Learning how to Make a Marriage

Dear A. B.

Thanks for the information-I've put a request in for the books at the library. Your answer, however, brings up more questions for me that I really am curious about. What if a person never really felt romantic love for the other person before they were married? Also, what if you don't begin to admire the other person and the love doesn't grow that way? Shouldn't there also be more of a physical attraction during sex? I've always thought of sex as a way to fully express myself in an intimate way with someone that I felt a strong connection with. Is it really just a duty to perform? K_________

Dear K______

We have romanticized sex and overshadowed the physical act itself, putting much more pressure on the act to give us the kind of self-fulfillment the act was never meant to deliver. Certainly old married couples treat sex as a physical intimacy that is pleasurable, but not the romantic movie version of it.

Many cultures have arranged marriages. There have been political marriages, marriages for money and influence that have developed into strong, healthy relationships. Disraeli, the English politician comes to mind. He married a plain woman who was wealthy and also wise. She said she knew he had married her for her position but she also knew that over the years he had come to love her for herself, for her qualities of kindness and intelligence.

If you didn't feel romantic feelings before you were married that doesn't mean they can't develop in low-key ways. But our cultural expectations of marriage are way beyond any possibility of being satisfied with the hum-drum of ordinary existence. A spouse's flaws can be overwhelming at times and it is not up to us to change them out of these flaws. It is our job to practice forbearance at these times. Most Americans don't even know what the word means. If you look it up yourself in the dictionary you may be surprised.

I consider myself fortunate to have a very loving relationship with my husband. The best part of the day for me is when he comes home about 4:30. I would not like to think about life without him. But it took my growing in wisdom and forbearance to have such a relationship. And sometimes when I'm stretched thin and my husband disappoints me I think, wow, it's like marriage is not getting happiness, it's giving up happiness in order to have a good marriage. It's like, what am I going to sacrifice to be married, not what am I going to get out of it.

The most happily married man I know said about his marriage is "I expect absolutely nothing from my marriage". He does, of course, derive a great deal. But whatever positive comes his way is valued and appreciated because he expects nothing A. B. Curtiss

Dear A. B.

Thanks so much for all of the information. I've read the Proper Care and Feeding of Husbands and I'm on to the companion book Woman Power. I wish I had read this stuff before getting married but luckily I'm not far into it now so I feel good about that part. The book definitely opened my eyes up to the way that people can become trapped into bad habits in a marriage and how people need to work at it to make it better. I guess a lot of people think it's going to be easy and expect things to be different. I've decided I will work at changing the way I act towards my husband based on everything I've learned. I hope you have a good holiday weekend.

K________

I'm Not in Love with My Husband

Dear Mrs. Curtiss,

I have read your book Depression is a Choice: Winning the Battle Without Drugs and reference it often. I currently have an issue in my life that I'm not sure how to handle, and that could carry with it serious consequences for me. You discuss the topic a bit in the book but I'm not clear on whether my situation applies in the same way. Your book has helped me in many ways and I was wondering if you would be willing to listen to my story and offer your point of view.

Dear K_________

I will be glad to answer any questions you have


Hi there,

I hope all is well with you today. The issue that I'm dealing with right now involves my marriage. When my husband and I started dating, I realized that I just wanted to be friends and told him so. He was my friend for awhile and was a good friend. Then, I decided that I could try again to be more than friends because of the good person that he is and because he told me that he couldn't just be friends with me.

He was very romantic during that time-sending me flowers, buying me things, cooking dinner-the whole deal. I moved into a house with him and we lived together in the house for about 6 months before he asked me to marry him and I accepted. At that time I saw him as a stable anchor in my life, and I thought that we would make a good partnership-I didn't really think about the decision in depth like I should have.

We were not fully intimate except for one time before we were married, but did have intimate moments beforehand. Looking back on it now, I ended up not caring much about being that way with him in the months before we got married. We had a beautiful wedding with lots of help from our families and of course became more intimate.

Instead of feeling closer to him and more attracted, I've been feeling less and less so. In fact, we have gotten to the point of not being intimate except for maybe once a month. I can't find anything that will make me feel more than a friendship bond. I don't really know what to do at this point because I care about him but am not feeling a romantic, connected bond that makes me want to be intimate.

I feel very bad about this because he is a wonderful person and we have so much in common which is why I thought that we would have a wonderful marriage. I have looked at pg. 332 in your book and have read it over and over but without having attracted feelings come up does it apply in the same way? We don't have any children right now and we both come from families with divorced parents.

I appreciate any insight you can provide me with. I connected with your story and have felt many of the things that you describe in your book and value your opinion. At this point, I definitely think that I've learned a lot about life in the past couple of years and how the decisions we make can have huge implications. Hope to hear from you soon. Sincerely, K__________

Dear K_________

You are confusing romantic love with love that grows over the years for someone you admire and which is the best basis for a good marriage. Romantic love usually lasts a short time, time enough for us to get together initially. Then what generally happens to too many marriages is that the women are not all that interested in sex because they need the warm-up of romance to turn them on, they compare their partner to more romantic handsome men on tv, movies, and of course husbands never measure up to the "new guy".

Also in our culture, sex for women has been co-opted out of marriage and situated in meeting the "needs of the woman, herself". Sex is physically pleasurable and if it is not so for you, you have simply prevented it. You need to see sex more as a duty of marriage and that if carried on as a way to pleasure your partner, whether you are turned on or not, unless you are older and into your seventies, the physical feelings will usually develop for you.

Masters and Johhnson used the idea of "sensate focus" as a way of getting past lack of desire. Just concentrate on the physical feeling, not whether or not you are "in love" with your husband. I would suggest you read Dr. Laura Slessinger's books about marriage. I think she is spot on. One is called "The Care and Feeing of Husbands, and I think there is also one on "The Care and Feeding of Marriage. These should help.

Your problem is endemic in our culture. I had a lot of trouble with this in my own marriage. I actually hated my husband sometimes during sex. Later I learned to re-evauluate these feelings to see that the hate was simply my fear of many things which I projected onto my husband. Remember that blame (hating or disliking something or somebody) is the way we avoid feeling the pain of our fear. (Chapter 10 in Depression is a Choice is helpful in getting rid of repressed fear.) One thing that helps many women is erotic imaginary scenes, even rape, etc which are a good complement to sensate focus, until the physical feeling take hold on their own. A. B. Curtiss

Do You Know How You Get from one Thought to Another?

The comment on yesterday’s blog is quite understandable. For some reason neither the medical establishment, the psychological or psychiatric community nor the educational system in this country thinks it is important to teach people how their own brain works. They would rather douse all our mind problems with medicine.

We are not born with this knowledge, and without it how can we make the best use of this very enabling (or, if not managed properly, this very dis-enabling )faculty? We realize we have to get training before we drive a car, otherwise we would be helpless passengers to a run away machine. But we do not seek training in how to use our brain, and so we become captives to this bio-electrical machine. And the brain is the most complex and powerful piece of machinery on the face of the earth.

Do you know the process by which you get from one thought to the other? Unless you do you will be the servant of your mind rather than its master.

Doctors teach you how to regain proper use of your arms and legs, or speech, following a stroke or physical trauma. But following a depressive episode, they somehow feel no obligation to teach you how to regain proper use of your brain. Maybe they don't know enough about how the brain actually works, the process of pain perception, learned association and the role of neuro-transmitters, the fact that all depression is produced in the subcortex and there is never any depression in the neocortex, and the reality that you can learn to move from focusing your attention on the agitated subcortex to beefing up the neural activity in the neocortex in order to regain the proper use of the neocortex and your normal rational faculties.

And if doctors and psychiatrists don't know these things about how the brain works, how do they have the nerve to prescribe dangerous drugs to alter the chemical balance of our brains which dangerous drugs, so the latest research tells us, are no more effective than sugar placebos.

How Psychiatry Has Unfortunately Lost It's Way

To answer the question posted as a comment to yesterday's blog I would like to acquaint as many people as possible with the following article.

(It is is also printed on my website www:depressionisachoice.com).

The wise comments of Thomas Szasz have been sidelined as "fringe" by mainstream psychiatry and the pharmaceutical industry and this wise man has been labeled as "anti-psychiatry" in an effort to lessen his legitimacy. So far I don't think even mainstream psychiatry has been able to similarly downgrade the following author and psychiatrist and yet despite his criticisms of psychiatry, modern-day treatments seem to take no note of them and continue on as if the psychiatrists actually know what they are doing. The efforts of mainstream psychiatry to claim "disease" status for people's unwitting and destructive psychological strategies knows no bounds thanks to the funding of the pharmaceutical industry for research findings that are skewed if not downright fraudulent.

The following article was written by Paul R. McHugh when he was Psychiatrist-in-Chief at John's Hopkins University, and it first appeared in Commentary Magazine. Here is the article:

"THE DESIRE to take medicine," noted the great Johns Hopkins physician William Osler a hundred years ago, "is one feature that distinguishes man, the animal, from his fellow creatures." In today's consumer culture, this desire is hardly restricted to people with physical conditions. Psychiatric patients who in the past would bring me their troublesome mental symptoms and their worries over the possible significance of those symptoms now arrive in my office with diagnosis, prognosis, and treatment already in hand.

"I've got adult attention deficit disorder," a young man informs me, "and it's hindering my career. I need a prescription for Ritalin." When I inquire as to the source of his analysis and its proposed solution, he tells me he has read about the disorder in a popular magazine, realized that he shares many of the features enumerated in an attached checklist of "diagnostic" symptoms--especially a certain difficulty in concentrating and an easy irritability--and now wants what he himself calls "the stimulant that heals."

In response, I gamely point out a number of possible countervailing factors: that he may be taking a one-sided view of things, emphasizing his blemishes and overlooking his assets; that what he has already accomplished in his young life is inconsistent with attention deficit disorder; that many other reasons could be adduced for irritability and inattention; that Ritalin is an addictive substance. But in saying all this, I realize that I have also entered into a delicate negotiation, one that may end with his marching angrily from my office. For not only am I not doing what he wants, I am being insensitive, or so he will claim, to what "his" diagnosis clearly reveals. Less a suffering patient, he has been transformed, before my very eyes, into a dissatisfied customer.

It is a strange experience. People normally do not like to hear that they have a disease, but with this patient, as with many others like him, the opposite is the case: the conviction that he suffers from a mental disorder has somehow served to encourage him. On the one hand, it has rendered his life more interesting. On the other hand, it plays to the widespread current belief that everything can be made right with a pill. This pill will turn my young man into someone stronger, more in charge, less vulnerable--less ignoble. He wants it; it's for sale; end of discussion.

He is, as I say, hardly alone. With help from the popular media, home-brewed psychiatric diagnoses have proliferated in recent years, preoccupying the worried imaginations of the American public. Restless, impatient people are convinced that they have attention deficit disorder (ADD); anxious, vigilant people that they suffer from post-traumatic stress disorder (PTSD); stubborn, orderly, perfectionistic people that they are afflicted with obsessive-compulsive disorder (OCD); shy, sensitive people that they manifest avoidant personality disorder (APD), or social phobia. All have been persuaded that what are really matters of their individuality are, instead, medical problems, and as such are to be solved with drugs. Those drugs will relieve the features of temperament that are burdensome, replacing them with features that please. The motto of this movement (with apologies to the DuPont corporation) might be: better living through pharmacology.

And-most worrisome of all-wherever they look, such people find psychiatrists willing, even eager, to accommodate them. Worse: in many cases, it is psychiatrists who are leading the charge. But the exact role of the psychiatric profession in our current proliferation of disorders and in the thoughtless prescription of medication for them is no simple tale to tell.

WHEN IT comes to diagnosing mental disorders, psychiatry has undergone a sea change over the last two decades. The stages of that change can be traced in successive editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the official tome of American psychiatry published and promoted by the American Psychiatric Association (APA). But historically its impetus derives-inadvertently-from a salutary effort begun in the early 1970's at the medical school of Washington University in St. Louis to redress the dearth of research in American psychiatry.

The St. Louis scholars were looking into a limited number of well-established disorders. Among them was schizophrenia, an affliction that can manifest itself in diverse ways. What the investigators were striving for was to isolate clear and distinct symptoms that separated indubitable cases of schizophrenia from less certain ones. By creating a set of such "research diagnostic criteria," their hope was to permit study to proceed across and among laboratories, free of the concern that erroneous conclusions might arise from the investigation of different types of patients in different medical centers.

With these criteria, the St. Louis group did not claim to have found the specific features of schizophrenia-a matter, scientifically speaking, of "validity." Rather, they were identifying certain markers or signs that would enable comparative study of the disease at multiple research sites-a matter of "reliability." But this very useful effort had baleful consequences when, in planning DSM-III (1980), the third edition of its Diagnostic and Statistical Manual, the APA picked up on the need for reliability and out of it forged a bid for scientific validity. In both DSM-III and DSM-IV (1994), what had been developed at St. Louis as a tool of scholarly research into only a few established disorders became subtly transformed, emerging as a clinical method of diagnosis (and, presumably, treatment) of psychiatric states and conditions of all kinds, across the board. The signs and markers-the presenting symptoms-became the official guide to the identification of mental disorders, and the list of such disorders served in turn to certify their existence in categorical form.

The significance of this turn to classifying mental disorders by their appearances cannot be underestimated. In physical medicine, doctors have long been aware that appearances, either as the identifying marks of disorder or as the targets of therapy, are untrustworthy. For one thing, it is sometimes difficult to distinguish symptoms of illness from normal variations in human life. For another, identical symptoms can be the products of totally different causal mechanisms and thus call for quite different treatments. For still another, descriptions of appearances are limitless, as limitless as the number of individuals presenting them; if medical classifications were to be built upon such descriptions, the enumerating of diseases would never end.

For all these reasons, general medicine abandoned appearance-based classifications more than a century ago. Instead, the signs and symptoms manifested by a given patient are understood to be produced by one or another underlying pathological process. Standard medical and surgical conditions are now categorized according to six such processes: infectious disorders, neoplastic disorders, cardiovascular disorders, toxic/traumatic disorders, genetic/degenerative disorders, and endocrine/metabolic disorders. Internists are reluctant to accept the existence of any proposed new disease unless its signs and symptoms can be linked to one of these processes.

The medical advances made possible by this approach can be appreciated by considering gangrene. Early in the last century, doctors differentiated between two types of this condition: "wet" and "dry." If a doctor was confronted with a gangrene that appeared wet, he was enjoined to dry it; if dry, to moisten it. Today, by contrast, doctors distinguish gangrenes of infection from gangrenes of arterial obstruction/infarction, and treat each accordingly. The results, since they are based solidly in biology, are commensurately successful.

In DSM-led psychiatry, however, this beneficial movement has been forgone: today, psychiatric conditions are routinely differentiated by appearances alone. This means that the decision to follow a particular course of treatment for, say, depression is typically based not on the neurobiological or psychological data but on the presence or absence of certain associated symptoms like anxiety--that is, on the "wetness" or "dryness" of the depressive patient.

No less unsettling is the actual means by which mental disorders and their qualifying symptoms have come to find their way onto the lists in DSM-III and -IV. In the absence of validating conceptions like the six mechanisms of disease in internal medicine, American psychiatry has turned to "committees of experts" to define mental disorder.

Membership on such committees is a matter of one's reputation in the APA--which means that those chosen can confidently be expected to manifest not only a requisite degree of psychiatric competence but, perhaps more crucially, some talent for diplomacy and self-promotion.

In identifying psychiatric disorders and their symptoms, these "experts" draw upon their clinical experience and presuppositions. True, they also turn to the professional literature, but this literature is far from dependable or even stable. Much of it partakes of what the psychiatrist-philosopher Karl Jaspers once termed "efforts of Sisyphus": what was thought to be true today is often revealed to be false tomorrow. As a result, the final decisions by the experts on what constitutes a psychiatric condition and which symptoms define it rely excessively on the prejudices of the day.

Nor are the experts disinterested parties in these decisions. Some-because of their position as experts-receive extravagant annual retainers from pharmaceutical companies that profit from the promotion of disorders treatable by the company's medications. Other venal interests may also be at work: when a condition like attention deficit disorder or multiple personality disorder appears in the official catalogue of diagnoses, its treatment can be reimbursed by insurance companies, thus bringing direct financial benefit to an expert running a so-called Trauma Center or Multiple Personality Unit. Finally, there is the inevitable political maneuvering within committees as one expert supports a second's opinion on a particular disorder with the tacit understanding of reciprocity when needed.

The new DSM approach of using experts and descriptive criteria in identifying psychiatric diseases has encouraged a productive industry. If you can describe it, you can name it; and if you can name it, then you can claim that it exists as a distinct "entity" with, eventually, a direct treatment tied to it. Proposals for new psychiatric disorders have multiplied so feverishly that the DSM itself has grown from a mere 119 pages in 1968 to 886 pages in the latest edition; a new and enlarged edition, DSM-V, is already in the planning stages. Embedded within these hundreds of pages are some categories of disorder that are real; some that are dubious, in the sense that they are more like the normal responses of sensitive people than psychiatric "entities"; and some that are purely the inventions of their proponents.

LET US get down to cases. The first clear example of the new approach at work occurred in the late 1970's, when a coalition of psychiatrists in the Veterans Administration (VA) and advocates for Vietnam-war veterans propelled a condition called chronic post-traumatic stress disorder (PTSD) into DSM-III. It was, indeed, a perfect choice-itself a traumatic product, one might say, of the Vietnam war and all the conflicts and guilts that experience engendered-and it opened the door of the DSM to other and later disorders.

Emotional distress during and after combat (and other traumatic events) has been recognized since the mid-19th century. The symptoms of "shell shock," as it came to be known in World War I, consist of a lingering anxiety, a tendency toward nightmares, "flashback memories" of battle, and the avoidance of activities that might provoke a sensation of danger. What was added after Vietnam was the belief that-perhaps because of a physical brain change due to the stress of combat--veterans who were not properly treated could become chronically disabled. This lifelong disablement would explain, in turn, such other problems as family disruption, unemployment, or alcohol and drug abuse.

Once the concept of a chronic form of PTSD with serious complications was established in DSM-III, patients claiming to have it crowded into VA hospitals. A natural alliance grew up between patients and doctors to certify the existence of the disorder: patients received the privileges of the sick, while doctors received steady employment at a time when, with the end of the conflict in Southeast Asia, hospital beds were emptying. Anyone expressing skepticism about the validity of PTSD as a psychiatric condition-on the ground, say, that it had become a catchall category for people with long-standing disorders of temperament or behavior who were sometimes seeking to shelter themselves from responsibility-was dismissed as hostile to veterans or ignorant of the mental effects of fearful experiences.

Lately, however, the pro-PTSD forces have come under challenge in a major study that followed a group of Vietnam veterans through their treatment at the Yale-affiliated VA hospital in West Haven, Connecticut, and afterward. The participants in the study had received medications, group and individual therapy, behavioral therapy, family therapy, and vocational guidance--all concentrating on PTSD symptoms and the war experiences that had allegedly generated them. Upon discharge from the hospital, these patients did report some improvement in their drug and family problems, as well as a greater degree of hopefulness and self-esteem. Yet, within a mere eighteen months, their psychiatric symptoms, family problems, and personal relationships had actually become worse than on admission. They had made more suicide attempts, and their drug and alcohol abuse continued unabated. In short, prolonged and intensive hospital treatment for chronic PTSD had had no long-term beneficial effects whatsoever on the veterans' symptoms.

This report, which brings into doubt not only the treatment but the nature of the underlying "disease," has produced many agonized debates within the VA. Enthusiasts for PTSD argue that the investigators somehow missed the patients' "real" states of mind while at the same time overlooking subtle but nonetheless positive responses to treatment. They have also stepped up the search for biological evidence of brain changes produced by the emotional trauma of combat-changes that might validate chronic PTSD as a distinct condition and justify characterizing certain patients as its victims regardless of whether a successful treatment yet exists for it. In the psychiatric journals, reports of such a "biological marker" come and go.

Yet while we await final word on chronic PTSD, the skeptics-both within and without the VA system-would appear to hold much the stronger hand. They have pointed, for example, to analogous research on war veterans in Israel. According to Israeli psychiatrists, long-term treatment in hospitals has the unfortunate tendency of making battle-trauma victims hypersensitive to their symptoms and, by encouraging them to concentrate on the psychological wounds of combat, distracts their attention from the "here-and-now" problems of adjusting to peacetime demands and responsibilities.

This makes sense. After any traumatic event--whether we are speaking of a minor automobile accident, of combat in war, or of a civilian disaster like the Coconut Grove fire in Boston in 1942--exposed individuals will undergo a disquieted, disturbed state of mind that takes time to dissipate, depending (among other things) on the severity of the event and the temperament of the victim. As with grief, these mental states are natural--indeed, "built-in," species-specific-emotional responses. Customarily, they wane over time, leaving behind scars in the form of occasional dreams and nightmares, but little more.

When a patient's reaction does not follow this standard course, one need hardly leap to conclude he is suffering from an "abnormal" or "chronic" or "delayed" form of PTSD. More likely, the culprit will be a separate and complicating condition like (most commonly) major depression, with its cardinal symptoms of misery, despair, and self-recrimination. In this condition, memories of past losses, defeats, or traumas are reawakened, giving content and justification to diminished attitudes about oneself. But such memories should hardly be confused with the cause of the depression itself, which can and should be treated for what it is. America's war veterans, who are entitled to our respect and support, surely deserve better than to be maintained in a state of chronic invalidism.

MEDICAL ERRORS characteristically assume three forms: oversimplification, misplaced emphasis, and invention. When it comes to chronic PTSD, all three were committed. Explanations of symptoms were oversimplified, with combat experiences being given priority quite apart from such factors as long-standing personality disorders, independent (post-combat) psychiatric conditions including major depression, or chronic psychological invalidism produced by prolonged hospitalization. Misplaced emphasis followed oversimplification when treatment concentrated on the psychological wounds of combat to the neglect of here-and-now problems that many patients were dodging, overlooking, or minimizing. Finally, the inventive construction of a condition called chronic PTSD justified a broad network of service-related psychiatric centers devoted to maintaining the veterans in treatment whether or not they were getting better-and, as we have seen, they were not.

Variants of these same mistakes can be discerned in the identification and treatment of other diseases du jour. Multiple personality disorder (MPD), for example, posits an unconscious psychological mechanism, termed dissociation, that occurs in people facing a traumatic life event. When such dissociation occurs, it disrupts the integrative action of consciousness, causing patients to fail to link experience with memory.

Typical dissociative "conditions" include dissociative amnesia, dissociative fugues, and dissociative identity disorder, the last-named being the DSM-IV term for MPD. Thus, a person who leaves home and travels to another city, only to remember nothing of the interval and amazed to find himself away from home, is said to have undergone a state of dissociative fugue. Patients claiming they cannot recall prominent events-their school years, their childhood friends-are said to suffer from dissociative amnesia. Finally, a person who displays over time two or more personality states that take control of his behavior is said to be in a condition of dissociative identity disorder.

The problem with dissociation, as with so many purported unconscious mental processes, is that it cannot be discerned and studied apart from the behaviors it is intended to explain. What generates and sustains those behaviors is the power of their effect on others, whether doctors or onlookers. But once attention has been transferred from the behavior itself to the imagined mental state of the patient exhibiting it, a diagnosis--dissociation--can be triumphantly invoked through reasoning that goes in circles: Why don't I remember first grade-/ Because you have dissociated your memory./ How do you know that-/ Because you can't remember first grade. This justifies, in turn, a long, arcane, melodramatic process of treatment.

MPD is, in fact, a form of hysteria-that is, a behavior that mimics physical or psychiatric disorder. Hysteria often takes the form of complaints of affliction or displays of dysfunction by people who have been led to believe that they are sick. More than occasionally, those doing the leading are the psychiatrists themselves, especially those in the business of helping patients recover "repressed" or "dissociated" memories of childhood sexual abuse.

It was the 1973 best-selling book (and later TV movie) Sybil, describing an abused patient with sixteen personalities, that launched the whole copycat epidemic of MPD. That book has recently been unmasked as a fraud. According to Dr. Herbert Spiegel of Columbia, who knew the patient in question and disputed her case with the author of the book prior to its publication, Sybil was in fact "a wonderful hysterical patient with role confusion, which is typical of high hysterics." Spiegel, whose protests at the time got him nowhere-"If we don't call it a multiple personality, we don't have a book! The publishers want it to be that, otherwise it won't sell!" he quotes the author as remonstrating-observes ruefully that "this chapter . . . will go down in history as an embarrassing phase of American psychiatry."(*)

ALTHOUGH THE MPD epidemic is now subsiding, the "disease" itself remains enshrined in DSM-III and DSM-IV, a textbook case of an alleged disorder whose identification is based entirely on appearances and then sustained as valid by its listing in DSM. So it is, too, with adult attention deficit disorder and social phobia.

Defined as a tendency to fear embarrassment in situations where one is exposed to scrutiny by others, social phobia relates in about 90 percent of cases to a fear of public speaking, an almost universal condition that can usually be overcome by practice. Some psychiatrists claim that one of eight Americans suffers from this supposed disorder and should receive pharmacological treatment for it. If that figure were accurate, we would be confronted with a mental disorder almost as common as depression and alcoholism-a dubious proposition on its face. Whether medication to make patients more comfortable (but perhaps less self-critical) in their public speaking will improve their lives or careers is another question altogether.

As for ADD, a diagnosis of that condition often rests on a perceived failure to attend to details: mistakes are made, and work performance is impaired, by restlessness and difficulty in concentrating. This, too, is a characteristic of many people, one that can emerge with particular salience in the face of challenges at home or work or with the onset of an illness like depression or mania. An individual seeking treatment for it may be expressing nothing more than a desire for "self-improvement." Whether it is the proper role of a prescription-dispensing psychiatrist to act as the patient's agent in such an enterprise is, again, another question altogether.

Although people may differ in such qualities as attentiveness and confidence, it is simply not true that most individuals deficient in these qualities are sick. What is true is that they will be changed by the medications proposed to heal the alleged sickness. Everyone is more attentive when on Ritalin; many are less emotionally responsive when on selective serotonin re-uptake inhibitors (SSRI's) like Prozac or Paxil. The fact that emotional and cognitive changes are associated with certain drugs should come as no surprise-even small amounts of alcohol will loosen your inhibitions. But that hardly means that the inhibitions constitute a mental disorder.

For the psychiatrists involved, there is another consideration here. In colluding with their patients' desire for self-improvement, they implicitly enter a claim to know what the ideal human temperament should be, toward which they make their various pharmacological adjustments and manipulations. On this point, Thomas Szasz, the vociferous critic of psychiatry, is right: such exercises in mental cosmetics should be offensive to anyone who values the richness of human psychological diversity. Both medically and morally, encumbering this naturally occurring diversity with the terminology of disease is a first step toward efforts, however camouflaged, to control it.

WHY ARE psychiatrists not more like other doctors-differentiating among patients by the causes of their illnesses and offering treatments specifically linked to the mechanisms of these illnesses? One reason is that they cannot be. In contrast to cardiologists, dermatologists, ophthalmologists, and other medical practitioners, physicians who study and treat disorders of mind and behavior are unable to demonstrate how symptoms emerge directly from activity in, or changes of, the organ that generates them--namely, the brain. Indeed, many of the profession's troubles, especially the false starts and misdirections that have plagued it from the beginning, stem from the brain-mind problem, the most critical issue in the natural sciences and a fundamental obstacle to all students of consciousness.

It was because of the brain-mind problem that Sigmund Freud, wedded as he was to an explanatory rather than a descriptive approach in psychiatry, decided to delineate causes for mental disorders that implicitly presupposed brain mechanisms (while not depending on an explicit knowledge of such mechanisms). In brief, Freud's "explanation" evoked a conflict between, on the one hand, brain-generated drives (which could be identified by their psychological manifestations) and, on the other hand, socially-imposed prohibitions on the expression and satisfaction of those same drives. This conflict was believed to produce a "dynamic unconscious" whence mental and behavioral abnormalities emerged.

This explanation had its virtues, and seemed to help "ordinary" people reacting to life's troubles in an understandable way. But it was not suited to the seriously mentally ill-schizophrenics and manic-depressives, for example-who did not respond to explanation-based treatments. That is one of the factors that by the 1970's, when it became overwhelmingly clear that such people did respond satisfactorily to physical treatments and, especially, to medication, impelled the move away from hypothetical explanations (as in Freud) to empirical descriptions of manifest symptoms (as in DSM-III and -IV). Another was the long-standing failure of American psychiatry, when guided by Freudian presumptions, to advance research, a failure that led, among other things, to the countervailing efforts of the investigators in St. Louis.

At first, indeed, the new descriptive approach seemed to represent significant progress, enhancing communication among psychiatrists, stimulating research, and holding out the promise of a new era of creative growth in psychiatry itself, a field grown stultified by its decades-long immersion in psychoanalytic theory. Today, however, twenty years after its imposition, the weaknesses inherent in a system of classification based on appearances-and contaminated by self-interested advocacy-have become glaringly evident.

In my own view, and despite the obstacles presented by the brain-mind problem, psychiatry need not abandon the path of medicine. Essentially, psychiatric disorders come under four large groupings (and their subdivisions), each of them distinguished causally from the other three and bearing a different relationship to the brain.

The first grouping comprises patients who have physical diseases or damage to the brain that can provoke psychiatric symptoms: these include patients with Alzheimer's disease and schizophrenia. In the second grouping are those who are intermittently distressed by some aspect of their mental constitution-a weakness in their cognitive power, or an instability in their affective control-when facing challenges in school, employment, or marriage. Unlike those in the first category, those in the second do not have a disease or any obvious damage to the brain; rather, they are vulnerable because of who they are-that is, how they are constituted.

The third category consists of those whose behavior--alcoholism, drug addiction, sexual paraphilia, anorexia nervosa, and the like--has become a warped way of life. They are patients not because of what they have or who they are but because of what they are doing and how they have become conditioned to doing it. In the fourth category, finally, are those in need of psychiatric assistance because of emotional reactions provoked by events that injure or thwart their commitments, hopes, and aspirations. They suffer from states of mind like grief, homesickness, jealousy, demoralization-states that derive not from what they have or who they are or what they are doing but from what they have encountered in life.

Each of these distress-generating mechanisms will shape a different course of treatment, and its study should direct research in a unique direction. Thus, brain diseases are to be cured, alleviated, and prevented. Individuals with constitutional weaknesses need strengthening and guidance, and perhaps, under certain stressful situations, medication for their emotional responses. Damaging behaviors need to be interrupted, and patients troubled by them assisted in overcoming their appeal. Individuals suffering grief and demoralization need both understanding and redirection from circumstances that elicit or maintain such states of mind. Finally, for psychiatric patients who show several mechanisms in action simultaneously, a coordinated sequence of treatments is required.

But the details are not important. What is important is the general approach. Psychiatrists have for too long been satisfied with assessments of human problems that generate only a categorical diagnosis followed by a prescription for medication. Urgently required is a diagnostic and therapeutic formulation that can comprehend several interactive sources of disorder and sustain a complex program of treatment and rehabilitation. Until psychiatry begins to organize its observations, explanatory hypotheses, and therapeutics in such a coherent way, it will remain as entrapped in its present classificatory system as medicine was in the last century, unable to explain itself to patients, to their families, to the public--or even to itself.

That is not all. In its recent infatuation with symptomatic, push-button remedies, psychiatry has lost its way not only intellectually but spiritually and morally. Even when it is not actually doing damage to the people it is supposed to help, as in the case of veterans with chronic PTSD, it is encouraging among doctors and patients alike the fraudulent and dangerous fantasy that life's every passing "symptom" can be clinically diagnosed and, once diagnosed, alleviated if not eliminated by pharmacological intervention. This idea is as false to reality, and ultimately to human hopes, as it is destructive of everything the subtle and beneficial art of psychiatry has meant to accomplish.

More on Repressed Fear and Phobias

The following was a comment and question on yesterday's blog. I repeat it here with my answer.

"I can see how I'm at the point where I can recognize/acknowledge that feelings are being triggered by old neural patterns. However, in the case of irrational fear for example, fears I experience while driving, or while being yelled at in my case, those feelings are hard to ignore in the moment as they produce a disturbing physical reaction. My heart starts pounding like it's going to burst through my chest! I get very shaky too. This makes the event seem more "real," the feelings seem "valid," & renders me less capable of dealing effectively with what's in front of me. In the case of driving, that could be dangerous, which is why I stay stuck in a limited driving "territory" & never venture beyond it. Have wondered if driving school would help, or if the repressed fear would still get in the way.

"Would Price's book help with managing the physiological reactions? His book sounds like one I need to read anyway, since I deal with chronic back & more recently, arm pain. I somatize a lot of fear, I believe, & have done so for years."

MY RESPONSE:

Yes, I think Price's book would help with physiological pain. But even better would be to take a course in hypnosis for yourself.

As for irrational fear of driving or being yelled at. These fears are like any phobia. You focus on the phobia rather than addressing your repressed fear in order to make some sense out of your daily life because, usually, you are not in touch with your repressed fear and therefore can't attach your fear to any rational cause in order for your mind to make sense out what is happening to you. So the mind makes sense by focusing on the event rather than your irrational fear. And always remember, too, that blame is the way we avoid feeling our fear. It is easier to blame the event as causing the fear rather than understanding that you're needing to avoid the pain of your repressed fear by focusing on the event that supposedly caused the fear.

You can cure any phobia by accepting the fear engendered by the phobia, relaxing into the fear, surrendering to it, without continuing to focus your thinking on the actual phobia itself (which would engender more fear), and insisting on maintaining rational behavior at the same time at the same time the phobic event is occurring.

As a treatment for phobia and post traumatic stress syndrome (a type of phobia) some people use soothing music, or relaxing videos, introduced at the same time the phobic symbol is introduced to make a neural connection between them, thus lessening the next fearful impact of the phobic symbol by associating it with a soothing symbol. This way, when the phobia pops up, like it does with post traumatic stress syndrome, the soothing image pops in the brain at the same time to help neutralize the phobia.

Sometimes repetition of a supportive thought can be used (this is one of the basic tenets of cognitive behavioral therapy) at the same time the phobic symbol is introduced which also, by association, tends to lessen the fearful impact of the phobia over time by dividing your one attention between the phobia and the support you are giving yourself. Such as when someone is yelling at you, you repetitively remind yourself that "I am okay and what can I do right now to take care of myself in this adverse situation." Or in the case of driving, remind yourself over and over that "I am okay and perfectly capable of driving safely."

We always have to remember that fear is produced in the the subcortex which is an instinct and triggers by itself. Your cognitive thinking is produced in the neocortex which may or may not be triggered by some learned association. So to be sure your rational faculties come to your aid under stressful circumstances, you must ask your brain "what can I do to help myself." You can pre-plan some supportive thoughts that will immediately provide support for yourself when they pop up through learned association whenever the chronic stressful event pops up.

Confusion Between Feelings and Thinking

As concerns methods of therapy that suggest "focusing on feelings" I would like to say further that due to the process of pain perception it is impossible to focus on feelings without thinking about them. This is because all feelings and emotions and pain of any kind are produced in the subcortex, and the signals that pain and emotion are being produced must go up the brain and not only be received but acknowledged in the neocortex before a human being can feel physical pain or emotions.

This moment of acknowledgment is usually beneath our awareness but once you understand that it exists you can better understand the very intricate relationship between feelings and thinking. Feelings and emotions are defense mechanisms, they are warnings. It does not seem reasonable to me stay stuck in warnings (which you would have to force yourself to do in order to focus on feelings) rather than move on to direct action which you decide upon as a result of warnings.

The other thing to consider is that many feelings and emotions are irrational, rather than the result of responses to actual danger. Many feelings and emotions are not necessarily legitimate warnings but replays in the mind of old neural patterns that are triggered off accidentally through learned association. This is because no matter how much you focus on some feeling, you are never going to get rid of that neural pattern in your brain.

So, concerning any neural pattern carrying some feeling or emotional that is painful, irrational, or unhelpful to moving forward with your day, once it pops up, and you acknowledge that it is not useful (if you are acknowledging a feeling, therefore you are not repressing it) , it seems to me it is wise to simply ignore it and choose another thought that moves you forward with another neural pattern that is more productive.

This process of pain perception is also the reason that hypnosis is a very effective treatment for the management of chronic physical pain. For a good book about chronic physical pain I would suggest the book "A Whole New Life" by Reynolds Price.

Should we Ignore Feelings?

This comment was left on another post and I would like to answer it here:

Dear A. B Curtiss,

I find your approach to depression very considering. I'm shaking if I order your books. I don't speak very well English, so it's a little bit difficult for me to understand a book in English. But I suffer so much, that I will give a try. I am uncertain if your method not thinking about depressive feelings is really the right one for me, because I made myself familiar with an other method -but also didn't practiced yet-, named Focusing, and Ann Weiser Cornell, a Focusing teacher (http://www.focusingresources.com/irf/how_this_works.htm) says the opposite than you say: we should a feeling give a space (also for negative feelings)because they have to tell us something and they have an evolution, and if we ignore a feeling and try to repress a bad feeling, it will come back and even stronger. If we get the same feelings over the years, that means this feeling have to say something about us, and we can transform the feeling in a better one by giving attention this feeling. A feeling is not a furniture that we can throw out. I think this opinion is different from yours about ignoring the feeling and think something else. Please give me some more explanations because I want to decide which way to follow, or how to reconcile the two methods.

Thanks M_________

Dear M________

Hi,

What language do you speak? My Brainswitch out of Depression book has been translated in Estonia and Lithuania and is being translated in Russia and Japan.My Depression is a Choice book has been translated in Portugal.

Feelings are supposed to finish when you feel them, accept them, and then move on. There is also such a thing as honest mourning wherein you are suffering and honoring your losses. However mourning can degenerate into depression which is simply a chemical imbalance in your brain caused by anxious worry that triggers the flight or fight response and dumps stress chemicals in your brain.

Mostly people are not suffering from feelings so much as suffering from an excess of stress chemicals in their brain which are very hard on the metabolic processes of the body and cause a general feeling of unwellness and despair. Repressing feelings is not good. However there is a difference between accepting your feelings and then moving on to more productive activity, rather than wallowing in generalized anxious worry which causes the production of more and more stress chemicals in your brain.

Also most people have a great deal of difficulty in distinguishing between feelings and thinking. Generally speaking if there is more than two words you use after you think "I feel," it is a thought rather than a feeling. "I feel angry" is a feeling, "I feel you did something wrong" is a thought.

The trouble with wallowing in negative feelings is that you make them dominant in the brain. The brain always follows the direction of its most current dominant thought. You can think any thought you want, and it is your thoughts that determine your feelings. What is the value in thinking thoughts that produce negative feelings? Since you have a choice, why not think those thoughts that produce positive feelings?

When you understand how your brain works, you can get it to think and feel what you want rather than be forced to think and feel what the brain wants to think or feel. You are not your brain and your feelings are not sacred entities to be worshiped. Feelings are defense mechanisms to be understood and managed.


----- Original Message -----

Regarding Insomnia

At a booksigning today I had a long talk with a radiologist who said his wife used mind puzzles for her insomnia and that it was fairly successful. I suggested that the problem with insomnia was that when the body was in the sympathetic mode (alert and ready for action) sleep was impossible. It was only when the body was in the para-sympathetic mode (at rest and relaxed) that sleep was possible. Sometimes the mind games we use to get to sleep are too complicated and in working at the games we are too alert and concentrating on the game and our body stays in the sympathetic mode too long.

I further suggested that I used to count from 1000 down to 1 to get to sleep but that I found it took too much effort and that when I substituted something simpler that simply bored the neocortex with incessant repetition, I did much better. Now I use something really simple like counting only 1-2-3-4 or a fragment of a nursery rhyme like barber, barber shave a pig and it works much faster.

My Sister Believes She Can't Get Out of Depression Without Drugs

Dear Ms.Curtiss

My name is T_________ and I have a younger sister who is feeling depressed. She is all about the medication and therapists making her feel better. She also believes that she will be on those pills for the rest of her life. I brought up the point that depression is a choice and it is up to her if she wants to feel better. She argued with me by saying all the doctors and therapists claim that there is a chemical imbalance in the brain and that we are born with it.

But I stood by what I believed and she did not take it too well. She claimed I was not her brother and that she wished me out of the family.

I am asking if there is any way I can present this information to her without her blowing up at me and refusing the fact that it is up to her to be happy.

Any help at all would be great. It hurts to see her the way she is.

Dear T______

If someone believes they are sick, they will be sick. People have been hospitalized with illnesses that were later discovered to be simply mass hysteria. You sister's doctor can offer no medical proof that she has a chemical imbalance in her brain that is genetic. There is a chemical consequence in your brain foer every thought you think and the balance changes constantly. That's why all depression is chronic instead of some kind of a permanent condition; it comes and goes.

What tests have been done on her brain or anybody else's brain that proves she has an inherited chemical imbalance? And as for medication. This year Newsweek's cover story was that anti-depressants were no better than placebos in relieving depression. Again, if you believe anti-depressants will make you feel better, you will feel better.

You sister's doctor probably doesn't know that the pain of depression is only produced in the subcortex, and that there is never any physical or emotional pain in the neocortex. Furthermore, due to the process of pain perception, which her doctor probably doesn't know about either, before a human being can feel any emotion or physical pain, the signals that such emotion or pain is being produced in the subcortex must go up the brain and not only be received but acknowledged in the neocortex. This is the reason hypnosis can be substituted for anesthesia in open heart surgery.

You can't be depressed for more than a few minutes if you refuse to think depression when it pops up and use mind exercises to block the acknowledgment in the neocortex that depression is being produced in the subcortex. Unfortunately the medical and psychological professions are not interested in this because you don't need drugs, or doctor's visits once you learn how your brain works and get some practice controlling it instead of letting it control you.

Lots of money being made on people's pain. When I gave a two day seminar of my work to the National Board of Cognitive Behavioral Therapists several years ago, the psychologists and psychiatrists were not interested. The only people who were interested were the psychiatric nurses who are the ones that have to mop up the problems that drug taking causes. A. B.Curtiss

An Exercise for "The Remorses"

Dear A. B.

I love the idea of "moving the depression train off the brain track." Thank you so much for this discussion. A_________

Dear A_________

You are welcome. I have another image for you that you might like.

My daughter gave me a good visualization the other day for curing "the remorses." The remorses are those negatives nagging at you when something has gone wrong, either socially or otherwise.

Sometimes you make a dumb comment and embarrass yourself and wake up at 3 o'clock in the morning with "Oh No, how could I?" Or you just missed out on something wonderful due to someone else's sabotage. Or Fate simply gave you a big hit and you are suffering.

I had mentioned to my daughter that my way of handling these setbacks was to "invest" them. This is a magical thinking exercise wherein you go to the Positive Returns Cosmic Bank and invest your failures because the cosmic bank returns to you in postive terms double whatever you invest in negative terms. It's just a way of getting things off your mind that bother you, and who knows? Maybe in the cosmic scheme of things you are doing yourself some great good.

My daughter says that a friend of hers does something similar. She learned this from her Dad who was a minister. My daughter says it works wonders for her. What does she do?

"I offer it up"

Wow. Powerful. Just "offer it up." Works for me too.

Social Anxiety is Not Present Reality

Dear A.B.

As I think about what you have written on this subject, I am realizing that I'm mostly not present in the moment, in some of the social situations. Thus the anxiety. It's kind of like being in the midst of a crowd but sticking my head in the sand so I won't be hurt, but still be there.

I have a fair bit of experience with public speaking, though not recent. I'm able to handle myself in those situations because I'm able to plan part of what I speak on. Sometimes conflict arises, and I'm able to think on my feet. The experiences have been good. There's more at stake when I'm standing in front of a crowd, so my concentration is clearer.

As I look at this now, it is more a fear of living in the moment. For me, that is always the hard part coming out of depression. To concentrate in the now. Once I realize, that, that what I am doing is not being present in the moment, I quickly make progress out of depression. A_________

Dear A_______

You are absolutely right. You have command over your depression when you fully understand that depression is not present reality. You can move from depression to present reality by choosing some on-purpose objective thought or productive action which you pursue on purpose, rather than drifting along and getting stuck in the old neural pattern of depression and self-produced despair.

The trick is to remember that depression is not reality when you are suddenly plunged into depression. As you practice the simple mind tricks of brainswitching, you actually build a new neural pattern in your brain that reminds you that depression is not reality and that you need to move away from the depression.

This new neural pattern will soon start popping up (via the process of learned association)whenever the depression neural pattern triggers. Then you simply move your brain train off the depression track, and get it going on some other track by thinking some new thought, such as a mind exercise, and making that new thought dominant over the depressive thought. (The brain always follows the direction of its most current dominant thought.)

Social anxiety is the same as depression in one very important aspect. Social anxiety, like depression, is not present reality. Social anxiety is an old neural pattern of self-focus on your self-perceived unworthiness when you are in the presence of other people, and you, rightly or wrongly, exaggerate their superiority over you in some aspect or another, thus shaming your self. Social anxiety is a very painful unreality that can only be cured by your taking your real space in present reality, unashamed, honestly accepting and sharing your good qualities with others with whatever social skills you have learned, and humbly acknowledging your flaws, and the lack of skills which you have yet to acquire.

In a way a good antidote to the stubborn unreality of self-focus is to surrender to the reality of what is, and yourself, as is. A. B. Curtiss

Shouldn't We Just Accept Our Social Anxiety? Why Try to Cure it?

I thought about this question after receiving a few letters from people struggling with social anxiety. Why should we go to the trouble of curing our social anxiety? Why isn’t it okay just avoiding parties and gatherings of people because they cause us distress? Why can’t we just cower in a corner when it is too painful to engage with a group because we never know what to say?

The answer is that we human beings need one another. We are a herd animal. And how do we communicate? We tell each other our stories. Our lives are immeasurably enriched and our spirit is nourished by the most basic of conversations or kindly remarks, both those we give and those we receive.

A pleasant “Good morning” from a stranger you pass on the street says so much more than just those two words. It says I care about you. You are important enough to me to make the effort, to take the risk you will just turn away, and then I’d look the fool.

So then why are we so afraid of one another, and hide away our secret heart, ashamed. Perhaps we are so afraid because we are so necessary to one another.

I went to a neighborhood party last night and I tried to remain very aware of any anxiety I felt while engaged in conversations in the group. I found I could always drum up some fear if I really stretched for it. And my next thought was, so what are you supposed to do with your fear?

We’re supposed to push beyond our fear, and show some spunk rather than hanging back. That’s all. We’re supposed to use our courage. Make an effort to find some small thing to say. If this is difficult , we can always play the straight man, and give the other person all the important lines.

That is, we can ask where they live. Have they always lived here in the city? If not, where did they come from. Most people need very little encouragement to talk about themselves. And most people are grateful to have been given a little script so their own contribution to the conversation is easy for them, and they don’t have to dredge up something on their own in order to have something to say.

Dale Carnegie, author of that great classic How to Win Friends and Influence People, said that the most precious sound to any person is the sound of their own name. So when introduced, can’t you pay attention for 4 SECONDS, and REMEMBER at least a first name? Use the name, out loud, right away so you don’t forget it.

“So, Janna, do you live here in San Diego?

Or comment on the name.

“Janna is a very unusual name. Is there a story behind your name?

It helps to read a newspaper or some on-line news before going out so you have at least one thing you can comment on.

The sad thing is that most people in any group all have their own fears and anxieties. There is nobody alive who doesn’t want love and respect from his fellows. If you said to one of them,” Hi, I’m not a great conversationalist. I don’t do groups very well because I never know what to say,” most of them would admit to some weakness of their own. And you’d have a conversation going right away.

I’ve told this story many times because it is so memorable. I met an elderly man at a neighborhood party once. He was in his nineties. I asked him what he did that he looked so great for being 93. He said “Well, I try not to be too authentic.” What a great line.

I asked him what his career was—his parents had owned a bakery and he worked in it for most of his life. His work was fascinating. Getting up at 3AM to get the days baking started. Everybody’s life could be a novel, and everybody has a story to tell if you just encourage them a little.

And don’t worry too much about impressing others. They won’t notice your cleverness that much anyway, because they are too occupied with trying to be clever themselves. If given the choice, most people would prefer to be impressive rather than being impressed.

So maybe the whole secret to good social skills is to stop worrying about how you are coming across to the other guy and, instead, let HIM look good.

Depression is Different from Social Anxiety

Dear A. B.

I'm not sure I know what you mean by fear being free floating and unattached.

I have a fear of people in social settings. It becomes difficult to start or carry on a conversation with someone in these settings. I go dumb. So much information coming in from all directions. The anxiety builds. I seek quiet corners where then I might become a listener rather than a participant. I fight to remain physically present (not run off) and tolerate it till the event is over. The next day is an emotional hangover... So much energy spent.

This leads to a lot of anger at myself... Into depression for days to a couple weeks. When I'm able to remind myself to keep it simple and use minds tricks to bring me back to present moment living, then I'm able to regain my well being.

But, social settings, I'd just rather avoid. They're not pleasant.



Dear A.M.

Free floating fear is a feeling of anxiety where you can’t account for the reason you are feeling anxious. Social anxiety is the fear and anxiety you get when you are in a group situation and are supposed to interact with people.

Social anxiety can never be cured per se because the afraid-of-people neural patterns you have built never disappear. But just because you still have old fearful neural patterns doesn’t mean you have to use them. You can replace the old ones and use new and improved neural patterns of social skills instead of the fearful ones when they get triggered.

Certainly you can improve your social skills so that social interactions are not painful all the time. Even I sometimes get self-focused in a group--even in a family group--and feel that I'm not as loving a person as I would like to be. My old “I feel unworthy in some way” neural patterns might pop up.

Whenever we feel unworthy and try to shake it off and pretend we're not feeling that way, we don't make much progress. Instead, we can just recognize that an old pattern has been triggered, feel our discomfort, use a bit of cognitive behavior on ourselves by telling ourselves that we are an okay person doing our best and what we are feeling is old habitual neural patterns that will always be there lurking in the background, but we can move forward and leave them behind with a little effort and practice.

You can leave a group if you suddenly become uncomfortable and give yourself space to regroup yourself. Find some other person who will give you the time of day or maybe one who also seems less socially adept, and have a one-on-one small chat. Even if you end up talking to the doorman at some party, it is still a social interaction with another human being and worthwhile practice for you.

Our brain and its product, our mind, is a defense mechanism and naturally paranoid on our behalf. We have to move forward from its warnings that we are failing at something, and, instead, take stock of what we do have going for us that works.

Most of us can put a sentence or two together that makes sense, comment on something going on locally, or at the party or find something pleasant to say about someone or ask them something about themselves and be a good listener.

I always suggest reading Dale Carnegie's book “How to Win Friends and Influence People” as a good place to start improving our social skills. It does take practice. Also I suggest a course in public speaking via Toastmaster's International which is in most cities and small towns and very inexpensive. Don't give up. You just have to go back to your scared childhood and pick up the skills you didn't pick up then. It can be done.

Depression that is brought on by thinking about your failure in social skills is different from the social anxiety itself. Use the mind tricks for depression. Depression is nobody's business but your own and you have to work it out away from other people and then rejoin them when you are in a better mood rather than inflicting your sadness and despair on others. A. B. Curtiss

Question About Repressed Fear

Hi A. B.,
I looked for a link on your blog page to 'post' to it. But could'nt find one. Used your, About Me, link to find your email address.

I'm a little puzzled by statements in Ch. 10 of, Depression Is A Choice, about letting repressed fear finish... Bringing up my old fears is not pleasant of course. But rather than getting some release, I'm finding that I end up creating more self focus which seems to magnify the depression and hold me like a vise. Each time this happens, I need to go back, re-learn, re-read, re-mind and hold in memory this info, to keep trying to work with the repressed fear. Frustrating. Trying to find some hope and relief in all this. Regards, A_______

Dear A_________,

Can you give me a specific example of a fear and how you address a particular fear. That is, was the fear free floating without being attached to anything. Or was it some fear that you just realized was a fear and not some laziness or annoyance such as not wanting to make a difficult telephone call. Getting out of depression and addressing repressed fear are two different actions requiring different methods.
A. B. Curtiss

Can I Restore my Brain Chemistry with Mind Tricks?

Dear Curtiss

I wanted to ask you a question about my self focus by negative thoughts for more than ten years. This devastated my life.

I could treat my self through listening to the music through I Pod. This helped me a lot in avoiding self focus and resulted in balancing my brain chemistry in a very short time.

But when I meet with a group of friends the self focus returned again.

I go to listen to music a gain to balance the brain chemistry because I found this way much faster than doing brain exercises and other things like daily jogging.

Do you think I can restore my brain chemistry by the time through this way.

I have interviews for jobs very soon but the self focus frustrated me.

All th-e best F___________________


Dear F_____________


Dear F____________

Brain chemistry is a very volatile thing. You can't do anything that will RESTORE brain chemistry. There is a chemical consequence in the brain for every single thought you think. Think the thought lemon and your brain chemistry changes to produce salivation. Stop thinking the thought lemon and the brain chemistry will change.

The purpose of the mind tricks is not to RESTORE brain chemistry. The purpose of the mind tricks it is to enable you to get out of the negative thinking that has put you into a depression.

You don't restore brain chemistry per se, you restore your ability to manage your own brain chemistry. You get better and better at substitution mind tricks for negative thinking so that you get better and better at getting out of depression quickly. What is permanent is that you get better and better at noticing you are in a negative mode of thinking and better and better out of changing your thinking, which then changes your brain chemistry.

Self-focus is the same. You will probably always have a tendancy to self focus. But you will get better and better at noticing when you are self-focused, and better and better about thinking those thoughts that will get you out of self-focus and into more outer directed thinking.

Mind tricks is better for self focus because you can use it ON THE SPOT. You don't have to go back home and calm down by listening to music. And anyway, self focus is much more likely when you are with other people than when you are alone.

It is not easy to get out of self-focus. For one thing it is very painful and alienating. But you can do it with practice and you get better as you practice. I told you before that a good book to read for social anxiety is Dale Carnegie's HOW TO WIN FRIENDS AND INFLUENCE. This will give you a little more confidence when you have some social tricks up your sleeve. A. B. Curtiss

Yes, Standing on My Own Two Feet

Dear A. B.

Thank you for the additional thoughts. I can't deny that I felt quite helpless & I must have a lot of repressed fear. My sister's note probably contributed to that sense of helplessness & fear.

I can see that there are nuances and levels to the situation. I do want to get the deeper growth, not just the superficial "winner" status. You said in the other e-mail, I would know things were better when I viewed his anger as his problem. So these are the things I need to work on:

Standing on my own two feet, relinquishing notions of how another should emotionally "be there" for me. Getting in touch & letting go of some repressed fear ( I know I'll never unload it all!)
Acquiring the mindset (& living from it) that his anger is his problem... & not the end of the world.

None of which will be easy, but at least I have a clearer idea of what I need to do.

I thank you for so generously sharing.

Sincerely, G___________

More Verbal Abuse Problems

Thanks, A.B.

I don't know why I dialed 911. It's not something I've ever done, & I tried to "retract" it asap. I feel stupid. I guess you're right, it was an act of manipulation. Anyway, the last thing in the world I imagined was the police arriving. As I said, I hung up the phone before they answered. It's embarrasing too, because I'm sure the neighbors saw the police come & husband go. I agree w/your analysis, but don't know how my husband views it. I am willing to wager he is pretty livid about it, but he may see it as an act I took on my own behalf. When I filed for divorce, I didn't do it to manipulate, it was for real, but it seemed to send him a message that I wouldn't put up with his antics forever. Alternatively, he may see it as so humiliating that he can't or won't get past it.

Also, this was the very first time I ever agreed he should leave. Usually I would plead for him to stay if he suggested such a thing; this time I encouraged it.

I do understand what you're saying about taking care of onself, & diffusing the power of the anger to control. It's never a good idea to say "this is not acceptable?" When someone rages at us for pressing a wrong button or something equally inane, we just slither away & act like it didn't happen? I've been more or less doing that most of the time, but felt at the end of my rope last night!

I received a note from my sister yesterday. She thanked husband & I for helping & supporting her. I felt upset reading it, due to the fact that my husband's behavior behind the scenes at that time was so appalling. He yelled at me on the way to almost every visit. I still can't believe he could be that heartless. I think reading the note lowered my tolerance for his outbursts, since the other incidents related to her were fresh in my mind.

Would you ever tell your spouse that you had been disappointed by them? Guess it wouldn't matter in my case. He'd just deny it, & blame me for his behavior somehow. It always ends up being my fault.

I know your husband threw tantrums, but I don't think your husband is a narcissist! I see your husband as a very manly man who eventually matured out of throwing tantums since you wisely made them less fun for him. I think he has the capacity to empathize & exercise compassion & remorse, & not just when it's "convenient." I hear what you're saying in the last paragraph though.

I don't know if my husband will return home tonight, or if so when, and if so, what state of mind he will have. He'll more than likely not wish to speak to me. I won't know what to do or say anyway.

Thanks again!

Ginger

YOUR QUESTION: When someone rages at us for pressing a wrong button or something equally inane, should we just slither away & act like it didn't happen? I've been more or less doing that most of the time, but felt at the end of my rope last night!

MY ANSWER: Your question cannot be answered in the same sense that you write it because there is no specific right thing to do in such a situation. This is the trouble with trying to understand things at the periphery. You need to get to the center and you will see a bunch of interconnections that you don't see at the edges of things. In any situation, whether you act out of fear of something or love of something will decide your specific action. Whatever that action, if it comes from the center of your core values and not from fear, that action will be somehow appropriate. Slithering away and acting like something didn't happen is acting out of fear. When you are afraid you behavior is reactive, not proactive.

YOUR QUESTION: Would you ever tell your spouse that you had been disappointed by them? Guess it wouldn't matter in my case. He'd just deny it, & blame me for his behavior somehow. It always ends up being my fault.

MY ANSWER: I might say such a thing. If I said such a thing the outcome would be appropriate to my life if I said it out of love for something. The outcome would be inappropriate to my life in some way if I said it out of fear of something. And remember, it is not so easy, sometimes, to see the difference between love of something, and fear of something. It is a pursuit of excellence, and seeking your core truth, rather than some check-list you could refer to. Wisdom is not easily come by.

The more I think about it the more it suggests to me that calling 911 was an act of uncontrolled rage on your part that things did not turn out to be the way you wanted. Such anger comes from a deep sense of helplessness and repressed fear. That doesn't mean that the outcome of calling 911 will not turn out well in some way, thus making you come out the "winner." See how difficult it is to live life of self-awareness? But then, as Socrates insists "the unexamined life is not worth living."

My Husband is Being Mean to me Again

A.B.,

I 'm feeling very confused.

After a series of outbursts, for the last couple of weeks my husband has not lost his temper. He's been very friendly, helpful and pleasant. I regularly thank him, praise him and let him know how I appreciate his good qualities and efforts. But, even when he is not being so endearing & pleasant I try to do that! Over the last 2 weeks I've sincerely had ample reasons to do so. It's been nice to have a pleasant environment, to not be walking on eggs & to feel like my "best friend" is back.

I work hard to run the household & want to help his life run smoothly. I'm happy to do so. I feel blessed & grateful to be able to stay at home & tell my husband that. I try to be supportive & pleasant. I make a real effort not to burden him or complain about much, save for my aches & pains on certain days! Frankly, I don't feel I have much to complain about.

Last night, my husband's disposition changed again. He was being critical, erupting in outbursts, all over the tiniest things. I pushed the wrong button on the air-conditioner & you'd have thought I had hit it with a hammer! I couldn't do or say anything right in his eyes, & he said the usual comments about "I was fine until you..." "I wouldn't have to yell if you..." I ignored him as always, gave him space. When he came in to sleep, I just couldn't remain silent. I usually just go to sleep, turn the other cheek & never bring his words back up to him. I just move on. He never offers me an apology. It would have meant the world if he could have said, " Yes, I was annoyed, but yelling doesn't solve anything. I'm sorry I over-reacted."

But last night I felt I had to say something (big mistake!) I said calmly & nicely, " I don't care if the air-conditioner is broken,. I just would like to be treated with kindness. I wish you could tell me there's a problem without screaming at me." That just set him off again. He got very defensive, said it was all my fault, made things up, starting yelling again.

At that point, I picked up the phone & said , "Should I dial 911?" He said , "I'll just leave." I said, "That sounds like a good idea." Thing is, I had already hit "911" on the phone. I've never done this, ever, in 23 yrs. of hostile, rages! I don't know what came over me.

Anyway, I hung up before someone could answer. The dispatcher called me back though. I apologized profusely, thanked her, & said no help was needed. 10 minutes later a policeman was at the door. I told him all was fine, & my husband was walking out the door. He spoke to the officer & told him he was "being kicked out" of his home. The officer said, "That's fine, everything else is okay?" We both said it was. The officer left & my husband left.

Questions like, "Should we cut those flowers shorter?" or pushing the wrong button, or asking if he likes his dinner too many times, might annoy any husband. I understand that. I am a very average, flawed person. I am bound to put my foot in my mouth, & make mistakes. I just feel like I really, really, try to be a pleasant, supportive & appreciative wife. To be on the receiving end of so much wrath, so frequently, for so little, doesn't make sense.

This has been going on for most of our marriage, with a respite of three years after I filed for (then dropped) divorce. Two yrs. ago it started up again. I think he thinks I'll never leave because we live in a nice house, I love our yard, & I don't have job skills. Cost of living is higher here & I just don't think he thinks I'd ever go anywhere, so he feels free to treat me like a doormat when he's so inclined.

The last several incidents have left me feeling not as scared or panicked as in the past, but with a sense of sadness that our home has to so often be a hostile, anger-filled environment. It seems he doesn't have any motivation to change. I try to be understanding, but I can't seem to "love" him out of this.

The reality is, even though he seems impossible to please, I'm so happy to see him when he comes home. I'm like a puppy! I enjoy our simple life & don't feel I need anything more. I read that Dr. Laura Schlessinger advised that all one can do around a man like this is "ignore him." I guess you can't "make" someone feel compassion or remorse. Aren't some people incapable of feeling compassion or remorse? He seems to feel utterly entitled to go crazy with anger if the smallest thing isn't to his liking!

I know I've written about this about a thousand times. I don't want to drive you crazy, A.B. I just don't know what to do. I want to get off of this roller coaster. Now that this 911 call was placed, he probably feels even more disdain for me. I'm sure he went to his office & didn't get any sleep. I am sorry for that.

G__________

Dear G________

I suggested this to you before. It might help to get out a camera and record his rages if you can. I don't think he really sees himself. The only thing he sees is that you still respond to his anger, and he can still control you with his anger, and that makes him feel safe. Calling 911 was probably not a great idea since it was done as an act to manipulate your husband into behaving better rather than to get help because you felt in danger.

The cliche in the counseling industry is to meet a behavior with a behavior. This does not necessarily mean yelling at someone that is yelling at you. But it does mean that in any situation an adult should be taking care of themselves independently and directly, rather than getting the other person to alter their behavior so that they are taken care of indirectly.

You still do not see this subtle point. You are still indirectly taking care of yourself by getting your husband to change his behavior, instead of directly taking care of yourself, and behaving in a way in which you are completely taken care of by yourself, and the consequences of your being able to take care of yourself removes the ability of the other person to control you by their anger.

Calling the policeman illustrates the point. You called them to manipulate your husband, to get him to alter his behavior so you would be taken care of. This is not the same as calling the police so that they can take care of you, which is their job, and which would mean that in the situation with your husband you are taking care of yourself directly by calling the police and are not calling the police to get your husband to take care of you. It is still a matter of being able to be self-sufficient in an adverse situation.

When my situation was similar to yours I would actually say to myself during my husband's rages, "What can I do in this adverse situation to take care of myself?" Sometimes I would simply get up and leave the house and go somewhere to collect my wits and handle my own emotions. But at this point I was able to start to make some judgments about the fact that my "hurt feelings" were simply caused by my emotional dependence on my husband, and "hurt feelings" indicated my needing to do some more work on repressed fear. That "hurt" is just fear.

And I had some glimmer that I was extremely weak and my husband did not come to this planet to do what I wanted. He came here to take care of himself in the best way he could. It is one of my core principles that everybody always displays the best behavior that they are capable of at the time they are displaying it.

Another problem with us women is that we use the "cover story" that we are "right" and our husband is "wrong" in some situations to cloud that fact that we cannot abrogate our responsibility to take care of ourselves just because we are "right" and put that responsibility on our husbands just because he is "wrong" by common sense standards. Again, there are no specific right and wrong actions that can be listed down and memorized that you can do to take care of yourself. You know you are on the right track when your husband's anger becomes is HIS problem and not YOUR problem.

If your behavior comes from love (of some core principle) instead of fear, it will be appropriate in some way to your life. Being appropriate to your life, however, does not automatically make you a "winner" as opposed to a "loser" in the short term scheme of things. In the long term, however, being true to your core principles will mean that you win yourself.

Hope this helps. A. B. Curtiss

All the Bad Feelings Went Away

Dear A. B.

Today I was driving my kids to camp and I was feeling sad and in pain like most of the time and I hated the feeling so much and then what came up was a very simple exercise from out of nowhere, counting 10 people names with letter A, B, or what letter I wanted. I did the exercise 2 times and all the bad feelings went away and a joy came to me and I felt full of energy. So isn't this good news that I am learning the away out of it ? E________

____

Dear E______

What a good exercise! You're on the right track. Isn't doing an exercise better than suffering? It is hard to pull yourself away from suffering. It takes a lot of courage. And even more important, to remember to do an exercise at all is a great breakthrough. A. B. Curtiss

Insomnia? Re-wire Your Brain To Get Some Sleep

A.B.,
I am finding your book quite thought-provoking, and useful from the point of theory.

However, there are autonomic symptoms that my depression has that can't be controlled with thought-jamming. My problem is sleep. Or, rather, an extreme lack of it. I know I am in deep trouble when my sleep starts to get disrupted. (completely)

I think I read that you count backwards from 1000 to fall asleep. From my perspective (limited though it is), sleep is the cornerstone of depression problems.

Have you tackled your sleep problem with the onset of depression? If you are hypersomniac during the depression rather than insomniac, then it's a different kettle of fish.

I am certainly doing thought-jamming, and forcing myself according to the advice on your website, but it's the (severe lack of) sleep that has me confounded.
I'd be interested in suggestions/recommendations, pointers. Thanks, R____

Dear R________

I used to count down from 1000 to 1 to get to sleep but I have since found simpler methods such as in this essay I wrote a short while ago. It may be of some help to you with your insomnia

Insomnia? Re-wire Your Brain to Get to Sleep by A.B. Curtiss

Why do we have trouble sleeping? Too many of us, instead of thinking about going to sleep when we get into bed at night, think about NOT going to sleep. Fearful thoughts about not being able to sleep trigger the fight-or-flight response, and the stress chemicals thus produced make us anxious and prevent us from relaxing.

As we get more and more in the habit of worrying that we can't get to sleep, we build a strong neural I-can't-get-to-sleep pattern in our brain. This pattern automatically associates the fear of not being able to sleep with the very act of going to bed each night. Voila! The insomniac is born!

Most people pay little attention to directing their thoughts. Most people believe that you have to think whatever thought pops up in your brain, whether you like it or not. Nothing could be further from the truth. Successful people have always known that they can choose what thoughts they wish to think, and they can refuse to think the maverick, self-defeating, keep-you-awake thoughts that come galloping unbidden across their mind.

Basically, if we don't know how we think, we won't know why we have insomnia. People should know the basic neuroscience of how they get from one thought to the other. This kind of information is an important part of my book Brainswitch out of Depression. Once you know how your brain works you can better take advantage of the mind exercises for insomnia that are also in the book.

If you haven't given much thought to why you think the thoughts you do, you probably don't know the difference between thinking about going to sleep and thinking about NOT going to sleep. It took me a while to understand the difference myself and I'm a therapist. Once your eyes are opened to it (no pun intended) you can see that the difference is subtle but huge.

If the dominant thought in your mind is that you can't get to sleep, it will be very difficult to do so because the brain always follows the direction of its most current dominant thought. Going to sleep is a particular neural pattern that the brain naturally follows, but not if fearful thoughts become dominant over your natural getting-to-sleep neural pattern. Then, of course you trigger the fight or flight response and stress chemicals flood the brain which make sleep as impossible as 10 cups of strong coffee before bed.

When you exercise a muscle, you make it strong. When you exercise a thought, you make it dominant. You exercise a thought by thinking it over and over again, repetitively.

The trick in getting to sleep is to purposely, as an act of will, choose neutral, calm thoughts repetitively and make them dominant, replacing the dominant fearful thought that you can't get to sleep. Over time you can re-wire your brain out of its insomniac pattern.

You can build a new neural pattern that automatically triggers when you get into bed. You can actually build a neural bridge, with neutral thoughts and mind exercises, that links you automatically to the natural neural pattern of falling asleep.

My expertise is to help people re-wire their brain to get out of depression. But I began to notice that these same techniques that worked to re-wire your brain to get out of depression, also worked for insomnia. As people age, they wake up more often at night and these exercises can help them, too, to get back to sleep.

Here are some examples of mind exercises for insomnia. The first is called "Make the Problem the Solution." Suppose you are trying to get to sleep and a faucet is dripping, or there is noise outside, or somebody's snoring. You can make the annoying noise into a meditation or mantra to help you get to sleep.

Simply close your eyes and relax your body. Then say to yourself, "With every sound of the dripping faucet I am going deeper and deeper asleep." Hear the sound, and repeat the meditation. Visualize yourself feeling the sensation of falling every time you hear the sound.

Falling deeper and deeper. Deeper and deeper. The repetition of this exercise can form a neural pattern to link the words "deeper and deeper" to the hard-wired neural process of falling asleep.

Another exercise is to fool the mind into believing you are asleep even if you aren't really asleep. Just keep saying over and over to yourself "I am asleep, I am asleep, I am asleep. Whatever thoughts I think are just dreams because I am asleep. Whatever sounds I hear are just dreams because I am asleep. I am asleep. I am asleep."

The same thing happens with this exercise. You re-wire your brain out of its fearful can't-get-to-sleep neural pattern by making a neural bridge from your dominant thought "I am asleep" to the brain's natural going-to-sleep neural pattern. The more you practice the exercise, the stronger becomes the neural pattern.

The Clever Accountant is another exercise." Emotionally speaking we have to be very clever accountants. We should never, for instance, carry the failures of today forward into tomorrow.

As we are preparing for bed, it is very easy to slide into the remorses if we have over-eaten. It's easy to beat ourselves up if we have taken some terrible social belly flop, haven't finished the report, or didn't get the house cleaned.

However accurate these thoughts may be, it is simply not helpful to our brain in any way to think them, especially when we are trying to get to sleep. We shouldn't take these thoughts to bed with us anymore than we would take our vacuum cleaner or our golf clubs. These things are useful, just like thoughts are useful. But they are not appropriate for bedtime.

Thoughts of a failure, for instance, puts our brain in touch with an infinite number of negative neural connections in our head (via learned association) that will trigger the fight-or-flight response that leads to stress. Instead, we should keep carrying forward our successes, however small.

If we can't magnify some success in our mind, we should keep repeating the small things as a kind of positive-train-of-thought which can "thought-jam" those insistent negative thoughts into silence. Yes, maybe we didn't lose weight today but we lost two pounds so far this month. Yes, maybe we over-ate but there was probably some small thing we passed up.

"Hey I didn't eat that third brownie. I was victorious over the third brownie. And anyway, it didn't taste really all that good. Maybe I'm getting tired of junk food. I'm losing my taste for junk food. I think I'm starting to want to eat better, to eat healthier." It's even a victory of sorts to say "Hey, I did over-eat, and now it's over. It's gone. I am free from what I did today forever because today is soon gone and thank goodness for that."

Our small triumphs don't have to make sense in the grand scheme of things or even in the less grand scheme of our lives. They just have to be positive so that they will connect with other positive thoughts in our mind by learned association. This is really a mind trick like some bookkeeping is an accounting trick that makes mathematical, not necessarily common sense.

It's the process that's important, rather than the specific content. If we have been really low functioning, it is a victory to have brushed our teeth or to have taken a shower. For those of us who are high functioning, perhaps we didn't win the Pulitzer this year, but we have done the first chapter of our next book.

Don't forget that our pain is exactly the same whether we are high functioning or low functioning. So the victories, however small, can bring us equal emotional relief. The inherent importance of victories is not relevant. The process of being positive is more important than the content of the positivity.

Brushing our teeth is no less positive than writing the first chapter of a book. It will have an equally positive effect, by learned association, with whatever positive mindsets exist in the neurons of our brain.

Not only are we connecting with the positivity in our mind instead of the negativity that can trigger the fight-or-flight response, but we are re-wiring another stronger positive neuronal pathway out of anxiety and stress with every single good thought we think. This is the pathway to the natural process of falling asleep: practicing repetitive exercises of calm acceptance.

Even nonsense thoughts repetitively thought will replace stressful thinking. I wake up every two or three hours myself. Usually to get back to sleep I just grab for the latest two or three word sentence that I thought. Last night, for instance, I was thinking about a show on TV that I had just seen and the phrase, "tailor will fix it," happened to enter my mind. I just used that to get back to sleep. "Tailor will fix it. Tailor will fix it. T Tailor will fix it. Tailor will fix it. Any non emotional word or phrase works. Through repetitively thinking it, it soon lulls the mind, and connects with the natural process of falling asleep. Pleasant dreams!