Depressive and Bipolar Disorders Chapter Summary



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Depressive and Bipolar Disorders



Chapter Summary

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.



TOPIC OVERVIEW

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

Psychological Views

Sociocultural Views



Bipolar Disorders

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

  1. DEPRESSION AND MANIA ARE THE KEY EMOTIONS IN DISORDERS OF MOOD

    1. Depression—a low, sad state in which life seems dark and its challenges overwhelming

    2. Mania—a state of breathless euphoria or frenzied energy

    3. People with depressive disorder experience only depression

      1. This pattern is called unipolar depression

      2. There is no history of mania

      3. Mood returns to normal when depression lifts

    4. Others experience periods of mania that alternate with periods of depression

      1. This pattern is called bipolar disorder

    5. One might logically expect a third pattern—unipolar mania, in which people suffer from mania only—but this pattern is uncommon

    6. Mood problems have always captured people’s interest

    7. Mood problems have been shared by millions, and today the economic costs amount to more than $80 billion each year

      1. The human suffering is beyond calculation

  2. 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]

    1. The term depression is often used to describe general sadness or unhappiness

      1. This loose use of the term confuses a normal mood swing with a clinical syndrome

      2. Depressive disorders can bring severe and long-lasting psychological pain that may intensify over time

    2. How common is unipolar depression?

      1. Around 8 percent of adults in the United States suffer from severe unipolar depression in any given year

      2. As many as 5 percent suffer mild forms

      3. About 17 percent of all adults will experience unipolar depression in their lifetimes

      4. The prevalence is similar in Canada, England, France, and many other countries

      5. The rate of depression is higher among poor people than wealthier people

      6. The risk of experiencing this problem has increased steadily since 1915

      7. People of any age may suffer from unipolar depression

    3. Women are at least twice as likely as men to experience episodes of severe unipolar depression

      1. As many as 26 percent of women (as opposed to 12 percent men) may have an episode at some time in their lives

      2. Among children, the prevalence is similar for boys and girls

    4. Approximately 85 percent of those with unipolar depression will recover, some without treatment

      1. Around 40 percent will experience another episode later in their lives

    5. What are the symptoms of depression?

      1. Symptoms may vary from person to person

      2. Five main areas of functioning may be affected:

        1. Emotional symptoms—feeling “miserable,” “empty” experiencing little pleasure

        2. Motivational symptoms—lacking drive, initiative, spontaneity

          1. Between 6 and 15 percent of those with severe depression will die by suicide

        3. Behavioral symptoms—less active or productive

        4. Cognitive symptoms—hold a negative self-view; pessimistic

        5. Physical symptoms—headache, dizziness, general pain

    6. Diagnosing unipolar depression

      1. 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.)

        1. In extreme cases, symptoms are psychotic, including:

          1. Hallucinations

          2. Delusions

      2. DSM-5 lists several types of depressive disorders

        1. Major depressive disorder

          1. People who experience a major depressive episode and have no history of mania

        2. Dysthymic disorder

          1. Individuals who experience a longer-lasting (at least two years) but less disabling pattern of depression

          2. When dysthymic disorder leads to major depressive disorder, it is termed double depression

        3. Premenstrual dysphoric disorder

          1. A diagnosis given to women who repeatedly experience clinically significant depressive symptoms during the week before menstruation

        4. Disruptive mood regulation disorder

          1. Characterized by a combination of persistent depressive symptoms and recurrent outbursts of severe temper

  3. What causes unipolar depression?

    1. Stress may be a trigger for depression

      1. People with depression experience a greater number of stressful life events during the month just before the onset of their symptoms than do others

      2. Some clinicians distinguish reactive (exogenous) depression from endogenous depression, which seems to be a response to internal factors

      3. Today’s clinicians usually concentrate on recognizing both the situational and internal aspects of any given case

    2. The current explanations of unipolar depression point to biological, psychological, and sociocultural factors

      1. The biological view—Genetic factors

        1. Family pedigree, twin, adoption, and molecular biology gene studies suggest that some people inherit a biological predisposition to unipolar depression

        2. 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

        3. Twin studies demonstrate a strong genetic component:

          1. Concordance rates for identical (MZ) twins are 46 percent

          2. Concordance rates for fraternal (DZ) twins are 20 percent

        4. Adoption has implicated a genetic factor in cases of severe unipolar depression

        5. Using techniques from the field of molecular biology, researchers have found evidence that unipolar depression may be tied to specific genes

      2. The biological view—Biochemical factors

        1. Low activity of two neurotransmitters (NT)—norepinephrine and serotonin—has been strongly linked to unipolar depression

          1. In the 1950s, medications for high blood pressure were found to cause depression; some lowered serotonin, others lowered norepinephrine

          2. The discovery of truly effective antidepressant medications, which relieved depression by increasing either serotonin or norepinephrine, confirmed the NT role.

            1. 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

          3. Biological researchers have also learned that the endocrine system may play a role

            1. People with depression have been found to have abnormal levels of cortisol, which is released by the adrenal glands during times of stress

            2. People with depression have been found to have abnormal melatonin secretion

            3. Other researchers are investigating deficiencies of important proteins within neurons as tied to depression

        2. This model has produced much enthusiasm but has certain limitations

          1. Relies on analogue studies: depression-like symptoms created in lab animals

            1. Do these symptoms correlate with human emotions?

          2. Measurement of brain activity has been difficult and indirect

            1. Current studies with modern technology are attempting to address this issue

      3. The biological view—Brain anatomy and brain circuits

        1. Biological researchers have determined that emotional reactions of various kinds are tied to brain circuits

          1. These are networks of brain structures that work together, triggering each other into action and producing a particular kind of emotional reaction

          2. It appears that one circuit is tied to GAD, another to panic disorder, and yet another to OCD

        2. Although research is far from complete, a circuit responsible for unipolar depression has begun to emerge

          1. Likely brain areas in the circuit include: prefrontal cortex, hippocampus, amygdala, and Brodmann’s Area 25

      4. The biological view—Immune system

        1. This system is the body’s network of activities and cells that fight off bacteria and other foreign invaders

        2. When stressed, the immune system may become dysregulated, which some believe may help produce depression

        3. Support for this explanation is circumstantial but compelling

      5. Psychological views

        1. There are three main psychological models:

          1. Psychodynamic view—no strong research support

            1. Developed by Freud and his student Abraham, this model links depression and grief

              1. 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

              2. For most people, introjection is temporary

              3. If grief is severe and long-lasting, depression results

            2. At greater risk for developing depression are those with oral stage issues—either unmet or excessively met needs

            3. Some people experience “symbolic” (or imagined) loss

            4. Newer psychoanalysts (object relations theorists) propose that depression results when people’s relationships leave them feeling unsafe and insecure

            5. Strengths

              1. Studies have offered general support for the psychodynamic idea that depression may be triggered by a major loss (e.g., anaclitic depression)

              2. Research supports the theory that early losses set the stage for later depression

              3. Research also suggests that people whose childhood needs were improperly met are more likely to become depressed after experiencing a loss

            6. Limitations

              1. Early losses and inadequate parenting don’t inevitably lead to depression and may not be typically responsible for development of depression

              2. Many research findings are inconsistent

              3. Certain features of the model are nearly impossible to test

          2. Behavioral view—modest research support

            1. Behaviorists believe that unipolar depression results from significant changes in rewards and punishments people receive

            2. 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

            3. Research supports the relationship between the number of rewards received and presence of depression

              1. Social rewards are especially important

            4. Strengths

              1. Researchers have compiled significant data to support this theory

            5. Limitations

              1. Research has relied heavily on the self-reports of depressed subjects

              2. Behavioral studies are largely correlational and do not establish that decreases in rewards are the initial cause of depression

          3. Cognitive views (two main theories)—considerable research support

            1. Negative thinking

              1. Beck theorizes that four interrelated cognitive components combine to produce unipolar depression:

                1. Maladaptive attitudes

                  1. Self-defeating attitudes are developed during childhood

                  2. Beck suggests that upsetting situations later in life can trigger an extended round of negative thinking

        2. Negative thinking typically takes three forms called the cognitive triad:

                  1. Individuals repeatedly interpret their (1) experiences, (2) themselves, and
                    (3) their futures in negative ways that lead them to feel depressed

        3. Depressed people also make errors in their thinking, including:

                  1. Arbitrary inferences

                  2. Minimization of the positive; magnification of the negative

        4. Depressed people experience automatic thoughts, a steady train of unpleasant thoughts suggesting inadequacy and hopelessness

              1. Strengths

                1. Many studies have produced evidence in support of Beck’s explanation:

                  1. There is a high correlation between the level of depression and the number of maladaptive attitudes held

                  2. Both the cognitive triad and errors in logic are seen in people with depression

                  3. Automatic thinking has been linked to depression

              2. Limitations

                1. Research fails to show that such cognitive patterns are the cause and core of unipolar depression

            1. Learned helplessness

              1. This theory asserts that people become depressed when they think that:

                1. They no longer have control over the reinforcements (rewards and punishments) in their lives

                2. They themselves are responsible for this helpless state

              2. The theory is based on Seligman’s work with laboratory dogs

                1. Dogs who were subjected to uncontrollable shock were later placed in a shuttle box

                2. Even when presented with an opportunity to escape, dogs that had experienced uncontrollable shocks made no attempt to do so

                3. Seligman theorized that the dogs had “learned” to be “helpless” to do anything to change negative situations and drew parallels to human depression

              3. There has been significant research support for the model:

                1. Human subjects who undergo helplessness training score higher on depression scales and demonstrate passivity in laboratory trials

                2. Animal subjects lose interest in sex and social activities—a common symptom of human depression

                3. In rats, uncontrollable negative events result in lower serotonin and norepinephrine levels in the brain

              4. Recent versions of the theory focus on attributions

                1. 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

                  1. Example: “It’s all my fault” [internal]; “I ruin everything I touch” [global] “and I always will” [stable]

                  2. 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]

                2. 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

              5. Strengths

                1. Hundreds of studies have supported the relationship among styles of attribution, helplessness, and depression

              6. Limitations

                1. Laboratory helplessness does not parallel depression in every way

                2. Much of the research relies on animal subjects

                3. The attributional component of the theory raises particularly difficult questions in terms of animal models of depression

      6. Sociocultural views

        1. Sociocultural theorists propose that unipolar depression is greatly influenced by the social context that surrounds people

          1. This belief is supported by the finding that depression often is triggered by outside stressors

          2. There are two kinds of sociocultural views

                  1. The family-social perspective

                  2. The multicultural perspective

        2. The family-social perspective

          1. The connection between declining social rewards and depression (as discussed by the behaviorists) is a two-way street

            1. Depressed people often display social deficits that make other people uncomfortable and may cause them to avoid the depressed individuals

            2. This leads to decreased social contact and a further deterioration of social skills

          2. Consistent with these findings, depression has been tied repeatedly to the unavailability of social support such as that found in a happy marriage

            1. 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

            2. 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

          3. Finally, it appears that people whose lives are isolated and without intimacy are particularly likely to become depressed at times of stress

        3. The multicultural perspective

          1. Two kinds of relationships have captured the interest of multicultural theorists:

          2. Gender and depression

            1. A strong link exists between gender and depression

            2. Women cross-culturally are twice as likely as men to receive a diagnosis of unipolar depression

            3. Women also appear to be younger, have more frequent and longer-lasting bouts, and to respond less successfully to treatment

            4. Various theories have been offered

              1. The artifact theory holds that women and men are equally prone to depression but that clinicians often fail to detect depression in men

              2. The hormone explanation holds that hormone changes trigger depression in many women

              3. The life stress theory suggests that women in our society experience more stress than men

              4. 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

              5. 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

              6. 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

            5. 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)

          3. Cultural background and depression

            1. 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

            2. Beyond such core symptoms, research suggests that the precise picture of depression varies from country to country

              1. Depressed people in non-Western countries are more likely to be troubled by physical symptoms of depression than by cognitive ones

              2. As countries become more Westernized, depression seems to take on the more cognitive character it has in the West

            3. 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

              1. 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

              2. In a study of one Native American village, lifetime risk was 37 percent among women, 19 percent among men, and 28 percent overall

              3. These findings are theorized to be the result of economic and social pressures

            4. In addition, although overall depression rates are similar, differences exist in specific populations living under oppressive circumstances

            5. Finally, research has revealed that depression is distributed unevenly within some minority groups

              1. This is not totally surprising, given that each minority group itself comprises persons of varied backgrounds and cultural values

  4. Bipolar Disorders

    1. People with a bipolar disorder experience both the lows of depression and the highs of mania

      1. Many describe their lives as an emotional roller coaster

    2. Unlike those experiencing depression, people in a state of mania typically experience dramatic and inappropriate rises in mood

      1. Five main areas of functioning may be affected

        1. Emotional symptoms—Active, powerful emotions in search of outlet

        2. Motivational symptoms—Need for constant excitement, involvement, companionship

        3. Behavioral symptoms—Very active; move quickly, talk loudly or rapidly

          1. Flamboyance is not uncommon

        4. Cognitive symptoms—Show poor judgment or planning

          1. May have trouble remaining coherent or in touch with reality

        5. Physical symptoms—High energy level, often in the presence of little or no rest

    3. Diagnosing bipolar disorders (See Table 7-5, text p. 241.)

      1. 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

        1. In extreme cases, symptoms are psychotic

      2. When symptoms are less severe, the person is said to be experiencing a hypomanic episode

      3. DSM-5 distinguishes between two kinds of bipolar disorder

        1. Bipolar I disorder

          1. This disorder requires full manic and major depressive episodes

          2. Most sufferers experience an alteration of mood

          3. Some have mixed episodes

        2. Bipolar II disorder

          1. Hypomanic episodes and major depressive episodes

      4. Without treatment, the mood episodes tend to recur for people with either type of bipolar disorder

        1. If people experience four or more episodes within a one-year period, their disorder is further classified as rapid cycling

        2. If their episodes vary with the seasons, their disorder is further classified as seasonal

      5. Regardless of the particular pattern, individuals with bipolar disorder tend to experience depression more than mania over the years

        1. In most cases, depressive episodes occur three times as often as manic ones, and last longer

      6. 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

        1. The disorders are equally common in women and men and among all socioeconomic classes and ethnic groups

        2. Women may experience more depressive and fewer manic episodes than men do, and rapid cycling is more common in women

      7. Onset usually occurs between 15 and 44 years of age

        1. In most cases, the manic and depressive episodes eventually subside, only to recur at a later time

        2. Generally, when episodes recur, the intervening periods of normality grow shorter and shorter

      8. A final diagnostic option

        1. If a person experiences numerous episodes of hypomania and mild depressive symptoms, a diagnosis of cyclothymic disorder is appropriate

          1. Mild symptoms for greater than two years, interrupted by periods of normal mood

          2. Cyclothymia affects at least 0.4 percent of the population

          3. May eventually blossom into bipolar I or II

    4. What causes bipolar disorders?

      1. Throughout the first half of the twentieth century, the search for the cause of bipolar disorders made little progress

      2. More recently, biological research has produced some promising clues

      3. These insights have come from research into NT activity, ion activity, brain structure, and genetic factors

        1. Neurotransmitters

          1. After finding a relationship between low norepinephrine and unipolar depression, early researchers expected to find a link between high norepinephrine and mania

          2. This theory is supported by some research studies; bipolar disorders may be related to overactivity of norepinephrine

          3. Because serotonin activity often parallels norepinephrine activity in unipolar depression, theorists expected that mania also would be related to high serotonin activity

          4. While no relationship with high serotonin has been found, bipolar disorder may be linked to low serotonin activity, which seems contradictory

            1. This apparent contradiction is addressed by the “permissive theory” of mood disorders

            2. 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

              1. Low serotonin + Low norepinephrine = Depression

              2. Low serotonin + High norepinephrine = Mania

        2. Ion activity

          1. Ions, necessary to send incoming messages to nerve endings, may be improperly transported through the cells

          2. 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)

          3. There is some research support for this theory

        3. Brain structure

          1. 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

          2. It is not clear what role such structural abnormalities play

        4. Genetic factors

          1. Many theorists believe that people inherit a biological predisposition to develop bipolar disorders

          2. Findings from twin studies support this theory:

            1. The rate of bipolar disorder among identical (MZ) twins is 40 percent

            2. The rate of bipolar disorder among fraternal (DZ) twins and siblings is 5 to 10 percent

            3. The rate of bipolar disorder among the general population is 1 to 2.6 percent

          3. Recently, genetic linkage studies have examined the possibility of “faulty” genes

          4. Other researchers are using techniques from molecular biology to further examine genetic patterns

          5. Such wide-ranging findings suggest that a number of genetic abnormalities probably combine to help bring about bipolar disorders

LEARNING OBJECTIVES

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.

KEY TERMS

anaclitic depression

automatic thoughts

bipolar disorder

bipolar I disorder

bipolar II disorder

cognitive triad

cyclothymic disorder

delusion

depression

depressive disorders

learned helplessness

major depressive disorder

mania


norepinephrine

persistent depressive disorder

premenstrual dysphoric disorder

serotonin

symbolic loss

unipolar depression



MEDIA RESOURCES

Internet Sites

Please see Appendix A for full and comprehensive references. Sites relevant to Chapter 7 material are:

http://www.nimh.nih.gov/health/publications

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.



http://en.wikipedia.org/wiki/Mood_disorder

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.



http://bipolar.mentalhelp.net/

A site that includes the symptoms, treatments, and online support groups for bipolar disorder.



http://www.adolescent-mood-disorders.com/

This site reviews the difficulties in recognizing depression and other mood disorders among teenagers.



http://www.mdsg.org/

This is a comprehensive site of the mood disorder support group of New York City.

Mainstream Films

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



Mr. Jones

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



Ordinary People

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

Other Films:

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

Fanlight Productions

c/o Icarus Films

32 Court Street

Brooklyn, NY 11201

(800) 937-4113

Email: info@fanlight.com



CLASS DEMONSTRATIONS AND ACTIVITIES

Case Study

Present a case study to the class.

Panel Discussion

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.

Depression Inventories

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.

Essay Topics

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).

Research Topics

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?



Film Review

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?
Directory: resources -> CW%20resources%20(by%20Author)
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CW%20resources%20(by%20Author) -> Multiple-Choice Questions The Tropisms; p. 661; difficult; ans: e
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CW%20resources%20(by%20Author) -> Affirm the antecedent or deny the consequent
CW%20resources%20(by%20Author) -> Chapter 16: Bryophytes Multiple-Choice Questions Introduction; p. 366; easy; ans: e
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CW%20resources%20(by%20Author) -> Disorders of Aging and Cognition Chapter Summary

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