What causes mental illness: a follow-up post

My last post received several interesting comments, which, as always, I’m extremely grateful for.  It really is a wonder to me that there are people who are interested or bothered enough to reply to something I’ve written.  As always, I tried to have a bit of a discussion with the people who had commented, but two comments engaged with what I had said in such detail that I felt I wanted to take the space of a whole new post to reply.  I’m hoping this will be interesting to the rest of you because these commenters took a fairly different view of a number of things that I wrote about in my original post, and I’m hoping that to see the discussion more ‘up close and personal’, as it were, might make some of the issues a little clearer.

Before I get going, there’s just a couple of things I want to add.  First of all, although I disagree fairly profoundly with the two commenters I’m replying to here, I have tried not to single them out for unfair attack.  In fact, the reason this post is appearing two days after I first promised it is that the dismissive and contemptuous tone of the responses made me rather angry, and I’ve deliberately allowed some time to pass in order to, hopefully, filter most of that anger out.

Secondly, although I’ll be quoting from the comments, I won’t be reproducing them in full here.  There’s a danger with this approach that I will end up misrepresenting what has been said.  I’ll be trying not to do this, but it’s for this reason I’d encourage you to follow the links to the full comments – you may well find you agree with them and not me, after all.  Oh, and just in case it’s not clear, the sections appearing in italics are quotes from the comments, the sections in blockquotes are from my original post, and everything else is fresh material written by me for this post.

Anyway, enough prefacing, let’s get on to the main event.  First up is npal (read the full comment here)

npal

So, you mean to tell me you can actually rule out every and all possible interferences (genes aside) that differentiate you from your siblings

I never claimed I could.  What I said is that the genetic model seems able to account rather elegantly for things that a psychological model seems to struggle with.  My personal experiences are a subjective and anecdotal illustration of my ideas, not the basis of them.

Since personality and mood disorders have become pretty much a plague

It’s a mistake, I think, to include personality disorders and mood disorders in the same category.  My feeling (and it’s one that I believe is quite widely shared) is that personality disorders have been very largely invented to explain clusters of hard-to-treat symptoms that psychiatrists otherwise find it difficult to account for.  Also, the ‘plague’ you refer to results, in my opinion, from the inaccurate description of people who are merely experiencing a temporary and reactive drop in mood as being ‘depressed’, when they are not in fact mentally ill.

does that mean that there’s this common gene going around that somehow has eluded discovery as the main or major cause for depression?

Again, you seem not to have paid attention to what I said:

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.

You’ll note that I specifically addressed the issue of why the ‘depression gene’ has not yet been discovered, and also acknowledged the possibility that depression may in fact not have a genetic cause at all.

The research on schizophrenia, which is thought to be heavily influenced by genetic factors hasn’t pointed beyond the shadow of a doubt to one or more genes responsible for it.

Indeed.  The situation we have with schizophrenia is that statistical analysis suggests that the condition may be inherited, but the specific genes involved have not been identified.  This is precisely the point I was making with regard to my own family’s history of depression.  One story like mine is, of course, nothing more than anecdote, but I believe it was an interesting illustration of why the possibility of a genetic cause might be worth considering.

I have little doubt that as far as schizophrenia and its derivatives are concerned, research will eventually point out exactly what’s the genetic factor.

I am curious as to how you can be so confident that schizophrenia does have a genetic cause, but that mood disorders do not.  The evidence for bipolar disorder (which is a mood disorder) being inherited is really very strong – a point DeeDee Ramona highlighted in a comment on the original post.

Depression though is far too complicated to be reduced to a mere genetic flaw.

This is an unsubstantiated assertion.  Why is it too complicated?  How?  In particular I would be interested to know on what evidence you base the assertion that schizophrenia is less complicated than depression, as this would seem to run counter to fairly widely-held opinions.

Also, I am unclear as to why you refer to ‘mere’ genetics.  Genes have created every functioning mind that has ever existed, after all.  Why is it impossible that they might produce a malfunctioning mind?

Certainly there might be genetic factors that make you more positively predisposed to mood disorders

Can you explain to me why, if a mood disorder can be partially genetic, it cannot be fully genetic?  And by explain, I mean provide evidence, not just an assertion that it’s obvious, or that it must be true just because some other people have said it is.

to deny the environmental/social contribution in favor of genes seems as much nonsense as acquiting the knife because your body is made in such a way as to be susceptible to wounds.

No.  To suggest that environmental factors cause mental illness the way a knife causes a knife-wound is nonsense, however.  Or rather, to be fairer to you than you have been to me, a currently unsubstantiated assertion.

Also, the Clinical Psychologist belief is moot. If everyone could learn and do everything, we’d have just GPs doing all the work.

I think you may have misunderstood me.  The reason I believe there will be no such job title as ‘Clinical Psychologist’ is because the things that clinical psychologists (as opposed to counselors) do will no longer be done by anyone.  There will be no need for the specialists, because the specialism will, I believe, have been exposed for the (well-meaning, for the most part) confidence trick it is.

The psychologist exists to claim those cases that can either be helped by some sort of psychotherapy in combination with psychiatric medication or whose illness is such as to avoid medication entirely

I refer you to the point I made in my original post:

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.  Counselors 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.

I believe counselors will do these things, not psychologists.  The difference?  Counselors do not claim to have a clinical understanding of what causes disease, or how to cure it.  They simply offer advice on how to cope.

As far as brain research on mental illness goes, the best I’ve seen is symptom description and the assumption that neurotransmitter density and movement is somehow related to a mental illness. Well, if it were that simple, how come anti-depressants don’t really work that way for all patients?

The fact that the current medical model is inadequate, which I would agree it is,  does not mean the whole idea of a medical cause is wrong.  Historically, physicians treated all kinds of physical ailments with blood-letting and leeches, treatments which were largely ineffective, or even counter-productive.  This does not mean those physicians were also wrong in their assertion that illnesses had a physical, as opposed to moral or spiritual, cause.

And how come electrospasmotherapy sessions can actually work in some cases of severe depression that doesn’t seem to respond to medication?

Well, I googled ‘electrospasmotherapy’, and it returned only one hit – your comment on my original post – so I don’t know what it actually is.*  That said, I’m assuming it’s either a different name for, or a new version of, ECT.

To answer your question: I would guess that applying an electrical current to the brain has an effect on its electrical functioning.  As you will know, nerve impulses are propagated along the length of a neuron (nerve cell) electronically, and when they reach the end of the neuron, are transmitted across the gap to the next neuron (known as a synapse) by means of a biochemical agent known as a neurotransmitter.  In other words, medication and ECT both have an impact on the transmission of nerve signals, but via different methods.  It would seem reasonable to speculate that this difference of methodology explains why the different treatments are effective in different patient populations, although there is (as I understand it) no evidence for precisely how or why each treatment works.

Do note that even if medication did work without fail as in most physical illnesses, the difference is that your organism will never make antibodies for mental illnesses. You will eventually NEED some form of therapy to practice the behaviors that will shield you from being re-exposed to the same illness.

You seem to be confused as to the nature of physical illness.  In particular, you seem to think that all physical disease is infectious disease – at least, your reference to antibodies only makes sense if you do.  There are many examples of physical diseases that are not caused by an infectious agent  (diabetes, haemophilia, cystic fibrosis, etc.).  Some  of these diseases require constant treatment with medication.  Would you say that a person with one of these diseases needs therapy (in the psychological sense of that word), and not medication?  My own feeling is that this approach would be rather less effective.

Please also note that you are (once again) making the assertion that it is ‘behaviour’ and not physiological factors that cause mental illness.  You are yet to put forward any evidence in support of this assertion, even the sort of partial, speculative, apply-lots-of-caveats ‘evidence’ I put forward for an alternate view in my original post.  Things don’t become true just because someone keeps saying them.

Remember that I’m talking about mood disorders and a number of personality disorders. Illnesses like of the schizo- kind seem to always need medication.

Again, on what basis can you be so certain that schizophrenia will ‘seem to always need medication’, but bipolar disorder (a mood disorder, don’t forget) will not?

Lastly, if you wanted to acquit yourself of the blame people place on you because many have this retarded belief that somehow the mental patient is responsible for his illness

Although I suspect you did not intend any disrespect to the learning disabled, referring to  beliefs you do not share as ‘retarded’ does rather stigmatise this group of people.  It is particularly unfortunate that you used this word in a sentence talking about how the mentally ill may overcome stigma.   For the record, I have never felt that anyone with a learning disability has stigmatised me.  On the contrary, it is almost always so-called ‘normal’ people who apply stigma.

you didn’t need to go as far as to outright deny the psychological contribution. It’s no one’s fault in the end

I refer you to the point I made in my original post:

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. […] 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.

You are yet to suggest a solution to the problem I raised here.  Simply saying that one exists somewhere is not enough.  If you want me to take you seriously, you will need to actually identify the solution, and, as a minimum, offer convincing speculation as to how it might manage to overcome the difficulties I identify.

Opinions in what’s supposed to be hard science is really pathetic, but people choose to avert their eyes from that fact.

At last, something we agree on!

I must point out, though, that the whole of the psychological model of mental illness is based on opinion, unsubstantiated assertions, and unfounded conjecture.  I will also point out that my original post advances (partial, incomplete and speculative) evidence for its assertions, and specifically emphasises that the conclusions drawn are both personal and provisional.  That is to say, I never claimed them as hard science.  I do feel it is rather unfair that you should have leveled this complaint at me, when you are not also leveling it at those who support the psychological model, who would seem to be rather more guilty of the thing you are complaining about.

Overall, the most interesting thing about your comment, npal, is what you have chosen not to mention.  You haven’t, for example, offered any specific criticism of those parts of my argument where I have attempted to show how my opinions and beliefs might fit into established and emerging scientific knowledge and speculation.  In particular, you haven’t challenged my assertion that a genetic model would seem to be able to account very neatly for why I am depressed and my siblings are not, and I and my grandmother suffer(ed) from depression, but my father did not.  If I’m honest, I do find myself wondering: is this because you can’t?

 

Next up, NiroZ (read the full comment here)

 

NiroZ

Not your best article.  […] you work in a straw man attack (nobody I know holds that psychological view, including psychologists)

I would invite you to consider that, in my original post, I specifically acknowledged that, in addition to those who defended the psychological and medical models, there were those who supported a ‘third theory’, which I described as ‘an uneasy synthesis’ of the psychological and medical models.  This seems to me to be reasonably close to what you assert psychologists actually believe.

Now bear in mind that the key thing about a ‘straw man‘ argument is that you deliberately misrepresent the points put forward by your opponents, substituting their actual case for one that is easier to argue against.  Since I made it clear that my attacks were aimed at the psychological model, and so were not aimed at the ‘third theory’ I had also outlined, is it really fair to say that I have ‘worked in a straw man attack’?  In other words, that I have deliberately misrepresented my opponents?  Mightn’t it be more fair (and, indeed, more accurate) to say that I identified a range of opinions, and then chose to concentrate upon a part of that range?

you made a false dichotomy (genes must be it, because upbringing can’t be it)

This, on the other hand, really is a straw man attack.  You see I emphatically did not say ‘genes must be it, because upbringing can’t be it’.  I said:

Depression may not have a genetic cause […] 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.

I’m sure you have noted the difference there.  In your straw man version, there are two categorical assertions – one that upbringing can’t be the cause of mental illness, the other that genes must be.  Whereas what I actually said is that it seems difficult for the psychological model to explain some things that a medical model seems able to explain rather elegantly.  Neither is a categorical assertion.  One is an expression of doubt, the other a speculation.

you made a reverse post hoc ergo propter hoc fallacy (other people had the same upbringing as me, therefore it can’t be the causation).

Another straw man attack.  I did not say that upbringing ‘can’t be the causation’ of mental illness.  I said that the psychological model struggles to explain some things which a medical model seems to be able to explain rather elegantly.  The difference, as above, is in the level of certainty I express.  Your knowledge of Latin terminology is very impressive, but you should realise that it doesn’t help your case if, either through ignorance or a deliberate attempt to mislead, you misapply the terms you use.

The real most popular psychological theory on depression is the cognitive theory of depression. […] (5th entry on google, if you’d bothered doing actual research

Oh dear, NiroZ, you’ve done this in a previous discussion, you know – that is, accused me of failing to carry out sufficient research.  That was when we were talking about atheism, if you remember.  You attacked me then, too, claiming that I did not understand agnosticism, and that I was guilty of failing to carry out a basic level of research.  Do you remember how that discussion ended?  I’ll jog your memory: you seemed to be entirely unable to back up your claim that I did not understand agnosticism, and ended up saying ‘I guess your right regarding god’.

In the same way, you are entirely wrong to suggest that the kind of basic, entry-level information contained in the encarta article you link to is something I’ve never heard of, or do not understand.  The alleged ‘cognitive errors’ this theory makes so much of I include in the category of ‘poor coping skills’.  That’s all the presumed predisposition to think the worst is, after all – a suboptimal response to life events.

I also second jono’s comments on this point – where is the evidence for the cognitive model?  Specifically, where is the evidence that negative thought processes are the cause of depression, rather than symptoms of it?  In fact, to make use of some of the Latin terminology you’re so keen on, isn’t this an example of a cum hoc ergo propter hoc argument?  That is to say, one that’s based on the mistaken assumption that correlation equals causation?  In other words, where is the evidence that, because people who are depressed have negative thoughts, negative thoughts must be the cause of depression?  How do you prove that this is anything more than a straightforward logical fallacy?

As with agnosticism, it would seem there is a chance that I actually understand the cognitive model better than you, not worse.  Certainly, I have been able to point out flaws in the argument which seem to have escaped either your understanding or your attention, or both.

I thought you said you figured out CBT in 10 minutes.

Perhaps you can explain to me where I have demonstrated a lack of understanding of how CBT works?  This would appear to be one of your wilder and more irrelevant accusations.

Just because it wasn’t the upbringing doesn’t mean it wasn’t the environment.

And yet another straw man.  I didn’t talk about upbringing in isolation.  I talked about what I called the psychological model, which I defined like this:

it holds that mental illness […] results from a combination of negative life events and poor ‘coping skills’.

It’s you, NiroZ, who have oversimplified, and have up to this point written only about upbringing.  Presumably, therefore, you are criticising yourself here.

It could be the peers you interacted with, the adults in your life, it could be an event that you experienced, it could be something that happened in your school grade. It could be something that happened after you left home.

Again, all of these fit absolutely within the definition of the psychological model I reproduce above.  It follows, therefore, that my criticisms of the psychological model apply to these potential causes you mention.  Just to remind you, this criticism takes the form of a question, not a categorical assertion: why do only some people who experience these kinds of things get ill?

It could be something you ate (like that neuroparasite that lives in cat feces), it could be a disease you suffered that got to your brain.

Well, you’ve got me bang-to-rights on this one, NiroZ – I didn’t discuss the possibility that depression is caused by an infectious agent or a parasite.  There was actually a good reason for that, since no-one has seriously suggested that it might be.  And there’s also a good reason why no-one has raised it as a serious suggestion.  You see, if depression was caused by a parasite, you’d expect it to exist in geographical clusters, reflecting the areas where the parasite exists in greater numbers, as happens with, for example, elephantiasis.

Similarly, if depression was caused by an infectious agent, there would likewise be evidence of clusters, reflecting the fact that the pathogen was circulating more freely within particular populations.  There would also be ‘good’ and ‘bad’ periods for depression (or new diagnoses of depression, if you believe the damage caused by the pathogen is permanent, and persists even after the infection has been cleared).  All infectious diseases, even ever-present ones like tropical Malaria, have peaks and troughs of activity.

I also can’t help but notice that you are now proposing solutions to the problem that actually undermine your own preferred psychological explanations.  I would suggest that, all in all, raising this possibility has perhaps not been your smartest move.

you jumped straight to genetics.

And one last straw man, just for old time’s sake.

I didn’t jump straight to anywhere.  I highlighted something that I felt the psychological model struggled to explain, and suggested that a genetic model seemed able to explain this same phenomenon simply and elegantly.  I note, as with npal, you haven’t actually challenged the specifics of this idea.  I feel forced to ask, in your case too – is it because you can’t?

 

Well, I hope my responses to these responses have been interesting.  I also hope anyone who disagrees with me will feel free to say so in the comments – this has been an attempt to continue the discussion, not close it down.  That said, I hope you can all understand that I am unlikely to stand quietly to one side where I feel I am being unfairly attacked.  In addition, I’m likely to respond with greater vigour where I feel I have been deliberately misrepresented, or my understanding of basic concepts has been called into question, without any evidence to back up these assertions.  Where I am proven wrong, I am always happy to acknowledge the fact – we all have more we can learn, and I probably have more to learn than many.

 

* – For the record the ‘electro spasm therapy’ that google suggests as an alternative to ‘electrospasmotherapy’ seems to be a group of treatments for muscular and circulatory problems.  From the context of the remarks, it seems unlikely that this is what npal is referring to.

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10 Responses to What causes mental illness: a follow-up post

  1. cellar_door says:

    Forgive me for not getting involved in the discussion, but having just slogged my way through a 3500 word essay on causes and interventions for depression I really can’t face talking about it any more! :o) But wanted to let you know I’m still reading…x

  2. NiroZ says:

    A straw man, IMHO, doesn’t have to be deliberate. You labelled it as the ‘psychology theory’, hence implying that this is what all psychology believed.

    As for the other ones, I was very very tired at the time, so I’m not surprised if I got it wrong. And to be honest, your post is frighteningly long. Maybe if I have a lot of time on my hands I’ll get around to reading it, but no promises.

  3. aethelreadtheunread says:

    Thanks for the comments.

    cellar_door – blimey, it’s very kind of you to slog your way through my posts on a topic you probably never want to have to think about again! But thank you for reading – it’s always nice to know. :o)

    NiroZ – well, that’s about as ungracious as a retraction can get, but it is still a retraction, so thank you for it.

    Your opinion on what constitutes a ‘straw man’ argument is certainly interesting, but really very unusual. In fact, i’ve never come across a definition of the term that didn’t insist that a deliberate attempt to mislead was the whole reason for framing a ‘straw man’ argument in the first place.

    Apologies in advance for the truly terrible pun – but i think you’re clutching at straws here.

  4. npal says:

    Eh, difference in translation I suppose, since English isn’t my mother tongue so I might have mistranslated the treatment term there, that’s true enough.

    I’ll comment on the other things that seem in need of comment, otherwise I generally agree (unless I somehow missed a spot, cause the post is long)

    I agree on the physical illnesses not necessarily being infectious, true enough.

    Just a small note on epidemics. While I agree that people feeling sad are nowadays more prone to believe it’s a full fledged depression, it is unfortunate that we’re talking about 5-10% of the population and rising.

    As for the “prove to me it is so”, I can only answer with “prove to me that it is not”. In the end, your claim and my claim are still claims that haven’t been proven true or false.

    Also, I did not group personality and mood disorders in the same category, not sure how you read it. I thought I’d drop one “disorder” cause it sounded repetitive.

    About schizophrenia, I’m confident enough because research is also confident enough and the results are far more concrete than genetic research on mood disorders . Research is free to prove me wrong eventually however.

    On the schizophrenia vs depression, schrizophrenia has more or less a set pattern plus a pretty consistent onset time in teen or young adult age. Much research has been done on the genetic bases of the illness and the results are promising. Depression on the other hand has NO clear onset time whatsoever, it can appear to anyone, anywhere, anytime, and many times than not, you can attribute its trigger to one (or in some cases multiple events piling up). Research on mood disorders still hasn’t given many genetic concrete results and percentages of first-degree relatives exhibiting mood disorder vary. Research is still unable to find more tight percentage space close to the higher scale and the results are far from being as concrete as the schizophrenia results. I didn’t completely disregard the genetic factor, I only said it’s contribution is at best secondary. Research on the environmental influences regarding schizophrenia has shown mixed results, with most researchers eventually abandoning the field, while the same research on depression has produced strong results about its influence.

    And the knife-wound metaphor, feel free to disagree, but you only did that, disagree without saying anything more. That makes your statement as unsubstantial as you seem to believe mine to be.

    About the schizo-depression medicine case, schizophrenics will take medicine and treatment for life, while many depression patients recover in part or fully, meaning the doctors can eventually lessen or drop the medicine altogether. If you want facts on that, you can visit a hospital I suppose.

    The false dichotomy still stands. You say that depression may not be only genetic but go out of your way to disprove the psychological model and accept another model, which, in your mind, seems to explain your issues more elegantly, when it fact the only thing it does is make a bold assumption that still is not strong enough. In the end, you choose to believe one for personal reasons. Belief is ok, but it’s a belief.

    About the Clinical Psychologist, again you are free to believe in the confidence trick, successful treatment plans BY those experts alone or in co-operation with other health experts will just keep proving you wrong. From what I have experienced, both psychiatrists and psychologists may at times pinpoint the triggering event of depression, so if you’ve something against psychologists doing that, feel free to go against psychiatrists, too.

    ADVICE on coping is extremely different from expert psychological treatment, but you can as well disagree on that, too.

    So, I need to accept your denial of the so called “psychological model” for its inability to currently explain why some and not others while you accept a model that calls for genetic factors without having enough results to prove it? I, and some others, told you that you are different from your siblings, therefore experiences that were yours alone, and experiences that you perceived in your own unique way may be responsible for your exhibit a mental illness and not the rest. Yet you still dropped that notion to argue for your point, so feel free to believe what you will.

    On the “retarded” comment, either you simply failed to get the spirit of my statement sincerely, so I must tell you I have nothing against mentally disabled individuals, it’s a figure of speech, if you will, commonly used, where you could substitute any other word that would convey the same meaning if you don’t like the sound of “retarded”, OR you just tried an ad homimen, which terribly failed and it’s really bad manners, too. On the matter of beliefs, yes I am myself and therefore I am free to accept some beliefs, give merit to others, disagree with some, and totally condemn others. And that the belief of a mental patient being responsible for his illness is something I condemn. Whether you agree with my stance or not, I don’t mind, but I’d refrain from trying to insult people that comment on your posts and your readers’ intelligence like that.

    About your last comment, I told you once in this comment, and I believe I also mentioned in my previous one, that I consider you and your brothers different enough for your case to occur, even taking the genetic factor into account. HOWEVER, unlike you, I cannot just come to a conclusion without a clinical interview of you and all your relatives, otherwise I’m making stuff up. Also, research is still on going for depression regarding both genetic and environmental factors so me saying that I know for certain is a huge fallacy. Remember though that as far as depression goes, research points to environmental factors far more times than it does to genetics.

    My sincere opinion is that the first post was a better, more honest read. This one seemed to me like a need to reply in order to support yourself and your beliefs and not really to discuss anything. While I have really not much against that, I can’t really feel that you comprehend that there are more parts of belief in your posts than what you accept there are and that one’s belief is just as good for factual purposes as anyone else’s.

    In any case, I’ll thank you for the chance to reply a second time for a topic such as this, however based on your more recent post, I’m not sure whether any further discussion will yield any other conclusions. For me this matter eventually stumbles on what one accepts as valid or in need of more investigation, what one accepts or rejects and how much scientific information is widely available. Now if you really want the facts, you can mail me and I’ll try and direct you to some articles regarding any genuine inquiries you might have, although I’m afraid not having an institutional account will only enable you to read the abstracts. My time is however very limited so I doubt I can make a list like that within June, if that will satisfy you.

  5. aethelreadtheunread says:

    npal – thank you for your comment.

    Regarding the ‘retarded’ comment – i sincerely disliked your use of the term. It’s a word i would never use, because it has been used so often to attack people. In my response i did acknowledge that i felt you were unlikely to have intended any offence, so i am sorry if it felt like an ad hominem attack – it wasn’t intended to be.

    As you yourself point out, this discussion is becoming less informative the longer it goes on, so i hope you will understand if i do not challenge you in a point-by-point way again. In particular, i’m going to avoid talking about the obvious flaw in your ‘schizophrenia has a fixed time of onset’ argument – namely that people can live quietly with depression for years, but this is rarely the case with florid psychosis. But i will concentrate on one thing.

    I fear you miss one vital thing when you talk about an environmental cause for depression – you do not look at the very much larger group of people who experience the same environmental conditions, but do not become depressed. Looking at a depressed person and saying ‘Well, they asked for treatment after their dog died’ doesn’t prove that the death of their favourite pet caused their illness, but forget that aspect. Because what about all the people who loose their dogs, but don’t become depressed? Why don’t they become depressed? If environmental factors cause depression, then shouldn’t the same environmental factors produce the same result, time after time?

    You see, this is the key thing, and until it can be answered my scepticism isn’t going to melt away – why do only some people get ill? Forget my family – that was an illustration i’m coming to sincerely regret including, because it’s clouded the issue quite badly.. Among the population as a whole – why do some people experience a never-ending catalogue of woe, but stay healthy, while others experience much less terrible events, but still get depressed? Until you can answer this question – why do only some people get ill? – you don’t have evidence, you don’t even have a plausible theory, all you have is the endlessly repeated refrain: ‘depression is caused by environment’. There’s no proof, only misplaced certainty.

    Oh, and one final thing – i’m prehaps not as ill-informed about psychology as you seem to assume i am. You see, I’ve been through psychodynamic psychotherapy, and i found it helpful. It helped me to think about myself more clearly, and it made it a lot easier to cope with the effects of my illness. But it didn’t cure me, and the therapist’s explanations as to the causes of my illness were ludicrous – she herself accepted they were. And the other stuff – well, that could have been done by a counselor.

    Again, thank you – sincerely – for taking the time to discuss this. I appreciate it.

  6. npal says:

    Well, the problem with “same environmental conditions” is problematic. There’s never the same environmental conditions, they tend to be only relative. You’re not exactly in someone else’s place at the exact time, typically speaking. Then, a very important thing is the eye of the beholder. As you don’t question how can two brothers be different in their abilities and one may want to be a doctor and have the skills and the others prefers opening his own business, that one will seek to retaliate against something, yet the other won’t, even when the other environmental conditions are the same is something I doubt will be answered anytime soon. Personally, I just assume that for reasons that escape me, it is so, therefore I’ll just do my best with the information I have at hand to help someone instead of wondering why it couldn’t be otherwise. The thing is done, no point dwelling on whether more or less people should have suffered instead. In the end, I’ll place the vague reason on the individual being an individual, being different than the rest and perceiving things in his own unique way, which means that the same things will be perceived differently. It’s not just about depression, it’s about everything that may not be an illness, but it’s a difference in life as well. “Why did I and not them” can also be “Why did I became an engineer and the became something else”, etc etc. A whole set of minor or interesting differences that people may not give the necessary attention because they aren’t harmful. Or even “Why did I succeed in life and they did not, if we bear the same genetic code and therefore are identical in everything, we should have the abilities and the perception to succeed anyway”. . Even genetics cannot tell what a person will become. The best they can do is assume predisposition towards something, that may or may not come to pass. My point is, it’s not just depression appearance that’s different. Everyone is different in a number of ways. Also, some people get a exposed to a way of life that could give rise to various illness, yet exhibit none, while others develop diabetes pretty easily. Or how come cancer appears whenever for whatever reason, if there was even an explicit one. Even in that, science can ONLY talk with percentages. If you’ve read researches the key words is “per cent” and “statistically important difference”. Those aren’t even close to mean 100% prediction. And for good or ill, neither can genetics claim a better percentage. Whether you prefer to take my percentage or yours into account is in the end irrelevant. There is no simple reason why, if there was, it would have been found. Our scientists aren’t stupid, and even if some are, others would have persevered. Both of us have no solid proof, but I’m the only one who accepts it.

    In the end environment doesn’t cause depression without fail, but where there’s depression, somehow there’s always environment behind it.

  7. aethelreadtheunread says:

    Hi npal, and thanks for commenting again.

    The cancer analogy is flawed, i think, in that the basic mechanism by which cancers occur is understood, and is furthermore understood in part to be random – hence why some people who bake themselves on a sunbed daily don’t get skin cancer, and other people who always stay in the shade, and slather themselves in sun block, end up dying of melanoma. We are not at the same stage of understanding for any of the mental illnesses, not by a long shot.

    You also seem, to me, to be confused about the relationship between conscious choice and mental illness. You ask why, of two brothers with equal opportunities, one might become a doctor and the other not. The answer is very simple – only one of them wanted to be a doctor. Now possibly they didn’t always think about the choices in those terms. Perhaps when they were younger it was just that one of them preferred to spend their spare time kicking a ball around, and the other preferred to spend his time reading, but the choice is nonetheless based on personal preference.

    The difference with a mental illness is that no-one would choose to have it. No-one is going to sit down and think ‘Well, i could have a happy life filled with fun and friends and family, but i think i’ll opt for loneliness, misery and desolation instead.’ Personal preference is always going to select those behaviours that are observed in people who are not mentally ill. Only those who are prevented from making a free choice by their illness will end up engaging in the negative behaviours observed in people with mental illness.

    In the end environment doesn’t cause depression without fail, but where there’s depression, somehow there’s always environment behind it.

    Sorry, but this is a logical fallacy. You are saying, because one thing (mental illness) happened after something else (‘environment’, as you put it), that means that the second thing was caused by the first. Now, that may be true, but you need to prove it, and there are two ways you can go about that. You can look across people who are and are not mentally ill, and see if the ‘environmental’ factors are different. As you freely acknowledge, they aren’t, so this way of establishing the link is closed to you. The second way of proving it is to identify the mechanism by which the first thing (environment’) causes the second – this again is something that has yet to be achieved by those who argue that ‘environment’ causes mental illness.

    Even genetics cannot tell what a person will become. The best they can do is assume predisposition towards something

    No. If someone has the faulty version of the gene that causes cystic fibrosis, they get cystic fibrosis, every time, without fail.

    Personally, I just assume that for reasons that escape me, it is so, therefore I’ll just do my best with the information I have at hand to help someone instead of wondering why it couldn’t be otherwise.

    This is, of course, exactly the same defence that is used by homeopaths, and ‘crystal healers’, and all the other sellers of meaningless pseudo-medical nonsense: ‘Well, i can’t prove that it works, but i’m going to carry on doing it anyway, and not worry about the ethical implications of selling the ill and the desperate a crock of shit.’ I agree that psychologists belong in this company, but i’m surprised to see you supporting the idea.

    Both of us have no solid proof, but I’m the only one who accepts it.

    No. You are badly misrepresenting the positions both of us have taken here. I have never claimed to have evidence – i still don’t. I have talked only in terms of speculation and anecdote. It is you who have talked of ‘evidence’ and ‘proof’, not me. And there’s another key difference. I don’t try to make money off the back of my speculations. I don’t make a comfortable (sometimes a lot better than comfortable) living offering ‘clinical’ interventions on the basis of my unsupported speculation and wide-eyed wondering. It’s psychologists who do that, and that’s why i think they need to be stopped from selling their lies.

  8. npal says:

    Ah, see according to genetics, “choice” isn’t that simple. You think choice is your right, but many choices are not. You’ll find MANY genetic scientists who will claim choice is overestimated, because many of the so called “choiced” are just genes calling. You will see far more claim that certain “likes” and “wants” are genetically programmed. I assume you can’t believe that the environment itself also plays a role in what you end up liking, so I won’t really bother getting into that. However I will point out that what you believe for this particular issue is irrelevant, because it’s unfortunately backed up and a huge array for research.

    The “doctor” paradigm assumes you all tried, but I suppose I should have made it clearer. The point was that having the same genes would also mean having the same intellectual and physical abilities, yet somehow only one makes it, something which is not uncommon. But really now, I was under the assumption that you people were triplets… Being just normal siblings only makes my cause far easier to support. It just goes to show that I should take more details into account. You don’t even have the exact same genetic print.

    Logical fallacy… Where did you see I was trying to make a point like if A, then B? What I DID say though is “B if and only if A”. The way it seems to work, A (environment) is necessary but not adequate for B (depression). In that sense, when B occurs, we know (and CAN find) that A indeed applies. You seem to mistake that the relation of A to B must be both necessary and adequate and I never said something like that. I did say though that where there’s B, we find A to apply. We still can’t pinpoint what’s the other factors, and we certainly cannot say A is both necessary and adequate to yield B, therefore A is not always followed by B, but B ALWAYS follows A.

    Eh, actually I can prove that it works by making it work. It’s the precise reason of why it works that seems to still be up for debate. You’re deliberately trying to make people look like they continue to exercise something that doesn’t work just for profit. The problem with your statement is that it actually works where it’s supposed to, so that point is moot. As long as something works, your argument will still not hold. And I’m afraid to inform you that those “homeopaths” of yours actually do help in various situations, and while I can’t really believe it, I will not call my friends liars or deluded when they say it worked for them, but you are, as always, feel to believe whatever makes you happy.

    Lastly, by all means, do hunt doctors down to for those famous “misdiagnoses”. Unlike psychologists, a misdiagnosis means a number of really bad things. But a misdiagnosis is impossible because medicine is logical, right? If doctors knew exactly what they were doing, the term misdiagnosis itself would have been impossible.

    However, I believe our talk has concluded. Everyone else is free to draw their own conclusions.

  9. aethelreadtheunread says:

    npal – thanks for commenting again, and sorry for the delay in your comment appearing. It got caught in the spam filter, for reasons i don’t understand.

    I can see why you want to quit this discussion, as you really are digging yourself further and further into a hole.

    But really now, I was under the assumption that you people were triplets… Being just normal siblings only makes my cause far easier to support. It just goes to show that I should take more details into account. You don’t even have the exact same genetic print.

    Your point here is truly bizarre. First of all, you seem to be assuming that triplets are genetically identical. In fact, such monozygotic triplets are rare. Many triplets are trizygotic, meaning they develop from three seprate ova, each fertilised by a separate sperm, and so are as genetically distinct as any other kinds of sibling.

    Secondly, if i and my siblings were genetically identical, and only i was depressed, then this would be an argument in favour of an ‘environmental’ cause for depression. As we are not genetically identical, this allows for the possibility of a genetic cause for depression. In other words, the fact i and my siblings are not genetically identical makes your cause harder to support, not easier. This has been really a very basic misunderstanding on your part, and leads me to wonder how much you have even been able to understand the points i have been making.

    Certainly, you seem to have misunderstood the issue about logical fallacies. Let me see if i can put this in terms that will be really very easy to understand.

    I imagine we would both agree that people who are mentally ill have a habit of drawing breath. Not all people who draw breath become mentally ill, however. Now, we can make exactly the same points about the ‘breathing hypothesis’ for the cause of mental illness as we can about your environmental hypothesis. In fact, i’ll quote you here:

    we certainly cannot say A is both necessary and adequate to yield B, therefore A is not always followed by B, but B ALWAYS follows A.

    You see how that works? We can’t say that breathing is adequate to yield mental illness, therefore breathing is not always followed by mental illness. But we can say that mental illness ALWAYS follows breathing. But this does not mean that breathing causes mental illness (except in the very general sense that people who are dead don’t breathe, and also don’t suffer from mental illness).

    This is the heart of the logical fallacy. Just because B is always preceded by A, this doesn’t mean that A causes B. It could be simple coincidence. In fact, this is a very well known type of logical fallacy, called post hoc ergo procter hoc or post hoc for short. You will find it very commonly mentioned in scientific discussion, often when people draw unsupported conclusions from study data, such as you are doing in this discussion.

    Eh, actually I can prove that it works by making it work.

    Really? You can prove that psychological interventions cure disease? Not that they help people to manage symptoms – i agree absolutely that counselling can help with this – but that they cure disease? You can prove that the people who recover don’t just go into spontaneous remission – something that happens very commonly in mental illness? You can point to unambiguous studies which prove that ‘clinical’ psychological intervention outperforms counselling to a statistically significant extent?

    Lastly, by all means, do hunt doctors down to for those famous “misdiagnoses”. Unlike psychologists, a misdiagnosis means a number of really bad things. But a misdiagnosis is impossible because medicine is logical, right? If doctors knew exactly what they were doing, the term misdiagnosis itself would have been impossible.

    Please point out to me where i have said that doctors are always right. (They aren’t) Please point out to me where i have said the current medical model is adequate. (It isn’t) You really are in the last refuge of the desperate now, aren’t you? Unable to prove anything in support of your case you’ve started lashing out randomly at other people.

    Oh, and one final thing:

    I’m afraid to inform you that those “homeopaths” of yours actually do help in various situations

    If you really do think that homeopathy – where they take the essence of a plant, and then dilute it so many times that the resulting ‘medicine’ no longer contains any plant extract – if you really think that homeopathy works as anything other than a placebo, then you are beyond help. You have abandoned reason and rationality and logical deduction to such an extent that you have truly closed your mind, and no evidence will ever persuade you to open it again.

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