RunningHead:DRUGSANDDEPRESSIONINTHESOUL

Drugs and Depression in the Soul

Abnormal Psychology MTWTh; 1:00 3:30 PM
UC Riverside
Kathryn Respicio

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Section A
Much is known about Kurt Cobain. He was the lead singer of the punk-grunge
band, Nirvana. His song writing gave a voice to a new generation of wasted teenagers
and redefined punk rock in the music industry. Many would expect Cobain to live the
lavish, rock-and-roll style that many rock musicians have lived. But behind closed doors,
Cobain was a shy, quiet soul who loved to write music. Cobain used his music to express
the anger and rage he had felt all of his life.
Kurt Donald Cobain was born on February 20, 1967 to Wendy Elizabeth and
Donald Leland Cobain. Both his parents were of Caucasian descent. As early as
childhood, family and friends reported that Cobain always had low self-esteem (Cohen,
2003). His low self-esteem would be amplified by his parents divorce. From the age of
nine, Cobain became withdrawn and defiant. While his anger and resentment toward his
parents influenced his musical creativity, no one was able to detect his cry for help. It has
been suggested by many authors that this event marked the beginning of his depression
(Cohen 2003). However, since Cobain never sought any medical or psychological
treatment, it went untreated.
As Cobain grew older, his teenage rebellion escalated. His father, who had full
custody of him, found his behavior to be overwhelming. During this time, Cobain began
to experiment with heroin. In the midst of his adolescence, he was also shuffled between
the homes of different relatives. This reinforced Cobains belief that he never received
the love he needed from a loving, supportive family.
Influenced by his troubling home life, Cobain expressed his emotions in writing.
He wrote lyrics and drew sketches in journals. Eventually, Cobain and a few of his

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friends formed a band called Nirvana. They headlined for popular artists and formed their
own fan base. The bands popularity came from the art and soul of Cobains writing. In
the last years of his life, he married fellow rock musician, Courtney Love. But as
Nirvanas fame grew, so did Cobains addiction to heroin. In the last couple of months,
Cobain suffered from several overdoses to heroin and manic-depressive episodes. He also
began to write suicidal notes to his fellow band mates and family members. Pressures
from the music industry, his unstable marriage to Love and the battle he had with
depression ultimately resulted in his suicide at the age of twenty-seven.
Section B
Axis I: Depression and Substance Abuse
Axis I is classified as clinical (mood) disorders. Medical professionals use this
axis to effectively communicate which disorder the client has been diagnosed with. A
diagnosis for this axis is reached if the client seeks treatment to get rid of the disorder.
The disorder may be chronic or acute. In the case of Kurt Cobain, medical professionals
would classify him with two disorders on this axis.
The first clinical disorder Cobain has been diagnosed with is major depressive
disorder (MDD). According to the DSM-IV-TR, the client has recurrent depressive
episodes. There has to be at least two months in between episodes. The average duration
of the first MDD, if it is not treated, is nine months. Research has shown that even though
depression usually develops mid-to-late twentys, people are developing depression at
younger ages.
Cobain could have been diagnosed with depression during his adolescence. Even
though a proper diagnosis for major depression involves the presence of at least five

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symptoms, Cobain exhibited four major symptoms. All of these symptoms were present
from adolescence up until the days before his suicide. The first symptom was feelings of
worthlessness. Cobain blamed his poor upbringing on his parents and relatives. His
parents separation deeply affected him. Since his father sent him to live with different
relatives, Cobain grew up believing he was not provided with the love and support of a
normal family. He carried these cognitions with him until his death.
The second symptom was recurrent thoughts of death and suicide. Charles
Cross, an autobiographer of Cobains, wrote that Cobain had threatened suicide in his
writing as early as 14-15 (Cohen, 2003). In addition, much of the songs written by
Cobain, had a lot of references to his suicidal ideation.
The third symptom exhibited was depressed mood for most of the day / nearly
everyday. Cobain showed much anger and resentment towards his family and society.
From his adolescence, Cobain behaved insolently towards adults. This behavior would be
exhibited through his relationship with his producers in the music industry. Towards the
last couple of weeks of his life, these episodes would become more evident to his wife,
band mates, friends and producers. As Cobains addiction to heroin began to spiral out of
control, his depressive symptoms would interfere with his life (Cohen, 2003). This was
especially apparent during concert performances, his relationship with his wife and his
suicidal ideations. Thus leading to the fourth symptom, depression reported by the self
or others.
In addition to his depression, Cobain was also diagnosed with substance-abuse
disorder. A diagnosis is given when recurrent substance use leads to significant harmful
consequences. Cobain began to experiment with heroin as an adolescent. Sihvola et al.

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(2008) found that a high prevalence of depressive orders observed among youth with
substance use disorders (p. 2045). He continued to experiment with the drug as he formed
Nirvana. As his fame with the band increased, his drug abuse increased as well. It did not
help that Cobain was also surrounded with people who were avid drug users, including
his wife and close friends. From 1992 1994, Cobain struggled with drugs. His drug
abuse reached a pinnacle when he overdosed on heroin several times in 1994.
Axis II: Personality Disorders
Cobain was not diagnosed with any personality disorders.
Axis III: Medical Conditions
Cobain was not diagnosed with any medical conditions.
Axis IV: Psychosocial and Environmental Stressors
Axis IV is categorized by problems with primary support group, social
environment, education, housing, occupation, economic status, etc. Looking back on
Cobains life, one could see the major stressors that were detrimental to his life.
The first major event that turned Cobains life around was his parents separation.
According to Sihvola et al. (2008), familial factors are likely to explain partly the
association of adolescent depression and multiform illicit drug use (p. 2051). During his
childhood, he had trouble adjusting to his parents separation. He felt resentment towards
his stepmother for taking away his father and witnessed domestic violence in his
mothers new relationship (Cohen, 2003). Cobain also expressed anger towards his
greater family members. This was evident when he shuffled between the homes of
different relatives. His difficult upbringing within his own family reinforced the cognition
that he was worthless and unworthy of love (Cohen, 2003).

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Another major stressor in Cobains life was his marriage to Courtney Love. Even
though Love was able to provide him with the love and support he never received as a
child, their relationship was highly unstable. Like Cobain, Love was an avid drug abuser.
Their marriage was highly publicized by their struggle with drug abuse and domestic
violence. Most of these reports of domestic violence occurred when both persons were
under the influence (Cohen, 2003). Although Love sought rehabilitation for herself, she
could not motivate her husband to do the same.
The last major stressor in Cobains life came from pressures within the music
industry. Cobain was unable to accept the fame and media that came with being a rock
star. His private, quiet demeanor always clashed with the intrusive paparazzi. In addition,
Cobain always saw his music as a freedom of expression. After the success of Nirvanas
latest album, he began to struggle with pressures from the music industry. Because he
was forced to make music that was demanded by the mainstream, he wanted to stop
writing. It was also at the peak of Nirvanas fame when Cobains addiction began to take
over his life.
Axis V: Global Assessment of Functioning (GAF)
The GAF sale considers the psychological, social and occupational functioning
of a person on a hypothetical continuum of mental health illness. Each number range
includes symptoms and impairments.
At Cobains highest functioning, his GAF score would be 58. The range from 50
60 describes the person as serious symptoms and impairment. Even though his
addiction to heroin grew into his late twenties, Cobains life was not seriously impaired.
At the peak of his health, was able to successfully write music for Nirvana. This was also

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a time in which Nirvana reached the pinnacle of fame. Most importantly, this marked the
time when he became a father. In 1992, Cobain and Love had a daughter, who they
named Frances Bean. According to Michael Azzerad, another autobiographer of
Cobains, Cobain was determined to be a loving father. This stemmed from the poor
upbringing he had has a child (Cohen, 2003). Jeff Mason, Nirvanas production manager,
noticed that this was the happiest time in Cobains life (Cohen, 2003).
At Cobains lowest functioning level, his GAF score would be 22. The range from
20 30 describes the person as some danger to self, fails to maintain personal hygiene.
In 1994, Cobains addiction began to take over his life. The last year of his life was
marked by several incidences of drug overdoses, heroin-fueled concert performances and
failed drug rehabilitation programs (Cohen, 2003). Cobain also began to spend more time
with his friends who were drug dealers and junkies. Towards the last couple of months of
his life, Cobains suicidal ideations became more obvious. At the end of concert
rehearsals, he began to write notes to his band mates saying that he wanted to die alone.
He also wrote notes to Love saying that his daughter would live a better life he was not in
her life. Even though Cobain was to maintain a sense of personal hygiene, his
dependence on heroin and suicidal ideations marked the last couple of months of his life.
Section C
One of the modern perspectives I will focus on is the behavioral perspective.
This perspective focuses on the role of reinforcement. Operant conditioning, an approach
to behaviorism, explains two aspects. If the reinforcement awards good behavior, then it
will be reinforced. If the reinforcement has bad consequences, then the behavior will be
extinguished. Cobains drug abuse could be explained with this perspective.

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Even though Cobains support system tried to intervene with his drug use, he felt
that the drug produced more benefits. Cobain started experimenting with drugs to escape
the troubles with his family. Ever since, he used the drug to help him get through his
troubles. In an interview for VH1s The Rise & Rise of, Cross said that he suffered from
depression in his life and his drug addiction was his way of self-medicating himself
(Cohen, 2003). Cobains depressive episodes emerged at around the time of his
adolescence. According to Volkow (2004), chronic exposure to a stimulant drug during
the period corresponding to childhood resulted in enhanced sensitivity in adulthood to
stress, decreased sensitivity to natural reinforcers and a decreased threshold for
helplessness (p. 14). The stressors Cobain suffered from culminated in his increasing
dependence on heroin. His unstable relationship with his wife influenced and fueled his
drug use.
In addition to medicating his depression, Cobain also used drugs recreationally.
Even though he was ashamed of his drug habit, he used it to stimulate his creativity
(Cohen, 2003). In many interviews, Cobain stated that he used heroin to write songs. The
drug also helped him visually translate his songs into music videos.
The second perspective I will be focusing on is the cognitive perspective. This
perspective focuses on the role of thoughts on emotions and behaviors. Because Cobain
lived such a troubled childhood and adolescence with his family, he believed he was not
worthy of love and support. This led to development of dysfunctional assumptions.
Cobains anger and resentment toward his parents fueled his depression and drug habit.
As stated earlier, many authors noted that Cobain used his heroin to medicate his
depression. Thus illustrating how his dysfunctional cognitions translated into maladaptive

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coping strategies. If Cobain had been raised in a healthy environment, maybe he would
not have had such a negative perspective on the world.
Much research has been done to find the connection between mood disorders and
substance-abuse disorders. Results have shown that a comorbid diagnosis of mood
disorders and substance-abuse was the most frequent individual diagnosis in suicide
attempts (Dhossche et al., 2000, p. 286). Older males were the group considered to be at
risk for high suicide intent (Dhossche et al., 2000, p. 286). Cobains suicidal ideations
have always been evident in his writing. If people were able to notice the warning signs
of his depression, a proper diagnosis for his depression could have helped him seek
treatment. It is also interesting to note that the rate of suicide is significantly higher in the
families of suicide victims (Runeson and Asberg, 2003, p. 1526). Cobains family had a
history of suicide. Researchers have counted at least four suicides within Cobains greater
family (Cohen, 2003).
Section D
Because Cobain was not properly diagnosed with depression, Cobain sought
treatment for his drug addiction to heroin. Even though he met with more than a dozen
drug counselors, he was never able to finish a program. Detox programs fall under
relapse prevention for substance-abuse disorders. Relapse prevention programs teach
people who abuse drugs to view slips as temporary set backs. As mentioned, Cobain
suffered from several heroin overdoses in the last year of his life. Several of these
overdoses occurred while Nirvana was on tour overseas. Because his increasing drug
addiction began to affect his career and health, Cobains inner circle held several
interventions for him. Danny Goldberg, a former Nirvana manager and Atlantic Records

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10

vice president, recalled that Cobain was extremely reluctant and denied his selfdestructive behavior (Keene et al., 1994). Although he agreed to complete these drug
programs, his tours with Nirvana and lack of motivation prevented him from completing
the programs.
Drug recovery specialist, Bud Aold, commented that drug addicts need to have
the motivation to stop using, but did not think that Cobain had it in him to stop (Cohen,
2003). Needless to say, the detox programs were not successful. Because Cobains
addiction gradually increased towards the end of his life, it appeared that they had an
averse effect on Cobains mind.
Another reason the treatment did not work was because he did not seek treatment
for his depression. As stated earlier, Cobain used heroin to medicate his depression. So if
Cobain sought treatment for his depression, then he would be able to focus on his
substance-abuse disorder. Considering the severity of his depression and drug addiction,
psychiatric intervention would have been beneficial (Dhossche, p. 2000). A combined
treatment of psychoanalysis and drug treatments could have been considered for Cobains
treatment. However, Cobains addictive nature to drugs would mke antidepressants an
impassability. A psychoanalysis treatment could have been used to identify the negative
cognitions that Cobain had. In restructuring these cognitions, a therapist could have
helped identify the maladaptive behaviors and change them. However, since Cobain
never admitted to having a drug problem, more therapy sessions would be required.
Seeing as how relapse prevention programs were not successful, I would suggest
a psychodynamic approach for Cobain. I would also suggest a contingency management

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11

program. This would give Cobain the incentive to want to seek treatment if he wanted to
continue his musical career and keep his family together.
Section E
After all the research I have done on Kurt Cobain, I believe that present
depictions of him are accurate. Past depictions focused on the rock star aspect of his
life. However, the discovery of Cobains personal journals has given new insight into the
musician. Even though his most intimate and personal thoughts are open for the world to
see, his legacy lives within the fans he inspires and reaches out too. I no longer see him as
another musician that fell victim to drugs. I see him as a talented artist who cried for help
through his music. I think that the diagnosis of Kurt Cobain for depression and substance
abuse might encourage someone to get treatment as fast as possible. These disorders need
to be addressed immediately. Even though there was an early onset for both diagnoses,
neither could be cured. If there are warning signs, then these must be addressed so
treatment could be given.

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12
References

Cohen, W. (Producer). (2003). The Rise and Rise of Kurt Cobain. [Television broadcast].
New York, NY: Viacom International, Inc.
Dhossche, D. M., Meloukheia, A. M., & Chakravorty, S. (2000). The Association of
Suicide Attempts and Comorbid Depression and Substance Abuse in Psychiatric
Consultation Patients. General Hospital Psychiatry, 22(4), 281-288. Retrieved
from https://webvpn.ucr.edu/.
Keene, L., Wilson, D., De Leon, F. M., Ho, V., MacDonald, P., Murakami, M., &
Whitley, P. (1994, May 11). Questions Linger After Cobain Suicide Credit Card
Activity, Details of Last Days Intrigue Investigators. The Seattle Times.
Retrieved from
http://www.justiceforkurt.com/coverage/newspapers/seattle_times.shtml
Runeson, B. & Asberg, M. (2003). Family History of Suicide Among Suicide Victims.
Am J Psychiatry, 160, 1525-1526.
Sihlova, E., Rose, R. J., Dick, D. M., Pulkkinen, L., Marttunen, M., & Kaprio, J. (2008).
Early-onset Depressive Disorders Predict the Use of Addictive Substances in
Adolescence: A Prospective Study of Adolescent Finnish Twins. Addiction,
103(12), 2045-2053. Retrieved from https://webvpn.ucr.edu/.
Volkow, N. D. (2004). The reality of comorbidity: depression and drug abuse. Biological
Psychiatry, 56(10), 714-717. Retrieved from https://webvpn.ucr.edu/.