A Systematic Investigation of Depression

,~ fie/PSYC}IOL~YNAMffC aspects o f ~dq)ression Ihav,e ,engag:ed t h e altea~tion

~'of x~a'iters since A b r a h a m s iiqrs~ explorat~on ,of ~he p r o b l e m in ilgll., a ~ h e
l.~sydaoantdytie literal-ure ,on this ~ub,j e ~ ]1as b e e n voluminous ,uad ~he ~folnn~da-
~ions have 'covered a w i d e range ,of ~ s y d l o a n a l y t i e ~eoncepts. As ~ndieated in
~t~e ,rect;n~ critical review ~by Mendelson, r ~he ,diverse,constructs h a v e !been ~oose-
ly defined and !the ,diagnostic ~erit.cria ,of ~det~ression ]lave ifluetuated x~id~ly.
In ,view .of t h e anultlplieity ,o1 ~he ,observations :and theol~ies a d v a n c e d to
exa)]ain ,depression, it is ,important ~o d e t e r m i n e w h i c h ,of these ,concepts a r e
specifieally tq)plicable to depression ;and ,which m a y s i m p l y daaracter~ze aaeurof
ic or psychotic .disorders, "generally, Moreover, at is possible ~hat some *of t h e
eoa,e ,conflicts a n d fixations p r e s u m e d to be associated witla depression m a y be
representative ~of t h e problems ~of a~ormal developmeaat and m a y h a v e a~o definite
pathological significance, ,except pea'haps ~in ~er.ms ;of q u a n t i t a t i v e ,differences.
A 'cr~ucial prob]em flint w a r r a n t s svste.matic s t u d y is whefl~er a n y psy<:ho-
,dya~amie p a t t e r n can be ;identified that is ~uniqudy ,tyl~ical o f d e p r e s s e d pat,ients.
T,he ,isolation of 'sudx a factor, o r fac:tors, m i g h t ~)e expected to c o n t r i b u t e clarity
~to ;the .understandii~g of depression .and p e r h a p s ~o its etiology. Of ,immediate
~intea'est dn this ,connection are t-we related ,concepts whid~ have :appeared con-
sistently ,in the literature ,on depression and are no teworflay :in t h a t . t h e y h a v e
n o t a c h i e v e d any c o m p a r a b l e p r o m i n e n c e in t h e literature on other conditions,
T h e s e two concepts are inverted l}ostility and guilti
A n earlier s t u d y of psychotic det~ressive xeactions in soldiers w h o h a d :acci-
dentally killed a comrade presented d a t a which s u p p o r t e d t h e i m p o r t a n c e at-
tributed .to inverted hosHlity a n d / o r 'guilt in depressions, e A .detailed examina-
tion of t h e ideational productions of these patients (dreams, hallucinations,
d a y d r e a m s , and obsessive ruminations ) revealed d e a r - c u t self-punitive themes.
In a tyl~ical ease, for example, the p a t i e n t hallucinated that t h e -dead b u d d y
w o u l d tall him to kill himself. T h e pat/ents uniformly expressed a desire for
p u n i s h m e n t ~or their deeds. T h e r e was some evidence in ead~ case that t h e pa-
~ e n t had f e l t a great~ deal of hostility to the b u d d y prior {oo~is being s h o t : a n d
t.h. .a.t. . he
. . subse q uentl Y tun~ed ..... .the
. . . an g el" !ag ainst
. . . . .himseif
. . Althou
..... g h.this
. . . . .type o f
pathological reaction occurred i n relation to a highly unusual event, it seems
reasonable to .suspect tllat Similar meehanisms~ m i g h t b e operative in t h e less
d r a m a t i c aaeurotic-depressive reactions.seen in civilian practice.
ha a later study, a more methodologically refined t e d m i q u e w a s utilized t o
isolate p s y c h o d y n a m i c themes that m i g h t b e specific for depression.a~ B), focus-
iI~g o n a n easily defined datum, the d r e a m , it ~ras possible to ~ n p l o y . objective
scoring techniques~ a n d a p p l y a statistical appraisal to t h e results: T h e first 20

From the D~oartrnent ot Psycl~iatry, Univeraity of Pennstclvania and. tlie:Philadelphta

General Hospital.f This iinvestigation was supported by Research Grant M3358 Item a t e
Natio~zl h~titt~e~pf Mental Health, U. S: Public Health Service.
163
 l l'i | AARON T. BECK

,h,'.,,,~.', ~,t th'lm'SS~'d a n d n o n - d e p r e s s e d p a t i e n t s in [y)s c h o a n. .a. l. v t i c p s y c h o -

t l , , r a p ) xw.n, r e c o r d e d v e r b a t i m a n d s u b j e c t e d to c o n t e n t scoring.,.Tlae basis
~! t lu" ~corinK system was the ol~servation t h a t d e p r e s s e d patients r e p o r t e d an
~U~ll.~mllv. hiRll f r e q u e n c y of d r e a m s in w h i c h the d r e a m e r w a s t h e r e c i p i e n t of
,~,, ,l~ph.a~ant. tratnna, for exam. 1) ; I t ,1)h ,sical in'url Y', insult, re'eetion,j or. . . t. h. .w a r t -
in~. ( )n the l)asis . of. the. associations
. . . elicited in regrards to thes[~ecifie u n p l e a s a n t
, h , . a m d e m e n t s a n d also on the basis of the o t h e r elinicizl m a t e r i a l p r e d u c e d b y
t l., imtirld, it a p p e a r e d that these d r e a m s reflected a n e e d to suffer. T h e label
that .,,~.~,m,,~! most a p l m ) p r i a t e to d e s i g n a t e t h e s e d r e a m t h e m e s w a s the term
~as(wllistic'" ( e , n p ] m ' e d in its e m T e n t l , c o m m o n u s a g e to d e n o t e a t e n d e n c y
t~ s~.~.k s~dterin~ w i t h o u t a n y n e c e s s a r y c o n n o t a t i o n of d e r i v i n g sexual gratifica-
ti,., t,-~,,n this ). A j,utge w h o h a d no k n o w l e d g e of tim p a t i e n t s or their d i a g -
,,~s,.s ~¢.~,-c,d the r a n d o m i z e d d r e a m s blindly. A r e l i a b i l i t y d a e e k s h o w e d a h i g h
,h,ervc.. , , { .a ~ r v e m e n t b e t w e e n tlm. two raters. .(95 p e r c e n t ) .~ T h e seorin . g) r b - : t h e
"'i~lil,~l'" rat,.r n ' v e a h . d a significantly h i g h e r f r e q u e n c y Of mas0elfistie d r e a m s in
tl,, (h.lm,Ssccl ~rmq~ than in the m a t c h e d non-depressed group.
This finding was c o n s i d e r e d to be c o m p a t i b l e w i t h t h e f o r m u l a t i 0 n s of h0stil-
ilx aml b~llilt in depression althoug, la o t h e r a l t e r n a t i v e inter ~retations-wcre . . . . . . . . lg°S'-
sil,h.. A c~mq~arison ()f the t h e m e s in the m a s o c h i s t i c d r e a i n s with: Certain c h a r -
act(.ristk, s y m p t o m s a n d attitudes, in depressed. [)atients Shows hiterestin: g simi-
l;,rities. Th'e typical w a y in w h i c h the d e p r e s s e d p e r s o n : d e b a s e s himself,: exag-
g,'rah's his }ailtm.s anct minimizes his a c h i e v e m e n t s arid d e s i r e s : t o . i n j u r e : o r
kill I~imsdf may. b(' c o m p a r e d with the masochistic d r e a m t h e m e s : i n whiell tlle
~ l n , , m w r is & , l v , t s e d . fails to a c h i e v e w h a t he a t t e m p t s , killed.
In l | w masochistic d r e a m , the d r e a m e r !s g e n e r a l l y anocent
vu'tim {~i al)t~se. |n~stration or d i s a p p o i n t m e n t infliete
• --" ,
agency
O J

~, lwrso~ ~r b~ c i r c u m s t race. In contrast to this, in his Wakin:g:belmvi0r, the

imli'vid,,al ,,v~rth, inflicts pain upon hinaself.:~i6ilis sdf:-almse!:and
s,.if-tl,,,.a,-ti,,g. T h e reasons "for this p a r t i c u l a r c o n t r a s t b e t. w e. e n. : {he:~e0ntent:0f
. . . .
ll,, d r e a m a n d the a t t i t u d e s in t h e w a k i n g state are iio[ i l n m e d i a t e l y : : a p p a r e n t .
"I'1,,. d t e v ! o,~ the individual, h o w e v e r , is a b o u t the safiie; Wlmtllerii:-asleep::~b~•
awak(', h(" s~,fl(,rs.
T h e investigation r e p o r t e d in
in *t~a-,1~ ~ ' y - a n d -p-r-ovid e m o r e
pression. First, it: was necessar~
are specific for depressions. Seeo
w h e t h e r othe r types of ideational
Third, it w a s c o n s i d e r e d d e s i r a b
p r e s s e d p a t i e n t is m o t i v a t e d by
s e q u e n c e of the neurotic process.
F o u r different types of l)ehavior w e r e samplediin:.ordei~?t011:establisli:whetlmr
the m a s o c h i s t i c themes a r e p e r v a s i v e in t h e d e
the most r e c e n t d r e a m , t h e thi'ee earliest mere'(
t u r e d projective test, a n d the item c h o i c e s on a
.'I~| a~s article will s u m m a r i z e t h e results o f a
•

d e s i g n e d to test the h y p o t h e s i s l t l a a t there is a

 A SYS'I'F~IAT1C INVESTIGATION OF DEPRESSION 165

manifestations of the need to inflict suffering on the self and the clinical state of
depression. Tile individual studies referred to in this sunamary will be described
in greater detail in separate reports. Since t h e s e studies were initiated at dif-
ferent times, the technics used: are at different Stages of development and re-
finement,.and the size of the. . .patient,
. samples,, investigated varies accordingly.
Also, some of the studies-liaxre been completed while others are still i n the
earlier phases. Nonetheless, the data are considered adequate to present an
over-all description and appraisal of the major trends in the investigation.
MEaaloz)
Populatio~
The patients w e r e d r a w n ~from routine admissions to the psychiatric out-patient depart-
m e a t of t h e H o s p i t a l of file University of Pennsylvania, and t h e psyOfiatrie out,paHent and
psydfiatric in-patient S~rvice of fire P]filadelphia General Hospital.* T h e y received a com-
plete diagnostic appraisal, a n d i n a d d i t i o n , t h e following tests were administered: a .~hort
intelligence test, t h e d i g i t symbol test, an inventor), to m e a s u r e the d e p t h of depression, a
projective test d e s i g n e d to elicit masochistic t h e m e s , a n d an inventory containing :items
relevant to masodaiSm, hostility, a n d submission. In addition, e a c h . p a t i e n t was asked to re-
port h i s most r e c e n t d r e a m a n d his three earliest memories.

Clinical-Diagnostic Appraisal
F o u r experienced psychiatrists participated in t h e d i a g n o s t i c study; Before engaging in
the f o r m a l aspects of the investigation, the psychiatrists h a d a Series of preliminary n~eet-
ings d u r i n g whida filey discussed the various diagnostic c a t e g o r i e s a n d eventually re,~ched
a consensus r e g a r d i n g the specific criterla f0r each o f t h e nosological entities and f o r t h e
d e p t h of depression. 4
TO establish t h e d e g r e e of agreement, t h e psydfiatrists i n t e r v i e w e d 169. patients and
m a d e i n d e p e n d e n t j u d g m e n t s of the diagnosis and the: d e p t h of depression. All four
diagnosticians p a r t i c i p a t e d in the d o u b l e a s s e s s m e n t and were r a n d o m l y paired with one
another so flint each of tile p a t i e n t s was seen b y two diagnosticians.

The/ Del>ression- Inventory

I n d e p e n d e atly o f the d m g n o s t m m n s actlvltles, an i n v e n t o r y for naeasurang the d e p t h of
| • • * I o * • • . o " "

depression WaS developed.4 T h e ~ r a t i 0 n a l 6 f o r d6x, eloping a n i n v e n t o r y w a s that the.variabfl-

simism, self-hate; a gra-ded

series o f :tl]ree to range of
seVeiit y iof-fiie S)qllptonis": from ?Iieiltral ~[0 mdxiiiml.:' N u m e r i c a l Values (r0iil 0 tO 3 are as-
signed e a c h s t a t e m e n t :'to ifidieate t h e degree: o f severity: "

Measures: of, Masochism

i,:~iMost: r. e c .e ~ . ' d r. e a .~ i ~. T l.i e . ; most.
. . recent
. . . d r e a m w,qs collected, from tile p a t i e n t s - i n :a
 166 AAI'{ON T. BECK

report.a Tile reliability in the earlier s t u d y was shown to be high, t h e a g r e e m e n t b e t w e e n

t h e two raters a p p r o x i m a t i n g 95 per cent. T h e dreams collected in t h e current s t u d y w e r e
p r e s e n t e d w i t h o u t a n y i d e n t i f y i n g d a t a to two judges w h o scored the d r e a m i n d e p e n d e n t l y .
T h e i r level o f a g r e e m e n t was 9 6 , p e r cent a n d differences w e r e resolved b y the c o n f e r e n c e
meflmd.
9.. Earltq m e m o r i e s , ~ E a e h p a t i e n t was ask~:d according to a set r o u t i n e to r e p o r t his three
earliest memories. In most cases it was possible to obtain these three early memories.
A scoring m a n u a l to i d e n t i f y masochism in each early m e m o r y was d r a w n up. It was
f o l m d Lhat the same categories that were u s e d in scoring d r e a m s could b e a d a p t e d for
scoring the memories.
3. Focused/antas~l te.W.--Tilis test consists c~f a set of four 13icturc cards. E a c h card has
four " f r a m e s " which p o r t r a y a continuous s e q u e n c e of events. T h e action in the s e q u e n c e
centers essentially a r o u n d t w o figures w h o are sutlqciently similar to m a k e it equivocal
which figures ira one frame correspond to the figures in the s u b s e q u e n t frames. Only one of
the two figures appears in the first frame. In the last frame, one of the two figures is sub-
jected to an u n p l e a s a n t experience, while the other figure avoids the u n p l e a s a n t experience
or has a pleasant experience.
T h e subject is presented one of t h e pictures a n d then is asked to tell a story about the
seque~,ce. After listening to the story, the examiner d e t e r m i n e s w h i c h of the two characters
in the story r e c o u n t e d b y the subject is the main character or "'hero." T h e hero, b y definition,
is the character w h o is present in all four frames ira t h e story; i.e., he is identified as the
solitary figure in lhe first frame. T h e outcome is labeled as masochistic or non-masochistic
d e p e n d i n g upon w h e t h e r the hero or the se~.~ondary d m r a e t e r is identified with the figure
w h o is h u r t ira the final f r a m e (see fig. 1).
4. The masochism inventor~j.~This i n v e n t o r y consists of 46 items r e l e v a n t to the follow-
ing behaviors: nmsochism (20 items) : hostility (20 i t e m s ) ; a n d submission (6 i t e m s ) . T h e
items were primarily clinically derived. T h e masochism items were based on clinically ob-
served behaviors which were considered to be at least in part manifestations of a n e e d to

' 1

l 2 I

Fig. l . - - O n e o f a series o f four F o c u s e d Fantasy Test Cards u s e d a s a m e a s u r e

of masochism.
 A SYSTEMATIC ~INVEST]CATION OF DEPlltESSION 167

suffer a n d were observed in p a t i e n t s w h o w e r e n o t clinically depressed. E a c h i t e m in t h e

i n v e n t o r y consists o f a s t a t e m e n t w h i c h is read a l o u d to t h e p a t i e n t , w h o is t h e n asked to
select w h i c h o f five a l t e r n a t i v e p h r a s e s best c o m p l e t e t h e s t a t e m e n t . . T h e daoices of c~m-
pletion phrases are scored on a f r e q u e n c y dinaension as follows: n e v e r ( 0 ) , s o m e t i m e s ( 1 ),
often ( 2 ) , nsually ( 3 ) , always ( 4 ) ,

]:~ESULTS
Clinical-Diagnostic S t u d y
A group of 162 patients w e r e i n t e r v i e w e d b y pairs of the psychiatrists. T h e
a g r e e m e n t b e t w e e n the p a i r e d d i a g n o s t i c i a n s for the various sub-categories
( s c h i z o p h r e n i a , a n x i e t y reaction, n e u r o t i c d e p r e s s i v e reaction, etc.) was 56
per c e n t . T h e a g r e e m e n t on the specific category of n e u r o t i c d e p r e s s i v e reac-
tion was 58 per cent.
W h e n the d i a g n o s t i c i a n s m a d e their assessments of the d e g r e e of depression,
it was f o u n d t h a t t h e y m a d e identical ratings in 56 p e r c e n t of the cases a n d
w e r e one rating u n i t :apart in 43 per cent. T h u s in 9 9 p e r cent of the cases there
was no m o r e than one scale p o i n t difference in the ratings. A n o t e w o r t h y f e a t u r e
is that t h e d i a g n o s t i c i a n s a c h i e v e d the s a m e d e g r e e of exact a g r e e m e n t (56 per
c e n t ) w h e n m a k i n g clinical diagnoses ,as w h e n j u d g i n g the d e p t h of the de~
pression irrespective of the clinical diagnosis.
Depression. I n v e n t o r y
This i n s t r u m e n t was a d m i n i s t e r e d b y an i n t e r v i e w e r to a r a n d o m s a m p l e of
226 clinic a n d h o s p i t a l i z e d p s y c h i a t r i c patients. F o r purposes of replication,
a second s a m p l e of 183 cases was s u b j e c t e d to the s a m e p r o c e d u r e . It was
f o u n d that e a c h of the 21 s y m p t o m categories s h o w e d a significant relation to
the total score for t h e i n v e n t o r y ( p < 0.001). T h e split-half r e l i a b i l i t y s t u d y
y i e l d e d a coefficient of 0.93; the correlation b e t w e e n scores on the D e p r e s s i o n
I n v e n t o r y and the clinicians ~ratings of the d e p t h of depression was 0.67 ( p <
0.001) .*
M e a s u r e m e n t s of M a s o c h i s m ~
1. M o s t r e c e n t d r e a m . - T w o h u n d r e d eigl!ty-seven d e p r e s s e d a n d non-de-
p r e s s e d p s y c h i a t r i c p a t i e n t s w e r e i n c l u d e d i n t h i s p h a s e of t h e s t u d y . In 219
cases a s i n g l e m o s t r e c e n t d r e a m Was~c 0 1 1 e c t e d a n d s c o r e d b y t h e j u d g e s for
the p r e s e n c e o f m a s o c h i s t i c themes.: Previous studies establislaed t h a t the ap-

d r e a m s o c c u r r e d i n tlae m o s t d e p r e s s e d group' thanin the non-depressed roup

w h e n the chi s q u a r e t e c h n i q u e was used t0 e v a l u a t e the d i f f e r e n c e s ( p < 0.01 ).
s• e p a. .r.a. t. e. analyses
. . . . . . . . :Of t h e ~d i s t r i b u t i o .n.-. 0. .f. .thel
. . . . . d. .r e a m s acc0rdin
. . g ~ t o ' a, g e, sex;
- race, •
I Q, a n d social i n d e x i n d i c a t e d that these v a r i a b l e s did_not influence the results, a

. * A ; m o r e c o m p l e t e description o f t h e s e findings a r e r e p o r t e d in an article b y Beck et al.,:

" A n I n v e n t o r y for M e a s n r i n g Depression."3
 168 A A R O N T. a E c x

2. E a r l y memories. The verbal reports of 25 patients who reported their

,three earliest memories were analyzed blindly for the presence of masochistic
~hemes. It was found that the frequency of ~nasodaistic early memories reported
by patients in the depressed group was significantly higher than for patients ill
the non-depressed group. T h e association between the scores on the Depres-
sion Inventory and the frequency of masochistic early memories was evalu-
ated statistically by the Mann-'~Vhitney U Test 8 and found to be significant at
the 0.05 level.
3. Focused fantasy test. This test was administered to 87 patients. Since
four cards were used, the score for each patient ranged fl-om 0 to 4. The pa-
tients were divided according to their Depression Inventory scores into de-
pressed and non-depressed groups and ranked accordirag to the scores on the
Focused Fantasy Test. It was found that the scores were significantly higher
among the depressed than the non-depressed patients (p < 0.003, Mann-'~Vhit-
ney U Test).
4. liIasochism inoentory. This test was administered t o 109., patients. The
scores on the masochism items were then compared with the scores on the De-
pression Inventory. It was found that there was a correlation of 0,51 between
these two tests using the Spearman Rank Correlation (p <, 0.001).8 The cor-
relation between scores on the Depression Inventory and on the hostility, items
was substantially lower, tl~e coefficient being 0.24.
DISCUSSION
The generalizability of anv~ research fndings depends on ~the use of an ap-
propriate system for defining tlie experimental and the control groups. Since
the generally accepted practice in psychiatric treatment a11d research has been
to classify patients according to tile standard nomenclature, this approach was
studied to determine its specific suitability for the research study reported ill
this article. I t became clear that the high degree of Variability that •occurred ....
when the standard nomenclature was used precluded its utiliZation as a basis
for classification in this study
Although there was a high percentage of exact or near agreement on the clin-
:ical r a t i n g s of the depth of ¢lepression, that method of asSeSSinent :~could not
be :fully relied o n to provide a stable~ criterion 0 f d e p r e s s i 0 n ~ c a u s e ~ i t l w a s
highly: subject to ~.inconsistencies On the partl o f the:~ cliniCians.~i FUrthermore,
tl~ere was no assurance ~that:: otho~r clinicians aSSessingldepre~si0n.(W0uld ~Use
• the same indices. Hence, if the clinical ratings w e r e :used to:identify!i thelde-
pressed patients; a n y generalization emerginit from 0ur'studies: WoUld l~e limited
t o t h e s p e c i f i c patient sample rated by the
itiYthis study. It waS therefore considered [
strument w h i c h w o u l d provide a n opera
which b y virtue o f its stability could be u
felt that since this instrument Was sufficiently descriptive b .....
to attain a reasonably high correlation w i t h Clinical rating.,
pressi0n, it COuld b e u s e d as t h e s o l e criterion of depressic
.~ Even w i t h the problem of classification disposed of, the~
of issues to b e decided b e f o r e we can conclL~he t h a t these studies Confirm the
A SYS:IqE~IATIC IN~rESTIGATION ~OF D E I ' I ~ E S S I O N 169

hypothesis that there is a significant relationship betnveen masochism (,or t h e

need to suffer) and depression. It could be asser~ted, for example, that ~he un-
pleasant themes in dreams and .other matea-ial simply reflect the ~ml)leasant
subjective state of the depressed person and do not necessarily ~mp!y l h a t there
is a motivation to suffer. While our studies have not progressed far enough as
yet to answer this question definitely, w e have some preliminary data that is
worth noting. It has been found that a n u m b e r of patients report masodaistic
dreams with the same degree of f r e q u e n c y during relatively long symptom-/ree
periods between episodes of depression. Also it has been found that a n u m b e r
of individuals who have never been d e p r e s s e d b u t who show typical ~nasochistic
behaviors in their interpersonal rel~tSons report the masochistic dreams with .a
high degree of frequency. These observations suggest that masochistic dreams
could be best regarded as a r e l a t i v e l y persistent characteristic of individuals
who are prone to develop depression a n d m a y be more directly related to cer-
tain personality features of depression-pt'one individuals than to the s t a t e of
depression p e r se.
Another problem that needs to be settled in connection with interpreting the
results of the study is w h e t h e r the technics employed in:thls' study actually
m e a s u r e the construct, masodaism. In order to establisli t h e validity of the
various technics designed to measure this construct as well as the validity of the
construct itself, it is necessary to utilize a complicated, logical and empirical
approach, as outlined in the article on construct validity by C r o n b a c h and
Meehl. ~
Since there is no definitive criterion of masochism, it w a s necessary to make
a series of predictions based on t h e u n d e r l y i n g tlmory and to design tests a n d
experiments to confirm or disconfirm tt~ese predictions. In the Current study, it
was predicted a p r i o r i that the scores, on various tests which w e r e d e s i g n e d to
e l i c i t .a .certain
. . . t),pe of
. . response
. . ("masochistic") would correlate significantly
with m e a s u r e s Of depression. S i n c e tllese tests d e a l t w i t l i various forms and
levels of b e h a v i o r including dreams, nlemories, story telling; a n d self-reports
on an inventory, a fairly broad area of:behavior was tapped. T h e fact.that each
of tlmse measures slmwed a significant relati0nSllip tO depression is supp0rtSng
evidence for the hypothesis. H o w e v e r , more complete Confirmation: will d e p e n d
oi~ifurtller investigations, including tlm:h{tercorrelati6n and factor:analysis Of
the scores on these measureJ.
SUM~AR~
A series of related Studies w e r e designed t0 test t h e g e n e r a l h y p o t h e s i s t h a t
depressed patten h ave!a p~rSistent n~ed:::t0 SUffer In :order t o i denti~i t h e
de~resSedgroup~ a D e p r e s s i o n InVent0ry: was:de~;elSped andl found t6: I m v e a
Illg~I t ,.: d e g r.......
e e l.........
o f reliability
.... a......
nda . ............:eorrelati6n
.... . with
CliniCians' ratings of the d e p t h Of depression:
The: COncept of t h e need to ~suffer; or masochisin, :was operationally defined:
b y : a variety of ~easUres deSigised to refleCt:tiie manifeStation.~ o f masochistic
~endencies in t h e ideational: p r o d u c t i o n s of:patients: :It ix~as:'found:that thel de:
p~sSed group reported Significafitl~ m o r e masoclaistiC d r e a m s and :6arly: memo,
ties ~ i m n tlae ~n0n~de~ressed:group~i ai~d::Haat t l m masochism s c o r e s On t h e F o :
],70 AARON T. ,BECI~

c u s e d F a n t a s y T e s t a n d the M a s o c h i s m I n v e n t o r y w e r e also significantly h i g h e r

in t h e ,depressed group. T h e results ,of t h e s e studies s u p p o r t ~he hypothesis.

ACKNO~VLEDG~{ENTS
The author wishes to express his gratitude to Dr. Kenneth E. Appel for his inspiration
and support. The author also wishes to express his appreciation :1o the following for their
contributions to this invesligation: John Erbaugh, M.I)., Sc~,nnour Feshbadl, :Eh.t)., Marvin
Hurvich, Ph.D., Myer Mendelson, M.I)., John Mock, M.I)., Lyla Meek, A.B., Brij Sethi,
M.D., and Clyde Ward, M.D.

I:~EFERENCES
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investigation and treata~mut of manic- measuring depression. Arch. Gen. Psy-
depressive insanity and allied condi- chiat. 1961. In press.
tions. In Selected Papers on Psycho- 5. ~ , and ~ : Thematic content of dreams
analysis. New York, Basic Books, 1953. of depressed patients. Ardl. Gem
2. Beck, A. T., and Valin, S.: Psychotic de- Psychiat. In press.
pressive reactions in soldiers who ac- 6. Cronbach, L. J., and Meehl, P. E.: Con-
cidentally killed daeir buddies. Am. J. struct validity in psychological tests.
Psychiat. 110:347--353, 1953. Psychol. Bull. 52:281--302, 1955.
3. ~ , and Hurvich, M. S.: Psychological 7. Mendelson, M.: Psychoanalytic Concepts
correlates of depression. 1. Frequency of Depression. Springfield, 111., Charles
of "masochistic' dream content in a C Thomas, 1960.
private practice sample. Psychosom. 8, Siegel, S.: Nonpararnetrie Statistics for
Med. NS 2l:50-55, 1959. the Behavioral Sciences. New York,
4. ~ , \Vard, C. H., Mendelson, M., Mock, McGraw-Hill, 1956.

Dr. Aaron T. Beck, M.D., Assistanf Pro[essor of Psychiatry,

Ul~iversity of Pennsylvania; Chief el Section at the Philadel-
phia General Hospital; Member of the AlteT~ding Slaff at ~he
Institute of the Pennsylwtnia Hospital.