Advancements in the Neuroscience of Anxiety and Depression

For the last several hundred years the fields of behavior, psychology, and psychiatry had little choice but to rely on descriptions of events – behaviors – when making a diagnosis.  The brain has been seen as a “black box” – a mystery of subtle activities.  Anatomists of the middle ages threw out the brain – because it didn’t seem to do anything – although its location might have been a clue that something was going on in there.  Indeed, there is much going on in there!  Major shifts are occurring not only in the views of behavior disorders but also in their treatments.

If this topic interests you then go HERE.

 

Advertisements

Maslow’s Hierarchy of Needs is not Accurate

In 1943 Abraham Maslow published a Hierarchy of Needs in a paper titled “A Theory of Human Motivation” appearing in the Psychological Review. A   In this paper he proposed a scheme of human motivations that act hierarchically to control actions.   In his theory, safety and physiological needs form the foundational motivations, with other drivers such as self-actualization taking roles when the foundational motivations are adequately satisfied.  In some situations, such as emotional health, his hierarchy seems reasonable.  However, there are critical human behaviors that challenge the theory, such as suicide, war, dangerous pursuits serving some form of status or self-aggrandizement.

If it were true that meeting safety and physiological needs were of highest priority then suicide would not exist.  If it were true that safety and physiological needs were of highest priority then humans would not pursue dangerous activities except where such were driven by the needs of safety and physiological sufficiency.  Yet, extreme sports, war, and even contact sports challenge this idea.

Rather, we need to understand the profound importance of social status as a driver of human (and other mammalian) behaviors.  We have all seen nature videos wherein male animals literally put their lives at stake in order to gain the social status necessary to breed with females.  Certainly an evolutionary perspective might explain such behaviors as a service to propagating the best/strongest genes.  Yet, that does not serve the battling males who may be injured or sometimes killed for the privilege of passing on these genes.  The explanation for the willingness to be injured or killed rests in the profound importance of social status.

Similarly, human males recurrently expose ourselves to various kinds of potential injury in order to “win”, “be a hero”, or otherwise gain social status.  Gangs, for example, have “rites of passage” that involve risky activities.  Maslow’s theory would not explain such behaviors.  However, a primacy of status pursuit would explain such behaviors.

The evidence is all around us: the most critical driver of human behavior is actually pursuit of status.  In exchange for this pursuit humans, particularly males, will voluntarily expose themselves to risk of physical harm and/or deprivation.

With this rebalance in understanding then anxiety, depression and even suicide take on new perspectives.  We may understand that a core driver for these behaviors may be an untenable loss of social status.  This loss may derive from childhood abuse (physical or mental) which results in an acquired belief in low status (aka “low self-esteem”).  Or, loss of status along the life line may account for these behaviors (such as the stories of financially devastated men jumping out of windows after the 1929 economic crash).

Therefore, one important consequence of re-organizing our concepts of needs hierarchy is that an analysis of status-beliefs  may be critical to effective treatment for chronic anxiety and/or depression.  Nearly two thousand years ago said, “It is now what happens to you but how you react to it that matters.”  This reaction is some form of judgment.  Among the various forms of judgment is “loss of face” (as asian cultures would say) – that is, loss of status.

In an analysis of anxiety, depression and adverse beliefs we do need to recognize that within the brain beliefs do not exist as an idea.  They exist as states of neuron functions.  Thus, feelings of depression or anxiety may derive not only from existential belief issues but also from adverse states of neuronal function derived from physiological developmental issues (including genetic proclivities).  Thus a tendency to negative self-thoughts may derive from some mixture of constitutional brain physiologic issues and acquired physiologic stated derived from adverse beliefs, values, and/or expectations.

When these perspectives are considered a different hierarchy of needs becomes apparent.  It looks like this:

Screen Shot 2017-12-08 at 1.09.30 PM.png

The term “Social Status” does not refer to something as trivial as whether you have a new car or not.  Rather, it is a critical feeling of having “adequate” status within a self-defined peer group.  “Adequate” is a self-appraisal, and a belief more than a fact.  Thus, outsiders may reassure a person that he/she is “good” or “okay”, or by contrast may reassure a person that he/she is doing much better than many others, yet this may not be convincing, and depression or even suicide may follow if the self-assessment of social status leaves a strongly negative feeling.  Note that Maslow’s hierarchy considered this idea under the higher level assessment: “esteem”.  However, as the above considerations reveal, an individual may be willing to loose all in the pursuit of a sense of adequate status.  Thus, this actually takes a position as a more fundamental drive than even meeting physiological needs.

We may also observe that individuals may sacrifice themselves for the safety of loved ones.  For example, mothers may willingly put themselves in grave danger to save their children.  Thus, safety is a complex consideration that not only references self but also the safety of others with whom there is that very strong connection called “love”.

The desire for connection, belonging, and love is a driver of behavior independent of its importance in social status.  For example, we may very much want to belong to social groups and to be cared-for by others; yet, we may not be willing to forego lower drives in order to get them.  This is revealed in the desire for belonging to groups but “every man for himself” when the situation turns dangerous.

Last, at the top of the behavioral drivers is the complex idea of “self-actualization”.  Broadly this is all the daily activities that are pursuits of goals while following the dictates of our internalized set of beliefs, values, and expectations.  We want to “be all we can be” but at this level we are not willing to sacrifice the more fundamental drivers to achieve being all we can be.  However, one tricky part of this analysis is that the pursuit of social status may link drives that are at the top of the pyramid with the drive at the bottom of the pyramid.  Thus, an individual may pursue high level goals excessively because the goal is strongly linked to self-assessments of social status.  An example of this was revealed many years ago in a documentary of three men who had all lost a leg to an injury.  Two of the men adapted to the injury and went on to build an appropriately modified life.  They did fine.  The third man had always considered himself a “jock”.  His entire self-image (and status) was tied to his function as an athlete.  When his leg loss precluded functioning at the same levels as before his life fell apart. His loss of self-assessed social status resulted in use of drugs and other behaviors that were clearly self-damaging to physiological needs, safety, connections and self-actualization.

In total, this reconsideration of the old Maslow hierarchy gives better correlation to observed phenomena such as chronic depression, suicide, voluntary risk-taking activities, and other damaging pursuits such as addiction.  It reveals the critical need in behavioral-illness treatment to focus on how the ill individual views his/her social status, particularly when that status is viewed as “below what I should be” or reduced from some prior perceived level.

Predicting the Difficulty of Change: Unclear Future Image

Change involves taking people away from a known situation and going to a relative unknown.  Confusion, hesitation, and outright resistance are common.  If leadership does not have a clear image of the future state then the extent of these negative reactions may be under-managed, adding to the risks of change failure.  For more on this topic go HERE.

Quickie: Check this out

For those interested in neuroscience and change management I suggest you check out Cecil Dijoux’s article at his blog, #hypertextual: Social Neuroscience, SCARF Model and Change Management.  The article is very well written and acts as invitation to a variety of good informtation.

He also has a great image of what is now being called “The Connectome” – a representation of how neurons are interconnected in the brain.  The data for the image is derived from special types of MRI scans.  The work is very early in its evolution.  The image presented at #hypertextual is a compilation of information from many patients.  However, in future years images from single individuals may become one of our most important brain diagnostic tools.  Some day we will understand certain types of illnesses as disorders of the brain’s “wiring diagram”.