some historical dimensions of commonsense knowledge about depression and antidepressive behaviour

Bchou. Res. d Therapy Vol. 18. pp. 373 to 385 Pcrpmon Press Ltd 1980. Printed in Great Britain

SOME HISTORICAL DIMENSIONS OF COMMONSENSE KNOWLEDGE ABOUT DEPRESSION AND

ANTIDEPRESSIVE BEHAVIOUR

VICKY RIPPERE

Department of Psychology, Institute of Psychiatry, London, SE5 SAF, U.K.

(Received 11 March 1980)

Summary-Ss of the present study were asked to endorse one member of each of 10 forced-choice pairs of propositions representing the main principles of the neoclassical tradition of thought on the prevention and treatment of melancholy and to estimate the percentage of the group that they thought would endorse each proposition. Comparison of observed and mean predicted perccnt- ages showed a high correlation for two of three groups. All three groups gave very similar mean predictions, which suggested that they possessed an a priori schema of the distribution of consensus regarding these beliefs amongst peers. The results are examined as an empirical demonstration of quantitative dimensions of common culture and of the continuity of classical tra- ditions in the contemporary social stock of knowledge. The recent general revival of scientific and popular interest in the role of factors traditionally regarded as contributory to health and disease is briefly considered as a wider context in which the present hndings should be viewed.

The present study belongs to a series of reports on aspects of people’s everyday knowledge about depression and antidepressive behaviour (ADB) and the ramifications of this kind of knowledge in ordinary social life. Earlier studies in the series have established that the social stock of knowledge in our Western English-speaking culture contains a set of unitary items of recipe-knowledge about ‘the thing to do when feeling depressed (Rippere, 1977b) as well as a set of discursive propositions bearing on the nature, causes, effects and appropriate handling of feelings of depression (Rippere, 1977~). It has also been shown that this socially-shared commonsense knowledge possesses several orders of logical complexity: over .and above their awareness of the substantive contents of this stock of knowledge, people also appear to possess certain types of higher-order knowledge. Several studies in the series have demonstrated that when people in variously constituted groups are asked to fill in a novel questionnaire bearing upon their own and other people’s everyday depressive experience and antidepressive behaviour and to predict the pattern of that group’s responses to the questionnaire, they are able to do so with striking accuracy, whether the items concern the frequency of their own and the hypo- thetical average person’s experience of depression, the frequency of engaging in antidepressive behaviour and of finding it helpful (Rippere, 1977a), or the intensity and duration of feelings of depression (Rippere, 1980b) or the subjective helpfulness of various typical antidepressive activities (Rippere, 1979).

Taken collectively, these studies suggest that, over and above their own personal experience of feeling depressed and of carrying out antidepressive activities, people are aware, in a generally accurate quantitative way, of how these experiences compare to those of other people. Moreover, in the realm of higher-order discursive propositions, their knowledge appears to extend beyond simple qualitative awareness of the content of other people’s beliefs to an appreciation of the degree to which these beliefs are socially shared. Thus when a group of people were asked to indicate personal preference for one member of each of 10 forced-choice pairs of propositions concerning depression and ADB and to estimate the percentage of people in their present group that would endorse each statement, their predictions were found on average to be in close agreement with the percentages that were actually observed (Rippere, 1980a).

The present study represents our extension of this earlier work into a new dimension, the historical. In the previous study, the propositions investigated were chosen to represent a cross-section of contemporary views on the subject of depression and antidepres-

313

374 VICKY RIPPERE

sive behaviour, both commonsensical (“It rarely helps to tell a depressed woman to go and buy a new dress”) and scientific (“A depressed woman may be better at doing her job than at looking after her home and family”). In the present study, the propositions in questions were formulated in order to represent the main principles in the corpus of neoclassical advice on the prevention and treatment of melancholy which vernacular medical writers such as Andrew Boorde, Timothy Bright, Sir Thomas Elyot, Levinus Lemnius, Thomas Cogan, Andre du Laurens and others transmitted to the English- speaking world in the mid-to-late 16th century (see Rippere, 198Oc for a fuller discussion). A brief synopsis of this historical development, which is likely to be relatively unfamiliar to many readers, is in order.

The Western tradition of thought on mel~choly is said to have begun with I-Iippo- crates in the 5th century B.C., to have been systematised by Galen of Pergamon in the Zndcentury A.D., and thereafter to have been preserved and elaborated by Arabic and other Eastern physicians in the milennium between the end of the clasical period and its reintroduction into the West. When the classical ideas re-emerged in the Middle Ages, they were mainly available in the common currency of Latin translations and it was in this form that they were adopted into the curriculum of the new medical schools attached to medieval universities. Once established, they were passed on, largely unchanged, well into the Renaissance. In the late 15th century, however, a new development occurred, which, though it was not itself a part of the ancient tradition of thought on melancholy, was to contribute more to the transformation of this tradition than perhaps any other single event since its earliest origins. This development was William Caxton’s introduction of the printing press into England in 1477. Within the span of less than 50 years, the Graeco-Roman heritage of advice on the nature and treatment of melancholic disorders had begun a new phase of its history, as the traditional materials were translated into the English vernacular and disseminated further in forms that were gradually adapted to conform to the different circumstances of the Christian, post-medieval receiving culture. The ideas that had hitherto been available only in ancient and foreign languages rapidly became the- basis of popular vernacular literary and medical tradition, This fund of received neoclassical ideas also provided a ready-made foundation for the development of an English-language social stock of knowledge about depression, its prevention and appropriate management. What were these ideas?

The medical belief system of the period rested on the theory of the four humours, which postulated four vital fluids-blood, phlegm, yellow bile (or choler) and black bile (or melancholy)--which were present in varying proportions in the human body. Each humour combined two of the basic properties of hot or cold and dry or moist, melancholy being cold and dry. The individual’s constitutional type, which determined his relative susceptibility to various afflictions that might result if the balance of humours was upset, depended upon whichever of the humours predominated. Those of a melancholic constitution, e.g. with a predomin~~ of melancholy, were, accordingly, the most susceptible to disorders of this cold, dry humour.

Within this system of thought, the prime responsibility for preventing susceptibility from developing into full-blown disorder was vested in the individual himself. Writers of the period shared the belief that much illness was self-induced through living habits conducive to humoral imbalance. But by the same token, good health could be main- tained and promoted by the cultivation of appropriate living habits. In the words of Dr. Timothy Bright’s (1586) Treatise of Mehcholie it was in the “use of those familiar things which every one daily puts into practise, without the advice of a physician”-such as eating, sleeping, activity and recreation- that the most suitable occasions for the practise of hygiene were to be found.

It was lack of knowledge-both of self and of the rules of right tiving-that was held to prevent people from following healthy modes of living. Thus Lemnius (1576) wrote in the Preface to his Touchstone of Complexions, an extensive guide book to self-knowledge based on constitutional theory, that it was “by ignoraunce or not knowing our own selves, and by negligente looking to the state of own bodyes and mindes” that we are

Historical dimensions of commonsense knowledge about depression 375

“throwen into sondry diseases and innumerable affections”. The work of the early popular&s aimed, accordingly, to furnish the health-conscious reader with the heritage of ancient wisdom that would enable him to adopt the lifestyle most likely to preserve him from avoidable affliction. By what means was this considered possible?

The general factors which were held to play a role in the production or prevention of melancholic disorders were both numerous and heterogeneous. All derived their logic from the overriding theory of humoral pathology and were thus proposed as rational means of combating bodily and mental disorder. The relevant factors were schematised under the traditional headings of Galen’s six non-naturals, so-called because, with the exception of air, they did not form part of a natural body, and comprised:

1. Air 2. Meat and Drink 3. Sleep and Wakefulness 4. Exercise and Rest 5. Repletion and Evacuation of Superfluities 6. Regulation of Affects and Passions of the Mind

Impropriety in any of these respects could lead to imbalance of the natural humours of the body or to the production of unnatural ones. The end result of humoral derange- ment, stagnation or transformation might be one of the melancholic affiictions, that were characterised as simple to prevent but difficult to cure.

More specifically, within this scheme of things, people, and particularly those of a melancholic constitution, were considered to be putting themselves at risk of disorder if they, inter ah, inhabited an unhospitable climate, consumed foodstuffs with a particular propensity to engender melancholy humour, obtained insufficient sleep or were given to wakefulness in the night, neglected physical exercise for a sedentary existence, cultivated idleness, indulged in immoderate eating or drinking, failed to ensure adequate evacuation, allowed their passions to reign unchecked, and magnified the importance of the misfortunes which befell them.

By contrast, it was held that people were in a position to decrease the risk of developing a melancholic disorder if they inhibited a suitable climate, consumed foods which did not tend to produce melancholy, obtained adequate sleep and avoided wakefulness in the night, engaged in regular moderate physical exercise, avoided inactivity, avoided gastro- nomic excess, and adopted a philosophical outlook.

It was these particular beliefs about the factors relevant to provoking or preventing melancholic disorders that were used in formulating the statements for endorsement in the present study. For each of 10 beliefs, two statements were composed, one representing general agreement with the relevance of the factor in depression and the other representing general disagreement.

METHOD

Subjects

Three groups of people took part:

Group 1 consisted of 36 final year psychology students at University College London (10 m, 26 f, mean ages 22 and 23 years, respectively) attending a course lecture on ‘Coping with Depression’ in March 1979. Group 2 consisted of 15 people (10 m, 5 f, mean ages 27 and 34 years, respectively) attending an evening lecture on depression sponsored by the Goldsmith’s College Psychology Society in May 1979. Group 3 consisted of 13 first year clinical psychology postgraduate studients (4 rn, 9 f, mean ages 25 and 24 years, respectively) on the M.Phil. course at the London Univer- sity Institute of Psychiatry attending a course lecture on research design in May 1979.

376 VICKY RIPPERE

Materials

A single-page ‘Factors in Depression’ questionnaire was used, which consisted of 10 forced-choice pairs of statements (text in Tablel) regarding various aspects of depression represented in the historical canon of advice on melancholy. One statement in each pair represented the historical view of the matter in question and the other its negation. One statement was labelled a and the other b and the distribution of positive and negative statements in the first position was randomised. Ss were asked for each pair to “indicate by circling the letter a or b which of the two is more nearly the truth as far as you are concerned”. Alongside each letter in the lefthand margin was a short line upon which Ss were then asked to “write a number from 0 to 100 to show what proportion of the present group you estimate will select each member of the pair. The two numbers for each pair should, of course, add up to 100%“.

The questionnaire was to be completed anonymously, but Ss were asked to indicate age, sex, and occupation.

Procedure and design

The study was designed to investigate the degree to which groups of contemporary people would be in agreement with historically-derived views about depression, its causes and prevention, and to examine Ss’ ability to predict the degree of consensus shown by people in the group they happened to be in when endorsing the propositions. The two replications were intended as a check on the generality of the initial findings using differently constituted’groups. In the social context within which the data were collected, the studies served to introduce two of the audiences (Groups 1 and 2) to the sorts of issues that the lecture they were about to hear would deal with and to demonstrate to the third the priinciple of using successive replications in circumstances where ascertaining retest reliability of the data is unfeasible. The questionnaires were administered during the first few minutes of the lecture period and followed up with an explanation of what the exercise was in aid of during the lecture.

RESULTS

Quantitative

The 10 pairs of study propositions are given in Table 1 along with (a) the observed percentages of Ss in each group endorsing them; (b) the average of Ss’ estimates of the proportions of people in the group who would endorse them. The data are arranged within category by groups (rather than within groups by category as in the 1980a study) for ease of comparison. Propositions marked with an asterisk are those which represent the neoclassical view. With regard to the observed percentages, it will be seen from the Table that with the exception of items 4 (35x), 7 (25.12%) and 10 (21.54x), the amount of variation between the three groups in their endorsement of the proportions is relatively small, being under 20%. Spearman rank order correlations between the three sets of data, while failing to reach the critical value of 0.564 in two of three cases (IS observed %: Group l/Group 2 = +0.382, N.S.; Group l/Group 3 = +0.455, N.S.; Group 2/ Group 3 = +0.603, p < 0.5) are all clearly positive. This inter-group consistency suggests both that the general trend of consensus is a fairly robust phenomenon, since it tends to hold up across differently constituted groups, and that the groups chosen are in fact somewhat differently constituted.

With regard to the mean estimated percentages, the most striking finding is that the inter-group differences are smaller than the inter-group observed percentage differences in nine of ten cases. If the two sets of differences are treated as matched pairs, the difference is highly significant by the Wilcoxon test (n = 10, T = 1, p < 0.005). The greater inter-group consistency in average estimates is reflected in the higher intercorrela- tions between the three sets of data (rs mean estimated y0 = Group l/Group 2 = +0.776, p c 0.01; Group l/Group 3 = +0.927, p < 0.01; Group 2/Group 3 = +0.661, p < 0.05), all of which reach statistical significance. The finding that the Ss’ mean esti-

Tab

le

I.

Obs

erve

d an

d m

ean

estim

ated

pe

rcen

tage

s of

sub

ject

s en

dors

ing

prop

ositi

ons

s,

Obs

erve

d pe

rcen

tage

s M

ean

estim

ated

il

Gro

up

I G

roup

2

Gro

up

3 pe

rcen

tage

s 5.

It

em

(n =

36)

(n

=

IS)

(n =

13

) G

roup

t

Gro

up

2 G

roup

3

6

la.

*Som

e ty

pes

of p

eopl

e ar

e m

ore

likel

y th

an

othe

rs

to b

ecom

e de

pres

sed

a

b.

83.3

3 10

0.00

92

.31

74.5

8 80

.50

78.0

8 B

T

he c

hanc

es

of b

ecom

ing

depr

esse

d ar

e pr

etty

m

uch

the

sam

e fo

r ev

eryo

ne

16.6

6 0.

00

a 2a

. 7.

69

25.4

2 19

.50

21.9

2 T

he w

ay p

eopl

e liv

e is

not

an

impo

rtan

t fa

ctor

in

whe

ther

or

not

th

ey g

et d

epre

ssed

11

.11

13.3

3 3.

b.

15.3

8 *T

he w

ay p

eopl

e liv

e ca

n be

an

impo

rtan

t fa

ctor

in

whe

ther

or

not

the

y ge

t de

pres

sed

32.5

0 33

.93

23.1

5 0

88.8

8 86

.66

2 3a

. 84

.62

67.5

0 67

.07

76.8

5 *T

he w

eath

er

and

clim

ate

can

affe

ct p

eopl

e’s

liabi

lity

to d

epre

ssio

n 83

.33

66.6

6 b.

84

.62

54.7

2 43

.93

50.3

8 3,

Pe

ople

’s l

iabi

lity

to d

epre

ssio

n is

gen

eral

ly

unaf

fect

ed

by t

he w

eath

er

and

clim

ate

4a.

16.6

6 33

.33

IS.3

8 45

.28

56.0

7 49

.62

8 T

he a

mou

nt

of s

leep

a p

erso

n ge

ts i

s pr

obab

ly

unre

late

d to

whe

ther

or

not

he

get

s de

pres

sed

41.6

6 6.

66

7.69

42

.92

44.2

9 39

.23

b.

*Los

s of

sle

ep c

an h

elp

brin

g on

a d

epre

ssio

n an

d ob

tain

ing

adeq

uate

sl

eep

can

help

pre

vent

it

58.3

3 93

.33

92.3

1 1

5a.

57.0

8 55

.71

60.7

7 A

per

son’

s di

et i

s pr

obab

ly_g

nrel

ated

to

whe

ther

or

not

he

get

s de

pres

sed

22.2

2 20

.00

8

b.

7.69

43

.47

43.9

3 46

.54

*An

impr

oper

di

et c

an h

elp

brin

g on

a d

epre

ssio

n an

d a

prop

er

diet

can

hel

p pr

otec

t pe

ople

fr

om i

t B

6a.

17.7

7 80

.00

92.3

1 56

.53

56.0

7 53

.46

The

am

ount

of

exe

rcis

e a

pers

on

gets

is

prob

ably

un

rela

ted

to w

heth

er

or n

ot

he g

ets

depr

esse

d 41

.66

33.3

3 30

.77

I?

b.

47.2

2 55

.00

55.0

0 *i

nsuM

ent

exer

cise

ca

n he

lp b

ring

on

a d

epre

ssio

n an

d su

ffic

ient

ex

erci

se

can

help

pre

vent

it

58.3

3 66

.66

69.2

3 g

7a

52.7

8 45

.00

45.0

0 *A

n ac

tive

pers

on

is l

ess

likel

y to

get

dep

ress

ed

than

on

e w

ho i

s id

le

69.4

4 86

.66

61.5

4 P

b.

60.2

8 61

.07

61.9

2 A

per

son’

s am

ount

of

act

ivity

is

unl

ikel

y to

con

trib

ute

muc

h to

whe

ther

or

not

he

get

s de

pres

sed

30.5

5 13

.33

38.4

6 A

8a.

39.7

2 38

.93

38.0

8 *K

eepi

ng

one’

s bo

wel

s re

gula

r is

im

port

ant

in p

reve

ntin

g de

pres

sion

22

.22

13.3

3 15

.46

4 b.

31

.81

32.8

6 28

.85

Kee

ping

on

e’s

bow

els

regu

lar

has

little

to

do w

ith p

reve

ntin

g de

pres

sion

9a

. 77

.77

86.6

6 84

.62

68.1

9 67

.14

71.1

5 A

phi

loso

phic

al

outlo

ok

isn’

t re

ally

muc

h us

e w

hen

thin

gs

go w

rong

in

one

’s l

ife

g

b.

25.0

0 26

.66

15.3

8 36

.81

45.3

6 35

.38

_ e *A

phi

loso

phic

al

outlo

ok

may

hel

p a

pers

on

whe

n th

ings

go

wro

ng

in h

is l

ife

IOa.

75

.00

73.3

3 84

.62

63.1

9 54

.64

64.6

2 *K

eepi

ng

a ch

eck

on o

ne’s

em

otio

ns

may

be

help

ful

in p

reve

ntin

g de

pres

sion

a

b.

50.0

0 40

.00

61.5

4 50

.56

49.6

4 52

.31

Kee

ping

a

chec

k on

one

’s e

mot

ions

is

not

m

uch

use

in p

reve

ntin

g de

pres

sion

u

50.0

0 60

.00

38.4

6 49

.44

50.3

6 47

.69

;il

1.

8

378 VICKY RIPPERE

Table 2. Spearman rank order correlations between observed and

mean estimated percentages

Group 1 Group 2 Group 3

i-s +0.615 +0.739 - 0.062 P < 0.05 < 0.05 N.S.

mates are more homogeneous than their observed pattern of endorsements is similar to the results of the earlier study in which Ss were asked to predict their groups’ patterns of consensus (Rippere, 1980a) and strengthens the suggestion, made earlier, that Ss in the various groups shared a common cognitive map of propositions belonging to this domain of discourse. The consistency of this finding from a selection of contemporary propositions to a selection of historically-derived ones suggests, further, that both sets are subject to the same principles of cognitive processing.

Table 2 shows the Spearman rank order correlations between the observed and mean predicted percentages for all three groups. Two aspects of the table are of interest. The first is the finding that in Groups 1 and 2 high, positive, significant correlations of approximately the same order of magnitude were found. This finding is consistent with the results of all the earlier studies of predictive accuracy in the present series. The second is that in Group 3, whose observed performance and average predictions were closely similar to those of the other two groups, the observed correlation is negative, near zero, and non-significant and is the first and, to date, only such finding in the series.

How is this anomalous result to be explained? The answer to this question would seem to reside in the social and temporal context in which the data were collected. The study was carried out towards the end of the third academic term, at which time the students on the course were actively engaged in preparing for written examinations. One of the topics to be covered for this purpose was contemporary psychological approaches to depression. Thus the students’ prior common sense knowledge of depression had recently been or was presently being subjected to massive supplementation with new, technical material, which led to a revision of the students’ views about certain aspects of depression. Some evidence. to support this suggestion is found in the three items where the strength of Group 3’s consensus was at least 10% stronger than that observed in either of the two undergraduate groups. These are items 5b, endorsed by over 92% of Group 3, but by only 78% of Group 1 and 80% of Group 2 (rounded figures), concerning the effects of proper and improper diet on susceptibility to depression. The group’s stronger endorsement of this item reflects their recent exposure to formal instruction in academic organic psychiatry, on the one hand, and to informal exposure to local climate of opinion in which nutritional approaches to prophylaxis and treatment of mental disorders are gaining credence. The group’s stronger endorsement (85% vs 75% for Group 1 and 73% for Group 2) of items 9b (“A philosophical outlook may help a person when things go wrong in his life”), and of 10a (“Keeping a check on one’s emotions may be helpful in preventing depression”)--endorsed by 62% of Group 3 vs 50% of Group 1 and 40% of GrouR 2--reflects their involvement with cognitive approaches to depression (e.g., Beck, 1976).

However, the group’s participation in these sorts of ideas has evidently not signifi- cantly affected their prior, more widely shared cognitive map of the way the study propositions are represented in general consensus, since their mean estimates on these items are virtually identical with those of the other two groups. The differences between the Ss’ personal beliefs and the pattern of beliefs they attribute to others observed in the case of these three propositions provides informal confirmation of the notion which has been tested in earlier studies, viz. that Ss’ predictions of their peers’ responses are inde- pendent of their own personal feelings about the matter in question. That is, they do not arrive at their predictions by simply assuming others to view things as they do them-


selves: in addition to their own first-order views, people would seem to possess a separate mental representation of the way the matter in question is viewed in society at large.

Qualitative

Having considered the extent to which the three subject groups were in agreement with each other about the study propositions, we may now examine the degree to which their consensual endorsements supported the neoclassical canon of antidepressive advice. In this context, consensus may be operationally defined as endorsement of a proposition by over 50% of the group, such that the higher the percentage of people in the group endorsing the proposition, the stronger the consensus. In view of the observed differences between groups, let us first consider them separately.

In Group 1, a majority of Ss endorsed nine of ten propositions and were equally divided in their views on both members of a tenth (10a and b) pair. Of the nine in which consensus was found eight (la, 2b, 3a, 4b, 5b, 6b, 7a, 9b) were in accordance with neoclassical views. Thus a substantial majority of Ss were in agreement with a substantial proportion of the historical canon of advice and in disagreement with only one prop osition (8s).

In Group 2, Ss showed consensus in all ten cases. Their views were in accordance with the historical canon in the same eight cases as with Group 1 and in disagreement both with proposition 8, with which the first group also disagreed and with 10, on which the views of Group 1 were divided.

Group 3 likewise showed consensus in all ten cases. A majority endorsed the same eight historical propositions as the other two groups and agreed in disagreeing with the historical position about 8. However, on the tenth item, whereas Group 1 was divided and Group 2 came down against the historical view, Group 3 endorsed the historical position by a small majority. Thus in 90% of cases this Group’s consensus supported the historical canon of advice.

For purposes of discussing the collective view of the total sample of 64 Ss, the original numbers endorsing the propositions have been extracted and new collective percentages calculated. When this is done, the pattern remains essentially unchanged, but the aver- aged figures are more representative. Ss show consensus on nine of ten statements, eight of which are consistent with the historical canon (which is marked with an asterisk). In order of degree of consensus, we find the following (% consensus in brackets)

1. *Some types of people are more likely than others to become depressed (89.06%) (item la).

2. *The way people live can be an important factor in whether or not they get depressed (87.5%) (item 2b).

3. *An improper diet can help bring on a depression and a proper diet can help protect people from it (81.25%) (item 5b). Keeping one’s bowels regular has little to do with preventing depression (81.25%) (item 8b).

4. *The weather and climate can affect people’s liability to depression (79.69%) (item 3a).

5. *A philosophical outlook may help a person when things go wrong in his life (76.56%) (item 9b).

6. *Loss of sleep can help bring on a depression and obtaining adequate sleep can help prevent it (73.44%) (item 4b).

7. *An active person is less likely to get depressed than one who is idle (71.88%) (item 7a).

8. *Insufficient exercise can help bring on a depression and sufficient exercise can help prevent it (62.50%) (item 6b).

9. *Keeping a check on one’s emotions may be helpful in preventing depression (50%) (item 1 Oa). Keeping a check on one’s emotions is not much use in preventing depression (50%) (item 1 Ob).

380 VICKY RIPPERE

From this summary it appears that many of the general beliefs about the nature, causes, and prevention of melancholia that constituted the neoclassical canon of advice which vernacular medical writers bequeathed to the English-speaking public in the 16th and 17th century are still current today. Only the old belief in the importance of maintaining regular bowel function constitutes a matter of clear disagreement for these Ss.

DISCUSSION

From a quantitative point of view, the two main findings of interest in the present study are the highly accurate predictions by two of the three subject groups of their own patterns of consensus regarding the historical propositions and the disjunction between the inaccuracy of the third group’s prediction and the similarity of its mean predictions to those of the other groups.

The first finding is consistent with the results of earlier work with contemporary propositions and suggests that separate principles are not required to account for the subjects’ performance with ‘historical’ and ‘contemporary’ materials. Descriptively different in their origins as the two may be, they would appear to be subject to the same sort of cognitive processing.

The second finding, while partly inconsistent with previous results, is nonetheless instructive, since it suggests that the Ss’ cognitive map of this terrain, which serves as the basis for their predictions, exists prior to and more or less independently of their own- relatively more mutable-beliefs about the matters in questions. The close agreement in mean predictions across all three groups confirms the earlier suggestion that Ss come to the task already equipped with a common cognitive map of the domain and that in making their predictions they refer to this shared, general, a priori schema rather than to a fund of particular knowledge about the group they happen to be in at the time (Rippere, 1980a). Thus it is. probably fair to say that with regard to at least certain socially salient topics, people share not one but two sets of beliefs. At the first level are their own personal, substantive views on a subject, which represent a choice from an array of socially validated alternatives (normally pro, contra, and undecided) and which are not necessarily consensual for any particular individual, since it is possible for someone to endorse a minority view. At the second level is their-normally-consensual view about the relative frequency with which these positions are held by others in the social milieu. Not everyone need share the vie.w of the majority but most would share the common knowledge of what view it is that the majority shares. As Jarvie (1972) has written, it seems that people’s “mental map of the social world.. . is largely about other people’s mental maps” (p. 162).

The observed similarity between the three groups’ mean predictions constitutes an empirical demonstration of the sociological notion of ‘common culture’, as described by Garfinkel (1972). In his essay on “Common Sense Knowledge of Social Structures”, originally published in 1962, he writes:

“Sociologically speaking ‘common culture’ refers to the socially sanctioned grounds of inference and action that people use in their everyday affairs and which they assume that other members of the group use in the same way. Socially-sanctioned-facts-of-life-in-socthe- society-knows depict such matters as conduct of family life; market organiz- ation; distributions of motives among members; frequency, causes ox and remedies for trouble; and the presence of good or evil purposes behind the apparent workings of things. Such socially sanctioned facts of social life con- sist of descriptions from the point of view of the collectivity member’s inter- ests in the management of his practical affairs” (p. 356, italics mine).

Although Garfinkel’s interest in these phenomena is sociological rather than psychological, his characterization of them is certainly apposite in the present context, particularly his stress on the pragmatic focus of these social facts.

Historical dimensions of commonsenSe knowledge about depression 381

The pragmatic character of the facts of common culture is probably the most important factor contributing to the main substantive finding of the present enquiry, viz. that the majority of Ss studied in 1979 endorsed eight of the ten neoclassical propositions depresssion introduced to the English-speaking world in the 16th century under the aegis of the now long-obsolete theory of the four humours. If a substantial core of beliefs, which were once represented as deriving from theory, nevertheless survive in the contemporary social stock of knowledge, something other than appeal to authority is required to explain their persistence, particularly since quite a few of them are not currently represented in the teachings of orthodox Western psychiatry. One very likely explanation for their continuous survival would seem to be that many of them were in the first instance derived inductively from empirical observation rather than deductively from theory and that, since they pertain to highly salient and readily accessible aspects of daily life, it is open to anyone to repeat and confirm the observations in his own daily experience, both at first and second hand.

Thus from personal observation and experience, ‘everybody knows’ (and those who don’t believe the dictates of common sense can find out for themselves) that a grey day can induce feelings of lethargy and gloom and that a bright spring day is more enlivening than a nasty, cold, wet winter afternoon. Similarly, people can observe the effects on their own wellbeing of what they eat or the relative amounts of sleep or exercise or activity they obtain. They can reflect upon their reaction to losses and disappointments and test whether they have found it more beneficial to say “Oh well, such things do happen” or “It’s so terrible that I shall never recover”. And they can observe whether some seem more likely to get depressed than others and whether their liability to depression seems to have any correlates in visible aspects of their lifestyle. And they can do these things without benefit of formal academic instruction in psychiatry or abnormal psychology because to do so, to test and evaluate the dicta of common sense and reaffirm the pragmatics of recipes for the formulation and management of everyday life is what much of everyday life is all about.

But the pragmatic character of these facts of common culture may also have influenced the findings in another, more indirect way. The study was conducted at a time when many of the ideas of ancient Greek medicine, which have remained in circulation in the social stock of knowledge, are being subjected to empirical verification in widely-flung corners of the medical and scientific community. News of these developments features from time to time in the popular press, and numerous popular books are appearing which aim to bring the findings to a wider audience. Let us briefly consider a few of these developments.

Constitution

The notion of constitutional differences in physique, temperament and liability to particular forms of pathology has enjoyed a certain currency in psychiatry throughout the 20th century, through the work of investigators such as Kretschmer (1926) and Sheldon (Sheldon, Stevens and Tucker, 1940; Sheldon and Stevens, 1942). It is in the ostensibly physically-based personality typology of Eysenck, however, available to the public in the form of a convenient paperback self-knowledge kit (Eysenck and Wilson, 1976) that the notion has achieved widespread popularity.

A related development has occurred in medicine. Rees wrote in 1960:

“In recent years greater interest has again been taken in the constitutional factors in disease and this has been greatly stimulated by the marked preva- lence at the present time of the so-called stress diseases or psychosomatic disorders in which constitution appears to play an important role” (Rees, 1960).

Probably the best-known of the present-day medical typologies is the ‘Type A’ behaviour found to be associated with certain forms of heart disease (Friedman and Rosenman,

382 VICKY RIPPERE

1974), but Watson’s (1976) so-called rapid and slow oxidiser psychochemical types implicated in adverse dietary reactions could also be mentioned.

Climate

In the field of the effects of climate on health there is also evidence of a recent resurgence of interest, readably described by Thomson (1979) in his book, A Change of Air, which is subtitled ‘Climate and Health’. There he notes that after a long history the notion of climatic effects on health fell into disuse, but is now regaining ground. In the chapter ‘Climate and the Psyche’ he quotes a variety of evidence, mainly as yet anecdotal, regarding the effects of weather on depression. Though the evidence for such effects in psychiatric disorders does not yet match that for physical disorders such as repiratory complaints, there is a suggestion that further research in the area might corroborate many of the conclusions that generations of people have drawn from their own experience.

Sleep

One of the by-products of the post-war spurt of interest in defining the nature of sleep has been a new generation of books offering the public advice on ways of attaining it, preferably without recourse to pharmaceuticals (e.g. Lute and Segal, 1970; Heard 1972; Anon., 1972; Rubenstein, 1974; Coates and Thoresen, 1977; Tyrer, 1978). Much of the advice is straightforwardly behavioural-ensure proper physical conditions for sleeping, avoid upset at bedtime--and is reminiscent of the counsels of the 16th century writers. While not concentrating on depression in particular, most authors, like the ancients stress the importance for ensuring physical and mental well-being of obtaining adequate sleep, and also the fact that different people may require sleep in different amounts.

Exercise

The recent awakening of interest in exercise among the affluent Western middle classes would seem to derive from two main sources: its ostensible role in the prevention of certain forms of heart disease and in the reduction of overweight. Though to date the burgeoning literature available in paperback shops and public libraries is concerned with the promotion of health, generally, and fitness and slimness in particular (e.g. Roby and Davis, 1970; Nottidge and Lamplugh, 1970; Shelton, 1971; Fewster, 1973; Cooper, 1968, 1970; Cooper and Cooper, 1973; King and Herzig, 1974; Watson, 1975; Getchell, 1976; Ford, 1976; Pontefract, 1979) rather than depression, some work at the University of Wisconsin, as yet unpublished, has examined running as a treatment for depression (Murray, 1979).

Nutrition and diet

It is undoubtedly in the area of dietary influences upon health and disease that the greatest amount of medical rediscovery and discovery and then popularisation have taken place. As Williams and his co-workers (1979) have written:

“There is. . . a rapidly growing grass roots interest in ,better nutrition on the part of millions of people as is evidenced by the multiplication of health food stores, the sale of food supplements, and the publication of numerous books and magazine articles dealing with health and nutrition” (p. 9).

In some areas of active work, such as research on the role of dietary fibre in preventing many of the ‘diseases of civilisation’ (Stanway, 1976), depression per se has not been implicated. But in many of the other areas, depression is often cited as a ‘mental’ con- dition that can not infrequently be shown to depend upon dietary factors, either in the form of an insufficiency of important nutrients or in the form of an excess in the frequency of consumption of certain foods. The areas of enquiry in which depression is most commonly cited are: work arising from Williams’ (1956) concept of biochemical individuality in people’s needs for certain nutrients; related work under the aegis of


Pauling’s (1968) concept of orthomolecular psychiatry, and, finally, work devolving primarily from Rinkel’s (1944) concept of masked food allergy, as elaborated by Randolph (1976). But besides books which treat either primarily or in particular chapters the role of nutritional and dietary factors in the promotion of mental well-being and prevention of disorder (e.g. Hoffer and Osmond, 1966; Blaine, 1974; Feingold, 1974; Pfeiffer, 1975; Fredericks, 1976; Mackarness, 1976a; Cheraskin, Ringsdorf and Brecher, 1976; Watson, 1976; Pfeiffer, 1977; Eagle, 1979), there are also numerous works of a more general character which deal with the role of diet in health and disease (e.g. Davis, 1961, 1966; Cheraskin and Ringsdorf, 1971; Williams, 1973; Fredericks, 1974; Cheraskin, Ringsdorf and Clark, 1977; Hoffer and Walker, 1978) and many also on the role of diet in the treatment of particular disorders, including acne (Hoehn, 1977); arthritis (Dong and Banks, 1974, 1976); bronchitis (Moyle, 1969); cancer (Culbert, 1976; Newbold, 1979); the common cold (Pauling, 1970); constipation (Wade, 1976; Moyle, 1976; Hill, 1976; Adams and Murray, 1977); ‘flu (Pauling, 1976); functional hypoglycemia (Fredericks and Good- man, 1969 ; Abrahamson and Pezet, 197 1; Steincrohn, 1973 ; Davis, 1974; Adams and Murray, 1975; Duffy, 1975; Weller and Boylan, 1977; Martin, 1978); and obesity (Adams, 1972; Mackarness, 1976b), among others. These books, which represent only a small fraction of the popular literature that is currently in circulation, attest the vitality of the proposition that diet may play a significant role in the genesis and treatment of disorder.

In view of the current revival which many of the basic ideas in the classical canon of views on depression are enjoying it is hardly surprising that our subjects were able to demonstrate such an awareness of the extent to which these beliefs are presently shared by other members of the culture. Their ability to do so, independently of whether they personally happen to agree with any particular idea in the canon, is what establishes the beliefs as part of living culture-what Thomas Carlyle once inelegantly termed “the main thinking furniture of every head”. One of the factors which must contribute to this ability is the length of time these beliefs have belonged to the traditional heritage of socially- shared ideas informing that culture, their continuity over generations. To understand the culture, we must neglect neither its continuities-indeed, as Gombrich (1969) has noted “the study of culture is largely the study of continuities” (p. 93~nor the discontinuities, salient or subtle, which distinguish its psychological, as opposed to political, economic, or social, epochs. The decline of the ancient theory of humoral pathology, which for milennia provided the rationality of the canon of beliefs regarding melancholy, is one such discontinuity. But even the most modern, up-to-date, biochemical theories of depression as a disorder of neurohumoral transmission, which provides, if not full-scale rationality then at least an inferential basis of plausibility for many contemporary beliefs (including those regarding the role of sleep and nutrition in depression) bears a certain family resemblance to its departed ancestor. As Curtius (1953) has remarked, “tradition is a vast passing away and renewal” (p. 393), and we stand to improve our understanding of the life of our culture by attending to the traces it leaves on the cognitive palimpsest of every day life.

REFERENCES

ABRAHAMSON E. M. and &ET A. W. (1971) Body, Mind and Sugar. Pyramid Books, New York. ADAMS R. (1972) Did You Eoer See a Far Squirrel? Rodale Press, Emmaus, PA. ADAMS R. and MURRAY F. (1975) Is Low Mood Sugar Making You a Nutritional Cripple? Larchmont Books.

New York. ADAMS R. and MURRAY F. (1977) The New High Fibre Approach to Relieaing Constipation Naturally. Larch-

mont Books, New York. ANONYMOUS (1972) Sound Sleep. New English Library, London. BECK A. T. (1976) Cogniriw Therapy and rhe Emotional Disorders. International Universities Press, New York. BLAINE T. R. (1974) Mental Healrh Through Nutrition. Citadel Press. New York. BRIGHT T. (1940) A Treatise ofMelancholie. Reproduced from the 1586 edition printed by Thomas Vautrollier.

with an introduction by Hardin Craig. Columbia University Press, New York. CHERASKIN E. and RINGSD~RF W. M. (1971) New Hope for Incurable Diseases. Arco Books, New York. CHERASKIN E.. RINGSWRF W. M. & BRECHER A. (1976) Psychodiererics. Bantam Books, New York.

384 VICKY RIPPERE

CHERASKIN E., RINGSD~RF W. M. and CLARK J. W. (1977) Diet and Disease. Keats Publishing, New Canaan, cr.

COAXES T. J. and THORESEN C. E. (1977) How to SleepiBetter. A Drug-Free Program for Overcoming Insomnia. Prentice-Hall, Spectrum Books, Englewood Cliffs, NJ.

COOPER K. (1968) Aerobics. Bantam Books, New York. COOPER K. (1970) The New Aerobics. Bantam Books, New York. COOPER M. and CARPER K. (1973) Aerobics for Women. Bantam Books, New York. CULBERT M. L. (1976) Freedom from Cancer. ‘76 Press, Sea Beach, CA. CURTIUS E. R. (1953) European Literature and the Latin Middle Ages. Routledge & Kegan Paul London. D~vts A. (1961) Let’s Eat Right to Keep Fit. George Allen & Unwin, London. Dlrvts A. (1966) Let’s Get Well. George Allen & Unwin, London. Davts F. (1974) The Low Blood Sugar Cook Book. Bantam Books, New York. DONO C. H. and BANKS J. (1974) The Arthritics Cookbook. Hart-Davis, MacGibbon, London. DUNG C. H. and BANKS J. (1976) New Hope for the Arthritic. Hart-Davis, MacGibbon, London. Dum W. (1975) Sugar Blues. Warner Books, New York. EAGLE R. (1979) Eating and Allergy. Futura Books, London. EY~ENCK H. J. and WIL.S~N G. D. (1976) Know Your Own Personality. Penguin Books, Harmondsworth. FEINCDLD B. (1974) Why Your Child is Hyperactioe. Random House, New York. FEWSIZR A. (1973) Lose Weight and Live Normally with DIETEXERCISE. A Practical Course in Weight

Reduction for Business Executives. Pelham Books, London. FORD M. (1976) Keep Fit and Slimming Exercise in Pictures. Wolfe, London. FREDERICKS C. (1974) Eating Right for You. George Allen & Unwin, London. FREDERICKS C. (1976) Psvchonutrition. Grosset & Dunlap, New York. FREDERICKS C. and &~&AN H. (1969) Low Blood Sugar and You. Charter Books, New York. FRIEDMAN M. and ROSENMAN R. H. (1974) Type A Behauiour and Your Heart. Wildwood House, London. GARFINKEL H. (1972) Common sense knowledge of social structures: The documentary method of interpreta-

tion. In J. G. MANIS and B. N. MEL-IZER (Eds.), Symbolic Interaction-a Reader in Social Psychology. (Second Edition) pp. 356-378. Allyn & Bacon, Boston.

GEXHELL B. (1976) Physical Fitness. A Way of Life. John Wiley, London. C~MBRICH E. H. (1969) In Search of Cultural History. The Philip Maurice Deneke Lecture 1967. Clarendon

Press, Oxford. HEALY C. (1973) Methods of Fitness. Kaye & Ward, London. HEARD V. (1972) The Sleeo Game. How to Win a Niaht’s Rest. Thorsons, London. HILL R. (1976) bran and &her Natural Aids to Intestinal Fitness. Thorsons, Wellingborough. H~EHN G. (1977) Acne Can Be Cured. Arco Books, New York. HOFFER A. and OSMOND H. (1966) How to Liw with Schizophrenia. Johnson, London. H~FFER A. and WALKER M. (1978) Orthomolecular Nutrition. A New Lifestyle for Super Good Health. Keats

Publishing, New Canaan, CT. JARVIE I. G. (1972) Concepts and Society. Routledge & Kegan Paul London. KING F. and HERZIG W. F. (1974) Keep Fit, Stay Young. Simple Exercisesfor the Health and Well Being of Men

and Women Over Sixty. George Allen & Unwin, London. KRETSC!HMER E. (1926) Physique and Character. Harcourt Brace, New York. LEMNIUS L. (1576) The Touchstone of Complexions. Thomas Barth, London. LUCE G. G. and SEGAL J. (1970) Insomnia The Guide for Troubled Sleepers. Longmans, London. MACKARNESS R. (1976a) Not All in the Mind. Pan, London. MACKARNES R. (1976b) Eat Fat and Grow Slim (Second Edition) Fontana/Collins, London. MARTIN C. G. (1978) Low Blood Sugar. The Hidden Menace of Hypoglycemia. Arco Books, New York. MOYLE A. (1969) Chronic Bronchitis. Its Cause and Cure. Thorsons, London. MOYLE A. (1976) Conquering Constipation. The Natural Guide to Intestinal Health. Thorsons, Wellingborough. MURRAY R. (1979) A reappraisal of American psychiatry. Lancer i, 255-258. NEWEQLD H. K. (1979) Vitamin C against Cancer. Stein & Day, New York. NOTTIDGE P. and LAMPLUGH D. (1970) Slimnastics. Angus & Robertson, London. PAULING L. (1968) Orthomolecular psychiatry. Science 160. 265-271. PAULING L. (1970) Vitamin C and the Common Cold. Freeman, San Francisco. PAUL.ING L. (1976) Vitamin C, the Common Cold and the ‘Flu. Freeman, San Francisco. PFEIFFER C. C. (1975) Mental and Elemental Nutrients. Keats Publishing, New Canaan, CT. PFEIFFER C. C. (1977) The Schizophrenias-Yours and Mine. Jove HBJ Books, New York. PON~EFRACT R. (Ed.) (1979) Feel Fit-Come Aliue. Oxford University Press, Oxford. REES L. (1960) Constitutional factors and abnormal behaviour. In H. J. EY~ENCK (Ed.) Handbook of Abnormal

Psychology. An Experimental Approach. pp. 344-392. Pitman Medical, London. RINKEL H. J. (1944) The role of food allergy in internal medicine. Ann. Allergy, 2, 115-124. RIPPERE V. (1977a) Some cognitive dimensions of antidepressive behaviour. Behau. Res. Ther. 15, 57-63. RIPPERE V. (1977b) ‘What’s the thing to do when you’re feeling depressed?-a pilot study. Behau. Res. Ther. 15,

185-191. RIPPERE V. (1977~) Commonsense beliefs about depression and antidepressive behaviour: a study of social

consensus. Behav. Res. Ther. 15, 465-473. RIPPERE V. (1979) Scaling the helpfulness of antidepressive activities. Behao. Res. Ther. 17. 439449. RIPPERE V. (1980a) Predicting consensus about propositions concerning depression and antidepressive behav-

iour: another dimension of commonsense knowledge. Behav. Res. Ther. 18, 79-86. RIPPERE V. (1980b) Predicting frequency, intensity and duration of other people’s self-reported depression.

Behau. Res. Ther. (in press). RIPPFXE V. (198Oc) Behavioural treatment of depression in historical perspective, in S. RACHMAN (Ed.) Contribu-

tions to Medical Psychology, Vol. 2, pp. 31-54. Pergamon Press, Oxford.


ROBY F. B., JR and DAVIS R. P. (1970) Jogging for Fitness and Weight Conrrol. W. B. Saunders. Philadelphia and London.

RUBINSTEIN H. (1974) The Complete Insomniac. Jonathan Cape, London. SHELDON W. H. and STEVENS S. S. (1942) 7he Variries of Temperament. Harper & Brothers, New York. SHELDON W. H., SEVENS S. S. and TUCKER W. B. (1940) The Varieties of Human Physique. Harper & Brothers,

New York. SHELTON H. M. (1971) Exercise. Natural Hygiene Press, Chicago. STANWAY A. (1976) Taking the Rough with rhe Smooth. Dietary Fibre and Your Health: o Medical Breakthrough.

Pan Books, London. STEINCROHN P. J. (1973) Low Blood Sugar. Allison & Busby, London. THOMSON W. A. R. (1979) A Change of Air. Climare and Healrh. Adam and Charles Black, London. TYRER P. (1978) Insomnia. Sheldon Press, London. WAM C. (1976) The Book o/Bran. Pyramid Books, New York. Warso~ B. (1975) Health and Fitness for the Owr Forties. Stanley PauL London. WATSON G. (1976) Nutrition and Your Mind. Coronet Books, London. WELLER C. and BOYLAN B. R. (1977) How to Live wirh Hypoglycemia. Jove HBS Books, New York. WILLIAMS R. J. (1956) Biochemical Indioiduoliry. John Wiley & Sons, New York. WILLIAM R. J. (1974) Nurrition Againsr Disease. Environmental Prewnrion. Bantam Books, New York. WILLIAMS R. J., HEFFLEY J. D., YEW M.-L., and BODE C. (1979) A renaissance of nutritional science is imminent.

In R. J. WILLIAMS and D. KALITA (Eds.) A Physician’s Handbook on Orthomolecular Medicine. pp. *IO. Keats Publishing New Canaan, CT.

some historical dimensions of commonsense knowledge about depression and antidepressive behaviour

Documents