Above: Environmental factors which increase the risk of developing mental illness. Childhood adverse experiences, especially when repetitive and chronic, are frequently particularly damaging.
We have seen that those of us who suffered significant childhood trauma are far more likely than those who were fortunate enough to experience a relatively stable upbringing to develop mental (and, indeed, physical) health problems in later life (all else being equal) – e.g. see my article on the Adverse Childhood Experiences (ACE) Study.
However, when in comes to treating mental disorders, there exist two distinct approaches; we can call these the nature approach and the
nurture approach; I explain how these two approaches differ from one another below.
Research indicates that both nature and nurture (e.g. genes and environment) contribute to mental illness (e.g Tsuang et al., 2004) and it is how these two factors interact that is crucial. (One might inherit genes that make one susceptible to developing a particular mental illness but only go on to actually develop it if one’s environment conspires against one too (e.g. severe and protracted childhood trauma).
1) The Nature Approach:
Mental health professionals who use the nature approach assume the mental disorder is caused by physical factors such as:
– neurological biochemistry
– hormone dysregulation
Therefore, the treatments such mental health professionals use seek to correct the assumed physical problem; these include:
– drugs that alter the brain’s biochemistry such as anti-depressants that change levels of serotonin in the brain and anti-psychotics that alter levels of dopamine in the brain
– transcranial magnetic stimulation
– electroconvulsive therapy
– implants of electrical devices
– vagus nerve stimulation
2) The Nurture Approach :
Those who take this approach regard one’s environment as being the cause of one’s mental illness. Such environmental factors include, for example :
– parental neglect/abandonment/rejection/abuse
– social ostracization
Treatments based upon the nurture approach include :
– attempts to improve the individual’s environment
INTERACTION OF PHYSIOLOGICAL AND ENVIRONMENTAL FACTORS :
The truth is, however, that mental illness is caused by the ways in which physiological and environmental factors interact with one another.
In the case of schizophrenia, a person with a first-degree relative who has schizophrenia has a 10% of developing schizophrenia themselves and, if both parents have it, the risk goes up to 40%. And, if an identical twin has it, the risk of developing schizophrenia goes up to 50%. This means that some people are more genetically predisposed to developing schizophrenia than others, but will not necessarily do so unless the environment in which they grow up interacts with this genetic predisposition in a particular way.
Whilst scientists are not sure exactly how nature and nurture may interact to cause schizophrenia a longitudinal study (that spanned a period of 40 years) found that those who are genetically predisposed to developing it can be protected from doing so by positive, protective family factors. In fact, according to the study, such protective family factors can reduce the child’s risk of developing schizophrenia by 86%.
According to Reiss (George Washington University) factors that help to make a family environment healthy include:
- Clear communication
- Attitude towards discussion is not rigid
- Are assertive without being aggressive
- Can disagree with each other without this giving rise to resentment or grudges
- Do not need to hide emotions – e.g. are able to express sadness
- Create a friendly environment (including humor and the ability to laugh at themselves)
- Have respect for one another’s privacy
- Are open to compromise
- Arguments are resolved amicably
Other research (carried out at the University of Liverpool) found that the MAIN CAUSE of mental illness was related to environmental factors such as bullying in childhood, abuse in childhood, and other traumatic experiences. Indeed, these environmental factors were found to be better predictors of mental illness than genetic factors.
By over-focusing on the physical underpinnings of mental illness clinicians may neglect to properly examine vital environmental/psychological contributing factors, and vice versa.
David Hosier BSc Hons; MSc; PGDE(FAHE).