What You Can Change . . . And What You Can't*: The Complete Guide to Successful Self-Improvement (41 page)

Clearly, we have not yet developed drugs or psychotherapies that can change all these. I believe that success and failure stems from something other than inadequate treatment. Rather, it stems from the depth of the problem.

Depth, an old but elusive notion, is, I believe, the key. We all have experience of psychological states of different depths. Sometimes when I have been on the road for weeks and I come home fatigued, something strange happens to me in the middle of the night. It is called
depersonalization
. I wake up and can’t remember. I don’t know where I am. I can’t remember what year it is, or even the season. I don’t know what kind of car I drive. I don’t know who is sleeping next to me. When the phenomenon is really extreme, I don’t know how old I am. (But I always know that I am male.) This state passes in a few seconds, and my memories come flooding back to me—at least they have so far.

If you ask someone, out of the blue, to answer quickly “Who are you?” they will usually tell you—roughly in this order—their name, their sex, their profession, whether they have children, and their religion or race. Underlying this is a continuum of depth from surface to soul—with all manner of psychic material in between. Lest the purists among you be put off by my using the word
soul
, let me remind you of Freud’s terminology. Freud’s word for his subject matter was not
psyche
(as it has been rendered in English by his medical translators), or
mind
(as the modern cognitivists prefer), but
die Seele
, the soul—an entity connoting much more than cold cognition.

I believe that issues of the soul can barely be changed by psychotherapy or by drugs. Problems and behavior patterns somewhere between soul and surface can be changed somewhat. Surface problems can be changed easily, even cured. What is changeable, by therapy or drugs, I want to speculate, varies with the
depth
of the problem.

What exactly does
depth
mean? How do we know if we are dealing with a deep issue or a superficial one? Depth, as I intend it, has three aspects. The first is biological. The second has to do with evidence. The third concerns power.

The biological aspect of depth is evolutionary. Is the state
prepared?
Prepared learning, you will recall from the
sauce béarnaise
phenomenon, occurs with but one experience, is not rational, is not conscious, is resistant to change, and is selective only for objects of adaptive significance. Phobias about animals and insects display these hallmarks and are, therefore, prepared. So are obsessions about infection or violence, fetishes about female legs or breasts, and depression over the death of a child. Biologically deep problems are prepared or even innate. Therefore they are represented genetically, and, as adaptive traits, they are heritable. There has been a long evolutionary history operating to promote the state. Manic-depression is an example. The cycling of energy with the seasons, from summer activity to winter hibernation, may be its evolutionary basis, and it is highly heritable.
²
That identical twins are more concordant for manic-depression than are fraternal twins provides evidence for the adaptive value of mood cycling.

The first claim of my theory is: To the extent that a psychological condition has biological underpinnings because it is prepared or heritable, it will be harder to change; to the extent that it is unprepared—simply a learned habit—it will be easier to change.

The evidentiary aspect of depth is about confirmation and disconfirmation: How easy is it to get evidence for the belief underlying the problem? The other side of the coin of evidence-gathering is even more important: How difficult is it to get evidence that will disabuse you of the belief? It is perilously easy to live our lives noticing only evidence in favor of our deep beliefs and to shun testing whether those beliefs are false. The thought underlying post-traumatic stress disorder—“The world is a miserable, unjust place, with no solace for me”—is easy to confirm. Just read the front page of this morning’s newspaper. The thought underlying obsessive-compulsive problems—for example, “If I don’t wash my hands thoroughly, I will contaminate my child”—will not get disconfirmed by someone who avoids testing it. The person with this thought washes her hands two hours a day. Her hands are always clean, and her child never gets contaminated. She will never get disconfirming evidence because she performs the ritual so frequently. So she will never find out that not washing her hands does not lead to contamination of her child.

So the second claim of my theory is: The easier a belief underlying a problem is to confirm and the harder it is to disconfirm, the harder it will be to change.

The third aspect of depth is the power of the belief underlying the problem. I use
power
in the sense of the power of a theory. A theory is said to have high power when it is general and so explains many of the facts about the world. Relativity theory—applicable to all of time and space—has high power. A theory has low power when it applies to only a few isolated facts. “There are a lot of ticks this year because it has been a dry summer” does not apply much beyond ticks and humidity, and so is of low power. Everything else being equal, we cling to a powerful theory more tenaciously than to a less powerful theory when we are confronted with exactly the same contrary evidence disputing both.

Some of our personal beliefs are powerful in just the same way a theory is powerful—they make sense of a great deal of our world. Being a socialist or believing in a benevolent God are but two of many possible examples. These beliefs permeate our understanding of what happens to ourselves and to others. They are deeply entrenched. Stalin’s purges did not shake the beliefs of socialists very much, nor did the Black Death make God seem evil or indifferent to most believers. Other personal beliefs have low power. Believing that cars made in Detroit on Fridays have more defects because the workers are looking forward to the weekend explains only your windshield-wiper problem and little else in your life. The thoughts underlying our problems can be of high or low power. The belief that spiders are very dangerous is of low power, whereas the belief that I am an unlovable person or that I need to drink to get through the day has high power.

So the third claim of my theory is: To the extent that the belief underlying a problem has high power, it will be hard to change; to the extent that it has low power, it will be easier to change.

Added together, these claims may explain when a problem will change easily and when it will resist change. Let us reconsider the problems and see.

Transsexualism
, the inversion of sexual identity, is, by these criteria, the deepest problem. It is biologically laid down in gestation. It is virtually undisconfirmable and pervades all of life. It is also totally unchangeable.

Sexual orientation
(homosexuality and heterosexuality—not, to my way of thinking, problems, but simply patterns of behavior) is almost as deep. Part of its basis is probably laid down during gestation, and it probably has specific underpinning in the brain. Once orientation is adopted, evidence steadily mounts for it—you enjoy it and it fits. That a woman is attracted to members of her own sex is easy for her to confirm and hard for her to disconfirm, and this attraction is of high power—pervading much of what she does. While the desire itself resists change mightily, whom you perform with is a bit flexible.

Post-traumatic stress disorder
is a disorder of the soul. It probably has little evolutionary basis and is not known to be heritable, but the underlying belief is powerful and readily confirmed. If, for instance, your child dies, you have been robbed, by a stroke of cruel fate, of what you hold most precious. Your worldview changes: This world is cruel, there is no justice, I have no future, there is no hope, and I wish I hadn’t survived. There is pervasive reality to what you now believe, since your child is never coming back. All you have to do to confirm your new philosophy is turn on the eleven o’clock news. The cascade of bad events that usually follows in the wake of a tragedy further confirms your pessimism. Sometimes surprisingly good things happen and your view softens, but only reluctantly. Therapy and drugs might make you less afraid of the specific place of the tragedy. Little more, except for rape victims, has so far been accomplished in alleviating PTSD. You now
know
just how fragile all happiness is.

Weight
is quite a deep matter. Dieting works only temporarily for more than 90 percent of “overweight” people. Your weight is defended by powerful biological and psychological processes that served your ancestors well through famine and hardship. Appetite and weight have layers of biological and psychological defense: brain centers firing, blood-sugar level dropping, metabolic slowdown, fatigue, fat storage, changing number and size of fat cells, intense food cravings, stomach rumbling, and binge eating. Natural selection has assured that we will be able to starve ourselves voluntarily only with the greatest of difficulty. The evidentiary criterion is not applicable to overweight, but the power criterion is. Your habits of eating are part of your way of life. Your styles of working, loving, and playing are often tied up with what, where, and how much you eat.

Alcoholism
has some biological underpinnings. It is moderately heritable, and part of what it means to have a biological addiction is that cells living in an alcohol-laden environment become dependent on the presence of alcohol to function well. That I need a drink to get through this interview, or this class, or this date is hard to disconfirm—particularly when I don’t abstain and find out that the date goes well anyway. Usually, I drink and it goes tolerably well, or I don’t drink and I have the shakes. Alcoholism has power. It is a way of life. Like the intellectual who goes to a party and sees it in terms of her interests (“Isn’t that guest politically naive? How many books does the host have in the living room?”), so, too, the alcoholic (“How well stocked is the bar? Who will make the rounds with me afterward? Who knows my boss and might report my drinking heavily?”). Alcoholism is therefore not easy to change.

Everyday anxiety
is not as deep as alcoholism. Fear and courage are basic facts of personality and genetics. They have a strong evolutionary basis (“It is safer in the cave”). Those of us born fearful and timid lead, for the most part, fearful and timid lives. We are assailed with frightening thoughts. These thoughts are hard to disconfirm if we manage to avoid the feared circumstances, and they are frequently confirmed (muggers
do
come out at night). That the world is a frightening place is a fairly powerful theory. This can be changed, but not easily. With discipline, drugs, and clever tactics in therapy, we can be steeled, at least a bit.

Pervasive
anger
is probably somewhat less deep than pervasive anxiety. It has a clear evolutionary value, and there is some evidence for its heritability. If you believe you are being trespassed against, you can usually find evidence for it: The targets of your anger
are
sometimes out to get you. But you will also get some disconfirmation too, since sometimes the targets of your anger turn out to be manifestly innocent. The belief in trespass is powerful when it is a general belief like “Others are out to get me” or “The world is full of people who only care about themselves.” It is of low power when it is only a specific (“My boss is a jerk!”) belief. The therapy evidence is far from conclusive, but anger seems somewhat—although not sweepingly—modifiable.

Sexual preferences
(called
paraphilia
when disordered) are at middling depth. They seem to be evolutionarily prepared. They are easy to obtain confirming evidence for once adopted—they are great fun—but they are narrow beliefs influencing only your erotic life. Once adopted, they do not wane spontaneously, but they can be modified somewhat in therapy.

Obsessive-compulsive disorder
also has middling depth. The thoughts and rituals seem to be evolutionarily prepared (cleaning and checking, dirt and violence, were all issues for pretechnological humans), and there is some evidence for heritability. The obsession is extremely hard to disconfirm: An efficient ritual ensures that you don’t sit around to find out if your ritual—unperformed—results in disaster. But the obsessions are not powerful: They are limited to germs, violence, explosions, and the like. Therapy helps quite a bit but usually does not cure.

Sex role
may have some brain and fetal-hormone contribution. When you are a child, evidence pours in to support your stereotyped beliefs, and they are powerful beliefs, organizing much of childhood. But the evidence and their power wanes dramatically with maturity, when you can better appreciate the virtues of tolerance, justice, and individuality. Sex roles are inflexible for young children, but increasingly flexible as children grow up.

Depression
is also of middling depth. Sometimes the beliefs are distortions and are easy to disconfirm: for example, the belief of a wealthy woman that she is a bag lady.
³
But often the beliefs are based in reality; indeed, depressives are more accurate at judging their success and failure than nondepressives.
⁴
Sometimes depressive beliefs are of low power: “She doesn’t love me;” “I’m a hopeless golfer.” Sometimes they are powerful and pervasive: “I’m not worth loving;” “I’m a total failure.” There is some mild heritability and possibly an evolutionary basis for staying in the cave and conserving energy for a while after a loss. At any rate, with therapy or drugs, moderate relief ensues, but your battle against depression—even then—can still be life-long.

Social phobia and agoraphobia
lie nearer the surface. They make some evolutionary sense, and there is some evidence of mild heritability. The underlying beliefs are easy to confirm since they are not wildly inaccurate: Shy people
do
get embarrassed by others; if you have one of your panic attacks in public, it may very well be that you
will
be sick as a dog and no one will help you. If you avoid social gatherings or do not leave your apartment, these beliefs will not get disconfirmed. The social-phobic beliefs have moderate power: Seeing yourself as socially unskilled or unlikable may explain a fair amount of what happens to you. The agoraphobic belief that you will get ill and no one will help you has relatively low power. With therapy and drugs, some relief ensues for both, but not a complete cure.