By Geoff Watts BBC World Service
Confronted with some of life’s upsetting experiences – marriage breakdown, unemployment, bereavement, failure of any kind – many people become depressed. But others don’t. Why is this?A person who goes through experiences like that and does not get depressed has a measure of what in the psychiatric trade is known as “resilience”.
Definition:
Resilience: The idea of an individual’s tendency to cope with stress. Resilience is a dynamic process whereby individuals exhibit positive behavioural adaptations when they encounter significant sources of stress.
http://en.wikipedia.org/wiki/Psychological_resilience
According to Manchester University psychologist Dr Rebecca Elliott, we are all situated somewhere on a sliding scale.
“At one end you have people who are very vulnerable. In the face of quite low stress, or none at all, they’ll develop a mental health problem,” she says.
“At the other end, you have people who life has dealt a quite appalling hand with all sorts of stressful experiences, and yet they remain positive and optimistic.” Most of us, she thinks, are somewhere in the middle.
But what is this resilience? Is it something we inherit or do we learn it? Can it be traced in the chemistry of the brain? Or in its wiring, or its electrical activity? And if we lack it, can we acquire it?
Note:
The term “resilience” is being used with a slightly variant meaning over here. Instead, what the researchers could be studying is “resiliency” and not “resilience”.
Definition:
Resiliency: The quality or set of qualities of an individual that lead(s) to the dynamic process known as resilience.
http://www.psychologytoday.com/blog/the-good-life/200903/resilience
The answer, regrettably, to all those questions is much the same. We don’t really know. But we’d like to, and we need to. According to the World Health Organization, depression affects just over 120 million people worldwide.
Note:
Studies that examine the relationship between an individual’s geographical location and the same individual’s risk of developing depression have arrived at mixed results; Whilst some reports show a positive correlation between level of urbanisation and the population’s predisposition to depression, others have reported no apparent differences between the two variables.
A study by Sundquist et al. (2004) reports that patients who live in densely populated areas were 12 to 20 percent more likely to be at risk of developing depression as compared to patients who lived in less densely populated areas.
“We think about a fifth of the UK population will suffer from depression at some point in their lifetime,” says Bill Deakin, professor of psychiatry at Manchester University. Worryingly, he adds that more people are getting depressed now than in the past, and that it is beginning to affect younger people.
Note:
The increased incidence of depression amongst the general population, “more people are getting depressed now than in the past”, could be due to factors such as increasing levels of urbanisation, better availability of mental health services, increased willingness to turn to mental health professionals for help, heightened tendency to diagnose an individual as depressed etc.
As mentioned above, a positive correlation might exist between the level of urbanisation and the population’s susceptibility to depression. If such a relationship were true, a causal link could be that individuals’ coping mechanisms to stressful situations are increasing less than proportionately as compared to the levels of stress that arise as a result of urbanisation. Schools may want to constantly review their curriculum to ensure that the population’s resiliency rises in tandem with the stress-levels in society. This parallels the author’s view that “finding some way to boost [resiliency] is an ambition well worth pursuing”, differing only in the sense that a cognitive approach, instead of a pharmacological one, “resilience pill”, is being suggested.
Improved availability of mental health services is also a possible cause of the higher incidence of depression among the general population. If the clinician-patient ratio is much smaller than unity then mental health professionals may be less willing to diagnose individuals with depression for fear of being overworked. With revisions to this ratio being made, mental health professionals are able to treat a larger number of patients as compared to before, thus leading to higher rate of diagnosis of depression in the population.
Increased willingness to turn to mental health professionals for timely assistance due to the dilution of stigma against depressed individuals or greater publicity for the disorder, by mental health campaigners, may also be factors contributing to the larger number of depressed individuals. In the local context, posters aimed at increasing awareness of depression among Singaporeans were put up all over the island in 2011 in an effort to promote mental well-being. More patients with depression could be a reflection of the efficacy of mental health campaigns and not a sign of increased levels of depression in a population.
Lastly, such a trend could be explained in terms of greater tendency of clinicians to diagnose patients as depressed as before. While advances have been made in the field of psychiatry to improve the accuracy of psychiatric diagnoses since the introduction of the DSM in 1952, psychiatrists and psychologists alike are still unable to effectively overcome the subjectivity of psychiatric diagnoses. Without an thorough standardisation of psychodiagnostic labels, difficulties will constantly arise in the interpretation of these epidemiological data.
It is also noteworthy that definitions of mental abnormality are constantly changing according to shifts in the statistical norm. The fact that depression is increasingly being diagnosed in our youth says little if revisions to the diagnosis of mood disorders (particularly depressive disorders in this context) to reflect changes in global or societal norms are not being made.
With the support of the Medical Research Council, Bill Deakin, Rebecca Elliott and their colleagues are peering into the brain, trying to fathom the origins and nature of resilience. They think that a better understanding of it might pay dividends in helping those who lack it.
The subjects of their study are a mixed bunch – intentionally so. Some have suffered bouts of depression, others have not. Some have had more than their share of adverse life events, while others have had an easier time of it.
In knowing where to start looking for the differences that might underpin resilience to depression the Manchester group has the advantage of being able to draw on previous work that has investigated resilience to post-traumatic stress disorder.
This, says Bill Deakin, has pointed them to several relevant features of brain function. They include cognitive flexibility – our capacity to adapt our thinking to different situations – and also the extent to which our brains concentrate on processing and remembering happy, as opposed to sad, information.
Definition:
Cognitive flexibility: The ability of an individual to switch his behavioural response according to the context of the situation.
http://en.wikipedia.org/wiki/Cognitive_flexibility
Note:
The image below illustrates the diathesis-stress model.
[Insert Image Here.]
According to the theory, an individual has a diathesis, or a predisposition, to certain mental abnormalities. Determinants of the individual’s diathesis are genetic, cognitive and environmental factors. Central to the model is the concept that an individual vulnerable to a particular mental disorder will develop the specific disorder if and only if sufficient stressors are present to trigger the onset of the abnormality. This point is marked by the “kink” along the vulnerable individual-curve in the diagram above. As the vulnerable individual’s environment/experience becomes less positive (i.e. his set of genetic, cognitive and environmental predispositions are increasingly unable to cope with the stressors he is encountering) there will come a point where environmental or experiential stressors exceed his coping capabilities and he “slides” down the curve and begins to experience increasingly negative outcomes. The extent of his mental abnormality is then determined by how negative his reaction, or outcome, to these stressors actually are.
According to the article, what previous investigations on resilience and post-traumatic stress disorder (PTSD) has shown is that cognitive flexibility and optimism yield a diathesis against the development of PTSD in individuals.
Emotional memory
Each subject in the Manchester study has been allocated to one of four groups based on the four possible combinations of high and low life stress, with or without depression. All have given saliva samples from which their stress hormone levels can be measured, and many of them will undergo a brain scan.
A scanning technique much used by brain researchers called functional magnetic resonance imaging allows them to see which parts of the brain are active while subjects are performing specific tasks.
“In one task we give them pictures to look at which are emotionally charged,” says Rebecca Elliot. “They have to memorise them.” Shortly afterward they’re shown these pictures again, with others, and have to identify those they’ve seen already. “This probes emotional memory – how well people remember material which has an emotional component to it.”
The research is not yet complete, so Rebecca Elliott can’t say whether there are distinct differences in brain function between the groups. But there are encouraging hints, such as the correlations she’s finding between the psychological measurements of her subjects’ resilience and how they perform on some of the tests.
“For example, our early data suggest that people who are more resilient are more likely to recognise happy faces and less likely to recognise sad or fearful faces. The more resilient someone is, the better they remember positive words and pictures.”
Note:
Early data suggests a relationship between an individual’s resilience and optimism.
This data resonates with the hypothesis that “the extent to which [an individual’s] brain concentrates on processing and remembering happy, as opposed to sad, information” is a determinant of the individual’s level of resilience when faced with depression, a postulate formulated through the study of previous research on resilience to post-traumatic stress disorder (PTSD).
Precisely how a clinician might eventually use whatever the Manchester research reveals about our brain activity is still an open question. What we refer to as resilience is the outcome of a complex and continuing set of interactions between our genes, our body chemistry, the wiring of our brains, and our life experiences.
But broadly speaking, the hope is that an understanding of the brain activity that underpins resilience might offer pointers towards new treatments, or better ways of using existing ones.
A resilience pill?
Bill Deakin talks of using brain scanning to create what he calls a “neuroscientific profile” of an individual’s problem. This might be used to identify relevant aims and goals in deciding on the best treatment.
A patient may turn out to have normally functioning cognitive flexibility but a tendency to dwell on sad thoughts. “This might allow you to tailor-make a therapy to reduce the likelihood of a further episode of depression,” says Deakin. In the first instance this would most likely be a talking therapy of some kind.
Responding to the suggestion that a drug, a daily “resilience pill”, tailored to our brain activity or chemistry might be a useful development, Rebecca Elliott is cautious. “I suppose this is something that would theoretically be possible,” she says. “Whether people would be willing to take that kind of drug, I’m not sure.”
But whatever the means, finding some way to boost resilience is an ambition well worth pursuing. To be assured of that you have only to compare Aeron’s experiences with those of Pauline, another of the Manchester research subjects.
While out of work, struggling financially, and single-handedly responsible for three children, Pauline had several bouts of depression during which she felt completely isolated. “And emotionally I was very detached. I would come in and sit on my bed and cry. And when it got so bad I didn’t want to be with the children, that’s when I went to the doctor.”
Note:
Pauline’s feeling of “isolation” may not have been completely imagined; patients who are suffering from depression may often lack social support. According to Klerman and Weissman (1986), patients with depression often find themselves trapped in a vicious cycle that reinforces their own negative views about themselves. These patients often make negative comments about themselves, making them particularly unpleasant to be around with. As a consequence, interpersonal relationships are strained and those around them subsequently withdraw from these patients and/or fail to initiate social support with these patients. This further reinforces the individuals’ negative concept of themselves.
Negative Concept of Self > Strained Interpersonal Relationship > Loss of Social Support > Reinforced Negative Concept of Self
Legend –
> : Leads to
No clinician can yet prescribe what she most needs – resilience. But one day… maybe.
The original article can be found here – http://www.bbc.co.uk/news/magazine-16749565
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