Shame and community: social components in depression

Although there are many theories of the causes of depression, they all assume that some cases are primarily endogenous; that is, they are largely independent of situational influences. This article proposes that most cases of depression have a social component that is closely tied to the immediate situation. During 5 months in 1965 I observed nearly all intake interviews of male patients in a mental hospital near London. Most of them were over age 60, and all but one were diagnosed as depressed. However, there was usually a temporary lifting of depression in those interviews in which the psychiatrists asked the patients about their activities during World War II. At the time I didn't understand the significance of these episodes. I now offer an interpretation in the light of current studies of shame and the social bond: Recounting memories of belonging to a community temporarily resolved shame and depression. These episodes suggest a modification of existing theories of depression, that shame and lack of community, in addition to biology and individual psychology, could be a component of major depression.