Why is this happening to me?
What we know about human behavior is likely a very tiny proportion of all that is possible to know. So, it can be particularly delightful when the field of psychology does a decent job at answering questions that people have been mulling over for centuries like the “nature versus nurture debate.” Think of Confucius: "By nature, men are nearly alike; by practice, they become far apart." If you’ve wondered why certain mental health challenges appear for some people and not for others, then this blog is for you. You may have heard someone philosophize about the “nature versus nurture,” debate. If so, then you have stumbled upon one such forced-choice question that has a profound, yet relatively straight forward answer: yes.
I think what people really want to know, at least some of the time, is what caused the situation we find ourselves facing. When we are being our best selves, we ask this question from a place of ownership, to ward off painful things from happening to our loved ones in the future and take responsibility for what is within our control. When we are operating from baser instincts, this question is sometimes born from a desire to place or remove blame. Other times, we’re just curious, and other times it’s just hard tolerating uncertainty. So, before we go after answering the question with more than just “yes,” let’s take a little side-quest to make sure we’re honestly coming at this question from a useful and compassionate place.
The problem with insight as end goal
Imagine one day you walk into the room where your favorite chair is sitting and you decide you want to rearrange some furniture. When you go to move the chair, you discover that the chair is stuck in place! It would probably thwart your interior design agenda to discover this obstacle, and you’d likely pause to figure out your next step. One way to attend to this problem would be to stand beside the chair, a wistful look on your face, speculating about all the possible ways the chair could have come to be stuck. You could go after this honorable mission for hours. You could devote a lifetime to examining the possible cause.
However, it wouldn’t get the furniture rearranged.
If instead of pondering big existential questions for eternity, you’d really delight in rearranging the room, it might be useful to make some moves. The job of a therapist is to be able to look at the chair, talk with you about it and recognize what kind of stuck it is. You can think of us as your psychological Home Depot sales associate. If your chair is glued down, I’m going to be recommending that you buy very different tools than if your chair is nailed into the floorboards. In fact, if I’m really doing my job, I might even provide really clear instructions on how to use the products rather than do it for you. I would make sure that you know how to get yourself unstuck on your own, should you ever find yourself in a similar predicament in the future.
This metaphor only goes so far. Fundamentally, for someone to be willing to go to their local hardware store and ask for help, they need to know that the sales associate knows what they’re talking about and can be trusted to make useful recommendations. I think the same is true of going to therapy. After all, rearranging our life choices is probably at least as high stakes as the placement of furniture.
Some types of therapy focus on pondering the etiology of stuckness. Behavioral therapies are not that. I’m fond of saying that insight is the prerequisite, but it’s not the 400-level course. There is still a place for answering the big questions, so long as we don’t stop there.
The answers to the big questions, like why is this happening to me or why is my kid struggling, are often more complicated than a simple either-or, genetics or environment, nature or nurture, medications or therapy, chemical imbalance or behavioral problem. It’s very common for there to be misinformation as a result of oversimplification of concepts by the time it trickles out of the ivory tower of academia and into the homes of the rest of the normal folk surrounding it. Let’s remedy that.
Information as shame inoculation
The main reason why I believe this question is worth answering, despite the obvious problems with thinking instead of doing, is because of the shame that permeates societies when we don’t have a great handle on human behavior. Toxic shame alone can be damaging in and of itself, but it also breeds practices like exorcism for psychosis and conversion therapy for gender or sexual orientation nonconformity. So, rather than approaching the question of cause like a problem that needs to be solved, I invite you to approach it like a beautiful garden to behold.
People often find themselves wondering why certain mental health experiences happen. When we come from a family with a lot of mental health challenges and are on the brink of starting our own families, we might worry about what we’re “passing down.” When we reflect back on how we were raised, we might wonder how life would have been had we had a different history. Each time I’ve been asked whether I think nature or nurture has a greater bearing on mental health, I’ve felt it was such a shame that there was little clear information available to most people about this. Many of the stances that are publicly available are dogmatic, lack nuance, and skip to getting the chair unstuck without understanding the precise nature of the stuckness: take a pill, “blame the mother,” do yoga. I’d like to try to clear things up a bit here about what causes mental health disorder.
I like to think of the word “disorder” as referring to a process wherein our way of coping with some symptoms worsens the symptoms or come with their own distinct consequences. It’s important to distinguish “disorder” from diagnosis, which obscures our understanding of how normal experiences become disordered ones by slapping a label on it and attributing cause to the label rather than our attempts to cope. For example, the difference between anxiety and anxiety disorder is that everyone experiences anxiety (if you don’t, that may actually be its own problem) because anxiety is a normal, natural and necessary response to uncertainty. Something becomes an anxiety disorder when we get stuck in a pattern of avoidance that amps the anxiety up more and more, rather than letting it run its natural course.
Getting to know the garden
The view I take is that what we call mental health symptoms are kind of like seeds. Imagine a neighborhood where one side of the street has many pine trees and the other side has oaks. On the oak side, the trees drop acorns. On the pine side, the same thing occurs with cones. A seed may never sprout unless it is pollinated. A sprout may never grow unless it has enough sunlight, water, and room to establish its roots. Not all of these seedlings turn into full grown trees, but given the right set of circumstances following pollination, we might occasionally see a new tree.
Mental health symptoms work much the same way.
In some families, certain genes are more likely to drop a potential for growth into the yard of the next generation (e.g. a family that has a history of psychosis v. a family with a history of significant anxiety). A mental health symptom might never sprout if the seed is never pollinated with stressful circumstances. A mental health disorder may never grow unless the sprout is watered by the way its social system responds to it.
So, the answer to the debate is not nature or nurture. It’s “yes” or epigenetics. Epi- means “on top of” and genetics derives from the Latin word genesis, meaning birth or origin. The root, if we’re sticking with this tree metaphor, of the answer cannot be reduced to an either-or.
Our genetics do predispose us to particular expressions of distress (e.g. distorted perceptions of reality, difficulty tolerating uncertainty, racing thoughts), though this is far more complicated than two sides of the street with different species of trees. We’ve actually got a lot more figurative flora and fauna in our genetic gardens that complicate matters. We can’t know in advance whether any particular oak tree started to grow on the pine tree side. It could have arrived by way of a bird being messy with his takeout, it could have been a particularly strong breeze, or a kid collecting acorns tossed one across the street. For example, there’s some research that suggests early cannabis use may make people more likely to express distress in the form of psychosis even in a family without a strong history of these symptoms. This does not mean that cannabis causes psychosis. Just that there are factors that interact with each other, like birds and seeds. Even if the seed ends up across the street, becoming a fully grown tree is not inevitable.
By definition, it’s normal to experience stress in response to a stressor. For many people, mental health symptoms emerge following the experience of an acute stressor and those symptoms often resolve naturally when we are surrounded by community and the wound we suffered is able to heal. The seed may be germinating, but it may never convert to a sapling, expand its roots, and reach new heights unless the environment is suitable to such growth. Much of what determines whether a stress seed becomes a sapling is influenced by how we cope and how our community responds.
For example, it is totally normal for humans to feel afraid in the presence of danger. However, even one instance of fear-based avoidance—in contrast to danger-based avoidance—can lead to a pattern of coping that we term an anxiety disorder. As another example, grief is a normal “symptom” of traumatic loss. If we receive messages that there is something wrong with our grief, we may stuff it down, shame may abound, and the grief process is prolonged. Sometimes this gets called PTSD. Other times it gets called complicated grief.
If we are able to cope effectively, our symptoms resolve naturally and often do not become a disorder. In those situations, seedling never takes root, even if it sprouts. The circumstances don’t allow for it to grow into a full blown disorder. There’s a famous study from back in the late 70s that showed that psychosis is much less common in developing countries where there are different extended family systems, employment expectations, etc., even though the use of psychiatric medications in those same countries is much lower.
Other times a sapling does become a mature tree. Our environment can predispose us to particular ways of coping when we are distressed. We tend to do what we see around us. This is not the “blame the parents” mantra that some psychologists of old would go on. Sometimes there is a perfect configuration of circumstances that leads to the development of a psychiatric disorder. To prevent the tree from taking over the full yard, families and communities are the most powerful tools. The Trieste model of community mental health and Open Dialogue are powerful examples when it comes to psychosis. The SPACE model is a wonderful gardening approach to little anxiety and obsessive-compulsive trees.
So, while the answer is “yes,” or “both” or "epigenetics," it cannot be captured in a single word alone. Ultimately, I encourage folx to take a beat and ask why they care about finding a debate winner. Given that this is not debate club and it’s life we’re talking about, what would it be like to drop the search for how this particular seed ended up in this particular inch of the garden, litigating how much sunlight it received on March 24 and by whom? Letting go of the etiology debate can free us up to home in on what matters: tending to the garden and appreciating its beauty.
