To Flourish (Even) Unto Death: Toward a Theory of Wellbeing for Serious Illness Care
Tyler Tate, MD, MA, Assistant Professor, Pediatrics, Doernbecher Bridges Program, Oregon Health and Science University

‘Wellbeing’ is having a heyday. Yet despite recent popularity, both the definition and experiential content of wellbeing are difficult to pin down. In order to deepen our understanding of what wellbeing is, I will enter the concept through its obverse: suffering. In a recent critique of the influential work of physician Eric Cassell, suffering has been described as a state of affairs consisting of a negative affect, seen as a phenomenological mood, and a loss of one’s sense of self, seen as a loss of one’s relationships, roles, or narrative. In this paper I will extend the connections among suffering, flourishing, wellbeing, and narrative. Specifically, using the work of theorists Harry Frankfurt, Jerome Bruner, and Karl Marx, as well as psychological insights gleaned from Paul the Apostle’s epistle to the Romans, I will analyze human wellbeing as the absence of suffering, with suffering understood as either [1] an alienated sense of self, or [2] a disordered will. Hence the essence of human suffering is conflict, disintegration, and doublemindedness, while the essence of human wellbeing is harmony and integration. With this framework in mind, I will investigate the mechanisms by which serious illness and health engender, respectively, suffering and wellbeing. As demonstrated by the work of social scientists including Arthur Kleinman, Cheryl Mattingly, and Arthur Frank, these mechanisms are inherently narrative; particular peoples’ suffering and wellbeing are connected directly to their experience of illness, an experience that is inseparable from communal-cultural stories about what counts as illness. The upshot of this analysis will be [1] a deeper understanding of the social nature of wellbeing, and [2] practical recommendations for the promotion of wellbeing as a form of health and community membership.