Quantitative Psychology involves the application of mathematical and statistical modeling in psychological research, and the development of statistical methods for analyzing and explaining behavioral data. The term Quantitative psychology is relatively new and little used (only recently have Ph.D. programs in quantitative psychology been formed), and it loosely covers the longer standing subfields psychometrics and mathematical psychology.

Psychometrics is the field of psychology concerned with the theory and technique of psychological measurement, which includes the measurement of knowledge, abilities, attitudes, and personality traits. Measurement of these unobservable phenomena is difficult, and much of the research and accumulated knowledge in this discipline has been developed in an attempt to properly define and quantify such phenomena. Psychometric research typically involves two major research tasks, namely: (i) the construction of instruments and procedures for measurement; and (ii) the development and refinement of theoretical approaches to measurement.

Whereas psychometrics is mainly concerned with individual differences and population structure, mathematical psychology is concerned with modeling of mental and motor processes of the average individual. Psychometrics is more associated with educational, personality, and clinical psychology. Mathematical psychology is more closely related to psychonomics/experimental and cognitive, and physiological psychology and (cognitive) neuroscience.

Labels: Psychology

Psychopathology is a term which refers to either the study of mental illness or mental distress, or the manifestation of behaviours and experiences which may be indicative of mental illness or psychological impairment.

It is also the name of an academic journal that specialises in the understanding and classification of mental illness in clinical psychiatry.

Study of Mental Illness

Many different professions may be involved in studying mental illness or distress. Most notably, psychiatrists and clinical psychologists are particularly interested in this area and may either be involved in clinical treatment of mental illness, or research into the origin, development and manifestations of such states, or often, both. More widely, many different specialties may be involved in the study of psychopathology. For example, a neuroscientist may focus on brain changes related to mental illness. Therefore, someone who is referred to as a psychopathologist, may be one of any number of professions who have specialized in studying this area.

Psychiatrists in particular are interested in descriptive psychopathology, which has the aim of describing the symptoms and syndromes of mental illness. This is both for the diagnosis of individual patients, or for the creation of diagnostic systems which define exactly which signs and symptoms should make up a diagnosis, and how experiences and behaviours should be grouped in particular diagnoses.

Psychopathology should not be confused with psychopathy, which is a type of personality disorder.

Labels: Psychology

Personality psychology studies enduring psychological patterns of behavior, thought and emotion, commonly called an individual's personality. Theories of personality vary between different psychological schools. Trait theories attempts to break personality down into a number of traits, by use of factor analysis. The number of traits have varied between theories. One of the first, and smallest, models was that of Hans Eysenck, which had three dimensions: extroversion introversion, neuroticism emotional stability, and psychoticism. Raymond Cattell proposed a theory of 16 personality factors. The theory that has most empirical evidence behind it today may be the "Big Five" theory, proposed by Lewis Goldberg, and others.

A different, but well known approach to personality is that of Sigmund Freud, whose structural theory of personality divided personality into the ego, superego, and id. He utilized the principles of thermodynamics metaphorically to explain these three distinctive and interacting tripartite divisions. In 1923 Freud published the ground breaking book: "The Ego and the Id" in which he named and identified the functioning psychodynamics of human personality. This theory has been used in modern psychology paradigms such as Transactional Analysis. However, Freud's theory of personality has been criticized by many, including many mainstream psychologists.

Labels: Psychology

Mainly focusing on the development of the human mind through the life span, developmental psychology seeks to understand how people come to perceive, understand, and act within the world and how these processes change as they age. This may focus on intellectual, cognitive, neural, social, or moral development. Researchers who study children use a number of unique research methods to make observations in natural settings or to engage them in experimental tasks. Such tasks often resemble specially designed games and activities that are both enjoyable for the child and scientifically useful, and researchers have even devised clever methods to study the mental processes of small infants.

In addition to studying children, developmental psychologists also study aging and processes throughout the life span, especially at other times of rapid change (such as adolescence and old age). Urie Bronfenbrenner's theory of development in context is influential in this field, as are those mentioned in "Educational psychology" immediately below, as well as many others. Developmental psychologists draw on the full range of theorists in scientific psychology to inform their research.

Labels: Psychology

Last week, I described "personality" as the unique way in which each person interprets the world and responds to it. We looked at the ways in which personality, especially temperament, is genetically determined. We noted the ways in which character traits, which are more changeable, interact with temperament. Defense mechanisms, which determine how each person handles unacceptable impulses or thoughts, give an added dimension to personality. Intelligence is an important individual characteristic, but does not change personality style very much. Each personality is a unique "fingerprint" resulting from a combination of these characteristics. Like fingerprints, even though no two are exactly the same, personalities can be sorted into types. Today, we'll begin looking at the ways in which personality can contribute to mental health problems. When personality becomes disordered, it can cause psychiatric symptoms all by itself.

Personality disorders are extreme personality styles. Like fun-house mirrors, these disorders cause distorted views of people and events. When someone's perception of others is distorted, her responses are apt to be inappropriate as well. In this way, personality disorders disrupt thoughts, emotions, behavior, self image, and relationships. Personality disorders last for years, untreated, and create a broad range of difficulties. They are not easy to overcome. Although the symptoms of personality disorder may mimic the symptoms of other disorders, they do not respond well to medicines used to treat those other conditions. Mental health professionals group personality disorders together into three categories, or "clusters." Broadly, the disorders of Cluster A may be described as odd or eccentric. Those of Cluster B are dramatic or emotional. Cluster C disorders are anxious or fearful. Today, we'll look at the Cluster A Personality Disorders - Paranoid, Schizoid, and Schizotypal.

Paranoid Personality Disorder causes someone to interpret the world as a dangerous and hostile place. A person with this disorder is very distrustful. He does not take people or events at face value, but is always looking to uncover the real truth, the hidden motive. These people assume that others are out harm them, even without evidence for it. Honest mistakes are seen as attempted rip-offs and harmless jokes as demeaning insults. Projection is the chief defense mechanism of paranoia. Using projection, the person attributes her own unacceptable impulse or feeling to others. (" I don't want to attack you. You want to attack me!", or, "I'm not jealous. People are out to get me because they're jealous of me!") People with Paranoid Personality Disorder often believe that another person, or organization, has wronged them permanently. They may believe that they were swindled in a business deal, or that some government agency has changed or destroyed records in order to prevent them from getting something. They are preoccupied with doubts about the loyalty of their friends and associates. These people guard their personal information carefully and may refuse to answer questions, assuming that the information will be used against them somehow.

People with this disorder respond angrily to the perception that others are out to do them wrong. They may become preoccupied with ideas of revenge. They may wage an endless struggle to correct some perceived injustice and attempt to enlist attorneys, physicians and others to assist them in their quest for the "missing records" or their goal of suing some government official, bank, or business. Although these individuals have a great deal of difficulty cooperating with others, they may band together in cults with a few others who share their simplistic and stereotypic view of the world.

Schizoid Personality Disorder, also part of the odd and eccentric group, is less colorful. These people show a pattern of social detachment. They show little emotion. People with this disorder greatly prefer to be by themselves. They are "loners" who prefer mechanical activities, like working with computers or doing math games. They have little interest in sex and do not pursue romantic relationships. People with Schizoid Personality Disorder may appear cold and aloof, and may not care what others think of them. People with this disorder often go against the grain of social expectations. They may not return social gestures like smiles, nods, or greetings. Despite the outward appearance of being bland or empty, people with this disorder often have a rich and elaborate fantasy life. Withdrawal from the social world is the principal defense mechanism of Schizoid Personality Disorder. Even though they shrink from human interaction, these folks may be very self-critical and very keen observers of the human condition.

Schizotypal Personality Disorder is the third member of the odd or eccentric cluster of personality disorders. People with Schizotypal Personality Disorder perceive connections between unrelated events. Their thinking is magical and superstitious. They may be preoccupied with the paranormal or believe that they have power to see the future or to control the future with thoughts or rituals. Some people with this personality disorder may believe that they can "sense" the presence of others, or read their minds. They may have unusual perceptions, such as hearing a voice murmuring their name.

Unlike schizoid people, schizotypal personalities want relationships, but have a great deal of trouble making it happen. This personality disorder causes someone to be anxious in social situations and to be very aware that he does not "fit in". Although most of us have some anxiety at meeting new people, our anxiety gets better as the meeting goes on. This is not true for people with Schizotypal Personality Disorder. Their anxiety gets worse. Others notice right away that schizotypal people are odd. These folks have difficulty adhering to social conventions. They may avoid eye contact. They dress haphazardly and without regard for any known style or fashion. Their clothing may be mismatched, dirty, or poorly sized. Schizotypal people often use strange words or use common words in unusual ways. There has been some debate about whether Schizotypal Personality Disorder is simply a mild form of Schizophrenia. There is general agreement, however, that it is a true personality disorder, stable and predictable, not fluctuating and progressive.

Last week, I quoted Dr. William Osler as having said, "It's as important to know what kind of patient has the disease as to know what kind of disease the patient has." You can see how that applies, for example, to depression. Anyone can develop Major Depressive Disorder. However, the individual's personality style often determines the treatment and its outcome. Imagine a depressed woman with Paranoid Personality Disorder. She is wary of her doctor. He must be up to something. Why is he asking her all these personal questions? The doctor seems nice, but maybe he's just pretending to be nice so he can trick her into taking medicine to "control her mind". Now, imagine a woman with the same degree of depression, but with Schizoid Personality Disorder. She might want to take antidepressant medicine but might not want to see a therapist. She might find it repellant to share her thoughts and feelings. She might be puzzled by her therapist's questions and really have little to say about herself. Finally, a depressed woman with Schizotypal Personality Disorder might disagree with her doctor about why she is depressed. She may believe that her depression is caused by food additives, solar radiation, or people who are sending out "bad vibes". If she agrees to take medicine, she will see connections between the medicine and unrelated events. In therapy, she will feel anxious and misunderstood. She may tell her therapist long-winded rambling stories having no connection to her depression. Mental health professionals who focus only on symptoms, and who use a one-size-fits-all approach to interacting with their patients, will quickly run afoul of these strong personality undertows, and the treatment will founder. Next week we'll take a look at more personality disorders - the emotional and dramatic group.

Dr. Dingley is a psychiatrist at Evergreen Behavioral Services in Farmington. He may be contacted at adingley@fchn.org.

Let me begin by pointing out that schizophrenia has nothing whatsoever to do with having a "split personality", whatever that is. Schizophrenia is a psychotic disorder in which thoughts, speech, behavior, and perception may become disorganized.

A person with schizophrenia may use words incorrectly, invent words, or put words together in ways others can't understand. Behavior may become disorganized as well. A person with schizophrenia may dress in layers of heavy wool clothing in summer, or go barefoot in winter. He may avoid all human contact, hoard useless items, and become agitated or even violent. A person with schizophrenia may have ideas which are plainly incorrect, yet remain unable to change these ideas when he sees evidence to the contrary. These fixed ideas are called delusions. Examples include ideas that one is being filmed with cameras everywhere she goes, that people are entering her home or apartment and removing things or leaving evil items, that her blood is contaminated, that "transceivers" have been implanted in her brain, or that all her internal organs have been removed. Schizophrenia may distort the senses. These experiences are called hallucinations. People with schizophrenia often hear sounds, particularly voices that others around them do not hear. They may see things that others do not, or they may report that things "don't look right".

In addition to these more dramatic disturbances of thought and behavior, schizophrenia may leave the person lethargic and unmotivated. Thoughts and speech may slow down to a snail's pace. Observable emotion (affect) may "flatten" until the person's face becomes expressionless. The person may appear depressed but deny feeling sad. Schizophrenia is distinguished from other psychotic illnesses, in part, by its duration. The symptoms must persist for six months to warrant a diagnosis. Although the disease may remit after six months, it is usually life-long.

Schizophrenia is a very serous illness because it leaves a person vulnerable to all sorts of difficulties such as unemployment, homelessness, social isolation, chronic medical illness, and substance abuse. The rates of suicide, alcoholism, and tobacco addiction in people with schizophrenia are many times higher than in the general population. Rates of serious medical conditions, such as heart disease and diabetes, are higher in folks with schizophrenia.

Although we have much to learn, a good deal is known about this disease. It most often strikes in the second and third decades of life, the teen and young adult years. Often the onset is gradual and easily confused with the more harmless oppositional and idiosyncratic features of adolescence. Healthy teens may lack motivation, clam up, dress in weird clothes, or appear fascinated with the supernatural, the spiritual, or the occult. However, kids who are evolving a major mental illness become isolated from friends and groups. They are not joining a spiritual movement or dressing like other people they admire - they are simply odd.

Only about one percent of the population has schizophrenia. Men and women are affected equally often, but women may have later onset and tend to have a more benign form of the disease. There is a clear genetic component, but schizophrenia is not simply "inherited". Identical twins have the same genetic makeup, yet, if one twin has schizophrenia, the other twin has less than a fifty-percent chance of developing the illness.

There are some things which make schizophrenia worse. Many people with schizophrenia refuse medicine, whether for their mental illness or other conditions. This makes the disease hugely worse. People with schizophrenia may abuse alcohol or drugs. This increases their confusion and may result in anxiety and depression, while contributing to homelessness and unemployment. Rejection, or loss, of "natural supports" like family, friends, work, and church result in a much greater degree of disability.

What is the treatment for schizophrenia? Individuals affected by this illness need many kinds of assistance. Adequate housing is crucial. The homeless mentally ill are often victimized. Well-trained social workers, who meet with their clients weekly, provide invaluable assistance navigating the maze of services. A person with schizophrenia may be too confused or frightened or lethargic to locate available help on her own. Supportive family members are the strongest source of help for people with mental illness. Severely mentally ill people without close family ties are at a big disadvantage. Regular paid employment is extremely important on the road to recovery from severe mental illness. Work has an organizing and uplifting power that is the equal of any other treatment we have. Medicines for schizophrenia work to reduce hallucinations and disorganized thinking by blocking a chemical in the nervous system called dopamine. There are many such medicines available. Beyond the fact that each of them blocks dopamine, their characteristics vary widely. As in the treatment of any disease, the goal is to select a particular medicine which will address a particular patient's symptoms, not interact with other medicines, and not aggravate other illnesses. These medicines are very effective for many of the symptoms of schizophrenia, but the medicines must be taken consistently. This is difficult for people with severe mental illness. It is uncommon for people with schizophrenia to take medicine consistently for more than a year. When the medicine is discontinued, the illness flares up and disorganization increases. Sometimes, the person needs hospital care to get back on medicine and re-oriented to reality. There has been a lot of blather in the "news" about the side effects of some medicines for schizophrenia. This has generated a lot of heat and smoke, but not much light. The mortality from schizophrenia, particularly suicide, far exceeds mortality from many infections and many cancers, yet we aren't bombarded by "news" stories on the potential side effects of antibiotics and anticancer drugs.

Even though schizophrenia is a serious persistent illness, there is an excellent chance for recovery by taking medicine consistently, securing safe affordable housing, staying away from drugs and alcohol, paying attention to diet and exercise, looking to family and friends for support, avoiding stress, and locating at least part-time employment. In fact, people with schizophrenia, using this approach to managing their illness, have been able to use their unique thoughts and perceptions to produce great works of art, music, and literature.

People who live through a horrific event may be affected by the experience for a long time. This has been recognized for centuries. Veterans of military combat were described as having "shell shock" or "combat fatigue" when they had psychological problems which persisted after the fight was over. United States military doctors and psychologists began to think differently about this phenomenon during the Viet Nam war. Their observations led to a more exact description and definition of what we now call Posttraumatic Stress Disorder (PTSD).During the last thirty years, there has been growing recognition that civilians who have endured, or witnessed, terrible events sometimes exhibit the same persistent difficulties seen in combat veterans.

Research by the Veterans Administration began to confirm that the symptoms of PTSD could appear later, not just immediately after the traumatic event. The VA also began to explore effective treatments for PTSD.PTSD can result from experiencing near death, actual or threatened serious injury, or actual or threatened violation of one's physical integrity. Sometimes, PTSD can result from witnessing the death or injury of another. PTSD has been known to result from having unexpectedly learned that a close friend or family member was killed or injured. Examples of non-combat events of this magnitude are assault, robbery, rape, kidnapping, motor vehicle accidents, and natural (or man-made) disasters.


During the event itself, a person may react with intense fear, helplessness, or horror. If the person has one of these reactions to such an event, he is at risk of developing PTSD. When that happens, he has three types of symptoms.First, the traumatic event is persistently re-experienced. This may happen in dreams, or during wakefulness. The dreams or intrusive thoughts are vivid and create a sense that the traumatic event is actually happening. These unwanted recollections may result from cues that resemble or symbolize some aspect of the traumatic event.Second, the person goes to some lengths to avoid these cues. He may make a conscious effort to avoid thoughts, feelings, people, places, or things which remind him of the event. He may also use unconscious methods to avoid cues, such as feeling numbed, forgetting aspects of the event, losing interest in activities, or keeping feelings flat or bottled up.


Third, the person has an exaggerated "fight-or-flight" response. He may have insomnia, irritability, decreased concentration, hyper vigilance (unnecessary watchfulness), or may be easily startled.When these symptoms have lasted more than a month, and when the symptoms cause impairment in functioning, the person has PTSD. Although everyone with PTSD, by definition, has all three symptom clusters, the intensity of each symptom differs with the individual and with the type of traumatic event he experienced. There is some evidence that if the traumatic event was inflicted by another person (as opposed to an accident or natural disaster) symptoms are more apt to include problems with regulating emotion, self-injury, impulsive behavior, hopelessness, and hostility.


What other conditions can be confused with PTSD? Acute Stress Disorder may follow a traumatic event. The symptoms are the same but resolve in less than four weeks. Other anxiety disorders, such as Obsessive-Compulsive Disorder, with its intrusive disturbing thoughts, may mimic PTSD. People who are becoming psychotic, especially people with paranoia, may be anxious, hyper vigilant, avoidant, and having intrusive disturbing thoughts. People with Borderline Personality Disorder are exquisitely sensitive to perceived rejection and are quick to interpret negative interactions with family members and close associates as "abuse". They may ruminate about past "abuse" when things go badly in real time. It is not clear that people can forget a traumatic event, such as childhood sexual abuse, and then suddenly remembers it years later. Many of these experiences are the work of incompetent psychotherapists who have unintentionally created false memories in their clients by the power of suggestion. "Recovered memories" of childhood abuse were the basis of many lawsuits against accused abusers ten to twenty years ago. Now, "false memory syndrome" is increasingly the basis of lawsuits brought by clients and family members against therapists whose work "uncovered" evidence of forgotten abuse.


What makes PTSD worse? Drugs and alcohol always make PTSD worse. The side effects of alcohol, and many illegal drugs, include depression, anxiety, paranoia, memory loss, decreased concentration, and greater impulsivity - things a person with PTSD doesn't need. Avoidance, although it does not make PTSD worse, always makes it permanent. People with PTSD who avoid work, hobbies, relationships, and social interaction will never get better. Psychotherapy which focuses on the past, not the present or future, can increase the symptoms of PTSD.


How is PTSD treated? It was hoped that "debriefing", or counseling, immediately after a traumatic event would help prevent PTSD. Although there was never any evidence for this, it seemed intuitively correct. Versions of "critical event debriefing" or "grief counseling" have been widely provided in disasters or in schools where there has been a traumatic event such as a student suicide. Research has shown this approach to be worthless.


There is some evidence that treating people who have been exposed to horrific events, immediately after the event, with medicines called "beta blockers" can prevent PTSD. Once the symptoms have developed, however, medicine is less useful. Although medicines can relieve some of the symptoms of PTSD, they should be prescribed sparingly. Indeed, to the extent that medicines simply allow the person to avoid the unpleasant aspects of her condition, pills may prolong the symptoms.


The most effective treatment for PTSD is cognitive-behavioral therapy. CBT teaches skills which make people more effective in controlling their thoughts, feelings, actions, relationships, and self-image. This form of treatment is most effective in a group setting. Participants complete "homework" assignments between sessions. The homework allows people to practice putting their skills to work in the real world, not just in therapy sessions. Avoidance techniques (conscious and unconscious) must be identified and overcome.As with most psychiatric illness, recovery depends upon sobriety, family supports, and attention to physical health through diet, sleep, and exercise. Regular, purposeful activity (preferably, paid employment) is the equal of any other form of treatment.

Although children's brains are injured by accidents, and less commonly by infections or tumors, developmental disabilities are present from birth. The condition is often treatable, but permanent. There are many developmental disorders. This column discusses only three: Asperger's Disorder, Autistic Disorder, and Mental Retardation.

Asperger's Disorder causes severe impairment in a child's ability to interact with others. The child has normal curiosity about his environment, as well as normal intelligence, adaptive behavior, and language acquisition. The impairment of Asperger's Disorder is from a serious disruption of the child's ability to relate socially. This disruption results from two types of difficulty.

First, the child is unable to understand, or use, nonverbal social cues. These include making eye contact and using, or "reading", facial expression, body posture, or hand gestures. Children with Asperger's Disorder ignore these things. These children have difficulty sharing enjoyment, interests, or achievement with others. They don't understand how other people feel. They have trouble forming friendships with children their own age.

Second, the child with Asperger's Disorder has a restricted range of interests. He may become intensely preoccupied with one subject, to the exclusion of everything else. One child with Asperger's Disorder became completely preoccupied with vacuum cleaners. He collected product information on vacuum cleaners, compared their specifications, wrote to the manufacturers with questions, and talked incessantly about vacuum cleaners, even to people who had no interest in the topic. A child with Asperger's Disorder may follow detailed, purposeless, routines. He may make stereotyped, repetitive movements like flapping his hands or twisting his fingers. Asperger’s Disorder is more common in boys. Adults with Asperger's Disorder have continual trouble getting along with others because they disregard normal social cues and have no grasp of how others are feeling.

Autistic Disorder is all over the news these days. Everyone has something to say about it, even (and, perhaps, especially) people who know next to nothing about it. Much of this is driven by junk science. There are many internet websites promoting wiggy ideas about Autistic Disorder. These include the idea that Autistic Disorder is caused by vaccinations, or food additives, or fillings in our teeth. Periodically, the idea re-surfaces that autistic children are mentally normal, just trapped by their inability to talk normally. It would be great if any of this were true.

Autistic Disorder is a severe developmental disability which is always evident before the age of three. Often, it is apparent from infancy. It impairs a child's interest in the outside world. She is unable to use language effectively. Speech is delayed, rudimentary, or altogether absent. She doesn't appear to understand questions, directions, or jokes. She cannot carry on a conversation. A child with Autistic Disorder does not acquire written language normally. She does not play games. As a person with Autistic Disorder matures, he shows a very restricted range of interest and may be preoccupied with a few stereotyped behaviors. He may become very attached to a random object or fascinated by moving things. He may insist upon following the same purposeless routine or performing the same ritualistic behavior over and over. She often makes abnormal, repetitive, movements or maintains odd posture.

People with Autistic Disorder often have other problems. At least three quarters of children with Autistic Disorder have mental retardation, and most of that number have an I.Q. between thirty-five and fifty. The child may also have hyperactivity, impulsivity, aggression, self-injury, and temper tantrums. She may swallow inedible objects. She may have no fear of dangerous things.

Autistic Disorder is not common. There are perhaps five cases per 10,000 people. Boys are five times more likely to have this disorder. Special education programs, behavior plans, and, sometimes, medicines are helpful. Young children typically show improvement. Adolescence, however, is the watershed. Although teens with Autistic Disorder may continue to improve, some deteriorate behaviorally. Only a small percentage of adults with Autistic Disorder are able to live and work independently. Even these folks will continue to have marked problems with interaction and will live very constricted lives.

Mental Retardation (MR) is a more common developmental disability. Children with MR have intellectual functioning that is well below average. One standard measure of intelligence is the Intelligence Quotient (I.Q.). Intelligence tests have been designed so that the average score will be 100. About half of the Earth’s population has an I.Q. below 100, and the other half above 100. The majority of people have an I.Q. between 85 and 115. Roughly 94% of people have an I.Q. between 70 and 130, leaving only about 3% at either extreme. The relatively few who score over 130 are "referred to" as gifted. The relatively few who score below 70 are "diagnosed" as having Mental Retardation if they also have significant limitations in communication, self-care, employment, and the like. Until the early part of the last century, people with MR were classified diagnostically as Morons, Imbeciles, or Idiots. Although we now fling these words as insults, they were not originally meant to be demeaning. Today, MR is classified as Mild, Moderate, Severe, or Profound. About 85% of all people with MR have Mild Mental Retardation. They will be proficient academically at about the sixth grade level, and may be able to live independently as adults with some supervision. About 10% of all people with MR have Moderate Mental Retardation. These folks will acquire very basic (second-grade) academic skills. A person with Moderate MR can be expected to perform simple work, with help, and adapt to community life in a supervised setting, such as congregate housing or a group home. Only about 3-4% of all people with MR have Severe Mental Retardation. These folks may read a few words. They require a good deal of assistance, but can be expected to perform simple tasks. They require close supervision, either by family, or in a group living facility.

Historically, Mental Retardation was often caused by lead poisoning, metabolic defects, poor prenatal care, and maternal drinking. We are getting better at preventing these. Today, in most cases, the cause of MR is not known. However, there are many, many genetic conditions which cause Mental Retardation. The most common of these is Down Syndrome. People with Down Syndrome are often recognizable by their short stature and characteristic facial features. They most often have Mild, or perhaps Moderate MR. Although they are prone to some additional physical problems, these folks do very well with some assistance.

People with MR may have other problems, such as aggression or inappropriate sexual behavior, which challenge caregivers. In addition, people with MR can have the same psychiatric illnesses as anyone else. Diagnosing and treating these psychiatric problems can be tricky, since the necessary information must come from other sources, such as the family, the case manager, and residential, vocational, and day-program staff. It is crucial to get "360 degrees" of input, not just the point of view of one person. There may be philosophical differences among caregivers on what is driving the symptoms or how much latitude the person with MR should have in matters like sexuality or making purchases. When all these parties, including the person with MR, are "on the same page", a psychiatric problem can usually be identified and treated effectively.

Depression is a disorder of mood. People with depression feel sad. Sometimes, people with depression completely lose the ability to feel good about the things they used to enjoy. It's a serious illness. The World Health Organization reports that depression is the most common cause of disability across the Globe. In order to understand why this is true, we have to begin by looking at things which look and feel like depression but are caused by something else.

Chronic stress can make people feel sad and helpless. Poverty, unemployment, physical illness, loneliness, and difficult relationships are common causes of stress. Basically, the stressed person is having a normal reaction to bad circumstances, and the usual treatments for depression don’t work very well.

Grief certainly makes people sad, and can interfere with appetite, sleep, and concentration. Grief, although it feels like depression, is the normal human reaction to loss. Death of a loved one is a common cause of grief, but other losses, such as loss of a marriage, career, physical health, or even a beloved pet, can be debilitating as well. Unresolved grief can surface years later and masquerade as an episode of depression.

Medical problems can mimic depression. Obesity, physical reconditioning, thyroid problems, sleep apnea, and chronic pain all result in fatigue or lethargy. A person who is continually fatigued may begin to feel guilty over not getting things accomplished and may begin to believe that things will never get better.

Drug and alcohol addiction may cause mood changes that feel like depression. As soon as the intoxicating effect of an alcohol binge wears off, the drinker feels depressed. Alcohol is simply a depressant drug. Marijuana famously causes inertia, memory problems, and mood changes. When the euphoria of stimulants, like amphetamine and cocaine, wears off, the frequent user feels terrible. Stimulant drug addicts often lose the ability to enjoy the ordinary pleasures of daily life without the drug – a true devil's bargain.

People with personality disorders often have brief bouts of "depression" which are brought on by unfortunate interactions with other people, or by negative thoughts. Medicine does not help with this type of "depression", although some forms of psychotherapy are very helpful.
In the elderly, dementia may cause a condition which looks like depression. People with Alzheimer's dementia, or dementia from stroke, may become apathetic or have pronounced mood changes along with their memory loss.

Now, if someone has been sad, or has lost all interest in life, for at least two weeks straight, and their difficulty is not the result of one of these other problems, she may be having a Major Depressive Episode. (There is no diagnosis of "clinical depression", and the expression is meaningless to mental health professionals. I'm not sure how that "diagnosis" worked its way into the common parlance.) In order for two weeks of sadness, or loss of interest, to be considered a Major Depressive Episode, the person must have at least four from the following list of difficulties: appetite disturbance with weight change, problems with sleep, agitation or lethargy, decreased energy, feelings of worthlessness or guilt, diminished concentration, and thoughts of death.

How long does depression last? An untreated Major Depressive Episode will last nine months to a year. Anyone who has had a Major Depressive Episode can be said to have Major Depressive Disorder. Sometimes, people have repeated episodes of depression. In fact, if you have had an episode of major depression, there is more than a fifty-percent chance you will have another. If you have had three episodes, there is a ninety-percent chance of having a fourth.
How common is Major Depressive Disorder? If you are female, your lifetime risk of having at least one episode of major depression is twenty percent. If you are male, your lifetime risk is about ten percent. This means that, for the whole population, the lifetime risk is fifteen percent. Rates for both men and women are highest in the 25-to-44-year-old age group and lowest in people over 65. The lost productivity and disability from depression can be translated into a colossal sum of money. About fifteen percent of people with untreated Major Depressive Disorder commit suicide. In the United States alone there are more than thirty thousand suicides annually. This morbidity and mortality, combined with the prevalence of depression, result in a rate of disability which exceeds all other illnesses.

What makes depression worse? People with depression are extremely vulnerable to the usual stressors: poverty, unemployment, and physical illness, isolation, and relationship problems. Negative thinking often contributes to depression. Alcohol is a particularly nasty drug for depressed people because alcohol is a central nervous system depressant. Alcohol interferes with the frontal lobes of the brain causing disinhibition. Disinhibition plus depression equals suicide.

How is depression treated? Eating well, getting enough sleep, and getting regular exercise are very important to people recovering from depression. Regular, scheduled, purposeful activity, preferably from employment, is very important. As for many psychiatric illnesses, work has an organizing power which is the equal of any other treatment. There are many medicines for depression. None works better than the others. None can say that it is the best. The goal is to select the right medicine for each individual. We know that an untreated episode of depression will last for about a year. So, for a first episode of depression, medicine should be continued for a year. The medicine can be withdrawn after that. If depression returns, medicine should be taken for three years before it is discontinued. If depression returns again, it is reasonable to take medicine continuously, since your odds of having a fourth episode are ninety percent.

Electroconvulsive therapy (ECT) is powerfully effective for depression. ECT is reserved for people who have been failed by medicines and psychotherapy because it is expensive and invasive. ECT is done under general anesthesia in hospital day-surgery units. Modern ECT bears no resemblance to the "shock" treatments depicted in popular movies. Side effects are uncommon and improvement is rapid. The limitation of ECT is that, as with medicine, treatment has to continue for substantial periods of time. Most people who do well with ECT need treatment every six weeks or so. One promising new treatment for depression is Tran cranial magnetic stimulation. This is being standardized by research in large medical centers like Massachusetts General Hospital in Boston.

There are an endless number of unproven "treatments" for depression offered by companies and individuals with no education or training in mental health. Most of them claim to use "natural" supplements or some type of "energy". These are a waste of time and money. If any of them worked, your doctor would have been using them years ago. Depression is a very serious illness. Delaying treatment by pursuing "alternative" methods is about like delaying treatment for cancer or heart disease.