Question: What is happiness?
Steven Hayes: You know, there's many different definitions of it. I think one dangerous definition of it is to think of happiness as kind of a warm, joyful, **** feeling in your heart that you have to pursue and grab and hold onto for fear that it'll go away. I mean, it's fun when you have those feelings, but we know, and the evidence shows, them more intent you are on having those feelings and chasing those feelings, that's a butterfly that flies away the more you chase it. A better way to think about happiness that actually is something that I think you can reach towards is, it's living in accord with your values and in a way that is more open and accepting of your history as it echoes into the present, that's more self-affirming, self-validating and values-based. The Greeks had a word for it; they called it eudaimonia, and it's not a bad definition. And I think that definition of happiness is something that will empower human lives.
The definition that we have that gets very hedonistic and emotion-oriented -- the problem is that there's too many quick and dirty ways to chase that in ways that end up being unhelpful to people. If you avoid the feelings of betrayal and the sense of insecurity that comes in relationships that aren't working by running into detuned relationships, by sexuality that isn't connected to intimacy, et cetera. Yeah, you might feel good, but it doesn't live well. If you just have another martini or even more severe forms of substance use, yeah, it might feel good, but it doesn't live well. And if you escape into kind of a materialism -- the right car, the right woman, the right house, the right trip, the right place, the right job, the right praise -- you know, these things -- all of the folks who are wise in our culture, over the history of our culture, have written about the dangers of trying to define a meaningful life that way. But commercial culture and our media is constantly encouraging us to think that if we feel good we live well. And then we're only too happy, thank you very much, to sell you goods and services from the dancing oivoids and the pill you can take, or the trips or the cars or the clothes or the women that you can get with -- whatever that is that will give you the quick route to that.
And it's an empty promise. I think young people know it's empty, but they're not quite sure what to do. And I kind of look at what's on the T-shirts and I see another solution, which also worries me. I see "Just do it." "No fear." -- this kind of suppressive response to the treacle that the culture tries to define for us as a meaningful life also blows up on you. "No fear" is not something that you should put on your shirt. How about "I can hold my fear and still connect with you"? Put that on your shirt. "It’s okay to be me, with all of my history." Put that on your shirt. So there's a middle path. There was a guy who sat under a tree a long time ago who is important to a pretty big chunk of the human population that called it The Middle Path. There is a middle path between indulgence and suppression, but the culture has overwhelmed that in the cacophony that has been created in the modern world and the commercial encouragement of avoidance and indulgence on the one hand, or suppression and "just do it," treating yourself as an object on the other. We've got to find a way that's more compassionate, softer, that allows us to move forward towards the kind of lives that we really want to live.
Question: Are Americans striving too much for happiness?
Steven Hayes: I think the commercial culture, and also science and technology after all, which gives us greater ease but also makes it harder for us to sit with the small amounts of distress that come just by living itself, is probably -- the combination of the commercial culture and the media culture and the science and technology has probably made it more difficult in American culture. But I think it's built into language and cognition. It was only given some counterweights -- the major institutions that are there are our spiritual and religious traditions, which emerged very early on, at the point at which human language grew and written language created kind of the problem that we can have now with language kind of running away from us. And those traditions have weakened too in our culture, and they've changed. So we probably do -- it isn't that we're chasing happiness; I think we have the wrong model of happiness. I mean, defined as eudaimonia, defined as a values-based life of integrity and fidelity to yourself and what you most deeply want to stand for, that definition of happiness -- man, that's the kind of life I want to live and I think that will support people and sustain people.
But this cheap-thrill version, this sort of ease definition, the feel-good definition of happiness is an empty promise. And the culture in the West I think has done a particularly bad job of indulgence in that vision of what happiness is and encouraging people to chase it. And I think we can see in the growing amount of problems that we have in the developed world that it's an empty promise. And I'll give you an example, not from the U.S., but in Scandinavia probably the most worker-supportive part of the planet, they have the highest rate of chronic pain and the greatest rate of worker-related disability. So right inside this idea that any kind of pain and difficulty is so much unwelcome that if you say that you're in pain, we're going to come in guns a-blazing and even pay you full salary to quit work because you're burned out, or to -- inside that what you're going to create is gigantic amounts of chronic pain syndrome. Scandinavians spend 15 percent of their gross national product on disability. Fifty percent of the public health nurses are on disability. I mean, and that's where we're headed in the U.S. too, because unless we get wiser as to how to carry the difficulties of life in a way that's self-compassionate and empowering, we can create this kind of world in which we'd rather sort of plug into the matrix with whatever pills or escapist tendencies we can think of instead of walking through a process of living that's going to include loss. It's going to include limitations on function. It's going to include some significant difficulties. We need to learn and teach our children how to do that. And the West is just doing a terrible job of that right now.
Question: Do you believe in medicating depression and other forms of mental illness?
Steven Hayes: Medication -- I want good science, and big pharma is only too happy to give us bad science, because the way the FDA is set up and what the requirements are -- I mean, these are geek topics, and the normal person wouldn't really know how to evaluate it. But you only require a certain number of randomized trials. You don't have to have the proper control groups. You can have the blind be penetrated; people can know that they're on the medication, which we know there's a big placebo effect inside medications. So the science is often inadequate. The best science that's out there, then I want to -- then that's fine; let's go there. And there's decent science.
Let's take something like antidepressant medications. There's decent science saying it has an effect, but it's shockingly small after you control for penetration of the blind, people knowing that they're getting the active pills versus sugar pills, if you use an active control. It's probably only a few points. Like in depression, on the 56-point scale, the estimate is it probably accounts for about two points difference. But it's a multi, multibillion-dollar industry. And by the way, has huge side effects. And some of these medications, 40 percent of the people taking them have significant sexual side effects, for example. And that's just one. The level -- a single antidepressant medication can be worth a billion dollars to a company.
So I want good science, and I want it to be realistically marketed. I wouldn't like -- I think all these commercials that we have -- only two countries on the planet that allow pharmaceutical companies to market directly to people, New Zealand and the United States -- it's a bad idea, in my opinion. I think it ought to be better regulated. And when it's presented to people, it ought to be presented in a way that's realistic. For example, often people will prescribe these medications, and we'll say, you have a brain disease; you'll have to be on these medications permanently. It's because you have a brain disease. Well, brain disease -- there would be a specific biological marker for the so-called disease. There is no biological marker for depression. It's not true that we know that it's a brain disease. Is the brain involved in depression? Yes, the brain is involved with what you and I are doing right now. If neither one of us had a brain, we wouldn't be having a conversation. But that doesn't mean it's a brain disease.
And so the prescribers very often overstate, oversell, and the detail people are only too happy to tell them to do that. This idea that there's something wrong with your brain, and because of that you're permanently -- by the way, almost never are these medications evaluated with what will happen if you're on them for three, four, five, 10, 15 years. Sometimes some of the side effects that come up come up only later, and sometimes they're very severe, even irreversible side effects. So I would like it to be more like yes, these medications might be helpful to a degree, but what they do in areas like depression or antipsychotics is, they give you a little more distance between the things that cause you to get entangled with thoughts and feelings. And so they might be of some help, open up a little window. Now can we go in there and learn some of these methods directly to do that?
For example, antidepressant medications, you still have some depressive thoughts. Antipsychotic medications, you still have some psychotic symptoms for the vast majority of the people taking them. But it gives them a little separation, and it doesn't control his behavior as much when you have a sad feeling, difficult thought, an odd perceptual experience. We can teach people those exact skills in therapy, and so evidence is pretty good if you use it as just a window to get in there and teach these skills, you get longer-term benefits and without the side effects. So don't be sold just because a commercial interest wants to sell you things. The government ought to help out, because the average citizen can't go out and be doing reviews of the scientific literature. And focus on the processes that have low side effects and good long-term outcomes. Right now you're going to find those in the psychosocial area, in the therapy area, in the empirically supported treatments such as ACT or cognitive behavior therapy, behavior therapy. And go there first rather than going to the pill bottle as if it's going to be the end of your journey, that it's going to solve the problem. Very often it's only going to help, and even only to a minor degree, and more is going to be needed.