What You Can Change . . . And What You Can't*: The Complete Guide to Successful Self-Improvement (6 page)

Humanistic psychologists are also bootstrappers. Abraham Maslow urged “self-actualization” as the highest form of human motivation, though it is only when more basic needs—like food, safety, love, and self-esteem—are slaked that we can achieve it. The ideas of will, responsibility, and freedom command center stage in existential and humanistic psychotherapy; patients can even have disorders of will, and therapy emphasizes widening the capacity to choose.

The advocates of Alcoholics Anonymous (AA) are also bootstrappers. In 1935, Dr. Robert H. Smith began AA, and since that time AA has assisted perhaps a million people in giving up alcohol, a problem that had once seemed quite hopeless. AA is not pure bootstrapping, however: One element in recovery is individual determination and will. This is coupled with a belief in assistance from a Higher Power and vigorous social support from the group. In fact, AA is a curious mix of the seemingly conflicting elements of self-improvement and acceding to a higher power, and I will look at its doctrines and its successes and failures more closely in the chapter on alcoholism.

In twentieth-century America, somewhere between the ministrations of the booters and the boosterism of the bootstrappers, the dogma of human implasticity died. The old dogma has been replaced by a new dogma, its opposite, which maintains that human beings can always change and improve—by the agency of others and by themselves. Like the dogma it has usurped, the new one makes sweeping claims.
All
aspects of human character, it says, can, with enough effort, or learning, or insight, yield and change for the better.

Is the dogma of human plasticity true?

The Maximal Self

Many widespread beliefs are true. Some, like the medieval belief that the moon is covered with a crystal sphere, are false: Some are self-fulfilling. The rest of this book is about whether the belief in limitless human plasticity is true. But before evaluating it, I want to emphasize that the belief that we can change ourselves differs from most other beliefs. It has, at the very least, one remarkable self-fulfilling aspect.

The society we live in exalts the self—the self that can change itself and can even change the way it thinks. Our economy increasingly thrives on individual whim. Our society grants power to the self that selves have never had before. We live in the age of personal control.

When the assembly line was created at the turn of this century, we could buy only white refrigerators. Painting every refrigerator the same color saved money. In the 1950s, the development of rudimentary machine intelligence created a bewildering range of choices. It became possible (and profitable, if there was a market for it) to, say, encrust every hundredth refrigerator with rhinestones.

Such a market was created by the glorification of individual choice. Now all jeans are no longer blue; they come in dozens of colors and hundreds of varieties. With the permutation of available options, you are offered a staggering number of different models of new cars. There are hundreds of kinds of aspirin and a thousand kinds of beer.

To create a market for all these products, advertising whipped up a great enthusiasm for personal control. The deciding, choosing, pleasure-preoccupied self became big business. (Now there is even a successful magazine called
Self.)
When the individual has a lot of money to spend, individualism becomes a profitable worldview.

Since World War II, America has become a rich country. Although tens of millions have been left out of the prosperity, Americans on the average now have more buying power than any other people in history. Our wealth is tied to the bewildering array of choices opened to us by the selfsame process that produced the rhinestone refrigerator. We have more food, more clothes, more education, more concerts, more books, and more marketed knowledge to choose from than any other people has ever had.

Who chooses? The self. The modern self is not the peasant of yore, with a fixed future yawning ahead. He (and now she, effectively doubling the market—and add in kids) is a frantic trading floor of options, decisions, and preferences. The result is a kind of self never before seen on the planet—the Maximal Self.

The self has a history. We have seen that until the Renaissance the self was minimal; in a Fra Angelico painting everyone but Jesus looks just like everyone else. With Pico and Bacon the self expanded, and in the works of El Greco and Rembrandt the bystanders no longer look like interchangeable members of a chorus. By Andrew Jackson’s time the self, wielding political power, possessing free will, and capable of divine perfectibility, had become elaborate.

Our wealth and our technology have now culminated in a self that, to a degree never experienced before, chooses, feels pleasure and pain, dictates action, optimizes, and even has rarefied attributes—like esteem and efficacy and confidence and control and knowledge. I call this new self, with its absorbing concern for its gratifications and losses, the Maximal Self, to distinguish it from what it has replaced, the Minimal Self, the self of the Bible and of Luther. The Minimal Self did little more than just behave; it was certainly less preoccupied with how it felt. It was more concerned with duty.

Advocating self-improvement would have made no sense before the rise of the Maximal Self. A society that views tornadoes as God’s will does not build tornado shelters. Even if it does, people will not go into them or even listen to the radio for tornado warnings. A society that views drinking as stemming from a bad and immutable character will not try to get alcoholics to refrain from drinking. A society that views depression as stemming from bad genes or unfortunate brain chemistry will not attempt to have depressives change what they think when they encounter failure. Notions of therapy, rehabilitation, and self-improvement do not arise in a society of Minimal Selves, which would not be much interested in psychology in the first place. Believing the dogma of human implasticity, the Minimal Self does not act to change itself.

But when a society exalts the self, as ours does, the self, its thoughts, and their consequences become objects of careful science, of therapy and of improvement. This improving self is not a chimera. Self-improvement and therapy often work well, and it is a belief in human plasticity that underlies these strategies. The Maximal Self believes that it can change and improve, and this very belief allows change and improvement. The dogma of human plasticity tends to fulfill itself.

3

Drugs, Germs, and Genes:
The Age of Biological
Psychiatry

F
OR ALL THEIR CURRENCY
, self-improvement and psychotherapy are viewed by many with skepticism and even disdain, for this is also the age of biological psychiatry, with its biomedical vision of emotion, personality, and mental illness. It has three basic principles:

• Mental illness is really physical illness.
  

• Emotion and mood are determined by brain chemistry.
  

• Personality is determined by genes.
  

All three run counter to the idea that we can change ourselves—with or without a therapist. Biological psychiatry has a radically different vision of change:

• Curing the underlying physical illness cures mental illness.
  

• Drugs cure negative emotions and moods.
  

• Our personality is fixed.
  

This is the extreme position. There are many compromise positions that refer to the “interaction” of biology and environment, genetic “contribution,” “preparedness,” and genetic “predispositions.” Some of these compromises are just anesthetics, numbing us into thinking that the fundamental dispute between nature and nurture has somehow been solved or is a pseudoquestion. Much of this book is about reasonable in-between positions, but this chapter is not. It lays out the extreme position, and the extreme position is neither frivolous nor is it a straw man. It represents the bedrock beliefs of a very large part of the biomedical world. This view emerges from three momentous discoveries.

The Italian Pox, the French Pox, the English Pox

The worst epidemic of madness in recorded history began a few years after Columbus discovered the New World and continued with mounting ferocity until the beginning of our century. It afflicted the mighty—from Henry VIII to Randolph Churchill, Winston’s brilliant, erratic father—along with the ordinary. First there was a weakness in the arms and legs, then eccentricity, then downright delusions of grandeur, then global paralysis, stupor, and death. The malady took its name from its final, paralytic symptom: general paresis.

By 1884, the asylums of Europe burst with men in the final stages of this disease, shrieking obscenities. Controversy swirled over its cause. Established opinion, led by the dean of German psychiatry, Wilhelm Griesinger, held that paresis comes from loose living, especially from inhaling bad cigars. A minority—empirical scientists rather than armchair psychiatrists, among them the young Richard von Krafft-Ebing—held that it comes from syphilis.

Griesinger would have none of this. How could it come from syphilis? Many paretics had had no sexual contact for years. Almost all heatedly denied ever having had syphilis. A few others may have had syphilis, but twenty or thirty years before—a sore on their penises for a week and then the sore disappeared. How could paresis possibly come from syphilis?

Scientists then could not just look into the brain of one of these dead paretics and see if the syphilitic germ was present. In this era, microscopes were still primitive and tissue stains even worse. When you looked into the brain, what you saw was grayish-white mush. Moreover, the syphilitic organism was unknown—it was just a hypothetical germ; no one had ever seen it. The evidence was mounting, however, that paresis was a disorder of the brain: The pupils of paretics’ eyes didn’t contract when light was flashed on them, and the autopsied brains of dead paretics were shrunken.

It was not only Griesinger who denied that this mental illness is a disease of the body. Unlike today, when we argue that madness is either mental or physical, nineteenth-century common sense held otherwise. Madness was a
moral
defect, the outward manifestation of a bad character. Strange as this sounds to our ears, this belief was an advance over the common sense of earlier centuries, which had held that madness was possession by the Devil.

Krafft-Ebing changed all this. In one of the most daring experiments in psychiatric history, he showed that general paresis is caused by syphilis. He showed this without once looking at the brain, and he showed this thirty years before anyone was to glimpse
Treponema pallidum
, the syphilitic spirochete, through a microscope. He knew, as did all streetwise males, that syphilis, like measles or mumps, was a disease you could not catch twice. If you got a sore on your penis once after intercourse with an infected woman, you would be uncomfortable for a few weeks: Urination stung; you might run a fever. After that you seemed to be safe and could then enjoy unlimited pleasure with even the most notorious whores, and never get another sore.

Krafft-Ebing experimented on nine of his patients, all middle-aged men with delusions of grandeur, all of whom vehemently denied ever having had the shameful “French pox” (the Germans called it the French pox; the French called it the Italian pox; the Italians called it the English pox). He scraped material from the penile sores of men who had just contracted syphilis (no armchair science, this) and injected it into these nine paretics.

Not one of the nine developed a sore. The controversy was settled by one monumental experiment. All nine of these men must already have had syphilis, and the syphilitic germ must therefore cause, by some very slow process, general paresis.

Supporting evidence soon cascaded in.
Treponema pallidum
was discovered, and was found in the brains of paretics. A simple blood test was developed to detect syphilis, and “606,” so named because six hundred and five prior concoctions had failed, was created—it killed
Treponema
and thus prevented paresis.

So successful was Krafft-Ebing’s work that the most common mental illness of the nineteenth century was eradicated within a generation. (When we look for paretics in Philadelphia—where I teach at the University of Pennsylvania—to instruct present-day medical students, it is very hard to find one.) But Krafft-Ebing, this scientist of courage and genius, accomplished more than just discovering the cause of paresis. With this discovery, he convinced the medical world of something much more global:
Mental illness is just an illness of the body
. This became the first principle, the rallying cry, and the agenda for the new field of biological psychiatry. A century of research on schizophrenia, depression, Alzheimer’s, and many other problems hypothesized as stemming from some underlying brain disorder followed. Schizophrenia is now seen as caused by too much of a neurotransmitter in the brain; depression by too little of another neurotransmitter; Alzheimer’s by the deterioration of certain nerve centers; overweight by the underactivity of another center (the verdict is in on none of this).

It follows for all mental illness that real change is possible only after eliminating the physical illness. Kill the spirochetes, for example, and the mental deterioration ends. Raise the neurotransmitter level and cure depression; lower the level and cure schizophrenia. Lobotomize—cut out the appropriate brain centers—and cure the anxiety disorders. Reset the appetite center with a drug and cure overweight. Psychotherapy for a biological illness, from this point of view, is sentimental nonsense. At best, it might be cosmetic: A therapist might help a paretic adjust to his worsening mental and physical state; a therapist might urge a schizophrenic not to forget to take his pills and not to tell his boss about his delusions.

Drugs and Emotion