Thursday, 29 January 2015

Nature and Narratives of Depression: 18th EPA and WPA Meeting in Paris

Salpetriere Hospital, Paris
The 18th Meeting of the Psychopathology Section of the European Psychiatric Association (EPA) and the World Psychiatric Association (WPA) took place on the 5th and 6th December 2014 at Salpetriere Hospital in Paris, France.

Over two days those invited to speak presented their talks related to the meeting’s leading theme – Nature and Narratives of Depression: Philosophical and Psychopathological Aspects, followed by plenary discussion. The meeting was chaired by Michael Musalek and the list of presenters included: Femi Oyebode, Pedro Varandas, Maria Luisa Figueira, Luis Madeira, Norbert Andersch, Raimo Salokangas and Gilberto Di Petta.

The first, opening talk by Birmingham based psychiatrist Femi Oyebode was entitled ‘Sadness and Depression. What is the psychopathological boundary?’ Oyebode led his audience through a variety of conceptual issues related to the distinction between sadness, melancholia and depression. In his talk he attempted to find the correct answers to the following questions: are psychiatric phenomena/disorders qualitative or quantitative abnormalities? Can behavioural abnormalities be disentangled from cultural norms? Oyebode presented several examples of sadness, melancholia and depression depicted in literature and art as well as attempting to define the status and validity of diverse types of norms, which might influence our perception of the conceptual problem. He concluded that in the light of the available evidence, there is a clear, well-stated boundary between the phenomena of sadness, which relates to particular content and involves intentionality-and melancholia (a prototype of depression), which does not require content, but instead is nonreactive and persistent.

Maria Luisa Figueira and Luis Madeira in their talk ‘Distimia, Unipolar and Bipolar Depression: is modern nosology making us crazy?’ presented conceptual confusion over depression-related diagnosis throughout history. Figueira and Madeira showed the audience that starting in nineteenth century, the perplexity of concepts related to melancholia or/and depression became more and more complicated, to reach the most severe confusion in the DSM-5. Is there a way out of diagnostic mess? The authors expressed such hope, proposing better simplicity and return to the fundaments of psychopathological distinction.

In his talk ‘Depression: a flip of psychosis?’ Norbert Andersch argued that modern psychiatry attempts to turn human suffering into an illness. He pointed out that the term ‘depression’ has no conceptual or linguistic equivalent in most languages around the globe. For example, in Japan there was no concept of ‘depression’ per se, instead there was ‘yuutsu’-a general grief and gloominess of body and spirit-which, however, was not constitute an illness. Quite recently, the marketing strategy run by pharmaceutical companies has managed to convince many Japanese that the sadness they experience should be considered as an illness and ought to be treated.

Raimo Salokangas presented a talk entitled ‘Casual Connection between Depression and Paranoia’, where he debated the question whether clinical forms of depression might predict the occurrence of delusions. His research questions were based on the works of Griesinger, who claimed that paranoia is always preceeded by an affective disorder and was secondary to it, as well as Specht, who argued that all psychoses are originated in mood abnormalities. Salokangas then presented the results of his own research, showing that the wide spectrum of depressive disorders, but not the level of depressiveness, was significantly associated with paranoia. Salokangas concluded that depression is considerable as a background for delusions.

The meeting in Paris was an excellent opportunity to meet like-minded researchers and practitioners and share thoughts and ideas associated with depression. The meeting next year is expected to refer to the psychiatric and philosophical issues of guilt and shame.

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