Antidepressants: A Treatment for Bad Marriages?

Newswise, July 29, 2016 — Psychiatrists nearly always responded with prescriptions for antidepressants when clients complained of bad marriages, according to a new study spanning 20 years at a Midwestern medical center.

The assumption that people struggling with their marriages or other domestic issues are suffering from depression is not supported by the way depression is defined medically, said Jonathan M. Metzl, Frederick B. Rentschler II Professor of Sociology and Medicine, Health and Society at Vanderbilt and the study’s lead author. 

The study, conducted using a Midwestern medical center’s records from 1980 to 2000, appears in the Yale Journal of Biology and Medicine.

Notably, Metzl said, the time period of analysis followed a 1974 decision that removed the term “homosexuality” from the Diagnostic andStatistical Manual of Mental Disorders (DSM), the standard reference book of psychiatric illnesses.

“As it became less acceptable to overtly diagnose homosexuality, it became increasingly acceptable to diagnose threats to female-male relationships as conditions that required psychiatric intervention,” Metzl said.

“Doctors increasingly responded by prescribing antidepressants when patients came to the office describing problems with heterosexual love and its discontents.”

The researchers argue that this pattern became particularly prominent after the advent of Prozac and other SSRI antidepressants and widespread pharmaceutical advertising in the 1980s and 1990s.

20 years of records

In their review of archived psychiatrist-dictated patient charts from the expansive hospital system, the researchers discovered a pattern.

“In the charts we analyzed, the pressures of attaining or maintaining heterosexual relationships functioned as common modes for describing depressive symptoms,” Metzl said.

But women and men with marriage woes “have little connection to the current DSM criteria for depression and much more to do with ways that society thinks that men and women should behave,” Metzl said.

“And yet these cultural pressures seemed to go a long way in determining whether psychiatrists diagnosed depression or prescribed antidepressants.”

“In many ways, the 1974 decision was a major step forward,” Metzl said. “But as we show, implicit gender still functioned in the exam room, and our analysis suggests that psychiatry still has work to do in that regard.”

Metzl conducted the study with Sara McClelland, assistant professor of women’s studies and psychology at the University of Michigan, and Erin Bergner, a Ph.D. candidate in sociology at Vanderbilt.

The paper, “Conflations of Marital Status and Sanity: Implicit Heterosexist Bias in Psychiatric Diagnosis in Physician-Dictated Charts at a Midwestern Medical Center,” was published June 27 in the Yale Journal of Biology and Medicine.

Thinking and Feeling'

UC Santa Barbara researchers studying empathy in relationships find that in the absence of caring, understanding alone doesn't cut it when stressful situations arise

Newswise, March 9, 2016 — So you had a terrible day at work. Or the bills are piling up and cash is in short supply. Impending visit from the in-laws, perhaps?

When stress sets in, many of us turn to a partner to help us manage by being a sounding board or shoulder to cry on. Your odds of actually feeling better are much improved if they're both those things.

New research by psychologists at UC Santa Barbara reveals that simply understanding your partner's suffering isn't sufficient to be helpful in a stressful situation; you've got to actually care that they're suffering in the first place.

The findings, published in the journal Psychological Science, provide the first evidence that cognitive and affective forms of empathy work together to facilitate responsive behavior.

"When people were empathically accurate -- when they had an accurate understanding of their partner's thoughts and feelings -- they were more responsive only when they also felt more empathic concern, more compassion and motivation to attend to their partner's needs," explained lead author Lauren Winczewski, a graduate student in UCSB's Department of Psychological & Brain Sciences.

"People might assume that accurate understanding is all it takes to be responsive, but understanding a partner's thoughts and feelings was helpful only when listeners were also feeling more compassionate and sympathetic toward their partner.

When listeners had accurate knowledge but did not feel compassionate, they tended to be less supportive and responsive."

Responsiveness has become an important line of study in social and health psychology because research evidence increasingly suggests that feeling understood, validated and cared for by other people is crucial to relationships and personal well-being. But exactly what enables one to be responsive to others?

In the study, Winczewski and fellow graduate researcher Jeff Bowen, working with UCSB psychology professor Nancy Collins, argued that responsiveness requires not only accurate understanding but also compassionate motivation.

Specifically, they hypothesized that understanding another person's thoughts and feelings -- a cognitive skill known as empathic accuracy -- would foster responsive behavior only when paired with benevolent motivation, or empathic concern.

They tested their theory by asking couples to discuss a previously identified personal or relationship stressor -- jealousy, say, or, as in one case, one partner's extreme fear of flying.

By videotaping the conversations,­ the researchers were able to gauge empathic accuracy and empathic concern, as well as responsiveness, both in real time and after the interaction had concluded.

And as it turned out, they were right. When a listener's concern for their partner was high, their accuracy bolstered responsiveness; but when compassion was scant, understanding did little to aid responsiveness.

According to Winczewski, the findings suggest that empathic accuracy facilitates responsive behavior only when one is motivated to use that insight for benevolent goals.

"You can know very well what your partner is thinking and feeling -- maybe you've heard this story 17 times, the fight with the boss and so on -- but if you don't care?" said Winczewski.

"Having accurate knowledge in the absence of compassionate feelings may even undermine responsiveness."

The researchers speculate that everyday support conversations, like the ones they observed in their lab, inform people's more enduring perceptions of their partners' responsiveness over time.

"People use these kinds of interactions as diagnostic of their partner's motivation and ability to respond to their needs," she continued.

"'If that's how you're responding to me now, is that how you'll respond to me again in the future?' Over time, you may build trust in your partner's responsiveness or you may start to wonder if your partner is even willing, let alone able, to respond to your needs."

Said Collins, who leads UCSB's Close Relationships Lab: "Having an accurate understanding of our partner's inner world, combined with compassionate feelings, enables us to provide the kind of support that is wanted and needed by our loved ones. But in the absence of compassionate feelings, cognitive empathy alone is not enough.

"In this way," Collins added, "our study shows that 'thinking and feeling' work together to help us be as supportive as possible to those we love."