
Once upon a time, depression was generally seen as a purely psychological disturbance; these days, people are likely to think of it as a tidy biological syndrome. In fact, it’s hard to make sense of the distinction. Most depressive disorders are now thought to involve a mixture of reactive (so-called neurotic) factors and internal (“endogenous”) factors; depression is seldom a simple genetic disease or a simple response to external troubles. Resolving the biological and the psychological understanding of depression is as difficult as reconciling predestination and free will.