That is what my therapist was trying to say in this statement. This is said so often, it has become the mantra of the McLean Hospital Partial Hospital Program. It is meant to address the inertia that comes with depression, the lack of interest in life and in doing things (called anhedonia). What it means is that even when you are depressed and don't feel like doing anything, you should go ahead and do something anyway. Do not wait until you feel like doing it, because in depression, that will not come for a very long time. If you begin to do things, eventually the motivation to do them will follow. It is far easier to stay in bed or on the couch, but that is not in your best interest. Just get going on some small thing and eventually the interest in doing it will follow, and you will become interested in more things. Start with one small thing at a time, and the motivation for doing it will later appear. Sometimes we experience a combination of physical, emotional, and interpersonal symptoms for such a long time that we don't even recognize them as symptoms. We get used to them and think they are normal. We discussed this in group therapy years ago, and I just now discovered who wrote it, although it is taken from a book I have not read. I know that it is very true in depression. When symptoms persist for a long time, and your memory gets fuzzy, it is hard to remember what your past self is like. When you get used to the symptoms of longstanding depression, you may think of it as your "normal" self. Remember--that is not true. It is not your normal self. The exercise in chapter 3 is designed to help you define your baseline healthy self and have that as a goal to work toward during your recovery. Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying "I will try again tomorrow." This quotation speaks volumes to me.

Depression is the kind of illness that requires a lot of courage. Many of us go around with this illness in silence, not mentioning it to any but a few of our closest friends and family, quietly struggling. It takes a lot of effort just to get up each day, to get showered and dressed and try. It takes enormous courage to get up and face another day of depression, of darkness and despair and hopelessness. When you are willing to do that day after day, you have courage unlike any other. You do not have to shout it from the rooftops--you show it quietly by your efforts. You cannot absorb praise unless you decide to believe and validate what is being said. A psychiatry resident said this to me one day during one of my major struggles. It is meaningful to those with depression who are overwhelmed with negative self-talk and beliefs that interfere with their ability to receive praise or a compliment. She meant to say that you need to be able to respect and believe what the other person is saying, and validate them, before you can absorb the positive comments they are offering you. That is not easy to do. Once you decide that you can trust and believe the other person, then you can accept their words as accurate and complimentary. There is Hope because ... we see you in a different way than you see yourself, and if you were to see yourself as we see you, then you could believe and hope that life could be different. And so, the fundamental nature of the experimental method is manipulation and control. A scientist manipulates a variable of interest (e.g., gives a drug to one group and a placebo to another), and sees if there's a difference. At the same time, he/she attempts to control for the potential effects of all other variables (e.g., by randomization). The importance of controlled experiments in identifying the underlying causes of events cannot be overstated. In the real--uncontrolled--world, variables are often correlated. For example, people who take vitamin supplements may have different eating and exercise habits than people who don't take vitamins.

As a result, if we want to study the health effects of vitamins, we can't merely observe the real world, since any of these factors (the vitamins, diet, or exercise) may affect health. Rather, we have to create a situation that doesn't actually occur in the real world. That's just what scientific experiments do. They try to separate the naturally occurring relationships in the world by manipulating one specific variable at a time, while holding everything else constant.3 Without such a procedure, we would be doomed to believe in things like therapeutic touch and facilitated communication. Our knowledge of science and the scientific method is crucial to our ability to form reasoned beliefs. And yet, the National Science Board estimated that two-thirds of us do not clearly understand the scientific process.4 The sad truth is that most of us don't know enough about scientific procedures to be able to adequately evaluate the quality of data when we formulate our beliefs. Science relies heavily on controlled experimentation, since, as we have just seen, an experiment is one of the best ways to determine if A causes B. Of course, not all of science can use controlled experiments. Many geological and astronomical hypotheses, for example, can't readily be tested in the lab. But they can be tested in the field where we can look for data that confirms or refutes a given hypothesis. So what is science?5 The hallmark of science is the rigorous testing of hypotheses. As science writer Kendrick Frazier observes, "Science proposes explanations about the natural world and then puts those hypotheses to repeated tests using experiments, observations, and a creative and diverse array of other methods and strategies."6 My favorite definition of science was proposed by Michael Shermer: "Science is not the affirmation of a set of beliefs, but a process of inquiry aimed at building a testable body of knowledge constantly open to rejection or confirmation."7 I like this definition because it emphasizes an extremely important point--science does not try to prove any specific belief. Science doesn't start with a preconceived notion of what we should believe, as some other human institutions do. Rather, science is simply the process we use to better understand our world. In fact, a true scientist never claims to know anything with absolute certainty. Instead, a scientist believes that all knowledge is open to rejection or confirmation, and that we are constantly refining and expanding our knowledge of the world. This quest for knowledge may never result in absolute truth--but it's still the best thing we've got to unravel the mysteries of life. You and I started this journey together with me confessing my own personal "sellout" of self. I told you that I caved to expectancies, life-chain momentum, and money. I was trapped for ten years and had neither the courage nor the focus to do anything about it.

I completely ignored my own voice, needs, and passions, and fulfilled what I perceived to be the expectancies of others. Looking back, that story probably did not inspire your confidence in me! You were probably asking yourself: "What the hell was he thinking?" (There's a switch: You dogging on me, instead of the other way around!) Uninspiring as it may have been, it was the truth, and one that I had the power to control if I had just claimed it. Fortunately, I eventually exercised that control, or I wouldn't be here writing this book. In a strange way, even though I was caving to the expectancies of others, they were my expectancies as well. Clearly, I was not doing what I consciously wanted to do, but I felt a vague yet strong pull to conform and comply. The tug of that life chain was amazingly powerful. I mean, you hang with family, right? You go where your people are, do what they do, and live in their world. My personal truth was terribly limiting as I felt the need to stay in the flow of my family and their patterns. It seemed selfish to think of doing anything different just because I wanted something else. It was familiar, it was safe, and at one level it did feel right. Or so it seemed at the time. Because my "data window" had been closed by fixed beliefs and a life script that were set in the "you're trapped" mode, I had completely missed the resource that lay in my wife. She wasn't nearly as trapped as I was, and was way more flexible than I gave her credit for. I had failed to see her willing spirit about change. Live and learn! Science generally begins with a simple question about something in our world. For example, does smoking cause health problems? Next, we form a hypothesis to specifically address the question.

A hypothesis is a testable statement about the relationship between two or more variables. For our question, a testable hypothesis might be that smoking causes lung cancer. This statement identifies two specific variables that can be measured, smoking and lung cancer, predicts a causal relationship between the variables, and can be falsified. A scientist then conducts an experiment, or uses a number of other rigorous testing methods, to confirm or refute the hypothesis. Upon completion, the study is submitted for publication. But before a study is published, it's reviewed and critiqued by the scientist's peers to ensure that the research is of high-quality. And once in print, the research is open to criticism by the entire scientific community. This process of review and criticism is one of the most important aspects of the scientific method because it provides an error-correcting mechanism that keeps science on track. In fact, this self-correcting mechanism is a main reason for the success of science over the years.8 In science, every idea is open to criticism. When a scientist publishes a study, she must give the details of her study so others can attempt to replicate the results. If the study's results can't be replicated, they're not worth much. As you can see, you have to have pretty thick skin to be a scientist--your work is constantly under scrutiny! Peer review and criticism are essential because scientists are human, and can make the same decision-making errors as everyone else. Some scientists may have a favorite theory they want to support, and may therefore search for supporting evidence and discount contradictory evidence. The great advantage to the scientific approach, however, is that any scientist's potential biases are scrutinized and criticized by his peers. In essence, science provides a process of checks and balances, where the errors of one scientist are rooted out and corrected by others.9 One study, by itself, can't tell us all that much. Even in legitimate science, the quality of studies can vary, which is one reason we sometimes get conflicting results. Confounding variables can affect the results, statistical errors can be made, and the data can even be faked. That's why others must replicate the findings of any study before we give them much credence.10 As the preponderance of evidence from different studies converge, our confidence in a finding should rise. For example, initial research on smoking pointed to health problems.