Psychopathology is a fancy term for the study of mental dis-ease. It’s a general term to describe mental health challenges – from the mundane to the disordered and is a broad term to label the pain of the human experience.
But what causes emotional pain? What causes psychopathology? Why do some people suffer from depression and anxiety, personality disorders, schizophrenia or Bipolar, while others don’t?
Why are some more mentally ill than others?
If you have ever sought help with ‘mental health’ or emotional difficulties in your life – you will probably have asked yourself this question. Some of us pound this question into our psyche.
“Why am I like this?”
The answers are diverse. If you ask a scientist they will point to biological reasons. Genetic markers in our DNA, hormone in-balance, brain development or structural problems. They will say you were probably born predestined for mental illness, it’s in your genetic code. They might use fancy terms like the ‘diathesis-stress model’; a complicated way of saying that you have genetic markers that get triggered with stressful or traumatic events and ‘switch-on’ your diagnosis, be it addiction or personality disorders. Perhaps these scientists might give some credit to the environment; experiences of nurture, or lack of it, trauma or other environmental factors, perhaps not.
If you ask a priest, they might tell you it’s because you are a sinner and haven’t atoned for those sins yet. Perhaps Jesus is the answer.
If you ask a Buddhist monk, they will tell you it is because of attachment, because of the Ego. They will tell you to release attachment to everything, to simply live in an inescapable bubble of peace in the present moment.
If you ask a psychologist, especially one who practices Cognitive Behavioural Therapy they will tell you it’s because of your thoughts – those automatic negative thoughts that you can’t seem to let go of.
If you ask your doctor, they might send you to a psychiatrist. They might point to chemical in-balances in your brain, to a delayed uptake of serotonin or lack of dopamine production.
If you ask a psychotherapist, one steeped in Psychodynamic modalities they might purpose your suffering is due to early childhood experiences that leave a lasting impression – negative events that require survival techniques that no longer serve you later in life but were necessary for survival in those early days.
As you can see, our field is divided – people are divided, and the answer seems to remain largely unanswered.
But this answer is of great importance to individuals and the larger society. How we answer this question informs our policy decisions, where our taxes are spent on mental health resources and solutions. The answer to this question also has a personal impact. How we answer this question impacts how we choose to look for answers to our own suffering. Do we exercise more, take drugs to turn off the demons in our heads? Perhaps we work harder or meditate more. Maybe we seek professional help – psychologists, psychiatrists, our doctors, our priests, our favourite self-help forum.
I’d like to share my perspective on this question – what causes emotional pain? My perspective is informed by my own experiences, what I have witnessed in my therapy practice, and what I have learned.
The major and most pervasive reason we are suffering is that we the majority of us have experienced trauma, and this trauma is lodged in our psyche and our bodies. I believe that the underlying cause of all psychopathology, regardless of severity, expression or type, is caused by either our own or our family’s experience of trauma.
But let us come back to that…
Adverse Childhood Experiences
A massive recent study conducted in the United States called the Adverse Childhood Experiences Study outlined evidence that traumatic experiences in childhood, including what we call ‘developmental trauma’, have significant and lasting impacts on our biology, and are predictive of mental health problems down the road.
“Adverse Childhood Experiences Study, done by Dr. Vince K asked 17,500 adults about their exposure to what they called Adverse Childhood Experiences or ACE’s. These were physical, emotional or sexual abuse, physical or emotional neglect, parental mental illness substance dependence or incarceration, parental separation or divorce or domestic violence. For every yes, you get a point on your ACE score”
The study found staggering results. They discovered that 67% of the population has at least one ACE. In fact, 12.6% of the population indicated they had experienced 4 or more ACE’s.
And the correlated health problems, both mental and physical were incredible. The higher your ACE’s the worse your health outcome looked. For someone with 4 or more ACE’s, their relative risk of obstructive pulmonary disease was 2.5 times that of someone with an ACE score of 0. This was the first time a study of trauma had been linked to physical health outcomes in such a dramatic way – statistically, the sample size of the study and the correlations were too large to be ignored.
When they looked at mental health, the results were even more staggering. For someone with 4 or more ACEs their relative risk of depression was 4.5 times that of someone with no ACEs; for suicidality, it was 12 times. For the millions of American’s who struggle with depression and suicidality, this study showed that there is a good chance a portion of this suffering was a direct result of negative and traumatic experiences in childhood.
This means if you had an adverse childhood, if you experienced domestic violence, a parent with mental health issues, abuse or neglect your health and mental wellness later in life would be impacted. For some, the ones who endured over 4 adverse childhood experiences, they were particularly vulnerable to struggle later in life.
To me, this study underlines a critical piece of information for our question – why do we suffer?
We suffer because more often than not, we were abandoned, neglected, abused or otherwise struggled in our early childhood. And the ACE’s study, along with modern neurobiology are starting to confirm this idea. Trauma has a negative impact on a child’s developing brain structure. What is the result?
Experience Creates Gene Expression
An entirely new field of study called Epigenetics is investigating how our experiences impact our biology and even our genetic codes. Epigenetics is a thrilling scientific frontier that investigates the possibility that our experiences of trauma, neglect or abuse have a biological impact on our bodies, our minds and on a genetic level.
This new research agrees with the ACE’s study, and suggest the cause of our emotional and mental difficulties in adulthood is perhaps written in our genetic code. However, the genetic expression of mental disorders originates with trauma – our own trauma and those of our ancestors.
If our experiences are being encoded into our DNA, the implication is the more trauma in our family history, the more we ourselves will suffer. The biological explanation for psychopathology is correct – to a degree. The findings of the epigenetic research are suggesting that we are carrying, in our biology, the trauma of our ancestors, our parents, our grandparents and further back in our DNA.
I don’t know about you, but when I first started making these connections, my motivation for going to therapy multiplied tenfold. It meant that my own struggle was a partial reflection of my experiences, but perhaps also a burden of trauma I carry from my ancestors. Perhaps my own terror of abandonment might also be linked to that gypsy child 3 generations ago that was adopted out to Dutch parents and stolen away even after her mother changed her mind. Perhaps my annoying and inconvenient ‘paranoid passenger’ issues in a car are remnants of the terror my grandfather felt when he met his death in a terrible motor vehicle accident.
Epigenetic research goes beyond saying these histories impact us because of our thinking – this research is postulating these histories impact us because they are written into our biology. Perhaps trauma is inter-generational on a biological level.
So what does this mean for people seeking help for mental illness? And more importantly, for the application of therapy, psychology and counselling as a means for helping people who suffer from depression, anxiety, sleep disorders or all the other diagnoses for mental illness?
How do we help people heal?
The implications of these questions are profound on many levels. These new discoveries in the field of psychology are forcing practitioners and the entire helping profession to ask some uncomfortable questions.
If all of this is true, how do we really help people heal? Is it truly sufficient to sit in a room with a client, listen empathically to their story? Or to simply require they start to interrupt negative thoughts? These kinds of interventions require the individual to use their outer brain structures – the pre-frontal cortex and thinking systems to manage what is happening deep in the instinctual and primal parts of the brain.
The tragedy of the ‘medical model’ of psychology is that practitioners and helpers have been entirely focused on dealing with the symptoms of problems.
Because let me be clear – in my opinion, all psychopathology, be it depression, anxiety, schizophrenia, insomnia, Borderline, Narcissistic, Antisocial personality disorders and beyond, all psychopathology are simply symptoms of a deeper pain.
The deeper pain is the real problem.
The pain of abuse or neglect, abandonment or symbiosis. The pain of never feeling good enough for our high achieving parents, or the pain of being left to fend for ourselves in an unfriendly world. There is pain from overindulgence just as readily as there is the pain of total neglect. Pain for abuse – physical, emotional or sexual, or the sometimes equal pain from needing to reach unreachable standards just to feel okay.
This pain; it’s messy. It’s complicated. Its multidimensional and can’t always be tidied until a little box or a neat and tidy ‘cognition’. This pain causes humans, the most resilient and ingenious species on this plant to come up with strange and often baffling mechanisms for coping and performing.
Some decided to be perfect or to work so hard that everything would be okay. Some decided to drown the pain in alcohol or drugs or sex or shopping, computer games or cat memes. Some kill themselves.
Others decided to be anxious or depressed because these feelings are far easier to handle and explain than the agonizing grief or rage at the experienced injustices.
What is critical to understand is that all of these coping strategies, these symptoms of our greater pain, are all done at the unconscious level. We are not aware of our reasons, and have often dissociated from or blocked out our traumatic experiences. Often, for very important reasons – for survival, if not physical survival than definitely for emotional survival, we shut down this real pain to feel a lesser and more manageable one. And this mechanism is genius. It allows us to carry on with our lives, and although we are still suffering, it has been reduced to a manageable level. For the severe drug addict, asking them to live in the world without drugs is akin to crucifying them on a cross. It is better to be drugged than to experience the pain of being sober.
Mechanisms for healing
So what do we do now? How do we heal? Is healing even possible if this stuff is encoded into our biology?
The good news story is this: healing is possible. Change is possible.
Our brains and even our genetic makeup is capable of change. With each experience we have that is different than our upbringing, we create new neural pathways, and with practice, we start to reshape our biology. We create new experiences and write new stories for ourselves.
Often, people benefit from therapy, from the relationship with their therapist to help them rewire their brains and their stories. Therapeutic models designed to work with trauma at the deep limbic structure of your brain – beyond ‘talking’ about your problems and instead re-experiencing a new reality of safety and security. Energy psychology such as Advanced Integrative Therapy (AIT) practiced at Therapy for People, Eye Movement Desensitization Reprocessing (EMDR), Hypnosis, Neurofeedback are all valuable. Any modality that has a process to help you work through past trauma, and focuses on the relationship of trust between client and therapist can be helpful.
Just remember the famous words of Fritz Perls – “there is nothing more dysfunctional than talking about your problems”. One has to work through them, experience some of the emotions long blocked. Experience the present moment as different than the one ingrained in their bodies and minds. Attachment matters. One must approach trauma work gently, slowly. And at all costs avoid just ‘re-living’ the trauma – talking about it over and over again without a mechanism for healing attached. Talking about trauma re-traumatizes the talker. But having a competent and kind therapist to guide you through makes all the difference in the world.
I can say this with confidence because I have experienced it myself.
Therapy works, if given a chance, a dash of patience, and a whole lot of willingness to get uncomfortable and trust in the goodness of the therapist to help you through.
Mental illness or dis-ease exists, but so does its antidote.