Subjective Incompetence, the Clinical Hallmark of Demoralization John M. de Figueiredo and Jerome D. Frank zyxwvutsrqponmlkjihgfedcbaZYX A LL CONDITIONS psychotherapy attempts to relieve have in common demoralization.’ The purpose of this paper is to present our current thinking on the concept of demoralization. Previous research has shown that (1) persons less integrated in their social groups report more distress than those more integrated even when the former have fewer stressful life events than the latter;‘.3 (2) the former are also more likely to see a doctor or to be hospitalized for a physical illness than the latter;’ (3) the most common com- plaints of patients in psychotherapy are symptoms of demoralization;’ (4) complaints of migraine headaches and stomach pain often occur in the context of hopelessness and helplessness.’ Taken together, these findings suggest that demoralization is a major public health problem in its own right. whether or not the demoralized persons suffer from other conditions. This is made plau- sible by recent estimates that “the rate of demoralization in the United States approaches one quarter of the population. “’ “about half of those who are demoralized are also clinically impaired,“h and an important majority of clin- ically impaired persons are also “demoralized” (81.4% of outpatients and 66.7% of hospital inpatients, according to one survey).’ We claim that demoralization consists of distress combined with subjective incompetence. Distress is manifested as symptoms, such as anxiety, sadness, discouragement, anger, and resentment. By subjective incompetence we mean a state of self-perceived incapacity to act at some minimal level according to some internalized standard in a specific stressful situation. We maintain that distress and subjective incompetence coexist when assumptions relevant to self-esteem are disconfirmed. We shall describe how social bonds may be involved in preventing distress or subjective incompetence from occurring together (i.e., from becoming demoralization). We will distinguish demorali- zation from symptoms of distress assessed by psychiatric screening scales. We shall discuss the measurement of demoralization and review the trends in research which are relevant to an understanding of its epidemiology. We believe that the lack of a scale to measure subjective incompetence is a major obstacle to advancement in this area. We shall indicate how future studies could fill some of the gaps in what we now know. Mastery, orientation of the locus of control, learned helplessness. self-efficacy, and neuroticism, are all zyxwvutsrqponm Comprehensive Psychiatry, Vol. 23, No. 4 (July/August), 1982 353