Preliminary remarks

The term melancholia was first used in the fifth century bc by Hippocrates. Based on the ancient doctrine of the four elements, four humours were identified in blood, each of which in excess could lead to problems; thus, the melancholic type suffered an excess of black bile. Whichever type you were though, the treatment was usually the same—bloodletting. Over the subsequent thousand years and more a lot of melancholic individuals lost an awful lot of blood. Galen in the first century ad added further to our knowledge of melancholia, emphasising the occurrence of, in his term, hypochondriacal symptoms in the disorder. He also recorded the first case successfully treated by electricity, an individual who recovered from melancholia after being shocked by an electrical fish. Descriptions of individuals who were clearly depressed can be found for example in the Bible. One such famous account is in the Book of Job, in which Job is robbed by Satan of all his children, his possessions, and his health. These losses lead Job into a state of severe depression (Job, 17:1-2):

My spirit is broken, my days are extinct, the grave is ready for me... He has made me a byword of the peoples, and I am one before whom men spit.

There is even a classic painting by Lucas Cranach the Elder entitled "Melancholie" which depicts a depressed woman harangued by three young children at home while her husband is out hunting with his friends, predating the now well-known Brown and Harris (1978) vulnerability factors for depression by several hundred years!

So what is depression? The diagnostic approach to this question, as represented in the World Health Organization's (1992) International Classification of Diseases— Version 10 and the American Psychiatric Association's (1994) Diagnostic and Statistical Manual—Version IV, typically demands a certain number of symptoms lasting for at least a particular length of time, in the absence of certain other symptoms or conditions. For example, the individual might be required to have something like the following (see Champion, 2000):

1 Depressed mood lasting for at least 2 weeks

Plus at least three of the following:

2

Loss of interest in pleasurable activities

3

Low self-esteem

4

Feelings of guilt

5

Thoughts and/or attempts of suicide

6

Decreased energy

7

Agitation or retardation

8

Sleep disturbance

9

Increase or decrease in appetite

10

Problems with thinking and concentration.

However, while this diagnostic approach might seem eminently reasonable so far (apart from a little arbitrariness about exact numbers and duration of symptoms), the few attractions of the approach are then lost under an avalanche of further distinctions: for example, organic mood disorders, schizoaffective disorder depressive type, bipolar affective disorder, recurrent depressive disorder, persistent mood disorder, and adjustment disorders—to name but some of the distinctions made in ICD-10. The major problem of these systems is that they are deliberately designed to reflect fashion and practice rather than inherent order within nature. Linnaeus' classification of living things and Mendeleev's periodic table of the elements are designed to reflect such inherent order. The upshot is that diagnostic distinctions should be kept to a minimum and that while there may be some evidence in support of conditions such as bipolar disorder (see Chapter 10), such distinctions should only be offered because they have an aetiology and course that is clearly different from the common disorder of unipolar depression that is under consideration (see Power, 2004).

Our view, therefore, as we have stated in Chapters 5 and 6 is that a psychological classification system of the emotional disorders needs to be theoretically based; that the range of such disorders needs to be derived from a shared underlying framework; and that at no point should we lose sight of the fact that emotions lie on dimensions of strength or severity. The definition of disorder may therefore be provided by individuals themselves because they have labelled their experience as such (e.g., Thoits, 1985) or by an expert working with a replicable algorithm. However, the catch is that the experts' definition will cast its net wide over the majority of people in the community who do not define themselves as emotionally disordered even though they may be "depressed", have panic attacks, or whatever. One of the powerful messages from epidemiology is that there is a considerable amount of "caseness" out there that never comes into contact with any professional service (e.g., Bebbington, 2004) and that the "filters" that lead a small minority to seek professional help are many and various, only one of which is the severity of the symptoms experienced.

The epidemiology of depression, as we have noted in earlier chapters, provides such a puzzling picture that almost any simple model can be eliminated by one or other of the statistics. One of the most cited and replicated findings is that there is a 2:1 ratio of women to men who experience the disorder (e.g., Bebbington, 2004; Weissman & Klerman, 1977), a ratio that holds for both clinical samples and untreated community cases (Nolen-Hoeksema, 1990). However, any simplistic biological explanation can be discounted by the fact that the ratio differs significantly according to marital status such that the rates for single men and women are about the same, whereas the rates for married women are highest and those for married men lowest (e.g., Champion, 2000). Additional problems include the following observations: first, that prior to mid-adolescence there is more depression in boys than in girls (Harrington, 2004), with twice as many boys as girls being treated for depression; that the rates of depression appear to be increasing in younger as compared to older age groups, especially for men, and that the rates for depression appear to even out for older adults (Laidlaw, 2004; Nolen-Hoeksema, 1990). In addition, cross-cultural studies further demonstrate that the 2:1 ratio is not obtained consistently either between or within cultures; for example, Jenkins, Kleinman, and Good (1991) reported a number of studies that have found higher rates of depression for women in cultures where the female role is devalued, but significantly lower rates among women in the same culture who reject the traditional roles (see also Tsai & Chentsova-Dutton, 2002).

With these issues in mind, therefore, we turn now to some theoretical considerations of how the SPAARS approach to emotion and emotional disorder might illuminate a number of the problems posed by depression.

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Do Not Panic

Do Not Panic

This guide Don't Panic has tips and additional information on what you should do when you are experiencing an anxiety or panic attack. With so much going on in the world today with taking care of your family, working full time, dealing with office politics and other things, you could experience a serious meltdown. All of these things could at one point cause you to stress out and snap.

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