Like medicine in general, psychiatry and psychotherapy have long focused on relieving illness and pain. Traditional psychotherapeutic approaches have often emphasized examination and understanding of painful experiences as a route toward obtaining relief from suffering.
However, does an approach that focuses instead on teaching patients how to be happy offer an alternative and more direct route to happiness? Certainly this approach has a strong appeal, as demonstrated by the popularity of a course by Tal D. Ben-Shahar, a lecturer in psychology at Harvard, whose Positive Psychology course, according to an article last year in the Boston Globe, enrolled over 800 students—more than any other course on campus.1
Is positive psychology an innovative way to find happiness faster? Or with its claims, does it do a disservice to people with serious mental health problems?
According to one of its most prominent proponents, positive psychology works. "I'm an evidence-based researcher," said Martin E. P. Seligman, PhD, in a phone interview. "In randomized controlled trials, we've seen good evidence that the interventions utilized in positive psychology alleviate suffering and increase happiness."
Seligman, Fox Leadership Professor of Psychology at the University of Pennsylvania in Philadelphia, helped develop positive psychology. He is the director of the Positive Psychology Center at the University of Pennsylvania and a former president of the American Psychological Association.
He defines positive psychology, or positive psychotherapy, as an approach that focuses on 3 areas: a pleasant life, an engaging life, and a meaningful life. "Positive psychology is the study of what causes these to occur and how to build them," he said.
In an article in American Psychologist,2 he and coauthors wrote that this approach as a treatment of depression "contrasts with standard interventions for depression by increasing positive emotion, engagement, and meaning rather than directly targeting depressive symptoms."
In a preliminary study, they reported, positive psychotherapy delivered to groups of patients significantly decreased mild to moderate depression over a 1-year period; positive results were also obtained in therapy with individual outpatients who suffered from major depressive disorder. In informal settings, they added, participants "not uncommonly reported [positive psychotherapy] to be 'life-changing.'"
Beyond damage and disabilitySeligman differentiates positive psychology from other therapeutic approaches by its focus on how to build these 3 components, in contrast to the focus on "damage and disability" that he says has historically characterized psychiatry and psychology. Howev- er, he stressed, "Positive psychology should be seen as a way to supplement any therapy that the patient or client needs, not replace it."
The approach has not been with- out criticism, he acknowledged. Key among the points of criticism have been the following: focusing on happiness is irrelevant in a world with so much suffering; the approach offers nothing new; and the focus on feeling is a distraction from the goal of improving patients' function.
"Regarding the suffering in the world, striving for a meaningful life means that people don't just care about their own issues," he said. "This approach is a strategy for buffering against suffering." The example he gave was the world of bridge players, a world that is populated with senior citizens and therefore with people who live with significant arthritis. "Bridge players don't complain about their arthritis when they are playing bridge," he said, noting the relief that being engaged brings.
"There are several new discoveries we have made due to the use of positive psychology," he noted in response to the criticism that the field provides nothing new. "One of the key discoveries is that optimistic individuals live 8 to 9 years longer than pessimistic individuals." The criticism that mental health professionals should focus on function and not feeling was met with this response: "Happy people function better and the happiness is causal."
Not surprisingly, Seligman foresees a bright future for positive psychology. "This approach will play an increasing role in school and work, as we see that increasing happiness decreases the 'tonnage of suffering,'" he said. His Authentic Happiness Web site (www. authentichappiness.org) provides a variety of resources on positive psychology for patients and mental health professionals.
Too simple?According to one expert, however, positive psychology is at best a repackaging of standard approaches used by many psychologists and psychiatrists, who focus on strengths and virtues as only one aspect of treatment.
"Freud was interested in depth psychology, the psychology of the deeper recesses of the mind," said Charles Goodstein, MD, professor of psychiatry at New York University, in a phone interview. "Positive psychology seems to be the psychology of the superficial. It seems to be a form of education, of exhortation. For some people, it might be beneficial to be the objects of an exhortation to be happy; after all, ministers and preachers have employed this method for years."
But then again, there are some people who benefit, at least transiently, from many kinds of psychological and psychiatric approaches. The question is the treatment's long-term value: does it help promote true, sustaining change in the individual?
"This is an approach that suggests people are relatively simple, and I don't think that's accurate," he continued. "It lacks an appreciation for the complexities of human personality. What very often happens in psychology and psychiatry is the repackaging of old wine in new bottles, but without an acknowledgment that it's old wine, and just emphasizing the package."
Positive psychology, he said, carries "the implicit suggestion . . . that everyone other than positive psychologists is operating in the sphere of negative psychology. In the arena of popular opinion, when the issue is framed this way, I imagine the positive psychologists emerge smelling of roses."
That dichotomy is fallacious, he said. "Psychiatrists and psychologists have been cognizant of the importance of the 'positive' aspects of human personality. The notion that psychologists and psychiatrists emphasize the negative is erroneous. When we work with symptoms, our goal is to free the patient of the unconscious impediments that have prevented them from using their positive attributes."
