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From the archives: What do you mean ‘Happy Christmas’?

From the archives: What do you mean 'Happy Christmas'?
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A more scientific view of proceedings, courtesy of a Yale professor writing for The Spectator's Christmas issue in 1994:

What do you mean ‘Happy Christmas’?, Robert Buck, The Spectator, 17 December 1994

It is the time of year when the pursuit of happiness is at its most frantic. People believe they should be happy in the holiday period because they are surrounded by tradition, mercantile enthusiasm and a desire to return to childhood, where, for the most part, it did not require an effort to be happy.

Is the experience of happiness only psychological? We know that the reductionist trends of science must be leading towards a molecular theory of practically everything. Will Christmas get scrunched down to a molecular evil? Could we really have a happy Christmas if the effect and the experience are just chemical?

A chemical basis of unhappiness is now accepted. Many psychiatrists have told their patients that the reason for their unhappiness and depression is that they have a ‘chemical imbalance’. Doctors are now relieved by science of the burden of listening to patients. Patients have gained because their disease, previously the result of psychological weakness, is now almost as prosaic as a broken leg. The phrase ‘chemical imbalance’ seems to be believable.

Is the opposite true? Does happiness represent a ‘chemical balance’? Here, public behaviour runs ahead of public belief. The taking of multitudinous chemicals indicates a widespread acceptance that happiness can be obtained chemically. Unfortunately, since happiness is not a disease, research efforts into the nature of joy have been quite limited. It has always been a peculiarity of medicine that joy is not allowable except on obstetrical words. ‘Euphoria’, a technical term that desiccates the experience of happiness, is listed frequently as a serous and undesirable side-effect of drugs.

When my son John was three years old, he had his first taste of ice-cream. As the ice-cream met his mouth he burst into laughter. The intensity of his joy was easy to see, and that joy invited sharing in his delight. This morning, in the hospital, I saw a little girl skipping around the edge of a decorative fountain. The sight brought a moment of joy, both because seeing happy children is so pleasant and because happiness is most easily associated with children. The moment was fleeting because within minutes I returned to the less pleasant reality of my psychiatric world. A pleasant surprise can bring happiness, and although happiness can be infectious it can also be transient.

Happiness is often short-lived and not a pervasive emotional state. We remember happy times more intensely because they were transient. We start wondering about people who are happy all the time. Surely it can’t be normal. It is possible, but rare, to be happy all the time, just as one could be sad almost all the time. It may be that we direct our greatest efforts to trying to be happy. Sometimes the effort is only to minimise happiness. Trying to control your mood state by an effort of will is most difficult. Some people change their environment to improve their mood. A widespread way of reaching for joy is to take various psychoactive materials.

The singular characteristic of the psychoactive drugs of ‘abuse’ being that they can cause a state of well being. There may be a clue here. What kinds of drugs have this effect?

Opioids, drugs like morphine, are well known to cause euphoria. Medical treatment for a patient previously in pain should not be so extreme as to make him or her too happy, so the morphine-like drug drugs must be used with discretion. Fortunately for the understanding of happiness, the opioids are also addictive and thus a scourge that must be studied to be eradicated. After opioid receptors were first characterised in 1973, a spate of research led to the discovery of naturally occurring morphine-like substances, the enkephalins. Other materials related to morphinoid effects were identified quickly. Research, often hurried and amateurish, was done to find out whether such experiences as orgasm and ‘runners’ high’ were associated with enkephalins or the more chemically intricate endorphins. A feeling that the substance of joy could be bottled pervaded those of us in ‘the psychological community.’

There were, however, many other drugs which seemed to make people happy but had no apparent effect on the opiate systems. The steroids, like cortisone for example, would often produce a sense of wellbeing and induce euphoria, but seemed unrelated to either endorphins or the opiate receptors. A physiological relationship was found later when it was shown that cortisone was released in synchrony with natural opioids.

Other chemically reliable trips to happiness, the stimulant drugs like cocaine and the amphetamines, did not directly affect the receptors for morphine-like drugs. Perhaps the actions of these drugs on receptors would lead to another chemical clue to the nature of happiness?

Here, again, there was a drug-abuse connection, and so billions of dollars were available for the study of stimulants. From this work, a new candidate for happiness-transmission arose. It was dopamine, a material found in the brain and previously associated with with theories of madness. (Antipsychotic drugs, like Thorazine, block dopamine in the brain.)

Listening to Prozac, a best-selling book about a best-selling drug, was instrumental in popularising another candidate for the chemical base of happiness. The book set forth a thesis that Prozac was unique in changing personality. Prozac is the trade name for a drug, fluoxetine, an anti-depressant which affects the amount of seratonin in specific brain areas. Seratonin, a chemical involved in sending messages across the space between connecting nerves, has been credited with a wide variety of mood effects.

It never seems to be clear where more – or less – of this chemical must be in order to have a particular effect, but the relationship of serotonin to mood and anxiety is widely accepted. The selective serotonin re-uptake inhibitors (SSRIs in psychojargon) were claimed to increase assertiveness and improve the sense of wellbeing even in apparently undepressed individuals. The complicated-sounding name really describes only one action of these complicated drugs. The reported changes in personality brought greater confidence and happiness to the ‘patients’. This effect was, in fact rarely seen, but the idea that serotonin was the chemical key to happiness was accepted eagerly by the literate public. In the science of mood chemicals, there is often confusion in increase or decrease of a mood state. This is not surprising since we can rarely figure out exactly where or how a particular chemical is working.

The panoply of possible chemical mechanisms for happiness was not yet complete. It was, however, becoming obvious that the problem was not simple. Let us look at what makes people happy and how a scientist might measure happiness. There are the clues required to begin to understand the chemical basis of job.

When we try to find universal stimuli or universal environs for happiness the problem becomes apparent. There are very few, if any, circumstances or vents which always cause happiness. We must then turn to chemical or electrical stimuli which can be administered in an experimental setting. If there is to be a believable substrate for chemical happiness, there must be a method to check it against ‘real’ joy. For that to happen we need a measure of happiness and methods of producing happiness repeatedly and reasonably reliably.

If one were to follow traditional scientific approaches, it would be handy to start with an animal model of happiness. It is, after all, much more convenient to look into the brain chemistry of animals than people. Charles Darwin, in an early, illustrated work, examined the expressions of emotions in animals and man. It was clear that he could show the expression of a convincingly happy dog or a happy person. Most pet-owners would be unsurprised by this demonstration. The wagging tail of a puppy is an unequivocal indication of delight. Unfortunately, the display of joy in rabbits and rats is more subtle. Happiness as a perceived emotion can serve as an experimental variable in people, but it does not cut the mustard with animals.

Separate from the chemical nature of happiness was the idea that the brain had ‘centres’ where happiness resided. This concept derived from work which apparently localised ‘reward’ areas in the brain. If an electrode were placed in the brain of a rat at the right place, the rat would repeatedly press a lever to receive small electrical pulses in that area. There seemed to be no limit to the desirability of such stimuli. In a series of questionable experiments similar results were found in humans with electrical self-stimulation. The principle of working for a rewarding stimulus became an equivalent for happiness and a benchmark for animal experimental research. Bar-pressing rats with wires in their brains tirelessly working for pellets became a scientific standard. Maybe these rewards were the places to look for the chemicals of joy. We were not at some distance from real happiness, but experiments were possible.

One could ask, ‘Is there any accepted chemical basis of any emotion? The answer would be no. The tantalising goals of associating thought or emotional with either neural activity or chemical changes have been elusive. The importance of depression as a psychiatric disorder has led to much investigation at both psychological and chemical levels. The disease depression is much more than the mood state of unhappiness. If we did not have a good idea of the chemical changes in depression, we might at least have a lead on the mood state of sadness. Strangely enough, the antidepressants tend not make people happy. They have little immediate effect on mood state. The opioids and stimulant drugs re not effective treatments for depression and may make the depressed more unhappy.

Some scientists believe the worry accompanies unhappiness and that total lack of worry is associated with cheerfulness. We cannot say that if you are not worried you are happy, but the chances of being happy are better. It may be that lack of worry or relief from stress is a necessary condition for joy. There is some reasonable argument that this is true, since it is widely accepted that people often feel better after a stressful experience. When we watch one of the popular game shows on television it is fascinating to see the play of emotions on the participants’ faces. Stress then relief, then joy is the pattern. Even roller-coaster rides may hold their enjoyment in the cessation rather than the experience. But yet there is a difference between thrills and joy. Certainly people differ in their responses. Not everybody enjoys the relief from stress, unless you consider ‘happy to be alive’ the equivalent of true joy.

We know of no rapid way to reverse depression, the obverse of happiness. The drugs which relieve depression take weeks to have an effect. The immediate effects of antidepressant drugs are often unpleasant side-effects. The end of depression does not happen straight away. There are, however, chemicals (e.g. opioids and stimulants) which produce an almost euphoric effect that is different from the relief of depression. If we re to consider a chemical basis of happiness, time will be an important variable. How long does an emotion have to last before it can be called joy? Is the duration or the intensity of an emotion more important? These may seem to be nit-picking questions when related to a grand concept but they are necessary to define before we can try to establish a scientific basis.

If we could define, measure and produce happiness, could we then start to know the chemical or hormonal or neutral basis of joy? The tools to study a sensation, thought or emotion have expanded greatly in a new era of technological development. Various ways of studying the nervous system have been used. Studying diseases or accidents which damaged brain tissue in specific areas was the way we found out about speech and later about the emotional changes from prefrontal lobotomy. Experimental removal of brain tissue in animals and neurosurgical removal of brain stuff from patients have led to a new understanding of the localisation of brain processes. These methods may tell us where something happens.

More powerful tools such as functional magnetic resonance-imaging bring us pictures of where the brain events occur and sometimes information about the chemistry of the events. Extraordinary experiments can now be derived, and so the problems of animal experimentation are avoided. The methods are relatively slow, but thought and emotion change quickly. In the past, most of the study of rapid events in the nervous system had been from electrical recordings of nerve activity. Electrical measures are still used, but there are marked limitations to what can be found. Electrophysiological recordings in humans from identified brain areas are rarely done and then only to examine abnormalities. There is little justification for invasive recordings in pursuit of emotional understanding, and so it is unlikely that this experimental pathway will be pursued.

The ability to enjoy and thus to be happy is not present in all people at all times. Sometimes the conditions of life make happiness impossible to reach. Presumably the results of unhappy events are chemically represented in the brain. That chemical environment may preclude the emotion of happiness. When someone is not able to gain pleasure he is deemed ‘anhedonic’. This condition can be transient or a permanent part of an individual’s makeup. Some people are cheerful and others are sad. Can we say that they are chemically different? We cannot identify the specifics or the location of such differences. Some externally applied chemicals can change mood states for the better. Some internally existent molecules are apparently related to pleasurable states.

The acceptance of a chemical derangement in depression leads scientists to greater aspirations. Psychiatry, driven by the need to be scientific and to ascribe an organic basis to all feelings, maintains a lurking suspicion joy, too is chemical. Science has not yet advanced that far. Molecular madness, if it could be established, would be enough of a triumph for psychiatry as a brain science. Should all emotion be reduced to the particulate? Happiness is reactive and is often unreasonable. If we isolate it only to the chemistry, perhaps we take all the fun out of it. A visit to a Christmas party will certainly convince you that liquorous chemicals are assistants to holiday joy. Whether it can all be condensed into an equation is for future scientists to discover.

Robert Buck is Professor of Psychiatry and Pharmacology at Yale University School of Medicine.