There Are No Simple Explanations for Mental Illness

Is there ever just one explanation for mental illness? - graphic of head made up of puzzle pieces

Recently, Kacha of Food.for.Thoughts posted a very cute animated video called 7 Reasons to Love Someone Who’s Depressed. Some of those seven reasons were that people with depression are more understanding and more honest. While the messaging is quite positive, it got me thinking about how there are various ideas floating around out there about depression, as well as other mental illnesses, always looking a particular way. Is it realistic to think there’s ever just one explanation for mental illness?

While there’s certainly stigma that pigeonholes mental illness in clearly problematic ways, there are also quite a few well-intentioned people who think they’ve figured out “the” answer.

All-nature vs. all-nurture

When looking at the nature vs. nurture question, there are reductionistic views on either side of the coin; some argue that it’s all biology while others argue that it’s all psychosocial. Neither extreme makes sense to me, and both strike me as overly simplistic. And really, if it was that simple, wouldn’t research have conclusively established that by now? The problem with hypotheses at all-or-none extremes is that it only takes one exception and the whole hypothesis is wrong. If I say there are no purple eaters, you only have to show me one and that makes me wrong.

Kacha’s post also included this quote from Marshall Rosenberg, the creator of nonviolent communication, about depression:

“My theory is that we get depressed because we’re not getting what we want, and we’re not getting what we want because we have never been taught to get what we want. Instead, we’ve been taught to be good little boys and girls and good mothers and fathers. If we’re going to be one of those good things, better get used to being depressed. Depression is the reward we get for being ‘good.’ But, if you want to feel better, I’d like you to clarify what you would like people to do to make life more wonderful for you.”

Reading this, he could be speaking a foreign language for all that it resonates with me. Yet I’m sure it’s a very powerful message for some people. It’s not a matter of the idea being bad, but rather the idea not applying to all depression.

I’m more inclined to favour something like a diathesis-stress model, which considers the interplay between environmental stress and biological vulnerability.

Diathesis-stress model of mental illness

Not everyone fits in one box

The problem with saying “illness [A] is [X]” is that it leaves out all of the people with illness A who experience C, D, E, and/or F. In my mind, that’s very different from saying “illness [A] can be [X],” because that doesn’t try to. put everyone in that box.

That may seem like semantic nitpicking, but I think the difference does matter. It seems unlikely that any explanation is going to cover everyone who experiences depression, or any other mental illness. That should be okay. The existence of multiple theories means that it’s more likely that people with the illness will find something that resonates with them.

In his book Lost Connections, Johann Hari claimed that depression was due to several specific forms of disconnection. In my review of the book, I wrote: “Of the various disconnects that he believes cause depression, I had a whopping none of them for my first two depressive episodes.”

I recently saw a tweet by someone with borderline personality disorder expressing frustration that people assume that everyone with BPD “MUST” have had childhood trauma. Sure, a lot of people with BPD have experienced trauma, but it’s not a requirement for the diagnosis. The only illnesses requiring traumatic experience(s) are the specific group of trauma-related diagnoses like PTSD. Assuming that everyone with depression, for example, has a trauma history is going to end up excluding all the people who don’t fit in that box.

How the DSM fits in

A common argument is that the DSM puts people into arbitrary boxes. That’s true, but I see a difference between descriptive labels for symptom clusters and theories about how people must have gotten to a place of illness. It’s easy to assume the DSM takes a stance in favour of biological causation; however, it doesn’t actually try to provide a single explanation for mental illness. There’s also wiggle room for different people with the same illness to have different symptom combinations.

The diagnoses are imperfect labels, but in order to conduct meaningful research into conditions and their treatment, there do need to be some type of widely used descriptive labels; otherwise, no one’s talking about the same thing.

Don’t box me in

I’m a very independent, and also rather stubborn, person. I don’t like other people telling me who I am or how I experience things. Perhaps that means I have a stronger negative reaction than some other people might, but that’s okay. If someone says they know the explanation for mental illness and depression IS [X], and I am not [X], then either I don’t have depression, or not all depression IS [X].

In my case, there seems to be a fairly strong biological element to my illness; as a result, the all-psychosocial ideas about how depression “IS” really do grate my rutabagas. Likewise, I’m sure that people whose illness is strongly influenced by psychosocial factors are hoping for a purple people eater to dive-bomb that dumbass doctor telling them it’s 100% brain chemistry.

There’s room for many explanations to cover the wide range of individual illness experiences and the contributing biological, psychological, and sociocultural factors. There’s no need to put all of our purple people eaters in one basket. Or our rutabagas, for that matter.

book cover: Managing the Depression Puzzle, 2nd Edition, by Ashley L. Peterson

Managing the Depression Puzzle takes a holistic look at the different potential pieces that might fit into your unique depression puzzle.

It’s available on Amazon and Google Play.

36 thoughts on “There Are No Simple Explanations for Mental Illness”

  1. I think people like tidy answers (just look at how some react to the pandemic!). It makes them feel more in control. I’m pretty sure I would have reacted differently to some of my experiences in life if I hadn’t been in physical pain too. It matters. My emotional reserves are lower than other people’s and I can’t handle much stress. This also explains why I never pursued higher career goals.

        1. Exactly. I call this a disease of ‘digital thinking’, and I call the most extreme case of it ‘binary thinking’.

          I always start getting suspicious when I see people arguing in circles over whether something is in either category X or category Y. So often it’s a bit of both, and moreover a bit of both in differing amounts in different scenarios.

          “Some of the reasons were that people with depression are more understanding and more honest.”

          That’s quite shocking!! That’s very simplistic.

          Just got to be open-minded all the time, and most importantly to listen to the person who is ill 😄.

          1. I’m actually quite interested in whether ‘digital thinking’ has increased along with digitisation of technology. Or more generally whether ‘digital behaviours’ have increased. Certainly extremism/’binary thinking’ has, but it’s easy to understand that in the context of the internet and the channels of interaction on it. I wouldn’t be surprised though if it did influence us into seeing things as being more digital than they are.

            1. Thanks, now that it’s in your head you won’t be able to stop noticing it, lol. Maybe! I’ve been having this feeling for 5-10 years or so.

              A concrete example of digital thinking I’ve witnessed is in how people have often assumed there must be a ‘cure’ for my knee injury, and that treatment for such things should ‘perfectly’ fix them. Like all you have to do is walk into a hospital, and come out with a brand new knee. (Thus by implication blaming me for continuing to have a bad knee 😆).

              Biology has to be the least digital thing that there is, but I’ve seen that idea expressed a lot of times. And I’m sure that’s tied up in people taking physical health for granted more and being more risk-taking.

            2. Yeah, the simple fix idea seems to be quite common. Who cares about taking risks when you can get a quick fix afterwards?

            3. I mean, I’m understanding that people without direct experience don’t immediately get these things and I’m patient and forgiving, but it’s when they persistently push on anyway that it gets really irritating! Lol.

  2. That bit about the BPD startled me. Yeah, I had childhood trauma, BUT I had a mother with the disorder. My current therapist says part of my own case of BPD is exposure to someone who had it (Ma) (My own BPD is NOT traditional. In my opinion. I’m a lay man though, so I don’t KNOW facts about BPD or ‘acquired BPD’). That, to me, speaks of nurture (to an extent), BUT also makes me wonder if there’s a genetic component (i.e. wonky brain chemistry) that runs through my maternal family line. Not everyone in my family has mental illness either. My depression is so multi-faceted that to label it “X” or it’s not “real” line of thinking is b.s. In my opinion. I’ve also observed that aging adds a component to mental illness. In my experience and opinion, aging worsens (in some people) the illness. My own version is both better and worse. The worse side is greater. Sum up: To me (opinion) one cannot ‘pigeon hole’ mental illness – whatever flavor or mixture might be the case for an individual. Because we’re ALL unique. A professor I worked with once told me that nobody perceives or experiences anything exactly the same way – thus (again to me), given that fact, how could mental illness be grouped as being ONE way? The individual will have acquired or will have the illness in his or her own unique way. Very very interesting topic Ashleyleia! Thanks 🙂

    1. I agree with that professor. We all experience things differently based on many different factors. I think it helps to recognze that and get to know ourselves and our own unique illness and work from there.

  3. Not sure I got the entire message here, but it seems to me the quote about depression is missing the mark. Sure, some depression is situational based on experiences we had or did not have growing up. And can be addressed in part with some sort of behavior change on our part. But I think most people agree these days that depression and other mental illnesses are due to chemical deficiencies or imbalances in the brain. While changes in behavior are helpful to some, they do not address the whole picture. Behavioral changes do not magically wand the depression or anxiety or whatever it is away.

  4. I love this post! I also find it frustrating when people try to come up with simple, one-size-fits-all explanations for mental illness. As you say – “if it was that simple, wouldn’t research have conclusively established that by now?” I think people make simple generalizations because it helps them to make sense of the world/feel like they have more control over their life…but it can still be incredibly problematic and damaging to those with mental illness.

  5. Are we bumping up against the limitations of the science versus the art of diagnosis?

    Over time, it seems that science evolves to see more. We also worry that science looks in only specific ways that could exclude some Truths that are hard to measure. Is science a lens made up of other lenses, other ways we have learned to think? One of the last times we saw T-1, T-1 said, “You seem to exhibit symptoms of X” (another diagnosis), but realizing we are in the middle of pandemic, T-1 decided to not pursue that. It is out there now…

    That quote by Rosenberg troubled us, too. Even reading it in its full context, it seemed very sweeping. We wondered based on context if he was referring to our mass medicating of the population (art of diagnosis colliding with how we are “educated” by our institutions). He has a PhD in Psychology, so one might naturally be surprised at the generalization.

    It does seem like we are at an intersection in which so many people are anxious, depressed, and traumatized that we question if the human-made systems (economic, social rules, education systems, etc.) are no longer serving populations, if they ever did.

    Maybe one reason we can’t all see things the same way ever is that right/wrong, good/bad, holy/evil are actually subjective. For example, Sally thinks doing X is wrong, and we engage in X, so we get mad at Sally and judge Sally for judging us. And so on.

    What if good/bad, right/wrong are actually lenses that we have been socialized to see through (via family, school, media, religion)? What if we could educate ourselves differently? To drop the judgments and labeling. To see *why* we do the things we do. What needs do our actions serve? Is this the best action to get our needs met? Or does it conflict with other of our needs? Does it infringe upon other people’s needs? What if we dialog about what our needs are, about what is alive in us? And then we take actions that make life more wonderful for all parties? That is the crux of Nonviolent Communication.

    Buddhism says that the stronger we cling to our beliefs, the more we suffer. Because we believe we are right and the other person is wrong. We don’t know shit, though. We were raised a certain way or had certain experiences and these are what form what we see as right/wrong, good/bad. If everyone experiences this, then everyone’s versions have some validity, because it is their experience. And so we if we cling less to our beliefs, we make space for other people’s beliefs as expressions of their experience. Maybe we feel less threatened then.

    Ashley, your writing is very stimulating! Love you!

    1. I think any judgments like good/bad and right/wrong are inherently subjective, so there’s never one true way.

      Where I think labelling can be useful is when it serves to describe rather than to judge, and it’s clearly defined and operationalized. I find diagnoses useful because establish a label that captures a certain number of set of symptoms. It doesn’t define what that person’s individual experience is or the reasons for that experience; it simply says that someone has symptoms that are consistent with that label. That way research can be done looking at the different experiences of people who match that label, and trials can be done looking at the effectiveness of treatments for people who fit that label. If there are no clearly defined labelled, then everyone’s just talking about what they think something means, and that opens the door for various judgments to get attached to the label. I think this is a huge problem when people use medical/psychological terms without understanding what they actually mean, and then instead of the label being purely descriptive, all kinds of other mess gets drawn in and attached to it.

      That was a bit of a ramble. Love you too!

      1. That’s makes sense: Describe in order to help versus describe in order to __ (however we think judging helps: boost our own self-esteem, justify our actions, delude ourselves)

        Trying to move beyond judging is something we actively are practicing. We do judge and then try to recognize it, not judge the judging, and look for other ways to process the information. If we can practice enough, we can possibly be triggered less or get ourselves out of a flashback or get to the reality of now

  6. I see mental illness as demons that bring us darkness.
    Not in necessarily in a religious sense. Just in a generally negative sense. These demons can manifest in others who mistreat us and push us into darkness. But they can also come from our own doubt and insecurities that might be fuelled by others. Our own minds create these demons who torture us in ways few truly understand. I don’t let these demons in, but they found my weaknesses and whispered all the doubts and fears in my ear got too much.
    That’s just my fantasised version of it that helps me make sense of my own illness. I think if I can make sense of it, I can fight it.

  7. I agree with you… in some cases, a one size fits all mentality does such a disservice. I feel as though my situation was brought on by a certain amount of negligence by my parents (no real close family history of psychosis), when I was two or three. A 107 degree fever can do a lot to damage the brain!

  8. I am just starting to to look into this concept. I have just started to do a lot of volunteer work on hospital committees around mental health. Then covid hit. I am just starting to understand Mental Health and I have a lot of ideas of where I would like it see things go. I wish we could get rid of the boxes and stigma. I do understand why though that we need the boxes for research.
    I appreciate all the work you do and the blogs that you post.

    1. I think some boxes are okay, but only if there are no judgments attached to those boxes, and a recognition that someone’s box only says a few specific things about them, and doesn’t provide the whole picture.

  9. Interesting post as always Ashley. I think whatever explanation is used it has to make sense to the person experiencing the distress or their experience is not being validated which is the most important part of any therapeutic intervention or support. I think the usefulness of diagnosis is more to define what is being talked about, research etc. as you say. For individuals a formulation is more helpful – why am I experiencing this in my life at this time? There are usually multiple factors – sometimes more psychosocial and others more biological. The fact women are more likely to develop depression at times of major hormonal changes is clearly biological as an example. Epigenetics shows that past generations experiences can effect our genetic expression now so the answers may not be within our own experiences but be this impact on our genes which we can only experience as coming from nowhere so it’s complicated and a one size fits all approach is always going to be too simplistic. With PD I think the links to trauma if there can help take the judgement out of the diagnosis which is important I think as so much mental illness is judged as weakness which is just wrong and so unhelpful. In my work the task of the formulation is done with the client – I have my experience and views but they are the expert in themselves and we reach a shared understanding that is meaningful for them in their life – otherwise I’m not being much help!

    1. I think in that sharing of views and experience between professional and client a greater understanding can be reached for both parties. And like you said, validation is key.

  10. Interesting post, as always Ashley. I agree with what most other have said – each ‘disorder’, ‘illness’ is different for each person and often there appears to be no rhyme or reason for it.

    Mental illness runs through my family but I also believe my illness was part situational, part psycho socio economic – nature/nurture? Who knows eh? At the end of the day, we all just have to deal with it, also in our own way 🙂

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