Depression and demoralization: Phenomenologic differences and research perspectives

Demoralization may be viewed as a combination of distress and subjective incompetence. The main problem in demoralization is the sense of incompetence experienced by the demoralized individual; this sense of incompetence results from uncertainty as to the appropriate direction of action. By contrast, the major difficulty in endogenomorphic depression is a decreased magnitude of motivation even when the appropriate direction of action is known. This distinction is important not only because demoralization appears to be a major public health problem, but also because subjective incompetence appears to influence the course and worsen the prognosis of both nonpsychiatric and psychiatric disorders.