What causes Mental, Emotional or Behavioral illness? We have been wrong.


By David Joel Miller

Looks like a lot of the theories about what caused mental illness are wrong.

Mentally Ill Child

Mentally Ill Child

What causes mental illness? What do we know and what do we think we know?

Many of the things we thought were causing mental illness turn out to not be causes. In the process, we missed a lot of things that are impairing the mental health of our society.

There have always been people who were clearly mentally different from others. We have seen explanations for what causes mental illness come and go. Today we know more than ever before about the human brain, how it works and some of the problems it may develop, still we are less sure than before about what is causing that thing we call mental illness.

There is hardly a day now when you can turn on the T. V. or read the news on-line and not hear about someone with a “mental illness” and some terrible thing they have done. This media coverage is leaving more out than they put in and the result is less, not more, understanding about mental illness.

The mentally ill and violence.

As an aside here, the mentally ill, those with serious long-term illnesses, are more likely to be victims of crime than the perpetrators. They get beat up and robbed on a daily basis. This rarely gets on the news unless the perpetrator is a police officer, and even then the sense is that the mentally ill somehow deserved it.

Personally, experience has taught me that I have more to fear from the person who was just served with divorce papers or found out their spouse is cheating and has shown up at a work site with a gun, than from someone who has a long-term mental illness.

Emotional problems in someone who has not been identified as having a serious and persistent meant illness is the larger threat. It is easy to see in retrospect that there “had to be” something wrong with the person who came to a school with a gun. But if you follow all the people who are diagnosed with schizophrenia, for example, very few of them ever get a gun and shoot up someplace.

Parents and gun violence.

Gun violence at schools and public sites is a huge problem. We need to do something about this. but for the record, for every child killed at a school site by a gunman, 25 to 50 children will be shot and killed at home by a biological parent with a gun. The cure seems simple. Do not let bio parents raise children or own guns. See how simple solutions turn into complex problems and do not always work the way they were intended?

There have been a lot of theories, most of them very simplistic, over the years about the causes of mental illness. Some people continue to cling to the over-simplistic views despite overwhelming evidence to the contrary. But then the flat earth society and those who doubt that some form of evolution has occurred are also still in existence.

In this post let’s look at some of the things that have been suggested as causes for mental illness in a necessarily oversimplified way.

First the things we now doubt are true about or are not causes of mental illness.

1. Are there are two kinds of people, normal and the mentally ill?

We used to separate emotional problems into two categories, Neurosis and Psychosis. That was it. So people were seen as having a psychosis, they were in effect “crazy” or they had neurosis, problems of living that might respond to talk therapy.

The more this has been studied the less reliable it has become. First we found that there were people who sort-of had both. They got the label of “Borderlines” then we found there were a whole lot of different kinds of neurosis, like anxiety and depression and OCD. And people with psychosis can also get depressed. You can have two or more problems.

From that two problem view, we continued to study symptoms and the result in the DSM-4 was over 400 recognized mental illnesses.  Even more, possibly another 400 disorders were proposed (the DSM-5 was supposed to simplify this but we still know way less than we would like.) Today we are seeing that some of this splitting up is the result of people moving on a continuum from one level of symptoms to another. People’s illnesses can change over time and they can have more than one illness.

2. For a while we blamed the victim, some people still do.

There was that belief that mental illness was from God or the gods. Some thought that God had cause the mental illness as a punishment for the person’s sins, or the sins of the father or grandfather.

There are still people who take this approach, avoiding the mentally ill or insisting that they should just snap out of it as if being ill was a choice.

We do know that this fallacy like every good lie has some grains of truth embedded in it.

Parents provide both the environment and the heredity. Some life events, like age and use of drugs or alcohol, may increase the risk of a gene mutation. But risk factor is not cause and so we find that some very poor home environments produce some mentally healthy people while “normal” homes produce some very dysfunctional people.

More on the environment verses heredity issues to come.

If the problem is that God is punishing this person somehow then the cure should be a religious conversion. The prescription for mental illness used to be, and in some circles still is, prayer, fasting, self-control or self-abuse and the like.

Some of the evidence to challenge the “its Gods will” concept of mental illnesses comes from the sudden miraculous improvement in some mental illnesses that medication produces; that and the cases where a person lives a good part of life, often in a “Godly way,” and is suddenly struck by a mental illness. Some of these appear to be the result of the changes our bodies undergo as we age.

3. People said “It is the mother’s fault.” Occasionally this is read “it is the father’s fault.”

This was popular for a while under the guise that the cause of psychosis was “refrigerator mothers.” We found that there was some truth to emotional problems that resulted from early life experience; we now refer to this as attachment theory.

The idea that lack of love or poor mothering skills was primarily the cause of serious mental illness has been largely discarded. We now think that there is such a thing as “good enough” parenting. Do a halfway good job and you child should turn out fine. Abuse or neglect can increase the risk of mental or emotional problems but risk is not result.

One new area of study is the role of “complex trauma.” A number of traumas or ongoing trauma changes the brain in ways that are different from what we were looking for in the past. This complex trauma can cause more problems than the sum of its parts.  More on Complex Trauma in some upcoming posts.

4. It is just the way they are

There was a school of thought, back when the psychologists seem to offer us answers to all these issues, that mental illness was the result of “personality factors.” Again some truth here, but in my view not nearly the whole story.

Some children are born “fussy” they are hard to sooth, cry a lot and get on their parents nerves. Those kids may have a fussy temperament or they may have a physical illness. Either way fussy kids get less care or upset the parents. Maybe the stressed parents yell at the child more. Their life experiences are different from the “naturally happy child.”

Personality can and does change over the life time. We can debate how much or why but the fussy child may grow into a contented child and the good child may at the onset of puberty suddenly become the problem child.

All these factors, to me, argue against the idea that mental illness is caused solely by personality.  It points in the direction of gene expression, genes act differently at different points in our lifetime. It also points out the ability of all of us to learn from life and as a result our personality shifts.

Sorry this ran long. More on the causes and by implication the cures for our mental emotional and behavioral illnesses in some upcoming posts.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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