Feeling Good: The New Mood Therapy (9 page)

Do I mean you should get rid of
all
emotions? Do I want you to turn into a robot? No. I want to teach you to avoid painful feelings based on mental distortions, because they are neither valid nor desirable. I believe that once you have learned how to perceive life more realistically you will experience an enhanced emotional life with a greater appreciation for genuine sadness—which lacks distortion—as well as joy.

As you go on to the next sections of this book, you can learn to correct the distortions that fool you when you are upset. At the same time, you will have the opportunity to reevaluate some of the basic values and assumptions that create your vulnerability to destructive mood swings. I have outlined the necessary steps in detail. The modifications in illogical thinking patterns will have a profound effect on your moods and increase your capacity for productive living. Now, let’s go ahead and see how we can turn your problems around.

When you are depressed, you invariably believe that you are worthless. The worse the depression, the more you feel this way. You are not alone. A survey by Dr. Aaron Beck revealed that over 80 percent of depressed patients expressed self-dislike.
*
Furthermore, Dr. Beck found that depressed patients see themselves as deficient in the very qualities they value most highly: intelligence, achievement, popularity, attractiveness, health, and strength. He said a depressed self-image can be characterized by the four D’s: You feel Defeated, Defective, Deserted, and Deprived.

Almost all negative emotional reactions inflict their damage
only
as a result of low self-esteem. A poor self-image is the magnifying glass that can transform a trivial mistake or an imperfection into an overwhelming symbol of personal defeat. For example, Eric, a first-year law student, feels a sense of panic in class. “When the professor calls on me, I’ll probably goof up.” Although Eric’s fear of “goofing up” was foremost on his mind, my dialogue with him revealed that a sense of personal inadequacy was the real cause of the problem:

In this brief dialogue, Eric showed that he believed it would be terrible to be disapproved of or to make a mistake or to fail. He seemed convinced that if one person looked down on him then everyone would. It was as if the word REJECT would suddenly be stamped on his forehead for
everyone to see. He seemed to have no sense of self-esteem that was not contingent upon approval and/or success. He measured himself by the way others looked at him and by what he had achieved. If his cravings for approval and accomplishment were not satisfied, Eric sensed he would be nothing because there would be no true support from within.

If you feel that Eric’s perfectionistic drive for achievement and approval is self-defeating and unrealistic, you are right. But to Eric, this drive was
realistic
and
reasonable
. If you are now depressed or have ever been depressed, you may find it much harder to recognize the illogical thinking patterns which cause you to look down on yourself. In fact, you are probably convinced that you really are inferior or worthless. And any suggestion to the contrary is likely to sound foolish and dishonest.

Unfortunately, when you are depressed you may not be alone in your conviction about your personal inadequacy. In many cases you will be so
persuasive
and
persistent
in your maladaptive belief that you are defective and no good, you may lead your friends, family, and even your therapist into accepting this idea of yourself. For many years psychiatrists have tended to “buy into” the negative self-evaluation system of depressed individuals without probing the validity of what the patients are saying about themselves. This is illustrated in the writings of such a keen observer as Sigmund Freud in his treatise “Mourning and Melancholia,” which forms the basis for the orthodox psychoanalytic approach to treating depression. In this classic study Freud said that when the patient says he is worthless, unable to achieve, and morally despicable, he
must be right
. Consequently, it was fruitless for the therapist to disagree with the patient. Freud believed the therapist should agree that the patient is, in fact, uninteresting, unlovable, petty, self-centered, and dishonest. These qualities describe a human being’s true self, according to Freud, and the disease process simply makes the truth more obvious:

The way a therapist handles your feelings of inadequacy is crucial to the cure, as your sense of worthlessness is a key to depression. The question also has considerable philosophical relevance—is human nature
inherently
defective? Are depressed patients actually facing the ultimate truth about themselves? And what, in the final analysis, is the source of genuine self-esteem? This, in my opinion, is the most important question you will ever confront.

First, you
cannot earn
worth through what you do.
Achievements can bring you satisfaction but not happiness. Self-worth based on accomplishments is a “pseudo-esteem,” not the genuine thing! My many successful but depressed patients would all agree. Nor can you base a valid sense of self-worth on your looks, talent, fame, or fortune. Marilyn Monroe, Mark Rothko, Freddie Prinz, and a multitude of famous suicide victims attest to this grim truth. Nor can love, approval, friendship, or a capacity for close, caring human relationships add one iota to your inherent worth. The great majority of depressed individuals are in fact very much loved, but it doesn’t help one bit because
self
-love and
self
-esteem are missing. At the bottom line, only your own sense of self-worth determines how you feel.

“So,” you may now be asking with some exasperation, “how
do
I get a sense of self-worth? The fact is,
I feel
damn inadequate, and I’m convinced I’m really not as good as other people. I don’t believe there’s anything I can do to change those rotten feelings because that’s the way I basically am.”

One of the cardinal features of cognitive therapy is that it stubbornly refuses to buy into your sense of worthlessness. In my practice I lead my patients through a systematic reevaluation of their negative self-image. I raise the same question over and over again: “Are you really
right
when you insist that somewhere inside you are essentially a loser?”

The first step is to take a close look at what you say about yourself when you insist you are no good. The evidence you present in defense of your worthlessness will usually, if not always, make no sense.

This opinion is based on a recent study by Drs. Aaron Beck and David Braff which indicated that there is actually a formal thinking disturbance in depressed patients. Depressed individuals were compared with schizophrenic patients and with undepressed persons in their ability to interpret the meaning of a number of proverbs, such as “A stitch in time saves nine.” Both the schizophrenic and depressed patients made many logical errors and had difficulty in extracting the meaning of the proverbs. They were overly
concrete and couldn’t make accurate generalizations. Although the severity of the defect was obviously less profound and bizarre in the depressed patients than in the schizophrenic group, the depressed individuals were clearly abnormal as compared with the normal subjects.

In practical terms the study indicated that during periods of depression you lose some of your capacity for clear thinking; you have trouble putting things into proper perspective. Negative events grow in importance until they dominate your entire reality—and you can’t really tell that what is happening is distorted. It all seems very
real
to you. The illusion of hell you create is
very convincing
.

The more depressed and miserable you feel, the more twisted your thinking becomes. And, conversely, in the absence of mental distortion, you
cannot
experience low self-worth or depression!

What types of mental errors do you make most generally when you look down on yourself? A good place to begin is with the list of distortions you began to master in Chapter 3. The most usual mental distortion to look out for when you are feeling worthless is all-or-nothing thinking. If you see life only in such extreme categories, you will believe your performance will be either great or terrible—nothing else will exist. As a salesman told me, “Achieving 95 percent or better of my goal for monthly sales is acceptable. Ninety-four percent or below is the equivalent of total failure.”

Not only is this all-or-nothing system of self-evaluation highly unrealistic and self-defeating, it creates overwhelming anxiety and frequent disappointment. A depressed psychiatrist who was referred to me noticed a lack of sexual drive and a difficulty in maintaining erections during a two-week period when he was feeling blue. His perfectionistic tendencies had dominated not only his illustrious professional career but also his sexual life. Consequently, he had intercourse regularly with his wife every other day precisely on schedule for the twenty years of their married life. In spite of his decreased sex drive—which is a common symptom
of depression—he told himself, “I
must
continue to perform intercourse on schedule.” This thought created such anxiety that he became increasingly unable to achieve a satisfactory erection. Because his perfect intercourse track record was broken, he now began clubbing himself with the “nothing” side of his all-or-nothing system and concluded, “I’m not a full marriage partner anymore. I’m a failure as a husband. I’m not even a man. I’m a worthless nothing.” Although he was a competent (and some might even say brilliant) psychiatrist, he confided to me tearfully, “Dr. Burns, you and I both know it is an undeniable fact that I will never be able to have intercourse again.” In spite of his years of medical training, he could actually convince himself of such a thought.

By now you might be saying, “Okay, I can see that there is a certain illogic which lurks behind the sense of worthlessness. At least for
some
people. But they are basically winners; they’re not like me. You seem to be treating famous physicians and successful businessmen. Anyone could have told you that their lack of self-esteem was illogical. But I really
am
a mediocre nothing. Others
are
, in fact, better looking and more popular and successful than I am. So what can I do about it? Nothing, that’s what! My feeling of worthlessness is very valid. It’s based on reality, so there is little consolation in being told to
think
logically. I don’t think there’s any way to make these awful feelings go away unless I try to fool myself, and you and I both know that won’t work.” Let me first show you a couple of popular approaches, used by many therapists, which I feel do
not
represent satisfactory solutions to your problem of worthlessness. Then I’ll show you some approaches that will make sense and help you.