What you can change and what you cannot the complete guide to successful selfimprovement learning to accept who you are Seligman and Martin

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What you can change and what you cannot the complete guide to successful selfimprovement learning to accept who you are Seligman and Martin

CONTENTS

Preface to the Vintage Edition
PART ONE
Biological Psychiatry vs. Psychotherapy and Self-Improvement
1. What Changes? What Doesn’t Change?
2. Booters and Bootstrappers: The Age of Self-Improvement and
Psychotherapy
3. Drugs, Germs, and Genes: The Age of Biological Psychiatry
PART TWO
Changing Your Emotional Life: Anxiety, Depression, and Anger
4. Everyday Anxiety
5. Catastrophic Thinking: Panic
6. Phobias
7. Obsessions
8. Depression
9. The Angry Person
10. Post-traumatic Stress
PART THREE
Changing Your Habits of Eating, Drinking, and Making Merry
11. Sex
12. Dieting: A Waist Is a Terrible Thing to Mind
13. Alcohol
PART FOUR
PART FOUR
Growing Up—At Last
14. Shedding the Skins of Childhood
15. Depth and Change: The Theory
Acknowledgments
Note

PREFACE TO THE VINTAGE EDITION

What You Can Change . . . and What You Can’t was my attempt
to review with un􀀥inching candor the e􀀧ectiveness of most of the
di􀀧erent kinds of treatment for the major psychological disorders.
As I survey the e􀀧ectiveness of these treatments thirteen years
later, I am somewhat surprised to 􀀭nd that most of the results
remain the same, and the rest are not substantially different. But a
pattern has become increasingly clear, and it is important for
consumers to know about it. Because of the exigencies of
􀀭nancing and insurance, the psychological and biological
treatments of patients confront ever more restricted budgets. In
response, the professions of clinical psychology and psychiatry, as
well as their research arms, have come to concentrate on
􀀭re􀀭ghting rather than 􀀭re prevention. They focus almost entirely
on crisis management and the rendering of cosmetic symptom
relief, and they have all but given up on the notion of cure.
There are two kinds of medications, and similarly, there are
two kinds of psychological interventions: curative and cosmetic.
With medication, if you take an antibiotic and you take it long
enough, it cures by killing the bacterial invaders. That is, when
you’re done taking it, the disease does not recrudesce. On the
other hand, if you take quinine for malaria, you only get
suppression of the symptoms. When you stop taking quinine,
malaria returns. Quinine is a cosmetic drug, a palliative, and all
medications can be classi􀀭ed either as curative in intention or
cosmetic in intention. Palliation is a good thing (I’m wearing a
hearing aid right now.), but it is not the highest goal of
interventions. Ideally, intervention is a way station to cure.
Yet every drug in the psycho-pharmacopoeia is cosmetic. There
are no curative drugs, and biological psychiatry seems to have
given up on the notion of cure. I am by no means a Freudian, but
one thing that was exemplary about Freud was that he and his
one thing that was exemplary about Freud was that he and his
disciples sought cures. Freud wanted a psychotherapy that was
like antibiotics, not a psychotherapy of cosmetics, and palliation
is still not a signi􀀭cant goal in Freudian psychotherapy. But the
decline of Freudian in􀀥uence, as well as the stringencies of
insurance plans, has shifted the focus of clinical psychology and
psychiatry from cure to symptom relief.
This book examines just how good this symptom relief is when
di􀀧erent drugs and psychotherapies are compared for di􀀧erent
psychological problems. Roughly these treatments are about 65
percent e􀀧ective. Depression, as you will read below, is typical.
Consider two treatments that “work,” cognitive therapy versus
SSRI’s (e.g., Prozac). For each, you get roughly a 65 percent relief
rate, along with a placebo e􀀧ect that ranges from 45 percent to
55 percent. This means that the treatment’s net actual e􀀧ect is
between 10 and 20 percent. The more compelling the placebo,
the higher the placebo percentage, and therefore the smaller the
actual e􀀧ect. These sobering numbers crop up over and over,
whether you’re looking at the percent of patients who experience
relief or at the percent of their symptoms for which patients
experience relief.1*
Why are the e􀀧ects of almost all the drugs and psychotherapies
only small to moderate? Why have therapists reached a 65
percent barrier?
From the 􀀭rst day I took up skiing until 􀀭ve years later when I
quit, I was always 􀀭ghting the mountain. Skiing was never easy.
Every psychotherapeutic intervention is a “􀀭ghting the mountain”
intervention. The treatments don’t catch on and maintain
themselves. In general, therapeutic techniques share the
properties of being di􀁃cult to do and di􀁃cult to incorporate into
one’s life. In fact, the way researchers usually measure therapy
e􀀧ects is how long they last before they “melt” once treatment is
discontinued.
Scienti􀀭c ignorance, cost limitations, and the decline of
Freudian psychotherapy may not be the only reasons for the 65
Freudian psychotherapy may not be the only reasons for the 65
percent e􀀧ect: Better treatments may always be elusive. In the
therapeutic century that we’ve just lived through, it was the job
of the therapist to minimize negative emotion: to dispense the
drugs or the speci􀀭c psychotherapy that would make people less
anxious, less angry, or less depressed. But there is another
approach to symptoms, older than the notion of therapy: learning
to function well in the face of symptoms—dealing with them.
Dealing with your symptoms is beginning to look more
important again in light of the most important research 􀀭nding in
the 􀀭eld of personality of the last quarter of the twentieth
century: that most personality traits are highly heritable.2*
Symptoms often, but not always, stem from personality traits. As
such, I believe that they are modi􀀭able, but only within limits.
How do we address the likelihood that most psychological
symptoms stem from heritable personality traits that can be
ameliorated but not wholly eliminated?
Do you know how snipers and 􀀭ghter pilots are trained? (I’m
not endorsing sniping by the way; I only describe how training is
done.) It takes about twenty-four hours for a sniper to get into
position, and then it can take another thirty-six hours to get the
shot o􀀧. Now that means that typically before a sniper shoots, he
has not slept for two or more days. He’s extremely tired. Now,
let’s say the military went to a psychotherapist or a biological
psychiatrist and asked how she would train a sniper? She
undoubtedly would use drugs or psychological interventions to
break up the sniper’s fatigue.
That’s not how snipers are trained, however. One trains a
sniper by having him practice shooting when he is extremely
tired. That is, one teaches snipers to deal with the negative state
he is in so as to function very well in the presence of fatigue.
Similarly, 􀀭ghter pilots are selected to be rugged individuals and
not to scare easily. There are many things that happen to 􀀭ghter
pilots that terrify even the most rugged personality, however. But
one does not call on therapists to teach the tricks of anxiety
reduction, thereby training candidates to become relaxed 􀀭ghter
reduction, thereby training candidates to become relaxed 􀀭ghter
pilots. Rather, the trainer heads the plane straight for the ground
until the trainee is in terror, and the trainee then learns to pull
up even when terrified.
The negative emotions and the negative personality traits have
very strong biological limits, and perhaps the best science and
practice will ever do with the approaches I review in this book is
to encourage people to live in the best part of their set range of
psychological symptoms. Think about Abraham Lincoln and
Winston Churchill, both likely unipolar depressives. They were
both enormously productive human beings who dealt with their
“black dogs” and functioned beautifully even when very
depressed.
So here is my prescription for how to use this book optimally:
If you or someone you are close to has symptoms of a mental
disorder, you will be able to 􀀭nd here candid and tough-minded
recommendations for what speci􀀭c psychotherapy or what
medications are likely to help and the degree to which they are
likely to help. But these will not be curative. Many of the
symptoms will recur, even if they are so ameliorated. An oldfashioned
virtue must be coupled to these interventions. It is
called courage: the courage to understand your psychological
problems and manage them so as to function well in spite of
them. When you couple courage with the interventions that I now
review, you may break the 65 percent barrier.