Beck(15) 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 it is not assured but is only a possibility, because of the depressed person's feeling of helplessness to change the situation.

2) Mania is the state in which the comparison between actual and benchmark states seems to be very large and positive, and often it is a state in which the person believes that she or he is able to control the situation. It is especially exciting because the person is not accustomed to positive comparisons. Mania is like the wildly-excited reaction of a poor kid who has never before been to a professional basketball game. 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 be more emotional about it than 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 in anxiety. One is anxious about whether one will miss the plane, 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 neg-comps by giving up goals, so that there is no longer a neg- comp. 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.

The English psychiatrist John Bowlby observed a pattern in children aged 15 to 30 months of age who were separated from their mothers that fits with the relationships between types of responses to neg-comps 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."(16)

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 The active physical movements diminish or come to an end...He is withdrawn and inactive, makes no demands on people in the environment, and appears to be in a state of deep mourning."(17)

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"(18) So the child eventually removes the painful neg-comps by removing the source of the pain from his thought.

5) Various positive feelings arise when the person is hopeful about improving the situation--changing the neg-comp into a more positive comparison -- and is actively striving to do so.

People we call "normal" find ways to deal with losses and the consequent neg-comps and pain in ways that keep them from prolonged sadness. Anger is a frequent response, and 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.(19) On the other hand, consider this exchange reported between Walter Mondale, who ran for president of the United States in 1984, and George McGovern, who ran in 1972: Mondale: " George, when does it stop hurting?" McGovern, "When it does, I'll let you know." But despite their painful experiences, neither McGovern nor Mondale seems to have fallen into prolonged depression because of the loss. And Beck asserts that survivors of painful experiences such as concentration camps are no more subject to later depression than are other persons.(20)

This book confines itself to depression, leaving these other topics for treatment elsewhere.

Let's close this chapter on an upbeat topic, love. 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, which often figures in depression) and that messages from the beloved say that in the eyes of the beloved he or she 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!

And of course it makes sense that unrequited love feels so bad. The youth is then in the position of not having the most desirable state of affairs one can imagine, 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 the lover formerly had. The comparison 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.

Summary

The basis for understanding and dealing with depressing the negative comparison between your actual and hypothetical benchmark situations that produces a bad mood, together with the conditions that lead you to make such comparisons frequently and acutely, and combined with the helpless feeling that makes the bad mood into a sad rather than angry mood; this is the set of circumstances constituting the deep and continued sadness that we call depression.

Negative self-comparisons and a Rotten Ratio produce a bad mood because there is a biological connection between negative self-comparisons and physically-induced pain. Psychological trauma such as a loss of a loved one induces some of the same bodily changes as does the pain from a migraine headache, say. When people refer to the death of a loved one as "painful", they are speaking about a biological reality and not just a metaphor. It is reasonable that more ordinary "losses" -- of status, income, career, and of a mother's attention or smile in the case of a child -- have the same sorts of effects, even if milder. And children learn that they lose love when they are bad, unsuccessful, and clumsy, as compared to when they are good, successful, and graceful. Hence negative self-comparisons indicating that one is "bad" in some way are likely to be coupled to the biological connections to loss and pain.

Because the causes of sadness and depression are largely learned, we can remove the pain of depression by managing our minds properly. With respect to a stimulus that we have learned to experience as painful--lack of professional success, for example--we can relearn a new meaning for it. That is, we can change the frame of reference, for example, by altering the comparison states that we choose as benchmarks.

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. 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.

In direct contrast is the cognitive viewpoint. 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.

next: Good Mood: The New Psychology of Overcoming Depression Chapter 4