What You Can Change _. And What You Can't - Martin E. Seligman [50]
After you have read the rest of this chapter about what treatments work for depression, and if you have trouble finding a qualified professional in your area, I welcome your writing me at the Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104. I will try to send you the names of some of the qualified people in your area who do the therapies that work.
THE SYMPTOMS of depression in the questionnaire fall into four clusters.
First, the way you think when you are depressed differs from the way you think when you are not depressed. When you are depressed, you have a dour picture of yourself, the world, and the future. Your future looks hopeless, and you attribute this to a lack of talent. Small obstacles seem like insurmountable barriers. You believe that everything you touch turns to ashes. You have an endless supply of reasons why each of your successes is really a failure. A pessimistic explanatory style2 is at the core of most depressed thinking. You see the causes of your tragedies and your setbacks as permanent, pervasive, and personal (“It’s going to last forever, it’s going to undermine everything I do, and it’s me”), and you see the causes of good events in the opposite way.
The second group of symptoms is a negative change in mood. When you are depressed, you feel awful: sad, discouraged, sunk in a pit of despair. You may cry a lot, or you may even be beyond tears. Life loses its zest. Formerly enjoyable activities become flat. Jokes are no longer funny, but unbearably ironic. Sadness is not the only mood of depression; anxiety and irritability are often present. And when depression gets intense, anxiety and hostility drop away and the sufferer becomes numb and blank.
The third cluster of symptoms of depression concerns behavior: passivity, indecisiveness, and suicide. Depressed people often cannot get started on any but the most routine tasks, and they give up easily when thwarted. A novelist can’t get her first word written. When she finally does manage to get going, she quits writing when the screen on her word processor flickers, and she doesn’t return to her work for a month. Depressed people cannot decide among alternatives. A depressed student phones for a pizza, and when asked if he wants it plain or with a topping, he stares paralyzed at the receiver. After fifteen seconds of silence, he hangs up. Many depressed people think about and attempt suicide.
In depression, even your body turns on you—the fourth cluster of symptoms, somatic. The more severe the depression, the more bodily symptoms. Your appetites diminish. You can’t eat. You can’t make love. Even sleep is affected: You wake up too early and toss and turn, trying unsuccessfully to get back to sleep. Finally the alarm clock goes off, and you begin the new day not just depressed but worn out, too.
To be depressed, you needn’t have symptoms from all four clusters, and it is not necessary that any particular symptom be present. But the more symptoms you have and the more intense each is, the more certain you can be that the problem is depression.
For some of us, these symptoms are rare, descending on us only when several of our best hopes collapse at once. For many, depression is more familiar, a state that descends every time we are defeated. For still others, it is a constant companion, souring even our sweetest times and darkening the grayer times to an unrelieved black.
Until recently, depression was a mystery. Who is most at risk? Where does depression come from? How do you make it lift? All were enigmas. Today, thanks to thirty years of intensive scientific research by thousands of psychologists and psychiatrists in dozens of laboratories and hundreds of clinics around the world, the shape of the answers is known. If someone has severe symptoms of depression, that person might have one of two very different disorders: unipolar or bipolar depression. These provide everyday work for clinical psychologists and psychiatrists. What determines the difference between them is whether