Interview Q & A with Ahron Friedberg, MD about his new book: Towards Happiness ― A Psychoanalytic Approach to Finding Your Way

For starters, how do you define happiness? We all want to be happy but it seems kind of an intangible concept.

We define happiness as satisfaction in certain basic areas of your life — work, relationships (including familial and romantic), health and well-being (including as one ages). It’s not some state of bliss or nirvana, but a dynamic state that you’re continuously trying to improve. Therefore, the book’s title is Towards Happiness, with the emphasis on moving in the right direction. Furthermore, happiness is unique to each individual. So, you have to determine what makes you happy and find your way toward it. Therefore, the book’s subtitle is A Psychoanalytic Approach to Finding Your Way. Because a basic premise of the book is that you need insight and understanding about yourself to find your way, the approach is considered “psychoanalytic”.

You’re a psychiatrist in private practice in Manhattan and Clinical Professor of Psychiatry at Mount Sinai. My impression is that psychiatrists treat depression, anxiety, trauma. What makes your orientation or approach different?

It’s true that much of psychiatry is now based on diagnosing and treating symptoms, as in other areas of medicine. In psychiatry, the mind and its manifestations (what we think, how we feel) is based in brain functioning. So, in a general way, psychiatry is geared toward restoring the brain’s imbalances, which corrects or at least reduces symptoms such as depression and anxiety. I’m a psychodynamic psychiatrist which means that in addition to diagnosing and treating mental illness, I try to help people feel better and more whole, personally and professionally. While considering diagnoses, I focus on an individual’s personal growth and self- betterment. The shared goal, like the ancient Greeks said, is to have a sound mind in a sound body. Making good choices for yourself, setting and working toward achievable goals, and having higher aims and purposes is integral to that achievement.

You break happiness into 5 distinct domains. Please tell us what they are and how they relate to one another.

We cover the basics by defining 5 domains of happiness, which compose the chapters of our book: work and money, wellness and personal growth, sex and love, family and friends, and aging. These areas are essential to overall happiness. Of course, someone can be happy in one area, say work, and not another, say love. It’s also interesting how the domains overlap, for example there’s a story about how one member of a couple is so dedicated to her own career that their marriage falls apart. In a committed relationship, you need to take time for one another, prioritize your relationship, and resolve differences. In another story, a professional neglects his personal health and well-being, and thus has to reassess what’s most important in his life in order to recover a sense of who he is. Mental health is basic to wellbeing, and you have to work at it.

So, what does satisfying work look like? Many people are unhappy with their jobs and would like to know.

It’s good to pursue work that gives you satisfaction. Not all jobs or careers offer that opportunity, but you can try to find one that does. It helps if your role offers you a chance to be creative, gain new skills and develop your abilities, and even do good in the world. If this isn’t the case, you may still find aspects of your work that you like and can learn from. Work is called work for a reason: it takes effort and commitment. One of the main reasons people stay in their job is they like the people that they work with. A good supervisor or colleague can be part of what you look forward to in starting your day, and that you enjoy throughout it. It’s harder to find meaning and a sense of purpose in your daily life if you don’t gain self-esteem — or at least some decent financial return — from what you do. So, apart from the monetary, there may be less tangible satisfactions that can be found at work. Most careers involve some interaction with other people — you can connect with them and make the most of those relationships. Many jobs have some room for growth and learning, so you want to optimize that part as well.

Beyond a better diet and exercise, what does wellness mean?

As a psychiatrist, I find that wellness has a significant mental health component. Of course, it’s important to recognize that diet and exercise contribute to mental health, sometimes as much as psychopharmacology and psychotherapy. Healthful eating and physical activity are an integral part of treating depression and anxiety, or at least they should be for most people. Still, a person may be physically fit but unwell personally. That’s a situation where psychotherapy — cognitive and behavioral approaches as well as insight and understanding — can play an important role. In one story in the book, an attorney is wracked by guilt for an error of judgment that he made a long time ago. He had to understand the context of what happened, take responsibility for the consequences, forgive himself and move on. We can’t change the past, but we can learn from it and move on. As Heidegger famously remarked, “Learn backwards, move forward.”

In your book, you discuss the importance of both sex and love to a relationship. Do you need both for a happy relationship?

Chemistry, both physical and emotional, are essential to a good relationship. I only half-jokingly say that sexless marriages don’t work. There may be reasons — medical, aging, etc. — for why a couple no longer has an active sex life. But they can still be physical and affectionate in other ways. You can hold hands or cuddle. On the other hand, physical chemistry may diminish over time. The flames of desire tend to fade into warm embers of intimacy. Men are not as testosterone driven as they age (lower blood levels of that hormone), so in a certain sense they often become more like women in seeking emotional connection. If a relationship is only based in chemistry, it’s often problematic. For a lasting relationship, it’s important to have a shared and solid foundation, good communication and the ability to resolve differences, acceptance and understanding of each other as well as shared goals and some common interests. In one story, the man comes to recognize he’s gay (it happens), and his former fiancée stays friends with him and his family. Relationships can be complicated that way; they can evolve; compromises and even sacrifices are often necessary. Sex and love can make for strange bedfellows, but when the two come together, it’s a beautiful thing.

Obviously, friends and family are both part of having satisfying relationships. Not everyone has good family relationships or many friends for that matter, so are they doomed to be lonely and unsatisfied?

It’s been a challenging time for people. During the pandemic and in this past pandemic phase, many have suffered from loneliness and isolation. Even people with good and supportive families sometimes felt cut off, especially the elderly who were at greater risk. Families are often complicated anyway with Oedipal conflicts and sibling rivalries. Still, one of life’s greatest satisfactions can be achieving a good family life. It’s a source of loving support during challenging times and of joy during life’s celebrations and special moments. It’s been said that friends are the new family, and there’s some truth in that. You choose your friends, so it helps to choose wisely. They reflect who you are and can help you become a better version of yourself. In the book, we’re candid about loneliness — it’s important to take care of one’s friendships, and be mindful of creating friends throughout one’s life. We can’t help the families that we inherit, but we can work at maintaining friendships.

The final chapter of your book is on aging. What makes for a ripe old age? As a follow-up, if someone is unhappy later in life, what do you suggest they do?

Aging well often consists of a combination of genetics and taking care, nature and nurture. As with heart disease and diabetes, people may be genetically inclined toward depression, anxiety and the like. Still, by attending to how we feel and optimizing status of mind, we can feel better. Like anything worthwhile, it takes work and effort. You don’t lose weight or get in better shape simply by sitting on a couch. A ripe old age, often has in it seeds you have planted earlier on in your life — meaningful work, satisfying relationships, good health habits, as we demonstrate in Towards Happiness. Each of us has to come to terms with the fact that we die, and we have to accept the life that we’ve lived. Any stage of life, even the last one, can be an opportunity for continued growth and betterment. It’s important to try and do you best. My father, who is in his 90s, had a crippling accident. He’s shown a great deal of resilience and is learning to walk again. That’s a source of satisfaction for him, and pride for those of us who love him. One point we make in the book is that “old” is actually “feeling old,” and that we can’t let others define how we feel. If you’re laid off because of age, you still have marketable skills; if your partner has left, that doesn’t mean you’re unattractive. You need to take charge of your life at every stage — including as you get older.

What are some of the main takeaways from Towards Happiness: A Psychoanalytic Approach to Finding you Way

One is the importance of making good choices throughout life. Don’t let things slide, and don’t let other people make choices for you. Sometimes that requires thinking ahead and imagining the future. Sometimes that requires stepping out of line to assert your own identity. Making good choices at every stage really adds up over time. Sure, not everything turns out as we expect or hope, but if it’s a good choice (the best we could make at the time), we can make the most of it. Sartre said that we are our possibilities, which I suppose is true in an existential sort of way. I’d say we’re the sum of our choices. So, choose well and wisely about your personal and mental health, your work, your friends and family. Also, as I began with, happiness is personal and individual. It’s not one size fits all. You have to determine for yourself what makes you happy and pursue it in the steps you take every day.

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