IWAS DRESSED IN A white space suit, helmet on, all ready to go into space on the soon-to-be-launched shuttle. But I was in Cincinnati and had to get to Wright Patterson Air Force Base in Dayton where liftoff was in a few hours. I didn’t think it was at all strange that the shuttles were now lifting off from Dayton, but I did think it was peculiar that NASA had not arranged my transportation from Cincinnati to get there. NASA had, however, let me know that the best way to go was by public transportation, and I was on a city bus. People stared at me in my space suit but no one commented. I kept changing buses, but none seemed to be going to Dayton. I grew more and more frantic, I was sure I was going to miss the liftoff. I kept asking people for help, but they just shrugged and didn’t seem the least bit interested in my problem.
That was a dream. I had it several years ago while living in Cincinnati. It was so vivid and so frustrating I have never forgotten it. We all have dreams, and many of them have this theme of trying desperately to do something that never seems to work out. While the dreams are going on, they seem so real, even though what is actually happening may have little to do with reality. Dreams, like all behaviors, are total behaviors. They should be called dreaming and, since they all take place in our heads, they are the thinking component of that total behavior. During the dream, I was mostly acting, but I was also thinking about getting to Dayton, I felt the pain of my frustration, and my physiology was certainly normal for what I was doing.
I mention that dream not because it was of any significance in my life but because it is a vivid example of how creative all of us are. Dreams have no boundaries, little logic, and no necessary grounding in anything that could be called reality. Literally, anything can happen, but while it is happening, it all seems to make sense. In that dream, I was sure I would be on my way to outer space if only I could get to Dayton on time. Although researchers believe that dreams help us get the maximum rest from sleep, it is the inherent creativity they represent that is what this chapter is all about.
A life without creativity would be hardly worth living. But unless we are given creativity-destroying drugs, often used to treat psychosis, or have Parkinson’s disease, where we lose our ability to move creatively, this can never happen because in our brains we have a creative system that adds creativity to all our total behaviors. The creative system may operate when we are sleeping as in dreaming but what it does while we are awake is far more important. It can add creativity to one or more of the four components of any total behavior.
We see it clearly in the actions of great athletes, dancers, surgeons, and others who perform neuromuscular feats that are creative beyond compare. Michael Jordan comes to mind as one of the most creative athletes who has ever lived. It is their creative thinking that sets great writers, artists, musicians, and scientists apart from the rest of us. Einstein, Shakespeare, Mozart, and van Gogh are examples of a group that could fill the pages of a whole book. It is the ability of great performers to create and express feelings that hold audiences spellbound. There are also instances of new and creative physiology when people who are given up for dead create a way to recover from a severe illness in ways that cannot be explained by medicine.
While these are examples of the phenomenonal ways the creative system works, in this chapter I will explain that there is also the possibility this same system can cause us great harm as it goes about its business by creating painful and self-destructive total behaviors. This destructive creativity is most often seen when we want good relationships and are not able to get them.
For example, when we are lonely, as Francesca was when Robert left, there is nothing effective we can do to close the wound. But because there is nothing effective we can do does not mean we do nothing. This is exactly the situation for which our creative system evolved. It never shuts down or gives up. It keeps trying on its own to help us deal with our lonelinesss or anythng else we want either by adding creativity to a behavior we already have or, at times, creating a whole new behavior that might be more effective in the given situation.
In many instances, it offers new actions and thoughts, which we can reject if we believe that what is offered will make things worse. It is difficult to reject what it offers, and often we could use counseling to help us, but we usually have enough voluntary control over our actions and thoughts to do this, especially if we are able to understand this is a choice. What I am talking about here is when we are offered violent or suicidal thoughts and actions that for us are very new. Also when we are offered psychotic or crazy thoughts or what is commonly called schizophrenia or bi-polar disease. Or when we obsess and compulse as we frequently do when we are lonely. And when we are exposed to a traumatic situation as in posttraumatic stress disorder and handle it painfully but creatively. In almost all instances, by improving our relationships, we may be able to reject these thoughts and actions. Many people do. Later in the chapter I will discuss all of this in more detail.
When we are lonely or frustrated our creative system may also offer us new feelings. Depressing is the most common but there are also anxieting, headaching, backaching, and other painful feelings. While we cannot reject the feeling—we have no direct control over how we feel—we can try, with counseling or without it, to improve the relationships we have or find more satisfying new ones. This is what my client in chapter 4 was able to do and what Francesca began to think about in the previous chapter.
When our creative system offers us new but destructive physiology, we cannot reject this offering. Unless we know that improving our relationships may actually slow or stop the destructive process, we may suffer great harm. The most common examples of this destructive physiology are the autoimmune diseases such as rheumatiod arthritis. Even though this process is so destructive and so puzzling I still believe there is a choice we can make which could help. I use the general heading of psychosomatic disease to describe this process.
PSYCHOSOMATIC DISEASE: THE DARKER SIDE DF CREATIVITY
There is no way to predict when these diseases will occur or how much out of control our lives need be for them to occur. We can find out that we have rheumatoid arthritis, for example, only when it appears. But if what I explain here is correct, there is something helpful that we can do on our own or with good counseling at the first indication that we are becoming destructively creative. I want to emphasize that nothing I suggest has any chance of doing harm, and I advise anyone with these diseases to seek accepted medical care and to follow their doctors’ advice.
Most doctors believe that adult rheumatoid arthritis is caused by the victims’ immune systems attacking their own joints as if these joints were foreign bodies. Another way of putting it is that their own creative systems are trying to protect these people from a perceived harm. If we could figure out a way to stop this misguided creativity, millions of people who suffer from this disease and a host of other relentless diseases, called autoimmune diseases, could be helped. They might even be cured if the attacks were caught early enough.
Norman Cousins succeeded in aborting such an attack. As he described in detail in An Anatomy of an Illness,* when he began to suffer pain and stiffness in his back, he was diagnosed as suffering from an acute ankylosing spondylitis, or rheumatoid arthritis of the spine. If it continued, the doctors told him, he would be severely disabled by a badly bent and painful spine. The pain and inflammation might eventually stop, a common occurrence in the life history of many of these diseases, but the deformity would be permanent.
His doctors told him there was nothing that could be done for him medically and no pressing reason for him to stay in the hospital even during the acute phase of the disease. Therefore, he left the hospital and chose a regime that seemed to lead to what was medically confirmed as a complete cure. What he did had nothing directly to do with his immune system, but it had a lot to do with taking more effective control of his life.
Cousins’s explanation of the circumstances in which he got sick, clearly showed that he had lost control of a significant event in his life. Cousins was an important man who was used to people both listening to and appreciating what he had to say. Yet some foreign officials, vital to one of his many help-the-world projects, ignored him. His picture of himself in his quality world as a well-known, powerful man was severely frustrated, and his life quickly went out of effective control. As it always does when we are frustrated, his creative system got involved. This involvement was not in the thinking or acting component of his total behavior, however; it was with his immune system, a vital part of our physiology. The immune system began to attack and damage his spine as if it were a foreign body.
My explanation of what was going on in the physiological component is that his immune system, whose major purpose is to protect us from outside invaders, such as bacteria, viruses, and poisons, misread his loss of control and wrongly concluded that he was being attacked by a bacterium or virus. When we become sick with a severe infection caused by an invading bacteria or virus, it is accurate to think we have been attacked. I have often heard people say, I am fighting a bad cold or wrestling with the flu. But people also say, I am fighting to save my marriage, my job, my reputation, my beliefs, my way of life.
Because this is such a common way to think, it is not farfetched to infer that what was going through Cousins’s mind was, I’ve got to overcome this indifference to my ideas; I see it as an attack on the important work I am trying to do. Because the immune system reads only the physiology of thought, it can’t know anything about the psychology of that thought or any thought. It may mistake the physiology of the being-attacked thought for the similar physiology of an actual bacterial attack. It certainly seems possible that the immune system is alerted by that thought and begins to hunt for a microorganism that is not there.
Finding no microorganism, but not wanting to shirk its duty, the immune system somehow targets an organ or body part and attacks it as if it was infected with a microorganism. To confirm what I am trying to explain, experiments have shown that a person who is allergic to strawberries may break out in hives when he or she goes into a room papered with strawberry-patterned wallpaper. The hives are caused by an overactive immune system. The pathology in rheumatoid arthritis is almost the same as if the joints were infected by bacteria. Medically, this mystery is called a sterile infection.
For unknown reasons, adult joints seem to be the prime target of the autoimmune system, and rheumatoid arthritis, no matter what joints it attacks, may be the most common autoimmune disease. Other target organs and their corresponding autoimmune diseases are the skin, scleroderma; the kidneys, glomerulonephritis; the blood vessels, periarteritis and lupus; the lungs, adult asthma; the sheath that covers or insulates the nerves, multiple sclerosis and other common diseases that are too numerous to mention here.
But a feature story in the Los Angeles Times of April 4, 1997, reported that medical researchers seem to have discovered a new widespread autoimmune disease in which the immune system attacks the lining of coronary arteries.* The article began: “A subtle but unexpected attack on the coronary arteries by the body’s own immune system may be the cause of as many as half of all heart attacks and coronary artery disease. It also may explain why aspirin is so good at preventing heart attacks.” At the end of the newspaper article, Dr. Valent Fuster, of Mount Sinai Medical Center in New York City, offered this opinion: “Such inflammation may be a response to the accumulation of even small amounts of cholesterol in the walls of blood vessels.” The conclusion I drew from this research and Dr. Fuster’s comment is that the immune system may be misreading this cholesterol in the lining of the coronary arteries, a common, almost normal, accompaniment of aging in men, as a foreign body.
This is strong evidence of what a few doctors, including me, have been speculating for years. In a chapter on creativity in an earlier book, Take Effective Control of Your Life,† I wrote the following:
As the cardiovascular system is tensed for years on end, the blood rushing through the arteries begins to erode the artery walls and produce rough spots. The excess clotting elements already circulating are trapped by these rough spots and begin to form small clots at these sites. The immune system, “seeing” a clot that normally would not be there, somehow (no one yet knows why) becomes crazily creative and attacks the clot as if it were a foreign body. This quickly causes the clot to become inflamed and the inflammation enlarges the clot just like a scab on a skin wound is always larger than the initial blood clot. As time passes, the clot continues to enlarge through the repetition of this process until the clot obstructs the flow of blood through the artery.
What Fuster described as “small amounts of cholesterol” could be part of “the rough spots” I mentioned in the preceding paragraph. The rest of what I describe is the well-known process of inflammation, including the proliferation of clotting elements in the blood. People with heart disease are routinely given anticlotting drugs, such as coumadin, to reduce the circulation of clotting elements in the blood. In recent years, aspirin, an anti-inflammatory drug, has often been added to this regimen. As you can see, I have been thinking for a long time about what part this self-destructive—I call it crazy—creativity may play in coronary artery disease.
When your doctor tells you that you have an autoimmune disease, he or she is trying to tell you it is caused by your immune system attacking the part of the body involved. Cousins couldn’t do anything directly about what his immune system was doing; at that time, he may not have even known this was what was going on. What he did know was that he was miserable and that he thought he could do something about it.
He decided to leave the hospital and make himself comfortable in New York’s Plaza Hotel. He hired some cheerful, attentive nurses; ate great food; and asked his friend Allan Funt to visit and bring videotapes of some of his funny Candid Camera sequences, often too risqué to show on television. Cousins watched these videotapes and laughed and laughed. The combination of good food, attentive nurses, good friends, and a lot of laughter gave him the sense that the world need not end because a few foreigners he hardly knew refused to listen to him. He stopped fretting about what had happened and regained effective control of his life, and his creative system stopped pushing his immune system. He quickly became normal; the disease never recurred.
Cousins wrote about taking massive doses of vitamin C and continued to see his doctor. But he took the vitamin C on the advice of Linus Pauling, a renowned physicist, not his doctor. There is no indication that this is an effective treatment for rheumatoid arthritis. But Cousins believed in the vitamin C and made the point that he did more than laugh his way to good health.
Anyone who suffers from rheumatoid arthritis or any other destructive, or potentially destructive, creativity, could attempt to take more effective control over his or her life. But even though what Cousins did seemed to have worked for him—of course, his regimen has never been proved—it is not the only way. I also suggest that when you become aware that your immune system has harmed some aspect of what should be your normal physiology, concentrate on trying to improve the frustrating relationship that may be the cause of what is happening.
Although it seems simple, most people with a psychosomatic disease don’t even think of doing what Cousins did or of entering counseling with a counselor who knows choice theory, which may be easier and equally effective. People who are sick often make the logical mistake of concentrating their efforts on the symptoms of the disease, which they can do nothing about. Instead, I suggest that they give equal time to the relationships in their lives that may not be in effective control.
It is difficult to live in such a way that all our relationships are in effective control, and usually it doesn’t make that much difference as long as some relationships are satisfying. But when you get sick, it is a good idea to review all of them. Some may be more rankling than you are willing to admit. You can review these relationships by yourself; with the help of a friend or family member you trust; with your doctor if he or she can give you the time; or, best of all, with the aid of a good counselor.
To illustrate what a counselor can do, I would like to share with you the most dramatic incident I have ever been involved in as a psychiatrist. It occurred in 1956 while I was working as a resident on the psychosomatic ward of the Wadsworth Veterans Administration Hospital in West Los Angeles. A forty-year-old man who had been suffering from intractable asthma for the past ten years had been given every known medication with essentially no relief. His lungs were scarred and clogged as if his immune system had been attacking his bronchioles. He could hardly breathe; it was difficult for him to talk, and he had been put on a positive pressure respirator once or twice a week to keep him alive during the attacks he frequently suffered. The medical resident who called me in told me his condition was hopeless, but if I wanted to try to help him, I could see him.
The man’s human relations were nonexistent. He was in the dry-cleaning business with his brother, but he could do so little that they were not on good terms. This hospital admission had lasted six weeks, and the medical staff doubted they could ever get him in good-enough shape to leave the hospital. The man could barely talk, but I was patient and told him that even though it was hard, I was determined to counsel with him.
I saw him for several weeks almost every day, and we gradually got acquainted. He kept telling me it was worthless; he needed good medical care, not a psychiatrist. But I persisted. Several times he had a mild attack of not being able to breathe during the sessions and begged me with gestures to let him go back to the ward, but I told him that even if he couldn’t talk, this was our time together and I didn’t want him to go back until it was up.
He seemed to be doing a little better, and I was encouraged. But then he got an attack so severe that I had to call the respirator crew, who put him on a respirator and wheeled him back to his bed. I got the idea that he was choosing the attack to get away from me and from having to talk about his present life. I decided that when he had the next attack, I would keep counseling even while he was on the respirator, and he could respond with his hands or nod to my comments. The next attack was the worst yet. The respirator crew pumped and pumped but couldn’t seem to get enough air into him, and he turned blue. The respirator crew; the medical resident; and, of course, the patient thought I was crazy. I paid no attention; I continued to counsel and could see his expression get more and more desperate.
This went on for about twenty minutes, when suddenly he ripped the respirator from his mouth and nose and screamed at me, “For Christ’s sake, I’m dying. Won’t you leave me the fuck alone?”
I said, “No, I won’t leave you alone. You need counseling and I’m not going to give up. You seem OK now; let’s go on.”
And he was OK. His face, which had been blue-black from anoxia, had a little color, and he seemed to be breathing easier after the outburst than I had ever seen him breathe. We continued, and his breathing took a sharp turn for the better.
The man stayed in the hospital for another two weeks getting his strength back but then was discharged. His lungs were badly scarred and he had to walk slowly, but he was able to breathe well enough to take care of himself. He came back to see me as an outpatient three or four times and said he thought he could handle things on his own.
The key in this therapy was his trying to push me away and my not letting him do it. When I persisted, it was as if something had happened that he had never dreamed would. As much as he tried, he could not get me to reject him. It was enough to help him get back into some kind of control. His lungs were damaged, but he could breathe and take care of himself. There is tremendous power in good counseling. The medical resident who witnessed that dramatic episode was astonished and, truthfully, so was I. What I learned was never to give up, and I don’t.
I will now go into greater detail so you can see exactly how choice theory applies to what I am trying to explain. Again, I want to state that it is important to know that even if what I suggest does not help, it can do no harm. It is also free or moderate in cost, depending on whether you can apply it yourself or seek several months of counseling, which should be enough, especially if the counseling involves learning choice theory, which explains what the problem may be and what the client can do to cope with it better in the future.
When we face a large frustration in a relationship, as did Norman Cousins, my veteran with asthma, and Francesca, we don’t know what to do to reduce the frustration. We search our memories for an old behavior that has given us some relief in the past. In almost all instances, we immediately find depressing, a familiar behavior we learned as a child. I am sure Cousins and the asthmatic were depressing strongly, as was Francesca, when their lives spun out of control. But depressing is not an effective behavior; it hurts and immobilizes. Still, it gives us more relief than anything else we know, for three reasons.
First, depressing, and all other symptomatic behaviors, including arthritis, restrain a lot of anger, which, if unleashed, would make things worse. Second, these behaviors include a powerful call for help, and in many instances good counseling is effective. If we have an autoimmune disease we will also look for a doctor who may counsel or recommend counseling, which could be helpful. Third, these behaviors keep us from trying to do something we fear we may fail at. It’s easier to depress or to be sick than to look for a new relationship or a new job, especially if we’ve had some experience with rejection, which most of us have.
Although depressing gives us some control, it does so at a very high price: misery. Even as we depress, our misery and our continued frustration force us to keep looking for better behaviors. Even when we seem resigned to what has happened, we are not. It is not in our genes to accept a major frustration, such as an unsatisfying relationship, without getting our creative systems involved. Our creative system may not come up with anything effective; rather, it may come up with something that is mentally or physically more harmful than depressing. But whatever it does, its purpose is to try to find a new total behavior that will lead to some resolution of the problem.
However, it is not uncommon for people who cannot find a way to regain more effective control over their lives or who, for a variety of good reasons, refuse to give up on an unsatisfying relationship to choose to depress for the rest of their lives. That they may have additional symptoms is common, but often a new symptom like arthritising may give them enough control over their lives so they no longer choose to depress.
Arthritis did so for two women I counseled in my practice. It gave them something tangible to struggle with that they could try to do something about. Not much, but something. They were not willing to struggle with their unsatisfying marriages. They were not going to leave, and they didn’t want to change the way they dealt with their husbands.
But besides physiological behaviors, it is far more common for us to be offered usually one, but sometimes a whole group of, psychological acting, thinking, and feeling behaviors by our creative systems. Together with depressing, psychiatrists call these total behaviors mental illness. Most of these total behaviors fall under the heading of neurosis; psychosis; or physical pain, such as headaching and backaching, for which there is no evidence of a physical cause.
If they are psychological, we may never, even with counseling, discover the reason we choose them, but it almost always has to do with a relationship problem. The problem does not have to be love; it may be that we want more care or less demanded of us, but whatever it is, an important relationship is not working for us. If you look for the unsatisfying relationship, you are on the right track. This is the usual method in our madness.
But because these behaviors, called mental illness, are offered does not mean we have to accept them. In psychosis, our creative system offers hallucinations and delusions, even physical creativity as in catatonia, and offers them so strongly it is hard for us not to accept them. If our lives are far out of effective control, it may be almost impossible for us to reject them. We need to restrain the anger. We often want help, and we can use the symptoms to avoid having to take care of ourselves or to look for and hold on to a new and necessary relationship. Good counseling can often persuade us to stop accepting the offered psychological creativity. But even with no help, not everyone who chooses to accept craziness stays crazy.
Hundreds of thousands of people who function very well today have had episodes of craziness in their lives. Millions more who have chosen to depress, phobic, obsess, compulse, anxietize, panic, and ache and pain with no physical basis for that pain no longer do so. Some start to refuse these creative offerings on their own, and many go to counselors. With counseling, they are able to gain enough effective control over their lives that they no longer choose these behaviors. Finally, the creative system may offer the idea of suicide: Get rid of the problem and, with it, the pain once and for all. People who commit suicide make their last creative move. But many of them, if offered counseling, would welcome it and avoid the final step.
The following case that I dealt with in the first month of my psychiatric residency illustrates my contention that craziness is offered and accepted and that the offer can be refused if the person believes it is not working in a particular situation. In 1954, I was a ward doctor in the Brentwood Veterans Hospital in West Los Angeles. The patients had all been diagnosed with schizophrenia, and one man was almost frightening in his delusional behavior. Each morning when I made the rounds, he would curse me and spit on the floor when I approached. He was very threatening and kept yelling at me to get the imaginary monkey off his back who was tearing the flesh off his bones. He acted as if the monkey was there and cried out in pain and cursed me for being such an inadequate doctor that I could do nothing about this small animal who was making his life a living hell.
I had no experience with this kind of problem, and I was a little frightened of him. He was a World War II veteran, and the symptoms started soon after he was discharged from the military. I dreaded going up to him, and I could never get any conversation going no matter how hard I tried. This went on for three months, when one day, instead of being threatening, he asked me politely (not even mentioning the monkey) if I could see him in my office after rounds. I was uneasy, but the attendant said it would be OK; he would stand by. I was baffled by this total change, but curious. After rounds I beckoned for him to come to my office, which was right off the ward, forty feet from where he usually sat.
He told me in a perfectly normal way that he thought he was sick and asked me to examine him physically. He said he was feverish and was having trouble breathing. When I felt his head, it was hot. I then tried to listen to his lungs, and it was like listening to a brick wall; he had lobar pneumococcal pneumonia. I told him that he had to go to the medical ward; we could not treat him in the psychiatric unit. Because of antibiotics, this disease was becoming rare and I had never before seen a case.
I walked him over to the medical ward in a nearby building, and during the walk there was no sign of any psychosis. He kept thanking me for being so nice to him. I introduced him to the internists, who confirmed my diagnosis and were glad to take care of him. This was a disease that some of them had never seen either. During the two weeks he was in the medical ward, I visited him every day as I had promised, and he never showed any signs of craziness. The hard part was to convince the medical residents that he was crazy, actually the craziest patient I had ever seen and that he did need to be on the psychiatric ward. I never convinced them, and I took a lot of ribbing for keeping a sane man in the hospital.
If I knew then what I know now, I think I could have helped this patient when I saw that he had the capability of choosing to stop being crazy. But I didn’t know what to do, nor did anyone else. Gradually, the monkey reappeared, and all his symptoms returned, but he was always polite to me when I made my rounds. He kept telling me how well he had been treated on the medical ward. He still told me about the monkey, but he never accused me of being incompetent or blamed me for not relieving his suffering. I tried to work with him, but I didn’t know what to do. I think that he had put me into his quality world, and today I could use that fact to try to work more intensively with him.
I believe he was talking and acting right out of his creative system, as do most severely psychotic people, but he was able to choose to turn off his creative system for the few weeks he spent on the medical ward. My guess is that staying alive took precedence over whatever problem he was choosing to psychose about. After he was cured of the pneumonia, he chose to go back to the craziness, rather than try to deal with the problem. But with me, he was able to choose some sanity; he was never as crazy as he had been in the past. This was in the days before psychiatric drugs, some of which might have helped him. In the course of my residency, I learned how to deal with people like him, and a year later, during my last four months on service, using the beginnings of reality therapy, I was able to discharge thirty-two of the thirty-six patients I was assigned. Many had been crazy for years, and all but four chose to be sane enough to leave.
One of my techniques was to spend time with my patients, get close to them, and then ask them, “Please pretend to be sane with me. I have no interest in your craziness.” I reasoned that even the craziest people do a lot of sane things every day. They eat, sleep, smoke, watch television, go to the bathroom, clean up around the ward, and go to various therapies like arts and crafts where many do fine work. When I asked them to be sane with me, someone they liked, I wasn’t asking for much more sanity than what they were demonstrating in much of what they did in the hospital. In my experience, it is not difficult to help people stop listening to their creative systems in the safe confines of a good hospital. What is hard is to guide them in the direction of the better relationships they need to stop being crazy when they leave. The main purpose of a hospital is to take care of their physical needs, provide them with the good relationships they need, and prepare them to stay close and try to get along with people when they leave.
Let me now return to Francesca and use her huge frustration to explain some of the other ways our creative systems can get destructively involved with our lives and what we can do about it. I use Francesca because there is hardly a married woman who hasn’t occasionally thought, My life would be a lot better with someone else. It is the acting on that simple thought that is so tragically portrayed in thousands of books, plays, and movies.
In Francesca’s case, her husband, Richard, as a lover and her life on the farm had not been in her quality world for years. But she was able to accept the status quo because she had no pressing picture in her quality world of a better life than what she had. What sustained her was a picture of her children doing well and needing her and a picture of herself as a loyal, if not loving, wife.
She handled her dissatisfaction with Richard and farm life by mild, long-term depressing. Her choice to depress satisfied the first of the three reasons we depress—it restrained her anger—and that was enough for her. Angry outbursts would have made the situation worse. The other two reasons did not apply. She didn’t want help, and she wasn’t thinking of doing anything else but keeping the life she had. The level of depressing she chose was high enough to give her enough control of her life so that her creative system did not get involved physiologically. She was healthy; she was not crazy; and before Robert came, she had chosen to do nothing that anyone would have labeled a mental illness or even abnormal.
The four days with Robert upset the fragile equilibrium that Francesca had maintained for years. Afterward, to keep the anger in check and to maintain the status quo, she had to depress much more intensely. She felt terrible. She could do little or nothing around the farm, and she was worried that she would not be able to keep the bargain with Richard that she had kept for years. Now she had the picture of a satisfying life with Robert in her quality world, a picture so discordant with the take-care-of-my-children and loyal-wife pictures that had sustained her for years.
Francesca was in a conflict, by far the most serious frustration we can suffer because there is no good solution. Either way, Richard or Robert, there is misery. She was trying to depress so strongly that she would not even think of making the choice. She recognized that life with Robert was an impossible picture. She said she couldn’t leave her family under these circumstances, and she didn’t.
All her energy was going into the effort to depress, and she was immobilized. She wanted some help with how she felt and with her difficulty in doing even the routine chores around the farm. In the first session, she said that she would be satisfied if I could help her get back to the mild depressing—her life as a frog—that she’d been choosing for years. The problem is that our quality worlds do not recognize the impossibility of any picture we put into it. If a picture is in our quality worlds, we want to achieve it in the real world and do so as soon as possible. The only way we can stop wanting that picture is to take it out of our quality worlds.
When she came to see me, she had not even thought about finding a picture to replace Robert, and she didn’t even want to. It was he, no one or nothing else. But because she knew that what she wanted was impossible for her, she was dealing creatively with that impossibility. Her creative system had told her, Francesca, forget about living without Robert. Without him all you can do is go through the motions. For all practical purposes, you are dead. That may not have sounded creative, but it’s not something most of us are even willing to think much less to say. If dead is that you can no longer do anything or feel anything, this was what she was trying to achieve when I saw her.
In counseling, I tried to help her toward another picture, not a sexual or love picture, but a picture that might give her some of what she wanted—a social, if not a sexual, life off the farm in which she would have some power and people would listen to her and respect her for what she was saying and doing. I believe that if she could have had such a life and enjoyed it, she might eventually give up the picture of Robert or live better with it. Time would tell if that would ever happen. All I saw her was for a few sessions.
In Waller’s book, Francesca doesn’t seek counseling. She dealt with her life by choosing to depress, which restrained her anger enough so she could be a reasonably good mother and wife. Writing in her journal helped her to accept the life she had. She was able to come up with the creative fantasy: My children will read this journal after I die, understand me better, respect me for what I did by staying home, and appreciate how hard it was to give up Robert. It also helped that Robert did not forget her. He had his belongings shipped to her when he died, including the note she wrote and pinned to the bridge that brought them together. All this, especially all the misery, is very romantic, which was Waller’s intention. I liked the book. I felt deeply for this woman and for the love she had and then gave up.
What also helped Francesca to gain enough control over her life was to seek out a relationship with a neighbor, Mrs. Delaney, who had gone through a similar situation but had not been able to keep it secret and had been ostracized by the narrow-minded community in which they lived. The two women became close and stayed close until Francesca died.
What actually happened or didn’t happen to the fictional Francesca is not important. I want to discuss what might have happened to her or to anyone who suffers a long-term high level of frustration and how our creative systems can get involved with our behavior in ways that are destructive to our lives. Let’s start briefly with the autoimmune diseases I have discussed.
If Francesca’s immune system had gone crazy several months after she sent Robert away, she might have noticed that her fingers had become very painful, swollen, red, and hard to move. Even Richard might have noticed and said, You ought to see a doctor. Her family doctor would have immediately recognized that she was in the early stages of rheumatoid arthritis. He would have taken tests and X-rays, noted that her sedimentation rate was up, and confirmed the diagnosis.
He might have referred her to a specialist in Des Moines. After a few more tests, the specialist would have started her on an anti-inflammatory medication, but that treatment is palliative; it does not cure. The specialist might have even asked her if there was anything in her life she was upset about, but it is unlikely that she would have told him about Robert. Why risk his disapproval? Besides, Robert was gone; what good would it do?
Whenever we are frustrated, it is impossible for our physiology to remain aloof, for us to say to the acting, thinking, and feeling components of our behavior, You guys, get creative and deal with it; leave me out of it. So in this example, her physiology got involved. My experience counseling people who suffer from rheumatoid arthritis is that they have very frustrating personal relationships, often blatantly unsatisfying marriages that they are trying to preserve at all costs. They cannot risk angering or even depressing because doing so might impair their ability to keep up their side of the relationship and maybe lose it.
It is not easy to deal with these frustrations, and I am not implying that I could have helped Francesca if she had come to me with rheumatoid arthritis. If she didn’t tell me about Robert, I would have probed for the breakdown in a relationship that I believe is behind most chronic frustrations and tried to help her deal with it. If she could have resolved the frustration favorably, as she began to do in counseling, there is a good chance her arthritis would not have gotten worse and might have improved or even gone away. If you can apply choice theory to your life to improve or eliminate your own unhappy relationship, you have a chance to help yourself.
Francesca was not likely to become psychotic because she was both capable of good relationships and of taking care of herself and her family. The kind of people who become psychotic often lack ganas. Their profile is similar to that of the workless. They want good relationships but are not capable of giving the amount of care to others that it takes to get them. That has been my overwhelming experience with people who have dealt with an unsatisfying life by choosing psychosis.
Some people who become psychotic want to be taken care of; they don’t have the confidence that they can take care of themselves. They can often be helped as much by a good live-in situation in which they are slowly introduced to the demands of the real world as by good counseling. Most of them need a place where they feel secure and have people to talk with; it does not have to be a hospital.
It is interesting that psychotropic drugs that control hallucinations and delusions all tend to paralyze the creative system so severely that even the muscles get involved. This is seen in the Parkinson-like gait and other symptoms that usually accompany the use of these drugs. Under the influence of large doses of these drugs, many people lose their ability to move smoothly, their faces lose expressiveness, and their voices may become altered and lack timbre. Although these drugs may reduce the crazy creativity by paralyzing the creative system, they do not really solve the problem. I am not saying don’t use the drugs, but understand that there is almost always a frustrated relationship involved. If it is dealt with in counseling, my experience is that with some clients, those who have some strengths or who are taken care of can stop choosing psychosis and live much better, though somewhat sheltered, lives.
Bipolar or manic depressive psychosis, discussed earlier in connection with the workless, is another variation of crazy creativity. It is not restricted to the workless, however; some successful people choose this up-and-down behavior when their relationships are extremely unsatisfying. Furthermore, it is usually more up or more down, not the complete swings from way up to way down that is commonly thought. With manic depressive psychosis, what is often in operation is the third reason: The sufferer is trying to avoid facing the reality that a long-term relationship is not working out.
Francesca did not do much about her problem except to depress, but at least she faced it. Bipolar people can’t even seem to do that. When they are in their manic state, they are living right out of their creative systems. Their brains are going as fast as they sometimes do in long, complicated dreams during five-minute naps. I’m always amazed at how much can happen in dreams in such a short time.
When bipolar people are in the normal part of the swing, they can often be helped by good counseling. Sometimes they are so successful in their lives that when they are not in the up or down position, it is impossible for anyone, including counselors, to believe that they are having problems in their relationships. And maybe they are not. But my guess is that most of them are and that anyone who counsels them should check out their relationships first.
There is also a whole group of creative total behaviors that are commonly called neuroses. People who choose these behaviors don’t deny reality, as in psychosis, they just have trouble dealing with it. Phobicking, anxietizing, panicking, obsessing, compulsing, or posttraumatic stressing are common examples of these ereative choices. For example, Francesca could have told me nothing about Robert, or mentioned him but not shown much concern over the loss of their brief relationship. Her complaint might have been that she was afraid to leave the house by herself. If her husband couldn’t take her somewhere, she couldn’t leave the house. He would be in the waiting room to drive her home. Once in a while she could go out with her son or daughter or with a neighbor, but she would really be comfortable only with him.
My guess is that the real fear from which the phobicking would protect her would be that if she left the house alone, she might go looking for Robert. Her choice to phobic would prevent her from doing that. As long as she wanted Robert but felt loyal to Richard, she would continue to phobic. This creative choice would help her to think, It’s not Robert that I want at all. My problem is that I’m afraid to leave the house. Here you see all three reasons we choose what is usually called mental illness operating creatively. First, as long as she phobicked, she could replace angering with fearing, which is more acceptable. Second, she would have an excuse to go for help. Third, since she would feel safe only at home, going to Robert would be out of the question.
As the years went by and the memory of Robert faded, she would need the phobicking less, and as the frustration disappeared, the symptom would disappear with it. Counseling would be very helpful, and I would counsel her much as I did. But to help her, the same as I would if she were arthritising, I would have to probe for Robert and the unsatisfying relationship with Richard. Richard, however, would be close to the surface and not hard to find. With my help to get out of the house and into a less lonely life, she could accept that Robert was gone and, with that acceptance, no longer have any reason to phobic.
Francesca could also have chosen panicking, a similar but disabling symptom. As long as she was in fear of a panic attack, she wouldn’t stray far from home or from people she trusted. She might even panic at home if she thought of Robert, but home would be a safe place to have such attacks. For example, if Francesca was a panicker and lived in constant fear of an attack, when she came to see me, I would have known that a painful relationship was involved. As I probed for the relationship, she would protest but not too much. Part of her would be pleased. She would want desperately to talk about Robert, and if she trusted me, my office would be a safe place to do it. When she told me about Robert, she would say, “It’s over.” But I would know that it was not over; the panicking would be proof that it wasn’t.
Still, Francesca would insist, “It’s over”; I don’t want to think about him anymore. In a sense she would be right about that, too. She wouldn’t think about Robert very much. Rather, she would think and worry about when the next attack would occur, and that thought would keep her and a lot of other people busy worrying about her. All these dramatic symptoms are marvelous ways for lonely people to get attention and ask for help without begging.
An attack might have occurred in my office when I started to probe, and I would have welcomed it. I would have told her, “That’s marvelous; now we can really deal with it.” It saves a lot of time when clients discover that, with my help, panicking can be handled. My job would be to get Francesca to think about Robert, not to be more miserable but to learn what she could do to find a life without him. I would have gone into great detail about what was happening when she had the last panic attack. She could have chosen to panic when she saw a couple about her age walking down the street holding hands, which could have revved up the whole affair with Robert. I might have told her to think about Robert and, if she could, choose to panic right then with me. She might not have been able to do so, but this statement would have made it more difficult for her to panic from then on because she would have gotten some understanding that a choice was involved.
This technique of thinking about what you are trying not to think about is called paradoxical counseling, and it can be very effective. To do it properly takes some experience, and it is not something anyone without experience should try to do on his or her own. Choice theory is about making better choices, but we have to understand the reason for the bad choices before we can make good ones. As much as Francesca was infatuated with Robert, I believe there are few one-person people, certainly not a person one has known for only four days. In my counseling, I offered her a way to find belonging, if not love, by going to work.
Francesca could have chosen obsessing, saying over and over that she was sick and going to die or that her husband was sick and going to die. She could have also started compulsively washing her hands over and over and developed an overwhelming fear of dirt and germs. Either obsessing or compulsing could have kept Robert from surfacing in her mind. People who choose compulsive hand washing frequently feel guilty, and Francesca certainly could have felt enough guilt to have chosen it. The counseling would be the same as with phobicking.
Posttraumatic stress disorder, or PTSD, is another frequent diagnosis in the external control world where it is common for people to think: I am the victim of something external over which I have no control. After a painful, unexpected injury, accident, or exposure to a frightening situation, the people involved are so traumatized they cannot cope and need counseling to deal with what happened. The symptoms may be physical, such as a pain in the head, neck, or back; a disability, such as being unable to walk; or psychological, such as fear and anxiety that are so severe that the person can’t work. A huge disaster, such as an earthquake, is a classic cause of this condition. I worry that the assumption that the people involved can’t cope without expert help is frequently made too quickly.
By now, this assumption is so widespread that a whole post-trauma care system has come into existence. This system consists of doctors, lawyers, and therapists who have a financial incentive to convince the world that those who have been traumatized need help for what happened and compensation for their suffering. All this may be well intended, and the victims did indeed suffer, but it may also convince some of them to choose to perpetuate their suffering.
What is wrong with this assumption and the subsequent diagnosis of PTSD is that thousands of people who are exposed to huge amounts of trauma gather themselves together and deal with it. They do so because they have good relationships and a belief they are doing something worthwhile with their lives that they want to get back to doing. People who suffer so much disability after a trauma that they can’t go on with their lives do not usually have strong relationships and may not be doing anything they consider worthwhile with their lives.
For these people—uninjured physically—the choice to disable themselves after a trauma is widely supported by the common sense that we are all controlled from the outside and provides a good excuse for people who are not coping to escape from their own inadequacy. The possibility of insurance settlements helps them believe they have been disabled. I am concerned that money to compensate them is being diverted from people who have suffered more tangible injuries. I do not have the answer to this dilemma, but I think it would occur less in a choice theory society. The more we teach people that they can deal with what happens to them, the better off we all will be.
It is important to me that I not be seen as lacking compassion. I never tell people that they are choosing any painful or self-destructive symptoms. I help them to make better choices and better relationships and teach them some choice theory. In almost all instances, they are very pleased with the therapy and are willing to give up the symptoms or beliefs when they find better ways to take control of their lives. It is no kindness to treat unhappy people as helpless, hopeless, or inadequate, no matter what has happened to them. Kindness is having faith in the truth and that people can handle it and use it for their benefit. True compassion is helping people help themselves.
It has been my experience that helping people to look at a psychological problem as a choice is a liberating awareness. The mystery, the fear that something beyond their control has suddenly come over them, is removed. They can now learn that other choices are possible, and acting on those new, more effective choices sets them free to explore lives filled with creativity that does not harm them.
* Norman Cousins, An Anatomy of an Illness as Perceived by the Patient: Reflections on Healing and Regeneration (New York: W. W. Norton, 1979).
* Paul Ridker, “Inflammation, Aspirin, and the Risk of Cardiovascular Disease in Apparently Normal Men,” New England Journal of Medicine (April 3, 1997).
† William Glasser, Take Effective Control of Your Life (New York: HarperCollins, 1982), p. 112.