Thirty years ago, I submitted a manuscript for publication and received the following response from the editor: “There is nothing new here, but some ideas warrant repeating.” The manuscript was published.

I have already written about the problems in reframing psychiatric disorders as brain disorders, but I was inspired to write yet another post about depression more specifically when I read a passage that resonated with me—especially intriguing because it was not penned by a mental health professional but rather by a philosopher, Alva Noe, who also has acquired expertise in cognitive science and neuroscience.

In the preface to his book, Out of Our Heads: Why You Are Not Your Brain and Other Lessons from the Biology of Consciousness, he wrote the following about the idea that depression is a brain disease:

“In one sense, that is obviously true. There are neural signatures of depression. Direct action on the brain—in the form of drug therapy—can influence depression. But in another sense, it is obviously not true. It is simply impossible to understand why people get depressed—or why this individual here and now is depressed—in neural terms alone. Depression happens to living people with real life histories facing real life events, and it happens not only against the background of these individual histories but also against the background of the phylogenetic history of the species. The dogma that depression is a brain disease serves the interest of drug companies, no doubt; it also serves to destigmatize the struggle with depression, which is a good thing. But it is false.”Brain

I think Noe has the perspective just right and expressed it eloquently. Unfortunately, as I’ve written in previous posts, he was wrong about one thing: construing psychiatric disorders as brain disorders has not ameliorated stigma.

The only solid rationale for the brain-disorders view is the plain truth in it, as Noe states. But this truth can obscure another truth that Noe has firmly in mind: in conjunction with genetic risk, disordered brains develop from disordered lives.

As my colleague, Tom Ellis, PsyD, ABPP, pointed out when he read this line, we should keep in mind that this adverse influence goes both ways; in his words, Disordered lives damage brains no less than disordered brains damage lives.” The disorders in lives relate extensively to problematic relationships throughout the lifespan. Traumatic experiences in attachment relationships, earlier or later in life, are a particularly significant risk factor for depression. More broadly, I think of a pile-up of stress over the course of the lifetime as the major contributor to disordered brain functioning in depression, as it is in many other psychiatric disorders.

Simply put, the danger in the brain-disorders view of depression is that patients will focus solely on medical treatment (primarily, medication) and will not adequately address the stressful life experiences and relationships that play such a significant role in depression. The worst-case scenario is patients feeling hopeless because they are told they suffer from “treatment-resistant” depression owing merely to poor response to medication.

I feel fortunate to work in a hospital where treatment-resistant depression is addressed not only by refining the medication regimen but also through extensive education coupled with individual and group therapy along with family work—all in a therapeutic milieu that supports engagement in healing relationships with staff members and peers. Similarly, in outpatient settings, treatment with medication is optimally coupled with psychotherapy; marital and family therapy is always something to consider as well.

We need to attend to the health of the brain, but never to the neglect of the life of the person—who, as Noe emphatically states in his book, should never be reduced to a brain.

References:

Allen, J.G. (2006). Coping with depression: From catch-22 to hope. Washington, DC: American Psychiatric Publishing.

Noe, A. (2009). Out of our heads: Why you are not your brain, and other lessons from the biology of consciousness. New York: Farrar, Straus and Giroux.

 

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A few years ago I wrote a blog post about the trait of stubbornness and its application to personality disorders. This time, I’m here to delve into the complicated and misjudged trait of envy.

According to the DSM-V, the trait “often envious of others” is among the traits of narcissistic personality disorder. Two perfectly reasonable questions to ask yourself are, “What exactly defines the word often?” and “Is all envy bad?”

Envy is commonplace

I agree these are important questions to ask in a diagnostic process, and it is my job as a research interviewer to determine if a person has a certain trait by asking a series of diagnostic questions as delineated in the Structured Clinical Interview for the DSM-IV.

In fact, as in the trait of stubbornness, many people I interview endorse being envious right off the bat. According to Merriam-Webster, envy is the “the feeling of wanting to have what someone else has.” Envy is, in part, what drives us. It allows us to strive for whatever we want to accomplish.

I’ll admit that I’m guilty of being envious, and it’s not a rare occurrence. It’s so commonplace, you might even say it’s the American way. So at what point does envy become a bad thing? What did the writers of the DSM have in mind when they said, “often envious?”

Envy vs. jealousy

It is also important to recognize the fundamental difference between jealously and envy. Jealously occurs when a person possesses something which becomes threatened, usually by a third party.

An example: My best friend and I spend lots of time with other. My best friend begins dating a girl, taking up some of the time we used to spend with each other. As a result, I become jealous. Envy is a two-person dynamic which occurs when someone lacks something. My best friend gets a new car and I want it, therefore, I am envious (Smith, 2014).

Welcome to envySo, first let me touch on the DSM-V’s commentary on the subject. It states that people who possess the trait of envy may begrudge others their successes or possessions. Such individuals may also feel that they are more deserving of achievements, admiration or privileges. They may also harshly devalue the contributions of others, especially when these individuals receive praise for their accomplishments.

I agree that there are degrees of envy, and it may have more of an impact on us than we may believe. But maybe envy has gotten a bad rap; it clearly has an implicit negative connotation. It is one of the seven deadly sins, and while I will not even touch on envy’s relevance to religion, it is pervasively seen by many cultures as an undesirable quality. As far as the DSM is concerned, it all comes down to “functional impairment” — that is, how much it interferes with someone’s life.

Envy and personality disorders

In one study, Emmanuel Habimana (2002) examines the role of envy in personality disorders. He questions why the trait of envy is only seen in one criterion of one personality disorder, despite it being such a common and widespread trait. Habimana asserts that envy cannot be restricted to narcissistic personalities. He also explores the link between envy and maladjustments such as interpersonal conflict, low self-esteem, depression and criminal behavior, just to name a few. Envy is truly a cultural and social phenomenon.

Habimana also states that there are two types of envy: morally acceptable and morally reprehensible. Acceptable envy occurs when “an individual lacks what others have and either desires it, admires the persons envied or wishes to be like them.” This type of envy can be seen as motivating and healthy. The latter type of envy involves wanting to take what someone else has and is more malicious. So there are different types of envy and the trait of envy is not always a bad thing.

Envy in context

Like stubbornness, this trait should be viewed in the context of relationships. One scenario: A person engages in a relationship with someone they admire and idealize. This person begins to feel envious and then he or she sabotages the relationship. In psychotherapy, this dynamic can cause such envious patients to destroy a promising therapeutic relationship.

I could continue writing about the concept of envy till the end of time. It can be debated philosophically, psychologically, semantically, religiously and sociologically. The point I want to make is that if you find yourself being envious, don’t feel bad; you’re in good company. If you do feel like it is becoming a problem for you, it is a perfectly reasonable topic to discuss with someone close to you. whether it be a family member, friend or therapist.

References

1. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). Washington, DC: American Psychiatric Association; 2000.

2. Habimana, LE. Envy manifestations and personality disorders. European Psychiatry. 2000; 15:15-21.

3. Smith, R. What is the difference between envy and jealousy? Psychology Today.com; January 3, 2014.

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Why write about domestic abuse and violence in a mental health blog? Especially since these two behaviors are not caused by mental illness?

I write about domestic violence and abuse here because domestic violence and abuse can result in physical injury, psychological trauma and, in severe cases, even death. The devastating consequences of domestic violence can cross generations and last a lifetime. It is a problem at the societal, organizational and individual levels. Mental health, social service, law enforcement and correctional personnel see victims of domestic abuse and violence every day.

Defining domestic violence and abuse

Both are about systematically maintaining power and control in an intimate partnership with the intent of keeping someone from doing what they want to do, making them do something they do not want to do or making them afraid.

According to the National Coalition Against Domestic Violence (NCADV), domestic violence is an epidemic affecting individuals in every community, regardless of age, economic status, sexual orientation, gender, race, religion or nationality. Intimate partner violence is often accompanied by emotionally abusive and controlling behavior, which is only a fraction of a systematic pattern of dominance and control.

purple ribbon

Just how big a problem is it?

According to the NCADV,

  • On a typical day, there are more than 20,000 phone calls placed to domestic violence hotlines nationwide.
  • On average, nearly 20 people per minute are victims of physical violence by an intimate partner in the United States. During one year, this equates to more than 10 million women and men.
  • From a sociological perspective, conversations about women as perpetrators of these behaviors only distracts men from taking the level of responsibility required for their behavior and continues to condone violence and abuse by men against women. It is not to say those conversations are not important; it is just that they should not distract from men’s responsibility, and it is men’s job to see that they are not distracted.

The above numbers relate to physical abuse and physical violence. They do not take into account incidents of abuse and violence that do not inflict physical injury. They do not include behaviors such as economic and spiritual abuse, social isolation, intellectual and emotional abuse. From work with intimate partner violence victims and batterers, we have discovered that some form of these abusive behaviors have likely been occurring months or years before the hitting starts.

Domestic violence is not a one-time incident. It is the culmination of months, or years, of nonphysical abuse. The abuse is systematic and planned. It might be difficult to imagine this, yet in my five years of working with batterers in both group and individual settings, each individual was clear that his behavior was always designed to maintain and assert power and control.

Pro sports and domestic violence

Our culture has condoned the attitudes that allow abuse and violence to take place at all levels of society. The examples of this are numerous:

  • Jane McManus, an ESPN reporter, observed in a recent National Public Radio Show that NFL Commissioner “Roger Goodell, in 2014, should not have to be told to have a female in the room when discussing NFL policies regarding domestic violence.”
  • According to NPR, ESPN’s business model depends on pro sports. One of their reporters, Bill Simmons, was suspended for calling Roger Goodell “a liar” regarding the Ray Rice domestic violence investigation.
  • Katie Nolan, another ESPN reporter, observed in a YouTube vdieo that “Sports television has relegated women to helping out their male reporter counterparts, patrolling the sidelines for human interest stories and eye candy.” She goes on to note, “The NFL and pro sports will not respect women till the media does.”

This kind of disrespectful behavior toward women goes on at all levels in all parts of our society and creates fertile ground for abuse and violence toward those who have less status and power and are less able to protect themselves, especially women and children.

On the other hand, University of Texas head football coach Charlie Strong has five core values. They are honesty, treating women with respect, and no drugs, stealing or guns. He has dismissed nine players from the team this year, two after they were charged with violence against women.

How to help

Here are some things we can do to improve the mental health of our community, our partners, our children and maybe even ourselves:

  • Recognize domestic violence is every man’s responsibility to address.
  • Speak up — silence  condones violence.
  • Challenge the “good old boy network.”
  • Ask a woman how threats of violence impact her life — then be quiet and listen.
  • Think about how attitudes and language support abuse of women. When you see examples of this, ask a female friend or relative how they feel or what they think about those attitudes and language. Again, be quiet and listen.
  • Call 911 — domestic abuse is a crime, not only a family or personal matter.
  • Boycott places, ideas and media use degrading images of women or promote violence against women.
  • Talk to and teach your boys and young men about healthy relationships.
  • Get help if you have a problem with physical and emotional violence against women.
  • Join Men Against Violence Against Women.
  • Support anti-violence campaigns in your community.

The attitudes that support abuse and violence against women affect men as well and keep us all locked into predictable and ultimately harmful ways of thinking and behaving. As individuals and as a society, we have a long way to go to address this epidemic of violence and abuse. We can each help by doing one of the above. Think of it as helping keep your daughter or partner or mother or grandmother safe. It really is personal.

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Quiet: A Book for Introverts

by Jon G. Allen, PhD October 3, 2014

Being a prototypical introvert, I was drawn to Susan Cain’s popular book, Quiet: The power of introverts in a world that can’t stop talking. Cain’s subtitle could have been shorter: “In praise of introversion.” Sadly, her subtitle also could have been: “In defense of introversion.” The basic premise of her book: About a century ago, […]

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Is anomie the enemy? Another perspective on the increase of school shootings

by Hannah Szlyk, LMSW September 30, 2014

Anomie: the breakdown in the bond between the individual and community is evidenced when there is a discrepancy between the values and ideologies of society and what is achievable in normal life. This term, popularized by French sociologist Emile Durkheim in his 19th century book Suicide, was referenced in a discussion of the recent school […]

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We Are Becoming Less Violent

by Jon G. Allen, PhD September 25, 2014

Perhaps I can be forgiven for my pessimism about ameliorating the violent side of human nature. Like everyone else, I am assaulted on a daily basis by stories of violence, including war, genocide, terrorism, homicide, rape and child abuse. Compounding this routine assault, I have specialized in psychological trauma, which entails professional immersion in suffering […]

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Robin Williams and the Power of Suicide

by John Oldham, MD, MS August 13, 2014

For the last several days, we have been riveted by the tragic suicide of Robin Williams, a larger-than-life favorite on both the large and small screens. However much we know about the prevalence of depression and of suicide itself, we are still shocked when someone who feels so familiar chooses this way to disappear. Yes, […]

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Attempting suicide (and living to tell the story)

by Thomas Ellis, PsyD, ABPP June 2, 2014

I have been attending professional conferences for more than 30 years, so they have become rather predictable to me. Plenary sessions, research paper presentations, skills workshops: Sessions are generally informative, though sometimes deadly dull. That said, my experience at the 2014 conference of the American Association of Suicidology in Los Angeles a few weeks ago […]

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Speaking up and out to reduce the stigma of mental illness

by Nancy Trowbridge May 28, 2014

As a staunch advocate for eliminating the stigma surrounding mental illness and brain disorders, Menninger encourages conversation in our homes, our communities and our media outlets. So let me begin this conversation by offering kudos to the Houston Chronicle editorial writers for the May 19 admonishment “Low Blow” that said the tactic of leaking a […]

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Addict, junkie, pothead, crackhead, loser: Putting tired old labels to rest & challenging stigma

by Beth Eversole, LMSW, LCDC May 22, 2014

Labels play a large part in defining our experiences; they also play a role in stigmatization. Webster’s Dictionary defines stigma as “a mark of disgrace associated with a particular circumstance, quality, or person.” Just take the word “addict,” a common label for people who use substances. The mark of disgrace here is the label. Many […]

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