Choice Theory (12 page)

So the patient usually lies and says, “I feel good,” and that lie harms the doctor-patient relationship. The question also implies that the doctor’s treatment alone can make the patient feel better, when in fact it can’t. The better question to ask is this: “What are you planning to do today?” No matter how sick a patient is, he can do something, even in the hospital, besides just lie there. Implying that he can do something positive for himself gives him a sense of control that will help him feel better even in this difficult situation.

If the patient looks at the doctor as if the doctor is crazy, as some of the quadriplegic patients did when I asked them this question, I was always prepared to suggest some activity—perhaps as simple as watching a television program and talking to their roommates about it. If I saw them every week, they began to look forward to that question and had something prepared to tell me. Often they would add that they felt better when they were doing something, which confirms that this change in the usual approach is effective. In a choice theory world, we would get rid of the phony greeting
How are you?
and replace it with
What are you planning to do today?
or
Anything important happening?—
some variation of an active doing question instead of the inactive feeling question that usually traps people into phony answers.

Now that I have described total behavior, let me explain the three logical reasons why so many people choose to depress. These reasons explain the whole gamut of what is commonly called mental illness, such as depressing, anxieyting, or phobicking. Even sicknesses like adult rheumatoid arthritis may be explained by these same three reasons. Many doctors believe that there is a psychological component in many diseases and call these diseases psychosomatic. The
psycho
of psychosomatic means that the way we are thinking may have a lot to do with what is going on in the
soma,
our bodies. It is safe to say that when we are not in effective control of our lives, as when we are in unsatisfying relationships, our physiology may get painfully involved in that loss of effective control. We may not get sick, but we cannot have a totally normal physiology any more than we can feel good when we are frustrated.

Whenever we are not in effective control of our lives, many of us immediately think about using the total behavior we are born with:
angering.
Angering is built into our genes to help us survive, and since infancy we have used it or thought about using it whenever
we are not able to satisfy an important picture in our quality worlds. Based on a lifelong experience with frustration, Todd, like most people, had an immediate impulse to anger when he saw the note from his wife telling him she had left. Angering is the first total behavior most of us think of when someone in our quality worlds does something that is very much out of sync with what we want that person to do.

But by the time we are a few years old, we learn that angering is usually an ineffective choice. It rarely gets us what we want, especially when we use it to try to control adults who are also angering. When we choose to tantrum, and our parents are smart enough not to pay attention, we find out that tantrumming is worthless. It is not getting us what we want, and we end up wasting energy and suffering a lot of pain. If we keep it up too long, we learn that this choice can make things worse—we may get punished or rejected, neither of which we want.

Todd had learned that. In a later session, he told me he knew that if he went after his wife and tried to force her to come back, a thought that had run through his mind for a moment when he read her note, he could make things much worse. Although we are not aware of it, depressing is also one of the most powerful ways that human beings have discovered to restrain angering, and all of us use it a lot. But, as I will soon explain, in its own way, depressing is a very strong controlling behavior.

When you are strongly depressing, what you are most aware of is its miserable feeling, a feeling that takes over your thinking, acting, and even your physiology and tends to slow you down. It takes a lot of energy to block the angering completely, which is why you are so tired. As long as you depress, you have little energy to do anything else. If we were not able to depress quickly and effectively, we could not function in marriage, as a family, or as a society. Depressing prevents huge amounts of marital and family violence. If most of us didn’t depress a lot of the time when we were frustrated, our streets and homes would be war zones.

The killing and mayhem that we watch almost daily on television are good examples of what happens when adults choose to
rage and strike out. If even a few of them depressed, we and they would be much better off. Most of us know how to depress, and we do it well. Some of us dedicate our lives to this behavior and must be cared for. Those who do so are so immobilized by this choice that they cannot function, but it is still a choice. They can stop choosing it if they can figure out another choice that will give them more effective control over their lives.

Depressing prevented Todd from going after his wife, harming her, and even killing her, a common behavior in this country where weapons are so available. It also might have prevented him from killing himself. Suicide is another total behavior that people choose when they have given up on the idea that they will ever be able to get their lives back into effective control. If a person who is depressing strongly suddenly stops depressing but seems to observers to have no good reason to stop, since his life is no more in effective control than it had been, that person may have decided to kill himself. That decision has given him the way out of his misery; in a sense it has given him the idea, Finally, there is a way to end this suffering forever.

Psychotherapists always look for that
feeling better
sign in people who have been depressing for a long time. When we see it, we suspect they may now be thinking of suicide. The pain of restraining their angering is so great that many people decide it’s not worth living anymore and turn the anger against themselves. This was not a problem for Todd, but it might have been if he had not been willing to choose to find another woman to replace the picture of his wife in his quality world. For a man who seemed so social, suicide would have been unusual, but given time, anything is possible.

Depressing is a way we ask for help without begging. It is probably the most powerful help-me information we can give to another person. Because it is so strongly controlling, a lot of people
choose it to try to get control over other people despite the pain. What the suffering does is to legitimize our asking for help. If we just asked or pushed for help with no show of pain, others might see us as incompetent or unable to take care of ourselves, and we do not want to be seen that way. For most of us, being seen as incompetent is too painful; too frustrating to our need for power; and too much like begging, which goes against our pride. But in many cases, we are perfectly willing to choose to depress as a way to get help that might not otherwise be offered.

After I had taught Todd some choice theory, he admitted that he had hoped his wife would call him after she left and then he would try to play on her sympathy by telling her he was so depressed that he couldn’t even go to work. Since he rarely stayed home from work, that might have impressed her. But she didn’t call. He also thought I would be impressed with how badly he was feeling, and if I had been, he would have depressed more to try to get me to solve his problem. But since I know choice theory, it is difficult for my clients or anyone else to control me with any total behavior that has misery as its feeling component. If it is coupled with compassion, not allowing anyone to control us with depressing helps them to see that there are much better choices than to depress.

We often use depressing as an excuse for not doing something we don’t want to do or are afraid to do. When someone suggests that we go ahead and do whatever we are trying to avoid, we usually agree and say, “I think you’re right, but I’m just too upset right now to do it.” For example, your company is downsizing and you lose a good job through no fault of your own. You tell me what happened and how depressed you are. I try not to pay much attention to your depressing. Instead I say, “I know it’s hard, but don’t sit around; get out your résumé.”

But you are depressing for a good reason. You have just been
laid off and feel rejected, even though it was not your fault. You are afraid of another rejection, of facing the fact that there may be no good jobs for you at your age and with your experience. As painful as depressing is, it’s less painful at this time than looking for a job and getting rejected again and again. Todd had no problem at work, and he had no fear of looking for another woman, but the first two reasons,
restrain the anger
and
help me,
were in full operation when he first came to see me.

After reading this far, especially if you have recently depressed strongly, you may still say,
You may be right, but it still doesn’t feel as if I’m choosing all this misery.
To check out my claim that depressing is a choice, force yourself to make a different choice for a short time, for at least an hour. Do something physically hard that, under different circumstances, you can easily do and that you usually enjoy, perhaps a brisk walk or a short hard run. If you can do it with a good friend who is not overly sympathetic, so much the better. While you are walking or running, especially with a friend, you will notice you are not depressing. For a short time, you are not thinking about your unhappy relationship, and you feel much better.

But as soon as you finish, you tend to go back to thinking about the relationship that has gone bad, and the feeling comes back. To depress, you have to keep thinking the unhappy thoughts that keep one or more of the three reasons to depress going. To stop thinking these thoughts, you have to do what I have been suggesting all through this book: change what you want or change your behavior. There is no other way. Todd did attempt to change his behavior toward his wife, but it was too late; she had already taken him out of her quality world. But with my help, he was able to change what he wanted—he took his wife out of his quality world and put another woman in—and he was able to stop depressing for as long as I was in touch with him.

By far the most uncomfortable of all the choice theory ideas to accept is that our chosen actions and thoughts may have a great deal to do with our health, that these actions and thoughts may
adversely affect our physiology. For example, are there thinking choices that can lead to what is called psychosomatic disease? I’ll touch on this briefly here (a large part of chapter 7 describes how choice theory explains these extremely common and, sometimes, fatal diseases and how we may use this explanation to help ourselves, both in cooperation with a doctor or over and beyond what a doctor can or will do). Let’s take a look at the most common disease of men and, increasingly, of women: coronary artery disease or arteriosclerotic heart disease.

You are a forty-seven-year-old movie producer who is frantically trying to get financing for what you are sure will be a blockbuster film. You are doing all you can to get the money, but your option on the property is running out. You feel bad. Eating rich foods and smoking are your attempts to get some pleasurable relief from the pain of getting rejection after rejection from the people who could easily give you the money. Although at first you felt only a heaviness in your chest, this heaviness gradually turned to greater and greater chest pain and shortness of breath.

You go to your doctor and learn that your coronary arteries are badly clogged with plaque. You ask him what can be done, and he tells you that a lot depends on how you choose to live your life. He talks about diet, exercise, smoking, stress, the whole lifestyle now known to be strongly related to heart disease. Your doctor may not understand choice theory, but what he is saying when he mentions stress is that when your life is not in effective control, it is bad for your health. This is the same as saying, bad for your physiology.

But since all your behavior is total behavior, when you lose effective control of your life, you cannot separate your feelings or your physiology from your actions and your thoughts. In this case, from your physician’s standpoint, the most obvious result of the altered physiology that is part of all the ineffective behaviors you are choosing to get the movie made is your diseased coronary arteries. Following what I have just explained, heart diseasing could well describe your choice to eat fatty foods, to smoke, and not to exercise.

The doctor has medicine and even surgery that will help, but it is your choice to stop the unhealthful eating, smoking, and sedentary life. I would go further than many doctors and suggest that in addition, you try some counseling to help you learn to take more effective control of your life. Frustration, a much more accurate word for what is going wrong than stress, may be making as large a contribution to your heart diseasing as what you are eating.

As I have stated, when our lives are out of effective control, all four components of the total behaviors we are choosing to try to get them back into more effective control are involved. We may pretend we are happy and nothing is wrong, but we can’t pretend to be healthy; we don’t have that kind of control over our physiology. When we are choosing to depress, our brain chemistry is not the cause of what we feel. It is the usual or expected brain physiology associated with the acting, thinking, and feeling that together make up the total behavior called depressing. For this reason, I believe that the currently accepted explanation that “depression” is caused by an imbalance in our brain chemistry is wrong.

I can assure you that when Todd found the note on his refrigerator, his brain chemistry instantly changed, as did his feelings, his activity, and what he had been thinking just before he saw that note. He probably wanted to do more, and if he knew choice theory he might have been able to. But, as it was, when he found the note, by choosing to depress, he was able to restrain the urge to get going and do something active to get her back. That activity, if it included confrontation or even violence, would have made his situation much worse.