Chapter 6: Happiness, Depression and Self-Concept 
How do we become happy?
The interaction of happiness and depression
Forces affecting happiness and depression
Suggestions for increasing happiness
Life circumstances in |happiness
Promising routes to happiness
Theories about the causes of depression
How do you explain things?
Sad times of our lives--
Understanding suicide
Barriers to getting treatment
Rate of suicide by special groups
Predicting suicide is hard
Warning signs
Prevention and treatment (cautions about drugs)
Intensive individual psychotherapy
Useful information
Injury or suicide?
Stopping self-injury (books and sites)
Methods for coping with depression...
Dealing with Anti-depressants
Behavioral Methods--self-observation, outcome analysis,
self-evaluation, use rewards, change environment, observe     
payoffs, atone, get support... 
desensitization, express feelings
Skills--develop social skills, assertiveness, communication skills    
Cognitive--build self-esteem, learn to be optimistic, attribution
re-training, determinism, support groups 
Unconscious--insight by reading, find underlying emotions
We have all been sad. We have lost loves, dreams, pride, hopes,
faith and on and on. Even periods of serious depression, like Abe
Lincoln's, are not rare events. About 15% of us have been so
depressed that it would have been wise to seek professional help
(Wilcoxon, Schrader, & Nelson, 1976). But only one third of depressed
people seek treatment (and they wait an average of 258 days to do
so). Nevertheless, one third of all people seeing a psychiatrist are
depressed. Depression is the first or second most frequent reason why
people are admitted to the psychiatric wards in general hospitals
(NIMH, 1971). A Presidential Commission on Mental Health estimated
that 1 out of 5 of us (about 1 in 10 for males and 1 in 4 for females),
will suffer from depression sometime in our lives. That is 20% in an
affluent country--the happiest country on earth; what about the poor
countries? Women are twice as likely as men to be depressed; men
get upset over jobs, women over relationships; married people in "not
very happy relationships" are more likely to be sad than unmarried
and divorced people. We will discuss these statistics later. 
Depression is not only fairly common, it can be very serious. Like
Abe Lincoln as a young man, the misery can be so constant, so great,
and seem so seemingly endless that one wants to die--to escape the
pain. In the U.S. one person every minute attempts suicide; one
person every 24 minutes succeeds. There are more suicides than
murders. Even among teenagers, it is third only to accidents and
homicides. Almost 500,000 teenagers attempt suicide each year, not
counting suicides disguised as "accidents" (McCoy, 1982). Suicide is so
sad because it is a permanent, desperate solution to a temporary
problem. What a loss to the world if Lincoln had killed himself. What a
blow to each family in which an unnecessary death occurs. 
My interest here is not so much with serious, disabling or suicidal
depression, usually called Clinical or Major Depression. Indeed, if
sadness is disrupting your work and schooling--and you are thinking of
ending it all--seek professional help immediately; you need more than
self-help; run no risk with your life. This "common cold of mental
disorders" hospitalizes 250,000 a year, the most extreme cases. The
"common cold" slows down many more of us and makes us gloomy.
This chapter focuses on these less serious forms of depression:
sadness, disappointment, loneliness, self-criticism, low self-concepts,
guilt, shame, boredom, tiredness, lack of interests, lack of meaning in
life, etc. Most of us are or will be somewhat depressed or disappointed
and could use self-help. Overall, depression costs the country more in
treatment and lost work than heart disease. 
Are some people just naturally happy?
It sometimes seems like it. Were they just born with the hard
wiring that makes them happy, cheerful, active, social, and optimistic?
Maybe. It might have been an inherited family trait but happiness
happens in other ways apparently. For instance, in many cases happy
people are different from anyone else in the family; indeed, some had
an unpleasant, neglectful, abusive family which they had trouble
understanding but learned to tolerate. We don’t know all the ways to
become happy yet. Some chronically happy people are referred to by
some doctors as having hyperthymia, similar to but the opposite of
dysthymia (chronic, mild depression). See Richard Freiman’s 2002
Maybe some people just have more serotonin in their brains. Well,
that sounds simple but it appears more complex than that because
antidepressants increase serotonin within days but it takes weeks to
reduce the depression. Research has also shown that giving an
antidepressant, such as Paxil, to normal people, who are not
depressed, does not increase their happiness (it did reportedly reduce
their anger slightly and increase their sociability). In addition, it is
common knowledge that certain illegal drugs, such as Cocaine and
Ecstasy, quickly produce euphoria (these drugs, like Paxil, presumably
do this by increasing serotonin and dopamine), but the positive
emotions soon fade and then depression and/or apathy rapidly
If you have a cheery disposition, count your blessings. Let’s look
more closely at our limited knowledge about happiness. 
There is a long-running controversy about the cause of depression
(which means no one knows): some say our personal history or
experiences (psychology) cause depression, others say brain chemistry
causes depression. Both psychology and drugs relieve depression in
some cases, so the treatment doesn't clarify the causes. My guess is
that psychological factors play a role in almost all depressions and
physiological (chemical) factors are significant causal factors in some
depressions, especially the very severe cases. 
Like several other human disorders, there is evidence that
unhappiness runs in some families. Studies estimate that 15% to 40%
of the risk of major depression results from genetic factors. Your genes
may have predisposed you to be at a certain point on the happiness-
depression scale, just as other genes may have predisposed you to be
at a certain weight. But, most psychologists believe you can influence
your weight and your mood; genes don't have perfect control. Yet,
David Lykken and Auke Tellegen at the University of Minnesota
suggest that we really don't have much control over happiness,
pointing out that the thrill of a promotion or winning the lottery fades
away in 3 to 6 months and you go back to your set point. Moreover,
some of their studies have reported that happiness does not tend to be
highly related, in our country, to education, income, success, type of
job, or marital status. So, maybe the genes do seriously influence our
happiness, but what are the possibilities of controlling our sadness? 
I don't doubt that genes have some influence over your level of
happiness. But, I also believe (hope?) that ways of seeking joy, being
optimistic, tolerating losses, etc. are learnable skills. Some experts
argue that your happiness is more under your control than your
depression is. Interesting possibility but I don't think we know that
much about mood control yet. In the case of both happiness and
sadness, self-control will take wisdom, planning, and effort. You surely
have to pursue happiness; it takes mindfulness and skills or
What this chapter offers
In this chapter, after briefly discussing happiness, we will first
consider the signs of depression: How do we recognize it? Of course,
each of us feels and acts differently when depressed. There are many
ways to become depressed; thus, we will consider several explanations
of sadness (see index above). 
Since sadness may occur in many circumstances and arise via
several psychological processes, we will also consider how depression
develops in several common situations: during death or loss of a loved
one, when alone, when feeling low self-esteem, when pessimistic,
when having suicidal thoughts, when experiencing guilt and shame,
when feeling bored, tired, or without interests, and when there are no
obvious causes. Each depressive situation and each psychological
dynamic may require its own unique solution. 
After gaining some understanding of depression, self-help
approaches will be discussed by levels: 
Behavior--increase pleasant activities, more rest and exercise,
thought stopping and reduction of worries, atoning for wrong-
doing, and others, 
Emotions--desensitization of sadness to specific situations and
memories, venting anger and sadness, elation or relaxation
training, etc., 
Skills--social skills training, decision-making, and self-control
training to reduce helplessness, 
Cognition--more optimistic perceptions and attributions,
challenging depressing irrational ideas, a more positive self-
concept, more acceptance and tolerance, decide on values and
meaning, and 
Unconscious factors--learn to recognize repressed feelings and
urges, understand sources of guilt, and read about depression. 
At the end of the chapter, you should be able to select the
techniques that seem most likely to reduce your sadness. Then,
following the steps outlined in chapter 2, you should be able to get in
control of these kinds of feelings. In general, self-confidence, an easy-
going disposition, and family support lead to a better recovery from
History and Gender Factors in Depression
What experiences precede depression?
Does an unhappy adult have a history? You'd think so. Some
researchers say there is not a strong relationship between how happy
you were as a child or an adolescent and how happy you are as an
adult. Yet, keeping in mind that happiness and depression are
independent, Harrington (1990) followed up 80 children and
adolescents hospitalized for serious depression and found 60% became
depressed again before they were 30. Several childhood experiences
have been related to adult depression: (1) feeling guilty as a child (1/3
did) and (2) a strained relationship with the same-sexed parent,
especially if a divorce is involved, (3) a mother depressed enough that
she needs help caring for the children, and (4) dominant, over-
protective parents using poor child-rearing practices, especially if
fathers gave poor child care. 
A large study of depressed adolescents (Kandel & Davies, 1982)
found these factors were sometimes involved: (1) low self-esteem, (2)
"acting out" anti-social behavior, (3) over-involvement with peer group
and little with parents, (4) over-involvement with parents and little
with peers, (5) authoritarian parents or "do-what-you-want" parents,
and (6) depressed parents. Adolescents, in general, are happier if they
have some pleasant involvement with peers and with parents who are
basically democratic and happy. 
Coryell, Endicott, & Keller (1992) followed adults who had never
been diagnosed as mentally ill. Within 6 years, 12% developed major
depression. Younger persons (under 40) were three times more likely
to get depressed than were older people (yet, suicide goes up with
age). Going through a divorce doubles the chances of getting
depressed, especially for women. Women are diagnosed as depressed
twice as often as men. Higher education increases the risk for women
(not true in all studies) and decreases the risk for men. Women living
on farms are prone to depression. There are other gender differences. 
Gender discrimination in depression
In adulthood, some studies have found that depression is most
likely to occur in unmarried women who are poor and have little
education. They are disadvantaged and have little control over their
lives so depression is not surprising. 
Why are women more depressed then men? There are several
possibilities why 25% of women will be depressed sometime in their
lives, but only 10% to 15% of men. (Incidentally, 37% of women
psychologists will be depressed, so knowing about academic
psychology apparently doesn't help.) First of all, women are taught to
conform, to serve, and to please others in a society that truly values
and rewards self-serving individualism (if you aren't valued for doing
what you think is right, you suffer a loss). Within this context, about
50% of women are physically or sexually abused before age 21,
another 25+% are abused or coerced in later relationships, and 70%
are sexually harassed. 75% of all people in poverty are women with
children. Being a victim is, of course, depressing. 
Also, an amazing thing happens at puberty. Before developing
sexually, boys are more likely to be depressed than girls, but
afterwards girls become twice as likely to be depressed and boys turn
to delinquency. Not all girls get depressed, however. Susan Gore at
University of Massachusetts reports that the adolescent girls who get
depressed tend to become over-concerned and over-involved
emotionally with their mothers' problems in a stressful home. Boys do
not show this sensitivity to and involvement in family problems. (For
one thing, depressed mothers interact less emotionally with sons than
daughters.) Moreover, research by Joan Girgus at Princeton suggests
that it is body image ("I'm too fat" or "too flat"), not life events, sex
roles, or social popularity, that causes the depression in teenage girls
(while boys saw their adding weight as "adding muscle"). 
Nolen-Hoeksena and Girgus (1994) suggest that girls have certain
personality traits that interact with the stresses of being a teenaged
girl that produce depression and lower self-esteem. The personality
traits are thought to be emotional dependence on relationships, less
assertiveness, and passivity (or an inclination to worry about a
problem situation rather than do something about it quickly and
decisively, as a boy might do). Thus, maturing young girls may get
distressed when interacting with desirable but sexually aggressive
(scary?) young males, when they dislike or don't know how to handle
their own bodily changes (breasts, pimples, over or under-weight, no
butt, etc., etc.), when sexually teased, used, or abused, when their
social activities are restricted more than boys, when peers, culture,
and parents start to emphasize attractiveness, sexiness, and
friendships more than intelligence, genuine caring, and preparing for
one's life work. We are gradually finding more and more childhood
factors related to teenage depression. 
A frequently cited statistic is that women are twice as likely to
become depressed as men (and two or three times more likely than
men to attempt suicide). It is an interesting coincident that women are
also about twice as likely as men to “over-think,” which is ruminating
mostly about unhappy events in the past (in contrast to worry which
often focuses on bad things that might happen in the future). This
could be another bit of evidence that negative thoughts produce
negative emotions (although the above observation that females
dramatically increase their negative thoughts at the time of puberty
also suggests something else may be an underlying cause of both
negative thoughts and depressed feelings). 
Susan Nolen-Hoeksema (2003) has written a book based on her
research about “over-thinking” in women, Women who think too
much: How to break free of overthinking and reclaim your life. The
result of over-thinking is that women (and men!) work themselves into
a complex, confused emotional state where conclusions and solutions
become difficult, if not impossible. Women may be more prone to
over-think because they are sensitive to others and are often expected
to solve personal conflicts without offending anyone. Nolen-Hoeksema
found three types of over-thinking: 1. Rant and Rave—we believe
someone has done us wrong and become self-righteous and plan
revenge. 2. Psycho-analyzing—we replay an offending event over
and over in an effort to understand why people did what they did and
why we are emotionally responding as we are. We construct a huge
psychological problem which seems to defy any treatment plan. 3.
Chaoticone upsetting thought (emotion) triggers another in a chain
reaction, often not directly connected at all with the current event, so
that eventually there is a huge conglomeration of entangled emotional
experiences in one’s mind but few constructive conclusions. 
Nolen-Hoeksema believes the over-thinking tendencies can be
countered by 1. being mindful of the onset of the process, then
immediately switch to another activity, perhaps take a walk, call a
friend, read a book, plan a nice weekend, etc. Somehow stop the
mental buildup of emotions. 2. If you are mentally absorbed with a
problem, DO SOMETHING that might clarify the situation, lessen the
stress, or point a way out, don’t just think about being upset. For
instance, if you are dwelling on the impact of weight on your looks,
health, and love life, reduce the thinking and increase the serious
long-term problem-solving, such as plan and buy the food for healthy
meals, firmly commit yourself to daily exercises (no excuses!), get
your doctor’s advice, read references that may help you understand
the emotional needs to over-eat. 
When a woman gets married, she often has more roles to manage
than a man: work, partner, mother, social relations, friend, budget
balancer, etc. She may identify with her mother rather than her
father; her mother was more likely to be dominated, anxious, and
depressed. Therefore, she is more likely to be passive-dependent,
pessimistic, doubtful of her ability to manage her own life well, and
depressed. Since we are a more mobile society, women may also have
more sadness when leaving relatives, friends, etc. The spouse of a
depressed person is more likely to become angry and blaming. Finally,
women must give birth, which is supposed to be a glorious experience
but is scary and painful, plus 50% have PMS, 50%-80% have
postpartum depression, and 30% have surgical menopause, according
to Ellen McGrath of the APA Women and Depression Task Force. A
victim of discrimination, such as getting less attention in school and
less pay for the same work, is likely to be mad and/or sad (McGrath,
Keita, Strickland, and Russo, 1990). 
The Signs of Depression 
Depression is a loss of an important life goal without anyone to
blame. Such a loss affects our behavior, our moods or subjective
feelings, our skills, our attitudes or motivations, and our physical
functioning and health. Several writers (Levitt & Lubin, 1975; Beck,
1973; Lewinsohn, 1975) have summarized the signs of more severe
Behavioral excesses --complaints about money, job, housing,
noise, poor memory, confusion, loneliness, lack of care and
love... acting out (adolescents), running away from home,
rebellious, aggressive... obsessed with guilt and concern about
doing wrong, about being irresponsible, about the welfare of
others, and about "I can't make up my mind anymore"...
crying... suicidal threats or attempts. 
Behavioral deficits --socially withdrawn, doesn't talk,
indecisive, can't work regularly, difficulty communicating,
slower speech and gait... loss of appetite, weight change, stays
in bed... less sexual activity, poor personal grooming, and
doing less for fun. 
Emotional reactions --feels sad, feels empty or lacks feelings
of all kinds, tired ("everything is an effort")... nervous or
restless, angry and grouchy (adolescents), irritable, overreacts
to criticism... bored, apathetic, "nothing is enjoyable," feels
socially abandoned and/or has less interest in relationships,
sex, food, drink, music, current events, etc. 
Lack of skills --poor social skills, frequently whiny or boring,
critical, lack of humor... indecisive, poor planning for future and
unable to see "solutions." 
Attitudes and motivation --low self-concept, lack of self-
confidence and motivation, pessimistic or hopeless, feels
helpless or like a failure, expects the worst... self-critical, guilt,
self-blaming, "People would hate me if they knew me"...
suicidal thoughts, "I wish I had never been born." 
Physical symptoms --difficulty sleeping or sleeping
excessively, awaking early... hyperactivity or sluggishness,
diurnal moods (worse in the morning)... low sex drive, loss of
appetite, weight loss or gain, indigestion, constipation,
headaches, dizziness, pain, and other somatic problems or
If you are trying to determine if you are depressed, there are
several things to keep in mind. First, Levitt and Lubin (1975) found 54
symptoms of depression. Obviously, no one has all these signs. These
are problems that tend to be associated with being sad. Yet, a
depressed person may have only one, two or three of these signs.
There are three important types of depression: (1) major depression is
serious enough to interfere with work and social life. Sometimes it is
called endogenous depression because it seems to come from within
and not a reaction to external events. It affects sleep, appetite, energy
level, self-esteem, and thoughts of suicide often occur. (2) Situational
or reactional depression is more common and sometimes more clearly
a reaction to a loss in life. It is a serious "downer" or "blue spell" but
usually not disabling. Psychiatrists call it dysthymia or chronic sadness
if the blue mood lasts for two years or more. After a while, many do
not know why they are down in the dumps. (3) Bipolar disorder or
manic-depression involves cycles of sadness and mania (too happy,
irritable, insomnia, grandiosity, hyperactive and talkative, poor
judgment, fast and unreasonable thoughts). The bipolar types are just
as likely to be men as women, more extroverted, and more likely to
have relatives with depression. Unipolar types, (1) and (2), are twice
as likely to be women. Bipolar and unipolar respond to medication
differently; thus, they appear to be different disorders. 
Secondly, the symptoms found and the judgment of how serious
the symptoms are, vary according to who is making the diagnosis and
how it is being made. For instance, the judgment that a particular
person is depressed might be made by a therapist, family doctor,
friend, spouse, psychological tester, or by self-evaluation. There is
often little agreement among these judges; for instance, MD's miss the
diagnosis in 7 of 10 depressed men and 5 of 10 depressed women. On
the other hand, mental health workers over diagnose depression by
15% to 20%. Sometimes even the psychological tests don't agree with
each other. This is a serious problem for diagnosis and for treatment
as well as for research. Don't be surprised if you get conflicting
In most instances, the person knows when he/she is unhappy. If
you feel sad, that's it; you are the final authority. However, the victim
doesn't always recognize his/her own depression (so the "final
authority," i.e. you, may need to re-think the situation). Physical
complaints sometimes hide depression. 
Consider this: Gillette and Hornbeck (1973) reported a case of a
54-year-old housewife who went to an emergency room with a painful
earache. She had seen three other MD's in recent weeks. None could
find the cause. Again, nothing could be found wrong with her ear and
she was sent home with pills (aspirin). Three days later she jumped off
a bridge. She hadn't opened the aspirin bottle. Accurate diagnosis of
depression is a problem. Depressed people frequently have physical
complaints; ill people are often depressed. Certainly some don't tell
their doctor even if they are aware of sadness. This concealed gloom is
called masked or smiling depression. 
Even when depression is clearly expressed, physicians often ignore
it. A follow up of 25 people who committed suicide showed that 23 had
visited a physician within the last few weeks--and, according to the
doctors' own notes, 80% "showed clear evidence of depression." Yet,
few were actually diagnosed as depressed and none were given anti-
depressant medication! Physicians might do better if they used a brief,
simple questionnaire. But don't expect your doctor to read your mind
or even to ask about depression, you must be very clear about your
feelings and your needs. It is crucial that doctors know and DO
SOMETHING about your emotional state. And, if your doctor or anyone
thinks you have a psychological problem, please listen carefully. 
Thirdly, the diagnostic picture is often complex, i.e. a person isn't
just depressed and that's all. On the negative side, many depressed
people are also anxious, and they may have personality disorders,
such as cyclothymic, borderline, schizoid, dramatic, passive-
aggressive, avoidant, and so on. On the positive side, perhaps more
than half of well known poets, playwrights, and novelists have mood
disorders, unfortunately several have severe manic-depression as well
as great creativity and sensitivity. 
Fourthly, it is tempting to believe there are two separate, unrelated
processes going on in depression, one biological-chemical and one
psychological, each causing a different kind of sadness. Several
experts (Free & Oei, 1989) say the evidence for this basic assumption
is scant, because the organic and the cognitive components seem to
be very interrelated. 
Even the professionals often have difficulty detecting depression,
so recognize that self-diagnosis may be hard. When in doubt, get help.
In its serious form, depression is a dangerous illness. Even in its
milder forms, it is a miserable condition. This is a sickness that can not
be simply "willed" away. 
What is meant by happiness? 
Considering that happiness is "the most important thing in life,"
according to about half of Americans, science doesn't know a lot about
it. We don't even have an agreed upon definition for it. Is it having lots
of fun and pleasure? Is it being good looking, popular, and intelligent?
Is it feeling very lucky and gratified? Is it living a virtuous and
intellectual life, as Aristotle said? Is it having a positive attitude and
simply believing you are happy? Is it having lots of money? Is it when
things are going well, you have gotten more than you expected, and
you are having far more pleasant feelings than negative feelings?
Experts often say happiness is more than just having a good time or
lots of things, it involves a lasting sense of well-being, it is having a
fulfilling, meaningful, pleasurable life (Meyers, 1992). 
Perhaps the definition of happiness is vague because each person's
happiness is contingent on achieving his/her own unique life goals,
which often involve secret hopes and dreams. This may also explain
why other people are hard to understand--we just don't know how
they are trying to achieve happiness. Once we understand what
"makes them happy," we may have significant new insights into the
other person's psyche. In our culture, we often seek happiness by
removing all stress, sadness, and irritations. Of course, that is
impossible over a long period of time. 
There are several measures of depression, self-esteem, internal
control, optimism, etc. but few ways to measure happiness. Perhaps
because we all think we know what happiness is. Nevertheless, it
would encourage science if we had an objective, reliable measure of
happiness. Two British psychologists, Pete Cohen and Carol Rothwell,
interviewed 1000 people and came up with a formula for measuring
Happiness = P + (5 X E) + (3 X H) 
where P is a single self-rating from 1 to 10 of several Personal
characteristics, including being outgoing, energetic, open to change,
having positive expectations, and feeling in control, 
E is a single 1-10 rating of health, financial situation, feeling safe,
having choices, and friendships, and 
H is a single 1-10 rating considering self-esteem, ambitions,
support system, sense of purpose, and ability to get into “flow.” 
This formula produces a number (9 to 100) which defines a
person’s level of happiness but the total number is based entirely on
self-ratings. Self-ratings often have little agreement with ratings by
therapists, family, or friends or with objective and physiological
measures. However, we usually accept a person’s opinion of how
happy he/she is. Also, on the positive side, the formula clarifies the
several factors that these investigators believe contribute to
happiness, much in the same way Seligman (2002) does later in this
Many more people say they are happy than say they are unhappy,
maybe because it is more socially acceptable to be positive. It is also
quite possible that more pleasant than unpleasant events actually
happen. Most of us consciously try to find or arrange positive events.
In addition, there seems to be a natural tendency (except in depressed
persons) in our memory system to forget unhappy events faster than
happy events (Walker, Skowronski & Thompson, 2003). Many
cognitive researchers don’t believe, as Freud did, that traumatic
events are forgotten as a defense mechanism; they think unpleasant
memories are just remembered less negatively because that feels
better. So, from the cognitive viewpoint, the greater fading of unhappy
memories is seen as healthy coping. 
Another way to think about it is that being happy in a wealthy
materialistic society, like ours, involves putting your head in the
sand…and forgetting that a billion people go to bed hungry every
night…and need medical care…and need an education…and are
unhappy. So, some people would say happiness is a sickness or, at
least, gross denial. No wonder we don’t know how to measure it or
change it. 
Another theory that would seem to discourage trying to change is
the notion of individuals having a happiness set point (Lucas, Clark &
Diener, 2003), much like a weight set point. We will see over and over
in this chapter that both wonderful and awful changes in life
circumstances can make us delighted or really down for a while, but in
a couple of years our level of happiness is back to our old set point.
Such set-points may also influence how much our feelings change in
other situations. For instance, stable happy people may not react with
a big surge of happiness when they get married even if it is a
wonderful new relationship…but, in contrast, the usually happy people
might experience a huge increase in unhappiness if faced with a
divorce. Likewise, an unhappy, lonely person may be quite happy
getting into a good marriage but not be very bothered by a divorce
since their life-long set point is low. At least, that is a theory. And,
there is a related theory that some of us become obsessed with or
addicted to unhappiness (Pieper & Pieper, 2003). 
All these theories have to take into account that Buddhists,
practicing meditation, have been shown to be happier and less
shocked, surprised, distressed and angry than other people (Dr. Paul
Ekman, New Scientist magazine, 2003). There are many other
mysteries—Latin Americans are much happier than Asians;
Scandinavians have both a high rate of happiness and suicide; women
are as happy as men but twice as likely to feel depressed. We need
scientific studies to understand exactly how cultures, attitudes, belief
systems or whatever produce these different levels of happiness. 
Indeed, as noted in the introduction, good luck and bad luck don't
influence happiness for long. For instance, big lottery winners after a
few months are no more happy than the average person!
Quadriplegics are no less happy than the average person! Yet, 70% to
80% of Americans are happy and 84% take pride in their work. People
are considerably less happy in poorer countries and only 35% to 40%
of Europeans and Japanese take pride in their work (while making the
best cars, computers, TV, etc.). While America is among the happier
countries, our level of happiness has not increased as our country's
level of real income has grown... but our problems, such as violent
crime, divorce, and depression, have soared. Also, in spite of
Americans' claiming to be generally happy, 33% said they worried
constantly, 40% had often felt lonely, and 28% felt worthless during
the last six months (Shaver & Freeman, 1976). Over 50% said their
happiness changed daily or every few days. Married couples in their
20's are the happiest; divorced women with children and unmarried
males are among the more unhappy. As we will see, good
interpersonal relations are crucial to many people's happiness. 
Clearly, certain events, such as a party, are pleasurable to most
people, but certain people, namely the depressed, get little pleasure
out of many such events. You have probably had a similar experience:
you have to be in the right "mood" to enjoy certain activities. So, is
happiness the mood or the activity? Probably both. A big argument
between philosophies is whether happiness is gained by satisfying our
desires (hedonism) or by getting rid of our desires? Maybe both, again.
Also, does happiness occur mostly during the striving for worthy goals
or after having achieved our goals and desires? It seems that a
windfall or achievement makes us happy for a short while, but we
adapt to the bigger house, boat, car, income, etc., and soon start to
lust for a still bigger one. 
How do we become happy? 
There seems to be so many ways to be happy and, as we will see,
unhappy. Why do we know so little about this very important topic?
Why haven't humans investigated it more seriously? I suspect it is
because a lot of us erroneously believe we have little control over our
happiness, so why bother studying it... and those of us who believe we
are in control of our happiness already think we know all we need to
know about it. Sad. Surely humans will in the coming decades learn to
influence their own happiness to a great extent. The secret, I currently
believe, is finding hard, meaningful, demanding-but-fun ways to
achieve your highest values. See chapter 3. For me, a serious cultural
problem may be that 75% of college students say "becoming very well
off financially" is their highest aspiration--above "raising a family" and
"helping others." Only 40% said that in 1970. Note that criminals,
cons, deceptive business people, and drug dealers are also striving to
become well off financially. 
In our culture, it is commonly believed that happiness happens
when you become rich, powerful, or popular. Recent research
(Sheldon, Elliot, Kim & Kasser, 2001) suggests those beliefs are
wrong. Their study found that meeting other needs bring more
happiness. What were the most happiness-related needs? Autonomy
(self-direction, being in charge of your own activities), competence
(feeling and being able and effective), relatedness (having meaningful,
satisfying, caring relationships) and self-esteem (accepting and feeling
OK about one's self). Other research findings have also found that
happiness is related to self-esteem, loving relationships, extroversion,
good health, satisfying and challenging work, having exciting goals and
interests, status and power (education and money), a sense of control
over our good fortune and an optimistic outlook, being helpful to
others, and making an effort to do new and fun things (Diener,
Sandvik, & Pavot, 1990). Thus, there seems to be some research
agreement about what makes us happy, but the young still yearn for
extraordinary stardom and the older folks want to win the 1-in-30-
million lottery. Being able, caring, and self-directed, so that we
accomplish ordinary goals and have a sense of adequate mastery of
common lives and relationships, has the potential of making us happy,
but many of us seem to invest our hope in some highly improbable
goal. The result sometimes is that we spend our lives wishing for the
impossible while we merely get by at work, our relationships
deteriorate, and we can't even learn to lose weight. 
Waterman (1993) says there are two aspects to happiness. One is
"personal expression" and the other is "hedonic enjoyment." Personal
expression is self-actualization, i.e. using your talents, taking on
meaningful and challenging projects, working hard and guided by your
values, and feeling confident and satisfied. Hedonic enjoyment is
having fun, i.e. satisfying your needs, feeling relaxed, excited, happy,
content, etc., and being able to forget your personal problems. What is
very surprising and perhaps quite important was Waterman's finding
that the two types of happiness are highly correlated, i.e. happy
people tend to achieve and have fun while unhappy people get neither.
Vigorous, productive self-actualizing doesn't eliminate fun, it seems to
enhance it. 
Ed Diener at the University of Illinois says that life is judged happy
if we have more positive experiences (an enjoyable job, loving spouse,
a hobby, etc.) than negative ones on a day to day basis and, in
addition, can occasionally manage to have an intensely positive
experience, such as a new child, a fantastic vacation, public
recognition for an achievement, etc. The frequency of positive
experiences is more important, Diener says, than the intensity of
occasional positive events. 
The Interaction of Happiness and Depression 
It is commonly thought that happiness is the positive end of the
depression scale. Of course, in the extremes, great happiness and
deep depression are mutually exclusive; you can hardly be in the
depths of suicidal depression and be considered happy at the same
time. But in the less extreme ranges, happiness and depression appear
to be rather independent of each other. It is very interesting that
psychologists consistently find women in general are more depressed
than men, but psychological tests also show men and women are
equally happy. This clearly shows that happiness is not just the
opposite of depression (Myers, 1992). This also fits with common
sense about happiness. That is, people know they can go out and have
a good time at a party, then come home to be lonely and miserable
again. Another example: you can handle some situation that is causing
you to be very unhappy, but that accomplishment may not produce
much happiness, just relief from the pain. You can be unhappy about
some things and happy about others at the same time, much like you
can both love and hate a person at the same time (Swanbrow, 1989;
Diener, Sandvik, & Pavot, 1990). In contrast, you can't be both
relaxed and anxious at the same time. 
We are learning more about happiness. One interesting point is
that happy people tend to be decisive, healthy, creative, motivated,
social, trusting, and caring, compared to unhappy people. Another is
that they feel "in control" and/or have a sense of well being. As you
might expect, happy people have more faith in a "higher power" than
unhappy people. Among atheists and non-religious, only about 15%-
30% claim to be "very happy." Among religious folks, 25% to 40% say
they are "very happy." A religion helps us handle great losses
(probably due to the concept of eternal life), but religious people
sometimes feel less in personal control (Myers, 1992). 
Religion becomes self-therapy.
-David Myers
We must select the illusion which appeals to our temperament and
embrace it with passion, if we want to be happy.
-Cyril Connolly
In some cases, however, religion reinforces feelings of guilt and
the person becomes a martyr who feels he/she deserves punishment
or needs to endure unhappiness. They may feel so unworthy that life
only has meaning if they suffer great hardship and pain. Others think
they do not deserve to feel good; thus, if life is going well for them,
they quickly find a problem to feel badly about (see later discussion of
shame and guilt). Such people focus on the seriousness of life. Overall,
however, to most people religion probably gives more satisfaction than
The important point for the self-helper is that happiness and
depression are two somewhat independent dimensions--you need to
work on both decreasing depression and increasing happiness, if
unhappiness is a problem for you. Yet, it seems that trying too hard to
be super happy is like trying to be someone you aren't; that too may
be a bad idea. Instead, "To thine own self be true" while making
efforts to be happy: seek demanding, challenging work; exercise in a
fun way; do several pleasurable things every day and show your
happiness; nourish close relationships, and be good to others. 
Finally, a Buddhist friend would tell you to learn to accept the good
and the bad in life--accept and relish all of life (see irrational ideas and
determinism in chapter 14). This means recognizing the 6-year-old
inside each of us who wants the most attention and the biggest piece
of cake. This self-centered child part sees bad events as a personal
insult that shouldn't be happening, rather than as a naturally occurring
event. We must come to see that our I-don't-like-it attitudes create
our unhappiness, not the actual event. Why should getting just an
average piece of cake make us upset when many people are literally
starving and others are killing themselves by over-eating? Should
everything happen because we want it to? Of course not. Happiness is
based on the ability to take all the insults of life, without responding
with tension, sadness, or rage. Whatever has happened was
psychologically lawful. Accept it... and try to improve the future for
yourself and others. 
Martin Seligman’s Thesis on Happiness 
Psychology Finally Attends to Positive Feelings and Traits
Martin Seligman (2002) was once best known for his research of
learned helplessness, an important aspect of hopelessness and
unhappiness. He became interested in Cognitive-Behavioral Therapy in
which the patient is helped to look for evidence for and against his/her
own beliefs. His focus shifted to optimism. He has in recent years
become a leader of a new "Positive Psychology" movement which
underscores the importance of positive emotions and traits, especially
optimistic thinking, such as “I can manage.” 
Positive Psychology points out that applied psychology for over 50
years has focused mainly on psychopathology--disorders people will
readily pay to get rid of, such as depression, fears, anger, bad habits,
psychoses, marital problems, etc. We have learned to be somewhat
successful treaters in many of these troublesome areas (Seligman,
1995). All this attention was given to suffering, sickness, and
treatment, and while that was commendable, it left other important
aspects of life neglected, e.g., finding really meaningful lifestyles,
being truly happy and satisfied with life, feeling confident and
optimistic, and behaving generously, altruistically and nobly, and so
on. These are important, exciting new directions for applied
For decades, psychology "bought" the Freudian notion that the
major driving forces in humans were bad motives--greed, lust,
aggression, etc.--and originated in our basic human nature and/or
from bad parenting. Even being good and altruistic is often believed to
come from our evil core, as when generous, helpful people are thought
to be compensating for their immoral selfish urges, faults, fears, and
sick needs. It seems more superficial and Pollyannaish when we
explain some human behavior as being caused by good parenting,
genuine concern for others, feelings of satisfaction and joy, a sense of
responsibility, a devotion to high morals, and so on. Such positive
explanations often give rise to the question, "Don't put me on, what is
really going on?" 
If psychologists had emphasized positive traits more, they surely
would have conceptualized the causes of behavior in more positive
terms. If they had focused more on positive human characteristics,
they probably would have concentrated more on psychoeducational
approaches, such as character development, developing a philosophy
of life, learning self-control and self-help, exploring how to develop
good families, friendships, work relationships, humanistic educational
systems, peaceful caring nations, and so on. Seligman and other
positive psychologists think enhancing our positive traits and emotions
is the key to further improving human lives. Positive Psychology goes
far beyond treating mental illness, in fact doesn’t have much to do
with it. Positive emotions are powerful influences; they increase our
social, mental, and health benefits; they help prevent problems. 
Not just Seligman but a productive group of psychologists are
engaging in research and theory-development about positive
emotions. See the Handbook of Positive Psychology by C. R. Snyder &
Lopez, S. J. (2003). Barbara Fredrickson (2003) at the University of
Michigan has published a series of studies and a theory, called the
“broaden-and-build” model, which proposes that positive emotions and
attitudes broaden our thinking about possible solutions to problems.
If we are open to new ideas, we think better. Over time this broader
perspective enables us to build broadly our coping skills and
confidence. Thus, positive and optimistic societies become more
innovative, resilient, socially adjusted, and healthy. Seligman gives
Fredrickson credit for opening his mind to the general importance of
positive psychology. Psychology is currently generating considerable
research that empirically documents the value of positive thoughts and
emotions, e.g., Emmons & McCullough (2003) have shown that
counting our blessings (being grateful) has positive impact on several
aspects of our mood, adjustment, and physical symptoms. 
Forces Affecting Happiness and Depression 
Current research suggests a tendency towards depression is inborn
so that each of us probably has a set point for depression and on a
different dimension for happiness. Studies of twins and adopted
children support the inheritance notion. Of course, in spite of any set
point, radical changes in our lives can change our feelings. Someone
important to us dies and we are saddened for months, but eventually
we usually come back to our set point. Winning a multi-million dollar
lottery has drastic impact on our emotions but only for a year or so,
then we go back to our usual mood. Paraplegics return to their pre-
accident level of happiness after a year or two. Sure, there are some
terrible experiences so traumatic that some people can’t ever recover,
like the death of a child or a brutal assault. In the opposite direction, a
lonely person, who finds someone who really loves him/her, may be in
high spirits for the rest of his/her life. 
Seligman doesn’t let us forget our ever-present genetic guidance
system and estimates the available data suggests that one's general
level of happiness is about 50% inherited—he believes even being of
good cheer is about half determined by the genes. Okay, but the
genes are, thus far, beyond our control. We have to just make the
most of what we were given at birth. We also have only limited control
over our natural body chemistry, such as serotonin, that affects our
happiness. Most people believe that life circumstances have a
powerful influence over their happiness (“if I get rich, I will be happy”)
but the research findings, as we have seen, suggest that our
circumstances are the source of only 10-15% of our happiness. In
short, our genes and our brain chemistry may be barriers to
happiness…and our hopes that good fortune will bring us happiness via
good circumstances may be illusions. To Seligman another approach to
happiness has much more potential--he believes we have the ability to
develop and use personal habits, attitudes, and traits that can
increase our happiness. This is his general thesis and the basis of his
self-help approach. Let’s try to understand this. 
Seligman, being an academic researcher, cites a great deal of
research and presents it in an interesting way, but keep in mind that
he is mostly discussing the "commonly used ways to gain happiness"
that are currently available to the average person. In general, he
doesn’t invent new happiness-producing techniques. Remember, too,
this is primitive science...just estimates of correlations between crude
circumstances and happiness over large numbers of people. It is
important to keep in mind, I think, that there are probably hundreds of
unique ways for unique individuals to gain happiness. You don't have
to be married and have children...or be educated, highly successful,
and make big money...or be religious and get your hope through the
promises of religion...some people can probably even be happy while
being self-centered and immoral. There are many ways you can carve
your own niche of happiness in the world. 
Given time, often involving life-long endeavors and goals, you can
certainly have some influence over the circumstances of your life, in
spite of the research cited above. Yet, we all know being born with
below average academic ability or given parents who belittle learning
or provided a poor K-12 education, it is very hard to become a
physician, astronaut, professor, etc. Much of Psychological Self-Help
deals with exactly how to make some of these changes in
circumstances or the environment (see the chapter indices and use the
search engine on the main page to find self-change methods). Keep in
mind, however, that while your life circumstances usually only
determine a small part of your total happiness, once a barrier is
overcome and put behind you, such as poor education, self-doubts, or
shyness and a lack of friends, it is no longer a barrier and your
unhappy circumstances in the past may even become an asset. 
Positive reactions and attitudes towards the past, the present, and
the future may be more modifiable for most people than actual life
circumstances. Let’s review Seligman’s (2002) work to learn more
about this. 
Seligman’s Suggestions for Increasing Happiness 
Note: the next several pages offer a detailed summary of Authentic
Happiness and a critique. If you are into serious and long-term work
on building happiness, you might be well advised to read and work
through the book itself, rather than read my summary. Hopefully, my
overview will put Seligman’s suggestions into perspective, and then
you can apply the more hopeful specific techniques from several
His book, Authentic Happiness, begins by reviewing the benefits of
being happy, much like the research I’ve just summarized. An
optimistic, happy person has a better chance of being more
productive, having more friends, a satisfying marriage, better health,
and a longer life (of course, those end results contribute to one’s
happiness, so there is a chicken and the egg question here). Happy
people are not the most realistic, e.g. they over-estimate their skills
and the control they have in dealing with problems; they see
themselves as above average in intelligence and social ability. Seeing
yourself favorably, even if wrong, contributes to happiness, I suppose,
but other research shows optimists are not happier and more
successful than pessimists (Chang, 2000). 
No one would deny that great contributions to the world have been
made by very unhappy people. So, sad feelings may have some merit
and contribute to doing good in many lives. Indeed, people with
bipolar disorders often enjoy the “highs” on their hyperactive days.
They are often more creative than us ordinary folks. Some therapists
believe that chronically happy and overly joyful people might be prone
to become hypomanic (impulsive and overactive) if they “go over the
edge.” Certainly, strong negative and strong positive feelings can both
motivate us powerfully. Some historians and anthropologists believe
that positive feelings helped our species evolve, just as fears and envy
surely did. Given the choice, however, most of us as individuals would
prefer a productive life without being depressed or manic. And no one
would deny that many important contributions have been made by
happy, enthusiastic, able, well adjusted people with lots of friends. 
Which life circumstances change our happiness level and which
Here is some important research we need to know: 
Relationships--a close, lasting, caring love relationship is for many
a wellspring of happiness. Having good friends also gives most people
continuing pleasure, too. A quarrelsome relationship can be the cause
of much lasting unhappiness. Being lonesome continues to be
unpleasant year after year. Maintaining a loving partnership is one of
the surest way to happiness—40% of married people say they are
“very happy” (that is a little higher than the usual estimates). Only
25% of unmarried, divorced, separated and widowed say they are
“very happy.” Remember they have suffered a significant loss. 
Religion--religious people tend to be a little happier and more
satisfied with life. And why not, since they have a relationship with
God, maybe a special sense of purpose, the promise of a wonderful life
after death, and a facilitated social life? The more fundamentalist the
religion, the more optimistic the believers tend to be, and the higher
level of hope they tend to have. 
Money—while, in general, people living in a wealthy, free country
are clearly happier than people in a poor country, making a lot of
money is usually an ineffective way to achieve happiness. In fact, once
we get into a materialistic mode of acquiring “things,” the result is
often less happiness, maybe even compulsiveness, competitiveness,
boredom, or meaninglessness in the long haul. 
Negative feelings--one might think that avoiding negative emotions
and situations might make our lives happier, i.e., filled with more joy,
but that is not necessarily true. Some people don’t have many
feelings, positive or negative. Other people have lots of negative
feelings and lots of positive feelings. Indeed, women have about twice
as much depression as men…and they have about twice as much joy.
So, holding down or escaping unpleasant feelings might help a little to
be happy but it isn’t a sure-fire powerful tool. 
Most other situations in life have relatively little to do with
happiness. That includes age, health, degree of education, climate you
live in, race, and gender. You can’t change most of these things
anyway. Thus, it is easy to see that gaining happiness by changing
your circumstances is a hard way to go. Only 25% or so of us achieve
a really good, lasting, loving relationship (in spite of the 50% “very
happy” ratings at any one time mentioned above). Perhaps only 10%
or 15% of us worldwide can arrange to live in a wealthy democracy.
Getting religion if you don’t have it is hard, it can’t be forced. Likewise,
reducing negative feelings requires psychological skills and methods. 
A little summary: According to Seligman the role of circumstances
in happiness is quite limited: education, income, and climate don't
influence happiness very much; feeling healthy, avoiding trauma, and
developing hope through religion only contribute moderately to
happiness; however, important life conditions include achieving a good
marriage and living in a wealthy democracy. OK, but what about other
life circumstances, such as raising a healthy, happy family? Having a
successful career one is very proud of? Living an altruistic life devoted
to helping others? What about being the best mechanic or a loved
teacher in your town for 50 years? 
More promising routes to happiness 
Seligman obviously doesn’t think “trying to change your
circumstances” is the best way to become happy. Instead, developing
new personality traits, different outlooks, and more positive attitudes
offer more hope because they may be more under your voluntary
Starting from the great virtues identified by philosophers over the
last 5000 years, such as wisdom, courage, love, justice, temperance
and transcendence, Seligman tries to help each person discover their
own unique strengths or virtues. He calls these individual traits your
“signature strengths.” Much of his book focuses on teaching you to
nurture your positive natural traits or virtues, so you can live “the
good life” and experience authentic happiness in work, love, and child
rearing. To his credit, he has also developed a Web site
(http://www.authentichappiness.org) which supplements his book. The
site offers rating scales which are automatically scored, explained, and
stored in your personal test folder. The ratings measure and provide
norms for several of your traits or characteristics, such as your
Signature Strengths (listed later), happiness, positive and negative
feelings, optimism, close relationships, and so on. If you decide to take
Seligman’s book seriously, please also make use of these rating scales.
Note: he openly states that he intends to use your test scores in his
future research…I feel confident that he will hold your information in
confidence and deal with your disclosures respectfully. 
Seligman has a very different understanding of psychopathology
than the Freudian psychodynamic psychotherapists who see childhood
trauma as the usual cause of adult unhappiness and disorders.
Seligman believes childhood experiences—abuse, neglect, divorce,
parent’s death—are over-rated causes. Many current therapies
reinforce people feeling victimized by the past; after treatment they
feel imprisoned and embittered by mistreatment as a child. But the
new Positive Psychologists say childhood experiences just don’t have
that much impact on adult unhappiness, so the bad feelings don’t need
to be dug up in therapy. They prefer the Cognitive Therapy approach
rather than uncovering the past in great depth. They admit, however,
that if bad past experiences are remembered over and over, ruminated
about, and expressed as terrible events, these thoughts could cause
depression. The assumption is that awful experiences will fade away if
they are out-of-mind and not re-lived. Therefore, the cognitive
approach (see my chapters 5, 6 and 14) is different from many insight
therapies (see my chapter 15). Remember—probably the majority of
psychologists believe bad, traumatic childhood experiences often have
a lasting impact, just as the good positive experiences recommended
by Seligman might. 
His next three chapters focus on developing healthy attitudes
towards viewing and accepting your past, being optimistic about the
future, and increasing your pleasures and gratifications in the
present. His Web site (http://www.authentichappiness.org) starts you
thinking about how you actually see the past by giving you three tests:
Satisfaction with Life Scale, The Gratitude Survey, and a Transgression
Motivation scale which measures your need for revenge. Your story of
your life is really your cognitive explanation of your life. What if, as
Seligman argues, childhood experiences have little to do with your
adult life? What if the genes have much more powerful influence than
a critical mother, a distant father, abuse, your parents’ divorce, a
death of a parent, etc.? The dwelling on childhood in therapy would be
pretty much a waste of time! The Cognitive Therapy view is that every
emotion is the result of our recent thoughts. Examples: a thought that
we are going to mess things up causes anxiety and feelings of
insecurity; the thought that someone is going to screw me over causes
anger; the thought that my lover may be interested in someone else
causes jealousy, resentment, and fear of loss. So, effective treatment
involves changing your thinking about your past in the direction of
appreciating good events in your past and understanding (with some
forgiveness) the wrongs done to you. How can you do this? 
Completing the Satisfaction with Life Scale and the Gratitude
Survey on Seligman’s Web site should get you started thinking more
positively about the past. These additional exercises are
recommended: Start keeping a daily diary in which you describe three
to five things that happened to you that day that you appreciated.
Your joy, happiness, and life satisfaction should increase because you
are thinking more about good happenings. Another suggestion is to
write up a one-page description of someone who has made an
important contribution to your life. Arrange to take some time face to
face with this person, express your gratitude, actually read your
testimonial to them and give them a copy, and spend some time
discussing the events, your feelings, and their feelings. The idea is to
learn to appreciate and savor the good parts of your life. 
This may be one of the weakest parts of Seligman’s approach. The
experiential and experimental bases for his therapeutic suggestions
are primarily brief classroom exercises, short experiments using
students, or old humanistic exercises. It seems to me that this is a
flimsy basis to suggest such brief experiences will change the life-long
habits of being unappreciative and emphasizing the negative. Being
more appreciative and grateful in a class assignment may be good
beginnings but much longer efforts to change spread over many more
areas of your life will be needed to permanently change your basic
personality from negative or positive. 
Likewise, negative thoughts, angry resentments, prejudice towards
groups, thoughts blaming others, and the urge for revenge (he has
another rating scale for that) can’t be undone in a short while.
Seligman, himself, enumerates several reasons we are reluctant to
give up our bitter thoughts about the past. Moreover, he has
repeatedly emphasized the power of genetic inheritance in influencing
these powerful behavioral/emotional reactions and then seems to
suggest in his book that these reactions can be overcome by briefly
“re-writing your history,” i.e., by reconsidering, forgetting, forgiving or
suppressing your bad memories. He gives one example of how a
psychologist (Worthington, 2002) forgave someone—a person who had
killed his mother. It is a good example of understanding (by a
professional specializing in forgiveness) forming the basis for
forgiveness. I certainly believe the research findings that forgiveness
training (done in the laboratory) leads many subjects to reporting less
stress and anger later. However, it may be different in highly complex
real life. Unlike a psychologist, such as Worthington, a critical,
resentful, vindictive person has years of habits of thought to overcome
and erase. In that case, becoming understanding and mellow is likely
to be a huge, long project with repeated backsliding. As another of
Seligman’s books suggest, science has not concluded that changing
oneself is simple and easy, such as just a couple of self-change
methods done in a group (Seligman, 1995). 
Perhaps several other self-change methods, applied over months in
several areas, would also contribute to appreciating and accepting the
past. Consider these additional methods: Understanding Behavior,
In the next step towards happiness, Seligman attempts to
brighten our future outlook, like the past, by increasing our positive
emotions—hope, optimism, self-confidence, and enthusiasm for things
to come. You can measure and understand your optimism-pessimistic
beliefs on his Web site
you study the test results carefully, you can see that when you feel
optimistic you tend to believe good events have permanent or
frequently repeated causes. For example, good actions and events
may be seen as due to your own consistent personal traits that have
considerable influence. Those conditions will keep the good times
coming. Likewise, if bad events are seen as being caused by
temporary, passing causes limited in scope, such as an accidental
happening, the reactions of a stranger, a coincidence, or bad luck that
day, you have more hope things will be different next time. A
pessimist would see a good event as just a fluke, won’t happen again,
and "I had nothing to do with it." In contrast, optimistic hope is based
on seeing good life events as caused by personal traits or by lasting,
broad causes which I can perhaps influence. And, an optimist sees
unhappy events as having temporary, specific, possibly controllable or
unlikely-to-happen-again causes. The next task—a daunting one—
might be to reduce your pessimistic thinking and expectations. 
Pessimistic, negative thoughts can be challenged by gathering the
facts—are these thoughts really true? As we have seen, it helps to look
for multiple causes for bad events and ask yourself if changeable,
specific, non-personal causes are responsible. Have you instead
concentrated on the most dire possible cause? Even if your negative
thinking is true and is the outcome truly awful events…is the negative
thought useful or does it just cause more trouble? Can less scary
explanations be found? Maybe the bad events don't have to happen
again. This disputing of one’s own negative or pessimistic thoughts is a
demanding, difficult process. We can change our thinking but it is
seldom easy. This is why therapists are needed in many cases,
especially serious ones. 
This is good advice as far as it goes, but it is flimsy guidance for
making major changes in the infinite thoughts that flit through our
minds minute by minute. Moreover, having hope for the future rests
on more than reducing pessimism and having hopeful fantasies. What
about developing reasonable, doable, testable, exciting plans for the
future, as in further education, interesting and gratifying careers,
fulfilling social-community service, etc., etc.? What about plans for
improving relationships? What about carefully thinking through a set of
values and goals you would love to accomplish during your life—
actions you feel would be morally laudable and spiritually deeply
satisfying? What about testing your ability to analyze problems and
make real changes? Proving to yourself that desired changes can be
made and self-improvements are not pipe dreams should build your
confidence in your self-change skills, your sense of mastery, and
change your future. (See Chapter 3: Values and Morals.) 
After learning to feel better about the past and more positive about
the future, Seligman turns to increasing happiness in the present.
He distinguishes in a meaningful way between pleasures (eating,
having sex, having fun, relaxing, doing exciting things, having
enjoyable feelings, being mindful, savoring life) and gratifications
(engaging in satisfying activities that absorb our attention and make
us feel proud or like a good person). Gratifications might include
reading/studying hard, doing excellent work, having meaningful
conversations, completing an important even difficult task, helping
someone, doing the right thing, etc., i.e., not highly exciting but
satisfying activities. Both pleasures and gratifications make important
contributions to our happiness but many pleasures soon lose their
thrill, so don't overdo having fun and space your fun out over time. 
Like Seligman, Csikszentmihalyi (2003) emphasizes in his new
book that a very important part of happiness is a worthy, ethical job
which is satisfying, challenging, and where you can get into “flow.”
Remember that flow
quietly gratifying and often demanding, pushing our abilities to the
limit. Also, be mindful that we often choose the easy way and pleasure
over gratification; there are powerful commercial and cultural
inducements to maximize the fun we have. Some people feel a
desperate need to just have fun much of the time. However, for most
people, it is their productive, altruistic activities using their good traits
and personal strengths that give us the most satisfaction, i.e.
gratification, in life. When you are nearing death, would you be more
likely to say "I wish I had partied harder, drank more beer, goofed off
more, and done more to have fun?" or say "I'm really glad I showed
genuine concern for so many people during my life, that I really
worked to develop my good qualities as fully as possible, and used so
much of my time, morals and strengths to help others in need?" 
From here on Seligman’s book is devoted to recognizing your own
good character traits, building strengths and virtues, and using them
optimally in life’s three great arenas: work, love, and raising children.
That is a good formula for happiness but there is a great need for
more research about this approach: 
1. Seligman measures each person's 4 or 5 more important
"signature strengths" by using self-ratings, which are notoriously
inaccurate (but better than nothing!). See his Web site
don’t know themselves that well, they exaggerate their strengths and
deny their faults. They don't realize other valuable skills; they may
think certain weaknesses are strong commendable traits. A review of
the specific signature strengths Seligman tries to measure will help
you recognize what characteristics we are talking about—and how
poorly a couple of self-ratings would measure them: Wisdom.
Curiosity. Love of learning. Open-mindedness. Good judgment.
Practical intelligence. Social-emotional intelligence. Courage. Bravery.
Industriousness. Honesty. Loving. Accepts love. Generous. Fair. Loyal.
Leadership. Temperance. Self-control. Cautious & prudent. Modest.
Transcendence. Appreciate beauty. Respect excellence. Gratitude.
Optimistic. Sense of purpose. Forgiving. Sense of humor. Zest for life.
These are great traits but they are often not accurately measured.
Much better tests can and will be developed if objective items and
ratings by others are also used. 
2. Seligman focuses only on the rated strength of current
strengths. What about strengths and values that the person doesn’t
have now (and would rate low) but would very much like to develop
and use in the future? 
3. Seligman puts very little emphasis on the individual actually
developing (growing) his/her desired traits, strengths and values.
Surely learning desired skills and increasing traits, like practical
intelligence, industriousness, fairness, self-control, gratitude,
optimism, etc. should be part of increasing one’s level of happiness. 
Consider your career: it is an important part of your life for 30 to
perhaps 50 years. Seligman’s prescription is to make it your "calling."
A calling involves using your best strengths and virtues to achieve
excellence in such a way as to be personally fulfilling, respected by
others, and a significant contribution to society. The concepts of
dedicated involvement and flow
are very important. He gives encouraging examples of people who
have converted their job into a meaningful mission. Changes at work
are sometimes possible but for many of us major changes in the
nature and goals of our work are impossible to make. We have to
make a living and the person paying us expects specific outcomes. As
an example, careers in law are discussed by Seligman partly because
it is the highest paying profession while lawyers are often unhappy. He
says they tend to be suspicious pessimists thinking a lot about
avoiding assorted catastrophes that might strike their clients or them
personally. The life of a lawyer is generally not filled with doing good
and stamping out injustice in the world as they might have thought
when they chose the career. More often they are expected to make
money, which is often a cynical, selfish, ultimately unhappy pursuit. 
Love is another big area of our lives. David Myers (2000) writes
"there are few stronger predictors of happiness than a close,
nurturing, equitable, intimate, lifelong companionship with one's best
friend." To understand your relationships better, Seligman provides a
Close Relationships Questionnaire by Chris Fraley and Phil Shaver at
(http://www.authentichappiness.org). From an early age, we tend to
be secure, avoidant, or anxious with others; secure is better. But how
do you cultivate feeling secure? It is common in a romantic
relationship to see your partner more positively than his/her friends
do, called the "romantic illusion." Seeing, valuing, and appreciating
your partner's strengths and good points are an important part of a
happy relationship. So, dwell on their positive traits, not their faults.
View the partner’s displeasing acts as being caused by temporary
factors (he/she is tired or in a bad mood, not he/she is always a
grouch). Nice acts can be seen as due to his/her permanent traits
(he/she is caring and bright). Communication skills, especially
empathy responding and "I" statements, are vital parts of a
relationship (see Useful Skills). Much advice and many useful
references are given in Love, Marriage & Sex
Many people will tell you that raising a family was the most
important part of their lives. Seligman has definite ideas about
childrearing. Seligman, Reivich, Jaycox and Gillham (1996) wrote a
book, The Optimistic Child. Seligman and his wife, both psychologists,
have earnestly tried to apply positive psychology while raising their
children. They believe that a child with lots of positive experiences and
emotions will inquisitively explore the world and, as a result, learn to
master problem situations and develop their strengths. He offers eight
techniques for rearing happy children: 1. Sleep with the baby. 2. Give
them a sense of mastery through games and play. 3. Say no seldom
and yes a lot. 4. Praise worthy accomplishments, not easy ones. Avoid
punishment. 5. Avoid sibling rivalry by giving each lots of attention. 6.
Focus bedtime rituals on positive experiences—“my best time today”
or priming for a pleasant dream. 7. Offer future rewards for self-
improvements. 8. Make New Year’s resolutions about adding desired
behaviors, not about stopping bad habits. There are hundreds of books
about parenting and Family Relations and Child Care
Overall, Authentic Happiness is theoretically well grounded in
Positive Psychology principles. Sometimes his practical advice seems
inadequate to meet the challenge. This is especially so if the child or
parent has depressed/pessimistic genes…what do we do then?
Seligman acknowledges the power of the genes and then seems to
disregard their presence. See Optimism and Pessimism by Ed Chang
(2002). Yet, Seligman delves into so many aspects of happiness and
optimism that the final result of reading his book may be fairly
effective in increasing many individual's happiness. The tenor of the
sweeping Positive Psychology movement has a little bit of the same
feel as the Self-Esteem movement. It goes without saying, of course,
that the chapters of the book as well as the whole movement should
be empirically evaluated to see how well it increases happiness and/or
decreases depression. In general, Seligman's suggestions are as good
as we can make today. 
OK, so winning lots of money only lifts your spirit for a couple of
years. Contrary to the “jolly fat people” notion, getting fat doesn’t
make most of us jolly. Reportedly, women with breast implants have a
higher suicide rate than other women, so perhaps having a nice body
won’t remove our psychological troubles. Getting into religion may
help but the research data isn’t entirely clear on that. Is anything a
good bet to bring us more happiness? Well, there are a few ideas but
they aren’t easy to create for yourself and not sure fire even after
much effort: (1) Become able to manage your own life doing
meaningful things that interest you. (2) Learn to feel truly competent
in your major activities. 3. Develop close, meaningful, mutually
satisfying relationships. 4. Come to feel good about yourself and the
life you have built for yourself. 
Finally, David Myers (1993) (http://www.davidmyers.org/)
summarizes several ways to seek a happy life: 
1. Don’t make the mistake of believing that being a big success will
automatically make you happy. Being a genuinely caring person with
good friends is a much better way. 
2. Learn to control your time and your behavior. Have a Daily-To-
Do List. 
3. Act like a happy person—smile, greet people, be outgoing and
optimistic, even if you are a little down (Fleeson, Malanos & Achille,
2002). Acting sour and unhappy keeps you feeling that way. 
4. Find respected tasks to do that use your talents and challenge
you to do your best…flow! 
5. Every day do exercises you enjoy to the point of “working out.” 
6. Learn to thoroughly rest. Get plenty of sound sleep. An alert,
relaxed body feels good. 
7. Attend to friends, loved ones, and the people you are privileged
to serve. 
8. Also, empathize with and respond with help to strangers in
need. Happy people are sensitive and giving. 
9. Take time each day to remember people and institutions who
have helped you. Count your blessings. Express your gratitude. 
10. Join caring groups that support your being your best self and
give you hope. 
Sad to say, we can’t suggest how to be happy much better today
than Aristotle did 2300 years ago: 
“The good of man is the active exercise of his soul’s facilities in
conformity with excellence or virtue—this activity must occupy a
lifetime…one day or a brief period of happiness does not make a man
supremely blessed and happy.” 
There are hundreds of Pop (not Positive) Psychology books and
Web sites about getting happy. They will help some people but there is
little research to back them up. There are a couple of research-
oriented psychologists who seem to be paralleling Seligman: Baker
(2003) and Niven (2000). Stevens (1998) also has a book and a Web
ad for the book but it does offer selected sections for free. Another
Web site is for kids, How To Be Happy
Theories about the Causes of Depression
It is enlightening but perhaps discouraging to realize that sadness
and its associated depressive symptoms can have many causes. We
will review the major theories. 
The result of losses 
While this is no profound theory, it is more far reaching than you
might at first realize. Depression is, of course, the normal, natural
reaction when we lose something we value. A friend or loved one dies
and we grieve. A loved one leaves us and we hurt, we miss them and
want them back. We fail to reach some important goal and we cry. Mc
Coy (1982) lists several triggers to teenage depression: death,
separation from a parent by divorce or work, loss of friends by
moving, loss of love, loss of dependency and childhood by growing up
and joining a peer group, loss of confidence when criticized, loss of
traditional values that are not replaced by other guides to living, loss
of health, loss of goals (especially after working long and hard for
some achievement), poor communication with family, family conflicts,
and having depressed parents. 
A recent survey at the Medical College of Virginia found that
interpersonal losses (death, marital problems, loss of a friend, job
loss) remarkably increased the risk of clinical depression in women.
But only about 25% of depressed persons have suffered such losses
and not everyone who does becomes seriously depressed. Martin
Seligman and Gloria Steinem suggest the Baby Boomers grew up
expecting the world to be a wonderful place but instead are finding it
to be cold and unsupportive. As economic conditions worsen, there is
no safety net when we fail--no close family, no helpful neighbors, no
concerned co-workers, no church, no kind and gentle government.
True, life today has its stresses, but is it more stressful than marrying
as a teenager, settling on a remote homestead in 1830, running the
risk of death in childbirth or in infancy, and raising a family in the
wilderness? I think not. 
Yapko (1992) makes the point that your value system and life style
(reflecting childhood, friends, and family background) affect your
outlook on every event in your life and on everything you do. Your
values determine what you see as important and unimportant, as good
and bad, as normal and abnormal, and so on. Furthermore, anything
you value becomes a potential threat--something you would hate to
lose. Examples: If you value being cared for by loved ones (to the
extent of being dependent), a scary loss might be graduating from
college or getting a divorce. If you value your looks highly, you will
lose a lot over the years. If you value financial success but can't
achieve it, that is a loss. If you value a close relationship with your
children, but they are taken away by divorce, it may be a terrible loss.
On the other hand, if you do not value day-by-day some activity (and,
thus, don't devote time to it) but psychologically you need it, you have
also experienced the loss of something important. Examples: a person,
who throws him/herself into either work or child care and avoids the
other activity, may only find out years later what he/she has lost. 
What are the points here? (a) If depressed, try to recognize the
losses you may be responding to. (b) Realize the intimate connection
between your values and your regretted losses. (c) Try to reduce your
losses, if possible. And, perhaps, join community efforts to reduce
other peoples' losses--and thereby reduce your own losses. 
Ancient drugs, like reserpine, cause depression; others, like heroin
or opium, cause elation. So there is reason to suspect that some
naturally occurring "chemical factors" in the brain could influence
depression. Also, the environment is a factor, consider "blue Mondays"
and wintertime depression (relieved by full-spectrum lights). Likewise,
as we will see, genetic factors clearly play a role, at least in the most
serious forms of depression. Even proneness to minor stress and mood
swings may be partially inherited. And, physical treatment, like electric
shock, may reduce depression. My point again is: the causes of
depression are complex and only partially understood. 
Note: every once in a while, some amazing finding comes along
that shakes your thinking about a mental disorder. (Often the finding
is an accidental outcome which doesn't hold up over time, so know
about the finding but be cautious.) Very recently (2001) a press
release by Stanford University psychiatric team reported that the
abortion pill RU-486 had reduced serious psychotic depression
symptoms within four days for five women. These women were not
pregnant, so this isn't related to having an abortion. The theory is that
a hormone, cortisol, is associated with psychotic depression and RU-
486 blocks the brain's receptors for cortisol. The drug seems to only
help this one disorder. Interesting. More studies are being done. Stay
Studies of identical twins, fraternal twins, adoptees, and several
generations within a family, suggest that your general level of
depression is partly inherited but not your level of happiness
(discussed in introduction). Your conscious efforts can influence
happiness regardless of the messages from your genes. However, if
one identical twin has a serious depression, the other twin has a 65%
chance of being depressed. Since 35% of the time one twin did not
become depressed, one could ask to what extent did the nondepressed
twin overcome his/her genes? We don't know. Maybe the depressed
twin is suffering from psychological causes. Again, we don't know but
in dizygotic twins the chance of the other twin getting depressed is
only 14%. Kendler, et al (1993) estimates that genes account for 41%
to 46% of the variance in depression. Clearly, depression runs in
families. The genes and the family environment are both involved, but
several studies find that it is individual specific-environmental factors
that influence depression and not shared family events, such as the
death of a parent. 
How physiologically do the genes, environment, and drugs
influence depression? Current speculation is that these factors
influence the transmission of nerve impulses (involving chemicals
called neurotransmitters) in the brain. Too little of certain
neurotransmitters (norepinephrine or serotonin) supposedly results in
depression, too much in mania or overactivity. Helpless rats shocked
repeatedly act depressed and lose their norepinephrine (Ellison, 1977).
Rats in a similar situation but able to turn off the shock themselves do
not act depressed nor get deficient in norepinephrine (Weiss, et
Another theory is that the "general adaptation syndrome" is
responsible for depression as well as stress (see chapter 5).
Remember the third stage in this process, after an alarm reaction and
resistance, is exhaustion. Depressed people feel tired, drained of
energy, "I just can't get going." Other symptoms--poor sleep,
appetite, and sex drive--are regulated by the hypothalamus, so it may
be malfunctioning. The real question is: What causes the stress or the
neurotransmitter or the hypothalamus changes? We don't yet know. 
If a person's depression involves radical bipolar mood swings
(feeling high and then low), delusions, and a high risk of suicide, some
form of medical treatment (drugs and hospitalization) in addition to
psychotherapy should be given. If the depression does not include any
of these factors but does include other physical factors mentioned
above (see signs), medication would probably help (Kocsis, 1981).
Even when there are no signs of physical illness, i.e. it seems to be
psychological, the treatment of choice is psychotherapy with
medication as needed. It isn't understood why or how but anti-
depressive medication changes cognition, and cognitive therapy,
believe it or not, changes body chemistry (Free & Oei, 1989). 
Other physiological conditions are related to sadness and anxiety,
for example, postpartum conditions, hypoglycemia, and premenstrual
syndrome. Hypoglycemia may have been overemphasized in the
1970's but premenstrual syndrome is a devastating problem for some
women. One woman was hospitalized 13 times for suicidal depression
before someone noticed that each admission was one or two days
before her period (letters, Ms, p. 4, January, l984). More commonly
(estimated from 20% to 80%), women experience increased tension,
headaches, irritability, and sadness prior to their periods. There are
likely to be complex physiological and psychological causes but we
know little about premenstrual stress, thus far. Research is badly
needed (Eagan, 1983). 
A word of caution: believing in physical causes, such as
psychiatrists' favorite expression "chemical imbalance," may interfere
with assuming responsibility for changing yourself. Examples: "I'm on
medication" or "I get depression from my mother" or "my system is all
messed up." Lewinsohn & Arconad (1981) reports that many
depressed patients see themselves as physically ill, as victims of some
bodily disorder. Thus, they expect the "doctor" or medicine to
magically remove their sadness--otherwise, they feel helpless. (Of
course, the opposite misunderstanding is equally harmful: when
physically caused depression is treated with psychotherapy, prayer,
illegal drugs, alcohol, talking to friends, self-help....) Don't neglect the
possibility of either physical-chemical or psychological-environmental
The very idea that drugs are the answer (to depression) suggests a moral, psychological,
and spiritual vacuum.
Peter Breggin (1994)
Poor social skills = no fun 
One social learning theory (Lewinsohn & Arconan, 1981) proposes
that depression is a result of an unrewarding environment and the
person's reaction to it. This is like the loss theory (1) except there is a
twist: the "depressing" environment may not be painful, it may just
not be any fun--it provides no pleasure, no "positive reinforcement."
That could be depressing! 
Lewinsohn and his associates have shown that depressives respond
slower and less often to others. They don't get others to respond to
them; thus, they get fewer social rewards (less fun) than
nondepressed people. More importantly, depressed people arouse
more anxiety, anger, depression, and rejection in others than
"normals" do (Coyne, 1976). How? By too many complaints, requests
for support, and premature discussions of personal problems. This may
account for staying depressed but it doesn't explain why the social
interaction and skills decline. 
Coyne suggests that this sequence of events occurs: (a) some
stressful events happen, (b) depression-prone people need more social
support and nurturance than others when under stress, (c) but they
have fewer social skills for getting the extra support needed, which
worsens the depression, and (d) they start relating in ways that drive
others away, which maintains the depression. Indeed, 70% seeking
therapy aren't getting what they want from their spouse (McLean,
1976). Some questions still remain about this theory: Why do they
need more support? Why do they lack these skills? Why can't or don't
they figure out how to have more fun? 
Recent research has studied which behaviors of depressed
students drive roommates away (Joiner, Alfano, & Metalsky, 1992).
Tentative findings are that depression per se doesn't turn people off,
but certain behaviors by self-depreciating depressed people do, such
as excessively seeking reassurance that the other person cares. This is
true especially between males. Obviously, how the depressed male is
received also depends on the characteristics of the "friend." For
instance, an empathic, tolerant, caring person would not be rejecting,
except under the most trying circumstances. Perhaps males are
rejected more for seeking support because they are supposed to be
self-reliant and "suffer in silence." Perhaps depressed women are
rejected for other reasons. In any case, there is clear evidence that a
depressed friend is depressing. 
Ferster (1981) says the depressed person is so overwhelmed by
their loss and anger that they can't respond effectively to the
environment (to others) to get what they want. Rather surprisingly for
an operant behaviorist, he implies this insensitivity to how-to-get-
what-we-want may come from early feeding experiences where the
infant responds more to the internal urge to eat (making demands--
which get reinforced) than to interacting and playing with the feeder.
Like the fussy, demanding baby, the depressed person becomes
fixated on complaints, criticism, demands, and loud cries of distress
(all punishing or aversive to any listener). Instead of seeking positive
reinforcement, they have learned to only punish and complain; they
hurt too much to do otherwise (like the hungry infant). By being so
glum and critical (and insensitive) they only drive others (sources of
fun) away. By therapy or self-education they must learn other ways of
Lewinsohn's approach to therapy is to first pinpoint the punishing
events present in the sad person's environment (usually marital
problems, work hassles, or criticism) and the pleasant events absent
(including friends, love, sex, fun activities, satisfying solitude, and
feeling competent). Then by careful, daily rating and plotting of one's
behavior and the resulting feelings, the therapist shows the depressed
person that the environment (and how they handle it) truly does
determine their depression. Treatment consists of teaching the patient
how to decrease the frequency and hurtfulness of unpleasant events
and increase the frequency and appreciation of pleasant events. This is
done by using many techniques, like those in chapters 11, 12, and 13,
but mostly behavior change or social and cognitive skills to increase
positive reinforcement. The University of Oregon started a class in
"Coping with Depression" (Lewinsohn & Arconad, 1981). 
You might notice that this is the same basic notion as most
dynamic psychiatrists operate under, namely, that most emotional
problems originate in our interpersonal relationships. Surely it would
work in the opposite direction too: if I became very sad, impatient,
demanding of attention, lethargic, and grouchy, I'd surely develop
interpersonal problems. So which comes first, sadness or poor social
skills? Have life events been painful or just no fun? 
Recent research confirms the importance of positive
We therapists and writers focus on reducing unpleasant negative
emotions--anxiety, fears, depression, anger, dependency and so forth.
We do this partly because patients frequently have gotten into a sink
hole of obsessive scary, irritating, or sad thoughts and feelings. Also,
our therapy methods are oriented toward reducing symptoms.
Research, however, has shown that positive thoughts and
experiences reduce the negative reactions we have to stress, loss,
frustration, and helplessness. Therefore, distress and unhappiness can
be reduced by using a variety of pleasant, satisfying or promising
coping methods, which are different from traditional therapy methods.
Note that how well we cope is related to (a) perceived characteristics
of the upsetting situation, such as how changeable the situation is
seen to be, (b) personality factors, reflecting such traits as optimism,
self-efficacy, toughness, a sense of humor, and neuroticism, and (c)
social resources the person has, such family support, a devoted friend
or therapist, a fun group, etc. (Folkman & Moskowitz, 2000). To some
extent these factors are within our self-control. 
What other coping methods might indirectly ease the pain of fear
or depression? One would be cognitive reappraisal or "reframing" or
"benefit finding." If there is one little bright spot, a ray of hope, or one
good thing, the situation is not so bad. You have to look for the
positive, however, so that you will not be overwhelmed by the gloom.
In bad situations, such as caring for a sick loved one, the bright spot
may be the satisfaction you feel about your steady contribution to
their care. Don't dismiss the good. And, at the other end, don't over-
estimate or reinforce the bad feelings (see Becoming Absorbed with
Another aspect of coping that yields positive feelings is the fact you
are trying to improve the situation. Problem-solving efforts focus our
attention on the important and changeable aspects of the distressing
situation, motivate us to try something, give us satisfaction when we
try, and lead to mastery and pride if we have some success. 
A third way to see the positive is to ask yourself "did I do
something that made me feel good?" Most people can find some
things, but you have to look for them and remind yourself that even in
the midst of an awful situation good things are still happening. So, in
the footsteps of Lewinsohn 20 years ago, today's cognitive therapists
often ask their patients to schedule positive events and to look for
positive meaning. The more positive events and experiences we can
have, the more we reduce the depression (Dixon & Reid, 2000). 
Helplessness and hopelessness
Being frustrated so many times that you have no hope is surely
depressing. This is a very old idea; 2,000 years ago Aretaeus, a
physician, said melancholia sufferers "complain of a thousand
futilities." But it is also a fairly recent and rapidly changing theory.
Seligman (1975) was studying escape learning and found that dogs,
forced to stay in a box where they were repeatedly shocked, soon
gave up and stopped trying to escape. Not surprising. Moreover, 65%
of the dogs didn't try to escape the next day when the box was
modified so they could easily escape. They just laid down and whined.
They had learned helplessness. Seligman said human depression with
its passivity and withdrawal might be due to "learned helplessness." 
This single study of dogs stirred enormous interest among
experimental psychologists who had heretofore ignored the ancient
idea of hopelessness. Amazing. However, I think we are seeing the
potential of research to slowly clarify and validate an idea. For
example, within a few years the "helplessness" theory was being
questioned because many people in helpless circumstances do not
become depressed and because this theory does not explain the guilt,
shame, and self-blame that often accompanies depression. How can
you feel helpless, i.e. without any ability to control what happens, and,
at the same time, feel at fault and guilty about what happened
(Carson & Adams, 1981)? 
A few years later, attribution and/or cognitive theory (Abramson,
Seligman, & Teasdale, 1978) came to the rescue with the reformulated
helplessness theory. This suggests that the depressed person thinks
the cause is internal ("it's my fault"), stable ("things can't change"),
and global ("this affects everything"). This is a very different theory
(no experimentalist had ever theorized that the dogs blamed
themselves). But soon there were more problems, e.g. research
showed that most depressed people, like dogs, see the causes of their
depression as being outside forces, not themselves (Costello, 1982).
Moreover, both the hopeless self-blamer and the hopeful self-helper
see the causes of their behavior and feelings as being internal. So,
internal causes may lead to optimism as well as pessimism. And,
finally again, how do we know that the feelings of helplessness or
hopelessness precede and cause depression rather than just being a
natural part of feeling depressed? 
To deal with some of these difficulties, Abramson, Metalsky, &
Alloy (1989) modified the helplessness theory into a still broader
hopelessness theory. The more complex hopelessness theory contends
that prior to becoming hopeless the person has (a) a negative
cognitive or attribution style (see next two theories) and (b) some
unfortunate, stressful experience. Because both of these factors are
involved, some people with depression-prone thinking don't become
depressed (by avoiding traumatic experiences) and some people go
through awful experiences without getting depressed (by avoiding
negative thinking). The hopeless person expects bad things will
happen in important areas of his/her life (pessimism) and/or that
hoped for good things will not happen, and he/she doesn't expect
anything to change that miserable situation. 
Considerable research has supported parts of the hopelessness
theory. For example, Metalsky & Joiner (1992) found that three
cognitive views: (a) attributing bad events to unavoidable and far-
reaching causes, (b) drawing negative conclusions about yourself from
a negative event ("it means I'm worthless"), and (c) assuming one bad
event will lead to others in the future, when combined with high
stress, are associated with depression. In another study, they found
that low self-esteem was another crucial ingredient in order to produce
depression (Metalsky, Joiner, Hardin & Abramson, 1993). Please note:
depression might be avoided by reducing your negative thinking
habits, avoiding high stress, or by building your self-esteem. 
Of course, your needs and personality will determine how stressful
a particular event will be for you. Segal (1992) found that recovered
dependent depressives were plunged back into depression by a loss or
conflict in interpersonal relationships. But, self-critical depressives
relapsed when they failed at school or work. Only our most dreaded
problems seem to set off depression. 
This new hopelessness theory explains depression to a
considerable extent on the basis of pessimistic expectations of the
future. Traditional thinking and other theories (#1, #5, #8, #9, #10
& #13) say depression is caused by obsessing about losses in the
past. Selective perception of the past is also thought to be important,
e.g. self-critical people don't see their successes. Both backward-
looking and forward-looking theories are probably true, sometimes.
Some people regret the past ("Of all sad words of tongue and pen, the
saddest are these, 'it might have been'") and others dread the future
(because they will mess it up or have no control), and some do both.
Maybe the negativism of some depressed people extends to
everything--the past, the future, me, you, the world... 
As we will see later, the therapy for helplessness and hopelessness
includes (a) making more good things happen and/or increasing
positive expectations, (b) increasing self-control--like with this book,
(c) increasing tolerance of whatever happens, and (d) increasing one's
optimism. Ideally, the depressed person will develop internal, stable,
and global explanations (attributions) for good events, e.g. "I'm
responsible for what happens, and I can make good things happen
again in lots of areas." Likewise, the shift should be to believing that
external, unstable, and specific factors account for unpleasant life-
events, e.g. one of Seligman's better adjusted dogs in the shock box
might say, "This man is hurting me, he will surely stop soon, people
only shock me in this box... and I will vigorously avoid getting into this
box again. For now, I'll just tough it out." 
Exercise: How do you explain things?
It might increase your understanding of your own depressive
moods to think of 8 or 10 situations that could happen to you--both
good and bad. Examples: doing poorly on an exam, getting a good job
or a promotion, having an auto accident, not being able to get a job,
getting a new friend, having a date that doesn't work out, losing a
girl/boyfriend, having a fight with a parent, relative, or child, etc.
Vividly imagine each situation, then, afterwards, write down what
seems like the main reason or cause for what happened. Next, ask
yourself: (a) Is this cause due to me or someone or something else?
(b) Is this cause going to influence just this situation or many others
as well, i.e. how general or how limited is the influence of this factor?
(c) Is this cause a temporary factor or long-lasting? (d) How important
is this situation to me? (e) When bad things happen to me, do I
conclude I am at fault or bad? (f) When something bad happens to
me, do I assume more bad events are on their way? By looking at
your answers over several situations, perhaps you can figure out your
attributional style. Are you a pessimist about the future? Are you a
harsh self-blamer? What do you think your faults are? Do you blame
your behavior ("I didn't study enough"--this is changeable) or your
character ("I'm lazy" or "I'm stupid"--hard to change)? What are your
strengths? How low is your self-esteem? Do you see ways to change? 
There are even more good questions you can ask yourself that
should help you realize that your depression can be changed (Johnson
& Miller, 1994): 
The Exception Question: When are you the least depressed?
What was the last time you weren't depressed (or down on
yourself)? Do you remember a time when you expected to get
depressed but you were able to avoid it? These kinds of
questions remind you that you have some self-control... that
depression can be changed. They cause you to start exploring
the reasons for these changes--what was different? How can
you reduce the depression again? 
The Miracle Question: If the depression (or self-critic)
miraculously went away, how would life be different for you?
What would be the first sign it was gone? How would others say
you are different? What would you be doing instead of being
depressed? Be very specific about how your behavior and
feelings would be changed. What are some of the exciting
possibilities if you were not burdened with depression? This
starts you thinking about your potential in the future as a
happy person. 
The How-Did-You-Do-It Question: Depression is an awful
condition, how have you managed to handle it? How have you
kept things from getting even worse? How do you fight off the
conditions that make you get really depressed or to want to
hurt yourself? Where do you get the strength to be a survivor?
These questions cause you to look for your specific strengths
and for other ways to cope with depression. They also help you
see that depression is not caused by you and is not an
unavoidable part of your being. Depression and self-putdowns
are external problems imposed on you by psychological or
historical factors and circumstances. These misery-causing
external factors can be changed. 
However, there are still serious questions about this hopelessness
theory: When and how are negative thinking styles learned in real life?
Again, which comes first the thinking or the feelings? Isn't it illogical to
feel responsible for making good things happen but not responsible for
bad events (although that is the way we frequently think about God--
we give God credit for good happenings but usually not the blame for
bad things)? Do hopeless depressives only feel guilty and ashamed of
sins of omission? Wouldn't sins of commission be impossible for me as
a truly "helpless" person, unless I was possessed by evil external
forces that "made me do it" and with whom I collaborated? Begins to
sound like a 1620 witch hunt, doesn't it? (See later discussion of guilt.) 
Actually, the victim of depression may feel helpless, but his/her
emotions, weakness, and pessimism can have a very powerful effect
on others. Examples: the typical "helpless" person "asks others to do
things for him/her," "never does things on his/her own," "gets others
to make decisions," etc. This is helpless? Hardly, it is dependent,
demanding, and controlling (Peterson, 1993). These "helpless" feelings
also serve as self-excuses for poor performance (for many of us it is
better to be seen as "feeling down" than as a failure). But only persons
prone to depression are willing to be extremely self-critical ("I'm a
loser... helpless... worthless") in order to protect themselves against
criticism and to avoid facing future responsibilities (Rosenfarb & Aron,
How do people respond to someone's helplessness? At first, people
try to make the person feel better; they try to meet his/her needs. But
after seeing a lot of "helpless" behavior from one person, people tend
to get angry and/or avoid the subtly (maybe inadvertently) demanding
depressed person who never changes. Clearly, not all "helpless" people
are passive, ineffective, and feeling futile, like Seligman's dogs. Some
are powerful. Seligman's latest views are in Peterson, Maier &
Seligman (1993). 
Yapko (1992) believes that depression not only results from an
"illusion of helplessness" but also from an "illusion of control." For
instance, Baby Boomers were taught they could have it all--education,
great job, wonderful family, nice house and car, fantastic travel, etc.
That wasn't true and Baby Boomers have an unusually high rate of
depression. They didn't meet their expectations. Unrealistic
expectations in both directions, i.e. hoping for too much change or
believing little change is possible, can cause depression. 
Negative views 
Beck's cognitive therapy states that somewhere in childhood the
depressed-to-be person develops a negative view of the self, the
world, and the future: "I'm no good," "the world ain't fair," and "it
won't work out." Each of these negative views gets expanded into
detailed beliefs: "I'm dumb," "I can't talk intelligently," "I'm ugly too"
and on and on. These negative assumptions seem to be held on a very
primitive level; facts don't influence these beliefs, so they never get
questioned or tested against reality. For a brilliant investigation of the
development of self-critical beliefs at an early age, see Carol Dweck's
studies of mastery-oriented thinking. These negative views just lie
dormant even while more rational evaluations of self, world, and future
may also be developed and used as we mature into adults. Then later
in life, when the self is hit with some serious loss or stress, often one
that reminds us of a loss or trauma at an early age, the old
unreasonable and destructive negative ideas suddenly take over and
dominate our thinking. It is our negative ideas that produce our
depression, not the stressful triggering event that produces our
depression. The deeper the depression, the more the negative ideas
replace rational thinking (Coleman & Beck, 1981). 
Under the influence of this primitive, negative thinking, our logic
fails us. For example, we jump to conclusions, look at only one detail
and disregard the big picture, overgeneralize from one experience,
magnify our faults and minimize our achievements, and take the
blame (see examples in next two theories). All of this adds a very dark
and gloomy shadow over our mental life. 
Research has confirmed that sad-prone people notice the negative
aspects of an event (they remember their goofs--but not other
peoples'--and overlook what they did right) and assume too much of
the responsibility when things go wrong. It has also been
experimentally demonstrated that thoughts (induced by the
experimenter) can influence feelings and behavior (Carson & Adams,
1981). Therefore, it isn't just the depressing event that makes us sad
but also every time we remember and fantasize about the
disappointing event in the past or imagine a similar thing happening in
the future, we create a more and more depressive mood. Remember,
though, negative cognition clearly accompanies depression but it has
not been proven that negative thinking is the exclusive cause of
depression; other factors may be involved in causing depression
(Barnett & Gotlib, 1988). 
Using methods much like Lewinsohn's, cognitive therapists
collaborate with the patient to get him/her to investigate the
relationship between his/her negative ideas and his/her feelings of
depression or actions. So, the therapist may ask the patient to
"investigate" whether or not he/she can start taking tennis lessons. If
he can, that is a little evidence against his belief that he/she can't
change anything. A few weeks later patients are taught to identify
their automatic negative thoughts that precede negative feelings. The
cognitive therapist does not attack the patient's irrational ideas as
being wrong. Only after the patient begins to doubt some of his/her
own negative ideas, can the validity of those thoughts (and the logic
and assumptions underlying them) be tested out and evaluated by the
patient with help from the therapist (Coleman & Beck, 1981).
Cognitive therapy notions about negative thinking overlap a lot
with the hopelessness theories, Rational-Emotive therapy (irrational
ideas), and faulty conclusions theories discussed later. 
Irrational ideas
Rational-Emotive therapy, as described by Ellis & Harper (1975),
Hauck (1973), and Maultsby (1976), emphasizes that irrational ideas
cause all our unreasonable or excessive emotions. In the 1st century
A.D., Epictetus, a Greek teacher enslaved in Rome, said, "Men are not
disturbed by things (that happen to us), but by the views which they
take of those events." In the 1960's Albert Ellis started teaching this
simple philosophy: our thoughts cause our feelings. Here is an
A. First, there is an event: our girl/boyfriend says, "I'm going
out with someone else." 
B. Then, our belief system--our irrational ideas--become part of
our perception of the situation: 
(1) She/he doesn't like me, I've failed, no one will want
me, I'm worthless, I'll never find as good a lover, it's
terrible that he/she is dumping me. Or:
(2) It's awful that she/he would do that, it's
inconsiderate, it's selfish, it's unfair, it's embarrassing,
it's mean, she/he is a terrible person, we made
promises, she/he has probably been "looking" for a quite
a while, I hate her/him. 
C. Then, we have an emotional reaction: 
(1) If your belief system (thoughts) is like B (1), you will
feel serious and lasting depression.
(2) If your belief system is like B (2), you will feel
intense anger. 
You see, it is not the external event--the rejection--that
creates the emotional response, but what we say (beliefs B 1 or
B 2) to ourselves! We have a choice. Indeed, we could tell
ourselves something entirely different and produce a very
different emotional reaction, for example: 
B. A more rational belief system: 
(3) We had some good times together but obviously
there were problems. I would have preferred that
she/he had told me that she/he was unhappy and
"looking" but it wasn't awful. I'm sorry we didn't work it
out but I'll get through the hurt, and I'll learn to be a
better companion next time.
C. A more reasonable emotional reaction: 
(3) Some pain, regrets, and sadness for a few days or
weeks but not intense, lingering anger or deep,
prolonged depression.
Rational-Emotive therapy is more challenging and aggressive than
most other therapies. These therapists immediately point out and
attack the client's irrational thoughts and unreasonable expectations.
They directly suggest more reasonable ways of viewing the self, the
world, and the future. They also assign homework designed to correct
false beliefs. 
What are some of the other harmful irrational ideas and thoughts? 
Everyone should accept and approve of me; it is awful when
someone criticizes me. 
I should always be able, successful, and "on top of things." 
I must have love to live (in some cases--a particular person's
love, as in the example above). 
If I am criticized or rejected or make a mistake, it means I'm
not liked, unlovable, and incompetent...it's awful! 
External events, such as bad luck, other people, a sick society,
cause unhappiness. I can't control these things, so it's not my
fault things are so awful. 
Note two things: first, a, b, and c are unreasonable expectations,
often impossible goals. They are, of course, nice, common and in
many ways useful wishes; everyone would like to be approved,
successful, and loved, but we can't demand that our wishes always
come true. When things don't go our way, it isn't something awful to
go into a rage or deep depression about. Although an event may be
regrettable, it is always a psychologically understandable and
behaviorally lawful outcome. Later we will see that Karen Horney
referred to these insistent neurotic needs or demands that things be
the way we want them to be as "the tyranny of the shoulds."
Secondly, d and e illustrate other kinds of faulty logic that might
underlie depression (see cognitive therapy) and other exaggerated
emotions. Rational-Emotive techniques and self-help methods are
discussed in chapter 14. 
Some scientists doubt that irrational ideas and faulty logic cause
depression. Some doubters believe the sad feelings existed before the
sad-helpless thoughts, i.e. that depressing genes or hormones or life
events lead to our negative cognitive styles (Barnett & Gotlib, 1988).
Other doubters, like Robert Zajonc, believe that emotion and cognition
are independent systems and, furthermore, irrational behavior is
based on emotions, not irrational thoughts (Cordes, 1984). In spite of
criticism, cognitive explanations are the most accepted explanations of
depression among psychologists today. 
Unreasonable thinking and faulty conclusions 
Depressed people are prone to think in several ways that may
produce sadness and pessimism. If things have gone badly in the past
(depressed people are past-oriented), there may be a tendency to
conclude that the future will be awful too. Actually, depressed people
usually don't think much about the future. The future is depressing
precisely because it has little meaning or no purpose for them... or is
threatening. The erroneous belief that things will not get better may
lead to suicidal thoughts. This hopeless vision of the future is based on
a general global perception that their problems are huge, innumerable,
and insolvable. A depressed person may have only a vague notion of
wanting "to be happy," "to put my life back together," "to find love and
happiness," etc. Of course, without the problems being definable,
objective, specific, manageable, and circumscribed, depressed people
don't have specific plans, i.e. doable, clear-cut, self-help steps in mind
for attaining realistic goals. Without plans for changing, they have no
hope and no motivation. They feel like victims, not masters of the
situation. That is unreasonable. They can change. 
Depressed people seem to reason poorly in several other ways.
Examples: they are concrete thinkers and have difficulty generalizing
(e.g. after being taught to be assertive with his/her boss, he/she
doesn't think of being assertive with his/her spouse). They see nothing
illogical about giving credit to luck, other people, God, fate, etc. for the
good things and blaming themselves for the bad things in their lives.
While depressed people focus on the bad happenings in their lives,
some of them tend to deny the "bad" emotional parts of themselves,
such as anger, violent, and selfish urges, etc. Others see only the bad.
And, their "solutions" for their problems are often unrealistic, such as a
person with two children and an unhappy marriage who wants to have
another child "to improve the marriage" or a floundering overly critical
student decides to drop out and live with his/her father although they
have never related well. We can't cope well without thinking straight;
this includes having a purpose and a plan for living (see chapters 2 &
There is still more wrong with the depressed person's thinking
processes. Therapists and scientists studying the brain have contended
that a part of our mental make up compels us humans to explain
everything (see attribution theory in chapter 4). Some of us, hating
uncertainty, need an immediate, simple, "it's for sure" explanation;
others of us need lots of data, time to weigh different opinions, and
careful thought about the issue before we arrive at an explanation.
This reflects the difference between simple "black-and-white thinking"
(dichotomous thinking) and complex "tolerance of ambiguity."
Depressed people grab hold of immediate, clear-cut but pessimistic
explanations; that is their "explanatory style," namely, "it's my fault"
(happy folks blame the situation or someone else), "my weakness
messes up everything" and "it will never change, so why try?" Wow,
what a prescription for depression! Reality is: you aren't entirely to
blame, the supposed fault won't mess up everything, and the
situation--including you--can and will change. Depressed people must
learn to think differently. 
We need to understand why some depressed people are such rigid
and poor thinkers. It is critical knowledge for working with suicidal
patients. The closed-mindedness of depressed people is amazing.
Yapko (1992) describes counseling a patient who recently had a heart
attack and a quadruple bypass. This man wouldn't talk or open his
eyes during the first hour of therapy; he quietly cried while his wife
told his story. When the patient finally talked in the second session, he
only said, "I'm going to die!" and sobbed. He could do nothing and
think of nothing but dying. In contrast, Viktor Frankl survived the
brutal conditions of a Nazi concentration camp, while many died, by
intensely desiring to live so he could be re-united with his wife. He had
a purpose and thought there was some chance if he could stay alive.
We must use our rational mind to find those rays of hope and to
develop realistic plans to make our future better. 
Self-critical withdrawal 
If we are sad, we respond more slowly and avoid ordinarily
pleasant (it may not be pleasant to the depressed person) and
unpleasant events. Indeed, there is evidence that depressed people
are especially sensitive to pain and even mildly irritating situations
(Carson & Adams, 1981). Perhaps because of this sensitivity, some
depressed persons have developed unique ways of reducing pain or
stress in addition to avoiding or withdrawing, namely, by making self-
critical or self-hurtful remarks (which may reduce criticism from others
or, in some masochistic way, reduce the stress). This sounds a lot like
the story of Sooty Sarah below. The outcome could be a miserable
We need to understand why some depressed people are such rigid
and poor thinkers. It is critical knowledge for working with suicidal
patients. Forest and Hokanson (1975) did an interesting study
supporting the notion that self-punishment could be rewarding, i.e. an
escape from conflict with someone else. In this study an aggressive
partner was permitted to shock depressed and non-depressed
subjects. Then those who were shocked were given the choice of
shocking their partner back, shocking themselves, or making a friendly
gesture to the partner. If the depressed subjects elected to shock
themselves, their autonomic responses (stress) declined more rapidly
than if they were aggressive or friendly. Non-depressives got relief
only by shocking the other person, not by self-punishment or being
friendly. For most of us, it seems astonishing that anyone would hurt
themselves more after being hurt by an aggressive SOB. Well, there
seems to be some relief--a payoff--for depressed persons if they
punish themselves instead of attacking the aggressor. Maybe sadness
is partly a self-punishment (and/or substitute for aggression). This
needs to be understood better and may also be involved in the next
odd-sounding theory. 
Anger turned inward 
Psychoanalysts have long believed that anger towards others gets
turned against ourselves. Our anger converted into self-hatred causes
depression. Karen Horney (see Monte, 1980, or any theories of
personality book) wrote that the basic problem starts with neurotic
parents who are inconsistent (both overindulgent and demanding),
lacking in warmth, inconsiderate or openly hostile, or driven by their
own needs. The child resents these things. But parents are powerful
and a child's only means of survival. So, because of fear or love or
guilt, the child represses the anger. The child, being small, alone,
confused, and helpless in an unpredictable, hostile world, is, of course,
scared. How does the child protect itself? 
The child, aware of his or her weakness, the criticism of others,
and his or her own hostility and fears, develops a "despised" self-
concept. Also, the resentment of others has been turned against the
self: "I am unlovable, a bad person." At the same time, the child starts
to develop a notion of an "ideal" self--what he/she should be--in order
to survive and get the love and approval he/she wants. This ideal self,
trying to compensate for weakness and guilt, sets up impossible
demands, called neurotic needs. These needs are unconscious,
intense, insatiable, anxiety-causing, and out of touch with reality. For
instance, if one has a neurotic need for affection, it becomes urgent to
be loved by everyone, all one's peers, all the family, teachers, the
paper carrier, etc. Horney listed several neurotic needs, primarily
needs for perfection, power, independence, and affection. All are
attempts to handle the primitive hostility from childhood. So, how do
we get depressed? 
In extreme cases, some people become so self-effacing, i.e.
compliant, unselfish, and modest; they almost do away with their
"self." Suffering, helplessness, and martyrdom are their ideals. They
need to be loved, liked, approved, important, but taken care of. Their
"solution" is: "If you love me, you will not hurt me." But beneath this
saintly, goody-goody surface sometimes boils the old anger, rage, and
strong urges to be aggressive and mean. Besides, love never runs
smoothly--remember everyone must love them--so these kinds of
dejected people may turn against themselves, becoming very self-
critical and unhappy. Often they have also become bitter because the
unwritten agreement was broken, namely, "I'll be nice and not hate
you, if you will love, respect, and care for me always." People striving
for sainthood often suffer because others will not always put them
Warning: Some words in this story may offend you. Skip it if you are
sensitive about "dirty words."
Sooty Sarah: A fairy tale 
Chapter One
Once upon a time there was a poor little girl who couldn't do
anything right. She lived with a wicked queen, her stepmother, in a
cold, gray castle. Sooty Sarah knew she never did anything right
because no matter what she did, the wicked queen (who had had an
evil spell put on her by an old witch) always found something wrong
with it. (You need to know that the old witch had slipped a pair of shit-
colored glasses on the queen, but she didn't know they were there
because they weighed nothing. Since Sooty Sarah had never seen the
queen without the glasses, she never asked about them. She just
thought the old queen hated her which wasn't necessarily so. But back
to the story.) Things went on this way for some time. The little girl
trying to please the queen and the queen continually finding fault with
her. Then, one day, when the little girl was older, she noticed the
queen looking very pale and sick. "What is the matter?" she asked.
"My, aren't we nosy!" said the tired queen, "Well, if you must know, I
have to stay awake nights thinking of things to criticize you about.
You're a very difficult child to criticize, you know." Sooty felt very
badly and said, "Oh, I'm sorry, I'll try to make it easier." Being a good
girl, she started to do all sorts of stupid little things. Actually, things
went well for a while--the girl misbehaving, getting the queen's
attention, and the queen criticizing the growing girl loudly. Everyone
was miserable but satisfied. But all good things must come to an end.
The queen's health began to fail again. 
Chapter Two
The little girl noticed right away, but she couldn't think of any new
ways to be bad, so she thought and thought. Finally, she had a plan
and ran to tell her stepmother right away. "I have it," she cried, "I
know how you can get all the sleep you need. I'll criticize myself!"
"That may be a good plan," said the queen, "it may be the best idea
you ever had." Sooty Sarah was overjoyed; finally she had done
something right. "You can still criticize me if you like, but I'll take over
the real work," she said and rushed off to study hard at finding fault
with herself. (As she got better and better at it, two things started to
happen. Little glasses started to grow over her eyes too and a wall,
one stone at a time, started to build up around her. The wall was
always there; it went with her. Like a chimney, the wall hid and
protected her from the world, which was scary because by now Sooty
Sarah was not only finding fault with herself but with everything in the
world as well.) Sooty Sarah found lots of faults--bad thoughts and
feelings the queen could never have found--and the queen slept
happily ever after. 
Chapter Three
While all of this was going on, there was an ugly frog nearby who
was firmly convinced that he was the most despicable creature on
earth. But a wandering wizard happened to meet him one day and
whispered a magic spell into his ear. All of a sudden the frog turned
into a handsome prince. 
Chapter Four
One warm, sunny day, the prince noticed a strange-looking stone
chimney with a few peep holes in it. Being curious he looked in and, to
his surprise, found a beautiful princess. "Hello, princess," he said,
"how did you get trapped in there?" "Who are you talking to?" said
Sooty Sarah. "You, of course," he said. "You are out of your mind," she
answered, "I'm a dirty, stupid, mean little girl, not a princess--but
since you mentioned looks, I don't mind telling you, you look shitty." 
"Ah, I know what's wrong, you're under an evil spell," said the
prince. "You're crazy," she responded, "and if you don't leave me
alone, I'll really tell you what I think of you." "Your words don't hurt
me, I'm going to stay and try to help you break your spell," he said.
"Spell, Schmell," she shouted, "I hate you bastards who look at
everything through rose-colored glasses!" "But, I'm not wearing
glasses," he answered. 
Chapter Five
"Hum, you're not are you!" Sooty Sarah said, "OK, if you're so
smart, mister prince, tear down this wall, break my so-called spell,
rescue me, big boy!" "I can't do that," he answered, "Only you can do
those things." "Some prince!" she scoffed, "You couldn't prince your
way out of a paper bag!" The prince was patient and said, "I just know
that if I tried to do it for you, the walls would get stronger and the
glasses dirtier and you'd end up criticizing yourself more. You have to
do it. I know a counter-spell but you have to have the courage to use
it. If you do, it will turn you into a princess so we can be married and
can live happily ever after." "Good line, mister, but it will never work,"
Sooty Sarah said softening a little, "I don't deserve to be happy!" "Yes,
you do," said the prince, "I know because the old wizard told me so."
With surprise, she responded, "Did he really say that? (the prince
nods) Then please help me if you can. You don't know what's it's like
to lie awake nights thinking of terrible things about yourself--it's
awful!" "I do know," he said, "before I learned the counter-spell I was
an ugly frog!" 
Chapter Six
"No foolin'?" she said. "It's true," he replied. "Then please, please
help me. Tell me the magic words and I'll say them--I'll do anything,"
she pleaded. The prince leaned over very close to her and whispered
the words in her ear. "Oh, no! I can't say that!" she gasped, "That's
terrible!" "I didn't say it would be easy, did I?" said the prince, "But
that's not the hardest part--you've got to keep saying it over and over,
louder and louder until the spell is broken. If you weaken and quit, it
will make things worse--you would end up even more hurt and angry
than you are now. Is it worth the risk?" Quietly she said, "I'll try."
"Good, you're half way home," smiled the prince, "But there's another
part of the spell I can't tell you. You must figure it out by yourself,
then the spell will be over." 
Chapter Seven
"Now, recite the magic words," urged the prince. Sooty Sarah felt
scared, she hesitated, then she whispered so softly he could barely
hear her say, "Go to hell, Mother." "Louder," he said. "I can't," she
said, starting to cry. "But you must," he said, "do it for me, we can't
stop now. Say it again!" Trembling, she spoke the counter-spell again:
"Go to hell, Mother!" and again louder, "Go to hell, Mother!" Inside her
heart there was a terrible wrench; she thought she would die. It was
the old queen waking up and her voice from within screeched, "How
dare you! You awful child! I'll get you." Sooty Sarah yelled back, "I
just want to be happy!" "Say it again," encouraged the prince. "Go to
hell, Mother!" screamed the girl. "You terrible child!" shouted the
queen in fury, "I'll destroy you." "Go to hell, Mother!" "Good, keep it
up," said the prince. The raging queen thundered, "Look at the misery
you've caused me. You don't deserve to be happy! Whoever said you
should be happy?" "The prince did," said the girl. The queen smiled.
"Who says so?" asked the prince. "The wizard says so," said Sooty a
little uncertain. The queen laughed. "Who says so?" repeated the
prince patiently. "I, I, I SAY SO!!" she shouted, "I say I deserve to be
happy, so Go To Hell, Mother! GO TO HELL, MOTHER! GO TO HELL,
Chapter Eight
Then a miracle began to happen. Every time the girl said the
words, the wicked queen began to shrink. She shrank down and down
way inside the girl until she was hot like a tiny coal. And she glowed
red hot, down dark inside, tiny, but very angry red. Sooty Sarah knew
she had not won yet. "But what can I do?" she begged the prince,
"What's the rest of the spell? Please!" "You've got to figure it out
yourself...and it isn't easy...and half is something you must tell your
step-mother...and they are words you have never spoken to anyone in
your life," he said and then added, "You must be quick--it's now or
Chapter Nine
The poor little girl thought and thought--what could she say to
herself and her mother that would be words she had never spoken
before? The coal inside her stomach was getting redder and redder.
Time was running out. At that moment the prince leaned over,
touched her hand and said, "I love you." Suddenly, like a flash of
lightning, she knew what to say. "Oh, Mother," she cried, her tears
falling down inside her onto the coal, "I know what to say! I'm OK!"
Then she screamed: 
"I'M OK and YOU'RE OK!
Now it seemed so simple. The minute she said it, she knew it was
true--she really was a princess! And the wall vanished. The glasses fell
away--and she knew she would never have to criticize herself again for
her mother's sake. And she knew that if she could only know her step-
mother's needs and suffering and sorrow, she would understand her
criticism and not be angry with her. And she knew that no matter what
she ever did, she would always feel OK about herself. 
Chapter Ten
So, she married the prince. And it was a beautiful world.   
The Sooty Sarah story, except for a few modifications by me, was
given to me by Paul Shriver, a colleague of mine. Some readers are so
distracted by the "dirty" words and hostility towards the mother that
they miss the main points. First, self-criticism may be learned by
modeling the mother or via negative reinforcement (avoids the
mother's criticism) or by being praised and reinforced by the mother or
by the above-mentioned reduction of stress by self-punishment.
Second, the story shows the long interpersonal history behind Sooty's
self-criticism, something the learning and cognitive therapists could
not do because they don't collect information about childhood. Thirdly,
the fairy tale fits nicely with Karen Horney's theories about hostility
turning inward and resulting in neurotic needs (too high expectations
or too critical a view so that one is never satisfied). Also, the story
illustrates psychoanalytic repression of violent emotions which can be
uncovered with insight and removed by expressing the emotion, called
Finally, the tale has a Transactional Analysis (see chapter 9)
theme. Sooty started with a "I'm OK; You're OK, Mother" attitude.
That changed to "I'm not OK; You're OK" when she adopted her
mother's views and became self-critical. Then to "I'm not OK and
neither is anyone else." Later, when the prince's insight enabled her to
see how the old queen's need to put her down had led to her hating
herself, she started to hate her mother: "I'm OK; You're not OK,
Mother." Eventually, to break the spell (of irrational, ain't-it-awful
thinking), Sooty had to understand and accept that both she and her
mother behaved "lawfully," i.e. there had to be reasons for the old
queen's put downs, cynicism, and unhappiness (maybe the queen's
mother was critical, maybe Sarah was prettier and smarter and a real
threat to the queen, maybe...). By accepting and understanding
herself, her mother, the past, and all human beings, Sooty Sarah was
freed from irrational thinking and could now become her highest
potential--an accepting, happy, beautiful princess. 
Depression-prone people are super aware of their wrong doings--
and feel especially guilty. Mowrer, et al (1975) does not believe this
guilt necessarily involves some highly immoral behavior, such as
intense hostility or vile impulses, but rather could be the accumulation
of many ordinary "sins." We all do inconsiderate things: selfish acts,
hurtful comments, just not thinking of others, etc. Our society
encourages us to look out for #1 first or "do your own thing." As
Mowrer observes, since the Protestants protested confessing to a
priest 500 years ago, the Protestant religions provide no authorized
way to confess our sins and atone. And, because we hold inside "real
guilt" for what we have done, we become depressed and may have
other neurotic reactions. (Other theorists say it isn't guilt as much as
being ashamed of not trying harder.) Mowrer's solution was to form
"integrity groups" (modeled after the small early Christian
congregations) in which understanding, permanent friends listened to
our shortcomings (our "sins"), forgave us, and then helped us make
up for the harm we have done. 
Regret for things we did can be tempered by time; it is regret for the things we did not do
that is inconsolable.
-Sydney J. Harris
Guilt isn't always the result of doing something inconsiderate or
immoral. Often it is just not doing what you think you should--"I
should never have let my son go out with that crowd," "I should have
known they weren't telling me the truth," "I should have kept better
records for taxes." In this case, you may be assuming too much
responsibility for whatever happened, setting impossible
(perfectionistic) standards, and/or engaging in irrational thinking (see
#6 and #7 above). Your mistaken views of the world and your
unreasonable expectations of yourself may cause guilt. Guilt may
cause depression. Or there is another possibility: whoever makes us
feel guilty is resented. In the case of guilt or regrets, you make
yourself feel badly; thus, you become angry at yourself, and that
anger is assumed by analysts to be the cause of depression. Handling
guilt and regrets is dealt with in the next section. 
Unmet dependency 
Some psychoanalysts and interpersonal therapists have looked into
the history of depressives and found over-protective, indulging, overly
involved or over-controlling, restrictive parents. The child grows up
with an "oral character:" dependent, low frustration tolerance, and so
desperate to have people like them that they are submissive,
manipulative, demanding and so on. Before becoming depressed they
are described by therapists as "love addicts in a perpetual state of
greediness...sending out a despairing cry for love" (Chodoff, 1974).
Their self-esteem depends on the approval of others. When their
dependency needs are not met, they become depressed and cry, just
as they did as infants. 
Moreover, it usually makes us mad when we feel weak and
dependent. So, an over-dependent depressed person may resist help
("You can't make me be productive and happy") and become hostile
("I will pay you back for not loving me"). Thus, the loss of love is a
triple threat to a dependent person prone to depression: (a) sadness
and panic occur because our vital, life-long struggle for security has
been lost, (b) low self-esteem and hopelessness occur because "I have
lost everything" or "I do not deserve anything" and (c) anger and
resentment occur because "they have deserted me, a helpless child"
(Zaiden, 1982). So, it isn't surprising that research confirms,
especially for very needy people, the old saying, "you can't live with
them; you can't live without them." Relationships (marital problems
and stress with children) are the most common stresses associated
with depression in women. And, relationships (good, caring, intimate
ones) are the best protection against depression (Brown & Harris,
1978; Klerman & Weissman, 1982). See sections below on loss of a
relationship and loneliness. 
These interpersonal, psychodynamic, and psychoanalytic therapists
would say that explaining depression as a result of negative thoughts
or a lack of social skills is superficial and foolishly ignores the life-long,
internal struggle for love for survival. Likewise, this theory sounds very
similar to the currently popular feminists' description of social
pressures put on traditional women to give up their individuality ("be
nice," serve and accommodate others, put your needs last) in order to
be "loved." Evidence is accumulating for this kind of theory (Barnett &
Gotlib, 1988), including relying on others for one's self-esteem (see
chapter 8). 
Impossible goals or no goals 
Overly demanding parents who are critical, perfectionistic, and
harshly punitive tend to have anxious, withdrawn, and sometimes
hostile children who have an "I'm not OK" attitude (like Sooty Sarah).
Perhaps they adopted the parents' impossible goals. On the other
hand, Coopersmith's (1967) work suggests that uninvolved parents,
who do not discipline consistently and/or do not provide moral
guidelines for living, tend to have children with low self-esteem (and
higher risk of depression). 
Losing one's goal or values may lead to depression too. Hirsch and
Keniston (1970) studied 31 drop outs from Yale during the late 1960's-
-during the time of the drug counter-culture, hippies, flower people,
anti-war demonstrations, etc. They did not flunk out; they just weren't
interested. Indeed, nothing interested them very much. They seemed
mildly depressed. But there had been no losses, no big stresses. Yet,
one experience was common: loss of respect for their fathers. They
had once idolized their fathers, but now could not accept their fathers'
values. Middle-class materialism, money, and the country club weren't
for them. They felt lost, unsure of what they wanted, and a little bored
with it all. Thousands dropped out of school and traditional society
during the 1960's and early 70's. This condition has been called
"existential neurosis." Existential therapy aims to restore the person's
sense of freedom and responsibility for his/her choices now and in the
future. To do this, life must have meaning and purpose. (Note: the
dropping out stopped in 1973-74 when we had a recession causing
people to start worrying about making a living. The drop outs would be
45 to 50 years old now and have 20-year-old children.) 
Shame: feeling ashamed of yourself has to be depressing
A critical problem with several previous theories is that the origin
of the depression is not clear, i.e. where exactly does the helplessness,
the negative views, the irrational ideas, the faulty thinking, the self-
criticism, the low self-esteem, etc., come from? The shame theory can
not be faulted in this way; it identifies the origin as early childhood
experiences. Shame is feeling you are inadequate, inferior, lacking, not
good enough, "ashamed of myself." In contrast with fear which
involves external threats, shame is when we feel disappointed about
something inside us, our basic nature. Shame is an inner torment:
feeling cowardice, stupid, unloved, worthless, "a bad person." We hide
in shame, i.e. we "hang," turn, or cover our heads, we lower our eyes,
we isolate ourselves. (There is a related dimension--shyness or
bashfulness--but here we are dealing with self-loathing or feeling
ashamed of oneself.) 
The great concern with addictions in the last 15-20 years has
resulted in a new body of literature about the dysfunctional family,
toxic parents, the inner child, codependency, adult children of
alcoholics, support groups, etc. There are 100's of relevant books:
Kaufman (1989, 1992), Bradshaw (1988, 1989), and Beattie (1989). 
The origin of shame is usually assumed to be in our infancy or
childhood. Shaming is used for control by parents, by friends, by
society. Some of the most hurtful discipline consists of shaming
comments: "shame on you," "you embarrass me," "you really
disappoint me when...." We say insulting things to children that we
would never say to an adult: "stupid," "clumsy," "selfish," "sissy,"
"fatty," "it's all your fault," "you're terrible," "you're hateful," "stuck
up," etc. Many adults vividly remember the sting of these comments.
Siblings and peers are cruel: mocking, laughing at, teasing, calling
names, etc. Children are slapped and whipped, overpowered and
humiliated, their "will" broken. All of this may make a child feel
ashamed (depressed) of him/herself. 
Even in adolescence we feel watched and judged (mistrusted); we
are "shamed into" giving up crying and touching; we are looked down
upon if we aren't successful, attractive, independent, and popular. We
feel ashamed if we are poor and dress poorly, if we are over or under
weight, if we can't express ourselves well or use poor grammar, if our
grades are low, if we have few friends, etc. Some shame and anxiety
may serve useful purposes, but it can be devastating. 
There is some data to support the shame-based theories. Andrews
(1995) found that "deep shame," not just dissatisfaction, in women
about their bodies (usually breasts, buttocks, stomach or legs) was
powerfully related to suffering severe depression. If a female is
physically or sexually abused as a child or as an adult, it increases the
likelihood of depression four or five times! Only childhood abuse
caused shame about the body in women, however. See Lisak (1995)
for an impactful discussion of the effects of childhood abuse on males. 
The memories of our past--our childhood and adolescence--form
our identity or our basic sense of self. Because we have shame-based
families and cultures, shame gets connected with many things, such as
our basic drives, interpersonal needs, feelings, and life purposes.
Examples: much shame is attached to sexual drives (witness the
uneasiness we feel about masturbation, not to mention homosexuality)
and to hunger drives (witness the feeding problems of infants, the
fights over food with children, and the eating disorders of young
people). We are deeply hurt and made ashamed of our needs for
closeness and security whenever a basic bond is broken by rejection,
abuse, neglect, divorce, or smothering overprotection and overcontrol.
Sometimes shame is connected with our bodies, our lack of
competence, our life goals (witness others' reaction to someone
wanting to be a popular singer or a girl wanting to be a mechanic or a
boy wanting to be a nurse). Also, emotion-shame connections ("Don't
cry!" or "Don't feel that way!" or "Stop sniffling or I'll spank you") are
made and we become ashamed of crying, anger, fear, self-
centeredness, even joy sometimes. And, in extreme cases, you can
become ashamed of everything you are--of your entire self--"I am
worthless." Shame is a powerful force but we can understand and
overcome some of its sources. 
There seem to be several natural defenses used against self-
attacking shame: 
Striking out at others. Attacking others by being critical,
sarcastic, or abusive are ways to repair a wounded ego and to
protect our vulnerable weak parts from exposure. Acting
superior and having contempt for others are other ways to
sooth a hurting self. 
Striving for power and being perfect. The wish of a child would
be to make up for our weaknesses by becoming powerful and
being perfect. 
Blaming others. What better way to deny our weaknesses than
to blame others for our problems or for the world's problems? 
Being an overly nice people-pleaser or rescuer or self-sacrificing
martyr. If you feel unworthy, your hope might be to
compensate for it by being "real good." Being super nice often
means pretending or lying about our feelings and true opinions,
presumably because we are ashamed of our real selves. 
The self can withdraw so deeply or shut off the outside world so
completely (denial) that shameful actions or events just don't
upset our self, in this way the self can't be hurt. 
Obviously, a person feeling shame but using these defenses would
inflict shame on others; that is, wounds of shame are passed from
parent to child. This is done by parents in a variety of ways: (a)
verbal, sexual and physical abuse, (b) physical and emotional
abandonment (the child may even be expected to take care of the
parent's emotional needs), (c) thinking of children as insignificant
inferiors to be dominated and blamed or as persons to be controlled by
threats of rage, disapproval, and withdrawal of love or as persons to
be taken care of excessively, and not told the truth because they are
needy, fragile, and "can't understand" or as persons to stay
emotionally enmeshed with because they are perfect, wonderful, can
meet your needs, and may be the only ones that care for us. So,
shame begets shame. 
What are the consequences of a shame-oriented family? Self-
blame and criticism (like Sooty Sarah). Constantly comparing yourself
with others and coming up short. Depression--we may dislike and
disown parts of our self and even feel disdain for our self as a whole.
The shamed person may engage in compulsive disorders--physical and
sexual abuse, drug and alcohol addiction, anorexia-bulimia and
obesity, workaholism, sex addictions, addictions to certain feelings
(rage, being shamed and rejected), intellectualization, anti-social
acting out, and other personality problems, including multiple
personality. The list is long. Some of these "sick" behaviors, like
addictions, help us hide our shame; some, like workaholism, try to
make up for our weaknesses; some, like abuse, adopt the harmful
behavior that was imposed on us; some, like criminal acts, reflect fear
and hatred of the shaming techniques used against us. Shame
operates inside all of us...it is a voice inside our head. The voice
usually sounds like our parent. Sometimes the voice of shame is
healthy and helpful; sometimes it is unhealthy and self-defeating.
Nathanson (1995) should help you understand this complex emotion. 
Shame-based families often have unspoken but well understood
"rules," such as: Don't have feelings or, at least, don't talk about
them. Don't try to make things better--leave the family problems
alone. Don't be who you really are; don't be frank and explicit; always
manipulate others and pretend to be something different, such as
something good, unselfish, and in control. Always take care of others,
don't be selfish and upset others, and don't have fun. Don't get close
to people, they won't like you if they know the truth. Rules such as
this keep you weak, hopeless, immature, hurting, and unhealthy--
depressed and maybe addicted as well. 
Discouragement is simply the despair of wounded self-love.
-Francois De Fenelon
Treatment, according to this theory, involves uncovering the
sources of shame and recognizing the oppressing controls placed on
you by internal voices of shame, family rules, and cultural-gender
restrictions. Getting free may mean taking care of the hurt, scared
little boy/girl inside, and building your self-esteem (see the later
section on shame in this chapter and method #1 in chapter 14). 
Lacking self-control causes depression 
This explains why single women with little education and low
income are the most likely to be depressed; they lack support and
control over their lives. Also, dominated women report feeling they
have "lost themselves." They are in a relationship in which they have
lost the option of expressing their feelings openly, lost faith in their
own ideas, lost reliance on their abilities and skills, lost their self-
respect, and even lost their right to express anguish and despair (Jack,
1991). One can see why they must suppress their very being to keep
their last shred of "love." Somehow these suppressed parts of our
inner self must regain some control and learn to express themselves
Rehm (1977) said the lack of self-help skills, i.e. not knowing how
to get better, caused depressed people to over-emphasize the
negative, set too high standards, and give too little self-reinforcement.
Pyszczynski & Greenberg (1987) contended that depression is the
inability to avoid focusing on one's self. D'Zurilla & Nezu (1982)
claimed that poor interpersonal problem-solving skills cause
depression; the skills depressed people often lack are (a) the ability to
see alternative solutions, (b) the ability to develop detailed plans for
reaching a final goal, and (c) the ability to make decisions. A sense of
self-control is basic to these three skills. This way of viewing
depression expands beyond the helplessness theory, which focuses on
a pessimistic attitude; it emphasizes the importance of skills and
cognitive techniques, which increase our ways and means of self-
control as well as our optimism. 
This "explanation" of depression says much more than "take
responsibility and heal thyself." To all of us, whether we are now
depressed or not, it says that more research must be done. Miserable
people can't learn what they need to know if wise people and science
haven't uncovered the knowledge yet. It is a scientific necessity to
laboriously test the effectiveness of each promising anti-depressive
self-help method. There is already considerable evidence that some
self-control methods work, but there are thousands of ordinary,
everyday methods still to be tested with many different kinds of
depressed people (maybe 100 years of research--let's get going!).
Consider these complexities which need to be clarified: married people
have more support, thus, less depression. Okay, but if women have
more support than men, why are they more depressed? (See
discussion of gender differences above and in chapter 9.) Moreover,
we ordinarily think support is gotten by talking to someone, but Ross &
Mirowsky (1989) reported that talking increased depression. How
could this be? Perhaps talking (without problem-solving) drives others
away and/or involves self-handicapping more than garnering support.
For instance, research has shown that depressed people more than
nondepressed people will actually fail a task (then talk about how
awful they feel) in order to avoid doing more of a simple task (Weary
and Williams, 1990). Like the motivated underachiever in chapter 4,
some depressed people seem motivated to do poorly, have little self-
control, and be depressed; depression may sometimes provide
convenient excuses to ourselves and to others. 
This last explanation of depression emphasizes how uninformed
the depressed person is about self-control and how much more science
needs to learn about what helps and what harms depression. 
Summary of the Causes of Depression and How to Use Them 
These 14 theories give you ideas about how depression develops.
Each theorist tends to assume that his/her explanation is the major
cause. But, as you know, I don't think life is simple. I suspect that any
one person's depression may have many causes. For instance, you
might have a genetic propensity for depression. Then, you grew up in
a shaming family who had a critical, pessimistic attitude. Feeling
rejected anyway, you sensed and resented the hostility within the
family, which lead to your gaining a lot of weight at puberty. All these
factors together resulted in your having serious social problems and
low self-esteem; you not only disliked yourself, you felt your family
had caused a lot of your emotional problems--and told them so. The
family had never been emotionally supportive anyway and honestly
thought "if you are fat, stop eating" and "if you are unhappy, get
happy--and drop all this psychology crap about parents being
responsible." Being unable to deal with these personal problems, when
your lover of two years, who you depended on greatly, decided to
dump you, the depression was more than you could handle. You
become lonely and sad all day, nothing seems fun any more, you gain
more weight, feel tired and listless, become more self-critical and
guilt-ridden, are unable to see anything good in your life now or in the
future, and even have some thoughts of ending it all if your lover
doesn't come back. The history is complex. You have serious
depression and need professional help; it is too late to depend on will
power alone. Yet, you must also learn about and help yourself. That's
real life. 
You need to understand and consider how true each theory is of
you--perhaps you need to read more or talk it through with a relative,
friend, or counselor. Clearly, understanding the possible causes (in
your case) helps you work out a possible solution. Consider the five
parts or levels of any problem--behavior, emotions, skills, cognition,
and unconscious factors--and then plan your attack, based on the rest
of this chapter and chapters 11-15. Keep trying to climb out of the
darkness until you feel better. Even if the depression is mild to
moderate, get help if your self-help efforts don't work within a month
or two. There are medications that relieve many people's depression;
don't be foolish and reject drugs if psychological approaches don't
work. Keep your hopes up. 
Sad Times in Our Lives
There are specific situations that especially depress us (see the
index at the beginning of the chapter). Understanding those times and
knowing some of the available resources can be helpful. Of necessity,
the coverage of these topics will be brief, but there are valuable
references listed here. 
All of us must die. If you have a long life, you will experience the
death of your grandparents, your mother, your father, your aunts and
uncles, your spouse, most of your friends, your brothers and sisters,
and maybe some of your children. These may be the saddest times of
your life. Death is, however, an experience most of us avoid thinking
about as much as possible. No matter if we believe in an afterlife or
not, almost all of us fear and dread death. No matter if we are
miserable and our condition hopeless, most of us want to postpone
death until the last possible moment. But this isn't always true;
indeed, some of us invite death (see next section). 
Death involves intense emotions. Elisabeth Kubler-Ross (1975), a
psychiatrist, has helped us understand the experience of our own
death. She describes five common stages: (1) shock and denial, "no,
not me," (2) anger, "damn it, why me?", (3) bargaining, "okay, but
first...," (4) depression, "I'll lose so much," and (5) acceptance, "I'm
not happy about it but it's time to go." We have different death-styles:
a few of us realistically accept it, others deny it. Some feel helpless
and just submit, a few seek death to avoid suffering. Some can
serenely transcend death, others defy it and go out fighting
(Bernstein, 1977). Understanding the stages and diversity in death
may help, but the best advice I've heard is Leo Buscaglia's: "live your
life so you won't die alone." 
The clock of life is wound but once,
And no man has the power
To tell just when the hands will stop,
on what day or what hour. 
Now is the only time you have,
So live it with a will.
Don't wait until tomorrow,
The hands may then be still.
-Author unknown
The most painful emotional trauma in life is the death of a loved
one. Our society denies the seriousness of death; we sometimes think
the grieving person should "get over it" and be back at work in a
couple of weeks. The truth is the sadness lasts for years, flaring up on
special occasions and anniversaries. One in six of us lose a parent
before we are eighteen (Bernstein, 1977); such people have a 35%-
40% chance of becoming depressed later in life. At the time of death,
it may be even sadder when the dying person is young and has not
gotten to finish living his/her life. But, in general, the closer we were
to the deceased, the longer the grieving takes. There is a saying,
"When your parent dies, you lose a part of yesterday. When your child
dies, you lose a lot of tomorrow." 
Facing a loved one's death is not only hard; it is complex. St.
Augustine observed that grief is a mixture of sorrow and joy--joy that
one is still alive and had shared one's life with the deceased and
sorrow to have one's life diminished by the loss of the loved one
(Grollman, 1974a). Lots of other feelings may be involved too: shock,
denial of the death or obsessed with it, anger towards others even the
deceased, self-criticism and guilt, abandonment, vulnerability, fatigue,
confusion, embarrassment, difficulty talking to others, fear of going
crazy (things may seem unreal and it isn't uncommon to think one has
seen or heard the deceased), dread of our own death, relief in some
ways, and so on. A grieving person may also have many of the
symptoms of depression mentioned early in this chapter. These
feelings are normal, but they must be "worked through." 
We never really "get over" a death of a loved one. Indeed, about
25% of widows are still seriously depressed one year later. Even with a
good adjustment, it is normal to feel a wave of sadness engulf us
occasionally, e.g. when we see something that belonged to the
deceased or on a holiday. We do get to the point that sadness doesn't
overwhelm us and we carry on with our lives. 
This "working through" of grief takes several weeks for some and
months for others. One has to build a new reality, a new life. Experts
suggest that you start by accepting reality--that the person is dead
and never coming back. Express your grief if you can, avoid drugs,
and avoid "throwing yourself into work," although keeping busy is a
good idea. The Bible says, "Weep with those who weep." This is your
grief work. Share your memories, good and bad. For some, however, it
will be easier to remember and release their feelings alone. Get back
into a routine. Break your ties and dependency on the deceased.
Cultivate new interests. Recognize that time heals. Read some
sensitive and useful books (Rando, 1991; Bernstein, 1977; Grollman,
1974b; LeShan, 1976; Lifton & Olson, 1975; Shepard, 1976; Colgrove,
Bloomfield & McWilliams, 1991). For a comprehensive coverage of
many aspects of grieving, I recommend Fitzgerald (1994). Try to
become active (unemployed widows had more difficulty overcoming
depression than anyone else). 
What kinds of losses are hardest to handle? A sudden, unexpected
death is usually harder to accept than an anticipated death for which
we have had time to prepare. A highly rated recent book by Noel &
Blair (2000), I Wasn't Ready to Say Goodbye, might be especially
helpful in this situation. The death of a person with whom we had an
intense but mixed relationship is often harder to handle, e.g. a loved
one who was both loving and inconsiderate, hurtful, untrustworthy,
selfish, etc. Or, perhaps you feel guilty because you were distant or
unkind to them. In any case, having "unfinished emotional business"
greatly complicates the grieving process. Also, the death of a person
on whom we have enormous dependency is difficult to handle,
especially if that dependency left us without a life of our own and
incompetent to care for ourselves. Lastly, the effectiveness of our
personal support system--family and friends--is an important factor in
recovery from a death. Support for certain losses are likely to be
especially weak: when we live away from family or have few friends;
when the relationship is "secret" or "silent," such as a divorced spouse,
a gay lover, a long-term affair, or a close co-worker; when the loss is
an unborn or a just born baby; when the grief-stricken person is a
child and "protected" from reality (Kleinke, 1991). 
Go get counseling if months later
you are sleeping and eating poorly, socially withdrawn, or feel ill, or
you have shed no tears or can't talk about the deceased, or
you have an undiminishing sense of loss and continuing lack of purpose, or
you are unhappy, think of killing yourself, can't concentrate or work, or
you can't get rid of the resentment or the guilt about the deceased, or
you are very frightened, behaving oddly, or fighting with relatives or friends.
A few cultures accept death as part of life; many defy death by
believing in "everlasting life;" others deny death by refusing to
consider what dying is really like. Nuland (1994) sensitively helps us
realistically confront the many physical processes of dying. On a
spiritual level, enormous effort is invested by our society in convincing
people of an afterlife and that death has great meaning. I hope they
are right but suspect that death simply means it's the end of another
life which was of great importance to the dying person, to his/her
offspring, and, hopefully, to a few other people as well. When a person
permits him/herself to believe that he/she may have only one life to
live (and not eternity), it changes his/her plans. Our society has not
thought that out very well; it's too busy denying and defying. For the
moment, that's apparently the best we can do. Regardless of what we
think happens after death, we should assure that every life ends with
dignity and honor in recognition of a significant life. 
There are many self-help books in this area, even though
research-wise we don't know a lot about coping with death. There are
even self-help books for the dying (White, 1980; Huntley, 1991, for
children), for people trying to understand death (Kramer & Kramer,
1994), for people wanting to die with dignity (Weenolsen, 1996), and
for persons with terminal illness wanting to die quickly (Humphry,
1991). Warning: Some people with depression and no terminal illness
have killed themselves in ways described in the latter book.
Depression can be relieved; no depressed person should kill
themselves without first trying extensive medical and psychological
treatment. Mental Health professionals denounce Humphry's book also
because it seems to neglect the consequences to relatives of a suicide.
There are also books for the survivors (Caplan & Lang, 1995; Stearns,
1993; James & Cherry, 1989; Staudacher,1987), including specifically
widows (Caine, 1990), young children (Palmer, 1994; Goldman, 2000;
Dougy Center Staff, 1999; Johnson & Johnson, 1998; Worden, 1996;
Kroen, 1996; Buscaglia, 1983—age 4-8; Moser, 1998—age 4-8;
Romain, 1999—age 5-10), and adults who lose a parent (LeShan,
1988), and for consoling the survivors (Zunin & Zunin, 1991). The
death of a child is especially hard to handle, so see Donnelly (1982)
and DeFrain, Ernst, Jakub & Taylor (1991). For those struggling with
why God burdened them with a death, read Kushner (1981) who
denies God's omnipotence in order to affirm that God is good and will
help humans find the strength to bear great losses. Grief following a
suicide is also very difficult to handle (see Neff & Pfeffer, 1990). Other
books to aid the grieving are cited above. 
Children and Grief 
I have remembered very few stories for many years, but this one I
have remembered and still cry when I think of it. I have no idea where
I read the story, possibly in Readers Digest. Many people believe that
children don’t know how to relate to a grieving person or how to
handle death. This is sometimes true, sometimes it isn’t. 
Two four-year-old girls, Betsy and Lori, were next-door neighbors
and the best of friends. They loved to play on the sidewalk in front of
their homes. They were careful to avoid the street. But, one hot
summer day, Lori was playing alone and for some reason ran between
the parked cars. She was hit by a car and instantly killed. Of course, it
devastated Lori’s family but everyone on the block, who knew the girls
and had watched them play so well together, was deeply upset. The
neighbors sensed the grief that filled Lori’s house but they didn’t know
what to do, except attend the funeral and express their condolences as
best they could. Betsy’s parents had carefully told her to not bother
Lori’s parents because they were very, very sad right now. 
The day after the accident, Betsy’s parents realized that she wasn’t
in the house, so they went outside and called for her. Soon, she came
out of Lori’s house. Betsy’s parents were irritated that she had gone to
Lori’s house, although both girls were permitted to go into each other’s
house at any time. They asked, “What were you doing at Lori’s
house?” “I was helping Lori’s Mom,” Betsy said. “How could you
possibly help her,” they demanded. “I climbed into her lap and cried
with her,” said Betsy…
Home health care and support groups may be especially helpful
during a time of deteriorating health and grief. For home care, I
recommend Deborah Duda's (1987) Coming Home: A Guide to Dying
at Home with Dignity. For hospice care of adults, write The National
Hospice Organization, 1901 N. Moore St., Suite 901, Arlington, VA or
call 1-800-658-8898 or 1-703-243-5900. Hospice Webb
(http://www.hospiceweb.com/) provides information and helps you
locate services in your area. For hospice care of children, write
Children's Hospice International, 700 Princess St., Alexander, VA
22314 or call 1-703-684-0330. For self-help groups dealing with a loss
of a child, write The Compassionate Friends, P.O. Box 3696, Oak
Brook, IL 60522-3696 or phone 708-990-0010. For groups dealing
with the loss of a spouse, write THEOS, 1301 Clark Building, 717
Liberty Avenue, Pittsburgh, PA 15222-3510 or call 412-571-7779. 
Are you having thoughts of suicide right now?
Are you feeling really down? Do things seem hopeless? Have you
thought of killing yourself as a way out? Do thoughts of suicide keep
bearing on your mind? Have you thought of a specific suicide plan?
Have you started to find some means of carrying out the plan? Have
you tried to kill yourself before? 
If you are not suicidal now, feel free to skip down a page to “A
powerful argument against suicide.” 
If you are answering some of these questions “yes,” your situation
could be serious and I want to get one main message across to you:
Please get help with your problems. Why is that my immediate goal?
First, because some people kill themselves impulsively, taking only a
few minutes between having the idea and acting on it. Please don’t be
one of those people. Second, your answers already indicate difficult
personal/emotional problems. It will probably take time and new
attitudes or skills to solve these problems. So, think seriously about
Considering the possible severity of the problem, there are no good
reasons to avoid such help. Help is almost certainly available! Third,
you are hardly in mental or emotional condition to make life-or-death
decisions. You need help finding other options. Fourth, and most
importantly, suicide is a permanent solution—you can’t take it back—
for what is almost always a temporary problem or situation. Please get
help to develop the best possible solution to the bad situation you are
How can you find a serious, helpful person to talk to you right
away? The answer to that may be a bit complex. 
If your urge to hurt yourself is very strong, possibly deadly, and
pressing now, you really need to contact emergency health care
responders immediately, so call 911. If you are bleeding, sick, or have
taken an overdose of pills, call 911 or have someone take you to the
nearest hospital ER. If you have a gun or other weapon, call 911 or the
police. If you are very confused and unable to concentrate or make
sense when you talk, call 911 or call a local Mental Health Crisis
Service or a Suicide Prevention Center (1-800-SUICIDE or 1-800-999-
9999). The hospital Emergency Room, if they aren’t overwhelmed, will
examine you, let you rest, have a doctor, social worker, or nurse talk
to you about your troubles and about getting continuing help, and
perhaps give you some medicine to temporarily calm you down, if you
want it. Many Community Mental Health Centers provide a 24/7 mobile
crisis service. 
If you are not in immediate physical danger but are feeling really
down and need to have someone to talk to right now in the middle of
the night (or day), call your therapist if you have one or have ever had
one…or call a parent, a relative, a caring friend whom you know will be
responsible…or call a Suicide Prevention Service (1-800-SUICIDE or 1-
800-999-9999). Any of these people will talk to you immediately, help
you calm down, and assist you to make plans for finding the long-term
help you need. Many Suicide Prevention Counselors are only available
by phone but they are familiar with your community resources and the
Community Mental Health Center which has counselors available
during the day. 
If you are not in that much trouble and can wait until tomorrow to
talk about your problems, I’d strongly recommend that you vow right
now to give priority to finding a therapist tomorrow. Don’t deceive
yourself by saying “I’ll just talk to a friend…Maybe I’ll feel better after I
think this through…my Mom will tell me what to do…I don’t need a
therapist; they couldn’t help me anyway.” Considering your answers to
the questions above, you have the kinds of problems that probably can
not be solved quickly and are best dealt with by talking regularly for
several weeks with a professional. Your situation should not become a
burden on a caring friend who does not have the time or the special
knowledge to deal with these particularly difficult problems. I discuss
the importance of finding a therapist in several places in this book. If
you haven’t tried therapy before, the idea can be a little scary at first,
but you will quickly discover how easy and reassuring it is. Therapists
know what they are doing. They care. Getting help is vitally important.
When the situation is very serious, preventing suicide is certainly not a
self-help project! 
As you work your way through your thoughts of suicide and get
help, you will see that it would be very helpful to understand suicide
better, especially the conditions and emotions that lead to depression,
self-criticism, hopelessness, anger, conflicts and disappointments with
others. This entire chapter deals with aspects of depression,
negativity, pessimism, and self-blame, which are closely related to
suicide. Explore the rest of the chapter, even the happiness topics,
when you have finished this section. 
A powerful argument against suicide 
Life can be hell in the distraught mind of a person trying to resolve
the complex, confusing and fierce arguments between the advantages
and disadvantages of living and dying. In a time of unbearably painful
hurt, stress, and misery, one can understand the appeal of quiet,
peaceful oblivion. However, there is a downside to dying. Those
consequences may not be clear to you without careful, objective
thought about the future. Here is one simple study that makes the
point I want every suicidal person to think about: 
A famous study was done of people prevented from jumping off
the Golden Gate Bridge between 1937 and 1971 (Seiden, 1978). The
bridge has been associated with more suicides than probably any other
structure. Between 1937 and 1978, 625 people are known to have
died of suicide there, perhaps another 200 possible deaths may have
occurred unseen at night or in bad weather. Dr. Seiden carefully
followed the 515 “attempters” who were restrained from leaping off
the bridge, and found that 94% were still alive an average of 26
years later or had died from natural causes. The follow up also found
that these persons were slightly but significantly more prone
(compared to the general public) to die violently, i.e., in accidents,
homicides, or suicides, but these deaths were often within 6 months of
the almost terminal experience on the bridge. Two important
points: (1) If a person who feels like killing him/herself can be
stopped, the chances are good that they will live a long and satisfying
life. If you chose to end your life by suicide, you may be overlooking
all the good that might happen in the rest of your life—the good
feelings you would have and the good you could do for others,
including the gift of life to all your possible descendants. Think about
it. (2) Of course suicidal people should be given psychological help
immediately and supported closely and carefully for at least six
months; they shouldn’t be left to handle these strong emotions on
their own. Local Mental Health Centers and health insurance
companies have this responsibility. 
Since the desire to die, no matter how intense at the moment, is
temporary in almost all circumstances, I strongly argue against the
notion that “suicide is a person’s choice at any time.” I believe the
considerate and loving thing to do is to prevent the suicide in any way
possible, to provide optimal psychological help, and to encourage
support and understanding from family, friends, and co-workers. Let’s
all urge the suicidal person to “hold on” and avoid using their fatal final
solution for what is likely to be a temporary problem (Quinnett, 1987,
1992). In no way is this attitude being overly optimistic. It is true that
some people have depression that lasts for years. But the suicidal
person has no way of knowing his/her depression or other problems
will be interminable. The Seiden follow-up study gives hope…therapy
offers hope…medication offers hope…self-help offers
hope…relatives…friends…groups…offer hope. You can get better! 
As a therapist that is the view I need to take. On the other hand,
we can all recognize that death probably ends the intense personal
pain another person is feeling. When that pain becomes unbearable
and lasts…and when there is little or no hope of lessening the pain,
one can understand the desire to die. A helper must listen with
understanding and deep sympathy to their insoluble (to them) plight.
The therapist’s job is to help them find a way out of this dilemma. 
Understanding Suicide
My purpose in this section is to give you some idea of the scope of
the problem and the rates of suicide in different groups and
conditions. Next, I’ll give a brief summary of the many
circumstances, traits, motives, and causes that might contribute to
suicide. Several kinds and types of suicide will be described. Then a
brief review of the efforts and measurement problems associated with
predicting suicide, i.e., finding and accurately using the warning
signs. Finally, we will briefly cover various ideas about how to prevent
or reduce suicides and how therapy can help a suicidal person, as well
as what self-help methods might serve you well. 
As usual, near the end of this section I will link you to several Web
sites and cite many books explaining suicide. Perhaps no other human
act is as shocking, intriguing and mysterious. It is a serious topic that
has been deeply explored by scholars, biographers, and researchers.
The result is lots of information; yet, much is still not known. I will try
to share with you the available advice for depressed people, and also
for their survivors--relatives and friends, and for therapists and suicide
Just as every life is unique, every suicide is different, complexly
caused, and profoundly sad
Somewhere between 10% and 50% of us, at some time, have
thought of killing ourselves. We almost always look back on those
times as being awful experiences but we think dying would have been
a terrible mistake. Yet, more than 30,000 Americans every year
actually act in times of terrible stress and commit suicide, men three
or four times as often as women. Over 200,000 in the US attempt to
kill themselves each year, women three times as often as men. Men
tend to use guns; women use drugs (70% of the time prescription
drugs). Suicide occurs more among college students than among non-
students, more among divorced than married, and more among
physicians, lawyers, and dentists than other professionals. 
The risk of suicide increases from ages 15 to 25. Also, amazing
as it seems, the suicide rate in that age range has tripled in the last 30
years. We don’t know exactly why. Today, only accidents and homicide
kill more than suicide in these ages. A 1991 U.S. Center for Disease
Control survey of high school students showed that 34% of girls and
21% of boys have considered suicide. Actually, during 2001, CDC
found that 28% of high schoolers had felt sad or hopeless for a two
week period, about16% had made a "specific plan," and 8% "had tried
suicide," resulting in 2% of them requiring medical assistance! That is
For teenagers their social environment can arouse intense
emotions. If a 14-year-old girl has very few friends and/or feels
socially rejected, she is twice as likely to have suicidal thoughts. It is
also distressing to girls if their friends don’t get along. That doesn’t
seem to be nearly as true for boys; keeping the same close friends
may not be as crucial to boys. Most boys can blow off conflicts among
their friends; they are less bothered if a buddy gets mad, doesn’t like
them, or disagrees with them. Girls need to be accepted by friends and
to keep the group together (Moody & Bearman, 2004). So, girls who
are alone or in the midst of emotional distress among friends may
need help. 
A safety net is needed. Teens of both genders have twice as many
suicidal thoughts if they have known a friend or relative who has killed
him/herself. Suicidal thoughts are also much more likely if they have
homosexual feelings. Being sexually assaulted doubles the suicidal
thoughts, at least for girls. Depressed adolescents using alcohol and
drugs are 30% more likely to attempt suicide than nonusers (25% of
the suicide attempters had made multiple attempts), and the
attempters reported much more loneliness, alienation, rejection, and
punishment during childhood. It is interesting that less than 1% of
young people, who attempted suicide, called a suicide "hotline," one
third of their parents never found out they made an attempt, and
almost two thirds lived in a home where a gun or other lethal means
was still available after attempting to kill themselves (Berman, 1990).
Wow! Lots of accidents waiting to happen. How foolish can we parents
be? At least lock up the guns securely. 
The rate of suicide is also high in the elderly (Leenaars, et al,
1992). Of course, deciding how to deal with a painful, discouraging
experience is strongly influenced by whether you potentially have 50-
60 years to live or only 2-5. Our society is gradually re-thinking the
morality of suicide (“calculated departure” or "dying with dignity")
when one is suffering near the end of life with little realistic
expectation of future happiness or usefulness. That seems acceptable,
maybe even healthy to me (See Quill, 1993). But where there is any
hope, including through the use of therapy, medication, and strong
pain-killers, suicide is just not a good option. At least, one should give
talking treatment and drugs a try. 
A major problem among the elderly is that depression is
overlooked or neglected by the primary care physicians and families.
Maybe old folks are expected to be unhappy; maybe doctors don’t ask
and they don’t tell; maybe general physicians don’t know how to ask
or test for depression. Anyway, their sadness, lack of interest, and
discouragement don’t get treated correctly. A recent study reported in
the March 3, 2004 issue of Journal of the American Medical Association
took an innovative approach. Randomly older patients considered
depressed were assigned to “routine care” or to a “special
intervention” which involved a MA level “depression-care manager,”
and either SSRI medication or, if they didn’t want to take pills,
psychotherapy by the care manager. Their feelings of depression and
frequency of suicidal thoughts were measured at 4 and at 8 months.
Results: Psychotherapy provided the fastest and the most effective
treatment of depression and suicidal thoughts. At 8 months, 70% of
the elderly who had started with major depression and thoughts of
suicide had lost those thoughts, compared to 44% of the “usual care”
patients. The massive use of antidepressants in GP’s offices may
eventually drag psychologists and social workers into the general
health care process. 
Almost 80% of all suicidal persons have been depressed for weeks
and, of those, 65% to 80% have "cried for help." Many have gone to
see their family physician; others have hinted to friends. Most have
mixed feelings about killing themselves. They certainly want to be less
miserable. They definitely want a solution, but at the moment, they
can't think of any other way out. Only an estimated 5% to 20% of
attempters definitely or completely intend to die; yet, many are willing
to run the risk of death. They sometimes yearn to be rescued and for
life to get better. I once had a deeply depressed patient who took drug
overdoses three or four different times but always just before our
appointments, partly, I think, to see if I would save her. These cries
for help are usually telling others they are terribly upset and hurting,
that they need help, care and love. If you hear such cries (comments,
hints, questions, and jokes included), take it very seriously, listen and
show your concern, urge him/her to get professional help immediately.
You don't have to solve all their problems; just a little help--a little
relief from the pain--may save a life (Shneidman, 1985). 
Suicide may result from an almost infinite number of causes and
A therapist may find some of these mental conditions and
situations related to suicide: 1. Intolerable life situations: Life
seems a total mess, faced with terrible losses or catastrophes, feeling
overwhelming guilt or shame, having untreatable and terminal illness,
or suffering a momentary loss of reason in an overly-emotional or
intoxicated state. 2. Existential reasoning: “It is better to die than
to live in prison or in such miserable conditions,” “People hate or
despise me, I can’t stand it,” or “I’m on the edge of killing myself, so
why not take a chance (like going over Niagara Falls) and see if some
good things might happen,” “Maybe they would treat me better if I
tried to kill myself.” 3. Characterological factors: An impulsive,
highly emotional, high risk-taking personality, an immature person
with mood swings and a history of poor and violent interpersonal
relations. These actions may look unintentional or almost accidental,
such as the person who thinks “I will not jump if just one person
smiles at me as I walk to the bridge.” 4. Cognitive causes (without
psychosis): Some suicides seem intended to change things, including
to reduce their pain and misery or to inflict self-punishment on
themselves or to hurt, punish, and defeat someone else. Suicides may
be an effort to resolve a conflict, to make a choice, or to force a
change on others. Often ongoing hopeless despondency is filled with
urges to self-injure, especially if the self-destructive thoughts are
mixed with angry and destructive impulses directed towards others. 5.
Serious psychotic illness: Persons with major depression, bipolar
disorder, paranoid schizophrenia and other psychoses get out of
contact with reality and rarely but sometimes make irrational decisions
that can result in death or suicide. Major depression and bipolar
disorders have high levels of suicidal ideation. About 10% to 12% of
persons suffering schizophrenia also have suicidal thoughts and it is
estimated that 25% to 50% of that 10-12% attempt suicide within the
first one or two years of being struck by their highly destructive
An early and prolific researcher of suicide, E. S. Shneidman
(1968), preferred to think of three types: (1) The results of thoughts,
e.g., for a social-political-religious cause, because of chronic physical
pain, because of inner turmoil and mental illness. Examples: When the
Christian church was young, many poor and deprived believers killed
themselves to pass quickly into heaven. The church fathers' solution
1500 years ago was to make suicide a sin. Cause of depression #9
above, anger turned inward, is another example of this type, but
among suicides only 25% were known to be negative towards
themselves (Sue, Sue, & Sue, 1981). (2) The results of interpersonal
conflict. Self-destruction can be a way to strike back and cause guilt; it
can be for some the only way to express their anger. Often these
people need help in handling relationships; they need social-
communication skills and better decision-making. For example, one
study reported that 30% of all adolescent suicides were gay, lesbian,
or bisexual youth. Our culture had, I assume, made them feel
different, abnormal, and guilty or resentful of homophobia. (3) The
results of "dropping out" of life and feeling alienated, isolated, and
futile. These people might need a meaningful purpose (which is usually
possible to find--see chapter 3). Obviously, there are many ways to
get to suicide as an end. If one really wants to explore in depth the
possible causes, refer to David Lester (1997), who cites a lot of
research, or even better, if one is concerned about bipolar disorders
and wants some sound advice, see Kay Redfield Jamison (2000). 
Other researchers describe two other basic kinds of suicide: direct,
quick self-destruction and indirect, slow self-destruction. The first is
when someone shoots him/herself or runs a car into a tree. The
second is when someone self-destructs by being accident prone,
refusing to get or follow treatment, abusing drugs or food, abusing
his/her body, risking getting AIDS, etc. Most of these people deny they
are killing themselves, and I agree that many factors other than death
wishes are involved in over-eating, driving recklessly, neglecting to
use a condom, etc. Unfortunately, some people even believe the
ancient Arabian idea that destruction or death is necessary before re-
building or getting a new life at a higher level. 
Two more views of suicide
There are many explanations of suicide: some erudite psychosocial
speculation of the clergy and psychologists and some puzzled wonderings by
grieving friends and family. I’ll share with you a sample of the wisdom of
both. Both convey many insights.
First sample: In his reflection about the causes of the deaths by suicide of
two friends on the same day in Ireland, Dr Sean Brady, the Archbishop of
Armagh, singles out the "twin afflictions" of (1) despair and (2) presumption
as the "enemy of hope". Despair because it eats away at hope, and
presumption because it involves a sense of entitlement to wealth and status
that encourages selfishness. 
The Archbishop writes: "Essentially despair derives from a loss of hope. This
despair is often accompanied by a crippling fear; a fear of the present and a
blindness to the future. A sign of this fear is an inner emptiness which
consumes and debilitates and manifests itself in destructive ways which would
include the inability to make life-long commitments and to face long-term
responsibilities. This in turn often results in a frantic attempt to escape
pressing reality within an aggressive pursuit of pleasure, which temporarily
distracts, but inevitably disappoints and further exacerbates an already
precarious situation." 
Presumption, he writes, is the other contemporary temptation against hope:
"What is alarming though, in a society focused on material gain, is the
accompanying over-confidence that wealth and status can bring with regard
to the apparent certainty and comfort of one's own position. This
disengagement from the reality of the plight of others can anaesthetize the
conscience, creating an institutionalized self-centeredness and selfishness,
which are sometimes unquestioningly promoted on principle, pushing
individualism to new extremes." © Irish Independent
The second example of trying to understand suicide is very different. On
January 1, 2005, the LA Times writers, Rubin & Murillo, describe some of the
events that preceded the suicide of a 15-year-old girl from a working-class
family who had had many conflicts, especially between Velia and her mother.
For quite some time, Velia felt no one liked her. She thought “friends” were
rejecting and telling stories about her. That sounds very simple but the
history is quite complex and a jumble of strong, disruptive emotions that are
hard to understand. It is true that she had clearly been bullied but she was no
mousey doormat. At times she was angry, mean, picking fights with others
and threatened teachers, and getting suspended from school several times.
Other girls jumped her after school. She was not a good student, missing
school often. Her siblings had their own troubles with the law. Her mood
changed quickly and often, being sweet and then bitter. 
There were plenty of reasons to believe that there was boiling turmoil inside
Velia. But few tried to help. Her mother tried but it often led quickly to a
verbal or even a physical fight. Anger management class didn’t help (it is
known that 60% of suicidal teens are violent toward others). She revealed to
a teacher a note about suicide but when informed her mother said “she
wouldn’t do that” and the father didn’t believe suicide was possible either.
However, she was hospitalized for 10 days or so. School Counselors seeing
her thought she had many psychological problems. Other girls continued to
reject her and some challenged her to fight. Then a new boyfriend killed
himself. A sister tried to get a suicide counselor at the school to see Velia. But
she died first. It is fairly common, as in this case, that intense problems set
the stage for suicide. Others who kill themselves are quiet, perhaps
withdrawn, and show few signs of having emotional problems or of being
Barriers to getting treatment
You may be surprised in the next several pages to read how often
suicide occurs, how often it is attempted, and how often it is thought
about. In the course of living, the frequency of suicide may not seem
high to you because many suicides are not publicly reported. Unless a
well known person is involved or the suicide is dramatic, many deaths
by this means are overlooked, covered up, or attributed to “unknown”
or other causes and many attempts are simply described as
“accidents.” The news media concentrates on the police reports of
homicides and violence or on fire reports so we are impressed with
these causes of death. The media frequently do not report suicides, so
it looks like there are fewer suicides than homicides (not true).
Actually, suicide is the leading cause worldwide of death by violent
means. It is more common than murder and dying in war combined.
Of course, most people just don’t talk about their suicidal thoughts. In
uneducated circles, suicidal thoughts are sometimes felt to be weird,
crazy ideas. Sort of a sick thing to do. Moreover, families are held
responsible by many people for not preventing this terrible behavior,
thus creating even more social stress and feelings of shame for the
Why do so many depressed people avoid getting help to deal with
their suicidal thoughts? Why don’t more people admit how sad they
are feeling to friends and loved ones? Why don’t more sad people get
anti-depressive medicine and/or seek therapy? In large measure the
answer seems to be because of the huge social stigma against suicide
(and/or against being mentally ill). In many cultures suicide is
considered such a dark, aberrant, or unnatural act that religions may
actually consider it a sin and, not too long ago, there were laws
against suicide and attempted suicide. Even today laws harshly punish
helping a loved one to die voluntarily, no matter how understandable it
might be. Dr. Kevorkian still serves his 25 year sentence for helping a
very sick patient who wanted to die. Our country until very recently
would not honor our soldiers by putting their names on the Vietnam
Memorial if they had killed themselves months or years later, even
when they fought and were awarded for bravery in Vietnam, had been
captured and tortured for several years, and then were shipped home
still traumatized and without treatment. It is as if, for the military,
suicide wipes out all of the good you have ever done. If the pain one
feels is emotional or psychological, then society seems to feel it's your
fault. (There may still be several Vietnam veterans deprived of the
recognition of having their name put on the wall.) 
It is this strong cultural disapproval and negative attitude about
suicide (blame-the-victim-ideas?) that result in people feeling too
ashamed to admit their psychological pain and ask for psychological
help. People with breast, colon, or prostate cancer might prefer to not
tell a lot of people about their health problem but it wouldn’t be
because they feel personally responsible for the condition and
personally shamed by it. Ironically, the wide-spread negative
emotional reactions to the idea of suicide may contribute to more
deaths by suicide, because fewer people seek treatment. Our cultural
attitudes need to be changed, not to the point that suicide is accepted
but to the point that treatment is accepted. Suicide involves intense
unhappiness and distress, feelings that deserve our sympathy.
Hopeless and self-destructive thoughts are not shameful but conditions
to be gently challenged and corrected, while we keep the person safe.
Every one of us, including people as young as junior high, must learn
to hear “cries (or hints) for help” and respond to them by, first,
recognizing there are intense emotional troubles in the person’s life
and, then, helping them find help. 
If you are feeling very down on yourself and thinking it might be
better if you just didn’t exist at all, your self-destructive thoughts need
to be expressed clearly to anyone who will listen. Don’t just hint that
you are sort of depressed or “feeling a little down.” Many people, even
though they are listening, will deny or distort those hints. Or they may
immediately try to reassure you that “you will feel better tomorrow,” “I
felt that way last year,” “as soon as you make up with her/him, it will
be all right again,” which you know isn’t true. Such comments are
trying to help, but they cut off further discussion of your painful
distress. You need to be very blunt; keep saying “I am terribly
depressed, things seem awful,” “I feel like ending it all,” “I really need
help,” and “Please help me keep from killing myself, I don’t want to
die,” until a parent, a doctor, a counselor, a friend, or someone hears
you clearly and will boldly help you. Your next step should be to seek a
“professional friend,” perhaps at school or through your health
insurance or your family doctor or a therapist at the local Community
Mental Health Center. Remember that over 50% of young people who
try to kill themselves do not get any professional help—not even after
their attempt. That is disgraceful. As a society we must change…be
more sympathetic, even or especially towards loners, jerks, and weird
people. They may need help the most. Getting professional help is
crucial. However, sometimes even the professionals drop the ball. So,
be sure the doctors do their jobs, too. 
In one study, 43,000 patients admitted frequent thoughts of
suicide on a Pre-intake Questionnaire. However, 57% of the
professionals who read the intake records missed or disregarded the
patient’s reports of suicidal thoughts and concluded there was “no
suicidal ideation.” Over half the time clinicians missed blatant “warning
signs.” This may be another reason so many depressed people do not
get treatment. Many general practitioners do not recommend needed
psychiatric or psychological treatment. You do not need a doctor’s
referral to go see a psychiatrist or a psychologist (you do need a way
to pay for it or go to the Community Mental Health Center). So, again,
the patient will benefit from knowing what is recommended treatment.
This study was done by G. S. Brown and E. R. Jones for the PacifiCare
Behavioral Health organization and reported in Crisis (May, 2003), a
journal of crisis intervention and suicide prevention. 
Of course, getting help from supportive and caring friends is very
important too but, please, do not stop there. They surely are
wonderful friends to listen and help but they are not trained therapists.
Be especially careful to not latch on to a sympathetic friend for all the
help you need. Helping a suicidal friend can be a terrible burden,
especially if you are the only one they tell their troubles to. It could
continue to be an enormous psychological load, perhaps for life, if the
friend you are trying to help dies, in effect, in your care. Please don’t
turn this comment, if you are the helper, into an argument for
avoiding helping a needy person or, if you are the helpee, for dealing
with your pain all by yourself. You need the best psychological help
you can get, including an evaluation for medication. You almost
certainly need therapy in addition to medication. You also need good
friends and a caring family. 
Within our culture, we should make it top priority for everyone to
seek expert help, when it is needed, with all kinds of mental health
problems, not just suicidal depression. It is an unforgivable tragedy
that an educated society lets so many people with suicidal thoughts
avoid careful treatment—remember 30,000 die every year. Over 50%
are untreated. We couldn’t stop all the deaths but we could prevent
many. Perhaps the emotional or stigma-generated barriers to getting
help could be reduced (a) by providing many public services
announcements openly urging depressed and disheartened people to
seek effective professional help, (b) by documenting to the public the
research showing that various treatment programs truly help people
recover from serious depression as well as interpersonal problems and
mental illness, (c) by helping the average person realize that there are
likely to be complex physical, biochemical, psychological, situational,
and genetic causes of depression and suicide which he/she is not
totally responsible for, (d) by helping people realize that good parents
and healthy families have suicides and mental illness; having
emotional problems doesn’t mean the family is sick (although it may
be), (e) by making it clear that suicidal feelings and urges, as well as
angry reactions, are usually caused by temporary conditions that will
eventually change, and (f) by funding the study and treatment of this
terrible condition that costs us so much in so many ways. Compare the
huge amount of research devoted to cancer and heart disease with the
limited funds for studying suicide prevention, especially in adults. We
just let depressed and suicidal patients go untreated. Would we just let
heart disease or cancer patients go untreated? Although I focus on
self-help, I urgently want to persuade a deeply sad person to take the
reasonable step of seeking help. You have to live before you can build
a better life through self-help. 
Rate of suicide by special groups 
between 15% and 20% of students reported seriously thinking about
attempting suicide in the year before they were interviewed. That is 1
out of every 5 or 6 students! When asked if they had made specific
plans, about 15% said yes. Surveys show that 8% to 10% of students
had actually attempted suicide sometime during the last year, with
over 2% of them needing medical care. A total of approximately
500,000 people in the US are taken every year to an ER following
suicide attempts. There are about 25 attempts for every death by
One American kills him/herself every 18 minutes, totaling about
30,000 per year. The US death rate is 11.4 people per 100,000. That
figure has remained fairly stable year after year. In one year,
approximately 765,000 Americans will attempt to kill themselves (they
don’t all go to ER). That is a lot of misery. World-wide 815,000 people
chose suicide in 2000. The World Health Organization (WHO) estimates
that every year one in every 60 people has a loved one or friend die
via suicide. 
These huge numbers, however, are hard for most of us to mentally
grasp and to understand the scope of the problem. Another way to
think of it is to compare suicide with other forms of violent deaths.
According to the World Health Organization (Oct., 2002), as mentioned
in the discussion of stigma, there are as many or more suicides than
the total of all other “violent deaths” reported on the local news,
including homicides, lethal domestic and child abuse, and casualties of
war. Every day you can, in this way, estimate how many suicides
occurred that day but were not reported. Note: while the social stigma
keeps people from admitting their suicidal thoughts and getting
treatment, the fewer reports of suicide in the news has a helpful
aspect, since a higher rate of reporting suicides results in an estimated
10% increase in the local frequency of suicide. Also, when the news
stories are long or make a front page or lead story, and when the
stories are dramatized or described in a gory way, or romanticized
(Romeo & Juliet), or the situation is glorified, the result is more
(http://www.afsp.org/) (2001), Reporting on suicide:
Recommendations for the Media. 
Serious depression and suicide in children and teens
The commonness of depression in adults has been cited before—
about 12% of women and 7% of men in America struggle with
depression sometime during each year. We are getting a clearer view
of how many young people also feel seriously depressed—about 2.5%
of children and 8.3% (3 million!) of adolescents. The CDC 2001 survey
also found that 28% of students had felt so sad or hopeless almost
every day for two weeks in a row during the year that they stopped
doing some of their usual activities. As a society, we are often
unaware of or deny sadness in young people; we don’t see the signs.
Many parents don’t even think children can have mental illness or be
depressed; thus, another reason they don’t get treatment. However,
when a child or teenager kills him/herself, which 5000 do every year in
the US, they suddenly get our attention. Only auto accidents and
homicides kill more teenagers. More than 1000 young people in the US
attempt to take their lives every day. WOW! Did you realize that? This
is a very serious problem. Schools have given suicide some attention,
but we need a national movement to increase our early recognition of
hurting youth. As mentioned before, adolescents and children need to
be taught and encouraged to tell friends, family, teachers,
professionals, etc. that they are feeling down. And every teenager
needs to be taught to take very seriously all disclosures of suicide
intent; they need to be taught what to say and do when a friend hints
that they are thinking about harming themselves. This is serious
The suicide rate for teens has increased three fold since 1960. This
seems to be in spite of many more Suicide Prevention efforts in
schools, more Community Mental Health resources available, better
Mental Health coverage in the media and in schools, and supposedly
more general psychological sophistication. What is going wrong here?
For one thing, most people who kill themselves are suffering or, more
likely, have suffered for many years from depression or some other
mental illness. The rising suicide statistics may be an indictment of the
entire Mental Health system in our country. Community Centers are
not well funded, focus more on chronic psychosis and not on youth or
young families, and they are not adequately staffed to treat all the
emotional problems in millions of families without health insurance.
The Community Mental Health Services were a great idea in the 1960’s
but the clinics have not been evaluated and supported. Mostly they
were turned into crisis centers for the poor and the chronically
mentally ill. Consequently, the Mental Health Centers have for several
years not been appealing to the middle class, the youth, or the elderly. 
Rate of suicide by special groups
One way to find out the circumstances that lead to suicide is to
investigate the backgrounds of adolescents and young people who
attempt suicide. This has been done (Johnson, et al, 2002). The
history of people who have attempted suicide often includes abusive
parenting and poor child-rearing conditions early in life (young
mothers, poor living conditions, belligerent behavior or trouble-making
in school) and difficulty getting along socially later in life. A mindful
society should consider serious interpersonal problems in childhood or
early teens as signals that this young person needs help with
emotional control, communication skills, and should be followed up for
antisocial behavior, psychological problems, and self-harm in the later
teens or twenties. 
A family history of suicide attempts is an ominous sign. The rate of
suicide is twice as high in families with such a history as in families
who have had no suicides (Runeson and Asberg, 2003). Combining
several studies of twins, adopted children, and controls, there is
evidence that suicidal tendencies may be genetically transmitted (Qin,
2003). A study of 21,168 suicides in Denmark also finds that mental
illness and substance abuse in the family are factors associated with a
risk of suicide (Qin, 2003). Overall, Qin interprets the data to mean
that several family genes, as well as environmental factors, may affect
the traits of aggressiveness and impulsiveness which are associated
with suicide. How much influence does the family history and genes
have on the risk of suicide? Experts estimate that 10% to 13% of
suicides would be prevented if suicidal death and psychiatric illness in
the family could have been avoided (by better mental health care). So,
while your family history is a factor, don’t make too much out of it;
having a psychotic relative or a suicidal one does not mean you are
doomed to an awful future. A bad family history simply means that
early in life your family and you should routinely and seriously
evaluate your emotional/psychological condition and get professional
help to stay as psychologically healthy as you possibly can. 
It has also been found that psychiatric patients who have both
serious psychiatric disorders, such as depression or bipolar disorder,
and significant personality disorders, such as passive-aggression or
narcissism, made more suicidal attempts than patients with only one
diagnosis. These dual diagnoses are called “comorbid diagnoses” and
are, in general, associated with more depression, more aggression,
more impulsiveness, lower self-esteem, poorer problem-solving skills,
feeling less loved by their families, and having had more parental
suicidal behavior (Hawton, K. et al, 2003). 
Interesting findings about suicide
1. 29,350 Americans died by suicide in 2000. That is 1.7 times as
many as homicides. 
2. Four times (some say 3 times) as many males as females die
from suicide. Females attempt suicide more than males but use less
lethal methods. 
3. Divorced and widowed men and women have a suicide rate
twice as high as married men or women. 
4. Western states, where there are more guns, have more suicides. 
5. Teens & young adults, middle-aged men, and elderly men have
the highest rates. The above data is mostly from Suicide in the United
States (http://www.cdc.gov/ncipc/factsheets/suifacts.htm).
6. About 3,000,000 American youth ages 12 to 17 contemplated
suicide in 2000, over a million of them (37%) actually tried (SAMHSA,
2002). Only one-third sought counseling. 
7. Over 10% of all young women have tried to kill themselves.
40% of suicidal Canadian girls reported conflicts with parents about
gender roles, such as rules about dating and future plans (Pinhas,
2002). White women commit suicide at three times the rate of Black
8. What group in the US has the highest rates of suicide? Some
studies say white males over 65. The rate for white women over 65 is
much lower. Having a gun in the house doubles the suicide rate and
71% of suicides at this older age involved a handgun (Conwell, 2002).
On the other hand, the Center for Disease Control and Prevention
reported in 2000 that men between 25 and 54 had the highest suicide
rate. Both groups (men over 65 and men 25 to 54) have very high
rates and neither has received much attention or prevention services. 
9. 12% of urban gay or bisexual males have attempted suicide,
which is 3 times the overall rate for males. Early suicidal attempts are
often related to “coming out.” 28% of older gays and 52% of younger
homosexuals report being harassed. 
10. Suicidal persons often report being self-blaming and in an
unbearable mental state before acting but the actual suicide action
may seem like a trance, feeling numb and no pain as they cut, and
essentially dissociating themselves from the process (Baumeister,
1990). 25% of “almost lethal” suicide attempters spent less than 5
minutes making the decision to act…5% of the quick decision-makers
reportedly took one second between decision and attempt (Simon,
2003). That is scary. 
11. One large study found that psychotropics, anti-depressives,
anti-OCD, and other medications did not lower suicide rates more than
placebos (Dr. Khan, 2002). However, other researchers have claimed
that anti-depressives are helpful. So, try medication but realize it isn’t
a sure cure. 
12. Many people believe the peak rate of suicide is during holidays,
such as Christmas and New Years, but fewer people kill themselves at
those times. Also, fewer people decide to suicide when a national
disaster strikes, like 9/11, perhaps because people support each other
when trauma strikes and attention is directed outside ourselves. 
13. A commonly cited statistic is that a suicide causes six loved
ones to suffer intense grief. More recent research suggests that more
like 20-25 people are affected by a suicide and they often need help
(Preventing Suicide, October, 2003). They feel guilt, shame, lack of
support, and rejection by others. See the later section on treatment as
well as Compassionate Friends (http://www.tcf.org.uk/) and
Bereaved by Suicide (http://sobs.admin.care4free.net/).
14. Children of “attempters” are six times more likely to attempt
suicide than children of nonattempters, especially if the mother had a
mood disorder and was sexually abused, and also if the offspring is a
female who has had a mood disorder, drug abuse, impulsiveness,
anger, and/or sexual abuse (Brent, et al, 2002). 
15. The American Foundation for Suicide Prevention (2001)
estimates that 90% (others say 30-50%) of suicide victims have
significant mental illness, often major depression with such symptoms
as insomnia, fatigue, poor appetite, poor concentration, impulsivity,
anger, high risk-taking, or addictions. About one in five depressed
patients attempt suicide. 
16. Anorexia Nervosa and Binge-Purge subtypes have reportedly
been found by some researchers to be over 50 times more likely to
attempt suicide than similar women without an eating disorder (Dr.
Debra L. Franko, Northwestern University, Bouve College of Health
Sciences). Also, binge drinking is associated with a higher risk of
suicide, according to Dr. Michael Windle (windle@uab.edu) in
Alcoholism: Clinical and Experimental Research (May, 2004). Perhaps
this isn’t surprising since some people try to use alcohol to cope with
17. Three studies have found that women who have had cosmetic
breast implants are three times more likely to attempt suicide than
similar women who have not had an implant (Dr. Joseph K.
McLaughlin, Annals of Plastic Surgery). The reason is unknown but
some speculation focuses on the personality makeup of women who
seek implants. 
18. People who have once attempted suicide may remain a
somewhat higher risk for the rest of their lives (Dr. Gary Jenkins [Nov.
16, 2002], British Medical Journal). Also, a Helsinki group of physicians
came to a similar conclusion after following 100 parasuicides (self-
poisoning) for 37 years (Suominen, et al, 2004). This is in line with
believing that previous attempts are a sign of high risk but it seems to
contradict the Sieden (1978) study cited above in “a powerful
argument against suicide.” The risk declines with time. 
19. Among 15-year-olds who have attempted suicide at that age,
more than twice as many of them (compared to non-suicidal 15-year-
olds) had consulted their family physician during the year. Some of
their concerns were about physical health, like upper respiratory
illness, but many had mental health problems. 
20. A WARNING: There are Web sites, perhaps several of them,
that present the view that suicide should be an individual’s choice to
be accepted by others. Some have described their sites as “sanctuaries
where people can discuss suicide in an atmosphere that is not
condemnatory.” Some of these sites allegedly provide directions for
committing suicide and it is known that online chat groups have
“egged” a person on and then watched them, via a camera, die. It is
not known how many deaths are encouraged by such sites. Yet, it is
something for the depressed and their families to be aware of.
Certainly, a person deeply into suicidal thoughts should not be
exposing themselves to morbid, dangerous, and possibly disordered
thinking of an unknown and unprofessional person on the Internet. 
21. Several studies have tried to determine what percentage of the
general population has had suicidal thoughts. The results have ranged
from 5% to 50% of us. One study by a careful Australian researcher
(Goldney, 2000) estimated that 17.5% of 15 to 24-year-old women
and 20.2% of men the same age had some suicidal thoughts. With so
many people having suicidal thoughts, while the act is quite rare, that
means that only one person actually died of suicide out of every 612
who had thought about it. That is why clinicians ask questions, use
tests, and gather additional information to estimate the risks—
questions like: Have you made plans? Have you thought of or
prepared a way or a means? How soon will you do it? Have you told
others? Thinking or talking a little about killing yourself doesn’t mean
you are going to do it nor that you are not going to do it. One always
has to be on guard. 
22. You might think that Ph. D.-level therapists would seldom get
depressed or think of suicide. However, out of 800 psychologists
surveyed, 84% had been in therapy, 61% with serious depression,
29% reported having had suicidal feelings, and 4% attempted it (Pope
& Tabachnick, 2004). Some might think these data mean that these
depressed therapists are poorly prepared to help others. I would
suggest that the life experience of having had depression and
overcoming it might improve their understanding, sympathy, and skills
as therapists. 
23. There are many myths or false ideas about suicide. Examples:
(a) “People who talk about it never do it” or “People who really want to
die never tell anyone.” In fact, 80% have given verbal signals. (b)
“Anyone who tries to kill him/herself intends to die.” In fact, many