Cognitive Behavioral Therapy or: How I Learned to Stop Worrying About This and Start Worrying About That

In an interview by Lisa Raskin in the most recent edition of Amherst magazine, David Kessler ’73 hypothesizes a common psychological mechanism for addiction, anxiety, depression, obsessive thoughts and violent anger. He describes the affected individual as “captured” by a behavioral feedback loop, in which a harmful behavior rewires one’s neural circuitry to all but guarantee that behavior’s continuation.

The illuminating aspect of Kessler’s work is his connection between addiction and other mental illnesses such as depression or obsessive behaviors. As someone who has struggled/struggles with depression, I can tell you that there are concrete things one can do to make oneself feel better. Regular exercise, healthy eating, emotional openness and social interaction, abstinence from addictive chemicals, to name a few. I can also tell you that one of the main symptoms of depression is that it’s almost fucking impossible to stick to those habits. This is the essence of the feedback loop mechanism Kessler proposes. Just as nicotine rewires one’s neural circuitry to create a perception of need that did not exist before, and suppress judgments that might lead to abstinence; depressed thoughts rewire one’s neural circuitry to preclude alternate ways of interpreting or interacting with the world. We are in a sense addicted to our negative outlook.

Such behaviors of course lie across a broad spectrum. Every choice we make, every stimulus, recursively shapes us and all of our future decisions. But some behaviors have more power than others to diminish our agency. Chocolate and nicotine are both habit forming, but by no means equally so. What strikes me as just as insidious as the chemicals themselves, however, is the infinite cascade of associations that tag along with addictive behavior. Besides the chemical relief a smoker gets from a cigarette, there’s a definite comfort in the ritual of it: the break from work to stand out on the street and people-watch, the visibly impressed look on other smokers’ faces when they watch you roll your own, exchanging pleasantries with the lady behind the counter of the gas station, et cetera. Not to mention the things you wouldn’t think of even if you were asked, and can hardly remember anyway, but would hold onto forever if you could: riding around in the back seat of dad’s jalopy, eyes squinted against the midday sun, smelling smoke despite the cool breeze through the open windows. I would become a smoker myself if it meant I got to hold onto memories of who my dad was back then. How could I possibly separate my nostalgia from the chemical effects secondhand nicotine had on me? The two are inextricable.

Despite the persistent disadvantages of class status and genetic predisposition, at least we all know we shouldn’t start smoking in the first place. Even by the time I was big enough to have my first secondhand cigarette, America had begun to erect a cultural bulwark against the evils of tobacco, thanks in part, I’m sure, to Mr. Kessler. Perhaps you could argue a negative side of that stigma, but it’s clear that fewer people smoke today than thirty years ago. What makes depression and other obsessive behaviors so difficult to tackle is that they often come on gradually and are easily concealed. By the time I first experienced debilitating physical pain because of anxiety and depression, I was pretty well up Shit Creek as far as harmful patterns of thought and behavior are concerned. To right the ship takes reaching way back… as far as you can remember and farther.

In the advanced stages of addiction and depression, the disease pervades every aspect of one’s being. It is impossible for the sufferer to be an impartial judge as to which thoughts and behaviors arise from/perpetuate the destructive cycle. That’s why it seems like relief is only possible after some sort of unquestionably horrible bottom, some floor of desperation that rises up to meet you, when your most lizard-brain instinct of self-preservation finally kicks in. Only when you can embrace change wholesale. When you Give Up and Come In. But even after the catharsis of acting on your desperation, you must continually face who you are. Who you still are runs unimaginably deeper than your recent realization of how fucked you are.

Confronting my depression reminds me of when I first went away to boarding school and I finally got consistent health coverage. My dad reminded me that I could probably get free surgery to correct the scar on my upper lip that I got from a corrective surgery as a baby. I considered it, but how could I decide to change my face, even for a deformity, if that deformity is so deeply a part of who I am? Perhaps I would be happier with myself if my lip looked more like other peoples’ lips. Perhaps I’d be happier still if while I was under they went and made my jawline look more like Douglass Booth’s… maybe made my dick a little bigger too. How do I decide in which ways I should try to change myself, and which things I must accept that changing could never satisfy me or make me better off? By that same token, how much of myself – my dry humor, my political conviction, my perceptiveness (at least of social dynamics of which I am not a party) – must I sacrifice in order to survive and prosper?


It’s really interesting to me that one of Mr. Kessler’s prime examples of depression is David Foster Wallace. Honestly I’d believe you if you told me he stole the whole idea from DFW’s work, which itself draws parallels between obsessive behavior, depression, and chemical addiction. But another aspect of DFW’s work that I think is equally important is idea that certain (novel) elements of mass culture either inadvertently lead us to the unchecked indulgence of our most base desires and destructive tendencies, or worse, are deliberately designed to do so. Take for example the bit about the TP videophone in Infinite Jest, in which callers become so obsessed with their self-presentation that they invest heavily – first in dental whitening and cosmetics, and then flattering facial masks and false backgrounds, and finally entire tableaux of idealized home environments.

You don’t need to think long to come up with real-world examples of how we are held hostage by pervasive technology, against our desire to more carefully curate or limit which parts of ourselves we bare to the world. To say “held hostage” is hardly hyperbole. Even to opt out of certain modes of self-expression or consumption, such as social media, is a declaration of values with pointed social implications. In some circles this is a fashionable iconoclasm, if not a calculated budgeting of one’s time and energy.

One related aspect of contemporary mass culture that neither DFW nor Kessler address (as) directly is consumption of goods. I’ve been told DFW talks about consumerism in some interviews that are available on youtube, and given his writing about televisual entertainment in the novel Infinite Jest and in the essay E Unibus Pluram, I’m sure he has made any connections I am about to. I’m glad he didn’t address it more directly in Infinite Jest. Fuck. Eleven hundred pages is long enough. But considering Kessler’s work hinges on extending an existing paradigm on addiction to include several related behaviors, I think this is a useful exercise.

Having grown up poor (although to be fair to my hardworking parents and my good luck, never wanting for food or shelter), I became accustomed at an early age to longing for things without ever experiencing how not-that-great it is to actually have them. Gameboy color, N64, Eminem CDs, Pokemon cards, you name it. I’ve spent countless hours dreaming I could have them and sometimes even obsessively scheming as to how to get them. Of course I longed not for the items themselves but for a feeling I supposed would come with them.

Pokemon Cards? Right from the get go I thought those things were fucking stupid, yet somehow over time I came to want them because my friends had them. This is my first memory of a second-order desire giving way to first-order desire, and it stands out to me all these years later because of how gradual and begrudging a transformation it was. But who’s to say that other desires I had perceived as first-order, direct desires for a particular item were not actually thinly-veiled desires to feel connected to other people? I find it highly likely that in other instances my social and personal-emotional motivations were simply subsumed by more readily rationalized inputs.

So I never got any Pokemon cards or a gaming system. Only once Napster came along did I get my Eminem tracks. Big freaking whoop, is how I think of it now. But the problem is not in getting or not getting the things I wanted. For someone with an addictive/depressed personality like me, the problem lies in becoming so attached to the ritual of desire – becoming enamored with an idealized and impossible notion of what the fulfillment of my desires will feel like. Just like opiates or alcohol, consumer goods and the marketing thereof imply a promise that neither they, nor anything else, could possibly keep. A feeling a transcendent inclusion and warmth. It’s a momentary release that quickly gives way to a downward spiral of all-consuming desire and pain. It’s a giant, cosmically fucked up bait-and-switch. (For all those reading this who care about me, you should know I don’t do opiates or anything like that, they are just a major subject matter of Infinite Jest, and a constant battle amongst people I know and care about deeply).

But just as I admit difficulty in separating the aspects of my thinking that define me, make me the person I want to keep around for a while, and the aspects I have thought at times might kill me; it’s difficult to separate the toxic aspects of consumerism from the material benefits our culture has produced. Take for example my old iPod nano, before I accidentally put it through the wash junior year in high school. That was my main means of listening to music and This American Life back then. It would not be an exaggeration to say music and This American Life podcasts are what made getting through high school possible for me. So in that sense, the iPod made my life better.

If you were around for the second-gen iPod nano, you might remember that the cheapest 2GB one was always silver, the 4GB one had a few color options, and the 8GB one was only available in black. You could always tell exactly how much money someone had spent by looking at it for second. These weren’t merely aesthetic choices by Apple, they were part of a carefully-crafted strategy to engender a symbol economic power and societal worth, a desire and its fulfillment, in a purchasable item. This ability to engineer such a powerful cultural icon is really quite remarkable, but everybody should be as afraid of it as they are of the needle.

Over time a cynical attitude toward these modes consumption, ones that are clearly designed to communicate membership in a group, has become as American as Miley Cyrus doing the Twerk. Was it the first guy I saw walking around in a $900 Canada Goose jacket that I thought looked like a total dick, or was it the 1,001st? Yet consumption-as-self-expression has grown, only the fashionable statements have changed. Fashionable Millennials value “authentic” experiences more than material possessions. Travel, adventure sports, gourmet food. Just as it has always been, the most successful products of our day are the accoutrements of a fashionable lifestyle, and the instruments with which we can broadcast our participation in that lifestyle to the world. Gopro. Mountain bikes. Red Bull. Skis. Fancy SLRs or mirrorless cameras.

Heroin, as toxic as it is, was contrived to alleviate pain. Ironically it was developed in an effort to mitigate the addictive properties of morphine. But for how much suffering those and other chemicals have caused, they were not designed to do so. It was an unintended consequence of nature – one that has since been exploited by man for a profit. Contrived systems of exploitation have been around since the dawn of man, perhaps longer. What makes our current day (perhaps what was at the time IJ’s near-future?) culture of consumerism so scary is that the science of pushing peoples’ evolutionary buttons for profit is so damn refined that we are often defenseless whether we notice it or not. Consumer goods and the marketing thereof are literally engineered to rob you of your agency.

I think part of what is so troubling about confronting the problems of consumer culture is that it seems so antithetical to our ideals of individual agency and rational self-government. One aspect of the rage in certain political circles against “socialism” is the assumption that a centralization of power or resources in the hands of government will necessarily undermine the interests of common people. But how much better is it if a number of corporations or other institutions have enough influence over culture, over our minds, to all but force people to act against their own self-interest? Consumer marketing is one example of an effort to do exactly that. Moreover, and DFW’s major insight with respect to addiction and consumption, is that we seem to have reached some sort of turning point as a society, past which we actually prefer it to be this way – to remain susceptible to having our wills subverted, to relinquishing agency – as long as the methods evolve quickly enough to keep us reliably entertained. As long as we can hop to the leading edge of each successive bell curve of fashionability.


But how could this happen, and how could we possibly rise up from our compromised state to fix it? The pros and cons of consumerism are highly debatable. To look at the other side of the metaphor, however, drug addiction, it is clear our society is amidst a crisis. A crisis of culture, if you accept that one exists, elicits some of the same hard questions that a drug epidemic does. What makes us susceptible? Who or what deserves the blame? How do we correct the problem and prevent it in the future?

I think it’s pretty clear to everyone at this point that you can’t effectively fight an drug epidemic by trying to cut off the supply of drugs. It also seems clearer every day that criminalizing users doesn’t help much either. Yet the war, and the stigma, persist.

It’s easy to look at those people that still think a Reaganesque war on drugs is worth the cost, and those that would shun or lock up users, and see them only as retrograde. To say they lack a nuanced understanding of the issue. But should we really expect everyone to have a nuanced understanding of every dilemma we face as a society? That would of course be impossible. No matter how smart or well-informed we are, we will always be forced to make tradeoffs as individuals as to our level of engagement with a particular issue. When we don’t have all the facts, we make decisions or form opinions based on culturally-endowed biases. But here’s the thing: we never really have all the facts. Even our most rational judgments are on some level exactly that: judgments.

Stigmas are just one way culture has evolved to inform individual decision-making. And despite the fact they carry very unfashionable connotations – retrograde conservatism, victim-blaming – they have at times served a useful purpose. Ironically, the thing that makes them a useful tool in the first place is also what can make them so harmful: they adapt much more slowly than real-world circumstances.

America has been confronted by a widening rift between the politics of the “elite” and “non-elite”. If we accept these opposing identities as largely falling along lines of education and economic power, it’s easy to see why an individual would arrive at a particular way of thinking depending on which side of that class divide they fall. This is to say stigma-embracing versus stigma-rejecting. If you belong to a capital-scarce social group (and I mean capital in all senses of the word) whose most pressing material interest is in preventing certain behaviors within the group, then a stigma or moralistic judgment is an attractive tool. If however you belong to capital-rich social group, not only are you more likely to take a macro-scale approach to a threat, you are also more likely to perceive and be able to articulate the pitfalls of moralism.

Of course individuals need to be held accountable for their actions. But it’s easy to forget that the purpose of individual responsibility, the utility of free will in a deterministic world, is to shape the future, not merely to interpret the past. So the idea of moral decay is mostly useless bullshit. To borrow an analogy from my brother Sam; it’s not like we have an obesity problem because people got worse at restraining themselves. We are just exposed to a lot more shitty food. By that same token, we have not as a society come to prefer giving ourselves away – to chemicals, entertainment, the false promises of consumption – because we decided to. We simply live in a time in which the institutions that bid to capture us have more power than ever to engineer objects of desire and shape the conditions that make complete capture possible.

I think it would be naive to think we could ever shed the dynamics of power and exploitation that drive our capitalist society. It’s unclear to me that we should if we could. What I think is important to realize is that the “invisible hand” we worship is merely a sum of parts. In any dynamic of exploitation, the equilibrium position is that the exploiting party will extract as much and as often as possible before the exploited party opts out. Before they Hit Bottom and Come In. Before they rebel against terrible master. Before they decide that what they really want is freedom from want. It’s up to us – every one of us – to decide where that equilibrium position will lie. To relinquish that choice to the invisible hand is to give ourselves to the grave.

 

So what I’m saying is we need strong labor unions and free healthcare and better public schools.

 

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