The Interactional Nature of Depression: Advances in Interpersonal Approaches

The Interactional Nature of Depression, edited by Thomas Joiner and James C. Coyne, is a representative compilation of the current literature on the ways in which depression can be understood as an interactional process between a person who is depressed and the social context of that person's life. It is written primarily for academic clinicians whose practice includes treating people who have been diagnosed as having depression. The text is intended to update Coyne's original conceptualization (1) of 25 years ago, in which he proposed that any model of depression must incorporate as an essential component how people are involved with each other.

The book falls short of its overall goals, however. It's not that the articles aren't thoughtful, well written, and thorough; they are. And they do address topics that generally fall under the rubric of "interactional." The problem is that they don't do anything to advance the understanding of depression within the contextual framework described in the introductory chapter. For example, a chapter by Dill and Anderson focuses on the interrelatedness of loneliness, shyness, and depression. Although the nature of the relationship between the three merits theoretical investigation, understanding and treating someone who is shy is not the same thing as understanding and treating someone who is clinically depressed.

More off the mark is a chapter by Gardner and Price on sociophysiology and depression, which, as an evolutionary model, employs an involutional physiological explanation of depression. The model generates a number of explanatory hypothetical constructs. Most noteworthy among them is the involuntary subordinate strategy, which is defined as an absence of behavior and somehow best compared to hibernation. Using "propensity physiological states" that antedate language—and human beings—as an explanation of present-day depression is not what I understand the authors of the introductory chapter to have in mind. However, this chapter does provide abundant material for debate on theoretical and ethical issues by referring to such treatment strategies as the following: "One marital therapist, treating a woman with depression, successfully gave the antidepressant to the husband to take himself, rather than to the wife."

A model presented in a chapter by Dana Crowley Jack is more consistent with the editors' conceptualization. This model suggests that one of the interactional components of depression has to do with the self-evaluative statements that people hold as a result of their experience with others. In particular, depression in competent, intelligent, professional women may have to do with the conflict in what it means both to have intimate relationships and also to take care of one's self.

It is disappointing that the literature in this important area remains very much in the realm of discordant theoretic discussion, providing more material for dissertations and graduate-level seminars than for understanding the complexities of depression and comprehensive therapeutic treatment interventions. Coyne expresses similar sentiments, albeit with more charity than I, in the postscript. Without providing a formal model, which he believes would be premature, he eloquently describes a way of thinking about depression and clinical research that exemplifies the simplicities and the complexities of the ways in which people are involved with each other in everyday life. This final chapter is worth the entire book.

Ms. Zambarano is a clinical psychologist in private practice in central Massachusetts.