Mood, as a mental phenomenon, is central to the human experience. Yet, most people — laypersons as well as mental health professionals, are stomped when asked to define what ‘mood’ actually is. To illustrate my point, stop reading for a minute and take a shot at defining ‘mood’ for yourself.
Welcome back.
I bet that (if you tried) you came up with relevant thoughts (doubtlessly, you have plenty of experience with ‘mood’) but not quite a definition fitting a fundamental, key phenomenon in the human experience. To remedy this, here’s a proposed definition: ‘Mood’ is a nonverbal constituent of consciousness, composed of the quality and intensity of one’s current feelings, reflecting one’s subjective interpretation of the overall quality of their present circumstances.
Permit me to elaborate: The term ‘feeling’ refers to both physical sensations (e.g., “I feel full” or “I feel a pain in my stomach”) and emotions (e.g., “I feel inspired” or “I feel ashamed”). Both types of ‘feelings’ trigger the formation of a narrative, which is the source of their meaning. Pure feelings are non-verbal signals (for example, hunger and satiety, fear and a sense of security) inherently possessing a binary quality — ‘feelings’ are either positive or negative, good or bad. Feeling energized, grateful, and loved are examples of positive feelings; feeling exhausted, ashamed, and abandoned are examples of negative feelings. At any given moment, positive and negative feelings register on an intensity continuum, ranging from barely noticeable to overwhelming.
The primary evolutionary purpose of ‘feelings’ is to protect survival by triggering reflexive behaviors (‘feelings’ have many other functions discussed elsewhere). The ‘quality’ of a ‘feeling’ determines the direction of the behavior it triggers; categorically, positive feelings trigger an attraction to something, and negative feelings trigger a repulsion from something. The ‘intensity’ of a ‘feeling’ determines the urgency of the response, whereby more intense or stronger feelings are automatically assigned a higher priority over less intense feelings.
The advantage this system offers, whereby feelings directly trigger conduct, is speed, a potentially critical factor in survival situations. The alternative — constructing a behavioral response based on a cognitive analysis is a much slower process that is less suitable for managing existential threats. Cognitive analysis is advantageous in situations that do not involve a survival threat, particularly in the pursuit of happiness.
The ‘quality’ and ‘intensity’ of our feelings carry essential information about the nature of the present circumstances in which one operates: An overall positive ‘quality’ informs that the present environment is inviting; an overall negative ‘quality’ informs of a problem or a threat. The ‘intensity’ parameter indicates the magnitude of the appeal and urgency of the threat, respectively.
It, therefore, makes sense that the brain would monitor these parameters. However, constant monitoring of the continuous flow of feelings would consume a lot of brain resources. From the brain’s standpoint, the need to track the ‘quality’ and ‘intensity’ of each emergent feeling presents a “resource-utilization” dilemma. ‘Mood’ solves the dilemma: As the definition proposed above indicates, the overall ‘quality’ and ‘intensity’ of the feelings in play at any given moment show up in consciousness automatically in what we experience as ‘mood.’
By automatically bringing the sum of the ‘quality’ and ‘intensity’ of present ‘feelings’ into consciousness, ‘mood’ functions as a tool for registering the perceived quality of one’s present circumstances in consciousness. By circumventing the use of language, ‘mood’ increases the system’s response speed; moreover, the exclusion of language spares the massive investment of brain resources that generating and paying attention to the meaning of the fluctuating flow of feelings would require.
This is not a big revelation; the link between ‘mood’ and the perceived quality of the present is pretty self-evident. What is less obvious — and of the utmost importance, is that the link between ‘mood’ and the perceived quality of the present is bidirectional: The ‘mood’ at any given moment influences the perception of the quality of that moment. A good-mood introduces a positive bias into the brain’s assessment of the quality of the reality in which it operates. A bad-mood has the opposite effect, i.e., it introduces a negative bias into the brain’s assessment of the quality of the present circumstances.
The mood’s impact on the perception of the quality-of-reality is a well-recognized psychological phenomenon called ‘cognitive-distortion’. A ‘good-mood’ tends to introduce a ‘positive cognitive-distortion’ and a ‘bad-mood’ tends to introduce a ‘negative cognitive-distortion’.
[Sidebar: 1. Since ‘mood’ conveys information intrapsychically — from brain centers that process sensory/emotional data to consciousness, it is no surprise that it also plays a role in interpersonal communication.
In the first year or so of life, before language develops, we can only experience pure feelings. At that stage of life, one’s ‘mood’ is the primary tool available to communicate our subjective perception of the quality of the present to our environment. Doubtlessly, anyone with experience caring for young children (or adults with undeveloped language skills) is aware of the role of mood as a communication tool.
At any age, displaying a good-mood, e.g., by laughing or joking, is a way to broadcast that the present registers as a positive experience, i.e., that “things” are going well or that “everything is okay.” Conversely, displaying a bad-mood, e.g., by crying or sulking, communicates that the present is registering as a negative experience, i.e., that “something” is not right, not going well.
Since ‘mood’ does not include a narrative, the information it carries lacks specificity. Hence, ‘mood’ alone is insufficient to convey the subtleties and complexities of mature interpersonal relationships. Over-reliance on mood as the primary means of communication can lead to misunderstandings, especially in complex relationships. Developing effective verbal communication skills is crucial for navigating the complexities of human interaction.
- Practice Point: There isn’t much one can do to directly improve or alter one’s mood at a given moment. (The closest practice I am aware of focuses on checking one’s attitude; sometimes, upgrading one’s attitude can improve mood. I will discuss this in detail elsewhere.) The next best thing to improve your mood is learning to recognize its “message” and take it with a grain of salt. As discussed above, a good-mood informs consciousness that the circumstances at that moment are good, and a bad-mood informs the opposite. However, since ‘mood’ can be, largely or entirely, shaped by internal, biochemical events (e.g., fluctuating hormone and neurotransmitter levels), the ‘mood’s’ quality — good or bad, may not accurately represent the quality of the circumstances. This can be explored by asking yourself why your mood, at any given moment, has the quality it has. Discovering that you are in a good or a bad ‘mood’ for no apparent reason is not likely to change your ‘mood’ but it should be enough
Moreover, beyond a certain intensity, ‘mood’ introduces a bias regardless of quality. Hence, it is important to develop the ability to recognize times when the ‘mood’ is intense, identify its impact, and examine its validity.
Cognitive-distortion occurs subconsciously, i.e., without awareness of it happening at all; but it doesn’t have to remain subconscious. Usually, it can be exposed — brought into consciousness, with a simple introspection. Given the potential cost of unrecognized cognitive distortion, the required effort is worth investing in.
Practically, with repetition, it is possible to develop a habit of checking one’s thought process for evidence of cognitive distortion. Initially, it may not feel “organic” or natural to direct attention to your mood to deliberately examine its intensity. With repetition (which is usually inner discipline dependent), it is possible to develop a (more-or-less) steady conscious awareness of the state of your mood. Noticing that the intensity of your mood — good or bad, is unusually high should serve as a prompt to verify that your thought process is not derailed by a (positive or negative) cognitive-distortion. In other words, it’s worth ensuring that the automatically generated assessment of the quality of the present stands the trial of reason.
Consulting someone you trust who is not influenced by your mood can be very helpful in this regard. This introspection and/or consultation can be very rewarding: Simply checking the impact of your mood on your perception of the moment’s quality can expose errors in judgment and, in turn, make it possible to avoid costly, poor choices. Usually, all that is required at that point to avoid costly, poor choices is just the deferment of making them until the threat of the mood-generated cognitive-distortion lifts.
I think that this point lends practical relevance to Dr. Jung’s psychoanalytic dictum: “Until you make the unconscious conscious, it will direct your life, and you will call it fate.” It may well refer to the impact that ‘mood’ has on the perception of the quality of the present, i.e., the phenomenon of cognitive-distortion, which is subconscious but can be made conscious with some effort which — given the potential consequences, is well worth putting forth.
- Mood-altering substances highlight how ‘mood’ impacts the perception of the quality-of-reality. For example, euphorigenic substances, i.e., substances that have a direct mood-elevating effect (such as stimulants, e.g., cocaine, methamphetamine, and caffeine), introduce a ‘positive cognitive-distortion.’ These substances improve the subjective sense of the quality-of-reality. Analgesics, or pain-reducing, substances (e.g., opioids and alcohol) tend to be sedating and appear to elevate ‘mood’ indirectly by reducing the negative impact that pain has on it (pain has been shown to have a negative effect on ‘mood’ even when it doesn’t register consciously because it is too subtle and/or monotonous). Directly or indirectly, artificially improved ‘mood’ can introduce a ‘positive cognitive-distortion’, i.e., it may, unfoundedly, raise the perceived quality-of-reality.
The improved sense of the quality-of-reality caused by mood-altering substances is, of course, temporary; it only lasts for as long as the chemical causing it circulates in the body at a high enough level. This well-recognized phenomenon underscores the seductive appeal of positive cognitive-distortion: It is powerful enough to offset the knowledge (possessed by every addict) that the substance’s effect is short-lasting, essentially guaranteed to trigger an urge for repeated use, and that the repeated use (of most of these substances) has disastrous consequences.
I am reminded of a quote from Kurt Vonnegut’s book Hocus Pocus: “And haven’t I myself said that the happiest parts of my life were when I played the bells? With absolutely no basis in reality, I felt like many an addict that I’d won, I’d won, I’d won!”
Mood-Disorders
Since the term ‘mood’ is poorly defined, it is to be expected that the term ‘mood-disorders’ would also be vague. And indeed, it is.
The magnitude of the problem ‘mood-disorders’ represent is enormous. In addition to the direct burden of the symptoms, patients with ‘mood-disorders’ are at an increased risk of general health problems, marital problems, accidents, substance abuse disorders, socio-economic problems, and increased all-cause mortality. The full impact of ‘mood-disorders’ on patients, their families, and society as a whole is simply immeasurable. The need for a better understanding of ‘mood-disorders’ is undeniably urgent.
Correctly understanding what a ‘mood-disorder’ is begins with understanding what a ‘mood-disorder’ is not: No ‘mood’ in-and-of itself represents a disorder. ‘Mood-disorders’ are disorders of mood regulation rather than disorders of a particular mood. Extreme mood-states, unpleasant and difficult to endure as they may be, do not necessarily indicate a ‘mood-disorder’. An extremely depressed-mood may be normal in the context of a profound loss, and an extremely euphoric-mood may be normal in the context of a great gain.
As discussed above, during wakefulness, ‘mood’ continuously presents non-verbal information to consciousness about the nature of the present conditions, composed of two parameters extracted from the ‘feelings’ in play at any given moment: ‘Intensity’ and ‘quality.’ The monitoring and registration of these parameters must be regulated closely so that the information delivered by ‘mood’ is accurate. A malfunction of this regulation results in a ‘mood-disorder’.
In principle, the ‘mood’ parameters’ regulatory-system can malfunction in two ways: it can become unstable and shift erratically, resulting in mood-disorders hallmarked by ‘affective-lability’; or it can become “sluggish” or even “stuck” and resist shifting altogether, resulting in mood-disorders hallmarked by a lack of ‘affective-modulation’.
Patients with disorders hallmarked by ‘affective-lability’ experience erratic fluctuations of either the quality and/or the intensity of their mood. The lability of the ‘quality’ parameter manifests as sharp shifts between bright and dark moods, disconnected from the objective circumstance. Lability of the ‘intensity’ parameter manifests as acute shifts between exaggerated and over-the-top to detached and under-responsive mood states, similarly out of sync with the objective circumstance.
‘Affective-lability’, at varying degrees, is a central symptom of numerous neurologic and psychiatric disorders. Perhaps the most striking example of ‘affective-lability’ is a condition called ‘pseudobulbar-affect’ (a relatively rare disorder, usually associated with a neurological disorder called ‘pseudobulbar-palsy’). Patients with ‘pseudobulbar-affect’ display extremely erratic fluctuations of both their mood’s ‘quality’ and ‘intensity’ parameters. As a result, they experience and display uncontrollable, acute shifts between intense crying and intense laughing spells, largely unrelated to the objective circumstances they are responding to.
Arguably, the lability of both mood parameters is also at the core of the mixed variant of bipolar-disorder’.
Another psychiatric disorder known as ‘Intermittent Explosive Disorder’ may be an example of the lability of only the mood’s ‘intensity’ parameter. Patients with the disorder respond to minute provocations with uncontrollable, explosive anger outbursts.
The most commonly encountered example of the lability of both the ‘intensity’ and ‘quality’ mood-parameters is associated with some of the personality-disorders; specifically borderline, histrionic, anti-social, and narcissistic personality-disorders. Patients with these personality disorders experience erratic fluctuations of both their mood’s ‘quality’ and ‘intensity’, which often result in disabling interpersonal and functional problems.
The second type of regulatory dysfunction, ‘affective-modulation’ failure, manifests as an inability to adjust one or both of the mood’s parameters, resulting in ‘mood’ states that are out of step with or detached from objective circumstances.
A condition called ‘euphoric mania’ may be the most obvious and often dramatic example of a mood-disorder hallmarked by modulation failure of both the ‘quality’ and the ‘intensity’ parameters. In full-blown ‘euphoric-mania’, the ‘quality’ of patients’ mood is stuck on high and, simultaneously, their mood’s ‘intensity’ is stuck on maximum.
Some depressive-disorders (e.g., ‘melancholic major-depression’) may result from a similar loss of ability to lower the mood’s ‘intensity’ parameter, while the mood’s ‘quality’ is concomitantly stuck on the negative side.
‘Affective-modulation’ disorders may only involve the ‘quality’ parameter, sparing the ‘intensity’ parameter. For example, in so-called ‘hypomania’ (the defining feature of ‘bipolar-disorder, type-2’), patients’ mood is euphoric, i.e., the ‘quality’ parameter is stuck on high, but the ‘intensity’ is relatively unaffected. Consequently, patients’ elevated mood and associated symptoms are less intense in comparison with full-blown ‘euphoric-mania.’
Dysthymia — a chronic depressive disorder defined by a limited severity of symptoms, may result from a similar regulatory malfunction, i.e., the ‘quality’ parameter of patients’ mood is stuck on negative while the ‘intensity’ parameter is relatively unaffected, manifesting with relatively milder symptoms.
In typical ‘major-depression’ (as I understand it), the mood’s ‘intensity’ parameter gets stuck at zero, and the quality parameter is largely unaffected. Hence, in my opinion (which is contrary to the broadly held view), ‘major-depression’ is primarily a disorder of caring or passion rather than a disorder of sadness. Caring, by definition, is the intensity with which an emotion is experienced. When the ‘mood’s’ intensity-control gets stuck at zero, patients experience a strange, oppressive inability to care. The clinical term for this symptom is ‘anhedonia’, which is a core symptom of ‘major-depression’. The loss of the normal ability to care causes a myriad of symptoms and functional limitations, including, for example, loss of motivation, poor concentration, self-neglect, and hopelessness. (For more on this topic go to: https://wp.me/P7aKBB-dX .)
Several other depressive conditions, most notably ‘adjustment-disorder with depressed mood’, as well as ‘grief’ related problems (which are often misdiagnosed as ‘major-depression’) also result from an ‘intensity’ modulation dysfunction, but the malfunction at the core of these conditions is very different from the dysregulation in ‘major-depression.’ Namely, it is an impairment of the mood’s spontaneous intensity-decay function.
I’ll explain: Elevated mood ‘intensity’ can interfere with the cognitive process (you have probably experienced this phenomenon if you ever found it “hard to think” in the face of intense emotions). Normally, the intensity of an emotional reaction decreases automatically over time (once it drops below a certain threshold, the interference with the cognitive process stops, and the person experiencing it is said to have ‘adjusted’ to the circumstances). When the mood’s spontaneous intensity-decay feature fails, which is an ‘affective-modulation’ problem, the mood’s intensity remains elevated for longer than expected. If the intensity is sustained at a level that interferes with other brain functions (i.e., thinking rationally), the condition may qualify as an ‘adjustment-disorder’ or a pathological grief reaction.
In other words, the intensity of the initial emotional response may be within normal limits, but a problem presents when it resists adjustments (i.e., modulation) — remaining elevated for longer than expected (in the context of the individual’s cultural norms) and leading to a functional problem.
Organic Vs. Reactive Mood-Disorders
A conventional classification divides ‘mood-disorders’ into two classes: ‘Organic’ — resulting from a problem with an organ, and ‘reactive’ — resulting from a problem with a reaction to the circumstances. Organic ‘mood-disorders’ are medical/psychiatric disorders, and reactive ‘mood-disorders’ are psychological disorders.
Psychiatric illnesses that manifest primarily with mood-symptoms (i.e., more than with other types of symptoms, such as anxiety, impulse-control, cognitive, or psychotic symptoms) are considered ‘primary (organic) mood-disorders’. The main ‘primary organic mood-disorders’ are ‘major-depression’ and ‘bipolar-illness’ (‘major-depression’ and ‘bipolar-illness’ are generally thought of as “brain disorders”; since the brain is broadly considered an organ, these disorders are organic ‘mood-disorders’). Consistent with their organic underpinnings, ‘primary mood-disorders’ typically involve both affective and physical symptoms. The physical symptoms associated with the ‘primary mood-disorders’ are referred to as ‘vegetative symptoms’. Examples of ‘vegetative symptoms’ include abnormally increased or decreased sleep energy and appetite, impaired concentration, and a general slowing or speeding of physical and mental processes (i.e., ‘psychomotor retardation or agitation’ respectively).
‘Secondary (organic) mood-disorders’ are conditions with significant mood-symptoms in which the primary problem is a medical (non-psychiatric) disorder involving the brain. ‘Secondary mood-disorders’ usually manifest with physical (typically neurological) signs and symptoms compounded by depressed, euphoric, apathetic, irritable, and/or labile mood-symptoms.
The list of medical conditions known to potentially cause significant mood-symptoms is long. It includes endocrine disorders (e.g., disorders of the pituitary, thyroid, and adrenal gland, premenstrual dysphoric disorder, postpartum depression), sleep disorders (e.g., sleep apneas, circadian rhythms disorders, and sleep deprivation in general), nutritional deficiencies (e.g., vitamin D and vitamin B9 deficiencies), seizure disorders (i.e., epilepsy), infectious diseases (e.g., AIDS, urinary tract infection), autoimmune diseases (e.g., SLE, autoimmune encephalitis), vascular brain diseases (e.g., strokes), brain degenerative diseases (e.g., Huntington’s chorea, Parkinson’s disease, and the dementias), and traumatic brain injuries.
In addition, many substances (e.g., alcohol, cannabinoids, opiates, cocaine, as well as many medications) can cause mood-symptoms and secondary mood-disorders. Substance-related mood-symptoms may be acute or chronic and potentially persist long after the use of the offensive substance is discontinued. Mood-disorders secondary to the use or abuse of substances can be tricky — at times impossible, to distinguish from the symptoms of primary (psychiatric) ‘mood-disorders’.
The second ‘mood-disorder’ type in this classification is ‘reactive.’ The most commonly encountered reactive ‘mood-disorders’ are a group of conditions referred to as the ‘adjustment-disorders’. In addition, ‘grief’ and ‘despair’ are (usually) reactive depressive mood states, which, depending on the specifics of the situation, may qualify as a disorder. Lastly, post-traumatic stress disorder (PTSD) and the personality disorders mentioned earlier typically involve significant reactive mood-symptoms, but these conditions are not formally considered ‘mood-disorders’.
Our understanding of the processes that lead to persistent, reactive mood-symptoms, and, ultimately, to reactive ‘mood-disorders’ is rudimentary and mostly speculative.
It is quite clear that traumatic life experiences can play a major role in the subsequent development of mood-symptoms (obviously, it is the case in PTSD), but it is not at all clear how it happens. Psychological trauma appears to have the potential to elicit persistent changes in biochemical processes (and, possibly, brain structures) that may manifest with subsequent persistent mood-symptoms. For example, childhood traumatic experiences are believed to alter the functional settings of the ‘hypothalamic-pituitary-adrenal axis’ (a system connecting the brain with the part of the endocrine system involved in the stress response) and, consequently, may increase the risk of developing a ‘mood-disorder’ later on in life.
The line separating ‘organic’ from ‘reactive’ mood-disorders is often blurred. Diagnostically, it can be difficult to distinguish primary organic from primary reactive ‘mood-disorders’. Since all mental activity results from electro-biochemical events in the brain, the distinction between ‘organic’ and ‘reactive’ mood-symptoms may turn out to be artificial, reflecting the limitations of our knowledge more than a real insight into the nature of the problems.
The primary justification for making a distinction between physiologic and psychologic ‘mood-disorders’ is in their treatment consideration: Presently, there are no FDA-approved biological/medical treatments for psychological disorders. Psychiatric disorders, on the other hand, require biological/medical treatment.
The main form of psychological treatment is psychotherapy, also referred to as “talk therapy” (Psychotherapy is a major topic, and discussing it is beyond the scope of the current topic). Spiritual practices and positive (corrective) experiences can promote psychological well-being and can have a role in the treatment of psychological disorders.
Medical treatments are ineffective in dealing with psychological disorders and can be harmful. In principle, therefore, medical treatment of psychological disorders should be avoided.
Medications may alleviate some symptoms associated with psychological disorders, most commonly insomnia and anxiety. Whether or not to use a medication to address symptoms associated with a psychological disorder can be a difficult decision. The use of medications in this context is complicated by the risk of dependence and habituation and by its potential to shift the treatment focus from where it is needed — on the psychological side and place it on the biological side, which is likely to be non-productive or worse. Hence, when it cannot be avoided, the use of medications as treatment for symptoms of psychological disorders should be minimized and applied cautiously.
[Sidebar: A growing body of current research suggests that some psychedelic drugs (e.g., MDMA, LSD, and psilocybin) may be useful in the treatment of some disorders that have been considered primarily psychological, particularly PTSD. These new research findings may signal a pending revolution in our understanding of these disorders and their treatment.]
The main treatment of primary (organic) mood-disorders (e.g., ‘major-depression’ and ‘bipolar illness’) is medical. Psychotherapy can be a valuable component of their comprehensive treatment, but it is a form of supportive care rather than core treatment. In principle, the role of psychotherapy in the treatment of ‘primary mood-disorders’ is no different from the role of psychotherapy in the treatment of any serious medical problem: Psychotherapy can help by promoting healthy cognitive and behavioral changes, coping strategies and useful insights, but it does not address the underlying core pathology.
Since the dysfunction in the ‘primary mood-disorders’ is biological, their treatment must utilize biological means; but psychological issues are inextricable from the course of these disorders. Therefore, it stands to reason that the optimal management of the ‘primary mood-disorders’ would utilize both medical and psychological treatments. Indeed, research indicates that treating the primary mood-disorders with a combination of psychotherapy and medical treatment is more effective than either one alone (as does research examining the role of psychotherapy in the management of general severe medical disorders).
Collectively, ‘mood-disorders’ are a leading global cause of disability. The functional limitations patients encounter are primarily the result of the ‘cognitive-distortion’ and the vegetative symptoms (discussed above) associated with the disorders, not as a direct result of the abnormal mood. (In bona fide ‘major-depression’, as mentioned above, much of the functional impairment is a consequence of the inability to care; for more on this go to https://wp.me/P7aKBB-dX ).
Nonetheless, abnormal mood can damage patients’ social functioning. Since ‘mood’ conveys information, in the context of a ‘mood-disorder’, it conveys misinformation, which usually impacts patients’ social functions negatively. For example, a persistently depressed mood is easy to misconstrue as a disapproval or a lack of interest, a misinterpretation that can readily damage personal and professional relationships.
The destructive, disabling impact of the ‘cognitive-distortion’ phenomenon is illustrated most clearly in the course of ‘euphoric-mania’: In general, patients with ‘euphoric-mania’ do not perceive their elevated mood — the hallmark of the disorder, as a problem; on the contrary, they usually find it pleasant and even enjoyable (at least initially). Yet, euphoric-mania is completely disabling. Patients with the disorder are incapacitated by the ‘positive cognitive-distortion’ caused by their pathologically elevated mood: During episodes of ‘euphoric-mania’ patients perceive themselves as much more capable and much less vulnerable than they are; they tend to be oblivious to risks and their self-confidence and optimism are unbounded. Sooner or later in the course of an episode of ‘euphoric-mania’ the ‘cognitive-distortion’ manifests as an “impairment of judgment”, which is diagnostic of the condition. The impaired judgment is the main cause of patients’ functional dysfunction, more than any other aspect of the disorder. Operating with impaired judgment, patients invariably make horrific choices antithetical to their value system and reasoning, which, unfortunately, almost always have disastrous consequences.
A depressed-mood can distort patients’ perception of the quality of their reality with the same intensity, in the opposite direction. The negative ‘cognitive distortion’ associated with depressive-disorders can make everything in the patient’s world register as lacking quality: Lack of quality of the ‘Self’ can manifest anywhere from low self-esteem and lack of self-confidence to outright self-hatred. The perceived lack of quality of the ‘Others’ in the patient’s life tends to manifest with a loss of capacity for intimacy, mistrust, suspiciousness, and, in extreme cases, frank paranoia. Lack of quality of one’s ‘Process’ tends to manifest with a sense of futility and purposelessness in life.
Moreover, depressed ‘cognitive-distortion’ can impact stored memories as well as expectations of the future. Depressed patients tend to recall past experiences as worse than they had been and relate to the future with a conviction that it will be worse than their present. The ‘negative cognitive-distortion’ invariably impacts patients’ choice-making. Consequently, patients typically become increasingly, even completely, passive; patients may appear obstinate as if they stubbornly elect to do nothing. The passivity of depressed patients makes sense, keeping in mind their negatively distorted assessment of their vulnerability, the threats they think they face, and the odds they attribute to positive future outcomes. Often, depressed patients’ poor choices amount to “self-fulfilling prophecies”, a source of considerable frustration to people close to the patient.
The conviction that the future is doomed to be worse than the already difficult-to-endure present produces potentially paralyzing anxiety and hopelessness. In extreme cases, the irrational hopelessness stemming from the negatively distorted take on the future can reach delusional intensity and feed into patients’ suicidal inclination.
Mood and the Pursuit of Happiness
Awareness of the difference between ‘Happiness’ and the experience of a good mood is at the foundation of mindfulness. Ignorance of the distinction between the two concepts is detrimental to the pursuit of happiness.
The aspiration for happiness is a defining human trait; arguably, it’s uniquely human. For members of our species, a respite from survival threats (an easily overlooked precious luxury) is far from enough. We want more than to stay alive — we want our lives to have meaning and purpose.
However, finding a meaning and a purpose in life can seem too lofty and distant, ultimately inaccessible to the ordinary person. This conclusion is incompatible with the deep-seated human craving for meaning and purpose, resulting in a frustrating, uncomfortable inner conflict. The conflict is resolved by transferring the cravings from ‘meaning and purpose in life’ onto the adjacent idea of ‘Happiness.’ It solves the problem because, in comparison with ‘meaning and purpose,’ ‘Happiness’ seems self-evident, simple, and, in principle, well within anyone’s reach.
‘Happiness’ is an amazing concept. Throughout recorded human history, it has been considered a peak goal in life — even though it is, at best, vaguely defined and often completely undefined!
This begs the question: How can something be universally considered supremely precious and its pursuit extremely important without being defined?
I think that the ubiquitous experience of ‘mood’ is a big part of the answer: The fact that ‘Happiness’ is undefined does not register as a problem because we rely on the ‘mood’ phenomenon to guide us in its pursuit.
It is broadly considered an obvious truth that a ‘good-mood’ implies success in the pursuit of Happiness, and a ‘bad-mood’ implies failing at it. Gradually, without realizing it, most of us eventually equate ‘good-mood’ with ‘Happiness’ and ‘bad-mood’ with unhappiness. This is most unfortunate as these are serious and costly misconceptions. Placing ‘good-mood’ on par with ‘Happiness’ sanctions avoiding the task of defining it (i.e., based on the prevalent, dubious notion that knowing what something “feels” like legitimizes not exploring it intellectually); at the same time, it invites fictitiously amplifying the importance of the ‘mood’ phenomenon. The negative consequences of the attachment to these misconceptions, individually and collectively, are difficult to overestimate.
(For an unemotional discussion of Happiness go to https://wp.me/P7aKBB-3C .)
The language we use to discuss ‘happiness’ and ‘good-mood’ exposes our tendency to treat these two very different concepts as if they were the same. For example, “I was very happy when I won the lottery” really means “I was in a very good-mood when I won the lottery”. Conversely, “I was very unhappy when the stock market crashed” really means that losing money in the stock market caused me to be in a very bad-mood. The notion that ‘Happiness’ can be attained by winning the lottery or lost by a stock market crash is simply wrong and out-of-touch with the true meaning of both ‘Happiness’ and ‘good-mood’.
Being in a good-mood does not mean that ‘Happiness’ has been attained any more than being in a bad-mood means it has been lost. Yet, the interchangeable use of these terms is so deeply ingrained that pointing to the logical fallacy therein is usually dismissed as overly pedantic. It is not.
Using the terms ‘happiness’ and ‘good-mood’ interchangeably reveals — and worse, perpetuates the failure to maintain awareness of the crucial distinction between them. Failure to maintain awareness of the distinction is far from trivial — the effective pursuit of happiness depends on it.
If you need convincing that the pursuit of ‘good-mood’ and ‘happiness’ are very different endeavors, be reminded that it is possible to do well in one and poorly in the other simultaneously. It is possible, even common, to be in a good-mood and, at the same time, do poorly in the pursuit of happiness. As a rather extreme example, think of a convicted felon serving a lengthy prison term. This imaginary felon may sometimes be in a good mood (say, after his beloved home team wins the Super Bowl), but by imprisonment, his pursuit of happiness is unlikely to be going well. Conversely, it is possible to be in a bad-mood and simultaneously pursue happiness effectively. For example, a monk can be in a bad-mood — deeply saddened following the passing of his mother, but it is unlikely to derail, or even impact, the efficacy of his pursuit of happiness.
[Sidebar: The pursuit of a good-mood is a “finite game” — it is focused on a desired outcome (which, ultimately, comes down to experiencing pleasure or avoiding pain). Pursuing happiness is an “infinite game” — there is no ‘there’ there; it is focused on the Process or the journey, not on an outcome. The pursuit of happiness is open-ended and lifelong.
I’m referring to an excellent and highly recommended book by J.P. Carse: ‘Finite and Infinite Games.’ It is. {Thanks, CB, for introducing me to it}.]
The tools that serve the pursuit of a good-mood are inherently different from the tools that serve the pursuit of happiness. Fundamentally, the pursuit of a good-mood is supported by innate reflexes, evolutionarily purposed to avoid pain and attain pleasures.
Reflexive behaviors are predetermined — specific stimuli lead to specific conducts, circumventing the need for a cognitive analysis, thus shortening the reaction time. Reflexive conduct is best suited for the survival arena where obtaining pleasure and avoiding pain reign supreme. It is best suited for processes where the reaction speed is a critical factor (i.e., in finite, competitive “games”) and loses value as the reaction speed becomes less important.
Innate reflexes are largely irrelevant to the pursuit of happiness — an open-ended process, in which reaction speed is not a significant factor (there is no “there” there to get to first, or at all).
Moreover, innate reflexes trigger predetermined behaviors that lack the complexity and nuance required for the effective pursuit of happiness. Ultimately, the pursuit of happiness benefits from avoiding or minimizing (reflexive) reactions in favor of (deliberate) actions.
[Sidebar: There are two types of reflexes: “hard-wired” — present at birth (to protect survival) and acquired — i.e., habits, which are developed through repetition or practice. Habits also come in two types — good and bad: Good habits support one’s cause; bad habits undermine it. Good habits can be developed intentionally — i.e., cultivated through deliberate practice. The practice of Mindfulness is a framework for the development of good habits — designed to support the pursuit of happiness.]
To be clear: there is nothing wrong with pursuing pleasures (and a good-mood) — pleasures are linked to the experience of ‘quality of life’ (since reflexes that serve the pursuit of pleasures are hard-wired in our DNA, there couldn’t be anything inherently wrong with it).
Problems do emerge, however, due to the failure to distinguish between the pursuit of happiness and the pursuit of a ‘good-mood’, specifically, when resources needed in the pursuit of happiness are unwittingly invested in the pursuit of pleasures.
Human resources are (by definition) limited and, therefore, should be used deliberately and mindfully. The mindful utilization of resources hinges on prioritizing their allocation, such that higher-priority needs are attended to first, before lower-priority needs.
In order of priority, the main human pursuits are survival, happiness, and pleasure. The mindful utilization of resources is synonymous with prioritizing their allocation accordingly.
In other words, mindful resource utilization means that survival needs are attended to first, and subsequently, resources can be invested in the pursuit of happiness — i.e., only after survival needs have been met. Resources can be invested in the pursuit of pleasures mindfully once the higher-priority needs have been met.
Investing resources in the pursuit of happiness if they are needed to secure survival is a mistake incompatible with mindfulness. Similarly, it is a mistake to invest resources in the pursuit of pleasure if these resources are required to pursue happiness (obviously, it is a grave mistake if these resources are necessary for survival).
For example, donating money to charity would be a mistake if that money is needed to pay the rent. Giving to charity may be an investment in the pursuit of happiness (as an expression of one’s passion and compassion) but a mistake if the money is needed for a shelter, i.e., to secure a survival need.
Similarly, the purchase of a new car (as an investment in pleasure) would be a mistake if it came at the expense of one’s inner peace — because that would undermine their pursuit of happiness, which is a higher priority than the pursuit of pleasure (of course it would be a mistake if the money was needed to meet a survival need, such as covering the rent).
The pursuit of Happiness is a much bigger deal than the pursuit of a ‘good-mood’. ‘Mood’ is a transient reaction to the perception of the quality of the present circumstances. In comparison, one’s level of happiness or, more accurately, the efficacy of one’s pursuit of Happiness is a defining personal trait. It manifests one’s attained levels of inner peace, passion, and compassion (it is also shaped by one’s fortune, or karma, an important point that is outside the scope of the present discussion).
Over my years of practicing psychiatry, I have encountered countless patients who presented complaining of “depression” and summarized their predicament with a statement along the lines of “I have just about everything anyone can want, and I’m still miserable… What’s wrong with me?” Often, they referred to their distress, self-deprecatingly, as a ‘first-world problem.’
With exploration, many have realized that their actual affliction was a painful sense of failure in the pursuit of happiness, exacerbated by their access to an abundance of pleasures.
The underlying problem they commonly shared was the failure to distinguish ‘Happiness’ from ‘good-mood’. Essentially, they were confused about a fundamental aspect of adult life. Their persistent confusion led to gradually increasing frustration and distress. In many cases, erroneously equating ‘good-mood’ with ‘Happiness’ also contributed to developing financial, substance abuse, and relationship problems that were traceable to a habitual misallocation of resources, i.e., investing resources in the acquisition of pleasures (and avoidance of pain) instead of where they were needed more urgently — in the pursuit of happiness.
The primary issue behind this common affliction, in my opinion, is ignorance: A lack of the knowledge that is necessary to pursue happiness effectively (an opinion influenced by and consistent with the Buddhist view that ignorance — Avidya in Sanskrit, is the source of all suffering).
The diagnosis of ‘Ignorance’ involves both good and bad news (as often is the case with diagnoses in general). The good news is that ignorance is a treatable condition: Learning can cure it! The bad news is that the treatment is not easy; it requires a sustained commitment and a persistent effort.
More often than not, learning is a slow process; moreover, implementing gained knowledge usually requires a lot of practice. But, to my knowledge, there is no alternative treatment for ignorance.
Indeed, my diagnostic and prognostic feedback has been met with mixed responses: Some patients were relieved to hear that they did not suffer from a psychological disorder or a psychiatric illness. Others were disappointed to learn that there was no quick fix — no pill to remedy what ailed them.
Some were even more disappointed when they learned that, to get better, they had to cultivate tolerance, a seemingly increasingly difficult selling point in today’s cultural climate.
Tolerance is required to contain the impact of unavoidable pain and suffering (as per Buddhism’s First Nobel Truth) on the pursuit of happiness. Tolerance — the ability and willingness to experience discomfort or pain without reacting enables overriding the reflexive response pain is designed to trigger. The role of tolerance is non-negotiable because, as discussed above, reflexive reactions lack sophistication and nuance and are, therefore, incompatible with the effective pursuit of happiness.
Furthermore, intolerance legitimizes the use of force, which is invariably detrimental to the pursuit of happiness.
Force is antagonistic to the pursuit of happiness because it is impossible to build with force — force can only be used to destroy. The use of force may be unavoidable (arguably, even reasonable) in the pursuit of survival, i.e., in the face of existential threats, but it is useless in the pursuit of happiness. It is simply impossible to pursue happiness with force.
[Sidebar: War can be defined as a method for conflict resolution that relies on the use of force (the mere willingness even to consider the use of force to resolve a conflict amounts to a veiled willingness to go to war; it may be outside of conscious awareness, but it’s there).
One of the greatest and most damaging myths propagated throughout human history is the idea that it is possible to win a war — it is a blatant lie: Wars can only be lost. No war has ever truly been won. While one side’s losses may seem to surpass the other’s, leading them to claim victory, this is merely an illusion. In reality (at any level — intrapsychically, interpersonally, and internationally), everyone involved is guaranteed to lose once a war starts.
The idea of war is so profoundly irrational that war-mongers inevitably rely on fanning anger and hate, which are intoxicating emotions. This intoxication clouds judgment, making the use of force seem like a reasonable option.]
The effective pursuit of happiness is a creative process: it amounts to creating order in place of disorder or chaos. Creating order requires an investment of energy (according to our trustworthy physicist friends and their annoying but indisputable laws of thermodynamics).
Energy can be invested in two ways: instantaneously or gradually. By definition, the instantaneous release of energy is a show of force. The alternative — a measured, gradual release of energy is a show of strength.
Encountering pain without tolerance results in a reflexive discharge of energy — all at once, in an instant, i.e., as a show of force. It may bring immediate, short-term relief, but it is guaranteed to have a destructive impact in the long run. When pain is met with tolerance, the same energy can be released gradually over time, i.e., as a show of strength. Tolerance then permits using one’s energy deliberately — constructively and creatively, protecting its potential to serve the pursuit of Happiness.
Intolerance is synonymous with espousing the use of force; it leads to one of two paths — either force is available (and applicable), or force is unavailable (or inapplicable). Neither path is compatible with the effective pursuit of Happiness: If force is used, as just discussed, it is guaranteed to have a destructive effect, incompatible with an effective pursuit of happiness. Alternatively, if force is unavailable or inapplicable, the reflex to use it is blocked or frustrated, which adds misery to the underlying pain (that triggered the reflex in the first place).
Note that, unlike pain and suffering, misery is avoidable; failing to avoid it, i.e., adding misery to a situation, can only interfere with the pursuit of happiness.
(For a discussion of pain, suffering, and misery go to: https://wp.me/P7aKBB-3w )
To be clear, refraining from the use of force is not the same as being passive or avoiding action. Being passive, as a method in the pursuit of happiness, is not more effective than being reactive.
The effective alternative to both is being active. Being active hinges on the ability to override the pressure generated by one’s feelings and mood.
From a Mindfulness perspective, being active in the pursuit of happiness means acting in a value-driven way — choosing actions that most accurately express one’s system of values.
The practice of Mindfulness (as are all the major schools of spiritual practices) is geared toward making ‘being active,’ i.e., acting in a value-driven rather than a feelings or mood-driven way, the habitual default.
(For a review of the practice of Mindful Choice-Making go to: https://wp.me/P7aKBB-6h .)