Dr. C. Robert Cloninger finished reading the personality profile of his new patient, a man who was clearly unstable and suicidal, and placed it in a manila file folder. Then he picked up a profile he’d promised to read, of a friend’s husband.
The profiles were almost identical.
But the friend’s husband was a well-adjusted business executive.
Cloninger sat there a minute, his hazel eyes narrowed, his hand absent-mindedly ruffling his silvery beard.
“Y’know what?” he said aloud. “I must have left something out.”
The Wallace Renard Professor of Psychiatry and a professor of psychology and genetics at the Washington University School of Medicine, Cloninger had earned his fame by brilliantly deciphering the genetics, chemistry and symptomatology of various addictions and disorders. He’d done everything by the book, which at Wash. U. meant ignoring anything fuzzy, ethereal, symbolic or touchy-feely.
But he’d just hit his second brick wall.
His first had been the realization that labels such as “schizophrenia” and “bipolar disorder” told him next to nothing. He needed to understand a patient’s personality to know how her symptoms were playing out in her life. He created a Temperament and Character Inventory that assessed both the biological, inherited aspects of temperament and the character traits we develop. The TCI was hailed as a psychological breakthrough—and then he hit the next wall.
He couldn’t tell his patients from his friends.“It wasn’t whether people were anxious or had bad tempers or were warm and sociable that made a difference in their mental health,” he realized. “It was their character traits—how responsible and resourceful they were, how cooperative and compassionate.”
For years Cloninger had worked within Wash. U.’s framework.
Now he had to look beyond it.
Nobody had the whole picture, Cloninger reminded himself. Freud had introduced the lusty unconscious, but he’d written off humanity’s nobler urges as wishful thinking. Biologists had revealed physical causes of mental illness, but their pills tackled symptoms, not whole lives. Cognitive psychologists had pointed out the influence of thought patterns, but their therapy was one long unending battle between reason and impulse, and most patients grew weary of the war.
Most recently, positive psychologists had finally shifted the emphasis from disease and aberration to health and happiness—but in all their talk of flow and bliss and gratitude, Cloninger couldn’t find a coherent view of human nature. What caused happiness?
“Three things,” he announced after poring over his TCI results, brain scans and case studies. “Three things give us genuine, lasting satisfaction or well-being: kindness, an attitude hopeful of accomplishing things and solving problems, and a growing awareness of what lies beyond the individual self.” People who tested high in all three capacities experienced more positive emotions than their friends, were rarely angry and had a resilient sense of well-being. Wealth, power and fame were irrelevant.
Cloninger conducted sophisticated brain-imaging studies that showed normal response patterns to be pro-social, based on telling the truth and cooperating with others. So antisocial responses weren’t natural and inevitable expressions of the human psyche after all, he realized. They were simply defensive reactions used when people felt fearful or threatened.
He was even more surprised to find that experiencing lots of negative emotions—sadness, anger, anxiety—didn’t matter nearly as much as everyone thought. What did matter was how many positive emotions people experienced. “How happy people are is a better predictor than how unhappy they are,” he explains. “As long as you have something that gives you meaning and hope, you can go through hell.”
Cloninger saw three capacities in people with a consistent sense of well-being. He labeled them “cooperativeness,” “self-directedness” and “self-transcendence” and, using his genetics background, calculated that they were about 50 percent heritable. In other words, we can have about 50 percent control over how happy we are by using our brains to strengthen certain character traits: cooperativeness (tolerance, compassion and working in the service of others); self-directedness (responsibility, resourcefulness and the ability to let go of competitive struggle); and self-transcendence (intuition, judiciousness and spirituality).
Spirituality? That word wasn’t used much at Wash. U. But self-transcendence, which Cloninger had initially included in his character inventory only for fear of omitting anything, seemed to be the core of joy. Spirituality, he was now convinced, was the missing ingredient in 20th-century psychiatry.
Even when the new positive psychologists wrote about virtues, they often avoided talking about faith—it wasn’t P.C., and many had private biases against it. Yet years of conducting psychotherapy had shown Cloninger that “we grow in understanding by intuitive leaps, and intuition requires you to trust your inner being, to listen to that quiet voice that tells you what is truly good and right and satisfying.” Intuition, he says, is what tells us we are connected to nature and to each other—and that sense of unity and connection sums up what most people mean by “spiritual.”
It also happens to be, in Cloninger’s opinion, the fastest way—once someone has been stabilized with medication—to quiet irrational fears and anxieties, change destructive habits and responses, and reverse depression’s downward spiral.
When a woman frantic with panic attacks came to see him, for example, he realized the panic attacks signaled her need to resolve conflicts with her family. After steadying her with antidepressants, he taught her to meditate, and for the first time in her life she felt a euphoric sense of unity and unbreakable connection. It quieted her desperate hunger for the approval of others, buying her enough presence of mind that she stopped feeling fearful and defensive and taking things personally.
“Most psychotherapy is locked into the mind only—or into conditioning the body as if it were an object,” he says. “You have to awaken that sense of unity. Once you do, what is amazing is how fast things can happen—people getting over a personality disorder in a matter of weeks. The question is how to build a foundation from which you can with certainty draw on the strength of your own being, so you are not dependent upon a therapist or a pill or a support group. That’s the foundation we all need to be solid—not to be perfect, but to live without fear.”
When Tony Sansone Jr. learned that his wife, Peggy Sansone, had committed suicide, he called Cloninger for help. He’d called before, desperate for a way to help Peggy with a depression that had spiraled out of reach. “He was the only doctor who returned my call within minutes,” Tony recalls. “I said, ‘How much time can you give us?’ and he said, ‘As much as you need.’”
They had agreed that Tony should not force the issue; instead, Peggy’s best friend would go with her to Cloninger’s office. She actually had her hand on the doorknob, the friend later reported, but couldn’t bring herself to go in.
Sansone feels sure that, had his wife turned that knob, she’d still be alive: “He’s so gentle, and when anyone is that sick, they need gentleness.” Sansone also saw Cloninger as “a man of deep conviction and conscience.” So when Cloninger—so engrossed in his work, he had no clue that his new patient was a millionaire—suggested easing the grief by helping others cope with depression, Sansone returned with a check.
The Sansone Family Center for Well-Being was to be “a safe haven for people suffering in the darkness of their soul.” It would allow Cloninger to oversee research, education and treatment integrating his new ideas.
And Wash. U. couldn’t turn it down.
“What Tony Sansone has helped me with is to get Wash. U., which is a very biologically based center, to acknowledge a broader concept of human nature,” Cloninger says now, trying not to sound elated at the coup. There are huge, well-lit signs for the Sansone Family Center on the first and third floors of Renard Hospital, in the Barnes Hospital complex on Kingshighway. Other psychiatrists have joined Cloninger on the center’s staff (psychobiology.wustl.edu), and residents are learning how to conduct therapy based on Cloninger’s ideas.
One internal-medicine resident, Lauren Munsch, was so excited by the approach that she proposed an international foundation—with the tongue-numbing name of Anthropaideia—to teach children around the world how to follow this path to well-being. She brought her father, ophthalmologist Robert Munsch, onto the board, and he mentioned the project to his friend Prince Albert II of Monaco.
The prince’s ideas meshed perfectly with Cloninger’s belief “that art and culture offer a sense of connection with the rest of humanity, and feelings of awe and beauty that biologically lift people’s spirits,” says Lauren. Albert agreed to serve on the board, she says, “and when he took over as sovereign prince last July, his mission statement for the principality used words about furthering the notion of well-being.”
Cloninger unlatches his laptop and blows a bit of dust from the screen. He presses a few keys and waits calmly, showing none of the mental toe-tapping with which most of us endure the seconds it takes a computer to open a file.
Suddenly a brain appears, its normally pale-gray coils glowing red at top center. Cloninger’s colleagues showed people images of a mother hugging a baby; the aftermath of an auto accident, with someone bleeding profusely; outdoor scenes; home interiors ... and asked how they felt. “When you have to be aware of what feels pleasant or unpleasant to you, blood flow increases in your prefrontal cortex, and you get a signal on the brain scan,” he explains. “We found that people whose prefrontal cortex is easily activated—people who are very aware of how they feel—are also very self-directed. And other scientists have measured serotonin receptors in the frontal cortex and found a correlation with the trait of self-transcendence.”
And so, having traced personality to the brain, restored soul to psychiatry and identified traits that lead to happiness, Cloninger began looking for ways to train the brain. He wrote a book, Feeling Good: The Science of Well-Being, and created a DVD series with exercises and guided meditations, The Happy Life: Voyages to Well-Being. Shot in high-definition video, it has stunningly beautiful footage from the Mediterranean, a soothing soundtrack and insights and exercises that can be silenced the moment they seem overwhelming.
“The goal is to help the person feel calm enough to listen well”—exactly what a good psychotherapist’s voice and physical presence would do, Cloninger explains. “The music and imagery speak directly to the emotional part of the brain.” Meanwhile, his sons—Kevin, a musician and educator, and Bryan, a cinematographer—are producing a series of films about “elevated beings”: artists, philosophers and religious figures, starting with Leonardo da Vinci, who have helped develop the notion of well-being.
So why is something so simple—a prescription that’s been repeated by the world’s great philosophers and religious leaders for centuries—so hard to attain? “A happy life is rooted in people constantly discovering more about themselves so they are letting go of all fights and selfish desires,” Cloninger says. “In this culture we tend to think in terms of transient pleasure instead of lasting satisfaction. And when you are striving to maximize your pleasure, you may do things selfishly.
“There’s also this sense that down deep within ourselves, there’s only darkness and misery, so we need to suppress it,” he notes. “What I’m saying is, our basic nature is wisdom and love. But we don’t trust that, and because we are trying to hide who we are, we end up in a constant struggle with ourselves and other people.”
Atheists and agnostics scoff at Cloninger’s insistence that we must have faith to be free of fear—but preachers won’t be happy with him either. “There’s a little bit of perversion in religion,” he says, “because they take an authoritarian stance that tells people how they should live their life instead of trusting that there is good at the core of people already.”
Good at the core? Freud would toss and turn in his sweat-soaked bed at such an optimistic premise. “When he was living, there was no way he could study neurobiology,” Cloninger points out. “He couldn’t see that each of these character traits is strongly correlated with individual differences in specific brain networks. In a way, I’m completing Freud’s biological project.”
“I’ve been known as a hard-nosed empirical researcher, a geneticist and descriptive psychiatrist,” says Cloninger. “I guess that’s changing.”
Luckily, his research has given him street cred in the ivory tower, so when he published his book, his peers came around quickly. “They acknowledge that it’s an intellectually responsible position,” he says. “The skeptics just don’t think it’s been proven. And people on the front lines want to know how to apply these abstract, noble principles in the trenches: ‘Tell me, Dr. Cloninger, exactly how do I conduct my therapy?’”
To answer, he wants to open a practical treatment facility in the community. “There are limits to who I know how to help,” he concedes. “It’s very difficult to do this work in the presence of autism or schizophrenia, or while people are abusing drugs or alcohol. They have to be calm enough to face reality.”
Kevin Cloninger and Lauren Munsch have already begun developing educational programs. A senior government official in Russia is interested in incorporating such programs into their official curriculum. And Cloninger is working on a new book.
“It’s about the feelings of separateness and aloneness that lie at the root of our problems and fears,” he says. “We become skeptical and cynical, and we try to point out all the bad we see around us. Fear leads us to act in ways that are defensive.”
And the mother of all fears, the fear of death? “The only way you overcome your fear of death is to have an experience in which you feel connected to all that exists,” Cloninger replies, “and know that a part of you is nonmaterial and everlasting. That is a profound experience most people never have. They want it, they yearn for it, but, like Freud, they believe it’s wishful thinking.
“What I’ve found is that I can teach people how to have that kind of experience.”
Does your outlook on life make you happy? Answer TRUE or FALSE.
1. I often feel that I am the victim of circumstances.
2. People involved with me have to learn how to do things my way.
3. Sometimes I have felt like I was part of something with no limits or boundaries in time and space.
4. People will usually tell me how they feel.
5. Each day I try to take another step toward my goals.
6. Members of a team rarely get their fair share.
7. I have had moments of great joy in which I suddenly had a clear, deep feeling of oneness with all that exists.
8. I often wait for someone else to provide a solution to my problems.
9. I sometimes feel so connected to nature that everything seems to be part of one living process.
10. I know what I want to do in my life.
11. I enjoy getting revenge on people who hurt me.
12. I often feel so connected to the people around me that it is like there is no separation between us.
13. I cannot have any peace of mind if I treat other people unfairly, even if they are unfair to me.
14. I think that most things that are called miracles are just chance.
15. I have many bad habits that I wish I could break.
Happiness comes from being self-directed, cooperative and self-transcendent.
How self-directed are you? Give yourself a point for each of the following answers: 1-false, 5-true, 8-false, 10-true, 15-false.
A score of 4–5 is above average; you are responsible and purposeful.
How cooperative are you? Give yourself a point for each of the following answers: 2-false, 4-true, 6-false, 11-false, 13-false.
A score of 4–5 is above average; you are tolerant and kind.
How self-transcendent are you? Give yourself a point for each of the following answers: 3-true, 7-true, 9-true, 12-true, 14-false.
A score of 3–5 is above average. You are spiritually aware.
Now add your scores for all three. A total of 11 or higher means you are in the top third, often happy; 9–10 means you are nearly average, with the usual ups and downs; 8 or less means you are often unhappy.
Quiz prepared for St. Louis Magazine by C. Robert Cloninger, M.D. (adapted from Temperament and Character Inventory, copyright C. Robert Cloninger).