"If Buddha is too good to be true, then Enlightenment is too true to be good,” said Dr. Vaillant while starting the most eloquent and captivating lecture at the 163rd APA meeting in New Orleans titled “Toward a New Psychiatry: Valuing the Positive Emotion,” in which he defended the importance of both paying closer attention to and the promotion of positive emotions in psychiatric patients care.
On the surface, his argument appeared heretical because since psychiatry’s inception as a science predicated upon the tenants of Enlightenment and until the end of the twentieth century, the only emotions that could be induced experimentally were associated with the amygdala. These were the flight-or- fight emotions such as fear and anger that were deemed both real and significant not only because they could be experimentally evoked by sticking electrodes into the amygdala, but also because a causal link involving survival could be easily established. On the other hand, what we now call positive emotions, such as awe, love, compassion, joy, hope, trust, and gratitude were disregarded not only because they could not be measured objectively, but also because they were viewed as inimical to survival since they went against the selfish interests of an individual.
At this point, Dr. Vaillant trail-blazed a new path. He argued that humans and mammals do have a special part in the brains’ limbic system, called the insula, and it is associated with positive emotions based on functional MRI studies. Furthermore, he argued that the primitive insula conferred a survival advantage to mammals during a reptilian age while a more developed contemporary insula allowed homo-sapiens to flourish in the plains of Africa and subsequently spread around the world to form the large ancient cities ranging from Egypt to Mesopotamia. Then, Dr. Vaillant demonstrated his vast knowledge of philosophy, theology, and literature while further advancing his argument for the importance of positive emotions, not only as a necessity for human survival, but as a foundation for human flourishing.
At the end of lecture, based on the Q&A session, there seemed to be a consensus in the room about the significance of positive emotions pertaining to the human self-actualization and achievement of happiness and fulfillment in life. Yet, the last words were spoken by Dr. Vaillant, who left us with a simple question: What will psychiatrists do to promote positive emotions in the future? Perhaps here lies the pride and promise of psychiatry.
Eugene Bukhman, M.D.
Georgetown University Hospital