For people who suffer from depression, are the mood state fluctuations due to uncontrollable, inevitable “chemical imbalances” that pharmaceutical companies tell us are only corrected by medicine? And are alcoholics doomed because of genetic predispositions that cannot be improved upon by human effort and support from loved ones? And gamblers who risk and lose everything – were they born to become helpless gambling addicts, or were their choices reflective of an unhealthy response to the stress in their lives?
What we know — and don’t know — might surprise you
The Diagnostic and Statistical Manual (DSM-5) is the tool mental health professionals use to diagnose mental illness, and while the manual broadens and widens its scope every couple of years, it offers nothing when it comes to the causes of the mental illnesses it lists. Furthermore, the distinctions made between normal, odd, quirky, and psychpathology change with every new edition of the DSM, sometimes because of new research findings, and in other examples because of societial changes (i.e. homosexuality was once a mental illness defined by the DSM). The big point is that mental illness changes with respect to how we view psychopathology, yet we don’t have a lot to go on when it comes to the origin of mental illness, nor do we have consensus when it comes to how to treat mental illness.
Going back to the original questions around depression, alcoholism, and gambling, it is very easy to immediately jump to all three having very strong biological orientations, providing for a safety net of “how can I control what is in my DNA?” kind of response. This thinking also promotes the pursuit of “the right drug” to correct the problem, thereby lessening the burden and responsibility of problem-solving alone or through professional counseling. Ironically, in my nearly 25 years of working in mental health, I have come to believe these are very faulty, defeating ways of thinking that completely miss the biggest factor contributing the mental illnesses we battle today: STRESS.
Stress response & mental illness
Drilling deeper, it’s actually not even stress that causes mental illness, but how we respond to stress. In my view, depression, over-eating, drinking, gambling, are signs of maladaptive coping to stress where people seek respite and relief from the issues in their lives. Please note that this position does not imply we are weak, unable, or poorly designed human beings, but instead suggests that when we are not taught how to successfully identify, appraise, and respond to stress, we will almost inevitably turn to something to “stop the music,” so to speak.
Depression may not have anything at all to do with faulty biology, but is simply a response and mindset that occurs over time when the world becomes too difficult and there appears to be no real hope for positive future change. The stress of that type of thinking leads to depression rather than the body telling itself to “be depressed” through neurotrasmitted messages that were destined to happen, regardless of what the individual experiences in life.
The alcoholic is yet another example where stress can lead to drinking. When life is tough and various stressors are thrown your way, it makes sense to seek a “timeout,” right? Drinking (and all recreational drug use) provide a quick, positive, happy response, and over time the drinking behaviors may eventually become problematic and result in a mental illness. In this example, learning the life skills necessary to cope with stress (i.e. communication and conflict skills, better decision-making, exercise, multi-tasking, etc) the likelihood of alcoholism declines as there is little need or want to numb the mind through drunkenness.
The list goes on as you read through the DSM, with far more evidence supporting poor coping that causes “mental illness” than there is for uncharacteristic, uncontrollable, or biologically driven brain damage that results in DSM mental health disorders. There are also great risks in shelving our critical thinking and simply assuming the drug companies have it right when they shower us with commercials telling us we are doomed without their drugs. Specifically, we suspend all critical thinking, objectivity, and efforts to find real data (and solutions) pertaining to the challenges we face in life – after all, why should we since there are drugs that can fix everything, or so it seems. Consequently, we readily accept the labels given, the drugs that follow, and quickly disregard that our inabilities to cope with stress are truly at the root of our problems, not genetic predispositions that can only fixed by psychotropic medications.
Case study: Successful stress appraisal and coping
To further my point you only need to watch what most happy, productive, successful people do with respect to dealing with stress. First, they rationally appraise stressful situations and stop themselves from dichotomous thinking (all or nothing thinking). They are realistic with the fact that we all have bad days, and they have learned that numbing themselves through chemicals won’t teach them the skills needed for survival, nor will it make their problems go away. Instead, they expect stress in their lives, and they respond to stress by using healthy mechanisms including exercise, meditation, talking with friends, playing music, or doing a host of other activities that provide for a short break to mentally regroup and problem-solve. In essence, their “mental strength” gained by learning healthy and effective coping with stress has helped them avoid depression, drinking, and a host of other maladaptive ways of dealing with life.
Young people today, often referred to as “millennials,” may be the most at-risk when it comes to improperly defining mental illness. The millennial cohort have been raised that mental illnesses, even pharmaceutically-created ones like ADHD, are inevitable and the best you can do is hope you don’t get one. Many millennials have bought in to this paradigm (consciously or subconsciously through repetitive advertising), and are now commonly criticized for being weak, lazy, incapable, and lacking any kind of resiliency. The vast majority of young people I see at my office come to me already on a medication (or multiple), and in many cases are severely lacking when it comes to having developed the life skills needed to not only survive in the world, but succeed. As M. Scott Peck once said at the very beginning of his famous book The Road Less Traveled, “Life is difficult,” suggesting that it is quite normal to struggle (and implying that this struggle doesn’t mean you are doomed by mental illness, but instead tasked with challenges we all commonly experience).
Millennials, by and large, have not been taught that stress is normal and that developing stress-response skills are important for life happiness, health, and success. They are also typically not taught and encouraged to face off with stress (“fight”), but instead drawn to the victim role of simply lying down and accepting any medicine that will help them get through the day. The pharmaceutical companies over a few decades now have strengthened this message to the point where it has become an assumed truth, and too many doctors are doling out mental health prescriptions, often acquiescing to the requests of ignorant parents who just want help, regardless of how.
What’s really puzzling is not the generation of millennials being persuaded into thinking all their problems are genetic issues that can’t be fixed without drugs, but the parents of millennials who regularly boast through social media about how “tough” they were growing up having to dust themselves off at every turn (in addition to walking to school barefoot through snow, etc). In one breath they remind their kids how tough it was (suggesting the need for healthy stress-coping), and in the next moment they are lining up at the pediatrician’s office with a list of drugs they heard about on television that can help their child’s issues.
Assigning the cause of mental illness to inevitable biological roots that can only be corrected by drugs is a very dangerous route to go for a number of reasons:
- There are countless side-, interaction-, and withdrawal-effects that often cause much bigger problems than the original “mental disorder.”
- Assuming genetics are the cause of mental illness prompts self-fulfilling prophecies of “why try, I’m doomed anyway.”
- Ironically, when people go on pharmaceutical drugs they are then viewed as “damaged goods” in the eyes of insurance companies, prompting higher rates of health insurance (and more stress).
- Perhaps most importantly, by not acknowledging the huge role stress plays in our wellness, little (if any) efforts are made to learn the skills necessary to make it in this world.
The good news
Fortunately, changing our thinking (and chances for true happiness) isn’t nearly as difficult as you might think. The first step, obviously, is to delete the “I’m doomed because of my DNA” thinking. By accepting that most of us are actually on equal footing but that our stress-responses differ greatly, only then can a person truly direct his thinking and energies toward fixing problems.
The next thing to do is to learn as much as you can about stress, particularly in the initial appraisal stage of “fight or flight” when tough situations come your way. If you tend to flee stress, it is important to challenge your thinking and ask why? In most cases the flight response is simply a response that has been learned over time, not something your brain has no control over. The flight-response also occurs when coping skills are minimal, prompting the larger discussion around how to learn the coping skills needed for life success.
Being drug-free from mental health meds is the biggest step toward this type of change, an important conversation patients should have with their doctors (especially if contemplating going off medications). Yes, life is difficult, but the human spirit is amazingly strong, and the life skills needed for success are skills that can be learned by all of us.