Say for example, your favorite game is soccer and that you would kill just to be able to see – LIVE – the FIFA world cup; you would do anything just so you could grab that ticket to the front row seat and maybe, the happiest moment in your life is the day your favorite team wins… but the scenario would be so much different if we’re talking about a person suffering from ANHEDONIA regardless if he/she is a die-hard fan of the game or of a particular team. What is ANHEDONIA? What is its connection to the above-mentioned situation? What are the manifestations that can be seen from a person suffering from Anhedonia? How can one acquire such illness? How can it be cured? These are only a few of the questions one might ask when he or she hears the “alien” word.
Anhedonia – Definition and Theories
Anhedonia is simply the absence of or the inability to experience pleasure from something (an event, a situation, a deed, an object) that would usually or normally be pleasurable. “Anhedoniais derived from the Greek a- (without) hedone (pleasure, delight). Other words derived from hedone include hedonism – a philosophy that emphasizes pleasure as the main aims of life, hedonist – a pleasure-seeker, and hedonophobia – an excessive and persistent fear of pleasure.” (MedicineNet, 1996)
The illness was fist recognized or acknowledged in the 19th century and was first used by Ribot but it wasn’t given the right amount of procedure, studies and was little understood until the 1980s. Even Sigmund Freud, the Father of Psychology, tried to understand the very existence of anhedonia with the use of his own theory, the Psychoanalytic Theory. He made id, ego, and the superego work for this study. According to Freud, “the id is the part of the personality that holds what is inherited, present at birth, and fixed in a person’s psychic constitution. It is the part of the personality that is responsible for the experience of pleasure. It is believed that any deficits in the development of the id could therefore lead to the deficit syndrome of anhedonia.” (Fortinash & Holoday-Worret, 2000). Some don’t believe how Freud traced the roots and explained anhedonia; some theorists say that it is biological in nature; others believe that it is just part of Schizophrenia; a fraction will tell us that it is what we manifest if we fail to adapt to our environment.
Social Learning Theorists have a different point-of-view when it comes to this matter; they say that our behavior today is a result of our “constant” reaction and interaction to our environment and it begins when we were born and it is, in fact, a life-long process. As children, we were guided by our parents or elders to be able to cope with our society and our milieu; part of that process is the Socialization stage wherein we interact with our parents, friends, strangers, and people who are part, and sometimes who are not part of, our social bubble. Through the Socialization process, as children, we learn; we learn how to kick the soccer ball, how to play the piano, how to read, how to fix our bicycle, etc.
If in case a child doesn’t know something, he/she tries to imitate somebody, a friend or his/her parents. Later on, the child will be able to absorb the rules of the game, the do’s and don’ts. Points and friends will be earned if the child obeys the rules; on the other hand, he/she will receive criticisms and other negative reactions if he/she makes a mistake. This idea or situation will be far different for a child or person suffering from Schizophrenia. The ‘abnormal’ state will become his/her limits and it also goes without saying that that state will deprive the child of so many things and that includes the development of pleasure and this results to “anhedonia”.
One study can also tell us that Depression triggers Anhedonia; death of a loved one, physical illness, and any grave situation that can cause someone depression. A brain of a depressed person was observed through functional magnetic resonance imaging (fMRI). According to Colin Brennan, It was found out that a depressed person has a different image of his/her brain: “smaller hippocampi (the area that deals with emotion), larger white matter lesions, differences in brain metabolism.” (Brennan, 1998) The Institute of Psychiatry in London made use of fMRI to compare the brains of individuals who were suffering from anhedonia and depression and from those who were at the healthy, normal state and these were their differences: “ventromedial prefrontal cortex – the front part of the brain associated with empathy and regulation of negative emotions, ventral striatum – the area of the brain that signals reward, amygdala – almond shaped area of the brain associated with mood and ‘forgetting’ fears – memory of recent events.” (Brennan, 1998)
There are two types of Anhedonia, the physical anhedonia and social anhedonia. Social anhedonia has been described and explained above by the Social Theorists; Physical Anhedonia, on the other hand, is the one manifested by those who have been inflicted by a serious disease that caused them disabilities and the inability to stimulate pleasure. Physical Anhedonia is being associated with Schizophrenia.
Anhedonia and Schizophrenia
Experts say that those who are suffering from Schizophrenia are, more often than not, also suffering from Anhedonia; in other words, Anhedonia is one of the symptoms of Schizophrenia. “Schizophrenia is a severe mental disorder typically marked by passivity, indifference, etc.” (Braham, 1993) Other symptoms of which include the following: “abnormalities in perception – hallucinations, disorganized speech, delusions, disorganized behavior, and blunted and inappropriate affect.” (JAMA, 2001)
Schizophrenic patients wouldn’t be able to respond to a particular stimulus or to stimuli properly and because of this, patients encounter a hard time expressing their emotions. Some say that Anhedonia is the effect of a neurophysiological dysfunction. The failure to experience pleasure or happiness may lead to a failure to respond to “social calls” and to the patient’s environment. In determining whether a person is Schizophrenic, experts were able to devise three methods: “interview-based measure, self-portrait questionnaires, and laboratory-based assessments of emotional experience.” (Schizophrenia Bulletin, 2008)
“In this PET study we compared cerebral blood flow in people with schizophrenia and healthy volunteers when they looked at pictures that evoke unpleasant emotions. The people with schizophrenia were unable to activate the “emotion circuits” in their brains. These areas of decreased flow are shown in blue. Note that the regions are distributed throughout the brain, reflecting a “misconnection syndrome” that involves multiple brain regions.” (Andreasen, nd)
Anhedonia: Other Probable Causes
Drug addiction is one probable cause of Anhedonia. “stimulants like cocaine and amphetamines cause anhedonia and depression by depleting dopamine and other important neurotransmitters.” (Wikipedia, 2007) Long-term drug addicts’ “pleasure pathways” breakdown leading to permanent or semi-permanent anhedonia. Sexual Anhendonia or the failure to take pleasure during sexual intercourse is cause by: “Hyperprolactinaemia – presence of abnormally-high levels of prolactin in the blood, Hypoactive sexual desire disorder (HSDD), also called inhibited sexual desire, Low levels of the hormone testosterone, Spinal cord injury, or Use (or previous use) of Selective serotonin reuptake inhibitors or SSRI antidepressants” (Wikipedia, 2007)
“Two false-colored positron emission tomography (PET) scans of human brains. At the top is the brain of a healthy person, and below that is the brain of a depressed person.” (Encyclopedia of Mental Disorders, 2007)
Different therapies and medications have been devised to cure Anhedonia. One of which is the Milieu Therapy wherein patients are being manipulated through his/her physical and social environment; this, later on, builds the trust of the patient to the doctor or therapist. Trust will later on develop to more open and pleasant conversations and of course, participation. Medications and therapies used in curing Schizophrenia are also being used to cure Anhedonia since doctors see these two subjects related.
Anhedonic patients are called to participate in art and music exercises as part of their therapy to build up the pleasure. Encouragement from friends and member of the family is of utmost importance to motivate the patient’s drive to be cured. Pharmacologic drugs are also being used to reduce the manifestations of schizophrenia and anhedonia; the patient should be aware of the treatment so as to further understand the aim of the whole process and so as to reap participation and acceptance (from the patient). Proper and continuous monitoring of the patients is also encouraged so everything in the process and procedure will take effect immediately.
“Prevention is always and way better than cure.” More than the scientific studies, patience, encouragement, and support claim the top spot to improving a depressed person’s way of life. Depression will not get any worse if we show our compassion and we just try to lend our hands or shoulder to those who badly need it. Before the doctors, nurses and therapists, family and friends come first. As part of the patient’s personal bubble, we should not be afraid too but, instead, we should be brave enough to lead our depressed friends and/or relatives to the light. Talk to them; invite them to do a few good activities with you and some other friends. Give them the reason to conquer every reason to feel or be ashamed of themselves or of the situation they are in. Don’t leave them behind and open up and encourage them that this place is the only place they should be in. Nobody can initiate the healing process but the people around the patient.
This paper aims to define, explain, and dig deeper on the subject of ANHEDONIA. A lot of people have not yet been acquainted with the term and subject being discussed but it is actually related to more familiar terms like DEPRESSION, SCHIZOPHRENIA, and ADDICTION. This paper will divulge the relevance and connection of Anhedonia to depressionm schizophrenia, and addiction. This paper will also help us identify the causes and symptoms of this illness. More importantly, this study will help us find the means to treat a person suffering from anhedonia.
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