Languishing: Feeling Meh

Feeling empty but not depressed

Languishing is a state of low mental health. You feel flat, empty or “meh”. Joy, interest and purpose are in short supply. It is defined not by the presence of mental illness, but by the absence of good mental health.

The sociologist Corey Keyes introduced it (Keyes, 2002).

The organisational psychologist Adam Grant brought it to a wide audience in 2021, calling it the “neglected middle child” of mental health. It sits between depression and flourishing.

People who are languishing often describe feeling “blah,” “meh,” or “dead inside.”

It is a subjective sense of stagnation, as if one is “muddling through” days without a sense of purpose or direction.

Because it lacks the acute distress of anxiety or the profound heavy darkness of depression, languishing often goes undetected until it has significantly eroded an individual’s quality of life.

Signs of Languishing

To recognize languishing, one must look for deficits in well-being rather than just active distress.

Dr. Keyes notes that languishing acts as an “existential alarm clock,” warning that the elements making life meaningful have been lost.

Keyes says he knows the state from the inside. In a Good Life Project interview, he described a “gnawing sense of emptiness”, like a void he wants to fill immediately, which he still feels on many days.

He added that people often lack a word for it. Well-meaning clinicians then lump them in with depression.

1. Emotional “Emptiness” and Indifference

Unlike depression, which is characterised by the presence of negative emotions like intense sadness, languishing is characterised by the absence of positive emotions.

• Indifference: Individuals often describe their state as a low-grade mental weariness, feeling “meh,” or just “muddling through”.
• Numbness: A key sign is feeling “numb,” “dead inside,” or “dying inside.” There is a lack of capacity for joy, excitement, or interest in life.
• Stagnation: People feel a sense of emptiness or stagnation, often described as “running on empty”.
• Invisibility: There is a sense of fading into the background, similar to being a ghost or living in a fog.

The organisational psychologist Adam Grant offers an image many readers found accurate: looking at your life through a foggy windshield.

As Grant explains in his 2021 New York Times essay, people who are languishing may not notice their enjoyment and motivation fading. They therefore do not seek help or do much to help themselves (Grant, 2021).

2. Lack of Functioning

While a person might not meet the clinical criteria for a mental illness, they lack key markers of functioning well, such as social contribution, personal growth, and warm, trusting relationships.

A languishing individual may technically “get by,” but they lack the markers of a life well-lived.

• Lack of Purpose: A feeling that life lacks direction, meaning, or coherence.
• Diminished Contribution: Feeling that one has nothing of worth or value to contribute to their community or the world.
• Lack of Growth: A sense that one is not being challenged to grow or become a better person; a feeling of remaining static.
• Social Disconnection: The absence of a sense of belonging or warm, trusting relationships. This can manifest as feeling unconnected to a community or team.

3. Behavioural and Cognitive Shifts

Languishing often changes how people interact with the world and perceive themselves:

• Invisibility: There is a subjective sense of being invisible or disappearing. In adolescents, this may manifest as withdrawing to a bedroom, refusing to talk, or wearing a hoodie to hide, effectively trying to fade into the background.
• Presenteeism: In the workplace or daily life, the individual is physically present but mentally “offline.” They may be going through the motions of the “grind” but feel their brain is unplugged from their heart.
• Cognitive Fog: It can feel like a fog where the world does not make sense (a lack of social coherence).
• Loss of Agency: A feeling that life is happening to them rather than being under their control, often accompanied by a dislike for parts of their own personality.

These patterns are widely reported in accounts written for general readers. None is an item on the Mental Health Continuum, so treat them as plausible correlates rather than established symptoms.

The same goes for this whole list of signs. It is descriptive, not diagnostic. The formal criteria are the 14 items described under Diagnostic Criteria below, and you can recognise yourself here without meeting them.

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Languishing vs Depression and Burnout

Languishing sits close to several better-known states. Comparing them shows what is distinctive about it.

Languishing vs Depression

Depression is diagnosed by symptoms that are present. These include low mood or loss of interest, plus changes in sleep, appetite and concentration. Languishing is diagnosed by well-being that is absent.

Keyes built the mental health diagnosis as the mirror image of the DSM diagnosis of major depression (Keyes, 2002). The DSM is the standard psychiatric diagnostic manual. That lets the two be compared item for item.

The two are empirically distinguishable. Adults classed as “pure” languishers in the 1995 US survey averaged 0.13 depressive symptoms out of nine. Nearly all had none (Keyes, 2002).

They overlap in practice, though. In the same survey, 28% of languishing adults also had a major depressive episode that year (Keyes, 2002). Those with both did worst on every measure of impairment.

Languishing is distinct from depression, but not independent of it.

Languishing vs Burnout

Burnout is exhaustion, cynicism and reduced effectiveness arising from prolonged, poorly managed work stress. Adam Grant separates the two by noting that the languishing people he describes still had energy and were not hopeless.

As Keyes explains in a Good Life Project interview, burnout is what happens when people meet heavy challenge with little choice and support. It can push a person into languishing. Languishing can also make a person more prone to burnout.

That is an expert’s account of the link, not a tested model. We found no study that compares the two directions.

The cost shows up at work. The first national analysis linked languishing to substantially more workdays lost and cut back because of mental health than moderate or flourishing mental health (Keyes, 2002).

Languishing vs Low Mood and Boredom

Everyone has dull days, and a single flat week is not languishing. A low patch after a bad week does not count. The research definition requires low scores across many items over the past month. It describes a pattern, not a passing mood.

Keyes’ scheme sets no duration beyond that. That is one of its acknowledged weaknesses.

Sociologists have described similar conditions at the level of society. Durkheim’s anomie (the loss of shared norms and purpose) and Marx’s alienation both describe people who feel unmoored and purposeless. Keyes measures an individual’s experience, not a society’s.

In interview, Keyes also traces the experience back to acedia, a medieval religious term for spiritual listlessness and indifference. That link is his own account. We did not check it against the historical sources.

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Causes

Languishing often creeps in slowly, making it difficult to notice until one is deep within it.

It can arise when individuals are unable to live as the person they wanted to be. It can also follow chronic stress, isolation, or moral injury: distress after taking part in, or witnessing, acts that violate one’s own moral beliefs.

The COVID-19 pandemic brought languishing into public view.

For many, the removal of normal coping mechanisms, social connections, and routines stripped away the elements of life that generated well-being, leaving a void that manifested as languishing.

National data support this. Two nationally representative surveys of Slovenian adults found that languishing rose from 4.5% in 2019 to 8.0% in 2021 (Vinko et al., 2022). Flourishing fell from 61.5% to 38.6%.

The rise was sharpest among 18- to 24-year-olds, from 5.7% to 14.9%. The surveys differed in response rate and mode, though. Part of the change could reflect the surveys rather than the pandemic.

The specific causes and triggers of languishing include:

1. The Loss of Meaning and Purpose

Languishing often sets in when an individual feels their life lacks direction or meaning.

Humans are described as having a biological and psychological need to grow and explore.

When these are removed, people feel they are “dying inside”. The same happens when a person feels they contribute nothing of worth or value to the world.

Stagnation often comes first. One is not being challenged to become a better person, or lacks a sense of personal growth.

2. Moral Injury and Demoralisation

A proposed cause of languishing, particularly in the workplace, is moral injury. We found no study that tests this link against languishing as measured on the Mental Health Continuum, so treat it as a plausible hypothesis.

This occurs when individuals are forced to witness or carry out actions that violate their own ethical and moral compass.

• Ethical “Dirty Work”: In professions such as healthcare or teaching, systemic pressures may force individuals to prioritise profit or bureaucracy over people, preventing them from practicing the values that brought them to their careers.
• Hollowing Out: This compromise of integrity “hollows” a person out, destroying the baseline for flourishing and leading to a deep sense of emptiness and demoralisation.

3. Social Invisibility and Isolation

Languishing is strongly linked to a lack of warm, trusting relationships and a lost sense of belonging.

Dr Corey Keyes describes languishing as a form of “invisibility,” where individuals feel they are receding into the background or becoming like ghosts.

• Marginalisation: This experience of invisibility is common among marginalised groups who are treated as unimportant by society, but it can affect anyone who feels their contributions are unacknowledged.
• Workplace Disconnection: In professional settings, if an individual cannot find a team or community that acknowledges their work as valuable, they are likely to languish. This often manifests as “presenteeism,” where the worker is physically present but mentally and emotionally “offline”.

4. The “Couch Potato Effect” (Drifting)

Languishing can be caused by simply stopping the behaviours that maintain flourishing.

Even a person who is doing well can drift. If they stop engaging in “mental health vitamins”, such as helping others, learning, or spiritual practices, they can slide downward into languishing.

This is described as the “couch potato effect,” where neglecting the active pursuit of purpose and connection leads to a gradual erosion of well-being.

The longitudinal evidence is compatible with drift. In a 10-year follow-up of US adults, about half of those languishing at the start were no longer languishing a decade later. About half of those flourishing at the start had declined (Keyes et al., 2010a).

Part of this movement is expected from regression to the mean alone, the tendency of extreme scores to move closer to the average when measured again. The drift account itself is untested. No study has watched people stop the behaviours.

5. Chronic Stress and The Pandemic Effect

While stress is often associated with anxiety and burnout, chronic adversity that strips away autonomy and joy is a primary driver of languishing.

• The COVID-19 Pandemic: The pandemic was a “well-being experiment that nobody wanted,” effectively creating mass languishing by stripping away the structural elements of a good life, including social contact, routines, and autonomy, without people’s permission.
• Unrelenting Adversity: Languishing is a normal reaction to prolonged adversity, grief, or isolation. It becomes pathological when an individual gets “stuck” in this state for too long.

6. Biological and Genetic Factors

Research indicates a biological component to languishing.

Twin studies suggest that the genetic factors influencing flourishing and languishing operate somewhat independently from the genes that predispose individuals to mental illnesses like depression.

Twin data point to a genetic component. Keyes et al. (2010b) studied 349 identical and 321 non-identical same-sex twin pairs in a representative US sample.

A single common factor underlying emotional, psychological and social well-being was 72% heritable. A follow-up in 1,386 twins then asked how much of that overlaps with genetic risk for depression, generalised anxiety and panic (Kendler et al., 2011).

The overlap was partial. That genetic risk accounted for about 41 to 50% of the genetic influences on well-being. Roughly half or more was therefore independent of it.

That does not make languishing fixed. Heritability describes how much of the variation between people in a population is linked to genetic differences, not how changeable a state is.

A person may lack the genetic risk for depression yet still lack a high genetic potential for flourishing. They may then be susceptible to languishing if their environment does not nurture them.

Low well-being may also shorten life. The evidence is limited, though. Keyes and Simoes (2012) followed 3,032 US adults for ten years.

The odds of dying were 1.62 times higher for adults who were not flourishing (95% CI 1.00 to 2.62). The model adjusted for age, past-year mental illness, smoking, physical inactivity and physical disease.

The interval just touches 1.0. The comparison also puts flourishing against everyone else, so it does not isolate languishing.

7. Social Position and Circumstances

Languishing is not spread evenly. In the 1995 US survey, “pure” languishing was more common among adults aged 25 to 64 (Keyes, 2002).

It was also more common among adults with a high school education or less, and among separated adults. It was about equally common in men and women.

Slovenian data from 2021 show a similar gradient. After adjustment, unemployed adults had about 2.6 times the odds of languishing of employed adults (95% CI 1.5 to 4.3). Students had about 2.3 times the odds (1.1 to 4.6).

Single adults had about 2.8 times the odds of married adults (1.7 to 4.4; Vinko et al., 2022).

A 2026 analysis of the Global Flourishing Study surveyed 207,919 people in 22 countries. Relative deprivation, being poor compared with a similar reference group, was linked to lower flourishing, both at one time point and one year later (Elgar et al., 2026).

It used a six-domain flourishing index. It therefore speaks to low well-being in general, not to languishing as Keyes defines it.

These are associations with social position, not proof of cause. They are consistent with the idea that circumstances shape languishing as well as personality.

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The Two-Continuum Model

For decades, the medical world viewed mental health as a single line.

On one end was “Depression,” and on the other was “Health.”

Dr. Corey Keyes flipped this script.

His research shows that mental health and mental illness operate on two independent axes rather than a single spectrum.

1. Mental Illness Continuum: Measures the presence or absence of psychiatric disorders (e.g., depression, anxiety, schizophrenia).
2. Mental Health Continuum: Measures the presence or absence of positive psychological and social functioning. This ranges from Languishing (low mental health) to Flourishing (high mental health).

Crucially, the absence of mental illness does not imply the presence of mental health.

It is possible to be free of a diagnosable disorder like depression but still be languishing, functioning poorly and feeling empty.

Conversely, it is possible to have a diagnosed mental illness but still possess aspects of flourishing, such as a sense of community or purpose.

The Four Quadrants of Well-Being

Because these two continua operate independently, individuals can exist in unique states of well-being:

• Flourishing: The ideal state characterized by low mental illness and high mental well-being.
• Languishing: A state where an individual has no diagnosable illness but suffers from low well-being and a sense of emptiness.
• Languishing with Mental Illness: A high-risk state where a clinical disorder is exacerbated by a lack of positive functioning and connection.
• Flourishing with Mental Illness: A counter-intuitive state where a person manages a chronic diagnosis (e.g., bipolar disorder) while maintaining high levels of purpose, social belonging, and personal growth.

The original US survey sorted 3,032 adults by mental health level (languishing, moderate or flourishing). It also recorded whether each had a major depressive episode in the past 12 months. Here are the six groups (Keyes, 2002).

	Languishing	Moderately mentally healthy	Flourishing
No major depressive episode	368 (12.1%), “pure” languishing	1,715 (56.6%)	520 (17.2%), complete mental health
Major depressive episode	143 (4.7%), languishing with illness	259 (8.5%)	27 (0.9%), flourishing with illness

Flourishing with illness was rare (27 adults) but not empty. A two-continua model predicts that. A single-line model rules it out.

Pure languishing (368 adults) was nearly three times as common as languishing with depression (143 adults). The risk of a depressive episode also rose as mental health fell. It was 4.9% in flourishing adults, 13.1% in moderately healthy adults and 28.0% in languishing adults.

The four quadrants are a simplification. The research keeps a middle group of moderate mental health, which was the largest group (56.6%).

Implications for Treatment

The Two-Continuum Model suggests that “getting rid of the negative” (treating illness) is insufficient for health.

A person treated for depression may return to languishing rather than flourishing. The argument is that they then remain at high risk of relapse, because they have not built the “positive” protective factors of mental health.

That claim is untested. No study we reviewed follows people who have recovered from depression but are still languishing.

Keyes therefore argued that treatment should also promote positive mental health, such as social contribution and warm relationships, and not focus solely on reducing symptoms (Keyes, 2002).

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Recovery: Moving from Languishing to Flourishing

Dr. Keyes argues that recovering from languishing is not about “thinking positive”. It is about changing what you do.

He identifies five specific “Mental Health Vitamins” that act as essential nutrients for the mind and soul.

These are behavioural activities that Keyes recommends to help a person move out of the “Gray Zone” toward flourishing. They are an expert’s practical advice, and we found no trial that tests them as a package.

You do not need to do all five every day. Even choosing one activity and increasing the “dosage” can significantly improve your day.

These vitamins include:

1. Helping Others

This vitamin involves engaging in acts of service or contributing to a community.

Dr Keyes notes that people who are flourishing engage in significantly more helping behaviour than those who are depressed or languishing.

This is social contribution, a marker of mental health. Here an individual feels their daily activities matter to the world. They feel they have something of value to give to society.

2. Learning

This is defined as pursuing personal growth and following one’s curiosity to learn something new.

It is not necessarily about formal education or productivity, but rather the act of “creating stories of self-growth”.

For younger people specifically, this vitamin manifests as being challenged to grow and developing skills that allow them to contribute to their communities.

Keyes links learning to a redemption narrative. That is a life story in which a bad experience is followed by growth or recovery. He recommends building one to move out of languishing.

The belief that you can change the story you tell about yourself is part of what makes learning a vitamin. It also maps onto an item on the Mental Health Continuum: feeling challenged to grow and become a better person.

3. Transcendence (Spirituality and Religion)

Dr Keyes identifies engagement in spiritual or religious activity as a crucial vitamin for flourishing.

He describes this as “Transcendence,” which involves stepping outside of the self and connecting to something larger.

He notes that this practice is vital for helping people move out of depression or languishing and is a common habit among those who maintain a state of flourishing.

4. Play

Play is defined as participating in activities simply because they are fun, removing the “commodity of time” and the pressure of productivity.

Dr Keyes argues that the worst mindset for this vitamin is believing that play is a “waste of time,” as this dampens the benefits.

Play is essential because it allows adults to flex their imagination, which is a prerequisite for dreaming of a better future or a different life trajectory.

5. Socialising (Warm, Trusting Relationships)

While general social contact is important, this vitamin specifically prioritises warm, trusting relationships over quantity of connections.

It focuses on building a sense of belonging and establishing bonds where there is mutual giving and getting.

Qualitative research shows how relationships feel different from the inside. In a South African study, relationships were the most important source of meaning for both languishing and flourishing participants (Wissing et al., 2021).

Languishing participants, however, described them mainly as sources of support for themselves. One wrote, “without my family I will not be me”.

Flourishing participants emphasised reciprocity and shared experience. The study was cross-sectional, so it cannot show whether this self-focus caused low well-being or followed from it.

Dr Keyes emphasizes that social well-being is often the hardest thing for people to achieve daily, yet it is critical because we are biologically wired for connection.

Keyes speaks from experience. He has spoken publicly about being in recovery from addiction.

He credits finding a way out to warm and trusting relationships, a place where he belonged and a place where he could contribute (Good Life Project interview). Those three things are items on his own scale.

The Dosage and Application

Dr Keyes stresses that these vitamins are about changing what you do, rather than just trying to “think” your way into mental health.

However, the application is designed to be accessible:

• Small Dosage: You do not need to take all five vitamins every day. Research indicates that if a person chooses just one of these activities and does more of it on a given day, they experience a significantly better day, regardless of whether they are currently depressed, languishing, or flourishing.
• Virtuous Cycle: Engaging in these activities creates a feedback loop. As individuals have better days through these activities, they become less emotionally reactive and more motivated to continue the behaviours, slowly moving up the continuum toward flourishing.
• Synergy: These vitamins often “bleed into each other.” For example, attending a yoga class (which Dr Keyes practices) can simultaneously provide the vitamins of play, transcendence, and socialising within a community.

Moving Beyond the Medical Model

By validating that well-being is a distinct outcome, the model challenges the “profit motive” and efficiency focus of mainstream psychiatry, which often prioritizes cheap, quick symptom reduction over holistic healing.

It aligns with a broader view of health (derived from “wholeness”) that integrates physical, mental, and social aspects rather than treating symptoms in isolation.

This perspective suggests that effective recovery requires helping clients find meaning, purpose, and connection, essentially “feeding the wolf” of flourishing rather than just starving the wolf of illness.

Recovery approaches should not wait. Well-being can be addressed before the illness is “cured”.

Clinicians are encouraged to focus on both reducing misery (the illness continuum) and building strengths/assets (the health continuum) simultaneously.

What the Evidence Shows About Recovery

Keyes’ five vitamins are recommendations, not tested findings. We found no trial that tests them as a package in people selected as languishing.

The nearest evidence is a randomised trial. It tested a nine-week guided self-help positive psychology programme with email support. A total of 275 adults with low or moderate well-being (average age 48, 86% women) were assigned to the programme or a wait-list (Schotanus-Dijkstra et al., 2017a).

Well-being improved more in the programme group (effect size d = 0.66, 95% CI 0.42 to 0.90). Anxiety and depression improved too (d = 0.63 and 0.43).

The proportion flourishing rose from 7% to 30% after three months and 34% after six.

The control was a wait-list, so the trial cannot say whether the email support, the content or simple attention produced the effect. The sample was also self-selected and mainly higher-educated women.

As Adam Grant explains in his 2021 essay, naming the feeling can help. It makes a blurry experience clearer, reminds people they are not alone, and offers a ready answer to “how are you?” that avoids forced positivity.

He proposes flow, uninterrupted time and small goals as ways out (Grant, 2021). No trial we found tests flow as an antidote.

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Diagnostic Criteria for Languishing

Dr. Corey Keyes developed a diagnostic protocol for languishing. It mirrors the criteria used for major depressive disorder.

While depression is diagnosed by the presence of negative symptoms (malfunctioning), languishing is diagnosed by the absence of positive symptoms (well-being).

To determine if an individual is languishing, Dr. Keyes uses the Mental Health Continuum, which assesses 14 specific signs of well-being.

Languishing needs low scores. Falling short of “flourishing” is not enough. People who fall short without scoring low are classed as moderately mentally healthy.

The 14 Signs of Mental Health

The criteria fall into two categories: feeling good (emotional well-being) and functioning well (psychological and social well-being).

1. Emotional Well-Being (3 symptoms) These relate to hedonic well-being or “feeling good.”

• Feeling happy.
• Feeling satisfied with life.
• Feeling interested in life.

2. Positive Functioning (11 symptoms) These relate to eudaimonic well-being, or functioning well in personal and social life.

• Purpose: Feeling that life has direction and meaning.
• Contribution: Feeling that one has something of value to give to society.
• Integration/Belonging: Having a sense of belonging to a community.
• Personal Growth: Feeling challenged to grow or become a better person.
• Self-Acceptance: Liking most parts of one’s own personality.
• Social Coherence: Feeling that the world makes sense.
• Autonomy/Mastery: Feeling able to manage one’s own life.
• Confidence: Feeling confident to think and express ideas and opinions.
• Social Acceptance: Feeling that people are basically good.
• Social Actualisation: Feeling that society is becoming a better place for people.
• Positive Relations: Having warm and trusting relationships with others.

The Diagnostic Thresholds

Dr. Keyes’s diagnosis relies on how often an individual experiences these 14 symptoms over the past month.

• To be diagnosed as Flourishing (Mental Health): An individual must experience at least one of the three emotional well-being symptoms every day or almost every day, and at least six of the 11 positive functioning symptoms every day or almost every day.
• To be diagnosed with Languishing: An individual rates themselves low (“never” or “once or twice”) on at least one emotional symptom and at least six functioning symptoms. Anyone who meets neither definition is moderately mentally healthy.

Specifically, severe languishing is characterized by:

• Rarely or never feeling at least one of the three emotional well-being symptoms (happy, satisfied, or interested in life).
• Rarely or never experiencing at least six of the signs of functioning well (such as purpose, belonging, or contribution).

Degrees of Languishing

The published scoring has three categories: flourishing, moderate and languishing. In a recent interview, Keyes said he now thinks of moderate mental health as mild to moderate languishing, and of what he first called languishing as severe languishing.

That graded view is his interpretation, not the scheme the research used.

The cut-offs are conventions, not natural boundaries. Keyes chose his original ones because no other unambiguous threshold existed.

Rates vary widely with the instrument, rule and population. They run from 4.5% of Slovenian adults in 2019 to 12.2% of Setswana-speaking South African adults (Vinko et al., 2022; Keyes et al., 2008).

Keyes has also noted that the categories have not been checked against expert clinical evaluation (Keyes, 2005).

Read as a spectrum, the degrees look like this:

• Mild to Moderate Languishing: An individual might feel some good qualities or emotions a couple of times a week, but not “almost every day”. They fall short of flourishing but are not completely devoid of positive feelings.
• Severe Languishing: This is the complete absence of the things that make life meaningful. Individuals in this state often describe feeling “numb,” “dead,” or “dying inside” rather than feeling sad.

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Evidence Check: Does the Research Hold Up?

Verdict: Supported with qualifications.

The central idea is well replicated. Mental health and mental illness are distinct but correlated dimensions. Low positive mental health also predicts later depression and anxiety.

It has not been shown to cause them, though. The languishing category itself is rarely isolated. Evidence that raising well-being helps people recover from illness is mixed.

Independent teams have tested the two-dimension idea. In 2,997 US adults, two correlated factors fitted far better than one bipolar factor (Keyes, 2005). The correlation between the two dimensions was -.53.

Lamers et al. (2011) found the same pattern in 1,662 Dutch adults, with a correlation of -.34. Franken et al. (2018) found it in 472 psychiatric outpatients. A scoping review of 83 articles was broadly supportive (Iasiello et al., 2020).

Those correlations mean illness and well-being overlap considerably. The absence of illness is not the presence of well-being, but the two do not vary independently either.

All of it rests on self-report, cross-sectional data. That shows how measures cluster. It cannot show how a person moves on one dimension while staying put on the other.

The link to later illness comes from prospective cohort studies. They measure well-being first and illness later.

A representative Dutch cohort of 4,482 adults was followed for three years (Schotanus-Dijkstra et al., 2017b). Flourishing at baseline lowered the risk of a new mood disorder by 28% and of a new anxiety disorder by 53%. It had no significant effect on substance use disorders.

Among 5,566 adults followed for ten years, those with low psychological well-being at about age 51 to 56 were 7.16 times as likely to be depressed (Wood & Joseph, 2010). They were still more than twice as likely after controlling for personality, prior depression and health.

In 1,621 medical interns, low well-being before internship predicted a steeper rise in depressive symptoms (Grant et al., 2013).

Prediction is not causation. Genetic influences on well-being overlap those on depression and anxiety by roughly 41 to 50% (Kendler et al., 2011). Low well-being may partly mark a shared vulnerability.

Each of these studies compares low or not-flourishing with others, so none isolates languishing.

Keyes suggested that languishing may act as a diathesis, a hidden vulnerability that makes illness more likely when stress arrives. It remains a plausible hypothesis for mood and anxiety disorders. No experiment has tested it.

Recovery is less clear. A US cohort followed people who had a mental illness in 1995 (Iasiello et al., 2019).

Those who maintained the highest level of positive mental health were 27.6 times as likely to have recovered by 2005 as those who stayed at the lowest level. Those who gained it were 7.4 times as likely.

A Dutch study followed 414 people with a 12-month disorder for three years (Schotanus-Dijkstra et al., 2019).

Positive mental health predicted recovery from anxiety disorders but, after adjustment, not from mood disorders.

In short, having no diagnosis does not guarantee well-being. Low well-being is a risk marker for later depression and anxiety. Whether raising well-being would prevent illness or speed recovery has not been established.

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