How a psychiatrist redefined joy, caught the imagination of a millionaire and the prince of Monaco and forced Wash. U. to acknowledge the soul
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…(read more)
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