Excerpted From The Book: What You Can Change and What You Can't

There are things we can change about ourselves and things we cannot. Concentrate your energy on what is possible--too much time has been wasted.

This is the age of psychotherapy and the age of self-improvement. Millions are struggling to change. We diet, we jog, we meditate. We adopt new modes of thought to counteract our depressions. We practice relaxation to curtail stress. We exercise to expand our memory and to quadruple our reading speed. We adopt draconian regimens to give up smoking. We raise our little boys and girls to androgyny. We come out of the closet or we try to become heterosexual. We seek to lose our taste for alcohol. We seek more meaning in life. We try to extend our life span.

Sometimes it works. But distressingly often, self-improvement and psychotherapy fail. The cost is enormous. We think we are worthless. We feel guilty and ashamed. We believe we have no willpower and that we are failures. We give up trying to change.

On the other hand, this is not only the age of self-improvement and therapy, but also the age of biological psychiatry. The human genome will be nearly mapped before the millennium is over. The brain systems underlying sex, hearing, memory, left-handedness, and sadness are now known. Psychoactive drugs quiet our fears, relieve our blues, bring us bliss, dampen our mania, and dissolve our delusions more effectively than we can on our own.

Our very personality--our intelligence and musical talent, even our religiousness, our conscience (or its absence), our politics, and our exuberance-turns out to be more the product of our genes than almost anyone would have believed a decade ago. The underlying message of the age of biological psychiatry is that our biology frequently makes changing, in spite of all our efforts, impossible.

But the view that all is genetic and biochemical and therefore unchangeable is also very often wrong. Many people surpass their IQs, fail to "respond" to drugs, make sweeping changes in their lives, live on when their cancer is "terminal," or defy the hormones and brain circuitry that "dictate" lust, femininity, or memory loss.

The ideologies of biological psychiatry and self-improvement are obviously colliding. Nevertheless, a resolution is apparent. There are some things about ourselves that can be changed, others that cannot, and some that can be changed only with extreme difficulty.

What can we succeed in changing about ourselves? What can we not? When can we overcome our biology? And when is our biology our destiny?

I want to provide an understanding of what you can and what you can't change about yourself so that you can concentrate your limited time and energy on what is possible. So much time has been wasted. So much needless frustration has been endured. So much of therapy, so much of child rearing, so much of self-improving, and even some of the great social movements in our century have come to nothing because they tried to change the unchangeable. Too often we have wrongly thought we were weak-willed failures, when the changes we wanted to make in ourselves were just not possible. But all this effort was necessary: Because there have been so many failures, we are now able to see the boundaries of the unchangeable; this in turn allows us to see clearly for the first time the boundaries of what is changeable.

With this knowledge, we can use our precious time to make the many rewarding changes that are possible. We can live with less self-reproach and less remorse. We can live with greater confidence. This knowledge is a new understanding of who we are and where we are going.

CATASTROPHIC THINKING: PANIC

S.J. Rachman, one of the world's leading clinical researchers and one of the founders of behavior therapy, was on the phone. He was proposing that I be the "discussant" at a conference about panic disorder sponsored by the National Institute of Mental Health (NIMH).

"Why even bother, Jack?" I responded. "Everyone knows that panic is biological and that the only thing that works is drugs."

"Don't refuse so quickly, Marty. There is a breakthrough you haven't yet heard about."

Breakthrough was a word I had never heard Jack use before.

"What's the breakthrough?" I asked.

"If you come, you can find out."

So I went.

I had known about and seen panic patients for many years, and had read the literature with mounting excitement during the 1980's. I knew that panic disorder is a frightening condition that consists of recurrent attacks, each much worse than anything experienced before. Without prior warning, you feel as if you are going to die. Here is a typical case history:

The first time Celia had a panic attack, she was working at McDonald's. It was two days before her 20th birthday. As she was handing a customer a Big Mac, she had the worst experience of her life. The earth seemed to open up beneath her. Her heart began to pound, she felt she was smothering, and she was sure she was going to have a heart attack and die. After about 20 minutes of terror, the panic subsided. Trembling, she got in her car, raced home, and barely left the house for the next three months.