Adler has already revealed how perfectly depression or melancholia is a problem of courage; how it develops in people who are afraid of life, who have given up any semblance of independent development and have been totally immersed in the acts and the aid of others. They have lived lives of "systematic self-restriction," and the result is that the less you do the less you can do, the more helpless and dependent you become. The more you shrink back from the difficulties and the darings of life, the more you naturally come to feel inept, the lower is your self-evaluation. It is ineluctable. If one's life has been a series of "silent retreats," one ends up firmly wedged into a corner and has nowhere else to retreat. This state is the bogging-down of depression. Fear of life leads to excessive fear of death... Finally, one doesn't dare to move—the patient lies in bed for days on end, not eating, letting the housework pile up, fouling the bed.
The moral of this example of failure of courage is that in some way one must pay with life and consent daily to die, to give oneself up to the risks and dangers of the world, allow oneself to be engulfed and used up. Otherwise one ends up as though dead in trying to avoid life and death. This is how modern existentialist psychiatrists understand depression, exactly as Adler did at the beginning of this century. Médard Boss sums it up in a few lines:
It is always the whole existence of the melancholic patient which has failed to take over openly and responsibly all those possibilities of relating to the world which actually would constitute his own genuine self. Consequently, such an existence has no independent standing of its own but continually falls prey to the demands, wishes and expectations of others. Such patients try to live up to these foreign expectations as best they can, in order not to lose the protection and love of their surroundings. [But they go more deeply into debt.] Hence the terrible guilt feelings of the melancholic... derived from his existential guilt.