What You Can Change . . . And What You Can't*: The Complete Guide to Successful Self-Improvement (43 page)

M.E.P.S.
July 1993

NOTES

A serious scholar writing for the general public walks a tightrope between readability and responsibility. My way of presenting the scholarship underlying the book is to offer these endnotes. These are intended for my scholarly audience and those of you who want to read further.

CHAPTER
1
What Changes? What Doesn’t Change?

1
. M. Seligman and J. Hager, eds.,
The Biological Boundaries of Learning
(New York: Apple-ton-Century-Crofts, 1972).

2
. M. Seligman,
Helplessness: On Depression, Development, and Death
(San Francisco: Freeman, 1975); M. Seligman,
Learned Optimism
(New York: Knopf, 1991).

3
. Copyright by Lisa Friedman Miller. I thank her for her generosity in letting me use it here.

CHAPTER
2
Booters and Bootstrappers

1
. This version is taken from the
Passover Haggadah
, distributed by Maxwell House Coffee, 1981.

2
. Even the more psychological books of the Bible—Job and Psalms, for example—are peculiar, seen from a modern perspective, in what mental states are present and what mental states are absent. There is some emotion—anger, grief, and joy; but less cognition—expectation, belief, inference, problem solving; and almost nothing of human will—decision, intention, choice, and preference. What Aristotle called
conation
is almost absent from the Scriptures (see Deuteronomy 30:19 and Isaiah 65:12 for two rare exceptions).

I used a concordance to bear out this impression. Since I am a far cry from a biblical scholar, I am not sure my observation would bear closer scrutiny. If it is true, however, I take the question of why this might be so to be a great historical question.

3
. The skeptical reader should spend some time with the stark account of Abraham’s sacrifice in Genesis 22: 1–13. Abraham’s absence of mentation is striking.

4
. Pico’s
Oration
(1486), translated by D. Brooks-Davies and S. Davies, quoted in S. Davies,
Renaissance Views of Man
(Manchester: Manchester University Press, 1978), 62–82.

I have been unable to find a history of free will. I hope that a scholar will someday be moved to undertake such a history. A history of free will, unlike, say, the history of empiricism, would be more than an airy exercise in the history of a philosophical notion. If I am right, what a given historical period believes about free will reflects, and may even affect, how active or passive that culture is, how helpless and how despairing that culture is.

This section of my book, along with this note and the note below on human participation in grace, is my bare sketch of such a history.

Pico was far from the first to articulate the concept of free will. Dante wrote, “A light is given you to know good and evil, and free will
(“e libero voler”)
, which if it endure fatigue in its first battles with the heavens, afterwards, if it is well nurtured, it conquers completely” (canto 16,
Purgatory)
. Before Dante, Aquinas endorsed it, more than halfheartedly.

It was clearly put forth one thousand years before Pico by Pelagius in his lost work
De Libero Arbitrio
. Unfortunately for Pelagius, he had the most towering of opponents, the luminescent Saint Augustine. Augustine, for most of his life, held that humans could indeed will evil, but that when they will good, it is merely by the irresistible action of divine grace.

Augustine’s conception traces back to the Stoic Seneca’s view that fate and human freedom are compatible. And Seneca’s view, in turn, traces back another century to Cicero. The Golden Age Greeks had a lively interest in free will versus fate, and this contrasts instructively with the debate’s absence from the Bible. The issue of free will is Greco-Roman in origin, not Judeo-Christian.

At any rate, Augustine’s opposition to Pelagius may have set back the idea of free will for a millennium or so, since save for Aquinas and Dante, it did not seem to reemerge with any force until Pico. See Marianne Djuth’s “Stoicism and Augustine’s Doctrine of Human Freedom After 396,” in J. Schnaubelt and F. Van Fleteren, eds.,
Collectanea Augustiniana
(New York: Peter Lang, 1990), for an illuminating account of this hoary dispute at the close of the fourth century.

5
. From the point of view of advocates of human choice, Luther’s
On the Bondage of the Will
(1525) makes chilling reading. He angrily rebutted the Dutch theologian Erasmus’s view of God (
On the Freedom of the Will
, 1524) as a father who lifts a fallen toddler. The father, Erasmus explained, does almost everything, but the toddler has some small agency of his own. The new Protestantism was a backward step on the road to belief in human agency when contrasted to the emerging Catholic humanists such as Erasmus.

6
. There are two related theological disputes. The first concerns free will. The second is whether humans participate in their own salvation, in “grace.” It is the attitude toward this second issue that probably best reflects what people believe about the power or impotence of human agency.

Grace,
gratis
in Latin, means “freely given”—by God, of course. In this original meaning, humans do not participate at all—receiving grace is entirely God’s will. Pelagius, in addition to believing in free will, believed that we do participate in grace. This is part of the Pelagian heresy: There
are
things humans can do to achieve salvation. Saint Augustine waffled on free will, occasionally endorsing the notion that humans could choose good as well as evil. But he clearly believed that humans do not participate in achieving grace. Thomas Aquinas, while closer to Pelagius on the subject of free will, also believed that humans do not participate in grace.

The possibility that humans participate in their own grace—and the accompanying leap forward in the belief in the potency of human agency—came from Erasmus, Arminius, and Wesley. This belief was simply without an effective voice throughout the Middle Ages and the early Renaissance.

7
. From “The General Deliverance,” in J. Wesley,
Sermons
, vol. 2 (New York: Emory and Waugh, 1831), 50.

8
. From “The Means of Grace,” in J. Wesley,
Sermons
, vol. 1 (New York: Emory and Waugh, 1831), 135–47.

9
. The Jackson speech is quoted in Alice Felt Tyler’s important
Freedom’s Ferment
(Minneapolis: University of Minnesota Press, 1944), 22. Tyler portrays the first half of the nineteenth century as centrally driven by the idea of the perfectibility of humankind.

10
. Letter of Freud to Wilhelm Fliess, 14 November 1897. From the
Complete Letters of Sigmund Freud to Wilhelm Fliess, 1887–1904
(Cambridge, Mass.: Belknap, 1985), 281. It is significant, however, that in concert with the therapist’s agency, the patient must “work through” his problems. The patient is never viewed as wholly passive, but he is not viewed as capable of unaided self-improvement. Most of the booters also have the individual at least cooperating in his elevation, but not being the primary motive force. It is like Erasmus’s toddler, with some little agency, guided by God, with most of the agency.

11
. From Bruce Kuklick’s brilliant
Churchmen and Philosophers
(New Haven: Yale University Press, 1985), 227. Kuklick traces the history and influence of American Protestantism on American social consciousness.

12
. J. B. Watson,
Behaviorism
(New York: People’s Institute Publishing, 1924), 237.

13
. It is astonishing to me that this stream of thought, which I believe is the religious manifestation of the idea of the potency of individual agency, seems to be beneath the notice of academics. I cannot find a learned treatise in social science that even
cites
these thinkers, much less takes them seriously. Serious they are.

CHAPTER
3
Drugs, Germs, and Genes

1
. This and all other case histories in this book are collages, with the details somewhat fictionalized to protect the identity of those concerned.

2
. A review of the only five well-done controlled studies of the antipsychotics can be found in P. Keck, B. Cohen, R. Baldessarini, and S. McElroy, “Time Course of Antipsychotic Effects of Neuroleptic Drugs,”
American Journal of Psychiatry
146 (1989): 1289–92. Across these five studies, roughly 50 percent reduction of symptoms is reported. A useful general review of rate of effectiveness is in R. Spiegel,
Psychopharmacology, 2d
ed. (New York: Wiley, 1989).

3
. Nathan Kline’s militant brief about the discovery of the first antidepressant drugs, “Monoamine Oxidase Inhibitors: An Unfinished Picaresque Tale,” in F. J. Ayd and H. Blackwell, eds.,
Discoveries in Biological Psychiatry
(Philadelphia: Lippincott, 1970), makes for delicious reading.

4
. Quantifying the effect of the antidepressants is not simple. Unlike the antipsychotics, there have been a large number of good outcome (double-blind, placebo-controlled) studies of the tricyclics. But depression goes away on its own in time, and so there is a high rate of remission with just a placebo, perhaps as high as 45 percent. A drug has to outperform the placebo to work, and this happens in only about two-thirds of outcome studies. Different studies quantify improvement in many different ways, and this also makes comparison difficult. A consensus figure is that about 65 percent of patients improve noticeably with the tricyclics. See, for example, the useful review by Phillip Berger, “Antidepressant Medications and the Treatment of Depression,” in J. Barchas, P. Berger, R. Ciaranello, and G. Elliot, eds.,
Psychopharmacology
(New York: Oxford University Press, 1977), 174–207. For a good recent study, see K. White, W. Wykoff, L. Tynes, L. Schneider, et al., “Fluvoxamine in the Treatment of Tricyclic-Resistant Depression,”
Psychiatric Journal of the University of Ottawa
15 (1990): 156–58.

A useful general review of rate of effectiveness is in Spiegel,
Psychopharmacology
.

5
. See, for example, J. Hall, “Fluoxetine: Efficacy Against Placebo and by Dose—An Over view,”
British Journal of Psychiatry
supplement 3 (1988): 59–63.

6
. This little-known story is narrated by John Cade in his “The Story of Lithium,” in Ayd and Blackwell,
Discoveries in Biological Psychiatry
, 218–29.

7
. Lithium is more effective on the manic side of manic-depressive illness than it is for the depression. It is preventative of manic episodes as well, if taken regularly. It has toxic side effects (both cardiac and gastrointestinal) and so must be monitored carefully. See R. Sack and E. De Fraites, “Lithium and the Treatment of Mania,” in Barchas et al.,
Psychopharmacology
, 208–25. One of the major problems of prescribing lithium is that many manic patients won’t take it. They feel good—very good—and they often don’t want medication.

See also H. Johnson, K. Olafsson, J. Andersen, P. Plenge, et al., “Lithium Every Second Day,”
American Journal of Psychiatry
146 (1989): 557, for a recent study on effective administration.

8
. The discovery and early history of the minor tranquilizers (as the anxiolytics are called) is narrated candidly by Frank Berger, “Anxiety and the Discovery of Tranquilizers,” and by Irvin Cohen, “The Benzodiazepines,” in Ayd and Blackwell,
Discoveries in Biological Psychiatry
, 115–29 and 130–41, respectively.

9
. The most optimistic recent estimate I know of concerning “percentage effectiveness” of the antipsychotics is: complete eradication of delusions and hallucinations, 22.5 percent; partial improvement, 60 percent; no improvement, 17.5 percent. This is from J. Chandler and G. Winokur, “How Antipsychotic Are the Antipsychotics? A Clinical Study of the Subjective Antipsychotic Effect of the Antipsychotics in Chronic Schizophrenia,”
Annals of Clinical Psychiatry
1 (1989): 215–20.