What You Can Change and What You Can’t
Written by Prof Martin Seligman and reviewed by Sarah Wilshaw-Sparkes
Are you determined to control your anger better? To lose that extra midriff tyre or even to conquer your spider phobia? This book, a review of the effectiveness of the treatments for major and common psychological problems, ranging from anxiety to alcoholism, will tell you what seems to work best and what your chances of success are.
Self-improvement books may give us false hope by celebrating short term results and one-off, but unrepresentative, successes. Science reveals some psychological challenges are much harder to overcome than others. If you’ve failed in the past, as many of us have, you shouldn’t assume you’re weak-willed. For some issues, evolution is against you, and your biology is very much your destiny. For other problems, psychiatry and psychology have yet to come up with an effective solution to support you. Indeed, many pills and psychotherapy interventions are intended to do no more than relieve your symptoms. The establishment has, avers the author, “…all but given up on a cure.”
Three Best Things
There’s a great deal to recommend this book but the three things I enjoyed most were:
- The author’s intellectual position in writing the book that his “loyalty is to reasoned argument, to the unfashionable positions that deserve a hearing, to the thoughtful weighing of evidence.” If there’s a better way to get me to listen willingly and attentively, I don’t know what it might be!
- Seligman’s rare and disarming knack of taking complex, erudite topics and making them entirely approachable. Even the man’s footnotes are engrossing and engaging, for goodness’ sake! Since they occupy almost 15% of this 300-page book, I urge you to read them.
- The sense of perspective imparted by his recap of beliefs about our capacity to effect change in ourselves. This recap ranges from earliest times through to ongoing modern scientific debates, a vast sweep into which the notions of destiny, free will, and nature versus nurture all fit. Parts 2 and 3 of the book offer his hardnosed, yet accessible, review of success rates for treating various disorders but they are sandwiched between parts 1 and 4. There you will meet the message of the Seder, iconoclasts like Francis Bacon and Krafft-Ebing, and the discoveries that made cases for biological psychiatry on one hand and environmentalism on the other. In a book about what you can change, with or without help, this perspective really sets the scene.
What You Can Change and What You Can’t: The Complete Guide to Successful Self-Improvement is no pop psychology work! Martin Seligman is a Professor of Psychology at the University of Pennsylvania and a past president of the American Psychological Association (APA). For decades he has studied aspects of “plasticity” – what can be learned and changed – for the purpose of bettering human life. Often referred to as the ‘father of Positive Psychology’, Seligman’s APA presidency marked the rebirth of this area of research, which explores what makes us thrive and flourish (in contrast to clinical psychology which focuses on how to fix what’s broken in us).
In Part 2, Seligman reviews seven different sorts of emotional challenge:
- Everyday anxiety
- Catastrophic thinking: panic
- Post Traumatic Stress
In Part 3 he expands on other major preoccupations of modern human life: sex (identity, orientation, preference and role), dieting, and alcohol
Each of these sections follows a broadly similar format. The author begins with a description of the problem or disorder, particularly in terms of its prevalence. For problems with few statistics, you may find a self survey instead. A statistically representative case study may also appear. Next, he reviews evidence for the various theories about what causes the problem. Is alcoholism an outcome of an addictive personality, for example, or is it a manifestation of a disease? Into this, he weaves a description and assessment of the available treatments for which there are outcome-based studies.
Finally, at the end of each separate review, he provides a summary table of the major treatment types and assesses them for improvement, relapse, side effects, costs, and time scale to take effect, before giving an overall effectiveness rating. At the end of the book he also summarises what can be changed, and what can’t, into a rough array from “curable” (panic, for example) to “unchangeable” (sexual identity).
Stuck at 65%
Across all the topics explored in parts 2 and 3, Seligman gives a summary of how effective the relief of symptoms is. Relief is measured both by the percent of symptoms for which patients experience relief as well as by the percent of patients who experience relief.
Whether by drugs or by psychotherapy, the relief rate is 65%. The placebo effect ranges from 45 to 55%. That means that the actual effect of the intervention can be as low as 10%. Further, the total relief rate appears stuck at the 65% mark. Seligman proposes reasons why this is so, not least the crucial discovery of the last quarter of the 20th century that most personality traits are highly heritable. This discovery implies that traits are modifiable but only within limits.
Can we progress beyond 65% relief? Seligman can only suggest the age-old advice of ‘learning to deal with it’, in other words to function in the face of the disorder. Just as terror-stricken trainee fighter pilots are taught to pull out of deadly nosedives in the midst of their terror, so phobics, alcoholics and depressives may be able to function at times, and within set biological limits, to the best of their ability.
1993 vs 2007
What You Can Change and What You Can’t: The Complete Guide to Successful Self-Improvement was first published in 1993 and there is no mention of “revised and updated” for the 2007 Vintage edition I read. Is it therefore hopelessly out of date? Have all the answers changed in the years since Seligman first wrote it? Fear not. In the foreword to this later imprint the author says,
“As I survey the effectiveness of these treatments for the major psychological disorders thirteen years later, I am somewhat surprised to find that most of the results remain the same and the rest are not substantially different.”
New Year’s Resolution
I suspect that many of you reading this review are wondering what Professor Seligman has to say on dieting. Gentle reader, the news is not good.
Why is weight loss one of the more intractable change targets? Seligman suggests that it’s a question of “depth”. Changing what lies deep within us – traits acquired in utero or over thousands of years of evolution – are very hard to overcome. We are the products of the uncertain environment of the Pleistocene, the descendants of those who survived famine by storing fat, by dropping metabolism even in the presence of renewed food sources and by avoiding starvation by responding to intense food cravings. If we fail to shed weight, it’s not because we are weak-willed but because we were designed over millenia to maintain weight at a set level.
This was perhaps the only part of the book I struggled with. Reasoned argument and thoughtful weighing of evidence be damned! I shall persist in my belief that my extra tyre will not only be gone in a month or two but will stay away forever…
Seligman anticipated my reaction. In his final paragraphs, he acknowledges that it is hard to surrender some of our hopes. His objective is not to destroy people’s optimism about change but to take that determination and desire for change, and point it at goals we have a much better chance of reaching: “My purpose is to instil a new, warranted optimism about the parts of your life you can change and so help you focus your limited time, money and effort on making actual what is truly within your reach.”
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