Wednesday, November 29, 2017

Week 8 Reflection

The Noonday Demon, Chapter IV “Alternatives”
            The quote Solomon uses to begin this chapter drew me in and made feel as though it was necessary to read this chapter in its entirety; the quote comes from Anton Chekhov and states “’If many remedies are prescribed for an illness, you may be certain that the illness has no cure’” (Solomon 135). I find it interesting that Chekhov is so sure of himself and his conviction that he uses the word ‘certain.’ Solomon goes on to describe the many different modes of treatment for depression, the most common/widely accepted were discussed and described in the previous chapter. Now, Solomon investigates the incredible number of “alternative” treatments, some of which are fairly promising/reputable but simply in very early stages of research, such as repeated transcranial magnetic stimulation (rTMS) and eye movement desensitization and reprocessing (EMDR) (Solomon 137, 139). Solomon ends this chapter’s introductory paragraph with a more optimistic tone, stating “the sheer quantity of alternative therapies reflects a persistent optimism in the face of the intractable problem of emotional pain” (Solomon 135). Although it is positive there is a (perceived) sense of optimism among those researching/pursuing a cure for depression, that optimism is often lost on the patients. They simply endure a frustrating, and often, never ending search for, not a cure, but more simply, something that will at least alleviate their symptoms of depression. Since so much is not understood about depression and how it works, when patients begin the process of searching for treatment, they begin a game of guessing and tinkering that may never end as different medications, and dosages of those medications, and combinations of different medications are seemingly thrown at them and a variety of different modes of therapy are suggested. It can be overwhelming and even unnerving that there seems to be no clear or right answer as every psychiatrist/psychologist/therapist has a different approach to treating depression and no one is necessarily right, but it is imperative that each patient finds a clinician who they respect and at least appreciate or agree with their approach to treatment.
            This may lead one to think that a placebo could easily be conceived as a treatment in the depressed patient’s mind, but Solomon argues “it is my absolute belief that in the field of depression, there is no such thing as a placebo” (Solomon 137). Solomon elaborates with “if you have cancer and try an exotic treatment and then you think you are better, you may well be wrong. If you have depression and try an exotic treatment and think you are better, then you are better. Depression is a disease of thought processes and emotions, and if something changes your thought processes and emotions in the correct direction, that qualifies as recovery” (Solomon 137). I (think) I can see and understand the point Solomon is arguing – that depression is all about thoughts and emotions and if you can find a way to change those negative thought processes that often lead to negative emotions, then it doesn’t matter what you are doing. It works for you; you are feeling better; great – you are in recovery. However, the way Solomon presents this argument provides evidence for the degrading argument that depression is simply “all in your head,” and that it isn’t truly real, and a patient should be able to somehow wish it away. I feel Solomon’s argument here can provide fodder for those who do not believe depression is a disease because if it is a “true” disease, it would require a legitimate, well-researched, treatment. Maybe Solomon is trying to say that since there is currently no known cure for depression that no one can really bash any kind of treatment as long as at least one depressed individual finds relief as a result from practicing it.
            Solomon asserts “the best treatment for depression is belief, which is in itself far more essential than what you believe in” (Solomon 137). This makes sense because depression is a disease of the mind, and if you believe that what you are doing is beneficial and that you will, at least eventually, get better then it makes sense that whatever you are doing to alleviate your symptoms will be beneficial. Also, if you strongly believe in some mode of therapy, it is more likely you will be persistent in your practice of it, which provides a depressed person something to do, and maybe even look forward to. If you are able to create some kind of schedule involving some type of therapeutic activity, then you are keeping yourself out of bed, for at least some period of time, and are active, hopefully, both mentally and physically.

            Solomon later discusses the importance of sleep and the significant role it plays in depression. Solomon goes so far as to state: “Even people who do not suffer from depression have had the experience of waking up too early with a sensation of ominous dread; in fact, that fearful despairing state, which passes quickly, may be the closest that healthy people come to the experience of depression” (Solomon 144). I find this assertion very interesting. I never would have thought of this on my own, but I definitely agree with it. Solomon quotes Thomas Wehr of the NIMH “…it is in sleep that the depression is maintained and intensified” (Solomon 144). Wehr is referring to the fact that, generally, people with a diagnosis of depression tend to feel better as they continue throughout a day (Solomon 144). Wehr has even conducted experiments with “controlled sleep deprivation” (Solomon 144). The idea behind this intervention is to “….extend the day’s improvement” “by not letting someone go to sleep…” (Solomon 144). This idea that sleep makes depression worse is somewhat counterintuitive because for most illnesses, sleep/rest is recommended to allow the body to heal. Unlike most illnesses, depression is centered in the mind and when the mind/body is not fully conscious, as in sleep, the mind is free to go about whatever direction it likes, and in a depressed person, that is generally a downward spiral of negativity.

Tuesday, November 28, 2017

Week 7 Reflection

The Noonday Demon, Chapter III “Treatments”
            Solomon begins this crucial chapter with a discussion of the main two treatments for depression – therapy and medication and argues that the two should not be seen complementary, and sometimes one will not reach its full efficacy unless the other is present (Solomon 101). Solomon also states that “it’s fashionable for psychiatrists to tell you first the cause of your depression (lowered serotonin levels or early trauma are the most popular)”; Solomon’s use of the words ‘fashionable’ and ‘popular’ highlight the ever-changing nature of the treatment of mental illness as little is truly understood and as more research is conducted and information becomes available, new approaches are taken (Solomon 101). Solomon’s two different “popular” proposed causes of depression could not be more different; one is an external event/memory (“early trauma”) and the other, “lowered serotonin levels,” is an internal chemical imbalance. How can two fundamentally different causes lead to the same effect? Does an “early trauma” result in lowered serotonin levels?
            Solomon goes on to discuss and describe therapy. Solomon proposes “talking therapies come out of psychoanalysis, which in turn comes out of the ritual disclosure of dangerous thoughts first formalized in the Church confessional” (Solomon 102). If Catholics practice a form of therapy on a regular basis, even without a formal diagnosis of depression, do they have lower rates of depression? A study was conducted in 1979 that highlighted the fact that a “therapist” does not need a fancy degree in order to be a good therapist, but, rather that “certain criteria [are] met [in both the person acting as therapist and the patient]: that both the therapist and patient were acting in good faith; that the client believed that the therapist understood the technique; and that the client liked and respected the therapist; and that the therapist had an ability to form understanding relationships” (Solomon 111). The study proved this theory by selecting English professors determined to hold all these characteristics and comparing them to “professional therapists”; the English professors were just as effective therapists as the “professionals” (Solomon 111).
            Solomon refers to his personal experience in working with a “psychopharmacologist” (Solomon 105). I wonder if a ‘psychopharmacologist’ is the same as a psychiatrist. The term psychopharmacologist emphasizes the person’s knowledge of prescription medications, while ‘psychiatrist’ implies an ability to provide therapy (like talk therapy) beyond medication. Solomon also discusses his personal experiences with various therapists and the importance of finding a therapist who you really like and trust (Solomon 105). Solomon asserts “if you think you are smarter than your doctor [or therapist], you are probably right” (Solomon 105-106). This comment was personally comforting and validating as I have gone through my fair share of therapists and have even felt quite disturbed that someone has, at the least, completed a Master’s degree and yet seem to be incredibly shortsighted.
            Solomon had the opportunity to interview a Holocaust survivor who shared she survived the experience by focusing on her hair, rather than the horrible things taking place around her because “if she let herself think about what was going on, she would go crazy and die” (Solomon 109). This woman “thought about when [she] could wash [her hair],…..about trying to comb it with [her] fingers…how to act with the guards to make sure they didn’t shave [her] head entirely. [She] spent hours battling the lice that were all over the camp” (Solomon 109). It is amazing that this woman had the ability to come up with this therapeutic distraction on her own, under such difficult, taxing, and inhumane circumstances. Most people require another to suggest such a therapeutic technique to them when undergoing some kind of difficulty in life.
            Solomon then goes on to explain antidepressants and how they work, or rather, how we think they work. After reading Solomon’s explanation on page 114, my first thought was that you would want an antidepressant that affects as many different neurotransmitters/neurotransmitter sites in the brain as possible because then you have a greater chance of having a positive effect, but if you are taking an antidepressant that affects more than one neurotransmitter, then you are introducing multiple variables at one time, and you have no idea which aspect of the antidepressant is working (if any) or why. One of the most prevalent negative side effects of antidepressants, highlighted by the introduction and ‘popularity’ of Prozac, is a side effect that negatively affects sexual intercourse (Solomon 115). Solomon also explains that these negative sexual side effects can also cause “sexual anxiety,” which can lead to the “develop[ment of] a psychological aversion to sexual interaction, which makes the symptoms worse” (Solomon 116). This leads to a cycle that can be incredibly difficult to discern whether “the sexual problems…..are a result of the [initial] depression” or the “sexual problems…are the result of antidepressant therapy” (Solomon 116). Solomon discusses the direction antidepressant research is currently taking: “It is popular at the moment to try for so-called clean drugs, drugs that have highly specific effects” (Solomon 118). This makes sense because it would allow for a better understanding of the cause or causes of depression and would also hopefully lead to negative side effects. However, “it seems that the more things you muck around with in the human brain, the more effective the treatment is likely to be for depression” (Solomon 118). This underscores the complex nature of depression and the human brain, itself.
            Solomon then moves on to a less popular but “most successful physical treatment for depression,” which also happens to be “the least clean and specific [treatment] of all” – ECT (Solomon 120). ECT has been in use since the early-mid 20th century but significant advances have been made in terms of its administration to allow for a much more tolerant experience for the patient. It is interesting that such an old and hardly understood treatment is so effective. ECT “is used in pregnant women,” which I don’t understand because general anesthesia is part of the administration of ECT; isn’t it dangerous for a pregnant woman to undergo general anesthesia? (Solomon 120). Solomon discusses Martha Manning’s experience with ECT, which is considered to be an overall success, yet Manning still takes multiple medications (Solomon 121). Does ECT ‘simply’ make it possible for medications to work in previously drug-resistant cases?
            Solomon quotes James Ballenger on the presence of human suffering and Robert Post’s, chief of the Biological Psychiatry Branch of the NIMH, explanation of the complex anatomy that is the brain and all the neurons and their many synapses that make the brain work, which leads Post to say “’Getting them to all run just so that people are wonderfully happy all the time – we’re a long, long way from that’” (Solomon 124). This makes me think of the British philosopher David Pearce and his personal endeavors end suffering, even for animals, by practicing veganism.

            Solomon then discusses the effects the word ‘normal’ has on people diagnosed with depression, as they are generally made to feel that their depression, and therefore themselves, are abnormal (Solomon 124). Does the word ‘abnormal’ convey/have any kind of negative connotation/judgment inherently? Can this word be used without any kind of negative connotation/judgment? Solomon describes a conversation he had with one individual who feared he was going crazy and was relieved to discover he was “just” experiencing clinical depression, which Solomon states is the “normal way to go crazy” (Solomon 124). It is sad that someone would rather have the label of “clinically depressed” and everything one experiences with that diagnosis than think they may ‘simply’ be the slightest bit crazy. Solomon then describes another person who overcame her depression by identifying all sources of anxiety in her life and drastically cutting them out (Solomon 125). This shows both significant insight and willpower on her part, two things that most people with depression are unable to harness or utilize in any way. This woman quit her job, “broke up with [her] boyfriend and never really looked for another one,” transitioned to living alone, “stopped going to parties that run late,…moved to a smaller place,….dropped most of [her] friends, [and] gave up, pretty much, on makeup and clothes” (Solomon 125). Could most, if not all, of these things this woman gave up be considered characteristic of or integral to Western culture? Is this why depression is so prevalent in Western countries? Solomon wraps up this section by quoting the Unabomber from his manifesto “….In effect, antidepressants are a means of modifying an individual’s internal state in such a way as to enable him to tolerate social conditioning that he would otherwise find intolerable” (Solomon 125). Why is our instinct to alter the individual rather than his/her society/external circumstances/relationships? Wouldn’t altering these other things be far more effective and result in fewer depression diagnoses in the long run? This approach promotes the idea that something is wrong with the individual, supporting stigma associated with depression. 

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.