An age-old debate continues to thrive in science and in society about the cause of mental illness. In some circles this is known as the nature-nurture debate. Nature refers to the biological makeup of an individual. Today the focus is on the genetic, cellular and molecular levels of the person. Nurture refers to the environmental and interpersonal factors that influence human biology and behavior.
Bridging the gap between nature and nurture
A recent article in the New York Times called attention to epigenetic research. Epigenetics refers to the expression of the genome that does not cause a change in the DNA. It is believed that the study of epigentics bridges the gap between nature and nurture. This area of research has much to offer the field of mental health, as those of us who are dedicated to the care of persons with mental illness strive to identify more effective interventions to improve the lives of those who suffer with mental disorders.
When we consider the role of the environment on gene expression, it seems consideration would be given not only to the family and social environment in which patients live but also to the healing capacity of the environment in which patients receive care.
Creating healing environments
Nurses at The Menninger Clinic have been promoting the idea of an optimal healing environment in which nurses and other clinicians create an atmosphere of healing places and spaces that:
- promote awareness and positive intentions;
- personal wholeness;
- collaborative medicine;
- healthy lifestyles; and
- healing relationships.
The idea of an optimal healing environment was first developed by the Samueli Institute as a framework for all of healthcare. An optimal healing environment is one in which the physical environment that promotes the biological, psychological and social experiences of calm, comfort, and support is experienced by all people within the environment. Such an environment calls for strong relationship-centered care in patient: clinician and clinician: clinician relationships that are built on respect and appreciation.
What would happen if there was an ethical mandate to promote an optimal healing environment in mental healthcare? Is it possible that such an environment would maximize biological and psychological interventions and ultimately improve the quality of care for the mentally ill?