports. ‘They told us that, although the conditions of their lives may not have improved, their ability to deal with them had.’ He denies that this amounts to offering individual solutions to social problems. ‘Yes of course we must work to improve the conditions of people’s lives, but you can also help people deal more constructively with adversity. Someone with greater resilience and a more positive outlook is better able to do something about the conditions in which they are living. This isn’t about telling people to accept their lot; it’s about giving them greater self-efficacy and improving their ability to make change happen.’