Feeling Good: The New Mood Therapy (32 page)

Figure 9–1.
Naomi’s worth and work graphs. In the upper figure Naomi plotted her human "worth" from the time of her birth to the time of her death. She estimated this at 85 percent. In the lower figure she plotted her estimated productivity and achievement over the course of her life. Her productivity began low in childhood, reached a plateau in adulthood, and would ultimately fall to zero at the time of death. This graph helped her comprehend that her "worth" and "achievement" were unrelated and had no correlation with each other.

Naomi was not a patient, but someone I spoke with while vacationing in my home state of California during the winter of 1976. I received a letter from her soon after which I share with you here:

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:

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?”

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 career, 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: