A PARADIGM OF WELL-BEING
First published by British Postgraduate Medical
Federation, University of London, December, 1981.
And later in British Journal of Holistic Medicine, 1: 2, 1984.
I suggest we abandon the distinction between conventional
and alternative medicine and adopt a comprehensive new medical paradigm for
modelling changes in human well-being. It is a model that can encompass (a)
therapy and cure, (b) prevention, (c) positive development.
The model sees well-being, physical and/or mental, as the
product of four relatively independent factors which are as follows:
1. Who is responsible? Who takes the responsible
well-informed decision about how my well-being is to be restored or
maintained or improved? This factor is concerned with the degree of
in generating the strategies that affect my well-being.
There are three main degrees. (i) I am fully responsible for deciding what
strategies I shall adopt. (ii) I share the responsibility with one or more
others on some kind of co-operative basis. (iii) I accept someone else's
authority to be fully responsible for deciding on the strategies. I will
call these three degrees, respectively, self-directed, co-operative,
We may note in passing that both conventional and
alternative medicine often rely strongly on the other-directed degree of
responsibility. It is assumed and expected that the patient will hand over
full authority for medical decision-making to the expert practitioner.
2. What sort of agency is involved? By what sort of
agency is the strategy that affects my well-being expressed? The fundamental
distinction here is between internal agency and external agency. My internal
agency refers to my ability to control my mind and body. Thus it includes
purely mental acts such as meditation, concentration, reflection, change of
attitude and belief-system, etc. It includes mental acts intended to have
some desired physiological effect, as in autogenic training (Luthe, 1969-73)
and related methods. And, of course, it includes my ability to change my
overt behaviour - to change my diet, take up physical exercise, alter the
way I interrelate with other persons, etc.
External agency refers to a person, or a physical process or
substance or piece of equipment, that acts on some aspect of my being from
outside. Combined agency involves both internal and external agencies: such
as visualization combined with radiation treatment; mental regulation of
bodily states through interaction with biofeedback equipment; changing
eating habits on the basis of a prescribed diet; etc. Agencies, then, are (i)
internal, (ii) combined, (iii) external.
Again, both conventional and alternative medicine have
traditionally relied strongly on external agencies. Conventional medicine on
drugs, surgery, radiation, resuscitation; alternative medicines on herbal
remedies, homoeopathic remedies, acupuncture needles, osteopathic leverages,
and so on. Of course, there are important exceptions such as autogenic
training, biofeedback and related methods; prescriptions that the patient
change dietary and other habits. Nevertheless, in both schools there has
been a strong emphasis on something being done to the patient from outside.
The full range of potency centred in the patient's agency has not been used
The first two factors, responsibility and agency, as here
defined are relatively independent factors. Responsibility is concerned with
who is accountable for making a well-informed decision about what strategy
for changing my well-being is to be applied. Agency is concerned with what
sort of strategy - whether it is centred in my agency and power, or whether
it is centred in the agency and power of something or someone else. Thus if
I take up some form of autosuggestion (internal agency) or take a pill
(external agency) - it may be because I have made a well-informed decision
to do so off my own bat (self-directed responsibility; or because it has
been prescribed to me by some practitioner who makes decisions about my
well-being on my behalf (other-directed responsibility).
By including the factor of responsibility, the paradigm
includes self-help and peer self-help approaches to well-being, as well as
practitioner-determined approaches. By including the factor of agency, and
distinguishing internal from external agencies, the paradigm draws attention
to the potency of patient-centred internal actions - the various forms of
consciousness training and mind control, self-regulation of physiological
states (Green and Green, 1977; Pelletier, 1977) - and self-regulation of
overt behaviour and habits.
3. What sort of process is involved when the selected
agency is at work? The basic distinction here seems to me to be between a
catalytic process and a confronting process. By a catalytic process I mean
one that facilitates and elicits self-regulatory processes in mind and/or
body. The process is one that triggers self-healing, that harmonizes,
realigns, restores self-generated wholeness of being. It intervenes in the
body-mind with a location, deftness and timing that elicits normal
functioning. By contrast, a confronting process is one that assaults the
disordered part or process directly, seeking to subdue it, eliminate it,
reconstruct it or whatever. A catalytic process seeks to encourage the
body-mind to deal with its disorder from within its own resources. A
confronting process deals with the disorder directly instead of and on
behalf of the body-mind, leaving the latter simply to tidy up the aftermath.
Again, both processes may be combined, used simultaneously. The use of both
together I will call conjunctive. Thus, for different sorts of process we
have: (i) catalytic, (ii) conjunctive, (iii) confronting.
It is this factor, the sort of process used in restoring
well-being, that has ostensibly been the main dividing issue between
conventional and alternative medicine. Alternative medicines have argued
that their approach is catalytic, eliciting - via homoeopathy, acupuncture,
osteopathy, etc. - the vis medicatrix naturae to do the
healing job from within. They have also charged conventional medicine with
relying on confronting processes - via drugs, surgery, radiation - that are
used excessively, often unnecessarily and inappropriately, with much
resultant destructive, iatrogenic effect. Conventional medicine has charged
alternative medicine that its championship of catalytic processes has never
been based on adequate proof, and that the supposed catalytic effect has not
been sufficiently separated out from a placebo effect, from suggestion, from
unexplained spontaneous remission, or from unassisted normal recovery.
No doubt there is validity in the charges made on both
sides. However, it seems more fruitful to me to sidestep the whole debate
with its entrenched positions; to acknowledge that both catalytic processes
and confronting processes are, qua processes, equally valid; to
acknowledge that conventional medicine has used many more catalytic (and
quite standard) processes than alternative medicines have noticed and that
alternative medicines have used more confronting
processes than they have admitted; and, finally, to acknowledge that the
main issue, in this new comprehensive paradigm, is the demarcation issue.
This is the issue, in some areas largely unaddressed, about when and for
what to use a catalytic process, or a confronting process, or a conjunctive
Catalytic interventions in the physical system cover a wide
spectrum. Firstly, there are interventions that are conceived to function,
by some of their practitioners, in terms of energy processes. Thus high
potency homoeopathic drugs, acupuncture needles are conceived as modifying
the play of energy in an energy system that underlies and is the informing
dynamic principle of the physical system. They regulate the balance of
energies which in turn restores physical self-regulation and homoeostatic
balance. This concept of an energy body, a vital body, a bio-energetic field
around and throughout the physical body, which can be influenced by minimal
physical interventions such as acupuncture needles or physical drugs so
highly attenuated that they are scarcely physically present, is one of the
main stumbling blocks for conventional medicine in its approach to the
acceptance of alternative medicine. However, a bridge is being built from
the conventional side with physiological studies of the regulatory control
mechanisms that appear to be affected by alternative therapies (Bergsmann,
Other catalytic interventions are more obviously physical
and so more conceptually accessible. Thus prescriptions for bed rest, or
regular physical exercise, or a balanced diet, or a special diet, are all
strategies that in their different ways enhance healthy self-regulation with
the body. Certain external stimuli may well be regarded as catalytic:
ultraviolet light, infra-red radiation, interferential therapy, applications
of water, massage, and so on. Then there are physical interventions that
make good what is missing in the body in order to maintain homoeostasis and
well-balanced physical functioning: prescribing thyroid pills for someone
whose thyroid gland is fibrosed and non-functional; prescribing vitamins for
someone with a chronic dietary deficiency; resuscitation through the
administration of oxygen, blood transfusions; the use of a saline drip;
sewing up a wound; and so on. Finally, there are compensatory catalytic
interventions: using a diuretic to promote the kidneys to do more work than
normal in order to compensate for the effects of an irreversibly damaged
4. In what dimension of being does the process
produce its effect? I propose here three primary dimensions of being. (i)
The transpersonal dimension: this has two aspects. First, the Source, the
wellspring, the originating Act whence a person, a distinct body-mind
process emerges. Second, a range of altered states of consciousness - spatio-temporal
extensions, shifts of level, inner spaces, etc. - which are accessible by
both physical and mental methods (Ring, 1974; Tart, 1975; Heron, 1975a; Grof,
1976). (ii) The psycho-social dimension: this covers both psychological,
mental processes going on within the person, and also the individual's
interactions with others. (iii) The energetic-physical dimension: the range
of energy processes going on within the person, and the purely physical
structures and processes.
Again, both conventional and alternative medicines have
intervened largely in the energetic-physical dimension, in their different
ways. There is much talk among alternative practitioners about a holistic
approach to the patient. There is little evidence that they practice, or
have the skills or practice, a real facilitation of growth in the
psycho-social and transpersonal dimensions of their patient's lives.
Similarly, general medical practitioners fully acknowledge,
through the pronouncements of their Royal College, the importance of
psycho-social factors in primary care. But, quite apart from the pressure of
limited time per patient, the skills to handle such factors are not
widespread in the profession. Hence in both arenas there is acknowledgement
in principle, deficiency in practice.
Of course, there are a wide variety of psychotherapies
currently being practiced; and some of these include or focus strongly on
the transpersonal dimension (e.g.: Jung's analytical psychology, Assagioli's
psychosynthesis, varieties of Californian transpersonal therapy). But a
practitioner with the skill to function comprehensively and effectively in
all three dimensions of being is rare indeed.
There are some fundamental, very valid issues to be debated
about these dimensions of being. The main issue, I believe, is the
independence-interdependence one. On the one hand each of these dimensions
appears to be relatively independent, with its own functional autonomy. It
seems that a person can engage in transpersonal methods effectively without
engaging in psychological or physical therapies; can receive effective
psychotherapy without address to the transpersonal or physical dimensions;
can effectively have the physical body treated as a self-contained system
without attention being paid to psycho-social and transpersonal factors.
Conversely, break-down and disorder can occur at any one level without
necessarily affecting the relative functional integrity of the other two
On the other hand, I think it is reasonable to believe, on
the formal and informal evidence currently available, that these three
dimensions are also relatively interdependent. They can have powerful
effects on each other both aetiologically and therapeutically. It is
sensible to believe this, but I don't think we know anywhere near
enough about it. And we need a new research paradigm to improve our
knowledge in this area of interdependence.
We need to know which factors promote relative functional
autonomy at each level, and which factors precipitate functional interaction
between the levels to the degree that procures breakdown or promotes cure.
I can now set forth the main features of the paradigm quite
simply, as follows:
Sort of responsibility:
Sort of agency:
Sort of process:
Dimension of being:
Each of the four independent factors is characterized by
three primary terms - two polar terms with an intermediate or bridging term.
The paradigm as a whole yields 81 different basic models of ways of
influencing well-being. Each model contains one of the three terms from each
of the four factors. Of course, there are many more than these basic 81.
Firstly, the basic 81 can be combined in many different ways. Secondly, a
distinction must be made between working at one level of being to affect
that level only (use of antibiotics), working at one level of being to
affect another level of being (use of psychotropics), and working at one
level of being to affect both that level and another level (use of iron
injections for anaemia and its associated mental states).
These two considerations greatly increase the number of models above
the basic 81.
One way of getting a grip on this plethora of possibilities
is just to consider the three vertical columns in the layout already shown.
The first and the third columns, respectively, are the polar extremes of all
possible models. While the second column presents a model for dealing with
well-being that is intermediate between these extremes. Just taking these
three models together gives a comprehensive, although still arbitrarily
restricted and reduced, programme for well-being.
At one extreme
(self-directed/internal/catalytic/transpersonal) the person takes full
responsibility - without prescription or control by another - for practicing
some form of consciousness training or mind control that elicits a shift or
expansion of ordinary consciousness so that it becomes more open to its
Source. The person may set aside time for practicing certain sorts of
meditation, and/or use a practice like satipatthana (inner
alertness, noticing) during everyday activities (Goleman, 1972).
At the other extreme
(other-directed/external/confronting/energetic-physical) the person consults
some expert practitioner who takes responsibility for attacking directly
some disorder at the physical level -thus the person has recourse to
dentistry, antibiotics, surgery, etc., as and when appropriate.
In between (co-operative/combined/conjunctive/psychosocial),
the person joins with one or more peers who together share responsibility
for adopting and using with each other some strategies that promote mutual
wellbeing at the psycho-social level, that combine internal mental actions
with external psychological interventions from each other, and that use both
catalytic and confronting processes. A classic example of this is the peer
self-help method of co-counselling (Heron, 1980) in which two people take
turns to be counsellor and client, the client having internal skills to work
on his or her own mental process, as well as responding to periodic
interventions made by the counsellor. In both the client's internal actions
and in the counsellor's external interventions, there are examples of both
catalytic and confronting processes. Other sorts of peer support and peer
self-help groups qualify as examples to the extent that they explicitly
conjoin these various elements.
The selection of these three models highlights their
differences in time management. Normally, a person's visits to the dentist
or doctor for the treatment of physical disorders will be infrequent, the
time between visits being measured in months or years. People who use
co-counselling or peer support groups as a means of maintaining and
enhancing psychological well-being, measure the time between sessions in
days or a small number of weeks. Those who use consciousness training such
as meditation methods to enhance their well-being may measure the time
between sessions in hours; may indeed use such methods intermittently as
part of and during everyday life.
The differences in time management reflect differences in
the exercise of responsibility. Maximum time is devoted to self-directed
responsibility; shared responsibility is fairly frequent; other-directed
responsibility is very infrequent.
Returning now to the paradigm as a whole, it puts much more
emphasis on education and training than it does on therapy and treatment.
Therapy and treatment are being applied to me typically when I am being
other-directed, when a well-informed, skilled expert takes decisions for me
and on behalf of my well-being. But only one third of the total number of
models for dealing with well-being fall within the other-directed sort of
responsibility. The other two thirds involve either self-help or peer
self-help. Persons who are sufficiently knowledgeable, skilful
and responsible to help themselves and each other have been well
educated - in the most comprehensive (and today not at all prevalent) sense
of the term - and are engaging in a process of continuing education. A
learning/ skills building/skills development account is appropriate, not a
therapy or treatment account.
As well as a shift from treatment to education and
training, the paradigm also encourages a shift from cure or attempted cure
of ills to prevention of illness and to positive enhancement and development
of well-being. Of course, it doesn't eliminate the notions of other-directed
treatment and of cure of illness. In fact it gives very comprehensive
account of the range of possibilities for treatment and cure. But it does
complement them with an equally comprehensive range of possibilities for
preventing disorders, for maintaining and enhancing well-being.
If the paradigm as a whole were to be used as a basis for
medical education there would be a revolution in practice on an
unprecedented scale. Firstly, practitioners would be educated and trained to
be open to the possibility of treating people at the energetic-physical,
psycho-social and transpersonal levels of being, dealing with these levels
both independently and interdependently. Secondly, practitioners would also
be educated and trained to educate and enable their patients to acquire
competencies in self-help and peer self-help. Thirdly, practitioners would
be educated and trained to abandon defensive chauvinism with respect to any
one sort of practice; and this, among other things, by a grasp of various
research paradigms, both old and new. For it is important to acknowledge
that classical experimental research paradigms need to be complemented by
experiential research paradigms involving co-operative enquiry, in any
comprehensive plan of research on the well-being of persons (Reason and
The idea of setting up a pilot postgraduate medical training
programmes based on this model is not at all fanciful. The sorts of
ideologies and competencies required to initiate it and staff it are
available in various domains of enquiry and practice in our culture. Some
parts of such a programme would be conjectural, provisional, tentative,
experimental. Others would rest on a mass of solid, but so far generally
neglected and unnoticed, data that has great potency for change in our
approach to human well-being. Nor does all the research data have to come in
before such a programme can be legitimated. For once the model of
co-operative enquiry is accepted as a valid new research paradigm,
practitioner and patient can together chart out new territories in our
understanding, for example, of how the different levels of being can affect
each other therapeutically (Heron, 1981). The practitioner simply needs to
learn how to run a co-operative enquiry project with selected patients.
I would like now to extract some parts of the whole paradigm
for more systematic description. But first of all we need a simple coding
device. I shall designate the sorts of responsibility by roman numerals,
thus: I self-directed; II co-operative; III other-directed or
The dimension of being at which the intervention occurs will
be represented by capital letters, thus: A
transpersonal; B psycho-social; C energetic-physical. The addition of a
lower case letter indicates which level the intervention is intended to
affect. Thus Cc indicates an intervention at the physical level to affect
that level. Cb indicates an intervention at the physical level to affect the
mental level. And so on.
This simply leaves the core of the paradigm: the nine sorts
of agency-cum-process, which I shall designate by ordinary numerals, thus: 1
external agency - confronting process; 2 external agency-catalytic process;
3 external agency-conjunctive process; 4 internal agency-confronting
process; 5 internal agency-catalytic process; 6 internal agency-conjunctive
process; 7 combined agency-confronting process; 8 combined agency-catalytic
process; 9 combined agency-conjunctive process.
Thus III Clb indicates, for example, a practitioner
prescribing a drug to interrupt a disabling state of mind in the patient.
III C4c indicates, for example, a practitioner prescribing that the patient
visualize the direct reduction of some disease process. I C5b might
indicate a person, fully on their own responsibility, using a simple mental
induction of physical relaxation in order to resolve an anxious, agitated
state of mind.
In order to demonstrate the comprehensiveness of the
paradigm I will describe only III Cc, III Cb, and III Bb. These are three
sorts of practitioner-determined ranges of treatment: at the physical level
to affect the physical level; at the physical level to affect the mental
level; and at the mental level to affect the mental level. The examples
given for each entry do not claim to be exhaustive.
III Cc: practitioner-determined interventions at the
physical level to affect that level. In every case, the practitioner
prescribes the treatment.
- External agency-confronting process: dentistry, surgery, many sorts
of chemotherapy, radiation, anaesthetics.
- External agency-catalytic process: many standard medical procedures
to support homoeostasis; massage, osteopathy, acupuncture, homoeopathy,
some naturopathic treatments, laying on of hands.
- External agency-conjunctive process: combinations of the previous
two, such as surgery together with acupuncture, antibiotics together
with massage, chemotherapy and homoeopathy to deal with different
aspects of the same complaint.
- Internal agency-confronting process: prescription that the patient
practice visualization of the disease process being directly interrupted
and reduced; or that the patient interrupt a self-destructive physical
- Internal agency-catalytic process: prescription that the patient
practice autogenic training, or some form of physical relaxation through
auto-suggestion, to promote general physical well-being; or that the
patient adopt some physical habit that promotes physical well-being.
- Internal agency-conjunctive process: prescription that the patient
practice both visualization of the direct reduction of a disease process
and autogenic training for general physical well-being; or that the
patient both interrupts a self-destructive physical habit, and adopts a
health promoting physical habit.
- Combined agency-confronting process: radiation or chemotherapy for a
cancer combined with a prescription that the patient practice
visualizing its direct reduction.
- Combined agency-catalytic process: prescription that the patient
practice mental control of physiological states by the use of
biofeedback equipment; or that the patient practice autogenic training
combined with acupuncture treatment.
- Combined agency-conjunctive process: the practitioner prescribes all
the following: antibiotics, visualization of reduction of the infected
area, massage, autogenic training for general physical wellbeing.
Only one or two possibilities are indicated under several of
the nine sorts of intervention; in each of these cases there are, of course,
many other possibilities. But each of the items cited, on the evidence
currently available, is worthy of serious consideration for enquiry and
controlled application. The use of internal agency in relation to the
physical level already applied the principle of functional interdependence
between the mental and physical levels, here working therapeutically from
the mental to the physical. The evidence for this is by now far too
extensive for any well informed practitioner to disregard it.
III Cb: practitioner-determined interventions at the
physical level to affect the mental level. This is working on the mind
via the body. "Confronting process" here means that the process directly
blocks, interrupts, alters, some mental state. "Catalytic process" means
that the process restores satisfactory mental functioning without any direct
blocking or interrupting effect.
- External agency-confronting process: some psychotropic drugs;
hallucinogens such as LSD; deep friction or pressure applied directly to
muscular armouring (as in Reichian therapy to release denied archaic
emotional distress); sleeping pills.
- External agency-catalytic process: homoeopathy, acupuncture and
herbalism where these are applied for a supposed mental effect; soothing
massage to calm the mind; gentle physical contact for relaxation to
elicit catharsis; a prescription that makes good dietary deficiencies
that undermine mental well-being.
- External agency-conjunctive process: combinations from examples of
the two previous sorts of strategy, such as the use of psychotropics
with acupuncture; deep friction on muscular armouring alternating with
light massage - to elicit catharsis.
- Internal agency-confronting process: prescribing that the patient
use hyperventilation or other forms of active body work, to interrupt
the somatic controls on archaic emotional distress - to elicit
catharsis; prescribing that the patient interrupt physical habits that
lead to mental distress.
- Internal agency-catalytic process: prescribing that the patient use
deep relaxation methods through autosuggestion to the body - to reduce
mental anxiety and agitation; prescribing that the patient adopt
physical habits that promote mental well-being.
- Internal agency-conjunctive process: prescribing that the patient
alternate the use of hyperventilation with autogenic deep physical
relaxation - to uncover and discharge buried mental contents.
- Combined agency-confronting process: psychotropic assisted
psychotherapy, with instruction to the patient to use hyperventilation
or some other form of active body work, to elicit buried mental contents
- Combined agency-catalytic process: acupuncture assisted
psychotherapy, with instructions to the patient to use autogenic deep
physical relaxation - to elicit buried mental contents and catharsis.
- Combined agency-conjunctive process: psychotropic assisted
psychotherapy, soothing massage, patient use of hyperventilation, active
body work and autogenic deep physical relaxation - integrated to elicit
buried mental contents.
Again, these are only a selection of possible examples, with
the same caveat and recommendation applying as before. And most of them will
be combined with interventions that work directly at the psycho-social
III Bb: practitioner-determined interventions at the
mental level to affect that level. "External agency" will, of course, be
exclusively in terms of communication, verbal and non-verbal, from
practitioner to patient.
- External agency-confronting process: the practitioner gives advice
to, gives interpretations to, confronts the defenses/beliefs/behaviours
of, the patient. Thus the practitioner directly intervenes in the
psychological processes of the patient in order to alter them.
- External agency-catalytic process: the practitioner facilitates
self-discovery in the patient, that is, elicits self-generated
exploration and release of feeling, self-generated insight and
understanding, self-generated problem-solving, decision-making; also
affirms the worth and value of the patient.
- External agency-conjunctive process: the practitioner both advises/
interprets/confronts and elicits self-discovery in the patient.
- Internal agency-confronting process: the practitioner teaches and
trains the patient to interrupt his own defensive processes, to
interrupt his own tendencies to distorted thought/attitude/behaviour.
- Internal agency-catalytic process: the practitioner teaches and
trains the patient to elicit and foster his own self-discovery process.
- Internal agency-conjunctive process: the practitioner teaches and
trains the patient both to interrupt his own defensive and distorted
mental processes and to elicit and foster his own self-discovery.
- Combined agency-confronting process: the practitioner combines, that
is, alternates Blb and B4b.
- Combined agency-catalytic process: the practitioner combines, that
is, alternates B2b and B5b.
- Combined agency-conjunctive process: the practitioner blends
together B3b and B6b.
For the sorts of interventions that the practitioner may
use qua external agency see my Six Category Intervention Analysis
(1975b); for the sort of techniques the practitioner may teach the
patient qua internal agency see my Co-counselling Manual
The analytic framework Blb to B9b does not so much identify
nine different sorts of psychotherapy, as it does bring out the range of
options open to any particular psychotherapeutic endeavour. The fundamental
options open to any psychotherapist are: whether to intervene directly in
the psychological process of the patient, or whether to train the patient to
intervene in his own process; and in either of these cases whether the
intervention is a direct interruption of defensive and distorted processes,
or the eliciting of positive self-realization.
Since fully developed mental well-being in a person
presumably involves having the awareness and skills to interrupt one's own
defensive and distorted processes and to foster one's own self-realization -
albeit in interdependent relationships with others with the same sorts of
awareness and skill - it seems better to abandon the notions of
psychotherapy, of treatment, of cure, and replace them with notions of
education, of learning and training and teaching, of skills building, in the
areas of emotional and interpersonal competence, and of decision-making,
life-planning competence. For even the most confused, disoriented and
distressed person is not so much being cured as being educated and trained,
as learning, to take increasing charge of his own mental processes.
Thus the patient or "student" would eventually graduate from being at the
receiving end of practitioner-determined responsibility for his mental
well-being to self-help and peer self-help sorts of responsibility. I will
not develop further parts of the paradigm. Long lists of different sorts of
interventions organized under some scheme of categories become more and more
intellectually inaccessible, simply through the tedium of following the
analysis through. Anyone who has grasped the basic categories can through
the exercise of both practical and creative imagination derive the many
other models for restoring, maintaining or enhancing well-being which the
paradigm provides. I have outlined some practitioner-determined models at
the physical and psycho-social levels. There are also
practitioner-determined models at the transpersonal level. And, of course,
self-directed and cooperatively determined models at all the levels.
A PARADIGM OF WELL-BEING
For (a) treatment, (b) prevention, (c) positive development.
The paradigm sees well-being, physical and/or mental, as the
product of four relatively independent factors, with three forms of each
factor, as below.
These factors, of course, apply to the person whose
well-being is under consideration.