Tag Archives: Mental health

Depression and its Antecedents

Today I will approach the problem of depression, but from a particular vantage point – that steeped in cognitive theory and informed by the work of Martin Seligman.

English: Abraham Lincoln, the sixteenth Presid...

English: Abraham Lincoln, the sixteenth President of the United States. Latviešu: Abrahams Linkolns, sešpadsmitais ASV prezidents. ?????? / Srpski: ??????? ???????, ????????? ?????????? ?????????? ????????? ??????. (Photo credit: Wikipedia)

There have been other views about depression- a psychoanalytical one whereby depression was deemed as rage turning upon inwards and directed towards the self; and a biomedical one whereby depression is considered a disease of the brain/body- imbalances in neurotransmitters etc. . Seligman rejects both models and considers depression (even clinically defined) as just the other extreme of response to loss etc. This is important to note as unipolar depression, clinically defined, is usually considered a  type rather than a degree phenomena, i.e. people in depressive phase are qualitatively different from those who are not clinically depressed as per the prevalent model.However, note that even Seligman considers the mild form of depression as distinct from sadness.

The theory of depression that Seligman and colleagues came up with is based on his famous experiments with dogs whereby experimental dogs were subjected to uncontrollable mild shocks while the control dogs either received no shocks or shocks that they could stop and control. When the dogs who were subjected to uncontrollable shocks were placed in anew chamber whereby they could escape shocks by climbing over a  low barrier, they sat passively. They had learned or internalized that nothing they do with respect to shocks makes the shocks go away and had even generalized it to new situations when things were actually under their control. Also the feelings of helplessness reflected in many diverse behaviors like less aggressiveness or exploration etc and was sort of generalized across situations too.  So not only the experimental dogs made permanent attributions about their lack of control, but also pervasive attributions and thus became depressed.

Seligman and colleagues designed and executed similar experiments with rats and also humans. Using these experiments they were able to create a model of depression. That model of depression requires different things to come together, but typically as its called learned helplessness model of depression, the focus has been on the learned helplessness following a loss of control.

The different components of the model, when explicated, have different implications for treatment/ prevention. To start with before the process can start one has to have loss of control – if our environments provided more opportunity for control over our experiences and in general if people learned to feel more in control of their life, despite losses and all, then the chain stops at its beginning itself. While some losses are inevitable, say loss of loved one, other losses like pink slips can be minimized and then no matter what the loss is , one can choose one’s own attitude towards the loss – the last of human freedom’s as per Frankl.

Once loss/ dejection/rejection/ loss of control has happened, almost all of us will temporarily become helpless. However, becoming helpless is not same as becoming mildly depressed too. For some of us who have a habitual pessimistic explanatory style, in terms of seeing the negative events in our lives as being permanent and pervasive, the learned helplessness turns into momentary , mild depression. We have sad affect, disturbed sleeping, eating etc. However, for those who have optimistic explanatory styles, we re-bounce from the learned helpless and do not become depressed. So changing the habitual explanatory style is another intervention opportunity.

Finally, the mild and momentary depression become full-fledged clinical unipolar depression, when the symptoms continue for 2 weeks or more and as per Seligman this happens when one adds a ruminating thinking style to the mix. Thus a person who has a pessimistic style and also keeps thinking about his own thoughts is more likely to get clinically depressed. Again , if we can prevent or reduce rumination we can prevent the clinical variant.

Cognitive behavioral therapy , which has been found to be quite effective for depression, has been shown to work on some of these aspects  increasing optimistic explanatory style and challenging negative automatic thoughts  but probably can be augmented by focusing on preventing rumination and story-editing techniques to re-frame issues of loss and control.

In the end, in my view depression has complex roots – some steeped in biology and temperament, while others due to environmental stressors and our reactions to them. A clearer understanding of the learned helplessness model of depression is likely to aid in therapy.

A tale of two diseases

I have Obstructive Sleep Apnea (OSA). I am also bipolar.

Now which of the above statements shocked/ surprised you more? If I am guessing correctly the latter statement about my being bipolar came across as more of a shock/ surprise/ concern. Now what does that say about your own reactions to mental illness and your own involvement in perpetuating the stigma against mental illness?

Both of the above are chronic diseases to an extent. My OSA (snoring in popular parlance) cannot be treated by surgery, so the only viable option I have is to use a CPAP machine while sleeping to get a good night’s sleep. Bipolar disorder as we all know can only be contained, and I take my medicines regularly to ensure that there are no relapse into either a manic or a depressive episode.

Both, if un-diagnosed and untreated can cause havoc. OSA which was un-diagnosed/ untreated for about a couple of years or so in my case led to excessive daytime drowsiness, less alertness and lowered productively etc; if untreated OSA can cause increased risk of injury to self and others while driving as you may actually get into micro sleeps while driving. Even if not that dramatic, on a daily basis the quality of your sleep and waking life can become very diminished.  The downsides of having a manic or depressive episodes are well known- at least to readers of this blog. However, what may be less well known is that even in the throes of psychotic extremes, the risk to others from violence by bipolar people is very little and if anything they may be subjected to violence than otherwise.

When treated, that is when I use my CPAP machine regularly I have no problems at all due to my OSA either in my work life or in my personal life – I am as refreshed in morning as ever. Rather I believe I might be getting better sleep than the average person. When treated, that is when I regularly use medicine, and take other precautions like having regular sleep cycles etc for my bipolar, I am totally episode free- rather I believe I have an advantage when it comes to managing my energy and mood.

However, given all the above, which disclosure do you think has drastically lowered my chances of employment (if I was seeking employment, which I am thankfully not:-)); which disclosure would have led to discrimination in the workplace or at least got me some amused and funny looks? About which of these are my friends and acquaintances likely to gossip more? Why as a society we are still not that accepting of mental illness and stigmatize those who have it?

Some immediate consequences I can think of:

  1. readers of The Mouse Trap will no longer take my interest in psychology as non-partisan. They will think of me as being interested in psychology only due to my being bipolar (to set the record straight I became interested in psychology in 1996 during my IIT delhi days, while my first episode happened while I worked with Hughes in 2001).  Also when I take a position like association of biploar with creativity, I will be considered biased; however nobody will say that a ‘normal’ person advocating otherwise is biased due to his being ‘normal’.
  2. Some will start to see signs of craziness in my old/ new posts and wonder whether when I was writing them I was in a normal frame of mind or episodic. Its usually my style to try and combine seemingly disparate research ideas and that is especially prone to this analysis.
  3. I will start getting sympathy, but like anyone living with say OSA or diabetes etc I think one should just ignore the fact about my being bipolar and not let it redefine my relationship with you. I am much more than a person with bipolar or OSA, and I prefer it that way.
  4. there will be some embarrassment for my near and dear ones.

Why did I not disclose for so many years?

  1. because I feared discrimination (and funny looks) at the workplace. It might have been imaginary but I was not strong enough to experiment. Now that I am self employed the stakes are much lower and I don’t care.
  2. I myself was grappling with my being bipolar. For initial some years it was hard to accept; later I struggled with accepting medication as necessary ; but now for quite some years I am at peace and thankfully episode free.
  3. As I believe it never affected adversely my performance at work , I did not deemed it necessary to inform my employers etc as I thought ,and still think, its none of their business.

Why did I decide to disclose publicly about this?

  1. I have no delusions (pun intended) that I am Deepika Padukone that my talking about a mental health issue is going to raise awareness drastically; still I want to do my bit to fight stigma and the journey starts with oneself. I had a decent career in software despite my being biploar and being biploar hasn’t stopped me from taking risks and experimenting with a second career; hopefully that can inspire or provide mental support to a person or two.
  2. Some immediate triggers- a mouse trap reader on facebook privately messaged me asking if I only have theoretical knowledge about psychosis etc or if I had some personal experiences too. I think it was a legitimate question that deserves a legitimate answer.
  3. Another immediate trigger- I came across a tweet by https://twitter.com/akhileshlinky about his year end ‘confession’ about being bipolar and I though heck why not ‘come out’ yourself.
  4. but really, it doesn’t matter to me one way or other – the only upside of sharing more publicly is that it can help combat stigma.

 

What I expect from you?

  1. don’t define me exclusively as being biploar.
  2. reflect on your own attitudes about mental illness and try to overcome that implicit bias
  3. resist discrimination and stigma

Lastly, thanks are due to my family and friends who have been prone to this ‘secret’ over the years and who have provided the necessary support and encouragement.

The BioPsychoSocioEnvironmental model

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.

Schematic of diathesis–stress model.

Schematic of diathesis–stress model. (Photo credit: Wikipedia)

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.

Book review: A Lethal Inheritance

Rethink Mental Illness

Rethink Mental Illness (Photo credit: Wikipedia)

 

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 .

 

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Labels, Mental Health and my Split Blog Disorder

LONDON, ENGLAND - OCTOBER 08: Nobel Prize win...

LONDON, ENGLAND – OCTOBER 08: Nobel Prize winner Sir John Gurdon talks to reporters on October 8, 2012 in London, England. Sir John and Shinya Yamanaka from Japan have both been awarded the Nobel prize for medicine or physiology for their work as pioneers of stem cell research. (Image credit: Getty Images via @daylife)

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.

Some people would have noticed that I proclaim myself as ‘Programmer, poet, philosopher !’; a couple of my poetry blogs include The Fools Quest and Songs to Soothe Your Soul.

Apart from this I have a Tumblr blog Flotsam and Jetsam, where i typically post quotes that I find interesting.

Not to leave out, I curate a lot of content on scoop.it and would recommend highly you take a look/subscribe.

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Autism and ADHD: the intelligent and the creative child!

ResearchBlogging.org
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

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Neurodiversity:an interview with Dr. Thomas Armstrong

Eight women representing prominent mental diag...
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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.

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Am happy, will broaden-and-build; am angry, will narrow-and-save

ResearchBlogging.org

Sympathetic (red) and parasympathetic (blue) n...
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Regular readers of this blog will be aware of my conception of positive emotions  in terms of promotion focus and negative emotions in terms of prevention focus. Today I will try to relate this to the specific action-tendency theory of negative emotions and broaden-and-build theory of positive emotions (as proposed by Barbara Fredrickson).

First its instructive to distinguish between negative and positive emotions. Negative emotions, like Fear, Anger, Disgust, traditionally have been conceptualized as specific action tendencies that get triggered or activated by particular type of threatening situations/stimuli. I view them as sensory driven. A stimuli impinges and is either presumed to be attacking/trespassing (thus arousing anger) or dangerous and threatening survival (thus arousing fear) or intimidating and overbearing (thus arousing sadness and disengagement)  or sickening and to be avoided (thus arousing disgust) ; in all cases a stimuli or situation acts as an immediate trigger for a specific action tendency – that of defending, fighting or fleeing, disengaging and surrendering or vomiting and keeping away.

In contrast consider positive emotions like Joy, Interest, Contentment and Love. They all happen when the environment is safe and bodily needs are met- they are not need driven, but growth oriented. They are not based around survival, but around growth.  they are non -specific thought action repertoire that is a broadened set and is not narrowly focused- rather one of the prime effects of positive emotions is to broaden attention, thought/cognition,  actions and interactions. I consider them as motor driven. they are not a response to a stimulus. Rather they are specific patterns of spontaneous action tendencies and opportunities to practice giving outlet to ones spontaneous action tendencies in a safe environmental. That is why every sort of play- be it physical rough-and-tumble or intellectual play of creativity or social play of flirting – is associated with the positive emotions.

To make my analogy more clear consider the fact that actions can be classically conditioned (and thus response to US/CS stimulus) or operant conditioned (and thus not reactive or reflexive but intrinsically driven and proactive) and while former may be more or less determined by  the external stimulus and internal associations and is deterministic in nature, the latter has spontaneous behavioral variability and initiation as its premise and has room for free will.  What I claim today is that negative emotions are reactive and thus keep you stuck in deterministic rut, while positive emotions are expansive and provide opportunities for exercise of free will in safe and playful environments by encouraging spontaneous behavioral fluctuations and felkxibility.

It has been found time and again that positive emotions are associated with a broadening and resource-building effect. Consider Joy. It encourages one to engage in acts for acts sake or encourages rough and tumble play- it builds physical resources.  Consider Interest . It encourages one to engage in exploration of a domain- be it actual physical domain or conceptual domain – it builds cognitive maps and cognitive or intellectual resources. Consider contentment. It encourages one to engage in reflection and self assessment and self integration – it builds psychological resources. consider Love (care-giving variety not romantic which is pathological and more of a negative emotion). It encourages one to engage in reciprocal interactions and to explore, act on and reflect on the other- it builds social resources.

Thus it is evident that positive emotions do help to broaden and build. That much has been proved by Barbara’s research program .  My additional claim is that negative emotions are sensory oriented and reactive while positive emotions are motor oriented, spontaneous and proactive. By signalling safe environments in which behavioral flexibility can be played around with they push us to relate to life more intrinsically.

Perhaps another analogy will be relevant.  there is a sympathetic nervous system and there is parasympathetic system. the sympathetic system helps us respond to stressful situations and readies the body. the parasympathetic restores the body and helps in regeneration of the body. So do negative emotions help us react to outside threats and make the mental-illness dimension while positive emotions help match intrinsic activity to opportunities in the environment and makes the mental health dimension.

The former (mental illness continuum)  is a zero sum game– if I win someone looses. For eg if a dominance hierarchy is there and I am on top I may feel manic while the person at bottom may feel depressed..but as long as dominance and survival and predation and germs are there the negative emotions would be there …the latter (mental health continuum)  is a win-win game.  There are more opportunities for everyone to fare better if everyone is positioned high on mental health spectrum as then doors to creativity and productivity open right then and there for all concerned. thus, I have become an advocate of the positive psychology movement and would like more efforts devoted to study of positive emotions.

Fredrickson, B. (1998). What good are positive emotions? Review of General Psychology, 2 (3), 300-319 DOI: 10.1037//1089-2680.2.3.300

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Happiness opposed to despair/ennui; sadness to anger/irritability

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We normally view happiness and sadness to be opposites on a single continuum, but I propose that it is time to change the textbooks and view happiness as opposed to ennui/despair and sadness as opposed to anger/irritability when it comes to basic opponent affects.

But before we go down that path first a detour.

I recently read Flourishing: edited by Keyes & Haidt , and the last article by Keyes caught my attention. I looked up a few more articles by Keyes and found this one that again elaborates on the theory put forward in the book chapter.

The point Keyes wants to make is that mental illness and mental health are two different things and are relatively independent of each other. Traditionally mental health has been conceptualized as the absence of mental illness, but Keyes says that our intuitions are incorrect here and mental health is another, parallel continuum on which people can differ.

Throughout human history, there have been three conceptions of health.The pathogenic approach is the first, most historically dominant vision, derived from the Greek word pathos, meaning suffering or an emotion evoking sympathy. The pathogenic approach views health as the absence of disability, disease, and premature death. The second approach is the salutogenic approach, which can be found in early Greek writings and was popularized by Antonovsky (1979) and humanistic scholarship (e.g., Carl Rogers and Abraham Maslow). Derived from the word salus, meaning health, the salutogenic approach views health as the presence of positive states of human capacities and functioning in thinking, feeling, and behavior (Stru¨mpfer, 1995). The third approach is the complete state model, which derives from the ancient word for health as being hale, meaning whole and strong. This approach is exemplified in the World Health Organization’s (1948) definition of overall health as a complete state, consisting of the presence of a positive state of human capacities and functioning as well as the absence of disease or infirmity. By subsuming the pathogenic and salutogenic paradigms, the whole states approach is, in my opinion, the only paradigm that can achieve true population health.

Thus when we talk of whole states mental health we are basically talking about two related things- a mental illness or disability dimension and a flourishing or mental health dimension. Keyes et al have performed confirmatory factor analysis on measure used to measure mental health and illness and found that the data is best explained by two latent factors-one related to flourishing and the other to illness.

This is how they define mental health or flourishing dimension.

Until recently, mental health remained undefined, unmeasured, and therefore unrecognized at the level of governments and nongovernmental organizations. In 1999, the Surgeon General, then David Satcher, conceived of mental health as “a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with people, and the ability to adapt to change and to cope with adversity” (U.S. Public Health Service, 1999, p. 4). In 2004, the World Health Organization published a historic first report on mental health promotion, conceptualizing mental health as not merely the absence of mental illness but the presence of “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (World Health Organization, 2004, p. 12).

Keyes comes up with 13 symptoms of mental health and these include Positive emotions (i.e., emotional well-being) including positive affect and avowed quality of life; Positive psychological functioning (i.e., psychological well-being) consisting of self-acceptance, positive relations with others, personal growth, purpose in life, environmental mastery, and autonomy (see Keyes & Ryff, 1999); and Positive social functioning (i.e., social well-being) consisting of social coherence, social actualization, social integration, social acceptance, and social contribution. In DSM style they propose that individuals exhibit some minimum symptoms to classify as flourishing and those with very low scores be classified as languishing.

To be diagnosed as flourishing in life, individuals must exhibit high levels on at least one measure of hedonic well-being and high levels on at least six measures of positive functioning. Individuals who exhibit low levels on at least one measure of hedonic well-being and low levels on at least six measures of positive functioning are diagnosed as languishing in life. Adults who are moderately mentally healthy do not fit the criteria for either flourishing or languishing in life.

Keyes then goes on to show the costs of languishing and not focusing on mental health and why a narrow focus on cure/prevention of mental illness is detrimental, but that is beside the point as to today’s topic. what is most important take way for today is that there are two separate factors of mental health and mental illness.

This brings us back to the affects- happiness, sadness, ennui/despair and anger/irritability. Consider for a moment depression. It is an illness characterized by sad mood and anhedonia etc. Consider its counterpart on the illness spectrum. while a normal person not having depression may seem the counterpart, the real counterpart is mania which often has a angry/irritable mood (alongside euphoria) associated with it. Also depression is characterized as a reaction to losses/continuous exposure to stresses that makes goals out of reach/unachievable. Here the focus is preventive in nature- the state does not deteriorate further and goals do not remain unmet. However, depression or sad mood is also an avoidance reaction. One becomes withdrawn from the situation and does not fight the stress, but flights from the stress by withdrawing in a cocoon. The loss of appetite and more sleep can be seen as behavioral counterparts of withdrawing or exhibiting a flight response to stress.

As opposed to this, mania can be seen behaviorally as an active approach state in which one works actively towards the things required to overcome the loss of valued entity/life goal. Again, I propose that mania is a reaction to a situation similar to depression – when something is lost/ is under threat of losing- but this time , under stress, one fights and not flights- thus one becomes energized to right the wrong and may become angry/ irritable if the efforts to retain goals/ valued entities are frustrated by external world. It is important that both mania and depression are on the illness scale of functioning/ mental health and are a result of life trauma/ stress/ perceived/ real/ threat of loss of loved object/person. Thus the focus is preventive and the state is of scarcity.

Contrast this to a state of abundance when ones (life) goals have been met/ are within reach.// This apparent positive state of affairs may again give rise to different emotions/ behavioral manifestations depending on whether one has approach or avoidance dominant reaction. If one approaches the more free time available after goal accomplishment as a boon that can be used to home ones hobbies/find other meaning in life/ build relationships etc and not as a threat ( free time can be a threat) then one experiences positive emotion of happiness and behaviorally flourishes.

In contrast consider a similar person who has achieved everything in life – (a good job, wife, kids etc ) , but given the fact that one is living in abundance is frightened or flights from the free time that has been made available. that person will be listless, will exhibit ennui or boredom and may even exhibit despair as he finds life meaningless. Thus behaviorally he would languish.

Thus, I rest my case that happiness is opposed to ennui/despair while sadness is opposed to anger/irritability and while happiness is a measure of flourishing; sadness is a measure of illness. One can definitely conduct experiments , perform factor analysis to confirm, that indeed happiness and sadness is not a unitary construct, but are two separate but related dimensions. I would love to hear your comments.

Keyes, C. (2007). Promoting and protecting mental health as flourishing: A complementary strategy for improving national mental health. American Psychologist, 62 (2), 95-108 DOI: 10.1037/0003-066X.62.2.95

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Orchids wither with stress, but bloom with care

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Figure 1. Graphical display of the diathesis-s...
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Traditionally, it has been evident that some children who show high stress reactivity or inbuilt vulnerability to stress (the diathesis of stress-diathesis model) fare badly when exposed to adverse early life circumstances/events. These adverse environmental influences can range from marital discord in family to stress of being born in a low socio economic status (SES) family or the stress of joining a new peer group.

A new theory however has been gaining ground that these children are orchid children who show high biological and behavioral sensitivity to context and thus can wither in stressful situations while at the same time have the capability to bloom far greater than a normal child given supportive and nurturing environments. One way to conceptualize this is to think of these child as showing greater phenotype variability and adaptability and being more plastic- so the underlying genotype manifest itself differently depending on environmental input. Being more plastic the orchid kids are able to use the environment to their best; or get abused by the environment for the worst.

A new study by Boyce et al looks at the interaction between stressful conditions and stress reactivity in 383 pre-primary children (aged 5-6 years) and reached a similar conclusion that there is indeed an interaction between life stress and stress reactivity such that those who are highly reactive are also more prone to developmental extremes mediated by environmental quality. they thus found that the orchid kids with high stress reactivity showed better adaptation in low life stress conditions, but worse adaptation in high life stress conditions, compared to the dandelions kids who had normal stress reactivity and were more or less immune to life stress. The adaptation measures they measured included clinical and pathological indexes like externalizing symptoms, as well as positive indexes like pro-social behavior, school engagement and academic competence.

The authors looked at two measures of human stress reactivity – Respiratory sinus arrhythmia (RSA)(related to heart rate variability and parasympathetic stress response) and salivary cortisol level changes. High resting RSA/ high RSA reactivity is good and indicates buffering against environmental stress; while low resting RSA / low RSA reactivity is bad and indicates high stress response to stressors . the picture with cortisol reactivity is much unclear and it was not clear (before this study) how cortisol reactivity would interact with life stress to affect adaptation of pre-primary children. the main goal of the study was to find how children stress reactivity and overall family adversity interact to affect adaptation of the child.

Here is the hypothesis in authors own words:

Based on the broad literature on risk and adversity, we hypothesized a robust negative main effect of family adversity across all indices of adaptation. We also expected to find main effects of stress reactivity on adaptation, but given the simultaneous test of interactive effects, as well as the paucity of studies examining the effects of RSA and cortisol reactivity, especially for positive developmental outcomes, and some inconsistencies within such studies, we did not hypothesize the directions of these main effects. More importantly, in accordance with the theory of biological sensitivity to context (Boyce & Ellis, 2005; Ellis et al., 2005), we expected to find evidence that ANS and HPA reactivity moderate the effects of early family adversity on various domains of functioning. We hypothesized that in high-adversity family environments, elevated levels of stress reactivity would be associated with maladaptive outcomes, whereas low stress reactivity would act as a protective factor. In the context of low family adversity, on the other hand, we expected high levels of reactivity to be associated with better adaptation. It is important to note that although biological sensitivity to context should be examined in both positive and negative settings, our assessment focuses on six types of family adversities, and a lack of overall family adversity does not necessarily imply a supportive and nurturing environment. In addition to the hypothesized Adversity × Stress Reactivity interactions, we controlled for children’s sex and tested whether main and interactive effects of adversity and reactivity vary across sex.

And this is what they found too! Here are the results:

The study’s most novel and salient findings emerged when adversity and stress reactivity were considered together, as components of interactions between environmental exposures and measures of biological sensitivity. Stress reactivity moderated the negative effect of family adversity across various domains of adaptation. Overall, the findings are consistent with the stress diathesis hypothesis that high-reactive children show worse adaptive functioning in the context of high adversity. Indeed, such children generally evinced the lowest levels of adaptive functioning of the entire study sample.

However, equally reactive children in settings of low adversity showed the highest levels of adaptation, levels even higher than those of their less reactive counterparts. Specifically, in the context of low family adversity, children who showed high RSA reactivity in response to challenges had the lowest levels of externalizing symptoms and the highest levels of prosocial behaviors and school engagement. Although adaptation showed significant stability from fall to spring, high-reactive children showed improvement in academic competence in the context of low adversity and a decline in competence in the context of high adversity, whereas the inverse was true for low reactive children. Similarly, children who showed high cortisol reactivity to the challenge protocol had the highest levels of prosocial behaviors in the context of low adversity. Further, children exhibiting low RSA reactivity in response to challenges were fully or partially buffered against the harmful effects of adversity on externalizing symptoms, prosocial behavior, and school engagement. Likewise, among children who showed low cortisol reactivity, levels of prosocial behaviors did not significantly change across different levels of adversity.

These findings support the biological sensitivity to context (BSC) theory advanced by Boyce and colleagues (Boyce 2007; Boyce & Ellis, 2005) and the concept of differential susceptibility to environmental influences proposed by Belsky and colleagues (Belsky, 2005; Belsky et al., 2007). This study illustrates that high reactivity is not merely a pathogenic, risk-amplifying response to adversity but can also promote adaptive functioning. Corroborating Boyce and colleagues’ theoretical perspective, children exhibiting high levels of biological sensitivity to context, as indexed by high autonomic and adrenocortical reactivity, were more susceptible to environmental influences in the context of both low and high family adversity. Thus, biologically sensitive children showed the highest levels of symptoms in the context of high family adversity but the highest levels of competence in the context of low family adversity. However, a lack of family adversity does not necessarily imply the presence of a nurturing family environment. Thus, future studies will need to further examine the role of heightened biological sensitivity to context across both stressful, health-undermining and supportive, health-enhancing contexts.

The conceptual figure clearly shows that for low Biological Sensitivity to Context (low BSC) children, adversity has relatively no effect on adaptation/maladaptation. However, for high BSC children, there is an inverse relation between adversity and adaptivity. To me this is further proof of the now robust orchid and dandelion theory of child development.

Obradovi?, J., Bush, N., Stamperdahl, J., Adler, N., & Boyce, W. (2010). Biological Sensitivity to Context: The Interactive Effects of Stress Reactivity and Family Adversity on Socioemotional Behavior and School Readiness Child Development, 81 (1), 270-289 DOI: 10.1111/j.1467-8624.2009.01394.x

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