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In pursuit of happiness

Happiness is something all humans crave and all doctors trumpet since it is known to play a key role in fighting illness. But exactly what this elusive state is and why it is such a powerful medical tool is difficult to decipher.

Many of the answers lie deep within the brain, medical experts say, so its complexity is immense. Yet for all its mystery and complexity, an Irish neuroscientist has found that there is, in fact, a formula for happiness.

The formula, which essentially comes down to having low expectations and the resultant feeling of surprise when things turn out better, emerged from the work of Galway-born neuroscientist Prof Ray Dolan, who recently spoke with the Medical Independent (MI). Prof Dolan, Professor of Neuropsychiatry and Director of the Wellcome Trust Centre for Neuroimaging at University College London, UK, has studied the concept of happiness from the perspective of what generates it and what its “brain basis” may be, he told MI in an interview from London.

His primary interest is in the neurobiology of emotion and how emotion impacts on cognition, including decision-making. A native of Co Galway and a graduate of NUI Galway (known then as University College Galway), Prof Dolan has published over 400 peer review papers and is ranked among the top five most cited neuroscientists in the world in the field of neuroscience and behaviour.

Prof Dolan explained to MI how he and his team of researchers believe that happiness is governed primarily by expectation and surprise. Their work has been published in the international journal The Proceedings of the National Academy of Sciences. Prof Dolan and his team used a combination of behavioural neuroscience, computational modelling and neuroimaging approaches to study emotional reactivity in the form of momentary happiness in response to reward.

I have studied happiness only for the perspective of understanding what generates happiness, how we might measure it and what its brain basis may be

“I have studied happiness only for the perspective of understanding what generates happiness, how we might measure it, and what its brain basis may be,” he told MI.

“We know that happiness is a metric used commonly by health professionals, by economists, by psychiatrists, but it’s a very subjective entity. We were interested in coming up with a much more quantitative measure of happiness. We were interested in developing a model that could predict whether variations in your reported state of happiness might be predicted by antecedent events.

“What we showed was that actually your state of happiness was predicted by antecedent events, such that if you got an outcome that was slightly better than you expected then you were likely to become more happy. We’re talking not about how happy you’ve been throughout your life or over the last six months, but about momentary variation in the subjective state of happiness. So the degree of surprise that you get when you get an outcome, if that outcome is good, will enhance your momentary state of happiness.

“We were able to show that for that momentary state of happiness and the mathematical model that could predict your state of happiness, there was a brain basis for it in a part of the brain called the striatum. This is rich in a chemical called dopamine. We subsequently showed that if we gave people a drug that boosted the level of dopamine we could increase their level of happiness in response to the same unexpected events, ie, events that were better than anticipated.

“The take home message is that the best way to be happy is to have generally low-ish expectations and therefore the future will always be a little bit surprising and always a little bit better. That element of being better than expected and surprise is the biggest contributor to happiness. It’s to do with the discrepancy between your expectation and what actually happens.”

Prof Dolan believes everyone inhabits a kind of “mood state”. But for some this state can be infused with horror rather than happiness, so Prof Dolan is very interested in exploring and understanding how someone’s background mood is regulated and how it might reveal more answers for those who suffer with depression.

“We all inhabit a kind of a mood state and we know that sometimes in people that mood state can become deregulated and they can go into a state of incredible misery, torture and psychological pain and may do some terrible things in that state like harm other people or kill themselves. So I’m very interested in the control of one’s subjective emotional state and how that understanding might explain what goes wrong with people who suffer with depression.”

Such an understanding, Prof Dolan believes, could lead both to better treatments and to preventative strategies for depression. “That understanding might help to provide us with more effective treatments, and if we developed very good models of what we think is going on we might have predictable ways that would tell you or tell somebody when they are at risk of falling off the edge and they need to do such and such. So it would not only help to develop treatments but would develop appropriate predictive and preventative strategies.

“Understanding our subjective emotional state, which is what we are trying to do with happiness, provides us with a way of getting at subjective states like depression. But when understanding these, the complexities are much greater than how a filter like your liver works or a pump like your heart works. We’re talking about the brain and all its complexities.

“The cost of depression as a condition in Europe is enormous. It is probably the single factor that contributes more to the loss of productivity than anything else. We know that clinical depression is associated with a whole range of health problems and has a huge cost, not only in itself, but also because of the associated health problems.”

However, he believes we are increasingly moving closer to solutions to this devastating condition. “We are certainly closer than we were 20 years ago and I think over the last 10 years there has been a much better theoretical basis for moving forward. We have better theories and with better theories you are in a much stronger position to come up with solutions to problems.”

Studies

Statistics supporting such progress are also emerging from Europe. A new study into the wellbeing of adolescents across Europe and North America shows that young people are happier and healthier now than their counterparts were a decade ago.

The study, with Irish participation, was part of a collaboration earlier this year with the World Health Organisation (WHO) and sheds new light on the habits and happiness of 11- to 15-year-olds in more than 40 countries across a 16-year period (1994-2010). The Irish partners, Dr Saoirse Nic Gabhainn, Dr Michal Molcho, and Dr Colette Kelly, from the Health Promotion Research Centre in NUI Galway, co-authored the study.

It found that there has been a decline in school-aged children drinking alcohol weekly and in experiencing multiple injuries in Ireland. There have also been improvements in both self-rated health and ease of communication with parents.

“By comparing today’s young people with their counterparts a decade ago we can better understand how their health is influenced by the circumstances in which they live. [But] of real concern must be the increases in social inequalities in Ireland, where children from poorer homes are more likely to report ill health, and the gap between rich and poor has increased over time,” commented Dr Nic Gabhainn, Principal Investigator for Ireland.

Another expert studying how happiness and positive feelings influence our health and wellbeing is Dr Nancy Etcoff, Assistant Clinical Professor at Harvard Medical School and Director of the Programme in Aesthetics and Well-Being in the Department of Psychiatry at Massachusetts General Hospital, US.

“We can view happiness in at least three ways – as a hedonic state, as a cognitive state, or as a general life philosophy. Happiness can refer to a way of thinking, such as being optimistic; a way of feeling joy, pleasure, relief, or gratitude; or simply a way of being,” Dr Etcoff explained in an interview from Boston with MI.

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Dr Nancy Etcoff

Evolution also plays a role, she suggested. “Human beings evolved in a dangerous world, where we had to recognise threats to survive. As a result, our brains are wired to be much more sensitive to negative emotions and sensations than positive ones. Indeed, a vast scientific literature has detailed how negative emotions harm the body.

“We’ve known for a long time that negative emotions can put you at greater risk of heart disease, diabetes and so on. One finding in our studies suggests that happiness or positive emotions can be protective of our health because they short circuit some of the negative emotions,” Dr Etcoff said. “When you’re angry or worried or down about something, if you’re able to short-circuit those feelings and head off the stress levels [then] you will bounce back and be much more resilient.

 “A second finding is that people who are happier tend to engage in more health-related behaviours. They take care of themselves more; they exercise; follow a healthy diet; and are more likely to take preventative health measures. Often what stops people from taking preventative health measures is anxiety and low-level depression but if you’re in a positive mood you’re more likely to engage in more positive behaviours.

“And thirdly, happier people tend to form larger social networks and we know that loneliness has a very negative impact on health and that happiness itself is contagious. So the more one is socially engaged, the happier one is. That’s an enormous factor in happiness. It doesn’t have to be a huge social network. It’s more that you have people you are close to in your life and with whom you’re engaged.”

One related study she cited was carried out among 180 nuns and looked at Alzheimer’s disease and healthy ageing. “The reason they looked at nuns was because the nuns all had the same environment and diet, and so on, so the study could rule out a lot of factors. It looked back at their biographies – about 300 words, which they had written when they joined the order – and at the emotional content and they found a very strong correlation between positive emotional content and the risk of mortality. Some showed more of a sense of joy or a sense of gratitude, a sense of hope, a sense of interest. There was a striking difference if you looked at those in the age group 75 to 95 who survived and were in the positive emotions group. So this again suggests – and there are other studies that back it up – that there’s something protective about the positive emotions.”

The happiness factor

But Dr Etcoff believes that many doctors do not fully recognise the importance of this ‘happiness factor’ in dealing with patients. “A lot don’t appreciate its importance and tend to focus on perhaps looking for signs of stress rather than a more proactive approach.

“I think doctors should find more time to explore this factor with patients. I think it’s not stressed enough [in training]. They realise when patients are unhappy but they could focus more on interventions and social interactions and also have better and brighter surroundings for the patients. It’s also about the way the doctor talks to the patient. They need to have empathy for the patient and what they’re feeling at a particular moment.”

But how can patients themselves generate more positive feelings in their lives and help to boost their health? “At a very basic level, it’s about encouraging exercise,” Dr Etcoff says. “We don’t make enough time for just physical activity, that’s very important for mood and happiness.”

Ireland

It’s a sentiment with which Irish Minister for Health Leo Varadkar would undoubtedly concur. He also sees a practical, financial return both for the health service and for employers when Ireland has a happier, healthier workforce.

In response to a WHO report earlier this year that predicted Ireland will be the most obese country in Europe by 2030, the Minister is trying to combat the financial loss attributed to obesity-related sick days by encouraging people to get fit and improve their diet and health generally.

Positive mental health and wellbeing, he pointed out, encourage people to deal with stress and personal difficulties and to seek help when necessary. “It’s well established that a healthy workforce is a happier one with low levels of sick leave and greater productivity. So this approach makes pure business sense too for the public and private sectors,” according to the Minister.

“The Irish health service spends billions each year on promoting, protecting and restoring people’s health and wellbeing.

“All of this funding is essential but we could target it so much more effectively by keeping people healthy, happy and out of hospital,” he emphasised.

Living in the moment

Dr Etcoff also believes we can achieve healthier and happier lives by giving more time and attention to close relationships and by living in the moment. “Too often we’re time travelling and worrying about the future,” she says. “Being able to stay in the moment and be mindful of the present is important. Taking control of your time is also important; maybe you need to say no sometimes. We should make sure too that money, when we have it, is a tool for happiness.

“Instead of just buying things for ourselves we should also spend money on other people or give some to charity. Money can bring happiness, it just depends on how you spend it,” she told MI.

One finding in our studies suggests that happiness or positive emotions can be protective of our health because they short circuit some of the negative emotions

Our attitude also plays a big part in happiness, she believes. “Attitude can overcome a lot in terms of coping with economic downturn. Everyone faces stress; it’s how you come out of it and what your attitude is towards it that is a big factor. A recent study on the effects of nature on happiness showed simple things like having flowers in the environment was important. Having something beautiful can increase compassion and positive feelings. Very small environmental changes can bring this about, like the design of an office and how people interact can increase people’s happiness. Little tweaks can be very meaningful.”

But how do you encourage a positive frame of mind when, for example, someone hears bad news from their doctor?

“It’s a very challenging situation. First, it’s a matter of communication. It begins with empathy, when the doctor realises how the patient is responding and makes sure to take that into consideration in how the matter is communicated – what can the patient understand at that moment, do family members need to be there, and so on.

“Always be mindful of how the patient is responding. Explain clearly what the patient can do, the options for treatment, what are the sources of hope there and then helping the patient to come to terms with it somehow, understanding what is meaningful to them, what might help them in the community.

Do they have a religious affiliation, for example? It’s important not just to convey the information but to convey it in a way that is most helpful and most empathetic and most compassionate to the patient.”

Correlation

Like Dr Etcoff, a number of other researchers at Harvard Medical School (HMS) have studied the ‘happiness factor’ and have come up with similar findings. Research by Dr Ichiro Kawachi, an HMS Associate Professor of Medicine at Brigham and Women’s Hospital, Boston, US, found a strong correlation between happiness and good health, both in individuals and within communities.

Prof Nicholas Christakis, an HMS Professor of Medical Sociology and Medicine, who has researched the contagion of emotions within the larger context of social networks, has shown that happiness may be a collective phenomenon: having a happy friend who lives within a mile of you, for example, appears to increase the probability that you will be happy as well.

He agrees with Dr Etcoff that happiness isn’t just one big event, but can be made up of smaller, incremental steps, like feelings of gratitude and helping others. “Rather than asking how we can get happier, we should be asking how we can increase happiness all around us,” Prof Christakis says.

Prof Laura Kubzansky of the Harvard School of Public Health believes there is a benefit of positive mental health that goes beyond the fact that you’re not depressed. “What that is, is still a mystery. But when we understand the set of processes involved, we will have much more insight into how health works.”

In a 2007 study that followed more than 6,000 men and women aged 25 to 74 for 20 years, she found that emotional vitality – a sense of enthusiasm, of hopefulness, of engagement in life, and the ability to face life’s stresses with emotional balance – appears to reduce the risk of coronary heart disease.

Prof Kubzansky stresses, however, the importance of setting her study in context. “My biggest fear was that journalists would pick it up and the headlines would be, ‘Don’t worry, be happy’. That’s useless. Not everyone lives in an environment where you can turn off worry. When you take this research out of the social context, it has the potential to be a slippery slope for victim blaming.”

Some public health professionals contend that the apparent beneficial effects of positive emotions do not stem from anything intrinsically protective in upbeat mind states, but rather from the fact that positive emotions mark the absence of negative moods and self-destructive habits.

Prof Kubzansky and others disagree. They, like Prof Dolan and Dr Etcoff, believe that there is much more to the phenomenon and that scientists are only beginning to glean the possible biological, behavioural, and cognitive mechanisms behind positive emotions.

In other words, happiness is far more complex than just the absence of depression. It is a positive, protective phenomenon in its own right and understanding it better will undoubtedly help to enhance health outcomes.

Global progress on happiness and health

Keeping people happy as a means of keeping them healthy has also become an important tool in global progress. The UN’s 2015World Happiness Report is a landmark survey of the state of global happiness. Leading experts across such fields as economics, psychology and health policy describe how measurements of wellbeing can be used effectively to assess the progress of nations.

The report reviews the state of happiness in the world today and shows how the science of happiness explains personal and national variations in happiness. It reflects a new worldwide demand for more attention to happiness as a criterion for government policy on a range of issues, including public health.

“Increasingly, happiness is considered a proper measure of social progress and goal of public policy. A rapidly increasing number of national and local governments are using happiness data and research in their search for policies that could enable people to live better lives,” the report says.

“Altogether 200 million children worldwide are suffering from diagnosable mental health problems requiring treatment. Yet even in the richest countries only a quarter are in treatment. Giving more priority to the wellbeing of children is one of the most obvious and cost-effective ways to invest in future world happiness,” it emphasises.

“The challenge is to ensure that policies are designed and delivered in ways that enrich the social fabric, and teach the pleasure and power of empathy to current and future generations,” it concludes.

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