Factors
When looking at Susan’s depression there are three sets of factors that need to be considered; predisposing, precipitating and maintaining factors. The predisposing factors are factors that lead to any genetic links, learned behaviours and cognitive distortions. Within the case study there was no indication that any previous family members have suffered with depression so this issue is not considered. Learned behaviours include the constant stream of complaints, the thought that she has no one to confide, drinking alone and being constantly miserable. Cognitive distortions include the fact she did not get into university which she blames on her mothers death. Other distortions include her believing that there is no-one to confide in, believing that the lady had bumped into her on purpose and her belief her husband was no longer willing to discuss their problems. The precipitating factors within this case are two events, her mother dying and as a result of this her not getting into university. The last factors considered are the maintaining factors this is what Susan does to contribute towards her depressive state. These events include her pessimistic view, her conversation being nothing more than complaints and her constant view that her husband does not listen to her. There have also been family problems as her father remarried and Susan states that she “wants my dad all to herself” this is causing family feuds.
Theoretical explanations
There have been many theoretical explanations towards depression such as beck’s theory, helplessness/hopelessness theories, and interpersonal theory, there are biological explanations. Beck’s (1967, 1987) theory suggests that the individual is depressed as there thoughts are based on negative interpretations. Beck’s suggests that the negative schema adopted at childhood will be seen throughout life such as loss of a parent would make the child see the world in a negative light. This negative schema is portrayed whenever they encounter new situations that even slightly resemble the one that the schema was set, the schema is enhanced through cognitive biases and so leads the individual to misinterpret reality this may then lead to negative self-evaluation and so lead to depression. Beck’s suggests that there are four categories of cognitive biases; arbitrary inference which is when the individual draws a conclusion from no actual evidence, selective abstraction, is when a conclusion is made on one element rather than the whole of the elements put together, overgeneralization, is when a conclusion is made on a small trivial event, and magnification and minimization is when the individual exaggerates in evaluating the performance. Many theorists see the individual as a victim of there own passions, Beck’s does not he takes into account that the individual is a victim of their own illogical thoughts and judgments.
The helplessness/ hopelessness theories were three separate theories all developed from one another. Firstly the helplessness theory is when an individual has a sense of loss of control over their life this feeling can be acquired through traumatic events. Seligman (1974) looked at this concept in dogs and found that the dogs became passive towards certain situation that had previously caused them pain or fear, this was then later applied to humans but many problems occurred as people hold themselves responsible for failure and if there was a feeling if helplessness then the individual would not be able to blame themselves. Abramson, Seligman and Teasdale (1978) revised the original theory and added the concept of attribution, this then allowed for both cognitive and learned elements, so an individual will look at the situation that they failed and attribute the failure to some cause. This in-turn suggests that people get depressed due to the fact of negative attributions towards life events and attach them to stable and global causes, if the individuals self esteem will remain intact if the individual does not blame the inadequacies on themselves. Abramson, Metalsky and Alloy (1989) revised the theory and devised the theory into the hopelessness theory. This has been revised so the individual believes that desirable outcomes will not occur and that undesirable outcomes will and there is nothing the individual can do to change the outcome. As in previous theories the negative life event that occurs enhances the state of hopelessness. This theory takes into account the negative attributes attached to stable and global factors but also takes into consideration low self-esteem and that negative events have negative outcomes. Interpersonal theory takes into account the relationship between the depressed individual and others around them. Keltner and Kring (1998) suggested that depressed individuals have sparse social networks which provide little support for them this in-turn suggests that the individual may not be able to cope with negative occurrences and make them more vulnerable to depression. Genetic factors also have to be considered, it also has been suggested that changes in the brain have caused depression, hormonal changes and traumatic events to the body have also aided depression.
Treatments for depression
When looking at the treatment needed to be given there is a wide variety of options ranging from cognitive behavioural therapy to drug therapy to electro-convulsive therapy. The national institute of mental health looked at the treatment given to major depressed patients and discovered that a basic sixteen week drug and psychotherapy course of treatment was not sufficient as it resulted in many relapses. The institute then studied patients and discovered that a twelve month course of antidepressants was the most effective way of curing depression; they also stated that it would be morally wrong to offer a long course of drug treatment without any kind of counseling. It can take a few weeks before the drugs will take affect and so to offer appropriate counseling is essential. These findings are contrary to most others such as Landreville et al (2001). The counseling that can be offered to Susan is interpersonal therapy which focuses on the here and now; it is a short term therapy that was specifically designed to deal with patients with major depression. This kind of therapy is designed to deal with any social dysfunction, unlike the psychoanalytic approach it does not deal with coping mechanisms, defense mechanisms or internal conflicts. Cognitive behavioural therapy was first founded by Aaron Beck’s (1921). Beck’s first started out from a psychoanalytic background which enabled him to outline the problem with cognitive distortions within the illness of depression. Cognitive behavioural therapy works on the bases that it is the negative thoughts that cause depression. This therapy aims to change negative unrealistic thoughts into positive realistic ones. It focuses on the here and now instead of focusing on problems from the past it looks at ways that can improve state of mind. The therapy takes one problem and breaks it down into smaller categories this in turn makes it easier to see how the problems are connected and how they affect you. Some critics of this therapy suggest that the negative thoughts are a result of the depression instead of them being the cause. Psychoanalytic therapies focus on unconscious mechanisms such as the defense mechanism these therapies focus on the historical reasons as to why the patient became depressed. This kind of therapy may take several years to go through at a couple of times a week this therapy is known as the most expensive and time consuming of them all. There is also family therapy which is not widely known to cure depression, but is advised if the patient is jeopardizing a marriage or family life. In this case Susan may be referred to family therapy as this may build confidence between there relationship and boost her in some of her pessimism towards her home life. Susan would also be advised to seek one of the other forms of counseling also. The counseling is provided along with drug therapy as it is the chemicals within the brain that are unbalanced such as serotonin, there are two major types of antidepressants that aid the chemicals; the selective serotonin reuptake inhibitors (SSRI) and tricyclic antidepressants. Trycyclic anti-depressants are used in conditions such as depression, obsessive compulsive disorder and panic disorder they alter the balance of chemicals within the brain, such as serotonin and another neurotransmitter norepinephrine these anti-depressants have been used for a long time for treating depression. There are side effects like there are in most drugs these include; dry mouth, blurred vision, constipation and tiredness. Selective serotonin reuptake inhibitors work only on serotonin levels where as tricyclic work on both. There seem to be fewer side effects with this drug this may be due to the fact that it only affects one chemical instead of two or several within the body. These side effects include dry mouth, nervousness, insomnia, sexual problems and nausea.
When looking at this evidence it is clear that Susan has depression it is also clear that she needs family therapy to reconcile her relationship with her husband it is also clear that some kind of drug therapy is needed coincided with the appropriate counseling. There are but a few mentioned above and are many more possibilities, Susan would need referral to a proper doctor.
