Can you change the way you think?
Can learning tools from other areas apply to fight mental illness-induced cognitive distortions?
There's a fairly large school of therapy, most famously Cognitive-Behavioral Therapy but also including other techniques, based on the belief that emotional distress is regularly caused by cognitive distortions: false beliefs we hold about ourselves and the world that cause us pain. It's not difficult to come up with examples:
Everybody hates you
If you're feeling sad, you should keep it a secret or people won't want to be friends with you.
People would be better off without you, even if they say otherwise
I'm not certain how I feel about this paradigm -- there's definitely truth to it, but I don't think it captures everything and think it also goes the other direction: feeling bad leads me to have more cognitive distortions, and it's hard to know which part to "treat" to make me feel better. But for the purposes of this post, let's assume the most oversimplified possible version of this idea: negative emotions are entirely due to cognitive distortions.
One of the more insidious parts of depressive episodes for me has been the way they suck away all hope. It doesn't feel like "I've been sad and unable to do much for a few days" so much as "I am sad and unable to do much and I will continue to feel like this for the rest of my life."
Part of this is a feeling that, whatever painful (and inaccurate) mode of thinking I'm stuck in, I will never be able to change it. Like most unfortunate feelings, this is hard to get rid of because there's legitimate evidence that it's true:
The therapists I've seen in Hyde Park who've promised to help me change my way of thinking have ranged from mediocre and unhelpful to actively terrible.
(If you promise you can help change how I think, and instead I come away with new cognitive distortions, does that count as evidence that I can change how I think?)
Despite two months of intensive treatment / partial hospitalization, I don't think I can say I've actually eliminated any of my cognitive distortions. Maybe they appear less often, but in the worst parts of a depressive episode I can't point to anything and say "I sure fixed that brain problem."
I've repeated the "think really hard about cognitive distortion -> find way to rephrase it that hits me hard emotionally -> interpret emotional reaction as 'breakthrough' and 'overcoming the distortion' -> time passes -> cognitive distortion returns" cycle enough times that I feel really, really skeptical of any promised long-term change in how I think.
And yet, people do change.
Change is really hard, and in the moment there seems to be overwhelming evidence that you can't possibly change.
But people do anyway.
And so, in the hopes of amassing evidence to tell my brain that this isn't permanent, I want to really look in detail about how I change the way I think about things. I have two examples: one about how, in math grad school, I've learned how I learn, and one about how my views on money and its role in social justice have changed over time.
(If you don't care about either of those, this is not the blog post for you.)
As a math grad student, I'm supposed to be becoming an expert at learning new ways of thinking. And over the past two-and-a-half years, one of the biggest skills I've gained is learning how I learn new things. (Obviously this might be different from how you learn things! People are different!)
Typically when I learn a new definition, I need two things: a vague, handwavy overview of what the definition is "doing," and a specific example that I can work out for myself. The overview lets me see the general idea: I might say (you can skip the rest of this paragraph if you don't want to hear topology words) a homotopy colimit is the homotopy-invariant version of a colimit, and that tells me why people are thinking about this thing to begin with. But I didn't feel like I understood what that meant until I looked closely at the (infinity-categorical) homotopy pushout of X to a pair of points in spaces, and thought carefully through why this had to be the suspension of X. (And the same in chain complexes!)
Once I know those two things, I can really start the learning process. It's not enough to just know my one example: I have to know which things work in general and which are special features of my example, but really owning an example gives me a foothold and some amount of intuition for what's going on.
I've gotten reasonably good at applying this mode of thinking to math, but I didn't realize until I was trying to process how I had internalized (sorry, last math words I promise) homotopy colimits that I'm not very good at thinking this way in real life.
Here's a very brief sketch of how I might try to think about one of the above cognitive distortions "mathematically" (meaning, to be clear, to try to intuit it in the same why I intuit math -- I'm not trying to say this is objectively true or anything like that.)
It's really easy for me during the worst of times to convince myself that my friends secretly hate me and don't want to talk me and only tolerate me to be polite.
Vague handwavy overview: In general, people like their friends. Not everybody likes everybody, but the chance of every single one of your friends (especially your close friends) hating you is very low. This is most likely your brain lying to you.
I think a lot of the time I stop at the "vague handwavy overview" and say "well, I tried, but I don't feel better." But this is like if somebody told me about Schrodinger's cat and then I claimed I understood quantum physics! I haven't really digested the idea that my friends probably don't hate me - I've just boiled it down to a few superficial sentences and then complained that it didn't change how I felt.
So we need to go one level deeper, to something that someone once told me was called "grokking" before I never heard that phrase again. We need to see how we, as individuals, actually learn new concepts.
For me, that involves specific examples I can reason with. Luckily, I have a perfectly good example of somebody who feels ways about people: me!
It is true that I don't like every single person (sorry). But it's also true that I care quite deeply about everybody I tell I care about, and it's also true that I care a lot about the people whose relationships I put time and effort into, and that I would be somewhat hurt if they told me I didn't care about them.
This is something I can reason with directly, build emotional resonance with, and test hypotheses against:
If everybody hates me, it doesn't make sense that people have put serious effort into spending lots of time with me and caring about me.
It's actively unfair of me to worry about people all secretly hating me. (Probably something to be careful of, because this can lead to spirals of its own, but is also a strong counter to the original distortion.)
I care about plenty of people that I don't have a deep relationship with --- depression brain isn't a huge fan of nuance, but it's probably worth noting that people can like and care about you without being your best friend!
There's still stuff to be careful of: I'm just an example of people, not all people, and we shouldn't assume all people feel exactly the same way, the same way not all rectangles are the rectangle I picture in my head when you say "rectangle". But it's a starting point, and for me it's a way to move from "I'm saying bs platitudes because some therapist told me to" to "here is a way I know helps me to internalize statements by building on examples I know."
The second is maybe more practical, and that's been my views on money. I grew up fairly wealthy and so I didn't have to think a lot about money up until college or so. Somehow, in the past six-and-a-half year, my views have changed from "donating some money seems like a good thing" to "donating regularly to effective altruist causes is a moral imperative." (Note - my views have changed mildly since the linked post, albeit mostly in terms of nuance and presentation.)
I can think of three things that have most strongly changed the way I think about money:
The summer after my freshman year of undergrad, I went on a month-long missions trip to Haiti and the Dominican Republic. There's a lot of criticism of missionary trips and much of it is valid -- I'm really sure how much "good" we did there, or even precisely what I mean by "doing good" somewhere. But the combination of hearing first-hand stories of how poverty had shaped people's (including our fellow missionaries, half of whom were from the DR) lives, seeing the results of both failed and successful attempts to alleviate said inequality, and significant night-time bible study in (mostly) Luke, trying to see Jesus' heart for global justice, had a serious, long-term impact on me.
A bit later in undergrad, I read Doing Good Better by William MacAskill, which exposed me for the first time to effective altruism - the idea that not all charitable organizations are the same, and that we should judge charities by their outcomes, not just how much they emotionally appeal to us. A definitely-misremembered thought experiment: you have a family member who is blind, and you want to make a donation in their honor. Do you donate to a charity that trains guide dogs, or a charity that buys malaria nets? Does your answer change given that it costs $50,000 to train a single guide dog, and only $3,000 to save a child from dying of malaria?
My Junior Year I helped co-lead a pair of bible studies with wonderful coleaders and members who challenged me to look at what Jesus said and really try to live it out. In particular, we used a technique I learned from another friend: the challenge of the week, where each week we'd pick a specific action and all agree to do it and report back on how it went. Thanks to some really really incredible friends who were down for anything, we were able to try some things far outside our comfort zones: having a meal with a person experiencing homelessness, selling something of value and donating the money, spending an hour per day in prayer for a week. These bible studies are one of the things I miss most from undergrad, and ultimately led to an outreach program for people experiencing homelessness that really helped me to see homelessness as a thing that affects individual people in horrible ways, and not just a vague problem that it was good to alleviate.
So how does this apply to cognitive distortions? It's not super direct, and it's something I'm going to think about more, but a few things jump off the page for me:
I can change how I think
In particular, change can sometimes take a really long time, but it still happens!
(If you have no, or different, mental health struggles this might seem obvious to you, but right now realizing that I have changed intentionally over a long period of time is blowing my mind.)
Books can legitimately change how I think
I've read like three books on depression, and only one of them was at all helpful. Sometimes my brain tries to generalize this to "reading is a waste of time" and "don't look back on your notes from the PHP, that's a waste of time", but it's clearly not true --- Doing Good Better took a few hours to read changed the way I think of charity forever. (Or at least until now, it could change again.)
Most of my major shifts on money-related topics have been associated with specific actions - going to Hispaniola, meeting and talking to the Cambridge street population, selling my mattress cover to donate the money. I think finding "challenges of the week" for mental health is a little bit more difficult, and is probably something I should be discussing with a therapist, but I'm realizing as I type this that actions are an important way for me to internalize and learn, far more than just listening to or reading things.
Writing this blog post has been extremely helpful for me, and I think I have a lot of takeaways about my own brain (most importantly that I need to reason about my cognitive distortions by trying them out in specific cases the way I would in math, and secondarily that I need to find specific mental health-related actions I can take to really internalize new ideas.)
If you made it this far, I hope it was at least somewhat helpful for you? I don't know what anyone else's brain is like so it's tough to say. But either way, I really appreciate you taking the time to read this :)