Post No.: 0326
The causes of mental health problems can be social causes e.g. a traumatic life event such as a bereavement, job loss, being a victim of fraud, sexual harassment, severe trauma due to a conflict, natural disaster or pandemic, chronic social adversity such as unemployment, stress at work, poverty, illiteracy, child labour, violence, abuse or neglect during childhood and a lack of a decent social support network; psychological causes e.g. poor coping skills and low self-esteem; and/or physical causes e.g. poor nutrition, infections, endocrine or genetic factors, physical trauma or a serious physical illness. There’s potentially a whole array of biological, psychological, structural, cultural, social, economic and political causes involved.
It’s ultimately down to a complex combination of personal constitutional factors, perinatal factors, upbringing conditions, lifestyle, cognitive habits, having other chronic mental/physical health problems (comorbidities), experiencing adverse/tragic life events, long-term or severe acute stress or pain, one’s social and community networks, nutrition, education, work life and work-life balance, living conditions, healthcare, housing situation, sanitation, financial stressors, relationship breakdowns, violence or war, substance abuse… along with general socio-economic, cultural and wider environmental causes and conditions. This includes how people in society treat or neglect those with disabilities and disorders, any under-educated assumptions about their contagiousness, or believing in superstitious ‘possessed by evil’ or ‘karma’ beliefs – as if sufferers somehow deserve their suffering in this life or because of some previous life or grand, divine future plan/fate.
People who have a sexual identity that isn’t heterosexual are more likely to have some kind of mental illness – this isn’t to say for certain that this is causal because other factors may be at play e.g. a culture of stigma against non-heterosexual people. Certain religions and cultures can stigmatise sufferers by believing them to be a shame on the family or due to a possession by evil spirits. If one’s own parents, family or close friends and colleagues, never mind the general media and general public, believe that all mentally ill people are ‘evil’ or ‘possessed’ and should be banished from or avoided in society – it can make a sufferer even less able and willing to tell others about their feelings and condition, which can directly exacerbate their symptoms too. Historically, many diseases, even those caused by microbes, were assumed to be caused by possessions, ‘malevolent spirits’ or otherwise non-physical reasons, so, collectively around the world, we’re still learning about the causes of illnesses, but our scientific knowledge has been gradually improving.
When a person ceases to remain mentally healthy, it’s usually down to multiple things compounding rather than only one thing, such as a recent tragic loss plus having experienced an acrimonious parental split-up when young – such people can consequently find it harder to attain or maintain good mental health and relationships when they’re as adults. Abuse or neglect (emotional, verbal, physical or sexual), caregiver depression, separation from a main caregiver or family (particularly if this happens when the child is greater than ~2 years old for he/she will directly remember the event), a lack of emotional or practical support, war, migration, social disruption, the loss of a secure home, chronic illness, unmanageable debt, hardship, isolation, being bullied or ostracised, unemployment, or socio-economic disadvantage, are examples of risk factors – whilst loving and consistent parents, good nutrition, good education, regular physical activity, strong social networks and emotional and practical support, belonging to the ethnic majority in a country, economic stability, or socio-economic advantage, are examples of protective factors.
Globally, poverty is strongly correlated with common mental disorders like depression, anxiety, bipolar disorder and schizophrenia. In various cultures, socio-economic status (SES), which affects education, food security, housing, social class, financial stress and even marriage status can all predict anxiety or depression. Exposure to violence, torture, rape, slavery, unfair detention, degrading treatment, social exclusion, persecution, oppression, racism, abuses against ethnic, sexual-orientation or gender-based human rights, child conscription, traumatic world events, a lack of justice, and displacement (asylum seeking), will also increase the chances of depression.
Poverty reduces freedoms, opportunities and options, and so it should really be no surprise that a low SES is correlated with greater levels of mental health problems. Poverty is stressful, and stress is one of the major causes of anxiety or depression. It can thus create a vicious cycle – poor people are more stressed, and being anxious and/or depressed doesn’t help for building one’s life or career. People limited in their abilities due to their anxieties and/or depression, and who have limited finances too, have limited options and prospects, which further buries them in their anxiety and/or depression and lack of options and prospects. A poor child is more likely to suffer from mental health problems as a child, and thus as an adult too due to the developmental knock-on effects. Then it becomes a vicious circle – if one cannot function well then one cannot lift oneself out of one’s poor SES, and so forth. These patterns and barriers are important to note and shouldn’t be ignored in society if we want to do something about improving the mental health of a nation.
Experiencing a conflict or natural disaster, being pushed out of your home or country, being a refugee and seeking asylum, are tremendous risk factors. Anything that causes tremendous stress or upheaval in one’s life will increase the likelihood of developing a mental disorder. So it’s hardly just inherent genetics but also critically an environment of violence, division, prejudice, mistreatment (e.g. torture) and misfortune (e.g. the loss of loved ones, dreams or the control of one’s life narrative) that can lead to a personal mental health crisis or build up to or trigger a suicide attempt if one already suffers from one. If someone has been chronically starving or if they’ve walked all day in the baking summer sun without drinking anything, for example, then you’d be more surprised if they didn’t suffer from a physical health problem than if they did – so if someone has experienced a traumatic situation in their life then you should be more surprised if they didn’t suffer from a mental health problem than if they did.
Viral infections of the brain, birth defects or diseases that affect the brain, for example, can cause cognitive impairments or learning difficulties directly. Even diseases, infections or health conditions that don’t affect the brain directly can affect the brain indirectly due to the impact of the disease, infection or physical condition on the person’s quality of life – especially if combined with a culture that stigmatises and unfairly discriminates against sufferers of any type of disability, disadvantage or difference. So mental illnesses often co-occur alongside other types of illnesses. There are many different contributory causes or amplifiers of mental illness, including physical (e.g. becoming paraplegic or having a skin disorder) and social (e.g. cultural stigma or a lack of professional care due to public funding shortages).
Trauma can also be passed second-hand from a parent onto his/her child environmentally e.g. a war veteran with PTSD, ends up becoming an alcoholic, who then abuses or neglects his/her child; or even possibly passing on an epigenetic vulnerability to stress via a transgenerational trauma legacy. Childhood traumas are a common cause of PTSD, not just events like war or witnessing a loss as an adult.
Therefore when assessing troublesome children and adolescents – look at their histories and domestic circumstances too to understand their present behaviours. Children’s behaviours need to be looked at in the contexts of their often-hidden, traumatic abuse and/or neglect experiences. Older children can appear to be ‘tough and in control’ but it’s often just a mask. ‘Lifestyle choices’ like taking recreational drugs or joining gangs are often attempted escapes, coping strategies or ways they think they can gain some respect in a life that so far hasn’t brought them any yet. So troublesome children are the victims, not the problem. Both these children and their families need advice and support to get them out of their vicious cycles.
Most mental health problems start to develop in childhood or adolescence, so the signs are there from young if only the people around them know about and recognise the signs. We see that unfortunate childhood stressors like child abuse or neglect lead to a heightened risk of mental problems later in life, such as depression or even psychopathy. Some people don’t become depressed or psychopathic despite their abuse or neglect experiences though, and this is because they had and/or have sufficient protective factors too (protective genes and/or protective environmental factors such as sufficient love and attention when young i.e. having an, overall, wonderful childhood). Some people do become depressed or psychopathic despite an apparent lack of noteworthy abuse or neglect experiences, and this will be because of their unfortunate high-risk genetics. It’s therefore about the complex interplay between risk genetics, protective genetics, risk environmental factors and protective environmental factors, that ultimately determines a person’s path and outcomes.
This is why there isn’t a perfect correlation between abuse or neglect and mental health problems later in life – there are other factors to also account for. Everything potentially adds up or contributes to a life outcome, as a risk factor or a protective factor, though; and trauma (whether idiosyncratic or systemic e.g. parental violence or a war affecting a community as a whole) definitely contributes in a major way.
We’d therefore rather no child ever experience such stressors, particularly chronically or repeatedly. It’s like there’s a correlation between football/soccer teams who have top strikers and teams that win the league, but it’s not a perfect correlation – the team that scores the most goals in a campaign isn’t always the team that wins the title, but a team would rather have top strikers than not, to increase the chances of them winning the title. They aren’t the only important factor and don’t guarantee success (e.g. the defence matters too) but it all adds up at the end of the season. If something isn’t part of the solution then it’s not necessarily part of the problem, but if it’s an area that has room for improvement then it’s an area that poses a risk.
Bones can heal but the mind not so easily – thus the cliché ‘sticks and stones may break my bones but words can never hurt me’ is too oversimplistic and often erroneous. Verbal abuse is essentially a direct physical attack to one’s brain – patterns of sound waves and light particles/waves that elicit associated meanings can trigger certain physiological stress responses in another person. Well physical abuse may seem only physical but it mentally affects us negatively too, especially the more frequent and/or extreme the abuse, and this mental harm is usually the longer lasting damage. Whilst physical scars and bruises heal – the hidden mental scars can last, sometimes for a lifetime. Bodily scar tissue is typically only cosmetic but a ‘brain scar’, or traumatic memory, can potentially change a person’s thinking and in turn attitudes and behaviours.
Psychological torture is potentially lifelong harmful. We superficially judge by appearances, but with depression, anxiety and many other mental disorders, a sufferer can superficially look like a non-sufferer but the damage or injury is to the brain, which we cannot see from the outside – or really understand even if we could observe one with just our naked eyes! The brain is the most complex physical machine we currently know of, in our bodies or anywhere else in the universe – so contrary to naïve perceptions, any problem of the ‘mind’ should be treated as the opposite of trivial to solve. It’s about that aforementioned balance and interplay of the protective versus risk factors – the things that can protect us from harm/illness (e.g. a supportive family and friends) versus the things that can push us into harm/illness (e.g. being bullied or ignored) – both genetically and environmentally. We learn the most about the human brain via brain injuries or mental health problems i.e. when things have clearly gone wrong.