Dear Restin,

I am so sorry that you are having these experiences. The great founder or perhaps greatest founder of CBT was an MD and was not anti-medicine at all.

I have never seen any contradiction between therapy and medication. To use a crude, very crude analogy, sometimes there is a software problem and sometimes a hardware problem and sometimes both.

The goal of CBT is to help a person feel generally happy no matter what is happening in that person's life. The goal is not to get someone to fit into the status quo.

There is a saying of Sigmund Freud that goes: "The goal of psychoanalysis is to relieve people of their neurotic unhappiness so that they can be normally unhappy."

Many off-shoots of Freud in the various schools of psychotherapy aim for variations of this goal. CBT is somewhat unique in that it does not aim to transmute acute unhappiness into general unhappiness. It aims, rather, at giving a person the tools so that the person can experience a general sense of peace of mind and a kind of default mood which could be called perhaps, "joy of living."

I am helped by both psychiatric medication and CBT although I am not qualified to give advice regarding either medicine or psychotherapy. I can only share my own non-professional experiences.

There is both deep and superficial CBT. Since insurance companies like CBT for financial reasons, many therapists call themselves CBT practitioners even though they are not really wholehearted proponents of this therapy. And sadly there are some CBT therapists who are anti-medication.

"Deep" CBT is quite profound in my opinion, whatever that is worth.

CBT actually springs from an insight of an ancient philosopher named Epictetus. Epictetus was the first philosopher who realized that our "objectivity" is often colored by the attitudes we bring to our thinking. People often feel differently depending on what they bring to their experiences

As a simplified example, imagine a classroom of students. On Friday the teacher announces that a poem will be required to be written and turned in on Monday. One student, who is fond of writing poems, is happy about this situation because he loves to write poetry. Another student, who is going on a weekend camping trip is unhappy because he will have to fit that into his schedule of weekend fun. A student who is not very good at writing, dreads and hates the assignment because he fears getting a bad grade. The assignment is the same for each student but engenders different moods: happiness, fear, dread, hate, unhappiness and so on.

CBT, deep CBT, is based on the idea that people bring powerful attitudes towards their observation of things and that these attitudes "color" their perception and have a profound effect on mood.

One of the deep teachings of CBT, is that many depressed and anxious individuals have a dominant or default attitude which tends to look at everything form the point of view of "could be better, but isn't better." I could be better, but am not better. The people in my life could be better, but are not better. My life itself could be better, but isn't better. Things and events in the world could be better, but are not better."

When everything is seen through the lens of "could be better, but isn't better" certain feelings, thoughts and moods are apt to commonly occur. Those are: disappointment, boredom, aggravation and frustration, anger, guilt, anxiety and unhappiness. It would be strange if looking at things through the lens of "could be better, but isn't better" did not produce these default moods.

But the very same things can be looked at through a different lens: "could be worse, but isn't worse." I could be worse than I am, but I am not worse. The people in my life could be worse, but are not worse. The things and events going on in my life and in the world could be worse, but are not worse. This "attitude" generally engenders quite different moods: feeling lucky, feeling appreciative, feeling at peace, feeling joyful.

A person "stuck" in the "could be better, but isn't better" frame of mind tends of selectively choose facts which reinforce this attitude. For example, today a plane crashed, today several people were in automobile accidents, today a train derailed, today there was in earthquake. These are, of course, facts. But it is also the case, that there are other facts.

Today tens of thousands of airplanes did not crash, millions of cars were not in accidents, hundreds of trains did not derail.

The "could be better, but isn't better" frame of mind is sometimes called "perfectionism." It has many good qualities but if it is not balanced it can lead to awful suffering in people.

Once a student told me that she was no good. So I asked her why she was no good. She told me she was no good because she did not get straight A's on her report card. She said to me: "I am bad. I am worthless. I am a waste of oxygen."

So I told her, there have been a couple of men in the last 100 years who caused the destruction of tens of millions of people through genocide and campaigns of forced starvation, men like Hitler and Stalin.

So I asked this young student: "Have you caused the destruction of tens of millions of people?" No? "Have you caused the destruction of a million people?" No. Have you caused the destruction of 100,000 or 10,000 or 1,000 people?" No? So then I asked her, "realistically speaking, how bad are you, really?" Is it not true that you are far, far, far, far, far, far, far, far, far away from the kind of badness of genocidal dictators?

A CBT therapist would probably try to help this girl put her guilt in perspective, balance the "could be better, but isn't better" against the "could be worse, but isn't worse." The girl I spoke with wanted to end her life. Her guilt was so extreme as if she had destroyed tens of millions of people. Good and bad fall along a continuum or range. There is also better and worse and degrees between these.

Sometimes there is real brain pathology involved in mental illness. In such cases, CBT or other forms of therapy are not effective or less effective because there is a biological dimension to the problem. These biological problems require medical treatment. I think that perhaps many CBT therapists know this. Certainly one of the fathers of CBT, Dr. Aaron Beck was aware of this.

At the same time, if a person is a radical perfectionist, it can happen that medication alone will not be as effective as possible because a person is "stuck" in an extreme perfectionist state of mind. And here CBT might be helpful [or not].

If one looks at things through dark glasses, everything is always going to look dark. Epictetus stated this insight in this saying: "Often we do not see things the way they are. Often we see things the way we are."

I have visited Third World Countries and seen people in desperate and deplorable conditions, absolutely depressing and hopeless conditions. And yet I have often found such people to be very joyful and carefree.
I have found the same thing in cancer wards where people have been diagnosed with terminal cancer. How can such people have a general peace of mind and joy of living in such awful circumstances? CBT might have a partial answer to this. How we look at things affects how we see them.

I have also seen people in exceptionally favorable conditions, enviable conditions, who are absolutely miserable. They say things like: "My life stinks. My parents stink. The people around me stink. Everything stinks. I stink."

Sometimes there is brain pathology involved in this extreme negativity.

CBT is not "positive thinking." It does not ask a person to blindly think positive. It asks a person to try to think realistically and in perspective.

Yes, realize that an earthquake happened today. Don't shut one's eyes to it. But also realize that the greater part of the earth and human cities did not experience a devastating earthquake today.

Yes, realize that a plane crashed today. But also realize that 10,000 planes safely took hundreds of thousands of people to their destination today.

Yes, realize if one has made a mistake today. But also realize that this mistake is not like causing the genocide of 10,000,000 people.

There are people who have made grave mistakes that caused horrible destruction and these people are in prisons for the rest of their lives. Realize that any mistake you have made today, is probably not like that.

If one is to feel guilt, try to feel guilt appropriate to the level of the mistake. If one blames someone, try to confine that blame to the degree of badness involved.

One of my friends was not very nice to me today. At the same time, this person is not Adolf Hitler. So even anger needs to be kept in perspective.

But why do all this? What good can come from this change of frame of mind? Well, hopefully it will result in a life with less stress and distress, less aggravation and disappointment, less rage and despair.

Some CBT practitioners might be somewhat hostile to medication, but at the same time they might be pretty good therapists. Even therapists can be looked at from the points of view of "could be better, but isn't" or "could be worse, but isn't."

I grew up as a perfectionist. Although I had times of happiness and peace, I would say that my general default frame of mind was "could be better, but isn't better."
I looked at myself this way and it ruined my self-esteem. I looked at my parents, friends, co-workers this way. I looked at everything this way. To me thing always looked kind of dark.

It wasn't until I had CBT that I realized that 90% of my misery was self-generated by my frame of mind.

And it was no easy thing getting balance. A lifetime getting a negative frame of mind cannot be changed overnight. I had to "will" to be happier and more at peace with myself and the world. Time after time I fell into unrealistic negativity. It was like negativity was the "hard drive" of my mind and the CBT stuff was just software. And I needed medicine too.

"Perfectionism" has certain very definite benefits. I am glad surgeons are perfectionists. There are so many areas where perfectionism is useful and laudable.

But when perfectionism becomes extreme and unbalanced it can lead to unhappiness, unnecessary unhappiness.

No human being is all-powerful, all-knowing, all-seeing, all-wise, all-perfect. Only an Infinite Being could be like that. So to strive for that level of perfection is unrealistic by definition. It is forcing an unrealistic expectation on oneself, others and the world in general.

Hopefully you will derive some benefit from CBT or will find something else of benefit to you. CBT is certainly not miraculous or anything like that. It has its faults, limitations and so on. But perhaps it will be helpful in some way.

Sometimes things that don't work are helpful in a way by showing us what doesn't work. Once a friend of Thomas Edison told him that he was a total failure because he did 10,000 unsuccessful experiments in trying to build a light bulb. Thomas Edison told him: "I did not fail 10,000 times. I just found 10,000 things that don't work." And eventually Edison found one that did work.

So I hope you find something that works for you. My deepest apologies if anything I have said has not been helpful or has made you feel worse. I wish that many people will see your post and have better words than my poor words! I sure hope you find something really, really helpful!

Sincerely yours, Yao Wen