2) Postpartum depression follows a whole series of biological changes, and seems to have no psychological explanation.

3) Mononucleosis and infectious hepatitis tend to cause depression. (7)

4) Some geneticists have concluded that there is "strong evidence in favor of considering manic-depressive psychosis to be genetically influenced in good part, [but] we are unable to come to any conclusions regarding its mode of inheritance."(8) And for a while it was believed that the causal gene had been identified, but later reports have cast doubt on this conclusion (Washington Post, November 28, 1989, p. Health 7). And some researchers believe that there is evidence for a "biochemical scar" which remains from past depression and which continues to influence feelings in the present; a deficiency of the chemical norepinephrine is commonly implicated by the biochemists. (This need not contradict the observation mentioned earlier that survivors of catastrophes such as concentration-camp experience do not suffer unusual amounts of depression.

There is clear biological evidence that depressed people have differences in body chemistry from non-depressed people.10 There also is a direct 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. And 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.

The Appendix to this chapter discusses the role of drugs in treating depression.

From Understanding To Cure

Ultimately we are interested in the mechanism of depression so that we can manipulate it to treat depression. Let's say that you have a Life Report which is predominantly negative, and it causes you to be sad and depressed. As noted in many places in this book, there are several ways to get rid of your sadness at any given moment. These include putting the Life Report out of your mind by pushing it out; changing some of the negative categories from important to unimportant; changing the standards by which you grade yourself on particularly important negative matters; learning how to interpret the external evidence more accurately, if you now do not interpret the evidence well; and involving yourself in work or creative activity that pulls your mind away from the Life Report.

The advantages and disadvantages of these and other methods of preventing depression depend upon your own psychology and your life situation. The pros and cons of each are discussed later in this book.

Summary

This chapter discusses why a particular person is more predisposed to depression than are other people who are closer to "normal".

The main elements that influence whether a person is sad or happy at a given moment, and whether one does or does not descend into the prolonged gloom of depression are as follows: 1) Experiences in childhood, both the general pattern of childhood as well as traumatic experiences, if any. 2) The person's adult history: the recent experiences have the greatest weight. 3) The actual conditions of the individual's present life-- relationships with people as well as such objective factors as health, job, finances, and so on. 4) The person's habitual mental states, plus her view of the world and herself. This includes her goals, hopes, values, demands upon herself, and ideas about herself, including whether she is effective or ineffective and important or unimportant. 5) Physical influences such as whether she is tired or rested, and anti- depression drugs she is taking, if any. 6) The machinery of thought which processes the material coming in from the other elements and produces an evaluation of how the person stands with respect to the hypothetical situation taken for comparison. (7) A sense of helplessness.

The depressive differs from the normal person in having a propensity for prolonged sadness; this is the stripped-down minimum definition of a depressive.

There are many possible reasons why depressives differ from other persons. For example, depressives may have experienced especially strong pressure from parents to set and achieve high goals, and in response have come to rigidly believe that those goals must be sought . They may have suffered traumatic loss of parents or others as children. They may have genetically-caused biological makeup's, such as a low energy level, that may easily make them feel helpless. And there are many other possible causes. But we need not further consider the matter because it is the current thinking and behavior patterns that must be changed.

Appendix: On Drug Therapy For Depression

Why not simply prescribe anti-depression drugs--several of which are in the armamentarium of physicians--for all cases of depression? The fact that bodily states may be related to depression suggests the use of drugs to artificially remove neurochemical imbalances, that is, to alter bodily states in such manner as to relieve depression. Indeed, Kline suggested that "physical repair through drug therapy is probably useful even in cases in which the original problem was primarily psychological." (9)

The word "repair" seems overly strong. The most important reason not to rely on drug therapy is that, in the words of one psychiatrist, "The drugs do not cure the illnesses; they control them."(11) As noted earlier, one long-term follow-up study shows that patients treated with cognitive-behavioral therapy in addition to drugs have few recurrences than do patients treated with drugs alone. (11.1 Miller, Norman, and Keitner, 1989)