Last week I was reading a post on Revenge of Eve about her weekly happy list challenge. The challenge for the week was to identify routines that bring you joy. I adore Candace and normally participate in her challenges and such things, but this one just wasn’t doing it for me, and that got me thinking.
When was the last time I felt joy or happiness? Honestly, it’s been around 3 years – before this current episode (although who can really call it an episode anymore) of depression got started.
In his book Stahl’s Essential Psychopharmacology, psychopharm guru Dr. Stephen Stahl divides mood-related depressive symptoms into two broad categories, decreased positive affect and increased negative affect.
Decreased positive affect
Decreased positive affect involves impaired ability to experience positive emotions, including:
- anhedonia (inability to experience pleasure)
- loss of interest
- loss of self-confidence
These symptoms represent a lack of positive things that would normally be present. Dopamine and norepinephrine appear to be the main neurotransmitters involved in these symptoms
Increased negative affect
Increased negative affect involves the presence of negative emotions, including:
Symptoms of decreased negative affect are difficult emotions that are experienced to a greater extent than they would be at baseline. Serotonin and norepinephrine appear to play a key role in this symptoms.
Experiencing decreased positive affect
While I certainly have increased negative affect thrown into the mix some of the time, overall my mood symptoms have been much more in the decreased positive affect category. Other than thinking the guinea pigs are cute, I just don’t seem to have the capacity to feel much of anything positive. When I’m being mindful of things in nature I’m able to feel interest and curiosity, but that’s about it. Perhaps in a way it’s a good thing that there’s not a ton of negative stuff kicking around in my head most of the time, and probably on a day to day basis decreased positive affect is easier to cope with than increased negative affect.
When it comes to treatment, though, I wonder if with decreased positive affect there’s less to sink your teeth into in terms of creating change. It makes me wonder if perhaps that’s why counselling has never really gotten off the ground for me. With decreased positive affect it seems like there would be less to grab onto from a CBT perspective than increased negative affect. Sure, CBT would suggest behavioural activation and all that crap, but I’ve done that before and it doesn’t make a difference. It’s not that I’m biased against behavioural activation in its various forms, and I think it’s the kind of thing that can be quite effective for some people some of the time, but personally I’ve tried activation with the hope of motivation following along later, and it just hasn’t happened.
That’s part of why my trip to Italy a few months back was important to me. When I’m well, travelling is my passion; it’s what matters most to me, and I find it exciting and fulfilling and all that jazz. The fact that I felt “meh” throughout the trip wasn’t necessarily all that emotionally distressing in and of itself, but I think it really reinforced in my head that the lack of happiness truly is a capacity issue rather than a circumstances issue.
Is happiness out of reach?
So if lack of happiness is in fact a capacity issue, is there any point in trying to choose happiness? I’m not saying I shouldn’t look for positives. I keep a daily gratitude log, and I make a point of writing down accomplishments and other positive things in my bullet journal. I try to be very attentive when it comes to practicing self-care. All of these things are important to help keep negativity at bay, and I certainly intend to continue doing them.
But trying to find happiness or joy where there is none available seems kind of like an exercise in futility. It’s not that I haven’t felt those things before; I used to experience them quite regularly. But I’ve come to accept that illness has taken that away from me, at least for the time being. It’s not a conclusion that has much emotion attached to it, and it’s not something that I’m invested in, in the sense that I wouldn’t be willing to let it go. But for now, at least, it just is.
Do you struggle more with lack of positives or excess negatives? Do you think it makes a difference in how we experience our illnesses?