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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by KenB on October 22, 2000, at 13:42:22
Greetings,
Regardless the best intentions of many researchers, it remains uncertain if a one-size-fits-all description of depression will soon, if ever, attract a genuine consensus among all practitioners. Even if a consensus opinion excluded practitioners considered “fringe,” informed patient/clients would likely continue to bring forward effective challenges to the one-size model.
The ways many clinical practitioners administer anti-depressants might seem to suggest that the medications are “happy pills,” but Athena’s suggestion ( http://www.dr-bob.org/babble/20001022/msgs/47062.html ) is consistent with the research. The medications usually are offered in hopes of satisfying a person’s hedonic needs. They are not offered, or at least not tested and marketed as recreational or self-improvement remedies intended to raise the person’s “hedonic set-point.”
There is a school of thought that suggests a change in philosophy toward use of medications for self-enrichment. Debate over prohibition of the popular illegal drugs properly includes discussion of whether the drugs are used as alternative remedies to normalize a person’s hedonic status, and whether it is appropriate to use medications, or anything else, in an effort to elevate the hedonic norm.
Although the discussion about the propriety of "happy pills" is interesting and relevant to the practice of medicine and the treatment of mood complaints, it might be appropriate to first reconsider the idea of a “hedonic set-point” that describes a person’s reasonable expectation of happiness.
Rather than an individual hedonic set point, it might be that we have instead an individually unique hedonic range. Some individuals might have a high tolerance for broad hedonic fluctuations. Some might tolerate either downward deviation (“depression”) or upward deviation (“mania”) or both, while others might be uncomfortable, unprepared or unable to handle fluctuations in either or both directions.
Granted, the research at this juncture suggests a set point rather than a range. Yet research and hedonic expectations alike are easily influenced by cultural and personal expectations. Mass communication, advertising and entertainment programming likely tend to elevate hedonic expectations. A rapidly changing technological and cultural environment might produce varied hedonic expectations among subsequent generations and among diverse cultural groups. “Low sex drive” for example might be considered evidence of a hedonic affect, but cultural expectations, especially in the United States might not be consistent with inherited drives. On average, U.S. adults reportedly have intercourse more frequently than those of any other nation, which might suggest exaggerated expectations rather than a disorder among individuals who are celibate or who practice intercourse less frequently.
These are merely hypotheses, and this is probably not the best place to develop or defend them, but perhaps these ideas can help advance the way some readers here look at various mood affects. A well-considered discussion of the current (primarily western) research on affective problems is available, at least for now, at:
http://www.medscape.com/Medscape/psychiatry/TreatmentUpdate/2000/tu03/public/toc-tu03.html
The "stress-diathesis model" is summarized in one section of the above article. This section also seems to suggest, as I have here, a wide range in hedonic expectations or tolerances among people who otherwise seem to exhibit similar risk factors for affective complaints:
http://www.medscape.com/Medscape/psychiatry/TreatmentUpdate/2000/tu03/tu03-03.html
Several articles suggesting that “happy pills” might be used to elevate, rather than to normalize, hedonic set points are available at:
xxx
In conclusion, the same considerations of nature/nurture factors relevant to discussions of hedonic set-points are also relevant to discussions of a hedonic range, and why some individuals are more or less tolerant of varied hedonic conditions. Further, in discussing “nurture” factors, it is important, especially in a diverse multi-cultural society, to consider how cultural expectations contribute to hedonic expectations.
For your consideration,
Kendall Baize
Posted by Athena on October 22, 2000, at 15:20:46
In reply to Hedonic range?, posted by KenB on October 22, 2000, at 13:42:22
Ah, I found the thread, thank you. I'm not sure why but I can't seem to navigate this site well...I have the "withdrawal symptoms" thread as a Favorites link so that I may find it again.
To clarify...you are suggesting that we as a society have a "Hedonic range"...as in a "happiness range"? A range of what is considered "normal" for the masses? And those who do not fall into the normal range are considered "depressed" or "manic"...out of the norm..?
I can definitely see validity in your point. Of course, our society, or the society mentality is incredibly fueled by people who want our money! Advertisers, corporations, tv, Nike, Pizza Hut, etc...and we believe that what we see should be our meter for normalcy. "Kill your Television" bumper stickers HAVE a point!
So what about those whose depressive moods dip below the "normal meter"...well here ya go, we have a pill JUST FOR YOU! No problem, you just have a chemical imbalance, it's just a physical problem, we can correct this for you, no reason to feel ashamed, blah blah blah...and we believe them. We take their damn pills and we believe their propaganda. Yet our issues are STILL our issues, pill or no pill...swallowing more of that which is poisoning us.
The answer does NOT lie outside of ourselves.
Athena
Posted by KenB on October 22, 2000, at 17:32:59
In reply to Re: Hedonic range?, posted by Athena on October 22, 2000, at 15:20:46
> To clarify...you are suggesting that we as a society have a "Hedonic range"...as in a "happiness range"? A range of what is considered "normal" for the masses?Athena,
There is generally not much of a range that is considered normal in individuals. There is a range of set points - each individual is believed to have a hedonic set point somewhere within a range of "set points" considered normal, but the majority of literature I have read on depression does not discuss variations as far as some individuals being able to tolerate a wider range of hedonic conditions than others. If anyone is familiar with literature along those lines, please educate me.
My suggestion is that individuals have a hedonic range, rather than a hedonic set point, and that the breadth of that range varies from person to person. Some individuals might be able slip into despair accompanied by suicidal ideation and make art of it. Others might feel way out of sorts when their happiness slips slightly below their individual norm - their personal hedonic set point.
The breadth of hedonic conditions any specific individual might be willing or able to tolerate might be determined by nature, by nurture or by both. Social expectations could contribute to a tendency for some individuals to worry about deviations from their presumed hedonic set point that they might otherwise find tolerable.
An example of similar variance in the ranges of tolerance among various individuals might be found in different people's tolerance for thermal variations. Some people might require a constant 72 degree environment or they will feel either uncomfortably hot or cold. Others might be able to live in a 50-degree house or in a 90-degree house with only minor inconvenience. Various people's tolerance might be based on inheritance, on childhood experience or on life-long experience. An outdoors person or a scuba diver might learn to extend their range of tolerances through practice. A foundry worker might learn to tolerate the heat. But others, because of the genetic predisposition of their thalamus, or because of their lack of experience with heat, might not last an hour on a foundry job.
The role of social expectations, at least in our time, seems to be to narrow popular expectations of hedonic range. The expectation is generally that we have a hedonic set point and that most downward deviations are treatable. The availability of medicines for people who cannot tolerate wide hedonic fluctuations might be driving a tendency to label most such fluctuations as "disease." If not for these social and clinical influences, some but not all people might more readily handle extreme fluctuations without wanting or needing medical assistance.
Kendall
Posted by stjames on October 22, 2000, at 19:49:32
In reply to Hedonic range?, posted by KenB on October 22, 2000, at 13:42:22
AD's don't make me happy, them make me normal. Then it
is up to me to do what is required to be be happy. Without the meds normal or happy
are out of the question. On the meds "happy" is possible, but it takes work. Just as it does
in a normal person.james
Posted by shar on October 22, 2000, at 21:48:35
In reply to Re: Hedonic range?, posted by stjames on October 22, 2000, at 19:49:32
This is an interesting topic, and I always feel that "operational definitions" are so important in research, or (if you've ever done a lit review) people can be discussing very different things under the same name. Moreover, in a journal article, words are everything.
A person may be "happy" or "fine" if there are no problems at the moment. While another person, may not be happy or fine in the same situation. Of course, that leads to defining happy and fine.
And, perhaps my mind is clouded, but I'm not immediately grasping the difference between a set point and range as it relates anhedonia. Heat, I understand, anhedonia is harder. Sort of like motivation (internal/external locus of control) or something.
Examples not related to what's inside one's head are fairly easy to come up with, and it happens frequently, but the point is, we're talking about what's going on in someone's head. And, anhedonia relates to so many psych conditions. Can there be one operational definition for all of them? Or will it vary with condition?
Even within depression itself, there are great variations in the conditions. Will a theory hold up for all of them?
Just a few questions I learned the hard way, but a good lesson to be sure. My dissertation was a meta-analysis, and going back to the original articles (as was necessary) and finding how things became changed/distorted over many citations made me realize the importance of clear unambiguous words to describe what one is discussing.
That plus my own not understanding this very well, led to this post. Not a critique of your work at all!
Shar
Posted by KenB on October 23, 2000, at 0:08:56
In reply to Re: Hedonic range?, posted by shar on October 22, 2000, at 21:48:35
> Can there be one operational definition for all of them? Or will it vary with condition?
My perspective would be that one operational definition cannot describe the infinite variety of anhedonic experiences, but scholars will probably continue to strive for such a definition. To properly develop the suggestion of a hedonic range vs. a set-point would, as you suggest, Shar, require a literature review and would require careful explanation of what is meant by a "set point."
> Even within depression itself, there are great variations in the conditions. Will a theory hold up for all of them?
Theories about depression have become increasingly specific, and over the year have better defined how some subjective experiences relate to specific neurochemical levels and to blood-flow and other measures of activation throughout the brain. The theories are far from precise, to be sure.
For purposes of popular literature, many researchers suggest that we as individuals tend to have a set point. Sorry, I can't readily summarize the source material on those theories or offer a dissertation on the nuances of the theories.
If we reduced the measurement of hedonic status to a multi-question test where absolute bliss is 100 points, many researchers might agree that some people would consider themselves "normal" or "happy" with a score of 95, and others might feel the same with a score of 85. That would be the individual’s hedonic set point.
That is somebody else's work, not mine. When possible, perhaps I can reference a better explanation of why many researchers are discussing a genetically determined hedonic set point.
As I appreciate the research, downward deviation from the individual's set-point, whether the individual's set-point is the hypothetical 95 or 85, can be described as anhedonia.
Assuming that a workable theory says some people feel mostly satisfied at 95 and others feel satisfied at 85, a more precise theory might be that some people might be comfortable at various times with scores ranging from 65 to 95, whereas others would tend to report debilitating symptoms if the score deviated only two or three points from their "set-point." That would be a individual hedonic range instead of an individual set-point.
Posted by shar on October 23, 2000, at 7:48:35
In reply to Re: Hedonic range?, posted by KenB on October 23, 2000, at 0:08:56
Oh, ok.. So a range is like tolerance for deviation from the set point. Right? So, if someone had a high tolerance for ambiguity in general, might overlap with tolerance in "h. range." Range makes much more sense, and seems to dovetail with a lot of personality work already done about individual rigidity, ie, Type A personality (tho I heard Type A is out of favor now).
Thanks for the explanation. And Best of luck.
SharP.S. If absolute bliss were 100, I would feel happy with a 50.
>
>
> > Can there be one operational definition for all of them? Or will it vary with condition?
>
> My perspective would be that one operational definition cannot describe the infinite variety of anhedonic experiences, but scholars will probably continue to strive for such a definition. To properly develop the suggestion of a hedonic range vs. a set-point would, as you suggest, Shar, require a literature review and would require careful explanation of what is meant by a "set point."
>
> > Even within depression itself, there are great variations in the conditions. Will a theory hold up for all of them?
>
> Theories about depression have become increasingly specific, and over the year have better defined how some subjective experiences relate to specific neurochemical levels and to blood-flow and other measures of activation throughout the brain. The theories are far from precise, to be sure.
>
> For purposes of popular literature, many researchers suggest that we as individuals tend to have a set point. Sorry, I can't readily summarize the source material on those theories or offer a dissertation on the nuances of the theories.
>
> If we reduced the measurement of hedonic status to a multi-question test where absolute bliss is 100 points, many researchers might agree that some people would consider themselves "normal" or "happy" with a score of 95, and others might feel the same with a score of 85. That would be the individual’s hedonic set point.
>
> That is somebody else's work, not mine. When possible, perhaps I can reference a better explanation of why many researchers are discussing a genetically determined hedonic set point.
>
> As I appreciate the research, downward deviation from the individual's set-point, whether the individual's set-point is the hypothetical 95 or 85, can be described as anhedonia.
>
> Assuming that a workable theory says some people feel mostly satisfied at 95 and others feel satisfied at 85, a more precise theory might be that some people might be comfortable at various times with scores ranging from 65 to 95, whereas others would tend to report debilitating symptoms if the score deviated only two or three points from their "set-point." That would be a individual hedonic range instead of an individual set-point.
Posted by Noa on October 23, 2000, at 17:10:23
In reply to Re: Hedonic range?, posted by shar on October 22, 2000, at 21:48:35
It is normal to feel happy sometimes, but no one can expect to feel one emotion all the time.
For me, happiness isn't what I am seeking out of medication.
As for the general state of well-being that you might call "happiness", as in a general, positive evaluation of one's life, well, sure, I am hoping for that. But I know that that won't mean I will feel happy all the time.
Medication, for me, is aimed at functionality and good-enough feelings to cope. How my life is then depends on luck and the choices I make.
This is the end of the thread.
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