Wednesday, November 12, 2008

Mental disorders and the fallacy of the single cause

Yesterday's NY Times ran an article on a sweeping new theory of mental illness ("In a Novel Theory of Mental Disorders, Parents' Genes are in Competition.") In summary, the theory is that "disorders" from autism to the mood/thought distortions found in the "psychotic spectrum," are caused by an imbalance between a mother's and a father's genes. Autism is said to be the overly-masculine side, as anyone might guess who has ever known a man who hand-rubbed seventeen coats of lacquer on a classic car.

I could write a book about the inherent assumptions in all this; that's why I put some words in quotes. But for now, I just want to comment on this example of single-cause thinking.

Over and over, I am fascinated by how dedicated Western medical research is to the idea of the single cause, even as researchers find it almost impossible to make it work, reminding you of the elaborate theory of epicycles that supported the conviction that the sun revolved around the world. In fact, trying to "control" for "other factors" is a major headache for those who design studies of human behavior and wellness. For example, does your health really improve just because you exercise? What is the role of other factors, like the socialization of the health club; walking out in nature; just getting out of the house; your will to live; your belief, and your doctor's?

Obviously, there is cause and effect, but we claim to have a handle on it at our peril. Here is where we stand to learn from the simple common-sense of basic Buddhist teachings about karma. As I understand it, karma does not simplistically mean "fate" or "what has to happen." Instead, it refers to the inexorable (and observable) fact that every one of our actions springs from an elaborate braid of causation, and also gives rise to our future. Nothing is without cause. No action fails to give rise to effects.

For this reason, spiritually advanced people are more likely to ask you questions than to give advice. I believe this caution is the result of genuine insight into the complex nature of human behavior. It contrasts to the behavior of the less enlightened who, unfortunately, sometimes think they know the answer. Friends tell a woman who is endangered by her alliance with a violent man, "You need to get your locks changed." It seems obvious to her friends. But her reality is more complex than anyone can know. She has made it through life by being strong, never vulnerable. Her self-esteem is built on her compassion, on never putting her own needs first. Telling her what she ought to do has not changed things.

A different understanding of "mental disorders" is overdue. As one who has met a crack baby, I welcome the insights not only of genetics, but also of the importance of the environment of the womb. Taking genetic balance into account sounds like a useful framework, a break from the American conviction that our minds are machines we can fix with chemicals and discussion. We need to give more thought to other influences on our mental well-being, such as the real impact of childhood experiences, and of our everyday environment.

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