Happiness: an often-overlooked goal of treatment

Even though most people would point to happiness as an ultimate goal in life, psychiatry tends to limit its focus to the relief of suffering.
Certainly, this has been the case with schizophrenia, where scientific and clinical attention has been directed toward trying to understand the nature of the illness and eliminating its symptoms.

Little work has focused on the extent to which happiness is present among people with this condition or the factors that may predict it.

Yet real mental health is more than just the absence of symptoms. Mental health should also consider positive mental states like purpose, satisfaction… and happiness.

A Happiness Study

In Wellness within illness: Happiness in schizophrenia, Barton W Palmer and colleagues administered a validated happiness questionnaire to 72 people with chronic schizophrenia who continued to experience symptoms of schizophrenia despite treatment with antipsychotic medications. A comparison group of age- and gender-matched 64 healthy subjects took the same tests.

Besides the happiness survey, study participants also completed questionnaires that looked at a variety of other happiness-related factors such as: severity of psychopathology; cognitive functioning; physical health; and psychosocial factors such as stress level, resilience, optimism, social support, attitude toward aging, and spirituality.

The Angel is in the Details

The average happiness score among the group with symptomatic schizophrenia was lower than the average happiness score of the healthy comparison group. This headline number might sound discouraging. However, the angel is in the details.

Even though the average happiness score in the schizophrenia groups was lower, the variation around that score was almost twice as great, suggesting a wide range of happiness states among those with the illness.

It turns out that over a third (37.5%) of the people in the schizophrenia group reported high levels of happiness. This despite having had the illness for a long time and still experiencing symptoms despite taking medication.

Factors Associated with Happiness in Schizophrenia

Health or Illness Status ≠ Happiness

Many things that one might imagine would predict happiness were actually unrelated to happiness in this study.
“There were no significant correlations of happiness with age, education, or duration of illness. In the schizophrenia group, there were no significant correlations between happiness and positive, negative, or anxiety symptoms, nor physical health, or cognitive functioning measures”

Strong Correlations with Psychosocial Factors

In contrast to the nonsignificant roles of physical, social or psychopathological factors in predicting happiness, there were significant associations between happiness and positive psychosocial factors.

Perceived stress, Resilience, Optimism, and Sense of Personal Mastery were strongly associated with higher levels of happiness among people with chronic schizophrenia.


This study shows that there are people with chronic, symptomatic schizophrenia who are happy. This finding is consistent with findings from Agid et al. (2012) that happiness levels among people with remitted first episode schizophrenia were equivalent to the happiness level of healthy comparison subjects. 

Clearly, happiness within schizophrenia is possible.

The big question then becomes: are there things we can recommend that will increase the likelihood of happiness for those with schizophrenia?

I should emphatically note here that this is a correlationalstudy. It shows a relationship between happiness and these psychosocial variables. It cannot say if these are causally related. So, we don’t know for example if being more resilient causes greater happiness, or whether being happier leads one to have higher resilience skills.

On the other hand…
Optimism can be learned.
Resilience skills can be taught.
Stressors can often be managed,
and one’s responses to stress can be modified.

So, this study’s findings certainly suggest the possibility that helping people improve their sense of personal mastery, seeking ways to reduce perceived stress, and fostering optimism and resilience might directly improve happiness among people with schizophrenia. Learning and practicing these skills is worthwhile for anyone. It stands to reason that they may be especially worthwhile for people with illness.


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