What You Can Change . . . And What You Can't*: The Complete Guide to Successful Self-Improvement (17 page)
Authors: Martin E. Seligman
Tags: #Self-Help, #Personal Growth, #Happiness
To determine how depressed you are, take this widely used test called the CES-D (Center for Epidemiological Studies-Depression). It was developed by Lenore Radloff at the Center for Epidemiological Studies of the National Institute of Mental Health. Circle the answer that best describes how you have felt
over the past week
.
I was bothered by things that usually don’t bother me.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I did not feel like eating; my appetite was poor.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I felt that I could not shake off the blues even with help from my family and friends.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I felt that I was not as good as other people.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I had trouble keeping my mind on what I was doing.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I felt depressed.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I felt that everything I did was an effort.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I felt hopeless about the future.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I thought my life had been a failure.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I felt fearful.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
My sleep was restless.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I was unhappy.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I talked less than usual.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I felt lonely.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
People were unfriendly.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I did not enjoy life.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I had crying spells.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I felt sad.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I felt that people disliked me.
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
I could not get “going.”
0 Rarely or none of the time (less than 1 day)
1 Some or a little of the time (1–2 days)
2 Occasionally or a moderate amount of the time (3–4 days)
3 Most or all of the time (5–7 days)
This test is easy to score. It is simply an aggregation of the symptoms of depression. The more you have, the more likely it is that you are depressed. Add up the numbers you circled. If you couldn’t decide and circled two numbers for the same question, count only the higher of the two. Your score will be someplace between 0 and 60.
Before interpreting your score, you should know that a high score is not the same thing as a diagnosis of depression. A few people who get high scores are not in fact depressed, and people with low scores can still have a “depressive disorder.” A full-blown diagnosis of depression depends on other things, such as how long your symptoms have lasted and whether they have some primary source other than depression. A diagnosis can be made only after a thorough interview with a qualified psychologist or psychiatrist. Rather than giving a diagnosis, this test gives an accurate indication of your level of depression right now.
If you scored from 0 to 9, you are in the nondepressed range, below the mean of American adults; 10 to 15 puts you in the mildly depressed range; and 16 to 24 puts you in the moderately depressed range. If you scored over 24, you are probably severely depressed.
If you scored in the severely depressed range, I
urge you to seek treatment
. If you believe that you would kill yourself if you had a chance, regardless of the rest of your answers,
I urge you to see a mental health professional right away
. If you scored in the moderately depressed range and, in addition, you often think about killing yourself, you should see a professional right away. If you scored in the moderately depressed range, take the test again in two weeks. If you still score in that range, make an appointment with a mental health professional.
After you have read the rest of this chapter about what treatments work for depression, and if you have trouble finding a qualified professional in your area, I welcome your writing me at the Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104. I will try to send you the names of some of the qualified people in your area who do the therapies that work.
T
HE SYMPTOMS
of depression in the questionnaire fall into four clusters.
First, the way you
think
when you are depressed differs from the way you think when you are not depressed. When you are depressed, you have a dour picture of yourself, the world, and the future. Your future looks hopeless, and you attribute this to a lack of talent. Small obstacles seem like insurmountable barriers. You believe that everything you touch turns to ashes. You have an endless supply of reasons why each of your successes is really a failure. A pessimistic
explanatory style
2
is at the core of most depressed thinking. You see the causes of your tragedies and your setbacks as permanent, pervasive, and personal (“It’s going to last forever, it’s going to undermine everything I do, and it’s me”), and you see the causes of good events in the opposite way.
The second group of symptoms is a negative change in
mood
. When you are depressed, you feel awful: sad, discouraged, sunk in a pit of despair. You may cry a lot, or you may even be beyond tears. Life loses its zest. Formerly enjoyable activities become flat. Jokes are no longer funny, but unbearably ironic. Sadness is not the only mood of depression; anxiety and irritability are often present. And when depression gets intense, anxiety and hostility drop away and the sufferer becomes numb and blank.
The third cluster of symptoms of depression concerns
behavior:
passivity, indecisiveness, and suicide. Depressed people often cannot get started on any but the most routine tasks, and they give up easily when thwarted. A novelist can’t get her first word written. When she finally does manage to get going, she quits writing when the screen on her word processor flickers, and she doesn’t return to her work for a month. Depressed people cannot decide among alternatives. A depressed student phones for a pizza, and when asked if he wants it plain or with a topping, he stares paralyzed at the receiver. After fifteen seconds of silence, he hangs up. Many depressed people think about and attempt suicide.
In depression, even your body turns on you—the fourth cluster of symptoms,
somatic
. The more severe the depression, the more bodily symptoms. Your appetites diminish. You can’t eat. You can’t make love. Even sleep is affected: You wake up too early and toss and turn, trying unsuccessfully to get back to sleep. Finally the alarm clock goes off, and you begin the new day not just depressed but worn out, too.
To be depressed, you needn’t have symptoms from all four clusters, and it is not necessary that any particular symptom be present. But the more symptoms you have and the more intense each is, the more certain you can be that the problem is depression.
For some of us, these symptoms are rare, descending on us only when several of our best hopes collapse at once. For many, depression is more familiar, a state that descends every time we are defeated. For still others, it is a constant companion, souring even our sweetest times and darkening the grayer times to an unrelieved black.
Until recently, depression was a mystery. Who is most at risk? Where does depression come from? How do you make it lift? All were enigmas. Today, thanks to thirty years of intensive scientific research by thousands of psychologists and psychiatrists in dozens of laboratories and hundreds of clinics around the world, the shape of the answers is known. If someone has severe symptoms of depression, that person might have one of two very different disorders:
unipolar
or
bipolar
depression. These provide everyday work for clinical psychologists and psychiatrists. What determines the difference between them is whether mania is involved.
Mania is a psychological condition that looks like the opposite of depression: Its symptoms are unwarranted euphoria, grandiosity, frenetic talk and action, little sleep for days on end, and inflated self-esteem. Bipolar depression always involves manic episodes; it is also called manic-depression (with mania as one pole and depression as the other). Unipolar depressives never have manic episodes. Another difference between the two is that bipolar depression is much more heritable. If one of two identical twins has bipolar depression, there is a 72 percent chance that the other also has it. (This is true of only 14 percent of fraternal twins.) Bipolar depression is exquisitely responsive to lithium carbonate. In more than 80 percent of cases, lithium will relieve the mania to a marked extent and the depression to a lesser extent. Taken continually, it tends to prevent new episodes. Manic-depression is an illness, appropriately viewed as a disorder of the body and treated medically. It is similar to unipolar depression only in appearance.
Now, therapists are not usually sued for malpractice when they use an outdated or ineffective therapy, and a poor therapist can always find some other guild member who does the same kind of therapy to testify that their therapy is a “usual” procedure. But so clear are the data that lithium usually works and that any form of psychotherapy alone usually does not that manic-depressives who are not treated with lithium should, I believe, be able to win malpractice lawsuits. At any rate, if you have manic-depression and are being treated with any form of psychotherapy only, drop your therapist. It is simply wrong to do psychotherapy on bipolar depression, except as an adjunct to drug therapy.
