The Causes of Psychiatric illness

The Causes of Psychiatric illness

Illness is generally the result of a number of different factors operating together rather than of a single cause. For example, an illness such as pneumonia may be regarded as an infection of the lungs by bacteria, but mere contact with such organisms does not necessarily lead to pneumonia. A person's inherited susceptibility to chest infection, his own acquired resistance to the bacteria and his general state of bodily health may all influence the result. In addition, his body's reaction to the infection may modify the severity of the illness.

Similarly, the causes of a psychiatric illness may include an immediate precipitating cause, emotional or physical, an inherited liability to emotional disorder, and the susceptibility which a person may develop in his own lifetime. The nature of the illness will depend on all these factors and also on the individual personality.

Inherited Influences
These are transmitted through certain structures in the germ cells of the mother and father. They are independent of the parents' influence on the developing child. The inherited characteristics may be tendencies to develop particular illnesses or a general greater-than-average liability to emotional disorder. In very few conditions is the inherited factor the chief cause, and types of psychiatric illness in which all blood-relatives are affected are very rare. Unaffected persons from an affected family may sometimes transmit the tendency to their children.

The majority of psychiatric illnesses occur without any pronounced inherited contribution and most children born of psychiatrically ill parents do not inherit the condition.

Influence of Personality and Psychological Development
Everyone knows that members of any given family may have similar personalities and temperaments, and that in some families there is a common tendency to be ‘highly strung’. This can be partly accounted for by truly inherited traits, as above. But perhaps even more important is the influence which members of the family have on each other's development. The effects on developing personality of family relationships and, later, of wider social contacts, have been described.

Varying Responses
Different people respond to the same situation in different ways. They show tendencies to react quickly or slowly, aggressively or submissively, in a hostile or friendly manner, suspiciously or trustingly according to their inherited qualities and the ways in which they have learned from their experience. Most people will respond at different times in each of these and many other ways. Often the personality and the way it has developed will decide the nature of the response as much as the person or incident arousing it. Often a person's responses will be consistent in that he will react similarly to a particular type of situation as it recurs. For example, he may show particular respect or particular rebelliousness in the face of authority. He may show undue aggressiveness or undue submissiveness when he feels uncertain of himself.

Recurring Difficulties
Everyone meets situations which for him are peculiarly difficult to deal with. Often he will not be fully aware of the nature of the difficulty and, in that case, the difficulty will tend to recur with unpleasant emotional accompaniments, the source of which is unrecognised. If this experience is severe or prolonged or leads to difficulty in managing his life, he will be said to be suffering from an emotional disorder. He will be aware of repeated and apparently unfounded feelings of anxiety, fear, guilt or depression. Such difficulties may begin in early life, and persist unrecognised and unsolved only to be encountered once more in later years when the individual concerned is under stress.

Immediate Emotional Causes
It is widely recognised in medicine that emotional stress may lead to illnesses, physical or emotional. Overwork and disturbed sleep are often blamed, probably too often. Prolonged and severe worries, shocks, bereavements and disappointments often contribute, as may debilitating physical illnesses.

It is not always recognised that the term `emotional stress' includes periods of high excitement or agitation caused by desired events, too. Such activities as a change of school, moving house, weddings, or promotion at work often include a sense of loss or anxiety intermixed with that of pleasure.

As described above, certain persons are likely to face the same difficulties in a given set of circumstances over and over again. When these circumstances arise they stir up the unpleasant emotions associated with them. In consequence they may be dealt with unrealistically or unconstructively with the result that the original difficulty may be prolonged and intensified. This then is a type of ‘cause’ arising in the environment which operates more because of the individual's personal difficulty in his emotional life than because of any difficulties inherent in the situation. Since no situation difficult in itself is apparent, it may seem to the person concerned, or to the observer, that there is no reason for the emotional discomfort experienced. His reactions to the situation may thus appear inexplicable and irrational.

Physical Factors
Psychiatric disturbances occur as an occasional accompaniment to physical illness. Delirium consequent on high fever or poisoning is a well-known example. It is usually a short-lived disturbance and clears up when the physical condition improves. Physical illnesses which affect the brain, such as injury or encephalitis (inflammation of the brain as a result of infection), are particularly prone to disturb its function. In most cases there is no permanent damage and recovery takes place.

Injury, Old Age, Tumours
Sometimes damage to the brain occurs as a result of various diseases or injury, and may lead to long-lasting or permanent psychiatric abnormality. In old age the brain, in common with other parts of the body, wears out and the structure of the nervous tissue deteriorates. Failing memory, diminished power of thought and, later, confusion about places and people and time usually ensue gradually.

When severe this deterioration is referred to as dementia. Similar mental deterioration may occur as a result of other sorts of brain damage, e.g. that due to diseases of the blood vessels, to tumours, or occasionally following serious head injuries. A rare group of illnesses occurs where dementia takes place earlythey are therefore called presenile dementias. In some of these disorders heredity plays an important part.

Chemical Disorders
Disorders of function of the chemical and hormonal processes of the body may result in psychiatric disorder. Certain rare types of psychiatric illness have been shown to be due to such chemical abnormality and it is likely that other illnesses, whose cause is at present unknown, are due in part to comparable disorders.

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