Agree that we need to move away from a binary "root cause" of mental illness that seems to pervade society, patients, and even amongst some of our colleagues! You bring up chemical imbalance, genetics, drugs, and trauma all being potential causes - is this not just really Engel's biopsychosocial model? :)
I see the biopsychosocial model as the antithesis to "root cause" question and use this model everyday in my own clinical practice. I often may spend a significant chunk of my consult time explaining to my patients the distress they have is through a complex interplay of these 3 factors, and some factors may have more weighting than others (for some patients, "depression" is 90% psychosocial and 10% biological, and others vice versa).
A thoughtful biopsychosocial formulation is often more validating than a simple biomedical explanation ("you don't make enough serotonin"). This takes a lot more time and effort for the psychiatrist though, and as a consequence, uptake and use seems to vary significantly between psychiatrists in different jurisdictions. @Awais Aftab also had a similar post about the hermeneutic silence that is occurring in our clinics when we don't have a more nuanced conversation about the source of psychiatric symptoms (whether or not a patient accepts this nuance is another question!)
I'm curious in UK psychiatry training how much emphasis is placed on learning and practicing biopsychosocial formulation? It is emphasized quite heavily here in Canada where I trained, and part of our Royal College examinations and residency training.
This is a thoughtful article and difficult territory for me. On the one hand, I think that the idea of one “root cause” is just as reductionist as the dopamine hypothesis, and possibly more likely to create unhelpful megalomania in people already suffering from psychosis, for example. On the other hand, the bio psychosocial approach can often look like a catch all that doesn’t really explain anything properly. You may well have looked around an acute psychiatric ward and thought “this is just a tragic scene and it’s just hard for everyone, it’s only human to try to find some meaning in this but at the end of the day these people are just really ill”. I have also grieved for the person I might have been if I hadn’t developed psychosis as a young adult. But ultimately I am just imagining who that person might have been. I’m left with who I am instead.
I like the comprehensive of your model. But people are also looking at language as a root cause (especially the ACT people). More specifically how the mind evolved with language and it's tendency to hook us in to rigid thinking styles.
Well, I think there is a spectrum of language. Ranging from verbal nations about threats (bawk) to representation (the word “pen” means pen). No other animal appears able to represent contacts. For instance, you can train a chimpanzee to touch the word pen. But they don’t seem able to make the word have meaning if they can’t directly see the pen. Thus, we can use the word ”pen” without directly accessing one.
Regarding mental disorders - what makes a mental disorder. I tend to be more behavioral. Like I think you only have a disorder when it affects your behavior. If someone is hallucinating all day but it’s not causing distress or affecting their functioning, then they don’t really have an issue. I do think animals can have disordered behavior tho. Like my old rescue dog scout. Super anxious. Did a lot better on a tricyclic anti anxiety med.
What a profound and moving story by Ted Chiang, thank you for letting us know about it. Having read Rosa Cartwright's book and Awais Aftab's response to her article, I find your article provides further insight and food for thought. Thank you.
Agree that we need to move away from a binary "root cause" of mental illness that seems to pervade society, patients, and even amongst some of our colleagues! You bring up chemical imbalance, genetics, drugs, and trauma all being potential causes - is this not just really Engel's biopsychosocial model? :)
I see the biopsychosocial model as the antithesis to "root cause" question and use this model everyday in my own clinical practice. I often may spend a significant chunk of my consult time explaining to my patients the distress they have is through a complex interplay of these 3 factors, and some factors may have more weighting than others (for some patients, "depression" is 90% psychosocial and 10% biological, and others vice versa).
A thoughtful biopsychosocial formulation is often more validating than a simple biomedical explanation ("you don't make enough serotonin"). This takes a lot more time and effort for the psychiatrist though, and as a consequence, uptake and use seems to vary significantly between psychiatrists in different jurisdictions. @Awais Aftab also had a similar post about the hermeneutic silence that is occurring in our clinics when we don't have a more nuanced conversation about the source of psychiatric symptoms (whether or not a patient accepts this nuance is another question!)
I'm curious in UK psychiatry training how much emphasis is placed on learning and practicing biopsychosocial formulation? It is emphasized quite heavily here in Canada where I trained, and part of our Royal College examinations and residency training.
This is a thoughtful article and difficult territory for me. On the one hand, I think that the idea of one “root cause” is just as reductionist as the dopamine hypothesis, and possibly more likely to create unhelpful megalomania in people already suffering from psychosis, for example. On the other hand, the bio psychosocial approach can often look like a catch all that doesn’t really explain anything properly. You may well have looked around an acute psychiatric ward and thought “this is just a tragic scene and it’s just hard for everyone, it’s only human to try to find some meaning in this but at the end of the day these people are just really ill”. I have also grieved for the person I might have been if I hadn’t developed psychosis as a young adult. But ultimately I am just imagining who that person might have been. I’m left with who I am instead.
Beautifully put!
I like the comprehensive of your model. But people are also looking at language as a root cause (especially the ACT people). More specifically how the mind evolved with language and it's tendency to hook us in to rigid thinking styles.
Interesting - do you believe that both mental disorders and language are both uniquely human characteristics?
Well, I think there is a spectrum of language. Ranging from verbal nations about threats (bawk) to representation (the word “pen” means pen). No other animal appears able to represent contacts. For instance, you can train a chimpanzee to touch the word pen. But they don’t seem able to make the word have meaning if they can’t directly see the pen. Thus, we can use the word ”pen” without directly accessing one.
Regarding mental disorders - what makes a mental disorder. I tend to be more behavioral. Like I think you only have a disorder when it affects your behavior. If someone is hallucinating all day but it’s not causing distress or affecting their functioning, then they don’t really have an issue. I do think animals can have disordered behavior tho. Like my old rescue dog scout. Super anxious. Did a lot better on a tricyclic anti anxiety med.
If dogs can have mental disorders but don’t have a language beyond basic communication, does this not go against language being a root cause though?
What a profound and moving story by Ted Chiang, thank you for letting us know about it. Having read Rosa Cartwright's book and Awais Aftab's response to her article, I find your article provides further insight and food for thought. Thank you.