4

Eudaimonic Well-Being and

Health: Mapping Consequences
of Self-Realization
Carol D. Ryff

The purpose of this chapter is to present a multidimensional model of

eudaimonic well-being and consider its implications for human health. In the
first section, distal philosophical underpinnings of the model are examined,
along with conceptual links to existential, humanistic, and developmental
psychology. These theoretical foundations predate the recent flurry of inter-
est in positive psychology. Together, they offer uniquely rich conceptions
of what constitutes the best within us. Following this historical overview,
six key components of eudaimonic well-being are defined and the process
of translating them to structured self-report inventories is briefly described.
Empirical findings as to who possesses high eudaimonic well-being, depend-
ing on one’s age, gender, socioeconomic status, race/ethnicity, and culture,
are then summarized. Also considered is how aspects of well-being are linked
to chronic and acute life events as well as other psychosocial factors.
A central argument is that eudaimonic well-being is not just a matter
of psychological flourishing and self-realization, but that it also matters for

DOI: 10.1037/14092-005
The Best Within Us: Positive Psychology Perspectives on Eudaimonia, Alan S. Waterman (Editor)
Copyright © 2013 by the American Psychological Association. All rights reserved.

77
health. Increasingly, there is recognition that well-being plays a role in offer-
ing protection against disease, disability, and early mortality, via optimal
regulation of multiple neurological and physiological systems. In support of
this perspective, emerging evidence that eudaimonic well-being promotes
good health is briefly reviewed. A concluding section addresses how the expe-
rience of self-realization might be maximized for ever-greater segments of
society, via a focus on intervention programs. Consideration is given to both
individual and social structural factors needed to nurture the best within
ever-larger segments of society.
Viewed in the context of this edited collection, the formulation
advanced in this chapter incorporates ideas of flourishing and self-realization,
but not happiness in the hedonic sense. What follows is also a blend of objec-
tive and subjective views. The historical overview makes clear that guiding
ideas about eudaimonic well-being have emerged from the speculations and
observations of individual thinkers, doubtlessly infused with their own sub-
jectivity. Subsequent efforts to develop empirical assessment tools to measure
and quantify different components of well-being lend an aura of objectivity to
the formulation, in the sense that direct comparisons on the same constructs
of well-being can be made across individuals. Still, it is important to recog-
nize that all obtained assessments come from the self-report of individuals
about themselves—effectively, their subjective judgments about themselves
and their own lives. Thus, where subjectivity ends and objectivity begins,
or the reverse, is not a defining feature of the formulation presented in this
chapter. Rather, it is a blend of both.

Philosophical and Psychological

Underpinnings of Eudaimonic Well-Being

This section summarizes Hellenic perspectives on eudaimonism, draw-

ing on the writings of Aristotle. Other contributions to the multidimensional
model put forth emanate from writings in the middle of the last century
related to humanistic, existential, and developmental psychology. These
combined perspectives were integrated via convergent themes among them
to distill six key components of psychological well-being. Each dimension is
defined and anchored to its conceptual precursors.

Aristotle’s Highest Good

The Nichomachean Ethics, written by Aristotle (trans. 1925) over

2,000 years ago, were put forth not to distill the nature of well-being but to
formulate an ethical doctrine providing guidelines for how to live. Aristotle

78       carol d. ryff

began with the question “What is the highest of all goods achievable by
human action?” His query thus situated the Ethics squarely on the task of
defining the best within us. He answered that for most people, both general
run-of-the-mill types as well as those of superior refinement, the highest good
is happiness. However, he emphasized that people differ in their views of
what constitutes happiness. He then went to great lengths to say that happi-
ness is not about pleasure or satisfying appetites, something he likened to the
life of beasts, nor is happiness about wealth or power, or even about amuse-
ment and relaxation. Instead, Aristotle claimed that the highest human good
was “activity of the soul in accord with virtue” (p. 11).
His answer raised another challenging question: “What is the nature
of virtue?” A first key meaning of virtue according to Aristotle is aiming
toward that which is intermediate. Whether in confidence or fear, anger
or pity, pleasure or pain, his point was that one should strive to experience
these feelings at the right time and in the right way, which was fundamen-
tally about the middle ground. So doing meant avoiding excess of either
one extreme or the other. Too much honor, for example, leads to vanity,
whereas too little honor leads to undue humility. Virtue was thus a state
of character concerned with choice in deliberate actions taken to avoid
excess or deficiency.
There was, however, more to achieving the highest good than finding
the mean in all modes of conduct. The additional part involved reaching
for one’s highest virtue, which is “the best thing in us” (Aristotle, trans.
1925, p. 263). These words underscored Aristotle’s strongly teleological
formulation—our highest human good requires achieving the best that is
within us. This, in turn, necessitates having goals and objectives, purposes to
live for. The essence of his virtue is thus growth toward realization of one’s
true and best nature.
In sum, Aristotle was strongly opposed to defining the highest of all
human goods as hedonic well-being (pleasure, satisfaction of appetites).
Rather, he viewed the highest good toward which humans should strive as
the task of self-realization, played out individually, each according to per-
sonal dispositions and talents. A further point was the recognition that other
needs must be met if we are to realize the best within us—for example, we
must have healthy bodies, adequate food, and shelter.
Contemporary works, such as David Norton’s (1976) Personal Desti­
nies, described eudaimonism as an ethical doctrine wherein each individual
is obliged to know and live in truth according to his daimon, which is a kind
of spirit given to all persons at birth. The focus is on innate potentialities and,
particularly, the responsibility of each individual to know himself or herself
and strive to realize personal capacities. These tasks were the essence of the
two Greek imperatives: Know thyself and become what you are.

eudaimonic well-being and health      79

Existential, Humanistic, and Developmental Views of Well-Being:
Extracting Core Themes

More than 2 millennia after Aristotle wrote the Nichomachean Ethics,

there has been heightened interest in formulating positive human function-
ing. Some contend that the devastation of two world wars prompted greater
reflection on what constitutes humanity at its best. Ideas from existential and
humanistic psychology (Allport, 1961; Frankl & Lasch, 1959/1992; Maslow,
1968; Rogers, 1962) offered useful reminders that meaning and purpose in
life could be found in the most difficult of times. Life-span developmental
perspectives further elaborated the tasks and opportunities for continued
growth at different stages of life (Bühler, 1935; Bühler & Massarik, 1968;
Erikson, 1959; Neugarten, 1968, 1973). From clinical psychology, Jahoda
(1958) worked to define mental health in positive terms, rather than as the
absence of dysfunction. Similarly, Jung (1933) offered a formulation of the
fully individuated person.
Input also came from utilitarian philosophy. John Stuart Mill (1893/
1989), for example, clarified that happiness will not be achieved if made an
end in itself. Instead, it results from keeping our minds fixed on things more
noble, such as the happiness of others or the improvement of mankind.
Bertrand Russell (1930/1958) further emphasized that happiness does not
happen to us effortlessly, like ripened fruit dropping into our mouths, but
rather requires hard work; it is a conquest for which we must strive.
The central challenge of working with these many prior perspectives
was to find a way to integrate them into a coherent whole. Focusing on recur-
rent themes or points of convergence among them (Ryff, 1982, 1985, 1989a)
offered a way forward. The following section distills key dimensions of well-
being that emerged from identifying the primary points of convergence or
overlap in the above formulations.

Six Core Dimensions of Well-Being

Positive Relations With Others

All of the previous perspectives describe the interpersonal realm as a

central feature of a positive, well lived life. Aristotle’s Ethics, for example,
included lengthy sections on friendship and love. Mill’s autobiography offered
a lengthy account of the great love of his life, and Russell saw affection as
one of the two great sources of happiness. Jahoda viewed the ability to love
to be a central component of mental health, whereas Maslow described self-
actualizers as having strong feelings of empathy and affection for all human

80       carol d. ryff

beings and the capacity for great love, deep friendship, and close identifica-
tion with others. Warm relating to others was posed by Allport as a criterion
of maturity. Erikson’s adult developmental stages emphasized the achieve-
ment of close unions with others (intimacy) as well as the guidance and
direction of others (generativity). Finally, philosophical accounts of the “cri-
terial goods” of a well lived life (Becker, 1992) underscore the primacy of
love, empathy, and affection. From a cultural perspective, there is universal
endorsement of the relational well-being as a key feature of fulfilled living.

Personal Growth

Of all the aspects of well-being, it is personal growth that comes closest

in meaning to Aristotle’s eudaimonia because it is the dimension explic-
itly concerned with self-realization of the individual. This part of positive
functioning is dynamic, involving a continual process of developing one’s
potential. Self-actualization, as formulated by Maslow and elaborated by
Norton, is centrally concerned with realization of personal potentialities,
as is Jahoda’s conception of mental health. Rogers described the fully func-
tioning person as having openness to experience in which one is continu-
ally developing and becoming, rather than achieving a fixed state wherein
all problems are solved. Life-span theories (Bühler, Erikson, Neugarten, and
Jung) gave explicit emphasis to continued growth and the confronting of
new challenges at different periods of life.

Purpose in Life

This dimension of well-being draws heavily on existential perspectives,

especially Frankl’s search for meaning vis-à-vis adversity. He developed logo-
therapy, which was directly concerned with helping people find meaning and
purpose in the suffering and travails of life. Creating meaning and direction
in life is the fundamental challenge of living authentically according to
Sartre. Although these views tend to emphasize the will to find meaning in
the face of what is awful, difficult, or absurd in life, themes of life purpose
are also evident in other, less dark literatures. Russell’s emphasis on zest, for
example, is fundamentally about actively engaging in and having a reflecting
stance toward life. Jahoda’s definition of mental health gave explicit emphasis
to beliefs that give one a sense of purpose and meaning in life. Allport’s defi-
nition of maturity included having a clear comprehension of life’s purpose,
which included a sense of directedness and intentionality. Finally, life-span
developmental theories refer to the changing purposes or goals that charac-
terize different life stages, such as being creative or productive in midlife and
turning toward emotional integration in later life.

eudaimonic well-being and health      81

Environmental Mastery

Jahoda defined the individual’s ability to choose or create environ-

ments suitable to personal psychic conditions as a key characteristic of men-
tal health. Life-span developmental theories also emphasize the importance
of being able to manipulate and control complex environments, particularly
in midlife, as well as the capacity to act on and change the surrounding world
through mental and physical activities. Allport’s criteria of maturity included
the capacity to “extend the self,” by which he meant being able to participate
in significant spheres of endeavor that go beyond the self. Together, these
views endorsed active participation in and mastery of the environment as
important ingredients of an integrated framework on positive psychologi-
cal functioning. This dimension has parallels with other psychological con-
structs, such as sense of control and self-efficacy, although the emphasis on
finding or creating a surrounding context that suits one’s personal needs and
capacities is unique to environmental mastery.

Self-Acceptance

The Greeks admonished that we should know ourselves—strive to

accurately perceive our own actions, motivations, and feelings. Many of the
previously mentioned formulations emphasized something more: namely,
positive self-regard. This is a central feature of mental health (Jahoda) as
well as a characteristic of self-actualization (Maslow), optimal functioning
(Rogers), and maturity (Allport). Life-span theories also emphasized the
importance of acceptance of self, including one’s past life (Erikson, Neugarten).
The process of individuation (Jung) further underscored the need to come
to terms with the dark side of one’s self (the shadow). Thus, both Erikson’s
formulation of ego integrity and the Jungian individuation emphasized a kind
of self-acceptance that goes beyond usual views of self-esteem. It is a kind of
self-evaluation involving long-term awareness and acceptance of both one’s
personal strengths and weaknesses.

Autonomy

Many of the conceptual frameworks emphasized qualities such as self-

determination, independence, and the regulation of behavior from within.
Self-actualizers, for example, are described as showing autonomous function-
ing and a “resistance to enculturation” (Maslow). The fully functioning per-
son described by Rogers has an internal locus of evaluation, whereby one does
not look to others for approval, but instead evaluates oneself by personal stan-
dards. Individuation is also described as involving a “deliverance from conven-

82       carol d. ryff

tion” (Jung), in which one no longer belongs to the collective beliefs, fears,
and laws of the masses. The existential idea of living in “bad faith” (Sartre,
1956) similarly underscores the importance of self-determination and living
authentically, rather than following the dogma or dictates of others. Finally,
life-span developmental scholars (Erikson, Neugarten, Jung) wrote about the
need to turn inward in the later years of life, which involved gaining a sense
of freedom of the norms governing everyday life. From a cultural perspective,
this aspect of well-being is the most Western of all of the above dimensions.
How these six dimensions were translated to empirical assessment tools
is briefly described in the next section, and initial descriptive findings regard-
ing who does and does not possess high levels of well-being are summarized.

Empirical Translation of Eudaimonic

Constructs and Scientific Findings

This section summarizes the process of constructing measurement

instruments for assessing psychological well-being. It is followed by a brief
distillation of key findings derived from using the scales in scientific research.

Creating Assessment Tools

Self-report scales were developed to measure the previously mentioned

six dimensions of well-being, using the construct-oriented approach to per-
sonality assessment (Wiggins, 1980). Of importance at the outset is the pres-
ence of psychological theory that specifies the constructs of interest. Thus,
the first step in the scale construction process is to define high and low scor-
ers on each of the six dimensions (Ryff, 1989b). Self-descriptive items that
fit with these definitions were then generated with large initial item pools
(about 80 items per scale). These were then culled on the basis of multiple
face validity criteria (i.e., ambiguity or redundancy of item, lack of fit with
scale definition, lack of distinctiveness with items from other scales, inabil-
ity to produce a variable response). Reduced-item pools (32 items per scale
divided between positively and negatively worded items) were then admin-
istered to the initial research sample of young, middle-aged, and older adults.
Item-to-scale correlations were computed, and items failing to correlate more
highly with their own rather than another scale were deleted. This process
was terminated with 20-item scales, divided equally between positively and
negatively scored items. Additional psychometric evaluations (e.g., test–retest
reliability, internal consistency) were generated.
Since the original publication (Ryff, 1989b), multiple investigations have
examined the factorial validity of the theory-based model of psychological

eudaimonic well-being and health      83

well-being. Five such studies (Cheng & Chan, 2005; Clarke, Marshall,
Ryff, & Wheaton, 2001; Ryff & Keyes, 1995; Springer & Hauser, 2006; van
Dierendonck, 2004) using confirmatory factor analyses have been conducted.
All, including three investigations with nationally representative samples, show
that the best-fitting model to the data is the theory-guided, six-factor model.

Empirical Findings: Who Has Eudaimonic Well-Being?

Initial empirical studies examined how the six dimensions of psycho-

logical well-being vary by sociodemographic characteristics such as age, gen-
der, or educational status. With regard to age, initial cross-sectional findings
(Ryff, 1989b) indicated that some aspects of well-being (e.g., autonomy, envi-
ronmental mastery) showed incremental profiles with age, whereas others
(e.g., purpose in life, personal growth) showed sharply decremental profiles
from young adulthood to old age, and still others showed little age variation
(e.g., positive relations with others, self-acceptance—only for women). These
patterns were replicated with other community samples (Ryff, 1991) and a
nationally representative sample of U.S. adults (Ryff & Keyes, 1995), using
scales of different length. More recent longitudinal findings have strength-
ened the evidence that the age differences, especially the downward aging
profiles on purpose in life and personal growth, represent actual losses in
well-being that many experience as they grow older (Springer, Pudrovska,
& Hauser, 2011). Such decline in the two most eudaimonic aspects of well-
being may reflect challenges faced by society in providing older persons with
meaningful roles and opportunities for continued growth.
Sociologists have referred to this situation as the “structural lag” prob-
lem. The idea is that contemporary social institutions lag behind the added
years of life that many now experience (Riley, Kahn, & Foner, 1994). Related
to such ideas, Greenfield and Marks (2004), using data from the MIDUS
(Midlife in the U.S.) national study, found that older persons who occupied
few major roles but who also engaged in formal volunteering had higher
levels of purpose in life than those lacking both major roles and volunteer
experiences. Cultural context may also matter; for example, aging in soci-
eties that honor and revere elders may be a different experience than grow-
ing old in youth-oriented societies. Our comparative research in Japan
(Karasawa et al., 2011) adds some credence to this view. In the comparison
of midlife and older adults, we found age increments in personal growth
among the Japanese, but age decrements in the United States. Nonethe-
less, downward trajectories were observed in purpose in life in both cultural
contexts.
Whether or not the surrounding context nurtures self-realization is also
illuminated by examining how well-being varies depending on one’s socio-

84       carol d. ryff

economic status, such as level of education, income, or occupational status.
We have shown that the six dimensions of well-being are positively linked
with educational attainment for both men and women, although the patterns
are stronger for women (Ryff & Singer, 2008). The two dimensions that
show the greatest increments as a function of educational advancement are
personal growth and purpose in life—again, the two pillars of eudaimonia.
These findings bring empirical support to Dowd’s (1990) observation that
the opportunities for self-realization are not equally distributed, but occur
via the allocation of resources, which enable some, but not others, to make the
most of their talents and capacities.
Aristotle seemed to miss this point. The Greeks lived in a hierarchical
society differentiated into subgroups of people. Surprisingly, only some were
thought to possess the essential daimon; women and slaves were excluded,
for example. In the present era, there is greater awareness of problems of
social inequality and greater concern about their implications for health
(Adler, Marmot, McEwen, & Stewart, 1999). Our research on educational
disparities in psychological well-being (Marmot et al., 1997, 1998) adds to
this literature, showing that those at the low end of the socioeconomic hier-
archy are not only more likely to succumb to disease and disability but also
suffer from diminished opportunities to make the most of their lives. As
detailed in the biological section that follows, these patterns are likely to be
linked, that is, thwarted self-realization may be a critical part of the interplay
of biological and psychosocial processes that contribute to early morbidity
and mortality.
Nonetheless, it is important to note variants from these patterns, which
show, on average, that higher psychological well-being accompanies higher
educational attainment. Our work has, however, also documented remark-
able resilience among those who lack socioeconomic advantage and/or have
been confronted with significant life challenges (Markus, Ryff, Curhan, &
Palmersheim, 2004; Ryff, Singer, & Palmersheim, 2004; Singer & Ryff, 1997,
1999; Singer, Ryff, Carr, & Magee, 1998). We have also found such resilience
among racial/ethnic minorities (Ryff, Keyes, & Hughes, 2003). Together,
these studies document the meaning-making and growth-producing effects
of adversity, thus bringing empirical substance to Frankl’s (1959/1992) view
that purpose can emerge from the confrontation with difficulty. Such findings
challenge the Hellenic view that realization of the highest human good was
somehow the exclusive terrain of privileged segments of society.
Apart from investigating age or socioeconomic variants in well-being,
other investigators have linked eudaimonic well-being to numerous other
psychological constructs, such as identity status (Helson & Srivastava, 2001),
self-enhancing cognitions (Taylor et al., 2003a, 2003b), emotion regulation
(Gross & John, 2003), personality traits (Lopes, Salovey, & Straus, 2003;

eudaimonic well-being and health      85

Schmutte & Ryff, 1997), personal goals (Carr, 1997; Riediger & Freund,
2004), values (Sheldon, 2005), coping strategies (Kling, Seltzer, & Ryff,
1997), social comparison processes (Heidrich & Ryff, 1993; Kwan, Love,
Ryff, & Essex, 2003), and spirituality (Kirby, Coleman, & Daley, 2004; Wink
& Dillon, 2003). Others have examined associations between well-being
and chronic and acute life experiences, such as early parental loss or paren-
tal divorce (Maier & Lachman, 2000), growing up with an alcoholic parent
(Tweed & Ryff, 1991), trauma disclosure (Hemenover, 2003), community
relocation (Smider, Essex, & Ryff, 1996), caregiving (Marks, 1998), and
change in marital status (Marks & Lambert, 1998). Collectively, these inves-
tigations illustrate the diverse interests researchers have brought to the topic
of well-being and, in addition, clarify the many factors that may influence, or
be influenced by, eudaimonic self-realization.

Linking Eudaimonic Well-Being

to Biology and Health

Consequential approaches to moral philosophy focus on outcomes or

consequences in determining what constitutes right action. Eudaimonic
well-being, as described previously, may be defended as right and worthy of
promotion, both at the individual and the societal level, to the extent that
it benefits human health. That is, if becoming the best within us is truly the
right way to live, it would be expected to lead to other beneficial outcomes,
such as greater likelihood of practicing good health behaviors (i.e., the expe-
rience of self-realization likely contributes to motivation to take care of one-
self). Those living lives of purpose, meaning, and growth may also have better
regulation of multiple biological systems because they are better equipped
for dealing with stress and challenge when they occur. This combination of
motivated self-care and healthy regulation of key systems (neuroendocrine,
cardiovascular, inflammatory), in turn, likely contributes to delayed onset of
disease and disability and thereby longer and higher quality life. This formu-
lation of health (Ryff & Singer, 1998) constitutes a notable departure from
traditional medical models that focus almost exclusively on pathways to ill-
ness, disease, and death rather than on the promotion of what keeps people
functional, healthy, and well.
An initial test of these ideas involved investigating the neurobiologi-
cal correlates of psychological well-being, measured with the six dimensions
described previously (Ryff, Singer, & Love, 2004). With a sample of older
women, we correlated reported well-being with diverse biomarkers (cardio-
vascular, neuroendocrine, inflammatory). We found that those who reported
higher levels of well-being (especially personal growth and purpose in life)

86       carol d. ryff

had better neuroendocrine regulation, shown in terms of lower levels of sali-
vary cortisol throughout the day. Similarly, higher well-being was linked with
lower levels of inflammatory markers, such as interleukin-6 (IL-6) and its
soluble receptor (sIL-6r). Higher levels of environmental mastery, positive
relations with others, and self-acceptance, in turn, were associated with bet-
ter glycemic control, measured in terms of glycosylated hemoglobin. Those
with higher personal growth and purpose in life also showed higher levels of
HDL cholesterol, known as the “good” cholesterol.
Extending these findings with the same older women, we documented
the interplay between one aspect of well-being (positive relations with oth-
ers), sleep, and inflammatory markers (Friedman et al., 2005). The highest
levels of IL-6, a precursor to multiple later life diseases, were observed among
those who reported both low interpersonal well-being and poor sleep effi-
ciency (defined as the period of REM sleep over total time in bed). However,
the findings also underscored various compensatory processes. For example,
those experiencing poor sleep were protected against higher IL-6 if they
reported better relationships with others; alternatively, those with poor
social relations were protected against higher IL-6 if they experienced bet-
ter sleep. These results were valuable for underscoring the role of well-being
as a moderator of other risk factors (e.g., poor sleep) on inflammatory out-
comes. A related analysis examined cross-time sleep patterns in these older
women and found that those with higher levels of eudaimonic well-being
(purpose, growth, mastery, positive relations) at baseline had reduced odds
of being in the sleep-disrupted group over time (Phelan, Love, Ryff, Brown,
& Heidrich, 2010).
In a separate sample of midlife adults, dimensions of eudaimonic well-
being were linked with salubrious brain activation patterns. Specifically,
greater left (than right) prefrontal activation was associated with higher lev-
els of multiple aspects of well-being, after adjusting for positive affect and
life satisfaction (Urry et al., 2004). This specific brain activation pattern was
previously linked to better health outcomes, including increased antibody
response to flu vaccine (Rosenkranz et al., 2003). In a more recent study
using functional magnetic resonance imaging techniques, van Reekum et al.
(2007) found that those with higher eudaimonic well-being showed better
regulation of subcortical emotion centers (amygdala) by higher cortical brain
regions (anterior cingulate cortex). Individuals with these brain patterns
showed reduced emotional responses to negative stimuli.
The more demanding test of whether experienced eudaimonic well-
being is biologically protective involves studying the individual under con-
ditions of challenge. Such inquiry brings into high relief the interplay of
well-being, biology, and health when faced with adversity. As noted earlier,
we have been interested in the experience of eudaimonic well-being vis-à-vis

eudaimonic well-being and health      87

social inequality, measured in terms of educational attainment. Prior health
research had repeatedly documented that lower socioeconomic standing con-
tributes to greater risk of illness, disease, and disability, along with earlier
mortality (Adler, Marmot, McEwen, & Stewart, 1999; Adler & Rehkopf, 2008;
Alwin & Wray, 2005; Kawachi, Kennedy, & Wilkinson, 1999; Matthews &
Gallo, 2011). Current inquiries have focused on identifying the biological
pathways through which these effects occur, including via heightened cardio­
vascular risk, elevated neuroendocrine activity, and increased inflamma-
tion (e.g., Friedman & Herd, 2010; Karlamangla et al., 2005; Lupien, King,
Meaney, & McEwen, 2001; Steptoe, Owen, Kunz-Ebrecht, & Mohamed-Ali,
2002). Limited work has addressed variability within socioeconomic groups,
that is, the extent to which some at the low end of the SES hierarchy manage
to evade adverse health outcomes.
We have studied this question using psychological well-being as a
moderating factor that may offset, or protect against, ill health outcomes
among educationally or economically disadvantaged individuals. One lon-
gitudinal investigation (Tsenkova, Love, Singer, & Ryff, 2007) based on
the above community sample of aging women found, as predicted, that
those with higher levels of income had better glycemic control, measured
in terms of glycosylated hemoglobin. The effect was, however, moderated
by reported levels of well-being (purpose in life, personal growth, positive
affect), but the direction of the interaction revealed an exacerbation of
biological risk via the lack of well-being. That is, those with low levels of
income had worse glycemic control when they also reported compromised
levels of well-being.
Recent findings from the MIDUS national sample of American adults
document the hypothesized protective effects with a different biological fac-
tor, namely, the inflammatory marker IL-6 (Morozink, Friedman, Coe, & Ryff,
2010). Consistent with previous research, the first finding was that those
with lower levels of education had higher levels of this inflammatory marker,
net of numerous confounds (health behaviors, body mass index, chronic ill-
nesses). However, reported well-being moderated this effect, such that those
with higher levels of environmental mastery, positive relations with others,
purpose in life, self-acceptance, and positive affect showed less elevated levels
of IL-6 compared with their same-education peers who did not report higher
levels of well-being. In fact, these individuals with only a high school educa-
tion or less had IL-6 levels comparable with those in college-educated adults,
thus underscoring that the maintenance of high levels of well-being in the
face of socioeconomic adversity is linked with better inflammatory profiles.
Additional work is needed to examine possible mediating processes, such
as better health behaviors (diet, exercise, weight) and better glucocorticoid
regulation that may underlie these effects.

88       carol d. ryff

 A central challenge of aging is maintaining functional capacities,
despite the accumulation of chronic conditions; medical comorbidity charac-
terizes the majority of adults over the age of 65 (Friedman & Ryff, in press-b).
These normatively experienced health changes also contribute to increased
biological risk for subsequent morbidity and mortality. Using the MIDUS
sample, we found, for example, that those with increased profiles of chronic
conditions had higher levels of IL-6 and C-reactive protein (Friedman &
Ryff, in press-a). It is important that these effects were, however, moderated
by reported levels of purpose in life and positive relations with others. That
is, despite increased burden of disease, those experiencing higher levels of life
purpose and quality ties to others showed reduced increments in inflamma-
tory markers compared with those with higher chronic conditions and low
well-being.
This summary of well-being and health findings ends with work from
other investigators involved with the Rush Memory and Aging Project, a
longitudinal study of community-based adults in and around Chicago. Three
studies from this group have underscored the protective influence of high
purpose in life. Controlling for a variety of confounds and using a prospec-
tive design, those with high life purpose showed a significantly reduced risk of
mortality 5 years later (Boyle, Barnes, Buchman, & Bennett, 2009) compared
with those with lower levels of life purpose. Two subsequent studies found
that those with high levels of life purpose were half as likely to develop dis-
ability over a 6-year follow up (Boyle, Buchman, & Bennett, 2010) and 2.5
times less likely to develop Alzheimer’s disease over a 7-year follow-up com-
pared with those having low levels of life purpose (Boyle, Buchman, Barnes,
& Bennett, 2010).
Taken together, this collection of empirical findings offers growing
evidence that eudaimonic well-being affords protection against the health
challenges of aging as well as those that accompany social inequality. The
findings vary with regard to which aspects of well-being convey such protec-
tive benefits, although the most consistent patterns were observed for purpose
in life, personal growth, and positive relations with others. The protective
benefits shown sometimes pertain to better biological regulation (reduced
stress hormones, reduced cardiovascular and inflammatory risk factors) and
in other cases, to actual disease outcomes (Alzheimer’s, disability, mortal-
ity). In several instances, the evidence has come from longitudinal inqui-
ries, thereby sharpening causal interpretations. Routinely, such studies have
included variables to control for confounding factors. Given the overall pat-
tern of supportive evidence, it is relevant to ask whether and how eudaimonic
well-being can be promoted. Of critical importance are interventions that
could make it possible for ever-greater numbers of individuals to experience
the best within themselves.

eudaimonic well-being and health      89

Conclusion: Can Eudaimonic Well-Being Be Promoted?

Self-realization not only is desired phenomenologically (a valued sub-

jective experience), but it also appears to be good for biological regulation
and health, via brain and biochemical processes that are becoming increas-
ingly understood. Whether more individuals can participate in this salubri-
ous interplay of subjective fulfillment with biology is of critical importance.
Fortunately, clinicians treating disorders, such as depression and anxiety,
provide encouraging evidence that experiences of well-being are not inher-
ently fixed but can be modified and changed. “Well-being therapy,” devel-
oped by Fava and colleagues (Fava, 1999; Fava, Rafanelli, Grandi, Conti,
& Belluardo, 1998; Fava et al., 2005), is one such intervention offered in
combination with cognitive behavior therapy. It has been shown to prevent
relapse of major depression over periods of 2 to 6 years. The goal of therapy is
to improve patients’ experiences of well-being in hopes of preventing relapse
during the residual phase of mood and anxiety disorders, when major debili-
tating symptoms have subsided but the patient remains at risk for falling back
into the depressed or anxious condition. It is a short-term therapeutic strat-
egy (8 weeks) that involves the use of structured diaries. Clients are required
to record positive experiences from their daily lives, however fleeting. The
focus in therapy sessions is on helping clients sustain such experiences rather
than prematurely interrupt or curtail them by maladaptive cognitions. The
fundamental idea behind the therapy is that recovery from mood and anxi-
ety disorders requires the capacity to experience well-being (Fava, Ruini, &
Belaise, 2007), which in treatment is guided by the eudaimonic model of psy-
chological well-being (Ryff, 1989b). Thus, eliminating symptoms of distress
is, in and of itself, insufficient to achieve full recovery; one must also be able
to participate in positive psychological experience (Fava & Ruini, 2003).
Given the success of well-being therapy in preventing relapse of psy-
chological disorders, it has been adapted for use in preventive contexts as
well. Ruini, Belaise, Brombin, Caffo, and Fava (2006), for example, devel-
oped an intervention protocol derived from the therapy that has been used
with students in school settings. Pilot research demonstrated that the inter-
vention resulted in a reduction of psychological symptoms and an increase in
psychological well-being.
Adapting the strategy to other contexts and other age groups, including
older adults in the community, is a worthy pursuit. To the extent that indi-
viduals can cultivate skills for seeing and savoring the positive in themselves
and their lives, much in the same way that people can learn to practice good
nutrition, they would have tools at their disposal to draw on in times of dis-
tress or adversity. The prior literature on resilience, in both childhood (e.g.,
Luthar, Cicchetti, & Becker, 2000; Masten, 1999) and adulthood (Klohnen,

90       carol d. ryff

1996; Reich, Zautra, & Stuart Hall, 2010; Ryff & Singer, 2003; Staudinger,
Marsiske, & Baltes, 1995), has underscored the presence of certain protec-
tive factors, such as personality attributes, intellectual abilities, and social
supports. The subjective experience of self-realization—that is, the feeling of
becoming the best one can be, regardless of age or stage in the life course—
may constitute an even greater protective resource. As Aristotle suggested, it
is possibly the highest human good, which also appears to be consequential
for good health. Taken together, the concluding message is that advanced
and enlightened societies are those that promote not the greatest happiness
for the greatest number of people, but instead opportunities to realize the best
that is with the largest segment of its members.

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98       carol d. ryff