Discovering the root causes of mental illness

Around 50 years ago, British researchers sent 134 American psychiatrists and 194 of their British colleagues a description of a patient and invited them to give a diagnosis. Around 69 per cent of the Americans said the patient was suffering from schizophrenia. Only two per cent of the British psychiatrists agreed.

A Straight Talking Introduction to the Causes of Mental Health Problems argues that if some of the greatest minds of psychiatry can disagree so profoundly, it is not surprising that the rest of the world can be confused and fearful of the panoply of diagnoses, theories, medications and other elements of the world of mental health.

In their book, Professor John Read and Mr Pete Sanders lay out a case for how this confusion comes about and suggest that most mental health problems are caused by trauma suffered by individuals who are often best supported by sensitive friends, family and co-workers rather than with medication and confinement.

Many experts believe that adverse life experiences are just one of several likely causes of mental illness. The Centers for Disease Control and Prevention in the USA, for example, says there is no single cause of mental illness, and contributing factors may include adverse life experiences; experiences related to chronic medical conditions; biological factors or chemical imbalances in the brain; use of alcohol or drugs; and feelings of loneliness or isolation.

The essential message of A Straight Talking Introduction is that not all mental health problems should be automatically regarded as illnesses.

Professor Read says,

It is in the complications of the past we are often most likely to find a proper understanding of someone’s mental health, and a stronger platform for recovery.

Most mental health problems are caused by our reactions to bad things happening. The more bad things that have happened the stronger the likelihood we will struggle. These bad things can include poverty, violence, abuse, grief, the breakdown of a relationship or the loss of a job.”

Professor Read acknowledges that his book’s focus on the social causes of mental health problems is controversial in some quarters.

He says, “Although surveys in more than 20 countries find that the public endorse social causes more than biochemical or genetic factors, many psychiatrists and most drug companies argue strongly for a more biological approach.”

In their book, Professor Read and Mr Sanders say innovation has created new tools to investigate mental health but the conclusions have not always led to clarity. Neuroimaging can identify the changes in the brain when a person is happy or depressed but that does not mean the brain changes are the cause of the feelings.

Neuroimaging has contributed to the theory that the manipulation of neurotransmitters in the brains with antidepressants can be beneficial. The authors say that 2.1 billion doses of antidepressants are taken in England annually but it is not clear how effective they are, citing studies that show that people taking placebos are as likely to report mood improvements as takers of antidepressants.

“Currently, we have a situation where if anyone mentions being sad or depressed to a GP, they are likely to be prescribed antidepressants, which can restrict the healing process by numbing emotions,” Professor Read says.

Antidepressants and other psychiatric drugs have been profitable for the pharmaceutical industry. The authors argue that the industry’s influence in funding research is pervasive and this has led to the categorisation of many human behaviours as biologically based disorders in need of a chemical fix. Examples include labelling children who are fidgety or talk too much as having ‘attention deficit hyperactivity disorder’ or forcefully object to something as having ‘oppositional defiance disorder’.

Labelling can offer comfort to some but Professor Read and Mr Sanders argue that the diagnosis is more likely to stop the search for the real cause for the behaviour or emotions. The authors support trauma-informed mental health care which emphasises the experience of patients.

Professor Read says, “The starting premise is that there are things going on in someone’s life (or past) that are causing the problems they need help with. It makes it sound terribly simple but our mental health services are very much geared towards assuming that our distress is caused by a biologically based disorder or illness so the doctor knows what pill to give you. In this process we often we don’t ask what’s going on in your life.

“The attraction of the medical model is that it is very simple. Why is someone acting weirdly? They have ‘weird behaviour disorder’ and we have a pill for it.

 “In mental health sometimes the most important question isn’t ‘what’s wrong with you’ but what has happened to you’”.

John Read, Professor of Clinical Psychology at the University of East London has also led research on withdrawal from psychiatric drugs.