Psychiatric Annals


Healthy Pleasures, Lethal Pleasures

Jan Fawcett, MD


Alcohol and cocaine can have toxic effects on our biological systems, but food we sustain ourselves with?


Alcohol and cocaine can have toxic effects on our biological systems, but food we sustain ourselves with?

This February's issue of Psychiatric Annals features a series of articles guest edited by Mark S. Gold, MD, entitled "Obesity and Eating Disorders." The series not only brings home the increasingly serious threat presented to the world's health from overeating, subsequent obesity, and insulin resistance, but presents intriguing and cogent evidence that overeating can affect changes in the pleasure-reinforcement circuits of the brain that closely resemble those seen in addiction.

This raises a series of questions about the role of our brain pleasurereinforcement system (PRS). If our PRS is yoked to the biological needs that support the survival of our species from an evolutionary point of view (reproduction and nourishment), under what conditions does this system lead us from survival behavior, perceived as pleasurable, to lethal self-destructive behavior? It's easy to understand how substances such as alcohol and cocaine can have toxic effects on our brains and other biological systems - but the food that we sustain ourselves with? How can that be? We all know that some pleasures (especially in excess) don't lead to happiness. We can accept genetic vulnerabilities to addiction - but how can food that we desire for our nourishment and survival turn out to be a threat?

The obvious answer is what kind of food. I doubt we will see a Psychiatric Annals series on celery or cabbage addiction any time soon. I will even predict that salmon or tuna addiction will be rarely reported. The type of food or substance may confer a major difference in substance abuse liability. Maybe we need a comprehensive, and growing list of substances (and maybe even behaviors) that have a high liability to become lethal pleasures (including certain types of fats and carbohydrates). About now some Calvinist in the group (defined by H.L. Meneken as somebody who suffers from the uncomfortable suspicion that somewhere someone is happy) will be thinking - "Look dummy, no list is necessary- it's obvious, the substances or behaviors that have the greatest liability to become lethal pleasures are the ones that we enjoy the most." I have noticed that my sunset watching is becoming more repetitive since my move to Santa Fe. Maybe a treatment program is in order. . .

What is clear is this: not all pleasures lead to happiness. Our PRS systems can mislead us. Happiness in life is not as simple as the pursuit of pleasure. Happiness attainment is an art form that requires cultivation and education (and taking into account the genetic cards we've been dealt can give us a leg up). So it seems that the lyric " if it makes you happy, it can't be that bad" gives way to the follow on line " if it makes you happy, why do you look so sad?." A lot of "pleasures" may be over rated and mislead us. Maybe a strategically timed course in Happiness 101 at some point in development would help.

The publisher of Psychiatric Annals is pleased to announce its inaugural meeting on Treatment-Resistant Depression, April 4-6, 2003, at the Marriott East Side in New York City.

Like each issue of Psychiatric Annals, this meeting will offer practical insights and developments that directly affect the practice of psychiatry. Our distinguished faculty deliver in-depth presentations providing attendees with skills to better care for their patients.

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