Why the Happy Are Nuts

From “A Proposal to Classify Happiness as a Psychiatric Disorder,” by Richard P Bentall, in the June 1992 issue of the Journal of Medical Ethics, published I London.

Bentall is a senior lecturer in clinical psychology at Liverpool University.


            Happiness is a phenomenon that has received very little attention from psychopathologists, perhaps because it is not normally regarded as a cause for therapeutic concern. For  this reason, research on the topic of happiness has been rather limited, and any statement about the phenomenon must therefore be based, at least in part on uncontrolled clinical observation. Nonetheless, I will argue that there is a prima facie case for classifying happiness as a psychiatric disorder, suitable for inclusion in future revisions of diagnostic manuals. (I am aware that this proposal is counterintuitive and likely to be resisted by the psychological and psychiatric community.)

            It is perhaps premature to attempt an exact definition of happiness. However, despite the fact that formal diagnostic criteria have yet to be agreed upon, we can state that happiness is usually characterized by a positive mood, sometimes described as “elation” or “ joy,”  although this may be relatively absent in the milder happy states, sometimes termed “contentment.” The behavioral components of happiness are less easily characterized, but particular facial expressions such as “smiling”  have been noted; interestingly, there is evidence that these expressions are common across cultures, which suggest that they may be biological in origin. Uncontrolled observations, such as those found in plays and novels, suggest that happy people are often carefree, impulsive, and unpredictable in their actions. Certain kinds of social behavior have also been reported to accompany happiness, including a high frequency of recreational interpersonal contacts and prosocial actions toward others identified as less happy. This latter observation may help to explain the persistence of happiness despite its debilitating consequences (which will be described below):  happy  people seem to wish to force their condition on their unhappy companions and relatives.

            In the absence of well-established physiological markers of happiness, it seems likely that a patient’s subjective description of his or her mood will continue to be the most widely recognized indicator of the condition. Indeed, Argyle has remarked that “ if people say they are happy then they are happy.”  In this regard, the rules for identifying happiness are remarkably similar to those used by psychiatrists to identify many other disorder, such as depression.

            The epidemiology of happiness has scarcely been researched. Although it seems likely that happiness is a relatively rare phenomenon, exact incidence rates must depend on the criteria for happiness employed in any particular survey. Thus, although Warr and Payne found that as many as 25 percent of a British sample said that they were “ very pleased with things yesterday,” Andrews and Withey, studying a large American sample, found that only 5.5 percent of their subjects rated themselves as scoring the maximum on a nine-point scale of life-satisfaction. Interestingly,  despite this uncertainty, there is some evidence that happiness is unevenly distributed among the social classes: individuals in the higher socio-economic groupings generally report greater positive affect, which may reflect the fact that they are more frequently exposed to environmental risk-factors for happiness.

            Genetic studies of happiness are a neglected avenue of research, but neurophysiological evidence points to the involvement of certain brain center and biochemical systems. Thus, stimulation of various brain regions has been found to elicit the affective and behavioral components of happiness in animals, as has the administration of drugs that affect the central nervous system, such as amphetamines and alcohol.

            A number of philosophers have suggested that the best way to distinguish between psychiatric disorders and types of behavior not worthy of psychiatric attention is to determine whether the behavior is rational. Both Radden and Edwards imply that irrationality may be demonstrated by the detection of cognitive deficits and distortions of one sort or another. There is excellent experimental evidence that happy people are irrational in  this sense. It has been shown that happy people, in comparison with people who are miserable or depressed, are impaired when retrieving negative events from long-term memory. Happy people have also been shown to exhibit various biases of judgment that prevent them from acquiring a realistic understanding of their  physical and social environment. There is consistent evidence that happy  people over-estimate their control over environmental events (often to the point of perceiving completely random events as subject to their will), give unrealistically positive evaluations of their own achievements, believe that others share their unrealistic opinions about themselves, and show a general lack of evenhandedness when comparing themselves with others. Although the lack of these biases in depressed people has led many psychiatric researchers to focus their attention on what has come to be known as depressive realism, it is the unrealism of happy people that is more noteworthy, and surely clear evidence that such people should be regarded as psychiatrically disordered.

            I have argued that happiness meets all reasonable criteria for a psychiatric disorder. It is statistically abnormal and consists of a discrete cluster of symptoms; there is at least some evidence that it reflects abnormal functioning of the central nervous system; and it is associated with various cognitive abnormalities--in particular, a lack of contact with reality. Acceptance of these arguments leads to the obvious conclusion that happiness should be included in future taxonomies of mental illness, probably as a form of affective disorder., This would place it on Axis1 of the American Psychiatric Association’s Diagnostic and Statistical Manual. With this prospect in mind, I humbly suggest that the term “happiness” be replaced by the more formal description major affective disorder, pleasant type, in the interests of scientific precision and in the hope of reducing any possible diagnostic ambiguities.

            There are two possible objections to the proposed inclusion of major affective disorder, pleasant type, as a psychiatric disorder. First, it might be argued that happiness is not normally a cause for therapeutic concern. Therapeutic concern has, in fact, been proposed as a criterion for disease by Kraupy-Taylor. However, Kendell has criticized this definition as worse than no definition at all because of its obvious circularity and because of the inevitable implication that diseases are culturally and historically relative phenomena. On this account, sickle-cell anemia, anorexia nervosa, and psychopathy (to name but three unequivocal examples of disease described only in recent times) were not diseases before their discovery.

            The second objection to the proposal that happiness be regarded as a psychiatric disorder points to the fact that happiness is not normally negatively valued. Implicit in this argument, however, is the idea that value judgments should determine our approach to psychiatric classification. Such a suggestion is clearly inimical to the idea that psychopathology should be considered as a natural science. Indeed, if psychopathologists persist in excluding happiness from the list of psychiatric disorders, it will serve as an admission that subjective values are the basis of their system of classification.

Harper’s Magazine January 1993