Wednesday, May 19, 2021

How Depression and Trauma Cast Multigenerational Shadows

 From Lit Hub:

Like thick curly hair, mental illness runs in my family. Psychosis and mood disorders, the two major groups of psychiatric classification, can both be found in the last three generations. Rumors and realities of institutionalization have been passed down my maternal line. My mum remembers the day when my grandmother, Renee, was taken away to a mental institution in the 1970s.

“That is one of my worst memories,” she told me over the phone in August 2017. “We didn’t know whether she was going to come back.”

Called High Royds, it was just one so-called asylum within a short van drive from their home in Thornton, a village just outside of Bradford in northwest England. But this memory is blurred in its details and may not have even happened. She was a child then and memories can be manufactured like nightmares. There’s no doubt that Renee struggled with depression, especially after her husband, Eric, my grandfather, died of lung cancer in 1975.

At a time when SSRIs like sertraline hadn’t yet been put into prescriptions, she was given diazepam (Valium) to calm her anxiety and dampen her grief. When at her worst, she described her mental anguish as “tearing down the wallpaper.” But no one else in the family remembers Renee being taken away for any period of time. The patient reports from High Royds, although incomplete with whole years missing, hold no trace of her. (Read more.)


The seed of suffering. From Aeon:

Since the publication of the DSM-III in 1980, psychiatric diagnosis has helped to select the right treatment for a person’s symptoms. It’s also made the tracking of diagnoses over time and space possible, a field known as ‘psychiatric epidemiology’. However, while these diagnostic guides might be useful for doctors who must make daily decisions about care and treatment, some critics argue that diagnostic systems have actually stymied the progress of psychiatry. While other specialities of medicine have drastically reduced mortality rates from heart disease, cancer and stroke, there haven’t been similar successes in mental healthcare. As a paper from 2013 put it, ‘mortality has not decreased for any mental illness, prevalence rates are similarly unchanged, there are no clinical tests for diagnosis, detection of disorders is delayed well beyond generally accepted onset of pathology, and there are no well-developed preventive interventions.’ In short, psychiatry appears stuck.

Perhaps it’s because the diagnostic system is faulty. Indeed, the fact that around half of patients with one mental disorder also fulfil the requirement for a second disorder has been well documented since the 1990s: major depression and generalised anxiety disorder (GAD), substance use disorders and attention deficit hyperactivity disorder (ADHD), bipolar disorder and schizophrenia. Either mental disorders really do tend to aggregate or, perhaps more likely and more worryingly, our classification system is drawing lines in unnatural places, carving nature far from its joints.

There’s an alternative approach. A growing troupe of scientists think that focusing on one or two diagnoses in a study – as is common in psychiatric research – has meant that the true nature of mental disorders remains hidden. To understand what are essentially brain disorders, they argue you have to zoom out. Considering the whole spectra of psychiatric possibility reveals similarities in symptoms, brain circuitry and genetics. Shaking off the shackles of diagnostic classification, there is growing evidence that all mental disorders are actually the product of a single underlying dimension, a common liability for psychopathology. Known as the ‘p-factor’, this theoretical concept brings the potential for important new ways to treat and prevent psychiatric disorders.

The p-factor also raises the question of whether Oliver and I are far more similar than a cursory glance at our symptoms might suggest. Perhaps we share the same underlying vulnerability, but certain life experiences have influenced the way it manifests. If my experiences had been different, perhaps the depression of my mid-20s could have emerged as psychosis in my late teens. And if all this is true, is it possible that Oliver’s and my experiences will merge in the future? (Read more.)


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