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“Nature Versus Nurture” And Mental Diseases

Jul 23, 2011 3:18:37 PM - thesundayleader.lk

Films like One Flew Over The Cuckoo’s Nest starring Jack Nicholson were iconic of the seventies.(Courtesy hville.hostzi.com)

By Dr. Marcel de Roos, Psychologist PhD

For example in the 19th century, European factory workers and their families showed a multitude of “biological/psychological/social” problems, with alcoholism as the most visible one. Alcoholism ran in families, tuberculosis was rife, and theft was common. The explanation at first seemed obvious: it was all about degeneration, consequences of a hereditary determination which generation by generation brings about a downward spiral (“nature”). Later on another explanation became dominant:

The workers had a tough seven day working week, they were underpaid, had no education and had very large families, who lived in miserable small houses with no sanitary facilities (“nurture”). When things are taken out of their (social economic) context then strange things can happen.

In the sixties and seventies of the last century the emphasis in the treatment of mental diseases was on the “nurture” side. Existing previous treatment with medication, electro shocks and isolation was seen as very “nature” orientated and became suspect. From then on the causes of the illness should be found with the parents and in society. Medication was “out”. Sexual liberation, encounter groups and sensitivity trainings were the buzz words. Movies like One Flew Over The Cuckoo’s Nest by Milos Forman, Family Life by Ken Loach and the book I Never Promised You A Rose Garden by Hannah Green became iconic of that period. Parents of schizophrenic children were much hurt by the general belief that the cause of schizophrenia lies with the parents (the ‘cold mother’ and the infamous double bind communication “Don’t do what I say!”). A number of studies and experiments showed that psychiatrists could not distinguish between their patients and normal people.

As in any revolutionary period the reformers went too far and in the eighties the pendulum swung back in favour of ‘nature’. Human behaviour (and in particular mental disorders) from then on was seen as neurobiologically based and genetically controlled. It also puts people into their comfort zone because the “blame” of the mental disease is not on the parents, the environment or the person himself. After all, it’s just some neurotransmitter deficiency in the brain which can be replenished with little pills, which you have to take for the rest of your life.

This conviction is “swallowed”, because almost everybody is convinced that very important discoveries have been made in psychiatry, genetics and neurobiology. In concrete terms this means that there is a belief that the physical causes of ADHD, depression, schizophrenia, etc. are clear. There are some minor gaps, but the big picture is there, isn’t it? In connection with this, the idea is that these discoveries have formed the basis for efficient pharmacologic treatments which directly influence the underlying biological processes of, for example, depression. We only have to monitor our “chemical imbalances”.

If only so! The advertising boys know very well that with the increase of the frequency of a message, the more the supposedly truth of that message is accepted. It can be found on the internet, books and in the other media. Big Pharma (the pharmaceutical industries) has invested a lot in the present belief in “the power of pills” for mental diseases. The stakes are high and the profits are phenomenal. A huge marketing and “research” industry has been created for this purpose.

They conveniently forget that most pharmaceutical effects of medications nearly always have been the result of coincidental discoveries (for example anti psychotic drugs, anti depressives, anti smoking pills, Viagra, etc., etc.). Their “specific” working at a certain “disorder” is hardly known. The positive effects are overestimated and the side-effects are underestimated. The most expensive drugs receive the biggest promotion. Psycho pharmaceutical medications have no solid scientific base; there is no scientific proof for the neurobiological causes of psychiatric and psychological problems.

In 2002, the American Psychiatric Association, published a report (David Kupfer, et al: A Research Agenda for DSM-V) concerning the preparation of the fifth edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders). They concluded that there are no positive conclusions for the assumed biological or genetic causes of the hundreds of DSM disorders. People with the same DSM diagnose are not homogeneous groups, and within these groups likewise treatments differ in effectiveness. Very often persons can be categorised with different labels. The fact that “antidepressants” are prescribed for a variety of disorders from the DSM signifies that the categorisation is arbitrary. There is a lot more to tell about the DSM such as the (pharmaceutical) interest groups behind it, the changes in perspectives between the different editions, and so on. Despite the above shortcomings, the DSM is without doubt one of the greatest social scientific successes ever. The classifications of the DSM are used worldwide  and embedded in the psychiatric/psychological practises.

ADHD (Attention Deficit Hyperactivity Disorder) is nothing more than a description of a number of behavioural symptoms. There is no scientific argumentation for choosing exactly these symptoms. The name ADHD suggests uniformity, but in reality it is a very heterogeneous group.

There is no compelling evidence that there is either a genetic or an environmental cause. It is suggested that the cause lies in a complex interaction between genetic and environmental factors, which is not surprising given the doubtful existence of ADHD as a syndrome.

Treatment with medication gives quicker results than psychological intervention but after a few years there is hardly any difference between the two forms; a combination seems preferable. But there are more and more indications that long term use of the said medication causes growth deficiency. Many children are just agitated, attention seeking and ADHD (if it exists) is over-diagnosed and over-medicated.

For depression and schizophrenia there is also no proof for a genetic or neurobiological cause. Again scientists assume that the diseases are caused by a complex interaction between the biological and environmental factors.

At present, there is no discovery, no evidence that biologic or genetic abnormalities are reliable predictors for psychiatric disorders (American Psychiatric Association). The scientific knowledge about mental disorders is much less than expected and the pharmaceutical treatments much less effective than people think. In the past years there have been many publications, media broadcastings and lawsuits against Big Pharma, which could signify that the pendulum is slowly swinging back in favour of “nurture”.