Journal ofHumanistic Psychology, Vol. 30 No. 1, Winter 1990 107.131 © 1990 Sage Publications, Inc.
FURTHER THOUGHTS ON
PREVENTING MENTAL ILLNESS
My original goal in writing this article was to respond to a critique by Albert Ellis (personal communication, 1986) of "Preventing Mental Illness: Some Personal Discoveries" (Ericson, 1986). Trying to answer him led to a deeper understanding on my part of mental illness, and to new therapeutic techniques. I discuss these techniques and answer Albert Elliss critique.
In an article entitled, "Preventing Mental Illness: Some Personal Discoveries" (Ericson, 1986), I described the self-help methods I developed to overcome my mental illness. Albert Ellis wrote me his comments regarding the article, bringing to my attention a weakness in my approach. This addendum addresses that problem as well as presenting further developments in my approach.
In my article, I discussed two methods of self-help. One method diagnosis and correctioninvolves using a list of core problems (see Appendix) as a diagnostic tool and sitting down with a pen and paper and spending some time working at it. The other method reversalI used when I did not have time to use diagnosis and correction. Reversal consists of trying to think the opposite of false negative thinking. After reading my article, Ellis (personal communication, 1986) commented:
The reason I came up with reversal in the first place was that during a depression I was desperately trying to understand what was going on, and I sensed that my negative thoughts were exaggerated. I jumped on that clue, as it were, and opposed the negative thoughts by what seemed to be the most logical way: by trying to think the opposite. It worked dramatically the first time I did it, so for many years afterward I continued to use the same approach. Recently I came across a book that advocates the same concepts of reversal that Albert Ellis objects to called What to Say When You Talk to Your Self (Helmstetter, 1986). Helmstetter writes, "When you hear yourself say something like, Ive really got a problem with this, turn it around and say, I can handle this! Im a capable person and I handle problems well." He continues, "Instead of telling yourself that youre tiredat a time of the day when you cant afford to be tiredimmediately tell yourself that you have plenty of energy and enthusiasm" (p. 100).
Nevertheless, I think Elliss comment is valid. For this reason I have tried to develop an alternative technique that does not share the problems of reversal but that shares its advantages. In order to do this I had to understand what was good about reversal.
Reversal was a very powerful technique for me because, when I succeeded, it gave me a new perspective and an emotional boost that countered the depressive effect of the negative belief and displaced the negative belief from my mind. Without considering the opposite, I would have had a more difficult time trying to come up with an approach to dealing with whatever was bothering me. A substitute technique for reversal should, therefore, open one's mind to a new perspective as well as give an emotional boost to displace the negative belief. One way to open one's mind to a new perspective is to consider the evidence for the opposite rather than trying to think the opposite. If one does find evidence for the opposite, that will lead to an emotional boost. Another approach to generating an emotional boost is to have prethought-out correct positive thoughts to use for specific negative thoughts.
The way I found what thoughts to use was by combining trial and error with my hypotheses so that my ideas would influence my trials and the results would influence my hypotheses. Once my hypotheses were developed and were supported by results, they became theories and were like windows that enabled me to perceive patterns in my thinking that I would not have otherwise seen. This led to new hypotheses.
My techniques are based on the concepts that follow.
1) One can posit a plausible explanation for how a condition as powerful as mental illness could result from psychological problems primarily. The reason psychological problems may lead to as severe a condition as mental illness is because of the self-feeding nature of mental illness, in which psychological problems lead to other problems and feed the problems they originated from either directly or indirectly (Ericson, 1986). In addition, ones defense mechanisms may be self-destructive. Therefore, the more serious ones illness gets and the more efforts one makes to fight it, the more one may be fueling ones illness. The reason that everyones problems do not escalate into mental illness could also be explained in terms of psychological forces, not only physiological ones, although in reality some people may be more prone to mental illness because of both. One could argue that people who are more prone to mental illness may have developed poorer coping mechanisms and defenses than those of people who are not more prone, because they were exposed to a hostile environment during childhood, when they were developing their defense mechanisms. Rejection during childhood is what brought on my mental illness.
In order to understand how psychological forces alone might be able to cause mental illness, it is helpful to consider the similarity of mental illness to a viral infection. In a viral infection, viruses multiply at an exponential rate, but the immune system develops defenses at an exponential rate as well and so can overcome the infection. If the viruses have too much of a head start or if the immune system is not functioning properly, one can develop a serious disease. In a viral infection the hosts cells end up producing the virus. Similarly, in mental illness the mind starts generating problems that feed it. Mental disorders often start when a person is faced with too many problems that overcome the defenses and escalate into disease in a fashion similar to viral infections. There are many psychological analogies that can be drawn to an unhealthy environment that increases the likelihood of a disease progressing. An important analogy to consider is that it is possible that a person becomes prone to negative self-motivation, such as self-criticism for failure, if others motivate him or her with negative motivations such as threats and criticism.
2) Realistic thinking usually leads to a better reality. Becoming more realistic in ones thinking leads one to deal more effectively both with external problems and the internal stresses they lead to and so leads to a better reality for oneself. Even if a false belief allows one to feel better in the short term, it is likely to hurt one in the long term.
3) Our moods are often influenced by thoughts, desires, and beliefs that we are unaware of and can become aware of through self diagnosis. We subconsciously may exaggerate threats and fears that, if we were aware of consciously, we would keep in perspective. This may be because our subconscious thought processes are not as critical and as logical as our conscious ones, and although consciously we may wish to be accurate in our perceptions, subconsciously our desire to believe certain beliefs may be stronger than our desire to he accurate in our perceptions. Motivations that we are unaware of can lead us to subconsciously generate negative thoughts in order to motivate ourselves to fulfill those desires and, as a side effect, cause emotional pain and depression. By bringing these thoughts into focus with diagnostic techniques, we can use therapeutic techniques to deal with them if they are incorrect. In fact, just bringing them into focus in some cases may be enough; once one is fully conscious of the thoughts that are causing ones depression, it often becomes apparent that they are wrong. By becoming consciously aware of the thought that is bothering oneself and by becoming consciously aware that it is wrong, one influences the subconscious to stop thinking the thought and causing depression with it.
4) There are basic motivating forces. These include the desire to defend against a threat, to avoid a threat, and to remove a threat; the desire to avoid pain and to achieve happiness; the desire for a bright future, high self-concept, self-acceptance, and a feeling of having achieved and of being important; and the desire for excitement, security, and the esteem and high regard of others.
5) The mind in response to these motivating forces creates additional forces toward motivation. For example, if one has the motivation to achieve something, the mind might tell itself, "It will be terrible if I dont achieve my objective," thus creating a perceived threat and generating the motivation to remove that threat by working hard at achieving, which was the original motivation. This example of motivating oneself generates pessimism, because it says that things will be terrible if one does not achieve. Thus generating motivations of this type is a force toward negative thinking.
6) The defensive mechanisms of the mind are by nature self-destructive. All defenses are costly and thus potentially self-destructive, especially if they divert effort from other productive activities. In mental illness the damage created by inappropriate defenses can be greater than any actual threat.
An example of a self-destructive defense mechanism would be defending ones self-concept by believing that those who disagree with oneself are hostile, rather than benefiting from their judgment. If this belief has not become too ingrained, a friendly environment should be able to shake it. Defensive mechanisms can be a force toward cognitive errors. For example, magnifying a threat to oneself to motivate oneself to deal with it is a way in which one distorts ones picture of reality for defensive purposes.
7) Correct related positive thoughts have more power to displace negative thoughts and the emotions associated with them than correction by itself. I shall call this concept "positive displacement."
8) One can tie positive thinking to ones motivations and thus generate a force toward positive thinking or feeling. For example, by telling oneself "Im proud of you for being happy" or "Im proud of the times that you have achieved happiness," you tie the motivation of desire for high self-concept to being happy. I have found that when I have trouble being optimistic, telling myself "Im proud of the times that you have been optimistic" helped me be optimistic. One can tie moral behavior to the desire for self-concept by praising oneself when one does a good thing by saying, "That was a good thing you did and Im proud of you." One can create a motivation toward resisting core problems (Ericson, 1986) by saying, "Im proud of you for not thinking more pessimism, paranoia, and low self-concept." This is of particular value, because I often find myself criticizing myself for feeling those things and thus creating a vicious circle in which I criticize myself for feeling low self-concept. The most effective motivation to tie positive thinking to is the one that is leading one to generate the negative thought in the first place. For example: If the threat of failure is leading oneself to feel fear in order to motivate oneself to take defensive action, the most effective motivation to tie to not being afraid would be the motivation to overcome that threat. This could be done by telling oneself, "My best chance of overcoming the threat of failure that I face is to perform well, and Ill perform better if I am not anxious." I shall call the motivations used in this way "therapeutic motivations."
9) Negative emotions are useful and good up to the point that they motivate us to take action to defend ourselves against threats. But the negative effects they have can be worse than the threats they were meant to defend against and can actually make it harder for oneself to deal with those threats and to achieve ones objectives. I believe it takes effort and knowledge of self-help to function optimally. It also requires a developed sixth sense, the sense ofwhat one is subconsciously thinking. This is a sense that develops when one uses self-help.
10) Self-concept is a barrier to immoral behavior. A basic way in which the mind gets around this barrier is by thinking worse of others than is true. Then it believes the immoral actions it is doing to others are right. Self-diagnostic questions such as, "Do I want to think so and so is wrong? and Would it hurt my self-concept if I believed that so and so was right and I was wrong?" can help one become aware of such immoral self-deception.
11) In mental illness the emotional paranoid and pessimistic states generate paranoid and pessimistic thinking and lead one to believe such thinking is accurate. An interesting property of paranoid and pessimistic emotional states that I have found in myself and that I expect occurs in other people is that they lead one to be sure that ones paranoid and pessimistic thoughts are true and to draw paranoid and pessimistic conclusions.
When I was mentally ill I used to hear hostile voices. "Hear" is really an incorrect term, but it is the common way to describe the experience among the mentally ill. "Sense" voices would be a better way to describe it. What I think happened is that my mind was in high gear because it was trying to defend itself. The side effect of being in high gear was that I started to sense random, disorganized thoughts or "mind noise," which my mind then turned into hostile voices because my emotionally paranoid frame of mind made it seem reasonable that there were voices. It seemed that the voices must belong to those responsible for the threat that I faced and thus must be hostile, and that it was imperative for me to understand what they said.
12) Raising ones spirits with self-help is a morally good act. One can boost ones self-concept by praising oneself for ones good actions in raising one s spirits with self-help and thus create a correct, positive feedback cycle toward higher self-concept.
THEORY BEHIND THE CONCEPTS
After discovering on my own how I motivated myself to be unhappy, a psychologist told me about the Option Process, in which the concept of destructive self-motivation leading to unhappiness plays an important part. Barry Kaufman (1977) described these concepts beautifully in his book To Love Is to Be Happy With. He wrote,
I understand Barry Kaufman probably better than most psychologists do, because I rediscovered some of the ideas that he set forth and experienced their power. These ideas should not be ignored. I have not seen any mention of these ideas in books on cognitive therapy. Aaron Beck and Gary Emery wrote an entire book about anxiety (1985) and never mentioned that a fundamental cause of anxiety is the fear people have that if they are not anxious they will not be motivated to deal with their problems. Beck and Emery never mention that people unconsciously use anxiety to motivate themselves. Becks cognitive model of anxiety is useful in that it leads to the therapeutic technique of teaching patients to minimize the magnitude of the threat to themselves. With motivational and positive displacement concepts, one can add to this therapy and thus make it more effective. An example of a therapeutic statement based on motivational concepts is "Things will be the best they can be if Im optimistic and relax." If the statement can be made more specific, such as, "Im more likely to succeed if..." instead of Things will be the best they can be if. . .," this therapeutic motivation would be even more effective.
I think the Option Process, which includes concepts of motivational and cognitive problems as contributing to emotional problems, should be more well known than it is. Barry and Suzi Kaufman used their Option Process to treat their son who was diagnosed as "incurable," "schizophrenic," and "autistic." Admirably, they did not accept these labels. Barry writes:
In the concepts that I presented, I state that realistic thinking leads to a better reality. This may seem to be common sense, yet an alarming vogue is taking shape in psychology as represented by psychologists such as Richard Lazarus and Shelley Taylor (Goleman, 1987), who believe that illusion is essential for mental health. In fact, Lazarus goes as far as to say that mildly depressed people are very realistic about themselves. The psychologists draw this conclusion because studies have shown that mentally healthy people tend to have a more positive attitude toward themselves than the people around them have of them and than is warranted by other "objective criteria" and because mentally ill people tend to have a more negative outlook.
I believe Lazarus and Taylor are making a fundamental mistake. What they are overlooking is that an objective positive reality may be correct and that both the depressed and happy subjects in their study were wrong because neither of them knew what that positive reality was. The people with the positive beliefs about themselves may have been wrong about details but may have actually been closer to objective reality than the people who were right about details but interpreted them in a negative way. For example, one could have two people who have a 50/50 chance of surviving an illness. One could be realistic and be depressed about it. The other could believe that he or she was not at risk and be happy. Because it has been shown that our immune defenses are weaker when we are depressed, it is clear that the person with the incorrect belief is more likely to make it if that person took appropriate medication. However, there is an objective reality that would make both of them more likely to make it. If both of them knew that being happy would increase their chances for survival, they would both be motivated to be happy. The advantages realistic thinking would give them are that they would be more likely to take appropriate treatments and to make appropriate efforts to get well, and they would take care of whatever last wishes they might have in case they did not make it. The object of my therapy and perhaps of the therapy of others who stress self-acceptance is to be able to have a positive outlook toward oneself and also be realistic.
In my concepts I state that we are influenced by thoughts and desires that we are unaware of but can become aware of through self-diagnosis. This is similar to Freuds concept of a subconscious mind. I have diagnosed myself subconsciously, generating negative thoughts in order to motivate myself to take defensive action against threats or to acquire what I want. By creating unhappiness or dissatisfaction or self-rejection, I subconsciously motivate myself to try and eliminate the undesired state by doing what I subconsciously or consciously want. This is not necessarily a bad thing. If one has done something wrong, its good if the subconscious generates guilt feelings so that one makes efforts to make up for the wrong one has done. If one has to protect oneself against a threat (for example, possible crime against oneself) and the subconscious generates fear so that one takes preventive action, again the negative thoughts that the subconscious has used to motivate the conscious self are beneficial. However, in mental illness the process of generating negative thoughts may get out of control by vicious-cycle mechanisms similar to the ones I presented in my previous article (1986). Often the process of generating negative thoughts gets out of control in people who are not considered mentally ill. For example, people often drive themselves with negative motivation and sacrifice their happiness for goals they might have achieved without sacrificing their happiness.
Examples of negative self-motivational defenses include blaming others, a defense that can be used in order to protect ones self-concept but that generates paranoia toward others. Becoming hostile or paranoid of others and deceiving oneself that one has a valid reason for it can be a defense against feeling obligated to help them with their problems, against becoming emotionally involved with their problems, and against feeling guilty for what responsibility one may have for their problems. This is a terrible defense, because it victimizes the victim for being a victim. I have experienced this several times.
Defense mechanisms even exist in which one attacks ones self-concept in order to protect it. I have criticized myself for failing, in effect telling myself, "I am not you, you are a failure. I am very critical of you and therefore am not responsible for your failure." I am not the only who has used this defense mechanism. I remember watching a pole-vaulter failing to vault over a bar. Every time he failed he cursed himself and put himself down. I think he was trying to protect his self-concept, because by cursing himself he was in a sense saying to himself, "I am not you; its your fault that I cant vault over the bar, not mine." In addition, he may have been trying to motivate himself to perform better through self-criticism. I have caught myself criticizing myself for not living up to my standards to motivate myself to live up to them. An equally bizarre defense that I have found myself using often is dealing with the anxiety that something bad will happen by convincing myself that it will. Once I am convinced that it will happen, I do not have to be anxious about it happening anymore, because there is nothing I can do about it. This defense has the unhappy side effects of creating pessimism and sapping my will to try and prevent the bad thing from happening.
A misconception I had that led to a self-defeating defense mechanism is that in order to be liked, one has to be superior, act as if one is omniscient, and be domineering. These misconceptions led to behavior that caused people to develop contempt for me. My defense against peoples contempt for me was contempt for them. and so a vicious cycle was created. The belief that I had to be superior led to the slightest failure traumatizing my self-concept. I think I developed the misconception that I had to be superior, because when I was a child I thought I was being rejected for being weak. It may be that desire for high self-concept also fed my believing myself superior.
Generating anxiety is a way of motivating oneself to deal with a threat. Generating anxiety about ones abilities is a way to make oneself more careful, but it generates insecurity. This insecurity can be felt by others and leads them to doubt a persons abilities. Thus such a defense in an employment situation can be very harmful. From a social point of view people want to avoid insecure people, because being around insecure people makes them feel insecure.
A defense mechanism that could prevent one from self-help or seeking therapy is to protect ones self-concept by rationalizing that one does not have any psychological problems and that anyone who suggests that one does has bad intent or is misled or also has problems. Similarly, a defense mechanism that prevents one from objectively evaluating the morality of ones behavior is rationalizing that one is good and anyone who suggests otherwise is bad. Although I have called these defense mechanisms, many of these can be thought of as offense mechanisms, as well. People can resort to these bad and maladaptive mechanisms not only to defend themselves against problems but also to acquire something and fulfill some motivation of theirs.
In Misunderstandings of the Self, Raimy (1975) writes, "A defensive misconception protects the individual from having to recognize an alternative misconception which is more threatening than the defensive misconception." Raimy gives an example of a patient who, anxious about failing, considered himself "too laid back" to take on challengesa more acceptable reason than the thought that he was inadequate. Another way of looking at the patients reasoning is that the patient was protecting his self-concept by attacking it.
A way of diagnosing the underlying misconception that Raimy mentions is to ask oneself, "What dont I want to believe and why?" I have found that identifying underlying misconceptions in this way helps me overcome the misconceptions that they support.
A danger of defending against a misconception with another misconception is that once ones attention is diverted to the second misconception, one becomes unaware of the first, so it is less likely that one will ever correct the original misconception unless one uses self-help.
I have developed therapeutic techniques, which I call "positive follow-ups," on the basis of the concept of positive displacement. These positive follow-ups follow the corrections I use for dealing with negative thoughts. The positive follow-up I have developed for dealing with hostility is based on something I learned from using an auxiliary technique for reversal. When I used reversal, I found that often I was not able to reverse a negative thought because it was being fed by another one. I learned to use this to my advantage. I found I could diagnose problems by trying to reverse a negative thought and observing the negative beliefs supporting it that then arose. For example, if I opposed the negative thought "Im no good" with "I am good," the thought "but I failed my task" might arise. By listening to the counterargument, I diagnosed why I felt that I was no good. The next step would be to correct the thought "I am no good because I failed my task" and then listen to the counterargument to that. I would repeat these steps until the problem was solved.
The most surprising thing that I learned from this method of self-diagnosis is that hostility toward others can be traced to self-hate. I do not mean to say that hostility is not partly generated due to external causes, rather that when I reversed self-hate I could reverse the hostility I felt. Because hostility frequently also stems from paranoia, a possible correction and follow-up to hostility could be "So-and-so doesnt hate me and I love you" (where "you" refers to myself). Similarly, a correction for low respect for others could be "They dont disrespect me," and a positive follow-up could be "I respect you." I have found that this correction works for me as well. The way this auxiliary method could be corrected to avoid the problem of creating false positive thoughts would be to substitute correcting the negative thought for trying to reverse it.
It might appear that after using the auxiliary technique outlined above as well as other self-diagnostic techniques, it should be possible to come up with some basic fundamental problems; then one should have to deal only with those in the future and not do self-diagnosis anymore. Although it is true that being aware of these fundamental problems is of value, sometimes, in order to deal with them, one has to deal with the problems that feed them and create them. These differ from situation to situation and from person to person. One has to trace the entire cycle and find the root problem, because by the circular definition of a cycle, all problems in it are root problems. There is no beginning or end to a cycle once the cycle has formed; another way of looking at cycles is that all parts of them are beginnings and ends.
THERAPY BASED ON THE CONCEPTS
From the concepts that I have presented, from trial and error, and from diagnosis of problems blocking my happiness, I have developed a quick therapy to use instead of reversal. The method that I developed consists of asking myself, "Whats bothering you"; "What can I do to remedy the situation?" and using the appropriate responses from the statements listed below. If I do not know what is bothering me, I might use the cues of low self-concept, paranoia, and pessimism to help me diagnose it (Ericson, 1986). Once I diagnosed a depressing belief, I might ask myself a brilliant question suggested by Barry Kaufman (1977): "What are you afraid will happen if you werent unhappy about that?" (p. 39). If I could not diagnose the beliefs leading to my unhappiness, I might ask myself, "What are you afraid will happen if you stop being unhappy or stop being anxious?" I then say the following statements to myself:
1. "I may be able to be happy with things the way they are.
2. "People will be more likely to like me if I like myself and will be more likely to approve of me if I approve of myself."
3. "I love you the way you are and am proud of you the way you are.
4."Things will be the best they can be if Im optimistic and relax."
5. "I can forgive and tolerate people in spite of their faults, and Ill be happier if I do."
6. "People are more likely to look up to me if Im happy and look up to them."
Statement 3 may be objectionable to some on the grounds that it could lead to vain and narcissistic thinking, but it has actually helped me face my faults. Vain and narcissistic thinking may be a defense mechanism against ones inability to accept ones faults as real, so, if anything, self-love should overcome them.
I reinforce these statements by praising myself for thinking them and for raising my spirits when I succeed in doing so. I try to evaluate the validity of these statements in the particular situation I am in, if I have the time.
All the foregoing statements deal with the most common negative thoughts I face, and most provide a therapeutic motivation that, for me, makes them much more effective. Five out of the six statements deal with acceptance, either of myself or of others. These statements have been very effective for me, which indicates that problems with self-acceptance are an important part of the problems I have to deal with and suggests that one way my subconscious may be motivating itself may be by generating self-rejection. The importance of self-acceptance was understood especially well by Carl Rogers and Albert Ellis, who designed their therapies to deal with this problem.
If the problem that is bothering me is anxiety, the foregoing statements and questions are often insufficient. I supplement them with the following statements:
1.I wont let you proceed with your work until youre optimistic and slow down.
2.You should be proud of your courage in being happy and not panicking.
3. Youre doing the best you can if you are following a course of action and going slow. If you push yourself to go fast youll become anxious. That will interfere with your performance and your happiness, which is your primary goal.
Depending on the situation, I supplement all the techniques I have with creative therapy This therapy is based on all the knowledge I have, not just the methods listed in this therapy section.
My mind often will resist my self-help methods or will not respond to them because of underlying problems. I have kept track of how it resists and of the blocking of underlying problems. I have listed some of them below (reactions) with prepared responses to them. A therapeutic technique I sometimes use is just to read this list to myself.
Reaction: Doing self-help just messes me up. It makes me feel and act strange. Its no good; its going to hurt me. The time I spend on it takes away time from thinking about my work.
Correction: Doing self-help wrong messes you up. You may be just saying self-help phrases to yourself instead of thinking about their meanings. You may be trying too hard at the wrong technique. If a technique doesnt work with a little bit of effort, drop it. Theres probably an underlying problem that you have to diagnose and deal with before you can use other techniques. Also, if a problem has been leading your subconscious to generate negative thoughts all day, a technique may be unable to instantly restore happiness, in which case its better not to try and force it. Dont panic when it doesnt work. Relax instead.
Reaction: But Im doing the wrong thing. Im doing X when I should be doingY. Maybe something terrible will happen because Im not doing Y. Im bad because Im not doing Y.
Correction: Choices arent always clear-cut in life. You may be making the best choice and yet still be taking a risk. Youre not bad because youre faced with difficult choices. Reconsider the choices that you are making and evaluateif the consequences of the wrong choice are really as bad as you think they are. Then decide to make one and not worry about the consequences of perhaps not making the right choice. Once you do that, if youre optimistic youre less likely to worry and more likely to be happy. In life we always will have threats hanging over us; once we accept that, we can stop motivating ourselves to deal with them by generating anxiety because we know we cannot deal with all threats. Theyre part of life.
Therapeutic Motivation: If you care less about the problems you face, youll devote less time to them and youll be a lot happier.
Reaction: I have to worry until I do something that I should do so that I dont forget to do it.
Correction: Write down what you have to do. Plan a time when you will do it. Than stop worrying about it.
Reaction: I have to feel inferior and be self-critical because Im not performing well enough. If I dont Ill fail, and that will be terrible. If I feel inferior Ill push myself to work hard, and if I hate myself Ill drive myself and I might just succeed.
Correction: The reality is that things take time, that you cant set deadlines on performance. You cant make problems simpler than they are. It is unreasonable to expect things to go faster because you want them to. View problems as exciting and challenging opportunities for achievement.
Positive Follow-up: I can approve of myself the way I am.
Therapeutic motivation: Youll be happier doing your work if you displace feelings of panic, inferiority, and self-hate with optimism, pride in being optimistic, pride in your work, and love for yourself.
Reaction: But Im afraid to be happy. Then my defenses will be down and Ill be too vulnerable. Ill get myself into trouble. I wont work hard enough. I wont take my obligations seriously, and that could result in disaster. I have to worry.
Therapeutic Motivation: Happiness is worth the risk. Life is too precious to spoil with worry. Happiness is more important than the problems you face. Negative defenses give you a feeling of security, but you really are more secure if you respond to them with a plan of action and then stop them by displacement with optimism and happiness.
Reaction: I want to be important. I want to achieve. I want to be great.
Therapeutic Motivation: Im proud of the times you have achieved happiness. I can like and approve of myself even if Im not great. I love you the way you are.
Reaction: But they hate me and have contempt for me.
Correction: Youre probably exaggerating.
Therapeutic Motivation: I love you and am proud of you. The way to fight those who wish you harm is to be happy.
Reaction: But Im in danger.
Therapeutic Motivation: If I take appropriate action and Im optimistic, things will be the best they can be.
Reaction: Things wont be great if Im happy. Im not satisfied with my life-style. I dont have what I want.
Diagnosis: What do I want?
Plan of Action: Consider how you can best achieve what you want and make a plan of action. Design therapeutic motivations in which you tie positive emotions to getting what you want. For example: If you want success tell yourself, "Im more likely to succeed if Im happy."
Positive Follow-up: You can be happy with what you have.
Therapeutic Motivation: Life will be more exciting if youre happy. Happiness is one of the things you want. If youre happy your chances of getting other things that you want, such as friends and success, are higher.
Reaction: But Ive done so many things wrong. The damage is done and its too late to undo it.
Positive Displacement and Therapeutic Motivation: Youve learned from your mistakes. Now youll do things right and others will be pleased.
Reaction: But the nice things I had are gone.
Correction: Be glad you had them when you did. You can still enjoy the present and look forward to what the future may bring.
Reaction: But Im lonely, I want them to like me but they dont like me.
Therapeutic Motivation: People are most likely to like me if Im optimistic and friendly.
Reaction: But Im in pain.
Therapeutic Motivation: Youll be less bothered by pain if youre happy.
Reaction: But Im bored.
Therapeutic Motivation: If Im happy my life is most likely to become more exciting.
Reaction: But Im bad. I feel contempt and mockery toward everything.
Correction: Feeling superior is a weakness but doesnt mean youre bad. Bad feelings dont make you bad. Dont protect yourself from the possibility that others have a bad opinion of you by disrespecting them.
Therapeutic Motivation: If you have a high opinion of others, theyre more likely to have a high opinion of you. React to the lack of respect of others with understanding, not contempt. Respect yourself; that will neutralize your feelings of contempt and thus eliminate those bad feelings. You can approve of yourself in spite of bad thoughts and feelings.
Reaction: But sad things are happening.
Therapeutic Motivation: The potential for sad things to happen may be the price for the potential for good things to happen. The way to fight sad things is to make a happy thing happen and to be happy.
Reaction: But Im going to die.
Therapeutic Motivation: Fear wont make you live any longer. Optimism will make you live more during your life span.
Reaction: But whats happening to me isnt fair.
Correction: Things could be a lot worse.
Positive Follow-up: I have a lot of things to be grateful for.
Therapeutic Motivation: If Im happy, life will be a lot fairer.
Reaction: But I dont have control over all the bad things that are happening.
Correction: You have a lot of control over your happiness.
Therapeutic Motivation: If youre confident, people are more likely to listen to what you have to say and to respect you.
Because these methods work so well for me, I recommend that others try them, then tailor these methods by observing their reactions and designing therapeutic motivations that work for them. I certainly recommend that psychologists reading this article try these techniques. Self-help psychology is a field in which you have to try before you can completely understand.
I have found that the therapeutic effectiveness of the statements wears off if an underlying undiagnosed problem builds up and causes me subconsciously to generate negative thoughts and emotions. These techniques are no substitute for self-diagnosis. They are complementary to self-diagnosis in that they can be used when self-diagnosis cannot be. When they lose their effectiveness, I use the diagnostic techniques that I described in my previous article (Ericson, 1986) but add the list of problems noted above to that list. Lengthy self-diagnosis and developing responses has trained me, so I am better at rapid diagnosis of problems and response development during the day.
I think that others should test my therapeutic techniques. An advantage of my techniques is that they were developed by a person having the problem, were immediately tested when developed, and have been constantly improved. I am living, happy proof that they work. For the 15 years that I have been out of the hospital, I have had no medication and have not been treated by a therapist. My condition has constantly improved.
There are other former schizophrenics who claim that self-help helped them get well. At the most recent plenary session of the National Alliance of the Mentally Ill, Lionel Aldridge (1987), a former football star with the Green Bay Packers, gave a speech describing how he overcame schizophrenia with positive thinking after being initially helped by drug therapy. He searched the Scriptures for a statement describing his feelings about positive thinking and found it in Phil. 4:8, paraphrasing it in his speech. He said:
The fact that I have had no relapses has led some psychiatrists to say that paranoid schizophrenia was a misdiagnosis and that what I had in reality was an adolescent psychotic break. Certainly my doctors were very convinced I was a paranoid schizophrenic at the time. I have learned that many define schizophrenia as an incurable progressive disease with relapses. I suppose this definition arose because there are patients with schizophrenic symptoms who get steadily worse. When people like me get well, doctors who cling to this definition have to say I was misdiagnosed or that I went into remission. The correct conclusion is that there are symptoms that the conventional medical wisdom labels as schizophrenic, and some people with those symptoms get well and some do not. If someone has a curable condition and is labeled as having an incurable one, that person will not receive the help that would otherwise be given.
It is possible that there exists an incurable condition with schizophrenic symptoms, but I suspect that even if such a condition exists, my techniques could help fight it: Psychological problems, even if they arise from physiological disturbances, become contributing causes. In my earlier article (Ericson, 1986), I talk about cycles that arise during the development of mental illness. It is probable that physiological disturbances are a part of these cycles.
It has been my experience that sometimes there is a lag time between self-help and feeling better. This lag time could be the time it takes for my physiology to restore itself to normal. Feeling worse due to physiological problems probably leads to negative thinking and creates a negative cycle. It may be that in addition to affecting ones attitudes, positive follow-ups and therapeutic motivations affect ones neurophysiology in a positive way. This may sound farfetched, but if one reflects on how ones thoughts control ones actions through physiological changes, such a connection becomes more plausible.
Psychiatry appears to be divided among those who believe that mental illness is purely physiological and those who believe that it has psychological components. There is increasing evidence that physiological differences are present in the mentally ill, and this reinforces the beliefs of those who view mental illness as entirely of physiological origin. Interpreting physiological changes in this way is a mistake because it ignores the obvious interrelation between the psychological health of the brain and the brains physiology. I make the very safe prediction that if science becomes advanced enough, physiological changes will be found in all of the mentally ill, and that even the physiology of those who get well with psychological treatment alone will return to normal.
In addition to the therapeutic techniques I have mentioned, it is important for the patient struggling with mental illness or recovering from it to have social support. If people would get together and form a circle of friends for a patient, I expect that would be of great therapeutic value. I remember how much I needed friends when I was mentally ill and recovering from the illness.
Several organizations provide badly needed social support for recovering patients. The Compeer organization, in which volunteers offer their friendship to the mentally ill, is used by many psychologists in conjunction with psychotherapy. In the 1985 program evaluation survey conducted by Compeer in which psychologists evaluated the program, 204 volunteer/patient relationships were evaluated: 68% of the volunteers were rated as extremely helpful and 18.6% as fairly helpful. Homes like Fountainhouse provide a social environment for recovering patients and are probably instrumental in their getting well. In their newsletter they print accounts of recovering patients and how valuable the house has been for them. Recovery is an organization in which the mentally ill help each other.
Even friendship between the therapist and the patient is important. Patients are asked what they found helpful during cognitive therapy. A common response was "the concern and warmth of my therapist" (Beck & Emery, 1985). They responded this way despite all the sound theory behind cognitive therapy!
CHOICE AND MENTAL ILLNESS
The notion that the mentally ill person chooses to be that way, that he or she makes the choice to think of and cling to false negative thoughts and to resist reason, is common among psychologists. In fact, one of Dr. Elliss comments about my article was,
I think Albert Ellis should imagine what rejection is like for a child and imagine what it would be like if one day when he went to work people jeered at him. When he walked on the sidewalk to his institute people hit him. Then they waited on his way home to beat him up. This is what happened to me. Then I want Dr. Ellis to realize that at the time I knew nothing about self-help, that even if I had I might not have been strong enough to defend myself emotionally against my peers, and that I was just a child who did not understand why everybody hated me. I think the real choice lay with the children who persecuted me. I certainly was mentally ill without wanting to be. In fact, I went to great lengths to develop self-help, which I then used to get myself well.
I think blaming me for conspiring with my illness is almost as irrational as patients grasping at improbable explanations to explain what they cannot understand. I think that psychologists should be very careful when they say that the patient chooses to be sick, because that can lead to their unjustly blaming the patient. Gammill (1986), in her article "Self-Direction as a Potential Influence on the Etiology of Schizophrenia," mentioned this problem when she wrote,
Nevertheless, Gammill argues that
I think Gammill is very insightful in recognizing that some schizophrenics may be able to influence the course of their disease, but I think that if one wishes to be "facilitative to schizophrenic individuals," one should also recognize the power of what they are up against. One of my favorite proverbs that applies to this is an American Indian saying:
If one views mental illness from the mental window of choice, one should also view it from the window of a separate living entity making choices. This is reasonable if one remembers that mental illness can take on a life of its own (Ericson, 1986). To view mental illness through this window I have personalized it in the following monologue:
Mental Illness: "Lets destroy Bill. How will we do that? Well make his mind destroy itself. We cant let Bill know how were doing it or hell interfere. Well create low self-concept, paranoia, pessimism, and self-hate in him that will lead to self-perpetuating cycles. Well convince him his problem is caused by outsiders. Well make him hear voices; thatll convince him. Well make him hold on to his self-destructive beliefs no matter how hard people try to change his mind. Hopefully, Bill lives in a superstitious culture where people may decide he is possessed and kill him. In any culture his vulnerability will make him a target of attack for the corrupt elements there. If we do a good enoughjob, Bill will be unable to function; that will lead to despair and feelings of inferiority and perhaps to loss of food and shelter. People will avoid him, and his loneliness will eat away at his sanity. His paranoia may lead him to attack innocent people, in which case he may be incarcerated with criminals who will continue our work for us. His only chance is if he gets help in a good mental hospital, but they dont have enough money to put him up and keep him off the street. The fools probably think theyre protecting his rights by releasing him before hes well."
THE EFFECTIVENESS OF THESE TECHNIQUES
I see no reason why these techniques could not help other mentally ill people the way they have helped me. The major obstacle I see to them is convincing the mentally ill that they are worth the effort. The transformation that has occurred in my mood from 15 years ago is unbelievable, even to me. Most of the time I feel the opposite of depression. One person, mystified by my good mood, asked a friend of mine if I was high on drugs. My friend replied, "No, hes high on life." I feel a lot more alive now than I used to feel when I was depressed. I still am unhappy part of the time, and I still have problems and insecurities, but nothing like I used to have. When I wake up in the morning and look in the mirror, sometimes there is a fellow smiling back at me. That never used to happen.
Core Problem List For Self-Diagnosis
1. Believe self inferior to others.
2. Believe self worthless.
3. Believe self bad.
5. Blame self for ones failures.
6. Believe one is alone in facing problems such as depression and rejection, and that one is alone in having the weaknesses that one has, that one is defective and inferior because of them.
7.Believe one deserves to suffer if one doesnt achieve or work harder.
8. Believe that if others disapprove of oneself, one is no good.
9. Believe one deserves to fail if one fails, one deserves to suffer if one suffers, and one deserves to lose if one loses. Believe "I suffer therefore Im bad" or "I fail therefore Im bad."
1. Believe others are hostile.
2. Believe others think self bad.
3. Believe others have contempt for self.
4. Believe others are bad.
5. Believe others want self to hate them.
6. Believe others find ones company unpleasant.
7.Believe the worlds a vicious and unfair place.
1. Believe current situation is grave, serious, or catastrophic.
2. Believe one has a bad future.
3. Believe one requires certain incorrect conditions for happiness, such as possessions or companionship.
4. Believe one will never find social fulfillment.
5. Believe one is beyond help because one is irreversibly damaged or intrinsically inferior.
Hostility and Contempt
1. Boost self-concept by believing that others are inferior.
2. Interpret the behavior of others as proof that they are contemptible.
3. Hate others to boost self-concept.
4. Boost self-concept by making other people do what they dont want to do.
5. Attack other peoples egos in order to get them to regard one as superior and to do what one wants.
6. Rationalize that people one has undesired responsibility to are bad so one really does not have responsibility to them.
1. Blame and vilify others for not giving one what one wants. Magnify to oneself the tragic consequences of not having what one wants so one can justify to oneself action to get what one wants or defend ones self-concept against the feelings of helplessness at not being able to obtain what one wants.
2. Blame others for ones mistakes and failures.
3. Delusions of grandeur: believe one is superior in some way to other people or that one is the object of someones love and admiration when one isnt.
4. Believe everyone else is wrong and one is right; those who criticize or disagree with oneself or who tell oneself one has weaknesses are bad or just dont have enough insight to understand.
5. Do not face ones responsibilities; rationalize that one does not have them.
Feelings of Insecurity or Helplessness
1. Feel insecure because one cant get what one wants.
Feeling of Loss
Desire for excitement
Desire for high self-concept
Desire to have what one cant have (stems partly from desire for high self-concept)
Desire for bright future
Desire to be loved and admired
Desire to be secure
Questions for Self-Diagnosis
What do I want to believe?
What do I believe that boosts my self-concept, or convinces me that I am superior to others, or have a great future, or am loved?
What bad things do I believe about myself and others?
What to I do thats extreme or forced and why?
Questions to Ask Oneself to Test Suspect Concepts Uncovered by Self-Diagnosis
What arguments can I come up with supporting the opposite of what I believe?
What alternative explanations can I come up with for things that trouble me?
Do I have sufficient evidence for my conclusions?
What am I telling myself I should do that I dont want to do?
Aidridge, L. (September, 1987). Speech presented at the Plenary Session, National Alliance for the Mentally Ill, Arlington, VA.
Beck, A., & Emery, G. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.
Ericson, K. (1986). Preventing mental illness: Some personal discoveries. Journal of Humanistic Psychology, 26, 61-71.
Gammill, C. (1986). Self-direction as a potential influence on the etiology of schizophrenia. Journal of Humanistic Psychology, 26, 72-79.
Goleman, D. (1987, November 26). Trying to face reality? It may be the last thing that the doctor orders. New York Times, p. B12.
Helmstetter, 5. (1986). What to say when you talk to your self Scottsdale, AZ: Grindle.
Kaufman, B. N. (1977). To love is to be happy with. New York: Coward, McCann & Geoghegan.
Raimy, V. (1975). Misunderstandings of the self San Francisco: ,JosseyBass.
Compeer, Inc., Monroe Square-Suite B-i, 259 Monroe Avenue, Rochester, NY 14607
Fountainhouse, 425 W. 47th St., New York, NY 10036 Recovery Inc., 802 N. Dearborn St., Chicago, IL 60610
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