We all see cases of depression that seem to arise, like some dark Venus, from a mysterious sea of genes and biology, without a clear precipitant. But this time there seemed to be a specific, inciting event. My patient, an accountant for over 30 years, had agreed to prepare a family member's federal income tax return. Unfortunately, the IRS discovered an underpayment of about $70, which the relative dismissed as “no big deal.” But for my patient, the moral order of the universe had been overturned. How, he wondered, could he have been so careless—and so stupid? He, who had prepared thousands of tax returns without a penny's error, and whose entire life was based on duty, honor, responsibility, and perfection! How could such vile incompetence issue from so pure a stream?