The Importance of Environment on the Development and Treatment of Mental and Emotional Disorders

by Carlos Solis, MD 

One of the most interesting things I learned in medical school many years ago was the importance of the role environment plays in the cause of medical diseases. So much so, that I was tempted to further my studies in the area of Epidemiology. But just as important the role of the environment is on the cause of disease states so one must consider the role of environment on the healing of diseases. There is an almost incredible interplay that goes on every day and every moment of our lives between our bodies and the external things that stimulate us. From the air we breath to the situations we encounter in our living spaces. Not only our bodies but also our minds and emotions are effected either in a good or in a negative way by the stimuli. I think most people would agree with me to some degree on this point. For example, If I spent many hours of my day in a crowded place (think of a daycare center) in the late Fall or early Winter I would have a very high chance of catching a cold. 

So it has also been argued by respected researchers in mental health that our environment plays a significant role in our states of mental health. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1940091/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883454/

However, many articles and television reports abound that argue that it is the biological expression of our genes that holds the real power and has the irreversibly determinative influence over the personal characteristics we express in life. Like the ancient belief in "fate", your genes irreversibly develop a human being into a life with a supposed physical and mental destiny that cannot be reversed or altered. From intelligence and temperament to stature, inclinations towards favorite foods and even apparently we are told, to sexual preferences (no gene has been found for this one). The genes you received from your parents have locked you into a life that you have no control over. Is this true? I hope not-because if it is, I, a human being, would be reduced to a mechanism simply following the unchangeable programming given to me by others. The genes my body has collected from my forefathers, one could then argue, would be hands down the most important factor in everything that makes me human. Free will and the healthy choices-truly healthy choices, would be inconsequential. In this respect at least, I would be no different than a stalk of corn. 

In my humble opinion, this belief has been overblown. Following the advancements in research techniques in the fields of molecular biology, biochemistry and pharmacology have led to the development of wonder drugs. Many of these have been designed to successfully alleviate symptoms of depression, mania, psychosis and anxiety. These pharmaceutical treatments have been very successful in what they've been approved to treat -sometimes wildly successful. Drunk with its own success, psychiatry is following the rest of the other specialties in medicine towards an almost exclusively biological way of looking at the development and the treatment of psychological diseases and emotional imbalances. However, this disease model has led to the belief that disease states are unavoidable. A very fatalistic way of viewing things. The point I would like to make is that the disease states in the mental and emotional realm must lie somewhere in between the "unavoidable" expression of genes within a person and the other, which is the environmental stressors which strain us and lead to emotional and physiological imbalances. As I have counseled many of my patients, a person can have a family inclination towards a particular mental, neurological and emotional disorder but it is not necessarily expressed or developed because of protective elements in that person's environment. Of course, God's Will trumps all explanations.

To illustrate let us consider a person whose family background is filled with ancestors who suffered from an addiction, such as alcoholism, and this person grew up in a dysfunctional alcoholic environment. The members of this family, some biologically oriented psychiatrists would argue, became alcoholic because they simply carried an "addiction gene". But, it's certainly not that simple. It must also be acknowledged that alcoholics have a heavy learned emotional component for coping inappropriately to the emotional stress they experience in their lives. Or stated in a different way, there was damage done to the emotional development of the person which did not allow the proper formation of the psychological defenses required to work through difficulties in their lives. In short, they're emotionally ill equipped to handle life's problems and are powerfully drawn to their addiction(s) to "deal with" or avoid them. I mention alcoholism here but there's a plethora of substances and behaviors that are used by people who cope by addiction for this purpose-video gaming, drugs, sex, pornography, perversions, gambling, self injurious behaviors, eg. cutting. Ironically, the "cure" they seek in their addiction to avoid "bad feelings" paradoxically leads to more guilt, shame, anxiety and depression which also adversely impacts their environment and makes the whole chaotic cycle easier to reboot.

To reiterate, psychological and emotional disorders are rarely purely genetic or purely environmental. It would be accurate to say that it is almost always a combination of the two, an interplay of learned and inherent traits. Let us now turn to the management of mental illnesses and emotional imbalances. Let me be very clear that I have confidence in the appropriate use of psychopharmaceutical medication. However, I rarely use them as the sole treatment for most illnesses that I treat. For instance, a person with depression may require antidepressant medication(s). A prescribing physician will prescribe the best one for that person judging by past responses and side effects. But patients are hard pressed in this stressful day and age to naturally decrease their symptoms and regain their prior level of functioning without treatment in anappropriate environment. To adequately progress in healing,  that person must address necessary changes in their environment that will facilitate a proper mental state. These changes, of course, will depend on the person, the severity and type of their symptoms and on the availability of the appropriate environmental treatments for their disorder. For example, if a person was abused in critical times of their development (please refer back to example of chaotic alcoholic family members), the availability of a good therapist and Alcoholic Anonymous groups could assist the person to advance by acknowledging the toxic relationships that hinder their well being.

To do this a healthy "therapeutic environment" must be established. A "healthy therapeutic environment" could be defined as anyone or anything that is outside of ourselves that we are in contact with which stimulates us to think and behave in a mentally healthy way. The environments we occupy provide us with stimuli that we perceive through our five senses. This stimuli is processed in our mind through past experiences with the use of our memory and imagination. These further produce waves of internally produced thoughts within our conscious and unconscious mind that lead us to experience emotions. Have you ever felt emotionally "good" but for some unknown reason had a drastic yet perceptible change in your emotions almost as though someone threw a switch and got you thinking you were traveling down a very different emotional track? Our environments play a role in that switch only we aren't aware of it most of the time. When a patient discloses a rapid switch like that, psychiatrists and therapists should enquire as to what the patient was doing immediately prior to noticing they were feeling bad. Most often times than not the patient was doing something fairly normal and benign like watching television. But upon further questioning the patient will disclose they were watching a program that was reminiscent, anxiety provoking or sad. It's not difficult to find this stimulus on television since it has rapidly become so base in its subject matter over the years. It has gotten to the point where I have asked patients to abstain from watching the news on a regular basis because "tele-journalism" ascribes to the belief that "if it bleeds it leads" as a means of capturing viewers who seek the negative emotional impact of real life events. Other vehicles of toxic stimulation can come from Internet videos, music, books, advertising, and even unhealthy food.

To understand the importance of avoiding toxic environments people must first learn how they are harmful to them and how to correct them. This can obviously come from a good therapist or gifted spiritual director but also can come from patient education classes, Employee Assistance Programs (EAP) and mental health groups. Once the "how" is answered a person should be compelled to seek healthier choices in what stimuli they allow themselves to be exposed to. If a change is in order, The person should first pray and ask Our Lord that His Will be done and to send the way and means to making the change. I say this because most people who are entrenched in toxic environments have been so for a while and may not be able to envision themselves living any other way. Whether it's moving out of a toxic apartment complex or simply not reading trashy novels-a bad habit takes a firm purpose of amendment and God's help to extinguish. Also, people need guidance in the "healthy choices" they choose to partake in. For instance, the acceptance of Yoga, tai chi, and rikei as valid healing arts is dangerous to one's soul since it involves the channeling of "energy" through inanimate objects and in the case of rikei through another person. This New Age "cure" is worse than the disease. Although I have personally seen it promoted by Catholics, I wholeheartedly advise everyone to stay away.

Ultimately, the means by which people seek good therapy and psychoeducation should lead those suffering from mental and emotional disorders to eventually become more self reliant by their prudence and good decisions. If one was to take a poll of the best therapists in the world and ask "what would be the best outcome in therapy for your clients?", I would bet that, by far the majority, if not all of them, would say that "my client become's his or her own best therapist". In saying this, as I would, wish that by guarding their environments people become more likely to stay mentally healthy and emotionally stable.

Carlos Solis MD is the medical advisor to the Guild of St Benedict Joseph Labre.  His background includes: Superior Court Psychiatric Examiner to determine Competency to Stand Trial, Expert Witness- Amador and Placer County, Mental Health Alcohol and Drug Advisory Board-Placer County, Consultant., Psychiatry Residency Program, San Mateo County. San Mateo, CA, Pediatric Residency Program, Kaiser Medical Center. Oakland, CA. For information see our board members page: https://guildbjlabre.org/About-us/Board-Members