Richard Smith: Now happiness is declared a disease

Richard SmithThe number of diseases seems to be increasing dramatically with the arrival of conditions like social phobia, attention deficit disorder, chronic procrastination syndrome, and female sexual arousal disorder. Now this progression has reached its logical conclusion—with the proposal that happiness be classified as a disease.

I made this discovery when reading Philip Roth’s Sabbath’s Theater. Many, including me, think that Roth is the greatest living writer in English, and Sabbath’s Theater may be his masterpiece. It’s the story of the disintegration of Mickey Sabbath, a retired puppeteer in his 60s, a kind of contemporary King Lear.

At one point in the book Mickey is visiting his alcoholic wife in a clinic and after betting on the blood pressure of various patients he encounters a young woman with “a scar on her wrist” who has been in the library of the clinic reading medical journals. She reports “word for word” on what she has read in the Journal of Medical Ethics.

I was stopped short when I read this—because the Journal of Medical Ethics is published by the BMJ Group, and I was responsible for it when I was the chief executive of the group. For a moment I wondered if the piece was really from the Journal of Medical Ethics. The young woman reports on what she has read.

“It is proposed that happiness”–glancing up, she said ‘Their italics’– “It is proposed that happiness be classified as a psychiatric disorder and be included in future editions of the major diagnostic manuals under the new name: major affective disorder, pleasant type. In a review of the relevant literature it is shown that happiness is statistically abnormal, consists of a discrete cluster of symptoms, is associated with a range of cognitive abnormalities, and probably reflects the abnormal functioning of the central nervous system. One possible objection to this proposal remains—that happiness is not negatively valued. However, this objection is dismissed as scientifically irrelevant.”

Roth mimics well the stilted prose of medical journals with their heavy emphasis on the passive voice. He also mimics the science that leads to problems becoming diseases. The “relevant literature” has been reviewed. This made me think immediately of Stephen Lock, my predecessor as editor of the BMJ, who always struck out “medical literature” and substituted “published reports.” “This stuff is not literature” he used to protest.

One scientific ground for declaring happiness a disease is that it is “statistically abnormal.” There are many ways to define what is “normal,” none of them satisfactory. One way to define the abnormal is to take measurements and define anything more than two standard deviations from the mean as abnormal. This means that every measurement renders 5% of the population abnormal. Take enough measurements—for instance, from a whole body scan—and we are all abnormal.

And for Roth, and certainly for Mickey Sabbath, it would be abnormal to be happy. Sabbath’s younger brother, whom he adored, was killed over Japan in the Second World War. His mother remained inconsolable for the rest of her long life and haunted Sabbath both before and after her death. Sabbath fled to sea and whoring, and his sexual incontinence, common among Roth’s characters, brought him much trouble interspersed with bouts of ecstasy.  His first wife disappeared, and his second took to drink. His long term mistress, somebody with a sexual appetite equal to his, died of ovarian cancer in her 50s.

Clearly for Sabbath it is abnormal to be happy, and, as Pink Floyd sing, “hanging on in quiet desperation is the English way to be.” There is much in the world to be depressed about, less to be happy about. Depression is appropriate, happiness inappropriate.

Then happiness is surely “a discrete cluster of symptoms…associated with a range of cognitive abnormalities.” People laugh and smile foolishly, speak too fast,  and exhibit “cognitive abnormalities” by failing to keep in mind death, decay, the plight of the globe, and the essential thoughtlessness, wickedness, and selfishness of people.

Clinching the proposition that happiness is a disease, the author of the paper in the Journal of Medical Ethics then writes that happiness probably “reflects the abnormal functioning of the central nervous system.” This is not an imaginary disease but one that could be demonstrated with anatomical, biochemical, or genetic abnormalities if we were clever enough.

Finally, some shallow readers of this blog might object that happiness is “not negatively valued” (Roth again mocks scientific writers’ love of double negatives like “not uncommon”), but this claim, the original author dismisses, as “scientifically irrelevant.” Scientists are prone to such grand dismissals, and I dare any BMJ reader to say that happiness is not a disease. That it is so is proved.

See also: Julian Sheather: Is happiness a mental disorder?

  • Roger Blaney

    By logical extension, we can postulate that health is a classifiable disease, since it is generally accepted that a healthy person is one who has been inadequtely investigated.
    Roger Blaney

  • Steven brown

    wonderful, as I am not happy I can now consider myself normal

  • Noritoshi Tanida

    Happiness may be a chronic infectious disease if you see the clustering of happy people in the Framingham Heart Study (Fowler JH, Christakis NA. BMJ. 2008 Dec 4;337:a2338. doi: 10.1136/bmj.a2338).

  • Jsheather

    Dear Richard,

    It seems we were reading – and then blogging about – the JME reference in Sabbath's Theater at the same time. Apparently the reference is not fictitious. Here is the link: J Med Ethics 1992;18:94-98 doi:10.1136/jme.18.2.94. It would seem that not even Roth could make it up.

    All the best