As you might expect, cortisol is the anti-contentment hormone. Contentment means all is well and it’s OK to chill. If the adrenal glands are releasing cortisol, something must be wrong: time to get some butt in gear—mobilize the glucose, mobilize the fat, grab a chain saw and prepare yourself for the zombie apocalypse. OK, too much Walking Dead (2010 to the present), but you get the idea. This ain’t chillin’ time.
Female monkeys, like humans, form social hierarchies. Some are pretty impervious to stress, so no big surprise that they are at the top of the social totem pole. Those who are more subordinate, who have to scramble for food and status, have the equivalent of a more stressful life. And their serotonin gets shot down too. They have fewer serotonin-1a receptors in the DRN.24 Indeed, stress and cortisol are the mortal enemies of the serotonin-1a receptor, and cause down-regulation throughout most species—in the Gulf toadfish,25 in the rat,26 in the tree shrew,27 and in the human.28 Fewer -1a receptors means less serotonin signaling, and less contentment.
Depressed people have problems with circadian (day-night) cortisol regulation. Normally, cortisol goes up in the morning before you wake up to help you mobilize glucose, raise your blood pressure, and get ready for the day. By the time nighttime arrives, cortisol levels are in the sewer. This circadian rhythm of cortisol is missing in depressed subjects: their cortisol is always up and you can’t even suppress it with medications, making this a tough nut to crack. One study suggests that cortisol reactivity may be a predicting factor for suicide.29 More stress means more cortisol, which plays havoc by down-regulating the -1a receptor, reducing serotonin signaling and increasing risk for depression and apparently for suicide as well.
And those who are cursed with a specific genetic difference making lots of serotonin recycler/transporters (hungry hungry hippos) are at the highest risk. If your hippos are gobbling most of your serotonin in the synapse, and stress is eradicating your -1a receptor, you are totally screwed.30 The worst of all chronic cortisol problems stems from adverse childhood experiences, or ACEs (better known as child trauma).31 Pick your abuse (physical, sexual) or your stress (parents’ divorce, fighting, bullying): ACEs can result in cortisol dysregulation into adulthood,32 including increased risk for addiction and depression. Kids who experienced ACEs and who also harbored a genetic difference in their serotonin recycler/transporter demonstrated a fourfold risk in depression when they hit adulthood.33
And what does America suffer from across the board? Chronic sleep deprivation. If you really want to make someone unhappy, deprive him or her of sleep. Given that roughly 35 percent of the adult population doesn’t get enough sleep (on average less than seven hours per night),34 what effect does this have on happiness? When I was in med school, I frequently pulled all-nighters, and I was anything but pleasant. Screen time, stress, work/life balance—it’s harder than ever to actually fall and stay asleep. Arianna Huffington has argued for a sleep revolution (“Ladies, we are going to literally sleep our way to the top!”)—possibly the least violent revolution in the history of humanity, but arguably one of the most important.
Sleeping Your Way to the Bottom
What is the relationship between sleep, eating, irritability, and serotonin? Well, like everything in the brain, it’s complicated. Chronic sleep deprivation is a hallmark of severe aggression and irritability in some people35 and suicidal depression in others.36 Those who suffer from depression generally have off-kilter sleep habits, either sleeping too much (hypersomnia) or sleeping too little (insomnia). Brief shout-out to all those new parents who managed to survive those first two years.
Chronic insomnia is a major risk factor for depression.37 Whether chronic sleep deprivation affects serotonin receptors directly or indirectly through effects on cortisol is not yet known, but mouse studies would suggest that cortisol plays some role.38 In rats, lack of sleep messes with cortisol reactivity to stressful situations39 and simultaneously decreases the function of serotonin-1a receptors.40 As you might suspect, human data are hard to come by, as most institutional review boards frown on Gothic research methods such as long-term sleep deprivation.
Not only does insomnia and sleep deprivation wreak havoc on our mood and emotions, it messes with our waistlines, increasing insulin resistance, glucose intolerance, obesity, and all the other diseases of metabolic syndrome.41 One study found that sleep deprivation increased wanting of high-caloric food items (compared to when the participants had a good night’s sleep), and these changes in behavior corresponded with decreased activity in brain regions related to decision making but increased activation in the amygdala (the stress and fear center).42 And it likely goes both ways. Adults who get five or fewer hours of sleep per night consume 21 percent more sugared beverages (including energy drinks) than the general population, while those who sleep six hours or less consume 11 percent more.43 But, as in all other correlation studies, what drives what? Do sugar and caffeine cause sleep deprivation? Or does sleep deprivation drive sugar and caffeine consumption? Either way, when you’re chronically underslept, the Cricket gets stomped, and it’s time for Taco Bell’s “Fourth Meal.”
The Most Unhappy of Pleasures
Indeed, one of the most pernicious causes of unhappiness across populations is bad food. Remember from Chapter 9 that tryptophan is low in the fast-food diet, yet the competing amino acids tyrosine and phenylalanine are abundant. More precursors for dopamine means more occupied transporters, which means less chance for tryptophan to get across into the brain to be converted to serotonin. It would seem that any pleasurable item we consume that drives dopamine up (sugar, alcohol, processed foods) can also drive serotonin down, possibly directly, or indirectly through metabolic syndrome. Conversely, weight loss that reverses metabolic syndrome can also improve symptoms of anxiety while at the same time increasing blood serotonin levels,44 although blood levels are not necessarily relevant.
Depression rates started to increase after the post-1940 birth cohort reached adulthood—in the 1960s,45 at the same time processed food started its ascendency as the world’s diet staple. While this temporal relation is not causation, it’s still pretty suspect.
In this chapter, we have identified all the components leading to unhappiness and how they interact to ruin our mental well-being. Serotonin keeps dopamine in check, yet it appears that the same things that raise your dopamine can also tank your serotonin. Add cortisol to the mix, and happiness becomes unattainable. Figure 10-1 demonstrates how our current environment can contribute to our anguish. And it can happen to anyone. The worst part is that the triggers to enter this pathway are all around us: reward and stress are the hallmarks of modern civilization. This is our seesaw pathway to misery, the fulcrum on which our entire society rests. And once you enter, it’s difficult to escape. Doctors prescribe SSRIs while people self-prescribe marijuana, all to accomplish the same effect; no wonder they’re both such hot sellers. But there are other, more sustainable solutions (see Part V).
Nature wired our brains for both contentment and motivation, two seemingly dichotomous states. Everyone wants to believe they have free will—that they have choice over their own actions. Then why would anyone freely choose addiction or depression, with more “choosing” them every day? Addiction and depression are not choices that people make willingly. Our environment has been engineered to make sure our choices are anything but free. It chronically nudges us toward reward and drives us away from happiness and contentment. These ostensible choices have obvious personal costs, but they also have societal costs as well. Part IV will elaborate on how all of this science impacts our seemingly conscious choices, how government and business have used this science against us to manipulate these choices, and how our choices negatively impact society at large.
Fig. 10-1: The road to hell is paved with good intentions. The same factors that increase dopamine (technology, lack of sleep, drugs, and bad diet) also decrease serotonin. Furthermore, stress drives dopamine release and
also decreases the serotonin-1a receptor reducing serotonin signaling. Addiction results from dopamine receptor down-regulation coupled with excessive stress. Depression results from reduced serotonin transmission from the same precipitating factors, also coupled with excess stress.
PART IV
Slaves to the Machine: How Did We Get Hacked?
11.
Life, Liberty, and the Pursuit of Happiness?
No man is an island,” wrote British poet John Donne (1572–1631). Each of us influences everyone else around us, whether in our family or our community. Wise words. The quote continues: “Any man’s death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee.” If Donne is right (and he is), our personal happiness is tied up in the general level of contentment or distress within the rest of the population. If I am unhappy, is everyone around me unhappy? And if they are unhappy, was I the cause, or is there an outside force detrimental to each and every one of us?
Chapters 3 to 10 delineated the reward and contentment pathways as: (1) distinct, (2) overlapping, (3) regulatable, and most importantly (4) interactive. We’re told that things will make us happy, but they don’t. We’re told we should be ecstatic, but we’re not. Because what we’re told is based on a faulty premise—that pleasure and happiness are one and the same. A premise ingrained in the American psyche, and indeed throughout Western civilization. Industry and government call it economic progress, but it is they who have subverted the meanings of these two emotions—reward versus contentment, pleasure versus happiness—for their own purposes.
And we bought the subversion, both figuratively and literally. It’s the bedrock on which our economy is built. We spend money on hedonic pleasures, trying to make ourselves happy, and in the process we drive dopamine, reduce dopamine receptors, increase cortisol, and reduce serotonin, to ever further distance ourselves from our goal. The cognitive dissonance between our expectations and our reality is deafening. But what happens when this cognitive dissonance is societal, on a grand scale? What happens when you go from “It’s all about me” to “It’s all about we”? The science that belies the interaction between reward and contentment fuels both individual and societal unhappiness.
In Chapters 11 to 15, I will demonstrate, in turn, how the confusion between these two terms in the name of “progress” has inflicted personal, economic, historic, cultural, and health/health care detriments to individuals and to society in general. Moreover, this confusion continues to be stoked by industry and government in order to preserve and sustain persistent economic growth at the expense of the populace. Some would argue that a strong stock market and an increasing GDP must mean that we’re on the right track. Yet, even before the 2016 election, three-quarters of the country thought we were on the wrong track.1 This is flagrant cognitive dissonance. Why? We can’t possibly fix the problem if we don’t understand it.
The Abdication of the Declaration
Thus far we’ve equated individual happiness with eudemonia, or contentment. What does societal happiness look like? Is collective unhappiness also driven by dopamine, cortisol, and serotonin? How do you define it? How would you measure it? How do you know if you’ve run off the rails? And if you have, how would you fix it?
To demonstrate this cognitive dissonance on a societal level, let’s take a familiar example: America. We have the best system of government ever devised, although lately it has been put to the test. We have more natural resources than any other country. We have personal liberties that are unparalleled; we have a constitution that in the past has equalized personal versus governmental authority that has allowed the individual to flourish; and we have a series of checks and balances that, while often acutely fallible, over time have tended to right themselves. Winston Churchill said, “You can always count on America to do the right thing—after they’ve tried everything else.” Witness the zigzag successes of the civil rights struggle, changes in gender and now transgender equality, and same-sex marriage. Although most of the world still envies us, we’ve recently taken a hit due to the U.S. government’s foray into isolationism and protectionism. One reason America remains a prime target for terrorism is that the internet and social media now demonstrate to the “have-nots” what it looks like to be the “haves”—and they’ve subscribed to the premise “If you can’t join ’em, beat ’em.” Yet for all of its benefits, fairness, and provisions for economic opportunity, America is very unhappy.
Our Declaration of Independence assures us of the rights to “life, liberty, and the pursuit of happiness.” Well, “life” is going in the wrong direction, as witnessed by an increase in the American death rate2 and a decline in the mean American life span.3 Compared to other developed countries, American life expectancy is not all that terrific—only twenty-sixth out of the thirty-seven in the Organization of Economic Co-operation and Development (OECD: the most wealthy countries). But now U.S. federal data drawn from all deaths recorded in the country show that life expectancy for women fell from 81.3 in 2014 to 81.2 in 2015; for men, life expectancy fell from 76.5 to 76.3 years. And this is true across demographics. Age-adjusted death rates increased in 2015 from 2014 for non-Hispanic black males (0.9 percent), non-Hispanic white males (1.0 percent), and non-Hispanic white females (1.6 percent).4 This is a measure that economists use to quantify societal health, and it is the first time in recorded history where U.S. life span has declined.5 While it doesn’t seem like much, statisticians argue that this is a watershed moment in our country’s history.6 In addition, between 2014 and 2015, America saw an increase in infant mortality.7, 8 Despite our prowess in advanced health care technology, America ranks thirty-fourth in perinatal mortality among all countries. Black babies are twice as likely to die at birth than white babies. These indices are used by policy makers to gauge the vibrancy, health, and stability of individual countries. Their deterioration foreshadows a very uncertain future for America.
“Liberty” is a mixed bag. We have many social freedoms, yet we are stuck in metaphorical jails of our own construction, whether they are private gated communities or urban ghettos. Even when we try to pry ourselves out of them, we haven’t really escaped. Harvard economist Raj Chetty has shown that children born in poor neighborhoods have only a 1 in 10 chance of being able to improve their financial situation and social standing. The neighborhood you grew up in predicts your chance for upward mobility.9 For example, each additional year that a child spends growing up in suburban Chicago, Illinois, raises the household income in adulthood by 0.76 percent. That’s worth a 15 percent annual salary bonus at adulthood compared to the national average. Conversely, each additional year spent growing up in inner-city Baltimore lowers the annual earnings by 0.86 percent. For a Baltimore native, that’s worth a 17 percent annual reduction in salary by adulthood. In the immortal words of the Eagles frontmen Don Henley and the late Glenn Frey, “You can check out any time you like, but you can never leave.”
And “happiness”? The hard data of the increase in death rate and decline in life span serve as markers of our societal unhappiness. With the obesity and metabolic syndrome epidemics in full force and continuing to worsen, common sense would dictate that these excess deaths would be occurring at the upper end of the age pyramid, and that type 2 diabetes and all of its complications would be knocking off the elderly. But that is not what is seen. Rather, these alarming mortality statistics are being driven by the deaths of white Americans. While America has been preoccupied with the continuing specter of the murders of young black men and police officers, deaths from drug overdose have reached an all-time high.10 In 2015 there were more deaths from opioid overdose than there were from shootings.11 Nobel prizewinner Angus Deaton and economist wife Anne Case have tracked this demographic group relative to other countries and relative to other racial groups. This increase in deaths was largely ascribed to: (1) acute self-inflicted poisonings, which suggest suicides, (2) acciden
tal overdoses of prescription and street opiates in people who had become addicted, and (3) cirrhosis of the liver due to chronic alcohol abuse.12 And all of these preventable deaths are being tallied in white America,13 the demographic with the highest income of any group on the planet (although the data argue that within these white American statistics the highest mortality rates are in those with only a high school education). Deaton and Case point to a “cumulative disadvantage over life,” which is unrelated to income, but exacts itself through the labor market, in marriage and child outcomes, and in health decrements.14 Since the advent of Prozac in 1987, suicides and suicide attempts have declined slightly in the U.S.15 as a whole; yet, in the otherwise well-to-do white middle-class demographic, the opposite is apparent, with a 2.3 percent increase in the suicide rate in 2015.16 If we’re pursuing happiness, we sure aren’t catching up to it.
Thomas Jefferson vs. George Mason vs. the Pursuit of Property
How did we get to this place in time? How and when did happiness become subverted by pleasure? A brief but deep dive into American history will help, because you can’t understand the message unless and until you understand the messenger(s). Our politicians routinely cite the Declaration of Independence and the Constitution, interpreting the words and the intentions of the founding fathers. But who were these men and why did they craft these specific cornerstones of our democracy? That last clause of the Declaration, “the pursuit of happiness,” has a very checkered history. It was mentioned twice in print in 1776, and then it disappeared, never to be written again. In its place, the U.S. Constitution replaced the word “happiness” with “property.” The acquisition of the tangible quickly superseded the quest for inner contentment.
The Hacking of the American Mind Page 14