TODD, A NICE-LOOKING, well-dressed young man in his early thirties, came to my office for counseling. He immediately told me he was very depressed, by far the most common complaint that brings anyone to a counselor. The therapy or counseling I practice is called reality therapy. It is based on choice theory and focuses on improving present relationships, almost always disregards past relationships, and depends for its success on creating a good relationship between the client and the counselor. As soon as Todd sat down, the following went through my mind.
If he knew choice theory, he would know a lot more about himself than he knows now. But, of course, if he knew choice theory, it is unlikely he’d be in my office because he would not have done what I’m certain he did that brought him to see me today. The need for psychotherapy, or at least for extensive psychotherapy, would be reduced if capable people such as this young man knew and used choice theory in their lives. But he doesn’t know it, so my job is to teach it to him as part of the counseling. What I will teach him is that he is not satisfied with a present relationship, the problem that always brings people to counseling. His past could have contributed to the problem, but even though most current psychotherapies initially focus on it, the past is never the problem.
It is possible that the relationship is with a girlfriend, but that’s unlikely. In my experience few men go into therapy over a girlfriend. At his age, it could be with his mother or father or with a child, but again it is unlikely. In his case, his wife is doing something he doesn’t want her to do. Of course, she may perceive the same of him, but since he is here, he is the person I have to counsel.
When he tells me he is depressed, I’m sure he believes that this misery is happening to him. But I believe he is choosing the misery he is feeling. What I will teach him is that he is choosing to depress to deal with something his wife is doing that he doesn’t want her to do. I will explain why I change the adjective, depressed, to the verb, to depress.
Since all we do is behave from birth to death, in choice theory all complaints are changed from adjectives and nouns (the way most of us express them) to verbs. This change is crucial because it teaches that not only are we actively choosing what we are complaining about, but we can also learn to make better choices and get rid of the complaints.
My counseling will offer him two options. If he chooses one or both of them, he will feel better. If he refuses to choose one or both of them, he will not feel better and very likely will feel worse than he does now. He won’t like these choices—at least not at first—but if he wants to feel better, they are all he has. First, he can choose to change what he wants his wife to do. Second, he can choose to change the way he is dealing with her. Depending on which option he decides he wants, he may do one, the other, or both. When he does, it is almost certain he will feel much better than he has felt in a long time.
Todd will immediately take exception to my claim that he is choosing the misery he feels. Whenever we feel bad, it does not seem like a choice; it seems as if it is happening to us. This is the reason I do not tell clients they are choosing what they feel until I have prepared them with enough information about choice theory so they can understand what I am talking about. If I just tell them straight out, they may get up and leave.
But after two or three sessions, this is exactly what Todd began to understand. In his case, it was too late to help his marriage. His wife had left him before he came to see me and did not come back. But these same choices were helpful with the next woman, whom he later married. If he treated her as he had treated his first wife, that relationship would not have had much chance either. The following is the essence of what we discussed in the first few sessions of therapy. A lot of the getting-acquainted talk and banter, during which we learned about each other, is omitted here, but it was important for us to do if we were to develop the warm supportive relationship necessary for successful counseling.
Todd came to trust me, and we quickly got down to what to do about the broken relationship with his wife. It was obvious to me that he wanted a good relationship with her. It was also obvious to me that if he couldn’t patch things up, he could probably find another love, but this option was not on his mind when he came in. The following are some short sequences of dialogue, just enough so you can begin to see what reality therapy is. I also pause as I go along to explain what was on my mind at the time, so you can see how I wove choice theory into my counseling. I started this way:
“Todd, what I need is the story. Tell me, what’s on your mind?”
“I’m depressed. I feel terrible. I’m so upset I haven’t been able to go to work for a week.”
“Are you blaming anyone for how you feel?”
At first I look for the relationship that’s gone awry. Then I look to see if he does the usual external control thing and blames someone else—in this case his wife—for how he feels. This question will gain his attention and get the therapy started.
“It’s my wife. She left me. About a week ago I came home from work. She’s usually there, but she wasn’t then. I didn’t think about it too much, sometimes she has things to do. But an hour went by and she didn’t call, and then I noticed it.”
“A note from her, held by a magnet to the fridge, two words, So Long. And she was gone. I went to the bedroom; her stuff was all cleaned out. All her clothes, everything. I was devastated. I mean, I love her. How could she do that to me?”
“I can’t tell you how; only she knows that. But I wonder why? That’s a big move. She must have been really upset about something. What do you think it was?”
“It’s hard to say. It’s really hard to say.”
When a client says, “It’s hard to say,” he usually knows what’s really going on but doesn’t want to talk about it. He may have to admit that he had more to do with what happened than is comfortable. I just break through that reluctance by acting as if it wasn’t there.
“Well, say it anyway. This is the place to say hard-to-say things.”
“Well, I don’t really think I am, but she had been saying I was too domineering—that I called all the shots. But the funny thing was I thought she liked it. She’s a lot younger, ten years, twenty-three years old. I know more than she does. I thought she liked it when I kind of always took over.”
“Do you want her back?
“My God, of course, I want her back. Can you help me get her back?”
I didn’t answer that question. Maybe we need to talk more to try to find out whether her coming back is the best thing for him or even for her. By not answering, I don’t say I can or can’t. But my next question, asking what he has been doing, implies that maybe he could do something better than he has until now. In my experience, that’s how most clients interpret it.
“What have you been doing since she left?”
“Nothing really. I’ve been so upset. I’ve just been sitting home. Some of the guys from the office were worried about me. They came to see me, and one of them gave me your number. I just can’t seem to get myself going. I’ve heard about depression, but I never realized what it was. I’m kind of paralyzed.”
I don’t respond to that remark because I can’t offer him anything that would directly help him feel better. While I listen to him telling me how he feels, I don’t talk much about feelings. He’s here and he’s talking, that’s doing something. I focus on what he’s been choosing to do. I’ve got to get him thinking about choice and choosing, and this is a good place to start.
“Since she left, I gather that you’ve chosen to sit home and not go to work, is that right?”
“Doctor, you don’t understand. I haven’t chosen to sit home.”
“You’re right, I don’t understand. How can you say you haven’t chosen to sit home? Has anyone been making you sit home?”
“But I’ve been upset, too upset to go to work. I haven’t chosen anything. I’ve been upset since I read that note.”
“You chose to come to see me today.”
“But I need help; that’s why I came here.”
“Have you tried to contact her? Have you heard from her?”
“I’ve been hoping she’d call. I thought about trying to find her, but then I thought we might get into a fight and that would make things worse. For a little while I was real angry, and then, when it sank in that she was gone, I got real sad. Doctor, I love her and I don’t know what to do. I don’t want to be domineering; it’s just the way I am. My dad’s like that, but it doesn’t seem to bother my mother. Maybe I learned it from him.”
“Does it matter whom you learned it from?”
“I thought psychiatrists were interested in stuff like that.”
“I’m not interested in your parents. You’re grown up. I’m interested in what you’re going to choose to do now. I’m interested in what you want. And I’m interested in helping you choose some way to get it if I can. We have to deal with the fact that she left. Do you think she’s gone for good?”
“That’s just it. I’ve been racking my brain. I don’t know. If she was thinking of coming back, I think she might have left some of her stuff. It’s all gone, clean. It all happened so suddenly; I just don’t know what to do.”
“Suppose you could talk to her right now. What would you tell her?”
“I’d tell her I’m so sorry. I’d tell her I didn’t know what I was doing. I took her so much for granted. I was such a blind asshole. I thought she loved the way I stuck my nose into everything. It was my criticism. I’d never admit she could do anything right. Always some little thing was wrong. She called me Mr. Perfect, not in a mean way or anything like that, and I kind of thought it was a compliment. We never fought. We made love. About a week before she left, she said that things weren’t working out the way she wanted. She asked if I felt that way. I said that the only thing that bothered me was that she didn’t seem real happy. I told her she should try to be happier. She said she had been trying, but it didn’t seem she could do it. She asked me if I thought there was anything I could do. I said that I’d always done everything I could do. I didn’t see how I could do any more. She said she’d guessed I’d say that. After that she seemed a little happier, and I thought things were better. That was why I was so surprised when she left.”
“You still think you couldn’t have done anything differently?”
“Oh no, no. Now I see I could have done a lot of things differently. But how do I tell her that? She’s gone. I’ve waited for her to call, but she hasn’t.”
“Don’t you want to tell her that you miss her, that you love her, that you’re willing to change?
“Of course, but how? Even if I knew where she was, I’m afraid I’d screw things up worse. I’m not the kind of guy who can admit that it was my fault. The first thing I’d do is blame her. I’m depressed but I’m still a little angry. She shouldn’t have left like she did.”
“Can I make a suggestion? It’s worked for some people I’ve seen.”
“My God, yes, what?”
“Write her a letter. Tell her how much you love her and miss her. And tell her you’ll change. I don’t want to tell you what to write. It has to be you, not me. It has to come from your heart or don’t bother. But you might tell her you’re seeing me for help and ask her if she’d come in and see me together with you. This way she wouldn’t have to be alone with you, and she might be willing to do this much.”
“I could do that. It’s a good idea.”
“This way there’s no pressure; she can read it and think. She won’t have you hanging on the phone; that would be too much pressure. Write the letter and bring it in to me. We’ll look it over together before you send it. Is that OK?”
“That’s good, real good. I like that idea. I’ll be glad to bring it in. That’s good.”
“Tell me, how do you feel now, I mean right now?”
“I feel better, a lot better.”
“Why do you feel better?”
“Because I’ve got something to do. I don’t feel as helpless. It may work; it just might.”
Todd went home and must have really worked on the letter. It was a masterpiece. If he was still in his wife’s quality world, it might work. I thought he had a chance, but her cleaning all her stuff out like that didn’t look good. His wife read the letter and called him. She wouldn’t talk much, and he didn’t pressure her, which was smart. She said she’d come to see me with him, and he made the appointment.
When she came, she didn’t say much. He made a long emotional pitch for her to try it again.
She listened carefully but then she shook her head, no, and said, “Look, we’d been married four years, I owed you this much. You’re not a bad guy; you’re just not for me. If you didn’t know what I was upset about, that really tells me something about you. I’m only twenty-three; I can’t take a chance with you. You sound great now, but it’s only because I put pressure on you. It’s a game for you, and you hate to lose. It’s not a game for me. It’s over. I don’t want anything that’s not my fair share. No alimony, nothing—just my part of what we saved while we were married. I can make it OK by myself.”
She thanked me and left.
Todd was quiet for a long time and then said, “I can’t live without her.”
“That’s a pretty dramatic statement. Are you planning on killing yourself?”
If I had any worry that he was going to commit suicide, I wouldn’t have said it, but he was not the kind of person who was suicidal. He had too much going for him in other parts of his life. What I said seemed to defuse the tension.
“No, I’m not going to kill myself, but I’m going to feel awful for a long time; I really loved her.”
“Take as long as you want. Unhappy people are how I make my living.”
“You don’t take all this very seriously do you?”
“Not very, because I know the rest of the story, and it’s OK.”
“What do you mean you know the rest of the story?”
“I mean that in a short time you are going to find someone else. And if you treat her like you promised your wife you were going to treat her a few minutes ago, you’ll be very happy. That’s how it’s going to end.”
And that’s how it ended. It took a few months for him to get his wife out of his quality world. He was already out of hers. He did find someone and even brought her in to see me. By that time I was so much in his quality world that he wanted me to meet her and approve of her. No one can predict how well a marriage is going to go, so there was no reason for me to do anything but be supportive. He had told the new woman all about me. He had told her the truth about his failed marriage, that he was too domineering. This woman was his age and seemed quite realistic about him.
Since he had told her the truth, I asked her, “What do you think, how has he been with you? Is he taking over your life?”
“No, quite the contrary; he’s been great.”
“But maybe he was great with her in the beginning. That happens, you know.”
He chimed in, “No, it’s not going to happen that way.”
And it didn’t. She was cautious, but in about a year they got married. I saw him a few times during that year. Things were OK. The interesting part is that his first wife called me in about a year to tell me that she was happy, too, that she had met the kind of man she wanted.
Reality therapy now includes explaining choice theory to my clients. While Todd was getting over the loss of his wife and getting started with the new woman, I had a chance to teach him the choice theory that explained what had happened, and he told me that he taught his new girlfriend all I taught him. It seemed to help them both get off to a good start. I especially taught him about his choice to depress. I taught him what to do if a situation arose in which he again was beginning to choose to depress or any other of the common varieties of unhappiness that human beings ordinarily choose.
As I stated, when he came in, I knew he was involved in, or had just lost, a long-term unhappy relationship because that’s almost the only reason a client comes to a psychiatrist’s office. As I explained, I was almost certain it was with his wife. What is more startling to most people is my claim that he was choosing the misery he was complaining about. This is a radical departure from what most people believe, especially from what every client I have ever seen believed when he or she sought psychological help for the painful symptoms he or she identified as depression. When we depress, we believe we are the victims of a feeling over which we have no control. When we depress strongly for a long time, this choice is usually called clinical depression and is considered a mental illness.
A widespread current belief is that mental illness is caused by an imbalance in brain chemicals. To correct this imbalance and to feel better, patients need brain medication, and for depression, most psychiatrists immediately think of a drug like Prozac. I did not think of using any drugs to treat Todd. I did not believe that he was suffering from mental illness. I believed that he chose to depress to deal with the situation and that I would be able to help him make some better choices with no need for medication.
Later, when I was teaching him choice theory, I began by teaching him that all he, or anyone else, can do from birth to death is behave. Examine your own life and try to identify a time when you were not behaving. All your significant conscious behaviors, that is, all behaviors that have anything directly to do with satisfying basic needs, are chosen.
Not only are we always behaving, but we are also always trying to choose to behave in a way that gives us the most effective control over our lives. In terms of choice theory, having effective control means being able to behave in a way that reasonably satisfies the pictures in our quality worlds. When he came to see me, Todd had the picture of himself, still with his wife, in his quality world. He knew nothing about choosing his misery or about his quality world; what he knew was that he felt bad and wanted to feel better.
After he wrote the letter instead of sitting around feeling miserable, he felt better because now he was doing something that might help him solve his problem. In other words, he felt better because he believed he was doing something to regain more effective control over his life. Writing a loving letter to a woman who has left you is a much more effective way to behave than just sitting around choosing to be miserable, and he did feel better. Later, when he changed what he wanted from a picture of his wife in his quality world to his new fiancé in that world, he got almost total relief. Again, these are our choices when we want to stop choosing a painful behavior like depressing: (1) change what we want, (2) change what we are doing, or (3) change both.
It was clear in the therapy that Todd had the ability to make better choices even when he was strongly choosing to depress. If he was able to make these better choices and to stop depressing, then it is also fair to say he was not suffering from any form of what is commonly called mental illness. There was nothing wrong with his brain that prevented him from being able to make these choices. As I explain later, choosing to depress, no matter how strongly or how long in duration, is not a mental illness. Like all our behavior, it is a choice. It is not as direct a choice as walking and talking, but when you understand the concept of total behavior, you will see that all our feelings, both pleasurable and painful, are indirectly chosen. But an indirect choice is still a choice.
To substantiate this claim, I have to explain that we ordinarily use the word behavior much too narrowly. My dictionary defines behavior as the way of conducting oneself. I accept that definition, but I want to expand on the word way. From the choice theory standpoint, that word is important. There are four inseparable components that, together, make up the “way” we conduct ourselves. The first component is activity; when we think of behavior, most of us think of activities like walking, talking, or eating. The second component is thinking; we are always thinking something. The third component is feeling; whenever we behave, we are always feeling something. The fourth component is our physiology; there is always some physiology associated with all we are doing, such as our heart pumping blood, our lungs breathing, and the neurochemistry associated with the functioning of our brain.
Because all four components are working simultaneously, choice theory expands the single word behavior to two words total behavior. Total, because it always consists of the four components: acting, thinking, feeling, and the physiology associated with all our actions, thoughts, and feelings. In this book I occasionally use only behavior, but I always mean total behavior. As you sit reading this chapter, you are choosing to sit, turn pages, and move your eyes and head; essentially, this is your activity. You are also thinking about what you are reading. Otherwise, you couldn’t understand what is written. In practice, when you are acting, you are always thinking, and vice versa. Because they go together, we frequently combine them into one word, doing. When I say I am doing something, I am almost always describing a particular combination of acting and thinking.
You are also feeling something. You are always aware of pain or pleasure. Probably, you are not feeling much right now, but you at least agree with, disagree with, or are thinking about my claim that you choose the misery you often feel and that thinking is always accompanied by some sort of a feeling. You always feel something, even though a lot of the time you do not pay attention to what you are feeling. Also, your heart is beating, you are breathing, and your brain is working; that is, there is always a physiology associated with your choice to act, think, and feel—your total behavior.
Now that I have introduced total behavior, I can explain what I mean when I say that you choose your feelings, both pleasurable and painful. If you pay attention, you can easily become aware that you are feeling something while reading this book. That awareness, however, does not mean that you are choosing what you feel. You may say, I’m aware of my feelings, but they just happen. I’m not aware that I’m choosing them. And I’m certainly not aware that when I’m unhappy, I’m choosing my unhappiness. If I had a choice, as you claim, I certainly wouldn’t choose to be miserable.
But if this statement was true, it would make no sense to see a psychotherapist. What good would it do to talk about your life and your problems if you couldn’t choose to do anything about how you feel? It’s how miserable he felt that led Todd to choose to come to see me. If he had hated his wife and been hoping for her to leave, he’d have felt wonderful and never have come to see me. My explanation of why you believe that you have no control over what you feel is that you have no direct control over what you feel in the way that you have direct control over your acting or thinking.
When Todd told me he felt depressed, it would have made no sense for me to tell him, Cheer up! No one can directly choose to feel better. It’s not the same as choosing an active behavior like tennis or a thinking behavior like chess. But, if you accept the concept of total behavior, that all four components are inseparable, you find that although you have no direct control over how you feel, you have a lot of indirect control not only over how you feel but even over a great deal of your physiology.
Although all four components are always operating when you choose a total behavior, you have direct control only over your actions and thoughts. You may argue: Sometimes I can’t seem to control what I am thinking about; I can’t get a repetitive thought out of my mind. I contend that you keep choosing to think that repetitive thought, miserable as it may be, because it gives you better control over some aspect of your life than any other thought you could choose at the time. This idea, that you always try to make the best choice at the time, is essential to understanding total behavior.
The following story illustrates the idea that the best choice is not necessarily a good choice but that it seems good at the time you choose it. A young man was walking through the large civic cactus garden in Phoenix. Suddenly he took off all his clothes, jumped into a huge patch of low cactus, and started to roll around. The bystanders eventually pulled him out, all punctured and bloody, and asked, “Why did you do that?” He said, “It seemed like a good idea at the time.” We have all done some cactus rolling in our lives, but not to hurt ourselves. It was always because at the time we jumped in, it seemed like a good idea. Divorce lawyers prosper from people who have rolled in the cactus more than once because each time it seemed the best thing to do.
For example, Todd said that he just couldn’t get the painful thought of his wife’s leaving out of his mind. There is a good choice theory reason for this repetitive, almost obsessive, choice. As I mentioned, when we are dealing with a perception, in Todd’s case, his wife, that is related to a strong picture in our quality world, we try to control the world so this picture is as satisfied in the real world as we can make it. Todd’s repetitive thought was his way of trying to do so. His logic was, As long as I keep thinking about her, maybe I’ll be able to figure out how to get her back. I don’t want even to entertain the idea that she may be gone for good.
But for now, let’s focus on the indirect choices of both how we feel and how we indirectly choose our physiology. We have almost total control over our actions and thoughts, and what we feel and our physiology are inseparable from these chosen actions and thoughts. If I choose the total behavior of beating my head against the wall, it hurts. Wouldn’t it also be fair to say that I am choosing to suffer the pain associated with this acting and thinking choice? If I feel miserable, I may choose the total behavior of drinking to try to feel better. From experience with drinking, I have felt better, so why not try it again? But I have to choose to think and act to get the alcohol into my bloodstream. The alcohol cannot get in there on its own, and I believe I can’t feel good until it gets there.
In the case of Todd, who said he was depressed, while I said he was choosing this misery, I didn’t say he was choosing it directly. What he was choosing directly were the acting and thinking components of a total behavior that I call depressing or choosing to depress. As long as he was depressing, he continually ran the same unhappy thoughts through his mind. Over and over he thought, I wish she’d never left, I wish she’d come back, I wish I’d treated her differently, what will I do without her?
As he thought these miserable thoughts, his activity slowed, almost as if he were paralyzed. Everything became an effort, and he didn’t even feel able to get up and go to work. And as he slowed down, his physiology got more obviously involved. He experienced a constant feeling of exhaustion and indolence—a total lack of energy—as if his get-up-and-go had got up and left. But since this is a total behavior, his feelings and physiology were integrated into this total. Whatever he felt and whatever his physiology, they are inseparably combined with his thinking and physical activity. When we depress, as we all have on many occasions, it feels as if our slowed activity is involuntary. But it is not. If Todd wanted to choose to make more of an effort, he could. He made the effort to come to my office.
Choice theory also teaches that he was choosing to depress for the same reason that all of us choose any total behavior—depressing gave him better control over his life than whatever else he could have thought of in this situation. It was his way of jumping into the cactus. Even though he was not aware of it, he, like all of us, had learned to depress as a child; had depressed on many occasions since then; and, in this situation, chose to depress so strongly that he came to me for help. As painful as depressing is, not to depress in this situation would have been more painful or, in his experience, would have led to more pain.
Shortly, I will explain why depressing is the best choice in this common situation and in almost all the situations in which you choose it. But you will be better able to understand this idea if I first explain why I label the total behavior I have been talking about depressing or choosing to depress.
Following choice theory, I label any total behavior by its most obvious component. To attempt to describe it by all four components is cumbersome and misleading. If I see you walking down the street, I would say you are walking. You are also thinking and feeling, and I’m sure your heart is beating, but it is your activity, walking, that is the most obvious. If I saw you pondering a move while playing chess, I would say you were thinking. I would not mention your minimal activity, how you felt or what your physiology was doing. If I saw you upchuck your dinner, I would describe your physiology and call it vomiting; I would not pay much attention to any other component of your behavior. If I brought you to an emergency room and told the doctor you had been vomiting, the doctor would question you about other components, such as what you had chosen to eat and where you ate it, but it is the vomiting, the most obvious component, that would lead to those questions.
When Todd came to see me and said he was depressed, he had correctly focused on the most obvious component of the total behavior he was choosing. He didn’t say he was depressing, but he easily learned to do so when I taught him the choice theory that explains why he made this choice. In fact, from now on in this book, whenever I mention a total behavior that is ordinarily considered a mental illness, such as anxiety neurosis or phobia, I will call it by its total-behavior designation. Anxiety neurosis will be called anxietying or choosing to be anxious, and phobia will be called phobicking or choosing to be phobic.
These new names sound cumbersome at first, but when you get used to them, they become perfectly natural. These designations are more accurate than the traditional ones because they are active. Because these are the result of a choice, it becomes obvious that there is hope. If you can make one choice, you can make another—better—choice. Your choice may be painful, but it is not irreversible. Because no one likes pain, it immediately gets both the client and the therapist focused on helping the client make a better choice. To be depressed or neurotic is passive. It happened to us; we are its victim, and we have no control over it. This use of nouns and adjectives makes it logical for us to believe that we can do nothing for ourselves.
Verbs, coupled with some tense of the verb to choose, immediately put you in touch with the basic choice theory idea: You are choosing what you are doing, but you are capable of choosing something better. If it is a choice, it follows that you are responsible for making it. With verbs, you are not a victim of a mental illness; you are either the beneficiary of your own good choices or the victim of your own bad choices. You are not ill in the usual sense of having the flu or food poisoning. A choice theory world is a tough, responsible world; you cannot use grammar to escape responsibility for what you are doing.
The common use of nouns and adjectives to describe “depression” and other “mental illnesses” prevents huge numbers of people from ever thinking that they can do something more than suffer. When you learn that you are almost always free to make better choices, the concept that you choose your misery can lead to optimism. This new awareness is a major redefinition of your personal freedom. The idea that a situation is hopeless, that you can do nothing about it, is what makes it so uncomfortable. Without knowing anything about choice theory or mental illness, millions of people, who never see a counselor, make better choices than to depress many times in their lives. So can you.
Try this. Imagine that you were expecting a substantial raise, but all you got was a pittance. You would be angry for a while, but because you want to keep your job, you would almost immediately feel “depressed.” Now instead of continuing to depress as you usually would, give yourself this little speech: I am choosing to depress because I didn’t get the raise I expected. How is this choice to depress going to help me deal with this situation? If it isn’t helping me, can I choose to do something better?
If you ran that through your mind, you would find it difficult to continue to depress; you would try to find a better total behavior. Although you are blaming this situation on your boss, you could take a look at what more you might have done to get a substantial raise. Or make up your mind that you are not going to complain but are going to look for a new job. Or tell your mate, “I did all I could, so give me a little support and we’ll get through this situation. There’s no sense my being miserable; none of us needs that. As long as you stand by me and accept that I did my best, I’ll be OK.” Doing something active like this is so much better than the passive acceptance of misery that so many of us choose now.
If we know about total behavior, we learn not to ask people who are obviously in pain or miserable: “How are you feeling?” This question is most commonly asked when someone is injured or sick and has no immediate chance to feel better. When I was the psychiatrist for the Orthopaedic Hospital in Los Angeles, I tried to convince the orthopedists and others who were dealing with suffering patients who were a long way from getting well not to ask this question. When it is asked, the questioner is looking for the answer “I feel fine” or “I feel better.” Both the patient and the doctor know that this is being asked for.
So the patient usually lies and says, “I feel good,” and that lie harms the doctor-patient relationship. The question also implies that the doctor’s treatment alone can make the patient feel better, when in fact it can’t. The better question to ask is this: “What are you planning to do today?” No matter how sick a patient is, he can do something, even in the hospital, besides just lie there. Implying that he can do something positive for himself gives him a sense of control that will help him feel better even in this difficult situation.
If the patient looks at the doctor as if the doctor is crazy, as some of the quadriplegic patients did when I asked them this question, I was always prepared to suggest some activity—perhaps as simple as watching a television program and talking to their roommates about it. If I saw them every week, they began to look forward to that question and had something prepared to tell me. Often they would add that they felt better when they were doing something, which confirms that this change in the usual approach is effective. In a choice theory world, we would get rid of the phony greeting How are you? and replace it with What are you planning to do today? or Anything important happening?— some variation of an active doing question instead of the inactive feeling question that usually traps people into phony answers.
Now that I have described total behavior, let me explain the three logical reasons why so many people choose to depress. These reasons explain the whole gamut of what is commonly called mental illness, such as depressing, anxieyting, or phobicking. Even sicknesses like adult rheumatoid arthritis may be explained by these same three reasons. Many doctors believe that there is a psychological component in many diseases and call these diseases psychosomatic. The psycho of psychosomatic means that the way we are thinking may have a lot to do with what is going on in the soma, our bodies. It is safe to say that when we are not in effective control of our lives, as when we are in unsatisfying relationships, our physiology may get painfully involved in that loss of effective control. We may not get sick, but we cannot have a totally normal physiology any more than we can feel good when we are frustrated.
RESTRAIN THE ANGER
Whenever we are not in effective control of our lives, many of us immediately think about using the total behavior we are born with: angering. Angering is built into our genes to help us survive, and since infancy we have used it or thought about using it whenever we are not able to satisfy an important picture in our quality worlds. Based on a lifelong experience with frustration, Todd, like most people, had an immediate impulse to anger when he saw the note from his wife telling him she had left. Angering is the first total behavior most of us think of when someone in our quality worlds does something that is very much out of sync with what we want that person to do.
But by the time we are a few years old, we learn that angering is usually an ineffective choice. It rarely gets us what we want, especially when we use it to try to control adults who are also angering. When we choose to tantrum, and our parents are smart enough not to pay attention, we find out that tantrumming is worthless. It is not getting us what we want, and we end up wasting energy and suffering a lot of pain. If we keep it up too long, we learn that this choice can make things worse—we may get punished or rejected, neither of which we want.
Todd had learned that. In a later session, he told me he knew that if he went after his wife and tried to force her to come back, a thought that had run through his mind for a moment when he read her note, he could make things much worse. Although we are not aware of it, depressing is also one of the most powerful ways that human beings have discovered to restrain angering, and all of us use it a lot. But, as I will soon explain, in its own way, depressing is a very strong controlling behavior.
When you are strongly depressing, what you are most aware of is its miserable feeling, a feeling that takes over your thinking, acting, and even your physiology and tends to slow you down. It takes a lot of energy to block the angering completely, which is why you are so tired. As long as you depress, you have little energy to do anything else. If we were not able to depress quickly and effectively, we could not function in marriage, as a family, or as a society. Depressing prevents huge amounts of marital and family violence. If most of us didn’t depress a lot of the time when we were frustrated, our streets and homes would be war zones.
The killing and mayhem that we watch almost daily on television are good examples of what happens when adults choose to rage and strike out. If even a few of them depressed, we and they would be much better off. Most of us know how to depress, and we do it well. Some of us dedicate our lives to this behavior and must be cared for. Those who do so are so immobilized by this choice that they cannot function, but it is still a choice. They can stop choosing it if they can figure out another choice that will give them more effective control over their lives.
Depressing prevented Todd from going after his wife, harming her, and even killing her, a common behavior in this country where weapons are so available. It also might have prevented him from killing himself. Suicide is another total behavior that people choose when they have given up on the idea that they will ever be able to get their lives back into effective control. If a person who is depressing strongly suddenly stops depressing but seems to observers to have no good reason to stop, since his life is no more in effective control than it had been, that person may have decided to kill himself. That decision has given him the way out of his misery; in a sense it has given him the idea, Finally, there is a way to end this suffering forever.
Psychotherapists always look for that feeling better sign in people who have been depressing for a long time. When we see it, we suspect they may now be thinking of suicide. The pain of restraining their angering is so great that many people decide it’s not worth living anymore and turn the anger against themselves. This was not a problem for Todd, but it might have been if he had not been willing to choose to find another woman to replace the picture of his wife in his quality world. For a man who seemed so social, suicide would have been unusual, but given time, anything is possible.
Depressing is a way we ask for help without begging. It is probably the most powerful help-me information we can give to another person. Because it is so strongly controlling, a lot of people choose it to try to get control over other people despite the pain. What the suffering does is to legitimize our asking for help. If we just asked or pushed for help with no show of pain, others might see us as incompetent or unable to take care of ourselves, and we do not want to be seen that way. For most of us, being seen as incompetent is too painful; too frustrating to our need for power; and too much like begging, which goes against our pride. But in many cases, we are perfectly willing to choose to depress as a way to get help that might not otherwise be offered.
After I had taught Todd some choice theory, he admitted that he had hoped his wife would call him after she left and then he would try to play on her sympathy by telling her he was so depressed that he couldn’t even go to work. Since he rarely stayed home from work, that might have impressed her. But she didn’t call. He also thought I would be impressed with how badly he was feeling, and if I had been, he would have depressed more to try to get me to solve his problem. But since I know choice theory, it is difficult for my clients or anyone else to control me with any total behavior that has misery as its feeling component. If it is coupled with compassion, not allowing anyone to control us with depressing helps them to see that there are much better choices than to depress.
We often use depressing as an excuse for not doing something we don’t want to do or are afraid to do. When someone suggests that we go ahead and do whatever we are trying to avoid, we usually agree and say, “I think you’re right, but I’m just too upset right now to do it.” For example, your company is downsizing and you lose a good job through no fault of your own. You tell me what happened and how depressed you are. I try not to pay much attention to your depressing. Instead I say, “I know it’s hard, but don’t sit around; get out your résumé.”
But you are depressing for a good reason. You have just been laid off and feel rejected, even though it was not your fault. You are afraid of another rejection, of facing the fact that there may be no good jobs for you at your age and with your experience. As painful as depressing is, it’s less painful at this time than looking for a job and getting rejected again and again. Todd had no problem at work, and he had no fear of looking for another woman, but the first two reasons, restrain the anger and help me, were in full operation when he first came to see me.
After reading this far, especially if you have recently depressed strongly, you may still say, You may be right, but it still doesn’t feel as if I’m choosing all this misery. To check out my claim that depressing is a choice, force yourself to make a different choice for a short time, for at least an hour. Do something physically hard that, under different circumstances, you can easily do and that you usually enjoy, perhaps a brisk walk or a short hard run. If you can do it with a good friend who is not overly sympathetic, so much the better. While you are walking or running, especially with a friend, you will notice you are not depressing. For a short time, you are not thinking about your unhappy relationship, and you feel much better.
But as soon as you finish, you tend to go back to thinking about the relationship that has gone bad, and the feeling comes back. To depress, you have to keep thinking the unhappy thoughts that keep one or more of the three reasons to depress going. To stop thinking these thoughts, you have to do what I have been suggesting all through this book: change what you want or change your behavior. There is no other way. Todd did attempt to change his behavior toward his wife, but it was too late; she had already taken him out of her quality world. But with my help, he was able to change what he wanted—he took his wife out of his quality world and put another woman in—and he was able to stop depressing for as long as I was in touch with him.
By far the most uncomfortable of all the choice theory ideas to accept is that our chosen actions and thoughts may have a great deal to do with our health, that these actions and thoughts may adversely affect our physiology. For example, are there thinking choices that can lead to what is called psychosomatic disease? I’ll touch on this briefly here (a large part of chapter 7 describes how choice theory explains these extremely common and, sometimes, fatal diseases and how we may use this explanation to help ourselves, both in cooperation with a doctor or over and beyond what a doctor can or will do). Let’s take a look at the most common disease of men and, increasingly, of women: coronary artery disease or arteriosclerotic heart disease.
You are a forty-seven-year-old movie producer who is frantically trying to get financing for what you are sure will be a blockbuster film. You are doing all you can to get the money, but your option on the property is running out. You feel bad. Eating rich foods and smoking are your attempts to get some pleasurable relief from the pain of getting rejection after rejection from the people who could easily give you the money. Although at first you felt only a heaviness in your chest, this heaviness gradually turned to greater and greater chest pain and shortness of breath.
You go to your doctor and learn that your coronary arteries are badly clogged with plaque. You ask him what can be done, and he tells you that a lot depends on how you choose to live your life. He talks about diet, exercise, smoking, stress, the whole lifestyle now known to be strongly related to heart disease. Your doctor may not understand choice theory, but what he is saying when he mentions stress is that when your life is not in effective control, it is bad for your health. This is the same as saying, bad for your physiology.
But since all your behavior is total behavior, when you lose effective control of your life, you cannot separate your feelings or your physiology from your actions and your thoughts. In this case, from your physician’s standpoint, the most obvious result of the altered physiology that is part of all the ineffective behaviors you are choosing to get the movie made is your diseased coronary arteries. Following what I have just explained, heart diseasing could well describe your choice to eat fatty foods, to smoke, and not to exercise.
The doctor has medicine and even surgery that will help, but it is your choice to stop the unhealthful eating, smoking, and sedentary life. I would go further than many doctors and suggest that in addition, you try some counseling to help you learn to take more effective control of your life. Frustration, a much more accurate word for what is going wrong than stress, may be making as large a contribution to your heart diseasing as what you are eating.
As I have stated, when our lives are out of effective control, all four components of the total behaviors we are choosing to try to get them back into more effective control are involved. We may pretend we are happy and nothing is wrong, but we can’t pretend to be healthy; we don’t have that kind of control over our physiology. When we are choosing to depress, our brain chemistry is not the cause of what we feel. It is the usual or expected brain physiology associated with the acting, thinking, and feeling that together make up the total behavior called depressing. For this reason, I believe that the currently accepted explanation that “depression” is caused by an imbalance in our brain chemistry is wrong.
I can assure you that when Todd found the note on his refrigerator, his brain chemistry instantly changed, as did his feelings, his activity, and what he had been thinking just before he saw that note. He probably wanted to do more, and if he knew choice theory he might have been able to. But, as it was, when he found the note, by choosing to depress, he was able to restrain the urge to get going and do something active to get her back. That activity, if it included confrontation or even violence, would have made his situation much worse.
He chose to depress for the same reason that millions of people all over the world choose to depress: An important relationship was not working the way he wanted it to work. Such people who choose to depress are not mentally ill; their brain chemistry is not abnormal. It is changed from what it is when they are happy, but that change is perfectly normal for the total behavior, depressing, they are choosing. As I stated, we all learned to depress when we were very young, and we have been using it, when needed, all our lives. It is only when the pain of this choice gets severe and long lasting that we begin to recognize that something is seriously wrong.
But few of us are prepared to recognize that something is seriously wrong with our lives. It is more comfortable to blame our discomfort on a mental illness or on abnormal brain chemistry. There is not one person reading this book who is not able to depress strongly when his or her life is out of effective control. To see why our brain chemistry is normal for the depressing we are choosing, consider the following scenario.
I am sitting on my cool front porch on a hot summer day. My neighbor, who is a consistent five-mile-a-day runner, comes up the street and heads for my house. I tell him to sit on the steps, which are in the shade. Without his asking, I get him a tall glass of water, and we chat. I decide to teach him a little choice theory. He knows what I do, so I’m sure he’ll humor me.
I ask, “Why are you perspiring so much?” He looks at me as if he doesn’t understand, and I say, “I’m serious, tell me.” He says, “I was running. No one can run on a day like this and not perspire; running and sweating go together.” I say, “I agree that they go together, but why do you say that the running caused the sweating? Why don’t you say that sweating caused the running?” He, not knowing about total behavior, looks at me as if I’m crazy and says, “I don’t understand what you’re driving at.”
And he doesn’t. We are so used to external control thinking, that when things go together, as do running and sweating, we often say one caused the other. But using the same logic, it makes just as much sense to say that sweating causes running. In actual fact, while they do go together, neither causes the other. What causes both the running (the acting component) and the sweating (the normal physiology associated with running) is his choice to run. If he had not chosen to run, he would not be perspiring.
When Todd chose to depress, for one or more of the three reasons I explained, he chose a total behavior for which depressing is the normal feeling component. Whatever brain chemistry is associated with that feeling is also normal. The brain chemistry no more causes his depressing than sweating causes running. It is the choice to depress or to run that results in both. That is why I call what I am explaining choice theory. When the neurophysiologists show that the brain activity of a depressing person is different from that of a happy person or from the same person when he or she is happy, they should expect what they find. But in this instance—choosing to depress—not only is the physiology different, but the thinking, acting, and feelings are different, too. In the case of the man who was choosing to run, a much more normal behavior than depressing, only the acting and the physiology are sure to be changed by this choice. What he was thinking and feeling may not have had much connection with his choice to run. But many runners report that they think more clearly and feel happier after they run.
Research that shows that drugs, such as Prozac, reduce the depressing activity in the brain also should be expected. Depressing lowers the brain chemical serotonin; Prozac raises it. A lower level of serotonin is the normal physiology when we choose to depress, and raising the level helps many people who choose to depress feel better. Alcohol, nicotine, and other addicting drugs also help most people feel better because each in its own chemical way injects pleasure directly into the brain. Prozac does the same. And if it gives the user, who has a chronic unsatisfying relationship, a lot of pleasure, it can also be addicting.
Some people who take Prozac say they would not think of living their lives without it. For them, it may be a lot like alcohol. They look forward to their daily Prozac as social drinkers look forward to a few drinks or some wine each day. They are no more addicted to Prozac than social drinkers are addicted to alcohol. But like social drinkers, they would miss it terribly if it was taken away. But some social drinkers move on to become alcoholics. The lonelier they are, the more danger there is of their becoming alcoholics. There may even be more danger of becoming addicted to Prozac because it is prescribed only for people whose lives are known to be out of effective control.
Prozac could not have brought a new relationship into Todd’s life. It might have helped him to feel better so that he was more able to look for someone else, but it would no more solve his loneliness than would alcohol or marijuana. We would be much better off getting rid of the psychology that is causing so much misery than looking for chemicals that make us feel better but do nothing to solve our loneliness. If Todd refused to take his wife out of his quality world and all he was offered was Prozac, he might need it for the rest of his life, and even then, it might not be effective. Drugs provide pleasure; they cannot provide happiness. For happiness, you need people.
Drugs like Prozac are often used along with psychotherapy. The rationale is that if people feel better through the chemical boost they get from the drug, they will be able to profit more from the psychotherapy. Most reality therapy counselors who focus quickly on faulty relationships have not found the use of Prozac to be necessary, and in all my years of practice, I have never used brain drugs. Good psychotherapy precludes the need for these drugs. If more people would learn and use choice theory, the use of these drugs could diminish. All the usual psychiatric diagnoses, excluding observable brain damage, are chosen for one or more of the same three reasons that people choose to depress.
Choice theory does not come easily to us in a culture that is external control to the core. But my experience with many people, including my wife and myself, who have learned enough choice theory to use it in their lives, has been positive. The fact that the use of choice theory improves marital, family, school, and work relationships instead of destroying them is what makes the difference. Besides, we all have proof of its effectiveness because it is all we use with our good friends.