HLTHAGE 1CC3 Lecture 3: Lecture 3
27 Jun 2018
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May 8, 2017
Mental Health Lecture 3
Test: Wednesday May 10th 2017 immediately after lecture; involves all lectures up to and including
today (not textbook).
Answer to practice question on avenue= a) Medical model. Key idea: talking about genetics
Discussion questions: now online, have to answer all questions.
Mood disorders: primarily affect mood (at least that’s how we interpret it).
Major Depressive Disorder
Have to have one or more major depressive episodes without mania, 5+ symptoms during 2-week
period (depressed mood most of the day, anhedonia, insomnia/hypersomnia, weight loss/gain, fatigue
or loss of energy, psychomotor agitation/retardation, feeling worthless, recurrent thoughts of death or
suicide, etc.).
Episode: discrete period of time that is overwhelmingly dominated by one feeling.
Why is this significant? In some ways it casts some doubt into this specific disease model, we think that
normally in disease model we have a specific cause and course of action, here we don’t. This proves how
disorders like this can be contested, or how many people disagree on diagnoses, because there’s so
much variance.
Persistent Depressive Disorder (dysthymia) is chronic, not periodic-but it is less severe than MDD.
This brings us to: what’s the difference between someone’s personality, and a disorder? At what
point does the personality stops, and the disorder begins? When does it become a consequence
of something else?
If we cannot make mental illness visible, then this question becomes even greater-the dividing
line between a person and a disorder.
Bereavement Exclusion: if a person has 5 above symptoms in 2-week period, etc. HOWEVER, if in last 2
months someone in their family has died, then that person is not depressed, they are grieving.
This was taken out in DSM 5 (2013).
Central debate here: some people say this is good because it allows for more professional autonomy,
the doctors are the experts and know best how to identify mental illness. If the person is just grieving,
then they will use their expertise and not give a diagnosis.
Counter argument: we are engaging in the process of widening the boundaries of the disorder.
All the potential symptoms of a disorder, every time you add a symptom you expand the
horizons of the disease; so behaviours that you once thought as normal, now become signs or
May 8, 2017
symptoms. Here, grief now becomes one of those things; meaning the signs of grief would be
indicative o you being sick and depressed.
This makes it much easier for someone to be diagnosed of being mentally ill, is this
good? Up for interpretation.
What IS the appropriate amount of time to grieve after a period of time? In some cultures, there are
strict rules on what to do after someone has died (e.g. can’t do anything ‘fun’ like parties/concerts for 6
months after someone has died).
Some therefore say that giving this bereavement exclusion is more culturally acceptable
because it extends the limits to when they can continue to bereave, and again gives physician’s
the choice to determine the extent of their “depression”.
Counter argument: instead of an exclusion, can’t we just extend it?
Argument for: death is merely one of many things that might cause stress in a person’s life, how can we
say that losing a job is not as bad as losing your grandmother? We have fetishized death by giving it a
special place previously, by getting rid of it, we are saying that it is not the only thing that causes stress.
What makes depression different than sadness?
1) With depression the mood change is far more sustained, and pervasive (filtering into all parts of
your life). Sadness is more linked with something that has happened in your life, and you are sad
about it-there may not be any obvious cause or reason for depression.
a. If someone is sad, and you take them to do something fun then they will fell better, this
will not happen with depression because the mood change is deeper.
2) Social and occupational functioning: is this person still going to work? Are they losing, or
damaging friendships? (these are key things that give way to more of a yes or no for depression
diagnosis).
3) The people who are diagnosed with depression themselves, talk about the feeling itself being
somehow different, not the same thing as sadness. E.g. Women describes: “as if a gargoyle was
over her shoulder, just feeding her negativity all the time (not psychosis-she knew it wasn’t
there, that’s just a description). Black clouds always present and consuming kind of thing”.
4) Biomarkers (a biological marker that something is present, e.g. blood test shows someone has
Hep C- there is a biomarker there so we can determine if they had it; a test where you can prove
if something is there or not.): there are none. We can’t measure anything in your body to
determine they have depression. **Neurotransmitters do not count, because our ideas about
them are theoretical-not proven.
Think: These lines are SO blurry…what’s the difference between depression with psychosis and
schizophrenia? It’s up to interpretation, there’s not clear line.
May 8, 2017
There will be emphasis though, e.g. depression would be primary, and schizophrenia would have
the disorganized thinking.
Bipolar Disorder
1) Cycling between 2 types of episodes dominated by either depression, or mania.
a. Mania: An episode of it is marked by really incredible sensation of the best mood you’ve
lived in your entire life. Individuals in this state feel incredible and on top of the world-
energetic, sharp, attractive, social. The greatest high you’ve ever possibly imagined.
a.i. A person feels a really inflated degree of self belief: e.g. they feel smarter than
everyone else, they have the best relationship-better than everyone else.
a.ii. **Blurred lines here with delusions of grandiosity, the lines between them are
very hard to draw. Those who make the case that these are all genetic
disorders, believe that there are shared risks between disorders like bipolar and
schizophrenia for example when it comes to terms like this one.
a.iii. Extraordinary flirtatious; so you see on one hand my relationship is the greatest,
but also an outward heavy engagement in the social realm.
a.iv. Individuals talk about not needing to sleep (NOT insomnia, which is when you
want to sleep and you can’t), these manic episodes can last for months so
someone can follow a pattern of sleeping for maybe only 2 hours a night for
that period of time.
a.v. Often described as goal oriented: they put a phenomenal amount of time,
effort, and creativity, into a deadline. It might be about the workplace, but could
also be socially (individual can sleep with lots of people, men, women, etc.-
becomes kind of like a mission for them). E.g. Gambling, extreme sports.
a.vi. Often involves a “crash”. Although the high might feel really good, coming down
from it may be a horrible sensation, e.g. sleeping for a week, not being able to
get out of bed. This crash may evolve into a depressive episode.
2) Individuals may also experience psychosis, not always though. (again, where is the dividing line
here?).
Hypomania is a related disorder. Described as “super-functional semi-mania”, they have all these
enjoyable things, but it doesn’t quite get to the manic phase where they are moving at a rate that is
almost impossible for others to keep up with. Aka bipolar II.
In the first part of our lifetime, there was a giant leap (1996-2004) tin diagnoses of bipolar disorder.
Increase from 1% to 4% of general population gets diagnosed with bipolar disorder.
**Video here on Slide 7 about experience of mania.
Benefits of bipolar disorder
Document Summary
Test: wednesday may 10th 2017 immediately after lecture; involves all lectures up to and including today (not textbook). Answer to practice question on avenue= a) medical model. Discussion questions: now online, have to answer all questions. Mood disorders: primarily affect mood (at least that"s how we interpret it). Episode: discrete period of time that is overwhelmingly dominated by one feeling. In some ways it casts some doubt into this specific disease model, we think that normally in disease model we have a specific cause and course of action, here we don"t. This proves how disorders like this can be contested, or how many people disagree on diagnoses, because there"s so much variance. Persistent depressive disorder (dysthymia) is chronic, not periodic-but it is less severe than mdd. If we cannot make mental illness visible, then this question becomes even greater-the dividing line between a person and a disorder. Bereavement exclusion: if a person has 5 above symptoms in 2-week period, etc.
