Depression Has Varied Sources

The otherwise excellent article on clinical depression by Lana Israel ("Students Confront Clinical Despair," feature story, Feb. 8, 1995) contains three issues that could use clarification.

1. While depression is indeed brought about, as Dr. Randolph Caitlin says, by a current loss (of love, relationship, a crucial ideal, a cherished self-image), the converse is not true: Loss does not usually cause clinical depression, but ordinary adaptive grief and sadness. The most comprehensive epidemiological study of depression (G. Brown and T. Harris, Social Origins of Depression, 1978) shows that 90 percent of depressions in women were caused by loss, but only 20 percent of women who experienced loss developed depression. Why? Past experience makes some people vulnerable to depression as a result of loss, while most people are not.

For long-lasting depression, clinical and research-based evidence implicates a combination of family causes and defensive factors: first, experiences during vulnerable childhood years of parental unavailability (often as a result of their own depression, alcoholism or self-involvement), emotional neglect or verbal abuse; and second, the young person's own "characterological" modes of psychological defense (based on withdrawal, self defeat and self-deprivation) that disrupt self-esteem and enjoyment of relationships.

2. The currently popular genetic model of mental disorder has much hearsay but little scientific evidence to support it. Never has any identifiable inheritance pattern--certainly not a straightforward, classical (Mendelian) one--been documented for any disorder or behavioral trait, including manic-depressive illness (MDI); every much-ballyhooed claim for "genetic markers" of MDI has been quietly retracted as a result of further unbiased scientific study. A renowned geneticist, Harvard's Evan Balaban, terms "behavioral genetics" research a "hierarchy of worthlessness."

The tendency of depression to "run in families" is clinically (and logically) more likely to result from relatives' sharing similar environmental influences than from genetics. In their families of origin, children experience the emotional deprivation that leads to later depression and/or learn to be depressed by identifying with depressed parents. Nonetheless, many children who develop more adaptive defense escape depression, even when they grow up in a depressive family.

It is tragic to me how many students worry without case about their "genetic loading" for the "biochemical imbalances" that supposedly result in depression. The autosuggestive and "self-fulfilling prophecy" powers of the mind are far more relevant to human suffering than genetics. Bad science can be bad for your mental health!

3. While brief psychotherapy is usually sufficient to resolve situational depression (as Israel states), long-term insight-oriented psychotherapy is often the treatment of choice for characterologic depressions. We do see students over time at the Bureau of Study Counsel, subject to assessment and availability of staff time (not on demand). Occasional instance in which therapy does not work out can often be ascribed to a student's natural anxiety or effort at self-protection, as with the English concentrator who "started to get really really scared, afraid to get into anything personal."

Thank you for your fine article, and for this opportunity to respond to it. Charles P. Ducey, Ph.D.   Director, Bureau of Study Counsel   Assistant Clinical Professor of Psychiatry Harvard Medical School