The notion that it is better to address the root causes of any problem or ailment than merely treat the symptoms may seem obvious to most of us, but it is often neglected and rarely unpackaged. It is relevant in multiple ways on multiple levels to multiple issues. And it forms a pathway toward continuing refinement of both our understandings and our actions.
In my new capacity on the Board of Directors of ClearMinds, Inc., a recently established non-profit dedicated to a more holistic, root-cause oriented approach to mental health care, this distinction is front and center. ClearMinds is the brain child of my friend Dr. Mark Foster and Amy Smith, a mental health services consumer who had testified to Congress several years ago on behalf of legislation favoring the status quo, only later to discover by accident how truly dysfunctional the status quo really is.
Amy’s experience involved an accident which prevented her from taking her medications for several days. She describes the effect as that of having woken up after a long stupor, fully alive again for the first time in many years. Mark’s experience comes from what he has seen in his practice as a family physician, and then discovered through research on his own, a discovery which paralleled that of science writer Robert Whitaker, who wrote Mad in America and Anatomy of an Epidemic, detailing how America’s reliance on antipsychotic, antidepressant, and antianxiety drugs has, far from being the miracle solution to the supposed chemical imbalances at the heart of various psychoses and neuroses, fueled an explosion in the rate and severity of mental health problems in America.
This leads to one interesting thing to note about the search for root causes: If not done honestly, it leads us astray. The conventional wisdom, echoed by many in the mental health care industry, is that we are addressing root causes with these various psychotropic drugs, when in fact we are merely addressing symptoms, and doing so in the most counterproductive of ways. The historical lauding of such drugs as “chemical lobotomies,” supposedly more humane and less intrusive than physical lobotomies, captures the truth perfectly: These drugs dull the mind and reduce the lucidity and vitality of their users.
It may be the case that for certain people, at certain times, such dulling of the mind, such a “chemical lobotomy,” is preferable to the alternative, when one’s mental health problems inflict so much damage on one’s ability to function that even being half-dead is a superior alternative. But story after story emerges of someone who describes the experience of finally getting off their meds, rarely on the advice of their doctor, as that of waking up after a long stupor, discovering a quality of life they had been told was unavailable to them, and enjoying that quality of life thereafter, treating their mental health problems in more balanced and restrained ways. This suggests that, while the judicious use of psychotropic drugs still has a role in a complete mental health care portfolio, we need to be more alert to the preference of not using them when not necessary, and striving to make them in almost all instances a mere temporary foot-in-the-door on the way to establishing a healthier and more life-affirming mental health regime.
Despite the rising awareness of the influence of genetics on personality, it increasingly appears to be the case that mental health is more deeply rooted in social context than in biological interventions after all. The citizens of those countries with strong families and communities but little access to psychotropic pharmaceuticals enjoy far better mental health than we do. While biological factors are undoubtedly in play, the environmental factors are the ones that have the greatest impact on how they affect one’s life.
There are many other areas of life in which this distinction between symptoms and root causes, and the quest for working our way ever deeper into the latter, form a critical challenge for us to meet. This is perhaps most evident in the political sphere, where those most passionate and engaged tend to be most focused on the symptoms of our political deficiencies, and least focused on root causes. Two examples illustrate my point:
The first example is that of eruptions of violence, whether in the form of ordinary violent crime, domestic terrorism, or international terrorism. The latter two are easily understood as a form of political action gone awry, with fanatical organizations or unbalanced individuals pursuing some political end through a misguided and violent means. But all of these forms of violence, I believe, are symptoms of deeper causes, and should be addressed by increased attention to those deeper causes.
After every such violent act, there is always a chorus of voices decrying the act in vengeful tones. Ironically, I consider this reaction to be as much a part of the problem as the act itself, because it forms the sea of anger and hatred from which those cresting waves of violence emerge. The anger and hatred in which so many participate, to so many various degrees and in so many various ways, is, I think, a deeper root cause of the violence than the mere malice or political agendas of the perpetrators of the violence.
There are many, of course, who dig a little deeper, and cite mental instability as a root cause, and even go a bit deeper than that and cite our failure to adequately address mental health issues as a root cause. This points to something I will talk about below: Digging deeper, and recognizing a root cause of a symptom that itself is a symptom of deeper root causes. Because, while recognizing the salience of mental health issues, and of our mental health care policies, as root causes of eruptions of violence are steps in the right direction, I think we can go deeper still, and recognize that our easy recourse to anger and hatred, often treated as harmless and normal in many contexts in which they are non-violently expressed, combined with our ideological tendency toward extreme individualism, is at the heart of both this aspect of our mental health deficiencies, and our failure to address those deficiencies with adequate public policies.
The second example from the political sphere is the distinction between electoral politics and public attitudes. Enormous amounts of energy and passion are devoted to affecting electoral outcomes, and, in the course of doing so, specific public attitudes on specific issues have come to be seen as an important battlefield on which this political struggle is waged. But we address those attitudes as means to an end, seeking the most effective marketing campaigns to affect perceptions on a very superficial and transcient level, mostly ignoring the underlying attitudes that would make people more or less inclined to favor this or that public policy or candidate.
In political debates about political outcomes, the focus is always on political strategies and tactics, but almost never on how we as a society, acting in organized ways, affect how we as a society, diffusely, fundamentally understand the world we live in. I have often said that the real political battlefield is the human mind, and that the greatest long-term investment political activists can make is to nurture an understanding of the world compatible with the policies that they favor.
This distinction between symptoms and root causes is less a dichotomy than a continuum, from the more superficial to the more profound, with the most easily identified root causes of particular symptoms being themselves symptoms of deeper root causes. Therefore, we should never be complacent that we have found the ultimate underlying answer to any question, or the ultimate treatment regime for any disease or social problem. Just as the fictional character Algono found that every solution to every puzzle was itself a part of a subtler puzzle to be solved (see The Wizards’ Eye), we are forever on a path into increasing subtlety of understanding, tracking a world far more complex than any of our models or conceptualizations.
That is why the starting point of all wisdom is the recognition of not knowing. More than any other habit of thought, more than any other virtue, this skepticism, this humility, is at the heart of our ability to grow and improve and do better. With it forever front and center in our consciousness, we can continue to dig ever deeper through the layers of symptoms and root causes, increasing both the subtlety of our understandings and the effectiveness of our practices, increasing our mental health as individuals and our social and economic and cultural and political health as a state, nation, and world. This is the real challenge, and glorious endeavor, of human existence.