In 2014, I visited a major American medical school to give Psychiatry Grand Rounds on sugar and addiction. The administrator of the hospital’s substance abuse recovery program was a woman in her late forties, a former drug addict who had pulled herself out of her misery from opiate use. On being asked what addiction and getting clean meant to her, she replied, “When I was shooting up, I was happy. What my new life has brought me is pleasure.” When I heard this, I was quite taken aback. Of course, it’s exactly the opposite. People shoot up to recapture the pleasure of their very first hit. But they never can. So they inject more and more to derive less and less pleasure. It is not a coincidence that this woman misconstrued pleasure for happiness; this is exactly why she was an addict, albeit now in recovery.
I have known about the dopamine-serotonin-cortisol connection for at least three decades, dating back to my postdoctoral fellowship in a neurobiology lab at the Rockefeller University in New York. But it wasn’t until meeting and talking to this semi-unfortunate woman that I recognized how this seemingly trivial confusion might figure prominently in terms of why people become addicted in the first place. If she was so sure that she was happy while shooting up, I figured others might feel the same way. I’ve since talked to many of my colleagues in psychiatry and substance abuse treatment, and they corroborate that this view is commonly held among their patients.
Shortly thereafter, I was in Minnesota on a family vacation. My sister-in-law used to run the consumer response department at Pillsbury in Minneapolis before they were bought out by General Mills in 2001. She had to deal with all the phone calls from irate customers when the Poppin’ Fresh dough didn’t rise or when there was freezer burn on the ready-to-bake biscuits or crescent rolls. Although she has been gone from that job for over a decade, she is still convivial with the crew she worked with, and they see each other once a year or so for a gourmet club. One of her friends who had undergone bariatric surgery several years prior commented to my sister-in-law, “You look wonderful! So nice and slim. How do you do it?” She said, “I don’t need to eat much. I don’t eat when I’m not hungry.” To which her friend responded, “Don’t eat? Who eats for hunger? We’re not hungry either. Eating is about happiness.”
That was the aha moment. How many other people get it wrong? Of course, I take care of obese children on a daily basis, and I get to see and hear what their parents feed them and what they eat when they’re on their own. I knew this issue of eating for happiness wasn’t just anecdotal. Many patients tell me “food is my friend”—after all, it’s always there when they need it, it comforts them, and it never leaves their side. Well, you could argue, that’s exactly what’s wrong with people with obesity: they eat when they’re not hungry! And for a certain segment of obese people, there’s a lot of truth in that statement. But that leaves two questions that demand answers. First, why do they eat for happiness and how did they get that way? What made them need a surrogate friend, one that doesn’t talk back? And second, there are a whole lot of thin people who also eat when they’re not hungry, and they manifest the same diseases as do the obese, such as type 2 diabetes, heart disease, fatty liver disease, hypertension, cancer, and dementia; all of the diseases of metabolic syndrome. How many thin people are destined to succumb to one or more of these diseases, just because they didn’t know?
Either of these two clinical vignettes might have been passed off by the uninitiated as purely anecdotal. But the science and my clinical experience said otherwise. And as I researched the data for this book, the dark underbelly of Western culture and how it manipulates our beliefs and behaviors became ever more painfully exposed. We take it for granted that our society values money and its pleasures over all else, and then conflates those emotions with happiness. If parents don’t teach it directly to their children, then the TV or the internet will. This book just had to be written.
How many people are addicted to either a behavior or a substance, and they think it’s just a part of their general personality? They might say, “Oh, I have a horrible sweet tooth,” or “I’m a chocoholic from way back,” or that they frequently engage in retail therapy and post about it on Facebook for validation. No one comes out of the womb that way. You have to activate the dopamine pathway first. It’s reward, but it’s also learning—“This feels way good.” Once exposed, each of these behaviors becomes reinforced through activation of the reward pathway. And then the receptors start to dwindle. In no time, each individual becomes just another member of the mainstream consumer culture, another cog in the wheel of our economy, which boasts hedonic substances as commodity numbers two (coffee), four (sugar), and eight (corn, which is turned into high-fructose corn syrup).
I hope this book conveys that there’s nothing inherently wrong with pleasure—but not to the exclusion of happiness. Pleasure and happiness are not mutually exclusive, although in this book I’ve separated them as much as possible so as not to confuse the reader. After all, Wall Street, Las Vegas, Madison Avenue, Silicon Valley, and Washington, D.C., have confused enough people. My goal for this book was to scientifically parse the difference between these two ostensibly positive emotions, examine them separately, and watch what happens when you recombine them. You can, and should, have both pleasure and happiness in your lives. One will make the other that much sweeter. There are moments in life when you can experience both simultaneously (your team winning the Super Bowl or an Olympic gold medal, attending a wedding, going on a great vacation, having a child, or finishing a job well done at work), which elevates the baseline feeling of contentment to joy or elation, and we might find those experiences nothing short of rapturous. Sometimes the amplitude of simultaneous emotion is so great that we cry. These events are likely to leave the largest imprint on our memories, and will likely stay with us for the rest of our lives. In the future, when we pull them out of our subconscious and examine them, the sense of reward will have long dissipated, but the contentment within the memory will still be there. And don’t forget, things that generate pleasure often can be expensive, but things that generate happiness are dirt cheap.
The prediction of our demise due to our quest for pleasure is attributed to Aldous Huxley, who pronounced, “What we love will ruin us.” In Brave New World (1932), he described a human race that by the year 2540 had been destroyed by ignorance, technology, constant entertainment, and material possessions. But his forecasting was off by four centuries, as we’re already there. Conversely, Tolstoy buffs will recall that in War and Peace (1865), after protagonist Pierre Bezukhov is incarcerated by the French, he has ample time to ponder the meaning of existence. Awed by the serenity of a fellow prisoner, Pierre learns “not with his intellect but with his whole being . . . that man is created for happiness, that happiness is within him, in the satisfaction of simple human needs, and that all unhappiness arises not from privation but from superfluity.” In his captivity, Pierre postulates the virtuous simple life as the shortest route to contentment: “The satisfaction of one’s needs—good food, cleanliness, and freedom—now that he was deprived of all this, seemed to Pierre to constitute perfect happiness.”
The keys to benefit from pleasure and happiness are to understand the differences between the two, because even though pleasure and happiness are not mutually exclusive, they can still be opposites. There is plenty of room for pleasure in life, and lots of things can bring you pleasure. But no thing can make you happy. Experiences can make you happy. People can make you happy. You can make you happy. There are many ways to get there, and I’ve outlined them in this book. Each of them necessitates that you peel back the curtain of your own brain. There are many obstacles—your boss, your friends, your family, and of course even you—and they will derail you, but only if you let them, and only if you don’t know the difference. To paraphrase Benjamin Franklin, a great pleasure seeker himself: Those who abdicate happiness for pleasure will end up with neither. The science says so.