 G'day mate 40 here. Welcome back to 40 University Today class our topic is Sadness and What's the difference between sad and Having major depressive disorder Right how how how we lost sadness reading this terrific 2007 book it's called the loss of sadness how psychiatry transformed normal sorrow into depressive disorder so this books by Alan v. Horwitz a sociologist of Medicine and Jerome wakefield a medical historian. So just a terrific book. So what exactly makes for? mental illness and And you say oh 40 mental illness. It's whatever the DSM 5 says So guys you might be mentally ill You might be suffering from major depressive disorder right now, but here to help you out Take take a recolour. It's no caffeine. It's sugar-free Tastes really really good. Trust the mental health experts. Okay, so let's listen to the experts guys All right, do you have a depressed mood? Most of the day nearly every day you feel sad empty hopeless Or are you observed by others feeling sad empty hopeless? Do you often appear tearful? Do you have an irritable mood? Are you in go and get enduring a loss of interest and a loss of pleasure? Do you experience a markedly diminished interest and pleasure in all activities most activities most of the day nearly every day? Have you endured weight loss or weight gain? Do you have insomnia or hypersomnia? Do you have psychomotor? agitation or retardation Do you have fatigue? Do you have chronic fatigue? If you have chronic fatigue, you may have major depressive disorder. Do you feel worthless? Only cry when I watch Luke straw man vaccine hesitancy Do you feel worthless? Are you suffering from excessive or inappropriate guilt? Are you enduring decreased concentration? Are you having thoughts of death or suicide? If you've got five or more of these symptoms guys, you've got major depressive disorder so Bigger picture what the heck is mental illness? So what's the difference between what's normal and what's abnormal? All right, so now there are lots of Yeah, depression is just my daphanel deficiency guys so There are lots of statistical Disorders that are normal like gum disease is normal Utherosclerosis in the hardening of the arteries that's normal, but they're still disorders So lots of just because something's normal doesn't mean it's not a disorder So it's entirely possible that 60% of the population may be Suffering from major depressive disorder and that doesn't mean it's not a disorder and that it's not an illness Okay, and there's also a difference between Disorder and what is socially desirable and socially acceptable? So it may be in your area voting for Donald Trump or supporting nationalism is Socially unacceptable, but that doesn't mean that your nationalist Magga tendencies are a disorder so you can have an individual who's socially deviant like you You may have an individual whose nature is in conflict with the values of wider society like you But that doesn't make you Disordered, right? So we have to distinguish disorder from social values All right disorders are real medical ailments right Where disorders mean an objective problem in human functioning? So this is a safe place for you to share you are suffering from an objective problem in your individual functioning Please let me know have I been depressed my understanding of my life experience is that most of my life I Had some kind of low level of depression, which is currently called dysthymia So it's like a low level and then I certainly had times Where I was pretty much sunk in depression So I remember at age six my family moved from back from England to Avondale College in Australia And when we'd walk around the college People thought that I looked like a Holocaust survivor because I was just like such a depressed unhappy six-year-old so I think I've I Think I've endured Probably more than my share of depression. I think I probably have above average tendencies towards neuroticism, which means enjoying feeling negative Emotions and so a lot of this is not just feeling regret right at age six. I'm not sure how much regret I was feeling But yeah, I think I've had more than my share of depression Okay, but I Think here's the authors here give us this plausible demarcation point between human normality and disorder in a medical sense Right between biologically designed functions the resort of natural selection and the failure of such functioning meaning dysfunction All right, so the normal function of bodily organs is are they doing what they were designed to do? So the heart serves to pump blood if your heart is pumping blood Then you don't have a heart disorder if your kidneys are eliminating waste You don't have a kid kidney disorder if your lungs are enabling you to breathe. You don't have a lung disorder Right So disorder exists when the organ is unable to accomplish the function for which it is biologically designed Okay, so let's take that and apply it to psychological processes So let's say My good friend Ricardo. Let's say Ricardo goes on a Twitter jihad and denounces me For next 30 days and Every day he makes some trenchant Telling criticism of me, right? It would be weird of me now giving given my Three-plus year history with Ricardo if that didn't bother me, but if that didn't make me feel hurt that would be weird and So what do we do when we feel hurt, right? We're all manly men here when we feel hurt We usually try to mask it with anger, right? So it'd be weird if it wasn't like angry at Ricardo for denouncing me, but the the the anger is really just a covering for the hurt it's like oh man, I thought we were I thought we were bonded here and And now he's denouncing me and you know, I thought we were so awesome together Like I feel like I've lost an important friend in my life It would be weird if I was not sad and hurt by you know the loss of Ricardo's friendship and then In all likelihood, I would mask that sadness and hurt by being angry right so on the other hand if I was if I was equally sad and Equally hurt and he Cree equally angry about it a year later. That's obviously a dysfunction All right, you lose an important friend in your life. It would be weird if you didn't feel sad All right So sadness serves a function it tells you that things that you expected or wanted Anticipated are not happening that your life is not going in the direction that you wanted. So so sadness serves a function It's like a you know flashing yellow side Yellow light or flashing red light, right? it would be dysfunctional not to have some sadness some hurt and So And among blokes that's most likely going to manifest as as Anger right so anger almost always covers up hurt Right, so it'd be weird if you lose an important friend and you don't feel hurt right that that that would just be strange So you'd want to have some hurt But you wouldn't want to if I let's say I couldn't work Because I was so hurt that would be a dysfunction and let's say I was I was too depressed over the loss of my friendship with Ricardo That I couldn't go to sure that would be a dysfunction. Let's say I'm so hurt by By the loss of my friendship with Ricardo that I couldn't go on a date or I couldn't couldn't make sweet sweet tender Love to to my woman that that would be a dysfunction or if I if I could not watch the Dallas Cowboys with pleasure anymore because Ricardo likes the Dallas Cowboys I like the Dallas Cowboys and when I watch the Dallas Cowboys it reminds me of Ricardo Therefore, I'm too upset to watch the Dallas Cowboys. That would be that would be a level of dysfunction or if I started talking to like complete strangers, you know in a hospital waiting room or You know on a bus or at a 12-step program like inappropriately like bringing this up and and moping about it that would be a level of dysfunction Okay, Holly says my dog died yesterday. I'm either sad or depressed. I don't know which one and I don't care It just feels bad. Yeah, there's no there's no difference empirically between feeling sad and feeling depressed Right. So what the DSM cause major depressive disorder is usually just a temporary condition of sadness That is frequently functional like if you have had a close relationship You know a good bond with your dog and then your dog dies it would be weird and it would be dysfunctional if you didn't feel sad and What you're feeling is is going to fulfill all the criteria for major depressive disorder But if you're still moping around and still sad Still equally sad as you are now About the loss of your dog six months from now and a year from now then then it's turned into a dysfunction So we need context. All right, so Philip Roth was depressed for many years. Do you think it's likely this depression was tied to many years of bad behavior? Yes Yes, I think that probably had something to do with it So we need context so You you get a flat tire on the way to an important appointment It'd be weird if you weren't bummed out you lose your wallet, right? It'd be weird if you weren't bummed out But if you were equally bummed out about the flat tire losing your wallet two months later Then it's turned into a dysfunction, right? There's something wrong. So we need context. Let's say you lose your spouse Or you lose your job or you lose your status in your community or You lose the the use of a limb It would be weird if you weren't still bummed about it two months later, right? You lose your spouse of 30 years Let's say it was a good relationship All right, you're obviously going to be sad about it But if you're equally sad about it 10 years later, then there's something wrong So if we lose if we lose status if we lose prestige If we lose income if we lose savings if we made a bad investment if we lose important friendships if we lose a pat These are all huge losses and It'd be weird if you won't Reduce to essentially the all the symptoms of major or many of the symptoms of major depressive disorder For a few days a few weeks a few months even if it's a major loss But if you're still moping around about the loss of your parakeet six months later at the equivalent level That you did on the first day then something's wrong. Mr. Whitemail says I got pulled over on my way to a job interview I immediately knew I wasn't getting the job There's a moral dimension to depression that we must acknowledge Okay, well sometimes there's there's a moral dimension like yeah often what you could call depression a major depressive disorder I would expect the primary cause for this is a lack of Normal ability to Connect with other people Yeah, give yourself one day of mourning for every year of marriage presuming the marriage is good if your marriage stinks Then you're not a bad person if you don't mourn the death of your spouse All right if if you if your marriage is bad and then Your spouse dies and you immediately like plunge into some exciting new romance It would be weird if you're all bummed and depressed so Context is important, right? So fear responses like fear responses are biologically designed to arise in dangerous situations But not in safe situations right, so if you're having a disproportionate fear response then That's dysfunctional if you're having a complete lack of fear when you should feel Feel afraid then that's dysfunctional, right? If if you feel zero sadness over the loss of an important friend, that's dysfunctional, right? So fear loss These these play an important role so if your Your fear mechanisms and your sadness mechanisms do not operate as designed Then you've got a disorder And also there's much variation among individuals in the sensitivity with which they respond to loss With sadness part of this is cultural so in Persian culture as I understand it if your spouse dies And you hated your spouse you still must publicly mourn if your friend dies and Oh Member of your family dies and you hated this member of your family. You're still expected to publicly mourn Right, so culture is going to affect us So Anglo-Saxon culture is much more stiff upper lip than say Middle Eastern culture So I've had Jewish friends tell me they were the only ones who are crying at at a Gentile funeral So Jews tend to be more demonstrative of their emotions than Anglos Middle Eastern people tend to be more demonstrative of their emotions than people from northern Europe So our culture and genetics our heritage is going to affect how much we Share our sadness and our negative feelings so despite this virtually all of us have the capacity to develop sadness as a Biologically select selected adaptation to handling loss So we did not fully understand our last response mechanisms So we can't always stay with confidence the function of the last response and we don't clearly know what exactly is normal and Abnormal so unlike say the function of the eyes or the function of the muscles the functions of last responses and not as apparent And they are subject to much more dispute But we can kind of infer what responses of a mechanism like a last mechanism are normal right, so we know that sleep is a Biologically designed response to life and that some sleep conditions are normal where others are sleep disorders But we don't we don't have a scientific consensus that explains why we sleep so One way of Defining sadness in a scientific way. It's just let's just call it a harmful dysfunction of loss response mechanisms alright, we all have loss response mechanisms and If you're feeling too much sadness too much fear or not enough sadness not enough fear You you've got a harmful dysfunction HD right harmful dysfunction of loss response mechanisms So you've got a mental disorder when it meets two Criteria one is dysfunction something has gone wrong with your internal mechanisms ability to perform its biologically designed functions Second the dysfunction must be harmful to you So you've got a mental disorder and you've got the failure of a person's internal Mechanisms to perform their functions as designed by nature and it impinges harmfully on the person's well-being This is not precise, but I think we're we're getting somewhere right, so Think about William Styron's Black depression which which arose after the he received a prestigious award right that was that was a dysfunction or David Karp He he got tenure as an academic he got tenure and Somehow their lost mechanisms went awry and they plunged into dark dark depression after getting good news So if you got a dysfunction of your loss response, that's going to involve some Distorted cognitive perception of yourself of the world and of the future that triggers inappropriate levels of sadness that whatever happened that old guy from Canada Kevin Michael Grace is still broadcasting every day and His foil Kyle is pursuing his life without regard to live streaming So Kyle as well Kevin seems well. They're both flourishing Okay, so somebody becomes deeply depressed after the death of a pet goldfish or some minor perceived slight Like if you come into the this chat room and you don't like bow down. It's like all hail 40 Hail 40 Hail our people right and I go oh man. There's no bowing down right if I'm bummed about that Then there's something wrong with me. I'm having some kind of cognitive distortion So getting overly just overly sensitive having some kind of disproportionate loss response Right, then then you've got probably some dysfunction So these disorders might arise after initially no more level response to actual loss But then sometimes our responses to loss become Disengaged from the circumstances of the loss and they persist with disproportionate intensity long after the loss provoking conditions of end it So let's say your girlfriend breaks up with you and You feel sad, but then you get a new girlfriend But you're still sad Then if you've got a new girlfriend if you've got a girl on a job You should not generally speaking be going around moping With with some some exceptions and sometimes our Normal experience of loss events for whatever reason produces biochemical and anatomical vulnerabilities That make recurrence of depressive episodes more likely with less and less provocation So you can have lost responses that begin as normal responses but then your emotional reactions can become detached from a specific time place in circumstance and you can become somehow Your wiring can get miswired and you can just fall into Sadness disproportionate sadness and and and depression with less and less of a trigger needed and Sometimes you can have Dysfunctions in your last response that will cause symptoms that are so extreme That they scream. Hey, you get you've got a dysfunction here So if you hallucinate if you have delusions, right? If you completely immobilize if you lose contact with reality All right, you're Your loss mechanism is not functioning correctly. It's become a disorder So if you have a dangerously, this is like dangerously high fever fever uncontrolled vomiting, right? So normally a fever and vomiting are Adaptive responses to your circumstance, but occasionally You'll have an abnormally high fever and uncontrolled vomiting And so now you've got a failure of what is otherwise an adaptive response So there's a difference between sadness due to your own internal dysfunction your own miss wiring Versus sadness. It is a biologically designed and appropriate response to external events so There is sadness that is endogenous meaning spontaneously caused by some kind of internal miss wiring That has no external trigger and then there is reactive sadness meaning triggered by some external event so endogenous depressions arise in the absence of real loss and so these are almost always internal dysfunctions, but reactive depressions are usually going to be proportionate to outside events are usually going to be normal Responses and the sadness will go away with time and distance from the triggering event So not all depressive disorders have physiological causes. It's not always a brain problem when there's a depressive disorder So physiological causes biological causes can produce disorders But also psychological and social factors can lead to dysfunction So if you're bummed that the the Democrats won the 2020 election Then then it'd be weird if you didn't feel sad for a while so What what psychiatrists called major depressive disorder is frequently even usually an appropriate natural Biological response to Loss in your life loss of a pet loss of a friend loss of status loss of income loss of assets loss of health Now there are much more radical critiques of psychiatric diagnoses That leave no room for any kind of constructive engagement with psychiatry So psychiatrists Thomas Zah as argued there are zero mental disorders because a disorder requires physical lesions Okay, that doesn't make sense to me Sociologist Thomas chef Has this labeling theory that says, you know all mental health disorders are simply social control so What are the advantages of distinguishing normal sadness from major depressive disorder? Okay, well number one pathologizing calling something a real medical illness When it's just a normal condition they cause harm And avoiding this pathologizing decreases the harm Because if you tell people they got a major depressive disorder They will take it that that you know, they they're seriously sick. They've got an ailment like like cancer And that they need medication So if you're just sad normally if you're a normal person you'll live within a social matrix a social network That will respond with social support and sympathy to sadness after you've engaged Endured stressful life events But if you're diagnosed with major depressive disorder and the word gets word gets out then this You're told that you've got dysfunctional depression And this will tend to elicit hostility stigma rejection and a loss of social support, which is going to make you even more depressed So to subject those with normal levels of sadness to the social prejudice faced by those with mental illness Does not do people a favor And for those who have a genuine mental disorder All right, they need Access to services that may provide relief But if all sorts of people who have just normal sadness, but are being diagnosed With you know, a genuine mental disorder That reduces access to services on the part of those who do have a genuine mental disorder and they need treatment Also distinguishing between a major mental disorder and normal sadness Should improve assessment of prognosis normal levels of sadness go away They they rebate Accurate diagnoses will point more accurately to more appropriate treatments. So if you've got normal sadness, you don't need any medical treatment Separating normal sadness from depressive disorder Helps to recognize the relationship of sadness to difficult social conditions and thus to help Identify appropriate social interventions Separating major depressive Disorder from normal intense sadness provides a basis for more accurate epidemiological estimates the prevalence of depressive disorders and the cost of treating it Distinguishing disorder from normal sadness allows for a better estimate of How large is the quote-unquote unmet need for mental health services? If we draw a more careful distinction between disorder and normal sadness Then researchers will be able to Choose samples to study that more accurately reflect true mental health disorders instead of ordinary sadness distinguishing ordinary sadness from mental illness avoids medicalizing our thinking about normal sadness and it helps to maintain the conceptual integrity Of psychiatry and I know you're all down with maintaining the conceptual integrity of society. Bye. Bye