International Journal of Qualitative Studies on Health and Well-being.

2006; 1: 4 /10

ORIGINAL ARTICLE

Well-being as being well

a Heideggerian look at well-being

KI
ANNELI SARVIMA
The Nordic School of Public Health, Goteborg, Sweden, and Age Institute, Helsinki, Finland

Abstract
The background of this study was a critique of definitions of well-being and quality of life since they implied a view of human
beings as either divided into parts or were too narrowly focusing on the subjective experience of feeling good. The aim was to
deepen the understanding of human well-being by exploring the concept from the viewpoint of human being. The method
can be characterized as philosophical, since it dealt with questions on the ontological level. The strategy was based on
Heideggers philosophy of Being, which has previously been utilized as a basis for qualitative methodology in health and
caring research. The landscape of well-being sketched out from this viewpoint included being well as the everyday unfolding
of life, as alternating between a sense of familiarity and unfamiliarity in the world, between authentic and unauthentic. The
landscape also included being well as orientating towards the future and realizing ones potentialities as well as confronting
anxiety and death. This view can be used as an ontological understanding, which can indirectly point out a strategy for a
scientific understanding and conceptualization of human well-being.

Key words: Wellness, health, quality of life, philosophy, ontology, Heidegger

Introduction

Health as well-being

Well-being, health and quality of life may be seen as

three basic concepts / maybe the basic concepts */in
public health and other health sciences. There are,
however, neither any unanimous definitions of these
concepts nor a common view of how they relate to
each other. An overview of different definitions and
models of the three concepts, however, indicates that
well-being may well be conceived as a unifying
concept and a characteristic of both health and
quality of life.
In all empirical research the definitions, models
and measurements have philosophical underpinnings. Definitions of health, for instance, imply a
view of what it means to be a whole human being,
and definitions of quality of life imply a view of what
is worthwhile and how we ought to live. In the same
way, definitions of well-being have philosophical
underpinnings and implications. This study illuminates some traits in common views of well-being,
points out their philosophical underpinnings and
lays the foundation for an alternative way of
approaching well-being.

Both health and quality of life have commonly been

defined as well-being. In its classical definition of
health, the World Health Organisation (WHO, 1946)
equalled health and well-being by defining health as
physical, mental and social well-being. Later health
was defined as a resource for everyday life (WHO,
1986). In accordance with the latter, Berntsson
(2000) characterized health as the ability to resist
stress so that reduction in well-being can be avoided.
In Erikssons (1984) definition of health, well-being
was seen as one aspect of health. Well-being, in turn,
was characterised as a phenomenological concept
referring to a feeling or experience. Bowling (2005),
again, seemed to define health in terms of quality of
life. In her book on measuring health and quality of
life a considerable amount of the instruments presented are measures of psychological well-being.
Quality of life as well-being
Ferrell, who has carried out a large research programme on pain and quality of life, defined quality of

Correspondence: Anneli Sarvimaki, Ikainstituutti, Kalevankatu 12 A, FIN-00100 Helsinki, Finland. Tel.: /358 9 61221628. Fax: /358 9 61221616. E-mail:
anneli.sarvimaki@ikainst.fi

(Accepted 12 December 2005)

ISSN 1748-2623 print/ISSN 1748-2631 online # 2006 Taylor & Francis
DOI: 10.1080/17482620500518101

Well-being as being well 5

life as well-being covering four areas: quality of life is
physical, mental, social and spiritual well-being
(Ferrell, 1995; Ferrell, Grant, Padilla, Vemuri &
Rhiner, 1991). Lindstrom (1994) has presented a
model where quality of life was divided in a different
way into four life spheres */the global, external,
interpersonal and personal sphere */where the last
one was represented by the physical, mental and
spiritual dimension. Empirical support for the conception of well-being as a constituent of quality of
life has been offered by e.g. Gabriel and Bowling
(2004), who studied 80 older persons own definitions of the quality of life. Psychological well-being
was mentioned as a constituent of the quality of life
by 99% of the informants. Social relationships and
health had the same status. Only home and neighbourhood were mentioned more frequently (100%).
Rapleys (2003) critical overview of quality of life
research also showed that quality of life has commonly been associated with well-being. Both concepts seem to have an objective aspect referring to
socioeconomic and material circumstances and a
subjective aspect referring to personal experiences.
Bond and Corner (2004), who have examined
quality of life research in social gerontology and
health and social science, concluded that we should
make a clear distinction between objective indicators
and psychometric measures on the one hand and
subjective experiences of well-being on the other.
Their suggestion is that quality of life should be used
as a sensitising concept and a heuristic device in
investigating everyday discourses. Hendry and
McVittie (2004) have also pointed out that when
people are given the opportunity to describe their
quality of life they do not organize their experiences
into separate domains. Assessment tools built on
separate domains, they say, have insufficient regard
for the social and everyday situations in which
people make sense of their lives (p. 971).
Thus, the quality of life has commonly been
defined as well-being, but while some definitions
clearly divide well-being into separate areas, others
put the focus on psychological well-being. There
have also been critical voices against the whole effort
of dividing well-being into separate areas.
Well-being as the ultimate criterion of quality of life
In addition to the definitions of health and quality of
life as well-being, models have been presented that
describe the relationships between these three crucial concepts. One such model is Lawtons (1991)
multidimensional view of quality of life. According
to Lawton, quality of life consists of four main areas:
objective environment, behavioural competence (including health), perceived quality of life, and psy-

chological well-being (including life satisfaction). He

suggested a loose causal model, in which the
objective environment influences behavioural competence, which, in turn, influences perceived quality
of life. Psychological well-being is the ultimate
outcome. Nordenfelt (1991a,b) has argued along
the same lines. In his discussions of health, quality of
life and well-being, he suggested that health is a
resource for quality of life, but not a necessary
condition. Well-being, in his view, is an aspect of
quality of life and may well be seen as the ultimate
criterion of a good quality of life. He referred to wellbeing as the hedonistic criterion, thus associating
well-being with a philosophical tradition emphasising pleasure, pleasantness and enjoyment as the
good things in life (Frankena, 1973).
As was previously pointed out, well-being can be
characterized in objective as well as subjective terms
(Bond & Corner, 2004; Rapley, 2003). Furthermore, well-being is described as belonging to all
dimensions of a human being: physical, mental,
social and spiritual (Ferrell, 1995; Lindstrom,
1994; WHO, 1946). There seems, however, to be a
strong emphasis on one of these four dimensions:
well-being as a subjective experience or psychological well-being (Eriksson, 1984; Gabriel & Bowling
2004), which is seen as the ultimate criterion of
quality of life (Lawton, 1991; Nordenfelt 1991a,b).
In this sense, we could say that there is a tendency to
define well-being in terms of subjective experiences
as feeling good and being satisfied.
Identification of the problem
Every definition of well-being rests on an implicit
view of what it means to be a human being */a whole
and well human being. The definitions of well-being
as physical, mental (psychological), social and spiritual that have been presented here imply that a
human being is made up of these four parts or can
be studied from these four aspects. As a criticism of
this view, Heidegger (1978) claimed that the Being
of human beings is not the sum of body, soul and
spirit. If Being is the sum of separate parts, it is not
conceived of as a whole being. These parts may
constitute the foundation for empirical science, he
said, but they need to be problematized on the
ontological level. In Heideggers spirit we can say
that for the purpose of empirical research, well-being
may well be conceptualized as physical, mental,
social and spiritual, but in order to gain a deeper
understanding of well-being we have to transcend
the division of well-being as corresponding to four
parts of the human being. The conceptualization of
well-being as feeling good and being satisfied, again,
seems to offer a very limited view of well-being.

A. Sarvimaki

Aim
The aim of this study is to deepen the understanding
of human well-being by exploring the meaning of
well-being from a philosophical viewpoint of human
being. The questions guiding the exploration are:
. How can the being of human beings be characterized?
. In the light of this characterization, what does
being well mean?
. What are the implications of being well for
our understanding of well-being?
Method
The method can be characterized as philosophical.
The philosophical questions and methods aim at
revealing, problematizing and criticizing values,
conceptions and modes of thought that underpin
our thinking (McClellan, 1976; Niiniluoto, 1980).
They also aim at forming consistent and coherent
views of the world, human beings, human knowledge, ethics, etc. that is, world-views, views of man,
theories of knowledge and ethical theories (Sarvimaki, 1988). The philosophical questions are answered by philosophical methods, which cover a
wide variety of methods and techniques ranging
from formal, logical analysis to conceptual investigations, argumentation, discourse and more aesthetic
texts (Sarvimaki, 1999). In this study, the philosophic method used can be characterized as an
ontologically based discourse and analysis of human
well-being.
Since the starting point of this exploration is the
question of being of human beings, I will turn to
philosophies of being for material. The question of
being is the paramount question in the area of
philosophy called ontology. Since this study does
not deal with being as such but with the being of
human beings, the existentialistic thinkers seem to
provide the most suitable material. The whole
purpose of the existentialistic endeavour, namely, is
to explore the meaning of human existence or being.
The question of being of human beings has been
thoroughly investigated by Martin Heidegger in
Being and Time (1978) and by Jean-Paul Sartre in,
Being and Nothingness (1966). Since Sartre in many
respects can be seen as a follower of Heidegger,
Heidegger will be used as the primary source of
material. Another reason for choosing Heidegger as
the point of departure is that Heideggers philosophy
forms one of the basic philosophies behind interpretive phenomenology and hermeneutics. There is
already a tradition in qualitative health research
based on these philosophies (Benner, 1994; Benner

& Wrubel, 1988; Lopez & Willis, 2004). Therefore,

it seems reasonable also to investigate the possibilities of using this philosophy as a point of departure
for the understanding of well-being.
The idea with using Heideggers texts is not to
carry out some kind of Heidegger-exegetics. Rather,
the idea is to illuminate being, being well and wellbeing, and for this Heidegger will provide the light.
Metaphorically, the process can be described as
entering a dark landscape, illuminating parts of the
landscape with Heideggers light, and finally coming
out of the landscape with a clearer vision of what it
contains. Some parts of the landscape will, however,
be left in darkness, and some will be dimly lit. The
picture will be influenced by how the torch is pointed
and how far the light will reach.
The being of human beings
As was pointed out above, Heidegger (1978)
criticises the concept of human being as a substance
made up of three parts */body, mind and spirit.
For him human being is Dasein, existence.
Dasein, again, is not a substance with properties
but the temporal unfolding and creating of a life
course.
Human being or existence is Being-in-the-World
in ordinary everydayness. This may seem self-evident, but according to Heidegger (1978), existentially and ontologically existence is full of enigmas.
He derives Being-in-the-World from residing, dwelling and being familiar with and characterizes this
unitary phenomenon in the following way: The
expression bin is connected with bei, and so ich
bin [I am] means in its turn I reside or dwell
alongside the world, as that which is familiar to me
in such and such a way (p. 80). Everydayness refers
to a mode of Being-in-the-World. It means being
caught up in the practical affairs of life and acting in
an ordinary pre-reflective way. Everydayness is that
which is more or less the same every day, . . . the
accustomed, the like yesterday, so today and tomorrow, and the for the most part- . . . (p. 423).
Being-in-the-World could thus be interpreted as
being at home in the world and knowing ones way
around while going about ones ordinary practical
affairs, day after day. Being-in-the-World, according
to Heidegger (1978), involves confronting things,
tools and equipment that are there ready-to-hand,
and nature, which is present-at-hand. However, it
also involves the existence of other human beings
and the being of oneself. This part of Heideggers
analysis addresses the question of who exists in the
world.
Heidegger (1978) characterizes the existence with
others as Being-with and Dasein-with. The other

Well-being as being well 7

persons that the Self encounters in the world differ
from equipment and nature in that they are also
Daseins. The world of Dasein is thus in a very
profound meaning a with-world. Being-in-the-World
is Being-with-Others, Dasein-with. This with-world
of Daseins exceeds the mere existing side by side as
separate beings, Being-with. In the with-world of
Daseins, Dasein is defined as care.
In Heideggers (1978) philosophy, care (Sorge) is
not to be understood as a feeling or an attitude
towards others. Care is an existential a priori, Beings
existential meaning, which encompasses the unity of
the ways in which Being can be characterized. In that
sense, care is rather a presupposition for different
kinds of involvement, like concern and solicitude.
Concern (Besorgen) involves having to do with
something, producing something, attending to
something and looking after it, making use of something, giving something up and letting it go, considering and discussing. There are also deficient
modes of concern, like leaving something undone,
neglecting and taking a rest. Soliciting (Fursorge),
again, refers to different modes of being with other
Daseins as we encounter them within-the-world.
Soliciting can take the form of doing things for other
people or helping them realise their own potentials.
However, there are also deficient modes of Beingwith, like Being-alone, as well as deficient and
indifferent modes of solicitude. As deficient and
indifferent modes of solicitude Heidegger mentions
being . . . without one another, passing one another
by, not mattering to one another (p. 158). And he
says:
Just as circumspection belongs to concern as a way
of discovering what is ready-to-hand, solicitude is
guided by considerateness and forbearance. Like
solicitude, these can range through their respective
deficient and indifferent modes up to the point of
inconsiderateness or the perfunctoriness for which
indifference leads the way. (Heidegger 1978,
p. 159)
The question of who exists in the world also leads
us to the question of I or Self: The who is what
maintains itself as something identical throughout
changes in its experience and ways of behaviour, and
which relates itself to this changing multiplicity in so
doing (p. 150). This who can be referred to as
the I, the subject or the Self. That it is I who exists
may seem self-evident, but, It could be that the
who of everyday Dasein just is not the I myself
(p. 150). By saying that, Heidegger makes a distinction between the authentic Self and the inauthentic
Self. The authentic Self seizes itself and defines
itself. The opposite is the not-I, which is also a kind

of Being. Heidegger mentions losing oneself as one

example of this kind of Being and in doing so he
reveals his debt to Kierkegaard (1881). Inauthenticity can be a consequence of drifting along with the
others, to exist as presence-at-hand, that is, thinglike, or as They in the world of the others.
In inauthenticity, Dasein is in a state of tranquilized self-assurance and becomes too at-home in the
average everydayness. Heidegger (1978) calls this
state falling, we flee into the at-home of publicness. The world and the authentic Self, however, can
be disclosed by anxiety, an ever-latent primordial
state of mind. In anxiety, one feels uncanny or
unhomelike: Everyday familiarity collapses
(p. 233). Anxiety individualizes Dasein, it makes
manifest Daseins Being-free-for the choosing of
itself and taking hold of itself, i.e. the authenticity
of its Being.
One central determinant of Dasein is temporality.
Temporality reveals itself in the everydayness of
Dasein, in the day after day, yesterday, today
and tomorrow (Heidegger, 1978, p. 423). Temporality is also associated with the central aspect of care
as Being-ahead-of-itself , projecting ones possibilities into the future. As long as there are unfulfilled
possibilities, the Self is unfinished. Death, which
means that there are no more possibilities, the future
is no more, completes the Self. Thus, being is Beingtowards-Death, towards Being-a-whole.
The main points in Heideggers philosophy that
are used in this context can be summarized as
follows. The Being of human beings means being
caught up in everyday affairs with nature, things and
other people while at the same time orientating
towards the future and realizing ones potentials
until death completes the Self and the life course.
The meaning of human existence is defined as care,
the existential a priori for different kinds of being
and involvement, like concern and soliciting. These
have a positive aspect */like producing, attending
and doing things for others */as well as a deficient
and indifferent one */like neglecting, being alone
and not mattering. The self that exists can seize itself
and define itself (the authentic Self) or being caught
up in the stream of publicness and feeling too much
at home in everydayness (the inauthentic Self).
Anxiety discloses the authentic Self.
Being well
Can we, from Heideggers philosophy of being, draw
any conclusions about being well? One caution has
to be mentioned. Heideggers philosophy is an
analysis of the meaning of human existence */it is
not a normative recommendation about how people
should live. Being well, however, is a normative or

A. Sarvimaki

value-laden idea, since it refers to something good,

in contrast to being ill, which refers to something
bad.
There are, in Heideggers (1978) text, distinctions
and dichotomies that might easily be understood in
terms of good and bad. One is the distinction
between the authentic Self, the I, and the inauthentic
Self, the not-I. There are also the distinctions
between the positive and the deficient modes of
concern as well as between positive modes of
solicitude and the deficient and indifferent ones.
Being-with also holds the possibility of Being-alone.
About Being-with he says:
Thus as Being-with, Dasein is essentially for the
sake of Others. This must be understood as an
existential statement as to its essence. Even if the
particular factical Dasein does not turn to Others,
and supposes that it has no need of them or
manages to get along without them, it is in the way
of Being-with. (Heidegger, 1978, p. 160)
Thus, the not-I is a possibility of the I, Beingalone and being indifferent are possibilities of
Being-with, and leaving undone is a possibility of
Being alongside the ready-to-hand, concern.
It might be tempting to interpret these distinctions
in the way that the positive modes represent the good
while the deficient and indifferent modes represent
the bad. Authenticity would then stand for being
well and inauthenticity for being ill. Heidegger
(1987) says, however:
As modes of Being, authenticity and inauthenticity
/ . . . / are both grounded in the fact that any Dasein
whatsoever is characterized by mineness. But the
inauthenticity of Dasein does not signify any less
Being or any lower degree of Being. Rather it is
the case that even in its full concretion Dasein can
be characterized by inauthenticity */when busy,
when excited, when interested, when ready for
enjoyment. (p. 68)
In holding this view Heidegger (1978) seems to
agree with Buber (1985), something that has also
been pointed out by Macquarrie (1976). Buber
characterized the two attitudes to the world and
other human beings as I-Thou and I-It. The I-Thou
attitude means being in relation and being open,
while I-It means objectifying the world and other
people. Buber claims that living in constant I-Thou
relationships would be too consuming. Therefore, it
is natural to encounter other human beings with the
I-It attitude in some situations.
Sartre (1966), in building his philosophy upon
Heideggers, used the concept bad faith to refer to

the not-I. Living in bad faith means being who one is

not, that is, pretending, and not being who one is,
that is, concealing oneself. Sartre gives many examples of bad faith, like the waiter playing the role of
the perfect waiter. Sartre, however, seems to apply a
more normative stance to good and bad faith. He
sees bad faith as corrupted being, a state we can
recover from although we cannot completely escape
from it:
If it is indifferent whether one is in good or in bad
faith, because bad faith reapprehends good faith
and slides to the very origin of the project of good
faith, that does not mean that we cannot radically
escape bad faith. But this presupposes a selfrecovery of being which was previously corrupted.
This self-recovery we shall call authenticity,
. . . (Sartre, 1966, p. 116.)
Thus, in using words like corruption and
recovery Sartre expressed the view that authenticity, the authentic I, represents something healthier
and better than bad faith, the not-I.
To conclude, as a mode of Being, being well can
be described and understood in terms of:
. the way in which the life-course is unfolded in
everydayness, day after day
. being caught up in life
. being at home in the world and being familiar
with nature, tools and other human beings
. not being-at-home to the extent of loosing
oneself in publicness
. facing the world and oneself in anxiety
. managing to project oneself into the future,
unto death, and realising ones possibilities
. being involved, which accounts for doing as well
as leaving undone, turning to other human
beings as well as being alone, being the authentic I and defining oneself as well as being the
inauthentic not-I */thus not indulging in selfconsuming authenticity.
Well-being re-visited
A Heidegger-inspired way of studying well-being
would involve the abolishment of the division of
well-being into physical, mental, social and spiritual.
Nor would feeling good cover well-being in terms
of Being well. On the contrary, the unfolding of the
life course, being caught up in life, and alternating
between authenticity and inauthenticity would probably include some amount of anxiety, feeling bad.
Would it, then, be possible to describe well-being
in terms of Heideggers philosophy of Being and
then use this understanding in health sciences, for

Well-being as being well 9

example, as a basis for empirical research */research
that would construct well-being in a more holistic
way than the physical-mental-social-spiritual wellbeing or the feeling-good model? Yes, but only
indirectly. Heideggers philosophy is an ontological
analysis, and it is not possible to draw straightforward conclusions from ontology to empirical
sciences and empirical research. Heidegger (1987)
says:
Ontology can contribute only indirectly towards
advancing the positive disciplines as we find them
today. It has a goal of its own, even if, beyond the
acquiring of information about entities, the question of Being is the spur for all scientific seeking.
(p. 77)
It is possible, that a Heidegger-inspired description of well-being would fit badly into a clear-cut
definition. Rather, researching well-being inspired
by this philosophy might be better carried out as a
strategy focusing upon human beings caught up in
their life course in everydayness, in their doings and
not-doings, projects and anxieties. This strategy
resembles the one recommended by Bond and
Corner (2004) for investigating quality of life.
Discussion and conclusion
This study took its starting point in definitions of
well-being and quality of life that divided well-being
into separate parts or focused solely upon the
subjective experience of feeling good and satisfied.
The argument against the first ones was that these
may work well within the psychometric area, but that
they, nevertheless, have to be problematized on the
ontological level, because they imply a view of
human beings and life as divided into separate parts.
This view seemed to fit badly with how people
themselves described their lives. The argument
against the second type of definitions was that they
offer a very one-sided and limited view of human
well-being.
The alternative strategy was based on Heideggers
philosophy of Being, which has previously been
utilized as a basis for qualitative methodology in
health research, interpretive phenomenology. The
aim was now to use this philosophy as a basis for
deeper understanding of human well-being. The
landscape of well-being sketched out from this
viewpoint included being well as the everyday
unfolding of life, as alternating between a sense of
familiarity and unfamiliarity in the world, between
authenticity and inauthenticity. The landscape also
included being well as orientating towards the future
and realising ones potentialities as well as confront-

ing anxiety and death. This view can be used as an

ontological understanding, which can indirectly
point out a strategy for understanding and researching human well-being in health sciences.
Heideggers philosophy can thus be used for two
purposes. Firstly, it can be used to advance the
understanding and problematization of Being and
well-being on an ontological level, and secondly, to
inspire health sciences and empirical research to seek
alternative ways of describing well-being. These two
tasks are both legitimate in themselves. The ontological work holds a specific interest for philosophers,
since ontology is a sub-discipline of philosophy, but
it can also help health researchers become aware of
possible limitations in their way of understanding
well-being. The second task is a task for empirical
researchers who, inspired by Heidegger, want to redescribe well-being.

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