“No one sits down [for therapy] and says, ‘Are you happy?’” says Candice Ferguson, who is running for a Colorado state representative seat. “They say, ‘Are you sad? Are you depressed? Are you whatever.’ But no one tries [to] say that you’re going to be happy during your treatments, or once they’ve sent you on your way.”
Ferguson, who was sexually abused as a child and lived on her own before she graduated from high school, had a series of miscarriages in her 20s. She started having panic attacks. She sought a psychiatrist and was prescribed medication — now, at 43, she continues with therapy to maintain her health and is speaking publicly about her mental health history for the first time.
She prefers not to view her well-being in terms as stark as being happy or not, which she feels can set up those with mental health issues for failure. “Happiness is a dangerous carrot to dangle,” she says.
Among those living with mental illness, there’s a shared experience of your health being judged by whether or not you seem “happy.” Despite the increasingly popular refrain that everyone should be in therapy, many still think of therapy as something you need when you’re not content with life.
“I’ve had people tell me, ‘Oh, but you always seem like such a happy guy already,’” says Vardaan Arora, a 27-year-old New Yorker who has obsessive-compulsive disorder. “But even if someone presents as quote-unquote happy, it doesn’t necessarily mean anything. And also, you can have a mental illness, and have bad days, and still have good days.”
It’s a popular myth that mental health and happiness exist on the same side of a binary. Depression in particular is portrayed as the opposite of happiness — but happiness is an emotional state, and its opposite is sadness. Depression, like other mood disorders — and anxiety, psychotic, personality, eating, and substance-use disorders — is a health condition; the opposite, aside from never developing anything to begin with, is symptom management. “I mean, happiness is not something you learn about in medical school,” says James Murrough, director of the depression and anxiety center at Mount Sinai’s school of medicine in New York City. “It’s not even in our vernacular. It’s nothing we consider.”
Murrough says people will often refer to antidepressants as “happy pills,” a premise that makes no sense to clinicians. The ideal outcome of antidepressants isn’t happiness, but a return to the patient’s baseline level of functioning, or at least a reasonable approximation.
It’s a small irony that the demographic assumed to be furthest from happiness seems less clinically and personally preoccupied with reaching it, since the rest of the country’s scheming to optimize happiness continues apace. Among the general public, happiness is a whole industry now, churning with self-help gurus and college lectures and annual UN reports and a fetishized understanding of yoga. Of course, the kicker is that for all that expended energy, we’re only getting less and less happy.
People who live with mental illness do have longer odds on experiencing happiness than their healthy counterparts, but this is because they have more limited access to care. Compared to doctors in all other specialties in the US, psychiatrists are the least likely to accept insurance, and the options for those without private coverage are generally the thinnest of all. Mental health in this country is a luxury, and luxury is only for the wealthy.
It is inordinately difficult for even people of relative privilege, such as Ferguson and Arora, to access the basic levels of care that allow them to experience happiness, and often functionally impossible for lower-income Americans like Val Phillips, a 51-year-old farmer in Colorado.
“I’m on Medicaid, and used a public health option for most of my treatment, so we had to rewrite goals every three to six months,” Phillips says. She began having panic attacks in her late 20s, after her mother died. At 43, she attempted suicide.
After that, she began seeing a therapist regularly, and got a formal diagnosis of major depressive disorder and generalized anxiety disorder. She’s tried Elavil, overdosed on Klonopin, and currently takes Prozac and Wellbutrin daily, plus Vistaril as needed for panic attacks. But she says cognitive behavioral therapy and EMDR (eye movement desensitization and reprocessing, which involves recalling traumatic events while simultaneously tracking hand movements your therapist makes, sort of like you do at the eye doctor) have helped her the most.
“Initially it was just moving me away from suicidal ideation. Then it became specific positive changes in my relationships, work life, and general health management. I cannot recall happiness ever being a goal.”
People who’ve been through some form of mental health treatment might be less susceptible to the mirage — that sustained happiness can and should be our default state — because they’ve been taught to approach emotions as being inherently impermanent for everyone, in a way that, say, chronic illness is not. There’s less of an expectation that you’re striving for happiness at all times.
“Part of therapy is helping people to be less phobic or afraid of their emotions,” says Andrew Kuller, a senior behavioral health clinical team manager at the Harvard-affiliated McLean Hospital. “To recognize that they’re going to pass, and it’s okay to feel whatever it is they’re feeling.”
All the major emotions play an important role in our emotional lives, in giving us complexity and depth. Happiness is a healthy emotion. So is anger. Sadness is healthy and can facilitate real connection, and bears little resemblance to depression — which is not healthy, and often not so much like feeling sad as like feeling nothing. Yes, doctors want you to feel happy; they want you to feel.
For people like Arora, that’s a better goal. Arora was diagnosed with OCD in 2012. He’s tried Prozac, Lexapro, Anafranil, talk therapy, and exposure and response prevention therapy — exposure to something that triggers you, followed by prevention from completing the compulsive ritual with which you cope.
“With OCD, so much of your time is spent ruminating on what may happen in the future, or what may have happened in the past. Life just sort of goes by you, and you’re not really living in the moment,” Arora says. “To me, happiness doesn’t even have to be all the good things. I want to experience the bad things too, y’know?”
Kastalia Medrano is the travel writer at Thrillist. She was previously on the science team at Newsweek, and has written for outlets including Vice, Teen Vogue, the Paris Review Daily, and Pacific Standard.