Mood based disorders involve instability in emotional state which varies from severe sorrow and disengagement of depression to the excitement and petulance of mania.
The Diagnostic and Statistical Manual of Mental Disorders recognises two main categories of mood based disorder. The first includes disorders with signs of depression (depressive disorders), and the second those that contain manic symptoms along with symptoms of depression (bipolar disorders).
When someone develops a form of depressive disorder, their personal life can reverberate with anger and self- accusations. Likewise paying attention can be tiresome and they will suffer difficulty absorbing the information they are subject to. Often such sufferers see world from an extremely pessimistic or suspicious point, which eventually leads towards total despair. An individual suffering from depression will also experience physical symptoms, including fatigue, lethargy as well as symptomatic physical pain. The symptoms suffered are profoundly sufficient to persuade a distressed person that they have a dangerous medical condition, even if the symptoms they suffer from have no evident cause (Simon, Von Korff, Piccinelli, Fullerton, & Ormel, 1999). Even though sufferers usually feel extremely tired, they suffer insomnia and wake frequently during the night. Sufferers may find food bland and suffer loss of appetite, and others on the contrary may have to cope with an increase in appetite. Sexual attraction also falls in those with depression. Thought and physical movement may slow (psychomotor retardation), while others will fidget continuously (psychomotor agitation). Apart from cognitive and physical symptoms, initiative may vanish, social withdrawal may occur, isolation is also preferable and some may be negligent towards their personal appearance. After falling into complete depression and helplessness, thoughts of suicide may occur. Diagnostic and Statistical Manual of Mental Disorders recognises two kinds of depressive disorders: major depressive disorder and dysthymic disorder.
There are three types of bipolar disorders recognised by Diagnostic and Statistical Manual of Mental Disorders.: bipolar I disorder, bipolar II disorder, and cyclothymic disorder. Manic symptoms are the central point for each of these three disorders. The bipolar disorders are defined by severity and length of the manic episode. These disorders are labelled ‘bipolar’ as sufferers experiencing mania will also experience depression (mania and depression are regarded as conflicting opposites). Occurrence of depression is not necessary to diagnose bipolar I disorder, but is essential to diagnose bipolar II disorder. However, the majority of people who seek a treatment for bipolar I disorder have also suffered depressive symptoms (Johnson & Kizer, 2002). Mania in bipolar disorders presents as extreme euphoria or petulance together with other indications described via diagnostic standards. In the course of mania episode individuals usually become loud and formulate unusual comments, often filled with jokes and interjections about a stimulus which have caught their attention. Such comments can be hard to disturb and can swing promptly from subject to subject, displaying a range of ideas. Episode sufferers may become excessively self-confident and oversociable in the sense of intrusiveness. Unfortunately, they are usually unaware of the catastrophic costs of their actions, which may involve unwanted sexual remarks, wastefulness, and careless driving. Effort by others to control/restrain such enthusiasm may erupt bringing fury and anger. Mania can occur unexpectedly over short periods, and although manic episodes are ‘merely’ manic individuals can suffer combined episodes, characterised by signs of both mania and depression.
Psychoanalysis and psychoanalytic therapy:
Psychoanalysis is the tandem theory of how the mind works and its system of therapy. Psychoanalysis put emphasis on the working of the unconscious part of the mind; it identifies that some of the things which influence our performance and personality are experiences and emotions of which we are unaware. The primary aim of therapy is to get better insight on patients’ behaviour and feelings, and in doing so help to relieve anxiety and depression.
Psychoanalytic therapy is different than both clinical psychology and psychiatry as it does not engage in behavioural techniques or drugs, but attempts a ‘talking cure’. The originator of psychoanalysis, Sigmund Freud, focused on the potential of the unconscious mind and acknowledged that the most effective impacts on our performance and predispositions are those we are oblivious to. For example, as children’s development progresses as a reaction to outside world they perceive and to relations that may grow to be devious or counterproductive in later life the inner conflicts, though buried in the sub-consciousness may present well into adulthood.
The aim of psychoanalysis is to improve individuals’ understanding of unconscious conflicts which are the source of psychological distress. Psychoanalysts treat patients suffering from a variety of conditions such as: depression, anxiety, eating disorders, and relationship difficulties. Psychoanalysis attempts to reveal the main causes of irrational fears, anxieties, and destructive or self-destructive actions. Patients will normally be treated by sessions over a number of years. The process is designed to ensure patients feel in control of their life. If successful this type of therapy can bring permanent positive change. Medium term psychoanalytic psychotherapy and psychoanalysis have been found to have enhanced clinical effectiveness in neurotic and some personality disorder patients (Milton, Polmear & Fabricius, 2004).
There are numerous schools of thought pertaining to psychoanalysis. All are inspired by Freudian theory and practice, however new theories and concepts continue to be developed. Major contributions were made by Melanie Klein and Donald Winnicott in the UK, and by Jacques Lacan in France. Within the last ten years neuropsychologists have worked with psychoanalysts in the UK and USA to gain further understanding of the link between the processes in the brain and the functioning of the human mind.
Psychoanalytic theory of depression:
There is no one psychoanalytic theory of depression, but a spectrum of theories with different emphases. Abraham, Freud, Klein, Winnicott and Bowlby claimed that depression stalks from childhood problems, which outline a model for later looses and contribute to the likelihood of becoming depressed. Adults diagnosed with depression often have suffered psychological injury in early life, such as neglect or abandonment. Genetic factors and early problems of this kind may incline such persons to suffer depression when they experience loss in life.
In his essential paper ‘Mourning and Melancholia’ (1917), Freud drew a clear line between healthy grief (mourning) and depression (melancholia). The loss of someone or something (partner or a job) is primarily comparable to that in grief and depression, but the final response to loss is distinct. While in mourning it is possible to eventually accept the loss, in melancholia part or all of the loss can never be acknowledged. Freud speculated that the depressed person instinctively associates with the lost qualities (person or a job). Resultantly instead of aiming their strengths towards positives, depressed individuals withdraw into themselves. A common reason is that individuals often ‘blame’ the lost person for abandoning them. Accordingly in depression, hostile beliefs concerning lost person are turned inwards against oneself (depression is often explained as ‘anger turned inwards’). Because depression consists of complex emotions, depressed people usually feel irritated, lack self-esteem, and repeatedly punish themselves. Sometimes, an individual denies their feelings by modifying them into unrealistic elation, or ‘mania’. Melancholia in exchange with mania is the typical example of ‘manic depression’ (bipolar). Mania is a ‘reaction-formation’ (defence mechanism) to depression, in which an individual, for the short period of time, overcomes their depression by escaping reality.
In the late 1970’s people started becoming dissatisfied with behavioural and psychoanalytic theories. Many claimed that the procedures these theories involved were ineffective for mental health issues. Later emphasis on the significance of cognitions (thoughts) resulted in the development of cognitive therapy.
Cognitive theory of depression
Cognitive theory claims that disturbing experiences lead people to form pessimistic presumptions about themselves and the world. Cognition puts together the means of perceiving, reorganising, conceiving, judging, and reasoning. Aaron Beck (1989) claimed that people suffer from mental health problems because their thoughts are influenced by negative interpretations about previous experiences. These negative thoughts are then aimed inwards at the world and towards others. Beck called this the negative triad. Beck also claimed that the more a person feels depressed the more pessimistic their thoughts turn into, this is a form of negative feedback which may become destructive if left unchecked. This cycle of depression can be long-lasting and lead to self-destructive behaviour like suicide (O’Connor & Sheehy, 2001).
Cognitive model therefore suggests that thoughts and mood are interdependent. Cognitive therapy tries to break the cycle by helping people to recognize and confront their negativity. Cognitive therapy is derived from an educational model where new skills are gained through regular practice. The model develops problem-solving skills, social skills, reduces negative behaviour and allows positive thinking. Cognitive therapies are generally short-term individual or group therapy based on identifying and confronting negative thoughts. Cognitive therapy concentrates on investigating core beliefs and dysfunctional assumptions that trigger one’s behaviour. A therapist reinforces positive behaviour and challenges dysfunctional behaviour whilst actively providing compassion and understanding.
According to Beck (1989) a person’s cognition is a part of the cause of mental health problems. Beck argues that in depression negative thinking is not merely a sign of disorder, but a predominant aspect in the process of depression. Beck in his model of cognitive theory claims that there is an association between the manner in which a person reasons and explains their life events and the way they feel. To increase the awareness of the interaction between negative thinking and mood, Beck (1989) proposed the Beck Depression Inventory (BDI). The BDI assesses depressed mood and is used to monitoring levels of depression during treatment.
Beck’s 1989 Cognitive Model of Depression includes core beliefs, dysfunctional assumptions, critical incidents, negative automatic thoughts, symptoms, and cognitive biases.
The cognitive model assumes that negative experiences will lead to the formation of specific core beliefs concerning an individual and their surroundings. Such beliefs are normally set in the individuals mind. Core beliefs are based on early experiences likely to have happened during childhood or adolescence. From one core belief people can form a set of dysfunctional assumptions. Contemporary cognitive behavioural therapy concentrates on the early experience and tries to find and understand the assumptions and interpretations that the person has allocated to these experiences. Dysfunctional assumptions are normally conditional (i.e. IF I am not always successful THEN no one will like me). The ability to predict and understand one’s experience is necessary for everyday life, else wise assumptions may become rigid and extreme. These assumptions may resultantly become dysfunctional and counterproductive. For instance, people may have formed assumptions that affect what they feel is essential for them in order to be happy (e.g. if someone thinks poorly of me, then I cannot be happy) and they will acquire strategies to try to be happy (e.g. I must do well in everything that I do, otherwise I will not be liked). An individual may handle these assumptions very well and not suffer any problems in life. Nonetheless, troubles may arise if the persons come across life events that do not match these assumptions, people may experience a time in their adult life, which is challenging and hard, or involves a major event, such as loss of a loved one, divorce or redundancy. At these times an individual may discover their negative assumptions become triggered.
Critical incidents become initiated when a person comes across an experience which in some way is similar to the primary experience formed when the core beliefs were developed. As a consequence of this critical incident the person may loose control over their negative assumptions, and as a result may become overwhelmed by negative thoughts. Negative automatic thoughts (e.g. I’m no good at anything, I’m a failure, no one will like me, everything is going to go wrong, it’s going to be awful) are impulsively activated and mechanically ‘pop’ into the mind at frequent intervals. The person feels as if they were influenced by these thoughts and may become totally overwhelmed by them. Negative automatic thoughts usually concern repulsive feelings which exhibit somatic, behavioural, motivational and affective symptoms. These may contain some of the common emotions characteristic for depression e.g. insomnia, nausea, headaches and apathy.
Cognitions are the key element of cognitive behavioural theory and therapy. Cognition is the mental process of perceiving, reorganising, conceiving, judging, and reasoning. The main determinant of depression is the ‘irrational thinking’ (‘irrational cognitions’) which can take various forms such as:
Magnification and minimisation: ‘All or nothing thinking’ and exaggerations in assessing one’s performance. For instance, a person may consider that their car is completely damaged after they notice a small mark on it (magnification), in opposition stands minimisation which occurs when a person identifies themselves as worthless or unsuccessful in spite of a large amount of successful experiences.
Overgeneralization/Awfulising: An overall extensive assumption which is based on a one often insignificant experience. Depressed individuals often have a tendency to formulate exaggerated evaluations of negative events. For instance, a depressed student may consider their poor presentation from a particular module as a proof of their ‘overall’ worthlessness and stupidity.