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Book Forum: MOOD DISORDERS   |    
Cognitive Vulnerability to Depression
Am J Psychiatry 2000;157:1899-1900. doi:10.1176/appi.ajp.157.11.1899
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Chicago, Ill.

By Rick E. Ingram, Ph.D., Jeanne Miranda, Ph.D., and Zindel V. Segal, Ph.D. New York, Guilford Publications, 1998, 330 pp., $36.95.

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Depression is associated with particular kinds of cognition: thoughts of guilt, hopelessness, helplessness, worthlessness, and death. These unwarranted and unwanted thoughts cause much of the pain associated with depression and, what may be worse, deter sufferers from seeking help. The effectiveness of cognitive behavior therapy for mild to moderate cases of depression underscores the centrality of cognition in the genesis and phenomenology of the disease. Cognitive Vulnerability to Depression is a scholarly review and discussion of cognition as it relates to individual vulnerability to depressive illness. After a foreword by Aaron Beck, the foremost exponent of cognitive treatment, it proceeds systematically through chapters on cognitive theories of depression, approaches to the study of vulnerability to psychopathology, conceptual and methodological issues in proximal and distal factors in vulnerability, and an integration of published findings and theories. The authors go to great pains, sometimes too great, to lay out their intentions and the structure of their book for the reader.

Although the book begins with references to DSM-IV, it proceeds to extended discussions of studies on depression without any indication of how the disease was defined or diagnosed in those studies, and with reference to concepts, such as anaclitic depression, that are not congruent with the DSM-IV model. The authors seem unaware that the multiaxial DSM-IV system includes the level of function in the overall assessment of the patient. Although these deficiencies are substantial, they are tempered by a good critical analysis of diagnosis in general and the concepts underlying DSM-IV and its approach to nosology in particular. In a research, clinical, and general culture so dominated by DSM-IV, it is important that we be reminded that it is only one way of describing mental illnesses and that it is a product of our particular culture at a particular point in time.

This is a work of academic psychology, full of scholarly terms ("depression construct") that will not be familiar to most psychiatrists and that make the reading hard going. This challenge is further compounded by typographical errors and mistakes in syntax so serious as to make some sentences incomprehensible: "Recommendations such as these have substantially affected the ways in to which individuals experiencing symptoms of depression are referred" (p. 95). The authors carefully explain the difference between risk and vulnerability, but they fail to support the concept that cognitive vulnerability might precede and persist between episodes of depression while being undetectable. The experience of depression may well cause permanent change in an individual’s world view/cognition, and this change may be associated with vulnerability to recurrences of depression, but this would be effect as well as cause. Likewise, the concept of depression as adaptive in some circumstances is interesting but better explored in other texts. There are kernels of interest and significance in this book, but the book is a tough nut to crack.




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