Life Events and Emotional Disorder Revisited

Research and Clinical Applications

Antonia Bifulco, Ruth Spence, Lisa Kagan

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000317671
• Edition: 1
• Topic: Psychology
• Subtopic: Post-Traumatic Stress Disorder (PTSD)
• Index: Psychology

Life Events and Emotional Disorder Revisited explores the variety of events that can occur, their inherent characteristics and how they affect our lives and emotions, and in turn their impact on our mental health and wellbeing.

The book focuses on current social problems nationally and internationally, showing the reach of life events research including those linked to Covid-19. It also discusses trauma experiences and how they fit in the life events scheme. To underpin the various life event dimensions identified (such as loss, danger and humiliation), the authors have developed an underlying model of human needs, jeopardised by the most damaging life events. This includes attachment, security, identity and achievement. The book brings together classic research findings with new advances in the field of life events research, culminating in a new theoretical framework of life events, including new discussions on trauma, on positive events and an online methodology for measuring them. Additionally, it draws out the clinical implications to apply the research for improved practice.

The book will be of interest to researchers, clinicians and students in psychology, psychiatry and psychotherapy in broadening their understanding of how life events impact on individuals and how this can be applied to enhance clinical practice and stimulate future research.

1 Introduction

Adversity is always around us. It has important impacts on our lives, our state of mind and our wellbeing. When we experience life events, the change to our personal circumstances requires adaptation and coping. Such change can at times be minor or even positive, but when the events are both significant and negative, the impacts can be overwhelming. These events can threaten and damage our relationships, roles or material possessions with implications for our future lives. This can challenge our safety, close attachments or sense of identity or cherished achievements. For example, many severe life events involve loss. Amongst the worst is the death of people close to us. This will usually leave us bereft, affecting not only our mood but also our daily roles and routines and our ability to look forward to the future. It requires a period of mourning to process and accept the loss, and to find a way to renew investment in our roles and other relationships (Murray-Parkes, 1988). It often leads to depression as our basic attachment system is threatened. Many people are unaware that a similar process is needed to cope with other negative life events involving loss, such as losing a home or a job or a friendship. All require substantial adaptation and have implications for mental health. We hope to show in this book that problems with mental health, particularly around emotional disorder such as depression and anxiety, are in a large part due to the adverse things that happen to us. We aim to explore how life events can damage us emotionally.

Some losses may be related to conflict events which also invoke danger. For example, partner separation involving loss can sometimes follow a period of intense argument or violence which has danger elements. Coping is required both with the conflict and then with the loss. The challenges around coping with conflict involve dealing with danger and resulting vigilance, to which our instinct may be of flight or fight, or indeed, to hide. These events affect our sense of security – the world may seem suddenly unsafe and unsure. Disappointments too, such as failing an exam or a key job interview after hope of a new career direction, can lead to feelings that our life plans are de-railing and our achievement plans extinguished. Most of us think of life events around the life categories involved (e.g. ‘education’ or ‘partner’ or ‘housing’). But identifying experiences of loss, danger and disappointment under the heading of ‘severe’ life event is a different and effective way of explaining how adverse changes in our daily lives, across various categories, impinge on us personally and psychologically. Thus, we learn how such events can undermine our feelings of being safe, being close to others, being a worthy person or being successful. These threats can provide important indicators for how emotional damage occurs as well as how interventions should be focused. When we encounter severe events involving loss or danger, the likelihood of triggering a clinical depression or anxiety state is greatly increased (Brown & Harris, 1978). Exploring the variety of events that can occur, their inherent characteristics and how they affect our lives and emotions is the focus of this book.

It now seems intuitive that negative life events bring about depression, but for greater precision, the mechanisms involved, the identification of the types of events most harmful and the types of people most affected has involved decades of study. The study of life events has a long and multi-disciplinary history in relation to health. It can be traced from medicine and psychiatry, through psychoanalysis and psychology, to sociology and epidemiology. Its multi-disciplinary range fits with the modern notion of the integrated bio-psycho-social model of the causes of clinical disorder. For example, early in the 20th century, Freud’s writings on Mourning and Melancholia (Freud, 1924) explained the linkages between bereavement and depression. He considered two different processes – in mourning, a person deals with the grief of losing a specific person or ‘love object’, this process taking place in the conscious mind and leading to resolution. Whereas in melancholia (or depression), a person grieves for a loss they are unable to fully comprehend or identify, the process taking place in the unconscious mind and remaining unresolved. Thus, Freud considered mourning to be a healthy and natural process of grieving a loss, while melancholia occurred when this turned towards psychopathology and disorder. This has parallels for positive and negative coping with a wider range of loss events.

Whilst modern interpretations of bereavement may differ, it is well established that some individuals can come through the stages of mourning without experiencing a clinical depression, whilst for others, the loss is unbearable and unresolvable. For Murray-Parkes, grief occurs in phases and takes into account our own history, experiences and the relationship with the deceased (Murray-Parkes, 1985). These factors can affect the mourning process. He identifies four stages of mourning which include feelings of shock or numbness, yearning and searching, disorganisation and despair, and finally recovery and reorganisation – the latter indicating a completed and healthy mourning process. Earlier experiences of loss in childhood, he argues, can affect whether individuals adapt to recent loss – the event can awaken echoes of prior losses which may not have been resolved, thus creating a vulnerability for future loss. This approach was much influenced by John Bowlby’s attachment theory and the response of a child to losing a parent with emotions of fear, anger, frustration or grief (Bowlby, 1979), emotions carried through to adult life and affecting future relationships. These approaches focus on the psychological pain of losing someone close and how individuals have different capacities for coping based on early life experience. It lays a foundation for understanding not only the impact of severe loss events but also the factors which make some individuals more vulnerable. These will both be explored in this book.

Timing of severe life events in relation to emotional disorder is key. In order to show a causal effect, the event must come before the onset of disorder, but also relatively close in time if it is to have a casual role as a provoking agent. Yet people frequently experience a number of events, some more threatening than others, so determining a calendar of events that have happened in the recent period allows for scrutiny of which event is most likely to have brought about the disorder. Most individuals are aware of the event that has upset them most and led to overwhelming emotion and feelings of being helpless. But, sometimes, a significant event is not fully processed and remains a hidden provoking agent (Bifulco & Brown, 1996). This can be because events can happen in a sequence as a scenario unfolds and determining which is the most damaging point in that unfolding crisis can be unclear. (For instance, which was more painful – the angry rejecting row with a partner, his disclosure of infidelity, his leaving the home, or initiating divorce proceedings, all over a three-month period?) The important search for such sequences and timing of life events actually began in the 1950s, when the psychiatrist Adolf Meyer, having listened to his patients’ narratives of different crises, investigated life events as a cause of clinical disorder. He developed a life chart system for recording the temporal relationships of these negative life experiences and depression from his careful observation of his patients’ reported experience (Meyer, 1994). This was the first attempt to measure and chart life events systematically and was the precursor for the later intensive methods described in this book.

However, at some point thereafter, the timing of the event was disconnected from the life events with the innovation of brief checklist approaches in the 1960s (Holmes & Rahe, 1967). These only looked to the number of proscribed events experienced rather than their significance, sequence or timing in relation to disorder. It was left to the more sophisticated time-based interview approaches (Brown & Harris, 1978; Paykel, 1997) to investigate the events in full contextual scope as well as their timing and sequence. This then allowed for a focus on noting the particular event which preceded an onset of depression or anxiety to determine its characteristics in seeking mechanisms for psychological damage. Both methodological approaches (checklist questionnaires and in-depth interviews) have persisted in contemporary research and still constitute opposing theoretical and methodological viewpoints (Brown, 1993; Harkness & Monroe, 2016; McQuaid et al., 1992). It is only in recent times that online methods have bridged these two options (Bifulco, Spence, Nunn, Kagan et al., 2019).

Life events do not usually happen randomly to individuals. There are important social influences in bringing them about which are recognised in the social epidemiology of mental health. For example, early findings in the field of psychiatric epidemiology showed that rates of depression differed by location, even within cities, in relation to deprived areas – effectively ‘postcode’ distribution. A famous study in New York in the 1960s, The Midtown Manhattan Study, based on interviews of over a thousand individuals randomly selected, concluded that mental health risks were greatest among those with low socio-economic status (SES) often grouped in key neighbourhoods (Kraines, 1964). This was to inform a generation of researchers who subsequently investigated depression amongst those disadvantaged, poor and socially excluded (Ross, 2000). However, it was through the investigation of severe life events occurring to individuals that the mechanisms of emotional damage from their adverse environment (whether domestic or neighbourhood) could be established.

George Brown and Tirril Harris were pioneers in this area and termed their seminal work on life events the ‘Social Origins of Depression’ in view of their recognition of social inequality and disadvantage as a key to common clinical disorder (Brown & Harris, 1978). In the mid-1970s, when they published, psychiatry was in the pendulum swing away from a biological view of clinical disorder and towards a social view, and their book was influential in showing a key role for social adversity through the experience of severe life events. Thus, they conducted community-based studies to show that the social environment can increase the likelihood of depression, particularly in poor city areas such as Camberwell in London, for those deprived and of lower social class, and groups with less power in society, for example, women. Their intensive study of the lives of inner-city London women highlighted ways in which hostile and impoverished environments can increase stress on individuals to the point where depressive disorder occurs.

Life events are not only the consequence of social adversity. Some of the disadvantage individuals’ experience occurs earlier in life course development in relation to childhood, adolescent and early adult experience. This can also leave scarring (psychological, social and neurobiological) and can affect how individuals cope later in life. It may also lead to life events for example through difficulties in making close relationships which in turn results in relationship conflict or breakup events. It may also affect coping with such events in terms of helplessness or lack of emotional control. In the model described, these early life experiences are subsumed under vulnerability factors – those which make an individual more susceptible to both the occurrence and the impact of severe life events.

Brown and Harris’ additional contribution was their innovative use of measurement. Their semi-structured interviews allowed individual respondents to openly narrate their recent stressful experience and, with interviewer use of probing questions, give detailed descriptions of the range of circumstances involved. This conveyed the full context which helped explain why the event was experienced as damaging and how it disrupted day-to-day lives. This methodology started a wave of interest in the accurate identification of severe life events and their prevalence by location and class – and the process by which these events could trigger clinical depression in individuals. This book seeks to describe the key methods and findings of this approach, and to update and extend these into later research for the benefit of students, researchers or those in clinical practice.

Community life events and trauma

Many life events are ‘normative’ and mark out life stages for an individual, and they are usually benign and can chart growth, advancement and achievement in stable circumstances. For example, starting higher education, getting married, the birth of children and starting retirement. However, these changes can be threatening or unpleasant under more unstable circumstances. For example, getting married can be problematic (e.g. if enforced or to an unsuitable, antisocial partner), and births can be problematic too for reasons of the mother’s health, her poverty and poor housing or lack of a partner. Life events can also be non-normative in the sense of an unexpected disruption in the usual life course. These can come about because of conflict (e.g. domestic violence, mugging, sexual assaults, bullying) or through being badly let down or betrayed by close others (e.g. partner’s infidelity, child’s delinquency, parent’s rejection). Other such events occur because of more widespread economic problems in the local community (e.g. redundancy, loss of benefits, homelessness).

However, life events can also have a basis in group and societal experience. Sometimes, this is on a very large scale for whole populations. Our most recent experience is through the Covid-19 pandemic (Brooks et al., 2020). Whilst largely unprecedented in recent times, it has affected every country and to greater or lesser extent every individual. For some, it is inconvenient but has not personally threatened their basic security – requiring, for example, social distancing, working from home, additional childcare responsibility. But for others, it has led to life-threatening illness, unexpected bereavement, reduced income, job loss or a dangerous work environment. All of these involve life events – many severe and many leading to longer-term diffi...