William G. Nicoll, Ph.D. & Monica A. Nicoll, Ph.D.
Resilience Counseling & Training Center
North Conway, NH
[Published in the Conway Daily Sun, ‘To Your Health’ Supplement 26 March 2021]

Mark Twain once said, “The problem is never that we know too little, but rather that we know so much that just ain’t so!” This observation is particularly applicable today as it pertains to our understanding of, and approaches to, mental health issues. A tidal wave of research evidence now indicates that many of our diagnostic assumptions and treatment methods are not only mistaken, but often may cause or exacerbate the very problems they are intended to resolve.

For 150 years, two paradigms have been put forward to explain and treat mental health problems, the biomedical and the developmental. The biomedical model assumes that some as yet undetermined neurological dysfunction, imbalance or disorder causes our emotional and behavioral difficulties (depression, anxiety, behavior problems, attending problems, etc.). Thus treatments are offered to supposedly “correct” this neurological problem. In the 1980’s this paradigm exploded and began to dominate the public narrative on mental health. With strong financial backing from the pharmaceutical industry, the American Psychiatric Association rewrote the diagnostic manual (DSM II) and put forward a markedly expanded and medically based alternative in 1980, the DSM III.

Biological explanations provide logical credence to promoting biological treatments (medications). And indeed, psychopharmacological treatments have skyrocketed since the late 1980s and continue today aided by a 1992 federal law change allowing drug manufacturers to market their products directly to the public via advertisements (only USA and NZ allow such advertising). The diagnosis of both ADHD and Depression in America, for example, both increased by 400% or more from 1990 to the mid-2000’s. As Dr. Amos Wilson has noted, “To understand any problem in America, you need to focus on who profits from that problem, not who suffers from the problem”.

This presents us with a conundrum! If drug based approaches for improving mental health and people’s lives is correct, should not the numbers of people with mental health problems be declining? But, in actuality, just the opposite has occurred. In 1987 1.25 million people received SSI and SSDI payments for mental health problems. By 2007, this figure jumped to 3.97 million and to 8 million in 2017. The number of children (under age 18) receiving SSI or SDI for mental health problems in 1987 was 16,200 but with pharmacological treatments rapidly increasing, this number grew to 561,000 by 2007.

Further complicating the legitimacy of the biomedical paradigm is the fact that long term studies have failed to show beneficial effects for medication treatments which often are associated with deterioration, not improvement. Moreover, scientific research has also consistently failed to find any chemical or neurological causes for depression, ADHD, anxiety, addiction, and so forth. As a result, diagnosis and treatment of mental health problems is based solely on subjective opinion and not any objective medical evidence. So, what then is the explanation for mental health problems?

Adverse Childhood Experiences (ACEs)

Since the 1990’s, a growing body of research has begun to emerge on the effects of Adverse Childhood Experiences (ACE’s) on mental and physical health. This research contradicts the biomedical explanations and treatments for mental, emotional and behavioral problems. Thus, the need to now rethink our understanding of, and treatment strategies for, emotional and behavioral difficulties. In other words, it is the effects of stress, trauma, or chronic emotional distress that lie at the base of mental health and wellbeing, not brain chemistry! Children experiencing 4 or more ACE’s are 460% more likely to be diagnosed with depression than children with no adverse experiences and those with 6+ ACE’s are 4600% more likely to suffer from drug/alcohol addiction. Research has demonstrated a powerful link between early life stressors and mental health issues in both youth and adults including depression, suicide, anxiety, substance abuse, addiction, academic performance, school drop-outs, domestic violence, teen sexual behavior, impaired worker performance and so forth. As the number, frequency and toxicity of adverse experiences in children’s lives increase, so do both mental health and physical health problems.

It should also be noted that while the CDC sponsored studies are eye opening and quite compelling, they are also somewhat limited in scope. The actual ACEs connection with mental health difficulties is probably much higher! Early studies have focused exclusively on only the ten most common childhood stressor experiences. If the myriad of additional Adverse Childhood Experiences were included, we’d likely see this rate increase dramatically! The data is clear, as the number and frequency of adverse experiences in children’s lives increase, so do both mental health and physical health problems.

The most common psychological responses to ACEs appear to be: self-stigmatization (I’m a flawed, terrible person), loss of trust (in self and in others), self-blame (it’s all my fault}, and lost hope or optimism (life will never get better). Mental health difficulties are now better understood as based in developmental issues not biological. This suggests our diagnostic terms (depression, anxiety, ADHD, substance abuse/addiction, etc.) are in actuality only labels for describing the symptoms of underlying, unresolved issues and not ‘the problem’ per se. Emotional and behavioral symptoms are adaptive responses to adverse life experiences. Mental health issues involve a complex interaction process between social, psychological and biological factors. Adverse Childhood Experiences (ACEs) lead to psychologically unhealthy perceptions of self, others and life. These negative perceptions in turn trigger our normal biological responses to stress and danger. In other words, our HPA (hypothalamic Pituitary Adrenal System) system kicks into gear for a fight, flight or freeze response, levels of the stress hormone, cortisol, elevates. The HPA system is designed to facilitate self-protective responses to perceived temporary threats. But, some children are exposed to chronic threat, stress or trauma. Their HPA system never gets to reset to normal; it becomes overloaded and dysregulation is the result. This leads to adaptive, self-protective behavioral responses which in turn result in negative responses from the significant adults in their lives (parents, teachers, coaches, neighbors, etc.). Thus, a circular causation process is now complete! Punitive, critical and rejecting responses from the entourage of significant adults in their lives become yet further Adverse Childhood Experiences. Such a social, cognitive, biological and behavioral sequence often continues unabated leading to mental health difficulties.

The ACEs research suggests the real underlying cause of mental health problems is not chemically malfunctioning or imbalanced brains. Rather, it is adverse life experiences that result in unmet mental health needs for positive social connections, respect, healthy autonomy, a sense of competence and meaningful contribution, feeling safe (physical and emotional) and being a valued and worthwhile person. Studies further indicate emotional abuse or maltreatment to be the most common ACE leading to mental health difficulties.

It follows then that mental health interventions will need to focus more on the healing of the cognitive and emotional effects of adverse life experiences. Medications may, in some cases, provide some degree of temporary symptom relief. But, improving one’s mental health requires a greater focus on healing from the stress and traumas experienced and developing more fulfilling lives and relationships and not the pharmacological suppressing of disruptive emotions or behaviors.

With children this means family counseling is more in keeping with the ACEs research findings, not medications. Studies consistently indicate that changing adult perceptions of, and behavioral interactions with, a child lead to the quickest and most lasting positive changes in children’s behavior and emotions.

Want to Learn More? Some suggested readings

  • Lost Connections: Uncovering the real causes of depression and the unexpected solutions by Johann Hari (2018)
  • The Emperor’s New Drugs: Exploring the antidepressant myth by Irving Kirsch (2010).
  • Crazy Like Us: The globalization of the American psyche by Ethan Watters (2010).
  • Manufacturing Depression: The secret history of a modern disease by Gary Greenberg (2010)
  • Anatomy of an Epidemic: magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America by Robert Whitaker (2010)
  • ADHD Nation: Children, Doctors, Big Pharma and the Making of an American Epidemic by Alan Schwarz (2016)
  • Shyness: How normal behavior became a sickness By Christopher Lane (2007).
  • Why Zebras Don’t Get Ulcers By Robert Sapolsky (2010)
  • Chasing the Scream By Johann Hari (2015) -addiction
  • In the realm of Hungry Ghosts By Gabor Mate (2010) -addiction