Healthy personality development and well‐being
Authors: C. ROBERT CLONINGER
Journal: World Psychiatry (2012)

George Vaillant describes seven concepts of positive mental health: effective functioning, strengths of character, maturity, positive emotional balance, socio-emotional intelligence, life satisfaction (true happiness), and resilience. His descriptions reflect his outstanding contributions to the epidemiological investigation of mental health as well as his affiliations with psychoanalysis and positive psychology. He makes the valuable observation that these seven concepts of well-being overlap extensively. The correlations observed by Vaillant among empirical measures of these constructs suggest that feedback interactions among multiple distinct processes influence the development of well-being as a complex adaptive system 1,2. The development of well-being must involve such a complex adaptive system because the same personality traits can lead to different health outcomes (i.e., multi-finality), and different sets of personality traits can lead to the same health outcome (i.e., equifinality) 2. As a result, linear stage models of development like those of Erikson, Piaget, and Kohlberg are inadequate. The feedback dynamics of well-being has hopeful implications for mental health care because it means that there are multiple paths to well-being that can be accommodated by the unique strengths and weaknesses of each person. At the same time, such complex dynamics presents a severe challenge for the validation of distinct measures of the components of well-being. Measures of all seven of the concepts of well-being described by Vaillant are moderately correlated with Temperament and Character Inventory (TCI) measures of maturity (i.e., self-directedness and cooperativeness) and low harm avoidance 3. Regrettably, the residual variability is not well understood in terms of content, structure, or function of other personality dimensions like self-transcendence and persistence, although progress is being made 4,5,6. Nevertheless, the dynamic nature of the processes that promote well-being implies that there is a crucial role for self-transcendence in the flourishing of health with maturity, integrity, wisdom, resilience, and creativity. Erikson's and Vaillant's spiral of maturity can be systematically related to the development of the three character traits of self-directedness, cooperativeness, and self-transcendence 1. Like Vaillant, the DSM-5 is proposing a general definition of healthy personality in terms related to self-directedness and cooperativeness. However, the DSM-5 neglects self-transcendence, even though all three character traits are important in predicting physical, mental, and social components of health and happiness 3. A self-transcendent outlook of unity is actually fundamental to healthy personality development, even though it may be devalued in materialistic cultures. For example, the humanistic psychologist G. Allport stated: "The basic existentialist urge to grow, pursue meaning, seek unity is also a given. It is a major fact — even more prominent in man's nature than his propensity to yield to surrounding pressures" 7. Recognizing the need for a dynamic balance between autonomy and coherence, Allport described the characteristics of psychological maturity as an adaptive set of seven functions: a) self-extension (authentic and enduring involvement in significant life activities, such as work, family life, or community service); b) dependable ways of relating warmly to others, such as tolerance, empathy, trust, and genuineness; c) self-acceptance or emotional security (the ability to regulate and live with one's emotional states); d) realistic perception and appraisal (seeing the world as it is in contrast to being defensive or distorting reality to conform to one's wishes); e) problem-centeredness (resourceful problem solving); f) self-objectification (self-awareness allowing a person to know oneself with insight and humor); and g) a unifying philosophy of life, allowing comprehension and integration of one's goals and values 7. According to Allport, a healthy person is constantly striving toward unification of personality by integration of all aspects of his/her life. Inspired by the descriptions of psychological maturity by Allport and other humanists, C. Ryff developed reliable measures for components of mental health, which she calls psychological well-being 8. Ryff's measures have been helpful in differentiating the psychobiological correlates of well-being and ill-being 9. Her empirical findings show that the absence of symptoms of mental disorders does not assure the presence of positive emotions, life satisfaction or other indicators of well-being. Unfortunately, Ryff's proposal does not provide an adequate measure of self-transcendence or a unifying philosophy of life. Her measures are moderately explained by high self-directedness, high cooperativeness, and low harm avoidance. Ryff's measure of personal growth is positively correlated with self-transcendence but only weakly 10. An adequate model of well-being will require a better understanding of the role of self-transcendence 5. In contrast to defensiveness and effortful control, an outlook of unity is expressed in activities such as fluidity in athletic performance, improvisation in musical composition, trustful perception of social support, and generosity in charitable donations, which each activate the most recently evolved parts of the brain, particularly prefrontal poles 11. Activation of the anterior prefrontal cortex produces feelings of satisfaction even when anticipating adversity or when making meaningful personal sacrifices. In summary, Vaillant's concepts can help people to reflect on the content and functions of the components of well-being. Much more work is needed to develop empirical measures that are able to reliably distinguish the different processes that promote healthy personality development and well-being. We need to better understand the crucial role of self-transcendence along with other dimensions of personality in the development of health and happiness 3,5. The great deficiency of emerging classifications of mental disorders is that they embody little or no understanding of the science of well-being. I applaud George Vaillant and the leadership of World Psychiatry for their roles in stimulating this valuable discussion of well-being.