Psych Central

Mental Illness is Not Simply a Brain DiseaseLast month, Andrew Brown writing for the UK’s Guardian, noted when Professor David Nutt kept referring to depression as a “brain disease” on a popular UK television program.

We commend Andrew Brown for his calling out Professor Nutt in trying to dumb down the portrayal of mental disorders to simply “brain diseases.” Mental disorders remain complex disorders that involve all aspect of a person’s functioning and life — their brain and biology, their psychological makeup and personality, and their social interactions and relationships with others. The cause isn’t just one of these things in the vast majority of people who have a mental illness — the cause is all of these things, in differing proportions.

I’ve written about this in the past and in fact, I tag it as one of the top 10 myths of mental illness — because it still is. Even well-meaning family physicians and psychiatrists still refer to the false chemical imbalance theory as though it were fact. A theory, by the way, that has never enjoyed strong research support.

42 Comments to
Mental Illness is Not Simply a Brain Disease

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  1. Is any disease “simply a disease”? Etiologies of a number of illnesses are complex, with biological and environmental components, and treatments may be multi-faceted and involve medication, lifestyle management, etc. Perhaps we would benefit if a holistic approach were more uniformly applied to all medical conditions, including mental illnesses.

    I do not believe that referring to mental illnesses as serious medical conditions is inaccurate. I believe it is appropriate. Acknowledging that these are serious illnesses is not inconsistent with also understanding that they have a number of factors involved in their development (and which will vary from person to person) and that the best treatment may involve more than one treatment modality.

  2. In explaining mental illness, either to a patient or another professional (in your or an aligned one), how deeply the discussion goes should be based on the educational and/or “worldly education” of the person to whom you are speaking. Calling mental illness a “brain disease” is correct if you are only looking at one aspect of the disease. SMI (serious mental illness) is more of an insurance description than anything else. I am not sure, but I don’t think that it is being at all helpful to state that “if a professional calls it a brain disease you should take anything else they say with a grain of salt.” Not everyone is able, willing or “intense” enough for a detailed description of mental illness.

  3. Everyone feels depressed at some stage in their life, and it is something some of us can work through and for others it is overwhelming, great to get some guidance and emotional psychological help,maybe stop drug taking and alcohol which are usually the catalyst to the majority of mind problems anyway,behavior, environment, etc, the crutches that stopped you walking kind of thing, a friend helps too, but when you are called names and treated like a disease and forced to take poison against your wishes, then it leaves the therapy domain and enters the torture domain, and then no matter what anyone says you will be poisoned and oppressed for the rest of your life because someone says so, that’s the government mental health practice and its destroying psychiatry and their victims ans their family’s as a whole, their therapy sessions give new meaning to police interviews, where not only what you say will be taken down in evidence but what you say,think,feel,imagine, dress like,act like, will be taken down and used in evidence to incarcerate and poison you against your wishes, and if you fight them they just might put you in a straight jacket or electrocute you,and traumatize you and your family in the process and they call that helping you or treatment, well i can tell you that sort of treatment is making everyone hate psychiatrists, im just one of thousands probably millions of them, and the drugs are there to shut you down and dumb you down,weaken you emotionally and mentally, and make you realize that what you were concerned about fades into insignificance compared to the mind state that these poisons put you in and without escape, but if you tell the doctor, he or she gives you more and says you aren’t compliant and don’t have insight and that then allows the rat to keep poisoning you free will, Either way mate until psychiatry is overseen by non professional normal thinking people they have monopoly on our minds that they are simply poisoning, abusing the body and the soul, and depressing the victims with, even the good private practice psychiatrists are guilty, because they aren’t speaking out against what these government parasites are doing to our children, its all about not biting the hand that feeds you, not rocking the gravy boat, and until honesty about the obvious pain it is causing involves itself in psychiatry, then im afraid all psychiatry is criminal in nature and in practice, because we all have a responsibility to care for all those who cant protect themselves from dominant forces, nasty name callers, and anyone forcing something down our throats that is making us insane depressed and in fear, injecting someone forcefully with the 14 day mind clamp of madness(flupenthixol) is criminal, making them sleep 14 hrs a day and not be able to feel normal or comfortable in their body’s and minds for a fortnight at a time, and then forever, when they are crying real tears from what they are being forced to endure is the act of a dog, failing to see the obvious pain and emotional disturbance they are causing shows them to be fools caught up with ignorance and arrogance and their own must keep safe at any cost blinkered importance, unfortunately for all the emotional and insecure victims there is no where to turn to, because the government, psychiatry as a whole, the drug companies and the drug administration have monopoly and control on your freedom and your mind, and it seems they have no conscience but they all have the desire for the dollars to keep rolling their way, even if it means keeping their heads down and being quiet about the abuse they are all part of, OK m8 Ive said my bit i hope i haven’t offended you, i agree some people might need medication but as long as it is only temporary, and seen that way,and until all the proper non invasive care healing avenues have been explored and tried/practiced,with the temporary medication, then its all about psychiatry and nothing else, and at the moment psychiatry is a pig. and pigs stink.

    • Hey John,
      It sounds like you’ve had a pretty rough go with psychiatrists and psychiatrists. What kind of things do they have you doing or did they have you do to get you on the spiral back upward? I’m not a psychiatrist or psychologist, and I’m not trying to interrogate you, just curious…It’s definitely an interesting discussion

  4. I beg to differ with you doctor as it seems you are limiting your thinking into the possibility that Bipolar Disorder and other psychiatric illnesses don’t have a brain connection, and one where neurons are damaged. I’d like to see and read your research that proves BP and other psychiatric disorders are only a mind illness. If I am not mistaken the brain is an organ, which can suffer trauma. If your hypothesis is correct, than heart disease, kidney disease, cancer, diabetes, Alzheimer’s disease, dementia, Parkinson’s disease, and etal have nothing to do with the damaged organs, including unhealthy cells. So, basically in my opinion you are stating that these diseases, which are medical conditions, also can be healed with the mind, perhaps the mind over matter approach? Science, medicine as well as holistic approaches, including psycho-social functioning should be considered for all illnesses. Lets not go back to the dark ages doctor.

    • @Martina: Thank you!

    • Marilyn, I do understand what you are saying. Yes the brain is an organ and yes, there are neurons that are affect by depression. Depression can cause a variety of problems; memory loss, weight gain, vomiting, weakness, etc. Depression can be cured and controlled. I think you need to read a little closer; The title says ‘Depression is NOT SIMPLY a brain disorder’. Take another look at the article.
      Thanks, ): o ) Beth

  5. Martina — Why a serious medical issue? Why not a serious psychological issue? Why is one term more valid than the other? Of course these things are serious, but I object to them being termed strictly “medical” when that’s inaccurate.

    Marilyn — I didn’t say it didn’t involve the brain, I said it is a gross over-simplification to just suggest it is a brain problem. While we’ve done thousands of tests on the brain in the past decade, none have shown there to be any “disease” in the brain that is responsible for these disorders.

  6. Mental illnesses are medical conditions that have a psychological COMPONENT. Just as, say, migraines are a medical condition with an environmental component (i.e. the triggers that set them off). To negate the medical nature of mental illness is to ignore what is known about the biological underpinnings of mental illness, including the results of brain imaging. Why are you so convinced that the term “medical” somehow eliminates the psychological part? You are drawing a false dichotomy.

    We have brains – if the kidneys or liver can malfunction, why not the brain? And if the brain malfunctions and produces a mental illness (through whatever causes), we end up with physical symptoms (fatigue, cognitive slowing) as well as “psychological” (depressed mood or mania). There is absolutely nothing in current day psychiatry that says mental illnesses are simple in any way. I’m curious as to why you keep using the word “simply”.

    I’m leaving for vacation, so I won’t be able to participate in this thread further.

    • I’m not “negating” the medical component of mental disorders. I’m suggesting reducing them down to a matter of medicine to be treated by doctors and medications is like reducing down a symphony to the notes on a page.

      I could just as easily say these are psychological disorders that may have a medical component. Both statements are equally as true. But I would argue we shouldn’t say mental disorders are only one or the other, because it reduces the inherent complexity of these disorders down to a single component.

      Diabetes has a lot of components, too, but if you don’t control and treat the medical component, the person is at risk of complications that can result in death. You can successfully treat most mental illness without medications, which suggests that if they have a medical component, it’s not nearly in the same league as most other medical diseases.

  7. It is true. All diseases ” remain complex disorders that involve all aspect of a person’s functioning and life — their brain and biology, their psychological makeup and personality, and their social interactions and relationships with others. ” Nothing unique to mental illness there. (Ex. I have a blood disease that affects my functioning life, my social interactions, etc).
    But your next sentence that the “cause” is all of these things, in differing proportions is only true if you (as most do) consider any form of less than ecstacy a form of ‘mental’ illness. If sadness, bad grades, unhappy marriages, unsure sexual identity, etc. are “mental illnesses’ your point is perhaps maybe kindof, if you stretch it, valid.
    But I know of no body of reputable research that shows a “relationship with others” or “social interactions” can cause schizophrenia.
    Unfortunately, the needs and issues facing the most seriously ill are hurt by those who talk about “mental health” without mentioning their exclusion of the most seriously ill from their soapbox.
    (My memory is that you don’t cotton to links on this site, but if you google “Mental Health kills mentally Ill” you will find a Huffington Post report I did on this. )
    Thanks for letting me get my 2 cents in.

    • All diseases are most definitely not complex disorders that involve all aspects of a person’s functioning and life. Some are very straight forward and have little impact in a person’s life.

      Mental health includes serious mental illness, sorry to say, just as talking about a person’s general health naturally includes what happens when a person’s general health is impacted by a disease.

      We don’t know what causes schizophrenia any more than we know what causes depression, anxiety, etc. So to suggest it is *not* caused by something is putting the cart before the horse.

      • Absolutely agreed. Again, Jaffe is falling victim to a logic problem.

  8. I feel positive that mental illness is caused by a malfunction of the brain, not a disease.

    The brain can become inflamed from overwork and lack of rest combined with a lack of proper nutrients like omega 3 and Lecithin or other suitable blood thinner

    An inflamed brain can become very hot and sensitive, if you have a hot drink you’ll feel the effects of that hot liquid moving through veins in your head quite noticeably, a sort of tingling sensation. You can only concentrate reading a book for only a minute or two, sometimes only seconds if the inflammation is severe

    It is absolutely essential that the brain is kept cool by a fan or a cool environment as much as possible throughout the duration of the malfunction which is around 5 – 6 weeks

    Your mind “habits” determine how well your brain functions physically, if you decided to drink wine while you are concentrating heavily on solving a problem, you greatly increase your chance of brain malfunction

    A severely malfunctioning brain, while not apparent for the first week into the disorder, can inflict a separation of minds, one voluntary (a certain normalness that you’ve always had) and an involuntary mind that seems weird to a first timer but is the one that should be taken seriously if the patient will express what’s in there. At the end of the brian injury, when it begins to heal, the two minds come back “together”, that coming together curing sensation can actually be “felt” by the patient and things proceed to normalize finally, in the mind but habits must change, different changes for different individuals however the various changes will have a common theme, to maintain the brain in good condition

    Stigmatization is a terrible thing, it does more damage than mental illness will ever do

  9. This comes off akin to the scientology argument of “They’re wrong – BUY what WE are selling”.

    Psychology is useful, as is psychotherapy (in the few instances where the evidence in the literature supports it).

    To dismiss brain as the battleground for fighting mental illness is dated and outmoded thinking. You seem to be making the rather illogical leap from the fact that we cannot cure it biologically or explain it perfectly from a biological perspective then it can’t be a brain disease. Just because we don’t fully understand it yet doesn’t mean its a brain disease. For a long time we didn’t understand diabetes – that didn’t change what was causing it.

    This article may have had legs a decade ago, but now the field is bringing in all factors to build models of depression for example. A whole new field of epigenetics opened up – reflecting the interaction of environment with genes.

    Yes it is complex, yes it will take time but that in no way provides evidence for it not being a brain disease.

    Psychology will be folded into neuroscience eventually, as will psychiatry in the coming decades.

    • Except, of course, you can’t fight diabetes simply with talk therapy, while you can fight virtually all mental illness with psychotherapy. That’s a pretty strange “brain disease” that can be cured or positively impacted simply by the act of speaking.

      If epigenetics has shown us anything so far, it’s how darned complex these disorders’ expressions are within the genes. There are certainly no clear answers… yet.

      Which isn’t to say that I don’t share your general optimism that we’ll eventually one day figure some of these things out. But I don’t think that it’ll make sciences like psychology be folded into something else…

      • What is the mechanism of action of talk therapy?

        Where does the effect take place?

        In the brain.

        Look at the literature. You are changing the functional patterns of the brain with talk therapy. Check out Am J Psychiatry. 2007 May;164(5):778-88 for an example.

        Instead of thinking the effect of psychology weakens the idea that it is a brain disease, in fact it bolsters it.

      • All mechanisms of action when it comes to thought take place in the brain; that goes without saying, no? I’d argue that’s not at all the same as saying that the brain suffers from some sort of “disease” (one which has largely eluded our ability to measure and describe its precise mechanisms of action). Any and all activity you engage in has a measurable impact in the brain. Let’s not confuse causation with correlation here.

        After all, all thought and emotion comes from the brain. Have we determined the patterns and proper neurochemical composition of a “balanced” brain or one with “proper, rational” thoughts versus the unbalanced one with irrational thoughts?

      • Dr Grohol, while I agree that some mental illness can be fought with talk,for myself, if I don’t have the medications I take, then talk therapy doesn’t work for me. I’ve tried just the talk therapy and kept ending up in the hospital. With the medications my mind is “clearer” and I can actually take in what the therapist says. I also don’t like that you said in your article it can be treated with psychology and “even social work”. My therapist is a social worker and she’s the best therapist I’ve ever had, better then the few psychologists I’ve had. I do agree with you that it’s not just a brain disease, I’ve always said that it’s a combination of things. In fact I don’t think I’ve ever had a Dr, psychologist, or social worker that said it was just a brain disease.
        For me, the only thing that works is talk therapy and medications.

  10. Obvios typo on my part -mean to say “Just because we don’t fully understand it yet doesn’t mean its [not] a brain disease.”

    See what happens when you type before coffee….

  11. Great article! And somewhat interesting feedback! It seems like everyone has a strangely specific opinion about this topic. I guess the average undergraduate psychology student should just walk away from this discussion accepting that mental disorders are a interesting combination of physical and psychological complexities within an individual? And to not discount either side of that proverbial coin?

  12. You are asking me to not confuse causation and correlation, yet you use the fact that we haven’t answered the critical questions yet as evidence to support your position.

    Absence of evidence is not evidence of absence – everyday we get closer to outlining those ‘patterns and proper neurochemical compositions’.

    As you say “All mechanisms of action when it comes to thought take place in the brain…” – Exactly, the hallmark behaviours of the various mental illness ALL have their start in the brain.

    Just as the brain has to be the end point for treatment, it is the physical starting point for the expression of the illness to.

    Really look at the literature, consistent pictures of the disorders are emerging, the missing evidence is being developed every day.

    Great chatting with you today. Thought provoking and all that good stuff!

  13. continued from my first post….

    The sensation of the “coming together” of the two minds at the beginning of the healing process of the inflamed brain is best described by an analogy : the switching of your stereo player from Stereo to Mono, that’s the only analogy that I can think of that comes close but whereas your stereo player does that in a milisecond, it takes about 30 seconds for that mysterious separation in your injured brain/mind to close, bringing your mind back to normal in as much that your mind is back where it used to be, bringing great relief to the sufferer. If it happens when you’re asleep, it won’t be noticed

    During the time the brain is inflamed, the last 4 weeks of the 6 week period, it’s important that the brain is not left in idle mode, mental and physical exercise are needed but with the physical exercise, cooler blood from the body will travel through the brain faster than normal and cause a feeling of dizziness or even blacking out but blood circulation is beneficial as is mental exercising, both must be kept short initially

    To explain the “second” mind, commonly called “voices in the head”, it’s a symptom of the injured brain and I think doctors should forcefully probe and inquire if it’s actually there in the patients brain/ mind, if it is, the patient needs hospitalizing, straight away, for weeks, not days, no matter what

    Stigmatization is a terrible thing

  14. Well, this was interesting. I guess things DO come full-circle eventually. After YEARS of mental illness being viewed by many people as a personal weakness or just being plain crazy, it was finally acknowledged that there IS a chemical/physiological basis and there has started to be acceptance and less judgment out in the world. Now you’re upset that the media refers to mental illness as a serious medical condition?!? THAT is crazy.

  15. Very interesting!

  16. I’m quite comfortable with the tag brain disease and with the medical model. Mental illness is a medical condition – with psychological and all sorts of other components. A medical condition is a health condition. My disorder definitely is a health issue. I think psychotherapy is really important, but I really don’t like putting medication and medication against each other. The combination helps many of us. I have some bipolar friends who are fine with meds alone. Saying that psychotherapy alone can eliminate almost all mental illness seems pretty off to me.

    I think these categorical views really don’t help us – we need to move towards more holistic approaches not the opposite. And fret a little less about terminology. I’m so thankful that I fell within the medical system (which has looked after me very well). You also have to consider that in many places what is “medically necessary” is covered by the state (ie no or minimal out of pocket payment) whereas things that are not medically necessary are considered elective. In these situations the medical model and viewing mental health as a real part of the health care system means we can access care.

  17. John,

    Good for you for continuing to resist this simplistic characterization of mental conditions. As a lay observer, it seems as though there’s a measure of political axe-grinding and professional turf-carving going on when “experts” persist in using these terms. There are certain factions which appear bent on actively deny the role of *any* form of psychological or social influences in the etiological development of mental disorders, to the point of denying the biopsycosocial model altogether.

    To their advantage, the “brain disease” point of view seems to piggyback nicely on the concept of the brain-as-a-wet-computer model of mental health, wherein inherent genetic or biological software glitches alone are capable of messing up our mental hardware. Hardware that is, for some unexplained reason, at the same time immune from social or developmental influences, or, apparently more to the point, open to any of the less-hard sorts of old-school psychologically-based explanations which don’t conveniently fit with today’s fashionably-techno way of conceptualizing things.

    How exactly this conceptualization hopes to inform “more modern forms of treatment” is unclear, but when one hears the terms “illness” or “disease” pressed so relentlessly, it’s not much of step to assume that the implied modes cure are intended as medical or pharmaceutical rather than humanistic in nature.

    As with any fashion, the pendulum will swing back towards the center with time, but for the moment it seems as though this hyper-mechanistic conceptualization of mental health issues remains on the ascendance.

    As always, the truth is in the pudding, and how patents themselves end up responding to this model of what, to them, remains an intensely humanistic dilemma remains to be seen.

  18. There are several issues being discussed although I’ll comment only on a few. There seems to be a redundant semantic debate between referring to mental illnesses as a brain dysfunction rather than a brain disease. I call it redundant because at first, it side-steps the medical model by excluding, “disease” but it then re-introduces the medical model as a mode of treatment and understanding, thus, redundancy occurs.

    I agree with Dr. Grohol that mental illnesses are influenced by various components. However, I do view mental illnesses as having a neurobiological origin and manifestation. Dr. Grohol, you’re correct, there are no studies showing dysfunction in a particular area causes a certain mental illness, however, I find your argument to be a bit confusing. Part of it centers on a lack of evidence from the neurobiological side, which is a valid claim, however, you’re using it as an argument and committing a fallacy called argumentum ad ignoratium. I get confused though when you assert various therapies work, whether pharmaceutical to psychotherapeutic because they both affect the brain, so emphasis is fully on the brain. Perhaps I’m misunderstanding you but to me this seems contradictory.

    In the aforementioned paragraphs I typed, I stated I was in support of the brain-view. I take the view mental illnesses are caused by a neurobiological dysfunction OR disease. I capitalize “or” to avoid a potential semantic debate. I’m not alleging these are causal as there is a lack of sufficient evidence for that but there is plenty of evidence to allege they play a massive role. Focusing on obsessive-compulsive disorder (OCD), neurobiological view range from the 2 loop OCD circuit (functional neuroanatomical) to hyperactive HPA axis (neuroendocrinal)to genetics. In either one, there is sufficient evidence to assert they are valid.

    For 2 examples:

    Atmaca, Murad, Yildirim, Hanefi, Ozler, Sinan, Koc, Mustafa, Kara, Bilge & Sec, Simeh. (2009). Small pituitary volume in adult patients with obsessive-compulsive disorder. Psychiatry and Clinical Neurosciences, 63, 516-520.

    Chakrabarty, Kaushik, Bhattacharyya, Sagnik, Christopher, Rita & Khanna, Sumant. (2005). Glutamatergic Dysfunction in OCD. Neuropsychopharmacology, 30, 1735-1740.

    Dr. Grohol, you also allege that psychotherapy works for depression. I’m not going to challenge that unless I wish to play Devil’s advocate, which for this I do not. Instead, psychotherapy supports the brain disease/dysfunction model because there the brain is being changed. In fact, learning anything changes the brain’s structure and subsequently function. Social components can play a role but they ultimately lead back to changing the brain’s structure and function. With this last part in mind, should non-neurobiological components have a greater or lesser weight than neurobiological components, and why? In my view, it all boils down to neurobiological correlations. From your view, the same seems to be true, it’s correlations as well minus the logical fallacy.

  19. Dear Dr. Grohol,

    I greatly appreciate the article you’ve written, disputing the myth of “biological brain disease” as the simple explanation for depression (and other psychiatric conditions, as well).

    One thing I’d like to add is that, in addition to adjunct treatments, like therapy and skills training, is the importance of community links, especially to peer support and the mental health recovery community. I know, from both my own experience as many others, that people who are diagnosed with depression or other psychiatric conditions get farmed into different pockets of the mental health system, and connection to life, meaning, joy etc gets cut off. Hopelessness, helplessness and purposelessness often follow. Being exposed to people who have been there and moved beyond can be more beneficial to recovery than any pill or intervention in the mental health system.

    Thank you again for your powerful article. LYN

  20. You might was to read the “Best Practices” and “Promising Practices”.
    Adverse Childhood Experiences and Health and Well-Being Over the Lifespan
    This chart shows the sequence of events that unaddressed childhood abuse and other early traumatic experiences set in motion. Without intervention, adverse childhood events (ACES) can result in long-term disease, disability, chronic social problems and early death. 90% of public mental health clients have been exposed to multiple physical or sexual abuse traumas. Importantly, intergenerational transmission that perpetuates ACES may continue without implementation of interventions to interrupt the cycle.
    Adverse Childhood Experiences
    (Birth to 18) Impact of Trauma and Adoption of Health Risk Behaviors to Ease Pain of Trauma Long-Term Consequences of Unaddressed Trauma
    Abuse of Child
    • Emotional abuse 11% *
    • Physical abuse 28% *
    • Contact sexual abuse 22%
    Trauma in Child’s Household Environment
    • Alcohol or drug user by household member 27%
    • Chronically depressed, emotionally disturbed or suicidal household member 17%
    • Mother treated violently 13%
    • Imprisoned household Member 6%
    • Not raised by both biological parents 23% (Loss of parent by separation or divorce, natural death, suicide, abandonment)
    Neglect of Child
    • Physical neglect 19%
    • Emotional neglect 15%
    *Above types of ACEs are the “heavy end” of abuse. Eg. Emotional: recurrent threats, humiliation, chronic criticism
    Physical: beating vs spanking
    Neglect: Lack of basic needs for attachment, survival/growth
    One ACE category
    = score of 1.

    List is limited to ACE study types. Other trauma may include: combat, poverty, street violence, historical, racism, stigma, natural events, persecution etc. Neurobiologic Effects of Trauma
    • Disrupted neuro-development
    • Difficulty controlling
    Anger – Rage
    • Hallucinations
    • Depression (and numerous other mental health problems – see below)
    • Panic reactions
    • Anxiety
    • Multiple (6+) somatic problems
    • Sleep problems
    • Impaired memory
    • Flashbacks
    • Dissociation

    Health Risk Behaviors
    • Smoking
    • Severe obesity
    • Physical inactivity
    • Suicide attempts
    • Alcoholism
    • Drug abuse
    • 50+ sex partners
    • Repetition of original trauma
    • Self-injury
    • Eating disorders
    • Perpetrate interpersonal violence. aggression, bullying, etc.
    Disease and Disability
    • Ischemic heart disease
    • Cancer
    • Chronic lung disease
    • Chronic emphysema
    • Asthma
    • Liver disease
    • Skeletal fractures
    • Poor self rated health
    • Sexually transmitted disease
    • HIV/AIDS

    Social Problems
    • Homelessness
    • Prostitution
    • Delinquency, violence and criminal behavior
    • Inability to sustain employment
    • Re-victimization: by rape; DV, bullying, etc
    • Compromised ability to parent
    • Negative alterations in self-perception and relationships with others
    • Alterations in Systems of Meaning
    • Intergenerational transmission of abuse
    • Long-term use of multi human service systems,
    At Annual Cost of:

    Multiple studies reveal the origin of many mental health disorders may be found in childhood trauma, including Borderline Personality Disorder BPD, Anti-Social Personality Disorder, PTSD, Schizophrenia, Bipolar Disorder, Dissociative Identity Disorder DID, Anxiety Disorders, Eating Disorders including severe obesity, Attention Deficit Hyperactivity Disorder ADHD, Oppositional Defiant Disorder ODD and others.

    Sources: Adverse Childhood Experiences Study (CDC and Kaiser Permanente, see http:// The Damaging Consequences of Violence and Trauma (see and Trauma and Recovery (J Herman). Cost data: 2007 Economic Impact Study (PCAA). Chart created by Ann Jennings, PhD. Revision: April 6, 2010

  21. Do all of you even know what you are doing to people who are depressed, etc? You talk about this as if it is so simple, so ho hum. You talk about it so medically and not personally. Have you ever really experienced it or have you just studied others who are experiencing it? When those who have depression read things like this, not just the article, but also the comments…it is terrifying. It makes us feel even more hopeless. Look back and see that the things which have been said can make one feel as if NOTHING works and that is really scary. You should be very careful about what you write and what you are trying to pass off as experts. Where else do those who have depression, etc. go for help? I am having a difficult time expressing myself but the article I thought might give me hope and help me feel better…did not. So, I read the comments made and they did not help either. Now what???????

  22. have to agree with dot. i knew nothing about depression until i got it, and got it bad. i am learning that both psychiatry and psychology are at war with each other and themselves. this does nothing but confuse and scare people suffering from this dreaded disease or condition or whatever the heck you want to call it.

    i truly believe that psychiatry and psychology are possibly the only 2 medical fields that are moving backwards in regards to helping the patient.

  23. I’m coming late to the party, but felt compelled to post in agreement with the previous two posts, those by dot and john. I’m not a mental health professional or expert, I’m a long-time patient. As such, I found this article extremely un-helpful. Who CARES what terms are used?? I mean SERIOUSLY? Semantics aren’t what get me out of bed everyday or make me more (or less) able to leave my home for a simple errand. After close to 20 years of seeing medical doctors, taking antidepressants of every variety, psychiatrists, therapists, etc., the only thing that really matters to the people that suffer from mental health issues is WHAT HELPS MAKE IT BETTER. This article serves no purpose to those of us that suffer. It’s a total NON argument. It struck me as cruel irony as I was reading this article that the only people that care if mental health problems are labeled as “medical” or “psychological” or whatever, are the insurance companies that can deny coverage based on the terminology used to describe the problem.

  24. Hi,
    Im not a expert but after 17 years of Recovery Inc. i have do doubt whatsoever where nervous conditions come from.It’s called the working up process
    Alot of professionals send people there but not many go.Why because we don’t listen well.
    Im sure glad I stayed with Recovery Inc.

    I most likely would not be around had I not gone and kept going .
    They have free meetings everywhere,

  25. You saying that “Depression, like all mental disorders, is caused by a complex and still poorly-understood confluence of a combination of factors.” sums up very well the complexities involved in appropriate diagnosis and treatment.

    GP’s are in a ‘triage’ position and need such a wealth of knowledge about the full spectrum of human illness, I wouldn’t want my GP (a superb physician) to perform ENT surgery on me, and don’t expect him to have the full psychiatric skill-set either.
    It’s a delicate balance for GP’s to assess and refer where, here’s that word again, appropriate.

  26. Are there any well controlled studies with well defined outcome parameters like (GAF) from a treatment blinded observer that show that psychotherapy is an effective treatment of depression? It is well established the depression DOES have physical components that involve physiological and even anatomical changes in the brain. Physical treatments do often work and have been carefully tested. Can psychotherapy show the same? The simple fact that the monoamine hypothesis is not sufficient to explain all the facts of the disease neither means it is wrong nor psychotherapy is useful. It simply means that the monoamine hypothesis is not complete.

    • Cognitive Behavioral therapy has been extensively researched to show effectiveness with depression and many other issues. The list would simply be too long to publish here. As for the question of whether or not the researchers are “treatment blinded observer(s)” I don’t know exactly what you mean. Is that a question of whether or not they are biased? You could assume that most researchers of these studies are professors in psychiatry or psychology. That does not necessarily mean they are biased. But perhaps there are more “independent” studies out there. I don’t know. Dr. Grohol? Are you aware of this?

  27. I’ll keep it simple. The article is called “Mental Illness is Not Simply a Brain Disease.” Read that slowly. Process it. It is not complicated.

  28. Sometimes mental issues can arise from the body doing screwy things, like hormone imbalances. In those cases, hormone/medication therapy as a treatment is completely valid.

    I know someone who’s Schizophrenic. He’s bright (he’s certainly on the ball with mathematics), and the sweetest thing but if he doesn’t take his medication he starts wandering around in circles talking to himself. His medication allows him to be able to function in society and to contribute in a positive manner.

    In most other cases, mental issues can arise from so many things including traumatic events. It could be that the person has some underlying event/issue which was never concluded and then a trigger happens. It’s like they’re carrying a loaded gun and then something happens and *bang* you’ve got a whole world of trouble. It can be as quick as that.

    My panic attacks are a good example of this. I have stupidly sensitive senses (the loaded gun) and it takes a sensory overload to bring me to a gibbering wreck (the trigger just got pulled).

    I am also on hormone therapy because my lady hormones are imbalanced. The effects of this on my daily life are a nightmare especially when it came to pre-menstruation. Now that I have a hormone implant (which also prevents me from getting pregnant too so extra bonus) implanted in my arm, I’ve never been calmer and not screaming and getting violent in the few days before my menstruation.

    I was put on Prozac once and it really made a huge mess. It switched my body clock around for a start. I was also wearing a long sleeved top, thick winter jumper and a winter coat in the middle of summer and still shivering like I was naked in the middle of the Arctic. I don’t begrudge that it has helped millions of people, but it didn’t work for me.

    I’m deliberately keeping my language simple so as not to confuse people, which I often do if I start using medical terms.

    The point of my post is that different treatments work for different people for different reasons. Too many doctors just write out the prescription(s) for pills and consider the job done. It doesn’t always work that way especially with things like PTSD, depression, ADHD, etc.

    • Well said! Glad to read that you’re doing well.

  29. Interesting debate. While I don’t suffer from mental illness on a regular basis, I have had some pretty long-term bouts with depression. My mother and sister were both diagnosed bi-polar and were medicated for that. I have never taken psych meds and I never will. I believe they do more harm than good and I will always opt for interventions that avoid medication, even if it means that I have to live with the depression for many months.
    If medication is the only answer, why do 40% of schizophrenics recover without medical intervention and yet only 5% of them who are medicated ever recover and go off meds?
    Also, if it is totally a “brain disorder”, why do so many people with mental health issues respond quite well to the GAPS diet? That’s not to say it’s a cure for all people with mental illnesses, but many people have shown great improvements on the diet.
    Just some things to consider in the debate.

  30. The author of this article confuses the question of “what causes mental illnesses” with “what are mental illnesses.”

    Bottom line: He is correct about there being multiple causes, yet is incorrect to say that mental illnesses are not brain diseases. The mind and the brain are the same thing, and multiple factors such as genes and environment play a role in the development of mental illness.


  31. Hello,

    This is a good article and it is true that other modalities for treatment offer the best way possible to help treat mental illness. But sometimes the lay public perpetuate stigma because they can’t ‘see’ or there is no concrete medical explanation for the mental illness such as depression and tend to write it off as willful behavior instead of something the person is suffering with on a daily basis and is real. I heard someone say to their family member who had to go to the hospital with acute depressive episode say: ‘I can’t come with you right now, your pulling this ‘expletive’ again. If you broke your leg I would have sympathy and understand but your just whining–get over it and get on with life.’ On the way to walking into the ER at a major University hospital when I was walking by the door on the way to work. The person looked severely depressed.

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