Posts tagged Mental health
Most of us have heard about the BioPsychoSocial model of mental illnesses and have also heard about the stress-diathesis model. Today as I was contemplating the two, taking cue from my ABCD model of psychology, I tried combining the two and find quite some merit in that approach.
To recap, BioPsychoSocial model says that any disease is a result of multiple interacting factors- some of them biological in nature while others psychological and social. The mind affects the body and the body affects the mind and together they may lead to health or illness. This model is as opposed to the BioMedical model which considers the disease to be predominantly due to biological factors.
The stress-diathesis model posits that people have underlying biological or psychological vulnerabilities and when exposed to an environmental stressor may develop a mental disease with varying probabilities. The same stressor may be harmless to a person who does not have those many vulnerabilities, but prove detrimental for someone with the right kind of vulnerabilities.
Combining the two models together, one can have biological, psychological or social diathesis or vulnerabilities and when exposed to the right environmental toxin/stressor may lead to the emergence of a mental health issue in the individual.
To elucidate by way of an example. Consider a person whose serotonin neurotransmitter system is such that he typically has lower levels of baseline serotonin. This would be a biological vulnerability to depression. He also has tendency towards negative automatic thoughts or pessimism. This would be a psychological vulnerability. Moreover he has limited social support and is unmarried and from a low SES background. This would be the social vulnerability. Strike three. On top of this, lets say he suddenly loses hos job and is laid off. That environmental life event may be enough to drive this person to clinical depression.
The BioPsychSocioEnvironmental model has application not only in psychopathology, but I believe its a powerful framework for normal development too. For e.g., if we replace diathesis-stress model with differential susceptibility thesis then the diathesis or sensitivity to context can interact with both positive and negative environmental events to lead to positive or negative life outcomes.
To me combining the two models is immensely fruitful; hope you too find it useful.
Today, i.e. 15th may 2013 is being celebrated as a mental health blog day by APA and in the spirit of the day I am posting a review of ‘A Lethal Inheritance’ by Victoria Costello. It is a book chronicling how ‘ a mother uncovers the science behind three generations of mental illness‘ and is an apt topic for the day highlighting the importance of public education and discourse about the topic of mental health. this blog pots and book review is a homage to all the people who silently suffer from mental illness, most of the time undiagnosed, or even after diagnosis kept under warps due to associated stigma, and their family members who face the burden of not just care-giving but the counterproductive and unnecessary guilt that many of them either by themselves feel or are made to feel by indirect societal gestures.
Let me also take this opportunity to apologize to Prometheus Books and Victoria : the book had come out a year ago and I was sent a review copy promptly, but could not review it earlier. Better late than never!
The book, as the subtitle reveals, revolves around three generations of Victoria’s family (this book is autobiographical) : her two sons Alex and Sammy, which have their own mental health challenges and the unraveling of one of them: a first time encounter with a psychotic experience which could be quite disconcerting for everyone involved: leads her on on her journey to trace the roots of this malady affecting her family and also on a scientific pilgrimage where she continues to search for reasons, symptoms and preventive measures for the various mental health conditions afflicting her family’s three generations.
If the third generation is her sons, the second generation comprises of her and her sister Rita. While she struggles with undiagnosed/ untreated depression for most of her life, her sister is found struggling with serious substance dependence and addiction- which in the end cost her her life.
The first generation consist of an Irish immigrant grandpa in USA, whose claim to family fame, is that nobody wants to talk about his death: a purported accident where he feel asleep /drunk on the railroads and died. Now Victoria is a journalist and a good investigative journalist at that. Not satisfied with the account her mother has narrated to her, she undertakes an investigation of her own that leads to surprising discoveries like the fact that her grandpa had dies seven months before hew mother was born , rather than afterwards as believed. Also that his official death transcript reads as died from accidental drowning in a lake, thus casting doubts over the real conditions surrounding his death and also raising a question, could we ever really know if someone had committed suicide or died accidentally even if the incident was of yesterday and not many years before. The fact that his grandpa was an alcoholic, an immigrant laborer most probably facing economic stress and suffering from some mental illness, and likely committed suicide, based on the guilt/ disgust and many other emotions it aroused in his relatives (wife , daughter etc) points to the various ways genes (Irish inheritance) and environmental factors come together to wreak havoc.
The book is large part sensitive narration of one’s own story, some part thrilling investigative journalism and remaining parts informed scientific documentation of symptoms, risk factors, early signs, preventive measures and genes-environment interplay in the making and unmaking of mental health. While the scientific facts are up-to-date, they wont be path breaking as this is not mostly a scientific book- its value lies more in a first hand account of how a family deals with mental health issues and how there are common genetic risk factors that manifest in various forms- from a teen having conduct problems and eventually psychosis, to an adult in the grips of substance use and addiction, to a mother fighting and feigning at the same time that she does not suffer from depression, to a long dead grandpa who was alcoholic and probably committed suicide, to traces of violence in other relatives.
The book is also important as it highlights that mental illness and genetic risk does not respect diagnostic boundaries- from depression to conduct disorders to substance use to psychosis – all manifest in the same family tree and were perhaps myriad manifestations of a same common inheritance.
My recommendations; read it, read it as a piece of fiction , as an autobiographical account; as an educative opportunity to know more about mental illness and risk factors or just to get a first hand experiential account of what it meas to live under the weight of a lethal inheritance- read it whichever way you like, but you are bound to come out with an enhanced and more nuanced perspective that would be richer for having read this .
I have a post over at Psychology Today about Labeling and its deleterious effects. That did lead to some heated discussions on Facebook, so be sure to add your voice to the discussion by commenting on the post.
The way I have framed the above issues, I’m sure you know by now, which way my sympathies lie. To make it explicit, I do not like labelling children / adult who have slightly differently wired brains, or who are temporarily thrown off-track due to acute stressors and circumstances beyond their control, with mental disease/illness labels – I believe the stigmatisation that accompanies such a labelling does more harm than good. This does not mean labelling per se is bad- we do need to label differences amongst us, both to harness properly the special abilities that such a diverse population presents, and to help them overcome whatever shortcomings they have by providing adequate and tailored societal support to accommodate such differences. Labelling becomes bad and counterproductive when the label is seen as permanent and innate (even a ‘gifted’ label is counterproductive if such giftedness is seen as innate and non-malleable), and has a negative, stigmatising and disability connotation.
Read the rest at the source; the last point needs elaboration. Just as labeling someone as Gifted may have negative effects, labeling someone as stupid or incapable also has long lasting negative effects. My TOI blog post touches on how Sir John Gurdon faced such a situation and came out victorious.
What are the chances that you would overcome such negative feedback, not be irrevocably scarred by such negativity, but instead show a high degree of resilience and positive attitude and take that as a challenge rather than a setback; and finally become not only a successful scientist, but also receive the highest honour in your field- a Nobel Prize? If that seems too good to be true, take heart. Sir John Gurdon, who received the Nobel Prize in physiology or medicine for 2012 has actually lived that life. However, while most of us may wither into nothingness after getting so much negative early feedback; he took that as a challenge – he got that report framed and put above his desk in the Gurdon Institute in Cambridge (the only piece of accomplishment he ever got framed!) – And decided to prove his teacher wrong.
This brings me to announcing my brand new blog at Times Of India, which would be targeted more towards the layman, and also have a contemporary and Indian touch. My first post, on the occasion of world Mental Health day, questioned the exclusive focus on disease and illness to the detriment of a focus on health and positive aspects.
Consider again the widely available public knowledge that some children, having a particular genetic vulnerability (one form of Serotonin transporter gene), if abused as children, have a greater likelihood of getting depressed when they grow up. How many of us, also know of the recent Orchid and Dandelion hypothesis, whereby the genetic vulnerability is more of a heightened sensitivity to environment, whereby the same vulnerable children, if abused, can become depressed; but if provided a nurturing and supportive environment, can paradoxically be more resilient and resistant to stressors than those not having that gene variant. However, as the discourse on protective and resilient factors is lacking, the spotlight continues to shine on seeing such children as ‘at-risk’, rather than seeing them as resilient, if provided the right early start. These orchid children, requiring exquisite early care, to bloom fully, continue to be seen as liabilities rather than assets to be proud of.
And that finally brings me to my Split Blog Disorder. I think I owe a post listing all my various blogs. If you are reading this you are already aware of The Mouse Trap.
My other psychology themed blog is at Psychology Today, called The Fundamental Four.
I use my The Creativity Post blog The Muses and The Furies to focus exclusively on creativity and intelligence and also their relationship to insanity.
I have started blogging for Times Of India, and Mind Cafe focuses on topics of general interest with a psychological angle.
Apart from this I have a Tumblr blog Flotsam and Jetsam, where i typically post quotes that I find interesting.
A new study by Ruthsatz and Urbach is doing the rounds nowadays. That study has nothing to do with Autism or ADHD per se. The study focuses on child prodigies and finds that they have high levels of intelligence, enhanced working memory and that they pay attention to details.
What the study also found was high level of autistic relatives and high scores on Autism spectrum for the prodigies. The relation between autism and prodigiousness was mediated by the endo-phenotype ‘paying attention to detail’ and none of the other symptoms of ASD seemed to play a role.
Many savants also are high on ASD and have exception working as well as long term memory. There too they pay excessive attention to details and are fascinated by speical interests.
On the other hand there is gathering literature that suggests that the ADHD kid is basically on the creative side of the spectrum – restless, trying multiple strategies, having diffused and peripheral attention, and to an extent novelty and sensation seeking.
Also, if one thinks about that for a minute, autism and ADHD seem to be opposed on a number of dimensions. The three basic features of ADHD are 1) inattentiveness and distractibility vs too much focus and fascination for an object shown by Autistic kid 2) impulsiveness vs restricted and repetitive motions and interests of the autistic kid and finally 3) hyperactivity vs restrained interactions and communications of the autistic kid.
There is also some data from fly models that suggest that autism and ADHD are opposites in a sense.
I may even go ahead and stick my neck and say that while autism is primarily characterized by emotion of Interest/ fascination/ attention ; ADHD is characterized by emotion of Wonder/Awe/surprise.
One theory of autism suggests that the social and communicative difficulties arise as the child hides in a cocoon to prevent over-stimulation and sensory overload; a theory of ADHS says that the child is under-stimulated and needs stimulants like Ritalin to achieve baseline of activation and sensory stimulus.
Another popular theory of autism posits that it arises primarily due to ‘weak central coherence’, or inability to see the context/ gestalt/ ‘the big picture’. The ADHD kid on the other hand is hypothesized to use a lot of peripheral attention and daydreams missing what is being centrally taught in the classroom.
And that brings me to the root of the differences in my opinion; while the Autism spectrum is characterized by a local processing style, the ADHD-psychotic spectrum is characterized by a global processing style.
Some clarifications are due here. I believe ADHD to fall on the psychotic spectrum and have been proposing the autism and psychosis as opposites on a continuum model for close to eternity.
Also, when I say global/local processing styles I dont restrict the application to perception alone, but extend it to include cognitive style too.
There is a lot of work that has been done on global/ local processing styles with respect to perception, using Navon letter tasks and it is fairly established that normally people lean towards the global processing style.
Forrester et al extend this to cover there GLOMOSYS system that posits two basic types of perceptual/cognitive style- global and local.
It is instructive to pause and note here that psychosis is associated with a global processing style while autism with attention to details.
It is also instructive to pause and note that similar to autism-psychosis continuum , it seems Intelligence and creativity are also in a sense opposed to each other. Also while creativity is associated with broad cognitive style that is divergent; intelligence is conceived of as narrow and focused application of abilities.
That brings me to my final analogy: while autistic kids may have pockets of intelligence and savantism and may be driving the evolution of intelligence; it is the ADHD kids who are more likely to be creative and are driving the evolution of creativity.
The romantic notion that psychosis is the price for creativity may not be untrue.
Joanne Ruthsatz, & Jourdan B. Urbach (2012). Child prodigy: A novel cognitive profile places elevated general intelligence,
exceptional working memory and attention to detail at the root
of prodigiousness Intelligence DOI: 10.1016/j.intell.2012.06.002
Jens F¨orster, & Laura Dannenberg (2010). GLOMOsys: A Systems Account of Global Versus Local Processing Psychological Inquiry, DOI: 10.1080/1047840X.2010.487849
I recently read ‘Neurodiversity: discovering the extraordinary gifts of Autism, ADHD, Dyslexia and other brain differences‘ (you can read a mini review here) by Dr. Thomas Armstrong and came away impressed. In the book Dr Armstrong makes a strong case for viewing the traditional disabilities from a differences perspective and to focus on the different strengths and abilities of the neurodiverse people. A recurring theme of this blog has been that autism and schizophrenia/psychosis are opposites on a continuum model as proposed amongst others by Christopher Badcock and Beranard Crespi. Dr Armstrong touches on this model in his chapter on autism, though that not central to his theis .
Dr Armstrong, was kind enough to answer a few questions for the benefit of our readers and these are reproduced below:
[SG] You have written a wonderful book on neurodiversity. Could you explain in brief, for the benefit of our readers, why neurodiversity has become so important in today’s context and why the focus on neurodiversity now when the differences that underlie the neurodiverse spectrum themselves are age-old?
[TA] I think neurodiversity is, as I’ve suggested in my book, “a concept whose time has come” because of the disability culture we live in. Almost half of us will have mental disorders sometime during our lifetime according to the National Institute of Mental Health, and even more will have “shadow syndromes” or minor versions of those disorders. When we get to the point where virtually everyone is seen as having a mental disorder to one degree or another, I think it’s time that we shift paradigms and use a diversity model instead of a disability model to account for those differences.
[SG] How much does neurodiversity owe to the Autistic advocacy movement and whether those beginnings are productive or counterproductive when one wants to bring other differences like mood or anxiety differences in the fold and talk about them as well?
[TA] I believe that the autistic advocacy movement deserves a great deal of credit for coining and developing the idea of neurodiversity. It’s rather amazing that a group of people who are known for their non-social attributes have made this contribution to our social understanding of brain differences. My hope is that my book Neurodiversity will help to broaden the concept of neurodiversity to include a wider range of abilities/disabilities. As far as I can see from looking at many sites online, there is an openness in the autism community to expanding the definition of neurodiversity beyond simply autism and Asperger’s syndrome.
[SG] Positive Psychology shares some of the same concerns as that of the Neurodiverse movement- the focus on strengths and what works and skepticism about the disease and pathology model- yet why hasn’t, in your opinion neurodiversity become center stage like the positive psychology movement has? Is it because in neurodiversity we are swinging the pendulum too much to the other side and perhaps blinding ourselves to underlying pathologies by claiming everything as differences?
[TA] No, I think it has to do with the credibility of the leadership of the Positive Psychology movement – spearheaded by a former president of the American Psychological Association and other famous professors of psychology. It’s essentially a top-down movement, whereas neurodiversity seems to me to be a bottom-up or “grass roots” movement that is coming from the people who are actually themselves neurodiverse. I don’t think of the neurodiversity movement as saying “we’re all different so leave us alone” I believe that attention needs to be given to ameliorating the disability part of neurodiversity, even as we focus the spotlight on the abilities.
[SG] For the benefit of our readers, if you could highlight the differences between the dimensional and categorical model of pathologies/differences. I believe neurodviversity leans towards the dimensional (continuum ) model. What can DSM V learn form the findings you have discussed in the Neurodiversity book? is a dimensional model of pathology a better one as compared to the categorical one? a necessary evil? or can the DSM mentality be done away with altogether?
[TA] One of the eight principles that I discuss in my book Neurodiversity is that everyone exists along “continuums of competence” with respect to a range of human processes including sociability, literacy, intelligence(s), attention, mood, and so forth. This is very similar to the DSM-V’s embracing of a dimensional perspective, and to that extent, I think the DSM-V is moving in the right direction. The problem is that the DSM-V will be a high stakes publication, and if people are put on a continuum from normal to pathological, the fuzzy line where normal becomes pathological (and vice versa) becomes very important, and may determine whether a person will be labeled with a disorder, given a drug treatment, and perhaps even stigmatized as a result. There’s a danger that many so-called normal people will be added to the ranks of the mentally disordered. Also, what’s missing from the DSM (in all its versions) is any kind of discussion of the positive dimensions of each of the disability categories.
[SG] Just like DSM, positive psychologists have come up with a list of character strengths and virtues as for ex can be seen on VIA signature strength website. Do you think those lists are sufficiently inclusive and give equal weighting to the special abilities found in neurodiverse individuals?
[TA] I think the VIA-IS (or Values in Action Inventory of Strengths) is a positive contribution to our understanding of human personality. It would be good to see someone take this inventory and map it onto the various pathologies taken up in the DSM-V. Wedding the two manuals would be a definite step in the right direction.
[SG] How much yours and your fathers experience of depression has been a driving force in your passion for psychology and especially instrumental in your focusing energies on the neurodiverse people.
[TA] I think it’s been very much a contributory factor. Seeing how my father’s depression affected our family’s functioning while growing up, and how my own depression has shaped my adult life, has been extremely influential in leading me to the field of psychology, and in trying to find the silver lining beyond the dark cloud.
[SG] People who are on extremes of the neurodiverse spectrum face immense stigma in our society. Your chapter on neurodiverstity in classroom talks about inclusive classrooms as you believe special classrooms for special ed programs end up labeling children. How practical you think is the concept of a neurodiverse classroom, esp in developing countries like India. Is a special ed class, even if it ends up labeling a child, better than no intervention at all and traditional classroom education only?
[TA] In a system based on traditional classroom learning, I believe that special education programs outside of the traditional classroom have a place, especially if they are using cutting-edge techniques for helping kids with special needs. But as an educational reformer, I am always pressing educators to expand beyond traditional learning environments for all kids, and when we utilize teaching methods that are good for all kids, we end up helping kids with special needs in the process.
[SG] Niche construction appears to be one of the special focus of your book. would you support or recommended special reservations in jobs/academics for neurodiverse people who may do especially well in those particular niches? For ex. would you favor a legislation that mandated for reservation for autistic people in computer testing industry. I’m thinking of cultural diversity guidelines in colleges, should we have similar neurodiversity guidelines too?
[TA] Are you talking about affirmative action for neurodiverse people? If so, then I believe there might be some merit in exploring how this might work. ([SG] note: yes, I was indeed talking about affirmative action; in India we typically refer to the issue as that of reservations!)
[SG] How did the writing of Neurodiversity enrich you as an individual. wWat can readers hope to take away from the book?
[TA] I wrote Neurodiversity while in the midst of a major depressive episode. At times I could hear myself saying “why are you looking at the strengths of these disorders, for God’s sake, when you know that they’re hell to deal with?” But there was another part of me, an intuitive part I believe, that instinctively believed it was important for me to bring strengths into the discourse about mental disabilities. I hope that readers will see this book as a supplementary guide to all the other books on disabilities that focus on the negatives. It’s important that we see both sides of the issue. We are, after all, whole human beings, with a great deal of complexity and richness. I hope that readers will take away a sense of this richness in the diversity of minds that make up humanity.
I would like to thank Dr Armstrong for taking some time off for the interview and would recommended the readers to read up some of his books, many of which focus on the special abilities and aptitudes of the neurodiverse people.