The psychologist Helson put it this way: "[All judgments (not only judgments of magnitude) are relative." Without a standard of comparison, you cannot make judgments.8.1 [Harry Helson, Adaptation-Level Theory (New York: Harper and Row, 1964), p. 126]

An example of how one cannot communicate factual knowledge without making comparisons is my attempt in the Epilogue to describe to you the depth of my depression. It is only by comparing it to something else that you might understand from your own experience--time in jail, or having a tooth pulled--that I can give you any reasonable idea of how my depression felt. And communicating factual knowledge to oneself is not basically different from communicating with others; without comparisons you cannot communicate to yourself the information (true or false) that leads to sadness and eventually to depression.

The Old and New Views of Depression

Now the difference between this view of depression and that of traditional Freudian psychotherapy is clear: Traditional psychotherapists, from Freud on, believe that negative self- comparisons (or rather, what they call "low self-esteem") and sadness both are symptoms of the underlying causes, rather than the negative self-comparisons causing the sadness; their view is shown in Figure 1. Therefore, traditional psychotherapists believe that one cannot affect depression by directly altering the kinds of thoughts that are in one's consciousness, that is, by removing negative self-comparisons. Additionally, they believe that you are not likely to cure yourself or ameliorate your depression in any simple direct way by altering the contents of your thoughts and ways of thinking, because they believe that unconscious mental elements influence behavior. Rather, they believe that you can only remove the depression by reworking the events and memories in your early life that led you to have a propensity to be depressed.

Figure 1

In direct contrast is the cognitive viewpoint of this book as shown in Figure 2. Negative self-comparisons operate between the underlying causes and the pain, which (in the presence of a sense of being helpless) cause sadness. Therefore, if one can remove or reduce the negative self-comparisons, one can then cure or reduce the depression.

Note: The rest of this chapter is rather technical, and intended mainly for professionals. Laypersons may well skip to the next chapter. Professionals will find additional technical discussion in the Postscript for the Professional Reader at the end of the book.

Freud pointed in the right direction when he talked about people avoiding pain and seeking pleasure. Nor was this purely a tautology in which what people chose to do is simply called pleasurable; painful events can be connected to chemical events within the body, as discussed in Chapter 2. This idea is helpful here because it helps us understand the relationship of a variety of mental illnesses to negative self-comparisons and the pain they cause.

Some of the possible responses to neg-comps and the consequent pain are as follows:

1) One can sometimes avoid pain by changing the real circumstances involved in the neg-comp; this is what the "normal", active, undepressed person does, and what the normal rat does who has not previously been subjected to shocks that it cannot escape(9). The absence of such purposive activity with respect to neg-comps because of a sense of helplessness to improve the situation is a crucial characteristic of sufferers from depression.

2) One can deal with the pain by getting angry, which tends to make you forget about the pain -- until after the rage subsides. Anger can also be useful in changing the circumstances. Anger arises in a situation where the person has not lost hope but feels frustrated in attempting to remove the source of the pain.

3) You can lie to yourself about the existing circumstances. Distortion of reality can avoid the pain of a neg-comp. But this can lead toward schizophrenia and paranoia.(10) A schizophrenic may fantasize that his actual state is different than it really is, and while believing that the fantasy is true the painful neg- comp is not in the person's mind. The irony of such distortion of reality to avoid the pain of a neg-comp is that the neg-comp itself may contain a distortion of reality; making the neg-comp more realistic would avoid the need for schizophrenic distortion of reality.(11)

4) Still another possible outcome is that the person assumes that he or she is helpless to do anything about it, and this produces sadness and eventually depression.

Other states of mind which are reactions to the psychological pain of neg-comps fit well with this view of depression.(12)

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.(13) 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(14). This is explained by the fact that a person who is "down" reflects on a variety of neg-comps, some of which focus on the past and present whereas others focus on the future; those neg-comps pertaining to the future are not only uncertain, but may sometimes be altered, which accounts for the state of arousal that characterizes anxiety, in contrast to the sadness that characterizes depression.