On common unhappiness

In Studies on Hysteria (1895) co-wrote with Breuer, Freud wrote about “transforming your hysterical misery into common unhappiness”. What is common unhappiness and what can we take from it that can help us to better understand the way we suffer?

Freud appears to suggest that a state of unhappiness is an unavoidable norm:

“No doubt your fate would find it easier than I do to relieve you of your illness. But you will be able to convince yourself that much will be gained if we succeed in transforming your hysterical misery into common unhappiness. With a mental life that has been restored to health you will be better armed against the unhappiness.”

Is he being a fatalist or a realist here?

The well-known statistic 1 in 4 seems to suggest he was being fatalistic:

1in4

This statistic is often banded about on social media. It is catchy and easily understood. However, it came from studies carried out in the 80’s and 90’s using structured interviews. More recently the WHO assessed rates of depression in the population, the results far exceeded 1 in 4 and ended up being reported as a crisis.

There is another explanation for these results however and it resides in the flaws in the measures used to assess the symptoms of subjective experiences of things like depression and anxiety. The reality is that no one really knows how many people suffer from “mental health problems”.

There have been efforts made to diagnose mental illness only when it starts to impair abilities in functioning. In the DSM-V the language has shifted from:

“clear evidence of clinically significant impairment in social, academic, or occupational functioning.”

to

“clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.”

Perhaps this is where we can make the differentiation between mental health problems and ordinary unhappiness? If the symptoms we experience are getting in the way of us doing things like having relationships or going to work, does that tip the balance into having a clinically significant medical illness? What if I’ve just been diagnosed with cancer and how I feel about this is making me not want to go to work or see my friends?

There does not appear to be an accurate and precise definition that will define in absolutes whether the subjective  pain and objective symptoms experienced by someone is an illness or not. This is not to say in any way that mental illness does not exist, it is more to highlight the difficulty in recognising subjective states of distress that would benefit from some sort of supportive approach (mindfulness, therapy, medication), while at the same time not medicalising ‘normal’ reactions to life events.

What sort of paradigm or approach does a good-enough job of recognising this dichotomy?

For the majority of people in the UK going to a Dr with a complaint about mental health will involve being diagnosed with an illness, such as Generalised Anxiety Disorder, being prescribed medication and a referral for CBT to learn skills to cope. For some this will be the best approach and have the best outcome for the individual. For others short term therapy is not wanted or is not helpful. If someone is willing and able they could choose to access a different type of therapy.

Psychoanalysis first put forward the idea that the inner world of humans can be understood. Not by carrying out large statistical studies (that seem to tell us a lot, but actually tell us very little about someones unique experience) but within the inter-subjective analytical relationship. Psychoanalysis has an important part to play in giving unhappiness a space to be explored without making judgements about whether it is “ordinary” or not.

Perhaps there is an argument for offering longer term therapy on the NHS.

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27 thoughts on “On common unhappiness

  1. when I used to teach supervisees to make clinical assessments my rule of thumb was to ask them given the conditions of this person’s life/situation how would you (as a relatively ok person) feel? and if you would likely be anxious or depressed or such than don’t rush to diagnose them as dis-abled let alone ill.
    ugh “positive” psychology gives me the creeps, maybe it has different resonances here in the USA…

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      • ah yeah that’s more or less the same than, I had some fruitful exchanges with Mihaly long ago when I was doing some research with an engineering group on expertise (early flight simulators) but I find the popularizations to oversell both the occurrences and especially the implications (not unlike with “mindfulness”) as for flourishing what can one say in these days of economic, political, and environmental collapses, if most folks can find ways to cope day to day that would be really something.

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  2. I couldn’t agree more. Having suffered from major depression for most of my teens and 20’s, and having been so depressed that I was hospitalized for it at one point, I’ve learned that there is definitely a difference between mental illness and common unhappiness. I’m unhappy right now, following the death of my father a few months ago, but I’m not depressed. I can feel the difference between grief and sadness vs depression and suicidal ideation, but I’m not sure how I could tell someone the difference. It’s just an internal feeling. That being said, I know that my brain could easily get addicted to the sadness and turn it into depression, so I’m guarding against that and monitoring myself in case I need to seek help. So far, so good. I think blogging about it is actually helping. On a different note, I’ve just started reading your blog and am really enjoying it. Well thought out.

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  3. For me the issues can be distorted by treating happiness or unhappiness as something one either is or isn’t. Looking at this another way, sadness is a developmental achievement. It’s a sign of maturation in children and of progress in the bereavement process. It does not then mean that all life is sad, but the transformation of depression into sadness moves our life into a state that affirms the value of being. For me, this is what Freud was getting at.

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  4. I don’t agree with Freud, recently i was watching the movie “A Dangerous Method” – Jung didn’t agree with Freud either, he went further in his work and left Freud. I believe that everything can be cured and that “common unhappiness” can be transformed in something much better – at least I managed to do it for myself.

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  5. Offering a range of chocies usually works best for humans since each individual is very individual: chemically, biologically, interpretation of existence/their reality. Who can determine what is acutually baseline “normal” for aperson and which solution will work? For many thyroid meds, increasing or decreasing sunlight exposure, diet, altering activity levels, volunteering or a session with a good friend or a good book can make a difference – or maybe not.
    There used to be a lot of “quit wallowing in your misery” and “”please suffer in silence”. Just telling a person to cheer up – it’s not that bad or “choose to be happy” is usually said by those who/ve never experienced the deep hole with the walls falling in – so of course they say shallow things about something they haven’t experienced.
    Fighting environment or genetics? Destroyed by unrealistic expectations many they were lead to believe from childhood? A basket load of reasons. Certainly one size fits few.

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  6. Very interesting post. Personally I think we’ve come to rely to strongly on CBT as a treatment for any and all mental health problems (on the neurotic level at least). As you imply there is a strong case to be made for moving back to psychoanalysis as a treatment style.

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  7. In general, people identify with misery and commonly accept it as ‘part of life’ because they see others being miserable. Happiness confuses them and they are often times made to feel guilty for being happy. Everyone is unhappy so they should be too! What non-sense is this? There is no reason on Earth why happiness cannot be all (not just on week ends) of a person’s life. Study nature. Happiness is everywhere in nature! It is natural to be happy and un-natural to be otherwise.

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    • I’m not sure if our natural state is one of happiness. What about Hobbes: Nasty, brutish and short?
      People shouldn’t feel guilty about feeling happy, but I think we do. What did Zizek say about this drive to Enjoy Enjoy Enjoy.

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  8. Thanks for stopping by my blog and liking my post on increasing your mental health. I hope you checked out the positivity links in it. They offer a good perspective on our mental health.

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