Depressing Beliefs and Stoic Therapies – by Mary Braun

As far back as medical records go, physicians have been part therapist, part philosopher, part translational scientist. Today in semi-rural New Hampshire, in exam room number three, that tradition continues. But can the doctor heal herself?

John, my ten o’clock patient, loves his paycheck, but hates his boss. More specifically, John feels that his boss treats him disrespectfully. In order to keep working at his job he must face the question “Am I willing to let people treat me disrespectfully for money?” He does not want to believe that he is this sort of person. He can’t decide to stay because that’s demeaning and he is unwilling to leave because he fears he’d be poor. He’s stuck in a kind of limbo of perpetual deciding. Spending all this energy spinning meaninglessly causes him to be depressed.

I want to say to him, “John, I hear you! I am stuck myself. My work is fine, but let me tell you about what is going on with my boyfriend!” I would tell him, if my professionalism didn’t stop me, that he’s not right for me and I know it. I know that I am not the sort of woman who would be afraid to be without a boyfriend, but I can see that I am. I feel bad to be unwilling to be alone; I deny to myself that I feel that way; I manufacture reasons I’m staying because I can’t admit the real one: I’m afraid to be alone. I have no ability to think any other thoughts or feel any other feelings because my brain is trapped in perpetual deciding, spinning, spinning, spinning.

In both of these cases the depressed person has two beliefs about themself that are in conflict. “I do not let people disrespect me,” “I will not be happy unless I make the amount of money I make at this job,” “I am independent,” “I cannot be alone.”

They all hinge on self-judgments: Am I the kind of person who…? I do not want to be that kind of person, and yet I seem to be acting in that fashion. The cognitive dissonance set up by knowing one doesn’t want to be someone who XYZs and the fact that one is such a person makes one depressed. It saps the energy for paying attention to anything else.

People have a difficult time doing anything about the situation that has made them unhappy because they cannot unbelieve either belief. Often these beliefs are so deep that at first one does not even know one has them or one may not recognize them as beliefs. Any progress one can make in identifying, fleshing out, and unbelieving these beliefs can be helpful in getting one unstuck.

I am John’s doctor, not his friend or therapist, but my pills are not really helping very much. I feel we are at the end of what medicine has to offer. Perhaps pointing in the direction where I think the real problem lies would help. Might we explore what exactly you mean by disrespectful?

Me: What exactly do you mean by “disrespectfully”?

John: Making me clean up other people’s messes.

Me: So it is bad to clean up other people’s messes for money? Is it bad, say, to pump portapotties?

John: No, because someone has to do that and if no one did it, we’d all be awash in our poop.

Me: Well, if no one did the stuff they ask you to do at work, XYZ would happen.

John: Yes, but that’s different.

Me: Exactly how?

John: That’s their job; they have a contract to do that.

Me: Well, it’s your job, too.

John: But I didn’t sign a contract saying I’d do it.

Me: Did you sign a contract saying what you would do at work?

John: Well, no, but there are just certain things I shouldn’t be asked to do at work.

Me: Are there certain things no one should be asked to do or are you special?

John: No one should be asked to clean up other people’s messes.

Me: But we’ve already determined that sometimes that’s ok, like cleaning portapotties so maybe that’s not the case.

Yes, you’re going around again, but your belief in “it is disrespectful that my boss has me cleaning up other people’s messes” is a little bit weaker because you’ve just found at least one time when cleaning up other people’s messes is OK. Try it again and again. What other arguments can you find? When else is it OK in your worldview to clean up other people’s messes? What would have to change for you to think it is OK in your case?

This is, of course, not a real conversation (because all details have been changed to make the patients unidentifiable), but it’s similar to ones I’ve had many times. There are other ways to attack “disrespect” once you have figured out what it means to you.

Once John understands the belief (It is bad that my boss is treating me disrespectfully), I might next invite him to question it. I do not do this next step with patients because it is not a doctor’s role, but if John were a friend next I might suggest to him to be as creative as possible with attacking disrespect. How might this not be disrespect?  Maybe your boss recognizes that you’re the one who will do these things correctly the first time. Maybe one of the other workers has a bum knee or fear of heights you don’t happen to know about. Maybe having to do things you don’t want to do is how being paid to do a job actually works. Maybe there is a benefit to you of doing it that you haven’t considered. Maybe other people are cleaning up other things you don’t know about. Maybe you’re not being paid as much as other folks, but you’re still being paid enough and that’s good enough. All of these need to be thoroughly looked at and taken apart. This is the kind of work people do in CBT which I recommend frequently.

If John were a friend and not a patient, once he was a little wobbly on “my boss treats me disrespectfully,” I would recommend a dose of Marcus Aurelius. Sure, my boss treats me disrespectfully, but this is not a bad thing. What is it to you how your boss treats you? Does his treatment of you (which is out of your control) affect anything that actually matters about you? Does it damage you in any way? Maybe it’s simply a consequence of the way you act, for instance. Maybe it’s just the way she is. If you simply ignore what feel like snubs does anything bad happen? The purpose of a job is not to make friends. Maybe it doesn’t matter if you and your boss don’t really like each other.

Now, we’re ready for some Pyrrhonism. The easiest path in might be to apply, “Nothing is good or bad, but thinking makes it so.” What if the way your boss treated you was something like the weather, where you like sunny weather when you have a picnic planned, and rain when your grass is dying? Is it possible that you don’t like your boss treating you this way, but do like it when he treats others this way, for example? What if you reformulated your belief as “I don’t like the way my boss treats me.” Now, it is no longer a belief, but a simple statement of fact and notice that much of the sting for you is removed. This is the power of Pyrrhonism; it teaches you to pull the venom out of a belief and makes life much less painful.

After you’ve got that side squared away, looking at the other belief causing pain, “I will not enjoy my life unless I make X amount of money.” This needs to be evaluated. Figure out if you really need everything you’re spending money on. Of course, you need food, clothes, and a place to live that is safe. What kind of food? Which clothes? How big does that place to live need to be? Do you need a new car? Every time you get into your beat up car, it can remind you that you are saving money so that you can maybe cut back your hours at work. Every time your friends make fun of your car, you can think about how they complain about their jobs and decide if you want to be trapped in a job you hate in order to impress your friends who are trapped in a job they hate in order to impress you with their nice car. Do you need the boat? Remember that the boat keeps you anchored at a job you may not like.

I notice that the money issue often comes down to “There are certain things I need in order to make things nicer for my kids than they were for me.” This can be attacked from many angles: How much nicer? How will you know things are nicer for your kids than for you? Might things already be nicer enough? What things are a benefit for your child? Might there be a point at which making things “nicer” no longer benefits your child? How will you know if you’ve passed that point? Is the downside of having things be nicer really worth the nicer? But the most fruitful angle to attack it from is often Why do things need to be nicer for my children than they were for me?

Me: Because some things about life were hard for me and I don’t want those things to be hard for my kids.

Also Me: Is there any chance that life is just hard? Is there any chance that if you remove one struggle, they will find another struggle? Is there any chance that there’s a benefit to the struggle?

Me: But other kids made fun of my cheap jeans and I hated that. I couldn’t be friends with some kids because I didn’t have nice stuff.

Also Me: And have those kids turned out to be adults you really want to spend time with now?

Me: Well, actually, no.

Also Me: And what about the other kids like you who wore unfashionable clothes? Have they turned out to be adults you want to spend time with?

Me: Actually, yes, I do still hang out with them.

Also Me: Maybe if your children are forced to find their friends among the less cool kids they will end up with friends who are worth spending time with when they’re sixty. Maybe it is not worth the extra hours at work to buy them things so they can attract friends who may grow up into adults neither you nor they like.

Me: But I want to pay for a college education for them. I don’t want them saddled with a huge educational debt.

Also me: I understand this impulse. In order to fully evaluate it with you, we’d have to consider whether or not a college education is really a good thing for all children and that is way off topic.

Me: Is there any chance that what is really going on here is that you’re trying to avoid conflict and do not wish to touch areas of social controversy?

Also Me: Well, yes, you’re right.

Me: Is conflict always bad? Maybe conflict can be a good thing? Maybe it will cause you to get more readers and more people will be exposed to your ideas and thus their lives will be less painful. Isn’t that your goal?

Also Me: Yes, it is, but I fear if we get side-tracked onto that discussion, we will “lose the plot” of this article which is about how philosophy can help people become less depressed.

Me: And does your idea that conflict is bad sometimes cause you to be depressed?

Also Me: OK, fine. Yes, it does. How about if I come back to that after we finish this article?

I think you will find that “I want things to be nicer for my kids” often boils down to “I don’t want my kids to have the same bad things about their life that I did and by throwing money at the problem, I imagine I can improve it. Often consideration of these facts is useful. There are limited hours in a day and we all have finite energy. Is spending time at work better for your children than spending that same time with them?

Dislodging the belief that has kept a person stuck can provide them with enormous relief. I have seen multiple people in various shades of the hate-my-job problem who “just woke up one morning and realized that all this material stuff–my boat and big house and TV equipment–doesn’t really make me happy. It’s just not worth the job. I found a new job and I’m so much happier with less stress.”  Their blood pressure, weight, and diabetes control will improve over the next few visits.

Or sometimes people just wake up and realize that if their boss wants to pay them their skilled rate to do unskilled work, that’s ok with them.

Or sometimes people just wake up and realize that what has kept them from looking for another job is lack of confidence and they are going to take a deep breath and just do it.

This “waking up and realizing that” can be helped along by finding the belief that has you stuck and challenging it. The “realizing that” experience is when the old belief has come dislodged. These techniques can help you “realize that.”

Yes, well, John, I can help you get unstuck. But is the doctor brave enough to “unstuck” herself?

Mary Braun, MD is a primary care and hospice physician working in southern New Hampshire. You can subscribe to her you-tube channel, to hear her thoughts on medicine, philosophy, and the natural world. Her most recent article in Stoicism Today was “I wouldn’t hit you if you didn’t make me so angry.”

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