Mental Health Professionals and Patients Often Disagree on Causes of Symptoms

A new study finds that clinicians’ disregard for psychiatric patients’ insight into their own condition may be detrimental to treatment.

Ayurdhi Dhar, PhD
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In a new article published in the journal Psychiatry Research, John Read of the University of East London investigates how patients taking antipsychotics understand the causes of their symptoms. Read argues that mental health professionals should better appreciate the causal explanations offered by both psychiatric patients and the public at large to improve care.

Read finds that while mental health professionals tend to offer bio-genetic causal explanations for patients’ symptoms, the patients themselves frequently endorse psycho-social ones. While, at first, this disagreement may seem trivial, the author suggests that it can have significant consequences. Many psychiatrists consider a patient’s refusal to acknowledge the bio-genetic genesis of his/her symptoms as “lack of insight” and, therefore, a marker of a diseased brain. Read writes:

“So making causal attributions that involve your life experiences or circumstances is a clear sign of ‘lack of insight’, which, in turn, is a clear symptom of an ‘illness’ with a bio-genetic etiology … Believing that your psychosis is a meaningful reaction to life events has always been proof that you are ‘schizophrenic’, ever since the invention of the construct over 100 years ago.”

A Different Perspective – Points of View by Japanese Photographer Yusuke Sakai (Creative Commons)

Throughout the history of psychology, the viewpoint and expertise of the clinician have been privileged over that of the patient, even when the patient’s experience was the topic of discussion. There is a small but growing push within the discipline to acknowledge the importance of the patient’s insights into their condition, as evidenced by recent research involving patient’s views on diagnosis and antipsychotics. Read’s insistence, that clinicians pay closer attention to the causal explanations of symptoms offered by patients, is in keeping with this trend.

There is much debate around the causes of “madness” and psychosis. As indicated in this article, the majority of mental health professionals seem to hold a biomedical view of psychosis as a brain disorder, identifying many causal mechanisms in biology, such as dopamine deregulation, loss of grey matter, and inflammation in the brain. However, there is a growing body of evidence suggesting that psycho-social causes (adverse experiences during childhood, trauma, social disadvantage, etc.) may be as important, if not more so, than bio-genetic ones.

Regarding the treatment of psychosis, the biomedical model tends to advocate for the use of antipsychotics despite the harmful long term effects, impairment of working memory and executive function, and links to brain atrophy. More recently, interventions for psychosis that acknowledge the psycho-social causes are becoming increasingly common. By emphasizing the importance of social relationships and involving the patient more in their treatment, some clinicians have started producing better outcomes than long touted biological interventions.

The current study is the largest survey of its kind, asking 701 participants from 30 countries about the causes of their psychological symptoms. Although all the participants in the study were prescribed antipsychotic medication at the time of the research, only 277 of them had a diagnosis in the psychosis spectrum.

Read points to some of his research from 2013 showing that psychiatric patients and the public at large overwhelmingly prefer psycho-social causal explanations of madness, with 73% believing that psycho-social factors are more important and only 20% favoring bio-genetic factors. Another study is discussed indicating that among clinicians, patients, patients’ families, and the general public, clinicians were the most likely to endorse bio-genetic factors and least likely to support ‘the way he was raised’ as a causal explanation of psychiatric symptoms.

One possible exception to this comes from a study conducted with samples from the United States, where 45% of patient’s family members favored bio-genetic factors compared to just 12.5% of samples from other countries. Read also notes that several studies have outlined the positive correlation between the belief that psychosis is caused by bio-genetic factors and negative attitudes towards those that experience psychosis.

The current research seeks to collect additional data about patients’ causal beliefs regarding their psychological symptoms by employing ‘The Experiences of Antidepressant and Antipsychotic Medication Survey.’ The survey was conducted online using the Qualtrics platform. The data reported in the current research came exclusively from patients’ open-ended responses to a single question from the survey: ‘There are many theories and lots of debate about what causes mental health problems. What do you think caused the experiences for which you received antipsychotic medication?’

The responses were then organized into seven causal categories using thematic analysis, and each participant was given a “bio-social” score between 1 – 5 with one indicating purely biological and five indicating strictly social. Finally, these “bio-social” scores were analyzed in relation to the participant’s pertinent demographic information (gender, age, duration of antipsychotic treatment, helpfulness of antipsychotics, symptoms, and diagnosis).

The results of the current research seem to validate the 2013 findings further. 76% of the participants, including 81% of the participants experiencing psychosis, reported a causal understanding of their symptoms as exclusively or predominantly social versus just 17% that said the same of bio-genetic causes. Only 6% of the participants experiencing psychosis reported a predominately bio-genetic causal understanding of their symptoms.

17% of respondents also understood the cause of their symptoms to be the very treatment meant to help them, citing among other factors: forced drugging, inattention on the part of the clinician to the patient’s past traumas, and withdrawal from medications. 54% of the participants believed their quality of life was worsened through the use of antipsychotics versus 35% that believe the drug had improved it.

The overall average bio-social score of all the participants was 4.24, indicating an overwhelming preference for psycho-social causal explanations over bio-genetic ones. These scores were negatively correlated with the patient’s perceived quality of life changes brought on by taking antipsychotic medication, meaning those with predominantly bio-genetic causal beliefs are more likely to experience positive effects from antipsychotics. Read writes:

“Respectful recognition of both the full range of causal explanations, and of the preponderance of social causes in the lives of people experiencing psychosis should, in conjunction with the confirmatory research mentioned earlier, lead to a more balanced, genuinely integrated approach to assessment and treatment, but one that places appropriate emphasis on the sorts of causes identified by those who know best about what has gone on in their lives.”

Read acknowledges that this research had several limitations. The participants were selected using a convenience sample that significantly underrepresented minorities and overrepresented women. The online nature of the survey may attract people that are less satisfied with the topic of the study — in this case, antipsychotics and bio-genetic causal explanations for psychiatric symptoms. The author also recognizes the subjective nature of thematic analysis as a limitation.

Read is arguing for an approach to treating mental health patients that acknowledges the limits of psychology’s current understanding of ‘mental illness.’ Rather than interpreting patients’ causal understanding of their symptoms as further evidence of their madness, perhaps clinicians should recognize the wisdom in their patients’ explanations that the bio-medical model cannot appreciate.

 

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Read, J. (2020). Bad things happen and can drive you crazy: The causal beliefs of 701 people taking antipsychotics. Psychiatry Research, 1-39. DOI: https://doi.org/10.1016/j.psychres.2020.112754 (Link)

33 COMMENTS

  1. Dear Doctor,
    I am so relieved that I am in the care of someone that knows which illnesses I have after telling you
    how I feel and how I think I think.
    Thank you for listening closely so you know exactly which neurons are coated with protein and which have weak connections.
    Thank you for the non toxic drugs and your willingness to let me try more.
    Thank you for helping me gain insight into the reasons why I have this, this thing.
    I believe your drugs gave me insight.
    Thank you for the time I was beside myself and you cared enough to rescue me from suicide and kept me locked up for my own good. I did not realize what was good for me until I met you.
    Even though I worship you, I promise not to get too dependent on you, except for the prescriptions because I know how needed they are for my survival.
    I also realize they do not cause other harms because you assured me that they were safe.
    I am glad dear doctor that there are such caring people such as yourself.
    I would not ever have gained insight into my biology if not for you.

    I used to not trust psychiatry, but you are so different, so caring….in hindsight, perhaps I did not trust them because of my lack of insight, but you fixed that major obstacle.

  2. “Rather than interpreting patients’ causal understanding of their symptoms as further evidence of their madness,” which, in and of itself, is maddening maltreatment.

    “perhaps clinicians should recognize the wisdom in their patients’ explanations that the bio-medical model cannot appreciate.” And the clinicians should learn a little about the drugs they’re prescribing. Like, for example, both the antidepressants and antipsychotics can make people psychotic, via anticholinergic toxidrome. And the ADHD drugs can also make people psychotic.

    Thank you, Dr. Read, for pointing out the blatantly obvious to the “mental health” workers, who apparently are ignorant of the importance of treating others in a mutually respectful manner.

    And I do hope our “mental health” workers will some day get out of the child abuse covering up business, since that’s an illegal business. But it is the primary actual societal function of both our psychologists and psychiatrists today.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo

    https://www.madinamerica.com/2016/04/heal-for-life/

    As well as all the other “mental health” and “social” workers, since NO “mental health” or social worker may EVER bill ANY insurance company for EVER helping ANY child abuse survivor EVER, by DSM design.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    And these systemic child abuse covering up crimes of our “mental health” workers have also functioned to aid, abet, and empower the pedophiles and child sex traffickers. Systemic crimes against child abuse survivors, and their legitimately concerned family members, which are destroying our country from within, even according to ethical “mental health” workers, and world leaders. World leaders, who still seemingly don’t know the root cause of these societal problems, however.

    https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT
    https://nypost.com/2018/04/11/trump-signs-law-against-online-sex-trafficking/
    https://worldtruth.tv/putin-the-west-is-controlled-by-satanic-pedophiles/

    • Non Bio/Bio

      The Bio approach doesn’t work that’s why “Schizophrenia” is classed a long term Mental Illness, characterized by enduring disability, physical ill health, and early death.

      The only people with “Schizophrenic” Diagnosis that I’ve heard of genuinely recovering, have managed to do this through the non bio approach, and rejection of the bio approach. So, for me it’s straightforward.

  3. ““So making causal attributions that involve your life experiences or circumstances is a clear sign of ‘lack of insight’, which, in turn, is a clear symptom of an ‘illness’ with a bio-genetic etiology … Believing that your psychosis is a meaningful reaction to life events has always been proof that you are ‘schizophrenic’, ever since the invention of the construct over 100 years ago.””

    Lack of insight? I could almost laugh at the notion. How many human beings, mentally ill or otherwise, have that kind of insight? Very very few. To label a person schizophrenic because of that would seem beyond foolish to me.

    • It is psychiatry that holds the insight. If we spend enough time in their presence we too can gain such and especially alongside meds and compliance is part of that insight.

      Isn’t insight to know that one does not know? After all, if I knew what my ‘problem’ was, I would never need a shrink. The good thing is, he knows that my ‘problem’ has a name, and the meds to deal with it.

          • No, that’s “anosognosia!” EVERYONE is mentally ill because we SAY they are mentally ill! True insight is giving up on rationality and accepting psychiatry’s nihilistic worldview. At least, that’s THEIR definition of it.

          • Psychiatry’s worldview is nihilistic. Succinctly put, Steve. It’s a shame our mainstream religions have bought into that nihilistic worldview. But that reality does also explain the complete and total lack of ethics, criminal behavior, and refusal to repent and change from one’s evil ways, by both today’s nihilistic mainstream religions, and their “mental health” minion.

    • Nonstandard_Nolan wrote: “Lack of insight? I could almost laugh at the notion. How many human beings, mentally ill or otherwise, have that kind of insight? Very very few. To label a person schizophrenic because of that would seem beyond foolish to me.”

      I could give many personal examples. It’s not something I’m i the habit of doing so just this once I’ll choose one and then we’re done with it.

      I had become convinced that my body had been infiltrated by undetectable supernatural parasites. Or they may have been alien life-forms. I was undecided. Time went by and I ran a bath and half filled it with bleach and topped that up with hot water and I sat in it and I scrubbed off much of the outer layer of my skin.

      That, to me, was a lack of insight. Which really means that the intense insight I had, and the actions spurred on by those erroneous inisghts, were clearly a lack of insight into the fact my insight had become severely impaired.

      • Sitting in a tub of bleach and scrubbing your skin off is an inherently illogical and irrational act. It can’t be understood logically and rationally. It can only be understood illogically and irrationally…. Which basically explains *WHY* psychiatry is in fact also illogical and irrational…. But it makes $$$$ for PhRMA!….

        • Bradford wrote: “Sitting in a tub of bleach and scrubbing your skin off is an inherently illogical and irrational act. It can’t be understood logically and rationally. It can only be understood illogically and irrationally….”

          Now that there is some distance between myself and the previous self that performed that act, I can tell you with utmost sincerity that my insight at the time was perfectly logical and rational and very many people who’d followed a similar course that led up to that point would have done much the same, or worse. I’ve only ever encountered one similar narrative and that person chose to douse themselves in a flammable liquid, set themselves alight, and then quickly attempt to extinguish the flames. The insight they were working under was also, contextually, logical and rational.

          What was lacking was insight into impaired insight,

          It can often require a third party to perform that function. To assess whether someone has logically and rationally arrived at mentally healthy insight, or has in fact, an impaired mind, or as some perfer to call it, a mental illness.

          At the same time as such things were going on in my life I was submitting literary analyses that were praised.

          So it’s not like I had taken leave of all my faculties of reason or comprehension.

          • An impaired thought or action is not an impaired mind. You wrote analyses with the same mind.
            Yes it helps to have third parties to suggest options to bleach. However, if that third party is more “impaired” than the bleach theory, but uses another chemical to rid you of your bugs, or rather, psycho surgery, which “treatment” is the better, more temporary option? Perhaps the bleach is a one time treatment and enough to ward of the bugs, or gain a better understanding of the bugs.

            So perhaps, there are great third parties that don’t rush to more chemical agents.

      • There are not such suffixes of Greek origin (to match the psych-iatrikos part which is in Greek) to sound familiar enough (to be used in other scientifical terms). Other choices would be to change the meaning, like pseudopsychiatry or psychiatromania.

        Nevertheless, the essence is that psychiatry is imo an expression of a state of confusion among most people, including those who become psychiatrists. Such a deep and apparently unrecoverable (for most of them) confusion that may be considered insanity.

        For a specialist to be helpful for others in cognitive problems, he needs to have a more complex understanding of what the human mind, in fact the human being is. I think it would require extended philosophical and theological studies. I hope not be intrusive if I would refer to Eastern Christian ascetic literature, which may be an interesting lecture (if you don’t know it already), as it contains sort of humane psychology discovered by the life of contemplation of some hermits. It has nothing to do with organized religion, official churches just stole this spiritual – cultural heritage and made it theirs. Also, in its psychological approaches at least, it contains observations that are not religious but just “psychoanalytic”. I speak about works like The Ladder of John Climacus, Apoftegmata Patrum, Philokalia etc. And from contemporary authors, Sophrony Sakharov, who speaks about the “microcosmos” human nature and about the subtilities of mental “movements” and their effects in the overall structure of the personality.

      • No, psychiatry is a disease of belief. You can only have it if you believe in it. Stop believing in it, and it ceases to be real. Psychiatry is 100% belief-dependent. I’d go so far as to say that the ONLY true so-called “mental illness” is belief in psychiatry itself.

        • Beliefs have very strong psychological and even physiological effects. If you believe the psychiatrist telling you that you are mentally sick, you really damage your cognition.

          This why most people enter mental hospitals with mild affection and come out with severe, irreversible mental impairment.

          As for psychiatrists, I can’t say how sincere is their belief in their profession. It would be interesting to know how many of them take dopamine-inhibiting drugs themselves or prescribe them to their family’s members.

          In Romania I’ve read years back about a psychiatrist giving himself electroshock therapy but beside being tragic, is something rather peculiar.

          • Psychiatry started with great enthusiasm of being interested in other people’s minds.
            It was an obsession and neurotically driven. Psychiatry said, we can deal with your diseased mind. We are the experts, believe in us. People have generally been impressed with those who have answers.

            The psychiatry we have now, are just people looking for a job and they do best in fields where they can exert their biases in a legal manner.
            Psychiatry and most psychology along with it’s minions needs to come down to earth.
            As far as delusions, I propose that “resiliency” might be a delusion. It cannot be measured. What often looks like resilience is perhaps apathy. We can be emphatic in one area and yes, be blessed with an ability to distance from stuff that affects the sensitive or neurotic.
            We tout resilience as a character stable. How can we, when it might simply be a an inability to feel or identify with others?
            I doubt we would have utopia if everyone was resilient.
            I still have not gained the insight needed to see that psychiatry is helpful.

  4. Regarding “Causes of Symptoms”:

    The discovery of science is all about asking different questions. The purest source of the science we are talking about is the patient, their experience. The simplest answer is to actually ask the patient. Rather simple but true.

    Yet, ‘simple’ does not satisfy the human intellect. We have to write hoards of documents to prove to ourselves and the world what we have discovered!

    Feel the truth in this statement:

    “What is causing many symptoms is the medication treatments themselves. There is a great overlapping of ‘similar symptoms’ from treatment and illness. It can’t be seen if the ‘right questions’ are not being imposed on the person with illness.”

    All we have right now is a question. Not technology!

    Ask me. I am a patient.

  5. Absolutely outstanding. The best synopsis of the causes in a person’s life I have ever read. Only Paris Williams has done this well describing “schizophrenia” studies in the first couple chapters of his book on psychosis. Congratulations, Dr. Read. And a brilliant summary by the author as well.

    • One last note: All that this summary neglects to mention is the ACTUAL, root cause and the REAL resolution of schizophrenia, which is always — without any question — to be found in one’s relationship, to God whether one is aware of it or not. More research of this kind is urgently needed on precisely this question, and when someone does it, you will have almost the whole ball of wax in a single go.

  6. Obviously, politics is part of the equation too. There must be recognition of social factors including TBI cover-ups,gas-lighting, framing/entrapment, conspiracies, etc.

    When a scapegoat becomes a political target; there are bandwagons that many, many people jump on and take out their frustrations on that scapegoat. It is a sport that brings out the worst in people.

    MIA readers who understand that psychiatry is a fraudulent business must advocate for restorative justice for psych scapegoats. Restorative justice is healing that is badly needed in this society that depends far too much on punishment and throwing away keys to truth and justice.

    • That is a good point, not oft made, psychiatry scapegoats their clients. I’ve been painting goats in my artwork to represent that reality for decades, but haven’t heard it verbalized often. Chagall, a Jew who survived the Nazi psychiatric holocaust of the Jews, painted “scape” goats often, too.

      I couldn’t agree more, “Restorative justice is healing that is badly needed in this society that depends far too much on punishment and throwing away keys to truth and justice.” We are now living in a world where speaking (or visually documenting) the truth is a revolutionary act, which gets you attacked by criminal minded “mental health” workers, hell bent on covering up previous “mental health” workers’ crimes.

  7. How can mental health professionals offer bio-genetic causal explanations for patients’ symptoms, when chemical imbalance theory has never been proven? Yet I see it in my work everyday, and just experienced it personally with a nephew. This was revealing – “One possible exception to this comes from a study conducted with samples from the United States, where 45% of patient’s family members favored bio-genetic factors compared to just 12.5% of samples from other countries”. Marketing machine is getting the job done in the USA – damn

  8. Charles Whitfield has written book about his findings that environmental traumas cause most psychiatric disorders. Perhaps because I went into medicine from postgrad science I always looked into patients personal histories for the cause of their emotional disorders, and found that this was so successful that drugs were seldom needed. I had several courageous psychotic patients who trusted me enough to work with me to discover the trauma that had caused their condition: it was in infancy, when our right cerebral hemispheres are learning and developing, and our left brains haven’t yet developed their linguistic abilities.
    Recovery required not only insight, but often nurturing to replace what we mammals require. Darwin had to remind us that we are animals who’ve evolved, and I sometimes wonder if we forget that we are mammals who are born very prematurely in order to get our big heads through the birth canal.

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