Assign 12 Reaidy Sept 29 (2)

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1 Assignment 12: Discussion Paper 1 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 September 29, 2023

2 Assignment 12: Discussion Paper 1 on A Cure for Darkness Depression has long afflicted our society, but its journey from its origins to our current understanding has been extensive. A Cure for Darkness: The Story of Depression And How We Treat It entails the history of depression, spanning from its etiology to its treatment to the influence society had on access to treatment and the formation of the disorder. Despite this book focusing on depression, the themes abundant throughout the text in Part One and Part Two can be applied to the development of psychopathology. Before diving into the key takeaways that were highlighted in the text, first a summary of these parts of the book. In Part One, there was a primary focus on following the research and discussing the etiology of depression, specifically circling back to a pivotal figure in psychoanalysis, Sigmund Freud. Depression was not understood, and research was being conducted to better understand the etiology behind the disorder, resulting in the biological approach, which meant the disorder affected the nervous system, or the environmental/social approach, which involved talking therapies, change in diet, and psychoanalysis. Part Two further delves into treatments of the disorder, specifically those addressing the biological approach, being cocaine, electroconvulsive therapy, and MAO inhibitors. More research and publications have led to our now common methods of assessment and treatment of depression, as well as other developmental psychopathologies. As much as we have learned, there is much still to be discovered about developmental psychopathology, however, this book has contributed much thought to how one can view developmental psychopathology. Overall, the following three takeaways are ones of significance and repetition: the complexity of the etiology of disorders, the individualization of treatment plans, and the influence of social and cultural constructs in research.

3 Key Insights Complexity of Etiology and Symptomology Disorders often resemble intricate webs, challenging to trace to a single point of origin but shaped by numerous contributing factors, as seen in the case of depression. The book outlined two major approaches to the cause of depression: biological and social/environmental factors. The debates of “nature versus nurture” persist today for various disorders and various contributors can cause the development of the disorder, while also aiding in grouping disorders based on these factors. When first studying psychopathology, the nervous system was one that particularly caught the eye, so much so that mental institutions became “hospitals of ‘nerves’ and ‘nervous disease’.” (Riley, 2021) Biological reasonings for understanding mental illnesses rooted in fascination with the nervous system, thus wanting to further understand this system may help physicians understand why individuals were suffering from these psychological disorders. Many biological psychiatrists were convinced that neurons or the brain attributed to the development of these mental disorders, going as far as to believe that “every facet of insanity was rooted in some physical aberration in brain tissue (Riley, 2021).” Kraepelin believed that manic depressive insanity was a body disorder and was hereditary, a trait passed down from parent to offspring (Riley, 2021). In a study regarding the etiology of pre-and postnatal depression, it was found that a genetic component did contribute to “heritability of depressive symptoms was 16.2 % prenatally and 25.7 % postnatally,” which in turn does seem to align with Kraepelin’s train of thought (Samuelson, 2023). However, the disorder was not heritable, but rather some similar symptomology.

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4 Inching closer to the function of biology contributing to depression, a discovery was made when Phineas Gage, a construction foreman, was in an accident where a metal rod had impaled him right below the cheekbone, through his brain primarily injuring his frontal lobe (Riley, 2021). Phineas Gage had survived the incident, however, the doctor noted that his personality had changed. This led psychiatrists to believe that the frontal lobe was detrimental to one’s personality and mood. This was a stepping stone in the right direction, as physicians regarded the body to be out of homeostasis or in an unstable condition. To maintain homeostasis, monoamines, an enzyme, were controlled by monoamine oxidase, or MOA, which can grab and hold serotonin and norepinephrine, temporarily disabling them by altering their chemical structure, thus halting the message the monoamine was trying to send (Riley, 2021). Without this biological process, the brain would be bombarded with a confusing abundance of signals all competing for space in the synapse and causing an overall overload for our consciousness (Riley, 2021). Current research is still trying to understand the role of serotonin pathways in the development of depression. In Borroto-Escuela, et. Al. (2021), it was found that disruption in certain heteroreceptor complexes has affected the diffusion of serotonin, which can contribute to the development of depression and other types of psychiatric diseases. However, the theories have changed biologically, and the same questions of why and how remain. Studies regarding theories developed decades prior are still being studied and perfected as we continue to understand how our bodies and brains work and how these functions, or lack thereof, contribute to psychopathology. Another valid approach considered was the effects of environmental and social surroundings on the development of these disorders. Men were thought to develop depression due to the “fast-paced modern lifestyle and need to compete in growing urban centers around the

5 world” while women developed depression due to “caring for sick relatives or educating themselves in matters for which they were supposedly unsuited (Riley, 2021).” It was found that many of those suffering from the illness were women, particularly those who had just given birth. Psychoanalysis was developed to understand the subconscious, unraveling the meaning of dreams and memories that may have the onset of one’s depression. Certain events may have triggered or contributed to the development of the disorder, which we still consider today. For instance, in the case of Freud, he was in a town away from his fiancé, struggling financially, and facing racism constantly (Riley, 2021). These social and environmental factors took a toll on Freud, leading to his development of depression. Additionally, Samuelsen et al. (2023) Found that environmental factors were significant contributors, such as lack of support or life stress, to pre and postnatal depression as opposed to genetics. The way one acts and thinks towards oneself can be shaped by one's surroundings; a pivotal remark made throughout the book. When combining both factors, one can conclude the development of the biopsychosocial model, which indicates one’s mental health is tied to biological, psychological, and social contributions. When focusing on the complexity of etiology, one realizes that many factors contribute to the development of a disorder, it is not grey and white, so continuous contributions and developments for understanding disorders continue. The book focused on the aspects of adults, however, these factors can also affect children and adolescents and when being aware of what factors to look for, as seen in the case of depression, one can be able to appropriately diagnose and treat an individual and possibly inform parents on how to prevent the onset of certain disorders, such as depression and anxiety that have strong environmental factors.

6 Individualization of Treatment Treatments, like clothing, cannot be 'one size fits all'; each case requires individualized care. The book discussed various treatments, some of which worked for certain populations, while others did not. Freud had suggested cocaine be used to ease depression symptoms, an antidepressant before its time. Although effective, cocaine had severe side effects that were concerning, one of which was addiction, which Freud had noted was more prone in the population recovering from Morphine addiction (Riley, 2021). These treatments were seen as heinous and unpreferable, either having little success or significant success at a great cost. Then there was the incident that occurred to Phineas Gage and the discovery of the frontal lobe and its effect on mood and personality. This led to the performance of a prefrontal leucotomy which was further developed into a lobotomy. When performed correctly, a lobotomy has been seen to significantly improve the mood of individuals with depression, however, this was not everyone’s results as seen in the case of Rosemary Kennedy, where her mental capacity was compared to that of a two-year-old post-procedure. Soon electroconvulsive therapy was discovered and deemed more suitable compared to lobotomies, as the risks were lower, but the treatments were required to be done more frequently. However, ECT was not effective for the entire population with depression, leaving a gap for MOA inhibitors, a precursor to the SSRIs used today. This drug was not widely accepted because psychoanalysts insisted that psychoanalysis was the appropriate way to treat depression. These were the only treatments that would address the biological approach to depression, however, depression, as we have covered, is a complex disorder, one that may require more than a simple pill. William Tuke took a turn from the focus of biological approaches and instead built a cottage-style retreat for those with depression. This cottage was a stark contrast to

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7 “conventional” institutions, the participants were not chained or starved. Instead, they roamed free and were provided with three healthy meals a day, were encouraged to engage in activities (e.g., sewing or reading), and were met with compassion, conversed through any morbid ideas or delusions to ones that were more peaceful (Riley, 2021). This became a popular therapy that began being adopted by mental institutions due to its tremendous outcomes. Freud then paved the way for psychoanalysis as a valuable treatment for depression. Understanding one’s thoughts, dreams, and root causes may help identify what may be triggering these emotions, leading to the resolution of these issues in hopes of alleviating some of the symptoms of depression altogether (Riley, 2021). Huang et al. (2023) looked at the effects of non-pharmacological treatments in the onset of major depressive disorder, or MDD, and found that using these interventions had a significant effect in preventing the onset of MDD and improving depressive symptoms. Addressing environmental and social factors is pertinent to helping improve symptoms of disorders and better understand how to prevent further worsening of the disorder. Both biological and environmental/social factors should be considered and addressed for effective treatment and understanding of psychopathology development. Only treating one cause and ignoring the other will not better one’s condition fully. Developmental psychopathology is not simply focusing on one aspect of a disorder but taking multiple into consideration, as done by the numerous treatments being used. Despite their development due to varied beliefs in approach and developed separately, they have led to current treatments used today, such as SSRIs and CBT, often used in unison. Social and Cultural Constructs. Society and culture play varied roles in our lives in how we view ourselves and the thoughts we have. Due to society’s influence on the view of depression, Abu Zayd’s beliefs that depression was a spectrum and was shaped by one’s

8 perspective of self was not adopted as people were focused on the biological reasoning behind depression. Eugenics fueled the Nazi party based on Kraepelin’s belief of “defective hereditary,” leading to sterilization in Britain and the US and the murder of thousands of mentally ill patients in Germany (Riley, 2021). Rudin had been studying if mental disorders could be passed down from parent to offspring. This was true in the case of dementia praecox (now schizophrenia) but there were no hereditary links in manic-depressive insanity (Riley, 2021). Unfortunately, Rudin never published the study because it did not fit his or his country’s worldview, so he allowed people to continue to think that this disorder was due to defective hereditary, leading to more slaughter of these individuals (Riley, 2021). The development of disorders was not the only thing affected by social and cultural constructs, as these strong beliefs in biological reasoning and eugenics influenced what information was spread worldwide. This may have delayed the development of psychopathology as we know it today, as well as how we perceive mental health and illnesses. Conclusion Discussion The development of psychopathology was driven by curiosity about the complexity of etiology, how we can individualize treatment, and the effects of social and cultural constructs on information and individuals. Despite research advancements made, we continue to strive to learn more about disorder and psychopathology, and much is left unknown. Several factors must be considered and impact our decisions as future psychologists regarding choosing research information, treatment plans, or even assessments for our future patients. Implications

9 Psychologists face increasingly challenging roles, as novel studies are constantly being produced, etiologies being discovered, and new interventions being approved. These steps bring us closer to gaining a deeper understanding of disorders and how we can better help individuals with that disorder. Additionally, social, and cultural constructs play a significant role in assessments, treatments, and even publication of research, thus one should be mindful of such things when discussing with clients, as this can help with providing the best and most effective care.

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10 References Borroto-Escuela, D. O., Ambrogini, P., Chruścicka, B., Lindskog, M., Crespo-Ramirez, M., Hernández-Mondragón, J. C., Perez de la Mora, M., Schellekens, H., & Fuxe, K. (2021). The Role of Central Serotonin Neurons and 5-HT Heteroreceptor Complexes in the Pathophysiology of Depression: A Historical Perspective and Future Prospects. International Journal of Molecular Sciences, 22(4). https://doi- org.ezproxy.lib.utexas.edu/10.3390/ijms220419 Huang, K., You, S., Yue, X., Yan, S., Bai, L., He, R., Jiao, Y., Han, B., Momin, K., Wu, J., Jia, Y., & Chen, L. (2023). Effects of non-pharmacological interventions on depressive symptoms and risk of major depressive disorder in adults with subthreshold depression: A systematic review and meta-analysis. Psychiatry Research, 326, 115333. https://doi- org.ezproxy.lib.utexas.edu/10.1016/j.psychres.2023.115333 Riley, A. (2021). A Cure for Darkness: The Story of Depression and How We Treat It. Simon & Schuster,Inc . Samuelsen, K., Ystrom, E., Gjerde, L. C., & Eilertsen, E. M. (2023). Kind of blue – An evaluation of etiologies for prenatal versus postnatal depression symptoms. Journal of Affective Disorders , 335 , 305–312. https://doi- org.ezproxy.lib.utexas.edu/10.1016/j.jad.2023.04.135

Assign 12 Reaidy Sept 29 (2)

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