Although undoubtedly a fine publication, I think it is probably fair to say that it is not every day that the Journal of Medical Ethics puts in an appearance in a major work of contemporary fiction. Imagine my delight then, mid-way through Philip Roth’s torrential late novel Sabbath’s Theater, when the following appeared, attributed to the JME:

“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 the proposal remains – that happiness is not negatively valued. However, this objection is dismissed as scientifically irrelevant.”

I am not sufficiently familiar with the JME to know it if is apocryphal. I suspect it is. That too-rapid dismissal of the objection about negative evaluation suggests a deal of authorial licence. Disease states may have their uses: sickle-cell anaemia is handy if you are in malaria country; myopia kept some young men from the trenches, but they ordinarily have intrinsic disbenefits as well. No matter though. Roth makes delightfully free with a handful of contemporary questions about health and illness. Are they descriptive or evaluative concepts? Is illness a matter of statistical deviation from a species-typical norm, or is it more to do with how we, or how society, value particular states of mind and body? What gives this little interlude its droll authority though is the novel’s eponymous hero. Micky Sabbath, priapic ex-puppeteer, libidinal anti-hero – and one of the most mesmerisingly repellant characters in contemporary fiction – is a student, an initiate, an adept in the labyrinthine ways of unhappiness. His fingers – a puppeteer’s fingers – buckled with arthiritis, his mistress dead, his wife in rehab, he storms through his dwindling years, hell bent on bursting any constraint, howsoever taboo, on the absolute liberty of his appetites. Unhappiness, it follows, is his milieu.

It can sometimes feel like a mixed blessing, being of the generation heir to Roth and his contemporaries. The unease can be intensified when the chronicler – and one of the chief combatants – is a writer as compelling as Roth. It calls to mind Plato’s ancient dispute with the poets, that art is too good at reconciling us to the fallen and the mutable, that it makes us too at home in the contingent. For Plato literature is inimical to virtue for its fatal talents lie in the representation of vice. Bad characters are always more vivid than good. Virtue arrests narrative, vice spawns it. The devil has all the best tunes.

Is happiness a mental illness? The question is obviously a playful one. But in my more pessimistic moods, I sometimes ponder the legacy of Roth’s generation, its libidinally driven revaluation of all values. And at times I find myself thinking that although the ensuing disorientation may not have rendered happiness so aberrant as to be a mental illness, it has nonetheless made it more elusive than it was even a generation earlier. For at least Roth had the fresh pleasures of iconoclasm and transgression. We have just inherited the fragments.

Julian Sheather is ethics manager, BMA. The views he expresses in his blog posts are entirely his own.See also: Richard Smith: Now happiness is declared a disease