By Al Galves
The large majority of Americans say they believe mental illnesses are caused by chemical imbalances, brain disorders and genetic anomalies. But there is a problem with that belief. If people believe that, they believe they have no control over their thoughts, emotions, intentions and behavior, the faculties they use to live their lives. If they have no control over those faculties, they have no control over their lives.
Let me explain. The symptoms of mental illness are thoughts, emotions, intentions and behavior that are troubling to people. If people believe mental illnesses are caused by chemical imbalances, brain disorders and genetic anomalies, they believe that their thoughts, emotions, intentions and behavior are caused by chemical imbalances, brain disorders and genetic anomalies. But human beings don’t have any control over their biochemistry, brain function or genetic functioning, at least not in any direct way. So that means they believe they have no control over their thoughts, emotions, intentions and behavior.
This is simple logic. It goes like this.
Mental illnesses are caused by chemical imbalances, brain disorders and genetic anomalies.
The symptoms of mental illness are thoughts, emotions, intentions and behavior that are troubling to people.
Therefore, thoughts, emotions, intentions and behavior are caused by chemical imbalances, brain disorders and genetic anomalies.
Human beings don’t have control over their biochemistry, brain function or genetic functioning.
Therefore, human beings don’t have control over their thoughts, emotions, intentions or behavior.
Believing that people don’t have control over the faculties they use to live their lives is cynical and dangerous. It means they don’t have agency, the capacity to act independently and to make their own free choices. It means their lives are at the mercy of forces over which they have control. It means they don’t have control over what they do or say. And, if what they do or say is hurting other people, too bad. They don’t have control over that. They aren’t responsible for it.
So, is there another idea about what causes mental illnesses? There is. A clue is provided by the positive psychologists who study the roots of mental health and happiness. According to them, there are three characteristics of people who are mentally healthy. They use the best part of themselves in the interest of something bigger than themselves. They have positive relationships. And they have a sense of achievement, competence and mastery. Perhaps, mental illness occurs when people are unable to use the best part of themselves in the interest of something bigger than themselves, have positive relationships or have a sense of achievement, competence and mastery.
This idea fits with my experience as a patient and a psychotherapist. That experience tells me that mental illnesses are caused by reactions to life situations and to concerns that people have about their lives and themselves. According to this way of thinking, the states of being and behaviors that we call mental illness are reactions to emotional distress, life crises, difficult dilemmas, spiritual emergencies, overwhelm and terror. To paraphrase the positive psychologists, in order to be mentally healthy, people have to be able to love the way they want to love, express themselves the way they want to express themselves and enjoy life the way they want to enjoy life. When they can’t do that, haven’t been able to do it for a long time and are afraid they’ll never be able to do it, when they suffer significant loss or feel extremely helpless and inadequate, they become agitated, manic, angry, panicked, obsessive, depressed, anxious and psychotic. They become mentally ill.
So what does cause mental illness? I began this article by saying Americans are confused about that. What makes me think so?
Several years ago I interviewed ten Americans on this topic. Their responses are a window into this confusion. I asked them what they thought caused mental illnesses. They all gave me some kind of physiological explanation – chemical imbalance, brain disorder, genetic problems. Then I asked them what they thought triggered the change in the biochemistry, brain function and genetic dynamics. They all responded with something like “something happened to the person.” “But,” I said, “you first told me that mental illness is caused by chemical imbalances, brain disorders and genetic problems and now you’re telling me it is caused by something happening to the person.” They were all nonplussed, flabbergasted, flummoxed. Then I asked them the final question: Do you think there is a difference between how a person is reacting to her life situation and to concerns she has about her life and herself, on the one hand, and a diagnosable mental illness, on the other? They all said “Yes”. This is evidence of confusion.
Joseph David is a professor at the University of Virginia. He talks with his students about mental illness. He finds that they subscribe to neither the physiological explanation nor the psychological explanation of the cause of mental illness. They believe mental illness is some kind of third entity but they are not clear about what that is.
I recently read about the confusion of college students over this question. When they are feeling debilitated, agitated, upset, exhausted, they wonder if they are just reacting to their life circumstances or if they have a mental illness. They assume there is a difference between those two things.
In 2003 six Americans vowed not to eat solid food until the American Psychiatric Association, Surgeon General and National Alliance for Mental Illness presented scientific evidence that mental disorders are caused by chemical imbalances, brain disorders or genetic problems. The American Psychiatric Association submitted a psychiatry textbook as evidence. A panel of scientists that had been created to review submissions used other evidence in the textbook to debunk the APA’s response. The problem was that the evidence that mental illnesses are caused by physiological dynamics is correlational and correlation does not prove causation. So scientists may find an association between physiological dynamics and mental illness but they have no way of knowing what caused what.
This confusion about mental illness is not just an academic question. It determines the kind of treatment people seek and receive, how they understand themselves and how they manage themselves. It determines how they behave and the degree to which they take responsibility for their behavior.
It doesn’t appear that science is going to be able to answer this question in the foreseeable future. Perhaps, therefore, we should take a pragmatic approach. We should ask the following question:
Which of these beliefs will lead to better mental health and better behavior?