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Chronic Depression Interpersonal Sources Therapeutic
Solutions 1st Edition Jeremy W. Pettit Digital Instant
Download
Author(s): Jeremy W. Pettit, Thomas E. Joiner
ISBN(s): 9781591473060, 1591473063
Edition: 1
File Details: PDF, 12.09 MB
Year: 2005
Language: english
 Chronic
Depression
INTERPERSONAL SOURCES,
THERAPEUTIC SOLUTIONS

Jeremy W.Pettit
Thomas E. Joiner

A M E R I C A N P S Y C H O L O G I C A L A S S O C I A T I O N

W A S H I N G T O N , DC
Copyright © 2006 by the American Psychological Association. All rights reserved. Except
as permitted under the United States Copyright Act of 1976, no part of this publication
may be reproduced or distributed in any form or by any means, including, but not limited
to, the process of scanning and digitization, or stored in a database or retrieval system,
without the prior written permission of the publisher.

Published by
American Psychological Association
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Washington, DC 20002
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Psychological Association.

Library of Congress Cataloging-in-Publication Data

Pettit, Jeremy W.
Chronic depression: interpersonal sources, therapeutic solutions / Jeremy W. Pettit and
Thomas E. Joiner.—1st ed.
p. cm.
Includes bibliographical references and index.
ISBN 1-59147-306-3
1. Depression, Mental. 2. Interpersonal psychotherapy. I. Title.

RC537.P438 2006
616.85'27—dc22 2005008956

British Library Cataloguing-in-Publication Data

A CIP record is available from the British Library.

Printed in the United States of America

First Edition
To Dolores, for encouraging me to pursue those things of importance.
Jeremy W. Pettit

To Ezekiel, Malachi, and Graciela, con amor.

Thomas E. Joiner
 CONTENTS

Acknowledgments ix

Chapter 1. Depression Chronicity: Perspectives on Forms

and Reasons 3

Chapter 2. Depression as a Persistent and Recurrent Scourge 13

Chapter 3. Stress Generation 27

Chapter 4- Negative Feedback-Seeking 41

Chapter 5. Excessive Reassurance-Seeking 55

Chapter 6. Interpersonal Conflict Avoidance 73

Chapter 7. Self-Handicapping 85

Chapter 8. Blame Maintenance 95

Chapter 9. Stable Vulnerabilities 105

Chapter 10. The Complex Interplay of the Factors 119

Chapter 11. Application to a Depression-Related Disorder:

Bulimia 127

Chapter 12. Clinical Assessment 137

vii
Chapter 13. Therapeutics 151

Chapter 14. Prevention: The Potential to Save Lives 165

References 171

Index 203

About the Authors 213

viii CONTENTS
 ACKNOWLEDGMENTS

Many factors contribute to the development of books like this one:

education and academic interests, research pursuits, and clinical and per-
sonal experiences, just to name a few. While recognizing the influence of
each of those, we specifically highlight the importance of our interactions
with chronically depressed persons. These interactions fully embody the two
components at the heart of this book—chronic depression and interpersonal
relationships. We are grateful to our patients for teaching us much about
depression, for reminding us that we still have much to learn, and for repeat-
edly showing us the joy of growth and change. Our primary goal in undertak-
ing the writing of this book is to further contribute to the body of ongoing
work aimed at ameliorating and ending the painful, chronic scourge of
depression.
In addition, I, Thomas E. Joiner, owe my development as a scientist,
scholar, psychologist, and writer to a group of colleagues, friends, and stu-
dents who, taken together, represent a true cornucopia of inspiration, talent,
knowledge, and support. What a bounty! They include Lyn Abramson, Lauren
Alloy, Steve Beach, Tim Beck, Jan Blalock, Jim Coyne, Anders Ericsson,
Connie Hammen, Todd Heatherton, Jenny Katz, Al Lang, Chris Lonigan,
David Rudd, Bill Sacco, Natalie Sachs-Ericsson, Brad Schmidt, Kristen
Schmidt, Bill Swann, Katie Vohs, and Karen Wagner. My graduate students
Marisol Perez, Jeremy W. Pettit, Zach Voelz, and Rheeda Walker see to my
continued development.
I want to single out Jerry Metalsky, who, through long and patient SPSS
sessions on the mainframe in Austin (and many, many other exchanges),
somehow forged links in my mind interconnecting the minutiae of data analy-
sis with the grandeur of theory and philosophy, and with everything in
between.
 Works like this are hounded by distractions: I am thankful to Rob
Contreras, Janet Kistner, and Karen Wagner, who, in various ways and at
various stages, kept these hounds at bay.
I am also grateful to Margaret Sullivan and APA Books for their initial
belief in the project and ongoing support of it.
My family, Graciela, Malachi, and Ezekiel, to whom this book is lov-
ingly dedicated, not only tolerate my professional excesses but also seem to
encourage and enjoy them, and definitely inspire them.

PREFACE
 Chronic
Depression
 DEPRESSION CHRONICITY:
1
PERSPECTIVES ON FORMS
AND REASONS

This book develops a new explanatory framework for chronic depres-

sion that is based, where possible, on psychological science. The framework
rests on the premise that depression appears to include self-sustaining pro-
cesses, that these processes may be, at least in part, interpersonal, and that
understanding of these processes from an interpersonal standpoint may be
useful in applied settings. The book thus builds on this framework to develop
clinical implications.
The audience for the book should, therefore, include anyone who is
concerned with depression; as we argue in chapter 2, most everyone should
be concerned with depression because it cuts such a wide societal swath. The
writing style is thus intended for as wide as possible an audience; the content,
however, is intended to be of direct use to people on depression's "front line"
(e.g., psychological and other scientists, psychologists, psychiatrists, social
workers, nurses, licensed professional counselors, marriage and family coun-
selors) and mental health trainees (i.e., psychology graduate students, psy-
chiatric residents, and others in training). In writing this book, we draw from
a large base of empirical research on interpersonal processes in depression,

3
much of which has focused on depressed women, and much of which has not
examined potential ethnic and cultural differences. The research emphasis
on ethnic majority women is due in part to the higher rates of depression
among women (discussed in chap. 2) and in part to practical issues of obtain-
ing research participants, but it also reflects the need for more investigation
of depression in men and members of ethnic minority groups. Evidence thus
far suggests that the processes outlined in this book may work similarly among
women and men from different ethnic backgrounds, although we emphasize
the importance of further study in these areas.
In addition to the book's foundation on research, there are also specu-
lations included herein; we believe they are reasonable ones, and we label
them as speculations in the book, but ultimately, the judgment as to whether
they are reasonable and useful is left to subsequent psychological and clinical
science.
We begin with a discussion of the chronic nature of depression, includ-
ing the forms depression chronicity can take and current explanations for
why depression is often a chronic problem. We present this discussion first
because depression chronicity represents the heart of this book. In chapter 2,
we examine depression in broader terms to address questions like what is
depression, what is its typical course, and how prevalent is it?

FORMS OF CHRONIC DEPRESSION

There is good reason to emphasize the chronic nature of depression.

First, some forms of depression, such as dysthymia, are chronic by definition
(at least 2 years' persistence in the case of dysthymia). Second, depression
appears to be persistent within an episode, and, once it finally lets up, it
tends to come back. Depression is both persistent within episodes and recur-
rent across episodes.
In general, three forms of depression chronicity can be distinguished.
The first has to do with the fact that depression lasts so long (i.e., it is persis-
tent within a particular episode). This dimension of depression chronicity is
of obvious importance in that long episodes involve prolonged experience of
the most acute, painful, and debilitating aspects of depression. As we explain
in chapter 2, the average episode length of major depression is around 8 months
in adults, and is similar or even longer in youth.
It is worth dwelling on this point. The most severe, acute, impairing,
and painful aspect of major depression lasts months. There are other acutely
painful conditions (e.g., stomach flu), but there are few that are acutely pain-
ful for such an extended period of time (e.g., the stomach flu remits in 72
hours or so). Of course, several months is the average episode length; those
who experience above-average episode lengths may face years of suffering
and impairment.

4 CHRONIC DEPRESS/ON
 The story with dysthymia is equally astounding. What dysthymia lacks
in acute pain (it is a low-grade depression) it makes up for in sheer length of
episodes. The average length of dysthymic episodes is around a decade, and it
is relatively common for people in their 40s and older to report decades-long
dysthymias (e.g., a woman in her 50s who had experienced persistent, low-
grade depressive symptoms since her teens; a 40-year episode!).
Therefore, episode length or duration is an important form of depres-
sion chronicity. As noted earlier, once depression finally does go away, it
tends to return. The two other important forms of depression chronicity have
to do with depression's return.
Recurrence is defined as the reestablishment of clinical depression fol-
lowing a diagnosis-free period. Someone who recovers fully from a past de-
pression, but then experiences a future depression, can be said to have expe-
rienced a recurrence. Recurrence, too, is of considerable importance, in that
it can affect substantial portions of people's lives (Lee & Murray, 1988).
There are times when people get somewhat better from a past depres-
sion, but some depressive symptoms remain nonetheless. Someone who par-
tially recovers from a past depression but then experiences a subsequent de-
pression is said to have experienced a relapse. Relapse is the resumption of
symptoms in the vulnerable timeframe just following remission of a depres-
sive episode. Here, as with recurrence and with episode duration, depression
relapse is an important concept in that it conveys the very chronic nature of
depression.
There is an important distinction among these three forms of depres-
sion chronicity. In a scenario in which someone is experiencing a long-last-
ing episode, depressive symptoms are an obvious part of the clinical picture.
So, too, with relapse: The person has partially recovered, but depressive symp-
toms remain. In both of these cases, depressive symptoms are part of the
picture. Depression recurrence, however, is different. By definition, recur-
rence includes a period of time when symptoms were not present (i.e., the
person has fully recovered).
Why is this an important distinction? Several theorists have argued
that depressive symptoms have a way of sustaining themselves. In this view,
it is as if depression "feeds off itself," "maintains its own momentum," and
"self-amplifies." A key argument of this book is that these self-sustaining
processes in depression may be interpersonal in nature. But for something to
sustain itself, it has to be there in the first place. Most of the interpersonal
explanations provided here thus apply to episode duration and to relapse (when
some depressive symptoms are present), but they may not apply equally well to
recurrence (when depressive symptoms have been absent for a period of time).
For each of the interpersonal factors described in the following chapters, appli-
cation to episode duration versus relapse versus recurrence is noted.
Although not specifically a form of depression chronicity, one other
fact about depression deserves mention. As pernicious and chronic as it can

DEPRESSION CHRONICITY 5
be, it can also spontaneously disappear (i.e., spontaneous remission). A power-
ful view of depression chronicity will have at least something to say about
spontaneous remission; this too is addressed in later chapters on the interper-
sonal factors.

SOME CURRENT EXPLANATIONS

FOR DEPRESSION CHRONICITY

Three forms of depression chronicity (i.e., episode duration, relapse,

and recurrence) have been defined, but an explanation as to why depres-
sion is chronic has not been. The remainder of this book turns to an inter-
personal explanation of depression chronicity, but first, other explanations
are summarized.

Scarring and Erosion

A very intriguing explanation for why depression lasts so long is that a
past episode of depression leaves a type of permanent "scar" that represents a
vulnerability for future depression. Stated another way, past depression erodes
protections against future depression. The central idea of this perspective is
that a depressive episode erodes personal and psychological resources such
that episodes may be lengthened and, on recovery, the formerly depressed
individual is left with fewer buffers to protect against future depression. This
is an intuitively appealing view because health problems often operate in just
this manner, as anyone who has injured a joint and then reinjured the same
joint, can tell you.
Consider, for example, a generally optimistic man who experiences a
string of negative life events, including job loss and divorce, and subsequently
experiences his first depressive episode. His depression is replete with pessi-
mism and hopelessness (common symptoms of depression) as well as the ten-
dency to blame himself for all of the stress he is experiencing. His extreme
focus on all things negative drives others away from him and prevents him
from pursuing opportunities that might reduce his depression. For instance,
he skips job interviews because he believes he that no employer will hire "a
loser like me." Consequently, he remains inactive, alone, and depressed, mired
in a slough of pessimism.
Eventually, his depression begins to lift (as most do), and he resumes a
degree of normal functioning. Nevertheless, he remains relatively pessimis-
tic about life, about his worth as a person, and about his future job and rela-
tionship prospects. On the occurrence of further setbacks and negative life
events, his pessimism is reaggravated to the point that he rapidly falls back
into depression. In this sense, the experience of depression left him with a
scar of pessimism that both prolonged his depressive episode and increased
the likelihood of experiencing future episodes.

6 CHRONIC DEPRESSION
 Do scenarios like the one just described actually occur? Despite the
intuitive appeal of the scarring model, there are questions about whether
scar and erosive explanations stand up to empirical scrutiny. This view has
been applied primarily to the domains of personality, cognitive style, and
neurobiology, with varying degrees of empirical attention and support.
The possibility that depression changes personality has received the
most empirical attention, and findings are mostly unsupportive of the ero-
sive perspective. In a compelling test of the prediction that a depressive epi-
sode would change personality, Shea, Leon, Mueller, and Solomon (1996)
conducted a 6-year study of a group of people who, at the outset of the study,
were nondepressed and had no past history of depression. At the study's con-
clusion, those who experienced their first-episode of depression during the
6-year study were compared with those who remained well. No support for the
erosive perspective was obtained: The amount of personality change—for
the better or for the worse—was not different between the groups. The Shea
et al. study replicates earlier findings by Rohde, Lewinsohn, and Seeley (1990)
and Zeiss and Lewinsohn (1988). It is interesting to note that few studies on
this question have been conducted among children and adolescents, perhaps
because of the complexities of conceptualization and measurement of per-
sonality among youth. As exceptions to this, Ge and Conger (1999) found
that psychological distress and emotional problems in early adolescence pre-
dicted personality levels of positive and negative emotionality in late adoles-
cence, and Rohde et al. found that self-rated social skills remained lower
after recovery from a depressive episode. Drawing from those studies, one can
make an interesting speculation that depression may erode personality resources
in youth but not adults, because personality may be more malleable in youth
than in adults. In adults at least, depression apparently does not erode person-
ality strengths; depression does not appear to leave a personality scar.
It may, however, erode cognitive and attributional resources, such as
the ability to maintain optimism or to explain the causes of life events in
optimistic ways. This appears to be particularly the case among children but
may not apply to adults (e.g., Hamilton & Abramson, 1983), perhaps be-
cause children's cognitive style is more malleable than that of adults (Turner
& Cole, 1994). In the most comprehensive studies on this issue, Nolen-
Hoeksema, Girgus, and Seligman (1986, 1992) found that the attributional
styles of depressed children deteriorated and did not later ameliorate, even
on remission of symptoms. These results are consistent with the model of
Segal, Williams, Teasdale, and Gemar (1996), who theorized that negative
cognitive patterns, once used and practiced, become more and more easily
activated. With regard to cognitive style, then, depression may be erosive.
We elaborate on this point in our chapter on the interplay of propagatory
and erosive processes (chap. 10).
Beck (1996) hypothesized that a key depression-related phenomenon,
suicidality, may operate similarly. Briefly, Beck theorized that previous sui-

DEPRESSION CHROMCITY 7
cidal experience sensitizes suicide-related thoughts and behaviors such that
they later become more accessible and active. The more accessible and ac-
tive the schemas and modes become the more easily they are triggered (even
in the absence of negative events), and the more severe are the subsequent
suicidal episodes. In recent research, we and our colleagues have found that
as past suicide attempts accumulate, subsequent episodes of suicidality take
on distinct qualities, including stress-independence and a particularly unpre-
dictable course (Joiner & Rudd, 2000; Rudd, Joiner, & Rajab, 1996).
Similar to the cognitive models of Segal et al. (1996) and Beck (1996),
Post (1994) has theorized that the experience of acute stress or of a depres-
sive episode may leave behind "memory" traces at the level of gene expres-
sion that heighten subsequent vulnerability. The model thus proposes a neu-
robiological sensitization process in which the underlying biological
mechanisms responsible for depression-free functioning are permanently
eroded, thus sensitizing the individual to stress. As the individual becomes
more sensitized, less stress is required to trigger a depressive reaction.
The erosive perspective, with regard to cognitive style and neurobiol-
ogy (but probably not to personality), holds promise with regard to explain-
ing depression chronicity and guiding clinical interventions (e.g., rehabili-
tating eroded domains of functioning). The perspective is limited, however,
by a small empirical base. An additional difficulty is that there are features of
depressive chronicity that the perspective does not adequately explain. For
example, why is it that interpersonal factors, arguably above all others (e.g.,
Hooley & Teasdale, 1989), comprise very strong predictors of depression
chronicity? Once erosion has occurred, the resulting sensitivities should be
similarly impinged on by an array of stressors, interpersonal and
noninterpersonal alike.
Yet, interpersonal factors are among the strongest predictors of depres-
sion chronicity. Hooley and Teasdale (1989) reported that perceived criti-
cism was a powerful predictor of relapse. People with more interpersonal prob-
lems experience longer duration of depressive episodes (Hale, Jansen, Bouhuys,
Jenner, 6k van den Hoffdakker, 1997). Lara, Leader, and Klein (1997) found
that social support was predictive of recovery from depressive episodes, even
controlling for common clinical variables, such as episode severity and the
presence of "double depression." Impaired relationships predict long-lasting
episodes of several disorders, including depression (Miller, Ingham, Kreitman,
6k Surtees, 1987). Interpersonal problems have also been implicated in chro-
nicity of a depression-related disorder, bulimia nervosa (e.g., Steiger, Leung,
& Thibaudeau, 1993), discussed in detail in chapter 11.
The erosion-scarring perspective does not fully explain why interper-
sonal factors, as opposed to other forms of life stress, appear to be closely
related to depression chronicity. Moreover, there are features of depression's
aftermath that are not best described as mere diminutions of resources but,
rather, appear to be active, motivated processes that propagate life problems

8 CHRONIC DEPRESSION
and depression (depression feeding off itself). These latter processes, described
in chapters 3 through 8, are, in the main, actively performed by the depres-
sion-prone person, whereas erosion happens to the person—a passive pro-
cess. Depression not only may erode existing resources but also may "build
up" processes that maintain depression vulnerability. These latter processes—
the building of depression-maintaining patterns—as well as the suggestion
that they are interpersonal in nature, compose the heart of this book.
As a prelude to following chapters, reflect back on the man whose opti-
mism was eroded by a depressive episode. This was a passive process in that it
happened as a result of depression. As we briefly have alluded to, and expand
on in chapter 3, his pessimism then drove others away from him, creating the
risk factor of decreased social support. How did this happen? It was an active
interpersonal process of communicating his hopeless outlook to others. As
others grew weary of hearing his negative views on life and himself, they
distanced themselves from him. In this sense, the interpersonal expression of
his pessimism built up problems in his social network, which likely length-
ened his current depressive episode and increased his risk for future episodes.

Stable Vulnerabilities

Another important perspective on depression chronicity is that people

are persistently depressed because they possess persistent vulnerability fac-
tors. Chapter 9 expands on this perspective in more detail, but as a preface,
there are several genetic—neurobiological as well as psychological vulnerabil-
ity factors postulated to be stable risks for depression.
Regarding genetic-neurobiological factors, it appears that unspecified
genetic factors contribute to—but do not fully account for—the develop-
ment of depression. Adoption and twin studies show that genetic factors
make up approximately 40% of the risk for becoming depressed (Kendler,
Neale, Kessler, & Heath 1992). The nature of this risk (i.e., its location on
the genome; its mechanism of action) is not well understood.
Dysregulations of serotonin neurotransrrdtter systems, as well as of the
hypothalamic-pituitary-adrenal axis (which regulates cortisol levels), have
also been proposed as a stable depression risk. There is little question that
serotonin and cortisol levels are altered during depressive episodes (and re-
lated phenomena such as suicide). It is interesting to note that animals de-
feated in social skirmishes display behavioral and neurochemical similarities
to depressed people (e.g., Mehlman et al., 1995; cf. Price & Gardner, 1999,
social competition view of depression). However, there is little persuasive
evidence that dysregulation of these systems provides a full account of
depression's causes.
Regarding psychological explanations (covered more fully in chap. 9),
these theories can be grouped into those emphasizing cognitive vulnerability
factors (e.g., pessimism), those emphasizing interpersonal vulnerability fac-

DEPRESSION CHRONICfTY 9
tors (e.g., excessive dependency), and those emphasizing personality-based
vulnerability factors (e.g., high neuroticism, low extroversion). As with ge-
netic—neurobiological explanations, psychological approaches have made some
progress but cannot claim to provide a complete account of depression's causes.
As with erosion—scarring, the stable vulnerability perspective does not
easily explain depression's chronicity, including its apparent tendency to pro-
long itself. If people are persistently vulnerable, why do they have depres-
sion-free periods? One answer to this question is that stable vulnerabilities
only eventuate in depression when activated, for example, by the occurrence
of negative life events. Consider a person who has been shy "since birth." As
we discuss in chapter 6, shyness represents a stable vulnerability for depres-
sion. However, this person is not always depressed; rather, shyness only ap-
pears to promote depression when the person also feels lonely (Joiner, 1997),
perhaps after the termination of a romantic relationship. In this case, the
stable vulnerability (shyness) must be activated by some stressor (romantic
breakup) to produce depression. Although the notion that stable vulner-
abilities like shyness only lead to depression in the context of some stressor is
a reasonable view, it does not account for the finding that some shy (or oth-
erwise vulnerable) people experience depression independent of negative life
events.
Partly in response to this quandary, a main purpose of this book is to
explore interpersonal mechanisms whereby depression prolongs itself, even
in the absence of external causes like negative life events. Other theorists,
too, have focused on the self-propagating nature of depression (although not
from an interpersonal perspective). For example, Lyubomirsky, Caldwell, and
Nolen-Hoeksema (1998) have shown that the tendency to ruminate about
negative things in response to a negative mood prolongs the mood and may
serve as an entryway to full-blown episodes of depression (which themselves
may be prolonged because of rumination). These researchers have shown, for
example, that people who experience negative moods and who ruminate
during negative moods recall more painful autobiographical memories. These,
in turn, may only exacerbate negative mood, encourage further rumination,
and prolong dysphoria and possibly depression.
Somewhat similarly, Pyszczynski and Greenberg (1987) have maintained
that potentially depressed people become caught in a cycle of excessive self
focus, which leads to an increase in negative affect, self-blame, self-criticism,
and the like. As a result, self-image may become more negative, and this new,
negative self-image is sustained by the "depressive self-focusing style." Both of
these models of depression chronicity are examined further in chapter 9.

SUMMARY
There are three forms of depression chronicity: episode duration, re-
lapse (i.e., when one becomes depressed again after incomplete symptom

10 CHRONIC DEPRESSION
remission), and recurrence (i.e., when one becomes depressed again after
complete symptom remission). There are several current explanations of de-
pression chronicity, including scarring-erosion and stable vulnerabilities. Al-
though the perspective offered in this book is different from current explana-
tions, there is potential compatibility among the various perspectives, and
chapter 10 is devoted to exploring this topic.
Chapter 2, presented next, describes depression in depth, addressing
the nature, course, and prevalence of the disorder. We view this as an essen-
tial background that is necessary to understand prior to an exploration of
interpersonal processes in depression. In chapters 3 through 8, six processes
are described, each of which may represent a contributory factor as to why
depression may, in a sense, sustain itself. It is noted that the six processes
differ from one another with regard to the empirical attention paid to each;
nonetheless, each at least holds promise in explaining the pernicious phe-
nomenon of depression chronicity. The first, stress generation (defined as con-
tributing to the occurrence of one's own negative life events, especially nega-
tive interpersonal events), is viewed as a broad, higher order concept that is
inclusive of several of the other five processes, and thus is described first, in
chapter 3.

DEPRESSION CHRONICITY 11
 2
DEPRESSION AS A PERSISTENT
AND RECURRENT SCOURGE

The nature, definition, epidemiology, consequences, and comorbidity

of depression deserve a book unto themselves (and have several). The goal of
this chapter is not to exhaustively review each of these voluminous litera-
tures. Rather, this chapter touches on several important facts about depres-
sion, exploring some in more depth than others, so that subsequent chapters
on an interpersonal view of depression chronicity are set in a broader con-
text, and so that chapters 12 and 13 on assessment and treatment are fore-
shadowed. The chapter's perspective is thus selective and is not intended as
comprehensive.

MOOD DISORDER NOSOLOGY: WHAT IS DEPRESSION?

The Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; 3rd
ed., rev.; 4th ed.; DSM-III; DSM-III-R; DSM-IV; American Psychiatric
Association, 1980, 1987, 1994) defined major depression as a condition that
(a) is relatively persistent (e.g., symptoms occur more days than not for at
least 2 weeks), (b) is associated with significant distress and impairment, and

13
(c) includes a majority of the following symptoms: loss of capacity for plea-
sure (anhedonia), sadness, low energy, suicidal thoughts or behaviors, sleep
disturbance, appetite disturbance, psychomotor disturbance (slowing or agi-
tation), concentration difficulty, and feelings of guilt or worthlessness. As
we point out in the chapters that follow, major depression is a chronic condi-
tion, but less so than dysthymia, that can be viewed as a low-grade, more
chronic version of major depression. The DSM definition for dysthymia is
that depressed mood has persisted (most of the day, more days than not) for
at least 2 years, accompanied by at least two of the following: low energy,
sleep disturbance, appetite disturbance, concentration difficulty, low self-
esteem, and feelings of hopelessness.
Major depression can be superimposed on dysthymia. For example, con-
sider a patient who has had depressed mood more days than not for about 4
years, accompanied by energy and concentration problems (i.e., has dys-
thymia). This patient's symptoms become precipitously much more severe
and expand to include sleep and appetite disturbance, suicidal thoughts, and
psychomotor retardation. A major depression has developed in addition to
the dysthymia, a phenomenon termed double depression. Double depression is
not a formal term in the DSM—IV but is worth noting because patients who
experience double depression may respond to treatment more slowly than
patients with major depression or dysthymia alone.
This book presents an interpersonal view of major depression, dysthymia,
and related chronic mood problems. The DSMs present useful definitions of
these phenomena. It is important to note, however, that the DSM defini-
tions are works in progress and are defined by committed consensus. Al-
though things like major depression and dysthymia seem to exist in nature,
precise, scientifically supported definitions have been difficult to come by.
Can it seriously be questioned that major depression, as defined in cur-
rent class ificatory systems such as the DSM—IV (American Psychiatric Asso-
ciation, 1994), represents a true and valid construct? From diverse perspec-
tives ranging from the genetic (Kendler et al., 1996) to the interpersonal
(Coyne, 1976a), the construct enjoys considerable support. To take just one
example, Kendler et al. (1996) have shown that "typical depression," similar
in composition to major depression, can be discerned as a syndromal class,
distinct from nondepression as well as from "atypical depression" (character-
ized by increased eating and sleep), among a large sample of women from a
population-based twin registry. These and other results, when added to the
actuarial, historical, grantmaking, industrial, and conventional momentum
enjoyed by the concept of major depression, combine to make it a formidable
concept indeed.
Yet, despite all this, there are disquieting strands of evidence and
thought. For example, is depression a category, an all-or-none, "either-you-
have-it-or-you-don't" phenomenon, similar to heart attack, or, a clearer ex-
ample, biological gender? Or is depression a continuum distributed along a

H CHRONIC DEPRESS/ON
graded dimension, similar to temperature or mass, where a thing can have
very little of it, or a little more of it, and so on up to having very much of it?
On the categorical view, there is a gap in nature between those who
have depression and those who do not. Those who have it are categorically
different from those who do not. By contrast, on the continuum view, we are
all in the same boat, just at different places along the boat. That is, depres-
sion applies to all of us, just in varying degrees.
Those who assert that depression is categorical (and they are legion)—
and, for that matter, those who assert that it is a dimensional continuum—
all display a lack of awareness that this is, at bottom, a taxometric question.
The whole point of taxometrics, developed by Waller and Meehl (1998), is
to discern categories (i.e., taxa) from dimensional continua and to establish
the true indicators and base rates of established taxa. The technique capital-
izes on the brilliant insight that any reasonably valid indicators of a potential
taxon behave in a certain way—they intercorrelate in samples in which taxon
members and nonmembers are mixed, and they do not correlate in pure
samples of taxon members or in pure samples of taxon nonmembers.
What, then, is the verdict of the taxometric jury? If ever a jury were still
out, it is this jury. A handful of early studies that used taxometric methods to
examine depression had important methodological limitations and did not
assess major depressive disorder (MDD) per se (e.g., Franklin, Strong, &
Greene, 2002; Grove, Andreasen, Young, & Endicott, 1987; Haslam & Beck,
1994; Whisman & Pinto, 1997). As such, they had little conclusive to say
about the taxonicity of clinical depression. Two additional taxometric stud-
ies on depression stand out in terms of their quality but have reached differ-
ent conclusions (Beach & Amir, 2003; Ruscio & Ruscio, 2000,). Ruscio and
Ruscio found some evidence of depression taxonicity using self-reported de-
pressive symptoms but concluded that the majority of their findings sup-
ported a dimensional view (see also Hankin, Fraley, Lahey, &. Waldman,
2005, for similar results among depressed youth). Beach and Amir (2003)
examined MDD and reached different conclusions. Crucially, they distin-
guished between symptoms of mere distress and hallmark symptoms of MDD
(e.g., depressed mood, anhedonia) and found evidence for taxonicity of hall-
mark symptoms but not of general distress symptoms (see also Ambrosini,
Bennett, Cleland, & Haslam, 2002, for a similar finding in adolescents). This
raises the possibility that depression is taxonic but that most studies to date
have not used rigorous enough indicators to detect depression taxa. Research-
ers who are interested in whether depression represents a continuum or a
discrete category would do well to learn and apply taxometrics; in this as in
all areas, mere assertion is not good enough and may even retard progress. It
is disquieting that this basic question is currently unresolved (and has hardly
even been broached regarding dysthymia).
As another disquieting example, it is well-known that depression is a
very heterogeneous thing—well over 200 different possible combinations of

DEPRESSION AS A PERSISTENT AND RECURRENT SCOURGE 15

symptoms all satisfy the current definition of just one form of depression—a
bewildering array of manifestations for a supposedly singular entity (whether
continuous or dichotomous). Buchwald and Rudick-Davis (1993) found that
of the 227 possible combinations of symptom presentations for DSM-1II-R
major depression, 42 were represented among their sample of depressed people,
and 26 of these 42 were single occurrences (i.e., a combination of symptoms
that occurred in only one person in the sample).
Resolution of fundamental definitional issues is a virtual prerequisite of
real progress in science. A lurking but neglected issue in depression research,
then, is the very definition of the syndrome in the population at large, not to
mention the possibility that the properties of the syndrome may vary in dif-
ferent subpopulations (e.g., older people). And there is some reason to sus-
pect that depression's properties may differ in certain subsets of people. Re-
garding late-life populations—for example, depressions that first occur
in later life, as compared with those that first occur in early adulthood—
occurrences may be about equally common in men and women (whereas
"early" depressions are more common in women; Krishnan, Hays, Tupler, &
George, 1995). In addition, late-life first occurrences are less associated with
first-degree relatives' depression risk (Bland, Newman, & Orn, 1986); more
related to neurological or medical disease (Alexopoulos, Young, Meyers,
Abrams, & Shamoian, 1988); less severe (Burvill, Hall, Stampfer, &
Emmerson, 1989); less associated with suicidal and anxious symptoms
(Cassano et al., 1993); and less related to personality problems, such as ex-
cessive dependency and avoidance (Abrams, Rosendahl, Card, &
Alexopoulos, 1994).
Definitional problems plague depression research. As the search for true
and deep definitions evolves (using, one would hope, taxometrics), how should
we proceed in the meantime? A workable approach is to fall back on DSM-
like working definitions of major depression and dysthymia but, at the same
time, to avoid the trap of viewing these as the final word in depression noso-
logy. Throughout this book, then, research on and therapeutics for major
depression and dysthymia is emphasized but so too is research on subsyndromal
depressive symptoms as they occur in unselected populations (e.g., commu-
nity participants, college undergraduates).

THE COURSE OF DEPRESSION

Course—the way that a disorder "behaves" over time—is informative

for a number of reasons. Clinically, it can aid in differential diagnosis. Imag-
ine, for example, that a mother brings her son to a pediatrician's office and
says, "He's irritable, down on himself, fidgety, and his teachers say he's not
paying attention in class." From this description alone, depression is a diag-
nostic possibility—depressed kids are irritable, have self-esteem problems,

16 CHRONIC DEPRESSION
can be agitated, thus, fidgety, and have concentration problems. But another
good possibility is attention-deficit/hyperactivity disorder (ADHD)—
children with ADHD also can be moody, fidgety, and inattentive. How does
one discern between these possibilities? The following question may do the
trick: "Is he always like this, or do these problems come and go?"
Mothers of ADHD boys will often reply "he's been like this since he
was a baby," whereas mothers of depressed boys may reply "the problems are
really bad at times but disappear at other times." (Children can both be de-
pressed and have ADHD, a complicated diagnostic picture.) The reply of the
mother of the ADHD boy conveys a constant and persistent course, with
little variation in symptom picture; the reply of the mother of the depressed
boy conveys an episodic, recurrent course, in which symptoms come and go
in episodic and recurrent fashion. Knowing symptoms' course can aid in dif-
ferential diagnosis, even in situations in which the current symptom picture
is consistent with more than one diagnosis.
Major depression's course is episodic and recurrent. The disorder comes
and goes; at times it is in full swing, with numerous and severe symptoms; at
other times, it is mild or moderate, with symptoms present but less notice-
able; and at still other times, it is absent, with symptoms in full remission.
Dysthymia, by contrast, has a less episodic, more chronic course. The symp-
toms of dysthymia tend to remain at relatively constant levels, with little
variation over time.
The implications of depression's course for an interpersonal explana-
tion of depression chronicity are discussed in chapter 1. There, we present a
main argument of this book, that depressive symptoms have a way of sustain-
ing themselves. Depression appears to "feed off itself," a process that we ar-
gue may be interpersonal in nature.

DEPRESSION AND ANXIETY CO-OCCUR

Although depression can co-occur with an array of other conditions

(e.g., substance use disorders, personality disorders), there is reason to single
out its relation to anxiety and its disorders. First, the co-occurrence of de-
pression and anxiety is very common. As many as 50% of people with major
depression also experience an anxiety disorder (Regier, Rae, Narrow, Kaelber,
& Schatzberg, 1998). Second, it is possible that this co-occurrence relates to
the same underlying cause for depressive and anxiety disorders (Kendler,
Neale, Kessler, 6k Heath, 1992). For example, Kendler et al. found that the
same genetic factors are implicated in the development of MDD and gener-
alized anxiety disorder, although environmental factors differed between the
two disorders. Third, comorbid depression and anxiety are more clinically
complicated than depression or anxiety alone (e.g., the prognosis can be worse,
and suicidality and general impairment greater, for those who are comorbid

DEPRESSION AS A PERSISTENT AND RECURRENT SCOURGE 17

vs. those who are not). We return to this point in chapter 13 on therapeutics.
Fourth, depressive and anxious symptoms are phenomenologically similar,
to the point that it can be difficult to discern one from the other. In this
regard, a useful heuristic is Clark and Watson's (1991; Mineka, Watson, &
Clark, 1998) tripartite model of depression and anxiety. The model posits
that both depression and anxiety disorders are characterized by a shared, non-
specific factor of general negative affect and that each disorder includes a
specific, nonshared component. In particular, depression is distinguished by
anhedonia (low positive affect), and each anxiety disorder is characterized
by its own unique component (e.g., physiological hyperarousal is specific to
panic disorder). Empirical support for the model is promising (Clark, Steer,
& Beck, 1994; Joiner, Catanzaro, & Laurent, 1996; Steer, Clark, Beck, &
Ranieri, 1995; Watson, Clark, et al., 1995; Watson, Weber, et al, 1995). We
return to the tripartite model in chapter 12 on clinical assessment, because
the measures associated with the model can be very useful in making the
often difficult distinction between depressive symptoms alone, anxious symp-
toms alone, and their co-occurrence.

THE (INCREASING) PREVALENCE OF DEPRESSION

At any given time, somewhere between 4% and 10% of the popula-

tion experience major depression or dysthymia, with lifetime prevalence
rates somewhere around 20%. With regard to depression prevalence, an
enormously important age-related phenomenon may be occurring
(Seligman, 1998). If, in the late 1990s, you are about 70 years old, the
chance that you have experienced depression in your lifetime is about 2%.
If, in the late 1990s, you are in your 50s, your lifetime chance of depression
is approximately 5%. Despite fewer years in which to get depressed, this
younger group is nonetheless about twice as likely to have experienced de-
pression. This is remarkable enough, but the same pattern continues as
younger and younger groups are examined. Those in their 30s in the late
1990s experience approximately an 8% risk of lifetime depression; teenag-
ers in the late 1990s, despite approximately four times fewer years than
their 70 year-old counterparts, experience approximately six times more
risk for lifetime depression. If this trend continues, imagine the rates when
these teenagers reach late life!
More remarkable still, this pattern is not limited to a country or two.
The trend is similar across all industrialized countries examined to date (Cross-
National Collaborative Group, 1992). As nonindustrialized countries are
better studied, the same trend may emerge there as well.
Apparently, depression is on the rise across much of the world. Why?
One possibility is that the trend is artificial and not really representative of a
true increase in depression across time. For example, perhaps the older one

18 CHRONIC DEPRESSION
gets, the more prone one is to forget having experienced a prior depression!
Or perhaps depressed people die earlier and thus are not around to report on
past depressions when older cohorts are assessed. (In fact, there is some evi-
dence that mortality rates are elevated among depressed people, even ac-
counting for higher suicide rates among depressed people.) Or perhaps health
care professionals are doing an increasingly better job of detecting depres-
sion; if so, what has changed is the behavior of health professionals, not the
rates of depression. Or perhaps it is increasingly acceptable to report depres-
sion. If so, what has changed is the perceived stigma of depression, rather
than the actual rates of depression.
All of these alternative explanations should be considered, but for an
array of reasons, they are not completely convincing. For one thing, if in-
creased prevalence were merely due to forgetting, why would 30-year-olds
differ so much from 18-year-olds? Also, we could only wish that depression
were stigma-free or that health care professionals detect it carefully! Although
there has been progress on both these fronts, there has not been so much
progress as to account for the large cohort difference in depression preva-
lence rates. Finally, researchers who conduct this work make efforts to con-
trol for various confounds like these, and even when they use stringent con-
trols, the effect emerges nonetheless.
The increase in prevalence rates thus may be a real phenomenon. Why
might depression be on the increase? Many possible explanations exist, in-
cluding (among other things) changes in environmental toxins, increased
drug abuse, increased divorce rate, changes in parenting practices, and changes
in communication methods (i.e., more electronic, less face-to-face), but none
yet has good scientific backing.
Regardless of why (and assuming the trend is real), the upshot of all this
is a looming (if not current) epidemic of depression. In the middle of the 21st
century, when those in their teens at the turn of the century are in their 70s,
their lifetime prevalence of depression may be astonishingly high. And, as
we discuss, depression is rarely a once-in-a-lifetime event—someone with a
lifetime history of depression is far more likely than others to experience
current depression. A cohort with a very high lifetime rate of depression is
thus quite likely to have a high rate of current depression. Accordingly, as
younger and more vulnerable cohorts age, depression looms as an even more
urgent international health problem than it already is.

GENDER, ETHNICITY, AND DEPRESSION

If the prevalence of depression is on the rise, as appears to be the case,

who is most likely to be affected? In this section, we briefly review what
is currently known about gender and ethnic variations in the rate of
depression.

DEPRESSION AS A PERSISTENT AND RECURRENT SCOURGE 19

Gender

We have just seen that age may represent an important factor regarding
depression prevalence. There is little question that gender is as well. The
incidence of clinical depression and depressive symptoms is two to three times
higher among women than men. In their review of large epidemiologic and
family studies, Klerman and Weissman (1989) noted that women show a
higher lifetime prevalence of major depression across all birth cohorts. A
recent report on epidemiologic surveys conducted in a number of industrial-
ized countries, including the United States, showed higher rates of depres-
sion in women across all sites (Weissman et al., 1993). The effect seems
resilient: It tends to persist when demographic variables such as race, income
level, education, and occupation are controlled (McGrath, Keita, Strickland,
& Russo, 1990; Radloff, 1977). It is interesting to note that the gender differ-
ence emerges at adolescence because there is no gender difference in depres-
sion for preadolescent children (e.g., Hankin et al., 1998).
Although the gender differential in depression is consistent and well
documented, little is known about the processes that underlie these differ-
ences. The artifact hypothesis suggests that gender differences in depression
result from women's greater reporting of stress and symptoms (Weissman &
Klerman, 1977), and the masked depression hypothesis posits that depression
in men remains undetected, or is masked by their higher rates of alcohol and
substance use (e.g., Egeland & Hostetter, 1983). Biological hypotheses sug-
gest that greater vulnerability among women is due to genetically transmit-
ted factors and that women are at greater risk because of mood changes asso-
ciated with their reproductive cycles (Nolen-Hoeksema, 1987; Weissman &
Klerman, 1977, 1985). Psychosocial explanations include the social status
hypothesis, which suggests that the disproportionate rate of exposure to stres-
sors resulting from women's lower social status is responsible for their higher
rates of depression (Weissman & Klerman, 1977, 1985). Social role hypoth-
eses focus on aspects of the traditional female role, such as concern with
relationships and dependence, which may increase women's vulnerability
(see also Nolen-Hoeksema, 1987; Weissman 6k Klerman, 1977, for review).
Evidence for each of these hypotheses has been largely inconclusive (Nolen-
Hoeksema, 1987; Weissman & Klerman, 1977, 1985). Although researchers
continue their search for clues that might explain the gender difference in
depression, this consistent finding goes largely unexplained.
A promising explanation was provided by Nolen-Hoeksema and Girgus
(1994). These authors focused on the intriguing fact that the gender differ-
ence in depression does not exist in young children but emerges in adoles-
cence and persists throughout adulthood. They suggested that the combina-
tion of preexisting risk factors for depression and the social and biological
challenges faced by adolescents lead to gender differences in depression.
According to this view, girls have more childhood risk factors for depression

20 CHRONIC DEPRESSION
and are confronted with more biological and social challenges in early ado-
lescence than boys. Nolen-Hoeksema and Girgus cite lower instrumentality,
lower aggression and dominance in interpersonal interactions, and greater
ruminative coping in girls than boys as specific risk factors for depression.
In addition to being depressotypic, ruminative coping is also anxiotypic
(i.e., involves worry and fear). Because ruminative coping is more common
among girls, a comorbid depressive and anxious presentation may also be
more common among girls, consistent with our findings. Anxiety may be a
preexisting risk factor for the development of depressive symptoms in adoles-
cent girls. For example, Reinherz et al. (1993) found that early onset (by age
9) of anxious symptoms in girls was significantly related to the development
of depression in adolescence. Anxiety was not found to be a significant child-
hood risk factor for male adolescent depression.
In addition, the contribution of parental psychopathology to gender
differences in adolescent depression requires further exploration. Children
of parents with affective disorders are more than twice as likely to develop
major depression than children whose parents have no disorder (Beardslee,
Keller, Lavori, Staley, & Sacks, 1993). Furthermore, daughters of parents
with recurrent major depression have three times the risk of major depres-
sion compared with sons of recurrently depressed parents (Warner, Mufson,
& Weissman, 1995). Radke-Yarrow, Nottelman, Belmont, and Welsh (1993)
provided interesting observations about the affective interactions between
depressed mothers and their children as they relate to gender. Depressed
mothers exhibited more negative affect (e.g., irritability, anxiety, fear) to-
ward their daughters than mothers without depression. However, this find-
ing did not apply to depressed mothers and their sons. In addition, depressed
mother's episodes of negative affect corresponded to episodes of negative
affect in their daughters.

Ethnicity

In contrast to the consistent finding regarding depression gender differ-

ences, there are few well-documented ethnic differences in depression. Al-
though some studies find ethnic differences, these differences tend to disap-
pear when variables such as socioeconomic status are accounted for.
Mexican American adolescents represent one possible exception to this
rule. In perhaps the most compelling study on this issue, Roberts, Roberts,
and Chen (1997) assessed major depression in several thousand 10- through
17-year-olds from diverse ethnic backgrounds (e.g., African American, Anglo
American, Asian American, and Native American). Only Mexican Ameri-
can youths displayed elevated rates of major depression, and this was true
even when socioeconomic status, gender, and age were statistically controlled.
In a study of over 2,000 African American, Anglo American, and Mexican
American 12- through 17-year-olds, Roberts and Sobhan (1992) reported

DEPRESSION AS A PERSISTENT AND RECURRENT SCOURGE 21

the same finding regarding self-reported depressive symptoms, now control-
ling for age, gender, perceived health, and occupation level of the family's
primary wage earner.
As with so many group differences in depression (e.g., age cohorts, gen-
der), there is persuasive evidence that Mexican American adolescents, as
compared with other adolescents, experience higher rates of depressive symp-
toms, but there is little understanding as to why Mexican American adoles-
cents, among all others, experience heightened depression (again, previous
work suggests that this effect is not due to lower socioeconomic status; e.g.,
Roberts et al., 1997).
Acculturative stress (i.e., the strain of leaving behind a first culture and
adapting to another) has been suggested as a reason that Mexican American
adolescents experience heightened depression. Although there does appear
to be a positive relationship between acculturative stress and depressive symp-
toms among Mexican American adolescents (Hovey 6k King, 1996), there
are at least two reasons why it may not provide a complete explanation. First,
many of the ethnic groups in Roberts et al.'s (1997) study experienced
acculturative challenges, yet some of these (e.g., Chinese Americans) had
very low rates of depression. Second, the research base regarding accultura-
tion in Mexican American adolescents is very small, and research on accul-
turation in Mexican American adults is contradictory: Some studies find
that high assimilation into a new culture is related to more depression
(Golding, Karno, & Rutter, 1990), whereas others find that high assimila-
tion relates to less depression (e.g., Garcia & Marks, 1989). Although more
research on the question is needed, acculturation, in itself, appears unlikely
to explain elevated depression levels among Mexican American adolescents.
Another potential explanation is genetic: People of Mexican descent
may have a higher genetic risk for depression than those of other ethnicities.
Two lines of evidence contradict this possibility. First, among adults, depres-
sion rates vary within people of Mexican descent depending on country of
birth, with depressive symptoms among U.S.-born Mexicans higher than for
those born in Mexico (Golding et al., 1990). If U.S.-born Mexicans and
those born in Mexico have similar genetic makeups, depression differences
within this group are difficult to explain from a genetic perspective. Second,
in contrast to the finding that Mexican American adolescents have higher
depression rates than their Anglo American counterparts (e.g., Roberts et
al., 1997), when Mexican adolescents living in Mexico were compared with
non-Hispanic Whites, depression rates were, if anything, lower among Mexi-
can adolescents (Swanson, Linskey, Quintero-Salinas, & Pumariega, 1992).
A purely genetic explanation thus does not seem particularly plausible.
Therefore, genetics—or any stable predisposition—is unlikely to fully
explain elevated Mexican American adolescent depression, because Mexi-
can people with the same predispositions, but who do not face acculturative
challenges, have relatively low depression rates. Yet, acculturation alone can-

22 CHRONIC DEPRESSION
not explain the effect either, because other ethnic groups who confront
acculturative stress do not have elevated depression rates. A possible resolu-
tion to this quandary is the following hypothesis: On average, Mexican people
(wherever born) possess a depression risk that (a) many other ethnic groups
do not possess to the same degree and (b) is activated by the experience of
acculturative stress.
What is the nature of this hypothesized depression risk? There is pre-
liminary evidence that a negative cognitive style (e.g., pessimism) is cultur-
ally favored among Mexican people (Domino, Fragoso, & Moreno, 1991; cf.
Fehrenbach's, 1995, statement that "The people of the United States like to
believe that political will and good intentions can solve most human dilem-
mas. They often find it hard to understand Mexicans, who know better").
This style may represent a depression risk factor, but only among those who
are faced with serious stress (including acculturative stress). Joiner, Perez,
Wagner, Berenson, and Marquina (2001) obtained evidence in favor of this
view among Mexican American adolescents; namely, that higher rates of
pessimism accounted in part for the higher rates of depression among these
adolescents. The role of negative cognitive style in depression in general is
returned to in chapter 9 on stable vulnerabilities.

CONSEQUENCES OF A DEPRESSION EPIDEMIC

Depression has been termed the common cold of mental disorders. With
regard to prevalence, this analogy may be apt: Depression is becoming more
and more common. But otherwise, the analogy may be unfortunate because
it belies the pernicious quality of a depressive episode.
Depression is among the most debilitating and costly of any health prob-
lem. In a recent large-scale study of medical outcomes, only heart disease was
associated with more bed days, physical symptoms, and social and role im-
pairment than depression. Depression was associated with worse outcomes
than all other conditions studied, including chronic lung disease, diabetes,
arthritis, gastrointestinal problems, back problems, and hypertension (Stewart
et al., 1989; Wells, 1991). Furthermore, depression is associated with the
ultimate health index: In a study of nursing home residents, depressed people
died at higher rates than nondepressed people (O'Connor & Vallerand, 1998),
and this was true even controlling for general health status. Numerous other
studies likewise support the association between depression and increased
early mortality rates (e.g., Cuijpers & Smit, 2002).
In a 2-year follow-up of over a thousand participants in the medical
outcomes study, Hays, Wells, Sherbourne, Rogers, and Spritzer (1995) re-
ported that depressed patients were similar to or worse off than all patients
with other medical problems, including congestive heart failure and myocar-
dial infarction. It is interesting to note that this result applied to many types

DEPRESSION AS A PERSISTENT AND RECURRENT SCOURGE 23

of depression, including an acute episode of clinically severe depression (i.e.,
major depression), subclinical but disruptive depressive symptoms, and per-
sistent but less acute and severe forms (e.g., dysthymia). Thus, as Hays et al.
stated, "depressed patients have substantial and long-lasting decrements in
multiple domains of functioning and well-being that equal or exceed those of
patients with chronic medical illnesses" (p. 11). When depression goes un-
treated, the impairment in functioning and well-being is worse still (Coryell
et al., 1995).
In addition to its impact on individual suffering and impairment, de-
pression burdens the health care system. Simon, Ormel, VonKorff, and Barlow
(1995) found that among primary care patients, those with clinical depres-
sion were twice as costly to treat than other patients. This finding was not
due to increased medical problems among the depressed, although it ap-
pears true that depression may exacerbate some physical symptoms, and
there is no question that depression prevalence is extremely high in most
general medical samples (e.g., Wells, Rogers, Burnam, & Greenfield, 1991).
Rather, the increased cost derived from increased utilization of health care
services. Even when improvement in depression had occurred 1 year later,
the costs associated with the care of formerly depressed patients had not
decreased substantially.
The burden of depression on those who have it and on society is clear.
It is disturbing that the amount of money spent on depression research pales
compared with that spent for conditions that cause similar or lower levels of
distress and impairment. Depending on how computations are done, depres-
sion can be viewed as the most debilitating of the major conditions, as well as
the least well funded (Gross, Anderson, & Powe, 1999; World Health Orga-
nization, 2002). This disparity must be repaired, one would hope, by increas-
ing health research spending overall instead of by "robbing Peter to pay Paul"
(e.g., diverting funds for cancer research to depression research).
Depression can be fatal. One of its primary features is suicidal thoughts
or actions. Of all the people who commit suicide, a majority experienced
some form of diagnosable depression at the time of their death (Hawton,
1992). In a recent study, approximately 70% of young adults who had re-
cently attempted suicide had a diagnosable mood disorder (Rudd et al., 1996).
Compared with the general population, depressed people's risk of death by
suicide is around 30 times higher (Hawton, 1992). Suicide affects all age
ranges. Among adolescents, suicide is the third leading cause of death, ac-
counting for 14% of total deaths in this age group, and the overall suicide
rate among this age group has increased 312% from 1957 to 1987 (Berman &
Jobes, 1991). Suicide also affects older people. Indeed, suicide rates for people
over the age of 65 are at least as high, if not higher than those for other age
groups. This is particularly true for Anglo American men, whose suicide rate
among those 65 and older is at least double that of any other group (U. S.
Bureau of the Census, 1993).

24 CHRONIC DEPRESSION
 All of this would be bad enough, even if depression were an isolated
event in the lives of people who have experienced it. But depression is re-
markably persistent and recurrent (Wells, Burnam, Rogers, Hays, & Camp,
1992). The average length of major depressive episodes is approximately 8
months in adults (Shapiro & Keller, 1981), and 9 months in children (Kovacs,
Obrosky, Gatsonis, & Richards, 1997). And the mean length of dysthymic
episodes may be as much as 30 years in some adult samples (Shelton, Davidson,
Yonkers, & Koran, 1997); the corresponding figure for children is 4 years
(Kovacs et al., 1997). Emslie, Rush, Weinberg, and Guillon (1997) found
that 61% of depressed children experienced recurrence of depression within
2 years; similar 2-year relapse rates have been reported among adults (Bothwell
& Scott, 1997). Tsuang and Coryell (1993) found that 56% of people with
psychotic depression at intake remained ill 8 years later. In studies with fol-
low-ups of 10 years or more, Coryell and Winokur (1992) found that 70% of
people with one depressive episode subsequently experienced at least one
more. Lee and Murray (1988) reported that 18 years after an initial depres-
sive episode, approximately 20% of patients remained incapacitated by de-
pression. Depression is thus persistent within acute episodes, and recurrent
across substantial portions of people's lives.

SUMMARY

This chapter summarized (a) definitions and related problems regard-

ing the concept of depression; (b) the course of depression; (c) the comorbidity
of depression and anxiety; (d) the possibility that depression prevalence is
increasing; (e) the relation of depression to gender and ethnicity; and (f) the
pernicious quality of depression, including its chronicity. The next chapter
describes the phenomenon of stress generation as a potential propagating
factor in depression.

DEPRESSION AS A PERSISTENT AND RECURRENT SCOURGE 25

 3
STRESS GENERATION

The link between life stress and depression is well-known—in general,

the occurrence of life stressors appears to contribute to the development of
depression (e.g., Lewinsohn, Hoberman, & Rosenbaum, 1988; Monroe &
Simmons, 1991), although life stress is by no means a full explanation of who
does and who does not become depressed. A prominent example comes from
the work of Brown and Harris (1978), who argued that the occurrence of
particular stressors (e.g., the loss of a loved one) causally contributes to the
development of depression. In this and related work (e.g., Lewinsohn et al,
1988), the direction of theorizing has always been from stress to depression.
Stress is construed as essentially unsystematic—it is foisted on people in ba-
sically random fashion, much as an accident suddenly occurs in the life of an
unsuspecting victim. And in stress' wake comes depression.
But some people seem more accident-prone than others. Is stress a mere
accident in the lives of unlucky people or, rather, might the occurrence of
stress be systematically tied to the actions of those experiencing the stress?
Just as some people are accident-prone, might some people be stress-prone?
One might hypothesize that a stress-prone person might, for example,
engage in a pattern of decision making that routinely causes problems in
close relationships or at work. Or a stress-prone person might gravitate to-
ward the relationship partners who are unsupportive or even hurtful.

27
 Haramen (1991) theorized that depressed people are particularly stress-
prone, in the sense that they actively generate negative life events. (It is
important to distinguish active from intentional here—we do not believe that
depressed people intentionally create problems for themselves, but that some
of their behaviors have the unintended consequence of making life more
stressful). If so, a self-sustaining process would be implicated in which for-
merly depressed people actively generate future life events that, in turn, sow
the seeds of future depression. This would explain, at least in part, why de-
pression persists and recurs.
In a series of empirical studies, Hammen, Davila, Brown, Ellicott, and
Gitlin, (1992) have documented the phenomenon of "stress generation."
Most of these studies have focused on depressed women to the exclusion of
depressed men, although limited evidence suggests that the processes may
work similarly in both genders (e.g., Hammen et al., 1992; Potthoff, Holahan,
& Joiner, 1995). In a 1-year study of women with depression, bipolar disor-
der, medical illness, or no disorder, Hammen (1991) showed that depressed
women experienced more interpersonal stress to which the women them-
selves contributed (e.g., disputes with teachers or bosses; conflicts with chil-
dren or partners), even compared with the women with bipolar disorder and
medical illness. The finding was specific to interpersonal events—depressed
women did not differ from others with regard to "fateful" events (i.e., those
that really are randomly foisted on people). This result highlights the impor-
tance of interpersonal events, as well as the idea that nonrandom, self-
produced negative events are characteristic of depressed people. Notably,
the depressed women in Hammen's (1991) study all experienced chronic
forms of depression. This finding has been replicated in samples of men and
women (Hammen et al., 1992), marital couples (Davila, Bradbury, Cohan,
& Tochluk, 1997), adolescent women (Daley, Hammen, Burge, & Davila,
1997; Davila, Hammen, Burge, & Paley, 1995), children (Adrian & Hammen,
1993), as well as by other research groups (Potthoff et al., 1995; Simons,
Angell, Monroe, & Thase, 1993). This line of research implicates the impor-
tant possibility that, although depression may occur in the wake of stress, so
may stress occur in depression's wake.
A series of studies of adolescent girls attending an obstetric-gynecology
clinic provides a potential example of a stress generation process (Wagner,
Berenson, Harding, Si Joiner, 1998). Wagner et al. had suspected that the
combination of a pessimistic attitude style and the experience of teenage
pregnancy might produce depression, consistent with cognitive theories of
depression (e.g., Abramson, Metalsky, & Alloy, 1989). However, in the first
of these studies, they found that pessimistic, pregnant girls were less depressed
than optimistic, pregnant girls and nonpregnant girls.
This result was the opposite of the prediction, and Wagner et al. (1998)
speculated that depression-prone (e.g., pessimistic) girls may attempt to "solve"
problems such as loneliness, lack of identity, lack of status, and so on, by be-

28 CHRONIC DEPRESSION
coming pregnant. If so, they reasoned that this "solution" would backfire post-
partum, when illusions were shattered by the travail of teenage motherhood.
In the second study of the series, Wagner et al. (1998) replicated the
original surprising result—again, pessimistic, pregnant girls were less depressed
than other girls. However, as many parents know, that which applies during
pregnancy need not apply after delivery. In the third study of the series, they
found that postpartum, pessimistic teenage mothers were far more depressed
than optimistic teenage mothers.
Wagner et al. (1998) interpreted the pattern of findings as follows: The
depression-prone girls—along with their partners—generated the stressor of
teenage pregnancy and motherhood, and the generated stress eventually
caused the pessimistic girls, but not the optimistic girls, to experience de-
pression. As we discuss in chapter 9, self-sustaining processes (like stress gen-
eration) may interact with persistent vulnerabilities (like pessimism) to en-
courage depression chronicity (cf. Hankin & Abramson, 2001). A possible
example occurred in the study, in which a sample of girls generates a stressor
(i.e., pregnancy), but only a vulnerable subsample (i.e., pessimistic girls) re-
acts to the generated stress with depression.
Hammen (1999) made a very interesting point with regard to the stress
generation phenomenon in her studies: Women tended to generate stress
(e.g., initiate interpersonal conflicts) at times when they were not in a de-
pressive episode. This finding leads to an important speculation about recov-
ery from depression; namely, depression—because it is generally incapacitat-
ing—may shut down many processes, including stress generation processes.
While things are shut down, stress may recede, and recovery may be facili-
tated. Once depression lets up, however, stress generation may reactivate,
inducing stress and sowing the seeds for future depression. In this way, the
stress generation perspective may accomplish something that other models
do not, in that it provides at least a tenable explanation of why depression
lets up (cf. Jack, 1991). We caution, however, that some stress-generating
behaviors likely continue to occur during active depression, and speculate
that perhaps they simply slow down at times of greatest incapacitation.
The stress generation model appears to provide prima facie evidence of
an interpersonally sustaining process. Indeed, in the stress generation stud-
ies, it seems that recurrently depressed people are actively doing something
to produce stress. Moreover, it has been shown that generated stress, in turn,
exacerbates or reinstills depression (Davila et al., 1995; Potthoff et al., 1995;
Simons et al., 1993). But what are depression-prone people doing to produce
stress and thus perpetuate depression?
On the surface, this question is not difficult. According to the stress
generation literature, depression-prone people are initiating interpersonal
conflicts and disagreements, a form of interpersonal stress. But the deeper
question—why certain people initiate interpersonal problems—is not quite
as easily answered.

STRESS GENERATION 29
 DYSFUNCTIONAL MATE SELECTION

Like not only finds like; it can't even escape from being found by its
like.. . .
—William Faulkner

One important way that depression-prone people may contribute to

the occurrence of stress in their lives is to choose "stressful" relationship
partners. As a prelude to psychotherapy for depressed people, I (Joiner) often
ask patients to list the most important people in their lives, both positive and
negative, and for each, to describe what they got out of the relationship (cf.
McCullough et al., 1997; see also chap. 12 on clinical assessment). As pa-
tients describe their relationships, I make notes. After this exercise is com-
pleted, I often show patients my notes, and it is not uncommon for them to
exclaim something like, "no wonder I'm depressed; look at the people I get
into romantic relationships with!" Relationships are rarely foisted on people;
rather, by and large, people seek out or drift toward certain types of partners
(a phenomenon called assortative mating)—which is why patterns emerge in
the exercise I do with my patients. In this exercise, I emphasize that there is
no reason for self-blame about these patterns—the pattern is what it is, and
the question merely is whether it is something the person would like to alter.
Consider, for example, a woman who, for whatever reasons, tends to
"choose wrong" when it comes to romantic partners. More specifically, she
tends to gravitate toward men who are unsupportive, preoccupied with them-
selves, and at times verbally abusive. It is no mystery that this woman is in for
some stressful experiences, partly because of her choice; her relationship choice
can be seen as an instance of stress generation. (It is discussed in chap. 4 on
self-verification theory that poor choices such as this probably have very
little do with masochism, the enjoyment of pain. Indeed, it is clear that people
in these situations do not enjoy them at all. But this is a separate question
from whether they gravitate toward them, even despite not enjoying them).
Thus, relationship choice can be viewed as one way that people generate
stress.
Do depression-prone people choose badly? There is preliminary evi-
dence that they may. As one example, Hammen (1999) reported that in
her series of studies on stress generation in depressed and other women,
depressed women tended to gravitate toward men who themselves are prone
to psychopathology.
For two reasons, it appeared that the women were attracted to the men,
in part, on the basis of the men's preexisting psychopathology (as opposed to
the alternative explanation that living with a depressed woman may instill
psychopathology in the men—which, as discussed in chap. 5, may happen as
well). First, the type of psychopathology displayed by the men was usually
substance use disorders or antisocial personality disorder, both of which rep-

30 CHRONIC DEPRESSION
resent long-standing problems. In this context, it is interesting to note that,
at odds with the Faulkner (1932) quote, "like is not finding like" here. Rather,
women and men with one form of psychopathology appear to gravitate to-
ward partners with a distinct form of psychopathology. Second, the men ap-
peared to have high rates of past psychopathology (before they met the
women). The end result is both people with elevated chances of experienc-
ing their own as well as each other's psychopathology—a stressful scenario
indeed. If both experience depression (which men with substance use disor-
ders often do), and both generate stress as a result of depression, stress and
depression will abound for this couple. Dysfunctional mate selection thus
may represent one way that a depressed person contributes to the phenom-
enon of stress generation.
Consider the case of Carla, a depressed woman in her mid-40s who had
experienced a string of relationships with neglectful, at times abusive, and
often heavy-drinking men. After completing the previously described exer-
cise of listing the most important people in her life, Carla noted that she had
given a lot—but received little—in her relationships. This served as a launch-
ing point for addressing several important issues in therapy, such as qualities
to look for (and to avoid) when forming new relationships, developing
assertiveness skills to even the balance of her giving and receiving in rela-
tionships, and examining the role of loneliness in her becoming involved
with men who might mistreat her.

IMPAIRED INTERPERSONAL PROBLEM SOLVING

In addition to dysfunctional mate selection, Davila et al. (1995) pro-

posed that poor interpersonal problem solving is a way that depression-prone
people generate stress. Evidence suggests that people who are depressed dem-
onstrate average problem-solving skills in impersonal settings (e.g., solving a
puzzle), yet display specific problem-solving deficits in interpersonal settings
(Gotlib & Asarnow, 1979). Examples of lapses in interpersonal problem solv-
ing may include the misperception of an offhand, trivial comment as an in-
sulting attack; persistently avoiding someone who represents a key source of
social support because of a minor misunderstanding; and angry, accusing con-
frontation of someone who was sincerely trying to help. Indeed, dysfunc-
tional mate selection can also be viewed as an instance of poor interpersonal
problem solving. Davila et al. showed that poor interpersonal problem solv-
ing led to increased stress, that in turn led to increased depressive symptoms.
The explanation of why some people appear to possess good problem-
solving skills, whereas others do not, is complex. Hammen et al. (1992) theo-
rized that the effects of early depression and dysfunctional family experiences
were implicated in stress generation. Other work has shown that both early
age of depression onset (e.g., Lewinsohn et al., 1994) and family dysfunction

STRESS GENERATION 31
are associated with impaired problem solving (Ebata & Moos, 1994; Holahan
& Moos, 1987). Thus, early depression and family dysfunction may prevent
the development of good problem solving; impaired problem solving, in turn,
may generate stress and perpetuate depression. As we see in chapter 13 on
clinical intervention, treatments focused on improving problem solving ap-
pear to work, even if the ultimate source of impaired problem solving re-
mains somewhat unclear.
For example, consider a depressed man who reacts negatively when his
wife (sincerely) suggests that his productivity in sales might increase if he
updated his wardrobe. He views her comment as a veiled criticism of his
appearance, and he responds by "shutting down" and withholding affection
from her but does not directly express his feelings. His wife picks up on his
aloofness and hostility, and responds in turn (i.e., she also shuts down). After
a day in this cold environment, the man explodes with an outburst of anger
toward his wife over a trivial, unrelated matter. He feels both angry with his
wife and disappointed about his own behavior and appearance. Although
the developmental roots of his poor interpersonal problem-solving skills are
uncertain, it is likely that strategic coaching in problem solving and asser-
tion would help him manage his negative feelings more appropriately and
avoid the ensuing generation of interpersonal conflict.

THE PERNICIOUS INTERPERSONAL EFFECTS OF HOPELESSNESS

In a recent series of studies, Joiner, Wingate, Gencoz, and Gencoz (2005)

examined a somewhat different explanation for why depression is associated
with stress generation. Many stress generation studies examine the links
between self-reported depression and self-reported negative life stress. Be-
cause self-report is the source for assessment of both depression and stress, it
is possible that increases in reported negative life events may merely reflect
an increasingly hopeless outlook, rather than actual stress increases. A de-
pressed person may thus perceive and report stress, even when stress is not
actually present. Although Hammen et al. (1992) used careful assessment
approaches to negative life events (approaches that should be relatively im-
mune to this artifact; e.g., Hammen, 1991), the possible influence of increas-
ing hopelessness in stress generation deserves attention nonetheless, espe-
cially insofar as hopelessness is a hallmark of major descriptive and etiological
accounts of depression (Abramson et al., 1989; American Psychiatric Asso-
ciation, 1994; Beck, Rush, Shaw, & Emery, 1979). Moreover, hopelessness,
because of its embittering and stultifying effects on other people, may be
particularly likely to disaffect others (i.e., to generate the stress of interper-
sonal rejection).
If it were found that increased hopelessness accounted for stress genera-
tion in depression, two interpretations would be possible. First, of course, it

32 CHRONIC DEPRESSION
may be that depression induces a hopeless outlook, rather than inducing ac-
tual negative events; or second, depression may generate actual stress, and
hopelessness may be depression's "active ingredient" in the generation of
actual stress increases.
A main purpose of Joiner et al.'s (2005) studies was to evaluate these
two possibilities. Does depression merely induce a hopeless outlook that, in
turn, generates the perception but not the occurrence of stress? Might de-
pression generate actual stress—for example, interpersonal rejection—through
the generation of a hopeless outlook (which others may find aversive)? Joiner
et al. suggested that answers to these questions bear on the very existence of
a true stress generation effect, as well as on how the effect happens (i.e., its
mechanism).
Joiner et al. (2005) conducted three studies among undergraduate men
and women, all longitudinal using a relatively short time frame, and all ex-
amining self-reported depressive symptoms (not clinical diagnoses of depres-
sion). In each study, they tested the hypothesis that depressive symptoms
would be predictive of prospective increases in reported negative life events—
that depression would generate stress.
The first study represented a straightforward replication of the stress
generation effect. Students who reported depression at Time 1 were more
likely than other students to experience increases over time in self-reported
negative life events.
The second study, too, provided a replication of the stress generation
effect—here again, depressed students, as compared with their nondepressed
counterparts, experienced more increases in self-reported negative events.
But this second study also addressed the important possibility that a hopeless
outlook on the part of the depressed person may account for the stress gen-
eration effect. In fact, it was the case that depressed students tended to expe-
rience increases in hopelessness (in addition to increases in self-reported
negative events) over the course of the study. Furthermore, it appeared that
depressed students' perception of life stress occurred as a function of increased
hopelessness. As the students became more hopeless, they reported more
negative events in their lives.
But was there actually more stress in their lives (perhaps encouraged by
evolving hopelessness), or were the students merely perceiving more stress
(because they were becoming more hopeless)? The third study in the series
provided at least a partial answer to this question. In this study, instead of
assessing respondents' own perceptions of life stress, an instance of actual life
stress—roommate rejection—was directly assessed by including respondents'
roommates in the study. Joiner et al. (2005) reasoned that if depression was
leading to actual stress (here, roommate rejection), and that if increased room-
mate rejection occurred as a function of increased hopelessness, then hope-
lessness may be a main "carrier" of the generation of actual stress (not merely
perceived stress). In fact, results showed just this: Students who reported

STRESS GENERATION 33
depression experienced increased roommate rejection, and this appeared to
occur as a function of respondents' increased hopelessness.
How might hopelessness operate as an actual stress generator? Future
work may benefit from exploration of several related speculations (it is em'
phasized that these are speculations in need of future research).
First, depression chronicity itself may be involved in stress generation.
As depression persists, those who experience it may become more and more
hopeless, and their significant others may become more and more burdened
and disaffected. Consistent with this speculation, Sacco, Milana, and Dunn
(1988) provided participants with transcripts of depressed people whose epi'
sodes were long lasting, and transcripts of depressed people who experienced
short episodes. Compared with short-episode transcripts, long-duration
"depressives" elicited more anger and more interpersonal rejection. It is worth
remembering that Hammen's (1991) study on stress generation in depres-
sion focused on people with chronic forms of depression.
A second possibility is that hopelessness, because it has embittering
and stultifying effects, may lead to cognitive representations of depressed
people in the minds of significant others that are negative and change resis-
tant. Sacco (1999) argued that once these representations are developed,
they selectively guide attention and expectancies to confirm the representa-
tion. These social-cognitive processes may occur spontaneously and outside
of awareness (Lewicki, Hill, & Czyzewska, 1992). Such processes may be
particularly attention grabbing with regard to negative as opposed to positive
behaviors. There is evidence that, as compared with positive behaviors, nega-
tive behaviors are more likely to draw attention (Pratto & John, 1991). Fur-
thermore, when negative behaviors are attributed to the person (as opposed
to the situation), they are more likely to be remembered (Ybarra & Stephan,
1996). Once crystallized, cognitive representations of negative behaviors are
more change resistant than representations of positive behaviors (Rothbart &
Park, 1986). Moreover, such representations gain momentum with use, in that
they come to disproportionately influence social cognition relative to actual
subsequent behaviors of the represented person (Sherman & Klein, 1994).
These processes are emphasized again in chapter 8 on blame maintenance.
Hopelessness, then, may generate stress by producing in others a person-
schema that negatively biases subsequent perceptions of the hopeless person
and is difficult to change. Others' negative views may, in turn, encourage
critical communications from others to the hopeless person, and these com-
munications have been shown to be strong predictors of depression chro-
nicity (Hooley & Teasdale, 1989). With regard to others' perceptions, the
hopeless and potentially depressed person may face a very difficult problem:
Continued hopelessness may only serve to maintain others' negative views
and thus generate stress in the form of criticism; positive changes, because
they do not match others' schemata, may be unnoticed or misattributed, leav-
ing others' negative representations unchanged.

34 CHRONIC DEPRESSION
 To summarize the three studies, each replicated the stress generation
effect. The second study of the series showed that as hopelessness increases,
so does generated stress. The third study demonstrated that this process ap-
plied to the generation of actual stress (at least as reflected by roommate
rejection), instead of merely applying to the perception that stress is increas-
ing. It is important to note that the findings from this series of studies suggest
that similar processes are at work in both depressed women and men (in
contrast to earlier studies that focused exclusively on depressed women).
One other aspect of these three studies deserves mention, in that they
compared the specificity of the stress generation effect with depressive versus
anxious symptoms. It is conceivable that many mental disorders and numer-
ous types of emotional distress may be associated with generated stress. Is
there something special about depression in terms of generating stress?
Hammen (1991) reported that people with depression, as compared with
those with bipolar disorder and those with nonpsychiatric medical illness,
experienced higher rates of generated stress, in line with the specificity of
stress generation to depression. My studies extended this finding to anxious
symptoms—depression generated actual (not merely perceived) stress through
increased hopelessness, whereas anxious symptoms did not operate in this
fashion. Because anxious symptoms overlap considerably with depressive
symptoms (Clark & Watson, 1991), a finding that generated stress stemmed
from depressive but not anxious symptoms lends strong support for the speci-
ficity of stress generation to depression. An important reason that stress gen-
eration processes may be specific to depression is that depression is more
strongly associated with hopelessness than are most other mental disorders
and symptoms.
The potential role of hopelessness in the generation of stress suggests
an interpersonal elaboration to Abramson et al.'s (1989) hopelessness theory
of depression. According to the hopelessness theory, hopelessness produces
depression, and hopelessness, in turn, is produced by stress impinging on a
negative cognitive style (e.g., pessimism; cf. Wagner et al, 1998 study on
pregnant teenagers).
The addendum to hopelessness theory is depicted in Figure 3.1. The
highlighted aspects represent the suggested elaboration to the theory. Spe-
cifically, Figure 3.1 shows that hopelessness, once developed—perhaps as a
result of the operation of negative cognitive style activated by stress—
(a) leads directly to depressive symptoms; (b) leads indirectly to depressive
symptoms by generating interpersonal stress; and (c) in generating stress,
provides more "grist" for negative cognitive style's "mill," thus propagating
the sequence and perpetuating depressive symptoms.
The sequence depicted in Figure 3.1 is recurrent and self-sustaining
(i.e., feeds back on itself), and thus may shed light on why depression is
chronic. This process of stress generation is particularly relevant to two of
the three forms of depression chronicity discussed in chapter 1. First, current

STRESS GENERATION 35
Exploring the Variety of Random
Documents with Different Content
of truth, because Malthus has certainly pled less for the cosmopolitan
than for the domestic and civic virtues. He wishes to lay the
foundations solidly and leave the building to others. Cosmopolitan
morality can rarely be the foundation. In the Empire, Christianity
may have raised the people, and Stoicism the philosophers, to the
wider morality without the training of the narrower, so that the
converts were made better members of their own small communities
by becoming members of the commonwealth of the saints and
citizens of the great world. But it seems to Malthus that, in the world
of to-day, the many conditions of a steady moral progress are best
secured if the domestic and civic virtues precede the cosmopolitan.
We must not legislate for a world of heroes, but for men as we know
them to be; and a comfortable domestic life (βίος τέλειος) must be
the common highway to goodness in a society of ordinary men. If
poverty were no evil, churlishness would be no vice. But extreme
poverty[942] is a real hindrance to goodness. In the apparent
exceptions, as in the voluntary poverty of St. Francis, the greatest evil
is absent, for there is no struggle for bare life. To abolish that
struggle, and help men to comfort, is in some degree to help men to
goodness; and it was the end for which Malthus laboured. The most
sure and solid way of reaching it lay, as he thought, in impressing
every man with a strong sense of his responsibility for his acts and of
his power over his own destiny. To reform a nation, we must reform
the members of it, who, if they are good at first in spite of their
institutions, will at last conform their institutions to the model of
their own goodness. To hold men the creatures of society, and make
society responsible for their character, was, he thought, to mistake
the order of nature. Society can feel its responsibility only in its
individual members; and no member of it can free his own soul by
the purity of a collective or representative conscience.
The doctrine of Malthus is, therefore, a strong appeal to personal
responsibility. He would make men strong in will, to subdue their
animal wants to their notion of personal good and personal
goodness, which, he believed, could never fail to develope into the
common good and goodness of all. Believers in the omnipotence of
outward circumstances and the powerlessness of the human will, to
alter them or the human character, may put Malthus beyond the pale
of sympathy. But all can enter into the mind of Malthus and
understand his work, who know the hardness of the struggle between
the flesh and the spirit, and yet believe in the power of ideas to
change the lives of men, and have faith not only in the rigour of
natural laws, but in man’s power to conquer nature by obeying her.
 BOOK V.
BIOGRAPHY.

Parentage—Early Education—Graves and Wakefield—Course at

Cambridge—Correspondence with his Father—Change in Studies
—The Crisis and the Curacy—Effect of the Essay on its Author—
Early and Late Styles—Life from 1799 to 1834—Ingrata Patria?
—East India College—Professor’s Lectures—Hic Jacet.

The few facts that are known of the life of Malthus bring us nearer
to him than we can come in his writings, and show us how well, on
the whole, his antecedents and surroundings fitted him for his work.
Our chief authorities are Bishop Otter’s biographical preface to the
second edition of our author’s Political Economy, which was
posthumously published in 1836, and Professor Empson’s notice of
the book in the Edinburgh Review for January 1837.[943] Otter was
the college companion and life-long friend of Malthus; Empson was
his colleague at Haileybury. The information they give us, though
meagre, is trustworthy; and happily it can be supplemented by hints
from other quarters.
His father, Daniel Malthus, was born in 1730, and went to Queen’s
College, Oxford, in 1747,[944] the year when Adam Smith went home
from Balliol to Scotland. He left without a degree, not because of the
Articles, for he subscribed them at matriculation,[945] or from Dr.
Johnson’s reason of poverty, for he was a gentleman commoner, but
probably from a contempt for the distinction itself.[946] His mind was
active and open, and he seems to have formed literary friendships
that stood his son in good stead afterwards. He liked to stay up in
Oxford in vacation, working hard at his own studies in his own ways,
and seeing none but chosen friends. He wrote to his son in later
years, “I used to think Oxford none the less pleasant and certainly
not the less useful for being disburdened of some of its society; I
imagine you will say the same of Cambridge.”[947] On leaving the
university he married and went to live in Surrey at a quiet country
house on the way from Dorking to Guildford, still known by its old
name of the Rookery. Of his eldest son, who took his grandfather’s
name of Sydenham,[948] we know little except that in due time he
married, and had two sons, Sydenham and Charles, and a daughter
Mary. Mary died single in 1881 in her eighty-second year, Charles in
1821 in his fifteenth, their father in 1821 in his sixty-eighth.
Sydenham, our author’s nephew, who died in 1869, was proprietor of
Dalton Hill, Albury, where members of his family were, till recently,
still living; his son, Lieut.-Col. Sydenham Malthus, C.B., of the 94th
Regiment, served with distinction in the Zulu war a few years ago.
Daniel’s second son, Thomas Robert, familiarly known as Robert,
was born at the Rookery on 14th February, 1766, the year when
Rousseau came to England. His mother seems to have died before
her husband; she is not mentioned in our meagre biographies.[949]
His father, full of the teaching of the Émile, and by no means
prejudiced by his Oxford experience in favour of the ordinary
conventional training of the English youth, seems to have sent his
sons to no public school of any kind, and in all probability brought
them up at home under his own eye for the first eight or nine years of
their life. We may think of Robert, therefore, as passing his
childhood without privation, if without luxury, in the home of an
English country gentleman of moderate fortune, who was devoted to
books and botany, fireside and hillside philosophizing,[950] and the
improvement of his house and grounds,—a man full of life and
originality, gifted with vigorous health, and joining in his boys’ walks
and games.[951] In his quiet little valley it was easy for Daniel Malthus
to picture to himself a Millennial Hall of the future in store for every
one else, on the type of his own Rookery, with no worse interruption
than the rooks that cawed there nightly on the hill above him. From
his son’s description[952] and his own letters, we gather that he was
one of the best sort of the Enlightened followers of Nature. He knew
Rousseau personally, and became his executor;[953] but they were
liker in views than in character; Daniel Malthus had a deeper vein of
reverence and a stronger inclination to put theory into practice.[954]
The neighbours thought him an amiable and clever man who was an
ornament to his parish, but decidedly eccentric, for he made few
friends and was fondest of his own and his children’s company.[955]
He was versed beyond his compeers in French and German
literature, or he would hardly have been credited with having
translated Paul et Virginie, D’Ermenonville’s Essay on Landscape,
and the Sorrows of Werther. We have Robert’s authority for saying
that, although he wrote no translations, he wrote many pieces that
were very successful, but always anonymous.[956] With much of his
son’s talent, he had no power, like his son’s, of sustained intellectual
effort.
He saw the boy’s promise early, and gave him an education which
is condemned by Robert’s chief biographer as irregular and
desultory, but had a method in it. He believed that sons are always
what their fathers were at their age, with the same kind of faults and
virtues; and the men whose influence would have been best for
himself would, he thought, be the best teachers for Robert. At the
same time he believed with the “Émile” that a sort of laissez faire
was the best policy in the education of children; they should be left to
grow, and use their own eyes and hands and heads for themselves. At
the age of nine or ten, say in the year 1776, Robert was accordingly
delivered over to Mr. Richard Graves, Rector of Claverton, near Bath,
to be taught little but Latin and good behaviour, along with a few
other boys, most of them older than himself. Graves, who was
Daniel’s senior by some years, had been intimate with the poet
Shenstone at Pembroke College, Oxford, “a society which for half a
century” (on Johnson’s partial testimony) “was eminent for English
poetry and elegant literature.” From his novel, The Spiritual Quixote,
or the Summer’s Ramble of Mr. Geoffry Wildgoose,[957] we should
not fancy him the best guide for ingenuous youth. The book is a
coarse and offensive satire on Whitfield and Wesley;[958] and shows
Graves as a clergyman to be liker Laurence Sterne than Dr. Primrose.
“Don Roberto,” however, as the tutor nicknamed his pupil, was
fonder of fun and fighting than of his books, and at the ripe age of
ten is not likely to have been troubled about the universe or about
clerical consistency. From Graves he passed[959] into the hands of a
much better man, Gilbert Wakefield, a clergyman who had rebelled
against the Articles, turned dissenter, and become classical master of
an academy at Warrington, founded in 1779 “to provide a course of
liberal education for the sons of dissenters, and particularly for
dissenting ministers.”[960] About one-third of the boys at the
Warrington Academy were sons of members of the Church of
England, who were, like Daniel Malthus, liberal in their opinions,
and wished their sons to be likewise. Wakefield held decided views
on education; and they were in close accordance with Daniel and the
Émile. “The greatest service of tuition,” he said, “to any youth, is to
teach him the exercise of his own powers, to conduct him to the hill
of knowledge by that gradual process in which he sees and secures
his own way, and rejoices in a consciousness of his own faculties and
his own proficiency. Puppies and sciolists alone can be expected to
be formed by any other process.”[961] The tutor’s best service is to
point the pupil to the best authors and give him advice (not lectures)
when he wants it. There was self-denial as well as wisdom in
Wakefield’s view, for in one case at least the pupil showed his
proficiency by departing from the opinions of his tutor.
Wakefield, himself a Fellow of Jesus,[962] procured Malthus an
entrance to that college, and directed his studies till he matriculated
there as a pensioner (or ordinary commoner) on 17th December,
1784, beginning residence in 1785.[963] Robert esteemed him highly.
He described him twenty years afterwards[964] as a man “of the
strictest and most inflexible integrity,” who gave up not only
prospects of preferment, but even opportunities of usefulness, rather
than deny the truth and offend his conscience,—a man hot and
intemperate in public controversy,[965] but modest and genial in
society, never advancing his opinions till challenged, nor trying to
make converts to them, but urging others to an independent study of
the facts,—finally, a genius cramped by its own learning and good
memory, never taking time and pains to do itself justice in its
writings. Though a foe to the thirty-nine Articles, Wakefield was a
stout believer in Christianity, and attacked Paine’s Age of Reason in
a rough style that contrasts strongly with the sober remarks of
Malthus on Paine’s Rights of Man.
Up to 1785, therefore, his father and Wakefield had the largest
share in the education of Malthus; and their influence was shown in
the very fact that the opinions of Malthus were not fixed by them. His
opinions were to be of his own forming; and, having never learned
the schoolboy’s ambition of prize-taking,[966] he found time at college
not only for what would give him the best degree, but for every study
that interested him, especially history and poetry and modern
languages, as in his later years for Italian literature. Frend, author of
a political tract, Peace and Union, which brought him the honour of
prosecution,[967] was his college tutor, and spoke highly of him.[968] It
says much for his mathematical powers that in spite of his wide
general reading he took the ninth place among the wranglers of his
year, 1788. If he had been confining himself, as his father supposed,
to the beaten track, he might, like Paley, have reached the senior
wranglership.[969] After the Tripos he proposed to study at Cambridge
and at home on a plan of his own. His father, on the false analogy of
his own experience, had warned him against the abstract studying of
scientific and mathematical principles apart from their applications;
he must not “work curious stitches on a piece of rag”; he must
become a practical surveyor, mechanic, and navigator. The son had
answered that there would be ample time after the Tripos to make
the applications, and there was little enough time in three years to
study the principles. But thereafter, “if you will give me leave to
proceed in my own plans of reading for the next two years (I speak
with submission to your judgment), I promise you at the expiration
of that time to be a decent natural philosopher, and not only to know
a few principles, but to be able to apply these principles in a variety
of useful problems.”[970] In reality, so far from having his father’s
tendency to abstract speculation, he was (as he says himself) rather
“remarked in college for talking of what actually exists in nature or
may be put to real practical use.”[971]
Though the son had the best of this personal controversy, he would
have done well to have responded to his father’s letters in the spirit
in which they were written; in one instance at least, his father
complains that Robert “drove him back into himself.” But this was
rare. His father describes him as an admirable companion,
sympathetic and generous, and making everybody easy and amused
about him.[972] He was a favourite at home. When the family was
removing from the Rookery at Dorking to the Cottage[973] at Albury in
1787, he was told: “You must find your way to us over bricks and tiles
and meet with five in a bed and some of us under hedges, but
everybody says they will make room for Robert.” It was Robert’s own
warm heart that led him to give those years of leisure after the Tripos
to studies very different from those of his first plan. Social problems
were competing for his attention with scientific.
 In 1797 he took his Master’s degree. In the same year he got a
fellowship at his college; wrote but, on his father’s advice, did not
print the Crisis;[974] and took a curacy near Albury. If the Crisis did
nothing more, it showed how the attention of the man was fixing
itself on the subjects that engrossed him during life, and how his
character was changing from gay to grave. It is difficult for a reader
of the later Essay or the Political Economy to conceive that the
writer could ever have been very merry in heart or light in touch; and
there is a still wider distance between the pugnacious Don Roberto,
never long without a black eye, and the grave gentle host of Miss
Martineau at the East India College. The change in style between his
early writings and his later was due to a real change in character,
produced by the concentration of his thoughts on the problem of
poverty. The success of the first Essay on Population[975] fixed for
him the work of his life. He was to set one neglected truth clearly
before the world; and he devoted himself wholly to it, pushing his
inquiries not only by study of authorities and facts at home,[976] but
by his own[977] and his friends’[978] travels, and by conversation and
correspondence with all that were likely to give him anything in
conference.[979] He sacrificed to it, fortunately or unfortunately, his
youthful buoyancy and freshness of style, though in speculation his
opinions passed from pessimism to a moderate optimism, and he
was never too old in spirit to unlearn a fault.
In his mature writings the composition is less faulty than the
diction, which is certainly too Johnsonian. The composition is a little
bald and often diffuse; but the meaning of each sentence is always
clear, and in economical writing that is the first of virtues. In a work
of imagination we may desire to have the greatest number of the
greatest ideas put into each sentence; but a scientific treatise is more
often concerned with a single truth in its full development; and the
perpetual recurrence of the same phrases in different connections is
unavoidable, in proportion to the thoroughness of the discussion.
Great variety of language would either imply in the writer or cause in
the reader some confusion of thought. It is not surprising, then, to
find Malthus saying substantially the same thing in nearly the same
words, whether he is presenting his views on Population directly in a
book on the subject, or placing them in their economical context in a
book on Political Economy, or touching them incidentally in a Corn
Law pamphlet or Quarterly article, or answering questions about
them before a Commons Committee. His abundant metaphors in the
first essay[980] had simply led to misunderstanding; and he
deliberately renounced fine writing for high thinking, present
popularity for permanent usefulness.[981]
The first essay was the turning-point in his literary life. Except the
pamphlets on Haileybury College, all his later writings are
economical. His personal history, being uneventful, was, like a time
of dull annals, presumably happy. The fine portrait of him by Linnell,
[982]
taken in his old age, gives a pleasing impression, not only of
mildness and firmness, but of serene contentment, without any trace
of physical suffering or physical defect, though it is certain he had the
latter.[983] In person he was tall and “elegantly formed.”[984] 1799 is
the year of his first Continental journey.[985] In January 1800 his
father died, at the age of seventy. In the same year appeared the tract
on The High Price of Provisions. In 1802 Malthus was again on the
Continent.[986] In June 1803 he published the second (or quarto)
essay, which seems, from a passage in Edward Clarke’s Travels, to
have been long expected by his friends. “I am sorry,” writes Clarke to
him from Constantinople on 16th March, 1802, “to find you confess
your breach of duty in not having written a book. But you have been
engaged in the press, because I heard at the Palace that you had
published a new edition of your Population, and, moreover, I was
there assured so long ago as last year that you had written a work on
the Scarcity of Corn. How does this accord with your declaration?
Perhaps it is a pamphlet, and therefore strictly not ‘a book.’”[987]
It is not impossible that Clarke had heard this rumour from Lord
Elgin, and Lord Elgin from Pitt himself, for Pitt had visited
Cambridge on the eve of the dissolution following the Peace of
Amiens. On the 16th (December 1801) he was present at the
Commemoration dinner in Trinity College Hall.[988] The visit is
described by Otter:[989] “It happened that Mr. Pitt was at this time
upon a sort of canvassing visit at the university.... At a supper at
Jesus Lodge in the company of some young travellers, particularly
Mr. Malthus, &c., he was induced to unbend in a very easy
conversation respecting Sir Sidney Smith, the massacre at Jaffa, the
Pacha of Acre, Clarke, Carlisle,[990] &c.” Though the talk was largely
on poetry and foreign politics, it may easily have embraced
economics; and the personal meeting may have helped to gain
Malthus his appointment as Professor of History and Political
Economy at Haileybury College. With or without Pitt, the
appointment was made in 1805; and in view of it Malthus was able to
carry out, on 13th March 1804, his marriage with Harriet Eckersall
(daughter of John Eckersall of Claverton House, St. Catherine’s, near
Bath), to whom he had probably been for some years engaged.[991] In
1806 he published the third edition of the essay (in two volumes), in
1807 the fourth edition, and also the letter to Samuel Whitbread on
his Bill for amending the Poor Laws. If it is true that he visited Owen
at New Lanark, it must have been in the course of the next seven
years.[992] There is nothing signed from his pen in that time but a
letter to Lord Grenville in defence of the East India College;[993] but
in 1814 and 1815 he wrote the Observations on the Corn Laws, the
Grounds of an Opinion on the Policy of restricting Importation, and
The Nature and Progress of Rent. In 1807 he had been with Horner
in Wales, impressing Horner, as they went together from Raglan to
Abergavenny, with his idea that the people should “live dear”;[994]
and in 1817 he visited Kerry and Westmeath. In the same year, 1817,
he published the fifth edition of his essay. 1818 would be memorable
to him as the year when Mackintosh joined him at Haileybury as
Professor of General Polity and Law in succession to Mr. Christian.
In 1819 Malthus appears as Fellow of the Royal Society, though the
honour did not tempt him back into physical science.[995] In 1820
appeared the first edition of the Political Economy. In 1821, Thomas
Tooke, the author of High and Low Prices, founded the Political
Economy Club, James Mill drafting the rules. Malthus, Grote, and
Ricardo were among its members; and the survivors are said to
remember well the “crushing criticisms” by James Mill of Malthus’
speeches.[996]
1823 is the year of the tract on the Measure of Value and the
Quarterly article on Tooke; 1824 of the paper on Population in the
Supplement to the Encyclopædia Britannica, and the article on the
New Political Economy in the Quarterly Review.[997] In 1825 he lost a
daughter, and went for his own and his wife’s health to the
Continent. In that year he contributed his first paper to the Royal
Society of Literature, of which he had been made an Associate two
years before; and that year saw Empson take the place of Mackintosh
at Haileybury. In 1826 was published the sixth edition of the essay,
the last published in his lifetime. In 1827 we find him before the
Emigration Committee, and we have from his pen the Definitions in
Political Economy, and the second paper contributed to the Royal
Society of Literature. In 1829 letters passed between him and W.
Nassau Senior, which were appended by the latter to his Lectures on
Population. In 1830 he wrote the Summary View, which involved no
new effort. Indeed his whole time seems to have been spent in
revising his Political Economy in the light of his public and private
discussions with Ricardo, though he did not live to print the new
edition himself. Shortly before his death he said to some one who
rebuked him for his delay: “My views are before the public. If I am to
alter anything, I can do little more than alter the language, and I
don’t know if I should alter it for the better” (Empson, l. c. p. 472).
He was one of the first Fellows of the Statistical Society, founded in
March 1834, and its first Annual Report contains a high eulogy on
him and his work; but he did not live to take much share in its
proceedings. He died suddenly of heart disease on Monday, 29th
December, 1834, on a visit to Mr. Eckersall at St. Catherine’s, where
he was spending Christmas with his wife and family. He is buried in
the Abbey Church at Bath, in the north aisle of the nave. Of his three
children, two survived him, of whom one, a daughter, is still living.
[998]

Brougham, in a letter to Macvey Napier (31st Jan., 1837), denies

the truth of an assertion of Empson’s, that Lords Lansdowne and
Holland tried to get preferment for Malthus, but failed; on the
contrary, he had himself, he says, offered Malthus a living, but
Malthus had declined it in favour of his son, Henry,[999] “who got it,
and I believe now has it.” Henry, however, did not become vicar of
Effingham (near Leatherhead in Surrey) till 1835, the year after his
father’s death,—or of Donnington (near Chichester in Sussex) till
1837, the year when Brougham was writing. The second appointment
may have been due to Empson’s reproach or Otter’s influence. Henry
died in August 1882 at the age of seventy-six. Since, between the two
parishes, he kept as many as four curates at a time, the combined
salaries of the two, amounting to £672, seem a small income.[1000] His
father himself told Gallois, the French publicist, in 1820, that all his
works till then had not brought him above £1000. Gallois, repeating
this to the poet Moore, slily remarked that in England poetry seemed
to be better paid than useful learning.[1001] There is no reason for the
belief that Malthus was made rich by the second essay,[1002] or indeed
by anything else. He did not go the right way to be rich. He could no
doubt have got Church preferment if he had pursued it like Paley. At
the end of his days, even if he had desired it, he was too mild a
partisan to be a grata persona to the Whigs in office; he had
acquiesced in the Reform of 1832, but without enthusiasm,[1003]
having a livelier interest in social than in political changes. But the
world after all used him kindly. Of worldly comfort, after 1805, he
had enough; and he was fully satisfied, as he had reason to be, with
his lot in the East India College. It gave him nearly thirty years of the
leisure which Godwin had justly counted the true riches of life.
The position had its cares, for the college was an educational
experiment. Governor-General Wellesley[1004] had proposed to found
a college at Fort William, Calcutta, for the general education of the
civil servants of the Company as well as their special instruction in
Oriental languages. He pointed out that their functions, judicial,
administrative, diplomatic, were now totally unlike their names of
writer, factor, and merchant, and they needed something higher than
the commercial training which was all that was then required of
them. The Directors of the East India Company carried out his
wishes so far as to allow Fort William College to do the advanced
training in languages; but they thought that the general education
should be given before the cadets left England, and at the end of
1805 they passed a scheme for establishing for that purpose a college
at Haileybury, near Hertford. On their nomination, instead of going
out at once to India, the future civil servants of India were to spend
two or three years at Haileybury, and to receive first a General
education on the lines of Oxford and Cambridge, and second a
Special education to prepare them for their duties in their province.
[1005]
The Professor of “History and Political Economy” and the
Professor of “General Polity and the Laws of England” were regarded
as giving both the general and the special kinds of training. “As the
study of law and political economy” (so runs the scheme) “is to form
an essential part in the general system of education, it will be
required that, in the lectures upon these subjects, particular
attention be given to the explanation of the political and commercial
relations subsisting between India and Great Britain.”[1006] The two
professors were required to give “(1) a course of lectures on general
history and on the history and statistics of the modern nations of
Europe, (2) a course of lectures on political economy, (3) a course of
lectures on general polity, on the laws of England and principles of
the British Constitution.”[1007] The other subjects were Classics,
Oriental Languages, Mathematics, and Natural Philosophy. The
college course lasted, as a rule, two years, each year consisting of two
terms of about five months each (Feb. to June, Aug. to Dec.); and
there were periodical examinations, honour lists, and prizes. The
ages of the pupils ranged from as low as fifteen to as high as twenty-
two, and about forty joined every year. Malthus would seldom have a
class beyond twelve or fourteen, all in the later year of their course.
[1008]

The general discipline of the classes and the surveillance or want

of surveillance of the pupils in their private rooms were rather on the
model of an unreformed Oxford college than of a public school.[1009]
Sense of personal responsibility and habits of self-government were
to take the place of the schoolboy’s fear of punishment. Unhappily,
before learning the new motives, the boys too often abused the
absence of the old.[1010]
About half of the professors were in holy orders and did duty in the
college chapel. If Malthus took his turn with the rest, we need not
suppose with his clerical biographer that he magnified the office. His
sermons would always be earnest; they might often perhaps be too
long. His week-day lectures, unless he made them liker the first essay
with its fine writing than the later books with their plain unvarnished
arguments, could not have been very fascinating to immature youths,
especially as the lecturer had a slight defect in utterance.[1011] Eight
years of teaching convinced him that Political Economy was not, as
he once thought, too hard for boys of sixteen or seventeen;—“they
could not only understand it,” he said, “but they did not even think it
dull.”[1012] We may hope it was so; but in view of the whole case, it is
probable that our author’s labours, in the classroom and out of it,
were far from light, and that the pleasantness of the life was
purchased with a large share of discomfort.
The physical surroundings were all that could be desired. “We are
so rural and quiet here, that there can be no greater contrast [to
London]. This house is in a cluster of tall shrubs and young trees,
with a little bit of smooth lawn sloping to a bright pond, in which old
weeping willows are dipping their hair, and rows of young pear trees
admiring their blooming faces. Indeed, there never was such a flash
of shadowing high-hanging flowers as we have around us; and
almost all, as it happens, of that pure, silvery, snowy, bridal tint; and
we live, like Campbell’s sweet Gertrude, ‘as if beneath a galaxy of
overhanging sweets, with blossoms white.’ There are young horse-
chestnuts with flowers half a yard long, fresh, full-clustered white
lilacs, tall Guelder roses, broadspreading pear and cherry trees, low
thickets of blooming sloe, and crowds of juicy-looking detached
thorns, quite covered with their fragrant May-flowers, half open, like
ivory filigree, and half shut like Indian pearls, and all so fresh and
dewy since the milky showers of yesterday; and resounding with
nightingales, and thrushes, and skylarks, shrilling high up, overhead,
among the dazzling slow-sailing clouds. Not to be named, I know and
feel as much as you can do, with your Trossachs, and Loch Lomonds,
and Inverarys; but very sweet, and vernal, and soothing, and fit
enough to efface all recollections of hot, swarming, whirling, and
bustling London from all good minds.”[1013]
Equally pleasant is a glimpse of the daily life at Haileybury, given
by Miss Martineau, who saw it in 1833. Malthus considered her one
of his best expositors;—“whereas his friends had done him all
manner of mischief by defending him injudiciously, my tales had
represented his views precisely as he could have wished;”—and he
was at the pains to seek her out in London and bring her down to the
college.[1014] “It was a delightful visit, and the well-planted county of
Herts was a welcome change from the pavement of London in
August.... My room was a large and airy one, with a bay window and
a charming view.”[1015] She found desk, books, and everything needed
for her work. Her entertainers had guessed from her books that she
must be, like Malthus himself,[1016] fond of riding; and she found her
riding-habit and whip ready. Exploring the green lanes round
Amwell, Ware, and Hertford, on horseback, in parties of five or six,
seems to have been the chief amusement. “The subdued jests and
external homage and occasional insurrections of the young men, the
archery of the young ladies, the curious politeness of the Persian
professor [Ibrahim], the fine learning and eager scholarship of
Principal[1017] Le Bas, and the somewhat old-fashioned courtesies of
the summer evening parties are all over now, except as pleasant
pictures in the interior gallery of those who knew the place, of whom
I am thankful to have been one.”
 When she again visited Haileybury, Malthus was gone; Professor
Jones was in his chair, and Empson in his house, probably one of the
most comfortable in a building which, if smaller, was much more
picturesque than the present school.[1018]
The “occasional insurrections of the young men” were a feature of
the college from the beginning. Sydney Smith writes to Lord Holland
in June 1810, when there was talk of making Mackintosh professor at
Haileybury: “The season for lapidating the professors is now at hand;
keep Mackintosh quiet at Holland House till all is over;”[1019] and to
Whishaw in January 1818, when the appointment had been made:
“His situation at Hertford will suit him very well, peltings and
contusions always excepted. He should stipulate for ‘pebble money,’
as it is technically termed, or an annual pension in case he is disabled
by the pelting of the students. By the bye, might it not be advisable
for the professors to learn the use of the sling (balearia habena)? It
would give them a great advantage over the students.”[1020] The
lapidations were probably no worse than similar scenes at our
English and Scotch Universities that have not yet destroyed the
credit of these institutions. But the opponents of the college
complained of much more than the insubordination of the students.
Lord Grenville had made an attack on it (in April 1813), on the
ground that it separated the future Civil servants from the ordinary
life of Englishmen, and prevented them from becoming imbued with
“English manners, English attachments, English principles, and I am
not ashamed to say English prejudices.”[1021] Malthus, who had gone
up to London to hear Grenville’s speech in the House of Lords,
became champion of the college, and had no difficulty in meeting
this assault. The defence of the professors, as set forth by him in
1817,[1022] was that the plan of the college was good in theory and had
proved good in practice. The insubordination was due to the
dependence of the professorial staff upon the Company’s Directors,
who had (till then) withheld from the teachers their best means of
discipline, the power of expulsion.
The students were as little likely as army or navy cadets to become
un-English; and they were much less likely to form a caste at
Haileybury than if they had been sent to an Indian college. The
details of this extinct controversy need not detain us. It is enough to
say that Malthus discharged his part with great vigour and
something of his early vivacity. At the best, it must be confessed, the
college was a compromise; and the unavoidable difficulties of the
situation were quite enough to try the mettle of the teachers. The
cadets of the first year might be fifteen or they might be eighteen,
and there was no natural aristocracy of senior boys to check the
juniors. Those of the younger age were physically and mentally more
like schoolboys than undergraduates, and unfit, as yet, for the quasi-
independent life of the latter. Many were unwilling to go to India at
all, and it was their parents or guardians who really feared the
expulsion of incorrigibles. But it was better that the unfit should be
rejected in England, where they could find other openings, than in
India, where they could find none; and it was better their training
should be carried on where the climate, the expense, and the moral,
social, and intellectual advantages were in keeping with their age and
their state of pupilage. “Little other change is wanting,” in the system
as it then was, “than that an appointment should be considered in
spirit and in truth, not in mere words, as a prize to be contended for,
not a property already possessed,[1023] which may be lost. If the
Directors were to appoint one-fifth every year beyond the number
finally to go out, and the four-fifths were to be the beat of the whole
body, the appointments would then really be prizes to be contended
for, and the effects would be admirable. Each appointment to the
college would then be of less value; but they would be more in
number, and the patronage would hardly suffer. A Director could not
then, indeed, be able to send out an unqualified son. But is it fitting
that he should? This is a fair question for the consideration of the
Legislature and the British public.”[1024] In these matters, at least,
Malthus was no reactionary.
In spite of Joseph Hume and its other enemies, the college lived
out its half-century, and does not die out, on the pages of the India
Register, till the death of the Company in 1858. Its monopoly was
gone some time before then. An Act of 1827 provided, theoretically,
for the examination and appointment of India Civil servants who had
not studied at Hertford College. In 1833 provision was made for the
limited competition which Malthus had recommended.[1025] In 1855
came the end. The Company was “relieved of the obligation to keep
up the college;” the reign of open competition, ushered in by
Macaulay’s Report (Nov. 1854), brought a new order of things; and
the college was only continued till those who had joined it at the time
of the change had been able to finish their course.[1026] There are
numbers of old officials, like Sir William Muir, who still hold it in
affectionate remembrance;[1027] but except in their memory it exists
no more.
The work of Malthus was less in the East India College than in his
writings. But his connection with the college was perhaps the most
important of the external facts of his life; and it has helped to
preserve a record of scenes and incidents which reveal the character
more clearly than all the adjectives of panegyrists. Otter, Empson,
Miss Martineau, Sydney Smith,[1028] and Horner,[1029] may supply the
panegyrics; and the eulogy of Mackintosh is remarkable: “I have
known Adam Smith slightly, Ricardo well, Malthus intimately. Is it
not something to say for a science that its three great masters were
about the three best men I ever knew?”[1030]
His epitaph in Bath Abbey, probably from the pen of Otter, is given
on the following page.
SACRED TO THE MEMORY

of

The Rev. Thomas Robert Malthus,

LONG KNOWN TO THE LETTERED WORLD

BY HIS ADMIRABLE WRITINGS ON THE SOCIAL BRANCHES OF

POLITICAL ECONOMY,

PARTICULARLY BY HIS “ESSAY ON POPULATION.”

ONE OF THE BEST MEN AND TRUEST PHILOSOPHERS

OF ANY AGE OR COUNTRY,

RAISED BY NATIVE DIGNITY OF MIND

ABOVE THE MISREPRESENTATIONS OF THE IGNORANT

AND THE NEGLECT OF THE GREAT,

 HE LIVED A SERENE AND HAPPY LIFE,

DEVOTED TO THE PURSUIT AND COMMUNICATION

OF TRUTH,

SUPPORTED BY A CALM BUT FIRM CONVICTION OF THE

USEFULNESS OF HIS LABOURS,

CONTENT WITH THE APPROBATION OF THE WISE AND GOOD.

HIS WRITINGS WILL BE A LASTING MONUMENT

OF THE EXTENT AND CORRECTNESS OF HIS

UNDERSTANDING.

THE SPOTLESS INTEGRITY OF HIS PRINCIPLES,

THE EQUITY AND CANDOUR OF HIS NATURE,

HIS SWEETNESS OF TEMPER, URBANITY OF MANNERS,

AND TENDERNESS OF HEART,

HIS BENEVOLENCE AND HIS PIETY,

ARE THE STILL DEARER RECOLLECTIONS OF HIS FAMILY

AND FRIENDS.

Born Feb. 14, 1766. Died Dec. 29, 1834.

 INDEX.

Abbot, Chas., mover of Enumeration Bill, 173, 178

Africa, 105, 111
America, North, 17, 28, 69 seq.;
Indians, 89 seq., 105, 111, 143, 167, 174, &c.;
cf. 369, 370 (American increase)
America, South, 88
Anderson, Adam, 173, 174
Anderson, Jas., 221, 377
Arabs, 109, 110
Aristotle, 113, 211, 214, 319, 356, 384

Bacon, Francis, 22, 47, 66, 124, 396

Bagehot, Walter, 227, 383
Ball, John, 385
Bamford, Sam., 298
Bentham, Jeremy, 43, 44, 323, 325, 331
Berkeley, Bishop, 201
Bert, Paul, 371
Births, no criterion of numbers, 149;
or of increase, 179;
cf. 161
Board of Agriculture, 176, 186, 216–218
Booth, David, 362, 371
Bosanquet, Chas., 291
Bounties, 31, 217, 220, &c.
Brassey, Thos., 257
Brougham, H., 228, 415
Brown, Dr. J., ‘Estimate,’ 173
Bruckner, Dr. John, of Norwich, 8
Buckle, H. T., 22, 33
Bullion Committee, 285 seq.

Caird, Jas., 69, 75, 76, 245

Cairnes, J. E., 138, 245, 261
Cannibalism, 94
Carey, H. C., 65, 68, 70, 239, 395
Census, Swedish, 132;
English, B. I. ch. vii.
Chalmers, Geo., 174
Chalmers, Dr. Thos., 316, 409
Chartism, 298
Checks on population, classified, 52, 81, passim B. I. and B. IV.
China, 112, 113
Clarke, Edw., 48, 127, B. V. passim
Cobbett, Wm., 6 and note, 287, 290, 298, 338, 363, 395
Cobden, R., 225, 287, 353;
cf. 55
Coleridge, S. T., the Poet, 22, 48, 95, 111, 371 seq.;
the MS. notes genuine? 374;
cf. 48, 377
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