Mood: The Key to Understanding Ourselves and Others - Softcover

Patrick M. Burke

Softcover

ISBN 10: 1616148330 ISBN 13: 9781616148331

Publisher: Prometheus, 2013

Synopsis

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.

About this title

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.

Excerpt. © Reprinted by permission. All rights reserved.

MOOD

The Key to Understanding Ourselves and Others

By Patrick M. Burke

Prometheus Books

Copyright © 2013 Patrick M. Burke
All rights reserved.

ISBN: 978-1-61614-833-1

Contents

Acknowledgments, 9, 
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, 
Notes, 193, 
Index, 229, 

CHAPTER 1

OVERVIEW

We are told that nothing in the world is certain except death and taxes. Butwe can add a third certainty. We are always in a mood. What is more, weare constantly faced with references to mood: popular tunes of happinessor sadness; pundits opining that the economic mood of the country will determinethe outcome of an election or that the mood in the locker room will determinewhich team wins the game; advertisements telling us a product will change ourmood and our lives. Mood is everywhere and somehow is linked to what we findimportant and meaningful. Emerson described life as a train of moods strung likebeads, 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 andhow the change occurs. It seems we can neither command nor will our mood tochange. Rather, our mood changes, and it is only after the change that we realizewe are in a different mood. Most of the time, we pay little attention to changesin our mood or how the changes occur. But the change can be disturbing. Wefind we are sad, anxious, uneasy, or feel threatened. If the new mood interfereswith our ability to function, the change may amount to a mood disorder. Formany, these disorders can be destructive to their lives and can warrant professionalattention. How does this happen?

We have good reason to suspect that difficulties with mood originate indevelopmental events. Changeable moods are accepted as part of childhood andadolescence. Take, for example, the irritable colicky infant, the temper-pronetoddler and preschooler, or the moody adolescent. There is abundant evidencethat most psychiatric disorders among adults that involve significant changes inmood first become evident in youth. At a clinical level, the annual rate of depressionin adolescents is estimated to be 5–9 percent, and in prepubertal childrenthe rate is estimated to be 1–2.5 percent. Between 2–5 percent of youth arediagnosed 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 theunderlying 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, andmuch research is geared toward understanding how genes and environmentsinteract to produce disorders. Similarly, research in personality developmentshows the importance of individual temperament. Advances in the neuroscienceshave implicated brain circuits and other bodily systems, and these arealso subject to genetic and environmental influence. Moreover, there has beenmassive growth in pharmacological treatments, as well as in psychosocial treatmentseach with its own school of thought and practitioners. Complicatingmatters further, diagnosis and treatment, especially in youth, have become controversialissues. Advances in all these areas have been rapid and have originatedfrom a range of disciplines. As a result, the available information is widely distributedin literature and is so complex that, unless you have some expertise inthe 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 ourselvesas agents in the world? Are we passive and simply subject to our genes and ourenvironments? What role do we play or can we play? Can mood be linked toresponsibility? Is there a way to address these questions and unify the abovethemes to guide the nonexpert?

Despite the breadth and depth of current studies, surprisingly little attentionhas been paid to the subject of mood itself and mood disorder. Most often, the focusis on emotion and mood is simply subsumed, used interchangeably with emotion,or is subordinated to cognitive activities. This book takes a unique approach bytreating mood as a central controlling factor that from childhood becomes thebasis upon which we choose and act, and sets the stage for how we are throughoutlife. The basic idea is that mood connects the person and the world, and this connectionis 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 systemsthat continually process information about the world, then the feelings of moodand the associated bodily systems provide the mechanism for the connection. Theyenable the assessment of possibilities and become the basis for action.

Development comes into the picture because genetic and environmentalinfluences starting with the fetus create the underlying systems. The stressresponse system, which is active when destabilizing events occur, is especiallyrelevant because it has profound influence on developing neural circuits. Howthis system functions influences the degree to which someone is vulnerable orresilient when something challenging happens. Disorders involving changes inmood emerge as breakdowns in the connections occur, and resilience comesfrom the connections being able to surmount challenge.

The book is organized as one possible roadmap that ties together the manybiological and social factors that not only shape development and functioningbut 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 ofthe 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 thebasis of action. The basic idea derives from Martin Heidegger, primarily hismajor work Being and Time. Although Heidegger did not write about children,we have adopted some of his central insights and placed them within adevelopmental context. The first theme is nested in a second theme—we areself-constituting. If we consider the self as a way of being, then who we are asagents is realized only by what we do and by what we make of ourselves as welive an active life. Relationships with others are at the core of these processes.Complex interactions between the child, other people, and the world underliethe child's struggles with becoming autonomous and responsible for himself.Mood, by revealing our possibilities, plays a fundamental role in developmentbecause development is the step-by-step process of becoming self-constituting.Interactions with others and the world have mood at their core, and they reciprocallyare at the core of how mood develops and can be changed.

To illustrate this approach, imagine a child as a stringed musical instrumentwith its combinations of strings and sounds. The tuning—mood—of theinstrument at any given moment is how the child tunes into the world. But thechild is a constantly resonating living organism. Therefore, a mood is alwayspresent and since a child has many strings and combinations of strings, manymoods are waiting to emerge. From the earliest beginning, genetic and environmentalinfluences form the strings, and throughout life continue to influencethe strings. The tuning underlies how events appear to a child, rather than beinga reaction to an event or how the child thinks about things. When somethinghappens, the child's strings reverberate and the resulting mood depends on thetuning of the individual string. The child's tuning (mood) alerts him to the possibilitiespresent, paving the way for him to choose and act.

Chapter 2 examines mood and what mood does and attempts to differentiatemood 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 usand that typically involve others around us. Things matter to us because eachof us is uniquely disposed or attuned to the world. Our attunement reveals theworld to us, and our attunement is mood. He elaborates that what and howwe experience is a function of our involvements with things, and especially ourinvolvement with others. Relationships and situations present possibilities, andour tuning differentially disposes us to the possibilities presented. As we interactwith the world, our senses provide information. Moods (how you are tuned tothe world) also provide information and reveal the situation. They tell us whatmatters and has significance.

Think of yourself as a very nervous and fearful person, who is walking alonedown a darkened street. Certain features, like doorways and shadows, stand out.Your mood (fearfulness) alerts you to possible danger and provides the conditionsfor you to react with fear (an emotion) should something happen. Mood islike 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 ahappy 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 possibilitiespresented to us is limited, and we vary in skill and understanding on how toproceed. This brings us to Heidegger's ideas about fundamental moods and hisconcept 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 followingour social and cultural roles and avoid any underlying anxiety about ourbeing. But when critical events occur that bring us face to face with our finitebeing, the submerged anxiety reveals the fragility of the way we live, and we'refaced 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, wellbefore 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 relatedemotions (sadness, guilt, anger, fear), emphasizing the role interpersonal relationshipsplay. The chapter introduces temperament, a key construct that ispartly defined in terms of characteristic moods and forms the building blocks ofpersonality. Later chapters discuss the relation of temperament and personalityto the emergence of anxiety, depression, and disruptive antisocial behavior.

The third theme is that mood and tuning arise through the activity ofcertain neural networks and body systems. The underlying concept is thatthe body is a framework through which we perceive the world, and the possibilitiesoffered by the world. Imagine a six-month-old infant lying on the floor andplaying with small blocks. The infant grasps a block, stares intently at it, puts in hermouth, exchanges it in a fumbling way for another, drops one, and searches untilshe picks up another block, which again goes in the mouth while her small handmanipulates it. This infant is experiencing the world of blocks through her bodilysenses—touch, sight, and taste. She is forming some rudimentary sense of the possibilitiesof the blocks, and in so doing of her world.

Chapter 4 discusses how the nervous system analyzes and evaluates informationabout the world, enabling and coordinating our reactions and responsesby organizing the activity of neural networks involved in mood and emotion.How these networks are made, and how they function, sets the tuning of eachchild. We can think of the circuits as the strings of the instrument. Assumingthe 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 formthe circuits (the strings of the instrument) and set how they function in dailylife and under conditions of stress. Individual differences in behavior reflectfunctional differentiation within the circuits. The stress response (chapter 6)is a complex array of neurohormonal processes that is activated when a potentiallydestabilizing event occurs. A variety of genetic and environmental influencesaffect the stress response, and interactions and relationships with othersare crucial influences that are essential for its normal development. How thissystem responds plays a large part in the development of the personal characteristicsassociated 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 familywith 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 (andadults) respond positively and effectively, but others respond in negative and/orineffective ways. Someone who responds well in one type of situation may not doas 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 factorssuch as genes, stress, and the environment involved in mood disorders? Individualdifferences are key to understanding what happens. Chapter 6 introduces somecurrent models that are helpful in explaining how multiple influences (genetics,early experience, temperament and other characteristics of the child, relationshipswith others) may interact to leave some individuals vulnerable and others resilient.The models can also be the basis of prevention and treatment efforts suggestingboth targets and strategies for intervention.

The fourth theme is that disorders emerge out of the interaction of events andthe functional status of neural circuits and systems. When vulnerable children arefaced with stressful events, significant alterations may occur in mood, behavior,and biological functions. Particular patterns of dysfunction underlie the principaldisorders in youth that are characterized by mood disturbances: anxiety, depression,bipolar disorder, and antisocial/oppositional disorders. Such features tend tocluster, and the clusters are the basis of the diagnostic categories. The diagnosticsystem is currently in transition. Chapter 7 sketches some key background issuesto the diagnostic process and outlines key changes in the new manual.

Chapters 8–10 consider the main disorders that involve mood and moodchanges. Although the focus is on youth, the relevance to adults is indicatedthroughout. In each case, the mood and emotion component is explored alongwith neural circuitry and the stress response to illustrate from a developmentalperspective how the disorders come about and manifest and why they oftenoccur together. It will be seen that in each case, the disorders have typical moodand emotion profiles, physiological changes, and action patterns. They alsoshow substantial overlap; the stress response system has a role in each; and relationshipsplay central roles both by influencing the development of mood andthe circuits underlying mood, and by the role they play in precipitating disorders.In each case current research on neural circuits and the stress response areexplored, and shows common patterns of activity in circuits related to moodand emotion. Anxiety (chapter 8) is characterized by worry and fear and is concernedwith present or future threats of harm. Anxiety disorders reflect dysfunctionin circuits underlying fear, manifest the physiological changes reflectingflight or fight, and action is typically avoidant. Sadness and negative thinkingcharacterize depression. Depressive disorders (chapter 9) are concerned withloss, reflect dysfunction in neural circuits involved in mood, manifest physiologicalchanges reflecting altered stress responses, and diminished activity. Bipolardisorder (chapter 10) involves mania and depression. Elated or irritable moodand grandiose thinking characterize mania. It can be viewed as a dysfunctionof neural systems underlying reward. The stress system plays a role, and activitylevels are increased. This disorder is increasingly and controversially diagnosedin children and adolescents. The background to the controversy is explored, andproposed changes are discussed.

(Continues...)

Excerpted from MOOD by Patrick M. Burke. Copyright © 2013 Patrick M. Burke. Excerpted by permission of Prometheus Books.
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Edition details

• Publisher: Prometheus
• Publication date: 2013
• Language: English
• ISBN 10: 1616148330
• ISBN 13: 9781616148331
• Binding: Paperback
• Number of pages: 256