Is happiness a useful therapy outcome?

Do you want to be happy or do you want to maintain a low BMI. Do you want to be happy and have big muscles and low body fat?  Do you want to be happy but only if you are running 50 miles a week?

Cannot have both.

A colleague had a session with a person with entrenched anorexia who said that she was coming to therapy because she just wanted to be happy.

We all want to be happy, but what does this mean? I was thinking about my own life (trigger alert) and it is not without stress. I have some inconvenient and slightly painful health issues, I always worry about my children, my work carries quite a bit of stress and my material aspirations are well beyond my financial capacity.  I have my fair share of regrets about past decisions and actions. Not only that, my ideal shape might be Taylor Swift but I’m not there by a long chalk.

But am I “happy”?  The answer is, I am.

People who quest for happiness can get it by sitting on a beach in Barbados. But will you be happy on that beach if you are a skeleton with a prune for a brain or you can’t have peaches for breakfast because you are terrified of the calories, or beating yourself up because you didn’t run 5 miles before dawn?

When the low-weight client tells you that they just want to be happy, take a pause.  You have a job to do with this statement. One thing you know – the happy life is not the same as the fulfilled life. The fulfilled person is not always happy, but they are glad to be alive.

We know, but we cannot explain to the unhappy client, that a starved brain cannot be happy. The starved brain can be dissociated, numb, proud (of being thinner than you), defiant (in being able to refuse eating) and full of shame (for not meeting perfectionist goals) – but it can never be happy.

We also know that the person who fights their anorexia and returns to a normal BMI will not be happy.  They will have lost all the pros of anorexia but got nothing back but “fatness”. They may be full of regrets for what they have done to themselves and to others. They will not quite have caught up with people who left them behind. So, you cannot say to them just gain weight and you will be happy.

So, when the client tells you that they just want to be happy, you are in a fix. They may become happy, when their lives improve, and their brains start to work properly and they notice a beautiful sunset with someone they love. 

The quest to be happy is a chimera. How can we talk to our client about that, because I am not going to agree that the main purpose of my therapy is to make them happy.  Perhaps it is to make them happy about being unhappy?  Food for thought.