Feeling Good: The New Mood Therapy

by Burns, David D.

  How can you use such a happy memory? When you are having a presumably pleasurable experience—eating out, taking a trip, going to a movie, etc.—you may unnecessarily sour the experience by making an inventory of all the ways it falls short and telling yourself you can’t possibly enjoy it. But this is hogwash—it’s your expectation that upsets you. Suppose the motel bed is too lumpy and you paid fifty-six dollars for the room. You called the front desk, and they have no other beds or rooms available. Tough! Now you can double your trouble by demanding perfection, or you can conjure up your “happy, imperfect” memory. Remember the time you camped out and slept on the ground and loved it? So you can certainly enjoy yourself in this motel room if you choose! Again, it’s up to you.

  14. Another method for overcoming perfectionism is the “greed technique.” This is based on the simple fact that most of us try to be perfect so we can get ahead in life. It may not have occurred to you that you might end up much more successful if your standards were lower. For example, when I started my academic career, I spent over two years writing the first research paper I published. It was an excellent product, and I’m still quite proud of it. But I noticed that in the same time period, many of my peers who were of equal intelligence wrote and published numerous papers. So I asked myself—am I better off with one publication that contains ninety-eight “units of excellence,” or ten papers that are each worth only eighty “units of excellence”? In the latter case, I would actually end up with 800 “excellenceunits,” and I would be way ahead of the game. This realization was a strong personal persuader, and I decided to lower my standards a bit. My productivity then became dramatically enhanced, as well as my levels of satisfaction.

  How can this work for you? Suppose you have a task and you notice you’re moving slowly. You may find that you’ve already reached the point of diminishing returns, and you’d do better by moving on to the next task. I’m not advocating that you slough off, but you may find that you as well as others will be equally if not more pleased with many good, solid performances than with one stress-producing masterpiece.

  15. Here’s the last approach. It involves simple logic. Premise one: All human beings make mistakes. Do you agree? Okay, now tell me: What are you? A human being, you say? Okay. Now, what follows? Of course—you will and should make mistakes! Now tell yourself this every time you persecute yourself because you made an error. Just say, “I was supposed to make that mistake because I’m human!” or “How human of me to have made that mistake.”

  In addition, ask yourself, “What can I learn from my mistake? Is there some good that could come from this?” As an experiment, think about some error you’ve made and write down everything you learned from it. Some of the best things can be learned only through making mistakes and learning from them. After all, this is how you learned to talk and walk and do just about everything. Would you be willing to give up that kind of growth? You may even go so far as to say your imperfections and goof-ups are some of your greatest assets. Cherish them! Never give up your capacity for being wrong because then you lose the ability to move forward. In fact, just think what it would be like if you were perfect. There’d be nothing to learn, no way to improve, and life would be completely void of challenge and the satisfaction that comes from mastering something that takes effort. It would be like going to kindergarten for the rest of your life. You’d know all the answers and win every game. Every project would be a guaranteed success because you would do everything correctly. People’s conversations would offer you nothing because you’d already know it all. And most important, nobody could love or relate to you. It would be impossible to feel any love for someone who was flawless and knew it all. Doesn’t that sound lonely, boring, and miserable? Are you so sure you still want perfection?

  Part V

  Defeating Hopelessness and Suicide

  Chapter 15

  The Ultimate Victory: Choosing to Live

  Dr. Aaron T. Beck reported in a study that suicidal wishes were present in approximately one-third of individuals with a mild case of depression, and in nearly three-quarters of people who were severely depressed.* It has been estimated that as many as 5 percent of depressed patients do actually die as a result of suicide. This is approximately twenty-five times the suicide rate within the general population. In fact, when a person with a depressive illness dies, the chances are one in six that suicide was the cause of death.

  No age group or social or professional class is exempt from suicide; think of the famous people you know of who have killed themselves. Particularly shocking and grotesque—but by no means rare—is suicide among the very young. In a study of seventh- and eighth-grade students in a suburban Philadelphia parochial school, nearly one third of the youngsters were significantly depressed and had suicidal thoughts. Even infants who undergo maternal separation can develop a depressive syndrome in which failure to thrive and even self-imposed death from starvation can result.

  Before you get overwhelmed, let me emphasize the positive side of the coin. First, suicide is unnecessary, and the impulse can be rapidly overcome and eliminated with cognitive techniques. In our study, suicidal urges were reduced substantially in patients treated with cognitive therapy or with antidepressant drugs. The improved outlook on life occurred within the first week or two of treatment in many cognitively treated patients. The current intensive emphasis on the prevention of depressive episodes in individuals prone to mood swings should also result in a long-term reduction in suicidal impulses.

  Why do depressed individuals so frequently think of suicide, and what can be done to prevent these impulses? You will understand this if you examine the thinking of people who are actively suicidal. A pervasive, pessimistic vision dominates their thoughts. Life seems to be nothing but a hellish nightmare. As they look into the past, all they can remember are moments of depression and suffering.

  When you feel down in the dumps, you may also feel so low at times that you get the feeling you were never really happy and never will be. If a friend or relative points out to you that, except for such periods of depression, you were quite happy, you may conclude they’re mistaken or only trying to cheer you up. This is because while you are depressed you actually distort your memories of the past. You just can’t conjure up any memories of periods of satisfaction or joy, so you erroneously conclude they did not exist. Thus, you mistakenly conclude that you always have been and always will be miserable. If someone insists that you have been happy, you may respond as a young patient recently did in my office, “Well, that period of time doesn’t count. Happiness is an illusion of some kind. The real me is depressed and inadequate. I was just fooling myself if I thought I was happy.”

  No matter how bad you feel, it would be bearable if you had the conviction that things would eventually improve. The critical decision to commit suicide results from your illogical conviction that your mood can’t improve. You feel certain that the future holds only more pain and turmoil! Like some depressed patients, you may be able to support your pessimistic prediction with a wealth of data which seems to you to be overwhelmingly convincing.

  A depressed forty-nine-year-old stockbroker recently told me, “Doctor, I have already been treated by six psychiatrists over a ten-year-period. I have had shock treatments and all types of antidepressants, tranquilizers, and other drugs. But in spite of it all, this depression won’t let up for one minute. I have spent over eighty thousand dollars trying to get well. Now I am emotionally and financially depleted. Every doctor has said to me. ‘You’ll beat this thing. Keep your chin up.’ But now I realize it wasn’t true. They were all lying to me. I’m a fighter, so I fought hard. You’d better realize when you are defeated. I’ve got to admit I’d be better off dead.”

  Research studies have shown that your unrealistic sense of hopelessness is one of the most crucial factors in the development of a serious suicidal wish. Because of your twisted thinking, you see yourself in a trap from which there seems to be no escape. You jump t
o the conclusion that your problems are insoluble. Because your suffering feels unbearable and appears unending, you may erroneously conclude that suicide is your only way of escape.

  If you have had such thoughts in the past, or if you are seriously thinking this way at present, let me state the message of this chapter loud and clear:

  You Are Wrong in Your Belief That Suicide Is the Only Solution or the Best Solution to Your Problem.

  Let me repeat that. You Are Wrong! When you think that you are trapped and hopeless, your thinking is illogical, distorted, and skewed. No matter how thoroughly you have convinced yourself, and even if you get other people to agree with you, you are just plain mistaken in your belief that it is ever advisable to commit suicide because of depressive illness. This is not the most rational solution to your misery. I will explain this position and help point the way out of the suicide trap.

  Assessing Your Suicidal Impulses

  Although suicidal thoughts are common even in individuals who are not depressed, the occurrence of a suicidal impulse if you are depressed is always to be regarded as a dangerous symptom. It is important for you to know how to pinpoint those suicidal impulses which are the most threatening. In the Burns Depression Checklist in Chapter 2, questions 23, 24, and 25 refer to your suicidal thoughts and impulses. If you have checked a one, two, three, or four on these questions, suicidal fantasies are present, and it is important to evaluate their seriousness and to intervene if necessary (see page 21).

  The most serious error you could make with regard to your suicidal impulses is to be overly inhibited in talking them over with a counselor. Many people are afraid to talk about suicidal fantasies and urges for fear of disapproval or because they believe that even talking about them will bring on a suicide attempt. This point of view is unwarranted. You are more likely to feel a great sense of relief in discussing suicidal thoughts with a professional therapist, and consequently you have a much better chance of defusing them.

  If you do have suicidal thoughts, ask yourself if you are taking such thoughts seriously. Are there times when you wish you were dead? If the answer is yes, is your death wish active or passive? A passive death wish exists if you would prefer to be dead, but you are unwilling to take active steps to bring this about. One young man confessed to me, “Doctor, every night when I go to bed I pray to God to let me wake up with cancer. Then I could die in peace, and my family would understand.”

  An active death wish is more dangerous. If you are seriously planning an actual suicide attempt, then it’s important to know the following: Have you thought about a method? What is your method? Have you made plans? What specific preparations have you made? As a general rule, the more concrete and well-formulated your plans are, the more likely you may actually make a suicide attempt. The time to seek professional help is now!

  Have you ever made a suicide attempt in the past? If so, you should view any suicidal impulse as a danger signal to seek help immediately. For many people these previous attempts seem to be “warm-ups,” in which they flirt with suicide but have not mastered the particular method they have selected. The fact that an individual has made this attempt unsuccessfully on several occasions in the past indicates an increased risk of success in the future. It is a dangerous myth that unsuccessful suicide attempts are simply gestures or attention-getting devices and are therefore not to be taken seriously. Current thinking suggests that all suicidal thoughts or actions are to be taken seriously. It can be highly misleading to view suicidal thoughts and actions as a “plea for help.” Many suicidal patients want help least of all because they are 100 percent convinced they are hopeless and beyond help. Because of this illogical belief, what they really want is death.

  Your degree of hopelessness is of the greatest importance in assessing whether or not you are at risk for making an active suicide attempt at any time. This one factor seems more closely linked with actual suicide attempts than any other. You must ask yourself, “Do I believe that I have absolutely no chance of getting better? Do I feel that I have exhausted all treatment possibilities and that nothing could possibly help? Do I feel convinced beyond all doubt that my suffering is unbearable and could never come to an end?” If you answer yes to these questions, then your degree of hopelessness is high, and professional treatment is indicated now! I would like to emphasize that hopelessness is as much a symptom of depression as a cough is a symptom of pneumonia. The feeling of hopelessness does not in fact prove that you are hopeless, any more than a cough proves you are doomed to succumb to pneumonia. It just proves that you are suffering from an illness, in this case, depression. This sense of hopelessness is not a reason to make a suicide attempt, but gives you a clear signal to seek competent treatment. So, if you feel hopeless, seek help! Do not consider suicide for one more minute!

  The last important factor concerns deterrents. Ask yourself, “Is there anything that is preventing me from committing suicide? Would I hold back because of my family, friends, or religious beliefs?” If you have no deterrents, the possibility is greater that you would consider an actual suicide attempt.

  SUMMARY: If you are suicidal, it is of great importance for you to evaluate these impulses in a matter-of-fact manner, using your common sense. The following factors put you in a high-risk group:

  1. If you are severely depressed and feel hopeless;

  2. If you have a past history of suicide attempts;

  3. If you have made concrete plans and preparations for suicide; and

  4. If no deterrents are holding you back.

  If one or more of these factors apply to you, then it is vital to get professional intervention and treatment immediately. While I firmly believe that the attitude of self-help is important for all people with depression, you clearly must seek professional guidance right away.

  The Illogic of Suicide

  Do you think depressed people have the “right” to commit suicide? Some misguided individuals and novice therapists are unduly concerned with this issue. If you are counseling or trying to help a chronically depressed individual who is hopeless and threatening self-destruction, you may ask yourself, “Should I intervene aggressively, or should I let him go ahead? What are his rights as a human being in this regard? Am I responsible for preventing this attempt, or should I tell him to go ahead and exercise his freedom of choice?”

  I regard this as an absurd and cruel issue that misses the point entirely. The real question is not whether a depressed individual has the right to commit suicide, but whether he is realistic in his thoughts when he is considering it. When I talk to a suicidal person, I try to find out why he is feeling that way. I might ask, “What is your motive for wanting to kill yourself? What problem in your life is so terrible that there is no solution?” Then I would help that person expose the illogical thinking that lurks behind the suicidal impulse as quickly as possible. When you begin to think more realistically, your sense of hopelessness and the desire to end your life will fade away and you will have the urge to live. Thus, I recommend joy rather than death to suicidal individuals, and I try to show them how to achieve it as fast as possible! Let’s see how this can be done.

  Holly was a nineteen-year-old woman who was referred to me for treatment by a child psychoanalyst in New York City. He had treated her unsuccessfully with analytic therapy for many years since the onset of a severe unremitting depression in her early teens. Other doctors had also been unable to help her. Her depression originated during a period of family turbulence that led to her parents’ separation and divorce.

  Holly’s chronic blue mood was punctuated by numerous wrist-slashing episodes. She said that when periods of frustration and hopelessness would build up, she would be overcome by the urge to rip into her flesh and would experience relief only when she saw the blood flowing across her skin. When I first met Holly, I noticed a mass of white scar tissue across her wrists that attested to this behavior. In addition to these episodes of self-mutilation, which were not suicide attempts, she had trie
d to kill herself on a number of occasions.

  In spite of all the treatment she had received, her depression would not let up. At times it became so severe that she had to be hospitalized. Holly had been confined to a closed ward of a New York hospital for several months at the time she was referred to me. The referring doctor recommended a minimum of three years of additional continuous hospitalization, and appeared to agree with Holly that her prognosis for substantial improvement, at least in the near future, was poor.

  Ironically, she was bright, articulate, and personable. She had done well in high school, in spite of being unable to go to classes during the times she was confined to hospitals. She had to take some courses with the help of tutors. Like a number of adolescent patients, Holly’s dream was to become a mental-health professional, but she had been told by her previous therapist that this was unrealistic because of the nature of her own explosive, intractable emotional problems. This opinion was just one more crushing blow for Holly.