Having introduced the problem of how to define mental illness and determine its boundaries in Chapter 2, and discussing the diagnostic and statistical challenges in determining etiology in Chapter 3, in Chapter 4 Mechanic turns to a more detailed examination of the various conceptions accounting for the development and trajectory of mental illness, and how these conceptions in turn have implications for approaches to treating and managing it. He therefore discusses a number of different theories which run the entire gamut of psychiatry, including genetic and biological factors, environmental influences, cognitive and learning processes, and a psychodynamic model.
One thing that seems immediately clear is that there is no right answer or clearly “better” approach, which makes sense given the immense complexity characterizing these disorders and the factors that led to their appearance. Completely aside from the genetic/environmental question, I am especially interested by the distinction between environmental causes of a disorder, environmental triggers, and environmental interactions with the subsequent course of the disorder once developed (e.g. secondary disabilities) ‒ not to mention how these influences then reciprocally interact with the patient’s own pattern of behavior and how he seeks care. The number of different levels and contexts in which environment can operate speaks to my sense that no matter how much progress we make in genetic research, this only illuminates even more of the contingencies mediating and complicating the relationship between heredity and environment, rather than directly increasing our predictive power per se with any one individual. The environmental side of the equation ultimately involves most of the richness in answering these questions as well as where we must put the bulk of our energy for solutions, but this also means we have to deal with human nature, and resource or political constraints ‒ so maybe these...