The pursuit of euthymia: are cultural factors relevant?
Authors: Santosh K. Chaturvedi, Soumya Parameshwaran
Journal: World Psychiatry (2020)

Fava and Guidi1 quote the definition of euthymia by Democritus, as a state of quiet satisfaction and balance of emotions. In the Indian context, there are two related cultural concepts which can be considered similar to euthymia, i.e. equanimity and equipoise. In the Buddhist literature, the term “equanimity” indicates a mental state or trait that cannot be swayed by biases and preferences2, an “even-mindedness in the face of every sort of experience, regardless of any pleasure or pain”3, and “a balanced reaction to joy and misery, which protects one from emotional agitation”4, 5. Equanimity has not been much discussed in the context of Western psychological theories4, but it emerges in related concepts such as acceptance, non-judgment, non-striving, and non-reactivity – especially in the context of mindfulness meditation practice. Desbordes et al4 reviewed the psychological, physiological and neuroimaging aspects of equanimity, and proposed that it potentially captures the most important psychological elements of well-being. To rephrase its definition in modern terms, equanimity is an even-minded mental state or dispositional tendency toward all experiences or objects, regardless of their affective valence (pleasant, unpleasant or neutral) or source4. Equanimity of mind is being able to keep the mind steady, balanced in all the conditions of life, contented, calm and peaceful. Equanimity is having the ability to remain cheerful in adverse conditions, to face danger, and to have the presence of mind and forbearance to bear insult, injury and persecution, without getting emotionally affected6. This description is close to the original derivation of the term euthymia (Greek origin: eu, well, and thymos, soul). Measuring equanimity, both subjectively and objectively, presents several challenges. Equanimity may be difficult to distinguish from apathy, indifference and emotional coldness, as well as from other situations with diminished emotional responses to a given stimulus. The concept of “equipoise” refers to a state which allows expression of empathy without letting subjective or reactive responses cloud one's judgment. “Emotional equipoise” describes a balanced and rational mental state, irrespective of external stimuli7. Equanimity and equipoise may appear to be indicating “optimal balanced well-being” , which is likely to vary from person to person based on socio-cultural and spiritual factors. They are dynamic states lying on a continuum, interrelated and difficult to assess using normative metrics. Gross et al8 have developed an affect regulation perspective of well-being. Desbordes et al4 have described equanimity as an emotion regulation strategy that can change both the magnitude and quality of responses. If euthymia is an affective state, it is probably arising from adaptive affect regulation and generation, like equanimity. However, emotions have more dimensions than just affect, i.e., the behavioral, cognitive and somatic components. Feelings are also expressed in bodily forms, in metaphors and idioms, and as idioms of distress. On the other hand, some patients consider euthymia distressing, complain of being “unable to feel” and make attempts to expose themselves to situations which can arouse feelings, or have a feeling of feeling – a meta-emotion. In terms of management, both psychotherapy and pharmacotherapy (mood stabilizers) probably help the person to achieve euthymia. However, many of us have the experience of patients on lithium prophylaxis complaining of having lost the creativity, spark, zing or zeal they had before the illness started and the drug was prescribed to them. They may be rated as euthymic on rating scales, but feel different from their premorbid self. In these cases, euthymia may not be the ideal recovery goal. Complementary and alternative modes of treatments, such as yoga and mindfulness, may be needed to achieve equanimity. The pursuit of euthymia will hopefully raise a debate on a more universally acceptable model of emotions, their variations and disturbances. One can agree partly with Fava and Guidi that psychological well-being needs an integrative framework which may be subsumed under the concept of euthymia. The constructs of equanimity and equipoise could be considered in this context, however challenging this may turn out to be.