- Disease is the first Horseman of Misery, and the modern toll is staggering. 23 U.S. states have obesity over 35%, Type 2 diabetes is up to 16% of adults, and depression hits 29% of youth.
- Chronic pain steals autonomy, the single most important ingredient for happiness. Once you can’t predict whether a simple action will hurt, the cage closes around your relationships and your sense of self.
- Metabolic dysfunction quietly attacks mood. Insulin resistance nearly doubles depression risk. Brain insulin resistance disrupts dopamine signaling and produces the flat, “anhedonia” state that mimics emotional fatigue.
- It’s not just a mental health crisis. It’s a metabolic crisis attacking the mind. Even the healthiest can fall to disease, but the protective behaviors (movement, blood sugar control, sleep) are the practical lever you actually own.
Psychic powers. Government conspiracies. 80s pop culture. Weak acting. Stranger Things had a little bit of everything.
One of the more ensnaring plot devices in Stranger Things is “the Upside Down.” It’s a dark, twisted parallel dimension that mirrors the fictional town of Hawkins, IN in the creepiest way, complete with floating dandruff and Stapelia flower monsters.
Fans of the show know the Upside Down as the main source of conflict, a place where disease and infestation have created decay and chaos. But it’s also a metaphorical reminder that everything “good” has a darker twin. And that it’s this contrast that gives meaning to both.
This article is the second in a five-part series. In the first, I took an additive approach to the idea of happiness, characterizing the good life as a sum of 3 pillars: health, harmony, and hope. (Go to the 3 pillars of happiness article to learn about those.) In this line of thought, the happiness equation looks like this:
Happiness is, in essence, a curation of happy things. Curate wisely and you’ll end up frolicking in a field of Bluebonnets singing “this is the dawning of the age of aquarius.”
The next 3 articles flip the narrative. Rather than a stroll through happiness, they’re a jaunt to the Upside Down. To do this, we have to shift our paradigm a little bit: A good life isn’t only about embracing the angels of joy. It’s also about avoiding the Horsemen of Misery.
Like our pillars of happiness, there are three Horsemen: disease, disequilibrium, and despair.
There are a couple of implications in this inversion:
- Instead of looking at happiness as an additive process, we’re talking about how to get there through subtraction. What causes unhappiness? What can we limit, control, or cut out entirely from that list?
- Our entire mindset changes. We go from an approach mindset (toward good) to an avoidance mindset (away from bad).
That equation now goes from a simple sum to division with a quotient (sorry for the mathy things):
We’re still trying to amass as big a number as possible. But it now recognizes that success leans on adding to the top number and taking from the bottom. In this article, we’re focusing on the bottom number—a mathematical Upside Down, if you will.
Today, we’re doing a deep dive into the first Horseman of Misery, disease.
Disease, by the Numbers
For our purposes here, disease refers to the deterioration of the body. We’re more concerned with chronic problems rather than acute ones, since it’s chronic problems that will have a substantial, cumulative effect on life satisfaction (AKA happiness).
It’s obvious to the casual eye that disease has grown into a California wildfire. Consider a few revealing truths:
- 23 U.S. states have an obesity rate over 35%. Prior to 2013, that number was zero.
- ~35% of U.S. adults suffer from high-risk, systemic inflammation.
- In 2023, ~16% of U.S. adults had Type 2 diabetes, up from 9.7% in 2000. Even more somber are the youth stats on depression (29%), obesity, and diabetes.
Quick recap: America has a tum tum ache. And a pretty big tum tum.
It’s clear that the U.S. is fraught with disease, acquired through a steely dedication to bad choices. What’s less obvious is the extent to which physical disease contributes to discontent by turning our body from a vessel to a cage.
I want to zoom in on 2 pathways through which disease becomes a conduit for unhappiness: pain and energy.
The Pain-Autonomy Connection
To understand the impact of pain, we should first learn the importance of autonomy—the power to decide what you’ll do, when, and how.
A meta-analysis of 63 countries compared the impact of wealth versus autonomy on happiness. Their conclusion? Autonomy was consistently a better predictor of well-being than wealth. In fact, when they controlled for autonomy, the effect of wealth on happiness disappeared entirely.
In other words, the happiness benefits of money dissolve when you lose control of your daily life.
This is surprising to the layperson, but it raises zero eyebrows among happiness researchers, who know that autonomy is the single most important ingredient for happiness. Conversely, losing autonomy is the quickest path to unhappiness.
This matters here for one reason: Autonomy is the pathway of pain. Said another way, pain exerts its biggest influence on our lives by stealing autonomy. It does this by forcing us into a state of hypervigilance, wondering with each new action how much is this going to hurt?
Can I walk to the store? Maybe not.
Can I pick up my child? Too risky.
Can I sit through dinner with friends? Hard to tell.
It’s helpful to think about this in terms of authorship. Autonomy means being the author of your life. Pain hijacks that authorship, effectively shrinking your world to the boundaries that it creates for you. It’s a prison, of sorts. And cage life often feels like no life at all.
Here’s why that cage creates so much unhappiness:
- When it takes away our autonomy, pain makes us more dependent on others. This changes key relationships from horizontal (mutual) to vertical (one-sided).
- Well-meaning loved ones often try to help by doing things for those dealing with pain. These “paternalistic” habits further erode autonomy and increase depression.
- To preserve dignity, people who lose autonomy often push people away and, in the process, damage core relationships.
- It’s also common for people in pain to avoid social situations. Studies have shown that pain intensity closely predicts a decline in social functioning.
In short, pain produces a loss of autonomy that’s degrading, depressing, and isolating.
The part on isolation is especially important. Healthy relationships are a critical part of wellbeing. Pain harms those relationships by making us more hostile and less socially capable.
To empathize, think about what happens each time you stub your toe. At that moment, how capable are you of human connection? Of hearing and seeing someone? Of anything other than cussing in front of innocent children?
There are neurological underpinnings to all of this. Brain imaging has shown that physical pain lights up the Anterior Insular Cortex (AIC), the primary region of emotional awareness and empathy. Our capacity for both is stunted when the AIC is focused on pain signals.
In plain language, a pain-riddled brain struggles with social cues and conversation. So we opt out altogether.
Energy and Metabolic Dysfunction
Next is energy, which is the driver of mood. It’s much easier to view life positively when you feel vibrant. Sluggishness and fog, conversely, strain happiness. This speaks to the role of metabolic dysfunction in happiness.
At the cellular level, metabolic issues play out in our mitochondria. Poor functioning mitochondria cause chronic fatigue and laziness, mostly because they can’t convert fuel (glucose/fat) into adenosine tri-phosphate (ATP) for energy. In one study, certain metabolic conditions were linked with a 35% drop in ATP production. People with this condition develop aversions to exercise, movement and, potentially, chronic fatigue syndrome.
The upshot is that mitochondrial dysfunction directly affects one of the keys of happiness: movement.
In the world of metabolic dysfunction, mitochondria are mere underlings to the reigning queen, insulin resistance. Insulin’s role in blood sugar is well-known. What’s less known is that it also regulates neurotransmitters in the brain.
Like other parts of your body, your brain can develop insulin resistance. This disrupts insulin’s role in regulating dopamine, causing levels of the neurotransmitter to crash. Even when we achieve a goal or see a loved one, the associated good feelings are punctuated. In short, we become chemically “numb” or “flat”, a condition known as anhedonia.
How much do these energy problems contribute to unhappiness? A lot, actually.
- A moderate increase in insulin resistance nearly doubles your risk of depression, an 89% increased risk according to a major study.
- Older adults with insulin resistance were 47% more likely to suffer from cognitive dysfunction (AKA brain fog).
- Studies show that 30-40% of bipolar disorder cases are linked to mitochondrial dysfunction. That’s nearly 1 in 3 cases.
- There’s a negative feedback loop here. People with high stress have a 45% higher chance of metabolic dysfunction, while those with metabolic syndrome have higher incidences of generalized anxiety. Stress breaks your metabolism and a broken metabolism feeds anxiety.
There’s a revealing story behind these numbers. First, they further the case that mental health and physical health are inseparable. The 89% higher risk of depression speaks volumes. Second, it puts in perspective a huge chunk of our emotional malaise. We don’t just have a mental health crisis; we have a metabolic crisis that is attacking the mind.
Our next step…
The toughest thing about our first Horseman of Misery is that it’s the one that we control the least. Even the healthiest among us can fall victim to cancer or genetics. We can minimize the chances of disease stealing life from us by adopting healthy behaviors. But the important takeaway is that it can quickly steal away our ability to be happy, functioning people.
From here, we go to our second horseman of misery, disequilibrium. In that article, you’ll learn why your balance with the material world is so critical to avoiding unhappiness.