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How Do You Diagnose Depression?

Ianthe Chase interviews Cris Clay, who holds a masters in Applied Behavioral Analysis and for the last 35 years has served as Director of the Community Reentry Program at the University of the Pacific.

Cris Clay: Thank you for inviting me to the DC radio.

Q: Tell us about your 35 years at UOP, talk about the big umbrella of the Community Reentry Program. What did you do and try to do there?

A: My history is working with major mental illness not specifically one type of diagnosis. I began my career here at Delta College as a student and moved on to study at the University of the Pacific where I completed my bachelors and Masters degrees. I was assigned to a program called the Community Reentry Program. Its function was to work with adults with major mental illness in the community as an experiential learning program I worked for 2 years in the graduate program then I applied for a full senior administrative position. Through out my term I worked primarily with adults with mental illness. Not necessarily depression but some of the more chronic diseases

I worked with graduate students who are training in an area of psychology called Applied Behavior Analysis. We’re the kind of people who work with what people do and say as opposed to what people think.

Q: Tell us more about the difference between cognitive and behavioral psychology.

A: As behavioral analysts we’re concerned about what people do and say as opposed to what people think and feel. Behavior analysts are concerned with what they can observe, define and measure in a very constructive manner. We cannot observe people thinking but we can observe what they do. Typically what you do is what gets you what you want or it gets you out of what you do not want. We are concerned with what goes on outside the skin as opposed to what happens inside the skin. As behavior analysts, we look at words as much as we look at overt behavior.

Q: Depression can be isolating and debilitating it’s experienced by millions of people yet mental illness and depression are stigmatized by society. Do you see cultural differences in the way communities react and interact with those in their circle that are experiencing depression or any kind of mental illness? Is bipolar disorder a form of depression?

A: Bipolar disorder is one of the symptoms of depression. Bipolar disease is a depression type disorder. But more specific to some of the chronicity of it. All humans experience an element of depression at one time or another.

When a person has a mental illness you usually can’t see it if the person is med compliant. If a person has a physical disability you automatically recognize that person as having a physical disability. You have empathy for that person. If you see a person with a mental health illness and he is not compliant or the meds need to be adjusted, you might see that person talking to trees or cracks in the sidewalk or have a very animated conversation with themselves. When people see this they think the person is drunk or on drugs. You may not know that this person is suffering from mental illness. Again, that’s where the stigma comes in.

Q: What can a person do or how might a person help prevent depression before it leads to suicide?

A: Again my history is with major mental illness, which is schizophrenia and bipolar disease, less with depression. In order to get a depression diagnosis you have to have 5 of 10 or 12 symptoms present for a period of 10 days or longer. Each symptom has to be present continuously for duration of time in order to get that diagnosis. That’s very unlikely to be diagnosed. Someone needs to be able to keep an eye on a person for a 2-week period continuously to be able to identify the presence or the absence of the symptoms.

Some symptoms of depression exist with schizophrenia and bipolar disease. They exist consistently. Still to be diagnosed as being depressed is very difficult. If you have symptoms present for 14 days continuously, you have to have something really aggressive to change or disrupt that. That’s where the problem comes with depression diagnosis.

Q: What might that look like?

A: That person is not eating or sleeping, or they’re sleeping too much there’s no excitement no enjoyment of life, they have anxiety, paranoia, fatigue. There’s a host of symptoms that have to be present continuously. Hygiene is one of the first things to go. Suicidal thoughts often occur. You can’t see anyone having suicidal thoughts. You can see them doing suicidal things. They are usually not expressive and they’re guarded.

They may have recurring dreams or thoughts but again they are not usually expressive. So they get caught in this downward trend of thinking down and doing nothing. That’s where depression is so severe. If you get in that spiral downward and stays for a long period of time then suicidal thoughts begin to occur. You are feeling so hurt that you just want to get rid of it. People with depression diagnosis are watched very closely and generally it only happens to that degree with people who are aged.

Q: Why are so many young people committing suicide? Is that a symptom of depression?

A: As a behaviorist that’s a tough question for us. Generally my perception is that most things that are dysfunctional or inappropriate or things that people do wrong or inconsistent with societal rules are a function of a deficit. People simply don’t have skills to deal with a particular situation, event, or person in their lives, environmental elements.

Q: As a behaviorist how do you deal with depression?

A: As a behaviorist we provide alternatives to depressive symptoms. I see symptoms of depression as fairly normal. We all experience it. We deal with the environment the community job demands and so forth. Whether we like it or not they’re going to occur. So you must come up with an alternative to the feelings of depression to make things a lot better for you. When I don’t want to eat I force myself to eat things that are absolutely healthy for me. When I’m having trouble sleeping I drink a cup of tea. That works for me. You find something to help you to respond to your symptom of depression. If you’re having a problem with your spouse or best friend, talk to them.

Q: Any parting thoughts?

A: I just want people to know that mental illness is just like any other illness. It just has to be treated and you have to get people to accept that they have an illness so that they can move forward and become participants in their treatment.

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