The Healthy Management of Reality - Stanford University

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problems. Prevention advocates argue that it is vitally important to direct more ofour efforts at providing our communities with education and other services thatcould avert the portion of these problems that are preventable.Since 1977, as a professor at the University of California, San Francisco, Ihave worked at San Francisco General Hospital, one of our teaching hospitals, andthe city’s public hospital. For twenty-eight years, I have seen at close range themany ways that people with very few economic resources can live their lives.I have seen the admirable ways in which so many people deal successfullywith adversity, as well as the disastrous results of personal choices. In my workwith patients, I have become ever more intrigued about how the way we think andthe things we do affect our feelings, our daily lives, and our relations with others;in short, how our day-to-day actions mold our personal reality.I worked with hospitalized psychiatric patients for six years and saw at closehand the major disorders that I wanted to prevent. I learned that many of thesedisorders have strong biological components, and gained great respect for thepharmacological and other medical interventions that are so important to helpindividuals resume their lives. But even here, choices made (including continuingwith their treatment after leaving the hospital) seemed to affect the kind of life eachpatient and their loved ones would live. I then found that if I wanted to intervenebefore individuals developed psychiatric problems, I needed to work with primarycare medical patients.Depression is one of the most common problems seen in primary caremedical settings. It turns out that most people suffering from depression do notseek mental health services. They go to primary care physicians. So, in the early'80s, I developed the Depression Prevention Course, which focused on reducingdepressive symptoms in people who had not yet developed a clinical, that is, aHMOR.July2005.Muñoz.doc 6
serious depression. The course was based on work I did for my dissertation, underthe direction of Peter M. Lewinsohn, and in collaboration with Toni Zeiss andMaryann Youngren. Our book Control Your Depression (1992) describes themethods we developed for the lay reader. This program of research, the SanFrancisco Depression Prevention Research Project, is described in the book ThePrevention of Depression: Research and Practice (1993), with Yu-Wen Ying.Our project, which took place in the early 1980’s, was awarded the NationalMental Health Association's Lela Rowland Prevention Award in 1994. During theproject, we found many patients in the general medicine clinics who already hadserious depressions and who were not receiving treatment. Therefore, in 1985,Jeanne Miranda, Sergio Aguilar-Gaxiola, and I founded the Depression Clinic atSan Francisco General Hospital. The clinic provided cognitive-behavioralindividual and group therapy in English and Spanish. The clinic is now part of alarger outpatient service of the Division of Psychosocial Medicine. Much of what Italk about in this book is based on my experiences with patients at San FranciscoGeneral Hospital, from those who are doing well and want to continue healthy lifestyles, to those with the most severe mental disorders one could imagine. Some ofthe manuals we have developed for the prevention and treatment of depression atSan Francisco General Hospital are available for downloading from:http://www.medschool.ucsf.edu/latino/manuals.aspx.Another source of ideas has been the adaptation of our DepressionPrevention Course to help individuals who are trying to give up addictions,especially those who want to quit smoking. In 1987, I began working with SharonHall on her Maintaining Nonsmoking project. We developed a mood managementintervention that blended her smoking cessation methods with the DepressionPrevention Course. We have done several treatment studies using these ideas in theHMOR.July2005.Muñoz.doc 7
Page 1 and 2: The HealthyManagementof RealityRica
Page 3 and 4: The Healthy Management of RealityCo
Page 5: Preface: The Origins of This BookEv
Page 9 and 10: Introduction: Sculpting RealityIn m
Page 11 and 12: The people of the Andes found thems
Page 13 and 14: Chapter 1On Managing RealityThe uni
Page 15 and 16: To continue with the example: If ou
Page 17 and 18: But, given that we are finite and l
Page 19 and 20: The objective environment refers to
Page 21 and 22: Throughout the book, we will addres
Page 23 and 24: Chapter 2Choosing a Direction"If yo
Page 25 and 26: Choosing a direction for one's life
Page 27 and 28: Few Christians would support the re
Page 30 and 31: The "healthy" aspect of "the health
Page 32 and 33: It appears, then, that there is a r
Page 34 and 35: Once one becomes aware of oneself a
Page 36 and 37: HMOR.July2005.Muñoz.doc 36
Page 38 and 39: are what I mean by necessary suffer
Page 40 and 41: unnecessary and can be prevented.Th
Page 42 and 43: the things that cause human sufferi
Page 44 and 45: HMOR.July2005.Muñoz.doc 44
Page 46 and 47: past that we remember (that is our
Page 48 and 49: The objective past had not changed,
Page 50 and 51: The fact is that five years hence,
Page 52 and 53: - The meanings we have accepted or
Page 54 and 55: Molding the past of our childrenThe
Page 56 and 57:
- The child's core beliefs. Though
Page 58 and 59:
your favorite book afterwards") the
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making sure that one's daily realit
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Change can move us toward a healthi
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Similarly, behaving in an exemplary
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Similarly, it is true that certain
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Learning which thoughts and actions
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do what you wish. If you are able,
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Tips on increasing the probability
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influence on us on one side and tho
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Being your own coach involves decid
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Beliefs and ConsequencesThe third l
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Aaron Beck, a psychiatrist who deve
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We Are Meaning-MakersThe fourth lev
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Closing the Loop: The four levels a
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To manage our reality optimally, we
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If you are feeling down or depresse
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PeopleThe social environment is at
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stimulation just as they need their
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In Chapter 2, I talked about choosi
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As we enter the twenty-first centur
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years. As I trace back my thinking
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what we both want.If we have a stro
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we will have progressed in terms of
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