Mind Wondering

Curating Curiosity

Month: May 2019

Is Happiness A Psychiatric Disorder?

In 1992, psychologist Richard Bentall published a paper in the Journal of medical ethics titled “A Proposal to Classify Happiness as a Psychiatric Disorder”. At first glance, the idea of classifying happiness as a mental disorder seems laughable. But consider the DSM (Diagnostic and Statistical Manual of Mental Disorders) definition:

A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognitionemotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. 

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5

…and the beginning of the proposal…

It is proposed that happiness be classified as psychiatric disorder and be included in the future editions of the major diagnostic manuals under the name Major Affective Disorder: Pleasant Type. In a review of relevant literature. it is shown that happiness is statistically abnormal, consists of a discrete cluster of symptoms, is associated with a range of cognitive abnormalities and probably reflects the abnormal functioning of the central nervous system.

Richard P. Bentall, Journal of Medical Ethics, Vol. 18, Issue 2, 94-98 (Jun/1992)

…and it becomes much easier to see how this proposition could be taken seriously.

If major affective disorder, pleasant type were to be considered a psychiatric disorder, it would make complete sense why some people are capable of feeling more joy than others, an idea as old as the Stoic philosophers and the hypothesis behind the classic 1978 study, Lottery winners and accident victims: Is happiness relative?

We all know people who are inherently happy most of the time. The majority of these people are far from monk-like in their dedication to training their minds, so it stands to reason that – just like common mental disorders – the cognitive processes responsible for their happiness have psychological and/or biological roots for which they’re not responsible.

Of course, one key aspect of mental illness we can’t ignore is its ability to cause distress or dysfunction in the person suffering and those around them. While this might not be as apparent in pleasant types as it is in, say, a schizophrenic, anyone who’s gone through a period of prosperity or spent a significant portion of time around unreasonably optimistic people will attest that it’s true.

Among other things, Bentall’s proposal points out that people suffering from the heights of happiness have been shown to…

  • Gain weight (commonly seen in recently married couples).
  • Consume excessive amounts of alcohol.
  • Act irrationally.
  • Behave in a manner discordant with their life goals.
  • Have difficulty with mundane, but essential tasks.
  • Force their condition on unhappy people.
  • Misremember negative events.
  • Believe that others share their unrealistic opinions about themselves.
  • Show a lack of evenhandedness when comparing themselves to others.
  • Overestimate their control of events and/or perceive random events as subject to their will.

The type of delusional thinking represented in the last point has been termed Magical Thinking and is a symptom of certain mental health conditions, such as Obsessive Compulsive Disorder.

My Week of Magical Thinking, by Ruben Bolling

Interestingly, depressed people often see the world through a much clearer lens than the rose-tinted glasses worn by pleasant types. Because they do not suffer from the biases shown in happy people, they exhibit more accurate judgment around unforeseen events than people with a positive inclination.

Dr. Bentall notes that, while current research has been focused on depressive realism

…it is the unrealism of happy people that is more noteworthy and surely clear evidence that such people should be regarded as psychiatrically disordered.

Richard P. Bentall, Journal of Medical Ethics, Vol. 18, Issue 2, 94-98 (Jun/1992)

All of the symptoms of happiness become even more disconcerting when you realize that they could convey an biological disadvantage for pleasant types, which might explain why people seem more miserable than ever. Still, if survival of the fittest does indeed favor those that are a little more fucked, then maybe we should seriously consider the happiness clinics and anti-happiness medications proposed by Dr. Bentall as a cure for pleasant types.

I realize this message borders on sacrilege in a country where the aspirational nature of happiness has been deemed so fundamental to being a human that the pursuit of it is one of our three inalienable rights. This was not lost on the British psychologist either and he addresses the possible objections to the proposal early in the paper.

One possible objection to this proposal remains—that happiness is not negatively valued.

Richard P. Bentall, Journal of Medical Ethics, Vol. 18, Issue 2, 94-98 (Jun/1992)

And with that we get to the heart of the matter. Namely, that it’s impossible to talk about mental health without having a discussion on values. So far it’s been a pretty unsophisticated discussion…

  • Happiness = good (positively valued)
  • Depression = bad (negatively valued)
  • Anxiety = bad (negatively valued)
  • Anger = bad (negatively valued)

Because of this, the cognitive distortions that lead us up the ladder to happiness are far less researched and discussed than the errors in thinking associated with negatively valued conditions. We know what it’s like to feel happy but are unsure of how to get there or why we should want to. This has led people to be surprisingly poor predictors of what will make them happy in the future. Psychologist Dan Gilbert wrote an entire book on this topic titled Stumbling on Happiness.

Dan Gilbert: The Surprising Science of Happiness

While on tour promoting the book, Gilbert was asked the one-trillion dollar question…

Interviewer: How do I find happiness?

Dan Gilbert: People have been writing books that promise to answer that question for roughly two thousand years, and the result has been a lot of unhappy people and a lot of dead trees. 

Author Q & A w/ Dan Gilbert

And it’s not just the books we have to contend with anymore, but the endless stream of #insprationaladvice that litters our news feed.

Terrible advice to give unpleasant types.

Well-meaning platitudes like the above may generate a lot of likes, but they do nothing for the people who really need to internalize the message. Anyone who’s suffered from a mental illness knows that telling someone in the grips of despair or anxiety to “keep calm and carry on” is as effective as telling their cheerful companions to “start stressin’ and feel depression.” Shit don’t work.

In fact, research has shown an inverse relationship between how much someone values happiness and how happy they become. Put another way…

The more you try to be happy, the sadder you become.

This is the ultimate double-edged sword for the “unpleasant” types of the world, many of whom are literally dying to feel better. The numbers are staggering…

  • Approximately 1 in 5 adults in the U.S. (46.6 million) experiences mental illness in a given year.
  • 6.9% of adults in the U.S.—16 million—had at least one major depressive episode in the past year.
  • Only 41% of adults in the U.S. with a mental health condition received mental health services in the past year.
  • Serious mental illness costs America $193.2 billion in lost earnings per year.
  • Suicide is the 10th leading cause of death in the U.S., and the 2nd leading cause of death for people aged 10–34.

(https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers)

And if you think that’s terrible, things are even worse for young people. Between 2009 and 2017, rates of depression more than doubled among 13 to 17-year-olds and suicide is now the 2nd leading cause of death for people aged 10 to 34. The rise is most apparent in young girls, who have been inordinately affected by this increase. While a causal link has yet to be proven, many experts theorize that the rise in social media use and cyberbullying has played a significant role.

The silver lining to all of this is that it’s no longer taboo to discuss mental health issues in the open. This alone is often enough to ease some of the suffering of those affected as most of these conditions feed on isolation.

Most of us weren’t lucky enough to be stricken with major affective disorder, pleasant type. But just because happiness doesn’t come easily to us, doesn’t mean it’s unattainable. The longest-running study on happiness has been collecting data for over 80 years on the things that make for a good life. And what did those tens of thousands of pages worth of data say?

The clearest message is this: good relationships keep us happier and healthier. Period.

Dr. Robert Waldinger

Cultivating these relationships if you don’t have them will be hard. But take it from Teddy Roosevelt, a president known to have suffered from periods of hypomania and depression.

“Nothing in the world is worth having or worth doing unless it means effort, pain, difficulty… I have never in my life envied a human being who led an easy life. I have envied a great many people who led difficult lives and led them well.”

Theodore Roosevelt

What Do Therapists Really Think?

Therapy elicits odd reactions because, in a way, it’s like pornography. Both involve a kind of nudity. Both have the potential to thrill. And both have millions of users, most of whom keep their use private.

Lori Gottlieb (Maybe You Should Talk to Someone)

I truly believe that everyone would benefit from therapy. Speaking personally, it’s as essential for my mind and spirit as eating healthy and going to the gym is for my body, and much more difficult than a Russian deadlift with no weight belt. This notion that people who are “weak” or “crazy” are the only ones that need therapy is utter bullshit. Would you also agree that only fat people should go to the gym? Or only people with learning disabilities should go to school? No, because that is something an idiot would think.

As a card-carrying member of the Counseled Crowd you’d think I’d be immune to these pernicious myths about therapy. But I can’t help but feel my sphincter clinch up anytime I’m telling someone I see a shrink for the first time. Afraid it’ll cause them to view me as “one of those people”, I seek to qualify my system of psychoanalysis…

“I see it as a workout for the mind,” I’ll say. “Most of the time, we talk about things that are going well and discuss the goals I have for myself.”

Underneath these words are the silent plea, “Please don’t think I’m crazy! Please don’t think I’m sad! Please don’t think I’m anxious!”

I’m saying it as much to the other person as I am to myself. Knowing you have multitudes and coming to grips with them are two very different things, and the gift of an introspective nature is thinking your self alternately cerebral and psychotic.

Meditation and creative endeavors tend to make me feel the former and mindlessly distracting myself by scrolling through news feeds the latter. Therapy seeks to reconcile these seemingly disparate aspects of myself.

Despite my years of proselytizing about therapy’s benefits I’d never endeavored to understand the mindset of the person with whom I was sharing my deepest desires and darkest secrets. That is, until I read Maybe You Should Talk to Someone: A Therapist, HER Therapist, and Our Lives Revealed by Lori Gottlieb.

Maybe You Should Talk to Someone

In Maybe You Should Talk to Someone, therapist Lori Gottlieb masterfully constructs a story featuring as captivating a cast of characters as you’ll find in any book, each with their own Hero’s Journey playing out over the course of the book.

If you’re at all struggling with the myriad issues that come with being a human, you’ll no doubt see aspects of yourself in all of them. And by watching them struggle and come to grips with their own issues, you can’t help but be incepted with certain ideas about how to deal with your own. However, the real joy of the book for me was getting a peak at the woman behind the curtain guiding these lost souls on their journey back home.

The Wizard of Oz

A Therapist’s Thoughts

As someone who’s always been fascinated by psychology and human behavior, I found the inside look Ms. Gottlieb gives us of what it’s like to be a therapist (and someone in therapy) fascinating. Below are some of my favorite musings from her memoir.

What determines success?

If you’re like me, you’ve gotten hung up Googling CBT, MBCT, EMDR, and any other acronym that can serve to postpone picking up the phone and scheduling an appointment. But apparently the method or therapy is far less consequential than we’ve been led to believe.

The most important factor in the success of your treatment is your relationship with the therapist, your experience of “feeling felt.” This matters more than the therapist’s training, the kind of therapy they do, or what type of problem you have.

Lori Gottlieb (Maybe You Should Talk to Someone)

I’ve often told friends who are thinking of seeing a therapist that they’ll likely need to go to 4 or 5 before they find one they connect with. In the future, I imagine there will be a match.com for patients looking for therapists. Surely Facebook could cobble together something with all of the user data they have.

Why do people go to therapy?

When Lori started her practice, she assumed the majority of people that saw a therapist went because they wanted to feel less anxious or depressed.

But no matter the circumstances, there seemed to be this common element of loneliness, a craving for but a lack of a strong sense of human connection. A want.

Lori Gottlieb (Maybe You Should Talk to Someone)

This echoes recent research suggesting that millennials are facing a loneliness epidemic and what countless studies on happiness have been trying to tell us for years.

“Good relationships keep us happier and healthier. Period.”

Therapists Sometimes Feel Helpless to Help

While there’s certainly a therapist out there for everyone, that doesn’t mean every therapist will be able to help you. After all, they’re human too.

I felt increasingly fatigued in our sessions—not from mental exertion, but from boredom. I made sure to have chocolate and do jumping jacks before she came in to wake myself up. Eventually, I moved her evening session to first thing in the morning. The minute she sat down, though, the boredom set in and I felt helpless to help her.

Lori Gottlieb (Maybe You Should Talk to Someone)

I found this insight into the mind of a therapist so relieving. We often give them deity status in our minds and make believe that they’re infallible, but the truth that they’re people who make mistakes and get angry, bored, happy and sad is the reason they’re able to relate to our suffering and provide guidance. It’s also why they don’t always know the right thing to say, “which happens more often than patients realize.” Luckily therapists have been taught how to deal with this.

I do what therapists are taught to do when we’re having a complicated reaction to something and need more time to understand it. I do nothing-for the moment. I’ll get consultation on this later.

Lori Gottlieb (Maybe You Should Talk to Someone)

Who do therapists turn to for advice?

Where does this consultation come from? After all, therapists work in a vacuum and aren’t allowed to discuss the particulars of their clients to the outside world. Are they just burying the heads in a Freudian tower of text? Maybe not…

Consultation groups are a fixture of many therapists’ lives. Working alone, we don’t have the benefit of input from others, whether that’s praise for a job well done or feedback on how to do better. Here we examine not just our patients but ourselves in relation to our patients.

Lori Gottlieb (Maybe You Should Talk to Someone)

For some reason, this was one of the things that fascinated me most about the book. It made me picture a group therapy session full of therapists all talking about the issues they were having with helping people deal with their issues. It also just made sense. Why wouldn’t a therapist consult other therapists if they were struggling to solve a problem with their patient? The advice of someone who’d helped a patient through something similar would be invaluable.

There are no right answers, only better questions.

One of the things that surprised me as a therapist was how often people wanted to be told what to do, as if I had the right answer or as if right and wrong answers existed for the bulk of choices people make in their daily lives.

Lori Gottlieb (Maybe You Should Talk to Someone)

The value of asking better questions is espoused by many experts in the self-help space. One of my favorite multi-hyphenates (author/entrepreneur/podcaster/etc.) Tim Ferriss has gone as far as writing an entire book around influential figures’ answers to the 11 questions that changed his life.

In her practice, Lori has found the process of getting people to ask themselves the right question the best way to initiate change.

Therapists aren’t persuaders… We can’t convince people not to be self-destructive, because for now, the self-destruction serves them. What we can do is try to help them understand themselves better and show them how to ask themselves the right questions until something happens that leads them to do their own persuading.

Lori Gottlieb (Maybe You Should Talk to Someone)

Social Media Ain’t Real Life

I imagine anyone reading this has hung out with a friend in a miserable mood or a bickering couple whose online lives show them living and loving it up. Depending on your own mood this can be both funny and infuriating to witness. But if you think your friend’s Instagram selves are a much shinier version of their real lives, imagine what their therapist thinks…

If you ever want proof that what people present online is a prettier version of their lives, become a therapist and Google your patient… I saw images of her receiving a prestigious award, smiling at an event standing next to a handsome guy, looking cool and confident and at peace with the world in a magazine photo spread. Online, she bore no resemblance to the person who sat across from me in that room.

Lori Gottlieb (Maybe You Should Talk to Someone)

This isn’t to say you should start posting arguments with your spouse in Stories or taking selfies of shitty situations, but I do think it’s important to consume media outside the sheen of social media. Something that’s got a little grit to it. Speaking personally, I feel more in common with almost any character in a book than I do with the characters my friends play online.

This was certainly true of Julie, John, Rita, Wendell, and Lori, and the rest of the people in this wonderful book.


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