The one thing that changed everything: Complex illness & the functional fallacy of a singular cause

When I asked my research participants what they felt had caused theirs or their patient’s schizophrenia, it was often put down to one thing or another, rather than one thing and another:

“It was because of this one bad acid tab”

 “I was cursed”

“There was this one problem no one else could see”

 “Someone gave me the wrong medication and I was never the same”

“It was hereditary”

“It was organic [in clinical terms, brain injury]”

“It was the trauma”

When it came to the solution, it tended to be a multitude of things. Each individual described a system of remedies working together. I observed health agency to be enacted through multi-pronged strategies: taking psychopharmaceuticals; consuming nicotine; getting outside the house; going to work; doing social activities; exercising regularly; engaging with God. 

This blog asks why the idea of multiple causes for a complex health condition is much harder to accommodate than the idea of multiple solutions (or, why the biopsychosocial model often fails to resonate with the lived experience of reasoning why things came to be). 

A preference for orderliness

First, the idea of a singular cause provides immediate clarity, no matter the later contradiction. Even though anthropologists like to point out the many aspects to human conditions — the interrelations, the dynamics, the ‘multiplicity,’ the temporal ‘fluidity’ — and then the contradictions that exist when simplistic dichotomies (such as social/biological) are made, we seem to always be looking to create order out of experience. As Mary Douglas explains:

‘It is part of our human condition to long for hard lines and clear concepts … The final paradox of the search for purity is that it is an attempt to force experience into logical categories of non-contradiction. But experience is not amenable and those who make the attempt find themselves led into contradiction’ (Douglas 1966:200)

To deal with all those contradictory meanings (or causes of a situation), anthropologists may still try to narrow things down by making up new and esoteric terms that still don’t capture everything (and annoy people who prefer clearer language). 

If resonant enough with someone’s messy lived experience, though, these new concepts may become very empowering to think through. I have experienced this firsthand.

The empowerment of seeing the context  

While taking an undergraduate anthropology course, I was introduced to some new concepts and perspectives regarding a life-threatening complex health condition I had once experienced. The ethnographic descriptions connected profoundly with things circling the time I was diagnosed. The place I lived, various troubling incidents, my relationships, the belief systems and the healthcare received together now produced a comprehensible, albeit still complex, story of this illness. This story also explained how I had recovered (basically all those contributing factors had since flipped). 

I reclaimed the experience, and in doing so probably felt what anthropologists Neely Myers and Tali Ziv call ‘autobiographical power’: ‘the ability to tell one’s own story and be the editor of one’s own life’ in the context of illness. For the first time, I felt like my previous complex health condition made sense, even if it was still quite difficult to explain. 

Yet, at the same time as learning more about the role of life context in illness, I agreed to participate in a biological study (requiring blood samples) looking for genetic markers of this condition. Perhaps I still wanted a neater story to tell, or perhaps I just wanted something more concrete to add to my new context-driven narrative. Because the empowerment given by my narrative may be limited if it doesn’t make enough sense to other people. 

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Western beliefs in objectivity 

Through my own lived experiences and through observing others, I have come to appreciate why searching for, if not identifying, particular causes helps us to feel more in command of our environments. This is especially the case if everyone in your social world believes in a particular cause for something, over and above the messy context involved. Here, the more orderly belief becomes socially affirming, and thus harder to dismiss. 

Perhaps at the heart of the difficulty is that people in western cultures generally tend to view themselves and others as separate entities from the world in which they live. Having a neat biological explanation somewhere in my narrative appeals to me because I grew up in a culture that looks for ‘objective’ answers, even when there might not be any.

Returning to biomedical ideas about mental illnesses like schizophrenia without clear genetic markers, there is often a tendency to suppose an  ‘error’ within the mind rather than the circumstances. Or, if not an error in the individual, the error might have been something taken into the individual (“that one bad acid tab”), or done to the individual (“the trauma”). 

Ultimately, the hope of locating this apparent error, or one particular cause, is likely more common in times or medical diagnoses of greater mystery (like schizophrenia). It follows that less certainty leads to a greater demand for singular answers or clear alternatives. I am left wondering whether it would necessarily help people with lived experiences of schizophrenia, in a western cultural context, to always contextualise and reconnect person with world. 

Sliding doors and reconnections

We can focus on single sliding doors in life, or we can think about the many doors that were walked through. The single doors that were and were not walked through can stand out later as ‘causes’ for a particular outcome. If only that had/hadn’t happened, my/their life could be so different.

While the anthropological take would be to capture the many doors and the wider context, my experiences have also taught me that nonetheless thinking about the singular doors — and searching for particular causes — can be part of building a personal narrative. But this may depend on the experiences of social acceptance, and feelings of recovery.

It is perhaps only when we turn our attention to what is happening when people are recovering from a complex health condition that the narrative can be more comfortably opened up to include multiple things. A further question is: Do people need the experience of a myriad of solutions before they can see the myriad of causes, to reconnect person with world? 

[Image by David Menidry at Unsplash: https://unsplash.com/photos/zpUsOQzByFg]

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