Good Mood: The New Psychology
of Overcoming Depression

APPENDIX

ON THE THEORY OF DEPRESSION AND ITS TREATMENT

Beck has properly claimed as an advantage of his Cognitive Therapy that "the therapy is largely dictated by the theory" rather than being simply ad hoc. (1976, p. 312). Beck also notes that "Currently, there is no generally accepted theory within the cognitive-clinical perspective." This book offers a more comprehensive theory of depression than do the others, and includes the others as elements in it. Furthermore, the therapeutic approaches suggested here are dictated even more clearly by the more specific theory given here, and more possibilities are suggested by it, than any of the previous approaches alone.

Each of the contemporary "schools", as Beck (On dustjacket of Klerman et. al., 1986.) and Klerman et. al. (1986, p. 5) call them, addresses one particular part of the depression system and, therefore, depending upon the "theoretical orientation and training of the psychotherapist, a variety of responses and recommendations would be likely...there is no consensus as to how best [to] regard the causes, prevention, and treatment of mental illnesses" (Klerman et. al., 1986, pp. 4,5). Any "school" is therefore likely to achieve best results with people whose depression derives most sharply from the point in the cognitive system that that school focuses upon, but less well with people whose problem is mainly at some other point in the system. (Of course the depression sufferer may have a defective mechanism that spreads into several aspects of the system, and therefore therapy at any one point can benefit the system as a whole, but that is beside the point here).

Self-Comparisons Analysis provides an expanded theoretical understanding of depression which encompasses and integrates the elements pinpointed and explored by these writers and others. This means that instead of the field being seen as a conflict of "schools", each of the "schools" has a distinctive method that fits the needs of different sorts of sufferers from depression. The overall framework of Self-Comparisons Analysis helps weigh the values of each of these methods for a particular person. Though the various methods may be serviceable substitutes for each other at times, to a considerable extent they are not simply competitive alternatives for the same situations, and Self- Comparisons Analysis helps one choose. This should be of particular benefit to the physician or other professional who must make the crucial decision of referring a patient to one or another specialist for depression treatment. Heretofore, the choice had to be made mainly on competing merits, and in practice the choice probably is made mainly on the basis of which "school" the referring professional is most familiar with, which has led to considerable frustration with the field voiced by recent writers (e. g. Papalos and Papalos, 1987).

There are hazards in offering a theory which claims to comprehend and integrate others. Psychotherapists, just as do professionals in others fields, have "intense loyalties to the schools they espouse" (Wender & Klein, 1981, p. 264). And contending schools in any field are greatly attached to their controversies; to offer to remove the cause of the controversy is to be in the position of a cop in a household dispute. The one matter that contending parties always can agree upon is that an outsider has nothing to contribute. Nevertheless, I step where angels professionally trained in particular `schools' of clinical therapy would be prudent enough not to tread. And not being the member of any `school' confers an advantage: Lack of socialization into, and absence of professional connection with, any particular school of therapy promotes breadth of thought and synthetic theory.

If you work at enough different tasks you sometimes experience the eerie and then exciting sensation that you have met the same idea before in another context. And so it is with many of the ideas in cognitive therapy, especially the types of thinking characteristic of depressed persons. The distortions of thought common to depressives are much the same, though with different names, as the obstacles to sound scientific knowledge faced by researchers, the logical fallacies that have been pointed out by philosophers through the ages, the devices used by propagandists to influence audiences, the causes of bias in estimates of probabilities, and many of the sources of faulty decision-making in business and other organizations. Once you recognize the similarity in these conceptual schemes, each one illuminates the others, and the overall scheme gains in generality.

Indeed, cognitive therapy has been moving toward greater use of concepts found in philosophy and other social sciences, some by borrowing but even more by independent invention. The analysis of logical and linguistic fallacies is a prime example of the bridge with philosophy. The utilization of the theory of information processing by Bowlby (1980) is another connection. Still another example is the employment (see Burns (1980, p. 150; Beck, 1987, p. 31) of such ideas from managerial economics as cost-benefit analysis, and supply of resources, and even the term "economy" with respect to the thinking mechanism. And the time is ripe for cognitive therapy to link up with decision theory, as studied in economics, psychology, political science and other fields.2 Cognitive therapy may eventually be the the first truly integrated social science.3

2.- An interesting connection is the "prospect theory" of Kahnemann and Twersky (1979). They find that people's evaluations of uncertain alternatives are best described as relative rather than absolute, in contrast to tahe assumption of expected-utility theory; this they explain in terms of perception theory, which fits with the discussion of comparisons in Chapter 3. Furthermore, they find that the common reference point is to the present state of affairs. This comparison scheme would seem to have appropriate properties for maximization of one's psychic well-being, in accord with discussion in this book of the appropriate choice of a benchmark-comparison state for a Rosy Mood Ratio, whereas expected-utility theory assumes that people will maximize their monetary wealth without reference to any particular state of affairs. In turn, the analysis given in this book should illuminate prospect theory by explaining why the prospect-theory form of utility function is held by people, and it suggests that the individual's utility function should be related to the individual's score on a depression inventory. And philosophers, psychologists, and economists have joined in exploring the logic and action of such mental mechanisms as "multiple selves", which fits with the practice of cognitive therapeutic techniques. (See Elster, 1986).

3.- My work in related cognitive fields -- economics, research methods, philosophy, and decision-making has dealt with a wider range of concepts than are traditionally available in clinical psychology. My experience with cognitive psychology and this set of subjects goes back to my undergradate thesis on concept formation in 1952-1953, and has continued with books and articles on each of these subjects mentioned above plus some others; each part of this experience has contributed to the conceptual scheme presented here. There are other remarks on this topic in Chapter 1.

Another aspect of cognitive therapy that one meets in other contexts: The dialogues between therapist and patient that Ellis and Beck and their colleagues conduct are identical in form to the Socratic form of dialogue used especially in law schools and also elsewhere in education. The back-and-forth between student and teacher is an attempt on the part of the teacher to have the student practice clearer thinking about the subject at hand, just as is the back-and-forth between therapist and patient.

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