Framing the River

When it was released in 1976, a music critic said of Steve Reich’s 54 minute composition Music for 18 Musicians:
“…try to impose a frame on a running river, making it a finite, enclosed work of art yet leaving its kinetic quality unsullied, leaving it flowing freely on all sides. It has been done. Steve Reich has framed the river.”

It’s clear from this week’s articles that depression researchers have at least as complex a task. Depressions’ fundamental “heterogeneity” is in part to blame. It’s a syndrome characterized by episodes, a long-term condition defined by ephemeral states. And these states or episodes may look the same but may be symptoms of different kinds of illnesses. Are mania and depression continuous? Or parallel and commonly comorbid? Are depressive or manic episodes sometimes non-discreet and cumulative, so that “scarring” from previous episodes muddles our understanding of subsequent ones?

That’s the river. Cueller, et. al and Coyne convince us that we definitely haven’t found the right frames. Apparently our methodologies for studying depression are kind of a mess, which, I think says more about depression than the state of the field of clinical science. The methodological problems actually teach us a lot about the elusiveness of depression. The nomenclature surrounding depression takes for granted what hasn’t been empirically supported. Our samples aren’t representative of the manic population because mania doesn’t normally bring people to treatment. Our measurements give us snapshots that crop out important background relationships and contexts. Self-report has been way overused, interview way underused, and questionnaires have been naïve. College kid samples may be biased. Coyne is very cogent about why an integrative approach is needed. Although he shows us to models of good interviewing techniques, I would have loved if Coyne detailed a design for an experiment that could capture the highly integrative phenomenon of depression he describes qualitatively. Interesting to note that in his “most recent work” he’s “drawing on the work of Bakhtin and Vygotsky, as well as feminist theoryists such as Dana Jack.” I think Vygotsky was pretty empirical but wasn’t Bakhtin a literary theorist? How interesting that Coyne has expanded the frame in this way, but tell us more, Coyne!

Gratefully, Cueller et suggest MAXCOV as “a natural technology” for exploring the continuity of uni- and bipolar depression. Kendler, Kuh, and Prescott model a method for parsing three variables involved in depression, and quantified the risk of being a female with high neuroticism. What would Coyne think about this? Yes, they left out all the relational, contextual variables he talks about, but, since Coyne has no proposal for the omnibus study on the river, taking the variables three at a time and subjecting them to the sophisticated models Kendler, Kuhn, and Prescott use (can we talk about the Cox and MAXCOV models in class?) seems like a promising start.