Rethinking mental health with Dr. Corey Keyes’ Dual Continuum Model

Written By Anna Wong

As healthcare professionals, we are trained to diagnose dysfunction and “what is wrong”. We identify what is broken, what is abnormal, and what needs fixing. This limited view of health leads many of us think mental health means the absence of mental illness.

Dr.Corey Keyes offers a more complete view of how we understand well-being.
He calls it the Dual Continuum Model of Mental Health.

What Is the Dual Continuum Model?

Instead of placing mental health and mental illness on one line and one continuum. Keyes explains they are two separate things.

  • On the X axis is mental illness. It ranges from serious illness to none.

  • On the Y axis is mental health. It ranges from poor mental health (languishing) to a state called of good mental health (flourishing).

This creates four possibilities:

  1. Flourishing with illness – A person has a mental illness and also feels connected, engaged, and well.

  2. Languishing without illness – A person has no diagnosis but feels stuck or empty.

  3. Flourishing without illness – This is the state of strong mental health and no illness.

  4. Languishing with illness – This is the most difficult state, with both low well-being and navigating a mental illness.

This model shows us that mental health is more than the absence of illness.



What It Means for Healthcare Professionals

This idea matters deeply in healthcare. Most of our work focuses on reducing symptoms.

  • Is the pain gone?

  • Is the anxiety better?

  • Are we managing the diagnosis?

These are valid and important questions. But they are not enough if we want a full complete understanding of health and well-being.

We also need to ask and think about the other dimensions of flourishing, including emotional, psychological, and social functioning.

  • Is this person feeling hopeful?

  • Are they engaged in life and relationships?

  • Do they feel like they matter, and contributing?

As clinicians, we must ask these questions about ourselves too. We may feel “burnt out” but maybe it is about about naming what it is: poor mental health (languishing). People can be languishing with or without a formal mental illness diagnosis.

Final Thoughts

Keyes' model offers us a new lens. We must begin to also recognize mental health in addition to mental illness, and understand that that both of these concepts can exist on a continuum. If we want better well-being for healthcare professionals, we have to reflect upon how we view and understand mental health and mental illness.

I’ve provided some academic references below for this work for your reading. For an non-academic read, I highly recommend Corey Keyes’ book titled Languishing, published in 2024.


References

  • Keyes, C. L. M. (2002). The mental health continuum: From languishing to flourishing in life. Journal of Health and Social Behavior, 43(2), 207–222. https://doi.org/10.2307/3090197

  • Keyes, C. L. M. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73(3), 539–548. https://doi.org/10.1037/0022-006X.73.3.539

  • Keyes, C. L. M. (2024). Languishing: How to feel alive again in a world that wears us down. Atria Books.

Anna Wong