Real Happiness

"Hope is itself a species of happiness, and perhaps, the chief happiness which this world affords."

Samuel Johnson

Happiness has been a hot and trendy topic in psychology for a while now. Philosopher David Sosa explores the concept by contrasting it with the experience of mere pleasure; using Robert Nozick's famous "brain in a vat" thought-experiment, he argues that happiness must consist in "human flourishing," which, while somewhat question-begging, does imply that human beings finally crave reality as a field of action, and not merely the kind of virtual subjectivity provided by, say, drugs (or of course the Internet, which is now a more plausible instance of virtuality than Nozick's 1974 chemical one). We stand in deep need of a real external world; the solipsist may think he is happy but he is not.

Sosa's argument suggests that happiness may be more objective than subjective, that is, an individual may not be the best judge of his own happiness. And the degree to which we can control our own happiness is forever in question. According to ancient Stoics and Zen Buddhists, we have the capacity to manage our own consciousness to the point of invulnerability to external accident. But skeptics of many stripes have disagreed, claiming that grave losses or hurts may seriously impair happiness.

Perhaps, to paraphrase Shakespeare's Malvolio, some are born happy, some achieve happiness, and some have happiness thrust upon them; happiness is some kind of interaction of temperament and luck. As today's illustration suggests, I happened to be in Washington, DC over the weekend. Surely George Washington led one of the happiest of lives, and not because he was consciously exultant: a middling Virginia planter and mediocre military man, his character coupled with happenstance propelled him to a truly charmed position in an insurgency apparently destined for greatness.

Happiness is not only not congruent with pleasure--it may be compatible with considerable suffering. Did Abraham Lincoln have a happy life? While he was a jovial sort at times, and an ambitious man who surely knew his own magnitude, he also suffered grim depressions, presided over national mayhem, and died grievously. And yet the scale of his moral achievement, as well as his lasting status as the most beloved of presidents, confers an indisputable happiness upon his life, just as the verdict of history renders Mao Tse-Tung's an unhappy life even if the tyrant died serenely at peace.

Is depression consistent with happiness? I think it depends on severity in a way that is comparable to the experience of pain. Many with chronic, low-grade distress, whether emotional or somatic, may achieve a certain detachment from their affliction that affords scope for happiness. Similarly, episodes of severe melancholy or pain, when transient, may be "happily" endured. But depression is unique among maladies in that a sense of hopelessness is itself a cardinal symptom, making it one of the chief obstacles to happiness.

Yer Blues

I have of late--but wherefore I know not--lost all my mirth, forgone all custom of exercise; and indeed it goes so heavily with my disposition that this goodly frame, the earth, seems to me a sterile promontory. This most excellent canopy the air, look you, this brave o'erhanging, this majestical roof fretted with golden fire--why, it appears no other thing to me than a foul and pestilent congregation of vapours. What a piece of work is a man! How noble in reason, how infinite in faculty, in form and moving how express and admirable, in action how like an angel, in apprehension how like a god--the beauty of the world, the paragon of animals! And yet to me what is this quintessence of dust? Man delights not me--no, nor woman neither, though by your smiling you seem to say so.

Hamlet


I don't know of a more powerful or compact account of depression than these few words from Shakespeare, and William Styron's Darkness Visible sufficiently conveys the essence of a severe melacholic episode and its treatment. But given the perennial shroud of mystery surrounding depression, I suppose additional memoirs couldn't hurt. So Daphne Merkin provides a narrative of her latest depressive episode, in the Times. I recall reading some years ago an article by her in The New Yorker, and this one generates a sense of deja vu. But given that depression tends to be recurrent, that may be fitting.

We speak much of the bottomless nuance of psychiatry, and the infinite individual variations of its maladies, but when it comes to really debilitating depressions, one is struck by their uniformity. The lethargy, the anhedonia, the leaden numbness, the hopelessness, the sense of utter isolation and estrangement from humanity, the inevitable thoughts of self-extinction. Whatever the myriad causes feeding into depression, its symptoms constitute a universal final common pathway.

As Merkin notes, depressives are always encouraged to seek out social contact and support, but they soon encounter the hard truth that most non-depressed people, beyond a few encouraging words, have little understanding of or patience with depression. The depressive essentially must forge a relatively euthymic facade to gain any real foothold in the social world that may eventually help boost his spirits for real. This masquerade of equanimity can feel dishonest.

She describes the peculiarly disheartening quality of the late middle-aged breakdown. The depression of youth may seem more appropriate--life is hard, and one is after all just learning the ropes, right? But several decades in, shouldn't one have gained some mastery? So the kernel of self-doubt germinates.

I relished Merkin's exasperation with her analytically-inclined therapist, who after long questioning the real helpfulness of medications, suddenly switches course and suggests that she have ECT--this is a nice illustration of the throw-up-your-hands-and-throw-in-the-kitchen-sink aspect of treating depression.

Depression, like most mental disorders, is both illness and meta-illness, sickening the body and mind at the same time that it saps the self's capacity to maintain in all respects. It is a bit like AIDS in this formal respect, an assault on the organism's defenses against all kinds of entropy. It wounds and disarms in one stroke.

Merkin's article contains what by now is the stock account of the dismal psychiatric ward experience. The usual players are here: the execrable decor, the mind-numbing routines, the callous and distant staff, and of course the insipid food. Even the antiseptic fluorescent lighting gets a mention. I'm no fan of psychiatric units, but what exactly is expected here, incandescent lighting? As if inpatient wards, in addition to their other crimes against humanity, should generate unnecessary carbon as well?

What is it about ping pong tables and psychiatric units? It is low-maintenance, offers competitive and enjoyable exercise, and unlike billiard balls, its implements cannot cause harm. The perfect pastime for the bored and potentially suicidal (and I mean this quite seriously).

Her episode ends as many, fortunately, do, more with a whimper than with a bang. Just when things seem bleakest and she is considering a return to the hospital for ECT, the gloom lightens subtly, and all of a sudden the notion of writing, of doing anything, no longer seems absurd or insurmountable. She is on Abilify--can we credit the drug, or did the episode simply wind down of its own accord? Neither she nor her psychiatrist can really know. Take what you can get and keep your fingers crossed.

The Great Cham

I finished Peter Martin's well-written biography of Samuel Johnson (1709-1784), who would have to rank as among the most prodigious of literary giants who suffered from melancholia, or what is more tamely termed Major Depression today. The best known English literary critic and general man-of-letters of his century, Johnson earned fame with his essays, his groundbreaking English dictionary, and his work in biography and translation. He was also renowned for his wit and powers of conversation. James Boswell described Johnson's affliction thus:

The 'morbid melancholy,' which was lurking in his constitution and to which we may ascribe those particularities, and that aversion to regular life, which, at a very early period, marked his character, gathered such strength in his twentieth year, as to afflict him in a dreadful manner...he felt himself overwhelmed with an horrible hypochondria, with perpetual irritation, fretfulness, and impatience; and with a dejection, gloom, and despair, which made existence misery. From this dismal malady he never afterwards was perfectly relieved; and all his labours, and all his enjoyments, were but temporary interruptions of its baleful influence.

While Johnson was a highly prolific writer overall, he abhorred what he considered to be his own propensities for sluggish indolence, and indeed, long periods of inactivity punctuated episodes of herculean writing (although I have never encountered any suggestion that he was bipolar). Throughout his life he had a morbid dread of death and of what he perceived as his own sinful nature, although to all appearances he led a largely blameless life. In his last years he noted his conviction that he was "one of those who shall be damned." Asked to clarify, he famously and bluntly replied, "Sent to Hell, Sir, and punished everlastingly."

Johnson' s melancholia infected what was otherwise an iron will, and he fought the black dog indefatigably. He "coped" (to put in anachronistically) by seeking out social contacts, engaging in vigorous exercise, throwing himself into his work, and fortifying his religious faith--pretty much the same methods people use today. However, as was the medical fashion of the era, he was also bled copiously and frequently during his depressive episodes (which would, of course, have produced the opposite of the intended effect).

Johnson was also notorious for ungainly and disconcerting bodily movements that have been speculated to represent Tourette's syndrome, although this is not decided, and he did not exhibit the involuntary profanity that often accompanies that disorder. Martin quotes Boswell's classic description:

...while talking or even musing as he sat in his chair, he commonly held his head to one side towards his right shoulder, and shook it in a tremulous manner, moving his body backwards and forwards, and rubbing his left knee in the same direction, with the palm of his hand. In the intervals of articulating he made various sounds with his mouth, sometimes as if ruminating, or what is called chewing the cud, sometimes giving a half whistle, sometimes making his tongue play backwards from the roof of his mouth, as if clucking like a hen, and sometimes protruding it against his upper gums in front, as if pronouncing quickly under his breath, too, too, too: all this accompanied sometimes with a thoughtful look, but more frequently with a smile. Generally when he had concluded a period, in the course of a dispute, by which time he was a good deal exhausted by violence and vociferation, he used to blow out his breath like a whale...

However, these signs reportedly diminished whenever he was closely engaged in work or conversation, and he could suppress them for limited periods of time, such as in church or while sitting for a portrait.

And here is Martin's remarkable account of an 18th century stroke:

The night after sitting for this last portrait, at about three in the morning, he awakened suddenly with 'a confusion and indistinctness in my head which lasted, I suppose, about half a minute.' To test whether or not it was a stroke and had affected his mind, he immediately composed a prayer to God in Latin, discovering to his infinite relief that 'the lines were not very good, but I knew them not to be very good.' However, he also discovered he could not speak. Calmly, he drank 'two drams' of wine 'to rouse the vocal organs' and 'put myself into violent motion,' but his speech would not come. He could say 'no' but not 'yes.'

One would expect a melancholic, I suppose, to be able to say 'no' but not 'yes' under the circumstances. But throughout his life Johnson was, like Oscar Wilde, supreme master of the one-liner, a few of which follow:

Marriage has many pains, but celibacy has no pleasures.

More knowledge may be gained of man's real character, by a short conversation with one of his servants, than from a formal and studied narrative, begun with his pedigree and ended with his funeral. [In psychiatry we call this collateral information].

Sir, we know our will is free, and there's an end on 't.

It is strange that there should be so little reading in the world, and so much writing. People in general do not willingly read, if they can have any thing else to amuse them.

No man but a blockhead ever wrote, except for money.

Happy Happy, Joy Joy

"Most people are about as happy as they make up their minds to be."

Abraham Lincoln

Abe was typically pithy when he supposedly said or wrote this, but even he may have nodded in this instance, for it reflects a simplistic and misleading conception of what happiness might be. It came to mind after the media buzz generated by a study about happiness and social networks. The study suggested that those individuals rated highest in happiness (by a "standard measure" of the same) were most likely to have broad social networks of similarly happy people.

The first thing that is apparent is the stunning obviousness of this "finding," like so much of social science research. I mean, who could have guessed that happy people are not usually recluses, or surrounded by miserably negative folks? It is much like another shocking recent study suggesting that television watching is usually inversely proportional to happiness. It also confirms what every disaffected teenager has suspected: the popular "in" folks really are different.

Well, I suppose the study may show that schadenfreude, by means of close-up exposure to the unhappy, is not the best route to happiness. To be sure, when I ask people what (if anything!) they have found helpful about a recent psychiatric hospitalization, I am surprised that the response often involves their apparently gratified awareness of others who are even worse off than they are. But this may suggest that it is primarily the distressed who may be helped by acquaintance with the even more distressed; happiness may enjoy a magnanimity that unhappiness cannot afford.

Of course, people have debated what happiness means for thousands of years. I guess the contemporary question is whether one can be seriously, lastingly unhappy without also meeting criteria for depression. We have decided that bereavement, as well as other various disappointments in life's natural course, is distinct from depression, but is unhappiness that occurs for no particular reason anything other than depression?

In this business we talk about someone being "euthymic," or free of significant depressive or manic symptoms. But this is a fairly sterile term, and it seems like happiness ought to be something more, perhaps a spiritual sense (secular or not) that one's life is headed in a meaningful trajectory. Yet happiness is not inconsistent with pain and suffering; indeed, we might say that unhappiness is suffering exacerbated by a sense of meaninglessness. So can one be happy and depressed at the same time? How about happy and dysthymic? I'm not sure.

I hope this blog has already established that medications are not my chief personal or professional interest, although in light of escalating psychiatry/pharma scandals, I think I may list a separate disclaimer indicating my near-total lack of interaction with drug companies over the years. And clearly there are things one can do on one's own or in psychotherapy to improve one's mood and likelihood of happiness.

One of those things is increasing one's proximity to other people, preferably happy people. One of the cruel vicious circles of depression, however, is that people, particularly happy people, do not generally relish the company of seriously unhappy people (that may be one way they stay so happy). At the risk of sounding excessively wry here, I suppose that unhappy people ought to seek out the company, at least, of those somewhat less unhappy than they are, thus ratcheting up their own happiness potential ever so slightly. Thereby one might progressively advance closer to the shangri-la of the truly happy.

A significant hitch can occur when the most negative people in one's life, the ones potentially most detrimental to happiness, also happen to be one's family, friends, or associates. There is always the possibility that, like a substance abuser needing to avoid triggers, one could need to break free of a toxic influence. Problematically, this study suggests that if you want to become or remain happy, you ought to avoid the unhappy like the plague. I guess the naturalistic fallacy, the notion that what (contingently) is the case ought in fact to be the case, is the basic hazard of science.

But there is also the risk that unhappiness, like depression, can come to be seen as primarily a lifestyle choice and not what it is, an extremely complex interaction of biology and behavior. The risk of Lance Armstrong stories is the notion that anyone ought to be able to overcome cancer if they only try hard enough; the parallel risk with this kind of study is the notion that we can safely blame the depressed because they "choose" their unhappiness. In this business, if it's simple, it's almost always wrong.

Those Melancholy Poets

This Humble Blogger has been tied up with travel, moving, and getting the kids into a new school year, so for now I'll briefly resort to a poem, "Having it Out with Melancholy," by Jane Kenyon. Recommended to me by a former patient with quite severe and chronic depression, it is one of the best poems I've read about "the black dog."

Kenyon apparently suffered primarily from depression, although according to an essay I once read by her husband, the poet Donald Hall, there were manic phases as well. Ironically (or not) she died of leukemia when she was only 48.

This poem features the strange and harrowing intimacy the melancholic has with an disease that is not a passing affliction--not the spring allergy season, not even the breast cancer that may possibly be eliminated--but rather a lifetime partner of sorts. There are some wonderful lines. "You taught me to exist without gratitude" reflects the all too common view of depression as a failure of character, and also illustrates the reality of depression as a blight upon a state of native health. One has to "learn" not to be grateful for what the non-depressed person takes for granted, an appreciation of the basic fact of life. Indeed, for the depressed, "the pleasures of earth are overrated."

For me the heart of the poem is section five, "Once there was light," in which the speaker, in a temporary reprieve, feels an unaccustomed and transcendent unity with humanity, a unity that is violated all too soon by the return of what is later called "the unholy ghost." The depressed are singled out; their condition is nothing if not solitary. And yet the poem ends with another momentary respite, in which the speaker witnesses a bird's "bright, unequivocal eye." Like that eye, the cruelty of depression is inscrutable, but that it exists in nature (that same nature that most poets find so compellingly beautiful) certainly is "unequivocal."

I would never suggest this poem to anyone with a relatively new diagnosis--it might terrify or even mislead--but it may offer succor to anyone who has learned to live with "the black bile" over the long term.