I’m enjoying re-reading David Burns MD’s classic book for professionals and non-professionals alike, Feeling Good: the New Mood Therapy (1980). I read it for the first time in graduate school in 1990. It becomes evident as one reads his descriptions of work with patients that Burns is a good clinician, that he’s thoughtful about his patients’ problems, that he listens to them and works hard to help them.
Still, Fred’s story (p. 16) is striking. A veteran, he suffered a severe 10 year-long depression that landed him on the psychiatric unit of a VA hospital, “staring at the wall all day long.” When staff tried to talk to him he always responded by saying, “Wunna die, doctor, wunna die.” They gave him all sorts of medication, and finally 18 shock treatments. When Burns was helping wheel Fred back to his room after the last ECT session, “he looked up at me and muttered sadly, ‘Wunna die’ (p. 17).”
Burns reports that staff did try to talk to Fred. Maybe they tried A LOT over 10 years, who knows? But I imagine that Fred made staff feel the futility he himself felt, hoping that they would really get what it felt like to be him. Maybe staff gave up on Fred because they might not have had a way to think about the hopelessness and helplessness they felt about Fred’s case, to try to contain these corrosive feelings and limit the demoralization caused by them. And so staff resorted to medication and shock treatment, which Fred’s illness predictably defeated as well.
My colleagues and I at Cambridge Hospital (now Cambridge Health Alliance or CHA) saw many patients like this while I worked there as a staff psychologist. We were not able to help everyone who presented for treatment, either. And Burns does not go into much detail about Fred’s treatment, unlike other cases in the book. But many of us who worked at CHA understood that everything a patient says is a communication of some kind, at times meant to make the therapist feel one way or another, often with the hope that the therapist will be able to empathize with him.
Did Fred feel like his therapist cared about him? Did he feel like someone was interested in his story? Like someone was really present and listening and working to understand him? Did anyone try to figure out if this veteran felt suicidal over guilt about combat? Post-Traumatic Stress Disorder or PTSD in veterans was much less understood in the 1970s at the time Burns wrote this book, but that might have been another angle to explore in Fred’s treatment.
Burns makes many good points in the book, including when he shows how distortions in thinking lead to depression and anxiety. But he oversimplifies things too, ignoring the beneficial effects in therapy of the therapeutic relationship, of careful listening, of deep understanding, of showing the patient how his mind works, and how intense emotional pain and misery develop. Burns also cannot explain the interaction between what the patient and therapist are each thinking and feeling. And he has no way to harness that interaction to use it to further the goals of therapy. His book is deservedly a classic, and I am going to enjoy re-reading the rest of it.
But I wish that Fred’s therapists had found ways to talk to him therapeutically, in ways that might have helped him cope more effectively with his wish to die.