Depression in Regard to Modes of Alertness

Lately, the class has been focused on how people experience culture. Culture affects people differently based on the extent to which an individual lives up to the culturally prescribed prototype. William W. Dressler’s model of cultural consonance targets this effect. This disentrainment to the primary cultural model creates stress and may be lead to depression. But what exactly is depression? In his 2013 article “Give Me Slack: Depression, Alertness, and Laziness,” John Marlovits describes depression as a mode of alertness.   For Marlovits, alertness can be viewed as one of many organizing principles that mediates everyday life. Specifically, depression is a process constituted by many enactments of alertness used to control what Marlovits describes as “affective currents.” These currents are recognized but not necessarily understood or categorized. Like the wind, the currents are felt yet invisible.

Marlovits’ ethnographic work in Seattle (18 months 2003-2004) left him with a sense of how different depressive enactments culminate in different modes of alertness.   Seattle was chosen for its pop culture definition of being a city in response to urban decay, a city more authentic, a city more grounded. Marlovits found that the reality of Seattle was in juxtaposition to this pop culture narrative. As represented by the dilapidated Kalakala art-deco depression-era ferryboat, Seattle as an imagined community was hopeful and nostalgic. The real Seattle could not measure up to this idea of an apocalyptic refuge and the depressive enactments of its inhabitants underscored this contradiction. For an informant named Steve, his response to a life-threatening heart attack was agency panic, meaning that he felt that something was a bit ajar after the incident but that he had the willpower to escape full on depressive symptoms. Marlovits’ coffee consumption, a habit in line with capitalism and the protestant ethic, led to a “pace” of life that was distinctly alert whereas the smoking habit of clients from a mental health clinic promoted more disengagement and “ellipsis in time.” Both coffee consumption and cigarette use are forms of self-medication and ways in which we entrain ourselves to a certain life tempo. Engagement and disengagement are thus everyday habits of alertness and help order time.

Marlovits seeks to tie alertness back to depression with the pop culture persona “Slacker” and the very real persona of Kurt Cobain. Cobain, the lead vocalist for Nirvana, represented alertness that was at once “confused” and “distorted.” His music and stage persona promoted “sensing the present,” which was a strong current in the act of self-harming. Cobain’s “passivity” and “despondency” typified the slacker identity as particularly defined in Richard Linklater’s 1991 film “Slacker.” The slacker’s inattentiveness can just be a way of disengaging to slowly “feel out” the new conditions of life. Why not “go with the flow” and eventually re-engage once the shock has run its course? Slackers are “lazy visionaries.”  Depressive enactments, acts of disengagement, are thus a way of coping with the uncertainties of life.

Rock music concert.
Rock music concert, “slamming bodies.”

I think that Marlovits makes some interesting points, but there is not a strong enough argument linking depression to modes of alertness. My question would be to what degree should depressive enactments be viewed as abnormal? As Marlovits illustrates, everyone has their own habits that promote engagement or disengagement (alertness or inattentiveness) so it seems likely that everyone at some point in their lives utilizes depressive enactments to mediate cultural contradictions or uneasy/unknowable realities.

Prefrontal Norepinephrine Determines Attribution of “High” Motivational Salience

Methods and Results

This study used intracerebral microdialysis to measure the norepinephrine outflow and depletion in response to both conditioned and unconditional stimuli in order to determine whether or not there is any chemical selectivity in the attribution of motivational salience to unconditioned stimuli. With regard to conditioned stimuli, the norepinephrine output corresponded to salience but the depletion of the chemical transmission was not affected by salience. This was was different when considering unconditioned stimuli, where they found that if the new stimulus was particularly intense and induced a sustained chemical outflow then the attributed salience was selective.

Study Participants and Factors

This study was performed on mice using chocolate consumption and forced isolation as stimulus for the norepinephric gauge of stimulus. White chocolate and milk chocolate were used as positive stimulus. Isolation with varying light exposure and food restriction was the adverse stimulus.

So, What Does this Mean

Exposure to new, highly salient stimuli increased norepinephrine output regardless of whether it was good or bad stimuli. Following exposure to a highly salient negative situation, previously mild stimulus triggered a norepinephric output on par with the highly salient. The results of this study point to norepinephric output as necessary for the place-conditioning process. Or in the words of the researchers:

“Thus, these results confirm our hypothesis and demonstrate that prefrontal cortical NE transmission is necessary for the acquisition of conditioned properties to stimuli paired with highly salient natural rewarding or aversive events in a place-conditioning procedure.”

Link to the Study

 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0003044

 

Why College Kids Always Be Smoking – It Isn’t Exactly Their Fault

Dr. Peter G. Stromberg, along with colleagues Drs. Mark and Mimi Nichter, conducted an ethnographic and qualitative study of college freshmen a few years ago, in an attempt to understand why so many college students transition to regular smoking during their time at school. They orchestrated a 16-month longitudinal (a type of observational study that looks at the same variables over long periods of time) interview study of early-phase tobacco users on two college campuses.  — He does not disclose which universities the study included, which I think is relevant information. Social attitudes vary wildly from university to university based on many factors, such as type of university (public, private, liberal arts, etc.) and location (UA’s values likely differ from UCLA). I would have liked more information concerning the students sampled. —

Stromberg begins by defining agency as “an understanding that the actions they (humans) initate and execute are linked to their projects, and that they understand other human beings in the same way.” He goes on to say, “agency is itself fundamentally a social strategy, a way to closely integrate individuals into cooperative projects.” He claims this sense of agency distinguishes humans from other primates. Psychologist Michael Tomasello says on the topic, “non-human primates are themselves intentional and causal beings, they just do not understand the world in intentional and causal terms.”

Lapses in agency, thus, are situations in which choices seem to be controlled by something beyond ourselves. This includes a range of things, from spiritual possession to drug-induced mania. He references dissociation as a similar and overlapping phenomenon in some cases.

Lapses in Agency in American Society

America’s relationship with lapses in agency is strained. Religious people often discredit these notions, as their faith is based on humans having free will. Stromberg writes that, “in American society, lapses in the sense of agency are typically the site of confusion, political conflict, and even illness. The point is not that lapses in the sense of agency are completely denied.” In American culture, there are, seemingly, no acceptable contexts for a lapse in agency.

Stromberg says of his study sample, “…as Americans – these young people are likely to have little awareness of the ways in which their actions are conditioned by social factors, and to consider most of what they do as a reflection of their own autonomous choices, they are likely to construe lapses of the sense of agency as being due to a mysterious power. Following culture-wide assumptions, they come to understand this power as the addictive potency of tobacco.”

Routines in Early Cigarette Use and the Social Character of Early-Phase Tobacco Use

Stromberg observes patterns in the routines of early-phase tobacco use among college students. The typical setting is at parties or other social gatherings. He states, “this conclusion is based on considerable evidence from interviews in which our subjects, who were only occasional smokers, repeatedly told us that they smoked mainly or exclusively at parties, while more established smokers spoke of smoking at parties or in informal gatherings of smokers.”

He lists three main categories of ideas and practices that are central to fostering this lapse of agency:

Imitation and Rhythmic Entrainment is the first among these. To put it simply, people have a desire to smoke when others do. One interview participant stated, “when you see someone else light a cigarette, you get this urge to do the same.” Others stated how difficult it was to refuse or quit while around people that are smoking. Stromberg asserts there are two reasons for this strong urge to imitate others. The first concerns the social history of smoking, In short, smoking used to be a symbol of status. Those who can handle a cigarette well were likely to be high class. Even when this notion dissipated, the attraction remained. He says of this, “the symbolic associations of cigarettes change more slowly than the structural situation of social mobility.” The rhythmic portion is a bit more difficult to understand, but essentially claims that humans wish to mimic rhythmic activity in groups. Stromberg says, “a rhythmic oral-manual activity such as cigarette smoking can to some extent provoke entrainment in the same way a musical rhythm does.”

Pretend Play is where the cigarette is “used as a prop in performances of pretending.” In this manner, smoking allows a person to role-play a new identity. It creates an alternative sense of environment and atmosphere. He claims it provides opportunities for creative improvisation, which can foster a lapse in agency. Overall, I found this section to be unclear and a seeming grasp at straws. I am not sure what he means, and from what I do gather, I don’t agree with its viability.

Emotional Arousal is the final category, in which people experience a heightened sense of excitement in social environments. Stromberg says this relates to a lapse in agency as, “this arousal is likely to be interpreted as coming from outside the individual, for in fact it is. And that interpretation, of course, lends further strength to the impression that forces are working to compromise one’s accustomed responsibility for one’s own mental states and actions.” In laymen’s terms, social gatherings provide an emotional intensity that creates a sort of “high”, that can in turn foster a lapse in agency.

Conclusively, Stromberg has argued that many college students transition to regular smoking due, in part, to lapses in agency, caused by hypersocial environments. In this way, he claims college students are not entirely responsible concerning their appetite for cigarettes. The wide range of effects they experience are not all chemical in origin, or related to tobacco itself, but can rather be attributed to the environments these activities take place in.

 

Addiction and Neuroanthropology: Querer mas y mas

Daniel H. Lende

Colombian Study: Colombian perspective of addiction versus the perspective of the United States, the world’s largest consumer of drugs

According to the Colombians studied in Dr. Lende’s study, drug abuse involved wanting more and more (querer mas y mas), cravings, desire, and urges. Drug use was seen as a range from a small vice (everyone has some sort of vice) to the worst case scenario mode of putting individuals directly onto the street. The latter is  a complete violation of Colombian social norms because of the overarching desire for drugs more than the value of desire to be with family and friends. Drugs, especially cocaine (referred to as la droga), have the potential to violate one of the most entrenched values of Colombian culture–protecting the well-being of loved ones. When the desire for drugs outweighs the values, it becomes a problem, a habit that becomes hard to control. Otherwise, drug usage is not harshly judged unless it becomes a big enough problem that it dictates the individual.

In the United States, perspectives of drug use include viewing use as a moral failing, or a pathology. Americans have the tendency to compare drug use to either a biological pathology (chemical imbalances caused by drug use, “reward deficiency syndrome”) or a reflection of an individual’s self-control . The American perspective of drug use is Puritanistic, relating drug use to the “immoral” desire of too much pleasure.  According to the American perspective, the disruption of the hard-wired pleasure circuits already within the brain can be “hijacked” by this “immoral” drug usage.

By comparing these two starkly different views, Dr. Lende was able to collage emic and etic perspectives and the connection between behavior and experience, creating an ethnographic, neurological revelation regarding addiction:

Addiction is a problem of involvement, not just pleasure or of the self.

So, how does neuroanthropology play a role in all of this? 

Lende identified two core components of addiction and addictive behavior directly from individuals experienced to study: users report compulsive desires and urges for drugs, leading to relapse or excess; users also identified drug use as an escape from the doldrums and stresses of every day life. Furthermore, Lende identified that sociocultural dynamics affect an individual’s cues and habits that create compulsive or destructive ends. According to the DSM, criteria for substance abuse requires the specific pharmacological structure and mechanism of the drug, whether or not individuals demonstrate tolerance or withdrawal, continued use despite negative effects, and using increasingly higher dosages to achieve greater effects. The problem, which the neuroanthropological view seeks to tackle, peaks when many drugs produce no physiological adaptations. How does one measure the extent of substance abuse according to the DSM’s guidelines if no physiological symptoms are expressed? Causation for addiction must be reviewed, according to Lende, in order to go beyond focusing on withdrawal. According to Lende:

“A full explanation for addiction is not to be found in deviations from rational choice, leaving out community dynamics, social meanings, and other important aspects of substance abuse. Morevoer, this approach also treats addiction as solely an individual problem, in particular, by assuming that addiction is a brain disease that limits the mind’s ability to lead a rational life. “

The aforementioned approach of treating addiction as a disease foregoes answering WHY. What drove this individual to substance abuse? Why did can it become so destructive for particular individuals? These questions, according to Lende, need to be examined in order to garner a full understanding of addiction.

Neuroscience and Addiction

Addiction is a complex process that incorporates many different parts of the brain, rather than just a few isolated sections. Motor, sensory, and bodily regulation must be integrated together before addiction can occur. It begins from the basal parts of the brain (regulation, activation of bodily functions), runs through the limbic system (emotions, evaluation of stimuli), up through the frontal cortices (higher-order cognition). As Lende put it, they have to do with what to do, when to do, and how much to do.

Wanting More and More: The Neuroanthropology of Involvement

Incentive salience, or the determination of which incentives for reward are most important (salient) to an individual, was proposed in a 1993 study as the core psychobiological process that is most affected in continued substance abuse. The biochemical mediator for incentive salience is the dopaminergic system. In Lende’s studies in Colombia, he found that using incentive salience as a model for a scale depicting experience turned out to be a good predictor of addicted status. Asking real people about their real experiences with drug use, Lende sought to better understand their want for drugs and how they would get drugs, and how they felt before actually getting the drugs. In the end, he found that the “want” actually corresponded to experiences during the drug use rather than before or after, and that meaning and social context played a role in the experience.

Incentive Salience and Addiction: Mediation, Environment, and Anthropology 

According to Lende, incentive salience is a much more focused means of examining drug usage. Incentive salience merely reflects a few aspects of addiction (remember, addiction is highly complex and dynamic), and does provide good insight into addiction, but does not fully explain it. Incentive salience gives researchers an insight into the neurological processes of decision making, and the means of seeking out rewards. It also links together cues and rewards through motivation and action.

Incentive salience, however, is not the same thing as conscious desire. As Lende puts it:

That urge for pizza people get, that sense that they want it now, and that they just have to have it–that is incentive salience.

Well, now I want some pizza. Thanks, Dr. Lende.

Anyways, a good way to garner information regarding incentive salience has to do with ethnographical research. In his Colombia study, Lende asked participants to describe a “typical day”. His results”

  • Heavy drug users described a sequence of feeling ambivalent towards drug use, a marked decision to use, and then the action of seeking out whatever drug they use. In addition, these people reported a stronger urgency and desire to use once the decision to use had been made. They reported that they felt the want for more and more (querer mas y mas) in the moment. Not before, not after, but in the moment that the drug use was happening.

^^^that’s incentive salience

The salience experienced by Colombian users, however, occurred when using that drug transformed their lives. It took them away from day to day life experiences, the monotonous, and created a  viaje (journey) to the sublime. Well, who wouldn’t want that?

According to Lende, “signals for salience depend on the presence of cues, the structure of environments, and present and past states. In other words, when behavioral options are salient, animals will pursue them–that is what incentive salience does.”

This incentive salience can be applied in two ways:

1. Involvement: the creation of a feeling of belonging or involvement in cultural meaning schema

2. Transition: Signaling transitions between activities, shifting involvement from what matters throughout the day

 

Yet, how does this explain habitual use? Incentive salience alone just doesn’t cut it. Habits play a role in the same neurological processes that incentive salience does. When the want for more and more (querer mas y mas) becomes a cultural commodity, partnering alongside feelings of belonging and transcendence from the mundane, that may lead people to wanting to repeat that experience. Repetition over continual, extended periods of time can create a habit. A habit (referenced in the text, Gaybriel 2008, p.363) is defined as:

“learned, repetitive, sequential, context-triggered behaviors which are performed not in relation to the current or future goal but rather in relation to a previous goal and the antecedent behavior that most successfully led to achieving that goal.”

Lende goes on to describe the interworkings of habits and culture, pointing out that the neuroanthropological approach sheds light into the social and biological aspects of drug use. In the end, the neuroanthropological approach helps better understand the complexity and dynamics of addiction.

C-Section Rates in Alabama (1996)

This is from nearly two decades ago, and the literature was concerned that c-section rates were as high as 25%. Now the rate in Alabama overall is 38% and in some counties it’s as high as 68% (per the Alabama Public Health Department link I also posted). C-sections vs vaginal birth isn’t what I was considering when I wrote the proposal, but upon reconsideration it would be worth it to include vaginal birth vs c-section in the study, not just home birth vs hospital birth. This would require further research into why c-sections happen when not medically necessary and the literature on VBACs, etc.

edit, corrected link:

http://onlinelibrary.wiley.com/doi/10.1111/j.1523-536X.1996.tb00456.x/abstract

 

Effects of Maternal Stess on Birth Weight

“Independent of biomedical risk, each unit increase of prenatal life event stress (from a possible sample range of 14.7 units) was associated with a 55.03 gm decrease in infant birth weight and with a significant increase in the likelihood of low birth weight (odds ratio 1.32), and each unit increase of prenatal pregnancy anxiety (from a possible sample range of 5 units) was associated with a 3-day decrease in gestational age at birth.”

 

http://www.ajog.org/article/0002-9378%2893%2990016-C/abstract

CDC Birth Rates

My best friend for a bit, this page on the CDC website is an easy to understand and nicely presented data sheet on out-of-hospital births in the United States from data collected from 1990-2012.

Notes: Out-of-hospital birth rate is low but rising (1.36%); Alabama is the 3rd lowest in the country, at only 0.39%.

http://www.cdc.gov/nchs/data/databriefs/db144.htm

Alabama Public Health Pregnancy Stats

Lots of interesting stats on birth in Alabama. Not sure if any are relevant at this stage, but could be more useful in a discussion, depending on the results. Many different stats here are noteworthy and could lead to additional parts of this study or a new study altogether (for example what is contributing to the  50-70% c-section rates throughout different counties?!).

http://www.adph.org/healthstats/index.asp?id=1513