Looking to the Past for the Future of Psychiatry

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What it means to be a psychiatrist invites many questions. Can psychiatrists go beyond controlling symptoms and managing maladaptive behavior, helping patients become happier rather than just less depressed? Today, can we do better than Freud who promised patients “much will be gained if we succeed in transforming your hysterical misery into everyday unhappiness”? The answer is more nuanced than expected, but exploring the teachings of ancient philosophers can help us understand its ancient roots.

Positive Psychology is proactive in that it helps people to have happy and meaningful lives as opposed to treating just dysfunction or mental illness.

As a medical specialty, psychiatry has excelled in disease identification (diagnosis); treatment and management of symptoms (therapeutics); and definition of long-term outcomes (prognosis). At the same time, we have not extensively discussed the flip side of mental disorders, i.e., happiness and mental health wellness. A quick search through the American Psychiatric Association main textbook finds the word “happiness” cited a meager six times in more than 1,500 pages.

Psychology, on the other hand, has undergone somewhat of a renaissance over the last 20 years by building on “Positive Psychology,” under the guidance of leaders Martin Seligman and Mihaly Csikszentmihalyi. Positive Psychology is proactive in that it helps people to have happy and meaningful lives as opposed to treating just dysfunction or mental illness. There are, however, forgotten roots to many ideas currently proposed by Positive Psychology, and they lay in ancient Greece, particularly in the work of Aristotle (384-322 BC).

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The son of a physician from Stagira, Greece, Aristotle was mentored by Plato, who in turn, had himself been mentored by Socrates. This trio of thinkers revolutionized philosophy; Socrates by questioning how we acquire knowledge – using Socratic questioning still utilized today in cognitive behavioral therapy; Plato by postulating his platonic ideas and ideals; while Aristotle wrote founding books on biology, psychology, logic, physics, political science, meteorology, astronomy and metaphysics. He also wrote a very influential essay on happiness around 350 BC, influencing the likes of St. Augustine and Thomas Jefferson: the Nicomachean Ethics.

In his Ethics, Aristotle tackles the question of happiness head-on and reaches conclusions similar to those proposed today by “Positive Psychology” and Positive Psychiatry.

…eudemonic happiness focuses on meaning and self-realization and defines wellbeing in terms of the degree to which a person is fully functioning and developing her, or his, own potential.

First, he differentiates between two types of happiness: hedonistic and eudemonic. The hedonist’s definition of happiness is based on pleasure and dismissed by Aristotle as being “evidently quite slavish in their tastes, preferring a life suitable to beasts” – Book 1, Part 5. A similar distinction has been articulated by Martin Seligman in his book Authentic Happiness. In contrast, eudemonic happiness focuses on meaning and self-realization and defines wellbeing in terms of the degree to which a person is fully functioning and developing her, or his, own potential.

Second, Aristotle correlates happiness with the practice of virtue – a point echoed today in a recent comprehensive review on the relationship between happiness and virtue written by Christopher Peterson and Martin Seligman in their book Character Strengths and Virtues. In that book, Aristotle’s list of virtues is a prominent source for the Athenian virtues of courage, justice, temperance and wisdom.

It may be presumptuous to conclude that any field, psychiatry or psychology, can teach individual happiness. However, are science and philosophy necessarily mutually exclusive? The ancient philosophers would have argued no. Indeed, they would have asserted that it is incumbent upon both industries to try, just as the ancient thinkers made it their life calling to imbue human existence with meaning and contribute to the pursuit of happiness.

Recommended reading and resources about Positive Psychology

Martin Seligman: Authentic Happiness

Martin Seligman and Christopher Peterson: Character Strengths and Virtues

Charles Duhigg: The Power of Habit: Why We Do What We Do in Life and Business

Dilip Jeste: Positive Psychiatry: A Clinical Handbook

https://www.authentichappiness.sas.upenn.edu/

https://www.viacharacter.org/www/

http://www.pursuit-of-happiness.org/

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