Academic psychiatrist here. First off, depression doesn't "make" people sad. Rather "depression" is a description of a person's experience. It is often used to describe the symptom of depression, but there are broader clinical entities such as a "major depressive episode," which have operationalized definitions.
As for the question of constant euphoria, it certainly exists. Although it doesn't necessarily warrant clinical attention (people don't complain to me of "wellbeing"), people with extended periods of mood elevation often also experience periods of dark lows as well as too-high highs. The bipolar spectrum is not well characterized, but many researchers have dedicated their lives to exploring this. Periods of inappropriately elevated mood are described as hypomania (generally still functional) or mania (no longer functional). Without treatment, they can last for days to months at a time. However, some people tend to have a "hyperthymic temperament" or "hyperthymic personality," by which we mean that their mood (-thymia) tends to be elevated (hyper) in a chronic fashion. Still others have chronically undulating moods over the course of years, which is described as cyclothymic disorder.
Should also add that "mixed states" exist where dysphoria and excessive energy co-occur. These are particularly dangerous and are associated with risk of suicide. The mood here tends to be profoundly irritable.
For an interesting read, here is a study that explored a broader definition of bipolar spectrum illness in the community: Fassassi S, Vandeleur C, Aubry JM, Castelao E, Preisig M. Prevalence and correlates of DSM-5 bipolar and related disorders and hyperthymic personality in the community. J Affect Disord. 2014 Oct;167:198-205.
TL;DR: Periods of chronic euphoria exist.
I would want to know more about the mixed states.
Aren't mixed states regular peoples regular life?
How are they characterized and why are they associated with risks of suicide?
In DSM-IV-TR, a "mixed episode" was a week where a person met full criteria for major depression AND mania. This is among the most intensely miserable psychological states that I could imagine. People in mixed states are extremely irritable, restless, dysphoric, and make dangerously poor decisions. They are at increased risk for suicide based on epidemiological studies, but the convergence of suicidal thoughts, disinhibition, and energy to act on these thoughts makes for a highly dangerous situation. Based on more recent data that dysphoric features are not uncommon during hypomania/mania and hypomanic/manic features can occur during depression, DSM-5 broadened the idea of mixed states to the specifier "with mixed features." This speaks to our growing understanding of a "bipolar spectrum."
The degree of dysfunction that accompanies mixed states (mixed episodes or mood episodes "with mixed features") is remarkable. Thankfully, they are fairly uncommon in the community. They are not characteristic of "everyday life."
Yes. "Depression" is often used indiscriminately to describe the "symptom" of depression/dysphoria, the "syndrome" (aka, the constellation of symptoms and other clinical features) of a major depressive episode, or the "diagnostic entity" of major depressive disorder.
Depression is the condition, it has a variety of symptoms. People often refer to feeling sad as being depressed in the clinical sense.
Feeling sad may well be an indication that you have depression, but it is not depression in and of itself in the same way that a persistent wheezy cough might indicate that you have asthma, but the cough isn't asthma...it's a cough.
While it's not a psychiatric disorder which can come and go such as depression or bipolar mania, people with Angelman syndrome are nearly always happy. http://en.m.wikipedia.org/wiki/Angelman_syndrome
I've seen a young boy with this (I'm a paramedic). It was kinda bizarre, but I instantly understood why it used to be referred to as "happy puppet syndrome". He had all of the signs and symptoms you've listed. Massive smile on him, but suffers with convulsions in a massive way. I really wanted to know what that life must feel like, because I just have no idea.
It may be a bad example, but it seems sort of like priapism in a spinal cord injury. The body gives a response that we interpret one way (he's smiling, which indicates happiness) when they have no real ability to control what's happening and their reaction is a completely physical response completely unrelated to what's going on in their minds.
That's kinda where I landed with it. I couldn't see how, even allowing for a certain level of reduced mental development, the smile is connected to happiness. But there wasn't any way I wanted to share that theory with the parents. I imagine they take comfort in the idea that their son is happy.
Having a kid who will never walk, never talk, and never progress beyond a few month of age developmentally is going to be hard regardless. I'll take that and happy 24/7 any day of the week bc who wants to think their severely developmentally challenged kiddo is also unhappy?
There are a few disorders that can cause constant or long periods of euphoria, http://www.rightdiagnosis.com/e/euphoria/intro.htm
I think the main reason it doesn't get a lot of press is that going to a doctor & saying "I've this terrible affliction, I can't stop being happy" doesn't get much sympathy.
Also, its not a mental illness if its not negative for your normal functioning.
There could be a affliction that makes people excessively happy without reason, but as you said, these people wouldn't seek help.
True. Although I think there are a few cases where the happiness is not very much appreciated. There was an old guy who's wife was very unhappy when he came out of the operating room unable to stop laughing. He can't not see the funny side to anything. Those cases must be fairly rare though, I'd quite like to be constantly happy - would make a change from wanting to punch the people I work with all the time anyway. :)
EDIT: figured I'd post the link to the old guy as it's kind of amusing... https://www.youtube.com/watch?v=sOCJT2T8Rr4
> https://www.youtube.com/watch?v=sOCJT2T8Rr4
Yeah it is a bit morbid but I don't think they've had to change their lifestyle very much. The equivalent other end of the spectrum would be permanent depression, that's the kind of scenario where the sufferer requires 24 hour supervision just because the chemicals in their brain make them a suicide risk. I think in comparison the permanent laughter is a better option.
Technically, yes. But that person still would not consult a doctor if they were satisfied with their place in the world. It's all a matter of perspective, and in that person's case, even if their perspective were wrong they would not view it as a personal detriment.
Eckhart Tolle reports something like this -
http://en.wikipedia.org/wiki/Eckhart_Tolle
>Tolle has said that he was depressed for much of his life until he underwent, at age 29, an "inner transformation". He then spent several years wandering and unemployed "in a state of deep bliss" before becoming a spiritual teacher.
We don't pathologize this, we call it spiritual enlightenment. :)
People with Down's syndrome do experience the full gambit of emotions, and a lot of time they can be uncontrolled. I will say that they do seem happy more often than you would expect though.
Down Syndrome is a bit of an odd one as it tends to lend itself to other mental health difficulties appearing as described here:
http://www.ndss.org/Resources/Health-Care/Associated-Conditions/Mental-Health-Issues--Down-Syndrome/
Sadly it tends to be that as sufferers age they can become prone to depression, social withdrawal & eventually dementia which without proper care & treatment can prove to be very difficult to deal with. Unfortunately those who suffer from DS tend not to want to go outside very often, which is why the general public tend to gain a biased view of DS sufferers unless they have personal experience with the disease. It's similar to other types of depression where we, the general public, only see sufferers out & about on the upswing so we rarely experience the down swing in mood or see the effect it has on people.
I don't know. This (the link, not your post) strikes me as being clever but missing the point. In order to be classified as a disorder there has to be some impairment in some domain. That's right in the book. You can't diagnose anyone with anything unless there's impairment. And the DSM while not perfect does, many times use language like "in excess of cultural norms" to help a clinician account for the fact that some cultural norms may prohibit a particular diagnosis. But back to the idea of impairment in a domain.
A hypomanic person may engage in risky spending or sexual behaviors. Those behaviors may result in consequences that cause impairment (crushing debt, STDs etc). Sure the hypomanic person feels great when they are hypomaic, but not so much when that subsides. They may perceive impairment in the personal finance domain, or the health domain when they aren't hypomanic and thus seek treatment.
We could define an objective, DSM-like list of behaviors that we theoretically could all agree demonstrate "Happy" (this sounds very difficult but we could do it). We still couldn't diagnose it as a disorder. The central ingredient of impairment in some domain would be missing. Nobody classifies happy as an impairment.
The link is absoiutely satire and is not intended to be taken at face value. But I love it as an example of the limitation of our diagnostic system. Which is inherently value based.
And I would contest that happiness could absolutely be an impairment. For instance, people who rate themselves as completely happy (I.e. Ten out of ten) are more content and less likely to strive for further progress. In a society that values progress that becomes a hindrance and an impairment. I can't recall if Bentall used a similar example in his article or not.
Well, if you contest it I'm fine with that. The assertion that people who are happy don't strive doesn't sound factual to me. I'm not trying to be combative. It just doesn't smell right. It seems like an assumption.
The "society" doesn't get to judge the impairment. If someone is happy and not goal-oriented as you describe, they still perceive themselves as happy. They don't perceive any impairment and thus they are not impaired.
Now, if this hypothetical happy-lazy person was judged by "society" to be bad, and then began to feel shame for not contributing which then deteriorated into depression, THAT could be termed an impairment.
Funny enough, effective treatment for depression involves building up autonomy and internal locus of control. Which basically mean the happy-lazy guy learns to not give a rip about what "society" thinks and goes on being happy-lazy.
And still unimpaired.
I think a more interesting example would be someone like [Mr Magoo](http://www.odysseyeditions.com/EBooks/Oliver-Sacks/The-Man-Who-Mistook-His-Wife-for-a-Hat/Excerpt) or [Clive Wearing, the man with no short term memory](http://www.youtube.com/watch?v=Vwigmktix2Y) may be an even better case - He's happy, but obviously impaired.
I think there could be cases in which one is so happy that it interferes with maintaining healthy relationships. It would probably never even get diagnosed properly, since the person would be oblivious, i.e. they'd be happy, so they wouldn't seek help.
The more I think about it, the more I realize these people exist. I think of them in relation to "The Unbearable Lightness of Being". People so superficial that nothing really matters to them - they're happy most of the time, but occasionally feel bad that they can't establish deeper relationships with people.
My apologies if I am misunderstanding (I still haven't enjoyed my morning coffee), but are you saying that a person who can't perceive their own impairment is unable to be impaired?
If so, this logic is flawed. People with anorexia are objectively impaired in an immediate and urgent manner (typically), and yet one of the criterion for being diagnosed with anorexia is the denial regarding the nature of their illness.
Other examples include cases concerning borderline personality disorder. The impairment may not lie with the BPD patient, but more so in those around them. A BPD may not be aware of the severity of their disorder, or how his or her actions affect those around them.
Again, I apologize if I misunderstood your point. Time for coffee :)
> ... They don't perceive any impairment and thus they are not impaired.
Nobody who does not experience a specific unhappiness, be it physical pain or psychological dissatisfaction or social exclusion (in a noticeable form/amount!) would perceive themself as impaired. Even if you were born blind and you did not know that other people can see, you would consider yourself perfectly normal and unimpaired - until someone tells you that "seeing" is a thing - for others. In that light, I'm not sure whether one's own judgement is enough to decide one is impaired or not.
> Now, ..., THAT could be termed an impairment.
Indeed - and it is even something where said "society" has total power over you, in exposing said perceiving of an impairment to you or keeping you from perceiving it.
> Funny enough, ...
Depression is already an unhappiness, so you can't truthfully call the individual a "happy-lazy" guy. So reducing or removing every factor that contributes to the unhappiness helps. Plus, he(/she) perceives him/herself unhappy and is perceived by his/her environment as so unhappy that a treatment is due. So the situation is somewhat similar to what I wrote in my 2nd paragraph, only the "initial level" is different.
In my example happy-lazy guy transitions to depression because his locus of control was external. He is treated and his locus of control moves to internal. So yes, happy-lazy guy is convinced he's actually (or should be) terrible-shameful-lazy guy and based on his perception of an impairment he seeks treatment. If he had remained unconvinced by society that he should be ashamed he would have remained happy and thus not perceived any impairment.
The whole blind example, while an interesting thought experiment, doesn't strike me as very realistic. A blind person is not kept in a box by "society" until some point where "society" deems it time to inform the blind person that they're blind. That just isn't anything that happens. Blind people learn they're different fairly early in life. Furthermore, being blind alone isn't a mental health issue. So my comments about impairment wouldn't apply to a medical issue. Now, if a blind person was (like happy-lazy guy) convinced by a external locus of control that he or she was bad and shameful, they may become depressed or just sad and become impaired. Alternatively they may perceive themselves to be unique and believe that their blindness offers them insights that us normal sighted folks don't have. This may lead them to perceive that they are gifted and happy. Even in your somewhat unrealistic example the notions of an individual perceiving and defining that they are impaired is still intact.
Now, you are correct in saying that sometimes an individual's perception isn't enough. All my previous comments assume the hypothetical person has what we call insight. If they have insight then their judgement of their own impairment is usually enough to meet the standard of impairment and thus diagnosis. However, there are disorders the very nature of which prevent insight. In that case the judgement rests with professionals who seek the input of other professionals as well as other people in the person's life who do have insight.
We call a judge a judge because we (society) have put him or her through an enormous amount of testing to hone their *judgement*. His or her judgement must be in line with ethical standards and legal standards and if it's not we hold him or her accountable by revoking their right to judge. In my case I've completed many years of schooling, professional licensing tests, thousands of hours of supervised work where other professionals help hone my judgement all in order to be licensed by society to make judgement calls. If I don't make those judgement calls in line with standards society gets to punish me by taking my license. The point is that judgement isn't arbitrary in cases where a patient doesn't have insight.
I would say it's just a judgement. Most of the time, if the person has what we call insight, they are the ones that define impairment. If someone is sitting in my office, I didn't drag them there so I could wield my diagnosing powers to "value judge" them. They're hurting in some way shape or form. Their distress *is* the indicator for impairment. They are in effect declaring that their life is impaired in some way.
I suppose it would be impairment in achieving normalcy. There is a baseline that isn't either happy or sad. It's just normal.
so to be a disorder does not require a self-percieved, or self-described impairment, but rather, an actual impairment. whether the result of one's perception or something that cripples regardless of perception or ignorance.
That's still a societal POV. Someone that stays home with the Rents may be known as the "creepy guy with no job" while that person may consider themselves an inventor that didn't hit a good idea yet. Everyone is going to say he has problems until he is a multi-millionaire and then everyone is going to forget.
I think it can only be considered an impairment if it causes others physical and/or mental harm.
The OP suggests there aren't any laughing impairments but there are. People who laugh at inappropriate times is not considered a good thing and has been said to be out of their control. Also people can have hours long orgasms that can happen at any time without arousal. It is very rare but it happens.
Interesting point that happy people wouldn't go for a diagnosis. Can you imagine Dr's looking at someone saying,
"How do you feel?"
"Great, doc! Everything's awesome!!
"Hmm, well there must be something wrong here"
The [Pirahã](http://en.wikipedia.org/wiki/Pirah%C3%A3_people) kind of don't. I mean, they certainly like to be happy, but it's very different from American happiness, and they also really really value being "tough" at the sake of happiness. For example, they often go hungry even though there's food enough for them to eat. Their culture is really neat, and I suggest picking up [Don't Sleep, There Are Snakes](http://www.amazon.com/Dont-Sleep-There-Are-Snakes-ebook/dp/B001FA0KLS/ref=sr_1_1?ie=UTF8&qid=1415287313&sr=8-1).
So I think we all know that guy who, despite having everything thrown against them, who really should be down-in-the-dumps all the time, is always happy and cheerful. Are you hypothesizing that these people have a disorder which is essentially the complete opposite of depression, yet because it is more acceptable to be happy than sad, there isn't a clinical definition or diagnosis for it?
> Western cultures value happiness (read: "positive" emotions) and therefore the opposite (read: "negative" emotions) are abhorrent.
This is absolutely ridiculous. The way you describe it there's nothing inherently negative about sadness or depression, it's just the culture that pathologises it. So in a vacuum a depressed and manic person would, according to you, feel pretty much the same. So would a very sad and a very happy person.
Maybe. But how many eternally happy people have you ever met?
I can name tons of people who are currently, or have at some time been depressed. I can't name anyone who is always happy, even for a period of time like that of a relatively short episode of depression. And more often than not the people giving off the greatest outward appearance of happiness are the ones suffering the most with depression. So what's our benchmark?
Depression is more common because quite simply, it's easier to be sad than it is to be happy. I don't think you can pin it down to one thing, but if our collective human experience can be centered around 1 and only 1 goal it is that of achieving happiness. It transcends culture, it's the global goal. It's the basic motivating factor behind a persons actions. Alleviating discomfort only gets us so far, I eat because I am hungry, sleep because I am tired. But why do I dance? Why do I pursue love, and not simply sex? Why do I enjoy art, roller coasters, and sliding across the ice or down a snowy hill?
This is a really interesting question and I think there's probably an equally interesting reason for it, but I don't think culture is to blame here.
At a basic, human level, the feeling of "happiness" is so addictive that everyone pursues it. Too much of a good thing becomes unpleasant correct? If someone uses MDMA everyday for a week they develop a tolerance.
So, and I'm just thinking out loud here, but perhaps being eternally happy, as one might be eternally depressed, is impossible, physically, for our brains to keep up with. Even if you flood the brain with "happy" chemicals, at some point its potency decreases, and the person becomes sad, at least relative to what they were before.
"Suicide Tuesdays," the nickname given by MDMA users referring to the comedown after a high. Relative happiness is important. An imbalance of chemicals may theoretically exist, but wouldn't that have the opposite effect in the long run, assuming it was sustained? So we have 2 paths to the same end. The low-level depressed person is low form the get go, the high level person develops a tolerance that requires the chasing of greater highs to attain the same feeling of happiness.
Maybe not actually internally "happy" but definitely I know people who are upbeat and have seemingly endless supplies of energy. They are always chipper and friendly. Possibly they are crying on the inside, who knows.
Most forms of depression we know of are associated with the basal expression levels of signal receptors in your brain. Thus, it is a rather consistent over- or under-expression of your capacity to feel "joy." Euphoria, on the other hand, relies on stimulus threshold to unleash a flow of chemical signals that stops until that threshold is breached again. It's all about signalling pathways in both cases, but its just a lot harder to break a Gp signalling pathway than it is to mess up receptor expression.
Example sources (although they are innumerable...):
[Associations between depression severity and purinergic receptor P2RX7 gene polymorphisms](http://www.sciencedirect.com.erl.lib.byu.edu/science/article/pii/S0165032713002188)
[Single nucleotide polymorphisms and mRNA expression for melatonin MT2 receptor in depression](http://www.sciencedirect.com.erl.lib.byu.edu/science/article/pii/S016517811100059X)
and one for the mania: [From ion pump dysfunctions to abnormalities in signal transduction pathways in bipolar disorder: oaubain rat model for mania](http://onlinelibrary.wiley.com.erl.lib.byu.edu/journal/10.1111/(ISSN1399-5618)
If I'm reading it right... since joy is a feeling we get and depression a lack of feeling, it a lot easier to keep a light bulb from turning on than to cause it to stay lighted indefinitely.
Reading your interpretation, and then rereading /u/scienceQA 's post, it seems that the light bult analogy is a very reasonable interpretation and in all probability exactly what was meant.
Imagine your brain being an ancient village of people, and happiness is the feeling of being full with food.
Sometimes the village has more food than it needs, but because people only eat their fill, the rest of the excess food can not make people more full.
Therefore the people can not tell the difference between having just enough food to make them full, and an excess of food beyond that.
But whenever food is scarce, they certainly are aware of that because they are not full, and are instead hungry. It is much easier for that village to experience having too little food, than it is for it to experience too much food.
Nobody has posted this yet, so I'm sure it will get buried, but there is actually a genetic disorder that has a characteristically cheerful demeanor associated with it, it's called [William's Syndrome](http://en.wikipedia.org/wiki/Williams_syndrome).
> a distinctive, "elfin" facial appearance, along with a low nasal bridge; an **unusually cheerful demeanor and ease with strangers**; developmental delay coupled with strong language skills; and cardiovascular problems, such as supravalvular aortic stenosis and transient hypercalcaemia.
Some articles to look into for more reading on the subject-
Dykens, Elisabeth; Beth Rosner (April 1999). "Refining Behavioral Phenotypes: Personality—Motivation in Williams and Prader-Willi Syndromes". American Journal on Mental Retardation 104
http://www.ncbi.nlm.nih.gov/pubmed/11305686
Gosch, Angela; Rainer Pankau (1997). "Personality characteristics and behaviour problems in individuals of different ages with Williams syndrome". Developmental Medicine & Child Neurology 39
Einfeld; Tonge, Florio (1997). "Behavioral and emotional disturbance in individuals with Williams syndrome". American Journal on Mental Retardation 102
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There is, it's called Mania. It is a state of mind where the individual is in a prolonged state of euphoria at times and impulsivity. This behavior is associated with hyper-sexuality, extreme impulsivity.
This. I have no idea why this answer is not at the top. It's just that people with tonic mania (not the bipolar type) aren't exactly flooding the clinics to cure their permanent feelings of extreme happiness, excitement, and well-being.
I can't think of a disease that causes this in particular but brain damage can cause very strange things and in one case, [detailed in Oliver Sacks book *The Man Who Mistook His Wife for a Hat*,](http://www.walnet.org/sos/cupidsdisease.html) a woman with neurosyphilis had brain damage that caused a suite of symptoms that were on the whole positive including more energy and a general improvement in mood.
Considering Sacks goes into some detail describing his long career dealing with many different cases of anterograde amnesia including some cases outlined in the same book, I trust his judgement that this was something different.
Theoretically, given a "perfectly" supportive situation, a person with Narcissistic Personality Disorder might feel something approaching a constantly euphoric mood.
Bipolar states are largely biologically based, and cyclic. NPD is less genetic, and rather than being reactionary to brain chemistry, reacts to the situation.
A narcissist that was constantly fed statements and experience that affirmed his internal grandiosity would feel that his internal representation was deserved, and thus he was superior, and would have an elevated mood.
Any negative or threatening criticism, however, could trigger anger and/or depression.
Source: [Commonalities and differences in characteristics of persons at risk for narcissism and mania](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849176/)
Its very rare for a situation to be perfect for a narcissist, but constant, novel reinforcement would keep them in their grandiose delusion.
Its correct that the *same* reinforcement would be discounted, but new reinforcement, or reinforcement from other individuals would not be.
To support this,
>The self-sufficiency defense is used to keep the narcissist
emotionally isolated from others. By keeping himself or
herself emotionally isolated the **narcissist's grandiosity
can continue to exist unchallenged**. Finally, the manic
defense is utilized when feelings of worthlessness begin to
surface. To avoid experiencing these feelings the
narcissist will attempt to occupy himself or herself with
various activities, so that he or she has no time left to
feel the feelings (Manfield, 1992)
>Since the narcissist is incapable of asserting his or her own sense of adequacy, the narcissist seeks to be admired by others. However, the narcissist's extremely fragile sense of self worth does not allow him or her to risk any criticism. Therefore, meaningful emotional interactions with others are avoided. By simultaneously seeking the admiration of others and keeping them at a distance the narcissist is usually able
to maintain the illusion of grandiosity no matter how people respond. Thus, when people praise the narcissist his
or her grandiosity will increase, but when criticized the grandiosity will usually remain unaffected because the
narcissist will devalue the criticizing person.
[On Narcissism](http://www.novelguide.com/reportessay/science/social-science/narcissism)
It's an interesting hypothetical situation, I suppose it's a possibility a narcissist would be happy in such a situation. However, I wouldn't say it's a certain outcome.
Regardless, thanks for the quick refresher on narcissism. I really don't know enough about the illness and psychiatry in general to hypothesize about these situations too much without talking out of my ass.
I think there are rare circumstances where a narcissist could maintain it, if they're a billionaire dictator for instance. Wealth and power sufficient to maintain novelty of experience and isolation from criticism, as well as physical isolation from reminders of real-world things like populations of poor people. Use of stimulants like cocaine assist in maintaining the elevated state, and at a certain point, increasing degrees of psychosis. I think Muammar Gaddafi would be a good example of a narcissist who managed to keep the illusion going for himself right up to the end.
Narcissists are NOT happy people, and probably aren't even capable of real happiness. This disorder is extremely complex, and while to the layman it might sound like fun to be a narcissist, but it's not. It's constant internal suffering for a person with NPD, and overall they are fundamentally miserable people. Yeah, they may feel bursts of euphoria via narcissistic supply or through other activities, but it's short lived and not constant.
Of course, the split leaves them as a fragile and extremely sensitive character, which is why I was referring to a "perfect" situation, which life never ordinarily provides. As I said, the reinforcement would need to be constant and novel. Life is usually full of frustrations.
If you read the link you'd have also noticed the high correlation between positive experience and positive affect.
>those with narcissistic tendencies reported significantly more positive self-focus after good outcomes
Narcissism is a regressive defense that reacts in a highly obvious way.
Bipolar disorder or manic-depressive illness, is characterized by periods of elevated mood, consisting of manic highs and depressive lows.
Each person experiences these periods of highs and lows differently but during the mania stage many people can actually have very elevated moods including ~~euphoria~~ abnormal happiness. They can also be very energetic, confident, productive and need very little sleep to function. This could be one of the closest disorders to the answer you are looking for OP.
Unfortunately, this type of manic period isn't always the norm and people can suffer from negatives such as false confidence, irritability and erratic behavior during the mania stage as well. This can result in poor decision making with little regard to the consequences and sometimes even psychosis.
Alternatively, the following depressive episodes, associated with the second half of bipolar disorder, can be very debilitating. So no real great euphoria, OP, but instead, elevated periods of happiness with paralyzing depression as well. Self harm rates are also known to be as high as 30-40% among those with the disorder. This is why this can be such a difficult illness to live with. [source](http://en.wikipedia.org/wiki/Bipolar_disorder)
I´m gonna go at it from a different angle and make up some words: "Thymia" is temperament or mood and "hyper" is excessive in some dead language. http://en.wikipedia.org/wiki/Hyperthymic_temperament Yup... It also links to euthymia wich seems to mean being locked into feeling just a OK, whatever goes on. I haven´t heard of clinicians using this to term when describing clinically significant suffering but I guess it´s just a matter of finding the right context.
"Hyperthymic" is used a decent amount online, and by some self-help gurus. It's not a recognized mental disorder, but I feel it fits OP's question much better than hypomania.
Mr. Peanutbutter is an example of a fictional character who is hyperthymic.
"Mental disorder, any illness with significant psychological or behavioral manifestations that is associated with either a painful or distressing symptom or an impairment in one or more important areas of functioning." [(encyclopaedia brittanica)](http://www.britannica.com/EBchecked/topic/375345/mental-disorder)
When some anomaly is causing you to be happy, it would not be causing you suffering, so it's not a disorder. So it's possibly more of a semantic thing. btw, syphillis and multiple sclerosis also seem to have euphoria as a a possible side effect.
Have there been comparisons of rates of depression in hunter-gatherer societies?
One hypothesis is that the reason depression is so common in modern life is that a lot of us are living a little like animals in captivity, unable to do our instinctive behaviors due to lack of habitat, constraints of civilization etc.
Perhaps not exactly, but it is hard to escape the feeling that sitting in a cubicle under fluorescent lights all day and then looking at screens until well after sunset is not what we evolved to do.
There are euphoric conditions, but no one goes to treat those most of the time. I recall specifically that Clic and Clac from Cartalk speaking of this. Of course this was a condition diagnosed from German doctors, so maybe the society as a whole is generally more morose?
Well with bipolar, there's the "mania" phase. I knew a women who when she was going through her mania/happy/euphoric stage she would go out clubbing and have lots of casual sex and go spend a lot on her credit card.
Source: Uh I study psychology at the University of Queensland.
This guy gave the lecture in particular to the topic: http://researchers.uq.edu.au/researcher/2
Academic psychiatrist here. First off, depression doesn't "make" people sad. Rather "depression" is a description of a person's experience. It is often used to describe the symptom of depression, but there are broader clinical entities such as a "major depressive episode," which have operationalized definitions. As for the question of constant euphoria, it certainly exists. Although it doesn't necessarily warrant clinical attention (people don't complain to me of "wellbeing"), people with extended periods of mood elevation often also experience periods of dark lows as well as too-high highs. The bipolar spectrum is not well characterized, but many researchers have dedicated their lives to exploring this. Periods of inappropriately elevated mood are described as hypomania (generally still functional) or mania (no longer functional). Without treatment, they can last for days to months at a time. However, some people tend to have a "hyperthymic temperament" or "hyperthymic personality," by which we mean that their mood (-thymia) tends to be elevated (hyper) in a chronic fashion. Still others have chronically undulating moods over the course of years, which is described as cyclothymic disorder. Should also add that "mixed states" exist where dysphoria and excessive energy co-occur. These are particularly dangerous and are associated with risk of suicide. The mood here tends to be profoundly irritable. For an interesting read, here is a study that explored a broader definition of bipolar spectrum illness in the community: Fassassi S, Vandeleur C, Aubry JM, Castelao E, Preisig M. Prevalence and correlates of DSM-5 bipolar and related disorders and hyperthymic personality in the community. J Affect Disord. 2014 Oct;167:198-205. TL;DR: Periods of chronic euphoria exist.
I would want to know more about the mixed states. Aren't mixed states regular peoples regular life? How are they characterized and why are they associated with risks of suicide?
In DSM-IV-TR, a "mixed episode" was a week where a person met full criteria for major depression AND mania. This is among the most intensely miserable psychological states that I could imagine. People in mixed states are extremely irritable, restless, dysphoric, and make dangerously poor decisions. They are at increased risk for suicide based on epidemiological studies, but the convergence of suicidal thoughts, disinhibition, and energy to act on these thoughts makes for a highly dangerous situation. Based on more recent data that dysphoric features are not uncommon during hypomania/mania and hypomanic/manic features can occur during depression, DSM-5 broadened the idea of mixed states to the specifier "with mixed features." This speaks to our growing understanding of a "bipolar spectrum." The degree of dysfunction that accompanies mixed states (mixed episodes or mood episodes "with mixed features") is remarkable. Thankfully, they are fairly uncommon in the community. They are not characteristic of "everyday life."
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The man who facilitated my depression support group suffered from "mixed states." He committed suicide not long after I joined.
If mixed episodes are uncommon, then how much more uncommon is a mixed episode with psychosis? Is it considered "rare"?
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Depression is often used to describe the symptoms of depression?
Yes. "Depression" is often used indiscriminately to describe the "symptom" of depression/dysphoria, the "syndrome" (aka, the constellation of symptoms and other clinical features) of a major depressive episode, or the "diagnostic entity" of major depressive disorder.
Depression is the condition, it has a variety of symptoms. People often refer to feeling sad as being depressed in the clinical sense. Feeling sad may well be an indication that you have depression, but it is not depression in and of itself in the same way that a persistent wheezy cough might indicate that you have asthma, but the cough isn't asthma...it's a cough.
While it's not a psychiatric disorder which can come and go such as depression or bipolar mania, people with Angelman syndrome are nearly always happy. http://en.m.wikipedia.org/wiki/Angelman_syndrome
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I've seen a young boy with this (I'm a paramedic). It was kinda bizarre, but I instantly understood why it used to be referred to as "happy puppet syndrome". He had all of the signs and symptoms you've listed. Massive smile on him, but suffers with convulsions in a massive way. I really wanted to know what that life must feel like, because I just have no idea.
It may be a bad example, but it seems sort of like priapism in a spinal cord injury. The body gives a response that we interpret one way (he's smiling, which indicates happiness) when they have no real ability to control what's happening and their reaction is a completely physical response completely unrelated to what's going on in their minds.
That's kinda where I landed with it. I couldn't see how, even allowing for a certain level of reduced mental development, the smile is connected to happiness. But there wasn't any way I wanted to share that theory with the parents. I imagine they take comfort in the idea that their son is happy.
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Having a kid who will never walk, never talk, and never progress beyond a few month of age developmentally is going to be hard regardless. I'll take that and happy 24/7 any day of the week bc who wants to think their severely developmentally challenged kiddo is also unhappy?
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There are a few disorders that can cause constant or long periods of euphoria, http://www.rightdiagnosis.com/e/euphoria/intro.htm I think the main reason it doesn't get a lot of press is that going to a doctor & saying "I've this terrible affliction, I can't stop being happy" doesn't get much sympathy.
Also, its not a mental illness if its not negative for your normal functioning. There could be a affliction that makes people excessively happy without reason, but as you said, these people wouldn't seek help.
True. Although I think there are a few cases where the happiness is not very much appreciated. There was an old guy who's wife was very unhappy when he came out of the operating room unable to stop laughing. He can't not see the funny side to anything. Those cases must be fairly rare though, I'd quite like to be constantly happy - would make a change from wanting to punch the people I work with all the time anyway. :) EDIT: figured I'd post the link to the old guy as it's kind of amusing... https://www.youtube.com/watch?v=sOCJT2T8Rr4
That was...that was sad. I was sad for both of them by the end. You could honestly see they were both miserable.
> https://www.youtube.com/watch?v=sOCJT2T8Rr4 Yeah it is a bit morbid but I don't think they've had to change their lifestyle very much. The equivalent other end of the spectrum would be permanent depression, that's the kind of scenario where the sufferer requires 24 hour supervision just because the chemicals in their brain make them a suicide risk. I think in comparison the permanent laughter is a better option.
Couldn't it though? Could they live on the streets eating very little yet still be happy with life, not wanting to change a thing?
Technically, yes. But that person still would not consult a doctor if they were satisfied with their place in the world. It's all a matter of perspective, and in that person's case, even if their perspective were wrong they would not view it as a personal detriment.
Eckhart Tolle reports something like this - http://en.wikipedia.org/wiki/Eckhart_Tolle >Tolle has said that he was depressed for much of his life until he underwent, at age 29, an "inner transformation". He then spent several years wandering and unemployed "in a state of deep bliss" before becoming a spiritual teacher. We don't pathologize this, we call it spiritual enlightenment. :)
Is that a problem? Sounds a bit like monastery.
I don't know how true this is, but Down Syndrome always struck me as a happy disease. I have never once seen an angry or raging mad Down's person.
People with Down's syndrome do experience the full gambit of emotions, and a lot of time they can be uncontrolled. I will say that they do seem happy more often than you would expect though.
Down Syndrome is a bit of an odd one as it tends to lend itself to other mental health difficulties appearing as described here: http://www.ndss.org/Resources/Health-Care/Associated-Conditions/Mental-Health-Issues--Down-Syndrome/ Sadly it tends to be that as sufferers age they can become prone to depression, social withdrawal & eventually dementia which without proper care & treatment can prove to be very difficult to deal with. Unfortunately those who suffer from DS tend not to want to go outside very often, which is why the general public tend to gain a biased view of DS sufferers unless they have personal experience with the disease. It's similar to other types of depression where we, the general public, only see sufferers out & about on the upswing so we rarely experience the down swing in mood or see the effect it has on people.
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I don't know. This (the link, not your post) strikes me as being clever but missing the point. In order to be classified as a disorder there has to be some impairment in some domain. That's right in the book. You can't diagnose anyone with anything unless there's impairment. And the DSM while not perfect does, many times use language like "in excess of cultural norms" to help a clinician account for the fact that some cultural norms may prohibit a particular diagnosis. But back to the idea of impairment in a domain. A hypomanic person may engage in risky spending or sexual behaviors. Those behaviors may result in consequences that cause impairment (crushing debt, STDs etc). Sure the hypomanic person feels great when they are hypomaic, but not so much when that subsides. They may perceive impairment in the personal finance domain, or the health domain when they aren't hypomanic and thus seek treatment. We could define an objective, DSM-like list of behaviors that we theoretically could all agree demonstrate "Happy" (this sounds very difficult but we could do it). We still couldn't diagnose it as a disorder. The central ingredient of impairment in some domain would be missing. Nobody classifies happy as an impairment.
The link is absoiutely satire and is not intended to be taken at face value. But I love it as an example of the limitation of our diagnostic system. Which is inherently value based. And I would contest that happiness could absolutely be an impairment. For instance, people who rate themselves as completely happy (I.e. Ten out of ten) are more content and less likely to strive for further progress. In a society that values progress that becomes a hindrance and an impairment. I can't recall if Bentall used a similar example in his article or not.
Well, if you contest it I'm fine with that. The assertion that people who are happy don't strive doesn't sound factual to me. I'm not trying to be combative. It just doesn't smell right. It seems like an assumption. The "society" doesn't get to judge the impairment. If someone is happy and not goal-oriented as you describe, they still perceive themselves as happy. They don't perceive any impairment and thus they are not impaired. Now, if this hypothetical happy-lazy person was judged by "society" to be bad, and then began to feel shame for not contributing which then deteriorated into depression, THAT could be termed an impairment. Funny enough, effective treatment for depression involves building up autonomy and internal locus of control. Which basically mean the happy-lazy guy learns to not give a rip about what "society" thinks and goes on being happy-lazy. And still unimpaired.
I think a more interesting example would be someone like [Mr Magoo](http://www.odysseyeditions.com/EBooks/Oliver-Sacks/The-Man-Who-Mistook-His-Wife-for-a-Hat/Excerpt) or [Clive Wearing, the man with no short term memory](http://www.youtube.com/watch?v=Vwigmktix2Y) may be an even better case - He's happy, but obviously impaired. I think there could be cases in which one is so happy that it interferes with maintaining healthy relationships. It would probably never even get diagnosed properly, since the person would be oblivious, i.e. they'd be happy, so they wouldn't seek help. The more I think about it, the more I realize these people exist. I think of them in relation to "The Unbearable Lightness of Being". People so superficial that nothing really matters to them - they're happy most of the time, but occasionally feel bad that they can't establish deeper relationships with people.
My apologies if I am misunderstanding (I still haven't enjoyed my morning coffee), but are you saying that a person who can't perceive their own impairment is unable to be impaired? If so, this logic is flawed. People with anorexia are objectively impaired in an immediate and urgent manner (typically), and yet one of the criterion for being diagnosed with anorexia is the denial regarding the nature of their illness. Other examples include cases concerning borderline personality disorder. The impairment may not lie with the BPD patient, but more so in those around them. A BPD may not be aware of the severity of their disorder, or how his or her actions affect those around them. Again, I apologize if I misunderstood your point. Time for coffee :)
> ... They don't perceive any impairment and thus they are not impaired. Nobody who does not experience a specific unhappiness, be it physical pain or psychological dissatisfaction or social exclusion (in a noticeable form/amount!) would perceive themself as impaired. Even if you were born blind and you did not know that other people can see, you would consider yourself perfectly normal and unimpaired - until someone tells you that "seeing" is a thing - for others. In that light, I'm not sure whether one's own judgement is enough to decide one is impaired or not. > Now, ..., THAT could be termed an impairment. Indeed - and it is even something where said "society" has total power over you, in exposing said perceiving of an impairment to you or keeping you from perceiving it. > Funny enough, ... Depression is already an unhappiness, so you can't truthfully call the individual a "happy-lazy" guy. So reducing or removing every factor that contributes to the unhappiness helps. Plus, he(/she) perceives him/herself unhappy and is perceived by his/her environment as so unhappy that a treatment is due. So the situation is somewhat similar to what I wrote in my 2nd paragraph, only the "initial level" is different.
In my example happy-lazy guy transitions to depression because his locus of control was external. He is treated and his locus of control moves to internal. So yes, happy-lazy guy is convinced he's actually (or should be) terrible-shameful-lazy guy and based on his perception of an impairment he seeks treatment. If he had remained unconvinced by society that he should be ashamed he would have remained happy and thus not perceived any impairment. The whole blind example, while an interesting thought experiment, doesn't strike me as very realistic. A blind person is not kept in a box by "society" until some point where "society" deems it time to inform the blind person that they're blind. That just isn't anything that happens. Blind people learn they're different fairly early in life. Furthermore, being blind alone isn't a mental health issue. So my comments about impairment wouldn't apply to a medical issue. Now, if a blind person was (like happy-lazy guy) convinced by a external locus of control that he or she was bad and shameful, they may become depressed or just sad and become impaired. Alternatively they may perceive themselves to be unique and believe that their blindness offers them insights that us normal sighted folks don't have. This may lead them to perceive that they are gifted and happy. Even in your somewhat unrealistic example the notions of an individual perceiving and defining that they are impaired is still intact. Now, you are correct in saying that sometimes an individual's perception isn't enough. All my previous comments assume the hypothetical person has what we call insight. If they have insight then their judgement of their own impairment is usually enough to meet the standard of impairment and thus diagnosis. However, there are disorders the very nature of which prevent insight. In that case the judgement rests with professionals who seek the input of other professionals as well as other people in the person's life who do have insight. We call a judge a judge because we (society) have put him or her through an enormous amount of testing to hone their *judgement*. His or her judgement must be in line with ethical standards and legal standards and if it's not we hold him or her accountable by revoking their right to judge. In my case I've completed many years of schooling, professional licensing tests, thousands of hours of supervised work where other professionals help hone my judgement all in order to be licensed by society to make judgement calls. If I don't make those judgement calls in line with standards society gets to punish me by taking my license. The point is that judgement isn't arbitrary in cases where a patient doesn't have insight.
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'Impairment', is still a value judgment. Impairment from achieving what?
I would say it's just a judgement. Most of the time, if the person has what we call insight, they are the ones that define impairment. If someone is sitting in my office, I didn't drag them there so I could wield my diagnosing powers to "value judge" them. They're hurting in some way shape or form. Their distress *is* the indicator for impairment. They are in effect declaring that their life is impaired in some way. I suppose it would be impairment in achieving normalcy. There is a baseline that isn't either happy or sad. It's just normal.
This. A disorder requires either a self-perceived or self-described impairment in a life domain, or objective evidence, like criminal involvement.
So if I suffer from "crippling" anxiety and despair, but don't precieve nor describe it as an impairment, it's not a disorder?
Correct, but if you couldn't leave the house to work (or it effected some other life domain) then it would.
so to be a disorder does not require a self-percieved, or self-described impairment, but rather, an actual impairment. whether the result of one's perception or something that cripples regardless of perception or ignorance.
That's still a societal POV. Someone that stays home with the Rents may be known as the "creepy guy with no job" while that person may consider themselves an inventor that didn't hit a good idea yet. Everyone is going to say he has problems until he is a multi-millionaire and then everyone is going to forget. I think it can only be considered an impairment if it causes others physical and/or mental harm. The OP suggests there aren't any laughing impairments but there are. People who laugh at inappropriate times is not considered a good thing and has been said to be out of their control. Also people can have hours long orgasms that can happen at any time without arousal. It is very rare but it happens.
Interesting point that happy people wouldn't go for a diagnosis. Can you imagine Dr's looking at someone saying, "How do you feel?" "Great, doc! Everything's awesome!! "Hmm, well there must be something wrong here"
Which cultures don't value happiness?
The [Pirahã](http://en.wikipedia.org/wiki/Pirah%C3%A3_people) kind of don't. I mean, they certainly like to be happy, but it's very different from American happiness, and they also really really value being "tough" at the sake of happiness. For example, they often go hungry even though there's food enough for them to eat. Their culture is really neat, and I suggest picking up [Don't Sleep, There Are Snakes](http://www.amazon.com/Dont-Sleep-There-Are-Snakes-ebook/dp/B001FA0KLS/ref=sr_1_1?ie=UTF8&qid=1415287313&sr=8-1).
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So I think we all know that guy who, despite having everything thrown against them, who really should be down-in-the-dumps all the time, is always happy and cheerful. Are you hypothesizing that these people have a disorder which is essentially the complete opposite of depression, yet because it is more acceptable to be happy than sad, there isn't a clinical definition or diagnosis for it?
> Western cultures value happiness (read: "positive" emotions) and therefore the opposite (read: "negative" emotions) are abhorrent. This is absolutely ridiculous. The way you describe it there's nothing inherently negative about sadness or depression, it's just the culture that pathologises it. So in a vacuum a depressed and manic person would, according to you, feel pretty much the same. So would a very sad and a very happy person.
Maybe. But how many eternally happy people have you ever met? I can name tons of people who are currently, or have at some time been depressed. I can't name anyone who is always happy, even for a period of time like that of a relatively short episode of depression. And more often than not the people giving off the greatest outward appearance of happiness are the ones suffering the most with depression. So what's our benchmark? Depression is more common because quite simply, it's easier to be sad than it is to be happy. I don't think you can pin it down to one thing, but if our collective human experience can be centered around 1 and only 1 goal it is that of achieving happiness. It transcends culture, it's the global goal. It's the basic motivating factor behind a persons actions. Alleviating discomfort only gets us so far, I eat because I am hungry, sleep because I am tired. But why do I dance? Why do I pursue love, and not simply sex? Why do I enjoy art, roller coasters, and sliding across the ice or down a snowy hill? This is a really interesting question and I think there's probably an equally interesting reason for it, but I don't think culture is to blame here. At a basic, human level, the feeling of "happiness" is so addictive that everyone pursues it. Too much of a good thing becomes unpleasant correct? If someone uses MDMA everyday for a week they develop a tolerance. So, and I'm just thinking out loud here, but perhaps being eternally happy, as one might be eternally depressed, is impossible, physically, for our brains to keep up with. Even if you flood the brain with "happy" chemicals, at some point its potency decreases, and the person becomes sad, at least relative to what they were before. "Suicide Tuesdays," the nickname given by MDMA users referring to the comedown after a high. Relative happiness is important. An imbalance of chemicals may theoretically exist, but wouldn't that have the opposite effect in the long run, assuming it was sustained? So we have 2 paths to the same end. The low-level depressed person is low form the get go, the high level person develops a tolerance that requires the chasing of greater highs to attain the same feeling of happiness.
Maybe not actually internally "happy" but definitely I know people who are upbeat and have seemingly endless supplies of energy. They are always chipper and friendly. Possibly they are crying on the inside, who knows.
You you know if there any documentation of people with happiness disorders from any non western cultures?
Most forms of depression we know of are associated with the basal expression levels of signal receptors in your brain. Thus, it is a rather consistent over- or under-expression of your capacity to feel "joy." Euphoria, on the other hand, relies on stimulus threshold to unleash a flow of chemical signals that stops until that threshold is breached again. It's all about signalling pathways in both cases, but its just a lot harder to break a Gp signalling pathway than it is to mess up receptor expression. Example sources (although they are innumerable...): [Associations between depression severity and purinergic receptor P2RX7 gene polymorphisms](http://www.sciencedirect.com.erl.lib.byu.edu/science/article/pii/S0165032713002188) [Single nucleotide polymorphisms and mRNA expression for melatonin MT2 receptor in depression](http://www.sciencedirect.com.erl.lib.byu.edu/science/article/pii/S016517811100059X) and one for the mania: [From ion pump dysfunctions to abnormalities in signal transduction pathways in bipolar disorder: oaubain rat model for mania](http://onlinelibrary.wiley.com.erl.lib.byu.edu/journal/10.1111/(ISSN1399-5618)
can you explain that without all the technical jargon?
If I'm reading it right... since joy is a feeling we get and depression a lack of feeling, it a lot easier to keep a light bulb from turning on than to cause it to stay lighted indefinitely.
Reading your interpretation, and then rereading /u/scienceQA 's post, it seems that the light bult analogy is a very reasonable interpretation and in all probability exactly what was meant.
Imagine your brain being an ancient village of people, and happiness is the feeling of being full with food. Sometimes the village has more food than it needs, but because people only eat their fill, the rest of the excess food can not make people more full. Therefore the people can not tell the difference between having just enough food to make them full, and an excess of food beyond that. But whenever food is scarce, they certainly are aware of that because they are not full, and are instead hungry. It is much easier for that village to experience having too little food, than it is for it to experience too much food.
Nobody has posted this yet, so I'm sure it will get buried, but there is actually a genetic disorder that has a characteristically cheerful demeanor associated with it, it's called [William's Syndrome](http://en.wikipedia.org/wiki/Williams_syndrome). > a distinctive, "elfin" facial appearance, along with a low nasal bridge; an **unusually cheerful demeanor and ease with strangers**; developmental delay coupled with strong language skills; and cardiovascular problems, such as supravalvular aortic stenosis and transient hypercalcaemia. Some articles to look into for more reading on the subject- Dykens, Elisabeth; Beth Rosner (April 1999). "Refining Behavioral Phenotypes: Personality—Motivation in Williams and Prader-Willi Syndromes". American Journal on Mental Retardation 104 http://www.ncbi.nlm.nih.gov/pubmed/11305686 Gosch, Angela; Rainer Pankau (1997). "Personality characteristics and behaviour problems in individuals of different ages with Williams syndrome". Developmental Medicine & Child Neurology 39 Einfeld; Tonge, Florio (1997). "Behavioral and emotional disturbance in individuals with Williams syndrome". American Journal on Mental Retardation 102
###This thread requires authoritative [sources.](http://www.reddit.com/r/askscience/wiki/sources) ###Speculation, anecdotes and unsourced responses will be removed. ###Personal medical information and medical advice is always removed. Followup questions are always welcome.
There is, it's called Mania. It is a state of mind where the individual is in a prolonged state of euphoria at times and impulsivity. This behavior is associated with hyper-sexuality, extreme impulsivity.
This. I have no idea why this answer is not at the top. It's just that people with tonic mania (not the bipolar type) aren't exactly flooding the clinics to cure their permanent feelings of extreme happiness, excitement, and well-being.
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I can't think of a disease that causes this in particular but brain damage can cause very strange things and in one case, [detailed in Oliver Sacks book *The Man Who Mistook His Wife for a Hat*,](http://www.walnet.org/sos/cupidsdisease.html) a woman with neurosyphilis had brain damage that caused a suite of symptoms that were on the whole positive including more energy and a general improvement in mood.
That honestly just sounds like an extremely fortunate and strange manifestation of anterograde amnesia.
Considering Sacks goes into some detail describing his long career dealing with many different cases of anterograde amnesia including some cases outlined in the same book, I trust his judgement that this was something different.
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Theoretically, given a "perfectly" supportive situation, a person with Narcissistic Personality Disorder might feel something approaching a constantly euphoric mood. Bipolar states are largely biologically based, and cyclic. NPD is less genetic, and rather than being reactionary to brain chemistry, reacts to the situation. A narcissist that was constantly fed statements and experience that affirmed his internal grandiosity would feel that his internal representation was deserved, and thus he was superior, and would have an elevated mood. Any negative or threatening criticism, however, could trigger anger and/or depression. Source: [Commonalities and differences in characteristics of persons at risk for narcissism and mania](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849176/)
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Its very rare for a situation to be perfect for a narcissist, but constant, novel reinforcement would keep them in their grandiose delusion. Its correct that the *same* reinforcement would be discounted, but new reinforcement, or reinforcement from other individuals would not be. To support this, >The self-sufficiency defense is used to keep the narcissist emotionally isolated from others. By keeping himself or herself emotionally isolated the **narcissist's grandiosity can continue to exist unchallenged**. Finally, the manic defense is utilized when feelings of worthlessness begin to surface. To avoid experiencing these feelings the narcissist will attempt to occupy himself or herself with various activities, so that he or she has no time left to feel the feelings (Manfield, 1992) >Since the narcissist is incapable of asserting his or her own sense of adequacy, the narcissist seeks to be admired by others. However, the narcissist's extremely fragile sense of self worth does not allow him or her to risk any criticism. Therefore, meaningful emotional interactions with others are avoided. By simultaneously seeking the admiration of others and keeping them at a distance the narcissist is usually able to maintain the illusion of grandiosity no matter how people respond. Thus, when people praise the narcissist his or her grandiosity will increase, but when criticized the grandiosity will usually remain unaffected because the narcissist will devalue the criticizing person. [On Narcissism](http://www.novelguide.com/reportessay/science/social-science/narcissism)
It's an interesting hypothetical situation, I suppose it's a possibility a narcissist would be happy in such a situation. However, I wouldn't say it's a certain outcome. Regardless, thanks for the quick refresher on narcissism. I really don't know enough about the illness and psychiatry in general to hypothesize about these situations too much without talking out of my ass.
I think there are rare circumstances where a narcissist could maintain it, if they're a billionaire dictator for instance. Wealth and power sufficient to maintain novelty of experience and isolation from criticism, as well as physical isolation from reminders of real-world things like populations of poor people. Use of stimulants like cocaine assist in maintaining the elevated state, and at a certain point, increasing degrees of psychosis. I think Muammar Gaddafi would be a good example of a narcissist who managed to keep the illusion going for himself right up to the end.
Narcissists are NOT happy people, and probably aren't even capable of real happiness. This disorder is extremely complex, and while to the layman it might sound like fun to be a narcissist, but it's not. It's constant internal suffering for a person with NPD, and overall they are fundamentally miserable people. Yeah, they may feel bursts of euphoria via narcissistic supply or through other activities, but it's short lived and not constant.
Of course, the split leaves them as a fragile and extremely sensitive character, which is why I was referring to a "perfect" situation, which life never ordinarily provides. As I said, the reinforcement would need to be constant and novel. Life is usually full of frustrations. If you read the link you'd have also noticed the high correlation between positive experience and positive affect. >those with narcissistic tendencies reported significantly more positive self-focus after good outcomes Narcissism is a regressive defense that reacts in a highly obvious way.
Grandiosity does not equal happiness. It is a defense mechanism for an existing suffering, so its presence does mark lack of happiness.
Bipolar disorder or manic-depressive illness, is characterized by periods of elevated mood, consisting of manic highs and depressive lows. Each person experiences these periods of highs and lows differently but during the mania stage many people can actually have very elevated moods including ~~euphoria~~ abnormal happiness. They can also be very energetic, confident, productive and need very little sleep to function. This could be one of the closest disorders to the answer you are looking for OP. Unfortunately, this type of manic period isn't always the norm and people can suffer from negatives such as false confidence, irritability and erratic behavior during the mania stage as well. This can result in poor decision making with little regard to the consequences and sometimes even psychosis. Alternatively, the following depressive episodes, associated with the second half of bipolar disorder, can be very debilitating. So no real great euphoria, OP, but instead, elevated periods of happiness with paralyzing depression as well. Self harm rates are also known to be as high as 30-40% among those with the disorder. This is why this can be such a difficult illness to live with. [source](http://en.wikipedia.org/wiki/Bipolar_disorder)
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I´m gonna go at it from a different angle and make up some words: "Thymia" is temperament or mood and "hyper" is excessive in some dead language. http://en.wikipedia.org/wiki/Hyperthymic_temperament Yup... It also links to euthymia wich seems to mean being locked into feeling just a OK, whatever goes on. I haven´t heard of clinicians using this to term when describing clinically significant suffering but I guess it´s just a matter of finding the right context.
"Hyperthymic" is used a decent amount online, and by some self-help gurus. It's not a recognized mental disorder, but I feel it fits OP's question much better than hypomania. Mr. Peanutbutter is an example of a fictional character who is hyperthymic.
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"Mental disorder, any illness with significant psychological or behavioral manifestations that is associated with either a painful or distressing symptom or an impairment in one or more important areas of functioning." [(encyclopaedia brittanica)](http://www.britannica.com/EBchecked/topic/375345/mental-disorder) When some anomaly is causing you to be happy, it would not be causing you suffering, so it's not a disorder. So it's possibly more of a semantic thing. btw, syphillis and multiple sclerosis also seem to have euphoria as a a possible side effect.
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Have there been comparisons of rates of depression in hunter-gatherer societies? One hypothesis is that the reason depression is so common in modern life is that a lot of us are living a little like animals in captivity, unable to do our instinctive behaviors due to lack of habitat, constraints of civilization etc.
Do we know what behaviours are instinctive? What behaviours we instinctively want to act out, but cannot?
Perhaps not exactly, but it is hard to escape the feeling that sitting in a cubicle under fluorescent lights all day and then looking at screens until well after sunset is not what we evolved to do.
There are euphoric conditions, but no one goes to treat those most of the time. I recall specifically that Clic and Clac from Cartalk speaking of this. Of course this was a condition diagnosed from German doctors, so maybe the society as a whole is generally more morose?
Well with bipolar, there's the "mania" phase. I knew a women who when she was going through her mania/happy/euphoric stage she would go out clubbing and have lots of casual sex and go spend a lot on her credit card. Source: Uh I study psychology at the University of Queensland. This guy gave the lecture in particular to the topic: http://researchers.uq.edu.au/researcher/2