What causes mental illness and do you have any choice?

The common medical assumption is that mental illness is the result of multi-faceted vulnerabilities in combination with stressors. A person may have some vulnerability markers but those alone are not likely to result in mental illness without biologic, social, or environmental stressors “turning on” the markers.

If you want to see this model in action, you should watch a most troubling episode of “Independent Lens” on your local PBS channel. It aired in Philadelphia last night. You can find more about the episode here on their website and watch clips of the show.

The hour long episode follows a 16 year old girl, Cyntoia, facing life for murder. You will see extended conversation with the girl, her adoptive mother, her biological mother (who she never really related to). Her bio mother drank throughout her pregnancy, smoked crack and prostituted herself. Cyntoia was being prostituted and was at a “john’s” house when she shot him thinking he was going to kill her.

You can see that Cyntoia probably meets criteria for Borderline Personality Disorder. Watch her mother for a bit and you can see that she comes by it quite naturally. They both have a similar pattern of speech and attitude. There is a long history of suicide and paranoia in the extended family. Very interesting to see how this young woman talks to the forensic psychiatrist.


Watch and wonder how Cyntoia could have avoided her predicament. She started out with poor genes, alcohol exposure and poor attachment opportunities. She lists 36 people she had sex with (she felt obligated to have sex with those who wanted her). The issues are legion.

Even more brutal is to watch the interviews with her adoptive mother who is trying to wrap her head around the facts that come out during the investigation. Watch also how Cyntoia talks about her and to her. Notice that there is love.

Very rarely would you get this kind of information from 3 generations of rape and sexual abuse (and adoptive mother’s story).

Watch the episode and consider this question: just how much choice do some people have? Even with her incredible insights (e.g., “everybody wants admiration, everybody wants to be desired. That is my **** problem too.”), this young woman had 3 strikes against her.

The truth is we often believe people have easy choices to avoid trouble. Cyntoia’s story reminds us that trouble begins generations before some people are conceived.And even when we acknowledge that Cyntoia could have made choices to tell adults about her abuse or to escape her pimp, we are left with the gnawing question, would we have made any different choice if in her place? For the record, I am a firm believer in that we do have choices to make. But some have a whole lot more than others and the roadsigns to better choices are bigger for some of us than others.

Challenging story which also pulls on your vision of redemption, restoration and appropriate punishment for minors who commit murder.


Filed under Abuse, addiction, cultural apologetics, Psychology, stories, suffering

5 responses to “What causes mental illness and do you have any choice?

  1. This post is really interesting. I’m a counseling major at a college, and I’m actually writing a paper for a Systematic Theology class about what causes mental illnesses (i.e. personal sin, genetics, etc.). I will keep this post and the PBS episode in mind as I continue my research!
    Thank you!

  2. Scott Knapp

    I work with “damaged” children and youth vocationally as a therapist. People helpers really can’t know for certain how much of the problematic behavior is choice, but those who work with these kids day in and day out get a much better feel for tell-tale factors: stress tolerance, values and beliefs, typical triggers, willingness to embrace treatment, moral development, etc. You develop a “feel” as you observe a young person in residential treatment for a time, and are better able to craft consequences for behaviors more effectively, albeit always subjectively to some degree. You begin to better “know” that one kid who perps on another kid in the shower is more in control of his desires and behavior, versus another kid who is more easily persuaded and manipulated. It’s usually management and public agencies who want to better quantify this gut level assessment, and these are usually the people who spend the least amount of time with kids in treatment, in general.

  3. Erin

    What causes Mental Illness ? Is there a choice?
    I Think Many things cause it and I also think there are choices too but that depends on the individual.
    It is up to the individual if they choose to get help or not in the end. I know people who are very sucessful who got help and I know many who are still the same who never got help . Sometimes people like the condition they are in and sometimes they want to better their life. Free will ? God’s Will? ..Both?
    Also, what about serial Killers? ,sometimes it is caused by Brain tumors causing the crazy behavior and sometimes its from past abuse and sometimes they are just plain Evil . Most people say they are mentally Ill. To my knowledge I have not heard of one serial killer that changed their ways even with treatment .So maybe sometimes there is just pure evil and there is no rhyme or reason as to why other than for us to have a free will ?? to choose between the two?complicated topic indeed! good post!

  4. Brooke

    choices…yes, but we must know what they are in order to choose….no?

  5. Naomi

    I love this statement “But some have a whole lot more (choices) than others and the roadsigns to better choices are bigger for some of us than others”. A great way of saying there is an element of choice but we aren’t all on a level playing field. When I hear of stories such as Cyntoia’s I’m filled with compassion and humility. I can not say I would not have made the same choices as her if I had to walk her road.

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