Well,
my talk is on depression and anxiety.
Sometimes,
some of us fall into black holes of self-doubt, anxiety, inferiority,
feeling like we're not good enough,
beating up on ourselves.
How many of you sometimes feel that way?
Put your hands up if you've ever struggled with depression or anxiety or self-doubt.
It's one of the worst forms of human suffering.
I've had patients who told me
that they pray to God at night that they could develop cancer
so they could die in dignity, without committing suicide.
How many of you have ever felt, maybe, that your life was not worth living
or have known a friend or a loved one or a colleague who made a suicide attempt?
Put your hands up if that's ever touched you.
It's one of the most horrible, horrible things.
I started out at University of Pennsylvania Medical School.
I finished my residency, and I did a research fellowship on depression,
and I was always curious:
What makes us depressed?
Why do we fall into these black holes?
What's the cause of it?
What can we do to turn these moods around?
And I started out like many young psychiatrists -
it's what you call a biological psychiatrist.
I was doing research on brain chemistry,
this idea that depression and anxiety
are due to some kind of chemical imbalance in the brain.
I was treating patients
with antidepressants and other medications,
but there were only two problems from my point of view.
The first is our own research we did;
it didn't seem to confirm that depression or anxiety
were actually due to a chemical imbalance in the brain.
In fact, our research indicated
that this probably is not the cause of depression and anxiety.
In addition,
I was giving out antidepressants by the bucketful to patients.
I had hundreds of patients,
and while a few of them were being helped,
most of them were not.
They were going on week after week, saying, "I want to die. I feel worthless."
And I said, "Gosh, there's got to be a better way."
If the pills had worked, I would have been perfectly happy.
And I thought, "Maybe there's some type of psychotherapy
I could combine with the medications,"
because I wanted people to be able to wake up
and say, "It's great to be alive."
and have joy and full of love: "I'm full of life,"
and I was rarely seeing that.
I tried different kinds of psychotherapy; they didn't seem to work.
And then a colleague said, "You know, there's something new
fellow here at Penn is developing - Aaron Beck -
and he calls it 'cognitive therapy,' and it's kind of simple in its theory,
and maybe you could try this out with some of your patients."
A cognition is a thought; it's just a fancy word for a thought,
and there's three basic ideas behind cognitive therapy.
The first is that our thoughts create all of our moods,
and that when you are depressed and anxious,
you're giving yourself negative messages,
you're blaming yourself,
you're telling yourself something terrible is going to happen.
Now, this idea is not new;
it goes back to the Greek philosopher Epictetus.
Nearly 2,000 years ago, he said, "People are disturbed not by things" -
in other words, not by the events of our life,
but by the views we take of them,
that we create all of our emotions, positive and negative,
at every moment of every day
through our interpretations of what's going on.
And it goes back even before Epictetus
to the Buddha, who was saying the same thing 2,500 years ago.
Well, the second idea is that when you're depressed and anxious,
those negative thoughts -
"I am no good," I'm a loser," "What's wrong with me?"
"I shouldn't have screwed up," "I should be better than I am" -
those thoughts are not realistic thoughts;
they're distorted,
that depression and anxiety are the world's oldest cons,
and that there's ten distortions that you always see
in the negative thoughts of individuals who are depressed and anxious.
Like all or nothing thinking:
"If I'm not a great success today, I'll be a total failure."
Shades of gray don't exist.
Or overgeneralization -
seeing a negative event as a never-ending pattern of defeat.
Or "should" statements or self-blame.
And the third idea
was that you could train people to change the way they think
and then suddenly change the way they feel.
Well, I heard that theory, and I said, "That sounds like so much bullshit."
(Laughter)
I know my patients have negative thoughts.
That's certainly the case.
But you can't help serious suicidal depression
with some kind of power of positive thinking.
And I told a colleague this.
He says, "Well, David, why don't you go to Beck's weekly seminar,
and as part of your research, try this with a few of your toughest patients,
and then you can prove to yourself that it doesn't work."
And I thought, "That's a great idea. I think I'll check it out."
Well, the first patient I tried it out on was a woman
referred from the intensive care unit of the university hospital.
She had made a nearly successful suicide attempt,
an elderly Latvian immigrant,
and they referred her to me for follow-up.
And I said, "Martha, there's this new form of therapy.
I'm doing some investigating.
Would it be okay if I present your case at this weekly seminar,
and then I can tell you what they say,
and maybe we can find some new techniques?"
She was fine with that; she gave me permission.
So I presented her case to Dr. Beck and said,
"How would you use this cognitive therapy with someone who's suicidal?"
And he said, "Well, our thoughts create all of our emotions,
so just ask her,
'What were you telling yourself the moment you tried to commit suicide?'"
So I went back to her, and she said, "What did you find out in the seminar?"
I said, "Well, I'm supposed to ask you
what you were telling yourself the moment you attempted suicide.
What were your negative thoughts?"
And she said, "Oh, I was telling myself that I'm a worthless human being
because I've never accomplished anything meaningful or significant in my life."
And she said,
"Now what am I supposed to do about that?"
And I said, "I'm not sure. You have to wait a week,"
(Laughter)
"[I'll] go back and ask at the seminar."
So I went back and said,
"Here's what I found out. What should I do?"
And Dr. Beck said, "Well, one technique we use is called 'examine the evidence.'
See if what you're telling yourself is true or not.
Ask her to make a list of several thing she has accomplished."
I thought, "That makes sense."
So I went back; she said, "What did you find out at the seminar?"
I said, "You're supposed to make a list of several things you have accomplished."
She said, "Well, that's just the problem. I can't think of anything."
And I don't know, maybe some of you folks felt that way some times
and look back on your life and say,
"What have I done that was really meaningful,
that was really significant?
What did my life really amount to?"
So I said, "Well, why don't you take it as a homework assignment?
Maybe you can think of something."
Well, the next week, I forgot I gave her the homework assignment;
I did my usual non-specific schmoozing and "How are you feeling?"
and "Do you need a refill on the antidepressant?"
and this type of thing,
and halfway through the session,
she said, "Well, aren't you going to ask me about my homework?"
I said, "Ah, I forgot. Did you come up with anything?"
And she handed me a list of about, oh, seven or eight things
that she had accomplished during her life,
and the first one, she said, "I overlooked the fact that -
I smuggled my children out of Nazi Germany.
My husband died in the concentration camps.
All of our relatives died in the concentration camps,
but I got the children out, and we made it to America.
And I've worked, scrubbing floors and cleaning people's houses,
to keep food on the table and to keep the roof over our head.
And this week,
my son just graduated first in his class from the Harvard Business School.
So I thought, 'Well, maybe that's an accomplishment.'"
(Laughter)
And then she said, "And I forgot that I speak five languages fluently,
and I'm a gourmet chef."
And she had all these amazing things.
And I said, "Martha, how do you reconcile this
with your claim that you're a worthless human being
who's never accomplished anything meaningful?"
And she said, "Dr. Burns, it doesn't compute.
It doesn't make any sense.
I don't know how I could have been thinking that."
And I said, "How are you feeling now?"
She said, "I'm feeling a lot better."
She said, "Do you have any more techniques?"
I said, "No, that's the only one I've learned so far.
You'll have to wait till next week. I'll learn another technique."
And so that's how it began to go,
and I began to see patient after patient that I'd been stuck with,
some patients who'd said they'd been depressed,
had failed therapy for more than 50 years,
some who said they've never had one moment of happiness in their entire life
suddenly experience joy and self-esteem.
And I said, "This is the thing I want to commit my life to."
I had just received a grant from the government - a five-year grant -
to develop a brain-chemistry research laboratory at the medical school.
And I sent the money back.
I said, "I don't want to spend my life
doing research on a theory that's not going bear fruit.
This is what I want to do."
And then the research began to come in.
First a pilot study at Penn that showed that this new form of therapy
was as effective, if not more effective, than the best antidepressant drugs.
And then study after study has come in,
and now it's become the most researched form of psychotherapy in history.
We all got excited, and Dr. Beck said,
"David, would you like to co-author the manual
that we're writing for therapists
so people can learn how to do this new form of therapy?"
And I said, "You know, you've got enough people -
Brian Shaw, Gary Emery and others -
who can co-author that book for you.
I think my calling is to write the manual for the patients and the general public
to show people, give them tools,
to begin to use these tools in their own lives,
and maybe patients could read the book between the sessions
to accelerate their recovery."
So then I wrote the book "Feeling Good."
Other research came along:
a fellow at University of Alabama began to do some research
on what is the fastest and most inexpensive way
to treat people with depression.
And he did some research I was unaware of.
He took people coming to the University of Alabama
asking for therapy for severe depression
and said, "You've got to be on a waiting list for four weeks
before you can see the psychiatrist,
but in the meanwhile, we want you to read this book, 'Feeling Good'."
And then he did research on them every week to see,
Would there be any change in mood?
And he reported that 69% of the patients
in four weeks were recovered and needed no additional therapy.
He's repeated - he's done at least eight outcomes studies
with older citizens and teenagers, people all ages in between
and has continued to come to the same conclusion.
And I kind of knew that was true
because I've gotten at least, probably 50,000 emails and fan letters from people
who said, "I read your book, and it changed my life."
Now, in my group at Stanford, my psychotherapy development group,
it's getting even better,
and we're developing even newer and more powerful techniques.
I think there's a difference between a technician and a healer,
and one of the differences is,
Can you use your tools in your own life?
Can you practice what you preach?
I kind of believe in the idea of "Physician, heal thyself."
And certainly I've known my own moments of anxiety,
like when I was invited to come to speak here,
and despair as well.
And I was put sorely to the test when our son was born.
I was there at his birth, and after he was born, the doctor said,
"You've got a wonderful, healthy son here,
but the only problem is he can't breathe."
And I looked at him, and he was bright blue.
His lips were blue and his fingernails were blue,
and he was struggling to get air.
And he said, "We're going to put him in the intensive care unit."
And I thought, "Oh my gosh. This is horrible."
He was born, I think, at around 10 at night,
and I went home, and I was feeling anxious and depressed and terrified.
And I told myself, "Well, remember it's not the events,
it's your thoughts that upset you."
And I said, "Oh no, that can't be true.
This is real."
I said, "That's what your patients say.
Why don't you write your thoughts down
and see if there's some distortions in them."
And so I thought, "Okay, I will."
And the first thought is,
"Well, my son needs oxygen for his brain, and he's going to have brain damage."
And then the second thought:
"We'll be bringing him to clinics for the rest of his life."
Then I did a little thing called the downward arrow:
If it were true, what would it mean to you?
And the third thought:
"Well, then people will look down on me because I have a mentally retarded son."
Then I said, "Are there any distortions here?"
I said, "Well, gosh, here's fortune-telling.
I don't know that he's going to have brain damage.
Doctor never said that, he just said, 'We'll put him the intensive care unit.'
And then,
are people going to look down on me because I have a son with brain damage?"
I said, "That's ridiculous.
People will feel about me depending on how I treat them.
And if I love them and treat people with care and compassion,
they will respond."
And suddenly all my anxiety disappeared.
And then I said, "You know, look at how self-centered you're being.
Your son needs you; he's suffering in the hospital,
And I said, "I'm going to go and see him."
I was on the faculty, so I said, "I can get into the intensive care unit."
I went in there about three in the morning,
and I said, "Can I see my son?"
They said, "Yes, certainly, Doctor."
And then he was in this incubator, and he was going [Raspy breathing],
and just his whole body was shaking to get a breath,
and he was still blue,
and it was so sad, and I said, "Can I touch him?"
They said, "You have to put this glove on
and put your hand through this hole in the incubator,
and so I put my hand in, and I put my hand on his forehead,
and I said, "Erik, I want you to know that we love you.
Your mommy and daddy love you,
and we're going to be with you every step of the way."
And I felt better, and I went home and felt at peace,
and the phone rang.
It was the intensive care unit nurse,
and she says, "You know, Dr. Burns, the oddest thing happened.
The moment you walked out of the intensive care unit,
Erik calmed down and started breathing, and the doctor discharged him.
He's cuddling with his mommy for the first time."
Well, that's about it.
Erik suggested I tell this story; I've never told it in public before.
I said, "I'll tell it if you'll come on up to Reno with me
so I can introduce you to the group."
(Applause)
(Erik) Wow. I think if I had dry eyes right now then I would not be your son.
I just wanted to - in case you didn't get the message -
I think it's that you don't have to be blue anymore.
All right? We can all be happy.
I just want to say to you, Dad, for inviting me up here -
it's such an honor.
I'm so proud of you. Wow, I'm so proud.
This speech is just phenomenal, and your life's work.
I just want to say I'm so thankful
that you had enough faith in yourself to have faith in me, to give me my life.
So thank you.
(Applause)