Anhedonia

Anhedonia (pronounced an-hee-doh-nee-uh)

In psychiatry, the lack of desire for or the capacity to experience pleasure.

1896: From the French anhédonie (an inability to feel pleasure (and an antonym of analgesia)), the construct being the Ancient Greek ἀν (an) (in grammar, the privative prefix, indicating negation or absence) + ἡδονή (hēdonḗ) (pleasure) + -ia (the abstract noun ending).  Hēdonḗ’s better known gift to the language was hedonist (one who seeks pleasure).  The an- prefix was an alternative form of on-, from the Middle English an-, from the Old English an- & on- (on-), from the Proto-Germanic ana- (on).   It was used to create words having the sense opposite to the word (or stem) to which the prefix is attached; it was used with stems beginning either with vowels or "h".  The word was coined in either 1896 or 1987 by French psychologist Professor Théodule-Armand Ribot (1839-1916).  Anhedonia is a noun and anhedonic is an adjective; the noun plural is anhedonias.  Unexpectedly, given the profession's propensity to intricate categorization, anhedonism seems not to exist.

Lindsay Lohan and her lawyer in court, Los Angeles, December 2011.

The term anhedonia encompasses a range symptoms related to a reduction in desire for or ability to experience pleasure.  It is a generalized condition which is diagnosed only in those where the experience is universal and does not apply to those with aversion to specific activities, this something (usually) considered healthy and not unusual.  The original model in clinical psychiatry was limited to an inability to experience pleasure but this was later extended to a reduction in motivation even to seek experiences which most would find pleasurable.  The fifth edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR (2022)) defines anhedonia as a “lack of enjoyment from, engagement in, or energy for life’s experiences; deficits in the capacity to feel pleasure and take interest in things”.  In modern practice, clinicians distinguish between anticipatory and consummatory anhedonia.  Anticipatory pleasure involves the prediction of pleasure from future reward and the experience of pleasure associated with a positive prediction while consummatory pleasure involves the reward that is the actual moment of experience.  Thus, anticipatory anhedonia is reflects an inability to predict the future experience of pleasure as well as lower motivation to take action toward achieving pleasure and consummatory anhedonia is the lack of pleasure in what’s experienced (ie synonymous with the original definition of anhedonia).

Specific instances usually are not of necessity anhedonic (although an inability to derive any enjoyment from listening to country & western music seems indicative of little more than good taste).  The exception to this seems to be the range of activities clinicians have on their “suspect categories” list including things like sex and human friendship and this view may reflect the long shadow Sigmund Freud (1856-1939) has cast over the profession.  Although in both Western theology and philosophy there's a discernible tradition of what verges on an insistence that humans are social creatures and that interaction with others should be both sought and enjoyed, Freud raised the bar by suggesting every form of sexual behavior among humans was "natural" (though some might be neither lawful or desirable) except the absence of such interest.       

Anhedonia accompanies a range of neuropsychiatric conditions and is frequently associated with depression although it’s not an essential component.  Clinically, anhedonia needs to be suffered as a generalised condition, not as the common phenomenon of losing interest in something specific, something a normal part of the human condition.  There are no specific treatments for anhedonia and there are some dissident psychiatrists and psychologists who suggest this is a tacit admission it may be a normal part of the spectrum of human behaviour.  It is commonly treated alongside the condition of which it’s a part including depression, bipolar disorder (the old manic depression), schizophrenia, post-traumatic stress disorder (PTSD) and the various anxiety disorders.  This association with schizophrenia is striking, the medical orthodoxy being that up to 80% of those with schizophrenia may experience anhedonia and because it’s classified as a negative symptom (indicative of the absence of something that occurs in most healthy individuals), it’s considered more difficult to treat.