Most people’s moods come and go. Their feelings of elation or sadness are understandable reactions to daily events and do not affect their lives greatly. However, the moods of people with mood disorders tend to last a long time. Mood disturbances are at the center of two groups of disorders—depressive disorders and bipolar disorders. These disorders, the focus of this chapter, have been shared by millions of people. As you will learn, the human suffering that they cause is beyond calculation.
Unipolar Depression: The Depressive Disorders
How Common Is Unipolar Depression?
What Are the Symptoms of Depression?
Diagnosing Unipolar Depression
What Causes Unipolar Depression?
The Biological View
What Are the Symptoms of Mania?
Diagnosing Bipolar Disorders
What Causes Bipolar Disorders?
Putting It Together: Making Sense of All That Is Known
LECTURE OUTLINE DEPRESSION AND MANIA ARE THE KEY EMOTIONS IN DISORDERS OF MOOD Depression—a low, sad state in which life seems dark and its challenges overwhelming
Mania—a state of breathless euphoria or frenzied energy
People with depressive disorder experience only depression
This pattern is called unipolar depression
There is no history of mania
Mood returns to normal when depression lifts
Others experience periods of mania that alternate with periods of depression
This pattern is called bipolar disorder
One might logically expect a third pattern—unipolar mania, in which people suffer from mania only—but this pattern is uncommon
Mood problems have always captured people’s interest
Mood problems have been shared by millions, and today the economic costs amount to more than $80 billion each year
The human suffering is beyond calculation
Unipolar Depression [Video: Antidepressants, Suicide, and the “Black Box” Decision; Depression; Postpartum Depression; Postpartum Psychosis: The Case of Andrea Yates; Seasonal Affective Disorder and Light Therapy]
The term depression is often used to describe general sadness or unhappiness
This loose use of the term confuses a normal mood swing with a clinical syndrome
Depressive disorders can bring severe and long-lasting psychological pain that may intensify over time
How common is unipolar depression?
Around 8 percent of adults in the United States suffer from severe unipolar depression in any given year
As many as 5 percent suffer mild forms
About 17 percent of all adults will experience unipolar depression in their lifetimes
The prevalence is similar in Canada, England, France, and many other countries
The rate of depression is higher among poor people than wealthier people
The risk of experiencing this problem has increased steadily since 1915
People of any age may suffer from unipolar depression
Women are at least twice as likely as men to experience episodes of severe unipolar depression
As many as 26 percent of women (as opposed to 12 percent men) may have an episode at some time in their lives
Among children, the prevalence is similar for boys and girls
Approximately 85 percent of those with unipolar depression will recover, some without treatment
Around 40 percent will experience another episode later in their lives
What are the symptoms of depression?
Symptoms may vary from person to person
Five main areas of functioning may be affected:
Emotional symptoms—feeling “miserable,” “empty” experiencing little pleasure
Motivational symptoms—lacking drive, initiative, spontaneity
Between 6 and 15 percent of those with severe depression will die by suicide
Behavioral symptoms—less active or productive
Cognitive symptoms—hold a negative self-view; pessimistic
Physical symptoms—headache, dizziness, general pain
Diagnosing unipolar depression
A major depressive episode is a period of two or more weeks marked by five or more symptoms of depression (See Table 7-2, text p. 220.)
In extreme cases, symptoms are psychotic, including:
DSM-5 lists several types of depressive disorders
Major depressive disorder
People who experience a major depressive episode and have no history of mania
Individuals who experience a longer-lasting (at least two years) but less disabling pattern of depression
When dysthymic disorder leads to major depressive disorder, it is termed doubledepression
Premenstrual dysphoric disorder
A diagnosis given to women who repeatedly experience clinically significant depressive symptoms during the week before menstruation
Disruptive mood regulation disorder
Characterized by a combination of persistent depressive symptoms and recurrent outbursts of severe temper
What causes unipolar depression? Stress may be a trigger for depression
People with depression experience a greater number of stressful life events during the month just before the onset of their symptoms than do others
Some clinicians distinguish reactive (exogenous) depression from endogenous depression, which seems to be a response to internal factors
Today’s clinicians usually concentrate on recognizing both the situational and internal aspects of any given case
The current explanations of unipolar depression point to biological, psychological, and sociocultural factors
The biological view—Genetic factors
Family pedigree, twin, adoption, and molecular biology gene studies suggest that some people inherit a biological predisposition to unipolar depression
Researchers have found that as many as 20 percent of relatives of those with depression are themselves depressed, compared with fewer than 10 percent of the general population
Twin studies demonstrate a strong genetic component:
Concordance rates for identical (MZ) twins are 46 percent
Concordance rates for fraternal (DZ) twins are 20 percent
Adoption has implicated a genetic factor in cases of severe unipolar depression
Using techniques from the field of molecular biology, researchers have found evidence that unipolar depression may be tied to specific genes
The biological view—Biochemical factors
Low activity of two neurotransmitters (NT)—norepinephrine and serotonin—has been strongly linked to unipolar depression
In the 1950s, medications for high blood pressure were found to cause depression; some lowered serotonin, others lowered norepinephrine
The discovery of truly effective antidepressant medications, which relieved depression by increasing either serotonin or norepinephrine, confirmed the NT role.
In terms of NTs, it is likely not one or the other but rather a complex interaction is at work and other NTs may be involved
Biological researchers have also learned that the endocrine system may play a role
People with depression have been found to have abnormal levels of cortisol, which is released by the adrenal glands during times of stress
People with depression have been found to have abnormal melatonin secretion
Other researchers are investigating deficiencies of important proteins within neurons as tied to depression
This model has produced much enthusiasm but has certain limitations
Relies on analogue studies: depression-like symptoms created in lab animals
Do these symptoms correlate with human emotions?
Measurement of brain activity has been difficult and indirect
Current studies with modern technology are attempting to address this issue
The biological view—Brain anatomy and brain circuits
Biological researchers have determined that emotional reactions of various kinds are tied to brain circuits
These are networks of brain structures that work together, triggering each other into action and producing a particular kind of emotional reaction
It appears that one circuit is tied to GAD, another to panic disorder, and yet another to OCD
Although research is far from complete, a circuit responsible for unipolar depression has begun to emerge
Likely brain areas in the circuit include: prefrontal cortex, hippocampus, amygdala, and Brodmann’s Area 25
The biological view—Immune system
This system is the body’s network of activities and cells that fight off bacteria and other foreign invaders
When stressed, the immune system may become dysregulated, which some believe may help produce depression
Support for this explanation is circumstantial but compelling
There are three main psychological models:
Psychodynamic view—no strong research support
Developed by Freud and his student Abraham, this model links depression and grief
When a loved one dies, an unconscious process begins, and the mourner regresses to the oral stage and experiences introjection—a merging of his or her own identity with that of the lost person
For most people, introjection is temporary
If grief is severe and long-lasting, depression results
Some people experience “symbolic” (or imagined) loss
Newer psychoanalysts (object relations theorists) propose that depression results when people’s relationships leave them feeling unsafe and insecure
Studies have offered general support for the psychodynamic idea that depression may be triggered by a major loss (e.g., anaclitic depression)
Research supports the theory that early losses set the stage for later depression
Research also suggests that people whose childhood needs were improperly met are more likely to become depressed after experiencing a loss
Early losses and inadequate parenting don’t inevitably lead to depression and may not be typically responsible for development of depression
Many research findings are inconsistent
Certain features of the model are nearly impossible to test
Behavioral view—modest research support
Behaviorists believe that unipolar depression results from significant changes in rewards and punishments people receive
Lewinsohn suggests that the positive rewards in life dwindle for some people, leading them to perform fewer and fewer constructive behaviors, and they spiral toward depression
Research supports the relationship between the number of rewards received and presence of depression
Social rewards are especially important
Researchers have compiled significant data to support this theory
Research has relied heavily on the self-reports of depressed subjects
Behavioral studies are largely correlational and do not establish that decreases in rewards are the initial cause of depression
Cognitive views (two main theories)—considerable research support
Beck theorizes that four interrelated cognitive components combine to produce unipolar depression:
Self-defeating attitudes are developed during childhood
Beck suggests that upsetting situations later in life can trigger an extended round of negative thinking
Negative thinking typically takes three forms called the cognitive triad:
Individuals repeatedly interpret their (1) experiences, (2) themselves, and
(3) their futures in negative ways that lead them to feel depressed
Depressed people also make errors in their thinking, including:
Minimization of the positive; magnification of the negative
Depressed people experience automatic thoughts, a steady train of unpleasant thoughts suggesting inadequacy and hopelessness
Many studies have produced evidence in support of Beck’s explanation:
There is a high correlation between the level of depression and the number of maladaptive attitudes held
Both the cognitive triad and errors in logic are seen in people with depression
Automatic thinking has been linked to depression
Research fails to show that such cognitive patterns are the cause and core of unipolar depression
This theory asserts that people become depressed when they think that:
They no longer have control over the reinforcements (rewards and punishments) in their lives
They themselves are responsible for this helpless state
The theory is based on Seligman’s work with laboratory dogs
Dogs who were subjected to uncontrollable shock were later placed in a shuttle box
Even when presented with an opportunity to escape, dogs that had experienced uncontrollable shocks made no attempt to do so
Seligman theorized that the dogs had “learned” to be “helpless” to do anything to change negative situations and drew parallels to human depression
There has been significant research support for the model:
Human subjects who undergo helplessness training score higher on depression scales and demonstrate passivity in laboratory trials
Animal subjects lose interest in sex and social activities—a common symptom of human depression
In rats, uncontrollable negative events result in lower serotonin and norepinephrine levels in the brain
Recent versions of the theory focus on attributions
Internal attributions that are global and stable lead to greater feelings of helplessness and, possibly, depression; if they make other kinds of attributions, this reaction is unlikely
Example: “It’s all my fault” [internal]; “I ruin everything I touch” [global] “and I always will” [stable]
Example: “She never did know what she wanted” [external], but “The way I’ve behaved the past couple of weeks blew this relationship” [specific]; “I don’t know what got into me—I don’t usually act like that” [unstable]
Some theorists have refined the helplessness model yet again in recent years—they suggest that attributions are likely to cause depression only when they further produce a sense of hopelessness in an individual
Hundreds of studies have supported the relationship among styles of attribution, helplessness, and depression
Laboratory helplessness does not parallel depression in every way
Much of the research relies on animal subjects
The attributional component of the theory raises particularly difficult questions in terms of animal models of depression
Sociocultural theorists propose that unipolar depression is greatly influenced by the social context that surrounds people
This belief is supported by the finding that depression often is triggered by outside stressors
There are two kinds of sociocultural views
The family-social perspective
The multicultural perspective
The family-social perspective
The connection between declining social rewards and depression (as discussed by the behaviorists) is a two-way street
Depressed people often display social deficits that make other people uncomfortable and may cause them to avoid the depressed individuals
This leads to decreased social contact and a further deterioration of social skills
Consistent with these findings, depression has been tied repeatedly to the unavailability of social support such as that found in a happy marriage
People who are separated or divorced display three times the depression rate of married or widowed persons and double the rate of people who have never been married
There also is a high correlation between level of marital conflict and degree of sadness that is particularly strong among those who are clinically depressed
Finally, it appears that people whose lives are isolated and without intimacy are particularly likely to become depressed at times of stress
The multicultural perspective
Two kinds of relationships have captured the interest of multicultural theorists:
Gender and depression
A strong link exists between gender and depression
Women cross-culturally are twice as likely as men to receive a diagnosis of unipolar depression
Women also appear to be younger, have more frequent and longer-lasting bouts, and to respond less successfully to treatment
Various theories have been offered
The artifact theory holds that women and men are equally prone to depression but that clinicians often fail to detect depression in men
The hormone explanation holds that hormone changes trigger depression in many women
The life stress theory suggests that women in our society experience more stress than men
The body dissatisfaction theory states that females in Western society are taught, almost from birth, to seek a low body weight and slender body shape—goals that are unreasonable, unhealthy, and often unattainable
The lack-of-control theory picks up on the learned helplessness research and argues that women may be more prone to depression because they feel less control than men over their lives
The rumination theory holds that people who ruminate when sad—keep focusing on their feelings and repeatedly consider the causes and consequences of their depression—are more likely to become depressed and stay depressed longer
Each explanation offers food for thought and has gathered just enough supporting evidence to make it interesting (and just enough contrary evidence to raise questions about its usefulness)
Cultural background and depression
Depression is a worldwide phenomenon, and certain symptoms seem to be constant across all countries, including sadness, joylessness, anxiety, tension, lack of energy, loss of interest, and thoughts of suicide
Beyond such core symptoms, research suggests that the precise picture of depression varies from country to country
Depressed people in non-Western countries are more likely to be troubled by physical symptoms of depression than by cognitive ones
As countries become more Westernized, depression seems to take on the more cognitive character it has in the West
Within the United States, researchers have found few differences in depression symptoms among members of different ethnic or racial groups; however, sometimes striking differences exist between racial/ethnic groups in the chronicity of depression
Hispanic Americans and African Americans are 50 percent more likely than white Americans to have recurrent episodes of depression—a finding possibly related to limited treatment opportunities
In a study of one Native American village, lifetime risk was 37 percent among women, 19 percent among men, and 28 percent overall
These findings are theorized to be the result of economic and social pressures
In addition, although overall depression rates are similar, differences exist in specific populations living under oppressive circumstances
Finally, research has revealed that depression is distributed unevenly within some minority groups
This is not totally surprising, given that each minority group itself comprises persons of varied backgrounds and cultural values
Bipolar Disorders People with a bipolar disorder experience both the lows of depression and the highs of mania
Many describe their lives as an emotional roller coaster
Unlike those experiencing depression, people in a state of mania typically experience dramatic and inappropriate rises in mood
Five main areas of functioning may be affected
Emotional symptoms—Active, powerful emotions in search of outlet
Motivational symptoms—Need for constant excitement, involvement, companionship
Behavioral symptoms—Very active; move quickly, talk loudly or rapidly
Flamboyance is not uncommon
Cognitive symptoms—Show poor judgment or planning
May have trouble remaining coherent or in touch with reality
Physical symptoms—High energy level, often in the presence of little or no rest
Diagnosing bipolar disorders (See Table 7-5, text p. 241.)
People are considered to be in a full manic episode when, for at least one week, they display an abnormally high or irritable mood, increased activity or energy, and at least three other symptoms of mania
In extreme cases, symptoms are psychotic
When symptoms are less severe, the person is said to be experiencing a hypomanic episode
DSM-5 distinguishes between two kinds of bipolar disorder
Bipolar I disorder
This disorder requires full manic and major depressive episodes
Most sufferers experience an alteration of mood
Some have mixed episodes
Bipolar II disorder
Hypomanic episodes and major depressive episodes
Without treatment, the mood episodes tend to recur for people with either type of bipolar disorder
If people experience four or more episodes within a one-year period, their disorder is further classified as rapid cycling
If their episodes vary with the seasons, their disorder is further classified as seasonal
Regardless of the particular pattern, individuals with bipolar disorder tend to experience depression more than mania over the years
In most cases, depressive episodes occur three times as often as manic ones, and last longer
Between 1 and 2.6 percent of all adults suffer from a bipolar disorder at any given time, and as many as 4 percent over the course of their lives
The disorders are equally common in women and men and among all socioeconomic classes and ethnic groups
Women may experience more depressive and fewer manic episodes than men do, and rapid cycling is more common in women
Onset usually occurs between 15 and 44 years of age
In most cases, the manic and depressive episodes eventually subside, only to recur at a later time
Generally, when episodes recur, the intervening periods of normality grow shorter and shorter
A final diagnostic option
If a person experiences numerous episodes of hypomania and mild depressive symptoms, a diagnosis of cyclothymic disorder is appropriate
Mild symptoms for greater than two years, interrupted by periods of normal mood
Cyclothymia affects at least 0.4 percent of the population
May eventually blossom into bipolar I or II
What causes bipolar disorders?
Throughout the first half of the twentieth century, the search for the cause of bipolar disorders made little progress
These insights have come from research into NT activity, ion activity, brain structure, and genetic factors
After finding a relationship between low norepinephrine and unipolar depression, early researchers expected to find a link between high norepinephrine and mania
This theory is supported by some research studies; bipolar disorders may be related to overactivity of norepinephrine
Because serotonin activity often parallels norepinephrine activity in unipolar depression, theorists expected that mania also would be related to high serotonin activity
While no relationship with high serotonin has been found, bipolar disorder may be linked to low serotonin activity, which seems contradictory
This apparent contradiction is addressed by the “permissive theory” of mood disorders
It may be that low serotonin “opens the door” to a mood disorder and permits norepinephrine activity to define the particular form the disorder will take
Low serotonin + Low norepinephrine = Depression
Low serotonin + High norepinephrine = Mania
Ions, necessary to send incoming messages to nerve endings, may be improperly transported through the cells
Some theorists believe that irregularities in the transport of these ions may cause neurons to fire too easily (mania) or to stubbornly resist firing (depression)
There is some research support for this theory
Brain imaging and postmortem studies have identified a number of abnormal brain structures in people with bipolar disorder, in particular the basal ganglia and cerebellum, among others
It is not clear what role such structural abnormalities play
Many theorists believe that people inherit a biological predisposition to develop bipolar disorders
Findings from twin studies support this theory:
The rate of bipolar disorder among identical (MZ) twins is 40 percent
The rate of bipolar disorder among fraternal (DZ) twins and siblings is 5 to 10 percent
The rate of bipolar disorder among the general population is 1 to 2.6 percent
Recently, genetic linkage studies have examined the possibility of “faulty” genes
Other researchers are using techniques from molecular biology to further examine genetic patterns
Such wide-ranging findings suggest that a number of genetic abnormalities probably combine to help bring about bipolar disorders
7.1. Compare depression and mania while discussing the symptoms of each.
7.2. Contrast unipolar depression and bipolar disorder while discussing the symptoms of each.
7.3. Describe the biological, psychological, and sociocultural perspectives of depression.
7.4. Describe the possible roles of neurotransmitters in unipolar depression.
7.5. Distinguish among the three diagnostic options for bipolar disorder.
7.6. Discuss the biological theory of bipolar disorder.
bipolar I disorder
bipolar II disorder
major depressive disorder
persistent depressive disorder
premenstrual dysphoric disorder
Please see Appendix A for full and comprehensive references. Sites relevant to Chapter 7 material are:
This website, provided by the National Institute of Mental Health, supplies downloadable links to PDF files and booklets on a variety of mental health topics.
This Internet encyclopedia offers a definition for mood disorders and links to the major types of disorders. In addition, there are links to other mood-related topics as well as to additional disorders related to mood disorders.
A site that includes the symptoms, treatments, and online support groups for bipolar disorder.
This site reviews the difficulties in recognizing depression and other mood disorders among teenagers.
This is a comprehensive site of the mood disorder support group of New York City.
Films relevant to Chapter 7 material are listed and summarized below.
Key to Film Listings:
P = psychopathology focus
T = treatment focus
E = ethical issues raised
Please note that some of the films suggested may have graphic sexual or violent content due to the nature of certain subject matters.
It’s a Wonderful Life
This film from 1946 stars Jimmy Stewart as George Bailey, a small-town man whose life seems so desperate he contemplates suicide. P, commercial film
Leaving Las Vegas
This 1995 film stars Nicolas Cage as a Hollywood screenwriter who has become an alcoholic. After being fired, he takes his severance pay to Las Vegas, where he plans to drink himself to death. P, serious film
This 1993 Richard Gere film follows the relationship between a bipolar man, Mr. Jones, and the female doctor who takes more than a professional interest in his treatment. P, T, E, commercial film
This 1980 film examines the treatment of a teenager suffering from depression, anxiety, and posttraumatic stress disorder in the aftermath of his brother’s death. P, T, serious film
About a Boy (2002), depression and suicide. P, commercial/serious film
About Schmidt (2002), depression. P, serious film
The Accidental Tourist (1988), depression. P, serious film
The Bell Jar (1979), anxiety and depression. P, T, serious film
Fear Strikes Out (1957), depression. P, T, serious film
Love Liza (2002), depression. P, serious/art film
Magnolia (1999), depression. P, serious film
Sophie’s Choice (1982), depression. P, serious film
Recommendations for Purchase or Rental
Films on Demand is a Web-based digital delivery service that has impressive psychology holdings. Their catalog can be accessed at http://ffh.films.com/digitallanding.aspx. In addition, the following videos and other media may be of particular interest and are available for purchase or rental and appropriate for use in class or for assignment outside of class.
When the Brain Goes Wrong
Franklin Institute, Tulip Films
c/o Icarus Films
32 Court Street
Brooklyn, NY 11201
CLASS DEMONSTRATIONS AND ACTIVITIES
Present a case study to the class.
Have students volunteer (or assign them) to portray mental health “workers” of different theoretical perspectives in a panel discussion. Each student should present the main explanation and treatment for the mood disorders from his or her theoretical background. Students in the audience can ask questions of the panelists. In addition, other students can role-play patients suffering from particular mood disorders. (NOTE: A brief reminder about sensitivity and professionalism is worthwhile here.) Have the panelists attempt to diagnose based on their orientation.
Bring in depression inventories. Discuss why these inventories are useful in both therapy and research. Ask students to suggest changes or modifications that could improve these instruments.
“Pretend, for a moment, that you are a . . .”
Divide students into groups and assign each group a task similar to the following. Pretend they are business owners who are interested in alleviating the negative (and costly) effects of depression on workplace productivity. Ask them to come up with creative and practical solutions to identifying and intervening with workers suffering from mood disorders. Similar roles are a high school principal, a medical doctor, a fraternity or sorority president, a college instructor, and a baseball team manager.
The Anonymous Five-Minute Essay
It is useful to ask students to take five minutes to explain the biological model of depression. Reviewing these answers can alert instructors to misconceptions and poor communication of important ideas. This can be done for the cognitive, behavioral, and psychodynamic models as well.
SUGGESTED TOPICS FOR DISCUSSION
Women and Depression
Ask the class to brainstorm why the rates of depression, even cross-culturally, are twice as high for women as for men. (See text pp. 237–238.)
Open Discussion: Manic Episodes
Discuss the idea that manic episodes can be extraordinarily pleasant. Encourage students to imagine aloud why such episodes might be enjoyable (more cheerful, more productive, more outgoing).
“Let’s Write a Self-Help Best-Seller”
Discuss the stigma associated with mood disorders. Many persons implicitly (and sometimes explicitly) presume that mood disorders occur only in persons who are weak or who “enjoy being sad.” Discuss the effect such attitudes might have on persons with mood disorders (reluctance to admit they have a problem or to seek help). Ask for ideas about how to educate the public about causes of these disorders, thus alleviating the stigma associated with them.
Open Discussion: Learned Helplessness
Martin Seligman and his colleagues suggested that depression is the result of learned helplessness. They proposed that depression, like learned helplessness, is the result of inescapable trauma or negative situations. The person learns that he or she has no control over these negative events and stops trying to respond in an efficient, adaptive manner. The individual thus learns to be helpless. Ask students for examples of how such a model of depression might apply.
Open Discussion: Beck’s Cognitive Theory
According to Aaron Beck and his colleagues, depression is caused by an individual’s tendency to think or reason in a certain fashion. In particular, people become depressed because of their personal schema about themselves, their world, and their future. Introduce the notion of perceptual sets and bias, which influence the manner in which a person perceives things. Perceptual sets cause distortions and selective attention that support the negative schema. An interesting exercise is to provide such a set of assumptions (personal schema), and then present a series of experiences and ask students for “congruent” (with the schema) interpretations of the event. For example, a woman may have a schema of herself as a terrible person. Her daughter is caught smoking at school. Another example: A young man believes that he is unlovable. His girlfriend breaks up with him. (These two people will take one event and distort it, then ignore or minimize contrary evidence, such as the fact that the daughter is a straight-A student or, in the case of the young man, that he acted in a way that encouraged his girlfriend to break up with him.)
ASSIGNMENTS/EXTRA CREDIT SUGGESTIONS
Write a Pamphlet
With the use of a software program like Microsoft Publisher or simply paper and markers, students can create a pamphlet on one or all of the disorders of mood. Students should be encouraged to be as accurate and up-to-date as possible and to present all sides of the disorder (e.g., alternate treatment approaches or theories).
Keep a Journal
In addition to helping students synthesize material, this activity also is helpful in developing writing skills. Have students keep a journal of their thoughts on course material throughout the semester. This can be done in the first or last five minutes of class or as an out-of-class assignment. Have students submit their journals for review on an ongoing basis as students can have the tendency to delay writing until the end of the semester. Some suggestions for journal topics include: reactions to the case examples; strengths and weaknesses of prevailing theoretical explanations; hypothetical conversations with sufferers of specific disorders, and so on.
For homework or extra credit, have students write an essay addressing one (or more) of the following topics:
(1) Write an essay discussing the power and acceptability of male versus female tears (see MediaSpeak, text p. 218).
(2) Discuss the decision to include Premenstrual Dysphoric Disorder in the DSM-5 (see PsychWatch on p. 238). Do you agree with its inclusion?
(3) Write an essay discussing postpartum depression (see PsychWatch, text p. 221). Address various theories/factors, the “four Ds” of the experience, and the shame and stigma experienced by many women.
(4) Discuss the relationship between abnormality and creativity (see PsychWatch, text p. 244).
For homework or extra credit, have students write a research report addressing one (or more) of the following topics:
(1) Conduct a “Psych Info” search and write a brief report on Premenstrual Dysphoric Disorder (see text p. 238).
(2) Conduct a “Psych Info” search and write an annotated bibliography on the various theories described on pp. 237–238 in the text to explain depression in women. Which of these models (if any) does the research most strongly support? With which of these models do you most agree?
(3) Conduct a literature review on abnormality and creativity (as discussed in PsychWatch, text p. 244). Does research support the link between the two? Is this association simply anecdotal or have controlled studies examined the association? What famous examples can you find?
To earn extra credit, have students watch one (or more) of the mainstream films listed earlier in this chapter and write a brief report (3 to 5 pages). Students should summarize the plot of the film in sufficient detail to demonstrate familiarity, but they should focus their papers on the depiction of psychological abnormality. What errors or liberties did the filmmaker take? What is the message (implicit or explicit) concerning people with mental illness?