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A reader-friendly yet in-depth overview of the latest research on mood as the way we are tuned to the world.
This book examines the central role that mood plays in determining our outlook on life and our ability to cope with its challenges. The central theme is that mood determines how we are tuned to the world. Tuning emerges over the course of our earliest development as environmental and genetic influences form the neural circuits and set how they function across the lifespan in daily life and under conditions of stress. How each person is tuned becomes the basis for resilience or vulnerability to events. Some will take events in stride; others may become angry, anxious, or sad.
A child psychiatrist with decades of clinical experience treating patients, the author stresses that relationships play a central role in shaping our mood. Security or insecurity, loss or the fear of loss of key relationships, especially in childhood, can have telling effects on the way we view the world.
A chapter is devoted to each of the disorders where mood is a central issue: depression, anxiety, bipolar disorder, and antisocial disruptive disorders. The author then discusses the various "talking therapies" and the main classes of medication often administered to treat emotional disturbances. Burke concludes by summarizing the latest research on preventing mood disorders and discussing the impact that illness can have on emotional well-being and the role of mood in resilience and recovery.
|Product dimensions:||5.90(w) x 8.90(h) x 0.60(d)|
About the Author
Patrick M. Burke, MB, BCH, PhD (Tucson, AZ), is a clinical professor of psychiatry at the University of Arizona. His previous positions include child and adolescent psychiatrist at La Frontera, Inc. and the Tucson Medical Center, medical director of Pantano Behavioral Health, chief of child and adolescent psychiatry in the Department of Psychiatry at the University of Arizona, and clinical and academic positions at Children's Hospital of Pittsburgh, the Department of Psychiatry at the University of Pittsburgh, Seattle Children's Hospital, and the Department of Psychiatry at the University of Washington. He has published book chapters and many scientific articles in medical publications.
Read an Excerpt
The Key to Understanding Ourselves and Others
By Patrick M. Burke
Prometheus BooksCopyright © 2013 Patrick M. Burke
All rights reserved.
We are told that nothing in the world is certain except death and taxes. But we can add a third certainty. We are always in a mood. What is more, we are constantly faced with references to mood: popular tunes of happiness or sadness; pundits opining that the economic mood of the country will determine the outcome of an election or that the mood in the locker room will determine which team wins the game; advertisements telling us a product will change our mood and our lives. Mood is everywhere and somehow is linked to what we find important and meaningful. Emerson described life as a train of moods strung like beads, which, as we pass through them, prescribe what we see. For the poet W. B. Yeats, literature is wrought about a mood or a community of moods.
But our moods change, and we seem to have little control over when and how the change occurs. It seems we can neither command nor will our mood to change. Rather, our mood changes, and it is only after the change that we realize we are in a different mood. Most of the time, we pay little attention to changes in our mood or how the changes occur. But the change can be disturbing. We find we are sad, anxious, uneasy, or feel threatened. If the new mood interferes with our ability to function, the change may amount to a mood disorder. For many, these disorders can be destructive to their lives and can warrant professional attention. How does this happen?
We have good reason to suspect that difficulties with mood originate in developmental events. Changeable moods are accepted as part of childhood and adolescence. Take, for example, the irritable colicky infant, the temper-prone toddler and preschooler, or the moody adolescent. There is abundant evidence that most psychiatric disorders among adults that involve significant changes in mood first become evident in youth. At a clinical level, the annual rate of depression in adolescents is estimated to be 5–9 percent, and in prepubertal children the rate is estimated to be 1–2.5 percent. Between 2–5 percent of youth are diagnosed with an anxiety disorder.
How do these disorders come about? And what can be done about them? Perhaps the most common view is that dysfunction in brain chemicals is the underlying issue. Stress is implicated, whether due to conflicts or loss in relationships, or other life events. Genetic influences are also thought to play a role, and much research is geared toward understanding how genes and environments interact to produce disorders. Similarly, research in personality development shows the importance of individual temperament. Advances in the neurosciences have implicated brain circuits and other bodily systems, and these are also subject to genetic and environmental influence. Moreover, there has been massive growth in pharmacological treatments, as well as in psychosocial treatments each with its own school of thought and practitioners. Complicating matters further, diagnosis and treatment, especially in youth, have become controversial issues. Advances in all these areas have been rapid and have originated from a range of disciplines. As a result, the available information is widely distributed in literature and is so complex that, unless you have some expertise in the field, the general reader is likely to have difficulty integrating the findings.
Beyond questions of causation and techniques to remedy problem behavior, how do mood and the disorders involving mood fit with how we see ourselves as agents in the world? Are we passive and simply subject to our genes and our environments? What role do we play or can we play? Can mood be linked to responsibility? Is there a way to address these questions and unify the above themes to guide the nonexpert?
Despite the breadth and depth of current studies, surprisingly little attention has been paid to the subject of mood itself and mood disorder. Most often, the focus is on emotion and mood is simply subsumed, used interchangeably with emotion, or is subordinated to cognitive activities. This book takes a unique approach by treating mood as a central controlling factor that from childhood becomes the basis upon which we choose and act, and sets the stage for how we are throughout life. The basic idea is that mood connects the person and the world, and this connection is built and shaped over the course of development. How might this work? If we think of mood as a phase of the activity of neural circuits and bodily systems that continually process information about the world, then the feelings of mood and the associated bodily systems provide the mechanism for the connection. They enable the assessment of possibilities and become the basis for action.
Development comes into the picture because genetic and environmental influences starting with the fetus create the underlying systems. The stress response system, which is active when destabilizing events occur, is especially relevant because it has profound influence on developing neural circuits. How this system functions influences the degree to which someone is vulnerable or resilient when something challenging happens. Disorders involving changes in mood emerge as breakdowns in the connections occur, and resilience comes from the connections being able to surmount challenge.
The book is organized as one possible roadmap that ties together the many biological and social factors that not only shape development and functioning but also underlie the emergence of disorders and are key to prevention and treatment. There are four key themes set around two core notions, the importance of the individual and the importance of developmental processes.
The central theme is that mood reflects the way we are tuned into the world, reveals our possible options in a particular situation, and thereby becomes the basis of action. The basic idea derives from Martin Heidegger, primarily his major work Being and Time. Although Heidegger did not write about children, we have adopted some of his central insights and placed them within a developmental context. The first theme is nested in a second theme—we are self-constituting. If we consider the self as a way of being, then who we are as agents is realized only by what we do and by what we make of ourselves as we live an active life. Relationships with others are at the core of these processes. Complex interactions between the child, other people, and the world underlie the child's struggles with becoming autonomous and responsible for himself. Mood, by revealing our possibilities, plays a fundamental role in development because development is the step-by-step process of becoming self-constituting. Interactions with others and the world have mood at their core, and they reciprocally are at the core of how mood develops and can be changed.
To illustrate this approach, imagine a child as a stringed musical instrument with its combinations of strings and sounds. The tuning—mood—of the instrument at any given moment is how the child tunes into the world. But the child is a constantly resonating living organism. Therefore, a mood is always present and since a child has many strings and combinations of strings, many moods are waiting to emerge. From the earliest beginning, genetic and environmental influences form the strings, and throughout life continue to influence the strings. The tuning underlies how events appear to a child, rather than being a reaction to an event or how the child thinks about things. When something happens, the child's strings reverberate and the resulting mood depends on the tuning of the individual string. The child's tuning (mood) alerts him to the possibilities present, paving the way for him to choose and act.
Chapter 2 examines mood and what mood does and attempts to differentiate mood from emotion. Heidegger argues that we are not detached beings, observing and making decisions based on what we see and then acting accordingly. Instead, we always already find ourselves in situations that matter to us and that typically involve others around us. Things matter to us because each of us is uniquely disposed or attuned to the world. Our attunement reveals the world to us, and our attunement is mood. He elaborates that what and how we experience is a function of our involvements with things, and especially our involvement with others. Relationships and situations present possibilities, and our tuning differentially disposes us to the possibilities presented. As we interact with the world, our senses provide information. Moods (how you are tuned to the world) also provide information and reveal the situation. They tell us what matters and has significance.
Think of yourself as a very nervous and fearful person, who is walking alone down a darkened street. Certain features, like doorways and shadows, stand out. Your mood (fearfulness) alerts you to possible danger and provides the conditions for you to react with fear (an emotion) should something happen. Mood is like a special sense that not only tells you about your world (the world is frightening, this situation is positive) but also informs you about yourself—you are a happy person, or a fearful person, or you are nervous and not doing well.
But we are not in full control of our situations. The range of possibilities presented to us is limited, and we vary in skill and understanding on how to proceed. This brings us to Heidegger's ideas about fundamental moods and his concept of authenticity, or what is unique and particular to each individual. For the most part, we live life to suit or to meet the expectations of others by following our social and cultural roles and avoid any underlying anxiety about our being. But when critical events occur that bring us face to face with our finite being, the submerged anxiety reveals the fragility of the way we live, and we're faced with making choices. To become authentic we need to act on this realization, becoming responsible for ourselves and choosing our own way to live.
How might tuning develop? Mood is present from the beginning, well before speech and language develop. Parents describe their newborns as "happy," "content," and "fussy" or as "hard or easy to console." They often say their child "was born" that way. Chapter 3 traces the development of key moods and related emotions (sadness, guilt, anger, fear), emphasizing the role interpersonal relationships play. The chapter introduces temperament, a key construct that is partly defined in terms of characteristic moods and forms the building blocks of personality. Later chapters discuss the relation of temperament and personality to the emergence of anxiety, depression, and disruptive antisocial behavior.
The third theme is that mood and tuning arise through the activity of certain neural networks and body systems. The underlying concept is that the body is a framework through which we perceive the world, and the possibilities offered by the world. Imagine a six-month-old infant lying on the floor and playing with small blocks. The infant grasps a block, stares intently at it, puts in her mouth, exchanges it in a fumbling way for another, drops one, and searches until she picks up another block, which again goes in the mouth while her small hand manipulates it. This infant is experiencing the world of blocks through her bodily senses—touch, sight, and taste. She is forming some rudimentary sense of the possibilities of the blocks, and in so doing of her world.
Chapter 4 discusses how the nervous system analyzes and evaluates information about the world, enabling and coordinating our reactions and responses by organizing the activity of neural networks involved in mood and emotion. How these networks are made, and how they function, sets the tuning of each child. We can think of the circuits as the strings of the instrument. Assuming the brain's networks function normally, the child will be appropriately happy; sad; or in an average, everyday mood. But if the tuning of certain string(s) is off, then the world may appear scary or highly exciting, and moods may be intense, subdued, or labile as those strings are sounded.
The way a child is tuned emerges over the course of development as genetic (chapter 5) and environmental influences (chapters 5 and 6) combine to form the circuits (the strings of the instrument) and set how they function in daily life and under conditions of stress. Individual differences in behavior reflect functional differentiation within the circuits. The stress response (chapter 6) is a complex array of neurohormonal processes that is activated when a potentially destabilizing event occurs. A variety of genetic and environmental influences affect the stress response, and interactions and relationships with others are crucial influences that are essential for its normal development. How this system responds plays a large part in the development of the personal characteristics associated with resilience and vulnerability.
Not all children who experience stressful events (e.g., parental separation and/ or change in schools) become depressed or anxious, nor do all children in a family with familial or genetic risk factors (a depressed or alcoholic parent) develop a disorder. There is a wide range of responses to the environment. Some children (and adults) respond positively and effectively, but others respond in negative and/or ineffective ways. Someone who responds well in one type of situation may not do as well in another. Why do some but not all children at risk develop a disorder? How can we relate how a child is tuned over the course of development to factors such as genes, stress, and the environment involved in mood disorders? Individual differences are key to understanding what happens. Chapter 6 introduces some current models that are helpful in explaining how multiple influences (genetics, early experience, temperament and other characteristics of the child, relationships with others) may interact to leave some individuals vulnerable and others resilient. The models can also be the basis of prevention and treatment efforts suggesting both targets and strategies for intervention.
The fourth theme is that disorders emerge out of the interaction of events and the functional status of neural circuits and systems. When vulnerable children are faced with stressful events, significant alterations may occur in mood, behavior, and biological functions. Particular patterns of dysfunction underlie the principal disorders in youth that are characterized by mood disturbances: anxiety, depression, bipolar disorder, and antisocial/oppositional disorders. Such features tend to cluster, and the clusters are the basis of the diagnostic categories. The diagnostic system is currently in transition. Chapter 7 sketches some key background issues to the diagnostic process and outlines key changes in the new manual.
Chapters 8–10 consider the main disorders that involve mood and mood changes. Although the focus is on youth, the relevance to adults is indicated throughout. In each case, the mood and emotion component is explored along with neural circuitry and the stress response to illustrate from a developmental perspective how the disorders come about and manifest and why they often occur together. It will be seen that in each case, the disorders have typical mood and emotion profiles, physiological changes, and action patterns. They also show substantial overlap; the stress response system has a role in each; and relationships play central roles both by influencing the development of mood and the circuits underlying mood, and by the role they play in precipitating disorders. In each case current research on neural circuits and the stress response are explored, and shows common patterns of activity in circuits related to mood and emotion. Anxiety (chapter 8) is characterized by worry and fear and is concerned with present or future threats of harm. Anxiety disorders reflect dysfunction in circuits underlying fear, manifest the physiological changes reflecting flight or fight, and action is typically avoidant. Sadness and negative thinking characterize depression. Depressive disorders (chapter 9) are concerned with loss, reflect dysfunction in neural circuits involved in mood, manifest physiological changes reflecting altered stress responses, and diminished activity. Bipolar disorder (chapter 10) involves mania and depression. Elated or irritable mood and grandiose thinking characterize mania. It can be viewed as a dysfunction of neural systems underlying reward. The stress system plays a role, and activity levels are increased. This disorder is increasingly and controversially diagnosed in children and adolescents. The background to the controversy is explored, and proposed changes are discussed.
Excerpted from MOOD by Patrick M. Burke. Copyright © 2013 Patrick M. Burke. Excerpted by permission of Prometheus Books.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Chapter 1 Overview 11
Chapter 2 What Does Mood Do? 19
Chapter 3 Mood and Development 29
Chapter 4 Mood and Neural Circuits 45
Chapter 5 Genes, Environments, and Neural Circuits 59
Chapter 6 When Events Threaten Stability-The Stress Response 67
Chapter 7 Issues in Psychiatric Diagnosis 81
Chapter 8 When Moods Are Worried and Fearful-Anxiety Disorders 87
Chapter 9 When Moods Are Low-Depression 103
Chapter 10 When Moods Are High and Low-Bipolar Disorder 117
Chapter 11 When Mood Is Indifferent-Disruptive and Antisocial Behavior 133
Chapter 12 Getting Back on Track-Psychological and Behavioral Therapy 145
Chapter 13 Getting Back on Track-Medication 169
Chapter 14 The Challenge of Medical Illness 179
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