Having a life vs. The Happiness Pill

I want to give a general description of a class of patients I have seen in recent months, and then suggest what I think is wrong with them, and by extension, our culture. Bear in mind that these people are seeing me by choice, because they believe that there is something the matter with them that can be fixed. For all I know, there may be many more people like this who have no equivalent complaints.

These patients are essentially idle, due to medical or psychiatric disabilities. A most recent patient has serious medical problems, is morbidly obese and has other chronic and severe medical disorders. He is well over 50 and has not been able to work for years. He lives alone, has few friends, all casual, and no close relatives.

He states that he is "depressed". He describes his depression as "a flat emptiness... my life has nothing in it. I watch television much of the day, work crossword puzzles to occupy my mind and give me some stimulation. Day after day..."

Later in the session he confessed that he had "thoughts of suicide". He wondered if medication would stop the suicidal thoughts and depression, or if therapy would "make the depression go away". He said he is grateful that at his age and condition he "doesn't have that much further to go". His manner is dispirited and discouraged.

However, after questioning, I don't hear the typical pattern of thought that characterizes depression. He is not blaming himself unduly nor exaggerating his negative attributes as would be the case in the usual depressive disorder. He is emotionally rather flat, but then there is little in his life to provoke much emotion of any kind.

From my perspective, he is probably not depressed. He is bored, lonely, unproductive and self-centered. His life has no excitement or reward. His days are empty and all pretty much the same, punctuated by illnesses. No one really knows him or even if he is alive or dead. Of course at times death seems preferable to him to his empty life, and I find myself thinking that if my life were as empty and boring as his, I would probably find myself considering the benefits of death. He wants a cure for his misery that 1) doesn't require any real change or effort, and 2) is quick and effective. He wants a "happiness pill". I wish I had one, though I'm not sure I would take one myself.

I tell him that I can help him and show him how to overcome his unhappiness, and also that I do not believe he is depressed and that his misery is not a medical problem. He is irritated but intrigued, and asks me how this might be accomplished. The hard part, I tell him, is that if he continues to live as he now does, he will continue to be miserable. I added that his thoughts of suicide were the result of how miserable his life is rather than because of "depression", and that the solution to his problems was not to kill himself or to take pills expecting miracles, but to change his life.

I'm not sure he has the will or interest in doing this. He needs to matter to someone or several people, but to do that, he would have to devote part of his life to other people, to find a way of contributing to the welfare of others. While clearly he is unlikely to find a job, given his condition and age, he could spend a few hours every day in a nursing home, assisting bedfast people by reading to them or writing letters for them or simply talking to them. This sounds very difficult to him. He has really never had to think about anybody but himself, and is not accustomed to reaching out.

I'm convinced, however, that a life centered solely about oneself and giving nothing to others is a miserable and unhappy life, and no pill in a bottle or quick fix, therapeutic or otherwise, is going to change that. I'm remembering that as a young and unhappy man I entered therapy with the expectation that some revelation from my past, surfacing during the therapy, would change everything and as a result of this "insight" I would suddenly become a happy and well-adjusted person. I now see that as only a slightly more sophisticated version of the "happiness pill".

Therapy doesn't provide happiness. A good life is the only thing that can do that.