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An Integrated Cognitive Theory of Depression

Lincoln Pashute

cont.

Other Related States

Other states of mind which are reactions to the psychological pain of negative self-comparisons5 fit well with this view of depression, as illustrated in the saleswoman joke earlier. Spelling out the analyses further:

1) The person suffering from anxiety compares an anticipated and feared outcome with a benchmark counterfactual; anxiety differs from depression in its uncertainty about the outcome, and perhaps also about the extent to which the person feels helpless to control the outcome.6 People who are mainly depressed often suffer from anxiety, too, just as people who suffer from anxiety also have symptoms of depression from time to time (Klerman, 1988, p. 66). This is explained by the fact that a person who is "down" reflects on a variety of negative self- comparisons, some of which focus on the past and present whereas others focus on the future; those negative self-comparisons pertaining to the future are not only uncertain in nature but may sometimes be altered, which accounts for the state of arousal that characterizes anxiety in contrast to the sadness that characterizes depression.

Beck (1987, p. 13) differentiates the two conditions by saying that "In depression the patient takes his interpretation and predictions as facts. In anxiety they are simply possibilities". I add that in depression an interpretation or prediction -- the negative self-comparison -- may be taken as fact, whereas in anxiety the "fact" is not assured but is only a possibility, because of the depressed person's feeling of helplessness to change the situation.

2) In mania the comparison between actual and benchmark states seems to be very large and positive, and often the person believes that she or he is able to control the situation rather than being helpless. This state is especially exciting because the manic person is not accustomed to positive comparisons. Mania is like the wildly-excited reaction of a poor child who has never before been to a circus. In the face of an anticipated or actual positive comparison, a person who is not accustomed to making positive comparisons about his life tends to exaggerate its size and tends to be more emotional about it than are people who are accustomed to comparing themselves positively.

3) Dread refers to future events just as does anxiety, but in a state of dread the event is expected for sure, rather than being uncertain as is the case in anxiety. One is anxious about whether one will miss the meeting, but one dreads the moment when one finally gets there and has to perform an unpleasant task.

4) Apathy occurs when the person responds to the pain of negative self-comparisons by giving up goals in order that there no longer be a negative self-comparison. But when this happens the joy and the spice go out of life. This may still be thought of as depression, and if so, it is a circumstance when depression occurs without sadness -- the only such circumstance that I know of.

Bowlby observed in children aged 15 to 30 months of age who were separated from their mothers a pattern that fits with the relationships between types of responses to negative self- comparison outlined here. Bowlby labels the phases "Protest, Despair, and Detachment". First the child "seeks to recapture [his mother] by the full exercise of his limited resources. He will often cry loudly, shake his cot, throw himself about...All his behavior suggests strong expectation that she will return" (Bowlby, 1969, Vol. 1, p. 27). Then, "During the phase of despair...his behaviour suggests increasing hopelessness. The active physical movements diminish or come to an end...He is withdrawn and inactive, makes no demands on people in the environment, and appears to be in a state of deep mourning" (p. 27). Last, in the phase of detachment, "there is a striking absence of the behaviour characteristic of the strong attachment normal at this age...he may seem hardly to know [his mother]...he may remain remote and apathetic...He seems to have lost all interest in her" (p. 28). So the child eventually removes the painful negative self-comparisons by removing the source of the pain from his thought.

5) Various positive feelings arise when the person is hopeful about improving the situation-- that is, when the person contemplates changing the negative comparison into a more positive comparison.

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People we call "normal" find ways to deal with losses and the consequent negative self-comparisons and pain in ways that keep them from prolonged sadness. Anger is a frequent response which can be useful, partly because the anger-caused adrenaline produces a rush of good feeling. Perhaps any person will eventually be depressed if subjected to many very painful experiences, even if the person does not have a special propensity for depression; consider Job. And paraplegic accident victims judge themselves to be less happy than do normal uninjured people (Brickman, Coates, and Bulman, 1977). On the other hand, Beck asserts that survivors of painful experiences such as concentration camps are no more subject to later depression than are other persons (Gallagher, 1986, p. 8).

Requited youthful romantic love fits nicely into this framework. A youth in love constantly has in mind two deliciously positive elements -- that he or she "possesses" the wonderful beloved (just the opposite of loss), and that messages from the beloved say that the youth is wonderful, the most desired person in the world. In the unromantic terms of the mood ratio this translates into numerators of the perceived actual self being very positive relative to a range of benchmark denominators that the youth compares him/herself to at that moment. And the love being returned -- indeed the greatest of successes -- makes the youth feel full of competence and power because the most desirable of all states -- having the love of the beloved -- is not only possible but is actually being realized. So there is a Rosy Ratio and just the opposite of helplessness and hopeless. No wonder it feels so good.

It makes sense, too, that unrequited love feels so bad. The person is then in the position of being denied the most desirable state of affairs imaginable, and believing her/himself incapable of bringing about that state of affairs. And when one is rejected by the lover, one loses that most desirable state of affairs which formerly obtained. The comparison then is between the actuality of being without the beloved's love and the former state of having it. No wonder it is so painful to believe that it really is over and nothing one can do can bring back the love.

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