Cause is not everything in mental illness

The past week has been big for mental illness. As reported last week in this journal, psychiatric researchers have uncovered a spread of genetic clues to schizophrenia, potentially shedding some biochemical light on how this dreadful disease develops. At the same time, a leading US centre for research on mental-health disorders announced a record US$650-million donation from philanthropist Ted Stanley to boost that work (see Nature 511, 393; 2014).

Good news all round. And more could yet follow: genetic understanding of psychiatric disorders, together with more research on the unusual ebb and flow of circuits in the brain, promise a revolution. Researchers of brain disorders compare the current state of their science to knowledge of cancer a decade or so ago, before molecular approaches could stratify patients and select specific treatments.

The latest study on schizophrenia could be a small step forward in this march. Or it could be another false start in a field that has endured more than its fair share. Psychiatric research has yet to provide a single reliable biomarker to aid diagnosis and treatment. Self-reported symptoms and their subjective interpretations remain the basis for clinical diagnosis. Drug companies have walked away. The task of unravelling the biological pathways that drive mental illness, which are needed before drug targets can be identified, has been declared too difficult and too expensive.

Of course, some perspective is needed. Psychiatric research had a long and painful birth. Just a generation or two ago, at a time when physicists had split the atom and biologists were deciphering the structure of DNA, a common treatment for schizophrenia and other mental disorders was a metal spike hammered up through the top of the eye socket and waggled around. With such a history, a lag of a mere decade or so behind cancer research can be taken as a sign of rapid progress.

Whether or not the latest study on the genetics of schizophrenia takes that progress forward, it has already contributed to the public debate around mental illness and public understanding of the issues. It has raised and highlighted the ‘C-word’: cause.

I have obsessive–compulsive disorder (OCD). That used to be a secret, but in April I published a book about the condition and my experiences of it. Despite its frequent portrayal as a behavioural quirk, OCD is a vicious and debilitating mental illness, with some similarities to the experiences of schizophrenia. Simply put, people with OCD can have some of the same dark ideas, thoughts and images as someone with schizophrenia, but the person with OCD is fully aware that they generate the thoughts themselves. (The psychosis that defines schizophrenia is characterized by a lack of such insight, and people with the condition typically attribute the intrusions to an external source.)

I now give talks about my OCD. A frequent question from the audience is one that I am still ill-prepared to answer: “What caused it?”

I don’t know, and more to the point I don’t care. For 20 years or so I have battled the symptoms. More recently, I sought and received treatment for those symptoms — a high daily dose of the antidepressant sertraline hydrochloride and several months’ worth of weekly sessions of cognitive behavioural therapy. It seemed to work, and without anyone — psychiatrists, psychologists or me — trying to identify the cause.

Perhaps the question from others is down to simple curiosity. I tell a human story and it is natural to want to know how such stories begin. Maybe there is a degree of self-interest because people do not want to follow the path that I did. It could be me who is unusual in not caring about a cause, but when I find out that people have cancer or heart disease or have had a stroke, the cause of their suffering is pretty far down my list of enquiries. In the past two or three years, I have met lots of other people with OCD and other mental disorders. Many of them, like me, do not know and do not seem to care about the who, the where, the why and the when of their illness. There is only how.


Thanks for sharing this with us, Firemonkey.

My response to this piece is as follows: For those who respond well to the current treatments that psychiatry and psychology have to offer (and the author of this piece seems to be one such individual), I can see why getting to the bottom of the cause of their illness(es) might be low on their list of concerns. One issue I see with the argument made in this piece is that there are a lot of individuals with mental illness who don’t respond well to the treatment options that are currently available. Simply playing a guessing game that drug x or therapy x might work based on these individuals’ presentation of symptoms isn’t cutting it for these individuals, and finding out what’s causing the illnesses that these individuals suffer from might be the only way of eventually coming up with treatments that work. Furthermore, with today’s trial-and-error approach to treating mental illness, there are individuals who do eventually find a treatment approach that works for them, but this sometimes takes a long time. By understanding the causes of mental illness and developing treatments aimed at the causes, researchers can help cut down at this wait time that oftentimes leads to things like damaged careers, damaged family relations, and even lost lives.


in this day and age there are so many causes that it could be it is impossible to pin it down to just one thing or another, there must be a series of events or a series of things that combine to trigger our mental illness,

these things are usually under the radar lurking in our unconscious waiting to rear their ugly heads, so why does our subconscious (the gate keeper) let these thoughts break through into reality? we have to filter out lots of rubbish from the masses of information we get everyday but when this filter is faulty this rubbish can really cause us distress.

like a computer systems filing system and the memory is the unconscious mind for example and things get put in to the wrong folders and some software doesn’t work because files are corrupted and things that were important get put in the trash bin, its really complicated but it makes sense in a way.

it would be good to have a reset button at this point or a restore button, if we could put all of our thoughts and feelings that we want to keep and then put it on a storage device then hit restore to factory settings would that be a cure?

it is a good time for mental illness but i am still not satisfied of a complete cure, i think if they could at least make medications less dangerous and make us live longer with better lives and no side effects i would be satisfied.

1 Like

I am amazed at how far this field has come in some cases. The way I was treated 12 years ago during my onset and the way my youngest brother is being treated now… it’s improved in some cases.

I also like to glimpse old books on mental illness and just shake my head at all the stuff they thought caused mental illness…

I’m not too worried about origin… it does scare me when I read stories like… “If we could just tinker with someone’s head before they have onset… or tinker with the development while in the womb… then we could wipe out mental illness.” That bothers me.

But finding better meds, finding better ways of patient management, finding better ways to address side effects and other functionality… that interests me greatly.

1 Like

the thing is that idk what they are expecting to do with this research and information once they get it,

i mean you can’t cure schizophrenia like you could cure cancer, for one thing cancer is a physical disease and sz is mental which is totally different

and when they talk about controlling the symptoms they are really talking about controlling you and your brain but how much control is it ok to have until you are not even yourself anymore,

can they target each individuals separate synapses that are miss firing in there own way leaving only what is deemed reasonable to modern day society

1 Like

The idea of brain tinkering concerns me a lot. I hate the idea of brain tinkering.

I would love to see better patient management.

Maybe this new research will help knock a brick or two out of the stigma wall depending on the findings and what they are trying to do and how it’s presented.

1 Like