Mental Disorder Has Roots in Trauma and Inequality, Not Biology

The scientific evidence is of social/psychological, not biological, causation: negative environmental conditions, not disease.

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Prescription drugs require verification that they are helpful, not harmful. Considerable data show this is not true for psychiatric drugs. Moreover, in stark contrast to the discoveries by medical researchers of biological causation for many physical illnesses, psychiatric researchers have failed to find physiological or genetic causation for the most diagnosed mental disorders—the anxiety disorders and depression—negating the rationale for the prescription of these drugs. This failure has occurred despite (a) the expenditure by the NIMH of tens of billions of research dollars over this same more than century-long time span in a fruitless search for physical causation of these mental disorders and (b) patients spending tens of billions of dollars annually on these prescriptions.

The science of health care, whether applied to a physical illness or a mental disorder, requires demonstrating a scientific basis for (a) the diagnosis, (b) the explanation of the problem, and (c) the treatment. The data related to these pillars of health care science as they pertain to mental health care are clear cut. There is an absence of medical science behind psychiatric care: Psychiatry’s diagnostic manual (the DSM) has failed to be found valid or reliable; psychiatry’s explanation for mental disorder, the chemical imbalance theory, has failed scientific testing; antidepressant drugs are no more effective than placebo and, unlike placebos, long-term use of these drugs, which is the psychiatric standard of care, is seriously harmful to many.

False psychiatric claims about drug effectiveness and the NIMH’s insistent, but unsupported medical stance conceal the absence of scientific justification for psychiatry’s medicalized care. And this is true for the very studies psychiatry cites to support their practices. Researchers and psychiatric journals misrepresent to doctors the results of outcome studies as confirming psychiatric drugs to be effective when the data, analyzed correctly, show they are no more helpful than placebos, indicating their value to be psychological, not biological. The public is being sold an illusory, commercially lucrative narrative about mental health care. And the media are not reporting the truth even when it is very well documented. Medicalized mental health care has been shown to be of corrupted origin, based on rhetoric not science, and the data show that psychiatric drugs exacerbate more than they alleviate mental disorder.

But we do know better. Considerable scientific evidence points to mental disorder having social/psychological, not biological, causation: the cause being exposure to negative environmental conditions, rather than disease. Trauma—and dysfunctional responses to trauma—are the scientifically substantiated causes of mental disorder. Just as it would be a great mistake to treat a medical problem psychologically, it is a great mistake to treat a psychological problem medically.

Even when physical damage is detected, it is found to originate in that person having been exposed to negative life conditions, not to a disease process. Poverty is a form of trauma. It has been studied as a cause of mental disorder and these studies show how non-medical interventions foster healing, verifying the choice of a psychological, not a biological, intervention even when there are biological markers.

For example, a study published in Nature Neuroscience found that children in low-income families had a 6% smaller brain surface area than children in high-income families. The researchers found that growing up in a stressful environment (poor and unstable homes) led to chromosome damage (a DNA change) that did not occur in children growing up in more advantaged homes. Fortunately, brain size and cognitive ability grow if conditions improve. Environments can be harmful, and they can be enhancing. The authors state, “The brain is incredibly plastic, incredibly able to be molded by experience, especially in childhood. These changes are not immutable.”

Another study, The Great Smoky Mountains Study of Youth, tracked the rate of mental disorder and the personalities of low-income Native Americans in North Carolina over more than a 20-year period. After a casino was built on their reservation, each tribal citizen received an annual payment of $4000. The authors report: “Not only did the extra income appear to lower the instance of behavioral and emotional disorders among the children, but, perhaps even more important, it also boosted two key personality traits that tend to go hand in hand with long-term positive life outcomes. The first is conscientiousness. People who lack it tend to lie, break rules and have trouble paying attention. The second is agreeableness, which leads to a comfort around people and aptness for teamwork. And both are strongly correlated with various forms of later life success and happiness…There are very powerful correlations between conscientiousness and agreeableness and the ability to hold a job, to maintain a steady relationship. The two allow for people to succeed socially and professionally.”

A study published in JAMA Psychiatry corroborated the finding that those children who experience socioeconomic deprivation in childhood show higher rates of psychosis. And again, when these negative conditions are reversed, the incidence of these disorders is drastically reduced; the children become like children who never experienced such negative experiences.

Amplifying the point, a study conducted in Mexico that was published in The Lancet reported that when the income of poor families is supplemented, within 18 months, children’s cognitive skills and language skills significantly improved.

Finally, a study of the consequences of stress on adults in the workplace, published in the journal Social Science and Medicine, found that income disparity—a more subtle person/environment variable than poverty—is associated with increased diagnoses of mental disorder. Women who made less money than their male counterparts were four times more likely to be diagnosed with an anxiety disorder and two and a half times more likely to be diagnosed as depressed. When their incomes at least equaled that of men they had significantly reduced diagnoses of anxiety and the same rate of diagnosed depression as men.

As would be expected from these results, studies of treatment effectiveness show psychological treatment to be superior to medical treatment of mental disorder. Outcome studies of relapse following treatment seemingly having ended successfully, show psychotherapy to be superior to drugs in the treatment of depression, the #1 psychiatric diagnosis. Great Britain’s National Institute for Health Care Excellence (NICE) reviewed 124 treatment outcome studies for depression, finding that psychological treatments are superior to drugs, and they become more effective with time. Moreover, NICE’s reviewers found that antidepressants become less effective with time, the negative effect being stronger the longer antidepressants are taken.

Yet despite the compelling evidence that favors a social/psychological, not a biological/medical approach to understanding and treating mental disorder, the prescription of psychiatric drugs remains psychiatry’s treatment of choice. Mental disorder continues to be viewed by psychiatry, the drug companies, other medical practitioners, the media, and the public as being of biological origin. And in full conformity with this scientifically unsupported belief, the NIMH invests relatively few of its research dollars on studies to expand our knowledge of the psychological causation of mental disorder, instead spending heavily on biological research, which continues to produce very little of value. There is no mystery as to why NIMH’s medical bias is failing to advance mental health care.

A double standard exists in health care with respect to adherence to science, definitively dividing the care of physical illness from that of mental disorder. While far from perfect, the record makes clear that medical authorities in their pursuit of the science related to the care of physical illnesses (a) respect and (b) hold themselves accountable to well-established scientific standards. They have enjoyed enormous success as a result, greatly benefiting countless patients. But the record also shows that neither standard is being applied to psychiatric mental health care, with disastrous effects. This is a tragedy, and it should be obvious, but it is not.

The consequences of this failure are well hidden because psychiatry and Big Pharma, who are demonstrably more intent on pursuit of their financial interests than on patient care, are in total control of the narrative. The terrible truth is that conflict of interest, not science, is driving mental health care and millions of people are unwittingly suffering the consequences as victims of this travesty. The bottom line is that mental health care is fundamentally misguided, exacerbating mental disorder more than alleviating it, and neither the authorities, the media, nor the public are holding accountable those who are responsible.

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