Professional Documents
Culture Documents
482 Session 8
Depression? Insanity?
Why?
Depression? Insanity?
Agenda
Violent behaviors, stress and inequality Mental modes High rates of significant mental illness in the US and responses, social aspects Rank differences and substance use Triune brain evolution Depression
Age distribution and overall rates of homicide: England and Wales compared with Chicago. (age and sex of perpetrator)
Source: Cronin H.
Age distribution and overall rates of homicide: England and Wales compared with Chicago. (age and sex of perpetrator)
Source: Cronin H.
Gilligan, Violence
Whites
http://www.prisonexp.org/
As we learn more about the neurobiology of normal and pathological human behavior, a challenge for society will be to use this knowledge to effectively guide public policy. For example, as we understand the neurobiological substrates that underlie voluntary actions, how will society define the boundaries of personal responsibility in those individuals who have impairments in these brain circuits? This will have implications not only for the management of drug offenders, but also of other offenders with diagnoses such as antisocial personality disorder or conduct disorder. At present, critics of the medical model of addiction argue that this model removes the responsibility of the addicted individual from his/her behavior.However, the value of the medical model of addiction as a public policy guide is not to excuse the behavior of the addicted individual, but to provide a framework to understand it and to treat it more effectively.
Appeasement transformed to reassuring,conciliatory gestures between mutually dependent individuals In moments of excitement, arousal level of individual is low (hedonic condition - chimpanzees, bonobos) Absence of fear of punishment characterizes relationship between individuals Have time for integration of reality, inter-personal relations and private feelings and thoughts, leads to systems-forming faculty (distinctly human, e.g. chess) Extensively studied in children in playgroups where (hedonic) leader type children do not escalate threat into aggression, but initiate play and cooperation contrast with agonistic
12 mo nth p re val en ce of DSM di so rd ers Americas An xi ety Co lomb ia 10 Mexico 6.8 United States 18 .2 Europe Be lgi um 6.9 Fran ce 12 German y 6.2 Ita ly 5.8 Ne the rl an ds 8.8 Sp ain 5.9 Ukra in e 7.1 Middle Eas t and Africa Le ban on 11 .2 Ni geri a 3.3 As ia Ja pan 5.3 Pe opl es Re publ i c of Chi na Be ij in g 3.2 Sh angh ai 2.4
Moo d 6.8 4.8 9.6 6.2 8.5 3.6 3.8 6.9 4.9 9.1 6.6 0.8 3.1 2.5 1.7
Impul se -Control 3.9 1.3 6.8 1 1.4 0.3 0.3 1.3 0.5 3.2 1.7 0 1 2.6 0.7
Su bstan ce 2.8 2.5 3.8 1.2 0.7 1.1 0.1 3 0.3 6.4 1.3 0.8 1.7 2.6 0.5
Se ri ous 5.2 3.7 7.7 2.4 2.7 1.2 1 2.3 1 4.8 4.6 0.4 1.5 0.9 1.1
Mental Illness
MORE EQUALITY
Triune Brain
Reptilian brain (R-complex) - evolved in reptilian ancestors 300 million years ago, shared with all vertebrates, and little changed - contains nuclei vital to maintaining life (CV, resp.), the basal ganglia - no emotions or cognition of future or past events Behavioral responses are governed by instinct and relatively automatic - territorial acquisition, defense, dominance, striving, agonistic threat displays, mating
Triune Brain
Paleo-mammalian brain (paleocortex) subcortical structures -limbic system (dopamine) -hippocampus, hypothalamus, thalamus, pituitary gland homeostatic mechanisms control via hormone levels (HPA) Balances - hunger versus satiation - sexual desire against gratification - thirst against fluid retention - sleep against wakefulness Emotions addressed: - fear, anger - love, attachment, bonding, mating, caring (oxytocin)
Triune Brain
Paleocortex behavioral differences from reptiles: - nursing and maternal care - audio-vocal communication for maintaining motheroffspring contact - separation call to maintain mother-offspring proximity (baby crying) Play hedonic - evolved to promote group harmony and affiliation - conscious awareness present, - behavior less rigidly determined by instincts Complex organ controlling basic psychophysical responses and attitudes to environment
Triune Brain
Neocortex (neo-mammalian) - cognition and sophisticated perceptual processes
as opposed to instinctive and affective behavior
- monkeys and apes have brains twice as large as those of typical mammal of equivalent body size Neocortex ratio (ratio of this part of the brain to the rest of the brain is related to group size among animals Neocortex is the social organ (absence of neocortex in pre-frontal leukotomy -puppy dog)
Adult human brain 2% of body weight, but consumes 20% of total energy intake ($$$) Purpose of such a large substrate needing organ -because we have a big body? -solve complex problems of food acquisition (frugivory vs folivory), navigating to find it? -demands of complex social systems? Why does the fetus develop such a large brain making birthing difficult? Humans evolved a large body to carry on energetic costs of feeding a large brain, and especially to provide for fetal development?
Attachment
Secure
Same eyes Strangers Synchrony Rhythm
Anxious
Different eyes
Disorganized
Too many or no eyes Frightened or frightening
Comfortable Uncomfortable Pair bonding Ambivalent with primary Or avoidant caregiver Anxious, less adapted Behavioral & other problems
Rose 2004
Rose 2004
In major depression, rates of antidepressant prescribing were 53%, 76%, and 31% for SPs making brand-specific, general, and no requests In adjustment disorder, antidepressant prescribing rates were 55%, 39%, and 10%, respectively Minimally acceptable initial care (any combination of an antidepressant, mental health referral, or follow-up within 2 weeks) was offered to 98% of SPs in the major depression role making a general request, 90% of those making a brand-specific request, and 56% of those making no request
All
Rose 2004
Rose 2004
Olfson 2006
Psychopharmacracy in Children
Social Position
Childhood and early influences Occupational status
Education
Income, wealth
Common mental disorders (neurotic conditions)
Physical illness Stressful life events Lack of supportive social networks Work circumstances Other known factors
Melzer 2004