If you can prove to yourself that you are not as bad as you think you are--that is, if you learn that the facts show you measure up much better than you thought you do--you may take a short and effective route to overcoming sadness and depression. So it makes sense first to check whether you can improve the numerator in your self-comparison Mood Ratio.
People can and do distort the facts about any of the aspects of their lives that are important to them. Consider as an example the case of a
woman who always had a great zest for life, had felt a great deal of pride in herself and in her achievements, and had cared for her children with obvious love and tenderness. [She] became morose and lost interest in everything that had previously excited her. She withdrew into a shell, neglected her children and became preoccu- pied with self-criticisms and wishes to die. At one point, she formulated a plan to kill herself and her children, but was stopped before she could carry out the plan.
How can conventional folk wisdom explain this woman's remarkable change from her normal state? In common with other depressed patients, she appears to violate the most basic principles of human nature. Her suicidal wishes and her desire to kill her children defy the most hallowed "survival instinct" and "maternal instinct." Her with- drawal and self-debasements are clearcut contradictions of another accepted canon of human behavior--the pleasure principle. Common sense is foiled in attempting to under- stand and to fit together the components of her depression. Sometimes the deep suffering and withdrawal of the patient is explained away by conventional notions such as, "He is just trying to get attention." The notion that a person tortures himself to the point of suicide for the dubious satisfaction of gaining attention greatly strains our credulity and actually runs counter to common sense.
In order to understand why the depressed mother would want to end her own life and that of her children, we need to get inside her conceptual system and see the world through her eyes. We cannot be bound by preconceptions that are applicable to people who are not depressed. Once we are familiar with the perspectives of the depressed patient, her behavior begins to make sense. Through a process of empathy and identification with the patient, we can understand the meanings she attaches to her exper- iences. We can then offer explanations that are plausible-- given her frame of reference.
Through interviewing this depressed mother, I dis- covered that her thinking was controlled by erroneous ideas about herself and her world. Despite contrary evidence, she believed she had been a failure as a mother. She viewed herself as too incompetent to provide even the minimum care and affection for her children. She believed that she could not change--but could only deteriorate. Since she could attribute her presumed failure and inade- quacy only to herself, she tormented herself continuously with self-rebukes.
As this depressed woman visualized the future, she expected her children would feel as miserable as she. Casting about for solutions, she decided that since she could not change, the only answer was suicide. Yet, she was appalled at the notion that her children would be left without a mother, without the love and care she believed that only a mother could give. Consequently, she decided that in order to spare them the kind of misery she was experiencing, she must end their lives also. It is note- worthy that these self-deceptions dominated the patient's consciousness but were not elicited until she was carefully questioned about her thoughts and plans.
This kind of depressive thinking may strike us as highly irrational, but it makes sense within the patient's conceptual framework. If we grant her the basic (though erroneous) premise, namely that she and her children are irrevocably doomed as a result of her presumed deficiencies, it follows logically that the sooner the situation is ter- minated the better for everyone. Her basic premise of being inadequate and incapable of doing anything accounts for her complete withdrawal and loss of motivation. Her feelings of overwhelming sadness stem inevitably from her continuous self-criticisms and her belief that her present and future are hopeless.1
Imprecise use of language can produce severe numerator problems.
When clients state, "I can't stop worrying," or "I find it impossible to diet", we try to get them to change their sentences to "I can stop worrying, but so far I haven't", and "I find it exceptionally difficult to diet -- but hardly impossible". 1.1
The steps toward improving your numerator are: (1) Direct your attention to negative self-comparisons arising from your numerator. (2) Study your numerator to learn how to bring it closer to the real facts. (3) If there are ways to improve your actual situation that you have thought yourself helpless to bring about, consider whether you are really unable to bring about the improvement, or whether the helpless feeling that accompanies your depression is a false impediment. (4) If your study of your numerator indicates that your assessment is biased in a negative direction because of unsound judgment, develop devices to ensure that your corrected numerator, rather than a biased numerator, affects your mood. Let's consider these steps individually.
1. Aim to reduce negative self-comparisons. The first step in improving your numerator is to understand that you must try to reduce negative self-comparisons, and thereby improve your Mood Ratio. People have known about self-comparisons before. But this key insight never has been integrated with the rest of our psychological knowledge in order to develop a systematic approach to the cure of depression.
2. Study your numerator in order to correct it. You are a journalist, say, and you think of yourself as sloppy and insufficiently disciplined. What are the facts? Are you really less careful and disciplined than others in the same work conditions, with the same talent? Or are you really quite careful and disciplined, and your criticism of yourself in this respect is not well-founded?
3. Improve your numerator if it can reasonably be improved, not letting a false sense of helplessness hold you back. You're still a journalist. After looking at a set of your articles as dispassionately as you can, you conclude that one more re-writing would improve your work considerably. Ask yourself why you don't give it that extra re-write. If you tell yourself that you just can't do it, you just can't force yourself to re-write one more time, that it is hopeless, the re-write won't matter anyway, you just don't have the energy and discipline to re-write again, blah, blah, ask: "Is it really so? Maybe I'm not as helpless as that. Maybe I can force myself to the effort of re-writing again." And if you do muster the resources to do the additional rewrite, you may be able to improve your numerator enough to have your self-comparisons no longer be negative.
If you can get yourself into this active mode and make improvements in the work, it will have the additional beneficial effect upon your mood that your activity will oppose your helplessness. And reducing the sense of helplessness reduces the sting of sadness, and the consequent pain, from self-comparisons. All this fits together with the discussion at the end of the last chapter about carrying out your plan of action.
4. Build the habit of assessing your numerator correctly. Here we may take full advantage of recent advances in cognitive therapy, which teaches you how to avoid misinterpretations and misconstructions of your situation that cause negative self- comparisons. A person may incorrectly gather or process the data about one's life, as for example, when I say "My writings are lousy" in response to one of my writings being ignored, without trying to remember those of my writings that have been successful. Or a woman may say "I'm a klutz" when she spills a bottle of beer, without remembering that she is actually a skilled professional ballet dancer. Or, after your suggestion for improving a machine is rejected by your boss, you may fail to analyze why the suggestion was rejected, and then take stock of further possibilities. That is, you may act like an unskilled and/or incompetent researcher into the facts of your situation, reaching unsound conclusions because of poor research habits or insufficient knowledge.
Simple habit-training, such as learning to say "I'm really the greatest" every time the world pans your work, is not likely to succeed in case like this one. But coming to see the flaws in your method of gathering and processing information about how good your work is, and how well it is received, can sometimes reduce unfavorable self-comparisons.
An important common problem is generalizing from a particular trait to your whole life situation. The person who is not good at school work generalizes to "I'm no good at anything." This misunderstanding is seen in the famous cartoon about Adlerian inferiority-complex psychotherapy. The psychiatrist is shown saying to the patient, "I'm very sorry, Mr. Smith, but you really are inferior." But there is no logical connection between a low relative standing in school work, or piety, or any other single dimension, and a person's relative worth as a whole person. Becoming aware of this logical error can remove the source of pain for many.
Interpretation of depressives' numerators are similar to the fallacies that logicians have taught about for centuries, which are also similar to the biases that cause difficulties in scientific research. The problem is a universal one: how to think clearly.
Peter L. is a social scientist who does research which is usually ahead of the times. Sometimes a piece of his work is at first neglected, but later it usually catches on and is successful. But he always gets depressed when the research is first published and receives a cool reception. He would be depressed less if he would take into account the possible long- run effects of his work, even if those effects are now uncertain, rather than ignore them entirely and focus on the short-run neglect.
Cognitive therapy aims to teach Peter how to think more realistically in this regard. But if your past history continues to lay a heavy hand upon you in such manner that you feel that you must find negative self-comparisons for yourself, or you must choose dimensions of comparison which show you in a bad light, then cognitive therapy will not succeed.
Now let's exercise the theory. We begin with the same analysis of uninvited thoughts that was introduced in Chapter 10. Refer again to Table 10-1, and notice the first line of the analysis which refers to changing the numerator of the woman who says "I never do anything right".
Consider Nancy who says "I am a bad mother".2 First she writes that uninvited thought in column 1 Table 12-1 below. Next she writes in column 2 the causal event just preceding that invited thought, a note from the teacher saying that one of her sons was having difficulty in school. Next she writes in column 3 the underlying self-comparison, which is that she is "less effective than other mothers".
Table 12-1 Uninvited thought Causal Event Self-Comparison Analysis Response "I am a bad mother." Note from I spend less time, and Numerator: 1. Do I spend "The hell you say." teacher work less with kids, relatively little time with than most mothers. kids, and working with them? 2. Are most mothers really "It ain't so, Mo." more effective and attentive than I am?
Now Nancy is ready for the analysis in column 4, asking "Is it true that I spend less time with my children, and less time working with them, than do most mothers? " Phrasing the question in this concrete fashion leads her to review her behavior. She also asks, "Are all or most mothers more skilled and more attentive to their children than I am?". This and the first question lead her to do a mental survey of the mothers whom she knows, and check out the statements. And as in so many cases, the facts that are known to her do not support the generalization that she had made in the absence of an examination of the data. If anything she spends too much time with her children, and she works with them on their schoolwork very actively -- certainly as much as the average mother.
With the facts in hand, Nancy can laugh at her error in judgment, and respond "The hell you say", when the uninvited thought "I'm a bad mother" floats into her mind. Getting rid of the Rotten Ratio makes her feel less pain, less sad, and less depressed.
This process is like scientific surveys such as a census, which check on casual generalizations such as that the death rate is going up, or people are getting poorer. If we could form valid generalizations without a census, we would not need to go to so much expense and trouble as we do. This is one more example of how a depressive's difficulty in thinking clearly is little different than our overall human problem of thinking clearly and arriving at sound conclusions.
Here is an example from Don F., a reader of an early draft of this book, about an event as he was emerging a from black depression following a breakup with his wife:
That night I had terrible dreams, all concerning confronting Linna and her new husband as a couple, coming face to face with the fact that she prefers some abusive maniac to me. By the time I got to work I was well on the way to feeling worthless.
Fortunately, that morning your manuscript was on my desk. As I read I began to see how I've distorted reality. Linna did not leave me for an abusive man beause I am worthless. She became obsessed with an abusive man because she is a fruitcake. I do not have to feel depressed over that.
Improving your numerator by assessing your life more realistically is not always a cure. Many of the negative self- comparisons that make one sad may be factually correct. You may indeed be in the bottom fifth of your class in high school, doing poorly relative to most of your classmates. You may really have lost a leg in an accident. It is no wonder that Beck finds that "It is often difficult for the patient to accept the idea that his interpretations are incorrect, or at least inaccurate." To assert that these conditions are distortions of reality is itself a distortion of reality which may later come home to roost with more pain. Distortions of reality in one's thinking process should be attacked with cognitive therapy. But factually-correct unfavorable self-comparisons that cause sadness should be attacked with one or another of the other approaches described here.
Indeed, a solid body of research in recent years2.1 suggests that depressives are more accurate in their assessments of the facts concerning their lives than are non-depressives, who tend to have an optimistic bias. This raises interesting philosophical questions about the virtue of such propositions as "Know thyself", and "The unexamined life is not worth living", but we need not pursue them here.
Cognitive treatment of the numerator also is not appropriate if the root of your problem is not illogic or misinformation but is particular values and hopes. For example, Ruth Y. is a child psychologist who devotes her time and energy to doing research on depression in children from a totally new angle. For a long time she has had little success and no professional recognition, which saddens her. A cognitive therapist might tell her to stop fooling herself, and to turn her energies to something different. But she replies that even though the chances of success are small, the benefits to people will be very great if she does succeed. And if she could look back at age eighty and feel that she had made such a contribution to people she would feel that her life was well-lived.
If this child psychologist has a reasonable idea of the odds facing her, it would be most presumptuous for a therapist to try to "straighten her out," or "show her the errors in her thinking." Rather, her best chance of cure may lie in Values Treatment of the sort described in Chapter 18.
Cognitive treatment of the numerator sometimes shades over into just plain lying to a person. "You are bound to find a job if you keep on looking for another month," or "There are lots of women who are less attractive than you who have made it in the movies," or "You weren't really trying to hurt your wife when you broke her jaw, you were just trying to give her a love tap." But such lying is likely to be disastrous with a depressed person, even aside from its ethics. Depressed people are experts in avoiding even true facts which would show them in a good light, and a fortiori they are even more effective at spotting falsehoods of that sort.
If a person is good at accepting self-supportive lies or half-truths in order to avoid the pain caused by negative self- comparisons, the person is unlikely to be a depressive; rather, schizophrenia or paranoia is the likely illness in such situations. And a depressive becomes even more depressed when he or she comes to feel that the truth as seen by other people is not flattering, and lying is necessary to construct an attractive picture.
Let's assume you understand that eliminating inaccurate self-assessments will reduce sadness and depression by improving the numerator in your Mood Ratio. Let's also assume that you have uncovered one or more ways in which you frequently bias your numerator against yourself. To benefit from this discovery you must develop the habit of correcting your biased assessments whenever they spring into your mind, or even better, adopt the habit of not even allowing such negatively-biased assessments into your mind at all. But how may this be done?
The recipe is simple--deceptively simple: By exerting effort, by practice, and by rewarding yourself for doing so, you build a habit of not making incorrect self-assessments. On the one hand this recipe is nothing more than everyday folk wisdom. On the other hand, this recipe is the staple of modern-day behavioral therapy, which uses various ingenious ways of rewarding people for repeating the desired behavior and for not repeating undesired behavior.
Our power to alter our thoughts by will and practice and suitable "reinforcement" has come to be vastly underestimated, probably because of the rise of Freudian psychoanalysis which emphasizes the power of events in our earlier history to influence our behavior. Columnist Mike Royko conveyed the essence of the method humorously in a column on New Year's Day.
This is the time of year when all sorts of advice is written about hangovers....
It should be remembered that part of a hangover's discomfort is psychological.
When you awaken, you will be filled with a deep sense of shame, guilt, disgust, embarrassment, humiliation and self-loathing.
This is perfectly normal, understandable and deserved.
To ease these feelings, try to think only of the pleasant or amusing things that you did before blacking out. Let your mind dwell on how you walked into the party and said hello to everyone, and handed your host your coat, and shook hands, and admired the stereo system.
Blot from your mind all memories of what you later did to your host's rug, what you said to that lady with the prominent cleavage that made her scream, whether you or her husband threw the first punch. Don't dredge up those vague recollections of being asleep in your host's bathtub while everybody pleaded with you to unlock the bathroom door.
These thoughts will just depress you. Besides, your wife will explain it in detail as the day goes on. And the week, too....3
Or consider the example of Peter F., a teacher who has difficulties in his relationship to his immediate institutional authorities. When he wants something--say, a new teaching assignment--he walks into the department office hat in hand, feeling like a beggar, because he feels that the department head knows just how much his achievements fall below some benchmark level and therefore he feels he has no right to make any request at all. Some people actually verbalize these feelings, saying something like "I know you won't want to say yes to this, but...." When a person makes a request feeling that way, the request has a much lower chance of being granted than if the request is made by a person who has confidence that his request should and will be granted. This sequence of events produces sadness after the request is denied, and also sadness in advance as he compares what is likely to happen (his numerator) with what he wants to happen (the denominator).
Peter could build the habit of entering such a meeting with confidence. And that might well produce positive results which would then help build the habit of behaving in that manner, and would actually improve his numerator. Certainly there are no disadvantages to this tactic, except for the effort involved in cranking up confidence in advance.
On the other hand, this particular habit-building might not be effective because Peter believes that he would be fooling the chairman with phony self-esteem, and that deception in itself would make him sad. Even more important, this sort of encounter is at most a partial cause of Peter's depression, and hence devoting much time and energy to this particular habit-building might miss the mark with him. For some other people, the first attempt at such habit-building may be so traumatic that they can't get started habit-building, as with a person who has been thrown off a horse. But for those people for whom interpersonal problems such as this one are at the root of their depression, such habit-building may successfully remove the cause of negative self-comparisons by improving their numerators, and hence alleviate their depression.
I often begin to get depressed thinking about an upcoming day or two during which there will be events that I think will be a burden upon me and in which I expect not to be very effective. I then get anxious about getting through the time, and with the anxiety comes a tightening of the stomach. I have trained myself to the habit that when I feel my stomach tightening I say to myself, "Hold on, will the day really be a terribly great burden? And will it really be a terrible disaster--for myself and for others--if it does not go super-well? No. So relax." The habit of responding to my stomach-tightening signal in this fashion works to modify my behavior and my self-comparisons, and hence improves my mood.
Behavior-modification therapy is a systematic approach to controlling one's behavior and thoughts by teaching oneself new habits, with the aid of positive and negative reinforcements -- that is, rewards and punishments --with the emphasis on the reward. An ape can be taught to work a machine properly with rewards of food, and later with rewards of tokens which the ape has been taught to associate with food. The behavior of persons in insane asylums has been made more helpful and appropriate with a system that rewards good behavior with points that can be used to obtain various good things. This sort of behavioral training perfectly complements cognitive therapy. Both approaches aim to change how depressives think. Cognitive therapists have concentrated on improving people's logic by showing them how they can think better, and behavior therapists have concentrated on the use of rewards to stamp in the improved thinking habits.
Behavior-modification therapy can help people stop smoking by having a person reward himself with a treat each time the person skips smoking a cigarette, or even when the person avoids thinking about smoking for a period of time, perhaps together with keeping a diary of such thoughts and actions. Similarly, behavior-modification researchers claim that it is possible to reduce unfavorable self-comparisons and increase pleasant (favorable) self-comparisons by teaching you to do something you like--perhaps looking out the window--each time you have a positive thought. The pleasurable relaxed feeling that I get in my viscera and muscles when I say, "Don't criticize. Breathe slowly, and relax your belly," is an example of such a reward.
But the rewards for habit-building need not be the short- term rewards of a lozenge or a work-break with a look out the window. Millions of people have broken the old habit of smoking and developed the new habit of refusing cigarettes, and not thinking about smoking, with the help of the long-run rewards of a longer life expectation and the feeling of better health. With time, behavioral therapy may become a sizable force in helping people overcome such problems as smoking, and it may help some who cannot succeed another way. But it clearly is not the only way in which to get that job done.
In the 1920's, a Frenchman named Coue' claimed that one could heal oneself of mental sickness by repeating, a certain number of times per day, "Every day, and in every way, I am becoming better and better." And apparently this method had some successes.
But to claim too much for habit formation and behavior modification--that is, to claim that they can cure all aspects of all depression without any other methods--is dangerous. A depressive whose hopes are raised high by such claims, and then finds that the claims are not well-founded, can become even more depressed. This can lead to the conclusion that no therapy can work, and hence finish her attempts to cure the depression.
Finding out that you are not as bad as you think you are-- that is, learning that the facts show you in a better light than you usually see yourself in-- may be a short and effective route to overcoming sadness and depression. People can and do distort the facts about any of the aspects of their lives that are important to them. So it makes sense first to check whether you can improve the numerator in your self-comparison Mood Ratio.
Some people induce negative self-comparisons and sadness because they incorrectly assess the actual states of their lives. If you are one of them, you can cut sadness and depression by identifying your patterns of incorrect self-assessments, and then train yourself to correct them, or not make such assessments at all.