Where Inner and Outer Worlds Meet: Psychological Research in the tradition of George W. Brown

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Where Inner and Outer Worlds Meet

The importance of George Brown’s contribution to medical sociology through his longitudinal studies of psychiatric disorder and its relationship to social context is widely recognised. This collection of seventeen chapters exemplifies a particular way of working as a medical sociologist which focuses on the understanding of the meaning of social experiences as the key to an individual’s health status. It combines the biographical richness of qualitative research with the ability to carry out quantitative analyses and thus reach conclusions on the basis of statistical significance. The contributors mainly focus on conditions of depression and anxiety, relating these to the meaning of people’s experiences or ‘life events’ prior to their onset. Within this framework different authors focus on more specific meanings including both demographic aspects such as gender, parity, lifestage, employment, refugee/immigration status, humiliation, entrapment, loss and also more interpersonal stresses such as neglect, abuse and critical or unsupportive relationships. This is a book which offers a rich treasury of information for all researchers interested in understanding the complex relationship between our inner and outer worlds: it captures the essence of George Brown’s unique way of working. Tirril Harris is Senior Research Fellow, Socio-medical Research Centre, Academic Department of Psychiatry, Guys, Kings and St Thomas Schools of Medicine (Research Officer to Professor George W. Brown).

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Where Inner and Outer Worlds Meet Psychosocial research in the tradition of George W. Brown

Edited by Tirril Harris

London and New York

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First published 2000 by Routledge 11 New Fetter Lane, London EC4P 4EE Simultaneously published in the USA and Canada by Routledge 29 West 35th Street, New York, NY 10001 Routledge is an imprint of the Taylor & Francis Group This edition published in the Taylor & Francis e-Library, 2005. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” © 2000 Tirril Harris All rights reserved. No part of this book måy be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library . Library of Congress Cataloguing in Publication Data Where inner and outer worlds meet: psychosocial research in the tradition of George W. Brown / edited by Tirril Harris. p. cm. Includes bibliographical references and index. ISBN 0-415-20268-X (hardcover) 1. Social psychiatry. 2. Depression, Mental–Etiology. 3. Life change events. 4. Adjustment (Psychology) I. Brown, George W. (George William), 1930– II. Harris, Tirril O. RC455 .W49 2000 616.89–dc21 ISBN 0-203-99204-0 Master e-book ISBN

ISBN 0-415-20268-X (Print Edition)

00–042214

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Contents

List of figures List of tables List of contributors Preface 1 Introduction to the work of George Brown

viii ix x xiv 1

TIRRIL HARRIS

PART 1

Social psychiatry and social science 2 George Brown’s contribution to psychiatry: the effort after meaning

53

55

JIM BIRLEY AND DAVID GOLDBERG

3 Bringing meaning back into social psychiatric research: making subjective meanings objective

61

DAVID MECHANIC

4 George Brown: the science of meaning and the meaning of science

71

PAUL BEBBINGTON

PART 2

Measurement of key psychosocial factors in research 5 Lessons from using semi-structured interviews with seriously ill patients

79

81

ELIZABETH DAVIES

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vi Contents

6 Expressed emotion: measuring relationships

97

JULIAN LEFF

7 Contextual measures and subjective appraisal

111

LOUISE LEMYRE

PART 3

Model building 8 Negative life events and family negativity: accomplishments and challenges

121

123

MICHAEL RUTTER

9 Towards a dynamic stress-vulnerability model of depression: the role of neuroticism, life events and gender

151

JOHAN ORMEL AND JAN NEELEMAN

10 The timing of lives: loss events over the life course and the onset of depression

171

PAUL SURTEES AND NICK WAINWRIGHT

11 The childhood experience of care and abuse (CECA): an exploration with adolescent refugees

195

MICHEL TOUSIGNANT, EMMANUEL HABIMANA, COLETTE BIRON, ESTHER SIDOLI-LEBLANC AND MATHILDE BRAULT

12 Gender differences in the experience and response to adversity

211

TOM CRAIG AND SOUMITRA PATHARE

13 The long-term effects of childhood adversities on depression and other psychiatric disorders

227

RON KESSLER

14 Evolved socio-emotional systems and their role in depressive disorders

245

MARTIN EALES

PART 4

Psychosocial factors in conditions other than depression

261

15 Life stress and bipolar disorder: is the dimension of social rhythm disruption specific to onset of manic episodes?

263

ELLEN FRANK, DAVID KUPFER AND SUSAN MALKOFF-SCHWARTZ

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Contents vii

16 The study of life events has clarified the concept of psychosomatic disorders

275

FRANCIS CREED

PART 5

Postscript

289

17 Some thoughts on the future of social psychiatry

291

GEORGE W. BROWN

Index

319

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Figures

1.1 1.2 8.1 8.2 8.3 8.4 8.5 8.6 9.1 10.1 10.2 10.3 10.4 10.5 10.6 12.1 17.1

Provoking agents and vulnerability factors for depression Irregular or disruptive severe events related to depression Severe events and difficulties in early adult life Parental personality disorder and hostility, and persistent child disturbance Effect of life events on variance in depressive symptoms MZ pair differences in life events and MZ pair differences in depression Family negativity and antisocial behaviour Family negativity and depression The dynamic stress-vulnerability model Some possible representations of self-reported adverse event effects Self-reported adaptation by gender to loss Self-reported upset to loss and adaptation to loss by lifestage MDD following maternal loss by age at time of loss MDD onset following marital loss with no event by gender interaction MDD onset following marital loss with allowance for event by gender interaction Simplified schema of Brown and Harris model of depression Percentage of women with at least one severe event in 12 months

11 25 131 132 135 137 138 139 153 177 181 182 186 187 188 212 303

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Tables

1.1 1.2 5.1 5.2 10.1 11.1 11.2 11.3 12.1 12.2 14.1 16.1 16.2 16.3 16.4 17.1

Premarital pregnancy as a key junction point in the lifespan model Typical forms of data presentation Inter-rater reliability for 13 interviews Scales where inter-rater reliability failed (Kappa