Is There Ever Only One Explanation for A Mental Illness?

Simple isn’t necessarily better

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A little while back, a fellow blogger posted a very cute animated video called 7 Reasons to Love Someone Who’s Depressed. Among the reasons identified were that people with depression are more understanding and more honest. Really? It got me thinking about how there are various ideas floating around out there about depression, as well as other mental illnesses, always looking a particular way.

While there’s certainly stigma that pigeonholes mental illness in clearly problematic ways, there are also quite a few well-intentioned people who think they’ve figured out “the” answer.

When looking at the nature vs. nurture question, there are reductionistic views on either side of the coin, with some arguing that it’s all biology and others arguing that it’s all psychosocial. Neither extreme makes sense to me, and both strike me as overly simplistic. And really, if it was that simple, wouldn’t research have conclusively established that by now?

The problem with hypotheses at all-or-none extremes is that it only takes one exception and the whole hypothesis is wrong.

The same blogger mentioned earlier included this quote from Marshall Rosenberg, the creator of nonviolent communication, about depression:

“My theory is that we get depressed because we’re not getting what we want, and we’re not getting what we want because we have never been taught to get what we want. Instead, we’ve been taught to be good little boys and girls and good mothers and fathers. If we’re going to be one of those good things, better get used to being depressed. Depression is the reward we get for being ‘good.’ But, if you want to feel better, I’d like you to clarify what you would like people to do to make life more wonderful for you.”

Reading this, he could be speaking a foreign language for all that it resonates with me. Yet I’m sure it’s a very powerful message for some people. It’s not a matter of the idea being bad, but rather the idea not applying to all depression.

The problem with saying “illness [A] is [X]” is that it leaves out all of the people with illness A who experience C, D, E, and/or F. In my mind, that’s very different from saying “illness [A] can be [X],” because that doesn’t try to. put everyone in that box.

That may seem like semantic nitpicking, but I think the difference does matter. It seems unlikely that any explanation is going to cover everyone who experiences depression, or any other mental illness. That should be okay. The existence of multiple theories means that it’s more likely that people with the illness are going to find something that resonates with them.

In his book Lost Connections, Johann Hari claimed that depression was due to several specific forms of disconnection. In a reviewed the book, I wrote that “Of the various disconnects that he believes cause depression, I had a whopping none of them for my first two depressive episodes.”

I recently saw a post on Twitter by someone with borderline personality disorder who was expressing frustration that people assume that everyone with BPD “MUST” have had childhood trauma. Sure, a lot of people with BPD have experienced trauma, but it’s not a requirement for the diagnosis. The only illnesses that require traumatic experience(s) are the specific group trauma-related diagnoses like PTSD.

The argument is often made that the DSM puts people into arbitrary boxes. That’s true, but I see a difference between descriptive labels for symptom clusters and theories about how people must have gotten to a place of illness. While it’s easy to assume the DSM takes a stance in favour of biological causation, it doesn’t attempt to identify root causes for the various diagnoses. There’s also a fair bit of wiggle room for different people with a given illness to have different combinations of symptoms, The diagnoses are most definitely imperfect labels, but in order to conduct meaningful research into conditions and their treatment, there do need to be some type of widely used descriptive labels, otherwise, no one’s talking about the same thing.

I’m a very independent, and also rather stubborn, person. I don’t like other people telling me who I am or how I experience things. Perhaps that means I have a stronger negative reaction than some other people might, but that’s okay. If someone says depression IS [X], and I am not [X], then either I don’t have depression, or not all depression IS [X].

In my case, there seems to be a fairly strong biological element to my illness, and the all-psychosocial ideas about how depression “IS” really do grate my rutabagas (and sure, that doesn’t make any sense, but that’s okay). And likewise, I’m sure that people whose illness is strongly influenced by psychosocial factors are hoping for a purple people eater to dive-bomb that dumbass doctor telling them it’s 100% brain chemistry.

There’s room for many explanations to cover the wide range of individual illness experiences. There’s no need to put all of our purple people eaters in one basket. Or our rutabagas, for that matter.

Originally published at https://mentalhealthathome.org on May 18, 2020.

Mental health blogger | Former MH nurse | Living with depression | Author of 3 books, latest is Managing the Depression Puzzle | mentalhealthathome.org