Anyone will have met people who cannot feel pleasure or are insensitive to situations once considered rewarding.
Perhaps we too have gone through similar periods; and we met, or clashed, with the many: “Why?”. Or maybe we have liquidated everything by putting it under the umbrella of the so-called anhedonia .
It is known that learned people like learned terms; I’d be more curious to hear something about anhedonia from someone who can first define what “pleasure” is.
Saint Augustine said, reflecting time: “I know what it is until nobody asks me”. Not having the greatness of the saint and not knowing how to define, spontaneously or upon request, with convincing arguments, what pleasure is – even knowing it – I rely on the reflections of others.
I believe we cannot define the term anhedonia if we do not agree first on what we mean by “pleasure” .
Pleasure has always been considered central to the understanding of human behavior, but focusing attention, from age to age, on the excesses or defects of this state of mind and on the “right” relationship that everyone should have with it, more than to define what pleasure itself is.
In the fourth century BC Epicurus considered pleasure a “supreme good”, the origin and ultimate goal of a happy life. For the Athenian philosopher, true pleasure consists in the gratification of natural desires – hunger, thirst, shelter from heat and cold – the only ones that can be completely satisfied and of which full realization is possible.
On the contrary, other more complex forms of pleasure – see luxury, wealth and fame – generate ever new needs and, over time, feelings of chronic lack and dissatisfaction, causing disturbance of the soul and pain. Epicurus had understood Weber’s law in advance (19th century) – we are more sensitive to the variation of a stimulus than to the persistence of it – that is, the natural ability to adapt to the pleasure levels of the human mind generates the risk that any new stable condition of acquired pleasure tends to move the threshold of actual hedonic experience higher (does this also happen in an area of our current hedonistic society?).
The natural and necessary pleasures represent the affective process that mediates the adaptation and the very survival of the subject. A praise of ataraxia, detachment from everything, including pleasures, we find it in the middle and late Stoà – Chrysippus, Panezio, Polybius, Cicero, Plutarch, Epictetus, Seneca, Marcus Aurelius – with the translation of the Greek term ataraxia into Latin tranquility.
Christian thought has tried to define the areas in which it is permissible to feel pleasure ; eighteenth-century libertine morality concentrated on the illicit nature of not feeling pleasure; and so on in the various ages.
Regardless of how it is understood, progressively the sensation of pleasure (as opposed to that of anhedonia ) has been recognized as having the role of associating a behavior with the ability to satisfy a biological or motivational need, leading to a reward. In this sense, pleasure is an affective marker of behavior that responds to the needs of organisms, including humans, to ensure survival and psychophysical well-being.
It is the experience of pleasure that induces to learn these behaviors and to put them back into action in the face of stimuli that evoke the experience.
The experience of pleasure has been broken down into two components: anticipatory and consumer. The anticipatory pleasure is linked to the representation of the gratifying experience, nourishing the desire and supporting the motivation so that the organized action necessary to achieve it is implemented.
The consuming pleasure, on the other hand, is the one experienced while, and immediately after, the satisfaction of desire takes place: a lack is filled, tension subsides and the action is extinguished. In this it differs from anticipatory pleasure, which instead generates tension and movements aimed at satisfying desire.
These two types of pleasure correspond to the activation of different brain systems: mainly dopamine-based ones in anticipatory pleasure and the endogenous opioid system in consumer pleasure. The comparison between anticipatory and consumer pleasure – lived gratification – is a fundamental element in the learning of instrumental behaviors, as it allows the measurement of the actual value of a circumstance, experience or relationship.
We can thus begin to realize the power that comes from being able to experience pleasure : become a powerful social force even more ù that something confined to the mere individual . Anhedonia, compromise in experiencing pleasure , is far beyond the simple affective flattening or the expression of an “empty existence”.
Dall’anedonia can derive a real impediment to our ability à learn and interact socially . Understanding the mechanisms of pleasure helps to understand what happens when these are altered and lead to anhedonia .
I can feel pleasure if there is a good functioning of a set of neurochemical processes mediated by the cortico-ventral basal ganglia, which include the orbitofrontal cortex, the anterior cingulate cortex, the ventral striatum, the ventral pale nucleus and the integrity of the which depart from the ventral tegmental area and cross the nucleus accumbens.
The cortico-ventral basal ganglia, in dialogue with other areas of the cerebral cortex, mediate the implementation of motivated and goal-oriented behaviors. The reward system is at the center of this system and constitutes the basic motivational element for conduct aimed at obtaining pleasure or gratification: instrumental behaviors.
Motor neural circuits preside over the organization and expression of the motor component of reward-associated behavior; the prefrontal cortical circuits, connected to the basal ganglia, encode the value of the reward, evaluate the relationship between costs and benefits of the action and the eventual social or moral opportunity of the conduct.
The cortical regions, based on previous memories and experiences, evaluate the strategies that optimize the value of the reward with respect to the motivational investment – of physical and psychological energy – necessary to obtain it and in this way regulate the decision-making processes in the behaviors associated with the rewards.
Experimental research has found that low levels of activation of the medial prefrontal cortex are associated with anhedonia . The reasons for this dysfunction are diverse and range from genetics to environmental factors such as chronic stress , emotional trauma , substance abuse .
Environmental situations can, over time, lead to functional and / or microstructural lesions in these cortical areas, impairing the brain’s ability to mediate rewards. Having said that: can anhedonia be considered a disease?
Let’s try to see how the concept developed in psychopathology. In 1897 Ribot used the term to describe a ” pathological insensitivity to pleasure “, referring to subjects unable to feel pleasure in sexual, food, relational and affective activities.
In 1911 Bleuler considered anhedonia to be a characteristic of schizophrenic disorder . Kraepelin, in 1913, spoke of anhedonia as a symptom of the “precox dementia” in which patients appear to have “an indifference towards human relationships with loss of satisfaction in activities normally considered pleasant and recreational. In the following years anhedonia was linked to mood disorders , so much so that the DSM-IV, in 1994, considered it a symptom of major depression , understood both as a loss of reactivity to pleasant stimuli and as a decrease in interest or affective flattening.
The ambiguities on the issue remain. In fact: we can consider anhedonia as the inability to desire contact with gratifying stimuli or the inability to feel pleasure once in contact with them; for some it means a “discreet” psychopathological condition or state, for others it is a personality trait; there are those who consider the temporal element to be relevant, distinguishing a state of chronic anhedonia – a psychopathological symptom – from transitory states linked to momentary phases of life or health (I am well aware of my moments of anhedonia during a banal seasonal flu).
As in all psychiatric conditions it is always advisable to evaluate the severity of the symptom step by step, starting from “physiological” and transient levels up to chronic and disabling pictures. I find it interesting the proposal of some scholars to replace the term “anhedonia” , which semantically refers to the only “absence of pleasure”, with the term ” dyshedonia “, which would include the possible qualitative and quantitative variations of the subject’s gratification skills .
In fact, qualitative and quantitative modifications of the hedonic function can be distinguished clinically and neuro-biologically which can be compromised in different areas: in the appetitive component (desire), in the motivational component (activation, arousal and approach) and in the consumer component (pleasure and satisfaction once the goal is reached) or in all of these.
The term anhedonia must be understood as a symptom, not a primary condition: we find it in many medical conditions (as a doctor I think primarily of hypothyroidism or the onset of neurodegenerative conditions) and psychiatric conditions such as depression, psychosis , some disorders personality , the disorder post-traumatic stress disorder (PTSD), the disorders and substance use , and more.
For this reason, anhedonia is usually treated in relation to the underlying disorder rather than as a disease in its own right.
I would find it very interesting to reflect on the phenomenon of “anhedonia” from the perspective of our historical period: can there be an anhedonia linked to the type of society and the pattern of values to which we are forced to submit (and if we rebel we can only partially succeed)?
Unfortunately, I have already abused the space granted me and your patience. It could be a starting point for a future article.
