Languishing: not yet depression, but no longer flourishing

2023-06-01 · 6 min read

By the kava.fyi editorial team · Last updated: 1 June 2023

You are not depressed, yet you do not feel that you are living life to the full. Days pass, tasks get ticked off, but your motivation and joy have quietly disappeared. Psychology has a specific word for this state: languishing. The term is over twenty years old and rests on solid research, though it only became widely known during the pandemic.

Where the term languishing comes from

The concept was introduced by the American sociologist Corey Keyes in a 2002 article published in the Journal of Health and Social Behavior. Keyes proposed describing mental health as a continuum, running from flourishing at one end to languishing at the other. His key idea was that the absence of mental illness does not mean good mental health. Someone can fail to meet the criteria for any disorder and still function poorly, lacking purpose or positive emotion. Keyes defined mental health operationally as positive feeling combined with positive functioning.

His analysis drew on data from the 1995 American MIDUS study, which covered 3,032 adults aged 25 to 74. The results: 17.2 per cent of participants were classed as flourishing, 56.6 per cent as moderately mentally healthy, and 12.1 per cent as languishing. Separately, 14.1 per cent met the criteria for a major depressive episode under the DSM-III-R classification then in use.

The most important finding concerned risk. A major depressive episode was around twice as likely among those languishing as among the moderately healthy, and almost six times as likely as among those flourishing. Languishing was also linked to poorer emotional functioning and to more lost workdays.

Languishing and flourishing: two ends of the same scale

In this model, flourishing is a high level of wellbeing and languishing a low one, with no diagnosis required. Is the state a lasting one? In 2010, Keyes and colleagues published an analysis in the American Journal of Public Health covering 1,723 people assessed twice, in 1995 and 2005. Around half of those languishing in 1995 were in a better state ten years later, while around half of those flourishing had a worse score by 2005. Among the 17.5 per cent of respondents who met the criteria for some mental disorder in 2005, 52 per cent were new cases.

At the same time, a change in the level of positive mental health strongly predicted the risk of disorder: improvement meant lower risk, and decline higher risk, of depression, generalised anxiety disorder and panic disorder. The authors took this as an argument for promoting and protecting mental health, not only treating illness once it appears.

Why everyone was talking about it in 2021

On 19 April 2021, the organisational psychologist Adam Grant published a piece in the New York Times titled "There's a Name for the Blah You're Feeling: It's Called Languishing." In it, he called languishing the neglected middle child of mental health: a state that saps motivation and concentration yet rarely gets noticed because it is not an illness, and possibly that year's dominant emotion. The piece brought the term into everyday language.

Among the studies cited alongside that article is work by the Italian team of Marta Bassi, published in the Journal of Affective Disorders (2021). Between 15 April and 3 May 2020, towards the end of the first lockdown, 653 healthcare workers in Lombardy completed the PCL-5 (post-traumatic stress symptoms) and MHC-SF (mental health continuum) questionnaires. Provisional criteria for post-traumatic stress disorder, defined as a PCL-5 score of at least 33, were met by 39.8 per cent of participants. On positive mental health, 33.4 per cent were flourishing, 57.7 per cent were moderate, and 8.9 per cent were languishing.

The link between the two scales was clear. Those languishing had three times the odds of a provisional PTSD diagnosis compared with the moderately healthy (odds ratio 3.00; 95 per cent confidence interval 1.56 to 5.77). Those flourishing had markedly lower odds (odds ratio 0.26). The authors suggested that supporting positive mental health could be one element of prevention, alongside training and psychological support for the groups most at risk.

How to recognise languishing

Languishing has no list of diagnostic criteria, because it is not a disorder. Researchers measure it using wellbeing questionnaires such as the MHC-SF. In everyday experience, it is most often described through:

a lack of motivation for things that used to bring pleasure, without any clear sadness,
difficulty concentrating and a sense that the days blur into one another,
emotional flatness: not especially bad, but not good either,
withdrawal from relationships and reduced engagement at work,
a lack of sense of purpose and direction.

These descriptions are worth treating as a prompt to look more closely at yourself, not as a diagnostic tool.

Languishing and depression

The difference is fundamental. Depression is a clinical diagnosis with defined criteria: low mood or loss of interest persisting over an extended period, together with other symptoms, causing significant distress or impaired functioning. Languishing is a low level of positive mental health that is not, in itself, an illness. In Keyes's model, the two dimensions are partly independent of one another: you can languish without depression, and you can also meet the criteria for depression at various levels of wellbeing.

What matters is what the 2002 and 2010 data show: languishing raises the risk of depression or anxiety disorder later. So if a state of emptiness and low motivation persists for weeks, and especially if it comes with sleep problems, appetite changes, feelings of hopelessness or thoughts of death, the right step is to talk to a doctor or psychotherapist. This article is for information only and does not replace medical advice.

What about kava

On kava blogs, languishing is sometimes linked to its effects. Some caution is warranted here. Kava (Piper methysticum) has been studied clinically as a remedy for anxiety symptoms, not for languishing or reduced wellbeing. A 2003 Cochrane review covered 11 randomised placebo-controlled trials (645 participants); a meta-analysis of six of them showed an advantage for kava extract over placebo on the Hamilton Anxiety Scale (weighted mean difference of 5.0 points). A 2013 study of 75 people with generalised anxiety disorder found a moderate effect after six weeks. A larger 2020 study of 171 participants over 16 weeks found no difference between kava and placebo, and the kava group more often reported worse memory and tremor. There is no research testing whether kava affects languishing. Its active constituents, kavalactones, and its reported effects, are covered separately. The NCCIH advises against combining kava with alcohol or sedatives and flags particular risk in pregnancy and breastfeeding; we cover the liver question in the article on kava and the liver.