Commonsense beliefs about depression and antidepressive behaviour: A study of social consensus

Behav

Res. & Therap).

1977. Vol. 15. pp. 465473.

Pergamon

Press.

Printed

m Great

Britam

COMMONSENSE BELIEFS ABOUT DEPRESSION AND ANTIDEPRESSIVE BEHAVIOUR: A STUDY OF SOCIAL CONSENSUS VICKY RIPPERE Department of Psychology, Institute of Psychiatry, London S.E. 5, U.K (Received ???)

Summary-The present study examines consensus in endorsed beliefs about depression and antidepressive behaviour in a group of 100 psychologists. Ss were given 20 pairs of items and asked to indicate which member of each pair they felt was ‘nearer the truth’. The numbers (and percentages) of Ss choosing each item was examined for each pair. Consensus was found to span the range from 100% agreement to near-complete disagreement and to be distributed roughly normally within the sample of items. People tended to agree about propositions that could be verified by an individual’s own firsthand experience and observation and to disagree about more abstract matters that the ‘experts’ are still debating. The congruence of these findings with previous results in the present series of studies is discussed and suggestions for further exploration in the realm of ‘what everybody knows’ about depression and how to deal with it are given.

Although psychologists and psychiatrists have recently begun to show an interest in cognitive aspects of depression, most work has stopped short at what might be termed generic psychopathology, e.g. the typical, ‘symptomatic’, cognitions of the class of depressed people, usually psychiatric patients. Researchers typically attempt to characterize, with varying degrees of abstraction, typical depressive cognitions. Thus depressed people have been variously described as having a ‘negative cognitive set’ consisting in ‘a pessimism specific to the effects of one’s own skilled actions’ (Seligman, 1975), a ‘cognitive triad’ comprising ‘a negative conception of the self, a negative interpretation of life’s experiences, and a nihilistic view of the future’ (Beck, 1971), and a ‘belief that available plans of action can no longer achieve established goals’ (Melges and Bowlby, 1969). While such efforts to explore this clinically familiar but empirically poorly-charted area may ultimately prove helpful in providing a basis for systematic approaches to cognitive behaviour modification, there are a number of reasons to doubt whether even an exhaustively detailed map of the gloomy ways in which depressed folk typically think will yield fully adequate guidelines for helping them out of the Slough of Despond. Such a map is likely to be insufficient because it will cover only a very limited part of the relevant terrain, We need to consider some of the things that are being left out : 1. First of all there is the fact that, besides simply thinking their gloomy thoughts, depressed people (like non-depressed people and unlike rats, dogs and other laboratory animals which frequently serve as subjects in depression research) may reflect upon their thinking. That is, over and above their first-order gloomy thoughts (henceforth ‘primary gloomy thoughts’), they may also think second and higher-order thoughts about the first-order thoughts they have had, as when someone stops himself and mutters, ‘What a morbid idea; I’ve been having a lot of them lately’. Moreover, people’s overt behaviour may be as much mediated by their second and higher-order as by their first-order cognitions. Thus it is not simply because a person thinks, for example, ‘Nothing means anything; I can’t go on any more’, that he presents himself to a member of one of the helping professions. Rather, he thinks his typical primary gloomy thought, reflects upon it, categorizes it generally as problematical and specifically as belonging to a frame of mind which, in our culture, is regarded as an appropriate matter for professional consultation, decides whether or not it is worth 465

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getting seen to, and then makes the necessary arrangements. His eventual presence on the other side of the consulting desk is not simply a fact given in nature but the outcome of a complex sequence of rule-following behaviour. We risk drastically oversimplifying our own cognitive representation of what is going on if we neglect to think how the prospective patient got there, which we effectively do if we focus exclusively on the primary gloomy thoughts that he may then reveal. For a complete picture, therefore, the higher-order thinking which accompanies primary gloomy thoughts needs to be examined as fully as the first-order depressive cognitions. 2. Secondly, as this example suggests, depressed people (again like non-depressed people) do not just think; they act upon their thinking. Consulting a professional is one possible behavioural outcome of reflection upon a primary gloomy thought; other possible outcomes are conceivable-not to mention more probable. But that is another matter. The point that needs to be made here is that the repertoire of behaviours to which a person’s primary gloomy thoughts may lead him, and the network of cognitions and meta-cognitions which are in turn associated with these behaviours, may be as important clinically as the primary gloomy thoughts themselves. Thus, for example, two depressed people may think gloomily to themselves, ‘I can’t stand it any more; I wish I were dead’, and the one may add, ‘so I’d better go find something to do to take my mind off it or 1’11really crack up’, whilst the other may say, ‘so to hell with everything’, and take another overdose. The clinician will have no difficulty in recognising that it is not the primary gloomy thought per se but the individual’s typical way of reacting to it that individuates him, not to mention the problems in clinical management that he poses. Thus people’s repertoires of behavioural reactions to their depressive cognitions also need to be included in any comprehensive inventory of the cognitive aspects of depression. 3. Finally, because people’s repertoires of depression-relevant cognitions, metacognitions, and behaviours are largely mediated to them in the course of their development by other members of their society, any fully adequate account of cognitive aspects of depression should not exclude the prevailing cultural and social matrix of beliefs and belief systems regarding depression and how to deal with it. It is this matrix of belief systems which provides the problem area for the present study. The problem is not so much that our culture harbours a multiplicity of belief systems about depression, but rather that, paradoxically, so very little is known about the most prevalent of these systems, e.g. the body of everyday, commonsense things that ‘everybody knows’ about depression and what to do about it, and that, as a result of this ignorance, professionals may sometimes be positively unhelpful to those who come to them for help. A number of tendencies contribute to the possibilities of this unhelpfulness. First is the common failure of helping professionals to appreciate lay views. Joynson (1974) has written at length of the ways in which psychologists routinely ignore the prior understandings human subjects bring with them to their participation in experimental research. But psychologists are not the only ones. In the context of considering why people fall ill or die at the time they do, Engel (1968) has written: It is interesting that most lay people take it for granted that a person’s frame of mind has something to do with his propensity to fall ill or even to die. Discouragement, despair, humiliation, and grief are generally thought to be conducive to illness and death while contentment, happiness, faith, confidence, and success are associated with health. But physicians, who in their nonprofessional roles may share such notions, rarely regard them as a legitimate area for their scientific interest. Indeed, most avoid discussing such phenomena with their colleagues, relegating them to the category of curious anecdotes (p. 294). In the setting of clinical psychiatry, it is probably well to distinguish between the tendency simply to overlook lay beliefs and the tendency actively to depreciate them. The first of these is widely evident in theory as well as in practice. The clinical corollary

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to the total silence on the matter of what ordinary people ordinarily think and do about depression which reigns in the professional literature is the routine omission to ask after a patient’s views on his condition and his own ways of managing it. This simple lack of interest in patients’ self-management techniques is unfortunate, because it means a loss of potentially useful information about people’s ways of coping, but it is probably not immediately unhelpful by itself if only because as a result of it the patient may be left to get on quietly with his efforts to help himself, unhindered by well-meaning interference. However, this tendency to ignore lay views may contribute indirectly to professional unhelpfulness. Because so little is known about the corpus of lay beliefs about depression and what to do about it, professionals may find it difficult to acknowledge the integrity of a patient’s views as part of a widespread body of shared knowledge with its own social institution for consensual validation. Instead, as Sutherland (1976) has commented in his recent autobiographical account of a psychiatric hospital stay, professionals seem primed to construe almost anything a patient says or does as part of his illness. Thus it may happen that when a patient expresses views on appropriate ways of acting when feeling depressed, which are consensually valid within the wider culture (‘When I feel low I try to keep myself occupied so I don’t think about my troubles too much and make myself worse’), this course of action may be promptly invalidated by staff as symptomatic, defensive or otherwise pathological (‘You’re just trying to run away from your problems; that’s your trouble’). It should not take much imagination to appreciate how such a reaction could be unhelpful or even positively antitherapeutic to a person who may already be struggling to differentiate between those of his cognitions which participate in the shared frames of reference of his society and those which do not. A belief which is in fact, and which he has hitherto-rightly-believed to be normative, belonging to the shared social reality of the wider culture, and which constitutes evidence of his adaptation to social norms rather than of his deviation from them, is summarily dismissed as evidence of his ‘pathology’ by powerful authorities with whom he is not in much of a position to argue. This sort of situation constitutes a ‘double bind’ of a most pernicious kind, and it is one which normally escapes professional awareness, by the operation of another tendency, the last to be considered here. This is the tendency of professionals to take their own views for granted, to hold them without due appreciation of the fact that they are views, merely schematic hypotheses about the way things are rather than some species of eternal verity. While it is in the nature of what Schutz (1972) has termed the ‘reality-taken-for-granted’ in a society to pass unnoticed, this scotomatization of the logical status of one’s own beliefs can be potentially damaging when it occurs in the context of some people’s adjudication of the ‘normality’ (or otherwise) of other people’s beliefs. The failure to acknowledge that this failure so frequently occurs also constitutes a component of the double bind that the patient may be put in. This sketch of the contemporary scene adumbrates the rationale of the present study: it seems high time that something was done to codify commonsense beliefs about depression and antidepressive behaviour, and the present investigation aims to contribute to a first approximation. It is the third in a series of attempts to explore the paradoxically unknown territory of ‘what everybody knows’ about depression and how to deal with it. The preceding members of the series may be described briefly. The first study (Rippere, 1974; 1977b) examined consensus concerning ‘the thing to do when you’re feeling depressed’ in a group of 50 unselected available English-speaking people. In a short, open-ended interview, each subject was asked ‘What’s the thing to do when you’re feeling depressed?’ Responses were transcribed, subjected to content analysis using inductively-derived categories, and then to frequency counts. People’s spontaneously-expressed views on this matter showed a fair degree of consensus, which was evident in a number of ways: on the one hand, a fair proportion of Ss, up to some 36%, concurred in mentioning particular items of behaviour; and on the other

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hand, the majority of the items mentioned, some 87x, were consensually mentioned by more than one subject. These findings, which provided data for an empirically-derived inventory of antidepressive activities, the Antidepressive Activity Questionnaire (Rippere. 1974; 1976) were taken to demonstrate the existence of a social consensus regarding ‘the thing to do when feeling depressed’. In the second study (Rippere, 1977a), first-year psychology students without previous academic instruction in abnormal psychology were asked to estimate what percentage of their class would choose each point on Spoint scales describing how often they felt depressed, did something about it when feeling depressed, and found that what they did was helpful. The distributions of responses actually observed were compared with the students’ mean estimates: a strikingly high degree of congruence was found, suggesting that Ss had a clear idea of the way their peers would respond to the novel questionnaire task. Moreover, they were very nearly as accurate in predicting the group’s responses to parallel questions about the hypothetical ‘average person’. To account for the results, it was necessary to postulate first, second, and third-order cognitions underlying the students’ ability to answer the questions themselves and make their estimates of the way their peers would answer them. Thus in order to answer questions about their own feelings of depression, self-help efforts, and the effectiveness of these, the students must have had some ideas about these matters. In order to estimate how their peers would respond, they must have had some ideas about their peers’ ideas. And in order to estimate how their peers would answer questions about the ‘average person’s’ ideas, students must have had some ideas about their peers’ ideas about the ideas of this hypothetical character. The results were taken to suggest something of the enormous complexity of the commonsense cognitions about depression and antidepressive behaviour which these students had acquired before ever entering upon the formal study of abnormal psychology. The present investigation extends these lines of enquiry. It looks beyond the unitary items of substantive content in the canon of commonsense knowledge about depression, examined in the first study as ‘the thing to do when feeling depressed’, to more discursive propositions about doing such things and the conditions under which people do them. The distributions of responses to be examined are the proportions of subjects endorsing each member of 20 pairs of items in a forced-choice procedure. Here the questions are whether, to what extent, and within which pairs of items 100 psychologists will show consensus about the item selected within each pair. The degree of consensus was operationally defined in terms of the number (or percentage, since there were 100 subjects) of people opting for the more frequently chosen item within each pair. In the case of complete consensus, all subjects would make the same choice, resulting in a distribution of 100:O. In the case of no consensus, the distribution of preferences would split at 50: 50. Distributions of responses between these two extremes are taken to reflect differences in the degree or strength of consensus within the subject group about the beliefs represented in any pair of statements. Thus a pair yielding a distribution of 80:20 would be considered to represent stronger agreement than a pair with a 60:40 distribution. The frequency distribution of the various degrees of consensus is of interest in its own right at the present stage of the enquiry as well as also, potentially, as a baseline for later comparative studies of consensual beliefs in various relevant criterion groups.

METHOD

Subjects Ss were 100 undergraduate, postgraduate, and staff members of psychology departments of 3 schools of London University during 1976 (41 m, 59 f, mean age mid 20’s). They were recruited either as volunteers or in the course of class-based questionnaire exercises.

Beliefs about

depression

and antidepressive

behaviour

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Materials

A single-sheet photoreproduced ‘Beliefs About Behaviour’ questionnaire was used, which consisted of brief directions and 20 forced-choice paired sentences, the text of which is given in Table 1 following. Ss were instructed to circle the letter of the item in each pair which they thought was ‘nearer the truth’. Procedure and design

The study was designed to examine the degree, pattern, and content of consensus in endorsed beliefs about depression and antidepressive behaviour in members of a relatively homogeneous English-speaking intellectual subculture. The questionnaire was assembled on an inductive basis to cover a range of content areas, including commonsensical descriptions of and prescriptions for antidepressive behaviour, semantic distinctions, judgements about usual or relative efficacy of various courses of action, and also, for contrast, a number of generalizations related to recent empirical findings (Brown et al., 1975, Weissman et al., 1971) and theoretical positions (Seligman, 1975; Miller et al., 1960). Ss filled in the questionnaires anonymously; after the questionnaires were returned, Ss were given an explanation of the aim of the exercise. RESULTS

Quantitative

1. Degree of consensus about the statements. The numbers of Ss (men and women separately and combined) selecting each member of the 20 pairs of items are given in Table 1. It will be seen that the degrees of consensus span the range from the complete agreement shown on item 1 (0: 100) to the near-complete disagreement about item 8 (49:51). Only one significant sex difference in the pattern of responses was found (item 12). More will be said about the contents of consensus in the section on qualitative results below. 2. Distribution of degrees of consensus. The frequencies of the different degrees of consensus found are given in Table 2, where it will be seen that the distribution approximates to a normal one, slightly skewed towards the upper end of the range. Although it must be borne in mind that Ss’ responses represent endorsements of statements with which they were presented rather than their own spontaneous productions, and that the endorsement procedure forced a choice between alternatives neither of which necessarily represented a S’s own individual views, this distribution suggests that the sample of items included in the questionnaire may represent a reasonable selection from the considerably larger population of beliefs about behaviour held in common by members of the group. Qualitative

Various ways of talking about the data in Table 1 are possible. Probably the two most important matters in the present context are the different ‘bandwidths’ of consensus and the substantive contents of each. The proposition that ‘Most people feel depressed at some time or other’ would seem to be a matter of universal agreement in the present group of psychologists, and the only point about which everyone agreed. If we take an arbitrary cutoff point of 90% or more to represent ‘the vast majority’, then the vast majority of this group agree that: 1. ‘When a depressed person recovers he should take most of the credit himself’ (93%); 2. “‘Feeling depressed” is not the same as “feeling depressed about something”’ (92%); 3(a). ‘When feeling depressed it usually helps to keep busy’ (91%) and 3(b). ‘Feeling “unhappy” is not the same as feeling “depressed”’ (9 1%).

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Table 1. Numbers of subjects choosing each member of paired statements ITEM

(n ,M4l) (n I59)

Most people never feel depressed. l(a) OJ) Most people feel depressed at some time or other. When people feel depressed, they most often try to do something to 34

(nAf’ &

0

0

0

41

59

100

34

(W When people feel depressed, they most often just give in and do nothing. 364 The things people do to help themselves when they’re depressed are

7

43 16

77 23

often more helpful than the things other people do to help them. The things people do to help themselves when they’re depressed are often less helpful than the things other people do to help them. When feeling depressed, it is most helpful to do something one enjoys. When feeling depressed, it is most helpful to do something that needs doing.

29

49

78

12 28

10

22

37

65

13

22

35

11

18

34

48

82

38 3

49 10

87 13

39

44

83

2

15

17

24

25

49

17

34

51

35

57

92

2 53 6

8 91 9

6

15

21

35

44

79

39

43

82

2 5 36

16 4 55

18 9 91

16

22

38

25

37

62

23 18

34 25

57 43

22

38

60

19

21

40

10

18

28

31

41

72

39

54

93

2 26 15

5 43 16

69 31

help themselves.

(‘4 4(a) 0) 5(a) (b) 664 @I 7(a) (‘4 8(a) (b) 9(a) W 10(a)

(‘4 11(a) (W

If someone is feeling depressed, there’s probably not much he can do about it. If someone is feeling depressed, there’s probably something he can do about it. It’s usually no use to tell a depressed person to ‘pull himself together’. It’s usually helpful to tell a depressed person to ‘pull himself together’. When someone is feeling depressed, he ought to try to deal with it himself rather than consulting a psychiatrist. When someone is feeling depressed, he ought to consult a psychiatrist rather than trying to deal with it himself. A depressed woman is often no better at coping with her job than with her home and family. A depressed woman is often better able to cope with her job than with her home and family. ‘Feeling depressed’ is not the same as ‘feeling depressed about something’. ‘Feeling depressed’ is no different from ‘feeling depressed about something’. When feeling depressed, it usually helps to keep busy. When feeling depressed it usually helps to take it easy. Keeping busy when feeling depressed is a way of running away from your problems. Keeping busy when feeling depressed is a way of living with your prob lems.

6 38

*12(a) When someone is feeling depressed, it is often more helpful to talk it (b) 13(a) (b)

1464 W 1W (b) 16(a) (b) 1W (‘4 1W 04 1%) (‘4

over with a friend than with a doctor. When someone is feeling depressed, it is often more helpful to talk it over with a doctor than with a friend. Feeling ‘unhappy’ is just the same as feeling ‘depressed’. Feeling ‘unhappy’ is not the same as feeling ‘depressed’. Women with jobs outside the home are just as likely to get depressed as women who don’t go out to work. Having a job outside the home helps keep women from getting depressed. People get depressed when they haven’t got enough to do. People get depressed when they’ve got more to do than they can manage. People get depressed when they lose control over important things that happen to them. People get depressed when they realize their plans aren’t going to work out as they had hoped. Having someone to tell her troubles to isn’t likely to prevent a woman from getting depressed. If a woman has someone to tell her troubles to, she’s less likely to get depressed. When a depressed person recovers, he should take most of the credit himself. When a depressed person recovers, his doctor should take most of the credit. It rarely helps to tell a depressed woman to go and buy a new dress. It often helps to tell a depressed woman to go and buy a new dress.

7

471

Beliefs about depression and antidepressive behaviour Table 1. Continued M (n = 41) (n z59)

ITEM 20(a) (b)

It makes no sense for people to get depressed just when they’ve achieved a goal that has long been important to them. It is understandable for people to get depressed just when they’ve achieved a goal that has long been important to them.

(n*i &)

12

8

20

29

51

80

*x2 = 6.66; df 1; p < 0.01.

A cutoff point of 80% or more taken as representing ‘the majority’ shows the majority of the group to agree that: 1. ‘It’s usually no use to tell a depressed person to “pull himself together”’ (87%); 2. ‘When someone is feeling depressed, he ought to try to deal with it himself rather than consulting a psychiatrist’ (83%); 3(a). ‘If someone is feeling depressed, there’s probably something he can do about it’ (82%) and 3(b). ‘When someone is feeling depressed, it is often more helpful to talk it over with a friend than with a doctor’ (82%); 4. ‘It is understandable for people to get depressed just when they’ve achieved a goal that has long been important to them’ (80%). A cutoff point of 75% or more representing ‘people generally’ shows the people in the group generally agreeing that: 1. ‘Keeping busy when feeling depressed is a way of living with your problems’ (79%); 2. ‘The things people do to help themselves when they’re depressed are often more helpful than the things other people do to help them’ (78%); and 3. ‘When people feel depressed, they most often try to do something to help themselves’ (77%). If the range 65-74x is taken to represent ‘people tending to agree’, the people in the group would tend to agree that: 1. ‘If a woman has someone to tell her troubles to, she’s less likely to getdepressed’ (72%); 2. ‘It rarely helps to tell a depressed woman to go and buy a new dress’ (69%); and 3. ‘When feeling depressed it is most helpful to do something that one enjoys’ (65%). Finally, if the range 5064% is taken to represent ‘people tending to disagree’, the members of the group would seem to tend to disagree about: 1. Whether women with jobs outside the home are (38%) or are not (62%) just as likely to get depressed as women who don’t go out to work; 2. Whether people get depressed when they lose control over important things that happen to them (60%) or when they realize their plans aren’t going to work out as they had hoped (40%); 3. Whether people get depressed when they haven’t got enough to do (57%) or whether it’s when they’ve got more to do than they can manage (43%); and 4. Whether a depressed woman is (51%) or is not (49%) often better able to cope with her job than with her home and family. Though the arbitrary nature of these broad divisions precludes an absolute categorization of the contents of each, a few broad generalizations nonetheless seem warranted. On the whole, Ss were in agreement about matters that are subject to verification by an individual’s own experience and firsthand observation: that feeling depressed is pretty common; that this feeling is qualitatively distinct from other feelings; that Table 2. Distribution

of degress of consensus about cognitions

% consensus about one member of a pair 100 90-99 80-89 70-79 60-69 50-59

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VICKY RIPPERE

there are usually things a person can do about it when feeling this way; that people do tend to do things to help themselves; that some of these things are more helpful than others; and that some things are generally not helpful. By contrast, Ss tended to disagree about matters that are still being debated by the experts: why people become depressed; what social factors can mitigate depression; and what effects being depressed can have on a person’s social role performance, The fact that Ss disagreed about matters that are not a matter of common sense increases the confidence one may have in the commonsensi~l nature of the matters about which they did show consensus. DISCUSSION

At the most basic level, the results show that a fair degree of consensus in beliefs about depression and antidepressive behaviour can be demonstrated with a forced-choice endorsement method in the relatively homogeneous subject group studied How far it is possible to generalize beyond these subjects and this method to the world at large remains to be seen. But even though the present results cannot be considered to give a complete picture of the domain, they are nonetheless highly consistent with some specific findings of previous studies in the series. Consensus about ‘the propositions that ‘Most people feel depressed at some time or other’, ‘When people feel depressed they most often try to do something to help them~lves’ and ‘If someone is feeling depressed there’s probably something he can do about it’ is grossly consistent with the pattern of responses to the 3 ‘average person’ items in the previous study (Rippere, 1977a). There it was found that: (1) the majority of Ss estimated that the ‘average person’ felt depressed ‘sometimes’ (76.32%) and no subject estimated that the average person ‘never’ felt depressed; (2) no subject estimated that the ‘average person’ ‘never’ tried to do something about it when feeling depressed and the majority estimated that such efforts were made at least ‘sometimes’ (44.74%) or more frequently (‘often’ 36.84%; ‘always’ 5.26%); and (3) no subject estimated that the ‘average person’ ‘never’ found his self help efforts effective and the majority saw these as being effective ‘sometimes’ (57.89%) or ‘often’ (23.68%). Consensus about the helpfulness of keeping busy or doing something enjoyable or of telling one’s troubles to, or talking things over with, someone, preferably a friend rather than a doctor or psychiatrist, is consistent with the high frequency with which ‘keep busy’ (24x), ‘talk to someone about it’ (24%) and ‘do something you enjoy’ (18%) were mentioned in the open-ended interview study of ‘the thing to do when feeling depressed’ (Rippere, 1977b) and also with the greater frequency of the advice to avoid professionals (6%) than to seek their aid (27$) (Rippere, 1974). From the congruence between the various sets of findings es~blished so far, it would appear that the forced-choice method may elevate the absolute degree of consensus shown but does not grossly distort the relative emphases. With this qualification it may be possible to apply the present method to the comparative study of relevant criterion groups: the general public, psychiatric patients and their relatives, family doctors, psychiatrists, psychiatric nurses, occupationai therapists, and social workers, as well as clinical psychologists. Some interesting differences in patterns of agreement might be expected to emerge. For example, would one expect doctors on the whole to agree that ‘when a depressed person recovers he should take most of the credit himself’, psychiatrists to agree that ‘when someone is feeling depressed he ought to try to deal with it himself rather than consulting a psychiatrist’, or any professionals (and, if so, which?) to agree that ‘the things people do to help themselves when they’re depressed are often more helpful than the things other people do to help them’? And what would one expect patients and their families to endorse? Would staff and patients agree to the same extent about the semantic distinctions? A comparative study of the psychiatric dramatis personae within a single institution might reveal some important areas of subcultural difference, as well as possibly drawing attention to unsuspected tracts of common ground. People occupying similar roles in different institutions might also be compared, within or across cultures. There are many possible directions in which

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further investigation could proceed. However, the choice of what an investigator might do next would depend to a great extent on the sorts of conclusions he might wish to draw from his data. Here we may consider the conclusions that appear to emerge from the present findings. The main conclusion is simply that, on present evidence, the canon of commonsense beliefs about depression and how to deal with it appears to be a complex and widelyranging phenomenon, but one that can be studied. To continue to ignore it, both in theories about cognitive aspects of depression and in clinical practice, is to risk the possibility not only of grossly oversimplifying our own ‘expert’ views of what we are dealing with but also of doing injustice to the cognitive complexity of our clients. At a time when the actual helpfulness of the help given by self-appointed ‘experts’ is being pointedly questioned by critics from all sides (e.g. Stuart, 1970; Malleson, 1973; Illich. 1975), and when adamantly lay self-help organizations are springing up in all directions, it is worth giving these risks serious thought and searching for ways of reducing them. Further exploration of the things people already know about managing depression and of the ways they apply their knowledge in getting through their daily lives seems likely to contribute to this effort. REFERENCES BECK A. T. (1971) Cognition, affect and psychopathology. Arch. gen. Psych&. 24, 495-500. BROWN G., BHROLCHAIN M. & HARRIST. (1975) Social class and psychiatric disturbance among women in an urban population. Sociology 9, 225-254. ENGELG. L. (1968) A life setting conducive to illness. The giving-up-given-up complex. Ann. Inc. Med. 69, 293-300. ILLICHI. (1975) Medical Nemesis. The Expropriation of Health. Calder & Boyars, London. JOYNSONR. B. (1974) Psychology and Common Sense. Routledge & Kegan Paul, London. MALLES~NA. (1973) Need Your Doctor Be So Useless? Allen & Unwin, London. MELGE~F. T. & BOWLBYJ. (1969) Types of hopelessness in pathological process. Arch. gen. Psychiat. 20. 690-699.

MILLER G. A., GALANTER E & PRIBRAMK. (1960) Plans and the Structure of Behaoiour. Holt, Rinehart & Winston, London. RIPPEREV. L. (1974) Antidepressiue Behauiour. Unpublished M. Phil dissertation, London. RIPPEREV. L. (1976) Antidepressive behaviour-a preliminary report. Behao. Res. and Therapy 14, 289-299. RIPPEREV. L. (1977a) Some cognitive dimensions of antidepressive behaviour. Behau. Res. and Therapy 15. 5763.

pilot study. Behau. Res. and Therapy 15. 185-191. SCHUTZA. (1972) The Phenomenology of the Social World. Heinemann Educational, London. SELIGMAN M. E. P. (1975) Helplessness. On Depression, Development, and Death. W. H. Freeman, San Francisco. STUARTR. B. (1970) Trick or Treatment: How and When Psychotherapy Fails. Research Press, Champaign. RIPPEREV. L. (1977b) ‘What’s the thing to do when you’re feeling depressed?-A

Illinois. SUTHERLAND S. (1976) Breakdown. A Personal Crisis and a Medical Dilemma. Weidenfeld & Nicolson. London. WUssMANM. M., PAVKELE. S., SIEGELR. and KLERMANG. L. (1971) The social role performance of depressed women. Comparison with a normal group. Am. J. Orthopsychiat. 41, 390-405.