Sunday, January 22, 2006

Hardwired for Happiness

Born to Be Happy, Through a
Twist of Human Hard Wire

In the course of the last year, the woman lost her husband to cancer and then her job. But she did not come to my office as a patient; she sought advice about her teenage son who was having trouble dealing with his father's death.

Despite crushing loss and stress, she was not at all depressed - sad, yes, but still upbeat. I found myself stunned by her resilience. What accounted for her ability to weather such sorrow with buoyant optimism? So I asked her directly.

"All my life," she recalled recently, "I've been happy for no good reason. It's just my nature, I guess." But it was more than that. She was a happy extrovert, full of energy and enthusiasm who was indefatigably sociable. And she could get by with five or six hours of sleep each night.

Like this woman, a journalist I know realized when she was a teenager that she was different from others. "It's actually kind of embarrassing to be so cheerful and happy all the time," she said. "When I was in high school I read the Robert Browning poem `My Last Duchess.' In it, the narrator said he killed his wife, the duchess, because, `she had a heart - how shall I say, too soon made glad?' And I thought, uh-oh, that's me."

These two women were lucky to be born with a joyous temperament, which in its most extreme forms is called hyperthymia. Cheerful despite life's misfortunes, energetic and productive, they are often the envy of all who know them because they don't even have to work at it.

In a sense, they are the psychiatric mirror image of people who suffer from a chronic, often lifelong, mild depression called dysthymia, which affects about 3 percent of American adults. Always down, dysthymics experience little pleasure and battle through life with a dreary pessimism. Despite whatever fortune comes their way, they remain glum.

But hyperthymia certainly doesn't look like an illness; there appears to be no disadvantage to being a euphoric extrovert, except, perhaps, for inspiring an occasional homicidal impulse from jealous friends or peers. But little is actually known about people with hyperthymia for the simple reason that they don't see psychiatrists complaining that they are happy.

If dysthymia is hyperthymia's dark twin, then hyperthymia may not always be so rosy. That is because about 90 percent of dysthymic people experience episodes of more severe depression in their lifetimes. Are hyperthymics at risk of some mood disorders, too?

If hyperthymics bear a kinship with any psychiatric illness, it may be bipolar disorder. Bipolar patients live on a roller coaster of depressive troughs and manic peaks. But unlike hyperthymia, mania is an inherently unstable state of euphoria, irritability and often psychosis that causes profound morbidity and impaired functioning.

Some researchers believe hyperthymics may be at increased risk of depression or hypomania, a mild variant of mania. And they may have high rates of affective disorders in their closest relatives.

Hyperthymic and bipolar people may also share a tendency to be highly creative, given the strong association between bipolar disorder and creativity. For example, a 1987 study of creative writers at the University of Iowa Writers' Workshop by Dr. Nancy Andreasen showed that writers had bipolar illness at a rate four times as high as control group members who were not writers.

Of course, the notion of a hyperthymic temperament is hardly new. Some 2,400 years ago, Hippocrates proposed that a mixture of four basic humors - blood, phlegm, yellow bile and black bile - determined human temperament; depending on which humor predominates, one's nature is happy, phlegmatic, irritable or sad.

Modern science has renamed the humors neurotransmitters, like serotonin and dopamine, and tried to link them to abnormal mental states. For example, depression was thought to result from a functional deficit of serotonin or norepinephrine in the brain.

But one problem with this theory is that antidepressants increase the levels of these neurotransmitters within days, yet their clinical effects take several weeks. If the theory were correct, then depression should clear up within days of taking an antidepressant, not weeks.

Still, many dysthymic people respond to antidepressants and watch their unhappiness melt away in a matter of weeks. If a lifelong depressive state like dysthymia can be erased in some cases with medication, is it possible then to make a person better than well, let's say hyperthymic?

Of course, humans have experimented with various recreational drugs for this purpose since recorded history without much success. Cocaine, to name one, produces an instant and intense euphoria by flooding the brain with dopamine. But the pleasure of cocaine is fleeting because the neurons that are activated by dopamine become rapidly desensitized to it, leading to a state of apathy and depression.

Ecstasy can induce tranquil euphoria, largely by enhancing brain serotonin activity, but it is short-lived. And it can permanently damage serotonin-containing neurons in animals, hardly good news for humans. In fact, the pleasure brought on by all recreational drugs will fade sooner or later because of the brain's own homeostatic mechanisms.

What about psychotropic medications?

A study by Dr. Brian Knutson at the University of California at San Francisco looked at the effects of the serotonin-enhancing antidepressant Paxil among normal volunteers, randomly assigned to either Paxil or a placebo. Neither the volunteers nor the researchers knew who was taking Paxil and who was taking the placebo. Compared with the placebo, Paxil reduced hostile feelings and slightly increased social affiliation. But Paxil did not make the normal people any happier.

In short, no drug - recreational or prescribed - comes close to creating the stable euphoria of hyperthymic people. Of course, antidepressants, unlike recreational drugs, are nonaddicting and retain their benefits over time.

So if some people are just born happy and stay happy for no good reason, does this mean that happiness is nothing more than a lucky combination of neurotransmitters?

For most people, no. Circumstance and experience count for a lot, and being happy takes work. But hyperthymic people have it easy: they have won the temperamental sweepstakes and may be hard-wired for happiness.

Connecting Depression and Artistry

New York Times June 3, 2002

Everyone knows that creative geniuses are all mad. At least that is what the time-honored notion linking creativity and mental illness holds.

Recently, this was underscored by "A Beautiful Mind," the film about the Nobel Prize-winning mathematician Dr. John Forbes Nash Jr., who struggled with schizophrenia. Bedeviled by hallucinations and delusions, Dr. Nash is seen scribbling mathematical formula on his Princeton dorm window and doing pioneering work on game theory in a pub. But in real life, Dr. Nash accomplished his greatest mathematics before his illness really took hold.

As a psychiatrist, I have treated several highly creative people, all relieved to be rid of the symptoms of their mental illnesses. So I was feeling confident when it came to understanding the connection between mental illness and creativity. Simply put, psychiatric illness rarely confers creativity and treatment would not impair it. At least, that was my cherished theory until I met Sheryl.

Sheryl, a photographer, had been depressed for nearly all her 36 years. Always gloomy and pessimistic, she accepted that she was hard-wired for unhappiness and that this was just her unlucky personality. So it never occurred to her that she might have a treatable illness. It was her boyfriend, singing the praises of his own treatment for depression, who sent her my way.

Though she had witnessed her boyfriend's transformation on medication, she was skeptical that it would work for her, since she had no concept of what it would be like to feel well. It turned out that there was a deeper reason. She was afraid the treatment might dry up the wellspring of her creativity. To Sheryl, her depression and her art were inextricably linked, even though she knew that she had been artistically paralyzed in periods of severe depression.

I told her that she had been suffering from a lifelong mild form of chronic depression called dysthymia, which she had mistaken for her personality, and that it was just as treatable as the severe episodes of acute depression that she periodically had.

In one session, we discussed the topic of mood disorders and creativity. She knew of creative geniuses like Robert Schumann and John Keats, each manic depressive, and was sure that suffering was a prerequisite of great art. I countered that their creative output actually dropped during flare-ups. While there was evidence of a strong connection between bipolar disorder and creativity, the data for a link between pure depression — like Sheryl's — and creativity was much weaker.

I reassured her that the antidepressant would not diminish her as an artist. The depression had hobbled her, and treatment, if anything, ought to free her to greater heights of expression.

Sheryl came to the next session carrying a large portfolio of her photography. She wanted me to see her art before treatment started so I could witness its effect on her work. In stark black and white photos, she had captured the homeless and poor. Her kinship with the dispossessed was obvious, and the images were sad and moving.

Despite her skepticism, Sheryl began treatment with an antidepressant that same day. In two months, Sheryl noticed that her lifelong pessimism, insomnia and fatigue had lifted. The depression melted away, and she felt happy without any other change in her life save the antidepressant.

There was only one problem. The antidepressant had not just improved her mood, but had also transformed the content of her art. While Sheryl was now making and selling more photographs, she judged the quality to be inferior to her depressed art. I was flustered and asked to see her recent work.

To my amazement, the photography had undergone a change as pronounced as her mood. Many shots were now in color, but the greatest effect was a change in subject: abject images had given way to street scenes of raucous boys and amorous couples. Sheryl dismissed the work as commercially successful but artistically mediocre. Who was I to judge?

Now she faced a difficult choice: happiness in life or excellence in art. She chose to stop the antidepressant but remain in therapy. Within three months she had fully relapsed into depression, but preferred the art now to her "happy pictures."

After several months of feeling depressed, she changed her mind and restarted the antidepressant. It sounds heretical coming from a psychiatrist, but a little depression probably was good for her art, even if the personal cost was too high. In the end, she opted for happiness.



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