Thursday, January 19, 2017

Feeling Good: The New Mood Therapy - David M. Burns, M.D. (2009) (incomplete)

Note that this book is due back to the library on January 19, 2017 and I am unable to renew it due to a lack of copies and one person waiting for it to be available again on reserve.

On November 30, 2016, I went to see my PCP.  I had never seen her before.  I just chose her arbitrarily because she was at the Logan Square Health Center.  I was just going in for an annual check-up, but she asked me a couple questions about mental health.  I told her that I was seeing a psychiatrist, but felt that he had never adequately addressed one of my primary concerns: volatile mood swings, as if on a 24 hour cycle.  Actually I wrote about it more than 5 years ago, and it appears to be a chronic condition at this point that I may not be able to end, unless I find the right medication. She recommended I read Feeling Good.

First of all, this is a self-help book.  This is not something like The Noonday Demon.  There are references to certain studies, but much of the material in the book comes in the form of anecdotes from past patients.  The method of treatment is cognitive behavioral therapy, which essentially involves stopping self-defeating thoughts before they cause one to become stricken with all of the usual effects of depression.  Will this work for everyone?  Not really, as Burns admits that some more extreme forms of depression require some form of medication.  But it may work for a lot of people and the book is mostly useful, in my opinion, for setting some kind of baseline on normal human emotions, and how easy it is to identify with many of the case studies from the book.

It bears noting that you probably need to work with this book, rather than just read it.  There are many, many exercises, and many "figures" in each chapter, charts and tables with columns of articulated thoughts and appropriate rational responses.  Sometimes the book is unintentionally hilarious, but for the most part Dr. Burns is able to pinpoint the most common states of depression and their likely triggers.

But as I started writing this review on Monday (January 16th), I realized I probably wouldn't finish it on time (it's listed as being 700 pages, but it pretty much ends at 681) and I really wanted to skip ahead to the end of the book, which is an analysis of many different kinds of antidepressants.  This was actually less interesting than I thought it would be, so I waded back around the 400 page mark where I had stopped and shifted to the chapter on suicide, just because.

I did find one of those unintentionally hilarious moments, and I don't want to act like a millennial teen using intentionally bad grammar and coming up with all sorts of new slang words so they can feel cooler than people over 30.  But the phrase "turned on" is kind of limited in how far it can go.  Of course, there is the famous hippie slogan, "Turn On, Tune In, Drop Out," which seems to mean "engage with your surroundings," but generally, "getting turned on" is, well, kind of obviously sexual.  So it was borderline inappropriate to read about a physician's "antiperfectionism sheet," which asks the subject to list an activity in column 1, how effectively the activity was completed from 0% to 100% in column 2, and how satisfying the activity was between 0% and 100%.

"Column 1: Talk to student about his career options.
Column 2: 50% (I didn't do anything special.  I just listened to him and offered a few obvious suggestions.)
Column 3: 90% (He really seemed to appreciate our talk, so I felt turned on.)" (357)

Dr. Burns also describes getting turned on by writing and revising that very chapter and I was drawn to recall a comment a friend once made about The Origins of Totalitarianism, after reading a ridiculously long sentence by Hannah Arendt.  He said it seemed like she was masturbating while she was typing.  Now I don't agree with that statement, but whatever, it reminded me of that moment.

While we are on the subject of totalitarianism, here is another hilarious passage, maybe not unintentionally hilarious, but darkly hilarious:

"First, would you say that everybody who achieves is particularly worthwhile just because of their achievement?  Adolf Hitler was clearly a great achiever at the height of his career.  Would you say that made him particularly worthwhile?  Obviously not.  Of course, Hitler would have insisted he was a great human being because he was a successful leader and because he equated his worth and achievements.  In fact, he was probably convinced that he and his fellow Nazis were supermen because they were achieving so much.  Would you agree with them?" (331)

This is from a section called "Does Work = Worth?" in a chapter called "Your Work is Not Your Worth."  This was a somewhat reassuring chapter to read, as I feel incredibly unsuccessful in my career (I recently wrote in an interview questionnaire that I considered my literary output my greatest achievement to date, but then also added one case with a particularly good result for the client for good measure--monetarily, however, this has not added up, and because I relatively suffer, and live constantly on the brink of barely ever adding funds to my savings, with no retirement, I feel I am treading water, and that things have been this way for so long that it will be difficult to turn them around....I see I am becoming a case study), but I believe everything written in the parenthetical above is relevant.  In short, my writing increases my feelings of self-worth; my job does not.  It was a reassuring chapter, but hard to accept when one's lifestyle is largely dependent upon one's financial success.

Moreover, this book was first published in 1980 and revised in 1999.  It was reprinted in 2009 (hence the title of this post), but I don't think any meaningful updates were made after 1999.  So while the internet was around, the prevalence of "internet thought" had not yet become a thing.  I would argue that "internet thought" (along with "Facebook envy") are new triggers for depression that should be analyzed.

For good measure, we will list the 10 cognitive distortions identified by Dr. Burns:

1) All-or-Nothing Thinking
2) Overgeneralization
3) Mental Filter
4) Disqualifying the Positive
5) Jumping to Conclusions (Mind Reading/The Fortune Teller Error)
6) Magnification (Catastrophizing) or Minimization
7) Emotional Reasoning
8) Should Statements
9) Labeling and Mislabeling
10) Personalization

When you are able to recognize that your mind is engaging in these types of thought patterns, you can begin to defend yourself against them.  You do, however, need to come up with the rational response on your own, and sometimes that can be difficult.  This is why many people resort to "do-nothingism" and procrastinate to the point of general inactivity.

To illustrate, I am somewhat disappointed by this review.  It's not one of my best, and I ran out of time to properly assess this book.  I should have started working on the review earlier.  But I can't change the fact that the book is due back at the library today, and I cannot renew it.  I could buy it and finish the review more appropriately later, but I'd rather not.  It's upsetting that I didn't do the best job, but at least I wrote something.

Actually yesterday I was thinking about how brilliantly metaphorical it was to post this review today, the last day of Obama's presidency, because many of us are depressed and feel hopeless about the future.  Then today I just feel like it's an embarrassing review, and there's so much more I could have said about it.  This was not a waste of time, however, and I will think of it as a kind of resolution for the rest of 2017: try not to accept the feeling that you are doomed no matter what--it may just be another cognitive distortion.