The Blame Game - who is at fault when it comes to mental health?

There has been an opening up in Dublin, and Ireland, about mental health issues in recent years. People are more willing to talk about their mental health to friends and family, and also to seek out advice from doctors, psychotherapists and counsellors.

This is a good thing. As the conversation continues more people who once may have suffered in silence now feel like they can get the help they need. There is still a long way to go in raising awareness and acceptance of mental health issues, and one area that is still painful for many is the notion of blame and responsibility.

Who is To Blame?

The belief that mental issues should be easily overcome because they are just in your head is a particularly common one, even held by those who are suffering with an issue themselves. That is why any evidence that there is a physiological or medical explanation for a mental health problem is usually embraced and greeted with great fanfare. The reality, as many in both the medical and psychological field will tell you, is usually far more complicated. This issue has come up again with a recent study into anorexia and genetics.

Is anorexia a mental health issue?

Anorexia Nervosa is one of the most lethal psychiatric conditions there is, and one that is considered extremely difficult to treat. A new study implies that the reason interventions at a psychiatric and psychological level have such poor success is because a huge part of anorexia is genetic. Up to 50% of the condition could be due to one’s genetic make-up, with a combination of genes interacting to make someone more likely to develop the illness. Traditionally, the main approach for the treatment of anorexia has been forms of psychotherapy such as Cognitive Behavioural Therapy (CBT) or similar, but if the findings of the new study are supported and corroborated by further research then the implications for the treatment of anorexia are far reaching. The emphasis to date has been on environmental and psychological issues being the cause of the illness, but having such a large part of the illness attributable to genetic factors could open the door for new treatments that focus on metabolism and other approaches that tackle the body and its physiology. 

A solution for eating disorders beyond psychotherapy?

There is a great need for caution in light of such findings. The study has so far uncovered eight genes that it determines are related to anorexia, but the reality is that any single person with anorexia, like everyone else, will have hundreds if not thousands of genes that go some way to determining their likelihood of developing the illness or any other form of condition.

Yes, having a more nuanced and comprehensive understanding of the role that our genetics play in anorexia, or any other form of mental illness for that matter, is a very positive development, but it is still only part of the story. Is the difficulty in treating anorexia down to this missing genetic aspect of the illness? If we rush to conclude that yes, the answer is in our genes, then we risk bypassing the person at the centre of the illness, the patient themselves.

There is no quick fix when it comes to mental health, and as we have seen with the increasing rate at which antidepressants and anxiety medications have been distributed over the last 10 years in Ireland, there is a large appetite for medical solutions to mental health issues. There are many cases in which medication provides vital relief and support to those suffering, but to rely on it exclusively rarely leads to long term benefits and recovery. 

Psychotherapy and Counselling for Eating Disorders

One worrying and hurtful aspect of the psychological explanation for mental illnesses such as anorexia and other eating disorders such as bulimia is the attribution of blame. Usually it is the individual suffering who is on the receiving end, because surely they must be able to just snap out of it if it is only in their head? Or worse, perhaps they are exaggerating or seeking attention. The other side of the blame game is the family and its environment. This is a common issue in anorexia, with parents particularly coming in for criticism if there is a child with the illness. This is not helped by an oversimplification of what is meant by ‘environmental factors’ involved in anorexia. Anorexia is often found in people with very loving and supportive family environments, and the implication of having done something ‘wrong’ can add further stress and upset to an already very difficult situation. Little wonder then that any explanation that places the blame for a condition on something beyond control, such as our genetics, would be embraced. 

Psychotherapy, Counselling and Psychoanalysis

A psychoanalytic approach to mental health (one which has had its own history of being subject to scepticism and doubt over the years) starts from the position that we know very little about what it is that motivates us in our actions. The existence of the unconscious is something which many still find difficult to understand, but it is key to understanding our behaviours and actions, especially the ones that seem to make no sense.

The fact that we often act against our own best interests or make seemingly irrational decisions is explained by the existence of the unconscious, a side of our mental life that we aren’t familiar with but still plays an important role in the choices we make. Psychoanalysis places an emphasis on working with the unconscious side of the patient’s mental life, and attempts to uncover the underlying issues that are influencing our behaviour. By bringing these underlying issues to the surface, psychoanalysis allows the patient the time and space to work through them, and gain some kind of understanding that eases the burden of their symptom. This leads to long term change, and can be life saving. 

If you or someone you know would like to speak with a counsellor or psychotherapy in South Dublin about this issue, contact us.