WHAT DO YOU MEAN, `HAPPY CHRISTMAS'?

Robert Byck says that his colleagues in the field

of psychiatric medicine have been attempting to define happiness, so far without success

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 tra- dition, 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 psy- chological? We know that the reductionist trends of science must be leading towards a molecular theory of practically every- thing. Will Christmas get scrunched down to a molecular level? 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 believ- able.

Is the opposite true? Does happiness represent a 'chemical balance'? Here, pub- lic 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 dis- ease, 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 wards. `Euphoria', a technical term that desiccates the experience of happiness, is listed fre- quently as a serious and undesirable side- effect of drugs.

When my son John was three years old, he had his first taste of ice-cream. As the chocolate ice-cream met his mouth he burst into laughter. The intensity of his joy was easy to see, and that joy invited shar- ing in his delight. This morning, in the hos- pital, 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 associat- ed 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 hap- piness, 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 almost 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 unhappiness. Trying to con- trol 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 psy- choactive drugs of 'abuse' is that they can cause a state of wellbeing. There may be a clue here. What kinds of drugs have this bad effect?

Opioids, drugs like morphine, are well known to cause euphoria. Medical treat- ment for a patient previously in pain should not be so extreme as to make him or her too happy, so the morphine-like drugs must be used with discretion. Fortu- nately for the understanding of happiness, the opioids are also addictive and thus a scourge that must be studied to be

eradi- cated. 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 morphinoul 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 communi- ty'. There were, however, many other drugs which seemed to make people happy but had no apparent effect on the opiate sys- tems. The steroids, like cortisone for exam- ple, would often produce a sense et wellbeing and induce euphoria, but seemed unrelated to either the endorphins or the opiate receptors. A physiological relation- ship was found later when it was shown that cortisone was released in synchrony with natural opioids. Other chemically reliable trips to hapPi' ness, the stimulant drugs like cocaine and the amphetamines, did not directly affect the receptors for morphine-like drugs. per- haps the actions of these drugs on recep- tors would lead to another chemical clue to the nature of happiness? Here, again, there was a drug-abuse con- nection, and so billions of dollars were available for the study of stimulants. prom this work, a new candidate for happiness- transmission arose. It was do p amine, a material found in the brain and previously associated with theories of madness. (Antipsychotic drugs, like Thorazine, block dopamine in the brain.) Listening to Prozac, a best-selling WI about a best-selling drug, was instrurnerna in popularising another candidate for the chemical basis of happiness. The book set forth a thesis that Prozac was unique 01 changing personality. Prozac is the trade name for a drug, fluoxetine, an antidepres- sant which affects the amount of serotonin in specific brain areas. Serotonin, a chenu. cal involved in sending messages across the _. space between connecting nerves, has bed credited with a wide variety of lu°° effects. It never seems to be clear where_ more — or less — of this chemical must be in order to have a particular effect, but th., relationship of serotonin to mood and arIXI ety states is widely accepted. The sclectiv.0 serotonin re-uptake inhibitors (`SSRI° I psychojargon) were claimed to increase „f assertiveness and improve the sense ",:i wellbeing even in apparently undepress.% individuals. The complicated-sound

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 lit- erate public. In the science of mood chem- istry, there is often confusion as to whether a particular chemical is involved 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 mech- anisms 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 scien- tist might measure happiness. These are the clues required to begin to understand the chemical basis of joy.

When we try to find universal stimuli or universal environs for happiness the prob- lem becomes apparent. There are very few, if any, circumstances or events 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 sub- strate 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 hap- piness repeatedly and reasonably reliably.

If one were to follow traditional scientif- ic 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, illus-

trated 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. Happi- ness 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 appar- ently localised 'reward' areas in the brain. If an electrode were placed in the brain of a rat in 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 happi- ness and a benchmark for animal experi- mental research. Bar-pressing rats with wires in their brains tirelessly working for pellets became a scientific standard. Maybe these reward areas were the places to look for the chemicals of joy. We were now at some distance from real happiness, but experiments were possible.

One could ask, 'Is there an accepted chemical basis of any emotion?' The answer would be no. The tantalising goals of associating thought or emotion with either neural activity or chemical changes have been elusive. The importance of `Who wants a wing?' depression as a psychiatric disorder has led to much investigation at both psychological and chemical levels. The disease depres- sion is much more than the mood state of unhappiness. If we did 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 to make people happy. They have little immediate effect on mood state. The opioids and stimulant drugs are not effective treatments for depression and may make the depressed even more unhappy. Some scientists believe that worry accompanies unhappiness and that total lack of worry is associated with cheerful- ness. 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 ces- sation rather than the experience. But Yet there is a difference between thrills and joy. Certainly people differ in their responses. Not everyone enjoys the relief from stress, unless you consider tappY t° 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 right away. There are, however, chemicals (e.g. opioids and stimulants) which produce an almost immediate euphoric effect that is different from the relief of depression. If we are to consider a chemical basis of happiness, time will be an important variable. How long does an ern(); tion have to last before it can be called j0Y. Is the duration or the intensity of an ent°- tion more important? These may seem to be nit-picking questions when related to 3 grand concept but they are necessary t° define before we can try to establish a sci- entific basis. If we could define, measure and produce happiness, could we then start to know the chemical or hormonal or neural basis .0, joy? The tools to study a sensation, thought or emotion have expanded greatly in a Pew, era of technological development. Varlouf ways of studying the nervous system hay! been used. Studying diseases or accidents which damaged brain tissue in spec w. areas was the way we found out abou, speech and later about the emotiona! changes from prefrontal lobotomy. Ex.Perlis mental removal of brain tissue in aminaa and neurosurgical removal of brain stu from patients have led to new understand ing of the localisation of brain processes. These methods may tell us where some- thing happens. More powerful tools such as functional magnetic resonance-imaging bring us pic- tures of where brain events occur and sometimes information about the chem- istry of the events. Extraordinary experi- ments can now be done without risk to human subjects. A picture of what parts of the brain are working can 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 record- ings 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 emo- tional understanding, and so it is unlikely that this experimental pathway will be pur- sued.

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. Presum- ably, 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 tran- sient or a permanent part of an individu- al's make-up. Some people are cheerful and others are sad. Can we say they are Chemically different? We cannot identify the specifics or the location of such differ- ences. 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 derange- ment 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 that joy, too, is chemical. Science has not yet advanced that far. Molecular madness, if it could be estab- lished, 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 unrea- snable. If we isolate it only to the chem- istry, perhaps we take all the fun out of it. A visit to a Christmas party will certainly convince you that liquorous chemicals are be to holiday joy. Whether it can all future condensed into an equation is for ruture scientists to discover. , Meanwhile, Happy Christmas, regard- less of the substrate!

n_oben Byck is Professor of Psychiatry and 'Pharmacology at Yale University School of Medicine.