Mood, disposition and disorder

In a previous post I referred to suicide as a “mood-specific” behavior, and I feel the need to clarify this statement. I wrote that nobody suicides when they’re in a happy mood, suggesting that if people in a depressed mood can “ride out” the mood without doing something lethal, the urge to end their lives will pass when their mood changes. Moods are transient emotional states that can be prolonged by irrational thinking and by ruminating.

Thoughts such as “My life is my problem; the only way to solve my problem is to end my life” can seem logical to a person in a depressed mood. When the mood passes, the person will likely recognize the thought as irrational – or at least as one that doesn’t have to be acted on immediately. Suicide hotlines have prevented many impulsive (mood specific) suicides by helping people to not act on suicidal impulses and to ride out the depressed mood – or to sober up. This principle doesn’t apply to suicidal people who experience chronic depression.

While moods aren’t enduring emotional states, dispositions are. We each have a unique disposition or set of dispositions. For instance, we’re each disposed to be somewhere on the continuum between optimism and pessimism – glass half full vs. glass half empty. I don’t know whether one’s disposition is a result of nature or nurture, or some combination of the two. Other adjectives I’ve heard used to describe disposition include gloomy, chipper, pushy, cranky, generous, stingy, passive and aggressive. They are a component of our personality. As a psychological construct, disposition has so many variables that it’s hard to precisely define or to measure, so these are just my opinions. Dispositions tend to be enduring traits, but that’s not to say that they can’t change over the course of one’s life. For instance, I think that people who’ve tended to be distrustful of others can learn to be more trusting, given enough positive experiences with trustworthy people.

When anxiety and depression are chronic emotional states that seriously affect our functioning, they’re diagnosable as psychiatric disorders. There’s considerable scientific evidence that there’s a biological basis for such disorders, although irrational thinking patterns can exacerbate them. The key to distinguishing  pathological states of anxiety and depression is impairment. Even during the saddest times in my life, my sleep and appetite weren’t seriously affected, and I was able to function adequately. I cried but didn’t have crying spells, and have never come close to attempting suicide. (I’m  not taking credit for this; I consider myself very fortunate.) During my year-long employment in an extremely stressful job, I suffered sleep loss; but my sleep improved immediately after I quit the job.

People who suffer from chronic anxiety and depression often get blamed for their symptoms, because they’re not understood as the symptoms of a chronic mental disorder. Because of the widespread stigma attached to mental illness, many people don’t feel the empathy they might feel for someone with a debilitating physical disorder. And people who suffer from these mental illnesses often blame themselves, telling themselves they “should be” able to control their symptoms. Others self-medicate with alcohol and other drugs that might give them short-term symptom relief, but only add drug dependency to their list of problems.

It’s hard enough to have a mental illness and to have to deal with societal stigma; but in addition, mentally ill persons are increasingly neglected in this country. The mental health system is shamefully under-funded, which explains why so many people with mental illnesses are homeless, why hospital Emergency Departments all over the country are swamped with people who are experiencing a psychiatric crisis, and why jails and prisons have become major providers of mental health services.

Everybody experiences anxiety and depression, and most of us learn how to cope with these transient conditions, because they’re not overwhelming or disabling. But some people with chronic anxiety and/or depression can’t cope without help from social support systems, whether in the form of professional services or community resources – family and otherwise – that recognize mental illnesses as treatable conditions, and provide needed help.

I’m taking a break for a couple of weeks, but will be back with a new post in early June. In the meantime, you can access other things I’ve written at my website: jeffkoob.com. It features links to my books, samples of my artwork, and a short story, “Demon Radio.”

Trains of thought

In my last post I said I’d explore how an initial irrational thought can lead to a train of connected irrational thoughts, expanding from incident-specific to generalized irrational thoughts. Thinking this way doesn’t help you to feel the way you’d like to feel, or to act wisely.

I used to lead a psychoeducational group (as opposed to a process group) called Skills for Recovery at South Carolina’s largest psychiatric hospital. When I taught my module on rational thinking and irrational trains of thought, I’d draw a crude train on the whiteboard as I taught the concepts. I started by drawing a rectangle on “wheels” on the right-hand side of the board, adding a smokestack and a triangular cowcatcher to distinguish it as the locomotive. Then (right-to-left) I’d draw several more rectangles on wheels – boxcars – behind the locomotive. Inside the locomotive rectangle I’d write Activating Event, then I’d write Thought 1, Thought 2, Thought 3, etc. in the boxcars (right-to-left). My standard rap on trains of thought went something like this:

Trains can take you places, hopefully places you want to go. Trains of thought can also take you places. If your thoughts remain rational, your trains of thought  will take you in positive directions. If they’re irrational, they’re likely to take you places you don’t want to go. Take Luke for example. He’s between girlfriends and looking for a new one. He fancies himself a pretty good dancer, and likes to hang out at dance bars and clubs. He’s attracted to Lucy and has seen her out on the dance floor with different men. He works up the courage to approach her at the bar, introduces himself, and asks her if she’d like to dance. She says “No thanks,” gives no qualifiers or explanations, and walks away. Luke isn’t sure how to read her Mona Lisa smile.

Luke’s first thought is rational. “I’m disappointed that she doesn’t want to dance with me.” If he remains rational, he might think “I don’t know why she turned me down. I probably never will, and that’s okay. It may not have anything to do with me, personally. I’ll find someone who wants to dance with me before the evening’s over. And even if I don’t, it’s not the end of the world.” If, instead, Luke has a gut reaction and starts thinking irrationally, his thinking might go in either of two directions: what’s wrong with her, or what’s wrong with me? If he boards the former irrational train, he might conclude that (T1) she’s either a lesbian, or that (T2) she’s stuck-up and thinks she’s too good for him. After another drink, he might start to generalize that (T3) all women are like that, thinking they’re better than us, and that (T4) they’re all stuck-up bitches who don’t know a real man when they see one. Luke’s behavioral response to these angry thoughts is to get hammered.

Luke may instead think of his rejection by Lucy as proof that there’s something wrong with him. He might jump to the conclusion that (T1) she turned him down because she doesn’t find him attractive – which may or may not be the case. He’ll probably never find out, but irrational thinkers with low self-esteem tend not to give themselves the benefit of the doubt on such self-judgments. Luke may think that (T2) he was foolish to ask Lucy to dance in the first place; he should have known she’d turn him down. He may convince himself that (T3) there’s no point in asking any other woman to dance, because she’d just turn him down like Lucy did. Riding that irrational train of thought, he might generalize that (T4) he’s just not attractive to women. From there he might label himself (T5) a pitiful Loser who will never find love, and leaving the club thinking suicidal thoughts.

Suicide is a mood-specific behavior; people never try to kill themselves because they’re elated. Some impulsive suicide attempts are triggered by a train of irrational thoughts, culminating in the irrational belief that suicide is the “solution” to the present conflict or problem. This kind of irrational thinking can be fatal. Suicide hotlines have saved innumerable lives by engaging people who are in crisis in compassionate dialogue until the suicidal mood passes.

Trains of irrational thought are perpetuated when we don’t recognize them as such, and ruminate on them. Situational depressions can be drawn out by dwelling on negative thoughts. If you should catch yourself ruminating on negative thoughts, learn to identify and challenge them. Luke might challenge his persistent thoughts that he’s a pitiful Loser in this manner: “Is it a fact or do I just feel that way? If it’s a fact, what’s the proof? Some pretty women have been attracted to me, and I don’t even know if Lucy turned me down because she doesn’t find me attractive. I have friends who believe in me and don’t think I’m a Loser. Loser is just a word, anyway. I’m not a Loser! Like everyone else, sometimes I win and sometimes I lose. Anyway, sitting here staring at the floor and feeling sorry for myself isn’t helping anything. I need to go for a run.”

Negative, irrational thinking and ruminations can be a “rehearsal for failure,” while riding rational trains of thought can be a “rehearsal for success.” People  who become mindful students of their own thinking can eventually become experts on their own thinking and where it typically takes them. They can avoid the traps of irrational thinking and ride trains of thought that take them to chosen destinations. Cognitive and cognitive behavioral therapies resonate with the buddhist teaching that all suffering arises from our attachment to things – in this case to irrational thoughts and expectations. Irrational thoughts often lead to irrational decisions and behaviors, based on false assumptions. Becoming a rational thinker means learning to spot and challenge your irrational thoughts before you act on them. It gets easier with practice.