Assign 18 Reaidy Nov 03

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Dec 6, 2023

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1 Assignment 18: Discussion Paper 2 on A Cure for Darkness Perla H. Reaidy Department of Educational Psychology: The University of Texas at Austin EDP 383C: Developmental Psychopathology Dr. J. Mark Eddy November 03, 2023

2 Assignment 12: Discussion Paper 1 on A Cure for Darkness “A Cure for Darkness: The Story of Depression and How We Treat It” by Alex Riley is a compelling exploration of the intricate relationship between mental health, science, and society. In this thought-provoking book, Riley delves into the multifaceted world of depression, taking readers on a journey through the scientific, personal, and societal aspects of depression. He investigates the factors contributing to depression, the evolution of treatments, and the profound impact of culture and community on the experience and management of depression. Riley's approach is deeply rooted in developmental psychology, a discipline that unravels the complex interplay between nature and nurture in shaping an individual's psychological development. Drawing on research in developmental psychology, he clarifies how early experiences, relationships, and genetic predispositions can influence the onset and progression of depression. This perspective not only aids in comprehending the origins of depression but also highlights the importance of early intervention and targeted support systems. The book delves into the complexities of depression and its remedies, offering an insightful perspective that resonates deeply with the field of developmental psychology. In this discussion paper, we embark on a journey to analyze the interplay between this insightful narrative and the fundamental aspects that influence developmental psychology, with a specific focus on three critical points: political and economic influences, cultural impact on diagnosis and treatment, and the significance of collaboration. Key Takeaways Political and Economic Influences Mental health worldwide is consistently underfunded, as depression and anxiety are left on the back burner. Riley delves further into discussing the funding of mental health within the

3 UK, detailing the healthcare budget to be £ 3.5 billion, however, only 1% of this budget was allocated to individuals with depression and anxiety, providing everyone with a roughly £ 500 budget for treatment. This is not enough to cover the treatment of cognitive-behavioral therapy (CBT), the use of anti-depressants, and if needed Electroconvulsive therapy (ECT). In Dwight- Johnson et.al. (2000), the study found that low-income patients were less likely to want active treatment, as these individuals were perceived to have “competing priorities for time and money” which could not be used on treatment. The lack of funding and providing individuals with proper care according to their needs and resources is continuously placing a disadvantage to those who are not wealthy or insured, expanding the gap of disparities for those with depression and those being treated. Furthermore, Riley discusses the underutilization of ECT in practice due to stigmatization and cost. In Ross et. al. (2018), they found that ECT, despite being a last resort therapy, should be given earlier, as it would be more cost-effective and efficacious as a third-line therapy since it’s been proven that psychopharmacology/psychotherapies are not effective with treatment- resistant depression. Additionally, ECT is seldom recommended due to the political stigma surrounding by the treatment, as it is labeled a “fascist treatment” (Riley, 2021). Riley further delves into the misuse of ECT by untrained professionals with a lack of psychiatrist supervision and the misconceptions of ECT used in Germany, as it was primarily used in Auschwitz to “make emotionally disturbed people fit for work again”. The reluctance to embrace ECT may be driven by both political and economic factors, including the stigmatization associated with its historical use, which in turn is preventing many individuals from reaping its benefits. Lastly, the book illustrates Weissman’s findings that children of parents with depression were at a higher risk of developing depression, specifically three times as high, as it was

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4 hypothesized that parents with depression were “less able to nurture, care for, and generally take interest in their child as they grow” due to their disorder (Riley, 2021). This led to Weissman wanting to treat the parents, moving them towards remission, as only remission from depression would benefit their children and hopefully break this cycle, and it was seen that parents being treated for their depression and the study indicated that as the parents improved, so did their children. This was a means of prevention of depression; however, this cannot be effective for all individuals. There may be single-parent households with confined time and money to spend on treatment, families in gang-affiliated neighborhoods, or simply parents being in denial of their depression, among various factors that may prevent parents from accessing these resources and treatments. In order to prevent the cycle of depression from one generation to the next, one must consider how to bridge the gap between those with depression and their access to care. Cultural Impact on Diagnosis and Treatment Depression has various words, stigmas, and presentations across various cultures; thus, it is important to consider the cultural impact on the experience of depressive symptoms and the method of treatment. Clinicians should be aware of culturally appropriate terms, as natives of Zimbabwe do not have a word for depression but rather use the term “kufungisisa” or “thinking too much”. The term “thinking too much” is quite common among regions of Africa, Southeast Asia, and South America to describe the Western diagnosis of depression. Being aware of the terminology, stigma, and symptomology associated with culture may help future clinicians with diagnosing and treating patients of various cultural backgrounds. Alex Riley focused a portion of his book on research done in Zimbabwe regarding the depression of the colonized natives. This topic was first discussed in terms of racism and colonization, as Westernizers did not perceive “uncivilized” individuals to experience depression

5 as they did not hold the mental capacity to have foresight and worry about distant goals. However, with the decolonization of Africa, rates of depression increased as the Natives were not seen as inferior but as equals and had professionals who spoke the local language and lived among the communities, thus being able to find the signs associated with depression. This motivated Abas to work towards finding the signs and instances of depression in Zimbabwe. She worked with the local respected figures to find participants to interview and found that in Harare, 20% of the people interviewed had depression and this was likely due to the increase in stressful events such as cholera, poverty, unemployment, and HIV. Not only were those deemed “unable” to develop depression doing so, but at higher rates than the Western civilizations due to an increase in stress factors. In order to combat the drastic increase in depression, clinicians had to find a way to utilize their culture in treatment so that the stigma surrounding depression would not be as impactful and the patients could develop a certain level of trust with the professionals. Psychiatrists were not the people patients would see, as they were “highly stigmatized” and expensive, leading to fewer individuals seeking help. Verdeli had trained community members, or “paraprofessionals” in psychological therapy, which several studies have found is just as effective or more effective than the use of professionals in therapy to relieve symptoms. Verdeli utilized interpersonal therapy in a group setting of 5 to 8 participants, as this culture prioritized creating a family, thus feeling safe and creating a support system, ultimately relieving depressive symptoms. Additionally, the utilization of culture in Operation Murambatsvina was proven significant, as Friendship Benches were set up and the use of grandmothers to provide therapies aided in increasing therapeutic outreach in the community, as grandmothers were respected figures in the community and provided comfort to those seeking their help.

6 The Friendship Bench was such a success in relieving depressive symptoms and helping those apprehensive or who could not afford professional help, so much so that a similar project was done in New York. Helen Skipper was a peer who could talk and relate to numerous situations, going through several life-altering experiences, such as incarceration, drug addiction, and homelessness. She did not trust medical professionals due to her cultural upbringing and experience, thus when she found a therapist who was willing to simply listen to her and not place her on medication, Skipper became patient about the use of peers to help those suffering in the community. The use of these peers was to help in the prevention of poor mental health and to help those out of their situations. Similarly, Felton et. al. (2023) created a study focused on delivering therapeutic services to low-resource communities by utilizing peer recovery specialists to provide care to the individuals in the community. The results of the study found that “Peer Activate delivered by a PRS in a community setting and supervised by an RN, including preliminary effectiveness for reducing substance use and depressive symptoms,” thus further proving that this utilization of community and culture can benefit in the prevention and treatment of those suffering from mental health issues (Felton et. al., 2023). Significance of Collaboration Alex Riley underscores the significance of collaboration and working together in the realm of mental health treatment and intervention. When looking at the works of Beck cognitive therapy and Skinner’s work of behaviorism, though somewhat rivals when created, these discoveries came together to form one of the most effective forms of therapy for depression: Cognitive Behavioral Therapy. which emerged because of various research and treatment methods coming together. Beck continued down this road of collaboration, closer to the works of Kraeplin, where he aspired for the combination of therapies, such as using medications and

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7 psychotherapies together in the treatment of depression. This collaborative approach demonstrates the power of combining diverse perspectives and strategies to address mental health challenges comprehensively. The effectiveness of collaboration is further discussed in the use of various cultures and individuals in the treatment of depression, as partially discussed in the previous section. In Africa, Chile, and India, methods of utilizing laypersons and group therapies as a support system in the treatment of depression were crucial, specifically when targeting treatment to low-resource communities, as first depicted in Verdeli’s study in Africa. This was further seen in Skipper’s experience of being a peer in New York, helping those in less fortunate situations, in hopes of preventing poor mental health. These treatments were based on the roots of cultures that differed from that of the Westernized world, yet we used these concepts among the theories and therapies, melding them together so a therapy is created that has been proven to be effective in reducing depressive symptoms without the direct use of a professional. Additionally, the exploration of culture and collaboration also delves into the utilization of unconventional treatments, including psychedelics like ayahuasca and LSD, in combination with professional guidance, typically by a therapist or trained practitioner. In Brazil, Araujo is invited to a sacred part of the culture, an Ayahuasca ceremony performed during shamanic rituals as a means to “lend a status of reality to inner experiences” (Riley, 2021). Araujo perceived the person of this drug was to make “sick people better” as they were able to “work through their problems” by undergoing this ceremony and navigating through the images and inner consciousness (Riley, 2021). Furthermore, a similar experience is seen with the use of LSD, where Eisner used the drug in a controlled setting, playing certain music and guiding patients through experiences to reach a therapeutic breakthrough, ensuring that she understood a person

8 in front of her that deserved and required to be the center of attention for as long as was needed (Riley, 2021). These forms of therapy require a sense of collaboration to aid the individuals in processing their experiences and emotions and prevent negative outcomes, rather than having a cathartic effect. Such approaches highlight the significance of working together across different domains, including psychiatry, psychology, and alternative medicine, to provide an individualized approach to mental health care. The value of collaboration in the field of mental health is reinforced by collaborative care that has shown positive outcomes for individuals with depression, emphasizing the benefits of multidisciplinary approaches. Additionally, the integration of alternative therapies like psychedelics, when administered in a controlled and supervised environment, has gained recognition for their potential to enhance traditional treatments. The involvement of both professionals and non-professionals in mental health outreach and support initiatives is considered an effective way to reach underserved populations and reduce the burden of depression on a broader scale. Discussion The information and insights presented in "A Cure for Darkness" by Alex Riley emphasize the critical components of developmental psychology. The factor of economic and political influence on access to treatment and research has left several individuals at a disadvantage. For instance, underfunding has global implications, as Riley delves into the UK's allocation of only 1% of its healthcare budget to individuals with depression and anxiety. This limited budget allocation means that individuals often have insufficient resources for effective treatments like CBT, antidepressants, and, when necessary, ECT. This has also contributed to the underutilization of ECT, despite its potential efficacy in treating severe depression, highlighting

9 how stigma and political factors can deter the adoption of effective treatments. These influences and situations emphasize how political and economic factors can influence the adoption and access of evidence-based therapies, ultimately preventing individuals from benefiting from these treatments. As part of increasing access to care, clinicians must be culturally sensitive, as there are cultural impacts on diagnosis and treatment. Riley's insights are complemented by the recognition that depression is experienced and understood differently across various cultures. The use of culturally appropriate terminology and approaches is crucial to diagnose and treat patients effectively. Furthermore, the discussion of colonial perceptions that indigenous populations could not experience depression further illustrates the significance of culture and historical context in shaping mental health understanding, diagnosis, and treatment. Moreover, the integration of culture and community into mental health treatment, such as the use of laypersons and group therapies, is a powerful example of collaboration, in both combining culture and community. The utilization of community support systems, as demonstrated in Verdeli's study in Africa, Skipper's role as a peer in New York, and other initiatives, emphasizes the significance of involving peers and culturally relevant methods in mental health care. Collaboration across different cultural, professional, and community domains can create more effective and inclusive mental health solutions. Collaborative efforts involving mental health professionals, alternative therapists, and traditional medicine practitioners can offer innovative approaches to mental health care. This interdisciplinary approach is especially significant in addressing the complex nature of depression and tailoring treatments to individual needs.

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10 Overall, "A Cure for Darkness" and the additional insights provided align with the overarching message that collaboration, cultural sensitivity, and influencing factors of politics and economics are essential in addressing the global challenges associated with depression and mental health. The multifaceted nature of depression calls for comprehensive, interdisciplinary, and culturally relevant solutions to bridge the gap in disparities and provide effective care for those in need. Implications The implications of the information presented in "A Cure for Darkness" by Alex Riley are profound and shed light on critical challenges within the field of mental health. The book highlights the pressing issue of underfunding in mental health care, emphasizing how depression and anxiety are often marginalized in budget allocation. This lack of funding perpetuates disparities in access to care, particularly for low-income individuals, who may have "competing priorities for time and money". These financial constraints and disparities are barriers to effective treatment and contribute to the global burden of mental health conditions. Furthermore, the book's exploration of the underutilization of effective treatment and prevention of generational depression is rooted in economic and political influence. The underutilization of ECT highlights how stigma and cost considerations can impede the adoption of effective treatments. ECT, despite its efficacy in treating severe depression, faces political stigma and misconceptions rooted in its historical misuse. Additionally, ECT is only accessible to those who are insured and wealthy, as those less fortunate would not have access to this treatment. Additionally, the finding that children of parents with depression are at a higher risk emphasizes the need for prevention strategies. While treating parents can help break this cycle, the limitations of time, money, and other barriers may prevent some individuals from accessing

11 necessary resources and treatments. These challenges call for a more comprehensive and accessible approach to mental health care, particularly in high-risk communities. When addressing cultural impact on diagnosis and treatment, the book demonstrates the importance of cultural sensitivity in diagnosing and treating patients from diverse backgrounds. Recognizing that depression is experienced and expressed differently across cultures is crucial for providing effective care. The utilization of community support systems, culturally relevant terminology, and peer-based interventions exemplifies the significance of collaboration and cultural competence in mental health care. Lastly, the emphasis on collaboration in mental health treatment, including the integration of various therapies, cultural approaches, and unconventional treatments like psychedelics, highlights the need for a multidisciplinary and inclusive approach to mental health care. These collaborations not only offer more tailored and effective solutions but also help reach underserved populations and reduce disparities in care. Conclusions Alex Riley’s novel delves into developmental psychology through three prominent themes: political and economic influence, cultural impact on diagnosis and treatment, and the significance of collaboration. With the information and insights discussed in this paper, several notions have come into light, particularly the underserving of low-resource communities, the need for culturally sensitive clinicians, and the importance of collaboration in all aspects of the mental health field. Developmental psychology allows us to help and understand those who are suffering from mental health issues, and this book does well to highlight the debilitation brought on by depression. When these disparities are prominent, as illustrated throughout the paper, it is

12 the duty of clinicians to find ways to bridge this gap, as we should be helping the entire population, not just the privileged few. In essence, "A Cure for Darkness" stresses the dire need for increased funding, reduced stigma, and a more comprehensive, culturally sensitive, and collaborative approach to mental health care. It is imperative to bridge the gap between disparities in access to mental health treatments and interventions. The book's insights serve as a blaring call for an individualized, culturally competent, and collaborative effort to address the global challenges associated with depression, advocating for a more equitable and effective mental health care system.

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13 References Dwight‐Johnson, Sherbourne, C. D., Liao, D., & Wells, K. B. (2000). Treatment Preferences Among Depressed Primary Care Patients. Journal of General Internal Medicine : JGIM, 15(8), 527–534. https://doi.org/10.1046/j.1525-1497.2000.08035.x Felton, Kleinman, M. B., Doran, K., Satinsky, E. N., Tralka, H., Dean, D., Brown, C. J. S., Anvari, M. S., Bradley, V. D., & Magidson, J. F. (2023). Peer Activate: A Feasibility Trial of a Peer-Delivered Intervention to Decrease Disparities in Substance Use, Depression, and Linkage to Substance Use Treatment. Journal of Psychosocial Nursing and Mental Health Services, 1–9. https://doi.org/10.3928/02793695-20230523-02 Riley, A. (2021) A cure for darkness: The story of depression and how we treat it. Scribner. Ross, Zivin, K., & Maixner, D. F. (2018). Cost-effectiveness of Electroconvulsive Therapy vs Pharmacotherapy/Psychotherapy for Treatment-Resistant Depression in the United States. Archives of General Psychiatry, 75(7), 713–.

Assign 18 Reaidy Nov 03

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