An invitation to critique current understanding of mood as disorder.
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An invitation to critique current understanding of mood as disorder.
Written by Johanna Lynch – University of Queensland
Continuing the exploration of the interconnected wonderfulness of being a whole complex person, this issue will explore the multiple meanings and layers of the word ‘feeling’.
I am not an expert in the area of emotion – but I bring it up for a topic of discussion as we think about the whole person. Just like sensation, I think it is another area that has become a narrowed concept. I am concerned that the categorical way the medical and lay community often use the words ‘mood’, ‘emotion’ or ‘feeling’ does not help us see whole complex people, and often pathologises something that is completely reasonable and understandable into a ‘mood disorder’.
It seems that a beautiful interconnected meaningful experience of ‘feeling’ has been turned into a noun of disorder – a passive one dimensional thing.1 When I first started writing about ‘feeling’ – I genuinely thought it was a verb – a process – a way of knowing or communicating to ourselves. But would you believe it – the Cambridge dictionary declares it as only a noun with multiple meanings (including ‘sense’, ‘emotion’, ‘opinion’, ‘experience’). I have since learnt that you can ‘have’, and ‘express’ feelings and can express past sensation as a verb ‘I sensed/felt x’. But there is no verb for the actual present emotive feeling process.
‘Feeling’ or ‘emotion’ or ‘mood’ or ‘affect’ being nouns, not verbs, doesn’t seem to match reality where so much activity and change happens in our bodies, minds, and intersubjectively in relationships with others when we are experiencing a ‘feeling’.
As a younger Australian general practitioner (GP) I can distinctly remember a moment when I felt a moral dilemma where my GP training called me to see the whole person, but mental health frameworks around depression saw it as a discrete thing – like a body part that can be treated. This narrowed assessment to a checklist independent of the personhood and experience of the patient. In those days drug company representatives used to book appointments, come into our consulting room, and give out pens and other paraphernalia to help embed their drug name into our consciousness. Those selling ‘anti-depressants’ used to leave ‘helpful’ little pads of questionnaires that would determine (quite often) that people needed that particular script. These questions were about mood over the last two weeks. As a new GP, the decision to prescribe an anti-depressant was difficult – but this tick box made it look straightforward. So – even though I knew that list didn’t ask about a person’s loss of a close pet, or existential distress as a widow, or childhood adversity, or work strain, or menopause – I still wrote that prescription – and it didn’t feel right.
Catergorising feeling or mood as a noun is not benign. It has completely altered how we relate to sorrow or fear in ourselves and other people.2-6 It has led to a cookie cutter view of complexity that can make healing and community comforting harder. Rather than complex words like ennui (thanks Inside Out 2!), lethargy, regret, despair, lament, sorrow, or disappointment we now have the bland pathologizing word ‘depression’. I think the tiny word depression has professionalised care, disenfranchised community from knowing how to help, and created an industry designed to offer narrow impersonal technological or pharmaceutical solutions.
This way of narrowing emotion to a noun has deep roots in trying to objectify something complex. Those who critique the concept of ‘depression’ call this ‘reifying’ – making something abstract into a noun and thereby creating something that is now more concrete but may not be quite as true or complex as it was before.7,8 Some say our fascination with nouns in medicine is that we crave certainty or that our original science came from dissecting immobile cadavers. Others say it may come from a dated view of a silent body that is just observed from outside by a mind (usually that of an medical observer) that speaks: “the silent body and the speaking mind.”9p.1097 What if that body could speak? And the person who is experiencing it could speak for themselves?
There is good quality research that shows that emotion is embodied in an inseparable kind of way.10,11 Some researchers describe a constant flow of communication between sensation and cognition – including what they call ‘hot thought’, or ‘cognitive emotion’ (links between emotion and thinking influenced by social, cognitive, neural and molecular processes).12 Others link interpretations of emotion (emotional cognition or emotional thought) to “somatic states” that include musculoskeletal and visceral inner aspects of the body (especially cardiac, lung and gastrointestinal viscera).13,14 Researchers have also named the ways that emotion is not passive – but can be manage through attention, soothing, and regulation- through what they call ‘effortful control.15,16 and both adaptive and maladaptive emotion regulation.17 Some theories of emotion and sensation – such as Dabrowski’s theory of positive disintegration, really highlight the interconnected purpose and development of emotion.18
Feeling and emotion are also closely linked with how we sense ourselves internally and respond to our external environment. Antonio Damasio in his essay ‘Feelings of emotion and the self’ describes exteroceptive senses (like sight, sound, touch, smell, and taste) alongside interoceptive senses (like proprioception that senses movement and gravity, vestibular sensation for balance, the internal sense of our organs, and environment that sense pain and temperature, and changes in chemistry such as pH, oxygen, lactic acid, glucose, histamine, hormones etc).19 He claims that this sensing is part of how we know who we are – our bodily self as part of an integrated nervous system20 that links ‘factual knowledge and bioregulatory states’.13p.296 Somatic markers or signals, for example heart rate, heart rate variability and skin conductance 21 can also reveal these inner processes. Stephen Porges would add ‘neuroception’ as an unconscious awareness of danger we sense all the time at multiple layers of our being.22
Each of our main emotions have different physical markers. So much so, that one of the early researchers into emotion was Jaak Panksepp, a veterinarian turned researcher, who named what he called core emotions based on physical markers. He named emotions of ‘seeking, fear, rage, lust, care, panic/grief, and play/joy’ as the basis of a neuroscience of emotion.23 Other researchers name core emotions of disgust, contempt, surprise, and happiness in their lists and describe ‘seeking’ as a type of focussed attention.24 Cross-cultural research into bodily maps of emotion is also really helpful to understand the intersection of body and emotion exploring “bodily fingerprints” of anger, fear, digust, happiness, sadness, surprise, anxiety, love, depression, contempt, pride, shame and jealousy.25
So, a ‘feeling’, that is often simplified into a noun (like ‘fear’) is actually a complex interconnected embodied experience that helps us know who we are, and connect to our own and others’ experiences. It is a kind of inner connector, communicator and regulator: from our embodied self to our whole selves, and to others.
When understood this way – as a form of knowing or communicating – then we can learn so much from the array of emotions in our world. Emotion can help us to understand deep things that have no words, it can connect past and present experience, and help us to unravel the riddles of some presentations. One of my Norwegian mentors, Professor Anna Luise Kirkengen describes the “complex bodily logic” or “logic of the lived body” (personal communication) that is inside symptoms. This points to a deeper kind of knowing inside a person that has deep reason and meaning. Feeling is a way of knowing that we sometimes cannot interpret (if we are numb and cannot name a feeling – alexithymia), or can misinterpret (if we experience fear but interpret that bodily experience to be anger). Feeling is a way of knowing that can be linked to forgotten or ignored history that our body still remembers26 (for example chronic pelvic pain after sexual assault). It can warn us about other people or places with gut feelings, and it can help us enjoy the world around us.
If you reflect on the last time you felt angry. Can you remember the thoughts you were having? Can you remember what it felt like in your body to feel angry? Can you remember how you calmed yourself down from that state? Can you sense that being angry involves all of you? The reason or meaning for the feeling, the bodily experience of your heart rate and stress hormones changing, the inter and intrapersonal context of the feeling? The way our voices get harsher and it becomes more difficult to sense or care about other people? We do not feel in just one part of ourselves – the whole of us experiences it.
I would also add that feelings usually make sense. They are rarely disordered. They usually have a reasonable cause somewhere within the whole person. Of course, feelings can be experienced in ways that are not helpful – for example rumination, rigidity, obsession, intrusions. And perception can be distorted. But if we took the time to understand the whole story and translate the meaning of that ‘feeling’, we would find the inner logic that Anna Luise Kirkengen describes above. This is something that I have encountered often.
With permission I share this story: I once had a patient who came asking for help because whenever she had unpleasant clients she found herself trying to give them more freebies than usual. As we talked, she realised that she recognised the feeling just before she was generous. She suddenly remembered being six years old and leaving a posy of flowers for her father on the front door steps when her mother took her away from the family home. The same (now wilted) posy was there two weeks later when she came to visit –her gift was unacknowledged, unreceived. Perhaps the logic of the feeling of needing to give to difficult clients was a kind of flashback – to a little girl trying to give a gift searching for acknowledgment from someone who did not notice her gifts. This feeling led us towards the healing logic.
If something meaningful is simplified to a discrete noun – we miss something important. We can miss the bigger story of harm or joy within the noun. In some ways this is why I think the professional psychiatric community is often late to the party about the importance of trauma-informed and strengths-based care. One writer that I think has captured this is Prentice Hemphill who notices how trying to suppress a feeling might actually mean we miss a chance to intervene and respond appropriately:
Image credit from Sense of Safety for Practitioners Foundation training course.
So – is feeling in our mind or in our body?
This vexed and important question changes how we understand, care for and manage emotion. Perhaps even the implied dichotomy in the question narrows our attention and makes us miss the amazing interconnections within a whole person. Perhaps this is so important that we need to resist simplistic answers that give simplistic (and perhaps therefore ineffective) solutions. Transdisciplinary researcher Sue McGregor says: “Simplifying reality to simplify our work is irresponsible”. 27p.7
I really think it is better to have an unanswered question than an incomplete answer. So, if we stay close to a person having or expressing a feeling, can we notice the bigger story, the interconnected sensory and cognitive meanings and regulation across the whole? Perhaps that is enough to critique the concept of mood as disorder?
I wrote a little poem to capture how much I think it matters if complex whole experiences become things:
Nouns of Disorder
If a feeling is a noun
then it becomes a thing
to be treated or categorised
with other impersonal things
it becomes disconnected
from me and you
it loses its nuance
and its meaning to me
it gets bleached of
its body memory
and history
its story
If feeling loses story
and connections to me
and to you
then what does it mean?
what can we do to help?
where do we go next?
Johanna Lynch 2024
The author would like to thank Professor Claire Donnellan and Dr Matthew Lewis for helpful comments on an earlier draft.
About the writer
Dr Johanna Lynch MBBS PhD FRACGP FASPM Grad Cert (Grief and Loss) is a retired GP who writes, researches, teaches, mentors and advocates for generalist and transdisciplinary approaches to distress that value complex whole person care and build sense of safety. She is an Immediate Past President and Advisor to the Australian Society for Psychological Medicine and is a Senior Lecturer with The University of Queensland’s General Practice Clinical Unit. She spent the last 15 years of her 25 year career as a GP caring for adults who are survivors of childhood trauma and neglect. She consults to a national pilot supporting primary care to respond to domestic violence.
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