Thursday, 27 September 2012
So let's talk about aetiology or etiology - the science of causes. The origin of aetiology is the Greek word, aitia, which is commonly translated an explanatory factors but is also translated as "responsibility".
Medical history is full of "causes" and "blaming". We don't have to look far back in history to see the rise of the concept of eugenics, improving the genetic composition of the population through selective breeding. Those unfortunate parents who gave birth to an intellectually disabled child were positively encouraged not to have any more children. They were somehow "tainted" and would be "tainting" the genetic pool. Aside from that, vast swathes of the population were condemned - the Jewish people, the Romany people, homosexuals, promiscuous women (?), the blind, the poor. All these children born this way were "unfit" to breed.
Extreme parent blaming?
Eugencis fell out of favour after the Second World War, which is a GOOD thing. However, to take its place, aetiology turned its attention towards parenting as a "cause" of various afflictions, including mental illness. "Bad parenting" was thought to cause autism, schizophrenia and a myriad of other conditions. Although advances in science has disproved the theory that "bad parenting causes mental disorders", the truth is that many clinicians still believe it and practice therapies that subscribe to the "root cause" being parenting.
As I have said so many times before, of course environmental factors can play a part in the onset of mental disorders. Of course, the world is not populated by perfect parents. Of course, parents have a huge influence on their developing child. However, the simplistic theory of attributing a patient's mental (and often physical) distress to "bad parenting" is not proven, not evidence based and not correct. All mental disorders seem to have no one single cause. Drug induced schizophrenia? Why was the patient abusing illegal drugs in the first place? Anorexia? Why did the patient have an energy imbalance? The advances in the studies of genetics (and epigenetics), neurotransmitters and neurobiology seems to be evening out the environmental "blame game" and swinging the pendulum against purely environmentally driven mental disorders.
Why am I still coming across discussions on the internet entitled "How do parenting styles cultivate symptoms of BPD?". Hold on a minute there, researcher. I think that is a bit of a loaded question and *I* am offended. Here is the NHS definition of the causative contributors to BPD. I like using the NHS definitions because they have nothing to sell by way of treatment.
One of the most important factors that seems to be missing from the continued research into the effect that parenting has on mental disorders is this:
Most of what mental health professionals know about parenting of people with mental health disorders comes from the patients themselves. When people are suffering great distress they tend to focus on, and recall, negative events, rather than positive ones. In recovery, or when less distressed, patients often change their focus and their recollection.
(Good old Hilde - you know how much I like to tear her work apart. Her clinical observations of patients who were severely malnourished and taking their "ramblings" as a truth did so much harm.)
Here is an extract from the Minnesota Starvation Experiment, which helped me to understand the effect of malnutrition on mood:
As semistarvation progressed, the enthusiasm of the participants waned; the men became increasingly irritable and inpatient with one another and began to suffer the powerful physical effect of limited food. Carlyle Frederick remembered “. . . noticing what’s wrong with everybody else, even your best friend. Their idiosyncrasies became great big deals . . . little things that wouldn’t bother me before or after would really
make me upset.” Marshall Sutton noted, “. . . we were impatient waiting in line if we had to . . . and we’d get disturbed with each other’s eating habits at times . . . I remember going to a friend at night and apologizing and saying, ‘Oh, I was terrible today, and you know, let’s go to sleep with other thoughts in our minds.’ We became, in a sense, more introverted, and we had less energy. I knew where all the elevators were in the buildings.” The men reported decreased tolerance for cold temperatures, and requested additional blankets even in the middle of summer. They experienced dizziness, extreme tiredness, muscle soreness, hair loss, reduced coordination, and ringing in their ears. Several were forced to withdraw from their university classes because they simply didn’t have the energy or motivation to attend and concentrate (3).
My view is that the continued devotion of too many clinicians and so-called therapists to attribute the blame for mental disorders on parenting is detrimental, life threatening and about as useful as a chocolate teapot. Treating mental disorders, without ascribing blame, partly involves keeping the patient in a warm, stable, loving environment as much as possible. The majority of parents offer this for no fee. Whilst some patients may need to be moved for their personal safety and the safety of others to a more specialised facility, most patients benefit from being in the security of their home, with their parents.
To highlight my argument for stopping the blame game, this piece of research popped up on Google.
Ascribing aetiology of mental disorders to bad parenting should be, and must be, a thing of the past.