By David Joel Miller.
If we find the cause of mental illness can we cure it?
Mental illness is costing us a lot more than most people realize.
Turns out that mental illness, untreated, undertreated or treated in ways that are not working are costing us a lot more than most of us realize. Cases of violent behavior are an almost daily part of our news media’s presentation. When a tragedy strikes the first question is almost always about the mental health status of the perpetrator of violence. If we could spot the mentally ill and treat them shouldn’t we, society and the professionals, be able to prevent this violence? Let’s set aside for the moment the uncomfortable truth that the mentally ill are more likely to be victims than perpetrators of violence.
Besides the human cost, mental illness is costing us a ton of money.
When we look at the cost to the economy of disabilities, the largest of all disabilities, as measured by days of work lost, that major disability is Major Depressive Disorder.
Mental illness is the major factor driving up health care costs.
In the discussion of what health care is costing us and how we pay for this ever-increasing cost, the role of mental illness is often overlooked.
Five percent of patients account for HALF of all medical spending. What do those patients have in common? These super heavy users of medical services are not heart patients, not cancer patients, not even diabetes patients, though they may have one, two, or all three of those diseases. The majority of super-heavy users have mental illness, substance use disorders and often they have both of these.
What are these things we are calling mental illnesses?
Over time professionals from a number of different professions have attempted to identify and categorize these things we call mental and emotional illnesses. The professions do not always agree and there are varying lists of just what should be diagnosed as an illness. Two lists are commonly in current use. The DSM (from the American Psychiatric Association) in the United States and the International Classification of Diseases from the World Health organization. While these two lists are moving closer together there is still not an exact one to one correspondence between them.
Most of the things we are calling mental illnesses are in fact “syndromes” groups of people who have symptoms similar enough that they get lumped together even if their conditions are not exactly the same.
Take Depression for example.
We all sort of know what depression is like. If that sadness lasts for more than two weeks and there are changes in sleep and appetite then we start looking for depression. Some people eat more and sleep more like the bear hibernating for winter. Other people can’t sleep, are agitated, pacing around and they lose their appetite. We might think that both are “depressed” but the part of the brain involved may be very different. We also know that the reasons people become depressed can be very different. We can’t be sure that all the people we are calling depressed really have the same disease. So just how many different things can be the “cause” Of depression?
Most of these “disorders” are diagnosed by using checklists of symptoms. We run down the list, you have 5 of 8 symptoms and you get the diagnosis. Cross one of these off and add a different one and you get a different disorder. Before we can be really sure about causes we would need to be reasonably certain that we are looking at the same disorder in all those cases.
Spectrum Disorders may have many causes.
Since these things we are calling mental illness vary in their presentation from one person to another we needed to create more and more disorders. No two people are exactly alike so in theory, we could end up with one unique mental illness for each and every person on earth.
The other option was to think of these things as “spectrums” that range from mild to severe. One person could have one symptom and another might have three. But this raises the question if Bob has symptom 1 and 3 and Mary has symptom 1 and 4 do they have the same disease? You mathematician types will see that there is a very large number of possible combinations of symptoms which someone might have, not even considering the possible severity of each symptom. Different combinations of symptoms and symptom severities could have different causes.
What is causing these mental illnesses?
Lots of things have been postulated as causes for mental illnesses. The “chemical imbalance” theory has been especially popular. Unfortunately, this idea has not been especially helpful in either diagnosing or treating mental illness. If we could find one specific cause of an illness, depression for example, then we should be able to test and treat people for this illness reliably.
Turns out there are two groups of things that are implicated as causes of mental illnesses. The causes from way back when called distant or distal causes and the recent causes, that just happened which are often called close or proximal causes.
Distant causes of mental illness.
The distant cause of mental illness are things like genetics, or childhood trauma, abuse, and neglect. Inheriting certain genes would up your risk of getting schizophrenia or having an episode of depression. So far this has not worked exactly. Some disorders, schizophrenia and Autism spectrum, for example, have over a hundred different genes that increase the risk of getting this disorder but an increased risk does not guarantee you will get it. Two siblings, twins may both inherit the gene, but one gets a disorder and the other does not.
Other distant things can also increase the risk of getting a mental illness, exposure to drugs or alcohol in the womb, early childhood experiences, abuse, neglect and just the stress of living.
Today’s, proximal, causes of mental illness.
Most mental illnesses get diagnosed because there has been a sudden change in functioning. Often this is the direct result of a recent life event. People get divorced or they lose their job. As a result of these events they become depressed. Maybe it is the result of a death in the family or living through a traumatic event.
Many “first breaks” or episodes of a mental illness occur as the body changes in puberty or when someone leaves home for the first time and attends college. Substance use, drug experimentation can also precipitate the occurrence of a mental or emotional issue. All sort of life events can cause someone to develop symptoms for the first time.
How can we treat mental illness if we don’t know what causes it?
Current treatments for mental illness are a lot more hit and miss than we would wish. Given a diagnosis and a medication on average one-third of people receiving that medication will get better and two-thirds will not improve. This partially explains why doctors often need to change meds and or add a second medication.
Psychotherapy fares only slightly better. Given any particular type of therapy, assuming it is done reasonably well, about half the people get better and the other half do not. Over time therapists may change the therapy they are doing with a client. If what they have been doing is not helping, and the client may need to change therapists also.
At this point is history there is a lot more that can be done to help someone with a mental illness than ever before. None of this is anywhere near an exact science. We can spot risk factors for some people some of the time but risk does not mean you will get it. Meds or therapy can be helpful but there are no guarantees on either for all people all the time.
Regardless of what has cause a mental or emotional illness remember that treatment has helped millions of people overcome their issues and live meaningful, productive lives.
For more on this topic take a look at the article by Tom Insel’s (former director of the National Institute of Mental Health.) Director’s Blog: What Caused This to Happen? – Part 2 where he talks about causes of mental illnesses and what we know about them.
You might also want to check out the piece that Jonathan Roiser wrote for the British Psychological Society titled “What has neuroscience ever done for us?”
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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