Environmental Factors in Depressive Illness

Abstract

There seems to be a series of conceptual problems regarding depressive illness and its classification. First, there is the problem of whether these illnesses have some biological function, whether they represent attempts on the part of human organisms to deal with or escape from situations of stress, or whether they should be thought of simply as psychologically meaningless events. Eysenck (1960) and Wolpe (1958) make it clear that they regard neurotic symptoms as meaningless, maladaptive patterns which can and should be removed by suggestion, deconditioning and behaviour therapy. Similarly, Mayer-Gross, Slater and Roth (1955) reject the suggestion that depressive illness may have an adaptive function. By contrast, clinical medicine, though resting heavily on the mechanistic causality models of physics and chemistry, does give some implicit recognition of biological purpose in physical illness. Thus, pneumonia represents not only the phenomenon of invasion of pulmonary tissue by infective agents, but also the phenomenon of bodily defence against such invasion. When such defence does not exist, the patient seldom gets to the physician in time to be diagnosed. That depressive illness might have an analogous biological function was suggested by Freud (1917) and elaborated in impressive detail by Lewis (1934). The converse view that depressive illness represents a breakdown in adaptive function is based on the views of Kraepelin (1913) who attributed the dominant place in the depressive group of illnesses to manic-depressive psychosis with its known hereditary basis. That hereditary factors do operate in the manic-depressive group proper seems to have been demonstrated more than adequately by Slater (1938) and Kallmann (1950). The evidence regarding other depressive reactions, whether recurrent or involutional, seems far from impressive. Nevertheless, Mayer-Gross et al. take the view that affective illness is primarily a question of constitution, that the content of the depression may be understandable in terms of the patient's life situation, but that the causes of breakdown given by relatives of patients are really symptoms of the oncoming illness. Interestingly enough, Henderson and Gillespie (1956) classify affective illness into manic-depressive and involutional depression, and note the importance of social factors (p. 276).

Prognostic effects of biographical data and differences between neurotic depressive, endogenous depressive and healthy subjects

“…Neurotic depressives also show lower AMS scores at the beginning and higher AMS scores at the end of inpatient treatment than endogenous depressives. According to discriminant analysis there is no significant difference neither in the number of life events nor in the biographic scale between neurotic and endogenous depressives, a result which is in accordance with Benjaminsen, 1981;Brown and Harris, 1978;Brown et al, 1979;Forrest et al, 1965;Leff et al, 1970;Paykel et al, 1969;Perris, 1984b;Thomson and Hendrie, 1972. Concerning the biographic scale in a strict sense our results are not correspondent to findings in the scientific literature. Parker (1979) found that neurotic depressives reported less parental care and greater maternal overprotection.…”

“…Some authors found no difference between endogenous or rather psychotic depressive disorders and reactive or neurotic depressive disorders (Benjaminsen, 1981;Brown and Harris, 1978;Brown et al, 1979;Forrest et al, 1965;Leff et al, 1970;Nanko and Demura, 1993;Paykel et al, 1969;Perris, 1984b;Thomson and Hendrie, 1972). But there are also investigations which show a difference in life events between endogenous and reactive or rather neurotic depressive disorders.…”

Childhood Attachment and Loss Experiences Affect Adult Cardiovascular and Cortisol Function

“…Most have attempted, with mixed success, to link loss of a parent during childhood with adult depression (28,29) and other forms of psychopathology (30,31). Overall, the literature is fairly consistent, however, that childhood parental loss in the absence of warm, quality caretaking is an important risk factor for the development of depression in adulthood (32-34).…”

Life Events and Depression in Transit Populations

“…All such events were not undcr the patient's control. In every compartment of RLE all events were enquired for and confirmation that events took place in the relevant period was obtained from relatives bearing in mind the tendency of depressed patients to recall events that 'explain' their mood (Brown and Harris 1978), to selective remembering of depressive events (Fava et al 1981) and to attribute depression to events which in fact resulted from the illness (Lewis 1938 andForrest et al 1965).…”