Nature vs. Nurture in the Etiology of Mental Illnesses: Implications for Residential Treatment
The following post represents thoughts of Dr. Christopher Grala, Psy. D., the executive director of Spirit of Gheel, a therapeutic community in Pennsylvania. The post was prompted by an article appearing in The Guardian on March 31, 2014 concerning the current state of research about the genetics of psychological traits and disorders.
It has become commonplace in modern psychiatry to attribute a wide range of mental disorders to genetic influences or risk factors.
Based on longitudinal studies of incident rates within families, genetic agents are considered to have a causal role in depressive and anxiety disorders, bipolar disorders, personality disorders, substance abuse disorders, and particularly in non-organic psychotic disorders such as schizophrenia.
There is less agreement, however, regarding the precise “loading” of genetic factors in the development of such illnesses:
Do genes constitute 40% of contributing factors? 50%? 60%?
Are genes (nature) significant determining factors in developing severe mental illnesses?
Or do they set pre-dispositional conditions which, in conjunction with environmental factors (nurture), lead to the onset of such disorders?
In a relatively recent article in London’s The Guardian (3/31/14), one of Great Britain’s leading genetic psychologists, Robert Plomin, made the astonishing statement that in the course of his work with the Human Genome Project’s research into identifying genes associated with psychological traits of all kinds, “I’ve been looking for these genes for 15 years and I don’t have any.”
According to Dr. Plomin, there is as yet no compelling evidence of any kind that decisively establishes a causal link between genes and mental/emotional disorders. While this is not to say that such links do not exist, or will not at some time be discovered, it certainly presents a very different picture of the actual state of knowledge regarding the causal role of genetic factors in the etiology of mental illnesses than what is often suggested in the popular literature.
Given this state of knowledge, it would appear incumbent for providers of mental health services to seriously consider the vital role that environmental and social factors may occupy in facilitating treatment and recovery.
This is particularly true of long-term residential treatment settings. In these settings, there are unique opportunities for planfully incorporating reparative, therapeutically-informed patterns of interpersonal relatedness into the structure of daily programs and activities. While psychotropic medications are a useful – and in many cases essential – component of treatment for severe mental illnesses, our current state of knowledge suggests that in the context of residential programs they should most aptly be regarded as adjuncts to a comprehensive, psychosocially informed therapeutic environment.
There is a contemporary trend of “medicalizing” problems of living – a trend beneficial to, and hence heavily supported by, the managed care and pharmaceutical industries. Residential therapeutic communities, while recognizing the importance of the judicious use of medication, place primary emphasis on providing emotionally secure “holding environments”. These environments enable trusting, restorative relationships to be nurtured, modeled, practiced, discussed, and internalized as a foundation for risking change.
Many of us who are responsible for providing residential treatment to individuals suffering from severe, chronic mental illnesses believe that this approach is not only consistent with the actual state of knowledge concerning the etiology of such disorders, but is in many respects strongly mandated by it.
About The Author
Dr. Grala is a licensed clinical psychologist with over 30 years experience providing direct care and senior management services within residential, inpatient, and long-term care settings. Dr. Grala’s previous positions have included Clinical Director of two psychiatric hospitals in the Philadelphia area, Administrator of a residential treatment facility in Ephrata, PA, and Regional Director for a behavioral health management company overseeing the operations of five mental health agencies in the Central and SE regions of PA. Dr. Grala most recently served as Clinical Director of Spirit of Gheel and Regional Clinical Advisor for a national geriatric health care company providing psychological services to long-term care facilities. Dr. Grala is the author of published papers in two professional psychology journals, and is a Member of the American Psychological Association. He is currently Certified as a Personal Care Home Administrator in the Commonwealth of PA.
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