1 The Truth About Mental Illness The truth about mental illness is that it is not as advertised. It is not what some special interest groups tell us. It is not what drug companies and some mental health groups may claim. It is not simply a group of genetically transmitted disorders of brain chemistry. It does not reliably respond to psychoactive drugs. And these drugs are not their only available recovery aid.* *I began to describe these facts in The Truth About Depression, where I focused on the most common mental illness--depression. Because these principles for depression are also true for the most other common mental illnesses, in the first three pages of this introductory chapter I describe the state of the dysfunctional mental health system today using similar wording as in chapter 1 of that first volume.
The rest of this chapter is new. These special interest groups may have misled us. Their special interest is in large part about money, power and influence in the diagnosis and treatment of common mental health problems. Much of what they tell us about mental illness is actually in their own best interest. It is not always in the interest of the people who experience the pain. At the top of the list of these groups is the drug industry. While drug companies have produced some effective pharmaceutical agents, such as antibiotics, insulin, and others, they fall short when it comes to mental illness. But to help market and sell their drugs, they have often resorted to making up a limited and still unproven theory about the cause of mental illness.
This theory is that most mental illnesses are caused by genetic and other biological defects that are somehow inherent in our makeup. In other words, they claim that we are born with faulty genes and brains--which their chemical will fix. A problem is that after a century of looking for a cause, and since 1960 looking for a ''magic bullet'' drug, we still do not know what causes mental illness, and our drug treatments for them do not work very well. Influenced and often financially supported by the drug industry, and probably for other reasons, health insurance companies, including those who call themselves ''managed care,'' some academics, professional organizations, some mental health advocacy groups and government agencies have bought this unproven theory. These groups, which some have called a major part of the ''mental health industry,'' have used this limited theory as a basic principle in the diagnosis and treatment of people hurting with what they call ''mental illness.'' On the surface they espouse the more accurate and balanced bio-psycho-social theory of mental illness. But they focus primarily on the biological aspects of these disorders and commonly ignore or even neglect the physical, psychological and social traumas in the person''s past and current history. Though it is in their name, managed ''care'' companies don''t really appear to care.
They are a pure business. They are managed money. Some have called them ''managed greed.'' Their goal appears to be to make as much money as they can without getting into legal trouble. For starters, just look at the salaries of their CEOs. Forget helping sick people in need. Most do everything they can to delay or disapprove coverage, and not pay clinicians appropriately for their services. Some, such as the nonprofit HMO Kaiser-Permanente, are exceptions to the rule.
In my thirty-eight years as a physician, and the last twenty-six years of that time as a psychotherapist, I have seen and assisted countless patients with a wide variety of mental and physical illnesses. Whether their problem was depression, an anxiety disorder, an addiction, or some other illness, in most of them I have not seen convincing evidence that the cause of their disorders was solely a genetic or another biological defect. (There is also no published proof for the biogenetic theory of mental illness.97, 542, 768) In fact, I regularly saw evidence for another equally, if not more important factor: a history of repeated childhood trauma. Among all of these people, I have rarely seen one who had a major psychological or psychiatric illness who grew up in a healthy family. Over the past century numerous observers have looked at trauma, and how it affects us. But since 1980 there has been an outpouring of more than 300 clinical scientific studies that have shown a strong link between repeated childhood trauma and the development of subsequent mental illness--often decades later. In most of these investigations the authors have controlled for other potential associations with mental symptoms and disorders (called ''modulating'' or ''confounding'' variables in the research trade), and they have found them to play a less important role than did the trauma itself.
These findings have major implications for the prevention and treatment of mental illness, which I address throughout this and the prior book. An Exemplary Study As an example, one of those studies was conducted on a large sample of people living in upstate New York. The resulting information that it gave us is not just psychologically helpful--it is remarkable. Psychologists and researchers Jeffrey Johnson, Patricia Cohen and their colleagues looked at 593 families and their children.532 Their aim was to compare and sort out the effects of parental mental illness versus faulty parenting on the children''s subsequent development of mental illness. The faulty or maladaptive parent behaviors included psychological and physical abuse, and neglect, all of which are forms of childhood trauma. They evaluated each family member four different times over the long course of eighteen years. At the start of the study the children were on average six years old, and so were about twenty-four years old by its end.
At each of these four evaluations, they conducted detailed psychosocial and psychiatric interviews with every participant. Their results showed that parents with mental disorders had enacted more faulty parenting behaviors than did the parents who had no mental illness. In turn, faulty parenting was associated with a highly significant risk for their children''s having a subsequent mental illness as teens or young adults. Indeed, most of the children who received poor parenting, and thus experienced varying degrees of repeated childhood trauma, developed these mental illnesses whether or not their parents had a mental illness. However, the children of parents with no mental illness, but who still had faulty parenting, had the same amount of subsequent mental illness, as shown in Figure 1.1. Parents with a mental disorder had twice as many faulty parenting behaviors than the comparison parents without a mental disorder. This finding could explain a possibly erroneous interpretation from other and less comprehensive research studies that a particular mental illness is genetically transmitted.
Thus, as shown in Figure 1.1, the children of mentally ill parents were not at increased risk for having mental disorders unless there was a history of faulty or maladaptive parental behavior (i.e., child abuse or neglect). The mental disorders that were looked for and found most commonly in both the parents and the children were among the most common disorders, and included: depression, anxiety disorder, substance abuse/chemical dependence, personality disorder and disruptive behavior disorders.* Looking at the lower left corner of Figure 1.1, we can see that the prevalence (i.e.
, percentage with a mental disorder) of these mental illnesses for the children who had 0 to 1 kinds of childhood trauma was about 20 percent; this was essentially the control or comparison group. But in this study, as the number of faulty parenting behaviors/traumas goes up, so does the prevalence of subsequent mental illness among their children. When there were six or more kinds of trauma present, the prevalence of mental illness increased by a factor of over three times that of the control group. * The further breakdown of these mental disorders included: alcohol or other drug abuse, attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, generalized anxiety disorder, panic disorder, social phobia, obsessive-compulsive disorder, major depression, personality disorders, including antisocial personality disorder, and post-traumatic stress disorder. These serious and life-threatening psychiatric disorders were clearly more common (by the above factor of at least three times) than they are known to exist in the general population. These numbers (in epidemiology called ''odds ratios'' or ''risk factors'') each represent multiples of 100 percent, so that a risk factor of 2 means that their chance for having that particular illness was 200 percent greater, or twice as often as people with no repeated childhood trauma (CT). As an example, smoking cigarettes is well known to double a person''s risk of having a heart attack. Epidemiologists consider such a doubling of a risk factor ratio to represent a strong or substantial degree of risk, and an odds ratio of 3 to be extremely high.
This study of people''s lives over 18 years revealed five kinds of mental illness to occur over three times more often for children who had six or more kinds of faulty parenting than for those who had no identified childhood trauma. When compared to most risk factors that both researchers and the public are used to seeing, these figures are impressive. Don''t let these terms and numbers fool you. In the field of epidemiology (the study of illness across populations), these odds ratios, or increases over the control group, do not represent just a slight increase. They a.