Mental Health IV: Cognitive Behavioral Therapy

The fourth in a series of five essays about Mental Health to celebrate the dog days of August.

Mental Health I: Why Do I Write?

Mental Health II: Suicide is Painless

Mental Health III: You Were Never Sick; Get Yourself Better

Mental health is a different animal than physical health, and though it’s important that we destigmatize mental illness and provide access to services and medications, our tendency to treat psychiatry as simply another medical specialty is misguided. Western medicine is rooted in considering the human body as a machine. When the machine is broken, we fix the components. Thus, we excel in treating physical trauma: repairing a broken bone is a matter of physics; installing a stent a function of fluid mechanics. Complicated chronic conditions are trickier: the same chemotherapy that remisses one person’s cancer may well kill someone else. The more complex our mind-body-societal interrelations, the more we flounder: no drug cocktail can calm a brain and alleviate all the stress our society inflects on a person’s sanity.

In the 1990’s, I was a forty-ish gay man in tumult, grappling with the realization that I’d spent most of my life running from a so-called mental illness that, turns out, had been redefined into the range of normal.

A psychiatric diagnosis is a reflection of the society that ascribes the label. Although mental illness may have roots in organic brain function, it often triggers in response to our over-specialized, hyperactive, competitive society; in revolt or capitulation to norms and expectations. By definition, a person who conforms to the basic standards of their culture possesses positive mental health, whereas a person at deviance to those norms is considered ill.

When I came of age, testosterone-fueled antics, heavy drinking, and sexual bravado were tolerated, even encouraged, as healthy signs of manliness; whereas male sensitivity was suspect, sodomy a crime, and homosexuality a certified mental disorder. Sixty years later, young men who drink, drug and whore to excess get shuttled off to twelve-step programs, while my particular predilections are legal and, in some sectors of society, my brand of masculinity actually embraced.

The proclivities of human males have not evolved all that much in two generations: we all still try to do whatever we happen to like as much as we can. What’s changed are society’s standards.

You’d think I’d be happy to learn, “You used to be sick but now you’re not.” Yet I suffered psychological whiplash. Years of having one’s nature bullied and denied hard-wires inadequacy. I was unable to simply rise one morning all Happy Gilmore, and during dark days I still knew depression as my oldest, truest friend. He might not be good for me, but he was a known quantity, and my life was so upended—marriage kaput, children by schedule, finances teetering, old friends grown distant—I welcomed depression’s familiar anchor.

I still dreaded mornings. I suffered doubt. I became jittery. I averted panic through constant activity. I read deep into sleepless nights, and immediately upon finishing one book, started another before turning off the light. I needed the illusion of required tasks to fill the abyss that loomed over my next day, week, month. The line between depression and anxiety blurred. And even though I no longer believed that therapy or psychopharmaceuticals offered anything to me, sometimes I felt so lost and unable to find a way through, I returned. To talk, and more talk.

A psychiatric diagnosis

 is a reflection of the society

that ascribes the label.

One of my iterative searches—in my Fifty’s now, wondering when the hell life would ever start to smooth roll—led to with a therapist who practiced CBT: Cognitive Behavioral Therapy. The gist is: thoughts influence feelings; we have (at least some) control over our thoughts; therefore by directing our thoughts, we gain mastery of our feelings. CBT struct me as cookie-cutter, more pop-psych than careful analysis. However, over our allotted eight sessions (plus assigned homework), several things became clear. First, all my previous talk therapy, premised on the notion that mine was a unique case of singular mental struggle, simply resulted in circular conversation. Second, CBT was practical: I could actually apply what we discussed in therapy to my life beyond. I reported concrete examples of catching runaway thoughts, slowing them down, and in the process, calming my feelings. Third, CBT played to my strengths. It’s a structure, a discipline, it lends itself to study. And if there’s one thing I’m good at, it’s studious discipline. When I applied the same skills that enabled me to escape my family and rise in stature, I yielded something more important: a deeper understanding of me.

CBT aligned with other aspects of my life at that time: my emerging yoga practice; exploring meditation; the conscience decision to cap my career. I still felt anxious, but less often descended into depression. I still responded to mental agitation with hyper-action, but my busyness turned inward, channeling energy into personal enlightenment rather than professional perfection. I became more comfortable with my introverted nature, neither needing nor wanting as much social life.

I’d never contemplated retirement, but when intriguing options presented, I stopped working. At age 58. Unstructured time had always been a challenge, but self-motivation kicked in. I volunteered, many gigs. I read, all variety of topics. I travelled, very slowly. I wrote: one book, then another; a play, then another, and another; and so many blog posts. For nearly a decade, I faired pretty well. Conscious adherence to the discipline of CBT helped me manage my life.

Then our nation grew ugly, isolated and divisive; and a pandemic hit. And the diligence required to sustain equilibrium became too great to sustain.


About paulefallon

Greetings reader. I am a writer, architect, cyclist and father from Cambridge, MA. My primary blog, is an archive of all my published writing. The title refers to a sequence of three yoga positions that increase focus and build strength by shifting the body’s center of gravity. The objective is balance without stability. My writing addresses opposing tension in our world, and my attempt to find balance through understanding that opposition. During 2015-2106 I am cycling through all 48 mainland United States and asking the question "How will we live tomorrow?" That journey is chronicled in a dedicated blog,, that includes personal writing related to my adventure as well as others' responses to my question. Thank you for visiting.
This entry was posted in Gay, Personal and tagged , , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s