What if We’re Wrong About the “Cause” of Mental Illness?

This may be the month we put together enough evidence that childhood trauma may not be the “responsible” agent in causing serious mental disorders to at least make us reconsider our popular theories. Of course there’s been plenty of prior evidence, but fixed ideas, even wrong ones, are hard to change.

On March 2, a story by Jeremy Laurence appeared, reporting that a common acne antibiotic was found, quite by accident, to alleviate symptoms in patients with schizophrenia. This was a shocking surprise for some, especially clinicians I imagine. The belief that curing mental illness happens by overcoming childhood trauma has been the anchor of psychotherapysince the last century, despite plenty of contrary evidence. The story linking antibiotics and relief from symptoms of schizophrenia is just another piece of empirical data, suggesting that we might be off base in the assumption that childhood trauma explains the etiology of serious mental illnesses.

Two weeks later, I read another research story pointing to the role of bacteria/viruses/fungi/parasites in mental illness. In this Month’s Atlantic(March, 2012) http://tiny.cc/znm4aw, an article describes the work of Jaroslav Flegr who got an idea that a parasite, Toxoplasma gondii (T. gondii or Toxo for short), excreted by cats in feces may be the cause of both minor and mental disorders including schizophrenia in people with a vulnerable genetic make up. In others it seems to affect personality, increasing introverted but reckless behavior in men, and the opposite in women. He’s done numerous studies, finding significant differences between groups infected compared to groups without. In some populations, for example Czechs, 30 to 40 % of the population tests positive for this parasite, making it possible to do all kinds of research. He, and now other scientists are finding that the recklessness in men with the parasite results in more car accidents. And sure enough, that’s what they’ve found looking at large samples.

The belief in the importance of childhood trauma is as fixed today as it was in earlier times, when even autism was thought to be caused by adverse childhood experiences—in the case of autism, it was the “refrigerator mother” that led to its development in infants and young children. We know a bit more about autism now, and we know more about schizophrenia than when it was thought to emerge in people who were raised by a “schizophrenegenic mother.” But largely, it seems we are still linking severe mental illness to the early psychosocial environment; even neuroscientists seem to be in on this generally wide-spread belief. Using evidence that the brain is “plastic,” capable of change, some brain scientists promote the idea that adverse childhood leads to detrimental changes in the brain. And the adverse environment they speak of is usually parents, and sad but true, more often than not, the parent focused upon is mother.

But what if we’re wrong, what if serious mental illness is entirely unrelated to lousy parents? What if blaming the psychosocial environment ends up harming patients and their families? What if, aside from similar genetics, parental behavior and/or psychosocial environment isn’t connected to the development of serious mental illness. Scott Lilienfeld wrote an article several years ago (2007), published in Perspectives on Psychological Science in which he pleaded with mental health service providers to “do no harm.” Instead of focusing on “empirically supported treatment” which may be ideal if or when a clinician correctly diagnoses a patient, and there really is a best practice for treatment, Lilienfeld said it was time we went out of our way to do no harm, at the very least we could think about that. I think he’s right, and I also suspect that focusing on what everyone considers to be “childhood trauma” may be barking up the wrong tree, and in the end, causing patients considerable harm.

Even within the empirically supported treatments, there is often a focus on trauma. People are very compliant; if someone in authority tells us we were traumatized, we’re likely to believe it. We’re even likely to go looking for trauma, and the traumatizers. Not only do we believe our authorities, we’ll start fabricating memories to fit the bill. This can be very harmful. Children love their parents, for better or worse, and most parents want to be good parents; they usually do what they think they’re supposed to do, in raising children. When clinical wisdom puts patients on the track of remembering the traumas that screwed them up, that may or may not have happened, they begin to create a serious break in family relationships. People who suffer from severe mental illness often have to depend on support from their families, extended families, siblings and parents. There’s research somewhere suggesting that solid support from families is really helpful in terms of predicting good outcome of treatment for mental illness. So creating, enlarging, elaborating on the failure of parents is hardly likely to be helpful for someone struggling with mental illness. What if this focus on childhood trauma is not only wrong, what if it’s harmful?

There may be environmental factors, traumas if you will, that contribute to mental illness. But these may be subtle physical traumas; high levels of lead in rundown housing, multiple combinations of neurotoxins, or, as suggested by these recent findings, bacterial, viral, fungal, and/or parasitic exposure at sensitive periods in childhood, perhaps in utero,or even in adulthood.

Other research points in the same direction: It’s been accepted that some children who develop serious OCD, do so in the wake of a bacterial infection (strep). Maybe we need to pay attention to these suggestive pieces of data. We know that many serious mental illnesses are in part heritable, but we also know that not all children with vulnerable genetics end up with a mental illness, even when they go through childhood with the same family. What makes the difference? One line of argument points out that even in identical twins, what happens to each fetus in utero may not be identical, and therefore whether genes are expressed or not, may be dependent upon some unknown but important difference in the pre-partum environment. This may explain why one twin living in the same home with the same family develops a serious mental illness, while the other twin is spared. Furthermore, not all identical twins are really identical, and those who are, still have differences considered “epigenetic”—that is something in the environment that changes gene expression.

Our common observations should not be discounted. Don’t we all know numerous people who grew up in seriously dysfunctional families, who arrived in adulthood relatively normal, and certainly without a severe mental illness? One more thing that leaves me questioning our conviction about childhood trauma and mental illness: Long ago we believed that children should be beaten for minor infractions. People believed “spare the rod, spoil the child.” They thought they were doing the right thing, they believed they were being good parents. Most children broke some rules some of the time, and therefore most children were beaten. And yet, I don’t think we found a higher incidence of mental illness in the long ago era when beating children was the norm. There are still places in the world, where culture dictates behavior that we consider child abuse. In our culture, we know or at least we think we know, that being abused, physically assaulted, is not conducive to developing a sense of security, confidence and competence. But that’s a whole other kind of problem, what used to be called “neurotic.” Today maybe it’s “generalized anxiety disorder.”

It has been suggested that today we have a higher incidence of serious mental illness than in the distance past. It’s reported that we’re in an virtual epidemic of depression. Maybe we need to look at the physical environment, the neurotoxin exposure, etc. And obviously we have to question the focus on childhood trauma, whatever that means, and most important, we need to be sure our explanations of problems as we pass them on to clients, are honestly doing no harm