A 49-year-old housewife, Norma Jean Luby, was seen in a central Appalachian clinic on referral from her primary care physician for evaluation of depression. She was a pale, neatly and plainly dressed woman, with hair combed straight back and no makeup. Her eyes were filled with tears during most of the interview, although she did not weep openly. She spoke slowly and so softly that at times she was inaudible. She appeared timid, abject, dependent, helpless, and hopeless, claiming she had been ill all of her life, and summed up her situation by stating, "My nerves are busted. I can't do anything."