As a freshman at UCLA I fell into a deep depression, believing that my parents, my sister, the whole world would be better off without me alive. When I told my friends of my suicidal thoughts, they made me promise to get professional help. I saw a UCLA psychologist whose cognitive therapy saved my life by helping me rewrite my suicidal thoughts and stop my suicidal impulses.
Cognitive therapy is also known as cognitive behavioral therapy or CBT, for short. As I was in CBT in 1981-1982, I asked my colleague Sarah Fader to help me identify the cognitive distortions, or types of inaccurate thoughts, I had back then. Sarah Fader and Simon Rego, PsyD co-wrote The 10-Step Depression Relief Workbook: A Cognitive Behavioral Therapy Approach (2018). If you are experiencing depression, I highly recommend this hands-on workbook.
If your symptoms are life threatening, please immediately call 911 (USA and Canada), go to the emergency room, or contact the National Suicide Prevention Lifeline at 1-800-273-8255 (USA).
Depression involves distorted, negative thoughts and beliefs which are “automatic,” or outside of conscious awareness. In CBT, I learned how to identify these automatic thoughts and “restructure” them. Changing my thoughts changed the way I felt and behaved.
My CBT homework was to keep thought records where I separated my thoughts and feelings to determine whether those thoughts were true. If my thoughts were negative inaccurate cognitive distortions, I’d replacement them with more realistic ones. Using these worksheets, I literally “rewrote” my negative thoughts. Doing so rewires our brains. The neural circuits in my brain used to short-cut to suicidal ideation. Cognitive techniques enabled me to identify the suicidal and depressive ideas as irrational, stop them, and rewrite (or reason with) them.
Here are the negative inaccurate cognitive distortions that I worked on in cognitive therapy:
“The world would be a better place without me,” which is an example of jumping to conclusions and fortune-telling. I did not have evidence to support that conclusion. At the time, I volunteered at the UCLA Medical Center Emergency Room. When I was in high school, I volunteered at local hospitals. Even if I didn’t volunteer my time to help others, the world would NOT have been better without me. My friends, family, and acquaintances would have been devastated. Unfortunately, depression lies.
In the same vein, I thought, “My family (or my sister) would be better off without me.” I believed that they’d have more resources available for my sister if I wasn’t such a drain on the family’s finances, time, and energy. My reasoning was emotional, not logical. As a Californian, UCLA in the early 1980s was a deal, especially compared to the Ivy League school I had wanted to attend. This might also be an example of a should thought. I thought I shouldn’t have any needs. That my family shouldn’t have to support me. I had to think more logically and get rid of those shoulds and shouldn’ts.
Using black-and-white all-or-nothing thinking, I believed, “This pain is unbearable. I need it to end.” Yes, severe suicidal depression hurts. In fact, it can feel like a living hell. But it’s not hell. Hell is permanent. The pain of severe major depression was temporary. Not only did I bear that hellish pain, but I overcame it.
Believing “I am unworthy of love,” I labeled myself negatively. Labeling involves making unhelpful overstatements, like “I’m a loser.” Of course, I was worthy of love. We all are. Not only was I worthy of it, I was loved, dearly. I just didn’t see it.
I thought, “I am a failure,” which involves labeling, overgeneralization, and personalization. An overgeneralization is when you take a single piece of evidence and then infer that it must always be true. I believed that I was a failure because I didn’t live up to expectations of attending an Ivy League university and because I was depressed. I personalized not getting accepted into an Ivy League school and becoming depression. I saw myself as responsible, when neither were my fault. I worked hard in high school to get into an excellent college. Likewise, depression was not my fault.
“I am ashamed of being depressed. I must be perfect.” I expected perfection of myself and was ashamed of my depression. Expecting perfection from myself involves both black-and-white/all-or-nothing thinking and should, that I should be perfect. No one is perfect. I was, and still am, imperfectly human. As for the shame, that involves internalized stigma (not specifically a cognitive distortion, but I’d argue it is) and personalization.
“I want to die.” This thought is an example of catastrophizing. Wanting a permanent undoable solution to a fixable problem. Besides, I didn’t want to die. I desperately wanted and needed help, which I sought and received.
I told my cognitive psychologist that I had fantasies of being hit by car and hospitalized. He responded, “You can be hospitalized right now.” My wish to be hit by a car is an example of a control fallacy, where I’m a victim of an outside force, a car accident. If I needed or wanted psychiatric hospitalization, the UCLA Neuropsychiatric Hospital was available; instead, I persevered in cognitive therapy.
Cognitive therapy helped me overcome severe suicidal depression and gave me a skill I still use today. Unfortunately, my biologically based underlying mental illness remained. Very active on campus, I volunteered in UCLA Medical Center Emergency Room, sat on the Executive Council of College Honors as Vice Chair of their Social Committee (glorified party planner), and trained as a Peer Health Counselor.
For all but my closest friends, I hid behind a facade of competency and social skills. But I was miserable and felt that the biochemistry curriculum was more of a technical training than the well-rounded interdisciplinary education I craved. The August before my sophomore year I came down with mononucleosis and used that as an excuse to quit UCLA. I visited family and friends, worked, and attended community college part-time. Then I transferred to UC Berkeley as a legal studies major, a fabulous interdisciplinary program run out of Boalt Hall.
During my junior year at Berkeley, symptoms of depression returned. My mother was diagnosed with non-Hodgkin’s lymphoma. I was devastated to learn of my mother’s diagnosis. My mother and I researched the cancer. At the time, studies indicated a five-year prognosis. She pointed out that research was out of date by the time it was published, that cancer treatment progressed, and life spans increased. She is still alive thirty-five years later thanks to cutting edge monoclonal antibody therapy.
That same academic year, my maternal grandfather died. My grandfather always held a special place in my heart. He was a kindred spirit as a gifted orator (I’ve always loved the stage) and storyteller (here I am – a writer, a storyteller). The fall after I quit UCLA, I visited him and my grandmother. When he died, it hit me particularly hard. My mother’s family asked me to give his eulogy, which was a huge honor. In speaking at his memorial mass, I was carrying on his spirit.
On my way home from the funeral, as I was driving over the San Francisco Bay Bridge, I fell into a trance state brought on by the flashing reflections of the lane markers, and had an out-of-body experience, or more accurately, an in-the-body experience. I felt a tingling all over my body, an energy pushing out, and a warm cleansing energy replacing it. The fact that I was driving over a bridge at the time disturbed me. To test whether I could safely drive, or whether I should put on my hazards and pull over to the side, I put on my turn signal and changed lanes to the right. At the time it seemed safer to continue off the bridge than stop on the bridge.
When I got home, I described the experience to my roommates as a spiritual orgasm. We were interested in spiritual enlightenment, read Alan Watts and D.T. Suzuki, and wanted to experience enlightenment. After that initial spiritual experience, I willfully entered a series of altered states. I would stare into a candle flame, go into a trance state, and enter an altered state of consciousness. The states I entered fell into two basic categories – the light and the dark. The light I would describe as a loss of self that led to clarity – a cleansing. The dark was addictive, as if a siren called me, and threatened a loss of self that could lead to madness. I identified the two experiences as the call of God and the enticement of the Devil and related it to my reading of The Screwtape Letters by C.S. Lewis. The dark disguised itself as the light. It was deceitful and dangerous.
In retrospect, I can understand these mystic experiences as the beginning of a hypomanic episode or mood cycling. At the time, given my history of depression, I knew if I went to a mental health professional and described the experiences, they would diagnose me with a mental illness. But I found them meaningful and did not want the meaning dismissed. I decided to stop entering the trance states and interpreted them as God calling me to the ordained ministry.
As I felt vulnerable and did not want to fall victim to fray religious sects, I went to an ancestral religious home, the Roman Catholic Church. Unable to reconcile confirming my faith as a Roman Catholic with the belief that I was called to ordination, I ended up confirming my faith as an Episcopalian and remain something of a Catholic apologist despite my issues with the Church and my involvement with other Protestant denominations.
Having graduated from Berkeley as a legal studies major, my first profession was as a legal assistant in Los Angeles and San Francisco. Working twelve-hour days six days a week, I crashed after a year on the job. What looked like over-achievement was a symptom of unrecognized, undiagnosed hypomania that came with a steep cost – my mental health and stability.
– Excerpt from Kitt O’Malley’s memoir Balancing Act: Writing Through a Bipolar Life