Happiness Pills: Yay or Nay?

Over the weekend I was hanging out listening to one of my old professors play music (because that’s how I roll). He introduced one of his songs with the question “if I could get happiness with a pill, would I do it?” Instantly my “grrrr, mental illness stigma” detectors went off, but I have great respect for this particular individual and challenged myself to think a bit further about it. I realized that in general, the question “if I could be happy with a pill” is a. unclear and b. misleading, as well as c. totally unrelated to the antidepressants that actually exist today.

The biggest problem I have with the question is what we mean by “happy”. Is it the actual presence of a positive emotion? Or is it simply a lack of negative emotion? Does it mean you can’t feel negative emotions, even when they’re appropriate? I suspect that when this question is posed most people mean feeling on the positive side of the emotion spectrum constantly. While this might sound appealing to lots of people, I think there are actually some serious problems with this concept, and that even the idea of a pill that can do this is self-contradictory.

Emotions have appropriate times and places. They come as reactions when they’re functioning healthily. They fit situations or they don’t. If you aren’t happy and you take a pill to be happy, your emotions probably don’t make any sense for the situation that’s happening around you. It seems a bit like taking away physical pain: you no longer have a barometer for when something is wrong or hurting you. You no longer have the emotions that tell you something has violated your boundaries or treated you inappropriately. Just as with a lack of physical pain, this will probably result in doing things that are actually hurting you without realizing it.

Negative emotions give us information. They make us more aware of what’s happening around us because they clearly communicate to us “something bad is happening”. Fear tells us to escape, anger tells us that a boundary has been violated, sadness and grief tell us that we’ve lost something we care about. This makes them appropriate.

We all understood why Ten was crying, and it would have been creepy if he wasn’t.

Oftentimes this awareness does more than simply tell an individual about situations that are harmful to them. We have empathy, so our negative emotions often inform us about things that are morally inappropriate and then give us an impetus to act. If I didn’t have anger or sadness, I think I would be hard pressed to care about something like anti-gay hate crimes, or oppression of women. I could come to an intellectual conclusion about why those things were wrong, but without any feelings of sadness it doesn’t have the same impact. Without our emotions we are less aware of the world around us, particularly the things that need to be improved.

I’m less worried about the concept of an identity or an essential self that many people find themselves wondering about when they think of pharmaceuticals. Every time we make choices we affect our brains and through our brains our emotions, thoughts, and selves. When we try to change a habit, when we go somewhere new for the first time, when we learn a new fact or skill, we are training our brains to operate differently. Therapy is all about changing the patterns that your brain uses and finding more effective ones. Perhaps there is some core that holds steady through all of that, but every human being in the world encounters so much change and adjustment to their personality, from within and without, that it seems a bit silly to be worried about losing yourself, especially if what you’re changing will improve things.

But that’s the question here: will being constantly happy improve your life and the world?

Will this make me a better, healthier, more functional person who is more capable of improving the world around me and contributing something? I don’t think depression or sadness are necessary to be productive or creative or any of those other silly myths that depression tells, but I do think having the full spectrum of human emotion is deeply important for having empathy, for understanding why certain things are morally inappropriate and others are morally praiseworthy, and for gaining motivations to make changes.

There are some ways in which always being positive will improve the world around you (for example you’ll probably be a much nicer person to be around), but as I mentioned above, it also makes you less aware of what’s wrong with the world, and in the end I think the balance would point towards no, it would not improve the world unless everyone in the world were fed happy pills at the same time so that we didn’t need to empathize with people who were in pain. As long as there are injustices and other unhappy people in the world, it’s important for our understanding of those people to be able to empathize and feel anger or sadness on their behalf. But what about improving your life?

I have a hard time imagining how a pill that consistently makes you happy would actually do anything to improve your life, because as I mentioned before, negative emotions tell us when a situation is bad for us. If we don’t have that information, we’re likely to stay in situations that will hurt us. Additionally, we’re less likely to develop healthy coping strategies. Pain gives us a reason to find a better way of doing things. This is why antidepressants are almost always accompanied by talk therapy so that the patient can find effective ways of managing their lives and emotions.

As an example, let’s say you were in a relationship where your significant other was emotionally abusive. They berated you constantly, expected you to do all the work, and never did anything for you. But despite all that you were constantly feeling just fine. It seems unlikely to me that you would be willing to work towards better relationship strategies, leave the relationship, or confront your partner about their inappropriate behavior if it never made you feel sad or unhappy. You would never learn that the things they said were inappropriate because they didn’t hurt you. You would never spend time trying to understand why they did what they did because it never had any impact on you.

What about appropriate emotions? How would we feel grief for things ending if we took a pill that made us always happy? Doesn’t it seem deeply wrong to not grieve things, unhealthy even? I suspect that not grieving (which leads to not processing and not effectively storing those memories and relationship in a way that you can cope with them and they’re not consistently popping into your mind) would make it harder and harder to be happy and we’d have to increase our happy pill dose again and again and again.

Unless happy pills came with effective coping techniques, appropriately living on conjunction with your values, healthy relationships, and other positive ways of living, they would stop working. And if everything feels ok all the time, why would you have any motivation to do all these other things? Most often the ways we understand what our values are is by feeling guilt or shame when we violate them. If you don’t have these emotions, it would be nearly impossible to live in tune with your values. People who don’t have these emotions get labeled sociopaths and psychopaths. We understand there’s something wrong with that.

The problem is that if you were made this way by a pill, you wouldn’t set up your life in such a way to create happiness, which means that you would keep yourself in bad situations, living antithetically to your values, in shitty relationships. And so the happy pills would have to do more and more work. And then you’d have to up the dosage, and you’d make your life even worse. And then the pills would have to do more so you’d have to up the dose…

We actually already do have these hypothetical happy pills that cut us off from appropriate emotions and make us feel good. They’re called drugs and most people agree that they’re a bad way of dealing with your emotions. They don’t provide a stable foundation for happiness and good living, because they mean if you stop taking them your happiness can flit away. They mean that you lose the fear of being homeless or starving because you’re stuck in the happy of this exact moment. They are deeply unhelpful.

The other thing I’d worry about is whether this stunted way of feeling would leave me with less happiness overall. Would you still get those melancholy/bittersweet moments that are so flipping good because of the fact that they hurt? Would I still get to watch Romeo and Juliet and love it? Would I still understand culture and relationships and other people? Would I turn into an annoying asshole because I never have to work on myself? What about the high of coming up from a bad day? The adrenaline of fear and anxiety heightens everything…what do we do without that?

If I could find a pill that made me content (which is what an antidepressant is supposed to help with: give you the emotional space to be able to tolerate things and find some contentment), that I would take. I would take the possibility of reacting accurately and effectively to the stimuli that surround me, of being able to reach my goals without my emotions getting in my way. What I wouldn’t take is a pill that disturbs the relationship between stimulus and appropriate response. Many people get these two things mixed up, and so when this question comes up in the context of antidepressants, I think it’s important that we remember to distinguish.

Sure it might be nice to feel good no matter what you’re doing, but what’s the point? It’s easy to be oblivious. It’s hard to be aware and truly work on yourself and your world.

 

“Mental Illness is Not Biological”

I am a big proponent of being careful with language. I don’t think that we should oversimplify something simply because it sounds better or is better marketing. Especially when it comes to mental illness, we are so sloppy with our language as it is that I think we must be careful. I don’t like the idea that we should describe mental illness as “a chemical imbalance” because it deeply oversimplifies things. So I was fairly dismayed when I sat down to read an article in my local paper about the need to talk more about mental illness and it simply repeated over and over “mental illness is not biological” and that we need to spend more time talking about the pharmaceutical industry.

Many people do not pay enough attention to the biological factors of mental illness. Yes, we recognize that genes can cause a predisposition, but more than that, basic biological systems can deeply affect your mental health. A few examples: sleep deprivation can easily cause symptoms of mental illness. It can deeply affect mood, emotional stability, depression, anxiety, and other brain functions. Continual sleep deprivation can spur a mental illness. I’m not sure what one would call that if not a biological factor.

Similarly, food deprivation is deeply correlated with some serious signs of mental illness. In the hunger studies performed at the University of Minnesota, individuals who willingly deprived themselves of food became depressed, anxious, obsessed, violent, withdrawn…they had diagnosable mental illnesses that were not present before the removal of food. Again, this seems to be a strictly biological change that triggered a mental illness.

Factors like these are often heavily discounted when we talk about mental illness, particularly when we’re attempting to recover from mental illness. Not enough time is spent focusing on the fact that if you don’t have a healthy biological basis with adequate sleep, nutrition, and exercise, it is significantly more difficult to have a stable mood and recover from a mental illness.

In addition, we do know that genes play some role in mental illness. We know from twin studies that many mental illnesses are far more likely to occur in an individual if they have close family members with that mental illness. For some mental illnesses, we have identified specific genes that might be linked to that mental illness. The most likely theory about mental illness right now is that we are genetically pre-disposed to an illness (to varying degrees depending upon the person) and social or environmental factors then can trigger that mental illness. And yes, neurotransmitters and brain chemistry are implicated in that mental illness. Yes, there are physical processes that have been disrupted when we are talking about mental illness. No, it’s not just a chemical imbalance, yes it is more complex than that, but of course it’s biological because our brains are a biological organ.

This is intensely frustrating, because it makes it seem as if the social factors that affect our mental health have no bearing on the physical existence of our brain. In fact studies done on chimps have shown that certain brain chemicals are altered over the course of years by trauma or isolation (if a chimp is isolated at a young age they will have different levels of certain brain chemicals when placed in isolating situations than a chimp not isolated at a young age and these effects last for many years). This is a physical change brought on by an environmental factor.

Of course it’s important to be careful not to oversimplify, but obscuring that there clearly is a biological factor to mental illness is not helpful either. In addition, the fear of labeling mental illness as biological plays directly into the fear of overdiagnosing and overprescribing. When we repeat over and over that mental illness is not a biological illness that revolves around neurotransmitters and brain chemicals, we become even more paranoid about prescribing medication (something that people are already worried about in the case of things like ADHD and Xanax). Speaking as someone who takes medication, this is incredibly damaging. Medication can be a complete life-saver: it made my anxiety manageable and so it gave me a window to actually begin dealing with some of my underlying issues. I was afraid to begin taking medication because I didn’t want to “alter my brain”. Repeating the myth that pharmaceutical companies are out to get us all and that medications are not the proper way to treat mental illness reinforces that stigma.

Of course we should include various kinds of therapy when we’re working on mental illness, but it is actually incredibly difficult to get medication for many mental illnesses and particularly difficult to get insurance to cover it. People are already afraid of medication. People are already afraid of being turned into zombies by pills or having unknown side effects. It is possible to advocate for improved standards for pharmaceutical companies AND accept that medication can be an incredibly important part of treating mental illness.

We need to recognize that mental illness is complex, requires a number of kinds of treatments, and involves a variety of factors including the biological, social, environment, genetic, chemical, and situational. While it is important to move past the “chemical imbalance” trope, that doesn’t mean completely removing any mention of chemistry or biology from our descriptions of mental illness.