This appendix contains brief descriptions of a variety of methods of intervention in cases of depression, which follow from the theory set forth in the main body of the paper. The appendix is written for vividness in "you" language aimed at the sufferer.
Improving Your Numerator
Are you actually in as bad shape as you think you are? If you have an incorrect unflattering picture of some aspects of yourself that you consider important, then your self-comparison ratio will be erroneously negative. That is, if you systematically bias your estimate of yourself in a manner that makes you seem to yourself objectively worse than you really are, then you invite needless negative self-comparisons and depression.
Keep in mind that we are talking about assessments of yourself that can be checked objectively. An example: Samuel G. complained that he was a consistent "loser" at everything he did. His counselor knew that he played ping pong, and asked him whether he usually won or lost at ping pong. Sam said that he usually lost. The counselor asked him to keep a record of the games he played in the following week. The record showed that Sam won a bit more often than he lost. This fact which surprised Sam. With that evidence in hand, he was receptive to the idea that he also was giving himself a short count in other areas of his life, and hence producing fallacious negative self- comparisons and a Rotten Ratio. If you can raise your numerator- - if you can find yourself really to be a better person than you now think you are--you will make your self-comparisons more positive. By so doing you will reduce sadness, increase your good feelings, and fight depression.
Sweetening Your Denominator
When told that life is hard, Voltaire asked," Compared to what?" The denominator is the standard of comparison that you habitually measure yourself against. Whether your self- comparison appears favorable or unfavorable depends as much upon the denominator you use as upon the supposed facts of your own life. Standards of comparison include what you hope to be, what you formerly were, what you think you ought to be, or others to whom you compare yourself.
"Normal" people--that is, people who do not get depressed frequently or for a long time--alter their denominators flexibly. Their procedure is: choose the denominator that will make you feel good about yourself. The psychologically-normal tennis player chooses opponents who provide an even match--strong enough to provide invigorating competition, but sufficiently weak enough so you can often feel successful. The depressive personality, on the other hand, may pick an opponent so strong that he almost always beats you. (A person with another sort of problem picks an opponent who is so weak that he or she provides no exciting competition.)
In the more important of our life situations, however, it is not as easy as in tennis to choose a well-fitting denominator as the standard of comparison. A boy who is physically weak and unathletic relative to his grammar-school classmates is stuck with that fact. So is the child who is slow at learning arithmetic, and the big-boned thick-bodied girl. A death of a spouse or child or parent is another fact which one cannot deal with as flexibly as one can change tennis partners.
Though the denominator that stares you in the face may be a simple fact, you are not chained to it with unbreakable shackles. Misery is not your inexorable fate. People can change schools, start new families, or retrain themselves for occupations that fit them better than the old ones. Others find ways to accept difficult facts as facts, and to alter their thinking so that the unpleasing facts cease causing distress. But some people--people we call "depressives"--do not manage to free themselves from denominators that hag-ride them into depression, or even unto death by suicide or other depression-caused diseases.
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Why do some people appropriately adjust their denominators while others do not? Some do not change their denominators because they lack experience or imagination or flexibility to consider other relevant possibilities. For example, until he got some professional career advice, Joe T. had never even considered an occupation in which his talent later enabled him to succeed, after failing in his previous occupation.
Other people are stuck with pain-causing denominators because they have somehow acquired the idea that they must meet the standards of those pain-causing denominators. Often this is the legacy of parents who insisted that unless the child would reach certain particular goals--say, a Nobel prize, or becoming a millionaire--the child should consider himself or herself a failure in the parent's eyes. The person may never realize that it is not necessary that she or he accept as valid those goals set by the parents. Instead, the person musturbates, in Ellis's memorable term. Ellis emphasizes the importance of getting rid of such unnecessary and damaging "oughts" as part of his Rational-Emotive variation of cognitive therapy.
Still others believe that attaining certain goals--curing others of illness, or making a lifesaving discovery, or raising several happy children--is a basic value in itself. They believe that one is not free to abandon the goal simply because it causes pain to the person who holds that goal.
Still others think that they ought to have a denominator so challenging that it stretches them to the utmost, and/or keeps them miserable. Just why they think that way is not usually clear to those persons. And if they do come to understand why they think so they usually stop, because it does not seem very sensible to do so.
I'll tell you later about a six step-procedure that can help you change your denominator to a more livable standard of comparison than the one which may now be depressing you.
New Dimensions and Better Ratios
If you can't make the old Mood Ratio rosy or even livable, then consider getting a new one. Folk wisdom is indeed wise in advising us to forcefully direct our attention to the good things in our lives instead of the bad things. Counting one's blessings is the common label for focusing on dimensions that will make us happy: remembering your good health when you lose your money; remembering your wonderful loving children when the job is a failure; remembering your good friends when a false friend betrays you, or when a friend dies; and so on.
Related to counting blessings is refusing to consider aspects of your situation which are beyond your control at the moment in order to avoid letting them distress you. This is commonly called "taking it one day at a time." If you are an alcoholic, you refuse to let yourself be depressed about the pain and difficulty of stopping drinking for the rest of your life, which you feel almost helpless to do. Instead, you focus on not drinking today, which seems a lot easier. If you have had a financial disaster, instead of regretting the past you might think about today's work to begin repairing your fortunes.
Taking it one day at a time does not mean that you fail to plan for tomorrow. It does mean that after you have done whatever planning is possible, you then forget about the potential dangers of the future, and focus on what you can do today. This is the core of such books of folk wisdom as Dale Carnegie's How to Stop Worrying and Start Living. Finding personal comparisons which make your Mood Ratio positive is the way that most people construct an image of themselves which makes them look good. The life strategy of the healthy-minded person is to find a dimension on which he or she performs relatively well, and then to argue to oneself and to others that it is the most important dimension on which to judge a person.
A 1954 popular song by Johnny Mercer and Harold Arlen went like this: "You've got to accentuate the positive...Eliminate the negative...Latch on to the affirmative...Don't mess with Mister In-between." That sums up how most normal people arrange their views of the world and themselves so that they have self-respect. This procedure can be unpleasant to other people, because the person who accentuates his or her own strengths may thereby accentuate what in other people is less positive. And the person often proclaims intolerantly that that dimension is the most important one of all. But this may be the price of self-respect and non-depression for some people. And often you can accentuate your own strengths without being offensive to others.
A more attractive illustration: appreciating your own courage is often an excellent way to shift dimensions. If you have been struggling without much success for years to convince the world that your fish-meal protein is an effective and cheap way of preventing protein-deficiency diseases in poor children (an actual case), you may be greatly saddened if you dwell on the comparison between what you have achieved and what you aspire to achieve. But if you focus instead upon your courage in making this brave fight, even in the face of the lack of success, then you will give yourself an honest and respectable positive comparison and a Mood Ratio which will make you feel happy rather than sad, and which will lead you to esteem yourself well rather than poorly.
Because of childhood experiences or because of their values, depressives tend not to be flexible in choosing dimensions that will make them look good. Yet depressives can successfully shift dimensions if they work at it. In addition to the ways mentioned above, which will be discussed at length in Chapter 14, there is still another -- and very radical -- way to shift dimensions. This is to make a determined effort -- even to demand of yourself -- in the name of some other value, that you shift from a dimension that is causing you grief. This is the core of Values Treatment which was crucial in curing my 13-year depression; more about this shortly.
The Sound of a Numerator Clapping
No self-comparisons, no sadness. No sadness, no depression. So why don't we just get rid of self-comparisons completely?
A practicing Zen Buddhist with an independent income and a grown family can get along without making many self-comparisons. But for those of us who must struggle to achieve our ends in the workaday world, some comparisons between what we and others do are necessary to keep us directed toward achieving these ends. Yet, if we try, we can successfully reduce the number of these comparisons by focusing our minds on other activities instead. We can also help ourselves by judging only our performances relative to the performances of others, rather than judging our very selves -- that is, our whole persons -- to others. Our performances are not the same as our persons.
Work that absorbs your attention is perhaps the most effective device for avoiding self-comparisons. When Einstein was asked how he dealt with the tragedies he suffered, he said something like: "Work, of course. What else is there?"
One of the best qualities of work is that it is usually available. And concentrating upon it requires no special discipline. While one is thinking about the task at hand, one's attention is effectively diverted from comparing oneself to some benchmark standard.
Another way to shut off self-comparisons is to care about other people's welfare, and to spend time helping them. This old-fashioned remedy against depression--altruism--has been the salvation of many.
Meditation is the traditional Oriental method of banishing negative self-comparisons. The essence of meditation is to shift to a special mode of concentrated thinking in which one does not evaluate or compare, but instead simply experiences the outer and inner sensory events as interesting but devoid of emotion. (In a less serious context this approach is called "inner tennis.")
Some Oriental religious practitioners seek the deepest and most continuous meditation in order to banish physical suffering as well as for religious purposes. But the same mechanism can be used while participating in everyday life as an effective weapon against negative self-comparisons and depression. Deep breathing is the first step in such meditation. All by itself, it can relax you and change your mood in the midst of a stream of negative self-comparisons.
We'll go into details later about the pro's and con's and procedures for various methods to avoid self-comparisons.
Getting Hope Back
Negative self-comparisons (neg-comps) by themselves do not make you sad. Instead, you may get angry, or you may mobilize yourself to change your life situation. But a helpless, hopeless attitude along with neg-comps leads to sadness and depression. This has even been shown in rat experiments. Rats that have experienced electric shocks which they cannot avoid later behave with less fight and more depression, with respect to electric shocks that they can avoid, than do rats that did not experience unavoidable shocks. The rats that experienced unavoidable shocks also show chemical changes like those associated with depression in humans.10
It behooves us, then, to consider how to avoid feeling helpless. One obvious answer in some situations is to realize that you are not helpless and you can change your actual state of affairs so that the comparison will be less negative. Sometimes this requires gradual re-learning through a graded series of tasks that show you that you can be successful, eventually leading to success in tasks that at the beginning seemed overwhelmingly difficult to you. This is the rationale of many behavioral-therapy programs that teach people to overcome their fears of elevators, heights, going out in public, and various social situations.
Indeed, the rats mentioned in the paragraph above, which learned to be helpless when given inescapable shocks, were later taught by experimenters to learn that they could escape the later shocks. They showed diminished chemical changes associated with depression after they had "unlearned" their original experiences.
A New Hope: Values Treatment
Let's say that you feel you're at the end of your rope. You believe that your numerator is accurate, and you see no appealing way to change your denominator or your dimensions of comparison. Avoiding all comparisons, or drastically reducing the quantity of them, does not attract you or does not seem feasible to you. You'd prefer not to be treated with anti-depression drugs or shock treatment unless there is absolutely no alternative. Is there any other possibility open to you?
Values Treatment may be able to rescue you from your end-of- the-rope desperation. For people who are less desperate, it may be preferable to other approaches to their depressions. The central element of Values Treatment is discovering within yourself a value or belief that conflicts with being depressed, or conflicts with some other belief (or value) that leads to the negative self-comparisons. That is how Bertrand Russell passed from a sad childhood to happy maturity in this fashion:
Now [after a miserably sad childhood] I enjoy life; I might almost say that with every year that passes I enjoy it more. This is due partly to having discovered what were the things that I most desired, and having gradually acquired many of these things. Partly it is due to having successfully dismissed certain objects of desire-- such as the acquisition of indubitable knowledge about something or other--as essentially unattainable.11
Values Treatment does exactly the opposite of trying to argue away the sadness-causing value. Instead it seeks a more powerful countervailing value to dominate the depression-causing forces. Here is how Values Treatment worked in my case: I discovered that my highest value is for my children to have a decent upbringing. A depressed father makes a terrible model for children. I therefore recognized that for their sake it was necessary to shift my self-comparisons from the occupational dimension that led to so many negative comparisons and sadness, and focus instead on our health and the enjoyment of the day's small delights. And it worked. I also discovered that I have an almost religious value for not wasting a human life in misery when it can possibly be lived in happiness. That value helped, too, working hand in hand with my value that my children not grow up having a depressed father.
The depression-fighting value may be (as it was for me) the direct command that life should be joyful rather than sad. Or it may be a value that leads indirectly to a reduction in sadness, such as my value that my children should have a life-loving parent to imitate.
The discovered value may lead you to accept yourself for what you are, so that you can go on to other aspects of your life. A person with an emotionally-scarred childhood, or a polio patient confined to a wheelchair, may finally accept the situation as fact, cease railing at fate, and decide not to let the handicap dominate. The person may decide to pay attention instead to what he can contribute to others with a joyful spirit, or how he can be a good parent by being happy.
Values Treatment need not always proceed systematically. But a systematic procedure may be helpful to some people, and it makes clear which operations are important in Values Treatment.
next: An Integrated Cognitive Theory of Depression
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