Quality of Life

Concept, Policy and Practice

David Phillips

• Publisher: Routledge
• Year: 2006
• ISBN:
  9781134349333
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

Quality of life is one of the most important issues facing the world today and is central to the development of social policy.

This innovative book discusses this crucial topic, assessing the criteria for judging attempts to raise quality of life, including the satisfaction of basic and social needs, autonomy to enjoy life and social connectivity. It considers key topics such as:

• individual well-being and health-related quality of life
• human needs - living fulfilling and flourishing lives
• poverty and social exclusion
• social solidarity, altruism and trust within communities.

Quality of Life is the first systematic presentation of this subject from both individual and collective perspectives. It provides a powerful overview of a concept which is becoming increasingly prominent in the social sciences and is essential reading for students of social policy, sociology and health studies.

1 Quality of Life and the Individual

This chapter starts with the basic building blocks of quality of life, with the actual sensations of pleasure and pain that are the foundations of feelings of happiness. Then the important notion of subjective well-being (SWB) is introduced and explored in relation to two big questions: ‘What makes us happy?’ and ‘Why are some people happier than others?’ The search for answers to these questions moves from individual, genetic and biological explanations related to personality, through to economic perspectives – is it all down to money? – on to large-scale social and political aspects of the culture and politics in different societies. Along the way, these questions are explored from two different perspectives, incorporating people’s own verdicts on what affects their quality of life as well as the views of social science academics.

The second part of the chapter builds on these insights in moving from notions of SWB towards a wider view of ‘quality of life’, bringing in other aspects in addition to people’s subjective appraisals. The chapter concludes with some case studies of visions of what a good quality of life looks like.

Happiness, Life Satisfaction, Subjective well-Being

Happiness, life satisfaction and subjective well-being are mutually interrelated – and indeed they are all closely connected with the notion of quality of life – but they are also highly contested constructs. ‘Happiness’ is perhaps the most contested; indeed, the disagreement about happiness is at an absolutely basic level. One of the leading figures in the study of quality of life and a Nobel Laureate, Daniel Kahneman does not trust people’s own statements and beliefs on this topic. Indeed, he goes further than this and claims: ‘they do not generally know how happy they are, and they must construct an answer to that question whenever it is raised’ (Kahneman, 1999). He claims that the starting point should not be people’s subjective views about how happy they are but instead objective measures of those sensations that are associated with the real-time feeling of happiness – in other words, objective happiness.

Objective Happiness and Pleasure

The idea of objective happiness is at first sight fanciful and bizarre in that it can lead to a person being happy when not actually thinking they are happy and – potentially much more problematically – can at least in principle lead to a person thinking they are happy when they are not happy in this objective sense. The first of these alternatives is not really too problematic so long as the person is not actively believing that they are unhappy. This is because it is not necessary for a person to be articulating a sensation, feeling or mood at the moment they are experiencing it. Indeed, people’s happiest moments are often when they are too deeply engrossed in an activity to be self-conscious about their state of mind. The second alternative is much more problematic because if a person is believing that they have a certain mental state at a time when an objective measurement is demonstrating that this is not the case, then the person, again within this formulation, is either deceiving themselves or else is attaching a different and, from Kahneman’s perspective, incorrect meaning to the word.

It is instructive to look at each of these alternatives in some more detail but first it is necessary to be rather more specific about what objective happiness is. For Warburton (1996: 2) it is a pleasant physiological sensation caused by a neurochemical response of the dopamine system of the brain to external stimuli. He notes that drugs used to treat depression act on these brain systems, as do a range of drugs which produce ‘anhedonia’ (a loss of pleasure). He claims that people strive to achieve objective happiness by maximising their contact with pleasurable stimuli. This is good for individuals and, he claims, good for the species in that the sensations associated with sexual interactions and consuming food are in general pleasurable: ‘it would seem of evolutionary importance that these biological experiences should be associated with a feeling of well-being which results in the repetition of the experience’ (ibid.: 3).

The important aspect of this proposition for the purposes of this book is not the role of pleasurable experience in the propagation of the species but in relation to theories of quality of life. Warburton explicitly links this seeking of pleasurable sensations to a utilitarian rational choice economic theory: ‘This is an attractive theory of rational choice because it proposes a single metric by which individuals choose among competing alternatives’ (ibid.: 2). This ‘single metric’ is the basis for utilitarian theory, in at least some of its manifestations. This is discussed at length in Chapter 3.

Kahneman (1999) has a similar starting point to Warburton’s but he develops the utilitarian perspective even further. For Kahneman, it is of primary importance to maximise good experiences rather than maximising ‘satisfaction’ or SWB: according to Kahneman, true well-being is not necessarily related to a person’s judgement of how happy they are. Instead:

Real-time measures of experience can be obtained, stored without error, and aggregated to yield a measure of objective well-being that is anchored in the reality of present experience, not in fallible reconstructions and evaluations of the past.

(Kahneman, 1999: 22)

These real-time measures are of what Kahneman calls instant utility, that is, being pleased as an attribute of experience at a particular moment. The term utility is crucial here because the datum of instant utility is the absolute indivisible basis for a bottom-up utilitarian approach: here the greatest happiness of the greatest number is the maximised aggregation of each datum of instant utility. So Kahneman’s theory of objective happiness is an extraordinarily rigorous utilitarian vision of quality of life. Indeed, it is perhaps the ultimate presentation of utilitarianism because it is impossible to imagine a more stringent foundation that that of instant utility.

It is important to note here that there is no place whatsoever for an assessment of either subjective well-being or even objective good fortune in what Kahneman calls his ‘objective and normatively justified definition of true well-being’. This is because, as noted above, for him, true objective well-being is anchored in ‘the reality of present experience’ (ibid.: 22).

Therefore, to return to the two questions asked above, according to Kahneman, it is indeed possible for a person to think they are happy, and to be in circumstances of great objective good fortune while not being objectively happy and, conversely, for a person to be objectively happy while having low levels of both subjective happiness and of objective good fortune: ‘All combinations of levels of good or bad fortune, objective happiness or misery are possible, and are all probably quite common (ibid.: 5; italics in original).

It was noted above that the idea of objective happiness appears rather bizarre, and the quote above from Kahneman perhaps underlines this. On a practical level, it is possible to think of the most paradoxical examples where the pursuit of pleasurable stimuli leads to extreme situations, such as an early death for a person addicted to pleasurable but dangerous drugs.

Also there is another potential problem with the link which Kahneman makes between ‘objective happiness’ and ‘good experience’. This is that different people may well have – and as seen later in this chapter, indeed do have – different levels of dopamine and related chemicals in their bodies because of genetic factors rather than in response to external stimulus, that is, some people have happier personalities or dispositions than other people. These ‘happy people’ will have greater ‘instant utility’, irrespective of external experiences. So objective happiness may comprise two parts, one genetic and the other experiential.

This opens the unnerving possibility of a further way to increase instant utility and objective happiness: that is by genetic engineering via manipulating the chemicals in people’s bodies. There are less sophisticated ways of achieving this aim by use of anti-depressant-type drugs, for example, through a nation’s drinking-water supply system. This science-fiction possibility was foreshadowed in Aldous Huxley’s (1932) Brave New World in the use of the recreational drug ‘soma’.

There is, in fact, another and, fortunately, far less dangerous way of enhancing objective happiness – by taking aerobic exercise. Argyle (1996: 24), for example, reports that: ‘brisk walks of ten minutes produced a positive mood, together with more energy, less anxiety, depression and tiredness, for two hours’. Two questions arise from this. The first relates to the use of ‘happiness’ or ‘instant utility’ here. There is no doubt that moderate exercise is a good thing and that it has a beneficial physiological effect and indeed that a part of that effect can be a feeling of wellbeing. But is it reasonable to call this objective happiness? In this context, Veenhoven (2003) makes the useful distinction between hedonism as being open to pleasurable experience and happiness as being more holistic and related to life satisfaction.

The second question is to do with issues of importance as opposed to intensity: the objective measurement for this physiological event might be able to differentiate on the basis of physiological intensity but does not necessarily indicate its meaning or its importance to its recipient. Thus it is entirely possible that two events may score the same ‘instant utility’ even if one has very little meaning and the other is of massive significance in a person’s life.

Thus, there are serious conceptual problems in the use of instant utility as the foundation for a utilitarian vision of quality of life. Nevertheless, there are lessons to be drawn from this exposition, the most important of which is the centrality of the experience of pleasure to well-being. This perhaps appears to be too obvious to be worth stating yet, as can be seen in Chapter 3, whole edifices of quality of life have been constructed and implemented – and some are extensively used by international agencies – which have no place at all for the experience of pleasure or even happiness. So it is clear that this message has still not been fully received.

Definitions of Subjective well-Being (SWB)

In practical terms, subjective happiness and subjective well-being are much more easy to deal with than their objective counterparts. Also, according to Diener and Oishi (2000), subjective well-being (SWB) is very democratic because it allows people to judge their own lives instead of focusing on judgements made on the quality of their lives by ‘experts’. Basically, a person’s level of subjective happiness can be ascertained from the reply given when asked how happy they are (Kahneman, 1999). So it can only be measured indirectly and it cannot be verified or validated objectively, as can objective happiness. Similarly it cannot be measured with precision and, as noted above, many people will not have a response ready to hand and will have to think about their circumstances in order to construct an answer.

SWB is rather more complex than happiness and comprises three or four elements. For Diener and Lucas (1999), SWB has three components: (1) pleasant affect; (2) unpleasant affect; and (3) satisfaction. It is interesting to note that they identify pleasant and unpleasant affect as two separate items rather than as two sides of the same coin. They do this because it is possible to have high levels of both or indeed low levels of both. Thus Diener and Lucas identify four different classifications of affect, as follows:

1 High levels of pleasant affect plus low levels of unpleasant affect = happy.

2 Low levels of pleasant affect plus high levels of unpleasant affect = unhappy.

3 High levels of both pleasant and unpleasant affect = emotional.

4 Low levels of both pleasant and unpleasant affect = unemotional.

The first two are intuitively unproblematic but the last two might appear a little contrived at first sight. However, Diener and Suh (1999) show that they are substantively important in a comparison between the ‘hedonistic balance scores’ of different countries. They found that Japan and Turkey had identical average scores, taking pleasant and unpleasant affect together, but that Turkey had higher levels on both than did Japan, so Turkey had higher levels of emotional response than Japan.

Some other interesting aspects emerge when satisfaction is included in the equations. Leaving aside the ‘emotional’ and unemotional responses for the moment, we can construct the following four classifications:

1 happy and satisfied

2 unhappy and dissatisfied

3 happy and dissatisfied

4 unhappy and satisfied.

The first two instances are straightforward. The satisfied, happy person with high pleasant and low unpleasant affect has very high SWB and the dissatisfied, unhappy person with low pleasant and high unpleasant affect has very low SWB. But what of the other two classifications? There seem to be three plausible answers. The first is that they are self-contradictory and in fact impossible, on the grounds that a satisfied person must be happy, a happy person must be satisfied and the opposites must also be true with regard to dissatisfaction and unhappiness. The second is that, yes they are self-contradictory but that people may well be ambivalent and simultaneously hold contradictory views (as stated by Kahneman in the quote above on objective and subjective happiness and objective good fortune).

The third and most interesting answer, is that they are not necessarily contradictory but can tap into different dimensions of SWB. To some extent the answer selected depends upon definitional issues but rather than trying to define these terms minutely, instead an attempt is made here to identify some real-life situations where the third and fourth categories have substantive meanings. If this attempt succeeds, then the distinction between happiness and satisfaction can be seen to be meaningful, in at least some circumstances. It can be noted in passing that this debate is not entirely abstract and esoteric: it does have some important significance when operationalising the SWB construct, and it might even throw some light upon recent research results which show an unexpected divergence between trends in SWB between Britain and the USA, discussed later in this chapter.

Happy and dissatisfied: critics of the notion of objective happiness can have considerable impact if they can demonstrate that this is a valid and substantive classification. There are several possible avenues here, perhaps the most popular one is the ‘poor little rich boy/girl’ of contemporary fiction and music. An example would be a person who has full and unfettered access to all life’s hedonistic pleasures but eventually finds them unrewarding and shallow and who is looking for deeper and perhaps more spiritual meaning in life. This issue is dealt with in more detail in Chapter 3 when exploring ‘heavyweight’ value and capabilities. Another, and rather disconcerting example at the national level is the high level of suicide in countries with both high material standards of living and reported levels of happiness (Diener and Suh, 1999).

Unhappy and satisfied: such a person would have low levels of pleasant affect, high levels of unpleasant affect and yet be satisfied with their lives. Perhaps the most obvious candidates for this classification would be people doing extremely distressing and unpleasant jobs who perform an essential and highly valuable service to humanity. Regrettably there are very many examples which can be given here, including those international aid workers who are uncovering and identifying the bodies of genocide victims in former Yugoslavia and investigators and prosecutors in war crime tribunals.

Returning to the ‘emotional’ and ‘unemotional’ categories, it is clear that there are no conceptual difficulties in identifying ‘emotional...