Research reportGuilt, fear, submission, and empathy in depression
Introduction
Depression is one of the most debilitating psychiatric disorders in the United States. Over 15 million people suffer from depression annually, accounting for 4.7 million office visits (Vital and Health Statistics, 1996) and costing over $30 billion annually (National Institute of Mental Health, 1998). The prevalence of depression has been increasing over the past 50 years (Klerman, 1988, Seligman et al., 1995), tends to be recurrent (Coryell et al., 1994), and has a lifetime prevalence of 17.1% (Blazer et al., 1994). Given the human cost of this disorder, research has been aimed at understanding its causes and developing treatments, focusing on genetic, neurobiological, cognitive and psychodynamic explanations.
Cognitive and psychodynamic approaches to depression emphasize the depressed patient’s preoccupation with the self. From a cognitive perspective, depression occurs in people who have negative cognitions about the self, manifesting in detrimental self-statements and a pessimistic attributional style (Beck et al., 1979, Hollon and Kendall, 1980, Seligman et al., 1979). From a self-psychological viewpoint, depression is the result of a lack of early mirroring and support needed for a healthy and secure sense of self (Kohut, 1977, Shane and Shane, 1988, Stolerow et al., 1987). Blatt and Zuroff (1992) classify depression into two types, both related to concerns about the self.
Evolutionary psychologists have described depression as an involuntary self-protective response to defeat, or to loss of attractiveness or reputation (Allan and Gilbert, 1997, Gilbert, 1992, Price, 1967, Price et al., 1994, Stevens and Price, 1996) and attempted to identify psychobiological mechanisms that account for the associated passivity, loss of confidence, and low self-esteem. Depressed people see themselves as inferior, tend to behave submissively in conflict situations and feel trapped and defeated (Gilbert and Allan, 1994). Data supports the proposition that depression may be related to biological states which evolved to cope with losses of rank, status and heavy defeats (McGuire and Troisi, 1998).
While self-focused concerns and defensive strategies explain some types of depression, they fail to address depression related to worry about others (Akiskal, 1998, Modell, 1965, Modell, 1971, Neiderland, 1961, Neiderland, 1981, O’Connor et al., 1997, O’Connor et al., 1999, Weiss et al., 1986). Akiskal (1998) has proposed that Generalized Anxiety Disorder (GAD), which predisposes a person to depression, is based on an adaptive form of ‘altruistic anxiety’ that, when exaggerated, is pathological. Weiss (1993) suggests that depression occurs as the result of inhibitions derived from pathogenic beliefs inferred from childhood experiences. These beliefs warn a person that by pursuing normal developmental goals, he or she risks harming loved ones. The person vulnerable to depression often suffers from a set of pathogenic beliefs, predicting that personal success will make others feel inadequate by comparison.
Section snippets
Empathy, altruism and concern about others
While concern for the self is an important motivational system in human life, some researchers believe that the importance of self-concern has been overstated (McClelland, 1995, Miller and Ratner, 1998). Other goals include care for others, altruistic pursuits, and protection of the family and social group. Humans and other higher primates appear to be predisposed to empathy, to respond emotionally to others’ distress, and to attempt to help others who are suffering (Batson and Weeks, 1996,
Altruism-based depression
While depressed people often see themselves as defeated and lacking in feelings of confidence (Allan and Gilbert, 1997, Gilbert, 1992, Gilbert and Allan, 1994), some have suggested that depression and submission may be related to altruistic concerns (Modell, 1965, Modell, 1971, Neiderland, 1961, Neiderland, 1981, O’Connor et al., 1997, O’Connor et al., 1999, Weiss, 1993). In clinical settings, some depressed people demonstrate a high proneness to survivor guilt, that is, guilt over surviving
The present research
The present research investigates these factors, comparing the relative contributions of self-focused and other-focused motivations in depression. In a sample of depressed patients and a non-patient student sample, we compared the contribution of survivor guilt with the contribution of feelings of inferiority and the fear of negative evaluation. We hypothesized that both factors would be found to be relevant to the presence of depression; we expected that in some cases self-interest and concern
Participants and procedure
There were two groups of participants in this study: 52 (18 men and 34 women) students and 50 (30 men and 20 women) patients hospitalized for depression. The mean age for the non-patients was 20.2 (S.D.=2.6) and for the patient sample was 39.2 (S.D.=10.7). All participants in both samples were Caucasian. In both samples participation was voluntary.
The Interpersonal Guilt Questionnaire-67
IGQ-67 (O’Connor et al., 1997) is a 67-item, self-report questionnaire designed to assess guilt related to the fear of harming others. This
Prediction of severity of depression
Table 1 presents the zero-order correlations between severity of depression (BDI scores) and major predictor variables. As suggested by the involuntary yielding theory of depression, severity of depression was significantly correlated with both submissiveness (positively) and social comparison (negatively). Severity of depression was also significantly correlated with fear of negative evaluation and fear of envy, both of which reflect self-focused motivations and self-protective concerns.
Discussion
These results support the hypothesis that survivor guilt may be an important psychological mechanism associated with depression. Prior perspectives on depression, informed by evolutionary theory, have focused on loss of social rank and fear of harm to the self, and this was supported in the present study in a non-clinical sample. A non-depressed person who loses a job, who is demoted in some area of life, is likely to experience a lowering of mood, and possibly transient symptoms of depression.
Acknowledgements
This research was supported by a grant from the Miriam F. Meehan Charitable Trusts, 1996, 1997, and 1998 and by a Broitman Foundation Grant for 1996. The authors wish to thank Eunice Yi, Ellen Middaugh, and Mia Sevier, for their assistance, and Margaret Lynch at San Francisco State University for her help with this and many other studies.
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