Individual Responsibility versus Collective Action

If social welfare is the objective – the thing that needs to be maximised – the next issue is Who is going to make that happen?

In traditional economics, a huge reliance is placed on the unfettered choices of individuals. As Adam Smith argued in the Wealth of Nations, people may be selfish; but, in order to get what they want, they do best by supplying what others need. The result of this process of voluntary exchange is an efficient situation where (on four assumptions) it would be impossible to make anyone better off without making someone else worse off. These assumptions are:

• no monopoly or oligopolies,

• no public goods (like roads or parks),

• full information for all,

• no one affects anyone else except through voluntary exchange (i.e. there are no ‘externalities’).

The classic example of a negative ‘externality’ is air pollution. The pollution just comes my way whether I agree to it or not. So an externality is something that just happens to me without my choosing it. Psychologists and sociologists will immediately realise that externalities comprise a huge fraction of everything that happens – from how we learn our values to whether we are robbed.Footnote ¹ Coping with externality is essential if we want an efficient society.

There is also another problem with pure laissez faire (where individual action is unfettered). This is the issue of equity. Even if the framework is efficient, it may leave some people much less happy than others. People differ hugely in their talents, in the wealth they inherit and, most importantly, in their inner capacity to live an enjoyable life.

Thus pure laissez-faire is neither efficient (the four assumptions are not satisfied) nor is it equitable. So we need both society and the state to be active in promoting the wellbeing of the people and the prevention of misery. And for this they need wellbeing science.

There is also a further reason. People themselves differ hugely from what is assumed in traditional economics. On the one hand, they are much less good at promoting their own best interests than economists assume. And, on the other hand, they do often care a lot about the wellbeing of others. So we have to begin this book with a fundamental look at some of the basics of human behaviour.

In this chapter we shall investigate two questions.

• To what extent do people pursue their own best interests?

• In what ways are people affected by others’ behaviour beyond voluntary exchange – in other words, what are key examples of externality?

Human Decision-Making

Clearly, people do to some extent pursue their own best interests. That is one reason why the human race has survived. People are ‘attracted’ to things that are good for survival – and feel happier when they achieve them (eating, mating etc.). And they ‘avoid’ things which are bad for their survival. This ‘approach/avoidance’ system is a basic part of human nature. But things are more complicated than that.

In 2002, the Nobel prize for economics was awarded for the first time to a psychologist. Some would say ‘About time’, since economics is based on a psychological theory about how people behave. But Daniel Kahneman’s message was different from that of the economists. As Kahneman put it, economists typically assume that people ‘are rational, selfish and their tastes do not change’.Footnote ² After decades of research with his friend Amos Tversky, Kahneman believed otherwise.

Together they founded a new subject – called behavioural economics by some and behavioural science by others. Many others followed them, especially the economist/psychologist Richard Thaler (another Nobel laureate) and the lawyer Cass Sunstein. In their book Nudge,Footnote ³ they distinguished sharply between the people of traditional economic theory (who they called Econs) and real people (who they called Humans).

The two central issues are these: how effectively do people pursue their own wellbeing, and how do they impact on the wellbeing of others? There are at least five major ways in which humans do not maximise their own wellbeing:

• Addiction and lack of self-control,

• Unforeseen adaptation,

• Framing,

• Loss-aversion,

• Unselfishness.

Unforeseen adaptation/habituation

Another source of bad decisions is adaptation that is not foreseen. Human beings are generally pretty adaptable. They adapt to hardship – and they habituate to good experiences. In other words, the initial impact of a change on wellbeing eventually wears off, either partially or totally.Footnote ⁵ As we shall see in this book, people adapt (partly at least) to divorce, disability and poverty, and they also adapt to new houses, a new car, a new partner or a new child.Footnote ⁶

If adaptation is total, the only way to change your wellbeing permanently is to experience continual change. Thus in ‘total adaptation’ we might have

$W_t=b\left(X_t-X_{t-1}\right)$(1)

where X is anything that matters to you. So if you like X, your mood is higher when X is increasing. But, once X stops increasing, you return to your previous level of wellbeing. In other words, there is a ‘set point’ of wellbeing – neither good changes nor bad ones have any permanent effect.Footnote ⁷

But if in fact we follow people through their lives, we find that their wellbeing often fluctuates a lot from one decade to another.Footnote ⁸ So, total adaptation is relatively rare – poorer people are, for example, less happy than rich people (other things being equal). But they also suffer less than you might imagine if you thought about how you would feel next year if you suddenly became that poor.

For the most common case in real life is ‘partial adaptation’. This is very common. When you move house, your next new house makes you feel great at first, but then gradually you take it for granted (you reduce your attention to it) and you return towards how you felt before the move.Footnote ⁹ The same happens with a new car or a rise in income. A typical case of partial adaptation is

$W_t=a{X}_t+b\left(X_t-X_{t-1}\right)$(2)

So suppose we start from a position where X has equalled X₀ for some time, with

$W_0=a{X}_0$

Then X rises to X₁ and stays there from then on. In response, wellbeing in the first time period is

$W_1=a{X}_1+b\left(X_1-X_0\right)$

But in the following period, there is no further stimulating increase in X. So

$W_2=a{X}_1$

This sequence is shown in the Figure 3.1, where X is taken to be desirable.Footnote ¹⁰ The key point is that the degree of adaptation is measured by the ratio of b to a. The higher b is relative to a the more adaptation occurs, and the further W moves back to its original position after its initial change. This kind of pattern applies to the effects of finding a partner, losing a partner, having children and many basic experiences.

Figure 3.1 Partial adaptation of wellbeing to changes in X

If one looks deeper into the reasons for adaptation, it clearly has much to do with attention. When you attend to things, they become very important. When you do not, they become less so. As Kahneman puts it, ‘nothing in life is as important as you think it is when you are thinking about it’. Things that are very salient and obtrusive like money can easily grab people’s attention, although for much of the time most people don’t actually think about them. For example, most people think that people in California are happier than people in the mid-west region of the United States. This is because, when they make the assessment, they are thinking about the difference in the weather. But in fact there is no difference in happiness because neither group actually spend that much time thinking about the weather.Footnote ¹¹ Nor after a while do most people spend much time thinking about their car, unless someone draws their attention to it.

So what are the implications of adaptation for the wellbeing of the individual? The key question is whether or not individuals foresee their adaptation. If people foresee the adaptation, the decisions they take will be optimal. But in many cases, people clearly overestimate the gain in wellbeing they will eventually get from a change – a higher income, a new car, a new house or even a new partner. In such cases, people will put too much effort into acquiring the new situation, and in some cases they will come to regret the effort they made.Footnote ¹² The Harvard psychologist, Daniel Gilbert, has called this a case of ‘miswanting’.Footnote ¹³

Loss-aversion and the endowment effect

This leads directly to another key human characteristic: loss-aversion. Even for small things, people hate losing them by more than they would value gaining them. This is a deep psychological trait in all animals – their strongest impulse is to hold on to what they have. Just try removing food from your cat.

Richard Thaler calls this the ‘endowment effect’. So here is a remarkably simple experiment.Footnote ¹⁹ Students are randomly divided into two groups. The first group is shown a particular type of mug and asked how much they would be willing to pay for it. The average answer is $3.50. The other group are given the same mug for free. After a while they are asked how much money they would need to be paid in order to get them to part with the mug. The average amount is $7. So the same mug is worth $7 once you have it, but you are only willing to pay half that in order to get it. Thus there is no simple answer about the value of the mug, even to the same person: it depends whether she already owns it.Footnote ²⁰ The value depends on the ‘reference point’.

Another clear example of loss-aversion is people’s response to uncertainty, where Kahneman was awarded the Nobel prize for what he and Tversky called ‘prospect theory’. So here is one simple experiment. You are asked whether to accept the following gamble:

• 50% chance of winning $150 and

• 50% chance of losing $100.

Someone who accepts this gamble can, on average, expect to win $25. Yet the majority of people decline the offer.Footnote ²¹ This cannot be explained by assuming that there is a smooth relationship between happiness and income, regardless of what the person’s income was until now.Footnote ²² Instead, when people value their future income, they are comparing it with their present income. And they dislike losses more than they like gains. In other words, as Figure 3.2 shows, if a person started with an income of $y_o, she would lose more happiness if she lost $100 than she would gain if she won $150.

Figure 3.2 Loss-aversion

Loss-aversion goes way beyond our attitude to income, and it affects behaviour in all sorts of ways.Footnote ²³ For example, professional golfers are more likely to sink a putt if it is needed to avoid a bogey (a loss) than if the same shot would give them a birdie (a gain). Taxi drivers work longer hours on bad days, even though there is less work. Homeowners insist on selling their houses for a higher price when it involves a loss. And investors are more likely to sell stocks that have increased in value (since they were bought) than to sell stocks that have gone down: they hate to ‘realise’ losses. None of these attempts to avoid losses would be in the interest of a rational maximiser of expected outcomes.Footnote ²⁴

Many studies have attempted to measure the scale of loss-aversion, as measured by the slope of the wellbeing/income relationship for losses relative to that for gains. The typical finding is a ratio of 2:1. For example, suppose there was

• a 50% chance of winning $x and

• a 50% chance of losing $100

and you were asked what value of x would make you just willing to undertake the gamble. The typical answer is $200.Footnote ²⁵

A similar size of effect can be found at the level of the whole economy – this time in relation to actual wellbeing experienced rather than anticipated wellbeing. When incomes fall in a slump, the fall in national happiness is double the increase in happiness that occurs when incomes rise in a boom.Footnote ²⁶ Once again the ratio is 2:1. Loss-aversion explains many forms of behaviour that standard economics cannot explain but that wise people have always noticed. One of these is wage stickiness in the downward direction. As Keynes pointed out, people fiercely resist a cut in the money value of their wage. If prices are falling enough, this may appear irrational since a person might gain in real income even though their money wage fell. But people do not see it that way, and a combination of loss-aversion and ‘money illusion’ stops wages falling and exacerbates the slump. This simple observation is central to Keynesian economics, but it is inconsistent with pure rationality.

More generally, it is loss-aversion that makes many economic reforms so difficult to achieve. Even if 95% of the population would gain, a reform will often be defeated because of the 5% who lose. Examples abound in every country. In Britain in the 1930s, mass unemployment caused little political protest until the government reformed the unemployment benefit system in a way that benefitted most unemployed people but hurt a few.Footnote ²⁷

Before leaving loss-aversion, let’s note one further fact: diminished sensitivity. One aspect of this is standard in economics – as you gain more and more, you value each additional gain less and less. But the same is true of losses – as you lose more and more, each extra loss causes less and less additional pain. For example, suppose once again that we look at gains and losses of money. The corresponding changes in wellbeing are shown in Figure 3.3.

This has remarkable results. Suppose people have to choose between the following alternatives:

• a 50% chance of losing $100

• the certainty of losing $50.

They will prefer the gamble since it offers at least a 50% chance of losing nothing. To retain the hope of avoiding loss, decision-makers worldwide are prone to risk a lot, even though it might be more rational to accept a much smaller loss and move on.Footnote ²⁸

Figure 3.3 Loss aversion with diminished sensitivity

Source: Adapted from Kahneman (Reference Choi, Laibson, Madrian, McCaffrey and Slemrod2011)

The combination of loss-aversion and diminished sensitivity constitute what Kahneman and Tversky called ‘prospect theory’ and it was for this that Kahneman won the Nobel prize (Tversky having sadly died). Each prize-winner receives a personalised drawing, and the drawing on Kahneman’s certificate was a more artistic version of Figure 3.3.

Externalities

The conclusion so far is that Humans do not always maximise their own wellbeing. In cases where this produces a bad outcome, good advice, nudges and even government intervention might help them do better.Footnote ³⁵ But there is another reason for government intervention that also arises from human nature: the role of externality. Let us look briefly at three forms of externality: the trustworthiness of others, the sources of our social norms and social comparisons.

Conclusions

In the traditional economic model, people have well-defined preferences and pursue them consistently and selfishly. According to this model, wellbeing is efficiently promoted, in a laissez-faire world, except for various problems. The biggest of these problems is ‘externality’, which is the way in which people affect other people without their agreement.

However, there are in fact many other problems. Humans are different from the traditional economic model in many ways.

• They often lack self-control (e.g., over drugs, alcohol and gambling), and what they plan for tomorrow they often fail to execute.

• They often do not realise how much they will adapt to change, and they put effort into new acquisitions that make less difference to them than they expect.

• They are hugely affected by how decisions are framed – for example, many will adopt a pension plan when it requires effort to opt out of it, but they would not choose it if they had to opt in to it.

• People are hugely loss-averse, which often makes desirable changes much more difficult.

• And, on the other side, they often help each other without expecting anything in return.

These complexities mean that government intervention or nudges are often needed to produce efficient outcomes. These arguments become even stronger when we consider the many pervasive ‘externalities’ affecting our experience:

• We benefit if we live in a trustworthy society.

• We get many of our norms and tastes from society.

• Because of rivalry, we lose wellbeing if others are more successful.

Thus, the simple economic model explains a lot about the behaviour of companies and workers. But it is a very incomplete account of how people often behave. Clearly we need to understand why people behave as they do. But to know what behaviours should be encouraged, we also need to know how behaviour affects wellbeing. That is the central feature of the rest of this book.

Questions for discussion

1. (1) If people fail to pursue their own best interest, should the government ever do more than nudge them?

2. (2) What is the right mix of competition and cooperation?

3. (3) Whose job is it to produce good citizens: (i) parents, (ii) schools, (iii) government, (iv) faith organisations, (v) others?

4. (4) How useful is traditional economic theory for thinking about public policy? What are its main short-comings?

Our experiences affect our wellbeing but so does the way we think about our experience – and about our future. The best evidence about this process comes when people are taught how to control their thoughts better. So in this chapter we examine three types of mind-training:

• Clinical psychology (for people in distress),

• Positive psychology (for all of us),

• Meditation and mindfulness

The Experimental Method

In each area, we shall rely on evidence from well-controlled experiments. Such experiments are a vital part of wellbeing research. They are the surest way to establish causality in general and they are particularly important if we are trying to find out how to improve things. It is so easy to think that some method works – you see that those treated (the ‘treatment group’) improve. But would they have improved anyway? You can only answer this question if you had a ‘control group’ who were as similar as possible to the ‘treatment group’ but did not receive the treatment. The progress of the ‘control group’ then provides the ‘counterfactual’ with which you can compare the progress of the treatment group.

The gold standard for such a comparison is the randomised-controlled trial (or RCT). Here the treatment group and control group are drawn randomly from a single population. This does not guarantee that they are identical, but it hugely reduces the risk of conclusions that are biased because of pre-existing differences between the treatment and the control group.

The key issue with any intervention is the size of its effect. This is more important than whether the effect is or is not significantly different from zero (which also depends largely on the size of the sample).

The size of the effect can be measured in two ways. In the first, we measure it in units of the outcome being measured. For example, we could measure the effect in units of life satisfaction on a scale of 0–10 and find that an intervention raises life satisfaction by say 1 unit.

But it is also interesting to see how big this effect is, when compared with the overall spread of life satisfaction in the population. So suppose the standard deviation (SD) of life satisfaction is 2. Then this same intervention has increased life satisfaction by 0.5 standard deviations. This is the statistic known as the effect size (or Cohen’s d).Footnote ¹ So for an outcome variable Y, the effect size of an intervention is given by

Effect size = Effect (in units of Y)/SD(Y) = Cohen’s d

Cognitive-Behaviour Therapy (CBT)

So, let us start with clinical psychology and ask, Are people in distress just victims of their past, who can only be helped by uncovering their past? Or can they improve their state of mind by changing their present pattern of thinking?

The leading exponent of the first view was the Austrian psychiatrist Sigmund Freud (1856–1939). According to Freud, our current feelings are largely the result of what happened to us in childhood. If our experience was bad, this has a lasting effect, especially if the memories of the bad experiences are ‘repressed’, buried deep in the ‘unconscious’ part of the mind. According to Freud, it is only if these memories are brought to the surface that the person can move forward. This is best achieved through psychoanalysis. Here the patient lies on a couch with the therapist behind him, while the patient practices ‘free association’. And, through this free association, the repressed memories come to light and the patient’s suffering is relieved.

Many people have been helped by Freudian treatment, though it is not easy to know how many, due to the paucity of controlled trials.Footnote ² Freud was hugely influential on our culture, especially our greater openness about sex. But Freud’s view of human possibilities lacked optimism. In Civilisation and Its Discontents, he wrote: ‘The intention that man should be happy is not in the plan of creation.’

Most psychotherapists in the generation that followed Freud had a more optimistic view of human welfare. This was particularly true of Carl Rogers (1902–1987), who founded what he called humanistic psychology.Footnote ³ More than anyone, Rogers stressed the importance in psychotherapy of the therapeutic alliance between the therapist and the client, which is so central to much of counselling today. But the main focus of such counselling (now face-to-face) continued to be on understanding the past and how it has influenced the present.

Positive Psychology

If thoughts influence moods for people in real distress, the same must surely be true of everyone else also. This was the insight of Beck’s leading followers. In his presidential address to the American Psychological Association in 1998 Seligman proposed a new concept called Positive Psychology.Footnote ¹² This applies the same principles as CBT to the lives of everybody. Everybody, it says, can be happier if they have better control of their mental lives and more sensible goals. The secret is to build on your strengths rather than to correct your weaknesses.Footnote ¹³ And to look for the best in any situation and the best in any person – to reach out and to feel grateful for what you have.

There are many good books on positive psychologyFootnote ¹⁴ and there are many controlled trials of the procedures it recommends, such as

• a daily gratitude exercise and

• a daily extra act of kindness.

At this point it is enough to present the 10 Keys to Happier Living, distilled from this literature by the movement called Action for Happiness. The five items in the left-hand column (see Figure 4.1) are five recommended actions for every day – the psychological equivalent to the daily five fruit and vegetables recommended by the WHO.Footnote ¹⁵ The five items in the right hand column are the main long-term dispositions we should cultivate in ourselves. To promote the 10 Keys, Action for Happiness has offered an eight-session course, which has been subjected to a randomised control trial. This showed that, two months after the course ended, the treatment group had gained over 1 point in life satisfaction (on a scale of 0–10), which is more than occurs when someone gets a job (after being unemployed) or finds a partner to live with.Footnote ¹⁶

Figure 4.1 10 Keys to Happier Living

Source: Action for Happiness, 10 Keys to Happier Living

A key issue in positive psychology is attention. What we focus on affects not only what we do (as in Chapter 3) but also how we feel. As we have seen, when humans evolved in the Savannah, there was a daily risk of being killed. So a high level of anxiety was functional, and it became embedded in our genes. As the psychologist Rick Hanson has put it ‘the mind is like Velcro for the negative and like Teflon for the positive’.Footnote ¹⁷ But in most of today’s world, people are much safer from violence than they have ever been.Footnote ¹⁸ So most people are more anxious than is good for them – they devote excessive attention to what goes wrong. The way to be happier is to devote more attention to what goes right.

Positive thinking has been subject to considerable criticism by those like Barbara Ehrenreich, author of Smile or Die, who says it encourages a Pollyanna attitude. According to these critics, it makes us overlook the bad stuff that is going on. Instead, these critics advocate ‘realistic thinking’. Obviously when it comes to other people, realism is vital – we should attend to their suffering. We need to notice it and help them – and the evidence shows that happier people are more helpful to others.Footnote ¹⁹ But, for ourselves, it is we who can, in part, create our own reality. The glass may be both half-empty and half-full: but how much better to think of it as half-full!

Meditation and Mindfulness

The habits encouraged by CBT and positive psychology have much in common with those advocated by Eastern wisdom, especially Buddhism.Footnote ²⁰ The East has developed a more effective method of mind-training than is common in the West.Footnote ²¹ It is meditation. There are many forms of meditation, but the most common and the most studied is mindfulness.Footnote ²²

Mindfulness means focusing on the present in an open, aware and non-judgemental frame of mind. You set aside the past and the future and you simply observe the present moment. You choose what you will attend to, and then attend to it. If your mind drifts off, you gently bring it back.

At first, the most natural object of attention is your breathing (where simple breathing exercises are also very useful).Footnote ²³ But you can then move on to different parts of the body (including a full ‘body scan’), and then you can observe your thoughts, be they happy or sad. You do not push sadness or anxiety away, but you observe it from outside in a friendly way, so that it no longer possesses you. And you practice compassion towards yourself. If you feel you have done something stupid or wrong, you think, What would I say to a friend who was in this state? And you say just that to yourself.

Much mindfulness meditation in the West is based on Jon Kabat Zinn’s eight-session course of Mindfulness-Based Stress Reduction (MBSR) developed at the University of Massachusetts. This was originally a course for people in chronic pain, but it has proved very beneficial to many other people. For adults, MBSR has been found to have beneficial effects on mood and sleep, on substance abuse and on concentration and empathy.Footnote ²⁴ It also affects the body. Mindfulness has been found to increase the amount of grey matter (critical for learning) and the regulation of emotion, and to increase telomerase, which increases longevity.Footnote ²⁵ In one randomised trial, four months after the MBSR course was over, members of the treatment group and the control group were given a flu jab. The meditators produced more antibodies.Footnote ²⁶

For children, comparable courses in mindfulness have been evaluated in a meta-analysis of 33 separate studies. They were found to have significant positive effects on depression (d = .22), anxiety (d = .16) and social behaviour (d = .27).Footnote ²⁷ Some studies have also found good effects on academic learning.Footnote ²⁸

Mindfulness meditation is totally non-judgemental. But there is another powerful strand in Eastern wisdom: the importance of compassion. A different form of Buddhist meditation focuses on developing compassion for others. In this, the meditator wishes first for her own wellbeing, then that of a loved one, then of an enemy and finally of all humankind. In a meta-analysis of 21 studies, this practice was found to increase wellbeing as well as compassion and to reduce depression and anxiety – all with effect sizes around 0.5.Footnote ²⁹ Compassion meditation has also been found to increase levels of the feel-good hormone oxytocin and to improve the tone in the vagus nerve, which controls the heart rate.Footnote ³⁰

Even so, there are some people for whom meditation does not work particularly well. But everyone can find some way of regulating their thoughts to improve their wellbeing.

All religions offer some way of doing this, but we leave the discussion of religion to Chapter 14. We can end this chapter with the Dalai Lama, who of all Eastern teachers has been the most influential in the West. He was until recently the head of the Tibetan government in exile but practices the life of a monk. He has also travelled and taught widely in the West. His many books teach ways to achieve happiness that may or may not include meditation. But at every stage the Dalai Lama, who has a strong scientific sense, stresses the unity of mind and body.Footnote ³¹ This is the theme of Chapter 5.

Conclusions

As we have seen, there are many interventions that can make us feel better through influencing our patterns of thinking and our reactions to the world around us. But these interventions tell us more than that. They show (through experiments) a more general truth: that how we think has a major effect on how we feel. Of course the opposite is also true: our feelings affect our thoughts, but it is mainly through our thoughts that we can manage our feelings.

Our thoughts, feelings and behaviour do not occur in disembodied space – they occur in our bodies. This chapter investigates four big questions about the relationship between mind and body:

• Can we locate our feelings in the brain?

• How does our mental wellbeing affect the rest of our body?

• How in turn does our body affect our mental wellbeing?

• How do our genes affect our mental wellbeing?

Feelings and the Brain

Neuroscience is still in its infancy. But we can already locate areas in the brain where people experience their mental wellbeing and their distress. The method is to ask many people how they feel and then to correlate their answers with the electrical activity in different parts of their brains. The best method of measuring electrical activity in different parts of the brain is by functional Magnetic Resonance Imaging (fMRI).Footnote ¹ Using fMRI, significant correlations have been found between measures of wellbeing and electrical activity in a number of different brain areas. For example, Richard Davidson and his colleagues at the University of Wisconsin have found a strong relationship with activity in the ventral striatum (and within it the nucleus accumbens).Footnote ² The relationship holds both over time for the same person (as when a mother is shown a picture of her child) and also, more importantly, across people. Thus people with higher sustained activity in the ventral striatum report higher psychological wellbeing (see Figure 5.1). Their adrenal glands also produce less cortisol – another positive sign of wellbeing (see below).

Figure 5.1 Sustained activation of the ventral striatum predicts psychological wellbeing

Source: Heller et al. (Reference Heller, Johnstone, Light, Peterson, Kolden, Kalin and Davidson2013)

The ventral striatum is a subcortical area that humans share with other mammals. But neuroscientists have also found correlation between wellbeing and activity in different parts of the pre-frontal cortex (including the ventro-medial and the dorsolateral).Footnote ³ Researchers have also identified a Default Mode Network in the brain that takes over when nothing much else is going on. It is focused on the self, and people where the network is more active report themselves to be less happy.Footnote ⁴

So there are objective measurements that correlate with reports of subjective experience, and this confirms that there is some objective information content in the reports of subjective wellbeing. But our understanding of the neural correlates of wellbeing is still quite partial.

More advanced is the neuroscience of pain. The main area where people feel distress when they are in pain is the anterior cingulate cortex (ACC), which is another subcortical area. Physical pain has two components – the ‘sensory’ aspect and the ‘emotional’ aspect. The sensory aspect informs us where the pain comes from (back, leg etc.) and its nature (e.g., pulsating, continuous, hot, cold), and it is recorded in the somatosensory cortex. But the emotional distress felt as part of the pain is located in the ACC.Footnote ⁵

So too, is the emotional distress resulting from social pain.Footnote ⁶ So it is not surprising that the pain-killing drug paracetamol (Tylenol in the United States) has the same dulling effect on the experience of both physical pain and social pain. In each case, the drug is moderating the electrical activity in the same part of the ACC.

So we already know something about where our conscious feelings of wellbeing and pain are experienced. But how does our mental life affect the rest of our body?

How the Mind Affects the Body

The clearest effect of the mind on the body is its effect on longevity. In September 1932, the mother superior of the American School Sisters of Notre Dame decided that all new nuns should be asked to write an autobiographical sketch. These sketches were kept, and much later psychologists independently rated them by the amount of positive feeling they revealed. These ratings were then compared with how long each nun lived. Remarkably, the amount of positive feeling that a nun revealed in her twenties was an excellent predictor of how long she would live. Of the nuns who were still alive in 1991, only 21% of the most cheerful quarter died in the following nine years, compared with 55% of the least cheerful quarter of the nuns.Footnote ⁷ This shows how happiness can increase a person’s length of life.

More recently, a random sample of English adults over 50 were asked questions about their happiness, and they were also asked whether they had been diagnosed with any long-term physical illness, such as heart disease, lung disease, cancer, diabetes or stroke.Footnote ⁸ They were followed for nine years to see if they died. The crude results are shown in Figure 5.1. The least happy third of them were three times more likely to die than the happiest third. And, even when controlling for all their initial physical illnesses, the least happy third were still some 50% more likely to die. Another study traced everybody in a Norwegian county over a six-year period. At the beginning, they were all diagnosed for their mental state and also asked other questions, such as whether they smoked cigarettes. Over the next six years, it turned out that diagnosed depression was as powerful a predictor of mortality as smoking was (Figure 5.2).Footnote ⁹

Figure 5.2 Percentage dying over the next nine years (People originally aged 50 and over)

Source: Andrew Steptoe. See also Steptoe and Wardle (Reference Steptoe, Hamer and Chida2012)

What explains this effect of mood upon physical health? The clearest channel is through the effects of stress. The body has a mechanism that responds to stress in a similar way whether the stress is physical or mental. This is sometimes called the ‘fight or flight’ response: our heart rate, blood pressure and breathing rate increase; we sweat more and our mouths go dry.

This response begins in the brain, which is linked to the rest of the body by two main sets of nerves. One set includes the sensory nerves and the motor nerves, which give conscious instructions to our limbs about what to do. But the other set is the ‘autonomic nervous system’, which is largely outside our conscious control and regulates the workings of all our internal organs.

The autonomic system has two main branches: the sympathetic and the para-sympathetic. It is the sympathetic nervous system that initiates the fight or flight response. It immediately instructs the adrenal gland to produce what Britons call adrenaline and Americans call epinephrine. This is a hormone (Greek for messenger) that enters the bloodstream and galvanises the whole body for action. It also mobilises the immune system to produce pro-inflammatory cytokines in case they are needed to handle possible infections. The parasympathetic nervous system, in contrast, calms the body. When it is active, the body’s organs become less active. For example, in meditation or breathing exercises the vagus nerve is active in reducing the heart rate. But, so long as stress is maintained, it is the sympathetic system that is most active.

At the same time, a second hormone is produced in another part of the adrenal gland: cortisol. A message goes from the brain’s hypothalamus to the pituitary gland to the adrenal gland, which releases cortisol into the bloodstream, and this then stimulates the muscles by releasing their store of glucose.

The stress response is totally functional when the stress is brief. But when the stress is persistent, it can lead to over-activity of the immune system (especially of C-reactive protein and IL6) and to persistent inflammation around the body, which eventually reduces life expectancy.Footnote ¹⁰ It also leads to more fibrinogen in the blood – intended to cause blood clots in a wound but unwanted in the longer term. In Western countries the most common sources of prolonged stress are psychological, and increased inflammation has been observed as a result of marital conflict, caring for demented relatives, social isolation, social disadvantage and depression.Footnote ¹¹

Another cause of stress with long-lasting effects is child abuse. One study followed children born in Dunedin, New Zealand. Those who had been abused in the first ten years of life had increased markers of inflammation twenty years later.Footnote ¹² These findings on child abuse are confirmed in a meta-analysis of many comparable studies.Footnote ¹³ By contrast, optimism and purpose in life protect against coronary heart disease and stroke.Footnote ¹⁴

Perhaps the simplest evidence of the effect of mind on body comes from a simple experiment. In it people were given a small experimental wound. Those who were depressed or anxious took the longest to recover.Footnote ¹⁵ In another experiment, people were given injections, and people in the greatest psychological distress developed the fewest antibodies.Footnote ¹⁶ Since we can affect the mind by psychological intervention, we can also affect the body that way. For example, mindfulness meditation reduces the level of pro-inflammatory cytokines.Footnote ¹⁷ It also increases the production of telomerase, which increases life-expectancy.Footnote ¹⁸

Perhaps the most striking effect of the mind on the body is the placebo effect. For many diseases, up to 30% of people given a placebo pill (with no active ingredient) will recover.Footnote ¹⁹ People recover because they believe that they will.

So the mind has profound effects on the body. These are a major part of how our wellbeing is generated, and the different chemicals involved provide useful biomarkers of how our wellbeing is developing.

How the Body Can Affect the Mind

But there is also a stream of causation going in the opposite direction – from our body to our wellbeing. Bodily events can alter our mental state. Healthy living is vital for our mental wellbeing and this means plenty of exercise, enough sleep and good sense in drinking and eating.Footnote ²⁰ Equally, physical illness and dementia reduce our wellbeing.

But one of the clearest examples of the effect of the body on the mind is the power of drugs, be they recreational or psychiatric. These work by affecting the operation of chemical ‘neurotransmitters’, which are crucial to the working of the brain. The brain consists of about 100 billion brain cells or neurons, and each neuron is connected to thousands of other neurons. Messages travel round the brain one neuron at a time. When that neuron ‘fires’, an electrochemical impulse travels from one end of the neuron to the other. But then it reaches a gap between that neuron and the next neuron. This gap is called a ‘synapse’ and the message is carried across the gap from the sending neuron to the receiving neuron by a chemical neurotransmitter.Footnote ²¹

So the different circuits in the brain are operated by different neurotransmitters:

• Serotonin produces a good mood.

• Dopamine and acetylcholine are neurotransmitters that stimulate (and can heighten) mental activity. (A ‘high’ feeling is generally associated with a rush of dopamine).

• GABA (gamma aminobutyric acid) and endocannabinoids reduce mental activity.

• Endorphins reduce pain.

Drugs affect the operation of a neurotransmitter. Some stimulate production of a neurotransmitter, others reduce its production, while others bind to the same receptors as some neurotransmitters and thus have a similar effect as the neurotransmitter that they mimic. Table 5.1 shows how the main recreational drugs alter our mental state, through the way in which they alter the operation of the neurotransmitters. Unfortunately, all these drugs can be addictive.Footnote ²²

There are, however, other drugs that can make people feel better: psychiatric drugs. These are generally less addictive. Table 5.2 shows some of the psychiatric drugs recommended for different psychiatric conditions. Take one example, Prozac. This is a psychiatric drug that increases the flow of serotonin and thus activity in the circuits that it serves. It does this by inhibiting the reuptake of serotonin, thus increasing the supply of serotonin and improving mood. In other words, it is a selective serotonin-reuptake inhibitor (SSRI). In many depressed patients, Prozac improves mood. Clearly dopamine is a tricky neurotransmitter: increasing it can be stimulating, but an excess of dopamine leads to schizophrenia (and a deficiency of dopamine to Parkinson’s disease). Like psychological therapy, psychiatric drugs do not always work. They are, however, strongly recommended for severe depression, where they achieve 50% recovery rates. But they have no effects on relapse unless they continue to be taken.

A key fact about the brain is the ease with which it can be altered by experienceFootnote ²³ – in other words, there is a high level of ‘neuroplasticity’. Blind people use part of their visual cortex to hear. And London taxi drivers have to remember so many streets and routes that they develop abnormally large hippocampal areas in their brains.Footnote ²⁴ There are many places in this book where we shall report the effect of wellbeing interventions on brain activity.

How Our Genes Affect Our Wellbeing

The one part of our body that never changes is our genes. They were determined at the moment of our conception and, apart from mutations, we keep the same genes throughout our life. The same genes are present in the nucleus of nearly every cell in our body. It is the continuity in our genes that explains much of the continuity in our personality, our appearance and our behaviour over our life.

But how do we know this, and how far do differences in our genes explain the differences in wellbeing in the population? To explore these questions, we shall proceed this way.

1. (1) We shall examine twins and show that identical twins (with the same genes) are much more similar to each other in wellbeing than non-identical twins are (with many different genes).

2. (2) We shall look at adopted children and show that they still resemble their biological parents in many ways.

3. (3) We shall show that the genes and the environment do not have independent effects on our wellbeing – they interact. Therefore, it is not possible to say in any meaningful way how much of the spread of wellbeing is due to differences in genes and how much to differences in environment.

4. (4) We shall describe the pioneering search for the specific genes that affect wellbeing.

5. (5) Finally, we shall examine the inter-relation between genes, personality and wellbeing.

Evidence from twins

To see that genes matter we have only to look at the following data on Norwegian middle-aged, same-sex twins (see Table 5.3). Some of the twins are identical: both come from the same egg. They therefore have the same genes and look more-or-less identical. The other sets of twins are non-identical: each twin comes from a separate egg. So half her genes are the same as her co-twin’s but half are different (just as is the case with any other pair of siblings).Footnote ²⁵ And what a difference that makes! As Table 5.3 shows, if the twins are identical, their life satisfaction is fairly similar (with a correlation across the 2 twins of 0.31). But if the twins are non-identical, their enjoyment of life is much less similar (with an across-twin correlation of only 0.15).

Table 5.3 Correlation in life satisfaction between each twin and his/her co-twin (Norwegian adults in mid-life)

Identical twins	0.31
Non-identical twins	0.15
Difference	0.16

Source: Roysamb et al. (Reference Røysamb, Nes, Diener, Oishi and Tay2018)

What could account for this difference? Clearly it must be because the identical twins have genes that are more similar. Even though both sets of twins were raised together, their final wellbeing was very different. This suggests that the family environment has a smaller influence than many people suppose.

Countless twin studies testify to the effect of our genes not only on our wellbeing but also on our mental health. For example, if you are bipolar and you are an identical twin, then the chance that your co-twin is also bipolar is 55%. (That is the degree of ‘concordance’.) But, if your co-twin is not identical, the chance is only 7%.Footnote ²⁶ Thus if someone has bipolar disorder, the risk to the co-twin is a huge 48 points higher (55%–7%) if the co-twin is identical rather than non-identical. Figure 5.3 gives comparable numbers for many other types of mental illness. In every case, the difference is substantial. That is an astonishing testimony to the power of genes.

Figure 5.3 Difference between identical and non-identical twins in the concordance between twin and co-twin

Note: For each condition, we calculate the concordance for identical same-sex twins and for non-identical same-sex twins and report the difference. For OCD, alcoholism and all childhood conditions except autism, we give the difference in co-twins’ correlation (on a continuous measure). For rare binary conditions, the concordance and the correlation are very similar

Source: Plomin et al. (Reference Plomin, DeFries, McClearn and McGuffin2013) pp. 245, 249, 251, 252, 259, 265, 290

Heritability

A natural question now is to ask What fraction of the variance of wellbeing across individuals is due to the genes?Footnote ³⁰ In other words, what is the heritability of wellbeing? Questions on heritability are usually answered using some strong assumptions, which we will question later.

We assume an additive model with (in its simplest form) two components – G for the genetic component and E for the environmental component. Thus wellbeing (W) is determined by W = G + E. It follows that the variance of wellbeing equals the variance of the genetic component plus the variance of the environmental component plus twice the covariance of the genetic component and the environmental component:

$\mathrm{Var}\left(W\right)=\mathrm{Var}\left(G\right)+\mathrm{Var}\left(E\right)+2\mathrm{Cov}\left(G,E\right)$

Crucially, in behavioural genetics this covariance is considered to be due to the genes. But in truth, it can be as much due to the environment as to the genes. For while it is certainly true that people with good genes are skilful at finding good environments, it is equally true that in most societies good environments are more receptive to people with good genes.Footnote ³¹ So the first arbitrary assumption in behavioural genetics is that individual outcomes related to genes are caused by genes. The second arbitrary assumption (to which we shall return) is that there are no gene-environment interactions.Footnote ³²

But if we wish away these two problems, we can show that the heritability of a trait (like wellbeing) equals twice the difference between the correlation of the trait across identical twins and its correlation across non-identical twins.Footnote ³³ So if we use the numbers in Table 5.1, the heritability of life satisfaction is 2 (0.31−0.15) = 32%. This is a typical estimate of the heritability of life satisfaction obtained from twin studies worldwide.Footnote ³⁴

Personality and Wellbeing

As we have seen, an important way in which genes affect our wellbeing is through our mental health. But a more general way is through all aspects of our personality. Psychologists find that much of the variation in character that we experience in those we encounter can be described by five dimensions. These are Openness, Conscientiousness, Extroversion, Agreeableness and Neuroticism (which spell OCEAN). Some of these dimensions appear to be poorly correlated with our life satisfaction. But two are highly correlated with life satisfaction. These are neuroticism (as you might expect from our earlier analysis) but also extroversion. So, if we revert to the mid-life Norwegian twins we discussed at the beginning of the chapter, personality overall explains about a third of the variance in wellbeing. And personality itself is partly determined by our genes (see Table 5.5). So a significant part of the heritability of wellbeing comes from the heritability of personality.

This said, it is crucially important to recognise that personality (like wellbeing) varies substantially over the life course. Not only do we on average become more conscientious, agreeable and emotionally balanced over time, but we also become less open and less extrovert. And we also change a lot relative to our contemporaries – due to differences in how life treats us.Footnote ⁴³ Genes are important, but from now on we concentrate on the effect of what policy-makers can affect – namely our experience of the environment in which we live.

Conclusions

1. (1) Self-reported wellbeing is correlated with activity in a number of brain areas. The sensation of pain is most clearly experienced in the anterior cingulate cortex (ACC), which registers both physical pain and social pain.

2. (2) The mind affects the body. Wellbeing predicts mortality as well as smoking does. Prolonged psychological stress leads to excessive production of adrenaline/epinephrine and cortisol, over-activity of the immune system and excessive inflammation in the body. Mindfulness meditation reduces these effects and increases life-expectancy.

3. (3) The body affects the mind. The most obvious effects are those of drugs, recreational and psychiatric.

4. (4) Genes have important effects on our wellbeing. We know this in two ways.

   • Identical twins (who have identical genes) are much more similar to each other in their wellbeing than are non-identical twins (who share only 50% of their genes).

   • Adopted children are more similar in mental health to their biological parents than to the parents who raised them.

     • It is important that parents and professionals realise the importance of these genetic effects and do not automatically blame parents’ behaviour for the problems of their children.

5. (5) It is, however, not possible to neatly separate the effects of the genes and the environment for two reasons:

   • Genes and environment often interact in their effects on wellbeing.

   • Genes and the environment are correlated, and there is no simple way to apportion that part of the variance of wellbeing that comes from the covariance of genes and the environment.

And we should never assume that, because a problem is partly genetic in origin, it cannot be treated as effectively as one that is primarily environmental.Footnote ⁴⁴

This completes our review of some basic processes common to all humans – our behaviours, thinking styles, physical processes and genes. It is time to turn to the impact on us of specific features of our experience.