There’s a long and dishonourable tradition of blaming the mentally ill for their own illness. For a long time, people thought the mentally ill were possessed by evil spirits or demons. Here, for example, is the description of a man who was ‘exorcised’ by Jesus:
And when he [Jesus] was come out of the ship, immediately there met him out of the tombs a man with an unclean spirit, who had his dwelling among the tombs; and no man could bind him […]: neither could any man tame him. And always, night and day, he was in the mountains, and in the tombs, crying, and cutting himself with stones. [Mark 5: 2-5]
Clearly, the bible authors were not in the habit of using standardised criteria to classify the people they claimed Jesus had encountered, but it certainly seems likely that anyone displaying these characteristics today would be described as mentally ill. (Well, either that, or as an emo kid. I mean, look at the evidence – the guy spends all his time on his own, crying and self-harming, and lives in a graveyard. I bet if they’d gone to his dwelling among the tombs they’d have found about a million pairs of skin-tight black jeans, and enough eyeliner to sink the Titanic…)
Jesus, as was his wont, has a bit of a natter with the supernatural phenomenon:
And he [Jesus] asked him [the emo kid possessed man] ’What is thy name?’ And he answered, saying, ‘My name is Legion: for we are many.’ [Mark 5: 9]
Again, the diagnostic categorisation is absent, but a modern-day person asked the question ‘What is your name?’ who replied by saying he was called ‘Legion, because we are many’ would be likely to be described either as mentally ill, or as a fan of supernatural horror films.
Anyway, really the key thing is what happens to this ‘mentally ill’ man. He manages to overcome his demons long enough to worship Jesus [Mark 5: 6], who casts out the demons and causes them to enter a herd of swine, who immediately take a running jump off a nearby cliff and drown. After this, the man is, ‘miraculously’, cured:
and see him that was possessed with the devil, and had the legion, sitting, and clothed, and in his right mind [Mark 5: 15]
Interpreting this myth is easy: those of us who are mentally ill need only worship Jesus and we will be cured. It follows from this that everyone who is mentally ill has either deliberately turned their back on god, or, if they are a practising christian, are insufficiently sincere in their faith.
This is one of the main ways that mentally ill people have been and are blamed for their own illnesses. In fact, the frequency with which we use the phrase ‘overcome his demons’ shows just how central this myth still is to our explanations of mental ill-health. But there’s also a rather newer way in which the mentally ill are blamed for their own illness, and it’s done, shockingly enough, by people who claim to be in the business of supporting the mentally ill, and even curing them. I’m talking, of course, about the psychological model of mental illness.
Broadly speaking, there are three main theories of the cause of mental illness. The first of these I’m going to call the medical model, as it proceeds on the assumption that mental illness is identical to physical illness, except that the physiological disruptions take place in the brain, rather than in other areas of the body, and consequently have mental symptoms. The second theory I’m going to call the psychological model, as it holds that mental illness is wholly different to most physical illness, and results from a combination of negative life events and poor ‘coping skills’. The third theory is an uneasy synthesis of the two preceding theories, and holds that a combination of medical and psychological factors cause mental illness. It’s difficult to be precise in this definition, because it seems to mean different things to different people. So, some people argue that ‘serious’ mental illnesses (like Bipolar Disorder or Schizophrenia) are caused by medical factors, but the rest are caused by psychological factors, while some others argue that there is a biological ‘predisposition’ towards mental illness, but it is ‘triggered’ by negative life experiences.
I should make sure that I come right off the fence here and state flat-out that I am very far from being impartial in this ‘discussion’. I think, so far as genuine, enduring mental illness is concerned, the psychological model is nonsense, and psychologists little better than quacks. I am convinced that, within 100 years at the most, there will be no such job title as ‘Clinical Psychologist’. I think there will be psychiatrists, but psychiatry will be a radically reformed specialism, and will tend to be seen as a branch of neurology – the only difference between a neurologist and a psychiatrist will be that the former will focus on surgery, while the latter will make use of medication. I also think there will be counsellors, but these will be limited to helping with sub-clinical problems (someone who is finding it difficult to cope with grief, for example), and to helping the mentally ill manage their symptoms. Counsellors will not seek to claim, as many psychologists currently do, that they are able to divine the cause of mental illness, or to cure it.
This position is, of course, a belief, although I do also think that the balance of probabilities supports it. Statistical analysis is making a genetic cause for certain mental illnesses (like Bipolar Disorder) seem very, very likely. Research into conditions like Alzheimer’s is also demonstrating that physiological conditions within the brain can cause disruptions in the mind that are very, very similar to those that are associated with mental illnesses, and can be treated with the same drugs – The Shrink, for example, has discussed the benefits he has achieved treating dementia patients with antipsychotic medication. Nonetheless, my belief remains a belief, and I wouldn’t want to claim that it was anything more than that.
For me, the greatest stumbling block encountered by the psychological model is that it struggles to explain why some people who experience negative life events are mentally ill and others are not. Take a hypothetical example of a family of children growing up in difficult economic and personal circumstances with a parent who is mentally ill. This is a scenario that many who subscribe to the psychological model believe would lead to a greatly enhanced risk of the children themselves becoming mentally ill. Now imagine that one of these hypothetical children grows up to suffer from mental illness while the remainder stay healthy. (This is a not uncommon scenario.) A medical model that takes account of genetic factors can very easily account for why this is – because of the random selection of genetic material at conception, only one child has inherited the genetic factors necessary to cause the illness. The psychological model, on the other hand, encounters difficulties – what marks out as different the child who goes on to develop the illness?
This is something that cuts close to the bone for me. I have three siblings, and I am the only one with serious mental health problems. If we are to believe in the psychological model, this is something that it has to satisfactorily account for. Why was I unique in responding to the upbringing I shared with my siblings in this way? If this is not the result of physical factors that apply only to me, then what does it result from? It seems to me that the psychological model is going to struggle to explain this in terms that don’t end up blaming the victim (i.e. me) for a personal weakness, or an inability to cope.
There is a history of mental illness in our family, although, as with many families, it’s not spoken about in those terms. My grandmother would experience lengthy bouts of unspecified illness, during which she would take to her bed. These illnesses were always described as ‘a virus’, and were of sufficient concern that my granddad would take days at a time off work to look after her. It was during one of these bouts of illness that my grandmother died, on the day that my granddad had returned to work after a period of two weeks looking after her. The family version of events is that she had become confused, and died of an accidental overdose. It’s not, I think, a huge leap to reach the conclusion that her unspecified illness was recurrent severe depression, and her death suicide.
So, how can we explain the fact that my grandmother was mentally ill, that her illness skipped a generation altogether, and then manifested itself only in one of her four grandchildren? The answer, of course, is that all of this can be very easily explained if we assume a genetic cause.
It’s perhaps unlikely that a single defective gene is responsible for depression – if it was, it would probably have been at least tentatively identified already. If depression does have a genetic cause, it’s much more likely to be the result of the interaction between several genes. For the sake of clarity, however, I’m going to label the combination of genetic factors that leads to depression as though it were a single gene. I’ll be calling this gene a (that is, a lower case letter ‘a’), and I’ve labelled the opposite combination of genetic factors – the one that leads to an absence of depression – gene A (that is, an upper case letter ‘A’).
In almost all cases, an adult human possesses two versions of every gene, one that they have inherited from their mother, and one that they have inherited from their father. It is also frequently the case that one version of a gene takes precedence over the other, if both versions are present. The gene that takes precedence is called ‘dominant’ while the other is known as ‘recessive’. In this case, I am presuming (because fewer people are depressed than are not depressed) that the version of the gene that leads to no depression – gene A – takes precedence over the version of the gene that leads to depression – gene a. In other words, gene a is recessive, while gene A is dominant.
There are four ways these versions of the gene can be combined in a person, but these four combinations lead to only three possible outcomes.
- The first possible combination is AA, in which a person has inherited a dominant version of the gene from their father, and another dominant version from their mother. This combination leads to a person who is not depressed.
- The second possible combination is Aa, in which a person has inherited a dominant version of the gene from their father, and a recessive version of the gene from their mother. Because the dominant version takes precedence over the recessive version, this person is not depressed; however, they are a carrier of the ‘depression gene’, and may pass it on to their children.
- The third possible combination is aA, in which a person has inherited a recessive version of the gene from their father, and a dominant version of the gene from their mother. Again, the dominant version takes precedence over the recessive version, and so the outcome is the same as with the second combination – a non-depressed carrier of the depression gene.
- The fourth possible combination is aa, in which a person has inherited a recessive version of the gene from their father, and another recessive version from their mother. This combination leads to a person who is depressed.
If depression has a genetic cause, then my grandmother must have been a double recessive – that is to say she must have had the genetic makeup aa. My father, who did not suffer from depression, must have been a non-depressed carrier, as his mother (my grandmother) only had recessive versions of the gene to pass on. In other words, he must have had the genetic makeup Aa – a dominant gene from his father and a recessive one from his mother. If my mother was also a non-depressed carrier (Aa or aA) then it would be possible for my mum and dad’s children to have the full range of possible genetic combinations – AA, Aa, aA, and aa. This coincides exactly with the situation that exists with me and my siblings – the three of them do not suffer from depression, while I do.
This is, of course, no more than informed guesswork. Depression may not have a genetic cause, in the same way that not all illnesses with physical symptoms have a genetic cause, and even if depression is caused by a genetic abnormality, there’s no guarantee that it works as neatly as in my example above. In fact, if it’s multi-factoral (i.e. more than one gene is involved) then it’s almost certainly a lot more complicated.
The fact remains, however, that a medical model like this is able to provide an elegantly simple account of why I suffer from depression, but my three siblings do not. It is also able to explain how the depression skipped a generation, and how I ‘caught’ it from a grandmother I never knew – she died 8 years before I was born. The psychological model, on the other hand, isn’t able to provide an answer to any of these questions, except to fall back on the unsubstantiated assertion that there is some deficiency within my character or personality that explains my illness. It’s for this reason that I’m inclined to believe – until compelling evidence to the contrary comes along – that major depression, in common with all other mental illnesses, has a physical cause.