Depression lies

With that disclaimer, I'll say that I went on several regimens of drugs for a few years. They had serious side effects, didn't work or worked only for a few months. They did keep me afloat long enough to get the rest of my life together.

Stephen Ilardi's "The Depression Cure" is 80% insipid self-help; I'm surprised I didn't throw it away in disgust. The remaining 20% (which is mostly the table of contents) had a profoundly positive effect. It did more good than all the drugs I'd taken combined; but I had to take it seriously and have the willpower to make changes.

In the end, CBT techniques got me to the point where I instinctively revise my thought patterns. Combined with a lifestyle that includes a lot more exercise, time outside, and physical contact with people I care about, I have been un-medicated for almost three years and haven't had a single major depressive episode.

I'm not sure if I understand your objections to CBT -- there's a lot of them -- so let me restate them. If I've misunderstood please correct me. You seem to be saying:

1) One can control one's highest-level, "executive" thoughts, but not feelings. CBT is assuming far too much control over emotions, and it's like blaming a depressed person for not "snapping out of it".

2) It is also bad to throw off blame onto other people when you should be learning lessons about your own failures.

Okay, first of all, I think you are quite mistaken about how much your emotions are related to the content of your thoughts. There are indeed people who have chemical imbalances in their mind, but for most people, their thoughts are the primary trigger of their emotions.

The basic assumption of CBT is not that you should blame others more, or yourself more. The assumption is that your thinking is clouded somehow and needs to be set straight. This is usually done by rigorously stepping through every part of the thought process to reveal the errors. One should accept the blame that is due oneself, but not go any further.

I never followed a program of cognitive-behavioral therapy all the way, but I have done it sometimes. I do remember a moment of revelation that occurred when I was out for a walk. CBT encourages you to slow down and listen to yourself very carefully. I noticed, for the first time, a voice in my head that was constantly leaping to very bad conclusions based on poor evidence (e.g. very minor setbacks, like an untied shoe, are connected into a pattern of lifelong failure). The thoughts were so automatic I had stopped realizing that they were thoughts at all; I only felt the wave of bad feelings that resulted from them.

My personal feeling is that a lot of people have this sort of problem, rather than any chemical imbalance. Antidepressants may be primarily useful in lifting the fog enough for one to have the mental energy to start CBT. Some studies show that using both is better than either alone.

Statistically, CBT combined with medication is currently the most effective clinical treatment for depression. Personally, having tried a number of sessions, I think it works very well for some, and not so well for others. If your tendency is to blame yourself for things that are beyond your control, it may be a great aid. If instead you want to understand the world so as to make it better, CBT probably isn't a good choice.

I'm seeing people throw blame all the time, precisely because it's easier to cope with failure.

See, you've already got it. Stop there.

But it's not healthy to pass the blame,

Why? The studies seem to show that for most any measure of 'health', it is better not to blame yourself for the mistakes you make. You'll be happier, and live longer. You (and I) might wish that taking personal responsibility would always be the better choice, but statistically it's often not.

My conclusion was that CBT is effective to the extent that you are willing to give up on the concept of truth. People who train themselves to see only the positive are happier than those that insist on truth. I decided that truth was more important to me than happiness, dropped the CBT, and stuck with the meds.