As of April, l975, I had been severely depressed almost every day for thirteen years--which is quite unusual. Then I braced myself for one last attempt to get rid of the depression before giving up the struggle against it. In the process, I discovered the psychological mechanism that is the proximate cause of sadness and depression. That discovery enabled me to take advantage of a couple of insights about myself. Within two weeks I had banished my depression.
Since April, l975, until now (September, 1990) I have been glad to be alive, and I have taken pleasure in my days. I have occasionally even been ecstatic, skipping and leaping from joy, especially in the early years when relief of the pain of depression was fresh. Though I must still fight off depression, I have not lost more than a minor skirmish since then, and I believe that--if my family and community stay safe from catastrophe--I have beaten depression for life. When I wrote the first draft of this article in 1978 (I then put it away to be sure that my cure was not just temporary) I wrote that "Even if I am wrong and eventually I suffer a permanent relapse, these three years of happiness and freedom from depression would leave me grateful for my good fortune." The good fortune continues, and I am more grateful than ever.
When I say that I was depressed for thirteen years, I mean that except for some of the hours when I was working or playing sports or making love, I was almost continuously conscious of being miserable, and I almost continuously reflected on my worthlessness. I wished for death, and I refused to kill myself solely because I believed that my children needed me, just as all children need a father. Endless hours every day I reviewed my faults and failures, which made me writhe in pain. To dramatize the matter: As I look back now, I'd rather have a tooth pulled, and have the operation bungled, or have the worst possible case of flu, in comparison to re-living any one of those days feeling as I did then.
By "depression," psychiatrists and psychologists mean a state of mind in which you are 1) sad or "blue", and 2) have a low regard for yourself. This article explains the mechanism that makes a person sad. After you understand it you can alter the mechanism in a variety of ways that can alleviate sadness and depression. The mechanism does not by itself produce or explain low self-regard. But if you manipulate the mechanism properly you will not be pre-occupied and ravaged by low self-regard. Though this mechanism has been noted by others, its explanation had not been developed systematically and scientifically. The key elements have now been confirmed in experimental studies, however. And leading psychiatrists and psychologists agree that this is a sound way to deal with depression.
This is the mechanism that causes the sadness in depression: when-ever you think about yourself in an evaluative way--which most of us do frequently throughout the day-- your thought takes the form of a comparison between the state you think you are in, and some other hypothetical "benchmark" state of affairs. The benchmark state may be the state you think you ought to be in, the state you formerly were in, the state you expected or hoped to be in, or the state you aspired to achieve. The comparison will make you feel sad if the state you think you are in is less positive than the state you compare yourself to. Consider this formula:
Mood=Perceived state of oneself Hypothetical benchmark state
If the numerator in the Mood Ratio is high relative to the denominator--if the comparison is positive--you feel pleasure. If the numerator in the Mood Ratio is low relative to the denominator--that is, if the comparison is negative--you feel pain.1 And if you also feel helpless to change the situation or your thoughts, you will then feel sad. A continuation of this state of sadness hardens into depression.
The comparison may be with respect to many possible personal characteristics-- occupational success, personal relationships, health, and morality, for a few examples. You may compare yourself on several different characteristics from time to time. As long as the bulk of your self-comparison thoughts are negative over a sustained period of time, and you continue to feel helpless to change your situation, you will be depressed.
The most convincing proof that sadness is caused by the unfavorable comparison of actual and counterfactual situations is your own introspections. Check and you will observe negative self-comparisons prominent in your thoughts when you are sad--whether the sadness is part of a general depression or not. And there is now a good-sized body of technical studies showing that what are commonly called "negative thoughts" accompany depression and are unusually common among people who have a propensity for depression.
Only this analysis makes sense of such exceptional situations as the person who is poor in the world's goods but nevertheless is happy, and the person who "has everything" but is miserable; not only their actual situations affect their feelings, but also the benchmark comparisons they set up for themselves.
The sense of loss--which often is associated with the onset of depression--also is a negative comparison, a comparison between the way things were and the way they are now. A person who never had a fortune does not experience the loss of a fortune in a stock market crash, and does not suffer grief there from.
Before we discuss how you can manipulate the Mood Ratio in order to remove depression, let us compare this view of depression with the conventional psychological views of depression.
Freud and his followers--who until the past few decades dominated psychological thinking about depression in the twentieth century, have viewed depression simply as a result of loss. "Melancholy is in some way related to an unconscious loss of a love object, in contra distinction to mourning, in which there is nothing unconscious about the loss.... In grief the world becomes poor and empty; in melancholia it is the ego itself that becomes poor and empty" (l9l7-l925, p. l55). Freud arrived at this idea because he observed great similarity between the depression of people grieving after a death, and other depressives. But the idea of loss by itself is not useful as the central concept in understanding depression. Unless one employs a tortured logic, the notion of loss does not fit the psychological states of many depressives. For example, being convinced that one is of low moral character can feed one's depression, but it is not a loss in any meaningful sense; the person probably does not think of him/herself as ever having had the high level of morality that is the benchmark for the negative self-comparison. A Freudian may find a way to define this comparison as a loss, but such reasoning only confuses the issue.
The psychoanalysts then joined the Freudian notion of loss to the observed fact that people whose parents die, desert them, or cut them off emotionally in childhood, have a higher likelihood of adult depression than do other people. This observation was then combined with a medical approach to depression as an ailment that should be treated by dealing with the root cause of the childhood loss. This view of depression and its cure are diagrammed in Figure l. In this scheme, both the sadness and the negative self- comparisons are seen as symptoms of the underlying causes.
Figure 1
The medical view of depression has at least two crucial drawbacks: (l) the therapy based upon it does not have a good record of success in curing depression; and (2) even where it is successful, such therapy is enormously costly in time and money.
A very different view of depression--whose roots may be found in the emphasis on self-esteem by William James, who now is finally being recognized as the greatest of all psychologists, and a better student of human nature than Freud--is in the spirit of what is commonly called "cognitive psychotherapy". Cognitive psychotherapy, which by now is perhaps the dominant position in contemporary psychology, views the person's present thinking as in the middle of the chain of causality running from the person's childhood and present events at the input end to the sadness at the output end, as seen in Figure 2. The "irrational thinking" which both Albert Ellis and Aaron Beck emphasize as the cause of depression is consistent with this point of view.
Figure 2
At the foundation of the cognitive point of view is the age-old commonsense idea that each of us has at least some power to decide what we will spend our moments thinking about, and which other persons, events and ideas we will attend to. This is in sharp contrast with the psychoanalytic view, which considers our thoughts to be mainly determined by our personal history and present external events. Of course the difference between these two points of view is a matter of emphasis, but the emphasis is all- important in deciding how to tackle a case of depression.
The cognitive view holds that we can use their minds to deal with our inner problems just as we deal with our outer problems. For example, we assume that an ordinary person can say to himself or herself, "Now I'm going to stop watching television and start doing my income-tax return," and then the person can carry out that decision. Similar, the cognitive view is that you can say to yourself "Every time a customer makes me feel that I haven't done a good job, which usually puts me into a blue funk, I will remind myself how many of my customers appreciate me". Another example: In the cognitive approach, an excellent 40-year-old tennis player learns the habit of remembering, after a bad day on the courts, that he can beat 99% of the 20-year-old players, and also remembering how many people are not even physically fit to play tennis at all at age 40.
Self-Comparisons Analysis, as I call this point of view, is consistent with the cognitive view of human psychology that one can banish depression by changing the depressive's present mode of thinking. But the Mood Ratio is more precise in its identification of the depression mechanism than simply referring to "irrational thinking" or "negative thoughts" or "poor cognition". This formulation offers several avenues for fighting depression--by altering the numerator, or the denominator, or the dimension of evaluation, or the frequency of any evaluations, rather than focusing only on the numerator (and perhaps on the denominator), as do cognitive therapists. Furthermore, Self-Comparisons Analysis opens up a wholly new way of combating depressions that resist other approaches--Values Therapy.
Why Do Some People Have A Tendency To Get Depressed?
Unflattering self-comparisons come into everyone's mind from time to time. And everyone occasionally feels helpless. But some people--chronic depressives--continually make negative self-comparisons. Their prevailing mood therefore is sadness, and a sense of worthlessness accompanies the sadness even if the negative self-comparison apparently has nothing to do with the person's own worth--say, the loss of a beloved mate. Other depressives suffer from intermittent bouts of negative self-comparisons, either cyclically or irregularly. Both types of depressives have a special propensity to make negative self-comparisons.
How and why do some people get into the habit of making negative self-comparisons whereas other people do not? Among the possible influences are early separation of a child from a parent, especially by the parent's death; cold, unloving, or untrustworthy parents; genetic-chemical biological inheritance; overly-ambitious professional or moral aspirations; a series of experiences of failure and rejection in childhood or adulthood; and major personal or professional shocks in adulthood. It is usually a combination of influences that make any given person a depressive.
The depression sufferer wants to know: How can I, alone or with a counselor, alter these elements or their effects so as to produce fewer negative self-comparisons and hence less sadness, and thereby pull me out of depression?
The basic causes of the depression certainly are not irrelevant. And for any particular person it may prove reasonable or necessary to go back to the basic causes as part of curing the depression--or it may not be necessary or reasonable to do so. For now, let us focus on the fact that no matter what the basic cause is, there must be negative self-comparisons and a sense of helplessness or there will be no depression. To say the same thing positively: Eliminate the negative self-comparisons and/or the sense of helplessness, and you eliminate the depression, no matter what does or does not happen with the basic causes.
This analogy may help: Your mind is like a system of minor and major streams that join up to form a river, which then passes through a narrows before it flows toward your city. Sometimes the river breaks loose and floods the city. The streams are like the basic causes of the depression. You may or may not be able to identify which stream or combination of streams constitutes the original cause. And even if you are successful in identifying the causal streams, you may or may not be to dam up or re-channel it or them. But if you turn your attention to the narrows, you know that if you dam or re-channel the river at that point you can prevent the depression from flooding you with sadness.
The self-evaluative process is like the narrows. If you choke off or re-direct your thoughts at that point, you can prevent the damaging flow of negative self-comparisons.
The key element for understanding and dealing with depression, then, is the sadness- producing negative comparisons between one's actual and benchmark hypothetical situation, together with the conditions that lead a person to make such comparisons frequently and acutely and make you feel helpless to chance the situation.
How may we manipulate the comparison-producing mechanism so that we prevent the flow of negative self-comparisons? There are several possibilities for any given person; one or another may be successful, or perhaps some combination will prove best. The possibilities include: changing the numerator; changing the denominator; changing the dimensions upon which you compare yourself; and making no comparisons at all. Let's consider them one by one.
Improving Your Numerator
Are you as bad as you think you are? If you have an incorrect unflattering picture of some aspects of yourself that you consider important, then your self-comparison ratio will be negative fallaciously. That is, if you systematically bias your estimate of yourself in a manner that makes you seem to yourself objectively worse than you really are, then you open yourself to needless negative self-comparisons and depression.
Keep in mind that we are now talking about assessments of yourself that can be checked objectively. An example: Samuel G. complained that, in his terms, he was a consistent "loser" at everything he did. His counselor knew that he played ping-pong, and asked him whether he usually won or lost at ping-pong. Sam said that he usually lost. The counselor asked him to keep a record of the games he played in the following week. The record showed that Sam won a bit more often than he lost, a fact which surprised him. With that evidence in hand, he was then receptive to the idea that he was also giving himself a short count in other areas of his life, and hence unnecessarily producing a negative self-comparison ratio.
Biased self-estimates are what Beck calls "distortions of reality based on erroneous premises and assumptions" and Ellis calls "irrational thinking". Such biased assessments are similar to faulty research into the facts of your life situation. Just as a student can be taught to do valid social-science research in university, and just as a child in school can improve her information-gathering and reasoning with guided practice, so depressives in the course of psychotherapy can be taught better information-gathering and processing. And if a person judges his situation in the light of a biased sample of experience--that is, an incorrect "statistical" analysis of life data and an unsound definition of the situation--he is likely to misinterpret reality.
In many cases, bringing this habit of making biased self-assessments to depressives' attention has helped them to correct their information-gathering and information-analyzing processes, and hence to remove depression. In one case I observed, Rachel J. was a woman very successful in her profession who was often depressed for long periods of time whenever her job hit an unsuccessful outcome; in her mind she ignored all her successes while ruminating on the recent failure. I was able to teach this woman to keep in mind a wider sample of her experiences in her profession after she had a failure. This tactic lightened the pain of her sadness, and greatly shortened the periods she was depressed after professional rejections.
People can and do distort the facts about any of the aspects of their lives that are important to them Sometimes people simply have wrong information about the world and about how well others perform because they collect data in a biased fashion. One of the virtues of the "sexual revolution" is that people now have a lot more information about what other people do, and hence nowadays people are less likely to consider themselves unusual with respect to such activities as masturbation or oral sex. This means that fewer people give themselves negative self-ratings as a "sinner" or "pervert".
Others, however, underestimate themselves systematically because they have a need to compare themselves unfavorably with others. For example, Geraldine M. insisted that she was incapable of doing many ordinary things done by ordinary people, that she was "incompetent". This caused much sadness, even though she is in fact one of the most successful women in her occupation. She frequently cited her inability to ride a bicycle as an example. In exasperation, her husband found a teacher who, in two lessons, taught Geraldine to ride unassisted around a large parking lot. She never went near a bicycle again, however, continuing to insist that she could not "really" ride a bicycle and is really an incompetent person.
People like Geraldine cannot be helped simply by teaching them to collect information more accurately, as can the other type of person mentioned above. Rather, the Geraldine types must think through why they feel the need to bias the facts negatively. Some of them are afraid to accept positive facts because they are afraid they will be punished by others for doing well. For others, a rotten numerator gives them an excuse to themselves, or to others, not to do some things they don't want to do.
If you can raise your numerator--if you can find yourself to be a better person than you now think you are, on the facts--then you will make your self-comparisons more positive. By so doing you will reduce sadness, increase your good feeling, and fight depression.
Sweetening Your Denominator
"Compared to what?" Voltaire asked, when told that life is hard. The denominator is the standard of comparison that you habitually measure yourself against. Whether your self-comparison is favorable or unfavorable depends as much upon the denominator you use as upon the supposed facts of your own life. The standard of comparison can be what you hope to be, what you formerly were, what you think you ought to be, or what you think others--to whom you compare yourself--are like.
"Normal" people alter their denominators rather flexibly in accordance with the implicit rule that the denominator should be chosen in such a manner as will make you feel good about yourself. That is, the psychologically-normal tennis player chooses opponents who provide an even match--tough enough to provide invigorating competition, but sufficiently easy so one can win enough to feel successful. The depressive personality, on the other hand, may pick a strong opponent who almost always wins. (A person with another sort of problem picks an opponent who is so weak that he or she provides no exciting competition.)
In the more important of our life situations, however, it is not as easy as in tennis to choose an "appropriate" denominator for the standard of comparison. A boy who is physically weak and un-athletic relative to his grammar-school classmates is stuck with that as a fact. So is the child who is slow at learning arithmetic. So is the big-boned thick-bodied girl. A death of a spouse or child or parent is another fact which one cannot deal with as simply as one can change tennis partners.
Though the denominator that stares at you in the mirror may be fact, this does not mean that misery is your inexorable fate. People change schools, start new families, or retrain themselves for occupations that fit them better than the old ones. They find ways to accept difficult facts as facts, and to alter their thinking so that the unpleasing facts cease causing distress. But some people do not manage to free themselves from denominators that hag-ride them into depression, and sometimes all the way to death by suicide or other depression-caused disease.
We must know, therefore, how and why some people appropriately adjust their denominators while others do not. Some people do not change their denominators because they are unaware--for lack of experience or imagination or flexibility--of relevant possibilities. For example, until he got some advice, three-time occupational loser Joe T. had never even considered an occupation for which his talent later enabled him to succeed. Others are stuck with pain-causing denominators because parents insisted that unless the child would reach certain particular goals--say, a Nobel prize, or becoming a millionaire--the child could consider her/himself a failure in the parent's eyes. Still others believe that attaining certain goals--curing others of illness, or making a life- saving discovery, or bringing up several happy children--is a basic value in itself, and should not be altered simply because it causes pain to the person who holds that goal. Still others feel that they ought to have a denominator so difficult to attain that it stretches them to the utmost, and/or keeps them miserable.
The worst possible denominator is the belief that you should be perfect in everything that you do. Associated with this denominator often is the belief that you have an obligation to remind yourself of every lapse by constant self-criticism, and that you ought to punish yourself for each such departure from perfection as a device to flay you into better performance.
If a denominator is killing or depressing you, I recommend that you proceed in these steps, which run from easier to harder:
(l) Ask yourself honestly whether you would like to change your denominator to one that will give you less pain, sadness, and depression.
(2) If your answer was "no" in Step l, go to Step 6. If you answer "yes", then consider whether you can change the objective conditions that give rise to the denominator that yields negative self-comparison.
(3) If changing jobs, colleagues, or what-have-you is not the answer for you, ask yourself whether your denominator--the benchmark standard to which you compare yourself-- is one that you feel you "must" retain. If you feel no such powerful "must", change the benchmark.
(4) If you feel that you are unable to change the benchmark standard of comparison by deciding to do so, and if the benchmark is general (such as a level of occupational achievement) rather than specific (such as producing as many insurance sales as the average man or the top man in your firm) then you might consider delving into your past to learn when and how you developed that denominator. Sometimes this historical adventure in psychotherapy leads to changing the denominator.
(5) If you do not wish to, or cannot, dig into your personal history to discover the roots of the troublesome denominator, or if after finding out the origins of the denominator through a search of your personal history you still prefer to hold onto the benchmark standard of comparison, then you may get tougher with yourself: You may demand and require of yourself that, by act of will and habit, you give up the old standards and instead compare yourself to standards that will make your comparisons positive rather than negative.
Shutting off the pain of depression would seem to be irresistibly attractive. But for many people this is not compelling, as we shall see later. Hence you must look for another reason for changing the denominator by brute force. The reason can be that there is something else which is very very important to you--say, the well-being of a beloved spouse or children--which is being injured by your negative self-comparisons. That is, the importance to you for that reason of making yourself happy for the sake of spouse and children can be sufficiently great so that you are willing to make the decision, and to do the work of implementing the decision, to change the denominator by force. (I myself might have taken this course of action, but I took a related but somewhat different course as I'll describe below.)
Can this actually be done? Of course it can be done, and it is done all the time. Think of the paraplegics confined to wheelchairs after accidents who take up wheelchair basketball, enjoy it vastly, and stoutly refuse to compare themselves to players who can run and jump when they play (or to themselves before the accident). Think of the Danish novelist who, if she wrote in a world language such as English, would be read by millions instead of by only a few thousands of her compatriots; she keeps herself cheerful thinking of the importance of bringing fine stories to a small number of people in their native language. Think about the postal clerk who, when lamenting his inadequate salary, forces himself to compare that salary to his father's laborer's wage, and to the wages of postal clerks in Asia and Africa.
(6) If your response in step (l) was "no"--as it is for a surprising number of persons--ask yourself whether you don't work to change denominators because (a) you want to feel pain, or (b) because you think that the denominator you now have is so important in itself that you feel you should not allow yourself to change it just for your own well- being. If you want to feel pain, perhaps it is because you think you ought to feel pain because you are so "bad". This may turn out to be a problem in improving your numerator, finding out that you are not "really" as "bad" as you think you are when you objectively assess your supposed sins and the sins of other people.
If you don't want to change denominators because you believe that the denominator reflects your most basic values, then continue to step 7.
(7) If none of the foregoing devices for giving you a more livable denominator seems promising for you, then perhaps you will most successfully battle your depression by changing dimensions of comparison, or by reducing the number of comparisons, or with the help of Values Therapy. These tactics will be discussed in succeeding sections.
New Dimensions and Better Ratios
If you can't make the old Mood Ratio livable, then consider getting a new one. This is the way all of us treat a troublesome washing machine or a broken violin, and it also is a sound way to proceed with troublesome self-comparison ratios.
Finding the basis for personal comparisons on which one comes up positive is, in fact, the way that most people construct an image of themselves which makes them look good, to themselves and to others.
The life strategy of the healthy-minded person is to find a dimension on which he or she performs relatively well, then argue to oneself and to others that it is the most important dimension on which to judge a person.
A 1954 song by Johnny Mercer and Harold Arlen went like this: "You've got to accentuate the positive...Eliminate the negative...Latch on to the affirmative...Don't mess with Mister In-between." That sums up how most people arrange their view of the world and themselves so that they have self-respect. This is often unpleasant to other people, because the person who accentuates her or his own strengths is thereby accentuating what in other people is less positive. And the person often proclaims intolerantly that that dimension is the most important one of all. But this may be the price of self-respect and non-depression to many people--much of the price being paid by others.
A more attractive illustration: appreciating your own courage is often an excellent way to shift dimensions. If you have been struggling without much success for years to convince the world that your fish-meal protein is an effective and cheap way of preventing protein-deficiency diseases in poor children (an actual case), you may be greatly saddened if you dwell on the comparison between what you have achieved and what you aspire to achieve. But if you focus instead upon your courage in making this brave fight, even in the face of the lack of success, then you will give yourself an honest and respectable positive comparison which will make you feel happy rather than sad, and which will lead you to esteem yourself well rather than poorly.
Another example: Bert F. is a poet who has struggled for years to win readers and respect for his poetry--with only occasional small success and never a really big success. Whether it is his ideas or his unconventionally simple style that keep him from succeeding, he does not know. He continues to believe that his poetry is fine and exciting work, but the overwhelming critical disinterest in his work finally wore him down and left him depressed. After months of deep sadness he decided that he could at least give himself high marks for courage and fortitude. And now when his mind turns to the failure of his poems, he consciously directs his mind to his courage--and this lifts his spirit. There are many physically-disabled persons who struggle to learn and work against tough odds, and who keep up their spirits with much the same device.
Counting one's blessings is the traditional label for the act of focusing on dimensions that will make us happy: remembering one's good health when one loses one's money; remembering one's wonderful loving children when the job is a failure; remembering one's good friends when a false friend betrays one, or when a friend dies; and so on.
This anecdote--a question put to former astronaut Edwin E. Aldrin, Jr.--shows how a person may shift to new dimensions of life to find happiness.
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The aftermath of Apollo II made me realize that I had no idea what I was looking for in my life. It took hospitalization for psychiatric treatment and the acceptance of myself as an alcoholic to make me see that faith, hope and love for people are infinitely better goals than individual achievement. (Family Weekly, February 26, l978, p. 2)
Some people, however, are not so flexible in their choice of dimensions on which to compare themselves; they cannot choose at will the best "line of goods" for them to carry. For others this is a matter of basic values; they will not accord importance to characteristics simply because it is psychologically convenient to do so. In some cases, people seem to get stuck with dimensions that cause them sadness because of destructive implanted values in childhood, for example, that one should get maximum formal education, or that one should not think bad thoughts. In some other cases, people seem to purposely focus only on dimensions which make them look bad in their self-comparisons; all of us have met people who live exemplary lives in all apparent respects but who flay themselves with scourging whips because they think they don't do enough for the community or for their aged parents or relatives.
How can you, even if you are the type that doesn't typically change dimensions of evaluation to suit your own psychological convenience, do so anyway? One way is to demand of yourself that you do so in the name of a higher value. This is another example of Values Therapy, and this is what cured me of my l3-year-long depression. The higher value was the welfare of my children, which I believed was being threatened by my continued depression. In my hierarchy of values, the welfare of my children was all-important. Therefore, I decided that I simply would not allow myself to make the comparisons of my actual occupational achievements to the aspirations I have had for my work, or to the achievements of some others whose work has been better received than mine. I determined that whenever such comparisons came into my mind I would either turn my mind toward other comparisons such as the wonderful health of our family relative to the bad health that luck could have given us, or to the happy home life I mostly have, or to the useful role I play in the lives of some friends and colleagues, or the peacefulness of our lives--or else I would make no comparisons at all. More about this in a moment.
The Sound of a Numerator Clapping
No self-comparisons, no sadness. And no sadness means no depression. So why don't we just get rid of self-comparisons completely?
A practicing Zen Buddhist with an independent income and a grown family can get along without making many self-comparisons. But for those of us who must struggle to achieve our ends in the workaday world, some self-comparisons are necessary to keep us directed toward achieving these ends. Nevertheless we can, if we try, reduce the number of self-comparisons by doing other things instead.
Absorbing work is perhaps the most effective device. It is usually available, and it requires no special discipline. While you are thinking about the task at hand, your attention is effectively diverted from comparing yourself to some benchmark standard. After my first year of depression, it was my ability to dive down into work for two to four hours every morning that gave me some respite from my constant pain of sadness and awareness of worthlessness.
Many depressed people do not manage to work. This may be because they feel hopeless that the work will amount to anything. But others may not work because they are not aware of the enormous therapeutic possibilities of work.
Another way to shut off self-comparisons is to care about other people's welfare, and to involve yourself in helping them. This old-fashioned remedy against depression-- altruism--has been the salvation of many. In a book reporting more than three decades of the life histories of a hundred Harvard students starting before World War II, George Vaillant documents how turning to altruistic activities saved several of these men from adulthood hells. Perhaps this is a fair translation of what Jesus meant when he said that in order to save one's life one must lose it--that is, by giving it to others.
How may one become altruistic? All I can suggest is that you may decide to do so, either because you come to realize that it is one of your most important values to be altruistic, or because you are so anxious to cease being depressed that you are willing to give part of your time and strength and thought to others, or some combination of both.
Meditation is the traditional Eastern method of banishing negative self-comparisons. The essence of meditation is to shift to that special mode of concentrated thinking in which one does not evaluate or compare, but rather simply experiences the outer and inner sensory events as full of interest but without emotion.
Making comparisons is the most basic element in any evaluation or judgment. Comparing is a process of developing and using abstract concepts to deal with the sensations that your mind receives from inside and outside your body. The various forms of meditations, and of Eastern religious practices generally, are devices to orient you away from abstraction, judgment, comparison, and evaluation, and toward the primitive sensations themselves. Meditation also points you toward the judgment-free perceptions of the sensory world, and perhaps toward cosmic imaginations that often arise from the elementary experience in meditation.
Some Eastern religious practitioners seek the deepest and most continuous meditation in order to banish physical suffering, while others do so for purely religious purposes. But the same mechanism may be used as a very effective weapon against negative self- comparisons and depression while participating in everyday life. When, while walking the dog or driving to work or trying to sleep, a negative self-comparison comes into your mind--"What an immoral louse I am," or "I just can't do anything right"--then you can turn off the comparing mode and turn on the experiencing mode by this well-known device: Breathe in with your diaphragm so that your belly inflates deeply and slowly, and then deflate slowly; then continue to repeat the cycle. At the same time focus your attention on your breathing, or on a leaf, or on some other unemotional stimulus, perhaps saying to yourself, "Don't criticize," or "I don't need to compare." Soon you may find yourself smiling--just as I now am smiling as I am breathing in accord with the instructions I've just written. (It is difficult to believe how powerful and exciting such breathing is until you have taught yourself to do it. Someday I'll write a piece entitled "Confessions of a sensual breather"). There are many excellent books on meditation by Easterners and Westerners that go into much more depth and detail, and describe varied approaches; a good paperback on this topic is The Relaxation Response by Herbert Benson and Miriam Z. Klipper.
Getting Back Hope
Negative self-comparisons by themselves do not make you sad. Instead, you may get angry, or you may mobilize yourself to change your life situation. But a helpless, hopeless attitude along with negative self-comparisons leads to sadness and depression. This has even been shown in rat experiments. Rats that have experienced a series of electric shocks which they cannot avoid, later behave with less fight and more depression with respect to electric shocks that they can avoid, than do rats that did not earlier experience unavoidable shocks. The rats that experienced unavoidable shocks also show chemical changes like those associated with depression in humans.
It behooves us, then, to consider how to avoid feeling helpless. One obvious answer in some situations is to realize that you are not helpless and you can change your actual state of affairs so that the comparison will be less negative. Sometimes this requires gradual relearning through a graded series of tasks that show you that you can be successful, eventually leading to success in tasks that at the beginning seemed overwhelmingly difficult to you. This is the rationale of many behavioral-therapy programs that teach people to overcome their fears of elevators, heights, going out in public, and various social situations.
Indeed, the rats mentioned in the paragraph above, which learned to be helpless when given inescapable shocks, were later taught by experimenters to learn that they could escape the later shocks. They then showed diminished chemical changes associated with depression after they had "unlearned" their original experiences.
Something Else: Values Therapy
You're at the end of your rope, let's say. You believe that your numerator is accurate, and you see no appealing way to change your denominator or your dimensions of comparison. Putting aside all comparisons, or reducing them radically, does not attract you or does not seem feasible for you. You'd rather stay away from anti-depression drugs and shock treatment. Is there still any hope for you?
Values Therapy may be able to rescue you from your end-of-the-rope desperation. And it can also help people who are not at the end of their ropes, in preference to other approaches to depression. The central element of Values Therapy is discovering within the depressed person a latent conflicting value or belief that causes the person to modify or constrain or oppose the belief (or value) that leads to the negative self-comparisons. Russell describes his passage from a sad childhood to happy maturity in this fashion:
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Now, on the contrary, I enjoy life; I might almost say that with every year that passes I enjoy it more. This is due partly to having discovered what were the things that I most desired, and having gradually acquired many of these things. Partly it is due to having successfully dismissed certain objects of desire--such as the acquisition of indubitable knowledge about something or other--as essentially unattainable. (Russell, l930, p. l5, italics added.)
The discovered value may be (as it was for me) the value that says directly that life should be happy rather than sad. Or it may be a value that leads indirectly to a reduction in sadness, such as the value (which also acted in me) that one's children should have a life-loving parent to imitate.
The discovered value may lead you to accept yourself for what you and your limitations are, and to go on to other aspects of your life. A person with an emotionally-scarred childhood, or a polio patient confined to a wheelchair, may finally accept such a fact as fact, cease railing at and struggling against fate, and decide not to let these handicaps dominate but rather to pay attention to what one can contribute to others with a joyful spirit, or how one can be a good parent by being happy.
Value Therapy need not always proceed systematically. But a systematic procedure may be helpful to some. At the least it makes clear what operations are important in Value Therapy. Such a systematic procedure may be described as follows:
Step l): Ask yourself what is important to you, what you most want in your life. Write down the answers. The list may be long, and it is likely to include very disparate sorts of items ranging from peace in the world and professional success, to a new car every other year and your oldest daughter being more polite to her grandmother.
Step 2): Now order these desires according to their importance to you. One simple way to do this is to put numbers on each want, running from, say, "l" (all-important) to "5" (not very important).
Step 3): Now ask yourself whether any really important things have been left off your list. Good health for yourself and your family? The present and future happiness of your children or spouse? The feeling that you are living an honest life? Remember to include matters that might seem important when looking back on your life at age seventy that might not come to mind now, such as spending plenty of time with your children, or having a reputation as a person who is helpful to others.
Step 4): Next, examine the list to see where there are conflicts, and/or if there are conflicts that are resolved in a manner that contradicts the indications of importance that you accord to the various elements. For example, you may put health for yourself in the top rank, and professional success in the second rank, but you may be working so hard for professional success that you are doing serious harm to your health, with depression as a result. Or--as was the case with me--the future and present happiness of my children is at the top of the list, and I believe that the chance that children will be happy in the future is much better if their parents are not depressed as the children are growing up. Close to the top but not at the top, is success in my work as measured by its impact upon the society. Yet in the past I had invested most of myself in my work. Furthermore, the results were not (at that time) a howling success in terms of their impact upon others, by my criteria. Therefore, thoughts about my work depressed me. This led to the discovery that if I am to live in accordance with my stated values and priorities, I must treat my work in some fashion that I do not let it depress me, for the sake of my children even if for no other reason.
In discussing other people's depressions with them, we usually discover some conflict between top-level values that demand that the person not be depressed, and lower- level values involved in causing the depression. The top-level value that life is a gift to be cherished and enjoyed is a frequent top-level value of this sort. More about that later.
Step 5): Take steps to resolve the conflicts between higher-order and lower-order values in such manner that higher-order values which require you not to be depressed are put in control. For example, if you recognize that too-hard work is injuring your health and depressing you, and that health is more important than the fruits of the extra work, you'll be more likely to face up to a decision to work less, and to avoid being depressed; a wise physician may put the matter to you in exactly this fashion. In my case, I had to recognize that I owe it to my children to somehow keep my work-life from depressing me. Many sorts of devices can help once you take on this task. With respect to work, it is often useful to make and enforce a less-demanding work schedule. Another device is to prepare and follow an agenda for future projects that promises a fair measure of success in completion and in reception. Still another device is to refuse to allow negative self- comparisons concerned with work to remain in your mind, either by pushing them out with brute force of will, or by training yourself to switch them off with behavior- modification, or with meditation techniques.
The result of the value-discovery process may be that a person becomes "twice born," by William James's term. This is radical therapy, like surgery that implants a second heart in a person to aid the leaky and failing original heart.
Values Therapy usually is not an easy and comfortable curve for depression. At the beginning, Values Therapy requires hard mental work and discipline, even with the aid of a counselor, in constructing an honest and inclusive graded list of what you want in life. After you have identified your most fundamental values, you remind yourself of those values whenever you start to make negative self-comparisons and get depressed. But it takes effort and dedication to keep reminding yourself of those values--just as it takes effort to remind another person of important matters when they are being forgotten. (The word "re-mind" is very precise.)
So staying undepressed with Values Therapy is not a piece of cake. But did you really expect otherwise? You'll have to judge for yourself whether the necessary effort is too high a price to pay for being free of depression.
More generally, all the techniques described here exact a price for overcoming depression. Many popular books promise that if you will just come to accept yourself, or just give yourself to God, or just love your neighbor with all your heart, you will immediately and miraculously and effortlessly go from sadness to bliss. Not likely. Such illusory promises can be destructive when they disappoint you. But if you are prepared to pay your dues, then you usually can overcome your depression.
Can You Fiddle Your Own Formula?
So, get your numerator straight, or change your denominator to one that produces positive comparisons, or choose other dimensions on which to compare yourself, or make no self-comparisons at all, or put your highest values in charge. Any or all of these devices may fit your situation and prove to be your own personal salvation.
But--can you climb out of depression by yourself, or must you have the help of a "doctor" to do it for you? I have been focusing on your capacity to help yourself. This is in contrast to the older psychoanalytical position that you are a patient who must have a therapist to "operate" on you. But all the newer scientifically-proven psychotherapeutic approaches and the psychological evidence agree in emphasizing the enormous possibilities for people to help themselves, to drag themselves up by their own bootstraps from depression, and thereby find new happiness.
You want evidence that people can successfully fight depression and find new happiness by one or another of these strategies. Stories of religious conversions are dramatic, as are newspaper anecdotes such as the Buzz Aldrin quote given earlier. Less- dramatic but better documented scientifically are the changes observed in depressed persons by practitioners of cognitive therapy such as Beck and Ellis, who work on clarifying people's numerators and sometimes altering their denominators. Also impressive proof that people can alter their moods by sheer decision and determination is the evidence of people's behavior on happy religious holidays, and especially the behavior of Orthodox Jews every Sabbath Saturday. No matter how miserable the person's life during the week, Jewish religious law requires that a person not be sad--not even to mourn the dead--on the Sabbath. And by and large, Orthodox Jews therefore manage to enjoy their lives on the Sabbath by demanding of themselves that they do so. In fact, though I am by no means an Orthodox Jew, three or four years before I cured my depression for seven days a week, I first found temporary surcease from my depression one day a week on the Sabbath.2
There is also rigorous scientific proof of the efficacy of cognitive therapy, proof that never existed before for any form of psychotherapy. The U. S. Public Health Service summarizes as follows: "Eighty percent of people with serious depression can be treated successfully. Medication or psychological therapies, or combinations of both usually relieve symptoms in weeks." Both kinds of treatment have been shown in controlled experimental research to benefit a large proportion of depression sufferers, within a few months or even weeks. Drugs, however, control the depression, whereas psychological therapy can cure it.
A counselor or therapist may help, of course, and may even be indispensable. But often the role played by the therapist is that of teacher, instructing you how to help yourself by new ways of thinking, which many of us are able to learn without hours of professional help.
Viewing the therapist as a "doctor" who has special helping powers that border on the miraculous may help you for a while, just as a sugar pill can bring improvement in physical ailments. If you are impressed by the promise of magic, a therapist may be able to re-educate you more effectively than a book or your own unaided powers can do alone. And of course a therapist may be a wise and experienced person who, like an experienced and wise teacher of any subject, can help you learn the ideas and the habits that fit your needs. But by no means every therapist is wise and helpful, even though highly trained. Some therapists point you in the wrong direction and mis-educate you because they cannot correctly assess what you need, or because they have been trained in only a single technique and use that technique willy-nilly even if it is appropriate for a given client, or because they are ignorant and stupid. (Yes, Virginia, people can earn Ph.D. degrees and yet be ignorant--even stupid--about everything except how to pass tests in school.)
My recommendation: First consider trying to banish your depression by yourself using the methods described here. If you can't manage satisfactorily, look for help. But be very discriminating about the therapist whom you choose, and don't be afraid to switch quickly if you judge that the therapist is not right for you. And try to understand what the therapist is doing in the framework of the New Happiness Formula.
Anti-depression Drugs, Electroshock and The Formula
Where do electroshock and anti-depression drugs fit into the picture? Drugs and electroshock can relieve painful sadness--at least after a while, and for a while--in many depression sufferers. Sometimes they also shake people out of vicious circles that keep them from making a curative attack on their problems. And sometimes these shock and drug treatments are enough to restore people to full normal life.
Electroshock and drugs sometime have physical and psychological side-effects, however. And for some people these techniques only postpone the day when they must finally reckon with the structure of their psyches, and come to grips with how they think, feel, and view the world and themselves. Furthermore, there can be great spiritual benefits in the self-understanding and self-satisfaction that one gains in mastering one's depression with one's own resources.
So--different strokes for different folks. You and your physician will have to decide about drugs and electroshock. As a general matter, however--try your own resources and Self-Comparisons Analysis first. If that works and makes drugs or electroshock unnecessary, so much the better.
Do You Really Want To Escape From Depression?
There is one indispensable element If you are to wrestle happiness out of depression: the desire not to be sad but rather to enjoy your life. At first that seems preposterous. Doesn't everyone want not to be sad? No. Many people get benefits from being sad, or are afraid of enjoying their lives, or don't want strongly enough to break out of sadness so that they are willing to make the effort to do so.
Being depressed allows you to feel sorry for yourself. Feeling sorry for yourself is the next most pleasant thing to loving yourself, and that in turn is almost as good as having others be attached to you and love you--which we all want and the lack of which is often a root cause of a person having a depressive nature. Another possible reason why a person does not fight depression is that any effort or exertion of the will implies a sort of pain, and the pain of the effort to crack the depression may seem greater than the pain of suffering from the depression. Still another reason is that the person may lack other strong desires which are inconsistent with being depressed--the desire that my children not be harmed by it, in my case. This brings us back to Values Therapy.
Some are so deeply mired in depression that they lack energy to break out of it. This latter state is "clinical depression," which may require drugs or electroshock or other radical therapy to get the person's motor started again so that the person has the will and the energy to reorganize her or his thinking to banish depression. But the reader of this piece--just because he or she has had the energy to find and read it--is not likely to be so lacking in resources with which to fight.
Once More With Good Feeling
Here once again in summary is the method: Check whether you can improve your numerator by accurately gathering the facts about yourself, and analyzing them appropriately. If that does not remove your depression, try sweetening your denominator by changing the standards against which you compare yourself. Next, consider evaluating yourself on dimensions different than those you now use. Additionally you may reduce the negative self-comparisons which produce sadness by reducing all comparisons and evaluations--with work, altruistic activity, or meditation.
For the person (a) whose numerator is not demonstrably at variance with the objective facts of his or her life, (b) who is not willing or able to change denominators for the sake of avoiding suffering, and (c) who will not change dimensions of comparison or stop making comparisons simply to avoid the pain of the depression, there may yet be another solution: Values Therapy. In Values Therapy you analyze your own personal desires in order to determine which values are most fundamental and important for you--your children's welfare, your spouse's welfare, your health, your contribution to others, material possessions, wealth, and so on. Then you go further and struggle to determine the hierarchy of these values--which are more important then which others. Next you consider whether achieving any of your most important values is inconsistent with being depressed--for example, the religious Jew's value for enjoying life on the Sabbath, or my value that my children have an undepressed father. If you can identify such important values, then if you are truthful with yourself you will bend every effort to force yourself to avoid negative self-comparisons even at the cost (at first) of energy and thought (later it becomes a habit), and you will give up the benefits of depression (feeling sorry for yourself, having an excuse not to do various chores, and so on).
It was this sort of values confrontation that broke my depression and allowed me to attain reasonably steady enjoyment of life, with occasional bliss and even the touch of ecstasy that is my happy lot now.
If Self-Comparisons Analysis and Values Therapy help you as much as I believe they can, this will improve my numerator, and make it even easier for me to keep winning my fight against depression. If out of my pain can come less pain and sadness for you, that, for me, is the bottom line.
FOOTNOTES
1Mathematical purists may notice that I sometimes say that this "ratio is negative" when it is really positive but less than one. When I say the "ratio is negative" I mean that the comparison of numerator to denominator is negative.
2Holidays such as Christmas also affect many depressives negatively, but that is a different sort of mechanism that need not be discussed here. The depression mechanism causes the sadness. If you under-stand and manipulate the mechanism properly, you can get rid of the sadness. Figure 4 pictures the depression mechanism. It shows the main elements that influence whether a person is sad or happy at a given moment, and whether the person does or does not descend into the prolonged gloom of depression. From left to right, these sets of elements are as follows:
(l) Experiences in childhood, both the general pattern of child-hood and particularly traumatic experiences, if any.
(2) The person's adult history, with the recent experiences having the greatest weight.
(3) The actual conditions of the individual's present life, including relationships with people, and objective factors such as health, job, finances, and so on.
(4) The person's habitual mental states, his views of the world and himself. This includes his goals, hopes, values, demands upon himself, and ideas about himself, including whether he is effective or ineffective and important or unimportant.
(5) Physical influences such as whether he is tired or rested, and anti-depression drugs if any.
(6) The machinery of thought which processes the material coming in from the other elements and produces an evaluation of how the person stands with respect to the hypothetical situation taken for compar-ison. The main lines of influence from one element-set to another are also shown in Figure 4. Figure 4 Benson, Herbert, with Miriam Z. Klipper, The Relaxation Response (New York: Avon Books, 1976).
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When can I begin to discover and complete all of the things that I wish had ended "different, better or more," and all of the broken "hopes, dreams, and expectations" about the future? The answer is immediately, according to John W. James, author of 
Depression is serious. You need to see a general physician as soon as possible-- don't wait longer than a few days. The sooner you get treatment, the sooner you will feel better. You need an appointment with your physician for a complete physical examination to see if there is a medical condition that is causing or worsening your depression, to plan your treatment and for possible referral to a specialist. If you do not have a physician, contact a mental health organization in your area for a recommendation.
I guess you would say that I'm still in denial about having anorexia. I've had two doctors and one dietician tell me that my problems come from my low weight. When I initially went to the doctor because my heart beats too fast, he told me it was the result of an eating disorder. He put me on heart medication.
It was really easy at first and I had no problem doing it until I got weak and constantly felt sick. Not to mention the sore throat. In the beginning, I was 116 pounds. I'm 5'4". Now I realize that wasn't bad at all. I got down to 98 pounds and I was even more upset when no one had noticed that I had shed a pound.
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