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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Burnout has become a popular indicator of the distress that individuals can experience at work. In Breaking Point: Job Stress, Occupational Depression, and the Myth of Burnout, the authors, in the context of more than a decade of research, show how the phenomenon hidden behind the label of burnout is, in fact, depressive in nature.
This book unravels the connections between work, depression, and burnout. The authors underline the dangers of mislabeling a depressive condition as burnout, including misdiagnosis, improper treatment, and unaddressed suicidality. Finally, they offer a path forward for individuals and society. By recognizing the depressive roots of burnout, human resources specialists and occupational health professionals can refer employees for appropriate treatment and understand how and why problematic working conditions must be changed.
- Review the history of depression and burnout and their connection to work
- Learn about research that supports occupational depression as a more valuable construct than burnout
- Understand and address the stigma that inhibits affected employees from seeking treatment
- Discover specific, research-grounded actions that occupational health specialists can take to prevent and address depression and burnout in the workplace
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Veröffentlichungsjahr: 2025
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Table of Contents
Cover
Table of Contents
Title Page
Copyright
Dedication
Foreword
About the Authors
Preface
Chapter 1: Occupational Depression
Brief History of Depression
“Depression is rage turned inward,” Dr. Jennifer Melfi
Challenge to Freud’s Explanation of Depression
Helplessness and Hopelessness
Early Linkages of Work to Psychological State
The Diagnosis of Depression
Another Way to Think About Depression
Assessing Depression in the Research Context
“The Stress of Life”
Stressful Life Events
The Demand–Control (DC) Model of Job Stress
A New Development: The Demand–Control–Support (DCS) Model of Job Stress
Reverse Causality
The Effort–Reward Imbalance (ERI) Model
Workplace Bullying
Underestimates
Conclusions
Postscript
References
Chapter 2: Burnout
Herbert J. Freudenberger
Christina Maslach
Correlation Coefficients and Reliability Coefficients
The Foundations of Burnout
More on Discriminant Validity
Antecedents of Burnout
The Multiplication of Burnout Scales
Problems with Burnout Symptom Items That Are Synonymous
Burnout as a Diagnosis
Longitudinal Research on Adverse Working Conditions and Burnout
Conclusions
References
Chapter 3: Burnout–Depression Overlap
The Idea of a Syndrome
First Look at Burnout–Depression Overlap
Burnout and Depression as Distinct Constructs
A Line of Research by Bianchi, Schonfeld, and Colleagues
Burnout and Depressive Cognition
Neurobiology of Burnout and Depression
Anxiety and Depressive Symptoms
The Occupational Depression Inventory
Other Studies That Bear on Burnout–Depression Overlap
Meta-analyses
Conclusions
References
Chapter 4: The Stigma Attached to Burnout
Some Background Beliefs
What Empirical Research Indicates
Burnout Versus Depression
Destigmatizing Burnout
Conclusions
References
Chapter 5: Interventions
Models of Interventions
Randomized Control Trials and Meta-analyses
Tertiary Interventions
Primary and Secondary Interventions for Depression, Psychological Distress, and Burnout
A Pertinent Primary Intervention Study
Conclusions
References
Appendix
Occupational Depression Inventory (ODI)
Inventaire de Dépression Professionnelle (IDP)
Index
End User License Agreement
List of Illustrations
Chapter 1
Figure 1.1 The relation of depression as a continuum to depression as a diagnosis.
Figure 1.2 Teachers in low-, medium-, and high-stress classrooms.
List of Tables
Chapter 1
Table 1.1 Karasek’s original demand–control model.
Table 1.2 High-quality longitudinal studies that bear on the relation of DCS wor...
Table 1.3 High-quality longitudinal studies that bear on the relationship of the...
Chapter 2
Table 2.1 Correlational findings regarding the convergent validity of the subsca...
Table 2.2 Correlations obtained from the Results section adapted from Maslach an...
Table 2.3 Correlation matrix excerpted from the meta-analysis conducted.
Table 2.4 Predicting burnout at Time 2 using a regression analysis adapted from ...
Chapter 3
Table 3.1 Differences between the burnout group and the no-burnout group.
Table 3.2 Differences between the burnout group and the no-burnout group.
Table 3.3 The Pearson correlations are presented for the depressive and anxiety ...
Table 3.4 How the Occupational Depression Inventory (ODI) compares to the Maslac...
Table 3.5 The correlations among the Occupational Depression Inventory (ODI) and...
Table 3.6 Correlations found in the 15-sample meta-analysis.
Table 3.7 Key findings from the meta-analysis conducted.
Table 3.8 The meta-analytically pooled disattenuated correlations from the 14-sa...
Table 3.9 The results of the 96-sample meta-analysis.
Chapter 5
Table 5.1 Meta-analyses of mental health effects of different stress management ...
Table 5.2 Meta-analyses bearing on workers in high-stress jobs.
Table 5.3 The results of meta-analyses bearing on teachers.
Guide
Cover
Table of Contents
Title Page
Copyright
Dedication
Foreword
About the Authors
Preface
Begin Reading
Appendix
Index
End User License Agreement
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Breaking Point
Job Stress, Occupational Depression, and the Myth of Burnout
Irvin Sam Schonfeld, Ph.D., M.P.H.
The City College and the Graduate Center of the City University of New York
and
Renzo Bianchi, Ph.D.
Norwegian University of Science and Technology (NTNU)
WorkWell Research Unit, North-West University
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For my wife, Pearl Knopf Schonfeld
And
In memory of my sister, Royce Joy Schonfeld Katsir
—Irvin Sam Schonfeld
Foreword
Breaking Point: Job Stress, Occupational Depression, and the Myth of Burnout by Irvin Sam Schonfeld and Renzo Bianchi is a groundbreaking exploration that challenges conventional wisdom about burnout and depression. The authors take readers on an enlightening journey through the history of depression, from its ancient roots to its modern understanding in psychiatry. They meticulously dissect the concept of burnout, revealing its deep connections to depressive disorders. Through their own rigorous research and the work of many other well-recognized colleagues in the field, the authors demonstrate that what is often labeled as burnout is, in fact, a manifestation of (occupational) depression.
The book is structured into five insightful chapters, each building on the last to create a comprehensive narrative. The authors begin by tracing the historical context of depression and its links to adverse working conditions. They then scrutinize the construct of burnout, highlighting its overlap with depression. The third chapter is a breaking point, presenting robust evidence of the burnout–depression overlap, supported by the authors’ extensive research. The discussion on stigma and the need for destigmatization of mental health issues is both timely, crucial, and surprising even to scholars like me. Finally, the book offers practical interventions to help affected workers and improve working conditions, aiming to prevent job-related depression.
Breaking Point is not just a scholarly work; it is a call to action. Schonfeld and Bianchi’s eloquent prose and compelling arguments make this book a must-read for professionals and laypersons alike. It challenges readers to rethink their understanding of burnout and depression, urging them to recognize the profound impact of job stress on mental health. This book is an essential addition to the conversation on workplace well-being, offering new perspectives and solutions to a critical issue.
Christian Dormann
Professor, Business Education & Management
Johannes Gutenberg-Universität Mainz
About the Authors
Irvin Sam Schonfeld, professor emeritus at The City College and the Graduate Center of the City University of New York, has studied the impact of job stress on workers, particularly teachers. He and Renzo Bianchi codeveloped the Occupational Depression Inventory and have worked to validate the instruments in several countries and languages. We have also codeveloped a second job-related instrument, the Occupational Anxiety Inventory. Other research interests include burnout–depression overlap, stress in the self-employed, multilevel modeling, and the interface of qualitative and quantitative research. He won an award from the Society for Occupational Health Psychology for his distinguished contribution to the field of occupational health psychology. He is also working on a memoir about growing up in a Brooklyn housing project.
Renzo Bianchi earned his doctoral degree in psychology from Bourgogne Franche-Comté University in 2014. After seven years as a lecturer and researcher at the University of Neuchâtel, with occasional academic duties at the University of Geneva, he joined the Norwegian University of Science and Technology (NTNU) as an associate professor of psychology in 2022. At NTNU, Renzo leads the MAD-OHP research group, which focuses on occupational health and psychological assessment. He is the co-creator of the Occupational Depression Inventory and the Occupational Anxiety Inventory. Since 2024, Renzo has additionally served as an extraordinary professor at the WorkWell Research Unit at North-West University. Renzo has (co-)authored over 100 scientific publications to date.
Preface
Our book has a prehistory that begins in 1991. In that year, Irvin was preparing two separate papers for national conferences, one on depression in teachers, and the other on burnout in teachers. He decided, based on his conference talks, to publish a short paper suggesting that there is more overlap between burnout and depression than many researchers suspected at that time. He published the paper in the database run by the Education Resources Information Center, better known by the acronym ERIC (Schonfeld, 1991).1 The ERIC paper did not get much play. Irvin estimated that if he were to include his wife and sister, he could safely say that three people in the world read the paper. He was soon diverted away from questions relating to burnout and depression. With one exception, other research questions called for his attention, and he did not follow up on the ERIC paper. The exception was that a University of Maryland professor whom he met at a conference colloquium asked him to write a chapter on burnout and depression for a book about stress. The Maryland professor was the book’s editor. Although Irvin wrote the chapter, unfortunately, it never got published because the publisher went out of business.
Twenty-one years after the ERIC paper was published, in December 2012, Irvin received an email from the editor of the Journal of Health Psychology. The editor asked him to review a submission. It was a time of year otherwise crowded with deadlines. Irvin was swamped with student papers to read, exams to mark, and grades to enter. And he and his wife were planning their annual New Year’s Day party. To lure reviewers, editors include an abstract of the manuscript up for review. Typically, during the reviewing process, the identities of submitters and reviewers are masked. Because he found the abstract tantalizing, awakening an interest in a subject he thought about many years earlier, he agreed to review the submission. The paper concerned three groups of French participants, a group of schoolteachers who had scores on the Maslach Burnout Inventory (MBI) that were relatively low, a group of teachers with relatively high scores on the MBI, and a group of depressed outpatients. Irvin found interesting that the depressive symptom profiles of the patients and the teachers with high burnout scores were largely similar and those two sets of symptom profiles dramatically differed from that of the teachers having low burnout scores. Irvin suggested that the authors make some small adjustments but recommended that the editor publish the paper.
After Irvin submitted his review to the editor, the month of December passed into January and January into February. He had forgotten about the paper he reviewed. Then in March 2013, he received an email from a French graduate student he did not know. The graduate student asked Irvin to collaborate on a research project. Irvin was busy and took time to think about the wording of a return-email to politely decline the graduate student’s request without hurting the student’s feelings.
Before he drafted that return email, he received a second email from the graduate student. Attached to the email was a PDF. To Irvin’s surprise, the PDF contained an updated version of the paper he reviewed back in December. The paper had been accepted for publication.2 The graduate student was Renzo. The paper demonstrated Renzo’s bona fides. To Irvin, Renzo was the Real McCoy. Irvin agreed to collaborate with Renzo. That would be the beginning of a collaboration that has endured more than a decade.
Irvin knew that he was scheduled to spend a few days in Paris in July 2013, before traveling to Ferrara, Italy, to see an old friend. Renzo was still at his university in Besançon. The two of us arranged to meet in person in Paris and work on an ambitious paper on burnout–depression overlap. Éric Laurent, a professor at Bourgogne Franche-Comté University, the institution that in 2014 would award Renzo a doctorate, also contributed to that paper. Also in 2014, the International Journal of Stress Management published the paper.3 The Journals Office of the American Psychological Association wrote to tell us that the paper received a great deal of interest on the APA’s Facebook site, and the paper was spotlighted by the APA Center for Organizational Excellence. We knew we were onto something important. We rapidly published several additional papers.
We saw each other in person again in July 2015, in Besançon. During that visit, Irvin got to see some of the sites in eastern France and the Suisse romande (e.g., la Citadelle, the homes of Victor Hugo and the Lumiere brothers, and the Collegiate Church in Neuchâtel). Renzo and Irvin, however, spent considerable time drafting a proposal to CUNY’s human subjects committee, seeking approval for a study they were planning to run in the United States. That human-subjects proposal eventually led to a study of burnout and depression that was published in the Journal of Clinical Psychology in 2016.4 We were making progress.
We have thus been research collaborators since 2013. We have dedicated countless hours of work to clarify the burnout case, trying to address the issue as comprehensively as we could. Our work has resulted in dozens of studies and papers over the years. We are grateful for the sustained interest that our research has elicited not only among the scientific and medical communities but also among organizations and the public.
In the spring of 2023, Irvin received a request from an editor at John Wiley, asking him to review another author’s book proposal about burnout. He read the proposal and wrote what he thought was a fair and thorough review. Some weeks after he sent the review to the editor, he received another email from the editor. In this email the editor asked Irvin to submit his own book proposal. Irvin asked Renzo if he would be willing to be a partner in writing the proposal and, if the proposal were accepted, to coauthor the proposed book. Upon Renzo’s agreeing, Irvin got permission from Wiley to have Renzo as an equal partner in writing the proposal and the book the proposal mapped out.
We don’t take for granted that we owe a great deal to modern communication networks. In writing the book, Irvin has mostly worked in Brooklyn, occasionally at the CUNY Graduate Center (kitty-corner from the Empire State Building), Great Neck, New York (less than a mile from the house where Scott Fitzgerald wrote the first chapters of Gatsby), and, very occasionally, in Minnesota. Renzo worked in Trondheim, Norway and, from time to time, in Geneva, Switzerland. Although sometimes we communicated via Zoom, we mostly collaborated via email with chunks of text and commentary on the text sailing back and forth day by day, often multiple times in a day. We occasionally had disagreements, which we strove to work out. We take pride in our endeavor because we believe that our work will further the efforts of governments, labor unions, and organizations to protect the health of workers. Workers don’t become depressed because there is something in the air. Sometimes elevations in workers’ depressive symptoms result from bad job conditions. Our goal is not just to show burnout’s overlap with depression and warn against the dangers of its neglect. We also want to underscore the importance of improving working conditions such that job-related depression will be rare and helping workers who have already become depressed to recover.
We organized the book into five chapters. The first provides the reader with a brief (and necessarily partial) history of the very long arc of human knowledge of the condition identified as depression. Within the context of that arc, we show how research has linked depressive conditions to life adversity, including adverse working conditions. The second chapter is devoted to the construct known as burnout, the history of which is millennia shorter than the history of our familiarity with depression. However, from the get-go, burnout has been viewed as a work-related phenomenon and a product of contemporary changes in the economy and the labor market—very much like neurasthenia one century earlier. The third chapter lays out the research on burnout–depression overlap, with an emphasis on our own research efforts. Focusing on burnout–depression overlap allows us to examine the nature of the burnout phenomenon further. The fourth chapter concerns the stigma attached to mental (ill-)health in general, and burnout and depression in particular. The aim of the fifth and final chapter is to show what we can do to help affected workers and prevent more workers from becoming distressed.
We sought to make the book appealing to both professionals (e.g., clinicians, researchers, academics, and graduate students) and educated nonspecialist readers. For the nonspecialists we created two sections, one in Chapter 2 and the other in Chapter 5, that explain in ordinary language some of the technical aspects of the research we review. We also used footnotes at specific junctures in the book to help nonspecialists if that help is needed.
The research we present has excited us. We hope that through this book our sense of excitement carries over to our readers. But ultimately, our foremost desire is that our book be an instrument that helps to make better the lives of people who work.
We thank a number of individuals who helped us with the writing and publication of this book. First, we thank Wiley’s Nathanael Mcgavin and Kelly Gomez, who were very helpful in providing us with information we needed in getting our writing done. We thank several individuals who read and made thoughtful editorial suggestions on drafts of different sections of the book when the book was at different stages of completion. These friends, relatives, and colleagues include Romain Brisson, David Kotelchuk, Joel Schwartz, Constance Gemson, Pearl Knopf Schonfeld, Jay Verkuilen, Milton C. Spett, Christina Guthier, and Christian Dormann. Thank you.
Notes
1
Schonfeld, I. S. (1991). Burnout in teachers: Is it burnout or is it depression? ERIC Document No. 335329.
http://www.eric.ed.gov/PDFS/ED335329.pdf
2
Bianchi, R., Boffy, C., Hingray, C., Truchot, D., & Laurent, E. (2013). Comparative symptomatology of burnout and depression.
Journal of Health Psychology, 18
(6), 782–787.
https://doi.org/10.1177/1359105313481079
3
Bianchi, R., Schonfeld, I. S., & Laurent, E. (2014). Is burnout a depressive disorder? A reexamination with special focus on atypical depression.
International Journal of Stress Management, 21
(4), 307–324.
https://doi.org/10.1037/a0037906
4
Schonfeld, I. S., & Bianchi, R. (2016). Burnout and depression: Two entities or one.
Journal of Clinical Psychology, 72
(1), 22–37.
https://doi.org/10.1002/jclp.22229
Chapter 1Occupational Depression
Depression is an important topic. It is a major contributor to the global burden of disease and disability (James et al., 2018). Our goal for the beginning of this chapter is to trace, however briefly, the history of humankind’s acquaintance with the disorder. Our forebears have known about depression for millennia. We commonly recognize it in a person when that individual is persistently sad, derives little or no pleasure from the things that ordinarily give pleasure, retreats from getting in touch with friends, and so forth. We will provide a more formal definition of the condition later in the chapter. Although the focal concern of this chapter is work-related depression, by way of an introduction, we briefly address some of the historical background regarding our knowledge of depression in general.
Brief History of Depression
Our brief history commences with the beginning of the recorded word, in Mesopotamia between 2900 and 2300 BCE. The context is The Epic of Gilgamesh. King Gilgamesh had been affected by two of life’s inevitabilities. First, he is grieving the loss of his friend, Enkidu. The second is his fear of his own eventual death and the fruitless search for a way to avoid it.
Urshanabi said to him, to Gilgamesh:
“Why are thy cheeks wasted, is sunken [thy face],
Is so sad thy heart, [are worn thy features] ?
(Why) should there be woe in [thy belly],
[Thy face be like that] of a wayfarer from afar,
With cold and heat be seared [thy countenance],
[As in quest of a wind-puff] thou roamest over the steppe”
[Gilgamesh] said [to him], to [Urshanabi]: “[Urshanabi, why should my] cheeks
[not be so wasted], [So sunken my face],
[So sad] my [heart], so worn my features?
[(Why) should there not be] woe in [my belly],
[My face not be like that of a wayfarer from afar],
Not be so seared [my countenance with cold and heat],
[And in quest of a wind-puff should I not roam over the steppe]
(Speiser, 1955, p. 91)
We note the sad heart, the somatic symptom of a stomachache, and the dour countenance. Later we will address the difference between depression and mourning, a subject about which Sigmund Freud famously wrote.
Depression, as a human condition, is also evident in several verses in the Hebrew Bible. In Ecclesiastes 1:8, we read: “All things toil to weariness; man cannot utter it, the eye is not satisfied with seeing, nor the ear filled with hearing” (The Jewish Publication Society, 1917). The verse underlines fatigue, anhedonia, and an indifference to life, hallmarks of depression.
Verses 1 and 2 of Psalm 40 are also instructive. The Jewish Publication Society (1917) translates the verses as follows:
I waited patiently for the LORD; and He inclined unto me, and heard my cry.
He brought me up also out of the tumultuous pit, out of the miry clay; and He set my feet upon a rock, He established my goings.
A more interpretative translation of the verses comes from the Tyndale Bible.
I waited patiently for the LORD to help me, and he turned to me and heard my cry.
He lifted me out of the pit of despair, out of the mud and the mire.
Tyndale House (1996)
The more interpretative translation refers to King David being in the pit of despair, an indication of his melancholic suffering. We observe despair/sorrow in Psalm 13:3, “How long shall I take counsel in my soul having sorrow in my heart by day?” (The Jewish Publication Society, 1917).
Scattered through the writings of Hippocrates, the Greek physician who lived during the fifth century BCE, is the term “melancholia.” In his Aphorisms, Hippocrates (1931) described melancholia as “fear and sadness that last a long time.” The term is thought to be largely synonymous with depression and is derived from the Greek words for black [µέλαινα] bile [χολή]. Humoralists like Hippocrates and his followers believed that sufferers of depression had an excess of black bile, black bile being one of the four humors, which also include yellow bile, blood, and phlegm. Good health required balance among the humors. Although that belief is considered useless today, Hippocrates and his followers, however, did something of great importance. Hippocrates advanced the idea that physical disorders and melancholia had natural causes (Jackson, 1986). The naturalist hypothesis of Hippocrates was then overlooked for centuries. In the Middle Ages, people commonly believed that some diseases, including melancholia, had supernatural causes, for example, the devil’s handiwork or God’s punishment (Jackson, 1986).
We observe evidence in Shakespeare’s Hamlet that Elizabethans understood melancholia.
. . . I have of late—but
wherefore I know not—lost all my mirth, forgone all
custom of exercises; and indeed it goes so heavily
with my disposition that this goodly frame, the
earth, seems to me a sterile promontory, this most
excellent canopy, the air, look you, this brave
o’erhanging firmament, this majestical roof fretted
with golden fire, why, it appears no other thing to
me than a foul and pestilent congregation of vapours
Thank you, Mr. Jacob Hendon, ISS’s middle school English teacher
The Hippocratic humoral theory of melancholia, with its idea that an imbalance in bodily humors accompanies melancholy, lived on through the Renaissance. The English scholar Robert Burton, who published The Anatomy of Melancholy in 1621, subscribed to a humoral view of depression. The view was commonly held throughout Europe (Sadowsky, 2021).
By the end of the nineteenth century, the mental disorder melancholia was commonly viewed as the province of psychiatry. From the standpoint of clinical science, it is important to reliably distinguish melancholia from other mental disorders. Important milestones in psychiatric classification were achieved in the late nineteenth and early twentieth centuries. In the 1890s, the German psychiatrist Emil Kraepelin developed the beginnings of a nosological system for psychiatry by differentiating manic-depressive psychosis and dementia praecox, which is recognized today as schizophrenia (Jackson, 1986). He used both the symptoms and, based on longitudinal follow-up, the course of the disorder (e.g., whether deteriorating over time or not) to help establish the diagnostic categories. Manic-depressive psychosis included depressed states and manic states (circular insanity), in other words, alterations of depressive and manic periods (today’s bipolar disorder). He brought “most melancholic disorders together, eventually to be named manic-depressive insanity” (Jackson, p. 193). As for symptoms of depression, Kraepelin included cognitive slowness, indecisiveness, limiting one’s thoughts to life’s dark side, exhaustion, and suicidal ideation. Kraepelin was able to discern levels of severity in melancholia from straightforward depression to a depressive condition so severe that it is accompanied by hallucinations and delusions. Kraepelin came to regard these disorders as frequently having a basis in heredity (Jackson, 1986), a far cry from an imbalance involving black bile. He, however, could not pinpoint anatomical markers of these disorders.
In 1904, the Swiss American psychiatrist Adolf Meyer advanced nosology further by distinguishing (unipolar) depression as a category that is separate from Kraepelin’s manic-depressive nosological category (Jackson, 1986). Meyer favored the term “depression” over its overripe synonym “melancholia” (Sadowsky, 2021). Meyer tended to regard mental disorder as a pattern of maladaptive responses to the circumstances of life, the patterning depending on “constitution and life experiences” (Jackson, 1986).
What is clear thus far from this brief survey is that from the beginning of recorded time melancholia or depression has been widely observed. But what causes it? As science matured, the idea that the basis for melancholia lies in excessive black bile was recognized as a dead end.
“Depression is rage turned inward,” Dr. Jennifer Melfi
Beginning in the late 1890s and continuing onward into the next century, the psychoanalytic movement had much to say about mental disorders, including depression, and came to dominate psychiatry for much of the twentieth century. The German psychoanalyst Karl Abraham (1968/1911) observed the similarities of grief or sadness, on one hand, and depression, on the other. He then suggested an important difference. Abraham advanced the view that depression is unconsciously motivated.
Sigmund Freud (1953–1974/1917) graciously allowed Abraham’s observation to be the point of departure for the influential paper “Mourning and Melancholia,” although Freud had made the grief–depression comparison even earlier than Abraham.1 In “Mourning and Melancholia,” Freud wrote that “although mourning involves grave departures from the normal attitude to life, it never occurs to us to regard it as a pathological condition” (p. 243). The mental features of melancholia include “a profoundly painful dejection, cessation of interest in the outside world, loss of the capacity to love, inhibition of all activity, and a lowering of the self-regarding feelings to a degree that finds utterance in self-reproaches” (p. 244). Freud noted that individuals who mourn a person they loved share many of the same features as the melancholic, but with one notable exception, namely, disturbed self-regard.
Freud observed that in mourning, eventually the individual who suffered a loss, as grief-stricken as the individual is at first, gradually comes to regain an interest in the world. He called that transition “the work of mourning.” The person suffering from melancholia may have, indeed, suffered a loss of varying degrees of personal importance, ranging from the death of a parent with whom the melancholic has had an ambivalent relationship to a romantic relationship that ended when one partner jilted the other to a personal slight from a close friend. In melancholia, Freud pointed out that the degree of symptom manifestation and duration is greatly out of proportion to the magnitude of the loss. In Freud’s estimation, melancholics regard themselves as “worthless, incapable of any achievement and morally despicable.”
Freud outlined what he regarded as a major cause of depression by attempting to solve the riddle of that surmised disproportion. He wrote, “If one listens patiently to a melancholic’s many and various self-accusations, one cannot in the end avoid the impression that often the most violent of them are hardly at all applicable to the patient himself, but that with insignificant modifications they do fit someone else, someone whom the patient loves or has loved or should love” (p. 248). Freud viewed the self-reproaches of melancholics as reproaches against a love object that have been unconsciously displaced onto the self. To reproach another who is (or should be) much loved (e.g., a mother or a father) is impermissible. Murderous rage against a love object gets displaced, becoming suicidal ideation. The treatment for melancholia is then psychoanalysis, an important goal of which is to make what has been unconscious conscious.
The quotation (Figgis et al., 2004) that heads this section comes from an episode of a popular TV crime series about a mobster named Tony Soprano who operates in northern New Jersey. Unknown to the soldiers and capos in Tony’s crime family and the crime families of his rivals, he sees a psychiatrist named Jennifer Melfi for treatment of his mental health problems. The episode we quoted was first broadcast in 2004, more than 87 years after the publication—in German—of Mourning and Melancholia and continues to be broadcast, evidence of the staying power of Freud’s ideas regarding a principal cause of depression.
Challenge to Freud’s Explanation of Depression
Freud’s theory of depression and other mental disorders (e.g., schizophrenia) has not been without critics. The Austrian British philosopher of science Karl Popper (1963) advanced the view that psychoanalytic theory should not even be regarded as a scientific theory. Popper rejected the tendency of adherents of psychoanalysis to interpret many kinds of human interactions as evidence for the truth of psychoanalytic theory. The first author, to help undergraduates attending his research course, created an illustrative example of what Popper meant. Here is an excerpt from that course.
A psychoanalyst would find consistent with psychoanalytic theory the following observations. A pair of overprotecting parents living in the Park Slope section of Brooklyn raises a very hostile boy. The analyst asserts that the parents’ overprotectiveness unconsciously generates belligerence in the offspring, who directs hostility to other neighborhood children, suspecting that they “are out to get him.” Another pair of overprotecting parents from the same neighborhood has a nervous boy. The analyst claims that the parents unconsciously and excessively communicate to the child that the other children in the neighborhood are dangerous delinquents, causing the boy to be meek and avoidant. Yet another pair overprotecting parents living in the same neighborhood has a normal boy and somehow that gets explained by the analyst. The psychoanalyst can somehow explain what takes place in every kind of parent–child constellation.
There was more to the classroom discussion of Popper’s views, but the foregoing example provides a flavor for what Popper thought of psychoanalytic theory. It explains everything, but it explains everything post hoc. Professionals allied to the psychoanalytic movement have failed to make predictions (hypotheses) in advance of collecting observations. By making such advance predictions, then collecting observations, these professionals could test the truth value of the predictions. Popper (1963) underlined the idea that it is important for science that scientific theories be able to generate hypotheses that are falsifiable. By that he meant that scientists need to show that theories generate hypotheses that can be shown, in principle, to be incompatible with the observations collected in a research endeavor. In plain English, the scientist proposing a hypothesis “goes out on a limb.” The scientist collects data that can be consistent with the hypothesis or contradict the hypothesis. Theories that generate hypotheses that are demonstrated to be consistent with the collected observations gain status in the scientific community. Theories that generate hypotheses that are inconsistent with observations lose status. The problem with psychoanalytic theory, according to Popper, is that it fails to generate falsifiable, that is, testable, hypotheses at all (in Chapter 3 we return to Popper’s ideas regarding hypothesis-testing, but in a different context). The American psychiatrist Aaron Beck was to our knowledge the first researcher to put psychoanalytic theory to the test.
Aaron Beck and Albert Ellis trained to become and indeed became practitioners of psychoanalysis. They both, however, evolved into apostates, rejecting psychoanalytic theories. Both men independently went on to develop cognitive therapies that contrast with psychoanalysis. Their therapies were nonetheless designed to help individuals with depression and other mental health problems. Ellis (1958), an American psychologist, broke away from psychoanalysis first. He viewed maladaptive behavior patterns as the result of irrational thinking and beliefs that have been learned. He developed a psychotherapy called rational therapy that later evolved into rational emotive therapy and that further evolved into rational emotive behavior therapy. Ellis’s approach to psychotherapy employs something like a Socratic dialogue and disputation to help individuals discover what is false or misleading in their thinking, correct that thinking, and thereby get clients to lead happier, more productive lives. Ellis’s approach influenced later cognitively oriented therapies for depression and other mental health problems (see Chapter 5).
Like Ellis, Beck was a psychotherapist. Beck, however, differed from Ellis in an important way. Beck was also a researcher. He and his colleague Marvin Hurvich (1959) conducted a study in which the dreams of depressed and nondepressed patients were transcribed and evaluated by two raters. The authors hypothesized that, compared to the dreams of the nondepressed, the dreams of depressed patients would be characterized by disappointment, sorrow, loneliness, and rejection. Beck also conducted a follow-up study with a larger sample, again finding similar results (Beck & Ward, 1961). But Beck and his colleagues made an easy prediction, namely, that, compared to the nondepressed, depressed individuals would report more depressive features in their dreams. The dreams in the depressed samples were consistent with what depressed individuals experience in their waking thoughts and feelings.
The test of psychoanalytic theory should be more nuanced. To understand that nuance, we should turn to the theory’s axioms bearing on dreams.
If we restrict ourselves to the minimum of new knowledge which has been established with certainty, we can still say this of dreams: they have proved that what is suppressed continues to exist in normal people as well as abnormal, and remains capable of psychical functioning [italics by the authors]. Dreams themselves are among the manifestations of this suppressed material. . . . (Freud, 1953–1974/1899, p. 608).
According to Freudian theory, during waking life an unconscious mental censor protects against id-related unconscious content, such as unacceptable sexual and aggressive thoughts and feelings, entering a person’s consciousness. During sleep, however, the censor relaxes somewhat, allowing the unacceptable content to emerge, slightly disguised by “dream work,” and that content plays a part in dreams. If dreams are the king’s highway to the unconscious, then dreams should, consistent with psychoanalytic theory, reveal content that underscores anger or hostility directed at a loved one or another important figure in a person’s life. An expression of that anger would ordinarily be deemed unacceptable in everyday family and social life. A Popperian hypothesis that would follow from psychoanalytic theory would be that, compared to the dreams of the nondepressed, the dreams of depressed individuals would show more other-directed angry and hostile imagery, which was not what Beck found.
Beck (personal communication to ISS, 2014) reported that he and his colleague Hurvich unexpectedly found less evidence of hostile content in the dreams of the depressed patients than in the dreams of the nondepressed patients, contradicting the abovementioned Popperian hypothesis that would follow from psychoanalytic theory, a hypothesis they did not include in their 1959 and, for that matter, Beck and Ward's 1961 paper. The papers were published before Beck’s transition away from psychoanalytic orthodoxy. Beck’s research and clinical observations led to his break with psychoanalytic orthodoxy. Beck went on to develop a cognitively oriented therapy designed to help individuals suffering from depression (Beck, 2019), a therapy we describe in Chapter 5.
Helplessness and Hopelessness
The purpose of the learned helplessness theory of depression, developed by psychologist Martin E. Seligman and behavioral neuroscientist Steven F. Maier, was to explain how individuals may come to regard themselves as powerless and become passive in the face of adversity (for reviews, see Seligman, 1975, and Peterson et al., 1993). The theory emerged from a series of experiments conducted in the 1960s (e.g., Overmier & Seligman, 1967; Seligman & Maier, 1967). The experiments showed that dogs that experienced uncontrollable and inescapable electric shocks did not attempt to escape even when given the opportunity to do so. They had learned to be helpless.
Seligman and Maier extrapolated these findings, suggesting that similar processes could occur in humans. According to their theory, when individuals repeatedly face negative situations that they perceive as beyond their control, they may learn that they have no agency over their environment. This belief in the inability to change or influence outcomes can lead to a state of passivity and depression.
The learned helplessness theory emphasizes the importance of three factors:
Contingency: the perceived lack of relationship between one’s behavior and the outcome of events.
Cognition: the development of a belief that outcomes are uncontrollable.
Behavior: a resulting passive or depressive response due to the belief that one cannot influence outcomes.
Learned helplessness theory has been influential in understanding cognitive aspects of depression, underlining how beliefs about control and efficacy can influence health (e.g., De Raedt & Hooley, 2016; Grahek et al., 2019; Moscarello & Hartley, 2017). The theory led to further research into cognitive-behavioral mechanisms and therapies designed to counteract these learned beliefs by fostering a sense of control and efficacy in individuals.
The original learned helplessness theory underwent significant refinement over the years, leading to a more nuanced understanding of how learned helplessness relates to depression and other psychological conditions (e.g., anxiety). Key developments in this evolution included an “attributional reformulation” (Abramson et al., 1978). Building on the initial theory, so-called attributional styles were introduced as an important factor in the learned helplessness model. This reformulation proposed that the way individuals explain the causes of negative events—whether they assess these causes as internal or external to themselves, stable or unstable, and global (pan-situational) or situation specific—influences their likelihood of developing learned helplessness. People who habitually interpret setbacks as permanent, pervasive, and due to personal failings are more likely to become depressed.
