Livia Gershon | Longreads | August 2018 | 8 minutes (2,015 words)

In 1869, a neurologist named George Beard identified a disease he named neurasthenia, understood as the result of fast-paced excess in growing industrial cities. William James, one of the many patients diagnosed, called it “Americanitis.” According to David Schuster, the author of Neurasthenic Nation (2011), symptoms were physical (headaches, muscle pain, impotence) and psychological (anxiety, depression, irritability, “lack of ambition”). Julie Beck, writing for The Atlantic, observed that, among sufferers, “widespread depletion of nervous energy was thought to be a side effect of progress.”

Recently, there have been a number of disconcerting reports that one might view as new signs of Americanitis. A study by the Centers for Disease Control found that, between 1999 and 2016, the suicide rate increased in nearly every state. Another, from researchers at the University of Michigan, discovered that, over the same period, excessive drinking, particularly among people between the ages of 25 to 34, correlated with a sharp rise in deaths from liver disease. A third, by University of Pittsburgh researchers, suggests that deaths from opioid overdoses, recognized for years as an epidemic, were probably undercounted by 70,000.

The common ways of thinking about economic health—and evaluating the success or failure of economic policies—usually focus on a few metrics: GDP growth, unemployment, median wage. But a growing number of economists and policy researchers are considering alternatives that factor in how satisfied we are with our lives. Starting in the Seventies, Jigme Singye Wangchuck, the king of Bhutan, began answering questions about his country’s gross national product by referring instead to “gross national happiness,” a measure of societal contentment; in 2008 that concept, developed as a formal index, became part of Bhutan’s constitution, and the country now conducts a survey to measure GNH. In 2011, inspired partly by Bhutan, the United Nations adopted a resolution “recognizing that the gross domestic product indicator by nature was not designed to and does not adequately reflect the happiness and well-being of people,” and inviting countries to pursue measures that “capture the importance of the pursuit of happiness and well-being in development with a view to guiding their public policies.”

Of course, an obvious challenge in designing policies to stave off Americanitis is figuring out how to index something as subjective as contentment. In the late eighteenth century, Jeremy Bentham, the social reformer and philosopher, came up with the idea of “utils,” or units measuring happiness. Economists deployed utils in thought experiments—if Joe gets 10 utils from eating a pizza, and 5 utils from skipping work, which would leave him with no pizza money, he’ll show up for his shift. Bentham’s concept was always pretty silly—for starters, he didn’t propose a standardized way to actually measure utils—and besides, the notion that people will consistently make choices that bring them happiness flies in the face of common sense.

Today, however, using the same survey methods that bring us monthly unemployment numbers, researchers have been able to develop helpful tools to evaluate collective wellbeing. It’s not a simple science—we’ll all interpret the question “How happy are you?” in our own ways. But researchers have found that they can arrive at consistent data. One measure is a “self-anchoring scale” of life satisfaction, which asks respondents to rank themselves somewhere between the best and worst possible lives they could imagine living. Another tracks daily emotions: Were you worried for a lot of the day yesterday? Happy? Stressed? Surveys like these deploy the same kinds of objective systems used to diagnose depression.

Still, it can be difficult to get people to accept happiness as a framework for developing economic policy. Since 2008, Dan Witters, the research director for the Gallup-Sharecare Well-Being Index, has produced data sets about wellbeing in every U.S. congressional district. Each year, his team asks more than 100,000 people a series of questions about their physical, social, and financial wellbeing—things like whether they smoke or have diabetes, how economically secure they are, whether they have loving relationships, and the extent to which they like what they do each day. For a while, the results were packaged for political leaders on a district basis, in the hope of getting representatives engaged. “We were not successful in piquing their interest,” Witters said. His team discontinued the congressional pitch for their project. “Quite frankly, it wasn’t worth going to the trouble.”

Carol Graham, an economist at the Brookings Institution who studies happiness, told me that, among mainstream economists, “If you talk about ‘gross national happiness,’ you just get laughed out of the room.”


If the idea of shifting policy to generate greater happiness seems improbable—or even a bit sinister, in a social-engineering sort of way, think back to the days of Americanitis. More than a century ago, the country was coming out of the Gilded Age, a period that, for good reason, frequently gets compared to our own—the wealthiest of robber barons were accumulating more wealth at a rapid pace; the gulf between rich and poor was expanding. From the standpoint of typical economic metrics, things were going swimmingly, with GDP and wages both rising fast, but unrest in much of the country—and the number of neurasthenia diagnoses—suggests that wellbeing didn’t follow along. In the South, Reconstruction plans were abandoned, leaving black people vulnerable to white terrorism. In New York, the Times reported that bombings were occurring monthly—the work of disaffected radicals seeking to disrupt capitalist power. In 1901, Leon Czolgosz, an anarchist and former steel worker, assassinated President William McKinley.

The Progressive movement was created out of those conditions. In drafting policies, Progressives sought prosperity that could be shared in an equitable fashion—something that we now know is key to societal wellbeing. They fought child labor and industrial monopolies, created minimum wage laws, and passed the 16th Amendment, allowing the federal government to collect income taxes. “The national parks were pretty much created to give neurasthenics places to retreat into nature and heal,” Beck writes. Americans also got playgrounds and other community spaces that helped children flourish.

The Progressive goal of using government in the service of personal and societal wellbeing is exemplified in the work of John Dewey, the influential education reformer. In a laboratory school he created at the University of Chicago, Dewey encouraged students to work cooperatively and to see their classrooms as tiny civic societies. At a time when classwork consisted largely of copying down lessons, Dewey aspired to teach children democratic values—by singing together, collectively studying how wool becomes fabric, and cooking in a “busy kitchen” filled with “buoyant outgoing energy.” In The School and Society (1900), Dewey defines a society as “a number of people held together because they are working along common lines, in a common spirit, and with reference to common aims.” He goes on, “The radical reason that the present school cannot organize itself as a natural social unit is because just this element of common and productive activity is absent.”

In economic terms, growth is only worth something if it improves people’s lives.

There was a dark side to the Progressive Era—middle-class reformers often adopted patronizing attitudes toward the poor; in their zeal to root out corruption in elections, white, native-born Progressives overturned political machines that were among the few ways immigrants achieved power; they supported literacy tests that disenfranchised black voters; and many backed eugenics, helping to legitimize the forced sterilization of tens of thousands of “unfit” people. The evils done in the name of social improvement should remind us that the voices of the most vulnerable must always be heard when developing policy geared toward making everyone’s lives better.

Still, there is a valuable lesson we can take from the Progressives, who shaped American institutions in ways that aimed to enhance people’s sense of contentment: the role of government is, in fact, to promote the wellbeing of citizens. In economic terms, growth is only worth something if it improves people’s lives.


With a mind toward reshaping economic policy, researchers are now getting answers about what makes us satisfied. The results reveal that, under some circumstances, money can buy happiness. “Daily emotions move with income up to about $80,000 a year,” Witters told me. For any household, “Once you get past that point, the probability of daily positive emotions is not higher, and the probability of sadness is not lower.” On the self-anchoring scale, he continued, contentment rises indefinitely along with income, though for rich people it takes much more money to move up a notch than it does for the poor.

For people who are struggling financially, relatively small income increases can make a big difference in wellbeing. Money doesn’t merely help them afford things they need, it helps lift some of the psychological pressures of poverty. “If you look at the low end of the labor market, people deal with tons of daily stress because everything’s unpredictable,” Graham said. Uncertainty—the possibility of losing your hourly-wage job if you have to skip a day to care for a sick kid, the fear that your car might break down in a town with no public transit—wears down one’s sense of wellbeing. A recent study conducted by researchers at Princeton and the Busara Center for Behavioral Economics in Nairobi found that, when workers in Kenya had health insurance, their self-reported stress and cortisol hormone levels fell—the key wasn’t the money, but the peace of mind that the insurance provided.

Today, we find that much of America’s existing social infrastructure is under attack. Public schools are focused on competitive, individual achievement based on standardized tests. Basic city services like the water supply may be turned over to private companies in the name of efficiency. The Trump Administration is pushing to make it easier to drill for oil and gas in our national parks, and to make parks more like private companies, with entry fees.

If the U.S. wanted to become serious about pursuing wellbeing as the ultimate goal of economic advancement, there are blueprints.

Outside of government, companies can take steps to improve the wellbeing of their employees. This spring, Perpetual Guardian, an estate-planning firm in New Zealand, conducted a two-month experiment in which it reduced work hours by one day a week without cutting pay. When researchers from the University of Auckland Business School and the Auckland University of Technology surveyed the staff, they found that employees’ life satisfaction improved, they reported better work-life balance, and, crucially, people were generally more productive. The company is now considering making the change permanent. Costco, which consistently ranks high on best-places-to-work lists, tends to offer better wages and benefits than its retail competitors and aims to empower employees to voice their concerns to corporate leaders.

If the U.S. wanted to become serious about pursuing wellbeing as the ultimate goal of economic advancement, there are blueprints. A report released earlier this year by the Global Happiness Council, an association of academics and policy practitioners based in Dubai, enumerates programs that have boosted wellbeing in countries around the world. Great Britain and Chile provide therapy to people with depression and anxiety. Quito, Ecuador, created a system for reporting sexual harassment on its municipal transportation system by text. Bhutan, as part of its effort to fulfill its constitutional resolution, introduced social and emotional training in schools; a study found that this program led to higher reports of wellbeing—and higher scores on exams.

Bhutan, which remains poor, hasn’t exactly found a magic key to achieving widespread wellbeing. In the United Nations’ most recent ranking of happy countries, rich places like Finland and Norway topped the list, while Bhutan came in 97th out of 156. (The U.S. was number 18.) For the happiness framework to succeed, there has to be money at the foundation. A 2012 study using an international data set from Gallup found that citizens of nations with progressive tax policies, that invest in public services (education, transportation) experience greater wellbeing. The truth, Graham said, is that there’s plenty political leaders could do that would improve people’s lives—from creating more green spaces to providing better access to health care to making public services more reliable. The trouble, particularly in the Trump Administration, is that they’re not interested in doing it. “Uncertainty and bad health are terrible,” she said. “The government in power is doing a great job of making it worse.”


Livia Gershon is a freelance journalist based in New Hampshire. She has written for the Guardian, the Boston GlobeHuffPostAeon and other places.

Editor: Betsy Morais
Fact-checker: Matt Giles