Friday, October 27, 2017

Week 6 Reflection

I found this reading INCREDIBLY interesting since it discusses depression amongst a current population in a different culture.

Culture in Psychology
Chapter 10: Culture and emotions: depression among Pakistanis by Rabia Malik
            Malik begins her writing with a discussion of emotions and how they are defined generally, as well as in different cultures (Malik 147-159). Malik states “When we think of emotions we think of them in the first instance as powerful personal experiences or feelings which arise within the body” (Malik 147). Throughout the chapter, Malik compares concepts of emotional states being internal and external (Malik 147-159. Malik also states, “The social constructionist perspective allows too for the possibility that emotions may work differently in different cultures” (Malik 147). Following this perspective, it is asserted that Westerners have a far more individualistic concept of emotions, including how they play out within the individual and the effect they have on the individual (Malik 149-150, 154). This individualized concept of self is also referred to as “’egocentric’ [and] ‘indexical’” (Malik 149). Conversely, “The ‘sociocentric’ ‘referential’ self is usually associated with non-western cultures” (Malik 149).  “Laungani (1992) and Kakar (1982) argue that South Asian society cannot be seen in terms other than familial and communal” (Malik 154). Because the South Asian culture has such a different view on society, compared to the Western view of society, this also leads to a different view on distress/depression and ideas on how to treat these negative feelings.
            Westerners “theorise emotions as [solely] internal essences” (Malik 147). Contrastingly, non-westerners view emotions as having multiple causes, most of which are external to an individual. This individual, Western view of emotions arose from Descartes’s separation of mind and body (Malik 148). After Descartes, “emotions were now clearly located in the body and thought in the mind” (Malik 148). I’ve never really thought of emotions as having a “location.” If an emotion has a “location,” in the body, does this mean it contains matter/mass? This “location” of emotions in the body could help explain the effects emotions have on the body, like stress (increased blood pressure, tension in the neck/shoulder area, etc.). The physical toll depression/melancholy has on the human body could then be more widely accepted with this theory of emotions.
            The “indigenous” and British Pakistanis who were interviewed categorized causes of distress/depression “into circumstantial, relational (kinship), personality and supernatural causes. The predominant causes…were circumstances and relationships, which are external to the body” (Malik 153). It seems like indigenous and British Pakistanis have a much better understanding of the complexity of depression and its multiple causes, as compared to the rather reductionist American/Western view that depression is ‘simply’ a chemical imbalance. Maybe depression is a chemical imbalance, but what causes the imbalance? Maybe stressful relationships result in either an over or under production of a certain chemical which then results in depression/depression-like symptoms. Attempting to solely treat depression is futile; there seems to almost always be other underlying causes/factors to depression – isn’t this why individuals go to therapy – in an attempt to better their relationships/thinking patterns? I don’t think anyone would assert that therapy of any kind is a direct intervention on chemicals in the brain. As long as these other underlying causes/factors of depression are present, the depression itself will be present, no matter what antidepressants an individual is taking. It is necessary to examine the underlying causes/factors of depression and learn how to best deal/cope with them since they most likely cannot simply be cut out of the individual’s life.

            In contrast to this view on depression, “In Euro-American cultures, although theorists acknowledge that emotions are evoked in a social context, they tend to ‘psychologise’ them, presenting them as an index of a personal state, rather than of social relationships as in other cultures” (Malik 148). Could ‘psychologise’ be replaced with medicalize? This view puts all the blame of any negative emotion on the individual, rather than looking at possible causes, like that individual’s relationships, the individual’s culture/society, etc. In this view, an individual could be blamed for his/her own depression, contributing to the negative stigma associated with mental illness in Western cultures.

Thursday, October 26, 2017

Week 5 Reflection

Depression: Integrating Science, Culture, and Humanities
            The beginning of Part II mentions “multiple models of depression” (Lewis 49). Why do we need multiple models of depression? Are there different models for different ‘types’ of depression? Do the different models have different causes/explanations for depression? The text later answers that the different models serve as “diverse approaches” to depression (Lewis 49). This ‘answer’ still feels fairly ambiguous to me. I think this answer also exemplifies the complexity of depression and that there is not one simple way to look at depression; there are many factors that cause and effect depression, which also means there are multiple ways to go about treating depression. None of the different treatment models or even view of depression are necessarily wrong – there is (hopefully) a reason why each are developed with different sets of evidence supporting each model.
            The story of Gilgamesh is “the oldest known depiction of intense sadness and depression” (Lewis 50). Gilgamesh’s “sadness and despair [are] tied to external events” (Lewis 51). These external events include the death of his close friend, Enkidu, and Gilgamesh’s distressing realization of his own mortality (prompted by Enkidu’s death), which then leads to a failed quest for a search of immortality (Lewis 50-51). Gilgamesh’s depression displays an element of existentialism as he becomes consumed with fear of his own death and hopes to prevent it by searching for a sort of elixir for this innate, inescapable human condition. This example of Gilgamesh also brings up the question of whether someone is ‘simply’ experiencing sadness, as to be expected after the death of a close friend, or if they are experiencing the more extreme depression. I think it is safe to say that Gilgamesh is experiencing depression since the death of Enkidu begins to take over his life as he (Gilgamesh) searches for immortality. Gilgamesh is unable to focus on anything other than escaping his own death (a morbid thought), so his condition could also be considered debilitating (a key characteristic of depression portrayed in texts previously ready for this course).
            There are multiple examples in literature of people suffering from sadness/depression either as a result of the death of a close friend/love one OR their own suffering. Although the text explains these difficulties as matters of “fate, bad luck, or the gods,” I think some people who prescribe to the Determinist point of view, would say that all events are the result of God/gods (Lewis 51). If God/gods really do determine/cause all events on Earth, why does these god/gods allow for such prevalent suffering? Does that mean a god is the source or cause of depression?
            Lewis then states “…if we really care about depression, we must change the social order to reduce human oppression” (emphasis added) (Lewis 52). Lewis gives “sexism, racism, [and] classism” as examples of “oppression” (Lewis 52). This argument, again, shows that depression is far more complex than a ‘simple’ chemical imbalance. This also relates to our discussion last week of women drinking wine in the morning, possibly as an attempt to help persist in the face of patriarchal systems. Could sexism be the reason more women than men are diagnosed with depression? Intersectionality would also need to be taken into consideration. Do Black women experience higher rates of depression? It would make sense, seeing as they face multiple forms of discrimination on a daily basis.
            Lewis then moves on from examples of depression in the Ancient World to examples in Classical Greece. Lewis provides Sophocles’ play Ajax as a prime example of depression, stating Ajax is “the most well-known depressive in Greek tragedy” (Lewis 52). Ajax felt “…he was denied rewards that he thought he deserved….” (emphasis added) (Lewis 53). This shows the popular theme/condition in Greek literature of hubris. Could an inflated ego or misplaced sense of entitlement be a source of depression? Who is to fault for an inflated ego or misplaced sense of entitlement? It is understandable that someone would get disappointed (possibly extremely, depending on the circumstances) when expectations are not met. The disappointment would be more extreme if the expectations were held for a long period of time. I think this is why so many college freshmen experience depression; they are primed from an early age to go to college and then they get there and it is either not what they expected it to be and/or far more challenging. There are multiple new variables when someone goes to college. They are responsible for their own daily well-being, they are likely in a new environment – whether it be a new city or state, and the classes they are taking are most likely the most challenging they have ever encountered. Add up all these (negative/challenging) variables, and you essentially have a recipe for depression, or at least despair. There is also a sense of control that I think is important to consider in cases like these. I think all humans like to think they have some sense of control over their lives, but as we have learned, all humans are susceptible to depression as the disease does not discriminate. It can be extremely disheartening to learn/feel that you have no control over your own life (like if you were to suddenly experience major depression). If something like depression can suddenly enter and take over your life, why pursue planning and working towards a rewarding life?

            In the Middle Ages, there are multiple examples of Christian authors who relayed depression as a punishment from God or a sign of the presence of demons (Lewis 55-56). This easily shows a source of stigma, particularly in “Christian nations,” like the United States, which was founded by Puritans. However, Marsilio Ficino found a “positive value of depression” in that it allowed for higher-level thinking and creativity (Lewis 58). Ficino asserted that melancholia was good because it allowed for higher-level thinking, but too much melancholia (depression) was bad because although an individual with this condition may be able to experience higher-level thinking, the depression they experience overshadows it to a point of debilitation (Lewis 57-58). Does this mean melancholy is necessary? Where would the human race be today without melancholy? What inventions/major works in human history can be traced back as a direct result of some state of melancholy?

Sunday, October 15, 2017

Week 4 Reflection

I can't remember why I didn't post the last reflection in a timely manner, but I remember all too well why I did not post this particular reflection after I composed it and shared it with my professor: It was the first time I received any kind of criticism from my professor on any of my reflections. I have always been rather "sensitive" when it comes to any kind of criticism about any kind of work I produce but it seems since my depression diagnosis that this sensitivity has been heightened to the highest possible level, and every time I receive any kind of criticism, instead of hearing what the person is saying, which is generally something along the lines of "this work needs some improvement," I hear "you, as a person, are bad and need some improvement." This generally leads to a sort of self-imposed shame spiral and makes it difficult for me to continue with that work/course/etc.
My professor said that I did not provide enough context from the text to really allow him to understand my thought process(es), which I think you will agree with if you read the reflection below. He was able to ultimately figure out what I was trying to convey and he picked up on a common struggle I have with my writing: being able to explicitly articulate a thought rather than simply describe it and essentially dance around it in the hope/belief that those who read my writing will be able to easily decipher what I am truly trying to say. Anyways, what I'm really trying to get at in this reflection is: Do we have a need for an altered state (i.e. depression)?
Let me know what you think!

Reinventing Depression (Continued)
            Does Huxley think depression and/or anxiety are the result of American culture? American culture being: “Mass Production, Standardization, Capitalization, Individualism, Consumerism” (Callahan 104). How has globalization affected depression rates and vice versa? Did Huxley get the inspiration for his drug, “soma,” from Peyote? The text states he was inspired by “Native American folklore” (Callahan 104). At this time, (early/mid-20th century), people were “…. using hallucinogens as a pathway to greater perception and insight (Callahan 104). If hallucinogens are used, does that eliminate the need for/replace psychotherapy? How much insight can one gain into one’s own identity, being, etc. without another person present – no matter what chemical (or other) influences he or she may be under? Is this currently considered the benefit of various psychoactive drugs (MDMA, LSD, etc.) that are currently being researched to treat mental illness? Is it possible to extract the chemical compounds from these drugs that are considered beneficial while avoiding any compounds that cause negative side effects like hallucinating? Right now, this is a “hot” issue with cannabis. The text also refers to an “opium of the masses” and says this issue has been “an age-old concern” (Callahan 104). Does this mean that some, if not all, people think humanity needs to experience in an altered mental state in order to function on a regular basis? Could this be a reference to alternate realities? Is the cure to depression a “break” from reality? Does “reality” cause depression? Exactly what aspects of reality could cause depression? Does the rate of depression increase during wars? There seems to be a strong correlation/causation between anxiety and depression, yet these two diseases are always characterized as “looking back into the past” (depression) and “looking into the future” (anxiety); how can two these two phenomena occur simultaneously when they are so different/antagonistic? Do/can they occur simultaneously or do they just occur (at least sometimes) very close to one another?
            Is psychopharmacology trying to dull all senses, like anesthesia, but to a lesser degree? When on an antidepressant, a patient no longer experiences extreme lows but also no longer experiences extreme highs. They are simply “stable.” This sounds more like a robot than a human. Is the “problem” (in mental illness) an over-active mind? Is that why so many “geniuses” experience depression and/or anxiety? What about the other side of the spectrum – individuals with an under-active/under-developed mind? Do they experience something just as difficult but aren’t able to convey to others what they are experiencing or do not know it’s not “normal”?
            What exactly makes an antidepressant an antidepressant, versus a hypnotic or tranquilizer? Can hypnotics or tranquilizers be antidepressants? There is a “lack of replicability” when it comes to psychopharmacology research (Callahan 107). Is this “lack of replicability” referring to the fact that no two minds/brains are exactly similar?

            According to Callahan, “Anglo-American[s]” were the main prescribers of “Miltown,” which was sort of the first Prozac in terms of its popularity and its status as a cultural phenomenon (Callahan 108, 106). Why were White Americans the main prescribers? Was it because of culture – they were more accepting of taking pills to lessen their daily stresses? Did they simply have better access (SES)? Was it “cool/popular” to have one of these prescriptions? Was something wrong with you if you didn’t have a prescription? Drugs like Miltown, known as minor tranquilizers, came to be known as “mother’s little helper” (Callahan 108). This highlights the gender bias for mental illness but also creates a sense of normalcy around the use of prescription drugs. Patients who were prescribed these minor tranquilizers were considered to not have a “severe mental illness,” yet the drugs were extremely popular (Callahan 109). Does this mean that the majority of the population has a “minor” mental illness and that the stigma surrounding mental illness is not simply its presence, but rather, its severity?

Friday, October 6, 2017

Week 3 Reflection

I apologize for getting behind with posting these regularly/as I complete them. I hope to address the main reason for my absence in the next post. Let me know what y'all think about this one or any of the previous posts/reflections!

Reinventing Depression
Callahan states “depression is a killer.” He goes on to say that it is a killer NOT just in the physical (human body) sense, but also in terms of “dreams and marriages” “as well as people” (Callahan 3). I’m glad the author made this point (and distinction) because most people do not realize the impact depression can have (like killing dreams) and that it not only significantly affects the diagnosed individual but also almost every person that individual has any kind of relationship with. Callahan goes on to describe how depression does not discriminate and affects “both rich and poor countries” (Callahan 4). Unfortunately, treatment is generally very expensive, and despite the fact that there are most likely just as many people in poor countries with depression as rich countries, they are, generally, less likely to have any kind of access to treatment because there is most likely no option or opportunity for treatment of depression at all. I’m very curious to know information about the rates of depression in different countries – comparing GDP, healthcare systems/types, etc.
            Callahan feels that highlighting the physical aspects of depression makes the illness seem less abstract (Callahan 5). I would be interested to see data that supports this claim/idea. Callahan also separates depression into 1. The Disease, 2. The Symptom, and 3. The Experience (Callahan 5). This helps to show the complexity of depression.
            In 2002, WHO said they did not know what causes depression (Callahan 6). I found this interesting since it seems that the medical establishment, in the US at least, is very convinced that chemical imbalances cause depression. Apparently, there is also a “lack of supporting evidence” that neurotransmitters cause depression (Callahan 7). It sounds like these theories of chemical imbalances causing depression were created after most antidepressants (targeting neurotransmitters) were developed in order to support/validate their use/creation. Callahan also states that the idea that depression is a chemical imbalance is an “oversimplification” (Callahan 7). I wholeheartedly agree with this. There is so much more that goes into depression, which is why it can be so difficult to treat, let alone understand. There are definitely social/environmental factors that also cause/affect depression that can never truly be controlled. Instead, patients have to learn to cope with them. Callahan asserts that the neurotransmitter explanation is biological and validates mental illness as a “real illness” because it makes it similar to other illnesses’ biological causes (like heart disease, diabetes, cancer, etc.) (Callahan 8). Despite this biological explanation, which could be inaccurate, there is still a significant stigma surrounding mental illness.
            Callahan then explains why the continued study of depression matters: 1. Depression is common and disabling 2. Nature has a strong effect on/causes depression, which is not accounted for in the current treatment model 3. The current treatment model is limited (Callahan 12). Callahan’s argument shows that there is a lot of work that needs to be done in order to gain a better understanding of depression, and in order to treat it more effectively, and work towards a cure for a great number of those diagnosed with the disease. The way depression is treated needs to be significantly altered.
            Callahan then goes on to discuss depression treatment by PCPs and states PCPs in the mid-twentieth century felt a sense of “demoralization and deprivation” regarding their work because they didn’t have the resources they needed (Callahan 45). We have come a long way, but I think this is still true, at least to some extent. Did only American physicians feel this way? How does the current state of health insurance play into this? Would it be better or worse if there was universal healthcare? Also, how would a plastic surgeon versus a Doctors without Borders volunteer differ in their feelings – assuming they have different motives when it comes to their career? Maybe depression/anxiety is under/mis-diagnosed because doctors (specifically PCPs) themselves are depressed/anxious and/or cannot imagine anyone in a different career having any cause to be distressed/anxious because their own job is so incredibly demanding?
            The general United States culture has evolved into one where a “patient has a need to take something [medication],” rather than work towards a well-balanced diet and/or exercise, which applies to all illnesses, including, possibly at least, mental illness as exercise is one of the first recommended therapies for depression (Callahan 49).

            The different schools of psychology, and later psychiatry, led to different takes on how to best approach/treat mental illness in terms of whether the mind (brain) could be treated the same way as other “simpler” human organs, such as the heart or lungs (Callahan 94). This lends to the question of where the mind is located (the brain?) and if the mind/brain is attached to human consciousness, human personality, the human soul. If all of these components are located in the brain, I, personally, would be very apprehensive to supervise any deliberate alteration of the brain in any way.

Friday, September 1, 2017

Week 2 Reflection

Depressive Disorders
What exactly does the author mean by saying major depressive disorder is “the common cold of mental health”? Is this comparison referring to a lack of cure, simply its commonality/frequency in patients, or something else? The author also states that major depressive disorder involves mood. Q: What exactly causes mood? A: External things like events, internal things like brain chemicals (though this is currently under debate), and a patient’s past, such as memories/trauma, and current events that trigger thoughts of those past events/trauma.
            The author emphasizes the importance of individualized treatment plans. This is one of the reasons why the field of mental health is so complicated: every individual responds to various treatments differently. Maybe this significant variety in treatment response is inherent to the fact that mental health deals with a patient’s mind, which is highly personalized and can easily become trivialized when looking at a more scientific, impersonal, empirical view. It is imperative to remember the humanity involved in this field. The thing that distinguishes humans and makes us superior to other animals is our mind. It is not something to be treated lightly. Do twins often respond similarly to the same mental health treatment(s)? The resources a client has also have to be taken into consideration, such as support from others and finances. Will treatment require the patient to take time off from work/school (inpatient treatment, ECT)? Finally, a cost/benefit analysis should be done and the likelihood of treatment’s efficacy should be taken into consideration.
            According to WHO “depressive disorders were the leading cause of disability” (Dziegielewski 243). Despite this, there is a significant, sometimes debilitating, stigma associated with essentially all mental health diseases. Why is there a stigma if depressive disorders are so common? Maybe people think patients diagnosed with depression are being “dramatic” or are simply trying to get out of certain obligations by emphasizing their symptoms of depression. The author also states “50-80% [of patients with a depressive disorder] go unrecognized or misdiagnosed” (Dziegielewski 243). That is terrifying and is probably at least partially because the “symptoms of depression…[are] often one of the most ambiguous to define” (Dziegielewski 243). How is “disabled” in terms of the mental health field defined? If you have “clinically depressed mood,” does that automatically categorize you as disabled? How was the statistic on undetected depression in primary care found? How is undetected depression detected? Was it diagnosed and determined that it had a much earlier onset and thus went undetected for some time?

            The author mentions culture on page 244 in terms of depression in White Americans versus African Americans. Generally, White Americans face less stigma and are more open to treatment for mental health diseases. Alternatively, African Americans may simply not have the same accessibility to mental health treatment. Also, females are diagnosed with depression at a rate twice as high as men’s rate of depression diagnoses. Multiple sources have found and stated that this doesn’t mean more women than men are depressed but that women are much more likely to report depression. Women do not face shame when displaying/talking about their emotions. Alternatively, men have a higher rate of completed suicide, although women have a higher rate of suicide attempts because men are more likely to attempt suicide in a more violent form, such as the use of a gun, while women are more likely to take a more passive route such as medication overdose. 

Tuesday, August 29, 2017

Week 1 Reflection

Mood Disorders
            James Morrison’s chapter on Mood Disorders in DSM-5 Made Easy: The Clinician’s Guide to Diagnosis, gives insight into the complexity and still relative lack of uncertainty when it comes to diagnosing mood disorders. While reading the first two/thirds of this section on the DSM-5, which supposedly makes it easy to understand, one comment continuously entered my mind: “Confusing!” If this is an “easy” explanation of the DSM-5, I would hate to try to interpret the original source.
            Many of the diagnoses mentioned in this section have an optional “other” category known as “unspecified.” This essentially allows a clinician to make a diagnosis for some type of mood disorder that is evident in a patient but does not meet the very specific criteria for a pre-determined diagnosis. I see both a benefit and a drawback to the incredibly specific diagnosis criteria: the benefit being that it limits/restricts diagnosticians from making a possibly significant and/or life-altering diagnosis without substantial evidence; the limit to the highly specific criteria for making a diagnosis when it comes to things like mood disorders is that these experiences can be highly subjective and even abstract or vague. So, these diagnosis criterions prevent unnecessary and possibly detrimental diagnoses from being made but also essentially attempt to create very concrete, objective, and empirical requirements for a medical condition that is highly subjective.
            Morrison includes some language, specifically on pages 119 and 122 that seems demeaning to the patients he describes with words like “outrageous” and the observation “they are so distractible.” I’m sure (or at least hope) that Morrison’s intention in writing this guide was to make the world of mental health more accessible, but by including such language in his work, he only contributes to the harsh, negative stigma the world of mental health cannot seem to shake.

            Morrison also reminds the reader that each edition of the DSM includes significant changes to its previous edition. Morrison highlights this point on page 143 under his description of cyclothymic disorder, stating “Note that this is a change from DSM-IV, which allowed a diagnosis of a bipolar disorder along with cyclothymic disorder.” Because the DSM changes fairly frequently and those changes are significant, it is apparent that mental health is still quite the enigma, even to experts in the field.

Extra! Extra! Read All About It!

     Long story short, I am taking a one credit hour independent study course this semester. The best part about it? I get to basically choose what I study/read/discuss with the professor who is overseeing the "course." It's pretty awesome. I am extremely lucky that I found a professor willing to support me in this endeavor and increase my knowledge about depression (that's basically what the "course" is about).

     Basically, I read scholarly articles, books, etc. each week and then write a short reflection on what I read and then meet with the professor and discuss the reflection with him. He initially suggested that I might want to start a blog to include my reflections. Well, my friends, as you can see, I already have a blog established that focuses on my journey with depression, so, is it okay with you if I post my reflections here? Will you read them? Would you want to???

     PLEASE!!!!! comment either here or on my Facebook or Twitter accounts (@dionerin), or send me a text, or email letting me know if y'all would be okay with this because I only want to share my reflections if you want to read them. Maybe this is too "academic"? Let me know what you think! <3