In an Atlantic essay called "The Science of Success," David Dobbs writes about two types of children: "orchids" and "dandelions." Dandelion children tend to do pretty well no matter what environment they grow up in. Orchid children, meanwhile, may develop behavior or mood problems in abusive or neglectful homes — but in loving ones, they may thrive even more than dandelions. And according to new research, the difference between dandelions and orchids may be genetic. For instance, kids with a certain variant of a dopamine-processing gene are at greater risk of ADHD and "externalizing behavior" (i.e. "acting out") than other children. But in one study, these kids also improved much more in response to a video-based behavioral intervention than did kids who didn't have the at-risk variant. Similarly, rhesus monkeys with another gene variant (one associated with depression in humans) are worse at processing serotonin than their peers if they are raised as orphans. But when raised by a loving monkey mother, these seemingly at-risk animals process serotonin more efficiently than other monkeys, and are also more socially successful. These and other studies suggest that certain genes confer not risk per se, but a kind of openness to environmental stimuli, positive or negative. Dobbs writes,

At first glance, this idea, which I'll call the orchid hypothesis, may seem a simple amendment to the vulnerability hypothesis. It merely adds that environment and experience can steer a person up instead of down. Yet it's actually a completely new way to think about genetics and human behavior. Risk becomes possibility; vulnerability becomes plasticity and responsiveness. It's one of those simple ideas with big, spreading implications. Gene variants generally considered misfortunes (poor Jim, he got the "bad" gene) can instead now be understood as highly leveraged evolutionary bets, with both high risks and high potential rewards: gambles that help create a diversified-portfolio approach to survival, with selection favoring parents who happen to invest in both dandelions and orchids.

Dobbs spends a lot of time talking about the population-level implications of this new idea. He points out "that a genetic trait tremendously maladaptive in one situation can prove highly adaptive in another" and that "every society needs some individuals who are more aggressive, restless, stubborn, submissive, social, hyperactive, flexible, solitary, anxious, introspective, vigilant-and even more morose, irritable, or outright violent-than the norm." If the orchid hypothesis is true, then perhaps a certain number of people who react extremely strongly to their environment, even if these reactions seem negative to our modern eyes, may be important to the flexibility and survival of our species. But what I found most interesting about Dobbs's piece was its implications for the individual. Dobbs writes of his decision to get tested for a gene variant that increases depression risk but may also confer orchid-like properties. A depression sufferer himself, he turned out to have the variant. Dobbs writes,

[A]s I sat absorbing this information, the chill came to seem less the coldness of fear than a shiver of abrupt and inverted self-knowledge-of suddenly knowing with certainty something I had long suspected, and finding that it meant something other than I thought it would. The orchid hypothesis suggested that this particular allele, the rarest and riskiest of the serotonin-transporter gene's three variants, made me not just more vulnerable but more plastic. And that new way of thinking changed things. I felt no sense that I carried a handicap that would render my efforts futile should I again face deep trouble. In fact, I felt a heightened sense of agency. Anything and everything I did to improve my own environment and experience-every intervention I ran on myself, as it were-would have a magnified effect. In that light, my short/short allele now seems to me less like a trapdoor through which I might fall than like a springboard-slippery and somewhat fragile, perhaps, but a springboard all the same.

In this early age of genetic testing, it's easy to think of genes simplistically — and since most testing is still meant to predict disease, our genotypes sometimes begin to seem like maps full of danger signs. But human beings (and monkeys, too) are extraordinarily complicated, and what seems like a risk may also be a blessing. We still tend to see depression, anxiety, ADHD, and other mood and behavioral abnormalities as defects — if a child is "at risk" for one of these, she needs to be protected as though from a gathering storm. Yet to be at risk may also be to have a unique opportunity.

If the orchid hypothesis is true, then people like Dobbs may possess a plasticity that makes them more vulnerable to sorrow and yet also more capable of change. This would have enormous implications for those suffering from certain mental ailments. Perhaps along with their difficulties, their genes have granted them a tool for solving them — and beyond that, for reaching new heights of personal fulfillment. It would also have an impact on how we raise and teach kids. Some have already speculated that children with ADHD need something different from the one-size-fits-all American educational model. If it's true that some kids are uniquely influenced by environment, then maybe what we need is not to try to make them more like other kids — the current approach — but rather to construct the environment that will best help them thrive. This is likely to be difficult, and expensive, and for these reasons it may not catch on. But we might have much to gain, both as individuals and as a society, by seeing a springboard where we once saw a trapdoor.

The Science Of Success [Atlantic]

Details of Kim's death are still emerging. This morning, Paris Match wrote that sources inside the police investigation say the model left a suicide note. Fellow gossip title Le Parisien stated that "multiple sources" are saying that Kim's father, a Samsung executive, does not believe his daughter killed herself. Kim's mother flew to Paris on Friday, and her father arrived in the city today. An autopsy is to be performed tomorrow — standard police procedure for violent deaths — and the pathologist's findings may be known as soon as the end of this week.

Friends of the young model are also speaking to the press. Several people told the Telegraph that Kim, in the words of reporter Kim Willshire, "had become fed up with modeling and its demands, considering her life was too frenetic and incompatible with forming the sort of long-term relationship she hankered for." Another anonymous friend said Kim would sometimes dodge her agency's calls in order to carve out some time for herself. One of Kim's former agents said, "She was an excellent model, but she used to say she had hard times off the job."

But the richest source of information on Daul Kim remains her blog. The temptation of recent posts that referenced feeling "mad depressed and overworked," a poem that reads in part, "i just know / the more i gain / the more lonely it is," and, most of all, the fact that her last post was titled "say hi to forever," has apparently been too much for major news sources to resist. These mostly quote selectively, ignoring the fact that Kim said she felt depressed and overworked in Seoul and was happy to be leaving for Paris, that Kim titled virtually all of her posts with "say hi to..." and that the post in question was just a YouTube clip of one of her favorite house DJ's tracks, and that in her poem, the lines about feeling lonely were followed directly by lines about falling in love. "but when people grow together," wrote Kim, "its something that is not easy but is nice / and that is something."

It's probably a good thing Kim died in Paris, not in New York, or else we'd have to contend with Geraldo Rivera's opinions of her verse, and television cameras filming the removal of her body, as we were treated to last year, when 20-year-old Kazakh model Ruslana Korshunova jumped to her death in the financial district.

It's understandable that reporters would look to a blog for insight into its author's mind when the author is no longer available for questioning, but it should be done in such a way that the excerpts accurately reflect the whole. Kim often wrote about being busy, yes, and sometimes seemed lonely — but she also wrote about loving Milan Kundera, Klaus Kinski, and Boy George, joked about how she would make a good wife one day, and posted pictures of her paintings. (She had a solo show in Seoul in 2007.) In one of her earliest posts to I Like To Fork Myself, she wrote mock-seriously about ending her life, and then immediately followed up: "KIDDING. I'm fine. Just tired." The overwhelming impression given in her blog wasn't that of a depressive lost soul crying out for help in post after tragically ignored post: it was of a smart young woman with an interesting life, managing bewildering array of responsibilities with a wickedly dark sense of humor. And some issues with insomnia. Not everything in her life should now be re-evaluated in light of her death. To try and turn it all into a series of "signs" diminishes the person that she was.

While it's natural that her next of kin would want to put a stop to quoting out of context, Kim's words have already been featured in articles published from here to Australia. The "I know I'm like a ghost" quote, the "mad depressed and overworked" quote, they're out there. They will be repeated from article to article, from broadsheet to broadsheet to tabloid to tabloid, until all context is erased. Ending access to Kim's blog, while it may tamp down interest in the short term, in essence only serves to deny interested parties a chance to glimpse the wider context of Kim's life. Or at least to see her life as she wished it to be understood. While of course, in the case of a 20-year-old's death, there are no parties more "interested" than her actual family, blogging was evidently important to Kim — she found time to write sometimes several times daily, even as she traveled to three or four countries in a week — and in my opinion, it would be a shame if the record of her life Kim chose to publish were to go permanently dark after her death.

I Like To Fork Myself [Official Site]
Daul Kim: Model 'Had Become Fed Up With Work' [Telegraph]
Daul Kim, La Jolie Fleur S'est Fanée [Paris Match]
Daul Kim S'est-Elle Vraiment Suicidée? [20Minutes.fr]
Enquête Relancée Après Le Suicide Du Mannequin Daul Kim [Le Parisien]
I Know I'm Like A Ghost: A Cry For Help Before Dying [Sydney Morning Herald]

Earlier: 5 Fashion Model Blogs That Are Actually Interesting

Interesting item in Newsweek: Sharon Begley discusses new findings (discussed in Scientific American]that strive to determine if there's any evolutionary benefit to what we consider clinical depression, a subject much on the minds of certain brain researchers. The questions: is a little depression not just natural, but healthy? In scientific terms, is there some reason for the Black Dog? This implies a fundamentally different way of considering what's been termed a mental illness. Say the study's authors, "There is another possibility: that, in most instances, depression should not be thought of as a disorder at all. " Here's how Begley describes it:

Writing in the journal Psychological Review, postdoctoral fellow Paul Andrews of Virginia Commonwealth University and psychiatrist J. Anderson Thomson Jr. of the University of Virginia present research suggesting that depression is present in the species, and in individuals, for a purpose, and we're playing with fire if we try to eradicate it. In evolution-speak, depression is an "adaptation," they argue. That is, it evolved because it made individuals who experienced it fitter, under natural selection, than individuals who did not experience it. Andrews and Thomson-who is best known for research on the psychology of religious belief, and who has also studied whether antidepressants threaten love and fidelity-offer as evidence the presence of a molecule in the brain called the 5HT1A receptor. This serves as a docking port for the neurochemical serotonin, which the Prozac/Zoloft/Paxil class of antidepressants targets. Human brains are not the only ones with the 5HT1A receptor. Rats also have it.

And said receptor's important to recognizing and dealing with stress and threat, rather than leaving us (and rats) in a perpetual state of unwary bliss. "In other words, losing the receptor that promotes depression in response to stress is something evolution thought would be a very bad move. Ergo: depression is not something to be thrown out lightly." Indeed, it's suggested that depression can lead to analysis and solutions, focused thinking, and even "negative" depressive traits - such as self-isolation or loss of libido, ie the reason we take Paxil - that may serve an adaptive function.

There are some really interesting points in here: are we overmedicated? Probably - and a little sadness, as the author says, should not be the bogeyman it's become in our times. But clinical depression - either human or rat - is a dicier issue altogether. As these researchers would surely be the very first to point out, even if depression can be proven to have en evolutionary purpose, as we all know, what's good for us as humans isn't necessarily good for us as people. Then too, it seems pretty logical that plenty of modern stimuli - to say nothing of pharmaceuticals, diet, chemicals, environment - could have a hand in that depression that Mother Nature had absolutely nothing to do with. Then there's the other elephant in the room: depression can lead to suicide - which, in the small scheme, isn't helping anyone's progress. It's both fascinating and reassuring to know that there may be an evolutionary rationale for what can feel like an unfair genetic curse, and with any luck, if true, this will be of substantial use to researchers. But as it stands, I'm not canceling that Lexapro prescription any time soon.

Depression's Evolutionary Roots [Scientific American]

The Upside Of Feeling Down [Newsweek]
The Bright Side Of Being Blue [APA]

According to Roni Caryn Rabin of the Times, the report, published by members of the American Psychiatric Association and the American College of Obstetricians and Gynecologists, recommended that doctors try talk therapy first if a woman's depression is mild or moderate. But it also said that the risks of antidepressant use and shock therapy on the developing fetus are low. Dr. Kimberly Yonkers, the lead author of the report, says,

There's not a one-size-fits-all answer. You can't say, ‘Stop medication for all women because it's harmful,' and you can't put all women on medication either.

Most pregnant women can probably agree that there is not a one-size-fits-all answer to their depression (for proof, check out the Times commenter who says she cured her PPD by drying and eating the placenta). But beyond that, the report may not give them much guidance. The authors still caution that because of the lack of randomized clinical trials on pregnant women, research on drug side effect is limited. And four of the report's nine authors had some connection to drug companies, casting all their drug recommendations into a certain amount of doubt.

Paxil, Celexa, and Zoloftall seem to increase the risk that a baby will be born with a hole in the heart. The holes often close on their own, and the risk of the defect is less than 1%, but it increases if the mother took more than one SSRI. SSRIs can also raise the risk of persistent pulmonary hypertension, a condition that impedes blood flow to the baby's lungs, but the risk of this is also low, about 1.2%. Perhaps the greatest risk is that of drug withdrawal, experienced by 15 to 30% of babies born to moms who took SSRIs late in pregnancy. This can cause irritability, hypoglycemia, and even seizures in babies, but usually gets better within two weeks. Untreated depression, of course, has its own risks. In addition to the dangers to the mother, it may contribute to premature birth, growth changes, or irritability in babies.

Not all clinicians even agree with the report's relatively mild recommendations. Dr. Shari Lusskin says,

By the time I get to hear about somebody's perinatal depression, it's usually worse than what can be treated with psychotherapy alone, because women go out of their way not to complain; they don't want to be put on medication, and they feel guilty. We should use a low threshold for treating women aggressively.

And though the report emphasizes the relatively small risk of drug side effects, many women aren't reassured. One commenter on the Times Well Blog, who suffers from bipolar disorder, wrote,

I've been stable for a long time, but going off all my medication might change that. A high-risk perinatal physician recommended that I stay on everything, because depression and manic psychosis may be harmful to the baby. But my psychiatrist recommended ceasing all medication for at least the first trimester, which is the phase where the developing embryo is most sensitive to mutagens. Her recommendation is that I should go off everything and then, if I have a problem, I should use electroshock therapy. I have decided that this is the right path to take. But I'm still putting it off.

Rabin interviews Sherean Malekzadeh Allen, who says, "Every single thing you put in your body when you're pregnant, you wonder, ‘Oh, my God, am I growing my baby an extra finger?' I was worried that I would hurt the baby if I took the pills, and I was worried I would hurt the baby if I didn't." She was so anxious about hurting her baby with her medication that, "I would wait six or seven hours before taking the pill, and just work myself up into more of a state." Ultimately, her son was born healthy.

Given the low risk of serious birth defects from antidepressants, Allen's story — in which the biggest side effect is maternal guilt — is probably the most common. The APA/ACOG report may have its problems, but at least it doesn't issue any blanket pronouncement that might add to this guilt. It may not be a very useful guideline, but it's true that depression, whether during pregnancy or not, should be evaluated on a case-by-case basis, and that what works for some sufferers won't always help others. For those pregnant women who respond well to talk therapy, the choice seems clear. But those who need medication have to balance the risks to their babies with the benefits of having a happy, healthy mother. Like so many aspects of parenting, this balance is individual, and the report deserves praise for acknowledging that.

Image via New York Times.

Depression Is A Dilemma For Women In Pregnancy [NYT]
Coping With Depression During Pregnancy [NYT Well Blog]

• It's believed that Hitler took a cyanide pill and shot himself in his Berlin bunker in April 1945. The Russians said they dug up his burnt and buried corpse, with a bullet in the head, and finally cremated it in 1970, saving the jawbone and a fragment from the skull. American archaeologist Nick Bellantoni, who was allowed to examine the fragments in Moscow, says, "The bone seemed very thin - male bone tends to be more robust. It corresponds to a woman between the ages of 20 and 40... There is no report of [Hitler's wife Eva Braun] having shot herself or having been shot afterwards. It could be anyone's." • Several California domestic violence shelters have closed in recent months because Governor Arnold Schwarzenegger eliminated financing for the state's Domestic Violence Program due to a budget gap. "The governor understands how difficult these cuts are," said Schwarzegnegger's spokesman. "But he can't promise money we don't have." Many shelters have had to cut back on staff, counseling services, safe visitation centers, and legal services like help obtaining restraining orders. • A 14-year-old British girl died today after receiving the Cervarix vaccine as part of a national immunization program in the U.K. Doctors say no link can be made between her death and the vaccination before the post-mortem is performed, but the batch of vaccine used has been quarantined. • Couples in Chonqing, China's biggest provincial municipality, will not be allowed to divorce during an eight day holiday beginning on Thursday celebrating 60 years of communist rule. Officers at marriage registration centers said they can't cope with the high demand for weddings during the holiday and issue divorces. • University of Washington researchers found that depression, obesity, and alcohol abuse or dependency are interrelated conditions among young women but not men. Carolyn McCarty, the study's lead author, says, "Body image is particularly important for women. There seems to be a transfer that when women feel bad they eat more. That can have devastating effects emotionally and physically. But for men experiencing obesity, the reverse is true, and obesity seems to be protective against depression. It's the so-called 'jolly fat man' theory, which suggests that overweight people are actually happier." • Scottish researchers found the transmission of HIV among heterosexuals is slower than among homosexual men, "The slower dynamics of the heterosexual epidemic thus offer more opportunity for successful intervention, but it is essential that diagnosis is achieved as early as possible," said study leader Andrew Leigh Brown. • A Malaysian religious court appeals panel upheld the sentence of Kartika Sari Dewi Shukarno, who will receive six cane strokes for drinking beer. The 32-year-old mother of two had refused to appeal her sentence, saying she wanted to serve as an example to other Muslims. Her father said, "She is ready to face her punishment and all she hopes for now is that it be done professionally and according to procedures set out in Islam." • Author Annette Gordon-Reed won the $25,000 Frederick Douglas Book Prize for her history book The Hemingses of Monticello: An American Family. The prize is awarded every year by Yale University's Gilder Lehrman Center for the Study of Slavery, Resistance, and Abolition for "the best book written in English on slavery or abolition." • 92-year-old Jane Bockstruck of New Hampshire completed a "flawless" skydive earlier this month. "I must have read it someplace and all of a sudden, 'I'm going to go skydiving.' So I did," Bockstruck said. "I've done so many things in life, I figured I'd just try something different for a change."

The ABC News story by Susan Donaldson James is a little frustrating. We find out that Vilar (in the video above, reading from an earlier book) has a troubled family history — she was born in Puerto Rico, where by 1974, 37% of women of childbearing age had been sterilized in an American-led experiment. Her mother had a hysterectomy with no hormone treatment at age 33, which led to depression, addiction, and eventually suicide. Two of her brothers were heroin addicts. As a teenage college student, she met her future husband, a 50-year-old professor who believed "having children killed sexual desire." Their marriage was troubled, and she engaged in self-mutilation and attempted suicide — but here's where things get confusing. James writes,

Vilar's pregnancies became compulsively self-destructive: After her 9th and 10th abortions, she "needed another self-injury to get the high."

"In the beginning I was taking pills and I'd skip a day or two or give up one month," she said. "I'd think I'll be better next time. But slowly, my days took on a balancing act and there was a specific high. I would get my period and be sad, then discover I was pregnant, being afraid, yet also so excited."

Vilar's description of what happened "after her 9th and 10th abortions" is disturbing, but what happened before then — how did she get to nine? Did the cycle of self-destruction actually began much earlier, was her husband uncooperative about birth control, did they decide to try for children and then back off? And, given that Vilar is obviously an extreme case, do these questions matter at all to the larger abortion debate?

Both James and Vilar are trying to make them matter. In the place where she might have explained to us what was going on between abortions one and nine, James instead gives us statistics about women who have multiple abortions. 10% of women who have one procedure, she says, will have three or more. She writes that "little is known about these women" but that for them, some research "might indicate mental problems." She also quotes Vilar, who says that women who have multiple abortions exhibit "recklessness."

But was Vilar really "reckless," any more than someone who self-harms by cutting is "clumsy?" Her 15 abortions seem like the product of depression and a bad relationship, not a cavalier use birth control — her contraceptive lapses became, as she says, intentional. That said, "little is known" about Vilar, because James doesn't give us her full history. She's too concerned — and, to be fair, Vilar is on board as well — with painting her as a type of "woman who has multiple abortions."

At first glance, Vilar seems like the perfect example for pro-lifers who think abortion rights encourage women to throw caution to the winds. But really, she's an example of how people who are desperate and depressed can do strange and disturbing things. Given that she saw abortion as a form of self-mutilation, it seems likely that she would have gotten dangerous back-alley procedures if she had to. And if for whatever reason abortion hadn't been available at all, she might well have turned to another method of "self-destruction."

Vilar says,

Women have a deep need for agency, for purpose and direction and society is not providing natural and healthy channels for creative action.

In school and on TV, every message I get is what I am doing as a mother or wife is wrong. I should be thinking about a profession and not mothering. Everyone is having babies, and yet they don't want to care for them.

Are many of the repeat abortions in part an embodiment of this mixed message? A lost, ambivalent attempt at an act of agency that cannot find its proper vessel?

I'm not sure that "many of the repeat abortions" can be explained in this way — or in any one way. But it would be interesting to see how a conflicted culture of motherhood influenced Vilar's particular form of "addiction" (a word she uses). Unfortunately, we don't really get that story.

Abortion Addict Confesses 15 Procedures In 16 Years [ABC]
Irene Vilar [Official Site]

Most of the nastiness about women's supposed gloom — all of it stemming from one study that purports to show women are less happy than they were in the 70s — has come from people who think the answer is getting back in the kitchen. Luckily, Maureen Dowd doesn't take that tack. Instead, she catalogues the various reasons why life these days sucks for women. There's the vaunted "second shift," in which women with careers are still expected to take care of home, hearth, and kids. There are various sexual inequalities — "men can age in an attractive way while women are expected to replicate - and Restylane - their 20s into their 60s" and "men also tend to fare better romantically as time wears on." And there's the (dubious) idea that "women are much harder on themselves than men." A factor Dowd doesn't mention: all these fucking articles on women's unhappiness.

Though as a women in my 20s I'm not yet supposed to have entered the downward spiral of despair that is apparently the province of my gender, nothing makes me sadder faster than reading that I'm destined for a life of socially-imposed depression. It's true that there's disproportionate pressure on women to raise successful children, maintain a spotless home, and hold down a job, all while looking like they're too young to do any of these. This is a serious problem — but does it have to ruin our lives?

I'm not even convinced that it has. The much-cited happiness study, as I mentioned before, was based on self-reports, and the advent of the self-help genre and a culture of therapy, downsides notwithstanding, has made it more acceptable than ever for women to talk about what's bothering them. Men, despite their much-ballyhooed ability to stay attractive into their later years (which we know is impossible for women) still don't have as much freedom in this department, which may be one reason men are less likely to be diagnosed with depression. The fact that women are allowed, even expected, to reach out to their friends when in trouble may be the reason that women actually cope better than men with the death of a spouse. Dowd says "men have an easier time getting younger mates," but maybe — shocker — having a younger mate isn't the key to lifelong bliss.

We should be working to fix the inequalities Dowd mentions — especially those, like the "second shift" that could benefit from social programs like subsidized childcare. But it's a little hard to work from a position of despair. If we get mired in misery over a society that wants us to be ever younger and more industrious, we won't have the energy to change that society. Nor will we be able to rebel against expectations by actually enjoying the old age and laziness we're always told to resist. What's more, focusing too much on women's unhappiness, as though it's a forgone conclusion in an unjust world, ignores all the good things in women's lives that patriarchy and stereotypes can't touch. I'm not suggesting we all slump back on our couches in complacent contentment — far from it. But anyone who knows a happy woman — particularly one who's had something shitty happen to her — knows it's possible to be both angry and joyful. It may even be necessary.

Blue Is The New Black [NYT]

Researchers used data from the Nord-Trondelag Health study that included information about the drinking habits and mental health of more than 38,000 participants. They found that those who reported no alcohol consumption during a two-week period were more likely to report depression than moderate drinkers (defined by the U.S. Department of Health and Human Services as drinking no more than one drink a day for women, and no more than two for men. Of course, standards may be different in Norway).

The highest risk for depression was found among the group who called themselves "abstainers." Researchers are not sure how to explain this. Indeed, it seems strange that depression would be found among those who do not self medicate with alcohol. We have become used to associating alcoholism with depression, so it is surprising to have abstinence linked to mental illness as well. Researchers also found that 14% of the abstainers had previously been heavy drinkers, which kind of makes sense, but does not explain the connection for the other 86%. The only explanation suggested by the authors of the study is that, in societies where drinking is common, even normal, abstinence may be associated with the socially marginalized, or with particular personality traits that are associated with depression.

But all hope is not lost for the non-drinking depressed folk: Some scientists believe that depression may serve an evolutionary function. Various studies have found that people in a depressed mood are better at solving problems, both social and mathematical. An article published last week in Scientific American expounds on the theory that the tortuous ruminations that characterize the severely depressed may in fact aid in problem solving. The critical thinking involved in depression may have lead our brains to evolve with a predisposition toward sadness. "The capacity to feel presumably helps us solve problems and survive, and is essential for group living, and perhaps inconsolable depression is simply emotional baggage that tags along with the good stuff. Or maybe unhappiness and a tendency towards suicide is the product of the uncontrolled nature of our quicksilver minds," wrote Meredith Small in an article for LiveScience last year.

Alcohol Abstinence Linked To Depression [UPI]
Why Did Evolution Produce Depression [LiveScience]
Depression's Evolutionary Roots [Scientific American]

Newser's Lindsey Tanner writes that although previous research indicated that about 2% of preschoolers suffer depression at some point, researchers didn't know if this depression could become chronic in kids so young. To determine this, the study followed 306 preschoolers, 75 of whom had major depression. They found that in 64% of children who were depressed at the start of the study, depression continued or recurred six months later. 40% were still suffering a full two years later. The findings are surprising because, as study author Dr. Joan Luby says, many psychologists thought "children under 6 were too emotionally immature to experience" depression.

The researchers found that toddlers were most likely to be depressed if they had depressed mothers, or if they had suffered abuse or the death of a parent. Psychiatrist Dr. Helen Egger says depression has different signs from ordinary toddler moodiness — kids seem sad even while playing, play death-themed games, throw especially violent tantrums, or become obsessively guilty over minor mistakes. However, it's not clear how clinicians should treat depressed toddlers. Some people are against prescribing drugs like Prozac to kids so young, but if left untreated, says psychiatry professor Dr. David Fassler, depression "can have a devastating and often lasting effect on a child's social and emotional development."

Early intervention may be helpful for a variety of mental illnesses, according to an article by researcher Mary E. Evans. For instance, cognitive behavioral therapy lowers the rate of depression in high-risk adolescents. But toddlers aren't teenagers, and it's not yet clear what kind of intervention might prevent their depression from becoming a lifelong problem. One thing's for sure — antidepressant use is on the rise across almost all American demographic groups, and might rise even more if more toddlers were diagnosed with depression.

Whether this is a good thing is up for debate. Many people get enormous relief from antidepressants, but the increase in their use hasn't corresponded with an overall improvement in American mental health. In fact, says Dr. Eric Caine, the suicide rate for middle-aged people in America is rising. Of course, that doesn't mean antidepressants aren't working — it could mean that life in America is just getting worse, or that the drugs aren't being prescribed to those who need them most. But since antidepressants can raise the risk of suicide in children, prescribing them to the very youngest kids isn't without its problems.

Still, depressed kids clearly need help, especially when depression starts before they even start school. Putting a face on this heart-wrenching illness is the HBO documentary Boy Interrupted (clip above), in which filmmakers Dana and Hart Perry chronicle the life of their son Evan. Evan first started talking about suicide in kindergarten, and was, according to Salon's Heather Havrilesky, "obsessed with jumping out a window." He killed himself at 15. Havrilesky calls the film "a smart, thoughtful and informative glimpse at a short life that sheds light on how tough it can be to recognize and effectively treat a kid." If Evan's life is any indication, it's a problem we still haven't solved.

Mental Illness Can Be Avoided In Youth [UPI]
Depression Affects Preschoolers [UPI]
U.S. Antidepressant Use Doubles In Decade [UPI]
Not Just A Cranky Toddler: Study Finds Depression In Children As Young As 3 [Newser]
Antidepressant Use Doubles In U.S., Study Finds [MSNBC]
Depressed Nation? [LA Times]
Critics' Picks [Salon]

A Time article on the Melanie Blocker-Stokes Postpartum Depression Research and Care Act (oddly, written by someone named Robert McNamara, presumably not the deceased former Secretary of Defense) says that although the bill doesn't specifically set aside money for postpartum depression screening, critics think screening would "naturally increase" if it passed. They say this could lead to false positives (as few as a third of women whose initial postpartum depression screen is positive actually have the disease) and unnecessary medication. Supporters of screening counter that postpartum depression is far from rare — up to one in seven moms get it — and that we routinely screen babies for conditions that are much less common. And screening might prevent tragedies like that of Melanie Blocker-Stokes, the act's namesake, who jumped off a building when her child was 3 1/2 months old.

It's hard to argue with increased funding for research into a condition that kills some new mothers and plunges many more into misery — not to mention putting babies at risk. At the same time, there's something a little "Yellow Wallpaper"-y about assuming that all women are in danger of flying off the handle and harming themselves or their kids. Psychologist Paula Caplan notes that adjusting to motherhood is tough, and we shouldn't assume that everyone who has some difficulty with it is mentally ill. Rather, we "should be addressing the social factors causing women to be upset after they give birth, not locating the problem within the women." Women's studies professor Ingrid Johnston-Robledo offers a similar opinion: "We need to find a way to come down in the middle: acknowledge women's depression but not assume that all women who struggle with the transition to motherhood are depressed." But that would mean developing a measured, considered response to a potentially divisive issue. Can we do that in this country?

The Melancholy Of Motherhood [Time]

The research in question shows that 4 out of 10 women cited "depression" as a reason to go on a shopping spree, while 6 out of 10 cited "feeling a bit low." Psychology professor Karen Pine said, "this type of spending, or compensatory consumption, serves as a way of regulating intense emotions," and speculated that worries about the recession might send some women into an emotional tailspin, in which they want to shop to relieve their stress but don't have the money to do so. The study says nothing about men, and frankly we're a little skeptical that women are the only ones who spend money to make themselves feel better. AdRants's take on the whole thing is pretty annoying: "if women had more paws for shopping bags, they'd probably be a lot less depressed. For the next eight minutes, anyway." Actually, we'd probably be less depressed if people stopped assuming women were materialistic, fickle shopaholics. Thanks!

Because Who Needs Hands... [AdRants]

The story is about men who commit mass-murders and suicides, spurred by several recent cases in which men killed their families prior to suicides. Not one expert quoted in the piece calls it love, though.

Unaccredited researchers said this, though.

For decades, psychiatrists have been studying such cases to determine what mental issues trigger this behavior. A person who kills his family could have control issues that lead him to decide the fate of the children, spouse and pets, researchers said.

Donna Cohen, a professor and head of the Violence and Injury Prevention Program at the University of South Florida, said something similar:

The person with a mental illness views his wife and children as possessions, believing, "I have to keep this. This is mine," Cohen said. "Nobody else is able to take care of them except me. If I can't control this in my life, I'll preserve it in death so that my world doesn't change. It's the psychiatric issues."

She adds that pre-murder domestic violence often plays a large role.

"People don't get involved, even when they know there's threat in violence because they believe they don't think anything will happen," Cohen said. "It's essential to get to domestic violence safe houses and be much more proactive in understanding there are people who have problems."

Louis Schlesinger, forensic psychology professor at John Jay College of Criminal Justice in New York City thinks that it's partially narcissism.

"They think they're saving their family and that they will be remembered with sympathy," Schlesinger said.

You know, like if CNN memorializes them as having killed "out of love."

Dr. Philip Resnick, director of the division of forensic psychiatry at Case Western, says that the men often suffer from mental illness which wreaks havoc on their perceptions of the world.

"They become very depressed as the breadwinner," Resnick said. "With their distorted, depressive perceptions, they feel that rather than allow their children to go hungry, they may feel they're doing a favor to take their family with them as they end their own life. ... They're not depriving them of life, they're ending what they see as an intolerable life."

Richard James Gelles, dean of the School of Social Policy and Practice at the University of Pennsylvania, agrees that it might be misplaced "altruism" derived from mental illness.

"They couldn't leave people behind to be ashamed and humiliated"

You know what none of them say? That men who kill their families do it out of love. Because they don't.

'Hopeless' Dads Kill Their Families Out Of Love, Experts Say [CNN]

Merkin has been in the news lately for her involvement with the Madoff scandal (her brother funneled money into Madoff's scheme), but her essay, "A Journey Through Darkness," covers more personal territory. She says she feels "as if in exiting the womb I was enveloped in a gray and itchy wool blanket instead of a soft, pastel-colored bunting," and that she was first hospitalized at age ten "because I cried all the time." The recent bout of depression that forms the focus of her essay was so severe that she not only lost thirty pounds but developed psychomotor retardation, moving slowly and speaking in a flat voice.

As obvious as these symptoms seem, Merkin was frustrated with how un-obvious her disease was. She writes,

The real question was why no one ever seemed to figure this grim scenario out on her own, just by looking at you. This was enraging in and of itself - the fact that severe depression, much as it might be treated as an illness, didn't send out clear signals for others to pick up on; it did its deadly dismantling work under cover of normalcy. The psychological pain was agonizing, but there was no way of proving it, no bleeding wounds to point to.

Because it lacks "bleeding wounds," Merkin feels, her illness doesn't seem real — even in comparison with other mental illnesses. Of the anorexia sufferers at her hospital, she writes,

They were clearly and poignantly victims of a culture that said you were too fat if you weren't too thin and had taken this message to heart. No one could blame them for their condition or view it as a moral failure, which was what I suspected even the nurses of doing about us depressed patients. In the eyes of the world, they were suffering from a disease, and we were suffering from being intractably and disconsolately - and some might say self-indulgently - ourselves.

But, as Carrie of ED Bites points out, "people with eating disorders are blamed for their illness, when it is even seen as an illness. Eating disorders are generally seen as some sort of failure—if not the sufferer, then clearly her parents." It's tempting to judge Merkin for assuming the anorexics have it easier, but one of the saddest things about the essay is how her illness isolates her even from other mental health patients, how she constructs a moral hierarchy of disease and puts herself at the bottom. The unfortunate reality is that, in society's moral hierarchy, all mental illness still lies at the bottom, too often ignored or dismissed as self-indulgence. This is changing, but Merkin's piece shows how deep the stigma still goes, and how difficult it is for those stigmatized to advocate for themselves — especially when their disease makes them feel that they are "a failure. A burden. Useless. Worse than useless: worthless." While Merkin's envy certainly seems misplaced, the blame for this belongs not with her but with her disease — and with the society that sometimes fails to recognize how real and serious this disease is.

A Journey Through Darkness [New York Times]
A Journey Through Darkness [ED Bites]

This morning, Anna sent me the link to a typically dispiriting 'kids today' tale of woe, from the Daily Mail, no less. It deals with the "rise of the child-woman" a terrifying breed of tweens who swathe themselves in Tammy Faye-levels of M.A.C. and obsess about calories and implants. Their mothers fall into the usual camps, depressing BFFs who buy their 10-year-olds pedicures, and bewildered types apparently lacking in any authority, who take a "what can I do?" approach to the precocious monsters who apparently sprung, fully-formed and scantily clad, from their loins and homes. So, nothing new there. Then BoingBoing put up a post to a series of thought-provoking photos of "dead-eyed" Russian children of privilege, which didn't do much for the day's portrait of the future of the world.

Whenever I am faced with one of these "news stories," in which the younger generation is presented as an ungovernable monolith sexting wildly in knockoff Louboutins , I mentally thank goodness, ironically enough, for that lead horseman of the youth-deadening apocalypse, MTV. Or, more specifically, for Made. It's one of the happier consequences of a recent bout with the Black Dog (as Churchill called his depression) that I rediscovered the venerable MTV makeover show in which, for you rock-dwellers, high-school kids realize a far-fetched dream with the help of a "coach" and a sizable MTV budget. And it's a bracing reminder that, even with high-budget editing, there are kids out there working hard, treating each other well, and surviving high school.

In the throes of sadness, I found that watching old episodes of Made (all backlogged on MTV.com) was the only thing that made me feel better - hell, that made me feel inspired! I started slow, with nerds-making-good, because I identified more with the quiet outsiders, even if I didn't fully understand their desires to become prom queens or members of their school's "streamer" teams (and wow, it's a crash course on regional customs, too.) For those who don't know the formula, kid faces skepticism and derision from family and schoolmates; coach takes kid in hand and makes him get out of his comfort zone; kid realizes it's hard and slacks off; coach loses temper and there's a battle of wills; kid buckles down and triumphs before amazed peers. There's generally some sort of goal kid and coach are working towards - be it a concert where a bookish loner will impress with his rap skills, a school pageant where an outsider shatters preconceptions about her social skills, or some kind of try-out. Even if a kid doesn't make the team or win the contest, they usually learn, grow and change enough that everyone feels satisfied, and it's never less than feel-good.

Having watched my way through every nerd-becomes rocker/bookworm-forms-dance-crew/outsider becomes ladies' man, I was forced to move on to popular-kids-challenging-stereotypes. To my shock, I found this subgenre even more inspiring! While it's easy to see why someone would want to become Homecoming Queen or learn to date, I found I admired the kids who (in the HS sense) had it made and opted to take on robot science or debate. While their challenges rarely result in spectacular results - these skills tend to be hard to master in six weeks - I was warmed by the unlikely friendships these resulted in between brains and jocks, cheerleaders and debaters.

Now, you might ask, who wouldn't want to be on MTV? And of course other kids are going to be nice to someone who's getting screen-time. Well, sure, and no doubt this has motivated a good number of the show's subjects. However, the reality of the work-load, the genuine difficulty of the goals, always tends to offset this. Do some girls agree to date the Made dork who obviously wouldn't give him the time of day otherwise? For sure. Do some people 'place' in competitions where they otherwise wouldn't? Probably. But less often than one might think! And what's heartening, always, is the genuine enthusiasm the other kids evince for their accomplishments. I'm not just talking about fellow students; the youthful commenters on the message boards are, generally, earnest and supportive, too. Maybe you're chalking this endorsement up to the vagaries of chemical instability, and I'm not saying this is something I'd have dived into with such enthusiasm had I been a bit heartier. But I'm glad I did. And I defy anyone to watch "John is Made into Prom King" without crying tears of relief, exultation, and true joy.

Rise Of The Child Women: The New Breed Of Girls As Young As Ten Who Dream Of Manicures, Diets And Breast Implants [Daily Mail]
A Train-Wreck Of Privilege [Boing-Boing]
Made, Official Site [MTV]

So now post-partum depression is not just a mom issue. There's even a site called SadDaddy.com, run by Dr. Will Courtenay, who says that whether a man will become depressed depends on whether his partner is depressed: "Half of all men whose partners have postpartum depression are depressed themselves," he says. He also counts stress, economic concerns, anxiety and hormone changes as factors in male postpartum depression. Yes, hormones. "Men's hormones change. too, both during pregnancy and early in the postpartum period," he explains. "Our testosterone levels go down, and our estrogen levels go up.Our testosterone levels go down, and our estrogen levels go up."

But even more unnerving is what Dr. Courtenay calls the "signs of depression" in men:

When we think of a depressed person, we usually picture someone who's sad and crying. But if we picture instead a guy who's working 60 hours a week, is a little short-tempered, drinks a couple of beers at lunch, slips out of the office to have an affair, then speeds home to his wife, that's not what we picture when we think of depression, but those are some of the signs of men's depression, which can often look different.

Yes. An affair. Additionally, Dr. Courtenay says:

One of the things we hear from men is that they have difficulty hearing a child crying uncontrollably. It's one of the things that seems to stand out the most. There's a kind of helplessness that men are not used to experiencing. We like to feel confident, so when we can't make this helpless infant feel better it creates a lot of difficulty.

Really? Really? Look, of course we should take depressed new dads seriously. But is it supposed to be easy to hear a crying child? Newsweek's Christina Gillham asks, "Surely there are many who might think, "Hey, wait a minute-I went through the nine months of pregnancy, I went through the grueling labor, I'm staying up all night doing all the breastfeeding-and you're depressed?'" Dr. Courteney's answer is that it speaks to "our cultural denial of men's depression in general." But is this about denial? Or expectations? Because even though having a child is a life-changing event for both a mother and father, don't women expect men to put emotions aside and "man up," as it were? And if drinking at lunch, affairs and avoiding a crying baby are sympotms, what's the difference between a man with postpartum depression and a total jerk?

Understanding Male Post-Partum Depression [Newsweek]