Since earliest civilization, people have been pondering the question: “What is well-being? ” We have scores of writings throughout history that wrote concerning this topic.  For example, Confucius believed that each person could live a good life by developing their outer and inner nature.  The goal of our “outer” nature was social harmony and the acceptance of our social roles, and the “inner” nature was the cultivation of our conscience and character.

Greek philosophers wrote of similar ideas on well-being. Socrates famously said “the unexamined life is not worth living”– as he believed that we should question and challenge our beliefs to discover the truth.  Plato wrote in the Republic that any flourishing society would need to exhibit Four Cardinal Virtues to flourish: Wisdom, Temperance, Courage, and Justice. Aristotle coined the term “eudaimonia“– in his book Nichomachean Ethics– as the moral philosophy on well-being. Aristotle believed that in order to live a good life, we should pursue knowledge and develop an excellent character.

In the 20th century, the field of philosophy mostly stopped pondering these types of life questions like what is well-being and human flourishing. Academic philosophers mainly became focused on analytical philosophy studying things like epistemology–the theory of knowledge.

Psychologists picked up where philosophers left off.  In 1943, the psychologist Abraham Maslow wrote the paper “A Theory of Human Motivation,” and  became best known for creating Maslow’s Hierarchy of Needs. His theory was that we fundamentally have developmental needs that lead to self-actualization–that is reaching one’s full potential.


Fifty years later, a professor of psychology at the University of Pennsylvania, Martin Seligman, decided on a radical idea when he became the president of the American Psychological Association in 1998.  He planned to join the concept of well-being and human flourishing with empirical scientific methods of psychology.  He wanted psychologists to test the effectiveness of the virtues and ideas of well-being–the field of Positive Psychology was born.

Through out the years, research in Positive Psychology interventions has been linked with not only well-being, but also with physical health, increased positive emotions, and alleviation of symptoms of anxiety and depression.

There are many theories and conceptual models on well-being, but Seligman finds the PERMA model as most helpful.  PERMA stands for: Positive emotion, Engagement, Relationships, Meaning, and Accomplishment.


Each of these elements is the foundation for well-being. Developing these elements are critical for a more fulfilling and flourishing life.

Now you don’t need to be a Pollyanna to develop positive emotions–it is more than just smiling and being cheerful.  We can create more positive emotions by spending time with friends and family, regularly doing hobbies we enjoy, exercising, spending time in nature, listening to music, or eating great meals.  People who regularly partake in these activities exhibit more positive emotions in their life. By creating more positive emotions, we feel more hopeful and learn to take on more opportunities that will enrich our lives.  Studies show that when people have more positive emotions, they are more productive at work, do better in school, have better physical health, better relationships, and they are more creative.

Engagement— the second element of well-being–seems to be the buzzword du jour from every company’s HR department. According to Gallup, the large majority of the American workforce is not engaged at work.  Many bosses want employees that are more engaged, but in the past 4 years since Gallup started tracking this metric, the needle really hasn’t moved towards any significant improvement in the workplace.

You are probably saying, “Yeah, I want to be more engaged too, but what the hell does that mean?” Well, when we are not doing some sort of meaningful work and get bored,  it results in feeling useless.  This is the opposite of engagement.

When you are engaged in your life or work, you become completely absorbed in what you are doing. Psychologist Mihaly Csikszentmihalyi developed the term “flow” to describe this.  You lose track of time, you are hyper-focused on the task at hand, and you feel a sense of bliss and vigor.  For example, one area of my work that I experience this feeling of flow frequently is during surgery. At that moment, there is nowhere else I’d rather be than in that operating room.  Another example when I get into the state of flow is when I sit down to write.

Think of your life and work, when do you experience the state “flow”? What activities cause you to become completely absorbed in what you are doing? Once you identify these activities, that is your fuel for engagement and focus on spending more of your time doing those things.

The third element of well-being is Relationships.  We are indeed one of the most social animals on this planet, and since earth is the only planet we know inhabits life, that makes us one of the most social animals in the universe.  So relationships matter.  We have an innate sense of connection, love, and need for physical contact. Some of our most inspiring stories in literature and movies are based on love.  Lao Tzu put it best when he wrote, “Being deeply loved by someone gives you strength while loving someone deeply gives you courage.”

We enhance our well-being by building a strong network of family, friends, co-workers, and neighbors. When you have people around that you care about and care about you, you get a sense of belonging, and you have a support system.  You feel as if you are part of something bigger than yourself.

But for as much as relationships can contribute to our well-being, if we are not careful, they can also erode our well-being especially if they are toxic relationships.   Good relationships are reciprocal, they require continued personal investment and a genuine interest in that person. Without these, relationships decay and disappear—we need to remember to maintain or grow them.  As psychologist Adam Grant put it, real friendships build over time through sharing moments of joy and moments of heartache.

Since our relationships make us feel as if we are part of something bigger, this brings up the fourth element of well-being: Meaning.  Our life is more fulfilling when we are dedicating it to something greater than ourselves.  This can be family, work, our faith, community, a political movement, a group of like-minded individuals working towards an important cause, etc.  Studies have shown that people who belong to a community and pursue shared goals are happier than people who don’t. We get a sense of confidence and well-being when we spend time doing something that we believe is creating more good in this world.

To find meaning in your life, think of your most important values?  Is it family, faith, alleviating suffering, learning, and education? Once you recognize what matters most, find like-minded people and work together on these values.  Nietzsche said it best when he wrote, “He who has a why to live can bear almost any how.”

Finally, the last element of well-being is Accomplishment. To achieve well-being, we want to look back on our lives with a sense of accomplishment. We want to know we did the things that mattered most, and we did it well.  Achievements and accomplishments also give us momentum and hope as we look into the future. When you have a sense of accomplishment, you are more likely to help others, have more positive emotions, and you will be more motivated in your next goal and ambition.

In positive psychology, they encourage people to identify their ambitions and cultivate the strengths that will help them achieve it. Maybe find a mentor or a coach.  Find someone to keep you focused on the long-term goals and celebrate the small successes along the way.

Importantly, it is crucial to build resilience against failure and setbacks. Success hardly comes easy,  so it is great to have the support of someone that can help you stay positive and focused.  Just ask any serious athlete about how vital this mindset and support is for them when facing a daunting challenge.

Seligman says that three other ingredients should also be added for well-being.  One element is physical health. Being physically healthy is vital to well-being, and we know that the mind-body connection is closely linked in health– if one aspect suffers so does the other. The other important element is responsibility. We are more likely to have health and well-being by taking responsibility on how we take care of ourselves–how we eat, how we exercise, how we sleep, etc. Responsibility is also essential in our relationships because it shows we are accountable. And with accountability, we build trust and cooperation. And finally, there is the element of autonomy.  With autonomy, you are able to make your own choices and go your own direction. Having a sense that our life is self-determined is a big part of our well-being.  As our founding fathers wrote on autonomy in the deceleration of independence—” Life, liberty and the pursuit of happiness.”

So that’s it, PERMA–Positive emotions, Engagement, Relationships, Meaning, and Accomplishments.  According to positive psychology, these five building blocks of well-being along with physical health, responsibility, and autonomy will create a life of human flourishing. Now over two thousand years later, has the empirical evidence from positive psychology studies finally given us the answer to Aristotle’s “Eudaimonia”?

I am a gynecologic oncologist, a husband, and a father. My blog is mostly about our healthcare system and well-being, but occasionally I get inspired to write about other "stuff" too.

3 Comment on “The Essential Elements of Well-Being

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