Mental health: ethnic minority experiences

Views about causes of mental health problems: individual factors

Introduction

Research suggests that various factors may interact and cause or contribute to the development of mental health problems, including physical, social, environmental and psychological factors. Here, people talk about what they believe caused their mental health problems. This summary focuses on individual factors; social and environmental factors are discussed elsewhere (see 'Views about causes of mental health problems: social & environmental factors').

Some people identified a range of factors building up over time rather than any one single cause for their mental health condition, whereas others pinpointed one specific factor or incident. People also distinguished triggers from causes, an underlying predisposition to develop a mental health problem that can be set in motion by any one of a number of factors [see Edward below].

Wanting to know “why me?”
Many people said they were unsure why they were experiencing mental health problems. As one person commented, “I couldn't think of a reason why I'm sad”. Some said they would like an explanation and had tried to find out more. One man felt sure that he was not experiencing reactive depression (depression that is triggered by a traumatic or difficult event).

Marlene doesn't know what causes her anxiety because she says "I haven't got anything on my plate...

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Marlene doesn't know what causes her anxiety because she says "I haven't got anything on my plate...

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Age at interview: 38

Sex: Female

Age at diagnosis: 24

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It's, I don't know why I'm getting like that because I, I haven't got anything on my plate, to be like that. I've got everything there for me. My husband's a really good person. He care, he care kids. He's a really good man. Like anything, if I feel down, he takes me out and he talks to me. That much, I'm lucky to get like that husband and kids…

But this, when this, when your mind takes over, like your picture, your mind, it takes over, then you get a little bit down and scary. You think, “Are you going to be living like that all your life with these fears? And stuff like that. Why, why we have to get it?” But you never know what causes it. Nobody knows.

Some had read books or research or had been informed by their doctor about possible causes, including one woman who was told “different people get it for different reasons”. A few said they had not been given any explanation by their doctor, including one man whose doctor couldn't find a reason for his bipolar disorder. Some thought it helped (or would be helpful) to know, “once you find a problem you can find a solution”. Several people asked, “why me?” [see Ataur below], although one woman thought there was no point asking herself a question she couldn't answer, and instead asked “Why not you?”.

Shaukat doesn't know what triggered his anxiety but felt less to blame when he found out it was...

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Age at interview: 36

Sex: Male

Age at diagnosis: 30

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So, you know, I don't know if there was any particular moment which triggered it badly but there's little things like that which happened. And then I think it went from one thing to another. But initially I was always, even when I found out about it, I was always trying to work out the reasons or the cause or, you know, why I can't I change myself. But after, you know, learning about, speaking with other people and learning from the books and that I've realised it's, it, you know, it can happen anytime with anybody or whatever and there's, you know, it doesn't really matter what are the cause is as long as, you know, you work on it to improve it.

So, like for ages I spent, you know, sort of thinking what had caused it or, you know, what, you know, why can't I, you know, improve , why can't I change? Because I thought it was my fault because I'm not improving or say like, you know, going to a shop I find it hard, and I thought, you know, what's so difficult about that, what everybody has to do, so I forced myself to go which would make it worse. Because I'd not, you know, changed my sort of thinking about it. And I still, physically I'd be there but inside I'd be feeling really worse so it's all these, you know, actually learning about it and not really focusing on why it happened, you know, that, that I've started working on sort of improving. Because initially, you know, when I was reading those books I was always trying to figure out why, you know, why, why is it happening? Because I always believed it was only me because I couldn't see anybody else feeling like this or showing any signs like this.

You know, like everybody else, you know what I mean, was, you know, OK they had friends, they're going out and they were able to get jobs quite easily but, you know, passed their driving test and whatever, and all the signs are showing that it was just me. And, you know, once I realised that there's other people and it's an illness and whatever, then that took that blame off myself as well. So, that made it easier and then learning about, you know, the things to improve it and you know, made it better to, to keep working on it rather than, you know, worrying about it which I always used to worry about why I have I got it or what have I got. And with all of that sorted, you know, went away and, when I just focused on just working on improving.

Even where people said they didn't know what caused their mental health problems they identified potential causes or triggers, contributory factors and things that made their mental health problems worse. Many referred to a combination of factors, “it was everything together, all of them were building up inside me”.

Many people identified physical and other characteristics in themselves or identified aspects of their behaviour that they felt might explain why they had developed mental health problems rather than other people.

Increased vulnerability & genetic explanations
Some felt they were particularly vulnerable to mental health problems because of their personality or their physical health. Several people talked about having a sensitive, over-analytical or perfectionist personality, including one woman who experienced anxiety who suggested that, “it's just not me but it's something, a condition that human beings suffer from”. Others mentioned not sleeping or eating properly, glandular fever, heart surgery, menopause and pregnancy as causes. One man said he became depressed when he was refused medication (see Raj's story).

Ataur feels he must have some weakness that makes him more vulnerable to depression than other...

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Age at interview: 60

Sex: Male

Age at diagnosis: 17

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I wondering every time that some people worse than me, worse problem than I have. Why they're not depression and I have depression, why? I ask myself but I don't get the answer, they don't care. Their attitude or their mind is broader than mine I don't know what I'm saying, I try to say they couldn't care, oh forget it' But I have nothing, my idea a lot of people have a house and all those things and suddenly it is gone, everything, they are on the dole, they have council give them a place or whatever, they're not worried, they're happy, if I have like this I'll be dead, worried, oh my God what am I going to do, what, and what are my children, where my children will go, I mean I'd be so much worried and more depression. I think it's something to do with blood, or what I don't know what, I don't know [Laughs].

To do with?

To do with blood.

Blood?

Blood or heart or I don't know. Why I'm very weak like that.

How can you, can you tell me what you mean because that's interesting.

Well why some people have a lot, worse problem than me and they don't get depression, why I get depression?

So...

I'm asking myself or I ask my daughter, I mean doctor.

And you think it's something to do with your blood or your heart?

I don't know that's what I, sometimes I think about it.

In what way?

Well I'm very, very poor'. very weak minded or very' very weak nervous system or what, that's all.

And something to do with the blood, you mean there's something in your blood or something'?

Well this is my thinking, I'm not a doctor

No, yeah but that's what I'm interested in.

Yes [laughs] some, some people have a very good, a very soft heart... that means some people have accident on the front of you. For example a lot of people say, 'Oh we tried to help the person.' Some people walking, seeing and walking straight away. So different, that's what I think. Then maybe I have a soft something or something miss in my body or the soft hearted, soft minded or, you know, one of the blood groups is very weak. I don't know, I mean if you, only a doctor can tell me, tell you or tell me what is the why but as far as I get the answer the doctor only advise me 'Don't worry for anything, you'll be alright.' Sometimes, some doctors say the nervous system so life is always, almost gone. So I'm not very much worried [Laughs].

Some people talked about the role of a genetic component in explaining mental health problems: they believed that mental health problems ran in their family or they had inherited them, especially where they were able to identify members of their immediate or extended family with a mental health problem or whose behaviour and personality was similar to their own.

Edward believes that his mental health problems have a genetic component and an environmental...

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Age at interview: 59

Sex: Male

Age at diagnosis: 20

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Yeah I would after seeing my mother, that's, 'til I actually met my mother I wasn't really aware of it at all. I knew that she'd been ill and she'd been, you know, she'd been in a mental hospital but I didn't really, didn't have that sort of , you know, in your face feeling that it gives you when you, when you're related to somebody who's not well. You know, you wonder where the boundaries are going to be and whether you're going to lose your grip straight away, you know, or whether you're going to lose your grip in a week's time or in a year's time. You really do because it's got a genetic component you can see yourself in the other person obviously, if it's your mother or your father you can see yourself in there in their reactions to certain things and thinking oh hang on a minute, you know, I'm sure I've had that, not only that look but the feeling behind the look before now and I didn't realise what it was and I didn't realise how serious it could get, you know. So that's sort of, yeah the genetic component is a very strong governor of the lack of confidence you free about the future that's it.

but the environmental component, I mean I think lots of kids have had a hard time, you know, one way or the other or they've had their parents go to hospital, leave them on their own for longer than they would if they knew about today's findings and, you know, it hasn't caused them to, it hasn't caused them to have schizophrenia so the genetic thing is the main determinant and the environmental things are incidental triggers if you, if you're in that category.

And what have been the environmental triggers for you do you think?

Well I think, I think' the forced migration at an early age, away from the people I considered to be my surrogate parents to people that I'd never met before and not only that it's not just down the road, I could never go back again so I was stuck on another planet, you know. When you're a little child coming to the UK from Australia is like being on Mars and not only that without a friend, without anyone you know. So that environmental trigger was a big one and then after that the migration back to Australia and in meeting your, your mother for the first time. Wow you know that can be, that can go either way can't it? It can be hugs and kisses and tears or it can be, ooh, you know, sort of terribly the opposite, you know, the antithesis of that. And that's what happened in my case so that was a big shock, you know. I'd say environmental factors need to be shocks, they need to be big lifestyle shocks like [intake of breath] losing your job or something, or losing your partner after a long illness or, you know, something like that where you're, it's pretty stressful and, and, and emotionally charging, those would be the sort of typical environmental triggers.

Others questioned the idea of a genetic link, however, including one woman who was the third person to be diagnosed in her family but didn't know if she agreed with that theory or not “because I have two brothers and two sisters and they are ok”. One man, who believed he “inherited some of the personality traits” from his grandmother, thought mental health problems could be a “genetic or physical condition”. Another man believed that his father, although undiagnosed, had social anxiety, and wondered whether he had learnt and not inherited his anxiety from him. Others referred to a chemical imbalance or the brain not producing serotonin.

Ali believes his mental health problems are caused by a chemical imbalance. (Played by an actor).

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Age at interview: 27

Sex: Male

Age at diagnosis: 26

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I think it's a chemical thing. Because I'm personally come from a science background, that although I'm not a doctor, but I do understand okay, so it's chemistry. It's some sort of chemical that's, chemical level that's high or low in my brain that's causing all of this, so I think medication probably is the best way to fix that, personally.

And I mean so how does that fit with, if you think it's a chemical imbalance, how does that fit with what we talked about earlier about some of the things that you thought had maybe had led to your depression. Do you see what I mean?

Yeah. No I think the chemical balance obviously is something to do with your moods and, you know, you've had these ups and downs, and ups and downs, and that sort of probably created the imbalance permanently. It's like you're in a void, you get your leg amputated. So, you know, what I mean? Like it's unusual circumstances that get you damaged. So I think it's trauma, up down, up down, and your brain sort of becomes, you know, unstable.

Another woman used the term “historical anger” to refer to the anger she felt about her home country being invaded and which she felt contributed to her nervous breakdown.

One man thought that his mental health problems may have stemmed from his ancestors making an agreement with the devil, and another woman thought that someone had put a spell on her.

Behavioural explanations
Many people believed that they were, to some extent, responsible for their mental health problems. Some believed that their behaviour may have caused their mental health problems, including one woman who believed that, “Illnesses don't come for free. All the mistakes that we make, we pay for them and that's how I feel; I'm paying for my mistakes”. Others felt responsible because they worried too much, had taken on too much and “burnt out”, weren't doing enough to try to improve their situation or hadn't developed the coping skills to be able deal with life. Some felt that their guilt had contributed to their illness.

Shareen asked herself why she was suffering and wondered whether she was being punished for...

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Age at interview: 39

Sex: Female

Age at diagnosis: 24

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I couldn't cope with it. I were crying. I were seeing stuff at night-time. I couldn't sleep. I were getting like fears, like the house has got on fire. But it wasn't. I was seeing smoke in the house. I were getting scared that if I go out on my own, I heard footsteps behind me and stuff like that. And I just didn't, I didn't want to live any more. I'd just had enough. I just thought, you know, 'Why has God put me on this earth? Why am I suffering that much? What have I done to hurt somebody?' And I was thinking to myself, 'If I weren't here, the big trouble would be, you know, all the trouble would be gone. Is it because I'm the youngest and that'?'

One day I was that so down because my husband and me had had an argument. And in-laws came in and they said to me, you know, 'You're not a good wife. You're not a good mum.' And I always thought to myself, 'Is it me who's causing all these problems? Maybe I'm not a good mum, I'm not a good wife.' So, and I thought to myself, 'You can't do right for wrong here.' So I said, 'A dog gets treated better than a human being''

I mean people there, they get mostly everything. I've never asked anybody for this and that. And sometimes I think, you know, 'Is it, am I being punished for it? Have I done something wrong? Is that why I'm going through all this and going through all these anxieties?' And I want to laugh. I don't want to cry any more. But I can't laugh.

Anton felt as if God had put a curse on him and wondered if he had done something wrong to...

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Age at interview: 64

Sex: Male

Age at diagnosis: 45

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I am a very religious and spiritual and everything. When the depression came in, it made my life hell. I prayed nothing happened. The, the church which I used to go and attend and preach in [town], they prayed, nothing happened. I found as the hand of God was against me, that he had decided to destroy me, because before I had the depression whatever I touched turned into gold. As if God is my next door neighbour' oh pray about it, and this used to happen, then suddenly the depression, everything collapsed, as if the hand of God was against me. I lost my faith in a way. That's why I decided to commit suicide. And then I regained it when I survived.

So then only I thought as if God had put a curse on me, that means nothing is going to happen. I'm one of those people I don't cry over spilt milk, I just, if something happen I pick up the pieces and start again. But in this case the more I tried to fight it, the more I had to pick up, it got worse. I was thinking like the Hindus, what karma have I done in my past birth to deserve this, then I see of course you can't help it, like in the Psalms, King David used to say, 'Well sometimes you get angry.' And he used to get angry with God. And I said, 'What is this? Is this the reward I get? For, you know, leading a Christian life.' And I used to think have I done anything dirty? Anything nasty to people to deserve this? Then I see the person who had been so nasty, they are prospering. They are okay. You know, in my life, in my work, I never made anyone redundant. I saved people's jobs. And even when people did the dirty on me, I never took revenge. I said, 'Oh forget it, you know, that's past.' That sort of a business. So then I thought to myself, 'What's happened?' You know I used to think like Job, if God were to tell me why is this happening, I could put right. Then I thought to hell with it, let me go and commit suicide. If I will meet you, I will tell you. What do you expect me to do? And there was a time when somebody committed suicide at the Christian church, I won't go to funeral, because obviously that's not on. Now I can understand. I can sit down and write an order of service for a person who committed suicide. I could counsel their parents, or their brother and sisters.

You mentioned karma. Is karma something that you believe in?

Well Hindus believe in karma. That means whatever if you have done bad things in a previous birth you will repay this and all these things, and once when I was at a meeting, I was telling this woman, who was next to me 'I don't know I've got this illness, but I'm looking after my Mum.' And you know what she told me. She told me in a previous birth, she wasn't your Mum, you have murdered her. So you have reincarnated this birth to look after her. Then I said, 'How do you know?' She said, 'Oh am a medium.' Of course I wouldn't to go and ask and consult a medium. But just came off chance conversation. Now it is so tempting to believe these things, but as a Christian I don't. So but then, as I say, I'm from Sri Lanka, Indian background. So it's part of your culture. Hinduism and Buddhism are part of your culture. Although you may be Christian, you tend to do things.

On the other hand, others saw their mental health problems as a coping strategy that had developed in response to their experiences. (See Jay's story) Some thought that mental health problems were caused by using drugs such as cannabis or marijuana, although one man didn't think his use of hash and weed had a part in his depression (find out more about drugs and mental health). A few felt that mental health problems might be caused by stifling creativity' “if you don't release it, it causes you problems”.

Michael believes drugs such as psycho-stimulants cause mental health problems, not social factors...

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Michael believes drugs such as psycho-stimulants cause mental health problems, not social factors...

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Age at interview: 49

Sex: Male

Age at diagnosis: 15

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And I can say that I, you know, it's like a leitmotif in my treatment that I constantly pointed out that the people around me are using drugs and, and that includes the staff by the way. [laughs] And that is affecting their mood and their thought processes and their personalities and that if you would take that out, that out of the equation then some of them would probably be more or less well. But I'm told that is kind of stereotypical medical thinking that drugs can't do that because they're merely chemicals and what really causes mental illness is social factors. And the strange thing is that, that if you, if you criticise that view you are seen as very, very right wing because being a social model practitioner makes you very politically right on and on the side of angels and completely incapable of self-criticism. [Laughs] Which is a bit like being high on drugs but there you go. And by drugs I'm not talking about any old drug I'm specifically talking about psycho-stimulants'

I wanted to, to talk about non-compliance with medication and attitudes to medication because I would say that my own attitude is, is really diametrically opposite of the mainstream attitude that I've encountered from community mental health teams and I can tell you that I've been told it's an article of faith that, street drugs do not cause mental illness, even the most extreme of street drugs like, like angel dust. Let alone stimulants like Methcathinone, which is strictly speaking illegal. Although I don't think it's illegal to give it surreptitiously but these are seen as innocuous and legitimate forms of self-medication. And it's as though the whole idea of, of drug use not only cannabis use has been romanticised, that people are seen as, as entitled to make themselves crazy in order to live this Bohemian creative lifestyle. And, you know, that, that they're better off keeping themselves happy with drugs, particularly downers and cannabis and, and Phencyclidine will certainly come under the category of downers, although it can have a paradoxical effects of course but in theory they're down, downers. Because, you know, otherwise they could be out in, in the real world committing crimes and it's so much better that they're medicating themselves into, into psychiatric patient status.

I think, you know, a) it's extremely questionable whether these people would be in the criminal justice system if they weren't in the mental health system, you know, says who? But in any case I, I don't see that, that the mental health system is intrinsically superior to the criminal justice system. And I would say, and it's not only me that says, that if you're struggling with a substance misuse problem you'd be better off in, in the criminal justice system. People say that their lives have been saved by being put in the criminal justice system being forced to come off the drugs and then given help to stay off. And I have to tell you that at the moment there's no, no plan to, to give that kind of care to, to people in my trust I mean maybe there's something in the pipeline but I don't know about it. But nothing to address the huge scale of the problem.

My, my view is that on the contrary it's, it's an article of faith that, that drugs might not be responsible for all mental illness but where, where people with mental illness take drugs they greatly compound the problem and prevent recovery. And I think that other things being equal, people do recover more or less but the drugs stop them recovering.

Last reviewed September 2018.

Last updated November 2010.