- BIOETHICS FORUM ESSAY
The largest course at Harvard University is now Psychology 1504, “Positive Psychology,” the study of “happiness, self-esteem, empathy, friendship, goalsetting, love, achievement, creativity, mindfulness, spirituality, and humor,” with a 650-student enrollment, according to the Harvard Crimson. Attention to these qualities may be no more surprising in Cambridge, Mass., than, say, an oversubscribed program on water resources in Tucson, Ariz., but happiness studies rule worldwide. The last few years have seen major general- interest works and professional surveys on happiness from economists ( Bruno S. Frey and Alois Stutzer, Richard Layard), biological psychologists ( Daniel Nettle), neuroscientist-psychiatrists (Gregory Berns and C. Robert Cloninger), social and personality psychologists ( Daniel Kahneman, Norbert Schwarz, and Ed Diener (co-editors); David G. Myers; Jonathan Haidt; andDaniel Gilbert), and historians ( Darrin McMahon). Martin Seligman, former president of the American Psychological Association, now directs the Positive Psychology Center at the University of Pennsylvania, which offers a new degree of Master of Positive Psychology intended for professionals as well as for recent college graduates.
Curiously, few philosophers (including bioethicists) are examining this topic for lay readers, with the major exception of Carl Elliott. But the findings of positive psychology go beyond issues like gender reassignment and performance-enhancing drugs. They potentially affect all of medical practice.
Consider informed choice and autonomy. A major finding of social psychologists is that people are not very good at predicting their future emotions after a decision. Daniel Gilbert believes our poor “affective forecasting” may be beneficial, but do physicians, for example, have a duty to inform patients that people who have made a certain choice are ultimately no more satisfied than those who have not? (Fortunately there is a brighter side to affective forecasting: misfortunes and disabilities, like such presumed blessings as lottery jackpots and moves to California, have a much lower effect on people’s later sense of well-being than they expect, a result that should encourage recovery and rehabilitation.)
Or think of the social ethics of raising taxes for redistributive purposes like single-payer national health care. Liberal economists like Robert H. Frank and Richard Layard find vindication for progressive income taxes in happiness studies, which suggest rapidly diminishing returns on life satisfaction above a middle-class standard of living. The columnistGeorge Will has countered that conservatives, partly because of their more pessimistic attitudes and lower expectations toward change, have, since 1992, consistently reported higher levels of life satisfaction than liberals.
Finally, current happiness studies suggest a difference between the sum of our happiness at various intervals throughout the day and our later evaluation of our experience. Daniel Kahneman found that adding an additional (and unnecessary) minute of low-level pain following a procedure otherwise ending very painfully may result in a memory of the entire experience as less painful. Which is more real, the experience or the later evaluation, and should this affect medical practice?
Poor Sigmund Freud, whose 150th birthday has been neglected in America during the year of his countryman Wolfgang Amadeus Mozart. Perhaps it’s because of that old, mangled pseudo-quotation, “The goal of psychoanalysis is to convert neurotic misery into ordinary unhappiness.” As the American Psychoanalytic Association website observes, the profession’s founder was really advising a patient that, once cured of hysteria, she would be better able to deal with her circumstances. Recently, one of their British colleagues, Adam Phillips, has called for a more active conception of sanity, actually using “happiness” in his subtitle. So now that brain scanning may be vindicating the idea of the subconscious mind, perhaps a new cohort of positive psychoanalysts will soon put the joy back in Freud.