Views about causes and triggers for mental health problems

Most people thought there was no one single cause of their mental distress. However, they could discuss events that played a role in their mental health problems, as outlined below. Other people weren’t so certain and wondered why they had developed serious mental health problems. Research also suggests that a number of factors may interact to contribute towards the development of mental health problems, such as physical, social, environmental and psychological factors
At the same time, doctors, service user groups, researchers, mental health charities and counsellors often disagree with each other about what causes psychosis. Possible physical causes for problems include people’s individual genetic make-up and the ways that this might put some people at more or less risk than others. Some experts think that the misuse of substances like cannabis can result in mental illness, or even that viruses like the flu can affect a baby’s development in the womb, and later influence their mental health.
Underlying factors can include poor attachments in early childhood and dysfunctional families. People living in a deprived neighbourhood are more likely to experience problems. Traumatic events in particular – such as child abuse, the experience of racism, sexual abuse or homophobia – can also be linked to mental health problems. Significant life events like relationship breakdowns and work stress can precipitate mental health problems.
People also mentioned things that could reduce the chances – or impact – of mental distress. Having good relationships with parents in early childhood and strong social support later in life appear to be significant protective factors. For discussion of these complex issues see websites for Rethink, The Hearing Voices Network or The Institute of Psychiatry, Psychology and Neuroscience (IoPPN).
Not everyone spoke about traumatic experiences in their childhoods; in fact several people described their childhoods as ‘happy’ or ‘normal’ (for more see ‘Childhood and life before diagnosis’). However, many people said past trauma in their lives had contributed to their problems. Several people we spoke to had experienced emotional, sexual or physical abuse when they were children, including being the victims of severe bullying. They reported abuse perpetrated by family members, child minders, or priests. Dolly’s father had left her alone in a vulnerable situation, and she had subsequently been sexually abused. Other difficult experiences included being brought up in institutional care, or having a parent with mental health problems or who misused alcohol.

Pete started to hear voices at the time he was sexually abused by a child minder, but he was…

Age at interview 48

Gender Male

Age at diagnosis 30

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Oh initially as a child life was quite difficult, [tuts] I had very, very loving parents but we used to have a childminder that would come round on a Friday evening and look after us, and after a period of time I started to experience sick sexual and physical abuse off this woman from the age of five up to about the age of thirteen. I would say about, when I was about seven year old that’s when I first started to hear voices. But the voices were quiet reassuring and, comforting at that time. I never told anybody because there was a, there was a big fear about abuse, I was very, very frightened to mention to anyone. and when I got to about eleven I think it was, the abuse and the voices changed, the abuse got more severe , it got more disgusting, but the problem was in it, in some ways me body responded which said I was enjoying it and it really, really confused me, how could I be enjoying something that I actually hated? And from that point the voices took a sinister turn, one became ten, ten became twenty, and they told me to harm meself and harm other people, and I would do, I would be out assaulting people and nobody could understand me behaviour, even to the point where I tried throwing meself down the stairs, and like a suicide attempt, I just really started to lose control but still never disclosed to anyone. I think the lowest point was probably when I was about thirteen year old but it proved to be a massive turning point as well. This woman had come round mid, mid-week while I was doing me homework and said to me parents, I’ll go and give him hand to do his homework And she had full sex with me, upstairs. And I had this big fear, what if she’s pregnant? I’ll get blamed for this’ and everything else, and obviously it turned out she wasn’t pregnant, but it gave me the courage to say to me parents, I can look after meself, I don’t want thi woman to come round And they agreed, and the interesting thing was once the abuse stopped the voices went away. But it laid repressed and buried, I never told them the bit about the voices or the abuse.

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Ceridwen’s grandfather sexually abused her and she has only recently realised how serious this was.

Age at interview 27

Gender Female

Age at diagnosis 20

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I’m supposed to be having psychological counselling at the moment, but it’s not happening. Because I was abused when I was a kid by my grandfather, severely. And I’m supposed to be having counselling for that, but they don’t seem to care enough. I’m almost at the point of giving up on them and finding someone else. The psychology at the hospital is, there’s not, there’s no regular appointments, no apparent continuity of care. I, I don’t need that. I’m going on the 10th December I think I’m going to say, Thanks but no thanks. I’ll find someone whos regular and reliabl. Because I don’t want to be messed about, you know, if you’re going to talk about something so horrible at least give me some continuity of care

And have you found anybody else you can talk to ?

Not as yet, but I’m looking at it, on the internet, I’m looking for people, because I do need to talk about it. But I need to talk about it with someone I can trust to talk about it. Does that make sense?

Yeah, absolutely. And have you always wanted to find somebody to talk about it or is this recent

No, I bottled it up for a very long time. And it recently hit me, just how bad what he did was. Because he told me he loved me. And I believed that, and I associated love with pain. And then I, over the last three or four years, well he may have loved me, but it was a twisted form of love. it’s not right, it’s not normal. And that’s not okay, and you need to talk through that and make sure that you know that someone loving you does not involve what he did to me. And I do find, I find relationships very, very difficult. I had a boyfriend at Uni, and he just, I couldn’t cope. Because I couldn’t fathom a normal relationship in my head, you know, and I need to [3 sec pause] to work through that. I know that what my granddad did wasn’t normal, but sometimes in your head you think, well he did love me. Do you know what I mean?

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Rachel said she developed anorexia as a result of being sexually abused by an elderly uncle, and that her mental state rapidly deteriorated after that. Dolly said her dad was a ‘monster’ who physically abused her and her siblings, and left them vulnerable to later sexual abuse. People said it can be difficult to get proper professional care for the psychological aftermath of abuse.

Two members of Kirstys family sexually abused her, and she was shocked; the psychologist and…

Age at interview 40

Gender Female

Age at diagnosis 24

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The thing, what had happened when I was younger, and I was being abused, was, I would pretend I was dead or it wasn’t happening to me, and I wasn’t there. And that, so it was the same survival coping mechanism or whatever, that helped me out with the hallucinations. Hm.

And was it abuse by a member of your family?

Yes. Yes. Two, two different members and that so. I mean obviously as a child I thought I was being persecuted and I thought it was only me, and I mean it wasn’t until some years later that I realised there was a word for it at all. And unfortunately, the… the psychologist that I’d had when I was younger, and I was having behavioural problems at school, it would appear that she breached confidence, and I got, backlash at the dinner table that night. And that just completely blew, blew any, any trust or rapport, or, you know, chance of sorting things out then. And then later on, when I came out to live with my Mum, and I spoke to the psychiatrist briefly about had happened, he was just, in my mind, I mean I know there’s a better awareness of it now, but in my mind, he was completely negligent, he just said, Oh, you know, so you’re not scared of the sight of a stiff prick then You know, because I told him that my sex life was a bit like Piccadilly Circus, you know, where I’d become promiscuous and that. And you know, I mean I see now that its completely irresponsible of him, you know, because it’s a, it’s a destructive behaviour and that, you know, but… yeah. I’d been let down, you know, I’d been let down by the immediate authority, the people who are supposed to protect and provide for you, and whatever, you know, and also the bureaucracy, you know, proper authority and that, so I’ve, you know

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Garys childhood was very difficult – his parents fought all the time, he was sexually abused and…

Age at interview 37

Gender Male

Age at diagnosis 23

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My Mum is an obsessional, my Dad was in the Army for a long time. And he came out of the Army like and was told he’d never work again because he had something in his brain that made him black out all the time. So he became an alcoholic.

When I was growing up. First of all I got mentally bullied by children at school. Then it became physical, [tch] then it became quite extreme. Where I was getting beaten every day. Some of the things they used to do me, because like, because I don’t like heights, they were dangling me off like a cliff or they would beat to the ground and then like urinate over me. So I’d have to go home smelling of urine.

So my life was, I’d wake up in the morning. My Mum and Dad would be shouting at each other. My Dad would become drunkI’d go to school. I’d get beaten at school. I’d get beaten after school. I’d go home and my Mum and Dad were like shouting at each other. I’d have to go out and play with kids that were supposed to be my friends, so they would beat me again. At weekends, sometimes my Dad used to sexually abuse me.

I didn’t have any escape, apart from reading. Sorry, this is why these things are so precious to me. All my friends are dead, Walter Benjamin, Spinoza, C G Jung. they’re all dead, but this was my only escape. I started to read story books at first, but I couldn’t read them. I don’t know. I couldn’t, I still don’t understand why, but I couldn’t read storybooks, I couldn’t get involved in reality.

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Naveed talks about many different reasons for his difficulties, including mental illness in his…

Age at interview 42

Gender Male

Age at diagnosis 15

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My mental health problemsbecause they’re triggered off by something or something happens, but some people have them genetically and it’s genetic. It runs in the family soI mean on my Dad’s side, even on my Mum’s side like one of her brothers used to have mental health problems. He’s also had epilepsy as well. And on my Dad’s side, and I think it’s skipped one or two generations, but I ended up with it so.

And what do you, I mean you’re saying what the doctors think of what causes your experiences, what do you think?

I think I was born with it you know, only people like this, you know, is born with the condition. And life’s events sort of made it worse. You know, so I already had it, you know, but life’s events sort of adds up to it, and makes it worse. Especially the bad experiences. Because I mean I can sit here, and I can stand in front of people like. I could tell them stories, like, and you could write novels like some of the bad things that have happened. Some of the good things that are quite touching like, you know, and some things that you don’t know whether to cry or laugh you know. But I just think that yes, I was born with the condition and life’s sort of added to it and made it worse, you know.

So what things have added to it that have made it worse?

I mean rejection. I mean my Dad’s side of the family they didn’t want to know. They didn’t acknowledge us. That you know, we were their nephews or nieces or their grandchildren. So I think the rejection could have been part of that. Like I said to you earlier, my Mum’s Mum died when my Mum was four years old, and her step Mum was really bad to my Mum. She was really bad to us and all. I mean that’s played a big part. You know, because every time I get treated badly by people outside I always think that had my Dad’s side of the family or my Mum’s side of the family, they treated us properly, then other people would have treated us probably. Because it always starts within, you know, our home, our family levels. And when people say, Oh I told you in this confidence, how did get out, and you find that nine times out of ten its someone from your family, you know, who will go out and tell people this that and the other. So that’s played a big part, rejection. I mean people dying. I mean, I lost five mates in a car crash all at once. You know, and things, so things build up and things you know, add up. And some people will say to me sometimes, Oh I can’t believe that you’ve been through all that and you’re still here You know, but what they don’t and I told one my Mum this and she was really upset. I said, When I go to bed at night, I pray that I don’t wake up in the morning And I said, When I wake up about 2 in the morning, like or 3, I think oh shit I’m still here You know. Mum said, People pray for all kind of good things like, and is that what you pray for And I said, Yes, that’s what I pray for You know, because sometimes it gets too much and I just don’t want to be here, you know.

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Others felt they had been neglected or had been through other troubles, e.g. lonely childhoods, relationship problems.

Johns dad was a heavy drinker and his mum had bipolar affective disorder. He was brought up…

Age at interview 46

Gender Male

Age at diagnosis 19

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Basically I’d come from the kind of describe a very dysfunctional family. My parentswell first of all my Mother had the same diagnosis as I’ve got, bipolar disorder and that didn’t help the marriage and my Father was a, was a heavy drinker as well. So, the marriage was very rocky and my family was quite difficult. And then I was in and out of care till I was 9, I think it was, and then I had a long term care order placed on me, till I was, until I was18. Then I was obviously, obviously left care then.

What was life like in care?

It was quite tough. It was quite tough. Because yes, I mean, when I first went into care it was okay. I was living in a children’s home in [place name]. Life up there was okay. But when I moved to the children’s home in [place name] it got a bit more difficult. Because there was a kind of, there were kind of different children, who were a bit more hard edge and tougher, and I learnt to kind of stand on my feet pretty quickly and there was enough, you know, there’s always a hierarchy within children’s homes, and because I was the new guy, they wanted to know how tough I was and I was picked on and bullied quite a bit and then it got to the stage where I could kind of stand up for myself and I got into a few fights there and so yes, it was quite tough. But it wasn’t, you know, don’t get me wrong, it wasn’t like I was fighting seven days a week. It was just that yes, it could be quite difficult at times and it’s not an ideal situation for any children let’s put it that way. You’re removed from your family, you know, with your brother and sister and everyone so it’s not, it’s not easy.

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Some people said that the death of a close relative or friend in their childhood had triggered their problems. A couple of people found that their mental state suffered at each anniversary of the death. Devon, a musician, thought that mental illness sometimes occurred when creative people couldn’t express their creativity properly. Karl felt that somehow black people’s experience of slavery had been passed down in their genes. However he rejected West Indian herbal treatments thinking they would not tackle the cause of his problems.

Devon had broken down while grieving for his granny and not looking after himself. He thinks that…

Age at interview 52

Gender Male

Age at diagnosis 22

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What it was when I was squatting homeless in Battersea, before my brother found me. Before I came to this country, I lived with my Gran in Jamaica. She brought me up till I was five. No till I was seven, until I came to this country. But she died, but I didn’t realise, I didn’t grieve it at the time. Until later years I realised and I broke down when I was squatting with my friends. I was crying to myself. I realised Gran had died. And that’s what caused it. It wasn’t no paranoid schizophrenic. I was grieving and they didn’t really understand it. I didn’t understand it either until later years. But that’s what the problem was. It was paranoid schizophrenia. I was grieving my granny’s death. I didn’t know what to call it, and they didn’t realise there was a bereavement. They thought I was hearing voices. I did hear my inner self. My inner self. Because I’ve not always eaten. I was unemployed, homeless, and most of the days I was buying chips. Fish and chips mostly and eating that. Weekends I used to go partying, drinking, smoking, not eating. Because as I said, Granny died, I don’t care now happens to me. My Mum’s having a go at me, I don’t care what happens to me. I was rebelling against my family. Because Gran died, you know. And then I destroyed myself really, by not eating, not sleeping properly, being homeless and unemployed. And that’s what brought me down. It was not paranoid schizophrenia. I wasn’t a danger to myself or any other person. Any one could tell you, I’m tall. But I’m not aggressive person. I talk quietly, I’m not a, I don’t cause problems really. So that’s what happened, yes.

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Robert thinks that his dad’s death, his own drug taking and his daughter’s death in distressing…

Age at interview 45

Gender Male

Age at diagnosis 43

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My childhood was, I suppose you’d call quite normal really. I went to Catholic schools, and you know. I suppose everything went downhill from about my last year at school because my old man died pretty much in my arms when I was about 15 years old like. Ah of course that didn’t give me a very good start.

I didn’t bother with school after that. I did ever bothered turning up like [laughs]. Got into drugs, as you do, and starting drinking and hm. I suppose from there, that’s all I’ve done for years is drugs. You know, and itnd as I say it relates to my mental health. If I knew then what I knew now, I’d have chose a different path. But hindsight is a funny old thing isn’t it?

Yes.

I suppose the mental health side of it, didn’t really appear until sort of… about sort of four or five years ago. I’ve always been one… years ago the drug used to be called Speed. But now they’ve changed and it’s called methamphetamine. And the psychosis involved in it alone is frightening.

I suppose the death of my daughter didn’t help much. Because when my daughter died like, I was married at the time, right. And I spent I don’t know fourteen years with my wife like. And we were pretty close like. But we just went that way. Like just couldn’t live with each other. couldn’t you know. I mean to say even now she’s like. I suppose I go and see her like. Still be a good friend like. But it destroyed us. Absolutely destroyed us.

And I suppose some of the mental health things come from round about then. Because I just started drinking and you know, you just godrinking and drugs like that’s all I done for months and months and months to try and get my head around it like. And of course after that as I said about the police knocking on me door. That didn’t help much. I remember being sat in me front room with my mate, [name], and this bloke walked down my steps in a suit, and before he put his foot on the second step I knew he was a copper. Child Protection Team. And that’s didn’t help. That didn’t help at all. That took me years and years and years to get over. it’s, I used to drink and get in fights and end up in jail and, you know, but its just one of those things. Its just one of those things that. I don’t know I just couldn’t get me head round I suppose. How someone could be so… I don’t know. Nasty? That doesn’t even go, describe the way I feel about it.

I suppose that didn’t help. Because you get into drinking and you get into drugs and things just start slipping.

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Tim thinks that schizophrenia isnt caused by bad families and that he had a good relationship…

Age at interview 61

Gender Male

Age at diagnosis 19

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And you were saying that they tried to take you away from your Mum?

Yes.

Who had tried to do that?

Doctors they thought it was bad for me. You see this is the stupid 70s theories, like R D Lang and all that nonsense about schizophrenia being caused by bad families or upbringing. Well if schizophrenia is caused by bad families, so their all relative bad families and it’s crazy it doesn’t happen like that. And also if schizophrenia was caused by family, what about my brother and sister. They haven’t got it and they had the same upbringing. And now they tried to force me away from Mum, the doctors. They thought it was bad for me. But I loved my Mum and for 23 years we went to the same bed and breakfast down in Cornwall near place called [place name]. you know, [place name]. I adored Mum and she sacrificed her life for me. She could have got married again. She was an incredibly beautiful woman, but she decided to take care of me. She was a family woman.

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Janey talks about being a molecular biologist, her understanding of genetics and her experiences…

Age at interview 52

Gender Female

Age at diagnosis 29

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I, well having a background as a molecular biologist, I think there’s definitely a genetic component, but also there is an environmental component and there’s a lot of research done at the moment in an area called epigenetics, where environmental components can change the way the DNA expresses. So even if you have a perfectly reasonable gene anywhere, if you do certain things then you can actually get that gene switched off. And that’s why they see things passed down through generations. Heart problems especially. So mothers who do things wrong in pregnancy pass it on to the children, who will have that gene switched off, and of course if it’s behavioural, if you’ve got behavioural genes switched off you’re going to be doing the same sorts of things. And so then it just passes on down the generations. So looking for genes is a complete waste of time as far as I am concerned. And some of the research I’ve seen would support that. It would probably make a lot more sense to have a look at environments, especially growing up, and perhaps during pregnancy as well.

And I guess relating that back to you? What do you feel about your environment, growing up and so on?

I’m not sure how much I messed myself up smoking cannabis at university.

I didn’t have an easy childhood.

But my sister and brother got through it okay. So… soI really don’t know completely where it came from. it’s a difficult thing to sort out.

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As well as talking about possible causes of mental health problems, people also talked about experiences that could make them feel worse, like experiencing rejection or feeling stressed by something (For more see ‘Strategies for everyday coping’).

Andrew has a predisposition to psychosis and describes several stressful life events.

Age at interview 59

Gender Male

Age at diagnosis 24

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There was some talk about pre clinical diagnosis and that was mentioned on All in the Mind, in May or June 2010, and Claudia Hammond was quite right to include in her programme that day, and I think that, as I said early, I had a pre-disposition towards psychosis and schizophrenia, paranoia and things like that. I think I had a pre-disposition towards psychosis. And I had all these life events at the time, as I said I lost my leg when I was seventeen and a half, I failed my degree when I was 24. My parents got divorced when I was 23 or 24. And I smoked a lot of pot when I was about 22. All these things can be sort of pretty disastrous that anyone with a pre-disposition towards schizophrenia and so I think I followed a sort of typical pattern in those days.

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Whatever explanations and understandings people reached in their own lives, most people thought that the causes for mental distress were complex and poorly understood.

Sources of information on psychosis

Many of the people we spoke to wanted to find out more information about mental health, or their diagnosis, so that they could better understand...

Talking therapies for psychosis

Many people were not offered any type of talking therapy or said that talking therapies were too difficult to access. A few didn’t want counselling...