CHAPTER EIGHT
MOOD DISORDERS AND SUICIDE
Learning Objectives
1. Describe the features of major depressive disorder and dysthymic disorder and distinguish
between them.
2. Discuss the prevalence of major depressive disorder, with particular attention to ethnic and
gender risk factors.
3. Discuss seasonal affective disorder and postpartum depression.
4. Describe the features of bipolar disorder and cyclothymic disorder and distinguish between
them.
5. Discuss the relationship between stress and mood disorders.
6. Discuss the psychodynamic, humanistic, learning, cognitive, and biological perspectives on
the origins and treatment of mood disorders.
7. Discuss the incidence of suicide and theoretical perspectives on its causes.
Chapter Outline
I. Types of Mood Disorders
A.
B.
C.
D.
Major Depressive Disorder
Dysthymic Disorder
Bipolar Disorder
Cyclothymic Disorder
II. Causal Factors in Depressive Disorders
A.
B.
C.
D.
E.
F.
G.
Stress and Depression
Psychodynamic Theories
Humanistic Theories
Learning Theories
Cognitive Theories
Learned Helplessness (Attributional) Theory
Biological Factors
III. Causal Factors in Bipolar Disorders
IV. Treatment of Mood Disorders
A. Treating Depression
B. Treating Bipolar Disorder
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V. Suicide
A.
B.
C.
D.
Who Commits Suicide?
Why Do People Commit Suicide?
Theoretical Perspectives on Suicide
Predicting Suicide
VI. Summing Up
Chapter Overview
Types of Mood Disorders
Mood disorders are disturbances in mood that are serious enough to impair daily functioning.
There are various kinds of mood disorders, including depressive (unipolar) disorders, such as
major depression and dysthymic disorder, and disorders involving mood swings, such as bipolar
disorder and cyclothymic disorder.
People with major depressive disorder experience profound changes in mood that impair their
ability to function. There are many associated features of major depression, including depressed
mood, changes in appetite, difficulty sleeping, reduced sense of pleasure in formerly enjoyable
activities, feelings of fatigue or loss of energy, sense of worthlessness, excessive or misplaced
guilt, difficulties concentrating, thinking clearly or making decisions, repeated thoughts of death
or suicide, attempts at suicide, or even psychotic behaviors (hallucinations and delusions). About
twice as many women as men seem to be affected by major depression, but the reasons for this
gender difference remain unclear. Depression can begin or recur at any age, but the risk of initial
onset of depression is age related. Major depression has been increasing worldwide.
Dysthymic disorder is a form of chronic depression that is milder than major depression but may,
nevertheless, be associated with impaired functioning in social and occupational roles.
There are two general types of bipolar disorders: bipolar I disorder and bipolar II disorder.
Bipolar I disorder is identified by the occurrence of one or more manic episodes, which
generally, but not necessarily, occur in persons who have experienced major depressive episodes.
In bipolar II disorder, depressive episodes occur along with hypomanic episodes, but without the
occurrence of full-blown manic episodes. Manic episodes are characterized by sudden elevation
or expansion of mood and sense of self-importance, feelings of almost boundless energy,
hyperactivity, and extreme sociability, which often takes a demanding and overbearing form.
People in manic episodes tend to exhibit pressured or rapid speech, rapid "flight of ideas," and
decreased need for sleep.
Cyclothymic disorder is a type of bipolar disorder characterized by a chronic pattern of mild
mood swings and sometimes progresses to bipolar disorder.
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Theoretical Perspectives
In classic psychodynamic theory, depression is viewed in terms of inward-directed anger. People
who hold strongly ambivalent feelings toward people they have lost, or whose loss is threatened,
may direct unresolved anger toward the inward representations of these people they have
incorporated or introjected within themselves, producing self-loathing and depression. Bipolar
disorder is understood within psychodynamic theory in terms of the shifting balances between
the ego and superego. More recent psychodynamic models, such as the self-focusing model,
incorporate both psychodynamic and cognitive aspects in explaining depression in terms of the
continued pursuit of lost love objects or goals that would be more adaptive to surrender.
In the humanistic framework, feelings of depression reflect the lack of meaning and authenticity
in the person's life.
Learning perspectives focus on situational factors in explaining depression, such as changes in
the level of reinforcement. When reinforcement is reduced, the person may feel unmotivated and
depressed, which can lead to inactivity and further reduction in opportunities for reinforcement.
Coyne's interactional theory focuses on the negative family interactions that can lead family
members of depressed people to become less reinforcing to them.
Beck's cognitive theory focuses on the role of negative or distorted thinking in depression.
Depression-prone people hold negative beliefs toward themselves, the environment, and the
future. This cognitive triad of depression leads to specific errors in thinking, or cognitive
distortions, in response to negative events, that in turn, lead to depression. The learned
helplessness model is based on the belief that people may become depressed when they come to
view themselves as helpless to control the reinforcements in the environment or to change their
lives for the better. A reformulated version of the theory held that the ways in which people
explain events – their attributions – determine their proneness toward depression in the face of
negative events. The combination of internal, global, and stable attributions for negative events
renders one most vulnerable to depression.
Genetics appears to play a role in mood disorders, especially in explaining major depressive
disorder and bipolar disorder. Imbalances in the neurotransmitter activity in the brain appear to
be involved in depression and mania. The diathesis-stress model is used as an explanatory
framework to illustrate how biological or psychological diatheses may interact with stress in the
development of depression.
Treatment of Mood Disorders
Psychodynamic treatment of depression has traditionally focused on helping the depressed
person uncover and work through ambivalent feelings toward the lost object, thereby lessening
the anger directed inward. Modern psychodynamic approaches tend to be more direct and briefer
and focus on developing more adaptive means of achieving self-worth and resolving
interpersonal conflicts.
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Learning theory approaches have focused on helping people with depression increase the
frequency of reinforcement in their lives through such means as increasing the rates of pleasant
activities in which they participate and assisting them in developing more effective social skills
to increase their ability to obtain social reinforcements from others.
Cognitive therapists focus on helping depressed people identify and correct distorted or
dysfunctional thoughts and learn more adaptive behaviors.
Biological approaches have focused on the use of antidepressant drugs and other biological
treatments, such as electroconvulsive therapy (ECT). Antidepressant drugs appear to increase the
levels of neurotransmitters in the brain. Bipolar disorder is commonly treated with lithium.
Suicide
Mood disorders are often linked to suicide. Although women are more likely to attempt suicide,
more men actually succeed, probably because they select more lethal means. The elderly, not the
young, are more likely to commit suicide, and the rate of suicide among the elderly appears to be
increasing. People who attempt suicide are often depressed, but they are generally in touch with
reality. They may, however, lack effective problem-solving skills and see no way to deal with
their life stress other than suicide.
Lecture and Discussion Suggestions
1. Interpersonal aspects of depression. Our interactions with others may be an important
factor in the onset and management of depression. Especially helpful here is James Coyne's
interactional theory, described in this chapter. According to this view, people who are depressed
affect and are affected by their interactions with loved ones. Basically, Coyne holds that living
with a depressed person can become so stressful that this person's partner or family become less
supportive over time toward the depressed person. Initially the depressed person may succeed in
eliciting support from others. However, over time, the depressed person's demands evoke
feelings of annoyance, anger, and eventually aversive reactions. The depressed person may then
react to rejection by becoming more demanding, which results in further rejection and
withdrawal of positive reinforcement in vicious cycles. Consequently, the depressed person
becomes more depressed and family members living with the person also experience higher
stress and depression. Coyne found that as many as 40 percent of family members of depressed
people were sufficiently depressed as to need therapeutic intervention; however, there may be
other contributing factors such as genetic and environmental overlap as well as selection-bias in
choosing friends and mates. This theory has important implications for managing depression,
including modifying the depressed person's demands for support and helping family members to
sustain realistic but helpful levels of reinforcement.
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2. Beck's cognitive approach to depression. Aaron Beck's cognitive theory of depression
holds that people who adopt a habitual style of negative thinking are more likely to become
depressed. The cognitive triad of depression, described in this chapter, involves the adoption of
negative thinking about oneself ("I'm no good"), the environment ("school is awful"), and the
future ("nothing will ever turn out right for me"). Early learning experiences are believed to play
a major role in shaping these negative attitudes. Once adopted, however, such habitual negative
thinking is manifested in "automatic thoughts," or cognitive distortions, such as all or nothing
thinking, overgeneralization, and disqualifying the positive. These spontaneous cognitive
distortions then sensitize people to interpret any disappointment or failure as a total defeat, which
then leads to depression. Therapeutic intervention includes helping depressed persons to identify
their particular pattern of cognitive distortions and modify them accordingly. Drs. Aaron and
Judith Beck have several training videos on using cognitive behavioral therapy to treat
depression. Discuss Dr. Beck’s theory while interspersing video segments that demonstrate key
aspects of the treatment protocol, how it links to Dr. Beck’s theory, and why it is effective in
treating symptoms of depression.
3. Exercise and depression. Many studies have shown a link between regular physical exercise
and the alleviation of depression. People who exercise regularly are less depressed. But, it works
the other way too, so that people who are more depressed simply exercise less. In order to
demonstrate a causal link between exercise and depression, Lisa McCann and David Holmes
("Influence of aerobic exercise on depression," Journal of Personality and Social Psychology,
1984, 46, p. 1142-1147) performed an experiment with college women at the University of
Kansas. Students were randomly assigned, either to an exercise group, involving running and
aerobic exercise, or to a control group, which involved no exercise. Results showed that only the
students in the exercise group became markedly less depressed, but it is not clear how or why
exercise alleviates depression. Some explanations focus on the changes in body and brain
chemistry, such as the rising levels of endorphins in the blood during exercise. Other
explanations stress the sense of mastery over one's body gained through exercise, which may
also contribute to a greater sense of personal control over other aspects of one's life. In a recent
exploration of the link between depression and exercise, Drs. Ruth L. Hall and Carole A.
Oglesby find support for the benefit of integrating exercise, sports, and therapy in treating
women with depression in their book, Exercise and Sport in Feminist Therapy: Constructing
Modalities and Assessing Outcomes (2003; The Haworth Press, Inc. and a monograph published
simultaneously as Women & Therapy, Vol. 25, No. 2.)
4. Getting rid of "the blues." Ask students what they do to get rid of "the blues." Everyone
has an occasional "down" day. Ask students to share their strategies for shaking off such moods.
How successful are these strategies? How many of the activities they describe are listed in the
Pleasant Events Schedule in the text? How can they tell "the blues" from a more serious
depression?
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5. Depression and politics. Invite students to discuss their feelings about having a presidential
or vice presidential candidate who has been treated for depression. When there was a public
disclosure that Senator Thomas Eagleton, a democratic candidate for vice president in the 1972
election, had been given electroconvulsive for depression, his name was reluctantly withdrawn
due to the uproar that followed the disclosure. Was Eagleton treated fairly? Should we make
treatment available and then effectively punish public figures who choose to get treated? Does
suffering from a mood disorder or other mental illness once mean that one is never qualified for
public office thereafter?
6. Postpartum depression. Postpartum mood changes attendant upon childbirth can reach the
level of depression and even psychosis in some women. In these situations the woman can
present a danger to herself as well as her newborn child. Invite students to analyze postpartum
depression according to the major perspectives presented in the text: psychodynamic, learning,
cognitive, interactional, humanistic existential, and biological.
For example:
Is the new mother re-experiencing unresolved childhood conflicts?
Has she learned that some reinforcers are contingent upon the role
of depressed person? Are certain distorted cognitions playing a
part in her disorder? Or, is it primarily a result of hormonal changes
that occur after childbirth? How might postpartum depression be
viewed from the interactional perspective?
7. Depression and children. The Journal of the American Academy of Child and Adolescent
Psychiatry, 1992, 31) devotes several articles to various aspects of the occurrence of mood
disorders in children and adolescents. Of special interest is an article by Weissman, Fendrich,
Warner, and Wickramaratne titled "Incidence of Psychiatric Disorder in Offspring at High and
Low Risk for Depression."
Of the 174 children in the study, 121 were offspring of 1 or more depressed parents. In a 2-year
longitudinal study, first onsets of suicide attempts and psychiatric disorders in these children
were determined. Of the children of depressed parents, 7.8 percent reported making at least one
suicide attempt in their lives, while 1.4 percent of non-depressed parents' children made an
attempt. All of the cases of major depression (10) and anxiety disorder (8) occurred in children
of depressed parents. Incidence of substance abuse did not differ for the two groups. Conduct
disorder rates were higher among the children of depressed parents, but not significantly so. The
cumulative probability by age 20 for the children of depressed parents that they will report
having a major depression is over 50 percent.
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What implications can students draw from these results about the occurrence of mood disorders
in children? Would periodic assessment of children at some risk for depression due to their
parents' depression be ethical? The federal law mandating early childhood intervention for
children at risk, PL 99-457, makes provision for family-centered and family-sensitive assessment
for children at risk for many disorders. Do students feel that a case could be made for early
intervention and assessment for something like depression? What could go wrong with an effort
at massive intervention like this?
8. Gender and depression. There have been many different explanations for the higher
incidents of depression in women versus men. Susan Nolen Hoeksema (1987) offers an excellent
review of these theories, and then offers her own. She believes that we all get depressed at times,
but that the genders react to these depressions in different ways. Men try to distract themselves,
such as by playing a sport, taking drugs, or doing physical work. Women, on the other hand, are
less active in their response. They ruminate more about the causes of their depression. NolenHoeksema believes it is this rumination that leads to helpless feelings, remembering of sad
things, and self-blame. This tendency to think and ruminate is possibly socialized early in life.
This theory suggests that women might respond to depression by engaging in pleasant activities
and other (non-drug taking) distractions as a way to fight the mild depressions we all experience.
Nolen-Hoeksema, S. (1987) "Sex differences in unipolar depression: Evidence and theory."
Psychological Bulletin, 101, 259-282.
9. Suicide on TV. Many studies suggest that suicide rates increase following depiction of
suicide in the media. These findings have raised public concern about imitation effects. We
might hypothesize that youths would be particularly prone to such effect, and indeed, some
research has demonstrated an increase in imitative youth suicides following both news stories of
suicide and television movies about suicide. However, more recent evidence raises doubt about
the suggested negative effects of depicting suicide on TV.
Berman (American Journal of Psychiatry, 1988, 145, 982-986) reviewed research on youth
suicide following made-for-television movies depicting suicide, and conducted a study to
improve methodological problems identified in previous research. The re-analysis found a
significant decrease in the number of suicides following the broadcast of three films depicting
suicide in 1985 and 1986. The decrease was nonsignificant for those age 24 or younger.
However, the findings suggested that films which depict a specific method of committing suicide
may result in selection of that method over other methods in subsequent suicides. The authors
conclude that a complex interplay of the person, the stimulus, and the environment affect the
impact of media suicide, and further suggest that beneficial effects of the depiction of suicide
cannot be ruled out.
Show the PBS film, The Silent Epidemic: Teen Suicide, and discuss factors unique to teens and
suicide. Given the proximity in age between high school and many college students, ask them to
comment on the fear of imitation effects and copycat suicides.
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10. Is depression contagious? What is it like to be around depressed people? Many experts
believe it exacts a toll on families of those seriously depressed. James Coyne's interactional
theory is concerned with this effect. In an early, study he had college students talk on the phone
to a seriously depressed person who was under treatment for that problem. After only a few
minutes, the students experienced various negative feelings, including depression, anxiety, and
hostility. In a later study, students spoke to a person who was only mildly depressed.
Nevertheless, the conversation provoked the same negative feelings reported in the first study.
Along with the lower mood, subjects in these studies also tended to devalue or reject the
depressed people they talked to.
All of this suggests that depression and social rejection is a two-way street. Sometimes being
rejected is depressing; other times being depressed induces rejection by depressing others. As
Coyne suggests, depression is not just a problem within the person who has it. It elicits social
reaction, which, in turn, can aggravate the depression.
Solicit your student's reactions to Coyne's idea. Does it fit with their experiences?
Coyne, J. C., Kessler, R. C., Tal, M., Turnball, J., Wortman, C. B., & Greden, J. F. (1987).
"Living with a depressed person." Journal of Consulting and Clinical Psychology,
55, 347-352.
11. Are anxiety and depression the same thing? Now that you have covered both anxiety and
mood disorders, it is useful to remind the class how similar these are. For instance, tests of
anxiety and depression typically correlate moderately to strongly with each other. How are
depression and anxiety alike or different? Leanna Clark and David Watson are among those who
cite the broad personality dimensions of positive affectivity (PA) and negative affectivity (NA)
as explanatory factors. PA is the tendency to experience positive moods, such as feeling cheerful
or proud. NA is the tendency to experience anxiety, anger, and other negative moods. Each of us
differs in the relative levels of these two tendencies, and PA and NA are uncorrelated across
people. Clark and Watson believe that high NA characterizes both anxiety and depression. This
no doubt accounts for the high intercorrelation of tests of those two constructs. The difference
comes in that depression is related to low levels of PA, while anxiety is not. Anxiety is marked
more by physiological arousal rather than low PA. This is seen in the clinical world, where many
patients seem to have an equal mix of anxiety and depression, while others have a high degree of
one and at least some of the other. So, anxiety and depression are alike, but they are also
different.
Clark, L. A. & Watson, D. (1991). "Tripartite model of anxiety and depression: Psychometric
evidence and taxonomic implications." Journal of Abnormal Psychology, 100,
316-336.
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12. Warning signs of suicide. Discuss the warning signs of suicide. Some of the classic signs of
suicide are expression of suicidal thoughts, prior suicide attempts, giving away prized
possessions, intense depression over broken relationships, despair over a chronic illness or
problem, change in eating or sleeping habits, marked personality change, abuse or increased
abuse, of alcohol or drugs, a sense of helplessness and hopelessness, veiled warnings or hints that
the person might not be around much longer, and increased withdrawal and isolation.
In discussing this, you should also discuss with students what to do if they see the warning signs
in a friend or loved one and suspect that the person is thinking about attempting suicide. The "A
Closer Look: Suicide Prevention" box in this chapter provides a good basic outline of the things
to do when faced with such a situation.
13. Suicide and its effects. The effects of suicide on those in a relationship with the person who
dies are complex, involving both pain and anger. Brent and colleagues interviewed 58 adolescent
friends and acquaintances of 10 adolescent suicide victims six months after their deaths. The
study found that exposure to suicide was "clearly associated with significant psychiatric
sequelae, namely major depression and symptoms of PTSD (p. 636)." The evidence showed no
imitation of suicidal behavior. In fact, suicides seemed to act to make the friends less inclined to
it. The most common sequela was major depression, which was found to be correlated with
severity of grief. The depression and grief were both correlated with closeness of relationship to
the victim.
Brent, D. A., Perper, J., Moritz, G., Allman, C., Friend, A., Schweers, J., Roth, C., Balach, L., &
Harrington, K. (1992). "Psychiatric effects of exposure to suicide among the friends and
acquaintances of adolescent suicide victims.” Journal of the American Academy of
Child and Adolescent Psychiatry, 31, 629-640.
14. Clinical, ethical, and philosophical issues in handling suicide. The topic of suicide is
likely to raise personal issues in any classroom; the odds are that at least one person in an
average class has had a personal experience with a friend or relative attempting or committing
suicide, or perhaps personally grappling with suicidal ideas. In regards to discussion topic #2
(above), you might point out that psychiatrist Thomas Szasz views suicide as a fundamental
right, in a manner not too different philosophically from the position claimed by Dr. Jack
Kervorkian. Szasz believes that responsibility for a decision to commit suicide rests squarely in
the hands of the patient, not the therapist or caregiver. He opposes the use of coercive means in
preventing suicide in adults. While Szasz has not gone so far as Dr. Kervorkian to the point of
actually assisting in a patient's suicide attempt, he stakes out philosophical ground that is only
one step away from such action.
Ask students what they think of Szasz's and Kervorkian's ideas and actions. What are the pros
and cons of our current laws and ethical rules regarding suicide? What are the pros and cons of
Szasz's approach or Kervorkian's approach? Talk about Kervorkian’s conviction and recent
release from prison for his actions? What responsibilities do mental health professionals have in
preventing suicide? Can they ethically support a "pro-suicide" position?
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Think About It
How do clinicians distinguish between normal variations in mood and mood disorders?
Feeling down or depressed is not abnormal in the context of depressing events or circumstances.
But, people with mood disorders experience disturbances in mood that are unusually severe or
prolonged and impair their ability to function in meeting their normal responsibilities. Some
people become severely depressed even when things seem to be going well. Still others
experience extreme mood swings from incredible highs to abysmal lows. For most of us, mood
changes pass quickly or are not severe enough to interfere with our lifestyle or ability to
function. People with mood disorders have mood changes that are more severe or prolonged and
affect daily functioning.
“Women are just naturally more inclined to depression than men.” Do you agree or
disagree? Explain your answer. Students should be familiar with gender differences in the
incidence and prevalence rates of depression. Encourage them to 1) maintain a skeptical attitude,
2) consider the definitions of the terms, 3) weigh the assumptions or promises on which
arguments are based, 4) bear in mind that correlation is not causation, 5) consider the kinds of
evidence on which conclusions are based, 6) do not oversimplify, 7) do not over generalize.
Why is it difficult to distinguish between cyclothymic and bipolar disorder? Cyclothymia
and bipolar disorders are similar in that both involve abnormal mood swings. The boundaries
between bipolar and cyclothymic disorder are not clearly established. Some forms of
cyclothymic disorder may represent a mild, early type of bipolar disorder. Approximately 33
percent of people with cyclothymic disorder eventually develop bipolar disorder. We presently
lack the ability to distinguish between people with cyclothymia who are likely to eventually
develop bipolar disorder.
Which of the cognitive distortions, if any, that are listed in the text characterize your way
of thinking about disappointing experiences in your life? What were the effects of these
thought patterns on your mood? How did they affect your feelings about yourself? How
might you change these ways of thinking in the future? This is a personal experience
question. Students need to be familiar with the different cognitive distortions as outlined in the
text.
What evidence supports a genetic contribution to mood disorders? Is genetics solely
responsible? Why or why not? Evidence has accumulated pointing to the important role of
biological factors, especially genetics and neurotransmitter functioning, in the development of
mood disorders. We know mood disorders, especially bipolar disorders, tend to run in families.
Twin studies and adoptive studies contribute evidence to the idea of genetic contribution with
high concordance rates. However, genetics isn’t the only determinant. Moreover, genetics may
not be the most important determinant. Environmental factors, such as exposure to stressful life
events, appear to play at least as great a role – if not a greater role – than genetics.
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Jonathan becomes clinically depressed after losing his job and his girlfriend. Based on
your review of the different theoretical perspectives on depression, explain how these losses
may have figured in Jonathan’s depression. Depression and other mood disorders involve the
interplay of multiple factors. Consistent with the diathesis-stress model, depression may reflect
an interaction of biological factors, psychological factors, and social/environmental stressors. In
Jonathan’s case, certainly environmental and social factors come into play with the loss of both
his girlfriend and job. He may be biologically at risk for depression from his family background.
Certainly genetics and brain chemistry can be a factor. Finally, Jonathan may be psychologically
at risk. If he engages in cognitive distortions or has a sense of learned helplessness, depression
can occur.
If you were to become clinically depressed, which course of treatment would you prefer-medication, psychotherapy, or a combination? This is a personal opinion question. Students
need to know the different treatments available and the pros and cons of each. End with an
emphasis on the effectiveness of combining both medication and psychotherapy for stable longterm improvement.
What factors are related to suicide and suicide prevention? Did your reading of the text
change your ideas about how you might deal with a suicidal threat by a friend or loved
one? If so, how? This is a personal experience question. Students should know the facts
relating to suicide and suicide prevention.
Activities/Demonstrations
1. Cognitive distortions. Ask students to select approximately six negative thoughts they
engage in from time to time. If they find it difficult to recall any, have them choose some
representative thoughts listed in table 8.5 in the text. Once they have chosen some characteristic
negative thoughts, have them identify the kind of cognitive distortion each thought represents
along with a rational response (see below).
Automatic Thought
Cognitive Distortion
Rational Response
"I rarely succeed at
anything"
Overgeneralization
"Sometimes I succeed,
sometimes I don't"
You might have students write a brief one-page reaction paper, telling what they have learned
from doing this exercise and how they can utilize these strategies in the future.
2. The “Are You Depressed?” Scale. Have students fill out the “Are you Depressed?” scale in
the text. Since students with high scores may feel embarrassed about revealing their scores, you
might have them write their scores anonymously on a slip of paper and collect the slips from
them. Scan through the slips and see what the scores are. Often, the scores will average much
higher than students might expect. This can lead to a discussion of what types of things are
causing depression among students and what are the various ways they can cope or get help.
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Video Resources
Prentice Hall Videos
ABC News/PH-Library #1: New Mother's Nightmare (20/20, 8/2/91, 15:31). Explores
the prevalence and effects of postpartum depression on mothers of newborns.
ABC News/Ph-Library #1: Desperate for Light (ABC News Series, 1988, 11 min.).
Describes cases of seasonal affective disorder.
ABC News/PH-Library #1: Depression: Beyond the Darkness (ABC News Series,
47 min.). Describes several cases of clinical depression and treatment approaches,
including talk therapy, antidepressant medication, and ECT .
ABC News/PH-Library # 2: The Only Way Out -- Teen Suicide in NH Town (Day
One, 2/28/94). Explores the causes and effects of five teen suicides in the town of
Goffstown, New Hampshire.
ABC News/PH-Library #2: American Agenda -- Prozac (World News Tonight with
Peter Jennings, 1/4/94). Explores problems related to the over prescription of
Prozac.
ABC News/PH-Library #2: Beating Depression (Nightline, 3/17/94). Case study of how
ABC News Washington bureau chief George Watson was treated for depression.
Patients as Educators, Case #3 -- Helen, Major Depression (14:05). Case study of
an 83-year-old female who has suffered depression since childhood and who still
keeps a potentially lethal supply of sleeping capsules with her.
Other Videos
Beck's Cognitive Therapy, Part of the "Three Approaches to Psychotherapy" series, 42 min.
color (Psychological Films, Inc.). Aaron Beck explains and demonstrates his cognitive
therapy with a depressed client.
Biochemistry of Depression, 29 min. color (CM). Presents a wide range of technical
material relating to the biochemical underpinnings of depression.
Depression, 19 min. color (Films for the Humanities and Sciences). Explains the difference
between occasional and realistically motivated mood changes and depression.
Depression, 59 min. color (Kent State Univ.). Follows the lives of people suffering from
depression or bipolar disorder, and includes a discussion of the causes of depression
and suicide risks.
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Depression: A Study in Abnormal Behavior, 26 min. color (CRM/McGraw-Hill Films).
Follows a young teacher and homemaker through her depression and includes
various approaches to treatment, including hospitalization.
Depression: Biology of the Blues, 26 min. color (Films for the Humanities and Sciences).
Focuses on the biological causes of depression.
Depression: Recognizing It and Treating It, 42 min. color (Human Relations Media). An
overview of the treatment of depression, including psychodynamic, cognitive, and
biochemical approaches.
Depression: The Shadowed Valley, 57 min. color (IU). An overview of the various forms of
depression, including suicide as the extreme form, and various treatment approaches.
Depression and Suicide: You Can Turn Bad Feelings into Good Ones, 26 min. color
(PCR). Explores some of the causes of depression in teenagers and ways to prevent
feelings related to depression from becoming overwhelming.
Do I Really Want to Die? 31 min. color (Polymorph Films). Shows a series of interviews
with people who have attempted suicide.
Dying to be Heard: Is Anybody Listening? 25 min. color (Films for the Humanities and
Sciences). Offers specific advice on how to recognize suicide warning signs in teens
and how to intervene successfully.
Gifted Adolescents and Suicide, 26 min. color (Films for the Humanities and Sciences).
Specially adapted Phil Donahue program focusing on two couples who lost gifted
17-year-old children to suicide.
Grief Therapy, 19 min. color (Carousel Films). A therapeutic interview with a woman who
lost her mother and daughter in a fire.
Mysteries of the Mind, 58 min. color (Films for the Humanities and Sciences). Explores
bipolar disorder, obsessive-compulsive disorder, alcoholism, and related mood
disorders.
On Death and Dying, 40 min. color (FI). Elizabeth Kübler-Ross discusses the stages of
death and dying and how the process can be made more humane.
One Man's Madness, 31 min. color (BBC). Documentary of a writer who developed
bipolar disorder. Shows extreme symptoms and treatment in the hospital.
Psychopathology: Diagnostic Vignettes: No. 1, Dysthymic Disorder and Major
Affective Disorder, 38 min. color (IU). Shows a group of depressed patients
with characteristic symptoms of these disorders.
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The Secret Life of the Brain Part IV. The Adult Brain: To Think by Feeling, 60 min.
(PBS). This film explores the brain as the center of both intellect and emotion, and this
episode chronicles the critical balance between these processes and explores what
happens when the balance is lost. Scientists draw insight from the stories of a stroke
victim and a sufferer of posttraumatic stress disorder, and break new ground in the
struggle to understand and treat depression.
The Silent Epidemic: Teen Suicide, 30 min. (PBS). This film is part talk show and part
docu-drama, focusing on the epidemic of teenage suicide and depression. The film
profiles teens who have attempted suicide and their progression in coping with
depression. Grammy-award winning recording artist CeCe Winans hosts a studio
audience segment in which teens and suicide experts discuss warning signs, causes, and
prevention of teen suicide.
Serious Depression, 28 min. color (Films for the Humanities and Sciences). Explains that
women are at higher risk for depression than men and interviews experts on the
causes and treatment of depression.
Suicide Survivors, 26 min. color (Films for the Humanities and Sciences). Explores the
special needs of suicide survivors.
Trouble in Mind: Postpartum Depression, 30 min. (Unapix/Ardustry Film; 2000). This film
is part of a series that looks at various mental disorders and treatments for them. This
episode on postpartum depression examines the changes in a woman's body during
pregnancy, birth, and the initial adjustment to motherhood, the associated stress, and
hormonal changes that contribute to this condition. It also discusses innovative
treatments to help mothers and newborns after delivery. Narrated by Jaclyn Smith.
Speaking Out Videos in Abnormal Psychology CD ROM
6 - Everett: Major Depression
VIDEO BACKGROUND:
In this interview, Everett talks about the major depression he has experienced since childhood.
Beginning at the age of two, Everett explains how his depression has affected many important
areas of his life: he had difficulties with relationships, low self-esteem, poor occupational
functioning, etc. To deal with his illness, Everett began self-medicating with prescription drugs
as well as alcohol and eventually tried to commit suicide. He was reluctant to be hospitalized
fearing stigma, but eventually spent more than six months in a hospital. Now he feels he has
turned his life around and is working to “tear down the walls” he built in his relationships during
the first 48 years of his life. A particularly interesting segment is his discussion of how one feels
during a Depressive Episode.
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DISCUSSION QUESTIONS:
1. Major Depression can begin:
a) during childhood
b) during adolescence
c) during adulthood
d) all of the above
Answer: d.
Although major depression is often thought of as an “adult’s disease,” it can begin at any age.
As Everett notes, when he was younger, childhood depression may have been an uncommon
diagnosis. Now childhood depression is more regularly recognized and diagnosed.
2. Which of the following would rule out a diagnosis of major depression?
a) psychotic features (i.e., hallucinations, delusions)
b) catatonia
c) mania
d) insomnia
Answer: c.
Psychotic features and catatonia are both included in the subtypes of major depression. Insomnia
can be a symptom of the required major depression episode. The presence of a non-drug induced
manic episode, however, prevents a diagnosis of major depression.
3. Which of the following is NOT a diagnostic symptom of major depression?
a) diminished interest in activities
b) weight loss
c) weight gain
d) irritability
Answer: d.
Although one might associate irritability with depressed people, it is not a diagnostic feature of a
major depressive episode. Note that both weight loss and gain are diagnostic features.
4. Everett discusses some of the cognitions associated with depression in this video. What kind
of thoughts do people with depression commonly have?
Suggested answers: suicide, death, worthlessness, guilt, etc. In addition, their thoughts tend to be
negative and pessimistic in regards to the self, the world, and the future.
5. Everett discussed the ways his depression affected his life. List some of the effected areas
and the way in which they were affected.
Suggested answers: occupationally, feeling he was the “world’s worst teacher” and “world’s
worst principal”; relationships, feeling like a bad father/spouse; self-esteem, feelings of
worthlessness, etc.
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CLASS ACTIVITY:
1. Although depression itself can be very difficult to overcome, often people continue to have
problems after their depression is in remission. Discuss depression-related problems people
might have after they feel they have overcome their depression. Suggested answers: difficulty
mending relationships, difficulty finding a job, problems reorganizing life, etc.
7 - Sarah: Depression/Deliberate Self-Harm
VIDEO BACKGROUND:
In this interview, Sarah discusses her early-onset depression stemming from her living situations
and abuse. The depression has affected her life in numerous areas including school functioning
and relationships; it has also led her to deliberate self-harm (cutting) as a coping mechanism.
She has moved from place to place and has been in foster care for some time. She experiences
low levels of trust for others as well as suicidal ideation and has been hospitalized for months. In
addition, she has symptoms of insomnia and irritability, which often are present during
depressive episodes. Sarah’s discussion of why she cuts and how it makes her feel during and
after are of particular interest.
DISCUSSION QUESTIONS:
1. In the discussion of her cutting behavior, Sarah notes that it makes her feel:
a) scared
b) pain
c) relief
d) anxiety
Answer: c.
Although it is natural to have fear and avoidance reactions to being cut, people who self-harm do
so as a coping mechanism and therefore seek relief.
2. Deliberate self-harm is also associated with:
a) Obsessive/Compulsive Disorder
b) Borderline Personality Disorder
c) Schizophrenia
d) all of the above
Answer: b.
People with borderline personality disorder sometimes use self-harm to prevent others from
abandoning them, while self-harm behavior is not associated with OCD or schizophrenia.
3. Sarah discusses her cutting in detail during this interview. What seems to be the purpose of
her cutting?
Suggested answers: relief, release of negative feelings, coping with depression, relaxation,
control, escape, etc.
4. What are some possible reasons someone would turn to deliberate self-harm?
Suggested answers: control, a “reality check,” familiarity, dissociation, endorphin release, sense
of escape, etc.
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CLASS ACTIVITIES:
1. It seems that cutting has become more popular in recent years. What are some reasons for
this?
Suggested answers: increased media attention, increased knowledge of cutting as a “coping
option,” peer pressure, etc.
2. People cope with depression in various ways. Discuss some other ways, both positive and
negative, that people cope with depression.
Suggested answers: self-medication, alcohol, drugs, suicide, violent behavior, seeking
psychotherapy, seeking pharmacological interventions, etc.
8 - Ann: Bipolar Mood Disorder with Psychotic Features
VIDEO BACKGROUND:
In this interview, Ann discusses how her bipolar mood disorder has affected her life in multiple
ways. Although she has had only one major depressive episode, Ann’s Manic Episodes have led
to significant difficulties including the loss of her marriage, job, friends, and custody of her
daughter. She also experienced delusions throughout the course of her disorder, including
beliefs that she was in line for the presidency of Harvard or MIT, that her mother was disguised
as Che Guevara on television, and that the CIA was going to assassinate her. These delusions
led to paranoia and alcohol abuse. Ann currently receives psychotherapy and medication and
attends self-help groups. She “runs light” on her medications so she can remain in a hypomanic
state at all times. Interesting segments include her discussion of how one feels during a manic
episode and the perceived benefits of being manic.
DISCUSSION QUESTIONS:
1. What symptom is most associated with bipolar I disorder?
a) mania
b) depression
c) psychosis
d) insomnia
Answer: a.
A diagnosis of bipolar I disorder requires either a manic or mixed episode. Depressive episodes
are very common as well, however. Psychosis and/or insomnia may appear as well, but are not
required for diagnosis.
2. What disorder might a clinician most want to rule out to determine a diagnosis of bipolar I
disorder?
a) Schizophrenia
b) Schizoaffective Disorder
c) Schizoid Personality Disorder
d) Schizotypal Personality Disorder
Answer: b.
As bipolar I disorder is a mood disorder, it would be most important to rule out disorders
involving a mood component. Although the other disorders listed might involve comorbid mood
disturbances, only schizoaffective disorder requires mood symptoms.
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3. What are some ways in which mania has negatively affected Ann’s life? Suggested answers:
loss of job/relationships, insomnia, racing thoughts, tension, etc.
4. What are some ways in which Ann feels mania affected her life positively? Suggested
answers: high energy, ability to see connections in business, creativity, etc.
5. How does Bipolar Disorder I differ from Bipolar Disorder II?
Answer: Bipolar Disorder I requires at least one Manic Episode or Mixed Episode. Bipolar
Disorder II requires at least one Major Depressive Episode and at least one Hypomanic Episode.
CLASS ACTIVITY:
1. Although not all people with Bipolar I Disorder have a wide range of symptoms, Ann’s
symptomatology was multifaceted. Discuss the symptoms Ann had and put them into diagnostic
groups.
Suggested answers: MANIC SYMPTOMS: energy, hyperactivity, substance use, etc.;
DEPRESSED SYMPTOMS: sadness, etc.; PSYCHOTIC SYMPTOMS: delusions (e.g., thinking
her office was bugged, thinking she was in line for university presidencies), etc.
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