Rethinking Depression

What Do ‘Treatments’ Really Do?

A Selection from Rethinking Depression

By Eric Maisel, PhD | Posted 8/15/12 | Updated 9/27/20

You may be thinking, "Well, psychiatrists, psychologists, family therapists, and other mental health professionals surely know what to do with these symptom pictures.

Maybe it isn't an exact science but more like an art, where, through practice, these professionals begin to discern the difference between a mental disorder and a life challenge. So, even though the system is flawed, practitioners do know important things about mental disorders."

You would be wrong.

An elegant experiment performed by psychologist Maurice Temerlin and published in the Journal of Nervous and Mental Disease makes this abundantly clear. Temerlin had an actor memorize a script that was designed to portray a mentally healthy individual (let's call him Harry). Harry was happy, effective at work, self-confident, warm, gracious, happily married, and insightful — as mentally healthy as a person can be. Temerlin interviewed Harry and taped the interview. He then played the interview for various groups of mental health professionals, informing them that Harry was a prospective patient and that they were listening to an "intake interview."

Temerlin set up three basic scenarios. In the first, a group of mental health professionals were played the tape and asked to rate Harry's mental health. In the second a well-known mental health professional informed the gathered professionals that they were about to listen to an interview with "a very rare person, a perfectly healthy man." In the third, a well-known mental health professional told the gathered professionals that they were about to listen to an interview with a man who "appears neurotic but is really psychotic." They were told not to base their rating on anything but the interview itself — that is, they were explicitly told not to use the information provided by the "prestige associate."

The results? In the first scenario, in which mental health professionals had no information about Harry other than the interview, not a single graduate student, psychologist, or psychiatrist found the subject to be psychotic (though more than 40 percent did find him either neurotic or character disordered!). In the second, in which the mental health professionals were told that Harry was "a very rare person, a perfectly healthy man," 100 percent found him to be mentally healthy. In the third, in which the mental health professionals were told that the subject "appeared neurotic but was really psychotic," almost every graduate student, clinical psychologist, and psychiatrist rated him as either psychotic or neurotic. The psychiatrists were the worst in this regard: 60 percent rated him psychotic, and 40 percent rated him neurotic.

Having listened to an interview with a healthy man and been told to confine their ratings to the evidence of the interview, 100 percent of the psychiatrists judged him disordered.

Many other experiments have confirmed that mental health professionals, when confronted by a patient or prospective patient, do not diagnose actual disorders but rather express unfounded opinions that match their training and that serve their pocketbooks. An excellent experiment run by Ellen Langer of Harvard and Robert Abelson of Yale and published in the Journal of Consulting and Clinical Psychology further illustrates this point. The experimenters wanted to gauge what therapists would say about a subject who for one set of therapists was called a "job applicant" and who for a second set of therapists was called a "patient." Would the latter label bias their opinions?

Did it ever!

Those therapists who thought that the subject was a job applicant used words such as candid, upstanding, innovative, and ingenious to describe him. Those who thought that the subject was a patient used words and phrases such as tight, defensive, frightened of his own aggressive impulses, conflicted over homosexuality, and passive-dependent type. The experimenters concluded, "Once an individual enters a therapist's office for consultation, he has labeled himself 'patient'...The therapist's negative expectations in turn may affect the patient's own view of the situation, thereby possibly locking the interaction into a self-fulfilling gloomy prophecy."

May, indeed!

If all it takes to convince mental health service providers that a fundamentally sane person is either psychotic or neurotic is the say-so of another provider, and if all it takes to turn a person's ordinary behaviors into symptoms of pathology is to label him a patient, our eyes should be opened to a fundamental truth about diagnostic labels. The system is designed to turn ordinary human experience into categories of disorder, trapping in any real disorders with the concocted ones. This bad science couples intellectual shoddiness with venality to produce tens of millions of "patients" annually.

Robert Whitaker has more to say about this in Mad in America:

A dark truth became visible in American medicine in the 1990s. Bias by design and the spinning of results — hallmarks of fraudulent science — had moved front and center into the testing of commercial drugs....When the [New England Journal of Medicine] tried to identify an academic psychiatrist who could write an honest review of antidepressant drugs, it found "very few who did not have financial ties to drug companies." One author of an article on antidepressant drugs had taken money from drug companies on so many occasions...that to disclose all of them "would have taken up more space than the article."

It is not that hard to explain this system-wide conspiracy to turn unwanted experiences into mental disorders. That you can make money doing it explains a lot. That you gain prestige and ego gratification by being a person who can "diagnose and treat" your fellow human beings is surely part of it. And a combination of incuriosity and intellectual shoddiness may be just as pertinent. When I sat in my psychology and counseling classes and listened to my professors' lectures, I asked many questions because what I was hearing did not make sense to me. But no one else did. My fellow students seemed to have no investment in comprehending.

When a professor said, "When you see these eight symptoms, you call it this disorder," no one (except me, until I got tired of inquiring) asked, "Why?" No one asked, "What is the relationship between diagnosing and treating?" Did that relationship seem self-evident to my fellow students? If I say to you, "When you have a depressed client, feel free to use medication, gestalt therapy, cognitive therapy, Jungian therapy, Freudian therapy, or anything you like, it's all the same," does that make sense to you? Yet that was what we were taught: diagnose according to the diagnostic manual, and then treat using your favorite treatment method.

How was Jungian therapy supposed to work on a biological disorder? How was medication supposed to work on arrested development? How was a combination of medication and object-relations therapy supposed to help a person with a depressing life? For whatever reasons — professional self-interest, ego gratification, prestige needs, distaste for rocking the boat, incuriosity, intellectual shoddiness, or some combination of these and more — no one posed these questions.

It should not surprise you that a few years after becoming a licensed therapist I switched from doing therapy to coaching. When the coaches I train ask, "What's the difference between coaching and therapy?" I reply, "We coaches are simple people; we just support our clients and hold them accountable." They laugh — they think I'm joking. I'm not. It's exactly what the best therapists also do — with one hand tied behind their backs, bound as they are by their need to diagnose and treat and the demands of a profession in which mental disorders are not discerned but created.

What about Antidepressants?

You may be thinking, "But don't antidepressants prove that depression does exist? I mean, when you treat an illness with a drug and you get better, doesn't that prove that you were ill in the first place?"

No, it doesn't.

To begin with, whether or not antidepressants actually work is open to debate. The very definition of what constitutes antidepressant effectiveness sets the bar very low. The physician Mark Hyman explained: "Just because antidepressants are popular doesn't mean they're helpful. Unfortunately...most patients taking antidepressants either don't respond or have only partial response. In fact, success is considered just a 50 percent improvement in half of depressive symptoms. And this minimal result is achieved in less than half the patients taking antidepressants. That's a pretty dismal record."

Second, drug companies regularly suppress research demonstrating the ineffectiveness of the antidepressants they sell, thus producing an inflated sense of their effectiveness. One example of this widespread practice is the following, as reported in NewsInferno: "Reboxetine, an antidepressant sold by ineffective, and could even be harmful, according to a new study conducted by German researchers....Researchers from the German Institute for Quality and Efficiency in Health Care have accused Pfizer of failing to disclose negative clinical trial results for reboxetine, after finding that eight out of 13 significant trials were never published."

Third, the extremely high relapse rate after patients discontinue antidepressants suggests that effectiveness is being defined as the temporary alleviating or masking of symptoms. Sharon Begley reported in the Wall Street Journal: "Unless patients continue taking the drugs, they have a considerable risk of suffering a relapse in the year after they stop....A large 2001 study found that the risk of relapse in patients taking antidepressants only, in the year after they stop, is 80 percent. In contrast, patients receiving only cognitive behavior therapy in that study had a relapse rate of 25 percent in the year after ending treatment."

Fourth, multiple studies indicate that a large component of drug effectiveness may be the placebo effect. Maia Szalavitz wrote in Time magazine: "A small but vocal minority of researchers have also questioned whether the mood-enhancing benefit of antidepressants amounts to anything more than a psychological artifact. They point to studies that suggest the drugs' seemingly powerful effects are the same as those of a sugar pill. Most recently, a headline-grabbing Journal of the American Medical Association paper published in January [2010] found that antidepressants worked no better than a placebo in patients with mild or moderate depression."

John Kelley in Scientific American elaborated on this:

In clinical practice, many people suffering from depression improve after taking antidepressants. But the evidence indicates that much of that improvement is a placebo response. Antidepressants do work in the sense that many patients in clinical practice show substantial improvement. However, if the standard is efficacy in comparison to placebo, the best available scientific evidence suggests that antidepressants do not work very well. Given their cost and side effects, the psychiatric community and the general public should not be satisfied with antidepressant medications that provide only a marginal benefit over placebo.

The fact that antidepressants are now prescribed for a myriad of very different "ailments" further suggests that we are looking at a placebo rather than a chemical effect. Peter Breggin wrote in Talking Back to Prozac:

While Prozac was originally approved for depression — and only recently for obsessive-compulsive disorder — it and the other SSRIs quickly began to be prescribed for a wide variety of ailments and difficulties, such as seasonal affective disorder (SAD) or "winter blues," obesity, anorexia, bulimia, phobia, anxiety and panic disorder, chronic fatigue syndrome, premenstrual syndrome (PMS), post-partum depression, drug and alcohol addiction, migraine headaches, arthritis, body dysmorphic disorder (BBD), and, finally, behavioral and emotional problems in children and adolescents.


There are more reasons than these to suspect the effectiveness of antidepressants. But even if it were proven to everyone's satisfaction that antidepressants work to "relieve the symptoms of depression," would that constitute proof that depression is a mental disorder? Hardly. All it would prove is that chemicals have effects and that they can alter a human being's experience of life.

Is that news?

Chemicals can make you giddy, they can cause you to hallucinate, they can give you an adrenaline rush, they can make you forget your troubles, they can give you an erection, they can cause you to skip your period. Chemicals can affect how your mind works. Chemicals can affect how you sleep. Chemicals can alter your moods. That a chemical, an antidepressant, can change your mood in no way constitutes proof that you have a mental disorder called depression. All that it proves is that chemicals can have an effect on mood.

There is a fundamental difference between taking a drug because it is the appropriate treatment for a medical illness and taking a drug because it can have an effect. This core distinction is regularly obscured in the world of treating depression. The mental health industry routinely makes the leap from "We don't know what you have and we surely don't know what's causing it" to "Take this chemical." This leap has naturally confused a lot of smart, sensible people who are not informed enough to ask, "Are you prescribing this drug because I have a biological disorder, or are you prescribing this drug because it is known to have an effect on my symptoms?"

An antidepressant may elevate your mood and rid you of symptoms. You may desperately want those positive effects and opt for chemicals to deliver them. You would need to factor in the characteristic side effects of antidepressants — among them sexual dysfunction, fatigue, insomnia, loss of mental abilities, nausea, and weight gain — and make your informed decision. To the extent that the chemicals really do deliver those effects and to the extent that their side effects aren't worse than their positive effects, antidepressants may be a reasonable choice. It certainly wouldn't be the first time someone took a chemical to get a respite from human unhappiness. But the fact that antidepressants can provide this respite does not constitute proof that they are a "treatment for a mental disorder called depression." It is only proof that chemicals have effects.

What Does Psychotherapy Prove?

The phrase mental disorder is supposed to put you in mind of medicine; and antidepressants, by their very existence, are supposed to constitute proof that a disorder, with a biological cause, exists. Let's say that you agree with me that giving something a name and providing chemicals that have an effect on that something do not constitute proof that you have a genuine disorder. However, you may still feel that something is going on that warrants that "mental disorder" label and that maybe that something is psychological rather than biological.

I'm afraid that emperor is also naked. It is no more legitimate to call an array of unwanted experiences a psychological disorder than it is to call it a mental disorder. It is the same specious operation. For it to represent something legitimate, the term psychological disorder would need to mean something more than experiences or feelings that are unwanted, unacceptable, odd, or extreme.

The two primary treatment methods that have arisen to treat mental disorders are chemicals (antidepressants) and talk (psychotherapy). Recently a great deal of investigative energy has gone into debunking the rationale for and efficacy of the chemical approach (see books such as The Emperor's New Drugs, The Myth of the Chemical Cure, and Anatomy of an Epidemic). Psychotherapy, however, has largely escaped similar scrutiny. Probably the main reason is that it can work rather well — except not as a "treatment" for the "mental disorder of depression." Rather, it works because the right kind of talk can help reduce a person's experience of unhappiness.

Since there are no mental disorders to be treated, what is going on in psychotherapy? Chatting and relating. A human interaction is occurring that is just like the human interaction that occurs between two friends, when one friend is perhaps a little more psychologically savvy than the other. It isn't fair to call the kind of talk that happens between a psychotherapist and her client "just talk," since this talk can help enormously. But it also isn't sensible to put this talk on a pedestal. Thomas Szasz, who for fifty years has heroically exposed the mental health industry in books such as The Myth of Mental Illness, The Manufacture of Madness, and The Medicalization of Everyday Life, says:

When I suggest that psychotherapy is a myth I do not mean to deny the reality of the phenomena to which that term is applied. People do suffer from all sorts of aches and pains, fears and guilts, depressions and futilities; many such persons do consult, or are compelled to consult, experts called psychotherapists; and one or more of the participants in the resulting transaction may consider it helpful, useful, or "therapeutic." The coming together of these two parties and the results of their coming together are conventionally called psychotherapy. All that exists and is very much a part of our social reality.

As Szasz explains, the myth is not that a troubled person arrives at the office of another person, sits with that person, talks to that person, and is sometimes helped by their conversation. Rather, the myth is that a fancy, scientific, medical-seeming thing that goes by the name of "psychotherapy" and purports to be the "treatment of mental disorders" is happening. Indeed, one proof that what has transpired is "talk" and not the "treatment of a mental disorder" is how little interest psychiatrists take in it. If psychotherapy were one of only two treatment methods that you believed worked to treat something, and if you were qualified to practice that something, why wouldn't you practice it? The fact is, psychiatrists rarely do.

In Unhinged psychiatrist Daniel Carlat recounts his experience treating a patient and suddenly realizing that he had done nothing "doctor-like" with her except write a prescription. He hadn't examined her; he hadn't asked for any medical tests. This realization that he wasn't acting like a genuine doctor was immediately followed by a second realization: that he also hadn't engaged in anything like psychotherapy with her. He wondered why he hadn't:

Just as striking to me as the lack of typical doctorly activities in psychiatry is the dearth of psychotherapy. Most people are under the misconception that an appointment with a psychiatrist will involve counseling, probing questions, and digging into the psychological meanings of one's distress. But the psychiatrist as psychotherapist is an endangered species. In fact, according to the latest data from a group of researchers at Columbia University, only one out of every ten psychiatrists offers therapy to all their patients. Doing psychotherapy doesn't pay well enough. I can see three or four patients per hour if I focus on medications (such psychiatrists are called "psychopharmacologists"), but only one patient in that time period if I do therapy.

Carlat's is the usual reason given as to why few psychiatrists bother to talk with their patients, namely, that it is more profitable not to talk. But as real a reason is that the game they are playing doesn't require it. If in your bones you know that psychotherapy is as suspect a methodology as psychopharmacology — if, that is, you know that you are dealing with human unhappiness and not a mental disorder, then there is no good reason to waste time playing the talking game. Let all those people with their family therapist licenses and their love of talking talk! Let me play just one game — the quicker, more profitable one.

Countless studies have shown that "successful therapeutic outcomes" in therapy are related to the therapist's warmth — not the therapist's theoretical orientation, not her training, not her experience. This is exactly what we would expect. Clients most enjoy and most benefit from talking with someone they experience as a human being. They are talking about their human troubles and having a human interaction. If psychotherapy is the "talking cure," it is in exactly the same sense that chatting with a wise friend is a talking cure.

Prospective coaching clients sometimes ask me, "What will we be doing?" My answer is always the same: "We'll talk." That answer hardly satisfies them! They are looking for a professional-sounding pitch that justifies paying good money. I prefer not to provide them with that pitch. Often I'll relent a bit and explain what we'll be talking about. But first I want to make it very clear that essentially we are just talking.

That talking improves one's mood is not proof of the existence of a mental disorder called depression. It helps many people — perhaps most people — to talk about their problems, get advice, act on that advice, feel intimate with another person, and feel supported by another person. This is the help that psychotherapy at its best provides. Psychotherapy is sometimes effective because talking can help.

The Existential Ideal—And Its Reality

By Eric Maisel, PhD

Tens of millions of people are regularly unhappy. Maybe it's hundreds of millions. Maybe it's billions.

Why should that be surprising?

It makes no sense to suppose that a creature with consciousness could always feel happy. It is absurd and telling that as a society we think that unhappiness is an embarrassing, inappropriate emotion. It is so preposterous an idea that it should be laughed right out of the room. Yet somehow we have landed in this strange place where we are supposed to smile and smile, and if for a few weeks on end we can't make ourselves smile, then we have a mental disorder.

How can you be happy as you contemplate a billion people starving to death during a never-ending drought? Yes, you can find a way not to be conscious of that starvation—but then you aren't conscious of it. If you are conscious of it, should you also be feeling happy? Shouldn't that horror make you feel unhappy?

How can you be happy if you are one of those billion people?

How can you be happy as you watch your parents grow infirm, incontinent, and incoherent? Yes, you can avoid visiting them, caring for them, or thinking about them. But if you are visiting them, caring for them, and thinking about them, should you also be feeling happy? Shouldn't their predicament make you feel unhappy?

How can you be happy if you are one of those infirm parents?

How can you be happy if you've married someone you no longer love or even like? Shouldn't living a loveless life in the company of someone you don't want to know make you feel unhappy?

How can you be happy if you had a beautiful dream to make use of your brains and your spirit and you find yourself doing dumb, dispiriting work? Shouldn't living a life significantly short of the one you envisioned for yourself make you feel unhappy?

How can you be happy if you are obliged to spend 50, 60, or 70 percent of your waking hours doing work that does nothing but allow you to survive? Shouldn't being reduced to being a workhorse make you feel unhappy?

Sometimes we're unhappy with ourselves. We may be unhappy that we aren't doing enough, that what we're managing to accomplish doesn't rise to a sufficient level of excellence, that our behavior is out of control, that we've made decisions we now regret. This unhappiness may make you toss and turn at night as your mind races, which leads to chronic insomnia, which makes you more tired than usual—and more irritable and more unhappy too. Sometimes we get very unhappy with ourselves.

Sometimes we're unhappy with others. Maybe we're unhappy that our parents ignored or belittled us. Maybe we don't understand why some people are getting ahead and we aren't. Maybe we're unhappy with our mate for being colder and more unsupportive than we would wish him or her to be, unhappy with our boss for piling duties on our head, unhappy with that gallery owner for smirking when we showed him our paintings. This unhappiness may be on our minds so much that we have trouble concentrating on anything except our feelings of envy and betrayal. Sometimes we get very unhappy with others.

Sometimes we're unhappy with our circumstances. Maybe we feel trapped by the incessant need to pay this insurance premium and that car repair bill, trapped by a winter that lasts too long and a bank account too small to allow us to run off to somewhere sunny. Maybe we feel trapped by a life that sounds all right in the expressing but that feels dark, stressful, and ordinary in the living. Maybe feeling trapped this way makes us feel helpless, hopeless, sour, and irritable. Sometimes we get very unhappy with our circumstances.

Sometimes we're unhappy with life itself, with the idea that we come and go and do not really matter in the scheme of things. We're unhappy that there is no line of thought that ends anywhere except with a sense of the void. This anger at the hand you've been dealt, the hand that your species has been dealt—of consciousness of our own mortality and futility—can make us bored, listless, careless, short-tempered, and unhappy. Sometimes we get very unhappy with life itself.

I say none of this in a spirit of pessimism.

There is indeed a pessimistic tradition that argues that unhappiness is not just unavoidable but our species' dominant experience. In that tradition unhappiness is viewed as always nipping at our heels, threatening to overwhelm us with despair. One of the reasons that psychotherapists are so comfortable seeing depression everywhere is that the founding father of psychoanalysis, Sigmund Freud, was a major figure in the pessimist tradition. Freud argued that while our wishes can be beautifully fulfilled in fantasy, they can never be adequately fulfilled in reality. That discrepancy colors all of life. Given its profit motive and its theoretical orientation, no wonder the field of psychotherapy sees life as enveloped in darkness!

Joshua Dienstag, discussing this tradition in Pessimism: Philosophy, Ethic, Spirit, wrote: "From [the perspective of Freud and Schopenhauer], it is not really surprising that our experience is dominated by unhappiness. Our situation is out-of-joint with the universe to begin with. We cannot hope to set it right—we can only await the release from this predicament provided by death. In the meantime, we merely manage our condition—such management is, to Schopenhauer, the purpose of philosophy; for Freud, it is psychotherapy that serves this end. But the aim, in both cases, is not to create happiness or virtue but to minimize unhappiness."

To acknowledge the reality of unhappiness is not to assert the centrality of unhappiness. In fact, it is just the opposite. By taking the common human experience of unhappiness out of the shadows and acknowledging its existence, we begin to reduce its power. At first it is nothing but painful to say, "I am profoundly unhappy." The words cut to the quick. They seem to come with a life sentence and allow no room for anything sweet or hopeful. But the gloom can lift. It may lift of its own accord—or it may lift because you have a strong existential program in place whereby you pay more attention to your intentions than to your mood. I'll present such a program in a moment.

Let us be mature and truthful and accept the reality of unhappiness. It is not the coloration of life, but it is certainly one of life's colors. Moments of unhappiness happen. Days of unhappiness happen. Unhappiness can cloud a year or a decade. This does not make you "disordered," and it is nothing you should feel embarrassed about. Ah, but what to do? For the experience of unhappiness is not one you want to prolong or, if you can help it, repeat. The answer: Work your existential program. Let me present that program now.

The Existential Ideal

One way to deal with the inevitability of unhappiness is to lead a life based on existential ideals. You take as much control as possible of your thoughts, your attitudes, your moods, your behaviors, and your very orientation toward life and you turn your innate freedom into a virtue and a blessing.

That was a mouthful—and perhaps not really very plausible. Can people really take such control of life and master themselves that well?

It certainly doesn't seem so. The existential ideal has fallen pretty flat in the real world. Existentialism is an ambitious philosophy that demands that each human being try. It begs the individual to make use of the measure of freedom she possesses, to look life in the eye and deal with reality, and to stand tall as an advocate for human dignity. It argues that life, by pairing tremendous ordinariness with tremendous difficulty and by leading to nothing but death, is a cheat. And it argues that human beings can nevertheless cheat the cheater by adopting an indomitable attitude and making the meaning they require. This agenda sets the bar very high and doesn't seem to suit most people.

Existentialists such as Dostoyevsky, Nietzsche, Kafka, Sartre, and Camus themselves often failed at living with the bar set so high. They could beautifully articulate why the bar ought to be set there, at a place of personal responsibility and ethical action they called authentic living, but they found it inconveniently difficult to live that mindful, measured, and pure a life. They proved in the living that our foibles trump our resolutions much of the time. They proved it by womanizing. They proved it by gambling. They proved it by succumbing to addiction. They proved it by giving in to despair and taking to the sofa. They proved it by rejecting real work and choosing second-rate projects.

It was simply too hard to live as carefully, ethically, and authentically as the tenets of existentialism demanded. The tenets were lovely, albeit in an ice-water sort of way, but the reality was daunting. Therefore, existentialism never really caught on. For a while after the Second World War millions of young people read about it and nodded in agreement with its premises but drifted away from it because of its rigors. Jobs called; sex called; vision quests called; soccer on Saturday called; stock portfolios called. It was fine to read a little Nietzsche in college—but more sensible to put that behind you and get on with your commute.

Existentialism did not allow for an array of things that human beings actually wanted, such as permission to be petty and permission to waste vast amounts of time. It didn't con-done spiritual enthusiasms, silent acquiescence, or slogan-size commandments. It frowned on group allegiance and social frivolity. Existential philosophy acknowledged these desires perhaps more clearly than any other philosophy but then asked people not to indulge them—and people passed.

People passed for other reasons too. Not only did existentialism demand that they live an ethically vigilant life in which each action was the culmination of an internal moral debate, but they were also supposed to transcend personality and the facts of existence and escape the net in which every human being is tangled. This was not only a lot to ask; it was perhaps unfair and impossible. How were you supposed to not be the person you had developed into? How were you supposed to shrug off illness, war, disaster, and every manner of calamity and constraint? Was any of that really doable?

To take one example, people were supposed to transcend pride. But our smartest, most talented people have rarely been able to come close to such maturity. In their relationship with each other, Dostoyevsky and Tolstoy couldn't. Camus and Sartre couldn't. Freud and Jung couldn't. Picasso and Matisse couldn't. Scientists haven't, business people haven't, and parents attending Little League games or PTA meetings haven't. It turns out that egotistic, wounded pride isn't a snap to transcend. Wherever did we get the idea that it was?

Or take appetite. People with large, undeniable, and maybe unquenchable appetites—for sex, for peanuts, for experience, for seduction, for fast rides, for competition, for the rush of adrenaline—were supposed to put their appetites in their back pockets and approach life with the measured restraint of an ascetic. Authenticity required that you avoid gluttony, promiscuity, cruelty, and unnecessary danger. Who wanted to give any of those things up? Could they even be given up?

Or take human energy itself. In the existential vision human beings are in control of themselves. But what if you are flying along in a perfectly lovely manic way in pursuit of some dream and really don't want to stop and take a measured reckoning? What if you want to act impulsively—intuitively, if you like—and skip the stolid calm that would seriously slow you down? It seems as if a choice has to be made between snail-pace rationality and our very life force—and people choose pulsation over calculation.

To be fair, existentialists understood all this very well. Each danced the poignant dance of demanding much from human beings while doubting that the effort was possible or even plausible. They doubted and wondered. Why make such a Herculean effort at authenticity when personality hung like a lead weight around our necks and the facts of existence ruined so many of our plans? All that wondering and doubting led to those trademarks of existential thought: fear and trembling, nausea, existential anxiety, existential dread, and, of course, absurdity.

Given all this, the existential program that I'm about to present as the best way to deal with human unhappiness may appeal to you in the reading but may prove too difficult in the implementing—may prove even impossible. We are not as courageous or capable as existential thinkers claim we are or wish we were, nor can we do an even adequate job of transcending the pitfalls of personality, negotiating the facts of existence, and living maturely. So working this arduous existential program may prove out of reach.

Or maybe it won't. Maybe you'll find authentic living suitable and doable. Let's champion that hope! If you would like to try to live that strange, shining ideal—an authentic life—given all the hard and perhaps impossible demands it will make on you, what follows is a program for doing so. I think you'll recognize it as what you've been searching for and as the best answer to the problem of human unhappiness.

Your Existential Program

By Eric Maisel, PhD

To paraphrase an old joke, if you put two existentialists in a room you'll end up with three opinions. Even about the most fundamental questions, for instance about whether or not something called "spirit" or "god" exists, there will likely be no agreement. If it were possible to tease out the place where existentialists agree the most about fundamentals, it would probably sound like the following, from Maurice Friedman's The Worlds of Existentialism: "There is a crucial and inescapable distinction between authentic and inauthentic existence. Man's task in life is to authenticate his existence, and to the existentialist this can never mean the mere adherence to external moral codes, on the one hand, or the romantic's deification of passion and feeling, on the other, nor even on the vitalist's emphasis on the organic flow of life. Instead it means personal choice, decision, commitment, and ever again that act of valuing in the concrete situation that [which] verifies one's truth by making it real in one's own life."

The following existential program is designed to help you "verify your truth by making it real in your own life" and to support you in eliminating the unhappiness that comes from inauthentic living. Not all unhappiness will vanish if you follow this program; you're a human being, after all, and not immune to pain. But a lot of your unhappiness will.

This existential program emphasizes the existential, the cognitive, and the behavioral. Living authentically means organizing your life around your answers to three fundamental questions. The first is, "What matters to you?" The second is, "Are your thoughts aligned with what matters to you?" The third is, "Are your behaviors aligned with what matters to you?" The following are the elements of the program.

Elements of an Existential Program

You Look Life in the Eye

You begin by removing the protective blinders that human beings put in place to avoid noticing the many painful facts of existence, including painful facts about their personality shortfalls. This unblinkering brings life into stark relief, and after that first gasp, life as it is can finally be faced and accepted.

You Investigate Meaning

You decide to understand "what meaning means" so that you can proceed to lead your life in ways that feel meaningful to you. You single out meaning as the one thing you really need to understand, realizing that if you do not fathom it you will likely remain confused about and estranged from life.

You Decide to Matter

You recognize that the universe is not built to care about you. You must care about you. You must announce that you have decided to matter. You must announce that you are making the startling, eye-opening decision to take responsibility for your thoughts and your actions and to lead life instrumentally.

You Accept Your Obligation to Make Meaning

You finally let go of the demoralizing wish that meaning rain down on you from on high and accept that the only meaning that exists is the meaning that you make. You announce once and for all that you are the final arbiter of your life's meaning.

You Decide How to Matter

Once you accept your obligation to make meaning, your next task is to decide how to proceed. Is there some step-by-step meaning-making process available, or is it much more a speculative, seat-of-the-pants sort of thing? Or maybe it revolves around honoring a single principle—and if so, can you name it?

You Honor Your Wants, Needs, and Values

You take a smart view of the human predicament and recognize that while you want to honor the values you deem worthy, life presents you with other purposes and pleasures too, among them guilty ones. You wisely factor in satisfying your desires, boosting your ego, enduring drudgery—you factor in everything human as you plot your course.

You Create a Life-Purpose Vision

You aim your investigation in the direction of identifying and articulating your life purposes. You let go of the idea that life has "a" purpose and replace it with the idea that life comes with many purposes and that you get to decide which ones are yours. You create a life-purpose vision and remember it even when you are tired, bothered, distracted, upset, and otherwise not in your best frame of mind. When life resumes it habitual business, you still firmly hold your intentions and manifest them.

You Use Your Existential Intelligence

We are built to think about and to make meaning. One way to construe this innate ability is as "existential intelligence." However, it is one thing to possess existential intelligence and another thing to use it. You reduce your experience of unhappiness by employing your existential intelligence in the service of authenticity.

You Focus on Meaning Rather Than Mood

One decision that an existentially aware person makes is to focus on making meaning rather than on monitoring moods. If you pester yourself with the question, "How am I feeling?" you create unhappiness. If the question you pose yourself instead is, "Where should I invest meaning next?" you live more authentically.

You Snap Out of Trance

Forces within us propel us in the direction of personal trance, a self-protective state of haze and fog that we experience when we simply go through the motions. Moreover, societal forces manipulate us into buying whatever our culture is selling, whether it be designer shoes or patriotism, and push us into cultural trance. Both trance states must be resisted.

You Reckon with the Facts of Existence

The world is not built to accommodate you. Your favorite bakery may close, or war may break out—from the smallest to the largest, the facts of existence are exactly what they are. They include pain and pleasure, loyalty and betrayal, life and death. And they include your formed personality. All this you learn to navigate as best a human being can.

You Personalize a Vocabulary of Meaning

You support your efforts at authentic living by adopting words and phrases that allow you to communicate with yourself intelligibly. You use and champion phrases such as making meaning and investing meaning to firm up the commitment you've made to live in a clear-eyed, mindful, and intentional way.

You Incant Meaning

You marry the power of deep breathing with short phrases that support your intentions, and you create breath-and-thought bundles called "incantations" that calm and center you. These incantations—for example, "meaning is a wellspring" and "I interpret the universe"—become your affirmations in the realm of meaning.

You Maintain a Morning Meaning Practice

You start each day by creating an existential plan for that day by deciding where you intend to invest meaning and by identifying those parts of the day that you intend to hold as vacations from meaning. This practice, which takes just a few minutes (or even just a few seconds), orients you in the direction of daily meaning.

You Negotiate Each Day

A day is a dynamic affair made up of meaning-making efforts and vacations from meaning. You choose your meaning opportunities, you repair meaning when it gets torn, and you accept the tedious, unrewarding, difficult bits with practiced maturity. Each day is a project requiring existential engineering skills as you bridge your way from one meaningful experience to the next.

You Seize Meaning Opportunities

Certain human endeavors, among them love, creativity, service, self-actualization, and achievement, are regularly experienced as meaningful. By conceptualizing these activities and states of being as meaning opportunities, you remind yourself of just how much meaning is available to you.

You Handle Meaning Crises

You learn how to handle meaning crises, and when a meaning crisis strikes, you decide which of the several options available to you—getting a grip and making the best of it, initiating changes that alter and improve the situation, investing in new meaning opportunities, and so on—you'll employ to restore meaning.

You Engage in Existential Self-Care

Existential self-help consists of grounding yourself in a pair of realities: that life is exactly as it is and that you are obliged to keep your head up and make yourself proud. By accepting the realities of life and by asserting that you are the sole arbiter of the meaning in your life, you provide yourself with a sure footing as you actively make meaning.

You Engage in Cognitive Self-Care

We help ourselves make meaning and reduce our sadness by talking to ourselves in ways that support our intentions. We want our thoughts to provide us with hope, defuse our doubts, and settle our arguments with life. What we think is how we feel, and it is up to us to get a good grip on what we think.

You Engage in Behavioral Self-Care

You do not always have to do something "out in the world" in order to make meaning or to feel less sad. Sometimes the answer lies in simply adjusting your attitude or re-framing the situation. But often you are obliged to do real things. Knowing when and how to act is an essential part of your existential program.

Even if you decide to take antidepressants or engage in psychotherapy to get help with your unhappiness, you will still have to find ways of dealing with your meaning needs, the shadows of your personality, your consciousness of mortality, and the facts of existence. The existential program that I've just outlined can help.

©2012 Eric Maisel. All rights reserved.