In the eye of the beholder

The end of 2024 is approaching rapidly, and it's time for a little recap of the year that has passed. This year featured 19 posts on various topics! The year started with an exploration of emotions and feelings, how they are constructed, and how they can be understood as responses to bodily experiences. Here’s an excerpt from Part 1, which continues with a review of the anatomical structures involved.

In this way, emotions are constructed and are also dependent on our language and how finely we can distinguish different interpretations of emotions. In one language, there may be terms for emotions that do not exist in another. We are all human, but language can still determine which emotions we feel! For example, in German, there are two words: Wanderlust and Fernweh; both describing a form of feeling when one wants to travel. The former is positive, while the latter has a melancholic undertone, even though both describe a sense of wanderlust. This high-resolution description is challenging in the Swedish or English language, as we lack equivalent words.

I have written about suicide, covering basic statistics, new approaches to prevention, and studies highlighting the suicide-preventive effects of antidepressants and mood-stabilizing medications. Below is an excerpt from Part 2, which summarizes a new perspective on the suicidal process as a dynamic and complex system rather than a linear staircase.

Some patients may clearly worsen in their depression and steadily move towards higher suicide risk, while others suddenly complete the act. Bryan, along with other colleagues, suggests viewing this behavior as a dynamic system. This is essentially a mathematical concept dealing with time-dependent/dynamic processes with many independent variables. A simple example is that it is relatively easy to mathematically describe how a planet moves around the sun, but disproportionately harder to describe how two or three do so. This is due to all the pairwise dependencies where the gravity from one planet affects another planet and all are influenced by the sun. In such systems, there are also bifurcations, also known as forks, where a small change in a parameter results in large changes in the outcome.

I wrote three pieces about functional neurological symptoms, mass hysteria, and how such phenomena can spread through social networks. Brain stimulation in its various forms was covered in a four-part series, starting with a historical overview of treating seizures. I also continued my series on psychedelics and their role as psychopharmaceuticals, as well as various aspects of psychiatric diagnostics. In the latter, I explored how diagnoses can be viewed as networks of symptoms, where different connections carry varying weights.

A further development of this is the so-called network models. In these models, various symptoms of depression, for example, are not only dependent on underlying latent variables but also affect each other. Sleep disturbance and fatigue are both symptoms of depression, but it is reasonable to assume that sleep disturbance also causes fatigue. Furthermore, the connections between different nodes in the networks differ from person to person, so that, for example, some people are more likely to have suicidal thoughts when they sleep poorly than others.

In addition, I wrote a piece for Bipolar Day, a review of catatonia, and reflections on common mistakes in psychiatry. Lastly, I published a column on psychotic depression, which also appeared in Läkartidningen, as well as a contemplation on the experience of being both elated and depressed. What is depression, and what does it feel like to perhaps be hypomanic?

So the twilight turned into night, and I couldn’t handle it any longer. But there were people around me—strangers and loved ones—who extended a hand and took mine in theirs. Even if I didn’t think I deserved help, others didn’t agree. It was spring, and the nights grew shorter with each passing day. When I most feared the darkness, I saw a light in the distance. Dawn came, and with it, the birdsong that belongs to spring. Maybe I can endure one more day? One step at a time, one foot in front of the other, and I move forward. This is a life too, and it must be lived.

There is an ongoing discussion in the fields of psychiatry and normal psychology aimed at understanding various behaviors as the result of underlying processes. Currently, it is popular to interpret behaviors and their deviations as part of a neuropsychiatric functional variation or as the outcome of childhood experiences. In last year's New Year's column, I highlighted the concept of pragmatic truth.

Here, I think a pragmatic approach can be adopted: if it works, it's true. If a certain treatment with certain premises leads to better well-being (both individually and in clinical studies), one can say that the premises are true in some sense. If it applies to SSRIs, it means serotonin is involved in depression, and if it applies to CBT, it means inadequate learning and thoughts have led to passivity. The treatments influence this and lead to improvement. The same applies in this case for PDT, where dysfunctional attachment during childhood may have led the person to have low self-esteem and attribute all setbacks in life as if caused by them.

Through this reasoning, one can arrive at an explanatory model that is both somewhat true and helpful. If a patient benefits more from an ADHD diagnosis and its corresponding treatment, rather than being diagnosed with a mild form of bipolar disorder type 2, then it is reasonable—and correct—to make that diagnosis. There are many such intersections, and in the text above about possibly being hypomanic and having depressive periods, this concept is illustrated. Necker's Cube, an optical illusion, demonstrates that the same factual image can be perceived as different objects, but only one at a time.

My colleague Valdemar Landgren used this very metaphor to explain why it can sometimes be so difficult to both convince oneself of the correct diagnosis and to agree with others. Some people wear a particular "lens" through which they tend to interpret behaviors as stemming from personality traits, and thus, they are more likely than others to arrive at such a diagnosis. As a researcher, I believe that in such cases, one should adopt a scientific approach. In the spirit of Popper, scientific hypotheses can only be falsified but never fully confirmed.

Hypothesis: Let us assume that the pleasurable feeling described earlier was part of a hypomanic episode. If so, in combination with recurrent depressions, this would suggest a condition within the bipolar spectrum.

Experiment: If we then test treating the depressive episode with appropriate antidepressant medication, it should, theoretically, lead to destabilization and perhaps a switch to mania.

Conclusion: This did not occur; instead, it led to remission, which can be considered to reject the hypothesis of bipolarity.

On one hand, the human psyche is incredibly complex, and the above is merely a simplified example of how one might think diagnostically. On the other hand, it is precisely by simplifying the complex that we can actually make progress and arrive at decisions.

With this, I conclude 2024 and welcome you back for new discussions in 2025. Until we meet again!