Discuss the Multicultural Perspective explanation for the development of unipolar/major depression. Then identify and describe at least three theories/explanations associated with this perspective.

CASE STUDY: "JOYCE" Presenting Complaint Joyce, (a forty-nine-year old, Caucasian, female) quickly walked to her SUV. She had just finished a two-hour presentation to her firm's new clients, and it had gone well. It had also let her focus on something else for a while so that she could forget about being depressed and stop ruminating about suicide. As Joyce headed toward the interstate for her near hour-long drive home, she felt the return of the dark cloud of sadness that had high jacked most of her life over the past month. Her current boyfriend, Gary, a colleague at work, began dating his new "millennial" secretary. She felt that her life had hit rock bottom that night Gary told her about his unexpected "love" for this other, much younger woman. Then two days later her mother, with whom she had never enjoyed a close relationship, died of her year-long battle with pancreatic cancer. She had just gotten back from her mother's funeral and had not even begun to deal with the issues that haunted her - like the guilt she felt for not being more help to her mother (even though she lived half way across the country) and the grief she felt because she never was close to her mother. For the past month, Joyce was consumed with thoughts about both the loss of her mother and relationship with Gary. Of course, he would have had to leave her for a younger, more attractive woman. On top of everything else, she could no longer sleep through the night and had lost several pounds. Joyce had not been happy with her body for some time and had hoped to lose some weight, but she believed that her recent weight loss was so rapid that it caused her skin to sag Adding insult to injury, the sleepless nights left bags under her eyes. Instead of enjoying being thinner, she obsessed about how much older she now looked, and began to doubt that any man would ever again find her attractive. Joyce wondered what she had done to deserve this. She had been confident and happy once...hadn't she? Now she felt hopeless and helpless to change her situation. Recently, however, Joyce found that thinking about suicide helped her feel better. She had a deer rifle that had once belonged to her grandfather, but she had heard that it was not a good idea to attempt suicide with a rifle unless one was a good shot. Yesterday she purchased a 9 mm pistol. Now that she and Gary were no longer together she could spend her weekends learning how to use it. She lived near a gun range where she could practice until she felt she was skilled and comfortable enough to turn the gun on herself. Then she would pick a day when Gary was in a meeting in one of the conference rooms down the hall from his office. She would leave a note on his desk, sit in his office chair, and pull the trigger. Maybe his new little girlfriend would see it happen. She had a plan! With this thought, her mood began to lift just a bit. She pulled up a Nine Inch Nails album on her iPhone and sang along with it all the way home.

Social and Family History Joyce was the third child in a family of four, three girls and a boy. Her older brother, Al, and sister, Jeanne, were 11 and 9 years older than she. Her younger sister, Denise, was 4 years younger. Joyce did not remember anything related to her brother when she was at home except when he left to join the Marines. She recalls her mother and Jeanne being distraught, and Al's girlfriend and her family being sad. All she remembers about Jeanne was her wedding, at the age of 18, to her high school sweetheart. What she mostly remembered about Denise, was that her parents doted on her. Joyce's father, Frank, was a binge-drinking alcoholic. About three times a year he went on binges. During these times he would drink nonstop for several days, get violently ill, have to be sent to the VA Hospital to "dry out" (he was a Vietnam vet), and return home to face the loss of yet another contract. Frank was a brilliant man who had lost his own parents when he was 8 years old. He and an older brother literally raised themselves in a dirt-poor rural community. Frank went into the service when he was 16. There he learned to work (and work on) heavy equipment like bulldozers and cranes. He owned some expensive equipment and was self-employed, mainly doing road construction. But when he went on his binges and was out of work for two or three weeks, the banks often repossessed his equipment and he lost the jobs. The funny thing was that Frank was so good at what he did that he would easily get new jobs, and sometimes earned back contracts after he "dried out." Nevertheless, the cycle always repeated. Frequently the family had to move, because Frank and Joyce's mother, Evelyn, often neglected to pay the rent. Evelyn was the middle child of 13 children. She, too, came from an extremely poor family. She and Frank married when she was 16 and he was 18. Evelyn was a quiet, unassuming person, and a religious fanatic - involved in a fundamentalist sect. But she never condemned Frank and was long-suffering. Evelyn worked unskilled jobs for as long as Joyce could remember. By the time Joyce was 8 years old, she was coming home from school to an empty house that she was obligated to clean. She cooked dinner, did the laundry, and cared for you younger sister. She recalls no affection from either parent, but she does remember harsh physical punishment for "talking back" to them or complaining about going to church. Joyce hated the church her mother dragged her to. And by the time she was 17 renounced all organized religion once and for all. In order to escape from her miserable home life, her father's drunken binges, and her mother's religious fanaticism, Joyce turned to a life of books, school work, and, when she was old enough, taking jobs herself. She excelled in school and was admired by her teachers. She had a couple of close friends whose parents "adopted" her. They felt badly that Joyce was so mistreated by her own parents. Joyce's mother resented Joyce's involvement in school, because she thought that she should be doing "the Lord's work" and not concerning herself with books and learning - the so-called "tools of the devil." Neither

of Joyce's parents ever went to any of the school functions that Joyce was involved in, nor did they recognize or praise her academic accomplishments. When Joyce graduated from high school as class valedictorian, she turned down scholarships at local colleges and literally ran away from home. She moved to Washington, DC and got a low-paying job with the government. When she became pregnant, she married a man 18 years older than she. After having the baby, she began college. From college, she went on to graduate school to earn an MBA and marketing degree. By then her marriage was floundering. The older man she had hoped would be kind and loving turned out to be controlling and distant - somewhat like her father. Though she had been described as a "good mom," one day, while still in graduate school, she walked out on her husband. She agreed to grant him sole custody of their then 10-year old daughter, Cassie. Joyce did visit with her daughter regularly and they took an annual vacation each summer. Over the years, Joyce continued to keep in touch with her daughter and eventually developed a good relationship with her, but she had no luck with men or relationships. After she received her MBA, Joyce went on to work at several prestigious firms. Each time landing a better and more lucrative position. Joyce had been totally successful in her professional life. She worked hard and got what she went after. She was admired in her field. But, as she got older and hit her late 40s, she suffered frequent bouts of depression and suffered from loneliness. She had a good relationship with her daughter and her colleagues, but she had no other social support. She had no close friends. She was always working but also felt out of place since she was single. She refused to hang out with her married friends and felt like an "old-maid" or social misfit. Work served two purposes - it increased her professional success and gave her an excuse not to have a social life. Joyce had little contact with her mother during her adult life. Her father had died right after Joyce was married, and though Joyce went home for the funeral she recalled feeling no real emotion about his death. When Joyce's child was still a baby, Joyce's mother made an effort to re-establish contact, but Joyce was pretty cool to the idea. However, as Joyce got older she visited her mother once a year and tried to connect with her and her sisters. But somehow Joyce never quite felt as if she belonged, and though polite and cordial, she felt "disconnected" from her mother and sisters. That is why it caught Joyce by surprise that she was so taken aback by her mother's death - somewhat after the fact. As with her father's funeral, she hadn't felt much grief. It was as if she dissociated from the events surrounding the funeral. But when she got home - once Gary "dumped" her, as she put it, her mother's death hit her hard. By the time Joyce had begun fantasizing about killing herself, she had been seriously depressed for almost a month. She had just about stopped eating (which was not hard to do, since Joyce was obsessed with being thin and at 5'5'' weighed 110 pounds) and rarely

slept. She worked all the time - and now had that new campaign she had landed for her firm. Joyce actually wanted to try psychotherapy, because she wanted someone to talk to. But she figured that no one would really understand her, so why spend the money? She was adamant that she would never take medication. For one thing, she thought that she could control her state of mind - if she wanted to. If she wanted to "snap out of it" Joyce felt that she could. But frankly, she was used to the absence of anything close to joy or happiness. The way she saw it, she had nothing to live for anyway. She didn't think her daughter would miss her all that much if she "checked out," since Cassie had a happy marriage and two nice kids (whom Joyce adored) and would inherit Joyce's saving and belongings. Yes, living had gotten to be a burden - and far more trouble than it was worth. Talk therapy, medication - they would just mask the underlying issue. Joyce had nothing to live for and the sooner she could do herself in, the better. All she wanted now was to get her hands on that gun.