Growing From Depression

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“Growing from depression” is a short, easy read on the subject of the depressive experience and how to make best use of and grow from that experience. The book is written by Dr. Neel Burton, who is a psychiatrist as well as a philosopher, and an exceptionally good writer.

“If I had more time, I would have written a  shorter letter” so wrote Pascal/ Twain and in case of Neel he seems to have spent enough time on this book, making it succinct yet easy to understand and follow by a layman.

The book is organized in four sections; one dealing with defining and delineating depression – an experience that is bound to affect us or our close family/friends once in the lifetime. Some estimates have put lifetime incidence of depression as high as 30 percent , which means we are either a sufferer or a caregiver at some point, thus the importance of the topic.

The second section deals with current treatments for depression, including CBT, ECT and antidepressants. Maybe in future editions newer treatments like Metacognitive therapy or rTMS/ DBS can be explored and elaborated at in depth.

The third section makes the meat of the book- its a self help section with bite sized chapters making one think aloud and get help growing from the depressive experience. Given that Neel is a philosopher, some chapters do digress a bit and become more philosophical/ at tangent with the main premise of the book, but overall the suggestions and elaboration is grounded in what we do indeed know about depression- including things like depressive realism.

The last section is related to mental health services and mental health law and has limited appeal to international audience as its focused and based around the UK health care system and the UK laws.

Overall, its a pretty good read and makes you realize that there is much that you can gain from the depressive experience- including wisdom as to how prevent a relapse by controlling daily stress, maintaining good daily habits like exercise etc.

I wish many more experts and scientists  were able to break up from the jargon, and write a self help book for people at large. I am sure we all will be richer for that!

Buy the book here.

Psychotherapy, East and West

Reading philosophical texts can be daunting- sometimes the terminology and words are dense and sometimes you have to re-read multiple times to understand what the writer means. But reading original sources can be highly enriching too.

Buddhist monk in Phu Soidao Nationalpark, Phu ...

Buddhist monk in Phu Soidao Nationalpark, Phu Soidao Nationalpark Waterfall, Thailand, Uttaradit Province Location: Phu Soidao Nationalpark Thailand. (Photo credit: Wikipedia)

So when I came across an opportunity to read and review ‘Psychotherapy east and west,’ by Alan Watts, I proceeded ahead with some mixed enthusiasm- I like his quote ‘What if money was no object’ very much; but I also knew that I might not have the right expertise to do justice to the book. I am not a participating psychotherapist- the only saving grace is that I am very much familiar with some of the eastern ‘ways of liberation’ like Vedanta and Yoga and somewhat moderately familiar with the other oriental ones like Zen Buddhism and Taoism.

However, there is much that I could not understand, so take what I say with a pinch of salt.

Alan Watts, considers the eastern ways of liberation as something akin to western psychotherapy, with the aim being to bring about a change in individual consciousness.

The main resemblance between these Eastern ways of life and Western psychotherapy is in the concern of both with bringing about changes of consciousness, changes in our ways of feeling our own existence and our relation to human society and the natural world. The psychotherapist has, for the most part, been interested in changing the consciousness of peculiarly disturbed individuals. The disciplines of Buddhism and Taoism are, however, concerned with changing the consciousness of normal, socially adjusted people. But it is increasingly apparent to psychotherapists that the normal state of consciousness in our culture is both the context and the breeding ground of mental disease. A complex of societies of vast material wealthy bent on mutual destruction is anything but a condition of social health.

And thus the importance of context to understand this book- it was first published in the early 60’s a time of cold war as also a time when the, now controversial,  double-bind theory of psychosis was proposed by Gregory Bateson, whose work Alan Watts seems to admire. Watts assumes, and tries to show ,that Eastern ways of liberation also work by making an individual come to see the true nature of the double bind that society / culture imposes. He references the Hindu concept of Maya or ‘world-as-illusion’ and applies it to social institutions and believes that even western psychotherapists are in the game of dispelling Maya for their clients:

For they (psychotherapists) are dealing with people whose distress arises from what may be termed maya, to use the Hindu-Buddhist word whose exact meaning is not merely “illusion” butthe entire world-conception of a culture, considered as illusion in the strict etymological sense of a play (Latin, ludere). The aim of a way of liberation is not the destruction of maya but seeing it for what it is, or seeing through it. Play is not to be taken seriously, or, in other words, ideas of the world and of oneself which are social conventions and institutions are not to be confused with reality.

 

….

Yet very few modern authorities on Buddhism or Vedanta seem to realize that social institutions constitute the maya, the illusion, from which they offer release. It is almost invariably assumed that Nirvana or moksha means release from the physical organism and the physical universe, an accomplishment involving powers of mind over matter that would give their possessor the omnipotence of a god.

Eastern ways of liberation work by dispelling Maya, dissolution of ego and letting Eros or Love/spontaneity reign. But first we have to understand the double-bind to comment on it and to come out of it.

 

And that is just the paradox of the situation: society gives us the idea that the mind, or ego, is inside the skin and that it acts on its own apart from society.
Here, then, is a major contradiction in the rules of then social game. The members of the game are to play as if they were independent agents, but they are not to know that they are just playing as if! It is explicit in the rules that the individual is self-determining, but implicit that he is so only by virtue of the rules. Furthermore, while he is defined as an independent agent, he must not be so independent as not to submit to the rules which define him. Thus he is defined as an agent in order to be held responsible to the group for “his” actions. The rules of the game confer independence and take it away at the same time, without revealing the contradiction.

This is exactly the predicament which Gregory Bateson calls the “double-bind,” in which the individual is called upon to take two mutually exclusive courses of action and at the same time is prevented from being able to comment on the paradox. You are damned if you do and damned if you don’t, and you mustn’t realize it. Bateson has suggested that the individual who finds himself in a family situation which imposes the double-bind upon him in an acute form is liable to schizophrenia. For if he cannot comment on the contradiction, what can he do but withdraw from the field? Yet society does not allow withdrawal; the individual must play the game.

….

But in liberation this comes to pass not through an unconscious compulsion but through insight, through understanding and breaking the double-bind which society imposes. One does not then get into the position of not being able to play the game; one can play it all the better for seeing that it is a game.

But we are getting ahead of ourselves. I will let Watts describe an example of double bind to you , both in philosophy and in practice, so that you get a clearer idea:

If all this is true, it becomes obvious that the ego feeling Is, pure hypnosis. Society is persuading the individual to do what it wants by making it appear that its commands are the individual’s inmost self. What we want is what you want. And this is a double-bind, as when a mother says to her child, who is longing to slush around in a mud puddle, “Now, darling, you don’t want to get into that mud!” This is misinformation, and this — if anything — is the “Great Social Lie.”

The theory of double -bind for psychosis, though largely discredited/ unproven; may still be a useful starting ground to think about how ways of liberation work. Is the purpose of Zen Koans like ‘show me your true self’ a way to put a person in double bind? Watts wanted this book to be provocative and not a summary of what  research had already happened in terms of commonality between eastern and western approaches to psychotherapy- and I believe he succeeds in making one think.

I loved the book and came out richer for having read that- but beware that like all philosophical books it could be a little dense at times. I hope others, including myself,  continue taking ideas from both east and west and keep cross fertilizing them, until we are all ‘liberated’!!

But the book here:

The ABCD of Personality Structure

Regular readers of The Mouse Trap would be aware of my ABCD model of psychology whereby all psychological phenomena are explained in terms of Affective, Behavioral, Cognitive and Dynamic/Desire dimensions.

Personality Traits from SignalPatterns.com

Personality Traits from SignalPatterns.com (Photo credit: Wikipedia)

The affective dimensions is also related to sensory processes; the behavioral dimension to motor processes; the cognitive dimension to associative processes and the desire/dynamic/motives dimension to social processes.

We are increasingly focusing on brain as a means to study psychological phenomena and thus four major divisions of neurosciences are affective neurosciences, behavioral neurosciences, social neurosciences and cognitive neurosciences.

Now, I have written extensively about personality, especially in relation to emotions, and have written a series of posts about the structure of personality traits and the underlying basic emotions. I have also tangentially touched upon or used ABCD and the fundamental four model while coming up with those previous posts; but today’s post is exclusively focused on the ABCD model and its utility for delineating personality traits.

Before we move onto personality traits, lets refresh our knowledge of brain structure. As per a controversial theory of brain structure, by Paul McLean, brain can be divided into a reptilian brain,a paleomammalian brain/ limbic brain and a neomammilain brain/neocortex; for our purpose the details of the model need not be true. However, one thing that McLean postulated was that older brain regions are in control of newer regions and if newer brain regions malfunction/ do not exercise control the behavior due to older system may get activated. Hughlings Jackson had surmised the same earlier and this is the part I will be focusing on.

Consider an earlier brain part that controls movement; (this may be mostly instinctual responding or impulsive initiation) ; a later brain part may inhibit and lead to better response/ proactive action that is well considered/ planned. I will call these two instances bottom-up effects and top-down effects on movement respectively.

With this in mind lets start a deeper look at the ABCD.

  1. Affective/sensory: This would be related to detecting unexpected stimuli or looking out for expected stimuli.
    1. The bottom up process of detecting incoming stimuli is enhanced by level of arousal. High arousal leads to better detection and low arousal to lesser detection; people may differ in their natural arousal levels and I guess you know where I am going with this-the introversion- eXtraversion dimension.
    2. The top down process of looking out for (potentially harmful) stimuli may lead to worry or anxiety. High Anxiety may help in vigilant detection, while lower anxiety to lapses in detecting harmful stimuli; the natural variation in this may be the trait Emotionally stable-Neuroticism( Emotionality). Anxiety remember was one of the dimensions discovered by Gray as relevant to personality.
  2. Behavioral/Motor:   This would be related to initiating action or responding to stimuli.
    1. The bottom up process here would lead to Impulsivity , another dimension elaborated on by Gray. The personality trait relevant here would be Impulsive Sensation Seeking as defined by Zuckerman.
    2. The top down process here would lead to Inhibition; when that process does not work, the low pole would be disinhibition (which is distinct from impulsivity). In FFM/HEXACO , this trait may be labeled as Conscientiousness and is related to strength of self-regulation.
  3. Drives/Social:  This would be related to interactions with others and the motives behind them – either to help others or the reciprocate a previous help.
    1. The bottom up process here is reactive reciprocation; or aggression in case of deception/defection by the other. The one end of this pole will be characterized by Aggression and hostility while the other pole by nice and reciprocal behavior and this leads us right on to Agreeableness dimension.
    2. The top down or expectation driven process here would be trusting and helping others on the one pole (in hope of reciprocation) and manipulating, hurting or exploiting people on the other. this naturally leads us to Honesty-humility dimension of HEXACO and the opposite pole that I believe is the dark tetrad of sadism, Machiavellianism, narcissism and sadism.
  4. Cognitive/ associative : This would be related to the tendency to make and use broad vis–vis narrow associations while doing information processing.
    1. The bottom up process here could be related to distractibility vis-a-vis focus. Some people may be easily distracted/ form loose associations and this may lead to Openness to experience in them; others may be more closed to new information. I think of this as the encoding process.
    2. The top down process here could be related to imagining novel associations between concepts etc. I would say this is a new dimension called Imagination dimension (Scott Barry Kaufman would be happy to hear:-)) .  At one end would be daydreamers and creative folks , at the other end more pragmatic/ reality oriented folks. I relate this to retrieval process. As this trait may still be evolving, we see psychosis related to this- imaginations/ top down processes overpowering reality orientation. this may also explain the association of creativity and mental illness.

 

I am happy with this personality structure organization with eight traits, instead of the usual five, that I have come up with. It has a solid theoretical rationale and a lot of thinking has gone into it; of course empirical work will prove whether its true or not and whether it stands the test of time!!

The Evolution of Altruism And Its Relationship to Personality

Altruism, put simply, is helping others or cooperating with others, even if it is costly to self. Of course, something like that cannot evolve, unless there are benefits too, associated with such acts of apparent selflessness.

Evolutionary theory mandates that there be some genetic payoffs in terms of either inclusive fitness or future benefits to self (reciprocity) for any kind of altruism/ cooperation to evolve.

I recommend reading Wikipedia articles on reciprocity, kin selection, and evolution of cooperation if they are not familiar to you or you need a refresher.

Cooperation, to start with, can evolve based on three forms of reciprocity: direct, indirect and network. All are based on the fact that there re repeated interactions between group of people- dyads, triads or many more. Reciprocity can typically be measured in the lab using the repeated Dictator/ Trust game.

Direct reciprocity was proposed by Robert Trivers as a mechanism for the evolution of cooperation. If there are repeated encounters between the same two players in an evolutionary game in which each of them can choose either to “cooperate” or “defect”, then a strategy of mutual cooperation may be favoured even if it pays each player, in the short term, to defect when the other cooperates.

Here, in direct reciprocity A trusts/helps B and hopes that when time comes B will reciprocate/help A. The top-of-the-mind factor is whether or not to trust somebody and whether or not to reciprocate someone’s trust. Trust and exploitation may be relevant issues here. In the Dictator/ Trust game this trust/exploitation manifests as the amount that is split and given to the other person vs kept with oneself.

In the standard framework of indirect reciprocity, there are randomly chosen pairwise encounters between members of a population; the same two individuals need not meet again. One individual acts as donor, the other as recipient. The donor can decide whether or not to cooperate. The interaction is observed by a subset of the population who might inform others. Reputation allows evolution of cooperation by indirect reciprocity.

This is partially correct that reputation for being trustworthy helps in indirect reciprocity; however that is only true for the downstream version; for the upstream version feelings of gratitude/happiness/awe/elevation in persons receiving the help/ witnessing the act also lead to more pro-social behavior by those receiving help/ witnessing. Thus feelings of gratitude/ awe/elevation mediate this kind of upstream indirect reciprocity. See below for upstream and downstream variants.

Individual acts of indirect reciprocity may be classified as “upstream” or “downstream”:

  • Upstream reciprocity occurs when an act of altruism causes the recipient to perform a later act of altruism in the benefit of a third party. In other words: A helps B, which then motivates B to help C.

  • Downstream reciprocity occurs when the performer of an act of altruism is more likely to be the recipient of a later act of altruism. In other words: A helps B, making it more likely that C will later help A.

Before touching upon network reciprocity, I will take a quick detour about kin selection. I believe kin selection or inclusive fitness is also a type of reciprocity (that between related individuals sharing genes) and may be rechristened genetic reciprocity. After all if A is likely to help B because they share x % of genes, the reverse is equally true and applicable. And of course this is mediated by emotional attachment to the kid/kin.

As per one definition of kin selection:

A biological theory stating that a gene that causes an organism to exhibit behavior detrimental to its survival will increase in frequency in a population if that behavior benefits the organism’s relatives, which will pass the gene on to subsequent generations.

If I slightly change words form above definition, I can now define a neighbor selection process as a cultural theory stating that a meme that causes an organism to exhibit behavior detrimental to its survival will increase in frequency in a population if that behavior benefits the organism’s neighbors, which will pass the meme on to subsequent neighbors.

We are now ready to look at network reciprocity:

Real populations are not well mixed, but have spatial structures or social networks which imply that some individuals interact more often than others. One approach of capturing this effect is evolutionary graph theory, in which individuals occupy the vertices of a graph. The edges determine who interacts with whom. If a cooperator pays a cost, c, for each neighbor to receive a benefit, b, and defectors have no costs, and their neighbors receive no benefits, network reciprocity can favor cooperation.

Basically, what I understand from the above is that if you help your neighbors sometimes such that the cost is not too high but benefits to neighbors are high and if  cost to benefit compares favorably with average number of neighbors/ neighborly interactions you have, then in the long run you will benefit and this form of cooperation can evolve.  To me the effects are mediated by the number of neighbors or sociability of a person.

Of course, even if you have all these mechanisms in place, cooperation may not evolve, as you may have free-riders. One important mechanism that has evolved to keep the free-riders in check is that of punishment. And once punishment is part of the picture you don’t even need repeated interactions, one-off games may be sufficient. I call this phenomenon Direct Punishment. One way it has been measured is with the Ultimatum game.

In the Ultimatum game, the second player can inflict costly punishment on first player by refusing to accept the division; this costly punishment is dyadic in nature and the aggression/hostility/vengefulness of the second player ensures that cooperation in even one-off encounters happens.

Basically instead of trusting and helping B, A starts by exploiting B and B retaliates by punishing A at cost to oneself.

Of course one can then surmise that there can be a phenomena of indirect punishment. This again may happen in two ways:

  1. Indirect punishment upstream: A is exploitative in nature; A exploits B; B punishes A, who then feels guilt/ gets reformed and stops exploiting C or even starts helping C.
  2. Indirect punishment downstream: A is exploitative in nature: A exploits B, B punishes A; B gets a reputation for being tough/competent and stops getting exploited by others say C or C may now even help B.

The Indirect reciprocity effects can be seen in Public goods/ trust game.

I will now take a detour and introduce the HEXACO model of personality which set me thinking about this in the first place.

HEXACO is an alternate personality model that is based on the same principles as the Big Five/FFM; i.e. it uses factor analysis of lexical terms in various languages to arrive at major personality traits.

The six factors are generally named Honesty-Humility (H), Emotionality (E), Extraversion (X), Agreeableness (A), Conscientiousness (C), and Openness to Experience (O). The personality-descriptive adjectives that typically belong to these six groups are as follows:

  • Honesty-Humility (H): sincere, honest, faithful, loyal, modest/unassuming versus sly, deceitful, greedy, pretentious, hypocritical, boastful, pompous

  • Emotionality (E): emotional, oversensitive, sentimental, fearful, anxious, vulnerable versus brave, tough, independent, self-assured, stable

  • Extraversion (X): outgoing, lively, extraverted, sociable, talkative, cheerful, active versus shy, passive, withdrawn, introverted, quiet, reserved

  • Agreeableness (A): patient, tolerant, peaceful, mild, agreeable, lenient, gentle versus ill-tempered, quarrelsome, stubborn, choleric

  • Conscientiousness (C): organized, disciplined, diligent, careful, thorough, precise versus sloppy, negligent, reckless, lazy, irresponsible, absent-minded

  • Openness to Experience (O): intellectual, creative, unconventional, innovative, ironic versus shallow, unimaginative, conventional

The factor H is a new factor not present in Big Five/FFM. The E though looking similar to N of big Five, is conceptually different; it no longer contains anger/hostility which are instead present in HEXACO A. similalrly there are important differences between HEXACO A and Big Five A. the other 3, C, O and X (extarversion) are similarly conceptualized and defined in both systems and have same loadings when tested together.

Ashton and Lee, the proponents of the HEXACO model, have themselves related evolution of altruism to these traits [pdf] and I am building on their work.

Basically as per them,

To begin, we have proposed that the Honesty- Humility and Agreeableness factors represent two complementary aspects of the construct of reciprocal altruism (Trivers, 1971). Honesty-Humility represents the tendency to be fair and genuine in dealing with others, in the sense of cooperating with others even when one might exploit them without suffering retaliation. Agreeableness represents the tendency to be forgiving and tolerant of others, in the sense of cooperating with others even when one might be suffering exploitation by them. (For a discussion of two broadly similar, although not identical, constructs, see Perugini, Gallucci, Presaghi, & Ercolani, 2003.) Presumably, high levels of Honesty- Humility are associated with decreased opportunities for personal gains from the exploitation of others but also with decreased risks of losses from withdrawal of cooperation by others. In a similar manner, high levels of Agreeableness are associated with increased opportunities for personal gains from long-run reciprocal cooperation with others, as well as with increased risks of losses from exploitation by others. (Note that we use the term altruism in terms of a dimension of altruistic versus antagonistic tendency, which involves both a willingness to help or provide benefits to others and an unwillingness to harm or impose costs on others.)
In addition, we have proposed that Emotionality represents tendencies relevant to the construct of kin altruism (Hamilton, 1964), including not only empathic concern and emotional attachment toward close others (who tend to be one’s kin) but also the harm-avoidant and help-seeking behaviors that are associated with investment in kin (see also Lee & Ashton, 2004). Presumably, high levels of Emotionality are associated with increased likelihood of personal and kin survival, as well as with decreased opportunities for gains that are often associated with risks to personal and kin survival.
To me, this looks like equating direct reciprocity with H and direct punishment with A.  With this in mind I now list the personality trait (HEXACO)/ evolution of altruism linkages.
1. Kin Selection/ Genetic Reciprocity : mediated by emotional attachments etc and related to Emotioanlity.
2. Neighbor Selection / Network Reciprocity: mediated by sociability and related to sociability aspects of Extrarversion.
3. Direct Reciprocity : mediated by trusting others and being honest and related to Honesty-humility.
4. Direct Punishment:  mediated by punishing others and being aggressive/ hostile when needed and related to Agreeablness.
5. Indirect Reciprocity upstream:  mediated by feelings of gratitude/ awe/ elevation and possibly related to Openness to Experience
6. Indirect Punishment upstream: mediated by feelings of guilt/responsibility and related to Conscientiousness.
 7. Indirect Reciprocity downstream: mediated by signaling and being trustworthy; need a new personality dimension for this.
8. Indirect Punishment downstream: mediated by signaling and being competent/ tough and possibly related to Surgency dimension of Extarversion.
I am more and more convinced, looking at the above model that we evolved to be cooperative/ altruistic rather than otherwise.

The Four Sub-Types of ADHD

Recently, I wrote a post about the four neural sub-types of depression. That classification was based on resting stage fMRI comparing depressive patients with controls; I hope someone does similar studies for other psychiatric conditions.

English: Symptoms of ADHD described by the lit...

English: Symptoms of ADHD described by the literature (Photo credit: Wikipedia)

The current post is an attempt to delineate what may come out in such a study if done for ADHD. I will be focusing on ADHD as it manifests in children, adolescents as well as adults.

I will be mostly relying on factor analytical studies of ADHD that have typically revealed 3 to 4 underlying factors.

ADHD has typically been diagnosed by looking at symptoms from inattentive or hyperactive-impulsive domains. You can find the DSM-5 criteria here. And its sub-types are combined presentation, predominantly inattentive presentation and predominantly hyperactive-impulsive presentation.

As per some studies, a majority (as much as 90 %) of ADHD subjects have inattentive symptoms while a few have hyperactive-impulsive symptoms. This is analogous to the depression findings that predominately depressive patients have a core pathology marked by low mood ; and subtypes marked by say anergia, anhedonia and anxiety.

However, factor analytical studies have presented a more nuanced picture. As per this study [pdf] there are four underlying factors of ADHD.

  1. Inattentive/ cognitive problems
  2. Hyperactivity/restlessness
  3. Impulsivity/ emotional lability
  4. Problems with self-concept

The first there factors are well established and quite apparent. To impulsivity description I may just add sensation-seeking too. The problems with self concept is something like low self-confidence/ self esteem, possibly due to continued underachievement and problems at school/ work. I would like to add another dimension to this fourth problems with self concept factor – that of disruptive/ defiant behavior possibly due to self-concept issues.

And I am sure in future, in future, when brain basis and neutral subtypes are more easily available for ADHD, we will find these four subtypes.

Before we leave, its important to note that ADHD lies on a continuum and its a matter of degree than a matter of kind .

Also, ADHD confers benefits too like enhanced creativity and some work has shown that creativity can be mistaken for ADHD in kids.

The above four sub-types may then be classified by their positive poles too:

  1. Daydreaming/broadened attention
  2. High energy and enthusiasm
  3. risk-taking and emotional sensitivity
  4. independent and idiosyncratic

All the above are also traits associated with the creative person. ADHD & creativity are indeed very closely related and its time we stopped seeing differences like ADHD in purely pathological terms.

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