What happened to happiness? How did it get stricken from the record? The pursuit of happiness is an inconsequential anachronism today: conceived of our best intent, yet reduced to our worst ignominy. The famed economist and pundit Robert J. Samuelson in 2012 wrote, “The happiness movement is at best utopian; at worst, it’s silly and oppressive.”17 He argued that the pursuit of happiness may be a right guaranteed by the Declaration, but its achievement is not an entitlement. Maybe he’s right, because we were only guaranteed its “pursuit.” Instead, the due process clause of the Fifth Amendment of the Constitution assures us of the government’s inability to deprive us of our right to “life, liberty, and property.” Property? Is property the booby prize for happiness? Or is property (as stated in the Fifth Amendment) just the guarantee of an individual’s right to acquire those necessities in life that can ensure happiness? In other words, is property a means to an end, or an end in itself? Is property necessary to one’s happiness? Can one be happy without property, or does one need it to be happy at all? Is happiness rooted in material possessions?
Thomas Jefferson, the primary author of the Declaration of Independence, was a master of eloquence and brevity. He charged our thirteen separate colonies to organize for a common cause and a set of common goals. He imbued our nascent country, on the verge of a revolution never accomplished in world history, to soaring aspirations—to be better than we were. Happiness was right up there with life and liberty. Not a word about pleasure. When you’re staging a rebellion, the central tenet can’t be about dopamine—nothing so sordid as a pint of rum (the substance of abuse of the time), which apparently was the coin of the realm back in 1776.
Yet it turns out that Jefferson lifted the line about happiness from his contemporary George Mason, who composed the Virginia Declaration of Rights, which was adopted by the Virginia legislature just three weeks before the fateful vote that established the Union. Mason was a student of history but not of creative writing or oratory. He drew on a long tradition of statements of rights and liberty including the Magna Carta (1215), the Habeas Corpus Act (1679), and British statesmen John Locke’s Second Treatise on Civil Government (1690). Mason’s actual verbiage in the Virginia document reads: “life and liberty, with the means of acquiring and possessing property, and pursuing and obtaining happiness and safety.” None of Mason’s primary sources mentioned happiness; he threw that in on his own. And Mason didn’t just want to be able to pursue it but to actually obtain it (at least for some people). A unique mind-set for those times, to be sure.
Jefferson liked the idea of including happiness, borrowed Mason’s line, and reworked it for his Declaration, but then he deleted the property clause. Why would he do that? Didn’t Jefferson believe in property? Or did he consider pleasure and happiness to be the same thing? More has been written about the moral vicissitudes of the enigmatic Jefferson than virtually any of our founding fathers (although Alexander Hamilton got the musical). Jefferson had more layers than a Shakespearean tragedy merged with a John Grisham novel. He was a patrician with a big bankroll, spent years living in luxury in France, and, most importantly, was a slave owner. And back in 1776, slaves were property. You’d think he of all people would have defended the right to accumulate and maintain property. But Jefferson deep-sixed the concept of property in the Declaration. Was deleting the property clause from Mason’s original text Jefferson’s method of absolving himself of his own shame and moral guilt that he felt as a slave owner? Making peace with his slave ownership? Was he perhaps advancing the cause of abolition? Or did it simply imply that you couldn’t very well pursue happiness unless you had property, including slaves? Many books have been written on this subject, perhaps the most revealing by historian Henry Wiencek.18 It’s not clear whether Jefferson truly abdicated happiness for property, because he couldn’t rescue the clause when the Constitution was drafted, since he was serving as ambassador to France.
Mason was also a very curious character in the history of our Union. He was the first to mention happiness as a goal of life and of government; yet happiness eluded him most of his life. His father drowned when he was ten, and his mother brought him up alone. He was a very bright student, and although he wasn’t formally educated at the bastions of learning of the day, he had resounding success in business dealings throughout his life and he became an extremely rich man, spending quite a bit of energy amassing property. His estate, Gunston Hall, was right next door and second in size to Mount Vernon, and he and George Washington had several business dealings before and throughout the Revolutionary War. He was married with ten children; however, his first wife, Ann, passed away giving birth to twins in 1773. In between, he was a Virginia statesman when he wrote his Virginia Declaration of Rights, in which happiness was a primary goal. No doubt his loneliness and possible depression during this interval weighed heavily on his mind, until Mason married his second wife, Sarah Brent, in 1780.
At this point, a perusal of Mason’s medical file is in order. Mason was quite affluent, but apparently his money couldn’t buy him happiness. In fact, he was in pain for most of the second half of his life. Check out the paintings of Mason from his legislative days on Google Images. He was quite obese and, more importantly, he suffered from gout. The bronze statue of Mason at George Mason University in Virginia has him leaning on his desk, favoring his left foot, due to the pain in his ankle from the disease.19 Gout is a chronic inflammatory disease of small joints due to the deposition of the liver waste product uric acid (see Fat Chance). Obesity and gout are both co-morbidities of metabolic syndrome, the cluster of diseases that signify metabolic dysfunction, such as type 2 diabetes and heart disease (see Chapter 10). What are the two causes of gout? Sugar and alcohol.20 In the 1770s these were two of the three readily available substances of abuse (tobacco being the third). But Mason was a teetotaler, so his gout and obesity weren’t due to alcohol. Mason knew that sugar was a primary cause of gout, because his contemporary Benjamin Franklin, a fellow sufferer from gout and other symptoms related to metabolic syndrome, knew that his sugar and rum consumption were the cause; he even wrote a famous poem about it.21 Similarly, Mason suffered from poor health for the twelve years after marrying Sarah in 1780. He refused to travel out of state, and in 1789 he declined a request by the state legislature to be the first U.S. senator from Virginia, as he would have had to travel back and forth to Philadelphia. Obesity and gout, both markers of metabolic syndrome and both consequences of his sugar habit, rendered him functionally disabled just as it does 25 percent of Americans today.22 Not a happy guy.
Two statesmen who birthed a nation. Both Jefferson and Mason yearned to steer the country toward the pursuit of happiness as an establishing principle of the Union. Jefferson saw it as a primary goal, while Mason saw it as a secondary outcome that emanated from ownership. Yet both abdicated in the end. The pursuit of property and pleasure trumped the pursuit of happiness in 1788. Dopamine trumped serotonin. And it still does. No wonder we’re unhappy.
“Good Night Sweet Prince, Flights of Angels Sing Thee to Thy Rest”
Aristotle argued “the pursuit of happiness and the avoidance of pain is a first principle; for it is for the sake of this that we do all that we do.” Yet it looks like our avoidance of pain has taken precedence over our pursuit of happiness, and it’s come home to roost in the guise of our national opiate crisis. Opiates mollify the perception of pain, but in the process they mollify the perception of life, and in the extreme they mollify life itself. There have been drug addicts for as long as there have been drugs. In the past, most victims tended to be young, misfit, and poor. Musicians of the 1960s like Janis Joplin and Jimi Hendrix were easy to dismiss as part of the prevailing counterculture. Lately such well-established talents such as Prince, Philip Seymour Hoffman, Amy Winehouse, and Heath Ledger are just a sampling of those who have recently succumbed. But this isn’t happening only to entertainers: they just get the publicity. Deaths from drug abuse are increasing in just
about every demographic—old, young, white, black, Latino, and now the middle-aged as well.23 Just look at the unfortunate consequence of secondhand drug availability: inadvertent opiate poisoning in toddlers, which has more than doubled in the past sixteen years.24 If toddlers are dying of accidental overdose, it’s not just because famous and disaffected youth are the abusers.
Athletes have long been using steroids for their performance-enhancing effects, but some have graduated up to opiates, starting usage due to an injury and then continuing it for its mind-altering effects.25 The same is happening with weekend warriors who tear an ACL or a muscle and end up using for the rest of their lives. A full 80 percent of heroin users started by using prescription painkillers first, and one out of fifteen people exposed to those painkillers will try heroin within the next ten years.26 Listen, when Saturday Night Live does a parody on “Heroin AM,”27 you know this phenomenon is mainstream. Why? Where did this come from, and why so fast? We recognize and bemoan the celebrity victims only too well, but do you recognize your neighbor? Your bus driver? Your kid? Your pilot? Who are the perpetrators of this national scourge and what’s driving it?
Pain Doctor or Drug Pusher?
This opioid explosion among the white middle class has escalated over the past fifteen years, and surprisingly the fuse was lit by the least likely of all pushers: the medical profession itself. Time for another brief history lesson that you won’t learn in high school—or in medical school, for that matter. For the first three decades after the Drug Enforcement Act of 1970, we physicians were counseled on how not to prescribe Schedule II drugs (i.e., those with addictive potential). People in genuine pain (e.g., cancer patients) had nowhere to turn for relief, even at the end of life. Fast-forward to 2001: A Drug Odyssey. In response to patient satisfaction questionnaires on physician behaviors as well as inpatient hospital feedback, it was clear that doctors were missing and/or not treating their patients’ pain. The American Medical Association and the entire medical profession did a complete 180-degree about-face. Treatment of pain was only cursorily covered in medical school, and the only course of therapy was opiates. But all of a sudden, pain became a painfully common topic among physicians. Was this a natural evolution in physician attitude? Or something more sinister? The timing of this pain revolution temporally coincided with two external changes in the legal drug culture.
Prior to the year 2000, the strongest narcotics, such as fentanyl, morphine, and heroin, were only available intravenously, which left many people out of the drug culture—because train tracks were grounds for losing your job or a Child Protective Services referral. However, in the late 1990s several potent oral opiates became available, such as OxyContin, Lortab, and Vicodin. Their introduction changed the playing field in several ways. The American Pain Society published new guidelines that advocated for doctors to aggressively treat pain. The Joint Commission on Accreditation of Hospitals, which certifies health facilities, issued standards in 2001 that instructed hospitals to measure pain: it became the fifth vital sign after heart rate, respiration, temperature, and blood pressure. But most importantly, the companies that manufactured these narcotics (Purdue Pharma, Johnson & Johnson, Endo Pharmaceuticals) began to aggressively market these opiates for muscle and joint pains, even long-term, on the premise that because they were long-lasting (like methadone) they were not addictive. They promoted prescription narcotics use through medical journals and continuing medical education courses, and even funded a report by the U.S. Government Accountability Office to give it the imprimatur of government complicity. State medical boards started to punish doctors for inadequately diagnosing and treating pain; and these same boards willingly accepted money from pharmaceutical companies to disseminate these new guidelines. Recently, unsavory narcotic marketing practices by Big Pharma have come under fire. One firm pled guilty to criminal charges that they had misled the FDA, doctors, and patients about the risks of narcotic addiction and abuse by marketing their drug as a safe alternative to standard narcotics.28
A new oral medication developed to combat opiate addiction called Suboxone (buprenorphine plus naloxone) was approved in 2002, giving physicians an added sense of security that any addicts could be easily be managed by preventing drug withdrawal. The advertisements from the pharma companies said that this combo drug reversed addiction because of the naloxone (which is an EOP receptor blocker). But in fact Suboxone is addictive in naïve people because of the buprenorphine. Suboxone, the medical anti-opiate, became a hit on the black market as a legal opiate.29
The Centers for Disease Control (CDC) reports that deaths from opioid overdoses in the U.S. have quadrupled since 1999, with twenty-eight thousand deaths in 2014 alone, of which half were attributed to prescription pain relievers obtained legally, some of which were then sold as black market drugs. Pain clinics are now almost as common today as emergency “Doc-in-the-box” franchises in some cities. One-third of all long-term users say they were originally prescribed their opiates due to an injury, but that now they’re addicted; and six out of ten say their doctor never told them how to stop.30 All of this has occurred while 99 percent of our citizens’ pocketbooks are growing to their highest level ever, even after controlling for inflation,31 although certainly not after controlling for the incomes of the top 1 percent. If the backbone of the middle class finds itself squeezed economically, drug addicted, and dying young, it sure doesn’t sound like America is particularly happy. The new iPhone just isn’t cutting it.
The Whole Country’s Going to Pot
Perhaps the most obvious display of America’s current unhappiness is the state-by-state switch from one anti-anxiety agent to another. Five states and the District of Columbia have now legalized marijuana for recreational use, and another twenty-eight states approve its medicinal use. In Washington, Oregon, and Colorado, the three states for which we currently have data, the drop in SSRI use has been inversely proportional to the increase in pot use.32 Short-term, marijuana has long been used to reduce acute anxiety, and many with terminal diseases have turned to pot to make the ride more bearable. But the question that still plagues us is: What does long-term use do? Numerous studies document that frequent cannabis users have a high prevalence of anxiety disorders, and patients with anxiety disorders have high rates of cannabis use.33 But again, is this cause or effect? We really need to know if marijuana use increases the risk of developing long-lasting anxiety disorders, yet sadly, the data continue to confound.34, 35 One lingering concern is whether long-term marijuana usage causes brain damage. While it would appear that THC stimulation of the CB1 receptor does not cause direct cell death, there is a burgeoning literature that marijuana use can alter brain networking and connectivity, especially in adolescents,36 manifesting as altered educational or social development into adulthood.37
Even though marijuana is not covered by insurance and it’s regulated and limited to purchases of one-quarter ounce at a time, costing about $150—it’s taxed to the hilt—in these states it’s legal without a doctor’s prescription. The fact that thousands of people have turned their backs on SSRIs in favor of pot in order to deal with their anxiety says two things: (1) they’re unhappy, and some may even suffer from undiagnosed subclinical depression, and (2) they’re willing to spend a lot of money in an attempt to get happy. Furthermore, with the repeal of Obamacare, and people not being able to afford their medications, expect to see an uptick in usage. If there’s good news here, it’s that more widespread legalization means more competition and prices will fall. But then more and more cannabis farmers will cry foul, trying to maintain control over this cash crop. It ain’t called the “green rush” for nothin’. When the U.S. government starts subsidizing marijuana (mark my words, it’s coming), you’ll know we’ve hit rock bottom.
12.
Gross National Unhappiness
When were we happy? The icons of the 1950s, such as Leave It to Beaver and Ozzie and Harriet and Father Knows Best and I Love Lucy, sugg
ested that husbands going to work, wives keeping house, kids with the usual adolescent angst and growing pains—i.e., family life—ostensibly was the Golden Age of American Happiness. Except the TV version wasn’t real. Actor Robert Young suffered from depression and alcoholism, and Desi Arnaz was a serial philanderer. Former Harvard president Derek Bok states that the percentage of Americans describing themselves as either “very happy” or “pretty happy” peaked in the 1950s, and thereafter has remained virtually constant, irrespective of rises in absolute or relative income.1 Were we really happier in the 1950s? Or is it that we were just told that we were? What happened to alter our perception of happiness? Or were we ever really happy? USA Today documents that our view of our happiness has not changed appreciably between 1972 and 2010: those responding “very happy” went from 30 to 29 percent, “somewhat happy” from 53 to 57 percent, and “not too happy” from 17 to 14 percent. Back in the 1950s we had minorities not voting, women not competing, and people not knowing what their government was doing. Even Adam and Eve were happy until they got some knowledge. So which is it? Ignorance is bliss or knowledge is power? Which would you rather have? Are we doomed to never be happier?
Americans invented the saying “Money can’t buy happiness” (and the Beatles knew you Can’t Buy Me Love, either). Yet Western culture has consistently chosen money over happiness. And we haven’t gotten any happier. Wallis Simpson, the woman who stole Edward VIII’s heart and crown, contributed the quintessentially American axiom, “You can’t be too rich or too thin.” Supermodel Kate Moss chimed in, saying, “Nothing tastes as good as skinny feels.” In other words, no matter your personal wealth, there’s always the impetus for more—or for your personal weight, there’s always the impetus for less. However much you have (or don’t), it’s just not enough. And therein lies the problem. Because there is no amount of monetary increase or body weight decrease that can activate the serotonin system to provide contentment, especially if you are food restricting. Why? Because money and food trigger our dopamine systems, not serotonin. So we will always want more (or less). Does chasing money bring happiness? And is Kate Moss really happier? Her history of cocaine use belies her $9.2 million salary and mega-stardom.2 Chasing the wrong dragon. Perhaps that’s how she stayed so thin.
The Hacking of the American Mind Page 15