Feeling Good: The New Mood Therapy (31 page)

Harriet mastered the Moorey Moaner Method quickly and reported a dramatic change in her mood and outlook because it gave her a simple, effective way to handle a problem that had been very real and overwhelming. When she returned for the next session, her depression—which had crippled her for over a decade—had lifted and was entirely gone. She was bubbling and joyous, and heaped well-deserved praise on Stirling’s head. If you have a similar problem with your mother, mother-in-law, or friends, try Stirling’s method. Like Harriet, you’ll soon be smiling!

6. Developing Perspective.
One of the commonest distortions that leads to a sense of guilt is personalization—the misguided notion that you are ultimately responsible for other people’s feelings and actions or for naturally occurring events. An obvious example would be your sense of guilt when it rained unexpectedly on the day of a large picnic you had organized to honor the retiring president of your club. In this case you could probably shake your absurd reaction off without a great deal of effort because you clearly cannot control the weather.

Guilt becomes much more difficult to overcome when someone suffers substantial pain and discomfort and insists it results from their personal interaction with you. In such cases it can be helpful to clarify the extent to which you can realistically assume responsibility. Where does your responsibility end and the other person’s begin? The technical name for this is “disattribution,” but you might call it putting things into perspective.

Here’s how it works. Jed was a mildly depressed college student whose twin brother, Ted, was so seriously depressed he dropped out of school and began to live like a recluse with his parents. Jed felt guilty about his brother’s depression. Why? Jed told me he had always been more outgoing and hardworking than his brother. Consequently, from early childhood he always made better grades and had more friends than Ted. Jed reasoned that the social and academic success he enjoyed caused his brother to feel inferior and
left out. Consequently, Jed concluded that he was the cause of Ted’s depression.

He then carried this line of reasoning to its illogical extreme and hypothesized that by feeling depressed himself, he might help Ted stop feeling depressed and inferior through some type of reverse (or perverse) psychology. When he went home for the holidays, Jed avoided the usual social activities, minimized his academic success, and emphasized how blue he was feeling. Jed made sure he gave his brother the loud and clear message that he too was down and out.

Jed took his plan so seriously that he was quite hesitant to apply the mood-control techniques I was trying to teach him. In fact, he was downright
resistant
at first because he felt guilty about getting better and feared his recovery might have a devastating impact on Ted.

Like most personalization errors, Jed’s painful illusion that he was at fault for his brother’s depression contained enough half-truths to sound persuasive. After all, his brother probably had felt inferior and inadequate since early childhood and undoubtedly did harbor some jealous resentment of Jed’s success and happiness. But the crucial questions were: Did it follow that Jed
caused
his brother’s depression, and could Jed effectively reverse the situation by making himself miserable?

In order to help him assess his role in a more objective way, I suggested Jed use the triple-column technique (Figure 8–4). As a result of the exercise, he was able to see that his guilty thoughts were self-defeating and illogical. He reasoned that Ted’s depression and sense of inferiority were ultimately caused by Ted’s distorted thinking and not by his own happiness or success. For Jed to try to correct this by making himself miserable was as illogical as trying to put out a fire with gasoline. As Jed grasped this, his guilt and depression rapidly lifted, and he was soon back to normal functioning.

Figure 8–4.

“Dr. Burns, you seem to be claiming that distorted thinking is the only cause of depression. But what if my problems are real?” This is one of the most frequent questions I encounter during lectures and workshops on cognitive therapy. Many patients raise it at the start of treatment, and list a number of “realistic” problems which they are convinced cause “realistic depressions.” The most common are:

I’m sure you could add to the list. However, none of the above can lead to a “realistic depression.” There is, in fact, no such thing! The real question here is how to draw the line between desirable and undesirable negative feelings. What is the difference between “healthy sadness” and depression?

The distinction is simple. Sadness is a normal emotion created by realistic perceptions that describe a negative event involving loss or disappointment in an undistorted way.
Depression is an illness that
always
results from thoughts that are distorted in some way. For example, when a loved one dies, you validly think, “I lost him (or her), and I will miss the companionship and love we shared.” The feelings such a thought creates are tender, realistic, and desirable. Your emotions will enhance your humanity and add depth to the meaning of life. In this way you
gain
from your loss.

In contrast, you might tell yourself, “I’ll never again be happy because he (or she) died. It’s unfair!” These thoughts will trigger in you feelings of self-pity and hopelessness. Because these emotions are based entirely on distortion, they will defeat you.

Either depression or sadness can develop after a loss or a failure in your efforts to reach a goal of great personal importance. Sadness comes, however, without distortion. It involves a flow of feeling and therefore has a time limit. It never involves a lessening of your self-esteem. Depression is frozen—it tends to persist or recur indefinitely, and always involves loss of self-esteem.

When a depression clearly appears after an obvious stress, such as ill health, the death of a loved one, or a business reversal, it is sometimes called a “reactive depression.” At times it can be more difficult to identify the stressful event that triggered the episode. Those depressions are often called “endogenous” because the symptoms seem to be generated entirely out of thin air. In both cases, however, the cause of the depression is identical—your distorted, negative thoughts. It has no adaptive or positive function whatsoever, and represents one of the worst forms of suffering. Its only redeeming value is the growth you experience when you recover from it.

My point is this: When a genuinely negative event occurs, your emotions will be created exclusively by your thoughts and perceptions. Your feelings will result from the meaning you attach to what happens. A substantial portion of your suffering will be due to the
distortions
in your thoughts. When you eliminate these distortions, you will find that coping with the “real problem” will become less painful.

Let’s see how this works. One clearly realistic problem involves serious illness, such as a malignancy. It is unfortunate that the family and friends of the afflicted person are often so convinced that it is normal for the patient to feel depressed, they fail to inquire about the cause of the depression, which more often than not turns out to be completely reversible. In fact, some of the
easiest
depressions to resolve are those found in people facing probable death. Do you know why? These courageous individuals are often “supercopers” who haven’t made misery their life-style. They are usually willing to help themselves in any way they can. This attitude rarely fails to transform apparently irreversible and “real” difficulties into opportunities for personal growth. This is why I find the concept of “realistic depressions” so personally abhorrent. The attitude that depression is necessary strikes me as destructive, inhuman, and victimizing. Let’s get down to some specifics, and you can judge for yourself.

Loss of Life.
Naomi was in her mid-forties when she received a report from her doctor that a “spot” had appeared on her chest X ray. She was a firm believer that going to doctors was a way of asking for trouble, so she procrastinated many months in checking this report out. When she did, her worst suspicions were validated. A painful needle biopsy confirmed the presence of malignant cells, and subsequent lung removal indicated that a spread of the cancer had already occurred.

This news hit Naomi and her family like a hand grenade. As the months wore on, she became increasingly despondent over her weakened state. Why? It was not so much the physical discomfort from the disease process or the chemotherapy, although these were genuinely uncomfortable, but the fact that she was sufficiently weak that she had to give up the daily activities that had meant a great deal to her sense of identity and pride. She could no longer work around the house (now her husband had to do most of the chores), and she had to give up her two part-time
jobs, one of which was volunteer reading for the blind.

You might insist, “Naomi’s problems are
real
. Her misery is not caused by distortion. It’s caused by the situation.”

But was her depression so inevitable? I asked Naomi why her lack of activity was so upsetting. I explained the concept of “automatic thoughts,” and she wrote down the following negative cognitions: (1) I’m not contributing to society; (2) I’m not accomplishing in my own personal realm; (3) I’m not able to participate in
active
fun; and (4) I am a drain and drag on my husband. The emotions associated with these thoughts were: anger, sadness, frustration, and guilt.

When I saw what she had written down, my heart leaped for joy! These thoughts were no different from the thoughts of physically healthy depressed patients I see every day in my practice. Naomi’s depression was
not
caused by her malignancy, but the malignant
attitude
that caused her to measure her sense of worth by the amount she produced! Because she had always equated her personal worth with her achievements, the cancer meant—“You’re over the hill! You’re ready for the refuse heap!” This gave me a way to intervene!

I suggested that she make a graph of her personal “worth” from the moment of birth to the moment of death (see Figure 9–1, page 235). She saw her worth as a constant, estimating it at 85 percent on an imaginary scale from 0 to 100 percent. I also asked her to estimate her
productivity
over the same period on a similar scale. She drew a curve with low productivity in infancy, increasing to a maximum plateau in adulthood, and finally decreasing again later in life (see Figure 9–1). So far, so good. Then two things suddenly dawned on her. First, while her illness had reduced her productivity, she still contributed to herself and her family in numerous small but nevertheless important and precious ways. Only all-or-nothing thinking could make her think her contributions were a zero. Second, and much more important, she realized her personal worth was constant and steady; it was a
given
that was unrelated to her achievements. This meant that her human worth did
not
have to be earned, and she was every bit as precious in her weakened state. A smile spread across her face, and her depression melted in that moment. It was a real pleasure for me to witness and participate in this small miracle. It did
not
eliminate the tumor, but it did restore her missing self-esteem, and that made all the difference in the way she
felt
.