GTD Implementation: The third dumpster: The Etiology of Mental Disorders

The third (?) or is it the fourth dumpster?
We are now filling up the third/fourth dumpster. I have gone through numerous piles of papers stuck on bookshelves, and for the next three days I'll be careening through file cabinets, trying to weed out all the "out of date" or "duplicates" files. Its a boring job and not one I'm likely to take seriously enough. I still have too much extra room, not yet filled in other words, in the newer cabinets. But the end point is in sight, I think June 1 might mark the end of our first serious "GTD Implementation" which began in earnest on March 1, 2007. I like having such an exact date from which to track everything that followed. I love doing work in the broad field known as "evaluation" and this marker has allowed me to keep a running evaluation component going on my own GTD process. I did a "review" yesterday, the first time I actually made it to the Sunday Review on time. I can't claim it was a complete review, but it was closer. Practice and more practice is how this is going for me, its all still in a phase I have to consider "practice." Three months and three dumpsters full of "stuff" from our house, while keeping up my regular work load, the heaviest of trimesters as this is the trimester with my large class, the period in which I will have had three presentations at conferences, the presentation to the self-help court (it went very well by the way) and still we are moving ahead with GTD implementation.

Dinner with my TAs led me back to "The etiology of mental disorders"
I know I have touched upon this before in prior blog entries, but it is such a serious topic and so misunderstood, that here I go again. Almost everyone connected to clinical psychology, particularly practitioners, holds on for dear life to the belief that mental illness is the result of childhood trauma. This is one of those beloved fantasies, rather like the old belief that the earth is flat, an error maintained for thousands of year. It is simply wrong, incorrect, a false belief that has clinicians and patients alike chasing after dragons from their past, in hot pursuit of an explanation for mental illness that makes little sense. Mental illnesses are not caused by childhood trauma. What is childhood trauma anyway? The myth of childhood has gained the status of king of the mountain in today's pop psych culture as well as in the hearts of clinicians. But getting realistic, we have to face the obvious. For centuries the going belief was "spare the rod and spoil the child." Children were routinely swatted, hit, the victims of what today we regard as child abuse and trauma. But those unspoiled children didn't grow up to suffer from major mental disorders. We have in our hearts a myth of the perfect childhood, and anything deviating from this ideal is considered detrimental to a child's developmental pathway.

The myth of the "good-enough childhood"
Lets get real. No one has a perfect childhood, never has and never will. We are barely out of an era in which it was considered not only appropriate to beat your children, but to beat your wife as well. Have to keep those women in line, while you are busy not spoiling your children. Our grandparents --or many of them anyway-- saw their moms beat up by their fathers, and got hit quite a bit themselves. And yet they did not arrive at adulthood suffering from serious mental illnesses. Our view of childhood is a fantasy. Our view of what causes mental illness is simply wrong. We don't have the answer, we don't know exactly what throws someone over the edge and into the terrifying world of mental illness. And we can't stand admitting we don't know. The unknown is simply unacceptable.

Bottom line, mental illnesses are genetic
Many severe mental illnesses are genetic, bottom line. Heritability rates are high, from 60 to 90%. But something more is needed, because not everyone with the genetic make up for a mental illness actually shows up with the illness. Or is that also just a fable? Is it not possible that its a matter of quantity, and not quality at all. Suppose there are polygenetic "causes" for bipolar disorder. Meaning, there are many genes contributing to the development of biopolar illnesses. Lets imagine there are 10 genes that, should you be unfortunate enough to have the "wrong" allele on any of the ten, you have an increased chance of coming out in the end, bipolar. Suppose you inherit an allele on each of these genes, from each parent. Suppose there are instructions about turning these genes on and off in the "junk DNA." Supposing each gene has a different "on and off" switch in the junk DNA. We're beginning to see lots of possible variations now. Bob can inherit maybe 5 of the 10 alleles that put him on the bipolar path. Then perhaps four of the ten junk DNA areas are instructing the DNA to go to "On" and six are pointing to "Off." Perhaps the precise conditions in uteri --not exactly the same even for identical twins-- lead to the "on and off" situation of the relevant junk DNA areas. We see even more variation possible. So Bob has 5 alleles that might contribute to frank bipolar disorder, and four areas that instruct these 5 alleles to the "On" position. So Bob appears in the world with a dark mood on most days, on and off suicidality, an occasional hypomanic period, never anything remotely like a true manic episode, and in the end Bob is a very unhappy adult with what is now known as Bipolar II. Just think of all the possible outcomes might have occurred from this myriad of possibilities. But none of them were due to childhood experiences, childhood trauma or the world's most perfect childhood.

Physical environmental contributions
Is it all up to chance? Yes and No . We know that children may appear with OCD post strep infection. The strep bacteria produce something that amounts to a brain toxin, that results in inflammation in some part of the brain that ends up screaming "OCD OCD" in the child. There may be many bacteria and viruses that effect the likelihood of Bob (our character above) demonstrating or not demonstrating his propensity to bipolar disorder. There may be neurotoxins in our ordinary contemporary drinking water. There may be other factors in the physical environment that instruct the DNA to go "ON" or "OFF." But how much does the "emotional" environment contribute? We get it confused. We see an erratic parent and we think "that behavior is pathogenic for the children." But what is really pathogenic is that the erratic parent has an untreated (because it is relatively mild and therefore not diagnosed) bipolar II condition, meaning the parent inherited perhaps four of the possible 10 bipolar alleles (two from each parent, such a small number that there were no visible signs in the parent) and perhaps three junk DNA areas yelling "ON," just enough to get some of that erratic, irritable parenting. Here we are, claiming that childhood trauma, present because of that irritable erratic parent, is responsible for the later development of bipolar II in the offspring. All wrong, the parental behavior doesn't cause the illness in the child or young adult. The parental genes and areas of instructions, in combination with the genes and areas of instruction from the other parent, are responsible for the development of the illness.

Its very simple, very simple math and very simple conceptually
Its simple really, very simple math, very simple concept. Major mental disorders are inherited and sometimes brought to life from some environmental (physical) factors. We always want to run away from physical causes because we (psychologists) think we have to think that way, we have to make other people think that way, in order to make a living. Wrong. Having a serious mental disorder causes numerous psychological problems, for which people need psychological treatment. We may know that addiction is an inherited illness, but the treatment is abstinence and psychosocial treatment modalities. Addiction leaves a mess in its wake. A person who has suffered from active addiction may get into recovery and wake up and find themselves in some of the nastiest messes possible, they've done horrible things, they've stolen from their families and friends, they've burned all their bridges. They need massive amounts of psychosocial help to regain their sense of personhood, and good personhood at that. There's plenty of work for psychologists who understand that major mental disorders are physical in nature and physical in origin. Psychologists who have their patients endlessly searching for childhood trauma miss the boat. People know their parents tried, tried and failed. It does not help to have them demonize their parents. It helps a lot to have an explanation for their parents adversive behaviors, to have sympathy for their parents as well as for themselves.

Mental disorders are physiological illnesses from beginning to end. People act like this simple statement is violating the most basic beliefs about life. Its time we all said the obvious. Mental illnesses are the same as any physical illnesses. The urge to rest on the psychology of childhood is an escape into devils inhabiting people. Lets stand up and say it like it is, so we can get some decent help and respect for people with mental illnesses, and for their families.