Optimism and Depression

The article on emotional health pointing out the benefits of self-deception {Psychology, Oct. 9} mistakenly gave optimists all the credit for imagination. It's not helpful to tell depressed people to cheer up, much less to start deceiving themselves, as anyone who has experience with depression knows.

Far from assessing their shortcomings realistically, depressed people usually exaggerate them. They underestimate their ability to solve their own problems and by definition don't have the energy to devise alternative approaches.

The best point the article made was on the optimist's willingness to take risks. To relinquish ordinary responsibilities, at least for a little while, may be necessary for healing -- and then to get some rest, to demand time for sorting out the details of one's life.

But taking these steps involves even greater risks for the depressed person because of the fear of lack of control. Sometimes, medication is needed; always, the assurance that the depression is a normal reaction to a painful situation. Julia McCahill Riva, Md.

While no one would argue that a positive approach may foster emotional health, when someone is anxious or depressed it is important to get them to be more realistic and not just present a positive bias. There is a great deal of scientific evidence that supports the notion that depressed and anxious people lose their ability to view situations in a realistic light. Instead, their thinking is characterized by rigid, systematic errors in reasoning.

It is not surprising that depressed people take more notice of negative events. The problem is that they may selectively dwell on them. This leads them to make global negative predictions about themselves, their life experience and the future. With anxiety, the distortions are similar, but the focus is on "danger" rather than "failure." For example, during a panic attack, they misinterpret physical symptoms.

In order to reduce the emotional response, it is important not to deny that a negative event has occurred but to accurately interpret it rather than let it produce a stream of thoughts that are negative and inaccurate. Regina Ottaviani, PhD Co-Director Cognitive Therapy Center Chevy Chase

Special Powers of Attorney

There is a small but important distinction that should have been made in the article on the right to die {Ethics, Oct. 16}. It stated: "Physicians who are already nervous about the risk of malpractice lawsuits are even more likely to refuse to withhhold extraordinary life-continuing care from irreversibly comatose patients unless they have a living will or a signed power of attorney form." In fact, in these cases, a power of attorney is less than no help at all.

A power of attorney document becomes invalid the moment it is most needed -- when the person who executes it becomes incompetent. What is needed is a durable power of attorney, a small change, to be sure, but a crucial one.

Many attorneys not well versed in health law are unaware that standard power of attorney documents cannot be used for this sort of matter. Therefore, it is important that the public understand the difference.

To further complicate matters, there are two types of durable powers: springing, in which case it takes effect the moment someone becomes incompetent to manage their own medical affairs, and immediate, which transfers the power to make treatment decisions to a designated person at the time the document is signed. Teresa S. Myers Silver Spring

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