Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 2
Overview of Etiology
The precise causes (etiology) of most mental disorders are not
known. But the key word in this statement is precise. The precise causes of most
mental disorders—or, indeed, of mental health—may not be known, but the broad
forces that shape them are known: these are biological, psychological, and
social/cultural factors.
What is most important to reiterate is that the causes of health and disease are
generally viewed as a product of the interplay or interaction between
biological, psychological, and sociocultural factors. This is true for all
health and illness, including mental health and mental illness. For instance,
diabetes and schizophrenia alike are viewed as the result of interactions
between biological, psychological, and sociocultural influences. With these
disorders, a biological predisposition is necessary but not sufficient to
explain their occurrence (Barondes, 1993). For other disorders, a psychological
or sociocultural cause may be necessary, but again not sufficient.
As described in the section on modern neuroscience, the brain and behavior are
inextricably linked by the plasticity of the nervous system. The brain is the
organ of mental function; psychological phenomena have their origin in that
complex organ. Psychological and sociocultural phenomena are represented in the
brain through memories and learning, which involve structural changes in the
neurons and neuronal circuits. Yet neuroscience does not intend to reduce all
phenomena to neurotransmission or to reinterpret them in a new language of
synapses, receptors, and circuits. Psychological and sociocultural events and
phenomena continue to have meaning for mental health and mental illness.
Much of the research that is presented in the remainder of this report draws on
theories and investigations that predate the more modern view of integrative
neuroscience. It is still meaningful, however, to speak of the interaction of
biological and psychological and sociocultural factors in health and illness.
That is where the overview of etiology begins—with the biopsychosocial model of
disease, followed by an explanation of important terms used in the study of
etiology. Then, against the backdrop of the introductory section on brain and
behavior, the following sections address biological and psychosocial influences
on mental health and mental illness, a separation that reflects the distinctive
research perspectives of past decades. The overview of etiology draws to a close
with a discussion of the convergence of biological and psychosocial approaches
in the study of mental health and mental illness.
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