There Are No Simple Explanations for Mental Illness

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.

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.