Again, thank you, sir!
As ever, Naomi
She died in pain but with dignity six months later.
Loss of Limb. Physical handicaps represent a second category of problems felt to be “realistic.” The afflicted individual—or the family members—automatically assume that the limitations imposed by old age or by a physical disability, such as an amputation or blindness, necessarily imply a decreased capacity for happiness. Friends tend to offer understanding and sympathy, thinking this represents a humane and “realistic” response. The case can be quite the opposite, however. The emotional suffering may be caused by twisted thinking rather than by a twisted body. In such a situation, a sympathetic response can have the undesirable effect of reinforcing self-pity as well as feeding into the attitude that the handicapped individual is doomed to less joy and satisfaction than others. In contrast, when the afflicted individual or family members learn to correct the distortions in their thinking, a full and gratifying emotional life can frequently result.
For example, Fran is a thirty-five-year-old married mother of two, who began to experience symptoms of depression around the time her husband’s right leg became irreversibly paralyzed because of a spinal injury. For six years she sought relief from her intensifying sense of despair, and received a variety of treatments in and out of hospitals, including antidepressant drugs as well as electroshock therapy. Nothing helped. She was in a severe depression when she came to me, and she felt her problems were insoluble.
In tears she described the frustration she experienced in trying to cope with her husband’s decreased mobility:
Every time I see other couples doing things we can’t do tears come to my eyes. I look at couples taking walks, jumping in the swimming pool or the ocean, riding bikes together, and it just hurts. Things like that would be pretty tough for me and John to do. They take it for granted just like we used to. Now it would be so good and wonderful if we could do it. But you know, and I know, and John knows—we can’t.
At first, I too had the feeling Fran’s problem was realistic. After all, they couldn’t do many things that most of us can do. And the same could be said of old people, as well as those who are blind or deaf or who have had a limb amputated.
In fact, when you think of it, we all have limitations. So perhaps we should all be miserable …? As I puzzled over this, Fran’s distortion suddenly came to my mind. Do you know what it is? Look at the list on page 42 right now and see if you can pick it out … that’s right, the distortion that led to Fran’s needless misery was the mental filter. Fran was picking out and dwelling on each and every activity that was unavailable to her. At the same time the many things she and John could or might do together did not enter her conscious mind. No wonder she felt life was empty and dreary.
The solution turned out to be surprisingly simple. I proposed the following to Fran: “Suppose at home between sessions you were to make a list of all the things that you and John, can do together. Rather than focus on things that you and John can’t do, learn to focus on the ones you can do. I, for example, would love to go to the moon, but I don’t happen to be an astronaut, so it’s not likely I’ll ever get the opportunity. Now, if I focused on the fact that in my profession and at my age it is extremely unlikely I could ever get to the moon, I could make myself very upset. On the other hand, there are many things I can do, and if I focus on these, then I won’t feel disappointed. Now, what would be some things you and John can do as a couple?”
FRAN:
Well, we enjoy each other’s company still. We go out to dinner, and we’re buddies.
DAVID:
Okay. What else?
FRAN:
We go for rides together, we play cards. Movies, Bingo. He’s teaching me how to drive…
DAVID:
You see, in less than thirty seconds you’ve already listed six things you can do together. suppose I gave you between now and next session to continue the list. How many items do you think you could come up with?
FRAN:
Quite a lot of them. I could come up with things we’ve never thought of, maybe something unusual like skydiving.
DAVID:
Right. You might even come up with some more adventurous ideas. Keep in mind that you and John might in fact be able to do many things you are assuming you can’t do. For example, you told me you can’t go to the beach. You mentioned how much you’d like to go swimming. Could you go to a beach that’s a little more secluded so you wouldn’t have to feel quite so self-conscious? If I were on a beach and you and John were there, his physical disability wouldn’t make one darn bit of difference to me. In fact, I recently visited a fine beach on the North Shore of Lake Tahoe in California with my wife and her family. As we were swimming, we suddenly happened upon a cove that had a nude beach, and here were all these young people with no clothes on. Of course, I didn’t actually look at any of them, I want you to understand! But in spite of this I did happen to notice that one young man had his right leg missing from the knee down, and he was there having fun with the rest of them. So I’m not absolutely convinced that just because someone is crippled or missing a limb they can’t go to the beach and have fun. What do you think?
Some people might scoff at the idea that such a “difficult and real” problem could be so easily resolved, or that an intractable depression like Fran’s could turn around in response to such a simple intervention. She did in fact report a complete disappearance of her uncomfortable feelings and said she felt the best she had in years at the end of the session. In order to maintain such improvement, she will obviously need to make a consistent effort to change her thinking patterns over a period of time so she can overcome her bad habit of spinning an intricate mental web and getting trapped in it.
Loss of Job. Most people find the threat of a career reversal or the loss of livelihood a potentially incapacitating emotional blow because of the widespread assumption in Western culture that individual worth and one’s capacity for happiness are directly linked with professional success. Given this value system, it seems obvious and realistic to anticipate that emotional depression would be inevitably linked with financial loss, career failure, or bankruptcy.
If this is how you feel, I think you would be interested in knowing Hal. Hal is a personable forty-five-year-old father of three, who worked for seventeen years with his wife’s father in a successful merchandising firm. Three years before he was referred to me for treatment, Hal and his father-in-law had a series of disputes about the management of the firm. Hal resigned in a moment of anger, thus giving up his interests in the company. For the next three years, he bounced around from job to job, but had difficulty finding satisfactory employment. He didn’t seem to be able to succeed at anything and began to view himself as a failure. His wife started working full time to make ends meet, and this added to Hal’s sense of humiliation because he had always prided himself on being the breadwinner. As the months and years rolled on, his financial situation worsened, and he experienced increasing depression as his self-esteem bottomed out.
When I first met Hal, he had been attempting to work for three months as a trainee in commercial real-estate sales. He had rented several buildings, but had not yet finalized a sale. Because he was working on a strict commission basis, his income during this break-in period was quite low. He was plagued by depression and procrastination. He would at times stay at home in bed all day, thinking to himself, “What’s the use? I’m just a loser. There’s no point in going to work. It’s less painful to stay in bed.”
Hal volunteered to permit the psychiatric residents in our training program at the University of Pennsylvania to observe one of our psychotherapy sessions through a one-way mirror. During this session, Hal described a conversation in the locker room of his club. A well-to-do friend had informed Hal of his interest in the purchase of a particular building. You might think he would have jumped for joy on learning this, since the commission from such a sale would have given his car
eer, confidence, and bank account a much needed boost. Instead of pursuing the contact, Hal procrastinated several weeks. Why? Because of his thought, “It’s too complicated to sell a commercial property. I’ve never done this before. Anyway, he’ll probably back out at the last minute. That would mean I couldn’t make it in this business. It would mean I was a failure.”
Afterward, I reviewed the session with the residents. I wanted to know what they thought about Hal’s pessimistic, self-defeating attitudes. They felt that Hal did in fact have a good aptitude for sales work, and that he was being unrealistically hard on himself. I used this as ammunition during the next session. Hal admitted that he was more critical of himself than he would ever be toward anyone else. For example, if one of his associates lost a big sale, he’d simply say, “It’s not the end of the world; keep plugging.” But if it happened to him he’d say, “I’m a loser.” Essentially, Hal admitted he was operating on a “double standard”—tolerant and supportive toward other people but harsh, critical, and punitive toward himself. You may have the same tendency. Hal initially defended his double standard by arguing it would be helpful to him:
HAL:
Well, first of all, the responsibility and interest that I have in the other person is not the same as the responsibility that I have for myself.
DAVID:
Okay. Tell me more.
HAL:
If they don’t succeed, it’s not going to be bread off my table, or create any negative feelings within my family unit. So the only reason I’m interested in them is because it’s nice to have everybody succeed, but there…
DAVID:
Wait—wait—wait! You’re interested in them because it’s nice to have them succeed?
HAL:
Yeah. I said …
DAVID:
The standard you apply to them is one that you think would help them succeed?
HAL:
Right.
DAVID:
And is the standard you apply to yourself the one that will help you succeed? How do you feel when you say, “One missed sale means I’m a failure”?
HAL:
Discouraged.
DAVID:
Is this helpful?
HAL:
Well, it hasn’t produced positive results, so apparently it’s not helpful.
DAVID:
And is it realistic to say “One missed sale and I’m a failure”?
HAL:
Not really.
DAVID:
So why are you using this all-or-nothing standard on yourself? Why would you apply helpful and realistic standards to these other people who you don’t care so much about and self-defeating, hurtful standards to yourself who you do care something about?
Hal was beginning to grasp that it wasn’t helping him to live by a double standard. He judged himself by harsh rules that he would never apply to anyone else. He initially defended this tendency—as many demanding perfectionists will—by claiming it would help him in some way to be so much harder on himself than on others. However, he then quickly owned up to the fact that his personal standards were actually unrealistic and self-defeating because if he did try to sell the building and didn’t succeed, he would view it as a catastrophe. His bad habit of all-or-nothing thinking was the key to the fear that paralyzed him and kept him from trying. Consequently, he spent most of his time in bed, moping.
Hal asked for some specific guidelines concerning things he might do to rid himself of his perfectionistic double standards so that he could judge all individuals, including himself, by one objective set of standards. I proposed that as a first step, Hal might use the automatic-thought, rational-response technique. For example, if he were sitting at home procrastinating about work, he might be thinking, “If I don’t go to work early and stay all day and get caught up on all my work, there’s no point in even trying. I might as well lie in bed.” After writing this down, he would substitute a rational response, “This is just all-or-nothing thinking, and it’s baloney. Even going to work for a half day could be an important step and might make me feel better.”
Hal agreed to write down a number of upsetting thoughts before the next therapy session at those times he felt worthless and down on himself. (See Figure 9–2, page 244.) Two days later he received a layoff notice from his employer, and he came to the next session highly convinced his self-critical thoughts were absolutely valid and realistic. He’d been unable to come up with a single rational response. The notice implied that his failure to show up at work necessitated his release from his job. During the session, we discussed how he could learn to talk back to his critical voice.
* * *
Figure 9–2. Hal’s homework for recording and challenging his self-critical thoughts. He wrote down the Rational Responses during the therapy session (see text).
* * *
DAVID:
Okay, now let’s see if we can write down some answers to your negative thoughts in the Rational Response column. Can you think of any answer based on what we talked about last session? Consider your statement “I am inadequate.” Would this in any way result from your all-or-nothing thinking and perfectionistic standards?
The answer might be clearer to you if we do a role-reversal. It’s sometimes easier to speak objectively about someone else. Suppose I came to you with your story and told you that I was employed by my wife’s father. Three years ago we had a fight. I felt I was being taken advantage of. I walked out. I’ve kinda been feeling blue ever since that time, and I’ve been tossing around from job to job. Now I’ve been fired from a job that was purely on a commission basis, and that’s really a double defeat for me. In the first place, they didn’t pay me anything, and then in the second place, they didn’t even figure I was worth that much, so they fired me. I’ve concluded that I’m inadequate—an inadequate human being. What would you say to me?
HAL:
Well, I … assuming that you’d gotten up to that point, say the first forty years or more of your life, you obviously were doing something.
DAVID:
Okay, write that down in the Rational Response column. Make a list of all the good, adequate things you did for the first forty years of your life. You’ve earned money, you’ve raised children who were successful, etc., etc.
HAL:
Okay. I can write down that I’ve had some success. We’ve had a good home. We’ve reared three outstanding children. People admire and respect me, and I have involved myself in community activities.
DAVID:
Okay, now those are all the things you’ve done. How do you reconcile this with your belief that you are inadequate?
HAL:
Well, I could have done more.
DAVID:
Great! I was certain you’d figure out a clever way to disqualify your good points. Now write that down as another negative thought: “I could have done more.” Beautiful!
HAL:
Okay, I’ve written it down as number five.
DAVID:
Okay, now what’s the answer to that one? (long silence)
DAVID:
What is it? What’s the distortion in that thought?
HAL:
You’re a tricky bugger!
DAVID:
What is the answer?
HAL:
At least I did more than most people.
DAVID:
Right, and what percent do you believe that?
HAL:
That I believe one hundred percent.
DAVID:
Great! Put it down in the Rational Response column. Now, let’s go back to this “I could have done more.” Suppose you were Howard Hughes sitting up in his tower, with all those millions and billions. What could you say to yourself to make yourself unhappy?
HAL:
Well, I’m trying to think.
DAVID:
Just read what you wrote down on the paper.
HAL:
Oh. “I could have done more.”
> DAVID:
You can always say that, can’t you?
HAL:
Yeah.
DAVID:
And that’s why a lot of people who have won fame and fortune are unhappy. It’s just an example of perfectionistic standards. You can go on and on and on, and no matter how much achievement you experience, you can always say, “I could have done more.” This is an arbitrary way of punishing yourself. Do you agree or not?
HAL:
Well, yeah. I can see that. It takes more than one element really to be happy. Because if it was money, then every millionaire and billionaire would be euphoric. But there are more circumstances that involve being happy or satisfied with yourself than making money. That’s not the drive that paralyzes me. I’ve never had a drive to go after money.
DAVID:
What were your drives? Did you have a drive to raise a family?
HAL:
That was very important to me. Very important. And I participated in the rearing of the children.
Feeling Good: The New Mood Therapy Page 22