In the early 1970s, I lived in Colombia, studying native uses of medicinal and psychoactive plants. During my stay I made a number of trips to the Vaupés Department of the Amazon basin to visit a tribe of Cubeo Indians. To get there, I had to drive from the capital city of Bogotá at eight thousand feet above sea level to a city in the lower, warmer eastern plains, then take a cargo plane to the tiny frontier town of Mitú in the rain forest. From there it was a half-day trip by motorboat to the Cubeo village. The climate was unrelievedly hot and steamy, and once in the village, I had a very limited range of foods and drinks. When I was not interviewing Cubeos or accompanying them on walks through the rain forest, I spent hours in a hammock under a mosquito net, mostly dreaming about ice-cold drinks.
In particular, I could not stop thinking about my favorite juice bar on Seventh Avenue in downtown Bogotá and the delicious, icy drinks it offered, made from combinations of fresh fruit both familiar and exotic. One that I found irresistible whenever I was in the vicinity was jugo de maracuyá, made from a kind of passion fruit, with just enough sugar to offset its natural tartness and just the right amount of crushed ice. I would have given anything to have one as I lay parched and sweating in my hammock in the jungle with nothing to drink but tepid boiled water or tea or the thick, sour beerlike drink (chicha), also tepid, that the Indians made from a starchy tuber. If only, I imagined, I could have that cold juice right then and there, I would be supremely happy.
When it came time to leave the Cubeo village, I became obsessed with planning my visit to the juice bar. I pictured myself taking a taxi directly there as soon as I got to Bogotá, but what would I have first? Should I go right for the passion fruit drink of my dreams, or should I build my anticipation and pleasure by starting off with a fresh mango frost? Or maybe a pineapple-coconut shake? Throughout my entire journey—on the boat ride downriver, during what seemed like an endless night in a Mitú flophouse, on the cargo plane (missing its door), and on the long ride to Bogotá—all I could do was contemplate the happiness that was in store for me. But as the road began to climb the eastern foothills of the Andes toward the high plateau of the capital, I felt my anticipation wane as reality intruded on my fantasies. It got cooler and cooler as my trip progressed, and by the time I reached the outskirts of Bogotá, I was in the chill, damp fog that often envelops it. When I was in the jungle and couldn’t get it, I had wanted my ice-cold drink. Now that I was close to getting it, I was no longer hot and thirsty and didn’t want it nearly as much. By the time I arrived, I was more interested in checking into a hotel and changing into warm clothes than in going to the juice bar. And as I felt the possibility of satisfaction evaporate, my disappointment was compounded by seeing the folly of my fantasies and my tendency to allow myself to be happy on condition of getting something not available in the here and now.
The Harvard psychologist Daniel Gilbert has spent more than a decade studying just how abysmal human beings are at predicting which future events will make them happy. He has found that we tend to overlook how the future context—in my case the climate change I encountered—devalues the happiness potential of the goal we seek, such as the refreshing jugo. Here, science confirms the advice of saints and sages over eons: emotional well-being must come from within, because reaching external goals often disappoints.
Clearly, many people today are unhappy. I hear the words “I’m depressed” very often—from patients, friends, colleagues, acquaintances, and strangers—and I’ve uttered them myself on more than one occasion. But what do people mean when they say they’re depressed?
For some, it’s nothing more than a way of describing a bad day or being bummed about the weather or about a favorite sports team’s loss. Others are admitting they suffer from a chronic mental illness that can be incapacitating. In between is a broad spectrum of negative moods and emotional states, including sadness, pessimism, and the inability to experience pleasure or maintain interest in the potentially joyous and rewarding aspects of life.
The root meaning of the verb depress is to “push down.” To be depressed is to have one’s mood or spirits lowered. Who or what does the pushing? And how can we define down except as relative to something else? What is the emotional equivalent of sea level, from which point all positions above or below can be measured? Are we better off hovering near that level, or should we strive to stay above it?
These questions interest me greatly, in my ongoing efforts to both come to terms with the changing contours of my own emotions and understand why so many people today are experiencing depression. Also, I’m not sure how to respond to the question “Are you happy?,” which I get asked frequently. Happy might mean “content,” “joyful,” “blissed out,” or simply not sad. And how happy am I—or is anyone—supposed to be? There are self-assessment tools designed to help individuals determine their level of happiness, but I find it frustrating to answer the questions and don’t find them useful.*
There are a great many books offering ways to attain happiness, and no shortage of books about depression and its treatment (with or without popular drugs like Prozac). This book is different. It is about emotional well-being, and it is informed by the new science of integrative mental health, a field I helped develop.
Integrative mental health works from the general philosophy of integrative medicine (IM), beginning with an emphasis on the human organism’s innate capacity for self-regulation and healing. IM views mind and body as inseparable: two poles of one human being. It takes into account all aspects of lifestyle that influence health and risks of disease. It also makes use of all available methods to maintain health and support healing—both conventional therapies and alternative ones for which there is scientific evidence of efficacy.
I understand health as a dynamic condition of wholeness and balance that allows us to move through life and not succumb to malfunctions of our own physiology or suffer harm from all the potentially damaging influences we encounter. If you are healthy, you can interact with germs and not get infections, with allergens and not have allergic reactions, with toxins and not be harmed. Moreover, a healthy person has a reserve of energy that allows for fulfilling engagement with life. The essential qualities of health are resilience and energy.
When I describe health as dynamic, I mean that it is always changing, allowing the organism to find new configurations of balance as external and internal conditions change. Physiologists use the term homeostasis to designate this dynamic self-regulation of living organisms. Thanks to it, our bodies are able to maintain relatively constant temperature, blood sugar, tissue chemistry, and so on, despite great variations in environmental conditions and demands. If, as I believe, mind and body are most usefully viewed as two aspects of the one reality of our being, then homeostasis must also be essential to optimum emotional health. By drawing analogies from the science of physiology and by using the principles of integrative medicine, I will try to answer the questions I raised earlier in this introduction.
Let me start by pointing to some new findings about the function of the human heart. Throughout history, and in many diverse cultures, people have regarded the heart as the seat of emotions. Our language reflects this association (heartwarming, heartbroken, heartaches, and heartthrobs); in written Chinese and Japanese, the same character denotes both heart and mind.* We often feel strong emotions in our chests, probably because continual hormonal and nervous communication between the heart and brain links the activity of these organs.
When I learned to perform physical examinations in medical school, I was taught to first measure a patient’s heart rate by timing the pulse in the radial artery at the wrist. I was taught also to determine whether the rate was regular or irregular, and if irregular, whether it was “regularly irregular” (as from benign premature contractions) or “irregularly irregular” (as in atrial fibrillation, a more serious disorder). Most of the patients I examined had regular pulses in the normal range of 70 to 80 beats per minute. I came to regard the healthy heart as a sort of living metronome, ticking away at perfectly regular intervals, and understood that if a heart beat too fast or too slowly or abandoned its regular rhythm, it was not in good shape and could jeopardize general health.
That was back in the late 1960s. Since then, much closer analysis of electrocardiograms has revealed a surprising fact: healthy hearts do not tick like mechanical clocks or metronomes. Rather, the intervals between beats vary slightly in length, and what is more, this heart-rate variability is a fundamental characteristic of cardiac health. Cardiologists now know that loss of heart-rate variability is an early sign of disease; when profound, it is a poor prognostic sign for recovery from a heart attack. We have also discovered ways to maintain and increase heart-rate variability in healthy individuals using combinations of exercise, stress reduction, and mind/body interventions.
You might wonder why the healthy heart beats at varying intervals. I see it as a sign of resilience and flexibility in responding to moment-to-moment changes in the rest of the body. Clearly, extremes of heart rate are abnormal and unhealthy. But normal and healthy do not mean “static.” In this core function of the human body, we can see the reality and importance of dynamic change that is characteristic of health.
Human emotional states also vary, from extremely negative to extremely positive. At one end is total despondency, with the pain of daily experience so unbearable that suicide appears to be the only option. At the other is ecstatic bliss so intense that attending to basic bodily needs is impossible. Examples of the despondent abound; you may very well know such unfortunate people. Examples of those who experience ecstatic bliss are not common today, but I have studied historical accounts of some, such as Ramakrishna Paramahansa (1836–1886), a famous Indian saint. He spent much of his life in a state of “God-intoxication,” wandering, dancing, and singing in ecstasy,* while totally neglecting his body. Ordinary people thought him insane, and he would not have survived if his followers had not cared for him.
I’m sure we can agree that such extremes of negative and positive moods are neither normal nor desirable if they persist, but might they—by marking the limits of emotional variation—help us discover the neutral midpoint of emotional health?
I will tell you at the start that I do not consider happiness to be that midpoint. Nor do I regard it as a mood that we should be in all or most of the time. I wrote earlier that I’m not sure what it means to be happy, especially when I consider the root meaning of that word. It derives from happ, an Old Norse root meaning “chance” or “luck,” and is closely related to the words happenstance and happening. Clearly, our forebears regarded good fortune as the basis of happiness, putting the source of this much-sought-after emotion out of our control and in the realm of circumstance—not, I would argue, a good placement. Happiness that comes from winning a bet or from another stroke of good luck is temporary and does not change the set point of our emotional variability. Besides, as we all discover, fortune is fickle. If we hitch our moods to it, we are signing up for lows as powerful as any highs.
Nonetheless, I observe that many people seek happiness “out there.” They imagine it will come to them if they get a raise, a new car, a new lover, a refreshing glass of juice, or something else they want but do not have. My own experience, repeated many times, is that the actual emotional reward of getting and having is usually much less than the one imagined. All of the recommendations in this book will help you create an internal state of well-being that is relatively impervious to life’s transient ups and downs and independent of what you have or don’t have.
I said above that I do not consider happiness to be our baseline or most normal mood. Before you accuse me of deceiving you into reading this book by means of a seductive title, let me explain my choice of the word spontaneous. I used that same word in the title of a previous book, Spontaneous Healing, intended to build confidence in the human body’s innate abilities to maintain and repair, regenerate, and adapt to injury and loss. I call these processes spontaneous to indicate that they are natural and that they arise from internal causes, independent of external agencies. This is an important biological fact, one commonly misunderstood and unappreciated by both medical practitioners and patients. The concept of self-healing is a foundational principle of integrative medicine and has long been a focus of my work. I am certain that if people trusted more in the body’s potential for self-healing, and if more doctors honored the healing power of nature, there would be much less need for costly health care services and interventions.
The reality of spontaneous healing does not excuse you from doing everything you can to support it with wise lifestyle choices. Nor does it mean that prudent medical care is unnecessary. The term simply calls attention to the fact that healing is an innate capacity of the organism, rooted in nature. By linking the words spontaneous and happiness I am asking you to question the prevalent habit of making positive emotions dependent on external agencies and to think of happiness as one of many moods available to us if we allow for healthy variability of our emotional life.
My personal opinion is that the neutral position on the mood spectrum—what I called emotional sea level—is not happiness but rather contentment and the calm acceptance that is the goal of many kinds of spiritual practice. From this perspective, it is possible to accept life in its totality, both the good and the bad, and know that everything is all right, just as it should be, including you and your place in the world. Surprisingly, this acceptance does not breed passivity. I have found that I am most effective at creating positive change when I am in this state; energy normally employed to ward off frustration at opposition or fear of failure is instead channeled precisely where it needs to go. Based on the moments I’ve been able to be there, I am sure that’s where I want to be more of the time.
Here are some basic tenets that inform my writing about emotional well-being:
These tenets are not merely my opinions; each is bolstered by a growing body of rigorous scientific research. If you are comfortable with them, I invite you to read further.
In the first chapter of this book I give you a sense of what emotional well-being means, the goal of your journey, and the role that happiness plays in it.
Chapter 2 is an overview of depression, including my understanding of the causes of the current epidemic of it.
Chapter 3 examines the limitations of the biomedical model now dominant in psychiatry, in particular how it has failed to help us prevent depression, treat it effectively in our population, or improve overall emotional wellness. I also share my excitement about the emerging field of integrative mental health and explain how its view of the causes of depression differs from that of the biomedical model.
Chapter 4 presents evidence for the effectiveness of integrating strategies from Eastern and Western psychology to optimize emotional well-being, drawing on both ancient tradition and contemporary neuroscience.
In the second part of this book I provide specific recommendations.
Chapter 5 presents a comprehensive list of body-oriented therapies aimed at supporting emotional wellness.
Chapter 6 focuses on ways of retraining and caring for the mind in order to change mental habits that undermine emotional resilience and keep us stuck in negative moods.
Chapter 7 concerns the importance of attending to the nonphysical dimension of our experience—what I call secular spirituality—in working toward optimum emotional wellness.
A final chapter gives you a detailed guide to help you use these strategies in order to meet your individual needs. Whether you are prone to depression or not, my suggestions will help you develop greater emotional positivity and resilience and contribute to your general health and wellness.
I have made an effort to present the scientific evidence for my recommendations in terms that nonscientists will understand. Readers who would like more information or details about the science of human emotions will find key references to the medical literature in the notes, beginning on here. An appendix on here will direct you to sources of further information, products, and services to support you on your journey to optimum emotional well-being.
I will end this introduction with some personal reassurance. Whether you or someone you love is struggling with depression, or whether you just want greater happiness in your life or simply to feel better in difficult and troubling times, I know that the suggestions in these pages will help you. They are all based on sound science and on my own forty years of clinical experience. Take your time with them and put them into practice at your own pace. You can feel better—much better—than you do now. I look forward to guiding you on your journey.